Modern medicine is a wonder, yet conditions like heart disease, cancer, chronic lung disease and diabetes remain the top killers of Canadians. This is because we haven’t been able to bring the interconnectedness of mental and physical health to life in medical practice.
Lifestyle behaviours such as smoking, diet, physical activity and mental-health concerns like stress, anxiety and depression heavily influence our physical health but have gone essentially unaddressed in our current health-care system. People are now sicker, sadder and more anxious than ever.
COVID-19 has highlighted just how vulnerable we are, both mentally and physically. Data from the Canadian National Public Health Office showed that 92 per cent of all people hospitalized with COVID had at least one underlying chronic health condition. And marginalized, racialized people who may not have the money or means to access things like private mental-health services are the ones who suffered most.
Family doctors are our primary point of contact for almost every mental or physical health issue. But our family doctors are overburdened and burnt out as they don’t have the time or resources to manage these issues effectively and on their own. Psychologists can help.
In April 2021, the NDP government announced that they were making the largest investment in mental and behavioural health as well as primary care in B.C.’s history over the next three years. Now they have to decide how to best invest the money. The well-being of all of us depends on our government directing this funding toward programs that are evidence-based and sustainable. On September 2, the B.C. Psychological Association presented to the Select Standing Committee on Finance and Government Services, asking for funding to be specifically allocated for psychologists to become a part of the primary care system.
Psychologists can work in family doctors’ offices side-by-side with physicians, providing brief (15-to-30-minute) consultations with patients while they’re being seen by their doctor, and this treatment is incredibly effective. They can also conduct diagnostic assessments.
Thousands of health-care centres in the U.S. and across the world, including the U.K. and New Zealand, are using Integrated Primary Care successfully to benefit people. Patients are healthier physically and psychologically, physicians are happier, and the health-care system and economy save money.
This model has already been successfully trialed in B.C. It involves psychologists working in family practices, seeing patients in the same rooms where they see their family doctor, and doing brief real-time assessments to help provide immediate same-day care. They specialize in understanding how cognitive and behavioural factors impact the management of chronic health conditions. Unfortunately, due to tight budgets and inadequate funding structures, almost no one is receiving this kind of care here in B.C.
One exception: The Burnaby Division of Family Practice. They hired two psychologists to develop an Integrated Primary Care program called B Well, which
uses an evidence-based model to help patients make small changes in their overall health and well-being. Since its launch in October 2020 (yes, during COVID), patients have significantly increased their physical activity, improved their diet, and experienced significant decreases in anxiety and depression. Notably, this program is delivered by undergraduate and master’s level providers who are supervised by registered psychologists.
Placing psychologists in family doctors’ offices lets us bring to life our knowledge of how mental and physical health affect one another. We can showcase mental and behavioural health care at its best — evidence-based, accountable and regulated — and make our health-care system not just a national, but also a global leader.
Lesley Lutes is a professor and the director of the Centre for Obesity and Well-being Research Excellence at the University of B.C. Okanagan. She is also the co-director, Public Advocacy, at the B.C. Psychological Association. Erika Penner is a co-director of Public Advocacy at the BCPA. Simon Elterman is a behavioural health consultant at the Hope to Health Research & Innovation Centre (B.C. Centre for Excellence in HIV/AIDS).