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 reoccurrence 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 systemwide 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)
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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 in Canada. Comprised of Credit Valley Hospital, the Mississauga Hospital
and the Queensway Health Centre. Trillium Health Partners serves the growing and
diverse populations of Mississauga, West Toronto and surrounding communities.
Trillium Health Partners is a teaching hospital affiliated with the University of
Toronto. Trillium Health Partners 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.