News - Jun 2020

A framework for rigorously evaluating digital mental health tools

Technology will play a vital role in addressing the worldwide need for better access to mental health services. And while new digital mental health tools are developed every day, decision makers struggle to determine which tools should be used and scaled with confidence in healthcare systems.

To help solve this problem, HRI has built a Framework to guide the development, evaluation, and regulation of top-quality digital mental health tools backed by solid science.

With funding from The RBC Foundation, HRI engaged faculty members from Harvard Medical School, including Yuri Quintana, Ph.D., Chief of the Division of Clinical Informatics at Beth Israel Deaconess Medical Center (BIDMC), and John Torous, M.D., Chief of the Division of Digital Psychiatry at BIDMC, to design the Framework. Drawing on input from a distinguished panel of Canadian and international experts in medicine and mobile health, the team produced a groundbreaking report entitled Framework for Evaluation of Mobile Apps for Youth Mental Health. While the report focuses on youth, the Framework is applicable to tools designed for adults.

The Framework was informed by a previous project led by Dr. Quintana, entitled Youth Mental Health Apps in the Digital Age: A Scoping Review of Trends and Evaluations. That project generated a comprehensive report, which explores current trends in youth mental health and looks more closely at several popular mental health apps. The report identifies strengths and limitations of available frameworks for evaluating apps and demonstrates a clear need for the science-backed Framework that has now been developed.

Who benefits from this Framework?

“This Framework will be of high value to consumers, healthcare providers, government leaders, as well as to those who design, evaluate, or invest in mental health apps,” says Dr. Quintana, an expert in clinical informatics and digital health services.

“Equally important, it will pave the way for improvements in regulations and policies related to mental health apps that can help guide how systems are selected, implemented, monitored, and evaluated. This work will help Canada and other countries develop a more scientifically informed process for strategic funding decisions and roadmaps for youth mental health needs.”

Click here to view the full report and framework.

HRI aims to move this work forward in partnership with other organizations interested in digital mental health. For more information on partnering with us to advance this important work, email

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Building the foundation for recovery monitoring in Ontario

Ontario recently launched Roadmap to Wellness: A Plan to Build Ontario’s Mental Health and Addictions System. The plan provides a clear path forward to improve mental health and addiction services and calls for a standardized approach to measuring performance of the current system – a call echoed by both the Auditor General and Addictions and Mental Health Ontario.

HRI is bringing experts together to answer that call.

On March 12, HRI invited key stakeholders from the mental health and addiction sector across Ontario to an exploratory workshop. The meeting was a crucial first step to co-creating a vision and exploring opportunities to advance recovery monitoring in Ontario.

Participants included addiction treatment providers from across the province, and representatives from key organizations, including:

  • The Mental Health and Addictions Centre of Excellence
  • Addiction and Mental Health Ontario
  • CAMH’s Provincial Support Services Program
  • ConnexOntario, and
  • Ontario Health

The group explored the feasibility of a province-wide data system that would help Ontario answer vital questions about its services: Are people getting better? Will proposed changes to care actually make a difference? Are investments in addiction care paying off?

A performance-measurement system would also enable:

  • Evidence-based improvements to care that will help people get better, sooner
  • More efficient treatment services so more people can access care
  • Improved cost efficiency in government spending

A foundational framework created by HRI

To open the meeting, HRI scientists Dr. Jean Costello and Dr. Brian Rush provided an overview of HRI’s Recovery Journey Project. The Project is a recovery-monitoring system for addiction treatment developed and tested over the past five years in partnership with Homewood Health.

Discussions followed about how such a system could be built upon for broader application. The group identified outstanding needs, available supports for implementing a province-wide system, the alignment of this initiative with provincial priorities, and next steps to build capacity for a system-level approach.

The group referenced performance-measurement systems currently in place in other healthcare areas — such as cancer treatment – that have generated invaluable data to guide improvements to care and ultimately, to save lives.

HRI is now exploring existing projects relevant to this initiative and seeking collaborative opportunities to advance this work in measuring outcomes on a broad scale.

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$1M awarded to HRI scientists studying new treatment for PTSD in first responders

Over the next three years, HRI scientists will receive nearly $1 million to support a study aimed at helping Canada’s public safety personnel (PSP).

A $990,000 grant from the Canadian Institutes of Health Research (CIHR) was awarded to Dr. Margaret McKinnon, Homewood Research Chair in Mental Health and Trauma, and Dr. Ruth Lanius, HRI Consulting Scientist, for their study exploring a new approach to treating PTSD in PSP.

PSP include paramedics, police, firefighters, nurses, correctional officers, and others working in emergency service and first response roles.

The study will test the utility of a cognitive therapy program, called Goal Management Training, in reducing the cognitive and emotional symptoms of PTSD, such as difficulty with memory, concentration and planning, as well as impulsivity and anger. The researchers will measure not only symptom changes among PSP receiving the treatment but also functional outcomes such as return to work and functioning in the family. They will also use MRI technology to examine changes in the brain structure and in brain function before and after treatment.

“The ability to capture very high-resolution images of the brain before and after treatment makes this study unique, and allows us to make the invisible wound of PTSD visible” says Dr. McKinnon.

“Not only can we measure how symptoms change in PSP with PTSD, but we can observe physical changes in the brain structure and function as a result of this treatment.”

A timely announcement

Funding for the study was announced as the COVID-19 pandemic took hold and Canada’s PSP were thrust into the spotlight.

“First responders and healthcare workers are dedicating their lives to society by working on the frontlines amid this global emergency,” says McKinnon.

“We know the pandemic will bring overwhelming trauma to many people working in the healthcare and public safety sectors at this time. It is very powerful to be able to offer hope to those who may be affected by PTSD and to be able to offer hope to our first responder and healthcare communities impacted by COVID-19.”

Focus on real-world application

To date, studies on trauma among PSP have focused on reducing the emotional symptoms of PTSD, such as hypervigilance and anxiety; however, many people are left with cognitive deficits that severely impact day-to-day functioning. These cognitive and emotional symptoms interact leading to difficulties such as poor planning, impulsivity, and problems with anger management”

“Very few studies have actually looked at real-world functioning – for example, the ability to return to work,” says Dr. Ruth Lanius, co-investigator and a Professor at Western University.

“If an individual struggles to process new information, maintain focus, or make a timely decision, their chances of returning to work and normal life are slim to none. We want to find treatments that help to close that gap – new approaches that help people get their quality of life back.”

Generous funding from Military Casualty Support Foundation, the Cowan Foundation, and the Bickell Foundation has been critical to the development of this program of research. Additional funding from the Worker’s Safety Insurance Board of Ontario will allow the team to look at various formats for delivery of GMT, and associated adjunctive treatments.

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Contributing to national discussions about COVID-19 and mental health

Protecting the psychological well-being of our nation during the COVID-19 pandemic has been a priority for anyone working in the field of mental health and addiction.

As the novel coronavirus spread throughout our communities, so too did our anxiety about the future. Prolonged isolation, the loss of loved ones, and financial hardship have placed many at risk of mental illness. For healthcare workers, another threat persists – the threat of moral injury.

Recently, HRI scientists have added to important discussions across Canada about the trauma-related impacts of COVID-19:

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