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CAMH Stories Centre for Addiction
and Mental Health

Helping primary care providers manage mental health conditions and addiction

By Sandeep Dhaliwal

Susan Lewis didn’t realize how heavily she had been drinking until she brought up her coping mechanisms for anxiety with her family doctor. Since her forties, the 72-year old Mississauga resident suffered from panic attacks, which were treated over the years through medication.

What her family doctor didn’t realize, however, was that Susan was also engaging in at-risk drinking—consuming alcohol at levels well above the Canadian health guidelines.

“When I was working, my anxieties got worse. The longest I could stay at one place of employment was three to four years. By then I would usually have to quit,” explains Susan. “This pattern repeated itself over again, so I retired early. That’s when the drinking began to spiral out of control.” 

Susan
Susan Lewis

To address Susan’s drinking, her doctor referred her to the PARTNERs program, the unique Medical Psychiatry Alliance research study based at the Centre for Addiction and Mental Health (CAMH). PARTNERs is a three-year study that tests an innovative model to expand mental health care to those who need it.

The premise is simple —working with a network of about 150 family physicians and nurse practitioners in Ontario—the PARTNERs team acts as a liaison between the patient and the larger mental health services community.

Physicians and nurse practitioners participating in the program refer a patient with mental health or addiction issues to PARTNERs, which designs a treatment plan overseen by a psychiatrist on the team. Then a specially trained mental health “coach” conducts a series of weekly telephone conversations with the patient for several weeks. Information from those consultations is passed back to the family physician.

It is estimated that as many as 40 percent of Canadians with mental illness and addiction, including at-risk drinking, will not seek help.

“Many of our patients are not aware of what ‘drinking in moderation’ entails, or what Canada’s low risk drinking guidelines are. Hence, they don’t see any harms associated with their drinking,” says Salaha Zaheer, one of the three CAMH mental health coaches with the project, who worked with Susan.

Through the program, Susan started tracking her drinking on a daily and weekly basis. During their calls, Susan and Salaha brainstormed evidence-based strategies and personalized solutions to help Susan achieve her weekly goal. After a year of participating in the program, Susan noticed a significant reduction in her alcohol consumption.

“Susan’s story highlights the gaps in addressing and supporting patients who are engaging in at-risk drinking,” says Salaha. “Based on feedback from our clients, it seems that it is more challenging for healthcare providers to have a conversation about alcohol use than depression or anxiety. At-risk drinking is being missed in the referrals which means either the patient or the doctor are avoiding having this important conversation.”

PARTNERs is currently working with 12 family health teams across Ontario. Primary care providers are referring patients who typically live in under-serviced areas, or who don’t want to wait for weeks or months to be seen by a specialist. The program is also appealing to patients who aren’t able to travel to a specialist’s office. For example, they may have physical limitations, such as those faced by elderly patients, or no access to a car or public transit.

“We really have two separate health systems, one that takes care of physical health and one that takes care of mental health,” says Dr. Benoit Mulsant, Lead Researcher of PARTNERs and Executive Director of the Medical Psychiatry Alliance. “We hope the PARTNERs project, a concept of integrated care, will support patients by increasing access to the care they need. If we can do this, we hope this model will be widely adopted.”


Published on November 10, 2017

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