A network of community-based centres improves access to mental health services for young people in multiple provinces across Canada.
A remote coaching program, delivered through evening telephone sessions, guides parents on how to handle children’s behavioural problems and symptoms of attention-deficit hyperactivity disorder.
An ambitious multi-city study demonstrates the benefits of providing immediate housing to people with mental illness experiencing homelessness.
These are among the novel projects that Dr. David Goldbloom explores in his new book, We Can Do Better: Urgent Innovations to Improve Mental Health Access and Care.
His latest book comes out at an opportune time. The pandemic has created a sense of urgency and accelerated the public’s demand for innovations in health care, including mental health, says Goldbloom, a senior medical adviser at the Centre for Addiction and Mental Health in Toronto.
And as he explains to The Globe and Mail, many of them are right at our fingertips.
You mention Canada is a “land of pilot projects,” with no shortage of great ideas in mental health care. What prevents them from taking off?
One of the challenges is just the constitutional reality of Canada. We’re dealing with these 13 provincial and territorial jurisdictions, and everybody understandably wants to do it their own way.
I hope that some of the things that I talk about in the book provide examples of how we can overcome those jurisdictional boundaries. At the same time, it’s all too easy for people in Manitoba not to be aware of something good happening in Nova Scotia and vice versa.
You cited a national survey showing nearly half of Canadians in the first wave of the pandemic felt anxious. Other surveys have showed an increase in depressive symptoms. How much of this is an appropriate response to the pandemic?
My answer would be a lot of it. Part of the problem comes from the semantic confusion between feeling depressed or feeling anxious and having a depressive disorder or an anxiety disorder – because these are adaptive responses, sometimes, in an evolutionary sense to threat or challenge. So I think there’s a danger in overpathologizing the experience of anxiety and depression in the midst of a pandemic, both in terms of the extent to which it’s a normal response, but also the extent to which people are resilient and find their ways around it.
Once the acute crisis of the pandemic is over, what impact do you think we’ll see of COVID-19 on Canadians’ mental health?
In the same way that multiple surgeries have been delayed, in the same way we know that visits for cancer and heart disease are down despite the unlikelihood that rates of cancer and heart disease are down, we may feel the impact of these delays down the road for people who have been profoundly isolated by the pandemic – people with severe and persistent mental illness, who used to be engaged in various types of community activities, let alone community treatment.
You write about the explosion in mental health apps in recent years, such as one called Wysa. What role do you think apps can play in addressing the demand for mental health care in Canada?
It’s a role in evolution. Unlike traditional services, there’s no appointment required and it’s there in your pocket when you need it. The beauty is you can log on at any time. And some of these apps use cognitive behavioural therapy principles with artificial intelligence. I’ve taken them for test drives and found them to make a lot of sense.
Now, it is challenging scientifically to do rigorous evaluations of these in the way that we would for traditional interventions. There are concerns of overpromising benefits, around what happens to the data.
Wysa was developed as an app in India, out of recognition of the fact that 70 per cent of the population is rural, with virtually no access to mental health services. So this was addressing an inequity and it’s very commonly used now within the National Health Service in the U.K. as a way of providing some people with the help they need. Is it everything? Absolutely not. But it is definitely something.
You write about programs that rely on coaches and psychological well-being practitioners. What opportunities do you see for training non-clinicians to carry out mental health care?
This is, I think, a critical element in the success of some of these innovations. Historically, our response has been, we need more psychiatrists, we need more psychologists, we need more of the same. And I’m not convinced that is the solution here, given two factors. It takes a long time to train a psychologist or psychiatrist. And not every mental health problem requires that level of expertise. So when we think about a stepped care approach to treatment, it is about finding: What is the smallest intervention you can do that makes a meaningful and satisfying difference?
What principles or commonalities would you say tie all these innovations together?
Probably one of the principles was that I was aware of these innovations. This wasn’t intended to be an exhaustive, comprehensive list of all innovations. Really, what I hope people will take away from it is not simply a message about the details of this or that innovation, but also a sense of hope and progress.
This interview has been condensed and edited.
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