One year into the coronavirus pandemic, psychotherapist Jane Alway says she — like so many others — has had to adapt to finding creative ways to work in these unprecedented times.
“I have spoken to people who, if they live in a congregate setting, they may go to their car and go out into the middle of an empty parking lot because that’s the only place they can get privacy,” she said.
“I’ve had sessions take place within sheds, walk-in closets — we go where we need to go to receive the service. So yes — very creative solutions.”
Alway, who is president of the Ontario Association of Mental Health Professionals, is one of thousands of Canadian mental health practitioners on the front lines of what she and others dub the “echo pandemic.”
Shut indoors, isolated, lonely and stressed, Canadians are reporting record levels of mental health problems as the coronavirus pandemic passes the one-year mark.
While the limited arrival of vaccines so far has heralded hope, the way forward remains uncharted with no clear mile markers for when life will return to normal or when people will be safe to hug their family and friends, or finally celebrate the long-delayed milestones that the pandemic shoved aside.
In December, a troubling national survey from the Canadian Mental Health Association in partnership with researchers at the University of British Columbia found not only that 40 per cent of Canadians said their mental health was worse than in March 2020, but also that suicidal thinking had sharply increased.
One in 10 Canadians — 10 per cent — reported recent thoughts or feelings of suicide.
That was up from six per cent in the spring and just 2.5 per cent pre-pandemic.
Those numbers were even higher in Canadians who already had mental health conditions, who identify as LGBTQ2 or Indigenous, have a disability or are between the ages of 24 and 35.
Amid those alarming numbers, mental health practitioners say requests for their help have jumped.
But it comes as many are facing the twin tasks of guiding clients and patients through this unprecedented time and trying to figure out how to live through it themselves.
“It’s definitely a challenge,” said Monika Green, director of public affairs with Canadian Counselling and Psychotherapy Association and a registered psychotherapist.
“The chronic stress that counsellors and psychotherapists feel also as part of our society, but also the degree of exposure to pain and suffering is really also able to take a toll.”
Green, who runs a private practice in Ottawa, said her organization did a survey of members in the early stages of the pandemic that found 13 per cent of therapists had to stop working because of a lack of child care or needing to provide elder care.
Burnout and compassion fatigue were two of the biggest occupational risks facing therapists throughout the pandemic, she said, with increased workloads being a key factor.
“We’ve all heard about Zoom fatigue and I know for us, coming to online platforms can also add to that fatigue,” Green explained. “It’s really easy for counsellors and psychotherapies to want to help and book clients back to back to back. So it’s important for us to make sure that we recognize our own limits.”
“Therapists going to therapy is also really, really important.“
It’s a sentiment echoed by Dr. Simon Sherry, a clinical psychologist and a professor in the Department of Psychology and Neuroscience at Dalhousie University.
“It is very hard to be in a crisis and helping people with that same crisis at the same time,” he said.
Sherry said the restrictions needed to fight the pandemic are also a perfect storm of factors that can worsen mental health — isolation from loved ones, significantly increased stress, and a lack of outlets like gyms and recreation where people would typically relieve stress.
And he said that leaves mental health professionals grappling with the fact they cannot keep up with demand and need to turn some people away.
“I would say there’s a five-fold increase in people seeking help and people are entirely correct to be seeking help in these circumstances. We’ve seen a major increase in suicidal thinking among Canadians, we’ve seen major increases in depression, anxiety and distress coinciding with this pandemic.”
Sherry, who was a new father during the lockdown phase of the first wave, said he has had to find ways to cope with the increased uncertainty and demands, and often turned to holding his son.
“One of my key coping tools was to go home and walk around the living room with my baby every night. It was good to hold that little guy and to feel close and comfortable with him during that first phase of the pandemic. It was an extremely difficult time to be a psychologist,” he said.
Sherry added he has taken up mountain biking and is part of a support group with his professional colleagues where they discuss best practices, burnout, adapting to the pandemic and self-care.
“Psychologists need psychologists, too.”
There isn’t as much data looking at the mental health impacts of the pandemic on mental health practitioners as there is with other kinds of front-line care workers.
The Centre for Addiction and Mental Health (CAMH) says it doesn’t maintain any data on mental health practitioners specifically. But recent data by Statistics Canada that looked at the mental health of health-care workers highlighted a worsening picture of how they are coping with the increased risks and demands on them as a result of the pandemic.
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That crowdsourcing initiative in partnership with the Public Health Agency of Canada looked at responses from 18,000 Canadian health-care workers between Nov. 24 and Dec. 13, 2020 to questions about how they are handling the unprecedented demands of the pandemic.
Seventy per cent of respondents said their mental health was “somewhat worse now” or “much worse now” than before March 2020. More than half also chose the two highest levels when asked to rank on a scale of one to five how stressful most days are for them now.
Of those respondents, Statistics Canada noted that among psychologists, social workers and counsellors specifically, 69 per cent said their mental health had worsened since March 2020.
Fifty-seven per cent rated most days as either quite a bit or extremely stressful.
Access to proper personal protective equipment (PPE) was a crucial factor in how poorly respondents rated their own mental health, with those who said they felt their access was adequate reporting less severe mental health challenges than those who said they lacked what they needed to try to stay safe.
It’s also a problem some Canadian practitioners say they are still dealing with a year in.
“That has been a challenge, especially because I know there are some grants that are there to help small business owners,” said Alway.
“Unfortunately, health-care providers or clinicians don’t qualify for those grants. So the Street Relief Grant for PPE is an example. We don’t qualify for that because it’s aimed at other hard-hit sectors such as retail and entertainment. But of course, we have to provide PPE to ourselves, our staff, our patients.”
Dr. Grainne Neilson, president of the Canadian Psychiatric Association and a forensic psychiatrist in Halifax, said it’s important to recognize the critical role mental health practitioners are playing in the pandemic.
“Psychiatrists, just like all other Canadians, have been under a lot of stress over this past year, not only because we have had the responsibility of managing patients who are struggling during the pandemic, but also because we ourselves have been faced with the same kinds of issues that other Canadians have been facing during this pandemic,” said Neilson.
“Many of our members are under incredible pressure on the front lines of this crisis and they’re showing a lot of endurance and strength and courage in this really unprecedented situation.“
Still, there remain significant barriers in accessing mental health care despite the increased need and the erosion of deep stigmas around mental health that has been taking place during the pandemic.
According to the Canadian Mental Health Association, roughly 1.6 million Canadians reported an unmet mental health care need before the pandemic — most commonly, this related to counselling.
The problem was worst in Ontario and B.C., where wait times were longest.
Again and again, experts have pointed to cost as a key barrier.
And specifically, practitioners point to a lack of coverage under employer insurance plans, insufficient coverage, and the requirement for them to charge HST as some of their leading concerns.
“It’s heartbreaking when we have to turn them away because they don’t have coverage under their plans,” said Green. “But many of us are really filling up very fast, and it’s harder and harder for Canadians to get access to mental health care.”
She said her organization has been advocating for the government to exempt counselling and psychotherapy from HST, as is the case for the health services offered by doctors, psychologists, psychiatrists and social workers.
“They don’t have to charge that,” she said. “We need that to be addressed.”
More coverage for counselling and psychotherapy under employer insurance plans would also make a big difference in allowing more Canadians to access mental health care, she said.
Alway expressed similar concerns.
“Because of the HST barrier or because they may have lost their jobs, we are having at times to carry that,” she said of the costs for clients who can no longer afford care. “The removal of that would help because it would provide greater access.
“It’s the responsibility of all of us to make mental health services as accessible as possible.“
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.
Crisis Services Canada’s toll-free helpline provides 24-7 support at 1-833-456-4566.
The toll-free Hope for Wellness helpline provides 24-7 support for Indigenous Peoples at 1-855-242-3310. Online chat services are also available.
Trans Lifeline operates a toll-free peer support hotline for trans and questioning people at 1-877-330-6366.
For a directory of support services in your area, visit the Canadian Association for Suicide Prevention.