Building Together
The Douglas Mental Health University Institute Annual Report 2007-2008
1
Conceptualization and writing Marie-Gabrielle Ayoub Marie france Coutu Stéphanie Lassonde Nancy Schmidt Christine Zeindler
When you click on this symbol, you will access to the web for more information
Translation Amy Butcher Martin Bernard Stéphane Otvas Photography Romualdo Barillaro Bivouac Studio Graphic design/Illustration Bivouac Studio Artwork Mark Grenon, artist Auditors Raymond Chabot Grant Thornton
MARK GRENON – artist Originally from the Ottawa area, I received a BA in English literature at the University of Ottawa before beginning a long period of living and travelling abroad. I then settled in Montréal, where, although I had initially been interested exclusively in poetry, I started, to my surprise, to develop an interest in digital photography and painting.
Legal deposit Bibliothèque nationale du Québec Bibliothèque nationale du Canada ISSN 0708-8647
The intensity of my creative work, plus a number of personal stresses, led to my requiring the aid of the Douglas Institute. After a two-week stay at the Burgess Pavilion at the Douglas, I became a client at the Prevention and Early Intervention for Psychoses Program (PEPP), where I was aided in particular by Dr. Emmanuelle Levy, my case worker Suzanne Larue, and Martin Lepage, PhD, a specialist in cognitivebehavioural therapy, in addition to many others on the PEPP team. After a two-year period with PEPP, I moved to Chile, where I have been writing sonnets in abundance. I am extremely grateful for the help and generous care I received from the humane staff of the Douglas Institute, and I am deeply aware of how lucky it is for the citizens of Quebec to have access to such an institution. Although originally uncomfortable with the idea of including this biographical sketch, I have decided to share this background information in an effort, in my small way, to try and reduce the stigma against mental illness. My experience has been that there are many people suffering in the world and that the more open we are the better we are able to help each other when in need.
6875 LaSalle Blvd. Borough of Verdun Montréal, Quebec H4H 1R3 CANADA Tel.: 514-761-6131, ext. 2769 Fax: 514-762-3043
Finally, I must thank the Douglas for its enthusiastic interest in my work and giving me the opportunity to share my creative projects with a wider audience through this annual report.
info@douglas.qc.ca www.douglas.qc.ca This annual report is a production of the Communications and Public Affairs Department of the Douglas Mental Health University Institute
Mark’s gallery 2
i n
t h e
A y e a r m a k i n g
Building the Institute together This year, we laid the foundation for what will become the Douglas Institute of the future. While last year represented a turning point with our designation change from a hospital to a university mental health institute, this year marked a new milestone in our work to cement our status as a leading-edge, international leader in mental health research, teaching and care.
Building a better mental health system Clinicians, researchers and managers were mobilized this past year to implement the Mental Health Action Plan—the reform initiative of the Ministry of Health and Social Services. Very soon, 50 health professionals from the Douglas Institute will be transferred to the 1st line to become part of multidisciplinary 1st line mental health teams. Several hundred patients who are stable and who do not require the Douglas Institute’s ultraspecialized services will be transferred to 1st line services, which will allow us to focus on those in need of greater levels of care. Despite major challenges, we are convinced that this reform will allow people with mental health problems to access a better organized and more efficient network.
Building an even stronger scientific community The leadership of the Douglas scientific community is undeniably a point of attraction for those working in mental health research. Last year, we recruited four researchers from within and outside the country, including the new Graham Boeckh Chair in Schizophrenia. What’s more, the Douglas Institute signed a research agreement with McGill University and with Yale University’s Program for Recovery and Community Health.
3
a
y e a r
i n
t h e
m a ki n g
Building our expertise, sharing our knowledge
Building an engaged community
Our expertise in mental health—in both care and research—is increasingly called upon. Our mandate is to teach and train students, to share knowledge with our health care partners, and to educate and enlighten the general public about mental health problems. This year, the Douglas Institute brought together more than 400 stakeholders in the field of mental health during the 4e Colloque Interétablissements. We provided instruction to more than 250 students and trainees from various professions and met with more than 700 members of the public who wanted to learn more about mental illnesses.
The Institute’s success resides in the exceptional quality of our teams of clinicians, researchers, support staff, teachers, volunteers and administrators. Members of the Douglas community are proud of their work and continously strive to do more for those suffering from mental health problems. Our success also stems from our compassionate donors, to whom we owe immense gratitude. They show devoted support to a cause that remains unpopular, despite its impact on a large number of people. We are particularly touched by the commitment of a new generation of budding philanthropists, as more and more young people are supporting the Foundation and openly speaking out against the taboos of mental illness. Their actions are a testament to exemplary vision and generosity. We need more people like them. It is clear how our history and long tradition have provided us with a solid foundation. We can now envision a modern institute that continues to build on our strengths.
Claudette Allard President, Board of Directors Douglas Institute
Jacques Hendlisz Director General Douglas Institute
Jocelyne Lahoud, MGP Administrative Director
François Morin President, Board of Directors Douglas Institute Research Centre
Rémi Quirion, PhD, O.C., FRSC, CQ Scientific Director Douglas Institute Research Centre
Marie Giguère President, Board of Trustees Douglas Institute Foundation
Jane H. Lalonde President and Chief Operating Officer Douglas Institute Foundation
4
A n
i n s t i t u t e About the Douglas
Our mission As a Mental Health University Institute affiliated with McGill University and the World Health Organization, the Douglas is an international leader in mental health care, research, and teaching. As such, the Douglas: »»
Provides specialized and superspecialized services within a continuum of care, in cooperation with first-line partners.
»»
Helps destigmatize mental illness within the scope of prevention and recovery principles.
»»
Contributes to the advancement of knowledge and best practices through state-of-the-art research and teaching.
The Douglas is renowned for innovation, multiculturalism and bilingualism. It also reflects humanism and openness, while benefitting from solid philanthropic support. Founded by the Montréal community, the Douglas enjoys a proud tradition of collaboration with numerous partners.
our mandate As a university institute, the Douglas’ triple mandate is to care, discover, and teach as it shares its expertise with the world at large.
5
a n
i n s t it ut e
Our values
BOARD OF DIRECTORS
foundation
The Douglas values excellence and innovation, based on commitment, collaboration, and education.
RESEARCH CENTRE BOARD OF DIRECTORS
ombudsman DirectOR gEnEral
Excellence: To apply best practices with rigor. Innovation: To provide a stimulating and dynamic environment, where new knowledge is developed to improve understanding and care.
RESEARCH CENTRE
CLINICAL ACTIVITIES, TRANSFER OF KNOWLEDGE AND TEACHING DIRECTORATE
Commitment: To remain dedicated to our mission. Collaboration: To work within interdisciplinary teams and with internal, community, university, and international partners. Education: To act as a learning organization that values its human resources and evolves through knowledge exchange and continued education.
QUALITY MANAGEMENT DIRECTORATE
PROFESSIONAL AND HOSPITAL SERVICES DIRECTORATE
Mental Health Program for Adults of South-West Territories
Child Psychiatry Program
Geriatric Psychiatry Program
Mood, Anxiety and Impulsivity Disorders Program
Psychotic Disorders Program
Intellectual Eating Disorders Handicap with Program Psychiatric Comorbidity Program
Recovery Program
INTERDISCIPLINARY COORDINATION CHIEFS OF CLINICAL DEPARTMENTS
HUMAN RESOURCES DIRECTORATE
PROFESSIONAL CHIEFS
FINANCIAL AND INFORMATIONAL RESOURCES DIRECTORATE
NURSING DIRECTORATE
TECHNICAL SERVICES AND FACILITIES DIRECTORATE
6
a n
i n s t it ut e
M e nta l H e a lth A cti o n P l a n
Reforming mental health services: Success in collaboration Plan d’action en santé mentale (Mental Health Action Plan) PASM
The reorganization of mental health care and services, as described in the Plan d’action en santé mentale - PASM (Mental Health Action Plan or MHAP) of the Ministry of Health and Social Services (MHSS), mobilized a number of resources at the Douglas Institute last year. The MHAP affects the entire Quebec network and involves sweeping philosophical and organizational changes.
MHAP summary: Mental health services and mental health workers in Montréal have, until now, been concentrated in hospitals specializing in psychiatry (such as the Douglas) and in general hospitals with a department of psychiatry.
psychiatric hospitals (which specialize in treating people suffering from serious mental health problems) find themselves obliged to respond to an ever-increasing demand, which results in corresponding delays in access to services.
Every year on the island of Montréal, approximately 142,000 people (7.6% of the population) use the mental health services offered through the health care system. Of this number, 60% consulted for disorders that do not generally require a hospital environment.
Faced with this situation, and in order to respond more effectively to the needs of the population, the Quebec Ministry of Health and Social Services decided to introduce major changes designed to improve the continuity of mental health services and provide better access to them.
However, due to a lack of organization in mental health services offered in general points of service, such as the CLSCs, the
Tiered mental health services
From now on, anyone suffering from a mental health problem will have to access 1st line care and services via the “guichet d’accès” (entry point) at a Centre de santé et de services sociaux (CSSS) or from a general practitioner. The decision of the MHSS to tier mental health services represents an acknowledgement that mental illnesses should be treated just as seriously as “physical” diseases. The
7
Douglas Institute salutes this initiative and believes it will help destigmatize people with mental health problems. By contributing to this reform, the Douglas will build upon its commitment to provide specialized 2nd and 3rd line care and services, perform cutting-edge research, teach the next generation of mental health professionals, evaluate technologies, and transfer knowledge to the world community.
a n
i n s t it ut e
MHAP challenges
MHAP implementation
The MHAP presents major practical challenges. The first and not least of which is to increase the role of general practitioners in treating patients with mental health problems. These doctors will be supported by Douglas psychiatrists, who will act as “responding” or “consulting” psychiatrists as needed.
To ensure the success of the MHAP, a Phase 1 Implementation Committee was created with representatives from the two CSSSs in our region (the CSSS Sud-Ouest–Verdun and the CSSS Dorval-Lachine-LaSalle) and from community organizations, the Montréal Health and Social Services Agency, and the Douglas. Last year, the committee worked to develop a plan to transfer patients and staff from the Douglas to the 1st line.
While there has been a lack of psychiatrists willing to play this role of “consultant,” those who have taken part in the exercise have given positive feedback about the experience, and we are counting on their contribution, among other initiatives, to increase their numbers.
To mobilize Douglas staff and implement these changes, the Clinical Activities, Knowledge Transfer, and Teaching Directorate created a Vigilance Committee, comprised of key representatives from the organization, who did a tremendous job last year of identifiying the patients to transfer and of evaluating these patients’ needs.
Challenges also reside in developing a common vision for both the Douglas and its CSSS partners, as well as in making these changes operational. We are confident that the welfare of patients will remain at the centre of our actions, so that we can create the best network possible to meet their needs.
Information Meetings, June 2008. Amparo Garcia (Douglas), Louise Beauchesne, (Douglas et CSSS Dorval-Lachine-La Salle), David Bloom, MD (Douglas), Louise Laurier (CSSS Dorval-LachineLaSalle), Andrée Roy (Douglas)
Information Meetings, June, 2008. Amparo Garcia (Douglas), Madeleine Breton (CSSS SudOuest-Verdun), Louise Laurier (CSSS Dorval-Lachine-LaSalle), Jean-Bernard Trudeau, MD (Douglas)
8
a n
i n s t it ut e
Assessment sessions with partners
In February, various health professionals from the Douglas, our CSSS partners, and community groups, along with Douglas psychiatrists, general practitioners and union representatives came together for two half-days to perform patient assess-
A collaborative success: The pilot project between the Douglas and the CSSS Dorval-Lachine-LaSalle
An initiative of the MHAP Phase 1 Implementation Committee, this pilot project between the Douglas and the CSSS Dorval-Lachine-LaSalle is a great example of increased collaboration
ments. The goal of these sessions was to create a discussion platform for staff who will be working together once the reform process is complete. These case assessments allowed everyone to pool their knowledge and expertise to determine the feasibility of the transfers.
with our 1st line partners. This project, to test a model for the 1st line mental health team, demonstrated how general practitioners, psychiatrists and other Douglas professionals can work together effectively. It also gave us full confidence to start transferring patients to the 1st line.
Transferring patients from the Douglas to the 1 st line Many patients who are currently treated at the Douglas Institute present stable profiles and/or have mental health problems that do not require the care and services of a superspecialized institution in mental health. Such patients will from now on be treated by 1st line health professionals, either by a CSSS or a general practitioner. After the transfers are complete, the Douglas sector clinics, as we know them, will cease to operate.
9
a n
i n s t it ut e
Information sessions for patients and families
To inform our patients and their families about the planned changes for autumn 2008 and to help them better prepare for these changes, two information sessions on the MHAP
Thanks to staff
were organized. Led by the Douglas and CSSS representatives who are overseeing the project, these sessions drew much appreciation from the 150 people who attended. Information is also now available at www.douglas. qc.ca/pasm.
We would like to thank the staff, particularly those affected by the transfers, for their professionalism and cooperation. This implementation process could not have succeeded without a foundation of solid relationships. Thank you for your understanding and patience throughout this reorganization process. Your contribution has helped create one of the strongest 1st line mental health teams that the health network has ever seen, and patients will now receive care that is better adapted to their needs.
Transfer of 50 Douglas staff members to the 1 st line In order to serve new mental health clients effectively, each CSSS will need to add mental health professionals to its team. Some of these professionals will come from the Douglas. In fact, 50 Douglas professionals will be transferred to partner CSSSs to help create multidisciplinary 1st line mental health teams. They will be joining other 1st line professionals, particularly general practitioners and the medical and psychosocial teams at the CSSSs. The Montreal Health and Social Services Agency had initially asked the Douglas to transfer 109 staff members to the CSSSs. However, in light of our mandate as an Institute and our role within the McGill RUIS, a decision was made to decrease this number by more than half to ensure that our status as a University Institute would not be jeopardized.
10
a n
i n s t it ut e
D o u g l a s A c c r e ditati o N : G o o d R e s u lt s !
T h e D o u g l a s G o e s Gr e e n Taking action for the environment
Like all Canadian health establishments, the Douglas must undergo a rigorous and mandatory accreditation process from Accreditation Canada every three years. The Douglas Institute received an excellent provisional report following Accreditation Canada’s visit last April and subsequently received conditional accreditation pending a follow-up report. While most Canadian establishments receive conditional accreditation, the Douglas achieved remarkable success with higher-than-average results.
In June 2007, the Douglas Institute launched a two-year “Go Green” project to radically reduce its environmental footprint. This initiative is improving the quality of the environment for patients, staff, and the community at large. The strategic goal for “Go Green” is to obtain the Environmental Recognition Certification in 2009 from the international Building Owners and Managers Association (BOMA), whose certification is recognized around the globe. This program includes: our energy efficiency project to reduce greenhouse gas emissions by 60%; our recycling initiatives, which were expanded this year; air and water quality initiatives; and a campaign to inform and educate staff about environmental issues.
In the months to come, the Douglas Institute will provide proof of follow-up regarding the improvement opportunities described in Accreditation Canada’s provisional report. We will also submit proof of the measures taken, as required. All accreditation teams will play a role in this process. These last steps, which will be finalized before December 26, 2008, will fulfill the remaining requirements of the accreditation process. Accreditation Canada will then revise the action plan and publish its final report. Our organization should then receive accreditation status, which will remain in effect for the next three years.
It’s easy being green
I n f ra stru ctur e P r o j e ct
The energy savings component of the “Go Green” plan involved converting the Douglas’ heating, cooling and electrical systems. This energy savings component is now complete, and contributes to a 38% reduction in energy consumption.
Building on the support and encouragement of our Board of Directors, efforts to pursue the renewal of our aging infrastructure have continued this past year in a more focused, formalized manner. During the past 12 months, the Project Team, led by the director general and the director of technical services, has held consultations and information sessions with nearly 300 people from key audiences, including patients, employees, our community mental health partners and representatives from local and provincial governments. The response to date has been positive. A pre-feasibility study, the first step in making a formal request for provincial government support, is currently in development and is slated for submission to the Ministry of Health and Social Services and the Agency in early 2009.
11
a n
i n s t it ut e
M e eti n g th e La b o ur Cha l l e n g e
New employees getting ready to take over! As many staff members will be retiring in the near future, the HRD is working to properly train their replacements. With the help of managers, the HRD has identified the positions that will require new staff and is now hard at work planning the most effective way to transfer knowledge.
Like most institutions in the Quebec health network, the Douglas has to face a shortage in qualified labour. To attract professionals, the Human Resources Directorate (HRD) set to work this year to develop a marketing plan and adopted various promotional tools, an engaging institutional identity, and a referral program.
career day With these tools, and with the help of clinicians, managers, and administrative staff, the HRD organized a career day at the Douglas on April 12. A great success, the event was attended by more than 250 visitors.
Caring for employees well-being The HRD is part of a working committee, comprised of financial and clinical staff, whose goal is to develop strategies to provide a challenging and supportive work environment in which employees can pursue their careers. For example, the structure of positions was reviewed to increase the efficiency of human resources management, while ensuring patient safety. The HRD also implemented a health and well-being program at the Douglas that, in addition to inviting employees to take care of themselves physically and mentally, also provides tools and methods to make their lives easier!
12
C a r e T h e C l i n i c a l , K n o w l e d g e T ra n s f e r a n d T e a c hi n g A cti v iti e s D ir e cto rate The Clinical, Knowledge Transfer and Teaching Activities Directorate team was very much involved in helping the Mental Health Action Plan progress this year, but the team also helped implement the following measures to improve access to Douglas services:
Committee to Improve Access t o S e r v i c e s This committee’s objective is to facilitate access to the Douglas Institute for anyone with a mental health condition that requires our services. This working committee is comprised of the co-Directors and assistant director of the directorate; the directors of the geriatric psychiatry, child psychiatry, adult mental health and mood, anxiety, and impulsivity-related disorders programs; the assistant to the director general; the consulting service continuity manager; a medical records administrator; as well as representatives from the Infocentre. The mandate of this committee is to optimize the accessibility and continuity of both inpatient and out-patient hospital services 13
while operating within the scope of our management agreements, the Institute’s strategic plan, and the legal parameters governing these activities.
C a r e
A reorganization of emergency services and the creation of the Brief Intervention Unit (BIU) have helped ensure that emergency cases and cases requiring immediate care are dealt with as soon as possible. Brief Intervention Unit
The Tactical Bed Management Team continued its collaborative efforts by holding daily meetings with representatives from each in-patient unit involved in the continuum of services between Emergency, the admitting units and external services.
A Rapid Intervention Module (MIR) was set up in response to an identified need to deal with cases from Emergency or the Evaluation Liaison Module (MEL) that involve a crisis or that require immediate care. These collaborative projects, involving both managers and clinicians, have indeed born fruit, as the average length of hospital stays has been reduced. Congratulations to all team members for their great work! In fact, Emergency wait times exceeding 48 hours have been eliminated, and the number of patients waiting more than 60 days for 2nd and 3rd line services has decreased by 33%.
MIR Team. From Left: (back) Michelle Nolet, Zibgniew Pleszewski, Sandra Massa, Michelle Fontaine, Mark Rabinovitch, Carlos Dias, (front) Elizabeth Blackmore, Chantale Boisselle and Sylvie Lauzon
14
C a r e
N e w P syc hiatri s ts o n B o ard In 2007, four new psychiatrists were recruited to join the Douglas team. We are proud to have a roster of talented health professionals with diverse expertise. Their abilities contribute actively to the Douglas mission and help us achieve our objectives as a Mental Health University Institute. The arrival of these new psychiatrists makes it possible to fill the positions of retiring staff. This will allow the Douglas to ensure its clientele has continued access to quality care.
Maria Di Tomasso MD, Geriatric Psychiatry Program
Suzane Renaud, MD Evaluation Liaison Module (MEL), Personality Disorders Program and Bipolar Disorders Clinic
Mark Rabinovitch, MD Evaluation Liaison Module (MEL) and Rapid Intervention Module (MIR)
15
Valerie Fedorowicz, MD Eating Disorders Program and the Child Psychiatry Program - Services for Adolescents
C a r e
Em e r g e n c y R e s p o n s e : Fa s t e r , M o r e Effi ci ent
N e w M e di c ati o n D i stri b uti o n Syste m Douglas medication distribution system
In 2007-2008, the Douglas improved its medical emergency response procedures. Clinical nurse advisor Jesney François led this initiative, which included: »» »» »» »» »»
During winter 2008, the new medication distribution system became fully operational. This project started in 2006 and was led by the Pharmacy Service. It was overseen by a group of professionals at the Douglas from eight departments who collaborated to bring this project to completion. Replacing the pharmacy’s computer program with a state-of-the-art version in medical distribution involved a rigorous selection process. The system chosen is called Gespharx 8, which is specially designed for hospital pharmacies.
Creating a Code Blue Tactical Intervention Team, available 24/7. Updating the emergency response procedures manual. Updating and refilling all Douglas emergency carts and “blue boxes” by the Technical Platforms and Specialised Diagnoses Department. Providing CPR training to all Douglas nurses. Raising awareness of the Code Blue protocol.
This program will give staff specific options as they enter information and will give pharmacists the option to enter medication protocols. Pharmacy staff will no longer have to type entire prescriptions into the computer by hand. Among its many advantages, the system will also alert pharmacists to potential problems including: »» »» »»
Dangerous interactions between newly prescribed drugs and medications that patients already take. Faulty prescriptions that call for dosages that are too high or too low to be effective. Patients with allergies to ingredients in prescribed medications.
This new system brings an added assurance that patients will receive the right medication in proper quantities and on time. It will allow pharmacy and clinical staff to update their management of medication and reach Quality and Risk Management objectives, as outlined in the Douglas’ strategic plan.
16
C a r e
M o v i n g A h e ad pr o g ram – t e s tim o n y f r o m a v o l u nt e e r Truly incredible Volunteering for the Moving Ahead program, which is managed by Stella GaucherMurovic, is an unforgettable experience. It is an experience that is unique, powerful and rewarding. I have been volunteering with this program for about eight months now and the differences I have found in my client Marion Pinto are truly incredible. It is amazing what the gift of time and care can do for an individual. At the beginning, Marion had trouble holding a conversation. She would simply answer yes or no. However, now she engages in conversations and asks questions on her own. At the beginning, she would sometimes be hesitant to go out and our outings would be limited. Now we have gone to many places, including art museums, the Ecomuseum, the Biodome and many other places. Now Marion gives her own input on where she would like go for our outing and she becomes very creative. One of the biggest changes that I have noticed is that, during our first couple of meetings, Marion did not show a lot of emotional expression and she would look tense. Now her emotional expressions are clearly there. She smiles often and looks at ease and comfortable! The volunteering experience is truly powerful as you clearly see how you, as the volunteer, have impacted another person’s life. It is rewarding and has an outstanding impact for both the volunteer and the client.
Marion Pinto, client, Ashley Reynolds, volunteer, Moving Ahead Program
17
D i s c o v e r i e s With more than 65 scientists and clinician-researchers and over 139 trainees, the Research Centre of the Douglas Mental Health University Institute is the largest mental health research centre of its kind in Quebec and the second largest in Canada. Three of our scientists are among the most highly cited neuroscientists in the world. Investigators at the Research Centre employ multidisciplinary and biopsychosocial approaches to expand our knowledge of the causes of mental illnesses, devise new diagnostic tools and treatments, and identify preventive measures for mental illnesses. The year 2007-2008 was very successful for Research Centre members in terms of both furthering research and obtaining competitive awards from national and international granting agencies. During the past year alone, Research Centre members published more than 230 innovative articles in peer-reviewed journals, as well as book chapters describing scientific breakthroughs and treatment advances.
18
D i s c o v e r i e s
R e s e ar c h Gra n t s a n d A w ard s
R ESE A R C H H I G H L I G H TS:
This fiscal year, the Douglas Institute Research Centre (DHRC) obtained close to $16 million in research funding. Granting agencies included the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council (NSERC), the Canada Foundation for Innovation (CFI), le Fonds de la recherche en santé de Québec (FRSQ), Valorisation-Recherche Québec, and many non-profit organizations and foundations.
Investigators at the Research Centre continue to push boundaries as they create new technologies to diagnose Alzheimer’s disease, develop policies to combat eating disorders, and study the effects of new mental health policies in Quebec. The three administrative units include the Clinical Research Division, the Neuroscience Research Division, and the Psychosocial Research Division. Below is a sample of their ongoing endeavours, which are made possible thanks to funding from key organizations
In March of 2008, the federal government announced increased funding for health research projects across the country, which will be administered by the CIHR. The Research Centre received an all-time high of $7.3 million in operating and seed grants. This amount represents approximately 22% of the total sum, which is a testament to the high-calibre research conducted at the Douglas.
$130 431
$2 544 832
$1 025 471 $9 145 004 $3 093 030
Clinical Research Division For over 50 years, clinical research activities have played vital roles at the Douglas Institute by covering all aspects of the etiology, diagnosis, treatment and prevention of mental disorders. Pivotal studies include understanding possible causes of attention deficit hyperactivity disorder (ADHD), suicide and sleep-wake disorders.
Canadian Government (CIHR, NSERC, CFI, etc.) Quebec Government (FRSQ, Genome Quebec, etc.) Foundations Non-profit organizations and private industry Other
19
D i s c o v e r i e s
Link between Mom’s stress and ADHD symptoms
Suicide: Who is at risk?
A new study published by Natalie Grizenko, MD, FRCPC, and Ridha Joober, PhD, examined whether there is an association between the severity of maternal stress during pregnancy and the severity of symptoms of ADHD. Their findings showed that children with ADHD whose mothers were exposed to moderate or severe stress during pregnancy tended to develop more severe symptoms than children with ADHD whose mothers were not exposed to prenatal stress. They concluded that it is important to minimize stress in pregnant women.
Attempted and completed suicides are major problems of our society. Gustavo Turecki, MD, PhD, has focused his research on why some people who become depressed commit suicide while others do not. His recent work examined the predictability of suicide attempts in young adults with histories of childhood abuse. The findings from this first community-based study showed that those reporting physical abuse, sexual abuse or both abuse types had higher odds of suicide behaviours. In addition, he demonstrated that this trend might be specific to female suicide attempters.
Jens Pruessner, PhD, and colleagues were the first to show that during stressful or demanding situations, a specific region of the brain, the hippocampus, turns off. This in turn allows other areas to become active and react to the stress. The hippocampus is an important structure in the brain that is involved in spatial orientation, understanding new information, and learning and memory. Jens Pruessner’s other research focus has been to characterize how hippocampal size influences the stress response and behaviour and how the environment can alter this response.
McGill Group for Suicide Studies
Natalie Grizenko, PhD, researcher
20
Jens Pruessner, PhD, researcher
D i s c o v e r i e s
Sleep-wake disorders If left undiagnosed, sleep-wake disorders may result in fatigue and poor job or school performance. Diane Boivin, MD, PhD, the team at the Centre for Study and Treatment of Circadian Rhythms, and Nicolas Cermakian, PhD, are studying these disorders and why some people are better able to adapt to changes in time and night shift work. Their studies have described the effects of a shifted sleep/ wake schedule on both “clock gene” expression and hormonal rhythms. They have shown that it is possible to train the body to a new routine, but that it takes several days for “clock gene” expression to adapt. These findings have implications for understanding medical disorders affecting night shift workers and others who have sleep-wake disturbances.
Standard Life has set a new standard for industry philanthropy. Thanks to their substantial support, Dr. Boivin and her team have recently created a Web site for the Centre for Study and Treatment of Circadian Rhythms. This site provides information on sleep, sleep ritual improvement, and ongoing research projects. This donation also provides for further circadian rhythm and sleep research and supports guest speaker engagements.
our team: Bruno Giros and Salah El Mestikawy. Bruno Giros, PhD, is the recipient of the Graham Boeckh Chair in Schizophrenia, and his interests lie in characterizing the neurobiology of schizophrenia and in developing improved genetic animal models of this illness. He has been a pioneer in the molecular characterization, cloning and study of the brain chemicals involved in schizophrenia. In addition, he has developed the first genetic mouse models that link these molecules to brain functions and mimic certain types of psychosis. His studies will lead to a better understanding of the key neurotransmitter systems involved in schizophrenia and to the development of new diagnostic and therapeutic tools.
Neuroscience Research Division Researchers of the Neuroscience Division apply cutting-edge technology to study the brain systems involved in a wide range of mental disorders, from schizophrenia and dementia to drug addiction and depression. This year, two distinguished investigators have joined
Diane Boivin, MD, PhD Director, Centre for the Study and Treatment of Circadian Rhythms
Nicolas Cermakian, PhD Researcher
Scientific Conference in honour of Bruno Giros, PhD, Graham Boeckh Chair in Schizophrenia Centre for Study and Treatment of Circadian Rhythms
21
Bruno Giros, PhD Graham Boeckh Chair in Schizophrenia
D i s c o v e r i e s
Salah El Mestikawy, PhD Canada Research Chair in Neurobiology
Stéphane Bastianetto, PhD
Tak Pan Wong, PhD
Salah El Mestikawy, PhD, is a Canada Research Chair in neurobiology who joined the Douglas to direct an international research team comprising the Douglas, the Institut national de la santé et de la recherche médicale (INSERM) in France, and Université Pierre et Marie Curie à Paris. He and his colleagues will combine different approaches to analyze how the brain works from its molecular and fundamental functions to the most integrated aspects, such as behaviour and pathology.
Cecilia Flores, PhD
further characterized these findings by demonstrating that some polyphenols acted by inhibiting the formation of these amyloid plaques. In addition, their studies have determined that binding molecules for polyphenols are broadly distributed in the rat brain, further proof of their biological role. It has been previously shown that intense stress may result in a loss of spatial memory. Using a rodent model, Tak Pan Wong, PhD, and collaborators, examined how this process occurs at a molecular and behavioural level. Their findings show that brief intense periods of stress can produce a behaviour called long-term depression. Their study is the first to demonstrate that this behaviour in turn affects memory retrieval. This study provides a new perspective on memory deficits and disorders and how they can be aggravated by stress.
This year, investigators of the Neuroscience Research Division published findings in many high-impact journals, which demonstrate the significance of their research. Noteworthy studies included those examining the role of particular brain structures in learning and memory, the importance of maternal care on the stress response, and the neuroprotective effects of natural products. Stéphane Bastianetto, PhD, along with colleagues, including doctoral student Jonathan Brouillette and Rémi Quirion, PhD, scientific director of the Douglas and of the Institute of Neurosciences, Mental Health and Addiction (INMHA), demonstrated that specific compounds, such as resveratrol present in red wine and polyphenols in chocolate and tea have defined neuroprotective effects. Their studies showed that cultured cells treated with resveratrol or other polyphenols resulted in degradation of amyloid, a protein that accumulates in the brains of Alzheimer’s patients. They
Cecilia Flores, PhD, and colleagues have identified the role of netrins, a group of chemicals involved in brain development, in schizophrenia. Her findings show that the binding element (receptor) of a particular netrin, netrin-1, is key. Altering levels of this receptor in rodent models results in different physiological and behavioural responses. This study describes how disruptions in brain development may result in increase predispositions to cognitive and behavioural abnormalities in adulthood.
22
D i s c o v e r i e s
Psychosocial Research Division Determining the psychosocial factors of mental illness and mental health will lead to positive strategies for those living with mental disorders, their families and health service providers. Investigators at the Research Centre are actively involved in this field, and below is a list of a few of this year’s milestones. Anne Crocker, PhD, and her team are involved in a unique collaborative study with the Service de police de la Ville de Montréal, which found that approximately 4% of emergency calls where made concerning individuals living with a mental illness and that the duration of police interventions with these individuals is twice that of interventions with other citizens. According to Anne Crocker, this number is conservative and may represent the tip of the iceberg. Although the police have external resource consultants to help during these situations, these may be currently underutilized. The next step for Anne Crocker’s team is to develop strategies to better connect individuals with mental health services. She serves on the Mental Health and the Law Advisory Committee of the Mental Health Commission of Canada and is currently leading a new national study on the services trajectories of individuals declared not criminally responsible on account of mental disorders. She is studying the implementation of the new Montreal Mental Health Court, and is a member of the Table de concertation psychiatrie-justice de Montréal.
Signature of the Memorandum of Understanding with Yale University. Jacques Hendlisz, d.g. Douglas Institute, Myra Piat, researcher, Douglas Institute, Larry Davidson, director, Yale Program for Recovery and Community Health program
and improving models of care for recovery. Pilot training sessions have been held to coach individuals about the steps of recovery and how to climb them. The two initial sessions, held in the spring, were so well received that three more have already been scheduled. Attendees included patients, caregivers, physicians, and family members. New agreement with Yale will promote knowledge exchange
Individuals with mental illnesses usually seek help first from their general practitioners (GPs), who are key to managing their care. Marie-Josée Fleury, PhD, is examining how comfortable and competent these physicians feel when treating this population. Although 25% of visits to GPs are related to mental health disorders, Marie-Josée Fleury’s findings show that many GPs do not have access to consulting mental health experts (psychiatrists, psychologists, etc.). She suggests that services should be coordinated and integrated between these different professionals to provide the best care. She serves on the Committee on Performance Indicators (Montreal-Centre Regional Agency) and the Committee on Primary Care (Commissioner for Health and Welfare).
Empowerment and self-determination are key elements to successfully living with mental illness. Myra Piat, PhD, along with research colleagues from Yale University’s Program for Recovery and Community Health, has started a new project dedicated to developing these qualities. This alliance, which involves sharing expertise, knowledge, resources and funding strategies for a period of five years, is aimed at developing 23
T e a c h i n g s Te a c hi n g a n d T rai n i n g C o o rdi n ati o n Bur e au (T TCB) In October 2007, the TTCB organized, with the Hôpital Louis-H. Lafontaine and the Centre Hospitalier Robert-Giffard, Institut universitaire en santé mentale, the 4e Colloque interétablissements en psychiatrie et en santé mentale. The colloquiums promote learning, reflection, and knowledge transfer in the field of mental health. More than 421 participants gathered in Montréal to address some of the issues regarding mental health and the health care system. A pre-colloquium public debate on mental health and homelessness was held at the Douglas. Renowned Quebec artist, Dan Bigras participated in the debate, along with the director of the Old Brewery Mission, James Hughes, and psychiatrist Pierre Migneault. The debate was moderated by mental health community organizer Jean Gagné.
24
t e a c h i n g s
D o u g l a s Trai n e e s Throughout the year, the Teaching and Training Bureau oversees the coordination of different kinds of training for internal employees or external trainees. In 2007-2008, the Douglas welcomed 264 trainees who came to get practical experience in various disciplines.
P u b l i c e du c ati o n a cti v iti e s Mini-Psych School
12
The Douglas Mental Health University Institute Mini-Psych 2007 program school was a success this year and attracted 240 people for the six consecutive classes held in October and November 2007. For the first time this year, the classes aired on Canal Savoir in a one-hour version last springs. Canal Savoir reaches more than 4 million Canadian homes, including 2.5 million in Quebec. Mini-Psych school classes were also recorded and are still available for watching on the Douglas Web site in their entirety. Web users can also find the classes on YouTube. The 2007 lectures were again given by renowned researchers and clinicians at the Douglas about the following subjects: child psychology, depression, Alzheimer’s disease, eating disorders, schizophrenia and brain function.
61 114 25 12
More info on Mini-Psy School
FRAMES OF MIND
36
NURSING
To celebrate its fifth year of offering movie nights on mental health issues, the Douglas has launched its 2008 Frames of Mind series at the National Film Board in downtown Montréal. The event featured Lyne Charlebois’ Borderline. Following the screening, the author and film cowriter Marie-Sissi Labrèche, together with Douglas expert Mimi Israël, MD, discussed the film and its related issues with the audience. Claude Deschênes, journalist for the Téléjournal at Radio-Canada, hosted the event and acted as moderator for the discussion. This event was filmed and made available on the Douglas Web site.
2 2
SOCIAL SERVICES CONTINUING MEDICAL EDUCATION OCCUPATIONAL THERAPY/SPECIALIZED EDUCATION
The Frames of Mind series provides a perfect opportunity to increase public knowledge and discuss mental health in a non-judgemental environment. This fifth edition took place as Mental Health Week 2008 unfolded from May 5 to May 11. The other movies shown Maryse Chartrand’s were Le voyage d’une vie and Fernand Dansereau’s La brunante
NUTRITION PSYCHOLOGY HUMAN RESOURCES ART THERAPY
25
t e a c h i n g s
Th e D o u g las I n stitute b r i n g s its expe rts c lo s e r to th e community through blogs A new way to educate and dispel taboos - The Douglas has been innovating this year by adopting social media as an educational tool and as a way to promote mental health. A lot of work needs to be done to overcome taboos and to help people who suffer from mental illness. Building on-line communities - By using blogs, social media networks such as YouTube and Flickr-, and RSS feeds, the Douglas encourages knowledge sharing among on-line communities. This initiative gave rise to the Douglas blogosphere, where our experts have committed to two main goals: 1. Educate the public and demystify mental health and 2. Share knowledge about care and research in mental health. Available at www.blog.douglas.qc.ca - The Douglas blogosphere currently has five bloggers who express themselves from the heart, each in his or her own speciality. The content of these blogs includes reflections on art therapy, information on mental health services in and outside of Quebec, as well as the inner workings of psychology, human nature, the brain and behaviour. Douglas’ blog
26
S u p p o r t Vita l s upp o rt The Douglas Mental Health University Institute Foundation, which has been a public foundation since 1972, supports high-priority Institute projects that lack other sources of funding. The Foundation’s small staff of professionals relies on committed volunteers from throughout the community—volunteers who are not fazed by the stigma of mental illness. Michael Novak is an example of one such volunteer: he serves at the Foundation as a Senior Trustee while juggling volunteer responsibilities at other charities, managing a demanding business career, and maintaining an active family life. The belief that organizations like the Douglas Institute are vital to the health and vibrancy of our communities is what motivates our volunteers and donors to support us. As stigma around mental illness wanes, new generations of volunteers are stepping up as advocates and fundraisers for mental health. Through the Productions Vertiges program at 27
the Université du Québec à Montréal (UQAM), students learn to organize events that raise money for charities. A group of these dynamic students contacted us about organizing an event after learning about our mission from the Foundation’s Web site. In March 2008, they put on a casino night that raised proceeds of $2,050. More heartening than the money was the sight of a full house of young people having fun for a great cause, and a stigmatized one at that. It was also a great opportunity for us to answer their questions and dispel myths about mental illness and to talk with a generation that is more open and at ease with mental health issues. Douglas Foundation
Michael Novak
s u p p o rt
The many expressions of true philanthropic spirit This year, the Foundation was pleased to receive several bequests willed to us by members of an older generation whose lives were affected by mental illness. The Foundation is also proud to see a rising trend in generosity towards the Douglas Institute among its employees, health professionals and researchers. The thoughtfulness, courage and caring of many individuals like Maurice Forget, O.C., foundations like the J. Armand Bombardier Foundation, associations and organisations like the Verdun Legion, and companies like Standard Life all reflect the true spirit of philanthropy that has contributed to the Douglas’ development and ever-impressive ability to support and treat, and perhaps offer the hope of a cure, to people with mental illness.
Generosity that bears fruit These many acts of kindness and generosity allowed the Foundation to raise a total of $2,574,593 as the financial year came to a close on March 31,
Details about donations received and this philanthropy-at-work can be found in our Annual Report on Giving 20072008. This publication and our full financial statements are available on the Foundation’s Web site (www.douglasfoundation.qc.ca).
Maurice Forget
2008. Thanks to you all, the Foundation was able to give the Douglas Institute $1,023,468 for research into curing mental illnesses. This research-oriented grant provided funding for 37 of the Institute’s 46 principal investigators. The largest portion of these funds went to research in mood, anxiety and impulsivity disorders, such as depression, sleep disorders, bipolar disorders, and addiction.
Iannicelli Garden
We would like to thank all our volunteers and donors. Together we are changing lives. As you read this annual report, we invite you to consider volunteering for a cause close to your heart or to make a donation. Of course, we hope you will think of the Douglas Institute among the many choices you have. After all … the mind is a precious thing. We recently joined Imagine Canada’s Ethical Fundraising and Financial Accountability Code Program. This code lays out standards for charitable organizations in Canada to manage and report their financial affairs. The Ethical Code Program authorizes the Douglas Mental Health University Institute Foundation to use a trustmark that signals to donors that we comply with the Code’s strict fundraising and financial accountability standards.
The Foundation also gave the Institute $253,028 towards improvements in patient care and facilities, as well as towards education and awareness initiatives to reduce stigma. Grants for patient services included funding from Joseph and Mary Iannicelli and their three young children, who made a donation to create a therapeutic garden for elderly patients who have memory difficulties or suffer from dementia.
www.imaginecanada.ca !
28
Excellence 2 0 0 7 E x c e l LENCE A W A R D S Congratulations to our award-winners, whose innovative spirit, determination and talent have significantly contributed to a culture of excellence.
R OBE RT S A W A R D
NOV A A W A R D
Clinical Excellence
This award is presented in recognition of outstanding patient services.
This award pays tribute to exceptional contributions in the area of quality client care.
CĂŠline Brunelle Clinical Nurse, Memory Clinic, Program for Dementia with Psychiatric Comorbidity
29
Annie Gauthier Administrative Technician, Nursing Directorate
E x c e l l e n c e
I NNOV A CTI ON A W A R D
InnovAction Award
In recognition of exceptional ideas and actions that have resulted in significant improvements for our Institute.
DIRECTOR GENERAL’S AWARD
PRESIDENT’S AWARD Administrative Support Category
Management
Suzanne Gagnon
Ghislain Roy Department Head Payroll, Financial and Informational Resources Directorate
Administrative Technician Eating Disorders Program
Professional Support Category Michel Perreault, PhD Planning, Programming and Research Agent, Clinical, Knowledge Transfer and Teaching Activities Directorate
DOUGLAS CUP Team Performance Moe Levin Centre Team
Technical Support Category Kam Prainsixiengnay Cafeteria Attendant, Food, and Nutrition Services
30
E x c e l l e n c e
O P EN M I N D S P R OF I LES CELEBRATING STIGMA–FIGHTERS Open minds profiles
Open Minds profiles share the stories of outstanding Douglas staff, patients, students, volunteers and other friends who battle stigma associated with mental illness with passion and determination. The following individuals are the most recent profile subjects :
Ellen Corin, PhD, a researcher in the Douglas Research Centre’s Services, Policy, and Population Health Research Theme, has made impressive inroads in helping people live successful lives, despite their mental illness. One of her main goals is to ensure mental health programs focus on “what affected people know they want and need.” Ellen has forged strong ties with patient rights and community groups. In addition, she has played a leadership role in organizing conferences on stigma, and conducted research in numerous countries, including Zaire and India.
Luz Garcia Zielinski, rehabilitation assistant for the Wellington Centre’s Card Workshop from June 2007 to May 2008, spent an amazing year raising awareness of art created by people with mental illness. In February 2008, she helped to organize the exhibit of a client-created sculpture in the halls of Montréal’s Place des Arts. She also teamed up with the selection of Verdun artists, the Verdun Economic Forum, and mental health groups to organize a series of art exhibits by people with mental illness which will continue into 2009.
Janet Komarnicka is a Douglas educator who has devoted thirty years to caring for patients with severe mental illness. In 2005, she helped to found the Low Stimulation Group, where patients who are easily upset by noise and bustle can improve social skills and develop interests. Janet also mentors students and new educators. She and her colleagues take patients to malls, restaurants, bowling alleys, etc. Janet notes, “In addition to raising patients’ self-esteem, these connections reduce the public’s anxiety about mental illness. It’s a powerful way to fight stigma.” 31
Gaëtane Pitre has operated a foster home for people with mental illness in Côte St-Paul since 1985. A feeling of gentle teamwork and mutual respect between her and the people in her care pervades the home. Gaëtane does not tolerate stigma against people with mental illness, “Give me one good reason why these residents shouldn’t be part of our community?” She often reaches into her own wallet to take them to activities they otherwise couldn’t afford. “The more other citizens see residents in the community, the more they realize they’re people, just like you and me.”
E x c e l l e n c e
CELEB R ATI NG TH E NEXT GENE R ATI ON OF SC I EN TI ST S A N D CL I N I C I A NS Encouraging the next generation of scientists and clinicians at the Douglas, through the distribution of awards and bursaries, has been a century-old tradition. Below are a few of this year’s distinguished recipients.
NARSAD’s Young Investigator Award Three Douglas researchers were awarded two-year grants to study psychiatric disorders by the National Alliance for Research on Schizophrenia and Depression (NARSAD), a leading mental health charity organization. The recipients include:
The Fuks fellowship The Fuks Fellowship was established in honour of Dr. Abraham Fuks, dean of the McGill Faculty of Medicine from 1995-2006. As a university institute in mental health, the Douglas shares Dr. Fuks’ vision that improved health care is best developed through the integration of research, teaching and clinical practice. The fellowship also acknowledges the
Johanne Renaud, MD, MSc,FRCPC, who is studying the unmet needs and utilization of services in 85 suicide attempters, all under age 25. Types, frequency and acceptance of the services will be examined.
Tak Pan Wong, PhD, who is examining the effect of stress on long-term depression. His findings may reveal the molecular signals triggered by stress that enhance vulnerability to schizophrenia.
exemplary friendship, dedication and support extended by Dr. Fuks to mental health care and research.The inaugural recipient of the Fuks Fellowship is Daniel Lambrosini, who is pursuing his doctoral studies through the Department of Psychiatry at McGill under the supervision of Douglas Institute investigator Anne Crocker. Mr. Lambrosini’s research project also
involves an active collaboration with members of the Faculty of Law at McGill. Mr. Lambrosini’s research addresses the implementation of a psychiatric advance directive (PAD) program at the Douglas. PADs are legal documents that permit mentally ill individuals to indicate their treatment preferences in advance of a mental health crisis. 32
Sarojini M. Sengupta, PhD, who is examining the association between various factors relating to stress and the environment in pregnant mothers. The development of attention deficit hyperactivity disorder (ADHD) and other disorders in these children will be explored.
I n d i c at o r s
33
INDICA T o RS
A CTI V I T Y I N D I C ATO R S 2007-200 8 general ACTIVITY INDICATORS Number of beds Short-term hospitalizations Long-term hospitalizations Out-patients Visits to Emergency Incidents/accidents Control measures
DOUGLAS institute PERSONNEL Hospital staff Research Centre staff Total Physicians (other than psychiatrists) Psychiatrists* Principal researchers Associate researchers and clinicians Residents, interns and students Nursing personnel Other professionals Other care personnel Other employees
2007 - 2008
2006 - 2007
239
239
1 076 64 9 888 4 123 1 721 12 100
723 97 9 783 4 067 1 668 11 427
2007 - 2008
2006 - 2007
1 153 246 1 399
1 179 246 1 425
18
15
47 49 16 461 331 240 131 451
57 48 17 510 330 245 136 468
2007 - 2008
2006 - 2007
57 505 562
27 493 520
* Including general practioners with privileges in psychiatry
COMPLAINTS AND CLIENT REQUESTS Processed requests Complaints* Requests for information, assistance, intervention, etc. Total * Total complaints received by the examining doctor and the ombudsman
34
INDICA T o RS
A CTI V I T Y I N D I C ATO R S 2007-200 8 EMERGENCY DEPARTMENT ACTIVITY LEVEL OVERVIEW
2007 - 2008
1. Occupancy rate per bed
Deviation
53%
91%
-38%
20.2% 31 4 123
27.8% 39 4 067
-7.6% -8 56
2007 - 2008
2006 - 2007
Deviation
Occupancy rate at Emergency Percentage of stays over 48 hours on a stretcher Average length of stay (hours) Number of annual visits
INTERNAL SERVICES
2006 - 2007
Variation
Variation
TYPE OF CARE 103.0%
106.1%
-2.9%
108.9% 106.2%
108.9% 107.6%
0.0% -1.3%
32.70
53.47
-20.77
Average
397.91 93.30
488.28 158.92
-90.37 -65.03
Short-term Long-term Average
2. Average length of stay (days)
TYPE OF CARE Short-term Long-term
3. Period before readmission Interval
2007-2008
2007-2008
2006-2007
2006-2007
Deviation
00 - 02 months
188
29%
111
23%
6%
03 - 05 months 06 - 11 months 12 - 23 months
76 97 101
12% 15% 16%
53 77 65
11% 16% 13%
1% -1% 3%
24 months and + Total
179 641
28% 100%
180 486
37% 100%
-9%
35
Variation
INDICA T o RS
A CTI V I T Y I N D I C ATO R S 2007-200 8 EXTERNAL SERVICES
2007 - 2008
2006 - 2007
Deviation
0 to 17 years 18 to 64 years 65 years and over Average
111
133
-22
82
85
-3
42 84
56 94
-14 -10
Average duration of external follow-up (days)
354
399
-45
Intensive follow-up (average number of patients) Support of varying intensity (average number of patients)
74
70
4.5
59
60
-0.8
1. Average wait period in days for access to treatment
2. Activities
3. Services in the community
36
Variation
INDICA T o RS
D O U GL A S m e n ta l h e a lth u n i v e r s it y i n stitute
B A L A NCE S H EE T A S o f M A R C H 3 1 , 2 0 0 8
Operating funds
2007 - 2008
2006 - 2007
Cash
$ 3 722 093
$ 2 627 970
Short-term investments
11 579 233
6 750 000
Receivables Prepaid expenses Inventories Interfund receivables Accrued interest receivable
8 891 649 387 385 248 049 115 025
7 433 495 441 898 273 476 0
265 352 25 208 786
223 123 17 749 961
550 402 25 759 188
351 012 18 100 973
Other payables
14 158 045
9 144 629
Interfund debts Revenues received in advance Deferred revenues
0 10 417
331 279 5 936 290
8 298 926 22 467 388
289 144 15 701 342
108 087 22 575 475
90 799 15 792 141
3 183 713 25 759 188
2 308 832 18 100 973
Short-term assets
Total short-term assets Other assets Total assets
Short-term liabilities
Total short-term liabilities Other liabilities Total liabilities Fund balance Total liabilities and fund balance
37
INDICA T o RS
D O U GL A S i n stitute/ H OS P I TA L
State m e nt o f r e v e n u e a n d e x p e n s e s A s o f M ar c h 3 1 , 2 0 0 8
Principal activities
2007 - 2008
2006 - 2007
$ 82 642 370
$ 83 260 968
0 6 732 535 116 224
0 6 594 161 107 688
3 286 784 92 777 913
1 675 315 91 638 132
Revenue Agency and MSSS Other institutions Beneficiaries (In-patients’ contribution) Services rendered Other Total revenue
Expenses Salaries Employee benefits and employer contributions Non-institutional resources
41 044 774
39 449 443
18 210 924 13 777 322
17 089 986 12 937 581
Medication and medical supplies
1 576 324
1 720 582
Food Maintenance supplies, housekeeping and laundry Facilities operations Facilities maintenance and repair Administrative costs Other
876 436 739 434 3 075 924 4 735 397 2 916 452
874 507 638 384 2 741 356 3 176 986 2 424 167
Total expenses
5 074 131 92 027 122
9 354 886 90 407 878
Excess of revenue over expenses
750 791
1 230 254
38
INDICA T o RS
D O U GL A S i n stitute/ R ESE A R C H CENTR E
State m e nt o f r e v e n u e a n d e x p e n s e s A s o f M ar c h 3 1 , 2 0 0 8
INCIDENTAL activities
2007 - 2008
2006 - 2007
Revenue Fonds de la recherche en santé du Québec Research - Other Government grants Donations from the Douglas Institute Foundation Grants from private corporations and others Investment revenues
$
743 437
$
743 437
11 494 597 1 025 471 2 544 832
10 579 411 1 189 296 2 695 754
130 431 15 938 768
76 646 15 284 544
9 474 967
9 028 274
627 665
584 302
Total expenses
5 836 136 15 938 768
5 671 968 15 284 544
Excess of revenue over expenses
-
-
Total revenue
Expenses Salaries and wages Employee benefits Research supplies and other expenses
39
INDICA T o RS
A P P EN D I X 3
I NFO R M ATI ON TO P R OV I D E CONCE R N I NG TH E S A FE D EL I VE RY OF H E A LTH A N D SOC I A L SE R V I CES (2002, c. 71) A N D TH E A P P L I C ATI ON OF TH E H E A LTH A N D SOC I A L SE R V I CES B I LL (L. R. Q. c. S-4. 2) 2007-200 8
Institution Identification Number : Institution Name : Responder’s Name and Title :
1.5 Number of meetings held by the committee during the current budgetary year : 4
1. Quality and Risk Management Committee
13727060
1.1 Adoption by the board of directors of the bylaw that created the committee: yes no
Douglas Mental Health University Institute Pedro Villagran, Continuous Quality Improvement and Risk Management Coordinator
1.6 Committee’s top priorities for the coming year . Hospital smoke-free . Patient safety
1.2 Date of committee’s creation :
11 / 12 / 2006 1.3 Number of members :
14
1.7 Two risk management programs (implementation or evaluation) to be applied in the coming year :
1.4 Members’ function : . Director General, . Coordinator ACQ/GR . Director of Technical Services and Facilities Directorate . 2 patients or patients’ representatives . Director of Nursing . Director of Professional and Hospital Services . 1 Council of Physicians, Dentists and Pharmacists representative (CMDP) . 1 Council of Nurses representative (CIII) . 1 Multidisciplinary Council representative (CM) . Lawyer of the Institute . Quality Intern . Deputy Director General . Head of Clinical Program
40
. Committee analysis of medical errors . Implementation of the suicide risk protocol
INDICA T o RS
2. Divulging all accidents
2.1 Adoption by the board of directors on the following rules : . providing all necessary information following an accident : yes no . support measures including appropriate care: yes no . measures to prevent the recurrence of such an accident : yes no 2.2 If yes, date rule was adopted :
28 / 07 / 2004 2.3 Rules regarding divulging information are respected : never sometimes most of the time difficult to know 2.4 An analysis to evaluate the main causes is immediately conducted after a serious accident never sometimes most of the time difficult to know
2.5 Solutions to avoid recurrence are applied, following an intensive analysis : never sometimes most of the time difficult to know
3.5 Number of declared accidents intensely analyzed : 17 20% 20%
20% 20%
80% 100%
20%
40%
60%
60%
80% 100%
01 / 04 / 2002 3.11 Number of reports transmitted to the Agency on incidents or accidents declared for the current budgetary year : 0
80% 100%
40%
3.10 If yes, the date of implementation :
3.3 Number of declared incidents where measures have been taken to prevent their recurrence : 344 20%
3.9 Implementation of a local incident and accident registry : yes no
3.2 Number of declared incidents analyzed : 344 20%
3.8 Average number of additional days of hospitalization after the declared accidents : 0
3.1 Number of incidents declared for the current budgetary year : 1 722
60%
80% 100%
3.7 Number of accidents resulting in death : 9
3. Declaration of all incidents and accidents and compiling a local register
40%
60%
3.6 Number of declared accidents where measures have been taken to prevent their recurrence : 124
2.6 Training on divulging information has been given to affected people in your organization during the current year : yes no
20%
40%
4. Accreditation Services Provided
3.4 Number of accidents declared for the current budgetary year : 623
41
4.1 Requested accreditation from an institution : yes no 4.2 If yes, name of the requested organization : . Canadian Council on Health Services Accreditation 4.3 If no, the name of organization to be requested : ___________________________ 4.4 Date when this organization will be requested : 01 / 04 / 2008 4.5 Consent obtained : yes no 4.6 If yes, type of consent obtained : . Accreditation in 2005 with report in 2007 4.7 Summary(ies) of report(s) sent : . to the Ministry : yes no . to the Agency : yes no . to professional orders concerned : yes no
Boards, C o m m i tt e e s A n d Et h i c s D O U GL A S I NSTI TU TE BOARD OF DIRECTORS AS OF MARCH 31, 2008 The Officers
The Administrators
Claudette Allard, President
Shari R. Baum
France Desjardins, Vice-President
Samuel Benaroya
Robert Roy, Treasurer
Martha Bishop
Jacques Hendlisz, Secretary
François Bourque David Coleman France Desjardins Marie Giguère André Giroux Jacques Hurtubise Martine Lalinec Michel Lamontagne Sylvain Lamontagne Brenda Laow Danielle Larivière Marcoux Howard Martin Pascale Martineu Deborah Nasheim François Neveu Danielle T. Paiement
42
Johanne Roy
B OARD s , COMMI T T EES AND E T HICS
D O U GL A S I NSTITUT E R ESE A R C H CENTR E BOARD OF DIRECTORS AS OF MARCH 31, 2008 Management Committee Jacques Hendlisz, President Director General Michel Dalton, Director, Financial and Informational Resources Services Amparo Garcia Clinical-administrative Director, Clinical Activities, Knowledge Transfer, and Teaching Directorate Michelle Gilbert Director, Human Resources Mimi Israël, MD, FRCPC Psychiatrist-in-Chief, Medical Director, Clinical Activities, Knowledge Transfer, and Teaching Directorate Jocelyne Lahoud, MGP Administrative Director Research Centre Hélène Racine, MSc, MAP Director, Nursing Director, Quality
Nicole Germain (observer) Assistant to the Director General Jane H. Lalonde (observer) President and Chief Operating Officer Douglas Institute Foundation Stéphanie Lassonde (observer) Communications Officer, Communications and Public Affairs Department
The Officers
The Administrators
François Morin, President
Michel Dalton
Paul Marcotte, Vice-President
Lorella Garofalo, PhD
Robert Roy, Treasurer
Gaston P. Harnois, MD, PhD
Jocelyne Lahoud, MGP, Secretary
Janet Henderson, PhD Jacques Hendlisz Jane H. Lalonde
MULTIDISCIPLINARY COUNCIL
Jocelyne Monty
Bartholomew Crago, President
Judes Poirier, PhD, C.Q. Rémi Quirion, PhD
COUNCIL OF NURSES
Vincent Corbo, Student Representative
Gérard Lebel, President
COUNCIL OF PHYSICIANS, DENTISTS AND PHARMACISTS Jacques Tremblay, MD, President
Ronald Sehn Director, Technical and Facilities Services Jean-Bernard Trudeau, MD Director, Professional and Hospital Services 43
B OARD s , COMMI T T EES AND E T HICS
Management Committee Jocelyne Lahoud, MGP Administrative Director Amparo Garcia, Clinical-administrative Director, Clinical Activities, Knowledge Transfer and Teaching Directorate Natalie Grizenko, MD Medical Chief, Child and Adolescent Psychiatry Mimi Israël, MD Psychiatrist-in-Chief Ridha Joober, MD, PhD Co-director, Schizophrenia and Neurodevelopment Disorders Research Theme
Michael Meaney, PhD Associate Scientific Director Research Centre
Management Committee members and: Mimi Israël, MD, FRCPC Psychiatrist-in-Chief, Douglas Institute
N.P. Vasavan Nair, MD Medical Chief, Dementia with Psychiatric Comorbidity Program
HEALTH AND SAFETY COMMITTEE Giamal Luheshi, PhD Chair
Duncan Pedersen, PhD Associate Scientific Director International Programs Jens Pruessner, PhD Director, Aging and Alzheimer Disease Research Theme Rémi Quirion, PhD Scientific Director
Suzanne King, PhD Director, Psychosocial Research Division
Joseph Rochford, PhD Coordinator, Teaching and Training Bureau
Samarthji Lal, MD Co-director Schizophrenia and Neurodevelopment Disorders Research Theme
Howard Steiger, PhD Chief, Eating Disorders Program
Éric Latimer, PhD Director, Services, Policy and Population Health Research Theme
Jacques Hendlisz, Guest
Martin Lepage, PhD Director, Brain Imaging Group
RECRUITMENT AND PROMOTION COMMITTEE
Ashok Malla, MD Director, Clinical Research Division
Christian Caldji Research Associate
Marc Laporta, MD Assistant to the Director
Doris Dea Research Assistant
Brain Imaging Group
Yvan Dumont Radioprotection Agent
Martin Lepage, PhD Director
Suzanne Gervais Executive Secretary, Research Centre
BRAIN BANK
Ronald Sehn Director, Technical and Facilities Services
44
WORLD HEALtH ORGANIZATION COLLABORATING CENTRE FOR REFERENCE AND TRAINING IN MENTAL HEALTH Gaston Harnois, MD Director
George Schwartz Coordinator, Clinical Research Activities
Stéphanie Lassonde (observer) Communications Officer, Communications and Public Affairs Department
Aude Villemain Research Assistant
Members
Jocelyne Lahoud Administrative Director
Ian Hellstrom, Student Representative
Dara Shahrock Student Representative
Naguib Mechawar, PhD Director Danielle Cécyre Coordinator
B OARD s , COMMI T T EES AND E T HICS
D O U GL A S I NS T IT UT E FO U N D ATI ON BOARD OF TRUSTEES AS OF MARCH 31, 2008 The Executives
Trustees
Marie Giguère, President
Martin Beauchamp
Joseph Iannicelli, Vice-President
Roger Beauchemin Jr.
Michael Novak, Vice-President
geneviève bich
Martin Beauchamp, Treasurer
Bernard Bussières
Jane H. Lalonde, Secretary
Jocelyne Chevrier Normand Coulombe, CA, CFA Peter Daniel Maurice Forget, CM Bruce Kent Daniel Mercier Erik Ryan Marc Sévigny François Touchette Meredith Webster President and Chief Operating Officer Jane H. Lalonde Trustees Mary Campbell Jacques Hendlisz 45
B OARD s , COMMI T T EES AND E T HICS
CO D E OF ETH I CS FO R BO A R D OF D I R ECTO R S 46 Members of the Board of Directors of the Douglas shall: »»
»»
»»
become familiar with the Mission Statement of the Douglas and the purposes, constitution, by-laws and policies of the Hospital, in order to fulfill the tasks associated with their positions with a maximum awareness of the priorities of the Douglas as established by its Board; constantly promote respect for human life and the rights of the population to receive quality health care; actively participate in the work of the Board and its committees, in a spirit of cooperation, in order to plan and implement the general orientations and operations of the Douglas;
»»
attend meetings;
»»
vote on resolutions when required;
»»
act courteously and in good faith in order to maintain the trust and
confidence which their position requires; »»
act with diligence, integrity, honour, dignity, honesty and impartiality in the interests of the Douglas and of the population served;
»»
act vigorously, prudently and independently, with integrity as well as objectivity and moderation;
»»
be loyal and frank towards all other Board members and at no time act in bad faith or dishonestly;
»»
a director independently from the promotion and conduct of any professional or business activities; »»
Rules relating to Conflicts of Interest A member of the Board of Directors of the Douglas shall at all times:
maintain confidentiality with respect to debates, exchanges and discussions which take place in camera.
»»
Specific Duties A member of the Board of Directors of the Douglas shall at all times: »»
act within the limits of the powers conferred upon directors by law;
»»
carry out his or her activities as
when representing the Douglas, faithfully reflect the general plans and objectives of the Hospital and avoid any comment or behaviour likely to discredit or disparage the Hospital or its Board.
46
avoid any situation likely to compromise his or her capacity to carry out his or her functions as a director in an objective, vigorous and independent manner and, in particular, avoid any situation where his or her personal advantage, direct or indirect, present or future, may conflict with the need for independence and the requirement
of acting in the best interests of the Douglas; »»
immediately advise the Board, once upon becoming a director and then, specifically in each case of possible conflict, of his or her direct or indirect interest in any enterprise which is likely to give rise to a conflict between his or her personal interests and those of the Board or of the Douglas or whenever personal, family, social, professional or business relationships or the public expression of an idea or an opinion or any outward showing of hostility or favouritism by the Board member may influence his or her objectivity, judgment or independence; such notice shall be addressed to the Board in writing and delivered to the chairperson or the Director General; an “Interest” may include, but without restriction, an interest in any corporation, partnership or business engaged in, or likely to enter into, agree-
B OARD s , COMMI T T EES AND E T HICS
ments with the Hospital or to provide professional services to the Douglas; »»
whenever a matter is brought before the Board which gives rise to a situation described in paragraph above, abstain from participating in any deliberations or decision on such subject matter and leave the room for the duration of such deliberations;
»»
abstain from conducting any activity incompatible with the exercise of his or her position or duties as a Board member;
»»
refrain from accepting any benefit from a third person when the Board member knows or should know that such benefit is intended to influence a Board decision;
»»
»»
refrain from using his or her position to obtain a personal benefit or a benefit for a third party when he or she knows or it is obvious that such benefit is against the public interest; refrain from making use of confi-
dential information or documents with a view to obtaining, directly or indirectly, a personal benefit for anyone.
»»
For the purpose of the foregoing rules, a conflict of interest will occur whenever the private or personal interests of a Board member are such that, as a result of such private or personal interest, he or she may reasonably be expected or apprehended to prefer one interest over another or that his or her judgment and attitude towards the Board may be thereby affected.
»»
in the case of the Director General, be prohibited from receiving, in addition to his or her official remuneration, any amount of money or direct or indirect benefit from anyone, except in the cases provided for by law;
»»
account to the Douglas for any benefit or advantage contrary to this Code, to the full extent of the advantage or benefit received.
Practices related to Remuneration A member of the Board of Directors of the Douglas shall at all times: »»
refrain from soliciting or accepting or requiring from any person for his or her own benefit, a gift, legacy, recompense, favour, commission, discount, loan or loan discharge or reduction, or other advantage or consideration of a nature to compromise the Board members impartiality, judgment or loyalty;
refrain from paying, offering to pay or undertaking to offer to any person a gift, legacy, recompense, favour, commission, reduction, discount, loan or loan discharge or reduction, or other advantage or consideration of a nature to compromise the impartiality of such person in the carrying out of his or her duties;
Behaviour after leaving the Board After the expiry or termination of his or her mandate, a former Board member shall at all times:
47
»»
maintain the confidentiality of any information, debate, exchange or discussion of any nature whatsoever of which he or she became aware in the exercise of his or her capacity as a Board member;
»»
respect and extend courtesy to the Douglas and its Board.
Sanctions »»
A Board member who is found, upon due inquiry and after having been afforded the opportunity of being heard, to have committed a substantial breach of this Code may be sanctioned by the Board and such sanction may consist of a reprimand, suspension, revocation or removal or any other sanction deemed appropriate, depending on the nature and severity of the breach.
»»
The procedure to be followed shall be the procedure contained in the Board’s By-Law on Governance or, failing which, a procedure adopted by resolution of the Board.
B OARD s , COMMI T T EES AND E T HICS
Publication and use of code »»
»»
The Douglas shall deliver a copy of this Code of Ethics to each director upon election and shall also provide a copy to any other person requesting such copy.
The present by-law must be revised every three (3) years by the Board of Directors.
Each member of the Douglas’ Board shall acknowledge in writing having received a copy of this Code, having read it and undertaking to comply with its terms. The signed originals of such acknowledgments shall be kept with the records of the Board.
This By-Law was enacted by the Board of Directors of the Douglas at its meeting of November 21, 2007 and it came into force on November 21, 2007.
»»
The Douglas shall publish the text of its Code of Ethics applicable to Directors in its Annual Report.
»»
The Annual Report of the Douglas shall include a statement on the number and nature of issues considered as the result of this Code, the number of matters ultimately dealt with and their follow-up as well as their outcome, including any decisions taken, including the number and nature of any sanctions imposed as well as the names of the Board members whose appointments have been suspended or revoked or who have been removed.
DECLARATION OF ACCURACY: CONTENTS OF ANNUAL REPORT
Revision Modalities
The information presented in this annual report is my responsibility. This includes the reliability of the data and related verification measures. The results and information in the Douglas Institute activity report dated March 31, 2008:
Enactment
»» accurately reflect the mission, mandates, values and strategic directions of the institution; »» present the indicators, targets, and results obtained; »» offer precise and reliable data. I declare that the information contained in this annual report and related verification measures is reliable and corresponds to the situation as it existed on March 31, 2008.
Jacques Hendlisz Director general
48