In primary care settings in developed countries, depression and anxiety rank as the third most common reason for consultation [
1]. Depression and anxiety are also considered the second most common condition in patients with comorbidities [
2]. In Canada and throughout the world, mood and anxiety disorders are the most prevalent mental illnesses [
3]. Individuals experiencing psychological distress most often initially consult in primary healthcare because it is accessible, less stigmatising, and more comprehensive, managing both physical and mental health [
4]. In the previous decade, patients consulting for mental disorders accounted for 20 to 25% of family physicians’ clientele [
5], but this number is likely much higher now. Indeed, a pan-Canadian survey, conducted during the pandemic, showed that 76% of primary care clinicians reported that they were seeing an increased number of patients with mental or emotional health needs [
6].
In their mental health practices, primary care physicians mentioned that the major obstacles to care for patients are difficulty accessing specialised resources and the scarcity of mental healthcare workers [
5]. They identified direct communication and collaboration with psychologists as being beneficial for patients [
5]. Thus, having a psychologist integrated into a primary care team facilitates patient access to psychological services [
7]. It is estimated that the integration of psychotherapy into primary care could result in a 20 to 30% decrease in medical costs [
8]. However, limited availability of publicly funded services represents a real barrier to accessibility [
9], leading to the creation of waiting lists that may stretch over several months [
10].
The current COVID-19 pandemic has the potential to create a secondary crisis of psychological distress and mental health system spillover [
11] that will have an increasingly negative impact on the mental health of communities [
12]. Considering that current service delivery models are insufficient to meet this increased demand, innovative models are needed to deliver mental health care to communities [
13]. The aim of this study is to analyze one such innovative model: a single-session intervention in psychology, delivered in primary healthcare.
Choosing a model of service delivery: the Single-Session Intervention (SSI)
The primary care environment under study aims to provide mental health services, while fulfilling its mission to serve all enrolled patients and maintain quality of care. Previous experience has shown that traditional models of service delivery in psychology, offering 8 to 12 sessions for each patient (in short-term approaches), quickly leads to a blocking of the schedule and the creation of a waiting list of several weeks. With very limited resources (half-time psychologist), a new model of service delivery was required to respond to the needs of patients with psychological distress in a timely manner.
A review of the literature revealed that, when considering interventions in mental health, patients were generally very satisfied with brief treatment episodes, even with a single session [
14]. In fact, the Single-Session Intervention (SSI) is not a new type of intervention, having been used by clinicians since the late 1970s [
15,
16], but its recognition by the literature is more recent [
17].
SSI is a modality of treatment that is conceptualized as an attitude or an approach to practice, rather than a specific therapeutic model [
18,
19]. Considering that most users only come once [
20] and that the majority of those attending an SSI find it sufficient and helpful [
21], delivery of psychological services through SSI could make it possible to meet the mental health needs of many patients.
Even if SSIs may be seen as an “extreme” form of brief therapy [
14], their short-term effectiveness has been shown by several studies [
14,
21‐
24]. In addition, positive results and satisfaction levels seem to be maintained over the medium to long term, ranging from a few weeks to several years, both in adults and in children and adolescents [
14,
23,
25,
26]. In terms of improving distress or initial symptoms, or reducing the severity of the problem/symptoms, effectiveness rates vary from 63 to 78% [
17,
22,
23,
27,
28]. Similarly, other studies have shown a significant decrease in anxiety, depression, levels of distress, and psychopathology [
29‐
32]. Moreover, the beneficial effects of an SSI are only slightly lower than those of a traditional multi-session intervention [
33].
Considering that readiness for change is optimal when a person asks for help [
16], as they are actively seeking to solve their problem [
28], it is important that an intervention is delivered in a timely manner. Knowing that a delay in accessing services increases the risk of a person’s condition deteriorating [
34] and their use of critical care services [
35], Advanced Access (AA) model principles could inspire the provision of psychological services in primary healthcare [
36]. AA is an organizational model that aims to improve accessibility for patients and support their relational and informational continuity with a primary healthcare provider or team [
37]. The AA model is a patient-centered approach, where the patient can access the service they need from the right professional at the right time [
38].
Initially developed in the United States in 2001, AA was mainly geared towards physicians and nurse, but it now seems relevant to engage in more interprofessional collaboration [
39]. The AA models have been revisited to more interdisciplinary team practice, based on five guiding pillars; 1) comprehensive planning for needs, supply, and recurring variation, 2) regular adjustment of supply to demand, 3) processes of appointment booking and scheduling, 4) integration and optimization of collaborative practice, 5) communication about advanced access and its functionalities [
40].
Since its development, AA has been implemented widely in North America, Europe, and Australia to engage professionals in more interprofessional collaboration [
41,
42] and to ensure both effective implementation and patient-centered care [
43]. A recent study exploring the possibilities and adaptations needed to transpose the principles of AA to a wider range of professionals [
44] served as inspiration for the conceptualisation of an SSI in psychology in primary healthcare settings.
Therefore, the main objective of the present study is to assess the feasibility and the effects of an SSI in psychology, delivered in primary healthcare settings. Regarding accessibility, the specific objectives are: 1) to assess whether the SSI service delivery model leads to a significant increase in accessibility, in terms of the number of patients who obtain a psychological consultation; 2) to evaluate whether the SSI model allows for faster access to service; and 3) to verify if the SSI model leads to a decrease in missed appointments. Regarding the clinical effects of the SSI, the objectives are as follows: 1) to assess whether the SSI contributes to the reduction of the intensity of problem and psychological distress, as perceived by patients, as well as the increase of their emotional well-being; 2) to examine if these effects are maintained over time; and 3) to evaluate patients’ satisfaction with their consultation experiences.