A Podcast about Mental Health and Addictions
Episode 4: Ontario
Episode 4: Tele-Mental Health Service for Children and Youth (ON)
April 14, 2021 – This initiative provides Ontario children and youth in rural, remote and underserved communities with access to specialized mental health consultations through videoconferencing. It connects children and youth to a specialist who can help them.
Loretta O’Connor: Welcome back to Promising Practices, a podcast on mental health and addictions brought to you by Canada’s Premiers. This is our fourth episode of sharing 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 Ontario. Located in Central Canada, Ontario is Canada's most populous province with more than 14.7 million people. Residents of Ontario may have different experiences in how they access mental health and addictions supports and services. Regional and socio-economic variations, for example, can impact how services are received.
Today, we are going to hear more about Ontario’s unique experience with the Tele-Mental Health Service. This service was originally introduced with a focus on northern Ontario, a more rural and far less populated part of the province. It has subsequently been enhanced and expanded across the province to address the issue of limited access to specialized mental health expertise, particularly child and adolescent psychiatry. First, let’s hear from the Premier of Ontario, Doug Ford, and the Associate Minister of Mental Health and Addictions, Michael Tibollo.
Premier Doug Ford: Hi everyone. I'm very pleased to partner with my fellow Premiers across the country on the Promising Practices podcast series, led by my friends, Premier Silver of Yukon and the Premier Moe of Saskatchewan.
I know the COVID-19 pandemic has been tough for many people. Now more than ever, it is critical that we speak out and help break the stigma around mental health and addictions. It can affect anyone, our family members, our friends, our co-workers, and even ourselves. As Premier of Ontario. I want to make sure there's always someone there, who is ready to listen and provide help to those who need it.
We're working hard to ensure that every Ontarian has access to the right supports to meet their unique needs, when and where they need them. That's why we developed the Roadmap to Wellness plan, which aims to build fully connected mental health and addiction systems across the province.
Today, we'll be talking about Ontario's Tele-Mental Health Service. It is truly an incredible and innovative program that helps connect children and youth in rural and remote underserved communities with the help and support they need, so that no matter where they are in our province, they can get help. I want every single person listening to know you're not alone. Together, let's keep working to end the stigma around mental health. Let's continue to speak out, ask questions and share stories and promising practices like we're doing today.
Today I'm joined by minister Michael Tibollo, Ontario’s Associate Minister of Mental Health and Addictions. Michael's an absolute champion. He's been doing an amazing job leading our efforts during this critical time and working directly with those on the ground and communities across Ontario. So, Michael, tell us more about it.
Minister Michael Tibollo: Hello, I’m Michael Tibollo, Ontario’s Associate Minister of Mental Health and Addictions. It is encouraging to see a growing awareness and improved support for people with mental health and addiction challenges. The statistics on mental health are clear – half of the population will have or have had a mental illness by age 40. This illustrates how serious a health issue mental health is in our province. We know that over a million Ontarians experience a mental health or addiction challenge each year. And the COVID-19 pandemic has only presented us with new and more complex challenges.
During these difficult times, we recognize that no one person is the same in their response to stress, anxiety and other mental health concerns. The small business owner struggling to get by in the face of a global pandemic…the long-haul truck driver feeling isolated from friends and family…and the grade 11 student struggling with his or her studies. Each of these individuals has unique needs. Matching them with the most appropriate services and supports, as close to their community as possible, will make a real difference in their lives.
That’s why our government is investing $194 million in emergency funding for mental health and addictions services and supports, which is already supporting over 62,000 Ontarians in every corner of the province. Prior to the onset of COVID-19, we launched a new comprehensive plan to address gaps in care and build a connected mental health and addictions system. Called Roadmap to Wellness, this plan reflects the priorities I’ve heard again and again through conversations with frontline mental health and addictions workers, experts and individuals with lived experience and their families. Our plan provides a clear path forward to addressing long-standing concerns: wait times have been too long, and for too long, people have been left on their own to navigate a complex and fragmented system.
People have faced many challenges when seeking help and have found it difficult to understand who they should be reaching out to for that help. Our government continues to deliver on our plan by committing an additional $175 million through the 2021 budget for more mental health and addictions support. We are now providing a total investment of $525 million in net new annualized mental health and addictions funding, something we have been doing since 2019.
This funding is being used to create four new mobile mental health clinics to provide a full suite of mental health and addictions services to people living in remote, rural and underserved communities… and we continue to expand mental health and addictions programs for children and youth, post-secondary students, first responders and veterans. We are also investing in a crisis call diversion program, to offer immediate support for individuals experiencing a mental health crisis. To fully implement our Roadmap to Wellness plan, we have committed $3.8 billion over 10 years to create new and innovative services, and expand programs.
The Tele-Mental Health Service in Ontario is one of these unique, long-standing services, which will be discussed in detail today. This important, innovative approach supports publicly-funded, community-based mental health services for children and youth in rural and remote areas in our province. This service aims to keep children and youth who need mental health support in their communities – by accessing resources close to home and receiving services from local providers, as well as preventing them from escalating into crisis. We know that the best results are achieved when services and supports are delivered directly in an individual’s community.
And we are making steady progress with our plan. We are on track to deliver real and meaningful change that will ensure people of all ages can be fully supported in their journey towards mental wellness. I am pleased to be taking part in this original Mental Health and Addictions podcast series. It allows us to showcase the incredible work being done in our communities to improve the delivery of effective and safe mental health and addictions care to individuals and families across our province. Thank you.
Loretta O’Connor: That was a great introduction to the innovative program that we are profiling today. Here to tell us more about Ontario’s Tele-Mental Health Service for children and youth is Dr. Tony Pignatiello, who has been the Medical Director of Tele-Mental Health Service since 2004 and works out of Toronto’s Sick Kids Hospital. We will also be speaking with Marc Williamson, a registered psychotherapist who has worked out of Algoma Family Services since 2003.
Shawn Fenton: Today, we are joined by Tony and Marc. Thank you, guys for joining. To kick off today's discussion, I just want to ask each of you what your role is within Tele-Mental Health Service. And if you could speak a bit about your professional experience and let the listeners know why you do what you do.
Dr. Tony Pignatiello: Sure, thanks very much. I'm Tony Pignatiello. I'm a child and adolescent psychiatrist. And from the Tele-Mental Health perspective, I am what's called the Medical Director of the central hub of the provincial pediatric Tele-Mental Health Services operating out of Sick Kids. In addition to that, I am also currently the Associate Dean of Health, Professional Student Affairs for the MD program at the University of Toronto. And as far as the program goes, I've been doing this work with Tele-Mental Health Services for over 20 years. And I've been the Medical Director of that for the last 17 years and seen the program grow and have a few different changes over time to its current state. And it's been really interesting and really exciting to be part of the program and watch it evolve over time.
Why do I do what I do? Well, I'm a child and adolescent psychiatrist. So, my focus has been on supporting kids and families and caregivers, that's my clinical area of focus and interest. I’ve always been interested in access to services as a child and adolescent psychiatrist. I've always recognized that there's just not that many of us to go around and there never will be. And so, we're a limited resource. And we have to do things in creative and innovative ways to try to get to as many people as possible. And when the opportunity for this program came along, it made sense with what I was looking to do, and to help build that access. And at that time, so 20 years ago, the whole concept of using video-conference, to deliver children's mental health services, or in any in medical care at all, was new, and hardly anybody was doing it. And I thought it was a really exciting opportunity to look at doing something different and do something outside the box that hopefully would make a difference on a longer-term basis.
Shawn Fenton: Thank you for that, Tony. I just wanted to now turn it over to Marc. Go ahead.
Marc Williamson: Hello, everybody. I'm Marc Williamson. I work at Algoma Family Services in Sault Ste. Marie, Ontario, way up north, in the region of Algoma. I've been employed with the agency since 2003, initially in the capacity as a case manager, and since 2006, as a counselor-therapist. I'm excited to be here to discuss about this service that one, I utilize a lot and I benefit from, but more importantly, my clients, the people I work with, they benefit from. Why do I do what I do? Primarily because I get an opportunity to help and support people. I think that's just an honourable thing. And I feel honoured to be able to do that.
Shawn Fenton: Thank you very much, Marc. And I just want to turn it over to Tony. I know Tony, you mentioned earlier about how Tele-Mental Health Services kind of developed about 20 years ago. Could you just speak to what makes it innovative and how it's different from other telemedicine services?
Dr. Tony Pignatiello: So, if we go back 20 years, one of the things that made us different is that hardly anybody was doing it. I know situations where people might have gone as far as purchasing video conferencing equipment, and then leaving it in the boxes and not actually assembling it and not using it and not knowing what to do with it. So, at the beginning, I would say that we were among the pioneers in terms of taking this on and working with it, and developing guidelines, and piloting different things out in different models of service delivery.
It was really, really exciting to make our way through this. And the other exciting part was to try to spread the information, spread the knowledge and foster uptake of this modality. It was really important because in the rural and remote communities that we service, prior to this, there really was very little available for children and families and caregivers to access in terms of child psychiatry or other children's mental health specialist services. So, it was also really exciting to make those relationships, to build those connections, and to work with communities that did not have access and build us into the point that that we become a mainstay. It's no longer an afterthought. We're just part of the business as usual. It’s been really exciting to be part of that and make that happen.
Before the pandemic hit. when we looked at the utilization of virtual care and children’s mental health in particular, across the province, only 1% maximum 2% of the visits were done virtually. So just by 20 years of trying to promote and market and be pioneers with it. There had been very little shifted in terms of changes to practice, and truly incorporating virtual care into practice. With the pandemic, there was basically virtual care propelled ahead probably 50 years, and now everybody is doing some form of virtual care. And so, what that's meant for us and why we're different. We've just been using that technology for 20 years. So. making the shift over to using the technology to work with patients and clients was no major shift. There was no major transition. We've had to look at using different types of technologies and make different shifts in terms of how we connect with our patients and clients as is everybody else. So, whereas our program was always focused on kids and families coming into agencies to meet with the case manager, to connect with us through equipment at the agencies, now the shift has been towards working with kids and families in their homes or in other situations. So, in that aspect, now, we're not different than anybody else. Everybody who's doing virtual care is doing it in that way right now. So, we're not unique, we will always be the pioneers, but we're not unique that way.
What is unique about our program, though, is that we are essentially a consultations kind of shared care model, where we support the primary care providers in the communities to stay where they are. So, primary care providers are folks like Marc and the agencies that we work with: physicians, schools, youth justice situations. And so, we work with the primary care providers so that they can do what they do within their community, so that kids and families can stay in their communities and they don't have to travel a day or two days or lose time to access the services.
We also provide education, skill-building capacity, building various types of indirect consultations, with the people that we work with. Then, we have the advantages of having people who have a variety of areas of interest and expertise. And so, we can address pretty well every issue that comes forward. And so, for somebody who's looking for agencies or communities, they're looking for services, they have the benefit of essentially a one-stop shop where you put in a request for referral, and then we take it from there and, and provide what's needed to match that. So, a little bit different than someone or an agency that's looking to do a one-to-one kind of contract with a consultant, and then everything is dependent on that contract.
Shawn Fenton: Thank you for that, Tony. And I know that you touched a bit about how COVID has really affected not only Tele-Mental Health, but all services across Canada. And I just wanted to turn it to Marc. With Algoma being in a coordination agency, I just wanted Marc, if you can provide some information on how COVID has really impacted your area of work and how you've seen that really with boots on the ground?
Marc Williamson: Well, I can speak from the perspective as a therapist working with children and families that being able to continue to provide service through COVID-19 and all the different sort of up and downs in terms of shutdowns and being open – that services have been able to continue using virtual mediums. And I think that is amazing how adaptable, you know, the clients I work with, are to using these and to learning how to use them. And they're grateful and I'm grateful as a therapist to be able to have continuity of service in a safe manner. So that's been an ongoing shift.
Shawn Fenton: Tony, I just wanted to give you the opportunity to – if you had any thoughts – to continue to speak on how COVID-19 has really impacted your line of work and how you've seen that through Tele-Mental Health Service.
Dr. Tony Pignatiello: The way that I would say … it's obviously a number of ways and I would start actually with the kids and youth and their families, and in what we've seen and you know, certainly as we all know, rates of anxiety, even rates of abuse, and neglect, those have all been going up as a stressful time for everybody. Yeah, we look at some of the families that we connect with, in some situations, you just kind of are in awe of how they manage, you know. A particular situation comes to mind of a small community with a single mother with, with two children in the household. And she has to work because she's in a service provision industry that didn't allow her not to, and in the small community where there are not a lot of opportunities for assistance with childcare. And so, trying to manage work, being at home, children with mental health needs, now having to homeschool for a period of time. And in situations where you know, she would have to pack up the kids in the car to take them to work with her to do what she needed to do. And then you hear those stories, and your heart goes out to them. And because you know that you can offer some support through talking. But in terms of the on-the-ground kind of support is very difficult, especially when you're operating from a distance. Communicating via technology was not the issue, because that's what we do on a day-to-day basis. But it was suddenly having to adjust and move to some new modes of connection, to having to be creative, to situations where you have the case manager or the therapist who cannot be at the same place at the same time with the client, and you're doing multi-point connections, and in figuring how to manage potentially high-risk or emergency kinds of situations. And I think it's fair to say we're in an okay place right now. We've all adjusted and made the move over. But I think quite honestly that we're all just waiting for things to settle down, so that we can then figure out where we're all going to land and where this is all going to fit in and how this is going to fit into our lives going forward.
Shawn Fenton: Marc, I've seen you with a few head nods. So, I just wanted to give you the opportunity to kind of comment on some of the things that Tony has been sharing and what you've seen through your lens.
Marc Williamson: You know, I think Tony just brought up some extremely valid points, you know, the resilience of the clients we work with. And also, you know, the challenges from the client standpoint, but also with us with the extended care teams that work with them, and the challenges they face on so many levels. And I think Dr. Pignatiello just outlined that so well, you know, economically, geographically … particular family situations. Yes, absolutely. That just really brought that point home, and that weren't part of different parts of the support teams that go in, and all the pieces are so important. And that's when we talk about Tele-Mental Health Services, you know, what an integral component of that of an extended care team for the people we work with. So, it's a really valued service.
Shawn Fenton: And then I just wanted to kind of shift and ask a question, just concerning some of the implementation challenges that you've seen over Tele-Mental Health. Um, what were the most significant implementation challenges? And how did you address them?
Dr. Tony Pignatiello: Quite simply, honestly, the biggest challenge that we used to come across more at the beginning was getting no, as a response. You know, when you’d have an idea and you say, well, let's try this. Let's try that. And, and it was not unusual to get no, can't do that. Well, why can't you that. Because we don't do that. Because we don't know how. Honestly, I'd say the readiness and the mindset was probably the biggest challenge. I think it's still remained one of the biggest challenges in terms of limiting the growth of the uptake. Once you get past that initial No, then really, you're just limited by your imagination as to what you can do with it. And what you can try. Having predictable, sustained funding at a Ministry level has been critical in a number of other programs over the years that really never make it out of the pilot phase. And really, because one of the big things is the funds run out. So, having ministry support and dedicated funds and commitment to the program has been a huge enabler of the success and sustainability of the program as a starting point.
I think then, what was after that is the importance of having like-minded people who share a common goal and vision, and you develop that team, and you develop those relationships locally and across the province, has been absolutely a requirement. As you know, we've seen over the years, that the tele-psychiatry probe or virtual care program is not one of those situations where if you build it, they will come. And we certainly seen situations where we built it, and they didn't come in. But they only started to come when we actually started to work on those relationships. We see that in particular with our Indigenous colleagues. And that, you know, we need to be ever-present and work with the elders and work with the communities and understand the needs. If you don't have those first elements of the secured funding, and the relationship and the commitment and the shared goals and vision, the rest of it just won't happen.
Marc Williamson: I'd like to follow up on what Tony said there. You know, I think it has greatly benefited not only myself in terms of my skills as a therapist, but ultimately the clients. That this was just the way it was at Algoma Family Services and we were able to avail ourselves of that. So, we had early buy-in, or I did personally.
Dr. Tony Pignatiello: I would add to that, too, you know, it's been really, really rewarding to see, you know, Marc talks about the early buy-in in all our original agencies that, you know, it started with us as a pilot. And at the very beginning, and they're still very active partners with us. And it's really exciting and encouraging to see that we haven't met many people in person, I feel like we have this bond that we are part of a larger team, and it feels like they literally are just in the next room and not, not miles away, or kilometers away.
Marc Williamson: Absolutely. Because right now, when we're on a screen with clients, we could be just about anywhere. That whole issue of proximity, in my opinion, oftentimes just evaporates. Even a lot of the mediums we're all using now, simultaneously so.
Dr. Tony Pignatiello: And I have to say the other thing that's been really great to watch is the improvement in the technology. So, early days, it was dial-up Internet – that recognizable beep and blaring, and an unpredictability of the connection and the cathode-ray TVs with the awkwardness with them. And it's been fascinating to watch the technology shift and improve and become more nimble and easy to maneuver. The number of times that we can't have a connection for a technology-related to reason is negligible.
Shawn Fenton: Now, I think one thing that was said with proximity first thing came to my mind in terms of communities has been unfortunately, how proximity has been where the Indigenous communities have been affected. So how does Tele-Mental Health Services support Indigenous communities in Ontario? Is there a separate culturally-safe service available and how does the service align western medicine with cultural healing practices?
Dr. Tony Pignatiello: So, we recognize that we have a really unique population, So, we have the Francophone populations, we have suburban rural, remote and Indigenous communities and populations and the way that the program is structured through these concept of coordination agencies, they're such that across the province, there are three coordination agencies specifically for our Indigenous colleagues and partners. I mean, all our consultants have received the training on cultural psychological safety. Within our group of consultants, we have a subgroup who would have spent time working and being in person in the various communities, as consultants. We also take the approach of – we're there to learn from our clients as much as we're there to provide information. And so, there's situations where we need to take that inquisitive approach, we need to understand what it's like, we need to understand how words, for example, hallucinations are translated or understood by Indigenous clients. We need to work through our case managers who act as not sometimes just interpreters of vocabulary or conversation, but also as cultural interpreters.
Marc Williamson: The one part I think I can speak to of that question, and that we have Indigenous staff at Algoma Family Services that actually work with the Indigenous communities locally, and they access the Tele-Mental Health Services. They are our liaison to the services. And I think that's almost the limit I can speak, but we have definitely a community of workers that work within the communities in our region that access the service, and make full use of it. And they're the advocates in terms of what their clients need.
Dr. Tony Pignatiello: To add to that to, you know, the on the ground advocacy, and paving the way is also critical for us to get to the point where we can be, if you will, invited into the communities and invited into the homes.
Shawn Fenton: And I just wanted to pivot to have a conversation on the clients those that that really matter. Well, how does Tele-Mental Health Service really benefit children in youth?
Marc Williamson: Really good question. Accessing, you know, this service, I've seen a shift from my perspective, which is frontline, that oftentimes early on, you know, we talked about having a sort of a single consultation with a psychiatrist, sometimes there was a follow-up. But as I remember, looking back to the beginnings of my career, oftentimes it was a single time with recommendations, pharmacological medication and otherwise treatment. But really seeing that shift and change. It's really a normal part of the process now with the involved psychiatrists, that the clients and myself as their support, you know, that's the right way, right? It's not the tail wagging the dog, by any means. We're there to support them, that it's a process where we can, again, fade in again and have a follow-up consultation at another point. I'm not saying it wasn't available, looking back, you know, 15 or 10 years ago. But now it's almost embedded as part of the process that's driven by the involved psychiatrist. And also, post-consultation debriefing with the client, with the child, with the caregiver, whomever that may be. If it's a psychologist, depending on the need, whoever's part of that team who took part, the debrief process, you know, how are we going to follow up? What would that look like? I mean, it's so rich, for your view, and looking forward, to really optimize that experience for the client, ultimately.
Dr. Tony Pignatiello: So, the client could absolutely be the child, youth and their family and what's been the impact at that level. I would say, honestly, the biggest impact that I would say is around access. We have situations where kids and families would not have been able to access a psychiatrist or specialist mental health service provider, because of distance being one of the biggest factors. You know, being in rural and remote communities, you either have to wait for somebody to maybe fly in every six months for a quick visit or not have anything, or wait longer, or families having to pack up to make the big trek down to Toronto, London or Ottawa and take three to five days off of work. And what we aim to do is help enhance the confidence and competence of the primary care providers, you know, who are sometimes working with children, youth and families in your complex and high-risk situations.
Shawn Fenton: Even for those that may be listening here and thinking how Tele-Mental Health Service could be a benefit to you. Marc, I just turn this question over to you and ask if you could briefly describe a bit about the process on how someone could access the service. Could you just walk us through the client pathway?
Marc Williamson: The pathway as known to me because I can speak from the I position. Well, through our agency and obviously there's other agencies in our region that can access. We are definitely you know, this sort of coordinating agency, but they make referrals to us. But I know there's physicians, pediatricians, other service agencies that access mental health departments through school boards can access. But how I do that is in consultation, clinical consultation, which happens with all clients. This is a very fast acting service. It's expedient you know as part of an overall assessment. We could be looking at, you know, a referral to us for a psychological assessment, which could take up to a year to occur internally. But we can also access in the interim, not instead of, but and also, a psychiatric consultation. Consult with a psychology department. What measures should we complete to support the questions we're asking? Define the questions we’re asking and what the client would like answered, put all that together. And I know, usually I can get contact back within two weeks to four weeks, we have a date.
Shawn Fenton: So, Marc, I just wanted to tap into some of your experiences over the years. So, could you just tell me, what are some of the biggest challenges that clinicians and caseworkers experience when trying to help children and youth in rural and remote communities?
Marc Williamson: I think part of the challenges are that, you know, there's not only a dearth of accessible services, but we have to almost perform as frontline therapists, as a Swiss Army knife, because in many cases, we're the whole show, Okay, we’re the one individual, one agency able to provide. And that's where the infrastructure support is needed, in terms of training, consultation, having to wear multi-hats isn't just okay. Well, now I can refer to this other agency. That's their specialty, but we have to be very eclectic. So, accessing Tele-Mental Health, client consultation, but as well as training opportunities are invaluable.
Shawn Fenton: So, Tony, I just have a question for you. Could you just let the listeners know, what is the Tele-Mental Health provincial education program?
Dr. Tony Pignatiello: We have, essentially three core service delivery offerings. One of them is the education program. And so, what it is is education, if you will, professional development for primary care clinicians, whatever their background maybe. This was initially something that's always been there as part of the program right from the beginning. When we were a single hub of Sick Kids, we worked with the designated agencies that were assigned to us. And then as the program has expanded to include the three hubs, we expanded this to a provincial approach. Programs of education are customized and tailored to request some demands that we do, sometimes a one-off education session. Typically, we prefer to do a series of three to four sessions where one builds on information from the previous one and, and we really emphasize making them as interactive as possible. And then I should add, there's no charge for them. That's all covered within the budget of the program.
Shawn Fenton: Who provides the technology and equipment for Tele-Mental Health Service?
Dr. Tony Pignatiello: Predominantly, Ontario Telemedicine Network has provided the equipment or can help us broker access to the equipment. They provide the connectivity and the secure connection. They are the main service provider.
Shawn Fenton: And Marc, I turn to you. How has Tele-Mental Health Services addressed service gaps in Algoma specifically?
Marc Williamson: Well, the one that initially comes to mind, we lack in terms of having child adolescent psychiatry, in the community. And you know, and that's been a real hole. Now, there's been a little bit added in. We have one psychiatrist who, who flies in quarterly, obviously virtual now. And in the last year have a psychiatrist through Sault-area hospital. But to access psychiatric consultations, this is pretty much the only show in town, in terms of they're not coming in through the portholes, like I said. The quarterly which is, you know, a clinical opportunity to review and through the hospital has to be a patient of the hospital as it were. So, it allows us the flexibility of accessing a service expediently that’s of the highest quality for the client. So, we need child and adolescent psychiatry services, so Sick Kids through Tele-Mental Health, in the three hubs, as Dr. Pignatiello said, is extremely vital. And that's in a community of, you know, 80,000, I can't even imagine how important that is, you know, going far north into much more rural settings. Training, training opportunities, I am a thankful individual, when I get the emails, these are the opportunities and as a consumer, I can choose … does that meet a current need. You know, as an agency Algoma Family Services offers a lot of internal training with our psychology department and otherwise, but it's so wonderful to have a variable menu that I'm going to be informed of. So extremely pleased to be able to pick and choose as I feel meets, you know, my knowledge needs being offered all the time.
Shawn Fenton: I know Marc, you've been there for multiple years. So, I just wanted you to provide some perspective for the listeners on how has this service evolved in Algoma?
Marc Williamson: Since I began in 2003, and as Dr. Pignatiello had stated it, it had already been set up prior to that. But it was fully operational at my agency upon my beginning there. So, wonderful …. was accessing soon after. From the technological standpoint, it has grown in leaps and bounds. And I can't say how many times there was consultation at our agency, so brick and mortar at our main site, and the feed would go down, and IT would come running downstairs to try to get things up. And those type of issues have pretty much been eradicated. So technological advances we've all benefited from. I'm so appreciative that it's the consulting psychiatrist who so often says, you know that, this is what I think we should do, a check-in, around this timeframe. Or if it's not, from a time perspective, you know, in terms of evaluating at a certain point, when we should do, again, a review. We'll see where things are at in treatment, you know, in balancing the need for the therapy with the medication regimen. So interesting, who should be there, how much that's grown, to who's involved, what school staff, you know, if a physician can’t attend due to their workload, you know, keeping them in the loop, and not just through the consultation being cc’d to the involved physician, but in terms of eliciting their input. You know, it's very much grown eclectically, who can play parts and what that would look like, you know, Child Protection, do they have a piece in this. So, it's very wide in terms of meeting the need of the child and the family. And that's just amazing.
Shawn Fenton: What really makes Tele-Mental Health Services a success from your perspective?
Dr. Tony Pignatiello: Meeting the mandate. So, the mandate was providing access to services where there was no access previously. And I think we have done that by leaps and bounds. And I think, getting to the point where we are seen as business as usual within the communities. We're no longer an afterthought. We are incorporated as part of the agency, part of the family. It is just part of what happens and how things go. I think that's probably one of the biggest measures of success -- is really that complete integration into the local systems in a seamless and collaborative way.
Shawn Fenton: Thank you for that, Tony. And I just turn over to Marc here. And Marc, I just wanted to ask if there were any other success stories that you've seen in Tele-Mental Health Services.
Marc Williamson: I think from the perspective of success stories, is again, just as part of a wide support team, that having the ability to access, you know, that level of psychiatric consultation. And let's make no mistake about it. Clients in the north, by far, are very cognizant of the geographical -- being away from Ontario -- as being Toronto-focused. And, you know, they acknowledge and appreciate having that level of service without having to travel outside of the community, as stated by Dr. Pignatiello. They're very appreciative of having that level of service, you know, from Toronto, to be part of their extended care team.
Shawn Fenton: How has the Children and Youth Mental Health addiction sector and demands for services evolved over the years, in your professional experience?
Dr. Tony Pignatiello: We've seen probably less of what we might have described as behavioral issues over time. But we've also seen an increase in parents’ knowledge and awareness, and investigation of issues and an increase in demand for service. So, I think there's been more of a shift of balances, if you will.
Marc Williamson: I think I’d just like to add a little from the frontline perspective of what Dr. Pignatiello said, just from my perspective. He touched on something really important that, for lack of a better word, I think there's been a decrease in stigma, and acceptance that caring for one's mental health is as important as one's physical health, from perspective of different settings, from parents, caregivers, schools, medical community, and therefore an openness to seeking out services, which puts a lot of internal pressures on being able to provide really what people need. It’s so interesting, you know, when I talk generationally …. Take a session last night with a parent and the teenager and the parent saying, you know, heck, I access mental health supports, and we're able to commiserate with the young person being an audience to hearing about that shift from the parent, like how validating can that be for a young person to hear that from their significant caregiver? And that's that trickle-down effect of acceptance, that it's a valid and a needed support.
Shawn Fenton: For those that are in different provinces, in different territories, hearing Ontario's take and perspective on Tele-Mental Health Services, I just wanted to ask both of you: what should other provinces and territories put in place if they're considering a similar service?
Dr. Tony Pignatiello: I think honestly the biggest thing to make sure is the resources to support a program like this because that's really the starting point. You know, I've seen other programs have everything ready to go, but they didn't have the funds to actually make it happen. And I think that has to be the starting point that the dedicated appropriate funds have to be there. It has to be part of a broader strategy that will demonstrate the relevance, the significance and the priority placed on something like this. And I think then you need the identified dedicated champions at all levels, you need them at the hub provider level, you need them at the at the local and at the frontline level. And if you're working with specific unique populations, then you need champions with those populations as well, for example, with Indigenous and Francophone communities, you know, in our province.
Shawn Fenton: So just looking a year, five years, ten years in the future, I just wanted to ask both of you: what are your hopes for the future of Tele-Mental Health.
Dr. Tony Pignatiello: I think we will find the place where virtual care to our mental health will fit. I mean, not just our program, but as a general concept. Prior to the pandemic, let's say when there was not a lot of uptake, we were always cognizant of the fact that virtual care is yes, the next best thing to being there, it's enhancing what's there, it's not a replacement for … its enhancement of what's already there. The pandemic kind of forced that a little bit differently … kind of forced it to be the place where that connection, where the care happens, and so I think that's a little bit artificial. I think we will land at a place where there's a hybrid, a reasonable blend. We’ll get more and more comfortable with what things are best done in person and what things are managed just fine with the virtual care approach. My prediction is we're going to see that at around the 70/30 or 60/40 kind of mix or 60 to 70% in person 30 to 40% virtual, and I think that that's where things will plateau out to.
Shawn Fenton: And I ask Marc as well, five years, one year, ten years down the road, where do you see this service going and supporting clients?
Marc Williamson: You know, if I think back 10 years ago, five years ago, three years ago, using a virtual medium was relegated to Tele-Mental Health psychiatric consultations. Now it's the norm, it's been generalized. So, it's an “end also”, not an “instead of”. It's another valuable tool to the toolbox, which I think pandemic has really normalized its use. And for a great many, it will fit that. We need to continue to listen to the clients.
Shawn Fenton: Thank you for that, Marc. And I think as we wrap up, we never know who may be listening to this podcast. And so, if there is someone who has gone through the system in terms of looking for help, is there any final words that you would like to speak to in terms of those that may be going through a mental health crisis or have gone through it?
Dr. Tony Pignatiello: The biggest thing that I would say is you don't have to be alone in that situation. And obviously, reach out, wherever to whomever, whether it's family, whether it's a physician, whether it's a teacher, whether it's a friend, or someone that you trust, a trusted adult, whomever it may be, to reach out. And it may not be what you need or want at the first reach-out, but hopefully then you can be directed to the right place, the right service, the right support. And then for folks in rural and remote communities, your close mental health agencies are there, you know, on site are doing outreach, and elders are there. At the end of the day, mental wellness and mental well-being is everybody's responsibility. To illness and more severe kinds of situations, sure, there's the specialist that needs to get involved with that one. But otherwise, it's everybody's responsibility, and it really does take a village and a community to keep it that way.
Marc Williamson: The message I give to clients will continue to be: we all have physical health; we all have mental health. We're sentient human beings, and every one of us deserves to be supported for both when we need it. Navigating the system, I think, is getting better and more transparent. But reach out, look at opportunities and make informed decisions. But it's something that's deserved, you deserve. We all deserve to be supported when we need it.
Shawn Fenton: That's absolutely true. Like you are not alone. And you deserve supports and opportunities to develop wellness mentally. So, I think those two final messages are key for those that are experiencing a mental crisis or who may experience mental crisis down the road. So, I just wanted to just say thank you very much, Tony and Marc, for being a part of this conversation. It is much, much needed. And I really hope this reduces the stigma of mental illness and allows those that are going through it to know that they're not alone, and that we, within Ontario and in Canada, are able to hear and listen. So, thank you very much for your time, Marc and Tony, and thank you very much for the listeners.
Dr. Tony Pignatiello: My pleasure.
Marc Williamson: It's been a great pleasure.
Loretta O’Connor: Thank you so much for helping our listeners gain a better understanding about Ontario’s Tele-Mental Health Service for children and youth. What a tremendous success story and a model for others. Please join us again next week when we head east across the country to discuss Nova Scotia’s approach to addressing wait times for mental health and addiction services in Cape Breton. Thank you for listening!