2017 CFPC/CPA Collaborative Mental Health Care Award · 2020. 5. 2. · • 5.0 FTE Family Doctors...

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2017 CFPC/CPA Collaborative Mental Health Care Award Dr. James Felix

PRESENTER DISCLOSURE

Presenter: Dr. James Felix

No Relationships with commercial interests:

• Grants/Research Support: none • Speakers Bureau/Honoraria: none • Consulting Fees: none • Other: none

Department of Family Medicine

Department of Psychiatry

LEARNING OBJECTIVES

Department of Family Medicine

Department of Psychiatry

Those in the audience will 1. Understand the approaches to collaborative care

implemented at University of Victoria. 2. Understand the factors influencing their success. 3. Learn about upcoming webinars providing ways to

initiate these approaches.

April 2016 - March 2017

• 21,696 students enrolled at university • Clinic Staff

• 5.0 FTE Family Doctors – salaried via Island Health

• 1.2 FTE Psychiatrists (provincial billing) • 6.0 MOAs FTE – provided by university • 3.2 Nurses FTE – provided by university

• Family Doctors did • 20,561 clinic appointments • 5,432 mental health appointments (26%)

Rapid Access Appointments

• Nursing Triage • Mental Health Nurse • Family Doctors

Eating Disorders Program

• In conjunction with city program • Mondays • Coordinated and followed by MH nurse • Psychiatrist • Nutritionist • Counselling and psychology • Family Doctors

Attention Deficit Hyperactivity Disorder (ADHD)

CADDRA Adult assessment

• diagnostic interview, medical evaluation, parental corroboration and report cards

Scales • Adult ADHD Self-Report Scale (ASRS) • Weiss Functional Impairment Rating Scale – Self Report

(WFIRS-S) • ADHD Checklist • Weiss Symptom Record (WSR) • Wender Utah Rating Scale (WURS) • Barkley Deficits in Executive Functioning Scale - Long Form

(BDEFS-LF).

ADHD Group Workshop

9 sessions 1) What is ADHD? neurobiology, executive function,

medication Q&A (GP) (R. Barkley) 2) Lifestyle interventions- nutrition and exercise (RN and

Dietician) 3) ADHD and emotional regulation (registered counsellor) 4) Academic strategies and coaching tips (academic

coach)

ADHD Group Workshop

9 sessions (continued) 5-9) CBT Time Management Strategies (M. Solanto)

• Time awareness and scheduling • prioritizing and to-do lists • overcoming emotional obstacles • activation and motivation, organizational systems

implementation

Mental Health Appointments 2013

• Family Doctors • Psychiatry

• Ongoing Psychiatry follow up and Psychotherapy

• Psychiatric Consultations

• In March, 2014, a quarter of 981 patients seen by GPs in random 2 weeks had mental health needs.

• Average wait to see a psychiatrist was 46 days (up to 272 days) • 100% of staff dissatisfied with MH services Applied for funding

Psychiatric Interdisciplinary Team (PIT) Project at UVic $390,000

Funding for this initiative was provide by the Specialist Services Committee (SSC), one of four joint collaborative committees representing a partnership of Doctors of BC and the Ministry of Health

And the Psychiatrist Survey Says…

• In April 2014, 50% of psychiatric consultations could have been treated with less than a consult

• 40 patients on the waiting list • Team reviewed and allotted 36/40 for “pit

spots” • May 14, 2014 began four 30 minute “pit crew”

spots 3 days a week • Proved successful and we continued

And the Psychiatrist Survey Says…

• In April 2014, 50% of psychiatric consultations could have been treated with less than a consult

• 40 patients on the waiting list • Team reviewed and allotted 36/40 for “pit

spots” • May 14, 2014, began four 30 minute “pit

crew” spots 3 days a week • Proved successful and we continued

43 35

23 15 12 11 10

05

1015202530354045

2013 2014 2015 2016

Avera

ge D

ays W

ait

Consultations

Pit Appointments

* transition year

New Pit Appointments Significantly Reduced Psychiatry Wait Times

27 26

7

24

0

5

10

15

20

25

30

35

January 20131.4 FTE

January 20141.4 FTE

January 20160.9 FTE

Num

ber o

f Pat

ient

s S

een

Pit Appointments

PsychiatricConsultations

More Patients Seen By Fewer Psychiatrists

PIT effect and ADHD consults

UCL

LCL 0

2

4

6

8

10

12

Jan-

13 feb

mar apr

may

june july

aug

sept oc

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n-14 fe

bm

ar apr

may

june july

aug

sept oc

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n-15 fe

bm

ar apr

may

june july

aug

sept oc

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n-16 fe

bm

ar apr

may

june

Number

of Consults

for ADHD

PIT Starts

Full Time Mental Health Nurse

1. Care coordination 2. Support patients in crisis 3. Eating Disorders Program 4. Managing Emotions Program 5. Liaise with profs, families, counselling,

residence, learning resource, hospital, and various other community players

6. Crisis management

In-House CBT for Anxiety and Depression (not seen by Psychiatry)

1st Year: • 191 patients seen in 800 sessions –

average = 4.2 sessions per patient • Patients had 11 illnesses – 58% had 2 or

more • 41% on one medication, 23% on 2 or more • Therapist spoke to a physician twice per

patient on average

x

UVIC Managing Emotions Program • Approximately 1 hour, offered monthly • Overview of symptoms, causes, Borderline Personality

Disorder, PTSD, diagnosis, treatment • Distribution of intake packages

Information Session

• Referral from family doctor • Approximately 1 hour with MH Nurse • Completed intake package review and eligibility assessment • Deposit for Foundations of Managing Emotions Module

Intake Appointments

• 6 sessions – 1 hour and 45 minutes each, offered each term • Introduces: Mindfulness, Distress Tolerance, and Emotion

Regulation

Foundations of Managing Emotions Module

• Modules are independent – participate in any order • 6 – 1 hour and 45 minute sessions per module • Different modules offered throughout the year

Advanced Managing Emotions Modules

Distress Tolerance May 2016

Mindfulness and Establishing Identity

October 2016

Advanced Managing Emotions

Healthy Relationships

Ready to move on

73

5 4

72

27

Mental Health Appointments (2017)

• Family Doctors • Pit appointments • Mental health appointments

• MH Nurse - Interim follow up • CBT (8 sessions for depression or anxiety) • Psychiatry

• Ongoing Psychiatry follow up and Psychotherapy • Psychiatric Consultations • Pit appointments

Mental Health Groups

• ADHD • Collaboration with Counselling groups • Managing Emotions

Original Care Pathway

Victoria Withdrawal Management Services

(250) 213-4441

ADHD Group Clinic

Intake Mental Health Nurse

Yes

No

Emerge

nt care?

Refer to Early Psychosis Intervention

(EPI) (250) 889-4270

If criteria met, refer to

Mental Health Counsellor

Refer to Urgent Short Term Assessment and Treatment (USTAT)

(250) 213-4400

Yes

No

Urgent

care?

Mental Health Nurse

Rapid Access Appointment with Family Doctor /

Urgent Care Doctor of the Day (DOD)

Treatment with Psychiatrist

Scheduled Appointment with Family Doctor

who will provide treatment

Diagnosis

Non-

Urgent

care

Yes

Call 9-1-

1

Campus Security

(250) 721-7599

Refer to Psychiatric Emergency Services

(PES) (250) 519-1528

Refer to Integrated Mobile Crisis Response Team

(IMCRT) (250) 361-5958

1 pm -

Midnight

Mental Health Care Pathway for University Health Services and Island Health

Rapid Access Triage Nurse

Complicated

Schedule a pit appointment

Consultation with

Psychiatrist

Substance Use & Addictions

Psychosis Pervasive

Developmental Disorders

Personality Disorders

Managing Emotions Program

ADD & ADHD

Eating Disorders

Eating Disorders Program

ADHD Protocol

Funding for this initiative was provided by the Specialist Services Committee (SSC), a joint collaborative committee of Doctors of BC and the BC Ministry of Health.

Anxiety Disorders

Affective (Mood)

Disorders

Refer to Vancouver Island Crisis Line

1 (888) 494-3888

Before 1pm

After

Midnight

54 Mental Health Team Members

Funding for this initiative was provided for by the Specialist Services Committee (SSC), a joint collaborative committee of Doctors of BC and the BC Ministry of Health,

VIHA and University of Victoria

www.pitproject.ca

Psychiatric Interdisciplinary Team (PIT) Project

Contact Information

Dr. Marilyn Thorpe (project lead) drmarilynthorpe@gmail.com Dr. James Felix (presenter, mental health co-

lead) jfelix@uvic.ca If you are interested in our July webinars, www.pitproject.ca

Thank you!

Questions?