Division Co-Chairs: Dr. Simon O'Brien, MD, LMCC, CCFP, FRCP (PCH)
Dr. Naz Alavi, MD, FRCPC and Dr. Taras Reshetukha, MD, FRCPC (Co-Chairs KHSC)
Administrative Support: Susan Beck (PCH) Claire Chow (KHSC)
The Division of Adult Psychiatry is comprised of an energetic multidisciplinary group of psychiatrists, psychologists, social workers, nurses, occupational therapists and pastoral care workers. Faculty members are engaged in a wide range of activities including providing clinical services, teaching, research and administrative duties.
Our services are provided at Hotel Dieu Hospital and Providence Care Hospital.
The Division of Adult Psychiatry out of Hotel Dieu Hospital offers acute psychiatric assessment and treatment to adults over the age of 18 through the following services: Inpatient Services, Outpatient Services and Emergency Psychiatry and Community Liaison. We have also two specialised regional programs: Heads Up! - Early Psychosis Intervention Program and Eating Disorders Program.
The Division of Adult Psychiatry at Providence Care provides a wide array of specialized services through three program areas - Adult Treatment and Rehabilitation, Geriatric Psychiatry and Forensic Services. Each of the three services offers a continuum of care - inpatient, outpatient and community - with an emphasis on reintegrating clients into the community at the earliest possible opportunity. As we move forward with restructuring, Providence Care will take on a clearly defined role as a regional provider of specialized services to people with serious mental illness and a regional resource to community agencies. In its role as a teaching facility, Providence Care participates in the training of students and a number of clinical staff conduct clinical research to contribute to the understanding of mental illness and treatment.
The Community Mental Health Services at Providence Care are described here.
The Adult Division also has comprehensive Psychotherapy Services and more information can be found on the Academic page under the Postgraduate tab.
Clincal Services
Personality Disorders Service provides care for non-psychotic adults who have been diagnosed with a personality disorder. These individuals tend to experience intense and distorted thoughts, and engage in self-destructive and socially inappropriate behaviours that are hard to change and impacts aspects of daily life.
Consultation and Education
The program psychiatrist, Dr. Jamey Adirim, provides consultation to family physicians, community psychiatrists, agencies, and other caregivers. Consultations are typically in the area of medication management, treatment, strategies, diagnosis, and issues that arise in psychotherapy. Other members of the Personality Disorders Service team offer assessments and consultations to professionals and community agencies in their area of specialty, as well as education in the understanding and treatment of personality disorders. We assist agencies in starting psycho-educational groups and provide placements for students in psychiatry, nursing, medicine, psychology, social work and nutrition.
Teaching and Reseach
Psychiatrists and psychologists with the Personality Disorders Service hold joint appointments at Queen's University and Providence Care and are active in teaching and research. Research interests include: The Treatment of Personality Disorders, The Biology of Stress, Learning Disabilities, Childhood Trauma, Sexual Orientation, Minfulness, Eating Disorders, Program Effect on Hospitalization, Common Factors in Psychotherapy, Gender Identity, Posttraumatic Dissociation, Attachment, and the Changing Role of Psychiatry at a Student Health Service.
The principal researchers are: Dr. Margo Rivera, Clinical Leader of the Personality Disorders Service and Director of Psychotherapy, Department of Psychiatry, Queen's University, and Dr. Juliet Darke, Psychologist, Personality Disorders Service.
The Emergency Psychiatry at Queen’s University is a team of clinicians and psychiatrist who assess and treat individuals with acute mental health problems who have presented to the Emergency Department at Kingston Health Sciences Centre (Kingston General Hospital site).
We work closely with the Emergency Medicine team at KHSC. After our team gets consulted to see an individual, we will meet with them as a team or individually. As part of the assessment, we will ask questions to understand the problems and concerns of the patient. Once all the information has been gathered, the team will meet to make a decision about the best care we can provide. We work with our patients to develop the best plan for them.
We also work closely with inpatient, outpatient and community mental health services to assist individuals in finding the right level of care. People experiencing a psychiatric crisis arrive in the Emergency Department in many different ways. Our goal is to provide the best support to individuals in crisis in our community.
Members:
The Emergency Psychiatry attendings each have varied interest expertise.
· Clinical Lead: Dr. Nazanin Alavi has interest in improving suicide risk assessment in the emergency settings.
· Dr. Eric Prost has expertise in women’s reproductive psychiatry.
· Dr. Taras Reshetukha has extensive clinical practice in addiction and concurrent disorders.
· Dr. Dijana Oliver has interest in psychopharmacology.
· Dr. Megan Yang has expertise in transitional age youth.
Teamwork and collaboration are our main goals. We work as part of a multidisciplinary team including mental health social workers, nurse coordinators, psychiatry nursing staff, psychiatry residents, students and psychiatrist.
Education
During the Emergency Psychiatry rotation residents do not cover other services. Usually, the team consists of a senior psychiatry resident, 1-2 junior psychiatry residents, and 1-2 off-service residents from family medicine or emergency medicine services.
Residents work as a team. Junior residents are involved in assessment of the patients under supervision of the senior psychiatry resident and the staff psychiatrist. This encourages all junior residents to get involved in the care of the patients and also helps the senior residents with leadership role.
ER psychiatry rotation lets the students and residents learn a different set of skills with a different patient population and supervisor, providing unique perspectives daily. It also allows for the knowledge acquisition and practice of acute care psychotherapy interventions that can be done in the ER setting.
Residents will get the opportunity for doing ER psychiatry at different stages of their training. They will usually do 2-3 blocks as a junior resident, and 1-2 blocks as a senior resident.
Online Psychotherapy Lab aims to improve the lives of all those affected by mental health disorders through the advancement in mental health research. Primarily located at Queen's University, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, ON.
In our online Psychotherapy Lab, we design, different online psychotherapy modules and courses for various mental illnesses including Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), Borderline Personality Disorder and substance use disorder.
Through online psychotherapy more service at lower cost could be delivered which could potentially double the performance of the healthcare system. This change in wait time and increased coverage could lead to significant financial and societal cost savings, given the debilitating impact of mental health disorders on individuals’ functioning while waiting for proper care. Diagnosis based care delivery through an online clinic provides a new approach to address the barriers of receiving therapy in the multi-cultural and geographically dispersed society.
Check out the QUOPL website for more information here.
The QUOPL is led by Dr. Nazanin Alavi, Psychiatrist and Assistant Professor.
The Chrysalis Group Treatment Program offers specialized therapy for adults (16+) who have difficulty managing intense and overwhelming emotions that often result in problematic patterns of thoughts and behaviours that are long-standing, hard to change and impact many aspects of their lives, including relationships, school, and work. Their problems frequently include some or all of the following: intense and unstable interpersonal relationships, often due to a combination of a longing for deep human connection and fear of intimacy, volatile mood swings, self-destructive and self-sabotaging behaviours, suicidal ideation, inability to modulate anger, unstable sense of self, struggles with substance abuse and eating disorders, and a range of other psychological and behavioural difficulties. Individuals who have recently experienced or are currently experiencing ongoing psychosis would not be suitable for the program, but occasionally severe traumatogenic dissociative symptoms are mistaken for psychosis, and assessments for individuals suspected of possibly living with dissociative disorders, including Dissociative Identity Disorder, are a service regularly offered by the Chrysalis Program.
Treatment approaches include Dialectical Behaviour Therapy, Radically Open Dialectical Behaviour Therapy, and psychodynamic psychotherapies (Transference-Focused Therapy and Mentalization-Based Psychotherapy), offered primarily in group-based settings.
The Chrysalis Program (previously referred to as the Personality Disorders Service) also offers specialized psychiatric assessments for those with suspected or confirmed personality disorders. Assessment referrals may be focused on diagnosis, behavioural, therapeutic, and medication management, and/or questions regarding appropriate treatment, including possible inclusion in the Chrysalis Program’s range of in-person and/or virtual Group Psychotherapy programs.
Community Groups
Managing Powerful Emotions (MPE Group)
Managing Powerful Emotions is a 12-week (90-minute) skill-building group offered three times a year for individuals who have significant challenges with tolerating their distress and regulating emotions and behaviour. Participants learn specific strategies to help tolerate emotional crises and intense emotions; including, examining the pros and cons of acting impulsively and engaging in destructive behaviour. MPE teaches participants to use practical tools to understand their feelings and exercise control over emotional outbursts that create significant and ongoing difficulties in their lives.
Weeks 1 to 6 cover the distress tolerance material and include concepts such as accepting reality, willfulness versus willingness, and crisis survival skills. Weeks 7 to 12 teach emotion regulation concepts and tools: participants learn to identify and/or label their emotions, understand the purpose of their emotions, recognize what activates their emotions, and how to use skills to gain control over emotional outbursts.
In order to successfully complete the MPE group, participants must attend at least 9/12 sessions, actively participate in the group, complete worksheets weekly, and use the skills and tools in their day-to-day life. If these requirements are met, they can then be considered for additional DBT-informed skill-building groups: Mindfulness and People Skills. Participants are welcome to repeat the MPE group.
Mindfulness (DBT Group)
Mindfulness is a skill-based group designed to help individuals live in the present moment, build awareness, and allow emotions and physiological reactions to naturally come and go. The goals of the group are to increase awareness of internal and external responses; and to raise the threshold for accepting and enduring painful emotions.
People Skills (DBT Group: Interpersonal Effectiveness)
People Skills is a skill-based group, designed to teach participants more respectful and effective ways of communicating with others; including, expressing thoughts and feelings, making requests of others, refusing unwanted requests, and resolving conflicts.
These two groups are offered weekly for 12-weeks. Each group runs for 60 minutes and they are typically offered back-to-back, on the same day. To successfully complete and benefit from the groups, participants are expected to attend regularly and to complete the weekly worksheets. Homework for these groups is essential for developing the skills being taught. A group member who misses more than three sessions will be encouraged to repeat the groups.
Seeking Safety (Substance Abuse and Emotion Regulation)
The Seeking Safety group focuses on the link between trauma and addictions. This group teaches a specific set of skills to help individuals establish safety in their relationships, thinking, emotions, and behaviour. Participants may be at different stages in their recovery from substance use, but all will be expected to work towards abstinence. Group discussions follow a series of topics focused on building a life free from substances, with participants setting commitments in each group aimed at reducing substance use. This group meets 1.5 hours per week for 25 weeks.
Kaleidoscope Day Program
The Kaleidoscope Day Program runs for 15 weeks, two mornings a week. This program is an intensive group treatment for people with severe, persistent symptoms that have not been resolved in other settings. The program is highly structured and integrates DBT and psychodynamic approaches. Participants must be functioning independently in the community.
Successful completion of the MPE, Mindfulness, and People Skills groups is required inorder to be considered for the Kaleidoscope Program. Individual screening will be requiredfor program suitability.
Dr. Margo Rivera, PH.D., C.Psyh.,
Clinical Leader,
Chrysalis Group
Treatment Program
Dr. Jamey Adirim,
Psychiatrist,
Personality Disorders Service and Chrysalis Group Treatment Program
Referrals
The Program is located at 303 Bagot Street, Suite 300.
A referral is mandatory to be considered for any of our groups.
Referrals to the Chrysalis Group Treatment Program are accepted from family physicians, psychiatrists, community mental health agencies, and medical care providers. Referrals can be better assessed if all collateral information is included (i.e., psychiatric assessments, social histories, discharge summaries, mental health consultation reports, or a detailed note outlining the purpose of the referral). The South Eastern Ontario Addictions & Mental Health Service Access Form can be found online or you may request a copy from our office.
Participants are encouraged to have their family physician or primary care provider continue to manage their ongoing care as our program is considered an adjunct to existing supports.
All referrals and requests for service or consultation are to be directed to the Chrysalis Group Treatment Program at (613) 542-8344 ext. 0; FAX (613) 542-1400