Though she considers herself fortunate to still have employment as a plumber and HVAC technician, Vanessa Newman’s workload has significantly diminished since the beginning of the COVID-19 pandemic. Her job requires access to people’s homes, which is happening much less these days.

She has struggled to pay rent for her Vancouver apartment on time. Not being able to see friends regularly has also led to a decline in her mental health, which started during the first lockdown.

“Dealing with everyday life struggles or personal struggles was difficult because I didn’t have anyone to turn to,” she explained.

Newman, 27, recognizes that her circle of friends are only a phone call away but says there is nothing like face-to-face interactions. “It’s made me feel very alone and hopeless. Reaching out for help is not something I do easily, so with the lack of proper social conditions, it’s been even harder.”

She did eventually reach out to her family doctor, who referred her to psychological help, but she was put on a waitlist due to high demand.

“After a couple of months waiting and my mental health deteriorating, I decided I needed to find another way to get help,” she said. Newman reached out to a therapist who was kind enough to reduce the price of sessions, which she is grateful for. But the cost still added stress, since she was already struggling financially due to the pandemic.

Still, Newman firmly believes that therapy gives her the tools to tackle the emotional toll lockdown measures and is trying to worry less. “These circumstances are out of my control,” she said resolutely. “I was going down a very dark path and strongly believe this therapy is necessary for me.”

Canadians’ mental health worsening

One of the many things the coronavirus pandemic has laid bare is the stark reality of what health professionals call the social determinants of health — the degree to which our social and economic environments impact our mental health.

A growing body of research has shown that mental illness is often triggered or worsened by joblessness, insecure housing, and social isolation. We have physiological needs, such as human connection, that must be met to ensure healthy neurotransmitter activity. The regulation of dopamine (the motivation chemical), oxytocin (the bonding chemical), and serotonin (the self-esteem chemical) are all directly related to our external environments. Without certain conditions, there is a lull in this activity.

According to polling from the Angus Reid Institute, half of Canadians reported a worsening of their mental health only weeks into the pandemic. While it’s necessary to address these environmental circumstances head-on — such as by tackling the forces contributing to housing instability or supporting unbarred-access to employment and education programs — it’s also critical to have evidence-based mental health services to support people through the difficult emotions that arise from them.

Canadians have been demanding this type of care for years. But in-person counselling and other data-driven therapies — such as cognitive behavioural therapy (CBT), eye movement desensitization and reprocessing, and repetitive transcranial magnetic stimulation — still aren’t covered, or are only partially covered under extended health coverage and job-related benefits. Access to therapy proves all the more difficult as unprecedented numbers of Canadians lose employment.

Fortunately, a growing number of virtual services that don’t involve direct contact with a care provider are available online at no cost.

Wellness Together Canada is a federally funded nation-wide program developed alongside mental health clinicians. It includes an app, an online community that offers support and coaching, and e-courses. The Canadian Mental Health Association’s BounceBack is now available across Canada thanks to government investment. Those living in Ontario can access the for-profit CBT program MindBeacon free of charge during the pandemic.

But most of the country has never heard of these programs, which comes as a shock given the investment of resources by provincial and federal governments.

Virtual resources underutilized

A survey of 3,000 people found that while 65 per cent of participants reported negative impacts on their mental health due to COVID-19, only 2 per cent had accessed virtual mental health resources.

Emily Jenkins, a researcher and professor of nursing at the University of British Columbia who analyzed the survey results, explained over the phone that even among those “who reported they had adverse mental health impacts,” only 2.8 per cent had accessed virtual mental health services. “So even among those who we would expect could benefit from these types of resources, the use was quite low.”

Among those who reported not coping well at all or engaging in deliberate self-harm, usage of virtual resources rose to about 10.3 per cent. “But that was the highest. So still, only one in 10 people are using these resources with the most acute kinds of experience,” Jenkins added.

“It seems like one of the larger barriers in terms of why people aren’t using them is that they’re just unaware,” said Jenkins. “Other possible reasons include things like privacy or confidentiality concerns, or inability to get space alone to connect with these resources. For a small proportion of the population, there might be challenges with connectivity or access to the internet. And for some people, it’s just a matter of not feeling that they’re going to be effective in helping them.”

Navigating online services can be hard, and many people aren’t aware of how online, questionnaire-friendly therapies such as CBT can reshape thoughts. But research shows that these pragmatic routines can develop skills and strengthen neural pathways that help move individuals out of habitual negative thinking or sudden worry.

“For those with these challenging emotions that are very prevalent under COVID-19 circumstances, the [virtual programs] could be all that somebody might need to help strengthen coping skills and reorient some of the thought patterns they’re having,” Jenkins explained. And some online programs even offer counselling. “Bounceback, for example, does include some online coaching, so there are different resources that might meet different needs.”

But it raises the question of how people can find these services, she said. The goal is to “encourage people to access some of these resources that the government has invested in, because they have an evidence base behind them and because they’re accessible with no cost associated with them.”

These tools could serve as a critical mediation for those in urgent need of care, Jenkins explained.

“As we are in the midst of what appears to be a second wave across the country, people are being asked to quarantine and isolate, and there are lockdown and distancing orders in place. People can access [the online tools] even under these circumstances to help manage those stresses,” she added.

“You don’t necessarily need to have a mental health diagnosis or a mental health challenge per se to be able to benefit. These are really well aligned with those experiencing some of the broadest challenges within the pandemic, which would be increases in symptoms of stress, or anxious feelings, or low mood, or fear of the virus, job or food insecurity, economic uncertainty, loss of childcare-related support, gendered caregiving. So a lot of different experiences.”

Many people are struggling with these challenges (which Jenkins noted all fall under the category of social determinants of health), and it doesn’t mean they’re weak or different.

“[It’s] very common for people out there right now, and what this helps to highlight is that our mental health is so impacted by our everyday circumstances and conditions. Expecting that our heavy orientation in mental health toward [expensive] treatment systems and pharmaceuticals and that kind of thing aren’t going to cut it for these types of experiences, so I think this is one reason why having some access that’s free and online for people, when they’re available to connect with it, is really important.”

For Vanessa Newman, change can’t come soon enough.

“I believe mental health is something to take seriously, and that it is not discussed enough, or paid enough attention,” she said.

“I hope this pandemic will bring improvements to the health care system as far as mental health coverage, and that someday, we [all] periodically get mental health assessments — just like we get medical assessments.”