In a small town, everyone knows your business, so if a patient is dealing with mental health problems, there can be added stigma when seeking treatment. That’s why many of Dr Tara Guthrie’s patients are thrilled that she now has training and skills to help them with their mental health issues in her family practice.
Guthrie has a busy family practice in Creston in the Kootenays, population 5000. In the past, when she had patients who needed mental health treatment, she would usually refer them to the mental health department at the local health authority, but now she can treat many of these patients herself, avoiding referrals and providing them a level of discretion and comfort that comes from seeing a family doctor with whom they are familiar.
Guthrie gained valuable skills through the Practice Support Program (PSP) Adult Mental Health learning module. A joint initiative of Doctors of BC and the BC Ministry of Health, the PSP provides training and support for physicians and their MOAs designed to improve clinical and practice management and to support enhanced delivery of patient care.
The PSP Adult Mental Health module enables family doctors like Guthrie to screen their patients more thoroughly for mental illness and diagnose conditions that were previously more difficult to detect. The module tools and resources include common screening scales, a diagnostic assessment interview tool, a tool for organizing patient issues, a cognitive-behavioural skills program, and a patient self-management workbook.
“Patients find it really useful, and I feel much more comfortable providing counseling using these tools,” she says. “There has been a tendency to reach for medications in these situations before. Now, by the time we’ve done some counseling, the need for medications for most patients is reduced.”
Gwen Benty and her family have been seeing Dr Guthrie for several years, so when Gwen’s anxiety and depression needed treatment, she was really pleased to be able to see her family doctor, who already knew about her situation.
“It helps that I already have a relationship with my family doctor and that the trust is there,” says Benty. “In small communities like ours, a referral to a specialist almost always means traveling, so it’s beneficial for us to have her here.”
Benty has worked with Guthrie through counseling and used the workbook provided by the Adult Mental Health module. “She answered my questions, and saw me on an ongoing basis, and makes me feel like she’s empathetic enough to understand,” says Benty. “Sometimes you cry and cry and tear yourself like an onion, but I gain strength from her approach. I think more family doctors need to have training in this area.”
Both Benty and Guthrie agree that some patients are reluctant to be seen even entering the mental health building in town. “It’s much more comfortable entering the family physician’s office, more discreet,” says Guthrie.
When she does have patients with moderate to severe problems who need to be referred for mental health treatment with specialists, Guthrie’s training has made it easier to help those patients. “Using the tools I now have, when I do need to refer, I’m on the same page as the mental health people,” she says. “Before, I wasn’t comfortable doing cognitive behaviour, so patients weren’t getting the same messages from me and the specialists. I have a much better relationship with mental health services now. I understand them more and vice versa.”
Guthrie says doing more mental health treatment herself has improved her job satisfaction. “I see patients over a long time, so I get to see that over years they are getting better, see that it helped,” she says. “It has made a very challenging part of medicine into something I know how to do.”
The PSP began as an initiative of the General Practice Services Committee (GPSC) – a joint committee of Doctors of BC and the BC Ministry of Health (the ministry) – and now receives additional direction, support, and funding from the Shared Care Committee and the Specialist Services Committee (also partnerships between Doctors of BC and the ministry).