Review Paper Mental Health Reform and Evolution of General Psychiatry In Ontario

Objectives: To discuss developments in Ontario mental health reform, describe general psychiatric serv-ices in contrast to tertiary services, describe guidelines for the training of general psychiatrists, and sug-gest what changes may be required to develop an integrated mental health system (IMHS). Method: We review the Ontario government’s recent blueprint for mental health reform and the Cana-dian federal government’s document on best practices in psychiatry, in the context of defining general psychiatric services and their relation to tertiary services. From this, we consider the education of general psychiatrists and make suggestions for their training. Results: General psychiatric services correspond to first-line and intensive psychiatric services delivered by community mental health agencies, community psychiatrists, and general hospitals for patients with moderate or serious mental illness. Many suggest that psychiatrists are not being trained to meet the needs of a reformed mental health system. An education program for general psychiatrists should include train-ing in a wide range of community and general hospital settings, work within a multidisciplinary mental health team, and experience working in a shared care model with family physicians. Conclusions: Along with training general psychiatrists better, we must also develop recruitment and payment incentives, which would allow general psychiatrists who are based in the community and gen-eral hospitals to work within an IMHS. (Can J Psychiatry 2002;47:644–651) See page 650 for author affiliations