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Why are some mental health patients unresponsive to traditional treatments?
It's a recurring question for those working in mental health, and one Dr. Suze Berkhout wants to answer.
The new clinician investigator with UHN's Centre for Mental Health believes that a better understanding of how people's experiences in healthcare impact their treatment, and the connection between physical and mental health are good places to start.
"You can't turn mental health care into an algorithm all the time," Dr. Berkhout says. "There is a big importance in understanding people's lived experiences."
These prominent grey areas and their ambiguity have long attracted Dr. Berkhout – first when completing her PhD in feminist philosophy, then experiencing psychiatry as a medical student – and ultimately landed her in an area of research where both intersect.
Obtaining her medical degree and PhD as part of the dual MD/PhD program at the University of British Columbia, and completing her residency at the University of Toronto, Dr. Berkhout looks forward to calling UHN her "work home" as she settles into her new role.
Being a clinician investigator allows her to spend half of her time on her research interests, and the other half mainly working as a psychiatrist in the Psychiatric Inpatient Unit at Toronto General Hospital, and also occasionally in the Psychiatric Emergency Services Unit at Toronto Western Hospital.
Feminist perspective infused in everything she does
Instead of working with big numbers and math in her research, Dr. Berkhout is more interested in using storytelling to think about larger systemic, structural and institutional challenges and issues.
She says her clinical work is deeply informed by the theoretical insight gained through her work in philosophy, and while she won't be working specifically only with women, her feminist perspective is infused in everything she does.
For example, even when Dr. Berkhout is working with men, she is considering the issues of masculinity and the impacts on patient's experience.
This perspective often leads her to think about issues around how people's different identities intersect with one another, including people's cultural backgrounds, gender, sexual identity, class and ability. Then, she further explores the relationship between those things and power structures.
After compiling this research, Dr. Berkhout hopes to be able to better analyze why mental health patients experience treatment resistance, or refractoriness, the medical terminology for patients who are unresponsive to traditional treatments.
According to the Austen Riggs Center, a psychiatric treatment facility in Massachusetts, these are patients who don't respond to the typical first, or even second and third line of treatments. These issues are seen more commonly in patients with mood and anxiety disorders, substance use disorders, post-traumatic stress disorder and eating disorders.
"The medical system is driven by hopes for the future, hopes for cure, hopes for people in those kinds of ways," Dr. Berkhout says. "So, when a patient is faced with treatment refractoriness, or resistance, and it feels like they're at the end of the road, how do we understand that and help make people's lives livable in those kinds of spaces? How do we work with the challenges?"
Within the next year, one of the big-picture ideas Berkhout is interested in laying the groundwork for is a research program that allows her to explore these questions further.
Exploring the realities of navigating the healthcare system
When completing her PhD, Dr. Berkhout was working on a project that looked at issues that would arise for women trying to navigate the complex healthcare system in Vancouver. They were often homeless, living with HIV, using substances, living in the downtown east side and trying to access HIV services.
Berkhout says there was this real thought that the problem was barriers at the door, blocking women from getting through the door and accessing care. As a result, a lot of attention and epidemiological work has been looking at what these barriers are.
One of the benefits her background in philosophy gives is the ability to look at it from a different angle. The problem wasn't access, the problem was navigation.
"People were accessing care, but it was their experiences in accessing that care, in the healthcare system, particularly in relation to their very marginalized identities – women, drug users, many working in the sex trade, impoverished and HIV positive," Dr. Berkhout says.
Berkhout explored how these social identities shaped their experience in the healthcare system and how that translated into their ability to engage in recommended treatments. This is one example of how her philosophical thinking intersects with medicine.
Coming to Toronto for the abundant research environment and opportunity, Dr. Berkhout continued doing similar work focusing on people's social identities and issues of power and hierarchy in the healthcare system.
"The dedicated time and space to conceptualize how to build and grow meaningful projects is one of the benefits of being a clinician investigator," she says. "My hope is that these projects will make important changes in how health systems work or in people's day-to-day experiences in navigating the healthcare system."
Dr. Berkhout also hopes to continue to publish this research in different venues (academic and public) and build on projects she has been working on in collaboration with others. She also hopes to return to Canada's North soon as she enjoyed working in communities in Nunavut during her residency and wants to continue that work.