The University of Toronto and Mental Health as We Age

Address to the Annual General Meeting of the University Arts Women’s Club

April 17, 2014

The Hon. Michael Wilson, P.C., C.C., B.Com., LL.D.
Chancellor of the University of Toronto

Thank you, Dr. Rudzik, for that kind introduction. And thank you to Sue Russell for inviting me to speak. It’s an honour to address the University Arts Women’s Club. I am especially pleased to do so on a topic that matters a great deal to me, and I expect to all of us.

There is a great deal to say about the contribution of the University of Toronto to the advancement of mental health – and in particular, mental health as we age. There is so much to say that in fact it’s difficult to organize the material.

So I’d like to give you the “chapter headings”, if you will, of what I plan to cover today. First, I’ll try to set the cultural context with a couple of stories. Next I’ll say why U of T is uniquely suited for its role as a national and global leader in the field of mental health. And then I’ll present what I think is an amazing sample of recent initiatives and breakthroughs across the University, specifically in mental health and aging.

So, first, the cultural context – starting with a personal account of my own involvement in this crucial cause. I was first exposed to the suffering caused by mental illness when I was a Member of Parliament, and saw how some of my constituents were dealing with mental illness, some with tragic outcomes. To that point my not-for-profit work had focused on the Canadian Cancer Society, which of course is eminently worthy. But from then on I felt moved to focus my volunteering on the promotion of mental health.

And then, as many of you know, we lost a son to mental illness. During what should have been an exciting time of exploring all of life’s possibilities, Cameron lost all hope of those possibilities, and succumbed to his illness. So, I know firsthand what it is like to see all of the potential that your child holds, and have that taken away.

I spoke at Cameron’s funeral, in part to raise awareness among those who attended of the challenge of mental illness. Like others who began to speak up in those years, I found there was great interest. People began to ask me to make speeches; and after those speeches, people approached me with questions and to share their stories. Most often, they would begin by saying, “I’ve never talked about this, but…” while looking side to side. Talking about it was new; but the more people talked about it, the more progress we made.

Arnie Cader, as you may know, is a long-time volunteer and supporter of the Centre for Addiction and Mental Health (or, CAMH), one of the University’s partner hospitals. Arnie co-founded and was first chairman of the Clark Institute of Psychiatry Foundation. The Foundation was a big step forward – but at first, Arnie couldn’t get anyone to sit on the board. People he asked said, “If I do it, I’ll have to explain why. And I can’t talk about what happened to me and my family.”

Fortunately, business and community leaders did agree to sit on the board. Individuals and corporations began to make landmark donations. And CAMH now has a wonderful new, state-of-the-art campus on its Queen Street site, providing a model for the world in education, research, patient care, and community integration. Its programming includes an impressive array of geriatric mental health services.

There are many other examples of progress that we could point to. Suffice it to say that when it comes to mental health, the social context has changed enormously and for the better.

But there is still so much to be done, in the advancement of mental health and in mental health and aging. One in five Canadians – that is, one in five of us – will experience a mental illness or addiction in our lifetime. Today more than 400,000 Canadians and their families are dealing with Alzheimer’s disease. One-third of adults over the age of 85 have some form of dementia. Looking at our aging population, over the next 25 years it’s expected that this number will double. And it’s estimated that by 2040, neurodegenerative diseases as a whole could become the second-leading cause of death worldwide – surpassing even cancer.

Every single one of us in this room has been or will be affected by a mental illness or addiction –through an illness of our own or through a family member, colleague or friend. And stigma remains a barrier to access – only a third of Canadians who actually need care ever receive it.

But again, we are making progress. And the University of Toronto is leading the way, not only in the Toronto region, but also across Canada and around the world. This brings me to the second “chapter heading” in my talk today: Why U of T is uniquely suited for its role as a national and global leader in the field.

When speaking of mental health, it’s natural to think first of psychiatry, so I’ll start there. The Department offers the largest training program in psychiatry in North America – 25 per cent of English-speaking psychiatrists in Canada and 60 per cent of all psychiatrists in Ontario, were trained at U of T.

Its clinician-researcher stream is preparing the next generation of Canadian academic leaders in the field. And it is providing training opportunities in mental health for nurses, occupational therapists, and other health professionals. U of T is the only university in Canada accredited in all three subspecialties of psychiatry – child and adolescent, geriatric, and forensic. And the Department ranks first in Canada in publications and citations.

U of T psychiatry researchers have made breakthrough contributions – from the discovery of the brain dopamine deficiency, to pioneering work on eating disorders, sleep disorders, schizophrenia, and addictions, to the world’s first PET scanner dedicated to psychiatric research and treatment. Today U of T psychiatry is a national and global leader in brain imaging, epigenetics, personalized medicine, social research, and evidence-based psychotherapies, including cognitive-behavioural therapy and mindfulness.

And leaders in the Department are making a huge impact on public policy. Professor David Goldbloom, for example, is Chair of the Mental Health Commission of Canada, established by the federal government in 2007. In 2012, the Commission launched Canada’s first national mental health strategy – much of it informed by U of T research. The first of its six strategic directions is to promote mental health – across the lifespan – in homes, schools, and workplaces, and to prevent mental illness and suicide wherever possible.

So, clearly, the University of Toronto is a powerhouse in psychiatry. But as in all things at U of T, there’s a multiplier effect. Our astonishing breadth of disciplines, and our depth of excellence across the disciplines, makes U of T a massive magnet of talent. In turn this convergence of brilliant researchers enables highly productive collaboration on complex problems requiring expertise in several – often many – fields.

Now I’ve arrived at my final “chapter heading” – a very selective list of recent initiatives and breakthroughs across the University, relevant to mental health and aging. (Many of these I found in the U of T Research publication, Edge – I encourage all of you to have a look online or request a free subscription; it’s full of fascinating and encouraging news.) I’ll start in the field of medicine; but when I’m done I think you’ll see what I mean in speaking of a “convergence of brilliance” at U of T.

Recently President Gertler took part in a landmark announcement – the establishment of the Medical Psychiatry Alliance. This initiative was made possible by an anonymous lead donor, with matching funds from the Government of Ontario and the four founding partner institutions – U of T; two of our partner research hospitals, CAMH and SickKids, and Trillium Health Partners. It’s designed to fill a major gap in our health care system: the care of those suffering from simultaneous mental and physical illnesses, among whom there is a large and growing number of older people. And among them is a disproportionately large number of women.

Professor Paula Rochon is a geriatrician and Vice-President, Research at Women’s College Hospital, another of our partner hospitals. Her research explores how medical therapies impact the health of vulnerable older adults with multiple conditions – particularly women.

Also within the Faculty of Medicine, there is the Tanz Centre for Research in Neurodegenerative Diseases. As many of you will know, the Centre is led by Professor Peter St George-Hyslop, who with his team was the first to discover key mutations in proteins involved in the early onset of Alzheimer’s – a huge accomplishment which has made early diagnosis and treatment of the disease possible. He is also Director of the Strategic Research Collaboration on Alzheimer’s Disease. This initiative, jointly funded by the Wellcome Trust, the UK Medical Research Council, and the Canadian Institutes of Health Research, brings together some of the world’s greatest minds, from an amazing number of disciplines. Professor St. George-Hyslop is also a member of British Prime Minister David Cameron’s advisory council on dementia research, treatment, and care.

In the Department of Neurosurgery, Dr. Andres Lozano, who holds the Dan Family Chair, is a pioneer in the use of Deep Brain Stimulation (or, DBS) in the treatment of Parkinson’s disease. He is conducting very promising clinical research in applying DBS to the treatment of Alzheimer’s.

Let’s move now to the Lawrence S. Bloomberg Faculty of Nursing. Professor Kathy McGilton, who is also a senior scientist at Toronto Rehab, is making a difference in one of the most common – and often perilous – experiences of elderly people: recovery from hip fractures. She has observed that often health care professionals mistake post-surgery cognitive impairment for dementia. As a result, they may send patients to long-term care facilities, instead of to rehabilitation centres where they can be treated and helped to return to their homes. To help ensure patients are directed to rehabilitation whenever possible, Professor McGilton and her colleagues have developed more gerontology-related content for nursing curricula.

On to the Dalla Lana Faculty of Public Health… Professor Pia Kontos is helping nursing-home staff to deepen their understanding residents with dementia. Her research shows that even people with advanced cognitive impairment continue to express themselves through their bodies – and that their self-expression is often misunderstood by those who care for them. Through her concept of “embodied selfhood”, Professor Kontos helps caregivers know how to respond in a way that reduces agitation and resistance to care while increasing nurturing and respect.

Now, let’s move out of what we would usually associate directly with medicine and health care. In 2012 we celebrated the launch of the Fraser Mustard Institute for Human Development. This groundbreaking, transdisciplinary initiative is focused on the first 2000 days of life, to optimize early childhood development. Researchers are studying the relationship between individuals’ earliest experiences and their well-being throughout the course of life – the ultimate preventive medicine, you might say.

Next, let’s look at the Department of Mechanical and Industrial Engineering. Professor Mike Carter is founder and Academic Director of the Centre for Research in Healthcare Engineering. He and his colleagues have developed models to enable governments to plan the allocation of health services for an aging population – scientifically, and not simply by trial-and-error. One of them has been used in the implementation of Ontario’s Aging at Home strategy.

In the Department of Chemical Engineering and Applied Chemistry, Professor Molly Shoichet is doing cutting-edge work in the advancement of regenerative medicine, using the science of neuroplasticity. She and her team are investigating minimally-invasive techniques to stimulate stem cells in repairing traumatic brain injuries, including damage from strokes.

In Computer Science, Professor Ron Baecker is founder and Director of the TAGlab – or, Technologies for Aging Gracefully lab. The mobile app MyVoice was developed in the TAGlab. MyVoice helps people with communication disorders – such as aphasia after a stroke – to make themselves understood audibly.

Finally, for now, the contribution of U of T researchers to mental health and aging extends even to literary theory. Professor Marlene Goldman observes that the common cultural “narratives” of Alzheimer’s disease are essentially horror stories. While fully respecting the terrible suffering caused by the disease, she cautions that we should be mindful of the way we speak about it. A few years ago, working with colleagues through the Jackman Humanities Institute, she co-organized an international conference with the intriguing title “Aging, Old Age, Memory and Aesthetics”.

As I said, these are just a sampling of the many innovative and hopeful developments at the University of Toronto, in the advancement of mental health, and mental health as we age. In closing, I’d like to relate another story, which was broadcast recently by CityNews.

Three years ago Evelyn Burns-Weinrib, who was 78 years old and suffering from depression, attempted suicide. Fortunately she received good treatment and has made great progress in recovery. And now she’s helping others. She is volunteering, and speaking out. And she helped enable the creation of a new mental health website for seniors, at another one of U of T’s partner research hospitals, Baycrest, which specializes in aging and brain health.

Dr. Robert Madan, a faculty member in geriatric psychiatry, and Chief of Psychiatry at Baycrest, created the site. Right now it’s focused on late-life depression, but over the next few years it will be expanded to include geriatric anxiety, bipolar disorder, and dementia.

Evelyn Burns-Weinrib sums up why such resources are needed, and why we need to spread the word. “I think that this is something that should be talked about, not brushed under the carpet. I will talk about it whenever and wherever I can. When you get older, you face a lot of losses…. I’ve learned that these [losses are] factors that can trigger depression in seniors.”

This wonderful story shows what can happen when you combine an individual’s courage and willingness to speak out, with cutting edge research and innovative care. It also shows the vital importance of the University’s role as a partner in our society.

Our U of T researchers are collaborating with creative and courageous individuals. And they are supporting vulnerable people in our communities and around the world, directly and indirectly, every day. The problems of mental health, and mental health as we age, touch all of us in one way or another.

Our University is helping to find the solutions. And it is therefore a great source of hope.

Thank you for your kind attention.