As a psychiatrist, I have lots of colleagues who are family physicians, many of whom refer to me. The thing about having a family physician, especially when we're thinking about women, is that a family physician follows you throughout your whole lifetime. They know you. They know if something isn't your baseline, if something is off. They're watching things.
If we're saying that 20% or more of women across Canada have a mental health issue.... That's like saying that all of the cardiologists would manage high blood pressure. The truth is that the family physicians are likely the first line of defence for mental health issues, and it's the family practices, like the teams, where that first basic counselling starts.
One thing that was really interesting is that we did a model of care for perinatal mental health where women didn't need to go through their family doctors to come in. When they first came in, we did that stepped care that we talked about. We sent them for peer support. We got them psychological treatments in the community, which they didn't even need to see a doctor for. A small proportion might have actually needed medications, or something more, so we were able to have somebody like me, who knows about all the drugs in pregnancy and everything, go through some quick phone calls with the family doctors to figure out what the patients needed. Patients trust their family doctors. Out of the 50 people we put through our initial pilot, only two had to eventually come and see me.
Family doctors know when there's something that isn't quite right with their patient. It's almost like when a parent knows there is something not quite right with their child. The importance of primary care as the backbone and as the infrastructure of our health system, I think, can't be understated.