The mental health staff members are available for support in situations in which primary care physicians might feel uncomfortable, such as addressing the needs of an urgent care visit patient who appears vaguely suicidal. In such cases, a nurse or primary care physician can have a curbside consult with the mental health clinician on site, or the psychiatric worker might go to the treatment room and role-play the most effective interaction.
Ms. Lynn Curran
The benefits of limit setting, Ms. Curran said, are a reduction in excessive phone calls or patients visits, and an overall reduction in the use of services.
Staff Buy-in Is Essential
At the University of Toronto, this model is called "collaborative care," but the essential goals are the same, said Dr. Diana Kljenak, who is affiliated with the university. She described her experience working to integrate mental health services with six Toronto-area health centers and a hospital-based mental health program. The collaborative arrangement is collectively known as the Toronto Urban Health Alliance (TUHA).
Getting clinical staff and leadership to buy in into the concept is crucial for success. "You can’t do much on your own; you do need leadership support to develop collaborative care," Dr. Kljenak said.
As in Massachusetts, mental health workers in Toronto have to make maximum use of limited resources. Under the TUHA model, mental health staff are colocated in primary care facilities in settings that are familiar to patients and that are not stigmatizing.
Each community health center has a psychiatrist and mental health staffer who provide consultations and services for clients who might not be insured, such as refugees or recent immigrants. Such patients also might not be proficient in English or have a community health center physician.
Dr. Diana Klejenak
Psychiatric services are provided on site one-half day each week, and mental health workers are available to health center clinicians for telephone consultations weekdays from 9 a.m. to 5 p.m. Health center clinicians also have 24-hour direct psychiatric emergency services privileges.
"If clinicians want to refer a patient to a psychiatry emergency department, we make sure that they have easy access, [and] that once they get in contact with us and discuss the case with us, they don’t have to wait for hours for medical clearance," Dr. Kljenak said.
All staff members of each community health center receive twice-yearly half-day education in mental health issues identified as being of primary importance to community clinicians.
"Collaborative mental health care is not a fixed model or a specific approach. Its goal is to strengthen the accessibility and delivery of mental health services in primary health settings through interprofessional collaboration, and to provide more coordinated and effective services for individuals with mental health needs," Dr. Kljenak said.
Dr. Avni-Barron, Ms. Etre, Ms. Curran, and Dr. Kljenak reported having no conflicts of interest to disclose.