early detection and treatment of mental health and substance use/misuse issues in primary health...
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Early Detection and Treatment of Mental Health and Substance
Use/Misuse Issues in Primary Health
Primary Care Resources for Helping Patients with Mental Health and Substance Use/Misuse Issues
Development of Treatment Pathways, Protocols, Screening Tools
• Family Physicians see 130,000 people a year for 400,000 contacts for mental health and substance use/misuse issues.
• Primary Health Care is generally the first point of contact for individuals with mental health and substance use/misuse issues.
• The Ministry of Health in collaboration with Dr. David Brown and 3 Primary Health Care sites (Leader, Meadow Lake and Lloydminister) have developed and refined treatment pathways, protocols and screening tools.
Risk
• With respect to mental health issues, the resources here focus on mainly depression and anxiety. The focus in terms of substance use issues is on risky alcohol use, prescription medication misuse, and the use of illicit substances.
• It is useful to think of each patient as being at some risk level for adverse consequences from substance use or mental health issues. The purpose of screening is to triage patients into one of three categories: low risk, moderate risk and high risk. The purpose of different care pathways is to help patients move from a high risk to moderate risk, to move from moderate risk to low risk, or to maintain low risk.
Risk
• Typically, the largest share of a primary care patient population will be at low risk. Patients screened to be at low risk do not likely need any kind of intervention. However, they still can benefit from primary health care prevention and health education.
• A smaller share of the patient population usually will be at moderate risk. Patients screened to be at moderate risk do not likely need specialist-delivered mental health or substance use treatment interventions. However, evidence indicates that these individuals can benefit from primary care-delivered early interventions. In the case of substance use issues, brief motivational interviewing (BI) approaches are shown to be effective. In the case of mental health issues, brief cognitive behavioral therapy (CBT) approaches are shown to be effective.
Risk
• This moderate risk group is larger than the high risk group and therefore has the larger burden on the health system at a population level. Since primary care-delivered early interventions are quite low intensity, they are a cost-effective upstream way of helping patients with moderate risk anxiety, depression and substance use.
• Individuals at high risk for adversities resulting from mental health or substance use issues tend to be the smallest share of the primary health care patient population.
• Patients screened to be at high risk from either mental health or substance use issues likely do need mental health or substance use treatment specialist intervention. Note that patients who screened at moderate risk for one of mental health or substance use issues and at moderate risk on the other should be treated as high risk on both.
Risk Categories and Corresponding Primary Care Clinical Responses
Risk-Based Clinical Practice Care Pathways
Care Pathway 1 (Patients at Low Risk)
Care Pathway 2 (Patients at Moderate Risk)
Care Pathway 3 (Patients at High Risk)
Healthy Living Questions - M
1. How often do you engage in vigorous physical activity for at least 30 minutes?
□ Never □ Monthly or less □ 2 - 4 days per month □ 2 - 3 days per week □ 4 or more days per week
2. How often do you use tobacco products?
□ Never □ Monthly or less □ Weekly or more
3. Over the past 2 weeks, how often have you felt under a lot of stress from things in your life?
□ Never □ Not often □ More than half the days □ Nearly every day
4. Over the past two weeks, how often have you been bothered by the following problems?
More than Nearly Never Some days half the days everyday
a. Felt nervous, anxious or on edge? □ □ □ □
b. Been unable to stop or control worrying? □ □ □ □
c. Felt little interest or pleasure in doing things? □ □ □ □
d. Felt down, depressed, or hopeless? □ □ □ □
5. How often do you usually have a drink containing alcohol?
□ Never □ Less than a day each week
_____ days each week
6. How many drinks of alcohol do you usually have on a day that you are drinking? (See the attached sheet for what counts as a single drink.)
_____ drinks each day
7. How often have you had 5 or moredrinks on a single occasion in the last year?
□ Never □ Less than monthly □ Monthly □ Weekly □ Daily or almost daily
8. How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?
□ Never □ Monthly or less □ Weekly or more
For more information contact:
Lorne SierCommunity Care BranchMinistry of Health
