Specific virtual mental health policies for rural communities needed, Acadia grad says

Some virtual mental health care programs don’t accommodate the unique barriers and needs that rural Nova Scotians experience, an analysis by a recent Acadia University graduate found.

“Moving forward, the government really needs to take steps to collaborate and discuss with rural practitioners, with rural people, to develop policies that are sensitive to rural Nova Scotians’ unique barriers and create (distinct rural) programs,” Robin Lauzon said.

Lauzon graduated from Acadia in July with an honours degree in politics after completing an academic thesis entitled Understanding Nova Scotia’s New Virtual Care Policies: mental health policy and rural Nova Scotians.

She condensed the thesis into an article released Tuesday by the Canadian Centre for Policy Alternatives-Nova Scotia.

“A lot of virtual care is very general, it’s created for a broad variety of audiences, which during the pandemic was what was needed, what was required,” Lauzon said of her work, which was based on extensive interviews with 16 Nova Scotia mental health care clinicians.

“They (province) needed to develop things rapidly, those basic coping mechanisms for people. But I think it’s now time to develop policies that will address the distinct barriers and the distinct needs that different communities have, especially rural communities.”

The clinicians Lauzon spoke with were psychologists, psychiatrists, registered counselling therapists and peer group support workers, all of whom had experience working in rural communities across Nova Scotia from Cape Breton to Yarmouth.

“During the pandemic, virtual care was something that was accelerated and offered as an option or something to pick up the slack for the rest of the mental health care system,” Lauzon said.

“In-person services were sort of shut down and I really wanted to see how that affects rural Nova Scotians who already have different barriers in terms of accessing mental health care and certain barriers that might be exacerbated by a shift to online.”

Lauzon said Nova Scotia had been working on developing a virtual care network for mental health for several years, a network that was intended to be implemented gradually and tested.

“Because things were instituted so quickly, there wasn’t that time for policy feedback and for different groups within the province to give feedback about how virtual care is working for them and how it might not be working.”

Lauzon said virtual care for mental health has become a core priority for the provincial government and something it hopes to expand in the future.

A report completed for the Nova Scotia Health Authority six years ago found that Nova Scotians have one of the highest lifetime prevalence rates of mental health disorders in Canada – 41.7 per cent in Nova Scotia compared with 33.1 per cent in Canada as a whole.

The gap is wider for those who are most disadvantaged in Nova Scotia.

The report quoted estimates that suggest that half of all lifetime cases of mental health disorders start by age 14, and 75 per cent start by age 24.

The Progressive Conservative party was elected to govern Nova Scotia in August 2021, riding the promise of fixing health care to a majority mandate.

The PC platform included a promise to make Nova Scotia the first Canadian province to provide all of its citizens universal access to mental health and addiction services, the establishment of a 24/7 telehealth counselling service and a three-digit mental health crisis line.

The government invested $6.4 million in e-mental health tools in fiscal 2022-23.

Lauzon said most of the practitioners she interviewed during the summer of 2022 were forced to quickly switch from in-person care, their primary mode of care, to virtual care with the onset of the COVID pandemic.

Many of them intended to adopt a hybid model of care when the pandemic ended.

“There are definitely some benefits for clients when accessing care virtually,” she said. “You don’t have to travel, you can be in your own home in a comfortable space, there are some people who, due to a variety of factors, may not feel comfortable going into a clinical environment.

For those people, to have the virtual care option and that added anonymity or comfort was really wonderful.”

The virtual care options offered were appointments by phone call, a Zoom or Teams meeting, even texting, or any other technological connection that supplanted in-person meetings, Lauzon said.

She said some of the 16 clinicians interviewed said virtual care worked better for some patients and they would continue on that path but many of the clinicians were “very eager to get back into the office because there are so many facets of care that you can provide with an in-person experience that might be more difficult virtually.”

Having face-to-face conversations and being in the same space with a patient is often advantageous, “diagnosing, making initial appointments, what does this person need, what kind of issues are we addressing.

“Doing a kind of initial in-person appointment can make diagnoses much easier.”

Clinicians described a “therapeutic bond and relationship that are better achieved for them through in-person appointments,” Lauzon said.

But there are other disadvantages, too, connected with virtual care.

“Speaking specifically about rural communities, I think the one that I heard about the most would be internet access,” Lauzon said.

The issues were that the internet wasn’t good enough, service was intermittent or the cost of rural internet or upgrading to high-speed service was often prohibitive.

“For some people that just adds that extra barrier,” she said. “Also for rural people who may already be experiencing isolation, talking to someone virtually might not provide the same sorts of connection that they are looking for.”

Lauzon said there are a good number of practitioners who have great program ideas and are trying to take the initiative themselves to work on virtual care alternatives for people in their communities.

“One of the big things that came out of shift to virtual care is because things became virtual and elements of treatment were removed from the publicly funded areas, like triage being moved to a phone line, a lot of people have had to turn to alternative resources for care, whether that be that the wait times are so long for a publicly funded psychiatrist working in the public system, they are turning to other counsellors and paying out of pocket, or they are turning to family members.”

Lauzon said it’s important that there is support provided for those organizations that have had to pick up the slack and to help practitioners who have the initiative to develop new virtual care alternatives.