How do you deal with a wounded mind?

Access to mental health care is a huge issue across the province. As with many of our services, we have pockets of excellence, but we still lack a system-wide coordinated approach to evaluation, treatment, and ongoing support for patients struggling with mental health problems. The consequences of inadequate resources to cope with these conditions cost us a great deal in the long run: burnout, suicide, relationship breakdown, substance abuse . . . the list goes on. So how do we address provision of mental health care in a way that is practical and sustainable within our already overstretched system?

As part of my generalist rural practice, I do shifts in the emergency room. Over the years, experience has taught me which situations can be the most difficult and stressful to manage. For me, they are the ones that start with a phone call from the RCMP advising they’re bringing in someone under the Mental Health Act. This isn’t because I’m uncomfortable with these patients who can sometimes be out of control or violent, and I like to think it’s not a lack of compassion on my part or an inability to know how to manage a psychiatric challenge. Rather, it’s because I don’t have the resources I need to adequately manage these patients locally, and it can be virtually impossible to access services outside of town. There are no beds, teams in the city are overburdened, and if you’re lucky enough to find a place that can actually provide care, there can be a significant challenge in safely transporting an unstable patient either by ground or air ambulance. The process can take days, and in the meantime violent patients are likely kept sedated and no active treatment can occur. And these are just the crisis situations. The wait for assessment and counseling is even worse when the patient is still functional yet struggling. Accessing services for children is a particular problem, and a lack of timely intervention can cause a lifetime of pain.

Doctors of BC has been involved in a number of initiatives striving to address this challenge. The Child and Youth Mental Health and Substance Use Collaborative (CYMHSUC), a provincial initiative now close to completion, brought together local action teams to develop community resources and integrate systems of care to improve access to mental health services and supports. A key feature was the involvement of parents and youth with lived experiences of mental health and substance use issues. This work started in 2014 and was funded by Doctors of BC and the BC government. It brought GPs, specialists, four ministries, health authorities, police, and community agencies together to implement approaches to care that will address these challenges now and in the long term. One outstanding outcome of the Collaborative is the Youth Wellness Program in Maple Ridge, which received this year’s Council on Health Promotion Award of Excellence for the development of a program that supports local youth with mental health and substance abuse issues.

Another noteworthy initiative is the program for psychiatric assessment and follow-up developed by the Adult Psychiatric Clinic at Mood Disorders Association of BC. Initial assessment by the psychiatrist is followed up with group medical visits that address particular aspects of ongoing care. This project has proved so successful that the clinic has been overwhelmed with referrals and had to undergo a restructuring. A merger with the Lookout Society this past July provided stable funding and an increased scope to improve capacity and access to psychiatric services across BC. And an innovative pilot project with the Vancouver Division of Family Practice will make use of family physicians working collaboratively with psychiatrists through group medical visits for improved follow-up care. Successful implementation will have a tremendous effect on addressing issues of access to psychiatric care.

So what do all of these programs have in common? They’re striving to change the culture of how we deliver mental health care in our province, with a focus on timely and accessible care in the community. They leverage collaboration by many key partners and providers across the continuum of care, striving to use the skills of each individual provider in a complementary manner.

We as physicians must encourage and support such innovation in health care delivery, because only by changing the culture of care can we improve and best serve our patients and our communities.
—Trina Larsen Soles, MD
Doctors of BC President