Purpose of the Virtual Mental Health Clinic
Access to mental health services is problematic throughout Canada. Wait times of six to twelve months are common, which results in untreated mental disorders and frustration in patients and primary care practitioners. It also means that research in mental health is largely irrelevant as it is unavailable to the right people at the right time due to lack of access.
Approaches to solving waiting lists focus on diversifying the workforce and engaging with service users and their caregivers. As part of the suicide prevention initiative, which aims to reduce rates of suicides and suicidal behaviour in Ottawa, we plan to launch a single entry portal for primary care providers to access mental health services, educational modules, and referrals for secondary mental health services in the Ottawa region, as well as to provide information and resources in order to access these referrals. In addition, to include links to videos and handouts to be provided to patients and families by their primary care provider.
This Virtual Mental Health Clinic, housed on ementalhealth.ca/primarycare, consists of three levels of stepped care – the first level is a sophisticated information database that generates care plans for practitioners and patients. The second level provides primary care practitioners access to eConsults, direct telephone access to psychiatrists and on-line e-therapies. The top level is a referral brokerage service to manage referrals to secondary mental health services. The establishment of a three level Virtual Mental Health Clinic allows for a centralized consolidation of resources and referrals to be in one easily accessible location.
Organization of the Virtual Mental Health Clinic
Level 1 (launched in September 2015 )
The first level of the clinic will contain a variety of information and resources about mental health disorders, and guidelines and treatment algorithms for clinicians. The content is accessible to all, though the main focus and direction is towards primary care providers.
Level 2 (to be launched in 2018)
The second level of the clinic will serve to provide self-help e-therapies such as: online Cognitive Behavioural Therapy (CBT), supplemented by e-Health Coaches to whom primary care practitioners could refer patients. Moreover, referrals to this service would allow for access to eConsults delivered by Psychiatrists. The services exist already for eConsults, however, this would allow for the amalgamation of such services to be housed in one location.
Level 3 (to be launched in 2019)
The third level will serve as a referral brokerage service moderated by Referral Brokers. The Virtual Clinic would function as a one stop central intake service for referrals from primary care practitioners to all mental health services funded by the Champlain Local Health Integration Network (LHIN).
The main purpose of establishing the referral brokerage service is to streamline referrals through the system and to aid in finding the most appropriate service for each patient. Responses to these referrals would include: eConsults, telephone discussions, as well as face-to-face appointments. Conversely, a parallel virtual clinic designed to be accessed by non-health care professionals must be established, and modelled on http://primarycare.ementalhealth.ca/index.php?m=fpStart.
To better serve timely and urgent patient care, an on-call Psychiatrist will be available in the Virtual Mental Health Clinic. While assessing the workload level required, the on-call Psychiatrist would be accessible to primary care providers approximately 4-5 hours per week in order to: provide advice on urgent cases, patients not willing to use eConsults, clarifying issues and/or relevant questions pertinent to advancing individual patient care.
Upon completion of the design of the outer layer of the Virtual Mental Health Clinic, this endeavor would be duplicated on a national scale and populated with local and provincial content.