Understanding the toll of COVID-19

Noah Brisebois was suffering. Lonely and living on his own, the 19-year-old University of Alberta student was following the COVID-19 restrictions. His friends didn’t come over. School was online.

Hunkering down in his basement rental, he experienced crushing isolation, and his despair manifested in depression.

“There were days when I couldn’t even force myself to pick up my computer to study. It was so terrible. It felt like I hadn’t done anything else but school for a year. I got overwhelmed. There was no hope. I was depressed, sad and lonely,” recalls Noah.

The second-year sciences student reached out to his mom, a physician, who took him to a hospital, where he was admitted.

A few months later, Noah says he’s doing better. He’s taken a break from his studies, has a job washing windows — where he can connect in-person with other people — and is getting additional supports. But his mother, Dr. Amanda Brisebois, associate chief medical officer for Covenant Health, worries about those who don’t have access to mental health services.

“How, as a society, can we do better for people who are isolated, who are almost in this social abyss? I believe that the pandemic has rocked the world of almost everyone in different perspectives,” says Amanda, who is also a clinical professor at the University of Alberta.

“Many people are suffering.”

A key concern is the lack of informed understanding of Albertans’ current mental health and other challenges they could be facing, such as problematic drug or alcohol use or financial strife — information that is critical to providing effective supports.

Amanda is not alone in her concerns. Other experts are predicting that a mental health pandemic could be in our future. That means now is the time to act, says Amanda, whose role also sees her serving as the medical director of the Grey Nuns Community Hospital and Covenant Health’s Palliative Institute.

In a Canada-wide survey of more than 3,037 adult Canadians conducted in January, 41 per cent of respondents reported a decline in their mental health since the onset of the pandemic. A survey released on May 3 by the Canadian Mental Health Association (CMHA) in partnership with the University of British Columbia showed that certain populations are struggling more than others. Unemployed people say their mental health has declined 61 per cent, while the figure is 54 per cent for those who have a pre-existing mental health condition and 50 per cent for those aged 18-24. For students generally, the figure is 48 per cent.

Amanda says an Alberta-wide survey would shed light on the current state of people in our province, which would be essential to providing care now. And it would help us prepare — and possibly even make changes — with the hopes of reducing the impact of what could be coming when we begin to “recover” from the pandemic.

“How do we get change that’s methodical and smart? We need to do the background work in order to start to understand how it will impact others. We need to have reasons for why we are doing things. Without knowing what’s happening, it’s hard to move forward,” she says.

Such discovery work allows for a more targeted approach. We need to understand whether different segments of the Alberta population are experiencing different challenges and what they are. We cannot assume that Albertans fit the same profiles as those revealed in the CMHA results.

“How do we look at the segments of our population and people differently so that we can get help for everyone? Right now, it’s this blanket solution that we have been asked to do. What about the small businesses that have crumbled? What about the youth who feel lost and unheard? There are many, many segments of the population that aren’t being individualized, and I think we really need to look at things from a different perspective in order to get through this,” says Amanda.

Noah feels the mental health needs of youth and young adults have been “severely overlooked” in the pandemic response.

“We need to take into account the effects the lockdown has had on the youth in terms of not just getting sick from COVID-19 but getting sick from loneliness and depression and how it’s affected so many people my age,” he says.

“At the end of the day, the biggest threat to my health was the damage of being locked in my house for so long, not COVID-19.”

Different population segments have different needs. In all the chaos of the pandemic, we’ve done little work to understand those differing needs, believes Amanda.

“We do know that social isolation increases the risk of suicide, depression and anxiety. Loneliness is one of the things that raises your risk for admission or readmission to hospital at any age,” she says.

Noah agrees, saying youth and young adults need human interaction. “Many of us deal with stress by socializing, and that has been taken from us.”

Substance abuse is also often directly linked with mental health issues, says Amanda. The CMHA survey found that 13 per cent of those who responded acknowledged they are using more substances, including drugs and alcohol, to cope with the pandemic.

Noah is among that group. He began smoking significant amounts of marijuana because he had nothing to do except study. He believes it contributed to his downward spiral.

“For the most part, almost all the people I’ve talked to, they’ve had an increased relationship with substances to cope with the stress that’s going on,” says Noah.

And that, says Amanda, is something we need to prepare to support as part of our recovery. Understanding the true Alberta picture is imperative to delivering good care, she says.

Once we have that picture, we need to collaborate to come up with solutions. We need to be open to having a respectful conversation that offers different opinions. It’s key to effective change, says Amanda.

“We must start thinking about recovery now. You don’t start thinking about the Olympics a month before it starts.”

Each of us can start helping one another by being aware that many people may not physically show the strain they’re carrying internally, she says. And that may leave them vulnerable to being misunderstood.

“While we rightfully express compassion for people who require ventilators, we need to understand that maybe for an individual his ventilator or lifeline is a small group of a few friends playing basketball,” says Amanda. “This is terrible. It will continue to be terrible for some time. As it continues to be terrible, how do we make it better for people? How do we recognize the trauma we’ve been through and have compassion?”

For Noah, there is hope that he’ll be able to return to in-person classes in the fall. “It will just feel good to be in a lecture hall with other people. It’s going to be nice to get to school and talk to people and have social interaction,” he says. “I think we need to take into account all the affects this pandemic has had.”