Question: I am suffering from crippling anxiety. My family doctor has referred me to a psychiatrist but I can’t get an appointment for months. What am I supposed to do in the meantime?
Answer: You certainly are not alone in having to wait a long time to see a psychiatrist. For a wide variety of reasons, access to mental-health services is a big problem in Canada, and that’s got some experts thinking about new and innovative ways to deliver care.
“Not every interaction has to be a health professional sitting in a room with a patient,” says Dr. Ed Brown, Chief Executive Officer of Ontario Telemedicine Network (OTN). “There are other ways to support people.”
OTN, a not-for-profit organization funded by the provincial government, is best known for creating a video-conferencing network that enables Ontario patients who live in remote locations to have virtual doctor appointments in their communities.
Based on a similar principle of virtual care, OTN has contracted with a British company to provide mental-health support through a website called Big White Wall (BWW).
The website serves as a forum where people with depression and anxiety can express their feelings and provide support to each other 24/7.
It also offers mental-health improvement tools including online group courses for dealing with issues such as depression, anxiety, weight management and quitting smoking.
A key feature of BWW is that everyone is anonymous. “It’s a space where people can feel comfortable sharing their thoughts and not reveal who they are,” says Harriet Ekperigin, senior business lead at OTN.
She notes that the stigma and fear of being judged harshly by family and friends often prevents people from opening up about what’s bothering them.
BWW is monitored by mental-health counsellors called “wall guides,” who will intervene if people are making inappropriate comments or someone seems about to inflict self-harm. A wall guide will assess the person and can provide contact information for a local crisis-support centre – if it’s needed.
The website is available free to Ontario residents over the age of 16. The cost is covered by the Ontario Ministry of Health and Long-term Care
BWW was started in the United Kingdom in 2007 and won accolades from the mental-health community – as well as from Britain’s Prince Harry, Duke of Sussex. It was then adopted in New Zealand.
When Ontario residents log in, they enter a portal where they share their feelings with people in Britain and New Zealand. “You’re in a global community,” says Ms. Ekperigin. “And you get a richness of experiences from a diversity of people from all walks of life.”
Since the website became available in Ontario in April, other provinces have expressed an interest in also offering their residents access to the site, says Dr. Brown.
BWW is part of a growing trend of providing mental-health assistance digitally or virtually.
Another example is the recent launch of a national “Crisis Text Line” that enables young Canadians to connect with mental-health responders via text messages.
In some cases, these services are meant to fill the gap while patients wait to see a psychiatrist or start other forms of therapy. In other situations, they may provide all the help the person needs.
“Obviously, Big White Wall is not for everyone. But for certain populations of patients, it works,” says Dr. Brown.
What can be said with some certainty is that more and more people are going online to diagnose themselves and look for treatments even before they see a health-care provider, says Dr. Carolyn Boulos, a youth psychiatrist at Sunnybrook Health Sciences Centre in Toronto.
“Big White Wall is one of the more reliable and comprehensive websites compared with other sites they might be researching.”
She also sees value in people sharing their experiences with those who have similar problems. “Having another person understanding what you are going through can be comforting,” says Dr. Boulos. The emotional connections forged online can lessen feelings of social isolation, she adds.
Affordability is also an issue. Provincial and territorial health-insurance plans will pay for an appointment with a psychiatrist, but most of them don’t usually pick up the tab for seeing a psychologist. As a result, the guidance provided by psychologists is out of reach for many people.
Online and virtual support can break down the financial barriers to care. “It really is open to everyone,” says Dr. Boulos, who often recommends mental health-related apps to her patients.
And apparently, some of these services are extremely cost-effective for the health-care system to deliver. “We pay a single licensing fee for every patient who uses the Big White Wall,” explains Dr. Brown. “I can’t reveal the amount, but it’s a lot less than seeing a psychiatrist even once.”
So far, about 10,000 Ontario residents have signed into the BWW website.
Dr. Boulos says patients who are waiting to see a psychiatrist can ask their family doctor for digital and virtual options that might be appropriate for them. “There are usually a number of different tools that can be helpful,” she says. “If symptoms get worse and the person has suicidal thoughts then this is best assessed by a health-care professional.”