The COVID-19 pandemic has led to concerns about potential mental health impacts globally. In Canada, various interventions have been implemented by the federal government intending to mitigate these repercussions. Now, a year later, we can reflect on what has been seen and done and what can be learned to better inform future policy.
Several dire predictions made by some pundits, mental health advocates and practitioners did not occur. For example, predictions that suicide rates would rise significantly have been wrong. Available data shows that suicide rates have generally fallen. Similarly, predictions of an overwhelming "parallel pandemic” of mental disorders have been incorrect. While there may be increased demands for treatment for eating disorders, there is no robust evidence that the prevalence of mental disorders in general has significantly increased. Surveys have demonstrated higher rates of mental distress, but this is not the same as an increase in mental disorders.
The lesson to be learned from these predictions is that we must be careful not to extrapolate from historic situations to this pandemic experience. Data, not emotions are needed to help guide policy.
Various polls purporting to quantify the mental health of Canadians have led to popular perceptions that we are all experiencing a mental health crisis. But careful consideration does not support this interpretation. Most of these polls suffer from significant methodological problems in design and measurement and thus do not accurately capture Canadians’ mental health status. For example, there is confusion in the use of terms that denote pathology, such as anxiety and depression, and a lack of focus on more nuanced states, such as worry or unhappiness. Most did not distinguish mental disorders requiring treatment from perceived stress, nor did they separate out situationally appropriate mental states from those requiring clinical interventions. Rarely did they measure adaptation, functioning, positive emotions or use of mental health services.
Increased rates of distress have often been "a-priori” interpreted as pathology without due consideration for the expected and necessary role of distress as part of normal adaptive responses to external threats. Additionally, there has been a scarcity of comprehensive studies examining subgroups in the population that may be at greater risk for mental health problems — such as racialized groups, those living in poverty, those living with family violence, those with precarious employment and so on.
The lesson to be learned from this is that we need much better data to understand what is going on. The federal government needs to lead a more robust national approach to obtaining valid data that is of sufficient quality to be able to guide mental health policy.
In response to the pandemic, the government instituted an electronic mental health intervention, Wellness Together Canada. However, to my knowledge, there has not yet been any reporting of what this project has achieved. Independent analysis is necessary to determine if this intervention was of value or not, and if so, to what degree and for whom. This is particularly important as pre-existing research has raised questions about the effectiveness of various types of electronic mental health interventions.
The lesson to be learned from this is that without comprehensive independent evaluation, it is not possible to determine if further investment in this intervention is warranted or if modifications could be helpful to improve impact and value. Such review could also help government consider how it will move forward in researching and regulating electronic mental health interventions.
The above issues notwithstanding, it is possible that the greatest positive impacts on the mental health of Canadians were realized through federal government interventions that decreased the rates of premature death from the pandemic (for example, deployment of the military into long-term care facilities) and those that cushioned its economic impact on individuals and families (like the Canada Emergency Response Benefit, the supplementary Canada Child Benefit payment and the Canada Emergency Student Benefit, to name a few).
Perhaps the most valuable lesson to be learned from this pandemic may be that mental health is not about feeling good all the time. It is about learning how to traverse the existential challenges we face by supporting each other, having our federal government invest in improving access to and quality of health care and addressing the social determinants of health — especially for those whose lives are most precarious.
Senator Stan Kutcher represents Nova Scotia in the Senate.
This article appeared in the April 19, 2021 edition of The Hill Times.