Mental Health Initiative

The Mental Health Initiative set of incentives (G14043, G14044, G14045, G14046, G14047, G14048, G14049) support and compensates family doctors for the time and skill it takes to work with patients with mental health illnesses. Doctors develop care plans in collaboration with the patient and their support network and, where needed, become an active member of a broader care team in order to help those patients remain safely in their community.

The Mental Health Initiative in action

A long-time patient of yours comes in with her 35-year-old brother John, who has just moved from another city. He has brought his clinical records with him and needs a prescription refill. His past history includes bipolar disorder with situational anxiety, which is managed with lithium, an anti-depressant and an anxiolytic.

He advises you he has not had a lithium level in the past six months, and with the stress of moving is worried about his mental health. You confirm he is not at risk of harm currently and he is staying with his sister until he finds a place of his own. You send him for some baseline bloodwork, including a lithium level, arrange for him to come in for a 30-minute mental health planning session in two weeks and ask him to complete a take-home risk assessment questionnaire to bring to that appointment.

He returns at the scheduled time, your last appointment of the day, and you undertake a review of his Axis 1 diagnosis of bipolar disorder, review his risk assessment, and develop a plan for management of his mental health condition. The total time spent is 40 minutes. He agrees to come to see you on a monthly basis for the next three months, and that at that third visit, you will review the direction of the plan for the following time.

His lithium level was low, so you adjust his medication dose. Jointly you agree that he also needs referral to the local mental health team as he is having some adjustment anxiety with his recent move. You advise him that you will contact mental health directly to discuss the management plan you have jointly developed and that your office will call him in three days to follow up on how he is tolerating this change as well as to discuss any feedback from the mental health worker.

The mental health planning visit has taken 30 minutes to complete.
The following day you contact the mental health team and spend 10 minutes discussing the case and management plan for the patient. They will see him the following week, and when you contact the patient as agreed two days later, you advise him of this information, plus review his status.

Over the course of the year, John sees you on a planned pro-active basis monthly for the next three months, then every two months for the last six months of the year. The first three visits were counselling sessions of at least 20 minutes but the other two were regular visits. In addition there were two crisis intervention counselling sessions of at least 20 minutes, each with one follow-up phone call management. He is also attending at the local mental health clinic on a regular basis and you have had two  more telephone conversations with his therapist around his management plan related to the acute crisis intervention, each one lasting 10 to 15 minutes.