Telemental Health Care: Supporting Clinicians & Patients

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by Christina Jones, Policy Analyst, OntarioMD (OMD)

The onset and duration of the COVID-19 pandemic and the drastic changes it brought to individuals’ daily lives, including social distancing, and periods of lockdown, impacted mental health across populations and how care could be provided to those in need. A study examining the impact of COVID-19 across Canada indicated that 44.3% of parents with children under 18 living at home reported worse mental health because of the pandemic[i].  

Telemental health care is the use of telemedicine to provide mental health care.  Telemental health care applies virtual modalities such as videoconferencing, instant messaging, and mobile apps as an adjunct or alternative to in-person mental health treatments including psychiatry, psychotherapy, self-help, and support groups[ii].

The Centre for Addiction and Mental Health (CAMH), the largest psychiatric hospital in Canada, reported that virtual care visits increased from approximately 350 per month to almost 3,000, an increase of over 850%, from March to April 2020[iii]. Speaking about the need to expand virtual care for mental health, the President and CEO of CAMH stated, “while we are apart right now, no one is alone and technology is helping to keep populations and patients connected during this difficult time. This is a pivotal moment for a new frontier of telemental health care in Canada reshaping how we deliver care now and into the future”[iv].

Supporting Clinicians & the Psychological Burnout from COVID-19

Compassion Fatigue (CF) is a secondary traumatic stress and defined as the cost of caring for others or their emotional pain, resulting from the desire to relieve suffering[i]. Often experienced with CF is burnout – a “psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment”[ii].  An OMA physician survey in March 2021[iii] revealed: 72.9% of respondents said they experienced some level of burnout, up from 66% in 2020.34.6% reported either persistent symptoms of burnout or feeling completely burned out, up from 29%  in 2020.  

Assessing the psychological and occupational impact of SARS at Mount Sinai Hospital, many staff members expressed feelings of fear, anxiety, anger, frustration, and conflict with their professional and personal roles about potentially exposing their families to infection[iv].   Familiar mental health struggles have persisted throughout COVID-19 balancing risking the lives of their loved ones and upholding their professional duty to care for those in need of medical attention. 

The Canadian and Ontario Medical Associations are supporting physicians through the Physician Health Program[v] providing services such as virtual daily drop-in chats, and a “buddy-up” system to connect with colleagues.

Physicians who are feeling burnt out because of technology and the time they have to spent charting in their electronic medical records (EMRs) after patient encounters after hours can get support from OntarioMD (OMD). OMD advocates on behalf of physicians to improve digital health tools so physicians can focus more on patient care and less on technology. OMD works with physicians to find ways to reduce their administrative burden through more efficient use of EMRs and other digital health tools. They offer practical advice and tips gained from years of experience working with over 20,000 clinicians and their practice staff.

The OMA offers physician mental health supports to their members including a referral service to connect physicians mental health resources, The Doctor’s Lounge a virtual space for physicians to share experiences, and OHIP-covered online group therapy sessions aiming to increase resilience and reduce burnout.  The CMA also has a24-hour Wellness Support Line providing free mental health and wellness support to physicians, residents, medical learners and their families.

Supporting Patients’ Telemental Health Care Needs

A view from OMD Patient Leader Sydney Graham on digital tools and mental health care:

What role would primary care play if it were to assist those with diminished capacity, access the appropriate services?  A large percentage simply don’t seek out treatment because of stigma, access, and capacity issues.  How do you help your patients who are not able to help themselves?

In terms of more effective virtual care treatment/support pathways, we might consider a more co-designed approach with patients and caregivers in developing these strategies, ensuring these results will be effective for the end user.  

The family caregiver, the forgotten provider of care, also experiences Compassionate Fatigue, along with their own acute mental health/addiction issues.  We must support their needs, preventing even more admissions, so they can continue supporting the system with home care.    ̶  Sydney

Some of these virtual, online mental health supports available free of charge to Ontario residents include:

  • AbilitiCBT: An internet-based cognitive behavioural therapy (iCBT) program that you can access from any device, any time including structured modules and scheduled check-ins with a therapist by phone, video or messaging.
  • BounceBack®: A skill-building program managed by the Canadian Mental Health Association (CMHA) designed to help adults and youth manage low mood, mild to moderate depression and anxiety, and stress over the phone with a coach and through online videos.
  • MindBeacon: A virtual therapy clinic including 24/7 messaging services with a therapist, guided CBT programs and live sessions.  Under current government funding, CBT programs are free for all Ontario residents.  

[i] Gadermann, Anne C et al. Examining the impacts of the COVID-19 pandemic on family mental health in Canada: findings from a national cross-sectional study. BMJ. 2021. Accessed August 23, 2021. 

[ii] Chan, Steven Richard et al. Mobile Tele-Mental Health: Increasing Applications and a Move to Hybrid Models of Care. Healthcare.  May 2014. Accessed December 2, 2021.

[iii] Gratzer, David et al. Our Digital Moment: Innovations and Opportunities in Digital Mental Health Care. The Canadian Journal of Psychiatry. 2021. Accessed August 23, 2021.

[iv] Centre for Addiction and Mental Health. CAMH enhances virtual capacity to respond to demand for mental health services. May 4, 2020. Accessed August 24, 2021.

[v] Ruiz-Fernandez, Maria et al. Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain. Journal of Clinical Nursing. 2020. Accessed August 23, 2021. 

[vi] Maslach, C et al. Maslach burnout inventory manual.  Palo Alto, Calif. (577 College Ave., Palo Alto 94306: Consulting Psychologists Press. (1996).

[vii] Ontario Medical Association. Ontario’s doctors report increased burnout, propose five solutions. August 18, 2021. Accessed August 23, 2021.

[viii] Maunder, Robert et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. May 13, 2003. Accessed August 23, 2021. 

[ix] Ontario Medical Association. Easing the psychological burden of COVID-19. May 20, 2020. Accessed August 23, 2021. 

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