The pathways project: Evaluating the transition of psychiatric services from hospital to community

Deinstitutionalization is the process and implementation of the transition of mentally ill individuals to community-based care. Although the rationale for transition from hospital-based to community-based care can be understood in terms of the desire to improve the quality of life of those living with mental disorder, the reality of resettling large numbers of previously institutionalized patients in the community raises questions about the potential risks and benefits for patients, their family members, and the public. Riverview Hospital, once Canada's largest psychiatric hospital, currently cares for the most chronically ill patients in BC, all of whom will be transferred to Tertiary Regional Psychiatric Facilities in the coming years. This significant restructuring of health care delivery provides a rare, naturalistic research opportunity to document the practical, clinical, and social implications of transferring psychiatric services to community-based settings.

Prior to transfer from hospital, Dr. Tonia Nicholls’ team will conduct a detailed evaluation of each patient’s clinical (e.g. physical health, psychiatric symptoms), (b) behavioural (e.g. suicide, self-harm, aggression, activities of daily living), and (c) psychosocial (e.g. consumer satisfaction, quality of life, stigma) status. After moving into a community care setting, each patient will be re-assessed several times to determine what, if any, changes are found. The study will evaluate to what extent closing Riverview Hospital has intended and unintended consequences. Specifically, Dr. Nicholls will study rates of homelessness, criminalization, and the transinstitutionalization experiences and health system utilization (e.g. contacts with police, admissions to correctional and forensic facilities, emergency room visits) of this cohort of individuals with severe mental illness.

In addition to patient interviews, information from patients' family members and peers, as official record databases will also be used in this study. Through a comprehensive evaluation of the process and outcomes of transferring psychiatric care to community settings, her work will demonstrate the implications of deinstitutionalization at both an individual and community level and will serve to inform future practice and policy decisions.

Functional dysconnectivity of hippocampo-prefrontal neural systems in Schizophrenia

Schizophrenia is a brain disease that affects one per cent of Canadians — more than 300,000 people — causing hallucinations and disordered thought . Early intervention and prevention of relapse are key to minimizing the impact of schizophrenia on individuals and society, and an understanding of the brain changes that lead to first episode and relapse are important for achieving preventive care. Major aspects of schizophrenia include memory dysfunction and reality distortion, such as hallucinations and delusions. The brain systems that underlie these symptoms appear to involve neural systems in the hippocampo-prefrontal regions of the brain. While these neural systems exhibit a high degree of connectivity in healthy subjects, it is thought that dysconnectivity may be an underlying cause for schizophrenic symptoms. To demonstrate the role of impaired neural connectivity in schizophrenia, Dr. Todd Woodward is conducting neuroimaging studies to identify and characterize two hippocampal-prefrontal neural systems associated with schizophrenia. This functional and physiological understanding of the disease may allow for better prediction of first episode and relapse, in order to maximize early intervention.