Breaking down the silos of mental health care

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The traditional approach to treating a person with schizophrenia who is admitted to hospital would be to focus on the patient's intrusive thoughts and paranoid delusions, and usually administer an antipsychotic drug. But scientists, clinicians and researchers working at the University of British Columbia's new Djavad Mowafaghian Centre for Brain Health offer a different approach. If this same potentially delusional, troubled individual were to walk into the $70-million centre in Vancouver, he or she would of course get a clinical assessment and also undergo a comprehensive neuropsychological assessment to hopefully shed light on the initial cause of their disorganized thinking and cognitive deficits.

It's an innovative, progressive approach that aims to bridge the research/clinical gap that too often exists in many health-care facilities. By taking a multidisciplinary and collaborative tack to studying brain-related disorders, Dr. Anthony Phillips, senior research professor at the centre, says they want to create an environment of "information sharing" between experts in neuroscience, psychiatry and neurology, all under one roof.

"It's this idea of having specialists working alongside one another, in one facility, who are aware these disorders [such as multiple sclerosis, Alzheimer's, Parkinson's and depression] are quite complex," says Phillips. "We are trying to create an atmosphere where we are breaking down the silos, and thinking about the patients and all the complexities of their conditions. Basically, it's a horizontal integration between clinical and research specialties. This is where we see solutions to these illnesses coming from."

Jon Stoessl, interim co-director of the centre with neuroscientist Brian MacVicar, says the cutting-edge facility hopes to break down traditional divides in medicine, bringing multiple disciplines into one easy-access place of healing. "For many years, neurology and psychiatry tended to work as separate entities – with clinical and research entities also often at a bit of a distance," explains Stoessl, who is also head of neurology at UBC. "We also hope patients will agree to volunteer for research projects taking place on-site."

The centre will house research labs in concussion, stroke, addiction and healthy aging. Phillips says the brain tissue and DNA bank will preserve donated patient material, which could be used in future to identify genetic risk factors for diseases.

"Take someone with Parkinson's, for example," says Phillips. "Traditionally, we have thought of it as a motor disorder, with people slowing down, perhaps developing tremors. For a long time [the motor dysfunction] was the focus of the therapy and was treated with drugs. As the disease progresses, many people start to complain about mood disorders, and feeling down or depressed. Earlier, depression was thought of as a secondary consequence that came as a result of knowing that you are seriously ill," he says. "But it's not. It's a second disorder the people are manifesting. For many years, psychiatric problems would not be attended to right off. A person who comes to our centre will be assessed for their psychological state at the same time they are assessed for their motor problems."

Fifty-four year old Marilyn Lenzen, who has MS, says the facility – with its cross-section of physicians from diverse fields – offers her new hope. "This building houses everything that patients such as me require – treatment, assessment, and end-phase clinical trials. They hope to accelerate research by taking the 'bench-to-bed' approach," says Lenzen, who goes to the centre's MS clinic.

"The clinicians here are looking for what else they can do," Lenzen adds. "They are not looking at the status quo. It's not just drug therapy. Their thrust is incorporating alternating forms of treatments so people get the latest and best possible care."

Brain dysfunction affects one in three Canadians at some stage of their lives, at a cost to governments of more than $30-billion annually. Brain-related illnesses are expected to overtake heart disease and cancer as the leading cause of death and disability in Canada by 2020. And a new American study, published this past week in the medical journal Neurology, says Alzheimer's disease contributes to almost as many deaths in the United States as heart disease or cancer.

Dr. Phillips calls the Centre for Brain Health "an exemplar" of where we're going in brain-related treatment and research. "Currently, brain-related illnesses cost governments $1-trillion worldwide," he says, "and one of the most prominent and urgent diseases is dementia – the aging brain and the loss of normal cognition and memory. Facilities like this show Canada's burgeoning commitment to position itself as a major player in brain health research and treatment."