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 care. This pathway for major depression and alcohol dependence was launched in 2013 and was one of CAMH’s first ICPs.
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 a physician, a nurse, a pharmacist and a psychologist. If it would be helpful for a particular patient, other professionals might also be involved (for example, an occupational therapist). 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 16-week outpatient program for people who have been diagnosed with major depression and alcohol dependence. Currently, it is common to treat depression and alcohol dependence as separate conditions. This new approach treats them together, with structured, evidence-based treatments that are matched to each individual patient. Each patient’s treatment plan is mapped out in a Personalized Care Pathway Schedule.
About the treatments
All ICPs at CAMH include both medication and non-medication treatment.
Medication: Medication treatment begins with a medical assessment by the physician, a nurse and the pharmacist. A treatment plan is designed, based on a patient’s individual needs and medical history. Patients are educated on their diagnosis, the medication prescribed and possible side-effects. Every two weeks there are follow-up appointments with the physician, pharmacist and nurse to assess the patient’s response to treatment and adjust the medication if needed.
Non-medication treatment: Patients meet with the psychologist once a week for individual cognitive-behavioural therapy. The goals of the therapy are decided by the patient and the psychologist together. Patients also receive psychoeducation to better understand the symptoms of their depression and alcohol use. They learn and practise new skills to help reduce symptoms now and in the future. The psychologist uses motivational interviewing and harm reduction approaches.
An alternative stream of treatment includes group therapy. In the structured treatment group, members are able to support and learn from each other.
The ICP also includes:
completing regular self-assessments to track changes in symptoms
exploring supports in the community for continued care after the end of the program.