Nurses at the St. Albert and Sturgeon Primary Care Network are taking a new approach to how they treat mental health cases.
Now trained as behavioural health consultants, nurses can sit down with patients who need help managing mental health problems or the emotional aspects of chronic disease.
These problems can range from depression, stress and anxiety to sleep, obesity, chronic pain, diabetes, asthma or irritable bowel syndrome.
"Anything that causes any kind of stress – whether it be physical or emotional – is going to turn into a mental health issue if it isn't dealt with," said Shelley Porter, registered nurse and clinical mental health lead at the PCN.
"The goal is to try and catch patients in any area – it's not just mental health anymore. We want to prevent things from getting worse."
Five nurses at the St. Albert and Sturgeon PCN were trained as consultants last fall. They are now booking consultations with patients after referral from a primary care doctor.
Two other primary care networks in the Edmonton region are also using the model.
In 2013, the St. Albert and Sturgeon PCN saw approximately 2,000 mental health patients.
The goals of the new model are to improve patient experiences and decrease health care costs by preventing mental health problems and dealing with them early on.
New mindset
Behavioural health consultations are 30 minutes long, a sharp departure from the traditional hour to hour-and-a-half assessments.
"By the time we got to the education part, they were gone," commented Melanie Truckey, a registered nurse recently trained as a behavioural health consultant.
The process now focuses on getting to the point, not delving into a novel about the patient's past medical history, she explained. Deal with what they're coming in for and give them one or two strategies to work on, not a list.
One of Porter's patients came to the doctor with acid reflux. She believed her medication wasn't working.
After a short interview, Porter found out the patient was eating junk food late at night, a possible culprit for reflux. She recommended the patient keep a log of how she feels when she craves a snack. When she feels that way, Porter advised her to go water her plants or talk to a friend on the phone.
If patients are feeling unhappy, lacking motivation or something just isn't working in their life, they can talk to a behavioural health consultant about it, explained Porter.
If the problem is more complex they will refer you to a specialist.
Reservations
Both nurses and doctors were initially skeptical about how the new model would affect their patients.
They were hesitant the short consults wouldn't yield enough information about the patient. They were also doubtful about prescribing activities such as gardening for treatment.
"In our traditional assessments, we did what we thought was best. Whereas now, we're trying to be more patient focused," said Porter.
"A lot of times when someone is stressed, depressed or anxious they stop doing things they normally enjoy doing," added Truckey. "If you can get them back into doing things they enjoy, that will improve their mood."
Patients are also feeling more empowered since they are participating in their own treatment.
"If we look at it as a team approach – we have the doctor in charge of everything, but the patients have a lot of power too. If we can get them tapped into anything that allows them to take that control back, and find that momentum, we can build on it," said psychiatric nurse Tami Brodeur.
Alberta PCNs are planning to train other professionals – dieticians, psychologists and social workers – to become consultants under the model as well.
Behavioural health consultants are widely used in primary care settings in the U.S.
A 2011 study published in the Wisconsin Medical Society Journal found that a behavioural health consultation program in a community health centre improved patient care for depression. It increased patient engagement and decreased use of anti-depressants and specialist referrals.
