Imagine that you’re a nurse or a physician on-call in the Emergency Department, when a 15-year-old is brought in after a suicide attempt. Once her physical symptoms have been treated, you find that the teenager is not cooperating -- she refuses to answer questions, is feisty, even hostile. Her attitude may frustrate you, and while you’ve been able to provide appropriate care for her physical injuries, you’re less comfortable about her mental well-being.
How do you communicate with this patient, diagnose her conditions accurately, and then provide the best possible treatment and support?
Surprisingly, you aren’t alone with this discomfort. Many healthcare providers are trained to focus on either physical or mental illness, and don’t feel confident about providing advice to patients living with both. In Ontario, 1.3 million people suffer from combined physical and mental health illnesses.
It’s a pressing concern, but new innovations may provide a way forward. The Simulation Centre at the Centre for Addiction and Mental Health (CAMH) recently piloted courses that are specially designed to provide health care professionals, trainees and medical residents the opportunity to learn new integrated approaches in mental and physical care for patients with complex needs. CAMH’s Simulation Centre, which is supported by the Medical Psychiatry Alliance, provides a safe learning environment for students, trainees, and health professionals to explore their clinical practice and test new approaches to better-integrated care.
What does mental health-based simulation look like?
While simulation training has been well-established in physical health specialties such as surgery and anesthesiology, the new Simulation Centre at CAMH is the first of its kind in Canada to focus primarily on mental healthcare. The centre takes advantage of mannequins that can simulate breathing and pulse rates of actual humans, combined with actors who play the role of patients and families, to provide a safe environment for clinicians to learn about the complexities of care.
The patient scenario described above was one of many live simulations held during the pilot run of a course focusing on mental and physical health issues within children and youth. A professional actor trained in education portrayed the role of the teen patient. Healthcare providers from a variety of Toronto Academic Health Sciences Network organizations ranging from nurses, pediatricians, psychologists, adolescent medicine specialists and family doctors participated in the simulations. The participants had opportunities to reflect on how to manage issues in interdisciplinary teams, such as assessment and treatment, as well as how to enhance communication and leadership to achieve better health outcomes for their patients and families.
“The complexity of physical and mental health challenges in this scenario felt very real,” says Dr. Brooke Halpert, a Clinical and Health Psychologist with the KidFit Health and Wellness Clinic at Trillium Health Partners. “It was helpful to participate in this workshop because it shows how interdisciplinary healthcare providers have to work together and combine their expertise and resources. For example, sometimes situations arise where you aren’t comfortable taking the lead, and you have to know who to bring in and where your resources are, so that the patient’s needs are met in the best way possible.”
In the simulated scenario outlined above, a physician on-call in the Emergency Department collected information from the 15-year-old patient gently and effectively. When new facts eventually emerged, such as the patient’s emotional disclosure of abuse in a foster care home, the physician brought in a psychiatrist to assist the patient and to ensure the patient’s mental and physical safety needs were being adequately addressed. As the patient’s admission came to light, the learners in the next room, who were watching the simulation unfold in real-time on a TV screen, were visibly shaken.
First-ever mental healthcare training in Canada of its kind
"The purpose of these innovative mental health simulations is to equip our healthcare providers with the training necessary for increasing their level of comfort and expertise in caring for patients with complex needs,” says Latika Nirula, Director of Simulation and Teaching Excellence, CAMH. “With the generous help of our collaborators from the Maudsley Simulation Centre in the U.K., we are excited to be able to bring this type of learning to Canada. The Maudsley has experienced success within their healthcare system through this type of simulation training and we hope to do the same here.”
Trainers from Maudsley Simulation were on-hand at the Simulation Centre to test-drive their simulation courses in a Canadian health system. The two days of courses followed patient populations across the lifespan, exploring mental and physical health conditions requiring integrated, timely care. These courses will then be refined based on feedback from the pilot participants, and will be offered more widely to clinicians starting this fall.
For more information about CAMH’s Simulation Centre, please contact: firstname.lastname@example.org.