Can digital care improve mental health?

Here we are, in 2021, more than a year after the start of a pandemic that nobody could have predicted. With concerns over vaccines, travel bubbles and COVID-19 variants, it almost makes sense that our collective mental health seems to be deteriorating.

Reports seem to be rolling in almost daily about workers’ mental health and, spoiler alert, it is not looking great for a number of industries, with health care and education being particularly affected. Mental health has become an increasingly important topic in the OHS for the last few years, but the pandemic has certainly accelerated this trend.

Since the start of the pandemic, I have found myself writing on the topic on an almost daily basis. The facts are frightening, and it only seems to be getting worse. Nevertheless, it seems as if solutions are multiplying to support Canadians during these trying times. As many services have shifted online, so, it seems, has health.

Worsening mental health

According to a survey conducted at the end of 2020 by the Canadian Mental Health Association (CMHA), 10 per cent of Canadians are experiencing recent thoughts or feelings of suicide. These feelings are exacerbated notably by those with existing mental illness or mental health issues (27 per cent).

Overall, 40 per cent of Canadians say that their mental health has deteriorated since the start of the pandemic last March.

Canadians have been widely affected by the pandemic, and, in fact, most of them will have had their mental health impacted in some way.

“We are seeing a direct relationship between social stressors and declining mental health. As the pandemic wears on and cases and related restrictions rise, a good proportion of our population is suffering,” said Emily Jenkins, lead researcher of the study Mental health impacts of COVID-19: Wave 2.”

Particularly concerning are the levels of suicidal thinking and self-harm, which have increased exponentially since before the pandemic and are further magnified in certain sub-groups of the population who were already experiencing stigma, exclusion, racism and discrimination,” she said.

It seems as if almost every month a new study comes out with results confirming that more and more Canadian workers are suffering with a range of mental health issues such as anxiety or depression. This is hardly surprising, with worries about finances, personal and family health, job security and isolation plaguing workers.

Tech advances

At the same time, tech solutions are seriously progressing as a result of the current situation. There have been winners and losers to this pandemic, and those companies that have managed to leverage their tech expertise have by and large been winners.

Last year, Canadian Occupational Safety organized a roundtable on the theme of tech in the occupational health and safety sector. The consensus was that COVID-19 had impacted the way tech was being developed and applied but also adopted in the OHS sector. Another thing that came up was that this was only the beginning; developments will no doubt continue after the pandemic.

One of the reasons why tech has advanced as a result of the pandemic is the imperative to reduce unnecessary physical contact. Conversely though, Canadians still need to access health services. This has led to many health services shifting online — including mental health services.

And, so, telemedicine is really where tech and mental health collide.

Digital health care

“The pandemic has certainly raised our social consciousness on mental health and wellness issues, with reported rises in anxiety, depression, stress and substance use in many areas. So, whether businesses are planning a full-scale return to work following COVID-19 or shifting toward virtual environments, they need to be aware that mental health needs will not be going away, and additional resources will be required to support employees and limit health-related absenteeism, health-care spending and impacts of productivity,” said Sean Baldry, product marketing manager at Cority Analytics, during the tech roundtable.

“Mental health is a big part of whole-person health. I believe that Canadians will come out of the pandemic much more aware that we should take care of our mental health much more deliberately and that employers will support that,” said Dr. Dorian Lo, president of Express Scripts Canada, to COS last September.

Although many services are closed or limited due to physical distancing guidelines, there is still an immediate need to provide access to continued care. Telemedicine can help provide easier access to health-care services — especially during this pandemic, where access to health care may be more difficult.

As noted above, access to mental health care has never been more important. “We've seen a tremendous increase in the need to access mental health support in the last few months,” says Dr. Marc Robin, medical director at Dialogue.

 “We have actually more than doubled our network of mental health care professionals to address the increased demand,” he says.

In terms of demographics, 20- to 30-year-old individuals are two times more likely to seek out mental health services than any others in his practice, says Robin. In addition, males and females are equally requesting access to care.

Case study: Dialogue

The pandemic has affected a number of businesses in both a positive and a negative way. For virtual health-care provider Dialogue, the pandemic has accelerated its growth.

“Twenty-twenty was a great accelerator for telemedicine … We’ve increased the number of members we serve by a factor of 10 since the start of COVID,” says Robin.

He says he sees between 1,000 and 1,500 people every day on Dialogue’s platform. It has around 1,000 employers who buy services from it directly and another 25,000 through other organizations. This means that millions of Canadians and their families have access to virtual care.

And this is just for Dialogue. There are several online health providers in the country and so one can imagine that there are millions more Canadians who have access to telemedicine. That is a huge number of people who have switched over, either by necessity or because they are interested in the benefits that telehealth services can bring.

Wait times for appointments can be long, especially for same-day appointments. Wait times in emergency rooms can also be long, especially given the current COVID-19 situation, where clinics and hospitals are overwhelmed with patients.

According to Robin and Dialogue’s internal data, using their telehealth platform saves around 4.2 hours of waiting. This is an advantage for employers and could potentially help reduce absenteeism at work (if, for example, a worker has an appointment during normal work hours, this would save time for the worker and the employer).

Looking at the case of Dialogue, we can see that COVID-19 has certainly impacted the evolution of telemedicine and has highlighted a number of advantages that it may present, especially for those suffering with mental health issues.

The benefits of telehealth

Although it certainly appeals to one’s practical sense, the main question, of course, is whether telehealth services, especially for mental health, are even effective.

Robin seems to think so. “We conducted a study on our model of addressing mental health complaints for Canadian workers and it is documented that you can do good work for mental health through virtual encounters,” he says.

And the practicality of the service may well play a part in why it is effective.

“In mental health, we know that 50 per cent of people who have a problem will not consult [for] their problem,” says Robin. “The barriers to get help are tremendous.”

Even if the person does consult, they may have to wait weeks or even months for a consultation. This can be off-putting in the long-term, even if the individual goes in once. Robin says 50 per cent of people who go in for a consult do not go in again.

This means that some individuals may seek help too late or that employers will notice mental health issues in an employee late in the game. This is detrimental to the worker’s health, but it can also impact the company if, for example, that worker has to take a leave of absence.

“We’ve found that virtual care really addresses the biggest barriers in getting help and that we can address a mental health situation much earlier in the continuum between mental health and mental illness,” says Robin.

An advantage for employers

“It is very important for employers to be proactive in providing virtual access to their employees and their families,” says Robin. This helps protect their human capital, but it also keeps people at work and increases productivity.

More and more, employers are looking at mental health as part of their broader health and safety concerns.

In addition, with mental health becoming such an important part of the conversation on employee health, workers are becoming more and more open about mental illnesses and mental health struggles. These employees will certainly appreciate access to virtual care.

The offer is also varied. Telehealth services may offer a range of options from coaching to help with work-life balance (a problem especially at the moment due to many employees working from home) to dealing with more advanced issues in which an individual may have to speak with a health-care practitioner such as a psychologist, psychotherapist, physician or nurse practitioner.

Telehealth services may offer the user a more flexible approach as well as an easier access to health-care services and a shorter waiting time. This can also translate into shorter leaves of absence and/or less absenteeism at work, so there is also an advantage for the employer.

Looking past COVID-19

Telehealth services are not just a solution for the present. Many experts — including Robin — reckon that virtual care is here for the long haul.

Even after the pandemic, telemedicine will stay, says Robin. “The genie is out of the bottle,” he says. “It will be an important part of how we access our health-care system.”

Telemedicine certainly offers a number of advantages. Although in-person care will not, and should not, be phased out, virtual care has some non-negligible aforementioned benefits that cannot be discounted. Virtual care is an interesting complement to a general health-care system and one that employers may be interested in looking into as part of their health plan.

Whether just for a consult or for a more expansive treatment, more mental health solutions can only be a good thing.

Finally, the silver lining is that the pandemic has “addressed the taboo of talking about mental health forever, hopefully,” says Robin.

“Mental health will be impacted by the next couple of years because of this pandemic, so it's really important that we can address this early in the course, keep people being able to work and help employers protect their human capital,” says Robin.

This article originally appeared in the March/April 2021 issue of COS.