Demand up, supply down: Coping with the post-COVID mental health service crisis

The Intake, Information & Referral Team [Amanda at centre and Maria at far right] and student volunteers at a mental health and wellness fair held at the Jane-Finch Mall in fall 2022

CMHA Toronto’s Intake, Information and Referral Program is noticing a massive spike in demand in the post-pandemic period just at a time when the availability of services is at an all-time low. The department is a barometer for the severity of the mental health service crisis provoked in large part by the pandemic.

Amanda Onetto and Maria Kalogridis are on the front-line answering questions, handling requests for resources, making referrals and initiating the intake process. “We field calls and emails from the community, from professionals, from within CMHA Toronto, and then we also handle the referrals. We do a lot!,” said Amanda.

Both Amanda and Maria have noticed a dramatic rise in call volume, with calls increasing by approximately 50 per cent over the course of the pandemic. “It's huge,” said Maria. “Our job is constant. It's about balancing the calls coming in, screening for the appropriate level of support, creating the referrals into our system, and ensuring transition to services so clients are ready to receive support. We also have to stay aware of programs that do not have the capacity to take on new clients and find alternate ways to support our clients.”

No small feat. As calls have increased, service availability has declined, and as a result waitlists have lengthened. CMHA Toronto has noted a 170 percent increase on waitlists for urgent, intensive mental health supports. Maria gives another concrete example: “Our Family Outreach and Response Program had no waitlist prior to the pandemic and now it’s around eight months and still climbing."

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Types of calls from public tell a story

It’s not just family support that has seen this kind of escalation in demand and resulting increase in the waitlist for services. Requests are wide-ranging but some trends are appearing that tell a story about what kinds of issues have emerged during the pandemic.

“Callers are asking, ‘how do I find a psychiatrist or a psychologist?’ It's addiction support. And then there’s mental health and justice, family members calling saying, ‘my brother is in legal trouble but he is not well, what are some services that can help him?’ or individuals letting us know that they've recently been released from jail and they want to get connected to supports,” said Amanda, citing some of the most common questions and issues presented.

“Our Family Outreach and Response Program had no waitlist prior to the pandemic and now it’s around eight months and still climbing.
Maria Kalogridis, Information, Decision and Support Coordinator

Maria adds, “A lot of calls are for counselling and psychotherapy. We're hearing from individuals who have had trauma in their lives. They are asking for services that will help with self-harming thoughts, anger management, depression, and anxiety."

Serious rise of mental health issues during the pandemic

A research project conducted at the two-year mark of the pandemic by the Canadian Mental Health Association, which surveyed 18 individual CMHA branches from 10 provinces and the Yukon, confirms what Amanda and Maria have been hearing on the phone and seeing in their inboxes. First, Canadians’ mental health deteriorated significantly since the start of the pandemic, and second, the overall mental health care system – already close to the breaking point – has now been pushed beyond it.

Among the CMHA study’s key findings are that the pandemic had devastating impacts on the mental health, substance use, and homelessness of Canadians and that it strained the already-overstretched community mental health sector and its workforce.

“Sometimes people just need to hear from us that, yes, the system is saturated, there are huge waiting lists. When it comes to housing. I often say to them, ‘it's really difficult, I know.’ Sometimes they need to hear from us on a human level, and have us validate their feelings.”
Maria Kalogridis, Information, Decision and Support Coordinator

Homelessness a key concern – especially in Toronto

How to access subsidized or supportive housing is the number one request received by CMHA Toronto’s Intake, Information and Referral team.

As the report notes, homelessness has risen dramatically across Canada in the wake of the pandemic. Toronto’s affordable housing crisis, combined with increases in mental health and addictions rates, is driving homelessness to the city’s highest levels ever.

The lack of availability of subsidized and supportive housing is reflected in the number one request CMHA Toronto’s Intake, Information and Referral program receives: “It’s housing. How to get into affordable housing or subsidized housing,” said Amanda, and Maria immediately concurred.

In Toronto, there is currently a minimum of an eight-year waitlist for subsidized housing, with more than 84,500 people currently on that list as of January 2023. When people call to inquire about housing, the team does their best to help them navigate the system. “There are different ways that people can apply for a subsidized or supportive housing. It's either through Toronto Community Housing if they're looking for subsidized housing within Toronto or, if they're looking for mental health supportive housing, we direct them to contact The Access Point and we will also complete an application with them,” Amanda explains.

But, she quickly notes, both those resources have “huge waiting lists. We'll also give out the number for the Housing Help Centre. And there’s a link where you can sign up to receive notifications about when new affordable housing is being built. Basically, there's a lottery system where you can apply.”

Shortages across the board

Although the housing shortage is extreme, the service shortages are across the board. The Intake, Information and Referral team is called upon to use their own ingenuity to deal with the increase. They regularly communicate with other agencies and non-profits to share ideas and resources but everyone is in the same boat trying to stay afloat.

Crisis and critical cases are prioritized. Amanda explains that she and Maria are “always assessing, is this a person in crisis, do they need crisis services, or do they have the capability to wait until services are available,” she said. That assessment, combined with their knowledge of what’s available and how long the wait is, determines what resources they will provide.

When it comes to psychotherapists or counselling, the team has started to refer people to Wellness Together Canada for free, online counselling. The government-funded program offers online therapy on demand 24/7. “It’s comprehensive. It's for families, it's for anyone who needs the service. It gives people someone to talk to about what is happening, so they're not feeling stuck,” Maria said. She adds that while the service does provide some people with an option, it is “a patch” on an overwhelmed system.

Rising demand has corresponded with decreased capacity and the lengthening waitlists, but it has not been the sole cause of them. Fractures in the mental health service system pre-date the pandemic.

Harder than crisis calls

The issues Maria and Amanda are seeing are more complex and, in some cases, more severe than those they have faced in the past, even when doing crisis work. “I worked crisis services prior to this role and some of the calls are just as complex. We’re getting parents calling in saying, my son is talking about suicide, and you have to try to provide them with immediate resources because parents are very scared. We're getting school counsellors, social workers, with youth presenting with the early signs of psychosis. It's just everywhere and it's not one thing.”

The need to be responsive to the widest possible range of issues in an environment where resources are scarce takes a toll on people on the frontline, as the CMHA report noted. Both Maria and Amanda are aware that “even when we're giving individuals the resources, we know that it's often not a perfect fit. We have this wealth of information and there are services out there but everywhere is so saturated that people can't get the help that they need right now,” said Amanda. The team offers CMHA Toronto’s Quick Guide, which identifies over 100 different support programs available to families, as a resource. It is now an interactive tool available on CMHA Toronto’s website.

Listening and validating

Although the Intake, Information and Referral Support team does their best, there’s still only so much that can be done. “Sometimes people just need to hear from us that, yes, the system is saturated, there are huge waiting lists. When it comes to housing. I often say to them, ‘it's really difficult, I know.’ Sometimes they need to hear from us on a human level, and have us validate their feelings,” said Maria.

Amanda agrees that at times the only course of action is to listen and be as transparent as possible. “A family member will call and have an idea that they might be able get help sooner. When we say, ‘unfortunately, no, there are waitlists for everything’, they're often surprised to know how many people are struggling. We try to be really straightforward with them because we don't want to set up unrealistic expectations,” she said.

What's the biggest picture?

Balancing requests coming in with availability of services is a daily part of the Intake, Information and Referral team’s job.

The rising need for mental health services sits within a larger societal context, which extends far beyond Toronto’s borders. Service demand has been driven by, among other things, the isolation and stress of a three-year pandemic and an increased awareness of mental health issues among the general population. Rising demand has corresponded with decreased capacity and the lengthening waitlists, but it has not been the sole cause of them. Fractures in the mental health service system pre-date the pandemic.

As the CMHA report notes, the pandemic “made visible the current patchwork system of care provided in the private, public and not-for-profit sectors.” This is the system that the Information & Decision Support team works within, striving to keep their fingers in the dam as the waters rise daily.

Michael Anhorn, CEO of CMHA Toronto, says that increased, stable funding is vital and so is increased integration of mental with physical health services. “We need to more fully integrate mental health and addictions services into our overall healthcare system and fund them equally. Currently, the two systems – physical and mental health – run on parallel tracks. But you can’t have one without the other. As a society, we need to take a more holistic approach, and operate in line with the evidence that says unequivocally that the social determinants of health drive people’s health and well-being overall. People need food security, adequate housing, income and employment, social inclusion, and access to mental health care. The pandemic has revealed more clearly what we, and definitely our frontline mental health workers, have known has been broken for a long time,” he said.