Improving access to mental health services is a top priority for divisions across BC, but many divisions experience logistical challenges in achieving this goal—particularly rural and remote communities. To address barriers to access in rural communities—such as geographical distance, transportation limitations, and/or financial barriers—the Rural and Remote Division of Family Practice (Gabriola Chapter), Campbell River and District Division of Family Practice, and the Comox Valley Division of Family Practice utilized funding from the Shared Care Committee to develop the Northern Gulf Island and Gold River Mental Health and Substance Use (MHSU) project. The project, initiated in October 2017, uses a team-based care approach to provide timely support for patients experiencing mental health or substance use issues in five rural communities: Cortes, Quadra, Hornby, and Denman Islands, and the village of Gold River.
Family physicians in these rural areas face the same geographical isolation as their patients, and often report feeling disconnected from complementary health care services such as psychiatrists or other mental health clinicians. Feeling alone in providing optimal care to their patients who need mental health support can take a significant toll on a GP’s own mental well-being. Many family physicians report feeling burned out and isolated as they struggle to access services that support vulnerable patients.
The Northern Gulf Island and Gold River Mental Health and Substance Use project uses a team-based model to provide care for patients in their home community, incorporating different approaches to meet each community’s individual needs. In one community, patients participate in telehealth psychiatric consults that brought their psychiatrist, family physician, and an MHSU clinician into the same virtual room to co-develop treatment plans and monitor progress. In another community, monthly case-conferences between the GP and the psychiatrist take place, as well as 15-minute weekly huddles between the GP and the MHSU clinician.
An unintended but positive outcome of this work has been an increase in on-site access to telehealth equipment, which has facilitated and enhanced much of the collaborative care. As one family physician said, "[the teleconferencing is] saving the patient from having to tell their story three times, and at the same time, it [provides] professional development for me."
The positive effects of a team-based care approach have been felt by both family physicians and specialists. Through working alongside psychiatrists, family doctors report that they feel more supported in managing patients, and that they learn a great deal through the case-conferencing process. One psychiatrist reported that it feels rewarding to co-develop treatment plans with her GP partner, and she feels secure knowing the family physician can better manage the patient after the collaborative consultation process. As a result, she can increase capacity and access by seeing more patients.
To continue to facilitate the feeling of connectedness, a rural MHSU Shared Care education forum was hosted by the Practice Support Program (PSP) in March this year. The aim was to decrease provider isolation, enhance relationships between the GPs and psychiatrists, and build capacity of care teams to provide rural-focused, culturally sensitive shared care. As one GP said, “I think that the remote locations feel like there’s more support, like there’s someone on the end of the phone. [We’re] putting a face to a name.”
The project will continue to engage other key partners in the community and work to ensure the outcomes of the project are sustainable and that learnings are shared with other rural communities.
For more information on the Northern Gulf Island and Gold River Mental Health and Substance Use project, view the following videos: