A CAMH-led collaboration will introduce a new model of care to improve treatment for adolescents and young adults who experience psychosis. The large-scale, community-based research project, announced today, is supported by a $1.5-million grant from the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) initiative, with matching funds from CAMH’s Provincial System Support Program, Project ECHO Ontario Mental Health and the CAMH Foundation.
“Our goal is to improve care and outcomes for young people with psychosis in the communities of Ontario,” says Dr. Aristotle Voineskos, Director of the Slaight Family Centre for Youth in Transition at CAMH, and one of the team leaders. While early psychosis intervention programs have been widely introduced in Ontario, ongoing work shows “there are challenges in consistently providing all aspects of evidence-based care, particularly those elements of care focused on recovery,” says Dr. Janet Durbin, Scientist with the Provincial System Support Program at CAMH and another team leader.
Psychosis can be a symptom of several mental illnesses, including schizophrenia and bipolar disorder, and tends to occur for first time between ages of 14 and 35. “We know that, for many people, a first episode of psychosis is one of the most frightening and disabling experiences they and their families can have,” says Sarah Bromley, Manager of the Slaight Centre Outpatient Services and another team leader.
To address these challenges in delivering care, a collaborative team, co-led by patients, family members, researchers and clinicians, will implement a coordinated, multidisciplinary type of care called NAVIGATE. The U.S.-developed model is effective in helping young people with early psychosis significantly improve their day-to-day functioning. “NAVIGATE standardizes the approach to care, giving frontline clinicians the opportunity to follow evidence-based guidelines in a consistent manner,” says Dr. George Foussias, Associate Chief of CAMH’s Schizophrenia Division and another team leader. CAMH’s Slaight Centre is the first to adopt this approach in Canada, beginning in November 2017.
NAVIGATE provides comprehensive care to patients and their families, including medication to reduce symptoms, a family education program, resiliency training to help patients identify and develop strengths, and counselling to help young people pursue their education and employment goals.
Lillian Duda, a family member and project partner, sees the benefits of expanding this model. Her son, now 20, experienced psychosis in his late teen years before being diagnosed with bipolar disorder. “We have had two experiences with hospitalizations, and they were really stressful and hard for my son and for us as his parents. The services in the outpatient program at the Slaight Centre have been so helpful. We started to feel we are on a better path.”
To expand the reach of NAVIGATE in Ontario, five early psychosis programs, responsible for covering 45 per cent of Ontario’s geographic area, will partner in its implementation, supported by CAMH’s Provincial System Support Program with help from Alexia Jaouich and colleagues, and Project ECHO Ontario Mental Health, a CAMH-University of Toronto collaboration, led by Drs. Sanjeev Sockalingam and Allison Crawford, which will provide real-time video-conferencing for ongoing support and training. All sites are part of the Early Psychosis Intervention Ontario Network (EPION), which would allow for rapid uptake across additional Ontario sites if the project expands in future.
Young people with lived experience and family members contributed in developing the project proposal, and will be equal partners in guiding the work locally at each site and in contributing to the project overall through an advisory committee, ensuring that care services are aligned with the needs and interests of patients and their families.
Members of the Ontario SPOR Support Unit are also key partners in the study, as well as Ontario’s Ministry of Health and Long-Term Care. The study is designed to inform policy regarding mental health services in the province.
Over the four-year project, researchers will evaluate the effectiveness of NAVIGATE compared to standard early psychosis care in terms of improving recovery and functioning in young people with psychosis. Led by Dr. Paul Kurdyak, the researchers will also look at health-systems measures including affordability and ease of use in different health care settings. (Dr. Kurdyak, also a team leader, is the Director of Health Outcomes and Performance Evaluation in CAMH’s Institute for Mental Health Policy Research and Lead of the Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Sciences.)
Ms. Duda believes comprehensive, integrated care is key. “Mental health is so hard to understand. It’s not a broken arm where you patch it up, and you’re back out there,” she says. “It’s about bringing together different disciplines and perspectives to help see a path forward – bringing together the social worker, the case worker, the psychiatrist, the employment counselor, and not just depending on meds. That collaborative effort really appeals to me because it builds a stronger base for the individual and a stronger community response to care.