Guest editorial

By Mary Bartram and Kathleen Leslie

More than one in three Canadians report serious mental health concerns, and one in four report problematic substance use, according to the most recent data from the Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction. These are staggering numbers.

The impacts of the global pandemic on the mental health and substance use of the Canadian population are proving to be complex -- and persistent. The mental health and substance use health workforce is the backbone of the critical response but is at risk of being overshadowed by the crisis in the broader health workforce.

Regulation of this field would help provide Canadians with more equitable access and enable needed critical workforce planning. The federal government has an important role streamlining this process in partnership with the provinces and territories -- and in creating a new national health workforce registry, which would help the health system as a whole.

Mental health and substance use health counselling in some parts of Canada right now is a bit of a wild west.

If you go to a regulated psychotherapist or counselling therapist in Nova Scotia, New Brunswick, Quebec, Ontario or PEI, you will know what kind of service to expect, who is providing it and what kind of accreditation they’ve received. You are also more likely to get these regulated services paid for by the province, or at least partially covered by your workplace benefits program if you are fortunate enough to have one.

But if you live elsewhere in Canada, many provinces and territories have yet to move forward with psychotherapy regulation. This means you won’t know what you’ve signed up for.

Some protections are in place through the voluntary certification and competency frameworks of provincial associations, but services from these providers may not qualify for public and private funding. And from a health planning perspective, understanding the supply of these mental health and substance use providers is more difficult.

In this way, the fragmented regulatory landscape for mental health and substance use health providers across Canada is undermining equitable access to services and inhibiting our capacity to undertake workforce planning.

Our current research, led by Athabasca University in collaboration with the University of Ottawa and the Mental Health Commission of Canada, is zeroing in on both key barriers and facilitators to these critical regulatory reforms.

For example, progress in New Brunswick was helped by a unique approach.

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By Celine Zadorsky

Published in Molecular Medicine, researchers at Lawson Health Research Institute have found that patients with post-COVID-19 condition (long COVID) have unique biomarkers in their blood. The team is now working on developing a first of its kind blood test that could be used to diagnose long COVID. The discovery could also lead to new therapeutics for this condition.

Long COVID occurs when someone experiences symptoms like fatigue, cognitive issues, shortness of breath and gastrointestinal issues after an initial COVID-19 diagnosis. It can sometimes take up to 12 months for the condition to occur.

“It’s estimated that 30 to 40 per cent of patients with COVID-19 will develop long COVID,” says Dr. Douglas Fraser, Lawson Scientist and Critical Care Physician at London Health Sciences Centre (LHSC). “Physicians currently rely on symptoms alone to diagnose the condition, but our research offers a unique profile of blood biomarkers that could be used in a clinical test.”

The researchers studied 140 blood samples from participants at LHSC and St. Joseph’s Health Care London, including St. Joseph’s PostAcute COVID-19 Program. Participants were those with presumed long COVID, hospital inpatients with acute COVID-19 infection and healthy control subjects.

“We chose to study blood vessels that link all the body systems together to look for changes after an acute infection,” explains Dr. Fraser, who is also a Professor at Western University’s Schulich School of Medicine & Dentistry.

The team found that blood vessels of those with presumed long COVID were changing rapidly after a confirmed COVID-19 infection. They also found that patients with long COVID had 14 elevated blood biomarkers associate with blood vessels. With the help of machine learning, they discovered that two biomarkers called ANG-1 and P-SEL could be used to classify long COVID with 96 per cent accuracy.

“Long COVID is a relatively new condition and we have much to learn about it,” says Dr. Michael Nicholson, Associate Scientist at Lawson, Respirologist at St. Joseph’s and Associate Professor at Schulich Medicine & Dentistry. “This research advances our understanding of long COVID with the potential to improve diagnosis and patient care.”

The advantage of biomarkers is that they not only help diagnose a disease but also provide insight into potential treatments. The team is now focused on using their findings to create a clinical diagnostic test with a goal of also exploring therapeutics.

“With a point-of-care diagnostic test, we could confidently diagnose long COVID and eventually develop targeted therapeutics against these blood vessel changes that we have discovered,” says Dr. Fraser. “The ultimate goal is to improve patient outcomes following a long COVID diagnosis.”

This research was supported by funding from London Health Sciences Foundation, London Community Foundation and the AMOSO Innovation Fund. It builds on a growing body of COVID-19 research from scientists at Lawson Health Research Institute.

The study’s first author Maitray Patel, is a PhD student from Western’s Schulich School of Medicine & Dentistry. Patel worked on blood analysis under the supervision of Drs. Doug Fraser and Mark Daley. ■ HDr. Douglas Fraser, Lawson Scientist and Critical Care Physician at London Health Sciences Centre.

Dr. Michael Nicholson, Associate Scientist at Lawson, Respirologist at St. Joseph’s and Associate Professor at Schulich Medicine & Dentistry. Celine Zadorsky is a Communications Consultant at Lawson Health Research Institute.

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