Breaking the Silos: A New Model for Pain and Mental Health Care
At Toronto’s University Health Network (UHN), a quiet revolution is underway. Since joining UHN in 2022, Dr. Jeffrey Wieskopf has championed a mission that treats chronic pain and mental health as two sides of the same coin. His approach challenges traditional silos in medicine, advocating for a integrated model where pain specialists and psychiatrists collaborate to relieve both physical suffering and emotional strain.
“People recognize the importance of treating mental illness, and they recognize the importance of treating pain,” says Dr. Wieskopf, the first psychiatrist to work in a UHN pain clinic. “But the interplay between them — how one can easily impact the other — is often missed.”
This perspective reflects a growing recognition in contemporary healthcare: chronic pain is not merely a physical sensation but a complex experience that can fuel or be fueled by mood disorders such as anxiety and depression. Easing pain can alleviate mental distress, and treating mental health can lessen the perception of pain. Dr. Wieskopf’s work embodies that dual focus, aiming to help patients live free from both chronic pain and emotional burden.
From Seams to System: Building a Bidirectional Care Pathway
Dr. Wieskopf envisions a system where pain medicine and psychiatry “talk to each other” rather than operating in parallel tracks. His assertion reflects a key truth in pain management: mental health symptoms can intensify pain, while persistent pain can deepen emotional suffering. Integrating care means clinicians coordinate assessments, treatments, and follow-up across disciplines, ensuring patients receive timely, comprehensive support.
The urgency of integrated care becomes stark when considering the risk of self-harm among patients navigating both chronic pain and mental illness. Dr. Wieskopf notes that suicide risk nearly doubles in this population, underscoring the need for timely, compassionate intervention that addresses body and mind alike.
A Case That Illustrates the Model: Paul’s Journey
Paul’s story shines a spotlight on the realities and rewards of this integrated approach. Suffering from chronic pain for decades, Paul endured nineteen surgeries and years of opioid treatment. The physical pain was titanic, but the emotional toll—feelings of isolation, fatigue, and despair—was equally devastating.
Opioids offered temporary relief but altered his mental state, leaving him numb and increasingly vulnerable. After a hospitalization for sepsis, Paul sought help to reduce opioid dependence. He was referred to Dr. Hance Clarke at the Transitional Pain Clinic, Toronto General Hospital, where a careful, patient-centered weaning plan began. Dr. Clarke’s care was hands-on and humane, including 24-hour support during the opioid transition and naloxone administration when needed.
When Paul entered the care of Dr. Wieskopf, the focus broadened to include his mood and sleep. Paul was diagnosed with major depressive disorder, and a treatment plan combined mindfulness, meditation, and medication tailored to his entire well-being. Concurrently, Dr. Clarke offered innovative pain interventions—self-hypnosis, acupuncture, and hyperbaric oxygen therapy. The result was a notable reduction in pain and a regained sense of agency.
The healing extended beyond symptom relief. Paul’s depression eased as his physical pain diminished, but more importantly, he learned to navigate life beyond pain. Dr. Wieskopf encouraged him to reconnect with meaningful activities, including volunteer work at UHN—an important step in rebuilding purpose and identity after years of treating pain as a daily occupation. Paul now experiences better sleep, mobility, and a revitalized relationship with his family.
A Holistic, Patient-Centered Future
Paul’s story is not unique, but it is instructive. It demonstrates how integrated care can restore dignity and independence when pain and mental health issues are treated together. The collaborative model at UHN—rooted in ongoing education, multidisciplinary dialogue, and patient empowerment—strives to be a blueprint for other providers in Canada and beyond.
Dr. Wieskopf regularly hosts educational series at UHN to spread this approach, ensuring clinicians everywhere understand the links between pain and mental health and learn how to implement integrated care in diverse clinical settings. The ultimate goal is simple yet ambitious: help patients reclaim their lives by addressing both the physical and emotional dimensions of pain.
What This Means for Patients and Families
For patients facing chronic pain and mental health challenges, the integrated model offers a hopeful path forward. It means more coordinated care, fewer barriers between specialists, and more attention to the emotional and social factors that influence recovery. For families, it provides a clearer roadmap of what to expect and how to support loved ones on the road to improved function and improved mood.
In the words of Paul, the care he received didn’t just change his symptoms; it saved his life. And it stands as a testament to a forward-thinking health system that treats pain and mental health as intertwined journeys, best navigated together.
