Impact of the Pandemic on Rural/Remote Mental Health and
Substance Use. Overview of developing issues and unique challenges.

Our new policy brief examines the pandemic’s distinct impact on mental health and substance use in rural and remote communities, which is brought to life through a case study from the community of Princeton, British Columbia.

COVID-19’s continuing impact on mental health and substance use has shed new light on the growing need and decreasing access to adequate services and supports for people in rural and remote communities. Health equity issues, the unique context, and influence of the social determinants of health are making these individuals even more vulnerable to the pandemic’s effects.

Although governments have quickly pivoted to provide innovative virtual services, challenges across the mental health system remain, and rural and remote communities still lack access to timely and appropriate services.

Given the pandemic’s expected long-lasting effects on mental health and substance use, the post-pandemic period will be critical.

The policy brief — The Impact of COVID-19 on Rural and Remote Mental Health and Substance Use — contributes to the ongoing collaborative efforts to transform the system and address the unique impacts of COVID-19 for mental health and substance use of people living in rural and remote communities. In making new policy recommendations, it draws on a case study as well as some of the practical approaches and best practices developed domestically and internationally.



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.

Key messages

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The Mental Health Commission of Canada (MHCC) operates primarily on the unceded traditional territory of the Anishinabe Algonquin Nation, whose presence here reaches back to time immemorial. The Algonquin people have lived on this land as keepers and defenders of the Ottawa River watershed and its tributaries. We are privileged to benefit from their long history of welcoming many nations to this beautiful territory. We also recognize the traditional lands across what is known as Canada, on which our staff and stakeholders reside.

Our policy research work uses an intersectional sex- and gender-based plus lens to identify, articulate, and address health and social inequities through policy action. In this respect, it is guided by engagement with diverse lived experiences (and other forms of expertise) that shape our knowledge syntheses and policy recommendations. We are committed to continuous learning, and we welcome feedback.

The MHCC would like to thank the Princeton Community Health Table and our other partners, external reviewers, and staff for their important and valued contributions to this work.


Nelly D. Oelke, PhD, RN, Associate Professor, University of British Columbia school of nursing, Okanagan Lauren Airth, MSN, RN, University of British Columbia school of nursing, Okanagan

Expert reviewers

Carolyn Szostak, PhD, Associate Professor, University of British Columbia department of psychology, Okanagan

Rebecca Jesseman, MA, Policy Director, Canadian Centre on Substance Use and Addiction

Matthew Young, PhD, Senior Research and Policy Analyst, Canadian Centre on Substance Use and Addiction

Denika Ward, Community Suicide Prevention Coordinator, Roots of Hope Project — Eastern Health

Tanya Wilson, Senior Health Consultant, New Brunswick Department of Health, on behalf of the Roots of Hope New Brunswick team: Dr. Jalila Jbilou, coordinator Celine Fortin, Serge Robichaud, and Dominic Bourgoin.

MHCC staff

Katerina Kalenteridis, Francine Knoops, Dr. Mary Bartram

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.53 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 Table (PCHT).

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:

  1. Develop a community-driven package of mental health/substance use improvements.
  2. Study the implementation of specific enhancements to mental health/substance use service accessibility.
  3. Evaluate the outcomes attributed to the implementation of mental health/substance use service advancements.
  4. Sustain progress via new partnerships and existing community partnerships.
  5. Develop a transferable and adaptable model for implementing improved mental health/substance use services in rural and remote B.C. communities.

Current PCHT activities

1. Increasing awareness of mental health and substance use and the available services and supports:

2. 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 (inclulding 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.