Today was another remarkable day at CAMH. A new group of fourth-year psychiatry residents met for the first time their service-user advisors. The residents seemed understandably a little nervous — as was I! After all, these teachers — neither psychiatrists nor scientists — are unlike their other teachers. They are remarkable individuals who have experienced significant mental health and addiction challenges and found a way forward. They know recovery because they have been doing it every day for years and are helping others to do it too. They embody recovery in their own courageous journeys. They come to shape the practices of these future psychiatrists in a unique and powerful way.
For two years Pat Capponi and I, along with the rest of our team, have been developing a curriculum that pairs service-user advisors with psychiatry residents from the University of Toronto. We started with just 4 pairs, who met together monthly without really knowing how to approach the task. and have since gone through successive cohorts of residents, each participating for 6 months at a time, meeting monthly with their service-user advisors while learning the ropes of clinical practice on the hospital wards and clinics.
We have seen an amazing collaboration emerge.
According to some of the residents, the advisors have helped them appreciate in a new way the importance of connecting with their clients as people, conveying respect, finding a common agenda and instilling hope. Many have come to understand for the first time the central role of empowerment and peer support in recovery. Some have even gained a new perspective on the very purpose of their work.
For their part, the advisors have described feeling empowered as they do this work on behalf of their peers. Many of them have expressed surprise to discover that their advisees are well-intentioned human beings. We hope that these shifts ripple out to their communities.
We have made mistakes and learned lessons as educators. Certainly not every resident has completed the curriculum a satisfied customer. Yet over time I believe we are getting closer to our goal of creating a learning environment that is mutually beneficial, one that is professional but also touches on the personal, and one where residents experience things that will leave lasting impressions on their hearts and minds and make them better psychiatrists.
Today one of the residents asked why we are doing this so late in their training. I suppose his question speaks to the value of his experience today, talking with a group of fellow residents and advisors about what recovery means and how it can be better supported. Perhaps one day we will get to a place where learning with a service-user educator no longer seems unusual. Until then, we carry on with this work, helping people with lived experience find their voice as educators, and helping our participants discover their shared humanity while learning together how to help transform lives.
Those of us who’ve been around since the days of rapid, unplanned deinstitutionalization know too well what that a diagnosis of chronic mental illness paired with poverty, marginalization, and housing that is one broken step above the street means. It means a life without purpose, without hope, without the ability to be seen as anything but a threatening collection of symptoms that must be controlled, discouraged from risk, and medicated.
Part of the cause can be found in the term chronic, which infers no change for the better is possible. Another cause lies in the view that those who suffer from diseases such as schizophrenia lack any insight into their condition, so engaging them in treatment decisions and options is rarely possible or desirable.
New psychiatric residents entering their rotation to learn about “chronic illnesses” are as susceptible to these erroneous conclusions as their predecessors, which is why I was so pleased when Dr. Sacha Agrawal approached me to co-lead the project he has described so well above. For me, it ranks up there as one of best things to come out of CAMH, and one I wish the community beyond the walls would emulate.
Watching our client advisors grow into their teaching role has been an uplifting and validating process. The seriousness with which they approach their task, the patience and understanding they display, their ability to impact the residents’ views all show how much we have underestimated this population. and underlines the impact of work, friendship, respect and decent housing on mental health.
A mutual learning is happening in this project, one that bodes well for the future of psychiatry. It promises better outcomes for those with serious mental illness, encourages collaboration versus coercion, promotes advocacy versus acceptance of the status quo – always with the example of what could be a better system for their clients.