We invited Linda Jackson, Senior Clinical Program Director for Community and Primary Care at Unity Health Toronto, to share her thoughts on some of the work underway in the DET OHT focused on mental health. Linda is currently Co-chairing the Oversight Committee of the Stepped Care Pilot at the DET OHT. In this discussion, she shares the significance of the stepped care model and how it can support both family physicians and their patients in accessing mental health services.
As a senior leader for Community and Primary Care at Unity Health, what can you tell us about the challenges that the DET OHT’s priority populations (people experiencing homelessness, mental health illnesses, and addictions) have to face to access mental health care?
There is widespread recognition of challenges among the general population in accessing mental health services, specifically counselling and psychotherapy. These challenges include difficulty in navigating organizations offering these services, long wait times, and a lack of funded or affordable services. Our priority populations experience even greater challenges, often not having the resources and supports to navigate a complex mental health system. This issue of navigating to mental health service has been identified by family physicians and nurse practitioners in the Downtown East area who frequently encounter patients presenting with mild to moderate mental health issues, including anxiety and depression, who require and would greatly benefit from accessing counselling and psychotherapy services.
In your opinion, what distinguishes the Stepped Care Pilot from other delivery models?
The stepped care model has leveraged an existing program called SCOPE to support family doctors and nurse practitioners to refer patients with mental health issues to a trained mental health navigator, who works with these patients to better understand the issues affecting their mental health and their readiness and interest for counselling and psychotherapy. Together, the mental health navigator and patient develop an understanding of the most pressing issues and the options available in the community. The navigator then ensures a warm handover by connecting to appropriate resources and staying engaged with the patient until they are linked to the resource or decide that they are not ready to pursue counselling at this time. For some patients, the opportunity to meet with the mental health navigator for initial exploratory sessions has been the intervention that was needed and they did not wish to link for further counselling.
What do you hope the stepped care model can accomplish for the mental health and addictions community of the downtown core?
The model has assisted primary care providers to link their patients to community based mental health services. It has likely prevented some patients from presenting to emergency departments for this type of navigation. The model has identified where gaps exist in accessing mental health services, which can be a focus for further planning within the DET OHT. Assisting the primary care providers in navigating resources allows greater access to other patients at a time when there are many pressures on primary care. This is particularly important for providers who do not have access to mental health services in their clinics.
Given the rise in mental health crisis, particularly after the COVID-19 pandemic, how can we support the long-term growth and sustainability of programs like Stepped Care Pilot?
The evaluation of this program confirms that patients and providers have benefitted from being connected to the stepped care model as well as the importance of collaborating across organizations to integrate care delivery. Addressing the gaps in the availability of affordable and fully funded mental health services, particularly with a trauma informed approach, should be a focus of the DET OHT to support the sustainability of this program.