An incentive payment introduc­­ed last year to acknowledge the efforts of family physicians in caring for their mental health patients will soon be complemented by a Practice Support Program (PSP) module offering specialized training and support.

Both the incentive payment and the new module are programs of the joint BCMA­–­­Ministry of Health Services General Practice Services Committee (GPSC). The module, with $2.5 million funding from GPSC, launches in health authorities across the province this June.

“Family physicians treat the vast majority of people who have mental health issues, and these issues are often complicated,” says Liza Kallstrom, BCMA lead, Change Man­agement and Practice Support. “This module will meet a huge demand for specific support and training related to the screening, diagnosis, and treatment of patients who need mental health care.”

The mental health practice guide: Addressing current challenges
Although the primary health care system is the appropriate home for much of mental health care, both physicians and patients experience challenges with the current situation in BC. As an example, most mental health patients have more than one issue, but these issues—and the way in which they interlink—are difficult to diagnose and address in a short visit and without special training. Substance use, for instance, is common in mental health patients, but is frequently not addressed. Another challenge is organizing a patient’s issues in order to address them systematically. Yet another difficulty is lack of knowledge of patient resources, resulting in more medications than may be necessary, and potentially inappropriate referrals.

The new PSP module will address these and other challenges in mental health practice, says Ms Kallstrom. “The module offers simple quality improvement approaches that doctors and their medical office assistants can use in real time as part of patient visits or counseling sessions,” she says.

Among its resources, the program introduces common screening scales, a tool for organizing patient issues, a cognitive-behavioral skills tool, telephone coaching for mood management, and a patient self-management workbook. “And of course the program is underpinned by the PSP module approach, which involves learning sessions interspersed with action periods to test new skills and knowledge,” says Ms Kallstrom.

The module’s implementation will be monitored and evaluated carefully, with measures of success including:

• Increased physician confidence in managing depression and other mental health conditions.
• Patient satisfaction.
• Increased referrals to community programs.
• Increased number of patients with a care plan.
• New and enhanced relationships between physicians and mental health clinicians.
• Medical office assistant confidence in dealing with and assisting mental health patients.

Launching the module: Engaging champions and mental health experts
GPs and medical office assistants recruited as mental health module champions attended a train-the-trainer session in early April. After an action period in which they implement what they learned in their own practices, a second session—on coaching—takes place in May.

“The idea is that our champions learn and try out new clinical skills first, to discover what works and what needs to be modified,” says Ms Kallstrom. “Then, in the second session, they focus on supporting the provincial roll-out.”

The module involves three half-day learning sessions with two intervening action periods. The uniqueness of the module is the support of mental health clinicians and psychiatrists in addition to GP and MOA champions, during the action periods and on­going. “We see the support of mental health experts as vital for physicians and MOAs in such a complicated area of care,” says Ms Kallstrom.

The mental health module is one of five modules offered through the GPSC’s Practice Support Program (others are advanced access, group visits, managing patients with chronic diseases, and patient self-management). As well as the PSP, the GPSC administers approximately $100 million annually through incentives in four areas of primary health care: chronic disease management, maternity care, end-of-life care, and mental health care. For more information visit www.bcma.org/committee/general-practice-services-committee-gpsc [10].

—Greg Dines
Senior Program Ad­visor, BCMA Professional Relations