The Psychiatry Program at CHÉOS conducts research in mental health services, virtual care, psychotherapy, dementia care, and concurrent disorders with research goals that focus on the most important and relevant mental health questions.
The Psychiatry Program at CHÉOS is driven by a passion for patient care and innovation in mental health. Our research harnesses a unique set of resources — scientific expertise, access to patients and community, collaborative partnerships, and the capacity for large-scale and longitudinal studies — to focus on the most important and relevant mental health questions.
The Program includes a diverse group of research members covering a broad range of research areas at Providence Health Care. We are interested in leveraging clinician research potential, promoting evidence-based mental health care, and ensuring that everyone can become an active member of research teams. Now a CHÉOS research program, this group of investigators works in close collaboration to develop study protocols, analyze data, and share results through publications and other platforms.
Mental health clinicians at Providence Health Care provide care and treatments to individuals across a range of services from acute care to tertiary mental health services. In our acute care program at St. Paul’s Hospital, we see on average 700 patients each year, many of whom present with complex health and social issues. We offer a range of specialized services, including reproductive and geriatric psychiatry and are a provincial centre for eating disorders care. As a group of clinician–researchers, our research aims to:
Dr. Russolillo brings extensive clinical expertise from acute and community mental health and substance use settings serving in nursing leadership and frontline clinical roles for nearly 15 years.
The primary research & methodology areas the Psychiatry Program undertakes are:
Reimagining Perinatal Mental Health Services: Collaborative Development Of An Integrated Model Of Care (Project link)
Co-leads: Dr. Emily Jenkins and Michelle Carter
Team Members: Wendy Hall, UBC; Angela Russolillo, SPH; Brittany Bingham, VCH; Christine Ou, UBC; Valerie Rychel, SPH; Sheila Duffy, Pacific Post-Partum Society; Nichole Fairbrother, UBC.
Perinatal mood and anxiety disorders (PMADs) are the most common obstetrical complication in Canada, with serious implications for both the mother and infant. Untreated PMADs are associated with increased risks for poor health and social outcomes, including maternal suicide and medical complications as well as impaired infant and child development. There is increasing scientific evidence that collaboration across clinical services is essential to addressing the complex bio psychosocial needs associated with PMADs. Nevertheless, perinatal mental health (PMH) services in Canada remain fragmented, often resulting in missed opportunities to support necessary care and treatment. There is an immediate need to improve the access and integration of services for PMADs in BC. In an effort to narrow the evidence to practice gap, we plan to create a collaboration between clinicians, researchers and individuals with lived experience through a scientific consensus process (Delphi approach) and one-day virtual workshop. Our main objective is to develop an evidence-based, user-informed model of care to advance integrated PMH care delivery in BC and beyond.
Redesigning health care for concurrent disorders: The role of multimorbidity in complex co-occurring psychiatric and substance use disorders (Project link)
CHÉOS lead: Angela Russolillo
Project Summary: Individuals with both psychiatric and substance use disorders, defined as concurrent disorders, are more complex to diagnose and treat due to several interacting health and social challenges. In the absence of appropriate treatment people with concurrent disorders are at high risk for increased morbidity and mortality. A growing body of evidence recommends abandoning the traditional single-disease health model in favour of a multimorbidity approach to care. Despite available evidence, important gaps persist in our understanding of how individual and health system context influence service utilization and outcomes for people with complex multimorbid disorders (e.g. concurrent disorders). The proposed research will establish a prospective cohort of individuals with a concurrent disorder. Individuals will complete a series of brief questionnaires and provide consent to use their personal identifiers for linkage to a number of health databases. This research offers a unique opportunity examine health outcomes associated with multi-morbidities and understand patterns of health care utilization overtime. This research will advance knowledge to inform best practices and service reforms for the optimal delivery of care in BC.
CHÉOS lead: Angela Russolillo
Project Summary: A retrospective cohort study (2016-2020) examining the clinical and demographic characteristics of admitted psychiatric patients and their relationship to hospital service use (length of stay [LOS] and readmission) over time. This research will advance knowledge to inform best practices and service reforms for the optimal delivery of care.
Study Findings:
COVID 19 and Psychiatric Inpatient Admissions: Recent findings from Dr. Russolillo and colleagues demonstrate associations between length of stay (LOS) and diagnosis type for psychiatric inpatients (St. Paul’s Hospital) during the COVID-19 pandemic. The admission rate of schizophrenia, delusional and non-organic psychotic disorders was significantly lower during the pre-COVID period, when compared to the during-COVID period and the admission of substance-related disorders was significantly higher during the pre-COVID period when compared to the during-COVID period. Manuscript pending.
Homelessness and Psychiatric Readmission: Recent findings from a retrospective cohort study found that homelessness at discharge was associated with a statistically significant and clinically meaningful increase in 30-day and 90-day readmission rates in a large comprehensive sample of adults diagnosed with mental illnesses and substance use disorders. Interventions to reduce the burden of readmissions among individuals experiencing homelessness, addiction and mental illness are critical. Our findings reinforce the urgent need to revise policies and practices addressing housing and social care. Manuscript pending.
Patient Experiences of Using Virtual Care — Outpatient Psychiatry
CHÉOS lead: Angela Russolillo
Project Summary: The COVID-19 pandemic has resulted in a significant increase in the use of virtual health services because of the need to limit face-to-face contact. We aimed describe the demographic characteristics of patients accessing virtual health service and measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. Results support ongoing need for virtual health services post COVID-19 pandemic. Patients reported feeling extremely satisfied or satisfied with the overall virtual health experience noting positive experiences across several care quality domains.
Development and Implementation of a Clozapine Toolkit in Inpatient Psychiatry (Poster link)
Michelle Carter…., Angela Rusollillo, Joseph Puyat.
CHÉOS lead: Angela Russolillo
Project Summary: Individuals with both a psychiatric and substance use disorder are at increased risk for drug related death. Harm reduction interventions such as take home naloxone and safe injection sites are known to reduce the risk of over dose death; however, evidence uses poor uptake in acute psychiatric settings. Clinician attitudes, stigma and provider specialization are factors impacting the implementation of harm reduction best practice. Our study seeks to explore health care provider attitudes towards substance use and examine substance use assessment and documentation practices by health care provider.
Project Summary: A survey based on the Brief Substance Abuse Attitudes Survey was conducted in a convenience sample of mental health care providers at a single tertiary care hospital between May and June 2022. Our study found that postgraduate education contributes to less stereotyping attitudes and a higher level of treatment optimism when working with individuals with substance use or dependence. These findings highlight important dimensions of health care provider attitudes that could improve harm reduction education and integration into clinical practice. Manuscript pending.
CHÉOS lead: Angela Russolillo
Project Summary: Individuals presenting with concurrent disorders have historically encountered a treatment system that has been ill-prepared to meet their needs. Despite evidence that individuals with a single diagnosis are a clinical minority, integrated management approaches are rare in the current medical system. We aim to bring health care providers,researchers and patients/families together through a Delphi study. The study will be achieved through a series of questionnaires ranking items of high importance for integrated treatment. Items reaching consensus will be prioritized for inclusion into a clinical framework to support pragmatic approached to service delivery. Project link.
CHÉOS Scientist Dr. Joseph Puyat helped design the evaluation of the toolkit, in collaboration with colleagues at St Paul’s and VCH
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Dr. Joseph Puyat joins a team of point-of-care clinicians led by Michelle Carter, a Clinical Nurse Specialist in the Mental Health Program at PHC
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