Keep calm and carry on? Promote resilience for better outcomes amid COVID-19 crisis, says CAMH psychiatrist

As a new season blooms across the country, after months of lockdown, Canadians are feeling the effects of the COVID-19 pandemic on their mental health. 

Whether related to episodes of previous mental illness, or new feelings of waning self-worth, one of the country's top psychiatrists says the emotional toll on people will be ongoing. 

"The real problem [that is] brewing, and some people are calling it the echo epidemic, is that there will be this sort of rising anxiety and depression now and after COVID," Dr. Kwame McKenzie told host Dr. Brian Goldman in an interview for White Coat, Black Art. 

The director of health equity at the Centre for Addiction and Mental Health (CAMH) in Toronto says Canadians were already in a "mental health epidemic" before the pandemic began. The additional strains of job loss and financial insecurity are resulting in people starting to think more negatively about the future, McKenzie said. 

The psychiatrist and CEO of the Wellesley Institute said generally, 15 to 20 per cent of people who have been exposed to traumas need extra support — in addition to their family — to cope. 

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In a new Angus Reid survey, nearly half of Canadians said their mental health was suffering because of the COVID-19 pandemic.

Last month, an Angus Reid survey found half of Canadians described feeling more worried and anxious, and a worsening of their mental health. The national survey found job loss, negative financial impacts, and distanced relationships have had a great impact. 

"Now, we're in a situation where everybody has been exposed to this in one way or another," McKenzie said, "and that exposure means that the actual number of people who are at risk of developing mental health problems because of it is huge and unprecedented in our lifetimes." 

Moving past keeping calm and carrying on

McKenzie, an international expert on the social causes of mental illness, said we can find examples in history of how we've recovered from collective traumas, such as world wars, 9/11 and residential schools.
 
"Some of the things that came out of the Holocaust and others was this idea of coherence, that if there's a plan that makes sense and helps people … then they're even more likely to stay healthy throughout the trauma," McKenzie told Goldman. 

At the same time, he says it's important that Canadians in 2020 move away from outdated notions about mental health that might have been considered healthy in wartime and during the baby boom of the middle of the last century.
 
"The same sort of stiff upper lip type messages — 'keep calm and carry on' — that they may have used in wars of 50, 60, 70 years ago may not be as applicable to [Canadians] now," McKenzie says. "There's much more introspection and self-reflection than there was at that time."

The CAMH psychiatrist also said we shouldn't expect the worst and suggested there are ways to mitigate the impact on our mental health. 
 
"If you give everybody trauma counselling, you increase the number of people traumatized, but if you try to promote people's resilience, and you make sure that you identify the people who are struggling, and then you give them the support they need, you get better outcomes for all." 

McKenzie also noted there was a bump in anxiety, depression, and suicide after SARS, an epidemic of a much smaller scale that had major coverage in the media. He believes this correlation from the past may help reveal how people are doing when it comes to their mental health right now. 

"When the media goes full frontal on a particular issue, when it's happening night after night, and when you're in a situation where there's a lockdown, and that lockdown means that every day you're reminded of the danger, and when you go for testing and you see people who look like they're in space suits — these are incredibly triggering situations," McKenzie said. "You cannot escape COVID-19, and that is a significant issue for people's mental health."

Personal grief

McKenzie believes more work needs to be done to explore and help support people find new ways of coping in a physically distanced world.

"A lot of the support you get in grief is about being able to talk. It's about being able to emote. It's about being given licence to grieve and to let that emotion out in the way that you see fit," the psychiatrist said. 

He told Goldman he is personally navigating the issue, having lost his mother, who died from COVID-19 in the U.K. 

"I don't know how to grieve during COVID-19, and I'm not sure anybody does," he told Goldman.

"It's something that feels like it is not real, it's temporary, and it's not complete," he added. "I'd love to be saying that there have been studies which say this is how you do it. I have not been able to find them, I'm afraid." 

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Grief over deaths of loved ones in the recent past is something that listeners of White Coat, Black Art have reported feeling during the pandemic. 

Dawn Kelly, a teacher of grades 8-12, lost her husband last year, and feels as though her own grief flowed into COVID-19. 

"No break. No line in the sand. The ebb and flow … I thought, and sometimes said [to people who experienced other kinds of loss from the pandemic] ... welcome to my grief life," Kelly wrote in an email to the show.

There is a oneness, a loneliness, a disconnect in grief. There is in COVID-19, too.- Dawn Kelly

One of the lessons she's learned as she identifies "grief tools" that have helped her get through this time is the presence of others who will witness and spend time with her, but not attempt to change how she's feeling. 

"So few people are open to knowing how challenging the grief walk is. They are afraid to walk beside me. No fixing. No happying out of my sad. Just [be] with me in my 'darkest hours.' There is a oneness, a loneliness, a disconnect in grief. There is in COVID-19, too. How ill-prepared and fearful we are, to sit in and with ourselves." 

McKenzie agrees.

"Allowing you to grieve and cry and do stuff the way you need to, in order to remember and mark the passing, is going to be vital," he said.

Written by Arianne Robinson.