COVID-19's effect on mental health in the regions, through the eyes of a small-town Gasp psychologist

From where Dr. Bernard Nadeau sits which these days is mostly in his home office in New Carlisle, on the Baie des Chaleurseach wave of the COVID-19 pandemic has brought its own trials and tribulations.

Nadeau is a psychologist who mostly works with health-care workers, teachers,other people in the education system, and kids.

Last spring, he spent a lot of time advising overburdened parents on managing the stresses of having children at home, and helpingthose kidswith theirassociated difficulties with being home from school.

In the autumn, the focus was on helping local nurses, orderlies and other health workers deal with overwork, anxiety and stress stemming from a second wave that battered the region hard for a few weeks in November and December it reported one of Canada's highest per capita infection rates.

As the virus has receded in this winter, what's jumped out at him is what's happening with teens and pre-teens in the Gasp region and elsewhere in Quebec's regions thanks to the miracle of video conferencing, he's helping a far-flung array of clients from Indigenous communities in New Brunswick, to Sept-les and points north.

What he's seeing is not good.

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The pandemic has pushed young people apart at a point in life where social networks are the most important.

"In the Gaspsie we like to talk about the ocean a lot, and what I would say is this: we're still in the storm. And when you're on the water, the storm affects everybody, we're all in it together. But not everyone has the same boat," Nadeau said.

The situation with younger patients is "terrible, the young people are having a tough time."

The COVID-19 pandemic's overall effect on Quebecers' mental health has been well documented. As a society, we are more anxiousand depressed and stressed out.

Not everyone has been affected equallyand the resources in place to help people aren't evenly distributed.

Living outside major metropolitan areas, as Nadeau has done for most of his career, doesn't necessarily equate to feelings of isolation "I have never felt cut off from the world, quite the opposite," hesaid but there are particularities.

In his decades of practice, Nadeau has witnessed the extraordinary resiliency that humans can muster in trying circumstances, and from that standpoint the pandemic is not unlike any other traumatic event. Some will emerge unscathed, others less so, often because the stress and anxiety will dredge uptraumafrom the past,he said.

COVID-19's heavy impact on small towns

But in communities where social networks are small, and where familial and friendship links are strong, social isolation hits hard.The usual bonds become stretched, and support systems crumble.

Ultimately, he said, "it's all about the outlets at your disposal."

That's the rub: winter in the Gasp, and other regions, is about enjoying the outdoors, yes, but also about hunkering down with friends and family, and taking part in organized sports and cultural escapes like amateur theatre or choirs.

"It was dead in the winter here before COVID, you can imagine how it is now," Nadeau said.

Coping with the added mental health burden of a health emergency requires distractions, and while it's easier for a rural dweller to clear their head with a long walk in the woods or by the seashore, there are fewer substitutes for the other traditional pursuits.

And that's hardest on young people.

"At that age, school is basically a pretext to see your friends," he said. "And so motivation starts to dip, and if you're studying remotely it ends up being more solitary."

The strain is particularly acute on kids who have learning difficulties and aren't able to benefit from peer support and the type of positive reinforcementthat can come from in-person classes.

Even in cases where kids are back at schoolwhether it's socially distanced or on alternating daysthe extracurricular activities have been pared to a strict minimum.

"That's how self-esteem is built, it's the stage at which you're constructing an identity," Nadeau said.

AUniversitdeSherbrooke study published this week sheds more light on exactly how bad the the situation is.

The study, led by Dr. Mlissa Gnreux, a former public health director for the Estrie region who now teaches at the university and advises the regional health authority, involves a poll of 16,000 high school, CEGEP and university students at 47 institutions across the Eastern Townships, the Mauricie and Centre-du-Qubec regions.

Survey resultsare 'very, very disturbing'

Two-thirds of respondents were high-school age, the rest were 18 to 25.

While the distress seems most acute in the older segment, the poll revealed three main causes at play across all age groups: the absence of extracurricular activity, sharply increased time spent staring at a screen and remote learning.

Nearly half the respondents reported symptoms associated with generalized anxiety disorder or depression, like insomnia, loss of appetite, constant sadness and thoughts of self-harm. And only one in five who presented "probable depression or anxiety" said they felt comfortable seeking help from an adult.

"Most of [the distress] might be attributable to all the disruptions and stress we have experienced since the beginning of the pandemic," Gnreux told CBC's Quebec AM.

The results, she continued, are "very, very disturbing."

She found particularly worrisome findings that showed nearly half of respondents expressed a preference for "self-management" and a third expressed worry about the harm to their image if their peers found out they were seeking professional help.

There is a persistent stigma attached to questions of mental health, according to Dr. Georgia Vrakas, a psychologist who teaches psychoeducation at the Universit du Qubec Trois-Rivires and who has worked on mental health promotion and prevention among youth.

"Mental health has always been taboo people who don't know any better think 'ah, it's not that serious, pull yourself together.' There's a lot of education needed on the basics," Vrakas said. "People are still scared of being judged."

There might be a tendency to think judgment can be especially harsh in small, tightly-knit places where a person might run across someone they know in the waiting room.

Nadeau suggests the reality is more nuanced, that the appropriate frame isn't the size of the community so much as it's the solidity ofsocial networks and support systems (which he allows have been enfeebled in his region because of isolation and distancing guidelines).

Also, he said, it's a mistake to view regions as monolithic.

"There are several Gaspsies, not just one. Ste-Anne-des-Monts is different from Gasp, which is different from Chandler and Bonaventure," he said.

A funding gapin the regions

There is one constant, however: publicly-funded mental health resources are thin across the province, sometimes too meagre to be of much help.

In the Abitibi, for example, regional health officials are still trying to fill 10 open positions for psychologists and therapists. Even in urgent cases, it can take between six weeks and three months to secure an appointment.

Those who can turn to the private sector may be able to shorten that wait somewhat, but demand is skyrocketing everywhere.

"I've had to stop taking on new patientsand it's hard because I know people need help," said Vrakas. "It's a particularly tough time for a lot of people and the government needs to step up."

A coalition of mental health advocates from eastern Quebec recently urged Lionel Carmant, the junior health minister who is working to create a new post-pandemic mental health framework, to invest more heavily in the regions.

Carmant told Radio-Canada earlier this month that his focus remains squarely on improving access.

"That's really where the problem is," he said.

It's particularly acute for the anglophone community outside Montreal, said Nadeau, who often treats patients in English and calls the situation "a tragedy."

As is the case with many other government services, mental health resources are a challenge to findfor small anglophone communities in overwhelmingly francophone regions.

Technology to the rescue?

But the pandemic has shown technology may be able to help bridge some of the gaps.

Nadeau has spent his career with the firm belief that in-person sessions are absolutely essential to the therapist-patient relationship.

Having to suddenly switch to online sessions although he does still occasionally see patients in his officehas prompted a rethink.

It turns out it's easier for some of his clients to fit in an appointment if it doesn't require driving to his office. And, he said, there is an added element of reassurance and confidentiality to someone, alone in a room, speaking to a therapist in their home environment.

The more practical fact is Nadeau can travel to Baie Comeau or spend the day in Listuguj, as he did this week, without having to get into his car.

"I've been able to expand my activities and areas of interest," he said. "I'll probably continue to do it once the restrictions have lifted. I'd imagine I won't be the only one."

This story is part of a special CBC Quebec project Out of the Dark: Real Talk on Mental Health. If you are having a hard time coping, here are some resources that could help.

If you are in crisis or know someone who is, here is where to get help:

• Canada Suicide Prevention Service: 1-833-456-4566 (Phone) | 45645 (Text, 4 p.m. to midnight ET only) crisisservicescanada.ca

• In Quebec (French): Association qubcoise de prvention du suicide: 1-866-APPELLE (1-866-277-3553)

• Kids Help Phone: 1-800-668-6868 (Phone), Live Chat counselling at www.kidshelpphone.ca

Canadian Association for Suicide Prevention: Find a 24-hour crisis centre