A new program sponsored by the BC Medical Association and the Ministry of Health is designed to help family physicians be better able to treat patients with depression or other mental health issues.
Creston’s Dr. Tara Guthrie has attended learning sessions on what the General Practice Services Committee calls the “mental health module of practice support”. And she has taken the tools and skills she learned and shared them with other family physicians in Creston, Cranbrook, Invermere and Fernie.
“This mental health module — Making it Real — makes sense to me as a physician, so it has been interesting to become a trainer so that I can pass on the information to my colleagues,” she said.
Guthrie went to Vancouver three times for “train the trainer” sessions.
“Stats in 2008 showed that of the 700,000 mental health services provided in B.C., 600,000 were delivered by general practitioners (GPs),” she said. “So we are doing the work, but the Medical Services Health Plan (MSHP) wasn’t structured to handle it. Under this system, GPs feel more comfortable.”
In addition to being supported by the MHSP fee structure, physicians like Guthrie are giving their colleagues a refresher course and the latest information about screening and treatment tools.
“Under this program, GPs are doing a lot more mental health screening,” she said. “Fewer referrals are made to Mental Health and patients are dealt with in our offices. Our comfort level in these cases has increased dramatically.
“I have always believed in the connection between mental illness and physical illness. Now I am better equipped.”
Chronic pain, she said, is often the cause of depression.
“We concentrate so much on the physical,” she said. “But if we recognize and treat depression, patients are much better able to cope with physical pain. ‘Holistic’ is a word you hear bandied around, but that really is what this approach is all about.”
Part of the Making it Real program involves a change in the medical billing system that allows GPs to bill MHSP for providing mental health services.
“Mental health treatment is getting much better — change is definitely in the wind,” Guthrie said. “Now we need to make mental illness not have the stigma that has been associated with it. Then people will be more likely to seek help.
“That’s one of the reasons I was so excited to become involved in this program.”
Making it Real enables general practitioners like Guthrie to screen their patients more thoroughly for mental illness and diagnose conditions that were previously more difficult to detect. The program also includes tools for organizing patient issues, a cognitive-behavioural skills program, and a patient self-management workbook
One of Guthrie’s patients, Gwen Benty, says that she has benefited from the Making it Real approach.
“Tara has been our family doctor since we came to Creston,” Benty said. “A while ago I developed clinical anxiety and depression. I just started feeling overwhelmed and I wasn’t dealing with what I needed to deal with. I needed help.”
As a nurse, Benty said she was familiar with the symptoms she was experiencing, but getting help can be an embarrassing step for a health care professional. That’s where Guthrie came in.
“You need to have a level of trust when you have mental health issues,” Benty said. “I have that with Tara, but it was enhanced because she didn’t just automatically refer me to a specialist.
“When Tara prescribed medication I had to let go, resisting the urge to look up the side effects. That’s a big step, because people with mental health problems can be ultra-paranoid, overthinking everything.”
Going for an appointment with Guthrie and learning that mental health diagnosis and treatment is now a part of her everyday practice was a big help, she said.
Benty’s mental health was affected by a physical condition.
“Any acute illness puts stress on one’s mental health,” she said. “Unfortunately, in this age of specialization, there have become fewer and fewer medical professionals who have a whole view of their patients. And the waiting lists for specialists are huge.
“I went to Tara with what I thought was just a physical illness, but she understood that I had a huge component of anxiety that needed to be treated. My physical problem turned out to be gallstones, but they were an incidental finding, and were not at all needing to be treated. The real problem was my anxiety/depression, which was causing stomach problems — digestion problems and constipation. Once the anxiety/depression was treated, the stomach problems went away and I still have my two gallstones.”
Benty said she advises anyone in a similar situation to make an appointment with a general practitioner.
“You are already probably so caught up in your situation that it is much easier to talk to someone that you already have a relationship with. You need to understand that there is help available and that you need to engage with a level of trust before you can move on.
“Don’t be afraid to ask for help — you have to give yourself permission to trust.”
Having a physician who can diagnose and treat mental health issues can save time and reduce the added stress of being referred elsewhere.
“This is a good step for GPs,” Guthrie said. “I know it feels right for my own practice. I’m sure of that.”