With longer wait times and lack of in-person support, parents are sounding the alarm about gaps in mental health care

“He would not go to a computer screen for virtual learning, partly because his tics were so pronounced and he’s very aware of it,” Carson said, adding his anxiety significantly worsened as the months dragged on.

But when Carson finally got the call from CAMH in July about her son’s enrolment in the group therapy program, she was told it would only be offered online — a delivery model that was a trigger for his mental health diagnoses, which included ADHD and Tourette’s. When she asked for an in-person appointment, Carson was initially told it wouldn’t be possible until January 2022.

Carson and other Toronto parents are frustrated with the long wait and the lack of in-person mental health-care services this late into the pandemic, at a time when students are able to attend school, daycare and camp face to face. Many health-care providers still offer virtual care by default, forcing Ontario’s chief medical officer of health, Dr. Kieran Moore, to urge physicians to see patients in person.

“There are limits to what can be done virtually and the standard of care is often difficult to meet in a virtual-care environment,” Moore wrote in an Oct. 13 letter to Ontario doctors. The Ministry of Health followed by releasing official guidance to health-care providers on Oct. 19, stating they should be resuming in-person visits based on clinical need and patient preference.

While COVID has forced much of health-care delivery online, virtual mental health care received targeted funding from the Ontario government, including emergency money of up to $12 million for internet-based cognitive behavioural therapy at the onset of the pandemic. Research on usage of online services shows that many people are accessing and largely benefiting from virtual therapy options, but advocates say it might not suit some people with more complex needs.

“What we’re seeing is that for kids under 12, generally, in-person (care) works better,” said Kimberly Moran, the executive director of Children’s Mental Health Ontario. Moran added that said while the pandemic hastened the adoption of virtual care in the mental health sphere, experts are still trying to determine its effectiveness in treating an array of issues.

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Moran said the government directive for much of the pandemic has been to prioritize virtual health services, though many mental health-care providers are now beginning to offer services in person as COVID case numbers fall. The issue, she said, is that wait lists for care are growing, and providers lack the resources to keep up.

“I don’t understand why we don’t start with those kids who have the most significant mental health issues and get them the care they need as soon as we can,” Moran said, “but the government funding is not weighted that way,” creating a gap in service for children who need intensive care.

After Moore urged physicians to see patients face to face, Carson said she received an update from CAMH that the hospital will see her son, now seven years old, in person on an individual basis starting in November. She said it’s a welcome development, but he would still not have access to the benefits of an in-person group therapy program, which is designed for attendees to make connections with one another as a form of therapeutic care.

“While I understand that they wanted to be careful and not rush to all in-person too soon, I think it's sad and problematic that they couldn't have found a way to manage the risk and see their youngest and sickest patients sooner,” Carson said.

In response to questions from the Star, the hospital said its priority has been to keep COVID-19 at bay so that its emergency department and inpatient programs remain open for in-person care, and it has adopted virtual care options for outpatient services where possible. But spokesperson Hayley Chazan said the hospital recognizes virtual care is not ideal for everyone.

“With our staff vaccination rate at nearly 97 per cent, we are now in the process of making plans to safely resume more of our in-person outpatient programs,” Chazan said.

Care providers, however, are reinstating in-person services at different paces, and at the Hospital for Sick Children, some psychiatric consultations with children are still being done virtually. Kim Munro Roberts saw anxiety in her eight-year-old son spike after two sudden deaths in the family, leading to outbursts and anger. She sought a psychiatric assessment in February, but was only able to schedule an appointment in September with Sick Kids — around a six-month wait.

While waiting, Munro Roberts sought therapy for her son and paid out of pocket. She tried virtual therapy, but she said it did not help, as it was hard for him to interact with a therapist who seemed disengaged.

“The whole virtual thing was a disaster, and it didn’t give an opportunity for him to connect,” Munro Roberts said. She has since transitioned her son into in-person play-based therapy, which he has been attending successfully since March. But Munro Roberts said she is still frustrated with the lack of options for families who can’t pay, and for the many more families who are still waiting months to access essential health care for their children.

Jessamine Luck, a spokesperson for Sick Kids, confirmed the hospital is still offering online therapeutic groups and day programs under its psychiatry wing, with plans to shift to in-person care in early 2022. “A family can request an in-person appointment if they feel a virtual appointment is not appropriate for their case,” Luck said, adding the hospital is still gathering feedback from parents about their virtual experience.

Spokesperson for the Ministry of Health, W.D. Lighthall, said while the province issued guidance for care providers to resume in-person services, it is still up to hospital administrators to figure out what works best for them day to day. To address lengthy wait times for services, Lighthall added the province announced funding in June — around $20 million — to government-funded children and youth mental health agencies.

Dr. Doron Almagor, a Toronto-based psychiatrist and director of the Possibilities Clinic, which offers mental health-care services to children, teens and adults, said for many providers, the pandemic has been a balancing act of ensuring safety and curbing spread, while trying to keep services open and available. For this reason, his practice defaulted into virtual care early on, and it remains the main mode of delivery.

“Things change and it’s very hard to predict the situation around the pandemic,” Almagor said, adding he’ll also likely wait until January to begin offering more services in person.

He added virtual care has benefited many families and patients, especially those who live outside Toronto and don’t have much access to care in their own communities. But he acknowledged that for some patients, especially younger ones, it may not be the best option, and that some diagnosis must be done in person, like testing for autism.

For Moran at CMHO, the key to improving access to mental health care is understanding the pros and cons of in-person and online models, as well as better funding to reduce wait times for services — a problem that has only worsened under COVID.

“There was a little bit of money put towards virtual care for older children, and it was all for services for people who have mild mental health issues,” Moran said. But the government has not adequately funded intensive mental health treatment, she added, and wait times are only growing.

Correction — Nov. 1, 2021: This article was edited to correct Carson’s age.

Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Follow her on Twitter: @nadineyousif_