What started in the basement of St. Michael’s Hospital in downtown Toronto nearly 50 years ago has evolved into a network of family medicine clinics. Today, six clinics, located in diverse neighbourhoods in downtown east Toronto, serve the needs of more than 50,000 patients, of whom 30 per cent are living with low income.
Dr. Karen Weyman is Chief of St. Michael’s Hospital Department of Family and Community Medicine (DFCM), which operates the clinics. She says that each location provides comprehensive care, along with various specialties like addiction medicine, HIV and LGBTQ2S+ health – but all have a guiding principle in common.
“We focus on looking after all our patients, with compassion and respect,” she says. “We take an equity lens to everything we do, so that each person gets the care they need.”
The clinics’ staff of 250, including 80 family physicians and seven nurse practitioners, do that by taking social determinants, like housing, race and income, into account.
For instance, those who can’t afford it have access to physiotherapy, chiropractic, counselling, dental care and legal services. And for those who are having trouble making ends meet, there are staff, known as income support health promoters, who help them negotiate the system.
The department’s work has been so innovative that it was recognized by the World Health Organization for improving primary-care delivery in Toronto’s inner-city community.
For the last eight months, COVID-19 has had a big impact on how care has been provided, according to Dr. Weyman.
“While COVID has affected everyone, it has had a disproportionate impact on people experiencing disadvantage, not only income-wise, but also those living with mental-health conditions, substance-use disorders and HIV,” she notes. “Patients living on lower incomes must go to work and travel to work, putting them at higher risk. And for families living in small spaces, being able to isolate if they need to is difficult.”
COVID-19 has magnified pre-existing challenges of caring for people living in poverty, those experiencing homelesssness or those who face racism, says Dr. Weyman.
“As a society, we can’t ignore social and structural issues that impact people’s health,” she notes. “For instance, patients who don’t have a phone or internet are having more trouble accessing health care.”
To bridge the gap, within two weeks of the pandemic being declared, St. Michael’s DFCM created a COVID-19 Social Determinants of Health working group. A number of initiatives were launched, including proactive wellness checks for more than 2,000 patients who were especially vulnerable to the effects of COVID-19, providing food cards, referrals to other forms of support and even buying tablets and phones for patients for telemedicine appointments.
“Our health-care team was able to figure out what each person needed and then link them with the right resources,” says Dr. Weyman.
Mental health continues to be an area of concern. “We’ve always cared for a higher proportion of patients who suffer from mental-health illnesses, including bipolar disorder and schizophrenia,” says Dr. Weyman. “I’ve seen firsthand in my own practice that these illnesses have worsened, along with increased alcohol and drug use, during COVID. Some patients have been suffering from episodes of psychosis and need more intensive treatment, including hospitalization.”
Twenty-one-year-old Pamela Smith (not her real name) has been struggling with depression and anxiety since she was a child. After high school, she found it increasingly difficult to get out of bed and had thoughts of suicide. Through Dr. Weyman, who has been Pamela’s and her parents’ physician for many years, Pamela was able to tap into the resources she needed. By combining medication and cognitive behaviour therapy, she learned ways to regulate her mood by seeing a social worker and attending a youth group.
“I was able to create a toolbox of coping mechanisms,” Pamela says, “like deep breathing, finding things I enjoy doing and challenging my thoughts.”
It had a profound effect on her life. She is currently in her first semester of college, studying to be a vet tech and, until recently, volunteered to shape mental-health policy through a youth advisory council at St. Michael’s Family Health Team. She continues to see her social worker for support. “I feel so much better,” she says. “I can now imagine my life five years from now and I’m hopeful about my future.”
Stories like Pamela’s are gratifying for Dr. Weyman: “I think the St. Michael’s Academic Family Health Team provides a sense of connection, particularly for people feeling socially isolated or facing challenges. I hope we can give patients with mental illnesses a sense that there are people who care and are there for them.”
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