There has been much discussion about the mental health crisis that is upon us due to the lasting impacts of the pandemic. But the crisis was not the making of COVID-19. It’s been in the works for some time now. Prejudice and discrimination have been pervasive forces putting mental health on the outside, instead of making it an integral part of health care for a more equitable and inclusive Canada.
Mental health and COVID-19
Stress about our health and that of our loved ones, worry about job loss and financial security, increased social isolation, lack of child care and the unknowns surrounding return to school have affected Canadians’ mental health.
A multitude of surveys and studies have given us a sense of how people are faring. The results are not surprising. The Centre for Addiction and Mental Health (CAMH) found that one quarter of respondents to a survey indicated moderate to severe anxiety levels. Those reporting higher levels of anxiety included women, youth, adults with children, people with high-risk jobs and those who had lost their employment due to COVID-19. The surveys have also shown continuous feelings of loneliness (24 percent). Heavy alcohol consumption has been a serious issue during the pandemic, with almost one quarter reporting having engaged in heavy episodic drinking, also known as binge drinking. And, a study surveying youth showed a significant decline in mental health in this demographic and disturbingly pointed to the significant disruption of mental health services and unmet support needs.
People with severe mental illness have also found themselves at greater risk during these times. They may experience delusions, cognitive impairment and disorganized behavior and may also be precariously or under-housed, often living in group settings. They may have a harder time adhering to social distancing, hand hygiene and masking provisions, putting them at greater risk of contracting COVID-19.
The opioid crisis, which governments have struggled to manage for years, significantly worsened during COVID-19. Due to a more toxic drug supply and service reductions at supervised consumptions sites, opioid-related deaths have soared and have outpaced the daily death rates due to COVID-19 on a regular basis. These record overdoses reflect a crisis that was in existence before the pandemic but were exposed and enhanced by it.
Early evidence is showing that racialized populations and those living on lower incomes were more likely to be affected by COVID-19. In Toronto, there is evidence that Black people have been disproportionately affected by the virus. And studies from the H1N1 pandemic suggest that this may be the case for Indigenous Peoples as well, though data is limited.
And lastly, Statistics Canada has shared emerging findings confirming early hypotheses that COVID-19 lockdowns may lead to increased domestic violence, child abuse and mental health trauma with increased calls to police for domestic disturbances, child welfare checks and mental health crises.
Further study is needed to understand the long-term effects of the pandemic on Canadians’ overall mental health and for those living with mental illness. For instance, it’s too early to know whether the pandemic has had or will have an impact on suicide rates.
Not surprisingly, the pandemic has shone a light on crises that have been in existence for far too long and has made explicit the importance of the social determinants of health. It has amplified the inequity faced by Black and Indigenous and other racialized populations, the risks associated with homelessness and income and food insecurity, and it has exposed significant gaps in the mental health system. The importance of social determinants has been grossly minimized, but these are actually about human and health care rights.
An action plan for recovery would include the following elements:
It’s time to make housing a human right. Safe and dignified housing leads to better health outcomes and makes employment possible.
Lack of affordable and supportive housing has been a persistent issue in Canada for decades. In 2012, there were 520,000 people with mental illness who did not have access to appropriate housing and almost 120,000 where homeless. Housing is a key determinant of health.
The pandemic forced an unprecedented level of speed and collaboration to house people who were homeless or precariously housed. In order to flatten the curve, ensure safety and support the necessary infection, prevention and control protocols, those who were homeless and living in group settings were moved to available hotel space, providing safe spaces and supports. Scaling approaches that have shown positive results, like Housing First, and investing in rapid options like modular housing is a starting point.
Basic income and employment
Income and employment are key determinants promoting mental health. The complexity of income supports across different levels of government has been an impediment to lifting people out of poverty and supporting Canadians with a living wage.
The introduction of the Canada Emergency Response Benefit (CERB) during COVID-19 was meant to provide those who had lost their jobs with immediate access to support. This has been positive, but more can be done. Studies coming out of Finland regarding the introduction of a basic income have shown positive results. Ensuring Canadians have the means to support the basic necessities of living is a smart approach.
Let’s make CERB a permanent benefit and ensure we eliminate clawbacks from provincial governments that disproportionately affect those living with disabilities, including mental illness. Governments should explore ways to support people with the lived experience of mental illness and substance use find meaningful employment. Adapted training and education programs for those who need flexibility to complete certification and creative lending programs to support entrepreneurial ventures will give people the dignity of work and promote a more inclusive economy.
Universal mental health care
Today, life-saving treatments for mental illness like structured psychotherapies, including cognitive-behavioural therapy, are generally not publicly funded and therefore not universally accessible. Having access to treatment and supports beyond hospital care is complicated and reliant on being insured or having the level of income to support interventions.
This leads to people not receiving care until it’s too late – exacerbating crises and leading to a longer journey of recovery. If mental health is health, then people who are in need must have access to timely, evidence-based treatments and supports. Health promotion and early intervention must be part of the continuum of care, and services need to be culturally safe and trauma informed.
Wait times for children and youth with mental health problems in Ontario are upwards of two-and-a- half years. Imagine a child with diabetes waiting two-and-half-years for treatment. Insurance plans often do not fund levels of care commensurate with evidence or need – can you imagine being told that you need 12 chemotherapy treatments, but your insurance only covers four?
Ontario has moved forward with the Ontario Structured Psychotherapy program, a pilot to support public-funded therapies. The program needs to be scaled up quickly. Evidence-based treatment and supports must be available across the country with a focus on equitable access. Removing barriers to access also means a commitment to the collection of race-based data.
Public health approach to substance use
The opioid epidemic is a crisis born of prejudice and discrimination. Substance use needs to be addressed from a public health lens, not a criminal one. This starts with providing a continuum of services that includes treatment and harm reduction.
Low-barrier access to a range of opioid agonist treatments and to supervised consumption services is needed. The evidence is clear that these are essential to preventing overdoses and connecting people to care. Once and for all, we need to abandon judgement – it’s the only way we are going to save lives.
Virtual health and access to broadband
As COVID-19 hit, the world shifted quickly to a virtual one. With workplaces and schools shut down at lightning speed, Canadians needed to adapt to working from home. Health care was forced to innovate overnight, moving to virtual care where possible.
At CAMH, tele-mental health has been a fixture of our services for decades but the ramp down of in-person outpatient services sped our plan to expand virtual access in a mere weeks, increasing virtual visits by 750 percent.
Technology can be a positive force, increasing access to care and supports. But a starting point on the journey to equitable access demands connection to basic infrastructure from coast to coast to coast. Access to high-speed Internet must be recognized as a fundamental human right.
For policy-makers, the pandemic begs a response to the immediate impacts of COVID-19 on the health of its population and the economy – two sides of the very same coin. Importantly, though, we cannot miss the opportunity to right some wrongs, to look at things a little differently, to hold true to our values as a country – to ensure that when we talk about the health and well-being of our population, that we mean all of the population, and when we talk about the economy, that we mean everyone’s capacity to contribute to it.
This year we proved what we could accomplish when lives were at stake. We galvanized resources, worked together in support of community, set partisanship aside, supported research to solve a complex and urgent problem. Imagine if we took that same approach to address the mental health crisis?
This article is part of the Tackling inequality as part of Canada’s post-pandemic recovery special feature.