What can we expect from the combination of social isolation, sky-high stress, job losses, food and housing insecurity, grief, closures of regular services and supports, access to cannabis and alcohol, and an overwhelmed and preoccupied health care system? A perfect storm for mental health and substance use issues, at a time when our systems for handling them are labouring under long-standing inequities, funding shortfalls, and an opioid crisis.
We should absolutely expect the natural resiliency of people and communities to come to the fore. Getting back to some kind of new normal will be enough for most of us to recover our equilibrium over time. But we should also prepare as best we can for increases in prevalence across the full range of issues, from distress to anxiety and substance use disorders to psychosis and suicide.
There are strong signs of growing risks. At the end of March, 40% of Canadians were worried a lot or extremely worried about COVID-19, 75% said they were anxious and 32% said they were having trouble falling asleep. Calls to distress lines are way up, and, according to Statistics Canada, one in 10 women are very or extremely concerned about the possibility of violence in their home. Meanwhile alcohol and cannabis sales are spiking as people turn to substances in an effort to cope with stress and boredom.
In the second half of March, a first wave of response from governments and organizations focused primarily on mental health promotion for the population as a whole. The internet was flooded with guidelines from governments and mental health organizations on how to take care of your mental health by staying socially connected, getting enough sleep, and so on.
Governments also moved swiftly to shore up income security. While many gaps remained for people with precarious employment, for example, these first efforts began to mitigate the mental health impacts of job losses. As early as mid-March, Health Canada loosened prescribing practices for controlled substances used to treat opioid disorders so that people could access drugs such as methadone without having to make daily visits to pharmacies or clinics.
A second wave in early April has seen an unprecedented increase in access to online resources and psychotherapy for people in distress or with existing issues, the most recent entry the federal government’s new Wellness Together Canada portal. Just moving existing services online is radical on its own. Human connection is so fundamental to psychotherapy and to mutual aid groups. But other changes are also underway, with social workers temporarily being added to workplace benefit programs that have long only recognized psychologists, and new programs being launched for the whole population and for specific groups like youth, seniors and first responders. Psychotherapists, psychologists and social workers even teamed up to provide free therapy to frontline health care workers.
This second wave has also included radical changes for populations with disproportionate risks for mental health and substance use problems. While such changes are far from reaching everyone in need and may not come with necessary mental health and substance use supports, a few months ago it would have been hard to imagine hotels being opened up to the homeless and people in need of shelter from family violence, social services being extended for youth aging out of foster care, and low-risk prisoners being released into the community.
A third wave is just starting up, focused on the needs of people living with severe and persistent mental health and substance use problems. While the resiliency of this population should never be underestimated, neither should the possibility that its needs could be overlooked. With so many services and supports moving online, can more be done to support people and caregivers who are having to fall back even more than normal on their own resources?
Are acute care and first responder systems ready for people who go into crisis during the pandemic? Are there plans in place for people who have both severe psychosis and acute COVID-19, and do these plans protect human rights? Hard lessons being learned in other countries suggest that these plans are urgently needed. We are now also just starting to see a collective focus on grief as the number of deaths steadily increases.
If we act now, we have an opportunity to get ahead of the mental health and substance impacts of COVID-19. This effort will require collaboration across the public and private sectors. Now is not the time to forget that up to two-thirds of Canadians have access to private mental health and substance use services through employment-based benefits, or that the one-third with more precarious or no employment rely on more limited public services or go without.
To assess surge capacity, we urgently need to do something we should have done a long time ago: take full stock of the mental health and substance use workforce across the public system, but also employee assistance programs, private practitioners, private residential treatment centres and informal peer support. The Canadian Institute for Health Information collects information on the number of different types of providers across the country. However, addiction counsellors are not included, and many critical pieces of data are only collected for physicians and nurses but not for other providers such as psychologists and social workers.
Who is working in the public sector or in the private sector? Who has additional time to give? Who has skills in grief counselling and in the trauma therapies that will be especially needed by frontline workers? Rather than running off in all directions in our rush to expand access to online supports, this information may tell us that we should expand the number of providers if we want to see a true increase in the availability of services.
To truly get ahead, and stay ahead, of the perfect storm of mental health and substance use issues being propelled by COVID-19, all three response waves need to keep rolling for some time. Looking ahead, we will also need to consider bigger reforms such as decriminalization of all substances, broader access to housing first programs, and addressing gaps in public health insurance for long-term care and psychotherapy, so that our society is more mentally well in the first place.
Mary Bartram, PhD, RSW is a mental health and substance use policy researcher with McGill University, Carleton University and the Mental Health Commission of Canada