For years, Kirstie Leedham stayed away from doctors and counselors trying to cope with her mental health on her own. At 23 years old, she realized she needed to reach out. She says her mood was terrible and that she struggled to deal with small day-to-day issues.
A friend of Kirstie’s was a patient at the First Episode Mood and Anxiety Program (FEMAP) at London Health Sciences Centre (LHSC). When the friend completed the intake assessment, she was surprised by how accurately it described Kirstie and the feelings Kirstie had shared. She recommended that Kirstie check out the program.
FEMAP is a novel outpatient mental health program that provides treatment to emerging adults, ages 16 to 25, with emotional concerns that fall into the categories of mood and anxiety symptoms. Treatment at FEMAP takes a patient-centred approach in a youth-friendly setting where patients receive care from a multidisciplinary team.
During her intake, Kirstie agreed with her friend. “I thought okay, they know who I am so maybe they can help’.”
Once Kirstie was placed, the program moved quickly. She was paired with a psychiatrist who was very helpful and began attending a weekly group therapy.
“For me, the group therapy was unbelievably helpful. To be in a room full of people who actually understood what it was like to be me. It was the changing point,” states Leedham. “I was able to shift my thinking to it’s not the way that I am, it’s what I’m going through, and there are others going through this too.”
Kirstie was involved in the program for a year before she was slowly transitioned to community services. She was also involved in research studies at FEMAP.
“The program helped me to understand that I wasn’t alone in how I felt or was handling things. They helped me learn how to cope and deal with issues in a constructive way that made things so much easier.”
For Kirstie, the research component was an added benefit to a program already helping her.
“Being involved in the research studies was really cool. It was a concrete way to remind to myself I was making progress even when, sometimes, it didn’t feel that way, and know the research was going to help future patients” says Leedham.
Entering into FEMAP, Kirstie was struggling to finish school, didn’t have job prospects and struggled with relationships. Three years out of the program, she is now a Creative Director for a large social media company, married and owns a house.
“I never thought these things would be possible for me. FEMAP helped me make the changes I needed to achieve them.”
Kirstie is one of many patients to benefit from the services provided at FEMAP.
In a series of studies from, researchers examined the impact of FEMAP - Canada’s only early intervention program for youth with mood and anxiety disorders. Results suggest that treatment at FEMAP leads to improvements in patients’ symptoms and functioning, access to psychiatric care in the most appropriate settings and fewer visits to the emergency department (ED).
Improved patient outcomes
In a recent study, researchers found that treatment at FEMAP leads to improves patient outcomes. The study included 370 youth eligible for FEMAP services. Before beginning treatment at FEMAP, they were, on average, experiencing moderate depression, moderate anxiety and low satisfaction with their quality of health. They also reported poor functioning an average of 4.3 days per week.
Of 370 youth eligible for treatment at FEMAP, 322 attended a clinical assessment. Seventy-one disengaged from treatment either before or immediately following the clinical assessment. The research team found that those who disengaged early had less severe symptoms than those who stayed engaged.
Follow-up questionnaires were completed by 174 youth approximately six months into treatment. The research team discovered significant improvements in patient outcomes, including reduction in mood and anxiety symptoms, improved functioning and a higher quality of health satisfaction.
“These results demonstrate the effectiveness of early intervention programs offering personalized treatment that adjusts to patient’s needs and wishes. The data suggests our model is successful in helping patients manage their mood and anxiety disorders,” says Dr. Elizabeth Osuch, Clinician-Scientist at Lawson, Associate Professor at Western University’s Schulich School of Medicine & Dentistry, and Medical Director at FEMAP.
Improving patients’ access to care
Another study by the team suggests that FEMAP improves patients’ access to care.
The team analyzed de-identified public health data from 2009 to 2014. In total, over the 5 year period, nearly 30,000 emerging adults in the same geographic region as FEMAP had contact with mental health services for mood and anxiety.
The research team identified 490 patients treated at FEMAP and compared them to a control group of 967 patients treated elsewhere.
They discovered patients treated at FEMAP were three times more likely to see a psychiatrist and had more rapid access to care. FEMAP users saw psychiatrists within a median of 16 days versus 71 days in the control group. FEMAP patients also had lower rates of ED visits when compared to patients treated elsewhere and were less likely to access primary care for mental health concerns. No differences were observed between the groups for psychiatric hospitalization rates.
“We knew from other studies that early intervention programs are effective for improving outcomes in patients with first-episode psychosis but less was known for mood and anxiety disorders,” notes Dr. Kelly Anderson, Associate Scientist at Lawson, Assistant Professor at Schulich Medicine & Dentistry, and Adjunct Scientist at ICES. “Our results suggest FEMAP provides access to mental health care in the most appropriate settings by preventing ED visits, demonstrating the health system potential of this novel treatment program.”
“This is particularly important given that mental health–related ED visits among emerging adults have increased in North America. In Ontario, this increase has occurred at more than double the rate of corresponding increases in outpatient mental health visits, with anxiety disorders being the most common reason for ED presentations.”
Impact on costs to the health system
The research team is also investigating FEMAP’s impact on costs to the health system. In this study, they examined de-identified public health data from 2009 to 2015 to compare 366 FEMAP patients to a control group of 660 patients who received care elsewhere in the geographic region.
They found that over the course of one year, FEMAP patients cost the health system significantly less money for inpatient hospital services, ambulatory services and drug benefit claims, and significantly more money for physician services. Overall the cost of FEMAP was less, but the difference was not statistically significant.
“While the total cost difference was not found to be significant, these results might represent FEMAP patients accessing care in settings most appropriate to their needs,” explains Dr. Ava John-Baptiste, Associate Scientist at Lawson, Assistant Professor at Schulich Medicine & Dentistry, and Adjunct Scientist at ICES. “Increased use of physician services combined with access to a broader range of treatments, including psychology, counselling and social services, may make FEMAP a worthwhile investment.”
The team hopes to conduct further studies on the cost-effectiveness of the FEMAP program, which currently relies on funding from research grants and donors through London Health Sciences Foundation. They will also continue researching patient outcomes as a result of treatment at FEMAP.
---
“Process Evaluation of a Treatment Program for Mood and Anxiety Disorders Among Emerging Adults: Preentry Factors, Engagement, and Outcomes” is published in Psychiatry Services.
“Access and Health System Impact of an Early Intervention Treatment Program for Emerging Adults with Mood and Anxiety Disorders” is published in The Canadian Journal of Psychiatry.
“Healthcare utilization costs of emerging adults with mood and anxiety disorders in an early intervention treatment program compared to a matched cohort” is published in Early Intervention in Psychiatry.
