The post-pandemic future: All mental health services will be covered under OHIP
Thomas Ungar is psychiatrist-in-chief at St. Michael’s Hospital, part of Unity Health Toronto
We’ve moved past the peak of the first wave of Covid-19 in Canada, but the repercussions of the pandemic spread far beyond the lives it has taken. Millions of Canadians are consumed with anxiety, stress and fear: for loved ones, for their health, for their jobs, for their kids’ educations. Front-line workers at supermarkets and on transit are dealing with the daily risk of exposure at their jobs. And many health care providers are likely coping with trauma resulting from their inability to save the people who’ve succumbed to Covid already.
Throughout the pandemic, mental health care has been available around the clock at Ontario’s hospital emergency rooms. But regular psychiatrist consultations have been and continue to be a challenge for many Ontarians, with waits ranging from a few weeks to several months. An added challenge, and one that predates Covid-19, is that most therapeutic services do not fall under OHIP, which only covers medical doctors who provide talk therapy, psychotherapy or counselling. Psychologists, social workers and other types of therapists are not covered.
My biggest concern is that the stresses of the pandemic will create new cases of mental illness and exacerbate the ones that predate the lockdown. One in five Canadians experience mental illness in any given year, and about eight per cent suffer from major depression at some point in their lives. These statistics are for normal times—the numbers have skyrocketed since physical distancing began in March. Since then, Canadians reporting high anxiety levels have quadrupled, and those with high depression levels have doubled. Covid-related grief and stress—from losing family members or being unable to pay the bills—could contribute to more suicides and substance-use disorders. Our front-line workers might develop post-traumatic stress disorder and clinical depression.
Some medical experts call this spike in psychological collateral damage the “fourth wave” of the pandemic, and potentially its most enduring effect. We need more mental health services to cope with this fast-approaching wave, and we need them to be accessible and affordable. The question then becomes: how do mental health services improve and adapt, especially amid distancing limitations?
As the Canadian health care system adjusted to Covid-19 at lightning speed, mental health care providers made a turbo-charged pivot towards remote care. Before the pandemic, only virtual care provided through the Ontario Telemedicine Network, or OTN, was covered by OHIP. Now, in response to Covid-19, the province is temporarily covering all phone and video-conferencing treatment, even using platforms like Zoom and Microsoft Teams, which has led to reduced wait times for some patients.
Since the pandemic started, I’ve been remotely treating all my patients, including new patients I’ve never met in person. This isn’t ideal, but I’ve been able to make a connection with every one of them. Many even ask how I’m doing, which is touching. One patient cannot leave home because they live with a severely ill, immunocompromised family member. They’ve been thankful that I can support them in way that works for their life circumstances.
There are no major drawbacks to remote care, and its benefits go far beyond addressing the constraints of the pandemic. Remote care enhances access to people in isolated areas. It’s more convenient than in-person appointments, meaning patients will miss less work and won’t need to resort to expensive child-care options. Providers, meanwhile, will need less space to give treatment, which cuts overhead costs for things like offices and support staff. Remote care has transformed how we deliver mental health services, and my hope is that the province will decide to permanently cover phone and video-conferencing treatment under OHIP.
I also believe that OHIP should expand coverage to a wider variety of mental health care practitioners. Many practitioners not covered by OHIP are an essential part of mental health care delivery: there are clinical psychologists, nurses, social workers, occupational therapists, licensed psychotherapy providers and addiction counsellors, as well as community case workers who help people get medication coverage, secure housing, obtain disability coverage and find treatment programs. Those case workers are the glue between us medical providers and social care agencies. At St. Michael’s, we provide team-based care involving many types of practitioners in our Starting Treatment Early Psychosis Service program, which treats young people experiencing symptoms of psychosis. Patients with complex needs require this type of program, and we need more of them. And on a larger scale, this approach will reduce patient backlogs and address the root causes of chronic health issues.
Boosting OHIP coverage would be part of a comprehensive transition toward an integrated remote care system for mental heath. Right now, mental health care is like a small single-runway airport that has outgrown itself with many more offshoot runways. There’s little coordination of departures and landings, so we need an air-traffic control office to help patients and providers navigate the system. The province is introducing Ontario Health Teams, a new model of care that brings together health care providers to work as one unit, and will coordinate and organize the fragmented providers and agencies. We’ve already accomplished this with cancer care, and I am optimistic it can also be done for mental health.
In an effort to integrate remote care in response to Covid-19, the St. Michael’s mental health department has accomplished 10 years of change in the span of a few months. We’ve provided iPads to patients in isolation rooms, which helps them stay in touch with loved ones and allows psychiatrists to treat them without wasting protective equipment. We’ve distributed donated smartphones and iPads to vulnerable patients in our community programs, allowing them to access care wherever they are. In a few rare cases, suicidal people have disclosed their need for care over the phone, and we’ve dispatched emergency services to bring them to hospital. This all offers an early glimpse of the bright future for an integrated remote care system.
Of course, the number of people getting support has plummeted, and those gaps have to be filled. Forty-three per cent of Canadians diagnosed with an anxiety disorder say they have less access to mental health supports since the pandemic began, and 36 per cent feel the quality of support has declined. The numbers for depression are almost identical.
That’s why we have to keep harnessing technology to improve accessibility and coverage. When we anticipated a huge surge of Covid-19, we transformed our health care system in a remarkably speedy fashion. If the pandemic results in an equivalent surge in mental health care needs, we must address them just as fast.