The development of our Mental Health Program began in early 2021 with the aim of improving the patient experience and providing comprehensive support for those in need.  

After evaluating our previous contractor-based model, we identified several areas of improvement that would become the core principles of the new program:  

• Flexibility for patients was an essential requirement for our Mental Health Program. We determined a fully remote model would allow for increased patient access — allowing them to book with their psychologist on any day of the week.  
• Our psychologists would offer evidence-based psychotherapy with no predetermined appointment limitations, — allowing patients the time and resources to successfully navigate complex mental health concerns.  
• The Mental Health Program Manager would be a mental health professional with the expertise and experience needed to successfully lead and develop the program.  

The first milestone in this development process was the hiring of our first internally employed Registered Psychologists in February 2021. The title of our mental health providers officially became Primary Care Registered Psychologists (PCRPs).  

The next milestone was the hiring of our Mental Health Program Manager in November 2021 — a Registered Psychologist who would be instrumental in guiding the future of the program.  

In December 2021, our contracts with the external providers officially ended. Our Mental Health Program Manager expanded the recruitment process to build a team of Registered Psychologists who would provide therapy for patients within the new model.  

To supplement the support offered by our psychologists, we continued to develop and strengthen our connections with specialized community resources that could provide support to our patients with complex mental health needs or schedules that required evening or weekend hours.  

In the early days of the program, our psychologists would receive a list of referred patients from their assigned member clinics. They would then personally contact those patients to determine if an appointment was suitable, provide self-management resources, and book an appointment with the patient if appropriate.  

It was quickly identified that this referral process was not effective or efficient. The administrative tasks required of our psychologists reduced the time they could reserve for patient appointments — ultimately working against our primary goal of providing accessible and timely care. We also saw a spike in wait times, with some patients waiting almost three months for their appointment. 

Our Mental Health Program Manager conducted literature reviews regarding referral models in primary care systems to determine which method would be the best fit for our PCN and patients. After careful research, several updates were made to our referral system to improve patient access and maximize psychologist availability:  

• An appointment coordinator was added to the team. The appointment coordinator contacts patients to book a time for them to speak to a psychologist for their initial consultation. This step allowed patients to schedule their intake consultation for a time when they were comfortable discussing potentially sensitive concerns.  
• Two psychologists were hired to dedicate most of their time to speaking with patients for their initial consultations, with support from the rest of the PCRP team, to help manage overflow. During the initial consultation, PCRPs would work with patients to determine their needs and personal preferences for treatment.   

After being referred by their primary care physician, our finalized patient referral process follows three steps:  

1. Patients will be contacted by the Mental Health Program appointment coordinator to book a time for an initial consultation with a PCRP. 
2. Patients will speak with a PCRP within 14 business days for their initial consultation. During this appointment, the patient will work with the PCRP to determine which resource would be the best fit for them based on their needs and preferences. 
3. Depending on the patients’ needs, they may be referred to either a community resource or to a PCRP for therapeutic sessions. All referred patients will also receive self-management resources. 

A six-month review of the mental health referral process was completed. This evaluation provided insight into whether the new referral program was improving wait times and efficiency. The review also investigated the relationship between patient distress level and referral outcome. This review found:  

• Most referred patients reported medium to high distress levels. Very few referred patients indicated low distress levels, meaning our physician members were appropriately referring patients to our program who needed it most.  
• The updated referral process was more effective in referring patients to the most appropriate CWC PCN or external community resource. This reduced wait times for our PCRP appointments and ensured patients were connected with the best possible treatment option for them.   
• A reduction in administrative tasks helped reduce the stress levels of our PCRPs and allowed them more time to complete their tasks and provide care to patients.