Bridging the Gap: Advancing Cancer Care and Mental Health Through a Collaborative Care Model
December 17, 2024
Kelly Irwin, MD
Three Questions for Kelly
1. Can you tell us a little about your role and background?
I am a psychiatrist, and a health services researcher focused on advancing health equity for individuals with mental illness and cancer. At the Mass General Cancer Center, I direct the Collaborative Care and Community Engagement Program in the Center for Psychiatric Oncology, a clinical and research initiative dedicated to improving cancer and mental health outcomes for individuals with serious mental illness and their caregivers. Individuals with preexisting serious mental illness- including schizophrenia, bipolar disorder, and severe major depressive disorder - are more than twice as likely to die from many common cancers in part due to inequities in cancer care. Adults with mental illness have been systematically excluded from clinical trials. Our team aims to develop and implement new approaches to care delivery and research to help close the cancer mortality gap and improve wellbeing for individuals with mental health disorders. Additionally, I lead the Engage Initiative, a cross-sector coalition with 1,000 members, dedicated to ensuring that mental health is never a barrier to cancer care or research. This year, I am a fellow at the Harvard-Radcliffe Institute for Advanced Study. My project focuses on learning from the narratives of patients, caregivers, and clinicians to promote dignity and decrease mental health discrimination in health care.
2. What interventions have you found most effective in addressing cancer disparities among individuals with serious mental illness? How have you engaged the community in this research, and in what ways has this engagement strengthened your work?
We found that individuals with serious mental illness who had access to mental health care at the time of cancer diagnosis were more likely to receive timely, guideline concordant cancer care. However, access to mental health care remains inadequate and fragmented from cancer care. To address this gap, we developed the BRIDGE model of person-centered collaborative care. This approach is based on the evidence-based collaborative care model and tailored to patients with serious mental illness and cancer. Key strategies of the BRIDGE model include:
Proactive psychiatry consultation and caregiver engagement
Partnering with a social work and navigator team to identify patient goals and values, build rapport, and address barriers to care across settings
Collaborating with the oncology and mental health teams to develop an integrated plan for cancer and mental health treatment and systematically tracking progress.
A randomized trial at the Mass General Cancer Center found that patients on BRIDGE were half as likely to experience clinically meaningful disruptions in cancer care and had decreased anxiety and psychiatric illness severity versus the Enhanced Usual Care.
Community engagement has been central to this work. The Engage Initiative’s Community Advisory Board – which includes representation from individuals with mental illness and cancer, caregivers, clinicians, researchers, and advocates – guides our research agenda and strengthens our clinical programs. Our Community Advisory board and partners, including the Massachusetts Department of Mental Health, prioritized increasing the reach of the BRIDGE model particularly to community settings without on-site psycho-oncology. We recognized the need for targeted approaches to prevent widening gaps in access to virtual care. With PCORI support, we developed a toolkit to promote digital health equity for older adults with mental illness and Spanish-speaking populations to promote digital health equity for older adults with mental illness and Spanish-speaking populations.
One key next step has been developing a Virtual Cancer and Mental Health Tumor board on the North Shore. Supported by the Trefler Foundation, we partnered with MGH Danvers Cancer Center, Eliot Community Health Services, North Suffolk Mental Health and Lynn Community Health Center to pilot a monthly virtual tumor board focused on cancer and mental illness. These meetings have increased access to psycho-oncology expertise and strengthened regional partnerships through case discussions and sharing best practices.
3. What advice would you give researchers or clinicians looking to integrate community engagement into their work?
Community engagement is the most rewarding part of my work. I think it helps to understand what communities we are part of- whether that’s a neighborhood, region, or a community of practice dedicated to improving cancer survival and wellbeing for people affected by mental health needs.
When I think about building sustainable partnerships, I keep in mind these principles our community advisory board has taught me:
Keep it real: Acknowledge gaps in access to care and research, structural discrimination, and power differences that contribute to cancer disparities.
Keep showing up: Continue to learn about community strengths and needs
Stay centered: Focus on who the challenge affects most and work toward inclusion
Be vulnerable: Create spaces to connect as humans first and why this work matters
Be transparent: Create a structure and opportunities for growth outside the project
It has helped to ask: What challenge are we trying to solve? Who does this matter to? Whose voice is important to include? How can I elevate other perspectives? In other words, how can I be helpful? Our first step may depend on our background, expertise, resources, and partnerships with community organizations and leaders. Through my research and clinical practice, I continue to look for ways we can bring people together. This involves listening to people’s concerns and identifying opportunities for alignment to address challenges together. We frequently build trust by caring for patients together, and it has been important to be a clinical resource across systems. It has helped to create spaces where we can share our own narratives and use language that honors dignity and the human right to health. We aim to create opportunities for our community partners to build research and clinical skills and be able to transition to new professional and leadership roles.
It has been rewarding to amplify community strengths and meet cool people with a shared dedication to advocating for a marginalized population who have frequently been silenced. It has helped me to stay hopeful as we work to raise awareness about a health disparity that has remained invisible and implement best practices in real time.
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To learn more about the Collaborative Care and Community Engagement Program at Mass General Cancer Center, please visit: https://www.massgeneral.org/cancer-center/patient-and-family-resources/supportive-care/collaborative-care-and-community-engagement
To learn more about the Engage Initiative, please visit: https://engageinitiative.org/. Please reach out with questions and ideas, particularly about work at the intersection of cancer and mental illness.
If you would like to collaborate with the Center for Cancer Equity and Engagement on community outreach and engagement activities, please email Jenny Reiner (Jennifer_reiner@dfci.harvard.edu) or Center for Cancer Equity and Engagement (CCEE@partners.org).