BC’s need for mental health support has never been more critical than during the COVID-19 pandemic. People are struggling with fear about their own health and the health of their loved ones, financial anxiety, the social isolation that comes from gathering and physical distancing restrictions, and working on the frontlines.
COVID-19 has only exacerbated this need for support, but Canada’s Centre for Addiction and Mental Health (CAMH) states the country was already in the midst of a mental health crisis prior to the pandemic.
VIU Professor of Nursing Dr. Shannon Dames has been researching human resilience for many years, and has developed a different approach to addressing the mental health crisis—Roots to Thrive-Ketamine Assisted Therapy (RTT-KAT), an innovative program that combines resilience development with psychedelic-assisted therapy.
In partnership with VIU and the Vancouver Island Health Authority (VIHA), RTT-KAT has yielded impressive results in its first cohort. In a press release from VIU, Dames explained that of the 16 participants in the first quality improvement cohort, 11 screened positive for PTSD prior to the program.
“All of the PTSD patients screened negative upon program completion, which is unheard of,” she said.
In addition, 62 percent of the patients who screened positive for anxiety left the program screening negative, and of the 13 people who screened positive for depression, all showed a significant improvement in their scores post therapy. Dames and her multidisciplinary team of therapists, Indigenous Elders, nurses, psychiatrists, Doctors of Medicine (MDs), social workers, and administrators have so far demonstrated that positive change doesn’t have to take years to implement.
The RTT-KAT program is a 12-week community of practice—a group of people who work collectively towards an end goal—that focuses on two core resilience factors: congruence (harmony/compatibility), and a sense of coherence (a person’s ability to use existing and potential resources to promote wellbeing). The weekly group therapy sessions use evidence-informed strategies aimed at enhancing mindfulness and self-compassion. Three ketamine sessions are then interspersed within those 12 weeks as a medicinal tool to address barriers, relax defenses, and facilitate insight.
“It’s a great opportunity to feel one’s essence outside of all the noise,” Dames says in an interview.
She explains that when people have a mental barrier such as PTSD or anxiety, it often shows up in the body in physical ways. The Roots to Thrive (RTT) component helps people to address that physical feeling, and the Ketamine-Assisted Therapy (KAT) helps to address those emotions in a non-attached way because the body no longer feels threatened by them.
“You’re in a dissociative state … which helps to discharge that energy that’s been stuck,” Dames says.
We live in a world that tells us putting on a brave face and wearing busyness as a badge of honour are ideas valued by society.
Many are experiencing the effects of this busyness “badge of honour” mindset, especially since COVID-19 has forced some to slow down, and others to continue their frontline jobs. Dames explains that RTT originally began as a program for professional caregivers, where rates of depression and PTSD were already high.
“I think COVID is giving us a bit of grace and permission to be honest about that. Even without COVID, we as a population have been turning ourselves off for many years to serve others, and when you’re in a high-stimulus, trauma-laden environment day after day, you’re going to get a really noisy body,” Dames says.
VIU Professor of Nursing Margaret Huml has recently joined the RTT-KAT facilitators’ team after participating as a patient in the first cohort, which began in October of last year. Upon entering the program, Huml was suffering from burnout and compassion fatigue. After years of working as a nurse and nursing professor, Huml realized she wasn’t able to show up for her students and patients as herself anymore, and had to take a semester off to take care of her mental health.
“It was like I was running this sprinting marathon for such a long period of time that when I finally stopped, I realized how depleted I was, how empty I was, how dispassionate I was for all sorts of things,” Huml says.
The RTT program is structured as a weekly check-in and group therapy session via Zoom. Each session typically begins with a guest speaker followed by an Indigenous Elder. The group then splits into smaller groups to facilitate a more in-depth check-in.
A large draw, Dames explains, is that facilitators participate in the sessions alongside participants to create equality within the group. In a typical healthcare professional-patient relationship, there’s a professional boundary between the individual with medical knowledge and the patient who is seeking medical attention.
“We have therapists, nurses, psychiatrists, MDs, and none of us wear our titles,” Dames says. “We take our hats off, and go into our groups, and share with everyone else. We are not above or below; we’re just humans. Our staff are all patients who have just gone through and are holding space for other patients going through.”
“We’re pushing boundaries a bit because we have to model [to the participants] what it looks like to be vulnerable and embodied in that vulnerability.”
This method of fostering an equal relationship between the facilitators and the participants was a huge reason Huml felt so connected to the program. “I needed someone to work with me as an equal as opposed to separate from me,” Huml says, though she acknowledges the importance of medicine and professional knowledge.
“I’ve had incredible therapists and counsellors—my physician did incredible work within what her scope is—but it wasn’t what I needed for my healing.”
The KAT part of the program is optional for participants, and takes place at Ladysmith Community Health Centre. Ketamine is commonly used by healthcare professionals to treat depression and as an anaesthetic, among other medical functions. It is currently the only legal medicine that produces psychedelic effects. The first round of KAT is administered with a lozenge. This introduces patients to the medicine with a gentle dose to manage expectations and establish a comfort level.
“The idea is that the body, the mind, and the spirit can get comfortable with what the non-ordinary state will feel like—it’s more of a befriending,” Dames says. The second and third sessions are administered through an IM (an injection into the muscle).
Huml recalls being nervous for the KAT sessions. “I was very naïve to psychedelics in general in my life. Of course as a nurse, I have an understanding of how ketamine is used in hospitals, but I just had to remind myself that I was okay, that I was safe.”
“Each of the three journeys were different,” Huml recalls. “Reflecting back on it, [each one] was exactly what I needed it to be because it brought me to a deeper place of healing.”
“I have more tools to be able to find my balanced state. One of the pieces I came away with after my third ketamine session was knowing that I can be grounded, even if there is chaos around me. I then realized I can be grounded in myself, even when I feel internally chaotic,” she says.
Huml has been able to integrate what she learned from the program into her family life and her classroom.
“I’ve always thought of my class of students as an organism, and as an instructor I was always outside of that organism. So, this past semester I’ve done what feels right in my heart, my body, and my teaching, and have stepped into the organism with them. Not for all my classes, but a particular course where that style fits appropriately,” Huml says.
“What I’ve heard from them is that their learning has been deeper and that they feel safe and seen as they grow into nurses and human beings.”
Despite its success so far, RTT-KAT hasn’t been without its setbacks. Dames explains that since it’s such a cutting-edge project, and since the system is so slow to change, there’s a lot of back-and-forth discourse.
“We’re building a roadmap for others across Canada to pick this work up … there’s been a lot of healthy [collaboration] with Island Health. And, it’s part of the process. This is what it looks like to pioneer.”
“Do we get pushback? Yes, but I don’t care, as long as we still get the go ahead,” Dames says. “At this point, it’s nice because we have evaluation data, soon to be research data. Look at the [numbers]—we’ve never seen anything like this—it’s not magic. This is what happens when people start feeling like they belong somewhere.”
Huml says, “I imagine that some people are going to see [the results] on paper and go, ‘Hmm… what happened there?’ Because it’s almost so unbelievable. What other program has shown this kind of evidence? And, I can tell you, as someone who has participated in it, it doesn’t surprise me one bit. The people I began the program with were the same people I ended the program with. And, the changes, the growth, the peace in each of them in the end… is evidence enough.”
Roots to Thrive-Ketamine-Assisted Therapy began its second cohort in early February. The program operates on a cost recovery model, passing any profit it makes onto future participants in the form of sponsorship. This is to ensure that those who don’t have the financial resources can still access the program. The labour and costs of the program rely heavily on donations and grants.
Dames says, “It’s a hybrid model at this point, so donations come right through the [RTT-KAT] website into the VIU Foundation, and into our program.”
To continue spearheading this research, Dames was recently awarded $450k from the Michael Smith Foundation for Health Research and the Lotte & John Hecht Memorial Foundation to use over the next five years.
Dames and her team are currently working with VIU to develop an accredited psychedelic-assisted therapy training certificate with a practicum aspect. They have aspirations that RTT-KAT will eventually be implemented all over Canada.
Perhaps the Roots to Thrive program is precisely what Canada needs to correct its current CAMH statistics on mental health and help mitigate the after-effects of COVID-19.