Single-session therapy is necessary during the pandemic

Exploring virtual SST as mental health treatment both during and post COVID-19

The negative influence of the COVID-19 pandemic on psychological health presents an immediate need for timely mental health solutions. Virtually delivered single-session therapy (SST) is a mental health intervention that could alleviate COVID-19-related psychological concerns. 
Maltby Centre is a not-for-profit organization located in Kingston, Ontario. The Centre offers youth aged 0-24 and their caregivers access to a free one-hour counselling session with a registered psychotherapist. Since the COVID-19 outbreak, the service has shifted online. Its new Mental Health Access program operates five days per week to connect clients for a session within 24 hours of contact. Continued services are also available. 
As both staff and clients adjust to the virtual learning curve, the service nonetheless provides timely mental health support to the Kingston, Frontenac, Lennox & Addington region.
Protective measures taken in response to the pandemic have varied. The impact of curfews, self-isolation, social distancing, and travel restrictions have been compounded by the circulation of misinformation and global changes to educational, political, and economic procedures. 
Some of the anticipated negative consequences of social distancing, including substance abuse and domestic violence, are risk factors for mental health issues. Studies have linked social isolation to anxiety, depression, self-harm, and attempted suicide.  These concerns have manifested in countries where feelings of stress, anxiety, and depression are attributable to the pandemic.
The global spread of COVID-19 has endangered both the physical and mental wellbeing of people across the world. While the pandemic’s complete impact on mental health isn't yet quantified, early reviews suggest psychiatric interventions could help the general public. 
Adapting to the social landscape of the pandemic requires individuals to be resilient and mindful of others—it should be a public health priority to facilitate these skills both during and after the pandemic.
Research has found unchecked mental health concerns beginning during a pandemic may later develop into severe mental illnesses like post-traumatic stress disorder. For example, the 2003 SARS epidemic was associated with a 30 per cent increase in suicide rates among those older than 65, 50 per cent of infected SARS patients reported anxiety, and 29 per cent of health care workers faced emotional distress. 
If the mental health fallout post-SARS is any indication, similarly adverse symptomology might follow the COVID-19 pandemic. 
SST is a well-established model for delivering mental health services for various needs. By focusing only on present issues, counsellors can offer support for specific challenges. 
Clients learn from a counsellor’s advice and work with them to develop a plan to take control of their mental wellbeing. This model is effective in treating conditions that are of particular concern during social isolation measures, including mood, anxiety, anger management, and sleep issues. 
Many organizations are implementing SST through walk-in clinics, hoping that more people will seek support without the added barrier of long waitlists for an appointment. 
Although the suspension of in-person visits has made the traditional delivery of walk-in clinic services impossible, the same services can be offered through virtual sessions. Telepsychiatry has made remote mental health support more common. 
The Chinese government has been a pioneer in implementing large-scale virtual mental health services during COVID-19. These services include online surveys to assess patients for specific mental health risks, online cognitive behavioural therapy for depression, anxiety and insomnia, and novel AI programs targeted toward suicide prevention. 
Virtual services can reach a wider client base, especially those living in rural areas where walk-in clinics would otherwise be inaccessible. Virtual SST supports the safety of staying home during the pandemic while ensuring mental health support is readily available. 
However, virtual services still have limitations. Varying access to technology and reliable internet strains the connection with mental health service providers, while concerns surrounding the security of online video chatting presents privacy risks. 
Organizations across all levels of governance are searching for solutions. Ontario Premier Doug Ford has spoken about the lack of internet access in rural areas and committed $150 million to increase broadband cellular connectivity. Similarly, school boards across Ontario are looking to make more technology available to students working remotely. 
Community-based mental health agencies are also determining how to make their services more accessible. With restrictions on in-home service delivery, these agencies may consider reallocating these budgets to provide better technology access for their clients. 
The concept of reverse-opening—where office space is opened to clients while staff stay home—might also mitigate these privacy concerns. The flexibility of virtual service delivery has created many opportunities for socially distanced support. 
The implementation of virtual SST is a cost-effective solution for organizations to continue offering mental health support by limiting wait times and other barriers to service. The promising transition made by Maltby Centre to offer SST online should set a positive example for other mental health centres to follow. 
Kathryn Matsushita is a second-year Master of Public Health student.

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