Psychiatry

• Support research that addresses the needs of individuals of marginalized and underserved communities (e.g., social determinants of health)
• Produce research that identifies mechanisms contributing to the persistence of mental health disparities, and tests interventions aimed at reducing disparities, improving outcomes, and promoting equity
• Advance research on chronic health conditions including research on co-morbid mental health and substance use disorders and their pediatric antecedents, including trauma/adverse childhood experiences (ACEs), social determinants, and health disparities

Reproductive Psychiatry

Reimagining Perinatal Mental Health Services: Collaborative Development Of An Integrated Model Of Care (Project link)

Co-leads: Dr. Emily Jenkins and Michelle Carter

Team Members: Wendy Hall, UBC; Angela Russolillo, SPH; Brittany Bingham, VCH; Christine Ou, UBC; Valerie Rychel, SPH; Sheila Duffy, Pacific Post-Partum Society; Nichole Fairbrother, UBC.

Perinatal mood and anxiety disorders (PMADs) are the most common obstetrical complication in Canada, with serious implications for both the mother and infant. Untreated PMADs are associated with increased risks for poor health and social outcomes, including maternal suicide and medical complications as well as impaired infant and child development. There is increasing scientific evidence that collaboration across clinical services is essential to addressing the complex bio psychosocial needs associated with PMADs. Nevertheless, perinatal mental health (PMH) services in Canada remain fragmented, often resulting in missed opportunities to support necessary care and treatment. There is an immediate need to improve the access and integration of services for PMADs in BC. In an effort to narrow the evidence to practice gap, we plan to create a collaboration between clinicians, researchers and individuals with lived experience through a scientific consensus process (Delphi approach) and one-day virtual workshop. Our main objective is to develop an evidence-based, user-informed model of care to advance integrated PMH care delivery in BC and beyond.

Complex Co-occurring Disorders & Acute Psychiatry

Redesigning health care for concurrent disorders: The role of multimorbidity in complex co-occurring psychiatric and substance use disorders (Project link)

Advancing Health lead: Angela Russolillo

Project Summary: Individuals with both psychiatric and substance use disorders, defined as concurrent disorders, are more complex to diagnose and treat due to several interacting health and social challenges. In the absence of appropriate treatment people with concurrent disorders are at high risk for increased morbidity and mortality. A growing body of evidence recommends abandoning the traditional single-disease health model in favour of a multimorbidity approach to care. Despite available evidence, important gaps persist in our understanding of how individual and health system context influence service utilization and outcomes for people with complex multimorbid disorders (e.g. concurrent disorders). The proposed research will establish a prospective cohort of individuals with a concurrent disorder. Individuals will complete a series of brief questionnaires and provide consent to use their personal identifiers for linkage to a number of health databases. This research offers a unique opportunity examine health outcomes associated with multi-morbidities and understand patterns of health care utilization overtime. This research will advance knowledge to inform best practices and service reforms for the optimal delivery of care in BC.

Patient Acuity and Complexity (PAC) Study

Advancing Health lead: Angela Russolillo

Project Summary: A retrospective cohort study (2016-2020) examining the clinical and demographic characteristics of admitted psychiatric patients and their relationship to hospital service use (length of stay [LOS] and readmission) over time. This research will advance knowledge to inform best practices and service reforms for the optimal delivery of care.

Study Findings:

COVID 19 and Psychiatric Inpatient Admissions: Recent findings from Dr. Russolillo and colleagues demonstrate associations between length of stay (LOS) and diagnosis type for psychiatric inpatients (St. Paul’s Hospital) during the COVID-19 pandemic. The admission rate of schizophrenia, delusional and non-organic psychotic disorders was significantly lower during the pre-COVID period, when compared to the during-COVID period and the admission of substance-related disorders was significantly higher during the pre-COVID period when compared to the during-COVID period. Manuscript pending.

Homelessness and Psychiatric Readmission: Recent findings from a retrospective cohort study found that homelessness at discharge was associated with a statistically significant and clinically meaningful increase in 30-day and 90-day readmission rates in a large comprehensive sample of adults diagnosed with mental illnesses and substance use disorders. Interventions to reduce the burden of readmissions among individuals experiencing homelessness, addiction and mental illness are critical. Our findings reinforce the urgent need to revise policies and practices addressing housing and social care. Manuscript pending.

• Support research that leverages mobile and other emerging technologies to develop, test, and deliver targeted prevention and treatment interventions for mental health disorders
• Support innovations that facilitate monitoring and early detection for individuals with mental illness that might signal the need for additional or more intensive services to reduce relapse or hospitalizations

Patient Experiences of Using Virtual Care — Outpatient Psychiatry

Advancing Health lead: Angela Russolillo

Project Summary: The COVID-19 pandemic has resulted in a significant increase in the use of virtual health services because of the need to limit face-to-face contact. We aimed describe the demographic characteristics of patients accessing virtual health service and measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. Results support ongoing need for virtual health services post COVID-19 pandemic. Patients reported feeling extremely satisfied or satisfied with the overall virtual health experience noting positive experiences across several care quality domains.

• Work with partners/collaborators, including government, targeting preventative and early intervention opportunities for mental health.
• Pool data across research areas (e.g., imaging, genetics, socio-demographics) to model information and implement solutions to clinical problems.
• Produce population health solutions that address prevention and treatment for the most challenging mental health and addictions issues (e.g., concurrent disorders).

Clozapine Toolkit

Development and Implementation of a Clozapine Toolkit in Inpatient Psychiatry (Poster link)

Michelle Carter…., Angela Rusollillo, Joseph Puyat.

Implementation of Harm Reduction Best Practice In Acute Psychiatry — Substance Use Assessment and Documentation (SAD) study

Advancing Health lead: Angela Russolillo

Project Summary: Individuals with both a psychiatric and substance use disorder are at increased risk for drug related death. Harm reduction interventions such as take home naloxone and safe injection sites are known to reduce the risk of over dose death; however, evidence uses poor uptake in acute psychiatric settings. Clinician attitudes, stigma and provider specialization are factors impacting the implementation of harm reduction best practice. Our study seeks to explore health care provider attitudes towards substance use and examine substance use assessment and documentation practices by health care provider.

Attitudes towards people who use substances: A survey of mental health professionals from an urban hospital in British Columbia

Project Summary: A survey based on the Brief Substance Abuse Attitudes Survey was conducted in a convenience sample of mental health care providers at a single tertiary care hospital between May and June 2022. Our study found that postgraduate education contributes to less stereotyping attitudes and a higher level of treatment optimism when working with individuals with substance use or dependence. These findings highlight important dimensions of health care provider attitudes that could improve harm reduction education and integration into clinical practice. Manuscript pending.

Developing a Model That Works: Integrated Care for Individuals with a Concurrent Disorder – A Delphi Study

Advancing Health lead: Angela Russolillo

Project Summary: Individuals presenting with concurrent disorders have historically encountered a treatment system that has been ill-prepared to meet their needs. Despite evidence that individuals with a single diagnosis are a clinical minority, integrated management approaches are rare in the current medical system. We aim to bring health care providers, researchers and patients/families together through a Delphi study. The study will be achieved through a series of questionnaires ranking items of high importance for integrated treatment. Items reaching consensus will be prioritized for inclusion into a clinical framework to support pragmatic approached to service delivery. Project link.