Imagine our only response to the COVID-19 pandemic had been increasing ICU capacity. Maybe encouraging hand-washing and optional mask-wearing, but no social distancing. And no vaccines.
ICUs would have overflowed long ago, our health-care budget would be drained and many more lives would have been lost. It seems like an absurd approach, and yet that is how we’re responding to the mental health and addictions crisis that has been surging in parallel to this pandemic.
The current mental health and addictions crisis
In a typical year, 20 percent of Canadians experience a mental illness and 75,000 Canadians die from substance use. The Canadian economy loses $46 billion to substance use and $50 billion to anxiety and depression.
In the past year during the COVID-19 pandemic, 25 percent of Canadians have experienced anxiety, 10 percent of Canadians have had suicidal thoughts and 74 percent of adults, and 70 percent of children and adolescents, have experienced worse mental health.
As a result, mental health wards and waitlists have overflowed. In Ontario, children are waiting up to 2.5 years for services.
In response to this crisis, governments have made much needed investments to increase equitable access to mental health care. However, missing from current plans is a long-term strategy to reduce the number of Canadians who will end up needing costly mental health services.
How to promote population mental health
At present, many non-profit agencies, schools and workplaces in Canada implement advocacy campaigns, skill-building workshops or violence-prevention programs to promote the mental well-being of their patrons.
However, many Canadians do not have access to programs and services that meet their needs, especially people from historically marginalized communities such as Indigenous, LBGTQ+ and low-income people, and refugees. Most Canadians receive only a fraction of the resources needed to reduce their risk of experiencing mental illness: the COVID-19 prevention equivalent of maybe one free mask, but certainly no vaccine.
What would a more comprehensive prevention strategy for mental health look like? The Canadian Mental Health Association recommends increasing research, funding and social marketing for the implementation of culturally safe, population-level mental health programs. Since between 50 and 75 percent of mental illnesses have their onset during childhood and adolescence, prevention programs tend to target these developmental periods.
However, children learn to regulate their thoughts, emotions and behaviours from the things they hear, the behaviours they see modelled and the way adults respond to their emotions. That means programs that improve the well-being of adults also often have intergenerational benefits. Three examples of evidence-based mental health promotion programs include:
1. Parenting and family support programs
Programs that provide psychoeducation and support to parents and caregivers are one of the most effective ways to reduce emotional and behavioural problems among children and youth. Many also have positive effects for parental well-being. Examples include the Nurse Family Partnership, Incredible Years and Family Check-Up.
These programs can be cost-effective, culturally safe and implemented effectively online. Indeed, the pandemic has sped up a pre-existing trend of delivering services virtually to increase access and decrease costs, and preliminary research suggests it is working.
2. Mental health literacy and skill-building
While it is not always possible to control people’s environments, it is possible to equip people with skills and strategies to process stressful experiences in positive ways. For example, hundreds of studies have confirmed that universal, school-based programs that focus on building students’ mental health literacy, exercise habits, mindfulness, socio-emotional skills, resilience, media literacy or substance awareness improve child and adolescent mental health. There is also evidence that they are cost-effective.
Workplace mental health programs, such as the Canadian-based Working Mind program, can also improve employee mental health. And initial research on skill-building mobile apps also suggests they have a lot of promise. Across settings and across the life-course, there are many low-cost, evidence-based opportunities to help Canadians build skills that support their mental well-being.
3. Social connection and stigma-reduction
To thrive, people need to feel respected, accepted and connected. Programs that help meet these needs are an effective approach to mental health promotion. For example, there is strong evidence that anti-bullying programs in schools promote positive mental health outcomes. Programs that foster positive connections between children and adults in their communities—such as teachers and mentors—are also proven to be effective at promoting mental well-being, as are programs that enhance the quality of adults’ social connections.
Finally, while robust research on interventions is lacking, current evidence suggests psychoeducation programs that reduce stigma and racial discrimination, or increase sense of belonging, are also likely to have a positive impact on mental health.
A 360° approach to prevention
To slow the spread of COVID-19, we have had to distance, wear masks, improve ventilation and develop vaccines. To reduce the prevalence of mental illnesses, we will need to take a similar, multi-targeted approach, as there is no single solution that addresses all the social determinants of mental health.
To maximize impact, this approach will need to be systematic, with a focus towards choosing evidence-based, cost-effective, culturally safe programs and making them equitable and accessible. It is by extending support, skill-building opportunities and a sense of belonging to all Canadians that we’ll ensure our mental health beds, and budgets, don’t overflow forever.
Let’s not be left facing a third wave of the mental health crisis years from now because we didn’t create a preventive public health strategy early enough.