Canadian Collaborative Mental Health Initiative

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Globe and Mail, November 14, 2005

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Collaborative Mental Health Care in Hamilton, ON

Dr. Nick Kates has been a long-time supporter of collaboration between health professionals, particularly as it relates to mental health care.

Kates, a Hamilton psychiatrist, is chair of the Canadian Collaborative Mental Health Initiative (CCMHI), a Primary Health Care Transition Fund project that seeks to improve access to mental health care prevention, promotion, early detection and recovery through primary health care providers. The initiative is a group effort between 12 national organizations, representing community services, consumers, families and caregivers, self-help groups, dietitians, physicians, nurses, occupational therapists, pharmacists, psychologists, psychiatrists and social workers.

The goal of the CCMHI is to improve access to mental health services in primary health care by promoting interdisciplinary teams, and collaboration among health care providers, consumers, families and caregivers. It’s a goal that mirrors Kates’ own; he has advocated for greater collaboration for more than 20 years and has worked hard to put his beliefs into action in a variety of areas.

Kates has been Director of the Hamilton Health Service Organization (HSO) Mental Health and Nutrition Program for 11 years. The program has successfully integrated mental health and nutrition services into the offices of more than 80 family physicians in Hamilton and is one of many initiatives that will be featured in the CCMHI’s  “Canadian Review of Collaborative Mental Health Care Initiatives” to be available this fall.

As part of a primary health care team, each practice has a counsellor permanently attached and a consulting psychiatrist who visits every one to four weeks. The counsellors provide assessment, treatment/management and follow-up recommendations, as well as facilitating groups on topics that include stress management, depression and parenting. The psychiatrist sees new and follow-up cases in consultation (often with the counsellor present), meeting with the family physician prior to the consult and following it to review the proposed management plan. The psychiatrist is also available by telephone between visits to offer advice and support.

“This (program) helps to make mental health services accessible to a population who might not be able, or wish to use traditional community mental health services,” Kates explains. It reduces both the stigma some people still attach to visiting a mental health service, as well as waiting times to be seen , which according to Kates, can be six to nine months in many Canadian communities.

It’s an idea that’s working. Research shows that family physicians in this environment will refer 11 times as many people for a general mental health assessment. The satisfaction ratings are high for both the health professionals involved in the program and those receiving mental health care. And outcomes, too, have improved. Kates says there has been a significant improvement against a number of standard scales for over 70 per cent of the people seeking care.

Kates credits the success of the program on its emphasis on collaboration.

“If you look at what we are trying to do in our program – address the wellbeing of the populations we serve as well as  just the people who come in to see us – it’s obvious that no single provider can do it alone,” he says. “You need a team. Collaboration is already becoming the way of the present.”