Evidence:

Dr. Jack Haggarty, the lead psychiatrist of Shared Care/Collaborative Care in Thunder Bay and District, has conducted on-going research and program evaluation since its inception. He has found that:

patients receiving short-term therapy and psychiatric consultation in a Shared Care setting may show significant, sustained improvement in mental and physical functioning;
Shared Care increases access to care and decreases demand on existing mental health services; and
the Shared Care site provided services over 40 days sooner and helped to reduce wait times at the non-Shared Care sites. After the Shared Care program began, existing non-Shared Care services had wait times of approximately 13 days shorter than during the three subsequent years. The Shared Care service maintained the lowest overall wait times than existing non-Shared Care services. The existing services experienced a decrease in the number of days waiting when the baseline wait time was compared with that of the following year.

Haggarty et al. (2008). After Shared Care: Patients’ symptoms and functioning 3 to 6 months following care at a rural Shared Mental Health Care clinic. Canadian Journal of Community Mental Health 27(2): 47-54.

Haggarty et al. (2012). Wait Time Impact of Co-Located Primary Care Mental Health Services: The Effect of Adding Collaborative Care in Northern Ontario. Canadian Journal of Psychiatry 57(1): 29-33.

Gaylord et al. (2015). Introducing Shared Mental Health Care in Northwestern Ontario: An analysis of changing referral patterns of primary care providers. Canadian Journal of Community Mental Health 34(2): 63-72.

Find more evidence

St. Joseph’s Care Group (SJCG) in Thunder Bay wanted to strengthen its Collaborative Care model of practice - a model of mental health care developed in partnership with family physicians and local family health teams to improve access and reduce wait times for specialist mental health services that places clients at the center of their care.

By implementing Collaborative Care (formerly known as Shared Care) in the Northwestern Ontario, SJCG’s goal was to better serve mental health patients by streamlining access to, and incorporating specialized psychiatry services within a primary care setting. The model is designed to ease the burden on the mental health care system while improving the ability of primary care providers to provide mental health services to their patients. Primary care providers would have timely access to consultation, direct and indirect service and education from a psychiatrist and mental health nurses.

However, due to the expansion of the program, enhancements were necessary to ensure effectiveness and efficiency.

What are we doing about it?

SJCG approached the CAMH PSSP Northwest Region team to assist in increasing the efficiency of the Collaborative Care program.

Using an Implementation Science lens, PSSP assisted by offering a neutral sounding board and providing resources specifically aimed at implementation support and coaching; conducting key informant interviews to better understand the program’s context, potential gaps and barriers; and proposing solutions.

The result has been a collaborative effort incorporating specialized psychiatry services within a primary care setting, which evidence shows can improve the system and focus on patient centered care by focusing on the following key elements:

Accessibility;
Structures and systems which support collaboration;
Client-centered care;
Common goals and language;
Interdisciplinary teams and coordinated care; and
Improved continuity of care.

This means that patients requiring mental health services will now be able to access more timely services in a more navigable system. Incorporating specialized psychiatric teams offering mental health services from a primary care setting will alleviate some of the hurdles currently faced by patients. With a psychiatrist and mental health nurse working directly with family physicians, several direct pathways will now improve access to mental health services, including direct client service, indirect client service, and external referrals.

The Collaborative Care model works because these specialized teams are able to have a psychiatrist complete assessments and diagnose the patient, then have the physician provide the follow-up care with support from others on the psychiatric team.

An added benefit of the Collaborative Care model is that it creates in-situ mental health education opportunities for physicians and other primary care providers to learn about different illnesses, medications, treatments, and evidence informed interventions.

Exploration
Installation
Initial Implementation
Full Implementation

?What's this?

Full Implementation

Patients requiring mental health services are now able to access timely services in a more navigable system. Incorporating specialized psychiatric teams offering mental health services from a primary care setting alleviates some of the hurdles faced by patients. With a psychiatrist and mental health nurse working directly with family physicians, several direct pathways now improve access to mental health services, including direct client service, indirect client service, and external referrals.

The Northwest PSSP team will stay connected with the program staff, and remain available for continued follow-up and support, if necessary.

Next Steps

Maintain ongoing communication with the program for updates and information sharing.

Who is involved?

CAMH PSSP Northwest Region
St. Joseph’s Care Group

CAMH PSSP

Improving the Collaborative Care Model

What is the system challenge?

What are we doing about it?

Exploration

Installation

Initial Implementation

Full Implementation

Next Steps

Who is involved?

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