September 2023 I hope you had a restful and relaxing summer. CAMH is ready for the new academic year and for furthering our reach in brain science, clinical research and policy research, both nationally and globally. We look forward to sharing research developments with you in brainbuzz™, a monthly e-newsletter that keeps the CAMH Research Committee members connected and informed between our meetings. If you have any questions or feedback, please reach out at any time. Aristotle Voineskos 
Improving access to mental health supports for pregnant women and new mothers
SUMMIT study led by CAMH womenmind™ scientist is the largest talk therapy clinical trial ever conducted for perinatal women In 2018, Dr. Singla became the youngest recipient of a $13-million-USD award to conduct a five-year clinical trial known as SUMMIT (Scaling Up Maternal Mental Healthcare by Increasing Access to Treatment) funded by the Patient-Centered Outcomes Research Institute in the United States. The study is implemented at three sites across Toronto (led by Drs. Singla, Simone Vigod, and Cindy-Lee Dennis), as well as Chapel Hill (led by Dr. Samantha Meltzer-Brody) and Chicago (led by Dr. Richard Silver) in the U.S. Talk therapies are amongst the most effective interventions in medicine but remain inaccessible to many. Around the world, as few as one in five women can access effective treatment for anxiety and depression during pregnancy and postpartum due to a dearth of available specialists, and high costs, transportation and childcare. When women don’t receive treatment for these conditions, the ripple effects can be devastating for them, their children, their partners and their communities. The broad ambition of the SUMMIT trial is to see if talk therapy delivered by treatment providers with no previous training in mental health—for example nurses, midwives and doulas—is as effective as talk therapy delivered by mental health specialists, and if telemedicine is as effective as in-person treatment. In SUMMIT, everyone receives eight sessions of Behavioural Activation (BA) therapy, an approach that focuses on helping individuals increase their engagement in positive and fulfilling activities to improve their mood and overall wellbeing. “We chose BA because it is effective and easy to teach to non-mental health providers,” adds Singla. This historic trial has already recruited more than 1,100 perinatal women and is run by a diverse, interdisciplinary team of 120 investigators, advisors, research staff and stakeholders across North America. The study results are expected to be released early in 2024. “We are not currently optimizing the human resources in our healthcare system,” says Dr. Singla. “If we can show that non-specialists are as effective as specialists to deliver effective treatments, the implications go beyond perinatal mental health to revolutionize how mental healthcare is delivered across Canada. It means that we could offer a stepped care model with reduced wait times and patient-centered care. It would allow us to broaden access to effective treatments by relying beyond a small cadre of specialized treatment providers.” A sub-study within SUMMIT trial looked at the impact of BA through what the researchers describe as a “culturally-sensitive lens”. This study was recently published in the Journal of Consulting and Clinical Psychology. “Historically, all perinatal women are underserved when it comes to mental health,” says Dr. Singla. “However, BIPOC women face even greater barriers to mental health care due to systemic factors. SUMMIT is unique because almost 50 per cent of recruited patients self-identify as BIPOC. Equally important, we have found that most participants report being highly satisfied with their treatment, irrespective of their race or ethnicity.” For Tracy Robert, participation in the SUMMIT trial as a non-specialist provider has enabled her to connect with patients more deeply than through her work as a nurse alone, and has led her to want to devote the rest of her career to mental health. “I’ve loved nursing but I think [SUMMIT] has been my greatest work,” says Robert. “I was able to spend more time with patients than I typically do in a nursing role.” 
For Dr. Singla, her drive to improve access to mental health treatments was instilled early on by her parents’ experiences of immigration to Canada and further fostered by her work abroad. “In some ways, my parents are the greatest psychologists I’ve known,” she says. “Their resolve and resiliency in overcoming adversity reminds me that solutions are always available. In collaboration with organizations globally, I’m reminded of their attributes and the privilege to do this important work.” 
A call to improve mental health support to reduce the risks of self-harm and suicide in autistic individualsAutistic females (assigned sex at birth) have an 83 per cent increased risk of self-harm leading to emergency healthcare relative to non-autistic people, according to a new study from ICES and the Centre for Addiction and Mental Health (CAMH). Autistic males also had a 47 per cent greater risk of self-harm events and had the highest incidence of suicide death compared to autistic females and non-autistic individuals. The study, Self-Harm Events and Suicide Deaths Among Autistic Individuals in Ontario, Canada, was published today in JAMA Network Open and is the first in Canada to explore suicide rates and self-harm events in autistic versus non-autistic individuals factoring sex, sociodemographic and clinical risk factors. “The presence of psychiatric illnesses substantially accounts for these increased risks,” says lead author Dr. Meng-Chuan Lai, staff psychiatrist and senior scientist at CAMH. “We know that many self-harm and suicide-related events could be prevented when people have access to tailored mental health supports and services, and this is crucial for autistic people.” The study included cohorts of 379,630 and 334,690 individuals in Ontario, Canada to understand the incidence of self-harm events and suicide death, respectively. Autistic and non-autistic individuals were followed for self-harm events that resulted in emergency care (from 2005 to 2020) and death by suicide (from 1993 to 2018).
“In my twenties, I accessed the emergency room a
number of times seeking help for suicidal thoughts and ideations. During that time, I struggled with accessing mental health counselling and support in my city that didn’t have at least a six-month-long waiting list or were affordable, and I waited a over a year to access a psychiatrist,” says Megan Pilatzke, an advocate and autistic woman. 
”Autistic people are continually forced to mask and hide who we are to accommodate a world that generally does not accept our traits,” says Megan. “I want people to understand that autistic people are struggling because our needs are just not being met throughout society.” “Our healthcare system should take a two-pronged approach to support autistic people,” says Lai: “Enhancing access to mental health services, and autism-informed accommodations for those services. For example, we can support autistic individuals who come into the healthcare settings by offering calming spaces, providing maximal predictability possible, understanding their communication styles and preferences, meeting their sensory needs, and supporting them if they wish to come accompanied by a person they trust.” The CAMH Azrieli Adult Neurodevelopmental Centre offers resources and tools aimed at individuals, their families, and clinicians to support the mental health of autistic people. One limitation of the study is that the number of autistic individuals may be underestimated, because individuals who had yet to receive a formal diagnosis, or whose diagnosis
was made by private practice psychologists may not have been included. Autistic people could have been miscategorized in the non-autistic group, which would have underestimated suicide-related outcomes in the autistic group. Finally, many self-harm events are not captured by health records, as individuals may not visit the emergency department for health care in these situations. 
Brock University & Shkaabe Makwa co-hosts event on Indigeneity, neurodevelopmental disabilities and mental healthEarlier this month, the 2023 Gathering on Indigeneity, Neurodevelopmental Disabilities and Mental Health in Ontario brought Indigenous community members, including those with lived experience of neurodevelopmental disabilities and mental health concerns, together with researchers and clinicians to share knowledge and form connections. The two-day event was funded by a Canadian Institutes of Health Research (CIHR) Planning and Dissemination Grant awarded to Associate Professor of Applied Disability Studies Kendra Thomson and principle knowledge user Louis Busch of Shkaabe Makwa at CAMH, who co-organized the event with the support of research assistants Melanie Burgess and Sarah Bernier and Brock’s Knowledge Mobilization Officer, Jayne Morrish. Busch, a Community Support Specialist, says maintaining a community focus and relying on community members to lead conversations throughout the event’s panels, presentations and circles helped “strengthen relationships and establish a new network of collaborators.” “This gathering is just the beginning, we hope, of something that will lead to tangible action in the near future,” says Busch. “Indigenous communities have been subjected to research for the sake of research for many years, and I think what we heard loud and clear was that this needs to lead to something of substance that will positively impact families and individuals living with neurodevelopmental differences.” Burgess, a master’s student studying self-compassion and mental health through the lens of sport psychology, says that hearing from both community members and scholars was a meaningful experience. “I learned a lot about neurodevelopmental disabilities and especially how Indigenous culture looks at them — that they are common in Indigenous culture but it’s not talked about, so it’s great that this gathering addressed a topic that isn’t really discussed,” she says. “Everyone got a chance to contribute their knowledge, but a lot of it was listening and learning from everyone else.” Bernier (MA ’22) agrees that listening and learning was a key factor, especially around topics that are important to her everyday work as a research analyst at CAMH’s Azrieli Adult Neurodevelopmental Centre. “In current policies regarding personal health information, privacy in the way that data is collected and shared is really important, but we heard from people with lived experiences and cultural experts about how their data was and continues to be misused by government agencies or white, colonial researchers,” she says. “I deal with a lot of data, so that’s something that I really want to help with. It opened my eyes to an issue that I didn’t know existed, one that people need to know about so we can do something about it.” Event participant JJ Thunder Man was gifted an eagle feather by Elder Ron Linklater for sharing his personal experiences with the gathering. “On the first day, I was shy,” he says. “And then I heard people talking, sharing their stories, so on the second day, I don’t get shy no more and I talked.” For Thomson, who has been working with Busch on the project since 2019, it has been crucial to highlight an issue that can be burdened by stigma and has not received adequate attention in Ontario or Canada. “Centring the voices of people with lived experience within this particular intersection, those who are Indigenous and labelled with neurodevelopmental disabilities, is the only way we can really do meaningful work,” she says. “We tried really hard to engage people with lived experience, but that’s a continuous process and we can always do better at that. I think what can come out of this is learning how to do that better, or at least keeping that at the centre of what we’re doing.” Morrish agrees, noting that devoting two full days to the mutual sharing of expertise created a real opportunity for knowledge exchange leading to lasting impact. “Bringing together researchers and community members to move our knowledge and goals forward in a collaborative way offered a perfect melding of the content experts — the researchers and others with research-based knowledge — with the context experts — those who live in the community and have lived experience,” she says. “Community and those with lived experience bring critical knowledge regarding why research matters, how it matters, for whom it matters and how it can be best implemented, and that’s when you can really create and design impactful research.” The organizers are grateful to the following for additional funding and partnership:
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