Mental Health Program
The CWC PCN has developed a comprehensive, in-house Mental Health Program to better serve the needs of our community. This resource page discusses the development of the program, its current state, and its function within the primary care setting.
Introducing the program
The Calgary West Central Primary Care Network (CWC PCN) is a non-profit organization committed to supporting primary care physicians and their patients. Our PCN has approximately 475 physician members, making it one of the largest PCNs in Calgary.
We provide programs and services that support patients with key concerns, including chronic disease management, after-hours care, and mental health care. Current statistics indicate mental health disorders affect one in five Canadians, making mental health care a top priority for our PCN.
Prior to 2021, our mental health services were provided through contracts with external organizations. Most of the time, these services operated within a model called behavioural health. With this model, patients had a limited number of appointments they were able to book, with a maximum appointment time of 30 minutes.
Ultimately, we recognized this model was not adequately supporting patients’ mental health. We sought to develop our own comprehensive mental health support program that would provide patients with critical therapeutic services and connect them with available community resources.
This undertaking would require large time, resource, and financial commitments, but we were confident the results would have a significant, positive impact on our community, members, and patients.
Evolution of the program
The development of our Mental Health Program began in early 2021 with the aim of improving the patient experience and providing comprehensive support for those in need.
After evaluating our previous contractor-based model, we identified several areas of improvement that would become the core principles of the new program:
- Flexibility for patients was an essential requirement for our Mental Health Program. We determined a fully remote model would allow for increased patient access — allowing them to book with their psychologist on any day of the week.
- Our psychologists would offer evidence-based psychotherapy with no predetermined appointment limitations, — allowing patients the time and resources to successfully navigate complex mental health concerns.
- The Mental Health Program Manager would be a mental health professional with the expertise and experience needed to successfully lead and develop the program.
The first milestone in this development process was the hiring of our first internally employed Registered Psychologists in February 2021. The title of our mental health providers officially became Primary Care Registered Psychologists (PCRPs).
The next milestone was the hiring of our Mental Health Program Manager in November 2021 — a Registered Psychologist who would be instrumental in guiding the future of the program.
In December 2021, our contracts with the external providers officially ended. Our Mental Health Program Manager expanded the recruitment process to build a team of Registered Psychologists who would provide therapy for patients within the new model.
To supplement the support offered by our psychologists, we continued to develop and strengthen our connections with specialized community resources that could provide support to our patients with complex mental health needs or schedules that required evening or weekend hours.
In the early days of the program, our psychologists would receive a list of referred patients from their assigned member clinics. They would then personally contact those patients to determine if an appointment was suitable, provide self-management resources, and book an appointment with the patient if appropriate.
It was quickly identified that this referral process was not effective or efficient. The administrative tasks required of our psychologists reduced the time they could reserve for patient appointments — ultimately working against our primary goal of providing accessible and timely care. We also saw a spike in wait times, with some patients waiting almost three months for their appointment.
Our Mental Health Program Manager conducted literature reviews regarding referral models in primary care systems to determine which method would be the best fit for our PCN and patients. After careful research, several updates were made to our referral system to improve patient access and maximize psychologist availability:
- An appointment coordinator was added to the team. The appointment coordinator contacts patients to book a time for them to speak to a psychologist for their initial consultation. This step allowed patients to schedule their intake consultation for a time when they were comfortable discussing potentially sensitive concerns.
- Two psychologists were hired to dedicate most of their time to speaking with patients for their initial consultations, with support from the rest of the PCRP team, to help manage overflow. During the initial consultation, PCRPs would work with patients to determine their needs and personal preferences for treatment.
After being referred by their primary care physician, our finalized patient referral process follows three steps:
- Patients will be contacted by the Mental Health Program appointment coordinator to book a time for an initial consultation with a PCRP.
- Patients will speak with a PCRP within 14 business days for their initial consultation. During this appointment, the patient will work with the PCRP to determine which resource would be the best fit for them based on their needs and preferences.
- Depending on the patients’ needs, they may be referred to either a community resource or to a PCRP for therapeutic sessions. All referred patients will also receive self-management resources.
Referral process evaluation
A six-month review of the mental health referral process was completed. This evaluation provided insight into whether the new referral program was improving wait times and efficiency. The review also investigated the relationship between patient distress level and referral outcome. This review found:
- Most referred patients reported medium to high distress levels. Very few referred patients indicated low distress levels, meaning our physician members were appropriately referring patients to our program who needed it most.
- The updated referral process was more effective in referring patients to the most appropriate CWC PCN or external community resource. This reduced wait times for our PCRP appointments and ensured patients were connected with the best possible treatment option for them.
- A reduction in administrative tasks helped reduce the stress levels of our PCRPs and allowed them more time to complete their tasks and provide care to patients.
average business day wait time before implementation
average wait time after implementation
The program today
As of December 2023, our Mental Health Program has evolved into a crucial, well-utilized resource for our members and their patients. On average, our Mental Health Program receives 265 referrals each month.
The components of the program in its current state include:
Following their initial discussion with a PCRP, patients may be referred for short-term counselling sessions depending on their needs and desires.
These counselling sessions with a PCRP can support patients coping with a variety of mental health conditions, including addiction, anxiety, depression, grief, and more. Our PCRPs help patients identify their therapeutic goals and provide patients with tools for building resilience and creating change.
We do not limit the number of appointments available to each patient. Their PCRP will work with them until their needs are met, or an alternate resource becomes more appropriate.
- PCRP appointments offered from 2022-23
- Age of patients referred to PCRPs from 2022-23
From April 2022 to March 2023, our PCRPs offered more than 5,000 patient sessions. Individuals between the ages of 25 and 34 were the largest group to access our services with those aged 85 and above being the least common age group to access PCRP services.
Between 2022 and 2023, the top three patient concerns addressed by our PCRPs were anxiety, depression, and stress.
Our Social Workers support patients of all ages with accessing and navigating the health system. Depending on the needs of the patient, Social Workers and PCRPs may collaborate to provide the best possible care to patients with complex concerns.
Social Workers meet with patients as often as required through phone, video, or in-person appointments. During appointments, Social Workers may:
- Provide community support information to patients and/or their caregivers
- Assist patients with advocating for their needs
- Assist patients in accessing community services
Social Workers may help a patient access affordable housing, locate applicable community services, apply for benefits, and more. This work plays a crucial role in reducing patient anxiety and supporting their overall well-being.
Social Work appointments offered from April 2022 to March 2023
Our team continuously develops and maintains close partnerships with community resources that provide specialized care for our patients.
- These community partner referrals are often made to support patients suffering with complex conditions such as youth mental health, eating disorders, sexual violence, grief, and more. In these cases, specialized programs are often in the best interest of the patient.
In 2023, a survey was developed to gauge the patient experience and determine where improvements could be made. This survey found:
of PCRP patients rated their care as excellent or very good.
of Social Work patients rated their care as excellent or very good.
This increases access to crucial mental health services for patients and offers them avenues for therapeutic support.
Our previous model was only able to offer patients 30-minute behavioural health assessments. Our improved, sustainable model can offer patients true psychotherapy sessions at no cost.
By providing patients with the opportunity to speak with a psychologist, they receive accurate, meaningful referrals and support.
Our updated referral methodology allows our PCRPs and Social Workers to spend their time providing meaningful support to patients.
Mental health services are a crucial component of creating and maintaining healthy communities. We are proud of the success of our Mental Health Program and the dedicated staff who support it. Looking to the future, we hope to expand this program further to enhance the services we can offer to patients in need.
In 2024, our Mental Health Program will begin to offer evening and weekend appointment options to increase accessibility.