Dr. Sarah Brandigampola

Becoming a psychiatrist wasn’t always the obvious choice for Dr. Sarah Brandigampola. Interested in the arts from an early age, her passion for psychiatry emerged after a chance rotation during medical school. Today, she’s a psychiatrist in The Ottawa Hospital’s offsite On Track program for people experiencing early symptoms of psychosis, and she’s part of an essential team helping people get back to the life they want to live.

Scroll down to read more about how Dr. Brandigampola is helping people with psychosis rewrite their stories — and the surprising career she would have chosen if she didn’t pursue medicine.

Q: Can you tell us a little about growing up and your early years?

I grew up in Listowel, in the middle of Mennonite farming country. It’s a small town, with two stop lights. Growing up I was interested in a lot of different things, but I wanted to be a neurosurgeon or a star on Broadway. I did a lot of theatre, dance, and music. Our music program was a vocal program, and I was fortunate to travel a lot with our choir; we even performed at the Notre Dame cathedral in Paris.  

Q: When did you decide to pursue medicine, and specifically psychiatry?

I was finishing high school, and I had to make a difficult decision. I wanted to pursue both the sciences and the arts. In the end, I always wanted to help people. I had a strong sense of social justice and wanting to contribute in a meaningful way to helping people. So, I chose medicine because I thought it would be more fulfilling for me.

I studied cellular biology at Western University in London, Ontario, and then came to Ottawa for medical school. In third year medical school, you rotate through different areas, and I was not interested in psychiatry; I wanted to be an oncologist. But, when I went into the psychiatry rotation, I found it so meaningful looking at people from a global perspective — not just at their medical illness, but at their living situation, their relationships, their childhood, their income, at what makes them a person — and how can we help them with their illness. I also loved the teamwork aspect — it felt side-by-side with nursing, social work, occupational therapy, recreational therapy, everything; everyone was really working as a cohesive team with this vision of how we could help this person as a person.

“When you’re looking at the story of people’s lives, it’s a lot like reading a book; you pull out themes and look for critical moments.”

— Dr. Sarah Brandigampola

Now that I think about it, I think a lot of my skills were aligned with psychiatry. Psychiatry wound up being a meeting point between neurology and the arts. When you’re looking at the story of people’s lives, it’s a lot like reading a book; you pull out the themes and look for critical moments for communication. With psychiatry, we can help people tell their stories in a way that has meaning to them.

Q: How has the field of psychiatry changed since you started?

I definitely think there’s a lot less stigma about mental health now than when I started. People are talking about it a lot more. There’s a long way to go, specifically around severe and persistent mental illnesses. In terms of the future, there’s so much research that needs to be done. We still don’t truly understand what causes schizophrenia or most mental illnesses.

Q: You worked on Sean Heron’s case. What made that case challenging or unique?

“He really jumped into the program. Everything we suggested, he said, “Yes.” We have a walking group, a social group, a sports group, occupational therapy, recreational therapy, medication. He did it all, and we just saw him come to life.”

— Dr. Sarah Brandigampola

Sean is one of our star patients. It’s the kind of story you want to hear. When we met him, he was very unwell, and he’d been unwell and untreated for about a year and a half. That was worrisome because the longer the duration of untreated psychosis, this does have an impact on people’s prognosis. The goal of our clinic is to intervene earlier in the illness.

In spite of that, he just did so well. He really jumped into the program. Everything we suggested, he said, “Yes.” We have a walking group, a social group, a sports group, occupational therapy, recreational therapy, medication. He did it all, and we just saw him come to life.

The number one predictor in the program is whether they have a supportive and involved family member, and once he was in it, he started going out for walks every day with his mom again.

Q: What advice would you give to someone experiencing first-episode psychosis?

What I hope people can learn about schizophrenia is that there’s so much hope for this illness. Most people with schizophrenia do very well if they get into treatment.

We take self-referrals, so if people have a loved one, or if they’re wondering if something is happening to themselves, they can call us, and we’ll see them and help them figure it out.

It’s also important for people to know a symptom of schizophrenia is a neurological one called anosognosia — the inability to know something is wrong. The part of your brain that tells you something is wrong turns off. It can be really frustrating for family members, because they’re trying to reason with the person. It’s best to focus on things like not going to school, not seeing friends, or other changes, and start the conversation there.

Q: What is The Ottawa Hospital doing in psychiatry and mental health that is exciting or groundbreaking? 

Our On Track program is the model of care that I would hope everyone with mental illness could be a part of. I think it is very exciting what we do as a clinic — we have such amazing success stories. When you talk to people about a diagnosis of schizophrenia, you just see their face change and their parents are often shocked. But we have such great outcomes at this clinic. This illness does not have to dramatically change your life, and I would say it’s because of the model of care we provide.

Our leadership is also really great. Dr. Jess Fiedorowicz, Head and Chief of the Department of Mental Health, is amazing. He’s an endlessly optimistic person who sees what we could be doing and pushes us to be doing more. I think he’s striving for mental health to be even more comprehensive.

Q: As a psychiatrist, why did you choose to work at The Ottawa Hospital?

Dr. Sarah Brandigampola and the On Track team at a music festival

I did six months in the On Track program for my residency, and I wanted to keep working here with this team. They are amazing. This is not work you can do on your own, and it’s wonderful to have such a great clinical team, but also this community of people where there’s a genuine camaraderie. I never have any doubt people are going above and beyond. I know I can trust people’s judgment. It can be difficult sometimes, but there’s a lot of humour and friendship and genuine caring for each other.

I’m also so grateful for my patients and to be trusted with their stories and their care. They teach me everything.

Q: What would we find you doing when you aren’t at the hospital?

I have my family, and we like to get outside. I also love reading and travelling. If I can, I enjoy seeing live music and things that keep me engaged with the arts.

Dr. Sarah Brandigampola hiking in Gatineau
Dr. Christine Dickson, psychiatrist in the DBT Program at the Ottawa Hospital

For patients taking part in the Dialectical Behaviour Therapy Skills Group (or DBT-Lite Program) at The Ottawa Hospital, Dr. Christine Dickson will be a friendly and familiar face. She has co-facilitated the program since 2013, along with social worker Vicki Larsen before Larsen’s retirement in 2021.

Combining a compassionate approach with evidence-based therapy, Dr. Dickson and the team are helping patients live their most fulfilling lives by learning to balance the acceptance of intense and challenging emotions, thoughts, and urges with behavioural changes. Our program is unique, and for a long time, it was the only English DBT skills group available under OHIP in the city.

Q: Who does The Ottawa Hospital’s DBT-Lite program serve, and how is our program unique?

A: This program is for individuals with borderline personality disorder (BPD) who meet either full or partial criteria. These individuals have high sensitivity to emotional cues, with intense reactions and long-lasting feelings. They feel empty and struggle with a sense of self. They have intense interpersonal sensitivity, and relationships can be chaotic. They have urges to, and often engage in, self-harm and other impulsive potentially harmful behaviours. DBT views these behaviours as ways of dealing with painful experiences that work in the short term but are harmful and sometimes life threatening. DBT offers validation of the pain and the desire to find relief, and at the same time engages the patient in learning new effective behaviours.

A principle of DBT is that clinicians treating BPD need support, so we offer the skills group to complement the treatment and support that patients are already receiving from clinicians in the community. That way we are not only supporting the patients but also their clinicians.

Q: What makes DBT different from other therapies, and how does it help patients like Anita who are struggling?

A: It’s a combination of validation and change strategies. DBT has been described as CBT (or cognitive behavioural therapy) plus validation plus mindfulness. DBT sends the dialectical (or seemingly contradictory) message that everything you think, feel, and do makes perfect sense, and here are the tools to help you change, reduce your suffering in more functional ways, and get closer to your ultimate goals. It really reduces shame and self stigma. Overall, we want to convey a message of hope — BPD is highly treatable; it is not static and can go into remission even on its own and much more rapidly with treatment.

Q: What makes borderline personality disorder such a challenging condition?

A: I have loved working with individuals with BPD since my psychiatry rotations in medical school. They are often creative and passionate about life, society, and the environment. They are often empathetic and helpful to others, and they are really trying their best and want to get better.

That said, the suffering that people with BPD experience is intense. Some believe they cannot get better. Some have learned to invalidate and stigmatize themselves. Some clinicians may also believe it is untreatable and may find it challenging to validate behaviours that don’t make sense to them. It is also really important that clinicians treating BPD get support from other treating clinicians. So, time, training, and expenses can be a challenge. Obviously, the resources must be present.

Dr. Jess Fiedorowicz is shining a light on mental health through his work and research at The Ottawa Hospital. Originally from the U.S., Dr. Fiedorowicz has been at our hospital since 2020 as the Head and Chief of the Department of Mental Health. He’s also a Professor and Senior Research Chair at the University of Ottawa and a Scientist at the Ottawa Hospital Research Institute. On top of all that, he is Editor-in-Chief of the Journal of Psychosomatic Research, a member of the U.S. Food and Drug Association Psychopharmacologic Drugs Advisory Committee, and still holds an adjunct position at the University of Iowa, where he continues to collaborate with colleagues studying bipolar disorder.

Q: When did you realize you wanted to become a doctor? How did you wind up specializing in psychiatry and mental health?

A: I had an interest in medicine from an early age. As a high schooler, I even took overnight calls for my hometown’s volunteer emergency medical service, the Coleman Area Rescue Squad. Pinned to my desk was a partially crumpled cutout from LIFE magazine of an image from W. Eugene Smiths’ “Country Doctor” photo essay. A canvas print of this image currently hangs on my office wall. My ultimate interest in psychiatry developed in the middle of medical school. Of my many years of study and training, my first two (non-clinical) years of medical school were the only two that I frankly did not enjoy. My first clinical experience in medical school, at the close of my second year, involved interviewing patients at the Milwaukee County Mental Health Complex. This experience reinvigorated my passion for medicine. The first patient I interviewed there had schizophrenia, and despite having been a psychology major as an undergraduate, this experience sparked my first consideration of psychiatry as a career. Later, on an internal medicine rotation, which I also enjoyed, I sought to work with a patient with schizophrenia who had been admitted for an unexplained fever. With this and other cases, I observed patients with mental disorders not receiving the same attention and quality of medical care as their counterparts on general medical services. My interest in psychiatry and the overall medical care of patients with mental disorders has persisted over my clinical and research career.

Q: As a relative newcomer to Canada, can you talk a little bit about why you choose to work at The Ottawa Hospital?

A: The Ottawa Hospital has a rich tradition of research with a clear focus on practice-changing research. This focus couldn’t resonate more with me as my research is only as valuable as the impact it might have on people’s lives. With my interests in both psychiatric and other medical care for patients with mental disorders, I saw real opportunities here to build interdisciplinary teams engaged in research questions relevant to mental health and those living with mental disorders.

Q: You’ve brought an interdisciplinary and team-science approach to the department. With this in mind, how will this help The Ottawa Hospital will stand out in the area of psychiatry/mental health in the coming year?

A: We are promoting ensembles or interdisciplinary teams that connect researchers in mental health with other disciplines, including other fields of medicine. We have recruited some talented mid-career researchers and will be training early-career physicians with research interests. We are restructuring our positions to provide time for research and other academic work with a mentoring and advising plan.

Q: How does community support for research ultimately help patients who have bipolar disorder?

A: There is great potential benefit of not just community support but community engagement to direct priorities and to identify projects that have the potential to really change people’s lives. We have a team “Mind over Miles” in the Tamarack Ottawa Virtual Race weekend raising money for practice-changing research in mental health and plan to involve patient/family advocates and clinicians as part of the committee to determine how any funds raised will be spent.

Q: The Ottawa Hospital is currently working towards the creation of a new, state-of-the-art health and research centre to replace the aging Civic Campus. What will this new hospital mean for your patients?

A: We couldn’t be more excited about the new Civic build and what it means for our community. The department of mental health has been actively involved in the planning, which will include inpatient units with private rooms and courtyard space, a new psychiatric emergency services, and state-of-the art clinics with plans to develop services in neuromodulation. This will be a healing and therapeutic space to address a long under-met community need for acute mental healthcare.

Q: You’re working on a “risk calculator” to help predict the onset of certain mood episodes. What makes this project so important and unique?

A: I was approached by colleagues in child psychiatry who developed a risk calculator in youth and young adults that predicts likelihood of recurrence of a mood episode in bipolar disorder. I have a lot of experience working with a large and well-characterized adult sample that was followed for up to 30 years. We used this data set to externally validate this risk calculator — that is, to see if it still worked when applied in a different setting with older patients. We found this risk calculator performed about as well as risk calculators already being used to manage heart disease, such as to determine whether someone might benefit from a lipid-lowering medication. Risk calculators have not found their way into psychiatry and similarly have potential to personalize medicine. They also might facilitate research by making it more feasible to study prevention, by reducing time and cost through selection of those at higher risk. This can help us gauge the benefit of any preventative treatments, which are harder to study and subsequently less often studied.

Q: What is the most important thing you’d want people to know about you, The Ottawa Hospital, and/or psychiatry/mental health?

A: With two psychiatric emergency services, 90+ inpatient beds, a day hospital program, outpatient services, a mobile crisis program, and specialty programs in eating disorders, first episode psychosis, and perinatal psychiatry, we are a major provider of mental healthcare in the region. We also integrate services into hospital programs, such as oncology, and are developing similar integration with neurology and respirology. Beyond integrating with other medical services in the hospital, we are committed to partnership with other providers of mental healthcare in the region and have coordinated several initiatives with other hospitals and providers to improve access.

“When I first arrived at The Ottawa Hospital, I felt broken. But when I left, I felt like I could go on and not just survive another day, but thrive.”

– Petra Smith, who accessed our Perinatal Mental Health Program