DHiC 08 – Co-Designing Futures in e-Mental Health

Maggie Inrig: There’s really no health care or mental health care without technology these days. And there’s just so much potential.

Katie Bryski: Hello and welcome to Digital Health in Canada, the Digital Health Canada podcast. My name is Katie Bryski and I am a podcaster turned digital health professional.

Shelagh Maloney: And I’m Shelagh Maloney, a digital health professional turned podcaster.

Katie Bryski: Technology has long been used to provide access to mental health care, from telephone and texting lines, to emerging solutions integrating AI.

But as more people in Canada need mental health support, and encounter barriers to access, how are digital health solutions evolving to meet these challenges? Today, we are very excited to welcome two leaders in this space to share what their organizations are doing and to learn from their career journeys through the e-mental health space.

And a very warm welcome to Dr. Patricia Lingley-Pottie, President and CEO, Strongest Families Institute, and Maggie Inrig. Senior Director, Population Mental Health Innovation from Stepped Care Solutions. Thank you both so much for being here.

Maggie Inrig: Thanks, Katie. Great to be here.

Katie Bryski: So, on the podcast, we often like to start the conversation by learning more about your career journeys and the path that you’ve taken.

So, Maggie, maybe we can start with you. Would you tell us a bit about yourself, your work, and what your organization does?

Maggie Inrig: I’d love to. I was fortunate to start my career in Hamilton as a community-based social worker. I primarily started doing outreach on people’s homes, family’s homes, some respite programs, groups and walk-in counseling.

So it was part of the single session movement early on. And then after a few years, I moved into mental health system redesign, which is where I’ve worked for the last 10 to 15 years. That’s a great space to work in, because I’m passionate about reducing barriers to accessing mental health services, and really trying to meet people where they are at in the moment, any given day, any given hour.

And that’s a huge part of what we do at Stepped Care Solutions as a not-for-profit, trying to enable communities and institutions to re-imagine how they deliver mental health care, recognizing that there’s just still so many barriers to accessing services and systems. So, we work based on the Stepped Care 2.0 continuum, which was developed by our founder, Dr. Peter Cornish, and we work with communities and governments and other not-for-profits and post-secondary institutions to try to redesign mental health care systems, reduce wait times, and increase flexibility and access to a wider range of services across the continuum.

Katie Bryski: I’m really excited to dive into that in the conversation, but first, Trish, tell us about your journey.

Dr. Patricia Lingley-Pottie: Well, it’s been quite a journey. I’m old. So it’s been more than 25 years ago that I embarked on this career path. So I joined teams with Dr. Patrick McGrath back in the year 2000 and devoted this good part of my career towards developing, co-creating, empirically testing, committed to ongoing evaluation of our Strongest Families Distance Education Program, and it’s actually an entire system of care now, called Strongest Families. It was formerly Family Help, if you look at some of our past literature. And we’ve been primarily focused on mental health and other aspects of well-being, particularly focused on children and youth and families, but as well, further on, we have tested some of our programs in adults as well.

What’s interesting is, prior to that, I had a pretty established career in vaccinology and infectious diseases at the IWK, working on various different types of clinical trials, a lot of riguor, and including phase one trials, and that’s the first time in human vaccine trials, which is quite, quite interesting.

And that’s really where I obtained a lot of my regulatory background and rigorous randomized control trial design. And so that helped inform our very large efforts when we ran multiple clinical trials at the same time. So with millions of dollars of public funding investment from Canadian Institutes of Health Research, we embarked on the journey of designing a new system of.

hair that would bridge the access gap. And that’s how we designed Strongest Families with multiple programs. We ran multiple clinical trials at the same time. We have parenting programs, anxiety and depression programs, all along the age span. Nighttime bedwetting is another program that we have. We’ve expanded to parents empowering their neurodiverse kids, and we have multiple other programs.

And when we ran all of those clinical trials back in the year 2000, you can imagine how big the ethics submission was: probably the biggest ethics submission of my career, of my life. It was like two huge utility carts that we took down to the ethics board, like, really. So back in, you know, in around early 2000 was the first time that we developed one of the first cognitive behavioral approach parenting programs that was led by a paraprofessional coach.

And we do use paraprofessional coaches to deliver our care. They follow our protocols, and we monitor their outcomes. Looking back, it was very crude, this first system that we developed. But at the time, it was the first of its kind. And now, 25 years later, we’ve just expanded exponentially and advanced.

So, you know, I guess you can consider us pioneers in the field of e-mental health, especially around pediatrics and families. And now, thankfully, with our Stepped Care model and our 5.0 IRIS platform solution, we have a universal e-mental health system of care now. And everything’s been co-created. And that’s one thing I want to emphasize is the importance of co-creation to get it right beside.

So everything has been co created since the beginning. IRIS does use some basic AI, rule-based AI, but we’re excited about the future of AI and what it will hold for us.

Shelagh Maloney: Well, that’s a great summary, Trish, and a long, distinguished career indeed. Both of you talked about re-design, and reducing barriers, and the rigor that you’ve put into these programs to demonstrate their efficacy.

And technology has always been present: in telephone lines for support and texting, and there’s lots of cognitive behavior therapy apps and things out there. You know, given where you’ve come from and where things are going, what’s your relationship with technology now? And Maggie, why don’t we start with you?

Maggie Inrig: Sure. I mean, there’s really no health care or mental health care without technology these days. And there’s just so much potential. for ongoing developments of technology to increase access, but I really feel that’s only going to be successful if we actively address barriers that go hand in hand with technology.

So things like digital literacy, cost, access to reliable internet, which is still a barrier across many parts of the country. So, you know, in our work, I think we’re looking to increase access to technology and leverage it as a tool within the mental health space. And some of the ways that we’re actively working on that are through cost recovery pricing models.

So, you know, we offer not-for-profit tech-based solutions to really expand the continuum of care and support clinicians and end users and administrators to make the most of services. But that has to go hand in hand with co-design, as we’ve already talked a little bit about, and human-centered design at its core.

So making sure tools are inclusive and intuitive and accessible, in all realms of what accessibility means. There’s lots of potential to scale digital solutions to meet people where they’re at. You know, we’ve had some success as of late in a partnership with McMaster around some work that Dr. Sandra Moll has done with scaling peer support apps.

We’re working to leverage some, some lessons learned from our experience with Wellness Together Canada as a 24/7 digital platform. And scaling, you know, mental health literacy and a continuum of care, including counseling and self-guided mental health tools, which, you know, we had the fortune of working with Strongest Families to deliver that as well.

So, so many areas for partnerships, collaboration. I think blended care platforms are something that’s really exciting for the future. And again, making sure that they’re context sensitive and work for diverse communities is key, and AI as part of that complement, I think is a tool. And tool that can, can complement technological solutions, but not the only solution.

And we saw that it will never replace, you know, empathy and nuance that human clinicians also provide. So I see it as opportunity to blend these components and never stand alone.

Shelagh Maloney: Trish, how about you? Both of you talked about AI, so maybe why don’t we dive in and I think friend or foe, what’s your take on the future and how we might increase and enhance technology?

Dr. Patricia Lingley-Pottie: You can tell since the beginning in the year 2000, we’ve leveraged the advantages of technology right from day one. Co-creating it, but also using it to our advantage. And in fact, our technology IRIS has enabled us along the lines of our scalability and the way in which we do that is Iris is a very sophisticated, one of a kind system.

It has a user interface, but also a staff interface and they, they interact with each other. But also a workflow management system. And so anytime years ago when we were in person, and we’re virtual, primarily virtual now, but anytime I was walking around the office and I saw somebody writing something on a piece of paper, it’s like, “What are you writing? Because IRIS can do that for you.”

And so, IRIS does everything. She produces letters that pull in all of the patient information, the client information from all of our programs, digitizes it, creates graphs. And so it really reduces organizational waste, because our goal was to decrease the waste, so that our coaches, our telephone coaches, spend most of their time on the phone, not doing administrative work.

IRIS does use basic AI, but it’s rule-based AI, because we very much wanted to make sure that we had control, and it was safe. So there’s, you know, if and then type of statements, there’s triggers, quality assurance flags. There’s quite a few different types of decision making algorithms, but we are able to control it all.

We also bridge the digital divide with providing handbooks, um, and that has been very helpful for us. Skill demonstration videos and audios because we know people learn in many different ways, not just reading. Um, and that’s really bridged the digital divide for us for especially those remote regions.

The technology allows us to contextualize our content. You can’t easily do that in a handbook, so we are able to contextualize the materials for different populations, different ages, and so that people really see themselves in the materials when they use our app. When I look at what I’m excited about when it comes to AI, I’m really excited about the opportunities still to be able to control through like natural language processing type models that are trained exclusively on our data.

You know, what we can do to leverage our big data, because we’ve been doing this for a long time and we have a huge database, but I think we can do really unique things to just help complement the online components of what we do. Although we always provide a coach, regardless of what level in the step care they’re at, even our lowest, Level One, that is self-mediated, still has a human person available, a coach available for them because our research has shown that if you have some contact or human-led design, it improves adherence, and adherence is really important for outcomes.

Katie Bryski: I’ve been having a thought, and I think you’ve both touched on it a bit with talking about human-centric design, but thinking about, yes, access and scaling, but also that capacity building.

I’m curious, too, about capacity building on your internal teams as well, to stay abreast of these emerging technologies. How does that work in both of your organizations?

Maggie Inrig: I mean, I think it’s an ongoing iterative process, right? I think continuous learning from the team’s perspective and trying things, really trying to get into the seat of the person who will ultimately end up accessing the services or using the technology and, you know, comfortably pushing boundaries around that.

Right. So, you know, going. Going to conferences, going, trying pieces of technology, learning about them, bringing back to the team and digesting them is so critical, especially with the rapidly evolving nature of technology. I mean, we often have team shares of, “What are you finding out there in the digital space?” And bringing it back and digesting, you know, key features or, what do people come to expect now? What’s kind of accepted as current state, how might we be able to model that within a piece of mental health technology, just to make it more seamless to the person accessing it.

I think it’s a daily conversation and something that needs to be top of mind. Otherwise, you run the risk of becoming stale and technology or just having it be clunky for the person accessing it if you’re not using current practices.

Dr. Patricia Lingley-Pottie: I would have to say for us, I’m trying to think of something that’s a bit different than what Maggie said from our internal capacity perspective.

When I think about that, I think about our talent. We do have great retention rates. From a scaling perspective, we’ve been designed to scale. It takes me two weeks to train a coach to get them on the phone. And we use paraprofessionals who follow protocols. So this is very protocolized and prescribed care.

So that’s one of our advantages, but also with IRIS, IRIS keeps everybody on track. The protocols are embedded. The interaction between the user interface and the coach’s interface is quite dynamic. So, I would believe that all of those components speak to our scalability. Quality wise, our embedded QA, and using validated scales pre and post, really helps us really monitor the coaches’ outcomes, but also coaches have their KPIs.

And so we were able to look at, we have over a hundred people now on our team. It’s really important for us to have that type of technology. So leveraging the advantages of Power BI and. I do have to say that my entire team, like our culture, is based on respect, care, and innovation.

And so my entire team, right from ground level all the way up, are innovative thinkers. And I think that’s really important as far as a culture to make sure that that’s really part of that innovation so that people, even internally, they trust our system. They trust what we’re doing. They trust the trials that we’re designing and running.

And I think lastly. DEIA is critically important for us. We have a very diversity, equity, inclusion, and accessibility. We have a very diverse workforce all across Canada and DEIA is embedded in everything we do. And I think that also will build trust and care within our organization.

Shelagh Maloney: So, Trish, sort of, you talked about innovation, and you talk about meeting people where they’re at, and Maggie, similarly, you know, you’re always looking for advanced ways and different ways of doing things. But you also talked about a very rigorous methodology, and so it’s kind of interesting that it almost seems like a dichotomy. And when you look at different populations, youth mental health, or military personnel, or people living in rural and remote communities, Indigenous populations, how does that dichotomy work?

You give people enough flexibility, but within that evidence-based environment – is that how it works out for you? And did you ever have any issues around that?

Dr. Patricia Lingley-Pottie: This is very critical for us as far as the different populations that we serve. When we hire a coach and train the coach, we obviously train them on some of the milder cases, but also if a case is referred to us and they’re of a different cultural background, military or a military veteran personnel, we do have a military division.

We make sure that the coach that they’re assigned to has received cultural competency training, regardless of the background of the client and the family. And that’s critically important for us and our commitment to making sure that we match the right coach with the client and fulfilling their needs.

We also monitor Therapeutic Alliance. We all know that Therapeutic Alliance is a good predictor of adherence to programs and our programs are sometimes five months long of weekly coaching. So that’s critically important for us as well. Meeting people where they’re at, but at times convenient to them. We hire coaches who are flexible, who will work at times convenient to our family.

It’s not about our schedule, it’s about our families’ schedule. We don’t want people to take time off work or for kids to miss school. So that’s really engrained as part of our culture as well. Also, real data entry, I love the fact we’re so data driven. We can slice and dice our data any which way to make sure that we are still yielding high outcomes regardless of the time, day or night, but also regardless of the populations that we’re serving.

Maggie Inrig: What Patricia is saying is really resonating in terms of meeting people where they’re at. I think there’s so many different ways that that can happen and only enhanced through digital access. So I know, again, back to our experience on Wellness Together Canada, more than half of the platform access that we had during the 24/7 service happened outside of regular business hours and from people’s location of choice.

And so I think that really speaks to shifting away from services that are only offered during regular business hours and having the convenience of after-hours, overnight, and weekends. Saturday and Sunday afternoons were a popular time too, right? And so it really calls on all of us as service providers and system designers to really think about accessibility of service from a variety of different angles.

And, you know, the dichotomy is really kind of a healthy “both/and” situation. I think there’s a need to consider global population needs and then really targeted specific needs within particular communities. I mean, we’ve talked about rural/ remote, you mentioned military personnel, and I think that’s really where co-design comes in.

The more tailored a service or content or resource, the more co-design and input you can have from the community, the more it will resonate and be accessible to the group that you’re working with to serve them best.

Dr. Patricia Lingley-Pottie: Maggie, you’re so right. Everything comes back to co-design, in my view, when we’re designing these systems.

And for, you know, any advancement in technology in AI that comes about, if we don’t get it right by design, and if we don’t have proper regulations in place to make sure that what we’re producing is safe, we’re going to have a whole other global issue on our hands.

Katie Bryski: So I’m curious a little bit about some of the factors behind your success with co-design.

I’m also maybe thinking from like a real-world evidence perspective, like as you’re being very data driven and you’re using the scientific rigor, what advice would you give to other organizations also looking to create a really effective co-design system for themselves?

Dr. Patricia Lingley-Pottie: Right in the beginning, in the year 2000, Pat and I were very keen. I came from a nursing background, he’s psychology. Nurses are very good at needs assessments, as you know, and we were very keen on making sure that we embedded an integrated knowledge translation strategy in all phases of what we do, and that, that meant co-creating with people who’ve lived it, their living experience, just like I’ve mentioned throughout, but also with other key stakeholders.

Interest groups, experts in the field, you know, academics, health professionals, policymakers, influencers. We actually have a publication on our integrated knowledge translation strategy. And I really believe that that’s been the element of some of our success with scaling. And our outcome than getting it right by design, but it doesn’t end there.

It’s not a “one and done.” We continue to leverage our data and the voices of our families to inform what we do, regardless of their age. Some of the kids that we have on our advisory committees. I mean, there’s no flies on them. They know what they want. And I think it’s really, really important for us to continue that iteration over time by using, their voices, their satisfaction information and any other data that’s embedded as part of the process data.

Maggie Inrig: I completely support that notion that it’s absolutely not a one and done, and that notion of continuous improvement, right? You might have an initial co-design session, or series of sessions, or an ongoing process, but it’s that constant input.

In terms of qualitative and quantitative data, and people’s lived experience of what’s working, what’s not, and really hearing the feedback and, you know, I think that that takes a level of maturity and depth from teams to be able to sit with something that’s been developed and truly, truly hear it, and hold it out separate from our own professional or personal attachment to the work that we do, and really try to be empathetic with the information. In the spirit of how can we do this better, not because there’s a problem, but because there’s always areas for improvement.

Dr. Patricia Lingley-Pottie: If you could see what Strongest Families looked like years ago. Fundamentally, all of the elements based on that science are there, but the look and feel is different. And you’re right, Maggie, we have to continue to listen. You know, we need to improve our systems because there are so many advancements and time is changing.

COVID was such an odd era to come through, and just pivoting, and we’re still, goodness knows how many years of aftermath that we’ll be dealing with the effects and impacts on mental health. But we just need to keep this iterative process going. But that needs to have funding attached. For us charities, or us non-profits that don’t have the deep pockets that others do, it’s critically important.

Shelagh Maloney: It’s interesting. I think both of you are such adamant supporters of co-design. And Trish talked about COVID, and certainly, you know, there’s been a number of mental health reports, documents of late, and we’re in a crisis situation. It’s a real issue, and not thanks to, you know, COVID and social media, etc.

So I’m curious about, as professionals in this space, are you optimistic? Are you pessimistic? Are we going to get there? I wonder if you can speak to that a little bit.

Dr. Patricia Lingley-Pottie: I will always be on the optimistic end.

Shelagh Maloney: That’s probably why you’re in this business.

Dr. Patricia Lingley-Pottie: I mean, we’re certainly facing challenges, but we always need to look at the opportunities within.

I was part of the recent report that was produced by Mental Health Research of Canada, The Generation at Risk, and our youth are certainly at risk, but you know, I’ve been in this field for closer to 30 years. We’re having the same conversations now as we did back then, and I’m really worried because here we have two highly validated, excellent, low-cost solutions that are population-based, Canadian-made non-profits.

We’re here to make a difference, but yet we’re still seeing the same things. And as a 25-year-old organization, and we’ve been a non-profit for more than 12 years, we are not equitably available across Canada. And I’m baffled by that. It’s baffling to me that these solutions are not readily available, especially where a lot of public funding has been invested through our research areas like the Canadian Institutes of Health Research.

So I’m optimistic, but it’s time for action, it’s time for change, and I don’t know the magic solution because I’ve got a…Shelagh, you know, we’ve been in this field for a long time. You’ve been a huge influencer of ours. There’s a lot of influencers, but it’s very hard for non-profits to get to apply for funding, to secure funding for our technology because it’s unique. It’s unique for non-profits to own and operate their own technology.

Shelagh Maloney: Maggie, how about you? How optimistic or pessimistic are you?

Maggie Inrig: I mean, I think the notion of hope is what comes to mind for me, and I’ll circle back to it, but I wanted to pick up on a couple of comments that Patricia made in terms of, you know, I wonder if your optimism is because there are programs like yours and the great work at Strongest Families that are available and ready to scale.

You know, we had great success with Wellness Together Canada throughout the pandemic, but you know, what we need is a longer-term strategy and longer-term investment. The short term solutions provide an opportunity to deliver something, but never maximize the scaling when you don’t have a long enough runway.

And so I really see that as an opportunity to provide base level, population, accessible mental health across the country, like we’ve had in other areas like physical health. That’s the opportunity I see. The reason why I remain hopeful is because I think there’s no world in which we can’t be. And as the adults and elders and older community members, we need to maintain hope for younger generations and help see the solutions and try to mobilize action.

And I see that as a responsibility.

Dr. Patricia Lingley-Pottie: Yeah, it’s, it’s so true. I mean, it was such a great partnership, Wellness Together Canada, and the various solutions. We were fortunate to have our ICAN adult program as part of that. But you know, I wonder, like you say, longer-term investment and we could so easily mimic the similar approach as in New Zealand.

I often refer back to my colleagues there from the national telehealth service. I know they’re only one country. But we could do some really amazing things here, between, Strongest Families, Wellness Together Canada, Kids Help Phone. We could leverage such an opportunity if we could just find that long-term investment like Maggie said.

Maggie Inrig: Yeah, I think we need to harness the spirit of innovation and responsiveness that came early on in the pandemic and carry that forward. But again, with an eye to long-term sustainability.

Dr. Patricia Lingley-Pottie: And working together as non-profits to really come together with a loud voice. I’m a firm believer, and I will shout it from the rooftops, I believe that governments should first look at the non-profit, empirically tested, evidence-based solutions that are available, because they’re low-cost, high-impact. We’re data driven. Look at us first, and then get others to fill in the gaps.

Maggie Inrig: There’s so many amazing empirically-based, evidence-based programs.

And I just also want to acknowledge that there are gaps within that space as well. And we’d love to push the conversation forward around, you know, evidence-informed practices or wise practices, community driven practices. Which often, you know, I think bridge the knowledge to practice gap and can be really responsive to community needs.

And so when you compare evidence-based practice with co-design and engagement of communities, then you know where some of those gaps exist and have a tool in terms of a process to work with communities to try to fill them as well.

Dr. Patricia Lingley-Pottie: Yeah, that’s a good point. You know, as I travel up north, I think about, as you’re talking about hope, I also think about trust, the public’s trust in some of the e-mental health solutions.

I have some elders say to me, “Trish, you’re going to have to have multiple cups of tea with me before, you know, you build credibility and trust within our communities and in your services that you provide.” I think that too, when it comes to AI and, and the rapid advancement and lack of regulatory processes to make sure that what’s being produced is safe, it really does come down to trust. And I see this notion of virtual fatigue right now that we’re experiencing as I travel across the country, there is this virtual fatigue.

Some people are expressing concerns about lower quality solutions that they’re trying. And I think maybe the Mental Health Commission’s app assessment will help guide the general public on what are validated apps that are safe to use and produce great outcomes. But I am a little worried about how we’re controlling and regulating the production of new AI technologies in the space of mental health and health, especially when it comes to our vulnerable populations like children and youth.

And how do we build that trust and how do we make sure what we’re producing is safe?

Maggie Inrig: Such great points, because I think you’re really touching on quality, regardless of the type of evidence that goes into something, the quality that people can expect and how they can safely make choices about what to engage in.

And trust is so critical in terms of working with communities. And again, that goes back to the length of time it can take. And the funding required to do meaningful engagement work.

Dr. Patricia Lingley-Pottie: Totally. And travel. How can we get to those communities if there’s no support for travel?

Katie Bryski: It occurs to me, these things that, these themes that have been coming up, hope, trust, these aren’t quick fixes, right?

They’re things that we need to take a significant amount of time and focus and investment, not just of funding, but I think also of culturally, right? We need to invest our teams and ourselves into them as well.

Dr. Patricia Lingley-Pottie: So true. Absolutely.

Katie Bryski: I was just going to say, given both of your journeys and careers and given the dynamic nature of the space, if you had a piece of advice that you wish you’d gotten maybe earlier in your career, what would it be?

Maggie Inrig: Yeah, I think that something that I was thinking about during this conversation is the notion of tensions. And rather than viewing tensions as, as dichotomous, which I think they can be, and we often push conversations into “either/or” different camps. Viewing tensions through the lens of “both/and,” and just how they can offer a space for iteration and innovation, that it doesn’t have to be one or the other, but how can we leverage the best of both worlds, or blend the best of both worlds when we’re in that situation?

Dr. Patricia Lingley-Pottie: I’m just going to ground my response going back to, family-centered, client-centered, co-designed solutions. It’s just so imperative to what we’re doing. I guess before I started working with Pat in the year 2000, I always listened to my patients, but the medical system, it’s very difficult to make changes within a hospital or an institution like that.

So I think just embracing the opportunities that we have to really get this right, sharing our ideas, collaborating together, really looking at, what do we have that exists that’s Canadian-made, that works, that benefits our people.

But boy, I tell you, I really am worried about our future generations and really making sure that what we’re producing has been co-created with children and youth is evaluated, empirically, evidence-based, that there’s a dedication to measurement-based care.

So that we can report on what’s working and what’s not working. I really just have to emphasize the importance of this iterative co-design process.

Shelagh Maloney: That’s a great segue into our ending, Trish. I think, reflecting on the conversation that the four of us had today, it really is a critical time for mental health and particularly youth mental health in Canada.

And you’ve both done an excellent job of really underscoring the importance of co-creation, using data, using technology to improve the system, and the importance of access and equitable access across the country. So thank you so much for spending the time with us today and sharing your thoughts and your advice to us.

And thank you for what you do. And,it’s programs like yours that I think we’re all very thankful for and, we wish you all the very best in the future.

MUSICAL INTERLUDE

Shelagh Maloney: What a great conversation. That passion certainly shows through and, and lots of great ideas around mental health and equity and access. So, your initial thoughts, Katie?

Katie Bryski: I could have gone for another hour. I feel like there was so many different levels by which to approach this topic. There’s this sort of Evidence and the changing nature of evidence, and how both organizations are using it to inform tools that really meet people where they’re at.

There’s the larger system design level, where again, we’re talking about the scalability of solutions and how many different parties within the health system intersect and interact with each other. It really just made me think of that multi dimensionality of the e-mental health space.

Shelagh Maloney: agree with you and, and just, as we were off-air a little bit, just talking about the regulatory environment and all these AI-generated tools are sort of some of these things that may have less evidence, but, you know, for me, the comment that really resonated with me, I think it was Maggie that said, “we can do this and, and it’s not that we can’t, it’s that we don’t.” And you know, the mental health sector is very innovative and they can do it. They just, sometimes we lack the making it a priority across Canada and funding it equitably. You know, we all kind of know that intuitively, but it was a stark sort of teality for me based on the conversation we had today.

Katie Bryski: Such a good point. And I also really liked Maggie’s comment around, creative tensions, right? That sort of constructive tension, the both/and.

I think as career development is leadership advice, uh, no matter what sector you’re in, I think that’s such a good way to approach innovation, um, and clearly very evident in the work that they do.

Shelagh Maloney: I think one of the other things that, it can be sort of a game, is the number of times that co-design was emphasized and spoken about, and the absolute criticality of co-design. It just has come through in spades in that conversation as well.

We all know including the people, the end users is helpful, but in this particular space, I think it’s so, so important and both of these organizations, and Maggie and Trish have been championing this and we could learn a lot from that, I think.

Katie Bryski: So, question. I mean, we obviously invited guests from organizations where co-design is really important. Do you think that it’s particularly a mental health space focus?

Shelagh Maloney: That’s a great question. And you know, I wonder as you are asking it, I’m thinking back on these organizations are very supportive of co-design and champions of co-design, but they’re champions of evidence-based and doing the research and data analysis.

So I think those go hand in hand, right? So I am going to measure my impact. And if I’m not efficient, I’m going to reach and find out why. And I think people who are not necessarily involved in co-designed applications and initiatives won’t have the success that these organizations have had. So I wonder if there’s a link around evidence and efficacy and co-design, and one sort of as a contributor to the other.

I don’t know. Is that how you would interpret that?

Katie Bryski: Yeah, I mean, I’m thinking of the health technology assessment world. And certainly, what is best evidence includes the patient voice, includes clinical expertise, you know, includes perspectives that you wouldn’t necessarily get solely through a randomized controlled trial, right?

It’s that “both/and.” It’s evidence is rigorous, and it is scientific, and it also involves lived and living experience as well.

Shelagh Maloney:  I think you do what’s best, and what works, because you care enough to do the right thing. And you want to know whether you’re doing the right thing, and you measure the right thing.

And we could talk all day, but we probably shouldn’t.

Katie Bryski: True. So, this episode will be airing at the very end of 2024, so we wish you all of the best over the holiday season and an inspired, connected and empowered new year ahead. We will see you next in January, right here on Digital Health in Canada, the Digital Health Canada podcast.

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