December 2021

As I reflect on the past year and the accomplishments of the scientists, trainees and research staff at CAMH's Campbell Family Mental Health Research Institute, there are many successes to be proud of!From heart to mind, I'm confident that the year ahead will be full of exciting, ground-breaking discoveries that form the future of mental health care. Thank you for your support that has helped make 2021 a successful year. Happy holidays and best wishes for 2022!

Aristotle Voineskos
VP Research, CAMH
 

CAMH research reveals a link between cannabis use and psychosis

It has been long been known that cannabis users develop psychosis more often than non-users, but what is not fully clear is whether cannabis actually causes psychosis and, if so, who is most at risk. Researchers at CAMH have recently shown that while cannabis users had higher rates of psychotic experiences than non-users across the board, the difference was especially pronounced among those with high genetic predisposition to schizophrenia. 

Using data from a large-scale biomedical database containing participants’ in-depth genetic and health information, the researchers, led by Dr. Michael Wainberg, Scientist at the Krembil Centre for Neuroinformatics at CAMH, analyzed the relationship between genetics, cannabis use and psychotic experiences across more than 100,000 people.

Each person reported their frequency of past cannabis use, and whether they had ever had various types of psychotic experiences, such as auditory or visual hallucinations. The researchers also scored each person’s genetic risk for schizophrenia, by looking at which of their DNA mutations were more common among schizophrenia patients than among the general population.

These results are significant because they’re the first evidence we’ve seen that people genetically prone to psychosis might be disproportionately affected by cannabis. And because genetic risk scoring is still in its early days, the true influence of genetics on the cannabis-psychosis relationship may be even greater than what we found here.

Researchers found that people who used cannabis were more likely to have psychotic experiences, however, this increase was not uniform across the study group. Among the fifth of participants with the highest genetic risk scores for schizophrenia, it was 60 per cent, and among the fifth with the lowest scores, it was only 40 per cent. In other words, people genetically predisposed to schizophrenia were at disproportionately higher risk for psychotic experiences if they also had a history of cannabis use.

Notably, because much less is known about the genetics of schizophrenia in non-white populations, the study’s analysis was limited to self-reported white participants. This study, while limited in scope, is an important step forward in understanding how cannabis use and genetics may interact to influence psychosis risk. Researchers hope this research can lead to greater awareness of the connection between cannabis and psychosis and the potential risks of using this substance. This research offers a window into a future where genetics can help empower individuals to make more informed decisions about drug use.

This study is just one of many projects led by CAMH researchers who are exploring the unique risk factors for mental illness in young people. Since psychosis most often appears in people between the ages of 15 and 25, CAMH prioritizes the study of this age group to develop targeted ways to diagnose symptoms at the earliest stages. When psychosis is detected and treated early, young patients can potentially avoid a lifetime of disability and serious mental illness.

This research is part of the featured content within the powerful Today campaign 
which conveys the momentum that CAMH is creating to prevent suicide and invites people to accelerate it.  Visit the campaign website to see other featured content and to learn more.  
 

Virtual trans health care community of practice is building capacity across the province

With continued high rates of stigma, this trans-affirming space for clinicians to learn from each other has improved their confidence in supporting trans patients.

The COVID-19 pandemic has had a disproportionate impact on 2SLGBTQ+ people who continue to face higher rates of homelessness and worsening mental health.

According to survey findings of an ongoing study being led by Dr. Alex Abramovich, Independent Scientist with the Institute for Mental Health Policy Research at CAMH, 2SLGBTQ+ young people (14-29 years) are at risk of, and experiencing, homelessness in the Greater Toronto Area and surrounding areas, and approximately 36% of respondents had attempted suicide during the pandemic. 

For transgender people, the pandemic has also greatly reduced access to gender-affirming health care. According to the report, among transgender participants, 64% reported having to postpone or cancel transition-related medical appointments and 50% had to postpone or cancel a transition-related surgery or surgeries due to COVID-19. This has had detrimental impacts on the mental health of transgender people.

“Even prior to the pandemic, 2SLGBTQ+ people already experienced higher rates of depression, anxiety and suicidality. The impacts of the COVID pandemic have resulted in worsened mental health for far too many 2SLGBTQ+ individuals,” said Alex Abramovich, CAMH independent scientist and the lead author of this report published in The Public Library of Science (PLOS).

While the pandemic has worsened the negative impacts on this group of people who already face significant barriers, a lack of access to safe healthcare for transgender people was a serious challenge before the onset of the pandemic. According to a Trans PULSE Project, 21% of transgender people reported avoiding a visit to the emergency department because of previous stigma and discrimination they faced as a result of their gender identity.

Recognizing the gap in access to safe and affirming health care for transgender people, in 2018, CAMH, in partnership with Sherbourne Health and SickKids, launched a new initiative focused on trans and gender-diverse healthcare through ECHO Ontario Mental Health. 

“ECHO Ontario Mental Health is about increasing capacity across the health care system in Ontario so that people can get the care they need closer to home,” said Carey Lawford, Social Worker in the Adult Gender Identity Clinic.

Through virtual training and capacity building using multipoint video conferencing, this initiative has provided a trans-affirming space for health care providers from across the province to learn from one another about medical transition, with a focus on delivering trans and gender-diverse health care to their patients.   

In 2017, the Gender Identity Clinic was expanding virtual care to accommodate clients that were being referred from all over the province.  The clinic saw a large influx of referrals and questions from primary care providers across the province as a result of new policy changes that would enable them to refer clients to gender-affirming surgeries.  It quickly became apparent how beneficial ECHO could be in supporting primary care providers with this policy change. Through the efforts of the Gender Identity Clinic and funding from the Ministry of Health, this ECHO has been successful in achieving its intended goals. 

Since its launch in May 2018, ECHO Ontario Trans Gender and Diverse Healthcare (ECHO TGDH) has delivered 57 sessions to 270 providers from 192 organizations across Ontario.  Following their participation in the ECHO group, care providers reported an 80% increase in their perceived competence to deliver transgender and gender-diverse healthcare to their patients.

“This program has significantly increased our teams’ knowledge and ability to meet the needs of our gender diverse patients. We no longer have to send our patients 6+ hours out of town to get the health care they need.” –Participant Social Worker, ECHO Ontario Trans & Gender Diverse Healthcare.

The pandemic has had some positives when it comes to changes in the health care system for trans patients. Due to some primary care providers like family doctors having more downtime, registration doubled in the first Trans & Gender Diverse Health Care ECHO cohort after the start of the pandemic. 

“Clinicians not directly contributing to the fight against COVID-19 perhaps had more time and/or greater flexibility from home to pursue professional development,” said Lawford. “ECHO Ontario Mental Health creates this wonderful community of practice and decreases social isolation, which has impacted all of us. We meet weekly over Zoom and pool together our resources to find ways to support the trans patients who need care.”

While there is much work that still needs to be done to further increase healthcare capacity for transgender people, CAMH is encouraged to see the positive steps that this ECHO group has made towards increasing access to gender-affirming health care across the province.
 

CAMH simulation centre makes history

The CAMH Simulation Centre has just been granted official accreditation status by the Royal College of Physicians and Surgeons of Canada, making it the only hospital mental health simulation centre in the world to be so honoured.

“It’s a great achievement for CAMH,” says Stephanie Sliekers, Manager of Simulation and Digital Innovation. “Building a consistent standard and integrated competencies in mental and physical health assessment embodies CAMH’s vision that ‘mental health is health.’ Our simulation centre not only helps create a high standard of care for people with mental illness, but also a high standard of training and education for healthcare professionals who care for people with mental illness.”

Some of the key areas the simulation centre is currently focused on include suicide risk assessment, acute care psychiatry simulations and deteriorating patient scenarios, which are being used in virtual training exercises by Project ECHO Ontario Mental Health.

"These virtual simulations further develop knowledge and skills in mental health care that expand on our current ECHO Ontario Mental Health education experiences,” says VP education Dr. Sanjeev Sockalingam. “We are able to provide immersive learning experiences, hands-on skill development and accessible team-based training to more interprofessional primary care teams across the province to further support CAMH’s mental health capacity building efforts."

So how exactly do you do a mental health simulation?  For CAMH, it starts with creating psychological safety where health professionals can learn and reflect on clinical skills without risk to patients. It also involves co-producing with service user educators, who helped plan and design TIDES (Trauma-Informed De-escalation Education for Safety and Self-Protection).

One of those educators, George James, worked with TIDES and met with the Royal College accreditors to share his experience.

“It’s important to bring the patient’s and family’s voice to the table because we are the end users,” says James, who has received treatment for depression at CAMH. “When you get input from patients and family members, a fully integrated program can be developed. I believe the CAMH team saw the success of this approach with TIDES and appreciated the importance of having an integrated approach with teaching staff.  I definitely felt my voice was heard.”

For the actual mental health simulations, CAMH hires professional actors, who are trained as simulated patients, to portray real-world mental health scenarios developed by the clinical team and service user educators like James.

Because of the importance of providing as much uninterrupted mental health care as possible for patients at CAMH without the need to send them to another hospital for physical health emergencies, the simulation centre also provides extensive physical health simulation scenarios, including surprise medical emergency simulations and a physical health assessment program that has been offered to all nurses at CAMH. Just over 1,000 clinicians received training at the Simulation Centre in 2020/21, with much of being done virtually due to COVID-19 protocols.

“Simulation centres are well-established in other health care specialties, but there aren’t many examples of a simulation centre in a mental health hospital,” adds Sliekers. “When people ask me what we do in our centre, I think of Dr. Ivan Silver (Former CAMH VP Education), who said the only limit to the kind of simulations we can do is our imagination.”
 

Buzz-worthy News

• New study by Dr. Sean Kidd & Dr. Nick Kerman found that 4 out of 5 people who work in homeless services, supportive housing & harm reduction are experiencing burnout & declining mental health. Of these, 1 in 5 do not have access to paid sick leave.
  https://twitter.com/CAMHResearch/status/1465688762323816448
• Congratulations to Dr. Alison Crawford who has been awarded a Fullbright Canada Research Chair in Public Health at John Hopkins University for 2021-22. She will be a visiting scholar at John Hopkins Bloomberg School of Public Health studying approaches to public mental health, with a focus on suicide prevention.
  https://twitter.com/CAMHResearch/status/1466422789376774153
• While we all want to put the pandemic behind us, vaccine hesitancy has made this challenging. A CAMH research study published in PLOS ONE (an international, peer-reviewed journal) and led by Dr. Philip Gerretsen examines factors and strategies to help address this issue.
  https://twitter.com/CAMHnews/status/1464338403319758858
• As part of the Great American Smokeout in November 2021 (annual intervention event hosted by the American Cancer Society), Expertscape has recognized
  CAMH's Dr. Rachel Tyndale as a World Expert in Smoking. 
  https://twitter.com/Daily_Experts/status/1461318291905994760