Approximately 40 per cent of children and youth with physical health conditions are also living with coexisting mental health illnesses such as delirium, mood disorders, psychotic disorders, anxiety and others.

Delivering comprehensive, coordinated health care for these children and their families is extremely challenging. The current health care system operates as a mind-body dichotomy, leading to fragmented communication, untimely delays, medical errors, dissatisfied patients and families, unnecessary time lost from school and work, poor health outcomes and inefficient use of health care resources. Children and youth with co-existing physical and mental health conditions are the highest utilizers of provincial health care services, collectively accounting for almost one third of paediatric health care resources. An acute need in the health care system exists to develop an integrated approach to clinical care, education and research in medical psychiatry to improve health outcomes and quality of life for children and youth with co-existing physical and mental health conditions and their families.

In 2014, The Centre for Addiction and Mental Health (CAMH), The Hospital for Sick Children (SickKids), Trillium Health Partners (THP) and the University of Toronto (UofT) combined their expertise, resources and networks for relationships to establish the Medical Psychiatry Alliance (MPA). The MPA is a first-of-its kind in Canada collaborative partnership, supported by the Ministry of Health and Long Term Care (MOHLTC), a very generous anonymous Donor, and the Foundations from each of the four partner institutions. The goal of the MPA is to transform the delivery of mental health services for patients with coexisting physical and mental health conditions across the lifespan by streamlining and integrating a complex, disjointed system. The MPA has established four interconnected work streams to accomplish its goal: 1) develop innovative models of care delivery; 2) provide training programs for current and future health professionals that focus on preventing, diagnosing and treating co-existing physical and mental health conditions within a novel integrated care model; 3) implement a self-sustaining clinical research program on the interaction between the brain and bodily systems and health outcomes related to treatments of children and youth; 4) evaluate the effectiveness of all patient care, education and research programs to allow for continuous improvement and establish evidence-based best practices. The MPA at SickKids, in collaboration with medical and surgical departments throughout the hospital, MPA Partners, and community partners is leading the Child and Youth program of the MPA, with complementary work streams for the child and youth populations.

Clinically, the Child and Youth MPA has enabled the Paediatric Consultation-Liaison (CL) Psychiatry program to expand to provide comprehensive, interdisciplinary, collaborative care to children and youth with complex co-existing physical and mental health condition, including those with distressing and impairing physical symptoms. Through this initiative, coaching and inter-professional education programs across General Paediatrics and Emergency Medicine departments have been conducted to enhance capacity among health care clinicians to identify and properly refer patients with co-existing physical and mental health conditions to ensure timely access to appropriate care. A partnership with UofT medical education is enabling the integration of medical psychiatry curriculum into medical training for students and clinical health professionals. Within the mandate of the MPA, the Child and Youth program has the opportunity to study the needs of children and youth with complex co-existing mental health conditions, as well as their families and care providers, in more depth and to determine innovative ways of meeting those needs. As such, Child and Youth MPA has launched 14 Demonstration Projects province-wide, each project addressing unique challenges in patient care, education or research. Evaluation expertise from across MPA Partners has been leveraged to develop evaluation frameworks for all initiatives to allow for continuous evidence-based improvement.

Over the next four years, the MPA will be continuing improving the design of its initiatives, proceeding to implementation, evaluation and translation of finding into the community to achieve improved outcomes across the system. It is anticipated that the MPA initiative will pave the wave for permanent, integrative approach for patients with co-existing physical and mental health conditions, their families and communities.

In addition, this fall, the 2016 MPA Annual Conference will be hosted by SickKids and will bring together healthcare providers from across the system of child and youth healthcare, in order to help identify further ways to collaborate on integrated care for children and youth. For more information please visit(medpsychalliance.com).