The Royal: Where Researchers and Clients are a Team
Sophie is a 51-year-old woman who had suffered from treatment-resistant depression, and anxiety for years.
“Besides having medication and an awesome medical team, I still just wanted to drop dead,” Sophie says. “I knew I needed help.”
When she was referred to The Royal for treatment, she signed up for a study looking into the relative benefits of ketamine, a fast-acting anesthetic and painkiller used to address treatment-resistant depression in research settings. It’s administered by intravenous during 40-minute outpatient visits.
For Sophie, who, like 30 per cent of people with depression, doesn’t respond to more conventional treatments, it was life-changing.
“We think ketamine may require less health-care resource use and may work faster,” says Dr. Jennifer Phillips, who is conducting the study with her colleague, Dr. Pierre Blier.
Sophie’s story is but one example of The Royal’s approach to treating and studying mental health and substance use issues. Its new Strategy for care aims to “co-create access, hope and new possibilities.” And to do that, it makes sure clients are involved in the research from the word go.
Dr. Florence Dzierszinski, president of University of Ottawa Institute of Mental Health Research, and vice-president of research at The Royal, views the new strategy as inclusive and innovative.
“When I think about our research, I think about the hope that new possibilities can generate for people,” Dzierszinski says. “When they realize we’re doing a study on something that can make a huge difference in their lives, our clients will often say they had no idea this was possible. Our approach is to provide access to care through research, to bring the research to our clients, and to develop client- and family-oriented research.”
It’s a novel approach to mental health medicine: research scientists, clinicians, and their teams and staff work alongside clients, incorporating their experiences and lived expertise to guide the research they undertake. To bring clients into the research in a meaningful way, The Royal has struck a committee of clients and families to work on outcomes that matter most to them. “Research shows that when clients are involved in their care, outcomes are always better,” Dzierszinski says.
Translation research into care:
“There are academic studies that show it takes up to 17 years to bring research into practice,” Dzierszinski says. “We want to accelerate that pipeline and to do that we are building interprofessional teams — teams with clients, families, scientists, clinicians, physicians and health-care professionals – so we have built-in knowledge transfer right within the teams.”
Access to care through research
Dr. Blier’s ketamine clinical trial mentioned above is one of the many trailblazing treatments The Royal is developing to treat patients with depression. Its neuromodulation research clinic, led by Dr. Sara Tremblay, offers a non-invasive, non-drug therapy for symptoms of depression that has shown promising results in those for whom little else has worked. In five 30-minute sessions, researchers stimulate the formation of new brain cell connections using magnets, or repetitive transcranial magnetic stimulation (rTMS).
Of course, there are challenges. Neuromodulation was approved by Health Canada in 2002, but it’s still not covered by OHIP in spite of clear evidence-based results. This is why this care is only available through research streams at this time. And there’s a general lack of resources. “At this stage, we have two rTMS machines,” Dzierszinski says. “If we had four machines and the personnel to operate them, we’d be able to tackle our wait list pretty quickly.”
In another innovative program, The Royal hosts the first “regional coordinated access hub in the province.” AccessMHA is an online portal that connects health-care providers and clients so the latter can go to one point of access to get help.
“Our team is now talking about connecting research right at that portal, which has never been done before,” Dzierszinski says. “It’s about using digital technologies as an enabler to care for clients. This is going to be a major area of focus for us in the future.”
In its Brain Imaging Centre, The Royal is also starting some clinical research in geriatric psychiatry. For instance, a collaboration between physicians, scientists and technicians in the Brain Imaging Centre investigates dementia and catatonia.
Underlying The Royal’s research approach is its determination to consider the whole person living with mental illness — including the biological, psychological, social and spiritual facets of the individual. For instance, Dr. Kaminsky leads a multidisciplinary team working on military mental health, including PTSD. This team focuses on the determination of PTSD dissociative sub-types by looking at different markers — inflammation, levels of the stress hormone cortisol, neuromelanin in the brain, sleep markers — clinical scales and demographic data, and then they build an AI algorithm to be able to predict whether someone living with PTSD has a dissociative subtype.
“This speaks to making the leap from a direct behavioural-biological signature approach to looking at the integrated biological, psycho-social and spiritual aspects of the whole person,” Dzierszinski says