Health and Substance Use – the path is paved on the virtual superhighway
What is the future of mental health and substance use in Canada? Through the Covid 19 pandemic we have seen the use of technology take the driver's seat in connecting health care workers, physicians and patients with mental health and substances use needs. The use of telehealth medicine has been in use for many years already, but the pandemic has been the catalyst that has pushed the use of technology into the mainstream in healthcare.
Our society in general has used technology and social media for entertainment purposes. Most people have a Facebook profile or some other form of social media. LinkedIn for example was created and launched in 2003 as a platform for professionals to network and meet virtually. Today there are so many platforms used to meet and connect virtually. Due to the global pandemic, the need to establish ways to hold meetings in a safe way drove the need for new ways to meet from home offices. As borders across the world closed, professionals and particularly health care professionals needed a new way to meet the needs of their patients.
Technology of course does not and can not take the place of some in person services such as emergency health care, dental care, and surgeries. There are some services that have been adapted and a successfully meeting the needs of people who need them. I am going to look at some mental health and substance use services that are currently being offered through my health authority, the successes, and the challenges.
People with mental health and substance use disorders are vulnerable to relapses in symptoms and other related health conditions due to certain health inequities. These inequities are caused by the social determinants of health seen here in the info graph below.
(Canadian Observatory on Homelessness , 2014) Info graph 1
Some of these social determinants such as unemployment, housing/homelessness, food insecurity and genetics are often a component for many people with mental health and substance use disorders, making them a part of a vulnerable population. Without access to harm reduction supplies, drug and alcohol counselling and psychiatry consultation, many people are at risk for overdose, relapse in substance use and suicide. The federal government has recognized through the pandemic that more resources must be put into mental health and substance use treatment and prevention. This money put into these resources may help to lessen the load on the health care system during the Covid 19 crisis. In May of last year, the Prime Minister, Justin Trudeau announced $240.5 million to develop, expand, and launch virtual care and mental health tools to support Canadians. (Government of Canada, 2020)
Since the pandemic, our services through Mental Health and Substance use have been primarily virtual. We have used telephone and secure video conferencing platforms such as Pexip and Microsoft Teams to meet with clients. There are still some services such as medication administration and telehealth psychiatry appointments that the client must attend to the office in person. There of course is a barrier to virtual care as some of the clients we service do not always have phones or access to tablets etc. to participate in care. In these cases, every effort is made to see the client in person with masks in a larger space.
Another possible barrier to care is the lack of rapport and relationship building, or missing parts of a mental health assessment such as the physical observations. The moment I meet with a client I am assessing, is the client dressed appropriately for the season, how is their hygiene, do they maintain appropriate eye contact? Particularly with telephone appointments, these observations get missed. There are also some imperfections when it comes to using technology itself, as it can be unpredictable. There can be problems with websites, virtual platforms, servers, and internet providers. This has created a culture of do it at home IT technicians left to solve such challenges on their own. When in doubt restart the computer?
Virtual care is a new way for health care practitioners to work with patients. It also requires some special skills and knowledge to work with people in this new way, assessing needs and diagnosis illness without the patient physically in front of the practitioner. There is new education that has been developed specifically for virtual care and mental health. The Canadian Mental Health Association (CAMH) has developed some resources for healthcare workers during the Covid 19 pandemic and the use of virtual care. This webpage is designed with practitioners in mind and even has a link to a Digital Mental Health Training Certificate. Click on the link to have a look. Virtual Care | CAMH
The benefits that I have seen in my own practice as a Mental Health and Substance Use Clinician outweigh the challenges. I have been using virtual care with clients of our Opiate Agonist Therapy (OAT) program since 2017. In partnership with Northern Health and the Alliance Clinic and Dr. Alan Brookstone https://alliancesurrey.net/ we have been able to offer OAT to many clients who may not otherwise been able to receive treatment in our small community. Living in a remote Northern BC community has its challenges and access to specialized treatment is one such challenge. In 2017 the one physician in Kitimat who had been providing OAT to people in the community had decided to step back from this treatment as it was becoming to challenging to manage. With the introduction of more industry into the remote area it also brought with it an influx of people and specific healthcare needs. The clinic runs on a weekly basis using a virtual video platform in which the physician can speak with and assess the clients needs. Prior to the Covid 19 pandemic, Dr. Brookstone would travel to Kitimat for an all day in person clinic. Once the pandemic made it impossible for these in person visits, it did not change the care we were able to provide to clients. Dr. Brookstone was able to continue meeting with clients virtually and manage treatment without any gaps in care.
The options for people in terms of mental health and substance use has helped to reduce barriers to care. Making it into the building for an appointment for some clients is a barrier. I have often heard that there is a stigma for some people about coming into appointments in person, for fear of being judged by others. A person who lives with crippling anxiety may find it very difficult to come to an in-person appointment until a relationship with a practitioner is built. Having a telephone appointment may aide in building rapport and make treatment options more attainable. There are also so many more options to find reputable information for mental health and substance use treatment available online through social media, websites, and apps. This may help to empower clients to feel that they are able to start to have more control over their own healthcare options. A briefing document prepared by the Mental Health Commission of Canada concluded, “The opportunities for the advancement of e-Mental health in Canada are enormous, as are the potential benefits for all Canadians. Existing and evolving technologies have tremendous potential to transform the mental health system and positively change how resources and care are developed, delivered, and received. “ (Mental Health Commission of Canada, 2014)
Virtual care is leading the way in becoming part of the future in healthcare options. Using virtual care can help with the prevention and management of chronic diseases and disorders such as mental health and substance use. The federal and provincial health care systems are putting forth more money to making virtual care more accessible and user friendly for Canadians. In my experience there must be good outcomes and evidence for something before the government pours millions of dollars into an aspect of healthcare that is deemed an important part of our future.
Alliance Clinic. (2021). About Us. Retrieved from Alliance Clinic : https://alliancesurrey.net/
Andy Wong, R. B. (2021). Patient Care During the COVID-19 Pandemic: Use of Virtual Care. Journal of Medical Internet Research.
Canada Health Infoway. (2021). Virtual Care Resources During COVID-19. Retrieved from Canada Health Infoway: https://www.infoway-inforoute.ca/en/resource-centre/virtual-care
Canadian Observatory on Homelessness . (2014, July 02). Infographic Wednesday - Social Determinants of Health. Retrieved from Homeless Hub:
https://www.homelesshub.ca/blog/infographic-wednesday-social-determinants-health, Info Graph 1
Dialogue Technologies Inc. . (2020, November 2020). Majority of Canadians agree virtual care is the future of healthcare. Retrieved from Cision: https://www.newswire.ca/news-releases/majority-of-canadians-agree-virtual-care-is-the-future-of-healthcare-863153066.html
Glauser, W. (2020). Virtual care is here to stay, but major challenges remain. CMAJ, 868-869.
Government of Canada. (2020, May 3 ). Prime Minister announces virtual care and mental health tools for Canadians. Retrieved from Prime Minister of Canada Justin Trudeau: https://pm.gc.ca/en/news/news-releases/2020/05/03/prime-minister-announces-virtual-care-and-mental-health-tools
Health Canada. (2021). Government of Canada Invests $18 Million to Virtual Health Care Services in British Columbia . Retrieved from Cision: https://www.newswire.ca/news-releases/government-of-canada-invests-18-million-to-virtual-health-care-services-in-british-columbia-807050857.html
Lorian Hardcastle, U. O. (2020). Virtual care: Enhancing access or harming care? Sage Journals, 288-292.
Mental Health Commission of Canada. (2014). E-Mental Health in Canada: Transforming the Mental Health System Using Technology. Ottawa: Mental Health Commission of Canada.
Province Of British Columbia. (2020, December 8). Virtual Physicians at HealthLink BC. Retrieved from Healthlink BC: https://www.healthlinkbc.ca/virtual-physician
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