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THE POWER TO RECOVER
2012/2013ANNUAL REPORT
PREVENTION AND EARLY INTERVENTION A KEY PRIORITY
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The individuals appearing in this annual report are Douglas Institute employees.
Douglas Institute Mental Health University Institute 6875 LaSalle Blvd. Montreal, Quebec H4H 1R3
Telephone: 514 761-6131 Fax: 514 762-3043 [email protected]
www.douglas.qc.ca
www.facebook.com/institutdouglas
www.twitter.com/institutdouglas
AuditorsRaymond Chabot Grant Thornton, S.E.N.C.R.L.
DesignBivouac Studio
Legal deposit
Bibliothèque et Archives nationales du Québec Bibliothèque et Archives Canada ISSN 0708-8647
The Douglas aims to protect the environment. For that reason, this annual report is published electronically.
Centre collaborateur OMS de Montréal pour la recherche et la formation en santé mentale
Montreal WHO Collaborating Centre for Research and Training in Mental Health
TABLE OF CONTENTSMESSAGE FROM THE CHIEF EXECUTIVE OFFICER AND BOARD PRESIDENT OF THE DOUGLAS -------------------------------------------2
PRESENTATION OF THE DOUGLAS INSTITUTE ----------------------------------------6
DECLARATION OF ACCURACY ................................................................................................ 6MISSION ................................................................................................................................ 7HIGHLIGHTS OF THE YEAR ..................................................................................................... 8MAIN POPULATION CHARACTERISTICS ................................................................................16MAIN HEALTH DATA .............................................................................................................18ORGANIZATIONAL CHART.....................................................................................................19STRATEGIC DIRECTIONS AND PRIORITIES ........................................................................... 20
DOUGLAS INSTITUTE ACTIVITIES ------------------------------------------------------ 20
SERVICES PROVIDED .............................................................................................................21PERFORMANCE INDICATORS ............................................................................................... 30THE DOUGLAS OBTAINS INCONDITIONAL ACCREDITATION ................................................ 32SECURITY OF CARE AND SERVICES ...................................................................................... 32PROCEDURE TO EXAMINE COMPLAINTS, USER SATISFACTION AND RESPECT OF RIGHTS ............................................................................................................ 33OFFICERS AND ADMINISTRATORS ....................................................................................... 36
DOUGLAS INSTITUTE BOARDS AND COMMITTEES --------------------------------- 36
COUNCIL OF NURSES ........................................................................................................... 40MULTIDISCIPLINARY COUNCIL ............................................................................................ 40COUNCIL OF PHYSICIANS, DENTISTS AND PHARMACISTS ...................................................41VIGILANCE AND QUALITY COMMITTEE ................................................................................ 42USERS’ COMMITTEE ............................................................................................................. 43RISK MANAGEMENT COMMITTEE ........................................................................................ 43
DOUGLAS INSTITUTE HUMAN RESOURCES ------------------------------------------ 46
OUR VALUES ........................................................................................................................ 46
FINANCIAL STATEMENTS AND ANALYSIS OF OPERATING RESULTS ----------- 48
NOTE FROM THE FINANCIAL AND INFORMATIONAL RESOURCES DIRECTORATE ................................................................................................... 56DIRECTORS’ CODE OF ETHICS .............................................................................................. 58
DIRECTORS’ CODE OF ETHICS ---------------------------------------------------------- 58
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MESSAGE FROM THE CHIEF EXECUTIVE OFFICER AND BOARD PRESIDENT OF THE DOUGLAS*
We are both – as President of the Board of Directors of the Douglas Institute, and its Chief Executive Officer – proud to present this annual report in conjunction with the President of the Board Directors of the Research Centre and the President of the Board of Trustees of the Foundation. The scope of this always productive collaboration was extended still further this year, as we developed joint plans for the future interests of our patients, their families, and for the Douglas Institute itself.
Consequently, a review of the strategic plan was started during the year, with an emphasis on three priorities for 2013 and 2014:
1. Improved access to mental health services, from screening to recovery.
2. Optimized patient care by ensuring both satisfaction and a trajectory focused on relevance, quality and safety of care and services.
3. Promotion of a healing environment.
We are particularly proud that the Service Users’ Committee participated in the review of the strategic plan. Throughout, it has helped broaden our perspective and make the patient experience part of the review process.
Strategic Planning in Action
In 2010, during consultations for development of the 2011-2014 strategic plan, Professor Henry Mintzberg pointed out the need for us to create a strategic plan that was both flexible as well as adaptable to changing realities. Doing so let us rework the plan in 2012-2013, reinforcing it and ensuring the Institute’s processes meet its twenty objectives as efficiently as possible.
While the Institute’s core mandate remains the Power to Recover, our development in the coming years will be driven by prevention and early intervention, made possible through better access to care for our patients and advances in cutting-edge mental health research.
The time frame for the strategic plan now extends to 2015.
A Year of Great Accomplishments
The year bore fruit for many years of excellent work in research, care and service delivery. Additionally, it marked important milestones that will allow the Douglas Institute to meet strategic objectives, particularly in the areas of access to care and the optimization of the patient experience within the care trajectory.
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One important achievement involved efforts to work more closely with our service users in delivering care and helping them participate in decision-making processes surrounding the Douglas Institute’s future.
For example, to better meet service users’ needs, we created the new Residents’ Committee for service users who reside in three of our care units. Although the Service Users’ Committee and the Residents’ Committee share the same goals – protecting user rights and improving service quality – the committees represent two distinct populations with differing needs. It was important to add this second voice.
We also asked a research assistant, herself recovered from a mental illness and a service user of the Douglas Institute, to create an action plan towards implementing a Council of Service Users. That plan is currently under review.
There were many research accomplishments. The Brain Imaging Centre (BIC) was inaugurated, the Eating Disorders Program celebrated its 25th anniversary, and PEPP-Montréal marked 10 years of service. In addition, thirteen LEAN/6Sigma optimization projects were started, while collaborative work continued with the RUIS McGill and our community partners.
March saw a Montreal first in philanthropy and public awareness for mental health with the Bal des lumières. This partnership between the Douglas Foundation, the Mental Illness Foundation and the Institut universitaire en santé mentale de Montréal Foundation raised $1 million in donations.
From an organizational standpoint, we are extremely proud to have been recognized as a Milieu Novateur by the Conseil québécois
d’agrément. Healthy Enterprise certification also crowned many years of work to promote a healthy and safe environment for our staff. Our Institute is the only mental health institute in Quebec to achieve this certification.
Towards greater fluidity and accessibility
The Douglas provides its service users with quality support thanks to its care, research and teaching teams and partners in the network and the community. The challenge now is to remain focused on excellence and to improve access and maintain fluidity in the delivery of mental health services.
One essential transformation is modernization of the Institute itself. This will be achieved through construction of new infrastructures based on best practices in mental health, and on the concept of the healing environment. The renewal of our workspace has become critical to the success of our mission as a university institute, and to the continuous improvements that will meet our service users’ needs.
In 2013-2014 a new Scientific Director for our Research Centre will arrive. The position became vacant with the departure of the eminent Rémi Quirion, appointed Quebec’s Chief Scientist in 2011. The individual taking up this work, scheduled to join the Centre in 2014, will be responsible for maintaining and reinforcing the Douglas Institute’s leadership position in research, along with knowledge transfer in mental health.
Finally, the upcoming year will be filled with challenges because the Institute Foundation is preparing large-scale initiatives to ensure a long future and the capacity to rise to our ambitions, which, we admit, are very high.
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Thank you!
At the Douglas Institute, our duty and our passion aim to give people who suffer from mental illness concrete ways to achieve their full potential and live a rewarding life. The Douglas is a leader in our society’s emerging social inclusion movement.
We participate in this movement through excellence in care – care based on the scientific breakthroughs of our world-class researchers – which we share and promote with our partners, the healthcare network, and the residents of Verdun and Quebec.
Together, Douglas staff, service users, partners, volunteers, collaborators and donors are proof that work carried out with dedication, unwavering support, and generosity can give hope to those who are suffering. No matter how you get involved, you make a difference in the lives of people with mental health problems and their loved ones. On their behalf, we wish to express our heartfelt appreciation to everyone who has helped us in our mission.
Together, we thank you!
Executive Director
Lynne McVey, inf., M.Sc.
President, Board of Directors Douglas Institute Foundation
Marie Giguère
President, Board of Directors Douglas Institute
Claudette Allard
President, Board of Directors Douglas Institute Research Centre
François L. Morin
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Executive Director
Lynne McVey, inf., M.Sc.
President, Board of Directors Douglas Institute Foundation
Marie Giguère
President, Board of Directors Douglas Institute
Claudette Allard
President, Board of Directors Douglas Institute Research Centre
François L. Morin
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PRESENTATION OF THE DOUGLAS INSTITUTE1
DECLARATION OF ACCURACYAs Executive Director, I am responsible for ensuring the reliability of the data contained in this annual activity report and any related controls.
The results and data of the activity report for the 2012-2013 fiscal year of the Douglas Mental Health University Institute:
• faithfully represent the mission, mandate, responsibilities, activities and strategic orientations of the institution;
• present its objectives, indicators, benchmarks and results;
• present accurate and reliable data.
I declare that the data contained in this annual activity report and any related controls are reliable and present an accurate view of the institution’s position as at March 31, 2013.
Lynne McVey Executive Director
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MISSIONIn collaboration with people living with mental health problems, their families, and the community, the mission of the Douglas Mental Health University Institute is to:
• Offer cutting-edge care and services
• Advance and share knowledge in mental health
VISION
The Power to Recover
What is recovery? Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.
William Anthony, Executive Director of Boston University’s Center for Psychiatric Rehabilitation, 1993
MANDATE
The Douglas is a mental health university institute under the terms of An Act respecting health services and social services. As such, the Douglas must, in addition to carrying out activities inherent to its mission, offer specialized and ultra-specialized services (Care), participate in education (Teach), evaluate health technologies (Evaluate) and manage an accredited research centre (Discover and Share).
Care
Our interdisciplinary teams provide services to all age groups. The catchment population for the second-line services offered by the Douglas is close to 300,000 people and covers two territories in South-West Montreal: CSSS Sud-Ouest–Verdun and CSSS Dorval-Lachine-LaSalle. As a mental health university institute and in collaboration with the institutions of RUIS McGill, the third-line mandate of the Douglas covers 23% of the Quebec population, including close to 50% of the Montreal population (1.7 million people in total) and approximately 63% of the Quebec territory. Furthermore, in accordance with An Act respecting health services and social services, the Douglas is designated as an institution that must provide all of its services in English to the English-speaking population.
Teach
Affiliated with McGill University and in partnership with other teaching institutions, the Douglas trains new recruits and provides a state-of-the-art mental health curriculum for all professional disciplines involved. We also help advance best practices by consolidating training programs with our partners.
Evaluate
Within a context of continued improvement in practices, our clinicians and researchers assess health technologies and methods of intervention to improve clinical benefits and the efficiency of the overall network.
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SERVICE QUALITY AND ACCESS
25 years for the Eating Disorders Program
In 2012, the Eating Disorders Program (EDP) at the Douglas Institute celebrated its 25th anniversary, together with its partner organization, Anorexia and Bulimia Quebec (ANEB). Through its collaboration with this organization, the EDP has developed a unique and integrated network of care, teaching and research.
To mark the occasion, the Douglas hosted a free public lecture by internationally-renowned eating disorders specialist Dianne Neumark-Sztainer, PhD, on November 13, 2012. Her presentation was followed by a panel discussion featuring regional experts in eating disorders.
The Douglas EDP is the largest and most fully developed program of its kind in Quebec. A cornerstone of care for people from across Quebec with anorexia or bulimia, the EDP serves as a centre of expertise, offers the latest treatment, and carries out clinical research to uncover new treatments and prevention strategies. The program also trains university and healthcare network professionals.
10 years for the PEPP-Montréal
In 2013, the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) marked its 10th anniversary. This early intervention program is aimed at young people experiencing a first-untreated psychotic episode. The earlier a psychotic disorder is diagnosed, the greater the chances of recovery.
Discover
Our researchers and clinicians are dedicated to the study of both mental illness and mental health, through the development of knowledge in neuroscience, clinical practices and service optimization.
Share knowledge
Our researchers and clinicians advance practices by integrating scientific discoveries into clinical practices and service organization. We train professionals and, together with our partners, disseminate new knowledge and best practices in order to improve the network of mental health services. We develop tools to support clinical practices and decision-making based on the best available knowledge. We also help destigmatize mental illness through awareness programs offered to the general public.
HIGHLIGHTSThe highlights for 2012-2013 accord with the four major orientations of the strategic plan: improving access to quality services, optimizing the patient experience within the care trajectory, ensuring the Institute’s longevity through a solid financial position, and, developing organizational capacity, research and knowledge transfer.
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The Douglas is one of the few healthcare institutions incorporating its own process optimization and analysis team within its organizational structure. Highlighting the importance of these projects, this team reports directly to the Executive Director.
Evaluation of Needs and Access to Intensive Rehabilitation Services
The Clinical Activities, Knowledge Transfer and Teaching Directorate identified the residential needs of patients who are at the end of active care at the Douglas, and of mental health partners in the RUIS McGill.
These initiatives are meant to: improve service quality and access, find solutions to the problems of overcrowding in emergency rooms, and address wait times for patient discharge that result from a lack of intensive rehabilitation and specialized housing resources.
The goal is to provide the Montreal Agency with information, and an overall needs profile, for the development and transformation of residential resources to meet the growing need for services that allow patients to remain in their communities. Ultimately, a report will be drafted, in collaboration with the Institut universitaire en santé mentale de Montréal (L.-H Lafontaine) for submission to the Montreal Agency that targets appropriate community-based rehabilitation resources.
To celebrate, the Douglas organized a two-day international conference on early intervention in psychosis in spring 2013 that hosted elite researchers and clinicians in this field. Included was world-renowned psychiatrist Patrick McGorry whose work is used as an early intervention model in many countries.
Since its beginnings, PEPP-Montréal has helped hundreds of families by evaluating or treating over 500 patients from 14 to 35. PEPP-Montréal has also supported the creation and activities of other first-episode psychosis programs in the Psychotic Disorders Program of the RUIS McGill.
Ashok Malla, MD, founded and directs the program, with assistance from Ridha Joober, MD.
Continuous Improvement Project in the Emergency Department
Continuous improvement projects, or LEAN/6Sigma projects, have helped us optimize patient care resources. In 2012-2013, thirteen continuous improvement projects were being implemented at the Douglas. Largest among these is the Emergency Department project, which upon completion in 2013, will reduce access time frames and wait times for patients.
The teams working on this project focused on three components: the identification of clinical needs, continuous improvement and the optimization of clinical processes, and, renovations to buildings along with expansion of the Emergency Department’s floor space.
Work is being done in conjunction with renovations in the Emergency Department.
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Ultimately, the goal of the Montreal WHO/PAHO Collaborating Centre at the Douglas Institute is not only for more such efforts, but ideally to see the initiative managed through a training program developed by Haiti’s Ministry of Health.
In the meantime, given the success of this project, the Douglas will again host residents from Haiti in 2013-2014.
ENSURING FINANCIAL SUSTAINABILITY
The Bal des lumières
On March 20, the Douglas Foundation, the Institut universitaire en santé mentale de Montréal Foundation and the Mental Illness Foundation joined forces to organize the first edition of the Bal des lumières, an event that raised $1.1 million for mental health.
It was held at Montreal’s Bell Centre and attended by over 800 guests, including Quebec Premier Pauline Marois. With help from the dynamic emcees Normand Brathwaite and Anne-Marie Withenshaw, the Bal des lumières not only raised money but also made people aware of issues related to this cause.
The proceeds will go towards research in mood disorders at the Douglas.
The Douglas Institute Foundation sincerely thanks all our sponsors, guests, donors and volunteers for helping us shed a bright light on mental health concerns.
Implementation of a Second ACT team
An ACT team is a mobile interdisciplinary team that provides intensive out-patient follow-up so that people with severe mental disorders can remain in, or integrate into, a living environment of their choice.
Team members maintain ongoing contact and provide close supervision to prevent extended hospital stays, decreasing the burden on family caregivers. An ACT team often represents a last recourse for people with severe mental health disorders so they can stay in their homes.
The goal is to give both outpatients and their families a chance for a satisfying and dignified life.
To meet the network’s needs of ACT team services for every 100,000 residents, the Clinical Activities, Knowledge Transfer and Teaching Directorate started a second team in 2012-2013. The team’s composition will be finalized in 2013-2014.
A Visit from Haiti
Thanks to the work of the Institute’s Montreal WHO/PAHO Collaborating Centre, the Douglas welcomed Dr. Fred Donatien Ulysse, a medical resident from Haiti, in summer 2012. Throughout August, he did his rotation at the Intensive Care Unit under the supervision of Dr. Hani Iskandar.
Training needs in mental health are very high in Haiti. According to Dr. Ulysse, knowledge transfer through training programs could help doctors, nurses and others working in the country’s community organizations in their daily efforts.
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At one point a friendly game of basketball took place between patients and the police, paving the way for a successful second Rendez-vous policier in September 2012 on the Institute’s grounds.
This neighbourhood partnership is yet another step towards demystifying mental illness, a goal that both the Douglas and the SPVM view as very important.
Parle-moi d’amour… again!
For a second year, the Wellington Centre welcomed the Parle-moi d’amour exhibit and auction organized by Les Impatients. It took place between February 1 and March 12, 2013.
With honorary chairs Lynne McVey and Roger Cadieux, MD, President of the Forum économique de Verdun, the exhibit featured over 70 works of art that were sold in a silent auction. This was the first time that a Douglas representative and a member of the Verdun community served jointly as honorary chairs.
The funds raised will go towards the Wellington Centre and help Les Impatients continue to provide artistic activities and an ideal interactive and creative space for people with mental health problems.
Project to create a Council of Service Users
Janina Komaroff, a research assistant on the team of Michel Perreault, was asked by the Clinical Activities, Knowledge Transfer and Teaching Directorate to develop a project on recovery. In October 2012, she submitted a plan on recovery and the implementation of a Council of Service Users.
The Douglas Institute Foundation’s Young Ambassadors
The Douglas Institute Foundation’s Young Ambassadors is a new group of 11 volunteers, active members of their professional networks between 25 and 45 years of age. While their goal is to raise money for the Foundation, they also want to create awareness of mental health problems and remove the associated stigma – a very significant goal.
In 2012-2013, they organized their first fundraiser, MentaliThé, a sold-out event at the Phillips Lounge in downtown Montreal. For the occasion, young Douglas researcher Carl Ernst, PhD, talked about the benefits of green tea on the brain. The Foundation thanks its Young Ambassadors for all their work and congratulates them on the success of MentaliThé.
OPTIMIZING THE PATIENT EXPERIENCE IN THE CARE TRAJECTORY
Working with the SPVM to counter the stigma of mental illness
The Rendez-vous policier is an initiative of Douglas Institute educator Elizabeth Huk and Detective Sergeant Benoît Roberge of the SPVM. It’s meant to facilitate relations between police officers and Douglas patients and to fight stigmatization in the process.
Launched in 2011, this highly successful event has led to valuable discussions between patients and police officers.
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The Douglas Institute named Milieu Novateur by the Conseil québécois d’agrément
The Conseil québécois d’agrément (CQA) awarded the Douglas Mental Health University Institute Milieu Novateur certification in October 2012. The award itself honours the culture of innovation in Quebec healthcare organizations.
Although the entire Douglas Institute was recognized as a Milieu Novateur, three projects in particular drew the attention of CQA members for their positive impact on employees, patients, and families: the development of a culture of clinical ethics, mindfulness-based cognitive therapy for bipolar disorder, and training for family caregivers at the Memory Clinic of the Geriatric Psychiatry Program.
While the first project stood out through its professional and interdisciplinary approach, the other two reflected the Douglas Institute’s commitment to care and service that focuses on patients and their families.
When considering an institution for Milieu Novateur accreditation, the CQA evaluates the organization based on six criteria: (1) confidence (the strategic vision of senior management and managers), (2) decompartmentalization (interdisciplinary approach and knowledge sharing, both internally and externally), (3) creativity, (4) audacity, (5) development, and (6) identity (creation of an environment conducive to a culture of innovation).
The mandate of this users’ council is to: oversee the implementation of the plan developed by the working committee on recovery, to participate in the training program on recovery, and contribute to the implementation of an employment program for service users.
This innovative project, which has been well received, is currently under review.
DEVELOP ORGANIZATIONAL CAPACITY AND RESEARCH
Healthy Enterprise certification for the Douglas
The Douglas Mental Health University Institute became the first mental health institution in the province to be granted Healthy Enterprise certification by the Bureau de normalisation du Québec (BNQ). This certification affirms the Douglas Institute’s commitment to the overall health of its employees.
The Healthy Enterprise standard helps companies maintain and sustain improvements in an individual’s health. It also describes the interventions and measures that can be implemented in workplaces to encourage employees to adopt a healthy lifestyle. This standard encourages organizations to take action in four areas known to significantly affect employee health and productivity: lifestyle, work-life balance, work environment, and management practices.
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Women with PDD may suffer from depression, tension and irritability to such a degree that these symptoms interfere with their daily activities and interpersonal relations.
In 2012, Dr. Boivin published a book for a general audience on sleep and sleep disorders titled Le sommeil et vous : mieux dormir, mieux vivre. It’s a useful clinical resource for patients who suffer from sleep disorders.
Hope for the treatment of neurodevelopmental disorders
A study conducted by Douglas researcher Carl Ernst led to the discovery of an innovative genetic process that may play a role in treating neurodevelopmental disorders, such as intellectual impairments and autism. According to the WHO, these disorders affect one out of six children in industrialized countries. The study was published in the December 2012 issue of The American Journal of Human Genetics.
Possible link between smoking and ADHD
People who suffer from attention deficit hyperactivity disorder (ADHD) are more likely to start smoking at a young age and to smoke twice as much as people without ADHD. These are the findings of a study conducted by Dr. Ridha Joober and his colleagues at the Douglas Institute Research Centre in an article published in the Archives of Disease in Childhood. While this research reveals an association between ADHD and smoking, it does not show a cause-and-effect relationship.
Contribution to the Health and Welfare Commissioner’s 2012 report on mental health
Quebec’s Health and Welfare Commissioner devoted the fourth Appraisal Report of the Performance of the Health and Social Services System to mental health. To create the report, the Commissioner called on many experts, including Marie-Josée Fleury, PhD, a researcher at the Douglas Mental Health University Institute and a professor at McGill University. She and her colleague Guy Grenier, PhD, wrote a section of the report dealing with the current status of mental health care. In it, they demonstrated the importance of improving access to care and increasing flow between services.
At over 200 pages, this status report gives an overview of the prevalence of mental disorders and their consequences, the use and organization of mental health services, best practices in treatment and intervention, and the transformation of services over the past five years.
Impaired melatonin secretion may be related to premenstrual syndrome
In December 2012, Dr. Diane Boivin, and her research team at the Centre for Study and Treatment of Circadian Rhythms at the Douglas Institute, published the results of a study showing that the secretion of the hormone melatonin appears different in women with premenstrual dysphoric disorder (PDD) when they suffer from insomnia. These results may partially explain the sleep disruptions experienced by women with PDD, also known as premenstrual syndrome.
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Fondation IPSEN Prize
Michael Meaney, CM, PhD, CQ, FRSC
The Fondation IPSEN International Prize in Neuronal Plasticity is awarded to researchers for outstanding contributions in neuronal plasticity: development, synaptogenesis, aging, regeneration, grafts, etc. By identify emerging knowledge and new paradigms, the Fondation IPSEN aims to foster the most promising interconnections.
Étudiants-chercheurs étoiles Award – Fonds Santé, Fonds de recherche du Québec.
David Maillet, a PhD student in neuroscience at McGill University and a team member in the laboratory of Natasha Rajah
This competition recognizes excellence in research carried out by CEGEP-level and university students, post-doctoral fellows, and members of professional bodies who are enrolled in advanced research training programs. The competition is open to all areas covered by the three Fonds de recherche du Québec, which in this case is the Fonds Santé.
RECOGNITION OF EXCELLENCE
Queen’s Diamond Jubilee Medal
Serge Gauthier, MD, FRCPC
This commemorative medal, which marks the 60th anniversary of Queen Elizabeth’s reign, honours people whose accomplishments have benefited their communities and all Canadians. It recognizes the time, talent and enthusiasm that the recipient, Serge Gauthier, has dedicated to creating a better future for people affected by Alzheimer’s and related diseases. Gauthier was nominated by the Federation of Quebec Alzheimer Societies and its twenty member Alzheimer Societies.
Klerman Prize - Honourable mention
Johanne Renaud, MD, MSc, FRCPC
The Klerman Prize acknowledges excellence in clinical research by young scientists with the support of NARSAD Young Investigator Grants.
Hubert-Reeves Award for a scientific work adapted for a general audience
Serge Gauthier, MD, FRCPC and Judes Poirier, PhD, CQ
The Hubert-Reeves Award was created by the Association des communicateurs scientifiques du Québec to encourage the production of accessible scientific texts in French and to create a high quality scientific culture in Canada. This award was given to them for their book La Maladie d’Alzheimer – Le guide.
DOUGLAS INSTITUTE AWARDS 2012
Douglas Institute Apex Award
• Nicole Germain, Assistant to the Executive Director
Roberts Award - Personal Excellence, Direct Patient Care
• Liliane Diaz, Nurse, Moe Levin Centre, Geriatric Psychiatry Program
InnovAction Awards
• ADMINISTRATIVE STAFF Geneviève Dumont, Administrative Technician, Technical Services and Facilities Directorate
• TECHNICAL STAFF François Romeo, Building Technician, Buildings and Grounds Maintenance, DST
• PROFESSIONALS Claude Bélanger, Psychologist, Anxiety Disorders Clinic
• RESEARCH Joanne Frenette, Nurse and Coordinator for Clinical Research, StoP-Alzheimer Centre
• MANAGERS Julie Gendron, Department Head, Organizational Development and Management Staffing, HRD
• TEAM Ground Maintenance Team, Buildings and Grounds Maintenance, DST
Nova Award, Personal Excellence, Customer Service
• Eliane Léveillé, Medical Archivist, Medical Records, DSPH
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MAIN POPULATION CHARACTERISTICSThe Douglas Institute provides services to the entire population covered by the RUIS McGill (Réseau universitaire intégré de santé de l’Université McGill).
BREAKDOWN OF POPULATION OF RUIS MCGILL BY REGION (IN 2011)
BREAKDOWN OF POPULATION OF RUIS MCGILL BY AGE GROUP (IN 2011)
46,53% MONTRÉAL
20% OUTAOUAIS
7,91% ABITIBI-TÉMISCAMINGUE
0,77% NORTH OF QUÉBEC
23,26% MONTÉRÉGIE
0,65% NUNAVIK
0,87% TERRES-CRIES-DE-LA-BAIE-JAMES
21% 375 488 UNDER 18
65% 1 196 725 18 TO 64
14% 260 784 65 AND OVER
Source (in French only): Institut de la statistique du Québec (ISQ) : Projections de la population du Québec selon le territoire de réseau local de services (RLS), le sexe, l’âge et le groupe d’âge, 2006 à 2031 (Avril 2012)
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TOTAL NUMBER OF POPULATION BY RUIS MCGILL TERRITORY (IN 2011)
REGION/LSN (LOCAL SERVICE NETWORK)
PIERREFONDS – LAC SAINT-LOUIS 220,054
DORVAL – LACHINE – LASALLE 139,561
VERDUN – CÔTE ST-PAUL – ST-HENRI – POINTE-ST-CHARLES 148,302
CÔTE-DES-NEIGES – MÉTRO – PARC-EXTENSION 220,878
CÔTE-SAINT-LUC – NDG – MONTRÉAL-OUEST 124,085
GRANDE-RIVIÈRE – HULL – GATINEAU 237,009
PONTIAC 20,817
COLLINES-DE-L’OUTAOUAIS 34,625
VALLÉE-DE-LA-GATINEAU 20,907
VALLÉE-DE-LA-LIÈVRE ET DE LA PETITE-NATION 53,389
TÉMISCAMINGUE 3,156
VILLE-MARIE 13,368
ROUYN-NORANDA 40,708
ABITIBI-OUEST 20,430
ABITIBI 24,502
VALLÉE-DE-L’OR 42,875
NORD DU QUÉBEC 14,186
HAUT-SAINT-LAURENT 24,502
SUROÎT 56,494
JARDINS-ROUSSILLON 204,582
VAUDREUIL-SOULANGES 140,288
NUNAVIK 11,860
TERRES-CRIES-DE-LA-BAIE-JAMES 15,922
TOTAL 1,836,997
Source (in French only): Institut de la statistique du Québec (ISQ) : Projections de la population du Québec selon le territoire de réseau local de services (RLS), le sexe, l’âge et le groupe d’âge, 2006 à 2031 (Avril 2012)
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MAIN HEALTH DATAThe following graph shows the prevalence of mental health problems in South-West Montréal,* in Quebec and in Canada.
Agoraphobia Mania Panic disorder
Social phobia
Major depression
Drug abuse
Alcohol abuse
Substance abuse or
mental health problems
CANADA
QUEBEC
SOUTH-WEST MONTRÉAL
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Sources : Canadian Community Health Survey, Mental Health and Well-being, Statistics Canada, 2011.
CARON, J., FLEURY, M.J., PERREAULT, M., CROCKER, A., TREMBLAY J., TOUSIGNANT, M., KESTENS, Y., CARGO M., DANIEL, M., Prevalence of psychological distress and mental disorders, and use of mental health services in the epidemiological catchment area of Montreal South-West.
* Verdun, Côte-Saint-Paul, Ville-Émard, Ville LaSalle, Vieux-Lachine, Dorval, Pointe-Saint-Charles/Saint-Henri.
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ORGANIZATIONAL CHART
INTERDISCIPLINARYCOORDINATION
RESIDENTS’ COMMITTEE
USERS’COMMITTEEJANCY BOLTÉ
BRIGITTE FRIEDMAN
LOCAL SERVICEQUALI TY ANDCOMPLAINTS
COMMISSIONERFRANCINE BOURASSA
MULTIDISCIPLINARYCOUNCIL
MARIE-ÈVE LANDREVILLE
AUXILIARYMARY CAMPBELL
QUALITY DIRECTORATEHÉLÈNE RACINE
COMMUNICATIONS AND PUBLIC AFFAIRS DIRECTORATE
MARIE FRANCE COUTU (Interim)
RENÉE SAURIOL
COUNCIL OFNURSES
SOPHIE DESFOSSÉS
COUNCIL OF PHYSICIANS,DENTISTS ANDPHARMACISTS
JACQUES TREMBLAY, M.D.
BOARD OF DIRECTORSRESEARCH CENTRE
DHUMAN RESOURCES DIRECTORATE
CAROLINE DUBÉ
TECHNICAL SERVICES AND FACILITIES DIRECTORATERONALD SEHN
RESIDENTIAL RESOURCESDEBORAH NASHEIM
Interim
INFORMATIONAL SERVICESAXEL VAN LEEUW
FINANCIAL SERVICES
GENEVIÈVE PELLETIER
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FOUNDATIONJANE H. LALONDE
BOARD OFGOVERNORS
MCGILL CENTRE FORSTUDIES IN AGING
Mental HealthProgram for
Adults ofSouth-WestTerritories
Child andAdolescentPsychiatryProgram
GeriatricPsychiatryProgram
Mood, Anxietyand Impulsivity-
Related DisordersProgram
PsychoticDisordersProgram
IntellectualHandicap with
PsychiatricComorbidity
Program
EatingDisordersProgram
SpecializedPsychosocialRehabilitationand Housing
Program
CLINICAL, KNOWLEDGE TRANSFER ANDTEACHING ACTIVITIES DIRECTORATE
MEDICAL DIRECTOR / CLINICAL-ADMINISTRATIVE DIRECTOR SERGE BEAULIEU, M.D. / AMPARO GARCIA
REASERCH CENTER SCIENTIFIC DIRECTOR / ADMINISTRATIVE DIRECTOR
ALAIN GRATTON (interim)/ JOCELYNE LAHOUD
PROFESSIONAL ANDHOSPITAL SERVICES DIRECTORATE
WILLINE ROZEFORT, M.D.
CARLOS DIAS
PROGRAM CHIEF
Interim
SERGE BEAULIEU, M.D.
MEDICAL CHIEF
YVONNE HINDLE
PROGRAM CHIEF
NATHALIE GRIZENKO, M.D.
MEDICAL CHIEF
JOHANNE DUBÉ
PROGRAM CHIEF
RENÉ DÉSAUTELS, M.D.
MEDICAL CHIEF
CARLOS DIAS
PROGRAM CHIEF
SERGE BEAULIEU, M.D.
MEDICAL CHIEF
MICHEL LAVERDURE
PROGRAM CHIEF
DAVID BLOOM, M.D.
MEDICAL CHIEF
DAWN ROBITAILLE
PROGRAM CHIEF
Interim
DAVID BLOOM, M.D.
MEDICAL CHIEF
HOWARD STEIGER
PROGRAM CHIEF
AMPARO GARCIA
PROGRAM CHIEF
Interim
ASSISTANT TO THE EXECUTIVE DIRECTOR
NICOLE GERMAIN
CHIEFS OFCLINICAL DEPARTMENTS
MIMI ISRAËL, MD: PSYCHIATRIST
ACHLA VIRMANI, MD: GENERAL MEDICINE
SYLVIE DUBUC: PHARMACY
PROFESSIONAL CHIEFSPEGGY O’BYRNE: PSYCHOLOGY
JOAN SIMAND: SOCIAL SERVICE
HÉLÈNE LABERGE: MEDICAL ARCHIVES
MICHELINE CHAMMAA: NUTRITION
NURSING DIRECTORATEHÉLÈNE RACINE
EXECUTIVE DIRECTORLYNNE McVEY
BOARD OF DIRECTORS
MONTREAL WHO/PAHOCOLLABORATING CENTRE
MARC LAPORTA, M.D.
ASSISTANT EXECUTIVE DIRECTOR
MICHEL DALTON
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DOUGLAS INSTITUTE ACTIVITIES2
STRATEGIC DIRECTIONS AND PRIORITIES
Strategic direction 1:
Improve access and quality of service, drawing on input from patients and partners
Priorities
1. Lead the way so the community fully integrates people living with mental health problems as full citizens.
2. Optimize access, care and service flows with our partners, based on a continuum from diagnosis to recovery.
3. Provide our partners and the community with up-to-date, valid, and relevant mental health information, particularly as it relates to the Institute’s areas of expertise.
4. Introduce a strategy aimed at the prevention of mental illnesses.
5. Influence directions and policies in mental health.
6. Apply and share knowledge to improve the quality of services and clinical outcomes.
Strategic direction 2:
Assure sustainability through financial stability
Priorities
7. Conduct a major fundraising campaign to support the Institute’s priorities.
8. Promote a culture of philanthropy to ensure ongoing strategic development of the Institute.
9. Adopt a funding and optimization approach that enables the Institute to pursue established strategies.
Strategic direction 3:
Optimize the patient experience at each step of the care trajectory
Priorities
10. Optimize the patient care trajectory by ensuring quality and safety in the care and services provided, as well as satisfaction and suitability.
11. Implement an organizational approach supported by well-structured reflective practice, continuous improvement, and need-response in all sectors.
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12. Fully integrate patients and their families as active partners in the clinical care, research, and clinical and administrative decision-making process.
Strategic direction 4:
Develop organizational capacity and research
Priorities
13. Provide an environment that values human potential and collaboration.
14. Implement reliable, robust and practical tools to facilitate analysis and support research, clinical and administrative decision-making.
15. Enhance organizational capacity with respect to the sharing and application of knowledge and the evaluation of technologies and intervention methods.
16. Promote knowledge-sharing among basic and clinical researchers to implement translational research.
17. Promote the development and consolidation of research approaches (basic, translational, clinical and psychosocial) to strengthen the competitiveness and innovative capability of the Research Centre.
18. Promote a safe and healthy environment for human potential that is conducive to recovery and development.
19. Implement the new institute project, to be built on concepts of evidence-based design and a healing environment.
20. Develop a sustainable development culture and associated practices in all activity sectors.
SERVICES PROVIDEDAs a mental health university institute, the Douglas is an international leader in care, research and teaching.
CARE AT THE DOUGLAS
Interdisciplinary teams at the Douglas Institute provide clinical services to all age groups in both English and French. The different services correspond to various areas of expertise in mental health, such as:
• Anxiety
• Depression
• Alzheimer’s disease and other forms of dementia
• Schizophrenia and other forms of psychosis
• Eating disorders
• Bipolar disorders
• Behaviour disorders
The Douglas Institute offers a broad range of specialized and super-specialized, internal (inpatient) or external (outpatient) services through a variety of programs.
Child Psychiatry Program
The Child Psychiatry Program at the Douglas Institute offers a range of bilingual services to clients up to 17 years of age, and their families.
The services match the Douglas Institute’s areas of expertise in mental health, such as:
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Geriatric Psychiatry Program
The Geriatric Psychiatry Program at the Douglas Institute provides services to clients aged 65 and older and to adults younger than 65 with a geriatric profile.
The program covers psychiatric diagnoses such as:
• mood disorders
• anxiety disorders
• impulsivity disorders
• psychotic disorders
• cognitive disorders including dementia
Services provided
The program offers (2nd-line) general geriatric psychiatry services:
• Outpatient services: Evaluation-liaison team, Outpatient clinic and Transitional centre
• Inpatient services: Admission and Medical Unit and the Psychosocial Rehabilitation Unit
The program also provides a specialized 3rd-line geriatric psychiatry service: the Program for Dementia with Psychiatric Comorbidity.
Mood, Anxiety and Impulsivity Disorders Program
The Mood, Anxiety and Impulsivity Disorders Program at the Douglas Institute provides care to people aged 18 to 65 years with a mood disorder such as:
• Bipolar disorders
• Depressive and suicide disorders
• General anxiety disorders
• Anxiety
• Psychosis
• Eating disorders
• Attention deficit, with or without hyperactivity, disorders (ADHD)
• Depressive disorders
• Pervasive developmental disorders (PDD)
• Severe behaviour disorders
Services provided
Severe Disruptive Disorders Program, for youth aged 6 to 12:
• Day Hospital
• Attention Deficit, with or without Hyperactivity, Disorder (ADHD) Outpatient Clinic
• Outpatient Clinic
Intensive Intervention Program, for youth aged 13 to 17:
• Short-term Intensive Adolescent Inpatient Unit
• Intensive Intervention Adolescents Day Hospital
• Outpatient Clinic (transition program)
Child Psychiatry Outpatient Clinic, for youth aged 0 to 17 years:
• Pervasive Developmental Disorders (PDD) Diagnostic Clinic
• Depressive Disorders Clinic
• Outpatient Clinic
Services may include therapeutic activities such as music therapy, art therapy, speech therapy, pet therapy, greenhouse workshops (horticultural therapy), sports activities and other recreational activities.
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Psychotic Disorders Program
The Psychotic Disorders Program at the Douglas Institute provides services to adults aged 18 to 65 with schizophrenia or other forms of psychoses, with the exception of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal), which is designed for people aged 14 to 30.
Services provided
Psychosis Hospitalization Unit (Burgess 1). A 30-bed unit for people with psychotic disorders who require short-term hospitalization.
Intensive Rehabilitation Program. Hospitalization and transition services for people suffering from prolonged, complex and treatment-resistant psychotic disorders.
Out-Patient Services. Composed of the Out-Patient Clinic (OPD), the Intensive Community Rehabilitation team, and the ACT team.
Prevention and Early Intervention Program for Psychoses (PEPP-Montréal). Treatment for youth dealing with an untreated first psychotic episode.
Intellectual Handicap with Psychiatric Comorbidity Program
The Intellectual Handicap with Psychiatric Comorbidity Program is designed for people aged 18 to 65 who have a moderate to severe intellectual handicap accompanied by a psychiatric disorder.
Services provided
Care unit (Burgess 2). The goal of this 15-bed unit is to stabilize the health condition of patients before sending them back into the community.
• Panic disorders with or without agoraphobia
• Phobia problems
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Borderline personality disorders
This program also targets children and adolescents aged 6 to 18 years who suffer from a depressive or suicide disorder.
Services provided
Bipolar Disorders Program. Services for people suffering from refractory bipolar disorder.
Depressive and Suicide Disorders Program. Services for people suffering from refractory and/or recurrent major depressive disorder.
Anxiety Disorders Clinic. Services for people who have been diagnosed with one or multiple anxiety disorders.
Personality Disorders Clinic. Services for people with personality disorders.
Out-Patient Clinic. Short- or medium-length second-line services of variable intensity to stabilize patients and improve their quality of life while encouraging their independence.
Le Tremplin Day Hospital. Assistance for people suffering from a mental health disorder to develop their own functioning strategies, improve their social skills, and learn anger management techniques, ideally without hospitalization.
Short-Term Care Unit (CPC2). Helps people in the acute phase of a severe mental disorder. The goal is to stabilize patients so that they can return as soon as possible to the community.
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The In-Patient Unit is for people with severe medical and psychological complications or those for whom out-patient treatment is insufficient to resolve eating disorder symptoms.
Psychosocial Rehabilitation and Specialized Housing Program
The Psychosocial Rehabilitation and Specialized Housing Program helps adults of any age with a severe mental disorder return to and stay in the community.
Services provided
Specialized Housing Service: Provides a community living environment that promotes recovery, rehabilitation and community and social reintegration.
Wellington Centre: A rehabilitation and community support centre (SPECTRUM) that promotes the well-being and social reintegration of people suffering from severe and persistent mental disorders through training, activities and customized support.
Crossroads Day Hospital
The multidisciplinary team of the Crossroads Day Hospital helps people aged 18 to 64 with a mental health problem:
• Develop their own coping strategies
• Improve their social skills
• Learn anger management techniques
Its goal is to give people a sense of responsibility over their mental health problem and help them better manage everyday life.
Phoenix Learning Centre. This day centre can receive up to thirty people, who are divided into three groups based on different assessment tools.
Out-Patient Service. Thirty-five patients staying with fourteen different host families are currently being followed by the program’s Out-Patient Service.
Eating Disorders Program
Since its creation in 1986, the Eating Disorders Program (EDP) has offered specialized clinical services for people 18 years and older who suffer from anorexia nervosa or bulimia nervosa. Children and adolescents can consult the services for children and adolescents of the Douglas Institute or the child psychiatry program of the Montreal Children’s Hospital or the CHU Sainte-Justine.
Services provided
An Out-Patient Clinic that offers a comprehensive range of services that can be adjusted to meet individual needs:
• Individual, family/couple, and group therapy
• Pharmacological therapy
• Nutritional therapy
A Day Program that offers highly-structured, group-based treatment. The program addresses the needs of individuals requiring intensive care, provides a more structured environment than the Out-Patient Clinic, and addresses eating problems and related psychological and behavioural issues. The program runs for eight weeks.
The only one of its kind in Quebec, the Day Hospital is designed for people with severe eating disorders who are still able to manage adequately without overnight supervision.
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RESEARCH AT THE DOUGLAS
The Douglas Institute’s Research Centre is the oldest centre of its kind in Quebec. With an annual budget of $18.5 million, it brings together over 300 distinguished researchers and post-doctoral fellows from all over the world, whose breakthroughs produce some 215 scientific publications every year.
Recognized as a flagship centre by the Fonds de la recherche en santé du Québec (FRSQ), the provincial health research fund, the Research Centre, overseen by a board of directors, is financed in part by the Douglas Institute Foundation and in part by Canada’s most prestigious research grants, including the Canadian Institutes of Health Research (CIHR) and FRSQ, to name just two.
The Research Centre also sets itself apart with innovative research projects in the neurosciences, clinical and psychosocial divisions. In addition, the World Health Organization (WHO) Collaborating Centre in Montreal chose the Institute to establish its Centre for Research and Training in Mental Health.
Research themes
The Douglas Institute uses a multidisciplinary approach to research that combines the neurosciences, clinical experience, and psychosocial factors and is based on four major themes:
Schizophrenia and Neurodevelopmental Disorders
• Services, Policy and Population Health
• Mood, Anxiety, and Impulsivity-related Disorders
• Aging and Alzheimer Disease
The Day Hospital provides an intensive therapy program for groups and individuals along with diverse community activities.
These programs and activities are offered on a daily basis, six hours a day, five days a week, for an eight-week period.
Emergency Department
Individuals who have a mental health problem may go to the emergency room of the nearest hospital, to the Douglas Institute Emergency Department or to a community crisis centre.
The Emergency Department at the Douglas Institute provides care and services to anyone with a mental health problem and whose condition requires urgent care. Emergency is open 24 hours a day, 7 days a week.
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• The interaction of genes and environmental factors.
• The link between maternal infection during pregnancy and babies’ brain development.
• The link between prenatal stress and babies’ brain development (Suzanne King, PhD).
• The link between sleep and attention deficit hyperactivity disorder (ADHD).
• Anatomic and functional changes to the brain detected by means of a scanner or an electroencephalogram.
• The etiology of schizophrenia, such as the mechanisms of genetic transmission, structural and functional brain abnormalities and the changes this disease causes in brain chemistry.
Services, Policy and Population Health
The researchers working on the Services, Policy and Population Health theme come from a wide variety of disciplinary backgrounds: psychiatry, epidemiology, law, anthropology, economy, psychology, social work, and administration.
Their goal is to inspire and influence developments in mental health policy so that people living with a mental illness can obtain the care and services to which they are entitled. To accomplish this, the researchers:
Study the organization of mental health services, as well as the social, cultural and economic factors that contribute to mental and substance use disorders.
Exploring these four themes is a team of 67 researchers, some of whom are world-renowned; their work has contributed to a better understanding of the mechanisms involved in certain mental illnesses.
Each research theme includes research groups and laboratories that bring together researchers and their teams to study specific research topics.
Schizophrenia and Neurodevelopmental Disorders
The researchers exploring the Schizophrenia and Neurodevelopmental Disorders theme focus on the causes, course, treatment and prevention of illness.
In Canada, one in a hundred people will be diagnosed with schizophrenia, while 3 to 5% of children have an attention deficit hyperactivity disorder (ADHD). Effective treatment for individuals with neurodevelopmental disorders depends on finding ways to control the symptoms with the appropriate medication, psychotherapeutic and educational interventions, along with a healthy lifestyle.
Research under this theme is oriented towards:
• Early intervention, which increases the effectiveness of treatment for schizophrenia and other psychotic disorders.
• Identifying the genes linked to schizophrenia, autism and attention deficit hyperactivity disorder (ADHD).
• Identifying the predisposing factors, such as genetic and environmental alterations, that occur in early brain development.
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Our researchers focus on the following:
• Genetic marker: Researchers are attempting to identify genetic risk factors for eating disorders, personality disorders, suicide, alcoholism and substance abuse.
• Neurobiological marker: Researchers try to identify the neurobiological mechanisms behind depression and anxiety.
• Psychological marker: People react differently to stress and trauma. For this reason, researchers are currently conducting clinical studies to identify psychological markers, such as personality traits linked to anxiety disorders, particularly post-traumatic stress disorder.
• Treatments: Researchers are assessing the effects of specialized interventions in the treatment of different pathologies.
Aging and Alzheimer Disease
We all know that, as a population, we are getting older:
• By 2016, 17% of Canadians will be at least 65 years old and, as the population ages, the number of Alzheimer’s cases will rise accordingly (Statistics Canada)
• The risk of depression among caregivers of Alzheimer’s sufferers is twice as high as for informal caregivers of individuals with no dementia
The needs of our aging population will be a heavy load to bear if we do not find more effective means to treat and prevent Alzheimer’s disease and other forms of dementia.
Douglas Institute researchers are particularly interested in the identification and prevention of
• Sit on decision-making committees, alongside healthcare professionals and decision-makers, to assist in formulating concrete policies that integrate new scientific knowledge.
• Sit on the Quebec Primary Care Committee and act as a consultant for the Health and Welfare Commissioner.
• Are members of the Mental Health Commission of Canada and the Table de concertation psychiatrie-justice de Montréal (Montreal table for psychiatry and justice).
• Are members of the Provincial Advisory Committee on the Allocation of Mental Health Resources and also sit on the Institute of Health Services and Policy Research Advisory Board of the Canadian Institutes of Health Research (CIHR).
Mood, Anxiety, and Impulsivity-related Disorders
Researchers examining the Mood, Anxiety, and Impulsivity-related Disorders theme are aiming to identify the genetic, psychological, neurobiological and environmental causes of most mood disorders and testing the most effective treatments. Their main focus is on:
• Depression
• Bipolar disorder
• Personality disorders
• Post-traumatic stress disorder
• Eating disorders
• Substance dependence, e.g. drug or alcohol
• Suicide
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• Residency
• Fellowship
• Continuing medical education
Students interested in an internship may choose among the following disciplines:
• Nursing
• Psychology
• Occupational Therapy / Specialized Education
• Nutrition
• Social services
Students in a bachelor’s, master’s, doctoral or post-doctoral program can expand their expertise by participating in research projects.
Mental health professionals or workers, Douglas Institute staff members, or employees from any other institution may choose among the following training:
• Traditional training
• E-learning
• Visiotraining
• Cross-training
Mental Health Education Office
The prejudices and stigmatization surrounding mental illness prevent many people from speaking out and getting help. This is why a few years ago, the Douglas Institute created a public education program that aims at dispelling the myths related to mental illness and fighting prejudices. Since 2011, these activities have been organized by the Douglas Institute Mental Health Education Office (MHEO).
dementia in the elderly. They are exploring the following topics:
• The identification of new cognitive markers preceding Alzheimer’s disease in the elderly.
• Stress as a risk factor for dementia in older persons.
• The physical and mental health of informal caregivers.
• The link between Alzheimer’s disease and genotype (hereditary genetic constitution of an individual).
• The link between Alzheimer’s disease and phenotype (non-hereditary observable characteristics of an individual resulting from the interaction of its genotype with the environment).
• The link between dementia and depression in older persons.
• Estrogens as a protective factor against cognitive impairment in older women.
TEACHING AND TRAINING AT THE DOUGLAS
The Douglas Institute helps advance knowledge and practices in mental health through cutting-edge research and educational programs. As an educational organization, the Douglas shares its knowledge with students, staff members, researchers, mental health professionals and workers as well as with the general public.
Medical students or residents who would like to deepen their knowledge of psychiatry may choose from one of the following forms of medical training:
• Clerkship
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The more the public is informed, the more people will understand that it is possible to lead a satisfying and productive life with a mental illness that is correctly diagnosed, accepted and controlled.
The Institute’s MHEO organizes two main initiatives:
• Frames of MindTM: A series of films that deal with mental health problems. The screening is followed by a discussion between a Douglas expert, the film director/actors, and the audience.
• Mini-Psych School: A series of courses on different mental illnesses given by Douglas mental health researchers and professionals. Mini-Psych school courses are taped and broadcast on YouTube, McGill University’s iTunes U and the Canal Savoirztelevision station.
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PERFORMANCE INDICATORS
ACTIVITY INDICATORS
2012-2013 2011-2012
NUMBER OF BEDS 241 241
HOSPITALIZATIONS 2,003 1,772
OUT-PATIENTS (OP) 8,464 8,581
EMERGENCY DEPARTMENT VISITS 5,101 4,908
INCIDENTS/ACCIDENTS 2,374 2,525
CONTROL MEASURES 4,491 7,740
EMERGENCY DEPARTMENT
OVERVIEW OF EMERGENCY DEPARTMENT ACTIVITY LEVELS 2012-2013 2011-2012 DEVIATION VARIATION
OCCUPANCY RATE AT EMERGENCY AND BTU 144% 127% 17% ▲PERCENTAGE OF STAYS EXCEEDING 48 HOURS ON A STRETCHER
1% 0% 1% ▲
AVERAGE LENGTH OF STAY (HOURS) ON A STRETCHER
8 8 0 -
NUMBER OF VISITS 5,101 4,908 193 ▲
INTERNAL SERVICES
1 – OCCUPANCY RATE
2012-2013 2011-2012 DEVIATION VARIATIONALL INSTITUTE 119% 118% 1% ▲
2 – AVERAGE LENGTH OF STAY
2012-2013 2011-2012 DEVIATION VARIATIONALL INSTITUTE 45 44 2 ▲
3 – PERIOD BEFORE READMISSION
INTERVAL 2012-2013 2012-2013 2011-2012 2011-2012 DEVIATION VARIATION00-03 MONTHS 466 43% 441 42% 1% ▲03-06 MONTHS 160 15% 126 12% 3% ▲06-12 MONTHS 163 15% 94 9% 6% ▲12-24 MONTHS 0 0% 146 14% -14% ▼24 MONTHS + 305 28% 247 23% 5% ▲ALL INSTITUTE 1 094 100% 1 054 100%
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EXTERNAL SERVICES1 – ACCESS TO TREATMENT: AVERAGE NUMBER OF PATIENTS WAITING MORE THAN 60 DAYS ON THE LAST
DAY OF EACH PERIOD
2012-2013 2011-2012 DEVIATION VARIATION0 TO 18 YEARS * 52 139 -87 ▼18 YEARS AND + ** 127 77 50 ▲TOTAL 179 216 -37 ▼
* The number of PDD patients is an average of 162 patients in 2011-2012 compared to 159 patients in 2010-2011.
** The number of Eating Disorders patients is an average of 42 patients in 2011-2012 compared to 71 in 2010-2011.
2 – ACCESS TO TREATMENT: AVERAGE WAIT TIME IN DAYS
2012-2013 2011-2012 DEVIATION VARIATION0 TO18 YEARS 98 135 -37 ▼18 YEARS AND + ** 48 30 18 ▲TOTAL 61 56 5 ▲
* The average wait time for PDD patients was 368 days in 2011-2012 compared to 200 days in 2010-2011.
** The average wait time for Eating Disorders patients was 70 days in 2011-2012 compared to 115 days in 2010-2011.
3 – ACTIVITIES
2012-2013 2011-2012 DEVIATION VARIATIONAVERAGE LENGTH OF EXTERNAL FOLLOW-UP (DAYS)
429 573 -144 ▼
4 – SERVICES IN THE COMMUNITY
2012-2013 2011-2012 DEVIATION VARIATIONINTENSIVE FOLLOW-UP (AVERAGE NUMBER OF PATIENTS)
109 86 23 ▲
SUPPORT OF VARYING INTENSITY (AVERAGE NUMBER OF PATIENTS)
69 56 13 ▲
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conference, the Douglas Institute received Milieu Novateur certification for a four-year period. The Douglas Institute is the only mental health care organization to receive this certification.
SECURITY OF CARE AND SERVICESIn 2012-2013, the Douglas Institute achieved the following results in terms of the security of care and services:
Promotion of incident and accident declarations
• Institute employees are encouraged to declare incidents and accidents, as this provides us with a clear view of risks that need to be addressed if we are to reduce their frequency and severity.
• The rate of reported risks was 21.9 events per 1,000 patient days in 2012-2013. This represents a slight increase compared to the average of 21.1 events per 1,000 patient days observed between 2008 and 2012.
• An evaluation of the risk-reporting phone system showed that 75% of staff prefer phone reporting, as it reduces reporting time by 6 minutes and 3 seconds.
• Follow-up and awareness activities were also conducted. These took place during meetings of the quality teams for the accreditation process, meetings that the Nursing Quality Council held with managers, as well as orientation days for new employees.
THE DOUGLAS OBTAINS UNCONDITIONAL ACCREDITATION Following Accreditation Canada’s visit in April 2011, the Douglas Institute received final unconditional accreditation in March 2012.
In 2012-2013, the Quality Directorate held about 20 meetings in a continuing effort to coordinate the Douglas Institute’s 14 quality teams. In view of the next (April 2015) accreditation visit, these meetings allowed the quality teams to follow up on Required Organizational Practices (ROPs), evaluate the effectiveness of care tools and processes, and implement quality improvement projects, including:
• Declaration of incidents and accidents
• Analysis of risks related to medical equipment
• Evaluation of client satisfaction
• Information about activities of the Clinical Ethics Committee
• Activities related to Patient Safety Week
Milieu Novateur certification from the ConseiI québécois d’agrément
IIn spring 2012, the Douglas Institute took steps to obtain Milieu Novateur certification from the Conseil québécois d’agrément (CQA). Responsibility for this initiative went to the Quality Directorate. Thanks to staff members’ cooperation and expertise, we were able to submit innovative projects to the CQA and present the Douglas as a Milieu Novateur. On October 17, 2012, during the annual CQA
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PROCEDURE TO EXAMINE COMPLAINTS, USER SATISFACTION AND RESPECT OF RIGHTSIn accordance with An Act respecting health services and social services (ARHSSS), a statutory version of the 2011-2012 Annual Report on the Application of the Complaint Examination Procedure on User Satisfaction and on the Enforcement of User Rights was presented on June 20, 2012, in the absence of the Local Commissioner (due to unforeseen circumstances), so that the report could be submitted to the Montreal Agency after its adoption.
During this meeting, the Board of Directors appointed Élise St-Amant as the substitute Local Commissioner, in accordance with the By-Law on the Patient complaint examination procedure, for a one-year term to replace the current commissioner, who could not fulfill her duties following an accident.
As per the ARHSSS, an abridged version of the Annual Report on the Application of the Complaint Examination Procedure on User Satisfaction and on the Enforcement of User Rights was tabled during the Board of Directors meeting on October 20, 2012, and at the annual public information session held on December 6, 2012.
The abridged version of this 2011-2012 annual report was posted on the Douglas Institute’s website as a PowerPoint presentation to make it accessible to the public. The report was also sent to senior managers, clinical program chiefs
Evaluation of restraint use
• Decrease of 18% in the use of restraint measures throughout the Douglas from 2011-2012 to 2012-2013. Decrease of 15.05 cases of restraint use per 1,000 patient days from 2011-2012 to 2012-2013.
• In the “Towards a change in practice, reducing the use of restraints and isolation” training session, the participation rate of nursing staff and Douglas professionals was 77% in 2012-2013 compared to 68% in 2011-2012. The target set by the MSSS is 66%.
Corrective measures stemming from the coroner’s recommendations
In 2012-2013, a coroner’s report recommended that the Douglas Institute’s Risk Management Committee perform ongoing evaluations to ensure that its excellent suicide prevention plan is systematically applied and fulfills the set objectives.
To apply the required corrective measures, the Douglas Institute developed and implemented a suicide prevention checklist designed to uphold care quality and continuity after discharge from either Emergency or the Brief Intervention Unit for patients who present a suicide risk. The relevance of this process was recognized in the coroner’s findings. A summary of this procedure was submitted to the World Congress on Suicide, where it was accepted for a poster presentation.
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and medical chiefs as well as professional consultants to inform them of the complaints and requests received about all clinical programs and directorates.
NUMBER OF USER COMPLAINTS AND REQUESTS
NUMBER OF REQUESTS REVIEWED BY THE OMBUDSMAN/ LOCAL COMMISSIONER 2012-2013 2011-2012
COMPLAINTS HANDLED BY THE LOCAL COMMISSIONER 87 53
COMPLAINTS HANDLED BY THE MEDICAL EXAMINER 10 11
REQUESTS FOR ASSISTANCE, INTERVENTION, CONSULTATION AND REACTIVATED FILES 439 415
TOTAL 536 479
AVERAGE REVIEW TIME (IN DAYS) 2012-2013 2011-2012
COMPLAINTS HANDLED BY THE LOCAL COMMISSIONER* 17 DAYS 28 DAYS
COMPLAINTS HANDLED BY THE MEDICAL EXAMINER* 43 DAYS 28 DAYS
REQUESTS FOR INTERVENTION 27 DAYS 25 DAYS
REQUESTS FOR ASSISTANCE 2 DAYS 2 DAYS
** The legally required timeframe for a complaint review is 45 days. Timeframes for other kinds of requests are not specified.
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DOUGLAS INSTITUTE BOARDS AND COMMITTEES 3
OFFICERS AND ADMINISTRATORS
DOUGLAS INSTITUTE BOARD OF DIRECTORS AS OF MARCH 31, 2013
OfficersClaudette Allard, President
France Desjardins, Vice-President
Donald Prinsky, Treasurer
Lynne McVey, Secretary
AdministratorsSamuel Benaroya
Jancy Bolté
Mario M. Caron
Ginette Cloutier
Carlos Dias
Brigitte Friedman
Brahm Gelfand
Jacques Hurtubise
Pascale Martineu
Deborah Nasheim
Danielle T. Paiement
Matthew Pearce
Suzane Renaud, MD
Lorna Tardif
Luc Turcotte
Douglas Institute Management Committee Lynne McVey, RN, MSc, President Executive Director
Serge Beaulieu, MD Medical Director, Clinical, Knowledge Transfer and Teaching Activities
Marie france Coutu Director, Communications and Public Affairs (interim)
Michel Dalton, CGA Assistant Executive Director
Caroline Dubé Director, Human Resources
Amparo Garcia Clinical-Administrative Director, Clinical, Knowledge Transfer and Teaching Activities
Nicole Germain Assistant to the Executive Director
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Jane H. Lalonde (Observer) President and Chief Operating Officer, Douglas Institute Foundation
Mimi Israël, MD Psychiatrist-in-Chief
Jocelyne Lahoud, MBA Administrative Director, Research Centre
Hélène Racine, Nurse, MSc, MAP Director, Nursing and Quality
Willine Rozefort, MD Director, Professional and Hospital Services
Ronald Sehn, Eng. Director, Technical Services and Facilities
Multidisciplinary CouncilMarie-Ève Landreville, President
Council of NursesRachid Dahmani, President
Council of Physicians, Dentists and Pharmacists Jacques Tremblay, MD, President
DOUGLAS INSTITUTE RESEARCH CENTRE BOARD OF DIRECTORS AS OF MARCH 31, 2013
OfficersFrançois L. Morin, President
Donald Prinsky, Treasurer
Jocelyne Lahoud, MBA, Secretary
AdministratorsIan Boeckh, coopted member (as of November 6, 2012)
Michel Dalton, CGA
Abraham Fuks, MD (until November, 2012)
Alain Gendron, PhD
Alain Gratton, PhD
Jacques Hendlisz, coopted member
Sonia Jego, student representative (as of March 19, 2013)
Ridha Joober, MD, PhD
Jane H. Lalonde
Marc Laporta, MD
Lynne McVey, RN, MSc
Mariana Newkirk, PhD
Patrice Roy, PhD
Geeta Thakur, student representative (until March, 2013)
Research Centre Management CommitteeJocelyne Lahoud, MBA, President Administrative Director, Research Centre
Alain Brunet, PhD Director, Psychosocial Research Division
Anne Crocker, PhD Director, Services, Policy and Population Health Research Theme (on sabbatical since January 1, 2013
Éric Latimer, PhD Interim Director, Services, Policy and Population Health Research Theme (as of on January 1, 2013)
Pierre Étienne, MD Director, Clinical Research Division
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Howard Steiger, PhD Chief, Eating Disorders Program
Gustavo Turecki, MD, PhD Director, McGill Group for Suicide Studies
Claire-Dominique Walker, PhD Director, Neuroscience Research Division
Marie france Coutu (observer) Director, Communications and Public Affairs (interim)
Audit and Finance Committee of the Research CentreDonald Prinsky President
Michel Dalton, CGA Assistant Executive Director, Douglas Institute
Jocelyne Lahoud, MBA Administrative Director, Research Centre
Maryse Pigeon, CPA, CGA Financial Planning Officer, Research Centre
Patrice Roy Board of Directors Representative,
Research Centre
Dominique Rivest Department Head-Accounting: Other Funds, Douglas Institute
Charles Kaplan (observer)
Health and Safety Committee Giamal Luheshi, PhD President
Christian Caldji Research Associate
Doris Dea Research Assistant
Yvan-André Dumont Biochemist
Amparo Garcia Clinical-Administrative Director, Clinical, Knowledge Transfer and Teaching Activities
Bruno Giros, PhD, Director, Schizophrenia and Neurodevelopmental Disorders Research Theme
Alain Gratton, PhD Scientific Director (interim)
Natalie Grizenko, MD Medical Chief, Child and Adolescent Psychiatry Program
Jacques Hendlisz (observer)
Mimi Israël, MD Psychiatrist-in-Chief
Lynne McVey (observer) Executivie Director, Douglas Institute
Michael Meaney, PhD Associate Scientific Director
Naguib Mechawar, PhD Director, Mood, Anxiety and Impulsivity-Related Disorders Research Theme
Lindsay Naef Student Representative (until March 2013)
Ian Mahar Student Representative (as of 25, 2013)
Louise Harvey Post-Doctoral Student Representative
N.P. Vasavan Nair, MD Medical Chief, Dementia with Psychiatric Comorbidity Program
Jens Pruessner, PhD Director, Aging and Alzheimer Disease Research Theme
Natasha Rajah, PhD Director, Brain Imaging Centre
Joseph Rochford, PhD Director, Academic Affairs
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DOUGLAS INSTITUTE FOUNDATION BOARD OF TRUSTEES AS OF MARCH 31, 2013
OfficersMarie Giguère, President
Joseph Iannicelli, Vice-President
Michael Novak, Vice-President
Normand Coulombe, CA, CFA, Treasurer
Jane H. Lalonde, Secretary
TrusteesRoger Beauchemin Jr.
Bernard Bussières
Jocelyne Chevrier
Peter Daniel
Sophie Fortin
Frédéric Laurin
Brian Lindy
Daniel Mercier
François C. Morin
François L. Morin
Meredith Webster
Ex-officio Members Mary Campbell
Alain Gratton, PhD
Mimi Israël, MD
Lynne McVey
Jocelyne Lahoud, MBA Administrative Director, Research Centre
Pascal Martin Captain of Security Services
Michael Morin Animal Health Technician
Ève-Marie Charbonneau Animal Facility Supervisor and Neurophenotyping Centre Coordinator (as of February 21, 2013)
Aude Villemain Research Assistant
Brain Bank
Douglas-Bell Canada Brain Bank
Naguib Mechawar, PhD, Director
Danielle Cécyre, Coordinator
Québec Suicide Brain Bank
Naguib Mechawar, PhD, Director
Gustavo Turecki, MD, PhD, Co-Director
Danielle Cécyre, Coordinator
Montreal WHO/PAHO Collaborating Centre for Research and Training in Mental HealthMarc Laporta, MD, Director McGill Group for Suicide Studies
Gustavo Turecki, MD, PhD, Director McGill University Centre for Studies in Aging
Jens Pruessner, PhD, Director
Brain Imaging CentreNatasha Rajah, PhD, Director
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MULTIDISCIPLINARY COUNCILPresident: Marie-Ève Landreville
For 2012-2013, the Multidisciplinary Council pursued these objectives:
Continuous improvement of professional practices
The Council worked to create a committee whose goal is to describe the Douglas Institute’s current situation. It also started a reflection process on how to integrate physical activity in our patients’ recovery process. The committee will table its report at the meetings of the three councils (CPDP, CN and MC) scheduled for September 2013.
Council members also worked with their colleagues to develop a peer-review culture for all professional disciplines. A review checklist was created on record keeping and professional practices. This checklist is also used to inform chiefs about the strengths of professional practices and areas that require improvement and to develop recommendations for professional development and supervision. Peer review was included on the agenda for the meetings of social services groups as a recurring point of business. It’s expected they can then regularly discuss this subject and place greater emphasis on a culture of reflection and continuously improved professional practices.
Council longevity and motivation
Members attended specific orientation days for new employees, as well as the annual general meeting of the Douglas Institute on November 14, 2012.
COUNCIL OF NURSESPresident: Sophie Desfossés
In 2012-2013, the Council of Nurses (CN) ensured that its members’ duties facilitated recovery and improved quality of life for individuals suffering from mental illness, and that these duties aligned with the following objectives:
• Establishing a preventive approach to mental health.
• Improving knowledge and influencing policy in the field of mental health.
• Developing and enhancing human resources and promoting operational excellence.
Implementing best practices in nursing
The CN helped implement best practices in nursing by providing the necessary tools to transfer knowledge and by participating in the Quality of Care Committee.
Improving knowledge
The CN took part in organizing nursing care and practice-related roles and tasks. It also supported the deployment of nursing technologies and sought to improve staff retention and recruitment.
Promoting excellence in nursing
The CN participated in organizing nursing care and practice-related roles and tasks. It also supported the deployment of nursing technologies and improvement in staff retention and recruitment.
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of consent when a court-ordered confinement is lifted. Following this study, a reminder button will be created in the new eClinibase computer system.
• The study on the Pharmacy Practice Assessment Sub-Committee on the adjustment of medication doses based on kidney function.
At the request of the Pharmacology Committee:
• The withdrawal of Kaopectate from the Department of Pharmacy procedure manual.
• The publication of the Pharmacology Bulletin, Vol. 18, N°. 2.
• The Policy and procedures for accessing the Department of Pharmacy office.
• The Os-Cal D vs. Calcium D500 Formulation.
Furthermore, the Executive asked the Pharmacology Committee to determine the relevance of new collective prescriptions for metabolic follow-up by studying prescription frequency for atypical antipsychotics and mood stabilizers.
At the request of the Director of Professional, and Hospital Services:
• By-Law 18 – Procedures to ensure supervision in the use of seclusion and restraints so patients are treated in a respectful manner.
• By-Law 17 – Visiting hours for admitted patients.
• By-Law 23 – Procedure to be Applied when a Patient Leaves the Institution without Discharge.
They also maintained informal contacts to raise awareness about the council and encourage all members to get involved in projects for improving care quality and professional practices.
COUNCIL OF PHYSICIANS, DENTISTS AND PHARMACISTSPresident: Jacques Tremblay, MD
During 2012-2013, the Executive of the Council of Physicians, Dentists and Pharmacists (CPDP) approved the following policies, procedures and regulations:
Approval – Policies, procedures, and regulations
As requested by the Committee for the Assessment of the Medical, Dental, and Pharmaceutical Act (CAMDPA):
• The study carried out by the CAMDPA on physical exam frequency in patients hospitalized for more than three (3) months was continued. Also, it was ensured that levels of care established for geriatric psychiatry are also determined for all Douglas patients hospitalized for more than three (3) months.
• The final report of the advisory subcommittees from the annual retreat. A summary of this work was submitted to the College of Physicians of Quebec.
• The continuation of the study on record keeping and the expectations of parents for the Child Psychiatry Program.
• The study on the documentation
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by the Board (from its members who do not work for the Douglas or who do not practice their profession in the institution) and one member designated by the Users’ Committee. Finally, the Committee invited the Director of Quality and the Director of Professional and Hospital Services to share their respective expertise. Committee members cannot be replaced during their term. If necessary, the committee may enlist the ad hoc participation of other resource people to help it carry out its mandate.
The Vigilance and Quality Committee meets four times per year and ensures that the Board of Directors efficiently fulfils its responsibilities in terms of service quality. For this purpose, the Vigilance and Quality Committee:
• Follows up on the recommendations of the Local Service Quality and Complaints Commissioner, or the Health and Social Services Ombudsman, for any complaint lodged or for any services that were provided in accordance with the Act respecting health services and social services (ARHSSS).
• Coordinates all activities of other bodies established within the institution to fulfill responsibilities relating to any of the items mentioned below (section 181.0.3 of the ARHSSS) and follows up on their recommendations, such as:
1. Receive and analyze reports and recommendations submitted to the Board regarding the relevance, quality, safety or effectiveness of services provided, the enforcement of patient rights, or the processing of their complaints;
• Sentinel events flow chart.
• Collective prescription for the administration of influenza vaccine for patients of the Douglas Institute and the Outbreak Management Policy.
• The creation of the Antimicrobial Supervision Committee. This committee was incorporated within the Pharmacology Committee.
• The appointment of the external medical examiner and the substitute external medical examiner.
At the request of the Office of the Executive Director:
• Appointment of Dr. Willine Rozefort as Director of Professional and Hospital Services.
At the request of a member of the CPDP:
• Procedure for submitting a document to the CPDP.
• The creation of a special CAMDPA sub-committee to study a potential clozapine-related death.
Following the receipt of a complaint submitted by the medical examiner, the members of the Executive also created a Disciplinary Committee.
VIGILANCE AND QUALITY COMMITTEEPresident: Me Mario Caron
The Vigilance and Quality Committee is composed of five (5) members. They are the Executive Director, the Local Service Quality and Complaints Commissioner, two others chosen
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The committee elected nine members in November 2012. They will sit for three years.
In accordance with section 212 of An Act respecting health services and social services, the Users’ Committee fulfilled the following duties in 2012-2013:
RISK MANAGEMENT COMMITTEECo-Presidents: Hélène Racine and Dr. Willine Rozefort
In 2012-2013, the Risk Management Committee and the Infection Control Committee addressed the following topics:
2. Establish systematic links between these reports and recommendations and draw the necessary conclusions to make recommendations as set out under paragraph 3;
3. Make recommendations to the Board regarding any follow-up that must be performed as a result of these reports or recommendations with the aim of improving the quality of patient services;
4. Ensure that the Board applies any recommendations that it has made pursuant to paragraph 3;
5. Promote collaboration and cooperation among the stakeholders mentioned in paragraph 1;
6. Ensure that the Local Service Quality and Complaints Commissioner has the human, material and financial resources necessary to carry out his or her responsibilities effectively and efficiently;
7. Perform any other function as deemed appropriate by the Board in view of the Committee’s mandate.
USERS’ COMMITTEECo-Presidents: Brigitte Friedman and Jancy Bolté
Established in 1955, the Douglas Institute Users’ Committee is the oldest patient committee in Canada. Its mandate is to advise Douglas users of their rights and responsibilities, make suggestions to improve their quality of life, and bring their concerns to the attention of the right people, both internally and externally.
NATURE OF THE ACTIVITIES OF THE USERS’ COMMITTEE (APRIL 1, 2012 TO MARCH 31, 2013)
ACTIVITIES* NUMBER OF ACTIONS
CALLS 345
USER AND EMPLOYEE TOURS OF OUR OFFICES 118
MEETINGS IN THE UNITS (USER TOURS OR MEETINGS) 119
* More than one topic or issue may have been addressed during a call, tour or meeting.
DUTIES NUMBER OF ACTIONS
ASSISTANCE WITH LEGAL PROCEEDINGS OR WRITTEN COMPLAINTS 140
INFORMATION ON RIGHTS AND OTHER TYPES OF INFORMATION 130
LISTENING, REFERRAL TO OTHER SERVICES 123
VARIOUS COMMITTEES AND MEETINGS 87
ALL OTHER REQUESTS 292
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Main risks of incidents and accidentsAn improved version of the risk management dashboard was presented in 2013 to assess the following:
• The incidence of reported falls was 1.45 events per 1,000 patient days in 2012-2013, including 0.67% that required medical attention. This was a decrease compared to the average of 1.75 events per 1,000 patient days observed between 2008 and 2012.
• The incidence of reported medication errors was 1.07 events per 1,000 patient days in 2012-2013. This was a decrease compared to the average of 1.59 events per 1,000 patient days observed between 2008 and 2012.
• The incidence of unauthorized discharges was 0.51 cases of wandering per 1,000 patient days in 2012-2013. This was a decrease compared to the average of 1.39 events per 1,000 patient days observed between 2008 and 2012.
• The incidence of reported violent behaviour was 0.15 events per 1000 patient days in 2012-2013. This was a decrease compared to the average of 0.50 events per 1,000 patient days observed between 2008 and 2012.
The risk management dashboard has changed to include a component for benchmarking against other Canadian institutions that offer mental health and drug addiction services. We can now evaluate the Douglas Institute’s performance in fall prevention and unauthorized discharges and compare this data with other Canadian institutions, particularly in the context of the Mental Health and Addictions Quality Initiative.
Work is ongoing to establish benchmarking for other risks between now and the end of the 2014- 2015 fiscal year.
RISK MANAGEMENT FOLLOW-UP AND RECOMMENDATIONS
Sentinel events
In 2012-2013, 14 sentinel events were reported to the Risk Management Committee. Analyses of the underlying causes of these events were conducted in collaboration with managers, the care teams, as well as the patients involved or their families. After a presentation of these analyses, the Risk Management Committee made recommendations to prevent a recurrence of these types of events, with some recommendations prioritized for 2012-2013, mainly:
• Continue to improve the evaluation of patients’ physical health and mental state in addition to the documentation of patient records.
• Implement systematic use of a checklist for suicide prevention before the discharge of at-risk patients from emergency. Assess whether the goals of the ongoing process are reached.
• Emphasize the sharing of information and knowledge with police services to improve collaboration and care for people suffering from mental health disorders.
• Get families and loved ones more involved so they can play a role in monitoring the deterioration of a patient’s mental state or in making their homes safer against suicide.
• Study the association between polypharmacy and an increase in the risk of falls.
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Patient sexuality
In 2012-2013, the working group on patient sexuality completed a policy and procedure on the expression of patient sexuality. These documents were presented to the Board of Directors by Ms. Julie Desmarais Trépanier, Infection Prevention and Control Advisor, and Dr. Katherine Steger, Psychiatrist. Following their approval, these two normative documents were published and promoted by Ms. Desmarais Trépanier and Ms. Sonya Boucher, a sexology intern with the Quality Directorate.
Emergency measures and public safety
The Emergency Codes Committee followed up on emergency intervention at the Douglas Institute site and reported on this to the Risk Management Committee. The follow-up mainly addressed situations involving patients’ violent behaviour, the risk of fire, medical emergencies, and the search for patients who did not receive an authorized discharge. In 2012-2013, the new Procedure to be Applied when a Patient Leaves the Institution without Having Received Discharge was adopted. This procedure was reviewed with the Service de police de la Ville de Montréal, and a mechanism to monitor its implementation will be created. Furthermore, the Emergency Codes Committee participated in the regional working group on the plan to deal with bomb threats or suspicious packages. This committee’s work was presented to the Agence de la santé et des services sociaux de Montréal.
In July 2012, temperatures nearing the criteria for extreme heat set by the Direction de la santé
publique de Montréal prompted Douglas Institute staff to monitor and protect the physical and mental health of its clients who are susceptible to heat. No potential heath-related deaths were identified in the summer of 2012. The Douglas Institute shared its expertise in a presentation on Local Prevention and Protection Plan for High Heat and Extreme Heat during the provincial public safety conference held in February 2013.
Follow-up and recommendations on monitoring, preventing and controlling nosocomial infections
The Infection Prevention Committee is responsible for the epidemiological monitoring of nosocomial infections at the Douglas Institute. The committee also follows up on risks and gives recommendations based on established standards. As a result, our medical and paraclinical practices must be based on scientific literature, and also recognized and respected on their merits. This committee also submits a dashboard on the number of infections at the Douglas Institute, which includes a close monitoring of cases of Clostridium difficile, influenza and norovirus gastroenteritis. Committee members conducted a number of infection prevention and control activities, which included the adoption of the new hand-hygiene e-learning module that is now mandatory for each new employee.
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DOUGLAS INSTITUTE HUMAN RESOURCES4
OUR VALUESCommitted to the recovery of people living with mental health problems, the Douglas values excellence, innovation, and human potential based on commitment and collaboration.
Excellence
Have the courage to apply best practices with rigour, to question and assess ourselves, to integrate research into all of our activities, and to be a learning organization. Strive to achieve an optimal level of organizational efficiency.
Innovation
Provide a stimulating and dynamic environment, where new knowledge is developed in order to better understand, share, care, and give hope.
Human potential
Value potential and believe in people’s ability to reach new heights. Build on existing knowledge through initiatives supported by sharing and partnering.
Commitment
Carry out our mission to improve the quality of life of people living with mental health problems.
Collaboration
Ensure that patients play an active role in the decisions pertaining to their care, and work with the interdisciplinary team towards their recovery. Develop and strengthen internal, community, academic, scientific, and international partnerships to make our vision a reality.
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DOUGLAS HOSPITAL HUMAN RESOURCES
As required by the Ministère de la Santé et des Services sociaux, the following table provides data on resources employed by the Douglas Hospital.
Please note that the Auditor has produced this document only in French.
Source: Rapport financier annuel des établissements publics et privés conventionnés (AS-471) de l’Institut universitaire en santé mentale Douglas au 31 mars 2013, page 234.
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5 FINANCIAL STATEMENTS AND ANALYSIS OF OPERATING RESULTS
FINANCIAL STATEMENTS AND ANALYSIS OF OPERATING RESULTS
REPORT FROM THE ADMINISTRATION
The financial statements of the Douglas Institute were completed by the administration, which is responsible for preparing and faithfully representing this information, which includes important judgements and estimates. This responsibility also involves selecting appropriate accounting practices that meet Canadian accounting standards for the public sector and comply with the specifics outlined in the financial management manual published as per section 477 of the Act respecting health services and social services. The financial information contained in the rest of the annual management report is consistent with the information provided in the financial statements.
To fulfill its responsibilities, the administration maintains a system of internal controls that it deems necessary. This system provides reasonable assurance that assets are protected and that transactions are properly recorded in a timely manner, that they are duly approved, and that they can be used to produce reliable financial statements.
The administration of the Douglas Institute recognizes that it is responsible for managing its affairs in accordance with the laws and regulations that govern the institution.
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The board of directors monitors how the administration fulfills its responsibilities regarding financial information and approves the financial statements. It is assisted in these responsibilities by the audit committee. This committee meets with the administration and the auditor, reviews the financial statements, and recommends whether these statements should be approved by the board of directors.
The financial statements were audited by Raymond Chabot Grant Thornton S.E.N.C.R.L., which was duly authorized to do so, in accordance with generally accepted auditing standards in Canada. This firm’s report indicates the nature and scope of the audit and expresses an opinion. Raymond Chabot Grant Thornton S.E.N.C.R.L. can, without restriction, meet with the audit committee to discuss any item that is relevant to its audit.
Lynne McVey Executive Director
Michel Dalton Assistant Executive Director
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Please note that this document has been produced in French only by the Auditor.
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Source: Rapport financier annuel des établissements publics et privés conventionnés (AS-471) de l’Institut universitaire en santé mentale Douglas au 31 mars 2013.
Theses tables were produced in French only by the Auditor and were to be produced as is, as requested by the Auditor.
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Source: Rapport financier annuel des établissements publics et privés conventionnés (AS-471) de l’Institut universitaire en santé mentale Douglas au 31 mars 2013.
Theses tables were produced in French only by the Auditor and were to be produced as is, as requested by the Auditor.
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Source: Rapport financier annuel des établissements publics et privés conventionnés (AS-471) de l’Institut universitaire en santé mentale Douglas au 31 mars 2013.
Theses tables were produced in French only by the Auditor and were to be produced as is, as requested by the Auditor.
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Source: Rapport financier annuel des établissements publics et privés conventionnés (AS-471) de l’Institut universitaire en santé mentale Douglas au 31 mars 2013.
Theses tables were produced in French only by the Auditor and were to be produced as is, as requested by the Auditor.
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NOTE FROM THE FINANCIAL AND INFORMATIONAL RESOURCES DIRECTORATEFor information purposes, please note that the $2,446,408 surplus includes the surplus for principal activities ($2,205,532) as well as the surplus for ancillary activities ($240,876) (refer to page 358 of the AS-471 as at March 31, 2013).
Furthermore, the $2,205,532 for principal activities includes revenue of $3,000,000 that corresponds to a reimbursement for some of the accumulated surpluses recovered by the Agence de la santé et des services sociaux de Montréal in 2009-2010.
Therefore, on an operational basis, despite a deficit of $(1,366,982), the Douglas Mental Health University Institute finished the 2012-2013 fiscal year with a surplus of $2,446,408 thanks to the non-recurring revenue of $3 million and transfer from the capital fund.
Assistant Executive Director
Michel Dalton
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* DIRECTORS’ CODE OF ETHICS
DIRECTORS’ CODE OF ETHICS
INFRINGEMENTS OR BREACHES
In 2012-2013, there were no infringements or breaches related to Board member responsibilities or obligations.
General duties and obligations of members of the Board of Directors
In carrying out their mandate as Directors of the Douglas, the Board of Directors of the Douglas must:
• Become familiar with the Mission Statement of the Douglas and the purposes, constitution, by-laws, and policies of the Hospital in order to fulfill the tasks associated with their positions with a maximum awareness of the priorities of the Douglas as established by its Board;
• Constantly promote respect for human life and the rights of the population to receive quality health care;
• Actively participate in the work of the Board and its committees, in a spirit of cooperation, in order to plan and implement the general orientations and operations of the Douglas;
• Attend meetings;
• Vote on resolutions when required;
• Act courteously and in good faith in order to maintain the trust and confidence which their position requires;
• Act with diligence, integrity, honour, dignity, honesty, and impartiality in the interests of the Douglas and the population it serves;
• Act vigorously, prudently, and independently, with integrity as well as objectivity and moderation;
• Be loyal and frank towards all other Board members and at no time act in bad faith or dishonesty;
• Maintain confidentiality with respect to debates, exchanges, and discussions which take place in camera.
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Specific duties
A member of the Board of Directors of the Douglas shall at all times:
• Act within the limits of the powers conferred upon Directors by law;
• Carry out his or her activities as a Director independently from the promotion and conduct of any professional or business activities;
• When representing the Douglas, faithfully reflect the general plans and objectives of the Hospital and avoid any comment or behaviour likely to discredit or disparage the Hospital or its Board.
Rules related to conflicts of interest
A member of the Board of Directors of the Douglas shall at all times:
• Avoid any situation likely to compromise his or her capacity to carry out his or her functions as a Director in an objective, vigorous, and independent manner, and, in particular, avoid any situation where his or her personal advantage, direct or indirect, present or future, may conflict with the need for independence and the requirement of acting in the best interests of the Douglas;
• Immediately advise the Board, once upon becoming a Director and then specifically in each case of possible conflict, of his or her direct or indirect interest in any enterprise which is likely to give rise to a conflict between his or her personal interests and those of the Board or of the Douglas or whenever personal, family, social, professional, or business relationships or the public expression of an idea or an opinion or any outward showing of hostility or favoritism by the
Board member may influence his or her objectivity, judgment, or independence; such notice shall be addressed to the Board in writing and delivered to the chairperson or the Director General; an “interest” may include, but without restriction, an interest in any corporation, partnership, or business engaged in, or likely to enter into, agreements with the Hospital or to provide professional services to the Douglas;
• Whenever a matter is brought before the Board which gives rise to a situation described in the paragraph above, abstain from participating in any deliberation or decision on such subject matter and leave the room for the duration of such deliberations;
• Abstain from conducting any activity incompatible with the exercise of his or her position or duties as a Board member;
• Refrain from accepting any benefit from a third person when the Board member knows or should know that such benefit is intended to influence a Board decision;
• Refrain from using his or her position to obtain a personal benefit or a benefit for a third party when he or she knows or it is obvious that such benefit is against the public interest;
• Refrain from making use of confidential information or documents in order to obtain, directly or indirectly, a personal benefit for anyone.
For the purpose of the foregoing rules, a conflict of interest will occur whenever the private or personal interests of a Board member are such that, as a result of private or personal interest, he or she may reasonably be expected or apprehended to prefer one interest over another or that his or her judgment and attitude towards the Board may be thereby affected
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her capacity as a Board member;
• Respect and extend courtesy to the Douglas and its Board.
Sanctions
• A Board member who is found, upon due inquiry and after having been afforded the opportunity of being heard, to have committed a substantial breach of this Code may be sanctioned by the Board; such sanction may consist of a reprimand, suspension, revocation, removal, or any other sanction deemed appropriate, depending on the nature and severity of the breach.
• The procedure to be followed shall be the procedure contained in the Board’s By-Law on Governance or, failing which, a procedure adopted by resolution of the Board
Publication and use of the Code
• The Douglas shall deliver a copy of this Code of Ethics to each Director upon election and shall also provide a copy to any other person requesting one.
• Each member of the Douglas’ Board shall acknowledge in writing having received a copy of this Code, having read it, and undertaking to comply with its terms. The signed originals of such acknowledgments shall be kept with the records of the Board.
• The Douglas shall publish the text of its Code of Ethics applicable to Directors in its Annual Report.
• The Annual Report of the Douglas shall include a statement on the number and nature of issues considered as the result of this Code, the number of matters ultimately dealt with, and their follow-up as well as their outcome, including any decisions
Pratices related to remuneration
A member of the Douglas Hospital Board of Directors shall at all times:
• Refrain from soliciting or accepting or requiring from any person for his or her own benefit, a gift, legacy, recompense, favour, commission, discount, loan, loan discharge or reduction, or other advantage or consideration of a nature that could compromise the Board members impartiality, judgment, or loyalty;
• Refrain from paying, offering to pay, or undertaking to offer any person a gift, legacy, recompense, favour, commission, reduction, discount, loan or loan discharge or reduction, or other advantage or consideration of a nature that could compromise the impartiality of such person in the carrying out of his or her duties;
• In the case of the Director General, be prohibited from receiving, in addition to his or her official remuneration, any amount of money or direct or indirect benefit from anyone, except in the cases provided for by law;
• Account to the Douglas for any benefit or advantage contrary to this Code, to the full extent of the advantage or benefit received.
Behaviour after leaving the Board
After the expiry or termination of his or her mandate, a former Board member shall at all times:
• Maintain the confidentiality of any information, debate, exchange, or discussion of any nature whatsoever of which he or she became aware in the exercise of his or
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taken, the number and nature of any sanctions imposed, as well as the names of the Board members whose appointments have been suspended or revoked or who have been removed.
Revision modalities
The present By-Law must be revised every three (3) years by the Board of Directors.
Enactment
This By-Law was enacted by the Board of Directors of the Douglas at its meeting on November 21, 2007, and it has been in effect since that date.
