What are integrated care pathways?
An integrated care pathway (ICP) is a new approach at CAMH to treating a person who needs help. That person needs to see the right care providers, in the right order, in the right place, at the right time. An ICP makes sure this happens, by identifying a care team of different professionals and mapping out the treatment process from start to finish. An ICP takes a structured, evidence-based approach to care, and puts the person at the centre, resulting in better care.
ICPs have been used in some parts of the medical system for several decades. But it is only recently that they have been developed for mental health and addictions care.
Who is on this ICP team?
The patient is at the centre of the team. Around them is a group of professionals communicating with each other about the treatment plan. The team includes clinicians (such as a nurse, a social worker or an occupational therapist) and a psychiatrist. If it would be helpful for a particular patient, other professionals, such as a pharmacist, might also be involved.
The team works with the patient, giving advice and recommending both medication-based and non-medication treatments throughout the program.
How does it work?
This pathway is a six- to 12-month program for certain people who have been diagnosed with bipolar disorder. Specifically, it is geared towards people who experience more symptoms of depression than of mania.
The pathway includes a personalized schedule that maps out whom the patient will see, when and for how long. The patient will meet with their clinicians and the psychiatrist every month, as well as other team members over the course of the year. Families are also encouraged to participate in support services provided by CAMH’s Mood and Anxiety Ambulatory Services.
Patients can be referred to the bipolar depression pathway through ACCESS CAMH. However, the referral must come from their primary care physician, nurse practitioner or psychiatrist. Once referred, patients are assessed to see if the pathway will meet their needs.
About the treatments
All ICPs at CAMH include both medication and non-medication treatment (see the map of the treatment process below).
Treatment begins with the clinicians, who provide psychoeducation to help patients better understand the symptoms of their illness and the pathway to recovery. Patients also learn and practise skills to support their recovery in a 16-week group therapy treatment based on cognitive-behavioural therapy or interpersonal and social rhythm therapy. Throughout the ICP, there are regular assessments to track the patient’s progress.
At the beginning of the pathway, patients receive education about the medications they are taking. If needed, there are also follow-up meetings with the pharmacist to provide further education. Treatment also includes ongoing metabolic monitoring.
CAMH offers groups to help family members to support patients in their treatment and to learn more about bipolar disorder. Families can call ACCESS CAMH and request a referral to a Mood and Anxiety family support group.
Before patients leave the program, staff help connect them to health care providers, supports and other services in the community, to help them stay healthy.
For more information about integrated care pathways, please see our main ICP page.