PROMISING PRACTICES
A Podcast about Mental Health and Addictions

Episode 2: Saskatchewan

Episode 2: Internet-based Cognitive Behavioural Therapy Program (SK)

March 24, 2021 – This program uses technology to provide long distance care. Online therapists guide clinical treatment for people experiencing symptoms of anxiety, depression and a variety of other conditions. The program is designed to support people who need help in all parts of Saskatchewan, whether they live in cities, rural areas, or the Far North. www.onlinetherapyuser.ca

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Loretta O’Connor: Welcome back to the Promising Practices podcast. This is the second of a 13-episode series on mental health and addictions. The podcast is an initiative of Canada’s Premiers. The aim is to share promising practices that are underway in each province and territory. My name is Loretta O’Connor. I’m Executive Director of the Council of the Federation Secretariat, an organization that supports the work of Canada’s Premiers.

Today we are in Saskatchewan, a prairie province located in the heart of Canada. About half of Saskatchewan residents live in Regina, the provincial capital, or in Saskatoon, the largest city. However, a significant percentage of the population lives in smaller cities or in rural, agricultural and northern communities. This vast provincial landscape can create geographic challenges for those wanting to access mental health physicians. While alcohol is the most common problematic substance among Saskatchewan residents, the province has seen an increase in the use of opioids and the number of deaths associated with opioid use. Tragically, this is not unique to the province of Saskatchewan. Similar to most jurisdictions, Saskatchewan has also seen an increase in self-reported depressive and anxiety symptoms. The move to virtual and technology-based services has expanded during the COVID-19 pandemic to support those who need it, and has opened up innovative opportunities for how health services can be provided in both Saskatchewan and across Canada.

Today, we are going to learn more about Saskatchewan’s Internet-based Cognitive Behavioural Therapy Program. First, let’s hear from the Premier of Saskatchewan, Scott Moe, as well as the Minister of Mental Health and Addictions, Everett Hindley.

Premier Scott Moe: Hi, everyone. I'm Scott Moe, Premier of Saskatchewan. I'm pleased to be taking part in this podcast series about promising practices in mental health across Canada. This is a very important discussion for all of us. And I want to thank our colleagues from Yukon for spearheading this initiative alongside Saskatchewan. In particular, I'm very grateful for the advocacy of my friend, Sandy Silver the Premier of Yukon.

Across the country, there is a growing awareness of the importance of strengthening mental health and addiction services. In Saskatchewan, we're focused on putting the latest innovations into practice, and ensuring services are widely available to all and tailored to the needs of our population. One of our main challenges is not actually that unique to Saskatchewan. A fair number of people in our province live in rural and remote areas. We're working to make services more accessible to all of these folks.

In Saskatchewan there is a long tradition of neighbours helping neighbours, there's an expectation that we support, and we encourage one another and that we care for the most vulnerable among us. This community spirit serves us well as we expand and enrich services, as we work together to fight the stigma surrounding mental illness and encourage people to reach out for help if they should feel isolated, feel alone, or overwhelmed. Right now, I'm pleased to introduce and welcome our minister Everett Hindley, Saskatchewan’s minister of mental health and addiction services. Minister Hindley represents the constituency of Swift Current in the Saskatchewan legislature. And he is the first cabinet minister in Saskatchewan’s history whose main responsibility is mental health and addiction services. Everett, you've been on the job now for about three months. And I am sure that you have learned a lot about the challenge that we're facing in Saskatchewan over that time. This fiscal year, our government has invested a record $435 million in mental health and addiction services as well as the surrounding supports. I'd like you just to talk a little bit about the priority investments that we've made in Saskatchewan on behalf of the people that live here.

Minister Everett Hindley: Sure, Premier, and thanks for the introduction, and thanks for the opportunity to serve in this role. And you're right, I think it's been what I've learned, you know, in this initial four months as the minister responsible for this portfolio is just, you know, how important this is, I think for the people of Saskatchewan. You know, in any of the number of groups and individuals and organizations that I've had the opportunity to talk to, they've highlighted for me the significance of the mental health and addictions challenges that we face in this province. And I’ve identified that it's not, you know, just unique to our province. Of course, this is something that we're all facing, all governments in provinces and territories across the nation, and we're all looking at trying to do as much as we can to try to provide as much support as we possibly can.

Here, in Saskatchewan, and you talked, Premier, about some of the record investments, dollars wise that we put into mental health and addictions. We have, you know, we've made some significant announcements there. One thing we've implemented is the multi-disciplinary community recovery teams. These are in place across our province. They support both adults and youth who experience complex and often concurrent mental health and substance abuse challenges. These are operating in a number of communities across Saskatchewan.

Another thing we're doing is we're expanding supported residential services for individuals with chronic and persistent mental health issues. So, we have additional services and in a number of our communities -- Regina, Saskatoon, Prince Albert, and North Battleford. And what they do is they actually provide a step-down from acute mental health care to community-based care. And what this does is it addresses housing needs, and it also supports other aspects of recovery, things like life skills, employment, education, and social inclusion. Pillars for Life. You may have heard about that. That is Saskatchewan’s suicide prevention plan presented in May of last year. And it provides a foundation for our government and our partners to deliver and approve suicide prevention programs building on some good work that's already underway. And this plan calls for engagement with First Nations leadership and includes the learnings and perspectives in their suicide prevention work.

Speaking of that, and in addition to that, in addition to Pillars for Life, we've also signed a letter of commitment with the Federation of Sovereign Indigenous Nations, the FSIN and the federal government to address Indigenous suicide in Saskatchewan. That's a letter of commitment. It was signed back in last September by the former minister and what it does is it strengthens our commitment to take steps that will reduce suicide rates amongst our province’s Indigenous population. And, you know, I've had several conversations with representatives from the FSIN and about how we can best move forward on that.

Finally, one other example I can give to the listeners is the walk-in clinics that that we've instituted here in Saskatchewan. They're available in more than two dozen locations across our province, offering free single session counseling and providing referrals to people who need additional or more urgent support and those have been a welcome addition as well. So, I thought we've made some significant investments. I think we're moving in the right direction but no, of course, there's more work to do and we're looking forward to taking on that challenge.

Premier Moe: Everett, thanks so much for that very fulsome snapshot and really a comprehensive overview of what we're doing, here in Saskatchewan. Thank you for your commitment to engaging with the people across this province and across this nation on the topic of mental health and all too often subsequent addictions and ensuring that we are putting our best foot forward as a society to ensure that we are offering the supports that people will need today and into the future.

I'd like to remind everyone listening that if you or someone you know is struggling, help is available. Help is always available. There are resources listed on saskatchewan.ca. And anyone in Saskatchewan can call the helpline at 811 day or night, for free, confidential professional assistance. Please, if you need help, reach out. The help is there.

Minister Hindley: Thank you Premier. It's now my privilege to facilitate a conversation about a project that's making a difference for individuals across our province, known as Internet cognitive behavioural therapy or ICBT. This program uses technology to provide long distance care. Online therapists guide clinical treatment for people experiencing symptoms of anxiety, depression and a variety of other conditions. ICBT is designed to support people who need help in all parts of Saskatchewan, whether they live in cities, rural areas, or the Far North. Our government is proud to fund this ground-breaking, made-in-Saskatchewan initiative. It's delivered by the University of Regina and the Saskatchewan Health Authority with support from a variety of research partners. I hope you enjoy hearing about it. For more information, please visit www.onlinetherapyuser.ca.

Loretta O’Connor: That was a great introduction to the initiative we are discussing today, and the ongoing work of the Government of Saskatchewan. Let’s return to Minister Hindley to learn more about Saskatchewan’s promising practice.

Minister Hindley: I'm Everett Hindley, Saskatchewan’s Minister of Mental Health and Addictions. Today I'm talking with Heather Hadjistavropoulos, a professor in the Department of Psychology at the University of Regina. Heather is in charge of the online therapy unit and the Internet-based Cognitive Behavioural Therapy Program. Thanks very much, Heather, for taking time to talk to me about the program today.

Dr. Heather Hadjistavropoulos: Oh, my pleasure.

Minister Hindley: So, first of all, just maybe if you could explain for the listeners just very simply, what exactly is Internet Cognitive Behavioural Therapy or ICBT as we call it, to somebody who has no idea what ICBT is? Can you perhaps explain what the program is? And what the ultimate goal of the program is?

Dr. Hadjistavropoulos: Yeah, for sure. So that's a really good question because I think sometimes there's some confusion about what ICBT is. Sometimes people assume that it's a therapist and a patient talking over like a video like zoom or something like that. But in fact, it's really quite a bit different. So, what we do is give clients access to online treatment material that they work on over the course of several months. And what we're doing there is sharing the same type of information that you would get in face-to-face treatment. And clients are learning kind of key strategies that are designed to help them like with their mental health concerns, mainly like depression, anxiety, alcohol misuse, or coping with a chronic medical condition. And then at the same time that they're working on those online treatment materials, there's a therapist that provides support, usually through email exchanges. So, the client emails the therapist, and then the therapist responds back. And then for clients who are not really comfortable with email communication, we also do offer telephone support. That's kind of ICBT in a nutshell. And the main idea behind this is that we're really trying to improve client access to cognitive behavioural therapy, which is a type of treatment that we know is really effective, but people have a difficult time accessing. And we're trying to overcome lots of barriers that clients experience when they're trying to access therapy. So, one barrier would be like, the location that they live in. So, if you live in a rural or remote area, getting access to this treatment that we know is effective is very difficult. Another challenge is just having the time to get to treatment. And a third challenge is that sometimes clients are kind of reluctant to go in and see a therapist in person, and this gives them access to treatment, but in the privacy of their own home.

Minister Hindley: Right. Yeah, that's a very good point. So, it's yet another tool that that people can have access to. In the introduction, I talked about some of the things that are currently available in Saskatchewan, and some of that is in-person treatment, but you're right, I think for not every person they might not be comfortable with going to a local walk-in clinic or calling to schedule a face-to-face appointment. So, I think this, just at first glance, is a great option for folks, that they know that they're looking for some supports, but they don't know where to start. And I think that this is a great first step for people. And I think that's important. You mentioned the access piece. And I think that's pretty significant as well, because you're right, I think, perhaps people when they first hear about ICBT, as you said, they might think it's, well, it's an online zoom or video conferencing thing with a therapist, and that's not necessarily it and because you're right in, in certain parts of the province, if you're in rural or far remote areas, internet and cellular coverage can be a bit of a challenge. So, so that isn't, you know, that's taken as being a potential barrier. So, I think that's a really unique aspect to this.

Dr. Hadjistavropoulos: And you know, it's really valued by clients, we definitely get a lot of very positive feedback about how they wouldn't have gone to see somebody in person, or they didn't have access, so we're definitely finding that clients appreciate having this other way of getting care. It's kind of like a different doorway to care or different pathway.

Minister Hindley: Right. So, maybe just talk a little bit about the history of the program. How is it that this need was identified? What's sort of the timeframe? When did this this journey begin of when you decided to get the ICBT program up and running here in Regina?

Dr. Hadjistavropoulos: So, we started actually 10 years ago. It's hard to believe we celebrated our 10-year anniversary last fall. And really the idea came from the research literature. So, the research was showing through clinical trials that this was really effective. But when we started out, it was really not available to clients in Canada anywhere. And, we were one of the first programs that started this type of treatment program. And we were able to do so because we were able to secure some funding through the Canadian Institutes of Health Research, through what was called a Partnership for Health System Improvement Grant. And what that grant did was it paired up researchers who wanted to collaborate with providers and managers, and policymakers and government, basically to improve mental health care. And, so that's where it all came from.

Minister Hindley: Let's talk a little bit about the users of the program so far. I know you've got some statistics in terms of how many people have accessed the program. It's run out of the University of Regina. And for those that are listening into this podcast that might not be aware of the demographics of Saskatchewan, but we have a very varied province in terms of population fairly sparsely spread out in some regions of the province. But what have you found in terms of uptake from your users? Is there a large number of individuals from the cities, from Saskatoon or Regina that are participating? Or have you had some pretty good uptake from say, rural Saskatchewan or First Nations communities in northern Saskatchewan? What does that breakdown look like?

Dr. Hadjistavropoulos: Yeah, so we do serve the whole province. And last year, we worked with 2,600 clients, and they come from all over the province. And I think that is one thing that sometimes people are confused about, because we're based at the University of Regina, they think that we're just working with clients in Regina. But in fact, they come from all over the province. And in fact, 60% of our clients come from outside of Regina and Saskatoon, and 5% of our clients identify as being First Nations or Metis. So, it's quite a diverse group. And something else that's really interesting is the age range of the clients. It's varies from 18 years of age to 88. So, it's highly diverse. And then the other thing that we see is a lot of diversity in terms of client severity, so about 15% of the clients that we work with, you know, are kind of having very mild concerns. And then about 55% are actually taking medication and would be sort of more severe and about 32% actually report really regular suicidal thoughts. So, it's really a diverse range of clients that we're working with.

Minister Hindley: That's great. So, let's talk a little bit, you described it earlier on, just in terms of helping to describe what the program is, and, and how it works. You know, we've, learned that it's not super techie-based. Yes, it's online, but it's not intensive by any stretch of the imagination in terms of the technology that you have to use, for those folks that might be, adverse to that. You mentioned the online course components to this, and that sometimes perhaps, when some people hear the term online course, that that might be a little daunting for some folks. And I'm thinking, you know, just as an example, and I'm glad you mentioned the age range, and you talked about people from 18 years of age up to 80, because I'm thinking that there's probably some folks that might be thinking, Oh, this is, you know, too complicated. For me, it's been decades since I've been in school, this seems like a lot to take in. And that might, kind of turn them off from going down this path and trying to access the program. Maybe just talk a little bit about the online course portion of it, what that actually entails and what a person can expect.

Dr. Hadjistavropoulos: Yeah, so what happens first of all, is clients go to our website, so it's onlinetherapyuser.ca. And they start off by completing an online questionnaire that provides us with some background information about what they've been experiencing. And then we follow that up with a phone call. And that phone call is really important, because it helps make sure that clients sort of understand what's involved in the course, and, you know, builds rapport with the client. And assuming that they're still interested, then they're given a username and password to log on to the website. And that's actually as complicated as it gets. So, once they're on the website, they can actually download the materials and keep them on their computer and look at them long term like you don't have to be on the computer full time to review the materials. And that's especially important for clients who do have poor internet access. So, they just have to have enough internet access to get on, get the materials, and then they can review them on their phone or computer as they like. And then the other thing that they can do is they can log on, and that's where they would send their email to their therapist. But it's like a basic email system. And if they're really not comfortable with that, then we set up phone calls with them, and yeah, so that's, that's like, as low tech for them on their side. It's bit more technical, when it comes to the therapist side and the types of things that the website does. So, you know, on the therapist side, we have things like the automated messaging, we do have the materials that go up, that get distributed to clients, gradually, over time. There are questionnaires that track clients progress as they go along. You know, we have to make sure that everything is secure and backed up, and we take client confidentiality really seriously. There's a lot of support for therapists so that they know how to best support clients. So, there's a lot of online materials that really support therapists to help clients. And then there's also the data export for us. So, we like to take the data and really understand in this non-identifiable manner, but look at the data to really understand like, what are the strengths of the program? And where could we make improvements. So that side of it, it's a bit more technical, but from the client side, it's actually pretty straightforward. I should also mention that, and Justin's going to talk about this in a little bit. But we spent a lot of time looking at the materials and making them very patient-friendly, so that they're easy to understand to digest, you know, we present information in small bits of information so that it's really easy to understand and follow.

Minister Hindley: Are the courses, and is the program, is it flexible in terms of the client or is there a set schedule? Or do people do they have the ability to, and I think you've touched on this a little bit, but do they have the ability to go at it at their own pace. For so many people, they've got so many other things going on in their daily lives, whether it's, you know, families, or career, or perhaps going to school, any number of things. What's the flexibility in terms of the program and how the client could approach it? And, does it allow for some ability to have some movement, some kind of give and take that way?

Dr. Hadjistavropoulos: That's such an excellent question. There is a lot of flexibility that's built into the program. So, we do have a suggested timeline for clients to work on it over an eight-week period. But within that timeline, so when you're working on lesson one, you can really look at, work on that. And within any time: you could look at that at the night, or during the day; you can break it up into small parts over the course of the week. There's also a lot of flexibility in terms of, even, the content. So, we have some core strategies that we teach. And we think it's really important to go through those, but we also have a lot of additional resources that are there on the side that clients can look at if they like or, or not look at. So, we have extra resources for if you were having sleep problems, or you were having communication problems, or assertiveness problems. So, they're not required, and there's lots of flexibility. And then we also have a lot of stories and examples built into our materials, so that they're very relatable to clients. And we really try and take into account how diverse clients are and present as many examples as we can from past stories of clients who vary in terms of age, and gender, and occupation, the nature of their problems. So, there is a lot of flexibility that's involved in the program that way. At the same time, we do really encourage clients to try and keep up with this on a weekly basis, and to keep working on it because it's really easy when you're, have mental health concerns for other things to take over. And so, a lot of what the therapist is doing is really sort of helping the client, you know, make sure that they're giving their mental health the time that it deserves, because it's so important.

Minister Hindley: That's perfect. You know, I think you really hit the nail on the head there. The flexibility of the program that allows people to, you know, you've got the recommended eight-week time frame, but the flexibility for clients to be able to go at their own pace, any time of day or night, whatever it happens to be that they can, you know, access the materials. And I think that's an important part. And I think that does take away some of the barriers for folks that might not be able to access other mental health services. I think this an excellent program in that regard. You've been involved in this a long time, Heather, and, you know, we're talking today with Heather Hadjistavropoulos, a professor at the Department of Psychology at the University of Regina. Is there been anything that surprised you over the years in terms of the program? You've talked about how it's managed to adapt based on client needs, and we'll talk a little bit about that further in the second segment, when we speak to Justin about how that involvement has been part of the whole process. But has there been anything that surprised you with it throughout this this journey, as you continue to build upon this program and offer it to people across the province, anything that's kind of caught your attention along the way?

Dr. Hadjistavropoulos: So, so many things actually. From the very beginning, we had no idea when we started out how it would be received and how many clients would participate. And then how it would grow over time. And certainly, we continue to see group growth each and every year. So last year, for instance, we had 40% more clients than we did the previous year. And I'd say on average, we're between 30 and 40% growth each year. I think something else that's really surprising to me, is just how satisfied clients are with this type of program. So, at the end of the treatment, the completion rates are excellent. So, about 85% of clients will complete the majority of the materials. And that's a huge commitment, you know, that people put in and, and really are taking advantage of that service. And then at the end, 95% say that they would refer a friend to that service, and that it was worth their time. And that's just so encouraging. I would say the other thing that's so surprising is that when I started off, I really saw that this would be helpful for depression and anxiety. But we really see now it applies to so many different types of issues. So, we've expanded it to work with clients with alcohol misuse. And we've also expanded it to help people just deal with the stress of having chronic health conditions.

Minister Hindley: And we talked a bit about the statistical growth of the program. It's amazing and frankly, very encouraging to hear that, you know, number one, the number of people that go through the program and complete it all the way through, and then in addition to that, the number that say that they would gladly refer their friends and family members to it, that is a great measure of success right there. When you not only get people completing it, but that they would be willing to talk to others about it, to help spread the word whether it's by word of mouth, or through email or on social media pages, or whatever it happens to be just talking to people to make people aware of it. So, I think that's a great indicator of the success of the program right there, don't you think? 

Dr. Hadjistavropoulos: Oh, that means everything. If you're willing to tell somebody else about it, and especially clients who have mental health concerns, who are very often very private, so the fact that they were so impressed with the service and benefited to such a great degree that they're willing to disclose their difficulties and recommend us to other clients. That means a lot, yeah.

Minister Hindley: I'm Everett Hindley, Saskatchewan’s Minister of Mental Health and Addictions. And today we've been talking with Heather Hadjistavropoulos. She's a professor in the Department of Psychology at the University of Regina. And Heather is in charge of the online therapy unit and also what's known as the Internet-based Cognitive Behavioural Therapy Program or ICBT. And we've been learning from Heather today about the, the ICBT program and its successes here in Saskatchewan. We’re going to take a bit of a quick break here and then after the break, we'll come back and talk to someone who's had some involvement in the development of the ICBT program and learn a little bit more about how it works, and where perhaps we might be going into the future. So, we'll be back very shortly.

Loretta O’Connor: Thank you for helping our listeners gain a better understanding of Saskatchewan’s Internet-based Cognitive Behavioural Therapy Program. The program is effective in addressing the needs of a variety of clients, all from the comfort and privacy of their homes and some very far from city centres. The client-centred experience seems to be one of the keys to the success of the program over its 10-year run so far. Let’s re-join Minister Hindley and Dr. Hadjistavropoulos to learn more about the ICBT program and hear feedback from those who have been involved with the program.

Minister Hindley: Welcome back. I'm Everett Hindley Saskatchewan’s Minister of Mental Health and Addictions. We've been talking today with Heather Hadjistavropoulos about Saskatchewan’s Internet-based Cognitive Behavioural Therapy Program. Heather, just before the break, we were talking about some of the statistics and the uptake in the program. Perhaps we could talk a little bit about what's been on everybody's mind this past year, which is, of course, COVID-19 and the impact that the pandemic has had on people's lives. And perhaps, if you want to talk about the role of the ICBT program with respect to COVID-19, and the pandemic that we're all facing.

Dr. Hadjistavropoulos: Yeah, for sure. So, first of all, I was so pleased that we were up and running for the past 10 years to help clients, when COVID-19 public health measures came into place, because so many people didn't have access to mental health care. And this was something that was readily available. We didn't miss a day of taking new clients on. And we've certainly seen a lot of growth in the past year. We see growth every year. But, you know, this last year has definitely been our, our biggest year of growth. So, for example, in January, we had about 250 new clients who started with us. So, it’s definitely had an impact on our client volumes. And what we've learned during that time is that the same skills that work for dealing with depression and anxiety and stress, general stress, really worked for dealing with COVID-19 stress as well. So, what we're really trying to do is help clients be aware of their emotions, and what's going on and the role that your thoughts can play, and how you respond to stress, and also the importance of behaviours and responding to stress as well. And so, the same strategies that we would normally teach prior to COVID are the same strategies that that helped with dealing with stress of COVID-19.

Minister Hindley: Something that I don't think we've touched on much yet is the importance of partnerships. And with this program, and the history of the program, and where the materials were developed, and how it ended up here. But I imagine it's probably safe to say, Heather, I think that the partnerships were key in order to make this program successful, and there are a lot of pieces that are involved to make it work. Would that be correct?

Dr. Hadjistavropoulos: Yeah. So, when we started out, we, we started right away with partnering because we felt like we could, take advantage of research that had already been done, and not sort of start from scratch. So, we collaborated with some groups in Australia. And then over time, we've expanded those partnerships. So, we now have partnerships with groups in Switzerland, Sweden and Australia, and all of these groups are working on the same topic. So, we're really trying to help and support each other. So initially, we brought some materials here, and then we, looked at adapting them to Saskatchewan and for use in Canada, and then also building on them. So, adding extra stories and examples and new content. And then it's very collaborative and back and forth. So, as we develop materials, we share them with Australia, and they do the same. And so, it's just really, making use of information that exists in other places and not trying to start from scratch. You know, in that case, two heads are definitely better than one. So, working together is definitely helpful.

Minister Hindley: That's such a great approach. I think, I think you're right, you know, we talked about best practices and looking at what other jurisdictions, and other countries are doing and looking at what we can pull back and use here in Saskatchewan, you know, tweak it to be more of a made in Saskatchewan solution. But I think that's positive to hear that feedback so that jurisdictions can look at this and perhaps look to Saskatchewan’s programs and look to see what are some of the things that we've done here in this province and perhaps how we can apply that in other provinces and territories across Canada. So, I think that's a very positive aspect. I'd like to at this point now, welcome another guest to our podcast to give us some additional insights. Justin Waldrop, who has been a big part of the success of the ICBT program here in Saskatchewan. Welcome Justin to the program today.

Justin Waldrop: Well, thank you very much for having me. It's a very, very big honour.

Minister Hindley: Looking forward to some of your insights, as you've been involved with helping to develop the program here. So perhaps to start off with, let's just talk a little bit about why it is that you decided to get involved with the ICBT program, and what exactly is your role?

Justin Waldrop: Yeah, so about six years ago, my friend, Nicole, was involved with the online therapy unit and she emailed me and invited me to join what was called the advisory community panel for the online therapy program. And it was because of my marketing and communications experience at that time, and she also thought that my lived experience in mental health and addictions could be useful. And so, I started off, really attending meetings, really looking at things primarily from a marketing and communications perspective. And as time passed, and, and we got to know each other more, and we had more meetings, I started to open up a lot more about my shared experience and insights, I guess, as related to mental health. And I would say that both these roles have come to mean a lot to me, and they hold equal value. And I'm really grateful to be able to participate in two ways, I guess you could say, every time we get together. And I just really wanted to assign some meaning to my lived experience, you know, it's been a difficult life with a lot of abuse and trauma and addictions. And I live with bipolar disorder. And it's, it's not easy to manage all these things, sometimes you don't quite understand or see how everything you've been through can maybe help you in life, sometimes you’re so just wrapped up in it. And so, when you get to sit on a committee like this, and people value you and see your experience as an asset, it begins to create purpose for you. And so, for me, that's what it has meant. And I wanted to be part of something that was new and innovative and ground-breaking.

Minister Hindley: So, from the client’s perspective then, what would you say would be some of the key benefits of the program? You bring some valuable insight to it, as you've just described here, but if you perhaps could expand upon that a little bit. If you're a client looking at this program, perhaps you're listening today and your interest is piqued by what's being talked about, what are some of the most important benefits for clients that would be going through the ICBT program?

Justin Waldrop: Well, I think, as Heather alluded to previously, online therapy really provides people with another avenue, another pathway to seek help and treatment for their further issues. Especially if they're not really people who like to do in-person therapy or group therapy, or want to get involved in, say, 12 step programs, if they have addiction issues. There are a lot of folks who respond really well to kind of an independent treatment path where they work on things themselves in their own way and at their own pace. And then they’ve got an online therapist that they can touch base with weekly, and then they kind of keep going. And so, this provides just yet another mode modality for folks to get help. And I would say the biggest thing that clients will probably get from these programs, any of the online programs they take, with this particular program, is they're going to see an increase in awareness about their thinking and their issues and their behaviours and their triggers. And this is going to create an ownership over their mental health. And that's going to facilitate empowerment for them to recover and heal. And it's going to be raw, largely self-directed.

Minister Hindley: And you know, what that kind of leads into my next question, I'm glad you pointed out, I was going to ask you, what sort of a difference does that make in a client’s everyday life. And I think you just sort of touched on it right there, when you talked about how increasing awareness and how it helps gradually build a client’s self-confidence. But you mentioned the word awareness, but I think that it just gradually helps day in and day out, as you go through the program. Would that be correct?

Justin Waldrop: Well, yeah. So as, you know, obviously, as they work through the modules and through the eight weeks of the program, it starts off with generating awareness and then it really gets people to kind of look at what are the issues? And what are the things triggering you? And what are the maybe not so helpful behaviours and thinking you engage in. And then it moves into how can we change that and replace those thoughts and behaviours with things that are probably more constructive. And then they usually provide resources as well with most of the programs. And as Heather explained, folks can download these things and keep these things forever. And so, you know, I think the way it helps people in everyday lives, is it lets them know they're not alone in their struggles and there is a free accessible help at their fingertips. And it certainly helps them build that awareness. And I think it also gives people a lot of agency to, to realize that they can seek help for themselves and take care of themselves.

Minister Hindley: You hit on a good point there actually, and we didn't mention this earlier. But what's the cost to the program for the client?

Justin Waldrop: The cost is free. It's the best cost. And yeah, you can't beat that. I mean, so that's another thing, that's an amazing benefit to therapy like this is high quality, cognitive behavioural therapy, done via the internet. But you're looking at an average of $140 to $200 an hour if you go see an actual therapist, and sure, the reality is, is not everybody can afford that or have health plans that cover these things. And so, this is certainly a really wonderful program that is out there for folks that offers very high-quality therapy for them.

Minister Hindley: So, the program has been around for a number of years, as we've talked about, is there anything that's, you know, surprised you over that timeframe in terms of how it's unfolded, anything that's, you know, jumps out at you, that caught your attention along the way?

Justin Waldrop: Well, I would certainly agree with Heather on the exponential growth of the program. We receive monthly reports, all the statistics about the program, and we meet monthly. And for the six years that I've been involved, it's just been phenomenal to watch the growth and enrollment and the interest in it and also the growth of the program itself.  And like Heather said, when we began it was you know, depression and anxiety and then we moved into chronic health conditions, and then we moved into alcohol misuse, and then sleep disorders. And just so many different courses and ways to help people. And I've ran into a lot of people who have used these courses, and they praise them, and they say they were so helpful, and they were so appreciative that that resource was there for them. And so, it's really wonderful to know, actual people that have been through it and found it very helpful. And then I guess on a personal level, what surprised me was just being involved in the last six years, it actually helped me to see my value and worth in my lived experience, and that it can be an asset and not just a deficit. Yeah, and I'm very grateful.

Minister Hindley: And Heather talked about this earlier about, you know, the high rate of referrals coming out of this program, and the people who've been through it, clients who've been through it and talked to have highly recommended it. And, you know, I guess as someone who's directly involved with the program, you know, why? Why is it? Why would you recommend this program to people who might be struggling? What, what might be the benefits o this? And as we've talked about it, there's a whole suite of programs and services out there and it's not a one size fits all approach by any stretch of the imagination. And it's great that we have, we have things like the ICBT program out there. But what would you say to someone who's contemplating looking for help, that might be looking at this program? What would you say to them? You know, why would you recommend this to people?

Justin Waldrop: Well, you know, I was thinking about this. The first thing I would say to folks out there as minimal barriers to accessing the suite of our online therapy courses, and they're free, they're online, and the application is quick and straightforward. Another thing is that people can work at their own pace, as Heather was describing, and receive some support and check-ins from online therapists. And I would also say that online therapy, well, I mean, any type of therapy really, but online therapy does allow people to investigate their own mental health and decide how they will recover safely and independently. And I really think that this helps increase awareness more so. And it teaches them tools to manage their own mental health. And as we all know, quite often, when you're dealing with addictions, or mental health diagnoses, or just you know, anxiety or stresses of life, these are ongoing things, lifelong things and I think internet behavioural therapy, it either can provide a solid foundation for folks who've never had therapy before. Or it can be a really excellent refresher for people who have received therapy in the past. And so, either way, if it's kind of the first time or maybe a refresher for them, it just really arms people with a really solid foundation from which they can go forward and keep, you know, healing and recovering from the issues that they're dealing with.

Minister Hindley: And something else that I think is important is how the program has adapted over the years. We were talking offline a little bit beforehand about the patient or client perspective and, and how you have that involvement from the client and the clients can say, you know what, I went through the program, or I'm going through it right now and this is great, but maybe we could try something a little bit different here. Could speak to that a little bit? How would you use the client perspective to help make that program better?

Justin Waldrop: I have to really praise Heather and her team, because they engaged in what is called a patient partner model, for doing the research and designing the courses. And, you know, I think it's been the experience of a lot of people in life, that they're invited to participate in an advisory panel or a committee, and then they don't really get a voice at the table, right? Really, they're there just to be there right? Just maybe some tokenism or to represent someone but that's about it. I want to give a lot of praise to Heather and her team, because they not only invited a lot of us with lived experience to become patient partners, but they truly respected us. And integrated our viewpoints and our experiences and our feedback into pretty well, every single aspect of the programs, whether it be research, or content, or imagery, or wording or format, or, you know, structure or feedback forms or what have you. They were so willing to suspend their own viewpoints and maybe even egos at times, I think, you know, you got a lot of PhDs and master's degrees sitting in the room, but they listened to us so well and validated us and made us feel very, very much part, like partners in this like 50/50. And, and so as a result of that, you ended up with, for sure, the alcohol misuse course, for example, you ended up with content that was worded in a way that was safe, and positive and warm, and compassionate and gentle. And you ended up with images that were more uplifting and positive. You ended up with concepts that that they didn't include, but we knew from being in recovery from addictions should probably be included. So, they were just so open to including a lot of things, and it produced a much more comprehensive, compassionate and relevant course. It was just such a wonderful experience to be part of, part of a committee where you actually truly had a voice, and you actually had a seat at the table.

Minister Hindley: And I think the benefits of that are obvious in terms of the success rates that we've talked about today, and just how well regarded this program is so I think that is such an integral part of the program. As we get closer to closing the podcast, I'd like to ask both of you for your final thoughts about it. I'll start with Justin and then we'll go with Heather. Justin, just finally, thanks for taking time today. But if you could just perhaps say what motivates you to continue with this program, your involvement, and what is it that makes you so passionate about the ICBT program?

Justin Waldrop: Well, as I've kind of alluded to, I think it's really essential to convey to the world that people that live with mental health and addictions issues, and have that lived experience, we cannot only be advocates, but we can also be equal partners in mental health. And that's certainly something that's demonstrated by this program is we have a lot to bring to the table. And our online therapy courses are created using the patient partner model. And this reflects the truth and voice of the people that want to help and that is those people living with mental health and addictions. And so really, this program creates inclusivity and compassion in everything that we do. And this is very fundamental in recovery. And that's one of the reasons why I am a part of this program is because that compassion that inclusivity and that sincerity, that is there every day, every meeting every interaction that I have with this team.

Minister Hindley: And Heather just to wrap up with some closing comments from you, what do you think is, you know, from your perspective, being involved with this program, directly as you have been for a number of years here, what's the most important feedback that you've received the all those years?

Dr. Hadjistavropoulos:  Ten years of feedback to sum up but first I just want to say thank you so much to Justin and his very kind comments. It's so heartwarming and it's really, you know, feedback from Justin and also all of our clients that keeps us really going. And, you know, what we're hearing from clients is, it's having a positive impact on how they feel. But mental health has a ripple effect. And so, we really see them also talking about, it not only makes them feel better, but it ultimately has a really positive impact on their family and friends and colleagues and the community as a whole. And I think that's the most important thing that we've learned is, you help one person but you're really, you're helping so many other people by helping that individual.

Minister Hindley: And maybe just before we sign off, maybe just remind our listeners where they can access more information about the ICBT program.

Dr. Hadjistavropoulos: Yeah, so please just visit our website. It's www.onlinetherapyuser.ca.  And that's all one word. So onlinetherapyuser.ca. And we are very happy to have you there. If you come to the website, we have all sorts of information that explains more about the program. There's a short video that you can watch. FAQs or frequently asked questions. Just reach out. We're here to help.

Minister Hindley: Thanks so much, you two, for your, for the opportunity to have this discussion today. We were joined this afternoon by Heather Hadjistavropoulos, a professor in the Department of Psychology at the University of Regina who's in charge of the online therapy unit and Saskatchewan’s Internet-based Cognitive Behavioural Therapy Program, ICBT. And as well, Justin Waldrop, who has been a big part of the success of this program as well. So. Heather and Justin, thank you so much for your time today. And thanks for everything that you've been doing.

Thanks so much for the opportunity. And for everyone that has tuned in. Thank you for listening to this podcast to learn a little bit more about what we're doing here in Saskatchewan and as Heather mentioned, for more information on Saskatchewan’s Internet-based Cognitive Behavioural Therapy Program, simply log on to www.onlinetherapyuser.ca.

Loretta O’Connor: That was Minister Everett Hindley and Dr. Heather Hadjistavropoulos, joined by Justin Waldrop. Thank you all for sharing some of the success that the ICBT program is having in fostering mental wellness in Saskatchewan.

Join us next time as we head next door to Manitoba to discuss their use of Rapid Access to Addictions Medicine Clinics -- better known as RAAM Clinics. Each RAAM Clinic is an easy to access, walk-in clinic that people can visit to get help for substance use without an appointment or formal referral. RAAM Clinics have been successful in providing patients with the ability to receive assessment and counselling, be prescribed appropriate medication and be directed to community treatment programs. The RAAM Clinics are a big part of the Manitoba government’s continued commitment to improving addictions services for the people of Manitoba. So please join us again to learn more about another promising practice in the area of mental health and addictions.

 

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