It has long been known that the mental health system has some catching up to do to meet the needs of those who use it. Now at high noon of COVID-19, we as a healthcare system are marveling at how in a few short weeks, we’ve managed to accomplish what we’ve been talking about for decades: At the Institute for Advancements in Mental Health (IAM) — a unique, community-based space designated for innovation in mental health, as well as a mental healthcare service provider — we did what so many other organizations have done: gone digital. This was a necessary step to ensure we were available to those in need, and for so many, this has made a profound difference. Digital and virtual care has improved access, reach and our ability to meet people where they are.  

We also went virtual to respond to a population-wide surge in need for mental healthcare services. Prescribed isolation, disrupted routines and reduced social interactions, while necessary, have become points of exacerbation for our clients. Many are precariously housed and underemployed, and many may be impacted by increased stressors if their employment and housing are interrupted as a result of the economic response to the pandemic. Each of these factors contributes to poor mental health, and combined they are moving us toward a mental health crisis in Canada. 

To respond, from March to April, we quickly moved all of our on-site, in-person and telephone supports onto digital platforms — an agility that has allowed us to respond to a 353 percent increase in patient engagement and call volume and an unprecedented demand, a 78 percent increase, in our educational offerings. These include counselling, group education and supports, and mental health services and systems navigation. We’ve also expanded into evening hours, and triage and navigational support for other social issues, such as domestic violence and child welfare. 

We quickly moved all of our on-site, in-person and telephone supports onto digital platforms — an agility that has allowed us to respond to a 353 percent increase in patient engagement and call volume and an unprecedented demand, a 78 percent increase, in our educational offerings.

While we’ve settled into this gear for now, we are simultaneously taking stock of just how significant this transformation has been and where we are going, not just for us but for mental healthcare overall. 

Our country’s entire mental health system is overburdened, especially in the wake of this pandemic. There’s  been increased wait-times and difficulty accessing appropriate and culturally-relevant mental health support, and these barriers are likely to persist post-pandemic as the mental health effects continue to reverberate. What can we do at the societal level to respond to this upswing in mental health challenges and avoid a second crisis — one rooted in mental illness?

For IAM, this has meant an innovation of our own services and frontline response. This has meant virtualizing our programming so that first, we can continue to provide seamless support  to people with complex mental health needs; second, we can expand our reach in communities that are underserved, under resourced and fill a gap in care. This has also meant that while we are rapidly responding to this pandemic along with so many other community-based organizations, we are also being critical in our thinking, using human-centred and service design methodologies to find the inefficiencies and opportunities in how we work, and course-correcting quickly. We are relying on data collection and analysis to give us these insights and to help us understand how this pandemic is shaping the wellness of our most vulnerable. As we experience all of this change, there are countless lessons we are learning, and a few of these will be permanent fixtures in the way IAM operates moving into a post-COVID-19 climate. 

Be respectful in this digital transition 

For our clients with lived experience with mental illness, the onset of COVID-19 has impacted not only daily living, but the ways in which they can access support and care. For IAM to rapidly move from face-to-face services to a digital format required careful engagement and strategic implementation. Among our clients, for example, we are seeing a growing discomfort with the use of cameras, screens, and the general security and confidentiality of being online. The question then is, in a state of urgency, how do we still take the time to be respectful and thoughtful, consulting with clients about their comfort with our transition to digital and getting people the services they need? We needed to understand their readiness for change, their concerns about privacy, and their questions about whether their quality of care would go down. 

So we asked. We relied on years of trusted relationships with clients who feel confidence in our therapists and comfortable in our spaces. We did the detailed work of checking in with them proactively and walking them through this period of change. For instance, we were surprised to find that many of our clients preferred phone or text to video services, in order to maintain privacy from those they lived with , so we adapted. We understood the growing challenges of privacy and personal space during this climate of being at home with others, and for those who were ok with digital, we needed to facilitate this transition, so we developed a toolkit. What we realized in the end that we need to be agile, open and creative with our limited resources — we need human touchpoints, a mixed-method approach, and to focus on person-centric care. 

Client-user feedback must constantly shape the roadmap to virtual care 

As part of our response process, the feedback of people with lived experience has been taken in on a continuum, while we rapidly test our assumptions by including clients in our design process. We recognize this change is being supported by decades of trust with clients; our services are entrenched in the community and offer an ‘alternative’ for those in need of complex recovery supports. By leaning on these relationships, and through newly developed ones, we have been able to gain ongoing feedback that has helped us build the tools and strategies for virtual care. In the early days of COVID-19, our innovation team moved quickly to build a map of the digital user experience and identify opportunities where we could remove friction in the user experience. We streamlined our intake and paperwork, and created an onboarding toolkit for clients to prepare them for the shift to virtual care and for individual appointments. We continue to listen and respond to our clients as we chart our way forward onto new platforms, creating the tools we need along the way.   

Our service providers and frontline counsellors have invaluable insights

In the wake of the pandemic, IAM assembled a COVID-19 response team of design innovators, service designers, counsellors and programmers. We needed to understand what our teams were seeing as first responders to this crisis and as keepers of data and information; the interdisciplinary effort allowed us to contextualize these frontline experiences within service design and innovation, and get us from onsite to online care. We recognize that change is hard, particularly in such uncharted territory as COVID-19, so we leaned on a strategy that involved daily check-ins with staff and problem-solving together. We also mapped out what our teams needed to navigate unique complex cases, the blindspots of digital counselling (for example, our assumption that clients would prefer video sessions when many actually preferred phone or text), privacy and confidential spaces, and understanding the verbal and non-verbal cues of clients through new platforms. Most of all, we listened and integrated team observations into the engineering of this virtual suite of supports, giving us the assurance that our final design reflected what they and their clients want and need.

If we can design for those with the greatest need, we ultimately design for everyone. 

The most critical lesson we’ve learned during this highly transformative and unpredictable time has been that innovation can only happen when varying perspectives come together to move in one common direction. We rely heavily on the experiences of those who are working with us but we require their investment in what we are trying to achieve. Virtual care in mental health can be challenging for our clients and for front-line workers; virtual care with mental illness is uniquely complex. At IAM we have created impact in this space of digital health by introducing mental healthcare services to our clients — and their caregivers and families — and will continue to shape and lead in this space into the future. In doing this work we are guided by one main belief: if we can design for those with the greatest need, we ultimately design for everyone. 

This is the premise upon which we are building our response to this pandemic, not in a state of urgency but in thoughtful, scenario-based processing and planning for the future.

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