My first exposure to a primary care clinic as a psychology graduate trainee happened by accident. I was looking for volunteer opportunities and stumbled across a student-run interdisciplinary medical clinic that was serving the inner-city youth of Edmonton. It was through that experience that I progressively learned more about primary care settings and working collaboratively with other healthcare professionals. The more I learned about psychology in primary care, the more conviction I found in the belief that primary care is an essential avenue for psychologists to advocate for the profession and the clients they serve. Here are the top five reasons why I believe every psychologist, whether they work in primary care or not, should advocate and talk about primary care psychology:
1) Primary care is the first point of contact for most Canadians experiencing mental health difficulties
Every year, 20% of Canadians are estimated to suffer from a mental illness or substance use concern (Smetanin, Briante, Stiff, Ahmad, & Khan, 2011). By age 40, about half of the Canadian population will experience or have had experienced a mental illness (Smetanin et al., 2011).
The Mental Health Commission of Canada (2017) clearly articulates that there is a “significant unmet need” for treatment and resources for Canadians experiencing and living with mental health difficulties. This unmet need is especially pronounced in accessing evidence-based psychological interventions and counselling services.
Most Canadians access support services for their mental health concerns through their family physicians. Approximately 50% of family physicians’ time is concerned with mental health problems and they are the single source of support in roughly 84% of individuals seeking mental health services (Chodos, 2017).
In a study exploring the attitude of Canadians towards psychologists and access to psychological services (Ekos, 2011), participants were asked if they decided to access the services of a psychologist how they may go about finding one. A staggering 78% of the participants identified going to their family physician to access a psychologist.
These studies leave little doubt that in the current Canadian mental health services landscape, family physicians in primary care settings are predominantly the first point of contact for Canadians seeking mental health services.
2) Medicine and Psychology are natural and complementary allies (Grenier & Chomienne, 2006)
Family medicine in Canada is faced with a growing demand for mental health resources while experiencing significant challenges in accessing appropriate consulting services (Peachy, Hicks, & Adams, 2013). Many physicians feel uncomfortable in providing counselling services themselves due to a number of factors including time constraints, inadequate mental health and psychological intervention training, perceived pressure to address physical health concerns and personal preferences (Chodos, 2017; Grenier & Chomienne, 2006).
This has led to a severe gap in addressing the needs of many individuals who require psychological interventions and counselling. Peachy et.al (2013) described the fragments and challenges in mental health service delivery in Canada as a “silent crisis.” Integration of psychologists in primary care settings can bridge the gap between demand for mental health services and challenges in accessing appropriate resources.
Physicians are interested in collaborative and interdisciplinary care of patients, and psychologists in primary care can offer patients the interventions and supports that are needed (Grenier & Chomienne, 2006).
3) Stronger together
As a psychologist who has worked on multidisciplinary teams since my early training years, I have had the privilege of witnessing first-hand the strength in advocacy for the best care of patients as a collaborative team.
Integration of psychologists in primary care allows for a sense of community on healthcare teams. We are no longer seen as a separate, fragmented service, but as a core component of a patient’s healthcare.
Therefore, when advocating for mental health services locally, provincially or nationally, the advocacy is far more effective when a much broader group of healthcare professionals are advocating for improving service delivery. Other healthcare professions including but not limited to medicine, nursing, and pharmacy are allies that can strengthen our advocacy efforts in improving the Canadian mental health system.
4) Primary care psychology increases the visibility of the profession
In addition to having other healthcare professional groups working as allies to advocate for the best care of patients, primary care psychology enhances the visibility of the profession of psychology. Working alongside our colleagues from other healthcare professions, primary care psychologists can help in establishing mental health as a crucial component of our healthcare system.
5) Primary care psychology provides opportunities to enhance psychological literacy in other healthcare professions
Medical education emphasizes collaborative care with allied health professions. There are courses offered during medical, nursing and other healthcare programs that focus entirely on multidisciplinary practice and how to effectively work together as a team.
In my experience, formal opportunities for psychologists and/or psychology graduate trainees to participate in multidisciplinary education and training have been fairly limited. As a result, other healthcare professionals’ knowledge of the role of psychologists, their training and skills are primarily reliant on the individual healthcare professional’s interest and initiative to seek out this information.
As a profession, we need to do more to educate and communicate with our healthcare colleagues about our profession, credentials and skills. Primary care psychology provides a unique opportunity to improve the psychological literacy of our colleagues by offering information about the profession of psychology but also enhancing awareness of psychological and behavioural interventions. This will only serve to strengthen the quality of care for patients as well as strengthening the relationships on healthcare teams.
The reasons why I believe every psychologist should advocate for primary care psychology are abundant. For me, advocating for a better mental health system is the embodiment of the fourth ethical principle of “Responsibility to Society” as outlined in the Canadian Code of Ethics for Psychologists! My hope in writing this article is to begin a conversation around ways that we can advocate for our profession, our colleagues, the clients we serve and every Canadian and their family who is affected by mental illness.
This article was originally published for the College of Alberta Psychologists The Monitor, Issue 56, Fall 2018. Find the original article here.
