Question:

I am suffering from crippling anxiety. My family doctor has referred me to a psychiatrist but I can’t get an appointment for months. What am I supposed to do in the meantime?

Answer:

You certainly are not alone in having to wait a long time to see a psychiatrist. For a wide variety of reasons, access to mental-health services is a big problem in Canada, and that’s got some experts thinking about new and innovative ways to deliver care.

“Not every interaction has to be a health professional sitting in a room with a patient,” says Dr. Ed Brown, chief executive officer of Ontario Telemedicine Network (OTN). “There are other ways to support people.”

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OTN, a not-for-profit organization funded by the provincial government, is best known for creating a video-conferencing network that enables Ontario patients who live in remote locations to have virtual doctor appointments in their communities.

Based on a similar principle of virtual care, OTN has contracted with a British company to provide mental-health support through a website called Big White Wall (BWW).

The website serves as a forum where people with depression and anxiety can express their feelings and provide support to each other 24/7.

It also offers mental-health improvement tools including online group courses for dealing with issues such as depression, anxiety, weight management and quitting smoking.

A key feature of BWW is that everyone is anonymous. “It’s a space where people can feel comfortable sharing their thoughts and not reveal who they are,” says Harriet Ekperigin, senior business lead at OTN.

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She says the fear of being judged harshly by family and friends often prevents people from opening up about what’s bothering them.

BBW is monitored by mental-health counsellors called “wall guides,” who will intervene if people are making inappropriate comments or someone seems about to inflict self-harm. A wall guide will assess the person and can provide contact information for a local crisis-support centre – if it’s needed.

The website is available free to Ontario residents over the age of 16. The cost is covered by the Ontario Ministry of Health and Long-Term Care.

BWW was started in Britain in 2007 and won accolades from the mental-health community – as well as from the U.K.’s Prince Harry. It was then adopted in New Zealand.

About 10,000 Ontario residents have signed into the BWW website since April when it became available in the province. Brown says other provinces have expressed an interest in offering their residents access to the site, too.

BWW is part of a growing trend of providing mental-health assistance digitally or virtually.

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Another example is the recent launch of a national “Crisis Text Line” that enables young Canadians to connect with mental-health responders via text messages.

In some cases, these services are meant to fill the gap while patients wait to see a psychiatrist or start other forms of therapy. In other situations, they may provide all the help the person needs.

“Obviously, Big White Wall is not for everyone. But for certain populations of patients, it works,” Brown says.

What can be said with some certainty is that more people are going online to diagnose themselves and look for treatments even before they see a health-care provider, says Dr. Carolyn Boulos, a youth psychiatrist at Sunnybrook Health Sciences Centre in Toronto.

“Big White Wall is one of the more reliable and comprehensive websites compared with other sites they might be researching,” she says.

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Boulos says she sees value in people sharing their experiences with those who have similar problems. “Having another person understanding what you are going through can be comforting,” she says.

Affordability is also an issue. Provincial and territorial health-insurance plans will pay for an appointment with a psychiatrist, but most of them don’t usually pick up the tab for seeing a psychologist. As a result, the guidance provided by psychologists is out of reach for many people.

Online and virtual support can break down the financial barriers to care. “It really is open to everyone,” Boulos says. She says she often recommends mental-health-related apps to her patients.

Boulos says patients who are waiting to see a psychiatrist can ask their family doctors for digital and virtual options that might be appropriate for them.

“There are usually a number of different tools that can be helpful,” she adds. “If symptoms get worse and the person has suicidal thoughts then this is best assessed by a health-care professional.”

Paul Taylor is a patient navigation adviser at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

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