Program Program Program

CanadianCanadian Consensus Consensus Development Development Conference Conference on on SURVEILLANCE & SCREENING FOR AROs SURVEILLANCE & SCREENINGThe Westin Hotel, Edmonton, FOR Alberta, AROs Canada (Antimicrobial-Resistant(Antimicrobial-Resistant Organisms) Organisms)

JuneJune 18 18 - 20,- 20, 2014 2014 TheThe Hyatt Hyatt Regency, Regency, Calgary, Calgary, Alberta Alberta

Jury Members Expert Speakers Jury Members Expert Speakers Jury Chair – Tom Marrie Liz Bryce Yves Longtin Andrew Simor Jury ChairJury – TomMembers Marrie Liz Bryce Expert SpeakersYves Longtin Andrew Simor Bill JuryAlbritton Members Barry Cookson AllisonExpert McGeer Speakers Jim Talbot Bill Albritton Barry Cookson Allison McGeer Jim Talbot Helen Branswell Julian Davies Scott McEwen Henri Verbrugh HelenJury BranswellJury Members Chair – Alain LesageJulian Davies Carol AdairScott ExpertMcEwen SpeakersOrrin LysengHenri Verbrugh AndreJury Corriveau Chair - Alain Lesage Serge Desnoyers KimCarol Neudorf Adair OrrinBob Weinstein Lyseng Andre CorriveauKathy Aitchison Serge Desnoyers Tim Aubry Kim Neudorf Austin BobMardon Weinstein Barb Kathy Farlow Aitchison Michael Edmond LindsayTim Nicolle Aubry Austin Mardon Barb FarlowJuryRupert Chair Arcand - Alain LesageMichael Edmond Thomas BeckerLindsayCarol Nicolle Adair Oliver MasonOrrin Lyseng DavidRupert Heymann Arcand Dan Gregson HowardThomas Njoo Becker David KathyHeymannAndré Aitchison Delorme Dan Gregson Dan CohenHowardTim Njoo Aubry DavidOliver McDaidAustin Mason Mardon Steven Lewis Anthony Harris David Patrick StevenAndréRupert Lewis DavidDelorme Arcand Goldbloom Anthony Harris Giovanni deDavid DanGirolamoThomas CohenPatrick Becker ScottDavid Patten Mcdaid Pat Piaskowski Susan Huang Eli Perencevich Oliver Mason PatDavid Piaskowski Goldbloom Susan Huang EliGiovanni Perencevich de Girolamo Scott Patten Jennifer AndréRodgersKaj KorvelaDelorme John Jernigan Philippa A.Trish Garety PerlDan Cohen ThomasDavid Raedler Mcdaid JenniferKaj Korvela Rodgers John Jernigan TrishPhilippa Perl A Garety Thomas Raedler John SpikaDavidGloria Goldbloom Laird Joel Kettner Linda GaskPilar Ramon-PardoGiovanni de GirolamoLuis Salvador-CarullaScott Patten JohnGloria Spika Laird Joel Kettner PilarLinda Ramon-Pardo Gask Luis Salvador-Carulla Howard KajWaldnerGlenda Korvela MacQueen Mark Loeb Elliot Goldner Philippa A GaretyHoward ThomasSapers Raedler HowardGlenda FayWaldner MacQueen Orr Mark Loeb Heinz KatschnigElliot Goldner JitenderHoward Sareen Sapers SponsoredGloria by Laird Organized by Linda Gask Luis Salvador-Carulla SponsoredFay GlendaOrrJohn by J.MacQueen McSorley SarahOrganized Lapsley byHeinzElliot Katschnig Goldner Hon.Jitender RichardHoward Sareen D. SchneiderSapers Sponsored by Organized by JohnFay J.Tom McSorley Orr Shand Eric LatimerSarahHeinz Lapsley Katschnig GerritThe van JitenderHonourable der Leer Sareen Justice TomJohn ShandMichel J. McSorley Simard Antonio LoraEricSarah Latimer Lapsley RichardRichard WarnerThe HonourableD. Schneider Justice MichelTomSharon Simard Shand Sutherland Steve Lurie AntonioEric LatimerLora GerritRichard van der D. LeerSchneider SharonMichelHelen-Maria Sutherland Simard Vasiliadis SteveAntonio Lurie Lora RichardGerrit Warner van der Leer Sharon Sutherland Steve Lurie Richard Warner i OVERVIEW OF THE CONFERENCE

The Canadian Consensus Development Conference on Improving Mental Health Transitions, is a three-day conference being held in Edmonton, Alberta, from November 4 to 6, 2014. This conference is a juried hearing of evidence and scientific findings. It allows for the engagement and collaboration of experts, policy makers in government and the health system, and stakeholders in addressing key questions around community based care for adults with severe, persistent mental illness. On the final day of the conference,Improving an expert jury Mental chaired by Health Dr Alain Lesage,Transitions Department of Psychiatry, University of Montreal, will release a Consensus Statement summarising the evidence and making recommendations for policy and practice in Canada and other countries The transition of services for those with severe mental illness from institutions to the community: are the mentally ill The Consensusbeing Development well served? Conference model is an exciting format created in the US by the National Institutes of Health (NIH) to increase the dissemination and impact of findings from research. The Institute of Health Economics

(IHE) in AlbertaThe adapted last 50 years this have successful seen the substantial model for elimination the Canadian of mental hospitals, setting with and care has provided held insix the consensus community and conferences to date: Self-Monitoringin general in hospital Diabetes; settings Healthy in most Western Mothers-Healthy countries. While thisBabies: has also How been to a periodPrevent of rapid Low pharmacological Birth Weight; Depression developments, the question remains of how best to serve both the patients and society in this rapidly changing system. in Adults; FASD Across the Lifespan; Legal Issues of FASD; and Surveillance and Screening for AROs (Antimicrobial- Resistant Organisms).The reduction Consensus in the number Statements of psychiatric and beds, other with a documents, decreasing length along of stay with associated videotape with some of expansionthe proceedings, can be of community services, has corresponded with growth in homelessness and incarceration with no improvement in viewed on the IHEoutcomes website: for people with schizophrenia, which has changed little with modern management. Despite the fact that mental illnesses account for up to 40% of disability in developed countries, in Canada only 5% of the health budget is http://www.ihe.ca/research/lnowledge-transfer-initiatives/--consensus-development-conference-program/spent on mental health.

This deinstitutionalization (or as some refer to it, trans-institutionalization) has been a mixed blessing. Most people appreciate the additional freedom of being able to live in the community, but the anticipated improvement in outcomes is not being achieved. Increasing numbers of the mentally ill are to be found in the prisons and the homeless population. The recent evidence that the lives of those with schizophrenia, even when treated, are bleak, suggests that a review of the way in which we do things is in order.

This conference is a three-day juried hearing of evidence and scientific findings. It allows for the engagement and collaboration of experts, policy makers in government and the health system, and stakeholders in addressing key questions around communityACCREDITATION based care for adults with severe, persistent mental illness.

MAINTENANCE OF CERTIFICATION Attendance at this program entitles certified Canadian College of Health Leaders members (CHE / Fellow) to 7.75 Category II credits toward their maintenance of certification requirement.

This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada, and approved by the University of Calgary Office of Continuing Medical Education and Professional Development. Participants can claim up to a maximum of 13.5 study credits.

2 Consensus Development Conference on Improving Mental Health Transitions SCIENTIFIC CHAIR Scientific Chair

Roger C. C. Bland, Bland, CM, C.M., MB, MB, ChB, ChB, FRCPC, FRCPC, FRCPsych FRCPsych Roger Bland is Professor Emeritus in the Department of Psychiatry at the University of Alberta and Rodger Bland is Professor Emeritus in the Department of Psychiatry at the University of Albertawas Chair and from was 1990 Chair to from2000. 1990 He completed to 2000. Hemedical completed training medical at Liverpool training University at Liverpool in England Universityfollowed by in internships England followed and then by five internships years in generaland then practice five yearin sEngland in general and inpractice northern in Manitoba Englandbefore joining and in the northern psychiatry Manitoba residency before program joining at the psychiatryUniversity ofresidency Alberta. programHis research at the interests Universityhave included of Alberta. psychiatric His epidemiology,research interests the long-term have included outcome psychiatric of mental epidemiology, disorders, familial the long-termdistribution outcome of disorders, of mental suicidal disorders, behaviors familial and primary distribution care ofmental disorders, health. suicidal He has behaviorsheld a number andof administrative primary care positionsmental health. in mental He hashealth held with a numberthe Government of administrative of Alberta, positions including in Assistantmental healthDeputy with Minister the Government for Mental Health of Alberta, and Medical including Director Assistant with Deputy the Alberta Minister Mental for Mental Health Board. HealthClinically and he Medical has worked Director in rehabilitation with the Alberta psychiatry, Mental general Health hospitalBoard. Clinicallypsychiatry, he community has worked clinics, inprimary rehabilitation care psychiatry, psychiatry, crisis general services hospital and diversion psychiatry, programs. community He has clinics, received primary a number care of awards including: the Michael Smithpsychiatry, Award from crisis the Schizophreniaservices and diversion Society of programs. Canada; the He Alberta has received Medical a Association number of awardsMedal for Distinguished Service, the Canadianincluding: Academy the Michael of Psychiatric Smith Award Epidemiology from the Schizophreniaand Canadian PsychiatricSociety of Associations’Canada; the AlbertaAlex Leighton Award in Epidemiology; andMedical the Research Association Award ofMedal the Canadian for Distinguished Association Service, for Suicide the Canadian Prevention. Academy In 2012 of the Psychiatric Governor EpidemiologyGeneral appointed and Canadianhim a member Psychiatric of the Order Associations’ of Canada. Alex Leighton Award in Epidemiology; and the Research Award of the Canadian Association for Suicide Prevention. In 2012 the Governor General appointed him a member of the Order of Canada.Improving Mental Health Transitions - an overview

The lastlast 5050 yearsyears have seen seen the the substantial substantial elimination elimination of ofmental mental hospitals hospitals with with care care provided provided in the in thecommunity community and andin general inhospital general settings hospital in mostsettings Western in most countries. Western While countries. this has While also thisbeen has a period also been of rapid a period pharmacological of rapid pharmacological developments, the developments,question remains the of question whether patientsremains are of whetherbetter served patients in this are system better (orserved non-system) in this system of community (or non-system) care. of community care.To provide some background, we looked at the number of beds available for the mentally ill in Canada over recent times, at reports regarding the growth of homelessness, the increase of the mentally ill in the prison system and the outcome for people To provide some background, we looked at the number of beds available for the mentally ill in Canada over recent times, with severe persistent mental illness. at reports regarding the growth of homelessness, the increase of the mentally ill in the prison system and the outcome for peopleWe found with that severe Canada persistent has had mentala massive illness. reduction in the number of psychiatric beds per thousand population with a decrease in the length of stay. There has been considerable expansion of community services, but also a growth in homelessness and Weincarceration found that in Canada prisons. has Unfortunately had a massive there reduction has been noin the corresponding number of psychiatricimprovement beds in outcomeper thousand for people population with schizophrenia, with afor decrease which the in outcomethe length has of changed stay. There little has with been modern considerable management. expansion Despite of the community fact that mental services, illnesses but also account a growth for up in to 40% homelessnessof disability in developedand incarceration countries, in inprisons. Canada Unfortunately only 5% the health there budgethas been is spent no corresponding on mental health. improvement in outcome for people with schizophrenia, for which the outcome has changed little with modern management. Despite the fact that mentalWe conclude illnesses therefore account that for deinstitutionalization up to 40% of disability has inbeen developed a mixed countries,blessing. Most in Canada people appreciateonly 5% the the health additional budget freedom is spent of onbeing mental able tohealth. live in the community, but the anticipated improvement in outcomes is not being achieved. The recent evidence shows that the lives of many of those with schizophrenia, even when treated, are bleak, suggests that a review of the way in which Wewe doconclude things is therefore in order. thatOur deinstitutionalizationhome Canadian province has ofbeen Alberta a mixed can serveblessing. as a goodMost example:people appreciate oil-revenue the fed additional comprehensive freedomhealth-care of beingsystem, able relatively to live advancedin the community, ideas, and but inexpensive the anticipated (for the improvement patient) treatment, in outcomes and an isincome not being support achieved. system The to recentensure, evidence at least, a thatminimum the lives level of ofmany food of and those housing. with schizophrenia, Nonetheless, our even long when term treated,follow up are data, bleak, drawn suggests from residents that a review of Alberta ofshows the waythat, in once which diagnosed, we do things over half is in of order. the people Our home with schizophreniaCanadian province can expect of Alberta a life characterizedcan serve as bya goodmoderate example: to severe oil- revenuesymptoms fed and comprehensive disability. health-care system, relatively advanced ideas, and inexpensive (for the patient) treatment, and an income support system to ensure, at least, a minimum level of food and housing. Nonetheless, our long term followThis upConsensus data, drawn Development from residents Conference of Alberta brings shows together that, a substantial once diagnosed, number over of speakers half of thefrom people a wide with variety schizophrenia of countries canwho expect have experience a life characterized of both the by problems moderate and to potential severe symptomssolutions to and the disability.problems being experienced both by those with severe persistent mental illness and the systems that are intended to help them. It is hoped that their collective wisdom of the speakers, Thisthe insights Consensus of the Development jury and the audience Conference questions brings can together lead to a clear substantial directions number about ofthe speakers best path from to follow a wide and variety that this of will help countriesguide policymakers, who have administrators,experience of both clinicians the problems and last butand not potential least, consumers solutions toand the family problems members being in experienced ensuring the bothbest servicesby thoseand programs with severe with persistent the available mental funding. illness and the systems that are intended to help them. It is hoped that their collective wisdom of the speakers, the insights of the jury and the audience questions can lead to clear directions about the best path to follow and that this will help guide policymakers, administrators, clinicians and last but not least, consumers and family members in ensuring the best services and programs with the available funding.

Consensus Development Conference on Improving Mental Health Transitions 3 The Jury JURY CHAIR

AlainChair - Alain Lesage, MD Lesage, MD, FRCPC, MPhil, DFAPA Alain Lesage is currently a professor in the Department of Psychiatry at the University of Montréal. HeFRCP is a scientist (C), focusing MPhil, much of his DFAPA work around mental health and addiction services. He is alsoAlain the Medical Lesage Director is ofcurrently the Mental Health a professor Technology and in Interventions the Department Assessment Unit of at Psychiatry at the University of Montréal. the Institut universitaire en santé mentale de Montréal, and the Associate Director of the Québec ResearchHe is Networka scientist on suicide, focusing mood disorders much and associated of his disorders.work around He was formerly mental the health and addiction services. He is also Editor-in-Chiefthe medical of Santé director mentale auof Québec, the Mental and was the Health past President Technology of the Canadian and Academy Interventions of Assessment Unit at the Institut Psychiatric Epidemiology. Dr. Lesage graduated in medicine from the University of Sherbrooke and completeduniversitaire his postdoctoral en santé training atmentale the Institute deof Psychiatry Montréal, and Maudsley and Hospitalthe Associate in London, Director of the Québec Research England;Network and the on Istituto suicide, di psichiatria mood in Verona, disorders Italy. He was and an invited associated scholar at the disorders. Harvard He was formerly the Editor-in-Chief School of Public Health in 2005 and has recently been invited to join the executive board of the European Network of Mental Healthof Santé Service mentaleEvaluation (ENMESH). au Québec, He continues and to trainwas the the next generationpast President of mental health of the Canadian Academy of Psychiatric and addiction researchers in Epidemiology.collaboration with Quebec, Lesage Canadian graduated and international in colleagues. medicine He is an from active memberthe University on the of Sherbrooke and completed his Mentalpostdoctoral Health Commission training of Canada at theAdvisory Institute Council. of Psychiatry and Maudsley Hospital in London, England; and the Istituto di psichiatria in Verona, Italy. He was an invited scholar at the Harvard School of Public Health in 2005 and has recently been invited to join the executive board of the European Network of Mental Health Service Evaluation (ENMESH). He continues to train the next generation of mental health and addiction researchers in collaboration with Quebec, Canadian and international colleagues. He is an active member on the Mental Health Commission of Canada Advisory Council.

Katherine Aitchison BA(Hons), BM BCh, FRCPsych, PhD. Alberta Centennial Addiction & Mental Health Research Chair CONFERENCEProfessor, Departments QUESTIONS of Psychiatry and Medical Genetics, University of Alberta Dr. Aitchison serves as an Alberta Centennial Addiction & Mental Health Research Chair. She is Professor of Psychiatry and an Adjunct Professor of Medical Genetics at the University of Alberta, An Overview – Improvingand Mental a Consulting Health Transitions Psychiatrist with the Edmonton Early Psychosis Intervention Clinic. She obtained 1: What is severe and persistenther mental BA and illness BM (SPMI) BCh and (MDit’s social equivalent) and economic consequences?from the University of Oxford, psychiatry specialist training from 2:the What Maudsley is the effectiveness Hospital, of current and interventions PhD (Wellcome for adults with Trust severe, funded) persistent inmental pharmacogenetics illness? from King’s College London. The latter 3:included What is the a evidence Travelling for the roleFellowship of other support to thesystems, National including Institutes primary care inof effective Health interventions? and the University of Colorado (USA). Her Chair program of work is in Mental Illness and Addictions, with a secondary focus on Suicide Prevention: translational medicine, 4: What are the effective systems for supporting people with SPMI? in order to lead change and support evidence-based practice, resulting in health care innovations. Her publication areas 5: What information tools are required for high quality system management? include human genetics, pharmacogenetics, psychopharmacology, and mental health outcomes. She coauthored a 6: What further research is needed? book entitled “First Episode Psychosis” that has been used worldwide and translated into Korean; a updated handbook intended for a wide range of readers including carers is in progress. Dr Aitchison served on the Faculty of King’s College London from 2001-2011, and joined the Faculty of the University of Alberta in September 2011. She co-led a multicentre international pharmacogenetic study (GENDEP), a Workpackage on establishing biological sampling methods for children and adolescents for the STOP grant (http://www.stop-study.com/), and serves on Committees including the Canadian Scientific Advisory Committee on Substance Abuse, the Alberta Psychiatric Association Executive Committee, and previously served on the AHE Health Quality Council of Alberta Initiative Steering Committee.

Rupert Arcand Rupert Arcand is Cree and comes from the Alexander First Nation in Central Alberta. Rupert is a 4 pioneer in the Consensusarea of Development Native men’s Conference issues on Improving and Mental is currently Health Transitions the Executive Director of the Yellowhead Tribal Council Justice Society. Rupert has worked extensively in communities across Canada and the United States, in both Native and Non-native environments. In the last number of years his work has been in the area of restorative justice. Rupert has considerable experience working in the healing field, specializing in areas of Adult Children of Alcoholics, Community Development, Life Skills, and Relationship Building.

Dr André Delorme Dr André Delorme is a psychiatrist and Fellow of the Royal College of Physicians and Surgeons of Canada. He is National Director of Mental Health for the Ministry of Health and Social services of Quebec. He was previously Head of the psychiatry department at the Montreal University Health Center and medical director of the Granby Hospital. He still works as a clinician in a PACT team which offers treatment and rehabilitation to schizophrenic and bipolar patients. Dr Delorme produced the Quebec Mental Health Plan of Action in 2005. This plan followed and built on a major overhaul of the public health network by the provincial government introducing a new organization of primary care PROGRAM

Day 1: Tuesday, November 4, 2014

7:00 a.m. – 8:00 a.m. Continental Breakfast and Registration

8:00 a.m. – 8:30 a.m. Opening Remarks: Roger Bland Chair, Scientific Committee

Greetings from: Honourable Stephen Mandel Minister of Health

Greetings from: Councillor Scott McKeen City of Edmonton

Opening Prayer from Elder

8:30 a.m. – 8:45 a.m. Improving mental health transitions; an overview Roger Bland, CM, MB, ChB, FRCPC, FRCPsych Professor Emeritus, Department of Psychiatry, University of Alberta

8:45 a.m. – 9:50 a.m. Question 1: What is severe and persistent mental illness (SPMI) and it’s social and economic consequences?

What is the magnitude of the problem? Scott Patten, MD, FRCPC, PhD Professor, University of Calgary, AB

Living with mental illness; a personal perspective. Austin Mardon, PhD, CM, LLD(Hon.) Assistant Adjunct Professor, John Dossetor Health Ethics Centre University of Alberta, Edmonton, AB

Question Time

9:50 a.m. – 10:10 a.m. Break

10:10 a.m. – 11:40 a.m. Question 1 (continued)

Social impacts of mental illness on individuals and families Sara Lapsley, BA, MA Peer Researcher with the Collaborative Research Team to Study Psychosocial Issues in Bipolar Disorder (CREST.BD)

Consensus Development Conference on Improving Mental Health Transitions 5 PROGRAM

What are the connections between mental illness and homelessness? Tim Aubry, PhD, MA, BA Chairholder, Faculty of Social Sciences Research Chair in Community Mental Health and Homelessness; Professor, School of Psychology and Senior Researcher, Centre for Research on Educational and Community Services, University of Ottawa, Ontario

Implications of mental illness for corrections Howard Sapers Correctional Investigator of Canada, Office of the Correctional Investigator, Ottawa, Ontario

Panel Question Time

11:40 a.m. – 12:40 p.m. Lunch

12:40 p.m. – 2:40 p.m. Question 2: What is the effectiveness of current interventions for adults with SPMI?

Outcomes of long term medications Thomas Raedler, MD Associate Professor, University of Calgary, Alberta

How effective are psychosocial interventions? Thomas Becker, Dr. Med Professor, Medical Director and Chairman, Department of Psychiatry II Ulm University, Germany

How effective are psychological therapies? Philippa Garety, MA, MPhil, MA(Ed), PhD, FBPsS Professor of Clinical Psychology, Clinical Director, Psychosis Clinical Academic Group (CAG), South London and Maudsley NHS Foundation Trust, United Kingdom

The role of Assertive Community Treatment Gerrit van der Leer Director, Mental Health and Addictions, Ministry of Health Services, British Columbia

Community Crisis care in England and Wales: evidence and implementation Oliver Mason, DPhil, DClinPsy Senior Lecturer, University College London Clinical, Education and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences United Kingdom

6 Consensus Development Conference on Improving Mental Health Transitions PROGRAM

Panel Question Time

2:40 p.m. – 3:00 p.m. Break

3:00 p.m. – 5:00 p.m. Question 3: What is the evidence for the role of other support systems, including primary care in effective interventions?

What are the alternatives to hospital care for people with SPMI? Richard Warner, MD, DPM Director, Colorado Recovery; Professor of Psychiatry and Adjunct Professor of Anthropology, University of Colorado, Boulder, Colorado

Integrating Crisis and ACT teams Dan Cohen, MD, PhD Department Chronic Psychiatry, Mental Health Care Organisation North- Holland North, Heerhugowaard, The Netherlands

How can family physicians best support people with SPMI in the community? Linda Gask, MSc, PhD, FRCPsych, FRCGP Professor of Primary Care Psychiatry, National Primary Care Research and Development Centre (NPCRDC), University of Manchester, UK

How have mental health courts, diversion programs, and alternative sentencing been able to assist people with mental illness? Hon. Richard Schneider, BSc, MA, PhD, LLB, LLM, CPsych Justice of Ontario Court of Justice, Chair of Ontario Review Board; Adjunct Professor, University of Toronto, Ontario

What role do non-government organisations play in effective support systems? Orrin Lyseng Executive Director, Alberta Alliance for Mental Illness and Mental Health (AAMIMH), Edmonton, AB

Panel Question Time

5:00 p.m. Closing Remarks

5:00 p.m. – 6:00 p.m. Reception

Consensus Development Conference on Improving Mental Health Transitions 7 PROGRAM

Day 2: Wednesday, November 5, 2014

7:30 a.m. – 8:30 a.m. Continental Breakfast and Registration

8:30 a.m. – 10:30 a.m. Question 4: What are the effective systems for supporting people with severe and persistent mental illness?

Long-term mental health care: for whom, how and where? Giovanni de Girolamo, MD, PhD IRCCS Unit of Psychiatric Epidemiology and Education, Italy

What is the role of Federal Government in planning and funding mental health strategies? Steve Lurie, BA, MSW, MM Executive Director, Canadian Mental Health Association Toronto Branch, Ontario

How important is continuity of care and integration in the provision of effective support? Carol Adair, MSc, PhD Associate Professor, Departments of Psychiatry and Community Health Sciences, Faculty of Medicine, University of Calgary, Alberta

What are the effects of supported employment strategies for people with mental illness? Eric Latimer, PhD Research Scientist, Douglas Mental Health University Institute and Professor, Department of Psychiatry, McGill University, Quebec

Panel Question Time

10:30 a.m. – 11:00 a.m. Break

11:00 a.m. – 12:30 p.m. Question 5: What information tools are required for high quality system management?

Basic support decision tools for mental health system improvement Luis Salvador-Carulla, MD, PhD Professor of Disability and Mental Health, The University of Sydney, Australia

8 Consensus Development Conference on Improving Mental Health Transitions PROGRAM

The use of information systems for improving quality of care in severe mental illness Antonio Lora, MD Director, Department of Mental Health, Lecco, Italy Consultant, Department of Mental Health & Substance Abuse, World Health Organisation (WHO), Geneva

What are the most effective forms of knowledge transfer to improve quality of care? Elliot Goldner, MD, FRC(P), MHSc Professor, Centre for Applied Research for Mental Health and Addiction (CARMHA), Simon Fraser University, Vancouver, British Columbia

Question Time

12:30 p.m – 1:30 p.m. Lunch

1:30 p.m – 2:40 p.m. Question 5 (continued)

Financial incentives – the role of provider payment mechanisms in relation to the quality of mental health care Heinz Katschnig, MD Professor Emeritus of Psychiatry, Medical University of Vienna, and CEO, IMEHPS. research, Vienna, Austria

A road map for mental health research David McDaid, BSC, MSc, MSc Senior Research fellow, Health Policy and Health Economics, London School of Economics and Political Science, London, United Kingdom

Panel Question Time

2:40 p.m. – 3:00 p.m. Break

3:00 p.m. – 4:00 p.m. Question 6: What further research is needed?

Introduction and Chair Discussion Jitender Sareen, MD, FRCPC Professor of Psychiatry, Professor of Psychology & Community Health Sciences; Director of Research and Anxiety Services, University of Manitoba

Panel Discussion What are the priorities for research and spending in this field?

4:00 p.m. Closing remarks and summary of day’s proceedings

Consensus Development Conference on Improving Mental Health Transitions 9 PROGRAM

Day 3: Thursday, November 6, 2014

8:00 a.m. – 9:00 a.m. Continental Breakfast and Registration

9:00 a.m. – 9:30 a.m. Reading of the draft Consensus Statement Jury Chair: Alain Lesage, MD, FRCPC, MPhil, DFAPA

9:30 a.m. – 10.30 a.m. Open discussion

10:30 a.m. – 11:00 a.m. Break

11:00 a.m. – 11:15 a.m. Jury Chair Final Comments

11:15 a.m. – 11:30 a.m. Closing Remarks

Closing Prayer from Elder

11:30 a.m. End of the Conference

11:30 a.m. News conference/Media availability

10 Consensus Development Conference on Improving Mental Health Transitions The Jury

Chair - Alain Lesage, MD The JuryFRCP (C), MPhil, DFAPA Alain Lesage is currently a professor in the Department of Psychiatry at the University of Montréal. He is a scientist focusing much of his work around mental health and addiction services. He is also the medical director of the Mental Health Technology and Interventions Assessment Unit at the Institut universitaireChair - Alain Lesage, MD en santé mentale de Montréal, and the Associate Director of the Québec Research NetworkFRCP on (C), suicide, MPhil, mood DFAPA disorders and associated disorders. He was formerly the Editor-in-Chief ofAlain Santé Lesage mentale is au currently Québec, aand professor was the pastin the President Department of the ofCanadian Psychiatry Academy at the of University Psychiatric of Montréal. Epidemiology.THE Lesage JURY graduated in medicine from the University of Sherbrooke and completed his The Jury He is a scientist focusing much of his work around mental health and addiction services. He is also postdoctoral training at the Institute of Psychiatry and Maudsley Hospital in London, England; and the Istituto di psichiatria in Verona, Italy. He wasthe medicalan invited director scholar atof thethe Harvard Mental SchoolHealth of Technology Public Health and in 2005Interventions and has recently Assessment been invited Unit at to the Institut join the executive boarduniversitaire of the European en santé Network mentale of Mental de Montréal, Health Service and the Evaluation Associate (ENMESH). Director ofHe the continues Québec to trainResearch Chair – Alain Lesage, MD, FRCPC, MPhil, DFAPA the next generationChair - Alain Lesage, MD Networkof mental onhealth suicide, and addiction mood disorders researchers and in associatedcollaboration disorders. with Quebec, He Canadian was formerly and international the Editor-in-Chief Alain Lesage is currently a professor in the Department of Psychiatry at the University of Montréal. colleagues. He isHeFRCP an is aof scientistactive Santé (C), focusing member MPhil,mentale much of hison DFAPA work theau around Québec,Mental mental healthHealth and and addiction Commissionwas services.the past He is of PresidentCanada Advisory of the Council.Canadian Academy of Psychiatric alsoAlain the medical Lesage director is of currently the Mental Health a professor Technology and in Interventions the Department Assessment Unit of at Psychiatry at the University of Montréal. the InstitutEpidemiology. universitaire en santé Lesage mentale de Montréal, graduated and the Associate in medicineDirector of the Québec from the University of Sherbrooke and completed his postdoctoral trainingResearchHe is Network aat scientist the on suicide, Institute focusing mood disorders of much Psychiatry and associated of his disorders.work and around He Maudsley was formerly mental the Hospital health and in addictionLondon, services. England; He andis also the Istituto di psichiatria Editor-in-ChieftheKatherine medical of Santé director mentale Aitchison auof Québec, the Mental and BA(Hons), was the Health past President Technology ofBM the Canadian BCh, and Academy FRCPsych, Interventions of Assessment PhD. Unit at the Institut in Verona, Italy.Psychiatric He was Epidemiology. an invited Dr. Lesage scholargraduated in medicine at the from Harvard the University ofSchool Sherbrooke andof Public Health in 2005 and has recently been invited to completeduniversitaireAlberta his postdoctoral Centennial en santé training atmentale the InstituteAddiction deof Psychiatry Montréal, & and Mental Maudsley and Hospitalthe Health Associate in London, Research Director of Chair the Québec Research join the executiveEngland;Network board and the on Istitutoof suicide, the di psichiatria European mood in Verona, disorders Italy.Network He was and an invited ofassociated Mental scholar at the Healthdisorders. Harvard Service He was Evaluation formerly the (ENMESH).Editor-in-Chief He continues to train SchoolProfessor, of Public Health in Departments 2005 and has recently been ofinvited Psychiatry to join the executive and board of Medicalthe Genetics, University of Alberta theEuropean next Network generation of Mental HealthofDr. Santé Service Aitchisonof mental mentaleEvaluation serves (ENMESH).health au Québec, as He and continuesan Albertaaddictionand to trainwas theCentennial the next researchers generationpast President ofAddiction mental healthin of collaboration &the Mental Canadian Health Academywith Research Quebec, of Psychiatric Chair. Canadian She is and international colleagues.and addiction researchers He in Epidemiology.collaborationis an active with Quebec, Lesagemember Canadian graduated and on international the Mentalin colleagues. medicine He Health is an from active memberCommissionthe University on the ofof Sherbrooke Canada Advisory and completed Council. his Mental Health Commission of CanadaProfessor Advisory Council. of Psychiatry and an Adjunct Professor of Medical Genetics at the University of Alberta, postdoctoral trainingand at the a Consulting Institute of PsychiatristPsychiatry and with Maudsley the Edmonton Hospital Early in London, Psychosis England; Intervention and the IstitutoClinic. di She psichiatria obtained in Verona, Italy. HeKatherine washer BAan Aitchison, invitedand BM scholar BA(Hons),BCh (MD at theBM, equivalent) Harvard BCh, FRCPsych, School from PhD theof Public University Health of in Oxford, 2005 and psychiatry has recently specialist been invitedtraining to from jointhe Maudsleythe executive Hospital, AlbertaboardKatherine Centennial ofand the PhD AddictionEuropean (Wellcome Aitchison and Mental Network Health Trust ofResearch BA(Hons),funded)Mental Chair Health in pharmacogenetics Service BM BCh, Evaluation FRCPsych, from (ENMESH). King’s College He PhD. continues London. to Thetrain latter Professor, Departments of Psychiatry and Medical Genetics, University of Alberta theincluded next generation a Travelling ofAlberta mentalFellowship health Centennial to andthe Nationaladdiction Addiction Institutesresearchers of & Healthin Mentalcollaboration and theHealth withUniversity Quebec, Research of CanadianColorado Chair and(USA). international Her Chair colleagues. He is Dr.an Aitchison active serves member as an Alberta on Centennial the Mental Addiction Health & Mental Commission Health Research Chair. of She Canada is Advisory Council. program of work Professoris inProfessor, Mental of Psychiatry, Illness an Adjunct Departments and Professor Addictions, of Medical Genetics with of at thePsychiatrya Universitysecondary of Alberta, focus and on Medical Suicide Prevention: Genetics, translational University medicine, of Alberta in order to lead changea Consulting and Psychiatrist support with the evidence-basedEdmonton Early Psychosis Intervention practice, Clinic. resulting She obtained in her health care innovations. Her publication areas BA andDr. BM BChAitchison (MD equivalent) serves from the University as an of AlbertaOxford, psychiatry Centennial specialist training Addiction from & Mental Health Research Chair. She is include human genetics,theKatherine Maudsley Hospital,pharmacogenetics, Aitchisonand PhD (Wellcome TrustBA(Hons), psychopharmacology, funded) in pharmacogenetics BM BCh, from King’s FRCPsych,and College mental health PhD. outcomes. She coauthored a London.Professor The latter included of a PsychiatryTravelling Fellowship and to the Nationalan Adjunct Institutes of ProfessorHealth and the of Medical Genetics at the University of Alberta, book entitled “FirstAlberta Episode Centennial Psychosis” Addictionthat has been & Mental used worldwide Health Researchand translated Chair into Korean; a updated handbook Universityand of Colorado a Consulting (USA). Her Chair Psychiatrist program of work is in withMental Illnessthe andEdmonton Addictions, with Early Psychosis Intervention Clinic. She obtained intended for a widea Professor,secondary range focus of on readers SuicideDepartments Prevention: including translational of carers Psychiatrymedicine, is in inorder progress. to andlead change Medical andDr support Aitchison Genetics, served University on the Faculty of Alberta of King’s College evidence-based practice, resulting inher health BA care innovations. and BM Her publicationBCh (MD areas include equivalent) human genetics, from pharmacogenetics, the University of Oxford, psychiatry specialist training from psychopharmacology,London from and 2001-2011, mentalDr. health Aitchison outcomes. and joinedSheserves coauthored the as a anbookFaculty Alberta entitled of“First Centennialthe Episode University Psychosis” Addiction that of has Alberta been & used Mental in September Health Research 2011. She Chair. co-led She isa multicentre theworldwideinternational Maudsley and translated pharmacogenetic intoHospital, Korean;Professor an updated and of handbookPsychiatry PhDstudy intended (Wellcome(GENDEP), and for a widean rangeAdjunct Trusta of Workpackage readers Professorfunded) including carers inof on is Medicalpharmacogeneticsin establishingprogress. Genetics biological at the from University sampling King’s of methodsCollege Alberta, forLondon. children The latter Dr. Aitchison served on the Faculty of King’s College London from 2001-2011, and joined the Faculty of the University of Alberta includedinand September adolescents 2011. a SheTravelling co-led for anda multicentre the a FellowshipConsulting STOP international grant pharmacogenetic Psychiatrist to (http://www.stop-study.com/), the National study with (GENDEP), the Institutes Edmonton a Workpackage ofonEarly establishing andHealth Psychosis serves and on theIntervention Committees University Clinic. including of Colorado She obtainedthe Canadian (USA). Her Chair biological sampling methods forher children BA andand adolescents BM BCh for the (MDSTOP grantequivalent) (http://www.stop-study.com/), from the University and serves on of Oxford, psychiatry specialist training from programCommitteesScientific including ofAdvisory work the Canadian is Committee inScientific Mental Advisory onIllness Committee Substance andon Substance Addictions, Abuse, Abuse, the the Alberta Albertawith Psychiatric a secondary PsychiatricAssociation Associationfocus on SuicideExecutive Prevention: Committee, translational and medicine, inExecutivethepreviously order Maudsley Committee, to served lead andHospital, previously change on the servedand AHE onandPhD the AHEHealth support(Wellcome Health Quality evidence-based Trust Council Council offunded) Alberta ofInitiative in Alberta pharmacogenetics practice,Steering Initiative Committee. resulting Steering from in King’s Committee.health College care London.innovations. The latter Her publication areas includeincluded humana Travelling genetics, Fellowship pharmacogenetics, to the National Institutes psychopharmacology, of Health and the University and mental of Colorado health (USA). outcomes. Her Chair She coauthored a program of work isRupert in Mental Arcand Illness and Addictions, with a secondary focus on Suicide Prevention: translational medicine, book entitled “FirstRupertRupert ArcandEpisode is CreeArcand and Psychosis” comes from the Alexander that Firsthas Nation been in Central used Alberta. worldwide Rupert is a and translated into Korean; a updated handbook in order to lead changepioneer in and the area support of Native men’s evidence-based issues and is currently thepractice, Executive Director resulting of the Yellowheadin health care innovations. Her publication areas intendedinclude human for a genetics, wideTribalRupert Council range pharmacogenetics, Arcand Justice of Society. readers is HeCree has worked andincluding psychopharmacology, extensively comes in communitiescarersfrom the isacross Alexander in Canadaand progress. mentaland the First healthDr Nation Aitchison outcomes. in Central served She Alberta. coauthored on the Rupert Faculty a is a of King’s College Unitedpioneer States, in in both the Native area and Non-native of Native environments. men’s In issuesthe last number and of yearsis currently his work the Executive Director of the Yellowhead Londonbook entitled from “First 2001-2011,has Episode been in the area Psychosis” and of restorative joined justice. that the Rupert has Faculty has been considerable used of experience theworldwide University working andin the healingtranslated of Alberta into in Korean; September a updated 2011. handbook She co-led a multicentre internationalintended for a widepharmacogeneticfield,Tribal range specializing Council of readersin areas Justiceof Adultstudy including Children Society. (GENDEP), of carersAlcoholics, Rupert is Community in aprogress. hasWorkpackage Development, worked Dr AitchisonLife extensively Skills, on and establishingserved in communities on the Facultybiological across of King’s sampling Canada College and methods for children Relationship Building. andLondon adolescents from 2001-2011,the for United the and STOP joinedStates, grantthe in Facultyboth (http://www.stop-study.com/), Native of the and University Non-native of Alberta environments. in Septemberand serves In the2011. on last CommitteesShe number co-led ofa multicentreyears including his work the Canadian has been in the area of restorative justice. Rupert has considerable experience working in the healing Scientificinternational Advisorypharmacogenetic Committee study (GENDEP),on Substance a Workpackage Abuse, the on Alberta establishing Psychiatric biological Association sampling methods Executive for children Committee, and and adolescents forfield, the STOP specializing grant (http://www.stop-study.com/), in areas of Adult Children ofand Alcoholics, serves on CommunityCommittees Development,including the CanadianLife Skills, and previously served on the AHE Health Quality Council of Alberta Initiative Steering Committee. Scientific AdvisoryRelationship Committee onBuilding. Substance Abuse, the Alberta Psychiatric Association Executive Committee, and previously served on the AHE Health Quality Council of Alberta Initiative Steering Committee. DrRupert André Arcand Delorme RupertDrRupert André Arcand Arcand Delorme is is Cree a psychiatrist and comes and fromFellow the of Alexanderthe Royal College First Nation of Physicians in Central and SurgeonsAlberta. Rupertof is a Rupert Arcand is Cree and comes from the Alexander First Nation in Central Alberta. Rupert is a Canada.pioneer Hein theis National area of Director Native ofmen’s Mental issues Health and for theis currently Ministry of the Health Executive and Social Director services of the of Yellowhead Consensus Development Conferencepioneer on Improving in the Mentalarea Healthof Native Transitions men’s issues and is currently the11 Executive Director of the Yellowhead Quebec. He was previously Head of the psychiatry department at the Montreal University Health TribalTribal Council Council Justice Justice Society. Society. Rupert has Rupert worked has extensively worked extensivelyin communities in across communities Canada andacross Canada and Center and medical director of the Granby Hospital. He still works as a clinician in a PACT team which thethe United United States, States, in both in Native both andNative Non-native and Non-native environments. environments. In the last number In the of yearslast number his work of years his work hasoffershas been been treatment in the in area the and ofarea restorativerehabilitation of restorative justice. to schizophrenic Rupertjustice. has Rupert consid and bipolarerable has consid experiencepatients.erable Dr working Delorme experience in theproduced healing working the in the healing field,Quebecfield, specializing specializing Mental in Health areas in Planofareas Adult of ActionofChildren Adult in 2005.ofChildren Alcoholics, This ofplan Alcoholics,Community followed andDevelopment,Community built on a LifemajorDevelopment, Skills, overhaul and ofLife the Skills, and public health network by the provincial government introducing a new organization of primary care RelationshipRelationship Building. Building.

Dr André Delorme Dr AndréDr André Delorme Delorme is a psychiatrist and Fellow of the Royal College of Physicians and Surgeons of Canada.Dr André He is Delorme National Director is a psychiatrist of Mental Health and Fellowfor the Ministry of the Royalof Health College and Social of Physicians services of and Surgeons of Quebec.Canada. He was He previouslyis National Head Director of the psychiatryof Mental department Health for at the the MinistryMontreal Universityof Health Health and Social services of CenterQuebec. and medical He was director previously of the Granby Head Hospital.of the psychiatry He still works department as a clinician at inthe a PACT Montreal team Universitywhich Health offersCenter treatment and andmedical rehabilitation director to ofschizophrenic the Granby and Hospital. bipolar patients. He still Drworks Delorme as aproduced clinician the in a PACT team which Quebec Mental Health Plan of Action in 2005. This plan followed and built on a major overhaul of the publicoffers health treatment network byand the rehabilitation provincial government to schizophrenic introducing aand new bipolar organization patients. of primary Dr Delorme care produced the Quebec Mental Health Plan of Action in 2005. This plan followed and built on a major overhaul of the public health network by the provincial government introducing a new organization of primary care The Jury

Chair - Alain Lesage, MD FRCP (C), MPhil, DFAPA Alain Lesage is currently a professor in the Department of Psychiatry at the University of Montréal. He is a scientist focusing much of his work around mental health and addiction services. He is also the medical director of the Mental Health Technology and Interventions Assessment Unit at the Institut universitaire en santé mentale de Montréal, and the Associate Director of the Québec Research Network on suicide, mood disorders and associated disorders. He was formerly the Editor-in-Chief of Santé mentale au Québec, and was the past President of the Canadian Academy of Psychiatric Epidemiology. Lesage graduated in medicine from the University of Sherbrooke and completed his postdoctoral training at the Institute of Psychiatry and Maudsley Hospital in London, England; and the Istituto di psichiatria in Verona, Italy. He was an invited scholar at the Harvard School of Public Health in 2005 and has recently been invited to join the executive board of the European Network of Mental Health Service Evaluation (ENMESH). He continues to train the next generation of mental health and addiction researchers in collaboration with Quebec, Canadian and international colleagues. He is an active member on the Mental Health Commission of Canada Advisory Council.

Katherine Aitchison BA(Hons), BM BCh, FRCPsych, PhD. Alberta Centennial Addiction & Mental Health Research Chair Professor, Departments of Psychiatry and Medical Genetics, University of Alberta Dr. Aitchison serves as an Alberta Centennial Addiction & Mental Health Research Chair. She is Professor of Psychiatry and an Adjunct Professor of Medical Genetics at the University of Alberta, and a Consulting Psychiatrist with the Edmonton Early Psychosis Intervention Clinic. She obtained her BA and BM BCh (MD equivalent) from the University of Oxford, psychiatry specialist training from the Maudsley Hospital, and PhD (Wellcome Trust funded) in pharmacogenetics from King’s College London. The latter included a Travelling Fellowship to the National Institutes of Health and the University of Colorado (USA). Her Chair program of work is in Mental Illness and Addictions, with a secondary focus on Suicide Prevention: translational medicine, in order to lead change and support evidence-based practice, resulting in health care innovations. Her publication areas include human genetics, pharmacogenetics, psychopharmacology, and mental health outcomes. She coauthored a book entitled “First Episode Psychosis” that has been used worldwide and translated into Korean; a updated handbook intended for a wide range of readers including carers is in progress. Dr Aitchison served on the Faculty of King’s College London from 2001-2011, and joined the Faculty of the University of Alberta in September 2011. She co-led a multicentre international pharmacogenetic study (GENDEP), a Workpackage on establishing biological sampling methods for children and adolescents for the STOP grant (http://www.stop-study.com/), and serves on Committees including the Canadian Scientific Advisory Committee on Substance Abuse, the Alberta Psychiatric Association Executive Committee, and previously served on the AHE Health Quality Council of Alberta Initiative Steering Committee.

Rupert Arcand Rupert Arcand is Cree and comes from the Alexander First Nation in Central Alberta. Rupert is a pioneer in the area of Native men’s issues and is currently the Executive Director of the Yellowhead Tribal Council Justice Society. Rupert has worked extensively in communities across Canada and the United States, in both Native and Non-native environments. In the last number of years his work has been in theTHE area of JURY restorative justice. Rupert has considerable experience working in the healing field, specializing in areas of Adult Children of Alcoholics, Community Development, Life Skills, and The JuryRelationship Building.

Dr. André Delorme, MD, FRCPC The JuryDr.Dr André André Delorme is Delorme a psychiatrist and Fellow of the Royal College of Physicians and Surgeons of facilities across theCanada.Dr province. André He is National Delorme It alsoDirector promotesis of Mentala psychiatrist Health a formodel the Ministryand of Fellow careof Health shared andof Socialthe betweenRoyalservices of College family of doctors, Physicians mental and health Surgeons primary of care Quebec. He was previously Head of the psychiatry department at the Montreal University Health professionals andCenter secondaryCanada. and Medical He care Director is National mental of the Granby Directorhealth Hospital. specialists. Heof still Mental works as aHealthThis clinician new in for a PACT networkthe team Ministry should of Health have aand major Social impact services on mental of health promotion andwhichQuebec. offersservice treatment He delivery. was and rehabilitation previously to schizophrenic Head of and the bipolar psychiatry patients. Dr Delormedepartment at the Montreal University Health producedCenter the andQuebec medical Mental Health director Plan of Action of thein 2005. Granby This plan Hospital.followed and built He on still a major works as a clinician in a PACT team which facilities across theoverhaul province. of the public It healthalso network promotes by the provincial a model government of care introducing shared a new between organization family doctors, mental health primary care professionals and ofsecondaryDr.offers primary David caretreatment facilities care Goldbloom across mentaland the province.rehabilitation health ItDr. also specialists. promotesGoldbloom to schizophrenica model Thisofwas care shared newborn betweenand network in Montrealbipolar family should patients. and have raised Dr a Delormemajor in Quebec impact produced and on Novamental the Scotia. health promotion anddoctors,Quebec service mental Mental health delivery. primary Health care professionals Plan of and Action secondary in care 2005. mental Thishealth specialists.plan followed This and built on a major overhaul of the newHe network completed should have ana major honours impact on mentaldegree, health majoringpromotion and inservice Government, delivery. at Harvard University and then attended thepublic University health network of Oxford by asthe a provincial Rhodes Scholargovernment where introducing he obtained a new an M.A.organization in Physiological of primary Sciences. care He Dr.Dr.trained David David inGoldbloom, medicine Goldbloom OC, and MD, psychiatry Dr.FRCPC Goldbloom at McGill was University born in Montreal and is a andProfessor raised ofin PsychiatryQuebec and at Nova the University Scotia. Dr.Heof Goldbloom Toronto. completed was Dr.born aninGoldbloom’s Montreal honours and raised degree, activities in Quebec majoring and have Nova Scotia. been in HeGovernment, completed recognized an at and Harvard awarded University by his peers and then and attended students. honours degree, majoring in Government, at Harvard University and then attended the University oftheHe Oxford Universityhas as a authoredRhodes Scholar of Oxford numerous where he obtainedas a scientificRhodes an M.A. in Physiological Scholar articles Sciences. whereand Hebook hetrained obtainedchapters in an and M.A. has inprovided Physiological talks and Sciences. lectures He medicinetrainedto student, and in psychiatry medicine professional at McGill and University psychiatryand and public is a Professor at audiences. McGill of Psychiatry University atHe the Universitymaintains and of is ana Professor active clinical of Psychiatry and teaching at the role University at the Toronto. Dr. Goldbloom’s activities have been recognized and awarded by his peers and students. HeofCentre has Toronto. authored for numerous AddictionDr. Goldbloom’s scientific and articles Mental andactivities book Healthchapters have and where has been provided he recognized talks serves and lectures as andSenior awarded Medical by Advisor. his peers He and is alsostudents. Chair toHeof student, the has professionalMental authored Healthand public numerous audiences.Commission He scientific maintains of an Canada. activearticles clinical Inand additionteaching book role chapters atto his professional and has provided activities, talks Dr. and Goldbloom lectures is the Centre for Addiction and Mental Health where he serves as Senior Medical Advisor. He is also immediate past ChairChairto student, of of the the Mental Board professional Health Commission of Governors andof Canada. public of In additionthe audiences. Stratford to his professional HeShakespeare activities,maintains Dr. anFestival active of clinical Canada. and He teaching is an Officer role at theof the Order of Canada.GoldbloomCentre isfor immediate Addiction past Chair and of the Mental Board of Governors Health of thewhere Stratford he Shakespeare serves Festival as Senior Medical Advisor. He is also Chair ofof Canada. the MentalHe is an Officer Health of the Commission Order of Canada. of Canada. In addition to his professional activities, Dr. Goldbloom is immediate past Chair of the Board of Governors of the Stratford Shakespeare Festival of Canada. He is an Officer of the KajKaj Korvela, Korvela BA Art History; BA Fine Arts, BA Education Order of Canada. Kaj Korvela is Executive Director (2003-present) of the Organization for Bipolar Affective Disorder, aKaj consumer Korvela driven non-profit (BA Art that History; focuses on BAmood Finedisorders Arts; with a particularBA Education) emphasis on bipolar is Executive Director (2003-present) of disorders, the Organization as well as a board member/coach for Bipolar and Affective mentor for Opportunity Disorder, Works, a a consumernon profit driven non-profit that focuses on mood providingKaj Korvela entrepreneurship skills to mental health consumers. He is active in the mental health communitydisorders including with Alberta a particular Health Services emphasis (AHS) Strategic on Clinical bipolar Network, disorders, Alberta Alliance as for well as a board member/coach and mentor MentalKajfor OpportunityKorvela Illness and Mental (BA Health, Works,Art History; AHS aPatient non BAEngagement profit Fine ReferenceArts;providing BA Group, Education) entrepreneurship Calgary Mental isHealth Executive skills Directorto mental (2003-present) health consumers. of He Networkthe Organization and the Mental Health for Housing Bipolar Sector. Affective A successful fundraiserDisorder, through a consumerappeal to private driven non-profit that focuses on mood andis corporateactive patrons, in the gaming mental and other health events Kajcommunity is an advocate for including the mentally ill Alberta through public Health Services (AHS) Strategic Clinical eventsdisordersNetwork, and presentations, Albertawith a community particular Alliance consultation foremphasis Mental and promotion. onIllness bipolar He also and produces disorders, Mental educational Health, as well AHS as aPatient board Engagementmember/coach Reference and mentor materials,for Opportunity including the widely Works, recognized a non and employed profit “A Guideproviding to Recovery.” entrepreneurship Research affiliations skills to mental health consumers. He and designations include nationalGroup, and international Calgary CDRIN, Mental CREST HealthBD - Psychosocial Network issues in and Bipolar the Disorders, Mental Certified Health Peer Housing Sector. A successful fundraiser Specialist, Kaj is also affiliatedthroughis withactive Calgary appeal in Association the mentalto of private Self Help.health Asand a practicing community corporate fine artist, patrons,including Kaj maintains gaming aAlberta studio from and Health his other Services events (AHS)Kaj is anStrategic advocate Clinical for home base in Calgary and is aNetwork, supporter of Catalyst Alberta Contemporary Alliance Art, forCalgary Mental Philharmonic Illness and local and arts Mentalgroups. He isHealth, winner AHS Patient Engagement Reference theof the mentally2014 Lt. Governor’s ill through True Grit Award. public events and presentations, community consultation and promotion. He also produces educational materials,Group, including Calgary the Mental widely Health recognized Network and and empl theoyed Mental “A GuideHealth to Housing Recovery”. Sector. Research A successful affiliations fundraiser and designations includethrough national appeal and to international private and corporateCDRIN, CREST patrons, BD gaming - Psychosocial and other issues events in Kaj Bipolar is an Disorders,advocate forCertified thePeer mentally Specialist, ill through Kaj is alsopublic affiliated events andwith presentations,Calgary Association community of Self consultation Help. As aand practicing promotion. fine He artist, also Kajproduces maintains a educationalstudio from hismaterials, home base including in Calgary the widely and isrecognized a supporter and of empl Catalystoyed Contemporary “A Guide to Recovery”. Art, Calgary Research Philharmonic affiliations and local and designations include national and international CDRIN, CREST BD - Psychosocial issues in Bipolar Disorders, Certified arts groups. He is winner of the 2014 Lt. Governor’s True Grit Award. Peer Specialist, Kaj is also affiliated with Calgary Association of Self Help. As a practicing fine artist, Kaj maintains a studio from his home base in Calgary and is a supporter of Catalyst Contemporary Art, Calgary Philharmonic and local arts groups. He is winnerGloria Laird of the 2014 Lt. Governor’s True Grit Award. Gloria Laird is a member of the Métis Nation of Alberta and is one of the Elders for the Métis Regional Council, Zone 4. She has one son and two beautiful granddaughters who live at her home part 12 Gloria Lairdtime. She wasConsensus appointed Development and Conference served on Improvingon 3 different Mental Health Mental Transitions Health Boards for the Province of Alberta, Gloriaadvocating Laird foris a Aboriginal member ofServices the Métis within Nation the of Mental Alberta Heath and isSystem. one of theAt theElders end for of herthe Métis6th year Regional and Council,last term, Zone the Board4. She appointed has one sona Wisdom and two Committee beautiful granddaughters to advocate and who guide live Aboriginal at her home Mental part Health time.Services She and was ensure appointed there and were served opportunities on 3 different to incorporate Mental Health Traditional Boards and for Spiritualthe Province Healing of Alberta, Practices advocatingin the Mental for Health Aboriginal System. Services The withinWisdom the Committee Mental Heath was System. in existence At the for end about of her 8 years. 6th year Gloria and lastserved term, as the Co-Chair Board appointedon this Committee a Wisdom for Committee the duration to ofadvocate that time, and being guide reappointed Aboriginal Mentalby the CommitteeHealth Servicesto continue and to ensure co chair. there Gloria were has opportunities also trained to inincorporate a number Traditionalof healing modalities,and Spiritual and Healing is a Reiki Practices Master (Reiki means Universalin the LifeMental force Health (hands System. on Healing) The Wisdom Gloria ha Committees worked inwas the in Aboriginal existence Community,for about 8 years. Oil Industry, Gloria Federal Government and presentlyserved as for Co-Chair the Provincial on this Government,Committee for Children’s the duration Services, of that andtime, currently being reappointed works as an by Aboriginal the Committee Consultant at Yellowto continue head Youth to co Centre. chair. Gloria has also trained in a number of healing modalities, and is a Reiki Master (ReikiShe has means recently Universal been appointedLife force (handsto Alberta on HealthHealing) Services Gloria ha Wisdoms worked Council in the asAboriginal one of the Community, Metis Representatives, Oil Industry, Federal and is Government and presently for the Provincial Government, Children’s Services, and currently works as an Aboriginal Consultantone of the Fourat Yellow Co-Chairs head Youthon the Centre. Council. She has recently been appointed to Alberta Health Services Wisdom Council as one of the Metis Representatives, and is one of the Four Co-Chairs on the Council. The Jury

facilities across the province. It also promotes a model of care shared between family doctors, mental health primary care professionals and secondary care mental health specialists. This new network should have a major impact on mental health promotion and service delivery.

Dr. David GoldbloomDr. Goldbloom was born in Montreal and raised in Quebec and Nova Scotia. He completed an honours degree, majoring in Government, at Harvard University and then attended the University of Oxford as a Rhodes Scholar where he obtained an M.A. in Physiological Sciences. He trained in medicine and psychiatry at McGill University and is a Professor of Psychiatry at the University of Toronto. Dr. Goldbloom’s activities have been recognized and awarded by his peers and students. He has authored numerous scientific articles and book chapters and has provided talks and lectures to student, professional and public audiences. He maintains an active clinical and teaching role at the Centre for Addiction and Mental Health where he serves as Senior Medical Advisor. He is also Chair of the Mental Health Commission of Canada. In addition to his professional activities, Dr. Goldbloom is immediate past Chair of the Board of Governors of the Stratford Shakespeare Festival of Canada. He is an Officer of the Order of Canada.

Kaj Korvela Kaj Korvela (BA Art History; BA Fine Arts; BA Education) is Executive Director (2003-present) of the Organization for Bipolar Affective Disorder, a consumer driven non-profit that focuses on mood disorders with a particular emphasis on bipolar disorders, as well as a board member/coach and mentor for Opportunity Works, a non profit providing entrepreneurship skills to mental health consumers. He is active in the mental health community including Alberta Health Services (AHS) Strategic Clinical Network, Alberta Alliance for Mental Illness and Mental Health, AHS Patient Engagement Reference Group, Calgary Mental Health Network and the Mental Health Housing Sector. A successful fundraiser through appeal to private and corporate patrons, gaming and other events Kaj is an advocate for the mentally ill through public events and presentations, community consultation and promotion. He also produces educational materials, including the widely recognized and employed “A Guide to Recovery”. Research affiliations and designations include national and international CDRIN, CREST BD - Psychosocial issues in Bipolar Disorders, Certified Peer Specialist, Kaj is also affiliated with Calgary Association of Self Help. As a practicing fine artist, Kaj maintains a studio from his home base in CalgaryTHE and JURY is a supporter of Catalyst Contemporary Art, Calgary Philharmonic and local arts groups. He is winner of the 2014 Lt. Governor’s True Grit Award.

GloriaGloria Laird Laird GloriaGloria Laird Laird is a member is aof themember Métis Nation of of the Alberta Métis and is oneNation of the Elders of Alberta for the Métis and is one of the Elders for the Métis Regional Regional Council, Zone 4. She has one son and two beautiful granddaughters who live at her home The JurypartCouncil, time. She was Zone appointed 4. andShe served has on 3 one different son Mental and Health two Boards beautiful for the Province granddaughters of who live at her home part Alberta,time. advocating She was for Aboriginal appointed Services withinand theserved Mental Heath on 3System. different At the end Mental of her 6th Health Boards for the Province of Alberta, year and last term, the Board appointed a Wisdom Committee to advocate and guide Aboriginal Mentaladvocating Health Services for and Aboriginal ensure there were Services opportunities within to incorporate the MentalTraditional andHeath Spiritual System. At the end of her 6th year and Healinglast term,Practices thein the Board Mental Health appointed System. The aWisdom Wisdom Committee Committee was in existence to for advocateabout 8 and guide Aboriginal Mental Health years. Gloria served as Co-Chair on this Committee for the duration of that time, being reappointed byGlendaServices the Committee and M.to continue ensureMacQueen, to Co-Chair. there Gloria were hasPHD, alsoopportunities trained MD, in a number FRCPC to of incorporate healing modalities, Traditional and Spiritual Healing Practices The Juryandin isthe a Reiki Mental Master (Reiki Health means UniversalSystem. Life force The (hands Wisdom on Healing) Committee Gloria has worked was in in existence for about 8 years. Gloria the Aboriginal Community, OilVice Industry, Dean, Federal Government Faculty and presently of Medicine, for the Provincial Government, University Children’s Services,of Calgary and currently works as an AboriginalGservedlenda Consultant as M. Co-Chair atMacQueen, Yellow head on Youth this Centre.PhD, Committee She MD, has recently FRCPC for been the appointed is duration a toProfessor Alberta of Health that in time, the Departmbeing reappointedent of Psychiatry by the Committee at the Services Wisdom Council as oneto ofcontinue the Metis Representatives, to co chair. and is one Gloria of the Four has Co-Chairs also ontrained the Council. in a number of healing modalities, and is a Reiki Master University of Calgary in Calgary, Alberta, Canada. She is also the Vice Dean of the Faculty of Medicine (Reiki means Universal Life force (hands on Healing) Gloria has worked in the Aboriginal Community, Oil Industry, Federal at the University of Calgary. Dr. MacQueen earned her PhD in Psychology from McMaster University and Government and GlendapresentlyGlenda M. MacQueen,for M. the MacQueen, Provincial PHD, MD, Government, FRCPC PHD, MD, Children’s FRCPC Services, and currently works as an Aboriginal Professor,her MD Department from McMasterof Psychiatry, and University Vice Dean, Faculty Medical of Medicine, School, where she also completed her residency in psychiatry. Consultant at YellowUniversityVice head Dean,of CalgaryYouth FacultyCentre. of Medicine, University of Calgary Dr. MacQueen’s research focuses on the neurobiology and clinical features of mood disorders. She was She has recently GlendabeenGlenda M. appointed MacQueen M. MacQueen, is a Professorto Alberta in the PhD,DepartmentHealth MD, Servicesof Psychiatry FRCPC at Wisdom the Universityis a Professor Council of Calgary, as in one the of Departm the Metisent Representatives, of Psychiatry at and the is Alberta,a founding Canada. She member is also the Vice of Dean the of the Brain Faculty ofBody Medicine Institute at the University and of Calgary.is a memberDr. of the Hotchkiss Brain Institute and the one of the Four Co-ChairsUniversity on of the Calgary Council. in Calgary, Alberta, Canada. She is also the Vice Dean of the Faculty of Medicine MacQueenMathison earned Centre her PhD in Psychologyfor Mental from McMaster Health University Research and her MD and from Education.McMaster Dr. MacQueen is an associate editor of the Universityat the Medical University School, where of sheCalgary. also completed Dr. her MacQueenresidency in psychiatry. earned Dr. MacQueen’s her PhD in Psychology from McMaster University and Canadian Journalresearch of Psychiatry focuses on the neurobiology and the and Journal clinical features of of Psychiatry mood disorders. She and was aNeuroscience. founding Dr MacQueen was the 2011 recipient memberher MD of the fromBrain Body McMaster Institute and is aUniversity member of the Hotchkiss Medical Brain School,Institute and thewhere she also completed her residency in psychiatry. of the Douglas Utting award for studies in depression and is the 2014 recipient of the Heinz Lehmann award from the MathisonDr. MacQueen’s Centre for Mental Health research Research and focuses Education. Dr.on MacQueen the neurobiology is an associate editor ofand clinical features of mood disorders. She was Canadian Collegethe ofCanadian Neuropsychopharmacology. Journal of Psychiatry and the Journal of Psychiatry and Neuroscience. Dr. MacQueen was the 2011 recipient of the Douglasa founding Utting award member for studies in ofdepression the Brainand is the Body2014 recipient Institute of the Heinz and Lehmann is a member of the Hotchkiss Brain Institute and the award from the Canadian CollegeMathison of Neuropsychopharmacology. Centre for Mental Health Research and Education. Dr. MacQueen is an associate editor of the Canadian Journal of Psychiatry and the Journal of Psychiatry and Neuroscience. Dr MacQueen was the 2011 recipient FayFay Orr Orr of the Douglas UttingFay Orr wasaward Alberta’s for fourth studies Mental Health in Patientdepression Advocate from and May 2010 is theuntil October 2014 2013. recipient of the Heinz Lehmann award from the Canadian CollegeInFay thatof role Neuropsychopharmacology.Orr Fay was mandated Alberta’s under the fourth Alberta Mental Mental Health ActHealth to investigate Patient complaints Advocate and from May 2010 until October 2013. In that concernsrole Fay from or was relating mandated to mental health patientsunder in Albertathe Alberta under certificate Mental or community Health Act to investigate complaints and concerns treatment orders. As Advocate, Fay acted as a resource to health care providers on the proper applicationfrom or of therelating Mental Health to Actmental and provided health advocacy patients perspectives in and Alberta information underto the certificate or community treatment orders. MinisterAs Advocate, and the Ministry Fay of Health acted to assist as in the a developmentresource of policy to health and legislation. care She providershad on the proper application of the Mental articlesFay about Orr Alberta’s mental health legislation published in several journals including the Health LawHealth Review andAct Health and Law provided Canada. During advocacy her time as Advocate, perspectives Fay helped to establish and the information to the Minister and the Ministry of Health LieutenantFay Orr Governor’s was CircleAlberta’s on Mental fourthHealth and MentalAddiction. The Health Circle works Patient to prevent Advocate stigma from May 2010 until October 2013. In that to assist in the development of policy and legislation. She had articles about Alberta’s mental health byrole enhancing Fay awareness was andmandated understanding under about mental the health Alberta issues and Mentalrecognizing significantHealth Act to investigate complaints and concerns achievements in mental healthlegislation and addiction treatment published and programming. in several The Circle journals administers includingand hosts the annual the Health Law Review and Health Law Canada. Lieutenant Governor’s True Awardsfrom for or Mental relating Health and to Addiction. mental Fay continueshealth to patientsserve as a director in onAlberta the LG’s Circle. under Over certificate or community treatment orders. the past 21 years, Fay has heldDuring several senior her positions time within as the Advocate, Government of AlbertaFay including:helped Deputy to establish Minister of Alberta the Lieutenant Governor’s Circle on Mental Health andChildren Addiction. and Youth Services; The DeputyAs Advocate,Circle Minister ofworks Tourism, Fay to Parks, actedprevent Recreation as andstigmaa resourceCulture; byDeputy enhancing toMinister health of Community careawareness providers and on understanding the proper application about mental of the health Mental Development; Deputy MinisterHealth of Government Act Services; and providedManaging Director advocacy of the Alberta perspectivesPublic Affairs Bureau; andand, information to the Minister and the Ministry of Health issuesCommunications and Director recognizing of the Premier’s significant Office. Fay was a achievementsjournalist before joining inthe governmentmental inhealth 1988. Fay and is currently addiction the treatment and programming. The Circle administersVice-Chair of the Board and of Directors hoststo assist for the the United inannual the Way, development Alberta Lieutenant Capital Region. Governor’s of policy and True legislation. Awards for She Mental had articles Health andabout Addiction. Alberta’s Faymental continues health to serve as a directorlegislation on the published LG’s Circle. in severalOver the journals past 21 including years, Fay the has Health held Law several Review senior and positions Health Lawwithin Canada. the Government of AlbertaDuring including: her time as Deputy Advocate, Minister Fay of helped Alberta to Children establish and the Youth Lieutenant Services; Governor’s Deputy CircleMinister on of Mental Tourism, Health andParks, Addiction. Recreation The and Circle Culture; works Deputy to prevent Minister stigma of Community by enhancing De velopment;awareness Deputyand understanding Minister of Government about mental Services; health issuesManaging and Director recognizing of the significant Alberta Public achievements Affairs Bureau; in mental and, healthCommunications and addiction Director treatment of the and Premier’s programming. Office. The Fay Circle was administers and hosts the annual Lieutenant Governor’s True Awards for Mental Health and Addiction. Fay continues Consensusa journalist Development before Conference joining on Improving the government Mental Health Transitions in 1988.Fay is currently the vice-chair13 of the Board of Directors for the United toWay, serve Alberta as a Capitaldirector Region. on the LG’s Circle. Over the past 21 years, Fay has held several senior positions within the Government of Alberta including: Deputy Minister of Alberta Children and Youth Services; Deputy Minister of Tourism, Parks, Recreation and Culture; Deputy Minister of Community Development; Deputy Minister of Government Services; Managing DirectorJohn of the AlbertaMcSorley Public Affairs Bureau; and, Communications Director of the Premier’s Office. Fay was a journalist before Bornjoining in theBelfast, government Northern in Ireland, 1988.Fay a child is currently of what thewas vice-chair known as of “the the troubles” Board of which Directors took for the the lives United of Way, Alberta Capitalover Region. 3000 people in a vicious sectarian civil war that lasted almost 40 years. We were all traumatised by this experience and that more than anything made me determined at the age of 15 years to leave Ireland and to become a family doctor just like my father. I came to Canada, to Coronation, Alberta for 2 Johnyears and McSorley then moved to Airdrie in 1994 where I have been ever since. BornIn my in time Belfast, here NorthernI have served Ireland, on thea child board of whatof our was Primary known Care as “theNetwork troubles” since which its inception took the and lives was of overthe physician 3000 people lead inin aour vicious PCN sectariancomplex carecivil warclinic that for lastedseveral almost years. 40 I also years. teach We medical were all students traumatised and byinternational this experience medical and students that more at thethan University anything ofmade Calgary. me determined It is no exaggeration at the age to of say 15 thatyears I truly to leave love thisIreland work. and If I wasto become asked ato family pick a doctorfavourite just aspect like my of father. my work I came as a familyto Canada, physician to Coronation, I would say Alberta it would for 2 be working alongsideyears patients and then who moved are experiencing to Airdrie in overwhelming 1994 where I havestress been in their ever lives since. whether it is from their own or a loved one’s illness.In My my own time experience here I have with served clinical on depressionthe board of a our few Primary years ago, Care though Network awful since at the its time,inception has taughtand was me more than any textbookthe physician about the lead devastating in our PCN effect complex of mental care illnessclinic for on several the individual years. andI also their teach family. medical I owe students a deep debtand of gratitude to the internationalAMA Physicians medical and familystudents support at the programme University offor Calgary. helping Itme is throughno exaggeration that challenging to say that time I trulyin my love life. Medicine, my Catholicthis work. faith If and I was my asked family to are pick the a first favourite loves aspect of my life of butmy workI also aslove a familyto hike, physician kayak, play I would soccer, say read it would be working alongside patients who are experiencing overwhelming stress in their lives whether it is from their own or a poetry, modern history and last but definitely not least, is spending time with my dog, Seamus. loved one’s illness. My own experience with clinical depression a few years ago, though awful at the time, has taught me more than any textbook about the devastating effect of mental illness on the individual and their family. I owe a deep debt of gratitude to the AMA Physicians and family support programme for helping me through that challenging time in my life. Medicine, my Catholic faith and my family are the first loves of my life but I also love to hike, kayak, play soccer, read poetry, modern history and last but definitely not least, is spending time with my dog, Seamus. The Jury

Glenda M. MacQueen, PHD, MD, FRCPC Vice Dean, Faculty of Medicine, University of Calgary Glenda M. MacQueen, PhD, MD, FRCPC is a Professor in the Department of Psychiatry at the University of Calgary in Calgary, Alberta, Canada. She is also the Vice Dean of the Faculty of Medicine at the University of Calgary. Dr. MacQueen earned her PhD in Psychology from McMaster University and her MD from McMaster University Medical School, where she also completed her residency in psychiatry. Dr. MacQueen’s research focuses on the neurobiology and clinical features of mood disorders. She was a founding member of the Brain Body Institute and is a member of the Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education. Dr. MacQueen is an associate editor of the Canadian Journal of Psychiatry and the Journal of Psychiatry and Neuroscience. Dr MacQueen was the 2011 recipient of the Douglas Utting award for studies in depression and is the 2014 recipient of the Heinz Lehmann award from the Canadian College of Neuropsychopharmacology.

Fay Orr Fay Orr was Alberta’s fourth Mental Health Patient Advocate from May 2010 until October 2013. In that role Fay was mandated under the Alberta Mental Health Act to investigate complaints and concerns from or relating to mental health patients in Alberta under certificate or community treatment orders. As Advocate, Fay acted as a resource to health care providers on the proper application of the Mental Health Act and provided advocacy perspectives and information to the Minister and the Ministry of Health to assist in the development of policy and legislation. She had articles about Alberta’s mental health legislation published in several journals including the Health Law Review and Health Law Canada. During her time as Advocate, Fay helped to establish the Lieutenant Governor’s Circle on Mental Health and Addiction. The Circle works to prevent stigma by enhancing awareness and understanding about mental health issues and recognizing significant achievements in mental health and addiction treatment and programming. The Circle administers and hosts the annual Lieutenant Governor’s True Awards for Mental Health and Addiction. Fay continues to serve as a director on the LG’s Circle. Over the past 21 years, Fay has held several senior positions within the Government of Alberta including: Deputy Minister of Alberta Children and Youth Services; Deputy Minister of Tourism, Parks, Recreation and Culture; Deputy Minister of Community Development; Deputy Minister of Government Services; Managing Director of the Alberta Public Affairs Bureau; and, Communications Director of the Premier’s Office. Fay was a journalist before joining the governmentTHE JURY in 1988.Fay is currently the vice-chair of the Board of Directors for the United Way, Alberta Capital Region.

JohnJohn McSorley, McSorley MD, MB, MRCGP Born in Belfast, Northern Ireland, a child of what was known as “the troubles” which took the lives of Born in Belfast, Northern Ireland, John McSorley is a child of what was known as “the troubles” whichover took 3000 the lives people of over 3000 in peoplea vicious in a vicious sectarian sectarian civil civil war thatwar lasted that almost lasted 40 years. almost 40 years. We were all traumatised Theby traumathis experience of this experience andmore than that anything more made than him determinedanything at the made age of 15me years determined to at the age of 15 years to leave leave Ireland and to become a family doctor like his father. He came to Canada, to Coronation, AlbertaIreland for 2 and years andto thenbecome moved to aAirdrie family in 1994. doctor Since then just he haslike served my on father. the board of I came to Canada, to Coronation, Alberta for 2 theyears Primary and Care thenNetwork moved since its inception to Airdrie and was in the 1994 physician where lead in the I PCNhave complex been care ever since. clinic for several years. He also teaches medical students and international medical students at the UniversityIn my timeof Calgary. here It is noI have exaggeration served to say thaton he the truly board loves this of work, our but Primaryif asked to pick Care Network since its inception and was athe favourite physician aspect of his lead work as in a familyour physicianPCN complex it would be working care alongside clinic patientsfor several who are years. I also teach medical students and experiencing overwhelming stress in their lives whether it is from their own or a loved one’s illness. John’s own experience with clinicalinternational depression a few medical years ago, though students awful at theat time,the hasUniversity taught him more of thanCalgary. any textbook It is no exaggeration to say that I truly love about the devastating effectthis of mental work. illness If onI thewas individual asked and totheir pick family. a Hefavourite states that he aspectowes a deep ofdebt my of gratitude work as a family physician I would say it would to theThe AMA Physicians Jury and family support programme for helping him through that challenging time in his life. Medicine, his Catholicbe working faith and hisalongside family are the patients first loves of whohis life arebut he experiencingalso loves to hike, kayak, overwhelming play soccer, read poetry, stress modern in history their lives whether it is from their own or a andloved last but one’s definitely illness. not least, Myspend own time withexperience his dog, Seamus. with clinical depression a few years ago, though awful at the time, has taught me more than any textbook about the devastating effect of mental illness on the individual and their family. I owe a deep debt of gratitude to the TomAMATom Shand Physicians Shand and family support programme for helping me through that challenging time in my life. Medicine, my CatholicTom Shand faith has beenand working my family in the healthcare are the field firstin Alberta loves and BCof for my more life than but 30 years, I also love to hike, kayak, play soccer, read includingTom theShand past eight has focused been on mental working health in Alberta.in healthcare Tom is currently field the past in chair Alberta of the and BC for more than 30 years, including poetry, modern historyAlbertathe past Allianceand eightlast on Mental but focused Illnessdefinitely and onMental mental notHealth, least, having health is served spending in six Alberta. years as itstime chair. Tom Hewith isis also currentlymy dog, Seamus. the past chair of the Alberta Alliance a founding director, and now past chair of the Lt. Governor’s Circle on Mental Health and Addiction, andon was Mental Executive IllnessDirector of andthe Alberta Mental Division Health, of the Canadian having Mental servedHealth Association six years as its chair. He is also a founding director, forand eight nowyears, leaving past last chair April. Heof is the also aLt. core Governor’smember of the AHS Circle Strategic onClinical Mental Network Health and Addiction, and was Executive for Addiction and Mental Health as well as on mental health research projects through CDRIN andDirector CRISM. Tom of has the played Alberta a key role Division in the development of the of such Canadian significant directions Mental as theHealth Association for eight years, leaving last introductionApril. He of Communityis also aTreatment core Ordersmember in Alberta of andthe the AHS creation Strategic of Creating Connections, Clinical Network for Addiction and Mental Health the strategic plan for mental health and addiction in Alberta. Tom is a strong advocate for the need for increased emphasis andas support well for as mental on healthmental with increasedhealth collaboration research between projects community through service providers, CDRIN and CRISM. Tom has played a key role various arms of government andin thethe private development sector. He believes ofthat such the field significant also requires more directionsresearch and a strongeras the voice introdu for ction of Community Treatment Orders those living with mental illness and their families. Given that perhaps only a third of mental health needs are actually clinical in nature, the linkages with suchin areasAlberta as employment, and the social creation services, housing, of Creating education and Connections,justice are vitally important the tostrategic plan for mental health and addiction inimproving Alberta. supports Tom and helpingis a strongto better meet advocate mental health for needs. the Tom need has a background for increased in journalism, emphasis fund development and support for mental health with increased and organizational development for NGOs. A graduate of Queen’s University, in human geography and a minor in economics, collaborationTom and his wife Sheila between have two adult community daughters, one working service as a contemporary providers, dancer various in Israel and arms the other of in government a marketing and the private sector. He believes that theposition field in Montreal. also requires more research and a stronger voice for those living with mental illness and their families. Given that perhaps only a third of mental health needs are actually clinical in nature, the linkages with such areas as employment, social services, housing, education and justice are vitally important to improving supports and helping to better meet mental health needs. Tom has a background in journalism, fund development and organizational development for NGOs. A graduate of Queen’s University, in human geography and a minor in economics, Tom and his wife Sheila have two adult daughters, one working as a contemporary dancer in Israel and the other in a marketing position in Montreal.

Michel Simard Criminologist and theologian, MA Michel Simard has worked with homeless people for more than 25 years.He is the Executive director for Centre Le Havre de Trois-Rivières, a front line organisation for homeless men and women. Le 14 Centre le HavreConsensus has Development developed Conference emergency, on Improving Mental transitional Health Transitions and long term (permanent housing, work) services. He has also contributed to the development of an innovative interorganisational program for chronicle homeless people. He his one of the founders of a Quebec homeless network: Réseau solidarité itinérance du Québec.He has been the president of the Quebec Psychosocial Rehabilitation Association.He is a member of the advisory board on the homeless policy and the research committee on homelessness in Quebec for the Quebec Government. He contributes to the global development of services for homeless people, including aboriginal people, in Val-D’Or, Québec. He makes a significant contribution to the transformation of services at Old-Brewery Mission in Montréal. The largest homeless shelter in Quebec. He has also participated in many conferences and published many texts related to homelessness.

Sharon G. Sutherland Longtime Mental Illness/Health Advocate motivated by my son’s mental illness and the need to connect with people with similar issues. The Schizophrenia Society of Edmonton provided that connection and important support. Goals have been to ensure people with mental illness, their families and caregivers have a voice with the policy makers, the development of support programs and resources, changing public perceptions and identifying gaps in the system. Nothing is simple if you have a mental illness or it you are involved in its treatment. The Jury

Tom Shand Tom Shand has been working in healthcare field in Alberta and BC for more than 30 years, including the past eight focused on mental health in Alberta. Tom is currently the past chair of the Alberta Alliance The Juryon Mental Illness and Mental Health, having served six years as its chair. He is also a founding director, and now past chair of the Lt. Governor’s Circle on Mental Health and Addiction, and was Executive Director of the Alberta Division of the Canadian Mental Health Association for eight years, leaving last April. He is also a core member of the AHS Strategic Clinical Network for Addiction and Mental Health Tomas well Shand as on mental health research projects through CDRIN and CRISM. Tom has played a key role Tomin the Shand development has been working of such in significanthealthcare field directions in Alberta as andthe introduBC for ctionmore than of Community 30 years, including Treatment Orders thein pastAlberta eight and focused the creation on mental of health Creating in Alberta. Connections, Tom is currently the strategic the past planchair forof the mental Alberta health Alliance and addiction on Mental Illness and Mental Health, having served six years as its chair. He is also a founding director, in Alberta. Tom is a strong advocate for the need for increased emphasis and support for mental health with increased and now past chair of the Lt. Governor’s Circle on Mental Health and Addiction, and was Executive collaboration betweenDirector community of the Alberta service Division providers, of the Canadian various Mental arms Health of government Association and for eightthe private years, leaving sector. last He believes that the field also requiresApril. He more is also research a core memberand a strongerof the AHS voice Strategic for those Clinical living Network with mentalfor Addiction illness and and Mental their Health families. Given that perhaps only a thirdas well of mentalas on mental health health needs research are actually projects clinical through in CDRIN nature, and the CRISM. linkages Tom with has playedsuch areas a key roleas employment, social services, housing,in the development education of and such justice significant are vitallydirections important as the introdu to improvingction of Community supports Treatmentand helping Orders to better meet mental health needs.in Alberta Tom and has the a backgroundcreation of Creating in journalism, Connections, fund the development strategic plan and for mental organizational health and development addiction for NGOs. Ain graduate Alberta. Tom of Queen’sis a strong University, advocate for in the human need forgeography increased and emphasis a minor and in support economics, for mental Tom health and withhis wifeincreased Sheila have two adult daughters,collaboration one between working community as a contemporary service providers, dancer various in Israelarms of and government the other and in athe marketing private sector. position He believes in Montreal. that the field also requires more research and a stronger voice for those living with mental illness and their families. Given that perhaps only a third of mental health needs are actually clinical in nature, the linkages with such areas as employment, social services, housing, education and justice are vitally important to improving supports and helping to better meet mental health needs. Tom has a background in journalism, fund development and organizational development for NGOs. A graduate of Queen’s University, in human geography and a minor in economics, Tom and his wife Sheila have two adult daughters, one workingMichel as a contemporary SimardTHE dancerJURY in Israel and the other in a marketing position in Montreal. Criminologist and theologian, MA Michel Simard has worked with homeless people for more than 25 years.He is the Executive director for Centre Le Havre de Trois-Rivières, a front line organisation for homeless men and women. Le Michel Simard, MA MichelCentre Simard le Havre has developed emergency, transitional and long term (permanent housing, work) Michel Simard, a criminologist and theologian, has worked with homeless people for more than 25 years.Criminologistservices. He is the Executive He andhas Director alsotheologian, for Centre contributed Le Havre MA de Trois-Rivières,to the development a front line organisation of an innovative interorganisational program forMichel forhomeless chronicle Simard men and haswomen. homeless worked Le Centre with lepeople. Havre homeless has developedHe his people emergency, one for of transitionalmorethe founders than and 25long years.He of a Quebec is the Executivehomeless director network: Réseau termfor Centre(permanent Le housing, Havre work) de services. Trois-Rivières, Michel has also a contributed front line to organisationthe development of for an homeless men and women. Le innovativesolidarité interorganisational itinérance program du for Québec.He chronically homeless has people, been he is onethe of presidentthe founders of of the Quebec Psychosocial Rehabilitation aCentre QuebecAssociation.He homeless le Havre network: has Réseauis developed a member solidarité itinéranceemergency, of the du Québec,advisory transitional and has board been and the presidenton long the term of homeless (permanent policy housing, and thework) research committee theservices.on Quebec homelessness Psychosocial He has Rehabilitationalso incontributed Quebec Association. tofor Hethe theis adevelopment member Quebec of the advisoryGovernment. of an board innovative on the He interorganisational contributes to the program global development homelessfor chronicle policy and homeless the research committee people. on He homelessness his one inof Quebec the founders for the Quebec of Governmenta Quebec homeless network: Réseau of services for homelessand contributes people, to the global including development aboriginal of services for homeless people, people, in including Val-D’Or, aboriginal Québec. He makes a significant contribution to people,solidarité in Val-D’Or, itinérance Québec. Hedu makes Québec.He a significant has contribution been tothe the president transformation of of th servicese Quebec at Psychosocial Rehabilitation Old-Brewerythe transformation Mission in Montréal,Association.He of theservices largest homeless at is Old-Brewery sheltera member in Quebec. of Michel theMission advisory has also in participated Montréal.board inon many the The conferences homeless largest and policy homeless and the shelter research in committeeQuebec. He has also publishedparticipated many texts in related many onto homelessness. homelessness conferences inand Quebec published for the many Quebec texts Government. related to He homelessness. contributes to the global development of services for homeless people, including aboriginal people, in Val-D’Or, Québec. He makes a significant contribution to the transformation ofSharon services G. Sutherland at Old-Brewery Mission in Montréal. The largest homeless shelter in Quebec. He has also participated in manyASharon longtimeconferences Mental G. Illness/Health and Sutherland published Advocate, many Sharon textsis motivated related by her to son’s homelessness. mental illness and the needLongtime to connect withMental people withIllness/Health similar issues. The AdvocateSchizophrenia Societymotivated of Edmonton by provides my son’s mental illness and the need to connect thatwith connection people and importantwith similar support. Herissues. goals have The been Schizophreniato ensure people with mental Society illness, of Edmonton provided that connection and Sharontheir families G.and caregiversSutherland have a voice with the policy makers, the development of support programsimportant and resources, support. changing Goals public perceptions have been and identifying to ensure gaps in thepeople system. “Nothing with mental is illness, their families and caregivers Longtimesimple if you Mentalhave a mental Illness/Health illness or if you areAdvocate involved in itsmotivated treatment.” by my son’s mental illness and the need to connect withhave people a voice with similarwith the issues. policy The makers, Schizophrenia the development Society of Edmonton of support provided programs that connectionand resources, and changing importantpublic perceptions support. Goals and have identifying been to ensure gaps inpeople the system.with mental Nothing illness, is their simple families if you and have caregivers a mental illness or it haveyou a are voice involved with the in policy its treatment. makers, the development of support programs and resources, changing public perceptions and identifying gaps in the system. Nothing is simple if you have a mental illness or it you are involved in its treatment. Helen-Maria Vasiliadis, MSc, PhD Dr. Vasiliadis has a doctorate degree in Epidemiology and Biostatistics from McGill University and a master’s degree in Pharmacology from the Université de Montréal. She also pursued a post-doctorate in Psychiatric Epidemiolgoy at the Harvard School of Public Health. She is currently an Associate Professor and a Researcher at the Université de Sherbrooke in the Department of Community Health Sciences at the Faculty of Medicine and Health Sciences and at the Research Centre of the Charles Lemoyne Hospital at Longueuil and is a Junior 2 Research Scholar with the Quebec Health Research Fund (FRQ-S). Research program: Towards estimating a balanced mental health care system Prof. Vasiliadis’ program of research aims to inform decision makers on estimating a balanced mental health care system in Canada that will provide essential information for planning and budgeting services. This with the ultimate goal to adequately fund services for equitable access to evidence-based mental health services and to support seamless and efficient mental health care for all disorders and mental health client populations. For these objectives, population health and survey data as well as administrative databases are exploited as research monitoring tools that can be used to produce valid and easily available information to adequately fund and plan inpatient and community health services to support evidence-based treatment packages of care. In general terms, the program of research focuses on: (i) estimating the cost of treatment related to the severely mentally ill and those with common mental disorders (depression, anxiety, etc.), which have an important economic and social impact on society; (ii) describe population determinants (predisposing, enabling/impeding, need factors) of service use and (iii) relate health care costs to patient needs, clinical, and quality of life outcomes.

Consensus Development Conference on Improving Mental Health Transitions 15 SPEAKERS & ABSTRACTS Speakers & Abstracts

Carol Adair, MSc, PhD CarolAssociate Adair, Professor, MSc, Departments PhD of Psychiatry and of Community Health Sciences, AssociateFaculty of Medicine,Professor, University Departments of Calgary, of Psychiatry Alberta and of Community Health Sciences, Faculty of Medicine, University of Calgary, Alberta Carol Adair has an MSc. in Healthcare Research and a PhD. in Epidemiology (1996) from the University of Calgary. She Dr.is a Carol mental Adair health has services an MSc. researcher/psychiatric in Healthcare Research epidemiologi and a PhD.st affiliated in Epidemiology with the Depts. (1996) of fromPsychiatry the and Community UniversityHealth Sciences of Calgary. at U of She C. Heris a researchmental health interests services include researcher/psychiatric measuring outcomes forepidemiologist adults, children affiliated and youth with withserious the mental Depts. illnesses of Psychiatry such asand schizophrenia, Community eating Health disorders, Sciences disabling at U of C. mood Her disordersresearch andinterests addictions with the ultimate aim of promoting their health, wellbeing and quality of life. From 1999- 2004 Dr. Adair led a multi-site research includeprogram measuring including a outcomes large cohort for study adults, examining children continuity and youth of mentalwith serious health mentalcare in Albertaillnesses funded such asby the Canadian schizophrenia,Health Services eating Research disorders, Foundation disabling and 4 mood other funders.disorders She and ha addictionss more than with 90 published the ultimate abstracts aim of or presentations, promotinghas published their more health, than wellbeing85 scientific and articles quality or of health life. Frompolicy reports,1999-2004, and isDr. the Adair principal led acopyright multi-site holder for three researchwidely-used program research including instruments a large on cohortcontinuity study of care, examining quality ofcontinuity life and housing of mental quality. health Dr. careAdair in is a co-recipient Albertaof the 2008 funded Canadian by the Psychiatric Canadian AssociationHealth Services Award Research for Outstanding Foundation Continuing and 4 Education other funders. Activity She in Psychiatryhas for a more than 90 published abstractsCIHR-funded or presentations, symposium has on published Eating Disorders more than and 85 Obesity. scientific She articleshas also or been health an activepolicy grantreports, reviewer and for Canadian research funding and philanthropic organizations such as CIHR, AIHS, Bell Canada as well as for organizations in the is the principal copyright holderUS, for NZ three and thewidely-used UK. She currently research serves instruments as Chair on of continuitythe Scienti ficof care,Review quality Panel of for life Movember and housing Canada. She has also quality. Dr. Adair is a co-recipientserved of inthe research 2008 Canadian and evaluation Psychiatric leadership Association roles including Award with for theOutstanding former Alberta Continuing Mental Health Education Board and the Mental HealthActivity Commission in Psychiatry of Canada, for a CIHR-funded and as an expert symposium panelist/committee on Eating Disordersmember on and provincial Obesity. and She national has also mental been health an active surveillance grant reviewer and performance measurementfor Canadian committees,research funding such as and for philanthropic CIHI and PHAC. organizations Since 2007 Dsuchr. Adair as CIHR, has been AIHS, the nationalBell Canada Quantitative as well Researchas for organizations Lead for the in $110M At Home/ Chezthe US, Soi NZ multi-site and the Trial UK. of SheHousing currently First forserves homeless as Chair individuals of the Scientific with mental Review illness. Panel for Movember Canada. She has also served in research and evaluation leadership roles including with the former Alberta Mental Health Board and the Mental Health Abstract: How important is continuity of care and integration in the provision of effective support? Commission of Canada, and as an expert panelist/committee member on provincial and national mental health surveillance and Continuityperformance of care measurement has been touted committees, as important such foras goodfor CIHI outcomes and PHAC. for individuals Since 2007, with SPMIDr. Adair since has the been1960s. the It nationalhas historicall Quantitativey, in mental health services,Research been Lead defined for the $110Mas “a process At Home/Chez involving the Soi orderly, multi-site uninterrupted Trial of Housing movement First of forpatients homeless among individuals the diverse with elements mental of theillness. service delivery system” (Bachrach 1981) but variability in definition persists. Health services integration is even less well defined; just one of many definitions is “TheAbstract: extent How to which important key support is continuity functions andof care activities and integrationare coordinated in the across provision operating of unitseffective of the support? system to realize the greatest value.” (Conrad & Shortell, 1996). While ideas about these abstract health service ‘processes’ and related concepts such as coordination of care remain variable, andContinuity stories of of ‘fragmentation’ care has been andtouted ‘falling as important through the for cracks’ good persist, outcomes good for progress individuals has been with madeSPMI in since the past the 1960s.decade It or has so historically,on understanding their dimensionsin mental health and how services, they can been be definedoperationalized as “a processin health involving services. the While orderly, current uninterrupted evidence for their movement relationship of patients with patient/ amongclient the outcomes is not definitivediverse elements – there isof athe basic service foundation delivery of knowledgesystem” (Bachrach to inform practice.1981) but In variability this presentation, in definition what is currentlypersists. meantHealth byservices continuity integration of care (including from both provider and patient/client perspectives), integration and closely related concepts will be explored first. Next, the way that these ideas have been is even less well defined; just one of many definitions “The extent to which key support functions and activities are coordinated operationalized in mental health services, including examples from programs or interventions at least implicitly designed to improve care continuity for adultsacross withoperating SPMI such units as of ACT, the systemcase management, to realize the shared greatest care, value.” housing (Conrad first and & Shortell,discharge 1996). planning While will ideasbe outlined. about theseFinally abstracthighlights from the review literaturehealth service on the ‘processes’ association and between related continuity concepts and such integration as coordination on patient/client-level of care remain outcomes variable, such and as stories functioning of ‘fragmentation’ and quality of lifeand and system-level outcomes‘falling through such as the costs cracks’ will bepersist, presented, good alongprogress with has the beenimplications made inof thethese past findings decade for or policy.so on understanding their dimensions and how they can be operationalized in health services. While current evidence for their relationship with patient/client outcomes is not definitive – there is a basic foundation of knowledge to inform practice. In this presentation, what is currently meant by continuity of care (including from both provider and patient/client perspectives), integration and closely related concepts will be explored first. Next, the way that these ideas have been operationalized in mental health services, including examples from programs or interventions at least implicitly designed to improve care continuity for adults with SPMI such as ACT, case management, shared care, housing first and discharge planning will be outlined. Finally highlights from the review literature on the association between continuity and integration on patient/client-level outcomes such as functioning and quality of life and system-level outcomes such as costs will be presented, along with the implications of these findings for policy.

16 Consensus Development Conference on Improving Mental Health Transitions SPEAKERS & ABSTRACTS Speakers & Abstracts

Tim Aubry PhD, MA, BA Chairholder,Tim Aubry, Faculty PhD, of Social MA, Sciences BA Research Chair in Community Mental Health and Homelessness; Professor, SchoolChairholder, of Psychology Faculty and of Senior Social Researcher, Sciences ResearchCentre for ChairResearch in onCommunity Educational Mentaland Community Health and Services, UniversityHomelessness; of Ottawa, Professor, Ontario School of Psychology and Senior Researcher, Centre for Research on Educational and Community Services, University of Ottawa, Ontario Dr. Tim Aubry is a Full Professor in the School of Psychology and Senior Researcher at the Centre for Research onDr. Educational Tim Aubry and is aCommunity Full Professor Services in the at theSchool University of Psychology of Ottawa. and He Senioris currently Researcher holder of at the the Faculty Centre of forSocial SciencesResearch Research on Educational Chair in and Community Community Mental Services Health and at the Homele Universityssness. of Over Ottawa. the course He is ofcurrently his career, holder Dr. Aubry has collaborated on research projects with community organizations and government at all levels, contributing to the developmentof the Faculty of ofeffective Social socialSciences programs Research and Chairpolicies. in He Community was a Member Mental of the Health National and Research Homelessness. Team and the Co-LeadOver the of course the Moncton of his career,site in the Dr. multi-site Aubry has Mental collaborated Health and on Homelessness research projects Demonstration with community Project of the Mental Healthorganizations Commission and ofgovernment Canada. As at well, all levels,he is currently contributing the Co-Principal to the development Investigator of of effectivethe Housing social and Health in Transitionprograms study, and policies. a longitudinal He was multi-city a Member study of investigating the National the Research relationship Team of health and thestatus Co-Lead with housing of the transitions. Dr.Moncton Aubry is site a Fellow in the of multi-site the Society Mental for Community Health and Research Homelessness and Action. Demonstration He received the Project Award of for the Contribution Mental to Evaluation in Canada in 2013 from the Canadian Evaluation Society. He has served as the Senior Editor of the Health Commission of Canada.Canadian As well, Journal he is currentlyof Community the MentalCo-Principal Health (2005-2010).Investigator ofDr. the Aubry Housing teaches and graduate Health courses in Transition at the University of study, a longitudinal multi-cityOttawa study in investigating community psychology the relationship and program of health evaluation. status with housing transitions. Dr. Aubry is a Fellow of the Society for Community Research and Action. He received the Award for Contribution to Evaluation in Canada in 2013 Abstract: The Relationship Between Mental Illness and from the Canadian Evaluation Society. He has served asHomelessness: Findings from Prevalence Research and from the At Home / Chez the Senior Editor of the Canadian Journal of Community Mental Health Soi(2005-2010). Demonstration Dr. Aubry Project teaches in Canada graduate courses at the University of Ottawa in community psychology and program evaluation.

Background:Abstract: The The Relationship presence of seriousBetween persistent Mental mentalIllness illness and inHomelessness: the context of povertyFindings and from social Prevalence isolation has Research been identified and from in the the research At literatureHome / Chezas a both Soi aDemonstration risk factor for becoming Project homeless in Canada and a consequence of homelessness. The presentation will briefly review the findings of surveys of the prevalence of serious mental illness among homeless populations in western countries (Fazel et al., 2014). Subsequently, the demographic,Background: clinical, The presence and social of characteristicsserious persistent of over mental 2100 individualsillness in theparticipating context ofin thepoverty At Home and /social Chez Soiisolation (AHCS) has Canadian been identified Demonstration Projectin the research will be presented. literature These as a both will bea risk followed factor by for a presentation becoming homeless of the findings and a emergingconsequence from thisof homelessness. study in which theThe effectiveness presentation of Housingwill First approaches was compared to Treatment as Usual. briefly review the finding of surveys of the prevalence of serious mental illness among homeless populations in western countries Methods:(Fazel et al., Fazel 2014). and Subsequently,his colleagues (2014)the demographic, conducted a systematicclinical, and review social and characteristics meta-regression of analysisover 2100 of studiesindividuals conducted participating in 6 European in the countriesAt Home and / Chez the UnitedSoi (AHCS) States. Canadian The AHCS Demonstration Demonstration Project Project was will a non-blind-parallelbe presented. These group willRCT be in followed which the by outcomes a presentation of 1158 ofindividuals the receivingfindings Housingemerging First from (HF) this were study compared in which to 990 the individuals effectiveness receiving of HousingTreatment First as Usualapproaches (TAU). Individualswas compared in the to study Treatment were either as Usual. absolutely homeless or precariously housed (i.e., recent episodes of homelessness) and assessed as having high needs (i.e., lower functioning, diagnosed with moreMethods: severe Fazel mental and illness his colleagues and concurrent (2014) disorder conducted or recent a systematic hospitalizations review for and mental meta-regression illness or recent analysis arrest orof incarcerat studies conductedion) or moderate in needs. Participants6 European were countries followed and for the 24 Unitedmonths States.and data The was AHCScollected Demonstration on a wide range Project of outcomes was a thatnon-blind-parallel included housing group status RCTand instability, which service utilization,the outcomes health of status,1158 individuals and community receiving adaptation. Housing First (HF) were compared to 990 individuals receiving Treatment as Usual (TAU). Individuals in the study were either absolutely homeless or precariously housed (i.e., recent episodes of homelessness) Findings: The prevalence of alcohol and drug dependence as well as psychotic illnesses and personality disorders is higher in the homeless populationand assessed than as in having the general high population.needs (i.e., Thelower range functioning, of prevalence diagnosed of these with disorders more varied severe greatly mental across illness studies and concurrentand the prevalence disorder of oralcohol dependencerecent hospitalizations appears to have for mental increased illness over or recent recent decades. arrest or AHCS incarceration) participants or had moderate experienced needs. a significant Participants history were of followedhomelessness, for 24 and facedmonths multiple and data economic, was collected health, and on sociala wide challenges range of outcomesthat contributed that includedto their marginalization. housing status HF and was stability, found to service be more utilization, effective than health TAU in assistingstatus, and individuals community to rapidly adaptation. end homelessness, achieve housing stability, increase their quality of life, and improve their community functioning. Comprehensive costing of services received by the two groups showed HF to be almost cost neutral with HF program costs offset by savings in health,Findings: social, The and prevalence justice services. of alcohol and drug dependence as well as psychotic illnesses and personality disorders is higher in the homeless population than in the general population. The range of prevalence of these disorders varied greatly across studies Discussion:and the prevalence Prevalence of alcohol findings dependence from cross appearscountry observationalto have increased studies over along recent with characteristics decades. AHCS of AHCS participants participants had will experienced be discussed in thea significant context of thehistory needs of of homelessness, people with serious and faced mental multipleillness who economic, are homeless. health, Findings and social on thechallenges effectiveness that contributedof AHCS will tobe theircompared to and interpretedmarginalization. in the context HF was of foundfindings to beof previousmore effective American than research TAU inon assistingHF. Conclusions individuals / Policy to Recommendations:rapidly end homelessness, Program andachieve policy development recommendations will be proposed based on the findings from the reviewed prevalence research and from the AHCS study. housing stability, increase their quality of life, and improve their community functioning. Comprehensive costing of services received by the two groups showed HF to be almost cost neutral with HF program costs offset by savings in health, social, and justice services. Discussion: Prevalence findings from cross country observational studies along with characteristics of AHCS participants will be discussed in the context of the needs of people with serious mental illness who are homeless. Findings on the effectiveness of AHCS will be compared to and interpreted in the context of findings of previous American research on HF. Conclusions/Policy Recommendations: Program and policy development recommendations will be proposed based on the findings from the reviewed prevalence research and from the AHCS study.

Consensus Development Conference on Improving Mental Health Transitions 17 SPEAKERS & ABSTRACTS Speakers & Abstracts

Thomas Becker MedicalThomas Director Becker, & Chairman, Dr. Department Med. of Psychiatry II, Ulm University, Germany Medical Director & Chairman, Department of Psychiatry II, Ulm University, Germany Thomas Becker graduated in 1982, worked on psychiatric reform in Turin, Italy in 1982-1983 (doctoral thesis), subsequentlyDr. Thomas workedBecker ingraduated internal medicine in 1982, and worked neurology, on psychiatric started his specialistreform in training Turin, inItaly psychiatry in 1982-1983 in 1987, qualified as psychiatrist(doctoral thesis), in 1991, subsequently worked as senior worked medical in internal staff and medicine was appointed and neurology, lecturer (1994) started at the his Department specialist of Psychiatry oftraining Wuerzburg in psychiatry University. in His 1987, research qualified was on as neuroradiology psychiatrist in findings 1991, inworked patients as seniorwith psychotic medical disorders. staff and In 1995, hewas moved appointed to the lecturerSection of(1994) Community at the PsychiatryDepartment at the of PsychiatryInstitute of Psychiatry, of Wuerzburg King’s University. College London His research (Humboldt Foundationwas on neuroradiology scholarship) and findings was involved in patients in mental with health psychotic services disorders. research In and 1995, European he moved trials. to From the 1998 to 2002 he worked at the Department of Psychiatry of Leipzig University where he held a Public Health professorial appointment. HeSection was appointed of Community head of Psychiatry the Department at the of Institute Psychiatry of IIPsychiatry, of Ulm University King’s (atCollege the Bezirkskrankenhaus London (Humboldt Guenzburg) in 2002.Foundation His research scholarship) interest andis in wasmental involved health servicesin mental research, health servicessocial psychiatry research and and public European mental trials. health. From 1998 to 2002 he worked at the Department of Psychiatry of Leipzig University where he held Abstract: How effective are psychosocial interventions?a Public Health professorial appointment. He was appointed head of the Department of Psychiatry II of Ulm University (at the Bezirkskrankenhaus Guenzburg) in 2002. His research interest is in mental health services research, Background: Psychosocial interventions are essential tools in mental health care. A selection of these interventions is social psychiatry and public mentaldiscussed. health. Some themes covered in a German DGPPN S3 guideline on psychosocial interventions will be presented.

Methods:Abstract: LiteratureHow effective search andare (mostly)psychosocial systematic interventions? reviews were performed (in 2010/2011) for: milieu therapy (MT), peer involvement (PI), case management (CM) and intensive case management (ICM), vocational interventions, residential services, psychoeducation (PE), social skills training Background: Psychosocial interventions are essential tools in mental health care. A selection of these interventions is discussed. (SST),Some themesoccupational covered therapy in a (OT),German and DGPPNsports therapy S3 guideline (ST). on psychosocial interventions will be presented. Findings:Methods: /Milieu Literature therapy/ search MT andincludes (mostly) measures systematic that impinge reviews on weretherapeutic performed milieu/ (in atmosphere 2010/2011) in jointfor: professionalmilieu therapy / user (MT), groups peer in the course ofinvolvement treatment. MT (PI), provides case management a context in which (CM) treatment and intensive interventions case management can be implemented (ICM), andvocational treatment interventions, aims are reached. residential There isservices, evidence of itspsychoeducation effectiveness in improving(PE), social mental skills health training outcomes. (SST), /Peeroccupational involvement/ therapy PI and (OT), peer and support sports are therapy supported (ST). by promising evidence as innovative interventions in mental health care. /Case management/ Findings on CM are inconsistent. There are difficulties in defining CM. CM strengths include treatmentFindings: satisfaction /Milieu therapy/ and continuity MT includes of care. measuresCM was associate that impinged with increaseon therapeutic in inpatient milieu/ admissions, atmosphere inpatient in joint treatment professional duration /declined. user Reduction ofgroups inpatient in thetreatment course days of treatment. was greater MT if ICM provides teams a used context the ainssertive which community treatment treatment interventions (ACT) can approach. be implemented Higher fidelity and to treatment ACT was associated with reduction in inpatient days. Baseline level of inpatient days in a catchment area influenced the decline in inpatient days. Effects of introducing ICM wereaims relatedare reached. with level There of hospitalization is evidence ofprior its toeffectiveness ICM. /Vocational in improvinginterventions/ mental Studies health showed outcomes. supported /Peer employment involvement/ (SE) toPI be and more peer effective in achievingsupport are job supportedplacement. byA proportion promising of evidence SE users asfail innovative to find jobs interventions on the general in labour mental market. health Other care. types /Case of management/work rehabilitation Findings are required, on and thereCM are is room inconsistent. for pre-vocational There aretraining difficulties interventions. in defining Effectiveness CM. of CMpre-vocational strengths include training treatment can be improved satisfaction by financial and continuity incentives of and care. psychological CM interventions.was associated /Residential with increase services/ in inpatient There is aadmissions, lack of evidence inpatient on residential treatment services duration for peopledeclined. with Reduction severe mental of inpatient illness. Studies treatment suggest days that supportedwas greater housing if ICM arrangements teams used thecan assertivelead to a reductioncommunity in inpat treatmentient admissions/ (ACT) approach. treatment days.Higher Reduction fidelity into duration ACT was of hospiassociatedtalization with can be achieved by providing long-term residential care. Improved negative symptoms and social networks were reported in dehospitalization studies. Evidence suggestsreduction that in institutionalizationinpatient days. Baseline is associated level ofwith inpatient negative days effects. in a/Psychoeducation/ catchment area influencedThere is a variability the decline of results in inpatient on PE. Withdays. the Effects exception of theof introducing NICE schizophrenia ICM were guideline related meta-analyses with level of pointhospitalization at positive effects prior toof PEICM. with /Vocational respect to knowledge interventions/ acquisition, Studies relapse showed reduction supported and inpatient readmissions.employment (SE)/Social to skills be more training/ effective Social infunctioning achieving and job level placement. of social adaptationA proportion of patients of SE userscan be fail improved to find byjobs SST. on Effects the general on other outcome parameterslabour market. are less Other homogenous. types of work /Occupational rehabilitation therapy/ are Single-armrequired, andpre-post there studies is room of OTfor withoutpre-vocational control groups training were interventions. not considered. Systematic reviewsEffectiveness could not of bepre-vocational found. There istraining a substantial can be lack improved of high-quality by financial studies onincentives OT. /Sports and therapy/ psychological ST can reduceinterventions. positive and/Residential negative symptoms, depressive symptoms and anxiety (vs standard treatment). Physical health parameters could be improved. When physical training was compared with yogaservices/ rather There than standard is a lack treatmentof evidence positive on residential effects of physical services training for people disappeared. with severe Yoga mentalwas more illness. effective Studies regarding suggest some that outcome supported parameters. A RCThousing (in patients arrangements with psychosis) can lead showed to a reduction physical trainingin inpatient to be superioradmissions/ to a controltreatment condition days. and Reduction to lead to in increased duration hippocampal of hospitalization volume. can be achieved by providing long-term residential care. Improved negative symptoms and social networks were reported in Discussion:dehospitalization Psychosocial studies. interventions Evidence suggests are strong that interventions. institutionalization The strength is associated of the evidence with negativeis varied. effects.Occupational /Psychoeducation/ therapy requires effectivenessThere research.is a variability The use of resultsof psychosocial on PE. With interventions the exception rests on of experience, the NICE evidenceschizophrenia and ethics. guideline meta-analyses point at positive effects of Conclusions/ Policy Recommendations: PE with respect to knowledge acquisition,Psychosocial relapse reduction interventions and inpatientare indispensable readmissions. in building /Social mental skills health training/ care systems. Social functioning Vocational interventionsand level of socialand residential adaptation services of patients are mandatory. can be improved Social skills by training SST. Effects and sports on othertherapy outcome are important parameters tools. Peerare less involvement homogenous. could /help in moving mentalOccupational health services therapy/ forward. Single-arm pre-post studies of OT without control groups were not considered. Systematic reviews could not be found. There is a substantial lack of high-quality studies on OT. /Sports therapy/ ST can reduce positive and negative symptoms, depressive symptoms and anxiety (vs standard treatment). Physical health parameters could be improved. When physical training was compared with yoga rather than standard treatment positive effects of physical training disappeared. Yoga was more effective regarding some outcome parameters. A RCT (in patients with psychosis) showed physical training to be superior to a control condition and to lead to increased hippocampal volume. Discussion: Psychosocial interventions are strong interventions. The strength of the evidence is varied. Occupational therapy requires effectiveness research. The use of psychosocial interventions rests on experience, evidence and ethics. Conclusions/Policy Recommendations: Psychosocial interventions are indispensable in building mental health care systems. Vocational interventions and residential services are mandatory. Social skills training and sports therapy are important tools. Peer involvement could help in moving mental health services forward.

18 Consensus Development Conference on Improving Mental Health Transitions Speakers &SPEAKERS Abstracts & ABSTRACTS

Dan Cohen MD PhD DepartmentDan Cohen, Chronic MD, Psychiatry, PhD Mental Health Care North-Holland North, Heerhugowaard, The Netherlands StudiedDepartment Medicine Chronic in Amsterdam Psychiatry, and specialized Mental Health in Psychiatry Care inOrganisation Gent (Belgium) North-Holland and Leiden (Netherlands). North, Doctorate onHeerhugowaard, thesis “Diabetes mellitusThe Netherlands in schizophrenia and schizoaffective disorder: an iatrogenic or endogenic problem? (Utrecht 2006) Affiliations:Dr. Dan Cohen studied Medicine in Amsterdam and specialized in Psychiatry in Gent (Belgium) and -Leiden Department (Netherlands). of Clinical Epidemiology,Doctorate on Universitythesis “Diabetes Groningen mellitus (Netherlands) in schizophrenia and schizoaffective -disorder: Assertive an Community iatrogenic Treatment or endogenic Heerhugowaard problem? (Utrecht 2006) - Out-patient clinic for metabolic disturbances in patients with SMI Affiliations: Lectures• Department regularly of Clinicalon the issue Epidemiology, of diabetes mellitusUniversity and Groningenother metabolic (Netherlands) disorders in schizophrenia and related diseases. Member• Assertive of advisory Community board Treatmentof Eli Lilly and Heerhugowaard Bristol-Myers Squibb Abstract:• Out-patient clinic for metabolic disturbances in patients with SMI He lectures regularly on the Traditionally,issue of diabetes patients mellitus were admittedand other to metabolica psychiatric disorders hospital infor schizophrenia treatment. Once and outside related their diseases. own familiar environment, Memberthey often of needed advisory further board treatment of Eli Lilly for so and called Bristol-Myers (re-)socialization. Squibb. In contrast, for optimal recovery and patient satisfaction, patients need maximum control over their own life, supplemented with support on demand and or when indicated in those parts of their behaviour, in which they are more or less dysfunctional. Abstract:Transition toIntegrating outpatient-based Crisis treatment and ACT is teams. a complex undertaking, that requires changes in the whole organization, on all levels and in all segments. Traditionally,In accordance patientswith the lawwere of admittedsupply and to demand, a psychiatric existing hospital beds tend for totreatment. be filled Oncewith patients outside with their an indicationown familiar for hospitalienvironment,zation. Most they patients suffer from schizophrenia, bipolar disorder, personality disorder, some with comorbid addictive disorders. In short, they are patients with severe mental illness often(SMI). Changeneeded furtherneeds to treatment start with thefor developmentso called (re-)socialization. of an adequate outpatientIn contrast, supply for thatoptimal replaces recovery inpatient and care.patient Transition satisfaction, will be patientsaccompanied by a needshift of maximum costs, not controlby cost reduction.over their own life, supplemented with support on demand and or when indicated in those parts of their behaviour, in which they are more or less dysfunctional. FACT Transition- Development to outpatient-based and installation of treatmentfunctional assertiveis a complex community undertaking, treatment that teams requires (FACT). changes The Netherlands in the whole has organization, currently approximately on all levels 200 FACT- andteams. in all segments. In accordance with the law of supply and demand, existing beds tend to be filled with patients with an indication-FACT-teams for are hospitalization. a multidisciplinary Most team patients that is suffer responsible from forschizophrenia, all patients with bipolar SMI in disorder, a catchment. personality Every team disorder, has one some psychiatrist, with comorbid one psychologist, addictive6-8 care-providers disorders. with In a short, nursing they background are patients who with have severe a caseload mental of 19illness patients (SMI). for full-timeChange equivalent,needs to start social with psychiatric the development nurses, a dual-diagnosisof an adequatenurse, an outpatientindividual placement supply that and replaces support inpatient(IPS) worker care. and Transition a peer-worker. will be accompanied by a shift of costs, not by cost reduction. -Flexible treatment. Treatment is provided according to the needs of the patients as assessed by the care provider. The frequency of contact with the FACTcare provider normally varies from one a week to once every month. When indicated, the intensity of care can be upgraded to daily home visits, during •working Development hours and, and if needed, installation in the ofweekend functional as well. assertive community treatment teams (FACT). The Netherlands has currently - Shared caseload . Every patient is paired to a care provider. However, during holidays of the care provider or when intensification of care is needed, the approximatelypatient is phoned 200 or FACT-teams.visited by different team members. •-Catchment FACT-teams area andare asize multidisciplinary of caseload. The team maximum that iscaseload responsible of a teamfor all should patients be fixedwith SMIat around in a catchment.200 patients. Every This teamallows hasteam one members to acquire basicpsychiatrist, knowledge ofone all psychologist, patients in care. 6-8 The care-providers catchment area with is determineda nursing background by the size of who the patients:have a caseload 50.000 inhabitantsof 19 patients is feasible for full-time in the rural parts of North-Holland,equivalent, while social in psychiatricthe one main nurses, city of Alkmaara dual-diagnosis 3 teams are nurse, required an individual for a population placement of 95.000 and inhabitants.support (IPS) worker and a peer- - Assertiveness.worker. Exaggerated, the ideal office of FACT-team is empty because all care providers make home visits. In assertive treatment, the need of the patients for FACT-care is assessed by their care provider, independent of the patients need for psychiatric care. •-individual Flexib leresponsibility treatment. ofTreatment psychiatric is nurses.provided The according core skill to of thenurses, needs who of constitutethe patients the asmajority assessed of the by team,the care is their provider. individual The responsibility. frequency As theyof are contact the ones with who the make care theprovider home visit,normally it is the varies care fromprovider one who a week has assessto once severity every month. of the patient When at indicated, home and thewhether intensity to consult of care a colleague, psychologistcan be upgraded or psychiatrist, to daily because, home visits,when somethingduring working goes wrong, hours thisand, nurse if needed, is the personin the weekendwho has made as well. the last home visit and (s)he will be asked •why Sh noared consultation caseload took . Every place. patient is paired to a care provider. However, during holidays of the care provider or when intensification of care is needed, the patient is phoned or visited by different team members. Recommended reading •Veldhuizen Catchment R van. area FACT: and Asize Dutch of caseload. version of The ACT. Communitymaximum caseloadMental Health of a team J 2007; should 43:421-433. be fixed at around 200 patients. This allows Bondteam GR, members Drake RE. to Should acquire we basic adopt knowledge the Dutch version of all patients of ACT? in care. The catchment area is determined by the number of the Commentarypatients: 50.000on “FACT: inhabitants a Dutch version is feasible of ACT”. in the Community rural parts Ment of North-Holland, Health J. 2007; 43:435-358. while in the one main city of Alkmaar 3 teams are Drukkerrequired M et foral. A a real-lifepopulation observational of 95.000 study inhabitants. of the effectiveness of FACT in a Dutch mental health region. BMC Psychiatry 2008, 8; 93 • Assertiveness. Exaggerated, the ideal office of ACT-team is empty because all care providers make home visits. In assertive treatment, the need of the patients for FACT-care is assessed by their care provider, independent of the patients need for psychiatric care. • Individual responsibility of psychiatric nurses. The core skill of nurses, who constitute the majority of the team, is their individual responsibility. As they are the ones who make the home visit, it is the care provider who must assess severity of the patient at home and whether to consult a colleague, psychologist or psychiatrist, because, when something goes wrong, this nurse is the person who has made the last home visit and (s)he will be asked why no consultation took place. Recommended reading Veldhuizen R van. FACT: A Dutch version of ACT. Community Mental Health J 2007; 43:421-433. Bond GR, Drake RE. Should we adopt the Dutch version of ACT? Commentary on “FACT: a Dutch version of ACT”. Community Ment Health J. 2007; 43:435-358. Drukker M et al. A real-life observational study of the effectiveness of FACT in a Dutch mental health region. BMC Psychiatry 2008, 8; 93.

Consensus Development Conference on Improving Mental Health Transitions 19 Speakers & AbstractsSPEAKERS & ABSTRACTS

GiovanniGiovanni dede GirolamoGirolamo, MD, MD, PhD PhD IRCCSDepartment Unit of ofPsychiatric Mental Health, Epidemiology AUSL and di Bologna, Evaluation, Bologna, Italy Italy Dr. Giovanni de Girolamo is the former Scientific Director of the St John of God Clinical Research Giovanni de Girolamo is the former Scientific Director of the St John of God Clinical Research Centre (IRCCS) Centre (IRCCS) in Brescia, Italy. Currently he is the Head of the IRCCS Unit of Psychiatric Epidemiologyin Brescia, Italy.and Evaluation. Currently He he has is athe Degree Head in Medicineof the IRCCS and a Postgraduate Unit of Psychiatric Degree in EpidemiologyPsychiatry and Evaluation. He (Universityhas a Degree of Naples). in Medicine He has received and a FellowshipsPostgraduate as short-term Degree Visiting in Psychiatry Fellow at (University the Institute of Naples). He has received PsychiatryFellowships in London as short-term (with Prof. Visiting Michael FellowShepherd), at atthe the Institute Institute of PsychiatricPsychiatry Demography in London (with Prof. Michael Shepherd), inat Aarhus the Institute (Denmark, of Psychiatricwith Prof. Annalise Demography Dupont), andin Aarhus at the Western (Denmark, Psychiatric with InstituteProf. Annalise and Dupont), and at the Western ClinicPsychiatric in Pittsburgh, Institute (USA, and with Clinic Prof. inDavid Pittsburgh, Kupfer). From(USA, 1988 with to 1994,Prof. he David worked Kupfer). at the Division From 1988 to 1994, he worked ofat Mental the Division Health of of the Mental World Health Organization of the World in Geneva,Health Organizationunder the guidance in Geneva, of Norman under the guidance of Norman Sartorius.Sartorius. From From 1998 1998 to 2001 to he2001 was thehe Coordinatorwas the Coordinator of the Italian of N.I.H. the ItalianNational N.I.H. Mental National Health Mental Health Project, Project, which involved morewhich than 100 involved centres throughoutmore than Italy. 100 He centres has set upthroughout and directed Italy. several He multicentre has set up research and directed projects; several multicentre research projects; this isthis a selection: is a selection: (i) (i)the the national national survey of of psychiatric psychiatric residential residential facilities facilities (the largest (the survey largest ever survey done in ever this area), done called in this area), called PROGRES; (ii) the national surveyPROGRES; on all acute (ii) theinpatient national facilities, survey on calledall acute PROGR inpatientES-Acute facilities, called (equally PROGRES-Acute the largest (equally survey the ever largest done survey in this ever area); done (iii) the Italian site of the WHO World Mental Healthin this area); Survey (iii) Initiative,the Italian siteled ofby the Ronald WHO WorldKessler Mental (Harvard Health University);Survey Initiative, (iv) led the by large Ronald experimental Kessler (Harvard trial University); on first-episode psychotic patients, (iv) the large experimental trial on first-episode psychotic patients, called ‘GET-UP’, involving 110 Italian Community Mental called ‘GET-UP’, involving 110 Italian Community Mental Health Centres; (v) a trial on the use of intranasal oxytocin for the treatment of schizophrenia; Health Centres; (v) a trial on the use of intranasal oxytocin for the treatment of schizophrenia; and (vi) the European 8-country and (vi) the Europeanproject MILESTONE 8-country projecton the transition MILESTONE from child/adolescent on the transition to adult from mental child/adolescent health services. toHe adulthas been mental awarded health funding services. He has been awarded of funding from thefrom European the European Commission Commission for for the the organization organization of of an an European European Conference Conference on ‘Youth on mental ‘Youth health: mental from health: continuity from of continuity of psychopatology to continuity of care’,psychopathology Venice, December to continuity 2014. of care’, His Venice, research December focuses 2014. on His psychiatric research focuses epidemiology on psychiatric and epidemiology health services and health research; RCT in psychiatry; drug- utilization studies;services quality research; of life. RCT He in ispsychiatry; the author drug-utilization of 345 publications, studies; quality including of life. He40 isvolumes the author or of monographs 345 publications, edited including or author 40 ed, 251 journal articles (of which 202 indexedvolumes in Pubmed)or monographs and edited68 book or authored, chapters. 251 journal articles (of which 202 indexed in Pubmed) and 68 book chapters.

Abstract: ResidentialAbstract: ResidentialFacilities: Facilities: are they are promoting they promoting recovery recovery or or are are theythey ‘homes ‘homes for for life’? life’? Background: The closure of mental hospitals in Europe has seen the parallel growth of a large network of Residential Facilities Background: The(RFs) closure for patients of mentalneeding medium-hospitals or in long-term Europe mentalhas seen health the care. parallel Yet there growth are a number of a large of unsolved network controversies of Residential about Facilitiesthe (RFs) for patients needing medium-role orand long-term the functions mental of RFs. health Probably care. the mainYet there point areof controversy a number is ofto clearlyunsolved define controversies whether they shouldabout bethe conceptualized role and the as functions of RFs. Probably the main point intensiveof controversy treatment is programmes, to clearly define or merely whether as ordinary they homes should or beliving conceptualized settings for people as who intensive participate treatment fully in treatment programmes, and or merely as ordinary homes or livingpsychosocial settings for programmes people who provided participate by local fully mental in treatmenthealth services. and psychosocial programmes provided by local mental health services. Methods: The literature on RFs has been reviewed, and data from the Italian survey on RFs, the PROGRES study, the largest Methods: The surveyliterature done on internationally RFs has been so far reviewed, in this area, and as well data as from from a theprospective Italian studysurvey (the on PERDOVE RFs, the study) PROGRES on 403 residents, study, the have largest survey done internationally sobeen far analyzed in this toarea, draw as some well general as from lessons a prospect in this area.ive Findings study (theIn Italy, PERDOVE where all mental study) hospitals on 403 have residents, been phased have out, been analyzed to draw some general lessons in this psychiatricarea. Findings patients In requiring Italy, where long-term all mental care are hospitals being treated have in RFs. been The phased PROGRES out, project psychiatric in 2000 patientsfound in allrequiring Italy 1,370 long-term care are being treated in RFs. The PROGRESRFs with project17,138 beds, in 2000 an average found of in12.5 all beds Italy each 1,370 10,000 RFs population with 17,138 and a beds,rate of 2.98an average beds per 10,000 of 12.5 inhabitants. beds each Residential 10,000 population and a rate of 2.98 beds per 10,000provision inhabitants. varied ten-foldResidential between provision regions and varied discharge ten-f ratesold between were very low.regions Most andhad 24-hourdischarge staffing rates with1.42 were very patients low. per Most had 24-hour staffing with 1.42 patients perfull-time full-time worker. worker. In the In second the second phase of phasethe project of the2,962 project patients 2,962 living inpatients the sampled living facilities in the weresampled individually facilities assessed; were most individually assessed; most were males. A substantialwere males. proportion A substantial (39.8%) proportion had (39.8%)never hadworked never andworked very and few very were few were currently currently employed employed (2.5%)(2.5%) ; ;45% 45% of theof the sample was totally inactive, sample was totally inactive, not even assisting with domestic activities in the facility. Two-thirds had a diagnosis of schizophrenia. not even assisting with domestic activities in the facility. Two-thirds had a diagnosis of schizophrenia. In the PERDOVE study, after 1-year follow-up, only In the PERDOVE study, after 1-year follow-up, only 14% of patients were discharged to independent accommodations. Discussion 14% of patients were discharged to independent accommodations. Discussion For many patients with severe mental disorders and marked disabilities, For many patients with severe mental disorders and marked disabilities, limited or absent social support and increasing age, RFs limited or absentrepresent, social andsupport will represent, and increasing ‘Homes for age, life’, RFsas Julian repre Leffsent, named and RFs will in represent,the framework ‘Homes of the landmark for life’, asTAPS Julian project. Leff named RFs in the framework of the landmark TAPS project. Conclusions/Policy Recommendations: There is the need to develop a clear taxonomy of RFs, based on specific operational criteria. This taxonomy should spell out acceptable ranges of available RFs, staffing levels, optimal size, satisfactory environmental Conclusions/Policy Recommendations: There is the need to develop a clear taxonomy of RFs, based on specific operational criteria. This taxonomy features and activities needed to fill residents’ weekly time, and in particular weekends, evenings, and so on. Precise patients’ should spell outinclusion acceptable criteria ranges should beof developed;available allRFs, patients staffing that are levels, candidates optimal for residentialsize, satisfactory facility admission environmental should receive features careful, and activities needed to fill residents’ weeklymultidimensional time, and in assessments,particular weekends, highlighting evenings,not only clinical and characteristics so on. Precise but alsopatients’ impairments inclusion in social criteria and shouldvocational be developed; all patients that are candidates for roles.residential Management facility plans admission and related should organizational receive frameworks careful, multidimensional should match residents’ assessments, typologies and highlighting their various not needs only clinical characteristics but also impairments inand social requests. and Patients’vocational rehabilitation roles. Management plans should be plans carefully and monitored related organizational with appropriate frameworksinstruments. Avoiding should anmatch indistinct residents’ typologies and their various needs caseand mixrequests. (i.e. aged Patients’ patients mixed rehabilitation up with young, plans treatment-resistant should be carefully patients) monitored in RFs is awith prerequisite appropriate for the instruments. development of Avoiding an indistinct case mix (i.e. aged patientstailored mixed treatment up with plans young, and for treatment-resistant transforming RFs into pa effectivetients) rehabilitation in RFs is a settingsprerequisite for those for patients the development with realistic prospectsof tailore ofd treatment plans and for transforming RFsrehabilitation. into effective This rehabilitationstrategy also implies settings the selection for those of staffpatients with withspecific realistic characteristics, prospects and ofa reasonablerehabilitation. staff turnoverThis strategy should be also implies the selection of staff with specificforeseen characteristics, to prevent burnout. and a reasonable staff turnover should be foreseen to prevent burnout.

20 Consensus Development Conference on Improving Mental Health Transitions Speakers &SPEAKERS Abstracts & ABSTRACTS

Philippa Garety MA, MPhil, MA(Ed), PhD, FBPsS Professor of Clinical Psychology, Clinical Director, Psychosis Clinical Academic Group (CAG), South London and MaudsleyPhilippa NHS Garety, Foundation MA, Trust, MPhil,United Kingdom MA(Ed), PhD, FBPsS

PhilippaProfessor Garety of Clinical PhD is Professor Psychology, of Clinical Clinical Psychology Director, at the Psychosis Institute ofClinical Psychiatry, Academic King’s College Group London (CAG), and aSouth consultant London clinical and psychologist Maudsley and NHS joint Foundationdirector of the Trust,Psychosis United Clinical Kingdom Academic Group, South London and Maudsley NHS Foundation Trust. She was awarded her first degree in Philosophy and Psychology (Natural Sciences) byDr. Cambridge Philippa GaretyUniversity. is Professor She qualified of Clinical as a clinical Psychology psychologist at the in Institute 1981 at theof Psychiatry,Institute of Psychiatry,King’s College followed by completingLondon and a PhD a consultant on cognitive clinical processes psychologist in delusions. and jointSince director then she ofhas the combined Psychosis research Clinical with Academic clinical practice andGroup, service South development. London and Her Maudsley main focus NHS of research Foundation has been Trust. the She investigation was awarded of how her cognitive first degree and emotional in processes,Philosophy such and as Psychology particular thinking (Natural styles Sciences) or anxiety, by Cambridge contribute to University. psychosis, together She qualified with therapy as a clinicaldevelopment, inpsychologist particular CBT in 1981for psychosis. at the Institute Her work of continuesPsychiatry, to translatefollowed the by findingscompleting of theoretical a PhD on and cognitive empirical research into improvements in treatments and service provision. With colleagues, she established one of the first comprehensive Earlyprocesses Intervention in delusions. services Since for people then shewith haspsychosis combined (LEO) research in the late with 1990s. clinical She practice is currently and involved service in leading a nationaldevelopment. programme Her mainof Improving focus ofAccess research to Psychological has been the Therapies investigation for People of how with cognitive Severe Mental and emotional Illness (IAPT- SMI),processes, a UK governmentsuch as particular initiative thinking to increase styles fair accessor anxiety, to evidence-based contribute to psychologicalpsychosis, together therapies. with Her therapy psychological development, in particular CBTtreatment for psychosis. research Hercomprises work continuesrandomised to controlled translate trials the findingsof newer developments of theoretical of and CBT empirical for psychosis research and into improvements in treatmentsinvestigations and service of psychological provision. Withprocesses colleagues, which predict she established therapy adherence one of the and first outcome. comprehensive She was awarded Early the Shapiro lifetime achievement award in 2002 by the Division of Clinical Psychology Society and in 2007 was selected as a Senior Investigator of the NationalIntervention Institute services of Health for Research.people with psychosis (LEO) in the late 1990s. She is currently involved in leading a national programme of Improving Access to Psychological Therapies for People with Severe Mental Illness (IAPT-SMI), a UK government initiative Abstract: What is the effectiveness of psychological therapies to increase fair access to evidence-based psychological therapies.for people with severe and persistent mental illness? Her psychological treatment research comprises randomised controlled trials of newer developments of CBT for psychosis and investigations of psychological processes which predict therapy Background: People with Severe and Persistent Mental Illness (SPMI) frequently experience persisting psychotic symptoms and mood disturbances thatadherence affect everyday and outcome. life, causing She was personal awarded distress, the Shapiroimpeding lifetime social and achievement vocational functioning award in 2002 and leading by the toDivision relapse ofand Clinical re-hospitalisation. Psychology Although theSociety first lineand inof treatment 2007 was for selected SPMI is as typically a Senior medication, Investigator many of experience the National a sub-optimal Institute ofresponse. Health Research.Psychological therapies (PTs) have been developed to address these needs. Abstract: What is the effectiveness of psychological therapies for people with severe and persistent mental illness? Methods: Review of meta-analyses, guidelines, expert commentaries and publications from service user / campaigning groups. Wherever possible, evidenceBackground: for effectiveness People with for Severepeople andspecifically Persistent with Mental SPMI wasIllness considered. (SPMI) frequently experience persisting psychotic symptoms and mood disturbances that affect everyday life, causing personal distress, impeding social and vocational functioning and leading Findings:to relapse Theand PTsre-hospitalisation. identified as having Although the strongest the first evidence line of basetreatment as helpful for forSPMI people is typically with SPMI medication,are ‘high intensity’ many experiencecognitive behaviour a sub- therapy (CBT) and structured family interventions (FI). FIoptimal is effective response. in reducing Psychological relapse and therapies rehospitalisation (Ps) have in beenpeople developed with psychosis to address and bipolar these disorder. needs. However, it is only suitable for those in close contactMethods: with Review and willing of meta-analyses, to involve family guidelines, members. This expert may commentaries be a relatively smalland publications proportion of peoplefrom service with SPMI. user / campaigning groups. CBT is helpful for people with persistent, distressing, medication-unresponsive psychotic symptoms. There is emerging evidence that it may be effectiveWherever and possible, safe for peopleevidence who for refuse effectiveness to take medication. for people In specificallyaddition, CBT withtailored SPMI to specific was considered. diagnostic groups and/or target problems can help with emotionalFindings: problems The PTs and identified self management as having in psychosis,the strongest bipolar evidence disorder base and as personality helpful for disorders. people with SPMI are ‘high intensity cognitive Therebehaviour is also therapy evidence (CBT) supporting and structured other approaches family includinginterventions interpersonal (FI). FI therapy,is effective mentalisation-based in reducing relapse therapies and andrehospitalisation arts therapies forin specific diagnostic sub-groups/problems. Servicepeople withuser/ psychosisconsumer groupsand bipolar are increasingly disorder. However,demanding it fair is onlyaccess suitable to PTs. for those in close contact with and willing to involve family Evenmembers. where This policies may recommend be a relatively the provision small proportion of PTs, there of arepeople many withreports SPMI. of difficulties CBT is helpful in implementation for people andwith obstaclespersistent, to fairdistressing, access. medication-unresponsive psychotic symptoms. There is emerging evidence that it may be effective and safe for people who refuse Discussion:to take medication. The evidence In addition, for PTs forCBT SPMI tailored has been to specific accumulating diagnostic over the groups past twoand/or decades, target and problems is now strong can help enough with to emotional recommend its routine use. Research into how effective it is for specific sub-groups of people with SPMI remains, however, limited. Theproblems barriers and to fairself-management access are at national in psychosis, and regional bipolar policy, disorder local system, and personality service and disorders. individual levels. Implementation therefore requires sustained systematicThere is also programmes, evidence andsupporting is much enhancedother approaches by advocacy including and support interpersonal from service therapy, user/ consumermentalisation-based groups. therapies and arts therapies for specific diagnostic sub-groups/problems. Conclusions/ Policy Recommendations: 1.MedicationService user/ alone consumer is not the groups optimal are treatment increasingly for people demanding with SPMI. fair Pharmacotherapyaccess to PTs. should therefore be combined with evidence-based PT for optimal treatment effectiveness. 2.TheEven whereevidence policies base is recommend strong for ‘high the intensity’ provision CBT of andPTs, FI. there are many reports of difficulties in implementation and obstacles to fair 3.access. Where people refuse pharmacotherapy, emerging evidence suggests that it is acceptable and safe to provide CBT alone. 4.PTs differ in aims and methods and may address specific targets, such as command hallucinations, persecutory delusions, emotional problems. 5.ChoiceDiscussion: of PT The should evidence be offered for inPTs partnership for SPMI with has thebeen service accumulating user and family over theto promote past two service decades, user’s and recovery is now and strong self-management enough to goals, in a widerrecommend context ofits recovery-focussed routine use. Research services. into how effective it is for specific sub-groups of people with SPMI remains, however, 6.Tolimited. improve The access barriers to PTs,to fair national, access regionalare at national and local and organisational regional policy, programmes local system, and training service developments and individual are required. levels. Implementation The involvement of service user and consumer groups is an important component of advocacy, policy development and implementation. therefore requires sustained systematic programmes, and is much enhanced by advocacy and support from service user/ consumer 7.Furthergroups. research is required on the application of PTs with sub-groups of people with SPMI. Conclusions/Policy Recommendations: 1. Medication alone is not the optimal treatment for people with SPMI. Pharmacotherapy should therefore be combined with evidence-based PT for optimal treatment effectiveness. 2. The evidence base is strong for ‘high intensity’ CBT and FI. 3. Where people refuse pharmacotherapy, emerging evidence suggests that it is acceptable and safe to provide CBT alone.

Consensus Development Conference on Improving Mental Health Transitions 21 SPEAKERS & ABSTRACTS

4. PTs differ in aims and methods and may address specific targets, such as command hallucinations, persecutory delusions, emotional problems 5. Choice of PT should be offered in partnership with the service user and family to promote service user’s recovery and self- management goals, in a wider context of recovery-focussed services. 6. To improve access to PTs, national, regional and local organisational programmes and training developments are required. The involvement of service user and consumer groups is an important component of advocacy, policy development and implementation. 7. Further research is required on the application of PTs with sub-groups of people with SPMI.

22 Consensus Development Conference on Improving Mental Health Transitions SPEAKERS & ABSTRACTS Speakers & Abstracts

LindaLinda Gask Gask, MSc, PhD, FRCPsych, FRCGP ProfessorProfessor of Primary Care Care Psychiatry, Psychiatry, National National Primary Primary Care ResearchCare Research and Development and Development Centre (NPCRDC), University of Manchester, UK. Centre (NPCRDC), University of Manchester, UK Dr.Linda Linda Gask Gask is Emerita is Emerita Professor Professor of Primary of Primary Care Care Psychiatry Psychiatry at the at Universitythe University of Manchester, of Manchester, where she has worked wherewith the she Centre has worked for Primary with Carethe Centre since 1992.for Primary She trained Care sincein medicine 1992. She in Edinburgh, trained in medicineand in psychiatry in in the North West of England, and worked for many years as a Consultant Psychiatrist, latterly in Salford in Greater Manchester where Edinburgh, and in psychiatry in the North West of England, and worked for many years as a she helped to found an innovative primary care based mental health service. She retired from clinical practice in 2013. ConsultantHer research Psychiatrist, initially focused latterly on in the Salford impact in of Greater training Manchester front line health where professionals, she helped to particularly found an General Practitioners, innovativein mental health primary skills, care with based a focus mental on managinghealth service. depression, She retired medically from clinicalunexplained practice symptoms in 2013. and managing people Herwho researchat risk of initially self-harm. focused She helped on the toimpact develop of trainingand evaluate front thlinee STORM health professionals, suicide prevention particularly initiative, which has been Generaldisseminated Practitioners, throughout in mentalthe world. health She skills, spent witha year a focus as a Harkneon managingss Fellow depression, in Health medicallyPolicy Research and Practice, unexplainedbased with at symptoms the Centre and for managingHealth Studies, people Group who Healthare at risk Cooperative of self-harm. in Seattle, She helped with Edto developWagner, where she developed and evaluate the STORM suicidean interest prevention in Chronic initiative, Illness which Care. has Since been thendisseminated she has been throughout involved the in world.four randomized She spent controlleda year as trials of Collaborative a Harkness Fellow in Health PolicyCare for Research mental andhealth Practice, problems, based including at the Centre depression for Health both with Studies, and withoutGroup Healthco-morbid Cooperative physical illness. She is now developing an intervention for collaborative care (across the interface between primary and specialist care) for people in Seattle, with Ed Wagner, where she developed an interest in Chronic Illness Care. Since then she has been involved in four with severe and enduring mental illness (National Institute for Health Research Programme Grant led by Max Birchwood inrandomized Birmingham controlled UK). Linda trials has of published Collaborative more Carethan 150for mental peer reviewed health problems, academic includingpapers, authored depression or edited both with half aand dozen without textbooks co- on psychiatry and mentalmorbid health. physical She illness. has been She isan now advisor developing for the Worldan intervention Health Organization, for collaborative working care on (across ICD-11 the Primary interface Care, between and a zonalprimary representative and for the World Psychiatricspecialist care) Association. for people She with is ansevere Honorary and enduring Fellow of mental the Royal illness College (National of General Institute Practitioners. for Health Research Programme Grant led by Max Birchwood in Birmingham UK). Linda has published more than 150 peer reviewed academic papers, authored or edited Abstract :How can family physicians best support people with half a dozen textbooks on psychiatry and mental health. She has beenSPMI in the community? an advisor for the World Health Organization, working on ICD-11 Primary Care, and a zonal representative for the World Psychiatric Association. She is an Honorary Fellow of the Royal Background:College of General For people Practitioners. with SPMI, primary care (PC) will be a key (and sometimes only) contact point for health care. However, despite PC offering a less stigmatized setting for care than mental health services, many people with SPMI avoid PC services or attend less frequently than would be expected. Despite the major risk of physical co-morbidity in SPMI, less routine screening or health checks are provided in PC for people with SPMI, and fewerAbstract: interventions How can offered family tophysicians improve physical best support health people care. Family with SPMI physicians in the (FPs) community? report lack of support, problems across the interface with specialist services,Background: and difficultyFor people arranging with SPMI, follow-up primary and care timely (PC) re-refer will ralbe ina keyrelapse (and with sometimes uncertainty only) about contact roles point and forresponsibilitie health care.s. However, Some FPs view SPMI as beyonddespite PCtheir offering remit. a less stigmatized setting for care than mental health services, many people with SPMI avoid PC services or attend less frequently than would be expected. Despite the major risk of physical co-morbidity in SPMI, less routine screening or Methods: Narrative review of existing descriptive literature on how family physicians can support people with SPMI with review of recent systematic reviewshealth checks of interventions. are provided in PC for people with SPMI, and fewer interventions offered to improve physical health care. Family physicians (FPs) report lack of support, problems across the interface with specialist services, and difficulty arranging follow-up Findings:and timely Improving re-referral access in relapse to primary with uncertainty care: Mental about health roles workers and responsibilities. have a key role Some in linking FPs viewpeople SPMI with as SPMI beyond into theirprimary remit. care. PhysicalMethods: health Narrative monitoring review in of primary existing care: descriptive A number literature of interventions on how familyhave been physicians described can tosupport improve people primary with care SPMI monitoring with review of physical health care in SPMI, including use of registers and payment to practitioners (UK) and development of clinical algorithms. There is no current evidence from randomized controlledof recent systematic trials to support reviews current of interventions. guidance and practice for monitoring the physical health of people with SPMI in primary care. This is based on expert consensus.Findings: Improving Interventions access by FPsto primary to promote care: physical Mental health inworkers SPMI: haveDespite a key evidence role in linkingfor the effectivenesspeople with SPMI of specific into primary interventions e.g. for smoking andcare. weight Physical reduction health monitoringthese are underutilized. in primary care:There A isnumber a dearth of of interventions evidence on havethe impact been described of training to FPs improve to engage primary people care with SPMI in discussion aboutmonitoring lifestyle of orphysical motivate health them care to engage in SPMI, in includingtreatment. use of registers and payment to practitioners (UK) and development of Integrating primary and specialist care: Integrated models of service delivery have been proposed as a means to prevent service fragmentation and improveclinical algorithms.co-ordination There of care is forno currentservice users.evidence These from vary randomized from direct controlled collaboration trials (in to thesupport USA thiscurrent has alsoguidance involved and co-locatingpractice FPs in mental health services)for monitoring and agreed the physical guidelines health to waysof people of improving with SPMI communication in primary care. and Thisformal is contractualbased on expert arrangements. consensus. A Interventionscombination of by approaches FPs seems to be important.to promote More physical evidence health is inneeded SPMI: on Despite collaborative evidence care for interventionsthe effectiveness for SPMI. of specific interventions e.g. for smoking and weight Engagingreduction FPsthese in are working underutilized. with SPMI: There Evidence is a dearthfrom small-scale of evidence initiatives on the impact that FPs of trainingand PC canFPs beto engageengaged people in working with SPMIcollaborati in vely with mental health professionals.discussion about lifestyle or motivate them to engage in treatment. Integrating primary and specialist care: Integrated models of service delivery have been proposed as a means to prevent service fragmentation and improve co-ordination of care for service Discussion:users. These Therevary from is limited direct high collaboration quality evidence (in the on USA which this to has base also recommendations involved co-locating in this FPs area. in Howevermental health some services) conclusions and can be drawn with respectagreed guidelinesto good practice. to ways of improving communication and formal contractual arrangements. A combination of approaches seems to be important. More evidence is needed on collaborative care interventions for SPMI. Engaging FPs in working with Conclusions/Policy Recommendations: •SPMI: Mental Evidence health workers from small-scale have a key initiatives role to play that in FPs(re-) and engagi PC ngcan people be engaged with SPMI in working into primary collaboratively care. with mental health •professionals. Family Physicians have a key role to play in improving physical health care outcomes. •Discussion: Integrated care There models is limited such ashigh Collaborative quality evidence Care holdon which consid to erablebase recommendations promise. Further researchin this area. is needed However, to explore some conclusions impact on both physical and mental health outcomes, and service utilization. can be drawn with respect to good practice. • Mental health services should be jointly engaged with local FPs in developing local protocols for working at the interface, agreeing roles and responsibilities.

Consensus Development Conference on Improving Mental Health Transitions 23 SPEAKERS & ABSTRACTS

Conclusions/Policy Recommendations: • Mental health workers have a key role to play in (re-) engaging people with SPMI into primary care. • Family Physicians have a key role to play in improving physical health care outcomes. • Integrated care models such as Collaborative Care hold considerable promise. Further research is needed to explore impact on both physical and mental health outcomes, and service utilization. • Mental health services should be jointly engaged with local FPs in developing local protocols for working at the interface, agreeing roles and responsibilities.

24 Consensus Development Conference on Improving Mental Health Transitions SPEAKERS & ABSTRACTS Speakers & Abstracts

ElliotElliot GoldnerGoldner, , MD, MD, FRC(P), FRC(P), MHSc MHSc Professor,Professor, Centre Faculty for of Applied Health Sciences, Research Simon for Mental Fraser Health University, and Vancouver, Addiction British (CARMHA), Columbia Simon FraserDr. Goldner University, is a psychiatrist-researcher Vancouver, British Columbia who received an Honours BSc at the University of Toronto, an MD at the Dr.University Goldner ofis aCalgary, psychiatrist-researcher and completed his who Psychiatry received residencyan Honours training BSc at and the MHSc University in Health of Toronto, Care & Epidemiology at the University of British Columbia (UBC). He founded and directed the Eating Disorders Program at Providence Health an MD at the University of Calgary, and completed his Psychiatry residency training and MHSc in Care, directed Outpatient Psychiatry at UBC Hospital and founded and directed two research centres – one at UBC Healthand the Care other & Epidemiology at Simon Fraser at theUniversity. University Dr. ofGoldner British founded Columbia and (UBC). directed He the founded Division and of Healthdirected Policy and Services thein Eating the Department Disorders of Program Psychiatry at Providence at UBC. He Health is currently Care, a directed Professor Outpatient in the Centre Psychiatry for Applied at UBC Research for Mental HospitalHealth and Addictionfounded and (CARMHA) directed whichtwo research he founded centres at Simon – one Fraserat UBC University, and the other and atis Simonalso an Fraser Affiliate Professor in the University.Department Dr. of Goldner Psychiatry founded at UBC. and He directed is the authorthe Division of more of than Health 100 Policy scientific and Servicespublications in the and is the lead author of a Departmenttextbook entitled of Psychiatry ‘A Concise at UBC. Introduction He is currently to Mental a ProfessorHealth in Canada’.in the Centre Dr. Goldner for Applied has alsoResearch authored for the chapter entitled Mental‘Knowledge Health Translation’ and Addiction in the (CARMHA) textbook ‘Health which Research he founded Methods: at Simon A CanadianFraser University, Perspective’. and is Dr. also Goldner has received an Affiliate Professor in the Departmentawards from of the Psychiatry Canadian at Psychiatric UBC. He is Association the author forof hismore research, than 100 teaching scientific and publicationsscholarly work and andis the was awarded the Alex Leighton Award in Psychiatric Epidemiology by the Canadian Academy of Psychiatric Epidemiology. Dr. Goldner lead author of a textbook entitled, ‘A Concise Introduction to Mental Health in Canada.’ Dr. Goldner has also authored the chapter was formerly the Chair of the Science Advisory Committee for the Mental Health Commission of Canada and he has entitled, ‘Knowledge Translation’worked in the closely textbook with ‘Health governments Research at Methods:provincial, A regional Canadian and Perspective.’ national levels Dr. to Goldner research has and received implement programs to awards from the Canadian Psychiatricimprove Association mental health for services. his research, teaching and scholarly work and was awarded the Alex Leighton Award in Psychiatric Epidemiology by the Canadian Academy of Psychiatric Epidemiology. Dr. Goldner was formerly the Chair of the Science AdvisoryAbstract: What are the most effective forms of knowledge Committee for the Mental Health Commission of Canada andtranslation to improve quality of care? he has worked closely with governments at provincial, regional and national levels to research and implement programs to improve mental health services. Knowledge translation (KT) efforts are needed to achieve uptake and implementation of improvements to mental health services and policies. Without suchAbstract: efforts, What many are interventions the most effective fail to achieve forms theirof knowledge maximum translationpotential or reachto improve those mostquality in need.of care? This review provides an overview of the current state of knowledge translation literature and focuses on the role of KT in facilitating improvement of mental health services and policies, with an emphasisKnowledge on translation those that (KT)aim to efforts improve are outcomes needed to and achieve quality uptake of life andof individuals implementation with severe of improvements mental disorders. to mental health services and policies. Without such efforts, many interventions fail to achieve their maximum potential or reach those most in need. This Methods:review provides Two search an overview procedures of the were current combined state of to knowledge obtain relevant translation publications literature for review.and focuses The first on the was role a systematicof KT in facilitating search conducted using Medline, PsychINFOimprovement and of CINAHL mental healthdatabases services to identify and policies, review witharticles an publishedemphasis onin journals those that from aim 2007 to improve to 2012 outcomeson KT considered and quality to be of relevant life to mental health practice.of individuals Articles with were severe selected mental on disorders.the basis of eligibility criteria and the authors then added further articles deemed pertinent to the focus of the review. The second search procedure used the Medline database to identify articles published from 2000 to August 2014 that address KT specific to services orMethods: policy for Two individuals search procedureswith severe were mental combined disorders to and obtain for schizophreniarelevant publications and other for psychoticreview. The disorders. first was Publications a systematic obtain searched using both search proceduresconducted usingwere analyzedMedline, thematicallyPsychINFO and CINAHLconclusions databases were drawn. to identify review articles published in journals from 2007 to 2012 on KT considered to be relevant to mental health practice. Articles were selected on the basis of eligibility criteria and the authors Findings:then added The further first articlessearch, deemedafter removing pertinent duplicates, to the focus yielded of the 214 review. review The articles, second which search were procedurescanned for used relevance the Medline and, subsequently,database 45 articles were added by the authors, identified through hand searches of reference lists or from other sources. A total of 60 papers were retained for full review. Qualitativeto identify synthesisarticles published identified from five 2000 main to themes: August 20141) Defining that address KT and KT development specific to ofservices KT science; or policy 2) Effectivefor individuals KT strategies; with severe 3) Factors influencing the effectivenessmental disorders of KT; and 4) forKT schizophreniaframeworks and and guides; other andpsychotic 5) Relevance disorders. of KTPublications to healthcare obtained providers. using The both second search search procedures yielded were 218 articles, of which 62analyzed articles thematically were retained and for conclusions full review. Mostwere drawn.articles addressed KT strategies aimed at quality improvement of clinical care (such as incorporation of familyFindings: psychoeducation The first search, into treatment after removing protocols, duplicates, or adherence yielded to evidence-based214 review articles, clinical which guidelines were scanned such asfor PORT) relevance and and,applied a wide range of KT approaches including: educational sessions; dissemination of clinical guidelines; provision of decision-making tools; the formation of quality improvement subsequently, 45 articles were added by the authors, identified through hand searches of reference lists or from other sources. A collaboratives, and; efforts to improve cooperation and collaboration amongst treatment providers. Most of the 62 articles addressed KT directed toward clinicianstotal of 60 and papers patients, were whereasretained fewfor fullaimed review. at policy Qualitative makers synthesis and service identified leaders. Althoughfive main athemes: substantial 1) Definingproportion andof thedevelopment implementation trials produced disappointingof KT science; results 2) Effective with low KT levels strategies; of uptake 3) Factorsor poor influencing maintenance the of qualityeffectiveness improvements, of KT; 4) other KT frameworks studies were andable guides; to achieve and measureable and sustained5) Relevance improvements. of KT to healthcare providers. The second search yielded 218 articles, of which 62 articles were retained for full review. Most articles addressed KT strategies aimed at quality improvement of clinical care (such as incorporation of family Discussion:psychoeducation Specific into treatmentstrategies protocols,have been oridentified adherence to tobe evidence-basedeffective for each clinical of the guidelinesfollowing three such groups:as PORT) 1) andClinicians; applied 2) a wideGeneral Public, and; 3) Policy-makers.range of KT approaches However, including:there remains educational a paucity sessions; of evidence dissemination regarding effectiveof clinical KT guidelines; relevant to provision policy-makers. of decision-making tools; the formation of quality improvement collaboratives, and; efforts to improve cooperation and collaboration amongst treatment Conclusions/Policy Recommendations: Despite limitations in existing evidence, the concept and practice of KT holds potential value for mental providers. Most of the 62 articles addressed KT directed toward clinicians and patients, whereas few aimed at policy makers healthcare providers. Understanding of and familiarity with effective approaches to KT holds the potential to enhance providers’ treatment approaches andand promoteservice leaders. the utilization Although of new a substantial knowledge proportion in practice of to the enhance implementation outcomes. trials produced disappointing results with low levels of uptake or poor maintenance of quality improvements, other studies were able to achieve measureable and sustained improvements. Discussion: Specific strategies have been identified to be effective for each of the following three groups: 1) Clinicians; 2) General Public, and; 3) Policy-makers. However, there remains a paucity of evidence regarding effective KT relevant to policy-makers. Conclusions/Policy Recommendations: Despite limitations in existing evidence, the concept and practice of KT holds potential value for mental healthcare providers. Understanding of and familiarity with effective approaches to KT holds the potential to enhance providers’ treatment approaches and promote the utilization of new knowledge in practice to enhance outcomes.

Consensus Development Conference on Improving Mental Health Transitions 25 SPEAKERS & ABSTRACTS Speakers & Abstracts

HeinzHeinz Katschnig, MD Katschnig, MD Professor Emeritus of Psychiatry, Medical University of Vienna, and CEO, IMEHPS. resarch, Vienna, Austria Professor Emeritus of Psychiatry, Medical University of Vienna, and CEO, IMEHPS. resarch, Vienna,Professor Austria emeritus of Psychiatry, Medical University of Vienna/Austria. Chairman of the Department of Psychiatry and Psychotherapy and the Division of Social Psychiatry at the Medical University of Vienna (1991-2007), Director Ludwig Dr.Boltzmann Heinz KatschnigInstitute for is Social Professor Psychiatry emeritus (1978-2014), of Psychiatry, CEO Medical of IMEHPS.research University of (Resarch Vienna/Austria. Institute for “Improving ChairmanMental Health of thePathways”; Department 203-). of Involved Psychiatry over and several Psychotherapy decades in anddoing the research Division on of and Social planning deinstitutionalisation Psychiatryand setting atup the community Medical mental University health of services Vienna (1991-2007),in Austria, and Director responsible Ludwig for a Boltzmann completed multi-yearInstitute project of forclosing Social a large Psychiatry traditional (1978-2014), mental hospital CEO nearof IMEHPS.research Vienna and replacing (Resarch it by small Institute psychiatric for “Improving departments in general Mentalhospitals Health and a Pathways”;range of community 2013). Involved mental health over several services. decades WHO- EUROin doing counterpart research onfor andMental planning Health for the Austrian deinstitutionalisationGovernment, member ofand national setting and up internationalcommunity mentalmental health health committees. services in WorkAustria, package and responsible leader in multinational European Commission Funded projects, among others on mental health information systems (MINDFUL), financing forsystems a completed and pathways multi-year of care project related of to closing mental a andlarge physical traditional disorders mental (REFINEMENT), hospital near Viennapsychiatric and rehospitalisation replacing(CEPHOS- it LINK), by small and psychiatric in the Austrian departments national project in general on decision hospitals support and a for range health of communitypolicy and planning mental (DEXHELPP). health services. WHO-EUROParticipant counterpart in thefor EUMental 7FP Healthproject onfor a the roadmap Austrian for Government,mental health researchmember (ROAMER)of national and representativeinternational of the Austrian mental health committees. Workgovernment package in leader the ongoing in multinational European CommissionEuropean Commission “Joint Action Fundedon Mental projects, Health amongand Wellbeing” others on in the work packages on mental“deinstitutionalisation” health information and “mental systems health (MINDFUL), in all policies”. financing Author systems and editor and of pathwaysseveral books, of care among related them to onmental life eventsand physical and psychiatric disorders disorders and (REFINEMENT),on quality of life in mentalpsychiatric disorders rehospitalisation (the latter published (CEPHOS- in two LINK), editions and and in four the languages).Austrian national Author projectof more onthan decision 400 publications support for on clinical, social psychiatric and public mental health topics. health policy and planning (DEXHELPP). Participant in the EU 7FP project on a roadmap for mental health research (ROAMER) andAbstract: Financial incentives - the role of provider payment representative of the Austrian government in the ongoing Europeanmechanisms in relation to the quality of mental health care. Commission “Joint Action on Mental Health and Wellbeing” in the work packages on “deinstitutionalisation” and “mental health in all policies”. Author and editor of several books, amongBackground: them on In lifemodern events welfare and psychiatric states health disorders care is fragmented and on quality in terms of life of entitlementin mental disorders to care, its (the funding latter and published organisation. in two Different editions sectors – andprimary/secondary, four languages). outpatient/inpatient, Author of more than acute/chronic, 400 publications mental/physical on clinical, - are social not well psychiatric coordinated. and publicIn mental mental health health care, topics.different treatment philosophies, e.g. biological vs psychological, complicate the issue. When it comes to the integration of health with social care the situation becomes even more Abstract:complicated. Financial Policy objectives incentives of –deinstitutionalisation the role of provider and payment promotion mechanisms of community in mentalrelation health to the care quality are often of mental not met health becau secare. financing mechanisms, including raising and pooling of funds, provider payment mechanisms and user contributions, and related incentives and disincentives, are not well Background:aligned to meet In the modern needs welfareof persons states with health mental care disorders. is fragmented in terms of entitlement to care, its funding and organisation. Different sectors – primary/secondary, outpatient/inpatient, acute/chronic, mental/physical - are not well coordinated. In mentalMethods: health The care,information different presented treatment here philosophies, is mainly based e.g. on biological the findings vs psychological, of two work-packages complicate (financial the issue. incentives When itand comes pathways to the of care) in the EU funded project “Research on Financing Systems Effect on the Quality of Mental Health Care - REFINEMENT”, in which eight European countries integrationwith different of political, health withhealth social and socialcare the care situation systems becomes took part even (Austria, more England, complicated. Finland, Policy France, objectives Italy, Norway, of deinstitutionalisation Romania, Spain). Three approaches andwere promotion used: (1) reviewing of community the literature, mental (2)health collecting care are speci oftenfic examplesnot met becauseof financial financing incentives mechanisms, and disincentives including in partnerraising countries, and pooling and (3) developing ofassessment funds, provider tools (based payment on themechanisms principal agent and user model) contributions, for describing and and related analysing incentives financing and disincentives,mechanisms and are pathways not well ofaligned care. to meet the needs of persons with mental disorders. Findings: Incentives in provider payment mechanisms focused on separate sectors of care are detrimental to the policy aim of coordinated and Methods:integrated Thecare forinformation persons with presented mental disorders;here is mainly they maybased distort on the intended findings care of pathwaystwo work-packages and lead to unnecessary(financial incentives duplication and of services. A telling pathwaysexample is of the care) DRG in systemthe EU forfunded hospital project care “Researchwith its incentive on Financing to increase Systems the number Effect of on admissions, the Quality problems of Mental with Health the comorbi Care -dity with physical REFINEMENT”,disorders and cost-shifting in which to eight social European care institutions. countries Speci withfic different tariffs in feepolitical, for service health systems and social in the care outpatient systems sectortook partmay (Austria,incentivise cream skimming England,and lead toFinland, the neglect France, of whole Italy, patientNorway, groups. Romania, In view Spain). of these Three problems approaches payment were systems used: which(1) reviewing are independent the literature, of care (2) settin collectinggs are being explored, specificincluding examplesdesigning ofclassifications financial incentives which go andbeyond disincentives diagnosis, in regional partner budgets countries, for integrating and (3) developing in-, day- and assessment outpatient tools care, (basedand the on use the of personal budgets from which people with mental disorders can purchase services. principal agent model) for describing and analysing financing mechanisms and pathways of care. Findings:Discussion: Incentives Declared in policy provider aims payment of improving mechanisms the care of focused persons on with separate mental sectors disorders of careare, apartare detrimental from other reasonsto the policy such aimas stigma and ofdiscrimination, coordinated oftenand integratednot met because care for financing persons withmechanisms mental disorders;are not integrated they may and distortcoordinated. intended In the care present pathways mental and health lead tocar e landscape service centred payment mechanisms with specific incentives lead to distorted care pathways and reduced quality of life. Payment systems need to be unnecessarydeveloped which duplication are independent of services. of the A tellingcare setting. example No is“one the mo DRGdel fitssystem all countries”for hospital approach care with to theits incentivefinancing to of increase mental healttheh care is possible. A numberstructured of approach admissions, to analysing problems the with financing the comorbidity system of witha speci physicalfic country disorders (based and e.g. cost-shifting on the presented to social REFINEMENT care institutions. toolkit) could be a starting point Specificfor improvement. tariffs in fee for service systems in the outpatient sector may incentivise cream skimming and lead to the neglect of whole patient groups. In view of these problems payment systems which are independent of care settings are being explored, including designingConclusions/Policy/Recommendations: classifications which go beyondDeveloping diagnosis, and regional implementing budgets paymentfor integrating systems in-, that day- are andindependent outpatient of care,care settingsand the shoulduse of be a priority. A personalstructured budgets analysis from of the which actual people funding with system mental for mentaldisorders hea canlth is purchase recommended services. as a first step. Discussion: Declared policy aims of improving the care of persons with mental disorders are, apart from other reasons such as stigma and discrimination, often not met because financing mechanisms are not integrated and coordinated. In the present mental health care landscape service centred payment mechanisms with specific incentives lead to distorted care pathways and reduced quality of life. Payment systems need to be developed which are independent of the care setting. No “one model fits all countries” approach to the financing of mental health care is possible. A structured approach to analysing the financing system of a specific country (based e.g. on the presented REFINEMENT toolkit) could be a starting point for improvement. Conclusions/Policy Recommendations: Developing and implementing payment systems that are independent of care settings should be a priority. A structured analysis of the actual funding system for mental health is recommended as a first step.

26 Consensus Development Conference on Improving Mental Health Transitions SPEAKERS & ABSTRACTS Speakers & Abstracts

Sara Lapsley , B.A, M.A. PeerSara Researcher Lapsley, with BA, the Collaborative MA Research Team to Study Psychosocial Issues in Bipolar Disorder (CREST.BD) Peer Researcher with the Collaborative Research Team to Study Psychosocial Issues Sarain Bipolar Lapsley, Disorder B.A., is completing (CREST.BD) her Masters in Counselling Psychology at the University of British Columbia. She is a full-time counsellor and group clinician at the BC Forensic Psychiatric Hospital and an active member of the CollaborativeSara Lapsley, Research B.A., is completingTeam to Study her Psychosocial Masters in issuesCounselling in Bipolar Psychology Disorder (CREST.BD). at the University She has done research and published in the areas of recovery, peer support, self-management strategies, and forensic mental health. Sara was diagnosedof British withColumbia. bipolar disorderShe is a in full-time 2001, and counsellor raises awareness and group about clinician mental health at the issues BC Forensic through the media, clinician trainingPsychiatric initiatives, Hospital and communityand an active events. member of the Collaborative Research Team to Study Psychosocial issues in Bipolar Disorder (CREST.BD). She has done research and published in Abstract:the areas Socialof recovery, Impact peer of SPMI support, on Individuals self-management and Families strategies, and forensic mental health. Sara Background:was diagnosed According with bipolar to the disorderWorld Health in 2001, Organization, and raises one awareness in four families about includes mental a memberhealth issues dealing with a mental orthrough behavioural the media, disorder. clinician In recent training years, institutionalization initiatives, and hascommunity been replaced events. by community living and short term hospitalizations. As a result, families have had an increasing role in providing care to members affected by severe and Abstract: Social Impact of SPMIpersistent on Individuals mental illness and (SPMI). Families A significant burden on the individual and the family unit has been well documented, which includes both objective and subjective indicators of the impact that SPMI has on the family system. Background: According to the World Health Organization, one in four families includes a member dealing with a mental or behavioural disorder. In recentMethods years,: A surveyinstitutionalization of peer reviewed has literature been replaced on family by burden community was completed. living and This short was supplementedterm by a review hospitalizations. As a result, familiesof grey literature have had which an increasingaccessed rich role sources in providing of information care to relevant members to affected affected family by members.severe and Additionally, the lived experience of the presenter is integrated to illustrate the how SPMI can have a devastating impact on the individual and the family unit. persistent mental illness (SPMI). A significant burden on the individual and the family unit has been well documented, which includesFindings: both The literatureobjective documents and subjective high levels indicators of burden of theto families impact impa thatcted SPMI by ahas relative on the with family SMPI. system. Significant themes emerged related to the direct financial costs of supporting a family member, and indirect costs of lost productivity to family systems impacted by the upheaval. “Stigma by Association” Methods:is well documented, A survey and of peeraffected reviewed families literature report complex on family emotional burden reactions was completed. such as grief, This resentment, was supplemented overload, and by concerns a review for of the grey future, resulting literaturein levels of which anxiety, accessed depression, rich and sources insomnia of information that are twice relevant as high as to in affected the general family population. members. However, Additionally, a number the of strategieslived experience have been identified ofthat the can presenter help family is membersintegrated cope to illustratewith the burden how SPMI and increase can have resiliency a devastating in face of impact significant on the stressors, individual with andparticular the family evidence unit. for the helpfulness of support groups. Findings: The literature documents high levels of burden to families impacted by a relative with SMPI. Significant themes emergedDiscussion: related The variousto the directfactors financial contributing costs to the of burden,supporting such asa family stigma, member,financial andcosts, indirect and the costs effects of lostof stress productivity on the family, to familymust be directly systemsacknowledged impacted and addressed. by the upheaval. We also “Stigma need to considerby Association” the intersection is well ofdocumented, lifespan development and affected and how families a mentally report ill family complex member in various life stages such as adolescence, mid-life, and old age may impact the family. Factors such as co-morbid physical conditions, substance abuse, and emotionalsuicide need reactions to be considered. such as Thegrief, literature resentment, demonstrates overload, that and distress concerns was lower for the for future,families resultingwho were inthemselves levels of receivinganxiety, depression,mental health services. andAlleviating insomnia the burden that are and twice increasing as high the as resiliency in the general of family population. systems, through However, of variety a number of identified of strategies mechanisms, have beencan prevenidentifiedt further emotional and thatfinancial can helpcosts familyof supporting members a family cope memberwith the with burden SPMI. and increase resiliency in face of significant stressors, with particular evidence for the helpfulness of support groups. Policy Recommendations: Increase mental health care and services directly for individuals and family members; Peer support groups for individuals Discussion:and families; Provision The various of educational factors contributing resources targeted to the toburden, address such the unique as stigma, challenges financial that familiescosts, andface; the Provision effects of of fin stressancial andon the practical support family,to individuals must andbe directly families asacknowledged needed; Early and intervention; addressed. Anti-stigma We also interventions; need to consider Further the research intersection that draws of lifespan on the existing development expertise of consumers and familyhow a members mentally to ill identify family their member specific in needsvarious and life concern stagess. such as adolescence, mid-life, and old age may impact the family.References Factors such as co-morbid physical conditions, substance abuse, and suicide need to be considered. The literature demonstratesSaunders, J.C. that(2003). distress Families was living lower with for severe families mental who illness: were Athemselves literature review. receiving Issues mental in Mental health Health services. Nursing, Alleviating 24, 175-198. the burden and increasing the resiliency of family systems, through of variety of identified mechanisms, can prevent further emotional and financial costs of supporting a family member with SPMI. Policy Recommendations: Increase mental health care and services directly for individuals and family members; Peer support groups for individuals and families; Provision of educational resources targeted to address the unique challenges that families face; Provision of financial and practical support to individuals and families as needed; Early intervention; Anti- stigma interventions; Further research that draws on the existing expertise of consumers and family members to identify their specific needs and concerns. References Saunders, J.C. (2003). Families living with severe mental illness: A literature review. Issues in Mental Health Nursing, 24, 175- 198.

Consensus Development Conference on Improving Mental Health Transitions 27 Speakers SPEAKERS& Abstracts & ABSTRACTS

Eric Latimer,Eric Latimer , PhD PhD Researcher,Researcher, Douglas Institute Douglas and Institute Professor, and DepartmentProfessor, Department of Psychiatry, of McGill Psychiatry, University, McGill University, Quebec Quebec Dr Latimer is Research Scientist at the Douglas Mental Health University Institute and Professor in the Department Dr. Latimerof Psychiatry is Research Scientistat McGill at University.the Douglas MentalHe obtained Health aUniversity PhD in economics Institute and from Professor Carnegie in Mellon University in 1989 and, the Departmentbefore ofjoining Psychiatry the Douglas at McGill Institute University. and He McGill obtained University, a PhD in Economicswas Assistant from ProfessorCarnegie of Health Economics at the Mellon UniversityHarvard Schoolin 1989 and,of Public before Health joining fromthe Douglas 1989 to Institute 1996. and His McGill research University, interests was focus on community-based supports Assistantfor Professor people of with Health severe Economics mental at illness,the Harvard including School assertive of Public Healthcommunity from 1989treatment to 1996. and supported employment. He His researchhas interestscarried focusout economic on community-based evaluations supports and reviews for people of the with economic severe mental evidence illness, for various interventions for people including assertive community treatment and supported employment. He has carried out economic with mental illness, notably supported employment. He has also conducted research on the use of antipsychotic evaluations and reviews of the economic evidence for various interventions for people with mental medications in Québec using large administrative data bases. Recently, he was lead investigator for the Montreal illness, notably supported employment. He has also conducted research on the use of antipsychotic site, and lead economist nationally, of the $110 million Chez Soi / At Home research and demonstration study medications in Québec using large administrative databases. Recently, he was lead investigator for the Montreal site, and lead on homelessness and mental illness. This study tested the Housing First approach using nine concurrent trials in five Canadian cities. Currently economist nationally, of the $110 million Chez Soi / At Home research and demonstration study on homelessness and mental he is principal investigator of a CIHR-funded, $1.2 million study evaluating the strengths model of case management in seven sites across Ontario, illness. This study tested the Housing First approach using nine concurrent trials in five Canadian cities. Currently he is principal Québec and Newfoundland. He has served as consultant to the Québec government as well as research teams in Europe and North America. He is investigator of a CIHR-funded, $1.2 million study evaluating the strengths model of case management in seven sites across an associate editor of the Canadian journal, Healthcare Policy. He teaches economic evaluation in the Department of Epidemiology, Biostatistics and Ontario, Québec and Newfoundland. He has served as consultant to the Québec government as well as research teams in Europe Occupationaland North America. Health atHe McGill is an associate University. editor of the Canadian journal, Healthcare Policy. He teaches economic evaluation in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University. Abstract: What are the effects of supported employment for people with severe mental illness? Abstract: What are the effects of supported employment for people with severe mental illness? Background: About two-thirds of people with severe mental illness would like to work. A recovery orientation for mental health services emphasizes helpingBackground: people Aboutwith mental two-thirds illness of people integrate with competitive,severe mental asillness opposed would liketo segregated, to work. A recovery work settings. orientation Yet, for surveysmental health consistently indicate that fewer than 30%services of people emphasizes with mental helping illness people workwith mental at all, illnessand even integrate fewer competitive, in competitive as opposed settings. to segregated, Over the work past settings. 20 years, Yet, the surveys Individual Placement and Support (IPS)consistently model of indicate supported that feweremployment than 30% has of people emerged with mentalas the illnessmost effectivework at all, approach and even fewerfor helping in competitive people settings.with severe Over mental illness integrate the competitivethe past 20 labor years, market. the Individual Developed Placement on andthe Supportbasis of (IPS) extensive model empiricalof supported research, employment it follows has emerged 8 principles: as the most (1) effectivecompetitive work is the goal; (2) any client whoapproach expresses for helping a desire people to work with issevere eligible mental to enroll;illness integrate(3) employment the competitive specialists labor market.pay close Developed attention on tothe client basis ofpreferences; extensive (4) employment specialists areempirical integrated research, with clinical it follows teams; 8 principles: (5) they (1) engage competitive in systemat work is theic jobgoal; development; (2) any client who(6) they expresses offer abenefits desire to workcounseling; is eligible (7) job search begins quickly; (8) individualizedto enroll; (3) follow-upemployment is specialistsmaintained pay as close long attention as needed. to client preferences; (4) employment specialists are integrated with clinical teams; (5) they engage in systematic job development; (6) they offer benefits counseling; (7) job search begins quickly; (8) individualized follow-up is maintained as long as needed. Methods: A review of the literature on the IPS model was carried out, building on previous literature reviews and including results published until early 2014.Methods: The review A review aimed of the to literature address on four the IPSquestions: model was (1) carried what out,are thebuilding effects on previousof the IPS literature model reviews on job andacquisition including rates and job tenure, compared to other vocationalresults published models untilas a early group? 2014. (2) The do review programs aimed that to address adhere four more questions: closely (1) to thewhat IPSare the model effects (as of measured the IPS model by a onstandardized job fidelity scale) obtain better vocationalacquisition outcomes? rates and job (3) tenure, what arecompared the effects to other of vocationalIPS on any models non-vocational as a group? (2)outcomes do programs reported that adhere in the more literature? closely to(4) the what are its effects on costs? Findings.IPS model (1) (as Randomized measured by trialsa standardized conducted fidelity in many scale) countries obtain better (including vocational one outcomes? in Montreal) (3) whatconsistently are the effects report of thatIPS onIPS any is more effective than the alternativesnon-vocational to which outcomes it has reported been compared in the literature? in raising (4) what employment are its effects rates. on costs? The numberFindings: of (1) weeks Randomized worked trials in competitive conducted settings is similar across IPS andin other many programs,countries (including among thoseone in whoMontreal) do obtain consistently a job; report(2) Programs that IPS isthat more follow effective the IPSthan model the alternatives more closely to which achieve it has higher job acquisition rates; (3) Experimentalbeen compared studies in raising do not, employment in general, rates. report The betternumber non-vocational of weeks worked outcomes in competitive in IPS settings than is control similar groups.across IPS If andpeople other who work are compared with those whoprograms, do not work, among however, those who results do obtain suggest a job; (2)that Programs working that has follow favorable the IPS effects model onmore symptoms, closely achieve self-esteem higher job and acquisition quality of life; (4) studies to date also suggest,rates; (3) analogously, Experimental that studies mental do not, health in general, service report costs better decrease non-vocational significantly outcomes for inpeople IPS than who control enter intogroups. work If people thanks who to IPS services. work are compared with those who do not work, however, results suggest that working has favorable effects on symptoms, self- Discussion:esteem and qualityIPS is ofclearly life; (4) more studies effective to date atalso improving suggest, analogously, competitive that job mental outcomes health thanservice other costs models decrease against significantly which for it has been compared. Indirect evidencepeople whosuggests enter into that work people thanks who to enterIPS services. into work thanks to an IPS program tend to experience improvements in non-vocational outcomes as well as significantlyDiscussion: reduced IPS is clearly mental more health effective service at improving costs. competitive job outcomes than other models against which it has been compared. Indirect evidence suggests that people who enter into work thanks to an IPS program tend to experience improvements Conclusions/Policy Recommendations:in non-vocational outcomes as well as significantly A thoroughgoing reduced mental recovery health serviceorientation costs. towards mental health services should lead to a repurposing of existing vocational services, and if needed the development of additional ones, so that all individuals with severe mental illness who desire to work in competitive Conclusions/Policy Recommendations: A thoroughgoing recovery orientation towards mental health services should lead to a settingsrepurposing should of have existing access vocational to programs services, andthat if closely needed followthe development the IPS model. of additional ones, so that all individuals with severe mental illness who desire to work in competitive settings should have access to programs that closely follow the IPS model.

28 Consensus Development Conference on Improving Mental Health Transitions SPEAKERS & ABSTRACTS Speakers & Abstracts

Antonio Lora , MD MentalAntonio Health Lora,Department, MD Lecco General Hospital, Lecco, Italy Director, Department of Mental Health, Lecco General Hospital, Lecco, Italy Born in 1955 in Milan (Italy), I graduated as a Medical Doctor in 1979 at the University of Milan, and specialized in PsychiatryDr. Antonio in 1983 Lora at was the bornsame in University. 1955 in MilanI worked (Italy). as a clinician He graduated in community as a Medical mental health Doctor services, in 1979 and at am now thethe Director University of the of Department Milan, and of specialized Mental Health in Psychiatryin Lecco (close in 1983 to Milan), at the managing same University. a network He of communityworked mental healthas a clinician facilities in(CHMHCs, community psychiatric mental wards health in services,general hospitals, and is now day-care the Director facilities andof the community Department residential of facilities) in a catchment area of about 300,000 residents. From 1980 onwards, I managed, at the regional level, the mental healthMental information Health in system Lecco in(close the Lombardy to Milan), Region, managing and evaluated a network the of regional community mental mental health services.health facilities The regional mental(CHMHCs, health psychiatricinformation systemwards inis ageneral regional hospitals, psychiatric day-care case register facilities covering and communitythe whole Region, residential with a population offacilities) about 9,000,000. in a catchment At the Ministry area of ofabout Health 300,000 level, my residents. participation From was 1980 as anonwards, expert to he commissions, managed, at developing the nationalthe regional mental level, health the information mental health system information (including a systemframework in theof indicators Lombardy for Region,mental health and evaluatedservices monitoring) and identifying clinical pathways for severe mental disorders and clinical indicators monitoring these pathways. In 2003 I workedthe regional for one mental year in healththe Department services. of The Mental regional Health ofmental the Worldhealth Health information Organization system in Geneva is a regional developing WHO- AIMS,psychiatric a set of case indicators register for covering evaluating the the whole mental Region, health systemswith a population of low and middle of about income 9,000,000. countries. At theSince 2004 I Ministry of Health level, his haveparticipation been a consultant was as an for expert WHO, tocollaborating commissions, in projects developing like Mental the national Health Atlas, mental which health is aimed information at assessing mental healthsystem systems (including and, ultimately,a framework monitoring of indicators Mental forAction mental Plan 2013-2020health services goals. monitoring) I am past-President and identifying of the Italian clinical Society pathways of Psychiatric for severe Epidemiology, andmental have disorders published andmore clinical than 120 indicators papers (of monitoring which 45 appeared these pathways. in peer reviewed In 2003, journals) he worked on mental for one health year services in the Departmentevaluation. of Mental Health of the World Health Organization in Geneva developing WHO-AIMS, a set of indicators for evaluating the mental health Abstract:systems of The low Use and Of middle An Information income countries.System For Since Improving 2004, heQuality has been Of Care a consultant In Severe for Mental WHO, Illness collaborating in projects like Mental Health Atlas, which is aimed at assessing mental health systems and, ultimately, monitoring Mental Action Plan 2013-2020 goals. Background:He is past-President Routine mentalof the Italianhealth care Society quality of Psychiatricis far from optimal, Epidemiology, varying greatly and has from published region to moreregion thanand provider 120 papers to provider. (of which A mental 45 health information system represents the main tool to evaluate patients in contact with services and undergoing treatment, but alone it is not sufficient to evaluateappeared care in peerquality. reviewed To achieve journals) this, we on need mental to merge health the servicesdifferent healthevaluation. databases, and thus move towards a clinically oriented information system, whileAbstract: at the Thesame timeUse weOf needAn Information to identify clinical System indicators. For Improving Clinical indicators, Quality derivedOf Care from In administrativeSevere Mental data Illness and based on evidence, are useful to document care quality, establish benchmarking, and support accountability and quality improvement. Background: Routine mental health care quality is far from optimal, varying greatly from region to region and provider Methods:to provider. In the A mentalproject (carriedhealth informationout in Lombardy, system Italy) represents there was thethe identification main tool to ofevaluate 41 clinical patients indicators in contactfor schizophrenia, with services 33 for and bipolar disorders and 14undergoing for depression, treatment, by experts but throughalone it Delphi is not rounds.sufficient Each toindicator evaluate covers care bothquality. main Toquality achieve domains this, (accessibility,we need to continuitymerge the ofdifferent care, appropriateness, health safety) and phases of care (first episode, acute care, maintenance and promotion of recovery). These indicators were applied to the Lombardy Region’s healthdatabases, databases and thus containing move datatowards on mental a clinically health orientedactivities, informationhospital admissions, system, health while treatments at the same and time pharmaceutical we need to preidentifyscriptions. clinical Results from 28,191indicators. patients Clinical with schizophrenic indicators, derived disorder from (ICD 10administrative F2 category), data cared and for basedduring on2009 evidence, by the Departments are useful toof Mentaldocument Health care of thequality, Region, are analyzed.establish benchmarking, and support accountability and quality improvement.

Findings:Methods: Community In the project care (carrieddelivered out to patients, in Lombardy, such as Italy) that involving there was family the identificationmembers, was more of 41 intensive clinical forindicators onset cases for schizophrenia,than for prevalent 33 ones; in termsfor bipolar of continuity, disorders about and six 14 patients for depression, out of ten were by experts in continuous through care. Delphi It is common rounds. practice Each indicator for patients covers to receive both multi-professionalmain quality domains interventions, but(accessibility, psychotherapeutic continuity and psycho-educativeof care, appropriateness, activities aresafety) not widespread,and phases andof care were (first delivered episode, preferentially acute care, at onset maintenance rather tha nand during promotion the maintenance phase.of recovery). Support These for independent indicators living were and applied employment to the wasLombardy not frequent, Region’s but onehealth sixth databases of the patients containing became data involved on mentalin CHMC health social activities, and leisure activities. Following hospitalization, more than half the discharged patients attended psychiatric follow-up at a CMHC by two weeks from discharge, but inhospital the following admissions, six months health only treatments a quarter of andthe patientspharmaceutical received atprescriptions. least one psychiatric Results visit from per 28,191 month. patients Anti-psychotic with schizophrenictreatment adherence was much poorerdisorder for (ICDnew cases 10 F2 than category), for prevalent cared ones, for during such as 2009 metabolic by the side-effect Departments monitoring. of Mental After theHealth interruption of the Region,of antipsychotic are analyzed. treatment, half the patients received a follow-up visit to assess clinical status and; only one sixth of patients showing inadequate response to antipsychotic treatment received clozapine.Findings: With Community regard to hospitalcare delivered care, only to onepatients, patient such in ten as was that compulsorily involving family admitted members, or restrained; was more only one intensive admission for onsetin ten lastedcases thanmore than 30 days;for prevalent two out of ones; ten were in terms readmitted of continuity, within 28 aboutdays of six discharge; patients at out the of time ten of were discharge in continuous the patients care. were It usuallyis common given practice just the one for anti-psychoticpatients drug ofto adequate receive multi-professional dosage. Mortality during interventions, the period butwas psychotherapeutic significant (SMR=2.01). and psycho-educative activities are not widespread, and were delivered preferentially at onset rather than during the maintenance phase. Support for independent living and employment was Discussion: Clinical indicators showed strengths and weaknesses in the Lombardy mental health system. The project’s main limitation concerns the solenot inclusionfrequent, of but indicators one sixth drawn of thefrom patients current informationbecame involved system indata. CHMC social and leisure activities. Following hospitalization, more than half the discharged patients attended psychiatric follow-up at a CMHC by two weeks from discharge, but in the following Conclusions/Policy Reccomendations:six months only a quarter of the patients Clinical received indicators at least generated one psychiatric by merging visit health per databasesmonth. Anti-psychotic are a useful tool treatment to routinely adherence evaluate important aspectswas much of the poorer quality for of newcare casesfor patients than forsuffering prevalent severe ones, mental such illness, as metabolic placing no side-effect burden on mentalmonitoring. health professionals.After the interruption of antipsychotic treatment, half the patients received a follow-up visit to assess clinical status and; only one sixth of patients showing inadequate response to antipsychotic treatment received clozapine. With regard to hospital care, only one patient in ten was compulsorily admitted or restrained; only one admission in ten lasted more than 30 days; two out of ten were readmitted within 28 days of discharge; at the time of discharge the patients were usually given just the one anti-psychotic drug of adequate dosage. Mortality during the period was significant (SMR=2.01). Discussion: Clinical indicators showed strengths and weaknesses in the Lombardy mental health system. The project’s main limitation concerns the sole inclusion of indicators drawn from current information system data. Conclusions/Policy Recommendations: Clinical indicators generated by merging health databases are a useful tool to routinely evaluate important aspects of the quality of care for patients suffering severe mental illness, placing no burden on mental health professionals.

Consensus Development Conference on Improving Mental Health Transitions 29 Speakers &SPEAKERS Abstracts & ABSTRACTS

SteveSteve Lurie, BA, MSW, MM Lurie, BA, MSW, MM ExecutiveExecutive Director, Director, Canadian Canadian Mental Mental Health Health Association Association Toronto Toronto Branch, Branch, Ontario Ontario

Steve SteveLurie is Lurie currently is currently the Executive the Executive Director of Director the Canadian of the Mental Canadian Health Mental Association Health Toronto Association Toronto Branch, a post Branch, a post he has held since 1979. Steve has written and lectured extensively on mental health he has held since 1979. Steve has written and lectured extensively on mental health policy issues. He was a policy issues. He was a principal author of the Graham Report, Building Community Support for principal author of the Graham Report, Building Community Support for People, and conducted the 1992 snapshot People, and conducted the 1992 snapshot of community mental health programs for the Ontario of community mental health programs for the Ontario Ministry of Health and the Minimum Data Set Pilot Project Ministry of Health and the Minimum Data Set Pilot Project (1998), which established a common (1998), which established a common data set for the reporting of client characteristics and outcomes in community data set for the reporting of client characteristics and outcomes in community and hospital and hospital based mental health services. He served as guest editor of the Canadian Journal of Community Mental based mental health services. He served as guest editor of the Canadian Journal of Community Health special issue, Innovation in Community Mental Health: International Perspectives. Since 2004 Steve has had Mental Health special issue, Innovation in Community Mental Health: International Perspectives. Sincea 2004, collaborative Steve has had relationship a collaborative with relationshipSCARF, a withcommunity SCARF, mentala community health mental and researchhealth organization in Chennai, India. In and research organization in Chennai,2007 India. Steve In 2007,provided Steve technical provided technicalassistance assistance to the todevelopment the development of a of national a national mental health plan in Kyrgyzstan, through a projectmental funded health by plan the in Soros Kyrgyzstan, Foundation. through Asa project well Stevefunded and by the CMHA Soros Toronto Foundation. have As hosted well Steve organizations and CMHA Torontofrom China, have India, US, New Zealand, Australia, the UKhosted and organizations Japan. In 2008 from Steve China, lectured India, US, in New Japan Zealand, about Australia, community the UKmental and Japan.health In systems, 2008, Steve hosted lectured by in the Japan Matsubara about Psychiatric Hospital. In 2005 he providedcommunity technical mental assistancehealth systems, to thehosted Senate by the Committee Matsubara Psychiatric Report Out Hospital. of the InShadows 2005, he Atprovided Last: Transforming technical assistance Mental to the Health and Addiction Services in Canada.Senate Committee Report Out of the Shadows At Last: Transforming Mental Health and Addiction Services in Canada. In August 2007 he was appointed to chair the Service Systems Advisory Committee for the newly established Mental Health Commission of Canada. He wasIn August recently 2007, awarded he was appointedthe Canadian to chair Mental the Service Health Systems Association’s Advisory CommitteeCM Hincks for award the newly for national established leadership Mental Health in mental health. Steve has a Masters in ManagementCommission (MM) of Canada. from the He McGill was recently McConnell awarded Voluntary the Canadian Sector Mental Leadership Health Association’s program (2002)CM Hincks and award has a for BA national (1971) and MSW (1973) from the University of Torontoleadership Faculty in mental of Social health. Work Steve where has a Mastershe is now in Management an adjunct (MM)professor. from the McGill McConnell Voluntary Sector Leadership program (2002) and has a BA (1971) and MSW (1973) from the University of Toronto Faculty of Social Work where he is now an adjunct professor. Abstract: The Role of the Federal Government in Mental Health Abstract: The Role of the Federal Government in Mental Health WhileWhile provinces provinces have have a constitutionala constitutional responsibility responsibility for for health health care, care, the the federal federal government government has cost has shared cost with shared provinces with provincesand and territories since Medicare was established.territories since Prior Medicare to Medicare, was established. in the Prior1940’s, to Medicare, the federal in thegovernment 1940’s, the federalprovided government Dominion provided mental Dominion health grants mental to the provinces, to help them establishhealth general grants to hospital the provinces, based to services. help them While establish the general federal hospital government based services. transferred While $41 the billionfederal togovernment the provinces transferred between 2004 and 2014 to improve health$41 systems billion to through the provinces the Canada between Health 2004 and and 2014 Social to improve Transfer, health no systems specific through funding the Canadawas earmarked Health and for Social mental Transfer, health. The provinces spent the bulk of their nohealth specific transfer funding funding was earmarked on other forareas mental of healthhealth. careThe evenprovinces though spent mental the bulk illness of their comprises health transfer 13% funding of disease on other burden. areas With the expiry of the CHT, the federalof health share care evenof health though spending mental illness will decline comprises from 13% 19% of disease to 11% burden. over theWith next the expiry10 years. of the The CHT, federal the federal government share of will have fiscal room to contribute more,health while spending provinces will will decline be constrained from 19% to 11%according over the to next the 10 Parl years.iamentary The federal Budget government Officer. willThe have Federal fiscal roomgovernment to contribute has funded the Partnership Against Cancer,more, the while Mental provinces Health will Commission, be constrained and according At Home/Chez to the Parliamentary Soi. Therefore Budget a Office.case can Thebe madeFederal forgovernment continued has funding funded ofthe mental health services, and the establishmentPartnership Against of a MentalCancer, theHealth Mental System Health Transition Commission, Fund and to At help Home/Chez provinces Soi. and Therefore territories a case shift can tobe moremade communityfor continued based systems. In addition the federalfunding government of mental has health responsibilities services, and the to establishmentimprove services of a Mental for people Health in System areas Transitionof federal Fund jurisdiction: to help provinces armed forces, and RCMP, correctional services, First Nationsterritories and Inuit, shift refugees to more community and immigrants, based systems. as well In as addition using the federalsocial transfergovernment and has Social responsibilities development to improve funding services to improve housing and employment for people in areas of federal jurisdiction: armed forces, RCMP, correctional services, First Nations and Inuit, refugees and prospects for people living with mental illness. immigrants, as well as using the social transfer and Social development funding to improve housing and employment prospects for people living with mental illness.

30 Consensus Development Conference on Improving Mental Health Transitions Speakers SPEAKERS& Abstracts & ABSTRACTS

OrrinOrrin Lyseng Lyseng Executive Director, Alberta Alliance for Mental Illness and Mental Health (AAMIMH), Edmonton, AB Executive Director, Alberta Alliance for Mental Illness and Mental Health (AAMIMH), Edmonton,Orrin trained AB and graduated as a Registered Psychiatric Nurse in 1970 and as a Registered Nurse in 1974. He received Orrinhis Bachelor trained of and Arts graduated (Special) as at a the Registered U of A majoring Psychiatric in sociology Nurse in and 1970 psychology and as a Registered (1979). He Nurse was employed in by the Alberta Government for over 35 years, working as a staff nurse at a Provincial Psychiatric Hospital for 10 years, then 1974.as a communityHe received mental his Bachelor health nurseof Arts for (Special) 15 years at as the a UofAclinician majoring and supervisor in sociology of mental and psychology health clinics in the suburban (1979).communities He was around employed Edmonton by the andAlberta finally Government as a project for leader over in35 the years, corporate working offices as a staff of Alberta nurse Healthat a for 11 years. ProvincialHe has held Psychiatric various positions Hospital such for 10 as years, Acting then Manager as a community of Health Promotion mental health and Coordinatornurse for 15 of years Critical as Incident Stress aDebriefings clinician and for supervisor the Edmonton of mental Region, health and clinicsat the incorporate the suburban level he communities worked in a number around ofEdmonton capacities such as: Coordinator andfor mentalfinally healthas a project initiatives, leader specifically in the corporate mental officeshealth promot of Albertaion and Health Project for Leader 11 years. in Community He has held Development with a variousfocus on positions building suchcommunity as Acting capacity Manager around of Health mental Promotion health and and mental Coordinator health promotion. of Critical As Incident Project Leader in Community StressDevelopment, Debriefings he lead for theand Edmontonfacilitated theRegion, design and and at productionthe corporate of alevel number he workedof published in a number materials drawing attention to of capacities such as: Coordinatormental for health mental concerns health initiatives, within the specificallycommunity. Thesemental included: health promotion a suicide awarenessand Project audiotape Leader in (Deanna Don’t Do It) - produced to bring awareness to teenage suicide within Aboriginal communities, and; several handbooks on depression, Community Development withbipolar a focus disorder, on building Alzheimer community disease capacity and schizophrenia. around mental These health documents and mental were health produced promotion. to help communityAs members, Project Leader in Communityincluding Development, caregivers, he lead understand and facilitated the nature the design of each and mental production health ofconcern. a number He alsoof published served as materials a team member in the productiondrawing attention of a videotape to mental (Reach health out concerns with Hope) within aimed the to community. help individuals These identify included: common a suicide signs awareness and symptoms audiotape of depression (Deanna andDon’t thoughts of suicide in orderDo It) to - assistproduced those to aroundbring awareness them. Upon to teenageretiring from suicide government within Aboriginal in 2000, he communities, became Executive and several Director handbooks for the Schizophrenia on depression, So ciety of Alberta (2000- 2005),bipolar and disorder, during Alzheimer this time, was disease on the and Steering schizophrenia. Committee These for thedocuments first edition were of producedthe handbook, to help Rays community of Hope: Learningmembers, includingabout Schizophrenia, produced bycaregivers, the Schizophrenia understand Society the nature of Canada. of each This mental resource health is concern. now in its He 4th also Edition. served He as also a team was member a consultant in the to production the Alberta ofMental a Health Board in 2007 andvideotape 2008 with (Reach the outrole withof assessing Hope) aimed the extent to help of individualscollaboration identify and cooperation common signsbetween and thesymptoms Regional of Health depression Authorities and thoughts and the newly formed Primary Healthof suicide Care in Networks order to assist to deliver those comprehensive around them. Uponmental retiring health services.from government In 2006 and in 2000, 2007, he he became held concurrent Executive Interim Director Executive for the Director positions with the Canadian Mental Health Association - Alberta Division and the Society of Alberta Occupational Therapists. He also worked as a Community Mental HealthSchizophrenia Nurse within Society the of Home Alberta Support (2000-2005), Team for and the duringEdmonton this Mental time, was Health on theRegion Steering of Alberta Committee Health for Services the first from edition 2006-2009. of the Since 2008 he has beenhandbook, the Executive Rays of Hope:Director Learning for the Alberta about Schizophrenia,Alliance on Mental produced Illness byand the Mental Schizophrenia Health (the Society Alliance) of Canada. - a consortium This resource of 14 professional is now and non-profit organizationsin its 4th Edition. that haveHe also come was together a consultant to speak to the on Alberta issues ofMental common Health concern Board around in 2007 addiction, and 2008 mental with theillness role and of assessing mental health. the In partnership with theextent Alberta of collaboration Disability Forum and cooperation(a collective ofbetween 42 disability the Regional organizations), Health Authoritiesand on behalf and of the the newly Alliance, formed he was Primary co-lead Health of the Care recently created document: ValuingNetworks and to Supporting deliver comprehensive Alberta’s Non-Profit mental healthDisability services. Organizations: In 2006 and Challenges 2007, he andheld Solutions.concurrent Through Interim his Executive volunteer Director work he was a founding member andpositions President with of the the Canadian St Albert MentalStop Abuse Health in FamiliesAssociation Society - Alberta (1983-1986), Division which and the still Society continues of Alberta to serve Occupational the community. Therapists. He also worked as a Community Mental Health Nurse within the Home Support Team for the Edmonton Mental Health Region of Abstract: What role do non-government organizations play in Alberta Health Services from 2006-2009. Since 2008, he has been effective support systems?the Executive Director for the Alberta Alliance on Mental Illness Backgrounds:and Mental Health Non-profit (the Alliance) organizations - a consortium or non-government of 14 professional organizations and non-profit (NGO) provide organizations a wide range that ofhave services come andtogether play ato valuable speak and unique role inon supporting issues of common and maintaining concern persons around withaddiction, severe mental and persistent illness and mental mental illness health. (spmi) In partnershipin the community. with the Alberta Disability Forum (a collective of 42 disability organizations), and on behalf of the Alliance, he was co-lead of the recently created document: Methods:Valuing and This Supporting view is drawn Alberta’s from Non-Profitongoing observations Disability andOrganizations: comments byChallenges persons livingand Solutions.with mental Throughillness and his theirvolunteer loved ones,work heby NGO’s and mental healthwas a foundingclinicians. member It is also and demonstrated President of through the St Albertongoing Stop funding Abuse by in government. Families Society (1983-1986), which still continues to serve the community. Findings and Discussion: NGOs provide a rich array of services. They work in the areas of supportive housing, supportive work placement and, recreation.Abstract: What They assist,role do support non-government and encourage organizations their clients play to access in effective psychiatric support services systems? when they are needed. They offer peer support – which is so critical in helping the person with spmi to feel understood and not feel alone. They run telephone crisis lines which are frequently used by persons with spmiBackgrounds: because the Non-profit service is organizationsviewed as non-judgemental or non-government and is reorganizationsadily accessible. (NGO) NGOs provide are aa sourcewide range of support of services for families and play who find themselves tired anda valuable often frustrated and unique in theirrole inefforts supporting to ensure and their maintaining loved one persons has access with to severe and continues and persistent to use mental the mental illness health (SPMI) system. in the They are uniquely placed tocommunity. advocate on behalf of the person with spmi and their families for increased mental health services. In so doing NGOs provide an opportunity for the families and their loved ones to become meaningfully involved in advocacy and education programs that can inform key decision makers and the public aboutMethods: mental This illness view and is drawnits impact. from ongoing observations and comments by persons living with mental illness and their loved ones, by NGO’s and mental health clinicians. It is also demonstrated through ongoing funding by government. Conclusions/Policy Recommendations: Findings and Discussion: NGOs provide aGovernment rich array of and services. large government-funded They work in the areasorganizations of supportive need housing,to engage supportive the NGOs work in discussions and strategic planning for mental health service delivery to persons with spmi, to reduce any chance of needless duplication and take best advantage of the rangeplacement of services and, recreation. these organizations They assist, provide. support Government and encourage and othertheir fundersclients to need access to workpsychiatric with NGOs services on stabilizingwhen they multi-year are needed. fu nding to better enable theThey NGOs offer to dopeer long support range – planning which is aroundso critical their in service helping delivery. the person NGOs with need SPMI to haveto feel closer understood communication and not feelwith alone. other like-minded They run NGOs to share resources,telephone crisisplanning lines and which skill aresets frequently to enable usedmore by efficient persons use with of theirSPMI resources. because the In orderservice to istake viewed on a aslarger non-judgemental role in partnership and iswith government in the planningreadily accessible. and supporting NGOs of are the a personsource ofwith support spmi in for the families community, who findNGOs themselves need to consider tired and building often theirfrustrated respective in their organizational efforts to capacity through trainingensure theirand skill loved development. one has access to and continues to use the mental health system. They are uniquely placed to advocate on behalf of the person with SPMI and their families for increased mental health services. In so doing NGOs provide an opportunity for the families and their loved ones to become meaningfully involved in advocacy and education programs that can inform key decision makers and the public about mental illness and its impact.

Consensus Development Conference on Improving Mental Health Transitions 31 SPEAKERS & ABSTRACTS

Conclusions/Policy Recommendations: Government and large government-funded organizations need to engage the NGOs in discussions and strategic planning for mental health service delivery to persons with SPMI, to reduce any chance of needless duplication and take best advantage of the range of services these organizations provide. Government and other funders need to work with NGOs on stabilizing multi-year funding to better enable the NGOs to do long range planning around their service delivery. NGOs need to have closer communication with other like-minded NGOs to share resources, planning and skill sets to enable more efficient use of their resources. In order to take on a larger role in partnership with government in the planning and supporting of the person with SPMI in the community, NGOs need to consider building their respective organizational capacity through training and skill development.

32 Consensus Development Conference on Improving Mental Health Transitions Speakers &SPEAKERS Abstracts & ABSTRACTS

Austin Mardon PhD, CM, LLD(Hon.) AssistantAustin Adjunct Mardon, Professor, PhD, John CM, Dossetor LLD(Ho Health Ethicsn.) Centre, University of Alberta, Edmonton, AB FromAssistant an early Adjunct age Austin Professor, Mardon John dealt Dossetor with schizophrenia. Health Ethics His mother Centre, became University ill with ofschizophrenia Alberta, when Austin was just 5Edmonton, years old. EventuallyAB he also developed the disease, but not before he was able to finish a Bachelor’s degree and two Master’sFrom an degrees.early age AlongAustin the Mardon way, he dealt was witha member schizophrenia. of a NASA His Antarctic mother Meteorite became Recovery ill with team and helped discover over 700 meteorites, including some lunar samples. After returning from the South Pole with frozen lungs and nerve damageschizophrenia in his feet when from Austin frostbite, was Austin just 5 hadn’tyears old. yet completedEventually his he PhDalso programdeveloped when the hedisease, descended but not into the horror of hisbefore first he psychotic was able break. to finish Overnight a Bachelor’s his world degree changed. and two His Master’splans for thedegrees. future Alongtook athe permanent way, he detour.was a As he crossed themember threshold of a ontoNASA the Antarctic ward in the Meteorite psychiatry Recovery department, team he and thought helped his discover life was overover. 700 One meteorites, he was stabilized on his medication,including some he knew lunar that samples. to stay Aftersane, hereturning had to stay from on the his Southmedicine, Pole and with find frozen something lungs andto makenerve his life worth living. Thusdamage began in his many feet years from of frostbite, volunteer Austin activity. hadn’t His commitmentyet completed to servinghis PhD others program afflicted when with he thisdescended devastating disease continuesinto the horror to this ofday. his Hefirst also psychotic continued break. his academic Overnight pursuits, his world and changed.ultimately authoredHis plans overfor the 50 futurebooks, and over 250 peer reviewed abstracts and articles. He has given hundreds of speeches to students, professionals and the general publictook a on permanent living with detour.a mental As illness. he crossed He has the served threshold on a ontovariety the of wardpublic, in private the psychiatry and governmental department, committees. He he thought his life was over. hasOnce served he was with stabilized The Alberta on his Disabilities medication, Forum, he knewthe Premier’s that to stayCouncil sane, on he the had Status to stay of Persons on his medicine, with Disabilities, and the and find something to makeProvincial his life worth Advisory living. Committee Thus began on Mental many Health years andof volunteer Addictions. activity. He is anHis adjunctcommitment professor to servingat the University others of Alberta’s afflictedJohn Dossetor with Healththis devastating Ethics Centre. disease For hiscontinues tireless toadvocacy, this day. he He was also invested continued into histhe academicOrder of Canada pursuits, in Octoberand ultimately 2007. Heauthored continues over to write and 50advocate books, for and the over mentally 250 peer ill. He reviewed believes abstracts that his successand articles. is due He to has his givenoptimism, hundreds perseverance, of speeches the supportto students, of his professionals wife and a zealous and the adherence to generaltaking his public medication on living over with the lasta mental two decades. illness. He He has currently served lives on ain variety Edmonton of public, with his private wife, son,and andgovernmental spoiled basset committees. hound. He has servedAbstract: with The Alberta Disabilities Forum, the Premier’s Council on the Status of Persons with Disabilities, and the Provincial Advisory Committee on Mental Health and Addictions. He is an adjunct professor at the University of Alberta’s John Dossetor HealthI am afraid Ethics to watch Centre. the For news. his tirelessIt’s always advocacy, something. he was A man invested who bringsinto the a knifeOrder to of work Canada and tries in October to kill his 2007. co-workers, He continues a normal to collegewrite kid who out andof the advocate blue kills for a bunchthe mentally of people ill. at He a party,believes or athat taxi his driver success shooting is due up to a hislumber optimism, mill. Normal perseverance, people, when the support they see of such his wife things and on the TV or in the anewspaper zealous adherence will feel bad to fortaking the friendshis medication and family over of those the last involved. two decades. They will He feel currently sad, and lives perhaps in Edmonton say a prayer. with hisWhen wife, I see son, these and kinds of things, my spoiledfirst thought basset is, hound. “please don’t let it be someone with schizophrenia. Many times a serious mental illness is involved. Healthy people don’t do such bizarre things. I feel as if I have been fighting the stigma of schizophrenia since I was old enough to remember. My mother was diagnosed with schizophrenia when I was 5 years old. I was subjected to scorn and alienation. There was the constant fear of being placed in foster care, or of my parents divorcing, Abstractof my father dying from his heart condition because of the stress. The stigma I have lived my whole life with, made me believe when I was first Ihospitalized am afraid towith watch schizophrenia, the news. It’sthat always my life something. was over. When A man I first who metbrings my awife, knife I was to workafraid andto tell tries her. to killWhen his I finallyco-workers, did, she a normalsaid, “That’s interesting, so what.” I thought maybe she didn’t understand what schizophrenia meant. What I didn’t know is that she had a long history of working with the mentally collegeill homeless. kid who She out has of this the natural blue kills ability a bunch to separate of people a person at a party, from theiror a disease.taxi driver When shooting I have up break a lumber through mill. symptoms Normal andpeople, think when that the TV is talking theyto me, see she such very things calmly on tells the me TV that or inmaybe the newspaper it is time to willturn feelthe TVbad off. for When the friends I first andstarted family introducing of those her involved. to my friends They andwill family, feel sad, almost everyone andasked perhaps if she had say schizophrenia.a prayer. When She I see got these used kinds to parroting, of things, “no my I don’t first have thought schizophrenia. is, “please Thedon’t funniest let it be thing someone is that withthose schizophrenia.” who didn’t ask, just assumed, Manyand months times latera serious were mentalshocked illness to find is involved.out that she Healthy didn’t havepeople it. If don’t I was do deaf such or blind,bizarre no things. one would I feel ask as ifmy I havewife if been she wafightings likewise the afflicted. For those stigmaof us with of schizophrenia,schizophrenia peoplesince I justwas assume old enough that weto remember.are so damaged My mother that a normalwas diagnosed person wouldn’t with schizophrenia want to marry when us. I Ieven was bel5 yearsieved that for a long old.time. I It’swas not subjected easy to beto scornthis public. and alienation. Everywhere There I go, peoplewas the know constant I have fear a serious of being mental placed illness. in foster It would care, beor soof muchmy parents easier divorcing,to just blend in or hide. Fear seems to be the largest component of the stigma we face. During almost every speech I give at a school, someone asks if schizophrenia makes ofyou my violent. father We dying know from that his those heart with condition schizophrenia because are of more the stress.likely to The injure stigma themselves I have livedthan others,my whole but whenlife with, one ofmade us becomesme believe violent, it is usually in whena dramatic I was fashion. first hospitalized So how do wewith fight schizophrenia, it? By education, that myeducat life ionwas and over. more When education. I first As met medications my wife, I andwas afraidtreatments to tell improve, her. When we haveI to find a way finallyto allow ourselvesdid, she said, to reintegrate. “That’s interesting, It’s almost so as what.”if we Iare thought going to maybehave toshe learn didn’t how understand to forgive ourselves what schizophrenia for being ill. Mymeant. wife saysWhat I that didn’t all she expects knowfrom me is thatis to shelive hadas healthy a long andhistory happy of workinga life as I witham capable the mentally of. Now, ill homeless.I just have Sheto give has myselfthis natural permission ability to to be separate content awith person that. from their disease. When I have breakthrough symptoms and think that the TV is talking to me, she very calmly tells me that maybe it is time to turn the TV off. When I first started introducing her to my friends and family, almost everyone asked if she had schizophrenia. She got used to parroting, “no I don’t have schizophrenia.” The funniest thing is that those who didn’t ask, just assumed, and months later were shocked to find out that she didn’t have it. If I was deaf or blind, no one would ask my wife if she was likewise afflicted. For those of us with schizophrenia, people just assume that we are so damaged that a normal person wouldn’t want to marry us. I even believed that for a long time. It’s not easy to be this public. Everywhere I go, people know I have a serious mental illness. It would be so much easier to just blend in or hide. Fear seems to be the largest component of the stigma we face. During almost every speech I give at a school, someone asks if schizophrenia makes you violent. We know that those with schizophrenia are more likely to injure themselves than others, but when one of us becomes violent, it is usually in a dramatic fashion. So how do we fight it? By education, education and more education. As medications and treatments improve, we have to find a way to allow ourselves to reintegrate. It’s almost as if we are going to have to learn how to forgive ourselves for being ill. My wife says that all she expects from me is to live as healthy and happy a life as I am capable of. Now, I just have to give myself permission to be content with that.

Consensus Development Conference on Improving Mental Health Transitions 33 SPEAKERS & ABSTRACTS Speakers & Abstracts

Dr.Dr. Oliver Oliver Mason, Mason, DPhil, DClinPsy. SeniorSenior LecturerLecturer in Clinical Psychology, Education and University Health CollegePsychology, Londo University College London

OliverOliver MasonMason is is a asenior senior lecturer lecturer in inclinical clinical psychology psychology at University at University College College London London where where he has he has been a faculty member beensince a 2004.faculty He member is also since Deputy 2004. Director He is also of Research Deputy Director and Developm of Researchent and for NorthDevelopment East London for NHS Foundation Trust where Northhe also East works London as a NHS consultant Foundation clinical Trust psychologist. where he also His works clinical as ainterests consultant and clinical experience psychologist. have spanned adult mental health, Hisneuropsychology clinical interests and and community-based experience have spanned crisis resolution. adult mental He health, has been neuropsychology a chief external and examiner at several doctoral clinical community-basedpsychology courses crisis in resolution.the UK. Oliver He has completed been a chief his externalD. Phil. inexaminer 1996 at at The several University doctoral of clinical Oxford investigating schizophrenia psychologyand schizotypy, courses and in subsequentlythe UK. Oliver trained completed clinically his D. at Phil. The in University 1996 at The of Wales.University His of research Oxford interests include vulnerability investigatingfactors for psychosis, schizophrenia as well and as schizotypy, its treatment and subsequentlyand recovery. trained He is clinicallyan author at of The over University 70 chapters and articles across areas ofof Wales.clinical His and research personality interests psychology. include vulnerability He has contributed factors for to psychosis, a wide range as well of asgrant its treatment funded studies in the UK National Health andService recovery. as a Hecollaborator is an author or oflocal over investigator. 70 chapters andIn this articles context across he areaswill present of clinical aspects and personality of the CORE Research Program led psychology. He has contributedby toProf. a wide Sonia range Johnson, of grant alsofunded at UCL.studies CORE in the UKstands National for Crisis Health re solutionService asteam a collaborator Optimisation or and RElapse prevention and local investigator. In this contextfunded he will by presentthe National aspects Institute of the CORE for Health Research Research Program (UK). led by Prof. Sonia Johnson, also at UCL. CORE stands for Crisis resolution team Optimisation and RElapse prevention and is funded by the National Institute for Health Abstract:Research (UK).

Backgrounds:Abstract The United Kingdom has seen almost universal de-institutionalization from long-stay asylums: However, acute inpatient care is in a state of crisis. I describe the current situation with regards to alternatives to admission in the UK aiming to draw out broader lessons for other contexts. Background: The United Kingdom has seen almost universal de-institutionalization from long-stay asylums: However, acute Methods:inpatient care Evidence is in a stateis presented of crisis. Ifrom describe a range the currentof reviews situation and empiricalwith regards studies to alternatives in respect to of admission both ‘crisis in theresolution UK aiming teams’ to and ‘crisis houses’ in the UK setting.draw out In broader particular lessons I draw for on other evidence contexts. from the CORE Study; a national programme aimed at improving Crisis Resolution Team implementation. Methods: Evidence is presented from a range of reviews and empirical studies in respect of both ‘crisis resolution teams’ and ‘crisis Findings/Discussion: houses’ in the UK setting.The In particular,implementation I draw of on CRTs evidence is very from variable. the CORE When Study; well-resourced a national programme and led, CRTsaimed contributeat improving to reduced bed usage, cost savings and improved patient satisfaction. I describe how evidence gathering has led us to a model of best practice and a measure of fidelity against which Crisis Resolution Team implementation. teams can be judged. The CORE study based at University College London is currently developing a range of implementation resources designed to improveFindings/Discussion: fidelity to this The model, implementation and testing theseof CRTs via is avery randomi variable.zed controlledWhen well-resourced trial. and led, CRTs contribute to reduced bed usage, cost savings and improved patient satisfaction. I describe how evidence gathering has led us to a model of best practice Conclusions/Policy Recommendations: and a measure of fidelity against which teamsCRTs can beare judged. a cost-effective The CORE alternative study based to at admission University that College requires London well-resourced is currently implementation to achieve theirdeveloping aims. Ina rangeparticular, of implementation they require multi-disciplinaryresources designed professional to improve fidelity staff and to goodthis model,working and relationships testing these withvia a bothrandomized inpatient and community teams. When wellcontrolled implemented, trial. CRTs can lead to positive patient satisfaction and staff well-being. Use of fidelity measures and implementation resources are recom- mended for the cost-effective and successful implementation of CRTs. Conclusions/Policy Recommendations: CRTs are a cost-effective alternative to admission that requires well-resourced implementation to achieve their aims. In particular, they require multi-disciplinary professional staff and good working relationships with both inpatient and community teams. When well implemented, CRTs can lead to positive patient satisfaction and staff well-being. Use of fidelity measures and implementation resources are recommended for the cost-effective and successful implementation of CRTs.

34 Consensus Development Conference on Improving Mental Health Transitions Speakers &SPEAKERS Abstracts & ABSTRACTS

David McDaid,David McDaid BSc, MSc, MSc Senior ResearchResearch fellow, fellow, Health London Policy Schooland Health of Economics Economics, and London Political School Science, of Economics London, UK and PoliticalDavid Science, McDaid London, is Senior UK Research Fellow in Health Policy and Health Economics at LSE Health and Social David McDaidCare is Senior and the Research European Fellow Observatory in Health Policy on Health and Health Systems Economics and Policies at LSE at Health the London School of Economics and Social Careand and Political the European Science. Observatory He is involved on Health in a wide Systems range and of Policies work on at mentalthe London health and public health in the UK, School of EconomicsEurope and and atPolitical the global Science. level. He He is involved is also co-ordinatorin a wide range of ofthe work Mental on mental Health health Economics European Network, and public healtha member in the ofUK, NICE’s Europe Public and at Health the global Interventions level. He is Advisory also co-ordinator Committee, of the Co-Convenor Mental of the Cochrane Camp- Health Economicsbell Economic European Methods Network, Group a member and of has NICE’s acted Public as an Health advisor Interventions to a range Advisoryof international organisations. He has Committee, publishedCo-Convenor over of 200 the Cochranepeer reviewed Campbell papers Economic and reports, Methods including Group and a report has acted for the as UK Department of Health an advisor towhich a range looked of international at the economic organisations. case for He investing has published in mental over 200 health peer promotion reviewed papers and mental disorder prevention. and reports, Heincluding is the editora report of for two the new UK books Department – the firstof Health on economics which looked and at thewellbeing economic and the second, a collaboration case for investing in mental health promotionbetween and themental European disorder Observatory prevention. He on is Health the editor Systems of two and new Policies books – andthe first the OECD,on looks at the economic caseeconomics for investing and inwellbeing health promotionand the second, and diseasea collaboration prevention. between He the is alsoEuropean a past Observatory winner of theon HealthEuropean Systems Health and Management Policies and Association’s Baxter Awardthe inOECD, 2007 looksfor the at bestthe economic book on casehealth for policyinvesting – Mental in health Health promotion Policy and and disease Practice prevention. across Europe. He is also a past winner of the European Health Management Association’s Baxter Award in 2007 for the best book on health policy – Mental Health Policy and Practice across Europe. Abstract: A road map for mental health research This presentation considers how a road map for mental health research can be used to advance future priorities, drawing on recent experience in the development of a road map for mental health research in the European Union. Vital to developing an innovative road map is to provide mechanisms that actively allow for input from a very broad range of stakeholders, ranging from service users through to policy makers and pioneers and innovators from many different industries. Space and time are also needed to future scan and consider how both pure and applied research for mental health may develop over the next 10 to 20 years. The European Roadmap for Mental Health (ROAMER), which is due to complete its work in March 2015, has had a 3 year window in which to make its deliberations. It has used this space to set up a number of different working groups that have not only looked at novel research but also at ways of strengthening research capacity and infrastructure. It has gone beyond consideration of biomedical and psychological research to also look at social and economic research, public health actions and the rapidly developing field of wellbeing research. This presentation does not seek to go into detail on all of the research priorities that have been agreed upon, but instead highlights several important transversal health economic research challenges that perhaps will not have featured prominently in discussions at this Consensus Development Conference. One key issue is to understand the impacts that different and complex ways of organising and financing mental health services may have on the quality of care and outcomes achieved. This requires a combination of quantitative and qualitative approaches. This has become more feasible with ever growing access to data from longitudinal datasets and improved ways of data linkage within and across health and social welfare systems. Economic incentives can be powerful levers for change, as can for instance be seen in the way Canada has come to the forefront of actions to improve mental health in workplaces, as well as in the way that scholars such as James Heckman and Richard Layard have been able to build the case for early years interventions to improve mental health. A second key issue is to further embed economic analysis prospectively into future research plans rather than being seen too often as an afterthought. One vital area for economic analysis that still receives comparatively little attention, despite its profound impact on people with severe and persistent mental illness, is to better understand the costs of avoidable mental and physical comorbidities. Wellbeing research is currently in vogue, but it remains both complicated and confused with insufficient clarity even on definitions of wellbeing. Nonetheless, another important future research priority might be to consider whether investment in actions to promote better levels of mental wellbeing can in fact also reduce the risk of future mental and physical health problems. Finally achieving all of this requires investment in capacity and infrastructure.

Consensus Development Conference on Improving Mental Health Transitions 35 SPEAKERS & ABSTRACTS Speakers & Abstracts

ScottScott PattenPatten, MD, MD, FRCP(C), FRCPC, PhD PhD Professor,Professor, University University ofof Calgary, Calgary, AB AB

Dr.Dr. ScottScott Patten Patten is is a a Psychiatrist Psychiatrist and and Professor Professor at at the the University University of of Calgary Calgary andand aa Senior Senior Health Health Scholar with Alberta ScholarInnovates, with Health Alberta Solutions Innovates (formerly – Health the Solutions Alberta Heritage (formerly Foundation the Alberta for Heritage Medical Research).Foundation His research focusses on formood Medical disorder Research). epidemiology His research both in focuses the general on mood population disorder and epidemiology in populations both with inmedical the general comorbidities. This program populationof research and has in utilized populations national with survey medical data, comorbidities. national longitudinal This programpanel data, of researchadministrative has utilized data, simulation methods nationalas well assurvey prospective data, national and longitudinal longitudinal studies panel in data,Alberta administrative populations. data,This programsimulation of researchmethods hasas produced more than well350 as peer prospective reviewed andpublications. longitudinal He isstudies the Editor-in-Chief in Alberta populations. of the Canadian This Journalprogram of of Psychiatry research hasand was the co-chair producedof the Scientific more than Advisory 350 peer Committee reviewed for publications. Canada’s National He is the Population Editor-in-Chief Study of of Neurological the Canadian Conditions. Dr. Patten practices psychiatry through the Peter Lougheed Centre in Calgary and acts as a consultant to the University of Calgary JournalMS Clinic. of Psychiatry He teaches and epidemiology was the co-chair and supervises of the Scientific MSc and Advisory PhD students Committee through for theCanadas Department of Community NationalHealth Sciences Population at the Study University of Neurological of Calgary. Conditions. Dr. Patten practices psychiatry through the Peter Lougheed Centre in Calgary and acts as a consultant to the University of Calgary MS Clinic. He teaches epidemiology and supervises MSc and PhD students through the Department of Community Health Sciences at the University of Calgary. Abstract: Abstract Background: Estimating the prevalence of severe and persistent mental illness (SPMI) is a complex task because the concept of SPMI includes severalBackground: dimensions: Estimating severity the of prevalence symptoms, of the severe severity and of persistent impairment, mental and illness persistence. (SPMI) The is a term complex “SPMI” task is becausesometimes the appliedconcept to specific diagnoses, usuallyof SPMI Schizophrenia includes several and dimensions:Bipolar Disorder. severity This of suggests symptoms, that the the severity prevalence of impairment, of SPMI may and be persistence. estimated as The the term combined “SPMI” prevalence of Schizophrenia andis sometimes Bipolar Disorder. applied However, to specific this diagnoses, simple approach usually isSchizophrenia problematic becauseand Bipolar while Disorder. these illnesses This suggests are often that severe the prevalence and persistent, of they are not always so.SPMI Furthermore, may be estimated other diagnoses as the combined can manifest prevalence with severe of Schizophrenia and persistent and symptoms Bipolar Disorder. and impairment. However, An this alternative simple approachapproach isis to focus on symptom severityproblematic and persistence because while without these restriction illnesses areto specific often severe diagno andses. persistent, they are not always so. Furthermore, other diagnoses can manifest with severe and persistent symptoms and impairment. An alternative approach is to focus on symptom severity and Methods: Three strategies for quantifying the prevalence of SPMI will be described in this presentation. First, available data concerning the prevalence ofpersistence Schizophrenia without and restrictionBipolar disorder to specific will be diagnoses. used to produce a diagnosis-specific prevalence estimate. Second, prevalence data from a major study usingMethods: methods Three not strategiesdependent for on quantifying diagnosis will the be prevalence reported. ofFinally, SPMI thewill prevalence be described will in be this estimated presentation. using aFirst, hybrid available approach data that combines information aboutconcerning specific the diagnosis prevalence and of associated Schizophrenia severity. and BipolarRelevant disorder data for willthe thirdbe used strategy to produce derives a fromdiagnosis-specific the 2010 Global prevalence Burden ofestimate. Disease update. Results:Second, Accordingprevalence to data recent from systematic a major study reviews, using the methods point prevalence not dependent of Schizophrenia on diagnosis and will closely be reported. related Finally,disorders the is prevalenceapproximately 0.7% and that for Bipolar Disorder (I and II combined) is approximately 0.8%. Combining these estimates (strategy 1) leads to an overall SPMI prevalence of will be estimated using a hybrid approach that combines information about specific diagnosis and associated severity. Relevant approximately 1.5%. A diagnosis-independent definition of “serious” mental illness has been proposed by SAMHSA and evaluated in the 2012 US Nationaldata for Surveythe third on strategy Drug Use derives and Health from the (NSDUH), 2010 Global providing Burden an implementationof Disease update. of the Results: second According strategy. Theto recent prevalence systematic of serious mental illness was 4.1%reviews, in this the survey, point prevalencerepresenting of approximatelySchizophrenia 20% and ofclosely those related found disordersto have any is approximatelymental disorder 0.7% in the and survey that forsample. Bipolar Disorder Application(I and II combined) of the third is strategy approximately indicates 0.8%. that Combining whereas Schizophrenia these estimates and (strategy Bipolar Disorders 1) leads to have an overall a low prevalenceSPMI prevalence relative of to some other conditions (e.g.approximately Major Depressive 1.5%. A Disorder), diagnosis-independent they are characterized definition by aof larger“serious” proportion mental withillness severe has beenmanifestations proposed ofby theirSAMHS illness. and Co evaluatednversely, even though Majorin the Depressive 2012 US National Disorder Survey is not typicallyon Drug aUse severe and Healthand persist (NSDUH),ent disorder, providing a minority an implementation of those afflicted of theexperience second strategy.a severe The and persistent course. Furthermore,prevalence of due serious to its mental high prevalence, illness was the 4.1% absolute in this numberssurvey, representing severely afflicted approximately are not trivial. 20% of those found to have any mental disorder in the survey sample. Application of the third strategy indicates that whereas Schizophrenia and Bipolar Disorders have Discussion: Overall, the third strategy appears to provide the most balanced perspective on the prevalence of SPMI. It is reasonable to regard a low prevalence relative to some other conditions (e.g. Major Depressive Disorder), they are characterized by a larger proportion some illnesses as SPMI because they characteristically produce severe and/or persistent or highly recurrent symptoms, requiring continuous long- termwith management. severe manifestations On the other of their hand, illness. a substantial Conversely, proportion even though of SPMI Major in the Depressive population Disorder is due to is unusually not typically severe a severe manifestation and s of more common disorders.persistent disorder, a minority of those afflicted experience a severe and persistent course. Furthermore, due to its high prevalence, the absolute numbers severely afflicted are not trivial. Overall, a reasonable estimate is that 2-3% of the general population have SPMI at any point in time. Conclusions/Policy Recommendations: Discussion: Overall, the third strategy appears to provide the most balanced perspective on the prevalence of SPMI. It is Roughly speaking, about one half of the burden of SPMI is due to Schizophrenia or Bipolar Disorder with the remaining half due to various other disorders.reasonable to regard some illnesses as SPMI because they characteristically produce severe and/or persistent or highly recurrent symptoms, requiring continuous long-term management. On the other hand, a substantial proportion of SPMI in the population is due to unusually severe manifestations of more common disorders. Conclusions/Policy Recommendations: Overall, a reasonable estimate is that 2-3% of the general population have SPMI at any point in time. Roughly speaking, about one half of the burden of SPMI is due to Schizophrenia or Bipolar Disorder with the remaining half due to various other disorders

36 Consensus Development Conference on Improving Mental Health Transitions SPEAKERS & ABSTRACTS Speakers & Abstracts

Luis Salvador- Carulla, MD, PhD LuisProfessor Salvador-Carulla, of Disability and Mental Health, MD, The PhD University of Sydney, Australia Professor of Disability and Mental Health, The University of Sydney, Australia Luis Salvador-Carulla is professor of Disability and Mental Health at the Faculty of Health Sciences (University of Dr.Sydney, Luis Australia). Salvador-Carulla His field isof interestprofessor is supportof Disability decision and systems Mental and Health policy inat long-term the Faculty care, of Healthdisability and mental Scienceshealth, with (University a particular of focus Sydney, in the Australia). development His of fieldintegrated of interest atlases isof supporthealthcare. decision He is honour systems member and of the World policyPsychiatry in long-term Association care, and Secretarydisability of and the mentalWPA section health, “Classification, with a particular Diagnostic focus assessment in the development and Nomenclature”. ofDr. integrated Salvador-Carulla atlases has of intensivelyhealthcare. participated He is an honourary in the development member of ofinternational the World networks Psychiatry in the Association fields mentioned above, person centred medicine, healthy ageing, and bridging and knowledge transfer between disability, ageing and andhealth. Secretary He has beenof the advisor WPA to section the Government “Classification, of Catalonia Diagnostic (Spain), theassessment Spanish Ministryand Nomenclature”. of Health, the EuropeanDr. Salvador-CarullaCommission (EC) and has the intensively World Health participated Organisation in the (WHO). development He coordinated of international the European networks Commission in the (EC) project fieldseDESDE-LTC mentioned for the above, development person of centred an European medicine, classification healthy ofageing, services and for bridging long term and care knowledge (including persons with transferdisability betweenand ageing disability, population) ageing and he and participated health. He as hasnation beenal coordinator advisor to in the the GovernmentEC project Refinement of Catalonia to develop (Spain),a toolkit for the the Spanish assessment Ministry of financing of Health, of mentalthe European health syste Commissionms in Europe. (EC) He also and chaired the World the WHO Health working group on the classification of intellectual disabilities at chapter V of the International Classification of Diseases. He received Organisation (WHO). He coordinatedthe Leon Eisenberg the European Award ofCommission the Harvard Medical(EC) project School eDESDE-LTC in 2012 for his contributionsfor the development in the field of of an developmental European disorders.classification of services for long term care (including persons with disability and ageing population) and he participated as national coordinator in the EC project Refinement to develop a toolkit for the assessment of financing of mental health systems in Abstract:Europe. He Basic also support chaired decision the WHO tools working for mental group health on the system classification improvement: of intellectual The Integrated disabilities Atlases at of chapter Mental HealthV of the Care International DuringClassification the last decade of Diseases. Health AtlasesHe received have gainedthe Leon increasing Eisenberg attention Award as supportof the decisionHarvard toolsMedical for guiding School health in 2012 policy, for particularlyhis contributions in the context in of the evidence-informedfield of developmental model, asdisorders. they provide a more significant role to context/local information than the traditional evidence-based care approach. However, little is known on the actual impact of Atlases in local resource allocation and implementation. Three major approaches could be identified: 1)Abstract: population-based Basic support top-down decision atlases usingtools generalfor mental health health care indicators, system improvement: 2) population-based The atlases Integrated which incorporateAtlases of GeograMentalphical Health Information Care Systems and eventually geocoding of services identified by their names at local level, and 3) Integrated Atlases that may combine multiple health informationDuring the sources last decade (population, Health system Atlases indicators, have gained traditional increasing listing ofattention services), as standard support classification decision tools of servicesfor guiding to allow health for territorial policy, comparisons, andparticularly different visualizationin the context techniques of the evidence-informed including dynamic spatial model, analysis. as they We provide discuss athe more policy significant and practice role implications to context/local of different information service mapping approachesthan the traditional in mental healthevidence-based policy: a) the care WHO approach. Atlas series, However, b) the REMAST little is known atlases onin 8the European actual impactregions withinof Atlases the Refinement in local resource project; and c) the regional Integrated Atlases of Mental Health Care in Spain. We used a standard implementation impact scale to explore the policy impact of several mappingallocation projects and implementation. of MH Care in Spain Three carried major out by approaches the same service could researchbe identified: group. Service1) population-based mapping was performed top-down in atlasesnine regi usingons in generalSpain, with anhealth additional care indicators,integrated care 2) population-based approach including atlaseshealth and which social incorporate care, employment, Geographical education, Information crime and justice Systems and and child eventually and adolescent geocoding services inof 4services regions: identified Basque Country, by their Cantabria, names Cataluñaat local level, and Madrid.and 3) AIntegrated high disparity Atlases in the that impact may on combinepolicy and practicemultiple washealth observed information in these projects mainlysources related (population, to the extent system of cooperation indicators, with traditional the regional listing and nationalof services), MH planning standard agencies, classification the transparency of services within to theallow or ganizationsfor territorial and the level of collaboration of the different departments in the regional public care system. Integrated atlases of mental healthcare are key tools for supporting and guidingcomparisons, evidence-informed and different policy visualization and for understanding techniques the including context of care.dynamic The designspatial and analysis. collaboration We discuss with local the andpolicy regional and agenciespractice has a signifi- cantimplications impact in ofthe different implementation service of thesemapping visualisation approaches techniques in mental in health health policy. policy: a) the WHO Atlas series, b) the REMAST atlases in Salvador-Carulla8 European regions L et al.within Evaluation the Refinement of an integrated project; system and for classification,c) the regional assessment Integrated andAtlases comparison of Mental of services Health for Care long-term in Spain. care inWe Europe:used the eDESDE-LTCa standard implementation study. BMC Health impact Serv Res.scale 2013 to explore Jun 15;13:218. the policy impact of several mapping projects of MH Care in Spain carried Iruin-Sanz A. et al. The role of geographic context on mental health: lessons from the implementation of mental health atlases in the Basque Country (Spain).out by the Epidemiology same service and researchPsychiatric group. Sciences Service 2015 mapping (in press) was performed in nine regions in Spain, with an additional integrated care approach including health and social care, employment, education, crime and justice and child and adolescent services in 4 regions: Basque Country, Cantabria, Cataluña and Madrid. A high disparity in the impact on policy and practice was observed in these projects mainly related to the extent of cooperation with the regional and national MH planning agencies, the transparency within the organizations and the level of collaboration of the different departments in the regional public care system. Integrated atlases of mental healthcare are key tools for supporting and guiding evidence-informed policy and for understanding the context of care. The design and collaboration with local and regional agencies has a significant impact in the implementation of these visualisation techniques in health policy. Salvador-Carulla L et al. Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study. BMC Health Serv Res. 2013 Jun 15; 13:218. Iruin-Sanz A. et al. The role of geographic context on mental health: lessons from the implementation of mental health atlases in the Basque Country (Spain). Epidemiology and Psychiatric Sciences 2015 (in Press).

Consensus Development Conference on Improving Mental Health Transitions 37 SPEAKERS & ABSTRACTS Speakers & Abstracts

HowardHoward Sapers Sapers Correctional Investigator of Canada, Office of the Correctional Investigator, Ottawa, Ontario Correctional Investigator of Canada, Office of the Correctional Investigator, Ottawa, Ontario OnOn February 17, 2012, Mr.Mr. Howard SapersSapers waswas reappointedreappointed CorrectionalCorrectional InvestigatorInvestigator of of Canada Canada for a third consecutive forterm, a third having consecutive first been term, appointed having on first February been appointed24th, 2004. onA graduateFebruary of24th, Simon 2004. Fraser A graduate University, of Mr. Sapers has an exten- Simonsive background Fraser University, in criminology Mr. Sapers and correctionshas an extensive gained background through a combination in criminology of education, and corrections employment, community and public service. Prior to his appointment as Correctional Investigator, Mr. Sapers held a variety of criminal justice positions, gained through a combination of education, employment, community and public service. Prior to including: Vice-Chairperson for the Prairie Region, Parole Board Canada; Director of the Crime Prevention Investment hisFund appointment at the National as Correctional Crime Prevention Investigator, Centre; Mr. and Sapers Executive held Directora variety of of the criminal John Howard justice positions,Society of Alberta. Between including:1993 and 2001,Vice-Chairperson Mr. Sapers served for the two Prairie terms Region, as an electedParole Boardmember Canada; of the AlbertaDirector Legislative of the Crime Assembly representing PreventionEdmonton –Investment Glenora. HeFund held at variousthe National Critic Crimeportfolios Prevention including: Centre; Health, and Education, Executive Science Director and Finance. During his sec- ofond the term, John Mr. Howard Sapers Society served of as Alberta. House LeaderBetween and 1993 Leader and 2001,of the Mr. Official Sapers Opposition. served two An terms active as community volunteer, Mr. anSapers elected has member held a numberof the Alberta of positions, Legislative including: Assembly President representing of the Canadian Edmonton Criminal – Glenora. Justice He Association; President of the held various Critic portfolios Albertaincluding: Criminal Health, Justice Education, Association; Science and and Vice-Chair Finance. Duringof the City his ofsecond Edmonton term, Safer Mr. Sapers Cities servedAdvisory as Committee. He current- House Leader and Leader ofly the serves Official as a Chairman Opposition. of theAn DND/Canadianactive community Forces volunteer, Ombudsman Mr. Sapers Advisory has held Committee, a number North of positions, American Region Member of the International Ombudsman Institute Board of Directors, and a Member of the Board of the Directors of the Forum of Canadian Ombudsman. Mr. including: President of the Canadian Criminal Justice Association; President of the Alberta Criminal Justice Association; and Sapers has received national recognition for his work and service. This recognition includes: the Canada 125 Medal; the Weiler Award for Social Devel- opment;Vice-Chair the of Queen the City Elizabeth of Edmonton II Golden Safer Jubilee Cities Medal; Advisory and Committee.the Queen Elizabeth He currently II Diamond serves asJubilee a Chairman Medal. of In the2010, DND/Canadian Mr. Sapers was recognized as a ChampionForces Ombudsman of Mental HealthAdvisory by Committee,the Canadian North Alliance American on Mental Region Illness Member and Mental of the Health International and he has Ombudsman received the Institute President’s Board Commendation from the Canadianof Directors, Psychiatric and a Member Association. of the TheBoard Office of the of Directorsthe Correctional of the ForumInvestigator of Canadian serves Ombudsman.as an Ombudsman Mr. Sapersfor federally has received sentenced offenders. As Correction- alnational Investigator, recognition Mr. Sapers for his continues work and to service. pursue Thispriority recognition concerns andincludes: challenges the Canada in federal 125 correctionsMedal; the suchWeiler as Awardmental for health Social and corrections, preventing deathsDevelopment; in custody, the andQueen the Elizabeth special needs II Golden of Aboriginal Jubilee Medal;offenders, and aging the Queen offenders Elizabeth and federally II Diamond sentenced Jubilee women. Medal. A In much 2010, sought Mr. after public speaker andSapers media was commentator,recognized as Mr.a Champion Sapers has of deliveredMental Health keynote by addresses,the Canadian guest Alliance lectures on andMental chaired Illness academic and Mental panels Health at several and he prominent has conferences andreceived events the across President’s Canada Commendation and internationally. from theHe Canadianhas taught Psychiatric courses in Association.Criminology, TheCorrectional Office Law of the and Correctional Communications Investigator in the Correctional Ser- vices Program at Grant MacEwan University in Edmonton. Mr. Sapers is an Adjunct Professor in the School of Criminology at Simon Fraser University, serves as an Ombudsman for federally sentenced offenders. As Correctional Investigator, Mr. Sapers continues to pursue priority and has authored publications including journal articles and textbook chapters on ombudsmanship, human rights and corrections. concerns and challenges in federal corrections such as mental health and corrections, preventing deaths in custody, and the Abstractspecial needs of Aboriginal offenders, aging offenders and federally sentenced women. A much sought after public speaker and media commentator, Mr. Sapers has delivered keynote addresses, guest lectures and chaired academic panels at several Background:prominent conferences An increasing and eventsnumber across of federally Canada sentenced and internationally. offenders present He has withtaught significant courses inmental Criminology, health problems Correctional at admission Law and throughout their sentence.and Communications The Office inof the CorrectionalCorrectional Investigator Services Program (OCI) hasat Grant raised MacEwan numerous University concerns inwith Edmonton. the treatment Mr. Sapersand management is an Adjunct of mentally disordered offenders,Professor inincluding the School those of withCriminology severe and at Simonpersistent Fraser mental University, illness (SPMI). and has authored publications including journal articles and textbook chapters on ombudsmanship, human rights and corrections. Methods: As a corporate priority, the Office has published a number of stand-alone reports and investigations looking at access to mental health care in federal penitentiaries, the most recent being Risky Business: An Investigation of the Treatment and Management of Chronic Self-Injury Among Federally SentencedAbstract: Implications Women. of mental illness for corrections Background: An increasing number of federally sentenced offenders present with significant mental health problems at admission Findings:and throughout In the theirperiod sentence. between The 1997 Officeand 2008, of the the proportionCorrectional of Investigatoroffenders with (OCI) mental has healthraised needs numerous identified concerns at intake with thedoubled. At admission, 60% of male offenders and 65% of female offenders require further assessment to determine if they have mental health needs. Currently, 63% of federally treatment and management of mentally disordered offenders, including those with severe and persistent mental illness (SPMI). sentenced women are prescribed some type of psychotropic medication. The incidence of prison self-injury has more than tripled in the last ten years. AnMethods: increasing As anumber corporate of use priority, of force the interventions Office has involvepublished a si atuation number where of stand-alone a mental health reports concern and investigations has been identified. looking at The access five Regional Treatment Centresto mental (psychiatric health care hospitals) in federal admit penitentiaries, only the most the mostacute recent cases beingof mental Risky disorder; Business: the An regular Investigation male institutions of the Treatment lack intermed and iate health care capacity. Management of Chronic Self-Injury Among Federally Sentenced Women. Discussion: Prisons are not hospitals and lack both the therapeutic environment and resources required to address the needs of acutely disordered offenders.Findings: InThe the treatment period between centres struggle1997 and with 2008, their the dual proportion mandate of (i.e. offenders prison and with hospital, mental patienthealth andneeds inmate). identified Some at ofintake the treatmentdoubled. facilities are in- adequateAt admission, from 60%a physical of male infrastructure offenders and standpoint. 65% of female Recruitment offenders and retentionrequire further of mental assessment health professionals to determine in if correctionsthey have ismental a persistent concern. The usehealth of segregationneeds. Currently, to manage 63% of mentally federally ill sentencedindividuals womenis particularly are prescribed problematic. some type of psychotropic medication. The incidence of prison self-injury has more than tripled in the last ten years. An increasing number of use of force interventions involve a situation Conclusions/Policy Recommendations where a mental health concern has been identified. The five Regional Treatment Centres (psychiatric hospitals) admit only the 1. Long-term segregation of acutely mentally ill, self-injurious and suicidal offenders should be abolished. 2.most Patient acute advocates cases of mental or quality disorder; care coordinators the regular maleshould institutions be appointed lack at intermediate each of the fivehealth Regional care capacity. Treatment Centres. 3.Discussion: The most severelyPrisons arementally not hospitals ill male and femalelack both inmates the therapeutic should be environmentplaced in external and resources treatment required facilities. to address the needs of 4.acutely Self-injurious disordered behaviour offenders. should The be treatment treated and centres managed struggle as a withmental their health, dual notmandate security (i.e. or prison behavioral and hospital,issue. patient and inmate). 5.Some Provide of the for treatment 24/7 health facilities care coverage are inadequate at all maximum, from a physical medium infrastructure and multi-level standpoint. institutions. Recruitment and retention of mental 6.health Increase professionals efforts to inrecruit corrections and retain is a morepersistent mental concern. health professionals.The use of segregation to manage mentally ill individuals is particularly problematic.

38 Consensus Development Conference on Improving Mental Health Transitions SPEAKERS & ABSTRACTS

Conclusions/Policy Recommendations: 1. Long-term segregation of acutely mentally ill, self-injurious and suicidal offenders should be abolished. 2. Patient advocates or quality care coordinators should be appointed at each of the five Regional Treatment Centres. 3. The most severely mentally ill male and female inmates should be placed in external treatment facilities. 4. Self-injurious behaviour should be treated and managed as a mental health, not security or behavioral issue. 5. Provide for 24/7 health care coverage at all maximum, medium and multi-level institutions. 6. Increase efforts to recruit and retain more mental health professionals.

Consensus Development Conference on Improving Mental Health Transitions 39 Speakers & Abstracts SPEAKERS & ABSTRACTS

Jitender Sareen, Professor of Psychiatry, Professor of Psychology & Community Health Sciences; Director of Research and Anxiety Services, University of Manitoba Jitender Sareen, MD, FRCPC ProfessorDr. Sareen of is Psychiatry, a Professor Professor of Psychiatry of Psychology in the Departments and Community of Psychiatry, Health Sciences; Psychology Director and Community of Health Sciences Researchat the University and Anxiety of Manitoba. Services, He University currently ofserves Manitoba as the Director of Research, and Assistant Head for the Department of Psychiatry. Dr. Sareen is the consulting psychiatrist to the Veterans Affairs Operational Stress Injuries Clinic, and the Dr.Winnipeg Jitender Jets Sareen Hockey is a Professor Club. Dr. of SareenPsychiatry has in published the Departments over 225 of publicationsPsychiatry, Psychology in the field and of anxiety disorders, posttraumatic Communitystress disorder, Health epidemiology, Sciences at the service University use, suicideof Manitoba. prevention, He currently homelessness, serves as the military Director mental health, and First Nations ofhealth. Research, Dr. Sareen and Assistant has won Head several for the National Department awards of Psychiatry. for teaching, Dr. clinicalSareen iswork the consultingand research. psychiatrist to the Veterans Affairs Operational Stress Injuries Clinic, and the Winnipeg Jets Hockey Club.Abstract: Dr. Sareen has published over 225 publications in the field of anxiety disorders, posttraumatic stress disorder, epidemiology, service use, suicide prevention, homelessness, military mental health, andBackground: First Nations The health. impact Dr. of Sareen mental has illness won several on society National is enormous. awards for Yet, teaching, the amount clinical of work funding and for research is mental health research.is relatively small compared to other physical illnesses such as cancer, infectious diseases and heart disease. Almost any area of mental disorders and addictions could be studied. Before I state my suggested priorities, I will disclose my bias. I haveAbstract been doing suicide prevention and traumatic stress research for over ten years.

KeyBackground: priorities The for impactresearch: of mental illness on society is enormous. Yet, the amount of funding for research in mental health is 1.relatively Measurement-based small compared and to otherEvidence-informed physical illnesses care. such Many as cancer, Canadians infectious don’t diseases get minimally and heart adequate disease. Almost care for any common area of mental disorders. Most clinicians domental not measure disorders outcomes and addictions and docould not be practice studied. within Before Clinical I state myPractice suggested guidelines. priorities, Implementing I will disclose and my evaluatingbias. I have Measurementbeen doing based and Evidence informedsuicide prevention care across and our traumatic specialty stress will research reduce wastefulfor over ten resources. years. 2.Key Improving priorities access for research: to psychological treatments, and reducing access to inappropriate polypharmacy will save millions of dollars. Psychological treatments1. Measurement-based are often more and powerfulEvidence-informed than medications, care. Many but Canadians the access don’t to medsget minimally is much adequate easier than care psychological for common mental treatments. 3.disorders. Mental Health Most clinicians Disability do Assessment not measure and outcomes Treatment and doCenters. not practice Interprofessional within Clinical teams Practice that guidelines. facilitate theImplementing recovery from and mental illness and help the patientevaluating return Measurement to work quickly based will and reduce Evidence the informed disability care associated across our with specialty mental will illness. reduce wasteful resources. 4. Suicide prevention research that targets the most vulnerable groups (people with co-occurring conditions, previous self harm behavior, transitions between2. Improving Emergency access to and psychological hospitalization treatments, and outpatient and reducing services) access will to inappropriate reduce costly polypharmacy admissions, emergencywill save millions visits ofand dollars. injuries. 5.Psychological Biological studies treatments that arefacilitate often themore understanding powerful than and medications, guidance butof rationalthe access pharmacotherapy to meds is much foreasier common than psychological mental disorders, such that people are not ontreatments. polypharmacy inappropriately. These3. Mental five Health approaches, Disability in Assessmentmy opinion, and will Treatment improve outcomesCenters. Interprofessional and reduce the costteams of that mental facilitate illness the on recovery our society. from mental illness and help the patient return to work quickly will reduce the disability associated with mental illness. 4. Suicide prevention research that targets the most vulnerable groups (people with co-occurring conditions, previous self harm behavior, transitions between Emergency and hospitalization and outpatient services) will reduce costly admissions, emergency visits and injuries. 5. Biological studies that facilitate the understanding and guidance of rational pharmacotherapy for common mental disorders, such that people are not on polypharmacy inappropriately. These five approaches, in my opinion, will improve outcomes and reduce the cost of mental illness on our society.

40 Consensus Development Conference on Improving Mental Health Transitions Speakers SPEAKERS& Abstracts & ABSTRACTS

RichardRichard Schneider BSc, MA, PhD, LLB, LLM, CPsych, Schneider, BSc, MA, PhD, LLB, LLM, CPsych Adjunct Professor, University of Toronto, Ontario Adjunct Professor, University of Toronto, Ontario Dr.Is a Richard Justice Schneiderof the Ontario is a JusticeCourt of of Justice the Ontario (appointed Court 2000)of Justice and (appointed Chair of the 2000) Ontario and ReviewChair Board. He was previously ofa criminalthe Ontario defence Review lawyer Board. and He certified was previously clinical apsychologist. criminal defence Counsel lawyer to the and Ontario certified Review clinical Board from 1994 to 2000. psychologist.Certified by theCounsel Law toSociety the Ontario of Upper Review Canada Board as froma specialist 1994 toin Criminal2000. Certified Litigation. by thePrivate Law practiceSociety was generally limited to ofthe Upper representation Canada as of a mentallyspecialist disorderedin Criminal accused. Litigation. Also, Private Adjunct practice Professor, was generally Department limited of Psychiatry,to the Faculty of Medicine and Faculty of Law, University of Toronto. Named Honorary President of the Canadian Psychological Association in 2002. representation of mentally disordered accused. Also, Adjunct Professor, Department of Psychiatry, Also, presently Alternate Chairman of the Nunavut Review Board. A great deal of his time has been spent presiding at Facultythe Mental of Medicine Health Court and Facultyin Toronto of Law,[www.mentalhealthcourt.ca]. University of Toronto. Named Major Honorary research President interests ofare the competency and criminal Canadianresponsibility. Psychological Has published Association extensively in 2002. in the Also, area presently of mental Alternate disorder Chairman and the law.of the Recent Nunavut books include: Mental ReviewDisorder Board. and the A greatLaw: dealA primer of his for time legal has and been mental spent health presiding professionals at the Mental (2006, Health with Court H. Bloom); in Mental Health Courts: TorontoDecriminalizing [www.mentalhealthcourt.ca]. the Mentally Ill (2007, Majorwith H. research Bloom andinterests M. Heerema); are competency Annotated and criminalMental Health Statutes (2007); The responsibility. Has published Lunaticextensively and in the the Lords area of(2009); mental Law disorder and Mental and the Disorder: law. Recent A Comprehensive books include: andMental Practical Disorder Approach and (2013, with H. Bloom) the Law: A primer for legal and[all mental published health by professionalsIrwin Law / www.irwinlaw.com]. (2006, with H. Bloom); Mental Health Courts: Decriminalizing the Mentally Ill (2007, with H. Bloom and M. Heerema); Annotated Mental Health Statutes (2007); The Lunatic and the Lords (2009); Abstract:Law and Mental Mental Disorder: Health Courts A Comprehensive and Alternative and Practical Sentencing Approach (2013, with H. Bloom) [all published by Irwin Law / www. Mentalirwinlaw.com]. Health Courts and ‘regular’ sentencing courts subscribing to the principals of therapeutic jurisprudence seek to decriminalize the mentally ill. Too often individuals find themselves before the criminal courts as a result of behaviour caused by untreated mental disorder. The focus of these courts is uponAbstract: getting Mental at and Health treating Courts the root and cause Alternative of the criminalSentencing behaviour rather than upon punishment. A summary of the procedures employed by these courts and the results obtained from many jurisdictions will be reviewed. It is recommended that the approach described be employed throughout the criminalMental Health justice Courtssystem. and At the‘regular’ same sentencing time, the longcourts term subscribing answer to to the the problems principals confronting of therapeutic the criminaljurisprudence courts seek will noto doubt be found with reinvestment indecriminalize main stream the mental mentally health ill. care.Too often individuals find themselves before the criminal courts as a result of behaviour caused by untreated mental disorder. The focus of these courts is upon getting at and treating the root cause of the criminal behaviour rather than upon punishment. A summary of the procedures employed by these courts and the results obtained from many jurisdictions will be reviewed. It is recommended that the approach described be employed throughout the criminal justice system. At the same time, the long term answer to the problems confronting the criminal courts will no doubt be found with reinvestment in main stream mental health care.

Consensus Development Conference on Improving Mental Health Transitions 41 SpeakersSPEAKERS & Abstracts & ABSTRACTS

GerritGerrit van der Leer van der Leer Director,Director, Mental Health andand Addictions,Addictions, Ministry Ministry of of Health Health Services, Services, British British Columbia Columbia GerritGerrit vanvan der der Leer Leer is isthe the Director Director of Mentalof Mental Health Health and and Substance Substance Use services Use services with the with Ministry the Ministry of Health in British ofColumbia Health in (BC) British responsible Columbia (BC)for policy responsible development, for policy legislation development, and legislationstrategic initiatives,and strategic supporting a broad continuum of initiatives,mental health supporting and substance a broad continuum use services. of mental He holds health a andMaster’s substance degree use services.in Social He Work holds and a Bachelor in Commerce - aeducated Master’s degree both in in Canada Social Work and andin the a Bachelor Netherlands. in Commerce Over the - educatedpast 35 years,both in he Canada has worked and at the senior management and inpolicy the Netherlands. development Over level the both past in35 Alberta years, he and has British worked Columbia at the senior with management an emphasis and on policy policies and services for people with developmentsevere and persistentlevel both informs Alberta of mental and British illness. Columbia Gerrit withhas beenan emphasis instrumental on policies in the and establishment services of the Assertive Community forTreatment people with (ACT) severe program and persistent across formsBC. Heof mental has supported illness. Gerrit the developmenthas been instrumental and implementation in the of the standards and establishmentguidelines for of ACT the Assertiveservices, Community including an Treatment ACT evaluation (ACT) program framework across and BC. Advanced He has supported Practice. (Presently there are 15 ACT theteams development in BC with and additional implementation teams beingof the standardsplanned in and 2014/15). guidelines As for part ACT of services,his role withincluding the Ministry an of Health, Gerrit has also ACT evaluation framework andsupported Advanced the Practice. development (Presently of athere number are 15 of ACT major teams provincial in BC with mental additional health teamsinitiatives: being planned in 2014/15). As part of his role• Planningwith the Ministry guidelines of Health, for Mental Gerrit Health has also and supported Substance the development Use Services of fora number people of with major developmental disability and mental provincial mental health initiatives:illness; • Planning guidelines for Mental• Family Health physician and Substance treatment Use guidelines Services for and people patient with self-manage developmentalment disability tools andfor depression, mental illness; anxiety disorders, early psychosis • Family physician treatment, eating guidelines disorders and patient and substance self-management use disorders; tools for depression, anxiety disorders, early psychosis, • Provincialeating disorders Action planand substancefor people use with disorders; eating disorders, including the development of clinical practice guidelines, regional action plans and development of• enhancedProvincial services. Action plan for people with eating disorders, including the development of clinical practice guidelines, regional • Standardsaction plans and and guidelines development for secure of enhanced rooms services. and seclusion practices for mental health units designated under the BC Mental Health Act •• ImplementationStandards and guidelinesof the recently for secure announced rooms and $20 seclusion million provinci practicesal for Action mental Plan health that unitsaddresses designated the needsunder theof aBC specific Mental subset of patients with the most complexHealth forms Act of Severe Addiction and/or Mental Illness. These patients are more likely to be homeless, have more frequent interactions with police and present• Implementation a greater risk of theto themselvesrecently announced and others. $20 million provincial Action Plan that addresses the needs of a specific subset of Presently,patients he with is workingthe most oncomplex provincial forms guidelines of Severe Addictionto support and/or the interface Mental Illness.between These police patients and localare moremental likely health to be andhomeless, substance use services in dealing withhave mental more health frequent crisis, interactions including with information police and sharing present protocols; a greater risk a Service to themselves Framework and others. for people in contact with the Correctional System in BC supporting continuity of care between community and correctional services; and a Framework for psychosocial rehabilitation with a strong focus on recovery.Presently, he is working on provincial guidelines to support the interface between police and local mental health and substance Inuse his services private in life dealing he was with a mentalcaptain health of a Voluntarycrisis, including Fire department information forsharing over protocols;10 years ain Service Alberta, Framework owns with for his people wife inLeslie an IceCream store in Victoria “IceCreamcontact with Mountain” the Correctional and enjoys System fly in BCfishing supporting and travelling. continuity of care between community and correctional services; and a Framework for psychosocial rehabilitation with a strong focus on recovery. Abstract:In his private What life heis wasthe aeffectiveness captain of a Voluntary of current Fire interventionsdepartment for overto improve 10 years mentalin Alberta, health owns transitions with his wife in Leslie terms an of the role of Assertive Community Treatment?IceCream store in Victoria “IceCream Mountain” and enjoys fly-fishing and travelling.

Background:Abstract: What Assertive is the effectiveness Community of Treatmentcurrent interventions (ACT) is a torecovery-oriented improve mental mentalhealth transitions health service in terms delivery of the model role ofthat provides comprehensive services toAssertive individuals Community living with Treatment? severe and persistent mental illnesses within the community. ACT services are usually targeted to those individuals who make high use of acute care psychiatric and emergency services. Rather than brokering services, most treatment and rehabilitation services are provided directlyBackground: by the Assertive ACT team. Community Staff-client Treatment ratios are (ACT) small is a(approx. recovery-oriented 1:10) to ensure mental adequatehealth service individualization delivery model of that services provides through shared caseloads. The rangecomprehensive of services services is comprehensive to individuals livingand flexible with severe and and the persistentservices are mental provided illnesses in-vivo within where the community. problems occurACT services and support are is needed rather than in office- basedusually clinicaltargeted settings. to those individualsServices are who available make high on usea 24 of hour acute basis care psychiatric and the ACT and team emergency comprised services. of 10-12Rather multi-disciplinary than brokering team members (SAMSHA 2001).services, CT most clients treatment are often and admittedrehabilitation to the services program are providedafter completing directly by treatment the ACT inteam. acute Staff-client psychiatric ratios care are or small tertiary (approx. care facilities or transitioning from homeless1:10) to ensure shelters. adequate Once individualization admitted, crises of servicesare common through for shared ACT clients caseloads. and The crisis range assessment of services and is comprehensive intervention is and provided by ACT teams usually in partnershipflexible and withthe services other crisis are provided intervention in-vivo services where problemssuch as mobileoccur and crisis support response is needed services. rather ACTthan teamsin office-based continue clinicalto support clients while receiving short- termsettings. treatment Services in are acute available care on to aensure 24-hour continuity basis and of the care. ACT Within team comprised Canada, Ontarioof 10-12 andmulti-disciplinary British Columbia team are members leading the development of the ACT program. Both(SAMSHA provinces 2001). have CT clients developed are often ACT admitted Standards to the and program participate after in completinga fidelity reviewtreatment process in acute to psychiatricensure teams care orare tertiary adhering care to the BC Standards and fidelity offacilities the model or transitioning of care. from homeless shelters. Once admitted, crises are common for ACT clients and crisis assessment and intervention is provided by ACT teams usually in partnership with other crisis intervention services such as mobile crisis response Results:services. ACT ACT teams is a rigorously continue to studied support mental clients healthwhile receiving practice short-term and the evidence treatment for in its acute effectiveness care to ensure is well continuity established of care. including mental health transitions (BaronetWithin Canada, & Gerber, Ontario 1998; and Bedell, British Cohen, Columbia & Sullivan,are leading 2000; the development Bond, Drake, of theMueser, ACT program.& Latimer, Both 2001; provinces Gorey haveet al., developed 1998; Herdelin & Scott, 1999; Latimer, 1999;ACT Standards Marshall and& Lockwood, participate 1998;in a fidelity Ziguras review & Stuart, process 2000). to ensure ACT teams is known are adhering for its reduction to the BC inStandards psychiatric and hospitalization,fidelity of the high level of housing stability andmodel improvements of care. in quality of life (Philips et al., 2001; Nelson et al., 2007). Research has shown that ACT services are cost effective for individuals with extensive prior hospital use and frequent involvement with emergency services (Latimer 1999). The effectiveness of ACT has primarily been demonstrated with people who have a history of psychosis with frequent and extensive use of in-patient psychiatric and emergency services and who do not respond well to less intensive services. Some ACT programs have targeted new clients, such as those with concurrent mental health and substance use disorders, including those frequently involved with the criminal justice system showing promising results, however, the effectiveness and fidelity has not been confirmed for these populations.

Conclusions: The effectiveness of ACT including health transitions and cost effectiveness is well established. Adaptations of ACT in terms of new client populations highlight the need for further research. Up-to-date provincial standards, reliable outcome data and fidelity reviews are essential to ensure ACT programs meet established fidelity requirements. 42 Consensus Development Conference on Improving Mental Health Transitions SPEAKERS & ABSTRACTS

Results: ACT is a rigorously studied mental health practice and the evidence for its effectiveness is well established including mental health transitions (Baronet & Gerber, 1998; Bedell, Cohen, & Sullivan, 2000; Bond, Drake, Mueser, & Latimer, 2001; Gorey et al., 1998; Herdelin & Scott, 1999; Latimer, 1999; Marshall & Lockwood, 1998; Ziguras & Stuart, 2000). ACT is known for its reduction in psychiatric hospitalization, high level of housing stability and improvements in quality of life (Philips et al., 2001; Nelson et al., 2007). Research has shown that ACT services are cost effective for individuals with extensive prior hospital use and frequent involvement with emergency services (Latimer, 1999). The effectiveness of ACT has primarily been demonstrated with people who have a history of psychosis with frequent and extensive use of in-patient psychiatric and emergency services and who do not respond well to less intensive services. Some ACT programs have targeted new clients, such as those with concurrent mental health and substance use disorders, including those frequently involved with the criminal justice system showing promising results, however, the effectiveness and fidelity has not been confirmed for these populations. Conclusions: The effectiveness of ACT including health transitions and cost effectiveness is well established. Adaptations of ACT in terms of new client populations highlight the need for further research. Up-to-date provincial standards, reliable outcome data and fidelity reviews are essential to ensure ACT programs meet established fidelity requirements.

Consensus Development Conference on Improving Mental Health Transitions 43 SPEAKERS & ABSTRACTS Speakers & Abstracts

RichardRichard Warner Warner, MB, DPM MD, DPM Professor of Psychiatry and Adjunct Professor of Anthropology, University of Colorado, Boulder, Colorado Professor of Psychiatry and Adjunct Professor of Anthropology, University of Colorado, Boulder,Richard Warner Colorado is a British psychiatrist and the director of Colorado Recovery, a program that provides intensive treatment Dr.for peopleRichard with Warner serious is a mental British illness psychiatrist in Boulder, and the Colorado. director He of isColorado a professor Recovery, of psychiatry a program at the University of Colorado. For nearly 30 years, he was the medical director of the Mental Health Center of Boulder County where he and his thatcolleagues provides developed intensive antreatment innovative for and people internationally with serious recognized mental illness system in Boulder,of community Colorado. psychiatric He care. His research ishas a Professor focused on of socialPsychiatry and economicat the University factors thatof Colorado. affect outcome For nearly from 30mental years, disorder he was theand Medical on effective programs for the Directorpsychiatric of treatmentthe Mental and Health rehabilitation Center of for Boulder people County with serious where mental he and illness. his colleagues He has conducted developed cross-national an research innovativeand lectured and widely internationally in Europe andrecognized elsewhere. system For of15 community years, he helped psychiatric direct care.a World His Psychiatric research has Association project focusedcombating on thesocial stigma and economicof schizophrenia factors in that 20 affectcountries outcome around from the world.mental He disorder is the author and on of effective Recovery from Schizophrenia, programsthird edition, for Brunner-Routledge,the psychiatric treatment 2004; andThe rehabilitationEnvironment of for Schizophrenia, people with serious Brunner-Routledge, mental illness. 2000; He Alternatives to the hasHospital conducted for Acute cross-national Psychiatric researchTreatment and , American lectured Psychiatricwidely in Europe Press, and 1995 elsewhere. and, with ForJulian 15 years,Leff, The he Social Inclusion of helped direct a World PsychiatricPeople Association with Mental project Illness, combating Cambridge the Universitystigma of schizophreniaPress, 2006. in 20 countries around the world. He is the author of Recovery from Schizophrenia, third edition, Brunner-Routledge, 2004; The Environment of Schizophrenia, Abstract: TheBrunner-Routledge, decline in the use 2000; of psychiatric Alternatives hospital to the beds, Hospital since for the Acute 1950s, Psychiatric has provided Treatment, the opportunity American for Psychiatric the creation Press, of a number1995 and, of alternatives to the hospitalwith Julian for Leff,acute treatment.The Social Small,Inclusion open-door, of People non-coercive, with Mental domestic Illness, settingsCambridge providing University similar Press, services 2006. to those in a psychiatric hospital unit have been operating in community mental health services for decades in many places around the world including Colorado, British Columbia, Italy and theAbstract Netherlands. These alternative settings are in the same tradition as the moral management era York Retreat – small, normalizing facilities that are unlocked and genuinely in the community, allowing the resident to stay in touch with his or her relatives, friends, work and social life. They are moreThe flexibledecline inand the non-coercive use of psychiatric than hospital hospital wards beds, and since more the like ly1950s, to be basedhas provided on peer the relationships opportunity than for on the hierarchical creation powerof a structures and offer opportunitiesnumber of alternatives to residents to to the be involvedhospital infor the acute operation treatment. of the Small,environment. open-door, Since non-coercive, the cost is lower domestic than hospital settings care, providing the pace of treatment in the alternativesimilar services setting to need those not in be a aspsychiatric rapid, making hospital it possible unit have to offer been a moreoperating quiet inform community of genuine mentalasylum. health The recent services growth for indecades the use of alternative settingsin many of places this type around in Britain the worldis a trend including that has Colorado, been stimulated British by Columbia, the closure Italy of psychiatric and the Netherlands. hospitals and These encouraged alternative by the emergence of the recoverysettings aremodel in thewhich same emphasizes tradition theas theimportance moral management of patient empowerment era York Retreat and interpersonal – small, normalizing support. In facilitiesline with thisthat focus, are alternatives to the hospital offer a treatment approach in which coercion and paternalism are reduced and peer support is fostered. They offer a treatment atmosphere with more autonomyunlocked forand residents genuinely and in staff. the community,Important benefits allowing include the residenttheir greater to stay emphasis in touch on withhuman his interaction or her relatives, rather than friends, medication, work and and improved user- satisfaction.social life. They We should are morebe aware, flexible however, and non-coercive that in the U.S. than there hospital is often wards a drive and to increase more likely the tosize be of based such residentialon peer relationships facilities, lock the doors, and introducethan on hierarchical the use of seclusion power structures and restraints and – offer a reflection opportunities of the tension to residents between to the be driveinvolved to security in the andoperation cost-efficiency, of the on the one hand, and human- scale,environment. personalized Since care the oncost the is other. lower As than in moral hospital management, care, the pace treating of treatment people with in respect the alternative in normalizing, setting domestic need not settings be as rapid, leads them to exercise greatermaking “moral it possible restraint” to offer or self-control a more quiet over formtheir impulses.of genuine When asylum. you areThe in someone’srecent growth home, in youthe usefeel ofobliged alternative to treat settings your hosts of this and their property with consideration, but in an institution, anything goes. This helps us understand why it is possible to care for patients in involuntary treatment in open-door, domestictype in Britain settings. is aIf trendthe alternative that has settingbeen stimulated is more attractive by the closureto the person of psychiatric than a hospital, hospitals then and he orencouraged she will call by upon the emergencereserves of self-control in order to beof theallowed recovery stay theremodel rather which than emphasizes in hospital. the Cedar importance House, a of15-bed patient hospital empowerment alternative andthat interpersonalhas been in operation support. for In over line 3 with0 years in the public mental healththis focus, system alternatives of Boulder to County, the hospital Colorado, offer has a foundtreatment that theapproach facility canin whichaccommodate coercion at and least paternalism half of the catchment-areaare reduced and patients peer in need of acute inpatientsupport iscare fostered. at any pointThey in offertime, aincluding treatment many atmosphere requiring compulsory with more treatment.autonomy Recentlyfor residents developed and staff. British hospitalImportant alter benefitsnatives are similar to Cedar Houseinclude in their that theygreater are emphasissmall (average on human capacity interaction 8 beds), provide rather athan fairly medication, extended period and improvedof residential user care satisfaction. (over a month We shouldon average), have staff awake at night and accept compulsory admissions. A substantial proportion of patients are compulsorily admitted and most suffer from psychosis. be aware, however, that in the U.S. there is often a drive to increase the size of such residential facilities, lock the doors, and References:introduce the use of seclusion and restraints – a reflection of the tension between the drive to security and cost-efficiency, on the one hand, and human-scale, personalized care on the other. As in moral management, treating people with respect Warner,in normalizing, R. (ed.) Alternatives domestic settings to the Hospital leads them for Acute to exercise Psychiatric greater Care. “moral American restraint” Psychiatric or self-control Press, Washington, over their D.C. impulses. 1995 When you are in someone’s home, you feel obliged to treat your hosts and their property with consideration, but in an institution, Johnson,anything S.goes. et al. This Inpatient helps andus understandresidential alternatives why it is possible to standard to care acute for psychiatricpatients in wards involuntary in England. treatment British inJournal open-door, of Psychiatry, 194: 456-463, 2009.domestic settings. If the alternative setting is more attractive to the person than a hospital, then he or she will call upon reserves of self-control in order to be allowed stay there rather than in hospital. Cedar House, a 15-bed hospital alternative that has been in operation for over 30 years in the public mental health system of Boulder County, Colorado, has found that the facility can accommodate at least half of the catchment-area patients in need of acute inpatient care at any point in time, including many requiring compulsory treatment. Recently developed British hospital alternatives are similar to Cedar House in that they are small (average capacity 8 beds), provide a fairly extended period of residential care (over a month on average), have staff awake at night and accept compulsory admissions. A substantial proportion of patients are compulsorily admitted and most suffer from psychosis. References: Warner, R. (ed.) Alternatives to the Hospital for Acute Psychiatric Care. American Psychiatric Press, Washington, D.C. 1995. Johnson, S. et al. Inpatient and residential alternatives to standard acute psychiatric wards in England. British Journal of Psychiatry, 194: 456-463, 2009.

44 Consensus Development Conference on Improving Mental Health Transitions COMMITTEES

PLANNING COMMITTEE SCIENTIFIC/STEERING COMMITTEE Planning Committee Chair: Fern Miller Director Scientific Committee Chair: Maternal-Child and Mental Health Roger Bland, CM, MB, ChB, FRCPC, FRCPsych Addiction and Mental Health Branch Department of Psychiatry Primary Health Care Division University of Alberta Alberta Health Edmonton, AB Edmonton, AB Donald Addington, MBBS, MRCPsych, FRCPC Laurie Beverley Professor Executive Director, Community Treatment and University of Calgary Supports Calgary, AB Addiction and Mental Health Alberta Health Services Katherine Aitchison, BA(Hons), BM, BCh, Edmonton, AB FRCPsych, PhD Professor Allison Hagen, CGA, MBA University of Alberta Director of Finance, Operations and Administration Alberta Centennial Addiction & Mental Health Institute of Health Economics Research Chair, Edmonton, AB Edmonton, AB Lorraine Breault, PhD Helen Ramsey, MSc Professor Project Manager University of Alberta Institute of Health Economics Edmonton, AB Edmonton, AB Pierre Chue, MRCPsych Sarah Parkinson Clinical Professor Alberta Health University of Alberta Edmonton, AB Edmonton, AB

Cathy Pryce, RN Carolyn Dewa, PhD Addiction and Mental Health Strategic Clinical Health Systems Research and Consulting Unit Network Centre for Addiction and Mental Health Alberta Health Services Toronto, ON Edmonton, AB Elliot Goldner, BSc, MHSc, MD, FRSPC Doug Vincent Professor Director, Tertiary and Acute Care Faculty of Health Sciences Alberta Health Services Simon Fraser University Edmonton Area Burnaby, BC [email protected] Alan Gordon, MD Clinical Professor University of Alberta Edmonton, AB

Consensus Development Conference on Improving Mental Health Transitions 45 COMMITTEES

Fern Miller Doug Watson, MD, FRCPC Director Past President Maternal-Child and Mental Health Alberta Psychiatric Association Addiction and Mental Health Branch Calgary, AB Primary Health Care Division Alberta Health Edmonton, AB

Tonia Nicholls, PhD Associate Professor, Psychiatry Faculty of Medicine UBC – Forensic Psychiatric Services Commission (FPSC) BC Mental Health and Addiction Services / PHSA Vancouver, BC

Fay Orr Mental Health Patient Advocate Government of Alberta Edmonton, AB

Scott B. Patten, MD, FRCPC, PhD Department of Community Health Sciences University of Calgary Calgary, AB

Peter Silverstone, MD, FRCPC Professor Department of Psychiatry University of Alberta Edmonton, AB

Michael Trew, MD, FRCPC Addiction & Mental Health Strategic Clinical Network Alberta Health Services Calgary, AB

Doug Urness, MD, LMCC, FRCPC Alberta Health Services Edmonton, AB

Patrick J. White, MB, BCh, BAO, DCH, Dip OBS, MRCPsych Clinical Professor Psychiatry Department University of Alberta Edmonton, AB

46 Consensus Development Conference on Improving Mental Health Transitions NOTES

Consensus Development Conference on Improving Mental Health Transitions 47 Institute of Health Economics #1200, 10405 Jasper Avenue Edmonton, AB T5J 3N4 Tel. 780.448.4881 Fax. 780.448.0018 [email protected]

www.ihe.ca

48 Consensus Development Conference on Improving Mental Health Transitions