When Patty Lombardo experiences the first inkling of an anxiety attack, she knows right away something is wrong.
“My chest gets tighter. I get lightheaded and numb, and it feels like I’m having a heart attack,” she says. “I fainted once while making dinner; my husband caught me before I hit the floor. They can happen any time, and it’s scary.”
She adds, “When they started happening more frequently, my quality of life was horrible….I had dark days. I felt like I couldn’t be a mother, run my home or do the things I love doing. I was depressed.”
Patty’s family doctor recommended she see a psychiatrist. However, because she lives in a rural community far from the specialist’s office, Patty felt that she likely wouldn’t be able to make the trek into the city for her appointments even when she finally got to the top of the waiting list to see one. She sighs, “I knew it probably wouldn’t work for me.”
Her doctor suggested she try a new program based at the Centre for Addiction and Mental Health (CAMH), called the PARTNERs* project. In this project, researchers have introduced the innovative new role of a mental health coach, who monitors and supports patients over the telephone. Patients enrolled in the study are referred by their primary care providers (that is, their family doctor or nurse practitioner) because they are coping with depression or anxiety, or they have been flagged for ‘at-risk drinking’ (which means they are consuming alcohol in quantity above the recommended Canadian guidelines).
The project is supported by a generous gift from Bell Let’s Talk, and is part of the Medical Psychiatry Alliance, a recently established partnership between CAMH, The Hospital for Sick Children, Trillium Health Partners and the University of Toronto, with the goal of increasing access to quality integrated health care for Ontarians who are living with mental and physical illness at the same time.
Says Vanessa Garofalo, one of the three mental health coaches in the PARTNERs project, “We’re working with patients by supporting the care they receive from their primary care provider. For example, for patients with anxiety and depression, their family doctor may not be able to address their needs due to limited time and competing priorities. Through this project, we call patients and assess their symptoms, ask if they are taking and tolerating their prescribed medications, ask how effective the dosage is, if the treatment needs to be adjusted, etc. One of the strengths of this project is that we are able to call these patients frequently, provide information, discuss treatment options, and work on healthy lifestyle goal setting. We then relay the information back to their primary care provider, who stays informed about their patients regarding both their mental and physical health and adjusts their treatment as needed.”
Innovative new role
The role of a mental health coach is new to Canada, and has been adapted from a similar model in the U.S. The mental health coach is a trained technician, not a clinician (that is, not a nurse, social worker, or psychologist). Patients referred by their primary care providers complete a baseline assessment, answering questions about their symptoms, treatment history, functioning at work and at home, past trauma, and alcohol/drug use. Those findings are reviewed by a dedicated project psychiatrist who creates a treatment plan for the patient with the mental health coaches. The recommendations that are generated are then discussed between the coach and the patient during regularly scheduled 20-30 minute calls.
Now two years into the study, the PARTNERs project is working with 12 family health teams across Ontario. Over 150 primary care providers are currently involved, and are referring patients who typically live in under-serviced areas, or don’t want to wait for weeks or months to be seen by a specialist. The program is also appealing to patients who aren’t able to travel to a specialist’s office due to physical limitations such as those faced by elderly patients, or those who don’t have access to a car or public transit.
A system divided
“We really have two separate health systems to address our patients’ needs: a system that takes care of mental health problems, and a system of care that takes care of physical problems,” says Dr. Benoit Mulsant, the senior researcher on the PARTNERs study and the Executive Director of the Medical Psychiatry Alliance. “The gaps in access to quality health care occur when people have both types of issues at the same time. We hope the PARTNERs project, a concept of integrated care, will support these patients by increasing access to the care they need. If we are able to do this, we hope this model will be widely adopted in Ontario.”
Patty recently completed her one-year of participation in the PARTNERs project and misses the routine calls with Vanessa, her mental health coach during that time.
“My body still shakes so bad when I feel an attack coming on, and sometimes I can’t breathe…but then I remember what Vanessa has taught me,” she says. “This program gave me purpose. It’s like what I tell my kids: what is, is…what was, was. You keep on going, think positive and stay strong. Having a bad day does not equal a bad life.”
*PARTNERs stands for: Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources