A Community of Practice for Palliative Psychiatry
Palliative psychiatry is an approach centered on the quality-of-life concerns of patients and their families in circumstances of severe and persistent mental illness (SPMI) where there is a likelihood of significant morbidity or mortality. Despite growing recognition among clinicians and scholars that some cases of SPMI can be considered terminal illnesses, and that ongoing ‘aggressive’ mental health interventions may not provide all patients with meaningful clinical benefits, clinical models related to palliative psychiatry are scarce. High quality palliative care has been associated with improvement in both quantity and quality of life, yet unlike individuals diagnosed with physical illnesses, people who experience SPMI are typically offered curative approaches to treatment with limited discussion of alternative models of care.
Stigma and the Brain Disease Model of Chronic Pain: An Empirical Bioethics Investigation
Chronic pain is highly stigmatized. People living with chronic pain frequently experience doubt, skepticism, and distrust about their experiences, resulting in poor health outcomes. These harms arise largely because pain is an invisible and subjective experience. There is no clinical test that can confirm objectively that someone is experiencing chronic pain. Some neuroscientists and clinicians suggest that advances in the brain imaging of pain demonstrates that chronic pain is a brain disease. Some researchers argue that brain disease explanations of conditions such as addiction will eliminate the stigma associated with them and improve access to treatment. However, research suggests that brain disease explanations of addiction may unintentionally increase stigma and social distance. With chronic pain neuroscience following a similar trajectory, it is unknown whether brain disease explanations of chronic pain will reduce stigma.
Understanding Attitudes and Beliefs toward the COVID-19 Vaccines Among Youth with Mental Illness
People living with mental illness (MI) have increased risk of contracting, and dying from, COVID-19 compared to the general population. Possible explanations include behavioural and structural factors (e.g., living in congregate settings). While COVID-19 vaccine uptake rates for people with mental illness is lacking, influenza vaccination uptake is generally lower than the general Canadian population. COVID-19 vaccines are safe and effective, yet studies show that 11% to 18% of Canadians are hesitant. Black Canadians, Indigenous peoples, newcomers, and youth tend to have higher vaccine hesitancy and are more likely to experience social and structural barriers to accessing vaccinations. Youth between the ages of 16 and 29 are particularly vaccine-hesitant, with some of the lowest vaccination rates in Canada to date. Therefore, youth with MI may require more tailored interventions to increase uptake of COVID-19 vaccines.
Building Fair Machine Learning Models: Using Big Data to Explore Inequities in Risk Assessment at the Centre for Addiction and Mental Health (CAMH)
Big Data and advances in machine learning (ML) provide opportunities to improve risk assessments in mental health. Risk assessments can help manage uncertainty and account for past misfortunes. While few ML-based risk assessment tools are currently in use, it is easy to anticipate a future where such tools are used to help predict risk of inpatient violence, suicide, or psychiatric readmission. However, there is growing concern that ML tools amplify existing inequities, such as racial bias, often because they are trained on biased datasets. Few studies examine how risk assessments in mental health intersect with racism and other determinants of health, such as class, housing, and immigration status. Also, we know little about the experience of risk assessments from the patient’s perspective. Serious questions remain about how to account for biases and build fair models.
Toward Harm Reduction in Hospitals: A Qualitative Case Study of a Large Academic Health Sciences Centre
Harm reduction is a philosophy and set of strategies that aims to minimize the harms associated with substance use in people who are unwilling or unable to stop. There is a strong evidence base for harm reduction interventions in community settings, but there has been minimal uptake of these strategies in acute care facilities. This is concerning because people who use drugs (PWUD) have high rates of hospitalizations. Research suggests that PWUD report that their care needs and preferences are typically not met or respected while in hospital, and factors including restrictive hospital policies, stigma from healthcare professionals, and denial of pain medication contribute to a variety of health and social harms in this population. Despite calls for more integration of harm reduction into acute care, there has been minimal research that explores the perspectives of hospital-based healthcare providers on the potential role of harm reduction in hospital settings.
- Big Cannabis-Healthcare Relationships: Understanding the Commercial Determinants of Mental Health (CIHR/MHCC Catalyst Grant: Cannabis and Mental Health, Co-PI: Q Grundy, 2021-2022).
- The Seductive Allure of AI: Implications for Stigma and Compassion in Mental Health and Addiction (AMS Fellowship in Compassion and Artificial Intelligence, 2020-2021)
- Palliative Care for People who use Substances During Communicable Disease Epidemics and Pandemics: A Scoping Review (CIHR COVID-19 Rapid Research Funding Opportunity in Mental Health and Substance Use, Co-PI: J Lau, 2020-2021)
- The Ethics of Pain Research, Management, and Policy: A Planning and Knowledge Exchange Meeting (CIHR Planning and Dissemination Grant—Institute/Initiative Community Support, Co-PI: KD Davis, 2018-2019)
- Ethical and Policy Implications Related to Food Addiction in Obesity: A Planning and Knowledge Exchange Initiative to Develop a Research Network (CIHR Planning and Dissemination Grant—Institute Community Support, Co-PIs: S Sockalingam, S Cassin, 2017-2018)