many of us are itching to get back to ‘normal,’ but it’s easy to forget that before covid-19, ‘normal’ was far from ideal, particularly in terms of how we managed mental health.wait times for
mental health services were already too long, if not inaccessible, for many. and after months of being surrounded by news of illness, human suffering, tragedy, and death, it’s inevitable that many of us will emerge from this pandemic mentally scarred. all of this made worse by the fact that the world we’ll return to won’t be the same as it was before covid-19.as u.s. critical care physician
dr. victor tseng and dr. sohail gandhi, president of the ontario medical association, have predicted, the “
fourth wave” of this pandemic may be the biggest and most sustained effect. the first wave is the immediate burden of covid-19 on the healthcare system with patients of the disease itself. the second includes limited resources for other, urgent patients with non-covid-19 conditions. the third wave impacts those with chronic conditions whose care becomes interrupted. and the fourth wave will include psychological trauma, mental illness, economic injury, and burnout.during this time, there will be a large part of our population who have lost someone from covid-19, or through covid-19-related complications related to other diseases like cancer, mental illness, or heart disease. normally, death rituals can help people to move through their grief with their family members, but these gatherings
are no longer possible.“in a lot of religions or societies, there’s a norm around seeing a body after someone passes away and being able to pray at their side,” says adrienne spafford, ceo of
addictions and mental health ontario (amho). “people are going to be robbed of the opportunity to grieve in that way.”
frontline workers and psws will face ‘moral injury’
those working on the frontlines and in long-term care homes will be especially vulnerable because of the decisions they have had to make.“many will struggle with potential ptsd or some sort of trauma as a result of what they’ve seen or the work and decisions they’ve made,” says fardous hosseiny, vice-president of research and public policy at the centre of excellence on ptsd at the
royal mental health centre in ottawa.those working in healthcare or the public safety sector are especially at risk of ‘moral injury,’ which involves witnessing actions that would violate one’s own moral beliefs or standards. this can lead people to feeling inadequately supported or sense of betrayal from the system that puts them in this position to make these decisions.“everything points to a very significant psychological consequence to this crisis”, says hosseiny. “the battle lines have never been more ambiguous for our frontline healthcare professionals or public safety personnel because they have to weigh ethical decisions every day. with limited equipment, imagine the kind of moral dilemma they face and how much that weighs on them because their ethical and moral beliefs are being questioned.”even mental health professionals — whose job it is to exude confidence and strength — could feel the same difficulties deep down, he says.another part of our community feeling the psychological burden are unpaid caregivers taking care of their loved ones, as well as nurses and
personal support workers (psws). for many, seeing illness and death in numbers makes them particularly vulnerable for trauma and ptsd. for psws who have known their residents for years, it can feel like losing a family member, says spafford.
virtual care, closed social spaces leaves the vulnerable
another impact of covid-19 is the shift that healthcare and mental health services have had to make to virtual care — a move that leaves behind people who don’t have phones, computers, or even an unlimited internet access plan.“[virtual care] doesn’t even speak to northern or rural communities where internet connectivity is not even possible,” says spafford.with public libraries and public spaces, it affects the daily routine of people with schizophrenia, people who use opioids, those with serious anxiety and depression, and anyone who relies on those social supports.“we’re going to have the same unmet need with the people we were already serving, on top of serving a new population,” she says. “it’s really important we reflect that the inequities we came into covid-19 with are only being exacerbated by covid-19. covid-19 is really shining a spotlight on them.”
those who didn’t need mental health services before will be added to wait lists
all of this will result in a new cohort of canada’s population that will need mental health and addiction services — who wouldn’t have needed it prior to covid-19. data from
connexontario — a 24/7 free service for people experiencing problems with addiction, mental illness, or gambling — shows that calls for distress and support line services have gone up 44% between just february and april.so far, spafford says governments have been understanding of what is coming and acknowledge the investments needed. this month, ontario announced an initial
$12 million for virtual mental health sessions, but spafford estimates the amount needed will more like $100 million.“we were already a system under strain and this is going to add new strain,” she says. “we need to get ready for what’s to come because the average wait times were already too long, and peoples’ condition were worsening while they were waiting for services — sometimes dying while waiting. i am hopeful in our conversations with government. we get the sense they agree investment is needed and we’d like to see that investment sooner rather than later.”
diana duong is a writer and editor at healthing. find her on twitter @dianaduo.dduong@postmedia.com
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