Addressing the Access Gap: Leveraging the Potential of e-Mental Health in Canada

Purpose

Canada faces a “crisis of access” when it comes to mental health services, in part because as stigma recedes more people are seeking care. e-Mental health could play an important role in breaking up this logjam by extending reach, spawning additional access points and promoting higher quality care. To explore how e-Mental health technologies can be leveraged, the Mental Health Commission of Canada (MHCC) hosted a roundtable meeting in Vancouver on January 27, 2017. Policy makers, organizational leaders, people with lived experience and researchers from across Canada, along with a panel of international experts, came together to:

• increase awareness of the latest evidence on the effectiveness/efficacy of e-health solutions in improving access to mental health care;
• identify and examine existing models of e-Mental health that have been implemented in Canada and internationally;
• identify and discuss barriers and facilitators to the adoption and implementation of e-Mental health approaches to improve access to services; and
• explore recommendations to support the development, implementation and evaluation of current and/or future opportunities in e-Mental health.

In her keynote address, Dr. Lori Wozney of the Centre for Research in Family Health, focused on the state of e-Mental health in Canada. She and her colleagues have found there is a strong appetite for e-Mental health solutions—even if there is not always clarity about what constitutes e-Mental health—and that perhaps one of the greatest barriers to adoption is a risk-averse decision-making culture.

The morning panel looked at e-Mental health models that have been implemented in Canada. Dr. Peter Cornish, an associate professor and director of the Student Wellness and Counselling Centre at the Memorial University of Newfoundland, showcased Stepped Care 2.0. This integrated primary care model blends a heuristic for organizing programs with e-Mental health solutions for monitoring patient progress and delivering care. Dr. Heather Hadjistavropoulos of the University of Regina discussed her work with the Online Therapy Unit for Service, Education and Research (Online Therapy USER), a service offering free Internet-delivered, cognitive behavioural therapy to adults. Following a lunch and networking break, MHCC President and CEO Louise Bradley opened the afternoon session with brief remarks on her vision for e-Mental health in Canada, emphasizing the necessity of cooperation in order to move forward and address the access crisis.

The second panel featured experts from New Zealand and Australia, who talked about the e-Mental health experience in their countries. Andrew Slater, CEO of Homecare Medical, described taking on the challenge of managing New Zealand’s country-wide digital health care platform, while HealthTRx CEO Anil Thapliyal reviewed e-Mental health success factors, including a centralized approach and sustainable budgeting.

Young and Well Cooperative Research Centre founder and CEO Jane Burns described the revamping of Australia’s mental health care system to incorporate technology and patient-led care. Ian Hickie, co-director of the University of Sydney’s Brain and Mind Centre, followed with his take on how to effect system change.

During the three breakout sessions, participants worked through a series of questions on conceiving and advancing e-Mental health solutions in Canada. The ensuing discussions touched on a wide range of ideas and issues related to e-Mental health. Common themes included the need to bridge the digital divide, the challenge of bringing e-Mental health to rural communities, the need to overcome risk aversion to driving innovation, the value of person-led care and the possibility of applying promising solutions to like settings.
The meeting concluded with the MHCC stating its intention to disseminate the findings of its e-Mental health roundtable series via the MHCC website. Before departing, participants submitted their next steps, which included sharing new knowledge with colleagues, following up with select presenters and participants, engaging key stakeholders, evaluating existing e-Mental health solutions and taking steps toward implementation.

Key Findings

The following emerged from the roundtable as clear principles for future action on e-Mental health:

• Person-led is the way forward. This is important both in partnering with users who will be using the services in order to design them and in giving people control over their own data.
• The digital divide must be addressed. Those unable to access the requisite technology and services—or who lack the skills or knowledge needed to take advantage of e-Mental health solutions—will be left out.
• e-Mental health is integral to improving access. While there are no “magic bullets”, e-Mental health solutions provide the opportunity to increase access to services and help relieve Canada’s overburdened mental health care system.
• Innovation requires some tolerance for risk. Evidence of effectiveness is important to guiding mental health system decisions, but traditional methods of evidencegathering can be too slow or inexact for e-Mental health. A model more suited to technological solutions should be used, such as one that generates data through continuous quality improvement or ongoing program evaluations.
• We need coordination. There is a desire to proliferate e-Mental health solutions, but nothing will get done without a coordinated effort. Teamwork, partnerships and formalized strategies for e-Mental health are essential.
• Strong leadership is key. e-Mental health needs champions among practitioners, government and people with lived experience. Inspiring people to take up the cause requires increasing the visibility of e-Mental health and the evidence supporting it.
• Tech is borderless; collaboration should be, too. We need to look globally to see what works—and share our information internationally.
• Ultimately, it is about system change. Rather than an add-on to the status quo, e-Mental health is and should be seen as an enabler of system change.