Projects
CAMH Ethics Framework Revision Project
Clinical ethics frameworks are used in healthcare settings to help patients, families and healthcare teams think through ethically challenging situations. Additionally, having an ethics framework is required by Accreditation Canada. The CAMH ethics framework has not been updated since 2018. In this project we are seeking to address a gap in the clinical ethics literature where there is an absence of empirical evidence on the evaluation, efficacy and application of clinical ethics frameworks, particularly in psychiatric contexts. To revise the framework and integrate the experience of key interest-holders (staff, patients, family members) we are conducting a quality improvement project to evaluate the framework and revise it based on our evaluation for implementation in the psychiatric clinical setting.
Palliating Mental Illnesses: Developing Innovative Approaches in Mental Health Care
Palliative care for mental illness – also known as palliative psychiatry – is an approach centered on the quality of life (QoL) and suffering concerns of patients and their families in situations of treatment-resistant severe and persistent mental illness (TR-SPMI). Despite the growing acceptance among clinicians toward palliative approaches to psychiatry, that ongoing ‘aggressive’ psychiatric interventions may not provide all patients with meaningful clinical or psychosocial benefits, or are consistent with patients’ values, clinical models related to palliative care for mental illness are scarce. This project will develop practice guidance for providing palliative care for mental illness by 1) exploring the attitudes of key affected groups towards the ethical and clinical acceptability of palliating mental illness for people experiencing TR-SPMI; 2) building expert consensus surrounding the goals, clinical approaches, and access criteria for palliating mental illness for people experiencing TR-SPMI; and 3) creating a clinical practice guideline for the application of palliative approaches to TR- SPMI.
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.
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.
- A Community of Practice for Palliative Psychiatry (CIHR Planning and Dissemination Grant, Co-PI: S Levitt, L Costa, 2022-2024)
- Understanding Attitudes and Beliefs toward the COVID-19 Vaccines among Youth with Mental Illness (CIHR Emerging COVID-19 Research Gaps & Priorities, Co-PI: S Sockalingam, 2021-2024)
- Building Fair Machine Learning Models: Using Big Data to Explore Inequities in Risk Assessment at the Centre for Addiction and Mental Health (Dalla Lana School of Public Health Interdisciplinary Research Cluster Data Seed Funding, Co-PI: S Hill; Project Leads: L Sikstrom and M Maslej, 2021-2023)
- 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)