By Sandeep Dhaliwal
When University of Toronto medical student Jennie Pouget volunteered at a local hospital’s emergency department, she noticed a patient who would regularly return for treatment of her Chronic Obstructive Pulmonary Disease (COPD). “She was really frustrated, and seemed anxious. However, the hospital staff focused only on her COPD symptoms,” says Pouget, who saw that potential mental health issues went unacknowledged.
This observation is at the heart of the recently established Medical Psychiatry Alliance (MPA), an unprecedented partnership between the Centre for Addiction and Mental Health, The Hospital for Sick Children, Trillium Health Partners and U of T. It provides a link between physical symptoms and possible associated mental health conditions. At least 1.3 million people in Ontario experience physical symptoms linked to an underlying mental health concern.
As Pouget discovered, health care professionals in a busy hospital emergency room can often focus on the physical symptoms, while missing an underlying mental health concern. To address this, MPA is creating an entirely new approach to teaching medical students and health professionals to ensure clinicians recognize underlying mental health concerns.
“Up until recently, medicine has been siloed. Specialists have not worked in an integrated care model. We talk about mental health stigma in the general public, but the truth is, there is also mental health stigma among health care professionals, and this partly stems from a lack of comfort associated with caring for patients who have combined physical and mental health issues,” says U of T Psychiatry Professor Sanjeev Sockalingam, MPA Director for Curriculum Renewal. “The MPA is hoping to drive this paradigm shift.” Sockalingam is transforming curriculum in U of T’s Undergraduate Medical Education program and is the Director of Continuing Practice and Professional Development at U of T.
As a medical student, Pouget understands how the lack of integration between different areas of the medical school curriculum can cause long-term problems. ““I’m now seeing peers who are starting their residency, and who have chosen to specialize in psychiatry, constantly bombarded with the challenge of integrating physical and mental health care for their patients. This isn’t something they got to spend a lot of time learning about in medical school,” she says. “That is why the efforts of the MPA are going to be so important.”
New programs are now launching at U of T’s medical school that will provide students with a more integrated approach to patient care. “In years three and four of medical school, students will now follow patients throughout their care from start to finish,” says Sockalingam. “In partnership with MPA, this could impact how students integrate medical and psychiatry training. For example, if a patient with mental illness also has diabetes, the student would follow their patient through their care with both a psychiatrist and an endocrinologist. The result is a student who now feels comfortable to treat patients across multiple disciplines.”
In the old curriculum model, medical students would complete their assigned clerkships in blocks of rotation. This meant students didn’t have the opportunity to build significant relationships with patients or their care teams, before they were shifted to another area of health specialty. MPA aims to train at least 40 medical students in medical psychiatry through integrated clerkships by the year 2017.
In addition to medical education reform, MPA is also developing new education and training models in medical psychiatry, including a new simulation centre launching at CAMH in late 2015. It will be the first in Canada devoted to education and training in mental health, and will offer unique medical psychiatry training to health professionals.
MPA will also offer a medical psychiatry certificate, in collaboration with Trillium Health Partners and U of T, to equip current health professionals already working in their respective fields. It will provide the skills and resources needed to better treat patients suffering with both mental and physical illnesses.
“Our goal is to train and prepare future leaders across all health professions, so that they are better equipped to treat patients with both mental and physical illnesses,” says Dr. Benoit Mulsant, the Executive Director of the MPA. “This will be the foundation of a new model of care that will provide Ontarians better access to quality medical and mental health services.”
This year’s MPA annual conference will bring together health care professionals across the continuum of care to focus on transforming current health education for medical students and continuing professional development models for health care professionals. For more information about the 2015 Medical Psychiatry Alliance Annual Conference in Toronto on October 29-30, 2015 or to register, visit http://www.cpd.utoronto.ca/mpa-register. MPA was established in January 2014 through a $60-million grant from the provincial government, a generous donor and all four inaugural partners.