ANTIDEPRESSANTS, ANTIPSYCHOTICS

1
Nick Kates MB.BS, FRCP(C) Program
Director, Hamilton Family Health Team
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HFHT MENTAL HEALTH PROGRAM - 2008

• 80 practices (57 solo practices)
• 105 sites
• 145 family physicians
• 340,000 patients (68)
• 50 FTE counsellors

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INCLUDES OTHER PILOT PROGRAMS

• Childrens mental health
• Addictions
• Depression chronic disease management
• Peer support for depression
• Return to work project for injured workers
• Groups

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HOW THE PROGRAM WORKS

• See any case / any age (3-98)
• Criterion is family physician is looking for help
• Emphasis on short-term care
• Specialists integrated within primary care
• Indirect as well as direct service
• Emphasis on education
• Charting integrated
• Stepped model of care
• Shared care model

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REFERRALS 2007 (145 FAMILY PHYSICIANS)

• Total 7064
• Counsellors 6084 (87)
• 150 per Full Time Equivalent
• Psychiatrists 1564 (21)
• 590 per Full Time Equivalent

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REFERRALS 2007
Total Referrals 7064 lt12 5 lt18
14 gt65 8
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REFERRALS TO MENTAL HEALTH SERVICES (FIRST 13
PRACTICES - 45 PHYSICIANS)
Service 92-93 94-95 2000
2003 Out-patient clinics 203
75 72 82 HSO Mental
health - 2532
2180 2255 team Total Referrals
203 2607 2252
2337 Ref. / Phys / year 5
54 53 55
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Impact on use of mental health services
Initial 13 sites began 1994
Additional 23 sites joined
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CONSUMER SATISFACTION

• CSQ - 91 satisfaction
• Ave score on V.S.Q. 4.5 out of 5
• Each item meets or exceeds AAGH Benchmarks

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PROVIDER SATISFACTION

• Family Physicians
• With Counsellors 92
• With Psychiatrists 92
• Counsellors 90
• Psychiatrists 90

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BENEFITS

• Increases capacity of primary care
• Increases capacity of mental health system
• Improves access to mental health care
• Improves access for underserved communities

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BENEFITS

• Improves communication
• Increases continuity of care
• Creates a continuum of care
• Increases co-ordination of care
• Potential cost savings
• Mental health care is better integrated with
  physical health care

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PATIENTS PERSPECTIVE

• Easy access to care
• More culturally acceptable
• Co-ordinated through FPs office
• Ease of negotiating systems
• Familiar environment
• Less stigma
• Integrated with other care
• Family physician entry to care
• Counsellor can assist with community referrals
  / system navigation

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COLLABORATION HAS IMPROVED

• Access
• Waiting times
• Communication
• Relationships
• Co-Location is not enough
• We need further system changes

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OTHER CHANGES TO THE PROGRAM

• Population focus
• Registry
• Screening
• Treatment algorithm
• Pro-active follow-up
• Self-management support
• Goals
• Plan
• Information
• Education
• Use of the phone
• Increase efficiency Improve access / reduction
  of waste , what doesnt add value for the
  patients

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• 10th. Canadian Collaborative Mental Health
  Care Conference
• May 28th. 30th.
• Hamilton, Ontario
• www.shared-care.ca
• nkates_at_mcmaster.ca