Mental health services dealing with rising calls for help, as staff are leaving

Ontarians are reaching out for mental health help in record numbers, leaving community agencies stretched thin as they struggle with staff retention and ballooning wait lists.

Demand for services, from treatment to early psychosis intervention to housing supports, has nearly doubled from pre-pandemic levels in Toronto, while crisis calls for mental health and addiction supports in Peel region reached a record in January, according to the Canadian Mental Health Association. The CMHA is the oldest and largest community mental health organization in the country with local branches across Ontario.

Staff have been working around the clock to answer the phones and manage people’s mental health needs. But Michael Anhorn, the CEO of CMHA Toronto, said the unprecedented demand has been difficult to meet.

“The really honest answer is we’re not able to right now,” Anhorn said. Part of the challenge, he said, is the inability to retain staff at this point in the pandemic — a trend that is emerging across the community mental health sector.

“It’s a combination of salary levels in community mental health and addictions, and also the pressures of the pandemic and people realizing they want to do different work than they’ve done before,” Anhorn said.

While the sector struggles with a high turnover of staff, demand for mental health support in the province during COVID-19 has never been higher. A poll conducted in January by CMHA Ontario found one in four Ontarians have accessed mental health help — the most at any point during the pandemic — and 43 per cent said they’ve found it difficult to get the help they need.

As for why more people are calling for help, staff say it’s driven by a variety of factors. Abhilash Vanethu, program manager at CMHA’s 24/7 crisis services in Peel, said some of it is driven by the closure of in-person programs that people previously relied on for help.

One example, he said, is the Recovery West program in Brampton, a drop-in program that once offered social outings like movie nights and peer support. As of February, Recovery West is still only running virtually.

Staff have also observed an increased volume in the overall calls from families of people in distress who don’t know where to point their loved ones for help, or from people looking for addiction support. In Peel, CMHA is receiving an average of 130 crisis calls a day, which is about 45 to 50 calls per staff member on a given shift.

“It’s pretty heavy, and we try our best to provide support,” Vanethu said.

In Toronto, Anhorn said staff have also noticed the complexity of people seeking mental health support is higher, meaning they have to spend more time with each individual to make sure they’re getting proper help, which increases the backlog of cases overall. On average, people as of December are waiting 288 days for support, an increase of more than a month from wait times in March.

There are 552 people on CMHA Toronto’s centralized wait list, he added, and the organization only has capacity to serve 330 people at any given time.

“What we’re finding is people who are coming in with symptoms of mental illness, their symptoms are worse than they were before, and we believe that’s likely because of the stress of the pandemic,” Anhorn said, adding it’s a signal that the well-being of the general population is on a downward slope.

In Peel, data shows the volume of crisis calls has mirrored the waves of COVID, said CMHA Peel CEO David Smith. The increase in cases is followed by an increase in calls for support. Part of it, he said, is driven by people reluctant to visit hospital emergency departments for fear of getting sick.

But reopening also brings its own difficulties, Anhorn said, as Toronto is noticing an increase in people reaching out for help again now that some COVID-19 restrictions have been lifted following the Omicron wave.

Staffing retention remains one of the bigger challenges for the sector. In Toronto, Anhorn said the association has had a “very large turnover” in nursing, mainly due to low wages compared to what hospitals can offer, which is 30 per cent more on average. This, he said, despite CMHA’s best efforts to provide more health benefits for workers.

He added the turnover is also partly driven by public sector wage increases being capped at one per cent due to Bill 124 — a law in Ontario long opposed by nurses that also applies to front-line mental health workers.

Shortages are also affecting the crisis support program in Peel, Vanethu said, where hiring for vacancies has been a challenge due to a lower number of applicants than usual. “Pre-pandemic it was different,” he said. “If a vacancy opened, we didn’t have this delay in filing it and we used to get qualified candidates a lot.”

To mitigate this, Vanethu said his team has prioritized keeping the crisis lines open 24 hours in the day, and have borrowed staff from Dufferin and Caledon units to cover a wider geographical area. Still, there are days where staff can’t visit each caller, forcing delays in when people get support.

But amid these struggles, Anhorn said he’s also noticed a profound resilience in staff who are continuing to support people in crisis, despite the shortages and the difficulties brought upon by COVID-19.

“They’ve been managing their own response and safety in the pandemic, and still supporting their clients,” he said. “I just have deep respect that they’ve done both those things.”