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Improving Quality of Mental Healthcare by Family Physicians in BC and Unexpected Learnings about Stigma. Liza Kallstrom BSc, MSc, Content and implementation Coordinator for the Practice Support Program, British Columbia Medical Association
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by Family Physicians in BC and
Unexpected Learnings about Stigma
Liza Kallstrom BSc, MSc, Content and implementation Coordinator for the Practice Support Program, British Columbia Medical Association
Dr. Rivian Weinerman MD BSc(Med) FRCPC PSP Physician Quality Ambassador, Practice Support Program, British Columbia Medical Association, Associate Clinical Professor UBC
FP focus-best chance to affect most people early on
Local mental health clinic group
FPs’ patients not fully engaged in care planning, treatment decisions
Fear about not knowing what to do significant factor underlying physician discomfort/lack of confidence in treating mental health issues, and provider stigma- useful tools needed
****Weinerman R et al, Improving Mental Healthcare by Primary Care physicians In British Columbia. Healthcare Quarterly, 2011. 14:1, 36-38
Lifetime prevalence of
Major Depressive Episode: 12.2%
Past-year episodes: 4.8%
Past-month episodes: 1.3%
Source: Descriptive Epidemiology of Major Depression in Canada. Patten, SB; Wang, JL; Williams, JVA et al. Canadian Journal of Psychiatry; Feb 2006; 51, 2; 84.
Screen/assess for mental health disorders
Use 3 Supported Self Management cognitive behavioral therapy (CBT) tools
CBIS (Cognitive Behavioral Interpersonal Skills Manual)
Antidepressant Skills Workbook
Bill for mental health care services provided
Implement with patients with mild-moderate dep/anxiety, and use with other MH disorders and chronic stable SMI /chronic disease pts where depression/anxiety is comorbidAMH MODULE OBJECTIVES
PHQ 9, GAD 7
Using a proactive approach
All within the time constraints of busy family physician practices and fitting fee codes
Psychiatrists, Mental Health clinicians from each HA
Family Physicians are willing recipients of training when they are reimbursed to attend and the tools are extremely practical and fit within their time constraints
This module was extremely successful in changing Family Physicians practice and feeling they had:
This change in practice was sustained or improved at 3-6 month followup over time with various cohorts
Patients felt more comfortable and engaged
AIDs literature – AIDs patients stigmatized
Mental Health patients stigmatized
**Brown, L. Trujillo, L., Macintyre, K.; (2001)Interventions to Reducde HIV/AID Stigma: What have we learned?, Horizons Program/Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana,
***Clatney, L., MacDonald, H., & Shah, S.M. (2008). Mental health care in the primary care setting: Family physicians’ perspectives. Canadian Family Physician, 54,
Major insight evolved as physicians became more knowledgeable and comfortable/confident with the AMH training…..
And linking with the AIDs literature……
Realized -AMH training could lead to less avoidance and stigmatization of patients struggling with mental health problems.
Recent Mental Health Commission data on Module has shown that CBIS/ASW significantly decreased stigmatizing attitudes of physicians, residents after one day training by 10%- largest finding to date.
Used AMH as mental health training tool for
In urban rural or remote areas
For individual or group use
One language for all