By Dr. Catherine Zahn
The COVID-19 pandemic has set societal disparities in stark relief. There is evidence of this everywhere. We see it in who loses jobs, who is required to do dangerous jobs, who has the luxury of ‘self isolation,’ who’s digitally connected and capable, and the list goes on.
Those who live with complex mental illness are amongst the most vulnerable and disadvantaged. The current narrative of mental health and COVID-19 goes like this: at some ill-defined point in the future, we will experience a new pandemic – a pandemic of mental illness. This isn’t a description of the future, it’s today.
The idea that this is a problem to address later – after COVID-19, the public health measures imposed in response, and the economic downturn have taken their toll – is deeply worrisome. It suggests that the burden of mental illness is in the future and that it is directly related to the pandemic. Here’s the fact: the pandemic of mental illness predated COVID-19 by decades. Mental illness, including substance use disorders, is a burning hot issue right now.
Those who live with mental disorders interact with an underfunded, disconnected system. They are vulnerable in all aspects of life and in all spheres of health. Their care and supports have been interrupted. Many are poor and they have tough living conditions that put them at risk for COVID-19.
But there’s good news. The pandemic has, perhaps paradoxically, accelerated the exploration of solutions to longstanding mental health system challenges. Here are three examples.
First, we’ve embraced virtual care in a big way, and with lightening speed. Tele-psychiatry and tele-mental health have evolved over the past two decades, enabling service to remote and rural regions of the province with increasing sophistication. The COVID-19 crisis swept away obstacles to full-on implementation. Since March, virtual care visits at CAMH increased by over 750%, creating access to mental health care and supports for thousands of patients. There’s no turning back. Adoption of virtual health platforms is a permanent and growing fixture of the health care system, and when executed properly, provides an accessible, flexible and secure option for patient care. The caveats? It’s not just a matter of popping onto Zoom. There are legal, ethical and privacy issues that require attention. The provision of virtual care is a clinical competency that must be developed and demonstrated. And, virtual care is not appropriate or accessible for everyone. These are not reasons to step back, but rather reasons to formalize the practice, collect and share data to define and refine best practice.
Secondly, consequences of the intense shortage of affordable and supportive housing became a flash point during the pandemic, illustrating in living color the importance of housing to personal and public health. Safe housing is a health care right for those with mental illness. The scarcity of supportive housing is one aspect of inequitable funding for the mental health care system. It’s heartening to see that there’s been action. Emergency lodging for COVID-19- positive people living in shelters and on the streets – many of whom live with mental illness – has been procured in hotels. Toronto’s city council recently approved the development of 250 units of modular housing by September 2020. Is it too little? Yes. Is it too late? Maybe, but it’s a start. It’s time to amplify advocacy and maintain the momentum toward justice for society’s most vulnerable. If homelessness is a choice, it’s our choice.
And third, the mental health sector has shown a willingness to come together, to collaborate and problem-solve in a way that we haven’t seen in the past. Hospitals and community agencies have spontaneously organized or willingly responded to directives, aiming to help each other protect our caregivers and provide care. In mental health, this work has also created the potential for a unified advocacy voice that calls for nothing more than equitable access to effective care and supports for the people we serve.
We have more work to do. There are obstacles to overcome, speedbumps to navigate, structures to supersede. COVID-19 has presented an opportunity to position mental health at the centre of our healthcare system – to establish the fact that mental health is health.
Dr. Catherine Zahn is President & CEO at the Centre for Addiction and Mental Health.