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mhcep_tipp_
Mental Health Consultation
and Evaluation in Primary-care (MHCEP)
Overview:
MHCEP is a joint initiative, co-located at
family practice sites, which provides collaborative primary-based care to
clients in Middlesex County who are at risk of becoming increasingly ill. The
MHCEP team responds to referrals from the sites’ primary care physicians for
consultation, education or training. The preventative and on-site treatment
interventions of MHCEP should avert clients’ need to access crisis, urgent,
emergent or hospital admission, thereby, building system capacity. The emphasis
is on short-term care for individuals and families to promote accessibility and
minimal wait time for the service.
Family Practice sites: Victoria Family
Medical Centre; Byron Family Medical Centre; Southwest Middlesex Health Centre;
and St. Joseph’s Family Medical and Dental Centre.
Description of Service:
A nurse with mental health experience is
attached to each primary care provider practice, with the amount of time being
determined by the need and size of the practice. The psychiatrist provides
consultations as required. At all times, the nurse and psychiatrist work
collaboratively with the primary care provider.
The nurse is the first line of contact with
MHCEP for the primary care provider to see and discuss a client, when the
primary care provider considers additional expertise to be required. The nurse
is also responsible for coordinating the integration of all MHCEP activity with
community mental health agencies to ensure streamlined, simple, single point
access to community mental health services.
The nurse also provides the primary care practitioner with advice about specific
management strategies or local resources (e.g., Canadian Mental Health
Association [CMHA], Western Ontario Therapeutic Communities Hostels [WOTCH],
Crisis Intervention service, substance abuse rehabilitation, and consumer
initiatives) that the primary care provider can then incorporate into the
management plan. The nurse may refer a case to the psychiatrist for either
discussion with the primary care provider about the individual or for actual
assessment of the client.
a) Direct consultation
Following an interview with the client, the
psychiatrist and primary care provider create, with the assistance of the nurse
if necessary, a comprehensive management plan before the client leaves. When
referral takes place, there is immediate feedback to the primary care team
(i.e., electronic note included in the client's primary care electronic record)
for ongoing management by them. Discussions between the primary care provider
and the psychiatrist occur as required at subsequent visits to address any
problems that may have arisen in the interim. Psychiatric backup is provided to
the primary care provider by telephone for those clients previously consulted or
discussed during a site visit.
b) Indirect services
The psychiatrist reviews and discusses cases
with one or more primary care providers and the nurse in pre-arranged meetings
and undertakes brief contacts, of five minutes or less, with the primary care
practitioner to address discrete management issues, such as a medication
question, management problem for a client already involved in the MHCEP, a
medical-legal issue, or a potential referral. Frequently, such contacts are to
assist the primary care provider in implementing a chosen management plan.
c) Educational interventions
The psychiatrist is involved in both case-based
teaching and structured educational presentations around topics of the primary
care provider's choosing.
MHCEP Education and Research Activity
Continuing professional development of primary
care providers and their health care staff include, for example, review of
evidence based practice for common mental illnesses; how to efficiently and
effectively identify the best available empirical evidence for the treatment of
primary care practice clients with mental illness; case identification,
detection and care of the client expressing thoughts of self-harm; and
management of the potentially violent mentally ill outpatient.
Family Medicine and Psychiatry Resident
elective opportunities are available in conjunction with the Departments of
Family Medicine and Psychiatry, University of Western Ontario, respectively. The
MHCEP program has been formally accredited as a core community psychiatry
rotation of the UWO Postgraduate Program.
Depression Education and Enhancement
of Primary Care (DEEP Care) (Southwest Local Health
Integration Network sponsored) is an innovative, capacity building, MHCEP
initiative - the first of its kind in Canada, involving: (i) Depression
education for primary care providers and patients throughout Southwest Ontario,
and (ii) Primary care or mental health nurse provided telephone based depression
treatment monitoring and support while working in concert with the patient’s
family physician supported by a psychiatrist. (2009/2010).
MHCEP Research
“Diabetes screening, risk management and
disease management in a high-risk mental health population.” Funded by the Lilly
Neuroscience Solutions for Wellness Educational Fund; $81,781.00; Aug 1,
2005-Aug 31, 2007. Dr. David Haslam, Co-Principal Investigator with Dr. Stewart
Harris.
“Diabetes screening, risk management and
disease management in a high-risk mental health population: an evaluation
project.” Funded by The Ministry of Health and Long-Term Care, Primary Health
Care Transition Fund; $369,172.60; Oct 1, 2004–July 31, 2006. Principal
proponents: Dr. D. Haslam and Dr. S. Harris; Co-proponents: Dr. B. Lent, Ms.
Betty Harvey, Ms. Kristine Diaz, Mr. Michael Petrenko, Ms. Michelle Hurtubise,
Dr. Beth Mitchell.
“Continuous enhancement of quality measurement
in primary mental health care: Closing the implementation loop.” Funded by The
Ministry of Health and Long-Term Care, Primary Health Care Transition Fund,
National Envelope; $2,000,000; Feb 2004–Sept 30, 2006. Dr. Paul Waraich,
Principal Investigator; Dr. David Haslam, Co-Investigator; Dr. David Haslam,
Lead Investigator of Subprojects: “Knowledge Transfer,” $142,500.00; May
2004–Sept 30, 2006; Dr. David Haslam, London PI; Dr. Jatinder Takhar, Dr. Dave
Dixon, Dr. Stefane Kabene, London Co-Investigators; “Best Practices;”
$97,000.00; Sept 2004–June 30, 2005; Dr. David Haslam, PI. External Link:
http://www.ceqm-acmq.com/ceqm/index.cfm
Depression Education & Enhancement of Primary
Care (DEEP Care); Dr. D. Haslam, Dr. J. Takhar, Dr. D. Dixon. Consortium for
Applied Research and Evaluation in Mental Health (CAREM); $10,486.88; 2008.
MHCEP Presentations/Publications
Finigan, A; Bush, H; Desjardins, N; Haslam, D;
Jackson, L; Takhar, J. (June 7–9 2007). “Mental Health Consultation and
Evaluation in Primary-care: A sustainable delivery model.” Poster at 8th
National Conference on Collaborative Mental Health Care, Quebec City, Quebec.
Finigan, A; Bush, H; Desjardins, N; Haslam, D;
Jackson, L; Takhar, J. (May 15, 2007). “Mental Health Consultation and
Evaluation in Primary-care: A sustainable delivery model.” Poster at the
Regional Mental Health Care London and St. Thomas 8th Annual Research Half Day,
St. Thomas, Ontario. (abstract in Research Insights)
Haslam, D. (March 17-20, 2009.) “Diabetes
screening, risk management and disease management in a high risk mental health
population.” International Forum on Quality and Safety in Health Care, Berlin,
Germany.
Haslam, D. “Continuous Enhancement of Quality
Measurement (CEQM) in primary mental health care: Closing the implementation
loop.” (June 21, 2007). Trillium Primary Care Research Forum 2007, London,
Ontario.
Haslam, D. (June 1, 2007). “Continuous
Enhancement of Quality Measurement (CEQM) in primary mental health care: Closing
the implementation loop.” Department of Psychiatry, University of Western
Ontario, Academic Research Day, London, Ontario.
Haslam, D; Harris, S; Harvey, B; Biederman, T.
(June 7-9, 2007). “Sharing responsibility for the emerging problem of type 2
diabetes in mental health populations.” 8th National Conference on Collaborative
Mental Health Care, Quebec City, Quebec.
Haslam, D; Harris, S; Harvey, B; Biederman, T.
(June 1, 2007). “Diabetes screening and risk management (DSM) in a high risk
mental health population – pilot project.” Trillium Primary Care Research Forum
2007, London, Ontario.
Haslam, D; Harris, S; Harvey, B; Biederman, T.
(Feb 20-22, 2007). “Diabetes screening and risk management (DSM) in a high risk
mental health population – pilot project.” Poster at A Legacy for Change 2007
National Conference, Ottawa, Ontario.
Haslam, D; Harris, S; Harvey, B; Biederman, T.
(May 20-25, 2006.) “Diabetes screening and risk management (DSM) in a high risk
mental health population – pilot project.” Poster at American Psychiatric
Association Annual Meeting, Scientific Program, New Research; Toronto, Ontario.
Haslam, D; Harris, S; Harvey, B; Biederman, T.
(May 11-13, 2006). “Diabetes screening and risk management (DSM) in a high risk
mental health population – pilot project.” Poster at National Conference on
Shared Mental Health Care; Calgary, Alberta.
Haslam, D; Takhar, J; Dixon, D. (May 28, 2009.)
“Depression Education and Enhancement in Primary Care (DEEP Care).” 2009
National Conference on Collaborative Mental Health Care, Hamilton, Ontario.
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