Mental Health & Addictions

We take a unique, interdisciplinary approach to addictions by integrating evidence-based addiction medicine and psychiatry principles into our treatment plans. Including addiction experts from family medicine, psychiatry, internal medicine and emergency medicine as well as registered nurses, addictions case workers, nurse practitioners and peer support specialists with lived addiction experience, our day-to-day clinical team treats addictions of all kinds.

As part of the program, we offer addictions groups to help individuals look at both mental health and substance use problems. The Addiction Team wants to engage with you even if you’re unsure of your goal or what your needs are, so please feel free to reach out at any time.

Central Access Phone Service

Central Access is a phone service that individuals can call to self-refer to Residential Withdrawal Management Services (WMS) within the City of Toronto. By calling this number, clients can speak to an addictions community case worker who will help complete the screening process and connect them to one of the five WMS locations in Toronto.

1-866-366-9513

Monday-Sunday 8 a.m. – 11:30 p.m. (including holidays)

Coordinated Access to Addictions Services

Coordinated Access to Addictions Services is a central number that individuals, family members and community agencies can call for guidance and referrals to substance abuse support services within the City of Toronto. By calling this number, clients can speak to an addictions counselor who will help them find the appropriate level of care for their needs.

1-855-505-5045
Monday to Friday, 9 a.m. to 4:30 p.m.

Day and Community Withdrawal Management Services

Unity Health Toronto, St. Michael’s site offers day and community withdrawal management services designed to promote wellness and recovery from substance use.

Our day withdrawal management service offers short-term group therapy for people who use substances. This program is currently offered online, Monday – Friday 8 a.m. – 4 p.m. via Zoom. Clients can register for this program through Coordinated Access: 1-855-505-5045

Our community withdrawal management services support clients who require short-term community case management, resourcing, and/or counselling. Clients who may be eligible for this time-limited case management service offered Monday – Friday, 8 a.m. – 4 p.m. are screened through our residential withdrawal management programs.

My Baby & Me (Perinatal & Addictions Clinic)

My Baby & Me is a drop-in prenatal clinic designed to support individuals using substances in pregnancy. The clinic is open every Monday afternoon, no appointment or referral needed, and individuals are able to see both an obstetrician and addictions medicine specialist in the same visit. Meals, transportation, and other instrumental supports, as well as social work and counselling, are also provided. The clinic also offers on the spot ultrasound screening, blood work, sexual health testing, and access to harm reduction care.

Our clinic embraces a trauma-informed and flexible approach. There is no age or catchment requirement to access services at the clinic.

Every Monday from 1-3:30 p.m.

61 Queen St E, 4^th floor
416-867-7421
Fax: 416-867-3742

For more information or to reach the clinic Social Worker directly, please contact Jasmine Saleh at: jasmine.saleh@unityhealth.to / 437-288-8377.

Pathways Clinic

Pathways is an outpatient care clinic focused on assessment and care of people with co-occurring mental health and substance use disorders. Assessment and care is provided through a multi-disciplinary team comprising nursing, case management, peer support and psychiatrists. The clinic provides sub-specialty psychiatric care focused on identifying and diagnosing mental health disorders occurring in the context of substance use disorders. The clinic offers time limited individual and group supports for up to one year with the goal of mental health and addiction stability and referral to long term community care. Patients will be seen by referral by physicians or nurse practitioners only. Referrals from St. Michael’s RAAM must have had two RAAM visits and confirmed to be RAAM clinic patients.

Referrals

• To access this service a referral form must be completed by a physician and faxed to 416-864-5480.

Location:
St. Michael’s Hospital
17 Cardinal Carter South

Rapid Access to Addiction Medicine Clinic (RAAM)

The RAAM is an urgent care drop-in service for people with substance use disorder. We offer medications for withdrawal and alcohol craving (e.g. Naltrexone) or opiate agonist therapy (e.g. methadone or Suboxone). If you have already been started on methadone or Suboxone you will have to return to your original prescribing doctor.

17 CC Cardinal Carter Wing
416-864-3082
Monday to Friday, 9 a.m. to 11 a.m.

Residential Withdrawal Management Services

Designed to promote wellness and recovery from substance use in a residential setting, Unity Health Toronto, St. Michael’s site offers three voluntary non-medical withdrawal management facilities that operate 24/7.

If you identify as male, you can attend these locations:

• 135 Sherbourne Street, 3^rd Floor
• 16 Ossington Avenue

If you identify as female, you can attend this location:

• 892 Dundas Street West

Our team includes Human Services Counsellors, Community Case Workers, Registered Nurses, a Nurse Practitioner, and an Administrative Coordinator. We provide a robust withdrawal management service that is trauma informed and person-centered. Services we offer include:

• Substance use assessment
• Intoxication, withdrawal, and overdose monitoring and management
• Crisis intervention and management
• Counselling
• Linkage to community resources
• Health promotion
• Goal setting
• Treatment planning and support
• Harm reduction education
  • Naloxone kits, safer injection and safer inhalation kits upon discharge
• Psycho-educational groups

To access a non-medical Residential Withdrawal Management Service, please call Central Access: 1-866-366-9513

The Child and Adolescent Mental Health and Addictions Service at St. Michael’s offers a range of mental health services from consultation to ongoing follow-up and treatment coordination for children ages five to 17. We do not offer an inpatient mental health service for children at St. Michael’s.

The services we offer include:

• Outpatient consultation and follow-up clinic
• Collaborative care to the department of pediatrics at St. Michael’s
• Consultation as requested to St. Michael’s Family Health Teams, Medical Psychiatry, and Urgent Care Program
• Consultation as required to other children’s mental health agencies as requested

The service supports children and youth who have a wide variety of needs for treatment of anxiety, mood, neurodevelopmental disorders or oppositional, impulsive-control or disruptive behaviours.

The service is primarily a psychiatry consultation process for diagnostic clarification, medication treatment, and direction to community agencies that can provide counselling, child and youth services or social worker support.

For more information, please call: 416-864-5120.

Referrals

• To access the service, a patient referral form must be completed by a physician and faxed to 416-864-5480.

CATCH-Homeless

This program is collaboration between St. Michael’s, Inner City Health Associates and Toronto North Support Services with the aim of connecting homeless people to health supports including primary and psychiatric care, peer support and case management. Fax a referral form to the CATCH Office at 416-864-5467 or call 1-877-482-4595 to learn more.

Community Connections Case Management program

This team of psychiatrists, nurses, social workers and occupational therapists provides intensive case management services for people living with serious mental illness, substance abuse issues or homelessness. Individuals must be referred by St. Michael’s Hospital Mental Health and Addictions Services.

FOCUS

Our team of psychiatrists, nurses, social workers, occupational therapists, peer support specialists, psychologist and case managers offer community based services and supports to people living with serious mental illnesses in partnership with Cota Health. Learn more at theaccesspoint.ca. Patients may also be referred by their psychiatrist within the Mental Health and Addictions Services.

Geriatric Mental Health Outreach Program (GMHOP)

GMHOP provides specialized outreach consultation, assessment and follow-up services to older adults with mental health needs and complex behavioural problems living in long term care homes in Toronto’s inner city. Individuals must be referred by a designated long term care home. For more information please call 416-864-5120.

Project Dignify

Project Dignify is a multidisciplinary intensive case management team that provides psychogeriatric care to older adults (60 and above) who are homeless or who are at risk of homelessness and who have a mental health diagnosis. The team’s goal is to meet clients’ complex needs with support to find and maintain housing, to access geriatric psychiatric care, and to improve their psychological and social well-being.  Referrals can be made using the Project Dignify referral form.

The Starting Treatment Early for Psychosis Service (STEPS)

This early intervention in psychosis program is designed to offer treatment and supports to youth experiencing signs and symptoms of a first episode of psychosis. Learn more at theaccesspoint.ca. Patients may also be referred by their psychiatrist within the Mental Health and Addictions Services.

The Inpatient Program at St. Michael’s is a 33-bed unit for adults aged 18 years and older suffering from serious mental illness and/or experiencing a crisis. Our interdisciplinary team includes physicians, nurses, peer support specialists, social workers, occupational therapists and a mental health pharmacist.

The unit creates a safe and therapeutic 24-hour environment for patients, while the team provides treatment using modalities like psychiatric care, pharmacological treatment, supportive therapy, primary nursing and group activities.

17th Floor Cardinal Carter Wing
416-864-3088

The Interventional Psychiatry Program at St. Michael’s Hospital aims to define best treatment and care for people with mood and co-morbid disorders through innovative research and knowledge translation. The program has a focus on offering novel /emerging treatments including technology-enabled treatments for Mood and other Disorders.

The treatments offered by the Interventional Psychiatry program include Psychopharmacology (e.g., IV ketamine/other anesthetic agents), Neurostimulation (e.g., ECT, rTMS, emerging neurostimulation modalities) and Digital Therapeutics (e.g., mobile-based monitoring and interventions). Our interdisciplinary program collaborates closely with anesthesia, imaging, informatics, neurology and neurosurgery to offer these emerging treatments, and our research program aims to understand treatment response with these emerging treatments. By integrating clinical care and research with education and knowledge translation, we strive to create a stronger investment in mental healthcare and ultimately improve health policy and clinical practice.

For further information on the Interventional Psychiatry program, visit stmichaelshospitalresearch.ca.

Referrals

To access St. Michael’s Mental Health Interventional Psychiatry program, a referral form must be completed by a family physician and faxed to 416-864-5480.

Interventional Program Referral Form

Information for referring providers:

• A physician or nurse practitioner referral is required (self-referral is not accepted)
• It is preferred that the referral comes from the treating psychiatrist or physician
• The referring physician must accept care after patient has completed time-limited treatments offered within the Interventional Psychiatry Program
• This program is not catchment specific
• This referral form is for the Interventional Psychiatry Program only – for all other referrals, please use the general St. Michael’s referral form for Ambulatory Mental Health and Addictions Services

FAQ About Ketamine

What is ketamine?

Ketamine is a medicine that was developed as an anesthetic to block pain during surgery. It has been used this way for the last 50 years and is safe and effective. It is on the World Health Organization’s list of Essential Medications as an anesthetic.

Over the last 20 years, ketamine has been examined in smaller doses to treat psychiatric disorders, including major depressive disorder (MDD) in individuals who have not responded well to conventional treatments. Several short-term studies have shown that ketamine is effective for people with treatment resistant depression however there are limited long-term studies completed at this time. Compared to another drug or no drug at all, ketamine reduces the following in the short-term:

• Reduces depressive symptoms
• Reduces thoughts of suicide

How does ketamine work to improve depression?

Ketamine is thought to impact neurotransmitters in the brain including glutamate. Research suggests that these changes improve mood and thinking, which are impacted by depression.

Who is eligible for ketamine treatment?

To be eligible for ketamine treatment you must:

• Have a primary diagnosis of moderate to severe depression
• Have tried other forms of treatment (medications, psychotherapy, brain stimulation), but they have not helped you
• Have a referral from your doctor

You are not eligible for ketamine treatment if you have an active substance use disorders or have symptoms of psychosis.

Who should not get ketamine?

You should not get ketamine if:

• You suffer from psychotic disorders or have psychotic symptoms
• You have an active substance use disorder or are on maintenance treatment for a substance use disorder
• You have high blood pressure that is not well controlled or other serious medical conditions
• You have symptoms from a traumatic brain injury
• You have a hypersensitivity to the ketamine drug

Do I have to pay for this treatment?

No, there is no cost to you to receive this treatment, which includes 6 sessions.

How is ketamine given?

Our program uses intravenous ketamine (through an IV line). While ketamine can also be given in other ways, giving ketamine through an IV has been studied the most and shows the most benefit so far. If you have significant improvement after one series of the IV treatment, you could be considered for use of other forms of ketamine for maintenance therapy. Our program does not cover the costs of the other forms of ketamine for maintenance therapy.

What dose of ketamine will be used?

The most common dose is 0.5 mg/kg infused over 40 minutes. Your psychiatrist will decide if you need a different dose.

How many sessions of treatment will I need?

You will receive your IV ketamine treatment 2 times per week for 3 weeks. In total, you will receive 6 treatments over 3 weeks.

How effective is the treatment?

About one third of patients have significant improvement (their depressive symptoms largely go away) by the end of one series of IV treatments. About one third of patients do not improve with ketamine treatment. The other third usually have some improvement.

How quickly does IV ketamine treatment begin to work?

You may feel the effects within a few hours to 24 hours of a single treatment, however it often takes a few days to feel better. It has been shown that benefits improve with repeated treatments.

How long do the effects of repeated doses of ketamine last?

We do not know this with certainty. Here is what research has shown so far for patients who have significant improvement:

• After a single treatment of IV ketamine, effects can appear within a few hours, peak at 24 hours after the treatment, and often remain for at least 1 week.
• After repeated treatments, the effects can be longer. People remain well between several days to several months. Some people remain well for longer periods of time.
• People could maintain the benefits with more doses of ketamine or with other treatments (for example other medications, psychotherapy, or neurostimulation). Please note that we don’t currently have enough research about the best ways to maintain benefits following one series of IV treatments. At this time, booster treatments or maintenance with other forms of ketamine are not covered by OHIP.

What are the side effects of ketamine and what should I do if I have them?

The doses of ketamine that are used for depression are much lower than the dose used for anesthesia. This makes it quite safe and side effects are usually limited. Any side effects usually appear within 2 hours of infusion and go away between 4 to 24 hours afterwards.

The most common short term side effects of ketamine used for this purpose include:

• Nausea
• Vomiting
• Dizziness
• Headache
• Blurred vision
• Anxiety
• A sense of dissociation (feeling disconnected from yourself or surroundings)
• Increased blood pressure and increased heart rate

These symptoms appear during treatment and disappear shortly afterwards on their own. We can provide treatment for nausea during the infusion. We will monitor for these symptoms throughout the treatment.

If you have side effects more than 24 hours after your treatment, or the side effects are getting worse:

• Contact our office at 416-864-3920 during business hours
• Or go to your nearest emergency department

Are there any long-term side effects?

Short-term ketamine use (in lower doses for a limited number of treatments) has the side-effects listed previously, however there is limited literature on long-term side-effects. If you are considering maintenance treatments for a longer period of time, speak to your doctor about potential side effects.

Can I continue taking my antidepressant while getting ketamine treatment?

Ketamine treatment is safe to receive when taking most antidepressants. Some studies suggest that ketamine treatment may not work as well if you are also taking benzodiazepines and NMDA receptor antagonists. Your psychiatrist will review your medications to decide if ketamine treatment is right for you.

Do I need a referral for ketamine treatment?

Yes, you need a referral from your regular doctor. Our program does not provide long-term follow-up after completion of the IV ketamine treatments. You will need to follow-up with your doctor for ongoing care.

For more information

Talk to your doctor if you want more information about ketamine IV treatments.

The Medical Psychiatry program at St. Michael’s provides psychiatric consults to all the medical, surgical and subspecialty floors and outpatient clinics. We also provide follow up of patients upon discharge, if needed.

In addition to working within the St. Michael’s Mental Health and Addictions Service, we provide care through integrated clinics for patients living with conditions like HIV, head injury, cystic fibrosis, diabetes and more who also have mental health concerns. We also have a Memory Clinic where we provide comprehensive assessment and follow-up for older adults experiencing changes in memory and cognition.

Our team includes:

• Medical psychiatrists
• Geriatric psychiatrist
• Clinical nurse specialist

The services we offer include:

• Comprehensive interprofessional psychiatric assessment
• Diagnosis information for patients and caregivers
• Treatment recommendations and medication monitoring
• Links to appropriate community support services
• Short-term psychosocial interventions
• Psychiatric care through the Ontario Telemedicine Network

17th Floor Cardinal Carter Wing
416-864-5120
Fax: 416-864-3091

Referrals

• To access this service, a Medical Psychiatry Referral Form must be completed by a physician and faxed to 416-864-3091.

The Mental Health Emergency Service Area (MHESA), located in St. Michael’s Emergency Department, are available 24 hours a day. We offer psychiatric assessments, triage, crisis intervention and stabilization of clients experiencing a mental health or addictions-related crisis. No referral is necessary to come to the St. Michael’s Emergency Department, however access to the MHESA is by referral from the hospital Emergency Department. Upon arrival to the Emergency Department, you will be seen by the emergency nurses and doctors, who will notify the crisis intervention service as required.

Emergency Department, 30 Bond St.
416-864-5346

Collaborative Care Program

The Collaborative Care program offers mental health assessment and treatment recommendations for patients within the St. Michael’s Family Health Team. Embedded psychiatrists across five clinical locations (61 Queen Family Practice Unit, Health Centre at 80 Bond, St. Lawrence Health Centre, Sumac Creek Health Centre and Wellesley – St. James Town Health Centre) work within a multidisciplinary team of family physicians, social workers and psychologists to support comprehensive mental health service delivery.

This program is only available to patients registered with the St. Michael’s Family Health Team.

Mental Health Assessment Clinic

The clinic offers mental health assessments to diagnose and provide treatment recommendations for patients aged 18 or older living in southeast Toronto. If indicated, short-term follow-up for medication management and time-limited group psychotherapy options are available for patients referred to the clinic. This consultative and time-limited model enables the referring source to access specialized mental health services for their patients and receive recommendations to manage the presenting mental health issue after patients complete their care in the clinic. St. Michael’s Hospital is a University of Toronto (UofT) affiliated academic health centre and multidisciplinary health professions, including psychiatry residents and health professional trainees, are part of this mental health service.

For more information, please call 416-864-5120.

Referrals

• To access this service a referral form must be completed by a physician and faxed to 416-864-5480.

Urgent Care Program

The Urgent Care Program (UCP) at St. Michael’s Hospital provides timely outpatient mental health care for patients up to three months after they have been discharged from the Mental Health Emergency Service Area or an inpatient admission at St. Michael’s Hospital. The UCP offers outpatient psychiatric follow-up for medication management and stabilization of the acute mental health issue. Allied health-care professionals are part of the UCP team and support patients to connect to mental health services in the community or to return to care with their family physicians.

For more information, please call 416-864-5120.

• Mindful Awareness Stabilization Training (MAST) program