The physical health of individuals with long-term mental illnesses has long been of concern. In Western Australia, the overall mortality rate from preventable causes of people living with mental illness was reported to be 2.5 times greater than that of the general population. A trial peer support service was initiated to assist people with mental illness to attend to their physical health needs. This paper presents the planning, implementation, and results of this collaborative initiative involving nongovernment agencies, the public mental health service, consumers of mental health services, and the University of Western Australia.

This study reports the results of two self-report measures (PHQ & SF-12v2) completed before and at the end of a therapeutic intervention in a shared mental health care program. A significant reduction in symptoms was noted for 5 diagnostic categories, including depression. Statistically significant improvement was found for items assessing general health, interference in activities and work due to emotional problems or pain, feelings of calm and peace, level of energy, depression, and interference with social activities. The results suggest that integration of mental health therapists within primary care practice settings may significantly improve participants' mental health symptoms and functioning.

The present study evaluates the mental health of participants 3 to 6 months after completing treatment at a shared mental health care clinic. Twenty-five participants completed the Patient Health Questionnaire (PHQ) and the World Health Organization Disability Assessment Scale version II (WHODAS-II) at entry, exit, and 3 to 6 months following treatment. Results for the PHQ found significant sustained improvement for major depression, other anxiety syndrome, and somatoform disorder. The WHODAS-II scale demonstrated that significant improvement was maintained 3 to 6 months following treatment completion. These findings suggest that patients receiving short-term therapy and psychiatric consultation in a shared care setting may show significant, sustained improvement in mental and physical functioning.

Collaborative mental health care is a widely advocated model of community-based mental health care delivery. Previous work suggests that several contextual factors, such as the lack of stable funding for non-physician providers, have prevented widespread implementation of this model in Ontario. The introduction of interdisciplinary Family Health Teams (FHTs) as part of Ontario's primary health care renewal strategy presents an opportunity to overcome some of these barriers. This case study of emerging FHTs examines how contextual factors influence the mix of providers and quality of collaborative mental health delivery in FHTs. The findings inform policy-makers of opportunities to further develop community-based collaborative mental health care.

This article presents the results of a needs assessment of family physicians and residents concerning the provision of mental health care and an implementation evaluation of a multidisciplinary mental health service demonstration project, linking 2 family practices with mental health services of a general hospital. Family physicians and residents reported that collaborative mental health care provision would enhance but not replace their management of patients with mental health problems. The implementation evaluation found that collaborative care provided by a multidisciplinary mental health team co-located with family physicians was accepted by patients and valued by family physicians. Because of a shortage of family physicians, few patients from the mental health system who lacked family physicians were able to gain access to primary care through this project.

This project used the Colorado Client Assessment Record to compare individuals being seen by mental health teams in primary care with individuals being seen in outpatient services in the same community and to look at the implications for service delivery. While more individuals with a psychotic illness were seen in outpatient settings, many individuals seen in primary care had similar levels of need to those in outpatient clinics. Family physicians were more actively involved in the care of patients being seen in primary care. These findings suggest that a stronger role could be played by primary care in delivering mental health care, while differentiating which populations are best served in which setting.

Depression is a common problem that affects approximately 10 to 15% of pregnant and postpartum women. Health care providers often fail to recognize depression in this population, and pregnant and postpartum women may be reluctant to seek help because of the stigma associated with mental illness. This article describes the Maternal Mental Health Program, an innovative, shared care program that brings together previously fragmented services and co-locates multidisciplinary clinicians within a primary care setting. This approach shows promise with respect to improving mental health outcomes; meeting the needs of women, health care students, and service providers; and increasing awareness of and access to specialized mental health care.

While primary care faces many challenges, including an increasing prevalence of older individuals, emerging knowledge about the potential benefits of collaborative partnerships has encouraged the development of new means of providing and supporting primary care. First Link™ is an innovative program involving collaborations among primary care providers, Alzheimer Societies, and other health professionals. The program aims to support persons with Alzheimer's and related diseases after the diagnosis is made and to link them with support services earlier in the disease course. This paper describes the First Link program, provides an overview of a study currently underway to evaluate it, and identifies some of the benefits and challenges associated with this partnership.

Successful support of persons living with a mental illness in the community is challenged by the lack of primary care accessible to this population. The Canadian Mental Health Association–Windsor Essex County Branch explored options to provide mental and physical health care, initially creating an integrated primary care clinic and later a larger community health clinic co-located with its mental health care services and staffed by a multidisciplinary team. A retrospective review of 805 charts and a client satisfaction survey were conducted in 2001 to evaluate this service. Findings indicate that access to primary care and mental health care co-located at a community-based clinic has reduced the number of emergency room visits and admissions, and length of stay in hospital, for individuals with moderate to serious mental illness. A client survey in January 2008 supports these preliminary findings.

This paper describes a pediatric telepsychiatry program serving communities in rural Ontario, Canada. Since the program's inception in 2000, over 4,300 direct clinical consultations have been provided for a variety of presenting issues. Indirect consultations and educational sessions have augmented clinicians' knowledge. Participant evaluation of the program indicates that a comprehensive model of psychiatric consultation and education can be delivered effectively via live interactive videoconferencing to support primary care and to enhance capacity in remote, underserviced areas in Ontario.

The Healthy Minds/Healthy Children Outreach Service is part of Alberta's strategy to increase the capacity of primary care providers to identify and treat children and youth with mental health issues. Program development, implementation, and interim results are presented. Particular challenges connecting with Aboriginal communities, developing resources, and providing clinical consultation and online professional development are discussed. Evaluation data suggest that this form of collaborative, educational, interprofessional service is a promising approach to narrowing the care gap for children with mental health issues.

The benefits of interprofessional care in providing mental health services have been recognized, particularly in rural communities where health services are limited. In addition, there is a need for more continuing professional education in mental health intervention in rural areas. Although interprofessional collaboration and continuing education have both been proposed to address the paucity of mental health services available in rural areas, there have been no programs developed in which the two components have been combined. This paper describes the development, implementation, and evaluation of an interprofessional continuing education program specifically designed to enhance rural mental health capacity.

Developing effective strategies to keep health care providers' practice current with best practice guidelines has proven to be challenging. This trial was conducted to determine the potential for using brief educational sessions to generate significant change in physician delivery of mental health and substance use interventions in primary care. A 1-hour educational session outlining interventions for depression and risky alcohol use was delivered to a sample of 85 family physicians. The interventions used a supported self-management approach and included free patient access to appropriate selfmanagement resources. The study initially evaluated physicians' implementation of these interventions over a 2-month period. Physician uptake of the depression intervention was significantly greater than uptake of the risky-drinking intervention (32% versus 10%). A follow-up at 6-months posttraining (depression intervention only) demonstrated fairly good maintenance of intervention delivery. Implications of these findings are discussed.

Many patients with mental illness depend on family physicians (FPs) for their physical and mental health care, yet FPs often report dissatisfaction with the quality of mental health care they provide. A 2-year, quality improvement (QI) manual-based initiative was developed to increase FPs' diagnostic, cognitive-behavioural, and interpersonal treatment skills for depression. Two teams, each consisting of a psychiatrist and a mental health therapist, rotated through 18 family practices in Victoria, British Columbia, mentoring the model on-site with physicians and patients. Feedback suggests that this initiative enhanced the ability of FPs to diagnose depression and comorbid disorders, organize problems, and treat depression using non-pharmaceutical approaches.

This pilot study assessed the feasibility of a randomized controlled trial of an intervention for major depression among seniors in Canadian family practice. The intervention involved care by a family physician augmented by a Depression Care Practitioner, the latter working under the supervision of a psychiatrist. Treatments included family doctors' prescriptions of antidepressants according to an evidence-based study algorithm and/or brief problem-solving therapy. Eligible patients aged 60+ were identified in a 2-step screening process: 68 patients from 29 Montreal family practices were randomized, and 66 completed the 2-month follow-up. Results support the feasibility of a multisite trial of this intervention.

The University of British Columbia (UBC) has partnered with community primary care providers to implement a shared care pilot project for the management of depression. The National College Health Assessment survey conducted at UBC in 2004 identified a significant gap in the management of depression. This finding highlighted a need to better integrate existing resources and strengthen the capacity of primary care providers to effectively recognize, assess, and treat depression. This article outlines the development and evaluation of a shared care collaborative approach to the primary care of depression in the UBC campus community.