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We applaud Mary Bartram for her analysis “Making the most of the Federal Investment of $5 billion in Mental Health”.1 While recognizing the dire need for publicly funded psychological services (available in other countries such as the UK and Australia), we share Bartram’s concerns about inequitable distribution of such services. We also add concerns about creating yet another silo in our health care system whereby psychological services operate independently of primary care and community-based supports important to patients.
Collaborative mental health care involves primary care providers, mental health specialists, patients and other allied providers working together in structured methods founded upon Wagner’s chronic care model.2 Collaborative mental health care has well-demonstrated effectiveness, cost efficiency, patient-centeredness, provider satisfaction, and has been shown to reduce disparities in healthcare processes and outcomes based on ethnicity and socioeconomic status.2-4 When provided via telemedicine and/or telephone, collaborative mental health care can also close the gap between urban and rural care.5
Lack of implementation of the collaborative chronic care model for mental health is a major failure in health care systems across Canada, perpetuating scarce and inequitable access to care and poor population health outcomes. The federal investment in mental health provides a tremendous opportunity to overcome the initial cost barrier to implementing collaborative care.
References
1. Bartram M. Making the most of the federal investment of $5 billion for mental health. CMAJ Can Med Assoc J J Assoc Medicale Can. 2017 06;189(44):E1360–3.
2. Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012 Aug 1;169(8):790–804.
3. Gilbody S, Bower P, Whitty P. Costs and consequences of enhanced primary care for depression: systematic review of randomised economic evaluations. Br J Psychiatry J Ment Sci. 2006 Oct;189:297–308.
4. Miranda J, Azocar F, Organista KC, Dwyer E, Areane P. Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiatr Serv Wash DC. 2003 Feb;54(2):219–25.
5. Fortney JC, Pyne JM, Mouden SB, Mittal D, Hudson TJ, Schroeder GW, et al. Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry. 2013 Apr 1;170(4):414–25.