Family doctors 'highly concerned' about patients' mental health as pandemic drags on, survey suggests

Nearly nine out of 10 family doctors across Canada are increasingly concerned about patients' emotional stress related to COVID-19, a new survey suggests.

And some in Toronto warn of a mounting mental health crisis that will long outlast the pandemic.

In May, the College of Family Physicians of Canada surveyed 3,400 members about working through the pandemic. Because family doctors provide the vast majority of health care, their observations serve as a kind of barometer on how Canadians are doing and a "state of the union" on the system overall, said Steve Slade, the college's research director.

The results, released last week, show 87 per cent are "highly concerned" about their patients' mental health (compared to 80 per cent the year before) and 67 per cent are equally as concerned about their patients' alcohol and drug use. 

Dr. Noah Ivers, who practises family medicine at the Women's College Hospital, said many of his patients are struggling with loneliness and anxiety. 

"The amount and severity of mental health symptoms that I'm seeing in my practice day to day now is remarkable," he said. 

"I try to support people through that day in and day out, as best I can. On the one hand, it's a privilege to be there for them, especially when many don't have other sources of support. On the other hand, it's emotionally exhausting." 

Mental health supports missing

The pandemic has gone on much longer than anyone anticipated, and has taken a disproportionate toll on those who are especially vulnerable, such as seniors, people who don't have adequate housing and racialized communities, said Dr. Onye Nnorom, the president of the Black Physicians' Association of Ontario and a member of the Black Scientists' Task Force on Vaccine Equity. 

Nnorom also sees patients for nicotine dependence as a consultant at the Centre for Addiction and Mental Health (CAMH) and talks to them about their alcohol or drug use. She's noticed an increase in patients relying more on all three to cope with loneliness, boredom, stress and uncertainty brought on by the pandemic. 

"Many have argued that this is also a mental health pandemic," said Nnorom, who is also the Equity Diversity Inclusion lead for the University of Toronto's family medicine department. 

"And there's not a lot of resources available to meet those needs." 

The trauma people have gone through related to COVID-19 — such as the death of a loved one or financial instability — will have long lasting implications for how they cope, think and adapt, said Dr. Javed Alloo, who practises community-based family medicine in Toronto with a focus on mental health.

They're at higher risk for chronic pain and substance abuse problems and will need support even after society has gone back to "normal," he said.

But that support currently doesn't exist on the scale needed, said Alloo.

"And the challenge we're seeing as family doctors is that because the system is so fragmented, we're left not being able to help," he said. "We really are finding it distressing."

Doctors facing burnout

The survey also found 15 per cent of family physicians said they were burned out — a three-fold increase from a similar survey the college conducted in May 2020. 

"It's a big shift," said Slade, the research director. "There's also a lot more family doctors who are saying that they're just not doing well. They're feeling exhausted and coping is becoming difficult." 

While at the beginning of the pandemic, patients were less inclined to see their family doctors, that's certainly changed now, with more than half reporting they're working beyond their desired capacity, said Slade. 

And family physicians have taken on a number of new roles during the pandemic that's only increased their workload, the survey found. Thirty-seven per cent of respondents said they have worked in COVID-19 screening and vaccination centres. A quarter are on a COVID-19 planning group, 17 per cent are developing new response programs and six per cent contributed to research. 

On top of that, they're dealing with the same distress and uncertainty as everybody else. 

Nnorom, for example, has two young children. While working she was balancing their virtual kindergarten, "one of the worst things that happened in my life," she joked. 

"All of us have had times that we dealt with a physician who was short tempered or seemed distracted," she said. "It's likely because they were pouring from an empty cup." 

Ivers said what picks up his spirits is when he patients asks, "How are you doing, doc?"

"And that actually is a bit of a salve against burnout," he said.

"That sense that we're actually in it together."