Mental Health

General Psychiatry: Mood and Anxiety​

The General Psychiatry Program serves patients of Women’s College Hospital, using a trauma-informed, culturally sensitive lens. We have a specific focus on mood and anxiety disorders. ​

Those referred for care will be offered a full psychiatric assessment and may receive time-limited treatment within the program. Treatment recommendations may include referrals to brief psychotherapy in our program, recommendations for medications or other biological treatments, case management, and referrals to other programs in our department or in the community.

Recommendations for treatments will be sent to the patient’s family doctor to support ongoing care.​

*Patients with eating disorders or primary psychotic disorders should be referred to more specialized programs outside of WCH:​

• UHN – Eating Disorder Program
• CAMH – Early Psychosis Unit
• CAMH – Slaight Centre Early Intervention Service (SCEIS)
• CAMH – Psychosis Coordinated Care Service

Mental Health in Medicine

The Mental Health in Medicine Program is a specialized mental health service that addresses mental health concerns that are secondary to or complicated by a concurrent medical illness.

Those referred for care will be offered a full psychiatric assessment and may receive time-limited treatment within the program. Treatment recommendations may include referrals to brief psychotherapy in our program, recommendations for medications or other biological treatments, case management, and referrals to other programs in our department or in the community.

Recommendations for treatments will be sent to the patient’s family doctor to support ongoing care.

Substance Use Service (Addiction Psychiatry)

Our Addiction Psychiatry service provides an integrated biopsychosocial approach to the treatment of substance use disorders (with the exception of opioid use disorders*).

This clinic supports people who are seeking help for their substance use and are considering making a change.  Patients will be seen for a comprehensive assessment and when appropriate will be offered medications and/or time-limited psychotherapy for their substance use disorder(s).

*Note: Individuals who have an opioid use disorder may be directed to the RAAM (Rapid Access Addiction Medicine) clinic at WCH.

Concurrent Disorders Consultation Service

Concurrent Disorders Consultation Service provides assessments of concurrent substance use and mental health disorders.

Through consultation, the relationship between the substance use and mental health disorder(s) is assessed. The substance use may be a cause or contributing factor to the mental health disorder and vice versa, and this is examined in the assessment.

Depending on individual needs, the following may be offered:

• Short term psychiatric care (with medication management)
• Motivational interviewing
• Referral to other services

Note: This program does not provide opioid maintenance treatment with methadone or suboxone. This can be accessed in the Substance Use Service and RAAM (Rapid Access Addiction Medicine) clinic at WCH.

In-Service Support

The General Psychiatry Program at WCH is embedded in multiple departments and programs affiliated with the hospital:

• Centre for Headache
• Wellness for Independent Seniors  (WISE)
• TIIP (.pdf)
• YWCA
• Crossroads Clinic
• Scope – Mental Health
• Substance Use Service
• Family Practice Health Centre

Your doctor or other healthcare provider, within any one of these departments/programs, may consult the team psychiatrist at some point during your care for inter-professional communication and collaboration or it may be recommended that you meet directly with the psychiatrist for further assessment and/or you may be referred to a mental health group.

Mindfulness Based Stress Reduction Program (MBSR)

Duration: 9 weeks, 10 sessions

Frequency: 3 times a year, Winter, Spring & Fall

MBSR is a patient-centred psycho-educational group which has over 40 years of research that consistently demonstrates statistically significant reductions in symptoms for various physical and behavioral health conditions including anxiety, depression and chronic pain, along with positive changes in risk factors that may lead to more serious chronic ailments.

Those suitable for MBSR: Patients with a history of low mood or anxiety, +/- other existing medical health concerns.

This group is designed to provide participants with intensive and systematic training in mindfulness meditation and movement practices and integrating into one’s daily life. A referral from a physician is required.

Exclusion Criteria:

• No current history of active use of substances
• No history of psychosis
• No current active suicidal ideation
• No active history of trauma
• No history of personality disorders

Mindfulness Based Stress Reduction for Patients

Cognitive Behavior Therapy (CBT)

Duration: 8 weekly sessions

Frequency: Offered 3 to 4 times per year

Based on the work of Aaron Beck, this evidence-based treatment emphasizes the relationship between our thoughts, feelings and behaviors. The CBT group helps individuals increase their skill and self-awareness regarding thoughts and behaviors and provides opportunities to practice the tools of CBT in a supportive group setting.

If there is a trauma history or alcohol/drug dependence/abuse history it is important that the patient has a solid support foundation and care/relapse prevention strategy in place​.

Patient must have a regular treating physician to follow them while they are in the group.​

Note: This group is only open to patients of the Women’s Mental Health Program at WCH and is currently offered in a virtual format only.

Seeking Safety Treatment Group (SS)

Duration: 13 weekly sessions

Frequency: Offered 2 to 3 times per year. No waitlist is held for this group.​

Based on the work of Dr. Lisa Najavits, PhD, this treatment is designed for people with substance abuse and trauma experience and emphasizes the relationship between the two. ​

This group will assist individuals to develop strategies to manage previously overwhelming situations thereby increasing their self-awareness and reducing their symptoms. ​

Participants will be encouraged and provided with opportunities to develop a practice of using safe coping strategies and tools in a supportive virtual group setting. ​

Patients must have a history of relational trauma and symptoms of PTSD and be deemed appropriate for the group milieu. ​

Note: This group is open to internal and external referrals​ and is currently offered in a virtual format only.

Dialectical Behaviour Therapy Skills Group (DBT)

Duration: 12 weekly sessions

Frequency: Offered 2 – 3 times per year

DBT was developed by Dr. Marsha Linehan and consists of 4 components; emotion regulation, distress tolerance, interpersonal effectiveness and mindfulness. It is an effective treatment for people who struggle with intense emotions. ​

Participants learn skills that will assist in understanding and reducing problematic behaviors (i.e. self-harm, substance use, impulsive behavior), enhance emotion regulation and build coping skills. ​

For eligibility, we require that participants are not in a mental health crisis and have additional formal or informal supports that can be accessed during the program.​ The facilitators will not be available to support patients outside of the group​.

Referrals must be completed by a physician to register for this program.​

Note: This group is only open to patients of the Women’s Mental Health Program at WCH and is currently offered in a virtual format only.

Day Treatment PRogram (DTP)

Day Treatment Program (DTP) is an in person and virtual program aimed at helping individuals suffering with mood and anxiety disorders to move forward towards more valued living.

Using the Acceptance Commitment Therapy framework, psychoeducational groups, movement and breathwork, our objective is to support clients in lowering symptoms, increasing self-awareness and commitment to act towards their defined life values with more ease.

Day Treatment Program follows this format:

• Orientation Group (virtual): The 3rd Tuesday of the month prior to your start date (10am-1115am)
• Rolling admission Program: (In person) Twice a week for 8: weeks (Mondays 930am-12:15pm and Wednesdays 1pm-3pm)
• Follow up component (TBD): monthly for 3 months

This program runs year-round and clients are admitted on a first come first served basis.

Individual Time-Limited Psychotherapy

Individual time-limited psychotherapy services may be offered to patients as part of their treatment plan. This will be determined collaboratively between the patient and psychiatrist.

Mental health therapists assess and determine the most effective intervention to assist each patient one-on-one. Treatment may consist of Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy (IPT), Psychodynamic Psychotherapy, Acceptance Commitment Therapy (ACT) as well as supportive and integrative therapies.

Length of treatment varies depending on the intervention used.

Note: All individual therapy is currently offered in a virtual format only.

Time-Limited Case Management

The overall goal for Case Management services is to link patients to supports and services, which will aid in the wellness and recovery of patients in the General Psychiatry program. The case manager and patient will collectively set goals and develop a plan that uses inherent strengths of client to link patient to supports which will reduce social isolation and promote a healthy lifestyle.

Case Management supports are short term, goal-oriented services with a maximum of 6-8 sessions.

Referrals for Case Management Services are completed by psychiatrists within the General Psychiatry Program.

Note: Case Management services are currently offered in a virtual format only.

Mindfulness Based Stress Reduction Program (MBSR)

Note: This group is only open to patients of WCH. Priority access is given to patients of the General Psychiatry Program and if space is available, other WCH mental health patients may be referred. This group is currently offered in a virtual format only.

MBSR Referral Form (.pdf)
MBSR Referral Form (.docx)

Cognitive Behavior Therapy (CBT)

A CBT referral form must be completed by a physician.

CBT Referral Form (.pdf)
CBT Referral Form (.doc)

Seeking Safety Treatment Group (SS)

Seeking Safety Treatment Referral Form (.doc) 

The Seeking Safety Treatment Referral Form (.doc) must be completed by a physician who can follow the participant while they are in the group.​

Dialectical Behaviour Therapy Skills Group (DBT)

DBT Skills Group Referral Form (.docx)

Day Treatment Program (DTP)

DTP Referral Form (.pdf)
DTP Referral form (.doc)

• When your referral is received, it will be determined if one of our programs will best fit your needs. In some cases, you may receive a phone call from a clinician to help gather additional information before your first appointment.
• You will then be contacted by our administrative staff to schedule an appointment with one of our psychiatrists. Wait times for initial consultation vary. However, expected wait time is 1-2 months.
• Once you have received your appointment, you will be asked to set up your MyHealthRecord portal. You will receive an email from our administrative staff with instructions to complete this setup. Please refer to this link for more information on setting up your MyHealthRecord portal.
• All appointments are being completed virtually, unless otherwise specified.
• You will be asked to log into your MyHealthRecord portal 20 minutes prior to your appointment time, in order to complete the e-check in process. Once the check in complete, Zoom will automatically launch, and you will be able to connect with your psychiatrist.
• If you have any questions or concerns regarding the set up and activation of your MyHealthRecord portal, please contact myhealthrecord@wchospital.ca or call 416-323-6205.
• Information obtained in the consultation is used to provide a psychiatric diagnosis and recommendations for treatment. A letter will be sent to your referring doctor (and your family doctor if the referring physician is another healthcare provider). Treatment recommendations may include referrals to brief psychotherapy in our program, recommendations for medications or other biological treatments, case management, and referrals to other programs in our department or in the community.

Menstrual Cycle

Psychiatrists in our program provide consultation with treatment recommendations for mental health conditions linked to the menstrual cycle.

Many individuals experience worsening of underlying mental health conditions premenstrually (premenstrual exacerbation). Others may experience symptoms such as depressed mood, anxiety, irritability, and interpersonal sensitivity that are restricted to the time period leading up to menses (premenstrual dysphoric disorder).

Prior to an assessment, you will be asked to complete a set of questionnaires to track the relationship between your menstrual cycle and various symptoms for a period of at least two months.

Pregnancy Planning

Psychiatrists in our program provide consultation around pregnancy planning in the context of mental health conditions such as depression, anxiety, obsessive-compulsive disorder, trauma and stressor-related disorders (eg PTSD), bipolar disorder, and psychotic disorders. Consultations may include a discussion of medication use in pregnancy and risks associated with the underlying condition.

Pregnancy and Postpartum

The program offers a combination of education, brief psychotherapy and medication to assess and treat mental health conditions in pregnancy and postpartum. Individuals may be seen up to one year postpartum.

Conditions treated include depression, anxiety, obsessive-compulsive disorder, trauma and stressor-related disorders (eg PTSD), bipolar disorder, and psychotic disorders.

The majority of the therapy provided in our program is in a group format. (Group therapy is currently being conducted virtually due to COVID-19 containment efforts.)

Additional Online Resources:

• Healthy Babies Healthy Children
• Mother to Baby
• Medicines in Pregnancy
• Post Partum

Menopausal Transition

Psychiatrists in our program provide assessment and treatment recommendations for mental health conditions linked to the menopausal transition.

The transition to menopause (perimenopause) may take 5-10 years and may be accompanied by vasomotor symptoms (hot flashes and night sweats), changes in sexual functioning, and cognitive changes as periods become more irregular. Perimenopause is often associated with an exacerbation of underlying mental health conditions.

Additional Online Resources:

• Menopause

Wait times

At the present time, we are offering appointments for most referred patients within 8-12 weeks of the referral being received. If you are pregnant or postpartum, you may be given an expedited appointment based on your intake pre-assessment.

Intake & Triage

• Josephine D’Agostino, SSW

Mental Health Therapists

• Greer Slyfield Cook, MSW, RSW
• Kaeli Macdonald, BFA, MSW, RSW
• Marsha Gallinger MSW, RSW
• Keisha Greene, RP, MC

Psychiatrist Team

• Dr. Lucy Barker
• Dr. Hollie Citynski (clinical associate)
• Dr. Alicja Fishell
• Dr. Renu Gupta
• Dr. Aliza Israel (Child and Youth)
• Dr. Jovana Martinovic
• Dr. Diane Meschino
• Dr. Tatiana Valverde da Conceicao (Child and Youth)
• Dr. Simone Vigod
• Dr. Lori Wasserman, RLS Program Lead
• Dr. Elise Wright
• Dr. Crystal Clark

At any given time our team also includes social work and medical students, post-graduate medical trainees and fellows in psychiatry, obstetrics and gynecology, and family medicine, as well as clinical fellows from Canada and around the world.

This specialized Women’s Mental Health Program grew out of the understanding that a woman’s emotional well being is inextricably connected to that of her children and family.

Services Provided:
The program provides consultation and short-term treatment for children aged 0 to 18 and their families, with concerns including: mood/anxiety, behaviour management, attention/hyperactivity, parenting, and parent-infant attachment.

Treatment may include:

• parent counseling
• family therapy
• treatment with medication
• individual therapy

We are very pleased to offer group therapy for mothers with postpartum anxiety/depression and their infants, provided jointly with the Reproductive Life Stages program.

Our child psychiatrists work in collaboration with the Women’s Mental Health psychiatrists and therapists to provide integrated care for families with parental mental health concerns.

We do not provide assessments related to custody or legal concerns.

Referral

We are now open for referrals for infants, children and youth, from birth up to 18 years of age.

Referrals

We are now open for referrals for infants, children and youth, from birth up to 17 years of age.

Referrals should be completed from a family doctor or pediatrician, and must include the physician’s telephone, fax and billing numbers.

Download our Child and Family Psychiatry Program referral form (.pdf) and fax to 416-323-6356.

The RLS program at Women’s College Hospital is actively involved in a variety of research initiatives at our institution and through partnerships with other hospitals. We aim to conduct research that improves the health of women with mental health issues and their families across the reproductive life cycle, inclxuding across the menstrual cycle, pregnancy, postpartum and in the menopausal transition.

Current Studies Recruiting Participants

We have several clinical research studies underway that are actively recruiting participants:

Reproductive Mental Health of Ontario Virtual Intervention Network (rMOVIN)

Study funded by: Women’s College Hospital Foundation

Principal Investigators: Dr. Simone Vigod, Dr. Ariel Dalfen

Many people who experience depression or anxiety during pregnancy and postpartum have a hard time accessing the appropriate care. The online rMOVIN platform was created to help pregnant and postpartum people with depression and anxiety find suitable virtual treatment options. The platform includes many resources, access to a “care coordinator” to help people determine the best treatment option for them, link them to online mental health therapy interventions, and when needed arrange virtual e-consults to family doctors or direct patient video-consultation with the rMOVIN reproductive mental health psychiatrist. If you are pregnant or postpartum and experiencing symptoms of depression and/or anxiety, you may be eligible to participate in a study to determine if MOVIN can help to reduce your symptoms.

For more information and to access the pre-screening questionnaire, please visit MOVIN at the Women’s Research Institute

An Electronic Patient Decision Aid for Antidepressant Use in Pregnancy

Study funded by: The Canadian Institutes for Health Research (CIHR)

Principal Investigator(s): Dr. Simone Vigod

Deciding to start or continue an antidepressant medication during pregnancy can be a difficult and complex decision. If you are pregnant or planning a pregnancy, deciding whether you should start or continue an antidepressant medication for the treatment of depression, and are conflicted about what to do, you may be eligible to participate in a study examining whether or not an interactive website is a helpful tool for women who are making this decision.

For more information and to access the pre-screening questionnaire, please visit the PDA Study page.

Technology-enabled (Electronic) Measurement Based Care (eMBC) for Perinatal Depression and Anxiety: A Pilot Randomized Controlled Trial

Study funded by: Women’s College Hospital Academic and Medical Services Group (WCHAMSG) Alternate Funding Program (AFP) Physician Innovation Fund

Principal Investigators: Dr. Renu Gupta and Dr. Simone Vigod

Tracking symptoms of depression and anxiety during pregnancy and postpartum through self-report scales in the electronic hospital chart has the potential to tailor decisions about antidepressant medication to individual patients. Talk to your psychiatrist if you are interested in learning more about this study.

Decisional Conflict of Lithium Use in Breastfeeding in Women with Bipolar Disorder

PI: Dr. Simone Vigod

The postpartum period is a time of high risk for the onset and recurrence of bipolar disorder. The onset of symptoms is often rapid and may occur in late pregnancy or within the first few days to weeks after delivery. There is a higher postpartum relapse rate in women with bipolar disorder who were medication free during pregnancy than those who were maintained on medication.

Lithium is a gold standard pharmacological treatment for bipolar disorder because it is effective in both the acute and maintenance phases of manic and depressive episodes. There is also growing evidence of its effectiveness for the prevention and treatment of postpartum psychosis. For some women, lithium may be the only effective treatment or maintenance medication. However, the use of lithium in the postpartum presents a major dilemma for women with BD as it pertains to the issue of breastfeeding because lithium is excreted into breastmilk.

There are significant benefits of breastfeeding, so the risk of breastfeeding must be balanced against the risk of exposing the baby to lithium. The purpose of this study is to examine the decision-making around lithium use and breastfeeding among women with bipolar disorder.

You may be eligible to participate if you are pregnant or planning to become pregnant. For more information, contact Maria Michalowska at 416-351-3732 ext. 2302 or maria.michalowska@wchospital.ca

Using virtual care to reduce barriers to mental health care in postpartum women and full-time workers

Study funded by: MOHLTC AFP Innovation Fund

Principal Investigator(s): Dr. Jennifer Hensel

We are currently recruiting for a study where women can take advantage of personal computer videoconferencing as part of the therapy offered in the RLS program.

Completed Studies

Below are results from some of our recently completed studies:

Postpartum Depression: Action Towards Causes and Treatment (PPD ACT) Canada

Study funded by: Women’s Mental Health Program, Women’s College Hospital
Principal Investigator(s): Dr. Simone Vigod

Co-investigators: Dr. James Kennedy, Dr. Valerie Taylor, Dr. Cindy-Lee Dennis, Dr. Sophie Grigoriadis, Dr. Tim Oberlander, Dr. Benicio Frey, and Dr. Ryan Van Lieshout

Postpartum mental health problems are common and cause enormous human suffering and costs to society. As yet, we do not have a complete understanding of the causes of postpartum mental health problems, including postpartum depression and postpartum psychosis. So, we cannot accurately predict who will develop them. We now know that postpartum mental health problems have a genetic basis. Understanding the genetic basis of postpartum depression and other postpartum mental health problems is an important goal that could lead to the development of preventive strategies and targeted treatments that could dramatically decrease suffering for women and their families.

This research study used an iOS app to identify Canadian women who have ever experienced postpartum depression or other postpartum mental health problems, and collect genetic information from them.  Results from the genetic analysis were included in the first large genome-wide association study of postpartum depression which hopes to identify the genetic cause of postpartum depression.

Related publications by our team:

Pouget et al. (2021). Preliminary insights into the genetic architecture of postpartum depressive symptom severity using polygenic risk scores.

Transcranial Direct Current Stimulation (tDCS) for Depression During Pregnancy

Study funded by: SickKids Foundation and the Canadian Institutes for Health Research (CIHR)

Principal Investigator(s): Dr. Simone Vigod and Dr. Daniel Blumberger
To prevent poor child outcomes, treatment of maternal depression in pregnancy is essential. However, for women who prefer not to use antidepressant medication to treat their depression, treatment options are limited. Transcranial direct current stimulation (tDCS) is a focal form of neurostimulation to treat depression that may offer pregnant women an effective treatment option for their depression without exposing the fetus to the effects of medication. Pregnant participants experiencing depression who declined to use antidepressant medication treatment, were enrolled in a pilot trial of tDCS. It showed that participants had a positive experience with the treatment, there were no serious side effects for the participant or fetus, and symptoms of depression were reduced after tDCS treatment. The results suggest that tDCS can be beneficial in treating depression.

Results: Vigod et al. 2019). Transcranial direct current stimulation (tDCS) for depression in pregnancy: A pilot randomized controlled trial.

Stay tuned for our CIHR-funded randomized controlled trial (Expected July 2021)!

Virtual Psychiatric Care for Perinatal Depression (Virtual-PND): A Pilot Randomized Controlled Trial

Study funded by: Department of Psychiatry, University of Toronto 2016-2017 Excellence Funds

Principal Investigator(s): Dr. Lori Wasserman (WCH), Dr. Simone Vigod (WCH, acting PI), Dr. Ariel Dalfen (Sinai Health System)

This study assessed the feasibility of virtual psychiatric care for pregnant and or postpartum women with depression. The study was conducted at both Women’s College Hospital (WCH) as well as at Sinai Health System (SHS).  The results of this pilot study showed that virtual care is acceptable to clients and psychiatrists, and that virtual care may be just as effective as in-person care. These results informed the development of the MOVIN study, as well as the shift to virtual care during the pandemic.

Results: Dalfen et al. (2021). Virtual psychiatric care for perinatal depression (Virtual-PND): A pilot randomized controlled trial.

Mother Matters: A Pilot Randomized Controlled Trial of Mother Matters, a Therapist-facilitated Online Group Psychotherapy Intervention for Postpartum Depression

Study funded by: Ministry of Health and Long-Term Care Alternate Funding Plan Physician Innovation Fund

Principal Investigator(s): Dr. Simone Vigod

Advances in technology, such as secure, online platforms provide opportunities to make treatment for mental illness more accessible and efficient. Mother Matters is a 10-week, therapist-facilitated, online asynchronous psychotherapy group for postpartum depression (PPD).

This pilot randomized controlled trial randomized mothers with Edinburgh Postnatal Depression Scale (EPDS) scores > 9 to Mother Matters or usual care. There was a high level of engagement in the group, and high group cohesiveness. Treatment effect was significant in women with moderate to severe symptoms at enrolment. Learn more about Mother Matters and how to enroll.

Results: Vigod et al. (2021). Mother Matters: Pilot randomized wait-list controlled trial of an online therapist-facilitated discussion board and support group for postpartum depression symptoms.

Other Ongoing Research Studies

In addition to the clinical research studies described above, our staff are engaged in high-quality research activities of relevance to women during their reproductive life cycle. Some examples:

Schizophrenia Understood in the Perinatal Period: Psychiatric Outcomes and Reproductive Trajectories (SUPPORT) III
Principal Investigator: Dr. Simone Vigod

PACT Canada: Predictive Analytic Models of PPD Risk
Principal Investigator: Dr. Simone Vigod

Intake and Booking Process

Pregnant and Postpartum Individuals

Prior to your visit, your physician or midwife will request a consultation from us by faxing us a referral form. If your referral is appropriate for our program, we will call you to schedule a telephone pre-assessment with the RLS intake worker that will happen prior to your in-person visit with the RLS psychiatrist, and provide you with a consultation date with the RLS psychiatrist at the same time. If you have not heard from us within 1 week of your referral please call our program at 416-323-6230 to schedule your telephone intake. The RLS intake worker will ask you some questions about the reason for your referral, and any other information that will help us inform your assessment visit with the RLS psychiatrist. You will be asked to complete a short questionnaire over the phone so that we can better understand what symptoms you are having, and how severe these are. You must complete your intake telephone call prior to your visit with the RLS psychiatrist. If you have not done so, then your visit with the RLS psychiatrist will be cancelled. It may be rescheduled once the intake telephone call is complete.

Non-Postpartum Individuals

If you are not pregnant or postpartum, an appointment date and time will be sent to your referring doctor’s office. You may be asked to complete a set of questionnaires which must be submitted to the RLS program prior to your consultation with the RLS psychiatrist. If the questionnaires are not completed by the due date provided to your referring doctor then your visit with the RLS psychiatrist will be cancelled. It may be rescheduled once the questionnaires are complete.

What to expect at your first visit

When you arrive on the 7th floor, please proceed to check in at the information desk where you will be asked to fill out some important forms, including your current medications, and whether you would be willing to participate in research studies in our program if you are eligible. Please arrive 15 minutes early for your scheduled appointment to complete these forms.

Your first visit to our program will be with one of the RLS program psychiatrists who will help determine a treatment plan to meet your needs. Women who are pregnant or postpartum may be referred for additional services in the RLS program, including psychological therapy with a mental health therapist.

You are welcome to bring any children under the age of one in for your appointment. On-site child care is available through Stella’s Playroom and should be booked in advance.

There are many resources available for both patients and their healthcare providers. The following are leading websites that will provide the answers to many of the questions you may have about mental health during reproductive life stages:

Patient Handouts

• Patient Flow – Navigation of RLS Service (.pdf)
• List of RLS Therapies (.pdf)

Educational Videos

Postpartum Mental Health - video provided by Women’s Health Education Made Simple

Designed by Aileen Lin, the following series of videos provide information about mental health in pregnancy and the postpartum period.

How can you tell if you are struggling with your mental health in pregnancy and postpartum?

Pregnancy and Postpartum Community Resources

City of Toronto: Healthy Babies Healthy Children
Provides support services, including home visiting for pregnant and postpartum women in their communities (also available from local public health departments outside Toronto)

Postpartum Support International

Open Forum: weekly telephone support via 800 bridgeline.
“Chat with an expert” Call schedule and access codes are available here, or call 1-800-944-4773 for more information

Pregnancy and Postpartum Referrals

Please include hospital of delivery and EPDS score in the referral for triaging purposes.  Referrals will not be accepted without this information.

We see patients ages 18 and above through pregnancy and up until one year postpartum.

If a patient is planning on delivering or has delivered at a hospital that has access to perinatal psychiatry, they should be referred to that program instead.

e.g. Sunnybrook Hospital, Mount Sinai Health Systems, St. Joseph’s Hospital, Lakeridge Health

For midwives:

Due to new OHIP billing rules around virtual care, patients referred directly by midwives will need to be booked in person for their initial visit.  If a physician/nurse practitioner makes the referral, then the patient can be seen for their initial consult by video.  All follow ups can be provided by video after the initial visit.

PMDD Referrals

We provide assessments and treatment recommendations for patients ages 18 and above.  We do not offer regular follow up for these referrals.

Perimenopause Referrals

We provide assessments and treatment recommendations.  We do not offer regular follow up for these referrals.

Pregnancy Planning Referrals

We provide consultation for pregnancy planning for patients ages 18 and above in the context of mental health conditions and use of psychotropic medications.  We do not offer follow up and ongoing treatment in the context of pregnancy planning.

Group therapy is a primary modality of treatment in the Trauma Therapy Program with a focus on relational therapy. As such, it is not equipped to provide acute stabilization of mental health symptoms and requires individuals to have adequate affect regulation skills so as to be able to form and maintain a therapeutic relationship with the therapist and other participants.

The Trauma Therapy Program is not a domestic abuse or sexual assault treatment program. The focus of therapy is directly related to managing impact of symptoms related to childhood trauma. Physical and emotional safety is paramount to therapy and to maximize the benefits of the therapy and to mitigate any risks of harm.

Individuals will be assessed based on the following criteria to be considered for the program:

• Identify with a history of childhood trauma
• Are being referred by a Physician or Nurse Practitioner providing ongoing care
• Not in acute crisis (e.g. housing instability, unsafe relationships)
• No recent psychiatric hospitalizations
• No acute symptoms that interfere with ability to attend regularly and/ or get full benefit of therapy (e.g. acute psychosis, severe substance use, excessive case management needs)
• Ability to keep regular appointments and attend in a timely manner
• Capacity to engage in treatment and maintain guidelines (e.g. confidentiality)
• Ability to communicate with the treatment provider, treatment team and other patients in a respectful manner
• Clinical rationale and capacity to formulate goals for trauma therapy

Access to our Trauma Therapy Program services requires a referral by a Physician or Nurse Practitioner providing ongoing care. Every newly referred client is invited to a Trauma Therapy Program orientation session and attendance is required in order to be considered for our services. A subsequent intake interview will determine whether Trauma Therapy services are a good fit, starting with the Resourced and Resilient Group. Following this group, individuals will be offered an exit interview and will be assessed for further treatment.

Resourced and Resilient Group

The Resourced and Resilient Group is the entry point for accessing therapy in the Trauma Therapy Program. It is a mandatory foundational trauma group that is designed to meet the needs of individuals who are interested in learning strategies to help manage current symptoms of trauma and to enrich their quality of life. Note: The focus of the Resourced and Resilient Group is on helping people explore the impact of past traumatic experiences on their current life and is not a group for processing the details of individual trauma histories.

Pathways for Healing

The Trauma Therapy Program offers a variety of weekly, time-limited, stage-one groups for individuals who have completed the Resourced and Resilient Group and could benefit from further trauma treatment. These groups will focus on healing trauma through various treatment approaches including: healing through the arts, healing through the mind, healing through the body, and healing through relationships. We also provide some stage one couples therapy interventions.

Following the completion of up to 2 group pathways, individuals will be discharged for one year to consolidate gains made in therapy. Individuals can be re-referred to the program or to WRAP after this one-year period, if they are interested in additional services.

Women Recovering from Abuse Program (WRAP)

The Women Recovering from Abuse Program (WRAP) is an intensive group therapy program with accompanying individual therapy for women (trans and cis), non-binary and gender diverse people who have experienced physical, emotional, sexual abuse and/or neglect in childhood (0-18 years old). The program runs Monday to Thursday from 9am to 1pm for 8 weeks. The program is running as a hybrid model where participants will be in virtual sessions 3 days/week and in-person 1 day/week.

WRAP is part of the Trauma Therapy Program (TTP). After completing the Resourced and Resilient Group or other groups in TTP, individuals who are interested in WRAP will meet with a member of the clinical team for an assessment. If the clinician and clients agree WRAP would be a good treatment option, individuals will attend the Building Resources Group, a weekly therapy group to assess readiness and prepare for the intensive phase of WRAP, prior to attending the intensive component of WRAP.

The WRAP facilitation team includes individuals from various disciplines with specialized knowledge and training in trauma. Women’s College Hospital is a teaching hospital. WRAP provides education to graduate-level students, health care professionals and community agencies. Research may also be conducted to explore the impact of childhood trauma and determine the effectiveness of treatment.

• Family Services Toronto – 416-595-9618
• Catholic Family Services – 416-921-1163
• Jewish Family and Child Service – 416-638-7800
• Women’s Health in Women’s Hands – 416-593-7655
• West End Sexual Assault Treatment Program (WESAT) – 416-913-7540
• Canadian Centre for Victims of Torture – 416-363-1066

Group Therapy

• Breakthrough at the YWCA – 416.487.7151 ext. 266
• The Gatehouse – 416-255-5900 ext. 221
• Catholic Family Services – 416-921-1163
• The Barbra Schlifer Clinic – 416-323-9149

Download the TTP Orientation Handout