It has created stress in many areas of our life, and we have experienced multiple losses, including of loved ones under circumstances that have made grieving more difficult. It has changed our family and social relationships and social cohesiveness, led to a deterioration of pre-existing mental health problems and led to worries about our physical, emotional, financial and social future well-being. There are also some specific syndromes that have been identified, such as lockdown fatigue, COVID anxiety, COVID insomnia and, in a different context, Zoom fatigue.
For some, these have been transient and we have adjusted and moved on, but almost 50% of us are reporting significant changes in our mental health. For many, they have led to clinical symptoms of depression, anxiety and even suicidal ideation, while pre-existing mental health and addiction problems have worsened.
Of particular concern has been the impact of the trauma experienced by so many Canadians in many different walks of life, including the moral injury from being forced to make decisions that are incompatible with one's values, beliefs or culture. These have often been exacerbated by pre-existing inequities in income, housing, education, employment and work conditions, history and culture, race or ethnicity, family situations or stigma, and it is the overlap of these factors, often referred to as intersectionality, that further increases the risk of developing mental health and addiction problems. This happens at a time when the pandemic has exposed gaps in our existing mental health services and reduced access to many supports.
It has affected different populations in different ways. First nations, Inuit and Métis communities face particular challenges, often resulting from pre-existing inequities such as inadequate housing, lack of services, lack of public health infrastructure or existing mental health services, geographic isolation and stigma. Members of racialized communities are also likely to experience additional issues because of systemic racism or bias.
Children may be at particular risk as they may be dealing with anxiety about going to school, making a relative ill, loss of contact with their friends or valued family members. We've seen child maltreatment rates increase. One of the greater long-term concerns is that adversity in childhood increases the likelihood of physical and mental health problems in later life and highlights the importance of early years interventions.
Young adults are likely to be struggling with limitations based on social activities and often feeling like their future has been put on hold or even taken away. Seniors, whether living in congregate living situations or living on their own, are showing increased cognitive decline and increased symptoms of depression and anxiety only highlighted by the isolation and concerns about going out.
We've witnessed an increase in alcohol, cannabis and other drug consumption, as well as opiate-related deaths, and in compulsive gambling. Other populations are at risk: those who've lost their jobs, because we know the psychological impacts of unemployment; those who are homeless, already dealing with multiple social and economic challenges; and individuals living with significant psychiatric and physical disabilities, like autism spectrum disorders, and their families. Services and supports have been closed. Access to treatment is more difficult and in-house supports have often ended.
In terms of the impact of gender, we're seeing an increase in intimate partner violence, perhaps inevitable when individuals often living in dysfunctional relationships are on top of each other 24 hours a day without the normal outlets of social activities, and this is often fuelled by increased access to alcohol. A second gender-related issue is increased child care demands, where the bulk of responsibilities still fall to the mother. Many working parents are anxious about children being back at school, but even more so about what might happen if the schools were to close.
The evidence also suggests that in terms of virtual care, whether by video, audio, email or even text, both providers and patients find it more convenient with equally good outcomes, but we need to remember that many individuals still don't have access to computers or even phones, and we also need to identify for which clinical situations and populations and for which therapies virtual care is superior to face-to-face.
When we look at how we respond to these unprecedented demands, while there is no single situation, we are looking at common approaches that could benefit all. We need to think about smaller changes, which could be introduced more easily, and also about targeting our interventions at particular populations.
I have divided my suggestions into three areas.
The first are services and supports for individuals and families. First, we need to strengthen our existing mental health systems. Ways to do this would include developing a plan in conjunction with the provinces and territories that outlines shared purpose, guidelines and goals to guide the work taking place across the country; gathering data on the current needs to inform future service priorities; developing a mechanism to share ideas that are working in different parts of the country that could be adapted or adopted elsewhere; and continuing and formalizing billing codes for virtual care.
There is also going to be a need for existing resources to support targeted interventions. We need to adapt our models of care to respond to the current challenges with a focus on early recognition and also on prevention and proactive screening. For example, in primary care, family physicians could be calling seniors to find out how they are doing and identify those who may be at greater risk. We need to emphasize shorter-term care—including single-session treatments—a wide range of treatments for PTSD, and system navigation.
We need to build new partnerships across the system, with our systems working more closely together to pool their resources and support one another, and we need to better support self-care and management by providing resources and assistance for individuals to better look after their own well-being. This can include access to interactive or curated educational resources, developing a list of most useful sites for providers, developing accessible guides and blogs about specific—