Table 1 Summary of barriers and facilitating factors to mental health service delivery during the pandemic

Structural

1. Ministerial directives during the pandemic

• mental health staff relocation to “COVID red zones”

• treating emergency cases only

2. Mental health staff shortage

• difficulties in recruitment for mental health care/limited number of mental health staff during the pandemic

• limited availability of psychiatrists and psychologists during the pandemic

• reduced staff at mental health access points

1. Ministerial directives during the pandemic

• reinforcements to mental health care teams by relocating mental health staff to offer/reinforce mental health care

2. Learning from the pandemic’s first wave

• new funding for mental health teams

• implementing and mobilizing technological modalities for mental health service delivery

• new knowledge about the virus informing hygiene practices to facilitate re-opening clinics

Organizational

1. Mental health service interruption

• community-based care (groups in community settings used by psychiatrists to address patient isolation)

• primary care settings (family physician (FP) clinic closures, group interruption)

• hospital outpatient clinics (closures, group therapy interruption)

1. Reduced delays

• Guichets d’accès en santé mentale adulte (GASMA) (local mental health service access points) wait time to evaluate patient requests for services decreased

2. Support in the provision of mental health care, including through collaborations

• managerial support (e.g., facilitating the transition to technological modalities; allowing for staff to see certain patients in-person when there were limitations to technological modalities; offering lunch-time webinars and discussions for physicians on how to help with limited resources in a crisis context; “officializing” the use of mental health services in the private sector for “more fortunate” patients)

• inter-organizational collaborations through availability of a social worker, psychologist, and nurse practitioner at the FPs’ health establishment

• inter-organizational collaborations through meetings between all chiefs of services from the medical sector including mental health to coordinate health service delivery during the pandemic, as well as a community of practice for FPs working in substance use

Provider

1. Mental health staff on leave

• COVID-19 preventive measures

• medical leave (mental health related)

2. Physician availability and provider mental health capacity

• less in-person FP clinical activities

• FP feeling “alone” for mental health care

• psychiatrists with dual role of clinician and mental health manager during the COVID-19 context

1. Practice characteristics adopted by healthcare professionals

• care and follow-up for “unattached patients” (patients without an FP)

• GASMA workers contacting patients on wait lists to provide support and/or referrals to community organizations

• “reaching out” to more vulnerable patients by developing/mobilizing community resources

Patient

1. Pandemic’s effect on consultations

• patients not consulting during the first wave given the fear of the virus and because they thought the pandemic would be short-lived

• “people who have always worked well, who have always adapted well” consulting, as well as people with certain vulnerabilities

• the pandemic’s impact on everyone, but additional impact on people with certain vulnerabilities

• the pandemic’s impact on people’s mental health, a new subject in FP assessment and discussions for the management of clinic waitlists

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Innovation (technological modalities for mental health service delivery)

1. Technological modalities for mental health service delivery

• inability to capture certain information necessary to evaluate patients and/or provide care (for staff)

• shift to teleconsultations for mental health service delivery and its impact on certain patients’ access to mental health care (no email address, no technology access) (for patients)

1. Technological modalities for mental health service delivery

• the pandemic “propelling” Quebec into “computerization”

• “catching up” on consultations

• satisfaction with and utility of technological consultations (e.g.: efficiency (seeing patients quicker, patients not being late), useful for patients with certain socio-demographic and clinical characteristics)