Health
Embedded researchers can drive real change in mental health systems
Some adoption is already underway, with many mental health services embracing LHS principles and governments providing critical investments to scale these efforts. (Pexels Photo)
Canada’s mental health system is in crisis. Canadians increasingly lack access to adequate care, with equity-deserving groups being the most affected.
A recent report by the Canadian Mental Health Association, The State of Mental Health in Canada 2024, reveals a disjointed system riddled with gaps and inequities. Fragmented services leave patients navigating a confusing maze of referral pathways, while the system’s inability to collect or use data is preventing much-needed reform.
A bold reimagining is needed. One way forward is the learning health system (LHS) model, which emphasizes continuous cycles of improvement – collecting data from mental health services; learning from it; turning that knowledge into practical change; evaluating the impact — then repeating the cycle.
Some adoption is already underway, with many mental health services embracing LHS principles and governments providing critical investments to scale these efforts. However, persistent barriers to widespread implementation are limiting its potential.
A major asset for advancing the LHS model are embedded researchers. These professionals perform unique roles within health organizations that enable them to understand how research findings can be harnessed into more effective practices. They have the expertise to translate evidence into a co-ordinated, adaptable mental health system.
What do embedded researchers bring to the table?
Embedded researchers also apply diverse skills that extend far beyond the lab bench, from project management to partnership building and stakeholder engagement.
Their expertise in systems thinking, knowledge translation and data-driven decision-making allows them to navigate organizational structures, align with system priorities and drive meaningful change.
Unlike academic researchers who often work with health systems on a project-by-project basis, embedded researchers are fully integrated. This immerses them into an organization’s culture and operations, allowing them to gain a deep understanding of its priorities and challenges, as well as the needs of its community — patients and caregivers, children and families, and Indigenous and other equity-deserving groups.
Embedded researchers adapt to evolving priorities and develop tailored, practical solutions to address problems in real time. Their PhD-level training equips them to evaluate complex mental health system data and evidence, ensuring that decisions are grounded in the best available knowledge.
They also co-design interventions that are inclusive, impactful and sustainable, aligning with the lived experiences of those they aim to support.
This trust-building capacity, particularly with equity-deserving groups, enables long-term relationships that enhance the relevance and effectiveness of mental health services. Embedded researchers also catalyze system-wide improvements by embedding LHS principles more deeply into operations, driving continuous learning cycles and building an organization’s capacity to embrace sustained reform.
By bridging the frontline focus of clinicians, the operational priorities of administrators, the strategic decision-making of policymakers and the lived experiences of communities, embedded researchers help mental health systems shift away from reactive, short-term fixes.
They drive proactive, evidence-based strategies that deliver meaningful reform and ensure accountability for increased investment in the mental health system.
What is stopping the integration of embedded researchers?
Canada’s mental health system stands at a pivotal moment. Tools such as electronic health records, efforts to harmonize data across Canada and strategies for scaling interventions have laid a solid foundation for change.
The LHS model is gaining momentum as a way to address challenges and drive improvement, yet embedded researchers, who play a key role in putting LHS into action, remain underutilized. Overcoming that barrier is critical to fully realizing the promise of LHS.
One major obstacle is the lack of sustainable funding. Budget-constrained health service organizations typically prioritize frontline staffing over research-based roles, even though embedded research helps increase efficiencies and quality of care, making budgets go further in the long run.
Community-based organizations, which deliver local mental health services, face even greater financial pressures, often leaving them unable to support embedded research positions at all.
Initiatives such as the Canadian Institutes of Health Research (CIHR) health system impact program have made progress in training embedded researchers, but their reach is limited.
While the CIHR program embeds some of Canada’s brightest PhD-level researchers into the health system on short-term contracts, extending their roles through the four-year early career researcher funding stream is available only biennially and supported just 12 embedded researchers in its inaugural cohort.
Federal grants often prioritize discovery-based research over applied, system-integrated work and do not cover the salaries of embedded researchers who lead crucial projects. This forces highly trained professionals — often with more than a decade of scientific and mental health sector experience — out of the sector, creating a brain drain of precious and essential expertise.
Beyond funding, infrastructure gaps also present challenges. Many organizations lack job classifications and pay scales tailored to embedded research positions or the infrastructure to support research. These gaps force embedded researchers to spend valuable time resolving administrative hurdles rather than driving organizational and mental health care improvement.
A way forward
Fortunately, changes are possible within the current system to provide sustainable support. Sustainability is crucial to maximizing return on investment for these roles.
The unique benefits that embedded researchers bring — such as trust-based, long-term relationships and a nuanced understanding of system context — are achievable only through ongoing partnerships. Without stability in these roles, the continuity needed to cultivate these advantages is lost and the transformative potential is diminished.
At the federal level, an important first step is allowing grant budgets to include the salaries of embedded researchers who are leading projects, particularly those without permanent salaried positions.
However, this should be only a temporary measure until dedicated funding streams within the organizations themselves provide ongoing support for these roles. Relying on successfully competing for grant funding will only perpetuate long-term sustainability issues.
Another solution would be to expand the CIHR health system impact program. Increasing its number of funded positions and making its four-year early career researcher awards renewable would directly strengthen Canada’s pipeline of skilled embedded researchers.
Similarly, prioritizing funding streams for implementation-focused research in mental health care would provide financial support for applied, system-integrated work without burdening organizations to fund this work directly.
Organizations themselves must also demonstrate commitment by investing sustainably in embedded research. Developing formalized positions for them within organizational charts, guided by existing frameworks, can establish clearer pathways for integration.
As well, partnering with academic institutions to create cross-appointments between health systems and universities would grant researchers access to critical resources, such as grant management support and library services, while strengthening ties between research and the mental health system.
It is crucial that we think creatively about how to sustain embedded research. Encouraging organizations to share responsibility for funding, alongside federal contributions, can ensure these roles are not just sustainable but are deeply integrated into the health system.
Embedding research for a stronger mental health system
While increased investment in mental health is a start, money alone cannot address the deep-rooted problems of a system in crisis.
Embedded researchers are key to driving the bold reform that is urgently needed. This highly skilled but underutilized workforce can uncover inefficiencies, transform data into solutions that expand access to care and co-design interventions to reduce inequities.
They can reimagine the fragmented mental health sector as a seamless, integrated system where individuals can directly access the care they need.
By prioritizing embedded research, Canada has an opportunity to build a mental health system that learns, adapts and consistently delivers better outcomes for all Canadians.
Editor’s note: The authors disclose that they used an AI large-language model on this article for grammar corrections and clarification. The writing and ideas are original, but the authors are aware the article may flag AI indicators and wished to disclose its use.
This article first appeared on Policy Options and is republished here under a Creative Commons license.
