The pandemic has taken a toll on mental health in Canada. Will it also change mental health care?

By Nadine Yousif, Local Journalism Initiative Reporter, Toronto Star

Jan 06, 2021

How has the pandemic hurt the psyche of Canadians?

It’s a question that nagged at Michael Cooper since Canada’s first COVID-19 cases were identified. Sitting on a call with his colleagues at Mental Health Research Canada on March 10, Cooper discussed how the pandemic had the potential to upend the mental health of many, as evidenced by large-scale disruptive events that came before it, like the financial crisis of 2008 or the Fort McMurray fires of 2016.

“People were feeling anxious,” Cooper reflected on the general psyche of the time. “They were feeling nervous.”

It was a conversation that many elsewhere were having as well. From the Canadian Mental Health Association, to the Centre for Addiction and Mental Health, to big human resources companies like Morneau Shepell, major organizations knew that COVID-19 and the public health measures to combat it were going to hurt Canadians psychologically, whether the pandemic lasted two months or two years.

The pandemic has signalled a shift in how society talks about mental health, and opened conversations about what the future of mental health care could look like. Companies have invested in an unprecedented quantity of mental health research, including in Canada, where major mental health organizations have actively monitored changes in people’s well-being over the course of the pandemic. They did this through surveys, strategically implemented during pivotal moments in the pandemic’s progression, to measure COVID-19’s impact in almost real-time.

The results, researchers say, prove more Canadians are struggling with their mental health than ever before as a result of COVID-19. This has re-energized calls for systemic change in mental health care, particularly demands to include psychologists and psychotherapists under Canada’s publicly funded health-care system.

At the dawn of 2021, hospitals in Canada are under great strain as the country broke record numbers of COVID cases at the turn of the year. Lockdowns are being enforced for the second time in many regions, including the Greater Toronto Area, where social isolation has been emphasized as the only effective remedy until mass vaccination efforts begin.

All of these challenges are coupled with an economic crash that has hurt businesses and resulted in mass job and revenue loss, leaving Canadians adjusting to “the new normal.”

Back in March, Cooper, the director of development at Mental Health Research Canada, couldn’t have predicted to what extent the pandemic would evolve. But his team did predict the mental health toll the virus and subsequent lockdowns would have regardless.

“It’s a recipe for mental health issues,” said Dr. David Dozois, a professor of psychology at Western University and a member of MHRC’s board of directors.

“We know that social isolation and loneliness are strong predictors of mortality — they predict life expectancy better than smoking, obesity and diabetes,” Dozois said. “So being lonelier and socially isolated has a huge impact on us physically.”

Knowing this, the MHRC moved quickly to measure this impact. It began surveying Canadians on their mental health in April, then did so again in August and October.

They weren’t the only ones: CAMH did a survey of its own in six waves, ending in November, with the help of Delvinia, a Toronto-based research company. At the click of a button, researchers were able to deploy surveys to participants in real time, measuring the pulse of Canadians’ mental health at critical moments, said Sam Wells, senior director for CAMH’s Institute for Mental Health Policy Research.

“What makes the Delvinia study unique is the ability to be nimble, sort of press the button and collect the data at strategic time points,” Wells said, like how Canadians reacted to back-to-school in September or the easing of social distancing restrictions earlier in July.

Even the Canadian Mental Health Association, which focuses more on program delivery than research, did two surveys of its own in conjunction with the University of British Columbia.

“We typically wouldn’t do this kind of public polling,” said national CEO Margaret Eaton. “It wouldn’t be something we’d be able to afford, honestly.”

But Eaton said the association felt doing rounds of polling on Canadians’ mental health was “worth the investment.” The CMHA pooled money to conduct two surveys, one in May and one in September, with two more on the way.

Previous research on large-scale disasters shows a post-traumatic stress response follows and lingers for several years. Eaton said she witnessed this with CMHA’s Wood Buffalo branch as it tried to respond to the mental health toll left by the fires that devastated Fort McMurray, Alta., in 2016.

In a report published by University of Alberta researchers more than three years later, 37 per cent of 3,000 Fort McMurray students surveyed matched the criteria for PTSD, and 17 per cent dealt with depression of moderate severity. Eaton hypothesized similar results in the aftermath of COVID-19.

“It can sometimes take a while for the impact to even really be understood,” Eaton said, and while much remains unknown, she said it’s important to be prepared by monitoring the issue in real time so mental health services can respond adequately when the pandemic’s toll becomes more clear.

Plenty of information, however, has been uncovered thus far through the ongoing polling on the mental health of Canadians.

Anxiety

Anxiety disorders were one of the most commonly reported mental illnesses in Canada before the pandemic. Research from Statistics Canada shows Generalized Anxiety Disorder, the most common of anxiety disorders, affects about three per cent of the population in any given year.

Of the polls conducted during the pandemic, Mental Health Research Canada was the sole organization to ask participants about their pre-pandemic anxiety levels. About five per cent of participants in April’s survey said they experienced high levels of anxiety before COVID-19.

As the pandemic unfolded, the number of people who characterized their anxiety levels as moderate to severe jumped to around 20 per cent, quadrupling pre-pandemic rates. Those with pre-existing mental health conditions reported even higher levels of anxiety at 38 per cent. These results remained fairly consistent from April to October.

Depression

Major depression affects about 4.7 per cent of those age 15 and over in Canada, according to Statistics Canada’s 2012 Canadian Community Health Survey on Mental Health.

Mental Health Reseach Canada’s survey reveals about four per cent of those surveyed said they experienced severe depression before the pandemic. As COVID unfolded, that number more than doubled to around 10 to 13 per cent.

Other surveys show even higher numbers, particularly with a younger cohort: CAMH’s survey revealed around 24 per cent of people between the ages of 18 and 39 reported feeling depressed as of November.

Substance use

Alcohol and cannabis use have become a cause of concern for many mental health professionals, as addiction is tied to much higher mortality rates and other physical health issues in the long term.

Statistics Canada has recently examined heavy drinking in the Canadian population, which is classified as males having five or more drinks, or women having four or more drinks, on one occasion at least once a month in the past year. In 2019, they found 18.3 per cent of the population reported heavy drinking.

As for cannabis, about two million Canadians — roughly 5.3 per cent — reported weekly or daily use.

Both CAMH and Mental Health Research Canada surveyed Canadians on heavy drinking and cannabis. CAMH found around 25 per cent polled in November reported binge drinking in the previous week, a figure that has alarmed the hospital’s psychiatrists.

For cannabis use, MHRC surveys over the course of the pandemic reported that around 30 per cent of Canadians have increased their consumption. That number hit a peak at 34 per cent in October, though it’s not clear how frequently those who were surveyed are using cannabis.

Suicidal thoughts

Perhaps the most alarming trend seen is the increase in those having suicidal thoughts over the course of the pandemic. In countries where suicide rates are monitored more frequently than Canada, like Japan and South Korea, an increase in the number of suicides has already been reported.

CMHA’s surveys asked participants in May and October whether they’ve had thoughts of suicide. In the May survey, 6.4 per cent answered yes. That increased to 10 per cent in October.

Data from Statistics Canada indicates that 2.5 per cent of the population reported having suicidal thoughts in pre-pandemic 2019.

Eaton said all these figures are higher when looking at vulnerable populations, including those with pre-existing mental illness, Indigenous people and members of the LGBTQ community. Parents have also reported worsening mental health than the general population, and youth have reported their own challenges with navigating the pandemic.

Workers have also been exceptionally impacted, research from Morneau Shepell shows. The overall psychological health of Canadian workers surveyed has staggered downward consistently over the course of the pandemic, reaching a record low in November.

So what does having all this data mean for the future of mental health care in Canada?

For starters, Eaton of the Canadian Mental Health Association said the abundance of research during COVID-19 signals a shift in how the country talks about mental illness with large swaths of the population struggling, and this may indicate an opportunity to overhaul and expand the country’s mental health-care system in ways not done before.

“What’s happened with everyone talking about mental health is that it’s become sort of normalized, and seen more on a continuum, really,” Dozois echoed. “We all are dealing with mental health in different ways.”

It’s even noticeable in smaller ways. A simple COVID-19 Google search yields curated results on mindful coping mechanisms, reminding people to “pause, breathe and reflect.”

Wells said this attention will likely lead to more pressure on decision makers to fund mental health care in the future.

“I think that we’ll see more momentum along those lines, that policy makers will now prioritize mental health and this investment will be a huge payoff overall in terms of making sure that Canadians are healthy and well,” Wells said.

All three mental health organizations have presented their survey findings to policy makers in various levels of government, and some have listened. The Ontario government announced $323 million in mental health funding this year, $147 million of which is one-time funding to address mental health-care capacity issues due to COVID-19.

The federal government has also allocated funding of its own: $240.5 million announced by Prime Minister Justin Trudeau in May to expand virtual mental health care during the pandemic, and $10.2 million announced by Health Minister Patty Hajdu to support research on COVID-19 and its relation to mental health and substance use.

But what some have longed for — universal mental health care in Canada, including publicly funded access to psychologists and psychotherapists — may still be a long way away. It’s a conversation that has not been raised yet politically as a result of COVID-19. Advocates say most streams of mental health funding continue to be insufficient compared to demand for services, and money is often allocated for immediate relief rather than long-term change.

The impact of COVID-19 on Canadians’ mental health, however, has re-energized the calls for universal mental health care, Eaton said.

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“My wishful thinking is, maybe the fact that 40 per cent of Canadians now have been impacted and understand what it’s like to experience anxiety, means there’s more willingness for the public to actually push politicians to have that long term built-in support, not just for the pandemic, but after,” she said.

“But I guess we’ll have to wait and see,” Eaton said.