Mental health services in smaller Northern Ontario communities: A survey of psychiatric outreach consultants (2010)

The Ontario Psychiatric Outreach Program (OPOP) is funded by the Ontario government’s Underserviced Areas Program to provide clinical services through outreach, distance‐based clinical and support services via telepsychiatry, and educational services to participating communities. It also exposes undergraduate and postgraduate medical students to rural and remote practice settings.

Since OPOP was established in 1999, there have been several developments in mental health reform which have also influenced the delivery of mental health services. In response to an external review, OPOP partnered with the Centre for Rural and Northern Health Research at Laurentian University to conduct a research project to document the service delivery model(s) employed by OPOP. This report presents results from the research components focusing on psychiatric outreach consultants.

In this Research Report Round-up, we provide a summary of the report’s findings in a user-friendly format.

Title and link to report

Mental Health Services in Smaller Northern Ontario Communities: A Survey of Psychiatric Outreach Consultants

Authors

J.E. Sherman, R.W. Pong, J.R. Swenson, M.G. Delmege, A. Rudnick, R.G. Cooke, P. Ravitz, and P. Montgomery, Centre for Rural and Northern Health Research in Collaboration with the Ontario Psychiatric Outreach Program

Year/location

Sudbury, 2010

What is this report about?

The report examines the models of psychiatric care in Northern Ontario to identify opportunities for enhancing services provided by the Ontario Psychiatric Outreach Program (OPOP).  This program provides onsite services through specialty clinics and telepsychiaty services.

The report represents the result of a literature review, questionnaire, two focus group discussions as well as case studies that looked at:

  • Service delivery
  • Challenges in outreach practice
  • Collaboration and teamwork
  • Linkages with tertiary care centres
  • The OPOP model

Results are as follows:

  • Unlike other outreach providers (e.g., family physician or nurse practitioner) located in the community, most of the OPOP outreach consultants resided in Southern Ontario.
  • OPOP consultants based in Southern Ontario who provided services in the North had limited face-to-face interactions with community-based service providers compared with their northern counterparts that reported linkages with tertiary services. This impacted their referral patterns and their collaboration with psychiatrists in the North.
  • Most of the 34 outreach consultants who responded to the survey had provided care to the same Northern community over the previous 10 years, 25% were considering retirement in the next 5 years, and most said there was a lack of coordinated services between primary care and their outreach practice.
  • 65% of consultants reported working with the general population, 43% with the Aboriginal population, 35% with the Francophone population, 30% with seniors, and 22% with children.

    Other Findings:
     
  • 1 in 5 consultants had regular interaction with primary care physicians, in particular those in community health centres.
  • 89% of the consultants provided face-to-face direct clinical care (e.g., assessments). A small number said they provided in-person indirect care via telepsychiatry.
  • When consultants were able to work in partnership with community-based providers it increased their consulting capacity and they were able to see a greater number of patients.
  • Most outreach consultants preferred indirect versus direct clinical care; this was usually because indirect care requires less travel to hard-to-reach communities and  and shorter stays.
  • Most of the consultants were willing to work with family physicians but they were limited by a number of barriers: shortage of primary care providers and a payment mechanism that discourages collaborative activities,
  • Consultants were willing to provide training but they experienced several obstacles: 65% stated that there was lack of community interest, difficulty in arranging training opportunities, as they provided consultation during the weekends, and a need for administrative support.
  • Focus group participants said that greater linkages between the OPOP and regional services would improve the quality of services and provide opportunities to establish multidisciplinary outreach teams.
  • The most common OPOP model was the outreach to hospital and mental health services, with the on-going care left to community mental health providers, instead of physicians.

How can this report be used?

The report recommends the development of multidisciplinary outreach teams that could support Northern-based and visiting consultants providing psychiatric care. It highlights areas for consideration:

  • A need for greater coordination between consultants and referral centres;
  • Development of a tool to help prioritize patients and maximize the available time and expertise of the OPOP consultant in the community;
  • Incorporating telepsychiatry services to strengthen support services between visits by OPOP consultants by;
  • Ensure the models of care will work in remote communities and take into consideration the needs of rural communities; and
  • Create a psychiatric subspecialty to support visiting OPOP consultants.

Type of study

Mixed methods approach: literature review, survey questionnaire, focus group, and community case studies.

Population addressed

Rural and remote Northern Ontario communities

Contact person/source

Centre for Rural and Northern Health Research (CRaNHR)
Laurentian University, Sudbury, Ontario
www.cranhr.ca
cranhr [at] laurentian [dot] ca