The Ontario Medical Association (OMA) and Primary Care Collaborative have called for $37.5 million in immediate funding, as well as $75 million annually for 10 years, to help primary care providers treat patients with depression, anxiety, and addiction.
The recommendation is part of a four-point plan to strengthen mental health and addiction services in primary care doctors’ offices. Recent reports suggest that a third of Canadians are struggling with their mental health, yet they often face difficulties in locating care in their communities.
Dr Rose Zacharias
“Society is coming through a stressful global pandemic, and it’s hitting us all somewhat differently, which is contributing to a mental health tsunami,” Rose Zacharias, MD, president of the OMA, told Medscape Medical News.
“We know the scope of the issue is overwhelming, and the solutions are complex,” she said. “Patients should be able to come into a psychologically safe space to talk, and they need to be directed toward good care, where a family doctor has access to a team of mental health providers, counselors, and behavioral therapists, to point people in the right direction.”
The OMA announced the proposal on Oct. 3.
Providing Local Support
The OMA’s four-point plan urges the provincial government to invest in strengthening the delivery of mental health and addiction services. The plan highlights issues that are prevalent in Ontario, focusing on areas where primary care providers can make a difference with more support.
The funding would be used to embed mental health supports in interprofessional teams of primary care providers. These mental health experts would then offer treatment for moderate to severe depression and anxiety at the local level, rather than in hospitals that aren’t typically equipped to provide specialized mental health support.
“About three-quarters of Canadians rely on their primary care provider to treat their mental health needs, especially in communities where there are no or few mental health specialists or wait times are long,” Zacharias said.
The plan also recommends that the Ontario government expand Health Connect Ontario, formerly Telehealth, to allow primary care doctors and their patients to better navigate the mental health system. This expansion could prevent unnecessary emergency visits and delays in care, OMA said.
In addition, the plan suggests expanding access to supervised consumption and treatment sites, as well as other evidence-based harm reduction programs, for substance abuse and addiction. Since the onset of the pandemic, the rates of emergency medical services for suspected opioid overdoses have increased by 57%, and the rates of fatal opioid overdoses have increased by 60%.
During the pandemic, one in four Ontarians who died due to an opioid overdose had an interaction with the healthcare system in the week before their death, which suggests missed opportunities for overdose prevention, OMA said. Supervised consumption and treatment sites could create multiple points of contact with healthcare staff, social workers, and other mental health professionals in the community.
“Family doctors are chronically underequipped to handle their patients’ mental health concerns in 10-minute visits,” Zacharias said. “We want to equip and empower primary care providers to care for mental health, wrapping around them a team of mental healthcare providers so the entire team can care for our patients.”
The four-point plan also calls for the implementation of an indigenous-led mental health and wellness strategy to address the health inequities and challenges among the indigenous community. Throughout the pandemic, indigenous people with chronic conditions have faced higher risks for poor physical, mental, and social outcomes than other Canadians.
Several major factors lead to these greater risks among the indigenous community, OMA said, including low income, food insecurity, disrupted family dynamics, lack of immediate and ongoing social support, and increased substance use.
“If we call ourselves a province and country that care for everyone equally, we need to look where care is lacking and address gaps intentionally,” Zacharias said. “We’re not caring for our indigenous neighbors well.”
The OMA recommends specific strategies, such as incorporating traditional health and wellness practices throughout primary care, investing in indigenous-led mental health and addiction programs, recruiting and retaining indigenous healthcare professionals, addressing barriers for indigenous students who want to enter the healthcare field, and requiring mandatory cultural safety training for healthcare professionals.
The recommendation calls for the Ontario government to implement the four-point plan across the province, which could ripple into nationwide action.
Concerns Remain Elevated
“The Mental Health Commission of Canada is happy to hear Ontario Medical Association’s call for new funding to help primary care providers treat patients with depression and anxiety through team-based care,” Mary Bartram, PhD, director of policy, programs, and priorities for the Mental Health Commission of Canada, told Medscape Medical News.
Mary Bartram PhD
Bartram, who wasn’t involved with the OMA recommendation, has led mental health and substance use policy development and implementation with federal and territorial governments, indigenous organizations, and nongovernmental organizations.
“Mental health and substance use concerns have remained elevated in all provinces throughout multiple waves of the COVID-19 pandemic, but fewer than one in three people with current mental health concerns are accessing mental health services,” she said. “We need all hands on deck, including team-based primary care and increased direct funding for psychotherapy from governments and workplace benefit plans.”
Créditos: Comité científico Covid