Post COVID-19 Pandemic Recovery: Towards More Integrated Health and Social Care Systems That Addresses the Complex Needs of Canada’s Diverse Populations

Introduction

The COVID-19 pandemic has presented many health and social care challenges that have centralized concerns that exist at the intersections of physical and mental health, particularly among equity-seeking populations. Our team of researchers, knowledge users, and patient advisors undertook a scoping review and a rapid realist review to examine interventions to mitigate mental health responses among those with a condition that presents risk of severe COVID-19 infection. This presentation will focus on the findings from the rapid realist review component of our work.

Aims Objectives Theory or Methods

The realist approach identifies contextual factors that trigger underlying, invisible mechanisms associated with intended outcomes, known as context-mechanism-outcomes configurations. Realist literature reviews explain how and why contextual factors act as facilitators or barriers for intended outcomes; they uncover the ‘black box’ of mechanisms. We constructed a socio-ecological Mental Health Promotion Framework with context-mechanism-outcome configurations to explain why certain mental health interventions work and provide guidance for post-pandemic recovery. The Framework has four systems levels: the health policy level; primary health care/integrated care; the community; individuals, families, and caregivers. The five framework mechanisms are: trust, accountability, power, resilience, and social connectedness.

Highlights or Results or Key Findings

Our rapid realist review was a critical assessment of health and social care systems in the context of the COVID-19 pandemic. The review clearly demonstrated the intersections that occur among health and social inequities, physical health, and mental health. The need for more integrated health and social care was evident across all four systems levels with respect to mental health promotion. Societal recovery from the pandemic presents an opportunity to reverse societal imbalances through a comprehensive, inclusive, and integrated 'reset' of Canada’s uncoordinated health and social care systems. Canada has one of the most decentralized governments in the world, comprised of several federal health systems and thirteen provincial/territorial systems that typically operate independently of one another. For example, federal funding mechanisms do not hold the provincial and territorial governments accountable, particularly for social care. A framework that promotes integration within and across systems levels is needed to hold all levels

Conclusions

COVID-19 highlighted health and social inequities in Canada that can no longer be ignored. Better integration of Canadian health and social care systems must be a long-term strategy. Specific contextual factors and underlying mechanisms are associated with improved mental health promotion outcomes for diverse Canadian populations and equity-seeking groups.

Implications for applicability/transferability sustainability and limitations

Effective responses to COVID-19’s aftermath will necessitate health and social care reforms. Our Mental Health Promotion Framework, constructed through a rapid realist review approach, provides evidence for optimal integration of mental health policy and promotion practices across four systems levels of our Canadian public health care system.