CBC Manitoba released its list of the top 40 researchers and educators in the province under age 40 last month. Among the list was Jennifer Hensel, an assistant professor of psychiatry at the U of M’s Max Rady college of medicine, who was included for her pioneering work on virtual mental health care in Manitoba.
Hensel’s passion for program development and improving access to mental health care began during her training and residency in Ontario, where she completed her master’s degree at the University of Toronto’s Institute of Health Policy, Management and Evaluation.
“I was noticing that there were a lot of challenges in providing services, a lot of gaps in access to service, a lot of variability in the services that we provided not only within programs but certainly geographically,” Hensel said.
“I became very interested in how we do that better. I was always interested in research […] but rather than research in drug development or basic science, I became very interested in health services research […] more applied, pragmatic research.
“How do we do things better? How do we develop programs to really meet the needs of the people that are going to be using them? How do we get services to people who need them?”
Telehealth and virtual care solve a number of problems people face in receiving health care, both in Manitoba and elsewhere.
Hensel mentioned geographical distance as a major barrier in the province, with rural and remote communities often lacking access to mental health care in particular, but also talked about urban complications like public transportation schedules and parking.
Even having to plan around infants and young children can make health care difficult. Telehealth allows patients to receive care when and where it is convenient for them, rather than what works best for their provider.
Although both patients and providers have expressed uncertainty about whether mental health care is as useful virtually as it is in person, Hensel is confident the result is the same.
“There have been a lot of studies that have compared the use of telehealth assessment to a face-to-face assessment showing that you can, in the vast majority of cases, effectively and accurately diagnose and provide treatment and build rapport with a patient,” she said.
An interesting side benefit to making virtual mental health care more common, she added, is that people who might not otherwise seek treatment are increasingly using technology like apps or online tools to manage any symptoms on their own.
However, not every patient entirely benefits from virtual care or self-management, Hensel said.
“There’s a fine balance between making it convenient and reducing the stress of having to get to the office — there’s a lot of costs associated with that, too, parking and travel and so on — but then balancing that with that person’s need to actually physically get out of the house and challenge their anxiety and challenge their depressive symptoms,” she explained.
Of course, with the COVID-19 pandemic, patients and providers were left without much of a choice.
“I think when [COVID-19] hit, a lot of people had to suddenly shift to virtual care and really didn’t know much about it or how to do it,” Hensel said.
“There was a lot of anxiety about that among physicians, for good reason, but my reaction was, ‘Finally!’ Finally, we have this wide-open landscape to be able to move forward with virtual care. So, [COVID-19] has obviously removed all of the adoption barriers that were there.
“Technology, virtual care, telehealth — this is not a new solution that people are talking about. It has been touted as a solution for years and years and years, but there’s been a lot of reticence to adopt it into practice that [COVID-19] has effectively removed out of necessity.”
Manitoba also had to start from closer to the beginning in shifting to virtual care than other provinces.
“In Ontario, they already had an infrastructure to equip providers with the technology that they needed to be able to provide virtual care fairly quickly,” Hensel explained.
“Manitoba didn’t have that infrastructure. They have a good telehealth system, but for you to access telehealth, you have to go to a clinic that has a telehealth unit […] When I say telehealth, I’m talking about the traditional telehealth assessment that’s done in a suite. It’s located in a health care clinic, there’s usually somebody from the other end to help facilitate it.
“So, Manitoba has a great infrastructure for that, but they didn’t have any infrastructure for the home-based virtual care where the patient can access it in their home, so they had to quickly come up with some way for us to do that.”
Hensel also acknowledged all the topics that need further investigation. For example, using Zoom or other videoconferencing technology allows for some visual input, which is helpful for mental health practitioners, but much less is known about how effective telephone appointments can be.
Hensel is confident that the rise in telehealth will stick around after the pandemic is less serious, but there are still a number of questions to be answered.
“There’s a lot of things that need to change for [virtual care] to become a permanent solution,” she said.
“Not just provider attitudes, but the infrastructure, the technology, the payment, the remuneration set up. So, I think we’re seeing the government response to the idea that this actually is something that we should probably look at permanently, but I do think we need to really figure out how to do it right.”