Issue 08

SPARK

No health without mental health

There are many different kinds of mental illness. Today, around 800,000 British Columbians are experiencing at least one of them.

With no single known cause, and multiple social, psychological, and biological factors, many mental illnesses go undiagnosed and untreated. This can affect functioning and relationships at home, school and work, and costs the BC government an estimated $6.6 billion annually.

Although no age or social group is immune to the challenges and stigma of mental illness, the young and disadvantaged are particularly vulnerable and can often feel like they have nowhere to turn. In these instances, the emergency room is often a last resort. In fact, BC saw an 85% increase in youth emergency department visits for mental health from 2009 to 2013 — a period when other admissions remained relatively stable.

The Michael Smith Foundation for Health Research (MSFHR) is proud to have funded numerous researchers working to better understand the underlying causes and potential treatments for mental illnesses, the best ways to provide care, and how to support mental health and well-being in at-risk groups.

Chapter 01

Unlocking the black box: The biology of brain health

Until recently, the brain was a black box for researchers studying brain health.

With many other parts of the body you can physically see how an area functions, and what’s going wrong. But the protection of the skull and complexity of the nervous system has made it hard for researchers to really understand what goes on in our heads from a biological perspective.

As a result, surprisingly little is known about what goes on in the brain of someone managing a mental health issue.

Dr. Faranak Farzan, a neuro-engineer and brain health researcher at Simon Fraser University

To unlock this black box, Dr. Faranak Farzan, a neuro-engineer and brain health researcher, is drawing on the fields of engineering, computer science, psychology and psychiatry. Her team is developing new ways of looking at the brain in action, mapping its neural pathways, and spotting the changes that occur in conditions like depression.

“In the past, we were mainly looking at the brain as a series of static images. For example, magnetic resonance imaging (MRI) could show you what the brain looks like, but it’s hard to determine function from a still image,” explains Farzan. “Now with functional MRIs and electroencephalography (EEG), we can see which parts of the brain ‘light up’ during a particular activity to get a better idea of how the brain works. But these techniques are still passive observations, they don’t allow you to stimulate one area and see where the signals travel to.”

To change that, Farzan and her team at eBrain Lab at Simon Fraser University have been using technologies such as EEG and fMRI combined with non-invasive forms of brain stimulation to trigger one area of the brain and see what other areas respond. Like momentarily turning on a flashlight in a dark room, just for a fraction of a second the researchers can get a glimpse of what is going on, helping them gradually build a map of the connections between different parts of the brain.

This new understanding of how healthy brains work is opening up new treatment opportunities for disorders like depression.

In people with depression we have observed that some neural pathways may be excessively active, leading to abnormal connections between some parts of the brain,” explains Farzan. “Using non-invasive brain stimulation techniques like transcranial magnetic stimulation over a period of time, our aim is to target specific neural pathways and encourage healthier connections.”

The treatment can take as little as three minutes and feels like a tapping sensation on a ski or bike helmet. Afterwards, the recipient can go back to school or work without it affecting the rest of their day.

But for the treatment to work, multiple sessions are necessary. Think of it like learning a new skill. One training session doesn’t change much, but if you practise over time, you start to gain new abilities.

Farzan recently finished the first ever feasibility trial of this treatment in a group of 16 to 24 year olds who had not responded to other treatments such as antidepressants and cognitive behavior therapy. Over just 10 sessions, 85% completed the course and had a reduction in their depression symptoms, opening the door to a randomized placebo-control trial with more patients over more sessions.

For the 30-50% of youth with depression who don’t respond to standard treatments, or develop side effects, non-invasive brain stimulation could soon provide a much needed treatment option.

Dr. Faranak Farzan is an assistant professor in the School of Mechatronic Systems Engineering at Simon Fraser University, and Chair in Technology Innovations for Youth Addiction Recovery and Mental Health. She received a 2018 Scholar Award to support her research on neuromodulation for youth addiction and mental health.

Chapter 02

Creating a safe space with youth, for youth

“Three years ago, I’d reached a breaking point. Between drugs, depression and homelessness, it was a really difficult time. I was very closed off. I knew I needed help but didn’t know what type of help I needed, or where to get it.”

Mo, former service user and now youth peer researcher at Foundry

This is Mo. He is among the one in five young people living with a mental health challenge in BC. Of this group, only a quarter get the help they need. And when things get bad, the emergency department is often a last resort.

“I first heard about Foundry after waking up in St. Paul’s Hospital. I had no idea what it was, but a few weeks later I walked through the door and ended up spending two hours with a counsellor. I don’t know why I suddenly opened up, but I didn’t feel any pressure. Maybe that was it.”

Launched in 2015, Foundry centres are ‘one-stop-shops’ for teens and young adults looking for mental health and well-being support. One door to access the services you might need — no cracks to fall through, and no need to tell your story over and over again.

A lot of people don’t realize it really is a drop-in service,” explains Lacey Anderson, a peer support worker and youth researcher at Foundry Prince George. “So instead of seeing a doctor and being referred to see a psychiatrist in six months, you can just walk in to see a doctor or a counsellor, hang out with me or another peer support worker to chat about how things are going, get help looking for a job, or join an event on addiction recovery, budgeting, or yoga.”

Communal area at Foundry Campbell River — a safe space where you can get help and support without judgment

For Dr. Skye Barbic, Foundry’s lead scientist, this new approach takes the traditional medical model and turns it on its head. Instead of being driven by wait times or traditional disease measures, the team is focusing on the outcomes that really matter to young people.

“That’s where youth researchers like Lacey and Mo come in,” explains Barbic. “They’re the ones conducting the surveys, and learning what really matters to the young people walking through Foundry doors — being able to go to school or work, having friends and somewhere comfortable to live and thrive. We build research into every step of the journey so we can understand more about the needs of our clients and adapt our services appropriately.”

Dr. Skye Barbic, Foundry’s lead scientist

And so far, it seems to be working.

After a pilot in 2016 there are now seven Foundry centres in BC, four under construction and more are planned. Last year, 7,000 individuals visited close to 90,000 times, coming back repeatedly to make use of multiple services. In parallel, Vancouver — home to the first Foundry centre — has seen youth emergency room visits for mental health stabilize.

This early success of Foundry and similar models such as headspace in Australia has been so dramatic that other provinces and countries are planning to use similar models.

From a research perspective, this is a huge opportunity.

“We’ve worked hard to build a model of care that is familiar across all centres, leaves space for creativity in how care is delivered, and gathers data that is clinically meaningful to the people we serve. This allows us to compare results, spot bright ideas, and share learnings across the network,” explains Barbic. “By continually asking ‘What are we doing well?’, ‘What could we do better?’, ‘How can we make those changes now?’ We could really revolutionize the shape of youth mental health care in Canada and worldwide.”

For Mo, a former service user and now youth peer researcher, the research is an integral part of the care. “I’m 25 now, and I’m hoping to become a social worker or counsellor so I can make a career at the Foundry long term. Until then, I’m working with the research team. Doing the surveys show we really care, not just about the people coming through the door today, but also about making Foundry better for youth in the future.”

Dr. Skye Barbic is an assistant professor in the Department of Occupational Science and Occupational Therapy in the Faculty of Medicine at the University of British Columbia, a registered occupational therapist, and Foundry’s lead scientist. She received a 2018 Scholar Award to support her work to improve primary care services for youth with mental health and substance use challenges. MSFHR is also funding the research and evaluation component of Foundry.

Chapter 03

Growing roots to thrive: Building caregiver resilience

“I’ve been a nurse for over 20 years. In emergency departments, as a public health administrator, and now as a forensic nurse examiner focused on sexual assault, child abuse, and intimate partner violence. Most nurses who have been in the field long enough have wrestled with or are wrestling with emotional exhaustion to the point where it feels like some days you are barely holding on.”

Dr. Shannon Dames, professor of nursing at Vancouver Island University and a former emergency room nurse

Meet Dr. Shannon Dames, a professor of nursing at Vancouver Island University. She’s working with colleagues at Island Health to figure out why some people thrive in trauma-laden work environments, and why others barely survive. The goal is to better equip all care providers with the tools they need to protect their own mental health while providing quality care for their patients.

It’s support that can’t come soon enough. In international studies, up to 94% of emergency room staff and first responders have screened positive for symptoms of post-traumatic stress disorder (PTSD). Here in Canada, over half of new nursing graduates will have left their job, or the profession all together, by the end of their second year of practice, often related to emotional exhaustion and hostility in the workplace.

Between staff losses and absenteeism, mental health is a huge problem in health care — both in terms of cost and quality of care.

“As care providers we want to meet the needs of all our patients. But when you’re struggling to keep multiple patients alive, ‘small’ requests for blankets or water start to feel like a distraction, almost irritating. You know you have to prioritize but you also feel guilty for being irritated and not providing the care you want to be able to provide.” explains Dames.

This gap between our ‘ideal’ and ‘real’ selves feeds into the emotional exhaustion that many caregivers experience, and is often at the root of workplace hostility and bullying. Unfortunately, it’s a vicious cycle.

In an attempt to break this cycle, Dames and a team that included a physician, a psychologist, nurses and others, have developed an evidence-based curriculum to help boost stress resilience in health-care workers. Drawing on self-compassion and mindfulness, the six-week course uses both theory and practical tools to support stress management, authentic expression, and the healing of past trauma.

The gap between our ‘ideal’ and ‘real’ selves feeds into the emotional exhaustion that many caregivers experience, and is often at the root of workplace hostility and bullying

“The concepts might sound ‘fluffy’, but they are steeped in psychology research and are already generating huge interest from health-care providers,” notes Dames. “Initially we’re trialling the curriculum with Nanaimo Regional General Hospital leadership team and with forensic nurse examiners on Vancouver Island. But longer term, we’d love to offer it to every care provider working, or preparing for work, in a trauma-laden work environment.”

For those unable to attend in person, Dames and her team are also finalizing a book that will allow people to complete the course independently and help ensure that health-care professionals are better prepared to care for their own mental health, as well as the health of their patients.

Dr. Shannon Dames is a professor of nursing at Vancouver Island University, a forensic nurse examiner with Island Health, and a former administrator and emergency room nurse. This work is supported by a 2018 Reach Award.

Find out more about Dames’ work on self-compassion and mindfulness at Roots to Thrive.

Chapter 04

Advancing science for better mental health

The challenges of maintaining good mental health, and managing mental illness when it occurs, are certainly not unique to British Columbia, or Canada. But, as these stories demonstrate, BC is emerging as a leader in mental health research and care.

Like many other medical conditions, mental illnesses are treatable, and many are preventable. But we still have work to do to understand the inner workings of the brain and the right combination of education, support and care for the range of individual experiences.

MSFHR is committed to funding research that advances understanding in these areas to support mental health for all British Columbians. After all, there is no health without mental health.

MSFHR is BC’s health research funding agency. Funded by the Province of BC, MSFHR helps develop, retain and recruit the talented people whose research improves the health of British Columbians, addresses health system priorities, creates jobs and adds to the knowledge economy.