Supporting Individuals and Families in Coping with Covid-19

Written by: Bernadette Lettner, Registered Nurse

Since November, 2020, the Covid Resource Team (CRT) has been working to support people who test positive for Covid-19. Comprised of nurses, health promoters, social workers, case managers, counsellors, project coordinators, drivers and the infectious disease team at Michael Garron Hospital, the CRT links hospital-based testing to community agencies and supports. Through these links, we can connect with and support people by offering practical resources to manage the unequal burden of Covid-19 infection in Toronto.

The integrated web of people and resources that hold up, and hold together, communities is very apparent when doing this work. Relationships and resources are strained by the physical separation that happens when people must remain at home in isolation or quarantine, but the many places we turn to for help, comfort and care are also revealed.

Through regular phone calls, the CRT provides symptom management, personal protective equipment and grocery deliveries, financial support, counselling, settlement services and a wide array of other services. To be able to do this work, the CRT has developed relationships with many community organizations, including East End Community Health Centre, The Neighbourhood Organization, Health Access Thorncliffe Park, Scarborough Centre for Healthy Communities, and the East Effort Fund. Between November 2, 2020 and March 31, 2021, over 2,695 people were helped and new referrals are accepted daily.

We have seen first-hand that high vaccination rates have an impact. Many long term care, shelter, and group home residents in east Toronto have received at least a first dose of vaccine and have avoided the outbreak conditions seen in so many areas of the city. Other areas have seen the emergence of pop-up vaccine clinics, specifically designed to bring vaccination to areas with the highest rates of community transmission. Every single vaccination makes an impact – perhaps the biggest impact we can make right now.

Throughout the vaccine rollout, we will continue to support people who contract Covid-19, and ensure that we move towards health together. We started with a small team and a big vision, and it has been incredible to see how the CRT has grown and evolved. The connection and mutual support that has developed as a result of listening and responding to community needs will remain strong, and the ripples of these care-filled connections will carry us through this wave and beyond.

COVID-19 and the Mental Health Pandemic

Written by: Stephen Fenn, Social Worker

Since the beginning of the pandemic, almost all of us have been focusing on our physical health and keeping ourselves safe. This should be our focus as we navigate these difficult times of surges, variants and vaccine rollout. However, most of us have also experienced another pandemic, one of mental health.

Mental health practitioners around the world have been sounding the alarm over the increase in mental health challenges many have faced throughout this turbulent time. While we may still be able to access support for our physical health during the pandemic, mental health support, which was difficult to find pre-pandemic, has become even more challenging to secure.

The burden of mental health has also disproportionately affected those most vulnerable as communities living with unaffordable housing found this even harder as they lost income. People with chronic conditions, more vulnerable to becoming sick, were faced with increased difficulty accessing community supports or treatment, and increased isolation due the higher risk associated with leaving home. And for those who face discrimination and unequal access to society, hostility and insensitivity increased. The support mechanisms we used before, such as seeing family and friends, became impossible due to the associated risks.

The challenges of this pandemic will continue. Although a focus has been on bringing ourselves back to “normal,” we also need to account for the mental health challenges and trauma many have experienced. Many of us don’t know how to seek support and how to take this first step. But support is available and, although we have faced the last year alone, we don’t have to do this moving forward. SRCHC and many other agencies have mental health supports available. While our goal this past year has been on protecting our physical health, a focus on mental health is just as important and worthy.

According to the World Health Organization, “There is no health without mental health.”

COVID-19 Pandemic Guidelines for Mental Health Support of Racialized Women At Risk of Gender Based Violence

COVID19 Guidelines for mental health support of racialized women at risk of Gender Based Violence – Synthesis Report

Multidisciplinary Team: Nazilla Khanlou (Principal Investigator) and Dr. Andrew Ssawe (Principal Knowledge User) with Co-Investigators:  Yvonne Bohr, Jennifer Connolly, Iris Epstein, Thumeka Mgwigwi, Soheila Pashang, and Collaborators: Farah Ahmad, Negar Alamdar and Sajedeh Zahraei

Project Coordinator: Luz Maria Vazquez

Funding Source:  Canadian Institutes of Health Research (CIHR) Operating Grant: Knowledge Synthesis: COVID-19 in Mental Health & Substance Use

The COVID-19 pandemic has exacerbated gender-based violence against women and girls.  Statistics from across the world show a drastic increase in violence against women and girls during the current COVID-19 pandemic.  The United Nations has referred to this significant social and public health issue as the “shadow pandemic”. We know that violence against women results in high rates of mortality and morbidity and that is also associated with mental health problems – psychological distress, depression, anxiety disorders, substance use disorders.

The social determinants of health factors place racialized women and girls at an increased disadvantage during the pandemic. Practice and policy must address the structural determinants of the mental health of racialized women at risk of gender-based violence during COVID-19 pandemic.

In Spring of this year we received funding from the Canadian Institutes of Health Research (CIHR) to conduct a rapid knowledge synthesis for our project titled “COVID-19 pandemic guidelines for mental health support of racialized women at risk of gender-based violence.” This was an academic-community collaboration between Principal Investigator Dr. Nazilla Khanlou (York University) and Principal Knowledge User Dr. Andrew Ssawe (South Riverdale Community Health Centre).

Our project has multiple outcomes* that knowledge users can utilize to support trauma informed mental health care program planning, delivery, and evaluation during the COVID19 pandemic’s response and recovery phase.

We present multi-level recommendations and best practices for equity informed mental health promotion and care. These include individual, psychological and situational (micro); institutional, organizational and agency-based (meso); and structural, systemic (macro) levels.  We emphasize an upstream approach to public mental health support, presenting the recommendations from macro to meso to micro levels.

Using information from our project’s tools, decision-makers can assess potential venues to re-direct funding and programming to address inequities in the social determinants of mental health and related health disparities.

* Project Outcomes:

  1. Knowledge Synthesis Report: Click here
  2. Information Brief: Click here
  3. Infographic: Click here
  4. Toolkit: Click here
  5. Policy Brief: Click here

For more information visit:  York University


“Since Covid began, we’ve seen the highest number of overdoses since 2017”: What happens when the opioid epidemic meets a global pandemic?

“Since Covid began, we’ve seen the highest number of overdoses since 2017”: What happens when the opioid epidemic meets a global pandemic? – Jason Altenberg, April 14, 2020

I’ve worked at the South Riverdale Community Health Centre for 15 years, and I just took over as CEO in January. It’s a heck of a time to be starting a new job. We offer health services to the city’s most vulnerable people: newcomers to Toronto, people who living in poverty and who use drugs, and the homeless community. More than half of the people who come to us are low-income, and two-thirds are living with mental illness. On an average week, more than 500 people come here for communal meals.

We’ve also been in a sustained crisis for years: our job is to keep people alive through the opioid epidemic. We provide a safe place where people can use drugs under the supervision of nurses and doctors, where they can access medical advice free from judgment, and where they can access naloxone kits, safe disposal supplies and clean syringes and pipes, and that work keeps them alive. We usual deliver harm-reduction supplies, too, in unmarked cars to people’s homes or coffee shops anywhere from Lake Ontario to Eglinton Avenue East, and from Victoria Park Avenue to the Don Valley Parkway. I have a long history with my staff: some of us have been through other outbreaks together, like H1N1 and SARS. I don’t know that I’ve had time to absorb it yet. We’re just trying to keep moving.

We’ve been watching Covid-19 since January, and making plans with an infectious disease specialist, focusing on implementing measures that would help keep people out of the hospitals. We have a respiratory therapist who is running a primary-care asthma program and getting people access to nicotine replacements. Our diabetes program is still running, because those are people at high risk for Covid-19 complications. We’re doing insulin initiation and adjustment over phone and video, and we’re still doing wound care in-person. For homeless people who don’t have phones, we’re accepting in-person drop-ins at the health centre for medical and social support. And we’re doing everything we can to keep our safe-consumption sites fully operational. It’s our job to keep people who are using drugs alive and ensure they don’t get Covid-19. Somehow we have to do both at the same time.

We run two safe consumption sites: one in Moss Park and the other in South Riverdale. Along with supervised injection services, we provide harm-reduction supplies like naloxone kits, drop-in nurse practitioner services and a hepatitis C clinic. We’ve had to cut down our hours, and we’re seeing people more slowly because of social-distancing rules. Before, these spaces were built by our members and decorated with paintings by the community. Two weeks ago, we turned the sites into scenes from a science-fiction movie. We had to. We separated the booths and taped up plastic tarps everywhere, to keep people safe and distant from one another. Our staff are wearing full protective gear. It looks like a field hospital. People are freaked out and distrustful: these are people who have been criminalized and stigmatized for years, so when the services start to feel like policing, that’s hard for them to take. And it’s hard for our staff, too. Some people are grateful, and thank us for giving out cloth masks and bagged meals. Others have told us it’s weird, that the space doesn’t feel like theirs anymore.

Every day, we approach each client in scrubs and masks to take their temperature. We have screeners asking questions at the door now, and every time someone shows up, we have to ask whether they’ve travelled out of the country, even if we asked them the same question the day before, and even though it’s utterly unlikely based on their life circumstances. To the clients, it feels like discrimination. To be able to socially distance is a privilege, but I know people are trying to respect the rules as much as their circumstances allow. One man is camping near a pavilion on Lakeshore Boulevard, and set himself up just outside the caution tape so he wouldn’t violate the bylaw, instead of setting up underneath the shelter. Another man tested positive for the virus and refused to go back to his shelter so he wouldn’t infect his friends; he slept on the streets instead.

The spaces that create any kind of normalcy in our clients’ lives have disappeared overnight. The libraries are closed, the drop-in centres are closed. The spaces they would go for a cup of coffee or a sandwich or to use the bathroom are closed. The things that would allow them some semblance of basic dignity are just not available. People are more desperate. People are hungry. We’ve seen more fights breaking out between clients. Two weeks after those closures, on March 31, the city had the highest number of opioid overdose responses since the crisis started in 2017. I wasn’t surprised at all. This is the new normal. The needs in the community are the same, but resources are scarcer. Drugs are harder to find right now, and they’re more expensive. Some of our clients are buying from new dealers, and the potency is incredibly unreliable. Just last week, there was a strange overdose warning: four people ended up in the hospital with opiate overdoses after using what they thought was crack cocaine. That’s very unusual. Covid-19 hasn’t hit the homeless and street-involved community with full force yet; this is not a community that travels, so it will emerge later. When it does, it will hit hard.

We’ve had to explain to people that we’re making these changes—adjusting and reducing our hours, changing our spaces—because we love them and we want them to be here in three months. We know that if we could offer people a predictable safe supply, overdoses would go down dramatically, overnight. We’re hoping to get funding to offer an individualized safe-supply care plan for anyone who is eligible. That may involve picking up a prescription for high-potency hydromorphone at a pharmacy on a daily basis, or supervision by a consumption site. On the Downtown Eastside in Vancouver, they’re moving on this. It’s a solution that makes self-isolation possible. We’ve seen the system respond with incredible speed, recognizing where the rules we have in place don’t make sense. There has been resistance, but innovation always has resistors. We have a proposal in to Health Canada right now, and I’m optimistic.

I’m worried about the compounded nature of the epidemic and the pandemic. I worry that we will lose people that we otherwise wouldn’t have. It’s in my head all the time. We’ve been hearing about other deaths in the community, people dying in stairwells who would normally be somewhere else, like at one of the city’s nine safe consumption sites. The horrible thing we’re trying to reconcile is that if we don’t continue to re-engineer how we’re offering our services, we could spread Covid-19 through the community, which would be horrific. We’re doing this crazy balancing act. As we pivot to prevent this virus, the social isolation and distancing are creating other harms. They’re necessary and they’re predictable. They’re also brutal, and we need to be ready to respond to them, too.

As I go to work every day, I stop at the drug user’s memorial project. It’s a monument on Queen Street East, an eight-foot copper flame, where people come to honour the memory of their friends who have died. I start every day there, stopping to see what someone has put in front of the memorial the night before. And now, every day, I have a lump in my throat about how many people we are going to lose because we aren’t able to be there for them.