Programme 

About the Speaker

Dr. Bradford will describe the lived experience of how he developed PTSD after exposure to the videotapes created by Paul Bernardo and Russell Williams as part of his forensic psychiatric evaluation of these two individuals. Although this exposure was severe, there is no question that increasingly mental health professionals, legal professionals and frontline workers, including nurses are exposed to both vicarious trauma and real life events that put them at risk to develop trauma-related symptomatology and PTSD. This talk will cover some of the factors that put mental health professionals at risk and how the development of PTSD can be misdiagnosed which delays treatment and recovery.

Learning Objectives

• By the end of this talk, participants will be sensitive to the risks of vicarious trauma and PTSD in mental health
• By the end of this talk, participants will be aware of the natural history and outcome of PTSD
• By the end of this talk, participants will be aware of the risks to front-line professionals in mental health and others, including police officers, first responders, and also many in the legal profession including judges and lawyers

Dr. Bradford was a Full Professor in the Division of Forensic Psychiatry, Faculty of Medicine, University of Ottawa, now retired in June 2017. He had a cross appointment as Professor in the Department of Criminology, University of Ottawa. He was also previously a Professor in the Department of Psychiatry, Queen’s University and Adjunct Professor of Psychiatry at the University of Alberta and at the University of Saskatchewan. Dr. Bradford was a founding member of the University of Ottawa Institute of Mental Health Research and continues as a Scientist in The Royal Institute of Mental Health Research as it is now named. Dr. Bradford is currently a Full Professor (Clinical) at McMaster University in Hamilton Ontario. He is a forensic psychiatrist in the Forensic Program of St Joseph's Healthcare Hamilton. Dr. Bradford is a graduate in medicine and received a Diploma of Psychological Medicine, from the University of Cape Town, South Africa.

He holds specialist degrees in Psychiatry from South Africa, the UK, USA and Canada; he also has an added qualification in Forensic Psychiatry from the American Board of Psychiatry and Neurology. He is a Founder of Forensic Psychiatry granted by the Royal College of Physicians and Surgeons of Canada. He was the initial Chair of the Examination Board for the subspecialty of Forensic Psychiatry under the Royal College of Physicians and Surgeons of Canada. He stepped down after 5 years

He has published over 140 peer-reviewed papers; more than 50 chapters in academic books, including textbooks; presented at over 300 peer-reviewed international and national conferences, co-authored 4 books.

While institutional wellness programs have been implemented for health professions faculty for many years, they have not been largely effective in addressing the needs of individual faculty. One of the challenges to existing wellness programs relates to how stigma against help-seeking limits prevention and early identification of faculty distress. When experiencing the warning signs of psychological distress, faculty often do not seek support due to self-stigma which relates to fears of retribution, or appearing vulnerable or weak to others (Corrigan, 2009). Common approaches to reduce self stigma involve increasing explicit knowledge to challenge implicit prejudicial biases towards mental illness (Yanos, 2015). These findings dovetail with emerging models on implicit bias and recognition, which challenge individuals to solicit feedback on their biases, and role model new behaviours within a culture of safety and shared vulnerability (Sukhera, 2017). This session provides participants with a background on the issue of self-stigma and leverages promising approaches to recognize and manage implicit biases to transform how to approach wellness for yourself and others. 

Learning Objectives

• Explore the issue of self-stigma in the context of a critical review of existing institutional wellness programs.
• Describe how a model for implicit bias recognition and management may reduce self-stigma and improve wellness.
• Practice implementing implicit bias recognition and management within wellness initiatives through the co-construction of wellness innovations.

In the past 20 years, there has seen a renewed interest in neurosurgery for psychiatric disorders following the success of deep brain stimulation techniques for movement disorders. Reversible and adjustable to different target sites, this procedure has encouraged neurosurgeons and psychiatrists to explore new applications for neuromodulatory techniques to treat refractory psychiatric disorders. However, it has also invited re-examination of issues of ethics and legal regulation. Voices from within the functional neurosurgery community warn against an overly exuberant approach that might repeat some of the mistakes of psychosurgery’s past, putting patients and the field itself at risk. While some may prefer the use of professional guidelines to legal regulation, at least some suggest that a mandatory regulatory approach is warranted. Indeed, there are already legal regulatory frameworks in place in many jurisdictions, including within Ontario’s Mental Health Act, and some of these are arguably now outdated. This panel will discuss some of the existing regulatory models in Canada, the UK the US, Australia and New Zealand, and explore the concerns that might underlie the expansion of invasive and non-invasive neuromodulation for psychiatric conditions. Experts in law (Professor Jennifer Chandler) and in psychiatry (Dr. Mona Gupta and Dr. Peter Giacobbe) will lend their perspectives, drawing on current and ongoing research, and experience in practice. 

Learning Objectives

• At the end of this session, participants will be able to understand the existing regulatory models in Canada, the UK the US, Australia and New Zealand that regulate neuromodulation for psychiatric disorders.

• At the end of this session, participants will be able to understand the ethical issues that surround new neuromodulatory applications for psychiatric disorders.

Somatizing and somatoform disorders are an important part of physicians' caseloads. Up to 30% of patients who present with somatic complaints to primary care physicians may 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 cooperation on the part of those patients. We discuss the different presentations of somatizing, which include medically unexplained symptoms (MUS), distorted belief systems 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 somatoform disorders.
• Understand the range of conscious and unconscious mechanisms involved in these disorders.
• Be aware of treatment modalities for these disorders both psychopharmacologic and psychotherapeutic

Over the last several years, Health Quality Ontario has introduced Quality Standards for Mental Health and Addiction care, both community and hospital-based. As health care teams and individual practitioners strive to adopt and meet these standards, measurement will increasingly become an integral aspect of psychiatric care in Ontario. This interactive workshop will provide participants with a brief overview of the approach to quality improvement adopted by Health Quality Ontario, The Model for Improvement. Measurement is an essential part of this approach to improving the quality of psychiatric care. Measures allow health care providers to assess whether the changes they are making to health care processes have led to the intended goals. Workshop participants will be introduced to outcome, process, and balancing measures and will be encouraged to generate applied examples from their own practices. In addition, the workshop will review commonly used data analysis tools for quality improvement, such as pareto charts and run charts. The majority of the session will be devoted to a simulation exercise in which participants will gain hands-on experience with measurement for process improvement. In small groups, participants will have the opportunity to create, utilize, and interpret data generated from the simulation using several quality improvement tools. Experiential learning will promote knowledge and understanding of the benefits of measurement for improving the quality of psychiatric care and some of the frequently encountered challenges associated with implementation.

Learning Objectives

• To learn about the different types of measures used for quality improvement in psychiatric practice
• To review tools and methods used for quality improvement measurement in psychiatric care.
• To participate in an interactive, group-based simulation of measurement for quality improvement.

In this presentation, we will review the structure of the forensic mental health system in Ontario and Canada. We will also describe the legal criteria of the not criminally responsible (NCR) defense as well as the fitness to stand trial. When a patient is found NCR, the individual goes under a Provincial Review Board. We will review the different dispositions available to the Provincial Review Board and the implications for psychiatrists. We will also review how general psychiatrists can navigate the forensic mental health system for patients under their care. The second portion of the presentation will explore the link between violence and mental illnesses. We will review the different mental illnesses and specific symptoms related to the risk of violence. In addition, we will go over different risk assessment tools and risk mitigation strategies to decrease the risk of violence. The last part of the presentation will describe the obligations for physician related to duty to warn and duty to protect. In addition of reviewing the history of duty to warn in psychiatry, we will review the relevant Canadian case law including Smith v. Jones. 

Learning Objectives

• Describe the forensic mental health system in Ontario
• Explore the link between violence and mental health
• Review the history and obligations related to duty to warn

The Ontario Neuro-Psychiatric Association was founded in Kingston on 28th April, 1920. At that time, psychiatry was focused in the Ontario mental hospitals. It is the oldest psychiatric professional organization in Canada, It was active in the scientific research throughout the 1920s and 1930s. During the Second World War, it maintained limited activity and after the war the emphasis shifted to education. It was the main driver in the establishment of the Canadian Psychiatric Association in 1951. In 1956 it was renamed the Ontario Psychiatric Association. There were many ups and downs. The deinstitutionalization period (1975-1990) closed many mental hospitals that had been the mainstay of the OPA. A rapid shift toward academic hospitals and programs caused the OPA to search for a new mandate. The search continues but considerable progress has been made. It works closely with the OMA and other medical organizations as well as academic institutions across the province. The archives of the OPA are very valuable sources of information for the history of this period. Considerable work was done on organizing and cataloguing the material in time for the 90th anniversary in 2010. But there is still a large amount that remains undone and as part of this project we are working closely with the CAMH Archives to get all this information fully catalogued and available for historical research and education. We also want to make it the centrepiece of our centennial celebrations in 2020. As part of the project we plan to publish a complete history of the OPA. 

Learning Objectives:

• Appreciate the important role that the OPA has played in Canadian psychiatry.
• Understand the importance of the OPA Archives in defining the history of psychiatry in Canada.
• Develop a better understanding of the history, social and political importance of psychiatric organizations in defining healthcare and mental health care in Canada.

Mindfulness and mindfulness-based interventions (MBIs) are assuming an increasing role in mental health. This presentation will provide an overview of mindfulness and MBIs and the evidence that supports their use in a variety of different mental health conditions. Attention will be paid to the ways in which MBIs need to be modified for different clinical populations. Potential adverse effects of mindfulness interventions will be described as well as how clinicians can mitigate risk in prescribing these interventions. The value of mindfulness in health care professionals managing their own stress will be described. Resources to support patient and provider learning will be provided.

Learning Objectives

• Define mindfulness
• List current clinical uses of mindfulness
• Describe potential adverse effects of mindfulness and how to mitigate risk

There continue to be great disparities between the health and mental health status of Indigenous peoples and the general Canadian population.  Indigenous peoples bear a disproportionate burden of illness and suffering that is unacceptable.  In this session, the speaker reflects back on more than 20 years of work as one of Canada’s few Indigenous psychiatrists.  Indicators of the mental health status of Indigenous peoples in Canada are briefly reviewed. The changes, newer initiatives and challenges in Indigenous mental health will be discussed.  There will be a particular focus on introducing the concepts of cultural safety and cultural humility as a means to improving access to, utilization of and benefit from psychiatric and mental health services.  This in turn leads to better outcomes and narrows the gap in health and mental health status of Indigenous peoples across the country.

Learning Objectives

• Become familiar with the most significant national initiatives related to Indigenous mental health in Canada
• Learn about the mental health status of Indigenous peoples from a variety of perspectives
• Become aware of new and innovative approaches to mental health and wellness in Indigenous populations, including developing cultural humility and increasing the cultural safety of psychiatric and mental health services

About the Speaker

Dr. Cornelia (Nel) Wieman works for the First Nations Health Authority (FNHA) in Vancouver, BC in the Office of the Chief Medical Officer as Senior Medical Officer, Mental Health & Wellness.  She is an Adjunct Professor in the Faculty of Health Sciences at Simon Fraser University.

Nel is Canada’s first female Indigenous psychiatrist (Anishnawbe – Little Grand Rapids First Nation, Manitoba).  She completed her medical degree and psychiatry specialty training at McMaster University in Hamilton, Ontario. 

She provided psychiatric services at a community mental health clinic based on the Six Nations of the Grand River Territory for 8 years.  She was a member of the Advisory Group on Suicide Prevention that developed a national framework document for the AFN and FNIHB addressing the issue of First Nations youth suicide. She was the Co-Director of the Indigenous Health Research Development Program and an Assistant Professor in the Dalla Lana School of Public Health, Faculty of Medicine at the University of Toronto for 7 years.  She has been a co-investigator on several initiatives funded through the Canadian Institutes of Health Research (CIHR) – Institute of Aboriginal Peoples Health including the National Network of Aboriginal Mental Health Research (NNAMHR). In 2007, she was appointed to the Canadian Institutes of Health Research (CIHR) Governing Council.  She served on the Indspire Foundation’s Board of Directors for nine years.

From 2013-17, she was a staff psychiatrist at the Centre for Addictions and Mental Health (CAMH) working in various programs including the Aboriginal Services Unit, Telepsychiatry Service, Crisis Clinic and General Assessment Clinic. She was the Faculty Advisor to the Indigenous Students Health Sciences Office at McMaster University (2016-17). She is serving as President of the Indigenous Physicians Association in Canada for a three-year term (2016-19).

She is an Indspire Achievement Award Laureate (1998), recognized for career achievement in the category of medicine.  She was the inaugural recipient of the University of Waterloo’s Faculty of Applied Health Sciences Alumni Achievement Award.  In 2013, she received the Queen Elizabeth II Diamond Jubilee Medal.

Nel’s clinical, academic and advocacy work has always been focused on improving the health and mental health status of Indigenous peoples, especially Indigenous youth, across Canada.

Health Quality Ontario is developing quality standards on the topics of anxiety disorders and obsessive-compulsive disorder (OCD). The quality standards, comprised of a concise set of evidence-based, measurable statements with associated quality indicators and supports for adoption, are intended to outline what evidence-based high-quality care should look like for patients, caregivers, and health care professionals. These quality standards have been developed through a rigorous process, guided by a 19-member multidisciplinary advisory committee made up of clinicians, researchers, individuals with lived experience, and health care administrators with experience in anxiety disorders and OCD. The quality standards are informed by a thorough review of available Canadian and international clinical practice guidelines and broad consultation with stakeholders.

This presentation will summarize the quality standards, scheduled for release in Fall 2019. Nine quality statements have been prioritized for anxiety disorders and 11 quality statements for OCD. The topic areas include: identification and screening, comprehensive assessment, stepped-care approach, self-help, support for family and caregivers, CBT, pharmacological treatment, monitoring, relapse prevention, intensive treatment, and transitions in care. For both anxiety disorders and OCD, timely access to CBT and the need for CBT to be delivered by health care professionals with expertise in the specific health condition is emphasized. Recommendations for adoption and indicators to evaluate impact on clinical care have also been developed and will be reviewed.

It is anticipated that adoption of these quality standards will help to address current gaps in the treatment of anxiety disorders and OCD and result in improved access to evidence-based care in Ontario.

Learning Objectives:

• Describe the current treatment gap for anxiety disorders and OCD
• Outline core principles underlying evidence-based care for anxiety disorders and OCD
• Anticipate how the release of quality standards for anxiety disorders and OCD in Ontario may impact current practice

The past year has been a turbulent one for physicians especially psychiatrists practicing in Ontario. Equity has been a major theme for psychiatrists. Dr. Dufour and Dr. Hastings as co-chairs for the Coalition of Ontario Psychiatrists will provide an overview of the different associations representing psychiatrists in Ontario namely the Coalition of Ontario Psychiatrists, Ontario Psychiatric Association (OPA), and the Ontario Medical Association (OMA) Section on Psychiatry. Dr. Hastings will provide perspective of the work the OMA Section on Psychiatry has done to promote equity within the OMA. He will also go over the current arbitration process and next steps related to advocate improving the practice of psychiatrists in Ontario. Dr. Dufour will provide an overview of the advocacy work that the OPA has done for the profession including increasing access to psychiatrists and their work related to shortage of psychiatrists. Dr. Dufour will also review the new Ministry of Transportation legislation and the work of the OPA sharing the concerns of psychiatrists that led to the MTO considering creating an interpretive guide for physicians in Ontario. Dr. Sukhera will share an update on the issues related to psychotherapy funding for physicians in Ontario. Patrick Nelson will also provide an overview of the government relations work being undertaken for the Coalition of Ontario Psychiatrists. Finally participants will have an opportunity to share perspective, ask questions, and raise issues for the Coalition to consider.

Learning Objectives

• Appreciate the roles of the different organizations representing psychiatrists in Ontario.
• Understand the current arbitration process at the OMA and its impact on relativity.
• Describe recent advocacy work to improve the practice of psychiatrists in Ontario.

Historically, people have utilized a sequential approach for concurrent disorders: treat the addiction first and then we can address your mental health. More and more, evidence as well as guidelines are pointing to integrated treatment for people with concurrent disorders. This workshop will provide an overview of addiction medicine approaches as well as psychotherapy approaches for patients who use substances. It will give a framework upon which the attendee can do additional reading/training programs to develop proficiency in these skills. A non-industry funded booklet on anticraving medication will be provided as well as references for the development of the psychotherapy skill set for people who use substances. This will focus more on the behavioural intervention than on motivational interviewing. 

Learning Objectives

• At the end of the session, the participant will be able to list and describe the risks and benefits of various anti-craving medication for substance use
• At the end of the session, the participant will have a framework for understanding the patient who uses substances that will help guide which psychotherapy would be ideal for them
• At the end of the session, the participant will engage in a discussion about

Mental health services are likely to undergo major transformations in the next 5 to 10 years due to major social and economic changes. Despite the enormous investments in psychiatric services and treatments the needs of the Ontario population are not being met. Many efforts at mental health reform have been unsuccessful. Progress in psychopharmacology initially made a very significant impact but in recent years has stalled with no qualitative breakthroughs.

 Over the past two decades there have been important developments in the field of psychotherapy. There has been extensive research on effectiveness and outcomes and many studies of good quality in CBT, IPT, EFT, DBT and psychodynamic  therapies. Third wave therapies have come on stream and have found a place in clinical practice. Psychological services have been incorporated into the National Health Service in the United Kingdom (Improving Access to Psychological Therapies). These services are mostly provided by non-physicians. Ontario is introducing a similar approach for cases of mild depression and anxiety.

The purpose of this panel is to address the future role of psychiatrists in the delivery of psychotherapeutic services. The following questions will be considered. Should psychiatrists practice psychotherapy in the future?  If so which types of psychotherapy? Is it possible to train psychiatrists adequately?  What will mental health services look like in the future and what roles will psychiatrists have vis a vis psychologists and other healthcare providers in provision of psychotherapy. More broadly who should provide which therapy to whom? Should other modalities of intervention take precedence: biological treatments, the recovery model, community interventions?

Learning Objectives

• To understand the social and economic factors that may impact on the practice of psychotherapy in the coming decade.
• To review potential roles of psychiatrists in the coming decade.
• To learn about potential changes in health services delivery in the coming decade.

Borderline Personality Disorder (BPD) is found in 10% of inpatients and 20% of outpatients. National guidelines emphasize structured psychotherapy such as Dialectical Behaviour Therapy as first line treatment for BPD, and indicate that medications have a limited role in the treatment of this disorder. Despite these guidelines, people with borderline personality disorder are routinely prescribed medications with up to 45% receiving 3 or more medications, even when involved in psychotherapy. Good Psychiatric Management, the management approach to BPD that arose out of extensive research at McLean Hospital and Harvard University by Dr John Gunderson and colleagues, is an empirically validated treatment for BPD that performed as well as Dialectical Behaviour Therapy in the large CAMH DBT trial. In this workshop we will be presenting the approach described in GPM for managing medications for BPD. This will include: i) current guidelines and recent research on medications for BPD ii) when to consider the use of medications in BPD iii) how to introduce the use of medications iv) eliciting patient participation in monitoring effects and side effects of medications, and v) limiting polypharmacy. 

Learning Objectives

• Describe current guidelines and recent research on medications for borderline personality disorder
• Describe the GPM approach to prescribing medications including: collaboratively making the diagnosis, psychoeducation, attending to the therapeutic alliance and inviting patient participation in monitoring medications.

As mental health awareness continues to grow, physicians are increasingly choosing Psychiatry as a specialty (5.2% of NRMP positions in 2017). However, trainees often face additional professional struggles after identifying their specialty, including navigating a large professional organization; developing a professional identity; and expanding their network. During medical school and residency, trainees have limited time and resources to identify and optimize the opportunities available to them. As a result, cultivating trainees’ leadership skills early in their training will be instrumental in empowering future generations of leaders in psychiatry. This presentation aims to develop strategies for residents and medical students to 1) identify local and national opportunities for leadership experience and career advancement, 2) identify common barriers in leadership through group discussion, and 3) delineate tangible next steps in their own career goals. In this workshop, panelists will discuss the opportunities available to residents and fellows for research, community service, and leadership roles in psychiatry. The panelists will offer recommendations on developing a strong and unique professional identity deriving both from educational research and from personal experience. Participants will break into small groups to identify barriers to developing their professional identity, networking, or developing their leadership interests. The panelists will review strategies and resources that have been utilized by trainees in past and discuss opportunities available through APA including fellowships, council participation, elected regional and national positions, and mentorship. By the end of this session, participants will be able to identify at least one strategy they can implement during their training and offer an example of a strategy that they have found to be successful to the workshop group. 

Learning Objectives:

• Recognize opportunities available to residents and fellows for research, community service, and leadership roles in psychiatry and identify barriers to developing their professional network
• Review successful strategies and resources that have helped other trainees develop their career and professional identity
• Identify at least one strategy they plan to implement during their training

Recreational cannabis use was legalized in Canada on October 17, 2018. While there are clear advantages and disadvantages about a nationwide cannabis legalization framework, there is growing evidence that there could be disproportionate harms of cannabis legalization for people with mental health and addictive disorders. This plenary lecture will provide a comprehensive approach to this topic, including the epidemiology, neuroscience, clinical phenomenology, assessment and treatment related to problematic cannabis use and mental illness. I will then make a series of recommendations with respect to monitoring, prevention and treatment, which could further reduce harms for this vulnerable subset of the Canadian population. Ultimately, I hope to provide clinicians with an evidence-based clinical framework from which to approach this important issue at clinical and systems levels, and ultimately reduce potential harms to our patients with this impending national policy change.

Learning Objectives

• To understand the epidemiology and biology of cannabis and problematic cannabis use.
• To appreciate the effects of cannabis and cannabinoids in people with mental health and addictive disorders.
• To develop an evidence-based framework for assessment and management of people at risk for and with existing mental illness in the context of impending cannabis legalization.

About the Speaker

Dr. Tony George is Professor of Psychiatry at the University of Toronto (U of T), where he directs a program of research focused on understanding the biological basis of addiction co-morbidity (e.g. tobacco and cannabis) in serious mental illness, with a focus on schizophrenia and mood disorders. His research is supported by the National Institutes of Health (NIH), the Canadian Institutes of Health Research (CIHR) and the Canada Foundation for Innovation (CFI). He completed his undergraduate and medical school training at Dalhousie University in Halifax, Nova Scotia, graduating with his M.D. degree in 1992. Dr. George then completed psychiatry residency training (1992-96) and a fellowship in Translational Neuroscience (1996-98) at the Yale University School of Medicine in New Haven, Connecticut, USA, joining the faculty at Yale in 1998. He was an Associate Professor of Psychiatry at Yale University before coming to Toronto in late 2006. He was the inaugural holder of the Chair in Addiction Psychiatry at the University of Toronto (2006-2012), Clinical Director/Chief of the Schizophrenia Division (2008-2016), Medical Director of the Complex Mental Illness Program (2012-2016) and Chief, Addictions Division (2016-18) at CAMH.

Dr. George has over 275 peer-reviewed publications, and is a Fellow of the American College of Neuropsychopharmacology (ACNP), and since 2013 he has served as Deputy Editor of the ACNP’s journal Neuropsychopharmacology. Dr. George wrote the chapter on Nicotine and Tobacco for Cecil Textbook of Medicine in 2011, 2015 and 2019, and is also a member of the Scientific Advisory Board of the Canadian Council on Substance Abuse (CCSA) and co-edited its report on Cannabis and Youth in 2015.