Wednesday, March 24, 2010

Mental health clinics work

A letter to the editor published in today's edition of The Chronicle Herald:
By Dr. Ian Slayter

While we agree mental health services are under-resourced in Nova Scotia, we disagree with this paper’s criticism of the direction taken by our community mental health clinics. Through these clinics we try to provide the best fit between the mental health needs of individuals living in the Capital Health district and the skills and training of teams of health professionals. One article focused on the model of care at the Bayers Road Community Mental Health Clinic. The same model is followed at each of our other community mental health clinics in Dartmouth, Lower Sackville, Cole Harbour, and Windsor.

We are pleased with the direction followed by all five clinics. The clinics have difficulty meeting the high demand for service, nevertheless they do a very good job in the circumstances.

Each clinic works as a team. Priority is given to people with more serious mental illness. Individuals see one or two clinicians — a nurse, social worker, occupational therapist, intensive case manager, or psychologist — and a consultant psychiatrist. Patients with milder mental illness, for example, an adjustment reaction to a stressful situation, usually do not need a team approach. Not everyone needs to see a psychiatrist.

The different professionals offer a wide variety of knowledge and skills. Some skills overlap, some are unique to a particular discipline. For example, only an occupational therapist can do an assessment of someone’s functional level, only a psychiatrist can prescribe psychiatric medication. It might be noted at this point that the community mental health teams work closely with family physicians and that they too can assess, follow, treat, and prescribe medications for persons with psychiatric problems.

Patients are usually referred by family physicians. These referrals are reviewed by a member of the team and the patient may receive a call to ask for further details. Patients are not assessed by phone. The initial assessment is done face-to-face to determine what services the patient needs. Sometimes the person doing the assessment will refer the individual to another clinician as we try to match the needs of the patient with a clinician who has the skills needed.

Our clinicians work within their scope of practice. This means that they assess and treat within the boundaries of their knowledge and skill, as determined by their training, experience, and the guidelines of their profession.

We consider it our responsibility to see the patients as soon as reasonably possible. To provide timely care to those in greatest need, we discharge patients from our service who are ready in order to see those who are waiting and whose needs are more urgent. For the best care of our patients, and not because of management dictates, we do work to see new referrals within the target times set by the Department of Health: urgent patients within one to seven days, semi-urgent patients within 28 days, and non-urgent patients within 90 days.

This team model of care, where the psychiatrist acts primarily as a consultant to the other clinicians, is the standard model followed by public clinics in Canada, the United States, Australia, and elsewhere.

We are looking at newer ways to make our care more effective and efficient to better serve our patients.

As with other conditions, many people’s mental illnesses can be managed successfully in the community with the assistance of a variety of health professionals. However, this model is not for everyone. Depending on the nature and severity of their illnesses, some people require acute inpatient or specialized care, periodically or over the long term.

Could we do better with more resources? Certainly. And every part of the health care system would say so. Through Community Mental Health Clinics such as the one at Bayers Road, we succeed in providing effective, evidence-based care throughout our district in a responsible and efficient manner.

Ian Slayter, MD (Psychiatrist), is clinical director of General Psychiatric Services for Capital Health.

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