We’ve got to get on top of the COVID-related mental health crisis before it kills our patients

As we embark upon our emergence from our modern-day caves, following the compulsory lockdowns during the pandemic, there are many opinions on whether or not our emergence is “too fast” or “too slow.” Extremes of these opinions abound, some vehemently demand that triple masks should be permanent, while others argue that such measures are little more than ridiculous virtue-signaling. I’m sure that the debate will go on for some time, but as I closed the door to the examination room behind me in to attend to my 20th patient of the day, the buzz of the opinions outside of the room faded into the background hum of the building as I took in the appearance of yet another University student that booked an appointment with me because she “wasn’t feeling well.” In the past, such an unspecified reason for the medical visit would have a differential diagnosis as long as the Earth’s Circumference. Read: The anatomy of a cure for long COVID But lately, I’ve come to realize that “lockdown-related major depression and anxiety” will need to figure prominently in my differential diagnosis for patients with “unspecified complaints.” To break the ice, I ask this normally vibrant and confident 21-year-old how she is doing. “Fine,” she replies in a monotone whisper that tells me that she is exactly the opposite. I’m already over an hour late because of four similar visits that started out exactly the same way. The laptop I carry with me is an impediment during conversations like this, so I close the clamshell and focus entirely on the patient. “I can tell that you’re really sad,” I say. This particular visit is easier because the tears started to flow without much more encouragement. I noticed that her parents—both of them looking terrified—were waiting for her in my reception area; despite both being also terrified of losing their jobs from a company that is now hanging on by a thin financial thread. So, we talked. She doesn’t want to live anymore—not in this world. She has been stuck taking her courses for 2.5 years in her basement. Her parents refused to allow their only child to leave the house “to keep her safe.” She and all her friends have lost interest in interacting via electronic means. One by one, they have been fading from the virtual, electronic and social media landscape, which were her only lifelines to a social existence. Read: COVID is not over—and it won’t ever be One of her friends committed suicide six months ago. Initially she was devastated, then she became numb to the horrific news, wondering constantly if her friend was the smart one. The lockdowns prevented her from attending the funeral—which consisted of only the three immediate members of her family. We talked for a much longer time than her 10-minute scheduled visit, and she ended up contracting with me. She would call me personally and directly on my cell phone if her suicidal ideation were to rise to the point of being a risk to her. She could not afford counselling at $150-an-hour minimum and her parents’ health plan at work was the first victim of the company’s fight for survival. So what resources are available to her? Like the other 1,700 family doctors working in Calgary today, I could send her to one of four hospital ER’s where she would face at least a five-to-20-hour wait, depending upon circumstances. After a lengthy wait in a terrible psychological state, she would be seen by a triage nurse, then an intake Psych nurse, then after more waiting, an ER doc who would spend five minutes with her because of the non-stop and unpredictable stream of patients with acute emergencies—some of whom are actually spraying blood from somewhere. A pamphlet or three would be handed to her and she would be advised to follow up with her family doctor. The pamphlets would be discarded, as they all contain the same information, which is most accurately interpreted as: “Call this number and you will be put in touch with a professional counsellor. But not really.” The good people on the other ends of those pamphlets are being forced to stretch each allocated dollar so thin you can see through them. If they had the funding, they would become something more substantial for an unrecognized huge group of people in dire need of healing from the non-physical wounds of this pandemic. These wounds have arguably caused just as much morbidity as the actual virus and contributed to significant mortality. But back to my specific patient: we come up with a plan and the tears stop flowing—seeing them was a confirmation to me that the psychological pressure relief valve has been released some. We talk about and contract a plan, and she has my direct cell number. My colleagues that I used to share call with have left the province. She will start an anti-depressant medication that should help her some. As a society, we don’t broadcast daily death rates from suicide—unlike the daily case and death counts we've become used to seeing with COVID-19. We are cautious in discussing suicide because it has the potential to encourage more of the same - but this makes it just a little too convenient for governments to ignore the very real killer in our society and to allocate health are funding to a host of more visible illnesses and special interest groups that hop up and down in anger on the evening news broadcasts and loud street protests that draw reporters." We must demand that our governments address the severe shortfalls in mental healthcare funding. One month of CERB funding for the country, allocated to funding mental health would vastly exceed all the money needed to have a world class system in Canada, for a very long time. Read: Rapid antigen tests to the rescue: The new world without COVID restrictions It’s Monday. I have at least 20 more patients booked in for a mental health crisis to see over the next four days—on top of the all the “hidden” mental health crisis patients I have yet to uncover. At minimum, 20 patients per week in crisis seen by 1,700 doctors in Calgary would be 34,000 patients per week. At $150/hour for psychological counselling, we would need $5.1 million per week to address this need. Alberta has 4,151 registered psychologists, some of them working as particularly sympathetic bartenders. We can afford to put them all to work to heal these invisible wounds in our society. We can start by calling our elected representatives—the lack of attention this issue gets allow them to avoid addressing their responsibility. We are getting increasingly resigned to a government that seems to put more effort into avoiding and preventing the provision of healthcare than it does into facilitating and providing it. Even more, our government’s quick answer to this challenge is to consider an expansion in the role of Medical Assistance in Dying (MAID). I wonder, would they want to offer this ultimate relief from suffering as a red pill or a blue pill? One certainty that most people can all agree on is that we can do better than government. Humanity innovated marvelously to address the pandemic and to save countless lives. It is time to innovate again. Read: Excluding virtual healthcare will do more harm

We’ve got to get on top of the COVID-related mental health crisis before it kills our patients

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