For six months this year, Jenny Carson’s seven-year-old son was on a waiting list for a therapy program at the Center for Addiction and Mental Health.
A child who thrives on routine suffered as soon as the pandemic began. Suddenly, he was no longer going to school or meeting friends. Most days were spent staring at a computer screen as she finished third and fourth grade kindergarten from home, something exceptionally difficult, Carson said, as she struggled with tics and anxiety.
“He wasn’t going to a computer screen for virtual learning, in part because his tics were so pronounced and he’s very aware of it,” Carson said, adding that his anxiety got significantly worse as the months went by.
But when Carson finally got the call from CAMH in July about his son’s enrollment in the group therapy program, they told him it would only be offered online, a delivery model that triggered his mental health diagnoses, which included ADHD and Tourette. . When he made an appointment in person, Carson was initially told it wouldn’t be possible until January 2022.
Carson and other Toronto parents are frustrated by the long wait and lack of in-person mental health care services at this point in the pandemic, at a time when students can attend expensive school, daycare and camp. to face. Many healthcare providers still offer virtual care by default, forcing Ontario Medical Director of Health Dr. Kieran Moore to urge physicians to see patients in person.
“There are limits to what can be done virtually and the standard of care is often difficult to meet in a virtual care setting,” Moore wrote in an Oct. 13 letter to Ontario physicians. The Health Ministry continued to publish an official guide for healthcare providers on October 19, stating that they should resume in-person visits based on clinical need and patient preference.
While COVID has compelled much of online health care delivery, virtual mental health care received specific funding from the Ontario government, including emergency money of up to $ 12 million for Internet-based cognitive behavioral therapy at startup. of the pandemic. Research on the use of online services shows that many people access and benefit greatly from virtual therapy options, but advocates say it may not be suitable for some people with more complex needs.
“What we’re seeing is that for kids under 12, in-person (care) generally works better,” said Kimberly Moran, executive director of Children’s Mental Health Ontario. Moran added that while the pandemic accelerated the adoption of virtual care in the realm of mental health, experts are still trying to determine its effectiveness in treating a variety of problems.
Moran said the government’s directive for much of the pandemic has been to prioritize virtual health services, although many mental health care providers are now beginning to offer services in person as COVID case numbers decline. The problem, he said, is that waiting lists for care are growing and providers lack the resources to keep up.
“I don’t understand why we don’t start with the kids who have the biggest mental health problems and give them the care they need as soon as we can,” Moran said, “but government funding isn’t weighted that way,” Creating a gap in service for children who need intensive care.
After Moore urged doctors to see patients face-to-face, Carson said he received an update from CAMH that the hospital will see his son, now eight, in person one-on-one starting in November. She said it is a positive development, but that he would not yet have access to the benefits of an in-person group therapy program, which is designed for attendees to connect with each other as a form of therapeutic care.
“While I understand that they wanted to be careful and not rush to show up in person too soon, I think it’s sad and troublesome that they haven’t been able to find a way to manage risk and see their younger and sicker patients sooner.” Carson said.
In response to the Star’s questions, the hospital said its priority has been to keep COVID-19 at bay so that its emergency department and inpatient programs remain open for in-person care, and has embraced virtual care options. for outpatient services whenever possible. . But spokeswoman Hayley Chazan said the hospital recognizes that virtual care is not ideal for everyone.
“With our staff’s vaccination rate at nearly 97 percent, we are now in the process of making plans to safely resume more of our in-person outpatient programs,” said Chazan.
Care providers, however, are reinstating in-person services at different rates, and at the Hospital for Sick Children, some psychiatric consultations with children are still done virtually. Kim Munro Roberts saw her eight-year-old son’s anxiety rise after two sudden deaths in the family, prompting outbursts and anger. She sought a psychiatric evaluation in February, but was only able to schedule a September appointment with Sick Kids, about a six-month wait.
While he waited, Munro Roberts sought therapy for his son and paid out of pocket. She tried virtual therapy, but said it didn’t help as it was difficult for him to interact with a therapist who seemed disconnected.
“Everything virtual was a disaster and didn’t give him a chance to connect,” Munro Roberts said. Since then, she has transitioned her son to in-person play-based therapy, which she has been attending successfully since March. But Munro Roberts said she is still frustrated by the lack of options for families who cannot pay and the many more families still waiting months to access essential health care for their children.
Jessamine Luck, a spokesperson for Sick Kids, confirmed that the hospital still offers online therapy groups and day programs under its psychiatry wing, with plans to switch to in-person care in early 2022. “A family can request an appointment in person. if they feel a virtual appointment is not appropriate for them, ”Luck said, adding that the hospital is still collecting parent feedback on their virtual experience.
Health Ministry spokesman WD Lighthall said that while the province has issued guidance for care providers to resume services in person, it is still up to hospital administrators to determine what works best for them on a day-to-day basis. To address long wait times for services, Lighthall added that the province announced funding in June, about $ 20 million, for government-funded child and youth mental health agencies.
Dr. Doron Almagor, a Toronto-based psychiatrist and director of the Possibilities Clinic, which offers mental health care services to children, adolescents and adults, said that for many providers, the pandemic has been a balancing act to ensure safety and slow the spread. while trying to keep services open and available. For this reason, their practice defaulted to virtual care early on, and it remains the primary mode of delivery.
“Things change and it is very difficult to predict the situation around the pandemic,” Almagor said, adding that he will also probably wait until January to start offering more services in person.
He added that virtual care has benefited many families and patients, especially those who live outside of Toronto and do not have much access to care in their own communities. But he acknowledged that for some patients, especially younger ones, it may not be the best option and that some diagnoses need to be made in person, such as tests for autism.
For Moran at CMHO, the key to improving access to mental health care is understanding the pros and cons of in-person and online models, as well as better funding to reduce wait times for services, a problem. which has only gotten worse with COVID.
“A little bit of money was invested in virtual care for older children, and it was all for services for people with mild mental health problems,” Moran said. But the government has not adequately funded intensive mental health treatment, he added, and waiting times are only increasing.
Reference-www.thestar.com