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2020 Darlene Walton Scholarship Award Announcement

We are pleased to announce that Isabella Romano is the recipient of this year’s Darlene Walton Scholarship Award, an award that supports students pursuing careers in the field of mental health and addiction research.

Isabella Romano

Isabella Romano

Isabella is an HRI Trainee and a PhD candidate in the School of Public Health and Health Systems at the University of Waterloo. Over the past two years, she has made significant contributions to evaluation studies related to tobacco use among patients receiving treatment for substance use disorder.

Specifically, Isabella explored how the introduction of a tobacco-free policy impacted tobacco use in patients. Using data collected by HRI’s Recovery Journey Project, she examined how exposure to the tobacco-free policy was linked to reductions in tobacco use both during and after treatment. Her findings were published in the Journal of Substance Abuse Treatment. A second paper will be published in the Journal of Addiction Medicine in the coming weeks.

Isabella also contributed to a follow-up study examining patient perceptions of the tobacco-free policy and their experiences receiving treatment within a tobacco-free setting. The study provided insights into behaviours and attitudes affecting tobacco use. It also identified strengths and weaknesses of the policy, as well as opportunities to further support patients who are trying to discontinue tobacco use.

Together, findings from these studies have informed areas for policy improvement at the study site (Homewood Health Centre in Guelph, Ontario). These findings are also relevant to other organizations interested in enhancing tobacco-free policies to benefit patients across treatment settings.

Congratulations, Isabella, and thank you for your important research contributions!

New funding will support research exploring impact of COVID-19 on mental health

James MacKillop

Dr. James MacKillop

HRI Senior Scientist, Dr. James MacKillop, has received $491,000 from the Canadian Institutes of Health Research (CIHR) for a study that will examine the impact of COVID-19 on mental health and substance use.

Dr. MacKillop is one of 16 researchers from McMaster University to be granted funding that will help Canada understand the impacts of COVID-19 on various aspects of healthcare – from diagnostics and therapeutics to patient management and mental well-being.

The funding is part of the Government of Canada’s COVID-19 Rapid Research Funding Opportunity, which aims to mobilize science to address the health challenges of the current global pandemic. 139 projects have been supported across the country, for a total of $109 million.

Dr. MacKillop is currently running a long-term study investigating patterns of change in mental health and substance use over time among a cohort of adults. Recently he added a new stream of data collection to explore changes following the legalization of cannabis. He will now add additional data collection to this study to see how COVID-19 impacts both mental wellness and substance use over a one-year period.

Click here to read the announcement from McMaster University outlining all COVID-19-related projects funded through the CIHR grants.

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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 admin@homewoodresearch.org.

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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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Moral dilemmas and traumatic stress during COVID-19

The COVID-19 pandemic places many people at risk for exposure to potentially traumatic events. Some of us have already faced the loss of a loved one, long-term isolation from family and friends, or perhaps a near-death experience ourselves. But this pandemic brings another type of trauma-related risk: the risk of sustaining a moral injury.

What is moral injury?

A moral injury may occur when a person witnesses, fails to prevent, or engages in an event that violates their personal moral beliefs. Exposure to morally injurious situations has been linked to post-traumatic stress disorder and can bring profound shame, anguish, and guilt that severely disrupts one’s quality of life.

In the context of COVID-19, a moral injury could occur after an individual faces an ethical dilemma that results in harm to another or to oneself. For example:

  • A doctor who must make difficult decisions about how to deploy limited life-saving resources, such as ventilators
  • A healthcare worker who may put their own children at risk by continuing to work
  • An individual who cannot be with a terminally ill loved one due to self-illness or facility restrictions
  • An undiagnosed person who inadvertently infects vulnerable residents in a nursing home

These are wrenching situations no one wants to face.  And they can leave us scarred.


What to do if you experience traumatic events

“The first thing to do if you are exposed to a traumatic event is to talk about it,” says Dr. Margaret McKinnon, an HRI-supported scientist and trauma expert from McMaster University.

Dr. McKinnon serves as Homewood Research Chair in Mental Health and Trauma and is leading important research related to moral injury.

“Talk to your colleagues or close personal network. Failing to acknowledge a morally injurious event can make matters worse, so share your experiences and support one another. The next thing to do is to practice self-compassion and self-care as you move through these challenging times. Many virtual tools are now available to support our resilience and mental health.”

And finally, if you experience persistent and overwhelming feelings related to a traumatic experience that are severely disrupting your quality of life, talk to a mental health professional.

“Help is available, and protecting our mental wellbeing is of the utmost importance,” says McKinnon.


Mental health resources during COVID-19

If you are an Ontario healthcare worker, you can access free phone therapy sessions provided by licensed mental health workers who are volunteering their services during the COVID-19 pandemic.

For anyone experiencing mental health concerns, many online resources are available, including:


How to practice self-compassion and self-care

  • Accept your feelings without judgement. It is normal to feel negative emotions during uncertain times or after experiencing a traumatic event. Name your feelings and be gentle with yourself as you sit with them and process them.
  • Do your best to maintain healthy lifestyle habits. If you are able, maintain a regular sleep, exercise and meal schedule. Take breaks, communicate with your peers and family, and use mental health tools that work for you. A list of resources is available below.
  • Practice mindfulness techniques. A variety of mindfulness tools exist online. Apps such as Calm and Insight Timer provide guided recordings, breathing exercises, and other tools to stay grounded in the here and now.
  • Continue doing all you can. Follow public health recommendations to slow the spread of COVID-19. Stay informed via reputable news sources (but don’t be afraid to take a media break if you need one.) Remind yourself of the positive outcomes you contribute to each day.

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Mobilizing experts to address sexual misconduct in the military

In October 2019, 50 stakeholders from across Canada attended a workshop at the annual Canadian Institute for Military and Veteran Health Research Forum. The workshop focused on the psychological consequences of sexual misconduct during military service.

Researchers, policy makers, military members, veterans, and clinicians convened to explore the relation between exposure to sexual misconduct during military service and the onset of moral injury among female military members and veterans.

To mobilize action on these discussions, HRI hosted a symposium on December 3, 2019. Funded by the Government of Canada’s Defence Engagement Program, the symposium brought Canadian military and non-military experts together with a common goal of supporting the Canadian Armed Forces in addressing sexual misconduct.

The role of moral injury

Canada patch flags on soldiers arm

Work at HRI is exploring whether exposure to sexual misconduct in military environments is related to the onset of moral injury. For example, sexual misconduct may result in moral injury when an incident involves a perceived betrayal by those within a circle of trust or by an authority figure.

Similarly, a military member could be morally wounded by witnessing – but being unable to stop – a colleague from sexually harassing another military member.

The interplay between sexual misconduct and moral injury is complex and requires further investigation. What is known, however, is that military members affected by sexual misconduct in the workplace are at increased risk of post-traumatic stress disorder, anxiety, depression, and suicide.

Moving research, prevention, and intervention forward

During the December 3 symposium, discussions were diverse but focused on barriers, resources, and actionable items to affect change, including:

  • The rise of the internet and social media in skewing views of normal sexual behaviour and consent
  • Optimizing available resources for affected members, including the Sexual Misconduct Response Centre
  • Celebrating current training and education initiatives, including Operation Honour
  • Expanding education focused on emotional intelligence, boundary setting, assertiveness, bystander roles, and moral dilemmas
  • Understanding the needs of LGBTQ+ members, indigenous members, and members with disabilities
  • Improving screening tools to identify affected members or those at high risk of perpetrating sexual misconduct
  • Improving treatment and intervention approaches to help affected members
  • Vital research needs, including the need to explore where best to target resources, the link between sexual misconduct and moral injury, how to facilitate culture change among all levels and ranks, the value of peer support, and the need to expand research to include male, LGBTQ+ and non-binary members

Group of symposium attendees, December 3, 2019The symposium was attended by 18 representatives of leading universities, research centres, and treatment providers, as well as the Department of National Defence, Veteran’s Affairs Canada, Servicewomen’s Salute, and the Canadian Institute for Military and Veteran Health Research.

Dr. Margaret McKinnon, Homewood Research Chair in Mental Health and Trauma, is the lead investigator on this research. Key collaborators include:

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