Mental health and substance use during the COVID-19 Pandemic: Implications for healthcare

By Mary Bartram and Robert Gabrys

According to an on-going series of surveys being led by the Mental Health Commission of Canada (MHCC) and the Canadian Centre on Substance Use and Addiction (CCSA), the mental health and substance use impacts of the COVID-19 pandemic have been profound, and profoundly interrelated. So far, the survey series has highlighted the disproportionate impact of COVID-19 on people with a history of mental illness or substance use disorders, women living with younger children and people living alone. The healthcare system has a critical role to play in stepping up everything from screening and referral, to expanded access to treatment, to mental health and substance use supports for healthcare providers.

Since this series started in the Fall of 2020, respondents have been reporting significant mental health concerns at much higher rates than before the pandemic. For example, only 40 per cent of people surveyed reported very good to excellent mental health, compared to 67 per cent in a 2019 survey conducted by Statistics Canada. Anxiety and depression are also being more commonly reported now compared to previous years. Since October 2020, 15 per cent of respondents said that they were experiencing moderately severe to severe symptoms of depression and 25 per cent indicated moderate to severe symptoms of anxiety (increasing to 37 per cent of women living with young children). In March 2021, 25 per cent of respondents who have previously been diagnosed with a substance use disorder reported seriously contemplating suicide in the past month.

The COVID-19 pandemic has also been accompanied by an increase in use of alcohol and of cannabis by a large percentage (30 per cent and 35 per cent, respectively) of people who use these substances. Most striking, people with past and current mental health concerns have consistently displayed the greatest increase in the use of the substances as well as problematic use, highlighting the close connection between mental health and substance use. Not surprisingly, stress has often been cited as the top reason for the increase in use, although boredom and lack of regular schedule have been also commonly reported.  Some experts believe that increased availability and access to alcohol and cannabis, through takeout and delivery services, could have also facilitated changes in patterns of use. While the harms associated with the increase in alcohol and cannabis use have not yet been completely documented, a recent report6 by the Canadian Institute of Health Information (CIHI), for instance, described an increase in hospitalizations due to alcohol and cannabis during early months of the pandemic. Moreover, 21 per cent and 36 per cent of people who use alcohol and cannabis, respectively, report signs of problematic use. These statistics are higher among those with mental health concerns and those who live alone.

Feelings of stress, anxiety and sadness are normal responses to a very abnormal situation, and access to vaccines and lower rates of COVID-19 infection will be a lift for many. However, persistent anxious, hopeless and depressive states can interfere with various aspects of a person’s life, work, social and family responsibilities, and increase the risk of the development of both mental health and substance use disorders. We can expect the mental health and substance use impacts of the pandemic to be delayed, complex and long-lasting. What role can the health system play in mitigating these impacts?

Preventative strategies can play an important role. Now is the time to redouble efforts to include screening, brief interventions, and simple conversations about mental health and substance use as a routine part of healthcare, for everyone from mothers with younger children to people who live alone. Spreading the word about free online resources such as the federal government’s Wellness Together Canada portal could be a great starting point. Now more than ever, it is also be important to disseminate the Low Risk Alcohol Drinking Guidelines and the Lower Risk Cannabis Use Guidelines.

Additionally, there is an urgent need to strengthen the capacity of the healthcare system to meet the emerging mental health and substance use needs of the population. Treatment services and supports for mental health and substance use were already under-resourced before the pandemic. The pivot to virtual services has expanded access for some but left others – those without broadband access, a phone plan, or a safe and private place to take a call – even further behind.

The incredible strain placed on healthcare providers during the pandemic have left them far from immune from its mental health and substance use impacts. Reducing stigma and promoting psychological health and safety in healthcare settings is more important than ever.

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Mary Bartram PhD is the Director, Mental Health and Substance Use at the Mental Health Commission of Canada and Robert Gabrys PhD is the Research and Policy Analyst at the Canadian Centre on Substance Abuse and Addiction.