As pandemic-related stress and anxiety continues to take its toll, some doctors say what's needed is a system that will address the long-term psychological impact on Canadians. 

Mental health organizations across the country are launching online self-assessment tools, developing virtual consults and increasing the capabilities of crisis lines to address the increased demand for psychological support.

While she applauds those initiatives, Margaret Eaton, the head of the Canadian Mental Health Association, said a long-term plan for providing continuing support is necessary.

In an online address earlier this month to the parliamentary committee on health, Eaton raised concerns about an "echo pandemic" of mental health woes.

"Across the country, the phone lines have just been ringing off the hook," she said of the association that provides services in all provinces and Yukon, currently online and by phone.

An Angus Reid report published this week found half of all people surveyed said their mental health has worsened over the past month a half.

Eaton said it can take up to two years for someone who's experienced a tragedy to resume their normal life, and bolstering existing community programs that provide cognitive behavioural therapy, for example, could be one way to meet the long-term need for services.

"What we're looking at right now is scaling up programs that can be done online and on the phone," she said of the immediate need, noting one such program managed by the association, called BounceBack, provides online support for adults and youth over 15 to deal with mild to moderate depression, anxiety and stress. She said it has recently received more funding in British Columbia and Manitoba.

"This is where we're hoping the federal government will fill some gaps. What we're seeing is that some of the smaller provinces don't have the deep pockets to be investing in mental health."

She said Nova Scotians in particular are facing a "perfect storm" for post-traumatic stress disorder, as the province reels from a horrific shooting rampage while also struggling with ongoing anxiety over COVID-19. Residents are now also dealing with the recent crash of a military helicopter off the coast of Greece, operating from a Halifax-based frigate. Six crew members were aboard.

Calls to the association's crisis lines in Nova Scotia jumped as high as 700 calls a day from an average of 25 a day after stay-at-home measures were introduced last month, Eaton said.

The Nova Scotia Health Authority has launched a free service set up by the Association of Psychologists of Nova Scotia for people to talk about their distress over the recent shooting that left 22 people dead.

Eaton said the province will need federal support for long-term mental health care for people who can't even grieve together due to restrictions on gatherings and could suffer mentally for years.

Federal Health Minister Patty Hajdu has announced an online resource called Wellness Together Canada, which includes a self-assessment tool to rate the level of distress. It provides videos on mindfulness and a limited number of live phone sessions offering peer support from front-line workers and other professionals.

The government also beefed up funding for three crisis lines, including those dedicated to youth and Indigenous Peoples.

What makes cognitive behavioural therapy programs and community programs different from these initiatives is that they can provide people with ongoing coping strategies for specific issues related to anxiety and depression, said Eaton, whose association was founded in 1918 to help traumatized soldiers returning home after the First World War.

Residents in communities struck by disasters such as the May 2016 wildfires in Fort McMurray, Alta., have needed ongoing support and long-term resources, Eaton said.

One study, out of the University of Alberta, published in the journal Frontiers in Psychiatry, surveyed 3,252 students in Grades 7 to 12 a year and a half after the fires. It found 37 per cent showed signs of PTSD and about 30 per cent had probable depression.

Rebecca Canning of Fort McMurray said the pandemic has brought up some of the trauma she endured after escaping wildfires in that community with her husband, Brent, and their three sons.

"It took a good two years to even be able to talk about that," Canning said of fires that forced nearly 90,000 people to flee and reduced 2,400 homes and buildings to rubble.

"We drove past the fire on both sides of us," she recalled. "Everything was up in flames."

Her main concern was her eldest son Dylan, who had already been dealing with severe anxiety and panic disorder and whose grandfather, "his best friend," had died of colon cancer two weeks earlier.

"The first couple of weeks he cried himself to sleep every night, especially when we thought our home was gone," Canning said.

Dylan received support from a pediatrician as well as a school counsellor and is in the process of getting more help. Canning said she learned to manage anxiety through cognitive behaviour therapy -- which teaches clients ways to change their thoughts and attitudes to the emotions that cause them difficulty -- and mindfulness after seeing a therapist and a psychologist.

But she said the recent massacre in and around the town of Portapique, N.S., has added to her pandemic-related anxiety because she and her husband are from Nova Scotia.

"One of the areas where the shootings took place, I have family there. I feel like my brain has been totally on overdrive," she said. "Your body just holds on to the trauma."

As the traumas related to the pandemic are expected to last years, doctors with the Centre for Addiction and Mental Health say there's an urgent need for a model that offers free and readily accessible mental health care for Canadians.

Dr. Paul Kurdyak, a psychiatrist with the Centre for Addiction and Mental Health in Toronto, said more publicly funded psychotherapy is needed because most people can't afford the high cost of treatment.

Kurdyak was lead author of a study co-authored by the Institute for Clinical Evaluative Sciences and published last month in the online journal CMAJ Open. It showed that of nearly 13,000 primary-care doctors in Ontario, only 3.2 per cent were providing publicly paid psychotherapy in 2015-2016.

The findings of a 2 1/2-year pilot project by CAMH and three other psychiatric hospitals in Ontario, based on the Improving Access to Psychological Therapies program introduced in England in 2008, could change the way mental health services are provided, he said.

"We're in the process of figuring out how to expand (the project) across the province now and we hope to be able to provide the same kinds of outcomes to make the case for the rest of the country," Kurdyak said, noting health care is a provincial jurisdiction.

The program funded by the National Health Service in England involves training undergraduates to care for people suffering from anxiety disorders and depression, Kurdyak said, adding patients have shown a 50 per cent recovery rate.

Dr. Juveria Zaheer, a psychiatrist in the emergency department of Centre for Addiction and Mental Health and co-author of the CMAJ Open study, said isolation and job loss related to the pandemic are so widespread that options beyond online resources and the classic route of getting a doctor's referral for mental health treatment are needed.

"Right now what I see in the emergency department immediately is an increase in health-service needs for very vulnerable Canadians. For example, people who are precariously housed, young people and the elderly."

The experience from the SARS pandemic in 2003, when Toronto was Canada's epicentre of the crisis, showed that while health care providers fared well initially they experienced mental health distress two years later, Zaheer said.

This report by The Canadian Press was first published May 2, 2020.