Objective: To provide rapid evaluation and non-pharmacological treatment of mental health symptoms in Parkinson’s disease (PD) patients and their caregivers.

Background: Mental health problems are common in PD but access to support is often inadequate. Up to 40% of PD patients experience depression, anxiety, apathy, grief and coping difficulties. Focused assessment and non-pharmacologic management of these symptoms are within the scope of practice of a nurse with mental health training.

Method: We piloted a nurse-led rapid access mental health clinic. Patients with PD and mental health symptoms were eligible. Their movement disorders neurologist referred patients. If desired, patients and their caregivers underwent a virtual mental health intake assessment that included a focused history, education and local resource finding. A single virtual follow-up appointment was offered. Screening scales (Beck anxiety (BAI) and depression (BDI) inventories, PDQ-39) were administered pre-evaluation. Outcome measures included clinic metrics, patient satisfaction, and qualitative process measures.

Results: 26 new patients (65% male, mean age 67.5 yrs +/- 25.6 SD) were seen between September and December 2020. 17 of these patients were seen in follow-up. Mean PD duration was 6 +/- 4 SD. 46 % had pre-existing psychiatric diagnoses (38% anxiety, 46% depression; mean BDI was 20 +/- 8 SD; mean BAI was 22 +/- 10 SD). The average wait time was 25.6 days +/- 11.4 SD. Anxiety, uncertainty of disease trajectory, Covid-19 stress, and fluctuating mood symptoms were the most common complaints. Other common concerns were lack of education about PD and the neglected role of care partners. Interventions included: validation, normalization, PD education, body relaxation work, caregiver support and recommendation for psychotherapy. Referral to psychiatry was suggested in 8%. Patient satisfaction was high, and 65% of patients requested a follow-up. Local resource finding was needed in 45%.

Conclusion: A rapid access mental health clinic is a feasible, effective and patient-centred care pathway in PD. Patients benefit from a focused mental health evaluation and appreciate non-pharmacologic management strategies. Only a small proportion of patients required psychiatric review, suggesting that this model may be cost-effective in avoiding neuropsychiatrist referrals. Resource-finding is labor-intensive and collaborative models with social work can be explored.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/nurse-led-rapid-access-mental-health-clinic-a-new-care-pathway-in-parkinsons-disease/