A Strategic Approach to E-Mental Health

A strategy for the future

The Mental Health Commission of Canada launched Canada’s first E-Mental Health Strategy in 2024. It provides guidance for the development of e-mental health with emphasis on clinical safety, frameworks for data collection and retention, and culturally appropriate care.

“While e-mental health services offer many advantages, challenges like privacy and service quality must also be addressed. That’s why the Mental Health Commission of Canada, with the support of Mental Health Research Canada, developed a national strategy—shaped by a diverse advisory committee, with more than half the committee comprised of those with lived experience of mental health challenges,” Abbott says. “This guiding star document sets priorities for the future of digital mental health, ensuring meaningful engagement and collaboration across the sector.”

By supporting those creating e-mental health policies and solutions, the MHCC can inspire and improve the field at a systemic level ensuring that best practices cascade through to app developers, policy makers, and healthcare leaders and empower them to establish and adopt standards that will improve user outcomes.

In this way, it is a strategy that meets people where they are – because e-mental health keeps growing. According to the American Psychological Association, in 2021, more than 20,000 mental health apps were available on the market.

The proliferation is bound to continue because e-mental health tools can offer greater choice, convenience, lower cost, and, in some cases, higher-quality care than traditional services, according to an editorial called The “Uberisation” of Mental Health Care: A Welcome Global Phenomenon? by Ian Hickie, professor of psychiatry, Brain and Mind Centre, University of Sydney, Australia.

“If those with lived experience and research capacity in this field don’t respond appropriately, it leaves room for others to step in to respond consumer priorities: access, choice, competitive pricing, and user experience. Worldwide, demand for personalized mental health services far outstrips supply,” Hickie writes.

Here in Canada, the E-Mental Health Strategy serves as a blueprint, offering six recommendations and 12 priorities to chart the future direction of development of e-mental health in Canada and drive innovation – with consideration.

For example, one priority is to address the quality of e-mental health solutions and services, including privacy and data protection concerns. The strategy references the First Nations principles of ownership, control, access, and possession to guide health leaders, provinces and territories, jurisdictions, community organizations, and researchers around consent, collection, and data sovereignty.

“Trust is at the heart of e-mental health,” says Michel Rodrigue, president and CEO of the Mental Health Commission of Canada. “The efficacy and safety of e-mental health apps and supports should be paramount. People in Canada need assurance that these options meet the highest standards of safety and quality, prioritize equity-first data governance, maintain confidentiality, and include the perspectives of people with lived experience of mental health challenges.”

Stigma Crusher Jessica Ward-King notes that when people are in the midst of a crisis or struggling with their mental health, they may not be necessarily asking about how their data is being managed.

“Privacy is a huge concern that many don’t even think about,” she says. “Safety is another big issue. If a chatbot responds to suicidal thoughts, what protection is in place? If you’re getting advice from someone who doesn’t know your medications, what’s the risk there? A strategy makes sure someone is asking those questions before they become problems.”

Some of the recommendations in the strategy touch on issues of workforce and user readiness. People want help determining the quality and safety of options when there are so many options and no common standard. As e-mental health solutions continue to improve in quality and efficacy, there needs to be a means of communicating about evidence-based solutions with practitioners and to prove that they are both safe and efficacious.

With the speed of change, the e-mental health community is calling for specific guidelines related to AI use in mental health care; something that goes deeper than existing domestic and provincial guidelines and standards on the ethical use of AI in Canada.

Throughout the strategy-development consultations, the creation of a mental health app library and assessment process was one of the most discussed topics among both international experts and domestic collaborators. A database for assessed apps and a national assessment process would directly address some of the largest issues facing e-mental health in Canada, along with ongoing reviews and updates of best practice guidelines, since technology, legislation, and research evidence are constantly changing, particularly in relation to data security and privacy standards.

Addressing risks and readiness

E-mental health can offer access to care for people in rural areas who may not be able to travel to a care provider. It allows people to find culturally appropriate care for their situation, preserves privacy, and is usually less expensive than in-person services – for both the provider and the user. During the peak period of the pandemic, electronic mental health solutions allowed people to access care while physically distancing, isolating, or recovering from COVID-19.

Virtual consultations for mental health, substance use, and healthcare services went up during the spring and summer of 2022, with nearly three in five people in Canada accessing care this way, according to Statistics Canada.

According to a 2021 Canada Health Infoway survey, 63 percent of people said they would not have sought mental health care if virtual options had not been available.

Shaleen Jones knows this firsthand. She is the founder and executive director of Eating Disorders Nova Scotia, a community-based charitable organization that offers all of its services without a referral or a diagnosis.

Like many organizations, Eating Disorders Nova Scotia became 100 percent virtual in 2020, delivering all their services, supports, and training online, something that allowed the organization to expand its reach, says Jones.

“Technology is really a tool that allows us to connect with others – I believe it is that personal connection that has the greatest impact,” she says. “Like any new tool, thoughtfulness in how it is utilized is critical. The MHCC e-mental health strategy serves to identify potential challenges and strategies as we work to chart the future course of e-mental health services in Canada.”