Question: I am suffering from crippling anxiety. My family doctor has referred me to a psychiatrist but I can’t get an appointment for months. What am I supposed to do in the meantime?
Answer: You certainly are not alone in having to wait a long time to see a psychiatrist. For a wide variety of reasons, access to mental health services is a big problem in Canada, and that’s got some experts thinking about new and innovative ways to deliver care.
“Not every interaction has to be a health professional sitting in a room with a patient,” says Dr. Ed Brown, Chief Executive Officer of Ontario Telemedicine Network (OTN). “There are other ways to support people.”
OTN, a not-for-profit organization funded by the provincial government, is best known for creating a video-conferencing network that enables Ontario patients who live in remote locations to have virtual doctor appointments in their communities.
Based on a similar principle of virtual care, OTN has contracted with a British company to provide mental health support through a website called Big White Wall (BWW).
The website serves as a forum where people with depression and anxiety can express their feelings and provide support to each other 24/7.
It also offers mental health improvement tools including online group courses for dealing with issues such as depression, anxiety, weight management and quitting smoking.
A key feature of BWW is that everyone is anonymous. “It’s a space where people can feel comfortable sharing their thoughts and not reveal who they are,” says Harriet Ekperigin, senior business lead at OTN.
She notes that the stigma and fear of being judged harshly by family and friends often prevents people from opening up about what’s bothering them.
The website is monitored by metal health counsellors called “wall guides,” who will intervene if people are making inappropriate comments or someone seems about to inflict self-harm. A wall guide will assess the person and can provide contact information for a local crisis-support centre if it’s needed.
The website is available free to Ontario residents over the age of 16. The cost is covered by the Ontario Ministry of Health and Long-Term Care.
BWW was started in the United Kingdom in 2007 and won accolades from the mental health community, as well as from Britain’s Prince Harry, Duke of Sussex. It was then adopted in New Zealand.
When Ontario residents log in, they enter a portal where they share their feelings with people in Britain and New Zealand. “You’re in a global community,” says Ekperigin. “And you get a richness of experiences from a diversity of people from all walks of life.”
Since the website became available in Ontario in April, other provinces have expressed an interest in also offering their residents access to the site, says Brown of OTN.
BWW is part of a growing trend of providing mental health assistance digitally or virtually.
Another example is the recent launch of a national “Crisis Text Line” that enables young Canadians to connect with mental health responders via text messages.
In some cases, these services are meant to fill the gap while patients wait to see a psychiatrist or start other forms of therapy. In other situations, they may provide all the help the person needs.
“Obviously, Big White Wall is not for everyone. But for certain populations of patients, it works,” says Brown.
What can be said with some certainty is that more and more people are going online to diagnose themselves and look for treatments even before they see a health care provider, says Dr. Carolyn Boulos, a youth psychiatrist at Sunnybrook Health Sciences Centre in Toronto.
“Big White Wall is one of the more reliable and comprehensive websites,” she says.
She also sees value in people sharing their experiences with those who have similar problems. “Having another person understanding what you are going through can be comforting,” says Boulos. The emotional connections forged online can lessen feelings of social isolation, she adds.
Affordability is also an issue. Provincial and territorial health care plans will pay for an appointment with a psychiatrist, but most of them don’t usually pick up the tab for seeing a psychologist. As a result, the mental health guidance provided by psychologists is out of reach for many people.
Online and virtual support can break down the financial barriers to care. “It really is open to everyone,” says Boulos, who often recommends mental health related apps to her patients.
And apparently, some of these services are extremely cost-effective for the health care system to deliver. “We pay a single licensing fee for every patient who uses the Big White Wall,” explains Brown. “I can’t reveal the amount, but it’s a lot less than seeing a psychiatrist even once.”
So far, about 10,000 Ontario residents have signed into the BWW website.
Boulos says patients who are waiting to see a psychiatrist can ask their family doctor for digital and virtual options that might be appropriate for them. “There are usually a number of different tools that can be helpful,” she says. “If symptoms get worse and the person has suicidal thoughts then this is best assessed by a health care professional.”
Sunnybrook’s Patient Navigation Advisor provides advice and answers questions from patients and their families. This article was originally published on Sunnybrook’s Your Health Matters, and it is reprinted on Healthy Debate with permission. Follow Paul on Twitter @epaultaylor.
If you have a question about your doctor, hospital or how to navigate the health care system, email AskPaul@Sunnybrook.ca
The comments section is closed.
Mentally ill to me is telling someone they need something that only accomplishes your money goals… AKA take pills and you will be healed. IF doctors worked with us they would be getting us jobs and starting our independent lives… Maybe we sub-setted to the point we have no chance at job or significant other. If I were a doctor I would tell my patients they are just looking for a home and a significant other, and not to trust anyone trying to lock them in the strickened side of the system!
I need help and support
Big White Wall is a new tool that is easily accessible for those with mild mental health issues. So is BounceBack (digital and telephone) where the evidence shows it drives strong outcomes for adults with mild to moderate depression. These new, easily accessible mental health services will help a number of people. However, I think we have an opportunity to have a more nuanced conversation about mental health services with the question that was posed at the beginning of this article, the patient is waiting for a psychiatrist referred by the family doctor.
If the patient actually needs a psychiatrist–and if we agree that psychiatric services should be restricted to those with significant functional problems–then Big White Wall is not the right intervention, as it is targeted to those with mild mental health issues.
Of course, not everyone with a mental health issue needs a psychiatrist. Many people can be more appropriately treated by a mental health professional (psychologist, social worker, psychotherapist). Using a stepped care approach to mental health issues, a patient should see the professional with the training that matches their needs. Psychiatrists are a precious resource in our mental healthcare system. We need to ensure they see those clients that are most in need. In addition, in a publicly funded system, we need to spend our resources wisely which includes better matching needs to resources.
Digital tools that are matched to the needs of the patients are a good addition to publicly funded mental health services. However, matching the needs of patients to the right professional (provided traditionally or digitally) along with timely access to that professional is how we will best use limited public dollars.
Hello Kim:
For the record, I think it’s worth mentioning that a pilot study was carried in Ontario before OTN contracted a British company to provide the BWW service province wide.
“In our pilot, we actually used it when people were on a wait list to see a psychiatrist,” Dr. Ed Brown said in a telephone interview.
Patients were told, “while you are waiting, this (BWW) might be something that could help you,” Dr. Brown explained.
The pilot showed that certain patients did benefit from using BWW.
Dr. Brown noted it’s not for everyone, but it certainly can be helpful to some people as they wait for access to other mental-health services.
If a person’s condition get worse, regardless of using digital aids, then that individual needs to be “assessed by a health-care professional,” says Dr. Carolyn Boulos, a youth psychiatrist at Sunnybrook.