Backgrounder: Transforming Lives
A New Model of Integrated Care for Medical and Psychiatric Illness
The Challenge
In Ontario, 1.3 million people suffer from co-morbid physical and mental health illness. In many cases, treatment of these patients fails because our health care system is designed to focus on either physical or mental illness but not both at the same time. As a result, physical symptoms with a mental health origin often go unaddressed. Similarly, debilitating mental illnesses such as depression and anxiety can continue indefinitely because they may in fact be the result of physical ailments. The lack of an integrated approach perpetuates the condition.
In these cases, patients and their families endure prolonged suffering accompanied often by a growing sense of despair as they see little or no improvement in their health. The severity of their symptoms, combined with the time and energy required to attend a series of medical appointments, can result in absenteeism or poor performance at work and school, permanently hampering career prospects and quality of life. As time goes on, their ongoing condition can exact a tremendous personal toll and lead to trauma and addiction issues.
The gap in services can be particularly acute for those between the ages of 16 and 24 who fall between paediatric and adult streams of care. A difficult time of life in the best of circumstances, research has shown that the stress of transition into adulthood often precipitates the first episodes of psychiatric illness or a re-occurrence of a pre-existing condition. These particularly vulnerable patients may drop out of treatment if it is not relevant to their needs, resulting in increased symptoms, repeated medical interventions and withdrawal from school, the workforce and the community—potentially for life.
Family physicians share patients’ frustration and, in the absence of a comprehensive diagnosis, they may over-investigate the physical symptoms. The resulting unnecessary diagnostic testing and recurrent use of family doctors and emergency department resources drive up health costs by as much as 45 percent. It is estimated that Ontario spends $2.75 billion on individuals with combined illness. Untold costs include the impact on economic productivity associated with the loss of employment and education opportunities.
The disconnect between treatment of mental and physical health issues is deeply rooted within the framework of the health care system. Its resolution requires a coordinated approach across the entire continuum of health care.
The Medical Psychiatry Alliance
To meet the challenge of treating people with co-morbidities and to effect system-wide change, we will create an unprecedented network of excellence through the Medical Psychiatry Alliance. The Alliance will create a new model of integrated care that is supported by a new approach to the education of health professionals and through innovations driven by research.
The Alliance will be led by a consortium that brings a unique set of capabilities to the table: the Centre for Addiction and Mental Health (CAMH), the Hospital for Sick Children (SickKids), Trillium Health Partners and the University of Toronto. This collaboration features renowned strengths across clinical care, mental health, education, and research.
The powerful benefits of the collaborative nature of the Alliance will be carefully safeguarded through joint governance. The sharing of supervision by all partners will ensure accountability and results through measurement of outcomes and will also allow the Alliance to draw on a deep pool of stakeholders with whom the founding members already have long-standing relationships. This group is situated at the centre of one of the world’s major health care and medical research clusters. Their partners include Family Health Teams and practices, academic centres of the Toronto Academic Health Science Network and all health divisions of the municipal, provincial and federal governments. The many physicians who will be affiliated with the Alliance are cross-appointed to U of T and one of the partner institutions or another major Toronto hospital.
The profile and influence of the Alliance and its location within the Greater Toronto Area is ideal for the development of scalable new care models supported by integrated health education. Furthermore, creating these models within the largest and most diverse urban area in Canada with the greatest socioeconomic disparities will yield data containing the widest possible set of variables. Dissemination of information throughout the province can occur through existing channels including the new Ontario Links Initiative as well as through the Provincial System Support Program led by CAMH, or another major Toronto hospital.
The Collective Advantage
The four founding organizations of the Medical Psychiatry Alliance are located in the Greater Toronto Area, representing one of the world’s leading health care and medical research clusters. Each institution brings expertise, resources and a network of relationships to the Alliance that will provide the platform for an unparalleled integrated approach to patient care, teaching and research.
This collective advantage lies at the heart of this opportunity.
The Centre for Addiction and Mental Health (CAMH)
– CAMH served more than 28,000 patients and saw approximately 500,000 outpatient visits last year
– CAMH scientists have made personalized medicine for psychiatric patients a reality, using a patient’s genetic make-up to predict which medications are safe and effective
– CAMH treats those along the continuum of care from early intervention to complex mental illnesses, starting in the early years right through late life
– Last year, 7,425 professionals participated in CAMH’s training sessions; 7,377 people attended public education events and 486 articles appeared in peer-reviewed journals
The Hospital for Sick Children (SickKids)
– SickKids delivered 102,037patient days in 2012-13 with total operating cases numbering 11,906
– The hospital has extensive expertise in the integration of research, education and clinical care through its centres for Bone Health, Brain & Mental Health, Cancer, Cystic Fibrosis, Genetic Medicine, Healthy Active Kids, Heart, Inflammatory Bowel Disease, Image Guided Care, Pain, Transplant & Regenerative Medicine, and Global Child Health
– Each year, about 2,000 children with the most complex care needs in the province will have an inpatient visit to SickKids and many more will visit one or more clinics at the hospital Last year, SickKids researchers were the first to apply whole genome sequencing to autism and provide a definitive look at the wide-ranging genetic variation associated with the syndrome.
Trillium Health Partners
– Trillium Health Partners is one of the largest community-based acute care facilities in Canada delivering highly specialized regional programs including: Cardiovascular, Maternal-Child, Oncology, Renal Dialysis, Clinical Genetics, Seniors’ Health, Sexual Assault & Domestic Violence and Stroke & Neurosciences
– Trillium Health Partners is a teaching hospital affiliated with the University of Toronto and an associate member of the Toronto Academic Health Science Network
– With more than 1.5 million patient visits, Trillium Health Partners is one of the largest community hospitals in the province
– A full 90 per cent of all mental health visits to Trillium Health Partners hospital sites are received through Emergency Department (ED). Since 2009, mental health ED visits grew by one-third.
– Emergency and Urgent Care program at Trillium Health Partners currently sees more than 250,00 patients a year
– Paediatric mental health ED visits have increased by almost 32 per cent in just three years.
– Trillium Health Partners is located within one of the most richly-diverse communities in the country with an escalating demand for specialized mental health care services – especially timely, expert treatment for patients in mental distress who arrive at our Emergency Department.
University of Toronto
– U of T’s Faculty of Medicine is first in Canada and consistently ranks in the Top 20 programs worldwide
– The Faculty of Medicine has more than 475 neuroscience and brain health researchers engaged in leading-edge work in areas such as early development and cognition, addiction and mental illness
– U of T features expertise in curriculum design, evaluation, and educational scholarship; an integrated allied health professional curriculum; and integrated faculty development
– Last year, University of Toronto trained more than 1,000 medical students and delivered postgraduate programs for all specialties, including 200 psychiatry residents
More about the Partners
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, and one of the world's leading research centres in the field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca.
Trillium Health Partners is one of the largest community-based acute care facilities inCanada. Comprised of Credit Valley Hospital, the Mississauga Hospital and theQueensway Health Centre. Trillium Health Partners serves the growing and diversepopulations of Mississauga, West Toronto and surrounding communities. Trillium HealthPartners is a teaching hospital affiliated with the University of Toronto. Trillium HealthPartners is an associate member of the Toronto Academic Health Science Network.
The University of Toronto has assembled one of the strongest research and teaching faculties in North America, presenting top students at all levels with an intellectual environment unmatched in breadth and depth on any other Canadian campus.U of T faculty co-author more research articles than their colleagues at any university in the US or Canada other than Harvard. As a measure of impact, U of T consistently ranks alongside the top five U.S. universities whose discoveries are most often cited by other researchers around the world. The U of T faculty are also widely recognized for their teaching strengths and commitment to graduate supervision. Established in 1827, the University of Toronto today operates in downtown Toronto, Mississauga and Scarborough, as well as in 10 renowned academic hospitals.