After 20 years in the industry, one property manager says he’s seen a fair number of residents struggling with mental health conditions. “We face these things all the time,” says Vadim Koyen, president of CPO Management. “Unfortunately, the number of people who suffer from mental illness are increasing tremendously and those people are living in condominiums among us.”
In Canada, nearly half the population will experience some type of mental illness by age 40 and, in any given year, one in five people is living with mental health problems. Fears and anxieties that COVID-19 is generating may likely have a greater impact on people with pre-existing conditions. This is something high on the radar of mental health professionals right now. “We’re very concerned because the isolation and the economic effects and social limitations can worsen mood and exacerbate pre-existing depression and anxiety conditions,” says Dr. Thomas Ungar, psychiatrist-in-chief at St. Michael’s Hospital in Toronto.
Pandemic impacts are affecting people differently. For some, there is a real worry they may be “catastrophizing and magnifying the effects with their anxiety disorders,” Ungar finds. Others, with a paranoia or social anxiety, are managing a little better because they are isolating at home.
Post-traumatic stress disorder and substance use as a way of coping with stress are other worries. But it’s not just people with pre-existing conditions who face an increased risk of mental health difficulties due to COVID-19. As the Centre for Addiction and Mental Health reports, essential workers, COVID-19 survivors and vulnerable populations need special attention. This includes people in precarious jobs who cannot work virtually.
“I’m most worried about the economic effects for those who can’t cope or distance because of their physical space or who can’t maintain their incomes,” says Ungar. “Those are the vulnerable populations—the ones bearing the extra burden and the population we’re most worried about. They might be more at risk of both COVID and the downstream effects, including mental health, as they can’t distance or keep food on the table or pay rent.” If negative economic impacts kick in, some mental health issues could “start off as real-life stressors and maybe develop into a clinical disorder.”
The possible effects of economic damage seem to be of utmost concern. Also referred to as a fourth wave, the mental health community started bracing for a potential echo pandemic. Canada is currently in a second wave. If a bad economic wave hits as a result of job losses and dwindling government support, worsening mental health effects could follow. But this is a maybe. As Ungar notes, it’s important to have real scientific evidence backing up concerns, as this fourth wave might be more worried-based. “We will see if it is actual, or maybe it will be limited to vulnerable populations; we just don’t know yet.”
According to a study published last year in peer-reviewed medical journal, The BMJ, suicide rates are not going up in the developed world; reports suggest no rise or even a drop in the early months of the pandemic. But as the study cautions, it is too early to declare what the ultimate effect of the pandemic will be, and people should remain alert to emerging and known risk factors.
For those struggling with serious conditions, COVID-19 has also disrupted access to care. As CAMH states, many with more complex mental illnesses benefit best from in-person services. There is also concern that this marginalized group will continue to be neglected, as they have in the past, by mental health and social services systems.
Often, property managers and condo boards won’t know someone is suffering from a condition until there is an episode or behaviours escalate. “We can try to be very gentle with them—to help them without interfering with their privacy, without any sharp movements and make them comfortable,” says Koyen.
He thinks back to his own experiences with residents who were recovering in mental illness after an episode.
“Sometimes there are no family members around, so in these very traumatic times we need to be helpful,” he says. “When they are recovering, we sometimes buy their groceries, offer a listening ear, direct them to a safe place to get some fresh air and try to stay in contact. There is nothing in the Condo Act which directs us to do that; it is strictly a social call.”
The role of the corporation
The role a condo corporation plays in the life of a resident struggling with mental illness can often be a delicate matter, especially if the resident has no family support system to help de-escalate troubling behaviour.
Condos have a duty to accommodate residents they suspect may be struggling with mental illness—a recognized disability under the Ontario Human Rights Code. It is a duty that is both procedural and substantive, says condo lawyer Natalia Polis of Lash Condo Law. She explains that corporations must engage in “good faith discussions with the resident to determine their needs, obtain relevant information, and consider various options for accommodation,” but they must also “apply accommodation plans for the resident and adhere to the policies in a non-discriminatory fashion.”
She adds this duty to accommodate is only up to the point of undue hardship, and, in the process, documentation is key, including all correspondence, verbal discussions or meetings.
“In the event that either the resident is unwilling to engage in the accommodation process or, if an accommodation plan is set in place and the resident’s behaviour continues to the point of undue hardship, the corporation can take enforcement steps and the documentation would be necessary to show that the corporation took reasonable steps to try and accommodate the resident without success.”
Managers may be tasked with difficult conversations to inquire about one’s mental health state, while not encroaching on their privacy. As Polis says, such medical information can be obtained, but with certain limitations.
“The board has a duty to undertake proper due diligence in all matters concerning the corporation’s affairs, including with respect to exemptions from the restrictions in the declaration, bylaws and rules for accommodation purposes,” she says, adding, “Corporations can inquire what the resident’s medical needs are, but not the diagnosis. The corporation can request the information directly from the individual or, if the individual permits, the corporation can seek this information from a family member, friend or their physician.”
In the event an episode occurs, it is often a sensitive situation. If it appears a resident is having a severe episode, if there is concern for the individual’s safety and the safety of others in the condo, especially if no family or friends can be contacted and the resident has not provided any documentation or confirmation that they suffer from a mental illness, she advises the corporation might then want to consider obtaining a psychiatric assessment—to help determine whether a condition exists and how best to accommodate the resident. This can be obtained through a justice of the peace or by calling 911. “It really depends on the nature of the behaviour,” she says. “If the individual is threatening to inflict self-harm or threatening others, calling 911 would be the most appropriate in the circumstances.”
The corporation should advise police that the individual is without family members and request an assessment and, once they arrive on scene, should give them a one-page document outlining the individual’s conduct that prompted the call. “Under section 17 of the Mental Health Act, police have the authority to take the person to the hospital for assessment,” she adds. “The police must be satisfied that the individual has a mental health issue and there is a risk of harm to themselves or others in order for them to proceed with taking the individual to the hospital for an assessment.”
If a resident is checked into a hospital, corporations are advised to offer up any other information that can support the assessment. “This requires the physician complete a Form 1 pursuant to section 15 of the Mental Health Act,” says Polis. “If the individual has no one in their family to act as their substitute decision maker, the public guardian and trustee may be contacted.”
Better response to mental health emergencies
Provincial initiatives have highlighted the urgency for better response to such mental health emergencies, as police officers often lack specialized training and hospital visits are not always ideal.
“We know that more needs to be done to tackle the mental health crisis in our communities,” says Stephen Warner, press secretary and issues manager at the Office of the Solicitor General. “The nature of community safety and policing is changing: police officers are increasingly being called upon to respond to complex situations involving vulnerable individuals experiencing mental health crises.”
The Canadian Mental Health Association has long been advocating for 24-7 mobile crisis intervention teams to arrive first on the scene when a mental health or substance use emergency call is made. Police services in several jurisdictions, including Hamilton and Toronto, have already implemented these programs, which can assist condo management with such delicate situations.
Mental health professionals are paired with police officers to respond to such calls reported through 911. They are able to help de-escalate and stabilize persons in crisis, divert individuals from emergency departments whenever appropriate, and connect that person to community resources to address physical and mental well-being over the longer term.
More recently, Peel Regional Police and the CMHA Peel Dufferin Branch partnered to launch the program earlier last year. As COVID-19 has fueled the demand for services, in mid-November of 2020, the province announced critical new funding; the goal is to help 33 communities expand or launch mobile crisis programs.