The first of the fellowships began in February 2019. With an additional $734,000 funding from icare Foundation, two more fellowships were available in 2020, bringing the total to five. The new fellows, Doctors Bernard Myers, Kiran Lele, Abirami Ratnagopal and Daniel Smoothy are based at community and rehabilitation brain injury teams across NSW.
The program is a partnership between icare and The University of Sydney, involving the Royal Australian and New Zealand College of Psychiatry (RANZCP) and the Brain and Mind Centre, as well as Local Health Districts. This collaborative venture has contributed to the success of the program.
The program is a worldwide first. It provides high-level academic and clinical teaching for advanced trainees in psychiatry to help them develop specialist skills in the assessment and management of people with brain injuries and related psychiatric problems.
Seventy per cent of icare's Lifetime Care participants have a brain injury and 50 per cent of those have a mental health condition. With specialists trained in this area, customised support is provided to participants in their rehabilitation and lead to better outcomes and improved quality of life.
"We are excited to be part of this unique initiative and to expand the network of psychiatrists and fellowship opportunities in the area of brain injury across five health districts. This will provide direct benefits to those with a brain injury and their family through having access to this specialist brain injury psychiatry program," said Suzanne Lulham, General Manager, Care, Innovation & Excellence, icare.
There have been many achievements following the first year. Dr Ralf Ilchef, Professor Leanne Togher and Dr Jodi Cartoon share their views of the program with key successes outlined below.
Dr Ralf Ilchef, Supervising Psychiatrist, Royal Australian and New Zealand College of Psychiatrists (RANZCP)
Dr Ralf Ilchef is the Director of Liaison Psychiatry Service at Royal North Shore Hospital in Sydney, and a visiting psychiatrist at Royal Rehab.
Dr Ilchef was Supervising Psychiatrist for the first Fellowship, supporting Dr Jodi Cartoon through the program and he continues to supervise new fellows. He played a key role in developing the Fellowship program for advanced trainees.
Dr Ilchef hopes to encourage young psychiatrists to work in this fascinating and rewarding area, to improve access to mental health care among people who have suffered severe brain injuries.
"With more psychiatrists specialising in brain injury, it means more timely access to high-quality, evidence-based psychiatric care for people who are suffering from distressing and disabling symptoms. This will include psychological, pharmacological and neurostimulation treatments as well as social and behavioural interventions,” says Dr Ilchef.
Professor Leanne Togher, Brain and Mind Centre, The University of Sydney
Professor Leanne Togher is the Chief Investigator of the program and is responsible for making sure the program is conducted with scientific rigour.
It is recognised there is limited research and gaps in service for people with a traumatic brain injury (TBI) and psychiatric condition. Because of this, many people fall through the cracks and do not get the specialist services they need.
"Prior to the Psychiatry Fellowship program there hasn't been an opportunity for specialist training as there was no investment in this area. Through our partnership with icare and the Royal Australian and New Zealand College of Psychiatry, we have developed a rigorous curriculum for advance trainee fellows focused on learning about brain injury. Through training, which builds capacity and confidence, the program equips psychiatrists to work confidently with people with a brain injury," says Professor Togher.
"The brain is very complex. When there is damage it can impact so many areas of peoples' lives. It may impact their behaviour, their mental health, how they think and engage with those around them, how they express ideas and build relationships. If we better understand the problems, we can offer better treatments."
Dr Jodi Cartoon, Consultant Psychiatrist at Westmead Hospital
Dr Jodi Cartoon was the first Fellowship recipient and completed the program in 2019. With the benefit of having intimate awareness of the program, Dr Cartoon is now supervising one of the new fellows.
"It felt like the natural next step was to find a position where I could continue to refine as well as impart the knowledge and experience that I had gained from dedicated and learned leaders in the field. My transition to supervisor has been an exciting and enriching passage thanks to the support from the icare Brain Injury Psychiatry Fellowship team as well as the professionalism and enthusiasm of my fellow, Dr Lele," Dr Cartoon says.
"icare has provided me with expertise in an area that is otherwise very difficult to attain, as it is not generally provided in any depth through established psychiatry training programs. It has shaped the direction of my career with work in TBI Psychiatry forming a large part of my formative consultant experience."
Building capacity for psychiatrists
A community of practice was established for psychiatrists to talk about complex cases. Fellows are presenting case studies to educate clinicians about the possibilities of treatment options.
A workshop was held in 2019 with 80 clinicians which presented numerous case study examples for dealing with patients with differing situations. Services are available and accessible to the broader psychiatry community through both a liaison and consultation model.
Online education resources have been developed for clinicians to learn about TBI psychiatry. A series of vignettes have been filmed to help demonstrate common psychiatric symptoms following brain injury and will be used in an online training module.
This work has been presented in symposiums and clinical meetings and will be published in academic journals.
The program is looking at how to improve service provision for people in regional and remote areas and how telehealth services can play a role.
The fellowship program has created more psychiatry registrars and consultants interested and skilled in brain injuries. It has also encouraged close collaboration with relevant medical specialties including neurology, neurosurgery and rehabilitation physicians in treating patients.
Patients can access assistance for their mental health comorbidities in a more timely fashion, from clinicians who are aware of the many factors that make TBI psychiatry unique from other areas of psychiatry.
New models of care are being explored. Psychiatrists are now placed across five brain injury units to provide extra support and guidance with treatment that wasn’t available.
Support for families
A brain injury can be an isolating event for an individual and isolates twice as much if they have a mental health condition.
A person with brain injury can develop psychiatric symptoms, such as depression, anxiety, psychosis and other challenging behaviours. It has a devastating, vicarious psycho-social impact. These problems affect the whole family as they are dealing with issues they've never had to deal with.
Families and carers play an important role in the care of patients and can also experience isolation due to this. Families now have hope that interventions work to help manage this and create better ways to communicate.