Toronto Star article published April 7, 2017. Article in full pasted below.
Isabel Teotonio, Toronto Star
Each day, Antonio was slipping deeper into depression. His parents were ill, he feared being laid off from work and he was unhappy in his relationship, which he had moved to Toronto for.
But when he started thinking about suicide — and at one point two years ago came “really, really close” to taking his own life — he knew he needed help.
“I felt jailed, trapped,” says Antonio, who asked that his last name not be published. “I was in a very dark place.”
He confided in his family doctor, who suggested he participate in the Partners Project run out of the Centre for Addiction and Mental Health (CAMH). It’s a three-year study looking at the effectiveness of a mental-health coach — the first role of its kind in Canada — who calls patients with depression, anxiety and at-risk drinking, the most common mental-health problems in primary care.
Adam Whisler, one of the mental-health coaches, says patient response has been largely positive.
“It’s been really awesome to talk to people who would otherwise be completely isolated or who are very nervous to go and speak with someone in person (about mental health),” he says. “By talking to them over the phone, it can help them drop their guard a bit and feel more comfortable.”
The Partners Project, which started two years ago, is meant to bridge primary-care providers and the larger mental-heath services community.
The way it works is a family physician, or nurse practitioner, refers a patient to the project. A treatment plan is designed by a psychiatrist, who supervises three specially trained mental-health coaches.
It’s the coaches who regularly call the patients, usually weekly for about 20 to 30 minutes, to check in and provide support. The coaches then share the information from those calls with the overseeing psychiatrist, whose treatment suggestions may include medication, different dosages, blood work and referrals for formal therapy. Those recommendations are then given to the patient’s doctor so he or she can implement them.
The program is meant to assist family doctors, who don’t always have the resources when dealing with mental health and addictions issues, and may have limited time for followup and support. It can also prove crucial for those in rural and remote areas, where there are limited mental-heath services.
In Ontario, 1.3 million people suffer from co-existing physical and mental-health illness, and many aren’t getting the treatment they need because the health-care system isn’t designed to focus on both at the same time. That’s according to the Medical Psychiatry Alliance (MPA), which is supporting the study that’s being funded by Bell Let’s Talk.
At first, Antonio was reluctant to participate because he didn’t want to share personal details on the phone with someone he had never met. But he couldn’t afford a therapist and was desperate. So he gave it a try.
“After a few months, I was feeling better and doing better,” he says, noting the mental-health coach helped him set goals, monitored his symptoms and asked how he was responding to his anti-depressants.
“There was continuous feedback between (the Partners team), my family doctor and me. And that was very important. I felt like I was taken care of.”
This kind of integrated care was adopted from similar models in the United States and could become a widespread practice in Ontario. Those overseeing the project say results so far are encouraging.
“Our hope is that this model can assist us in meeting the health-care gaps and increasing access for mental-health services for patients in the primary care context,” says Athina Perivolaris, a senior project manager for the MPA.
“If we are able to do that, our hope then would be that we can take this model and have it widely adopted throughout the province.”
The MPA was established in 2014 with funding from the province, an anonymous donor and four partners (CAMH, the Hospital for Sick Children, University of Toronto and Trillium Health Partners). It’s tasked with improving access to better-integrated mental and physical health care in Ontario.
About 150 family doctors, mostly from the GTA, are working with the Partners Project, but researchers are trying to recruit more physicians in rural and remote areas.
As part of the study, patients are placed in one of two groups: one that keeps getting usual care and another that receives usual care, plus the extra phone support from a mental-health coach.
In some cases, the study’s researchers identified serious problems with patients, such as PTSD, drug use, mania and psychosis, which had been missed by family doctors.
“Even when physicians detect some distress, they do not necessarily have the time to find out what the problem is,” says Perivolaris.
Dr. Charles King of Village Family Health Team in Toronto welcomes the extra support and has referred about 35 patients to the project.
“The idea is that you want to actively manage depression, anxiety and at-risk drinking. Typically a lot of people fall through the cracks with those problems.”
Whisler has a bachelor’s degree in psychology and sociology, is a former youth worker and does mental-health research at CAMH. In order to participate in this project, he and the other coaches received special training that includes symptom-monitoring and how to speak with patients so they better understand their symptoms.
For those with mild to moderate symptoms of depression and anxiety, regular chats with a mental-health coach may be sufficient, says Whisler. Coaches can help them with life skills and goals so their situation doesn’t worsen and require formal therapy.
“From a system-level perspective, that makes a massive difference in reducing wait times for psychiatrists and psychologists and also reducing the cost to the overall health system.”
For Antonio, regular phone sessions with a mental-health coach — a “comforting and reassuring” voice — made all the difference.
“I’d probably be gone had I continued on that destructive path.”
He’s now putting many of the skills he learned during their discussions to good use. For instance, he recently broke up with his partner — something he says would’ve pushed him over the edge a couple of years ago — but he’s managing.
“I’m not exactly 100-per-cent OK . . . but I’m not where I was.”