You don’t have to have a mental illness to know there’s a
mental health crisis in this country. According to the Centre for Addiction and Mental Health, the economic burden of mental illness in Canada is $51 billion per year. Opioid overdoses account for more deaths than car crashes. People with mental illnesses are more likely to die early versus their healthy counterparts. And more than 4,000 Canadians die by suicide every year — that’s 11 of us a day. The companies in this section are making a difference. They’re innovating and making access to mental health services a priority.
OPTT
Dr. Nazanin Alavi has been researching ways to deliver online psychotherapy to patients since 2007. The co-program medical director for mental health and addiction care at Kingston Health Sciences Centre and co-psychiatristin- chief of the department of psychiatry at Queen’s University, Alavi and her husband, Dr. Mohsen Omrani, a neuroscientist, immigrated to Canada from Iran and were inspired to help fellow immigrants get mental health supports in their own languages. For years, Alavi would see patients in her practice and supplement their care with detailed PDFs she’d email them filled with content she created based on cognitive behaviour therapy (CBT). “She would send them information with homework to complete, then they would send their work back,” says Omrani. “Then, in 2015, I was thinking about it and told her what she was doing was incredible, but email wasn’t the right platform anymore. It isn’t secure, sustainable or scalable. I suggested we take the content from her emails and make a platform to securely interact with patients. With my background in data science, combined with her clinical expertise, we set out to make the next generation of mental health products that are measurement-based, evidence- based and data-driven,” he says.
What they created is Online Psycho- Therapy Tool (OPTT), a business-tobusiness, software-as-a-service providerof digital care augmented by artificial intelligence. Based on two pillars — clinical expertise and analytical AI capabilities — OPTT is committed to providing predesigned CBT content (that has been through clinical trials and has been peer-reviewed) that physicians can assign to patients. The clinician receives the work the patient completes and can provide helpful feedback. The program covers a range of mental health diseases, from anxiety disorders to post-traumatic stress disorder, and the content comes from Alavi and her research team at Queen’s University — they conduct multiple clinical trials and validate new content. “Our aim is to assist the clinician and optimize the interaction between clinician and patient to deliver a higher quality of care and to ensure each patient receives the exact amount of care they need,” he says. With work being done by patients outside of appointment times, clinicians can handle more patients. What’s more, patients can be assessed and triaged quickly, and the technology OPTT uses can predict patient adherence to completing their online CBT course. “The psychiatry field is behind in innovation from the rest of medicine because of the absence of objective measurements, so we’re trying to provide these and give diagnostic categories, which can tell clinicians what module is best for a patient.”
There are a range of modules clinicians can choose for their patients, depending on their diagnoses. “We find the most relevant and best level of care for each patient based on their needs. We can evaluate their needs using the data.” Modules are 12 sessions; each session goes through one concept or behavioural technique. “The content takes about 30 to 40 minutes to get through. Information is provided in an interactive way that’s light on text. The program is done in an asynchronous format, so the patient does it whenever they like. Clinicians provide written feedback and send it back with the next session,” he says
What’s unique to OPTT is that their technology can predict patient adherence and compliance off the bat. “We can suggest the best level of care for the patient — we can see if online CBT alone is enough, or if they need more engagement from a healthcare provider such as weekly phone or video calls. At the end of the day, we’ve found that for 35 percent of patients, supervised online CBT is enough, 50 percent need more engagement and 15 percent need to see a psychiatrist immediately.”
With clients such as Telus Health already using OPTT and many awards (including one from the American Psychiatric Association) already under their belt, the couple are continuing to innovate. For example, they recently signed a partnership agreement with a company that looks at tone and pitch of voice to evaluate mental status. “In our next version, patients will only need to record their voice and won’t even need to type their story — clinicians will be able to listen.” At the end of the day, says Omrani, they’re aiming for higher user engagement. “There are a lot of self-guided solutions out there, but many have low adherence. Our patients complete an average of eight sessions out of 12 because of the involvement of the clinician. We’re hoping to make a difference for patients.”
NEUMA
If you’re interested in the mental health- treatment space, odds are you’ve heard about the wonders psychedelic drugs — psilocybin, ketamine, LSD and MDMA — can do when it comes to helping people who suffer from suicidal ideation, treatment-resistant depression, post-traumatic stress disorder and other severe diagnoses. Studies from researchers around the world are showing that in regulated doses, and along with psychotherapy, these drugs might just be the answer to giving those who suffer much needed and long-awaited relief.
For the founders of Neuma, Kingston, Ont.’s first legal psychedelic community health facility, it’s psychedelic cannabis that has tremendous potential in helping people living with difficult mental health illnesses. Their Cannabis- Assisted Psychedelic Program — combining intentionally using cannabis, practicing mindfulness, breathwork and music — is one of the the first of its kind in the province.
There’s a long, storied history behind Neuma and its four founders. “This has truly been a grassroots mission. Rich Tyo, our cofounder and clinical director, started an underground psychedelic society about 15 years ago in Kingston where people gathered to talk, share and explore using alternative drugs. He nurtured that community and today, these drugs are becoming more popular and getting the light and recognition they deserve,” says cofounder and community director Cory Firth, who was also the first executive director of the Psychedelic Association of Canada. “Cannabis can activate different parts of the brain and lead to insights, but we haven’t been educated to believe it’s possible to use it for mental health,” he explains. “The founders have come together, each with experience in psychedelics and knowledge of mental health in underserved populations, to create access to natural medicine and education. We want to bridge the gap between skill and support and teach skills not just from the therapeutic side, but from the traditional side. We don’t want to lose these medicines that have come from thousands of years of experimentation.”
The founders — Shari Hughson, Caitlyn Chisamore, Tyo and Firth — are planning to accomplish this lofty goal by showing they can make a difference in the mental wellbeing of participants using their innovative model. The program works like this: In each session, six to eight participants bring their own cannabis to the group. “Everyone brings a bit, and we mix it together so we’re all taking from the same blend. You’re putting your intentions and thoughts into it, so it’s a collective experience,” says Firth, adding the great thing about cannabis is that it is light, accessible and fast-acting. There’s mindfulness meditation and breathwork that’s conducted, too, for a well-rounded journey.
Not only is the group innovative in using cannabis as a psychedelic for this purpose, its structure and funding model is also unique. “We have various layers of funding and a scaled price option to make this program more accessible to people,” says Hughson, a registered nurse and entrepreneur who has experience using psychedelics with Indigenous communities. “There’s supported access, for those who have limited financial resources; there’s fair access, for those who can pay fair market value for what we’re offering; there’s rebalancing access, for those who have plenty of financial resources and can help others in the community; and there are free membership events and learning sessions for those who can’t pay anything.” The team can offer this pricing thanks to funds from Wayfound Mental Health Group (Hughson is the former CIO/COO) and an investment made by the City of Kingston, which was awarded a $10- million grant from the Federal Economic Not only is the group innovative in using cannabis as a psychedelic for this purpose, its structure and funding model is also unique. “We have various layers of funding and a scaled price option to make this program more accessible to people,” says Hughson, a registered nurse and entrepreneur who has experience using psychedelics with Indigenous communities. “There’s supported access, for those who have limited financial resources; there’s fair access, for those who can pay fair market value for what we’re offering; there’s rebalancing access, for those who have plenty of financial resources and can help others in the community; and there are free membership events and learning sessions for those who can’t pay anything.” The team can offer this pricing thanks to funds from Wayfound Mental Health Group (Hughson is the former CIO/COO) and an investment made by the City of Kingston, which was awarded a $10- million grant from the Federal Economic Development Agency for Southern Ontario called the Health Innovation Fund. Neuma was given a facility to use for two years rent-free to bring psychedelic healthcare to the city. “Not only do we have four folks spearheading this, and a 500-person, tight-knit psychedelic group of community members, but we also have the backing from the Kingston Economic Development Corporation and Queen’s University,” says Hughson.
The eventual goal is to start with psychedelic cannabis and expand to ketamine or psilocybin, depending on legalities. “Given our wisdom of different medications, we know we can have a significant impact on treatment-resistant depression and trauma,” she says. “This is a really unique story that we’re bootstrapping and we’re hoping to make a difference in people’s emotional wellbeing. It’s a project I want to see succeed. “
INWARD STRONG
Paul Radkowski is passionate about helping people with what he refers to as the “common colds” of mental health. A registered psychotherapist, Radkowski has worked as a clinician for decades. It was his time in the far north of Alberta and the Northwest Territories where he worked on the frontline with Indigenous populations and saw a lot of intergenerational trauma and its impacts. “There was a huge demand for services, and I got tired of seeing people bleed and die in the gap, waiting for help. So, a decade ago, I thought, let’s take what works in terms of frontline evidence-based tools and techniques and put it online so it’s available 24 hours a day, seven days a week. If you can’t bring the person to the resource, you bring the resource to the person,” he says.
As the clinical director and CEO of Inward Strong (formerly the Life Recovery Program), Radkowski has identified a way to address the “common colds” of mental health — anxiety and depression — as well as other issues such as addiction, stress and trauma by using a self-directed software-as-a-service, peer-reviewed platform that acts as a personal and portable wellness coach. “Many psychotherapists are not covered by the Ontario Health Insurance Plan and there’s a long wait to see clinicians. This alleviates that pressure when someone needs help,” he says. “The quality and complexity of mental health issues have gone up in the last few years. Half of us will have a mental health or addiction issue by the age of 44 — that was pre-COVID. Plus, clinicians are burning out at an alarming rate.”
Inward Strong is made to mimic a therapeutic relationship with a clinician. It’s a video-based, self-directed model in which the user watches hour-long video modules that are done in short, easily digestible two- to three-minute clips. “It’s like having a clinician in front of you giving you the information. This is vitally important when it comes to building a rapport and having a sense of relationship. The clinician in the self-guided videos can convey a sense of empathy and can change the user’s perspective and maybe even behaviour. Watching these videos feels like there’s someone right there with you.” The software uses standardized tools and questions to curate a personalized care pathway that’s based on the needs of the user — the program’s algorithm pulls curated content, therapies, tools and assessments that will best help the issue. “We put tools in their resilience toolbox, so we use CBT, mindfulness, acceptance commitment therapy and a number of other evidence-based modalities. This is what makes our program one of the most comprehensive out there,” Radkowski explains. The other thing that makes it unique is it’s data collection. “Our uptake is high because we’re not collecting personal data. It’s not just confidential, but you can also be anonymous and provide a pseudonym. You don’t have to walk through hoops before getting to therapeutic content.”
The company is undergoing an extensive relaunch and the program is being rolled out in a business-to-business setting. LifeLabs Medical Laboratory Services has signed on to use Inward Strong as a value add to their offerings, so if a patient gets medical testing, the use of Inward Strong is offered after. It’s also being used in academic settings — one university offered it to students and there was a 20 percent uptake of the facility within 24 hours of launching. Radkowski and his team are experimenting with price; the goal is to make it affordable and accessible. “We’re looking at a variety of collaborations right now and trying to get ourselves established as a less-is-more model. Our mission is to make mental health a right, not a privilege.”
ONTARIO SHORES CENTRE FOR MENTAL HEALTH SCIENCES
For more than a century, Ontario Shores Centre for Mental Health Sciences has been advancing care for patients suffering from mental health illnesses, and they’ve been doing it through the kind of technology and innovation that many don’t even realize exists in the province. Located in Whitby, the public hospital specializes in assessing and treating people in crisis and those who live with serious, complicated mental illnesses. With 354 inpatient beds and eight buildings across the property, it is one of the top hospitals in Canada when it comes to mental health innovation, and has a storied history steeped in research.
In the pages of our Spring 2020 issue, we reported on the incredible technology and innovation that’s been used to help its most vulnerable patients. We mentioned its use of electroshock therapy in the early 1940s, the introduction of life-changing antidepressants and antipsychotics in 1955 and skipped ahead to 2015, when Ontario Shores was the first hospital in the country and the first mental health hospital in the world to receive the HIMSS EMRAM Stage 7 award, given to healthcare organizations that have a fully paperless health information and electronic medical record system. We outlined its introduction of repetitive transcranial magnetic stimulation (or rTMS) to help those who suffer from treatment-resistant depression, and talked about its successful implementation of electronic- based cognitive behaviour therapy for patients and staff.
If there’s one thing that hasn’t changed since that issue was published and a worldwide pandemic ensued, it’s the hospital’s intention to continue bringing innovation to the forefront.
Last year, Ontario Shores announced its plan to create Canada’s (and possibly the world’s) first-ever mental health innovation incubator. Tim Pauley is the hospital’s director of research and academics, and he says this “living lab” would connect Ontario Shores’ clinical experts with privatesector entrepreneurs, giving them a place to develop and design new technologies in a clinical setting. “We haven’t been able to find any accelerators that are doing mental health innovation embedded in the inpatient setting, and that’s what makes us unique. Private-sector partners are not being brought into hospitals, but we have the space to do it, and it becomes a living lab concept where you bring in these partners and they work with our psychiatrists, nursing staff, scientists, research chairs, data and analytics folks and patients and their families,” he says. “Our partners would really benefit from understanding the environment and culture for which they’re developing their technology and solutions.” This initiative, which has been supported by all of Durham Region’s municipalities, has a plethora of incredible benefits, including improving and optimizing the accessibility and quality of patient care and outcomes. Pauley and his team are pursuing funding from partners and hope to receive funding from the Federal Economic Development Agency for Southern Ontario to get off the ground.
The incubator will attract companies that not only deal in mental health research specifically, but also those that have interesting technologies that could be applied to healthcare. “We’re trying to cultivate interest in the possibility of how their application or technology can work in our setting,” says Dawne Barbieri, vice-president of clinical services and research. For instance, she gives the example of the potential of using robot technology with dementia patients. “It might not be the first thing you think about when talking about robots, but there are possibilities there, like how they could help with companionship, conversation with patients, the ability to oversee and identify the risk of falls, etc. We want to think in ‘what ifs,’” she says. “Ontario Shores is nimble and forward-thinking, and we talk about why not as opposed to why should we. We’re not afraid of failure and we have a culture that supports the work we want to engage in. That’s really important for entrepreneurs.” What’s really impressive is the hospital’s own clinicians and experts will have a place to bring their ideas and research to onsite. “You can’t underscore the importance of the engagement of our clinicians,” says Pauley. “Dr. Amer Burhan is our physician- in-chief and he has a phenomenal mind when it comes to looking at how to leverage technology in clinical practices. He can help us understand where the opportunities are for integrating technology into clinical care delivery to improve quality of care and patient experience.” The patient also plays a key role — through our co-design approach they and their families could participate in something new that could help their outcomes.
If that project wasn’t a big enough endeavour, the hospital has other irons in the fire when it comes to innovation. Barbieri says they’ll soon be involved in a research study to determine the efficacy of ketamine for treatment-resistant depression and post-traumatic stress disorder and could develop a clinic onsite. They’re also investigating whether rTMS can be used for patients suffering from obsessive-compulsive disorder in their brain stimulation clinic. Ontario Shores is also the only hospital that was supported in a recent round of funding from the National Research Council’s Aging in Place Challenge program for their plan to offer skill training via virtual-reality simulation to unpaid caregivers of patients with dementia. “We’re really focused on leveraging technology into our research,” says Pauley. “We want to create that natural bridge into leveraging that technology to further innovation.”
