Dear Colleagues,

Regardless of your specialty or scope of practice, every Fellow encounters patients with mental health conditions – whether visible or invisible to the eye. I want to share with you some significant work the Royal College has undertaken in collaboration with several partners to support Fellows in enhancing their knowledge and skills, and as a result, improve care for those with mental health conditions and addictions.

In June, a steering committee comprising the Royal College, the College of Family Physicians of Canada, the Canadian Psychiatric Association (CPA), the Canadian Medical Association and the Mental Health Commission of Canada (MHCC), as well as two people with lived experience, released a major report called Mental Health Core Competencies for Physicians. This report offers an important first step in what must become a broader effort, by outlining the foundational competencies that physicians and specialty societies need to develop the right environments in practice for improving care for patients with mental health conditions and addictions.

Allow me to provide the context for this important work.

No doubt, most of you are familiar with Canada’s compelling mental health statistics. More than 6.7 million Canadians live with a mental health condition and, according to Statistics Canada, roughly 17 per cent of the population 15 or older has reported a mental health care need in the past 12 months. Of these, 600,000 (12 per cent) have said that their needs were unmet by the health care system.

The Royal College fundamentally believes that all physicians should be equipped with at least the basic knowledge, skills and attitudes to interact with these patients in ways that will provide the best possible care. So why and in what ways has the system been falling short?

Large body of literature points to fundamental flaws

Canadian reports that have examined the unmet needs in mental health and addictions point to a lack of coordination and integration of services, regional disparities, inadequate resources and focus in the system, systemic stigma and significant gaps in care. Importantly for Fellows, they also raise as a major concern a lack of adequately prepared health professionals. A report from the MHCC, as one example, points to a lack of education and preparation for non-mental health specialist physicians during medical training. Meanwhile, the Royal College of Psychiatrists has estimated that family physicians spend 30 per cent of their time on mental health issues.

In response to these realities, the MHCC released a key piece of work in 2012 called Changing Directions, Changing Lives: The Mental Health Strategy for Canada. The report stands as the blueprint for change for how physicians approach the diagnosis and treatment of mental health conditions and addictions. It makes recommendations for how the system can facilitate the adoption of recovery-oriented approaches for treating these conditions, strengthen collaborative approaches to dealing with them and integrate mental health care into primary care. The recommendations also address the persistent problem of negative stigma as well as the challenges of ensuring that people with mental health conditions get timely and appropriate physical care.

All physicians require core competencies

The Royal College recognizes the clear link between physical and mental health, and we are committed to supporting physicians in providing better care for Canadians living with mental health conditions and addictions. We take seriously the recommendations of the many reports that emphasize, among other things, the importance of baseline mental health core competencies for all physicians. That is why we initiated the steering committee in 2011 in collaboration with the MHCC and our other partners (listed above) to develop competencies via Mental Health Core Competencies for Physicians.

The report recognizes that the development of core competencies is critical for all physicians since most patients with mental health conditions are seen by providers outside the field of psychiatry. The goals, principles and core mental health competencies that we set out are based on the CanMEDS Framework, which forms the structure for our ongoing maintenance of competence and lifelong learning. The framework was vital in the development of the report, which recognizes that collaborative mental health care is increasingly the preferred service delivery model since it involves family physicians, psychiatrists and other mental health providers.

Competencies that apply to all physicians

Donald Addington, board chair of the Canadian Psychiatric Association (CPA), represented his members as the report was developed. His comments reflect the commitment of his specialty to the work of the steering committee. I’ll quote him here: “The Canadian Psychiatric Association recognizes the major significance of the Mental Health Core Competencies for Physicians. The document’s clear statement that mental health competencies apply to all physicians reinforces the concept that mental health is an essential component of health.”

Dr. Addington went on to say that he looks forward to working with the Royal College and specialties other than his own to propose and develop more specific competencies. I believe this is an essential next step. Mental Health Core Competencies for Physicians is an immensely valuable foundational document and, given that the competencies are applicable across all aspects of primary care, it is my hope that the report will spur further work in all disciplines.

Read this report as a first step towards enhancing your knowledge

I encourage you all to read Mental Health Core Competencies for Physicians. The report is relatively brief and can benefit all members of the medical community by recapping best practices to follow when interacting with vulnerable populations.

Furthermore, with assistance from our CPA colleagues, we have prepared a list of related articles and other resources for Fellows to use to supplement their learning. (Reading these articles can count towards your annual Maintenance of Certification cycle.) The resources may also spark ideas for personal learning projects to deepen your knowledge about the diagnosis and treatment of mental health and addictions.

No less important, I am asking you all to explore further learning within your own specialty society. I also welcome your suggestions for professional development opportunities in this field to share with your peers.

Mental illness touches all Canadians, and as a result, all physicians will no doubt encounter patients with mental health conditions. This report is an important first step towards supporting our Fellows in improving the care for these patients. I believe a shared broader effort will be vital to further refine mental health competencies as an integral component of high quality care.

I look forward to hearing from you, and speaking with you, about this project.


Andrew Padmos, MD, FRCPC, FACP
Chief Executive Officer


Resources recommended by the CPA