Facing inequities magnified by the pandemic
The pandemic’s impact on mental health affects marginalized people most
You don’t need statistics to appreciate the profound effects that COVID19 restrictions limiting social connections and access to services have had on our collective mental health.
And yet, statistics — paired with qualitative data that offer in-depth descriptions of what people are experiencing — are essential for monitoring improvements, or lack thereof, during the process of recovery from the past two years of cumulative stress.
However, aggregate trends (which combine data from all members of a population) can be misleading. Even worse, they can exacerbate inequities by giving the erroneous impression that the data apply to everyone in the same way.
For example, Statistics Canada recently reported a general worsening in self-rated mental health among Canadians. Sixty per cent rated their mental health highly in fall 2020, decreasing to 52 per cent in spring 2021. However, this trend was more pronounced among some population subgroups. In young adults (18-34 years) the proportion rating their mental health highly dropped from 51 per cent in fall 2020 to 33 per cent in spring 2021.
Understanding how to build back equitably after the pandemic requires gathering the appropriate data and being responsive to the groups who were hardest hit by pandemicrelated distress.
In the first year of the pandemic, as public health equity researchers, we anticipated a need for mental health data. Health-care leaders, policymakers, politicians and members of the public would need access to rigorous data collected over time to monitor
and respond to the mental health of groups that are unjustly disadvantaged by the pandemic in Canada.
The Canadian Mental Health Association has warned of an “echo pandemic:” a wave of intensifying mental health concerns caused by pandemicrelated stress, including uncertainty, social isolation, unemployment and loss of services.
To better understand and track the differential effects of these pandemic realities, we established the B.C. Alliance for Monitoring Mental Health Equity. Using a newly developed web platform, we host findings from 15-plus research studies featuring data from British Columbia and, in some cases, complementary data from the rest of Canada and international locations.
We are committed to reducing and ultimately eliminating avoidable differences in mental health status by social positions and identities. For that reason, we prioritize research that centres socially defined population sub-groups such as those who are two-spirit, lesbian, gay, bisexual, transgender and queer (2S/LGBTQ), Indigenous, Black and people of colour, young or living in low-income households.
We are inspired by activist and writer bell hooks’s call to “center in the margins,” meaning to focus first on those who have experienced the greatest social marginalization. From several studies in Canada and elsewhere, we now know that over the past two years, 2S/ LGBTQ people have experienced a disproportionate worsening of mental health related to the pandemic. A similar growing disparity in mental health has been observed for those experiencing personal financial strain and those with pre-existing mental health conditions, or a combination of these factors.
A few common threads can help explain the disproportionate effect of the pandemic on these population subgroups.
First, members of these groups may be particularly affected by social isolation.
For example, before COVID19, we knew that many 2S/ LGBTQ people — who are less likely to be partnered, more likely to be living alone — experienced reduced social networks due to stigma and exclusion. During the pandemic, these networks have shrunk further, limiting the social connections that can help buffer against pandemicrelated stressors.
Second, the restrictions in access to in-person appointments had a greater impact on those who routinely relied on mental health supports, including those with pre-existing mental illnesses. Before the pandemic, there was already a large gap in access to adequate mental health care. Covid19-related service restrictions left those with chronic mental health conditions — who already experience significant stigma and discrimination — with profound barriers to care, often at the same time that their mental health symptoms were worsening.
Working from the local, equity-informed data compiled by members of the alliance, we offer four urgent calls to action, with further recommendations available on our website.
Improve funding and programs in accessible mental health services that are tailored to reduce barriers for equitydeserving groups.
Adopt a population approach to mental health, with the goal of improving mental health across populations. This approach would include promotion (to build contributors to positive mental health), as well as prevention to reduce mental ill health and treatment for those with a mental health diagnosis.
Strengthen mental health screening and referral pathways in primary care settings (for example, family practitioners and walk-in clinics) and support rapid access to followup for those who need it.
Develop guidelines to support digital mental health care solutions such as web-based resources and virtual access to care providers.
These solutions must be accessible, supported by evidence, and equity-oriented.
Decisions that policymakers make right now will determine how we, as a society, recover and build back mental health in the years to come. With equitable investments in mental health promotion, prevention and treatment, we can redress unjust differences in our population’s mental health and work to ensure that good mental health is an achievable goal for all.
• Travis Salway is assistant professor of health sciences at Simon Fraser University
• Emily Jenkins is professor of nursing at the University of British Columbia
• Hasina Samji is assistant professor of health sciences at Simon Fraser University
• Pierre-julien Coulaud is a postdoctoral research fellow in the Department of Medicine at the University of British Columbia.