New Stepped Care Pilot Aims to Bridge Gaps in Mental Health Services – Part One

The Barriers to Mental Health Care

This news story is part one of the series on the DET OHT Stepped Care Pilot and highlights challenges in doctors’ referrals and accessing individualized counselling and psychotherapy support.

Amid workforce shortage, accessing mental health support and services come with multiple challenges, including lack of one-on-one counselling and psychotherapy services tailored to individual needs, lengthy wait times, and timely referrals. According to the 2023 Ontario Association of Social Workers Survey of 1,265 adults, 10 per cent said that they tried but were unable to access mental health support. Their reasons for inaccessibility included long wait lists (60 per cent), high costs (38 per cent) and not having a referral from a family doctor (33 per cent).

Sara Al-Qasir, a mental health navigator with the Stepped Care Pilot and St. Michael’s Hospital Seamless Care Optimizing the Patient Experience (SCOPE) program, sheds light on the challenges.

Some local organizations are currently holding group counselling sessions. While that is a good option, many clients are looking for timely individualized counselling for their recovery.”

In her interactions with clients/patients, Sara has noticed that patients were not only managing challenges with depression and anxiety, they experienced additional stressors from financial barriers, transportation needs, cultural and language differences, and mental health stigmatization.

Clients/patients is not the only group facing accessibility challenges. Initial interviews conducted by the stepped care project team to understand family physicians’ needs revealed family doctors also face accessibility challenges when seeking counselling or psychotherapy services for their patients with anxiety and depression.

The considerable administrative tasks associated with seeking appropriate referrals often cause family physicians to handle them themselves, diminishing the quality of interaction between a family doctor and a patient.

By introducing a mental health navigator in the referral pathway, the stepped care model relieves some of the commonly occurring and significant challenges for both patients and family doctors, while also making effective use of the health system’s resources.

Sara mentioned the mental health navigator’s role having a four-pronged approach;

• Case management: Ensuring patients feel supported, developing care plans, following up every 2-3 weeks, and relaying information back to family doctors
• Brief-talk therapy: Ensuring clients can cope with distressing situations and routine challenges by talking to a trained professional while they wait for specialized care
• Customized care: Providing accessible list of resources tailored to the patient’s needs and circumstances
• Warm transfer: Assisting with a three-way call to support patients with completing intakes over the phone, allowing them to build confidence and trust newly found resources

Each step focuses on improving the quality of patients’ lives and adding value to the patient-doctor relationship.

32 family physicians, all members of the DET Family Practice Network and registered with the St. Michael’s Hospital SCOPE program, have enrolled in the pilot.

Participating physicians have collectively referred 243 clients to the mental health navigator, allowing the navigator to provide over 544 counselling sessions between April 2022 and October 2023.

While the project team continues to evaluate the impact of the pilot on patient experiences and outcomes, it is clear in the initial phase of the implementation that the pilot has allowed synergies between family physicians and the mental health navigator.

The project team aims to use their findings to inform the long-term growth and sustainability of the Stepped Care Pilot and similar programs. This will ensure that the positive outcomes not only benefit the local community, but also contribute to the broader mental health landscape.