Understanding Nova Scotia's new virtual care policies: mental health policy and rural Nova Scotians
LE3 .A278 2023
Bachelor of Arts
The COVID-19 pandemic placed the Nova Scotian healthcare system in an impossible situation. While demand escalated, many in-person services were shut down. Simultaneously, the pandemic had devastating effects on mental health across Canada. Facing widespread staffing shortages and rising wait times, policymakers were confronted with the need to adapt rapidly. In response, the Nova Scotia Government accelerated virtual care, offering it as an alternative to in-person services. Prior to the pandemic, rural Nova Scotians faced additional barriers to accessing mental healthcare. Thus, investigating how the shift to virtual care exacerbates or reduces pre-existing rural barriers is essential to policy evaluation. This thesis asks; (1) How did the Nova Scotia Government’s mental healthcare policy approach change in response to the pandemic?; and (2) Did those changes respond to the needs and priorities of rural Nova Scotians? To answer these two questions, I analyze data from Nova Scotian mental healthcare policies, proposals, and programs and interviews with 16 Nova Scotian mental healthcare practitioners, using critical care ethics as a theoretical framework. I argue that Nova Scotian mental healthcare policy has moved through overlapping waves of deinstitutionalization, policy development, damage control, tiered care implementation, and acceleration. New Nova Scotian virtual care policies are fiscally responsible and offer rural Nova Scotians some benefits, overcoming geographical and financial barriers and privacy concerns. Yet, I suggest that virtual care policies are a further extension of deinstitutionalization which does not meet rural Nova Scotians’ unique and diverse needs. Virtual care policies overlook and exacerbate pre-existing barriers, including internet issues, isolation, and access to culturally competent care. Improving virtual care for rural Nova Scotians will require addressing the effects of this new wave of deinstitutionalization of care to the private sphere and prioritizing contextual sensitivity. This thesis offers several policy suggestions based on practitioners’ observations. Key recommendations include: implementing core funding for the Canadian Mental Health Association Nova Scotia Division and other non-profit organizations; establishing new provincial initiatives to spread awareness about available virtual care services; expanding hybrid options that combine in-person and virtual modalities; creating new spaces for rural practitioners and communities to participate in mental healthcare policy and program design, supported by federal and provincial government funding; extending insurance coverage classifications to include registered counselling therapists; and increasing internship opportunities and funding in rural communities to attract new mental healthcare practitioners.
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