Leveraging Technology to Address Mental Health and Substance Use in Canada: Meeting Summary Report

Purpose

People with lived experience of mental health and substance use, policy‑makers, researchers, and service providers, have identified the potential of technology-based interventions (TBI) to extend the reach of, access to, and quality of mental health and substance use services in Canada. Currently, how to select, best leverage and scale-up TBI is the subject of much discussion, debate and research in jurisdictions across the country.

The Mental Health Commission of Canada (MHCC), the Canadian Centre on Substance Use and Addiction (CCSA) and Canada Health Infoway (Infoway) partnered to co-host a roundtable on November 16, 2017, focused on leveraging technology to address mental health and substance use in Canada, including the opioid and youth suicide crises.

The objectives of this roundtable were to:

• discuss opportunities and specific actions for TBI to address emerging mental health and substance use concerns and improve access to care; and,
• identify the most pressing system level and policy changes required to integrate the use of technology into current practice.

Methodology

In the first of three presentations aimed at setting the context for the day’s discussions, Dr. Michael Krausz, Providence Health BC Leadership Chair in Addiction Research, University of British Columbia, proposed that because technology and social media are now so integrated into our daily lives, it is time for a major paradigm shift in how we think about how and what we fund and deliver mental health and substance use services across Canada. Krausz posited that TBI offer many of the right tools to respond to current public health issues such as the youth suicide, overdose and trauma care crises, suggesting that Canada could and should learn from others who are further ahead in their TBI implementation and scale-up journeys, translating their lessons learned into Canadian practice. Clare Perry, Group Manager, Integrated Service Design, Ministry of Health, New Zealand and Andrew Slater, CEO, Homecare Medical, co-presented a case study on the design, planning and implementation of New Zealand’s National Telehealth Service. Perry shared her perspective as the government leader of the initiative, explaining that New Zealand’s success in this area has come about in significant part from the approach the government took in commissioning the service.

Slater spoke from the perspective of the service provider, describing what the National Telehealth Service does, how it is organized, and the factors that have been critical to its success (which include thinking nationally while acting locally, use of high-trust, outcome-focused, long-term contracts, partnering with expert providers, and extreme leveraging of social media).

Following the presentations, participants placed their jurisdiction on a continuum of TBI implementation and scale-up, from conception (thinking about TBI, not yet acting) to maintenance (full scale-up, evaluation and quality improvement) for each of their mental health and substance use systems. After getting a picture of “where things are at” across the country, participants discussed facilitators and barriers to further progress, and shared their ideas and recommendations as to the system-level changes needed to move jurisdictions and Canada along the implementation and scale-up continuum.

Overall, seventeen (17) required elements for sustained advancement of TBI in Canada emerged, including:

1. broad awareness of TBI availability and potential;
2. clearly defined objectives and areas of focus;
3. co-design of the TBI strategy, implementation and monitoring process with people with lived experience;
4. political will, strong leadership, and well-placed champions and change agents at all levels of the system who collaborate to develop a national TBI strategy and portal/platform;
5. development of new long-term funding/commissioning models and reduction in funding of one-off, short-term pilot projects;
6. organization of the service delivery system using a stepped care model within each jurisdiction;
7. generation and use of data to drive decision-making;
8. increased tolerance for risk, experimentation and failure;
9. collaboration and values- and trust-based partnerships across levels of government, sectors and industries;
10. different innovation models to guide how research is conducted and knowledge is disseminated/transferred;
11. assurance of privacy and confidentiality;
12. policy alignment (e.g., legislation, regulation, licensing, policy);
13. increased use of implementation science;
14. strategies to bridge the digital divide, both generational and geographical;
15. investment in education, training and capacity-building for service providers and communities;
16. address healthcare and e-health governance; and,
17. workflow (re)alignment.

Participants also focused on what they felt was one of the greatest barriers to progress — a strong aversion to risk on the part of policy-makers and funders — suggesting five strategies to shift the risk paradigm in Canada:

• put people with lived experience front and centre of the entire process, engaging in true co-design and ensuring they speak directly with decision-makers, policy-makers and funders;
• reframe the risk by documenting and communicating the real cost of not changing and re-orienting the system from “ruling people out” to “ruling people in” through universal design;
• use contracting to better manage risk by placing risks with those best positioned to manage them;
• bring national organizations (e.g., MHCC, CCSA, Infoway, others) together with a mandate to scope out what it will take to implement and scale-up TBI in Canada; and,
• change how funding/commissioning is done by bringing federal, provincial and territorial governments together to align and change the funding model(s)/commissioning structure(s) used in this area.
• The meeting concluded with MHCC, CCSA and Infoway committing to use the content of the day’s discussion to inform their work going forward, as well as identifying areas for future collaboration, particularly in regard to their collective knowledge translation and exchange activities.