The COVID-19 pandemic has put pressure on every sector of Ontario’s health-care system.
Facing a pre-existing mental health crisis and rocked by necessary provincial regulations to curb the spread of the virus, the mental health and addictions sector in Northern Ontario is no different.
Anticipating challenges at the onset of the pandemic, health-care professionals were hard at work on a project that sought to unite siloed health-care networks to ensure service continuity during the pandemic.
What started as a few emails back and forth morphed into a pan-northern committee that paved the way for collaboration between the mental health and addictions sector in northeastern and northwestern Ontario.
“This pandemic caused a ripple effect across the entire system, and as a sector, there’s a lot going on specific to mental health and addictions services,” said co-chair Natalie Aubin, administrative director for mental health and addictions at Health Sciences North.
“We quickly realized this wasn’t a one-person job. We have pulled in a strong team of leaders and collaborators to represent perspectives from across our sector because it’s so multi-faceted. Layer on top of that the northeast and the northwest, which have been two separately managed systems for a long time just by virtue of the Local Health Integration Network (LHIN) structures.”
The Mental Health and Addictions Pandemic Response Committee of the Ontario Health North Pandemic Regional Steering Committee is chaired by three women united in their passion and commitment to mental health and wellbeing.
The group aimed to tackle emerging issues during the COVID-19 pandemic and play a significant role in escalating those challenges to the province.
“This group is in a lot of ways a bridge, but a bridge that has multiple connections,” said co-chair Sara Dias, executive director of the Centre for Addiction and Mental Health (CAMH) in Kenora.
“It’s been a bridge to our membership, making sure we are flowing information to them, the bridge to provincial groups, and making sure that mental health has a voice in the system that is primarily health-care focused. There has been a lot of different connections made possible in terms of this committee.”
The working group set up a series of task teams that dealt with issues like the opioid crisis, a shortage of PPE in the sector, and workplace continuity during the COVID-19 pandemic.
“Our larger membership includes the different existing networks across the vast north, and within each of those area networks, there’s multiple agencies connected to those networks. It’s like a pyramid of interconnected tables and providers,” said co-chair Shannon Cormier, executive director of North of Superior Counselling Programs in Thunder Bay.
The larger membership includes LHIN-funded and non-LHIN-funded agencies alike that provide services across the lifespan to members of northern communities.
One of the issues the group tackled early on was the shortage of PPE in the sector.
“At the onset of the pandemic, it seemed to be a little more difficult for the mental health and addictions providers to access PPE over a hospital setting, for example,” said Loretta Bostrom, communications officer at Health Sciences North who sits on the Northern Addictions Task Team, a working group that is part of the committee.
“Our advocacy efforts really helped step that up and allow us to be seen as equal partners more or less in terms of priority.”
The group also played a big role in supporting northern mental health and addictions service providers as they pivoted during the pandemic and worked to build new pathways, create new service options, and work through barriers to serve their communities.
“The innovations in our sector have been remarkable. It has nothing to do with us. This is grassroots organizations figuring out how to navigate this pandemic,” said Bostrom.
“The goal has always been to ensure that the sector remains open to provide support and services for those that need it the most – for everyone really – who needs it.”
The tri-chairs acknowledged that before the COVID-19 pandemic, Ontario was already experiencing a public health crisis.
Among Ontarians aged 25 to 34, one of every eight deaths is related to opioid use, according to CAMH.
About two per cent of adults and 14 per cent of high-school students report having seriously contemplated suicide in the past year and four per cent of high-school students report having attempted suicide.
“Let’s call it a public health crisis for mental health and addictions,” said Aubin.
The crisis is not unique to the province, either – according to the Canadian Mental Health Association (CMHA), one in two Canadians have or have had a mental illness by the time they reach 40.
Opioid overdoses now account for more deaths in Canada than automobile accidents, and more than 4,000 Canadians die by suicide every year.
“The pandemic will have significant impacts on people’s mental health, but mental health was a crisis before the pandemic,” said Hayley Chazan, a media relations manager with CAMH.
“It’s probably the biggest health crisis of our time. The pandemic has just exacerbated what already existed, especially for people already experiencing complex mental health or addictions.”
Northern Ontario has its unique issues. The region represents the majority of the province’s landmass with a much smaller population dispersed geographically.
Communities often have less comprehensive, available, and accessible mental health and addictions services, according to CMHA.
Some of the barriers to accessing care include a lack of adequate transportation and access to digital technology and workforce recruitment and retention.
A lack of digital infrastructure emerged as one of the biggest challenges during the pandemic because of the swift transition to virtual care in the mental health sector.
“It was a big pressure point in terms of unique challenges faced in Northern Ontario,” said Cormier.
“The reality in the north is there isn’t equitable access to digital technology for many communities, especially the far north but even in the district of Thunder Bay. A lot of our communities just don’t have great internet.”
Community organizations in Thunder Bay collaborated on a project that championed access to technology for people living in poverty during the pandemic.
Kinna-aweya Legal Clinic, an organization that provides legal advice to Thunder Bay residents, particularly Indigenous people, who need assistance with poverty law issues, wrote a letter to a local telecommunications company requesting support for those living in poverty.
Tbaytel responded to the request and donated 61 cellphones with voice and data plans until the end of June 2020.
The company also worked with the District of Thunder Bay Social Services Administration Board to identify five community housing buildings where wifi hotspots were installed on a trial basis.
The initiative gained momentum and Telus reached out through their #AllConnectedforGood program to donate additional phones.
“We call it by the fancy term digital health equity, meaning that everyone should have equal access to digital or virtual care, and to have the same outcomes,” said Allison Crawford, associate chief of virtual mental health and outreach at CAMH.
“What we found that there was a lot of gaps for certain groups of people and being able to access care.”
The pandemic also shined a spotlight on the opportunities that technology presents and Crawford said that despite the challenges, the transition to virtual care was relatively successful.
“CAMH in general went from providing under one per cent of care through virtual health in December 2019 and by December 2020, we now provide about 35 per cent of our care virtually, and that’s about 9,000 visits per month,” she said.
“We’ve been developing virtual care for the last 10 years, but the pandemic has really allowed a lot of innovation and a lot of the problems or challenges that were hampering virtual care were removed.”
The Ministry of Health lifted certain restrictions around virtual care during COVID-19.
Instead of having to use the Ontario Telemedicine Network to connect with their patients, for example, the government allowed providers to use different video conferencing networks, like Zoom.
“It really opened up the possibilities, and facilitated all different kinds of configurations of care,” said Crawford.
Ultimately, Northern Ontario’s mental health and addictions pandemic response committee hopes the north will continue working together with and for one another during the pandemic and into the future.
“Whether you’re living in the north or you’re working in the north, we got each other’s backs. We are neighbours and we’re going to come together and get through this together, pool the brains, and the brawn of everyone in every way that is helpful,” said Bostrom.
Crawford said that she hopes the mental health community will put a great focus on community in the future.
“In health care, we so often think about mental wellbeing and mental health as the domain of the individual. Sometimes we think about their family or their supports, but one thing I’ve really realized during this pandemic is that where communities are strong, they come together,” she said.
“We don’t spend enough time on mental health in general or put enough resources into it, but that really stuck out for me. We have to think about the mental wellbeing of communities and take more of a public health approach.
“We’ve talked about public health in the context of the virus, but we need to start thinking about public health approaches to mental health and wellbeing and strong communities.”
Colleen Romaniuk is a Local Journalism Initiative (LJI) reporter with the Sudbury Star. The LJI program is funded by the Government of Canada.