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Better treatment: research to help people living with mental illness

Better treatment: research to help people living with mental illness

Queen’s researchers look at new ways to treat individuals, not just illnesses.

[phot of Dr. Kate Goldie: mental health and chronic disease]
Photo by Bernard Clark

Dr. Katie Goldie, NSc’06, MSc’08, is an assistant professor in the School of Nursing.

A person living with a mental illness is twice as likely to have a heart attack or a stroke than a person who isn’t.

There is also a higher chance that person will have a variety of other chronic diseases. Katie Goldie (NSc’06, MSc’08) isn’t just interested in trying to figure out why – she wants to find a way to reverse the trend. Since returning to Queen’s as an assistant professor in the School of Nursing in January, Dr. Goldie has focused her attention on looking at the relationship between mental health and physical health in people with schizophrenia, bipolar disorder, major depression and severe anxiety disorders.

Dr. Goldie is just one of a number of researchers at Queen’s focused on making life better for people living with mental illness. From working to fight the stigma associated with it, helping doctors find the best treatments for their depressed patients and helping people with mental illness get back to work, researchers across campus and across disciplines are committed to improving outcomes for those who struggle.

And it’s a worthy cause. According to Kate Harkness, a professor in the Department of Psychology who studies depression, this mental illness alone costs Canadian taxpayers up to $55 billion a year and is the leading cause of time lost from work –more than cancer or heart disease. “That’s why you want to treat people fast and early, so they don’t have a lifetime of depression,” she explains. Unemployment rates among those who have mental illness are also disproportionately high. Terry Krupa, a professor in the School of Rehabilitation Therapy, says that as many as 90 per cent of people with serious mental illness don’t work, which in turn leads to poverty and marginalization. “They often aren’t even counted as unemployed,” she says, “because they are already so far off the radar.”

Dr. Katie Goldie: understanding the relationship between mental health and chronic disease

Before returning to her alma mater with her doctorate degree from UBC in hand, Dr. Goldie took a year to pursue a post-doctoral fellowship at the Centre for Addiction and Mental Health. Working in the Nicotine Dependence Clinic, she focused her energies on looking at the relationship between mental illness, chronic disease and smoking. People with mental illness, she learned, are two to four times more likely to use tobacco than the general population. Moreover, tobacco smoking increases the risk for and progression of chronic diseases, including cancer, cardiovascular disease, chronic obstructive pulmonary disease, asthma and diabetes. Dr. Goldie says this leads to a reduced length and quality of life.

While she is still teasing apart the variables, Dr. Goldie, a fourth-generation Queen’s graduate, says factors like psychiatric medications and unhealthy behaviours – like using tobacco and alcohol, having a poor diet and not being physically active – all play a role. More importantly, she says that many people with mental illness may simply have difficulty accessing health care or communicating their needs once they get it. If they do get in to see a doctor, they may face even more challenges – from stigma to not being treated as a whole person. “Some physicians prioritize treating an individual’s mental health symptoms at the expense of his or her physical health,” says Dr. Goldie. She also says that people with mental health disorders are less likely to receive risk-reducing drug therapies or to undergo coronary procedures such as bypass surgery.

Some physicians prioritize treating an individual’s mental health symptoms at the expense of his or her physical health.

According to Dr. Goldie, this problem stems from a lack of overlap in medical services, especially with more patients living in community settings rather than in institutions. “Some of it is simply the way our healthcare system is structured,” she says. “We have been siloed for so long. If you have an area of specialty, you focus on that area without looking at the whole person.” In other words, if a patient is being prescribed a new antidepressant known to cause weight gain, Dr. Goldie wants to see his or her physical health proactively monitored – not just to see how the medicine is working, but also to see what other impact it might be having. “I want all healthcare professionals to monitor lifestyle factors, like whether the patient is smoking, or whether she wants to start an exercise program,” she says. “In an ideal world, if psychiatric medications are prescribed, then we need to implement an aggressive risk management program to go along with them.”

Dr. Goldie, who envisions a future in which mental health nurses do regular physical assessments of patients, says she is grateful to be in a role at Queen’s where she can make a positive difference. “I’m influencing the next generation of nurses to be hyper aware of these issues.”

[photo of Dr. Kate Harkness and Dr. Roumen Milev: helping doctors treat depression more effectively]
Dr. Kate Harkness and Dr. Roumen Milev: helping doctors treat depression more effectively. (Photo by Bernard Clark)

Dr. Kate Harkness and Dr. Roumen Milev: helping doctors treat depression more effectively

Together, Dr. Harkness and Dr. Milev, a professor of psychiatry and psychology and head of the Department of Psychiatry at Queen’s, are trying to find a better way to help doctors treat patients with depression. The pair are involved in a Canada-wide study called CAN-BIND (the Canadian Biomarker Integration Network for Depression) which is aiming to take the guesswork out of treating the condition, which currently affects as many as two million Canadians every year.

“CAN-BIND is looking at our ability to predict which person will respond to which treatment for depression,” says Dr. Milev. “Unlike with some health conditions, with depression we don’t have a lab test to confirm a diagnosis and to choose a treatment, so we often take a trial and error approach.” “Depression is a very heterogeneous problem,” adds Dr. Harkness, whose own research seeks to understand, among other things, what causes the first incidence of depression. “People present with different problems and respond to treatment in different ways.” Even with existing treatments, she says only 50 to 60 per cent of patients truly get better.

That’s why the CAN-BIND team, which is made up of approximately 200 researchers across the country, is seeking to devise an algorithm that family doctors will be able to use to match their patients with a treatment best suited to meet their needs, be it medication or a treatment such as Cognitive Behavioural Therapy (CBT), a type of mental health counselling. “Who responds to medication, who responds to newer neuro-stimulation treatments…we could probably predict that using some of the person’s basic biological or clinical characteristics, also called ’biomarkers’,” says Dr. Harkness. “We are hoping to come up with a way for people with depression to be easily streamlined through a decision tree of treatment.”

Both Dr. Milev and Dr. Harkness are concerned by statistics that indicate that only about a quarter of people with depression ever seek treatment for their condition. Their hope is that the five-year CAN-BIND study, which is currently in its third year, will help more people by better supporting front-line care providers. “A lot of people don’t realize that depression is the single leading cause of disability worldwide,” says Dr. Milev, who also does research on stigma. “Being able to treat it effectively will not only help people who struggle with it – it will also help with the other medical and psychological conditions that go along with it. It really is a step towards more personalized medicine – and Queen’s is really a very essential part of the study.”

For more information on the CAN-BIND study, or to get involved as a patient, visit canbind.ca. In the Kingston area? call 613-548-5567 to get involved.

[photo of Dr. Terry Krupa: reducing stigma through social enterprise]
Dr. Terry Krupa: reducing stigma through social enterprise. (Photo by Bernard Clark)

Dr. Terry Krupa: reducing stigma through social enterprise

Dr. Krupa’s research interests lie at the intersection between persistent forms of mental illness and creeping marginalization. “It can happen quickly,” she says, explaining that people may have their social connections disrupted even before the first recognized experience of mental illness.

“A person could have a family, but that family has stopped expecting things from them or even hoping that things could be different for their family member,” she says. “He or she could also be on disability payments, meaning society has already said that you probably aren’t going back to work. These are the people who go the emergency room and nobody wants to help them. They are people who are also at an elevated risk of homelessness.”

Dr. Krupa, who has been at Queen’s for 25 years, says rather than only treating mental illness in these populations, the focus needs to be on ­decreasing their societal marginalization. That’s why she is studying how people move from being on the fringes of society to fully participating as citizens and enjoying life.

She says that one of the most significant barriers to integration is employment. “A typical way to think about getting people back to work is for us to ask ’what is wrong with you’ and then assume that if we fix what is wrong, we can fit the person back in (to the system),” she says, explaining that the result is that too many people are asked to squeeze, unsuccessfully, into molds that don’t fit. When it doesn’t work out, stigma grows. “If that is going to be the only approach we are going to use to tackle such high unemployment, we really have to ask ourselves, what is the likelihood that we will ever make a dent in the bigger problem?”

That’s why Dr. Krupa, who does all her research in the community, is involved in the development and evaluation of what she calls ’social businesses’: everything from cafés to landscaping companies that are established and run by the members of specific marginalized communities using a social enterprise model. “We know that one of the best ways to reduce stigma is to increase pro-social contact,” she says. “With these examples, you are seeing people living a post-recovery life.”

We should be aiming to help people live the fullest life that they can.

Dr. Krupa, who has regularly employed people with a history of mental illness as research assistants and collaborators, says the model not only helps people get back on their feet – it saves money by helping people move towards more independent living, rather than institutionalization. Dr. Krupa says it also benefits communities when everyone knows he or she
has a way to contribute. “You can have a serious mental illness and you can experience recovery,” she says. “We should be aiming to help people live the fullest life that they can.”

[photo of Queen's staff, faculty and students with a sign "Focus on mental health"]