LHSC Based Services
Adult Eating Disorder Program
The Adult Eating Disorders Program (AED) is a community-based program provided by London Health Sciences Centre and the Canadian Mental Health Association (CMHA) Middlesex. This program has been developed to meet the needs of adults who require treatment for anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorders. We offer a wide range of programming that includes outpatient, day treatment, residential and relapse prevention services. Our commitment to the LHSC values and our Mental Health and Addictions program vision focuses our work on compassionate, client-focused interventions at the center of our care model. We utilize our abilities to incorporate evidenced-based work with curiosity for new ways to meet our patient needs to drive the best program and service delivery. We highly value the role of education and research for all disciplines. The multidisciplinary team includes administration, community mental health workers, dietitians, nursing, medical team, psychology, and social work as the main disciplines that provide the care for our patients.
Eating disorders consist of a disordered relationship with food that can involve both under eating and overeating. Individuals who struggle with an eating disorder find that at least one or more aspects of their lives are significantly affected negatively. Eating disorders can occur at any age and significantly impact the social, psychological and behavioural aspects of one's life.
Currently, we treat adults 18+ yrs. of age that are impacted with anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, and other specified feeding and eating disorders.
Centralized Emergency Psychiatry Service (CEPS)
The Centralized Psychiatric Service (CEPS) is a service housed in the Emergency Department at Victoria Hospital set up to cater for patients presenting in an emergency in a mental health crisis. There is a psychiatrist on call at any time working collaboratively with social workers, residents, medical students and psychiatric nurses.
When patients present to the hospital in an emergency with a mental health problem, they are initially assessed by Emergency Room physicians to ensure that they are medically stable and have symptoms that can best be managed by psychiatry before being consulted to CEPS.
CEPS is set up to cater for adults presenting in an emergency with a variety of mental health problems. The Medical Director for the CEPS Dr. Jedrin Ngungu states: “Our role is to provide comprehensive assessments of all patients referred to us in a professional and compassionate way, utilizing all the skill sets of the different professionals working in CEPS. Following the assessment, a determination is made as to the best care pathways for each patient, ranging from admission to our inpatient units, referral to our Urgent Psychiatric Service or referral to other outpatient programs and services.”
Consultation-Liaison Service
Consultation-Liaison Psychiatry is a specialized service that cares for patients with the mental health concerns while admitted to hospital for physical health concerns. The primary mandate is to provide timely psychiatric consultation to adult patients admitted to medical/surgical units at the University Hospital and Victoria Hospital sites. The service provides an interprofessional model of care, including psychiatry, psychology and nursing. The past year has reflected many changes within the Consultation Liaison team. Dr. Mahesh Nachnani was welcomed as our much needed second Consultation Liaison Psychiatrist. We also welcomed 2 new nurse case managers, Krista Fink and Isabel Facey. According to Service Leader, Dr. Jennifer Barr, goals for the upcoming year include: recruitment of Consultation Liaison Psychiatrists, ongoing service focus on education of psychiatric residents, psychology residents, off-service residents, medical students, and our medical colleagues. Another important goal is to work with existing outpatient mental health resources to facilitate pathways to care for bedded medical and surgical patient.
FEMAP (First Episode Mood and Anxiety Program)
FEMAP provides ambulatory psychiatric services for emerging adults aged 16-25 experiencing mood and/or anxiety disorders, with or without secondary substance use, in the early stages of illness. There are exclusion criteria for youth with prolonged histories of psychiatric treatment, primary substance abuse/dependence, and significant cognitive deficits.
FEMAP sees approximately 200 new emerging adults per year and has over 3000 patient visits per year. Treatment begins after an in-person intake to evaluate each emerging adult’s history, symptoms, functional challenges, needs, and social circumstances. Treatment at FEMAP may include psychotherapy, psychopharmacology, family therapy, addictions therapy and group therapy, depending on the goals of the emerging adult and illness characteristics. The team works together to help provide what is needed to help the young person return to optimal functioning.
FEMAP does not require a physician referral, but must speak by phone with the emerging adult seeking treatment. Because FEMAP is not funded by the Ministry of Health it must raise money from charitable donations and research projects to stay open. As such, research participation for heath systems evaluation is required for entry into FEMAP. There is a wait list for entry into the Program, but expansion to a second site is imminent and that should reduce the wait for entry.
FEMAP conducts clinical research on emerging adult populations. Research activities at FEMAP have included:
- Functional brain imaging into the pathophysiology of mood disorders, marijuana use, self-injury and other aspects involving the neurocircuitry of reward-processing.
- Systems evaluation research for the model of FEMAP as a clinically-effective and cost-effective paradigm.
- Clinical evaluations of individual aspects of treatment at FEMAP such as the stabilization group therapy program or the anxiety group therapy program.
- Recent research on the effects of the COVID-19 pandemic on FEMAP clientele and the impact of the pandemic on cannabis use.
GAAMHS (General Adult Ambulatory Mental Health Services)
In keeping with the overarching principle of right patient, right service, right time, the General Adult, the largest ambulatory service in the Division, GAAMHS provides a variety of outpatient based services for patients and their families in the London-Middlesex County area. Ambulatory Service will continue its primary focus on access to treatment and flow of patients from the three primary areas of referral, inpatients, community, and emergency department. All referrals to ambulatory care service are received via Centralized Access Point (CAP). Clinically, the service will try to prevent barriers to treatment by maintaining broad-based inclusion criteria. In addition to individual assessments and pharmacological treatment, group psychotherapy streams exist for CBT, DBT and Traumatic stress. GAAMHS also provides specified groups in a Track to Wellness format: Stabilization skills, Activation skills, and Managing Emotions skills. This helps to further identify subsequent treatment streams patients may move on to, as well as assist in transitioning patients from hospital. Bridging team was introduced in 2019 as a pilot project to facilitate discharges from in-patients and emergency department.
Inpatient Services
Inpatient services comprise one of the biggest units of the department. It is also where most of the resident and medical student teaching takes place. There are a number of specialist units that are part of this service; these are the Psychiatric Intensive Care Unit, the Geriatric Behavioral Unit, Short Stay Unit and the general non-specialized units.
Medical Director for the service Dr. Jedrin Ngungu states: “we continue to provide excellent evidenced based care for our patients using a team-based approach with emphasis on ongoing quality improvement. Processes are regularly reviewed as feedback is received from all stakeholders, especially our patients”.
Teams comprise psychiatrists, social workers, occupational therapists, nurses, neuropsychologists, spiritual care practitioners, residents and students. A number of therapeutic groups run daily focusing on skills building and brief psychotherapeutic interventions.
The past year has seen some major developments which have improved the care of our patients. Chief of these is the opening for the first time of the Short Stay Unit focusing on the management of patients needing only a maximum of 72 hours hospital stay. This together with close collaboration with more resourced outpatient services has resulted in a significant reduction in patients’ length of stay on the inpatient units.
The service’s popularity and reputation continues to grow and attract both locally trained and international graduates. This year we have seen a number of new recruits join the service with a few more anticipated to start second half of this year. We are especially excited to welcome our own cohort of residents to the team.
PEPP (Prevention & Early Intervention in Psychosis
Program Highlights of PEPP, Physician Leader, Dr. Julie Richard.
The PEPP program continues to provide innovative, compassionate, evidence based care for clients with first episode psychosis and their families. We provide intensive assessment, psychiatric treatment and case management to clients experiencing their first episode of psychosis under the age of 35.
2017 marked our 20th anniversary as one of the original first episode psychosis programs in the country. To mark the event, PEPP hosted a conference entitled, “Intervening Early in Psychosis: Opportunities Ahead for the Next 20 Years,” attended by several key figures in psychosis research.
At PEPP, we continue to have a strong belief in patient and family centered care. PEPP manages to maintain a no-wait list and no referral required policy despite a record number of new admissions.
We continue to recognize our clients’ diverse needs during recovery from psychosis. In addition to the core components of care, our program has been able to provide additional interventions for our clients including a Voice Hearer’s cognitive behaviour therapy (CBT) group and the very cutting edge Action Based Cognitive Remediation group.
We remain very grateful for our client and family volunteers who are such an important part of our PEPP community. We currently have approximately 20 client volunteers who are actively involved in various aspects of the program. Our PEPP family support group has is second to none in supporting the needs of our community through peer support to other families, advocacy to reduce stigma, and donations of essential items such as food and clothing that are so appreciated by our clients in need. The PEPP family support group was recently honoured with 2019 CMHA Mental Health Champion award for their years of dedication and service to our program.
Research Highlights:
Over the past five years, our research program has primarily focused on neuroimaging to unravel the brain changes that contribute to the onset of psychosis. We achieve this by studying patients in all phases of psychotic illness from prodromal stage (before the onset), anti-psychotic naive first episode stage, as well as those on established treatments. In addition, we continue to investigate the treatment effects, long term course as well as the societal and economic impact of this illness that help to set standards for early intervention programs across Canada. One of the developments from this research is the new PROSPECT program that supports individuals from a prodromal stage, even before the onset of full psychotic episode, with an aim to prevent or delay psychosis.
The PEPP physicians were the recipients of the LHSC President’s Award in 2019, accepted in honour of Dr. Raj Harricharan, longstanding and inspiring PEPP physician whom we lost that year. We will continue to carry out his commitment and vision for our program.
Urgent Consultation Service (UCS)
The mandate of the UCS is to provide a timely response to patients in need of urgent ambulatory mental health assessment whether referred by family physicians, the Emergency Departments at LHSC, and SJHC Urgent Care Clinic.
