Canada's mental health services were already overloaded. The pandemic made it worse

“People are very isolated, and there’s only one thing to do in their apartments: watch the news,” said Jean-Nicolas Ouellet. “So the downward spiral to malaise increases.”

Ouellet is the co-ordinator at CAMÉE, a mental health centre offering social housing support to people struggling with mental illness in Montreal North, one of the boroughs hardest hit by COVID-19 in Canada. With a dearth of mental health services in the neighbourhood, people at the centre often have to choose between buying food or paying bus fare to get treatment at the psychiatric hospital, an hour and a half away.

Rates of anxiety, depression and suicidal ideation have risen during the pandemic with surging demand for help, but the mental health-care system was overloaded before COVID-19. A report by the Mental Health Commission of Canada found the following: mental wellness has been steadily deteriorating, with one in five Canadians experiencing a mental health illness in any given year; by the age of 40, half of the population “will have or will have had a mental illness.” And based on conversations I’ve had with experts, Canadians will continue to suffer until systemic barriers to access are lifted.

The price of well-being

High-cost treatment and excessive wait times result in shuttered access.

Canada now spends an average of seven per cent on mental health compared to total health spending. At the same time, Canadians spend an average of $950 million on private practice psychotherapy, 30 per cent of which is paid out of pocket, with private insurance plans typically covering the cost of only two to eight sessions.

“There are many people who can't really afford $100, $150 per session,” said Dr. Ella Amir, executive director of AMI-Québec. “It has always been an issue.”

Dr. Christine Grou, president of the Order of Psychologists of Quebec, believes that free, universal public care is a bargain compared to the current model, especially considering the price on families and absenteeism rates at work and school. “I don't think that it’s expensive to (provide) mental health services. It’s expensive not to treat.”

According to Dr. Karen Cohen, CEO of the Canadian Psychological Association, the root of the access problem lies in its funding. Despite the fact that most mental health services are carried out in the community, services — aside from those delivered by physicians — are not covered by provincial health insurance plans, she said. “People who are employed may have health benefit plans that may include psychological services, but sometimes the caps on coverage are so low, you can't get a meaningful amount of service.

“If an insurer, be it private or public, is going to cover health services, (it) should do so equally for mental and physical health services.”

Dr. Peter Cornish, director of counselling and psychological services at University of California, Berkeley, said that in addition to out-of-pocket costs and limited insurance coverage, Canada’s current model of requiring intensive assessment before providing help effectively stigmatizes people and delays access to care.

“What (it) does is it makes everybody line up and get fully assessed before we provide care, and then it overprescribes care,” said Cornish. “It forces everyone with mild concerns to moderate to line up to see specialists.”

Support at your fingertips

Online platforms, portals, texting, messaging apps — e-mental health has brought psychological support to more Canadians’ fingertips, according to the experts I interviewed. Offering a blend of digital and in-person services as part of continuum of care has proven effective in bringing treatment to those who need it. In adopting a stepped-care model of blended services, Newfoundland decreased wait times for counselling by 68 per cent over a two-year period.

Wellness Together Canada, based on the stepped-care model, is a federally funded online portal that provides 24-hour access across Canada for low-intensity treatment. The patient-centred portal brings together a variety of services, including phone, video and text counselling with a mental health professional from providers like Kids Help Phone.

“You can talk to a counsellor within seconds,” said Cornish, who helped design the portal. Eighty per cent of users only require an initial session, while the remaining 20 per cent may need multiple sessions or tailored, intensive, team-based treatment, which frees specialists in the overburdened system to work with people who require more complex care, he said.

Nicholas Watters, director of access to quality mental health services at the Mental Health Commission of Canada, stressed that e-mental health services should not be understood as a replacement of face-to-face care. Many will manage by themselves using apps and other online resources, while others benefit from online tools, often between visits to the practitioner, said Watters.

But not all Canadians have equal access. A digital divide exists for many Indigenous people living in rural and remote, fly-in communities with limited cellular and reliable internet access, according to Deanna Dunham, director of Indigenous initiatives and equity programs at Kids Help Phone.

In Nunatsiavut, only one of the five communities has cell reception. Yet, despite initial setbacks, Laurie Russell, director of mental wellness and healing for the Nunatsiavut government, welcomes e-mental health tools like videoconferencing that have increased access in the region.

Turning to community care

Systemic racism has discouraged many in Indigenous communities from getting care. “Some kids are keenly aware of the discrimination that exists in the health-care system in Canada,” said Dunham. “So, the anonymity of our service protects them from that fear.”

Counsellors and volunteer crisis responders at Kids Help Phone undergo regular training by Indigenous partners so that they can provide culturally relevant support. Training helps to understand the ongoing effects of colonization and why, for example, ambulance services are unavailable in most Indigenous communities, said Dunham. The organization also works toward incorporating a more preventive, holistic approach. “(Mental health) is closely connected to things like economic opportunity, access to education, clean water (and) housing.”

Russell also believes in the power of community-level care to meet her region’s needs. “A lot of issues like substance use and suicide are symptoms of the experience of colonialism,” she said. “The harm reduction approach that we are moving towards (is about) deconstructing mainstream systems because a part of the issue is not just delivering services, (it) is looking at the barriers … in existence that make it difficult for Indigenous people to actually access mainstream services to begin with.”

Back in Montreal, the Sarker Hope Foundation has stepped up to make a difference in Park-Extension. The charity was founded in 2019 to help shelter orphans in Ghana. But after noticing an explosion of distress among the locals in one of the city’s most economically disadvantaged neighbourhoods, the foundation pivoted to creating a 24-hour mental health service connecting the community to counsellors by telephone and videoconference.

Client support leads such as Vanessa Viel connect callers to counsellors from India to Australia during the night hours.

“It was a big shock,” said Viel. “So we felt that we had to take it upon ourselves to do something to help them.”

At CAMÉE, people in need participate in a variety of activities, including art therapy and support group meetings. “We are obligated to offer so many (services) because in Montreal North, there’s no (psychiatric) hospital or real psychiatric clinic,” said Ouellet.

“You have to invest in the community, where the people are,” said Ouellet. “Services can come in many forms. They could be community-led, by telephone, but you have to respond when people ask for help.”

If you are thinking of suicide or know someone who is, there is help. Resources are available online at crisisservicescanada.ca, or you can connect to the national suicide prevention helpline at 1-833-456-4566 or the Kids Help Phone at 1-800-668-6868. First Nations people, Métis and Inuit can also reach out to Hope for Wellness at 1-855-242-3310 or the Kamatsiaqtut Help Line at 1-800-265-3333.