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For Dr. Mary Bartram, policy director at the Mental Health Commission of Canada (MHCC), gaining a better understanding of the realities of those who work in the field of mental health and substance use (MHSU) is key to unlocking improved mental health outcomes.
“For far too long, data about these essential care providers hasn’t been collected,” explained Bartram. “As we are bracing for an echo mental health pandemic, we have to understand the hidden workforce called upon to address it.”
Bartram noted that, while detailed data is regularly gathered about doctors and nurses, we only have a cursory understanding about psychologists and social workers and know almost nothing about all the other kinds of MHSU workers — from psychotherapists to addiction counsellors.
“Responding to the increased MHSU issues we are seeing as a result of the pandemic means knowing exactly what tools we have at our disposal,” said Bartram. “Yet we don’t know where this workforce works, how many hours of service its workers provide, which populations they serve, or what areas of expertise they have.” This lack of knowledge is concerning, given these workers’ unique position in responding to these emerging needs during the pandemic.
Shining a light into care gapsFortunately, this lack of understanding is beginning to change, with a recent survey conducted by the MHCC and the Canadian Health Workforce Network, which specifically set out to take a snapshot of this undiscovered landscape.
For Bartram, the numbers revealed in the Mental Health and Substance Use Workforce Capacity to Respond to COVID-19 Survey set off warning bells on several fronts.
“This survey lays bare the two-tiered nature of our system of care. Much as we like to tout universal health care, the reality is that 31 per cent of the providers we surveyed get no public funding for the services they provide. Instead, their clients pay out of pocket or through the private insurance provided by employers.”
Bartram says it is no surprise that the MHSU impacts of the pandemic have been worse among lower income populations. These are people who didn’t have access to private insurance before the pandemic and may have felt they had no means to mitigate their mental health challenges throughout its course.
As Bartram noted in a recent Hill Times op-ed, while two-thirds of the population have access to extended health benefits, “the remainder of the population pays out of pocket, faces long waits for limited publicly funded services, ventures into the brave new world of virtual services if broadband allows, or goes without.”
Indeed, the survey findings indicate that, although 33 per cent of MHSU providers decreased their capacity because of social distancing measures, almost as many (28 per cent) said the decrease was because clients encountered issues with virtual care.
Inequity on multiple frontsBartram says that, while the explosion in virtual care options such as the Wellness Together Canada portal is a positive sign, we need to be prepared for the significant learning curve many people will have and also understand that this form of care will not serve the needs of everyone.
“Equity is a huge piece of the puzzle,” she said. “It isn’t just about whether you would be comfortable using virtual services. It’s also about questions like, ‘Do you have broadband?’ and ‘Are you safe in your home?’”
A gender divide in the survey responses also highlights the importance of understanding how care providers of different genders are faring.
Overall, there was more of a decrease in service delivery by female practitioners (who make up almost 80 per cent of the survey sample), with “additional personal responsibilities” among the top reasons.
By contrast, more male practitioners have been able to increase their service delivery by offering voluntary services and taking advantage of new funding.
Bartram says the numbers align with findings in a recent Leger survey commissioned by the MHCC and the Canadian Centre on Substance Use and Addiction, which highlights the pandemic’s disproportionate impact on women.
“Women took on more of the caregiving and household responsibilities before the pandemic,” she explained. “Covid has amplified that disparity and left many women, particularly those with younger children at home, with less spare time and poorer mental health than their male counterparts.”
The way forwardEven with some practitioners able to increase their services, demand continues to far exceed supply. Earlier results from recent joint MHCC-CCSA polling found that only 18 to 20 per cent of those experiencing MHSU concerns accessed services during the month of February.
Addressing that imbalance, Bartram emphasizes, will require us to continue looking at the providers who are delivering those services. The findings from this survey, funded through a Canadian Institutes of Health Research operating grant, will be discussed at a policy dialogue in June. Of note is that we need much more than one survey to have the kind of data necessary for population needs-based planning.
“The realities of the MHSU workforce have been overlooked for too long,” said Bartram. “Our hope is that bringing them to light will take us one step closer to meeting the needs of everyone in Canada — including the providers themselves — both now and long after the pandemic is behind us.”
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