September 25, 2023
Mental health, once confined to the shadows of public discourse by comparison with physical health, has become an essential concern in Canada's social fabric. As a nation known for its rich cultural diversity and progressive values, Canada has profoundly transformed its approach to this issue. There is also a growing recognition of the bi-directional link between mental and physical health.
The road we've taken, however, has not been without its challenges, nor has it been without inspiring innovations that strive to make mental wellness a cornerstone of healthcare in the broadest sense in Canada; a task to which a team of professionals and administrators at Hôpital Montfort, in collaboration with the Institut du Savoir Montfort (ISM) and both national and international researchers, have dedicated themselves over the past few years. This hard work has resulted in an innovative service offering for French-speaking minority populations.
Dr. Jean Grenier talks to us about this new service offering, and places it in the context of efforts that have been taking root for several years. As a psychologist and clinical researcher, Dr. Grenier has been committed to mental health and health psychology at Hôpital Montfort for over 20 years. The expertise of Dr. Grenier and a team of researchers, in collaboration with hospital and ISM administrators, has paved the way for greater access to psychotherapy and mental health services for francophones living in minority situations, who struggle with common mental health problems (anxiety, depression, stress and trauma) as well as the psychological sequelae of chronic physical illness.
Dr. Grenier explains that it was his role as clinician-researcher at Montfort that led him to collaborate closely with experts nationally and internationally, particularly following the primary care reform of the 2000s, aimed at improving access to primary care services. Following a series of successive initiatives, the commitment of a team of clinician-researchers at Hôpital Montfort has broadened to encompass a variety of projects operating within this overall framework of increasing access to quality psychological services.
The Hôpital Montfort team has evolved over the years, including clinical researchers (Dr. Marie-Hélène Chomienne, Dr. Diana Kozicki, Dr. Jacques Bradwejn), administrators (Suzanne Robichaud, Annie Boisvert, Martine Potvin, Gasline Ternier, Jocelyn Veillard, Dr Bernard Leduc) in collaboration with the ISM (Marie-Andrée Imbault and her team) and a team at the Université de Sherbrooke (Dr Pasquale Roberge, Dr Helen-Maria Vasiliadis, Dr Alain Lesage) have proposed the establishment of a “phased community telemental health program” for francophones living in minority situations.
At the heart of this community telemental health program is a stepped-care model inspired by the British IAPT (Improving Access to Psychological Therapies) model, in which a continuum of services is delivered according to 3 levels of intensity.
Once referred by one of the healthcare professionals at partner clinics across Ontario, patients have access to the ēquilia virtual clinic - an intervention based on the principles of cognitive-behavioral therapy that is self-directed and accessible 24/7 via the web. “Through the virtual clinic courses, patients have access to meticulously designed strategies to enable them to better manage their mental well-being, foster resilience and promote proactive mental health management,” Dr. Grenier emphasizes.
The ēquilia virtual clinic is a French-Canadian adaptation of an Australian product (This Way Up!) that has been proven effective in over 26 randomized controlled trials and efficacy studies. These studies attest to the program's ability to significantly reduce the impact of anxiety and depressive disorders, whether in research or real-life clinical settings.
“Thanks to the financial support of Health Canada and the partnership between Hôpital Montfort, ISM, CIUSSS de l'Estrie-CHUS and Université de Sherbrooke, we have been able to acquire a Canadian license to adapt the This Way Up! virtual clinic to the French-speaking Canadian context, under the name ēquilia. We plan to acquire more than a dozen ēquilia modules, covering topics such as anxiety, depression, postnatal depression, insomnia, chronic pain management and social anxiety,” confides Dr. Grenier.
This model of care is patient-centered. Thus, “after completing care via the ēquilia virtual clinic, patients assess with their treating professional whether further services are required,” explains Dr. Grenier. If so, patients are referred to the second stage, which consists of participating in individual or group psychotherapy, delivered by a psychologist, doctoral candidates in psychology (under the supervision of a psychologist), or experienced psychotherapists.
For cases where stages 1 and 2 do not fully meet needs, there is a third, high-intensity stage that combines psychiatric intervention with a recommendation for pharmacotherapy for those who need it. In stage 3, patients may also have access to more intensive psychotherapy sessions.
At present, this new program is open to five partner clinics in Ontario, bringing together a range of health professionals, including psychologists, family physicians, psychotherapists, social workers, occupational therapists and nurses. These practitioners are empowered to refer patients suffering from depression and anxiety, for example, to the virtual clinic. Following this, patients will be able to benefit from step-by-step care as required.
Dr. Grenier points out that “Montfort practitioners can also refer patients to health psychology, and once the referral has been received, the request will be processed according to the stepwise care program”. It should be noted that, in order to refer to health psychology, it is important that the psychological distress be related to a physical health problem or chronic illness, and that, for the time being, the stepped care program is available to patients who can speak, understand and read French, as it is an initiative aimed at increasing access to psychological services for the French-speaking population of Ontario.
Beyond its focus on accessibility of services to Francophones, this model of care is a beacon of innovation and care based on rigorous assessment and research.
For Gasline Ternier, Clinical Director of the Health Psychology and Integrated Care Program, “this project contributes greatly to Montfort's university mission, because in addition to offering psychotherapy services in French, we are ensuring that this service is evidence-based and therefore constantly updated. It will also enable us to promote research and thus develop new service offerings” in the same vein.
Dr. Grenier affirms that this is “a service offering that embodies what we are trying to develop within our hospital and its academic mission, i.e. to seamlessly integrate clinical services, teaching, applied research and rigorous science-based evaluation”.
his visionary project embodies inclusivity, evidence-based practices and holistic mental health care. With plans to expand nationwide, this initiative is poised to transform the accessibility and quality of mental health care for Ontario's French-speaking minority communities, eventually extending its reach across the country. Thanks to the dedication and ingenuity of the teams who continue to work hard to make this project a reality, the future of psychotherapy and mental health care looks brighter and more inclusive than ever.
To find out more about this initiative, visit ēquilia.ca or write to equilia@montfort.on.ca. We also invite you to follow the Montfort Knowledge Institute via the Montfort Portal and on social media to stay on top of the news.