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While social distancing during this pandemic is hard on everyone, the stress and uncertainty can be particularly difficult for people with mental health disorders.

Many rely on regular visits with therapists or psychiatrists, group therapy sessions and Alcoholics Anonymous meetings. But with most in-person visits now no longer feasible, what can you do to maintain your mental health care?

Here’s a guide to what services are available and how you can protect your mental health:

Remote visits and assessments

Psychiatrists and other mental health professionals are still carrying out regular appointments, follow-ups and assessments remotely, either online or over the phone.

“It’s important for patients to recognize that many services still are available and that doctors may well be available,” even though some services may be reduced, said David Gratzer, attending psychiatrist at Toronto’s Centre for Addiction and Mental Health (CAMH).

Call or e-mail your care provider, or check their website for updates. But just because you’re feeling more anxious and stressed than usual, you may not necessarily need to see a professional. Anxiety in this situation is normal, experts say.

“If you’ve been doing well in terms of your mental illness, your treatment’s been working and you’re feeling a little bit stressed out about the virus, then maybe you don’t need to do anything right now,” Dr. Gratzer says.

By contrast, if you’re feeling overwhelmed and possibly suicidal, seek help immediately, he says. “That’s a medical emergency, whether or not there’s a pandemic.”

Brain stimulation treatment

At present, neuromodulation treatments, such as repetitive transcranial magnetic stimulation and electroconvulsive therapy, are considered essential services, so they continue to be offered to those who need them, Dr. Gratzer says.

But be prepared to wait longer than usual. Staff need to be much more careful about the potential spread of infection through bodily secretions, especially for those requiring anaesthetics, and, thus, may require more time for each patient, he says.

Mental health emergencies

The emergency department at CAMH and emergency departments at hospitals across the country remain open.

If you are thinking about suicide or are worried about someone who is, call the Crisis Services Canada national line: 1-833-456-4566 or text 45645 (in Quebec, call: 1-866-277-3553). If the risk is immediate, call 9-1-1.

Group sessions

While some support groups and group therapy sessions may be suspended for now, others are holding their meetings online.

For example, Joanna Mansfield, staff psychiatrist in the women’s mood and anxiety clinic, and cognitive behavioural therapy clinic at Toronto’s Sunnybrook Health Sciences Centre, says she continues to run a postpartum therapy group for women with depression and anxiety online via the Ontario Telemedicine Network (OTN).

Dr. Mansfield notes there are advantages to holding virtual sessions. It allows her to see people in their own environment and gives her more insight into how they’re functioning at home, she says.

But even if your regular meetings or the mental health-care services you normally use are currently suspended, “remember, things change really quickly,” Dr. Gratzer says, noting within the next week or two, they may be available again in another form. “Patients should stay informed and stay connected.”

Maintaining mental health

Exercise, avoid excessive caffeine, alcohol and cannabis, and if you’re on medication, take it as prescribed, Dr. Gratzer says.

Dr. Mansfield also offers the following advice:

  1. Create some structure and routine in your day. This can help you feel empowered and recognize you still have a lot of choice in your day, even when you face restrictions on where you can go and who you can see.
  2. Make a “pleasurable activity log." Recording all the things you do that make you feel good can help you recognize which behaviours are helpful to you, and incorporate them into your day, she says. It also allows you to see that you are, in fact, doing things that are enjoyable even when you may think everything is terrible.
  3. Watch out for cognitive distortions. She advises to “catch, check and change” distorted thoughts. This involves catching yourself, for instance, when you’re engaging in “all-or-nothing” thinking, checking that thought by considering the facts and changing the thought by reframing it based on the facts.
  4. Practise mindfulness and relaxation strategies. Some suggestions include breathing exercises, progressively tensing and relaxing the muscles throughout your body, and visualizing yourself in a relaxing setting.
  5. Practise good sleep hygiene. This includes going to sleep and waking at the same time daily, avoiding screens while in bed, and getting up to do something else if you can’t fall asleep after 15 or 20 minutes, then trying again when you’re tired.

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