New clinical approaches, research and funding needed to treat early traumas driving mental illness

By Dr. Robert Tanguay

Mental illness costs Canadians more than $50 billion per year in medical costs and loss of productivity, with over 500,000 people missing work every week because of mental health concerns.

Adverse Childhood Experiences, or ACEs, are events that have occurred in childhood that can have long-lasting consequences on physical and emotional health.

ACEs are generally described in four categories: abuse (sexual, emotional or physical); neglect (physical or emotional); household dysfunction (divorce, mental illness, incarcerated relative, violence towards one’s mother, or substance abuse); or other traumatic events that may occur outside the home (bullying, community violence, kidnapping).

The foundational ACE study was conducted by the Centers for Disease Control and health care company Kaiser-Permanente in the mid-1990s. This study reviewed over 17,000 health records and confidential health surveys regarding childhood experiences. Many follow-up studies have since been done.

This research shows that about two-thirds of society have had one or more ACEs, and about one in eight people have had four or more ACEs. People with four or more ACEs have a lower life expectancy and significant health outcomes.

The impacts include: three times the levels of lung disease and adult smoking; 11 times increased risk of being an intravenous drug user; two times increased risk of liver disease; and 14 times increase in the number of suicide attempts.

Most experts agree that ACEs are potentially traumatic events for many. Yet we are not treating them as such.

We know that ACEs are for the most part preventable. Advocacy should be for increased funding for prevention, by providing every new mother with all the resources necessary to raise her child in a safe and healthy environment. This would remove the risk factors that can lead to devastating outcomes for so many.

But what about those who have already suffered these early childhood traumas? And that’s what they are – traumas, not experiences.

Evidence-based care treats the root cause of mental illness

The International Classification of Diseases has recognized Complex PTSD (cPTSD) as a formal disorder, with treatments that include trauma-focused therapy, often in the setting of acquiring skills through cognitive behavioural therapy-like treatments.

cPTSD has been used for decades to describe severe psychological harm that comes from chronic, repeated trauma that continues over months to years, usually occurring in childhood. These individuals are often diagnosed with personality disorders, bipolar disorder, addiction, ADHD and more, but rarely is the childhood trauma a focus of treatment.

This is often because treatment is focused on a biomedical model, which leads to powerful medications being used to subdue the behaviours that come with the diagnoses, rather than a holistic bio-psycho-social-spiritual approach that looks to treat the root cause of the illness.

What if we turned to treating the underlying trauma and focused our efforts on the issues perpetuating mental illness? Specifically, what if psychological treatments were actually preventative?

By treating the underlying trauma, we can alleviate so many of the symptoms people are suffering with. We can help prevent the often-cyclical nature of mental illness.

So many are suffering and have little to no access to evidence-based care, while the health care system is struggling to keep up.

The Newly Institute has been pioneering an innovative approach to the treatment of mental illness by fusing a bio-psycho-social-spiritual treatment model into medically managed intensive outpatient programs.

Programming includes access to medical, psychological and physical treatments. These evidence-based treatment programs help people to overcome deeply embedded traumas (including ACEs) that are preventing them from living to their full potential.

The Newly operates with an interdisciplinary team working together on patient care, including psychiatrists, psychologists, nurses, pain doctors, addiction doctors, occupational therapists, social workers, physiotherapists and kinesiologists. The program takes a personalized approach to health for those who are suffering with mental illness and/or addiction.

With these services available we are seeing more Canadians get back to work quickly, safely and effectively, helping to save millions of dollars in health care costs.

More research, investment required for promising treatments

As these new programs are showing improved return-to-work rates for even the most complex and severely unwell workers, many employees still lack the health benefits to access intensive treatments. Investment in evidence-based mental health programming continually shows improvements in return to work. We must invest in our employees.

What if there are even faster ways to help people recover from severe mental illness?

Ketamine is a Health Canada-approved medication for chronic and severe depression, rapidly resolving symptoms and helping people get back to work and back to life. Yet ketamine is difficult to access or not approved by some disability services.

We must allow data and evidence to guide treatment, not the status quo. It is time for even more aggressive approaches to treatment as rates of disability due to mental illness have rapidly increased during the COVID-19 pandemic.

For example, psychedelic medicines are showing incredible promise, yet little investment has been put into researching their role in rehabilitation and disability services.

It is time to help people not only get their life back, but to start living without the guilt and shame that so often intensify suffering. It is time to remove the stigma of mental illness and addiction. We must make it okay to ask for help and ensure that help is available when needed.

We need to invest in research into aggressive treatments. We see a brighter future for mental health and together we can change everything.

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Dr. Robert Tanguay, MD, FRCPC, CISAM, CCSAM, is Vice-President and Chief Medical Officer at The Newly Institute based in Calgary, and a clinical assistant professor with the departments of Psychiatry and Surgery at the Cumming School of Medicine, University of Calgary.