BCPA Presentation to Standing Committee on Finance & Governance

On September 2nd BCPA’s co-Director of Advocacy, Dr. Lesley Lutes, met with the B.C. Standing Committee on Finance & Governance for the 2022 Budget Consultation process. We presented the committee with a proposal for the government to set aside separate funding for Primary Care Networks (PCNs) who may want to hire a psychologist, just like there is separate funding for physicians, nurses and pharmacists. By creating access to psychologists alongside our other colleagues, we can ensure that all people across B.C., receive comprehensive team-based care right in their backyard.

The full transcript from the meeting is below:

 

J. Routledge (Chair): Thank you.

 

Our next speaker is Dr. Lesley Lutes, B.C. Psychological Association.

 

B.C. PSYCHOLOGICAL ASSOCIATION

 

L. Lutes: Hi everybody. Thank you so much, hon. Members, for giving me the time to speak with you today on behalf of the BCPA. I know that I only have five minutes, so I want to keep it short and to the point.

 

I want to tell you about my auntie Betty. She was amazing. She was larger than life. When she walked into a room, she immediately commanded everybody's attention. Her laugh was pure joy. Her hugs could cure whatever ailed you, and her zest for life was infectious.

 

She also suffered from bipolar disorder. When she was depressed, she gained weight. She eventually developed diabetes and became insulin-dependent.

 

Sadly, after four previous attempts, she would ultimately use all of those medications prescribed to keep her healthy to take her own life. That was 25 years ago, just one year before I would start my doctoral degree in clinical health psychology.

 

[2:10 p.m.]

While I wish I was sharing a tragic story that is unique just to me and my family, I know it is not. Every single person in this room has someone special in their life, or even themselves, who is struggling with either a chronic mental health or physical health condition. They may be suffering in silence, just surviving, or worse, ending with a similar outcome as my auntie Betty.

 

What many people don't fully understand is how closely mental and physical health are connected. When people are stressed and suffering emotionally, they are more likely to become physically ill, partly due to the direct effects of the stress on their bodies. Also, it's much harder to engage in positive health behaviours like exercising, taking our medications as prescribed, getting enough sleep and eating healthy when we are distressed.

 

This is where psychologists can help. The best models of integrated primary care around the world have psychologists and/or those that they've trained and supervised working side by side with their family doctors in primary care practice providing mental and behavioural health interventions.

 

Integrated primary care psychologists are different from traditional mental health providers, usually getting 60 minutes a week in a traditional outpatient office. This can clog up fast-paced primary care systems immensely. Primary care psychologists help patients manage health conditions like chronic pain, diabetes, being better at adherence to medication, help change initial and long-term health behaviours as well as treat mental and behavioural health concerns like anxiety and depression.

 

For example, in the one clinical trial that I conducted in rural North Carolina, we compared 140 patients who were struggling with unmanaged diabetes who were also suffering with undiagnosed distress or depression. Half of them received traditional primary care. The other half received integrated primary care focusing on their mental or behavioural health needs.

 

After just ten 30-minute treatment sessions across 12 months, with either a nurse, a master's level clinician or a psychologist, depending on the severity of their symptoms, all supervised by psychologists, not only did their mental health improve, but for the first time in ten years, their physical health improved. They increased their physical activity, improved their dietary intake and lost weight, and the 90 day average of their hemoglobin A1c, or blood sugar, decreased. This study was published in 2019 in a leading medical journal, Diabetes Care.

 

These models are innovative but only in B.C. In the rest of the world, including places such as New Zealand, the U.K., the Veterans Administration in the U.S. and my former institution in North Carolina, where I was before returning home to B.C. in 2015, it has been the standard of practice for years, even decades, and for good reason. Not just does people's mental and physical health improve. It saves money within the health care system, and it improves GDP. The U.K. alone showed a 4 percent increase in GDP when they invested in mental and behavioural health, according to Evans-based models.

 

It costs more money to have psychologists as a part of the team, compared to other allied health professionals. Since I've been home in 2015, this resource had been essentially unused to date within a primary care system in British Columbia, leaving patients only with good health insurance or enough money to access these services privately.

 

There is one exception, the Burnaby primary care network, amazing people. Following a meeting where I flew down to meet with them in December of 2019, despite the higher cost, they hired psychologists to help develop their first behavioural medicine service called B Well.

 

Since its launch in October 2020 — yes, during the pandemic — patients have experienced significant improvements in all physical and mental health outcomes, including depression and anxiety, even though it is not a mental health program, promoting weight loss, physical activity improvements and significant engagement across the board with their health behaviours. Moreover, physicians are thrilled. One physician described B Well as life changing for her practice. Notably, I want to document that the coaching is delivered by undergraduate master's level clinicians, only supervised by psychologists.

 

So what am I asking for? Just like the government currently allocates separate funding for physicians, nurses and pharmacists in the primary care system, I'm asking that the B.C. government also dedicate separate funds for psychologists who are choosing, and that PCNs are wanting to include in, the primary care system.

 

By creating access to psychologists alongside our other colleagues, we can ensure that all people across B.C., representing the full spectrum of physical and mental health needs, receive comprehensive team-based care right in their backyard.

 

J. Routledge (Chair): Thank you, Dr. Lutes.

 

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