Poor mental health – especially depression, anxiety, and PTSD – is associated with slower recovery from physical illness, higher rates of hospitalization and readmission, and increased mortality.
That's why UHN is a leading proponent of deploying consultation-liaison (C-L) psychiatrists in concert with patient treatment and recovery. UHN has the largest contingent of C-L psychiatrists in Canada.
These 29 C-L psychiatrists collaborate closely with medical teams, providing seamless, human-centered support with dedicated teams at four sites. The C-L psychiatrists support inpatient care, accept referrals from any UHN medical team to an outpatient clinic, and are embedded in cancer care and transplant programs.
"It's what makes us unique," says Dr. Adrienne Tan, Associate Program Medical Director, UHN's Mental Health Program. "We have world-class medical care and we can provide specialized mental health care — before, during, and after treatment. That's where UHN leads."
In May 2020, the Royal College of Physicians and Surgeons of Canada recognized C-L Psychiatry as an Area of Focused Competence (AFC), a designation that sets in motion the creation of national standards that allow the University of Toronto (U of T) and other Canadian medical schools to provide physicians a one-year, advanced training program in this area. (Similar education opportunities are well-established in the United States, United Kingdom, Australia and New Zealand.)
Achieving recognition was no small feat. "The Royal College doesn't grant discipline recognition easily — they worry about fragmenting specialties," says Dr. Brian Hodges, UHN's Executive Vice-President, Education and Chief Medical Officer, as well as a psychiatrist and past president of the Royal College.
"This is a rare achievement, reflecting the importance of bridging psychiatry with hospital medicine and patient care."
UHN will serve as Canada's anchor site for this new training program. Dr. Alan Wai, a clinician-teacher within the division of Medical Psychiatry in UHN's Mental Health Program and member of inpatient, outpatient and transplant C-L teams at Toronto General Hospital, will be the inaugural program director. The program will be open to senior psychiatry residents and practicing psychiatrists.
"UHN is uniquely positioned to lead this training because of the depth and breadth of our medical and surgical services and the strength of our C-L psychiatrists, the most extensive in the country," says Dr. Tan.
Another fitting reason UHN will serve as the anchor site is thanks to the key role several UHN staff psychiatrists played in its creation. This includes Dr. Susan Abbey who led the initial push for recognition more than 15 years ago. Drs. Tan and Raed Hawa helped develop the national training standards as part of a Royal College working group, and, Dr. Rima Styra, continued to advance the initiative as Director of U of T's Division of C-L Psychiatry.
While the AFC program will shape the future of C-L psychiatry in Canada, UHN's patients are already benefiting from this specialized care. On a recent afternoon at West Park Healthcare Centre's geriatric rehabilitation unit, UHN geriatric C-L psychiatrist Dr. Ju Eun Lee, supports older adults recovering from falls, fractures or serious illness.
Many face the loss of independence and the challenges of life-limiting conditions.
"These are individuals who may have had delirium, mood and anxiety symptoms, or cognitive decline," she notes. "Psychiatry plays an important role in supporting their recovery."
Dr. Lee manages cognitive assessments, medications and psychiatric conditions while helping educate teams unfamiliar with mental health care in a rehabilitation setting.
Referrals come from Dr. Jamal Depradine, West Park's geriatrician, and patient plans are developed in collaboration with general practitioners and allied health staff.
"Dr. Lee has been a significant addition to the Geriatric program at West Park," says Dr. Depradine. "We are caring for increasingly complex patients – physically, socially, cognitively and psychiatrically and this requires a multi-disciplinary approach. With her clinical expertise, collaborative spirit and kindness, Dr. Lee is very much improving the lives of our patients."
During her rounds with patients recovering from strokes, chronic illnesses or surgeries such as amputations, Dr. Lee's approach is engaging and attentive. She leans in slightly, maintains an open posture and uses hand gestures and head nods to foster a supportive connection.
She reviews psychiatric and sleep medications, making notes to coordinate with their medical team or, in some instances, a family physician, ensuring a safe discharge.
Using active listening and motivational techniques, she helps patients take small, practical steps toward recovery. For example, with a patient who has withdrawn from physiotherapy and struggles with apathy, she negotiates that their next consult take place on one of West Park's outdoor patios – a small behavioural change to re-engage them in rehabilitation.
"It's about supporting patients through prolonged hospitalizations and determining how I can help them return home safely," she explains.
From Dr. Lee's hands-on work at West Park to the Mental Health program's leadership in establishing Canada's first AFC in C-L Psychiatry, UHN is advancing its strategic goal of integrating physical and mental health across care settings.
"What we are building at UHN will guide how hospitals across Canada bring psychiatry and medicine together," says Dr. Hodges. "Our goal is a future where every patient's recovery includes attention to both mind and body."
