Javed Alloo is a family physician with a bustling community practice in the north end of Toronto. Over the last two decades he has seen the nature of his practice change dramatically. As people are living longer, he is seeing patients with increasingly complex and co-occurring conditions and managing physical illness that previously could have been fatal. In particular, treating patients with multiple overlapping mental and physical illnesses is more and more common.
“I’m running an entirely different practice now than I was 15 years ago,” says Dr. Alloo. “Our population is changing and we are moving away from treating acute care needs to more chronic and complex needs.”
For many Ontarians, primary healthcare clinics are the first point of entry to the healthcare system and more than 20 per cent of all primary care visits in Ontario include mental health concerns. Frequently patients will present to a local clinic with physical health concerns then, through continued assessment, histories of trauma, sexual abuse, anxiety and severe depression begin to surface. With so many co-occuring concerns, it can be difficult to determine which condition to tackle first, and expertise is often stretched to the limit. Adding to the challenge are the long wait lists for specialized mental health care. “More people are seeking help now for mental illness, which is great, but we’re seeing that the need for services has far outstripped the supply,” says Dr. Alloo.
Amy Restoule is a social worker with Sudbury East Community Health Centre. As the only social worker serving three Sudbury-East communities, she sees the gaps in expertise and services for mental illness first hand. Similar to Dr. Alloo’s practice in Toronto, “we tend to see complex mental illness compounded with physical illness,” Amy says. High rates of anxiety, depression, post-traumatic stress disorder (PTSD) and limited local services available to support patients can make the Sudbury team feel like there aren’t enough options.
Bringing experts together
A new collaborative project led by CAMH and the University of Toronto (UofT) will help address these challenges faced by primary care providers. ECHO Ontario Mental Health at CAMH and UofT is a virtual community of practice connecting 18 rural “spoke” primary care sites with mental health and addiction specialists at the Toronto-based “hub”. The Project ECHO model, developed at the University of New Mexico School of Medicine, aims to bridge academic health science centres and the frontline of community care to improve and expand clinical skills and capacity. The new ECHO at CAMH and UofT was launched on October 6 and is the first mental health-focused ECHO in Ontario, thanks to support from Ontario’s Ministry of Health and Long-Term Care.
The new ECHO Ontario Mental Health at CAMH and UofT is a virtual community of practice connecting 18 rural “spoke” primary care sites with mental health and addiction specialists at the Toronto-based “hub”
“The ECHO model uses multi-point live video conferencing to connect mental health experts at the hub to multiple primary care providers, allowing for real-time case consultation and feedback,” says Linda Mohri, Executive Director of Access and Transitions at CAMH and co-chair of ECHO Ontario Mental Health. “Through this multi-directional learning structure, ECHO Ontario at CAMH and UofT will equip primary care providers with knowledge and support to manage complex needs within their own practices.”
Dr. Sanjeev Sockalingam (left) and Dr. Allison Crawford (right) co-chair the weekly, two-hour ECHO sessions of ECHO Ontario Mental Health at CAMH and UofT.
Dr. Allison Crawford, CAMH psychiatrist and assistant professor of psychiatry at UofT, co-chairs the weekly, two-hour ECHO sessions with Dr. Sanjeev Sockalingam, psychiatrist at the University Health Network and associate professor of psychiatry at UofT. “This is a really exciting project, with the opportunity for every healthcare provider at the table to learn together, which will translate into best practices that can help patients,” says Dr. Crawford, who is also head of the Northern Psychiatric Outreach Program and Telepsychiatry at CAMH. “It’s also a very patient-centered approach. Instead of sending one patient out to see multiple specialists, or where specialists may not be available, we are bringing the experts to one table and mapping out a treatment plan together.” The weekly sessions include a didactic presentation based on a curriculum validated by primary care, and anonymized case discussions by spokes.
Dr. Alloo in Toronto and Amy Restoule in Sudbury are both participants in the new ECHO community, and early impressions are very positive. As an expert in the Toronto-based hub, Dr. Alloo presented the first patient case to the ECHO group and found that the recommendations helped clarify a way forward to help his patient. “There was a renewal of hope and support that I got from the session, and I felt like there were options and that we could work together to solve a problem that previously seemed intractable,” says Dr. Alloo. “With so many different experts at the table, you can feel more secure with the decisions you’re making.”
Amy has also been energized by the first ECHO sessions noting that even though the case presented may not be someone in her practice, “there always something we can take back, some relatable factor that we may not have thought of,” she says. “Having ECHO to rely on-- and contribute to-- affords us the ability to get recommendations in a timely manner, and that is so important for our patients.”