A psychotherapist in Richmond Hill, Ont., says that that when emergency measures were announced in March 2020, many clients asked to reschedule for April — when they assumed they could meet in person again.
Then, the weeks turned into months.
For many, friends, loved ones, and trusted professionals were visible behind a screen, but just slightly out of reach.
Registered psychotherapist and Ontario Association of Mental Health Professionals president Jane Alway says since then, she and her colleagues have seen an increase in demand from new clients who are looking for support with mood challenges, substance use challenges, and eating disorders.
“The pandemic itself has certainly exacerbated risk factors around mental health,” Alway said.
A quarter of Canadians reported feelings of anxiety in early January, up six per cent since July 2021, according to a Centre for Addictions and Mental Health (CAMH) survey released earlier this year.
The study suggests that feelings of loneliness and depression also increased, with 24 per cent and 22 per cent of respondents reporting these issues respectively.
Twenty four per cent of the survey’s respondents disclosed that “they needed mental health services to cope with the pandemic in the past 12 months but were unable to receive them, as compared to 19.5 per cent last summer.”
(Margaret Montgomery/Toronto Obsever)
Wait times a challenge for Canadians seeking support
Some studies suggest that wait times were already a challenge before March 2020.
The results of a survey released by Canadian Institute for Health Information (CIHI) suggest that in 2019 through to 2020, “half of Canadians waited up to one month for ongoing counselling services in the community, while one in 10 waited more than four months.”
The CIHI is an independent, not-for-profit organization which provides data that measures health care and health systems performance,
“We saw an increase of 52 per cent over the pandemic of people just looking for service,” Laura Monastero, manager of information and decision support at the Canadian Mental Health Association’s Toronto branch, said of intake calls in a virtual interview.
WATCH | Wait times for mental health services on the rise:
The Canadian Mental Health Association is a non-profit organization which aims to make community mental health support accessible to all.
Monastero says that people can request CMHA services through a system called The Access Point.
CMHA Toronto and hundreds of other social agencies are connected to this system, which is designed to help people get the services they need.
She said that there are potentially thousands of people on waitlists for services through The Access Point. The Toronto Observer reached out to The Access Point for comment, but did not hear back in time for the publication of this article.
Chloé St Onge-Shank, who works as a licensed counsellor in the private sector in Quebec (Order of Guidance Counselors of Quebec, OCCOQ) says that she is not taking any new clients until August.
“Even in the private stream, you’re seeing a huge delay. Like five or six months of waiting,” St Onge-Shank said.
Other barriers to accessing support
“There’s a disconnect between the publicly funded and the private system,” Alway said.
“Oftentimes, you’ve got the [family] doctor who is wondering, ‘Okay, how do I find somebody?’ and they may know about, say, funded agencies, but the funded agencies, they may have a huge waitlist.”
Another issue, she said, is affordability.
While some clients may have workplace insurance coverage for mental health treatment, they may be limited in what their coverage applies to, she said.
In Canada, psychotherapy performed by a registered psychotherapist is not tax exempt, unless the service is regulated by an individual province.
“A psychotherapist is required to collect GST/HST on his or her supplies of services, if he or she is a GST/HST registrant,” according to a statement from the Canada Revenue Agency.
This does not apply to services made by licensed physicians, nurses and social workers, and tax exemptions are available to psychologists and occupational therapists.
According to the College of Registered Psychotherapists of Ontario, “Registered Psychotherapists [RPs] do not appear on the list of professionals whose services are exempt from HST. There may be some situations in which an RPs services can be exempt from HST.”
Alway said the 13 per cent added on to the psychotherapy service reduces the number of sessions a patient can cover under their insurance before they have to pay out of pocket.
There are also those who have no insurance plan at all.
Virtual mental health services
Monastero said that while essential visits continued in-person during the pandemic at CMHA Toronto (such as to deliver medication or perform wellness checks), support groups went online.
She said that the multicultural women’s wellness group, for example, attracted more than 16,000 participants during the pandemic. The group aims to support newcomers who feel isolated.
Monastero said that last year’s evaluations showed that “the groups helped them cope with their everyday challenges better, and that they felt more connected to their communities.”
She said that while such programs are effective, the virtual approach can “disenfranchise a big group that doesn’t have access to the electronic equipment required.”
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ConnexOntario is a provincially funded service that provides information and guidance for individuals seeking mental health and addictions services.
Their system navigators are available 24-7 via telephone, SMS, email, or webchat. ConnexGO is also available on the app store, for first point of contact services.
System navigators are trained to provide supportive listening, mental health or counselling service information, estimated wait times for services, and even translation services in real time.
For example, if the system navigator finds that a counselling service in the community will take up to 10 days to access, they might be able to provide alternative suggestions such as drop-in services that are available immediately.
“The number of crisis or supportive calls [since the start of the pandemic] have increased,” said Nerin Kaur, director of data, product, project management & information technology at ConnexOntario.
“During the pandemic a lot of programs went virtual, or closed, or couldn’t accept the capacity that they had pre-COVID, so that was definitely one of the stressors for Ontarians during the pandemic.”
(Source: ConnexOntario Margaret Montgomery/Toronto Observer)
The role of the federal and provincial governments
The federal government provides financial support to the provinces, so they may deliver mental health treatment and support services.
In 2017, the Government of Canada “committed $11 billion over 10 years in targeted funding for provinces and territories to improve access to mental health and addiction services, as well as for home and community care.”
The specific bilateral agreements between various provinces and the federal government outline how each province will allocate the funding over the coming years.
The Ontario government, for example, announced their “Roadmap to Wellness” in 2020, which was developed with input from service providers and people with lived experience.
A spokesperson from the Ministry of Health says that the province is also “continuing to invest in internet-based cognitive behavioural therapy through self-referral, which has been accessed by more than 106,000 Ontarians since launching in May 2020.”
The CAMH survey of Canadians’ pandemic health and substance use series was conducted via automated research platform Methodify by Delvinia. Results of the survey released in January 2022 are formed from responses of 1,004 English-speaking Canadians ages 18 + from an online survey of the Asking Canadians web panel, reflecting a variety of ages, genders, and regions.