Shared mental health care for a marginalized community in inner-city Canada.
OBJECTIVE
This paper describes the experience and evaluation of a shared care project targeted at marginalized individuals living in the North End of Halifax, Nova Scotia. This population has high rates of psychiatric disorder, often comorbid with chronic medical conditions, and people have difficulty in obtaining the help they need. This primary care liaison service covers all ages and includes outreach to emergency shelters, transitional housing and drop-in centres. Collaborative care improved access, satisfaction and outcomes for marginalized individuals in urban settings. Primary care providers with access to the service reported greater comfort in dealing with mental health problems, and satisfaction with collaborative care, as well as mental health services in general. Results were significantly better than those of control practices when such data were available. The median wait time was 6 days in comparison with 39.5 days for the comparison site.


CONCLUSIONS
This model can complement other initiatives to improve the health of marginalized populations, and may be relevant to Australia.
School of Medicine, Griffith University, Meadowbrook, QLD, Australia. s.kisely@griffith.edu.au
Stephen
S
Kisely
Pamela
P
Chisholm
D002170:Canada; D003156:Community Mental Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D006301:Health Services Needs and Demand; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D006755:Hospital Shared Services / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D017060:Patient Satisfaction; D011203:Poverty; D011320:Primary Health Care / Q000458:organization & administration*; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D035862:Vulnerable Populations; D014850:Waiting Lists