Over 20 per cent of children with physical health conditions are also living with mental health difficulties at the same time, such as delirium, mood disorders, psychotic disorders, anxiety disorders and others.
Delivering the level of care these children require is extremely challenging, and if not done properly, perpetuates a cycle of fragmented communication, untimely delays, medical errors, dissatisfied patients and families, unnecessary time lost from school and work, poor health outcomes, and inefficient and costly use of health resources.
Children with co-existing physical and mental health conditions are the highest users of provincial health care services, collectively accounting for almost one third of paediatric health care resources. The Medical Psychiatry Alliance (MPA) has enabled a collective effort at streamlining and integrating a complex dichotomous health system. By enhancing care, education and research capacity for these particular patients, the MPA is ultimately improving outcomes for children and families dealing with combined medical and mental health issues.
The Hospital for Sick Children (SickKids) is leading the Child and Youth arm of the MPA. MPA at SickKids has enabled the Paediatric Consultation-Liaison (CL) Psychiatry program to expand and help care for more patients living with both mental and physical health issues. MPA investment in educational resources has focused efforts on inter-professional education and coaching across various medical programs to enhance capacity among care clinicians, and to ensure timely access to appropriate care.
Within the mandate of the MPA, the Child and Youth program has the opportunity to study needs of children and adolescents with complex co-existing physical and mental health conditions in more depth and thus determine innovative ways of meeting those needs. As such, the MPA has launched 14 Demonstration Projects in collaboration with various medical programs across SickKids, Trillium Health Partners, and community partners. These demonstration projects address the unique challenges to patient care, health care quality improvement, knowledge exchange, and research.
Examples of these demonstration projects include:
- Somatization: system-wide strategy for patients with a tendency to express psychological stress in physical ways (Dr. Claire De Souza and Ms. Anu Chahauver)
- Family Therapy: comprehensively addressing complex needs of families (Ms. Anu Chahauver)
- Early Identification: developing care pathways for developmentally delayed patients (Dr. Barbara Muskat and Ms. Michelle Peralta)
- Personalized Care: pre-planning care for challenging behaviour patients (autistic) (Dr. Arlette Lefebvre and Ms. Michelle Peralta)
- PACT-CL Clinic: treating psychological suffering in palliative care patients (Dr. Pamela J. Mosher, Dr. Adam Rapoport and Dr. Kimberley Widger)
- Grief Support: education on grief support in medical schools and residency (Dr. Pamela J. Mosher and Dr. Sophie Soklaridis)
- Telepsychiatry: providing psychiatric support remotely via videoconferencing, across Ontario and beyond (Dr. Tony Pignatiello and Mr. David Willis)
- Mindfulness: interventions to modulate stress for children with chronic pain (Dr. Danielle Ruskin, Dr. Kathryn Walker, Dr. Jennifer Stinson, Dr. Peggy Marcon, Ms. Vikki Scaini and Dr. Sara Ahola Kohut)
- Mood and Metabolics: early identification of cardiovascular risk and depression (Dr. Catherine Birken, Dr. Kristin Cleverley, Dr. Daphne Korczak, Dr. Farid Mahmud, Dr. Brian McCrindle, Dr. Antonio Pignatiello)
- Martial Arts: fostering resilience and well-being for youth with diabetes (Ms. Trish McKeough, Dr. Ashley Morgan, Dr. Marjory Phillips and Dr. Ruth Slater)
- Brain Injury: optimizing mental health outcomes for patients with early brain injury (Dr. Tricia Williams)
- Obesity: an innovative day hospital approach to address obesity and mental health (Dr. Elizabeth Dettmer, Dr. Seena Grewal, Dr. Alene Toulany, Dr. Andrea Regina, Dr. Cathleen Steinegger, Elizabeth Lathrop, Dr. Claire DeSouza, Dr. Jill Hamilton)
- Mental Health: providing enhanced treatment for youth with co-existing physical and complex mental health conditions (Dr. Seena Grewal)
- Depression: identifying and treating depression in adolescents living with diabetes (Dr. Ian Zenlea and Ms. Deepy Sur)
It is anticipated that the creation and dissemination of new and existing knowledge will result in development of novel, client-centred, holistic, collaborative, evidence-based approaches to addressing the specific needs of this complex population.
The initial year of planning processes has now set the stage for the following years of design, implementation, evaluation, and translation of findings, towards improved outcomes and quality of life for children and youth with co-existing physical and mental health issues, and their families and communities.
Dr. Tony Pignatiello is the MPA Director of Child and Youth Health and Family Services, and Associate Psychiatrist-in-Chief at The Hospital for Sick Children.