Endings, beginnings and the confidence to grow

Alexis remembers sitting on her bed thinking “why am I even here? I don’t want to be.” At only 12 years old,  while most young girls are envisioning and wading into the freedoms that lie ahead, Alexis couldn’t see a future for herself. Nor could she understand this overwhelming feeling of hopelessness. 

Looking back, Alexis realizes it was the beginning of a long and difficult journey - one that would eventually bring her to St. Joseph’s Health Care London (St. Joseph’s) where treatment through Parkwood Institute’s Adolescent Psychiatry Program would change the course of her life.

This week (March 16, 2021) that program will officially close at Parkwood Institute, ending a legacy of adolescent mental health care at St. Joseph’s that has spanned more than two decades and helped to shape the lives of countless youths like Alexis. Mental health care for this unique population will now be located and delivered through Children’s Hospital at London Health Sciences Centre (LHSC) as part of its regional mandate.

“This change is part of an exciting opportunity to reimagine hospital-based child and adolescent mental health care services in Western Ontario,” says Jodi Younger, Vice President, Patient Care and Quality at St. Joseph’s. “Collaboration and planning are ongoing in partnership with patients, their families and our regional and community partners to re-design a new model of hospital-based care for child and adolescent inpatient and outpatient mental health services.”

There will be no reduction in the capacity of these services within the region as a result of this change, and there will be no reduction of beds.

“St. Joseph’s has built a lasting foundation upon which an enhanced model can now be developed to serve an ever-growing and expanding need in Western Ontario.”

Hospital-based adolescent mental health care services in London have been evolving since first introduced in the early 1980s. At the time, there was a need to address life-threatening mental and physical health conditions among youths arising from the rampant substance abuse of the 70’s. 

The first non-acute adolescent inpatient program opened at the former London Psychiatric Hospital (LPH) on Highbury Avenue with 24 beds and an in-hospital school. The program followed a strict behavioural based model of care, which awarded privileges to adolescent inpatients via a points system, but by the late 1990s, the program was struggling with low occupancy rates.

In 1998, psychiatrist Dr. Sandra Fisman, then Chair of the Division of Child and Adolescent Psychiatry at Western University, was recruited by LPH to help determine the future of the program. Dr. Fisman was well-known for her role in developing the gold standard of community-based autism programs at CPRI, and later, a children’s acute mental health care inpatient program at the former War Memorial Children’s Hospital on South Street.

“I wanted to better understand the program and explore an alternative service delivery model I believed would provide better outcomes for patients,” explains Dr. Fisman. 

From her time at CPRI, Dr. Fisman knew that bringing together many different health care professionals on one team was essential in treating and understanding children and youth. Under her guidance, care shifted from behavioural based to a trauma-informed, interprofessional model of care, and the specialized Adolescent Psychiatry Program for youth aged 12 to 18 was born, with a regional mandate for the entire South West region. 

Adolescent psychiatry continued to evolve as health care restructuring across the province got underway in the early 2000’s. LPH was renamed Regional Mental Health Care London (RMHCL) when St. Joseph’s assumed governance of the program and facility in 2001.

“The biggest reward has always been working with youth and making a difference.”

In 2006, Dr. Fisman became aware of a promising treatment program called dialectical behaviour therapy (DBT). DBT is a type of cognitive-behavioral therapy that teaches individuals how to live in the moment, develop healthy ways to cope with stress, regulate their emotions and improve their relationships with others. Impressed by the potential of DBT as a treatment for the adolescent population, Dr. Fisman convinced hospital leadership to invest in a large scale, intensive DBT training program for staff and physicians at both St. Joseph’s and LHSC, recognizing the model of care could be sustained over time. 

Within two years, inpatient and outpatient DBT teams were added to the Adolescent Psychiatry Program at St. Joseph’s with great success. It included a parental/family support component and became well known across Southwestern Ontario. “Very often, adolescents in the region were referred to St. Joseph’s specifically for our expertise with DBT,” adds Dr. Fisman.

By 2014, St. Joseph’s had opened a new, state-of-the-art, purpose-built Mental Health Care Building at Parkwood Institute, which replaced the former RMHCL facility. It would be the pivotal final step in the province’s restructuring of mental health care services in the region.
For Alexis, who was eventually diagnosed with major depressive disorder and post-traumatic stress disorder due to long-term abuse and neglect at home, the treatment she would receive through Parkwood Institute’s Adolescent Psychiatry Program, including DBT, was literally a life saver. 

“The program gave me the ability to be me… to be who I want to be... They helped me grow. I wanted to be better and they helped me get there, without having to walk alone.”

By the time she reached Grade 9, Alexis was self-harming and had attempted to take her own life on numerous occasions. After a short inpatient stay at Parkwood Institute, she received ongoing treatment through the adolescent outreach intensive DBT program. The care, she says, allowed her to gain control over her impulses and emotions, particularly anger and depression – her greatest challenges. 

 “The program gave me the ability to be me…to be who I want to be,” says Alexis. “They didn’t try to change me, they didn’t try to fix me. They helped me grow. I wanted to be better and they helped me get there, without having to walk alone.”

Trish Travis, a registered nurse and DBT therapist on the Adolescent Outreach Team, worked with Alexis throughout her care journey at St. Joseph’s and watched her grow. 

“Alexis soaked up everything that was made available to her throughout the program,” Trish recalls. “But just knowing these skills doesn’t help your life to get better. You have to be committed to doing that and Alexis was. Despite the many challenges she faced, she took all of the bad things that happened to her in her life and rose above them.”  

Today, Alexis is 18 years old, happily settled into a compassionate foster home and is completing her first year of college to become a developmental service worker. She was officially discharged from the graduate outreach program in early 2020.  

“Before I came to Parkwood Institute, I didn’t think I would be successful in life,” says Alexis. “I didn’t believe I could finish grade 10, let alone graduate high school. But along with the supports and coping mechanisms the program gave me, it also gave me the confidence to know I was smart enough and strong enough to make something of my life. The best gift you can give someone is the confidence to believe in themselves.”
Alexis also says staff and physicians at Parkwood Institute influenced her choice of career. 

“After going through this experience, I decided I wanted to be that person for others. To help others get to where I got to myself.”

Alexis’ story of recovery is just one of many that will live on in the hearts and minds of St. Joseph’s staff and physicians when the Adolescent Psychiatry Program closes its doors for the last time on March 16, 2021. “The therapeutic relationships our staff and physicians developed with these youths over the years are powerful,” says Trish. “They are real connections and for a lot of youth it is sometimes the first, or only, positive, trusting, adult connection they have.”

“The therapeutic relationships our staff and physicians developed with these youths over the years are powerful.”

Trish is now working in the new adolescent mental health care program at LHSC’s Children’s Hospital, providing St. Joseph’s outpatients with continuity of care and a familiar face. 

“It’s not about a program being in a certain building,” says Trish. “It’s about the connections you’ve made and the trust that you’ve formed. I’m so grateful I was able to take a position at Children’s Hospital and continue supporting the outpatient youth that were in our program at St. Joseph’s.” 

Dr. Fisman will also leave the St. Joseph’s family when the program closes. As she begins to transition into retirement over the next few years, she will continue part-time as a psychiatrist at Children’s Hospital within the acute ambulatory team. 

“The biggest reward has always been working with youth and making a difference,” says Dr. Fisman. “The teams I have worked with at St. Joseph’s have been such caring, and family-centred people. I have wonderful memories of so many people I’ve worked with. They have nurtured each other as well as our patients. Hopefully, the good work and the good deeds of the program will live on and find their way into a compassionate organizational culture.”

On the H5 Adolescent unit at Parkwood Institute, a discharge tree has graced the main hallway for all who enter the program. On the tree, each leaf has a hand-written message from a patient who has been discharged from the unit. The messages are filled with encouragement and hope for newly arrived patients. Because many youths are feeling a sense of hopelessness at admission, the messages are meant to provide a sense of promise and optimism from someone who has walked the same path.  

Read more messages of hope written by former patients

This discharge tree will move with the program to Children’s Hospital where it will remain a beacon of hope for future patients and a tangible legacy of the H5 Adolescent Psychiatry Unit at St. Joseph’s.

“St. Joseph’s remains so very proud of the exceptional care provided by our organization to the adolescent population in our region over the years, and we are extremely grateful for the countless staff and physicians who have contributed to the program’s success,” says Jodi. “St. Joseph’s has built a lasting foundation upon which an enhanced model can now be developed to serve an ever-growing and expanding need in Western Ontario.”

Alexis knows a thing or two about endings and new beginnings, and much of what she learned about dealing with transitions came from the staff at Parkwood Institute. 

“Someone once told me, change isn’t a closed door… it’s simply a ladder that gets you to your next step. I would not be who I am today without the staff and physicians at Parkwood Institute. The adolescent program showed me that I was not alone, and that it’s okay not to feel okay. It absolutely changed the path my life was on.”