Doctors in Canada sought more mental health support during COVID-19

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Humber River Hospital’s Intensive Care Unit, in Toronto, Canada, on April 28, 2020. COLE BURSTON/Getty Images
  • An observational study examined data from around 34,000 physicians in Ottawa, Canada.
  • Researchers found physicians participated in nearly 26{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} more mental health and substance use visits during the first year of the COVID-19 pandemic compared to the year prior.
  • The study team believes the increase is attributable to both increased stressors during the pandemic and additional access to mental health services through virtual outpatient options.

There is no denying the fact the COVID-19 pandemic has had an impact on the mental health of people worldwide. A recent study found the pandemic increased cases of major depressive disorder by 53 million and anxiety disorders by 76 million globally.

But for those working on the front lines of the pandemic — such as healthcare workers — how has the situation affected their mental health?

A team of researchers from the University of Ottawa Department of Family Medicine and The Ottawa Hospital in Canada is helping answer that question. Their new study has found a link between the pandemic and the number of outpatient healthcare visits physicians participated in for mental health and substance use concerns.

Researchers believe their study results will help shed light on the need for increased mental health services for the medical community.

The results from this population-based cohort study appear in JAMA Open Network.

Before the COVID-19 pandemic, studies showed an elevated rate of mental health issues among healthcare workers. One such study in 2015 found resident physicians were at high risk for depression. Another study in 2018 examined burnout among United States healthcare professionals, finding over one-half of physicians and one-third of nurses had symptoms affecting their mental health.

Interestingly, other studies have linked higher levels of substance misuse issues to healthcare professionals. According to American Addiction Centers, approximately 4.4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of medical workers have a problem with heavy alcohol consumption. And about 5.5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of healthcare personnel experience illicit drug use.

Dr. Daniel Myran, a family physician, public health and preventive medicine specialist, and postdoctoral fellow at the University of Ottawa Department of Family Medicine and The Ottawa Hospital, is the lead author of this current study.

According to him, multiple surveys have found high levels of mental distress in healthcare workers, including physicians, during the COVID-19 pandemic.

“However, because these surveys generally look at one or two points in time, it limits our understanding of whether these concerning rates of mental distress reflect a worsening during COVID-19 or reflect pre-pandemic baselines,” Dr. Myran told Medical News Today. “In addition, most surveys have low response rates, which raises concerns that their results may not represent the overall mental health of physicians.”

The team addressed this by taking an alternative approach, looking at changes in mental health care-related visits that physicians made during the pandemic. “Because we were able to follow mental health visits before and during the pandemic, we were able to quantify how visits changed over time,” Dr. Myran explained.

Dr. Myran and his team conducted a population-based cohort study of 34,055 physicians, fellows, and residents registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018. All study participants were eligible for the Ontario Health Insurance Plan. The researchers collected the data from the Ontario Health Insurance Plan from March 2017 to March 2021.

During the study, researchers examined all in-person and virtual outpatient visits via telemedicine to either a psychiatrist or primary care physician. Researchers considered all psychiatry visits mental health or substance use-related medical visits. In their study, the team also included any visits to a primary care physician that included a diagnostic or fee code related to mental health or substance use.

The research team also investigated specific demographic characteristics, including:

  • age
  • sex
  • residence, whether urban or rural
  • previous mental health history

According to the study, data on race and ethnicity was not available. And the researchers also looked at the data by physician specialty to see if a specific area of the healthcare industry was more prone to mental health concerns.

According to the study results, physicians participated in 29,460 mental health visits during the first year of the COVID-19 pandemic.

This is almost a 26{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} increase compared to the 23,574 mental health care visits physicians made the year prior.

When looking at mental health visits, researchers found anxiety was a frequent cause in both the first year of COVID-19 and the year before. Indeed, anxiety visit frequency increased during the first year of COVID-19 from 66.5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} to 69.1{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

Researchers found that drug and alcohol-related visits saw a slight decline to 5.8{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} during the first year of COVID-19 from 7.4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} the year before.

When looking at demographic information, researchers reported female medical professionals and healthcare workers in urban areas had a larger percentage of mental health and substance use visits. And among physician specialties, psychiatrists had the highest number of mental health care visits during the first year of COVID-19, while surgeons had the lowest.

The research team also reported that physicians without a history of mental health issues or substance misuse had the largest increase in the rate of visits compared to physicians with such a history. “This finding may reflect how the pandemic created new and highly stressful challenges for physicians,” Dr. Myran explained.

“These challenges may have caused a deterioration in the mental health of doctors who otherwise never would have needed care.”

“Another possibility is that changes in how health services were offered during COVID-19 — offering virtual mental health care — decreased important barriers to access for some physicians who used this opportunity to seek care for preexisting mental health concerns that they had never sought treatment for before,” Dr. Myran added.

In general, Dr. Myran believes the increased access to virtual options through telemedicine may partially explain the overall increase in mental health visits during the COVID-19 pandemic. “Physicians with mental health concerns that pre-dated COVID-19 may have used these services during the pandemic, as they were more accessible and less visible, reducing concerns over stigma,” he said.

Dr. Myran feels this research helps support the continuation of virtual mental health and substance use medical care for healthcare workers.

“While we suspect that much of the increase in visits during the pandemic is related to increased stressors and challenges, some of this increase may be related to better mental health access and reduced stigma.”

– Dr. Myran

“Ongoing access to virtual care services may be an important component of a post-pandemic mental health strategy aimed at improving the mental health of physicians and health care workers.”

Dr. Ken Duckworth, chief medical officer of the National Alliance on Mental Illness (NAMI), agrees. “It doesn’t surprise me that doctors are taking advantage of (teletherapy) — there’s probably no time in the middle of a busy day to see a mental health practitioner,” he told MNT.

“The pandemic represented this tremendous switch being flipped towards the understanding that teletherapy is a safe way to deliver effective care. Teletherapy is the silver lining to this really dark cloud we’re dealing with.”

Dr. Duckworth views this study’s findings as positive, as they show a change in the “old school” mentality that doctors would ever need or require help. “The idea of physicians accepting help, discussing their vulnerabilities, taking care of themselves under stress, so they can take good care of other people is to me, a very positive development,” he said.

“The stressors of the pandemic are clear — they impact anybody who’s in a frontline role. I would be very distressed if the finding was that physicians in the context of the pandemic were not seeking mental health and addiction support.”

As for the next steps, Dr. Myran plans to look at the time after the start of the COVID-19 pandemic. “Our study only looked at the first year of the pandemic, but the situation now is very different than it was a year ago,” he said.

“We plan on continuing to understand the longer-term changes in mental health visits in physicians during the pandemic. We are also interested in understanding predictors of mental health care use by physicians so that services and interventions can be better targeted to meet physician needs.”

Dr. Duckworth added he would like to see a study of this type conducted for United States physicians. And for frontline workers seeking mental health resources, he suggests visiting the Frontline Wellness section of NAMI’s website for free, confidential resources for all frontline workers, including healthcare professionals.

Biden’s support is fading as concerns over the economy and Covid grow, CNBC survey finds

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A bare the vast majority of Us residents nonetheless approve his dealing with of the virus, but the margin narrowed considerably. Fifty per cent now approve compared with 53{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} in July, and 45{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} disapprove, in contrast with just 38{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

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U.S. President Joe Biden holds a assembly with company leaders and CEOs about the financial debt restrict at the White Home in Washington, U.S., October 6, 2021.

Kevin Lamarque | Reuters

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Unequal access to workplace mental health support: Solutions

In this opinion piece, Tania Diggory — mental health trainer, business neurolinguistic programming practitioner, and founder and director of Calmer, a mental health and well-being training organization — explains what we still get wrong about mental health and how to improve well-being in the workplace.

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Why is mental health support in the workplace so important? Tania Diggory explains. Klaus Vedfelt/Getty Images

Today is World Mental Health Day, and this year, it certainly comes at a unique time in our history — particularly considering the mental health stories and studies that have arisen as a result of the COVID-19 pandemic.

The World Federation of Mental Health has set this year’s theme as “Mental Health in an Unequal World” — a truly poignant and timely discussion to be had.

The stark reality is that we don’t have to look very far to notice inequalities and the mental health impacts that result from them. From the gender pay gap and racial discrimination to income inequalities within countries and tackling climate change, to name a few, the United Nations (UN) cites that 71{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the world’s population live in countries where inequality has grown. There’s no doubt that many of the world’s inequality issues will, and do, have an impact on the mental health of those affected.

It is also commendable to see the UN’s Committee for Development policy, Leaving No One Behind, as the rallying call of the 2030 Agenda for Sustainable Development.

Although it may feel overwhelming to fathom how we as individuals can contribute to reducing unequal issues that are close to our hearts, the empowering reality is that when we each do our part, we truly can make a meaningful long-term difference.

While every issue that represents inequality deserves recognition, I’d like to explore a topic of inequality in relation to mental health that I believe doesn’t get enough air time: addressing the outdated perceptions of mental health, the negativity bias associated with it, and, as a result, unequal access to workplace well-being.

The words we say have meaning. The impact of our words can create a perception in another person’s mind that has the potential to form a belief and stay with them for a long time — even their entire lives. For centuries, people have largely perceived mental health as mental illness, and it’s still mostly discussed when someone is experiencing a decline in their well-being.

When we consider words that are often associated with mental health, while we’ve come a long way in raising awareness in recent years, there remain outdated perceptions of primarily viewing mental health from an illness perspective. Through my years of experience as a mental health educator, author, and owner of a mental health training organization, I’ve identified a key reason as to why this could be.

When you hear the term “mental health,” what comes to mind for you? There is no “right” or “wrong” — there are many valid answers. If you notice a natural lean toward thinking about mental health issues, struggles, and challenges, you’re not alone.

Particularly with new data highlighting the mental health crisis over the past 18 months — plus media stories surrounding this topic over many years significantly influencing our views, opinions, and understanding — it seems that many of us have been somewhat conditioned to focus on the aspects of poor mental health, which is what breeds the stigma associated with it. I’d like to offer a different perspective.

When I start my workplace training courses on mental health and resilience, I often open with a question to discuss, such as, “What does mental health mean to you?”

Initially, terms such as stress, burnout, anxiety, depression, inability to cope, absence of happiness, and feeling out of control spark the conversation.

When I ask, “What about good mental health?” I’m often met with a look of surprise and awkwardness, as though I’ve suddenly broken out into song — something not quite in keeping with the context of the training session the attendees were expecting.

I find this a fascinating observation. Only in the last few years have I started to receive a mixture of responses to this question, including phrases such as balance, family, contentment, nourishment, making time for self-care, practicing gratitude, recognizing emotional strength, and developing resilience, to name a few.

In addition to talking about poor mental health, we need to talk more openly about what we can do to nurture our mental health, open up conversations about what it means to experience a positive state of mental well-being, and look after our mental health.

This opens our minds to a more inclusive, accurate, and balanced approach to discussing this topic, inviting us to remember that we all have mental health. It also highlights that it is complex and (at times) fragile and that it can adapt and change depending on our life circumstances from day to day.

When we focus on using a balanced overview of language in relation to the different states of mental health, it can improve our wider understanding of this complex topic and gently release the outdated views of the stigma, which, for many years, have prevented open discussion on this subject in workplaces.

It can be a key starting point for instigating meaningful conversations around well-being in the workplace, and it can encourage business leaders and organizations to prioritize mental health.

The Promoting Mental Health report by the World Health Organization (WHO) states that “mental health and mental illness are determined by multiple and interacting social, psychological, and biological factors, just as health and illness in general.”

It also reminds us that “mental health implies fitness rather than freedom from illness.” When we understand that our mental health fluctuates, just as our physical health, this presents an opportunity to look at managing our mental health — maintaining, sustaining, and nurturing our mental state.

Even when you feel mentally well and fit, feelings and experiences change from day to day. Therefore, when we take the view of managing our mental health rather than waiting until there is a problem to address it, it reminds us that the human state is complex and that we can make conscious choices to support our own mental health, as well as that of others, on a daily basis.

Business leaders have a number of responsibilities and investments that they need to be conscious of each year. However, when it comes to investing in their employees’ health and well-being, studies have proven that this has a direct impact on the quality of their work, productivity, and focus.

It also enhances trust and connection as a team. It’s clear that healthy employees enable the machine of a business to function at its best.

Evidence has shown that chronic stress is a leading cause of physical illness, and the WHO has even recognized burnout as an occupational phenomenon.

It’s time we really looked at the return on investment of workplace well-being initiatives in a way that’s accessible to different budgets and needs. The evidence is clear for a strong business case to support employee mental health and well-being.

Although there has been notable progress in organizations opening up the conversation around mental health and investing in well-being initiatives, the data still show a disparity when it comes to wider mental health support in workplaces.

A recent study by Deloitte highlights that poor mental health costs employers in the United Kingdom up to £45 billion annually, and a Lancet report from 2018 estimates that issues with mental health will cost the global economy $16 trillion by 2030.

It’s also estimated that each year, around 300,000 people in the U.K. lose their jobs due to long-term mental health problems. All of this represents a serious issue of unequal access to well-being support in the workplace.

To counterbalance this, in the U.K., for every £1 spent by employers on mental health interventions, they get £5 back in reduced absence, presenteeism, and staff turnover. Although there has been a noticeable shift in public awareness of mental health in recent years, there is a great deal more that needs to be done.

Another consideration is our ever-on working culture. A study by the Myers‐Briggs Company states that individuals who are “always on” tend to be more engaged at work. However, they are also more likely to experience stress or mental exhaustion.

The results of the study are varied:

  • About 28{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of respondents find it difficult to switch off mentally from work due to increased connectivity, work emails, and smartphones.
  • Approximately 26{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} cite stress of work interfering with their personal life.
  • Around 20{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} report mental exhaustion.

Aside from considering the financial investment in mental health at work, we also need to look at how we can give ourselves permission as individuals to invest our time and energy in self-care modalities.

The Global Wellness Institute recently conducted the first research report to define, analyze, and size the global mental wellness economy, which is now a $121 billion market. It identifies and measures four submarkets, consisting of:

  • senses, spaces, and sleep
  • brain-boosting nutraceuticals and botanicals
  • self-improvement
  • meditation and mindfulness

While there is a greater need for support with mental health at work, there is growing evidence to suggest that individuals around the world are recognizing the importance and benefit of self-care more than ever.

Taking time for yourself is a selfless act that enables you to feel at your best — not only for yourself but for others around you. Taking breaks of varied lengths, whether micro-breaks or longer periods of time, helps boost productivity and happiness, which, in turn, creates a positive ripple effect for your colleagues and loved ones.

Many of us spend so much of our lives at work, and this undoubtedly has a significant influence on our state of well-being and happiness. When considering the investment in preventive initiatives, the resources behind a multinational corporation will be vastly different from those behind a self-employed worker or a micro-business.

For this reason, there need to be mental health provisions that can support any individual and any organization of any size. Although awareness of mental health has increased, research highlights that this topic, which affects every one of us, is still not being discussed or supported enough in organizations.

Deloitte’s Mental Health and Employers report notes that “interventions with the highest returns tend to focus on [preventive] large‐scale initiatives and on using technology or diagnostics to tailor support for those most in need.”

Although there’s no doubt that ongoing investment creates a powerful cultural shift and fosters a deeper level of rapport and connection within teams, for a tailored approach, a micro-business with a smaller budget can seek lower cost workshops that teach practical strategies alongside self-study tech resources, articles, and podcasts.

Through my experience of providing workplace mental health training and consultancy, I’ve realized how important it is that companies have access to many different forms of mental health training and support to cater to different budgets and time commitments.

At the end of the day, whether you invest long-term or short-term, this has the power to create a powerful mindset shift, and you might even discover a group of employees who are passionate about starting up a wellness committee to steer a longer-term well-being strategy for your workplace.

I’ve had the pleasure of working with a variety of passionate, dedicated, and heart-centered business leaders who choose to prioritize the development of their people and culture, and, as a result, have seen the biggest return on investment. However, there are a myriad of ways in which businesses can tap into mental health practices, whatever their budget.

Long-term strategy development and the implementation of and adherence to a mental health policy can help ensure ongoing, consistent support of staff well-being. This can include training a group of volunteers in the workplace to become well-being champions, which gives them the opportunity to contribute to their workplace culture and be part of a meaningful shift in how colleagues support one another.

Whether it’s through mental health-related events, articles, or resources for colleagues to access, there are many ways to engage staff.

I’ve witnessed great success with organizational mental health initiatives when managers are trained on how to support their staff and ensure a variety of support pathways that employees can access to support their well-being.

It’s important for staff to have options. For example, managers need to feel well-equipped to hold sensitive conversations with their team members, there should be encouragement for staff members to connect with trusted colleagues, and organizations should provide signposting to a wide range of professional resources, both internally and externally.

It’s worth bearing in mind that some staff may not feel comfortable opening up about their issues if mental health isn’t discussed at work. Therefore, it’s important to take a holistic view of how mental health is both managed and nurtured in the workplace.

Ongoing preventive measures that support the health and well-being of staff can ultimately contribute to a happy workforce as well as the sustainability of the business.

It’s important to recognize that professionals who work in leadership positions have a legal duty of care to support their staff. In the U.K., the Equality Act 2010 legally protects professionals from discrimination at work and in wider society, ensuring fair and equal treatment. Other countries have similar laws in place.

It is my hope and vision that businesses of all shapes and sizes can find ways to embed a positive approach toward supporting mental health in the workplace through various means. Anyone can start by encouraging consistent, meaningful conversations.

There’s no doubt that the most powerful change happens when there is buy-in and encouragement from members of the leadership team.

It’s also important for team members to feel empowered to instigate ideas and suggest mental health initiatives in their workplace — either way, one voice can make a difference. So, whatever your role or level of seniority, remember that each person in a company makes a difference and that you can be that voice to create a meaningful change in your company’s culture.

There are many inspiring examples of businesses role modeling mental health best practices and seeing a positive return on their investment.

In the Thriving at Work guide by Mind, a U.K. mental health charity, Paul Farmer CBE, chief executive at Mind, states: “Money spent on improving mental health has shown a consistently positive return on investment. At a time when there is a national focus on productivity, the inescapable conclusion is that it is in the interest of both employers and government to prioritize and invest far more in improving mental health.”

We can all start by educating ourselves and others on the wider complexity of what our mental health truly means at its core and remembering that there are varied states of mental well-being.

In order to let go of the stigma associated with mental health, although it’s crucial to understand mental ill health, long-term conditions, and how to access quality support, this must be counterbalanced with information on how to nurture, support, and practice mentally healthy habits that enhance your well-being.

Whether it’s starting a conversation about mental health with a co-worker, encouraging mental health training in your organization, or tapping into self-study e-courses that offer daily self-care practices, find what works for you and never underestimate the power and value of your voice making a difference in your workplace. If not now, then when?