For years, family doctors in British Columbia and elsewhere have been unequipped and unmotivated to deal with patients with more complex health problems.
In a fee-for-service world, GPs are induced to process as many patients as they can in a day. As callous as it sounds, spending the time required to properly evaluate someone complaining of depression or anxiety costs a family doctor money.
When it comes to mental-health issues, general practitioners don't have the training or experience to make more than the most cursory analysis and recommendations. For someone presenting symptoms of depression, the quick and easy solution for a doctor is often drugs. Referrals to expensive psychiatrists are often standard protocol.
In 2004, a survey of GPs in B.C. indicated a strong desire for more instruction on mental-health matters. It's an area they get little education in at medical school. And yet, 80 per cent of patients first see their local physician when a mental-health issue arises.
About 10 per cent of Canadians experience a mental illness in any given year. Some 20 per cent will have a mental illness in their lifetime. It's a growing societal dilemma.
It was against this backdrop that a joint committee of doctors and members of the B.C. Ministry of Health came up with a plan to provide physicians training that would allow them to more ably diagnose and treat mental health problems. The program, a first in Canada, was introduced in the summer of 2009. By August of the following year, 981 of the province's 3,300 doctors had enrolled.
The course is voluntary, but doctors who take the three sessions are paid almost $3,000 for their time.
The course was designed with the help of a psychiatrist and gives doctors the skills and knowledge to better screen patients and provide diagnostic assessments that include treatment and long-term care options. In other words, it imbues them with a confidence they didn't have in this field previously.
Dr. Bruce Hobson of Powell River, B.C., says it's been the biggest improvement in his practice in his 28 years as a doctor. He estimates that he uses his new skills every day with more than 50 per cent of his patients.
As well, family doctors are now paid for the extra time they spend assessing someone with mental health-related troubles. It also allows for over-the-phone follow-up consultations, something a doctor could not previously bill for under the Medical Services Plan.
Dr. Bill Cavers of Victoria, co-chair of the committee that devised the program and a GP who has also gone through it, said its benefits are many: It is helping clear up the backlog of patients waiting to see psychiatrists because fewer are being referred; GPs aren't reaching for the prescription pad as quickly when someone shows up complaining of depression or anxiety; doctors feel more challenged and invigorated by their enhanced skills and expanded mandate.
"The number of health-care providers hasn't kept pace with the demand on the system," Dr. Cavers said in an interview. "Everybody in a way is being forced to move a little bit upstream. Specialists are passing off some of the less complex matters to some of their colleagues who might not have handled those problems before."
Family doctors in B.C. will soon be able to sign up for programs like the one on mental health to give them advanced training in palliative care and chronic obstructive pulmonary disease, cases of which are clogging up emergency rooms in Canada at alarming rates.
"The quality of life for people who are chronically short of breath is abysmal," said Dr. Cavers. "We're going to bring in lung specialists and respiratory therapists to help doctors better diagnose problems in this area and help streamline the system a little.
"The more we can deal with these complex health issues at the primary care level, the less financial burden it will place on the system as a whole."
B.C.'s mental health learning program is the kind of creative solution to our mounting health care challenges that we'll need even more of in the coming years.