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Dr. Kwame McKenzie, Dr. Katherine Shear, Dr. Robert Maunder and Dr. Frank Sommers.
Ontario Medical Review
June 30, 2021
Stuart Foxman

Will mental health issues be the pandemic’s legacy?

Experts weigh in on COVID-19’s toll at annual disaster psychiatry conference.

Pandemics aren’t equal opportunity disasters. While all of society is vulnerable in theory, some groups will carry the burden of this health emergency. “Disaster times social stratification equals inequities,” said Dr. Kwame McKenzie, CEO of the Wellesley Institute and Director of Health Equity at CAMH. Dr. McKenzie made the comments at the fourth annual Psychiatric Dimensions of Disasters conference held in June. The virtual event, themed “Mental Health in the COVID-19 Pandemic,” was presented by Disaster Psychiatry Canada (DPC), and supported by the OMA.

The event attracted about 400 participants not only from Canada, but from around the world including: United States, United Kingdom, Ireland, Croatia, Turkey, India, Brazil, Chile, Nigeria, Qatar, Bahamas, Jamaica, and Trinidad and Tobago. DPC aims to develop specialists who can serve the mental health needs of those affected by disasters, working with emergency and public health responders.

While the damage of COVID-19 is widespread, Dr. McKenzie noted the elevated impacts of the pandemic are different for certain segments such as ethnic minorities, refugees, people who are homeless, seniors, people who live in institutional settings, and those in certain work environments. That’s often true with disasters. Dr. McKenzie recalled when he lived in the United Kingdom, he woke up to a radio program that featured people who had turned 100 years old. Naturally, they’d be asked about their secret to longevity. One centenarian’s answer floored the interviewer. “I think it was my decision to get off the Titanic.”

This woman had boarded in Southampton in April 1912 but became homesick and left the ship before its maiden voyage to New York. When the ship struck an iceberg, 1,500 of the 2,224 passengers and crew died. 

One size doesn’t fit all

Whether or not the disaster was avoidable, the response had flaws. “The Titanic had a one-size-fits-all disaster strategy – get to the lifeboats,” Dr. McKenzie said. According to Dr. McKenzie, your fate depended largely on where you were in the ship and how much support you had. People in first class were much more likely to make it, than those in second class. And those in second class, had higher odds than the ones in third class. “Survival depended on social class,” he said.

Now, as then, he said circumstance and privilege play a part in a disaster’s impacts. Dr. McKenzie noted how infection and hospitalization rates for COVID-19 have been disproportionately higher for marginalized communities. He also cited the work of the Black Healthy Equity Working Group in Toronto, which promoted the collection and analysis of socio-demographic data. The best predictor of COVID-19 rates? An area’s percentage of racialized population.

The data helped to mobilize population initiatives. It also underscored the disparities, and the social determinants of health – housing, income, employment, etc. – that drive them. Dr. McKenzie said that in a disaster, understanding that is vital to producing more equitable outcomes.

Risk of prolonged grief

Mental health impacts can be felt unequally, too. Statistics Canada reports a general decrease in mental wellness during the pandemic. But those who were experiencing poor mental health before the pandemic were affected even more. And in the first wave of COVID-19 Black and other minority groups had higher rates of anxiety, Dr. McKenzie told participants.

People who’ve lost a loved one to COVID-19 are at a particularly higher risk for mental health issues, said Dr. Katherine Shear, a professor of psychiatry and the founding Director of the Center for Complicated Grief at the Columbia School of Social Work in New York. She said any death is a major stressor, but with COVID-19 deaths, the risks could be amplified. “This is going to be an additional public health burden.”  She described prolonged grief disorder, a persistent and intense grief that’s now an official diagnosis, and could be more acute now.

Dr. Shear said COVID-19 deaths can be seen as random or preventable. People have died unexpectedly and alone. Moreover, the usual processes of bereavement (funerals, burials and other rituals) have been curtailed by public health measures. Along with the people who’ve lost someone to COVID-19, the pandemic has taken a toll on the well-being of those not infected with the virus: those who’ve tested positive, families who have financial worries, children who’ve seen their school routines upended, and anyone struggling with social isolation. “Pandemic-related stressors increase the risk of mental health disorders,” Dr. Shear said.

Burnout is rising

That’s true for health-care workers, too. “In general, the most common outcome of exposure to trauma is complete recovery,” said Dr. Robert Maunder of Sinai Health in Toronto. Still, he said many doctors, nurses and other allied health professionals have experienced short-term mental health issues.

At the conference, Dr. Maunder who is Deputy Psychiatrist-in-Chief and Head of Psychiatry Research at the University of Toronto, presented workforce surveys conducted at Sinai Health at three stages of the pandemic. He reported that burnout, psychological distress and moral distress (when you know the right thing to do but are prevented from doing it by external constraints) are all high and rising.

Dr. Maunder said individual interventions to “prop up” people matter, but organizational interventions should be the priority, as the pandemic’s impacts are part of “occupational harm.” To inoculate herself against pandemic stress, Dr. Shear finds herself thinking about the Serenity Prayer, wishing for “the serenity to accept the things I cannot change, courage to change things I can, and wisdom to know the difference.”

The role of resilience and empathy during a disaster was a theme at the conference. Other speakers touched on the importance of optimism, kindness and the concept of collective efficacy, communities where people truly care for each other. That’s vital to minimize the impacts. After all, as Dr. McKenzie reminded, in a disaster we need to ensure lifeboats for everyone.

Top image: Dr. Kwame McKenzie, Dr. Katherine Shear, Dr. Robert Maunder and Dr. Frank Sommers.

Stuart Foxman is a Toronto-based writer.