The Department of Psychiatry is a multidisciplinary department that provides secondary and tertiary psychiatric services for patients throughout Southeastern Ontario. To meet its obligations, the Department of Psychiatry has been organized into divisions along service lines that have been formed according to demographic characteristics, such as age, or identifiable epidemiological populations, with some divisions developed to support special programs for educational purposes, or clinics for service delivery. The divisions, many of which offer both inpatient and ambulatory care, are Adult Psychiatry, Child & Adolescent Psychiatry, Consultation-Liaison, Adult Psychiatric Rehabilitation, Geriatric Psychiatry, Forensic Psychiatry and Developmental Disabilities. The Division of Psychopharmacology is a virtual Division encompassing the organization and supervision of clinical trails across all facilities.

Through the divisional organization, the Department provides acute and chronic care, assessments, consultation, and rehabilitation. Services are housed and provided through three hospital sites in the Academic Health Sciences Centre and Ongwanada. In addition, the Department provides services through community outreach locations in Smiths Falls (Rideau Regional Centre and Open Doors for Children and Youth), Brockville (Child and Youth Wellness Centre), Belleville (Geriatric Psychiatric Outreach), Napanee (Mental Health Centre), and North Frontenac Township (Frontenac Geriatric Psychiatry Mental Health Services), and Kingston (Frontenac Community Mental Health Services and Pathways for Children and Youth). The catchment area of the Divisions of Adult Psychiatric Rehabilitation and Geriatric Psychiatry based at PCCC, and Developmental Disabilities based at Ongwanada, covers the counties of Hastings-Prince Edward, Lennox and Addington, Frontenac, Leeds and Grenville, and the southern half of Lanark, that is the whole of South Eastern Ontario up to Peterborough in the west. The Forensic Division is also part of the provincial forensic program and serves as back up for services to other areas of the Province. The Department has close relationship and provides consultation services to Canada Corrections Services especially at the Regional Treatment Centre based on the grounds of the Kingston Penitentiary. Telepsychiatry initiatives have been introduced.

Highlights of the divisions
The Adult Psychiatry Division of the Department of Psychiatry provides the Psychiatric Emergency Service, the Adult Acute In-patient Service and the Short-term Adult Ambulatory Care (Out-patient Services). A 34-bed acute care inpatient unit is currently located at Hotel Dieu Hospital Closely allied to the Inpatient Unit is the Psychiatry Emergency Service located currently at both Hotel Dieu Hospital (8:00 am - 11:00 pm) and Kingston General Hospital (24-hour service).

The URGENT CARE CLINIC has been established to provide very short-term follow-up of patients seen in the Emergency. This is a rapid assessment clinic. This clinic has been building up steadily and has taken some pressure off the acute care beds. The Hotel Dieu Hospital Psychiatry Ambulatory Services are academic programs that focus on acute and severe mental health problems including clinics covering Anxiety Disorders, Eating Disorders, Mood Disorders, General Psychiatry and Psychosis Prevention and Treatment (First Episode Psychosis) Program

The Division of Consultation-Liaison Psychiatry provides a team of professionals that is responsible for delivering psychiatric services to the adult patients of KGH and who manifest psychiatric symptoms. The mission of Consultation-Liaison Psychiatry is to strengthen and enhance the quality of patient care at KGH by providing timely psychiatric consultations for this group of patients. Although the main focus is on service provision to KGH inpatients, there has been recent developments toward the provision of psychiatric services to a limited number of ambulatory patients suffering from specific co-morbid medical conditions, i.e., HIV, hepatitis-C, cardiac disorders, neurological disorders, and obstetrics and gynaecologic conditions.

In addition to the above, the Consultation-Liaison Psychiatry Team consults with the Geriatric C-L Psychiatry Team when deemed necessary. The geriatric psychiatry team may be accessed only through the KGH-based C-L Psychiatry Team, not by direct consultation. Because of the increase of admissions of persons over 65 years of age and a consequent increase of number of patients presenting with delirium symptoms among persons in this age group, an initiative presently before the administration of the Hospital is the development of a Delirium Clinic in cooperation with the Division of Geriatric Psychiatry at PCCC. The Division also provides consultative and treatment services to the Cancer Centre on matters of psycho-oncology.

The Department of Paediatrics is provided with a Psychiatric Consultation Service through the Division of Child and Adolescent Psychiatry that may be consulted directly, not via the KGH Psychiatric Consultation-Liaison Service.

The Child and Adolescent Division presently based at HDH provides comprehensive psychiatric services to children and adolescents up to thier 18th birthday suffering severe psychiatric disorders. Its services include community outreach consultation to regional non-medical childrens mental health centers; an urgent consultation clinic serving the HDH/KGH emergency departments, community physicians and childrens agencies; consultation to paediatric inpatients at KGH; an in-hospital classroom-based day treatment program; ambulatory clinics including child and family forensic services; and an adolescent inpatient unit. The inpatient program is designated as serving the needs of adolescents with psychiatric disorder from Frontenac/Lennox & Addington, Leeds & Grenville, Hastings/Prince Edward, and 50% of Lanark Counties. While the program mandate and the expertise of the hospital-based mental health professionals is directed to the care of adolescents with severe psychiatric disorder, there is invariably a percentage of admissions of adolescents with conduct disorders associated with suicidal ideation to the unit.

The Urgent Consultation service provides efficient and timely response to the Emergency departments of KGH and HDH and to community physicians and other community mental health care providers referring children and adolescents who require urgent risk assessment or who are thought to require inpatient services. 5 hours/week of psychiatric time are allocated to this service ensuring that patients are seen within 24 to 72 hours of referral. Emergency physicians can book available times from their own department. While all on-call psychiatrists can admit to the adolescent inpatient unit, the introduction of this service and the close interaction of the Division with the emergency departments has resulted in a dramatic decrease in emergency admissions to the unit.

Some 90% of admissions are planned with a designated arrival date greatly contributing to the stability unit and therapeutic milieu. The inpatient program supported by the urgent consultation clinic serves the needs of adolescents with psychiatric disorder from Frontenac/Lennox & Addington, Leeds & Grenville, Hastings/Prince Edward, and 50% of Lanark Counties. It is the only tertiary care provider of adolescent psychiatric services in the region between CHEO/ROH and Lakeridge Health Corporation and is seen as a place of last resort for adolescent behaviour of high acuity regardless of etiology.

The Psychiatry Department works collaboratively with the Department of Family Medicine and Department of Emergency Medicine to support the provision of psychiatric care in the Kingston community. To this end, the Department also collaborates beyond the field of medicine through the Crisis Intervention Community Team and the Family Court Clinic as well as providing consultative services to all adult courts and provincial correctional facilities in South Eastern Ontario.

Research

The Department of Psychiatrys research activities are broad. An evolving role is to organize, conduct, and collaborate in multidisciplinary research with foci in health services research, psychopharmacological and epidemiological studies, and clinical trials. The research component is strong with 5.9 million dollars in funding for scholarly activity received in 2003. To fulfill its role in research, the Department maintains a discipline-specific database containing encounter-level patient and treatment data.