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CAMH settles with U of T professor Kenneth Zucker over 2015 report

CAMH agrees to pay $586,000, issues public apology

CAMH settles with U of T professor Kenneth Zucker over 2015 report

The Centre for Addiction and Mental Health (CAMH) has settled with U of T professor Kenneth Zucker over a 2015 report that erroneously described Zucker’s work at the centre. CAMH has also agreed to pay Zucker $586,000 in damages, legal fees, and interest.

The report in question detailed Zucker’s work as the former leader of the functional clinical and research team at the now-closed Child, Youth, and Family Gender Identity Clinic. The report falsely stated that he insulted a patient and practised conversion therapy on people who identified as transgender.

The external review, which included complaints against Zucker, was removed from the CAMH website in early 2016. Zucker was fired from CAMH after the review was published.

CAMH apologized “without reservation to Zucker for the flaws in the process that led to errors in the report not being discovered,” stating that the “the report contained some errors about Dr. Zucker’s clinical practice and interactions with patients.”

CAMH spokesperson Sean O’Malley offered the following statement via email to The Varsity:

“CAMH has reached a settlement with Dr. Ken Zucker following his departure from CAMH in 2015. CAMH stands by its decision to close the child and youth gender identity clinic following an external review which concluded the clinic was not meeting the needs of gender expansive and trans children and their families. We believe our modernized approach to delivering services to youth better supports diverse patients through best practice and timely care.”

In an interview with The Varsity, Zucker said that he “wasn’t able to speak publicly for three years” since the release of the report. He takes solace in the non-financial aspects of the settlement, particularly the public apology, which he claims has allowed him to be “vindicated and liberated” of false allegations.

The aim of Zucker’s work was to “reduce gender dysphoria” in children and youth, and he used one of three predominant approaches, which he refers to as “developmentally informed therapy,” to do so. Gender dysphoria and identifying as transgender are not the same thing — there is a misunderstanding of terminology that feeds the contentious debate in the field of gender dysphoria, according to Zucker.

Zucker expressed his concern with the relationship between his case and what he said is the broader political phenomenon in which academics cannot openly discuss their thoughts due to fear of retribution.

To Zucker, his case is an example of the “authoritarian scene we are creating.”

Disclosure: The Varsity’s reporting on the CAMH report was the subject of a legal complaint from Zucker in 2016, settled in 2017.

Depression changes the brain over time

Research from CAMH calls for different approach in therapeutic treatment

Depression changes the brain over time

A recent study by researchers at the Centre for Addiction and Mental Health (CAMH) showed that the brain changes with the progression of depression, suggesting that depression needs to be treated differently at every stage of the illness.

The team, led by Dr. Jeffrey Meyer, showed that people with longer periods of untreated depression — defined as lasting more than a decade — had significantly more brain inflammation compared to those who had less than 10 years of untreated depression.

This study is the first in its field to show biological evidence for how the brain changes in persistent depression. Consequently, it reveals that depression is not a static condition but is instead a degenerative brain disease like Parkinson’s or Alzheimer’s.

They examined how the total distribution volume of translocator protein (TSPO), which is a marker of microglial activation, correlated with the duration of untreated major depressive disorder, total illness duration, and antidepressant exposure.

It was important to study microglial activation, because microglia are involved in the brain’s normal inflammatory responses to trauma or injuries. However, too much inflammation has been associated with degenerative illnesses as well as depression.

Participants from the age of 18–75 were recruited for the study. They were from the Toronto area and CAMH, and they either had major depressive episodes or were healthy. This research was supported by the Canadian Institutes of Health Research, the Brain and Behavior Research Foundation, and the Neuroscience Catalyst Fund.

Using the Positron Emission Tomography, the researchers scanned three primary grey matter regions of interest and 12 additional regions to measure the total distribution volume of TSPO. The researchers also investigated the duration of untreated major depressive disorder, and the combination of total duration of disease and duration of antidepressant treatment.

The research found that the TSPO levels were about 30 per cent higher in different brain regions among those with long-lasting untreated depression, compared to those with shorter periods of untreated depression. The group with long-term depression also had higher TSPO levels than those with no depression.

“An implication of our study is that the current approach for antidepressant treatment isn’t addressing the issue that the illness is changing over time,” said Meyer.

Currently, no matter how long a person has had depression, they are treated with the same approach at every level. Meyer advocates that treatment methods should address the illness differently as it progresses.

However, there is still a lack of evidence in how to treat depression in its later phases. “People can certainly respond to treatment after not responding to previous treatments, but the rate is lower so clinical trials often exclude people who have not responded to a few previous treatments,” said Meyer.

“We are testing whether current treatments for other illnesses could be applied in depression to influence inflammation to make it more curative. There are also new treatments being developed by companies for depression for the same intent,” said Meyer.

Meyer noted that one study is not enough to change the treatment, but he is hopeful that their work will have this impact soon.

CAMH receives record $100 million from anonymous donor

Gift to be used for supporting research, new mental health initiatives

CAMH receives record $100 million from anonymous donor

The Centre for Addiction and Mental Health (CAMH) announced on January 11 that it received a $100 million donation from an anonymous donor. According to a statement posted on its website, this is the largest donation ever given to a mental health centre in Canada.

“We need to invest in the fundamental research and the clinical innovation that will improve the health of individuals and populations, locally, nationally and globally,” wrote Dr. Catherine Zahn, President and CEO of CAMH, in the statement on the CAMH website. “This gift will make that a reality.”

CAMH is a mental health teaching hospital that provides health services and does research, with three main sites in Toronto.

The donation will be used to endow the Discovery Fund, which will recruit top-tier scientists and medical research professionals to CAMH. The fund will also provide capital for any future research projects on mental health.

The Discovery Fund, according to CAMH’s website, will prioritize three different areas: developing the next generation of scientists focusing on mental health, furthering the centre’s understanding of mental illness and diseases, and using data to put research findings into practice.

“I believe CAMH is well-positioned to make a transformational impact in the field of mental health research,” read a statement from the donor. “I have seen the devastating impact of mental illness on individuals and their families; I want to provide support to the next generation of researchers and scientists to pursue the research that will directly transform care.”

The anonymous donor also highlighted that the gift will be used to support “high-risk, high-reward research.”

CAMH opens $15-million Krembil Centre for Neuro-informatics

Computational scientists to collaborate with clinicians to make sense of mental health records

CAMH opens $15-million Krembil Centre for Neuro-informatics

The landscape of mental health research is becoming increasingly digital. Clinicians are trying to bridge mental health research with artificial intelligence (AI) to make sense of the sea of data curated from medical records of an untold number of patients.

With a $15 million donation by the Krembil family, the Centre for Addiction and Mental Health (CAMH) opened the Krembil Centre for Neuroinformatics to “identify and treat mental illness, while shaping policy at national and global levels.” They will work toward one day delivering accurate and precise treatment to people with various mental illnesses.

Dr. Catherine Zahn, President of CAMH, hopes that this venture will move the flourishing field of mental health research into clinics.

With data containing “literally zillions of points of information… it [helps] to call on opportunities for high performance computing and machine learning for AI to help advance our understanding [of mental health],” said Zahn.

Zahn said that the Krembil Centre for Neuroinformatics is an opportunity to recruit and retain computational scientists to query the aforementioned extensive data and to develop and test models to advance the understanding of the various points of data.

Applying AI intervention in real clinical context has already proven to be a helpful aid for physicians in understanding various medical reports and histories of patients suffering from mental illnesses. According to Zahn, there are currently very poor techniques available to predict whether or not individuals with depression are at risk for self-harm and suicide.

Using technology to analyze physicians’ and psychiatrists’ notes of patients’ conditions helps identify “clues that the physicians themselves missed, as it is actually a better predictor than the humans in predicting the risk for suicide. So, opportunities to digitize information like that and examining it and predicting it is a very practical and clinical opportunity for us,” said Zahn.

“We know that a lot of what we do in healthcare and psychiatry is to prescribe treatments based on trial and error and based on our own experience,” she said, emphasizing that the accuracy of an AI method would be particularly helpful.

One aspect of AI and machine learning is to discover patterns amid copious amounts of information and data that otherwise go unseen by humans. “[We can] capitalize on that ability to synthesize [a] large amount of data to recognize patterns that are beyond the capability of the human brain and to point them out to humans, [which] helps with decision making based on the recognition patterns,” said Zahn.

Neuroinformatics can be viewed as the future for clinical-based treatments, one that will transform the way physicians and psychiatrists interact with their data in order to provide accurate treatments for their patients.

“We are at a very special, unique moment in space and time… in the world of mental health because there is so much interest and there is so much opportunity to [understand] the brain and [its] environmental interactions,” said Zahn.

CAMH removes external review of Gender Identity Clinic from website

Comments allegedly misattributed to Dr. Kenneth Zucker

CAMH removes external review of Gender Identity Clinic from website

The full external review of the Child, Youth and Family Gender Identity Clinic (CYF GIC) that the Centre for Addiction and Mental Health (CAMH) commissioned and released has recently been removed from the organization’s website. In its place is a six-page “executive summary” developed by CAMH. 

The content of the review has come under suspicion since its release. The CAMH summary alludes to the possibility that some statements included in the initial review may be been “erroneous.” According to their website, CAMH has sent a formal letter of apology to Dr. Zucker.

The replacement of the report follows Zucker’s issue of a notice of libel against The Varsity for its coverage of the Gender Identity Clinic’s services winding down.

According to CAMH, “[the] review did not happen in isolation and was not the only factor that informed our decision to wind down the CYF GIC. The review also took place in the broader context of an ongoing comprehensive internal examination of the functional operations of all of the outpatient services of CAMH’s Child Youth and Family Program in order to improve access, alignment and efficiency. Our action plan for the CYF GIC reflects this process and CAMH’s strategy going forward.” 

Regarding the active patients of the CYF GIC at the time of closure, CAMH said that “all clients and families in active treatment have been re-assigned and we appreciate the patience of all involved as we continue to make this important transition.” 

CAMH did not provide any further comment about the fact-checking issues and did not verify whether Zucker is persuing legal action against them. 

CAMH has plans intended to include members of the transgender community in any future services for children, youth, and families with gender identity issues, saying “It is our view that patients and families should be partners and co-creators in their care.” 

A group of doctors launched a petition on January 11 expressing concern over the “apparent firing” of Dr. Kenneth Zucker. It is addressed to the CAMH Board of Trustees and has 509 signatures as of the time of writing.

“We object to these actions because they appear primarily politically motivated and to have been rationalized and justified, after the fact, by public statements extremely damaging to Dr. Zucker’s professional reputation,” reads the petition. “The CAMH’s decision to post anonymous, unverified, and unexamined claims seems incomprehensible unless to bolster their shaky bases for closing the Clinic and firing (and attempting to humiliate) Dr. Zucker,” the petition continues. 

Dr. Zucker’s lawyers did not respond to The Varsity’s request for comment.

Controversial CAMH gender identity clinic winds down

Clinical & research leader at the clinic, Kenneth Zucker, fired

Controversial CAMH gender identity clinic winds down

Editor’s Note – February 11, 2016: This material is subject to legal complaint by Kenneth J. Zucker. This article was published based on the content of an external review, the results of which were published by The Centre for Addiction and Mental Health (CAMH) on December 15, 2015. That report has since been removed from CAMH’s website and replaced with an executive summary. 

The Centre for Addiction and Mental Health (CAMH) is winding down services at their Child Youth and Family (CYF) Gender Identity Clinic (GIC) for children and youth.

Reparative therapy, or conversion therapy, is an outdated practice that aims to change a person’s sexual orientation or gender identity. It is illegal to perform conversion therapy on children in Ontario.

Dr. Kwame McKenzie, a medical director at CAMH and professor of psychiatry at U of T, said that the review was not intended to investigate whether or not conversion therapy was taking place. “Our clinicians have always said, and still say that they do not practice reparative therapy. The review made it clear that it could not say that reparative therapy was taking place. But it could not say that it was not. Our position is that this should not be an issue,” he said, adding that he was satisfied with the way in which the investigation was conducted.

CAMH released a report on the review’s findings on December 15, 2015. The report made mention of several complaints submitted to Dr. Kenneth Zucker, the former functional clinical and research team leader at the CYF GIC.

Marissa Hetherington, a former patient at the GIC, said that she was happy to hear the clinic was winding down. “As a former patient, it was…really not a positive experience, and my opinion of it has only degraded over time,” she said.

Hetherington said that she was repeatedly deadnamed — referred to by the name given to her at birth instead of her chosen name — and that the views and principles held by the clinic caused her to break down crying during her interviews.

“[The] basic ideology practised was one completely lacking in empathy. It was, at best, only interested in potential research, and if you’re to ask me, it came from a thoroughly bigoted view that posited that just by existing as who I am, I was sick,” Hetherington said.

Zucker worked at the clinic for 30 years and is also a psychiatry professor at the University of Toronto. After the release of the report, Zucker was released from his position at CAMH.

Hetherington, who interacted with Zucker during her time at the clinic, said that sacking Zucker was the step towards any possible reconciliation, if CAMH is to continue services.

When asked what Zucker’s termination at CAMH meant for his position at U of T, Althea Blackburn-Evans, U of T’s director of news and media relations, said that the university does not comment on personnel matters.

“The diversity of our students, faculty and staff is a mark of quality and a source of strength. The University respects and supports all of its faculty, staff and students, including those in the transgender community. Specifically, we offer a range of services through the Sexual & Gender Diversity Office,” said Blackburn-Evans.

Jades Swadron, an organizer with the Trans Inclusivity Project at U of T, said that Zucker should have no place teaching at a university. “How can an institution where critical thinking is purported to be taught wash [its] hands of blame in situations like this so easily without looking into its impact?” she asked. “The university is playing dumb, while mistreating trans students in many ways.”

CAMH is fully affiliated with the University of Toronto as a teaching hospital. According to Blackburn-Evans, the institutions support each other’s research.

The report states that the clinic operates in isolation from CAMH and its resources, such as legal and public relations, the University of Toronto Division of Child & Youth Mental Health Services, as well as community agencies such as schools and child/youth organizations. Additionally, there were no opportunities for clients, family, or stakeholders to contribute to the direction or services of the clinic.

The report did not recommend that the current approach be sustained, acknowledging, “The GIC and CAMH in general, are not seen as a “safe space” for gender questioning & transgender populations.”

McKenzie said that he was pleased with the approach that the clinic took. “What was different in January 2015 was a group of community partners, including Rainbow Health Ontario, came forward in an organized way and with evidence. We met with them, we examined their evidence and we decided to have an external review. I’m proud of the way we approached this. The community came to us, we listened and then we did due diligence by looking to the international literature and taking evidence before acting,” he said.

According to McKenzie, CAMH hopes to improve and rejuvenate its approach. “Our overall interest and motivation is to determine the best approach for kids with gender identity issues, and it’s important that this process continues to be open and collaborative. Our next step is to consult with our community partners and have their input on to see what role CAMH can play to best serve these young people,” he concluded.

Hetherington said that she would like to see CAMH’s services closed down entirely. “[Including] a gender identity clinic at an organization for mental health is already making some highly questionable connections, and the way it has been cast as a central authority allows for abuse to occur with little oversight,” she said, adding that a move to an informed consent model with general practitioners rather than a centralised gatekeeping authority would be the only method that would provide appropriate services to clients.

“The difference between my experiences with CAMH and the informed consent model, which ended up being my path to actually getting a prescription for [hormone replacement therapy], was impressive,” Hetherington said.

“I spent somewhere close to ten months or a year waiting between my referral to CAMH and my first appointment, whereas after searching out a general practitioner that practised informed consent, I managed to start HRT a month after my first appointment, with only a two week waiting time between looking for a doctor and that appointment.”

Correction (Monday, January 11th): An earlier version of this article incorrectly stated that CAMH is winding down services at their Child Youth and Family Gender Identity Clinic for children and youth after an internal review reported that the clinic was practicing reparative therapy. In fact, the review, which was conducted by external experts, did not find that any clinician was practicing reparative therapy.