Mental Health In-Patient & Staff Summer BBQ 2017

moose-burgers-bbq-581x338

Tis’ the season to be Q’ing!!!!

Back by popular demand, the In-Patient MH services will be holding its annual Summer BBQ.

For the past 6 years during the summer months our Mental Health Team spends a lunch with our in-patients enjoying burgers and various summer dishes on the 3C patio.

All of this was birthed to improve our relationships with our patients during a season where being cooped up in a hospital during our short Canadian summers can be increasingly depressing.  Not only do staff enjoy a break from the normal daily grind, but our patients also enjoy this event veering away from the usual hospital experience.  Here at TSRH we strive to improve the patient experience and Mental Health is one department where our patients always come first.

This years summer BBQ kicks off on Friday, June 30th on our wonderful 3C patio.  Like previous years our kick off party will feature musical performances from various former in-patients.  Food will be cooked by our resident BBQ master, Michael M.  And to spice this up for this years kick off party we will be having staff bring in various dishes/desserts to share ala potluck style.

Hope to see you all there!!!

When:  Friday, June 30, 2017 @ 1200hrs

Where:  3C (Birchmount) Patio

Following Dates throughout the summer:  July 14th, 18th & August 11th, 25th.

bbq

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Mental Health Outpatient Services & Community Services: Patient Appreciation Day

Our Mental Health Outpatient Services along with our Community Services is teaming up to for a special summer BBQ for all our patients here in Scarborough.

Our staff take pride in the care we give our community and it is only fitting that we share this pride by giving back in more ways than our regular 9-5.

So to kick off the summer season we would love to invite all staff and patients to this years event.  (see flyer below)

Date:  Wednesday, June 28th, 2017

Location:  Thomson Memorial Park – Picnic Area D

Time:  1:00PM-4:00PM

If you are interested in attending please see contact number below.  Food will be provided with a slew of games and prizes to be won!

 

patient appreciation day flyer (8230)

 

 

Reading of the Week: Is ‘New’ Overrated? Antipsychotics in the Real World

From the Editor

Is new better?

You may be reading this on an iPhone 7, having driven to work this morning in a 2017 Hybrid Prius. So should your patients be taking a medication that became available four-and-a-half decades ago – when people drove gus-gusling 8-cylinder Oldsmobiles and smartphones didn’t even exist in science fiction novels.

This week, we look at a just-published JAMA Psychiatry paper which promises to look at the “real-world” effectiveness of antipsychotics. The authors tapped Swedish databases to consider outcomes for nearly thirty thousand people with schizophrenia.

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Sweden: elaborate welfare state, beautiful historic buildings, and – yes – rich databases

Spoiler alert: the authors found that new wasn’t better. That is, newer antipsychotics tended to underperform clozapine and depot medications.

We also look at similar “real-world” work drawing from a Finnish database considering treatment of depression.

DG

 

Antipsychotics and Outcomes

“Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29 823 Patients With Schizophrenia”

Jari Tiihonen, Ellenor Mittendorfer-Rutz, Maila Majak, Juha Mehtälä, Fabian Hoti, Erik Jedenius, Dana Enkusson, Amy Leval, Jan Sermon, Antti Tanskanen, Heidi Taipale

JAMA Psychiatry, 7 June 2017 Online First

http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2629295

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“The comparative effectiveness of antipsychotic treatments for patients with schizophrenia has remained controversial despite extensive research. Results from randomized clinical trials (RCTs) suggest that clozapine, olanzapine, and amisulpiride are superior to other antipsychotic medications in terms of efficacy. However, the most efficacious drugs such as clozapine and olanzapine frequently induce adverse effects, such as weight gain and dyslipidemia, which may result in severe deterioration of health after long-term treatment. Investigation of these adverse effects or associated outcomes such as hospitalization and death requires thousands of patients and several years of follow-up to achieve enough statistical power, which is not possible for RCTs.

 

“Another major issue in RCTs is the selection of patients. Those included in RCTs represent an atypical minority of the patient population because up to 80% to 90% of patients are excluded because of refusal, substance abuse, suicidal or antisocial behavior, or mental or physical comorbidity. Especially problematic is the comparison of oral antipsychotic medications vs long-acting injections of antipsychotic medications because patients with the poorest adherence (ie, those who would receive the greatest benefit from long-acting injectable antipsychotic medications) are excluded from RCTs because participation is fully voluntary. Because RCTs include only an atypical fraction of the most adherent patients, they do not provide information on the real-world effectiveness of the antipsychotic treatments.”

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Jari Tiihonen

So opens a new paper by Tiihonen et al. In this paper, the authors make an observational study, drawing on national databases. This approach isn’t unique – the authors acknowledge past work shows better outcomes for clozapine, olanzapine and long-acting depot medications – but such work has had the problem of selection bias.

They attempt to address this:

“We aimed to overcome this problem by using within-individual analysis, in which each person is his or her own control. In this approach, the exposure periods of each individual are compared with the nonexposure periods of the same individual. Therefore, the only factors that need to be adjusted are those that change as a function of time, such as time since cohort entry, temporal order of exposure periods, and concomitant medications.”

Here’s what they did:

  • “We used nationwide register-based data to conduct a prospective population-based cohort study of patients with schizophrenia…”
  • Drawing on Swedish databases, they looked at people with a diagnosis of schizophrenia between July 1, 2006, to December 31, 2013. Inclusion criteria included “all individuals residing in Sweden who were 16 to 64 years of age in 2006.”
  • Data on medication use was drawn from the Prescribed Drug Register – which includes outpatient medication, though no inpatient prescriptions. (!)
  • They considered outcomes as follows: “psychiatric rehospitalization” and “treatment failure” (defined as rehospitalization, discontinuation or switch to other antipsychotic medication, or death).
  • They did a more complicated statistical analysis – that is, they used within-individual Cox proportional hazards regression model. “The within-individual model is a stratified Cox proportional hazards regression model in which each individual forms his or her own stratum.” They also looked at covariables.

 

Here’s what they found:

  • There were 29,823 patients.
  • Demographically: more men than women (12,822 women and 17,001 men). The mean age was 44.9.
  • “13,042 of 29,823 patients (43.7%) experienced psychiatric rehospitalization and 20,225 of 28,189 patients (71.7%) had treatment failure.”
  • In terms of drugs used: Oral olanzapine was the most frequently used drug, and zuclopenthixol the most frequently used as a long-acting injectable antipsychotic medication.”
  • In terms of rehospitalization: “The lowest risk of rehospitalization was observed for once-monthly long-acting injectable paliperidone (HR, 0.51), long-acting injectable zuclopenthixol (HR, 0.53), clozapine (HR, 0.53), long-acting injectable perphenazine (HR, 0.58), and long-acting injectable olanzapine (HR, 0.58).” See figure below.
  • In terms of treatment failure: “The lowest risk of treatment failure was observed for clozapine (HR, 0.58), and the second lowest was seen for all long-acting injectable antipsychotic medications (HRs, 0.65-0.80), whereas the highest risk was seen for levomepromazine (HR, 1.15).” See figure below.

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Adjusted Hazard Ratios (HRs) and 95% CIs for Psychiatric Rehospitalization During Monotherapy Compared With No Use of Antipsychotic in Within-Individual Analyses in the Prevalent Population

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Adjusted Hazard Ratios (HRs) and 95% CIs for Treatment Failure During Each Monotherapy Compared With Oral Olanzapine Use

“Our results from a large nationwide cohort show that clozapine and long-acting injectable antipsychotic medications are substantially more effective than other antipsychotics in reducing the risk of rehospitalization or any treatment failure. The most consistent findings were observed for clozapine, being the first in rank order in most of the analyses. These results are in line with those of previous cohort studies using traditional between-individual analyses, although the effect sizes differed to some extent, especially for comparisons between long-acting injectable antipsychotic medications and corresponding oral formulations. Our results showed that the risk of rehospitalization was 22% lower during treatment with long-acting injectable antipsychotic medications compared with treatment with equivalent oral formulations in the total cohort and 32% lower in the incident cohort of newly diagnosed patients.”

 

A few thoughts:

  1. This is a good study, drawing on a huge dataset – not dozens of people with schizophrenia, or even hundreds, but tens of thousands.

 

  1. The findings are strong. Let’s not mince our words: new isn’t necessarily better. Of the five best performing medications for treatment failure that were studied, four were old. And, yes, clozapine topped that list. Depot medications were very strong in terms of rehospitalizations, with robust results for drugs that pre-date Atari’s Pong (the first and only video game in 1972), like perphenazine; though it should be added that paliperidone (new) did the best.

 

  1. There are implications here for practice – how many newly diagnosed patients are on depot medications? There are also implications in terms of health systems – does funding and billing schedules reward depot choices over non-depot choices? Dare I ask about clozapine?!?

 

  1. Has similar work been done for depression? Actually, Lancet Psychiatry has a solid paper with a very similar analysis. That’s not exactly surprising since Tiihonen is the first author. (Wow, he’s having a good month, at least compared to Theresa May.) In this study, he and his co-authors tap Finnish databases. I will quickly summarize “Pharmacological treatments and risk of readmission to hospital for unipolar depression in Finland: a nationwide cohort study”: they looked at the risk of readmission for all patients who had at least one hospitalization for depression, with data from almost 125,000; exclusion criteria included schizophrenia and bipolar. They found: “Lithium use was associated with a lower risk of re-admission to hospital for mental illness than was no lithium use.” Yes, lithium – speaking of older medications, this one is as old as the earth.6
  1. In the accompanying editorial, Allan H. Young of King’s College is enthusiastic about the findings, but calls for more investigation into lithium:

 

“Replication of these findings is needed, and should be possible given that similar databases exist in other countries (e.g., Denmark and Taiwan). These data could be easily assessed to establish whether they replicate the Finnish findings or not. The findings of Tiihonen and colleagues are particularly noteworthy because of recent disquiet about the use of antidepressants in unipolar mood disorders, and they suggest that lithium monotherapy might be the best long-term prophylactic drug.”

 

  1. Big data is changing psychiatry.

 

Reading of the Week. Every week I pick articles and papers from the world of Psychiatry. 

Dr. David Gratzer

 

MSW Seminar Series

It has been an exciting time here at Scarborough Rouge Hospital (SRH) over the past few months. Considering SRH’s commitment to clinical social work education, the department of mental health has been fortunate to have several wonderful Master of Social Work (MSW) students join our team for practicum placements.  These students, along with their field instructors have had and will continue to have a huge impact on our clients, colleagues and the Scarborough community at large.

Recently, a new initiative, entitled, ‘MSW Seminar Series’ has taken off!

What is the MSW Seminar Series?

Recognizing the importance of clinical education, MSW students from the mental health department are invited to gather for one hour each month to openly discuss practicum experiences.  Students are encouraged to discuss how theoretical classroom learning is applied in front line clinical work.  Student are asked to engage in self- reflective practices in order to identify areas of desired and continued development as this seminar series is a place for learning and development to take place.  Given that MSW students are our soon to become colleagues, Jawad B, MSW Educational Coordinator and Melissa D, Social Worker at AOP create an open, fun and warm environment which serves to empower students to  discuss new insights, improvement opportunities and to ask questions!

In the process of continued development and implementation, the MSW Seminar Series provides students the opportunity to increase their knowledge on quality-based social work standards.  Seminars provide pertinent knowledge about Evidence Based Practices and the importance of same in clinical practice, research and policy.  Given that on-going evaluation and feedback is something that us social workers value, student feedback is sought at the conclusions of each seminar.  This feedback is thoroughly taken into consideration as development and implementation of this program continues

-Melissa Donohue, Social Worker

1st Break 2nd Break

1st Break

 

Treatment at Ontario mental health facility  was ‘Torture,’ judge rules. -Toronto Star

An Ontario court has ruled that a provincial mental health facility ran therapeutic programs for years that amounted to torture for the patients involved.

Justice Paul Perell’s ruling came in the midst of a lengthy lawsuit filed by past and present residents of the Oak Ridge division of the Penetang Psychiatric Hospital in Penetanguishene that alleges patients were gravely mistreated. Continue to article….

Ontario mental-health services struggling to keep up with youth demand, report finds – The Globe and Mail

A new report on children and youth mental health and addiction in Ontario paints a bleak picture of the challenges facing today’s youth and the difficulties the health-care system has had in adapting to increased demands. Continue to article…

Demand for youth mental health services is exploding.  How universities and business are scrambling to react – Toronto Star

At age 18, Kimberly could no longer come up with a reason to live.

The Toronto university student locked the door to her parents’ garage, stepped onto a stool in the middle of the room and looped an electrical cord around her neck.

“It’s something I couldn’t explain,” recalls Kimberly, who asked that her last name not be published. “I didn’t understand what was going on in my head . . . You want to give up.”Continue to article…

 

 

2nd Break

Toronto Zoo could open soon after tentative deal reached – BlogTO

The Toronto Zoo might not stay closed for the whole summer, so you’ll finally get a chance to see all the adorable baby animals that now call the zoo home.

The Zoo has been closed to the public since May 11 after around 400 employees, who are members of CUPE Local 1600, walked off the job. Continue to article…

Toronto is finally moving ahead to combat overdose crisis – Torontoist

Despite having developed and approved the Overdose Action Plan to tackle the deepening opioid crisis in Toronto back in March, the City of Toronto has taken steps to now fund the plan, as delays from the province have forced the City to “triage.” Continue to article…

The rise and fall of Toronto’s classiest con man – The Walrus

It was the morning before Canada Day 2016, and James Regan needed somewhere to live. A distinguished, even handsome, man of sixty-two with silver hair and a trim moustache, Regan presented himself at the ­Chestnut Park Real Estate office, a luxury brokerage in the heart of Summerhill, one of Toronto’s most desirable neighbourhoods. Smartly dressed, he approached the receptionist and inquired about renting an apartment. Continue to article…

Reading of the Week: Better Treatment, Safer Roads? The New JAMA Psychiatric Paper on ADHD & Driving

From the Editor

How can we reduce the number of car accidents?

We often speak about treating mental illness in terms of reducing personal suffering. Recent selections have looked at the economic cost of mental illness. But what are the implications to public health?

This week, we look at a new JAMA Psychiatry paper; this national cohort study involved more than 2.3 million people with ADHD, and considered motor vehicle crashes (as measured by emergency department visits) and whether or not they were taking medications.

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Yes, he has a plaid shirt, but should he be taking his prescription meds?

Spoiler alert: The authors find “medication use for the disorder was associated with a significantly reduced risk” of car accidents.

We also look at an editorial that finds “clinical pearls” in this paper.

DG

Driving and ADHD

 “Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes”

Zheng Chang, Patrick D. Quinn, Kwan Hur, Robert D. Gibbons, Arvid Sjolander, Henrik Larsson, Brian M. D’Onofrio

JAMA Psychiatry, 10 May 2017 Online First

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2626505

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“Approximately 1.25 million people die each year globally as a result of motor vehicle crashes (MVCs). In the United States, more than 33 700 individuals died from MVCs in 2014 alone, with an additional 2.4 million visiting the emergency department as a result. In addition, MVCs are a major cause of the gap in life expectancy between the United States and other high-income countries.

“Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder comprising symptoms that include poor sustained attention, impaired impulse control, and hyperactivity. The disorder affects 5% to 7% of children and adolescents and persists into adulthood in a substantial proportion of affected individuals. Previous studies have demonstrated that individuals with ADHD are more likely to experience MVCs. However, the magnitude of this association has varied substantially because of differences in outcome measures, sample selection, and confounding adjustment.

“Pharmacotherapy is considered the first-line treatment for ADHD in many countries, and rates of ADHD medication prescription have increased significantly during the last decade in the United States and other countries. Evidence from controlled trials has shown that pharmacotherapy has marked beneficial effects on core symptoms of ADHD; to some extent, it also improves driving performance in virtual reality driving simulators. The use of population-based health record data and self-controlled designs provides an innovative and informative approach to evaluate the effect of medication use on important outcomes in real-world situations. A Swedish register-based study found that ADHD medication use was associated with lower risk of traffic crashes in men. However, the association in women was not clear. Moreover, there are cross-national differences in ADHD treatment practices and rates of MVCs between Sweden and the United States. In addition, it is unclear whether ADHD medication treatment will change the long-term course of the patients and lower the risk of MVCs. Therefore, additional population-based studies in the United States are needed to evaluate the effect of ADHD medication use on MVCs.

“In the present study, we followed up a national cohort of patients with ADHD between January 1, 2005, and December 31, 2014, using data from commercial health care claims in the United States.”

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Zheng Chang

 Here’s what they did:

  • The data was drawn from the Truven Health Analytics MarketScan Commercial Claims and Encounters databases – “one of the largest collections of deidentified patient data and includes inpatient, outpatient, and filled prescription claims for more than 100 insurers in the United States.” This covers 146 million people.
  • The study period was January 1, 2005, to December 31, 2014.
  • Patients were 18 and older, and had received an ADHD diagnosis (on an inpatient or outpatient basis) or a filled ADHD medication (the list of medications included amphetamine salt combination and methamphetamine hydrochloride).
  • The outcome event was an ED visit for an MVC, defined by the appropriate code (ICD-9 codes E810-E825).
  • Statistical analysis was done to find the risk of at least one MVC between patients with ADHD and controls. Additionally, to understand the association between medication use for those with ADHD and MVCs, the authors made “a monthly person-time data set” that considered the use of medications (if they filled a prescription in that month or there was a carryover prescription from a prior month). They also looked at 2-year follow ups.

 

Here’s what they found:

  • “The study cohort consisted of 2,319,450 patients with ADHD… observed for a total of 50,667,665 person-months.”
  • Demographically: the median age was 32.5, with a roughly equal gender distribution (1,121,053 men and 1,198,397 women). 83.9% (1,946,198) of those with ADHD had received at least one prescription for an ADHD medication.
  • “Patients with ADHD had a significantly higher risk of an MVC than their matched controls (OR, 1.49) and untreated patients with ADHD had the highest risk of an MVC compared with medicated patients with ADHD and controls…”
  • “At the population level, months with ADHD medication were associated with a 12% (OR,0.88) lower risk of MVCs in male patients with ADHD relative to unmedicated months and a 14% (OR, 0.86) lower risk of MVCs in female patients with ADHD… More important, the within-individual analyses showed that men with ADHD were 38% (OR, 0.62) less likely to have MVC events during medicated months relative to unmedicated months, suggesting that, within an individual (i.e., after controlling for all unmeasured static and measured time varying confounding factors), ADHD medication use was associated with a significant reduction in the risk of MVCs. Our PAF estimated that 22.2% of the MVCs among male patients with ADHD were attributable to lack of medication treatment, assuming that the association was causal.” The results were similar for female patients.
  • “At the population level, there were no significant associations between ADHD medication use and MVC events 2 years later. However, the within-individual analyses showed that ADHD medication use was associated with a 34% (OR, 0.66) lower risk ofMVCs 2 years later inmate patients with ADHD and a 27% (OR, 0.73) lower risk of MVCs in female patients with ADHD.”

 

“In this large, nationwide cohort study over 10 years, patients with ADHD had a higher risk of MVCs compared with controls without ADHD. However, in male and female patients with ADHD, medication use for the disorder was associated with a significantly reduced risk of MVCs. Similar reductions were found across all age groups, across multiple sensitivity analyses, and when considering the long-term association between ADHD medication use and MVCs.”

 The paper runs with a short and readable editorial by the University of Virginia Health System’s Vishal Madaan and Daniel J. Cox.

You can find the editorial here:

 http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2626500

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 Vishal Madaan

 The Editorial opens:

 “While driving is a ubiquitous functionality and an important activity of independent daily living, it also represents a complex neurobehavioral task involving an interplay of cognitive, motor, perceptual, and visuospatial skills. As a result, patients with neurodevelopmental disorders often have limitations in such skills. Although there has been a recent interest in understanding driving concerns in individuals with other neurdevelopmental disorders such as autism spectrum disorders, substantial research has reviewed the influence of attention-deficit/hyperactivity disorder (ADHD) on driving safety, especially given how pharmacotherapy may affect inattention, impulsivity, and executive dysfunction.”

 They praise the study, noting that: “The findings in the study by Chang et al in this issue of JAMA Psychiatry confirm and extend existing experimental studies and have impressive implications for judicious use of ADHD medication.”

 Madaan and Cox see “clinical pearls” for clinicians. The “management of ADHD is not limited to one’s school, college, or workplace: it extends to several other aspects of life, such as driving, which may be ignored to the clinician’s and patient’s peril.” They also comment that “health care professionals should be aware that MVCs in individuals with ADHD often happen later in the evening when their medications may have worn off.”

 A few thoughts:

  1. This is a good study.
  2. The topic is important.
  3. The findings are a gentle reminder of the importance of our work – literally keeping our patients safe. “The within-individual analyses showed that men with ADHD were 38% (OR, 0.62) less likely to have MVC events during medicated months relative to unmedicated months…” Wow.
  4. The paper isn’t without limitations, of course. The authors make some big assumptions: they equate medication compliance with pharmacy compliance (that is, if the prescription is filled, the patient is taking the medication); they only look to ED visits (post-MVC, a patient may seek care with his or her primary care physician); medication compliance doesn’t mean proper medication management (as Madaan and Cox note in their editorial, many stimulants have shorter half-lives, leaving patients under-medicated during evening and night-time driving). Still, it’s difficult not to be impressed with the incredible database that Chang et al. have drawn from – involving millions of people.
  5. If public health and psychiatry catches your fancy, the American Economic Review has an interesting paper on using CBT for crime reduction in Liberian men. Spoiler alert: it worked.

 

You can find that study here:

https://www.aeaweb.org/articles?id=10.1257/aer.20150503

(Nice surprise: the paper on CBT and its public health implications ran in an economics journal.)

  1. Mental illness casts a long shadow over our society. Yes, we can see this in terms of absenteeism and presenteeism. Yes, we can see this in terms of personal tragedy and loss. But, as the authors of this paper argue, yes, we can see this in terms of car accidents and general safety.

Reading of the Week. Every week I pick articles and papers from the world of Psychiatry. 

-Dr. David Gratzer

3 in the Key (May/June)

This months edition of 3 in the Key is special.  Previous editions of this segment focused on front line staff and will continue to do so in the future.

But this month we focus on 3 Mental Health Management members.

1 new Director, 1 new Manager and 1 well known manager who is known to be the biggest Rafael Nadal fan in the UNIVERSE!

So what does eating raw lobster on a Cuban fishing trip, tossing undergarments at a Tom Jones concert and a Car wash/detailing service for staff have in common?  

Lets find out in this months 3 in the Key….

(**Click on any of the RED underlined links for more information**)

Ping R. (Patient Care Manager for In-Patient Mental Health at the Birchmount Campus, 3B/3C/PIOU)

ping

What is your best childhood memory?

Playing with makeshift toys, nothing fancy.

Who would play you in the movie adaptation of your life?

A Chinese actress– Sylvia Chang

What do you feel most proud of?

Baked a non-deflated Chiffon cake

If you could travel anywhere, where would you go and why?

The mysterious Machu Picchu

What are your top three favorite books and why?

All books in Chinese (English links provided)

Dream of the Red Chamber

Journey to the West

Fortress Besieged

If you were prime minister, what is the first thing you would do?

Revisit the legalization and regulation of Cannabis

What is your favorite part of your job?

Opportunities to make staff proud of their work

How long have you worked at TSH?

5 months

How would your friends describe you?

Very practical and creative in getting things done

What does a perfect day look like to you?

Wake up naturally after having a good night sleep

What is a skill you’d like to learn and why?

Better cooking skill for life enjoyment

Fill in the blank: If you really knew me, you’d know________

I don’t like nonsense

What’s your favorite type of cuisine?

Chinese obviously

Who did you first see live in concert?

Some Chinese singers back home

What’s the 1 thing you’ve waited in line the longest for?

Red carpet event to get rush tickets to the Hunger Games movie

If you could choose 1 amenity to add to the workplace, what would it be?

It would have been something from staff feedback

What other languages do you know?

Mandarin & Taiwanese

Do you have any hobbies?

Go to movies and contribute to reviews

Which of your 5 senses is the strongest? Taste.

How about weakest?  Sight and hearing

What was the most incredible exotic place you’ve ever traveled to?

Eating raw lobster meat on a Cuban fishing boat 

 

Shawnna B. (Patient Care Manager for Community Services; Crisis/POP/ACTT/JAMH/ICM/ADHD & Adult Out-Patient Services)

shawnna

What is your best childhood memory?

Playing Lion King with my younger sister and reenacting the “Long live the king scene.” Obviously, I was Scar and my sister was Mufasa. I used to have her hanging off the diving board as I recited the line, and then would push her fingers off and watch her fall into the pool. I also liked playing the “Queen game,” where I would act like the Queen of England (because we share a birthday) and get my sister to run around and do things for me.

Who would play you in the movie adaptation of your life?

I can’t think of any South Asian actresses besides Mindy Kailing. We have the same pitched voice, so that works.

What do you feel most proud of?

I always wanted to pursue a career where I could help marginalized communities in some way, and be able to make meaningful changes. SRH has given me the opportunity to do this. I have been fortunate enough to be able to influence changes in the neighborhood I grew up in. I’m so proud of the achievements we have made, particularly how we have really worked to increase access to quality mental health care in Scarborough.

If you could travel anywhere, where would you go and why?

I love travelling and can’t pinpoint one place. Countries currently on my wish list include: Madagascar, Argentina, Cambodia, Vietnam, Portugal, the smaller non touristy towns of Italy and Spain, and I could really go on and on

What are your top three favorite books and why?

Pride and Prejudice

Why? Mr. Darcy, enough said. (On a side note, Colin Firth is hands down the best Mr. Darcy. Everyone should watch the 6 hour BBC version of Pride and Prejudice).

Emma

One of my favorite lines in all of literature is when Mr. Knightley says, “I cannot make speeches, Emma. . . . If I loved you less, I might be able to talk about it more.”

The Merchant of Venice

This isn’t my favorite play by Shakespeare. King Lear, Macbeth, and Titus Andronicus all surpass The Merchant of Venice for me. But, I fell in love with Shylock’s soliloquy the first time I read it, and it still moves me.

I am a Jew. Hath not a Jew eyes? Hath not a Jew hands,
organs, dimensions, senses, affections, passions; fed with the same
food, hurt with the same weapons, subject to the same diseases,
heal’d by the same means, warm’d and cool’d by the same winter
and summer, as a Christian is? If you prick us, do we not bleed? If
you tickle us, do we not laugh? If you poison us, do we not die?
And if you wrong us, do we not revenge? If we are like you in the
rest, we will resemble you in that.

 If you were prime minister, what is the first thing you would do?

Meet Nadal. We should really work on strengthening our ties with Spain.

 What is your favorite part of your job?

Refer to question 3!

How long have you worked at TSH?

5 years

How would your friends describe you?

Ambitious, loyal, compassionate, hardworking, determined, directionally challenged, and undomesticated.

What does a perfect day look like to you?

Sleep in, go for brunch with friends, grab a flight to watch the French Open in Paris, the end.

What is a skill you’d like to learn and why?

How to fight. Refer to question 1. My sister is taller and stronger than me now, and for some reason she wants revenge.

Fill in the blank: If you really knew me, you’d know

I absolutely hate Jack Armstrong. And everyone knows my number one nemesis is Djokovic.

 What’s your favoThairite type of cuisine?

Currently, it’s .

 Who did you first see live in concert?

My mom took me to see Tom Jones when I was a kid. I was confused as to why so many older women were throwing their undergarments at him.

What’s the 1 thing you’ve waited in line the longest for?

Food. Toronto loves lining up for food.

If you could choose 1 amenity to add to the workplace, what would it be?

Large screen TV for Grand Slams and playoff times.

What other languages do you know?

Tamil, kind of. At times it may just be me speaking in English, but with an accent…

 Do you have any hobbies?

I joined a pottery class, I wasn’t good at it. I joined ball hockey, flag football, dodgeball, volleyball, and softball. I wasn’t good at those.

Does watching sports, drinking wine, and travelling count as hobbies? Because then yes, I have hobbies.

 Which of your 5 senses is the strongest? How about weakest?

Strongest – taste

Weakest – sight

What was the most incredible exotic place you’ve ever traveled to?

Again, I can’t pick. I love travelling and try to go on one big trip each year. I’m fortunate to have friends with similar interests, and parents who took me all over the world from a young age. Some of my favorite “exotic” places have been Oman, South Africa, Israel, Egypt, Ghana, and Sri Lanka.

 

Sari G. (New Director for Mental Health, Seniors Health and Family Medicine Teaching Unit for SRH)

Sari_Greenwood_crop

What is your best childhood memory?

I have always loved animals, especially dogs. I was that kid that went up to every dog I saw despite the warnings from my parents so my best childhood memory was the day I got my very own, not stuffed, puppy for my 7th birthday.

Who would play you in the movie adaptation of your life?

Jennifer Lopez

What do you feel most proud of?

Being the mother of two fantastic amazing kids.

If you could travel anywhere, where would you go and why?

I’d love to go to Spain and Portugal and all around the Mediterranean. Sounds exotic.

What are your top three favorite books and why?

A Man Called Ove

Cutting for Stone

When Breath Becomes Air

If you were prime minister, what is the first thing you would do?

I would never want the job as prime minister so I’d probably resign.

What is your favorite part of your job?

Working with amazing people and contributing to making positive differences in the lives of so many patients, families and staff.

How long have you worked at TSH?

20 years!!

How would your friends describe you?

I think fun to be around, a bit competitive (or maybe extremely competitive), and someone who would do anything for them

What does a perfect day look like to you?

In the summer, a round of golf with my husband and kids followed by lunch, a swim, and then spending time with friends in the evening in the backyard, enjoying a BBQ dinner and some great wine. In the winter, I’d probably exchange the round of golf for a day of skiing, and then dinner in front of the fire…also with some great wine!

What is a skill you’d like to learn and why?

I’d really love to perfect my short game in golf. I need to be able to win.

Fill in the blank: If you really knew me, you’d know_____

I hate losing at any game.

What’s your favorite type of cuisine?

Sushi

Who did you first see live in concert?

Madonna

What’s the 1 thing you’ve waited in line the longest for?

A ride at wonderland

If you could choose 1 amenity to add to the workplace, what would it be?

Car wash service – interior and exterior

What other languages do you know?

A bit of French

Do you have any hobbies?

Golfing, anything that keeps me active. I love to run.

Which of your 5 senses is the strongest? How about weakest?

Smell is my strongest sense; and I think hearing may be my weakest.

What was the most incredible exotic place you’ve ever traveled to?

A week-long sea kayak trip down the Baja peninsula

 

Mental Notes would like to thank Ping, Shawnna and Sari for participating in this months 3 in the Key installment.  You are key players in our department.