Mental health is fundamental to health during the pandemic: A Q&A with Dr. Chandlee Dickey

What long term effects will the COVID-19 pandemic have on mental illness? It’s a question that Dr. Chandlee Dickey, Chair/Chief of Psychiatry at Schulich Medicine & Dentistry, addresses in a recent article she co-authored with her 17 counterparts in Psychiatry across the country.

She spoke to us about the groups that are most vulnerable to mental illness during the pandemic, and why this discussion is so important to the overall health of Canadians.

What is your biggest concern when we talk about mental health and COVID-19?

Even prior to COVID-19 the mental health system in Canada was broken. There were many people who suffered from mental illness who were not receiving adequate treatment.

Now, in the midst of this pandemic we're worried about very distinct populations of people struggling and who will continue to struggle as a result of this in the future. We’re trying to get the conversation started so that there is an awareness that the mental health problems and sequalae of the pandemic could last for decades. We’re calling on everyone to come together to try to plan for this increase of mental health concerns and mental illness.

What groups in particular are most at risk?

The first group are those who have existing serious mental illness including schizophrenia, bipolar disorder, depression, PTSD, developmental disorders, or severe personality disorders. Those disease processes are still going on in the midst of COVID-19 and yet they are either not presenting to our emergency rooms, or because hospitals and clinics across the country have cut back to seeing only urgent or emergent patients, they are having to manage these significant problems on their own.

And the longer we wait to intervene and treat, the longer the brain has to develop inappropriate networks and neuro-connections and the harder it is to achieve remission of the whatever the problem is. This delay in treatment right now for many obvious and important reasons is having a detrimental effect on people with existing conditions.

The second group is people who may be developing problems right now - and they include many of our health care workers who are either on the front lines and are experiencing moral distress. In medical school we talk about the moral dilemma of having to ration care, but I don't think any of us really envisioned that that would happen in such a significant way that it's happening now. And we're asking nurses and social workers and physicians to make some really difficult decisions which adds to their moral distress.

They are also very worried about the potential of contracting COVID-19 and bringing it home to the people they care most about in the world. Isolation is not helpful during periods of stress. When there are these stresses, it's good to come together and join forces, and yet we're telling people to stay apart, be weary and keep your distance.

The third group of people are those who may be suffering behind closed doors. We are referring to children, domestic partners, disabled individuals or the elderly, who to no fault of their own may be being abused. 

We know that during times of unemployment or underemployment, domestic violence or abuse increases, we know that substance abuse increases, and we know that substance use increases the risk of abuse. So, that's part of the story.

The other part of this story is that teachers in schools and preschools look out for kids that they are worried about. If there is a disabled adult, often there are people coming into the home, people with substance abuse issues are going to peer support groups, so there are people looking in and keeping track of what might be happening, but during this time of social distancing, these societal observers can't observe. Kids can't leave the house, so the neighbours down the street don't know if Johnny has a black eye. We're worried that there is more abuse happening behind closed doors, and that's awful as it is, but its particularly bad for children because one of the major risk factors for mental illness later in life, is childhood abuse - it predisposes people to schizophrenia, major depression, bipolar disorder, personality disorders, you name it, it's a risk factor. Because of this period in our society, we may be increasing the prevalence of future mental health problems, and the normal interventions aren't possible right now.

Why is this discussion so important right now?

Mental health is really fundamental to health. We know that people who have strong mental health and innate resilience, have better physical health. They are able to take their medications, they are motivated to comply with exercise regimes and are better able to manage any physical problem they may have.

By my nature, I am an optimistic, hopeful person and I do think that there is a will to draw attention to these issues. I think that if we collectively as a society decide that this is what we care about and this is what we value, we can start to chip away at these serious and significant problems.