People living with severe mental conditions and/or hepatitis C face significant barriers to access to healthcare. This is due to factors such as stigma, discrimination and socioeconomic inequalities. Though hepatitis C is easily diagnosable and curable, this population is often left behind, misinformed and excluded from care as treatment is viewed complex or time consuming.
This case study will explore how collaboration, partnerships and integration can contribute to viral hepatitis elimination goals and improve patient outcomes. It will provide insight into the inspiring work of Dr Renee Logan and Dr Jordan Feld, who are transforming how hepatitis C is treated within psychiatric and addiction care services.
“The problem of hep C seemed like quite a reasonable thing to treat. So, it seemed like it was within my power to be able to do it.” – Dr Logan
Whilst working as a Hospitalist at the Centre for Addiction and Mental Health (CAMH), Dr Logan noticed that a number of patients who were knowingly living with hepatitis C were not on treatment. They were told by doctors what couldn’t be treated due to their mental health conditions and this story was the same among several patients. To address this, Dr Logan started referring patients to the liver clinic at University Health Network (UHN), however, the patients were not attending their appointments due to the barriers to care that people living with mental conditions have.
Around the same time, Dr Feld, along with other colleagues, were thinking about an implementation strategy to deliver hepatitis C treatment to patients accessing mental health services and living with hepatitis C. Through this, they were linked with Dr Logan’s colleagues at CAMH.
After hearing a presentation from Dr Feld, Dr Logan was inspired. She believed that treating patients who came to CAMH and were living with hepatitis C was a possibility. However, she identified a key barrier. Since she typically had patients in her care for only two weeks, there wouldn’t be enough time to complete the full testing and treatment process and often the patient is discharged before receiving results. Dr Feld heard Dr Logan’s concerns and designed a randomised controlled trial (if patients agreed to it) that could be ran in CAMH’s acute care units, incorporating point of care HCV antibody testing and rapid RNA results. This approach sped up the process and allowed time to create a follow up plan, whether patients are randomised to start receive treatment on site or referred to the hospital for standard care.
Dr Logan increasingly started to become known as a champion within CAMH for treating hepatitis C. Slowly, teams who were not usually interested in screening or linking patients to hepatitis care now started to express interest and a willingness to treat patients.
“Once you start doing this work and people see the impact, it builds momentum. Others want to get involved. – Dr. Renée
The collaboration has also gained interest from other sites in Toronto, and they have helped train primary care givers to screen and treat patients within their psychiatric institutions.
Building upon the work, Dr Logan started carrying out quality improvement projects in the addiction outpatient clinic. This involves having a team of providers like nurses, physicians and pharmacists trained on how to screen, test and treat. This ensures that whilst patients are accessing the clinic for their addiction care, they are also accessing hepatitis C services. She believes that a strong team is the key to success, each member plays a vital role in screening, testing and treatment of hepatitis C.
“We’ve built teams—nurses can screen, pharmacists can support treatment, and patients can access care where they already are.”
– Dr. Renée
Dr Feld highlighted that people with mental health conditions have been largely overlooked in the hepatitis C elimination efforts. They have not been prioritised in global frameworks that often focus on other key populations. Mental health professionals can be strong advocates for their patients and by emphasising that people with mental health conditions are being left out of elimination strategies, greater collaborations can happen and ensure they are no longer neglected.
“People with mental condition are not prioritized in elimination efforts. But if they’re in hospital, or attending clinics, that’s our chance. We can cure their HCV, even if we can’t cure their schizophrenia.”
– Dr. Feld
Conclusion
Integration of hepatitis C care into mental health services is both feasible and impactful. Through co-locating, team-based approaches and capacity building, testing and treatment can be provided to a population that is often left behind. Collaboration and partnerships can make meaningful strides towards hepatitis C elimination.
Key learnings and recommendations
Call to Action
Hepatitis C specialists should establish collaborative partnerships with mental healthcare professionals to ensure integrated and accessible care for patients with mental health conditions and hepatitis C.
