Programme

There is anecdotal evidence that access to mental health services is challenging for individuals with mental health needs. There is more recent and emerging evidence based on population-based data that the anecdotal experience is true. Access to psychiatrists, in particular, has been shown to be an issue for individuals with need for specialty mental health care, and is complicated by a relationship between regional per capita psychiatrist supply and the ways psychiatrists practice based on region of practice. There are proven models of service delivery (collaborative care/integrated care) that improve access for individuals who need mental health services.

Learning Objectives

• To understand the importance of performance measurement to address issues related to health service quality.
• To learn about recent research describing access to mental health care amongst certain patient populations.
• To learn about emerging evidence describing different mental health service delivery models.

About the Speaker

Dr. Paul Kurdyak is Medical Director of Performance Improvement at the Centre for Addiction and Mental Health and Core Senior Scientist and Lead of the Mental Health and Addiction Program at the Institute for Clinical Evaluative Sciences. He is an Associate Professor in the Department of Psychiatry and Institute for Health Policy, Management and Evaluation at the University of Toronto. He is an Advisor to the Ministry of Health and Long-term Care and Health Quality Ontario on mental health system performance evaluation.

Over the past two decades, findings of clinical efficacy and neural changes associated with psychological interventions, have enabled psychotherapy to achieve an apex of credibility in both professional and public spheres. This presentation will consider psychotherapy's ongoing evolution, especially in light of 4 trends that could impact or determine its future configuration; reduced distinctiveness of psychotherapy modalities, the greater need for public health significance, the creeping dilution of expertise in knowledge based professions and the lack of pharmacological solutions for addressing the chronicity of many psychiatric disorders. It may be that the face of psychotherapy as it was known at the turn of the 20th century and as it continues to be delivered today may be altered in response to competitive and disruptive pressures. Could it be that business and utilization models such as UBER and WealthSimple expand to include how patients access therapy services? Will online platforms supplant dyadic, office based treatment? These are questions that will be actively considered. And yet, as important as they are, it is equally important that those aspects of the human condition that are uniquely suited to healing within the frame erected by psychotherapeutic treatment be recognized, amplified and integrated into an increasingly non-hierarchical and DIY (do it yourself) social/commercial ecosystem.

Learning Objectives

• Review four influential empirical studies of psychotherapy's clinical outcomes and neural changes associated with treatment response.
• Analyze the models by which disruptive technologies can flatten hierarchical relationships within knowledge based professional service.
• Identify elements of psychotherapy that can reduce recovery and sustain long term remission in depressive and anxiety disorders.

About the Speaker

Zindel Segal, PhD, is Distinguished Professor of Psychology in Mood Disorders at the University of Toronto – Scarborough and a Senior Scientist in the Campbell Family Mental Health Research Institute at the Centre for Addiction and Mental Health. Dr. Segal has pioneered the use of mindfulness meditation for promoting wellness in the area of mood disorders. He is the recipient of several awards, including the Douglas Utting Research Prize and the Mood Disorder Association of Ontario's Hope Award and has been continuously funded by the National Institute of Mental Health and the Canadian Institutes of Health Research for the past 15 years. His program of research has helped to characterize psychological markers of relapse vulnerability in affective disorder, especially the link between affective and self-devaluation components of dysphoria. This work has in turn provided an empirical rationale for offering training in mindfulness meditation to recurrently depressed patients in recovery. An author of over 10 books and 130 scientific publications, including The Mindful Way Through Depression – a patient guide for achieving mood balance in everyday life – Dr. Segal continues to advocate for the relevance of mindfulness-based clinical care in psychiatry and mental health.

Each year, thousands of migrants, including hundreds of children, are held in immigration detention across Canada. These are people who are detained in prison like environments not because of any criminal charge, but rather for administrative reasons, such as not having identity documents, or being deemed a flight risk. Many detainees have fled war and conflict, and arrive already traumatized. Others develop mental illness while detained. The mental health impacts of immigration detention include elevated rates of PTSD and Depression symptoms in both adults and children. Further, detainees who present with suicidal ideation or severe mental illness are often transferred to maximum security jails. Following years of community advocacy, in late 2014 a group of physicians and lawyers joined together to launch an advocacy effort aimed to challenge immigration detention. This group has completed several advocacy projects, including launching a public letter condemning the transfer of detainees to jail, as well as calling for an end to the immigration detention of children. Participants will have an opportunity to learn about the immigration and refugee determination system, and to understand the mental health impacts of detention on both children and adults. Using the work around immigration detention as a case study, this practical and interactive workshop will also provide an opportunity for participants to learn a variety of advocacy skills, from coalition building to letter writing. The workshop will involve presentations by leading advocates in the network, including lawyers, and provide opportunity for discussion.

Learning Objectives

• At the end of this session, participants will understand the impacts of poverty and health.
• At the end of this session, participants will be able to do practical interventions that can increase their patient's access to financial entitlements.

Somatizing and somatoform disorders commonly occur in all branches of medicine. Some studies have shown that 10-30% of patients with somatic complaints who present to the doctor have no adequate physical cause to account for them. In this workshop we define somatizing and discuss an overview of somatic symptom disorders using DSM-V criteria. We distinguish between conscious and unconscious processes involved in these categories. We discuss effective ways to make the "mind-body link" for patients in ways that are seen as collaborative and that engender alliance and co-operation on the part of those patients. We discuss the different presentations of somatizing, which include medically unexplained symptoms (MUS), distorted belief system about the body and its functioning, and comorbidity between somatizing and other primary psychiatric illnesses. We focus on treatment modalities, both psychopharmacologic and psychotherapeutic that are felt to be useful in the clinical situation. We will also discuss some of our problems with the DSM-V classifications which we feel collude with the stigmatization of psychiatric issues in medicine. The last part of the workshop will be opened up to the participants to discuss relevant cases and to ask any further questions.

Learning Objectives

• Appreciate the range of DSM-V diagnoses that make up the "somatic symptom and related disorders".
• Understand some of the problems in the DSM-V classification that were not present in DSM-IV, which are seen as possibly perpetuating psychiatric stigmatization.
• Be aware of treatment modalities for these disorders both psychopharmacologic and psychotherapeutic.

One of the best-known personalities in Canadian broadcasting, Landsberg has been with TSN since the network’s inception in 1984. He hosted Off the Record from its debut in September 1997. Twice nominated for the Gemini Award for Best Host or Interviewer in a Sports Program or Sportscast, Landsberg was the Whistler Host for Olympic Daytime on CTV during the Vancouver 2010 Olympic Winter Games. During the London 2012 Olympic Games, he anchored TSN’s Olympic Daytime.

Landsberg speaks publicly about his personal battle with depression and considers his ability to help reduce the stigma of mental illness as his most important professional calling. He has been an ambassador for Bell Let’s Talk, an initiative focused on raising awareness and encouraging dialogue about mental health, since it launched in 2011.

In 2013, Landsberg’s documentary, Darkness and Hope: Depression, Sports and Me, was nominated for a 2013 Canadian Screen Award for Best History or Biography Documentary Program or Series. In 2012, the Canadian Alliance on Mental Illness and Mental Health also named Landsberg one of its Champions of Mental Health. Landsberg also takes to Twitter, using the hashtag #sicknotweak to encourage discussion around mental health and create a forum for those needing help. For his longstanding dedication to promoting mental health awareness, Landsberg was honoured with the Humanitarian Award at the 2015 Canadian Screen Awards.

About the Speaker

One of the best-known personalities in Canadian broadcasting, Landsberg has been with TSN since the network’s inception in 1984. He hosted Off the Record from its debut in September 1997. Twice nominated for the Gemini Award for Best Host or Interviewer in a Sports Program or Sportscast, Landsberg was the Whistler Host for Olympic Daytime on CTV during the Vancouver 2010 Olympic Winter Games. During the London 2012 Olympic Games, he anchored TSN’s Olympic Daytime.

Landsberg speaks publicly about his personal battle with depression and considers his ability to help reduce the stigma of mental illness as his most important professional calling. He has been an ambassador for Bell Let’s Talk, an initiative focused on raising awareness and encouraging dialogue about mental health, since it launched in 2011.

This presentation will focus on opioid therapy for pain control. Approximately 30 percent of Canadians are struggling with chronic pain. From a medication management perspective opioids are still used as the primary analgesic for this patient population. However, this has resulted in serious consequences. Addiction rates have increased dramatically in the past 20 years and death from opioids has increased as well. Patients who die from opioid use have seen a physician within 11 days of their death. More important, the evidence that opioids reduce chronic pain and increase function is not robust. In this session Dr. Ennis will review the data surrounding the clinical use of opioids for pain control in chronic pain patients. He will discuss the pitfalls of such treatment and outline an approach should opioids be used. Finally, he will review treatment alternatives and the evidence supporting their use.

Learning Objectives

• By the end of this session participants will understand the differences between acute and chronic pain. The mechanism of action of opioids will be reviewed with an effort to understand why they are not as effective in chronic pain as they are in acute pain.
• Participants will gain an understanding of the pitfalls of prescribing opioids and how to handle typical problems facing clinicians treating patients with opioid therapy.
• Participants will learn about alternatives to opioid therapy and the evidence supporting their use.

About the Speaker

Dr. Ennis is an assistant professor of Psychiatry at McMaster University Medical Centre, with cross appointments in psychiatry and rehabilitation medicine. He received his masters in social work at the University of Toronto. After a number of years as the clinical director of a tertiary level children’s care facility he completed his studies in Medicine at McMaster University. During his final year of undergraduate medicine he was diagnosed with Guillain-Barre Syndrome. After a period of recovery and rehabilitation he went on to do a residency in Psychiatry with two years of additional training in the management of chronic non-cancer pain. Throughout this time he has required joint stabilizing surgery due to a history of Ehler-Danlos Syndrome. To date he has had 16 surgeries in all, with 6 to his back only. Dr. Ennis went on to have multiple relapses of what was thought to be Guillain-Barre Syndrome resulting in demyelination. The current working diagnosis is Chronic Ideopathic Demyelinating Polyradiculopathy (CNCP). 

In spite of these health related problems Dr. Ennis went on to become the co-director of the Chedoke Pain Program in the early 1990's. He made significant changes to the program's structure. Ultimately he went on to develop a unique pain management program in association with St. Joseph’s Hospital Centre for Ambulatory Care Services. In 2009 the program became independent of the hospital. The Ennis Centre for Pain Management utilizes tenants of cognitive behavioural therapy in helping patients mobilize in spite of the pain they experience. This program has been designed to provide treatment to patients with a wide range of function, from those who are still working and those who are profoundly disabled. Recent outcome research has demonstrated a positive impact of the treatment program on participants’ mood, self-perception of disability and level of function. Dr. Ennis’ work on the management of chronic pain has been presented on radio, the printed media, national television and in journal articles. In conjunction with Barlow Publishing, his book on Hypnotherapy for Pain Control, titled From the Outside-In, will be available within the year. Finally, he and his wife Gilda have created six endowment funds, in the area of Chronic Pain Management and Breast Cancer Research. These funds have been made available to residents in Toronto, Hamilton and British Columbia.

Each year, thousands of migrants, including hundreds of children, are held in immigration detention across Canada. These are people who are detained in prison like environments not because of any criminal charge, but rather for administrative reasons, such as not having identity documents, or being deemed a flight risk. Many detainees have fled war and conflict, and arrive already traumatized. Others develop mental illness while detained. The mental health impacts of immigration detention include elevated rates of PTSD and Depression symptoms in both adults and children. Further, detainees who present with suicidal ideation or severe mental illness are often transferred to maximum security jails. Following years of community advocacy, in late 2014 a group of physicians and lawyers joined together to launch an advocacy effort aimed to challenge immigration detention. This group has completed several advocacy projects, including launching a public letter condemning the transfer of detainees to jail, as well as calling for an end to the immigration detention of children. Participants will have an opportunity to learn about the immigration and refugee determination system, and to understand the mental health impacts of detention on both children and adults. Using the work around immigration detention as a case study, this practical and interactive workshop will also provide an opportunity for participants to learn a variety of advocacy skills, from coalition building to letter writing. The workshop will involve presentations by leading advocates in the network, including lawyers, and provide opportunity for discussion.

Learning Objectives

• At the end of this session, participants will understand the immigration and refugee determination system, and the mental health impacts of immigration detention.
• At the end of this session, participants will understand the advocacy work that a medico-legal partnership can accomplish, and build skills in advocacy.

Mental illness stigma can have negative consequences. Despite advances in eradication efforts, there are limits to stigma reduction strategies. Groundbreaking approaches in unconscious bias education have the potential to address these limitations and improve care for patients with mental illness. Unconscious bias education is an innovative area of pedagogy that emphasizes the power of unconscious biases and hidden beliefs that underlie stigma-related behaviour in individuals and organizations. The session will be primarily interactive and will include a description of a framework to educate learners about stigma through the concept of implicit stigma and unconscious bias. Smaller groups will be divided and participants will work in teams to consider a specific ingredient of the framework and design a mini-intervention and appropriate evaluation strategies. Groups will be asked to describe their intervention. At the conclusion of the session, a facilitated discussion will help consolidate knowledge and review key concepts.

Learning Objectives

• Describe a framework derived from existing educational research to incorporate unconscious bias into stigma reduction education
• Practice stigma reduction instructional design having participants create a mock educational intervention and discuss with colleagues
• Review strategies to reduce stigma and benefits and limitations of each.

The past year has been a turbulent one for physicians practising in Ontario. There is no current Physicians Services Agreement between doctors and government. Government has been decision making and implementing change to the health care system unilaterally, with no formal input from physicians. As a result, physicians are frustrated, anxious about their place in health care decision making and concerned about implications to their professional lives.

Workshop participants will have an opportunity to hear updates about key areas of change that have implications for psychiatric practice in Ontario. Dr. Hastings will present an overview of recent changes to the mental health act, and a proposed upcoming review of Community Treatment Orders. Dr. Chaimowitz will provide perspective on the challenges that the Ontario Medical Association have experienced in the last year both in terms of their relationship with the Ministry as well as their own membership. Dr. Freeland will provide an overview of implications of introducing mental health quality standards in Ontario, as well as key highlights of the Patients First Act (Bill 41) and Protecting Patients Act (Bill 87). Patrick Nelson will share an update on the government relations work being undertaken by the Coalition. Finally, participants will have an opportunity to share perspectives, ask questions and raise issues for the Coalition to consider

Learning Objectives

• At the end of this session the participants will be able to appreciate the current tensions between government and organized medicine in Ontario.
• At the end of this session the participants will be able to understand recent and potential upcoming changes to the Mental Health Act.
• At the end of this session the participants will be able to describe recent legislative changes impacting patient care in Ontario.

Physician Assisted Death (PAD) or Medical Assistance in Dying (MAiD) has been legalized or decriminalized in over a dozen jurisdictions around the world.  Following the landmark Carter v Canada ruling in 2015, Canada developed and implemented new policies on MAiD which continue to evolve.  Federal MAiD legislation introduced in 2016 calls for further study when mental illness is the sole criterion.  While the presence of mental illness does not preclude MAiD, the current legislation essentially does not allow for MAiD on the grounds of sole criterion mental illness alone.

This session will review shifting public, societal and medical concepts regarding assisted dying and the right to die, with a focus on challenges and issues relevant to mental health and mental illness.  Canadian and international experience will be discussed, including work of the Canadian Psychiatric Association Task Force on Medical Assistance in Dying and the World Psychiatric Association Round Table on Assisted Dying.

Learning Objectives

• Understand the context of the Carter decision ruling and its impact on Physician Assisted Death (PAD)/Medical Assistance in Dying (MAiD) policy in Canada.
• Appreciate issues that must be taken into account when considering key terms in the MAiD framework, like irremediable, intolerable and enduring suffering, and capacity.
• Appreciate challenges posed by mental illness in the context of assisted dying.

In Ontario's furthest corner, the northwest, mental health service delivery has required some substantial creativity and tenacity from its psychiatrists and other providers as the ebb and flow of physicians and funding has occurred. Recent ICES data shows that the two northern LHIN areas are dramatically underserved by psychiatry and yet waitlists for some services are less then those of higher served areas of southern Ontario. How can this be? 

As necessity is the driver of innovation, Dr. Haggarty hopes to share his understanding of Northern successful and less-successful adaptations of service delivery and psychiatry care that has permitted now a surge in recruitment, a drop of wait times and indeed making 'the North' a viable and vibrant career consideration, providing meaning, community and regard in our work. 

About the Speaker

John (Jack) Haggarty M.D. is a psychiatrist and former family physician working in Thunder Bay, Ontario.  A graduate of McMaster Medical School, he completed his residency at the University of Ottawa (Family Medicine), and the University of Western Ontario (Psychiatry).  He is Senior Medical Director (Chief) of Psychiatry, St. Joseph’s Care Group, Medical Director Community Mental Health Programs, and Consulting Psychiatrist of Shared Mental Health Services Fort William Clinic, Anishinabe Muskiki, Norwest Clinic and Lakehead Nurse Practitioner-Led Clinic in Thunder Bay, serving over 30 family physicians and nurse practitioners and 50,000 patients.  As Professor (Northern Ontario Medical School), Research Coordinator NOSM Psychiatry, and Adjunct Professor (Lakehead University), he has presented internationally on collaborative mental health, health outcomes, as well as publishing scientific papers on trans-cultural epidemiological research of Canada’s Inuit and First Nations people. He is actively engaged with delivering mental health to First Nations people. He is a fellow of the Royal College of Physicians of Canada, a Diplomat of the Board of Neurology and Psychiatry, and a Certified Physician Executive.

There is some concern that PTSD alone or the broader category of OSI does not describe the Moral Injury, which some military veterans may have experienced when confronted with morally questionable or ethically ambiguous situations in any type of warfare. The concept of Moral Injury is not a clinical diagnosis but it attempts to encompass the lasting response within the psyche to moral and ethical conflicts. Within military culture, soldiers and veterans suffering from Post-Traumatic Stress Disorder are encouraged to maintain their identity as modern warriors in order to have a positive view of themselves. The alternative, being perceived as weak, ill or broken, may lead to feelings of failure and inadequacy. However, for those who have experienced a moral injury and who can no longer accept the identity of “warrior” for ethical or religious reasons, alternate approaches must be offered. This workshop will explore the concept of Moral Injury and provide ample opportunity for discussion concerning approaches to help our patients deal with Moral Injury. 

Learning Objectives

• Appreciate that Moral Injury may be an aspect of PTSD which needs to be addressed.
• Identify situations in which a moral injury may be impeding progress in the treatment of PTSD.
• Identify the limits of psychiatry in addressing Moral Injury.

Dialectical Behavior Therapy (DBT) is an adaptation of cognitive behavior therapy which was developed to reduce suicidal and self-harm behaviors in people with borderline personality. Over time, its applications have broadened to address a variety of emotion dysregulation and impulse control problems. In this workshop, two addictions psychiatrists will present their understanding of how the fundamental principles of DBT can be applied build engagement and target complicated problems in substance use treatment. Using a true-to-practice case example, and plain, irreverent language, we will explain dialectics, Linehan’s Biosocial Theory and some of the unique tools available within DBT. There will be a hands on components, where participants will observe a behaviour chain analysis. This is a core skill that can help patients avoid repeating dangerous behaviours. They will also engage in a discussion around how this could be incorporated into their practice. 

Learning Objectives

• At the end of this session, the participants will be able to describe a dialectic and think of examples.
• At the end of this session, the participants will be able to explain Linehan’s biosocial model of emotional dysregulation in plain language.
• At the end of this session, the participants will be able to describe the components of a behaviour chain analysis as well as how they could integrate it into their practice. 

In 1973, the American Psychiatric Association removed the diagnosis of homosexuality from the DSM-II and issued a position statement in support of gay and lesbian civil rights.  All major professional mental health organizations have since gone on record to affirm that homosexuality is not a mental disorder.  However, controversy remains surrounding the inclusion of gender dysphoria within the DSM-5 (previously gender identity disorder in the DSM-IV).  Many argue that this diagnosis should also be removed from the DSM because the diagnosis pathologizes transgender identities, while others believe it should remain in the DSM to ensure continued access to appropriate medical treatment (access to hormones and/or gender-confirming surgeries) for transgender people.

Unfortunately, psychiatry has a history of conflating LGBTQ identities with mental illness and has, therefore, historically contributed to the stigma and discrimination faced by people who identify as LGBTQ, affecting not only their mental health but also their access to appropriate mental health care services.  Barriers to accessing appropriate mental healthcare among LGBTQ people are compounded by healthcare providers’ lack of appropriate knowledge and skills around LGBTQ health.  At most medical schools and psychiatry residency programs in North America, there is a lack of education related to LGBTQ health (often with even less attention paid to issues related to gender than sexual orientation).  Lack of knowledge about the healthcare needs of trans-identified individuals is one of the major barriers to the provision of high-quality care to this traditionally marginalized and underserviced population. 

This presentation will review some of the terminology related to the wide variety of trans* identities with a focus on the diversity within trans* communities.  Some of the specific mental health issues within this population will be discussed, including the high rates of suicidal ideation and depression.  Barriers to accessing mental healthcare experienced by many trans* people will be discussed, with emphasis placed on practical suggestions for individual clinicians as to how to reduce these access barriers by becoming a true ally to trans* communities.

Learning Objectives

• Improve understanding of terminology related to individuals who identify as trans* and the diversity within trans* communities.
• Gain knowledge regarding some of the specific mental healthcare needs of trans*individuals.
• Understand healthcare access barriers experienced by many individuals who identify as trans* and gain knowledge regarding how to reduce these barriers (learn how to be an ally).

About the Speaker

Dr. Albina Veltman is an Associate Professor at McMaster University in the Department of Psychiatry & Behavioural Neurosciences. From 2013-2016, she served as the Inaugural Chair of Diversity & Engagement for the Undergraduate Medical Education Program at McMaster. Dr. Veltman's clinical work as a psychiatrist focuses on traditionally marginalized populations, including people with severe and persistent mental illness, people with developmental disabilities, and people who identify as LGBTQ. Her research interests include social justice and diversity-related issues in healthcare education, LGBTQ mental health, and psychiatric stigma and advocacy. She is a frequent speaker at national and international workshops and conferences on topics related to social justice, diversity and LGBTQ health. Dr. Veltman is the lead author on the Canadian Psychiatric Association first position paper on the provision of mental health care for LGBTQ-identified individuals (published in 2014). She has been the recipient of numerous awards and grants, including the 2013 McMaster University Department of Psychiatry Undergraduate Educator Award, a 2014 AMS Phoenix Project Call to Caring Grant, and the 2015 Distinguished Service Award from the Association of Gay & Lesbian Psychiatrists.

The impact of psychosocial factors on the development and outcome of medical illness is now better understood. With the success of acute treatment of medical conditions there is the eventual emergence of chronic disease which has a substantial burden on both patients and their significant others. This workshop focuses on cardiovascular disorders (coronary heart disease(CHD) and heart failure)and chronic kidney disease, end-stage kidney disease and renal replacement therapies (dialysis and kidney transplantation) to highlight current approaches to psychiatric treatment of a patient population with complex health conditions, commonly seen in general and geriatric psychiatric practice. An update on risk factors for CHD such as anxiety, depression, anger and job stress will be reviewed along with their potential management. Managing patients with chronic illnesses includes the challenges of psychotropic treatment in individuals on multiple medications and certain side effect profiles (including QT prolongation). Our approach will emphasize the key role of cardiac rehabilitation programs and the integration of family caregivers in the treatment process. We will also review how renal replacement therapies impact the mental health and psychosocial well-being of patients and highlight psychotherapeutic approaches which can be helpful. These include CBT, IPT, group therapy, stress management, self-management support,caregiver support as well as existential approaches and end-of-life/palliative care. Both heart failure and chronic renal disease require an understanding of the impact of living with a chronic, potentially life-threatening medical condition (with multiple physical symptoms and co-morbidities) on the mental health of patients and caregivers. We will highlight the role of psychiatrist who can assist these patients in their difficult journey by reviewing the phases of the illness and the options available to the psychiatrist for the long-term management of this emergent population.

Learning Objectives

• To be aware of recent findings concerning the relationship of psychosocial risk factors and coronary heart disease.
• To identify the complexity of symptom presentation of those patients with both psychiatric and medical conditions such as cardiovascular disorders and chronic kidney disease.
• To learn what psychiatric treatment approaches could be effective for these population groups including counselling, psychotropic medication, rehabilitation, mindfulness and the inclusion of signficant others.

Assessment of personality disorder remains one of the most challenging tasks in psychiatry. As a result clinicians often defer this task, choosing to focus attention on other mental health issues. However, research clearly demonstrates that personality disorders : i) impact quality of life more than other mental disorder, physical illness or SES ii) are associated with poor prognosis for other mental disorders iii) are prevalent, seen 50- 80% of individuals presenting for mental health treatment. Longitudinal studies have shown that improvement is the norm, although symptoms improve more than function, and treatment has been demonstrated to reduce some of the most troubling symptoms of personality disorder. While routine clinical assessment results in under and over diagnosis of personality disorders, structured interviews improve reliability of diagnosis. Diagnosis of personality disorder using the semi-structured DSM5 Section III model has been shown in field trials to be as reliable as diagnosis of schizophrenia and bipolar disorder. This interactive session will: i) include a review of the research and the process which the DSM5 committee used to develop the DSM5 Section III personality disorders model ii) demonstrate how to use the new model in clinical practice iii) provide the opportunity to discuss and practice ways to utilize this model in day to day clinical practice.

Learning Objectives

• Be able to describe the research findings on prevalence, etiology, prognosis and treatment outcomes for individuals with personality disorders.
• Use the Section III personality disorders model to improve reliability of diagnosis of personality disorder in their patients.
• Use the Section III PD model to improve communication with patients and improve treatment planning with regards to personality disorder.

Ontario is the midst of an opioid epidemic where prescribing of opioids is increasing along with accidental overdose deaths of opioids. Some of the causes are iatrogenic in terms of opioid prescribing over the past 20 years while others are related to illicit opiate availability. Psychiatrists have an opportunity to assess and treat these patients in their outpatient practice, as well as in the emergency or inpatient environment. Given their comfort level with mental health issues, psychiatrist can also offer treatment for co-morbid mental illnesses. Here we will cover the basics of an opioid assessment (with or without chronic pain), risks and benefits of different treatments, as well as how to initiate someone on buprenorphine/naloxone in an outpatient setting. Attendees will receive a nonindustry booklet on the assessment and treatment of opioid use disorders as well as additional resources to increase their knowledge, proficiency, and comfort in this skill.

Learning Objectives

• At the end of the session, the participants will be able to screen and assess people for opiate use disorders.
• At the end of the session, the participants will be able to describe the risks and benefits of methadone and buprenorphine/naloxone in the treatment of opioid use disorders.
• At the end of the session, the participants will be able to develop a learning plan in order to develop proficiency at integrating this treatment into their outpatient practice.

Since the 1960s, when deinstitutionalization began in different parts of the world, many mental health care interventions have moved to outpatient settings. This increase in the scope of outpatient care has led to the introduction of more coercive community practices, including the use of mandated community treatment orders (CTOs) across many jurisdictions .The coercive elements of CTOs and other outpatient commitment models have raised ethical questions in community mental health services, where both formal and informal pressures are applied to encourage adherence to treatment among psychiatric outpatients. This symposium will include five presentations, highlighting the results of recent Canadian studies done by our team on the experiential aspects of CTOs and discussing opportunities to develop patient-centred practice in settings where CTOs are in use. Laying the groundwork, the first presentation will summarize findings from a recently published literature review on perceptions of coercion and CTOs that emphasized the contextual nature of treatment orders. Second, results will be shared from a qualitative study on the experiences with CTOs of 28 individuals from community mental health teams. Thematic analysis illustrated possible areas for exertion of patient agency while on a CTO, amid a potential increase in the salience of illness for patients. The third, fourth and the fifth presentations will discuss findings from a quasi-experimental study of patients being treated under a CTO and a control group of voluntary psychiatric outpatients receiving intensive community mental health outreach (n= 69/group). The presentations will focus on key findings from measures of patient perceptions of coercion and procedural justice, stigma, recovery and forms of leverage used to encourage treatment adherence. Presenters will then lead a facilitated discussion of the implications of this research for applications of CTOs across Canada.

Learning Objectives

• Gain a better understanding of the current literature on compulsory community orders and patients perception of coercion.
• Describe other forms of leverage that may influence patient experiences of coercion, stigma and recovery.
• Discuss possible strategies for reducing the coercive impact of compulsory community treatment orders on patients.

Assessment of personality disorder remains one of the most challenging tasks in psychiatry. As a result clinicians often defer this task, choosing to focus attention on other mental health issues. However, research clearly demonstrates that personality disorders : i) impact quality of life more than other mental disorder, physical illness or SES ii) are associated with poor prognosis for other mental disorders iii) are prevalent, seen 50- 80% of individuals presenting for mental health treatment. Longitudinal studies have shown that improvement is the norm, although symptoms improve more than function, and treatment has been demonstrated to reduce some of the most troubling symptoms of personality disorder. While routine clinical assessment results in under and over diagnosis of personality disorders, structured interviews improve reliability of diagnosis. Diagnosis of personality disorder using the semi-structured DSM5 Section III model has been shown in field trials to be as reliable as diagnosis of schizophrenia and bipolar disorder. This interactive session will: i) include a review of the research and the process which the DSM5 committee used to develop the DSM5 Section III personality disorders model ii) demonstrate how to use the new model in clinical practice iii) provide the opportunity to discuss and practice ways to utilize this model in day to day clinical practice.

Learning Objectives

• Be able to describe the research findings on prevalence, etiology, prognosis and treatment outcomes for individuals with personality disorders.
• Use the Section III personality disorders model to improve reliability of diagnosis of personality disorder in their patients.
• Use the Section III PD model to improve communication with patients and improve treatment planning with regards to personality disorder.

This interactive interdisciplinary workshop will cover essential aspects of keeping good boundaries in clinical practice. The unique component will be the opportunity for attendees to observe typical clinical scenarios. These are depicted on a professionally DVD produced by the American Psychological Association. We will show several typical boundary challenging situations between a real psychotherapist and an actor. The Panel members will then make some brief comments and attendees will get an opportunity to openly discuss the issues involved. Up-to-date remarks on keeping good ethical boundaries in the practice of psychiatry and psychotherapy will be discussed.

Learning Objectives

• Learn what we mean by a “boundary” in a doctor-patient relationship?
• Increased understanding of the “therapeutic frame” of the medical relationship.
• Both explicit knowledge of the crucial difference between boundary crossings and a boundary violation. Minimizing the risk of sexual violations in the doctor-patient relationship.