Published on April 6th, 2017 | from CAMH
PARTNERs in mental health: How our project is helping people with depression
By Salaha Zaheer, Mental Health Coach, PARTNERs Project
“Why can’t you just snap out of it?”
These are the questions my patients get asked by family members. Although we’ve made great strides in the mental health field, there is still a lot of stigma people with mental health disorders have to face.
Recently, WHO published that depression is the leading cause of disability, and this is likely also why WHO’s World Health Day is focused on depression this year. Despite the high prevalence and debilitating impact of depression, there is a stigma associated with getting help. When a person does decide to get help, sometimes they have to wait for months to see a psychiatrist or start therapy.
Introducing the PARTNERs Project
This is why innovative mental health initiatives like the PARTNERs project can address this gap, allowing people to access services while maximizing the use of resources and potentially reducing healthcare costs. The PARTNERs project uses mental health coaches, bachelor level providers receiving supervision from a project psychiatrist, who provide support over the phone.
I’m proud to be a Mental Health Coach (MHC) with the PARTNERs project.
As a mental health coach, I have witnessed first-hand how this project can address barriers to getting help in addition to improving treatment outcomes. I have patients tell me that they are “too embarrassed” to get help from a mental health hospital and this project provides support through doctors, with whom they already have an established relationship. Furthermore, offering support over the phone makes it very convenient for people who are unable to travel for their appointments but can fit these follow-up calls during their lunch hour at work. This also helps people with mobility issues or people in rural areas who have limited access to resources.
In addition to these benefits, the anonymity of the calls also make it easier for patients to disclose sensitive information which they may not have shared with doctors, including instances of self-harm or suicidal ideation. There have been cases where a patient has informed me about having suicidal ideation and thinking about methods to harm themselves.
As part of our project, we take patient safety very seriously. When a patient endorses suicidal ideation, we assess the level of risk by asking follow-up questions. Before ending the call, we remind patients about ways to get help (i.e. calling their local distress centre number, calling 911, going to the nearest Emergency Department).
Depending on the severity of their suicidal ideation, follow-up actions are taken, including contacting the project psychiatrist or patient’s doctor or providing these details in the next patient report. There have been cases where the doctor has reached out to the patient after our call and booked an appointment for the following day. Similarly, we report self-harm episodes to the doctors and provide patients with strategies to mitigate harm (i.e. snapping on an elastic band, putting a bag of frozen peas on their head).
How it works
My role as a mental health coach is to promote the self-management of depression symptoms, anxiety and at-risk drinking. I follow my patients on a regular basis, starting with weekly calls lasting from 20-30 minutes, and depending on patient’s progress, we switch to bi-weekly, and then monthly calls. I meet up with our project psychiatrist every week to discuss my patient calls during supervision. Based on these discussions, the psychiatrist provides evidence-based recommendations which are shared with the patient’s doctor, who makes all the treatment decisions. Hence, my goal is to use patient activation to ensure that medication initiation and dosage changes are happening in a timely manner, which allows us to aim for remission.
An important aspect of the call is medication management, which involves making sure the patient is taking medications as prescribed and monitoring the benefits/side effects. Balanced with this, we also provide education on topics like sleep hygiene, deep breathing, mindfulness, physical activity, appetite, alcohol use, etc.
Using motivational interviewing techniques, I set goals with my patients around the areas they would like to focus on to improve their mental health. Patients find this exercise helpful as it builds their confidence to set their own goals and achieve them. The patients usually comment on how receiving this regular call makes them feel more accountable and serves as an additional motivation to reach their goals.
Hearing feedback from patients about the positive impact the project has made on their lives is truly rewarding and makes me happy to be involved in such an important initiative. The public health implication of this project is huge as it uses limited resources to manage patients with depression, which can alleviate the doctors and psychiatrists time to focus on more complex cases.
While stigma still exists, it is my hope that the work we do in the PARTNERs project will help alleviate feelings of anxiety people have when discussing mental health concerns. Whenever a patient tells me “I look forward to your calls”, I am reminded that our work is making a difference.
The PARTNERs project is supported by Bell Let’s Talk and the Medical Psychiatry Alliance.