Conclusions
Many Canadian psychiatric leaders have voiced their concern about
difficulties with timely access to psychiatric care, particularly
in rural centres, and provision of care to the moderately and seriously
ill by well-trained general psychiatrists. Best practices are described
for mental health services that have demonstrated effectiveness,
and many such services require general psychiatrists working in
concert with other mental health professionals and family physicians.
Mental health reform has identified levels of service need, and
we believe that general psychiatric services correspond to the first-line
and intensive levels of mental health services.
To meet the need for general psychiatrists who would work within
an IMHS, we suggest the following: 1) design academic programs that
will train psychiatrists to work in first-line and intensive psychiatric
services (for example, the University of Toronto program in general
psychiatry); 2) establish reentry training positions for physicians
willing to train as general psychiatrists and be obligated to work
within an IMHS; 3) recruit well-trained psychiatrists from other
countries to work as general psychiatrists within an IMHS; and 4)
provide government funding for general psychiatric services that
includes sessional payments for shared care with family physicians,
greater support for hospital-based practice, and incentives built
into the fee-for-service plan for community psychiatrists to work
within an IMHS.
Acknowledgements
The authors thank Ms Peggy Taillon-Wasmund and Dr Keith Anderson
for their helpful comments and suggestions.
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Manuscript received September 2001, revised and accepted May 2002.
1 Deputy Head and Director of Outpatient and Community Psychiatry,
The Ottawa Hospital; Associate Professor, Department of Psychiatry,
University of Ottawa, Ottawa.
2 Head of Psychiatry, The Ottawa Hospital; Professor and Chair,
Department of Psychiatry, University of Ottawa, Ottawa.
Address for correspondence: Dr JR Swenson, Department of Psychiatry,
The Ottawa Hospital (General Campus), 501 Smyth Rd., Ottawa, ON
K1H 8L6
e-mail: jrswenson@ottawahospital.on.ca
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