Access to mental health services: the role of the family doctor

In last week's column I talked about some of the practical barriers to treatment faced by those with psychiatric conditions. For the most part I focused on how symptoms in themselves can present obstacles to treatment for many people.

Unfortunately, symptoms are not the only reason that people have difficulty getting treatment for a mental health problem. Access to appropriate mental health services is also a big problem.

I frequently end my column by suggesting people discuss their problems with their family doctor. In general, I believe this is a good place to start when a psychiatric condition is suspected. Ideally, a family doctor has a history with the individual and can assist in accessing appropriate specialist services if they are needed.

However, I have had a few comments from readers for whom this suggestion presents problems. Either they don't have a family doctor, or the doctor they have doesn't seem interested in their problem, or refuses to refer them for specialist care.

For those who do have a family doctor who doesn't seem to take an interest in your mental health issues, it may be wise to find a new doctor who will take your problems seriously.

It is true that in today's climate of doctor shortages there are a growing number of people who simply do not have a family doctor. This is unfortunate and is likely to get much worse as the baby boom generation retires and family practice becomes a less desirable occupational choice for medical students.

Still, if you don't have a family doctor simply because you haven't gotten around to it, I do recommend trying to find one that is accepting new patients. It is beneficial to have one doctor who becomes familiar with you and your medical history.

For those without a family doctor there are walk-in clinics available and the doctors working at these clinics can make diagnoses and refer to specialists as needed. When you don't have a long-term relationship with a physician who knows you there is a greater responsibility on yourself to figure out your problems and ask for specific help.

Fortunately, we do live in an age of information and it is possible to educate yourself about your health, but it does take time and some discernment to sift through information and learn what is credible and what is not. This is not easy for everyone and can be quite overwhelming for a person who is already suffering with upsetting symptoms.

If you think you have a particular disorder you will need to tell the walk in doctor and in some cases request referral to a specific specialist. This is not the way our system is supposed to work, but it is important for all of us to be our own health advocates.

Sometimes when psychiatric referrals are requested, the doctor will reply that it is hopeless to make a referral because of long waitlists. Often, this is not actually the case. The doctor may not have canvassed all available specialists and may not have time or motivation to do so. In these cases, you may have to do some research on your own. Call listed specialists and learn what options are available and the length of waitlists at a variety of offices.

You will still need a referral from a general practitioner to see a specialist, but usually if you request a specific individual your family doctor will make the referral.

I receive frequent emails from people asking for advice about specific situations. Usually people contact me directly because they are frustrated and have been unable to access care in a reasonable period of time. Very often I can help with a simple suggestion of where to go or who to speak with.

Unfortunately, this is not always the case and I cannot agree to see everyone myself. Sometimes there are specific clinics or physicians that specialize in or have a particular interest in the problem and they are usually the best person to see.

I hope these tips help you in your quest to access appropriate mental health services in our area. Don't give up hope, help is out there.


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