Maximize the potential of internet-based platforms

In the second Difference Makers Discussion Paper we explored the need for dialogue and action around the creation of mentally healthy online spaces. We recognized that for some, the emerging norm of constant connectivity came with potentially negative impacts. However, for those for whom digital communication is more comfortable, or those who experience geographic or social barriers to accessing in-person services and supports (such as those living in rural / remote settings or people living with mobility limitations), internet-based platforms represent a promising new opportunity for accessing care.⁴

• Telepsychiatry is a real‐time consultation by a psychiatrist to a client via secure videoconferencing, allowing treatment to occur when the psychiatrist and patient are located in different geographic locations.

  • The CAMH Telemental Health program works with over 225 communities across Ontario, reaching individuals in underserved communities where access to mental healthcare is limited. Originally, primary care providers referred clients to the first available CAMH psychiatrist for a one-time consultation. Based on lessons learned, the program has now shifted to a collaborative care model where a dedicated CAMH psychiatrist is virtually embedded in one of Ontario’s provincial health authorities or in a provincially-designated Family Health Team. Research studying client mental health outcomes and experiences with the collaborative care model is underway to build the evidence base for this approach.⁵

• Morneau Shepell has a student support app provided in partnership with some post-secondary institutions. Recent utilization data reveals that:

  • 70 per cent of the app’s users access counselling during non-office hours reinforcing that mental illness does not abide by a 9-5 schedule.⁶
  • Four in 10 users would not have reached out for help through alternative methods including on-campus, in-person support.⁷

• The growing comfort with online health platforms is not restricted to youth.

  • In 2017, across Morneau Shepell’s counselling offerings, 24.3% of users accessed support digitally. This represented a 3.4% increase from 2016. Offerings include chat, video counselling and internet-based cognitive behavioural therapy (ICBT).⁸

• The introduction of publicly-funded ICBT is emerging to varying degrees across provinces and territories.

  • In Saskatchewan, Difference Maker Dr. Heather Hadjistavropoulos leveraged research grant and provincial government funding into an online therapy unit based out of the University of Regina. Using programs initially developed in Australia, the unit serves residents across the province while building the ICBT evidence base.
  • Newfoundland and Labrador recently launched a demonstration project with the MHCC that will evaluate a stepped care model that includes ICBT with plans to share results nationally.⁹

• The MHCC’s 2017 scan¹⁰ of initiatives across Canada, along with its guidance¹¹ to users considering accessing the growing number of free, paid and publicly-funded internet-based mental health services points to the need for continued knowledge building among users, service designers and service deliverers given the emergent nature of these offerings.

  • Asking questions such as, “What data is being collected, who owns it and how is it being used?” remain important.
  • Considerations around whether users are consulted in service design, whether service designers consider the needs of diverse populations during development and whether processes are in place to connect users to services targeted to their needs are also critical.¹²

• As exciting as the opportunity to leverage internet-based platforms to connect more Canadians to care is, so too is the opportunity for shared learning as service users, designers, deliverers and providers (including governments) dive into exploring this rapidly emerging platform simultaneously.

Increased access to person-centred, integrated care requires an investment in partnership development

Treating each client as a whole person, co-locating services, aligning eligibility requirements to make it easier for people to access the range of health and social services they might need to support their recovery journeys - these are some of the activities and outcomes referenced when the value of person-centred, integrated care is discussed. While it may not be realistic that one practitioner, service site or even system will meet all the needs of each person they serve, the need to do better has led to some exciting care model innovations and pointed to the critical role of partnership development.

• Several initiatives are currently testing a similar model of integrated service delivery for youth across Canada, with project leads collaborating on shared evaluation approaches to build knowledge on impact and scalability.

  • ACCESS Open Minds is a national youth mental health demonstration project currently operating at 14 sites across six provinces and one territory. The project focuses on early identification, as well as providing speedy and flexible access to respectful, compassionate and integrated care that reflects the lived experiences of youth and their families, from ages 11 to 25 (spanning the transition gap that many youth face as they “age out” of community-based child and youth mental health services available to youth 18 and under). Each site is developed to reflect local assets and needs identified by community partners, with significant focus on the development of a culture of youth and family members/carers engagement. Youth voices are at the core of the ACCESS Open Minds project. ¹³
  • Youth Wellness Hubs Ontario, which has CAMH as a key partner, will be developing up to nine integrated youth service sites across the province.
  • In British Columbia, Foundry offers young people ages 12 to 24 health and wellness resources, services and supports online and through integrated service centres built up through partnerships, including with youth and family members / carers in six communities.

• Difference Maker Dr. Kathryn Dong grew frustrated as a downtown Edmonton emergency room physician treating the same patients repeatedly by addressing only their immediate physical health concerns and discharging them without addressing their other health and social service needs (mental illness, including addictions, precarious housing or income instability, for example). She leveraged research project funding to develop the Inner City Health and Wellness Program and within it the Addictions Recovery and Community Health Program. In addition to developing multiple community partnerships to provide emergency room patients experiencing mental illness with access to a range of services, the program includes a peer support component. The engagement of past clients in this role has been essential to supporting patients to feel truly seen and heard. Watch this video to learn more about the impact of the initiative.

CONCLUSION

Scale what we know is working, faster. Maximize the potential of internet-based platforms. Invest in partnership development including client and family engagement in order to truly capitalize on the potential of person-centred, integrated service delivery models. Let's ensure these and other lessons are remembered and utilized as individuals, communities and governments at all levels look to advance existing and new innovations to help us better meet the needs of the one in five Canadians who experience mental illness each year.

Be sure to also read our first Difference Makers Discussion Paper exploring Inspiration through stories of stigma being broken down and the pockets of hope created when individuals get easy access to appropriate care. Also check out our second Discussion Paper, on Connection. It explores what each of us can do to create more mentally healthy spaces where we live, learn, work and play - check these others papers out and join the conversation to create a more mentally healthy Canada!