An article published in today's edition of The Chronicle Herald:
Physician urges collaboration over fee-for-service model
By John McPhee, Health Reporter
Big changes are needed to fix our ailing mental health-care system, a Halifax family doctor says.
For example, the way doctors are paid doesn’t allow them to take time with people, said Ajantha Jayabarathan [pictured], better known as Dr. A.J.
She and other general practitioners are paid for every patient they see, a system called fee-for-service. That may work for simple problems, but the complexity of treating mental illness is another matter.
The collaboration of many practitioners, from social workers to psychiatrists, is needed, Jayabarathan said in an interview Wednesday.
"Already they (the province and Doctors Nova Scotia) are looking at a different way to pay people," she said.
"For instance . . . I meet with a social worker, psychologist or a psychiatrist for an hour to discuss patients, or let’s say they came to my clinic once a month and we all work together. The whole system has been turned around."
Collaborative care is at the heart of a national conference that starts today in Halifax.
Jayabarathan, who will co-chair the 12th Canadian Collaborative Mental Health Care Conference, is passionate about the concept.
"I think what it will take is willingness, interest and people stepping forward to say, ‘I think we’re ready to do something like this.’ "
A lack of health-care providers or resources isn’t the problem. It’s a matter of using those resources more effectively.
"We’re drowning in a sea of plenty," said Jayabarathan, who has practised in Halifax for 25 years.
"Family doctors don’t work enough with psychologists and vice versa to really understand each other’s expertise. You are unlikely to use a resource that you don’t know much or anything about, even if they work down the hall from you."
The collaborative effort must go beyond the people providing the care, said Dr. Ian Slayter, director of psychiatric services for the Capital district health authority.
For the patient’s privacy and other reasons, the family or other people close to the patient are often shut out, Slayter said Wednesday. Patient confidentiality is important, but addressing that issue can be as simple as asking for consent.
"The patient benefits because they will get better support from their family or whoever supports them," said Slayter, who will co-chair the conference with Jayabarathan.
"Their practitioners and clinicians will be better informed about what’s actually going on with the patient. Because what I see in the office and what the family sees at home can be different."
And family members benefit because they’re included in the process.
"They not only feel more effective but they get help in dealing with their own anxieties and the difficulties they have dealing with a person with a serious illness," Slayter said.
Next week, Capital Health is expected to approve treatment guidelines that include a duty of care to the family, Slayter said. These guidelines will be distributed to practitioners and health centres.
A group from the Meriden Family Programme in Birmingham, England, has been training a Capital Health team in its collaborative family approach, Slayter said.
The Collaborative Mental Health Care Conference runs from today to Saturday at the World Trade and Convention Centre in Halifax. Speakers and workshops will include officials from the Mental Health Commission of Canada, local practitioners and people who have used the mental health system.
The conference is open to the public, but registration and fees apply, although efforts will be made to make the event as accessible as possible. About 350 people were registered by Wednesday, Jayabarathan said. For more information, go to www.shared-care.ca.
(jmcphee@herald.ca)
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