Skip to main content
The Globe and Mail
Support Quality Journalism.
The Globe and Mail
First Access to Latest
Investment News
Collection of curated
e-books and guides
Inform your decisions via
Globe Investor Tools
Just$1.99
per week
for first 24 weeks

Enjoy unlimited digital access
Cancel Anytime
Enjoy Unlimited Digital Access
Canada’s most-awarded
newsroom for a reason
Stay informed for a
lot less, cancel anytime
“Exemplary reporting on
COVID-19” – Herman L
$1.99
per week
for 24 weeks
Get full access to globeandmail.com
Just $1.99per week for the first 24weeks
Just $1.99per week for the first 24weeks
var select={root:".js-sub-pencil",control:".js-sub-pencil-control",open:"o-sub-pencil--open",closed:"o-sub-pencil--closed"},dom={},allowExpand=!0;function pencilInit(o){var e=arguments.length>1&&void 0!==arguments[1]&&arguments[1];select.root=o,dom.root=document.querySelector(select.root),dom.root&&(dom.control=document.querySelector(select.control),dom.control.addEventListener("click",onToggleClicked),setPanelState(e),window.addEventListener("scroll",onWindowScroll),dom.root.removeAttribute("hidden"))}function isPanelOpen(){return dom.root.classList.contains(select.open)}function setPanelState(o){dom.root.classList[o?"add":"remove"](select.open),dom.root.classList[o?"remove":"add"](select.closed),dom.control.setAttribute("aria-expanded",o)}function onToggleClicked(){var l=!isPanelOpen();setPanelState(l)}function onWindowScroll(){window.requestAnimationFrame(function() {var l=isPanelOpen(),n=0===(document.body.scrollTop||document.documentElement.scrollTop);n||l||!allowExpand?n&&l&&(allowExpand=!0,setPanelState(!1)):(allowExpand=!1,setPanelState(!0))});}pencilInit(".js-sub-pencil",!1); // via darwin-bg var slideIndex = 0; carousel(); function carousel() { var i; var x = document.getElementsByClassName("subs_valueprop"); for (i = 0; i < x.length; i++) { x[i].style.display = "none"; } slideIndex++; if (slideIndex> x.length) { slideIndex = 1; } x[slideIndex - 1].style.display = "block"; setTimeout(carousel, 2500); } //

David Goldbloom is a psychiatrist and senior medical advisor at the Centre for Addiction and Mental Health. He is the author of We Can Do Better: Urgent Innovations to Improve Mental Health Access and Care.

We are all telepsychiatrists now, connecting with patients through telephones and a variety of secure televideo links. A year ago, we were not.

The first published report of televideo psychiatry for people in underserved communities appeared in 1957. By 2017, only 7 per cent of Ontario psychiatrists used this medium to connect with patients. Then COVID-19 arrived. And while the unprecedented rapid development of multiple vaccines has been the most exhilarating scientific advance engendered by the pandemic, it has occurred against a backdrop of less dramatic but still significant changes in health care delivery. Televideo hesitancy has resolved faster than vaccine hesitancy.

Story continues below advertisement

Telepsychiatry reflects both old and new values and traditions in health care. It constitutes the revival of the house call, for example. Such visits were an essential component of the clinical routine of my pediatrician grandfather and father, and one I occasionally incorporated into my own practice as a psychiatrist. New technology once again affords us clinicians the opportunity to see where and how our patients live, to meet their families, friends and pets, in an environment where they often feel more at ease. And, as we both stumble through the challenges – as in “You’re on mute” or seeing only the tops of foreheads – there is a levelling of the playing field.

Also notable is the patient-centred aspect of telepsychiatry. It is often maximally convenient to our patients that their encounters with us do not demand extensive travel, time off work, child care and inevitable waiting. And it introduces novel contexts to our encounters. Parked cars, bathrooms and even open fields have become telepsychiatry studios for patients whose living or working arrangements preclude the privacy necessary for confidentiality.

Some of us are accustomed to providing such care to underserved northern communities, but that model was based largely on patients going to their local health clinic’s televideo studio, and was often hampered in winter months by poor driving conditions. Now these patients connect using their computers or phones in their own homes.

Telepsychiatry is not without its drawbacks. Patients without access to smartphones and computers can be left behind – people who are homeless, poor or live in settings without sufficient broadband access. There will always be a need for in-person services, and there will always be people who do not feel “connected” through the web. But for most of my fellow clinicians, the surprise has been how many patients do feel comfortable with this mode of interaction – perhaps even more so than we do, because it represents such a transformative change in how we provide care. What counts, ultimately, is what helps our patients.

The ramp-up to televideo care was sudden. At the outset of the pandemic, the Centre for Addiction and Mental Health went from providing 350 such sessions a month to 3,500. Drivers included both clinical need and the need of providers to be working and to be paid. This triggered unprecedented changes to government payments for virtual care that must continue.

The pandemic has been described not as an equalizer but as a revealer of inequities in our society when it comes to vulnerability to infection, vaccine distribution, access to care – and access to broadband internet and hardware. This has implications for the delivery of health care and essential education services, and also for promoting social proximity at a time of physical distancing. As we plan for things such as adequate PPE supply and local vaccine development in a future pandemic, ensuring that all Canadians have access to virtual lifelines of broadband is a national priority.

Will we return to the tradition of visits to offices and clinics? I suspect a hybrid model will evolve, with patient choice at the centre. However stressful the pandemic has been, it has triggered radical changes in care delivery, catalyzing the uptake of opportunities that have had a long enough gestation. I have no doubt they will endure.

Story continues below advertisement

The prepandemic status quo of access to psychiatric care was not acceptable. We need to leverage the lessons learned – and forced upon us.

Keep your Opinions sharp and informed. Get the Opinion newsletter. Sign up today.

Your Globe

Build your personal news feed

  1. Follow topics and authors relevant to your reading interests.
  2. Check your Following feed daily, and never miss an article. Access your Following feed from your account menu at the top right corner of every page.

Follow topics related to this article:

View more suggestions in Following Read more about following topics and authors
Report an error
Due to technical reasons, we have temporarily removed commenting from our articles. We hope to have this fixed soon. Thank you for your patience. If you are looking to give feedback on our new site, please send it along to feedback@globeandmail.com. If you want to write a letter to the editor, please forward to letters@globeandmail.com.

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to letters@globeandmail.com. Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to letters@globeandmail.com. Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff.

We aim to create a safe and valuable space for discussion and debate. That means:

  • Treat others as you wish to be treated
  • Criticize ideas, not people
  • Stay on topic
  • Avoid the use of toxic and offensive language
  • Flag bad behaviour

If you do not see your comment posted immediately, it is being reviewed by the moderation team and may appear shortly, generally within an hour.

We aim to have all comments reviewed in a timely manner.

Comments that violate our community guidelines will not be posted.

UPDATED: Read our community guidelines here

Discussion loading ...

To view this site properly, enable cookies in your browser. Read our privacy policy to learn more.
How to enable cookies