Program Report: Implementing Mental Health Supports and Resources for Dialysis Patients Into Practice Through the Mind the Gap Project

People receiving dialysis experience a high burden of mental health challenges. Few dialysis-specific resources exist to support their mental well-being. The Can-SOLVE CKD Network 'Mind the Gap' project team identified mental health care challenges for the dialysis population and explored strategies to integrate relevant support and resources into practice.

Candidate interventions were a Dialectical Behavioural Therapy (DBT) Skills Training program implemented for people receiving hemodialysis in Manitoba and a provincial pathway for mental health care for people receiving all dialysis modalities at a system-level in Alberta. For this reason, we refer to both hemodialysis and dialysis in this report.

Mind the Gap's two interventions were identified after input from diverse interest-holders including people with lived dialysis experience, their caregivers, and kidney and mental health care providers and leaders. Emphasis was placed on patient engagement, Equity, Diversity, Inclusion and Accessibility (EDI-A), and Indigenous cultural safety. The Knowledge to Action Framework informed implementation.

Looking across both interventions, at the person-level, barriers included stigma around asking about and accessing mental health resources, and the perspective that mental health care does not belong in dialysis care. To empower people on dialysis to advocate for their mental health needs, we developed resource lists of freely accessible, online mental health supports for Canadians receiving dialysis. From the DBT project, Indigenous patients and patient partners were more engaged when the Mind the Gap Indigenous Research Coordinator was involved in team interactions. At the healthcare provider-level, the importance of mental health care in dialysis populations was recognized but there was uncertainty as to who was responsible to address this. Champions in various roles, including patient partners, healthcare providers, and leaders, have been a constant strategic facilitator. Intervention-level facilitators for DBT included holding DBT sessions at a location away from the hemodialysis unit and obtaining funding for allied healthcare providers to complete DBT Skills training. Intervention-level facilitators for the provincial pathway for mental health care for people receiving dialysis included engaging hundreds of knowledge users in its development. At both the intervention and system-levels, barriers included the impact of interventions on clinical care resources or workflow and high turnover of program leadership.

Our work reflects the perspectives of interest-holders in two Canadian provinces. Transferability of findings about mental healthcare challenges, available supports, and interventions to diverse dialysis populations across Canadian contexts requires further investigation.

All interest-holders expressed a compelling call to attend to mental health support needs in dialysis patients. The process involves numerous challenges, including stigma associated with people receiving dialysis accessing and healthcare providers engagement in mental health supports, time constraints, lack of relevant training among dialysis staff, and inflexible, siloed structures within healthcare systems. Blending mental health care with dialysis care is culturally novel and an important step to meaningfully support the emotional and mental well-being of people on dialysis.