Why we do what we do: New directions for the Hatching Ideas Lab
Written by Dr. Simon Hatcher
Image courtesy of Ian Schneider, Unsplash, 2016.
As I write this, we are emerging (hopefully) from the COVID-19 pandemic. And if the pandemic has told us anything it is that we are not “all in this together”. COVID-19 has disproportionately affected communities and countries around the world. Generally, those people who have fewer access to resources whether through systemic racism, economic or policy reasons have suffered more. As a doctor, I see this every day – most of the people I see don’t have a job or own their own home. This one of the themes that has inspired the work we do in the Hatching Ideas Lab – trying to improve the care of populations who are underserved.
Another theme that inspires us is that of integration. When I was training, the services which always impressed me most and seemed to deliver the best care were those who had managed to integrate clinical work, research, and teaching. One of my early inspirations was Dr. Julian Tudor Hart, a family doctor, epidemiologist, scientist, writer, political commentator, and social advocate who described the inverse care law 50 years ago. Simply stated, this said that those who need most health care are the least likely to receive it. Following this, at the Hatching Ideas Lab, we try to integrate clinical work, science, and policy to work out the best way to do things. What this often means in practice is either setting up research clinics or working closely with service users and policy makers. This isn’t easy, especially in mental health where stigma in the systems we work in throws up so many barriers.
Research work in medicine has essentially three work streams:
Basic science which looks at the mechanisms of disease by scanning brains, doing animal experiments or other laboratory work. In psychiatry, the last 25 years of neuroscience basic research, which has received the bulk of “mental health” research funding, has resulted in very few discoveries that are clinically useful. Most of the advances have come from using existing drugs off label in novel ways – for example the ketamine story.
Analyzing large collections of data either in the form of systematic reviews or large databases. One good example of this is the work of the IC/ES in analysing health service data in Ontario, which has been extremely useful for pointing out disparities and describing the existing state of affairs. But the data is always going to be incomplete (with those most underserved populations often not represented in the data – such as homeless and first responder populations).
Clinical research, which, using human participants, typically evaluates the effectiveness of drugs, medical devices and practices[1] and how to implement them into everyday care. This is the focus of most of the work of the Hatching Ideas Lab.
We are not that interested in just describing the problem. We try to come up with solutions to the problems we research, which is why we mostly focus on doing clinical trials of non-pharmacological treatments. Mental health research with patients is not well funded especially in Canada. Research on suicide and self-harm and so-called “personality disorders” are particularly underfunded. This means that the work we do is unique and when integrated with policy work will hopefully make a difference. The areas we focus on - suicide prevention, first responders, trauma in people who are homeless, and COVID-19, all overlap and complement each other as they all involve underserved groups, the effects of trauma and the combination of physical and psychiatric disorders. These populations are often missing from mainstream responses to “mental health” which tend to focus on common and easily recognisable disorders instead of severe mental illnesses. We are working to make sure that the marginalized do not stay marginal.
If you want to find out more or to be involved in research as a citizen scientist or patient partner, please get in touch using our Patient Engagement Contact Page.