Transition Into Primary-care Psychiatry (TIPP): A Mental Health Demonstration Project.

The TIPP service will consist, at both the London and Thunder bay sites, of: (i) a mental health care nurse (B.Sc.N.) with at least several years experience as an outpatient mental health service clinician, and (ii) a psychiatrist with a license to practice medicine in the Province of Ontario and sensitivity to the issues of family physicians providing mental health services in the community

The TIPP intervention will involve a service delivery that is a modification of the Consultation Liaison in Primary-care Psychiatry (CLIPP) program

Four elements will act in synthesis and enable collaboration between the primary care and TIPP teams:

(i) Co-location of mental health services staff will involve the psychiatric nurse and psychiatrist visiting the family physicians' office at 1 and 3-month intervals, respectively. During these visits they will review and document the client's progress. This empowers the family physician as clinical manager. Treatment plans will be developed for family physicians that can be easily implemented. The family physician will monitor the client's status between the psychiatric nurse and psychiatrist's visits. At times of greater need, and/or impending crisis, increase in contact to every 14 days, with weekly or more from the family physician, and contacts with all providers adjusted to accommodate client needs. By developing linkages with area mental health services the psychiatric nurse will assist the family physician in co-coordinating access, while minimizing redundant use, to these services.

(ii) The TIPP nurse will select, prepare, and facilitate appropriate clients from the outpatient department for transfer to the family physician. The initial transfer process includes a face-to-face meeting with the client, TIPP nurse and family physician in family physician's office. Warning signs and symptoms of an impending relapse will allow for an opportunity for intervention to prevent or lessen the severity of a relapse. For each client a "relapse signature" strategy will be developed by the TIPP nurse to assist the family physician in detecting clients at high risk of mental illness relapse. Having obtained the client's permission significant caregivers will be routinely involved in the development and implementation of a clinical management plan. Standardized CLIPP based contact sheets\data sheets will promote efficient and effective communication between clinical care providers.