Search

LONDON, ON- Strokes affect approximately 400,000 Canadians each year and can be debilitating. They can negatively affect a person’s cognition and mobility, and severely impact mental health and wellbeing.

 

A team at Lawson Health Research Institute are looking to improve mental health treatments and resources for patients who have experienced a stroke. The team will recruit 100 stroke patients to assess whether the completion of a guided therapy program can improve mental health and quality of life.

“More than sixty per cent of patients experience depression after stroke,” says Dr. Robert Teasell, Lawson Scientist and Physiatrist at St. Joseph’s Health Care London’s Parkwood Institute. “Having a stroke itself makes people more vulnerable and makes people feel their lives have changed negatively.”

During stroke rehabilitation, patients are typically offered mental health treatments, but the research team say it is post rehabilitation that stroke patients tend to experience worsening depression.

“Publicly funded allied health care services are available at inpatient and outpatient care; however, psychology is often limited across the rehabilitation continuum from acute to community care,” says Dr. Swati Mehta, Lawson Scientist. “We are looking at how we can provide a program that is cost effective to help those who have these barriers to access mental health services.”

“Patients have described to me that they feel like they have been dropped off a cliff because of the lack of resources once their programs have ended,” adds Dr. Teasell.

The study will examine the use of cognitive behavioral therapy (CBT), which is an evidence based psychological intervention that aims to provide people with increased coping ability and self-efficacy. Participants will complete a 10-week guided program with specific targeted lessons, tailored to the needs of those post stroke, delivered virtually through a trained clinician. They will then complete a questionnaire to see if there have been any improvements to self-efficacy and emotional wellbeing.

“We have found this form of therapy (CBT) has been very effective and feasible for spinal cord injury patients with mild traumatic brain injury and we want to see how a modified version could potentially help those with stroke and depression,” says Randy Upper, Clinical Research Associate at Lawson.

If CBT is proven effective through this study, Dr. Mehta hopes it will encourage similar programming that would be available to stroke patients after rehab.

“We are hoping we can connect with community organizations and work with them to implement this program in a service delivery model that would be easily accessible for stroke patients living in the community.”

Recruitment for this study is currently underway, those interested in taking part can email Dr. Swati Mehta at: @email

Over 130 hospital-based clinical, administrative and research staff members, persons with lived experience of mental illness, family caregivers, peer and community supporters, and staff from local community mental health agencies attended the 18th Annual Mental Health Research & Innovation Half Day on November 1, 2017. The event provided an opportunity to learn more about mental health research at Parkwood Institute and the Southwest Centre for Forensic Mental Health Care (Southwest Centre), part of the St. Joseph’s Health Care London (St. Joseph’s) family.

“This year’s Mental Health Research and Innovation Half Day was one of the best attended in our history of hosting the event. We had a very diverse and engaged audience with great energy and a lot of enthusiasm,” says Dr. Arlene MacDougall, Director of Research and Innovation for mental health care at St. Joseph’s and Lawson Health Research Institute (Lawson). 

Exciting recent projects were showcased though talks highlighting excellence in recovery and rehabilitation research, the theme of this year’s event; poster presentations; the 13th Annual Tony Cerenzia Research Lecture delivered by Dr. Sean Kidd; and interactive workshop sessions.

Image

“We chose ‘recovery and rehabilitation’ as the theme for the event because it is so important in our clinical care and research programs to have this focus. We need to prioritize the development, implementation and evaluation of practices and interventions that foster recovery of the whole person experiencing mental illness, which includes their psychological, social and other needs that go beyond traditional notions of healthcare,” Dr. MacDougall adds.

13th Annual Tony Cerenzia Research Lecture

Guest speaker Dr. Kidd’s talk – “From clinical trials to the clinic: A story about making Cognitive Adaptation Training for schizophrenia more accessible” – focused on how to implement interventions proven in clinical trials. Dr. Kidd is a clinical psychologist, senior scientist and psychology division chief at the Centre for Addiction and Mental Health (CAMH) in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto. 

Image

Workshop Sessions

Following Dr. Kidd’s lecture, attendees had the opportunity to participate in one of six workshops on a variety of topics related to recovery and rehabilitation focused mental health research:

“Implementing Interventions: A facilitated conversation attending to evidence, strategy, and recovery oriented care”

Led by Dr. Sean Kidd

Participants shared successful strategies for implementing novel approaches to care and discussed the challenges involved. They also looked at ways to leverage technology and education materials. 

“Spirituality in Mental Health Care: Practically Supporting Recovery and Wellness”

Led by Stephen Yeo, Lawson allied scientist and chaplain, Southwest Centre; and Dr. Clark Heard and Jared Scott, Lawson associate scientists and occupational therapists, Southwest Centre

This workshop focused on the practical application of spirituality within the clinical setting, including the use of labyrinths, which contribute to recovery by promoting spiritual self-care, insight development and personal meaning-making reflection.  Attendees had the opportunity to participate in a labyrinth walk and a related spiritual reflection. Read more about the labyrinths at Parkwood Institute and the Southwest Centre or watch the following video featuring highlights from the workshop:

“Indigenous Men’s Health and Wellbeing: Connection with Culture as a Rehabilitation and Recovery Tool”

Led by Bill Hill, social worker, Parkwood Institute and Dr. Vicki Smye, associate professor, director of nursing at Western University

Through the sharing of practitioner experience and Indigenous men’s voices, the workshop focused on understanding the powerful links between connection to culture and mental health and well-being (pictured below). 

Image

“Engaging Service Users and their Families in Research”

Led by Dr. Cheryl Forchuk, The Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery, Lawson; and Deborrah Sherman, executive director, Ontario Peer Development Initiative

Participants in this workshop discussed the benefits of patient and family involvement in mental health research and identified strategies to support patient and family engagement (pictured below). 

Image

“Innovation in Mental Health Care: Moving Ideas to Impact”

Led by Kaitlin Saxton, research and innovation facilitator, Parkwood Institute; and Lisa Bitcola, centre manager of projects and operations, Ivey International Centre for Health Innovation

This workshop focused on how innovation relates to research and quality improvement initiatives within St. Joseph’s Mental Health Care facilities. Participants discussed innovative approaches that could be implemented within their own clinical practice, research and quality improvement initiatives (pictured below).

Image

“My Professional Practice: Where's the Research?”

Led by Amanda Thibeault, director, professional practice, St. Joseph’s

In this session, participants discussed how they can incorporate research into their clinical practice (pictured below).

Image

International Women’s Day, taking place on March 8, 2020, is a day to celebrate the various achievements of women around the world and is a call to action for gender parity. This year’s theme is “Each for Equal” to emphasize that each individual has a significant part in working towards a gender equal world. 

This year, Lawson is highlighting the different paths for women who are working towards a career in the health sciences. Below are the perspectives from students, physicians and researchers on their contributions to science and medicine. 

Image

High school student, Nimrit Aulakh, is completing her co-op placement with Lawson Scientist, Dr. Cheryl Forchuk. Her research focuses on improving mental health care for youth.  

“Science has always been of interest to me and has now become significant within my academic endeavours. Part of my desire to become involved in the sciences stemmed from my older sister, who exposed me initially to the research side of science. It is with the help of rationale and logic in science that I can enrich my academic experience. Specifically, I have been working as a co-op student alongside the Mental Health Nursing Research Alliance and learning what it means to be a researcher. During my time, I conducted preliminary analyses on one of their studies, which focuses on improving mental health care for youth through virtual models of care. I will be presenting my findings at the Thames Valley Science and Engineering Fair later this month and if successful, will advance to the Canada Wide Science Fair. This experience has shown me a new side of science, one that I hope that I can continue to be a part of. I realized that through science and research, I can contribute to advancing society. To continue my journey through post-secondary education, I have applied to get my Bachelor’s in Health Sciences. Both within and beyond my four years of undergraduate studies, I hope to continue my contributions in serving the public through scientific research, as well as create an image for girls with the same interests as me, everywhere.” 

Image

Romaisa Pervez is a Research Assistant working with Lawson Scientist, Dr. Arlene MacDougall. She recently completed her Master of Science in Epidemiology and Biostatistics at Western University. 

“I’m the student lead on a project that’s titled “Building a Sustainable Model and Evaluation for Psychological Rehabilitation in Kenya: An Implementation Study.” I’m working with the CREATE (Community Recovery Achieved Through Entrepreneurism) Kenya team to conduct a study to improve how we deliver, evaluate, and train persons with lived experience or community members to facilitate the Psychosocial Rehabilitation (PSR) Toolkit so it can be locally sustained in Kenya. I’ve travelled to Kenya twice during my Master’s to build relationships with stakeholders and conduct focus groups/interviews. My passion lies in understanding how we can implement upstream initiatives for mental health that are both sustainable and effective. Furthermore, I want to explore how we can find leverage points within the current mental health system in low to middle income countries and create innovative solutions. In the near future, I want to pursue medicine and further my knowledge and build stronger skills in this field.” 

Image

Dr. Kelly Anderson is an Associate Scientist at Children’s Health Research Institute, a program of Lawson. She is also Assistant Professor in the Department of Epidemiology & Biostatistics at the Schulich School of Medicine & Dentistry, Western University.

“I lead a research program in public mental health research, with a primary focus on young people experiencing a first onset of psychotic disorder. Together with my team, we are investigating the distribution and risk factors for psychotic disorders, prevention in early psychosis, and access to care and utilization of services in first-episode psychosis. My research program is centered around mentorship and training of students from all levels, and I work with trainees to foster high-level skills in the design and analysis of epidemiologic studies using large complex datasets. I am committed to fostering a culture of equity, diversity, and inclusion within my research team, and I advocate strongly for gender and early career representation for awards, scientific symposia, and other career opportunities. As a female scientist, I regularly mentor young women, both formally and informally, and due to the focus of my research, I also regularly work with trainees with lived experience of mental disorders. The diverse experiences and perspectives of these students both inspire and inform our work together.”

Image

Dr. Michelle Barton-Forbes is an Associate Scientist at Lawson and a Physician at London Health Sciences Centre (LHSC) specializing in paediatric infectious diseases. She is also an Assistant Professor at the Schulich School of Medicine & Dentistry, Western University.

“My research program is focused on the clinical epidemiology of infectious diseases in children, particularly in vulnerable paediatric populations such as neonates and young infants. A secondary area of interest is in bacterial resistance and antimicrobial stewardship. Through engagement in multicentre research and contribution to national guideline development, I am able to make a difference in the management and prevention of common childhood infections nationally.  The combination of intense passion for my subspecialty, inquisitive curiosity and a drive to better understand common childhood illnesses is infectious to my students. I motivate my students to excellence by inspiring them to believe in themselves and their ability to make a difference. My students are encouraged and challenged to find answers to unanswered questions and unexplained trends through research. As a proud Canadian and an immigrant from a nation that prides itself in its diversity, I believe that diversity is our strength. The Jamaican national motto “out of many one people” has framed my worldview and has influenced my practice.”

Image

Dr. Eileen Crowley is a Scientist at Lawson and a Pediatric Gastroenterologist at LHSC. She is also an Assistant Professor at the Schulich School of Medicine & Dentistry, Western University. 

“My research interests include pediatric inflammatory bowel disease (IBD), the genetics of IBD, big datasets, therapeutic drug monitoring clinical trial endpoints and precision medicine. My work has served to be better delineate the genetic phenotype of children with IBD as well as optimizing response to therapy in this age group. I engage students and motivate them to work with enthusiasm! My aim is to create learning opportunities that are active, collaborative and promote learning relationships. Once I have identified a student’s goal, it is easier to share and attain that goal. Within the research setting, I aim to maintain an environment where every student feels accepted, valued and safe. Sharing of ideas creates opportunities whilst also fostering a sense of personal belonging and achievement.”

To learn more about International Women’s Day, visit https://www.internationalwomensday.com/. 

Dr. Rahel Eynan is a researcher with Lawson Health Research Institute who has dedicated her life to studying the nature of suicide and those affected. 

She is the lead author on a study recently published in Suicide and Life-Threatening Behavior by The American Association of Suicidology. A first of its kind in the world, this study retrospectively compared the psychosocial and clinical characteristics of people who have died by suicide and left an E-note with those who left a paper note, or no note at all. 

“Suicide notes are intimate last communications left by suicide decedents to their loved ones, friends or foes,” explains Dr. Eynan. Only a minority of suicide decedents leave a suicide note, which is defined as a message expressed by a person who intends to end their life. 

Typically, the notes are handwritten on paper, walls, body parts or mirrors. However, electronic suicide notes have been reported with increasing frequency including communication through email, text messages, tweets, blogs, video sharing websites, chat rooms and posts on social media networks. 

This emerging phenomenon remains generally under-researched. 

“The notes play an important role in forensic investigations and have evidentiary value in the courtroom. They are also considered integral to understanding suicidal behaviour as they provide a unique opportunity to examine an unsolicited account of the person’s thoughts and emotions prior to the self-destructive act,” says Dr. Eynan. 

This study was embedded in the Southwestern Ontario Suicide Study (SOSS) and was conducted  in collaboration with the Office of the Chief Coroner and Ontario Forensic Pathology Services and the London regional coroner office. The researchers collected data for 476 deaths by suicide that occurred between January 2012 and December 2014. Socio-demographic, psychosocial and clinical characteristics were collected with a modified version of the Manchester questionnaire used in the UK. 

“Note leaving does not appear to be a random phenomenon among suicide decedents. There are common characteristics between those that do offer a final communication and in what form,” states Dr. Eynan.

They found that final communication was left by 45.8 per cent of the individuals and of those almost 75 per cent left notes that were handwritten or typed. Electronic notes were left by 17.9 per cent, usually in the form of text messages, and 7.8 per cent left a combination of paper and electronic notes, as some people left more than one. Some notes contain a just a single word while others were several pages in length. 

The average age of suicide decedents is 47.2 years old and the majority are men. Death by suicide often happens after a major life transition, including those involving finances, business and employment or the dissolution of a marriage or relationship. In some cases, it is associated with a mental illness. 

Those who did not leave a note were more likely to have had a diagnosed mental disorder; histories of self-harm; other physical illnesses; previous admissions to hospital or mental health services; and, been assessed for suicide behavior 3 months prior to their death.

People who left a note were significantly younger in age; more likely to be divorced or separated; less likely to be living with a partner; and, less likely to have been retired. 

“Suicide decedents with fewer than two admissions to a mental health unit, including those with no history at all, were three times more likely to have left a suicide note,” explains Dr. Eynan. “Two-thirds of these people however did have contact with a primary health care provider in the month prior to their deaths. Interestingly, most were for routine and non-urgent reasons.”

Suicide notes are written for several purposes. It can be an opportunity to put affairs in order, justify or explain their suicidal action, or reduce the emotional burden of those left behind. 

It can be theorized that people without a diagnosis of mental illness and fewer health care admissions may be more compelled to complete their suicide narrative and explain their motives. On the other hand, those who did not leave notes may have felt that their long-standing struggles with mental illness were well known to family and friends. 

The findings point to a subgroup of younger suicide people who have less contact with mental health services, have no mental illness and yet are at risk of suicide. 

“This tells us that we can be more proactive in assessing for suicidal behaviours at each interaction of help-seeking and health care.” For example, routinely giving screening questions at every appointment which assess mood and other indicators. “It could be something like a paper form or tablet in the waiting room, reducing the stigma and more easily opening up the conversation,” adds Dr. Eynan. 

The general public should also be educated to take any communication by any means of suicide risk or intent as serious.

The shifting methods of communicating final good-byes that make use of newer forms of technologies could provide a window of opportunity for intervention. Social media sites and app developers could partner with researchers to develop innovative protocols and mechanisms that identify users at risk and intervene by sending the user links to crisis services or directly connecting them to an appropriate service.

Dr. Eynan is often reminded of the quote ‘whoever saves a life, saves an entire world.’ She takes the utmost care to treat each person’s story with dignity and respect. 

“There was a lot of suffering shared in the notes, but the most prevalent messages were expressions of love.”  

While this kind of research can be difficult, it gives her a lot of hope. 

If you need help:

Canadian Mental Health Association’s Reach Out program is a 24-7 telephone hotline and internet service for individuals experiencing mental health concerns, addictions or crisis.

Reach Out can be contacted at 519-433-2023, toll free at 1-866-933-2023 or online at www.reachout247.ca.