The Royal special report: From new discoveries comes new hope

CHAMPIONS OF HOPE

The Royal is so fortunate to have champions across our community and around the world who volunteer their time to support the incredible mental health care and research that helps provide hope and transform lives.

KEVIN

HOW THE ROYAL TOUCHED MY LIFE: Three years ago I started my journey as a volunteer, contributing to The Royal’s Strategic Plan following my experience as an inpatient. With the other hospitals, I survived; while at The Royal I was able to thrive as I was infused with hope. This is what inspires me, in turn, to infuse hope in Royal staff, clients, families, and community partners.

MY GREATEST HOPE IS THAT WE: Expand and enable greater access for both client and family peer support at The Royal.

I’M SO PROUD THAT TODAY I CAN: Work again! Over four years ago, I was an inpatient at The Royal and, when discharged, thought I would never work again. Years later, I am now on contract with The Royal as Supervisor, Client and Family Resource Hub with Peer Support.

LAUREAN

HOW THE ROYAL TOUCHED MY LIFE: After suffering from various mental illnesses since childhood –and not having a name for them until I was a senior –The Royal has enabled me to speak about my abusive childhood to better understand my mental illnesses. Although my time on this earth is limited, I’m happy to have met the people at The Royal who have made it better for me.

MY GREATEST HOPE IS THAT WE: Continue to bring mental illness to the forefront to show that it is nothing to be ashamed of and that most people will have it affect them either personally or being in contact with someone who suffers from a mental illness.

I’M SO PROUD THAT TODAY I CAN: Pay it forward by volunteering at The Royal.

JODY AND CAITLIN

I always made sure to be home before the school bus dropped the kids off. I needed time to check every room, one by one. I didn’t know what I might find. Would today be the day he couldn’t fight anymore and take his own life?

From the outside looking in, we had the seemingly picture-perfect life. My husband, Jody and I both had successful jobs. We were involved in our community. We had kids that were active in sports. We travelled all over the world. According to the outside world, life couldn’t get any better for us…

JOHN

HOW THE ROYAL TOUCHED MY LIFE: The Royal was there when I was lost. Now I’m able to give back. Volunteering your time to help someone in need makes it all worthwhile.

MY GREATEST HOPE IS THAT WE: Can stand together without judgment and focus on a path of healing. It takes so much strength to come forward for help when it should just be an act of kindness.

I’M SO PROUD THAT TODAY I CAN: Speak to you about my journey without apprehension. It’s been five years and I have changed my life. I know that there will be bad days when I will want to avoid people and stay in bed. But, I won’t sink like a rock. I can see land and I can get there for me.

ON THE COVER

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STEVEN WEST creates Brain BioArt imagery by using photographic processing techniques combined with software programming of data from fMRI brain scans, developed at The Royal’s Brain Imaging Centre. The resulting images visualize the physical dimensionality of the brain with emotive representation of the mind and connectome in a neural form.

Hope for people living with difficultto-treat depression

After decades of fighting a debilitating depression, Sam was on the brink.

“I was just holding on. Literally talking myself out of taking my life every hour,” said Sam. “My depression was debilitating. I was going to die.”

Over the years, Sam sat through hours of talk therapy and tried numerous medications, but nothing worked.

Depression is the world’s leading cause of disability, with one-in-six Canadians diagnosed with depression at some point in their lifetime, and up to one third of them not responding to existing treatments.

Unfortuately, many also choose not to seek treatment because of the weight of stigma and discrimination. When left untreated, depression can lead to suicide.

Three years ago, Sam’s psychiatrist urged her to enroll in a study at The Royal designed for people with treatment-resistant depression. Every day for six weeks, Sam sat in a chair for five minutes while a magnetic field stimulated her brain.

At the end of the first day, Sam already felt a lift in her mood.

BRINGING HOPE THROUGH RESEARCH

The remedy was a new shorter form of repetitive transcranial magnetic stimulation (rTMS). Repetitive transcranial magnetic stimulation (rTMS), is a type of neuromodulation method that directly stimulates the specific brain circuits known to be dysfunctional in people with major depression. This is done by producing a brief, painless magnetic field delivered via a coil placed against the scalp. This approach is approved by Health Canada to treat depression in adults, and research expands this scope.

Dr. Sara Tremblay, a neuropsychologist and scientist at the University of Ottawa Institute of Mental Health Research (IMHR) at The Royal, Dr. Lisa McMurray and their teams, worked tirelessly for the past four years to bring an rTMS research

clinic to The Royal. Her goal: to help those who have failed to respond to one or more different antidepressant medications.

“Across the mental health landscape, clinicians, researchers, and clients are all becoming increasingly aware that there is an urgent need for new, alternative therapies for mental health disorders,” says Dr. Tremblay. “Neuromodulation offers us a whole new way of looking at mental health treatment, where we can identify malfunctioning circuits in the brain and effectively treat them in a non-drug, non-invasive way.”

This dream of Dr. Tremblay’s became a reality in January 2020 when she began enrolling research participants in the study. The Royal’s Neuromodulation Research Clinic is the first

of its kind in the Ottawa region and is quickly becoming a much sought-after, preferred treatment for depression as it has few side effects.

Additionally, having rTMS as an alternative to drug interventions is useful for many people. Options are often quite limited when treating young adults with depression, and many elderly patients are also limited in using antidepressant drugs because of poor kidney or liver function.

Those who live in large urban areas with private clinics can pay out of pocket for treatment, but for many, the only other way to access rTMS is through research.

Through this research clinic at The Royal, Dr. Tremblay is offering treatment to as many people as possible while collecting research data to help better predict and refine rTMS treatment.

“Research in this area is leading to a better, more personalized standard of care for patients with depression and related mental health disorders, for whom traditional treatments haven’t worked,” says Dr. Tremblay.

The future of research at The Royal is about research-informed care and vice-versa. Our inter-professional teams composed of clients and families, clinicians, program leaders, and scientists are designing studies that are clinically impactful and provide access to care through research.

– Dr. Florence Dzierszinski, IMHR president and VP research, The Royal

rTMS saved my life — Sam

Drs. Tremblay and McMurray demonstrating rTMS.

Improving access: Connecting people to services quickly through technology

Technology has fundamentally changed access to mental health and substance use health services, especially for individuals in underserved areas or experiencing other barriers to accessing care.

Thanks to the teamwork between clients, families, service providers, clinicians, scientists, researchers, administrators, technology experts and donors throughout our region, this past year saw continued growth in virtual service delivery.

These innovative virtual health solutions are easing access and bringing new possibilities to people in the Ottawa region, and beyond.

“The encouraging news is that there’s more hope as the door is opening wider with the emergence of innovative care and related services and supports,” says lived experience transformative leader and former chair of The Royal’s Family Advisory Council, Michèle Langlois. “We’re committed to busting those barriers. We’re approaching them and tackling them one at a time with a goal to achieve more equitable, innovative ways to connect with, engage, and deliver care, services and support that meet people’s needs.”

emergency department visits, hospitalizations, and deaths.

Transitioning the RAAM clinic to a virtual environment helped address the growing need for substance use health and mental health treatment. Before the pandemic, The Royal’s RAAM clinic followed a traditional walk-in model. Services at the clinic include assessment and triage to the appropriate level of care, substance use and mental health treatment, withdrawal management, harm reduction, connection to primary care and navigation to community services (navigation services provided in partnership with AccessMHA; www.accessmha.ca).

Due to pandemic restrictions, clients were not able to walk-in to the RAAM clinic. “The processes we put in place due to COVID created delays and barriers to access, which is not ideal when someone is ready to do to something about their substance use health,” says Dr. Melanie Willows, addiction medicine physician, clinical director with the substance use and concurrent disorders

program at The Royal and co-creator of the RAAM clinic.

“We knew we had to find a solution.”

The answer came from a new “digital front door” to improve rapid access to care and expand reach.

Developed by a team of clients, service providers, clinicians, scientists, researchers, and administrators, this new virtual model enhances care delivery and essentially replicates the experience of an in-person visit, but virtually, from wherever the person is at.

All that’s needed is an internet connection and a device with a camera. Community partnerships provide connectivity and support for clients without internet access.

“This is now one of the most accessible health solutions in the region,” says Dr. Kim Corace, vice-president, innovation and transformation, and co-creator of the RAAM clinic at The Royal’s substance use and concurrent disorders (SUCD) program.

Individuals connect with the RAAM clinic by “checking in” at theroyal.accessRAAM.ca during clinic hours (if it’s after hours, they’re redirected to other resources). After “entering” the digital front door, they meet by video with a clinician who assesses their needs and goals. Individuals may also be connected virtually with other members of the health care team such as an addictions counsellor, social worker, nurse, or physician, among others.

The RAAM digital front door also allows the individual’s loved one or support worker to attend the appointment. With a catchment area that includes Ottawa and surrounding areas, the virtual RAAM clinic casts a wider net and can help more people.

With more than 50 RAAM clinics across the province, it’s an idea that is also scalable. The digital front door solution has been shared with 15+ other RAAM clinics in Ontario, and more clinics across the country want it.

For individuals seeking support for substance use health, getting help is as easy as walking through the “digital front door.” And, it couldn’t have come at a better time.

Recent findings show Rapid Access Addiction Medicine (RAAM) clinics improve outcomes and reduce opioid- and alcohol-related

“Digital health is about thinking outside the box and using technology to improve the overall care experience. It’s about access, care and outcomes, rather than just a single session,” adds Dr. Corace.

For more information about RAAM go to: theroyal.ca/ patient-care-information/clinics-services-programs/ substance-use-and-concurrent-disorders

THE ROYAL’S RAAM CLINIC HAS A ‘DIGITAL FRONT DOOR’ – AND IT’S WIDE OPEN

We have a huge crisis in this country. Demand for addiction treatment is skyrocketing. The Royal is a gem that a lot of people don’t know about. Not only was I treated there with compassion and expert care, but they are leading important research into the ‘why.’

– Former SUCD patient at The Royal

Meet part of the Digital Front Door to RAAM Clinics team (left to right): Melissa Webb, Dr. Kim Corace and Dr. Melanie Willows.

Artificial intelligence on the frontlines of suicide prevention

What if we knew who was at high risk for suicide long before they were in danger?

If it sounds like the premise of a sci-fi novel, you’re not far off – but neither is the technology.

In fact, Dr. Zachary Kaminsky says it’s here now. He has built an algorithm using artificial intelligence to identify Twitter users at high risk of suicide.

Public posts on the popular social media platform can hold clues about who might be at risk for suicide long before they reach a crisis point. The algorithm doesn’t just use word recognition or identify suicidal ideas – it analyzes speech patterns and pinpoints the psychological concepts related to suicide. It then scores and matches these patterns alongside all the public data linked to a Twitter user.

“This isn’t identifying only people saying, ‘I’m going to kill myself.’ It’s identifying a risk pattern for people who are moving towards that point,” says Dr. Kaminsky, DIFD Mach-Gaensslen chair in suicide prevention research at The Royal’s Institute of Mental Health Research (IMHR).

He says he built the algorithm using Twitter data because it’s public. It is also a social media platform used by more than a third of Canadians between age 18 and 34 – a population amongst whom suicide is the second leading cause of death.

The algorithm can effectively comb through years’ worth of tweets in minutes and, through machine learning – part of artificial intelligence – link together all of the data to identify at-risk users.

In the years since the original paper was published in Nature’s

NPJ Digital Medicine, Dr. Kaminsky has collaborated with other scientists at The Royal and at Carleton University to validate the algorithm’s performance in two online studies during the pandemic – finding that the algorithm correctly identified those with the highest levels of suicidal ideation with around 80 per cent accuracy.

Importantly, suicidality in these Twitter users was determined with depression scales, meaning that the method isn’t just identifying those who are comfortable sharing their suicidality on social media.

Having a tool that identifies those at risk for developing suicidal thoughts opens up the possibility of developing novel interventions based on this data.

“A key value-add of this technology is the ability to predict who is at risk before they reach a point of crisis. This means that we can hopefully pair this with fairly non-invasive interventions, like encouraging a timely connection to the people and supports that already exist in someone’s life,” he says. “Critically, if we do this early enough before someone is in distress, we may be able to avert periods of crisis entirely.”

Dr. Kaminsky is working alongside commercial partners at Dionysus Digital Health INC – a start-up company he helped to cofound – to develop such a digitally augmented intervention and hopes to evaluate its efficacy in future years.

He is also working to develop a new algorithm that uses personalized Twitter data to suggest the best way to intervene for someone who is in suicidal crisis.

“If we build a personalized model based on someone’s data, we may be able to generate a tool that gives crisis responders or peer supporters suggestions on how to tailor their responses in a personalized way,” he says.

Based on his preliminary analysis of over 200 people, those that received high scoring responses to their suicidal mentions had a significant decrease in their suicidality over the following days and weeks compared to those that received poorly scored responses.

Intuitively, this means when people received personalized responses from people that knew them and knew what was important to them, they were more likely to get better. Dr. Kaminsky hopes that in the future, anonymous crisis response lines may be able to use this sort of method to give their responders an inside track and boost the ability of their staff and volunteers to help those in need.

In reflecting on his work, Dr. Kaminsky adds, “At the end of the day, we want to move from just identifying those at risk of suicide to developing novel tools to help – tools that will enable interventions delivered at the right time and in a personalized manner that can be scaled and allow for improved access to care.”

The Future of Mental Health Research and Care

The Clinical Brain Research Centre (CBRC) at the University of Ottawa Institute of Mental Health (IMHR) at The Royal, provides a path to address big questions in mental health while improving care. With more than 150 ongoing research studies utilizing our various state-of the-art facilities, our inquiries and collaborations are answering some of the most important

questions facing scientists, clinicians and clients and families today.

The Clinical Brain Research Centre builds on the successes of The Royal’s Brain Imaging centre, which celebrates its sixth year in operation this fall.

The continued success and growth of The Royal’s Clinical Brain Research Centre would not be possible without community support and partnership.

Dr. Zachary Kaminsky, DIFD Mach-Gaensslen chair in suicide prevention research at The Royal’s Institute of Mental Health Research (IMHR) has developed an AI algortithm that can spot suicidal ideation in social media posts. PHOTO BY MATTHEW STEWART

Life-changing science beyond the lab: Providing real-time treatment alternatives through depression research

The Royal believes in a future where everyone living with a mental illness or substance use disorder can get the personalized help they need, where, when, and how they need it.

The brain is more complex than any other known structure in the universe. It defines our humanity. Yet we still know so little about it.

In the nation’s capital, more than 5,000 individuals suffer from difficult-to-treat depression, meaning it will not improve despite multiple rounds of treatment.

Medication can be a blunt instrument. With few scientific advances in treating mental illness over the past fifty years, we need medications that work faster, with more rapid-acting antidepressant effects as traditional medications to treat depression can take 4-6 weeks to begin to work. Second, we need medications that are effective for more people, medications with improved treatment response and remission rates. Ketamine, a novel treatment strategy for depression, appears poised to meet both these needs.

Recent research has shown that ketamine, a medication in use for over 60 years to provide general anaesthesia and pain relief, has rapid antidepressant effects. When administered in small doses by nasal spray (esketamine), patients show a rapid decrease in depression and suicidal ideation, often within

a few hours to a few days. This discovery has proven to be a life-changing – even life-saving – treatment and is considered the biggest breakthrough in the field of depression over the past 50 years.

Support to The Royal will help advance innovative treatments such as this. Here, research and clinical excellence co-exist seamlessly, together with our patients, as the research bench moves, quite literally, closer to the bedside.

The Royal has been a national leader in research on the antidepressant effects of ketamine and is ideally positioned to not only implement delivery of this innovative new treatment, but also to translate new knowledge into clinical practice throughout Canada. The first clinical trial of ketamine for depression in Canada was conducted at The Royal’s IMHR by a team led by Dr. Pierre Blier. The resulting paper describing the team’s findings was published by lead author Dr. Jennifer Phillips in the American Journal of Psychiatry, the most widely read psychiatry journal in the world.

While The Royal is a leader in this novel treatment, demand far outpaces supply. With new investments, we can scale this service nationally breaking down barriers to access this lifesaving treatment.

SEEMINGLY PERFECT LIFE

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What people didn’t see were the days and weeks that Jody couldn’t get out of bed in the morning. The days where he’d come home after work and cry himself to sleep. The days we’d come home from a nice dinner out with friends and he’d have a meltdown for no obvious reason.

I watched somebody that I thought I knew, turn into somebody that I didn’t know.

There were times where I would lie beside him all day, just because I was terrified that if I left, he would take his own life.

But I never gave up hope. We found a physician who referred Jody to The Royal, where we met Dr. David Bakish and a whole team of mental health experts. They saved my husband’s life –they saved our family.

For years, Jody lived in a state of mania…elevated mood, hyperactivity and disorganized behaviour. He was extremely high-functioning, successful, enthusiastic, incredibly outgoing and unstoppable. But he was also overcome by darkness and extreme despair.

For a long time, we minimized the severity and repercussions of Jody’s behaviours. We made excuses for his

impulsivity, sudden outbursts and changes in mood. At the time, we didn’t know that what Jody was experiencing were symptoms of bipolar disorder.

I know for a fact that without The Royal, Jody would not be here today. And our family would have been ripped apart.

It’s hard to put into words how beyond grateful we are for The Royal and for generous donors like you. Together, you helped spare two children a lifetime of pain and insufferable grief by not having to grow up without their dad – and for that my family will be forever grateful.

Sincerely, Caitlin Burton, wife of grateful patient, Jody Burton

New hope for resistant depression

In 2021, The Royal successfully launched a pilot esketamine clinic – a non-invasive nasal spray form of ketamine that is used together with oral medication to help clients with treatment-resistant depression.

The service is modeled on best practices in integrating patient care, research, education, and collaboration. Interdisciplinary expertise offers innovative, measurement-based, evidence-informed care fully integrated with research.

The goal is to expand capacity and offer increased access to the clinic, develop additional research opportunities, and link the clinic to other available treatments and services at The Royal to maximize therapeutic outcomes and client satisfaction.

“Rapid-acting treatment strategies like esketamine offer clients access to specialized care,” says Dr. Jennifer Phillips, Scientist at the IMHR. “We hope to offer esketamine as part of a comprehensive treatment plan and give clients the opportunity to harness the rapid improvement in symptoms seen with esketamine to support their longer-term recovery from depression.”

Dr. Jennifer Phillips, Scientist at the IMHR.

More personalized treatment for people with a post-traumatic stress disorder

The University of Ottawa Institute of Mental Health Research at The Royal has received more than $1M from the DND (IDEaS program) to find biomarkers that could lead to better diagnosis and more personalized treatment for people with PTSD.

The research study, called Multi-Dimensional Assessment of PTSD Subtypes (MAPS), aims to improve understanding of posttraumatic stress disorder (PTSD), in particular the dissociative subtype of PTSD, so that it can be more easily diagnosed and more effectively treated.

People experiencing the dissociative subtype of PTSD (PTSDDS) feel detached from themselves and the world around them, making the world seem unreal or dreamlike. They may also experience emotional detachment. These dissociative symptoms can come in addition to other symptoms of PTSD.

MAPS takes a comprehensive approach to exploring PTSD-DS, using various techniques and technology to look at PTSD-DS from a whole body perspective. The research team behind the study includes scientists with varying areas of expertise from the Institute of Mental Health Research (IMHR), in collaboration with The Royal Operational Stress Injury Clinic to reach out to veterans willing to share their experiences.

“This is really leveraging the strength of the IMHR when it comes to taking a bunch of experts, having them each do their thing and then putting it all together,” says Dr. Zachary Kaminsky, the DIFD-Mach-Gaensslen chair in suicide prevention research and the principal investigator for MAPS. “It’s everyone’s expertise coming together that makes this such an impactful project.”

The results so far are promising. The team initially studied information from 32 former Canadian military personnel, looking at a multitude of factors, including brain function and activity, heart rate, sleep patterns, genetics and inflammation. The team then generated an algorithm that can predict PTSD-DS with 91 per cent accuracy.

Over the past two years, the team also followed approximately 60 Canadian veterans over a more extended period of time to replicate their initial model and to understand what biological factors change with improving or worsening symptoms.

The first major result was that the team’s initial model, which predicts PTSD-DS, worked in the newly recruited participants with 85 per cent accuracy.

“This means the biomarkers we identified in the first part of the project truly represent some of the underlying biology distinguishing the dissociative subtype of PTSD,” explains Dr. Kaminsky. “Importantly, the results only really gel when multiple biomarkers are considered at once, demonstrating the power and promise of this whole body approach.”

The second major finding was that epigenetic data and brain imaging data implicated a possible dysregulation of a system responsible for making one of the major neurotransmitters in

the brain, glutamate. Interestingly, this brain signalling chemical has been involved in PTSD and other stress-related conditions, suggesting the change identified may be important for understanding the disease.

“These sorts of results act as signposts, pointing us in the direction of what to investigate further,” says Dr. Kaminsky.

The team notes that while there is more work and analysis to be done, they are on their way to achieving their two goals. First, to better understand the biological underpinnings of PTSD and its dissociative subtype, and second, to create predictive diagnostics and enable personalized medicine to improve the chances of recovery for people with PTSD-DS.

The brain is more complex than any other known structure in the universe. It defines our humanity. Yet we still know so little about it. Underinvestment and complexities in mental health research has meant that there are fewer new treatments and preventions for mental illness, which leads to lost potential, lost hope, and for many, lost lives.

At The Royal’s Clinical Brain Research Centre, research and clinical excellence co-exist seamlessly, in a patient-centered manner. Here, research is integrated into the patient journey from diagnosis through to treatment and meaningful recovery.

“By bringing research and care closer together, we have a unique opportunity to actually accelerate mental health research to ultimately transform the future of mental health care,” says Dr. Florence Dzierszinski, president of the IMHR and vice president of research at The Royal.

Dr. Jakov Shlik, Dr. Robyn McQuaid, Dr. Zachary Kaminsky, Dr. Cliff Cassidy, missing is Dr. Rebecca Robillard, Dr. Natalia Jaworska.

Prompt Care Clinic helping fill mental health care gap in Ottawa region

The Royal’s Prompt Care Clinic began as a short-term response to a mounting mental health crisis early in the COVID-19 pandemic, but has since evolved into much more. Today, the clinic is helping fill a significant gap in mental health and substance use services for the Ottawa region.

Years before she managed the Prompt Care Clinic, Haley Ashe worked as a mental health nurse in Ottawa emergency rooms.

“I saw the gaps firsthand. Patients would come in with serious mental health concerns that didn’t qualify for acute care – but there wasn’t anywhere else for them to go,” she recalls.

“By the time people seek mental health support, they’re already in a state of distress. We know early intervention makes an enormous difference, but trying to find services available in a reasonable timeframe often felt impossible.”

Motivated by those experiences, Ashe became a key player in a new plan to fill this gap in mental health care.

A SILVER LINING IN A GLOBAL PANDEMIC

When the COVID-19 pandemic hit, many services closed their doors. Life stressors skyrocketed while access to mental health resources dwindled.

The Royal, in collaboration with The Ottawa Hospital, stepped in to improve access to care. It began with a temporary endeavour called C-PROMPT, which grew from idea to reality in two weeks, bolstered by emergency funding from the philanthropic community.

In just over three months, it received more than 850 referrals. “It was clear to us that this service was desperately needed in our region,” says Ashe.

In January 2021, the Prompt Care Clinic opened as a service funded by philanthropy for adults 18-65 experiencing mild to moderate mental health challenges. It received financial support from The Royal’s donors and corporate sponsors, including an

ongoing partnership with the LOVE YOU by Shoppers Drug Mart Run for Women. More than half of the clinic’s clients are women, with anxiety and depression being the most common diagnoses. And while the Prompt Care Clinic serves all constituents of this region’s population, youth are disproportionately represented as its clients. Since January 2021, close to 500 youth aged 18 to 24 years old were referred to this temporary Prompt Care Clinic.

“Patients are referred to us by their physician or nurse practitioner, and usually they’re experiencing symptoms that are beyond what their primary health care provider is able to support them with, but not so severe that they require acute or emergency care,” says Ashe.

Until recently, the clinic has been completely virtual, but later this fall will move to 250 City Centre and begin offering in-person appointments as well. The location is easily accessible by public transit, just a short walk from Bayview Station.

“FINALLY, I FELT THAT THERE WAS A CHANCE FOR ME”

Whether someone has been struggling long-term with mental health challenges or developed new challenges due to the stressors of the pandemic, the Prompt Care Clinic is making a meaningful difference in the lives of those across the region.

“I’ve lost all my friends. I fought my depression for so long.

I don’t want to give up, but there are days… I’ve been on sick leave since 2011,” says one client who had been trying to access services for a long time. “My doctor referred me to The Royal’s Prompt Care Clinic. Finally, I felt that there was a chance for me.”

Another client, Jessica, had been living with depression and anxiety before the pandemic. As a teacher and mom of two, it became more than she could manage as the stressors piled up.

“My family doctor was out of ideas for treatment and I needed urgent help. I had tried to get ongoing treatment from a psychologist but after more than a year on a waitlist, had yet to receive care.”

Her doctor referred her to the Prompt Care Clinic, and within several weeks she met with a psychiatrist who helped her set up a care plan.

The clinic has already seen more than 2,500 clients, most of whom have never before accessed mental health care. On average, clients of the Prompt Care Clinic wait less than two weeks to see a specialist.

“Prompt access to care means better outcomes,” says Ashe. “This clinic is an investment in our future. It’s the embodiment of hope.”

Carleton Ravens for Mental Health team with captains Shannon Noonan and Jennifer Gray.

How The Royal amplified the need for housing with mental health supports

Communities nationwide are facing a housing and homelessness crisis, and Ottawa is no exception. For people living with a mental health issue, there’s an extra hurdle to jump because there isn’t enough housing with mental health support. This means many people stay in the hospital longer than they would need to if they had supportive housing or leave the hospital only to see their mental health decline in the absence of support.

Meanwhile, roughly half of unhoused people in Canada are living with mental illness.

“We can’t separate conversations about mental health from those about housing,” says Joanne Bezzubetz, president and CEO of The Royal.

“We felt the need to raise the profile of this issue and advocate for greater awareness of the issue and meaningful investments in supportive housing for people living with mental illness.”

Within these advocacy efforts, The Royal underscored the issue to elected officials, published a statement on the need for supportive housing, amplified the work of our community partners, and facilitated an important public conversation about evidence-based supportive housing.

THE CASE FOR SUPPORTIVE HOUSING

Housing with mental health support is an evidence-based investment that changes lives. At Home/Chez Soi – a four-year study in five Canadian cities –clearly demonstrated that housing with mental health supports works to end homelessness and transform lives. It also showed that it’s a sound investment – over a period of two years, the study found that every $10 spent on housing saved taxpayers $21.72. It also improves outcomes for people living with mental illness in numerous domains, including their symptoms, community involvement, and overall quality of life.

The Royal partnered with Alliance to End Homelessness Ottawa in endorsing and amplifying their #StartsWithHome campaign to advocate for increased access to affordable housing in Ottawa.

Through social media content that garnered 19,000 impressions, we drove traffic to the campaign and highlighted the issues of supportive housing through storytelling. This included sharing a video and article featuring Anita Manley, a mental health advocate, volunteer, and member of The Royal’s board of trustees. Her lived expertise lent a powerful voice to the need for supportive housing.

“It’s significant to have the weight of The Royal’s leadership focused on advocacy in this way,” says Kaite Burkholder Harris, executive director of the Alliance to End Homelessness Ottawa. “We look forward to partnering together more.”

MAKING SPACE FOR A PUBLIC DISCUSSION

The Royal’s Under the Lens conversation series is a space for an in-depth look at critical issues that aren’t discussed enough. On March 9, 2022, the event focused on mental health and housing. Bezzubetz facilitated a virtual conversation between community partners and experts, including representatives from the Alliance to End Homelessness Ottawa, The Royal, the Youth Services Bureau, Anita Manley, and Dr. Tim Aubry, a researcher at the University of Ottawa.

The discussion was collaborative and invigorating, with 116 individuals representing numerous organizations and areas of expertise participating.

“The need for supportive housing is ongoing, and we will continue our efforts to advocate for it at every level,” says Bezzubetz. “We will continue to work with our community partners and use our voice and reputation to make it loud and clear that housing with mental health supports saves and improves lives.”

MAKING A DIFFERENCE TOGETHER Private consists of services provided by and certain of its including Wood Gundy, a division of World The logo and Private are trademarks of used under license. trademark of CIBC Private Wealth we’re committed to advancing health and wellness in our local communities. various sponsorships and community involvement, we want to help reduce the stigma around mental health in Canada. That’s why we’re proud to support The Royal Ottawa Foundation for Mental Health.

COLLABORATIVE RESEARCH, FROM BENCH TO BEDSIDE:

‘When you know better, you do better’

In December 2020, The Royal announced its new operational strategy: Access, Hope and New Possibilities. President and CEO Joanne Bezzubetz referred to it as the beginning of a five-year conversation. It’s a conversation that opens the door to greater and more meaningful engagement, and reinforces collaboration with clients and families.

What many may not fully understand is how far-reaching the impact of this collaboration can be. When clients and families have meaningful input into the decisions that affect them, play

an active role in their own care, and help shape actual research questions, it can transform mental health and substance use health.

“Our clients are the experts,” says Tammy Beaudoin, director of clinical research administration at The Royal. “While we have physicians, researchers, and scientists who study mental health and want to improve mental health outcomes, what they deem as important might not be the same thing that is deemed important to the clients or families we’re working with.”

It’s an essential collaboration, especially given how many people are affected by mental health and substance use health, says Michèle Langlois, chair of The Royal’s Family Advisory Council. “If one person suffers, a constellation of people suffer as well, whether it be in a family, in a workplace or in a community,” she says.

There are many ways people with lived expertise can be involved in research, whether it’s helping develop research questions, being involved in the studies themselves, interpreting the results or disseminating the outcomes. Sometimes it’s as simple as redesigning consent forms, says Peter Winfield, a former client of The Royal and co-chair of a working group dedicated to client and family-oriented research.

Winfield says clients having a voice in the topics that are being researched and the way research studies are structured must be key considerations now, and moving forward. What’s more, “translating research into care is absolutely critical,” he adds. “A lot of good research has been done and we need to work on that and get it into doctors’ and clinicians’ offices.”

Langlois shares the wise words of Maya Angelou: When you know better, you do better. “I think research gives us clues into the knowing better,” says Langlois. “Everyone has a different perspective, but by bringing all the people together you get a more holistic view. I think from a research perspective, when it’s done purposefully by design, you achieve a more balanced view and ultimately, better outcomes.”

Proud to support The Royal’s efforts to highlight the importance of mental health & well-being

Joanne Bezzubetz, Glenda O’Hara, Michèle Langlois, Anne Graham.

TechInsights proudly supports The Royal to help promote mental health and wellness. We are the authoritative information platform for the semiconductor and microelectronics industry. Through our platform, we enable a marketplace which supports innovation to advance the world we live in. Through our relationship with The Royal, we help to inspire hope within our community. techinsights.com

A transformational gift for families impacted by schizophrenia

Written by David Attwood

No one thinks schizophrenia is their problem, until it is.   The numbers are difficult to read. One out of every 100 people live with schizophrenia. In Ottawa alone, 200-300 people will develop this brain disease this year. Schizophrenia is a disorder of psychosis and cognition that can dramatically impact how a person perceives themselves and the world around them, yet despite that, most struggle to recognize the need for assistance.

The good news is that the first episode of psychosis is very treatable, and about 90 per cent of people who have experienced the first episode of psychosis will achieve remission within one year of treatment.

The bad news is that 85 per cent will have a serious relapse within five years.

When I was a younger doctor, I imagined genetics would become the key to diagnosing and treating schizophrenia, but over the last 20 years, we have discovered more than 100 genes involved in this illness – all of them contributing a little bit, but not a single one of them diagnostic, or offering clear treatment directions.

The most remarkable thing about the genetics of schizophrenia is that we know family history is the largest factor in developing the illness, yet about 90 per cent of individuals do not have a parent with schizophrenia and over 60 per cent not even a first degree relative.

Allow that to sink in. For many families, this illness comes completely out of the blue.

Usually, by the time a person gets to The Royal’s Integrated Schizophrenia Recovery Program, they have seen several psychiatrists, acquired several diagnoses, and had a few efforts at treatment, perhaps even several hospitalizations. So when I see someone new, they are not new to this at all.

I often feel like I’m joining their family, but frankly, most do not want me to join. They want me to know what I am doing and to tell them everything is going to be ok so they can get on with their lives. I have never really been able to say that yet.

The statistics are sobering.

Around 20 per cent of our clients will get stable jobs, about 30 per cent will live independently, 35 per cent will get married, and only about 14 per cent will maintain a meaningful recovery. Yet, we remain devoted to creating that possibility.

It’s estimated that over 50 per cent of people who are unhoused have schizophrenia. Sadly, most people who have schizophrenia die about 20 years earlier than their peers, and often from treatable medical illnesses. Most tragically, while one per cent of people with schizophrenia die by suicide each year, this group accounts for 12 per cent of the annual total suicides in Ontario, with a lifetime risk of suicide just under 10 per cent – yet it is a constant struggle to access long term assistance.

As schizophrenia is a stigmatized, yet highly treatable, severe

psychiatric disorder, it requires a robust and highly integrated continuum of care.

The Royal’s newly established Ozerdinc Grimes Family Regional Psychosis Clinic is a community-based model designed to bridge this gap in the continuum of care for clients and families experiencing severe and persistent psychotic disorders. The clinic will provide effective long-term therapies, including early and easy access to long-acting injections and clozapine, and can be integrated into existing community based services, as well as cognitive behavioural therapy, family therapy, recovery and rehabilitation services. It is also exciting to note that all patients can volunteer to participate in cutting edge research, including fascinating studies in neuroimaging, electrophysiology, sleep, and cognition at The Royal.

Thanks to a transformational $2.5 million philanthropic gift from the Ozerdinc Grimes family, we are able to retain a team of experts supporting the newly established The Royal’s Ozerdinc Grimes Family Regional Psychosis Clinic through 2025.

This gift will help an additional 1,000 people living with schizophrenia and their families to access quality standard based care while connecting them to ground-breaking research. With rigorous education and evaluation embedded in the clinic, we will make the case for sustainable ongoing funding from the government.

Schizophrenia is a life-long illness. We are committed to providing our patients with the diagnostic and treatment tools they need, while also connecting them to a quality-based system of care, and staying with them for as long as they need us.  We also know we need to focus on families, because this is a

Peace of mind is something we often take for granted and, as a result, mental health is often overlooked when it comes to philanthropic support. Having said that, the community in Ottawa has stepped up to contribute to the improvement of quality of care and research in mental health. However, there is a critical need for improved access to care, particularly for those suffering from psychosis without a diagnosis. By providing a novel form of access to care, the new clinic will not only give hope to those suffering from psychosis, but it will also give hope to their families. Moreover, in the community at large, the Ozerdinc Grimes family believes that there will be a collective “sigh of relief” amongst those in the medical field, as well as educators and caregivers.

– Kathleen Grimes and Ersin Ozerdinc

family illness, and we want to reassure parents and loved ones that their person is getting the best care they can get, anywhere.

David Attwood, MD, FRCPC Assistant Professor, University of Ottawa

Clinical Director, Integrated Schizophrenia Recovery Program, The Royal

Left: David Attwood. Above: Kathleen Grimes and Ersin Ozerdinc.

Turning grief into hope

Melissa Kruyne and Jennie James grew up together in Ottawa. They met when they were six years old and stayed friends throughout elementary school, high school and university. Jennie’s incredible mind earned her scholarships to universities around the world. But that same mind kept letting her down.

“Jennie could light up a room,” remembers Melissa. “But she was also a troubled soul.”

Early in their careers, life brought them both to Toronto and Melissa and Jennie moved into the same neighbourhood. Soon after, Jennie began to experience back problems. She underwent surgery and unfortunately continued to suffer from chronic pain, which impacted her ability to lead a normal life. Depression settled upon her and later went away, only to return again.

Alongside Jennie’s family and friends, Melissa tried to help her friend through the ups and downs. Melissa drove to Jennie’s many times in the middle of the night to support her friend as best as possible. On July 3, 2005, Jennie died by suicide. She was 33. An encouragement card posted the day she died, yet never received, still haunts Melissa.

“Not a week goes by without speaking of her,” says Jennie’s sister Margaret. “Her life and death continue to impact my family. Suicide is something that I hope fewer families and friends will need to face with the help of destigmatization, research and

mental health programs.”

Depression profoundly impacts individuals and their friends and family, who often feel helpless. In 2006, Jennie’s father, Ben, started the Jennie James Depression Research Fund. The fund promotes awareness, understanding, research, and treatment of depression and seeks to end the silence surrounding suicide.

Jennie’s death prompted Melissa to learn more about mental health, a cause she has grown to care deeply about.

“Jennie is why I got involved with The Royal. She was cared for by The Royal –- and her story is how I got started –- but it’s grown into so much more.”

Melissa’s family firm, Kott Inc., has since been a significant

supporter of The Royal. It has led to some important conversations. The more people at the firm talked about mental health, the more people came forward with their own stories. Now led by Melissa’s brother, Ryan, mental health continues to be emphasized and supported in his dialogue with the employees.

Members of Melissa’s own family have been through their own mental health challenges. Melissa says that despite her family’s vocal support over the years since Jennie’s death, mental health challenges remain difficult to discuss and address.

“It’s easier to be involved when it’s not about you. When it is you, then real life sets in. That’s where we have to be both brave and vulnerable.”

LEFT: Jennie James (far right) with sister, Margaret (left) and father, Ben (centre). RIGHT: Laura Hammond who also raised money in support of Jennie’s fund, Ben James, Jennie’s father and Melissa Kruyne.

Allison

But, not only did she feel lost and overwhelmed as she began her journey to she felt shame did thanks to caring monthly everything she personal mental a mental health a monthly donor to Allison and other people her experiencing a mental health crisis with the and life-changing help they