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CAMH Stories Centre for Addiction
and Mental Health

CAMH making integrated care for depression and alcohol dependence a reality in Ontario

Nearly 30,000 Ontarians a year live with both depression and alcohol use disorder. For those who do receive care, it is often fragmented, and many people find themselves in and out of treatment centres with no coordinated plan for how to get better. Now, with leadership from CAMH experts who have developed a new, evidence-based approach, change is underway.

On June 10, CAMH was awarded an Adopting Research to Improve Care (ARTIC) grant from the Council of Academic Hospitals of Ontario and Health Quality Ontario. The ARTIC program will assist CAMH to collaborate with eight centres throughout Ontario to implement a new model that treats both conditions simultaneously – and with proven better outcomes.

The new ARTIC project is called Depression and Alcoholism – Validation of an Integrated Care Initiative (DA VINCI), and is co-lead by Saima Awan, Senior Manager of the Integrated Care Pathway Program at CAMH, and Dr. Andriy Samokhvalov, Psychiatrist and Clinician-Scientist with the Addiction Medicine Service and the Social and Epidemiological Research department in CAMH.

“Our goal is to affect the healthcare landscape in Ontario by reducing the overall prevalence of active cases of major depressive disorder concurrent with alcohol dependence,” says Dr. Samokhvalov.

“Other areas of medicine are quite ahead of the game in terms of evidence-based practice,” says Saima Awan, pointing to cancer treatment as an example of a rigorous, evidence-based approach applied consistently across hospitals. “This project is bringing that model to mental health and addictions.”

ARTIC announcement image
CAMH’s Saima Awan (left) and Dr. Andriy Samokhvalov (right) with Karen Michell, Executive Director of the Council of Academic Hospitals of Ontario, and Dr. Joshua Tepper, President and CEO of Health Quality Ontario, at the ARTIC announcement

Better patient results

Major depressive disorder and alcohol dependence frequently go hand in hand, but they are often treated at different times and by separate providers. “When they are treated separately, the two conditions rekindle each other and lead to poor results for patients,” says Dr. Samokhvalov.

The new treatment approach is called the Integrated Care Pathway for Major Depression and Alcohol Dependence, developed at CAMH and launched in December 2013.

“People with both major depressive disorder and alcohol dependence are now getting truly integrated care,” says Saima Awan, who led the process of creating this Integrated Care Pathway. Over the course of a 16-week outpatient program, participants receive scheduled treatments that include a combination of medications and psychotherapy addressing both conditions at the same time. Four specialists ¬– a physician, a psychologist, a pharmacist and a nurse – work collaboratively to provide care.

“We found that patient outcomes were superior to treatment as usual, with significantly better treatment retention,” says Dr. Samokhvalov.

ARTIC event speech
Dr. Andriy Samokhvalov and Saima Awan speak as part of the ARTIC event

Extending across Ontario

Under the new DA VINCI project, the CAMH team will partner with eight centres across the province to spread this treatment approach: Toronto Village Family Health Team (FHT), Hamilton FHT, South East Toronto FHT, Taddle Creek FHT in Toronto, Royal Ottawa Health Centre, North Bay Regional Health Centre, Trillium Health Centre in Mississauga and Toronto, and University Health Network in Toronto. Two other sites have also expressed an interest in learning more about and potentially joining the project.

Currently, the CAMH team is working with sites to prepare for the implementation, with a target to pilot the project in October 2015 and be fully operational across all sites by early 2016. The goal is to treat 500 to 800 patients over the course of the project.

The model will be customized to each site’s specialists – for example, some sites do not have pharmacists – and the unique population each site serves. The rollout of the model will involve a hands-on process, including the CAMH team providing in-person coaching and guidance to implement the model at each site.

At CAMH, the aim is to expand this treatment approach, including enlarging the team to see more patients and reduce the wait list for clients, which acts as a setback to obtaining treatment. Currently, clients receive this integrated treatment through CAMH’s Addiction Medicine Service. Soon, two clinics that are part of CAMH’s Ambulatory Care and Structured Treatment also will begin offer this treatment.

“It’s a big honour to be selected in the ARTIC program,” says Dr. Samokhvalov.

The program is “highly competive,” says Saima Awan, drawing submissions from all fields of medicine and healthcare facilities throughout the province.

The future of treatment

The Integrated Care Pathway (ICP) for Major Depression and Alcohol Dependence is one of seven ICPs developed to date at CAMH, which are proving to be successful models for treating mental health and addictions.

“These types of initiatives are promoting areas previously not thought of in the treatment of mental health and addictions,” says Saima Awan. For example, she says, the Integrated Care Pathway for Major Depression and Alcohol Dependence takes a new approach by combining measurement, clear medical algorithms, non-pharmacological interventions, and an interdisciplinary team. “These types of approaches will be the future in mental health and addictions,” she says.

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