Virtual learning model connects clinicians across Ontario to spread mental health expertise

In recent years, students at the Leslie Dan Faculty of Pharmacy have had more opportunities than ever before to learn about mental health and addictions through elective courses and practicum rotations. And Maria Zhang, clinician educator at the Faculty and advanced practice clinical leader at the Centre for Addiction and Mental Health (CAMH), encourages all pharmacists, regardless of their professional interest or specialty, to get general training in mental health.

“The specialty of mental health is not really a specialty at all because the prevalence of mental health issues is so high,” she says. “For pharmacists in any practice setting, whether it’s an intensive care unit or a busy community pharmacy, knowledge and skills around mental health issues are important because you will encounter it in some way with your patients.”

“For pharmacists in any practice setting, whether it’s an intensive care unit or a busy community pharmacy, knowledge and skills around mental health issues are important because you will encounter it in some way with your patients.”

Zhang explains that because pharmacists see patients at a time when their lives may be changing dramatically and are often more accessible to patients, they have a unique opportunity to screen patients for potential mental health concerns. That’s why she’s helping build capacity in mental health and addictions care through Project ECHO, a virtual education and capacity building model that connects geographically dispersed health care providers with a centralized team of health care specialists. Ontario is home to 26 ECHO programs which collectively aim to increase access to high quality health care in rural, remote and underserved communities across the province.

ECHO Ontario Mental Health at CAMH is funded by the Ministry of Health, and offers multi-week, live programming on a wide variety of mental health and addictions topics at no cost to participants. The programs encourage participation from learners, who are invited to ask questions, participate in active discussions about best practices, and present anonymized patient cases for discussion and feedback. Since the first ECHO Ontario Mental Health program in 2015, CAMH has expanded its programming to 10 mental health–focused ECHOs with more than 2,000 health care professionals reached to date. Among these participants are a number of pharmacists and pharmacy students, learning, teaching and advocating alongside their interdisciplinary peers.

Leveraging an “All Teach, All Learn” philosophy, ECHO Ontario Mental Health aims to equip health care providers with knowledge and confidence to address their patients’ mental health concerns. While specialists will always be necessary for patients with complex needs, primary and community care providers with additional training can support and treat patients with mental health conditions, keeping them off long waitlists for specialist care.

“ECHO allows people to receive more care where they typically do, and from health care professionals they visit on a regular basis — their family physician, nurse practitioner or community pharmacist.”

“ECHO allows people to receive more care where they typically do, and from health care professionals they visit on a regular basis — their family physician, nurse practitioner or community pharmacist,” says Zhang. “If we can provide those clinicians with increased knowledge around mental health issues and the confidence to support people with mental illness, everyone benefits.”

Monica Tsui, who graduated from the Leslie Dan Faculty of Pharmacy in 2012, recently participated in ECHO programs at CAHM focused on managing complex patients. She says that ECHO’s group learning and case-based setting allowed her to learn from experts and peers, as well as practice skills, all of which have provided confidence and insight into her practice.

“I’m grateful to have access to platforms like ECHO that enhance my own practice as a pharmacist by combining knowledge transfer and application to practice in a peer-based learning environment,” she says.

Pharmacists have important role in recognizing patient mental health concerns

Each ECHO program is led by a specialist interprofessional team called the “hub,” which includes a range of interdisciplinary providers, such as physicians, psychiatrists, social workers, nurses, pharmacists, occupational therapists and people with lived experience. Zhang coordinates participation of CAMH’s pharmacists in mental health ECHOs, and she serves on the hub of ECHO Ontario Integrated Mental and Physical Health ECHO, as well as the ECHO Chronic Pain and Opioid Stewardship Program.

Zhang says that all ECHO participants benefit from seeing pharmacists in leadership roles and as part of an interprofessional team. For pharmacist learners, it shows what is possible in their profession. “If pharmacists see that large academic institutions such as CAMH and University Health Network emphasize the pharmacist’s role and their importance as part of a patient’s care plan, that may help them to realize that they too are part of a team and can start to apply that model in their practice,” she says.

At the same time, other health care providers can get a better understanding of the scope of the pharmacy profession. “When they see a pharmacist on the hub or listen to a participating pharmacist, I think it gives them a lightbulb moment,” she says. “They start to realize the breadth and depth of our knowledge and skills, not just around dispensing medication but around issues like deprescribing, medication optimization and medication access.”

Zhang says that all health care professionals, including pharmacists, should have some training in mental health in order to recognize potential issues in their patients. “Whether we know it or not, we all work with people with mental health issues. As pharmacists, we can start to recognize mental health concerns in patients before they progress in severity,” says Zhang. “Specialty training is necessary and important to care for complex patients and build more capacity, but at the same time, we all need basic training in this critical area.”

By: Eileen Hoftyzer