Family Health Teams: Getting a Second (and Third) Opinion
Mental health concerns are among the leading reasons patients visit the family doctor’s office.
Having psychologists and other mental health providers work in collaboration with physicians can help patients get the quality care they require.
In an interview with Mirisse Foroughe, a clinical psychologist at Summerville Family Health Team (SFHT) in Mississauga, Ontario, The Trauma & Mental Health Report learned about FHTs and the family physician’s role in providing mental health care to patients.
Q: So what are Family Health Teams?
A: FHTs are a new approach to health care provided in a community health care center, through a team of family physicians, registered nurses, and other Interdisciplinary Health Care Providers (IHPs). Each team is set up based on local health and community needs, and focuses on chronic disease management, disease prevention, and health promotion.
Q: How can someone become a patient at a FHT clinic?
A: New patients enrol with one of the physicians working in a FHT setting. Patients gain access to the services available to them at that particular FHT. Parents can enrol their children in a FHT, without becoming patients themselves.
Q: How do FHT physicians differ from traditional family physicians?
A: Unlike traditional settings, FHT physicians have direct access to a team of health care professionals to provide services to their patients. At our site, family physicians can consult with and refer patients directly to nurses, social workers, dieticians, psychologists, clinical pharmacists, psychiatrists, nurse-practitioners, and health care promotion specialists. These IHPs can also refer patients amongst one another.
All patient records are kept on a common electronic medical chart, allowing for instant access to information and continued collaboration between all team members.
Q: Under what circumstances would a physician decide to refer their patient to a psychologist, psychiatrist or social worker?
A: There are a number of possible scenarios that may lead to a referral being made. A physician may see a child at an annual physical, and notice that he or she is displaying signs of possible depression or they may have a patient reporting their first panic attack, or wanting to lose weight or stop smoking. Of course, patients themselves may ask to be referred to a particular IHP.
Q: After receiving a referral from their physician, how do FHT patients get into proper treatment?
A: Most people trust their family doctor. For patients likely to take a help-rejecting stance, having their family physician tell them bluntly that they need help to stop smoking, or to deal with their child’s panic attacks, or see someone about their marital issues, can make all the difference. Physicians know the IHPs personally; patients may feel more comfortable to try a session even if they are reluctant or unsure. More than anything, prevention and early intervention have to do with early identification as well as trust and willingness to accept help.
Q: How do FHT’s differ from outpatient clinics and private practices?
A: The biggest difference between FHTs and private practice is that the IHPs design their roles and set up their practices within the FHT and don’t have to refer out, unless needed. This allows practitioners to respond to the needs of individual families in ways that are difficult in traditional settings.
For example, a teen anxiety group can be set up if there are a number of referrals coming in with similar presenting problems or a priority consult with a specific specialist can be offered for patients requiring closer attention when the waitlist is growing. This gives patients the opportunity to be seen almost immediately after the original referral.
Q: What are the greatest advantages that FHT’s have over other health care models?
A: From my perspective, after working in traditional settings including hospitals, mental health agencies, school boards, and private practice settings, FHTs are at a distinct advantage because of the level of close collaboration possible between mental health care providers and family physicians.
More than any other health care professional, family physicians have an ongoing relationship with their patients. This involvement over time, and the often intimate knowledge of the patient’s life events, extended family, and overall health and well-being, is highly valuable to IHPs beginning to work with a patient. Family physicians are in a position to share information with IHPs that would not be readily available to them otherwise.
Q: From your experience with FHT’s is there a mental health care professional that’s missing from these services?
A: There is definitely a need for greater representation of psychologists at FHT settings. Out of the more than 200 FHTs across Ontario, there are fewer than 15 with a psychologist on staff. Even among these, the majority of psychologists are working only a day or two a week and are not offered full-time positions. Summerville FHT is an exception to this rule, as some of the physicians on the Board of Directors decided to fight for a full-time position for child and family psychology.
Part of the problem is that FHT physicians have to decide which IHP services to apply for, and it is up to the physicians or other members of a particular FHT Board to recognize the benefits of mental health care services and advocate for them.
When psychologists are brought into the health care model, their expertise comes to be highly valued by all members of the team, as well as by the patients.
For more information on FHT’s please refer to the Ontario Ministry of Health and Long-term Care.