A person walks on the streets of Vancouver during a snowfall on Jan. 4. Fifty-four per cent of Canadians said their mental health had worsened during the pandemic in a new survey. (Ben Nelms/CBC)

Canadians' mental health worsened in the pandemic — and the system is at a crisis point

'Even if you realize you need help — it's very difficult to find it,' psychologist says

Adam Miller

The mental health of Canadians has deteriorated in the two years since the COVID-19 pandemic was declared, putting massive pressure on a mental health-care system that was already close to a breaking point. 

In a new survey conducted by the Angus Reid Institute in partnership with CBC, 54 per cent of Canadians said their mental health had worsened during the past two years — with women faring significantly worse than men.

Sixty per cent of women aged 18 to 34 said their mental health had worsened throughout the pandemic, and that number jumped to 63 per cent for women aged 35 to 54 over the past two years.
 

The survey coincides with new research from the Canadian Mental Health Association and the University of British Columbia (UBC) that paints a stark picture across the country of a mental health crisis growing in the shadows of COVID-19.

Many Canadians are stressed about what could come next in the pandemic — with 64 per cent responding they were worried about the emergence of new coronavirus variants in the future, which could jeopardize plans to live with the virus as public health measures lift.

Fifty-seven per cent of respondents felt that COVID-19 will be circulating in the population for years to come, while researchers found two years of pandemic-related stress, grief and trauma could lead to long-term mental health implications for some Canadians. 

"After two years, Canadians are really feeling overwhelmed and exhausted," said Margaret Eaton, national CEO of the Canadian Mental Health Association (CMHA). 

"There is an epidemic of chronic stress that's been going on for so long, and people are feeling so much uncertainty, that we're concerned now that it will take much time for them to get over this experience of the pandemic." 

The situation is similarly dire from a global perspective, with new research from the World Health Organization finding that the first year of the pandemic increased worldwide levels of anxiety and depression by an astonishing 25 per cent.

"The information we have now about the impact of COVID-19 on the world's mental health is just the tip of the iceberg," WHO Director-General Dr. Tedros Adhanom Ghebreyesus said.

"This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations' mental health."
 

'System has long been broken'

Canada's mental health-care system has operated for decades as a partially privatized, fragmented system of hospitals, psychiatrists, psychologists, therapists and community groups paid for either through donations, government funding or directly out of pocket. 

"We live in this patchwork quilt system of mental health where some people, if you have a good employer with a benefits plan, then you might get some psychotherapy," Eaton said. 

"But a lot of people have suffered through the pandemic and haven't found any support .... Many are finding that they have to get on a wait-list in order to see a psychotherapist or get into a counselling program and that has been very hard on Canadians." 

Dr. Peter Liu, a clinical psychologist in Ottawa, said the system is unable to keep up with the mental health-care needs that have grown dramatically in the pandemic, and isn't sure how the industry will be able to fill the gaps in the future. 

"The demand for services has increased to levels I've never seen before and psychologists that I work with and collaborate with are all saying the same thing," he said. 

"It's actually too much for what psychologists can meet …. Even if you realize you need help — it's very difficult to find it."
 

People walk down a sidewalk in Chinatown in Vancouver in December 2020. (Ben Nelms/CBC)

Emily Jenkins, a co-researcher on the survey and associate professor of nursing at UBC, said while Canada has seen significant mental health challenges at the population level over the past two years, the pressure on the mental health-care system pre-dates COVID-19. 

"People can wait for a long time, and their mental health has to be at such a critical point to be able to access those acute care services — that's really not providing care when needed," she said. 

"The system has long been broken." 
 

Breaking down barriers to access

Eaton said Canada is at a crucial "moment in time" for mental health that she said calls for the complete restructuring of the mental health-care system — rather than "just throwing money" at it. 

The federal government has pledged $4.5 billion through health transfers to provinces and territories over five years for targeted funding for mental health, something Eaton said could be a "potential game changer" if the funding is used to expand treatment availability.

Federal Minister of Mental Health and Addictions and Associate Minister of Health Carolyn Bennett said Canada has also launched resources to help Canadians access support like Wellness Together Canada and the PocketWell app — but they are largely conduits to care.

"The old-fashioned way of siloed thinking has not been serving Canadians," Bennett said.

"I think COVID has taught people that they can ask for help, they're not alone, and that they need to be able to let people know that they're struggling and that care is going to be a bit different than it was before."

Eaton said funding needs to go toward early mental health interventions in communities across the country to ensure vulnerable populations receive adequate, timely support — something she said is "not being taken care of in the system right now." 

"We would also like to see funding for psychotherapy and psychology, that should just be a basic service," she said.

"And ultimately what that wraps into is the notion that we all need universal mental health care — that health care should include mental health."

Eaton said as Canadians recover from the pandemic, funding from the federal and provincial governments needs to do more to address systemic problems and break down barriers to access to avoid a breaking point. 

"Our concern is that the longer-term impact is where we'll really need to invest," Eaton said. 

"Even though we might be getting back to work and to school, things are sort of normal — we expect it can take up to two years before we've dealt with the longer-term impacts of COVID and this chronic stress." 
 

'We're going to bounce back' 

The level of stress and anxiety many Canadians have been under throughout the pandemic can also have long-term implications on the brain that threaten to jeopardize our ability to bounce back in the future. 

"When people are feeling unsafe for very long periods, that has a real cumulative deterioration of their functioning," Liu said.

"Stress is only magnified with time when you're in this kind of state." 

Liu said this constant stress can also lead to the suppression of the immune system, sleep disruptions, anxiety, depression and emotional dysregulation. 
 

A woman wearing a face mask to help curb the spread of COVID-19 walks along Front Street in Toronto in November 2021. (Evan Buhler/The Canadian Press)

Liu said reducing work stress, withdrawing from toxic people in your life, building up connections with healthy relationships and seeking support whenever possible could maintain functioning, prevent sliding further into burnout and fend off additional stress. 

"Unfortunately, the pandemic has made it really hard for a lot of people to connect with others," he said. 

"But working on increasing contact, communication, and nurturing of relationships will definitely help everyone because the strength of attachment from relationships, it develops in a person a sense of safety and security and even confidence."   

Liu said the silver lining is that people are resilient by nature and the brain is built to adapt to a wide range of stressful experiences. 

"The brain can cope with just about anything that life throws at it," he said. 

"So I would say, long-term, we're going to bounce back. There is going to be a collective as well as individual resilience. Unfortunately, the path to get there is a very, very bumpy one and very stressful." 
 

The future of masking will look very different across Canada in the coming weeks as mandates continue to lift — but experts say some people will likely continue using them. (Graham Hughes/The Canadian Press)

Mask mandates are being lifted in Canada — and could further divide Canadians
 

Politicization of messaging could further divide Canadians over masking in the future

Mask mandates will continue lifting across Canada in the coming weeks, leaving people on their own when it comes to whether to pull the polarizing public health tool out of their back pocket to reduce their risk of COVID-19.

But as provinces and territories shift to living with the virus and the true scale of spread in Canada remains uncertain with testing scaled back dramatically, the future of masking will look very different across the country — and it may further divide Canadians.

Canada's Chief Public Health Officer Dr. Theresa Tam said Friday that federal agencies overseeing masking mandates in Canada for things like domestic travel are evaluating the situation and could make "policy adjustments as needed in the coming days and weeks."

Alberta lifted almost all pandemic public health measures on March 1, with capacity and gathering limits completely removed and indoor masking requirements abolished everywhere outside of only the highest-risk settings, such as hospitals.

Premier Jason Kenney said the province would also take the extraordinary step of forcing municipalities to lift mask bylaws to avoid "uncertainty and confusion" with public health restrictions. Calgary has abandoned them, while Edmonton repealed its mask bylaw on Tuesday.

Timothy Caulfield, Canada Research Chair in health law and policy and professor at the University of Alberta, said the debate over masking will be the next "divisive topic" for the public going forward.

"Masks have been a divisive topic for a very long time, but I think it's really going to become the focal point," he said. "This is going to be increasingly about ideology … this is really about where you stand politically." 

Masks will no longer be required in Manitoba as of March 15, after vaccine certificates were lifted earlier this month, while Saskatchewan lifted mask mandates March 1 and Quebec took its first step toward doing so this week. Most students in the province are no longer required to wear masks in class. 

Ontario has kept masking mandates in place for now, after lifting all remaining capacity limits on indoor settings and scrapping its vaccine certificate system last week, but will likely drop them by the end of the month. 

"If the question is asked today, should we lift the mask mandate? The answer is no. I think it's too soon," said Dr. Isaac Bogoch, an infectious diseases physician at Toronto General Hospital and member of Ontario's COVID-19 vaccine task force. 

"We can all look at the same data and come to different conclusions. I definitely think there will be a day where the mask mandate can and should be lifted — it's just not today." 

Toronto microbiologist Dr. Samira Mubareka was part of the first Canadian research team to successfully isolate SARS-CoV-2 and study its genetic code. (Kevin van Paassen/Sunnybrook Health Sciences Centre)

2 years into the pandemic, burning questions remain about COVID-19 — and how we fight it
 

Evolution of SARS-CoV-2, animal-to-human transmission, hospital capacity remain unknowns, experts say

In early 2020, as Dr. Samira Mubareka was following global updates on a strange new virus first reported in China, people with pneumonia-like symptoms started showing up in her hospital in Toronto.

One of the patients that came to Sunnybrook Health Sciences Centre was a man who'd travelled back from Wuhan. He was quite sick — more so than others who'd proven to be false alarms, Mubareka thought.

Inside Sunnybrook — a stately, sprawling hospital campus in one of Toronto's toniest neighbourhoods — a newly developed diagnostic test confirmed what she and others suspected: the man had Canada's first official case of what's now known as COVID-19.

"The fact that it came as early as January, it lit a fire," Mubareka later recalled.

While dressed in full protective gear, the microbiologist and infectious diseases specialist took samples from the patient's isolation room. Her team was then able to culture the virus from several specimens inside a Level 3 containment facility — just one piece of the global effort to better understand SARS-CoV-2.

Not long after, on March 11, 2020, the World Health Organization declared a global pandemic. One day later, Mubareka's team officially announced they'd isolated the virus behind it, joining other global scientists in offering hope that the world would be able to develop vaccines and treatments.

"Since then, we've just been following the virus around, whether it's been variants of concern that have emerged in fairly rapid sequence, and finally following it into animals," Mubareka said.

Two years into a pandemic that's still raging around much of the globe, scientists like her are striving to unpack what makes this mysterious pathogen tick.

Leading vaccines have proven remarkably effective at keeping severe disease at bay, yet SARS-CoV-2 remains a formidable foe — a mutating shapeshifter that's evading our defences and capable of spreading at rapid rates rarely seen among other viruses.

Despite a surge in research, leading Canadian virologists and front-line physicians say burning questions remain over how the coronavirus operates and where this pandemic is heading. 

Why are certain people so susceptible to infection, or serious illness? How will this virus continue to evolve? Which vaccines, drugs and public health strategies will protect our population from future variants? And where will SARS-CoV-2 show up next?

"There are just so many things we have to stay on top of," Mubareka said.

Read more from CBC Health's Lauren Pelley on what we're still learning about COVID-19 two years into the pandemic.  

Cynthia Hiebert, left, and her brother, Philip Hiebert, say they wish they'd had a chance to say goodbye to their sister, Cheryl Hiebert, before she had medical assistance in dying on March 3, 2021. (Brian Goldman/CBC)

This family learned loved one had medically assisted death only after she was gone

Patients have a right to privacy on this matter, says Ontario’s chief coroner

The sister, brother and father of Cheryl Hiebert had a lot of questions when she died suddenly.

She’d been diagnosed with early-onset Alzheimer’s disease, but she seemed to be doing fine so her death came as a shock.

The family didn’t know how she died, when, or where. It took two days of frantic searching to find out she’d chosen a medically-assisted death.

Ontario’s Chief Coroner, Dr. Dirk Huyer, says it's entirely within the right of the person who has MAiD to decide if they're going to inform their relatives or not.

That means the family might never know their loved one had a medically-assisted death. And, like the Hieberts, they might never get the chance to say goodbye.  
 

White Coat Black Art with Dr. Brian Goldman
March 12 & 13 on CBC Radio One

If people are noticing a new lump or new pain, they should contact their family doctor. (iStock)

Time for a regular checkup? Here's what doctors say you should ask about 

Physicians say they're 'trying to play catch-up' after pandemic-related delays

The pandemic interrupted routines for health, work and family — including regular checkups. So if you haven't been to see your family doctor since before March 2020, now may be the time. 

"There's a lot of diseases still going on," Dr. Peter Lin, a Toronto-based family doctor and a director at the Canadian Heart Research Centre, told CBC podcast The Dose. "If you have diabetes, high blood pressure, all of those things need some fine-tuning."

Those who have a chronic illness or new pain should see their health-care provider right away, he said. And if you're overdue for an age-related cancer screening test, like a Pap smear, colonoscopy or a mammogram, get in touch with your family doctor.

If you're unsure whether you need a checkup, several physicians told The Dose about what to consider before making an appointment. 

Listen to The Dose on CBC Listen or on your favourite podcast app — including Apple Podcasts and Google Podcasts.

Thanks for reading! You can email us any time at secondopinion@cbc.ca with your comments, questions, thoughts or ideas.