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This article was published 8/1/2018 (819 days ago), so information in it may no longer be current.
For years, the Manitoba Psychological Society has been pushing for an increase in clinical psychologists, hoping to bump up consistently low staffing numbers to be more in line with the Canadian average.
That’s why it was so heartening for the society to see the result of Dr. David Peachey’s 18-month system review not only highlight the "significant deficiency," but also recommend that in addition to bolstering staffing, the province should carve out an expanded community role for providers.
Now, nearly a year after the report’s release, Peachey’s psychology recommendations have so far taken a backseat to more high-profile changes such as emergency-room closures and mass hospital shift changes.
They shouldn’t, said the president of the Manitoba Psychological Society.
"It’s really critical for (us) to be at these planning stages to help address the diverse nature of changes in the health-care system," Dr. Andrea Piotrowski said, because "clinical psychologists are really well positioned to work in primary health care."
That’s what Peachey recommends they do more of.
In his report, he lays out an expanded team-based, community role for clinical psychologists.
Peachey recommends adding them to teams of health-care providers, having them do routine visits to remote communities and having them serve as a "prioritizing screen" for consults with psychiatrists.
Do that, Peachey said, and you introduce the possibility of same-day care.
"If a patient walks into the primary-care centre and requires urgent psychological attention, in the current environment, that simply doesn’t happen, and there are all sorts of bureaucratic layers that are really cumbersome for patients," he said.
"However, if you have a clinical psychologist on the team… when it’s evident that a psychological opinion and assessment are critical, the patient can get it the same day."
Getting there is, in some respects, a numbers game.
The most recent figures show 19 clinical psychologists for every 100,000 Manitobans, well below the national average of 49.
That’s down from 20 for every 100,000 people in Manitoba in 2013.
To more than double the ranks of clinical psychologists and bring them up to the national average will require education, recruitment and then clinical psychologists’ slow assumption of expanded roles, the Peachey report indicates.
"There’s a fix," Peachey said, but "it’s not a fix that happens by flipping a light switch on overnight."
Manitoba is looking at ways to put more clinical psychologists on the front lines of community health care, said Dr. Brock Wright, president of Shared Health Services, although he declined to set specific recruitment goals.
To a certain extent, work is underway at the Winnipeg Regional Health Authority (WRHA) to build psychological services into existing MyHealth Teams, said Dr. Lesley Graff, medical director of the region’s clinical health psychology program.
While the makeup of the teams varies depending on the communities and patients they serve, they can include doctors, nurse practitioners, dietitians, pharmacists, mental health workers and occupational therapists, among other health-care providers.
Because many people with mental health issues go to their family doctor first, Graff said, adding a clinical psychologist "could help the first time someone has a panic attack or is struggling with chronic pain."
The WRHA has also had a part-time psychologist working at Access Winnipeg West since 2015, and a second was added at Access Fort Garry last year.
More expansive changes will have to wait.
"We’re dealing with a lot of issues right now," Wright said.
"We think there is a broader role for psychology in the mental health space and it does, to us, make a lot of sense," he said, but "we can’t make any commitments today about how many more psychologists we’re going to recruit and how we’re going to go about that because we have to do the planning."
There are a lot of reports to sort through.
In addition to Peachey’s recommendations, Wright said there are multiple reports about psychology or relating to psychology dating back to 2013. The Wait Times Task Force report released last month also recommends a bolstered community role for psychologists, noting the psychiatric model needs to be restructured.
The government is also awaiting the return of a report by Virgo Planning and Evaluation Consultants Inc., hired last year to help Manitoba develop a strategic mental health and addictions plan. That report is expected back in March.
Psychology may be "a bit scarce in the health workforce," Graff said, and there is work being done on recruitment strategies, but she thinks "it has to go hand in hand with overall planning around (the) health workforce."
The work of clinical psychologists can help cut down on costs and wait times while improving care, Piotrowski said, which is precisely why the lead-up to Phase 2 of the Winnipeg health overhaul and the nearing launch of Shared Health Services makes this the ideal time for the province to grow its ranks.
"There are a lot of populations who are underserved," she said. "We need to reach out more than just in the Winnipeg region to provide adequate services."