UVic collaboration project eases treatment of mental illness

 

Watching a TED Talk by an American surgeon inspired a Victoria psychiatrist to pursue a more effective approach to treating mental-health patients at the University of Victoria.

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Psychiatrist Dr. Marilyn Thorpe is leader of UVic’s PIT project — Psychiatrist-led Interdisciplinary Team. The project is an approach at UVic Health Services in which family doctors and psychiatrists work collaboratively to deliver mental-health treatment.

Thorpe said that since it began in 2013, the team approach has dropped wait times for UVic students to see a psychiatrist from an average of 46 days to 11 days. It has also dramatically reduced costs.

Thorpe got the idea for PIT watching TED Talks in which Dr. Atul Gawande, an author, surgeon and public-health commentator, discussed the need for physicians to team up and work as part of a system.

Gawande said results and cost-effectiveness would improve if medical specialists worked together, the way pit crews service race cars, instead of applying their expertise one at a time.

Thorpe said she decided to start agitating for such a system when UVic Health Services looked about ready to crack. At one point, wait times went as high as 272 days, exceeding a full school term.

Meanwhile, it was becoming harder to keep psychiatrists, always in demand in Victoria, and 40 students were stranded on a wait list looking for help.

“We just felt, morally, we couldn’t live with that any longer,” Thorpe said.

Psychiatrists and family doctors started by going through the files of the 40 patients on the wait list.

Working together, specialists in mental illness and family doctors well versed in the patients’ unique histories decided 36 of the 40 did not require a full consultation with a psychiatrist.

The four who needed it quickly got a consultation with a psychiatrist. Less-specialized treatments, such as medication and talk therapy, were recommended for the remaining patients.

The UVic team then decided to try working collaboratively on all the students who showed up at the clinic with mental-health issues, Thorpe said. About 125 per week show up on average, which is typical for a university campus, she said

The collaborative team approach sees the patients being assessed initially with a 30-minute meeting.

That includes five minutes talking with a family doctor, followed by 20 minutes with the psychiatrist and family doctor to come up with a medical plan.

During the last five minutes, the family doctor prescribes any medications and discusses the treatment plan with the patient while the psychiatrist writes up the patient’s chart.

The approach satisfies most mental-health cases. If a full psychiatric consultation is required, that’s a different story, with a more intense series of discussions and tests. But even there, the wait time is now an average of only 21 days for UVic students coming to the clinic.

Thorpe said the morale and working conditions of the psychiatrists and family doctors had significantly improved. “It has hugely helped us all feel better about our jobs,” she said.

The professional benefit for the family doctors is the proximity to a psychiatric specialist to help develop an accurate diagnosis and treatment.

“Is this really a bipolar disorder or is it a personality disorder with depression on top?” said Thorpe. “Teasing out a diagnosis and a treatment, that’s mostly what people want from a psychiatrist.”

For the psychiatrist, the benefit of the team approach is having access to the family doctor. The family doctor usually has a longer history with patients and has already earned their trust. That can save enormous time for a specialist.

“It lets us all work better together,” Thorpe said. “We can tap into each other’s knowledge, rather than sitting alone in a little office seeing people once and then sending them away.”

Thorpe said the UVic clinic employs psychologists or counsellors who can conduct talk therapy and offer guidance, typically in about eight sessions. There is also a mental-health nurse, with another to be added soon.

Thorpe sees hope for the PIT approach in the wider community, where it can take as long as nine months to see a psychiatrist.

Too often, psychiatrists see mental-health patients for the first time when they are in a crisis and show up at a hospital emergency room.

Those moments of psychiatric emergency are difficult for everyone — doctors, nurses and patients.

“The patient is in a crisis, the psychiatrist has no access to the family doctor’s knowledge because it is 11 at night,” Thorpe said. “And the patient is frightened and has a hard time telling you the whole story. If we could get this [the PIT approach] into the community, we could prevent a lot of those people going to emergency.”

rwatts@timescolonist.com

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