This year’s Congress featured an agenda tightly packed with speakers from around the world including New Zealand, Sweden, Australia, Singapore, Hong Kong, UK, USA, and Canada. Due to COVID-19 border closures this year, the event was run as a ‘hybrid’ event. This involved hosting attendees both in-person in Auckland, New Zealand and virtually, with overseas speakers coming in over video and attendees from around the world viewing the livestreamed event on the online Congress event platform.

The theme of the Congress was ‘Equity’, specifically how eMental Health approaches can help tackle inequities around access to mental health services and enable greater choice of services to underrepresented populations around the world.

MORNING SESSION

The Congress kicked off at 8.40 a.m. with a Pōwhiri (traditional Māori welcoming ceremony) followed by event housekeeping by Congress MC Duncan Babbage. Duncan then facilitated a round table introduction of all in-person Congress participants whereby each person introduced themselves by saying their name, their role and three words to describe themselves. This welcome was extended to virtual participants, some of whom responded by posting their introductions in the event app chat.

Framing remarks

Professor Lindsey White welcomed honoured guests to the sixth annual eMental Health International Congress on behalf of the Vice Chancellor of AUT, acknowledging the participation of national mental health sector leaders from Sweden, Canada, Australia, the USA, Singapore, APEC, UNICEF and NZ, as well as this year’s esteemed keynote speakers. He highlighted the unique nature of the event being the only one of its kind in the world focused on implementation science. He spoke about the important role of the Congress in facilitating collaboration around ‘what works’ whether by sharing insights, new ideas, alternative approaches or identifying gaps, before handing over to Arran Culver, Chief Clinical Advisor of Mental Health and Addiction at the Ministry of Health (NZ).

After extending a warm welcome to Congress participants, Arran presented the Ministry’s new mental wellbeing framework which has “flipped the focus on wellbeing” by placing social, cultural, and economic determinants as the Ministry’s top priority and key condition for equity. He also spoke about how rapid development of a digital services ecosystem has been critical to NZ’s COVID-19 response with a focus on bridging the digital divide through sponsored data and device distribution initiatives. In response to COVID-19, development of a clinical governance framework enabled a “single source of truth” across the Ministry’s digital providers, while a new Digital Mental Health and Addiction Services (DMHAS) evaluation framework was fast-tracked to provide a reliable tool for the mental health sector and public alike to assess the effectiveness and safety of digital mental health apps and online programmes.

Finally, Anil Thapliyal summed up the aim of the Congress as being around collaboration to answer the core question “how do we get scalable implementation of solutions right?” in the current COVID-19 environment and beyond.

E-Health in resilience and recovery: lessons for public health and tackling inequalities with Professor Kam Bhui

At 9.40 a.m. Congress attendees heard virtually from Professor Kamaldeep Bhui, Professor of Psychiatry at the University of Oxford. In his keynote address, Professor Bhui highlighted to  attendees  how COVID-19 has both exposed and escalated existing inequalities in our communities and how various digital mental health initiatives implemented both locally (UK) and abroad amongst various ethnic communities have enabled a level of human connection and positive change which “transcends the digital medium”.

Professor Bhui highlighted several examples of innovations tackling inequity in eMental Health. These included:

He concluded by drawing attention to the NHSSS framework for assessing health and care technologies, summarizing that simple interventions are much easier to implement than complex ones which rarely, if ever, become mainstream. Commissioners should therefore design interventions that meet the specific needs of a single group or population rather than attempting something too complex. His key message was simple: “simplify, simplify, simplify.”

Impact stories from Sweden, Canada, UK and US

The next session invited leaders from Sweden, Canada, the UK and US to share inspiring initiatives helping to bridge the equity gap in their countries.

First up was Fredrik Lindencrona, Head of Innovation and International Coordination, Swedish Association of Local Authorities and Regions. Fredrik’s presentation looked at the ‘whys’ and ‘hows’ of digital population wellbeing. He pointed out that the industry needs a clear definition of Mental Health and understanding of the conditions necessary for collective wellbeing including social, cultural and economic determinants. Knowing the ‘why’ allows us to use digital technology for the “right reasons”, he said, which means co-designing our places and creating wellbeing promoting environments that serve the whole population.

Louise Bradley, President and CEO, Mental Health Commission of Canada spoke about the Government of Canada’s response to the COVID-19 pandemic, in particular the Wellness Together portal and Mental Health First Aid courses. Louise then highlighted progress in digital equity, including the Federal Government’s recent investment of 1.75 billion dollars to connect 98% of Canadians to high speed internet by 2026. However she also noted that “we also need to look critically at who may be left behind” including people who either lack money to pay for Wi-Fi or data, live in unsafe conditions, lack the skills or motivation to engage with digital tools or are homeless. Louise ended by saying that collaboration with other countries will continue to be instrumental in helping Canada leapfrog ahead towards equitable eMental Health outcomes.   

Gregor Henderson, National Lead for Wellbeing and Mental Health, Public Health England shared a case study about ‘Togetherall’ – a digitally robust, clinically managed service that provides 24/7 community (peer) support to try to reach parts of the population that others struggle to reach including the unemployed, students, BAME (Black, Asian and minority ethnic) populations and isolated individuals. Greg summed up by saying “In the future we need to see more platforms that are community focused, have got the ability to personalize, rely on peer-to-peer support and the ability to provide personalized solutions … moving away from that notion of ‘I will recover on my own’ to recovering to a state of wellness with others andthrough others on the community platform.”

The final speaker in this session was Jay Buckey, Professor of Medicine at the Geisel School of Medicine, Dartmouth College, USA. Jay told us about how the PATH Program online treatment for conflict resolution, stress management and depression originally developed for astronauts had low uptake during the pandemic, despite being widely publicized around the world. Jay ended by saying that “it’s certainly possible to make these tools available…but uptake was very low”, stating that the challenge for the future is to “put these tools into a warm human environment so we get the most value out of the kind of skills training people can get out of these eMental Health tools”.

MORNING-MIDDAY SESSION

eMental Health – Frontline Workforce

After a refreshment break, participants gathered at 11.05 a.m. to hear eMental Health frontline workforce leaders give exciting examples of eMental Health in action.

The first of these was Dr Peggy Brown, Quality and Safety Standards, Australia, who described the new National Safety and Quality Digital Mental Health (NSQDMH) Standards, now officially released on 30 November 2020. Peggy explained how the Standards cover clinical and technical elements which provide a consistent statement about the standard of care a service user can expect from a digital mental health service. To find out more about the Standards and future plans for their use, read her article here.

Next up was Anna Elders, Clinical Lead at Just a Thought, NZ who delivered a captivating presentation entitled ‘A year in the life of an eMental Health Saleswoman’. Choosing to focus on the barriers to the widespread adoption of eMental Health tools, Anna outlined some common reasons given by clinicians for not making digital resources part of their everyday toolbox. She then laid out the work ahead of us all to improve adoption outcomes within health practices and make eMental Health tools an integral part of healthcare services rather than simply an option.

Following Anna was a joint presentation delivered by Ben Hingston and Amy Wharewera of Lakes District Health Board, NZ. Ben told us about an early survey phase in the Lakes District community which revealed that half of providers interviewed felt they didn’t have the capacity or capability to use digital tools in their workplaces. This precipitated the development of the E-Mental Health Collective to explore how to build awareness of eMental Health and find ways to encourage people to engage with digital tools. From this arose a Train-the-Trainer Programme, designed to create a group of local change-makers equipped to champion and incorporate eMental Health tools into their organizations. More detail about the programme is available in this article.

Impact stories from New Zealand

The next session showcased two examples of eMental Health equity in practice.

Dr Tania Cargo, Clinical Psychologist at The University of Auckland School of Medicine introduced us to ‘Aroha’, a digital chatbot developed in response to COVID-19 to help young people cope with stress. Talking about the need for greater equity rather than just relying on adaptations of existing tools, she said “If our mental health community has got it wrong for Maori for 30 years, we need an opportunity to get it wrong for ourselves for 30 years,” challenging colleagues to “lay down the power” within the digital space. She went on to say, “Our communities know how to do our own thing, but we need to be able to get it wrong as well.”

Akerei Maresala-Thomson, Co-Founder of MyRivr received a standing ovation for sharing his journey from a survivor of abuse and trauma to a community trauma prevention advocate.

In an emotional presentation, Akerei highlighted the need for a change of approach to addressing community mental health issues. Drawing from a Samoan proverb about Starfish having two sides: one that stings and the other that heals, he said “Solutions for issues in the community can be found in that same community.” Rei described the historic lack of equity of access to services as the fundamental issue, saying “The lack of services wasn’t the issue, the lack of visibility of the services was the issue.” In response to this, Akerei co-developed the MyRivr app (available on Google Play and Apple app stores) as a tool for people to find services in their community wherever and whenever they need them. With 4,500 unique users and 8,000 service providers signed up, the App continues to reach people by bridging the equity gap from the roots up. 

Panel discussion of eMental Health experts

Sharing of best practice and experiences is essential to foster mutual learning and prepare for challenges ahead. We would like to particularly thank the speakers of our panel session for sharing their expertise on equity issues with Congress attendees. Highlights from this session included:

  • Hong Choon Chua stated the importance of “multi-level collaboration from the high governmental level to the communities including the clinicians, end users, the families and this will give the best probability of success and this has been coming out in a number of best practices in the APEC economy”
  • Speaking about the concept of scale, Professor Chee Ng said “The process of co-creating solutions should be the one that is scaled up rather than wholesale solutions that are spread because they never really adapt completely to a local community”
  •  Dr Alison Morehead talked about the importance of spelling out the notion of equity in all its forms. “There are things like skills and literacy and appropriateness, hardware, software devices, the place you’re accessing the services, and even your physical space,” she said, “I think that something that we could be exploring a little bit more when we’re talking about equity is ‘what does access really mean?’”
  • Dr Janice Wilson stressed the importance of communities taking ownership of their own eMental Health solutions which has happened during the pandemic. She noted that “People actually have their own solutions and their own ideas, and the challenge is to work with them to find the digital solutions that work for them.”
  • Erica Lloyd made a compelling point about the potential of technology to address inequity, saying “the thing about technology is it does disrupt, and it does democratize if used appropriately”. In terms of delivering the kind of support people want, she said “people want advice from someone who looks and sounds like them … in a trusted, scalable environment.”

After participating in a group photo, conference participants were then free to enjoy lunch and a chance to network before heading back for the afternoon session.

AFTERNOON SESSION

Making contact with the human experience with Matt Ball

Keynote speaker Matt Ball from the Humane Clinic in Adelaide, Australia gave a thought-provoking presentation on how mental health should primarily be focused on human to human relationships as a response to ‘what has happened to a person, not what is wrong with a person’.

Key messages from Matt’s session were:

  • Diagnosis and treatment are useful for professionals and systems, but don’t have as much meaning for families and communities
  • Mental health should be focused on the human to human relationship and connection should be a goal in healthcare in and of itself
  • Distress in our societies is not a new story, but if we have the courage be in relationship, we actually hear those stories, and it brings healing to all our communities
  • We (as clinicians or policy makers) need to think about what we are doing that is impeding a person or community’s ability to engage with us
  • Let’s stop trying to do something for someone, but instead just be with them, not seeking to change them but get into connection with them, acknowledging that it may be our systems and processes pushing them away in the first place.

Equity in evidence into practise

In this session, participants learned about the efficacy and effectiveness of current eMental Health tools and services.

Karolina Stasiak, Department of Psychological Medicine, University of Auckland introduced Congress participants to ‘HABITs’, a new digital wellbeing space where NZ youth can access digital screening and intervention tools for mental health and wellbeing.

Mario Alvarez-Jimenez Director of @eOrygen in Australia stimulated our thinking about how we can leverage the ‘attention economy’ for our digital tools and use lovable technologies to improve lives.

Dr Steve Locke, Psychiatrist, Boston, USA, spoke about how COVID-19 has skyrocketed the use of tele-mental health which allows services to address economic and ethnic disparities in healthcare by delivering care remotely.

Health IT Industry Perspective

Two NZ thought leaders provided a Health IT industry perspective on equity in mental health.

Kate Reid, Chair of New Zealand Health IT (NZHIT) spoke about the role Health IT plays in closing the gap and strengthening connections across the sector, saying “we can achieve more together than we could ever achieve alone.” The NZ Health Tech Opportunities Report to be launched early in 2021 “aims to set out a path for digital health for the next 3-5 years and a roadmap for where we can be collaborating for greatest impact”, she said, with the aim of moving from “digital health to just health …just the way we do things.”

Dr Will Reedy, CEO, Spark Health, NZ told us about the many things Spark Health are doing to address digital inequity. Within the last 12 months, Spark released two new initiatives. First, was a Skinny Jump initiative to get modems into about 20,000 residential homes that didn’t have access to broadband. This was followed by the Ministry of Health Sponsored Data Partnership which saw Spark work together with other telecommunications providers to offer access to particular mental health resources without incurring data charges. These resources include GP portals, depression.org.nz and 1737 mental health line. “We saw some massive uptake in terms of traffic for people using those applications, and a whole lot of new people come into those applications”, he said.

The eMental Health service horizon – snippets of the vision

In this session, two domain experts from New Zealand discussed their future vision for eMental Health services.

Andrew Slater, CEO of Homecare Medical, NZ presented the various digital mental health projects they have been involved with in reaching out to communities in NZ. He described the challenge of representing diverse groups, asking “how do we use digital technology to do mass personalization?” As a result of efforts to co-design products for Maori, they have seen huge jumps in engagement from Maori versus non-Maori across these digital tools, as well as an overall increase in usage across all ethnicities saying “what’s good for Maori is good for everyone.”

Associate Professor Jay Marlowe, University of Auckland introduced the idea of refugees or displaced people using social media as “digital lifelines” to help them stay safe and maintain a sense of belonging and connection. However, this relies on refugees having access to the internet via digital devices. To illustrate this, Jay showed participants a funny meme of Maslow’s hierarchy of needs with the added sophistication of Wifi and sufficient battery life forming the new base of the pyramid. In terms of resolving inequity, Jay proposed seeing inequity as existing on a gradient, meaning different solutions are needed for different identity markers including gender, sexuality, health, ethnicity, class, age and others. He also stressed the importance of staying conscious of the inherent privacy and safety risks which accompany the growing range of digital solutions.  

Annual eMental Health Innovation Leadership Awards

The awards ceremony commenced at 3.10 PM, with Shayne Hunter introducing the recipient of the eMental Health Innovation Leadership Award for New Zealand – Karen Evison,Director of Strategy, Planning and Funding at the Lakes District Health Board (DHB). Karen was commended for being a strong and vocal champion for eMental health at local, regional, and national levels through her work with the Lakes DHB eMental Health strategy and Train the Trainer programme. She was described as being “consistently focused on the importance of equity, and ensures initiatives prioritize access for Māori whanau”, as she “continues to prioritize and spearhead opportunities for driving innovation and change in mental health services to embrace eMental health alternatives”

Fran Silvestri then introduced the recipient of the International eMental Health Innovation Leadership Award – Niki Legge, Director, Mental Health and Addictions, Department of Health and Community Services, with special mention to the Government of Newfoundland and Labrador, Canada. He spoke about how Niki has “tirelessly championed not only eMental Health, but also the critical importance of lived experience within our systems both locally, nationally and globally”. He further described her as “a strong team player whose leadership style is one of humility and grace”.

Congratulations to our award recipients Karen and Niki for your remarkable achievements and contributions.

Framing remarks were delivered by Anil Thapliyal. He began by using the metaphor of a whare (house) to illustrate why equal weighting of each of the five industry group “pillars” is necessary for the effective implementation of eMental Health solutions. He then reminded participants of some key messages from the day. These included:

  • The importance of the human connection and how we are communicating these days, as raised by Matt Ball in his keynote address
  • How eMental Health should enable a person to be in control of their recovery at a time and place of their choosing
  • Exciting developments in policy implementation including the NZ eMental Health FrameworkeMental Health Standards in Australia and Synergi Collaborative in the UK
  • The starfish analogy introduced by Akerei Maresala-Thompson to illustrate how solutions to problems in the community can be found within that same community
  • Why multi-level collaboration (across the five industry groups) is the key to effective implementation, especially when a “brag and steal” approach is leveraged to create positive momentum
  • Bold leadership and risk-taking are the primary drivers for getting things done
  • We have come so far, but our journey has just begun…

As a parting thought, Anil stressed the importance of getting implementation right, saying “If it doesn’t work for the consumers, their families and carers then it doesn’t work at all.”

At 4.00 PM, Kaumatua George Hill returned to the stage to share his closing thoughts. This was followed by a group waiata (Māori song) to conclude the Congress. Participants then made their way to the foyer for drinks and nibbles, to share feedback on the day and discuss exciting possibilities for future collaboration.