Collaborative mental health care

Integration of virtual care and use of technology

Successful delivery of collaborative mental health care relies on efficient and effective communication between all members of a health care team, which is enhanced when psychiatrists and mental health professionals work within primary care settings. Recently this has been expanded through the use of telemedicine and virtual care. Telephone consultations, videoconferences, mobile health care, and remote patient monitoring are increasingly being used as viable options to ensure continuity of care^6-10; this has been evident during the pandemic, as many health care teams were forced to rapidly adopt new technologies to deliver care. Embracing a shift to telemedicine and virtual care in a deliberate and thoughtful way can improve access to mental health services for many underserviced populations and individuals living in rural areas. Distanced consultations may be more convenient for some individuals and allow physicians to provide timelier care. However, it is critical that with the transition to virtual care, the quality of care—particularly continuity and coordination of care, as well as equitable access to care and privacy of care—is not compromised.

Telemedicine can also enhance ongoing communication between family doctors and mental health professionals, ensuring common goals within a single plan. Telephone or video visits can also reduce barriers to case conferences or shared care appointments with patients. The regular and open flow of information between providers ensures that patients are receiving integrated care that includes prevention, health education, wellness promotion, and support for adaptive functioning, as well as treatment and relapse prevention. Moving forward, virtual appointments and the use of technology are going to be integral to the ongoing growth of collaborative mental health care; thus, it becomes even more important that health care systems and collaborative teams address the lack of equitable access to technology and virtual care to ensure inclusivity in access and continuity of care. While telephone-based care can help overcome these challenges and is well accepted by patients, we are still learning when a face-to-face visit is necessary, most appropriate, and clinically warranted. Family physicians and mental health providers will need to determine which populations and care needs are best served by technology and how best to deploy technology to support face-to-face care.

Opportunities for earlier identification and relapse prevention

The presence of mental health care providers in primary care can support earlier detection of mental health and addiction problems, earlier interventions, and relapse prevention. It can help a practice identify and track populations with specific problems or risk factors by monitoring the progress of each individual in that group, maintaining contact with anyone who is not being seen on a regular basis, checking that specific treatments or referrals are under way, and intervening rapidly if someone is showing signs of symptom recurrence. By working together, primary care and mental health providers can divide these tasks between them, according to expertise and availability.

For example, collaborative mental health care teams in primary care are well situated to address maternal and child mental health in a proactive and integrated manner. Screening all pregnant women for depression and anxiety during prenatal and postnatal periods and treating identified problems during these stages not only has a positive effect on mothers’ health but also has substantial short- and long-term benefits for children, too, as the early years are a critical time for monitoring a child’s well-being.¹¹ The enhanced 18-month baby visit enables health care providers to identify those children with more risk factors, including adverse childhood experiences or immediate needs. It is possible to proactively monitor each child (grouped in 1-year cohorts) to check on their progress, especially those at greater risk.

Another opportunity for early identification of risks is to see every individual in a practice with a psychotic illness at least annually to monitor both their emotional and physical health. If their medical conditions are stable and well managed, it can help reduce the “mortality gap” of premature death associated with schizophrenia.¹² Also, screening individuals who are 60 or older for depression, anxiety, and mild cognitive impairment can prompt health care providers to treat these conditions and may reduce the likelihood of dementia developing.¹³

Encouraging collaborative care with other services and in other domains

Throughout the past 30 years, family doctors, psychiatrists, and mental health professionals have demonstrated how working collaboratively can provide better mental health care for patients.⁴ Family doctors provide comprehensive care to patients with an emphasis on continuity while psychiatrists and mental health professionals provide the expertise needed to manage patients with greater complexity or risk. The integration of mental health professionals within primary care settings improves access to care and positions family doctors to better engage in early detection, treatment, relapse prevention, and wellness promotion, as well as treatment for remission, a target that has important implications for recovery, functioning, and risk of illness recurrence. Collaboration with community-based organizations and initiatives, social services, legal aid, and child protection services should be encouraged so that social determinants of health are addressed in tandem to support the best possible treatment outcomes. Other domains of medical specialty services may also see potential benefits for patients and health system efficiency by integrating mental health care in these ways.

Currently, wait times to see a specialist in Canada range from approximately 2 to 6 months, depending on the specialty.¹⁴ Collaborative care can improve access while reducing wait times, avoidable emergency department visits, and hospitalizations.^15,16 By optimizing the role of all health professionals and avoiding duplication of services, it is a cost-effective model of care and one that supports population health.^17-19 Collaborating with other services and in various domains can offer continuous and better-coordinated care and can ultimately lead to better health outcomes for patients and increased capacity and work satisfaction for family doctors.