Dr Andre Van Wyk, family doctor | Langley, BC
Before I adopted PSP's adult mental health module, I used more of a “reach for the prescription pad” type of approach. You basically diagnosed—put a person in a box—and then prescribed the appropriate remedy as it is known in that box, which leaned towards more pharmaceuticals. In my community it’s almost impossible to get a psychiatric appointment, so often, that’s just not an option.
One of the biggest barriers is stigma. And you only get rid of stigma by normalizing mental health and by engaging people on a person-to-person basis. That hasn’t always been possible in health care because traditionally, it’s been more pharmaceutically-driven. But with mental health, often the provider is part of the prescription.
This training has opened the landscape to allow us to see the person as a self-supporting human being. Not so reliant on the limited tools at a physician’s disposal, but instead on an alliance between the professional and the patient as a team, and on managing mental health on a sustained basis—not on an episodic basis.
One of the interventions is the “diagnostic assessment interview” which is very comprehensive. You start working with the patient using some of the cognitive behavioural intervention skills. But you don’t need an hour or two—which is a fear for physicians. You utilize tools that build on each other over time.
Our MOAs are trained to do some of the pre-work to cut down on the time we need to engage. It’s not unusual for me to walk into a visit and the patient has already completed the screening interventions. The MOAs organize commonly used tools, so I don’t have to go looking for them. And they are sort of an extra pair of eyes to look for potential mental health cases, because GPs don’t always know who has the problem. Patients don’t often present to say, “I have anxiety, I have depression.” But five to twenty per cent of people in their lifetime will have something.
Some of the tools help detect conditions that are right in front of you. For instance, I had been unaware of patients with post-traumatic stress disorder because it didn’t appear on my radar; or with bipolar disorder because I just wasn’t seeing it.
It’s still challenging. Any time you want to engage another human being, it’s an investment and you can’t formulize it. But being equipped with good tools certainly facilitates a more effective and efficient use of time.
And it creates a different level of relationship between the doctor and patient. The patient feels listened to; their issue is acknowledged and they have more wraparound care. Not just, “here’s a pill, goodbye.” It creates trust that is difficult to come by otherwise. Patients are getting a more comprehensive approach to their mental health issues than before.
I’ve had lots of cases. And patients whose life trajectory has changed. One had fallen out of society, was unemployed and into drugs. He has turned that around and is gainfully employed, owns his own house with his partner, and is on the right path to success. I credit [the module] with that.