QUESTIONS FOR

Dr. Andrea Levinson

2020 will go down in history as a time of public health, economic, and societal crisis. Less acknowledged is the significant toll it has taken on mental health. How would you describe this toll?

There are so many layers to it, but overall, COVID-19 has had a massive impact on our mental health. Government responses to the pandemic have touched us all, ranging from border closings, to physical distancing, to funding relief, so it makes sense that mental health — along with addiction issues — have been significantly impacted.

Certain sectors of the population are more vulnerable than others: Youths aged 18 to 22 are particularly vulnerable, given that they are on the verge of adulthood; women and people living in poverty have been shown to be more vulnerable; and of course, the elderly have been severely impacted. The list goes on and on: People with pre-existing mental health and addiction issues are at greater risk, and from a safety and mental strain standpoint, this has hit essential service providers very hard — not just healthcare workers, but also frontline grocery workers and teachers. And of course, we can’t forget those directly impacted by COVID-19, either themselves or via a family member.

The broad scope of mental health issues arising from the pandemic run on a continuum from low, appropriate stress, to experiencing some level of distress, to more severe impact. The fact is, people everywhere are dealing with a lot. Challenges can range from having to care for sick family members to being unable to mourn appropriately or say goodbye to a loved one, to adjusting to social isolation, which affects some people more than others. Common symptoms that are cropping up include irritability, fatigue, severe mood changes, and difficulty sleeping. In addition, liquor sales are way up and substance use has increased in the general population by about 25 per cent. There has also been an increased risk for intimate partner violence and family violence. Add to all of this mass unemployment and how deeply that affects people.

Care availability is still a big issue, but one silver lining is that we have seen transformative change around using technology for mental health care delivery. While this represents positive progress, we can’t forget that many people who are marginalized in our society are not able to access that. Another silver lining is that engagement in education is actually at an all-time high, which is great; but it leads to all sorts of questions, like ‘What kind of debt situation am I getting myself into?’ and ‘What kind of viability does my degree have in this world?’

As indicated, this pandemic touches just about everything. I don’t want to be all doom and gloom, but dealing with all of this is going to be more of a marathon than a quick sprint.

As the University’s Psychiatrist-in-chief, what does your role look like right now?

Like everyone else, my daily routine has shifted significantly. The University’s Health and Wellness Centre is still open for some urgent primary-care appointments, but as a psychiatrist, my physical presence isn’t really needed, so I’ve been working predominantly from home since last March. All of the work I do has shifted online, including seeing students face-to-face, working with fellow clinicians on complex cases and having regular leadership meetings. My days are full and busy, as always, but in a totally new way.

As part of my role I also deal with more urgent cases where students are in crisis, and this has challenged our team to be quite nimble and creative in utilizing online tools to reach out to individuals that we are concerned about. Students’ affinity to adapt to the digital medium is astounding, and I think that is going to be another silver lining going forward. Looking ahead to the post-pandemic world, I don’t think I’ll be spending my days in my home office forever, but this crisis has given us all access to new tools and demanded flexibility in terms of scheduling our time. As a practitioner, that disruption of the status quo is very exciting, and it just wouldn’t have happened without this health crisis.

In terms of the boundaries between our personal and professional time, our days are also much more fluid. I’m trying to set some healthy parameters around work and home life, but I’ve had to be flexible and pivot in and out of each. I might need to squeeze someone in late in the day or do late night ‘email appointments’. We’ve all got to be flexible and adapt.

What advice do you have for readers who want to lead effectively at a time like this?

In terms of interpersonal traits, some of the adjectives I’ve already used come to mind, like flexibility, agility and being nimble. Also, being kind, demonstrating empathy and having integrity. All of these things are highly valued at a time like this.

Then there is the innovation piece. Leaders need to think of innovative ways for themselves and their employees to adapt. At the University, last March our faculty had to pivot to online offerings in less than a week, which was amazing to see. And of course, this innovation will continue. The online learning that was offered in April would have evolved compared to what was then offered in September,

Common symptoms that are cropping up include irritability, fatigue, severe mood changes, and difficulty sleeping.

and what will be offered this year will continue to evolve in terms of depth and breadth as we figure out how to engage with e-learning.

For leaders everywhere, it’s important to seize this opportunity for innovation. In my role I am particularly interested in expanding access to mental health care and implementing new service delivery models to support our youth. This pandemic has disrupted the status quo, and in many ways that is a good thing. As leaders, we have to invest in the relationship-building piece and the trust piece with our direct reports — while at the same time, pacing our own work flow so that we don’t burn out.

At a time like this it’s more important than ever to be humble, intuitive, and to communicate very clearly — including being honest about what we don’t know. Every day people have to listen to government officials and health experts, and leaders only add to this barrage. My advice is to strive for clarity and to foster a context of psychological safety. When you achieve that, people feel like they can communicate ideas without fear of repercussion.

Finally, it’s not easy, but leaders have to be optimistic in a time of crisis. We need to accept that people will have different moments of despair — particularly in a highly diverse community like a University, where everyone’s circumstances are different. You never want your messages to sound trite. It’s not about being a Pollyanna, but rather offering realism tempered with optimism. We have to hang on to hope and believe that by sticking together, we will get to the other side of this — and that a lot of things that needed fixing before the pandemic will get fixed along the way.

This pandemic has exacerbated just about every regular life pressure. What are some of the coping mechanisms that you would recommend?

It’s important to stay informed and connected to what’s going on, but it’s equally important to take breaks from the news and the pandemic updates so that you don’t get overwhelmed. Mental health and physical health are very integrated, so it’s critical at a time like this to eat healthy and to get regular exercise. It’s also critical to stay connected to your social network and to put more effort into that than you did before. And watch your substance use.

Sleep is also paramount. If your sleep patterns are starting to shift, address it right away. My colleagues and I talk a lot about ‘sleep hygiene’, and in a time of crisis, it’s more important than ever. That means setting regular sleep and wake times. Our natural circadian rhythms make us want to fall asleep somewhere between nine and midnight and to wake up somewhere between six and nine in the morning. Adhering to that helps to ensure a healthy sleep/wake pattern. Other tips are to be in a cool room and limit your screen time a couple of hours before you turn out the lights. That’s a really hard one for many people, but I urge you to try it.

When you do wake up, try things like mindfulness exercises, listening to music, reading a book, or getting into a routine of exercise early in the day as opposed to late at night, which disrupts sleep. Those are some basic guides. If you try all these things and sleep issues persist, I would advise seeing your primary care physician.

You touched earlier on young people, who are facing severe disruptions just as they are transitioning into adulthood. Talk a bit about the particular challenges they face.

It’s tricky because as a group, people aged 18 to 22 are experiencing some major life transitions — going away to university, moving out of the family home, living with peers for the first time — and these life transitions have been arrested or changed by the pandemic. Also, they are in the age bracket where major mental illness tends to present itself. They’ve got academic stresses that are different from what they expected and they’re more isolated and disconnected. This age group already had financial concerns like student loans, and those have been compounded. To top it all off, they’re managing everything online, where relationship building is difficult.

Even at the best of times, there aren’t sufficient services to support these specific developmental needs. Health and Wellness Centres on campus are ideal because they are

easily accessible and they can be a one-stop shop. Of course, at the moment, students can’t just knock on our door and walk in whenever they want to; they have to reach out virtually. Thankfully at Uoft we have an app called My SSP [Student Support Program], which is available 24/7 to our students around the world. We started offering that even before COVID-19.

Do you have any advice for parents of school-aged children, who have also had their lives up-ended?

Without question, their world has been disrupted. They’re missing out on playdates and soccer games and graduations, and everything is very tenuous right now. My advice is to validate their feelings and provide support — but don’t try to make it all better. Acknowledge the upset, but do your best to present a calm and resilient response to what is happening around us. We need to model resilience and at the same time, recognize that kids are facing more hurdles than they normally would. But kids are intrinsically very resilient — especially in the school-aged years.

Our brains crave certainty and predictability—both of which are in short supply these days. Any advice for dealing with that?

My advice is to find things that represent stability for you on a day to day basis. Set your alarm for the same time every day; eat regular meals; walk your dog at set times and go to bed at the same time every night. Do your exercise at a specific time on certain days and a different time on different days. And reach out to close friends on a regular basis. These are all things we can control, even in a chaotic world.

When we do cognitive behavioural therapy work to help people deal with uncertainty, we always start with really small things. Maybe cook a meal that you’ve never tried before or watch a movie that you know very little about; just press play and commit to watching the whole thing. Once you’ve tried these unfamiliar things, ask yourself, ‘How did that go?’ ‘What was so hard about it?’ This will help you deal better with uncertainty moving forward. Focusing on what you can control, trying new things, journaling, the self-care piece we discussed earlier; all of this can help.

The University’s Faculty of Medicine recently received the largest donation in Canadian history: $250 million from James and Louise Temerty. What are your hopes for this gift?

This gift from the Temerty family is truly groundbreaking — especially coming in the midst of a global pandemic. The newly-named Temerty Faculty of Medicine will use these funds to focus on applying artificial intelligence and other new technologies to all areas of medicine — from surgery to mental health. There is also a mention about doing important work on suicide prevention, which is so relevant to the work my colleagues and I do with emerging adults. There is also mention of focusing more on personalized medicine. Psychiatry is ripe for that, given that the issues we deal with are complex and the phenotypes for illness are so varied. Overall, this gift will enable us to look at medicine, mental health and health in an integrated, interdisciplinary, interconnected way.

Dr. Andrea Levinson is Psychiatrist in Chief, Health and Wellness, and Assistant Professor of Child and Youth Mental Health at the University of Toronto.

It’s not easy, but leaders have to be optimistic in a time of crisis.