A UBCO researcher is calling for better ways to assess, diagnose and provide proper treatment for people who have mental health or substance use disorders.

While the federal government has pledged to help fund the expansion of free mental health services across Canada, UBC Okanagan’s Dr. Lesley Lutes says this is just the tip of the iceberg.

And she is not talking about money.

With the first ministers’ meeting on health care taking place in Ottawa this week, the Canadian Psychological Association has provided recommendations to help with federal and provincial collaboration regarding mental health and substance use health. Dr. Lutes says while this is positive news, more needs to be done.

She is the Director of the Centre for Obesity and Wellbeing Research Excellence in UBC Okanagan’s Irving K. Barber Faculty of Arts and Social Sciences. While the pledge for funding is positive news, she says that still won’t bring parity between mental and physical health care.

You’ve been working for years to bring mental health care to the same level of funding as physical health care. Can you explain why you are so passionate about this?

Let me say that we are in a landmark moment in history. After decades of advocacy and talking about mental health, the stigma surrounding it and the need for treatment—it is now front and centre in almost every conversation. Which is phenomenal. And is something to appreciate, savour and celebrate. However, when it comes to funding, mental or physical health care is treated like apples and oranges. In reality, there should be no difference between access to this care.

For example, patients undergoing cancer treatment have access to a multidisciplinary team with trained health-care professionals at all levels of expertise and focus. However, the existing structure and funding of care does not afford patients the same access to care that could provide lifesaving mental health treatment.

Can you imagine a patient needing a heart transplant having that surgery done by just one nurse in the operating room? Of course not. But that’s the reality when it comes to mental health care.

Other than funding, how can this be fixed?

Currently, when people need mental health help it is said that they just need “support” or “counselling” or “someone to talk to.” They are all lumped together and people believe that they all mean the same thing.

People need timely screening, focused assessment, diagnosis and treatment—targeted to their presenting issue, illness or disease—that can be tracked and evaluated across time.

On a very personal level, I know how lack of access to treatment impacts and shatters lives. I have lost an aunt to suicide. And some of the people I love and care about most in this world suffer from anxiety, depression and substance misuse.

The Canadian government is working toward establishing transfers to the provinces to expanding the delivery of comprehensive and accessible mental health services. Is this what you want to see?

While this investment would be the largest for mental health care in recent history, it is only the first step. Currently, there is a lack of a consistent definition of mental health or who is qualified to provide this care and the metrics for success. This lack of clarity threatens the foundation upon which we are creating and the very funding we need for this national mental health transformation.

So, it isn’t just about the money?

It is partly, but patients who need mental health care shouldn’t have to be burdened with understanding the training, regulatory oversight or scope of practice of each provider. That is the government’s job.

Our government ensures that our nurses and physicians and medical specialists are all providers that are regulated and performing duties consistent with their training and skills. That is currently not the case with the provision of mental health care.

Patients need proper assessment and diagnosis which in turn are critical to ensuring the right evidence-based treatment is offered and implemented with its outcomes evaluated. While programs can and do offer a range of services and supports, the assessment, diagnosis and treatment of mental and substance use disorders can only be performed by or under the supervision of regulated providers that have specialty training.

Without a clear determination of the services offered, who provide those services, and the evaluation and public reporting of meaningful service outcomes, mental health care will continue to be a blunt intervention that lacks the patient-centred precision we have come to expect for physical illness.

And it is the patients who continue to suffer.

Anyone with any health concerns, whether it be general wellness, mental health or mental illness needs to be treated in a timely, professional and equitable manner. It is possible. There are working models around the globe who have been doing this for decades. We just need to do it here in Canada. Until this is the case, I will continue to lobby for change.

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New UBCO research determines psychopaths may have a decreased ability to sense someone else’s pain.

While the manipulative and sometimes violent behaviour of psychopaths might be attributed to a lack of empathy, new UBC Okanagan research suggests that psychopaths may have a decreased ability to even sense someone else’s pain.

Dr. Kimberley Kaseweter, a postdoctoral fellow in psychology at UBCO, has recently published research examining the relationship between psychopathic traits and perceiving other people’s facial expressions of pain. Her paper was published in the Journal of Personality Disorders.

“A lot of the literature has focused on those basic emotions and psychopathy, like anger, fear and sadness,” says Dr. Kaseweter. “Almost no research has really focused on pain, which I found surprising because of the association between pain and violent behaviour.”

For this study, participants completed the Self-Report Psychopathy Scale to assess psychopathic traits within four different facets: callous affect, interpersonal manipulation, antisocial behaviour and erratic lifestyle. They also watched video recordings of patients manipulating injured shoulders in range-of-motion tests and then rated both the intensity and unpleasantness of the pain from patients’ facial expressions.

These recordings from actual patients showed spontaneous, natural expressions of pain that had been intensely coded frame by frame. The patients also self-reported their pain from these manipulations.

Dr. Kaseweter and her team were interested in whether psychopathic traits were connected to differences in how these participants might perceive others’ pain. They also wanted to know if that difference was due to conservative response bias—consistently rating all perceived pain lower on the pain scale—reduced perceptual sensitivity—inaccurate ratings, whether higher or lower—or both of these factors.

“We were able to break those two factors apart and tease that apart, which I think really gets at answering our questions. Do individuals who were high in psychopathic traits have an inability to see the facial expression of pain? Or if they can actually see it and just don’t care,” she says.

The study found that while people with psychopathic traits did not have a response bias—or were no more or less likely in general to ascribe pain to people—they were significantly less accurate in their ratings of pain in other people’s facial expressions.

This reduced sensitivity to other people’s pain was most associated with callous affect and antisocial behaviour. Dr. Kaseweter says this finding is not surprising, giving callous affect is related to low empathy and reduced concern for others while antisocial behaviour involves engaging in criminal acts.

The literature on psychopathy is still unclear on the underlying causes behind these facets of psychopathy, but Dr. Kaseweter says this study showed that one possible mechanism might be a reduced ability to see other people’s pain. The violence inhibition mechanism model suggests that in order to experience empathy, people have to first be able to accurately perceive someone’s distress to then withdraw from violent behaviour.

This study, she says, supports that theory.

“If they’re not accurately perceiving those facial expressions, they’d be missing the ability to identify that expression and then feel empathy and pull away from that violent behaviour.”

While psychopaths have high rates of criminal behaviour, rehabilitation efforts with current treatments for these individuals have been largely ineffective, if not at times counterproductive.

Dr. Kaseweter is hopeful that this study could help isolate an area to direct more successful treatment in the future, especially with the clarification between response bias and actual inaccuracies in pain sensitivity.

“I think it’s a very important distinction. So how do we help? Is it just that people high in psychopathic traits don’t care? Then we have to teach them empathy in a different way. Or is it that they’re not seeing facial expressions accurately? Our findings suggest the latter—and that this decreased ability to detect pain accurately may underlie the lack of empathy we see with psychopathy.

“If this is the case, then training interventions designed to improve pain detection may, in turn, reduce the callous affect and antisocial behaviour characterizing psychopathy.”

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Using cannabis while pregnant to combat nausea and vomiting, pain and sleep disturbances while pregnant is nothing new, say UBCO researchers. But women continue to face significant barriers about discussing this use with their health-care practitioners.

A UBC Okanagan researcher is calling for doctors to have an open mind when it comes to cannabis use to combat nausea and other symptoms during pregnancy.

Doctoral student Sarah Daniels recently published research examining the stigma—and the lack of open communication with their doctor—pregnant women experience if they discuss therapeutic cannabis use while pregnant. Her research was published recently in the Journal of Psychoactive Drugs.

Daniels, who studies with Psychology Professor Dr. Zach Walsh in UBCO’s Irving K. Barber Faculty of Arts and Social Sciences, says cannabis use during pregnancy is nothing new. But women face significant barriers to discussing this use with their health-care practitioners.

“Historically, cannabis has been used during pregnancy and childbirth—orally, topically, by suppository and by inhalation—to treat nausea and vomiting, pain, sleep disturbances and other symptoms,” says Daniels.

Despite decades of widespread prohibition, she notes cannabis remains among the most widely used drug in Canada in both general and prenatal populations.

More than 100 women participated in an online survey and 34 per cent reported using cannabis during pregnancy. Of those, 89 per cent said they used cannabis for prenatal nausea, and 92 per cent said cannabis is “effective” or “extremely effective” in treating their symptoms. A further 69 per cent said they substituted cannabis in place of a prescribed pharmaceutical.

This is particularly relevant in a landscape where there are few effective treatments for vomiting while pregnant, a condition that can have significant negative health impacts on both the mother and the developing fetus, Daniels says.

Research into prenatal use has resulted in ambiguous results, she adds. Some studies have reported differences in birth weight, head circumference, fetal development and neurodevelopment. Other studies have characterized the use as benign and attribute alleged negative effects to other variables such as poor prenatal nutrition, folate deficiency and tobacco use.

“While we do not have definitive and conclusive clinical data on the full range of potential consequences of cannabis use during pregnancy, the same is true for most pharmaceutical drugs currently available to those who may be pregnant,” says Daniels. “As such, physicians typically utilize their clinical insight to weigh the potential benefits compared to the potential harms in each case.”

Daniels says that physicians should drop the stigma and apply the same cost-benefit analysis to cannabis.

“Stigmatization has been identified as a barrier to discussing therapeutic cannabis use between a woman and her doctor,” says Daniels. “Patients report perceived negative responses from physicians when broaching the subject and fear that their care and the relationship with their physician will be negatively impacted.”

Of those pregnant women using cannabis, 62 per cent said they were not comfortable discussing it with their doctor and 74 per cent agreed they would not share this information with a health-care provider in future pregnancies because they sensed disapproval from their doctor.

Adding to the confusion, Daniels says health-care practitioners acknowledge not having enough information about cannabis use, both generally and specifically, to discuss it in an informed manner with a pregnant patient. A recent educational needs assessment found that physicians, nurses and medical students reported significant knowledge gaps and a lack of training and information about medical cannabis.

Daniels says a growing interest and conflicting information regarding the risks and benefits of therapeutic cannabis use while pregnant suggests a need to develop strategies that will provide women with the best available resources so they can make informed decisions with their doctor about using it.

“This research provides further evidence that prenatal cannabis use is pretty common—more common than people are often comfortable acknowledging,” says Daniels. “However, there continues to be this fear of judgment.

“At the end of the day, we want women to be able to have these conversations with their physicians to provide the best care possible without decisions being impacted by moral judgement, misinformation or stigma. Clear and effective communication with health-care providers—beyond issues of abstinence and legality—is essential to enable the safest therapeutic use of cannabis by pregnant women.”

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New UBCO research confirms a brief text-based conversation with a trained counsellor can help users to feel safe and de-escalate a mental health crisis.

Can a text conversation provide the support needed when someone is seeking help during a mental health breakdown?

New research from UBC Okanagan is saying yes, crisis text lines are useful and effective.

Dr. Susan Holtzman, who teaches psychology in the Irving K. Barber Faculty of Arts and Social Sciences, explains that mental health crisis services have expanded recently beyond telephone hotlines to include communication methods such as live chat and texting.

Dr. Holtzman notes there is growing pressure in Canada to create one three-digit suicide crisis hotline which would be similar to the one launched recently in the United States. If implemented in Canada, not only would it be easier for Canadians to immediately access help, it would also confirm that Canada sees mental health care and suicide prevention as serious matters of concern.

“Every year, millions of people all over the world reach out to crisis text lines,” Dr. Holtzman says. “However, because crisis text lines are anonymous, very little is known about the user experience. And despite rising mental health problems worldwide and a high uptake of crisis text line services, they remain understudied.”

Dr. Holtzman’s team, led by clinical psychology doctoral student Alanna Coady, turned to Twitter posts to examine how crisis text lines users responded to their experiences with the crisis lines.

Analyzing 776 tweets the research team examined six main themes including approval, helpful or unhelpful counselling, service delivery issues, accessibility and whether the service suits multiple mental health needs.

Overall, results determined text-based crisis support works, as many users reported positive experiences of effective counselling including helpful coping skills, de-escalation and reduction of harm.

“The goal of this project was to gather first-hand accounts of people who use crisis text lines to better understand the benefits and limitations of these services,” explains Coady. “Many users preferred the discreetness of texting over calling a crisis line, and the majority of tweets indicated that users found the service helpful.”

However, she notes there are drawbacks to texting crisis lines, including long wait times. Users also noted that some responses from counsellors were described as cliché, overly scripted or invalidating. This could be somewhat related to the texting platform, she explains, which can be more prone to misunderstandings.

“While some people may encounter negative reviews of crisis text lines on social media, our findings suggest that positive experiences are much more common and users report a wide range of benefits, including feelings of validation and concrete coping strategies,” Coady adds. “Overall, crisis text lines appear to be a promising method of delivering crisis support.”

Dr. Holtzman notes the study, published recently in Internet Interventions, did not make a direct comparison between telephone and text-based crisis lines. The purpose of the research was to examine user response. Results also identified areas for improvement, particularly ensuring more timely service delivery and effective communication of empathy.

“Our findings highlight that more research is needed to understand how we can effectively communicate empathy and understanding through texting,” she says. “At the same time, this research suggests that even a brief text-based conversation with a trained counsellor can lead users to feel safe and supported during their darkest hours. Given the many barriers to mental health treatment in our society, as well as the further strain caused by the pandemic, text-based crisis lines warrant much more attention from researchers than they have been given in the past.”

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A new UBCO study found that microdosing psilocybin demonstrated greater improvements in mood, mental health and psychomotor ability for participants.

The latest study to examine how tiny amounts of psychedelics can impact mental health provides further evidence of the therapeutic potential of microdosing.

Published in Nature-Scientific Reports this week, the study followed 953 people taking regular small amounts of psilocybin and a second group of 180 people that were not microdosing. This research, led by UBC Okanagan’s Dr. Zach Walsh and doctoral student Joseph Rootman is the latest study to come from the Microdose.me project.

For the 30-day study, participants were asked to complete a number of assessments that tap into mental health symptomology, mood and measures of cognition. For example, a smartphone finger tap test was integrated into the study to measure psychomotor ability, which can be used as a marker for neurodegenerative disorders including Parkinson’s disease.

Those microdosing demonstrated greater improvements in mood, mental health and psychomotor ability over the one-month period compared to non-microdosing peers who completed the same assessments.

“This is the largest longitudinal study of this kind to date of microdosing psilocybin and one of the few studies to engage a control group,” says Dr. Walsh, who teaches in the Irving K. Barber Faculty of Arts and Social Sciences. “Our findings of improved mood and reduced symptoms of depression, anxiety and stress add to the growing conversation about the therapeutic potential of microdosing.”

Large doses of psychedelic psilocybin mushrooms have a long history of use among some Indigenous peoples and are prized in Western culture for their psychedelic effects, explains Dr. Walsh. They were also labelled an illicit substance during the American-led “war on drugs.” But recent interest has expanded from large dose psychedelic use—known for creating dramatic alterations in mood and consciousness—to the potential therapeutic application of smaller microdoses. Amounts so small they minimally interfere with daily functioning.

The Microdose.me project is conducted by an international team including Dr. Pam Kryskow from UBC Vancouver, Maggie Kiraga and Dr. Kim Kuypers from Maastricht University in the Netherlands, American mycologist Paul Stamets, and Kalin Harvey and Eesmyal Santos-Brault of the Quantified Citizen health research platform.

Microdosing involves regular self-administration in doses small enough to not impair normal cognitive functioning. The doses can be as small as 0.1 to 0.3 grams of dried mushrooms and taken three to five times a week.

The most widely reported substances used for microdosing are psilocybin mushrooms and LSD. Psilocybin mushrooms are considered non-addictive and relatively non-toxic—especially when compared to tobacco, opioids and alcohol.

“Our findings of mood and mental health improvements associated with psilocybin microdosing align with previous studies of psychedelic microdosing, and add to them through the use of a longitudinal study design and large sample that allowed us to examine consistency of effects across age, gender and their mental health,” says Rootman.

The comparisons of microdosers to non-microdosers over the one-month period of the study indicated greater improvements among microdosers when asked about their mood, depression, anxiety and stress, he explains. Analyses of the finger tap test showed that microdosers demonstrated a more positive change in performance than non-microdosers, particularly among people over the age of 55.

“Despite the promising nature of these findings, there is a need for further research to more firmly establish the nature of the relationship between microdosing, mood and mental health, and the extent to which these effects are directly attributable to psilocybin rather than participant expectancies about the substance,” says Dr. Walsh.

The study was not designed to investigate the potential influence of participant expectancy on microdose outcomes, but the authors note this is a necessary advancement in the field.

“Considering the tremendous health costs and ubiquity of depression and anxiety, as well as the sizable proportion of patients who do not respond to existing treatments, the potential for another approach to addressing these disorders warrants substantial consideration,” Rootman says.

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While it is recommended toddlers have less than one hour of screen time per day, UBCO researchers suspect that number might be higher. They are investigating how screen time might affect a child’s sleep.

Young children and the amount of screen time they enjoy has always been a controversial issue. And now, after living with COVID-19 for more than two years, a team of UBC Okanagan researchers is taking a second look at how much screen time young kids are getting and how this impacts their sleep and the family dynamics.

There’s no doubt screen time has increased in households across North America during the pandemic, says Associate Professor Dr. Susan Holtzman. After two years of living in isolation and dealing with remote work, home learning and socialization through video chats and gaming, it is time, she says, to take a fresh look at screen habits and how it’s impacting lives.

Dr. Holtzman, who teaches psychology in the Irving K Barber Faculty of Arts and Social Sciences, and Dr. Elizabeth Keys, an Assistant Professor in the School of Nursing have launched a new study to determine how screen time and sleep habits may have shifted during the pandemic. They want to know what this means for families now, and in the future.

Dr. Keys explains why this research matters and why parents should tune in.

According to the Canadian Paediatric Society, children between the ages of two and five should use screens for less than one hour per day. But you suspect screen time is much higher, especially since the pandemic began. What’s changed?

Many parents have shifted temporarily or permanently to working from home. While this has had a number of advantages, it has also put parents in the tricky position of balancing work with caring for children who could not attend school or daycare due to actual or potential COVID-19 symptoms.

As a parent myself, I know that everyone has been doing the best they can. But some young children may have gotten used to having more screen time. Now that restrictions are lifting significantly, this is a good time to take another look at the habits that may have formed over the past two years to see how we can better support parents of young children.

What is the connection between a child’s screen time and sleep?

How screen time impacts the sleep of children is a fascinating area of research that is relevant to so many families. Some studies have linked more screen time with less sleep. One reason is that screen time can delay bedtimes. Another possible reason is that screen time can replace daytime physical activity—and we know being more active during the day can help with getting better sleep at night.

This new research looks at mothers and children aged two to five. Why that specific age?

Early childhood is a critical period for physical, social and emotional development—as well as the development of healthy habits. My research focuses on improving sleep health to promote healthy relationships in children and their families, starting in early childhood.

Sleep difficulties are very common in families of children under the age of five. These sleep difficulties can often disrupt parental sleep. In particular, we know the COVID-19 pandemic has been quite hard on mothers, who are already at increased risk of having sleeping difficulties. We all know how important a good night’s sleep is for our mental and physical wellbeing.

Why now?

We did a similar study in 2019 and more than 450 local parents participated. We are doing the survey again to look at the impact that COVID has had on the lives of families with young children. We are especially interested in looking at changes to sleep, screen time and family relationships. Are people less concerned about screen time? Is it seen as more normative? Has sleep changed in children and their mothers, who have had to juggle so many stressors over the last two years? What has been the impact on our family relationships?

To help with our research, we are looking for about 200 mothers of children aged two to five in the Central Okanagan to fill out a brief online survey located at: www.familyscreentime.ca.

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