Canadian psychological practice: Development of low intensity/high volume initiatives in public healthcare.

Abstract

Low intensity-high volume (LI-HV) interventions are increasingly being recognized as a means to communicate psychological principles and provide services to those with unmet mental health care needs. This article describes several different applications of LI-HV interventions in a central Canadian province, where underfunding of psychologists is well documented. The settings reviewed included tertiary hospital anxiety, depression, and sleep clinics, primary care, and a provincial mental health crisis setting. Descriptions of the LI-HV innovations and the impact of these innovations on referrals, providers, patients, and the healthcare system are reviewed. Some of the conclusions from these findings are that it is feasible to develop LI-HV interventions for psychological care, especially with limited psychologist resources. Patients find such interventions to be acceptable and satisfactory. Improvement in symptoms is often noted with LI-HV interventions, although the magnitude of improvement may be less than what is obtained with higher intensity services. Further, the provision of LI-HV services often results in changes to the higher intensity service. Anecdotally, psychologist providers report that the interventions are worth the investment. More work on investigating the efficacy of stepped care in this area is warranted. Public Significance StatementMental healthcare within the public health system in Canada is severely stretched in both human resource and economic capacities. Use of large group classes and internet-based programs represent a method to partially meet this need. Results suggest that these approaches are viewed favorably by patients and providers, and that implementation may change the nature of more intensive services.

The imperative to recruit and retain psychologists in Canadian hospitals: Challenges and proposed solutions.

“…Stepped care involves a process of assessing and triaging patients to the level of care that is appropriate to suit their needs (high vs. low intensity), thereby delivering more readily available, lower intensity options that could reduce wait times for health care. Psychologists are well-suited to defined leadership roles within stepped care models, such as providing comprehensive assessments and treatment for complex and severe patient populations (i.e., skills that lend themselves to higher intensity services) and providing the advanced, targeted higher intensity therapies (Vincent et al, 2021). Additionally, psychologists are trained to develop and evaluate treatment programmes, which lends itself to the programme implementation, monitoring, and improvement practices that are necessary when delivering large-scale interventions.…”