Saturday, Oct. 21
14:30 – 16:30 (2 hrs)
Meeting Room: Pavilion Ballroom D (3rd floor – North Tower)
Alexander I F Simpson*, MBChB, FRANZCP, F; TBC TBC, MD; TBC2 TBC2, MD; TBC3 TBC3, MD
Supported by the Canadian Academy of Psychiatry and the Law

CanMEDS Roles:

1. Medical Expert
2. Health Advocate
3. Collaborator

At the end of this session, participants will be able to: 1) Appreciate the evidence on psychotic illness and social adversity that gives rise to criminal justice involvement and other adverse outcomes; 2) Outline the origin and application of the concept of “syndemic” to these issues; and 3) Consider the potential ramifications of these links to clinical practice, service delivery, research, and sector advocacy.

“Random” acts of violence in public spaces have resulted in public concern about safety, social trends, and appropriate responses. The debate has been broad-based, noting that inadequate mental health addictions services are only part of the problems underpinning these concerns. How do we understand the effects of service inadequacy and the broader issues?
Canada has contributed to this literature through ‘housing first’ initiatives, but the challenges for people with psychotic illness are not integrated into our understanding of the factors that determine course and outcome of serious mental illness.
This course will explore these dimensions for people with psychotic illness and introduce the concept of a syndemic. Syndemic effects are synergistic among between various diagnostic and social factors that bring about different course and outcomes for people with certain disease entities. This concept has wide usage in infectious diseases and is now entering the area of serious mental illness. A syndemic model provides an opportunity to integrate apparently distinct social and contextual factors in a manner that assists us in explaining these adverse outcomes between psychiatric morbidity, substance misuse, violence, and biological and (or) behavioural risk for physical health.

This course will address the confluence of poverty, serious drug use, and psychotic illness and how it relates to violent behaviour and criminal justice involvement. The links between problems of structural poverty, social adversity, and service inadequacy are related to other adverse policies. This has implications on service design, clinical care, and sector advocacy.

References:

1. Jones RM, Manetsch M, Gerritsen C, et al. Patterns and predictors of reincarceration among prisoners with serious mental illness: a cohort study. Can J Psychiatry 2020;66(6):560–568.
2. Singer M, Bulled N, Ostrach B, et al. Syndemics and the biosocial conception of health. Lancet 2017;389(10072):941–950.