Feb 2017

Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-related Risks and Functional Impairments Tool

Introduction

One in five Canadian adults experience a mental health or addiction problem. Identify, assess and manage risks for patients with diagnosed, undiagnosed or changing mental health conditions using the Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-related Risks and Functional Impairments Tool.

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Adult Mental Health

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Adult mental health: Keeping Your Patients Safe Tool case (Podcast)

In this podcast, our Keeping Your Patients Safe Tool's clinical leads walk us through a case study that demonstrates how the tool can support providers during a patient encounter, where the patient is exhibiting a undifferentiated mental health problem.

Information

About the Tool

Primary care providers (PCPs) can face a high degree of uncertainty when it comes to identifying and acting upon risks associated with signs, symptoms or behaviours that are suggestive of a mental health condition. Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-related Risks and Functional Impairments Tool aims to support and guide PCPs in appropriately assessing and managing a patient with risks or functional impairments, even in the absence of a diagnosis.

The tool gives primary care providers the ability to assess the type and severity of risk(s) through four main components:

  1. Investigate and identify key signs, symptoms and behaviours associated with risks or functional impairments
  2. Gauge the type, severity and time-sensitive nature of identified risk(s)
  3. Initiate appropriate referral to emergency department for further psychiatric assessment
  4. Initiate interventions such as mandatory and permissive reporting, non-pharmacological interventions or lifestyle modifications

Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-related Risks and Functional Impairments Tool was developed using CEP’s integrated knowledge translation approach. The Centre for Effective Practice (CEP) ensures that primary care providers are engaged throughout the tool development process through the application of user-centered design methodology. Clinical leadership of the tool was provided by Dr. Jose Silveira, Dr. Patricia Rockman and Dr. Leah Skory, along with a clinical working group. Clinical experts were also engaged to provide feedback on key processes and components relevant to assessing and managing risks associated with mental health conditions.

The Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-related Risks and Functional Impairments Tool is one of several resources developed as part of the 2014 to 2017 Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supported primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

As part of this initiative, the CEP conducted a Primary Care Needs Assessment to determine topics of interest to primary care providers. In this survey, providers identified the need for more effective resources to help identify and manage risks associated with mental health conditions.

The project team conducted a comprehensive literature search, and developed evidence-based guidance in partnership with the clinical leads and working group. Health care providers and other stakeholders were also engaged throughout the development process.

Clinical Lead

  • Jose Silveira

    MD, FRCPC, Dip, ABAM

    Dr. Jose Silveira is an Assistant Professor in the Department of Psychiatry at the University of Toronto; Psychiatrist-in-Chief at St. Joseph’s Health Centre in Toronto as well as Medical Director of Mental Health and Addiction Programs. He works closely with primary care physicians and has been on the steering committee of Ontario College of Family Physicians Collaborative Mental Health Network since 2000. He has been providing indirect consultation and support to them across the province of Ontario throughout this time as well. In addition, Dr. Silveira has served as a psychiatrist providing shared care with numerous Community Health Centres and Family Health Teams throughout his career.

  • Patricia Rockman

    MD, CCFP, FCFP

    Dr. Patricia Rockman is Director of Education and Clinical Services at the Centre for Mindfulness Studies in Toronto and is also Associate Professor in the Department of Family and Community Medicine at the University of Toronto with a cross appointment to Psychiatry at UHN. She has a focused practice in Mental Health, and was co-chair and founder of the Ontario College of Family Physicians Collaborative Mental Health Network. Dr. Rockman has also functioned as an educator, public speaker and resident supervisor for the last ten years.

  • Leah Skory

    MD, CCFP

    Dr. Leah Skory works as a family physician at the Barrie Community Health Centre, where she provides comprehensive primary care to all ages. She has practiced family medicine since 1997 and has worked in both private and group settings. She is a trained McMaster Problem Based Learning Facilitator, and is currently co-chair for the Ontario College of Family Physicians upcoming Mentoring Network annual conference.

Clinical Working Group 

In addition to clinical leads, a clinical working group comprised of a family physician, primary care nurse practitioners and a social worker oversaw the development of this tool. Members include:

  • Gwen Morgan, Social Worker
  • Joanna Dickinson, MSc, PHCNP, CPMHN
  • Jennifer Wyman, MD, CCFP, DABAM

Thank you to all providers who participated in the development of this clinical tool.

Target End User Feedback and Expert Opinion

resources

Additional resources

To supplement the tool, we have developed additional resources for clarity and assistance. Click below to download each resource.



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