OPA Access to Care Initiative
In 2018, the OPA Council identified several priorities to address as strategic initiatives, one of which was access to mental health care and associated models of care delivery. We surveyed members of the OPA and OMA Section on Psychiatry this year for further direction on how to address this topic and received almost 200 responses.
There was widespread interest in various models of care to increase access, with no single approach being the preferred means. There was general consensus on several themes:
- A focus on stepped care models in which psychiatrists work with the most complex patients and provide ongoing care as needed – rather than one-time consults – while discharging those who are less ill. Many respondents wanted to highlight the broad-based role of psychiatrists incorporating both pharmacology and psychotherapy. In particular, the majority of survey respondents emphasized the continued relevance and need for various forms of psychotherapy provided by psychiatrists.
- A need to increase availability of community-based care in team-based settings, and to increase capacity of primary care providers to manage common psychiatric concerns
- A need for appropriate compensation for complexity and acuity of cases, funding for provision of indirect care and supervision of other care providers, and incentives for working in underserviced rural areas
With respect to team-based care, there was great appreciation for currently existing models such as shared care, reverse shared care; urgent care or bridging programs, rapid access clinics; early intervention programs, ACT and fACT teams; and collaboration with police through mobile crisis teams. Respondents also appreciated community outreach initiatives including programs for those without OHIP coverage and the use of telemedicine.
By and large, the majority saw the OPA’s role as that of being an advocate, especially through political means. Advocating to address psychosocial determinants of health including housing, disability income, social programming, and interventions to reduce high incidences of adverse childhood experiences were highly encouraged.
Our members confirmed our view of this being a complex issue requiring a multi-pronged approach. This Task Force is currently preparing a Position Paper for the OPA to add further voice to the need for systemic improvements. The OPA will continue work closely with the Coalition of Ontario Psychiatrists to advocate politically on issues relating to compensation models. The OPA Council will also consider further avenues of advocating. The "Access” Task Force welcomes ongoing input on how to increase access to appropriate and timely mental health care supports for all Ontarians.
The Canadian Psychiatric Association: Position Papers on relevant topics such as Collaborative Care, Psychotherapy, Indirect Services in Psychiatry, Psychiatric Resources Planning in Canada, and Wait Time Benchmarks for Patients with Serious Psychiatric Illness
Mental Health and Addictions Leadership Advisory Council: https://www.ontariominds.ca
Mental Health Commission of Canada. 2012. “Changing directions, changing lives: The mental health strategy for Canada”
Government of Ontario. 2011. “Open Minds, Healthy Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy”
Angela O. Ho, MD, FRCPC
Access Initiative Lead
Ontario Psychiatric Association