An innovation in adult mental health care developed by BC doctors is changing the way GPs practice medicine, and changing patients’ lives. Its success has inspired Nova Scotia family physicians to adopt it widely across the province in 2018.
The adult mental health (AMH) training offered by BC’s Practice Support Program (PSP) equips family doctors with tools and skills to diagnose and treat mild to moderate mental health conditions — mainly anxiety and depression — in their practice. With the training, GPs are more confident, able and willing to support patients with these conditions in their office setting, without referring them to a specialist or relying on medications as the sole approach to treatment.
In BC, most adults with mental health conditions receive some or all of their care from a family doctor. Yet GPs often have limited training and tools for mental health care, and they may not be able to get to the bottom of an issue during a short appointment. Patients, in turn, don't always speak up. As a result, they can miss opportunities for early diagnosis, be under-treated with medications only, or face long waits for specialists who are in short supply.
These circumstances are changing, thanks to the vision of BC psychiatrist Dr Rivian Weinerman and early adopter GPs like Dr Frank Egan —who, in collaboration with clinical partners and GPSC, designed and launched the PSP AMH module across the province starting in 2010.
Today, more than half (1,640+) of BC’s practising family doctors have taken the training and integrated new tools into their practice which they can use at the time of a patient visit.
The doctor starts with a diagnostic interview to identify mental health conditions. In cases of mild to moderate anxiety and depression, the GP then partners with the patient over a series of visits to manage the condition. Together, they use a combination of cognitive behavioural therapy ‘light’ skills (as an effective anti-depressant), a self-care workbook, and the Canadian Mental Health Association Bounce Back telephone coaching program.
“We found that these skills and tools increased GPs’ confidence in diagnosing, treating, and developing care plans for these patients, and in prescribing and relying less on medication,” says Dr Weinerman. “And it increased ability for their patients to return to work. And those results persisted three to six months after the training.1”
“Then we thought: if you give GPs these skills and decrease their anxiety, their attitude might also change,” she says. “If they had more confidence and were more comfortable asking the questions, and felt they had the skills, they would be more welcoming to these patients, less avoidant, and therefore we’d see less health care provider stigma.”
In 2017, in a double-blind study, Dr Weinerman and her colleagues were able to show those results. “We saw an decrease in social distance,” she says, “meaning, the distance the doctor put between them and the patient—an important dimension in stigma. The doctors were more welcoming to their patients.2”
Dr Frank Egan uses the tools on a daily basis in his Victoria, BC practice.
“It has changed the way I practice medicine for mental health patients,” he says. “Now, instead of shying away a bit from taking on someone with depression, I embrace it. I have more confidence and clearer insight into what my patients need and what type of follow up I can provide. I feel I can support them in their recovery in a much more valuable and authentic way than I did before I went through the training. And I know where my limitations are, and when it’s time to refer a patient.”
“I think the stigma has lessened with patients as well. They are much more willing to discuss their mental health, much more open to treatment, and more knowledgeable about their mental health.”
Dr Andre van Wyk from Langley has seen patients whose life trajectory has changed as a result of having tools that he can use in the practice. “I’ve had lots of cases,” he notes. “One had fallen out of society, was unemployed and into drugs. He has turned that around and is gainfully employed, owns his own house with his partner, and is on the right path to success. I credit [the PSP AMH module] with that.”
“The patients feel listened to. Their issue is acknowledged and they have more wraparound care. Not just, ‘here’s a pill, goodbye.’ Patients are getting a more comprehensive approach to their mental health issues than before.”
Based on the BC experience—where family doctors are more confident and willing to manage their patients’ conditions and patients are doing better with fewer medications —a group of GPs in Nova Scotia trialed the module and saw similar successes. They are now rolling it out across that province to family doctors. Newfoundland is lining up to follow.
1 Mental Health Practice and Attitudes Can Be Changed
2 Impact of Skill-Based Approaches in Reducing Stigma in Primary Care Physicians: Results from a Double-Blind, Parallel-Cluster, Randomized Controlled Trial