Pandemic distress testing Quebec's beleaguered mental health services, experts say

In the first days and weeks, as panic seemed to take over Alexandre Verville's body in the fall of 2019, he thought something must be wrong with his heart.

"I had tightness in my chest. I had these huge tensions and tremors," Verville, 28, said earlier this month.

He consulted a general practitioner at one of the province's no-appointment clinics, but all the tests came back clear. He and the doctor concluded anxiety and the panic attacks he'd had in his early twenties might have returned.

But as Verville's journey through Quebec's health care system dragged on, the symptoms worsened, settling into what he describes as a months-long panic attack that left him bedridden for most of the pandemic.

The Quebec government has boasted that the number of people waiting for mental health services went down from 28,000 in 2019 to 16,000 in the early summer of 2020.

But those numbers rose again to nearly 19,000 last November as levels of distress in the population continue to spike.

Experts fear the pandemic's effects are exacerbating the already significant barriers to accessing mental health services in Quebec.

And though Verville's ordeal began a few months before the coronavirus was detected in Quebec, they say the hardships he faced reflect problems that have plagued the province's mental health care system for decades.

"It really is a neglected sector, always has been, and it's probably been made worse by the pandemic we're experiencing," said François Champagne, a Université de Montréal professor whose research focuses on health-care system performance.

For Verville, what started as a two-week medical leave from his job as a motion graphics designer became a seven-month nightmare that wreaked havoc on his mind and body.

"The fact that I had to wait all that time just made things worse," Verville said. "I don't think I would have lost all those months of my life if I'd had access to the services I got, sooner."

He visited two emergency rooms only to be turned away and ended up waiting nearly six months to see a psychiatrist who could work on his case.

Marie-Josée Fleury, a McGill University professor and researcher at the Douglas Research Centre, says data on emergency room visits says data on emergency room visits provide a kind of barometer for how well the health care system is serving people.

Several studies she conducted concluded Quebecers with mental health issues are more likely to visit the emergency room than the rest of the population and at more frequent rates for all kinds of issues, indicating they aren't receiving the care they need.

Fleury also analyzed the latest figures on wait times for the province's one-stop program for mental health services, the Guichet d'accès en santé mentale adulte, which showed an average delay of three months to get a follow-up and five more to receive any kind of service, meaning it takes an average of eight months for most to get care.

The government targets for both timelines, respectively, are of seven and 30 days.

"That's enormous," Fleury said. "If I have a mental health issue and have to wait more than five months, a lot can happen in that time."

A poll released in October by a group of Quebec public sector psychologists — the Coalition des psychologues du réseau public québécois — found its members' clients had waited between six and 24 months before getting psychotherapy.

"It's very sad because anybody waiting more than necessary could be detrimental, could be fatal," said Connie Scuccimarri, a government psychologist working with youth and their families who is also a spokesperson for the Coalition.

The group has been decrying those wait times and the lack of access more generally, saying there would be more services available if public-sector psychologists weren't leaving for better salaries in the private sector.

In an interview with CBC News host Debra Arbec, Junior Health Minister Lionel Carmant acknowledged that wait times have been a problem for years.

He defended the Legault government's decision to offer $100 per hour to private sector psychologists — more than the $60 rate public sector psychologists are paid — saying the private sector psychologists have to pay office fees.

Carmant said the government is working to open up the list of professionals who can provide psychotherapy in the public sector to include, for instance, nurses and psycho-educators.

'You start losing hope each time you're turned away'

Verville's first emergency room visit was to the Douglas Mental Health University Institute last winter, after his family doctor prescribed a too-high dose of Ativan. He waited six hours only to be told he didn't live in the right part of town.

His second visit was to the psychiatric emergency room of Notre-Dame Hospital. After waiting hours again, he was told by a doctor that his case wasn't urgent enough.

"You just start losing hope each time you're turned away," Verville said.

Eventually, he learned about the Guichet and signed up at his local CLSC.

But weeks turned into months. The group therapy he was referred to by the clinic's social worker closed due to pandemic restrictions.

He waited for an appointment with a psychologist or psychiatris, and the panic stayed. The heart palpitations continued and clouded his days. Fear seemed to solidify in his back and he joined a McGill University study looking into the link between anxiety and chronic pain.

He poured his savings into the various promises of the private sector: chiropractors, acupuncturists, osteopaths, a couple of psychologists with whom he lacked chemistry.

In bed, he would peer at his laptop screen for hours searching the web for solutions.

"At some point in the day, I would just get exhausted enough to fall asleep, then the vicious cycle started over [when I woke up]," Verville said.

A 30 per cent increase in calls

The Health Ministry says it can't provide wait-time numbers because they differ per region, but Fleury says she doubts they would have changed much in the past year, if they haven't gotten worse.

She says the waitlist numbers the government has provided media are unlikely to paint an accurate picture of access to services.

People could drop off the waitlist for all kinds of reasons.

Martin Énault, who heads the board of directors of Relief, a non-profit organization that helps people with anxiety, depression and bipolar disorder, says about 30 per cent more people are seeking help.

Énault says many of those people are referred to Relief through the government.

"That new influx of people on top of a system that was already struggling to meet with the existing demand is making it almost impossible [for the government] to provide help to people," Énault said.

Maylee Keo, who is also 28, reached out to her CLSC earlier this month, after she found her feelings of distress and anxiety had gotten worse and more frequent during the pandemic.

"It just felt really generic," Keo said of the call she received from a social worker following up. "It felt like, "Oh, well, you might not get the help now…. It's just waiting in complete uncertainty, while being distressed."

The worker sent her a list of community organizations, including Relief, to call in the meantime.

Picking up the pieces

Finally, in the early days of the pandemic, a call came offering Verville an appointment with a psychiatrist at Notre-Dame Hospital.

Together, they found a medication and dosage that suited him and about a month and a half later, he was starting to feel well enough to return to work part-time in the spring.

He's been seeing a resident psychiatrist at the hospital every few months since and a psychologist she referred him to through the public system.

"I feel better but I'm not 100 per cent," Verville said, adding he's thankful for the services, but that he wanted to share his story to highlight how difficult they are to get.

It's hard for him not to think about the things he lost — the seemingly everyday-ness that makes up a happy life: a promotion at work, concerts he had tickets to that fall, a cottage weekend with friends, savings he'd built up to buy a house.

"You just feel so alone," he said. "I wouldn't want anyone to go through what I went through."

This story is part of a special CBC Quebec project Out of the Dark: Real Talk on Mental Health. If you are having a hard time coping, here are some resources that could help.

If you are in crisis or know someone who is, here is where to get help:

• In Quebec (French): Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553)