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University of Toronto
Department
of
Psychiatry
2002–2003 annual report
Contents
Chair’s Report
Research Report
Report of the Vice-Chair
Types of Funding Received
Sources of Funding Received
Education Report
Report of the Acting Vice-Chair
Undergraduate Education
Post-graduate Education
Continuing Mental Health Education
Fellowship Program
Programs and Divisions
Addiction Psychiatry Program
Culture, Community, &
Health Studies Program
Division of Child Psychiatry
Division of General Psychiatry
Ontario Psychiatric Outreach Program
Division of Geriatric Psychiatry
Law and Mental Health Program
Health Systems Program
Mood and Anxiety Disorders Program
Neuroscience Program
Psychiatry, Health, and Disease Program
Psychotherapy Program
Schizophrenia Program
Women’s Mental Health Program
1
5
5
6
6
9
9
11
14
18
22
Settings
Baycrest Centre for Geriatric Care
Centre for Addiction and Mental Health
Hincks-Dellcrest Centre
Joint hsc-camh Child Psychiatry Program
Mount Sinai Hospital
St. Michael’s Hospital
Sunnybrook & Women’s College
Health Sciences Centre
Surrey Place Centre
uhn Department of Psychiatry
The George Hull Centre
63
63
65
69
71
74
77
80
84
87
90
Administration
93
25
Faculty List
95
28
31
34
36
39
42
45
48
50
52
55
58
60
Research Funding
115
Publications
159
25
Refereed Articles
Books and Reports
Book Chapters
Fast Facts
159
173
174
177
Chair’s
Report
The Department of Psychiatry at the
University of Toronto
has concluded
another very successful year.
T
he Department of Psychiatry at the University
of Toronto has concluded another very
successful year. Details of the department’s
various activities are included in the body of this
report. I will highlight a number of important
accomplishments achieved by outstanding individuals
and groups. I would like to acknowledge the very
strong support provided by the Departmental
Executive Committee and the Senior Advisory
Committee and by the administrative staff of the
department headed by our Business Officer, Eva
Wong.
For the first time in its history, this year the
Faculty of Medicine gave awards for Excellence in
Post-graduate Education. Essentially, the entire 5,000
member faculty was eligible and only four awards
were given. One of the four was won by a member of
our department—Dr. Susan Lieff—in the category
of teaching, advocacy, and mentoring. This is a
tremendous honour and reflects Susan’s ongoing
commitment to supporting and encouraging students,
residents, fellows, and junior faculty in developing
strong and effective professional and personal roles.
This year, Drs. Shitij Kapur and Art Petronis
were the first two recipients of the Ontario Mental
Health Foundation Special Initiative Grant. The
grant provided $1 million each to Shitij and Art for
their new exciting and innovative research projects.
Shitij’s project is “Decoding Schizophrenia, Putting
the Pieces Together, Linking Genes, Neurochemistry,
Cognition, Affect, and Neuronetworks.” Art’s project
is “Epigenetic Studies of Chromosome 22 in Major
Psychosis.”
Dr. Sarah Landy, according to Dr. Joe Beitchman,
“in her own quiet way continues to accumulate
honours.” This year, she received the ywca Women
of Distinction Award for the Professions and
the Canadian Psychological Association Award
for Distinguished Contributions to Public and
Community Service. These awards reflect Sarah’s
ongoing efforts to encourage the healthy social and
emotional development of young children in Canada.
Finally, Dr. Donna Stewart was chosen for the
World Federation of Mental Health’s 2003 Biannual
Margaret Mead Memorial Lecture and Award.
Her lecture entitled Global Interventions to Improve
Women’s Mental Health was given in Melbourne in
February 2003. In addition, Donna was selected
2002–2003 department of psychiatry annual report
by the American Psychiatric Association and
Association of Women Psychiatrists to receive
the 2003 Alexandra Simmons Award—given to a
woman psychiatrist to acknowledge her outstanding
contributions and leadership in promoting women’s
health and the advancement of women. This award
includes a named lecture, which Donna presented at
the American Psychiatric Association annual meeting
in San Francisco this year.
I would like to congratulate our colleagues who
were granted academic promotion. Progress through
the ranks represents the best indicator of the strength
and vitality of a university department, and once
again this year promotion was achieved by a group
of very accomplished individuals. Promoted to Full
Professor were Drs. Anthony Feinstein, Shitij Kapur,
and Stephen Kish; to Associate Professor, Drs. Susan
Lieff, Martin Lalumière, and Peggy Richter; and to
Assistant Professor, Drs. Lindley Bassarath, Shree
Bhalerao, Carolina Cristi, David Dixon, Goran
Eryavec, John Langley, Henry Leung, Paula Ravitz,
and José Silveira. Once again, all of the candidates put
forward by our Departmental Promotions Committee
were successful, and I would like to thank Dr. Gary
Rodin who chairs our committee and the committee
members for their excellent work on our behalf and
on behalf of our candidates. I would also like to
acknowledge the terrific work done by Kathy Ostaff,
the Chair’s Assistant, in supporting the promotions
process.
Also this year, we have added two additional
Endowed Chairs. Dr. Anne Bassett was awarded
a Tier i Canada Research Chair in the Genetics of
Schizophrenia. Dr. David Wolfe became the inaugural
holder of the rbc Investment Services Chair in Child
Development and Psychopathology. Anne and David
will be leading important academic programs in their
respective areas, supported by generous endowments.
There have been a number of other important
changes. Dr. Ivan Silver, who has been absolutely
outstanding as our Director of Continuing Mental
Health Education, is now Director of the new
Faculty of Medicine / St. Michael’s Hospital Centre
for Faculty Development. This is a very important
new initiative at the faculty level, and it is a tribute
both to Ivan and to our department that he has been
chosen to provide leadership. Dr. Brian Hodges, our
equally outstanding Vice-chair, Education, is the
new Director of the Faculty of Medicine / University
Health Network Centre for Research in Education.
This is an extremely important leadership position
in the Faculty of Medicine, because the centre is
the focus for research and scholarly activity that is
related to teaching and learning in the medical school.
The fact that two of the three Faculty of Medicine
educational partnership programs are led by members
of our department is quite remarkable and probably
unique. In light of Ivan’s new responsibilities, he
has stepped down as our Director of Continuing
Mental Health Education, and this position has been
assumed by Dr. Sagar Parikh, who has himself already
established a very strong track record of achievement
and scholarship in the cme field. So the torch has been
passed to very capable hands.
One of the true leaders in our department, in
every sense of the word, Dr. David Goldbloom, is
stepping down as Physician-in-Chief at camh after
8 successful, entertaining years of exemplary service.
David has managed several considerable challenges
with unfailing grace, effectiveness, and good humour.
As of July 1, 2003, David’s new position will be Senior
Medical Advisor, Education and Public Affairs at
camh. I hope we will be able to engage him in a
number of important university activities in the years
to come.
Dr. Anthony Levitt, who has guided and expanded
our Fellowship Program, will be stepping down on
July 1, 2003, as a result of increased administrative
responsibilities at Sunnybrook & Women’s College
Health Sciences Centre. Anthony has done a splendid
job and has built a very solid foundation for his
successor.
We have continued this year to make progress with
our strategic plan. Dr. Trevor Young, working with
Drs. Bob Zipursky and Allan Kaplan, has done a
superb job of launching our new Clinician Scientist
Training Program. The inaugural participants in the
program—all pgy1 residents entering the Clinician
Scientist Stream—are Drs. Craig Beach, Timothy
Guimond, Aristotle Voineskos, and Andrea Waddell.
Congratulations to all four successful candidates and
to Trevor and his colleagues for getting us off to a very
promising start.
In the area of International Mental Health, a group
of faculty members and Dr. Pria Watson, led by Dr.
Clare Pain and coordinated by Dr. Paula Goering,
spent several weeks in Ethiopia last January. As a
result, we have established taapp—the Toronto–
Addis Ababa Partnership Program. This program will
involve regular visits by faculty members and residents
to help establish a training program for psychiatrists
in Ethiopia—a country desperately in need. Also,
2
chair’s report
thanks to the participation of Drs. Morley Beiser,
Brian Hodges, and others, the program will have
strong research and pedagogical components. Other
initiatives currently in development involve Nigeria,
South Africa, and Sri Lanka.
Our formal program in education continues to
develop smoothly. A new gft faculty member is being
recruited to strengthen our capacity, a fellowship
position is being advertised, and Dr. Brian Hodges’s
new position heading the Centre for Research in
Education should ensure strong academic linkages for
the program to faculty educational initiatives.
In the area of diversity, Dr. Brenda Toner and
others have been working hard to encourage and
mentor female faculty members, and negotiations are
underway for assistance in developing strategies to
address ethno-cultural issues.
The population health initiative led by Drs.
Paula Goering and David Wolfe was the theme of
Harvey Stancer Research Day this year. We have
recruited new faculty in this area and are leading the
organization of a national workshop on population
health and mental health next year.
Finally, Dr. Peter Prendergast has undertaken a
number of activities in clinical service coordination,
including a review this summer of aspects of departmental financing. So we are advancing on all six fronts
identified in our plan 2 years ago.
The primary reason that a university and medical
school exist is to educate, and our department is
fortunate in being led by a group of superb individuals
who constitute our Education Council. This year was
particularly challenging for our educators as a result
of significant disruptions caused by sars, uncertainty
about the Alternate Funding Plan process, the absence
of our Vice-chair who was on sabbatical and, very
importantly, the absence of Tina Martimianakis, our
Undergraduate Education Administrative Assistant.
Despite all of this, our educators performed admirably.
Dr. Ivan Silver filled in as Vice-chair. Dr. Allan
Kaplan and others produced the best carms Match
in our history and put into place, on very short notice,
a computerized evaluation system for post-graduate
education. Dr. Jodi Lofchy not only managed all of the
challenges to the undergraduate program presented by
sars, but she was designated the outstanding Bruce
Tovee Lecturer by this year’s medical student class.
Our Fellowship Program, directed by Dr. Anthony
Levitt, was bigger and better than ever. Support for all
of this, provided by Marie Mara, Victoria Costantino,
and Iris Chan, was outstanding.
As for sars, there was, of course, considerable
disruption and major change in the way we functioned
this year. I would like to acknowledge the very
important contribution to the sars response made
by Drs. Bob Maunder, Jonathan Hunter, and others
at Mount Sinai Hospital. Early on in sars-1, a
psychological support team was organized at Mount
Sinai. Throughout the first phase of sars, every
sars patient at Mount Sinai Hospital was seen by a
member of the Consultation Liaison Team, usually
either Bob or Jonathan. A great deal of informal
support was provided to staff at the hospital. A dropin centre was established for staff, and a telephone
counselling service was put into place. As well, within
weeks, these important processes were described in
the on-line version of the Canadian Medical Association
Journal. Leadership has now been provided to involve
a number of Toronto hospitals in an international
study of staff responses to the sars experience. Bob,
Jonathan, and colleagues have provided us with an
excellent example of concern and responsiveness to key
psychological aspects of this particular crisis as a result
of which we should all be appreciative and impressed.
We have continued this year through a task
force chaired by Dr. David Goldbloom to discuss
relationships with the pharmaceutical industry.
David prepared a draft report to be reviewed by the
Executive Committee, which will be presented to the
faculty in the fall of 2003. I believe the task force has
taken the reasonable position that academic psychiatry
and industry will continue to relate to one another in
ways that will benefit patient care and the academic
enterprise. However, there must be clear guidelines
that are well understood in order to protect our
professional and scholarly integrity.
Other opportunities to influence public policy in
the coming year will be afforded by the work of the
Kirby Committee studying mental health in Canada,
responses to the release of the Mental Health Task
Force Reports in Ontario, and, it is hoped, increased
funding for community mental health arising from the
Romanow recommendations.
The department sponsored a number of events this
year. The second annual Department of Psychiatry
Golf Day was held on July 10, and a good time was
had by all! I would like to thank Dr. Shree Bhalerao
for his ingenuity in ensuring the event’s success. In
September, an important faculty development event
on relations with the pharmaceutical industry was well
attended and illustrated the need for us to pay more
attention to this important area. Both the Chair’s
3
Welcome Reception in the fall and the Holiday
Reception were popular social events. Harvey Stancer
Research Day, extremely well organized by Drs. Sean
Rourke and Bob Zipursky, was a great success. For
the first time this year, an outside keynote speaker
was chosen, and Dr. John Frank, Director of the cihr
Institute of Population and Public Health, gave a
magnificent address. This was followed by a panel and
open session on the applicability of population health
approaches in the mental health field in keeping with
a key element in our strategic plan. Unfortunately, as
a result of the sars outbreak, our very popular annual
Psychiatric Institute for Medical Students from across
Ontario was cancelled, but is sure to return in June
2004!
A number of outstanding new faculty members
from several disciplines have joined the department
this year. The Division of Child and Adolescent
Psychiatry has recruited Claire De Souza, md,
Marcia Zemans, md, and Eric King, msw, rsw
rsw. New
additions to the Culture, Community, and Health
Studies Program are Kenneth Fung, md, Lisa
Andermann, md, Hayley Hamilton, PhD, and Samuel
Law, md. Mathieu Albert, PhD, joined the Education
Program. In General Psychiatry Mara Goldstein, md,
Adam Quastel, md, John Court, ma, Nadine Cossette,
md, Frederick Kroft, md, Tom Hastings, md, and
Anna Skorzewska, md, were added to the faculty.
Geriatric Psychiatry welcomed Mark Rapoport, md,
Vicky Stergiopoulos, md, Cindy Grief, md, John
Verghese, md, Mujeeb ur Rehman, md, Franklin
Wong, md, Robert Madan, md, and Andrew Hackett,
md. New staff in the Health Systems Program
include Nancy Read, MSc (cross-appointment from
Nursing) and John Cairney, PhD. Ayal Schaffer, md,
Sophie Grigoriadis, md, PhD, Trevor Young, md,
PhD, Sandra Mendlowitz, PhD, Jun-Feng Wang,
PhD, David Kriendler, md, Arun Ravindran, md,
and Glenda MacQueen, md, PhD, joined the Mood
and Anxiety Disorders Program. The Neuroscience
Program recruited Pierandrea Muglia, md, and
Yoshiaki Furukawa, md, PhD. Psychiatry, Health,
and Disease welcomed Clare Brandys, PhD, Lisa
Trepanier, PhD, Valerie Voon, md, and Lucia Gagliese,
PhD (cross-appointment from Anaesthesia). New
faculty in the Psychotherapy Program are Yvonne
Bergmans, msw
msw, Paul Johnston, PhD, Cynthia Lazar,
md, and Martin Svartberg, md. The Schizophrenia
Program added Jean Addington, PhD, Jeff Daskalakis,
md, Donald Young, PhD, and Derek Hopgood, md, to
their staff. Marie-Claude Cuimond, md, Cheryl Rolin-
Gilman, rn, mn (cross-appointment from Nursing),
Lori Ross, PhD, Alicja Fishell, md,, Sharon Zikman,
md, and Nancy Biddle, md,, were all recruited by the
Women’s Mental Health Program.
Several faculty members departed this year to
pursue other endeavours, and we wish them all the
best. In particular, Dr. Heather Munroe-Blum was
appointed Principal of McGill University. We also
regret the loss of Dr. Jeanette Cochrane who passed
away this year. She will be sorely missed by her friends
and colleagues.
Donald Wasylenki, md, frcpc
Professor and Chair
4
research
Report
of the
Vice-Chair
Psychiatry has rapidly become a major
research-intensive medical specialty,
and many factors have contributed
to this dramatic shift
over the past 25 years.
P
sychiatry has rapidly become a major researchintensive medical specialty, and many factors
have contributed to this dramatic shift over
the past 25 years. The field of medicine has embraced
“evidence” as a critical factor for the establishment
of “best practices,” whether in drug treatment or
psychosocial interventions. For psychiatry more
specifically, the development of new scientific
disciplines and technologies has led to an exponential
growth in psychiatric research. Advances in the
neurosciences—including molecular biology, genetics,
brain imaging, psychopharmacology, neuropsychology,
and electrophysiological—have provided remarkable
new tools for the investigation of psychiatric illness.
The ongoing growth of our research activities in the
Department of Psychiatry reflects this revolutionary
time. Our total research funding has increased by
20% in this past year. This reflects a 40% increase in
funding from federal sources. Funding for operating
grants has increased by 40% this year and personnel
grants by 52%. At the same time we experienced
close to a 40% reduction in industry support for our
research and a 33% reduction in support for research
contracts. This trend to greater government funding
for operating and personnel grants reflects the
increasing capacity of our department to compete
nationally and internationally for research funding.
This year marks the founding of the Department
of Psychiatry’s Clinician Scientist Program. If our
department is to realize the potential that new
scientific advances create for our field, we will need a
new cadre of academic psychiatrists who have a high
level of expertise in a range of scientific disciplines.
Whether in epidemiology, health economics, molecular genetics, brain imaging, or other fields, our
faculty will need to have extensive research
2000–2001
2002–2003
2001–2002
Operating
$
20,430,167
$
20,143,848
$
28,122,981
Personnel
$
1,850,607
$
1,544,996
$
2,341,389
Contracts
$
5,987,348
$
8,064,138
$
5,383,748
Travel/Conference
$
51,211
$
750
$
59,583
Total
$
28,319,333
$
29,753,732
$
35,907,701
2000–2001
2002–2003
2001–2002
Federal
$
9,526,154
$
14,028,157
$
19,989,375
Provincial
$
4,226,170
$
6,130,422
$
6,784,198
Industrial
$
4,587,998
$
2,514,900
$
1,533,557
US
$
4,647,621
$
4,057,556
$
4,437,210
International
$
973,090
$
18,465
$
1,150,102
Miscellaneous Agencies
$
4,358,300
$
3,004,232
$
2,013,259
Total
$
28,319,333
$
29,753,732
$
35,907,701
(in millions)
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(in millions)
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research
training in order to make important contributions
to our understanding of mental illness. A number of
our newest faculty begin their academic careers with
not only specialty training as psychiatrists (md and
frcp[c]) but with a doctorate (PhD) in their area
of scientific expertise. This development has been
increasingly common in other medical specialties
and for major American psychiatry departments over
the past decade and will become more important
for psychiatry departments in Canada. It also has
important implications for the training of psychiatrists.
Our department as well as other departments of
psychiatry in Canada will need new faculty with
this high level of training. This poses a number of
substantial challenges in attracting exceptionally
talented people, integrating their clinical and research
training, and providing the mentorship and financial
support to sustain their career development. Building
on the experiences of the Clinician Scientist Programs
developed at the University of Toronto in the
Departments of Medicine, Surgery, and Pediatrics, we
have developed a program to facilitate the training of
clinician scientists in our Department of Psychiatry.
Trevor Young, md, PhD, the Head of our Mood
and Anxiety Disorders Program and an outstanding
role model for our trainees, will lead this innovative
new program. Residents accepted into the Clinician
Scientist Program will be provided with mentorship,
support for their research training, and a residency
experience that more closely integrates their clinical
and research pursuits.
The department hosted a very successful 29th
Annual Harvey Stancer Research Day on June
19, 2003, at the university’s Munk Centre for International Studies. We initiated what we hope will
become a tradition of inviting a keynote speaker from
outside our department. We were privileged to be
addressed by Dr. John Frank, Professor of Public
Health at the University of Toronto and Scientific
Director of the Institute of Population and Public
Health, Canadian Institutes of Health Research
(cihr). Dr. Frank highlighted the importance of
broadly conceptualizing the determinants of mental
health—a perspective that has been strongly endorsed
as a critical part of our department’s strategic plan.
We are very proud to announce the award of a new
Tier i Canada Research Chair to Dr. Anne Bassett.
Dr. Bassett is an internationally renowned expert in
the genetics of schizophrenia. This award recognizes
her important contributions to the field and her
sustained high level of productivity. This prestigious
award provides enhanced and sustained support for
Dr. Bassett’s research.
The Department of Psychiatry has had a most
productive year as evidenced by the ongoing growth
of our funding base and excellent productivity in
publications. We are confident that the innovations
that we have brought about this year will contribute to
the future strength of our research program.
Robert Zipursky, md, frcpc
Vice-chair, Research
7
education
Report
of the
Acting Vice-Chair
The Education Council oversees
educational activities of the Department of Psychiatry.
T
he Education Council oversees educational
activities of the Department of Psychiatry.
Members of the council include Dr. Jodi
Lofchy, Director of Undergraduate Education, Dr.
Allan Kaplan, Director of Post-graduate Education,
Dr. Ivan Silver, Director of Continuing Mental
Health Education, Dr. Anthony Levitt, Director of
the Fellowship Program, and Dr. Brian Hodges, Vicechair, who was on sabbatical during this academic
year. Dr. Silver stepped in as Acting Vice-chair in his
absence. The Education Council is responsible for
delivering all educational programs in the department.
In addition to ensuring the quality of education
programs in the Department of Psychiatry, the
council worked on several projects during the
academic year. In July 2003, Education officially
became the 14th program in the department. Led
by Dr. Brian Hodges, the program is now known as
Research, Innovation, and Scholarship in Education
(rise)—the first endeavour of its kind in a department
of psychiatry in North America. The educational
program has three major foci: First, it is a home for
a cadre of full-time educational researchers. Second,
it will oversee the creation of a Teaching Scholars
Program that will create and support positions for
faculty members who identify teaching as their major
academic activity. Finally, the program will create joint
positions with other programs for faculty wishing
to pursue educational scholarship as a career focus.
The department provided infrastructure support
in the form of a gft salary for a faculty member
committed to education research, an education
research fellowship, and education conference funds
for faculty and residents to present their education
research at academic education meetings. During the
year a national search was conducted by the Education
Council to fill the education fellowship position,
but unfortunately no suitable candidate was found.
It is recommended that this search be conducted
internationally in the coming academic year. A
search was also conducted for the gft position in
education research. Dr. Silver and the Education
Council decided to wait for Dr. Hodges to return
to chair a search committee that has been struck.
There were seven applicants for the education
conference grants. Six candidates were chosen, and all
received $500 towards expenses for their presentations
on education scholarship at academic conferences.
The six residents and faculty are Drs. Tatyana
Barankin, Andrea Berntson, Leslie Buckley, Karen
Ghelani, Rhonda Martinussen, and Alison McInnes.
The second project took the form of a major
report entitled Fairness and Transparency in Awarding
Educational Stipends and Honoraria in the Department
of Psychiatry. This document arose in response to a
Faculty of Medicine decanal report released in 2002
entitled Valuing Teachers: Report of the Task Force on the
Recruitment of Clinical Teachers. This document outlines
the need for the Faculty of Medicine to substantially
increase recognition of and remuneration for teaching.
Fairness and Transparency is the Department of
Psychiatry’s proposal to grapple with this issue.
The report was tabled at sac and the Executive
Committee, and several recommendations were
made for its revision. Several issues were difficult to
resolve, including the different financial arrangements
currently used by partnerships to reward teaching,
the nomenclature used to describe part-time or
“volunteer” teachers, and the financial implications of
funding the Teaching Scholars Program (formerly
called the Master Teacher Program). The report was
revised once, but most of these contentious issues
remained. The Sunnybrook site of swchsc agreed
to pilot a teaching log system where all faculty there
would log all of their teaching, teaching preparation,
and administration in a transparent manner. They
propose to divide their Academic Trust Fund into
education and research sections. It will now be
possible to calculate a dollar amount/hour for those
teaching/preparation/education administration hours,
which can then be tabled for discussion at sac and the
Executive Committee of the department.
The third project, led by Dr. Solomon Shapiro,
was to resolve funding of the Therapeutic Communications elective for first-year medical students. Several
meetings were held with Dr. Shapiro and the Director
of the Psychotherapy Program, Dr. Zindel Segal, in
preparation for a review of this course, which was held
in May–June 2003. As a result of this review, it was
decided to fund the course for 1 further year and to
discontinue the funding after the 2003–2004 academic
year. It was recommended to Dr. Shapiro that his
planning committee assist him with adapting the
elective to the new electives program for second-year
medical students that begins this academic year.
The past year has presented many challenges for
those of us on the Education Council. We faced the
sudden departure of Richard Tiberius to warmer
climates, the sabbatical year of Brian Hodges,
the maternity leave of the almost irreplaceable
Tina Martimianakis (Undergraduate Education
Administrative Assistant) and great difficulty finding
a replacement for her, and finally sars ! The lack of
consistent administrative support was a significant
barrier for extensive program planning. The council
greatly appreciates Dr. Don Wasylenki, Chair’s
Assistant Kathy Ostaff, and Business Officer Eva
Wong for their ongoing support during this difficult
time.
Ivan Silver, md, frcpc
Acting Vice-chair, Education
10
Undergraduate
Education
The Undergraduate Education Committee
oversees the development and implementation of the
psychiatry curriculum in pre-clerkship and
clerkship medical training.
T
he Undergraduate Education Committee, led
by Dr. Jodi Lofchy, oversees the development
and implementation of the psychiatry
curriculum in pre-clerkship and clerkship medical
training. Providing over 8000 hours per year of
undergraduate teaching, faculty members of the
Department of Psychiatry make a significant
contribution to the training of medical students
and have a strong presence in the Art and Science
of Clinical Medicine, the Foundations of Medical
Practice, Brain and Behaviour, Determinants of
Community Health, the Psychiatry Clerkship,
the Ambulatory Community Experience, and the
Electives Program.
Administration
The Undergraduate Office experienced the effect of
sars and a variety of administrative gaps for the first 5
months of 2003. In June 2003, Iris Chan became part
of the undergraduate administrative team and took
on the undergraduate, vice-chair, and recruitment
responsibilities. She has continued to meet with
site administrators to identify problem areas and
address site-specific concerns. With the direction
of Dr. Lofchy and Dr. Kurdyak, she helped develop
the program on-line via Blackboard and created a
seminar article cd for students. According to a survey
conducted in July 2003, the administrative meetings
have proven to be a very useful and productive
forum for standardizing the administration of the
Undergraduate Education Program across teaching
sites, and for site administrators to interact with and
learn from their colleagues. Furthermore, the use of
Blackboard and the seminar article cd will commence
the transition to an on-line forum.
Pre-Clerkship
We welcomed Dr. Vicky Stergiopoulos as the new
Coordinator of the Art and Science of Clinical
Medicine ii, in place of Dr. Shelley Brook. Dr.
Stergiopoulos is a Lecturer in the Department of
Psychiatry, with a strong involvement in teaching
undergraduate medical students and residents as a
staff psychiatrist at St. Michael’s Hospital. We have
benefited from her continued work on revising and
updating the ascm ii psychiatry syllabus, and
to reflect this addition. The child syllabus was also
revised and merged into the student syllabus this year.
It was revised by Dr. Teshima, Acting Coordinator
for Child Psychiatry. Dr. Hanson stepped down
in September 2003 as Coordinator for Child
Psychiatry, and the committee greatly appreciates his
contributions over the year.
On May 23, 2003, the committee held the third
osce retreat. Committee members reviewed and
updated existing written osce stations, and new
stations were devised to cover content gaps in the
exam. The new cases have been incorporated and used
on this year’s exam circuit.
Dr. Ash Bender, Resident Representative, has spent
considerable time surveying residents across teaching
sites to ensure that the course is being administered
in a standardized fashion and to receive feedback on
teaching. He developed a teaching team proposal for
the committee, suggesting a teaching designate at each
site as a source of support for resident teaching. This
proposal is currently under review.
For the past academic year, North York General
Hospital has provided clinical experiences to two
clerks from the Peters Boyd Academy. For the
upcoming academic year, it will become a full teaching
site and will provide experiences for four clerks from
the academy. Dr. Zohar Waisman continues as the
Clerkship Coordinator and has been a participant in
the Undergraduate Education Committee this past
year.
she has plans to update the ascm ii video this year.
The committee also welcomed Dr. Mara Goldstein,
replacing Dr. Umesh Jain as the new Electives
Coordinator. She is presently a clinician-teacher in
the department. She has continued to update the
undergraduate website and its elective descriptions.
She is currently organizing half-day electives across
several sites for clerks in the sixth week of their
rotation, after their osce. We hope to offer these
electives in the upcoming year.
Dr. Mark Katz continues as the Psychiatry
Coordinator for the Foundations course. Dr. Katz
spent the year reviewing past feedback from students
and tutors, revising the psychiatry component for the
course, updating the learning objectives, restructuring
the Psychiatry Week, and attracting new tutors to the
course. Feedback from the course has continued to be
quite positive.
Dr. Albert Wong continues as the Brain and
Behaviour Psychiatry Coordinator for this year. The
psychiatry component of Brain and Behaviour is
the most highly rated part of the course. Dr. Wong
is looking forward to continuing to strengthen the
psychiatry component of the course and to creating
an innovative interactive experience for the psychiatry
Brain and Behaviour Discovery Lab.
Clerkship
At the outset of the academic year, the committee
reviewed the Global Evaluation Forms and revised
them with detailed descriptions for each section. A
subcommittee of the Clerkship Committee has been
formed to look more closely at the issue of grade
inflation. Dr. Edred Flak has become a leader in
representing psychiatry on this committee.
The case-based seminar articles were revised with
the help of newly appointed literature consultant, Dr.
Paul Kurdyak. The reading materials were updated to
reflect recent advances in psychiatry. Seminar articles
were made available electronically on cd and on-line
through Blackboard for the upcoming 2003–2004
academic year. Clerks are to receive the printed version
of the student syllabus and the seminar article cd
as part of their clerkship packages. Undergraduate
Administration provided each site with a master
binder containing all seminar articles, as well as a
section on Blackboard for each site to add on necessary
curriculum handouts and materials.
The student syllabus was further revised. canmeds
Objectives were incorporated into the syllabus as
Appendix 1, and clerkship objectives were revised
Recruitment
The Recruitment Committee continues to attract the
best and the brightest to the University of Toronto
Residency Program. This was Dr. Mark Katz’s second
year as Chair of the Recruitment Committee. Dr.
Katz encouraged the committee to review current
strategies and improve the organization of recruitment
events. As in previous years, recruitment activities
were geared to all levels of medical student training.
Students had the opportunity to learn about career
opportunities in psychiatry and the nature of the
Psychiatry Residency Program through a variety of
experiences organized by the committee, including
career nights, career lunches, and medical-student
dinners featuring prominent guest speakers. This
year’s speakers were Dr. José Silveira and Dr. Jodi
Lofchy. Unfortunately, as a result of sars, Dr. Lofchy’s
presentation was cancelled, but the committee
hopes to have her speak at another medical-student
dinner. Dr. Silveira’s presentation was well attended
12
education
and popular with the students. This year’s Tenth
Annual Psychiatry Institute for Medical Students
was unfortunately disrupted and cancelled as a result
of sars. The committee will give first priority to
previously accepted first-year applications for the
2003–2004 Psychiatry Institute.
The committee hopes to update the booklet Many
Faces of Psychiatry, which is used to promote and
provide information about the psychiatry program.
The updated booklet should be completed this
upcoming year.
The committee is also working on two research
projects. The first is a follow-up to the article written
by Drs. Jodi Lofchy and Aileen Brunet evaluating
the Psychiatry Institute’s success in attracting
applicants to the U of T Psychiatry Program. The
follow-up study reviews recent data and broadens
the scope by evaluating other recruitment activities
including medical-student dinners and career nights.
The second study the committee began working
on measures factors that contribute to a choice of
psychiatry as a career. Both studies are currently
analyzing data.
Future Directions
Our department will face a number of challenges in
providing good undergraduate training in psychiatry.
Several priorities have been defined and are included
in the department’s strategic planning:
• Establishment of a formalized process for
identifying, assigning, and remunerating teaching
responsibilities driven from the highest level of
the Departmental Executive and overseen by the
Education Council
• Further expansion of the recruitment activities and
electives programs to attract excellent students to
psychiatry
• Creation of a centralized databank of teaching
evaluations and responsibilities
• Re-examination of the medical school curriculum
in light of recent increases in enrolment.
Jodi Lofchy, md, frcpc
Director, Undergraduate Education
13
Post-graduate
Education
The Director of Post-graduate Education and
the Post-graduate Education Committee
focused on a number of priorities during the
2002–2003 academic year.
Membership on the PGEC
S
everal members of the pgec completed their
service on the committee during this past
academic year. These include Dr. Marshall
Korenblum, who was the Coordinator of Postgraduate Activities for child psychiatry for the past
12 years. We thank Marshall for all his efforts and
hard work on behalf of the Child Psychiatry Division.
Dr. Mark Sanford will be taking over this important
role on July 1, 2003. In addition, Dr. Joanne Sinai left
her role as pgy1 Coordinator in the spring of 2003 ;
Dr. Ian Dawe has been Acting pgy1 Coordinator as
well as Post-graduate Coordinator for Education at
St. Michael’s Hospital. Dr. Mark Hanson gave up
his position as Post-graduate Coordinator for the
Hospital for Sick Children; Dr. Pier Bryden will
be Acting Coordinator for hsc until a permanent
coordinator is appointed. We thank Mark and Joanne
for all their efforts on behalf of the post-graduate
enterprise.
Web-Based Evaluations for Trainees and
Supervisors
The pgec, Ms. Marie Mara, and in particular Ms.
Victoria Costantino worked diligently this past year
to set up and implement an Internet-based evaluation
system for completing resident and supervisor
evaluations. A task force was created specifically to
revise previous evaluation forms to assure they were in
the canmeds role format and that they were consistent
with the new Web-based system and the new Royal
College Final In-Training Evaluation Report (fiter).
The new system was implemented successfully at all
but two of the teaching sites for the rotations ending
June 2003. Post-graduate evaluation will become
completely paperless for all sites and rotations in
December 2003.
education
Residents and Level of Training 2002–2003
Name
Level
Abdel-Malek, Muller
Al-Shamma, Abdullah
Barakat, Sammy
Barlas, Joanna
Baxter, Stephen
Bender, Ashley
Biddle, Nancy
Boffa, Ernie
Bottas, Alexandra
Brar, Simuran
Buckley, Leslie
Buttar, Kulwant
Chatterjee, Sumeet
Chaudhuri, Bob
Chin, James
Cho, Brian
Chopra, Kevin
Cochrane, Katherine
Colton, Patricia
Coxon, Carol
Crawford, Allison
Crawford, Barbara
Dalfen, Ariel
Dang, Kien
Darani, Shaheen
Davison, Kristina
2
2
4
3
5
4
5
5
5
4
4
5
3
5
5
4
3
3
4
5
3
4
5
2
3
3
Name
Desouza, Minella
Donaldson, Heather
Driver, Kelly
Duggal, Vikas
Fan, Nancy
Fefergrad, Mark
Gandhi, Jasmine
Garcia, Carla
Geagea, Justin
Gelber, Stephen
Giacobbe, Peter
Gill, Jasbir
Goldstein, Benjamin
Gratzer, David
Grewal, Seena
Guan, Brian
Hales, Sarah
Hamidi, Jinous
Hanna-Dief, Sarwat
Hastings, Tom
Hlousek, Daniela
Holtby, Joanne
Iosif, Alina
Jamal, Lail
Keyhan, Nicola
Koo, Anson
Name
Level
Level
Korostil, Michele
Koutsoukos, Georgios
Kurdyak, Paul
Levinson, Andrea
Li, Madeline
Liu, Regina
Lok, Jennifer
McCabe, Laura
Mcdonough, Erin
McIntosh, Christopher
McPherson, Alexandra
Madan, Robert
Mangar, Mohini
Mansour, Ahmed
Margolese, Ellen
Meerdaula, Nazly
Miki, Nancy
Ng, David
Oskin, Alec
Peters, Lynne
Propst, Lara
Ravindran, Lakshmi
Rawkins, Sian
Robertson, David
Rogers, Anna
Roscoe, Clare
4
4
5
2
4
2
4
3
3
3
2
3
2
3
2
3
3
2
5
5
3
5
2
4
3
5
3
2
5
3
3
2
4
4
2
2
2
5
3
2
4
3
5
5
3
4
5
2
2
2
3
5
Name
Level
Rudky, Rina
Rumm, Ellen
Seli, Tonia
Shin, Karen
Shulman, Barbara
Siu, Maurice
Skorzewska, Anna
Sloan, Eileen
Staniloiu, Angelica
Stein, Debra
Tennen, Gayla
Thompson, Sarah
Vienneau, Theresa
Vijay, Nishka
Villella, Giovanni
Waese, Adam
Watson, Priya
Wesson, Virginia
Wiebe, Patricia
Wiesenfeld, Lesley
Wilkie, Treena
Wu, Grace
Zarb, Therese
Zurowski, Mateusz
5
5
5
2
5
5
5
4
5
2
2
3
4
2
2
4
3
2
5
5
3
5
5
5
The Clinician Scientist Stream and
Program
Continued Successful Recruitment and
Selection of CaRMS Applicants
The Clinician Scientist Program was initiated this
past July and admitted the first four pgy1 residents
into the Clinician Scientist Stream. These residents
will be spending 1 month of their pgy1 year doing
research and 3 months of their pgy1 year fulfilling
their Royal College requirements for consultation
liaison psychiatry, which will allow them to spend the
majority of their pgy4 and - 5 years in graduate school,
working towards an MSc or PhD.
The Psychiatry training program had a very successful
carms result this year, with all 22 entry positions
easily filled from the close to 90 applicants interviewed
for the program. Medical students from eight medical
schools across Canada were in the pool of 22 accepted
into the program, and 1 of the 22 accepted applicants
was from a medical school in the United States.
15
Resident Research Rotations and Electives
Name
Start Date
PGY
Type
Supervisor
Area of Research
Berntson, Andrea
March 2003
1
Elective
B. Hodges
Training for Rural Psychiatry
Cochrane-Brink, Katherine
August 2000
3
Elective
R. Lewis
Cognitive Deficits in Relation to Diagnosis
and Prognosis in Psychotic Adolescents
Colton, Patricia
January 2001
4
Elective
G. Rodin
Eating Disturbances in Preteen Girls with
Type 1 Diabetes Mellitus
Goldstein, Benjamin
September 2002
2
Elective
A. Zaretsky
Alcohol Consumption and Affective
Disorders
Law, Andrew
November 2002
1
Elective
N. Herrmann The Putative Links between Appetite
Change and Alzheimer’s Disease
Levinson, Andrea
January 2003
3
Elective
T. Young
Is There a Core Phenotype for Patients with
Major Depression?
Li, Madeline
November 2000
3
Elective
P. St. George
Hyslop Genetics of Dementia
McCabe, Laura
July 2000
4
Elective
P. Goering
Community Programs and Admitting
Practices
Quesnel, Susan
January 2003
1
Elective
A. Feinstein
Alcohol Use and Mental Health Outcomes
in Patients with MS
Shulman, Barbara
July 2002
5
Rotation
M. Corral
Reproductive Psychiatry
Tan, Adrienne
February 2003
1
Elective
G. Rodin
The Patient–Provider Relationship and
Palliative Care
Thompson, Sarah
February 2002
3
Elective
G. Rodin
An Examination of Cholinergic Pathways in
Multiple Sclerosis
Tseng, Michael
June 2003
1
Elective
T. Young
Identification of Novel Target Genes in
Bipolar Disorder Using cDNA Arrays
Expansion and Consolidation of Training
Sites in Northern Ontario
in general psychiatry, geriatrics, and chronic care in
North Bay, and general psychiatry and chronic care in
Sault Sainte Marie. As of July, eight residents will be
training in these rotations in the North.
The pgec worked closely with the Outreach Program
to expand the Royal College–approved rotations
available to residents in our program. In addition
to training the first resident matched to a carmsapproved residency position in the new yet-to-be
established Northern Medical School, the University
of Toronto Department of Psychiatry this past year
approved core rotations in consultation liaison in
North Bay, chronic care and general psychiatry in
Thunder Bay, and consultation-liaison in Sault Sainte
Marie, in addition to the already approved rotations
Assessment Program for International
Medical Graduates (APIMG)
The department participated in the first round of the
new Ontario apimg by accepting two of the eight
successful candidates into the University of Toronto
Program, both of whom successfully completed the
6 -month assessment period. The second round for
psychiatry has just been completed, and our program
16
education
will be assigned one of the four candidates who have
been accepted into this program for 2003–2004.
PGEC Modification of Training
Subcommittee
In order to deal with the significant number of
requests by residents to modify their Royal College
training requirements, and in lieu of the fact that
the Royal College now leaves such decisions to the
discretion of individual programs, the pgec decided to
establish a Modifications of Training Subcommittee,
with specific representation from prat as well
as Women’s Mental Health. The committee has
already dealt with a number of requests by residents
to be relieved of on-call duties. The objective of this
committee is to have a fair and transparent method
of adjudicating such requests while maintaining the
necessary Royal College standards for mandatory
rotations and experiences.
SARS
prat and the pgec, in consultation with the Postgraduate Office, spent much of March, April, and
May dealing with the impact of the sars epidemic
upon training. This was a very difficult time for staff,
and especially residents, some of whom had their
training disrupted and some of whom had to take on
extra call duty. Many thanks to prat
prat, especially Drs.
Allison Crawford and Alec Oskin, as well as all the
chief residents who worked tirelessly to assure that
patient care was maintained in the face of significant
difficulties.
Allan Kaplan, md, frcpc
Director, Post-graduate Education
17
Continuing
Mental Health
Education
The Continuing Mental Health Education Committee
continues to coordinate and target
continuing education activities
for health professionals.
T
he Continuing Mental Health Education
Committee continues to coordinate and target
continuing education activities for health
professionals, with special emphasis on educating
psychiatrists, family physicians, and pediatricians.
Continuing education (ce) activities are still largely
decentralized, with hospitals, programs, and divisions
providing their own administrative support. The
Centre for Addiction and Mental Health (camh)
continues to provide administrative support for some
hospital and program ce activities.
The committee is composed of representatives
from hospitals, programs, and divisions within the
department. Ms. Jean Street provides administrative
support. Dr. Sagar Parikh has been Associate Director
of the committee for several years and was appointed
the new Director of Continuing Mental Health
Education.
Events and Achievements
Formal CE Events
The Department of Psychiatry continues to be the
largest provider of accredited ce activities in the
Faculty of Medicine at the University of Toronto
(see list of 2002–2003 cmhe events below). We are
also the largest provider of longitudinal continuing
education courses. The delivery of some of our
education events was disrupted by the sars outbreak.
Six of the 27 events were longitudinal, spread over a
3- to 6 -month period. Approximately 20% specifically
targeted physicians. Of all formal ce events, 40%
are administered by the camh ce office under the
direction of Dr. Sagar Parikh. Dr. Tatyana Barankin
as Director of ce for the Child and Adolescent
Division continues to develop an increasingly
diverse list of ce events in Child and Adolescent
Psychiatry.
education
CME Event List
Date
Conferences and Workshops
Sponsor
July 25–27, 2002
Cognitive Behavioural Therapy with Children
Division of Child Psychiatry,
CAMH
August 15–17, 2002
Cognitive Therapy Summer Institute
CAMH
August 25–
September 1, 2002
Mindfulness-Based Cognitive Therapy: A 7-Day Workshop/Retreat
CAMH
September 2002–
June 2003
Methadone Treatment Workshop: Four 1-Day Events
CAMH
September 12–13, 2002
Skill-Building in Psychosocial Oncology: A Multidisciplinary Course. Princess Margaret Hospital
Highlighted Issue: Palliative Care
October 2002–April 2003
The Fundamentals of Psychotherapy
UHN
October 1, 2002–
January 21, 2003
Intermediate Cognitive Therapy Course: Supervised Applications;
Ten 2-Hour Evening Sessions
CAMH
October 18, 2002
Alzheimer and Related Dementias: The Prevention of Disease,
Morbidity, & Suffering
Kunin-Lundenfeld Applied
Research Unit & Baycrest
Centre
October 23, 2002–
March 26, 2003
Toronto Advanced Psychopharmacology Course for Psychiatrists:
Six 2-Hour Evening Sessions
CAMH
October 25, 2002
Innovations in Culturally Competent Care
Hong Fook Mental Health
Association
November 6–9, 2002
Schizophrenia 2002: Clinical Update
November 7, 2002
Emergency Psychiatry: Current Practice and Future Trends
November 8–9, 2002
IPT Advanced workshop and Research Half Day
CAMH
November 9, 2002
Interpersonal Psychotherapy: Fall 2002 Advanced Training
Workshop
CAMH
November 14, 2002
13th Annual Update in Child & Adolescent Psychiatry:
Current Perspectives on Child and Adolescent Disorders
Hospital for Sick Children
November 24, 2002
FCCP Annual Conference 2002: Mental Health
Culture, Community, and
Health Studies and Federation
of Chinese Canadian
Specialists
February 8, 2003
CBT on the Fly: Integrating CBT into Your Busy Practice
SWCHSC
February 13, 2003
Child Psychiatry Day 2003 - Infancy: Social and Biological
Perspectives on Early Development
Division of Child & Adolescent
Psychiatry
March 4–April 29, 2003
Child & Adolescent Psychiatry for Primary Care Physicians
Part 3: Management of Adolescent Disorders; Four 2-Hour
Evening Sessions
CAMH
19
CME Event List (continued)
Date
Conferences and Workshops
Sponsor
March 17–18, 2003
Neuroimaging of Cognitive Functions
Rotman Centre
March 22, 2003
Toronto Psychopharmacology Update Day, 2003
CAMH
May 8, 2003
Psychiatry, Health and Disease Research Day: Post-traumatic Stress
Disorder; Neurobiology, Psychology, and Cultural Construction
Dept. of Psychiatry & Institute
of Medical Science
May 8, 2003
Post-traumatic Stress Disorder: Neurobiology, Psychology, and
Cultural Construction
Dept. of Psychiatry, Health &
Disease
May 22–24, 2003
CBT Summer Training Institute 2003
CAMH
June 13, 2003
Current Perspectives on Treatment & Preventive Interventions for
Suicidal Children and Adolescents
Division of Child Psychiatry
U of T
With the introduction of the Knowledge
Translation into Practice (ktp) Program in the Faculty
of Medicine, our departmental ce planners are
beginning to evaluate the impact of our ce activities
on practitioner behaviour and patient outcome distal
to the education intervention. This has been especially
evident in the evaluation of the longitudinal courses.
the department on ce activities in the department and
included some scholarly editorials on education topics.
CMHE Award (renamed the Ivan Silver Award)
Four nominations for this award were received
this year. The nominees were of extremely high
quality. The winning course, directed by Dr.
Katharina Manassis, was Cognitive Behavioural
Therapy with Children.
Scholarly Work
Members of the committee continue to deliver
scholarly presentations on ce topics at education
conferences, including those at the Royal College
of Physicians and Surgeons Annual Meeting,
Department of Psychiatry Research Day, the cpa
icpd conference in Mexico, the Hospital for Sick
Children, Department of Psychiatry Grand Rounds,
Ontario Psychiatric Association Meeting, Association
for Academic Psychiatry, Canadian Association of
Continuing Health Education, and the Canadian
Psychiatric Association Annual Meeting.
The sars outbreak forced the cancellation of our
annual retreat. Dr. Parikh plans to hold a retreat for
strategic planning in the fall of 2003.
Dr. Rima Styra submitted a proposal to enter data
collected from all ce evaluations—including grand
rounds—into a database. As a result, in the coming
year, all grand rounds evaluations will be tabulated in
a database, and within a year, all ce evaluations will be
included on this database.
CMHE Newsletter
National Profile
CMHE Retreat
With the creation of the new education program
(rise), the cmhe newsletter was incorporated into
the new education program newsletter, and was
published exclusively on-line, three times in the past
academic year. The newsletter continued to update
Several members of the committee and department
continue to have national roles in organizing and
providing continuing education. Dr. Sagar Parikh
is a member of the Special Committee on Clinical
Practice Guidelines and the Continuing Professional
20
education
Development (cpd) Committee of the Canadian
Psychiatric Association. Dr. Susan Abbey is the new
Director of the cpd Committee of the Canadian
Psychiatric Association (cpa), and Head of the
Program Committee for the cpa Annual Meeting and
the new Ski- cpd program. Dr. David Goldbloom is
Co-chair of the icpd annual conference. Dr. Rima
Styra is the Web Editor-in-Chief at the cpa and sits
on both the cpa Scientific Committee and the cpd
Committee. Dr. Susan Lieff sits on the Program
Planning Committee of the Association of Academic
Psychiatry. Dr. Ivan Silver was appointed the Director
of the Centre for Faculty Development in the Faculty
of Medicine.
Ivan Silver, md, frcpc
Director, Continuing Mental Health Education
21
Fellowship
Program
The Fellowship Program flourished during
academic year 2002–2003.
Committee Membership
T
he Fellowship Program flourished during
academic year 2002–2003 with 49 fellows
registered! Membership in the Fellowship
Executive Committee expanded to include Drs.
Anthony Levitt (Chair), Gary Rodin, Russell
Schachar, Robert Levitan, Anneke Rummens,
Ambrose Cheng, Katharina Manassis, Eva Chow,
Jeff Daskalakis, Scott Woodside, Jennifer Jones, and
fellow representatives Drs. Tisha Ornstein and Rinat
Nissim.
Educational Events
The academic year commenced with a very successful
family barbeque for fellows and members of the
Fellowship Executive Committee, with numerous
planned activities. Fellows had the opportunity
to present their research at our annual Fellows’
Presentation Days and received constructive written
feedback on their performance from colleagues and
fellowship supervisors. Two educational seminars on
statistics entitled “The Nuts and Bolts of Clinical
Trials: Practical Necessities” and “Superiority vs.
Equivalence vs. Non-Inferiority Trials Designs
and Statistical Implications” were well attended by
fellows. We organized the first National Meeting for
Fellowship Program Directors on November 2, 2002,
during the cpa Annual Meeting in Banff.
Website
Dr. Ambrose Cheng created and maintained a new
Fellowship Website (www.utpsychiatry.ca/education
/fellowship.cfm) where visitors find everything they need
to know about fellowship training in our department,
including a description of over 70 fellowship positions
described in the Fellowship Handbook, the application
process and form, evaluation forms, and the annual report.
Awards
Fellows had the opportunity to nominate supervisors
for the Paul E. Garfinkel Award for Best Fellowship
Supervisor on-line, and the recipient was Dr. Robert
Zipursky. The recipient of the Best Accomplishment
by a Fellow Award was Dr. Linda McLean.
Assessment Program for International
Medical Graduates
Two of our fellows, Drs. Saulo Castel and Monica
Scalco, applied to the newly established Assessment Program for International Medical Graduates
education
Number of Fellows by Division and
Program
Number of Fellows by Source of
Funding
Division
Type of Funding
Number
14
Child Psychiatry
Peer-Reviewed Institution
Number
14
General Psychiatry
7
Out-of-Province
3
Geriatric Psychiatry
2
Local Institutional
4
Fixed or Occasional
16
Other
12
Program
Addiction Psychiatry
2
Culture, Community and Health Studies
2
Law and Mental Health
1
Medical Education
1
Health Systems
3
Mood and Anxiety
8
Neuroscience
3
Psychiatry, Health and Disease
9
Psychotherapy
1
Schizophrenia
6
MD
33
Women’s Mental Health
1
PhD
10
Number of Fellows by Degree
Degree
Number
MD, PhD, or PhD candidate
1
Master’s
5
(
(apimg
), and both have successfully completed the 6 month evaluation. The program assesses fully
qualified and recently practising specialist physicians
to enable them to provide needed physician services in
underserviced communities in Ontario.
Number of Fellows by Site
College of Physicians and Surgeons of
Ontario Licensing Requirements
Site
The Council of Ontario Faculties of Medicine and the
College of Physicians and Surgeons of Ontario have
agreed that international medical specialists applying
for fellowship training are no longer required to
successfully complete the Medical Council of Canada
Evaluating Exam and the tests of written and spoken
English. However, they have implemented a Pre-Entry
Assessment Program (4
( to 12 weeks) to ensure that
international medical specialists can function at the
appointed level of training.
Baycrest
Future Goals
One goal for the Fellowship Program is to improve the
evaluation system for fellows and their supervisors.
Anthony Levitt, md, frcpc
Director, Fellowship Program
23
Number
1
18
Hinks
4
7
Lakehead
1
Princess Margaret Hospital
3
3
Sunnybrook & Women’s College Health
Sciences Centre
4
Toronto General Hospital
1
Toronto Rehabilitation Institute
1
Toronto Western Hospital
3
Whitby
3
Fellows
Name
Program/Division
Name
Program/Division
Agid, Ofer
Mamo, David
Al-Jeshi, Abdulsamad
Child Psychiatry Division
McInnes, Alison
Arnold, Paul
Neuroscience Program, Child
Psychiatry Division
McLean, Lind
Millar, Golden
Addiction Psychiatry Program
Barbera, Joseph
Psychiatry, Health, and Disease
Program
Moller, Henry
Braun, Michal
Program
Monkman, Norman
General Psychiatry Division
Nissim, Rinat
Program
Program
Carlisle, Corine
Castel, Saulo
General Psychiatry Division, Mood
and Anxiety Disorders Program
Novak, Marta
Chamelian, Laury
Program
Obillo-Tumaneng, Edna Medical Education Program
Ornstein, Tish
Chaudhuri, Bob
Partap, Nadine
Cheung, Amy
Mood and Anxiety Disorders
Program
Pham, Hoa Cong
General Psychiatry Division, Health
Systems Program
Cummings, Joanne
Del Rosario, Joan
Praschak-Rieder, Nicole Mood and Anxiety Disorders
Program
Fernandes, Cheryl
Program
Quastel, Adam
Russel, Jennifer
Figueroa, Max
Scalco, Monica
Geriatric Psychiatry Division
Fung, Kenneth
Culture, Community, and Health
Studies Program
Srivastava, Ravi
Culture, Community, and Health
Studies Program
Gagnon, Nadine
Geriatric Psychiatry Division
Staniloiu, Angelica
Girard, Todd
Program
Gould, Brent
Stephens, Robyn
Greenaway, Masa’il
Child Psychiatry Division,
Strauss, John
Toplak, Maggie
Torti, Margherita
Tran, Simone
Willeit, Mattheus
Kriendler, David
Program, Child Psychiatry Division
Liashko, Vitaly
Program, Child Psychiatry Division
Maggi, Julie
Program
Mah, Kenneth
Program
Yaghoud-Zadeh, Zohreh Child Psychiatry Division
Wiebe, Patricia
24
Law and Mental Health Program
programs and divisions
Addiction Psychiatry
Program
The Addiction Psychiatry Program began in 1996
with the mission to provide
academic leadership and scholarship in addictions.
Program Description
T
he Addiction Psychiatry Program began in
1996 with the mission to provide academic
leadership and scholarship in addictions. Its
goals are to establish and maintain exemplary clinical
services for individuals with psychoactive substance
use disorders; provide high-quality multidisciplinary
education and training at the undergraduate, postgraduate, and continuing education levels; and
stimulate and foster research and scholarly work in
addictions within the Department of Psychiatry.
An overarching principle that guides the Addiction
Psychiatry Program is that a comprehensive
understanding of addictions and experience
in working with individuals with psychoactive
substance-use disorders is an integral component
of comprehensive psychiatric care and needs to be
achieved in a psychiatry training program.
Organization & Functions
The Addiction Psychiatry Program has its centre of
excellence at the Centre for Addiction and Mental
Health, with 20 of the faculty having primary
appointments at that site. Two have primary
appointments with St. Michael’s Hospital, one has a
primary appointment at the Hospital for Sick
Children, and one has an appointment at Humber
River, for a total of 24 Addiction Psychiatry faculty.
The goal of the Addiction Psychiatry Program is to
further develop training opportunities throughout the
U of T system. Dr. Patrick Smith is the Program
Head and Dr. Tony Toneatto is the Research
Coordinator for the program. Mr. Wayne Skinner
served as the Educational Coordinator for the program.
Centre of Excellence: Centre for Addiction and
Mental Health
Addiction services at the Centre for Addiction and
Mental Health are organized in four Addiction
Programs: General Addiction Assessment and
Treatment Program, Treatment Program for Special
Populations, Concurrent Disorders Program, and
Addiction Medicine Program. The General Addiction Assessment and Treatment Program includes
standardized assessment and follow-up of all
addiction clients in the four programs available
Psychiatry faculty teaches five morning seminars. This
pgy2 curriculum has been revised and expanded and
involved 10 of the Addiction Psychiatry faculty this
year covering a full range of topics. Members of the
faculty also teach a six-session seminar at the Hospital
for Sick Children focused on some of the unique
aspects of working with youth with substance-abuse
problems and their families. Residents complete a 1month rotation in Addictions as part of their pgy1 year
of training.
Faculty have also been involved in continuing
education and capacity building. Drs. Shelley McMain,
Lorne Korman, and Chris Courbasson continue to
be active in training across Canada and abroad in
the area of dialectical behaviour therapy (dbt). Drs.
McMain and Korman conducted a 2 -day intensive
workshop on dbt at the Cognitive Therapy Institute
of Lisbon, Portugal. They were also involved in
the Treatment and Research Advancements of the
National Association for Personality Disorders First
National Conference in Washington. Dr. McMain
presented a dbt workshop at the Canadian Psychiatric
Association Annual Meeting and was a participant in a
nimh-sponsored planning meeting to discuss research
on borderline personality disorder. Dr. Korman
has continued to pioneer the use of dbt in treating
clients with anger and addictions and presented his
work at the 17th Annual Forensic Conference and
at the Society for the Exploration of Psychotherapy
Integration in New York. Dr. Courbasson continues
to train in the use of dbt in working with clients with
concurrent eating disorders and addictions and has
trained locally and across Canada in this integrated
approach.
Dr. Bruce Ballon has continued his leadership
of the Youth Addiction Psychiatry training in
collaboration with child psychiatry and has provided
extensive education and training in youth addictions
for professionals and for parents. He was also an
invited faculty member for the 29th Institute on
Alcoholism and Other Drug Problems in Tobago. Dr.
Chris Doyle has been involved in training across the
province in the area of aggression and addiction and
has been involved in education and training on anxiety
and addiction. Dr. Jan Malat continues education and
training in psychotherapy and addictions, and he and
Dr. Korman were involved in local training on suicide
assessment. Dr. Tony Toneatto’s teaching in the
areas of problem gambling and concurrent disorders
continues, and he conducted training for the Canadian
Armed Forces in the area of concurrent mood and
at the Donwood site and the arf site. Also included
in this program are the brief treatments (i.e., Guided
Self-Change, Structured Relapse Prevention, Evening
Health Program), general day treatment, and
residential treatment.
The centre’s Treatment Program for Special
Populations (i.e., Women’s Service, Substance Abuse
Program for African Canadian and Caribbean Youth
[sapaccy], Youth Service, Lesbigay Service, Family
Services, Opus 55-Older Persons Service, Cocaine
Service, Drug Treatment Court, and Aboriginal
Services) is organized in response to meeting the
needs of underserviced groups. These services are
offered on the continuum of brief intervention to day
treatment to residential treatment.
The Concurrent Disorders Program includes
services that meet the needs of individuals suffering
with concurrent addiction and mental health
problems. These treatment services have become more
specialized as clinicians and researchers have tailored
treatments to meet the needs of specific subtypes of
this population (e.g., dialectical behaviour therapy for
individuals with concurrent addiction and borderline
personality disorder; treatment for individuals with
serious addiction and trauma; treatment for men
and women with concurrent addiction and eating
disorder; and treatment for individuals with anger and
addictions). The centre’s Problem Gambling Program,
which serves 25% of Ontario problem gamblers
receiving treatment, is part of this program as well.
The Addiction Medicine Program includes
comprehensive medical assessment and treatment for
individuals with medical problems secondary to their
substance use. Specialized services include opiate
clinic, methadone maintenance treatment, pain and
chemical dependency, pregnancy and substance abuse,
and pharmacotherapy for maintenance of abstinence.
Withdrawal-management services are also included
in this program as well as a comprehensive nicotinedependence service, which offers smoking-cessation
services on all four sites at the centre.
These four programs have been functionally
integrated over the past few years and will be
integrated as one Addictions Program in the next year.
Program Development
Educational Activities
Addiction Psychiatry faculty are involved in teaching
Clinical Clerkship Seminars and teach one of the
core seminars in pgy1. For pgy2, the Addiction
26
anxiety disorders and addiction. Dr. Patrick Smith’s
teaching and training initiatives continue to be in
mental health and addiction integration locally and
across the country.
Dr. Doug Gourlay, who was made a fellow of
the American Society of Addiction Medicine, was
involved in extensive training and education in
methadone maintenance for physicians and pain
management. He was a lecturer on Managing Chronic
Pain in the Health Care Worker at the Annual
Federation of State Physician Health Programs at
the American Medical Association. Dr. Peter Selby
continued to be involved in training and education
across Canada in smoking cessation and pregnancy
and addiction. He conducted two 2 -day workshops
on Smoking Cessation with Patients with Addictions
to all addictions service workers in Alberta. He
was also involved in the development of Supporting
Change: Helping Pregnant Drinkers, a knowledgetransfer program with Best Start. Dr. David Marsh
has also continued to be involved in training in opiate
dependence. Dr. Jurgen Rehm has continued his
involvement in international training and education in
health economics and addictions, epidemiology, and
population health. He was awarded the 2003 Jellinek
Memorial Fund Award for outstanding contributions
to the advancement of knowledge on alcohol and
alcoholism.
Dr. Charl Els completed his 1-year fellowship
focusing on the development of smoking cessation and
schizophrenia with Dr. Peter Selby and Addiction
Psychiatry curriculum development with Dr. Patrick
Smith. Dr. Sharon Cirone completed her fellowship
with Drs. Peter Selby and Bruce Ballon, focusing on
street-involved youth and addiction. Dr. Goldie Millar
joined the program this year as the Laurie Goldhar
Fellow in Youth Addiction Psychiatry under the
supervision of Dr. Bruce Ballon. Dr. Maurice Siu was
awarded this year’s Juan Carlos Negrete Award as the
Outstanding Resident in Addiction Psychiatry.
efficacy of acupuncture in the treatment for problem
gamblers), and concurrent disorders (e.g., youth
with substance-use disorders, eating disorders and
addictions, addictions and anger, and borderline
personality disorder and addictions).
Public Policy
Many of the faculty of the Addiction Psychiatry
program are involved in public policy. Some of the
faculty have been involved at local, provincial, and
federal levels in policy development and review as
well as with the World Health Organization on
global policy review. Dr. Ballon has had significant
involvement in youth policy issues and serves as a
psychiatric advisor and program reviewer for the tvo
program Planet Parent, where he reviews material to
ensure accuracy and appropriateness of psychiatric,
pediatric, and addiction issues. Dr. Smith was elected
Vice-president and President Elect of the Canadian
Executive Council on Addictions for the term 2003–
2005. Highlights for ceca in the past year include
the development of a National Adult Drug Survey
in collaboration with Health Canada (Smith and
Adlaf) and the coordination of a National Addictions
Research Priority-Setting Conference in collaboration
with cihr and the Canadian Centre on Substance
Abuse (Smith). Dr. Smith has also been involved
in the development of the Addictions Framework
in British Columbia to guide the integration of
addictions and mental health in that province. Dr.
Jurgen Rehm led the who comparative risk analysis
for alcohol as a risk factor for global burden of disease
and has been appointed Chair of Addiction Policy
in the Department of Public Health Sciences at the
University of Toronto.
Patrick D. Smith, PhD
Head, Addiction Psychiatry Program
Research and Capacity Building
Some of the research highlights for the Addiction
Psychiatry faculty over the past year have been in
treatment for opiate dependence (e.g., Methadone
Maintenance Best Practices—Health Canada),
tobacco research (e.g., Best Practice Guidelines
in Smoking Cessation for Nurses, Prevention of
Gestational and Neonatal Exposure of Tobacco
Smoke), problem gambling (e.g., evaluating manualassisted tele-counselling for problem gamblers,
27
Culture, Community,
& Health Studies
Program
The CCHS Program takes a
psychiatric epidemiology perspective on
understanding cultural and social determinants of population health,
with a focus on immigrant and refugee populations.
Program/Site
Research
n integrated research, training, and
consultation program, the Culture,
Community, and Health Studies (cchs)
Program takes a psychiatric epidemiology perspective
on understanding cultural and social determinants
of population health, with a focus on immigrant and
refugee populations. The cchs Program is located
at the Clarke site of the Centre for Addiction and
Mental Health. It comprises scholars from academic
disciplines including psychiatry, sociology, clinical
and developmental psychology, social epidemiology,
anthropology, demography, medicine, nursing, and
public health. Detailed project and staff information
may be found at www.utpsychiatry.ca/programs/cchs.cfm
or at www.camh.net/research/research_ar2000/culture_
comm_health.html.
The cchs attracted funding through the Canadian
Institutes of Health Research, the Social Sciences
and Humanities Research Council, Citizenship
and Immigration Canada, Health Canada, Human
Resources and Development Canada, and Canadian
Heritage in support of its research programs. Faculty
and scientists of the cchs Program currently lead 25
different research initiatives. The research program
consists of a national longitudinal study of the health
and development of immigrant and refugee children
(Beiser, Fenta, Hamilton, Kaspar, Khanlou, Noh,
Rummens, and Simich); epidemiological studies
in Toronto’s Ethiopian (Beiser, Noh, and Fenta)
and Tamil (Beiser, Noh, Rummens, and Simich)
communities; youth acquisition of ethnocultural
identity (Rummens); the mental health effects of
discrimination (Kaspar); long-term mental health
impact of exposure to traumatic stress (Kaspar);
A
multicultural meanings of social support (Beiser and
Simich); the development of a community resource
guide to assist newcomers to Canada (Beiser and
Simich); stress and tuberculosis (Beiser); depression
and suicide among Pakistanis in the uk (Husain); and
a randomized double-blind trial on Raloxifene as an
adjunct in the treatment of psychosis (Zhang-Wong).
Recent research highlights:
1.. Although immigrant families are 3 times more
likely to be poor than non-immigrant families,
immigrant children have fewer mental health and
behavioural problems than their non-immigrant
counterparts.
2. The prevalence of depression among Ethiopians
in Toronto roughly equals that found among the
general population of Ontario, but it is 3 times
higher than the rates in Ethiopia.
3. Approximately one quarter of visible minority
immigrants experience discrimination, and those
experiences jeopardize mental health.
Hospital, and focused on cross-cultural perceptions
of mental health. Rani Srivastava, Director of Clinical
Resources in the Faculty of Nursing at the University
of Toronto, is completing a PhD at the ims through
the cchs Program, with her research focusing on
institutional and individual cultural competence.
Through the cchs, Dr. Kenneth Fung worked on
a study of alexithymia among Chinese people, in
fulfilment of master’s degree requirements in ims.
Mark Baerlocher, a second-year medical student at the
University of Toronto, completed a study evaluating a
community resource guide for newcomers to Canada.
Finally, research institutions and universities
are increasingly recognizing an obligation to
provide information about their scholarship and its
implications for improved clinical practices. Members
of the cchs program participated in the development
of an ethno-racial initiative in the Joint General
Psychiatry Program, implementing a Cultural
Consultation Program that provides clinician training
in cultural issues relevant for patient assessment and
management. The cchs also created partnerships
with settlement agencies, public health units, and the
Addiction Research Foundation and Queen Street
sites of the Centre for Addiction and Mental Health
to develop a community education program on mental
health and addiction for ethno-racial groups.
Education, Training, and Clinical
Initiatives
The cchs provides education and training to future
generations of health researchers and health care
providers in support of establishing appropriate policy
and practice responses to the challenges of diversity
and equity. The program offers an Inter-Faculty
Research Seminar on immigrant and refugee mental
health, cross-cultural research, economic and social
determinants of health, and general topics of mental
health and addictions. The seminars are open to
researchers, staff, and students at the university and
the Centre for Addiction and Mental Health.
Faculty of the cchs Program also contribute to
the development, implementation, and delivery of
graduate and post-graduate courses offered by the
Department of Psychiatry, the Institute of Medical
Sciences (ims
ims), and other university departments.
Dr. Ted Lo conducts a cultural competence training
program for residents, psychiatrists, and mental
health staff. The cchs also offers resident and medical
student training, clinical service consultations, and
public education on culture and mental health,
including training in research methodologies for
doctoral students and post-doctoral fellows through
thesis supervision and opportunities for involvement
in cchs research projects. Dr. Lisa Andermann’s
post-doctoral work was jointly sponsored by the cchs
and the Psychological Trauma Clinic at Mount Sinai
Consultations and Review Panels
The cchs provides community, policy, and
scientific consultations at national and international
levels. Through affiliations with the Joint Centre
of Excellence for Research on Immigration and
Settlement—Toronto, a tri-university centre,
supported by sshrc through agreements with eight
departments of the federal government, the cchs
contributes to a national agenda of policy-oriented
research, focusing on immigration and mental
health. As part of a Canadian Heritage initiative, Dr.
Anneke Rummens continues to develop a database
on identities in Canada. Dr. Ted Lo provides cultural
consultation to hospitals, as well as education
programs in integrative medicine. He is currently
planning an international conference, a collaborative
initiative with China, on traditional medicines. Dr.
Lo also serves on the Toronto/Peel Mental Health
Reform Implementation Task Force. Dr. Violet
Kaspar is a member of the Canadian Institutes of
Health Research peer review committee for Strategic
Programs—Reducing Health Disparities and
Promoting Equity for Vulnerable Populations.
29
Visiting Scholars
Dr. Francis Lu—Professor of Clinical Psychiatry
and Director of the Cultural Competence and
Diversity Program, Department of Psychiatry, San
Francisco General Hospital and University of
California, San Francisco—visited the centre as the
2002–2003 Beverley Professor. The visit was hosted
by the cchs Program, through support from the
Centre for Addiction and Mental Health’s Beverley
Professorship fund. The professorship brings
distinguished researchers and clinicians to camh to
promote and participate in academic discussion on a
topic relevant to research, clinical care, and teaching
activities. As the 2002–2003 Beverley Professor, Dr.
Lu provided lectures, workshops, and consultation
groups on cultural competence in academic research,
clinical care, and teaching, focusing on the role of
cultural competence in understanding mental health
disparities.
International Initiatives
The cchs has taken the lead in developing a memo
of understanding involving the University of Port
Harcourt, the University of Toronto, and the
Centre for Addiction and Mental Health. This
initiative, resulting in the establishment of a Centre
for Stress and Health in the Niger Delta region
of Nigeria, received funding from idrc. Another
research initiative, with funding from the sshrc and
cihr, involved collaboration between the University
of Toronto, Centre for Addiction and Mental
Health, and the American University of Beirut, for
a comparative study of adolescent mental health.
Finally, the cchs participates in an initiative in Addis
Ababa, Ethiopia. The initiative will allow two staff
psychiatrists and one resident from the University of
Toronto to travel to Addis Ababa three times per year,
for 1 month per visit, to teach in the newly formed
Ethiopian psychiatry residency program.
This was a transitional year for the cchs, with
the retirement of Dr. Morton Beiser as Head of
the Program in June 2003, and the search for his
successor proceeding during the 2002–2003 academic
year. Thanks to Dr. Violet Kaspar for coordinating
administrative and academic activities of the program
during the transition.
Peter Prendergast, md, frcpc
Acting Head, Culture, Community, and Health Studies Program
30
Division
of
Child Psychiatry
The goal of the Division of Child Psychiatry is
to provide exemplary patient care, training, and research
in children’s mental health.
Organization
Functions
he Department of Psychiatry at the
Hospital for Sick Children (hsc) and the
Child Psychiatry Program at the Centre for
Addiction and Mental Health (camh) are unified
under a single leader, who is Head of the Division
of Child Psychiatry. This is considered the centre
of excellence in child and adolescent psychiatry, and
comprises the largest training component of the
Division of Child Psychiatry. Other components of
the division include Youth Services at Sunnybrook
and Women’s College Health Sciences Centre
(swchsc) as well as community-based settings such
as the George Hull Centre and the Hincks-Dellcrest
Centre. There is a clear understanding that residents
will be exposed to these community programs as well
as the hospital programs.
Clinical programs comprise the full range of services
in children’s mental health. It is understood, however,
that the Division of Child Psychiatry operates within
a system that includes other hospitals and community
agencies. The Division of Child Psychiatry has
focused on clinical services that provide opportunities
for training and research. Education functions include
electives for medical students and the mandatory
6 -week training in child psychiatry for clinical clerks.
These functions take place in all divisional settings.
Post-graduate training includes both the 6 -month
mandatory core rotation and career training in child
psychiatry, as well as a variety of electives. Continuing
medical education is organized primarily through the
Annual Child Psychiatry Conference Update Series
and Child Psychiatry Day. It also occurs through
other conferences and seminars in Child Psychiatry,
such as the series for pediatricians and family
doctors. Individual faculty members also offer
lectures to community groups.
T
Public Policy
Undergraduate
The Division of Child Psychiatry attempts to shape
public policy. The Head of the Division, or his
delegate, and the heads of various agencies within
the division, have been asked to sit on committees
examining issues such as the implementation of
legislation regarding child’s mental health. In keeping
with this mandate, Dr. Joseph Beitchman appeared as
an expert witness at the Select Senate Committee on
Mental Health.
The Division of Child Psychiatry Undergraduate
Committee implemented a revised clerkship
curriculum that emphasised more up-to-date and
evidence-based information. The existing sections
of the syllabus were expanded and revised. New
references and website resources were also added.
A new section on developmental disabilities was
created, focusing on mental retardation and pervasive
developmental disorders. A new section on anxiety
disorders was also created. New osce stations and
written exam questions were developed on the basis of
the revised curriculum. Informally, student response
to the curriculum has been positive. The syllabus
was also placed on-line, through Blackboard as a first
step towards using Internet technology, as a means
of curriculum delivery and co-ordination. Lastly, Dr.
Mark Hanson, who as Director of the undergraduate
program led the planning and development of the
child psychiatry clerkship curriculum over the
past several years, will be leaving his position. His
leadership and dedication will be greatly missed, and
the undergraduate group wishes him the best in his
future endeavours.
Post-graduate
The past year was again successful in the postgraduate portfolio. At the end of the academic year,
Dr. Marshall Korenblum stepped down as Divisional
Post-graduate Director after 12 years of outstanding
leadership. Dr. Mark Sanford became the new
Director of Divisional Post-graduate Education
effective July 1, 2003. A total of eight residents were
in the Child Psychiatry career-track program, during
this past year, one of the highest numbers in the
department. Half of the graduating residents chose to
do a fellowship, which bodes well for future academic
recruitment.
This year has seen consolidation of the program
in a number of areas. The Telepsychiatry Program
has grown and offers a unique training experience
in providing distance consultation for core child
psychiatry residents and career child psychiatry
trainees. Planning is underway to add elective
clinical rotations in community clinical settings
outside of the five clinical sites, as well to increase
training opportunities for in-patient child psychiatry
(hsc and swchsc) and medical child psychiatry.
The academic program is under review and some
changes are expected, including introduction of more
interdisciplinary learning opportunities, increased
coverage in infant psychiatry, and more teaching
of critical appraisal and other skills necessary to
becoming effective lifelong learners.
Residents continue to enjoy a diverse training
experience at ccamh. In addition to fulfilling core
rotation Royal College requirements, residents are able
to select many specialty elective experiences. This year,
with the integration of Youth Addictions and sapaccy,
sapaccy
residents have the opportunity to acquire experience
in seeing adolescents with comorbid mental health and
substance abuse issues. Resident satisfaction ratings
continue to be high, reflecting the richness of their
experiences.
Continuing Medical Health Education
(CMHE)
cmhe focused on development of multi-modal
longitudinal and 1-day courses using interactive
techniques, and needs and knowledge-gain
evaluations. The educational events included
the Annual November Update series in Child
Psychiatry, Annual Child Psychiatry Day devoted to
Infancy: Social and Biological Perspectives on Early
Development, longitudinal course for pediatricians
and family physicians on Management of Adolescent
Disorders, Faculty Retreat on Knowledge Translation
into Practice via Interdisciplinary Collaboration,
and ongoing seminars for Pediatric Telehealth.
Collaboration with adult psychiatry resulted in two
workshops presented by the Child Psychiatry Division
at the Toronto Psychopharmacology Update. Under
the leadership of Dr. Tatyana Barankin, and with the
participation of the cme Advisory Committee, the
cme office has become a leader in the Department of
Psychiatry, in providing accredited continuing medical
education events.
32
Other Activities
Telepsychiatry Program
The Infant Psychiatry Program
The Infant Psychiatry Program has expanded to
offer services to include pre-schoolers, and as a
result, we now see children from birth to 5 years of
age. The program has been established as a centre
for evidence-based interventions for parents and their
infants or young children. The program continues
to attract participants interested in collaboration
from a number of areas across the hospital and from
other faculties and colleges within the university. At
present, the Infant Psychiatry Program is working to
develop collaborations that will create a wider infant
mental health perspective to include service provision,
research, and teaching in the hospital, the university,
and the community at large.
The Division of Child Psychiatry completed its
2 -year contract with the Ministry of Community,
Family, and Children’s Services on March 31, 2003.
This contract was renewed with the division in
partnership with the Hospital for Sick Children for
1 year to March 31, 2004. The mandate continues
for this “hub” site to provide service and education
to 14 children’s mental health centres in rural and
northern Ontario. Any other children’s mental health
provider with compatible technology can access the
Telepsychiatry Program to a maximum number of 10
hours per week. A fire-setting consultation protocol
was recently initiated, which allows for direct delivery
of case consultation for children who are fire-setting
and who have other mental health symptoms. There
is a particular focus in the north for First Nations
communities, recognizing the cultural aspects that are
brought to practice in this area. Under the direction
of Dr. John Teshima, 14 educational seminars were
held via the network with a total of 962 front-line
workers participating. The formal evaluations of these
seminars have been outstanding and have been viewed
as very contributory in many different ways. Phase
iv of the “qualitative” evaluation was completed with
many of the recommendations being implemented.
The value and further potential of the Telepsychiatry
Program is becoming recognized with the hope of
continued growth.
The Divisional Psychotherapies Program
The Divisional Psychotherapies Program was
established to support clinical service, teaching, and
research in the range of psychotherapeutic modalities
useful with children, youth, and families. In a field
that once consisted of only play and family therapies,
we now find cbt, ipt psychodynamic, parent training,
individual, group, family, and multisystemic therapies,
among others. These are offered in long-term and
brief forms across the division with several sites,
including expertise in several different modalities.
Teaching and supervision are available at all five sites
with ongoing research at several.
Over the past year, the program initiated the
Annual Day in Child Psychotherapies, a day of
education for children’s mental health professionals
from the university and the community.
Infant Mental Health Promotion Project
The Infant Mental Health Promotion Project (imp),
directed by Ms. Rhona Wolpert, with co-chairs Ms.
Nancy Peters from the Massey Centre for Women
and Dr. Susan Bradley (hsc), has continued to
provide training and information for community
service providers working with infants and their
families.
In December 2002, imp published Competencies for
Practice in the Field of Infant Mental Health, and in June
2003 a special issue of the newsletter IMPrint was
published, dealing with interventions that promote
infant mental health. As well, in June 2003, imp
updated and reprinted Pregnancy & Alcohol/Drug Use:
A Professional’s Guide to Identification and Care of Mother
and Infant. All of these have been very well received
across Canada and the usa. Our video A Simple Gift:
Comforting Your Baby for parents, has been purchased
by Sweden for translating and use with families there.
Joseph H. Beitchman, md, frcpc
Head, Division of Child & Adolescent Psychiatry
33
Division
of
General Psychiatry
The Division of General Psychiatry is
the largest program/division within
the Department of Psychiatry at the University of Toronto.
T
he Division of General Psychiatry is the largest
program/division within the Department of
Psychiatry at the University of Toronto, and
is the academic home of acute care psychiatry, both
in-patient and outpatient. The division provides a
framework for clinical coordination across a range
of sites, as well as core training in psychiatry for
residents.
Members of the division—over 100 strong—are
extremely active in education of many types of
health professionals, with particular emphasis on
advanced studies in suicidology, emergency psychiatry,
psychological trauma, cross-cultural health, integrated
therapy, and in-patient psychiatry. Research in
diverse areas such as inner city health, dual disorders,
clinical treatments, population health, ethics, and
integrative psychotherapy / medication models are
pursued. Major sites include the University Health
Network (Toronto Western Hospital, Toronto
General Hospital, and Princess Margaret Hospital),
St. Michael’s Hospital, the Centre for Addiction
and Mental Health, Mount Sinai Hospital, and
Sunnybrook and Women’s Health Sciences Centre.
North York General Hospital also is active as a
secondary division site.
The purpose of the division is to foster the
role of the academic generalist as a critical bridge
in the academic and clinical worlds, to promote
and model broad-based and integrative teaching,
research, and clinical care in an era that emphasizes
subspecialization. The division’s commitment to
nurturing clinical excellence and comprehensive
responsiveness to the needs of society is demonstrated
by the wide array of clinical services that also includes
the University of Toronto Psychiatric Outreach
Program, which provides services across Ontario.
Program Developments
During the 2002–2003 period, the division underwent
a major internal review. Division Head Dr. Sagar
Parikh made a series of site visits to each of the key
teaching hospital locations—the University Health
Network, the Centre for Addiction and Mental
Health, Sunnybrook and Women’s Health Sciences
Centre, St. Michael’s Hospital, and Mount Sinai
Hospital. Additional visits were made to North York
General Hospital, which includes a number of staff in
the General Psychiatry Division, and to St. Joseph’s
Health Centre in Toronto, a non-affiliated site. These
meetings led to a series of recommendations for
enhancement of the division, with particular care to
identify and foster more focused activities at each site.
Specific strategies for enhancement of research and
education were articulated, with key roles identified
for population health research, clinical trials research,
and education research. Educational recommendations
included enhancing the overall continuing education
activity of the division, with care to meet the needs of
non-physician learners as well as physicians. In the
area of resident education, the need for a distinct block
of General Psychiatry training in the pgy2 year was
identified, with teaching to be done by members of the
division rather than by subspecialists. Initial planning
for the new General Psychiatry block has commenced.
From the clinical perspective, the internal review
noted that there were additional opportunities for
optimal general psychiatry activity outside the existing
network. In particular, St. Joseph’s Health Centre has
made mental health care a hospital priority area, and
has developed an unusually varied series of programs
spanning all types of service delivery. Additionally,
programming has featured high-impact services for
underserved ethnic groups, women, and the poor. In
view of the special expertise available at St. Joseph’s,
it was approved as a site for elective resident rotations
in General Psychiatry and may evolve into a site for
regular resident rotations. Similarly, new clinical
approaches being developed by two recent graduates
of the University of Toronto at the Joseph Brant
Memorial Hospital in Burlington have led to its
being approved as a site for elective rotations. Finally,
psychiatry training facilities and opportunities in the
city of Thunder Bay were reviewed, with approval of
that site for resident training in General Psychiatry.
At the end of June 2003, Dr. Parikh stepped
down as Head to take on new responsibilities as
Director of Continuing Mental Health Education for
the Department of Psychiatry. Dr. Paul Links was
appointed as Interim Division Head, with a new Head
to be appointed in the fall of 2003.
Sagar V. Parikh, md, frcpc
Head, General Psychiatry Program
35
Ontario Psychiatric
Outreach Programs
In November 2002, Commissioner Roy Romanow,
Head of the Commission on the Future of Health Care in Canada,
released his landmark report Building on Values: The Future of Health Care in Canada.
I
n November 2002, Commissioner Roy Romanow,
Head of the Commission on the Future of Health
Care in Canada, released his landmark report
Building on Values: The Future of Health Care in Canada.
In a time when countries around the world struggle to
find the best ways to ensure the health of their citizens,
Canadians articulated a clear and compassionate
vision: health care is a right, not a luxury, and is a
public responsibility that cannot be left solely to
the private sector. The commission’s final report
highlighted the many successes of the Canadian health
care system and celebrated aspects that make it widely
admired. At the same time, it addressed inequities
and problems of finding care that are incompatible
with the Canadian vision of equity and access. Most
notable was a focus on the significant needs of rural
communities and Aboriginal health needs.
As a program dedicated to capacity building in
underserviced areas, there is much for opop members
to consider. But above all, the Romanow Report helps
to articulate the need for all players—governments,
universities, health care professionals, and students in
Canada—to reflect on the persistence of underservice.
I believe the will to find solutions is propelled by a
sense of social responsibility. As you review this
annual report, you will see many examples of the
ways in which the opop family of programs is firmly
committed to ensuring that all Canadians, no matter
where they live, can participate and benefit fully in
health care and professional health education.
The Rise of Video Conferencing
The high cost and impracticality of travel illustrates
the utility of our move into the realm of video
conferencing for both education and clinical services.
All of the affiliated opop programs now utilize
telepsychiatry in some capacity, and I am very
pleased to see the evolution of this new technology
as a complement to fly-in and drive-in psychiatric
clinics. The priority will continue to be extending
and augmenting services to communities while
reinvesting any cost-savings into additional services.
opop has launched a formal study of the efficiency
of telepsychiatry with generous support from the
Underserviced Area Program. This year we have
worked hard to strengthen our links with north
Network and to develop strategies for sustaining
services and infrastructure that were built
through the federally funded telepsychiatry program
Project Outreach. In addition to clinical services, we
have connected residents through video conference,
conducted training on-site in North Bay, Sault Sainte
Marie, and Thunder Bay, and provided education
support to mental health workers in the communities
of Parry Sound, Bracebridge, Sunridge, Sioux
Lookout, Wapakeka, Kingfisher, and Wunnumin, just
to name a few.
are a step in the right direction. But there is much more
to be done.
—Building on Values: The Future of Health Care
in Canada
(Romanow Commission, Final Report, November
2002)
Rural and Remote Communities, p. 163.
In the field of education, OPOP, in its objective of
opening avenues for our Ontario medical school
psychiatric residents to experience the practice of their
specialty in outreach areas, has fostered the development
of OPEN. This group has allowed our Department of
Psychiatry Postgraduate Education Director, Katharine
Gillis, to dialogue with her counterparts in other
Ontario universities on a variety of training issues
related to underserviced areas.
It means that deliberate, decisive, and immediate
action can be taken to address severe shortages in
health care providers in many smaller communities. It
means the potential of new approaches like telehealth to
literally bring health care to the doorstep for people in
rural and remote communities can be realized.
—Building on Values: The Future of Health Care
in Canada
(Romanow Commission, Final Report, November
2002)
Rural and Remote Communities, p. 169
—André Côté, Director
Northern Ontario Francophone Psychiatric Program
It is expected that in 2003–2004, these core rotations
will be expanded to include other sites, such as Sudbury
and Timmins, and core rotations will be introduced
in the areas of Child and Adolescent Psychiatry and
Outpatient Psychiatry. These improvements will enable
future residents to complete most, if not all, of their
required specialty training in northern Ontario.
Redoubling Our Commitment to
Education
The Romanow Report highlights the need to address
health care in rural and remote areas with a particular
emphasis on the role of education.
Consistent with the final report’s recommendations, opop has redoubled its efforts to expand
training for psychiatry residents in northern
communities. The directors of our affiliated outreach
programs have turned attention to expanding
opportunities for residents. The growth has been
enormous. As of July 2003, we will have seven
residents training full-time in northern communities,
and there is every indication that all of these graduates
will remain in the north to practise psychiatry. Not
only will this begin to alleviate the shortage of
clinicians, but it will also extend the cadre of faculty
for future education programs, most notably the
evolving Northern Ontario Medical School.
—David Cochrane, Regional Coordinator
Northern Ontario Medical Education Corporation
There has been an increase in the number of medical
students being admitted to the University of Western
Ontario Faculty of Medicine and Dentistry, and
the creation of the South Western Ontario Medical
Education Network (SWOMEN) in Windsor, and
the enhancement of the Southwestern Ontario Rural
Medicine . . .
—Emmanuel Persad, Director
Extended Campus Program, University of Western Ontario
Part of the answer certainly lies in increasing physicians’
exposure to rural settings as part of their education and
training. With increased exposure to, and experience
in, rural settings, the likelihood of graduating doctors
wanting to practise in rural settings increased exposure
to, and experience in rural settings increases (BCMA
2002).
). Recent efforts by the Society of Rural Physicians
of Canada and the College of Family Physicians of
Canada to develop national curricula and guidelines
Over the past year, increased emphasis has been
placed on developing opportunities for knowledge
exchange between primary care and mental health
. . . Educationally, students across the allied health
disciplines, psychiatry residents, and fellows are
involved in outreach activities throughout the eastern
Ontario region . . . The program also supports a
training rotation for fellows in the Department of
37
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is leading the way in Ontario. I want to thank Drs.
Emmanuel Persad, André Côté, Robert Cooke, Gary
Chaimowitz, Melissa Andrew, Henry Leung, David
Cochrane, and Suzanne Allain, affiliated program
directors, for their leadership, vision, and spirit of
cooperation. And I particularly want to thank the fulltime opop staff who continue the good work of the
outreach program. A warm thanks to Sandy Parker,
Therese Millette, Ava Rubin, Achira Saad, Hanna
Seimiarczuk, Sibi Samuel, Helene Geoffroy, and
Carmen Larouche Mattar.
Family Medicine’s Care of the Elderly . . . These
developments have been greatly assisted by the evolution
of the first provincial committee which brings together
all of the postgraduate training directors in psychiatry.
The Ontario Psychiatric Outreach Network (OPEN)
committee has focused attention on rural and remote
training issues in a way that has not been achieved in
the past.
—Melissa Andrew, Assistant Professor
Division of Geriatric Psychiatry, Queen’s University
I am very optimistic that we are finding
enduring solutions to the longstanding problem of
underserviced psychiatry. I believe that psychiatry
Brian Hodges, md, M.Ed, frcpc
Chair, Ontario Psychiatric Outreach Programs
Director, University of Toronto Psychiatric Outreach Program
38
Division
of
The Division of Geriatric Psychiatry
strives for excellence in research into
mental disorders in late life and
the education of health care practitioners who treat
elderly patients.
Program Description
Mission
T
he Division of Geriatric Psychiatry strives for
excellence in research into mental disorders
in late life and the education of health care
practitioners who treat elderly patients. As service
providers to a growing and relatively underserviced
patient population, we also act as advocates for these
individuals in health policy.
Organization
Dr. Nathan Herrmann is Head of the Division. There
are six primary sites: Baycrest Centre for Geriatric
Care (Head, Dr. D. Conn), the Centre for Addiction
and Mental Health, Queen Street site (Acting
Head, Dr. L. Fornazzari), Mount Sinai Hospital
(Head, Dr. R. Meier), Sunnybrook & Women’s
College Health Sciences Centre (swchsc)
(
(Head,
Dr. N. Herrmann), the University Health Network /
Toronto Rehabilitation Institute (Head, Dr. A. Flint),
and St. Michael’s Hospital (Head, Dr. C. Fischer).
The designated centre of excellence is at swchsc,
Sunnybrook Campus.
Functions
The division sites provide the full spectrum of clinical
services for the management of elderly patients
with psychiatric illness. These include in-patient
units, outpatient services, day hospital, community
psychogeriatric services providing domiciliary visits
and consultation liaison services to both acute care
and long-term facilities.
Formal educational activities are provided at
the undergraduate, post-graduate, fellowship, and
continuing education levels. The undergraduate
education subcommittee is chaired by Dr. C. Cohen,
with division members active in all aspects of the
undergraduate curriculum. This includes the
pre-clerkship curriculum, with division members
teaching and organizing aspects of the Art and
Science of Clinical Medicine, Brain and Behaviour,
Foundations of Medical Practice, and Determinants
of Community Health. Division members are also
involved in teaching and tutoring in the clerkship
curriculum, and offering psychogeriatric electives. The
post-graduate education subcommittee is chaired by
Dr. S. Lieff. The division trains every single resident
in the program in Geriatric Psychiatry, as mandated
by the Royal College requirements. The division also
trains residents interested in career paths in Geriatric
Psychiatry. Division members participate in the core
curriculum, including a pgy1 session of assessment
of the geriatric patient. The fellowship committee is
chaired by Dr. A. Flint. The division offers fellowships
at the University Health Network, Baycrest Centre
for Geriatric Care, and Sunnybrook Health Science
Centre. Baycrest Centre for Geriatric Care, swchsc,
and the University Health Network offer fellowship
positions funded through their foundations.
The Continuing Education committee is chaired
by Dr. P. Cooper. The division endeavours to organize
a major Continuing Education event each year,
alternating between a target audience of primary care
physicians and a target audience of geriatric psychiatry
subspecialists.
business meetings were held in conjunction with
division-wide Grand Rounds held this past year at
Baycrest Centre for Geriatric Care, the University
Health Network, and Mt. Sinai Hospital. The
division also held a retreat, which focused on issues
related to post-graduate education.
Functions
The division trained 22 residents in mandatory
training positions and two full-year career-path
residents this year. For each 6 -month block, there
was a seminar in the first month that focused on
interviewing skills and diagnostic formulation. This
seminar, which utilized didactic sessions, videotape
interviews and small group teaching, was well rated by
the residents.
Residents and fellows training in the division had a
successful year. Dr. Grace Wu received the Canadian
Academy of Geriatric Psychiatry Resident Award and
also won the division’s Award of Excellence for a paper
titled “The Cost-Benefit of Cholinesterase Inhibitors
in Mild to Moderate Dementia: A Willingness
to Pay Approach,” which is currently in press. Dr.
Sarah Thompson attended the Stepping Stones
Program at the American Association of Geriatric
Psychiatry’s Annual Meeting. Dr. Nadine Gagnon
successfully completed her Geriatric Psychiatry
Fellowship and successfully defended her M.Sc
thesis through the Institute of Medical Science on
the fear of falling in the elderly. Dr. Monica Scalco
completed a 2 -year fellowship at the Baycrest Centre
for Geriatric Care. She published two peer-reviewed
articles and presented her work at several national and
international conferences.
This past year Dr. David Conn stepped down
as Head of Continuing Education for the division,
a position now held by Dr. Peter Cooper. Dr.
Cooper’s first task was to begin to organize a large
ce event for community psychiatrists and family
physicians updating topics in Geriatric Psychiatry.
This conference is scheduled for November 2003.
Another important development has been division
participation in the organization of the Canada–Israel
Behavioural Neurology and Geriatric Psychiatry video
teleconference rounds. These rounds, held twice in the
past academic year, are planned quarterly and involve
sites in Toronto, Jerusalem, and Tel Aviv. Besides
being excellent educational experiences, the rounds
also represent the division’s initiative with its strategic
plan to develop academic outreach to other countries
and utilize E-learning.
Public Policy
Division members lead in national (Canadian
Academy of Geriatric Psychiatry) and international
(International Psychogeriatric Association, American
Academy of Geriatric Psychiatry) organizations.
Division members have also been active participants in
health policy development, for example at the District
Health Council level.
Organization
The division had an extremely successful year with
significant activities at all its centres. Major staffing
changes during the academic year included the
appointments of Dr. M. Rapoport to swchsc, Dr. C.
Grief to Baycrest Centre for Geriatric Care, Dr. V.
Stergiopoulos to St. Michael’s Hospital, and Drs. M.
Rehman and J. Verghese to camh. Dr. Peter Cooper
moved from camh to the University Health Network.
These appointments significantly strengthen the
academic staff at the respective sites. The division
40
Division members had an extremely productive year.
Dr. Susan Lieff was recipient of the first University
of Toronto, Faculty of Medicine Award of Excellence
in Post-graduate Medical Education for teaching
performance, mentorship, and advocacy. Dr. Ivan
Silver became the Director of Faculty Development
for the Faculty of Medicine at the University of
Toronto. Division members continued to lead in
national and international organizations. Dr. Joel
Sadavoy became President-Elect of the International
Psychogeriatric Association. Dr. Ken Shulman is
on the Board of the International Psychogeriatric
Association, and Dr. Susan Lieff is on the Board of
the American Association of Geriatric Psychiatry.
Division members published in multiple peer-reviewed
journals and held peer-reviewed grants, including
grants from the Alzheimer Society of Canada, nimh,
American Health Assistance Foundation, Ontario
Mental Health Foundation, Population Health, as
well as a cihr net grant. In health policy and service
delivery, Dr. David Conn presented to the Senate
Standing Committee on Social Affairs, Science, and
Technology, which is currently reviewing mental
health in Canada. Dr. Conn is also Co-Chair
of the Canadian Coalition for Seniors’ Mental
Health, which recently obtained a Health Canada
Population Initiative Grant. Dr. Corrine Fischer
has chaired a Clinical Services Committee to look
at overlap and duplication of geriatric psychiatry
service and consultation to long-term care facilities in
Metropolitan Toronto.
Nathan Herrmann, md, frcpc
Head, Division of Geriatric Psychiatry
41
Law &
Mental Health
Program
The mission of the program is to
establish the Faculty of Medicine at the University of Toronto
as an
international leader in research on the
causes and prevention of violence and crime among the
mentally ill.
Brief Description
T
he mission of the program is to establish
the Faculty of Medicine at the University of
Toronto as an international leader in research
on the causes and prevention of violence and crime
among the mentally ill, by conducting and encouraging
research and scholarship through local, national, and
international collaborations; to model exemplary,
accessible, and comprehensive care to mentally
disordered offenders in Ontario; to train students in
psychiatry and other mental health disciplines at all
stages of career development, including undergraduate,
graduate, fellowship, and continuing education; to
promote comprehensive and coordinated mental
health care for mentally disordered offenders in
Ontario; and to promote public safety through
best-practice assessment and treatment of mentally
disordered offenders in Ontario.
The Law and Mental Health Program’s centre of
excellence is the Law and Mental Health Program
at the Centre for Addiction and Mental Health
(camh). Services include specialty clinics (e.g., the Sex
Behaviours Clinic, the Kurt Freund Laboratory, and
the Gender Clinic); the Assessment and Triage Unit
(formerly metfors; a 28 -bed in-patient assessment
unit); the Secure Observation and Treatment Unit
(sotu; a 9 -bed in-patient unit); four rehabilitation
units (two medium-secure in-patient units with a
total of 40 beds, and two minimum-secure in-patient
units with a total of 61 beds); and an outpatient
service with a roster of 80 patients.
The program faculty is active in other clinical and
administrative settings: the Mental Health Court
at Old City Hall, Toronto; the Oak Ridge Division
of the Mental Health Centre Penetanguishene; the
Forensic Assessment Program at the Whitby Mental
Health Centre; the Department of Psychiatry at
the North York General Hospital; and the Ontario
Review Board. Program faculty consult with external
agencies and institutions on forensic issues that
include the National Parole Board; the Correctional
Service of Canada at various sites, including the
Warkworth Sexual Behaviour Clinic and the Central
Office of the National Parole Service; the Ontario
Provincial Police; the Metropolitan Toronto Police
Service; the Royal Canadian Mounted Police; and
Canadian corporations.
Faculty in the program conduct
1. Forensic assessments for the courts, the Ontario
Review Board, the National Parole Board, and
other jurisdictional authorities. Assessments
may include fitness to stand trial, criminal
responsibility, assessments related to Dangerous
Offender applications, and risk for violent and
sexual recidivism.
2. Treatment of forensic patients in both in-patient
and outpatient settings. Treatments may include
drug therapies, cognitive-behavioural treatment
with a focus on relapse prevention, social skills
training, and psychosocial rehabilitation.
3. Community reintegration, including case
management coordinated with continuing
mental health care. We conduct assessments
of forensic in-patients for their suitability for
community release, and provide information
essential to release planning.
4. Consultation and liaison with other programs
and clinical settings addressing forensic mental
health issues.
be constructed over the next 5 years.
The Law and Mental Health Program has been
instrumental in establishing the Mental Health Court
Support Consortium to provide on-site service to
mentally disordered persons facing criminal charges
in the courts in Toronto to ensure their access to local
mental health services. In addition, the program has
established effective partnerships with five local act
teams that have been designated as “forensic-ready.”
These act teams have been receiving referrals from
forensic in-patient services and have been actively
integrating forensic patients into community living.
Research
In collaboration with the Centre for the Study of
Aggression and Violence at McMaster University, the
program organized the 7th Annual Law and Mental
Health Conference: Research, Applications, Public
Policy, and Law (formerly Forensic Research Day),
and this conference was to be held at camh in May
2003. sars restrictions forced the conference to be
rescheduled for November 2003.
Dr. Ray Blanchard and Dr. James Cantor continue
work on their prestigious Canadian Institute of
Health Research grant studying the neuropsychology
of pedophilia.
Dr. Martin Lalumiere, with colleagues from
Queen’s and McMaster Universities, has published
a book on juvenile delinquency, and their book on
rape will be published next year by the American
Psychological Association. Dr. Michael Seto is
working diligently on a similar book on pedophila for
the same publisher.
Calvin Langton completed his PhD dissertation
in the Institute for Medical Science under the
supervision of Dr. Howard Barbaree. Dr. Langton’s
thesis, which examined risk assessment in sex
offenders, has won the Association for the Treatment
of Sexual Abusers Graduate Research Prize, awarded
in St. Louis in October 2003.
Dr. Howard Barbaree has been appointed Editorin-Chief of Sexual Abuse: A Journal of Research and
Treatment.
Clinical Service
The program has received funding from the mohltc
for a six-bed Medium Secure Unit for female mentally
disordered offenders. Renovations are to be made this
year to the first floor of Unit 3 at the Queen Street
site to accommodate this new service that will provide
best practice mental health services in this specialized
field. In partnership with officials of the Ministry of
Public Safety and Security (Correctional Services),
the program has completed a functional program
plan to establish a 100 -bed mental health facility to
serve mentally disordered offenders on remand and in
detention in Toronto. It is hoped that this facility will
Education and Training
Students in all mental health disciplines and at all
levels of training participated in program activities
this past year. Three medical students participated
in electives within our forensic settings under the
supervision of program faculty. During the past year,
43
three residents completed senior selective rotations. In
addition, an lamh resident has been accepted into the
department’s newly established Clinician-Scientist
Program.
Undergraduate students in Occupational Medicine
continue to do core psychiatry rotations in the Law
and Mental Health Program, with an emphasis on
workplace violence.
Faculty in the Law and Mental Health Program
continue to make significant contributions to the
teaching of the undergraduate interviewing course as
well as the ascm series. Our faculty continue to make
significant contributions to teaching elsewhere in
the university, including an undergraduate course in
Forensic Psychology at the Erindale Campus of the
U of T, and a graduate course in Forensic Psychology
in the Centre for Criminology.
In Continuing Education, the Law and Mental
Health Program has implemented a series of weeklong courses that inform professional groups about
mental health law and the Mental Disorder Provisions
of the Criminal Code of Canada, and the delivery of
forensic mental health services. In partnership with
the Ontario Provincial Police, two courses (basic and
advanced) were delivered early in the academic year
to police officers from throughout North America.
Later in the year, the course was delivered to act team
professionals from around the province of Ontario.
Public Policy
The Head of the Program was a member of the
Forensic Expert Advisory Panel that submitted its
final report to the Ontario Ministry of Health and
Long-term Care in January 2003. This report will
significantly influence future development of forensic
mental health services in the province.
Howard E. Barbaree, PhD, C.Psych
Head, Law and Mental Health Program
44
Health Systems
Program
The mission of the Health Systems Program is to
facilitate the utilization of scientific information to
improve the delivery of
mental health and addiction services.
Program Description
T
he mission of the Health Systems Program
is to facilitate the utilization of scientific
information to improve the delivery of mental
health and addiction services. The target population
consists of individuals most in need of systems of care
because of the long-term, serious, and multiple nature
of their problems.
The program is directed by Drs. Paula Goering
and Peter Prendergast. It has as its centre of excellence
the Health Systems Research and Consulting Unit
(hsrcu) at the Centre for Addiction and Mental
Health (camh). This strong centre conducts servicedelivery research and has had a major impact on
provincial and local mental health reforms. It includes
a consulting practice through which faculty have
influenced the delivery of mental health and addiction
services in several regions and provinces.
The Health Systems Program has developed a
cohesive network of sites. Primary sites include the
Centre for Addiction and Mental Health, Whitby
Mental Health Centre, and St. Michael’s Hospital.
Monthly meetings of a core committee are the vehicle
for planning and implementing program activities.
Collaborations with other Department of Psychiatry
programs have included a shared research seminar,
joint grant submissions, and participation in joint
educational programs.
The Health Systems Program objectives in clinical
services are to support and assist in development
of programs that are community-focused, target
individuals with severe and persistent mental
illnesses and/or addictions, and are integrated into
a continuum of care. In education, the program
sponsors academic lectures and colloquia. As well,
fellows are associated with the program. Seminars for
psychiatric residents are presented in the departmental
core curriculum, and residents may structure career
rotations in the program. In undergraduate education,
a half-day workshop on the mental health system is
presented in the Determinants of Health course. As
well, faculty of the program have been very involved
in the course, as supervisors.
Many of the program’s research activities are
carried out by the centre of excellence. However,
the hsrcu also develops joint projects with
other sites within the program network and with other
groups in the Department of Psychiatry. In addition
to the creation of new knowledge in service delivery,
the Health Systems Program emphasizes knowledge
dissemination and the promotion of knowledge
utilization as well as the integration of qualitative and
quantitative research methodologies.
Members of the program are involved extensively in
public agendas. The program has developed effective
working relationships with decision makers at national,
provincial, and local levels. Activities include the
provision of technical assistance for planning processes,
advice and consultation to government departments,
commissions and task forces, and information to guide
public policy development in mental health.
developing a knowledge transfer plan for best practices
in concurrent disorders; organizing a research
education series for our policy partner; evaluating and
disseminating the research transfer training series
and working with our provincial evaluation project
to implement innovative communication strategies. A
paper describing our relationship with the provincial
policy branch has been accepted for publication. We
are also developing a knowledge translation research
program and a university course.
Consultation
Our consultation service is busy transferring
knowledge and keeping research staff in touch with
front-line service-delivery issues and problems. We
have added an evaluation component to all of our
projects, which in the last year included a review of
Toronto’s mental health court support services, an
evaluation of a lead agency in northern Ontario, and a
study of utilization of in-patient services in Southwest
Ontario.
Network Activities
In addition to the regular meetings of the core
committee, two colloquia were held. In the fall the
2nd Annual SJJ Freeman Lecture was held. Dan
Bilsker led a discussion on the merits of collecting
and reporting outcome data for report cards to the
public. In the spring a joint session with the Inner
City Health Research Unit at St. Michael’s Hospital
provided an opportunity to explore collaborations.
In addition to implementing our own Health
Systems Strategic Plan, members of the program
were actively involved in promoting departmental
strategic directions in population health, international
development, and clinical coordination.
Research
The last year was a busy and productive one for the
team at the centre of excellence, who were engaged
in research and consulting projects that generated
$1,023,096 in external funding. This work included 15
refereed articles published and 9 in press as well as 10
reports. Faculty also made numerous presentations at
scientific and educational meetings. We welcomed Dr.
John Cairney who has joined us as a Research Scientist
with expertise in population mental health. A brief
selection of our research projects follows.
Education and Training
We had 17 trainees supervised by scientists on the
hsrcu in the last year, three of whom won awards for
the excellence of their work. We have developed a very
successful summer studentship program that attracted
80 applications this year for four positions. Three
fellows have learned about health services research, as
have graduate students from several disciplines. We
are involved in two cihr Training Centres that will
provide stipends for trainees as well as opportunities
to connect with broader networks. Scientists are
teaching several new university courses, and there are
educational series available on the unit for trainees
and staff.
Community Mental Health Evaluation Initiative
The hsrcu is the coordinating centre for a multi-site
evaluation research project to advance understanding
of the roles played by case management, assertive
community treatment, crisis services, and consumer
and family initiatives. Common outcomes data are
being collected on a cohort of over 600 individuals
at baseline, 9, and 18 months. The outcome protocol
was designed to be relatively brief and comprehensive,
and portions of it have been incorporated into other
studies and monitoring initiatives. Projects are in the
final stages of data collection and are now focusing on
analyzing and interpreting results. A half-day plenary
was held at the Making Gains conference in the fall
of 2003 to engage Ontario stakeholders in discussion
about implications of the research for practice,
programs, and policy.
Linkage and Exchange
Our knowledge and exchange activities are well
established, and we have been instrumental in
46
Profile of Ontario Methadone recipients and
providers. Until recently, the availability of
methadone treatment in Ontario and elsewhere
in Canada has been restricted. In 1996, a series of
policy changes aimed at increasing the availability
and uptake of methadone therapy were introduced
in Ontario. Using registry data from the College
of Physicians and Surgeons of Ontario, the 5-year
impact of these policy changes on the patient and
physician populations is being assessed. Between 1996
and 2001, the total number of methadone clients in
treatment in Ontario increased substantially from
1595 to 7787. Over this time period, the number of
physicians prescribing methadone increased from
60 to 161. However, the estimated low proportion of
opiate users in contact with the methadone treatment
system shows that more efforts are needed to address
the potential demand for treatment.
Employees who did not use antidepressants typically
reported significantly fewer symptoms at baseline
on average than those who did. The results of this
study represent an important first step in exploring
the question of how antidepressants are used among
disabled workers who are most affected by depression.
Comprehensive Assessment Projects. This series
of needs-based planning projects originated in
Ontario’s psychiatric hospitals and expanded into
the community system. We used a consistent
methodology to assess current and recommended
levels of care for people who use mental health
services, and to determine how well care that was
being received matched the level of need. This series
of needs-based planning projects is now completed,
and a database that merges results from projects
across the province has been created. There are about
42,000 users of community mental health services and
13,000 users of provincial psychiatric hospital services
represented in this provincial database. Plans are
underway to transfer the database to the mohltc so
that researchers and planners can access it.
Drug and Alcohol Treatment Information System.
Drug and Alcohol Treatment Information System
(datis) is a provincial information system that
collects, summarizes, and reports information on the
volume and characteristics of people being treated
for alcohol, drug, and gambling problems in Ontario.
Unit staff help select performance measures within
datis and analyze and interpret trends that are useful
for planning, accountability, and research. This year
we completed a provincial report and three research
papers using the provincial data:
1. A study looking at the high rate of referral into
the treatment system of clients involved with
legal/correctional systems
2. A study showing the numbers and
characteristics of clients in treatment for
problem gambling
3. A study describing the volume and
characteristics of clients seeking help for
problems related to their use of cannabis
Paula Goering, rn, PhD
Peter Prendergast, md, frcpc
Co-Directors, Health Systems Program
Depression in the Workplace. In response to a
request from the Ontario Roundtable on Appropriate
Prescribing, we designed a study called Depression in
the Workplace: Examining Antidepressant Use and
Worker Characteristics and Their Associations with
Disability. Three Canadian companies with national
employee bases were recruited as project participants.
Together, they represent over 65,000 workers. Results
showed that approximately 58% of employees who
were receiving depression-related short-term disability
benefits had made at least one antidepressant claim.
47
Mood &
Anxiety Disorders
Program
The mission of the Mood and Anxiety Disorders Program is to
establish the Faculty of Medicine at the University of Toronto as an
international leader in research and education in
the field of mood and anxiety disorders.
Program Description
T
he mission of the Mood and Anxiety Disorders
Program is to establish the Faculty of
Medicine at the University of Toronto as an
international leader in research and education in the
field of mood and anxiety disorders. This program
is committed to understanding the causes for these
disorders, establishing treatment guidelines and
exploring normal treatments for the disorders, and
transferring this knowledge to professional groups and
the community.
The centre for excellence for the Mood and Anxiety
Disorders Program is at the Centre for Addiction and
Mental Health. This program includes outpatient
clinics for anxiety disorders, mood disorders, cognitive
behaviour therapy, interpersonal psychotherapy, as
well as the Mood and Anxiety Disorders Unit for
in-patients, which was established this past year. The
Sunnybrook and Women’s College Health Sciences
Centre is the second major site for the program, which
offers core services for patients with mood and anxiety
disorders as well as specialized treatment for youth
with these disorders. The University Health Network
has been established as another major site for mood
disorders, with enhancement of core services as well as
the establishment of several new programs at that site.
The Mood and Anxiety Disorders Program has a new
Program Head with the recruitment of Dr. Trevor
Young in 2002 to the Cameron Parker Holcombe
Wilson Chair in Depression Studies. A steering
committee has been established, which includes the
Chiefs at the Centre for Addiction & Mental Health,
the Sunnybrook and Women’s College Health
Sciences Centre, and the University Health Network,
as well as the Heads of the Mood and Anxiety
Disorders Program at each of those sites.
on the treatment of adolescent depression. A focus on
epidemiology will be stressed with the addition of Dr.
Amy Cheung.
The University Health Network has seen a large
growth in the area of mood disorders with the
appointment of the new Psychiatrist-in-Chief, Dr.
Sidney Kennedy, and the recruitment of Drs. Sagar
Parikh and Roger McIntyre. Neuropsychiatry is
also a major focus with the development of a trial
using novel electrophysiologic techniques with
refractory depression in collaboration with Dr. Helen
Mayberg and the Department of Neurosurgery.
Psychopharmacology and clinical trials will be
developed under the supervision of Drs. Roger
McIntyre and Sidney Kennedy.
There has been continued medical education
offered by members of the Mood and Anxiety
Disorders Program with the annual update on
psychopharmacology at the Centre for Addiction and
Mental Health, a program organized and directed
by Dr. Sagar Parikh. A number of presentations by
faculty from the program have also been highlighted
at the Annual Meeting for the Society for Biological
Psychiatry as well as the American Psychiatric
Association and Canadian Psychiatric Association
annual meetings.
As reflected in their publications in leading journals,
and receipt of grants, and awards, the faculty of
this program continue to excel in obtaining peerreviewed funding from multiple sources, including
the Canadian Institutes for Health Research and the
Ontario Mental Health Foundation.
In addition to the many accomplishments of faculty
members, it has been a productive year for the
program itself. A research laboratory dedicated to
the study of mood disorders was established within
the Clarke site building. This laboratory will focus
on using molecular biology to study targets of action
of mood-stabilizing and antidepressant drugs as
well as to study brain tissue from subjects with
mood disorders. This laboratory adds to the work
of other groups at camh, including the Molecular
Pathophysiology Lab. It will provide a teaching centre
for students, residents, and fellows, and those entering
the Clinician Scientist Program.
At camh
camh, there has been a continued focus on
studying the brain and depression. The pet-imaging
work done by Drs. Helen Mayberg, Zindel Segal,
and Sid Kennedy has identified changes in brain
metabolism in specific regions associated with
response to psychotherapy and antidepressant
treatment. The work of Dr. Jeffrey Meyer has
continued use of neuroreceptor imaging to look at
targets for antidepressant treatments. Dr. Young, in
collaboration with Dr. Glenda McQueen at McMaster
University, has applied volumetric imaging techniques
to study the size of key limbic regions in patients
at different phases of mood disorders. A new focus
on applying transcranial magnetic simulation has
been developed to use this technique as a treatment
modality to study cortical plasticity in patients.
At the Centre for Addiction and Mental Health
site we have recruited Dr. Arun Ravindran, a senior
clinician, to focus on psychopharmacology in the
Mood and Anxiety Disorders Program. Dr. Jun-Feng
Wang, a senior research scientist, has been recruited
to work in the mood disorders research laboratory.
Dr. Steven Sokolov has joined the Mood and Anxiety
Disorders Program to enhance the Outpatient
Program and to focus on patients who present in their
first episode.
At the Sunnybrook & Women’s College Health
Sciences Centre, there has been continued growth
in the Mood and Anxiety Disorders Clinic with an
enhancement of academic endeavours at that site.
Dr. Ayal Schaffer has taken over as the Head of
Mood Disorders. He focuses on treatment studies in
bipolar disorder. Dr. Ari Zaretsky has increased the
academic focus on cognitive behaviour therapy. Dr.
David Kreindler has joined the group and will focus
on novel techniques to monitor mood fluctuations. Dr.
Anthony Levitt has continued to develop his program
Trevor Young, md, frcpc
Head, Mood and Anxiety Disorders Program
49
Neuroscience
Program
Understanding how
psychiatric problems, alcohol, and other drugs
affect the human body and brain
is crucial to the development of more effective approaches to
treatment and prevention.
Program Description
U
nderstanding how psychiatric problems,
alcohol, and other drugs affect the human
body and brain is crucial to the development
of more effective approaches to treatment and
prevention.
The Neuroscience Program focuses on
neurobiological mechanisms underlying mental
illnesses, addiction, and their respective treatments.
The program benefits from state-of-the-art, inhouse research facilities. These facilities include the
Positron Emission Tomography (pet) Centre, which
allows researchers to scan the brains of live human
subjects, and the Transgenic Research Centre, which
can alter the genetic makeup of laboratory mice to
mimic human diseases such as schizophrenia, bipolar
disorder, or addiction.
Organization
The Head of the Neuroscience Program is Dr. Franco
Vaccarino, Executive Vice-president of Programs at
the Centre for Addiction and Mental Health (camh),
which is the centre of excellence for this program.
Membership of the Neuroscience Program spans
other institutions as well, thus creating a network of
sites consisting of the University of Toronto, Hospital
for Sick Children, University Health Network, and
Sunnybrook and Women’s College Health Science
Centre, along with camh. As a whole, members
represent a broad range of training and expertise that
range from molecular to clinical neuroscience.
Programmatic Activities and
Developments
The emphasis of the Neuroscience Program is on
research. As such, research in the program ranges
from systems neuroscience research, focusing on
neural organization of higher-order functions,
to molecular and neurotransmitter studies. For
example, we are investigating how variations in
the action of dopamine—a “neurotransmitter”
or chemical that allows signals to pass between
cells in the brain—have been linked to a range of
problems, from schizophrenia, bipolar disorder,
and Parkinson’s disease, to dependence on alcohol,
cocaine, nicotine, and amphetamines. Disturbances
in signal transduction and molecular and genetic
mechanisms within cells are also of great interest
and are now believed to be critical determinants of
mental illness and addiction. Examining the genes
for neurotransmitters, and other systems known to
be involved in drug response, may lead us to predict
the type and amount of medication best for each
individual patient. The study of how genes relate to
drug response, called pharmacogenetics, may also
help to predict those people who are at higher risk for
addictions.
By exploring these research strategies, researchers
within the Neuroscience Program broaden our
understanding of mental illness and addiction and lay
the basis for potential new treatments and diagnostic
approaches of the future.
Within the Neuroscience Program, as well
as within the extra-programmatic links of the
Neuroscience Program, a rich cross-fostering of ideas
is evident in innovative combinations of methods
across the program. One example of this integration is
our recent initiative that combined molecular genetics,
epigenetics, and pet scans to simultaneously assess
the human brain’s blueprint and biologic activity in
depression and in Parkinson’s disease.
In the past few years, we have focused on
consolidating and building on the strengths of our
neuroscience research groups, as well as establishing
future priorities and new directions such as using
f
fmri
to examine the neuroanatomical basis of chronic
opiate effects and drug craving. In the months and
years to come, neuroscience will gain increasing
importance in the education, clinical, and research
activities of the department. Of particular importance
will be the increased focus on integrating knowledge
derived from neuroscience research into clinical
programs. Examples of this include recent initiatives
aimed at understanding the neurobiological basis of
cognitive changes associated with neurorehabilitation
and brain injury. Studies in the addiction area are
further examining nmda receptors as targets sites
for the treatment of opiate dependence, as well as
pharmacotherapy-assisted extinction as a novel
approach to the treatment of nicotine dependence.
Plans are also underway at camh to identify clinical
programs that represent strong candidates for new
initiatives aimed at applying neuroscience knowledge
to clinical practice and diagnosis.
Franco J. Vaccarino, PhD
Head, Neuroscience Program
51
Psychiatry, Health, &
Disease Program
The focus of the Psychiatry, Health, and Disease Program is on the
relationship among psychological, biological, and social factors
in the expression of symptoms and disease.
Mission Statement
The University Health Network (UHN)
he focus of the Psychiatry, Health, and Disease
(phd) Program is on the relationship among
psychological, biological, and social factors in
the expression of symptoms and disease. The program
has a mandate to develop and promote research in
these areas, to train undergraduate and post-graduate
students in the psychiatric care of patients with
medical, psychosomatic, and medically unexplained
conditions, to establish and communicate standards of
care for these populations, and to provide and support
continuing education in these areas. The program
also has the responsibility to draw the attention of
the medical and general community to the significant
psychiatric morbidity and psychosocial distress in
medical populations, which are often undetected and
untreated, and to enhance the services and treatment
available for such problems.
The phd program is based at four general hospital
sites, with psychiatric consultation-liaison, clinical,
and teaching services and specialized clinical and
research programs at each site and one pediatric
hospital:
• Medical Psychiatry & Transplantation: Susan
Abbey, md
• Eating Disorders: Allan Kaplan, md
• Neuropsychiatry and Sleep Disorders: Colin
Shapiro, md
• Behavioural Cardiology: Robert Nolan, PhD
• Psychosocial Oncology & Palliative Care: Gary
Rodin, md
T
• Medical Psychiatry, Psychosocial Oncology, and
Pain: Jonathan Hunter, md
• Gastrointestinal Disease: Robert Maunder, md
• hiv Psychiatry: Peter de Roche, md
• Medical Psychiatry: Frank Cashman, md
• hiv Psychiatry: Mark Halman, md
• Neuropsychology: Sean Rourke, PhD
In addition, she was named co-recipient of the
2003 Arnold Pfeffer Prize from the New York
Psychoanalytic Institute, and she received the 2002
Distinguished Investigator Award from narsad. Dr.
Luis Fornazzari was appointed reviewer of Analysis
of the Mental Health Program of the Republic
of Argentina by the government of Argentina to
review and comment on the Elderly and Dementia
program. The American Psychiatric Association made
Dr. Edward Kingstone a Distinguished Life Fellow.
Dr. Raed Hawa obtained his American Boards in
Sleep Medicine. Dr. Brian Hodges was appointed
Director of the Centre for Research in Education at
the University Health Network, effective July 1, 2003.
Drs. Henry Moller and Alan Ong obtained their
American Boards in Sleep Medicine. Drs. Kenneth
Mah and Michal Braun received the uhn Award
for Best Research Presentation by a Resident or
Fellow. Dr. Paul Sandor was named the Chairman
of the Professional Advisory Board of the Tourette
Syndrome (ts) Foundation of Canada in May 2003.
Dr. Robyn Stephens was cross-appointed to the ts
Clinic at twh and Youthdale Research Institute. Dr.
Jennifer Saltzman-Beniah recently received a research
grant from the Dean’s Fund at the University of
Toronto for an ffmri study of social communication.
Dr. Gary Rodin was guest editor of a special edition
of the Journal of Psychosomatic Research on Psychosocial
Oncology, and Drs. Rodin and Mary-Jane Esplen were
elected to the Board of Directors of the Canadian
Association of Psychosocial Oncology. Dr. Allan
Peterkin was recently selected for the Board of the
Sherbourne Health Centre. Dr. Blake Woodside
was appointed President of the Canadian Psychiatric
Association, and is the Chairman of the Board
designate, November 2003–2006.
Sunnybrook and Women’s College Health Sciences
Centre (SWCHSC)
• Medical Psychiatry: Robert Jaunkalns, md
• Neuropsychiatry and Trauma: Anthony Feinstein,
Mphil, PhD
• Medical Psychiatry: Rose Geist, md
• Eating Disorders: Leora Pinhas, md
Baycrest Centre
• Sandra Rotman Chair in Neuropsychiatry: Helen
Mayberg, md
Program Organization
A program planning committee consisting of Program
Director, Research Director, Education Director, and
the Heads of the Medical Psychiatry Program at each
site meet regularly. Additional administrative and
clinical meetings are held within each of the hospital
medical psychiatry and specialized programs. The
Education Director is a member of the Post-graduate
Education Committee, and the Program Head is a
member of the University Senior Advisory Committee,
the University Department of Psychiatry Research
Committee, and the Executive of the University
Fellowship Committee. An annual research day is held
at which current research findings for all areas of the
program are presented.
Awards and Honours
A number of faculty in phd received recognition for
their academic accomplishments during this past
year. Dr. Janet Polivy was named the Norman Munn
Distinguished Visiting Scholar at Flinders University
in Adelaide, South Australia, and was honoured on
the isi Highly Cited list of the most cited researchers
in psychology and psychiatry. Dr. Sean Rourke was
given the Ontario hiv Treatment Network (Ministry
of Health aids Bureau) Career Scientist Award for
April 1, 2002
2002, to March 31, 2007. He was also named
to the Editorial Board for the Journal of the International
Neuropsychological Society and was elected as Scientist on
the Board of Directors of the Canadian Psychological
Association. He will also serve as President of the
Board of Directors, for the Ontario hiv Treatment
Network. Dr. Helen Mayberg was elected Member of
the American College of Neuropsychopharmacology.
The Psychosocial Oncology and Palliative Care
Program announced the opening of the newly
endowed Harold and Shirley Lederman Palliative
Care Centre at Princess Margaret Hospital. This
centre will become a venue for the development of
research and training programs in palliative care.
Education
The phd Research Day, which focused on posttraumatic stress disorder, was postponed as a result of
sars. This Research Day will be held in November
2003 and features an international panel of speakers
including Drs. Rachel Yehuda, Ruth Lanius, Alan
53
Young, and Clair Pain.
Drs. Jonathan Hunter and Gary Rodin undertook
a site visit to North Bay as part of the accreditation
of a C/L training position at the North Bay General
Hospital. This site was approved for training.
The Psychosocial Oncology and Palliative Care
Program at pmh held its third annual course for health
professionals in collaboration with the Mayo Clinic in
Rochester, in the fall of 2003. This course will be held
again with the Mayo Clinic, as a pre-conference course
prior to the Canadian Association of Psychosocial
Oncology (capo) Annual Meeting, which will be
hosted by the Princess Margaret Hospital Department
of Psychosocial Oncology and Palliative Care from
May 6 to 8, 2004.
Dr. Jay Moss received the prestigious Robin Hunter
Award for post-graduate teaching in recognition for
his teaching in Medical Psychiatry.
The fellowship training program in phd continues
to be highly subscribed and successful. There were
eight fellows in this program during the past year.
Dr. Henry Moller received the Fred Lowy Award
2002–2003 for the greatest contribution to research
in psychosomatic medicine by a fellow or resident
in psychiatry. Rinat Nissim, fellow and doctoral
candidate, was awarded a National Cancer Institute
of Canada Research Studentship. Dr. Julie Maggi,
fellow and master’s student, was awarded an ohtn
Fellowship and a Bristol-Myers Squibb Fellowship by
the Association of Academic Psychiatry.
Research
The research program in phd continues to grow.
Investigators in the program obtained approximately
$9 million in peer-reviewed grants during the past year
in areas including neuropsychiatry, psycho-oncology,
aids, and eating disorders.
Gary Rodin, md, frcpc
Head, Psychiatry, Health, and Disease Program
54
Psychotherapy
Program
The Psychotherapy Program mandate is to
provide academic leadership and scholarship in the
psychotherapies.
Program Description
Mission
T
he Psychotherapy Program mandate is to
provide academic leadership and scholarship in
the psychotherapies. This includes provision of
education and training; exemplary clinical service in
the application of the psychotherapies to individuals
suffering from a broad range of emotional and mental
disorders; and research to enhance applicability,
efficiency, and effectiveness of the psychotherapies.
An overarching principle guiding the Psychotherapy
Program is that the psychotherapies are an integral
part of comprehensive and integrated psychiatric care
and a central part of the biopsychosocial model of
treatment.
Organization
Dr. Zindel Segal is the Program Director, and the
Associate Program Director is Dr. Daniel Greben.
The centre of excellence is located at the Mount
Sinai Hospital. Important academic psychotherapy
activities are present in all of the teaching settings.
The Psychotherapy Program Committee is the
administrative body of the program and consists of
the Psychotherapy Modality Subcommittee Chairs;
the Psychotherapy Site Coordinators, who coordinate
psychotherapy activities at the respective sites; and
subspecialty and interest-group representation.
Functions
The Psychotherapy Program carries educational
responsibility for training residents in the
psychotherapies and for this purpose has developed
an extensive syllabus and implementation protocol
for training in the psychotherapies. These objectives
encompass the 4 years of resident training and are
intended to ensure that residents receive appropriate
training in the utilization of contemporary
psychotherapeutic approaches within psychiatry.
Educational foci also reflect initiatives at the
undergraduate and fellowship levels. Continuing
education and continuing professional development
activities reflect a major commitment by the
Psychotherapy Program faculty and are offered
in a range of formats including ongoing courses,
workshops, and conferences.
Psychotherapy Modality Subcommittee Chairs
Long-term Dynamic Psychotherapy
Brief Dynamic Psychotherapy
Cognitive Behaviour Therapy
Interpersonal Therapy
Family/Couple Therapy
Child and Adolescent Psychotherapy
Integrative Therapy
Group Therapy
Dr. Norman Doidge
Drs. Harvey Golombek and Howard Book
Drs. Zindel Segal and Ari Zaretsky
Dr. Paula Ravitz
Dr. Leo Chagoya
Dr. Jean Wittenberg
Dr. Daniel Greben
Dr. Molyn Leszcz
Site Psychotherapy Coordinators
Baycrest Centre
SWCHSC
The University Health Network
Division of Child and Adolescent Psychiatry
University Health Service
Hincks-Dellcrest Centre
Hospital For Sick Children
George Hull Treatment Centre
Dr. Michael O’Mahony
Dr. Jan Malat
Dr. Molyn Leszcz
Dr. Elyse Dubo
Dr. Harvey Golombek
Dr. Sam Izenberg
Dr. Jean Wittenberg
Dr. Victor Likwornik
Dr. Susan Dundas
Dr. Mark Hanson
Dr. Bill Wehrspann
Remaining Committee Membership
Dr. Mary Jane Esplen, Psychotherapy Research
Dr. Ron Ruskin, Psychiatry and Humanities
Dr. Howard Book, Continuing Education
Dr. Solomon Shapiro, Therapeutic Communication Program for Junior Medical Students
Dr. Marshall Korenblum Adolescent Psychiatry
Dr. Ellen Margolese, PRAT Representative
Public Policy
non-medical mental health professionals in the
provision of indirect service. Public education is an
allied component.
The Psychotherapy Program is committed to
addressing important issues in applicability,
accountability, and cost-effectiveness of the psychotherapies, in order to ensure appropriate access to
psychotherapy and a suitable balance and breadth
of the psychotherapies available to the community.
Such a commitment encompasses the training of
psychiatrists to be expert practitioners capable of
providing direct service, as well as effective
consultants, supervisors, and collaborators with
Organization
The Psychotherapy Program is in its first full year
of leadership under Drs. Zindel Segal (Morgan
Firestone Chair in Psychotherapy) and Daniel Greben
(Associate Head).
56
research focus is also developing in the teaching
and learning of psychotherapy, particularly through
examination of models of training and the acquisition
of psychotherapeutic competence (Drs. Paula Ravitz,
Ron Ruskin, and Molyn Leszcz).
Psychotherapy research has also addressed
prophylactic interventions intended to prevent
relapse in depression and alcohol abuse and to reduce
the emergence of clinical syndromes through early
intervention. A growing area of expertise within the
Psychotherapy Program in multi-site clinical trials
has led to collaborations with colleagues in Australia,
the United Kingdom, and Germany. Psychotherapy
Program faculty have presented and published
their work broadly at a range of psychiatric and
psychotherapy meetings and presented invited lectures
in France, England, Germany, Japan, Switzerland, and
Australia.
The Psychotherapy Program continues its active
commitment to the comprehensive training of
residents in the psychotherapies, guided by the
Psychotherapy Training Objectives document.
Although its scope is demanding, it is intended to be
flexibly applied, and results evident with the third class
to graduate influenced by its mandate reflect resident
achievement of the objectives. Five senior residents
pursued senior selective psychotherapy training: Drs.
James Chin, Nancy Biddle, Particia Wiebe, Ellen
Rumm, and Joanne Holtby. The successful blending
of psychotherapy foci with addictions, psychosomatics,
mood, and women’s mental health has also continued.
In addition, 18 residents pursued electives in the
psychotherapies focused upon cognitive behaviour
therapy, interpersonal therapy, group psychotherapy,
psychological trauma, and psychiatry and the
humanities.
The Psychotherapy Program also organized
three special academic days for residents that
included the 14th Psychotherapy Day, featuring
Dr. Leslie Greenberg on Working with Emotion in
Psychotherapy: The Transforming Power of Affect.
This event was very well attended, with residents and
fellows comprising the majority of participants. The
Annual Group Day featured faculty of Drs. Shari
Kirsh, Leo Murphy, Kaz Khorasani, Molyn Leszcz,
and Ms. Donna Scapillato, providing residents with
experiential training in group psychotherapy. Dr.
Leo Chagoya organized the Annual Family/Couple
Therapy Day. Faculty included Dr. Leo Chagoya, Mrs.
Charlotte Chagoya, Dr. Blake Woodside, Dr. Ameeta
Sagar, and Mr. Eric King.
Research in the Psychotherapy Program continues
to expand, addressing particular foci upon the
psychotherapy of mood disorders, particularly
bipolar disorder (Dr. Ari Zaretsky) and borderline
personality disorder (Drs. Shelly McMain and Paul
Links), the interface of brain and mind in depression
and ptsd (Drs. Zindel Segal, Clare Pain, and Alex
Tarnopolsky), the convergence of mind/body medicine
and psychotherapy in a range of funded research
examining interventions in psycho-oncology, genetic
predisposition, hiv
hiv, and postpartum depression (Drs.
Mary Jane Esplen, Molyn Leszcz, Ari Zaretsky, and
Bill Lancee). There is widespread interest in the use
of neuroimaging to study brain changes associated
with successful psychotherapeutic treatment, and Dr.
Segal is pursuing a collaboration with Drs. Mayberg
and Kennedy to carry out such a study. A growing
Challenges for the Coming Year
Two issues will likely draw program attention in
the coming academic year. The first, linked to the
restrictions imposed by sars, is a delay in instituting
curriculum review and renewal of the Psychotherapy
Program Training Objectives. This document, seminal
in its time, requires reappraisal, and the plan was to
initiate this process in the spring of 2002. Our ability
to form modality subcommittees to comment on
suggested revisions was hampered by sars and has
been postponed to the coming year. The second issue
is the burgeoning demand for resident supervision
for psychotherapy in the U of T Northern Outreach
Program. There seem to be excess supervision needs
and few program resources available to accommodate
them. Our intention is to work in the coming
academic year to effect greater liaison with the
Northern Outreach staff so that a realistic estimate
of resources required to provide the requested level of
supervision can be obtained. This would then inform
joint efforts to bring such support to the program.
Zindel Segal, PhD, C.Psych
Head, Psychotherapy Program
57
Schizophrenia
Program
The Schizophrenia Program of the Department of Psychiatry
is devoted to increasing our understanding of schizophrenia
in order to bring about
the greatest degree of recovery for those affected.
Program Description
T
he Schizophrenia Program of the Department
of Psychiatry is devoted to increasing our
understanding of schizophrenia in order
to bring about the greatest degree of recovery for
those affected. We are committed to training our
students, residents, and fellows in an environment that
inextricably weaves together excellence in research and
excellence in clinical care. The program provides care
for individuals across the range of stages and severity
of the illness. This includes an early intervention
program with a prodromal schizophrenia clinic
(prime Clinic) as well as a First Episode Psychosis
Clinic based at the Centre for Addiction and Mental
Health (camh). The major emphasis of our program
is to provide clinical care to those with the most severe
and debilitating forms of this illness. Specialized
services based at the camh provide intensive support
in a Continuing Care model to patients who have been
seriously disabled by their illness. In the Continuing
Care model of care, a team of case workers and a
psychiatrist work together to provide care to patients
in the hospital or at home in the community. Care
to seriously disabled clients is also provided in
Assertive Community Treatment ((act) teams based
at other University of Toronto affiliated hospitals: St.
Michael’s Hospital, the Toronto Western Hospital,
and Sunnybrook Health Sciences Centre.
Program Organization
The centre of excellence for the Schizophrenia
Program is at camh where the University of Toronto
Tapscott Chair in Schizophrenia Studies (Dr. Robert
Zipursky) also serves as the Clinical Director for the
camh Schizophrenia Program. Two additional
research chairs devoted to the study of schizophrenia
are also based at camh: Dr. Anne Bassett holds the
Canada Research Chair in Schizophrenia Genetics
and Dr. Shitij Kapur holds the Canada Research
Chair in Schizophrenia and Therapeutic
Neurosciences. The Schizophrenia Program has a
strong tradition in bench-to-bedside research and in
the integration of clinical, teaching, and research
activities. Research programs have been established
in early intervention and prevention, brain imaging,
genetics, psychopharmacology, neuropsychology,
psychotherapy, and electrophysiology. The
Schizophrenia Program offers two funded postdoctoral fellowships—the Bebensee Fellowship and
the Cleghorn Fellowship—to facilitate the research
training of psychiatrists and psychologists in schizophrenia. Residents in psychiatric training in our
department learn to provide care to individuals with
schizophrenia across a range of training sites including
camh (Queen Street and Clarke sites), St. Michael’s
Hospital, and Toronto Western Hospital. This year
we have offered residents the opportunity to complete
their clinical training in Northern Ontario under the
supervision of our clinical faculty based in Thunder
Bay, North Bay, and Sault Sainte Marie.
was of exceptional quality and was very highly rated by
participants.
Dr. Zipursky and his colleague Dr. S. Charles
Schulz, Chair of the Department of Psychiatry at
the University of Minnesota, edited The Early Stages
of Schizophrenia, published by American Psychiatric
Publishing. In addition to Dr. Zipursky’s chapter on
pharmacologic treatment, Schizophrenia Program
faculty contributed invaluable chapters on addressing
the emotional needs of patients (Dr. Beth McCay
and Ms. Kathryn Ryan) and families (Ms. April
Collins). A Spanish translation (Estadios Iniciales de
la Esquizofrenia) has recently been published.
With the generous support of the camh
Foundation, we opened learn at 1709 St. Clair
Avenue West in September 2002. learn is a 3-year
pilot project designed specifically as a specialized
rehabilitation service for individuals receiving services
in our First Episode Psychosis Program. Services
offered include vocational assessment, counselling,
education, job development and employment supports,
as well as education and support to families, which
are integrated into a holistic model of recovery. This
unique program is located in a beautifully renovated
storefront and aims to provide an alternative
community-based approach to helping patients and
families recover from psychosis.
Dr. Shitij Kapur was awarded a $1 million Special
Initiatives grant from the Ontario Mental Health
Foundation to support his research on the mechanism
of action of antipsychotic medication.
Three of our faculty have been honoured with
awards from the National Alliance for Research on
Schizophrenia and Depression (narsad) this year.
Dr. Albert Wong was awarded a Young Investigator
Award, Dr. Gary Remington was awarded an
Independent Investigator Award, and Dr. Anne
Bassett received an Established Investigator Award.
We are very pleased to welcome a number of new
faculty members to the Schizophrenia Program this
year. Drs. Michelle Carlier and Sam Packer have
joined our Continuing Care teams at camh.
The schizophrenia field has been going through
very rapid change over the past 25 years. The
achievements of our Schizophrenia Program in 2002–
2003 reflect the tremendous excitement and growth
that the field is experiencing.
Highlights of Events and Achievements in 2002–
2003
Dr. Anne Bassett was awarded a Tier i Canada
Research Chair to support her ongoing research
in schizophrenia genetics. Dr. Bassett is an
internationally recognized leader in this field, and this
prestigious award provides ongoing funding to support
her studies.
Dr. Robert Zipursky was awarded the John
Cleghorn Memorial Award for Excellence and
Leadership in Clinical Research by the Canadian
Psychiatric Association and the Michael Smith Award
for Schizophrenia from the Schizophrenia Society of
Canada.
Dr. Jean Addington, who joined our program
faculty in July 2002, has been awarded a 5-year
research grant from the U.S. National Institute of
Mental Health to study predictors of psychosis in
individuals believed to be at high risk for developing
schizophrenia. She has also started a clinical research
program for the study of cognitive behavioural therapy
in individuals experiencing a first episode of psychosis
and oversees our psychosocial intervention program
at the Learning Employment Advocacy Recreation
Network (learn
learn) Centre. Dr. Addington was
recently honoured by being elected Vice-president
North America for the International Early Psychosis
Association.
Dr. Gary Remington and colleagues organized
Schizophrenia Update 2002, held in Toronto in
November 2002
2002. With over 400 participating mental
health professionals and family members, this
conference offered a range of plenary sessions and
workshops led by international experts in psychosocial
and pharmacologic interventions. The conference,
with its emphasis on evidence-based interventions,
Robert Zipursky, md, frcpc
Head, Schizophrenia Program
59
Women’s
Mental Health
Program
The Women’s Mental Health Program
is dedicated to advancing the understanding and treatment of
women’s mental health problems
through an integration of clinical, educational, and research activities.
Mission, Organization, and Functions
T
he Women’s Mental Health Program is
dedicated to advancing the understanding and
treatment of women’s mental health problems
through an integration of clinical, educational, and
research activities. The overall goal of the program is
to develop mental health care that is more responsive
to the needs of women. Its primary mandate is to
focus on social, psychological, and biological factors
that will further our understanding of the origin,
expression, prevention, and clinical treatment of
mental health issues in women’s lives.
The centre of excellence is located at the Centre
for Addiction and Mental Health, Clarke site. In
addition to the centre of excellence, the Women’s
Mental Health Program has several initiatives in
the other teaching hospitals affiliated with the
University of Toronto. A steering committee has been
established to coordinate research, educational, and
clinical activities within the overall program. The
committee includes staff and student representatives
from teaching hospitals and university departments,
as well as representatives from international and local
communities.
A broad range of services offered in the program
include an in-patient unit specifically for women,
together with the outpatient Women’s Therapy
Centre located at the Centre for Addiction and
Mental Health. A general Outpatient Clinic, Women
Recovering from Abuse Program ((wrap),Psychopharmacology and Dependence Research Unit, and a new
Reproductive Life Stages Program are located at the
Sunnybrook & Women’s College Health Sciences
Centre. The program is also involved with the
Women’s Pelvic Health Centre at the Women’s
College Ambulatory Care Centre site of swchsc.
Activities within the Women’s Mental Health and
Addiction Research Section at camh are increasingly
linked with Women’s Mental Health and Addiction
Programs within the Clinical Division of camh. The
University Health Network continues to focus on
clinical, research, and educational activities directed at
a variety of women’s health and mental health issues.
At the Hospital for Sick Children, we are working in
partnership with the Division of Child Psychiatry in
eating disorders. Research is being formally integrated
into many of our clinical services throughout the
program. In particular, research is directed at testing
the efficacy of treatments that we offer women who
present with a variety of problems, including irritable
bowel syndrome, depression, anxiety, breast and colon
cancer, pelvic pain, history of sexual, physical, and
emotional abuse, eating disorders, life stressors, and
vocational and employment issues.
The program is active in professional training,
media presentations, and public forums, with a view
of influencing the provision of care to women locally
and internationally. In particular, the program has
been teaching and training at undergraduate, graduate,
post-graduate, and fellowship levels in psychiatry as
well as other university departments. Communication
and networking among staff and students is enhanced
through monthly citywide seminars in women’s
mental health and a bi-yearly women’s mental health
newsletter.
assuming greater leadership in working toward gender
equality within the department. This year, steps in
this direction include the further development of a
gender database in the department and a task force
examining the academic promotion of women.
This year the program had its 5-year external
review, and a report was submitted detailing
the program’s accomplishments. It listed
recommendations from the Program and Planning
Committee, academic appointments, recruitment,
organization and functional structure, academic
linkages, awards and honours, grants, publications,
presentations, educational activities, knowledge
transfer and exchange, and future directions. The
full report is available upon request. A summary of
highlights are contained in the summer 2003 issue of
the Women’s Mental Health News. We have been actively
pursuing recommendations made by the Program
and Planning Committee by attracting fellows,
new researchers, investigators, and clinicians in the
program. Prior to 1997 there were 11 faculty associated
with the program, whereas now we have 41. We have
established the Shirley Brown Chair in Women’s
Mental Health Research. Through the generosity
of Eli Lilly Canada, we have been able to offer five
fellowships in Women’s Mental Health Research. The
program has identified five strong areas of academic
scholarship: Violence against Women; Feminist
Principles in the Understanding and Treatment of
Women; Psychosocial Issues in Medical Disorders;
Reproductive Health; and Diversity Issues.
In addition, the Centre for Addiction and Mental
Health, the University Health Network, and the
Women’s Mental Health Programs at the Women’s
College Ambulatory Care Centre have been actively
involved in strategic and functional plans for Women’s
Mental Health at their sites. Very briefly, at camh
we are pleased to report that Dr. Diane Whitney
has returned to Toronto to become the Clinical
Director of the Women’s Program at this site. She
will work with Functional Plan for the Women’s
Program at camh to further develop services, as well
as educational and research activities in collaboration
with others including the Head of the University’s
Women’s Mental Health Program.
In October 2002, the University Health Network
held a Women’s Mental Health Retreat chaired
by Dr. Gail Robinson, where goals of the program
were identified, a summary of achievements to date
were summarized, current issues were addressed,
and several issues requiring immediate action were
Highlights of Events and Achievements in
2002–2003
2003
Over the past year, the first recipient of the Shirley
Brown Chair, Dr. Sarah Romans, has brought
researchers from teaching hospitals together to work
on numerous research proposals and databases in
Women’s Mental Health.
Through the generosity of Eli Lilly Canada Inc., Dr.
Patricia Wiebe was awarded an Eli Lilly Fellowship in
Women’s Mental Health Research. Dr. Wiebe was the
fifth fellow in our program to hold this competitive
fellowship.
Over the past year, academic staff with their
appointments in the Women’s Mental Health
Program have published widely in refereed journals,
and have given numerous presentations including
many invited and keynote addresses internationally.
Faculty have been very successful in obtaining external
peer-reviewed grants from provincial, national, and
international sources. Publications, presentations,
and grants have included a variety of important areas
within women’s mental health.
The Women’s Mental Health Program has been
61
raised. Finally, a Draft Overview of Strategic Plans
was developed under the leadership of Dr. Shari
Kirsh for the Women’s Mental Health Programs at
the Women’s College Ambulatory Care Centre. Of
particular note, this site will focus on two programs
for women—Interpersonal Trauma Program and
the Reproductive Life Stages Program—both of
which will have a comprehensive range of services in
association with education and research activities.
There has been active recruitment of faculty to work
in these two areas. In addition, funded fellowships will
be available.
It has been another successful year for the
Women’s Mental Health Interest Group seminar
series. Topics for the year included Singapore and
its cultural background: psychiatric services in
Singapore and cultural issues and their influence
on people’s perception of mental illness; the social
and economic context of immigrant women’s health;
introducing women’s mental health into a department
of psychiatry: the London story; epidemiology,
consequence, and treatment of stalking victims; gender
and gene expression in schizophrenia; and factors
determining age of menarche. Unfortunately, a few
events had to be rescheduled for the upcoming year
as a result of preventive measures around sars. This
included a presentation to the Interest Group on
the Women’s Recovering from Abuse Program and
a welcoming reception for women students, trainees,
and faculty in the Department of Psychiatry.
The Women’s Mental Health News, the bi-yearly
newsletter of the Women’s Mental Health Program,
continues to enjoy a broad readership. The newsletter
is widely distributed to faculty, students, and trainees
in the department, as well as to other researchers,
clinicians, and members of the community who have
expressed interest in the activities of the Women’s
Mental Health Program. This year, we have
introduced a new feature, a report from the Shirley
Brown Chair in Women’s Mental Health Research.
Brenda B. Toner, PhD
Head Women’s Mental Health Program
62
settings
Baycrest Centre
for
Geriatric Care
The new Baycrest strategic plan
gives priority to neurobehaviour and mental health,
with emphasis on dementia, mood and related disorders, and stroke.
Objectives
The mission of the Department of Psychiatry is
• To provide comprehensive geriatric psychiatry
services of the highest possible standard
• To maintain and develop excellent and innovative
educational programs
• To increase academic productivity with particular
emphasis on original research
• To balance and to integrate service delivery with
the development of research and education
The new Baycrest strategic plan gives priority to
neurobehaviour and mental health, with emphasis on
dementia, mood and related disorders, and stroke. A
new integrated clinic (The Brain Health Centre) will
open later this year.
During the 2002–2003 year the expansion of our
Geriatric Psychiatry Community Service has been
consolidated. The program has increased its provision
of clinical service and is offering increased education
to staff of long-term care facilities and community
agencies. In addition, the team is providing new
groups for family caregivers. The additional
recruitment of a Psychogeriatric Resource Consultant
funded through the mohltc Alzheimer’s Initiative
has proved to be very successful and has expanded the
capacity of the service to provide education.
Plans are underway for the development of a
Baycrest Bereavement Service. Dr. Cindy Grief has
been working with members of the Department of
Social Work in this regard.
The Telehealth/Telepsychiatry Program has
continued to expand. A weekly consultation program
for six communities in Northwestern Ontario has
been in operation since September 2002 and is proving
to be very successful. The program is funded through
the Canadian Mental Health Association. In addition,
consultations are provided through Ontario’s North
Network.
Staff Changes
Dr. Cindy Grief joined the Department in 2002. Her
academic focus is in bereavement. Dr. Barbara Schogt
joined the department on a part-time basis. Dr. Rob
Madan joined the Department in August 2003.
Research
with Lewy bodies. Dr. van Reekum was co-author
of a review of cholinergic agents in the treatment
of neurobehavioural deficits following tbi. Dr.
Schwartz published papers on the development and
implementation of an alcohol policy in a nursing home
and on meeting the psychosocial needs of cognitively
intact nursing home residents. Dr. Robillard had a
paper published on the use of lamotrigine in elderly
bipolar patients. Diana Clarke is currently pursuing
her doctorate. Her paper on suicidal ideation among
Holocaust survivors has recently been accepted for
publication.
Our department continues to be active in research
related to the care of elderly persons, with a particular
focus on geriatric neuropsychiatry. Data collection
for the Historical Cohort Study, related to
prediction of future onset of Alzheimer’s disease (pi:
Dr. R. van Reekum) was completed. The results of
this study have been submitted for publication. Dr.
van Reekum (pi) obtained a Canadian Institutes for
Health Research grant in support of a multi-centre
randomized controlled trial for Donepezil in treating
the symptoms of traumatic brain injury (tbi). The
randomized clinical trial of the discontinuation of
antipsychotic medication in nursing home residents
with dementia (pi: Dr. R. van Reekum) was
published. Dr. Monica Scalco, who was a fellow in our
department, is continuing to carry out a prospective
cohort study in follow-up to the Historical Cohort
Study. Dr. Paul Verhoeff continues to develop pet
radiotracers of beta amyloid plaques for the early
detection of Alzheimer’s disease. He has published
several papers on the effects of catecholamine
depletion on D(2) receptor binding as well as a review
on the pharmacotherapy of agitation and psychotic
symptoms in Alzheimer’s disease. Dr. Verhoeff ’s work
has been supported by the Alzheimer’s Society of
Canada through a Young Investigator Grant. He was
recently awarded a Scottish Rite Foundation Grant.
Dr. Conn was co-principal investigator in obtaining
a grant from the Population Health Fund (Health
Canada). This award allows for the development of
the Canadian Coalition for Seniors’ Mental Health
and provides funds to investigate the outcome of the
coalition. Dr. Susan Lieff continues her work on the
training of residents and fellows in geriatric psychiatry
and has worked on the development of an education
database for American geriatric psychiatry training
programs. She has published papers on the effect of
training and other influences on the development
of career interest in geriatric psychiatry and on
geriatric psychiatry fellowship programs in the United
States. Dr. Grief published a review of bereavement
in the elderly and another on antidepressants and
pain management in older adults. She is currently
analyzing data from a database related to grieving
and cognitive impairment. Drs. van Reekum and
Conn have collaborated with Dr. Martine Simard
in the study on the treatment of dementia with
Lewy bodies with olanzapine. Drs. van Reekum and
Myran collaborated with Dr. Simard in publishing
a paper on visuo-spatial impairment in dementia
Education
Dr. Susan Lieff continues to coordinate post-graduate
education in the department and is also Director of
Post-graduate Education for the Division of Geriatric
Psychiatry at the University of Toronto. Dr. Lieff
received one of the new prestigious Post-graduate
Education Awards from the Faculty of Medicine. The
award was in the category of Teaching Performance,
Mentorship, and Advocacy. Dr. Matt Robillard
coordinates undergraduate education. Dr. Rob
van Reekum coordinates the Research Fellowship
Program. Dr. Conn coordinates continuing medical
education. He stepped down from his role as
Coordinator of Continuing Education for the Division
of Geriatric Psychiatry.
The department continues to train psychiatry
residents for both mandatory and career-path training.
In addition, we continue to provide education for
undergraduate medical, social work, nursing, and
occupational therapy students. Family practice
residents, post-graduate year- 1 residents, and geriatric
medicine residents are also trained in the department.
Dr. Lieff completed her term as Chair of the
Teaching and Training Committee of the American
Association of Geriatric Psychiatry and is now serving
on the board of the association. Dr. Lieff took a minisabbatical during the year to focus on her research
activities in geriatric education. Members of the
department continue to be active in the planning and
development of educational programs for the Division
of Geriatric Psychiatry. In addition, staff have taken
on leadership in the development of cisepo
cisepo—Canada/
—Canada/
Israel video-conference rounds in geriatric psychiatry
and behavioural neurology.
David K. Conn, mb, frcpc
Psychiatrist-in-Chief, Baycrest Centre for Geriatric Care
64
Centre for Addiction &
Mental Health
The Centre for Addiction and Mental Health has celebrated its
fifth full academic year since the merger in 1998 of
the Addiction Research Foundation, the Clarke Institute of Psychiatry,
the Donwood Institute, and Queen Street Mental Health Centre.
T
he centre (camh) has celebrated its fifth full
academic year since the merger in 1998 of the
Addiction Research Foundation, the Clarke
Institute of Psychiatry, the Donwood Institute, and
Queen Street Mental Health Centre. As part of
the integration, a detailed functional plan for the
future of camh as well as a plan for integration into
new facilities on a single site on the 11 hectares of
land camh owns on Queen Street is now awaiting
government approval.
Our regularly published Balanced Score Card
provides a detailed accounting of activities across a
number of dimensions of our multi-partite mission.
Outpatient visits to our addictions programs increased
to over 156,000 compared to 107,
107 675 in 2001–2002.
Similarly, our mental health programs witnessed
an increase in outpatient visits from 474,776 to over
519,000. There were over 3,700 admissions to inpatient services, with one-third of these coming from
our Emergency Service, which experienced over 4,000
visits. Some clinical innovations this year included:
• Implementation of an interdisciplinary plan of
client care on in-patient services
• Utilization of an electronic version of the Resident
•
•
•
•
•
•
•
Assessment Instrument for Mental Health (raimh)
for all mental health admissions
Consolidation of Emergency Services at the Clarke
site
Opening of an Emergency Assessment Unit at
the Clarke site providing six beds for extended
assessment and brief intervention
Renovation of the Geriatric Admission Unit to
create its own acute observation area and to allow
the geographic integration of Geriatric Psychiatry
and Neuropsychiatry
Opening of the Integrated Rehabilitation Unit at
the Queen Street site for people receiving longterm care for severe and persistent mental illness
Opening of a specialized in-patient unit at the
Queen Street site for people with treatmentresistant mood disorders
Integration of Youth Addictions, Child Psychiatry,
and the Substance Abuse Program for AfricanCanadian and Caribbean Youth
Opening of the Learning, Employment, Advocacy
and Recreation Network (learn) Centre in
the community to address the needs of youth
recovering from a first episode of psychosis
External research funding continues to grow,
reflecting a 4% increase to $28.8 million, with
exciting developments and partnerships ranging
from epidemiology to neuroscience. Studies in such
diverse areas as genetic subtypes of schizophrenia,
mindfulness-based cognitive therapy for relapse
prevention in depression, optimal integration
of psychotherapy and pharmacotherapy for
schizophrenia, workplace mental health, epigenetics,
and gambling and mental illness reflect this breadth. A
newly acquired camera for the pet Centre will expand
the potential and output of this highly successful
research enterprise. In terms of knowledge transfer,
camh staff have led development of two Best Practices
documents published by Health Canada—one in
Design and Delivery of Methadone Maintenance
Treatment Programs and the other in Concurrent
Disorders.
Education activities continue at every level:
undergraduate, post-graduate, continuing, and public.
In undergraduate education, the centre continues
to be a popular site for medical student clerkships
and electives, and 112 such students trained here—as
did 320 nursing students, 35 social work students, 22
occupational therapy students, 20 psychology students,
11 addiction therapy students, and 25 others across a
variety of disciplines. Residents continue to pursue
both clinical and research opportunities at the centre,
particularly in the senior years; 57 psychiatry residents
and 15 family-practice residents received training
here. camh provided continuing medical education
to 420 physicians in 13 courses as well as non-medical
professional education to 635 people in 27 courses in
Toronto and to 2500 people in 69 courses held across
the province.
Health promotion and prevention remain an
important component of the camh mission, and a
recent survey catalogued over 90 such initiatives, many
in our clinical programs. camh staff in communities
across Ontario have worked with local partners
to develop and promote smoke-free bylaws. The
Madness and the Arts Festival celebrated artists
from around the globe who gathered for a 9 -day
event at Toronto’s Harbourfront Centre to educate,
entertain, and reduce stigma. Work with our various
communities included outreach to French-speaking
ethno-racial groups as well as the Building Bridges
Breaking Barriers Access Project. One million
dollars was obtained to support our new McLaughlin
Addiction and Mental Health Information Centre,
featuring a storefront location, telephone and Internet
access, and employment opportunities for patients.
camh has been influencing public policy in mental
health and addictions at the municipal, provincial,
and national levels. Our Office of International
Health opened in July 2002 and has already developed
partnerships in Central and South America and
Africa in training and service development.
Clinical Programs
Clinical services at the centre are organized into
clinical programs, each of which is co-led by a
Clinical and an Administrative Director, and consist
of a multidisciplinary staff based on a program
management model. As some of these programs
are the principal settings for university programs,
they are described in greater detail elsewhere in the
Department of Psychiatry Annual Report.
Following a successful external review in January
2003, our four Addictions programs will be integrated,
and a search for a new Clinical Director for this large
program will be initiated in the coming academic year.
Addiction Medicine Program (David Marsh, md,
Clinical Director)
This program addresses the needs of individuals who
require medical detoxification from substances of
abuse, who require ongoing methadone treatment,
or have significant medical results of their substance
abuse. This program provides a training opportunity
for residents and fellows in family medicine as well
as medical students and offers continuing education
to physicians and other health professionals in the
community.
Addictions General Assessment and Treatment
(Dennis James, MSc, Acting Clinical Director)
This program, paralleling the general psychiatry
program, addresses the needs of a wide array of
individuals with addictions, providing outpatient and
residential treatment for a broad range of addictions.
Addictions Special Populations (Dennis James,
MSc, Acting Clinical Director)
This program focuses on the needs of particular
identified groups with addictions, such as youth,
gay, and lesbian clients, African-Canadian and
Caribbean youth, and seniors. It has commenced some
integration with the Child Psychiatry Program in
fellowship training and clinical services.
66
settings
level clinical service, this program provides a training
setting for residents in Geriatric Psychiatry. A search
is being conducted for a Clinical Director. The
program has recruited a number of new geriatric
psychiatry specialists.
Concurrent Disorders Program (Wayne Skinner,
msw, Clinical Director)
msw
This program addresses the needs of people with
both addictions and psychiatric disorder, using
multidisciplinary personnel, including psychiatry.
It has served as a training ground for residents and
fellows in psychiatry.
Law and Mental Health Program (Howard
Barbaree, PhD, Clinical Director)
This program is also operated as a joint program
with the Hospital for Sick Children, with crossappointment of staff and opportunities for new
collaboration with adult psychiatry, particularly in the
area of psychosis and mood disorder, as well as with
addictions. It will be the subject of an external review
in the coming academic year.
This program, formerly known as the Forensic
Program, provides in-patient, outpatient, and
courtroom-based assessment of forensic psychiatry
issues, ranging from fitness to stand trial, through
to diagnosis and assessment of risk. It also provides
ongoing assessment and treatment for people with
psychiatric illness whose forensic status mandates
hospitalization and therapy. Research activities
include understanding of psychopathy, impulsivity,
and sexual disorders.
Dual Diagnosis Program (Susan Morris, msw,
msw
Mood and Anxiety Disorders Program (Trevor
Child Psychiatry Program (Joe Beitchman, md,
Clinical Director)
Clinical Director)
Young, md, Clinical Director)
This program offers both in-patient and communitybased clinical care to people with both developmental
disability and psychiatric disorder. The recent funding
of an Assertive Community Treatment team for this
program will allow for innovation and collaboration
in providing care. It completed an external review this
past year and has already implemented a number of
recommendations for change.
This program offers a range of consultation and
outpatient and in-patient treatment services for
people with bipolar disorder, depression, and anxiety
disorders. Interventions include cognitive therapy,
group therapy, day treatment, and pharmacotherapy.
Research ranges from brain imaging through to study
of cognitive and personality variables.
Neuropsychiatry Program (Luis Fornazzari, md,
General Psychiatry Program (Peter Voore, md,
Clinical Director)
Clinical Director)
This program offers both in-patient and outpatient
clinical care to people with both acquired brain injury
and psychiatric disorder. Under new clinical and
academic leadership, it has been revitalized from an
asylum model to one of increasing community care
and collaboration as well as research. It is anticipated
that in the coming year this program’s integration with
the Geriatric Psychiatry Program will be complete,
given the significant clinical and academic overlap.
This program directs much of Acute Care Psychiatry
within the centre, with responsibility for Emergency
Psychiatry, Crisis Services, General Outpatient
Assessment and Treatment, and General In-patient
Care. It serves as a major training locus for medical
students and pgy2 residents. Peter Voore was selected
to lead the program in its transformation into the
Consultation, Assessment, Triage, and Support
Service (cats), which will provide a major “front
door” to the centre and link with other hospitals and
agencies.
Schizophrenia Program (Robert Zipursky, md,
Clinical Director)
This program offers a range of acute and rehabilitation
services to people with schizophrenia and related
disorders, from initial onset through adaptation to
chronic illness. It provides a major training setting for
residents in psychiatry and other health professionals
and generates significant basic and clinical research
Geriatric Psychiatry Program (Luis Fornazzari,
md, Acting Clinical Director)
This program offers both in-patient and community
-based clinical care to older people with psychiatric
disorder including dementia. In addition to a high67
advancing the understanding and treatment of these
disabling disorders.
pleasure to witness and participate in the creation of
camh and to work with a superb group of colleagues
and students. I look forward to the leadership of
my successor, Dr. Trevor Young, who brings his
energy, enthusiasm, and intellect to the role effective
September 1, 2003.
Society, Women, and Health Program (Padraig
Darby, md, Acting Clinical Director)
This program provides a unique in-patient psychiatric
unit for women only, as well as a range of specialized
outpatient services for women. Dr. Diane Whitney is
the new Clinical Director for this program, and three
additional full-time psychiatrists have been recruited.
An expansion of in-patient capacity and development
of a day treatment program is planned.
David S. Goldbloom, md, frcpc
Physician-in-Chief
Research
Under the leadership of Dr. Franco Vaccarino, the
research activities of the centre continue to expand,
as reflected elsewhere in this report. Research has
been organized into three principal departments:
Neuroscience (Dr. James Kennedy), Clinical Research
(Dr. Michael Bagby), and Social Policy and Prevention
(Dr. Louis Gliksman). The appointment of Dr.
Vaccarino as Executive Vice-president, Programs, led
to a search for his successor; Dr. Shitij Kapur has
been appointed Vice-president, Research, effective
September 1, 2003.
Education
Peter Coleridge serves as Vice-president of
Communications, Education, and Community Health,
linking how we communicate, what we communicate,
and with whom we communicate. Our commitment
to public and continuing education has been markedly
strengthened. Within psychiatry, Dr. Sagar Parikh
has been responsible for overseeing continuing
education and has established a clear tradition for
longitudinal courses for primary-care physicians
and psychiatrists. Dr. Peter Voore has encouraged
creativity in residency training at the centre through
blended rotations as well as extended electives in
some of the settings in northern Ontario through
the Psychiatric Outreach Program; he continues
to revise the residency curriculum at the centre. Dr.
Danielle Bourdeau has succeeded Dr. Aileen Brunet
as Undergraduate Education Coordinator, and she has
maintained the undergraduate program at a high level
as reflected by feedback and popularity of the site.
Physician-in-Chief
Finally, my term as Physician-in-Chief comes to an
end effective July 1, 2003. It has been a privilege and a
68
Hincks-Dellcrest
Centre
The Hincks-Dellcrest Centre is a
community-based, multidisciplinary
children’s mental health facility.
Program Description
T
he Hincks-Dellcrest Centre is a communitybased, multidisciplinary children’s mental
health facility. Its mission is to promote
optimal mental health in children (from newborns to
18 -year-olds) and their families and to contribute to
the achievement of healthy communities. It is funded
by the Ontario Ministry of Community, Family, and
Children’s Services, as well as by the United Way,
businesses, and individuals.
A comprehensive range of services is offered, from
primary prevention, early intervention, outpatient,
and day treatment, to long-term residential and
mandated (Young Offender) services. Patients are
seen at locations across Toronto, and a rural treatment
program is located near Collingwood.
The centre is partially affiliated with the University
of Toronto, and has trained students in psychiatry,
psychology, social work, nursing, child and youth
work, early childhood education, and expressive arts
therapy for over 30 years. There is an active Research
Department and an evaluation team that regularly
facilitates quality improvement.
Education
For the fourth year in a row, the centre was rated as
the best training site within the Division of Child
Psychiatry, according to the Annual prat Site Survey.
Five career-track residents did their rotation at the
centre, including the Divisional Chief Resident.
In addition, a fellow from Alberta and one from
Manitoba received training. An Endowment Fund
(the Jesse K. Fellowship Endowment Fund) was
established to support the further education of fellows
in psychiatry, psychology, and social work.
Dr. Korenblum completed his term as Director
of Post-graduate Education for the Division of
Child Psychiatry, and Chairman of the Education
Committee of the Canadian Academy of Child
Psychiatry.
International Outreach
A low-literacy, multicultural tool for training
community workers and parents about child
development (Learning through Play) was widely
distributed (more than 100,000 copies) and translated
into 11 languages. With supportive funding from the
Canadian International Development Agency (cida)
and unicef, the program was implemented with
partner agencies in India, Pakistan, El Salvador, Peru,
the Philippines, and Haiti.
In a controlled evaluation study, knowledge about
and attitudes towards infant development were
significantly improved among Pakistani mothers, and
symptoms of psychological distress were reduced.
Research
The Canadian Language and Literacy Research
Network invited the centre to conduct a national
longitudinal study of children enrolled in prevention
programs. The centre obtained nserc and sshrc
grants to implement this study. A cihr grant
supported a study investigating the growth and
development of infants adopted from China. An hrdc
grant supported a literature review of Best Practices
in Child Care and Mental Health Promotion for the
Canadian Mental Health Association. A grant to
evaluate an early intervention program that promotes
language, communication, and cognitive development
in preschoolers was continued.
The landmark Pathways to Competence: Encouraging
Healthy Social and Emotional Development in Young
Children was published by Dr. Sarah Landy, blending
research, theory, and practice to offer evidence-based
guidance to parents and clinicians on socio-emotional
growth.
Recruitment
Dr. Eric Hood joined the staff as senior consultant to
the young Offender Program.
Marshall Korenblum, md, frcpc
Psychiatrist-in-Chief, Hincks-Dellcrest Centre
70
Joint Program in
Child Psychiatry
HSC & CAMH
The overall goal of the Joint Program at
the Hospital for Sick Children and
the Centre for Addiction and Mental Health is
to provide exemplary patient care, training, and research in children’s mental health.
Mission
T
he overall goal of the Joint Program at the
Hospital for Sick Children and the Centre for
Addiction and Mental Health is to provide
exemplary patient care, training, and research in
children’s mental health.
Organization
The Department of Psychiatry at the Hospital
for Sick Children (hsc) and the Child Psychiatry
Program at the Centre for Addiction and Mental
Health (camh) is unified under a single leader, who
is Head of the Division of Child Psychiatry. This
joint program is considered the centre of excellence
in child and adolescent psychiatry and comprises the
largest training component of the Division of Child
Psychiatry.
There is a complementary range of clinical
services and clinical research programs across the
two sites. At hsc, clinical services comprise the
psychiatric emergency program, an acute in-patient
unit, a medical psychiatry consultation service,
infant psychiatry, an eating disorders program, and
neuropsychiatry. At camh, the diagnostic and
therapeutic clinical programs comprise services for
children and adolescents with antisocial and aggressive
behaviour disorders, ranging from fire-setting, to
youth who have been adjudicated by the courts. There
is a short-term day treatment program for children
6–8 years of age. Other services include the gender
identity clinic, and early onset childhood psychoses,
and a cross-site collaborative mood anxiety program.
Functions
Clinical programs comprise the full range of services
in children’s mental health. However, it is under-
developmental disorders. A new section on anxiety
disorders was also created. New osce stations and
written exam questions were developed on the basis of
the revised curriculum. Informally, student response
has been positive to the curriculum. The syllabus was
also placed on-line, through Blackboard, as a first
step towards using Internet technology as a means of
curriculum delivery and coordination.
stood that the Joint Child Psychiatry Program at hsccamh operates within a system that includes other
hospitals and community agencies. Education
functions include electives for medical students and
the mandatory 6 -week training in child psychiatry for
clinical clerks. Post-graduate training includes both
the 6 -month mandatory rotation and career training
in child psychiatry and a variety of electives. Continuing education is organized primarily through the
annual Child Psychiatry Conference update series and
Child Psychiatry Day. It also occurs through other
conferences and seminars in child psychiatry such as
the series for pediatricians and family doctors.
Individual faculty members also offer lectures to
community groups.
Continuing Medical Education (CME)
cme focused on development of multi-modal
longitudinal and 1-day courses using interactive
techniques, needs and knowledge-gain evaluations.
The educational events included the Annual
November Update series in Child Psychiatry, the
Annual Child Psychiatry Day devoted to Infancy:
Social and Biological Perspectives on Early
Development, a longitudinal course for pediatricians
and family physicians on Management of Adolescent
Disorders, the Faculty Retreat on Knowledge
Translation into Practice via Interdisciplinary
Collaboration, ongoing seminars for Pediatric
Telehealth, and the Cognitive Behavioural Therapy
with Children Summer Training Institute led by
Dr. Katharina Manassis. Collaboration with Adult
Psychiatry resulted in two workshops presented
by the Child Psychiatry Division at the Toronto
Psychopharmacology Update. Under the leadership
of Dr. Tatyana Barankin, and the participation of the
cme Advisory Committee, the cme office has become
a leader in the Department of Psychiatry, University of
Toronto, in providing accredited continuing medical
education events.
Post-graduate
This year has seen consolidation of the program in a
number of areas. Planning is underway to add elective
clinical rotations in in-patient child psychiatry (hsc)
and medical child psychiatry and eating disorders.
The planned review of the training program at hsc
will now be led by Dr. Pier Bryden in her capacity
as Acting Head of Post-graduate Training. Some
changes are expected, including introduction of more
interdisciplinary learning opportunities, increased
coverage in infant psychiatry, and more teaching
of critical appraisal and other skills necessary to
becoming effective life-long learners.
Residents continue to enjoy a diverse training
experience at camh and participate regularly in the
Professorial Seminar held at hsc. In addition to
fulfilling core rotation Royal College requirements,
residents are able to select many specialty elective
experiences. This year, with the integration of Youth
Addictions and Substance Abuse Program for African
Canadian and Caribbean Youth (sapaccy), residents
have the opportunity to acquire experience in seeing
adolescents with comorbid mental health and
substance-abuse issues. Resident satisfaction ratings
continue to be high, reflecting the richness of their
experiences.
Other Activities
Telepsychiatry Program. The Division of Child
Psychiatry completed its 2 -year contract with the
Ministry of Community, Family, and Children’s
Services on March 31, 2003. This contract was
renewed with the division in partnership with the
Hospital for Sick Children for 1 year to March 31,
2004. The mandate continues for this “hub” site
to provide service and education to 14 designated
children’s mental health centres in rural and
northern Ontario. Any other children’s mental health
provider with compatible technology can access the
Telepsychiatry Program for up to 10 hours per week. A
fire-setting consultation protocol was recently initiated,
which allows for direct delivery of case consultation
for children who are setting fires and who have
other mental health symptoms. There is a particular
Undergraduate
The Undergraduate Committee implemented a revised
clerkship curriculum that emphasized more up-todate and evidence-based information. The existing
sections of the syllabus were expanded and revised.
New references and website resources were also added.
A new section on developmental disabilities was
created, focusing on mental retardation and pervasive
72
settings
focus in the north for First Nations communities,
recognizing the unique impact of culture upon
practice in this area. The value and further potential
of the Telepsychiatry Program is becoming recognized
with the hope of continued growth.
Infant Mental Health Promotion Project. The Infant
Mental Health Promotion Project (imp), directed
by Ms. Rhona Wolpert, with co-chairs Ms. Nancy
Peters (Massey Centre for Women) and Dr. Susan
Bradley (hsc), has continued to provide training and
information for community service providers working
with infants and their families.
In December 2002, imp published Competencies for
Practice in the Field of Infant Mental Health, and in June
2003 a special issue of the newsletter IMPrint focused
ib interventions that promote infant mental health.
As well, in June 2003, imp updated and reprinted
Pregnancy & Alcohol/Drug Use: A Professional’s Guide to
Identification and Care of Mother and Infant. All have been
very well received across Canada and the usa. Our
video A Simple Gift: Comforting Your Baby for parents,
has been purchased by Sweden for translating and use
with families there.
The Medical Psychiatry Program. The Medical
Psychiatry Program at hsc has increased its medical
staff complement and has implemented a Crisis
Response Team.
The Infant Psychiatry Program. The Infant
Psychiatry Program has expanded to offer services
to include preschoolers, and as a result we now
see children from newborns to 5 years of age. The
program has been established as a centre for evidencebased interventions for parents and their infants or
young children. The program continues to attract
participants interested in collaboration, from a
number of areas within the hospital and from other
faculties and colleges in the university. At present,
the Infant Psychiatry Program is working to develop
collaborations that will create a wider Infant Mental
Health perspective to include service provision,
research, and teaching in the hospital, the university,
and the community at large.
Joseph H. Beitchman, md, frcp
Psychiatrist-in-Chief, The Hospital for Sick Children
Clinical Director, Child, Youth & Family Program,
Centre for Addition & Mental Health
73
Mt. Sinai Hospital
The mission of the Mount Sinai Hospital Department of Psychiatry is
to provide excellence in clinical care, research, and education
in collaboration with the University of Toronto, Department of Psychiatry,
and other heath care partners.
T
he mission of the Mount Sinai Hospital
Department of Psychiatry is to provide
excellence in clinical care, research, and
education in collaboration with the University of
Toronto, Department of Psychiatry, and other heath
care partners. The department’s Joint General
Psychiatry Program with the Centre for Addiction
and Mental Health ended in the past year, retaining
the joint Emergency Department located at the Centre
for Addiction and Mental Health—Clarke site. The
Mount Sinai Department of Psychiatry is organized
into Ambulatory, In-patient, Psychiatry Health and
Disease, Psychotherapy, and Community Programs.
Ambulatory Program
The Ambulatory Program comprises a multitude of
services.
• The Assessment and Outpatient Treatment
Services had 351 referrals in the past year and 51,191
outpatient visits.
• The Assertive Community Treatment Team
provides a culturally competent and accessible
program of mental health outreach services
for severely mentally ill clients of ethno-racial
backgrounds primarily of Southeast Asian
origin, Tamil, black, and Aboriginal communities.
Currently there are 68 clients in the program.
• The Court Support Program, which is subsumed
•
•
•
•
•
•
•
•
under the Ambulatory Program, uses an intensive
crisis-intervention model, which provides quickresponse case management intervention.
The Crisis Intervention Service provides rapidresponse intervention utilizing the six-session
model. It received 147 referrals.
The Couple and Family Services is also in demand.
The Geriatric Service provides primary, secondary,
and tertiary consultations. An innovation was the
introduction of seminars addressing divisional
objectives, with consolidation of the weekly series
held in collaboration with the geriatric psychiatry
supervisors at St. Michael’s Hospital.
The Day Treatment Service assessed 112 patients
and provides a variety of outpatient and in-patient
programs, including the Schizophrenia Program.
The Psychological Trauma Service, which assessed
40 patients in the past year, has increased its
clinical staff. The service provides assessment and
consultation for individuals suffering from serious
post-traumatic stress, dissociative disorders, and
depersonalization.
The Panic Disorder Service assesses two to four
patients per month. It is predominantly a teaching
service run by Dr. Irwin Kleinman.
The Group Therapy Program had 135 referrals, 100
patients assessed, and 75 treated in treatment.
The Wellness Centre, a significant Mount Sinai
Hospital Community Program in partnership
settings
with Hong Fook Mental Health Association
and Yee Hong Centre for Geriatric Care,
provides a broad array of clinical, educational,
mental health prevention and promotions services
for the Chinese community in an accessible,
destigmatized storefront setting.
• The Cultural Consultation Team is a new program
development, which aims to provide culturally
competent psychiatric consultation and treatment
recommendations.
or effectively treated on as outpatients. Unique to this
unit is the Joint Admission, with support provided by
the Departments of Family Medicine, Pediatrics, and
Obstetrics/Gynecology of infants and their mothers
suffering from postpartum conditions.
Research
The research activities of our department continue
to have a very high priority. There are 26 clinicians
directly participating in 15 funded research projects,
and the research staff complement is the equivalent of
nine full-time employees.
The Psychotherapy Program is a central program
informing all areas in the department and has
been active in a broad range of post-graduate and
continuing education activities. It organized three
special academic days for residents. It is very active in
research.
The Mount Sinai Department of Psychiatry is actively
involved in the training of residents and medical
students. Eleven residents were trained over the course
of the past academic year.
In addition to this cohort of pgy2 to pgy4 residents,
an additional six pgy1 residents trained at our hospital.
Ten residents as well from pgy3 to pgy4 participated
in electives that were generally longitudinal over the
course of the year, having to do with psychotherapy,
psychological trauma, and women’s mental health.
This year we had a full-time fellow participate in the
family practitioner psychotherapy training program. A
number of residents received honours over the course
of the last academic year. Dr. Lesley Wiesenfeld
received the first Mount Sinai Hospital Bernie Ghert
award for outstanding achievement by a resident in
the hospital. Drs. Ariel Dalfen and Lesley Wiesenfeld
also shared the Greben Hahn Award for outstanding
achievement by a resident in psychiatry, and Dr.
James Chin won the Eli Lilly Award for best Grand
Rounds Presentation by a resident. In addition, Dr.
Ellen Margolese was nominated for the Abe Miller
Award for outstanding achievement in undergraduate
education. The faculty members honoured with
nominations for teaching awards included Dr. Paula
Ravitz for the Robin Hunter Award and Drs. Leo
Chagoya and Clare Pain for the Allen B. Tennen
Award.
Psychiatry Health and Disease Programs
The Psychiatry Health and Disease Program provides
psychiatric consultation to medical/surgical inpatients and ambulatory patients with concurrent
psychiatric disorders or psychological concerns.
Specialty areas include inflammatory bowel disease,
perinatology, oncology, and pain patients. It is a highly
sought-after training centre. It has particular interests
in psychosocial and psychotherapeutic research in
cancer genetics. The past year’s growth was focused
on the perinatology consultation service headed by
Dr. Kenneth Citron, with recruitment of Dr. Beverly
Young, as well as the increased involvement of Dr.
Nadine Cossette. Dr. Eileen Sloan and Dr. Ariel
Dalfen have concentrated their training in this area.
The hiv Clinic is the oldest and largest mental health
clinic in Canada, which provides for the needs of the
hiv infected and affected population of both men and
women.
In-patient Program
The In-patient Program provides a full range of
biological, psychological, and social services to patients
with a wide range of psychiatric diagnoses and ages.
There were 245 admissions in the past year. All
modalities of care are delivered by a multidisciplinary
mental health team in a manner formed by the
principles of psychotherapy. There is a close working
relationship with the act Team, and one of the beds is
designated for the Psychological Trauma Program for
patients with severe ptsd or did who cannot be safely
Undergraduate education for junior medical students
takes place in several courses: the Art and Science
of Clinical Medicine, Determinants of Community
Health, Foundations of Medical Practice, and the
elective course on Therapeutic Communication.
Teaching of senior medical students in the
75
mandatory third-year clinical clerkship psychiatric
rotation continues with in-patient, outpatient, and
consultation liaison.
widely in Canada and together with Dr. Christine
Dunbar taught a series in the International Course
on Dissociative Disorders Therapy Training Program
sponsored jointly by the International Society and our
department.
Dr. Joel Sadavoy, Psychiatrist-in-Chief, has been
elected President of the International Psychogeriatric
Association. Dr. Rosemary Meier participated
in the planning and presentation of core lectures.
Dr. Graeme Taylor was awarded the 35th
th Annual
Franz Alexander Memorial Lectureship. Our staff
were involved in many presentations, community
involvements, and international collaborations: for
example, the visit of Dr. Yao and Dr. Zhu from the
Second Ziangya Hospital Central South University
of China to the act Program. Dr. Timothy Gofine
resigned from the act Team in April 2003 and took a
new position at the Centre for Addiction and Mental
Health. Dr. Sam Law is the new Clinical Director of
act
act.
Significant Events and Achievements
The sars experience placed many strains on our
hospital, its patients, and staff, but none more
pronounced than in its psychological impact. As a
result of the sars outbreak, the C/L team became
a critical aspect of the Department of Psychiatry /
Mount Sinai Hospital administrative response, seeing
patients in the isolation ward, helping individual staff
members in stressful circumstances, and participating
in planning meetings. This involvement included
generalized academic work including a survey of
1,651 health care workers in three Toronto hospitals
coordinated by Dr. Robert Maunder in collaboration
with Dr. Fones of Singapore. Multiple papers and
presentations resulted from this work. Every member
of our department responded wholeheartedly to these
needs. Besides the very vital role provided by the
C/L Service, Dr. Molyn Leszcz provided a significant
contribution to the nursing staff of the Intensive Care
Unit and the sars units.
The Community Cultural Consultation Service
was initiated, the perinatal mental health program was
expanded, with three residents choosing to begin their
subspecialty training in it. The program is developing
external partnerships with community agencies, such
as Our Sisters’ Place, as well as collaborations with
other hospitals including swchsc and the Mother
Risk Program at the Hospital for Sick Children.
During the sars epidemic, the Wellness Centre
played a key role in setting up the language-specific
sars support line, joining the community coalition
concerned about sars in developing a bilingual
(English/Chinese) sars sheet to educate the public
about the disease and its prevention.
Mr. Paul Vrooman, Senior Social Worker, won the
prestigious Karen McGibbon Award of Excellence.
Dr. Martin Svartberg joined our department and
continues his research on psychotherapy, particularly
focused on personality disorder patients. Dr. Alex
Tarnopolsky was Guest Professor at Kyushu
University in Japan. Dr. Pain was re-elected President
of the Canadian Society for the Study of Trauma
and Dissociation and also became Chair of the
Membership Committee of the International Society
for the Study of Dissociation and Co-Chairperson
of the Program Committee of the coming annual
meeting of the same society. Dr. Pain lectured
Joel Sadavoy, md, frcpc
Psychiatrist-in-Chief, Mount Sinai Hospital
76
St. Michael’s
Hospital
The goals of the St. Michael’s Hospital Mental Health Service are
to provide a range of high-quality, integrated mental health programs
to residents of southeast Toronto and
to contribute to the academic mission of the Department of Psychiatry.
Introduction
T
he goals of the St. Michael’s Hospital Mental
Health Service are to provide a range of highquality, integrated mental health programs to
residents of southeast Toronto and to contribute to
the academic mission of the Department of Psychiatry.
The program model is urban community psychiatry.
The Mental Health Service is an integral part of the
Inner City Health Program at St. Michael’s Hospital.
Organization
The Psychiatric Emergency Service provides crisis
management and psychiatric assessment and
treatment. It is a highly rated departmental training
site. Emergency services are provided 24 hours per
day, 7 days per week. This year there were 3,390
patient contacts. Roughly 3% of emergency patients
are assessed by the Psychiatric Emergency Service
and roughly 31% of patients seen by the service are
admitted to hospital. The service also provides
a suicide consultant to link the Arthur Sommer
Rotenberg Chair in Suicide Studies with innovative
clinical programs.
The 33-bed In-patient Service continues to
be efficient and effective. This service deals with
individuals with complex care needs. There were
736 total discharges this year and average length of
stay was 14.46 days. Discharge planning continues
to improve as a result of the smooth functioning of
a community care program. The In-patient Service
emphasizes general psychiatry and also provides
expertise in addiction psychiatry, hiv-related
disorders, and patients with severe and persistent
mental illness.
A considerable volume of work continues to be
carried out by the Community Mental Health Service.
Total contacts for 2002–2003 were 16,965. This service
consists of five components: extended care clinics, the
Community Connections Program, the Substance
Abuse and Mental Illness Program, the Assessment,
Consultation and Treatment Program, and an
Outreach Program that provides services on site at
community agencies throughout Southeast Toronto.
Contact is an assertive community treatment
team. It was the first team established in a general
hospital psychiatric unit in Canada. Substance abuse,
homelessness, and physical illnesses often compound
issues related to severe and persistent mental illness
in Contact service clients. Contact has provided
leadership as the assertive community treatment
model has developed across Canada by hosting
numerous visitors seeking to learn how to implement
the Contact approach.
The Medical Psychiatry Consultation Service
functions smoothly. An advanced nurse practitioner
enhances the functioning of this service. A distinct
hiv Psychiatry Program has been developed, and
geriatric consultation liaison services are also provided.
The Mental Health Service trains students in all
professional disciplines. The majority of psychiatric
residency training is in general psychiatry. Training
in community psychiatry is well developed. Residents
participate in structured psychotherapy supervision
involving both individual and group modalities.
Training is also provided in consultation liaison and
geriatric psychiatry, and career rotations are available
in a number of areas. The Steven Godfrey Fellowship
in Suicide Studies and the St. Michael’s Hospital
Community Mental Health Fellowship are both
situated in the Mental Health Service. The service
also trains undergraduate medical students.
Scholarly activities are concentrated in a number
of areas. Dr. Paul Links holds the Arthur Sommer
Rotenberg Chair in Suicide Studies. He has built a
strong academic unit and has recruited several Steven
Godfrey fellows. The unit includes a research associate
and a research consultant. Drs. Mark Halman and
Sean Rourke direct research in hiv Psychiatry. Areas
of interest include Mood and Cognitive Disorders,
Treatment Adherence, and Rehabilitation. Dr.
Rourke’s Neurobehavioural Research Unit focuses on
the interface between brain and behaviour in several
key areas. In the area of evaluative studies, Dr. Donald
Wasylenki is principal investigator on a randomized
controlled trial of community treatment. This trial
is part of the comprehensive provincial Community
Mental Health Evaluation Initiative. As well, survey
research is underway to identify best practices in
meeting the health and mental health needs of
individuals who are homeless.
a substantial reorganization. The name of the service
has been changed from Crisis Service to Psychiatric
Emergency Service to emphasize the breadth of
activities. The essence of the reorganized service is a
greater degree of client-focused care. Staff are now
available 24 hours per day, 7 days per week, which
is an increase in accessibility. There will be closer
linkages between Psychiatric Emergency Service staff
and staff of the hospital Emergency Department. The
service model has shifted from a consultation model
to a direct-service model, which will allow for more
immediate client care. In addition, the Mobile Crisis
Intervention Team operated in conjunction with police
at 51 Division now has been extended to 52 Division—
a significant expansion of service. Finally, a three-bed
Crisis Stabilization Unit has been added to the service,
providing extended (72 -hour) assessment and brief
treatment as well as more informed dispositions. To
date the unit has had a very high occupancy and has
reduced short-term admissions to the In-patient
Service.
A second major reorganization was carried out
by the former Outpatient Service—now christened
the Community Mental Health Service in keeping
with its extended community mandate. This
reorganization has involved establishment of a single
point of entry to various components of care and a
realignment of services. In addition, there continues
to be a strong emphasis on work in collaboration with
family physicians. Staff of the Community Mental
Health Service liaise, in various ways, with Family
Practice groups, and all pgy2 residents participate in
liaison work with family physicians. A second strong
component, community outreach, involves staff
provision of mental health services in shelters and
hostels in southeast Toronto. Working in conjunction
with psychiatrists, residents, and allied health
professionals, a community linkage consultant has
been added to the service to ensure smooth hospital–
community relations. A conference on hospital–
community partnerships is planned for October 2003.
A major development in geriatric psychiatry has
been the establishment of a multidisciplinary Memory
Clinic. This clinic receives referrals from several sources
and focuses on careful assessment of memory function
in elderly people with mental disorders. A second focus
involves understanding psychiatric symptoms that
occur in conjunction with memory-related disorders
such as Alzheimer’s disease. The clinic has also
provided a locus for an important study of the role of
cognitive enhancers in memory-related disorders.
Developments
There were a number of important developments in
the St. Michael’s Hospital Mental Health Service in
2002–2003.
The Psychiatric Emergency Service has undertaken
78
settings
The Mental Health Service is in the process of
developing a new program for transitional youth in
the inner city. A very careful, comprehensive needs
assessment has been carried out and a number of key
community and hospital partners have been identified.
Response to this initiative has been extremely positive
and funding currently is being sought.
The Mental Health Service In-patient Service
reduced its bed numbers from 36 to 33 this year to
facilitate the establishment of the three-bed Crisis
Stabilization Unit. The In-patient Service performed
extremely well during the sars outbreak this year and
led in carrying out a large-scale survey on responses to
sars at St. Michael’s Hospital.
This year a very successful international conference
on emergency psychiatry was organized by a group
led by St. Michael’s Hospital. Dr. Ian Dawe took
responsibility for coordinating post-graduate
education in psychiatry at St. Michael’s Hospital
and Dr. John Langley assumed a similar role for
undergraduate education. Two new members
of the medical staff, Drs. Mara Goldstein and
Vicky Stergiopoulus, assumed responsibility for
departmental elective activities and ascm coordination
respectively, and Dr. Harold Spivak joined the staff
of the In-patient Service. Dr. Sam Law was also
recruited to the Community Mental Health Service
and adds a strong cultural component to the Mental
Health Service capacity. Drs. Sam Packer, Bruce
Menchions, and Joanne Sinai left the service, and
as for honours, Dr. John Langley won the Abe
Miller award as best undergraduate teacher in the
Department of Psychiatry.
The Arthur Sommer Rotenberg Chair in Suicide
Studies, situated in the Mental Health Service,
continues to be extremely productive. The emphasis
continues to be on impulsivity and affect in relation
to self-harm behaviours. Funding was obtained last
year from cihr, omhf, and the Ministry of Health
and Long-term Care, and Dr. Ann Rhodes, Associate
Scientist with the Chair, received a prestigious 5-year
Career Scientist award from the Ministry of Health
and Long-term Care.
Finally, in conjunction with the Inner City Health
Research Unit, investigators in the Mental Health
Service contributed to receipt of a substantial cihr
training grant to facilitate education for disadvantaged
populations. This was a $1.4 million grant, which will
increase the service’s capacity to provide state-of -theart, evidence-based training experiences.
In the area of scholarship, 12 new grants were
received this year, bringing the total number of active
grants in the Mental Health Service to 24. Total
external funding held during the reporting period
was $4,722,873. Four fellowship and other personnel
awards were received this year. Over a 5-year period,
1998–2003, the Mental Health Service has received
$8,803,218 in external funding. Of this amount,
$2,073,337 is from peer-reviewed grants, $481,675 is
from partnerships with industry, $2,120,352 is from
salary awards and fellowships, $25,000 is from St.
Michael’s Hospital, and $4,102,854 is in contracts
and Ministry of Health and Long-term Care funding.
In relation to funding by research foci, hiv-related
research, neuropsychology, mental health systems
research, and research related to suicide continue to
attract significant funds.
Members of the Mental Health Service continue
to be involved in the work of the Mental Health
Implementation Task Force for Toronto and Peel, and
the final report has been submitted to the Ministry of
Health and Long-term Care.
Donald A. Wasylenki, md, frcpc
Psychiatrist-in-Chief
79
Sunnybrook &
Women’s College
Health Sciences Centre
The Department at Sunnybrook and
Women’s College Health Sciences Centre
has witnessed significant growth and development in the past year.
T
he department at Sunnybrook and Women’s
College Health Sciences Centre (swchsc) has
witnessed significant growth and development
in the past year. We continue to benefit from the
influence of Dr. Shulman in his role as the Lewar
Chair in Geriatric Psychiatry and from Dr. Sarah
Romans, the Shirley Brown Chair in Women’s Mental
Health. We have expanded and refined the focus of
our Women’s Mental Health program to incorporate
Reproductive Mental Health and Trauma Therapy
for Women. Our department was recognized by
the hospital for its direct involvement in assisting
the hospital to deal with and recover from the sars
outbreak. In addition, Dr. Feinstein was promoted
to Full Professor, and Dr. Silver took on the role
as inaugural Director of the Faculty Development
Program of the Faculty of Medicine.
The department has been intimately involved in
strategic refocusing spearheaded by the new ceo,
Leo Stevens. The hospital is now committed to
Neurosciences as one of its six premier programs, with
Mood Disorders, Dementia, and Traumatic Brain
injury as pillars of the Neuroscience program. The
department will be working over the next year to
develop the Neuroscience focus at swchsc.
Neuropsychiatry
Over the past year, neuropsychiatric research has
focused on multiple sclerosis and traumatic brain
injury. In ms, the results of a cihr-funded mri study
of mood change in ms have been analyzed, written up,
and accepted for publication in Neurology. An article
entitled “The Neuropsychiatry of Multiple Sclerosis”
has also been commissioned by the Canadian Journal
of Psychiatry for an upcoming issue. Dr. Susan
Quesnel, during her research elective, undertook
an analysis of Alcohol and Substance Abuse Data
settings
research program in Mood Disorders is currently
being headed by Dr. Ayal Schaffer, who is involved
in clinical trials in mood disorders funded by the
Ontario Mental Health Foundation, the Canadian
Institute of Health Research, and the National
Institute of Mental Health. Collaborative work has
also been done on the pharmacoepidemiological
treatment of bipolar disorder in the elderly. Research
electives for residents and fellows have continued to
enhance the productivity of this group. Dr. Anthony
J. Levitt continues to be very productive and is the
lead investigator on two major trials: the treatment
of adults and adolescents with depression. The
cognitive behavioural therapy group continues to
be led by Dr. Zaretsky, and this group has recently
initiated a funded trial on adjunctive cbt in major
depressive disorder. Dr. Zaretsky continues to
be a co-investigator on a cihr-funded study of
psychoeducation versus cbt in bipolar disorder. Dr.
David Kreindler continues to be a leader in distance
mood monitoring and is continuing this area of study
in new innovative projects.
Education is emerging as a priority for the Mood
and Anxiety Disorders group, and Dr. Schaffer is
currently coordinating the Mood Disorders Core
Lectures for the psychiatry residents as well as
sitting on the Post-graduate Education Committee
as the Mood and Anxiety Disorders representative.
The group continues to see many elective residents,
fellows, and medical students as well as provide core
educational experiences for rotating medical students.
in ms Patients. The resulting publication will
appear shortly in the Journal of Multiple Sclerosis.
Furthermore, a study has recently begun looking at
mri Abnormalities in Patients with Multiple Sclerosis
in Pathological Laughing and Crying. The principle
investigator on this study is Dr. Laury Chamelian.
Traumatic brain injury (tbi)
(
research is focused
on functional and structural brain abnormalities
in patients with mild tbi. A cihr-funded study is
currently still underway, with recruitment complete
and the data in the process of analysis. The Traumatic
Brain Injury Clinic remains the main feeder for
multiple research projects in tbi, and at present
the number of patients in the database stands at
over 1,000.. Dr. McCullagh has become the primary
psychiatrist involved with the tbi Clinic and works
closely with Dr. Cheryl Masanic from the Department
of Psychiatry. The tbi Clinic now employs a fulltime coordinator, with funding provided by the
Sunnybrook Foundation. Dr. Omar Ghaffar has
recently completed an elective analyzing Treatment
Outcome Data in Mild tbi, and his manuscript has
been submitted for publication.
In education, Neurology pgy2 residents continue
to pass through the Division of Neuropsychiatry
as part of their core rotation. pgy1 students spend
part of their week in a Neuropsychiatry Outpatient
Clinic. Neuropsychiatry electives are part of the core
lecture curriculum for pgy3 and pgy4 residents. A
series of neuropsychiatry seminars are run in-house at
Sunnybrook for local psychiatry residents.
From a clinical perspective, the in-patient unit
has two dedicated neuropsychiatry beds and a
number of neuropsychiatry outpatient clinics as a
tertiary referral source for patients province-wide.
The Mild to Moderate Traumatic Brain Injury
Clinic now runs six clinics per month and sees on
average 200 new consults per year. The clinic is
run on a multidisciplinary basis, with input from
Psychiatry, Occupational Therapy, Physiotherapy, and
Neuropsychology.
Division members had a particularly successful year.
Dr. Shulman was very productive as the Lewar Chair
in Geriatric Psychiatry, one accomplishment being
the publishing of a paper in the British Medical Journal
on the pattern of lithium and valproate use. Dr. Silver
was appointed Director for Faculty Development
in the Faculty of Medicine at the University of
Toronto. Dr. Cohen continued her work with the
Dementia linc, coordinating dementia care in the
community, and received a net Grant for Transitions
and Dementia: Bridging Gaps in Service Provision.
Dr. Herrmann published a number of peer-reviewed
articles, was a visiting professor in the Department
of Geriatric Medicine at McGill University, and was
appointed Chair of the Pharmacy and Therapeutics
Committee of the hospital. Dr. Lanctôt wrote
numerous peer-reviewed publications and received
several grants, including those from the Alzheimer
Mood Disorders
The 2002–2003
2003 academic year has been a productive
one for the Mood and Anxiety Disorders Group at the
Sunnybrook campus. Clinically, the group continues
to provide tertiary and quaternary consultations,
focusing on treatment-resistant depression, bipolar
depression, seasonal affective disorder, and cognitive
behavioural therapy. The group has been especially
productive in a variety of research endeavours. The
81
Society of Canada and the American Health
Assistance Foundation. Dr. Rapaport wrote a number
of peer-reviewed publications and received an Ontario
Mental Health Foundation Grant.
The Division maintained a busy clinical service
with an In-patient Unit, Outpatient Services,
Consultation to Acute Medicine and Long-term
Care, and the Community Psychogeriatric Service for
the Elderly. A large number of psychiatry residents,
medical students, and allied health students trained
on these services in regular rotations and electives.
Women’s College Health Sciences Centre continues
to offer a broad range of clinical and teaching services
ranging from those provided by the act Team, the
Mobile Crisis Team, Short-term Crisis Intervention
in the Emergency Department, Consultation Liaison,
Psycho-oncology, women’s issues program, outpatient
and in-patient programs.
Residents of the General Division are supervised
in short-term and long-term Psychotherapy including
cbt, psychodynamic psychotherapy, and couple and
cbt
family therapy. The program in which the pgy2
residents work with a combination of in-patients
and outpatients throughout the year is in line with
the direction of the Royal College and allows the
residents a unique exposure to the daily functioning
of a general psychiatrist. Our in-patient numbers have
increased from 18 to up to 20 beds, which include
dedicated neuropsychiatry beds. Our pgy2 residents
are encouraged to develop a research interest and
focus, and many of them spend half a day per week on
specific research projects.
The swchsc Assertive Community Treatment
Team (Sunpact) continues to provide comprehensive
mental health services to individuals with severe and
persistent mental illness. Continuous data collection
and clinical evaluations demonstrate a reduction
in hospital days for clients enrolled in the program.
Survey results indicate a high level of satisfaction by
clients and their families. Sunpact offers a unique
learning experience for medical students who gain
a valuable perspective in community-based mental
health treatment.
The 24-Hour Mental Health Crisis Program is
fully integrated with swchsc’s Emergency Services.
As well, the Crisis program maintains a unique
partnership with Saint Elizabeth Health Care,
providing mobile crisis services to individuals and
families in their homes.
The Psychiatry Program at wcacc has been
engaged in strategic planning over the last year. We
have defined two foci that are rapidly solidifying
into two clinical programs with educational and
research components: the Reproductive Life Stages
Program (rls) and the Trauma Therapy Program
(ttp). The rls program offers evidence-based,
women-centred services including comprehensive
assessments, pharmacotherapy, and a broad range
of psychotherapies. The focus is on women with
mood and anxiety disorders and relationship
problems within the context of premenstrual,
pregnancy, postpartum, and menopausal stages of the
reproductive life cycle.
The Trauma Therapy program offers timelimited psychotherapy to both women and men
with psychological issues resulting from sexual,
physical, and emotional violence, and neglect.
This program’s services include a comprehensive
range of psychotherapy modalities as well as
psychopharmacology assessments and treatments.
Clinical activity is quickly increasing as we have
hired several mental health therapists for the Trauma
Therapy Program and will soon be hiring two mental
health therapists for the rls program. We have
recruited three psychiatrists; two have joined the rls
team and one has joined the ttp team.
We are now ready to commence a search for
Academic Leaders for the Trauma Therapy Program
and the Reproductive Life Stages Program. It is our
hope to recruit for these new positions in the coming
year, to enhance our academic productivity and
teaching capacity.
Once again Sunnybrook’s post-graduate education
program was one of the most highly rated programs
in the prat Site Survey. Residents continue to note
excellent supervision, collegiality, and the department’s
strong commitment to education as distinguishing
features. Supervisor evaluations reflect this teaching
excellence; we received the highest average supervisor
ratings (4.8) of all primary teaching sites.
During the sars crisis, supervisors remaining
on site rose to the occasion to ensure that resident
education did not suffer. Nathan Herrmann was most
General Team
The General Team is developing a shared-care model
with family practice. This is important from both a
clinical and teaching perspective. Sunnybrook and
82
settings
notable in this regard, providing residents with daily
teaching sessions. The residents acknowledged this
important contribution by honouring him with the
Sunnybrook Award for Excellence in Post-graduate
Education. Neal Westreich was also nominated for
this award.
Our integrated in-patient/outpatient General
Psychiatry rotation continues to be the highest
pgy2 General Psychiatry rotation, a ranking it has
maintained since its inception 4 years ago. This
past year our C/L core rotation was also ranked the
highest among all sites. The post-graduate program is
benefiting from the availability of clinical exposure to
the increasing number of experts in women’s mental
health in our department. At our annual Residents’
Seminar Day held at the Vaughan Estates, staff from
the Women’s Mental Health Program led a workshop
on psychiatric illness and the postpartum period. This
has spawned the development of a seminar series on
this topic for the coming year.
Anthony Levitt, md, frcpc
Sunnybrook and Women’s College Health Sciences Centre
83
Surrey Place
Centre
Surrey Place Centre,
accredited by the Canadian Council on Health Services Accreditation,
is an interdisciplinary community-based agency committed to
enabling people with intellectual disabilities and their families to
enhance their quality of life through integrated service, research, and education.
S
urrey Place Centre (spc), accredited by
the Canadian Council on Health Services
Accreditation, is an interdisciplinary
community-based agency committed to enabling
people with intellectual disabilities (id) 1 and their
families to enhance their quality of life through
integrated service, research, and education. In the past
year, in line with the vision of the Board of Directors
and our new Executive Director, clinical services have
been reorganized into quadrants serving the north,
east, south and west areas in Toronto. Psychiatric staff
in the Biomedical Services and Research Division
provide consultation to clients referred from these
quadrants. Consultations take place in a variety of
settings: at spc, home, school, and community work
settings. When resources permit, treatment is offered
where coordinated interdisciplinary approaches are
required and where it has been unavailable to clients
in their own community. Given the complexity
1. Sometimes referred to as developmental disabilities (Ontario) or
mental retardation (dsm–iv)
of the physical and mental needs of many of the
persons referred to spc, treatment of behavioural
and psychiatric disturbances invariably involves
close collaboration among many stakeholders in the
community: clients and carers, family physicians,
other specialists, dentists, residential and day settings,
emergency room, in-patient psychiatry, community
and out-patient psychiatry, and for adults, the Office
of the Public Guardian and Trustee. Much of the
consultation supports persons with intellectual
disabilities in generic health care settings, given the
very limited specialist psychiatric services available for
this population.
The past year has offered the opportunity for
staff affiliated with the Department of Psychiatry
to consolidate and expand educational and research
activities and through continued membership of
community planning groups to contribute to service
planning and development.
settings
Education
specific learning objectives.
Faculty at Surrey Place and the Dual Diagnosis
Program are members of the Ontario Academic
Health Sciences Centre Task Force on Intellectual
Disabilities and in this capacity contribute to the
medical undergraduate curriculum in intellectual
disabilities (available at www.psychiatry.med.uwo.ca/ddp).
Since 2000,, a formal linkage between the Dual
Diagnosis Program at the Centre for Addiction
and Mental Health (dd
( camh) has provided an
extended clinical teaching site offering physician
trainees a wider range of clinical experience in inpatient, outpatient, and community care. Teaching
staff from Surrey Place Centre are Drs. Berg, Bradley,
and Brooks-Hill. Other medical specialists in the
division (representing developmental pediatrics,
neurology, and genetics), and non-medical staff
within the age-related divisions (including Ms.
Clifford [nursing], Ms. Drummond [behaviour
therapy], Dr. Stoddart [social work], and Dr. Valerie
Temple [psychology]), reflect the interdisciplinary
nature of the clinical service. Teaching staff from
the Dual Diagnosis Program are Ms. Morris and
Drs. Homitidis, Lunsky (cross-appointed with
Surrey Place Centre), Palucka, Sanhueza-Luco, and
Gofine. Clinical and academic linkages with the
Hospital for Sick Children provide opportunities
for undergraduate and post-graduate trainees taking
electives at Surrey Place to work closely with other
medical specialists (developmental pediatricians,
neurologists, geneticists) and other multidisciplinary
teams involved in the care of children with intellectual
disability and complex health needs.
An experience in intellectual disability psychiatry is
now available in each of the residency years. Each
experience builds on the previous year to provide
a more comprehensive and integrated exposure.
Required reading, interactive seminars, and
participation in clinical consultations and assessments
are some of the educational activities. All teaching and
clinical experience is offered within a multidisciplinary
context and emphasizes a life-span approach. Two
half-day seminars within the core curriculum for pgy1
trainees focus on an introduction to the assessment
and treatment of mental health disorders in adults
with intellectual disability. At this time residents are
provided with a comprehensive manual of selected
readings, resources, and references on aspects of
intellectual disabilities for use during their 5 years of
training (Developmental Disability Psychiatry, Curriculum
Manual pgy1 to pgy4/5, developed by Ms. Marika
Korossy ,Resource Coordinator and Librarian,
spc, and Drs. Bradley and Lunsky). In response
to resident feedback over past years, an additional
text has been developed—Guidelines for Managing
the Patient with Intellectual Disability in the Emergency
Room—which this year was published by the Centre
for Addiction and Mental Health (also available at
www.utpsychiatry.ca/sites/surrey.cfm). In the pgy2 year
each trainee spends a half day with Dr. Brooks-Hill
and the multidisciplinary team at Surrey Place in the
outpatient consultation and assessment service. In
pgy3, residents during their core-curriculum Child
Psychiatry seminars are offered a seminar that focuses
on behavioural phenotypes and the assessment and
treatment of children with intellectual disability. This
year we added a seminar on intellectual disabilities,
psychosis, schizophrenia, and autism spectrum
disorders during the pgy3 core-curriculum seminars
on schizophrenia and continuing care. Throughout
the 5 years of psychiatry residency a range of elective
opportunities is now available: this year Dr. Illan
Fischler, a first-year psychiatry resident, selected an
elective focusing on community-based mental health
care across the life span.
Medical students regularly choose Surrey Place
Centre for their community research project
requirement in their second year. This year faculty
from Surrey Place and the dd camh were delighted
to have the opportunity to provide a seminar on
intellectual disabilities to the rotating third-year
medical undergraduates during their 6 weeks
psychiatry training at the Centre for Addiction
and Mental Health. Feedback from the students
consistently indicated that the highlight of these
seminars is the participation of our “Coffee Shed”
partners. The latter are self-advocates/consumers
who provide a refreshment and snack service at
Surrey Place Centre; these partners have been equally
delighted at the opportunity to participate in the
education of students who might someday be their
doctor. A 2 -week elective experience involving two
new community partners (New Visions Toronto and
L’Arche/Daybreak) is also available.
This year staff from the multidisciplinary
community teams at spc worked with Shelly Ungrin,
a fourth-year clerk, to create an elective based on her
85
Developmental Pediatric and Neurology fellows
from the hsc frequently spend time with the developmental pediatricians and neurologists providing
consulting services at spc, and this year we were
delighted to offer a short elective in mental health
disorders in children with intellectual disabilities to
Dr. Kawamura, a fellow in developmental pediatrics.
This year Dr. Bradley was invited to join the
International Editorial Board of Learning about
Intellectual Disabilities and Health, www
.intellectualdisability.info, a site that provides learning
resources for medical students and health-care
professionals.
Community Consultation and Service
Planning
Genetics Teaching
Drs. Berg, Bradley, and Lunsky continue to participate
in the yearly lecture series on intellectual disabilities in
the University of Toronto School of Graduate Studies,
Master of Science Program in Genetic Counselling
organized at spc by Marika Korossy.
Dr. Bradley has continued her participation in the
Dual Diagnosis Implementation Committee Toronto
and several of its subcommittees. Through these
committees recommendations about the needs of
persons with intellectual disabilities living in Toronto
are made to the appropriate ministerial planning
forums.
During the year Dr. Bradley has provided clinical
consultation to staff in the Dual Diagnosis Program
at the Centre for Addiction and Mental Health for
patients with a dual diagnosis; she has met regularly
with staff from the dd camh in-patient services
and the Dual Diagnosis Resource Service (ddrs),
(
a
Toronto-wide community resource, to discuss clinical
and related issues; and she facilitated a seminar series
with staff at these sites on anxiety as it relates to
persons with intellectual disabilities.
Continuing Education
A Neurodevelopmental Psychiatry Special Interest
Group meets monthly and is open to any psychiatrist
or psychiatry trainee working with persons with
intellectual disability in Toronto. Core members
of this group represent the mix of professional
support available at Surrey Place. The current focus
is on the biopsychosocial aspects and treatments of
diagnostic entities encountered among individuals
with intellectual disability. These conditions are
reviewed from multidisciplinary, best clinical practice,
and life-span perspectives. This year these meetings
covered fragile X syndrome and anxiety disorder in
individuals with intellectual disabilities. In addition
to staff from the multidisciplinary teams at spc, staff
from the Dual Diagnosis programs at the Centre
for Addiction and Mental Health (Drs. Gofine,
Homatidis, Sanhueza-Luco, and Lunsky) and Whitby
Mental Health Centre (Drs. Tran and Jowhar and Ms.
Blicharz) were regular participants at these meetings.
Monthly Clinical Sit-Down Rounds involving
psychiatry, psychology, and pediatrics provide a
further opportunity to better understand issues that
emerge at various times in life and how to assess and
treat complex medical and psychiatric disorders. Both
of these continuing education activities are accredited
by the Royal College of Physicians and Surgeons of
Canada for approved Continuing Medical Education
mocomp (Maintenance of Competence) credits.
Staff in the centre have contributed to two major
texts on intellectual disabilities: Dual Diagnosis: An
Introduction to the Mental Health Needs of Persons with
Developmental Disabilities, 2002 (available at www
.dualdiagnosisontario.org) and Developmental Disabilities
in Ontario, 2003, second edition (available at http://
oadd.icomm.ca/publications/ddinont/book/htm).
Research
Staff have participated in two cross-Canada initiatives
(in autism and health-care equity for persons with
intellectual disabilities) that were subsequently funded
by the Canadian Institute of Health Research. Dr.
Lunsky completed a first-stage report of a survey of
persons with dual diagnosis in the Ontario hospitals.
Details of these and other activates are available at
www.psychiatry.ca/sites/surrey.cfm
Elspeth A. Bradley, mbbs, frcpc
Psychiatrist-in-Chief, Surrey Place Centre
86
UHN Department
of
Psychiatry
Psychiatry at University Health Network
is located across the three sites of Canada’s largest health sciences centre:
Toronto General Hospital, Toronto Western Hospital, and Princess Margaret Hospital.
P
sychiatry at University Health Network (uhn)
is located across the three sites of Canada’s
largest health sciences centre: Toronto General
Hospital (tgh), Toronto Western Hospital (twh),
and Princess Margaret Hospital (pmh). The mission
of “Achieving Global Impact at uhn” is closely aligned
with the Department of Psychiatry’s “Extending Our
Reach” mission.
Seven academic programs are spread across the
three sites. Neuropsychiatry and some of General and
Community Psychiatry and Addictions as well as part
of Medical/Surgical Psychiatry, are located at twh.
Programs in Eating Disorders, Geriatric Psychiatry,
Women’s Mental Health, and In-patient General
Psychiatry, in addition to other aspects of General
Psychiatry and Medical/Surgical Psychiatry, operate
at tgh, while Psychosocial Oncology is based at pmh.
Each of the seven programs participates in the many
aspects of medical student and residency teaching, has
externally funded research activities, and provides
clinical care to a wide range of patients in hospitals
and the community.
Awards
Dr. Robert Buckingham received the 25-Year Service
Award from University Health Network and the
University of Toronto. Dr. Buckingham became
President-Elect of the Ontario Psychiatric Association.
Dr. Gerry Craigen successfully completed the Sixth
Certification Exam in Clinical Psychopharmacology of
the American Society of Clinical Psychopharmacology
Inc. on May 17,
17 2003. Dr. David Dixon was promoted
to Assistant Professor effective July 1, 2003. Dr.
Alastair Flint was appointed Section Editor of The
American Journal of Geriatric Psychiatry. Dr. Kenneth
Fung, Clinical Director of aim, spearheaded a working
group that oversaw the planning, training, operation,
and maintenance of the sars Support Line. Dr.
Raed Hawa obtained his American Boards in
Sleep Medicine. Dr. Brian Hodges was appointed
Director of the Centre for Research in Education at
the University Health Network, effective July 1, 2003.
Drs. Henry Moller and Alan Ong obtained their
American Boards in Sleep Medicine. Dr. Paul Sandor
was named Chairman of the Professional Advisory
Board of the Tourette Syndrome Foundation of
Canada in May 2003. Dr. José Silveira was the
recipient of an award for individual teaching excellence
for his outstanding work with the clinical staff of the
Portuguese and Mental Health Addictions program at
the Wightman Berris Teaching Awards. Dr. Jennifer
Saltzman-Beniah obtained her licence as a neuropsychologist. She recently received a research grant
from the Dean’s Fund at the University of Toronto for
an ffmri study of social communication. Dr. Robyn
Stephens obtained her licence as a neuropsychologist
and is cross-appointed to the ts Clinic at twh and
Youthdale Research Institute. Dr. Donna Stewart has
been chosen for the World Federation of Mental
Health’s 2003 Biennial Margaret Mead Memorial
Lectures and Award. Her lecture entitled Global
Initiatives to Improve Women’s Mental Health was given in
Melbourne, Australia. She has also been selected by
the American Psychiatric Association and Association
of Women Psychiatrists to receive the 2003 Alexandra
Symonds Award.
include Drs. Cathy Barr, Adam Blackman, Raed
Hawa, Leonid Kayumov, Alan Lowe, Paul Sandor,
Chanth Seyone, Jianhua Shen, and Colin Shapiro.
General Psychiatry / Community Mental
Health and Addictions (Dr. Robert
Buckingham)
Psychiatric Emergency Services are offered through
the Emergency Room, Emergency Psychiatric
Assessment Unit (epau), and Urgent Care Clinic (ucc)
at twh. This program also includes a 22 -bed inpatient program (including 8 acute-care beds) based at
tgh in addition to ambulatory and community mental
health programs based at the twh.
The Assertive Community Treatment team
(impact) and a Community Outpatient Mental
Health program provide shared care and outreach.
Cultural and language-specific services are offered
to the Portuguese, Hispanic, Italian, and Asian
communities. The addictions program consists of a
men’s and women’s withdrawal-management service,
an acupuncture program, and aftercare programs. In
response to bed closures within the General Psychiatry
In-patient Unit, several new community mental
health initiatives have been funded to enhance Asian
Mental Health, Concurrent Disorders, and Geriatric
Psychiatry.
Full-time academic staff in this program include
Drs. Robert Buckingham, Shelley Brook, Patricia
Cavanagh, Ken Fung, Dennis Kussin, Raed Hawa,
Diane Kljenak, Jodi Lofchy, Roger McIntyre, Sagar
Parikh, Anna Skorzewska, and José Silveira.
Neuropsychiatry (Dr. Colin Shapiro)
Neuropsychiatry is closely aligned with Neurology
and Neurosurgery at twh. The program is organized
into the following clinical units: Dr. Paul Sandor
leads the Tourette’s Syndrome / Neurodevelopmental
Disorders Clinic, Dr. Chanth Seyone heads the
Acquired Brain Injury Clinic, Dr. Adam Blackman
is the Head of Sleep and Alertness Clinic, and Dr.
Alan Lowe runs the Epilepsy Clinic. An additional
Sleep Laboratory provides research resources for this
program.
This program is focused on the interface between
neurological and psychiatric disease and on the
psychiatric presentations and consequences of
neurological disease. It provides ambulatory and
consulting services for patients with neuropsychiatric
problems and is part of the Neurosciences Program
at twh. Research in this program focuses on the
psychiatric aspects of movement disorders, Tourette’s
syndrome, Alzheimer’s disease, epilepsy, acquired
brain injury, and other neurological conditions. The
sleep program is affiliated with the multidisciplinary
U of T Centre for Sleep and Chronobiology.
Full-time academic staff in Neuropsychiatry
Eating Disorders (Dr. Allan Kaplan)
This program includes a consultation service, an
information centre, and a 10 -bed in-patient unit for
anorexia nervosa, directed by Dr. Blake Woodside,
and ambulatory services with a 12 -bed day hospital,
directed by Dr. Marion Olmsted. It is a provincial
resource for the treatment of eating disorders,
and along with the Hospital for Sick Children,
provides an outreach training program for healthcare professionals in the province. The program’s
recognition as an international research centre was
enhanced by the inauguration of the Loretta Ann
Rogers Chair in Eating Disorders. Research is focused
on relapse-prevention strategies for anorexia nervosa,
the genetics of eating disorders, the development and
evaluation of treatment approaches, prognostic factors
and high-risk groups, including young women with
88
settings
life stress. Research foci include psychiatric aspects
of cardiovascular disease, transplantation, cancer,
somatization disorders, and medical education.
Full-time staff includes Drs. Susan Abbey, Adam
Blackman, Esther Elliott, Raed Hawa, Brian Hodges,
Mark Katz, Rima Styra, and Valerie Voon.
Type 1 diabetes. Academic staff in the program include
Drs. Allan Kaplan, Blake Woodside, Marion Olmsted,
Jacqueline Carter, Traci MacFarlane, Lynda Molleken,
Randy Staab, Janet de Groot, and Gary Rodin.
Geriatric Psychiatry (Dr. Alastair Flint)
The Geriatric Psychiatry Program at uhn is a conjoint
program with the Toronto Rehabilitation Institute
(tri). There are three clinical research units: the
Mood Disorders Module includes seven in-patient
beds and an outpatient clinic, both located at the uhn;
the Dementia/Memory Module includes a 20 -bed
in-patient unit at the Toronto Rehabilitation Institute,
specializing in the behavioural and functional
rehabilitation of older people with dementia; a
memory clinic at uhn, and a satellite memory clinic
at Whitby Psychiatric Hospital. The memory clinic is
multidisciplinary, including specialists from psychiatry,
neurology, geriatric medicine, and social work. The
Psychiatric Disorders in the Elderly Medically Ill
involves collaboration with the geriatric medicine
service and consultation liaison services. Extended
community psychogeriatric services are planned.
Full-time academic staff include Drs. Alastair
Flint, Peter Cooper, and Rima Styra, and part-time
academic staff, Dr. Ron Keren.
Psychosocial Oncology & Palliative Care
(Dr. Gary Rodin)
This multidisciplinary program based at the Princess
Margaret Hospital is focused on the psychosocial and
psychiatric aspects of cancer. The program includes
staff in the disciplines of social work, psychiatry,
psychology, palliative care nursing, chaplaincy, and
occupational therapy. It provides outpatient and
consulting services at the Princess Margaret Hospital
to patients with cancer and their families. Research is
being conducted on such issues as quality of life, selfconcept, death and dying, cognitive effects of cancer
and its treatment, and psychotherapeutic interventions
in patients with cancer. The program continues to
offer award-winning Continuing Mental Health
programs.
Full-time academic staff in this program include
Drs. Alastair Cunningham, Mary Jane Esplen, Janet
de Groot, Gerald Devins, Mark Katz, Rima Styra,
Esther Elliott, and Gary Rodin.
The uhn Department of Psychiatry has continued
its educational exchange programs with the University
College Hospital in London, England, and with
Kyungpook National University and Wonkwang
University Hospital in Korea.
Scholarly activity has flourished at the uhn in the
past year. The academic staff have attracted over $7.1
million in research funding and have published 93 peerreviewed articles and eight book chapters. During the
past year at uhn, the department attracted 17 residents
and 10 fellows in Psychiatry.
Women’s Mental Health (Dr. Gail
Robinson)
This outpatient and consulting clinical research
program focuses on several aspects of women’s mental
health: sexual health, the psychiatric aspects of the
reproductive cycle, physical and sexual abuse, and
health issues associated with medical illness in women.
Emphasis on depression and reproductive biology will
be increased.
Full-time staff include Drs. Gail Robinson, Sophie
Grigoriadis, Karen Abrams, and Donna Stewart, who
is also the Lillian Love Chair of Women’s Health at
uhn.
Sidney H. Kennedy, md, frcpc
Psychiatrist-in-Chief, University Health Network
Psychiatry in the Medically and Surgically
Ill (Dr. Susan Abbey)
This program provides psychiatric and psychosocial
care at tgh and twh to medical and surgical
patients with comorbid psychiatric disorders through
consultation liaison and outpatient services. In the
past year, a successful pilot project on mindfulnessbased stress reduction (mbsr) was offered to
individuals with major medical illness and/or high
89
The George Hull Centre
f
for
Children & Families
Departmental Objectives
• To provide assessment, diagnosis, and consultation
to the comprehensive range of programs at
the George Hull Centre and to partner in
maintaining and developing excellent discipline
and multidisciplinary educational programs for
students and staff
• To integrate a range of child psychiatry teaching
with a wide experience of treatment modalities—
individual, family, and group—with systemic
collaborative mental health partnership experiences
• To support and participate in the development of
research productivity and aid its partnership with
the excellent clinical work of the centre
• To aid the centre in its continuation of excellence
by developing high-quality universal, target, and
clinical programs for primary, secondary, and
tertiary intervention
Drs. Betsy Bishop, M. Keesari, Lisa Sheinin, Ruth
Stirtzinger, and Bill Wehrspann offer assessment and
treatment, consultation, participation in program
development, and research evaluation in the services of:
• Prevention and Early Intervention Service for
families and children ages 0–5 years
• Residential treatment and day treatment, which
include two child-treatment in-patient units,
serving children, adolescents, and their families,
and classrooms in partnership with the Toronto
District School Board and the Toronto Catholic
District School Board
• Clear Directions, in partnership with Breakaway
Youth and Family Services and the Toronto District
School Board, which offers a comprehensive day
program for adolescents with substance abuse and
mental health problems
Within the context of the family, the clinic offers
family treatment, individual treatment, and play
therapy. A specialized diagnostic and assessment clinic
for children with disruptive behaviour disorders is
accompanied by cope Groups for parents and children.
Specific Areas of Teaching
Biologically and emotionally driven attention disorders with
behaviour results
Faculty: Drs. W. Werhspann and T. Portigal
Mental Health Collaborative Programs with target
populations for primary, secondary, and tertiary intervention
Faculty: Drs. R. Stirtzinger and L. Sheinin
Family and wider system interventions: family group
conferencing, family-therapy training programs,
residential treatment facilities
Faculty: Dr. M. Keesari and Ms. E. Ridgely
Psychiatry provided direct teaching to medical
settings
students and Psychiatry residents and shares in
multidisciplinary teaching.
Five psychiatric residents took a General Child
Psychiatry rotation and Career Track Child Psychiatry
Placements.
Forty medical students focused on diagnosis and
assessment of young children and issues of a shared
care/community mental health model of delivery of
service.
Interactive Interdisciplinary Seminars provided
an opportunity for student presentations and
multidisciplinary discussion of selected cases featuring
specific skills of each discipline. Increased knowledge
and information exchange between disciplines added
to clinical and research learning.
of Community, Family, and Children’s Services
to become the host centre for an Ontario Early
Years Centre. With the community’s support and
endorsement, the George Hull Centre was granted
the project. It will open during the fall of 2003. It
offers early learning and literacy activities, outreach
services, and parent training, to children aged 0–6 and
their families. It also tailors services to meet unique
community needs.
Toronto Family Group Conferencing Project
As the lead agency for the Toronto Family Group
Conferencing Project, the George Hull Centre
received a grant of $200,000 over 3 years from the
Ontario Trillium Foundation. The Family Group
Conferencing Project began as a pilot project in 1998
in partnership with Etobicoke Children’s Centre,
Children’s Aid Society of Toronto, and Catholic
Children’s Aid Society of Toronto and, more recently,
Native Child & Family Services of Toronto.
Treatment, Prevention, and Education
Prevention and Early Intervention Services continued
to partner with community agencies and parent
volunteers through the Etobicoke Brighter Futures
Coalition. Prevention and Early Intervention Services
offered multidisciplined assessment and treatment and
provided a wide range of therapeutic support groups.
The Community Clinic managed four-session
consultation services alongside ongoing child,
family, and group treatment. The mix of psychiatry,
psychology, and social work provided our clients
with a comprehensive view of the child’s and family’s
presentation. An expanded group program to meet
community needs was offered: Parenting Challenging
Children (cope
cope) Group, Kids Cope Group, Parenting
Adolescents Group, Temper Your Anger Group,
Father/Son Group, Talking Man to Man, and
Etobicoke Youth Centre Collaborative Group.
Highfield Community Enrichment Project
Queen’s University is conducting a longitudinal
research study on the Highfield Community
Enrichment Project, following the children for 25
years. It is the largest children’s research project ever
mounted in Canada and one of the largest projects
anywhere. In a short-term, 5-year study, the Highfield
site achieved the best results of all the sites in the
province.
Research
The Research Department at the George Hull Centre
is committed to supporting and informing the delivery
of mental health services to children, families, and the
community.
Program Innovations
Teacher Training and Partnership Program
CAFAS & BCFPI
The development of the Reframing Friendship resource
manual and video for teachers dealing with aggressive
and at-risk children was a partnership project between
the George Hull Centre for Children and Families
and the Toronto District School Board, supported
by a grant for the Change Foundation and is now online, accessible to educators and clinicians through the
George Hull website at www.georgehullcentre.on.ca
The centre has implemented both cafas and bcfpi
and has provided data to cafas in Ontario and
bcfpi to assist in regional planning. The centre is
also beginning to examine outcome data and will be
comparing information from both measures.
Client Satisfaction
The centre conducted centre-wide client-satisfaction
surveys semi-annually, as well as program-specific
satisfaction surveys (Parenting Challenging Children
Group, Clear Directions, Family Group Conferencing
Project).
Ontario Early Years Centre: Etobicoke Centre
Over the past year, the George Hull Centre
successfully worked with community partners to
prepare and submit a proposal to the Ministry
91
Funding Received
Source
Family Group Conference
Intensive Child & Family
Speech & Language
Brighter Futures
CAP-C
United Way
Trillium
Early Years Challenge
Fund (COMSOC)
Ontario Early Years
Trillium
MOH
Amount
$
$
$
67,500
62,597
903,281
$
$
$
79,000
110,000
60,000
$
$
68,000
500,000
Special Projects
The Research Department is currently working with
the Toronto Family Group Conferencing Project
and has proposed a research initiative to evaluate the
long-term effectiveness of family group conferencing.
The Research Department is also working with Dr.
Ruth Stirtzinger, exploring teachers’ and children’s
experiences of the Friendship Class project.
Ruth Stirtzinger, md, frcpc
George Hull Centre for Children & Families
92
administration
Administration
Office of the Chair
Dr. Donald A. Wasylenki
Ms. Kathy Ostaff
Ms. Eva Wong-Gladish
Ms. Irene Ly
Chair
Chair’s Assistant
Business Officer
HR & Finance Assistant
416-979-6949
416-979-6948
416-979-6893
416-979-4275
Programs and Planning
Dr. Paula Goering
Vice-Chair
416-979-6844
Research Program
Dr. Robert Zipursky
Ms. Cindy Faber
Vice-Chair
Administrative Assistant
416-979-6913
416-979-4276
Clinical Affairs
Dr. Peter Prendergast
Vice-Chair
905-430-4019
Education
Dr. Brian Hodges
Vice-Chair, Education
Head, Education Program
416-340-4451
416-979-6838
Post-Graduate Education
Dr. Allan Kaplan
Ms. Marie Mara
Ms. Victoria Costantino
Director
Administrative Coordinator
416-979-4734
416-979-6911
416-979-6995
Dr. Jodi Lofchy
Ms. Tina Martimianakis
Director
416-603-5500
416-979-6838
Continuing Mental Health Education
Dr. Sagar Parikh
Ms. Jean Street
Director
416-603-5734
416-979-6320
Ms. Tina Martimianakis
93

PDF - Department of Psychiatry

Transcription

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