By Greg Basky for SHRF
After her daughter was born 17 years ago, Elita Paterson began experiencing crushing bouts of anxiety and rage. She remembers going to see her family doctor when Ella was eight months old, telling her that she was feeling “all sorts of powerful emotions except suicidal…and I don’t want to get there.’ The anger I experienced was profound and it was scary.” The physician ran some blood work…and dismissed her concerns. “She said, ‘Your hormones are normal. You’re fine.’
While the intense postpartum emotions some new parents experience – both mothers and fathers – lead them to suicide, Paterson made it through and committed to taking action so that other new parents would not have to suffer. She co-wrote a book, “The Smiling Mask: Truths about Postpartum Depression and Parenthood.” She co-chairs the Saskatchewan Maternal Mental Health Advisory Group. And in 2014, she began bringing her voice to an advisory committee for the Online Therapy Unit (OTU), a service based at the University of Regina that began delivering internet-delivered cognitive behavioural therapy (ICBT) 10 years ago. “I just wish it had been around when I was suffering,” says Paterson. “A lot of the feelings (associated with PMAD) are very similar (to anxiety and depression). We all have a different story, but the feelings are the same.”
Depression and anxiety were the first mental health concerns that the OTU – the brainchild of University of Regina researcher Dr. Heather Hadjistavropoulos – was established to address. ICBT equips clients with tools to change their thinking and behaviour, through a combination of lessons and activities and weekly check-ins with a therapist via secure online messaging and phone calls. The model works for so many people because there’s no need to make and travel to an appointment; participants get the help they need whenever and from wherever they choose, and work at a pace that suits them.
Heather Hadjistavropoulos [University of Regina]
Image: Debra Marshall
Over the past 14 years, SHRF has been a major supporter of Hadjistavropoulos’s work to improve access to mental health services through ICBT, first with seed money to set up the Unit and then funding necessary to finetune its delivery model and support expansion of its offerings. The Canadian Institutes of Health Research (CIHR) and the Saskatchewan Centre for Patient-Oriented Research (SCPOR) have also invested in Heather’s efforts to better meet the needs of patients in this province and abroad.
Career focused on improving patients’ access to support
Hadjistavropoulos devoted the early part of her research career to finding better ways to help people struggling with both mental and physical health problems using face-to-face assessment and therapy. She adjusted her career focus when she realized that, for a host of reasons, many people didn’t have access to good quality care. Hadjistavropoulos recognized – nearly a decade before the COVID-19 pandemic pushed us all online – the potential the internet held for meeting people’s needs in a different way. She wasn’t interested in replicating what was already available in the system. She was interested in better supporting people who had trouble accessing face-to-face care because they live in a rural or remote location, have time constraints, or can’t afford to pay for therapy.
Since 2009, she’s honed in on moving online what’s normally shared in face-to-face treatment and teaching therapists how to deliver care in this new way. She’s also been advocating for this new tool to become part of the standard menu of options our health system offers to clients. “We’re trying to create this new doorway to care, recognizing that the other doorways are effective, but they don’t necessarily meet the needs of all clients,” says Hadjistavropoulos. “We know that there’s a lot of benefit to working on therapeutic materials independently, with a small amount of therapist support offered when help is needed.”
Kelsy Dabek, Aaron Philipp-Muller, Andrew Wilhelms, Heather Hadjistavropoulos, Ram Sapkota, Giuliano La Posta, Vibya Natana [University of Regina]
Image: Debra Marshall
The work is only possible, says Hadjistavropoulos, thanks to the leadership and management provided by the OTU’s operations director, Marcie Nugent, the hard work of a team of clinicians, research assistants and associates, trainees, information technology developers, and research collaborators from here in province and abroad, and partnership with the Saskatchewan Health Authority and the provincial Ministry of Health.
The art of the possible
Kathy Willerth can remember when Hadjistavropoulos first made her persuasive pitch for bringing online therapy to this province. Willerth was among the leaders and policymakers who sat across from Heather as she shared the results of promising sounding research and wondered aloud about the possibility of partnering with the health system to try something similar here. “We were quite intrigued, from a policy perspective, what the art of the possible could be in Saskatchewan,” says Willerth, who was at the time Director of Mental Health and Addictions with the Ministry of Health.
“Our population lives in a large number of places,” says Willerth. “I always come back to the statistic that we have one third of the population of Alberta, but three times as many highways. That’s a real indicator of our populations being spread so differently. Plus we have harsh weather and long winters. Those things alone made it seem like it might be a viable option.”
Ten years ago, in pre-COVID times, the notion of delivering mental health support online felt cutting edge, recalls Willerth. Back then, there was a long-held belief in health care that you had to sit in a room with someone as part of a helping profession. “You know, the idea that you need to see the whites of their (clients’) eyes,” says Willerth, now Director of Mental Health and Addictions with the Saskatchewan Health Authority, on the operations side of health care.
Numbers bear out the belief Hadjistavropoulos first felt a decade ago that online therapy could fill a major gap in the existing system. Since November 2013, the Online Therapy Unit has enrolled 11,600 clients ranging in age from 18 to 81. The majority of participants have reported very large reductions in symptoms; more than 90% say they have increased confidence in managing their symptoms, and 95% report that participating in the course was worth their time. The range of supports has grown from that initial wellbeing course for mental health to include courses for chronic medical conditions, and one targeted at post-secondary students. Hadjistavropoulos has gone on to establish PSPNET (www.pspnet.ca) which provides ICBT to public safety personnel from across Canada through the Canadian Institute for Public Safety Research and Treatment.
Hadjistavropoulos says that in some cases, online therapy clients have tried face-to-face care but it didn’t click for them because they felt an over-reliance on the therapist. Some people are after more in-depth learning and want to understand the skills they’re developing. “They like to approach this almost like a course you would take to become a better writer or photographer, or to play guitar, or do yoga,” she says.
Alcohol course equipping people to moderate consumption
At the encouragement of Willerth, Hadjistavropoulos and colleagues developed a course to help people better control their relationship with alcohol. Drinking is like mental health in that there’s still stigma attached to seeking help. People don’t necessarily want to attend AA meetings or go into a treatment program, but they would like to change their relationship with drinking and they need some support to do that, says Hadjistavropoulos. In some cases, individuals in AA or who have taken another treatment program will enroll in the OTU’s Alcohol Change Course for additional support.
The latest consumption guidelines have heightened people’s awareness that beyond the risk of addiction, alcohol increases their odds of developing several types of cancer and other health problems. Hadjistavropoulos and her team recently adapted their already-proven model to support clients with varying degrees of alcohol problems, including those at an early, still -preventive stage – people who don’t yet meet the clinical definition of alcohol use disorder. “It’s providing them with professional help in being able to moderate their behaviour long before they’re addicted and need to come to the building that I’m working in right now, which is a 49-bed detox facility,” says Willerth.
Willerth describes the opportunity she’s had to work with Hadjistavropoulos as “one of the gems” of her career. “To think that it (Online Therapy Unit) has made such a significant difference, that they’ve been able to reach more people, in more locations, at different times of the day, with results as good or better than what we expect from face-to-face (therapy).”
Research shouldn't be one and done
Heather Hadjistavropoulos, Alayna Gretton, Aaron Philipp-Muller, Kelsy Dabek [University of Regina]
Image: Debra Marshall
Hadjistavropoulos has never seen the point in doing one-off studies in a lab: “You do the study, then it’s over, and often whatever you were testing is no longer available.” The Online Therapy Unit is an ever changing experiment. She and her team are constantly delivering care, but at the same time they’re doing research on that care delivery. “We just keep doing these learning cycles over and over and over again, so we’re constantly learning how to improve our services.”
For Hadjistavropoulos, the most rewarding part of her research is knowing that it’s making a difference in people’s lives. “I love that I’m doing research on something that’s helping people while we’re doing the research,” she says. “Before, when I was doing research, I would find out things that were helpful or interesting to me…but were they immediately beneficial to lots of clients? No. This is so much more gratifying.”