How CAMH is Advancing Mental Health Through Innovation and Social Justice

Perspectives on Health and Tech

Perspectives on Health and Tech

How CAMH is Advancing Mental Health Through Innovation and Social Justice

Listen in for a timely conversation in recognition of Mental Health Awareness Month and National Nursing Week. In this episode, Dr. Gillian Strudwick from The Centre for Addiction and Mental Health (CAMH) and Danny Gladden from Oracle Health discuss how mental health care is evolving, and how CAMH is advancing care through the dual lenses of technology and social justice. Learn how AI tools like Oracle Health Clinical AI Agent are easing clinician workloads, how CAMH is using data to drive impact, and why framing mental health as a social justice issue is key to helping the CAMH team deliver more equitable and compassionate care.

Featuring:

Dr. Gillian Strudwick, Chief Clinical Informatics Officer, The Centre for Addition and Mental Health

Danny Gladden, LCSW, MBA, Director, Behavioral Health and Social Care, Oracle Health

Listen as they discuss:

o The Centre for Addiction and Mental Health (CAMH) background – 2:45

o Mental health care viewed as social justice work at CAMH and examples – 5:00

o Technology innovations at CAMH with a human-centered approach – 9:30

• • Wearable devices and the impact they have on research
  • Repetitive Transcranial Magnetic Stimulation (RTMS) treatment
  • Evidence-based apps and the integration of these into clinical care processes
  • Optimizing EHR use and exploring the opportunity to share mental health notes in Canada

o CAMH’s perspective on AI technology and its potential impact on clinicians – 18:25

Notable quotes:

“Mental health is social justice work.” – Dr. Gillian Strudwick

“To be able to deliver compassionate care in this day and age, we have to be innovative in our use of technology.” – Dr. Gillian Strudwick

CTA:

Learn how Oracle behavioral health solutions combine real-time, clinical data from across each patient’s unique healthcare journey and how Oracle is working to reduce the documentation burden on physicians and elevate the patient experience with the Oracle Health Clinical AI Agent.

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Episode Transcript:

Intro 0:00 - 0:29

Welcome to perspectives on health and tech podcast brought to you by Oracle Health. In this series, we have conversations on creating a seamless and connected healthcare world where everyone thrives. Let's get started.

Danny 0:30 – 01:44

Welcome to perspectives, Oracle Health and Life Sciences podcast. I'm your host today. Danny Gladden, I'm a licensed clinical social worker and general manager of behavioral health and social care here at Oracle Health. As we step into the month of May, we recognize Mental Health Awareness Month, a time to raise awareness reduce stigma and highlight progress in mental health care. I'd also like to give a special shout out to our nurses across Canada and the US as we celebrate National Nursing week. Thank you for your unwavering dedication and compassion. Social workers and nurses make great teams. Today, we're honored to be joined by a leader in mental health care innovation. Please welcome Dr. Gillian Strudwick from CAMH, the Centre for Addiction and Mental Health, Canada's largest mental health and addiction teaching hospital and one of the world's leading research centers in its field. So, Gillian, welcome. Before we dive into big topics here, can you introduce yourself and tell us a little bit about the great work happening at CAMH.

Gillian 1:45 – 03:47

Thank you, Danny, and thank you for the opportunity to be a part of this great podcast. I might break this into two sections. First, I'll introduce myself, and then I'll tell you a little bit about the organization that I'm fortunate to work for. I'm Dr Gillian Strudwick. I'm a registered nurse, and I've worked primarily in mental health clinical settings here in Toronto, Canada, and also in other parts of Canada and internationally. Currently, I am the inaugural Chief Clinical Informatics Officer at CAMH, representing our nurses and all of our non-physician health disciplines, like social work. And I have a couple of other hats as well. So one is that I'm the head scientist of the digital mental health lab, and I'm also the scientific director of our Digital Innovation Hub, which is about really accelerating our work in this digital sphere and research practice, education and beyond.

So that's about me, but I'll move on to talking about CAMH. So CAMH is C, A, M, H, the Centre for Addiction and Mental Health, and it's Canada's largest mental health and addictions teaching hospital. We think, and I think there's lots to suggest that we're true in saying this, that we're a world leading Research and Education Center on mental health, and we're located right in the heart of downtown Toronto, but we serve people across our province, Ontario and across the country as well. In terms of a few numbers that I'll share with you, we've had just over 16,000 emergency department visits in the last year, over 40,000 patients that were treated, over 80,000 virtual care appointments. And I'll provide a few more numbers here as well, almost 8000 RTMS visits, 60 million in a new research funds more than 1000 articles published. I think you get the point that there's a lot going on at CAMH, and it's a great place to be.

Danny 03:48 – 04:50

You know, I have been on your campus a number of times. I always appreciate that your campus is right in the heart of Toronto, in a bustling area, and I think there's, there's no greater way to reduce stigma than, you know, placing such a well-respected mental health and addiction treatment organization right in the heart of the city. Whereas if you go to many other communities, you'll kind of see the mental health hospitals and treatment providers kind of on the outskirts of town. Really appreciate CAMH’s role right there in the heart of Toronto. And I think this goes into something Gillian that you speak about passionately, which is the idea that mental health treatment is social justice. For our audience, tell us what you mean by that. Why is it an important lens - social justice, which you view your work?

Gillian 4:51 – 07:43

I think it's quite an important point that you bring up, Danny, and it's something we're really proud of talking about, that mental health work is social justice work. Part of doing social justice work is to be informed in this space. And part of being informed is understanding that mental illness disproportionately affects marginalized communities who are also often facing barriers to things like accessing care, and this could be due to racism, poverty, stigma, geography, and I could continue so on and so forth. At CAMH, we see mental health is deeply rooted in social justice, because access to care, dignity and treatment and prevention are not actively distributed. CAMH advocates for policies and systems change that ensure mental health care is not a privilege but a right. And so that's really our social justice lens, framing and shaping the last few statements that I made.

We have done some work more recently in the last couple of years on dismantling anti-black racism, which has become a more formalized organizational commitment. I'll just read a section from one of our documents around dismantling anti-black racism. And excuse me for it sounds like I'm reading here because I'm reading from a document, but systemic anti-black racism, is a barrier to high quality health care for black patients at CAMH and across the health care system, the data lay bare with those in black communities have signaled for decades. Discrimination and oppression based on race delays care and harms individuals on their way to recovery. Racism also has a negative impact on the quality of work life for black staff, beyond the damaging emotional and psychological consequences, it limits their career trajectory, and it goes on from there. I bring this out as one of the many initiatives that the organization is committed to. And as a result of this commitment, this public commitment, you can read what I just read on our website, camh.ca, that there's a number of activities that the organization is doing everywhere, from doing offering more culturally appropriate therapies to education for staff, staff support groups, creations of processes that support equity, lots of advocacy work with the government. A lot of this work is ongoing, but this gives you sort of a more grounded, more concrete example of some of the ways in which we look at social justice as being so related to mental health.

Danny 7:44 – 09:31

My goodness, you know the social worker in me is just grinning from ear to ear, as you describe, you know, the foundation in which CAMH is caring for folks. You know, I'm still a licensed clinician in Missouri and Alaska. You know, particularly, I think about a state like Alaska, with a disproportional number of folks who are Alaska Native. And we see, you know, in those communities, so much generational trauma, and the impact you know, and the impact that oppression you know has on sort of repeating traumatic occurrences across the generations and so, so very important, I think, an important perspective to look at the the experience of mental health and the treatment of mental health through a social justice lens. Gillian, I just appreciate that, that that is a focus of CAMH, and I'm sure the indigenous populations your organization works with, you see a similar, you know, a similar experience than the those in the in Alaska here. Now, as we pivot here, thinking about, you know, you're, I think the work you're describing, from a social justice perspective, is innovative. It seems like CAMH is always at the cutting edge of innovation. We're a technology company, and so, you know, from a technology innovation perspective, what are you seeing? What's CAMH doing?

Gillian 9:32 – 15:53

Great question. Danny, and because of my various roles at the organization, I get excited about this kind of a question, and it also describes the work that I'm doing every day, with my colleagues, with our patients, their family members and others across the organization. So yes, we're always interested in how we can use technology and to innovate with technology, but we do that so we can achieve various things and the things that we want to achieve are being able to improve access to care so we can see more patients, because probably unlike, or not unlike various organizations in the rest of Canada and in the US, we have long waiting lists for care. The second is to be able to improve the quality of care. And not to say that care isn't good already, but more that as we learn and develop evidence and get feedback from our clinicians, from our patients, we can then integrate that into care. So that's the second piece. The third is to improve the patient experience, and the fourth is to really personalize care. When we think about how we innovate with technology, we're really looking to see if we can do those four things. And yes, there's other, you know, other reasons you invest in technologies for various efficiencies and cost savings. But I'm going to talk about more work on the earlier four points that I described.

So maybe I'll provide a couple of concrete examples. The first one is thinking about the opportunity that we have by embedding wearables into care processes. These are things like Oura rings or Fitbit that you know, it doesn't matter which company it is. There's lots of wearables out there, but embedding them into care processes so we can look at sleep and activity which are often impacted when people have symptoms of depression or anxiety. We hope at CAMH to use this information to better understand someone's individual patterns, which could really help us tailor their treatments, as you can imagine, but also be able to identify early when a treatment may be starting to take some effect, or an early warning sign, or an indicator of someone potentially falling ill or relapsing. Lots of potential in that space, and we're getting going primarily in the research domain, in the wearable space. So that's sort of one concrete example.

Another concrete example is RTMS. So CAMH has been a leader in this space and doing brain stimulation research for a number of years. RTMS, in case listeners aren't familiar with it. It's a non-invasive treatment. It uses magnetic fields to stimulate very specific regions of the brain, and it's been shown to be particularly effective for people with treatment resistant depression. These are individuals who have not responded well to medication or therapy alone. To date, we've had about 8000 individuals last year who have received RTMS. We're thinking about it from advancing the science, treating individuals, of course, and doing lots of advocacy work.

The third example I'll provide is around the app space. There's lots if you were to type in depression or anxiety into any app library, you're going to see lots and lots of apps, most of which don't have a scientific backing to them, some of which may actually be a waste of time to engage in. It's also really hard to make sense of that app landscape. So, we've been working to develop and integrate into clinical care processes, apps that have that evidence base behind them, and have some sort of a portal or interface with clinicians so that the data can be used for care purposes. We've got one called my change plan for smoking cessation of behavioral modifications. We've got one called App for independence, which is a platform for supporting people with complex behavioral and mental health conditions, and it's currently used for recovery processes with individuals with psychosis and schizophrenia and now opioid use disorders. And then we also have another app called Hope by CAMH, which is a safety planning intervention for people at risk for suicide. So, there's, you know, that doesn't cover all the apps, but gives you a sort of a flavor of the various apps that we've been working on, so that there's the credibility the science and the engagement and feedback loop for those particular areas.

And then the finally, the last one I want to talk about is our electronic health record. We use the Oracle Health platform, and we're really thinking about how we can optimize our use of it for the best experience for clinicians and patients alike, including this concept of open notes through our patient portal, so where patients can see their notes and so well, if you're in the US and thinking, well, this is the norm for us, it's not quite the norm for folks in other countries. It's optional in Canada to share mental health notes, and so we're showing some real leadership by identifying how best we can do that and opening up our notes. So I'll just close on this topic, Danny, by just saying that importantly, we're taking a human centered approach when we're doing this work, whether it be in apps, wearables, with our EHR that we're co-designing with patients and clinicians to ensure that they're usable and they meet the needs that are the most pressing needs, but also that we deliver and implement technology that allows us to provide compassionate care. Because I think when we think about technology, it's often this sort of antithetical approach to compassion. And we are showing that to be able to deliver compassionate care in this day and age, we have to be innovative in our use of technology.

Danny 15:54 – 18:07

Wow. What a, what just, what a robust list of innovation. You know, that CAMH, is sponsoring. I'm not, not at all surprised Gillian, knowing your history. You know, Gillian, maybe a part two to this conversation. A separate podcast can be sort of on the intersection of social justice and technology. You know we regularly describe some just phenomenal innovation, consumer facing innovation and yet, we know that there's consumers of care that don't always get to take advantage of the latest and greatest innovation. The wearables or access to a device to allow, you know, portal or telehealth. You know, lack of hardware, lack of bandwidth, lack of sort of knowledge or trust in the available tools. So, you know, maybe we can. We'll bookmark that, I think for another day, but in the area of innovation, CAMH was part of our clinical AI work group for behavioral health. This was a year-long process. You know, Oracle has been an AI space for many, many, many years. You know, I'm sitting in a Marriott right now where, you know, I used Oracle tools to check in and to engage with the Marriott staff. Oracle knows a thing or two about AI, and has taken what they know about AI and applied it to healthcare. And we, Oracle Health, and CAMH and others have taken that and morphed it for behavioral health. So, our clinical AI agent today is available in the US in behavioral health, used across a number of behavioral health providers. I think to date, we've had nearly 20,000 medication management notes that were documented using Oracle Health's Clinical AI Agent. So, what's CAMH thinking about from an AI perspective?

Gillian 18:08 – 22:38

Oh, we're thinking about lots from an AI perspective. And I will just note that while you're sitting at a Marriott, I'm sitting at the hospital right now, and on the overhead speaker is a code being called. Apologies if you can hear that. We are really quite excited about the potential for AI and what it could bring for things like research, education, of course, clinical care, and how we operate and potentially achieve some efficiencies. I think there's a whole bunch of areas where we see the potential for AI. We're fairly early in our journey, but we're setting up all the right infrastructure so that we can accelerate more quickly. The first is that we recently launched, just this month, a BMO chair in artificial intelligence and mental health. So that's a research chair role specifically for AI in mental health, and I believe it's the first and only in Canada at this time. So Dr. Tristan Glittard Is the inaugural chair. He's an AI computer scientist, researcher and engineer, highly collaborative with clinicians. I think we have high expectations for what this role will achieve. We're also hiring for an AI scientist. From a research perspective, I think we expect big things, and I'll have more to report back on Danny in the not too distant future around that one.

In terms of education, we currently have a digital mental health and AI Certificate Program, which is free and currently available on our website. So folks here who are listening are welcome to go to camh.ca and who and can navigate to finding the digital mental health and AI certificate program, and that's really thinking about, mostly for clinicians who are working in this space where there's more AI tools available for them to develop their competencies and thinking about how to use them within their clinical practice. We're getting, sort of our baseline of folks ready so that we're able to really accelerate in this space.

And then I'll just mention one thing lastly, and while we don't have anything concrete yet to share the potential of AI scribes and ambient scribes, and using this sort of technology to free up our documentation time for essentially all clinician types is of big interest. Not just the documentation, but also other tools like being able to do note summarization or querying the electronic health record or the patient record. So I think all of these sorts of things are of interest for us, and our clinicians would jump on at scale. These sorts of things can have a big impact. And I'll give you an example. Not too long ago, we did a fairly small change in our EHR, and it result, and that was about nurses reducing their documentation time. We took out some particular areas of a power form. It resulted in a couple of seconds per power form that nurses were not documenting anymore. But when we calculated the total time savings over the course of the year for nurses, it was the equivalent of a full-time nurse by just doing that small change. And so if we think about that's just a really small example that we saved a full 1.0 full time equivalent of nursing time. If we did that at scale by using ambient scribes, by doing things like note summarization and querying, we could really take that to the next level and save large amounts of time, which we hope, could really support clinicians in being even more engaged less burnout. You know, the list goes on. So of course, in doing any of this work in AI, we need to be mindful of risk and bias, ethics. So there's a lot to be mindful of there, ensuring we keep mental health care human and so we're really making sure we're getting this right. We're starting our journey to ensure that we have all these various safeguards in place. But I will say it's a really exciting place to be. There's some very cool tools coming out, and I can't wait to get my hands on them.

Danny 22:39 – 23:58

Yeah, Gillian, we are so excited. You know our psychiatrist, psychiatric nurse practitioners, nurses, social workers, case managers, therapists, all benefiting today from use of Oracle Health Clinical AI agent. So, thank you for sharing those insights. Now. Before we close, we want to remind our listeners that if you or someone you know is struggling, help is available. In the US you can call or text, 988, 24/7 365.

988, is the suicide and crisis lifeline in Canada also, 988, 24/7 365, and just interestingly enough, 988, in Canada is provided and managed by CAMH to ensure that no one has to face a crisis alone. Trained responders are there for support. Dr. Gillian Strudwick, thank you for sharing your insights and for the work you and CAMH are doing every day to make mental health care better, smarter and more just. And thank you to our listeners for tuning in. Take care of yourselves and each other.

Outro 23:48 – 24:20

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