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2017 CFPC/CPA Collaborative Mental Health Care Award Dr. James Felix
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
tno
vde
cJa
n-14 fe
bm
ar apr
may
june july
aug
sept oc
tno
vde
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n-15 fe
bm
ar apr
may
june july
aug
sept oc
tno
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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) [email protected] Dr. James Felix (presenter, mental health co-
lead) [email protected] If you are interested in our July webinars, www.pitproject.ca
Thank you!
Questions?
