When 54-year-old Julie Lafontaine* went to her local family physician following a physical injury at work, her doctor discovered that she was also experiencing post-traumatic mental health symptoms. Her physician, based in a remote rural community in Northern Ontario, reached out to the telepsychiatry program at the Centre for Addiction and Mental Health (CAMH) for assistance. Through video conferencing, Ms. Lafontaine and her family doctor consulted with a psychiatrist at CAMH, and together, they were able to care for her mental and physical health needs at the same time.
In the past year, the telepsychiatry program at CAMH has worked with 225 communities throughout Ontario, primarily through linkages with local primary care providers. Within the mandate of the MPA, the telepsychiatry program is partnering with Family Health Teams to increase access to mental health care across Ontario. Using an integrated care model, primary care providers and their patients can connect with a dedicated psychiatrist via videconference.
“We believe that technology can be part of the solution to address the complex health needs of patients,” says Dr. Allison Crawford, Medical Director, Northern Psychiatric Outreach Program and Telepsychiatry, CAMH. “Before the roll-out of this unique MPA model of care, patients like Julie Lafontaine, who live in under-serviced or rural areas, would have typically been referred to see a psychiatrist, and unfortunately might have spent a very long time on a waiting list to access that mental health care. Even then, once finally at the beginning of the line, it is very likely her care may be fragmented in terms of the lack of integration and collaboration with her primary care team.”
At CAMH, the telepsychiatry program has evolved from a small northern outreach initiative into a province-wide service that is increasingly integrated with local and regional provincial health systems. With MPA support and collaboration, CAMH is expanding and enhancing their telepsychiatry services to primary care clinicians and to remote and underserved populations.
“This model provides consistency for providers and continuity of care for patients, who can now access psychiatric services in the same place they access their medical care,” says Eva Serhal, Manager, Telepsychiatry and ECHO Ontario Mental Health at CAMH and U of T.
Through another innovative model that uses multi-point videoconferencing, called Project ECHO (Extension for Community Health Outcomes), the ECHO Ontario Mental Health program at CAMH and U of T are helping to increase knowledge and build capacity of primary care providers to better care for their patients with complex health needs.
In Ontario, 1.3 million people suffer from co-existing physical and mental health illness. In many cases, treatment of these patients fails because health care services are typically designed to focus on either physical or mental illness but not both at the same time. ECHO, a tele-education innovation, leverages evidence-based education to support remote primary care providers in managing these types of patients.
“I have been an ECHO participant every week since its inception for the northern hubs,” says Bev Castonguay, Registered Social Worker, Sudbury District Nurse Practitioner Clinics. “For many isolated social workers who have practiced most of our careers in the north, and often as the sole social worker in a work setting, this truly is a novel and rewarding experience. I applaud the ECHO movement that has found a way to provide group education, supervision and networking in an ongoing weekly format that comes straight to our office.”
Starting in November 2016, the ECHO Ontario Mental Health program will be developing a unique Indigenous Telemental Health project, with an ECHO focused on indigenous wellness.
“The goal is to convert our entire telepsychiatry program to this new integrated model of care,” says Dr. Crawford. “This allows for more comprehensive, holistic management of patients, continuity of care, and helping primary care providers build capacity to care for their patients. Ultimately, we are working toward increasing access to quality mental health care across Ontario.”
To strengthen access to integrated care for children and youth, the MPA is also supporting the well-established provincial telepsychiatry program at The Hospital for Sick Children. With the launch of a new three-year Toronto telemental health services pilot project, patients in Toronto as well as rural and remote communities can access these services.
“We try to get to kids where they are,” says Dr. Tony Pignatiello, MPA Director of Child, Youth and Family Health and Associate Psychiatrist-in-Chief at SickKids. “For patients who access our telepsychiatry service due to mental health needs, we also need to be asking about their medical needs.”
*Name and identifying details changed to protect client identity.