Open letter: Flattening the mental health curve

April 20, 2020

The Honorable Stephen MacNeil, Premier of Nova Scotia
One Government Place
1713 Barrington St
Halifax, NS B3J 2A4

The Honourable Randy Delorey, Minister of Health and Wellness
Department of Health and Wellness
Barrington Tower 
1894 Barrington St
P.O. Box 488
Halifax, NS B3J 2R8

Dr. Rob Strang, Chief Medical Officer of Health
17th Floor, Barrington Tower
1894 Barrington St.
P.O. Box 488
Halifax, NS B3J 2R8

Re: Flattening the mental health curve

Dear Premier MacNeil, Minister Delorey and Dr. Strang,

As political leaders you have relied on public health data to map out our course to keep us physically well. However, early signs show that our mental health will be significantly and negatively affected by the pandemic. Now is the time to enact the best evidence-based policy tools to alleviate stress on what was already an overburdened mental health system. As with the COVID-19 public health response, we must try to prevent a huge spike in mental health needs, to avoid overburdening the system all at once. With the horrific events of April 19 squarely in the hearts and minds of Nova Scotians we must act now to ensure that the social determinants of mental health are acted on and ensure that all Nova Scotians have universal access to mental health services. We call on the government to: 

1. Ensure that all Nova Scotians have access to the family and client-centred mental health services that are required for healing, and allow all regulated mental health professionals to bill services to the province’s MSI program.
2. Substantially boost financial support for the public mental health systems after the pandemic, to ensure that we can meet the mental health needs of all Nova Scotians.
3. Adjust the Standard Household Rate to ensure that every Nova Scotian is lifted above the poverty line, and ensure that any benefits being received through CERB aren’t clawed back from income assistance benefits.
4. Offer portable rental supplements and short-term motel stays to everyone on the priority access waiting list for public housing, and ensure that Nova Scotia’s homeless population has additional access to safe housing which grants them the ability to self-isolate. No one should be without a home during this crisis.

Each person’s mental health is shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities: the greater the inequality, the higher the risk. We have commonly heard throughout this pandemic that we are all in the same boat. This is not an accurate idiom to describe the situation. We are all in the same storm, but because of the inequality and inequity that exists in Nova Scotia everyone is in a different boat, and some are not well-equipped for riding out this storm. To flatten the mental health curve, we need to act quickly to address these social determinants of mental health. 

The Canadian Centre for Policy Alternatives (CCPA) released a report (Early Warning: Who’s bearing the brunt of COVID19’s labour market impacts?) that showed in the first month of the COVID-19 crisis, 3.1 million Canadians lost work or most of their hours. This included:

• 1 in 5 women (1.8 million) 
• 1 in 4 youth (aged 15 to 24) 
• 1 in 3 low wage workers making $14/hr or less

Rates of domestic violence have spiked across the world in countries where there are lockdowns or where social isolation measures are in place. As Suzanne Rent points out in the Halifax Examiner, in Hubei Province, at one police station in the city, the rates of domestic violence were three times higher this February than rates in February 2019. In a survey sent by Women’s Safety NSW to 400 frontline workers across New South Wales, Australia, 40% of workers reported increases in pleas for help, while 70% said current cases were becoming more complex. France’s interior minister says cases of domestic violence have increased by 30% since the country locked down on March 17. In Paris, cases of domestic violence were up by 36%. And here in Canada, the Vancouver-based Battered Women’s Support Services hotline has seen a 300% increase in calls since the pandemic began.

We’re also seeing the effect of pre-existing health disparities created by income inequality, racism and ableism, as the pandemic has affected the (dis)Abled, prison population, those experiencing domestic violence, homeless, racialized and indigenous communities far more severely. In Nova Scotia we are seeing the result of long-neglected inequity between our African Nova Scotian communities and the effect of racism on our health, as well as the consequences of institutionalization of our (dis)Abled communities. We are also paying close attention to the toll that the pandemic is having on our health and social service workers as the stress and anxiety of the pandemic is leading to psychological workplace injury.

There are clear policy tools that we can implement to help prevent complex mental health disorder from progressing during this pandemic.

First, we must address the important and crucial role that income plays at reducing risks, and its important role as a protective factor. We are still in the early days of this pandemic but there is already concerning data on how substantial the loss of income will be. A report by the CCPA shows that Nova Scotians are particularly vulnerable as 62% of Nova Scotians who rent have less than a month of savings. 

We need to get families above the poverty line for income to work as a protective factor towards our collective mental health, but the current income supports available to vulnerable Nova Scotian families fall short. The report on Child and Family Poverty released earlier this year demonstrates that the Market Basket Measure for poverty (Canada’s official poverty line) for a single mother with two kids would require an income of $36,778 a year to be above the poverty line. Current income supports for this family sit at $24,280 a year leaving an income gap of $12,498 or $1079 a month. The recent provincial budget extended income support to vulnerable Nova Scotians through the Nova Scotia Child Benefit which amounts to about $32.00 extra a month. The provincial government’s emergency benefit of $50 per person for income assistance recipients, coupled with the federal government’s extended Canadian Child Benefit, amount to about $450 additionally a month. This leaves this family around $597 short to even reach the poverty line. 

To address this gap, we call again for the Standard Household Rate to be adjusted to make up this difference. We must ensure that any benefits being received through CERB aren’t clawed back from income assistance benefits. 

Safe housing is also a major social determinant of mental health. We have seen calls from housing and homeless community advocates, (dis)Ability advocates and African Nova Scotian advocates who have all called on the province to ensure safe housing during the pandemic. The federal government has committed $157 million to housing the homeless in hotels to provide safe and dignified spaces. However, this just scratched the surface, and the province and cities need to step up to make sure that everyone has access to safe housing that allows them to effectively self-isolate. This can be done by issuing portable rental supplements and offering short-term motel stays to everyone on the priority access waiting list for public housing, and ensuring that Nova Scotia’s homeless population has additional access to safe housing which grants them the ability to self-isolate. 

We must ensure that safe housing is secured for all. This is a terrible time to be evicted, or to have rent increases place further strain on limited or precarious income. We must expand the current COVID-19 eviction policy into a moratorium on all applications for vacant possession of residential premises and a halt on all pending eviction orders until at least July 1, 2020. We must also restore rent control in Nova Scotia by issuing an order in council to eliminate the exemption of all classes of residential premises from the Rent Review Act.  

We must ensure that all Nova Scotians have access to professional mental health supports both during and after the pandemic. Currently only 47% of Nova Scotians have access to extended medical benefits through their place of employment. This means that 53% of Nova Scotians do not have access to mental health services beyond what is available in our overburdened public mental health system. To ensure that all Nova Scotians have access to the family and client-centred mental health services that are required for healing we call for the government to allow all regulated mental health professionals to bill services to the province’s MSI program. After the pandemic, we call on the government to substantially boost financial support for the public mental health systems to ensure that we can meet the mental health needs of all Nova Scotians. 

The International Monetary Fund is projecting a global recession that will match the likes of the great depression. As we have learned from our history, fiscal austerity and neo-liberal fiscal policy will not sufficiently stimulate the economy or lead to greater well-being. To address the pre-existing inequality, the economic recession, and our overall well-being, policies should focus on raising human capital and skills and making tax systems more progressive. Now is not the time to worry about our province’s bottom line; our debt to GDP ratio before the pandemic and the record low interest rates gives the capacity to invest in protecting our well-being during the pandemic and reducing inequality during the pandemic. 

We must focus on what the evidence and data are telling us: that our mental health is going to be significantly affected and we have the tools and resources to prevent the worst effects. The time to act is now.

Kind Regards, 

Alec Stratford MSW, RSW
Executive Director/Registrar 
Nova Scotia College of Social Workers