This theme addresses research needed to better integrate mental health care ... o Apply jointly for funding with Island Health providing in-kind contributions.
28 October 2013 | Vancouver Island
Mental Health & Substance Use Research Planning Meeting
SUMMARY REPORT March 2014
Table of Contents SUMMARY REPORT Purpose ........................................................................................................................................ 1 Research Interests ........................................................................................................................ 1 Research Challenges ..................................................................................................................... 2 Recommended Solutions ............................................................................................................... 2 Next Steps ..................................................................................................................................... 4 APPENDIX 1: Comment Assignment to Themes .............................................................................. 5
Compiled by Wendy Young, Research Facilitator, Research and Capacity Building, Island Health Lynn Cummings, Research Facilitator, Research and Capacity Building, Island Health Dr. Abraham Rudnick, Medical Director, Mental Health and Substance Use Services, and Head, Department of Psychiatry, Island Health Cindy Trytten, Director, Research and Capacity Building, Island Health
ISBN: 978-0-9739243-5-0
SUMMARY REPORT on MENTAL HEALTH & SUBSTANCE USE RESEARCH PLANNING DAY This report summarizes the collated results of the health research-planning event of October 28, 2013 and provides a roadmap for next steps in developing a research agenda for Mental Health and Substance Use (MHSU) on Vancouver Island. Data from the group discussions were coded for high level themes. The assignment of comments to themes is included in Appendix 1.
Purpose Forty members of the regional research and care provision community came together with patient partners and advocacy groups to discuss: 1. Research interests related to accessibility/delivery of care, and prevention and health maintenance strategies; 2. Significant challenges related to conducting research and knowledge translation; and 3. Potential solutions to the challenges identified.
Research Interests Participants identified three research interests related to mental health and substance use on Vancouver Island: 1) Integration and Care Continuum 2) Best practices and 3) Research taking into account the perspective of Persons with Lived Experience (PWLE). 1. INTEGRATION & CARE CONTINUUM This theme addresses research needed to better integrate mental health care services into primary health care and across the continuum of care through improved information sharing systems. 2. BEST PRACTICES This theme addresses the research needed to identify and implement best practices in both therapeutic interventions and service deliveries, e.g. improve access to psychosocial interventions (e.g. cognitive behavioral therapy). 3. PERSPECTIVE OF PERSONS WITH LIVED EXPERIENCE (PWLE) This theme addresses research needed to better understand and engage persons with lived experience. Participants suggested that PWLE be involved in setting
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research priorities. In addition, participants suggested that PWLE be involved in research on the provision of culturally sensitive and stigma-reducing care.
Research Challenges The following two themes emerged from the discussion session: (1) Logistical Challenges [Bricks & Mortar]; and (2) Culture and Collaboration [Attitudes]. 1. LOGISTICAL CHALLENGES Resources (human and fiscal), time, compensation, data availability, and privacy. 2. CULTURE AND COLLABORATION Perceived undervalue of research within Island Health and lack of more robust collaborative university-community research efforts.
Recommended Solutions The following two solutions emerged from the discussion sessions: (1) Establish a Research Institute; (2) Build capacity within Island Health. The solutions are not mutually exclusive. 1. ESTABLISH A RESEARCH INSTITUTE To address the logistical challenges participants recommended the establishment of a joint venture Research Institute involving Island Health, academic and community partners. Ideas o Fund salaried researchers; o Prepare meaningful Memos of Understanding to address data sharing, privacy issues, joint appointments; o Leverage Canada Research Chair and apply for programmatic funding (up to 7 years of program research); o Apply jointly for funding with Island Health providing in-kind contributions such as access to iHealth data; o Develop a mechanism to connect students with healthcare providers 2. BUILD CAPACITY Capacity building (infrastructure, skills, education and services) was identified as a way to address the challenges related to integrating research and care and fostering improved collaboration.
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Ideas o "Work on culture shift." o Identify key leads or point person to be a link and report back to the centralized body/portfolio; o Connect different programs within Island Health and address participatory action research, health services, clinical research and population health research. o Get away from the heavy medicine focus; o Provide education on how to conduct research and on what support is available – break research into steps and encourage “small research”; o Encourage staff to get involved with granted research teams; o Develop job descriptions that include research – build in compensation and incentives and back fill through an internal granting program; o Provide dedicated knowledge synthesis and exchange events and coordination for front-line practitioners; o Increase capacity to pose meaningful research questions; o Develop community partnerships including schools, mental health commission, public health, primary care; o Bring the partners together around high impact issues; o Seek out a scholar-in-residence from UVic or elsewhere and link them with Island Health staff; o Create a Person With Lived Experience (PWLE) caucus; o Further support permission to contact to continue to streamline recruitment in research; o Develop a mechanism for researchers to efficiently access Island Health data
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Next Steps Key to the success of the meeting will be to follow up on resulting opportunities and to maintain the momentum established. This will be accomplished by: o Dr. Martin Wale (Deputy Chief Medical Officer and Executive Medical Director, Research) and Dr. Michael Hayes (Director, Health Research and Education, University of Victoria) will continue discussions about the Research Institute and the Canada Research Chair. o Dr. Rami Rudnick, Dr. Ken Moselle, Dr. Tim Stockwell and a member of the Research and Capacity Building Department met in December to begin to address Island Health data. o Wendy Mishkin and Hazel Meredith (BC Schizophrenia Society) met with the Research and Capacity Building Department in December to address the suggestion to form a PWLE caucus. o Dr. Rami Rudnick and the Research and Capacity Building Department developed and will distribute a survey to identify the highest priorities for building capacity over the next fiscal year (2014/2015). Survey results will be compiled, and a committee will meet in spring to identify how those priorities will be implemented within the next fiscal year.
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APPENDIX 1: Comment Assignment to Themes
⇒ Research Interests (Q1 & 2) 1. Identify three research themes that would best address the challenges facing the accessibility and delivery of care in mental health and substance use services on Vancouver Island. 2. Identify up to three key areas of research that would benefit prevention and health maintenance related to mental health and substance use on Vancouver Island. The following three themes emerged from the discussions related to the above 2 questions: (1) Integration & Care Continuum [The What]; (2) Best Practices [The How]; (3) Persons with Lived Experience Perspective [The Who]. 1. INTEGRATION & CARE CONTINUUM: This theme addresses the research needed to embed mental health care services into services such as primary health care and across the continuum of care. It includes research related to: Advocating for greater collaboration across the continuum of care Finding ways to integrate MH into primary care with a focus on wellness Integrating skill levels and skill sets Navigation for providers and seekers Impediments to transferring patients from high level care (e.g. hospital) to lower level care (e.g. supportive housing), Enhanced information flow (centralized referral system; tracking system to prevent referrals that get lost/dropped; integrated electronic health record) Facilitation to find information (what information is needed for patient with lived experience and health providers to navigate the full spectrum; can a one-stop-shop for information be established for mental health services) Primary and secondary prevention of MH issues Research to engage people in healthy lifestyle activities (nutrition, exercise) Target teachers, families, GPS Shift to self-care and health literacy Community involvement Move patients out of supportive housing when time comes, moving new rehab patients in.
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Identifying cases: e.g. where to identify patients: educational setting, crisis lines, remote parts are an issue, people with cognitive problems from seniors’ communities Transitions of care across life span Resilience across age groups
2. BEST PRACTICES: This theme addresses the research needed to identify and implement best practices in both therapeutic interventions and service deliveries i.e. improve access to psychosocial interventions (e.g. cognitive behavioural therapy). What can be done to improve access to psychosocial interventions, e.g. cognitive behavioural therapy (CBT) for mental health problems, in particular, for populations most in need of non-pharmacological approaches to care (e.g. pregnant women)? What works around the world, what hasn’t worked, and what is promising for Island Health Cost effectiveness of complementary therapy compared to conventional pharmaceutical treatment Borrow best practices from other care systems such as cancer care navigation Do we know the evidence regarding best practices? The effective use (KT) of existing research – process to keep abreast of research findings UVic health services, a mental health strategy for campuses Putting the right care in place according to level of distress, illness 3. PERSON WITH LIVED EXPERIENCE (PWLE) PERSPECTIVE: This theme addresses the research needed to better understand the perspective of persons with lived experience and provide appropriate culturally sensitive and stigma reducing care. How successful are we currently at providing culturally sensitive services in the face of diversity (e.g. aboriginal, visible minorities, LGBTQ, sex workers)? Less aggressive, less stigmatizing care for patients presenting under police escort What are determinants of why people need to access MH services? Understanding the barriers that prevent people from access e.g. stigma. Asking people what would make it easier for them What is the context of why individuals are arriving at the ED in the first place?
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Lack of advocacy to support people in accessing services when vulnerable Lived experience in children and youth
⇒ Research Challenges (Q3) 3. What are the three most significant challenges related to conducting research in mental health and/or substance use on Vancouver Island? The following three themes emerged from the discussion session: (1) Logistical Challenges [Bricks & Mortar]; (2) Culture and Collaboration [Attitudes]; (3) Conceptual Challenges [Theoretical]. 1. LOGISTICAL CHALLENGES: This theme includes issues regarding resources (human and fiscal), time, compensation, data availability, and privacy. Infrastructure to support the process Protected time for clinicians Time and compensation for physicians Non-physicians: getting research into job descriptions Working off side-of desk Difficulty getting the information we need Data are distributed across multiple government agencies Privacy issues Not having dedicated researchers Lack of psychiatrists in remote areas 2. CULTURE AND COLLABORATION: This theme describes challenges related to the perceived value of research in the organization and lack of collaborative research efforts. Collaboration and recognition among different areas Danger of isolation within and between VIHA units and areas; lack of communication; focus on urban/south island, invisibility of rural/remote areas, which are by necessity more resourceful and more efficient, so their isolation isn’t all bad Mobilization of other sectors of support (collaborative grants to help integrate/involve these groups) The need for a cultural shift to buy respect Limited/limiting research questions on narrower evidence-based topics i.e. medication
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Danger of VIHA research being medically driven/dominated to the exclusion of community Invisibility/disorganization of certain causes/areas Getting objective evidence-based feedback on what works and on what doesn’t, rather than calling it a success Harder to get qualitative research recognized or valued as evidence Client/patient self-report one of the proven best methods, but isn’t valued as highly
⇒ Recommended Solutions (Q4) 4. What are three potential solutions to the challenges listed in response to the challenges related to conducting research (for example, resources, funding, collaboration, etc)? The following three solutions emerged from the discussion sessions: (1) Establish a Research Institute; (2) Build capacity within Island Health; (3) Develop a conceptual framework in partnership. The solutions are not mutually exclusive. 1. ESTABLISH A RESEARCH INSTITUTE: To address the logistical challenges participants recommended the establishment of a broad [not just MHSU] Research Institute involving Island Health and partners. Research infrastructure is key Funding for main salaries is required Meaningful Memos of Understanding should be prepared to address data sharing, privacy issues, joint appointments Leverage CRC and apply for programmatic funding (up to 7 years of program research) Address the sustainability of initiatives in the long term Apply jointly for funding with Island Health providing in-kind contributions such as access to iHealth data Think through what would be the best kind of entity for students 2. BUILD CAPACITY: Capacity building was identified as a way to address the challenges related to culture and collaboration. Working on culture shift Identify key lead or point-person to be a link and report back to the centralized body/portfolio Connect different programs with Island Health and get away from the heavy medicine focus Provide education on how to conduct research and on what support is available; break research into steps and encouraging/coaching to encourage “small research” 8 of 9
Encourage staff to get involved with granted research teams Develop job descriptions that include research; build in compensation and incentives and back fill through an internal granting program Provide dedicated knowledge synthesis and exchange events and coordination for front-line practitioners Increase capacity to pose meaningful research questions Develop community partnerships including schools, mental health commission, public health, primary care Bring the partners together around high impact issues Seek out a scholar at UVic or elsewhere and link them with Island Health staff Create a PWLE caucus Further support the permission to contact to continue to streamline participation in research
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