Counsellors in primary care: Benefits and lessons learned

Objective: To describe a program that integrates mental health counsellors within primary care settings, to present data on the program's impact, and to discuss lessons learned that may apply in other communities. Methods: This paper describes a Canadian program that brings counsellors and psychiatrists into the offices of 87 family physicians in 36 practices in a community of 460 000 in Southern Ontario. It describes the goals and organization of the program and the activities of counsellors when working in primary care. In addition, it summarizes data from the program's evaluation, including demographic data and the individual problems seen and services delivered (all from the program's database) as well as data on patient outcomes using the General Health Questionnaire (GHQ), the Centre for Epidemiological Studies Depression (CESD) Rating Scale, and consumer-satisfaction questionnaires. Results: Each counsellor sees an average of 161 new cases yearly. The major problems are depression, anxiety, and family problems. In fact, over 70% of individuals who are seen show significant improvements in outcomes. The program has led to a significant increase in access to mental health services, a reduction in the use of traditional mental health services, high levels of satisfaction with counsellors and family physicians, and significant improvements in symptoms and functioning of individuals seen. Conclusion: This program has effectively integrated counsellors within primary care settings, increasing the capacity of primary care to handle mental health problems, strengthening links between providers from different sectors, and making mental health care more accessible.