Nicole Letourneau is a professor and researcher at the Faculty of Nursing, University of Calgary.
Recently, public-health restrictions to limit the spread of COVID-19 have been gradually relaxed in communities across Canada. While time will tell if this spells the end of pandemic-related concerns in general, this is welcome news to many Canadians – especially those affected by the mental-health challenges that soared during the pandemic.
According to Statistics Canada, one in four Canadians aged 18 and over screened positive for symptoms of depression, anxiety or post-traumatic stress disorder in the first half of the pandemic – up from one in five prepandemic. One Canadian study found that between 67 per cent and 70 per cent of youth under 18 experienced mental-health deteriorations, especially those affected by pandemic-induced social isolation.
To make matters worse, mental-health care was a challenge to find and offer during the pandemic, with restrictions severely limiting in-person clinic appointments. Thus, hospitals were challenged to manage the surge in children and adults showing up in emergency departments, not with COVID-19 symptoms, but in mental-health crises.
While an alternative to in-person care – telehealth – has been provided for decades across Canada, with physicians, nurses, psychologists and counsellors often providing care over the phone, it was in limited use prepandemic. In-person care has long been the preferred modality by patients and health care providers alike. However, COVID-19 ushered in new problems and opportunities to address them.
To respond to the increased demand for mental-health care, the World Health Organization’s 2021 Comprehensive Mental Health Action Plan recommended increased use of digital technologies, including electronic and mobile tools. They also recommended increasing the capacity of health care professionals’ capacity for remote delivery of digital-health solutions. Early on in the pandemic, the federal government provided funding to develop, expand and launch digital mental-health care tools to support Canadians.
Likewise, the pandemic required that Canadians achieve a new-found comfort, born of necessity, in connecting to work colleagues, family and friends with their smart phones, computer webcams and video conferencing technologies. Further, to meet the surging need for mental-health care, health care providers needed to be nimble and inventive to provide needed care remotely. Hence, Canadian health care pivoted rapidly to offer new digital modalities for mental-health care delivery and patients took full advantage.
For many health care providers, this was an experiment, but a systematic review of evidence that predates COVID-19 showed that mental-health care provided digitally, via video call, is as effective as in-person care. For the newly initiated health care providers and patients, the response was also positive during the pandemic.
In my team’s research on an intervention for new mothers affected by depression, we also pivoted from testing in-person care to digital-video care. These parents – typically tech-savvy young mothers – often preferred receiving the program from the convenience and comfort of their homes.
There are many benefits to digital-video care. It can be delivered wherever people have access to the internet, providing greater access to rural and remote clients, such as residents of Northern Canada. This convenience extends to both patients and providers, as the need for travel by motor vehicle or public transit to clinics is eliminated. This not only saves time, but reduces associated expenses.
The modality may also be less stigmatizing, as patients do not need to present themselves at a mental-health clinic. For patients with symptoms that make them less able to leave their homes, such as fatigue and depression, digital-video care helps ensure that they can still attend appointments.
Not only did all the advantages of this modality become clear during the pandemic, but changes to selected interprovincial regulation has even meant that care can be provided to a patient in one province by a health care provider in another. Physicians made major strides in this work and a 2021 report from Health Canada recommends that other health care providers, such as registered nurses, follow suit.
To continue on this positive path, equitable access to high-speed internet service across Canada and to digital technology (such as smart phone and computers with webcams) must be public-health priorities. We have an opportunity to ensure that all Canadians, regardless of postal code, have access to quality mental-health care.
While public-health restrictions may be ending, the fallout from the pandemic may still negatively impact Canadians’ mental health for the foreseeable future. We must not fall back to traditional overreliance on in-person clinic visits for mental-health care. Flexibility in care delivery must become a mainstay, with digital-video modalities remaining in the tool kit for health care professionals and patients.
Increased patient access to preferred, cost-effective and successful digital-video care for mental health may be the silver lining in the cloud of the COVID-19 pandemic.
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