As noted in my last column, we have a series of unpleasant anniversaries ahead. Over the next few weeks, we will begin to hit the four-year mark of when the COVID-19 pandemic first became a globally apparent threat and then began to arrive here in North America.
Ahead of these anniversaries, though, I’ve been thinking about a series of articles I wrote a few months before the pandemic. My young son had been injured in an accident and required medical care at a hospital. We were up in the country, and the first hospital we took him to was completely overwhelmed by a combination of an unusual number of emergency cases and a staff that had been reduced to a low level over a long weekend. The next hospital down the highway, though, a 45-minute drive away, was able to immediately take him and provide him the care he needed for what turned out to be a broken bone.
After that experience, I made it a personal mission of mine to really start to understand how health care in Ontario works. It certainly helped set my expectations for how we would perform — not great — when COVID arrived only a few months later.
One of the big takeaways from all of those weeks of interviews I did the summer before the pandemic began was that one of the major challenges in Ontario health care, and perhaps the most critical issue in our hospitals, is what we refer to as “alternate level of care” patients. (ALC, for short.) ALC patients are patients who are being treated in a hospital even though they no longer require hospital care. They are ready to be released into some other kind of medical care, such as a long-term-care home, a rehabilitation hospital for a spell of recovery, home care in their home, or a mental-health-care facility. But backlogs in those service areas keep patients in the hospitals longer than they need to be there, awaiting care outside the hospital. And those patients in the hospitals, those poor ALC souls, become obstacles for all the people outside the hospitals who are trying to get in for treatment they need.
The element of mental-health-care services, and the uniquely tragic failures there, fascinated me. I knew little of that part of the system and was dismayed as I learned more. On the night my son was injured and trying to get into the hospital, there was a young woman in the emergency room with us. She was there for a mental-health-care emergency. And I remember feeling particularly bad for this young woman, stuck with a few anxious but supportive friends in the waiting area with the rest of us. That young woman was only in that emergency room because of so many other failures.
We have long had huge waiting lists for mental-health care in this province. For those who cannot wait, it is sometimes possible to pay out of pocket for faster care, but that can be very expensive and beyond the means of many, especially those with no private insurance. It can be difficult to put or keep people in the kind of inpatient programs they may need to either recover or be taken proper care of as they manage long-term mental-health crises. I don’t know what this young woman’s personal circumstances were or what specifically could have been done to help her, but even as I stewed in my own frustration in that emergency room, she stood out to me as a particularly tragic example of a failing system. She should never have had to show up at an emergency room in the first place.
It's four and a half years later now. The world has certainly not become a more cheerful place in the interim. All of us have been subjected to pressures and strains that would’ve been hard to imagine five years ago. And, unfortunately, it appears as though many of these pressures and strains are here to stay. I joke with friends sometimes that human civilization may have peaked in the late 2010s, but then I think about it, and I’m not actually sure it’s a joke. We should probably assume life going forward will not be less stressful or complicated.
So what do we do? Every government has limited political capital, intellectual bandwidth, and fiscal capacity. Every decision in government reflects a tradeoff. It’s frustrating, but I think we all know this is true. It’s particularly frustrating in the realm of health care, where there literally is not one area that could not use more money.
But last month, as I read anexcellent article in the Globe and Mail by their health reporter, Carly Weeks, I just felt profoundly sad. Weeks was looking at a growing set of data from researchers showing that 1.6 million young people in Canada, particularly those from marginalized communities and/or with particularly complicated mental-health-care needs, are falling through the cracks of a system that simply cannot meet their needs in a timely way.
At the magazine I edit, The Line, my co-editor and I have sometimes mused that one way of trying to concisely explain what COVID did to our society is to say that it simultaneously raised the level of baseline demand on almost every form of social service, while also, mainly through staffing exhaustion, reduced the pre-pandemic baseline capacity of the system. A social problem that might’ve been roughly balanced in 2019, in terms of resources being able to roughly meet demand can very radically become a catastrophe when demand jumps by 10 per cent and resources drop 10 per cent. It doesn’t take big movement in either direction to knock things from a position of stability into what we’ve come to call a kind of social deficit. That's where we seem to be today. We are falling behind more and more every year, and that leaves us with more problems to fix the next year.
This is true across the board, but the issue of mental-health care for children strikes me as particularly important. What could be a more basic societal goal than that? This is especially important when you consider the enormous effort we have all put in in recent years to destigmatize mental illnesses and treat mental-health care as just as valid as any other form of health care.
How cruel is it to invest huge sums of money and flashy social-media campaigns into telling the kids (and the adults!) of today that it is okay for them to open up about their problems and seek help, only to then tell them that, while it’s great that they were brave enough to reach out, there’s no help available. Sorry! You know, budget issues, staffing shortages, and all that jazz.
As a new year dawns and some grim anniversaries loom, now is a good time to remember the importance of mental-health care, particularly for young people. If we do not get this right, that will be a dark stain on all of us in the history books. And we won’t be able to say that we were not warned.
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