New Models of Care for Psychology in Canada's Health Services

Psychological services in health care have expanded beyond traditional areas of mental health to the full spectrum of health disorders, as research has increasingly shown the importance of psychological processes in health outcomes. Behavioural and psychological factors can contribute to the onset, course, or severity of many chronic diseases, and psychology has much to offer with clinically and cost-effective interventions. Good principles of care, involving appropriate assessment, evidence-based interventions, and close collaboration with other health care providers, are vital for effective chronic disease management, but can be difficult to realise given issues of timely access, patient volumes, and availability of psychological services in publicly funded health care. This article provides an overview of psychological interventions in diverse areas of health psychology, with examples of innovative Canadian clinical service delivery models, particularly focussing on integrated screening and treatment for cardiac patients, computerized delivery of insomnia treatment, screening and brief intervention prior to joint replacement surgery, and on-site psychological consultation for family physicians. The case examples, developed and implemented in Winnipeg, Manitoba, demonstrate components for consideration when redesigning psychological service models, such as more systematic approaches to identifying patient needs, stepped levels of care that increase intensity of service relative to need, integration into systems already handling large patient volumes, innovative use of technology, and location of psychological resources "in situ" for timely, brief access. Although still in early stages of development and evaluation, these models show promise for improved access and enhanced ability to deliver psychological service to relevant patient volumes.