Progress in e-mental health will require clinician training

A national survey has found that Canadians dealing with mental health issues routinely use digital mental health supports – like apps and online programs – but only 29 percent are satisfied with them.

The survey, called Canadian Perspectives of Digital Mental Health Supports: Findings from a National Survey Conducted During the COVID-19 Pandemic, was carried out in 2021, with 1,003 participants across Canada. It was led by researchers at the Centre for Addictions and Mental Health (CAMH) in Toronto.

Dr. Nelson Shen, one of the researchers, moderated a discussion of the findings at the online e-Health 2022 conference in May.

The major concerns of patients and caregivers, noted Dr. Shen, were trust in the privacy and security of the applications (cited by 33 percent of the participants) and uncertainty about which digital tool to use (cited by another 33 percent.)

These factors are considered barriers to the further implementation of digital solutions in mental healthcare.

“There’s a lack of public awareness of the tools that are available,” said Dr. Shen, “and misconceptions about [the security] of mental health tools.”

Among those who didn’t use mental health tools, and completed the survey, the main reason for avoiding digital applications was the perceived lack of a human element. People naturally want a human connection when they’re discussing their issues; however, experience has shown that when patients actually use solutions such as videoconferencing or texts, they find the human dimension is present.

Others who avoid digital solutions cited concerns about trust, with fears about hackers. They also had a low perception of the usefulness of apps or didn’t know which ones to use.

Dr. Damian Jankowicz, vice president of information management and CIO at CAMH, was also a researcher involved in the study. He, too, was on the e-Health session to discuss the findings of the report.

“People are very interested in mental health tools, but they often don’t know what to use,” he said. At the same time, they have a lot of trust in mental health professionals.

For this reason, said Dr. Jankowicz, “it’s the healthcare professionals who must convince people to use the tools.”

To facilitate this, he added, “Our clinicians need to be trained in how to use and embed these digital tools … so that patients can use the tools in this brave new world.”

Dr. Shen agreed, saying that digital options should be integrated in care pathways for patients.

Dr. Jankowicz noted that CAMH in Toronto and the Royal, in Ottawa, have begun to do this. “So, you can use these tools even before you see us. It’s especially useful for low-intensity cases, and for recovery.”

He asserted that digital tools will be key to helping overcome the iniquities in the healthcare system – such as access to healthcare professionals for patients in remote locations. By using digital solutions, patients have access to clinicians, wherever they may be, day or night.

Maureen Abbott, a manager with the Mental Health Commission of Canada, observed during the e-Health 2022 session that her organization has released several reports and studies recently that are focused on digital tools for mental healthcare.

It has also created modules for healthcare professionals and administrators, showing them how to integrate mental health tools into their services.

According to the MHCC’s website, the modules enable mental health professionals to acquire the skills needed to integrate digital tools into their services. The modules include:

• Module 1: Exploring the world of e-mental health
• Module 2: Roadmap for launching e-mental health
• Module 3: Building your digital skill set
• Module 4: Engaging clients in e-mental health

She said that 650 healthcare professionals have already worked in one or more of the available modules. Access to the modules is available at: mentalhealthcommission.ca/e-mental-health-implementation-e-modules/

Mental health tools are becoming increasingly important, she said, as they provide access to care for people who might otherwise not receive it. “We’re hearing that e-mental health services literally saved their lives, through 24/7 access. We’re hearing that people like these services because they feel more anonymous, with no judgement.” She said these services have been especially effective for patients with suicidal ideation.

As Dr. Jankowicz observed: “Our patients really want digital mental health tools. They’re telling us every day and they’re asking us to prescribe something for them. Clinicians want it too. It’s just a matter of moving it forward.