COVID-19: Year two

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By: Dr. Catherine Zahn

In the summer of 2020, I wrote about the capacity of the COVID-19 pandemic to power change. One year after the WHO declared the COVID-19 pandemic, there are reasons to be optimistic. And building on the past year’s experience, I think we all agree that we can do better. In July 2020, I proposed opportunities to optimize our new reliance on virtual care, including barriers we needed to overcome. At that time, many identified the shortage of affordable and supportive housing as a crisis during the pandemic, but we underestimated the risks to infection prevention and control in congregate living settings, shelters and for people experiencing homelessness. I expressed sincere optimism about opportunities unfolding as the entire mental health sector created meaningful alliances and spoke in a unified voice on behalf of the people we serve. There is no denying the positive change. Now we need to ensure it’s operationalized and embedded.

Virtual care has exploded across all of healthcare. But do we see care via phone or video continuing to be a substitute for in-person care, or is it an opportunity to increase access to specialty care? In addition to studying safe and effective ways to deliver virtual care, we need to understand when, how and for whom it’s appropriate. There are decades of experience in virtual, long-distance care in psychiatry and now, expertise in its delivery needs to be considered a core competency. A bright side bar to the virtual care story is that the technology is being used to not only deliver direct care, but also to build individual and team expertise. The creation of this new capacity will serve remote and rural areas of the province in the long run.

This past year, our focus on the gaps in mental healthcare has sharpened, but a disciplined effort to address wait times and access to supportive housing, psychotherapy, psychosis care or complex addictions has yet to be seen. I acknowledge with hopefulness the small dent in the housing arena, but encampments continue to spring up in parks and ravines. For people with complex mental illness, housing, income support and food security are healthcare rights. A solution to homelessness, a suboptimal shelter system and congregate living settings will require a substantial capital and operating investment, not to mention the political will. This sector cannot be last on a long list of competing societal needs.

I’m encouraged by the strong collaboration and problem-solving of the mental health sector, but we’re keen to extend that partnership to government to help build rational and effective investments in the mental health system. It’s hard to hear public pronouncements about the importance of mental health when the words carry no investment. Despite articulations of dismay, right now there are 28,000 young people in Ontario on waitlists for mental healthcare. Filling the mental healthcare gaps that have been exposed by a global pandemic will take more than we’re giving right now. Mental health leaders have redoubled our advocacy efforts through a collaborative campaign, ‘Everything is not OK,’ bringing hospitals and community agencies together in a call for investment in the mental health system that matches the burden of illness – and investment that will have real impact and measurable results. We’ve been waiting for a decade-long commitment to be fulfilled. Change comes slowly for those who live with mental disorders.

During COVID-19, the pace of change slowed further, as the healthcare system’s focus narrowed to addressing the crisis and critical care needs of patients and the workforce impacted by COVID-19. I can’t help but wonder where we would be now if there had been a parallel task force charged with delivering upstream measures to mitigate the impact of the virus on people most vulnerable to infection and poor outcomes, such as those in congregate settings and those with complex mental illness. What if there had been an early focus to test, trace and isolate people known to be at high risk? This year has exposed longstanding inequities in our society. For example, data shows that rates of COVID-19 infection, hospitalization and death are higher in communities with greater numbers of people who identify as non-white – the same communities who have less access to vaccines. Improvements in health equity can’t come fast enough.

There is more good news. Last summer, I wrote ‘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.’ Slowly but surely, this message is being absorbed. Canada’s vaccination campaign is underway and with each injection there is a sigh of relief. I’m confident that our Year One COVID-19 learnings will not be squandered. For one, you can count on my mental health system colleagues and me to demand funding equity for mental healthcare. It’s time.

Dr. Catherine Zahn is the President and CEO, Centre for Addiction and Mental Health.


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