Doctor shortage weighs heavily on mental health
Family physician is often vital to patients' treatment, Justin Bergamini writes.
The shortage of primary care physicians is frequently in the news. The often-overlooked harm to Canadian mental-health care caused by this shortage, not so much.
Yet, the scale of the problem is already acute — roughly six million Canadians are without access to primary care physicians — and if the Canadian Medical Association is right about the federal budget's impact on doctors' retirement plans, things will only get worse. Research finds that individuals with primary care physicians experience better mental-health outcomes. The importance of primary care physicians in mental-health care is multi-faceted, and it goes well beyond the obvious connection between one's physical and mental health.
For Canadians suffering from mental illness, their family doctor is often the first point of contact and serves as a gateway and guide to additional specialized care such as psychotherapists, psychiatrists, psychologists and neurologists.
During the acute period of an emergent mental illness, many will naturally turn to their family doctor. That critical first medical appointment can serve as an impromptu counselling session. Here the patient can speak of their struggles with a trusted professional and, depending on the nature of their condition, receive immediate care.
Importantly, while much of mental-health care operates in a fee-for-service paradigm, mental-health care provided by a primary care physician is covered by provincial health plans. Given the differential funding framework for mental-health care, for many Canadians their annual checkup may be the patient's only contact with a health-care provider to discuss their psychological well-being. Without this basic connection, many Canadians would be completely untethered from the health-care system.
A person's participation in psychotherapy is often the result of encouragement from their doctor. The physician is uniquely positioned to provide this encouragement, given the continuity of care they offer, built on a relationship that can span decades.
In some cases, psychotherapists collaborate directly with a primary care physician, to provide what is known as a “circle of care” — allowing multiple care providers to share their insights into the experiences and well-being of the patient, informing diagnostics, referrals and treatments. In other instances, a primary care physician will determine that psychiatric medication is an appropriate treatment. The physician can monitor the patient's experience with the medication and make changes as necessary.
Compare this to the experience of someone without a family doctor. They are left to wait in line for hours in the hope of being seen at a walk-in or emergency clinic. There they are faced with the prospect of disclosing deeply personal and often troubling information to a complete stranger they are unlikely to ever see again.
If psychiatric medication is prescribed, they are often on their own: no monitoring of efficacy or side-effects. If changes need to be made to their prescription, they need to get back in line.
We know that ease-of-access to health care is associated with accessing care. For every person struggling with mental illness without a family doctor who attends a walk-in clinic, there are others who will not access care at all; slipping through the cracks of a broken system, feeling abandoned and unsupported.
Moreover, having a family doctor can be a prerequisite for receiving mental-health care. Psychotherapists have been known to turn down a potential client if they lack a family doctor. An already overworked clinician may not be able to take on the role of being the sole care provider for a high-need, high-risk client. That decision, while never taken lightly, is based on the reality that certain clinical issues pose higher risk for emergency intervention, hospitalization, offending behaviour and suicide.
Following the tabling of the federal budget, a chorus of voices rose to signal concerns about its impact on everything from innovation to economic competitiveness. The Canadian Medical Association, for instance, says the Liberals' proposed changes to capital gains taxation may endanger doctors' retirement savings. Because of its impact on physicians' retirement plans, the budget's most serious unintended consequence could well be damage to Canadians' mental-health care.