Non-invasive brain surgery helps heal mental illness

As an aspiring young psychiatrist, Nir Lipsman learned about the possibilities of new treatments called “neuromodulation” for mental illnesses. He switched to neurosurgery and has never looked back.

Today, Dr. Lipsman is director of the Harquail Centre for Neuromodulation at Sunnybrook Health Sciences Centre in Toronto. Neuromodulation involves stimulating nerves using drugs, electrical signals or other forms of energy. For example, Lipsman has used deep brain stimulation to treat alcohol use disorder and post-traumatic stress disorder. MRI-guided focused ultrasound is being used to treat obsessive-compulsive disorder and depression. Lipsman’s centre is also a leader in repetitive transcranial magnetic stimulation.

This work has garnered Dr. Lipsman the 10th annual Royal-Mach-Gaensslen Prize, jointly sponsored by the University of Ottawa Institute of Mental Health Research at The Royal and the Mach-Gaensslen Foundation of Canada.

“Dr. Lipsman, a clinician-scientist, is the first winner in the 10 years of the Royal-Mach-Gaensslen Prize who is a neurosurgeon,” says Dr. Chris Carruthers, chair of the board of the Mach-Gaensslen Foundation of Canada. “His area of research is novel and represents the value that the prize can bring to new approaches to mental health and illness.”

Neuromodulation approaches are less invasive or entirely non-invasive, avoiding traditional surgery. Lipsman and his team are trying them in patients who still have significant mental illness despite previous treatments with other, more conventional therapies, such as drugs and psychotherapy.

At the prize ceremony December 2 in Ottawa, Dr. Lipsman told the story of a young adult patient with severe obsessive-compulsive disorder that had a devastating effect on her life. Non-invasive neurosurgery resulted in a dramatic improvement that has allowed her to reach some of her life goals. The patient is now part of a patient team helping the hospital design new research studies.

Lipsman says many serious mental illnesses have their origin in brain circuits that don’t function as they should. In a video about his work, Lipsman says, “To me, it’s a reflection of where we are as a field, of recognizing that these are hard-and-fast organic conditions that require surgical intervention, whether non-invasive or invasive or across that spectrum.”

Media host and fundraiser Sam Laprade, who served as emcee of the ceremony, asked Lipsman about making sure that all members of society have access to such cutting-edge treatments.

“These are conditions that touch people from all socio-economic backgrounds,” said Lipsman. Reaching people who could benefit from neuromodulation is one of Sunnybrook’s aims. “It’s not enough to just have the fancy tools.” He described Sunnybrook’s outreach program to clinicians, especially throughout Ontario, to let them know that treatments are available. He says the hospital also receives referrals from across the country.

But there can be long waitlists for neurosurgery. He says the wait for neurosurgery for epilepsy — an effective and well-known treatment — is currently 18 years. “There is an access problem, and we need to address that.”

He would like to see neuromodulation for mental illness move from research studies to first-line treatment. Currently, he says the risks associated with neuromodulation are low and approaching zero. And treatment times are shrinking from weeks to minutes. These developments would make neuromodulation safer and more accessible.

Learn about Dr. Nir Lipsman’s research in this short video. Video production: SandBay Entertainment.

If you missed the prize ceremony, you can view it here.

Dr. Srividya Iyer wins the ninth annual Royal-Mach-Gaensslen Prize

Dr. Srividya Iyer is helping transform Canada’s services for mental health for youth and transforming lives as a result.

Dr. Iyer, a professor at the Douglas Research Centre, McGill University, in Montréal, Quebec, conducts research into the mental health of youth. Among this age group, mental illness is a top cause of disability and death. Dr. Iyer’s research aims to create mental health services for youth that are accessible, effective, and welcoming. She also innovates in mental health services for diverse, underserved youths in Canada and globally. She works with youth, family, community, health care, and government partners to change real-world practice and policy.

At a ceremony to present Dr. Iyer with the 2023 Royal-Mach-Gaensslen Prize held 5 December 2023 at the Royal Mental Health Centre in Ottawa, she said her experience working as a psychologist in India and the United States forged her path to this unique research in Canada. Seeing people with serious mental illness returning to hospital multiple times impressed upon her the importance of identifying mental issues and treating them promptly when they first arise—mainly in youth (12 to 25 years).

She said the existing mental health system is not set up for young people. Some services are not welcoming for youth. Many cut off youth services at age 18, sending youth into an adult system that may not be suitable for them. As well, the mental health system is still largely organized by diagnosis, whereas many youth are facing what she called a “mélange” of issues involving life events, mental health and substance use.

Joining her in a panel discussion was moderator Ian Mendes, a sports journalist with The Athletic and advocate for mental health, and Dr. Feodor Poukhovski-Sheremetyev, who started advocating for youth mental health when he was a youth himself and has made it his career. He is currently co-lead of a national youth advisory council for Access Open Minds, a national youth mental health network uniting youth, families/carers, researchers, service providers and decision-makers in transforming services. “How do we engage youth and other stakeholders in the design of research?” he asked. He said researchers are asking youth not only “what kind of system do you want, but what do you need to build that system?”

Dr. Iyer helped establish Access Open Minds. She said the answers to questions about youth involvement in their own mental health services can differ, depending on the community. She mentioned one First Nations Community in which youth took carpentry classes to actually build the spaces for youth. In another community, youth and their families have asked to be involved in hiring the staff who will care for youth.

The important thing, Dr. Iyer says, is that services for youth are a “learning health system” in which continuous feedback provides information on what works and what is missing, which changes the way services are delivered, evolving the system. For example, peer support is being added to services for youth with psychosis, in response to feedback from clients and community.

She says the future includes exploring ethical use of artificial intelligence to analyze large amounts of data or even youth people’s artistic expression to see if it offers clues to their mental health. Mental health services would also benefit from agile, digital systems to help them operate effectively and to determine questions like which young people need brief intervention and which need more formal services.

She looks forward to a future in which young people get the services they need in an environment that supports them to flourish and reach their potential.

Video about Dr. Srividya Iyer’s research on mental health services for youth

If you missed the live-stream of the Royal-Mach-Gaensslen Prize event 5 December 2023, it has been recorded and is available on The Royal’s YouTube channel.

“Mental health research in Canada cannot keep pace with the growing need for prevention, diagnostics, and treatments. The percentage of Canadians expressing the need for mental health care in a given year continues to increase, while overall funding for mental health research in Canada remains low,” say the organizations that sponsor the Royal-Mach-Gaensslen Prize: the University of Ottawa Institute of Mental Health Research at The Royal and the Mach-Gaensslen Foundation of Canada.

In a commentary published in the Canadian Journal of Psychiatry 14 November 2022, the authors call for governments to match philanthropic donations to mental health research. They also recommend forming a national organization for philanthropy for mental health research. They refer to statistics on mental health research funding and the prevalence of mental health problems in Canada to show the gap between the need and the current level of funding.

“We call on public and not-for-profit funders of health research to increase flexible funding for innovative mental health research and to hold a summit on addressing the challenge of funding for mental health research,” they conclude.

Dr. Sheri Madigan wins eighth annual Royal-Mach-Gaensslen Prize

“When kids are on screens for far too long, research shows they are not meeting their developmental milestones,” explains Dr. Sheri Madigan, a clinical psychologist, professor, and Canada Research Chair in the Department of Psychology at the University of Calgary and the Alberta Children’s Hospital Research Institute. When asked whether family time, such as around the dinner table, is important, she emphasizes that it’s not just the dinner but device-free dinners where families can interact with each other that help children’s mental health. Her advice: “Disconnect to connect.”

But she’s not advocating cutting off social media entirely. She says young people need their digital communication with peer networks, but this must be balanced with real-life human connections. “Youth who have no screen time or too much are struggling.”

These were among the research-based findings that Dr. Madigan discussed on 5 December 2022, when she received the 2022 Royal-Mach-Gaensslen Prize at an event at the Royal Mental Health Centre in Ottawa. The prize event was held in person for the first time in three years and was also live-streamed on Zoom for more than 60 people who attended remotely.

After accepting her award, Dr. Madigan discussed her research into children and youth’s mental health with moderator Ian Mendes, who is a sports journalist with The Athletic and advocate for mental health, and Dr. Nicole Racine, a clinical psychologist and assistant professor of psychology at the University of Ottawa. Dr. Racine previously studied with Dr. Madigan, and they worked on several research projects together.

Canada was experiencing a crisis in mental health care for children and youth even before the pandemic, said Dr. Racine, and the pandemic has made it worse. Resources and funding are desperately needed. Dr. Madigan said that, in Calgary where she lives and works, the waitlist for trauma treatment for young people is four to eight months. Researchers have worked with youth, their caregivers and clinicians to create a website to help young people and their families learn about trauma and mental health while the young people wait for treatment.

But she estimates only one in four children and youth are getting the mental health services they need. The other three-quarters are not. “And they’re struggling,” Dr. Madigan notes.

Dr. Madigan stressed the value of drawing on the experience of clinical psychologists who work with children and youth to develop research questions and of applying research back to a clinical setting. She and Dr. Racine worked with the Luna Centre in Calgary (see video) to help reduce the rates of traumatized children dropping out of treatment. The Luna Centre is one of more than 30 child advocacy centres across Canada that bring together police, social workers, and psychologists in one place to help children who have faced trauma, explained Dr. Madigan. These centres help prevent the need for children to tell their story repeatedly to different professionals, which can be re-traumatizing. The centres also give children a welcoming, safe space for treatment.

The Luna Centre is also available to parents and other caregivers if they need help with their mental health, Dr. Racine said. This reflects the importance of treating the whole family, and helping parents cope with the mental health stresses affecting their children and themselves. Research shows that children who have positive relationships are more likely to stay in treatment after trauma. Positive relationships at home are beneficial, but sometimes this is not possible if the source of maltreatment is a parent or family member. Good relationships at school and in the neighbourhood can provide needed support as well.

Dr. Madigan said such research in the community is “one of the most rewarding aspects of our careers so far.”

Video about Dr. Sheri Madigan’s research on mental health for children and youth.

If you missed the live-stream of the Royal-Mach-Gaensslen Prize event 5 December 2022, it has been recorded and is available on The Royal’s YouTube channel. 2022 Royal-Mach-Gaensslen Prize for Mental Health Research ceremony