Eighteen months ago, Tia* was in a car accident that left her with severe post-concussion syndrome, a condition marked by headaches and cognitive difficulties.
Six months later — just as she thought she'd recovered — she suffered a second head injury. She struggled in the aftermath.
"There were moments where I just didn't do anything, where my emotions were non-existent, which was very concerning," says Tia, speaking in advance of World Mental Health Day, which falls on Oct. 10 each year.
Concerned by the development of these depressive symptoms, Tia's neurologist referred her to UHN's Mental Health in Medicine Clinic (MHiM), which provides mental health care to outpatients followed by UHN medical or surgical care teams.
Tia initially responded to the referral with skepticism. Like many who navigate complex medical conditions, she wasn't sure how mental health care could contribute to her recovery from the effects of the concussion.
"At first, I was a bit apprehensive about sharing what had happened to me," she explains. "But it ended up providing me the support I didn't know I needed."
The MHiM Clinic was founded in 2021 with a philanthropic gift from the Slaight Family Foundation. Its creation reflects UHN's Centre for Mental Health strategic aim to integrate physical and mental health care system-wide.
The clinic treats patients such as Tia, whose physical conditions exacerbate mental health symptoms, as well as patients managing existing chronic conditions. It follows a "stepped care" model, providing basic support to patients with lower-needs, such as health system navigation or self-directed resources, while those with more complex conditions receive intensive care, including therapy and medication management.
"The whole idea of the clinic is to help to change the trajectory of people's physical health outcomes," says Dr. Sarah Bush, the clinic's Medical Lead.
This year, the clinic has seen a sharp rise in patient volumes and is on track to surpass 500 referrals — a considerable jump from the 295 it received in 2023. The clinic's growth highlights the widespread need for integrated care.
Dr. Bush attributes this increase to heightened awareness among referring physicians and new patient sources. Initially, the clinic's most frequent referrers were General Internal Medicine, Rheumatology and the Long COVID Clinic. Recently, referrals have increased from UHN's Epilepsy Program and Toronto Rehab clinics, such as Lyndhurst Centre's Spinal Cord Rehabilitation. Social workers embedded in UHN medical clinics have also played a key role in identifying patients.
In response to the rising number of patients and to keep wait times down, the team has streamlined its triage process. Initial assessments conducted by nurse practitioner Shannon Wright have been modified to chart and referral reviews in cases without acute safety issues. Additionally, social worker Nicole Bangloy's position has expanded to full-time.
In addition to addressing patient demand, the clinic introduced group psychotherapy sessions this year, recognizing that many patients, including Tia, needed more accessible mental health support.
"It's filling a huge need because a lot of patients were seeking psychotherapy, which wasn't feasible with just one clinician providing these services," says Dr. Bush.
In Tia's case, weekly group therapy helped her develop coping strategies, such as the "worry time" technique, which encourages individuals to set aside time to address anxieties without letting them dominate their day.
"Using 'worry time' has been transformative for me," says Tia. "It helped me reframe my frustrations and handle situations with more patience."
The group therapy model also connected Tia with a community of patients facing similar challenges, helping her feel less isolated in her recovery.
"The community aspect was incredibly valuable. We supported and learned from each other," she says.
After three months of group therapy, Tia experienced significant improvements in both her physical and mental health. She regained stamina, reduced her depressive symptoms and rebuilt vital coping mechanisms disrupted by her injuries. She now feels almost fully recovered.
"This program gave me the extra support I needed to reclaim my life," she said.
(Given the increase in patient volumes at the MHiM clinic and the availability of neuropsychiatry services within UHN's Centre for Mental Health, patient referrals involving brain injury such as Tia's will now be directed to neuropsychiatry. A dedicated care pathway is being created.)
Looking ahead, Dr. Bush and the MHiM clinic are focused on expanding the clinic's footprint.
With additional funding from the Slaight Family Foundation, they are developing a Transitional Aged Youth (TAY) project in partnership with Youth Wellness Hubs Ontario (YWHO), supporting patients aged 18 to 25 with chronic medical conditions and mental health challenges.
To support this patient group, the clinic is hiring a patient and family navigator, aiming to enhance capacity both at UHN and within the community.
"Many of these patients have never seen psychiatry before and have chronic health issues dating back to childhood," says Dr. Bush. "Their mental health issues often worsen their physical health conditions, making our work all the more crucial."
*The patient's name has been changed to protect their identity. Stigma and shame often accompany mental health conditions, making it difficult for individuals to share their experiences openly for fear of negative repercussions in their personal or professional lives.
