Oct 26, 2021
This policy brief provides an overview of the developing issues and unique mental health and substance use challenges that COVID-19 poses for rural and remote communities. It builds on a preliminary scan the Mental Health Commission of Canada (MHCC) completed at the outset of the pandemic and on an evidence brief on best and promising practices written just before it began. The current brief includes an updated literature review, a section on diverse populations and social determinants of health, domestic and international policy responses, and policy recommendations. Also included is a case study that highlights the British Columbia (B.C.) community of Princeton, in collaboration with the Princeton Community Health Table. Its primary audience comprises policy makers and organizations across the mental health and substance use sectors that serve rural and remote communities.
- The COVID-19 pandemic continues to have a substantial impact on the mental health and substance use needs in rural and remote communities and on a growing lack of access to adequate and timely services and supports.
- The unique context, the influence of the social determinants of health, and health equity considerations play major roles in how COVID-19 affects these communities in terms of mental health and substance use.
- Provinces and territories pivoted quickly to provide innovative virtual mental health and substance use services. However, the lack of access to broadband internet coverage and information and communication technology (ICT) make it harder for people living in rural and remote communities to access services and supports.
- The pandemic has been a challenge on the resources, capacity, and solidarity of rural and remote communities but has reinforced the importance of resilience.
- Given the pandemic’s expected long-lasting effects on mental health and substance use, the post-pandemic period will be critical. It will also be an opportunity to transform the system and address unique impacts for people living in rural and remote communities.
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Case Study: Princeton Community Health Table
Description of the community
Princeton is a beautiful town, situated in the Similkameen Valley and surrounded by mountains, as
seen in the pictures below. Among the 4,780 people who live there, the majority are 50 and older. Over 10 per cent of the population identifies as Indigenous. While the mean income is $57,000, eight in 10 residents fall below the poverty line. Mental health and substance use have both been identified as significant concerns. The rates of anxiety, mood disorders, and depression are eight times as high as those in the rest of the province, and like many rural communities in B.C., the community suffers disproportionately from the toxic drug crisis and consistently has one of the highest drug-related death rates per capita. Over the past year, these high rates of mental health and substance use have been further exacerbated by the COVID-19 pandemic.
Like other rural communities, Princeton has more limited resources for addressing mental health
and substance use concerns than urban settings. Currently, it has one mental health and substance use counsellor, one mental health adult psychiatric nurse, one youth mental health worker, and one outreach worker (shared with another town about 45 minutes away). These limits make it difficult for the community to provide services and supports that are adequate for the population’s needs. Another concern is the ability to retain staff, which is common in rural settings.
Despite these challenges Princeton has many strengths, which include the high level of resilience
common to rural communities and the many people and organizations who work together to
address the needs of community members. One such initiative is the Princeton Community Health
Development of the PCHT
The PCHT was formed in June 2020 as part of the BC Rural and First Nations Health and Wellness Summit, sponsored by the Rural Coordination Centre of BC and the First Nations Health Authority.
At the summit, partners came together to discuss and plan for health services delivery in Princeton
and surrounding areas. The PCHT identified mental health and substance use as priorities for the
health and wellness of the community. The group began with eight members representing various
partner groups, including community members, providers, policy makers, and academic partners. It decided to continue to meet after the summit to plan, develop, and implement various community based activities to promote mental health and well-being. The final makeup of the group provided a strong representation of community members who could lead this grassroots initiative to improve services and supports for the community at large.
Today, PCHT membership includes 14 people representing several organizations:
- Support Our Health Care
- Princeton and District Community Services Society
- Princeton Family Services Society
- Vermillion Forks Métis Association
- Okanagan Regional Library
- School District 58
- Princeton Secondary School
- Vermillion Forks and John Allison Elementary schools
- Town of Princeton
- Princeton Regional Hospital
- Princeton RCMP Victim Services
- Princeton Community Support
- Upper Similkameen Indian Band
- University of British Columbia, Okanagan
The PCHT meets every four to six weeks.
Goals of the PCHT
- Develop a community-driven package of mental health/substance use improvements.
- Study the implementation of specific enhancements to mental health/substance use service
- Evaluate the outcomes attributed to the implementation of mental health/substance use
- Sustain progress via new partnerships and existing community partnerships.
- Develop a transferable and adaptable model for implementing improved mental
health/substance use services in rural and remote B.C. communities.
Current PCHT activities
• Increasing awareness of mental health and substance use and the available services and
• two brochures (adults and youth) that include information about local and provincial
•education sessions for students in the Princeton Secondary School
• Princeton Secondary School forum with Jack.org speaker
• virtual public forum on Breaking the Stigma
Providing services and supports:
• Working in partnership with the South Okanagan Women in Need Society, a Penticton based agency that comes to Princeton one day each week to provide drug-testing resources and harm reduction information. Also offered is a pop-up table for health information (including COVID) and basic wound care, along with other harm reduction materials.
Successes and challenges
As the PCHT continues to work toward its goals, one significant success is the enthusiasm and commitment provided by its individual and organizational representatives and the new partnerships being developed. A second success has been a practicum with two fourth-year nursing students in Princeton, supported by the school of nursing at the University of British Columbia, Okanagan. These students worked half their hours with the PCHT in the community and the other half in the local hospital, contributing to various PCHT activities (e.g., the two brochures, education materials for secondary school students). Also, by connecting what was happening in acute care with what was occurring in the community, the students were able to see the importance of prevention and early intervention as a way to better serve those who live with mental health and substance use needs. A third PCHT success has been the strong partnership with the secondary school in Princeton, which enabled it to deliver education and awareness for the students. Having a student PCHT member has been key to facilitating this connection.
Alongside these successes, two main challenges remain. One is developing a strong connection, both with organizations that deliver harm reduction services and the individuals who use or may need them. The PCHT continues to build partnerships with additional organizations to explore further services and supports for this population. Funding is also a major challenge. While the PCHT has applied for numerous community-based and research funding opportunities, apart from some funding for the printing of brochures, it has had minimal success to date.
The PCHT has brought together a grassroots group of individuals and community organizations that have prioritized the mental health and substance used needs in their community. It includes a broad representation of partners who are working together to address these areas, which is particularly important in the pandemic context. Following some early successes, the PCHT continues to work on various activities and approaches to address the needs of community members. Despite some current challenges, the PCHT’s commitment to improving the mental
health and well-being of the Princeton community continues to be at the forefront of its work.