eMental Health: From Innovation to Implementation

When someone says they are stressed, or they are not feeling happy, then society tends to say, ‘Okay, go see a psychologist.’ However, not everyone needs to see a therapist all the time. The Stepped Care 2.0 model brings in many other ‘low intensity’ options for the client that are readily available in the community, but which we’re often not making use of.

— Dr Peter Cornish, Project Lead, Consulting Psychologist, Associate Professor, Memorial University, Canada.

Anil Thapliyal attended this e-mental Health match, held at St. John’s, Newfoundland and Labrador, in Canada in September 2019. It was hosted by Niki Legge, Director, Mental Health and Addictions, Department of Health and Community Services, Government of Newfoundland and Labrador and Nicholas Watters from the Mental Health Commission of Canada (MHCC).

Anil notes that the purpose of the match was to collectively explore the international developments in the adoption and implementation of eMental Health solutions across the IIMHL member countries. More specifically, the following items were explored during this match:

• successes and challenges from each jurisdiction/organization
• the co-production of e-Mental Health programs and services
• innovative partnerships to advance eMental Health
• blending existing technology with new innovations.

People who attended this match were from a wide range of disciplines, including Government officials, healthcare providers, clinicians, researchers, people with lived experience, peer support workers, practitioners and policy makers. Countries included were Canada, Ireland and Aotearoa/New Zealand and Government, NGO and university sectors were represented.

Interestingly, there was no agenda for the two-day match. Anil said that this worked really well as it enabled everyone participating to bring the real and pressing issues to the fore to set the agenda. Nicholas Watters (the chair) ensured that all relevant matters tabled by the participants were discussed thoroughly.  He also ensured that everyone had an active and respectful participation in a self-governing democratised manner. 

A background document to this match was Newfoundland and Labrador Stepped Care 2.0 e-mental health demonstration project, published in 2019 by the MHCC. Initially, NL’s Stepped Care 2.0 training sought to integrate recovery-oriented practices. More recently, it has become a more coherent and accessible system of care through the integration of eMental Health programs into each stage of care.

“These programs allow clients to access mental health care how, when, and where they prefer to receive it”. (p.3)

This document showed how if well managed and led, great mental health services can be provided for people who need them. An emotionally very moving and a real example was shared by Amber LeRoy, Peer Support Worker at CHANNAL. Amber shared her personal journey – “how eMental Health services enabled her journey to access mental health services in a non-stigmatised manner and how eMental Health was significantly instrumental in changing her life”. 

Anil stated that in his opinion there were three things that contributed to the success for the work done in eMental Health:

• First, strong involvement of people who use services in the design, development and implementation of eMental Health Services.
• Second, leadership at a national/state/provincial and local level by strong leaders of people who “get it”. Anil stated that in Canada those people were Louise Bradley from the MHCC, Dr John Haggie, Minister of Health and Niki Legge, Director Mental Health from the Government of Newfoundland and Labrador. In addition NL was forward thinking as it is the only province in Canada that has four Regional eMental Health Managers in place as a by-product of their Digital Mental Health and Addiction Strategy.  These eMental Health Managers ensure that progress was made through effective workforce development at all levels. 
• Third, the communication needs to be effective. eMental Health is “not just an app or a website”. An effective eMental Health system ensures digital dissemination of intervention across the following four categories ranging from 1) Information provision pertaining to promotion and prevention, 2) Service user engagement with services including PROM and PREM, 3) Treatment interventions across the stepped care continuum from mild, moderate to acute level of severity, and lastly 4) social support interventions post discharge from mental health care services.  Every person in the supply chain needs to understand the value of the service and everyone needs to see how it adds value for people who use services as a complimentary adjunct to traditional mental health treatment services.

The next step is embracing system level integration too. For example, a person might also get great support post-discharge from services in a system wide eMental Health service. It's also important to learn about different approaches and models. For example, the Recovery coaching, based on peer support, community-lead co-production from CAMH and Ontario Shores that is rolling out across the country.

Participants also discussed the challenges to supporting and enhancing such transformational change. Issues raised were:

• Territory and patch protection - People are not readily willing to collaborate, try different approaches to fully integrate.
• Strong leadership/master plan – We need strong and determined leadership to go forward and implement the master plan. In Canada, funding is provincial, and then stratified into smaller regions. In New Zealand for example, they are all united with a master plan for e-mental health services.
• There is very little standardization of the services provided – This varies from psychologist to psychologist, psychiatrist, etc. There needs to be clear expectations on services provided, and feedback on if those expectations were met. The education piece is so important for healthcare providers/physicians/primary care.