Roundtable: Advancing Best Practices in e-Mental Health in Canada

Purpose

E-health technologies have the potential to reach more people with high-quality care and improve outcomes. Yet they are not as widespread as they might be, especially in mental health care. To explore the reasons why and identify ways to advance e-Mental health, the Mental Health Commission of Canada (MHCC) hosted a roundtable meeting in Ottawa on December 1, 2016. Seeing e-Mental health as a catalyst for positive system change, the MHCC included it in two strategic directions of the Mental Health Strategy for Canada aimed at improving access to services and quality of care.

Methodology

At the roundtable, health care leaders and frontline mental health practitioners from hospitals, community settings, regional health authorities and national associations across the country came together to discuss e-Mental health, with the goals of:

• Increasing awareness of the latest evidence that exists on the effectiveness/efficacy of e-health solutions in improving access to mental health care.
• Identifying and examining existing models of e-Mental health that have been implemented in health systems.
• Exploring recommendations to support the development, implementation and evaluation of current and/or future opportunities in e-Mental health.

The morning session began with a keynote address by Dr. Ed Brown, CEO of the Ontario Telemedicine Network. He shared thoughts on the challenge of scaling up effective e-health solutions from projects to the population level, and pointed to models for spreading technology throughout the health care system. The question of scalability was one of several tackled by the morning panel of presenters.
Fraser Ratchford of Canada Health Infoway shared insights into what Canadians want of ehealth services; John Dick described the experience of Ontario Shores Centre for Mental Health Sciences in rolling out e-Mental health solutions; and Dr. Patricia Lingley-Pottie explained how the Strongest Families Institute has developed and scaled up both its distance care services andthe information systems that support them.
Following a lunch and networking break, MHCC President and CEO Louise Bradley spoke about the importance of investing in e-Mental health to solve Canada’s access-to-care challenges. While there is still a lot to learn about e-Mental health, the concept has strong potential that deserves exploration.

The second panel of the day described some of those explorations first-hand. Dr. Simon Hatcher of The Royal Ottawa Mental Health Centre spoke about his experience with e-Mental health solutions and the importance of sustainable implementation plans. Dr. David Gratzer and Faiza Khalid-Khan talked about the Scarborough Hospital’s Internet-Assisted Cognitive Behavioural Therapy (iCBT) solution—what it does, and lessons learned from implementation.

Dr. Shalini Lal described the recently launched PRISM project, how it will give youth more direct pathways to care, and why post-project sustainability is the biggest challenge to be solved. The last session of the day was a facilitated dialogue. Participants formed groups to discuss three related questions about barriers to—and facilitators of—e-Mental health, key priorities and who needs to be involved in implementation. Barriers ranged from privacy to funding to clinician buy-in, while the recovery model, individualized treatment and co-design with patients and communities were identified as facilitators. Virtually every conceivable stakeholder was found to have some role in the implementation of e-Mental health, suggesting it is truly a collective effort.

After the dialogue, participants had time to record what they felt were outstanding, unanswered questions about moving e-Mental health forward that might inform upcoming roundtables. Responses included how to determine which solutions work, devising a new funding model, increasing government and clinician buy-in, and reaching people with low socioeconomic status and other at-risk populations. The meeting concluded with the MHCC reiterating that this was the first in a series of three eMental health roundtables to inform the organization’s advancement of e-Mental health in Canada.

Key Findings

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

• Investing in e-Mental health is essential as it represents a way of addressing some of the Canadian health care system’s biggest issues, including long waits to see mental health practitioners.
• Clinicians must be onboard as designers, champions and users of e-Mental health solutions.
• A new funding model is needed to support e-Mental health. Current models are not set up to pay clinicians to offer remote treatment for patients at home and postdischarge support.
• The technology is out there. The challenge is determining which solutions work and then scaling them across the health care system.
• Scalability is key. Planning must include a roadmap for taking a project from the pilot stage to full-blown implementation.
• Sustainability is hard, but essential. Getting started with e-Mental health innovations is often easier than sustaining them over the long term, yet that sustainability is vital to their success.
• Privacy and security concerns must be addressed for system-wide e-Mental health to be viable.
• Standards and best practices must be developed so solutions can be assessed, practices chosen and outcomes measured.
• We need to think about vulnerable populations. People living in poverty, for instance, may not be reachable by e-Mental health.
• Everyone needs to be involved to resolve barriers to e-Mental health — clinicians, not-for-profit organizations, medical schools, regulatory bodies, and federal and provincial/territorial governments all need to be engaged to push forward e-Mental health strategies.