Canadian psychological practice: Development of low intensity/high volume initiatives in public healthcare.

Abstract

Low intensity-high volume (LI-HV) interventions are increasingly being recognized as a means to communicate psychological principles and provide services to those with unmet mental health care needs. This article describes several different applications of LI-HV interventions in a central Canadian province, where underfunding of psychologists is well documented. The settings reviewed included tertiary hospital anxiety, depression, and sleep clinics, primary care, and a provincial mental health crisis setting. Descriptions of the LI-HV innovations and the impact of these innovations on referrals, providers, patients, and the healthcare system are reviewed. Some of the conclusions from these findings are that it is feasible to develop LI-HV interventions for psychological care, especially with limited psychologist resources. Patients find such interventions to be acceptable and satisfactory. Improvement in symptoms is often noted with LI-HV interventions, although the magnitude of improvement may be less than what is obtained with higher intensity services. Further, the provision of LI-HV services often results in changes to the higher intensity service. Anecdotally, psychologist providers report that the interventions are worth the investment. More work on investigating the efficacy of stepped care in this area is warranted.