Mental Health Care NowThe FactsDr. Rohit MohindraDr. Leigh SolomonDr. David Koczerginski Dr. Stephanie KleinDr. Jerome Perera
Mental Health Care in a COVID- 19 World: Perspectives from the Doctors of North York
Mental health issues in a COVID-19 world are looming large. North York General Hospital’s team of mental health professionals, which includes social workers, nursing staff, child and youth workers, recreational therapists, occupational therapists, psychologists, peer support workers, emergency physicians, mental health crisis nursing team, primary care physicians, psychiatrists, and support staff, have served the mental health needs of our community for generations. During these particularly uncertain times, we asked a few of our highly skilled doctors of North York General to address some important questions as it relates to mental health care and share their insights.
Mental Health Issues by the Facts
| Mental illness is a leading cause of disability in Canada |
| 1 in 5 Canadian experience a mental illness or addiction problem in any given year |
| Approximately 1 in 5 children and youth in Ontario have a mental health challenge |
| Death by suicide is the 2nd leading cause of death between 15 and 34 years of age, after accidents |
| About 4,000 Canadians per year die by suicide – an average of almost 11 suicides a day |
| By the time Canadians reach 40 years of age, 1 in 2 have-or have had a mental illness |
| 70% of mental health problems have their onset during childhood or adolescence |
| 35% of Ontario high-school students indicate a moderate-to-serious level of psychological distress (symptoms of anxiety and depression). 14% indicate a serious level of psychological distress |
| Up to 30% of Ontarians aged 65+ has a mental health issue, and there is growing evidence that the incidence of mental illnesses is increasing in older adults |
Canadian Mental Health Association
Statistics Canada
Dr. Rohit Mohindra — Emergency Physician
Rohit Mohindra can often be found wearing his blue scrubs as an emergency physician at North York General Hospital. If this wasn’t enough, he is also the department research lead and is interested in resuscitation, knowledge translation and community emergency medicine care. He has many affiliations: the Schwartz-Reisman Research Institute, Li Ka Shing Knowledge Institute, and Ryerson University’s Faculty of Engineering and Architectural Science. This is one busy doctor!
Q: As an emergency doctor during COVID-19, when do you suggest patients come into the Charlotte & Lewis Steinberg Emergency?
A: I would advise visiting the Emergency Department (ED) at North York General for severe mental health issues. For example, if you (or someone you know) are having thoughts about hurting yourself or those around you. For physical symptoms, we encourage you to seek medical attention if you or a loved one are experiencing trouble breathing, pain in your chest (especially if it gets worse with exertion and better with rest), vomiting that doesn’t allow you to keep anything down, a fever that is not going away or anything that seems severe or worrisome.
I’d emphasize that sometimes it’s hard to know what’s serious. Reach out to your primary care/family physician or call Telehealth (1-866-797-0000) or visit a walk-in clinic. They can help guide you and can suggest if an ED visit is needed. Finally, our Emergency Department is always here to help, 24/7. Our dedicated mental health crisis nursing team is one of our most valuable services and they can help quickly triage patients. Avoiding visiting the hospital for potentially serious issues can make it harder to treat these problems and may put your health at risk.
Q: As an emergency doctor how and when would you do a consult with a psychiatrist relative to mental health issues during this Pandemic?
A: The psychiatrist inpatient team helps to stabilize patients with severe symptoms and who are at a risk to themselves or others. Consultations for these types of patients are done from the Emergency Department (ED) after a discussion with the psychiatry team. Our crisis nursing team in the Emergency Room is one of our most valuable services. They can help quickly triage patients and provide patients who are safe for discharge with outpatient follow up and access to resources from home. Finally, our outpatient Adult Mental Health Outpatient referral service allows us to get patients the help they need, but in an outpatient setting. These referrals are usually done by consultation forms.
Q: As an emergency physician during this time of COVID-19 and extreme uncertainty, are there different types of patient issues you are seeing in Emergency that you hadn’t seen pre-COVID-19 relative to mental health?
A: Yes there are.
Q: If yes, can you describe and what type of general advice, are you providing patients?
A: First, our patients with ongoing mental health issues have more trouble accessing the resources they have used previously to manage at home. Additionally, the social supports, like family or friends, are also much more restricted, so early warning signs of exacerbations are being missed. As a result, our patients who were previously living and coping well at home have had to come to the hospital. These patients must be managed carefully based on their diagnosis, social context and individual needs. Our colleagues in psychiatry and crisis have done an amazing job at managing this during the pandemic.
The pandemic has added job insecurity, family stress or just general uncertainty about the coming future and has caused a lot of people in the community we serve to have higher levels of anxiety and stress. Patients are presenting with different manifestations of this stress in terms of their symptoms. Although specific symptoms can require unique approaches, the general advice I provide is below.
Q: People are fearful of a second wave; how might you suggest they manage their fear and anxiety?
A: Sometimes it’s really the basics: eat fresh, healthy food, get good sleep, get outside and do physical activity (walking is all you need). Stay connected with the people that are important to you and make sure to make time in your schedule for relaxation and fun. And even though it seems counterintuitive, limiting screen time, especially in the evening, can be very beneficial.
Q: What sparked your interest in being an emergency doctor?
A: I was drawn to the small moments where we get to connect with patients, to let them know that we are there for them, and that they are supported in what is typically a very stressful situation. I also enjoy the variety of presentations and patients that we see every day, from the one day old to the 100-year-old, I try my best to help each one the best I can!
Q: Why did you choose to practice at North York General Hospital (NYGH)?
A: NYGH combines the best of a community patient driven hospital model, and a commitment to innovation, academics, and medical education. Everyone here works so well as a team and everyone looks forward to making things better. As well, I have a unique opportunity to develop and lead an emergency medicine research program from the ground-up, which is something that I am excited to be a part of.
Q: How would you describe the need for a Mental Health Emergency Services Unit at North York General Hospital?
A: This would be something that would be of such great value to our patients. Emergency Department visits are stressful, and the current layout of the department isn’t always conducive to providing safe, private, and compassionate care. Additionally, we see a large volume of patients with mental health emergencies, with increasing numbers every year. Our current department is not equipped for this sustained volume of patient visits.
Q: What would be your vision or the Mental Health Emergency Services Unit and patients requiring mental health care at NYGH?
A: Patients with acute mental health issues need a calm, quiet space where they can have private conversations with our emergency and mental health team. As well, these patients may benefit from a dedicated space away from the hustle and bustle of the rest of the department. This would be a place that would be designed to be safe for patients and for health care providers. I picture in my mind a space where patients have a sense of relief from their acute stress/illness when they arrive in the unit.
Q: Final thoughts Dr. Mohindra?
A: COVID-19 has had a significant impact on all our lives, and in ways we may not realize. Take a moment to reflect on the enormous changes we have all faced. Given this significant change, it is totally understandable that many of us are facing mental health issues. This is an opportunity to focus on healthy habits, good social support, and remaining hopeful for the future!
Dr. Leigh Solomon — Psychiatrist, Medical Director, Child and Adolescent Mental Health Unit
Dr. Leigh Solomon is a child and adolescent psychiatrist and the medical director of the child and adolescent mental health unit at NYGH, as well as an assistant professor at the University of Toronto. She is involved in various clinical, administrative and research opportunities at NYGH and U of T. She is intently interested in helping patients improve their quality of life through providing support and guidance as they navigate their mental health and believe through psychiatry, she would be best able to do this.
Q: What should we be aware of in terms of mental health issues in children and adolescents (particularly during this pandemic) and what resources are available at North York General Hospital?
A: Some of the signs that would indicate that a child may be struggling include change in mood, worsening behavior, sleep challenges, decreased appetite, increase in headaches or stomachaches, self-harm and difficulty functioning in the usual manner. If you’re concerned, I suggest initiating a conversation with the child in order to try to understand what they are feeling. If concerns persist for more than a couple of weeks, see the child’s physician who will then decide if a referral to a mental health professional is indicated.
At North York General, we have inpatient, outpatient and day hospital mental health and eating disorder services for children and adolescents provided at the Leslie St. site and at Phillips House. During the pandemic outpatient and day hospital services have mainly been provided virtually but the plan is to gradually return to more in person appointments. The Emergency Department should be accessed if there is significant concern about a child’s safety or level of functioning.
Q: As a psychiatrist what suggestions do you have for people during this period of uncertainty particularly as businesses, institutions (schools and other) are opening (albeit with restrictions).
A: Focus on the present. Try not to look too far into the future. Figure out what makes you feel better and decreases your anxiety… work, hobbies, etc. Maintain routine and structure as much as possible around sleeping, eating, exercise. Stay in touch with friends and family. Maintain safety and take appropriate precautions.
Q: Given your focus on children and adolescents, what advice do you have for parents, and for these younger patients, as they navigate potentially going back into the classroom?
A: Gradually return to normal routines. Connect with friends. Start to reduce screen time. Practise wearing a mask. Listen to the child’s fears and validate, support and empathize. Demonstrate and model healthy coping skills. Modulate your own anxiety while encouraging appropriate caution.
Communication with children and adolescents of all ages is important but the type of discussion varies according to the age, maturity level and personality of the child. For younger children (under 10 years old), it would help to explain how school will look this year and how it will be different from before. For older children, there can be more discussion about the child’s specific concerns.
Q: Do you have any advice for those parents deciding to do virtual learning at home with their children and the stresses that may result from this choice?
A: Some necessary conditions are the ability to supervise, having reliable technology and a child who can adapt to a virtual style of learning. If you plan to have your child learn virtually at home, I suggest a designated area and designated times, where possible. There are many challenges, including how to motivate the child and how to limit distractions. Try to have reasonable expectations and these may need to be adjusted over time. Parents need to manage their own anxiety about their child’s education and not transmit the anxiety to the child.
Q: Do you have any other advice for children and adolescents in coping with the anxiety of COVID-19?
A: Try to remember that although there is a lot of uncertainty, we can trust the people in charge and life will return to a more normal state at some point.
Q: What are the key issues children and adolescents have been experiencing relative to their mental health during COVID-19 and what general advice do you have?
A: Children and adolescents have struggled with isolation from their peers and their extended family, with lack of structure in their lives, with being confined for long periods of time at home, sometimes in small spaces, and with the absence of extracurricular activities in their lives. Overuse of screens was already a challenge but has now gotten much worse. Many children have been exposed to more conflict at home with increased potential for experiencing and/or witnessing violence. There has been an increase in depression, anxiety and behaviour disorders.
Q: Parents and their families may be fearful of a second wave – how might you suggest they manage their fear and anxiety and how can parents counsel and support their children?
A: Parents must try to manage their own anxiety in order to best support their child. Be aware of signs of increased anxiety such as sleep disturbance, low appetite, increase in somatic complaints, low mood, self harm and increased irritability and arguing. Initiate conversation and reassure. Seek professional help if difficulties persist.
Q: When do I seek a professional help for my children if I have concerns about their mental health?
A: If there are changes in mood, behavior, sleep or level of engagement with friends or family, and such changes persist for more than two weeks, and are identified in more than one setting (e.g. home and school), then I would suggest discussing concerns with the child’s family physician. He/she will then decide if a referral to a mental health professional is indicated.
Q: How are children and adolescents managing with mental health assessments and therapy via virtual care?
In general, the younger the child, the more difficult it is to deliver virtual mental health care.
Q: What sparked your interest in mental health and psychiatry?
A: When choosing a specialty after medical school, I felt I wanted to make a significant impact on patient’s quality of life. I believed that psychiatry was the medical specialty that would best allow me to do that.
Q: Why did you choose to work at North York General Hospital?
A: I did an elective at NYGH when I was in medical school and loved the experience. When it came time to choose a place to work after residency, I looked to NYGH because I wanted to work in a community hospital with both clinical and academic expertise.
Dr. David Koczerginski — Chief of Psychiatry and Medical Director of Mental Health
Dr. Koczerginski had spent greater than 20 years as Chief of Psychiatry in two GTA hospitals before joining NYGH. He is excited to work with exceptional NYGH colleagues in furthering a passion for the growth and development of health systems in support of patients and families facing challenges with mental illness and addiction. For Dr. K, as he is commonly known, coming to North York General was like coming home, as he spent many years of his youth growing up in a neighborhood not far from the hospital.
Q: Can you elaborate on the nature and importance of inter-professional mental health care at North York General Hospital?
A: In all clinical areas, from working in the Emergency Department, inpatient units, our day hospital programs and our outpatient ambulatory programs with specialty focus on general adult, children and adolescents, and seniors’ mental health, all of them rely on inter-professional care. Psychiatrists are one aspect of the care, but our patients and families would not receive the robust evidenced-based care without the entire team.
This includes social workers, nursing staff, child and youth workers, recreational therapists, occupational therapists, psychologists, peer support workers, emergency physicians, and primary care physicians. They all bring varied skill sets with a different perspective which can be applied to individuals who are struggling with emotional and behavioural problems associated with mental illness. As psychiatrists, we could not do the work we do at North York General without the clinical involvement, and very collegial team interactions with our professional colleagues from all disciplines.
Q: As the head of psychiatry at North York General Hospital, what do you see as the large societal mental health issues Canadians have faced with COVID-19?
A: From a societal perspective, I believe the biggest issue has been the unknown. There has been tremendous unpredictability. I think all of us tend to be creatures of habit with predictability on a day-to-day, week-to-week, month-to-month basis, much of that has gone out the window.
We have had to improvise very rapidly in areas related to work, socialization and family care. There has also been a lot of mixed messages regarding the pandemic across the world, across our country and across our city. That unpredictability has generated anxiety, apprehension and fear. I think we have all experienced some of this. The level of anxiety has differed depending who you are and on your life circumstances. For example, if you are immune-compromised, COVID-19 will be of bigger concern to you, if you have elderly people living with you this would make you more concerned, or if you are employed by a business that is closed during the pandemic and you cannot pay your rent, your fear and anxiety will be understandably different.
There are large generic societal fears and then there are personal stresses and fears depending on your life circumstances, this will all vary from person-to-person.
Q: What over-arching advice do you have for the community as we head into the Fall?
A: One suggestion is to paradoxically ensure that we stay connected to each other during this unusual time of social distancing. Talking to others and staying connected helps normalize the societal fea
A challenge is to take this fear and anxiety and put it into some sort of larger context and perspective within our lives. Focus on those things and people that are true to who we are. This could mean attending to family, exercise, or on those things one enjoys (for example: cooking, outdoor activities, reading, artistic endeavors). For some people, it might be trying something they haven’t done before or focusing on things you haven’t had time to do. Being true to yourself, connecting with others and pursuing healthy activity will help reduce anxiety and stress.
Q: What guidance do you have for people in the North York community if they are feeling overwhelmed from a mental health perspective?
A: Beyond what I have already said regarding positive /healthy coping strategies (and avoiding unhealthy coping strategies like excessive alcohol, drugs or gambling) people still find themselves truly in a state of unrelenting and persistent emotional distress and anxiety, and if one is not getting pleasure from things they would normally enjoy and not functioning well, then ideally, they would reach out for some supports.
First choice is always your family physician. We are fortunate in North York that we have a very robust and well- connected family physician community. There are other professional self-help supports. I was very pleased to see our provincial government has funded digital/on-line Cognitive Behavioural Therapy (CBT) focused platforms that people can do from their home and are supported by professional therapists. These can be found at info.mindbeacon.com and www.bouncebackontario.ca. There are also a number of mental health crisis lines that can help people connect with local supports such as the North York Toronto Health Partners support line at 416-640-1934. As well, a robust set of resources can be found on-line at www.mentalhealthcovi19.ca a web site developed by one of our NYGH psychiatrists. There is always the availability of the 24/7 Charlotte and Lewis Steinberg Emergency.
Q: When should someone come to the Emergency Department?
A: Anyone who is considered to be at some degree of risk to themselves to others or is showing evidence of an inability to care for themselves, can choose to come to an emergency department or may be supported in coming to an emergency department by family or friends. The emergency department is accessible 24/7 if there any concerns about safety or welfare. In addition, any individual who has developed evidence of psychosis or disorganization of their thinking, which may be due to illness that has been untreated and/or substance misuse should seek medical care and emergency departments are always available.
Certainly, the feeling of what is a crisis can be very subjective. If people are unable to reach out to find other supports like previously mentioned, including their family physician, and they are in a state of distress and don’t know where to turn, an emergency department, like North York General, provides rapid access to medical care and crisis support.
Q: Are there any specific needs of the North York community outside of the hospital?
A: Our community is reflective of the City of Toronto, as an extremely diverse, multi-cultural and multi-lingual society. We want to make sure that individuals of all cultural backgrounds, all racial backgrounds, and gender diversity – that they all feel comfortable and non-stigmatized in attending to supports. That diversity is part of what makes Toronto, in my opinion, a truly amazing city. But it also means we all need to be very culturally aware, particularly as it comes to mental health, because we know in parts of the world mental illness is even more stigmatized than what we see in Canada, and people may be extremely fearful of seeking help for themselves or a family member for a mental health crisis. We must be aware and sensitive to these differences.
Q: Can you describe the vision for the Mental Health Emergency Services Unit (MHESU)?
A: While we encourage individuals, who are in a state of mental health crisis to come to the emergency because they open 24/7, we also recognize that emergency departments may not be perceived to be a therapeutic environment for someone having a mental health crisis. They can be extremely busy, noisy and distracting and not necessarily a quiet and calming environment. There has been a trend in recent years towards recognizing this and trying to create an area specifically focused on mental health in an emergency setting.
Part of that is to ensure a safe environment, and part of it is to ensure that the care is being provided with clinicians with specific focus on mental health and addiction treatment. We are very excited and pleased by the opportunity to create a mental health emergency services unit embedded within our Charlotte and Lewis Steinberg Emergency. This setting provides us with an opportunity to pause, stop, assess and make sure the person gets to the right place with the proper care in a timely fashion.
Q: Please describe the MHESU unit we are planning to fundraise and build?
A: Specialized clinicians in mental health (nursing staff, peer support workers, physicians, social work supports) are all very much a part of our Emergency Mental Health team. They provide comprehensive assessment and develop a treatment plan going forward including connections to professional, social and family supports. We plan to create a safe, therapeutic environment embedded within the existing emergency department for such care to be provided for our patients and families.
Q: How would you convince people to donate to this initiative?
A: This is an opportunity to highlight, promote and de-stigmatize serious mental illness and addictions. This is an area of medicine deserving of equal attention and focus. Nobody chooses to be psychotic; nobody chooses to have addictions; nobody chooses to be so depressed that they put their life at risk. Investment in care and supports will improve and save lives.
Q: Why this initiative here in North York?
A: We are very ambitious at NYGH! We want to set the highest of standards for the care of individuals with serious mental illness. We are a large University of Toronto affiliated community hospital and in partnership with community mental health agencies, we actively want to re-design systems of care for those with serious mental health and substance use disorders. This is a great opportunity and we want “to lead the way in establishing those new standards of care”.
Q: As Chief of Psychiatry, why did you choose to work at North York General Hospital?
A: I have been at NYGH for two years and I have worked in medical leadership at two other GTA hospitals over my career. I have a great interest in systems of care as it relates to mental health and addictions, and emergency psychiatry. This was an opportunity to join a hospital that has an excellent reputation, a most collegial learning environment and exceptional clinicians. It was also like coming home, as coincidentally I grew up in the local North York area, attended U of T for medical training, and NYGH was my family’s hospital when I was a kid, and I went to high-school just down the street at George Vanier.
Dr. Stephanie Klein — Family Physician
Dr. Stephanie Klein is a family physician in North York and the Faculty Wellness Lead for the Department of Family Medicine at NYGH. You can usually find Dr. Klein starting her day with an early morning workout and meditation, both are key, she says, in keeping her well. Dr. Klein practices community family medicine at her family practice office and teaches medical trainees at the University of Toronto. Dr. Klein also works at the Senior Health Centre and lately she has been spending much of her time at the COVID-19 Assessment Centre at Branson. Dr. Klein is passionate about physician mental health and wellness and is a member of the OMA Burnout Taskforce. Outside of medicine, Dr. Klein is an avid golfer, huge sports fan and animal lover.
Q: If someone is not coping well through these uncertain times and feel they are in crisis, what advice do you have?
A: I think the key is to know there are people out there who want to help and you’re not alone. This can be hard to remember when the suffering feels so severe. Your family doctor is there to support you during a crisis. Speaking with your family doctor will help you create a personalized plan to address what’s going on. Many times, having that first discussion and creating a plan, will help you feel better. Reaching out to trusted friends and family can also be valuable.
There are helplines for support such as the North York Toronto Health Partners Mental Health and Addictions Access Point support line at
416-640-1934 open from 9:00 am to 5:00 pm Monday to Friday and Distress Centres of Toronto is available 24/7 at 416-408-HELP (4357). If you are in a mental health crisis, I would suggest going to your nearest emergency department which can connect you to resources in an expedited way.
Q: As a family doctor, what suggestions do you have for people during this period of uncertainty particularly as businesses and institutions are opening (albeit with restrictions).
A: It’s human nature to struggle with the unknown and we have faced a lot of unknown and uncertainty throughout the COVID19 pandemic. We are creatures of habit and accustomed to routines and a degree of control over our lives. When there’s a major disruption that can be a driver for stress and poor mental health. We are also inundated daily with exposure to sensationalized news stories which can be very distressing for us as we attempt to process all the change around us. Now, as we approach the school year and with more businesses opening, there is concern that cases may increase. I think many are suffering from pandemic fatigue as well.
My first suggestion is; in the face of ambiguity or uncertainty, assume everything is neutral and not negative. It’s so easy to jump to false conclusions and have that affect our behaviours and feelings. It’s tough to do, but if you can resist that automatic “worst case scenario” thinking, it will help with coping in this period of uncertainty. Instead, recognize that many times we are biased to think negatively about a situation, and it would be more beneficial to change that to a more positive outlook during times of uncertainty.
Another strategy is knowing that trying to “predict the future” is futile, and no matter how hard we may try to control how things will go, we can’t in this situation. It’s best to know when to let go. Focus on things we can control such as enjoying quality time with friends, family, time outdoors, healthy meals, exercise and anything that keeps you well!
Q: People are fearful of a second wave – how might you suggest they manage their fear and anxiety?
A: This is an understandable fear of many, and this again relates to a degree of uncertainty, and wanting to know what the future holds and how it might affect us. We may question if things will be worse than they were the first time or if things will ever go back to “normal”. Spending excess time worrying will only feed the underlying fear and anxiety, so it’s best not to let these thoughts or fears take over and prevent us from living the lives we want to live.
The fear around a second wave drives behaviors like not leaving your house or avoiding activities and prevents us from being able to enjoy post-COVID life. To manage this fear and anxiety, first it’s important to maintain social connections, so you feel like you’re facing your challenges together, which is much easier. Focus on staying in the present rather than thinking too much about what you “used to be able to do” or worrying too much about what might be.
It’s also important to recognize that it’s okay to have these feelings. Sharing your thoughts with a trusted friend, journaling, practicing self-compassion, breathing exercises and meditation are all helpful strategies to calm things down when feeling overwhelmed.
Lastly it goes without saying that prioritizing self-care is key. That means allocating time for exercise as a natural way to release endorphins and reduce stress, ensure adequate sleep to restore and recover, eat well balanced meals, spend time doing things you enjoy like a hobby and nurture the important relationships in your life.
Q: You have a special interest in older adults, what issues during the pandemic are you seeing with this population and what general advice might you have?
A: Throughout the pandemic I observed the greatest challenge facing older adults was the social isolation and loneliness. There was a lot of time spent away from their families and disconnected from social networks. This, understandably, had consequences on their mental health. Additionally, many of the senior’s community programs were shut down which meant less opportunities for exercise and physical activity. While staying home and isolated from the community helped protect older adults from being exposed to COVID19, the unintended consequence of these measures was the increased risk of functional decline.
It was great to see that many people and organizations came together to support seniors through friendly phone calls, grocery delivery, connection to social services etc. In terms of advice, I think the most important thing is to stay connected however you can. By telephone, IPAD, socially distanced visits, zoom etc. It’s a great time to have the younger adults teach their parents or grandparents how to use technology.
The other key advice is to ask for help or attend to medical needs that come up before things get worse. Very often I spoke with older adults who had a new medical concern but were fearful of seeking medical attention due to concerns about catching COVID. It’s important to call your doctor if a new medical issue comes up and listen to their advice if they feel it is necessary to visit the emergency department or go for tests. Often the risk of not addressing a new medical issue may be greater than the risk of catching COVID.
Q: What are the key issues people have been experiencing relative to their mental health during COVID-19 and what general advice do you have as a family doctor?
A: One of key issues I have observed people experiencing relative to their mental health during the pandemic is a disruption to their usual routine and habits. Working from home had its benefits like less stress with the commute, more time to spend with family, the ability to work in PJ’s! However, it also meant there was a lack of structure at times, less interaction with people outside your home and more responsibilities with childcare since schools were closed. The usual outlets for stress relief were also closed such as the gyms, restaurants, entertainment, travel etc. For a lot of people spending too much time at home brought them out of their routines. I heard a lot of people struggle with maintaining exercise, healthy eating habits and healthy sleeping habits. These are the key elements of self-care and when falling out of that routine, I noticed a lot of people suffer with respect to their mental health.
I also observed a lot of adolescents and young adults present with anxiety. To be honest, I don’t think this was an “issue” stemming from the pandemic. I think the opposite. For the first time doctors became more accessible through virtual means by connecting through videoconference and telephone. I think this reduced a barrier for younger adults in seeking help as they could access support easily from their own homes and devices.
The general advice I have is to create structure and routine but also set boundaries and set aside time to re-charge. Working from home meant there wasn’t an easy separation from home-life and work-life over the last 6 months. With remote access, you had the ability to work at all hours of the day, and not even leave your room! Therefore, setting boundaries or time limits on your work schedule is so important. Making time for self-care activities should be incorporated in your schedule. I often suggest writing it in your calendar, so it’s not forgotten or put off when things get busy. The times spent doing the things that make us happy will re-energize for the next day ahead and help reduce the feelings of stress and anxiety.
Q: Why did you choose to work with/be affiliated with North York General Hospital?
A: I’m what they call an NYGH “Lifer”. In the sense that I started as a first-year medical student and haven’t left since then! I was very fortunate to be placed at NYGH as a medical student when I first had the opportunity to experience the incredible learning environment. I love the community feel but at the same time NYGH has a strong reputation for academic excellence. All the staff are brilliant educators, and everyone supports one another in delivering excellent patient care. I completed many rotations and my family medicine residency at NYGH so it was a no-brainer when it came down to choosing where I wanted to set up my practice. I was welcomed by mentors to join their group and have enjoyed the opportunity over the last couple years to build my family practice serving the community in North York. There is such a strong collegiality at NYGH that anytime I visit the hospital or need some advice, there’s always a friendly response from colleagues. NYGH has given me so many opportunities to grow and develop.
Dr. Jerome Perera — Psychiatrist
Dr. Perera began working at NYGH in 2014 during a rotation with the psychiatric day hospital in his final year of residency. Currently, he works in the adult outpatient program and the mental health and justice program (which provides treatment for individuals with a legal history). He consults in the Emergency Department when he is on call. Dr. Perera teaches medical students and has been involved in wellness initiatives during the pandemic.
Q: What are the key issues people have been experiencing relative to their mental health during COVID-19 and what general advice do you have?
A: Uncertainty about the future, isolation, and fatigue are some of the factors impacting mental health during COVID-19.
I encourage people to practice a relaxing or rejuvenating activity every single day. This helps to counter the effects of chronic stress and builds resilience. Examples include breathing exercises in the morning, regular physical activity, spending time in nature (even in the winter) and listening to affirmations before going to sleep. It’s essential to recharge in any way possible.
Other strategies include visualization. Imagine a desired outcome and the steps that it would take to overcome a difficult situation (solution focused) as opposed to repeatedly thinking about how bad a situation might be (problem focused). Practice self-strengthening statements often (“I am able to navigate this, even if things get worse”).
Q: As a psychiatrist what suggestions do you have for people during this period of uncertainty particularly as businesses and institutions are opening up (albeit with restrictions)?
A: Our society needs more compassion between people – especially these days. With the stress that everyone is under, interpersonal conflict will make our collective burden greater. It’s important to give others the benefit of the doubt as everyone is doing the best they can. We will be better able to overcome our difficulties if we uplift each other with kindness – especially in the midst of conflict.
Q: People are fearful of a second wave – how might you suggest they manage their fear and anxiety?
A: Early on in the pandemic, I published a website (https://mentalhealthcovid19.ca) with the goal of helping people to cope. It provides a comprehensive set of suggestions and resources to improve mental health during the pandemic (and in general).
Q: What suggestions do you have for parents who are returning their children to school and those who are opting for virtual learning?
A: Parents are making difficult decisions during this time. It’s okay to choose what works best for your family considering your unique circumstance (health, safety, resources, employment, and socialization needs). Trust your instincts and try not to second guess your decisions. Every path will be imperfect. As difficult as things might become, do you best to be consistent and make the most of your situation.
Q: What do you see as the needs of the North York Community, particularly during the pandemic?
A: Having better access to mental health services (including a mental health emergency services unit).
Q: What sparked your interest in mental health? And in Psychiatry?
A: It started with an interest in psychology and wanting to learn about the human experience. I’m encouraged by the idea that we can find meaning when faced with difficulty (which hopefully allows us to better understand ourselves and have a positive impact on society). Working in mental health allows me the opportunity to help others improve their quality of life. I believe we all have the ability to “shine a light” in this world, and I’m grateful that my work allows me this privilege.
Q: Why did you choose to work at North York General Hospital?
A: I rotated through all the hospital systems in the 9 years of medical training I completed in Toronto. The workplace culture at NYGH is one of the best in the city – at all levels in the organization. I believe this plays a significant role in being able to provide high quality patient care.
