With so much innovative work underway to improve primary care in BC, it’s no surprise that the Practice Support Program’s Adult Mental Health (AMH) module has the medical community in other areas taking notice. While designed for practising family physicians in BC, the module’s positive impact on patient care and physician experience have gained recognition elsewhere—the module is now being used for training in other provinces and incorporated into training for the next generation of BC family physicians.
“We’ve taken the module on the road and presented at major conferences, trained front-line workers in Manitoba and front-line workers and physicians in PEI, and taught it at McGill University in Quebec,” says Rivian Weinerman, a physician in Victoria who was part of the team that created the AMH several years ago. “We’ve presented it in Hong Kong, Grenada, Tennessee, and other places. And now we’re embedding the module into the University of BC’s family practice residents’ program and the University of Victoria’s nursing program.”
A joint initiative of Doctors of BC and the BC Ministry of Health, the Practice Support Program (PSP) is a training and support program for physicians and their MOAs that is designed to improve clinical and practice management and to support enhanced delivery of patient care.
The AMH module includes screening and assessment tools and three supported self-management approaches: the Bounce Back program, the Antidepressant Skills Workbook, and the Cognitive Behavioural Interpersonal Skills (CBIS) Manual, which form the core of the AMH. CBIS provides an organized, guideline-based system for physicians to assess patients and to develop treatment strategies that incorporate self-management processes to empower patients to be active partners in their mental health treatment. The manual is also featured in the Canadian Medical Association national e-learning anti-stigma course for physicians, in partnership with the Mental Health Commission of Canada.
“We’ve trained front-line workers such as case managers, pain clinicians, diabetic clinicians, substance use clinicians, nurses, and family practice residents in the use of CBIS,” says Weinerman. “Both patients and clinicians enjoy it.”
PSP learning modules typically involve three half-day group-learning sessions, offered locally in communities throughout the province. Each group session is followed by an action period of approximately eight to12 weeks during which PSP participants try out what they’ve learned in their own practice. During action periods, participants receive in-practice support to ensure they get as much benefit as possible from the learning sessions, and have the guidance they need to incorporate newly acquired tools and processes into their everyday practice workflow.
For UBC’s family practice residents, the exposure to the module is more limited. During their residency, new medical school graduates have a one-day session on CBIS as part of their academic training that supplements their clinical work.
“Residents consider CBIS to be important, and they can be a hard bunch to please at times,” says Dr Karen Shklanka, faculty member for behavioural medicine in the University of BC’s Department of Family Medicine Residency Program.
Dr Helen Campbell, who was also part of the team that developed CBIS, teaches residents on Vancouver Island and in the Lower Mainland and says she’s had great feedback.
“Residents are very receptive to it,” she says. “Through their training, they are comfortable with the medication side of managing mental health in the office but are not quite as confident with non-medication options for their patients. Learning about CBIS increases their satisfaction. It feels good to be offering more than just reaching for a prescription pad.”
“I feel like I have some tools to use for mental health conditions that I didn’t have before,” said one resident after Campbell’s lecture. “I look forward to testing out the different strategies with my patients.”
Dr Annemarie Falk teaches the AMH module both as a mentor to doctors receiving training through the PSP, and to residents at St. Paul Hospital in Vancouver. “The AMH module has given physicians a much bigger toolbox of treatments to offer patients, and more information about treatments other than medication,” says Falk.
Falk teaches St. Paul’s residents about the online resources the PSP provides. “They get everything on a flash drive, and I show them the CBIS manual and go through some basic screening tools,” she says. “Then we spend time listening to residents describe their real-life office experiences with patients. Having this training earlier in their practice benefits everyone. As family physicians, we have to know so much about a wide range of medical and health-related conditions. Treating mental health conditions can be daunting if you don’t have adequate skills.”
Weinerman says that teaching these skills to physicians and other front-line workers can also decrease the stigma sometimes associated with patients presenting with mental health issues. “I think that physicians sometimes avoid patients when they feel they don’t have the tools to treat them,” she says. “The module enhances the idea of patients being heard and understood by their doctors, which makes them feel respected. Doctors begin to feel more comfortable and confident, and when a patient senses that and feels heard and respected, it helps decrease self-stigma.”
Weinerman is currently working with the Mental Health Commission of Canada on a randomized controlled trial of the AMH module with family doctors in Nova Scotia that will run from January 2014 to the end of 2015. Doctors will partake in module group training, and the module’s efficacy and the participating physicians’ attitudes toward patients with mental health conditions will be evaluated. Weinerman’s hypothesis is that there is a relationship between training and skills-building and health care provider stigma reduction, but, she says, “This is the first time we’ll have a formal study with a control group to see if this reduction is really happening.”
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).