2020 was a monumental year that brought the world to its knees: The pandemic precipitated an economic downturn and a healthcare crisis, which was accompanied by environmental disasters, political turmoil, and social upheaval.
All of these events affected mental health in significant ways. Meanwhile, as of 2017 less than 2% of the global median of health budget was dedicated to mental health, and today nine is the median number of mental health workers per 100,000 population – alarming statistics. Should we start preparing for a looming global mental health crisis?
How did the COVID-19 crisis affect mental health in 2020, and what are the long-term effects?
People continue to struggle with anxiety, fear, isolation, financial concerns, and uncertainty about their health and their families’ health. Families have had to endure isolation from loved ones dying in hospitals or long-term care facilities without being able to see them for a last goodbye. People have lost jobs, businesses – their livelihoods – due to COVID-19. Essential workers have risked contracting the disease and exposing their loved ones to ensure societal functioning. Healthcare workers have watched patients die alone.
Quarantining and isolation have affected everyone, particularly children and the vulnerable. A study conducted by the Centre of Addiction and Mental Health (CAMH) hospital in Canada found that certain groups of individuals are more vulnerable to the mental health impact of COVID-19: People who have lost their jobs, women, people worried about personal finances, people with children at home, and young people are more likely to experience symptoms of anxiety and depression.
Substance use has been on the rise in Canada since the pandemic hit. A recent poll found that 25% of Canadians aged 35-54 and 21% aged 18-34 have increased their alcohol consumption. Another study found that Canadians who described their mental health as ”fair” or ”poor” were more likely to have increased their use of alcohol, cannabis, and tobacco during the early stages of the pandemic than those with better mental health.
According to the World Health Organization (WHO), 800,000 people die from suicide globally each year. Recent projections show that COVID-19-related unemployment could result in 418 to 2,114 additional excess deaths due to suicide in Canada during 2020-2021.
In the United States, unemployment rates from March 15 to April 30, 2020 showed that 30 million individuals had lost their jobs. Recent studies found that a one-point increase in unemployment rates increased suicide rates by approximately 1-1.6%. A one-point increase in unemployment increased drug-related deaths by 3.3% (3.9% for opioid-related deaths).
What additional strain will the effects of COVID-19 put on mental neurological substance (MNS) services?
A survey conducted by the World Health Organization (WHO) revealed that most countries have experienced a disruption to MNS services due to insufficient or redeployed healthcare workers for COVID-19 response, the use of mental health facilities as COVID-19 quarantine or treatment facilities, and an insufficient supply of personal protective equipment (PPE).
MNS services are already challenged in many countries, where demand for care has outweighed supply. Governments and decision-makers need to recognize the heightened need for a long-term, system-wide response. According to CAMH, this response must include a range of mental health resources and care, support for new models of mental healthcare delivery, employers and workplace engagement, investments in social determinants of health, and a public health approach to alcohol policy.
What options and tools are available to augment mental healthcare?
Support and expansion of virtual mental health services is required. COVID-19 has accelerated virtual healthcare in general, providing the elderly and other vulnerable people with access to physicians from the comfort of their home without the added stress and expense of travel to a doctor’s office. Virtual care for mental health in particular has the potential for much greater outreach to individuals, especially for those in rural areas. As an added benefit, virtual care removes the stigma of attending mental health facilities.
The Mental Health Hub online portal in Finland offers an example. A series of questions evaluates users and directs them to qualified mental health professionals if necessary or, for those not requiring professional help, engages them in self-help tools. In 2016, the total number of unique users for the Mental Health Hub comprised 10% of the Finnish population. 
Internet-based Cognitive Behavioral Therapy (ICBT) provides digital access in the treatment of psychiatric disorders via guided therapy and weekly touch points with a therapist through email or online sessions. Self-guided programs allow users to access a range of customized modules. In Canada, the Ontario government is offering guided digital therapy free of charge during the pandemic to local residents. While Cognitive Behavioral Therapy (CBT) has been around for quite some time, the digital experience allows access anywhere, anytime in a stigma-free environment for both young and old. It also promotes better compliance and adherence to the program due to its flexible nature.
Pandemic-induced isolation has affected people in various ways, provoking anxiety and fear and disrupting work-life balance. Horticulture and garden spaces have long been used as a therapeutic activity for people with mental illness. A therapeutic garden’s basic features include gently graded, accessible entrances and paths, raised planter beds and containers, and a sensory-oriented selection of plants geared to color, texture, and fragrance. Dr. Benjamin Rush, recognized as the Father of American Psychiatry, was the first to document the positive effects working in the garden had on individuals with mental illness. Ecotherapy is a more formal type of therapy that involves professionally led activities in nature. Ecotherapy can also incorporate CBT in sessions, and research has shown that it can help with mild to moderate depression. When we eventually move forward from the pandemic, many cities will be faced with urban renewal challenges. Urban development plans should include therapeutic or sensory gardens, allowing people access to spaces designed to elevate their mood and stimulate their senses.
Music can also elevate mood, and another form of mental health intervention involves regular meetings with a qualified music therapist. Researchers have found that music therapy, added to treatment as usual (TAU), appears to improve depressive symptoms more than TAU alone. Music therapy shows a decrease in anxiety levels and improves the functioning of depressed individuals, as well as aiding with cognitive impairments. Read more about music therapy in this RGAX blog: Music Therapy and Cognitive Impairments
These are only a few of the tools and options that can be integrated in the digital delivery of mental healthcare. COVID-19 has accelerated virtual care, paving the way for even greater innovation in mental health, which is desperately needed.
The key moving forward will be to integrate mental health services in the workplace, in COVID-19 recovery programs, and in community health. Per the U.S. Centers for Disease Control and Prevention (CDC): “Working at the community level promotes healthy living, helps prevent chronic diseases and brings the greatest health benefits to the greatest number of people in need.”
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2-5. http://www.camh.ca/-/media/files/pdfs---public-policy-submissions/covid-and-mh-policy-paper-pdf.pdf, Statistics Canada, 2020; McIntyre & Lee, 2020
6-8. Stephen Patterson, PHD; John M. Westfall, MD, MPH, Benjamin F. Miller, PsyD Deaths of Despair from COVID-19 ; Luo et al, 2011; Phillips and Nugent, 2014; Hollingsworth et al, 2017
9. The impact of COVID-19 on mental, neurological and substance user services: results of a rapid assessment
10. Mental Health in Canaa: Covid-19 and Beyond CAMH Policy Advice July 2020