COVID-19 and Mental Health (CMH) Initiative: Research

Pandemic-Proof: Synthesizing Real-World Knowledge of Promising Mental Health and Substance Use Practices for Young People Who Are Experiencing or Have Experienced Homelessness

Key Messages

  • The majority of providers are reporting concerning increases in mental health challenges and substance use among the youth they serve. Approximately 1/3 are reporting increases in suicidal ideation and drug overdoses.
  • The majority of providers have adapted their practices by connecting virtually or over the phone; however, this can be problematic for young people with no internet or phone access and for those living in unsafe situations.
  • Promising practice adaptations include: holistic mobile outreach (e.g., mental health and substance use supports combined with meals and art supplies), “live” virtual drop-in sessions on social media platforms, and “self-serve” virtual applications.

Lay Summary

Pandemic Impacts on Mental Health and Substance Use Patterns

Provider perspectives regarding pandemic impacts on mental health and substance use patterns are insightful and alarming. Overall, these insights paint a picture of young people and providers struggling to adapt to pandemic-related closures. Moreover, current public health restrictions and ensuing service limitations operate on the premise that young people: have a place to isolate; can isolate safely and with others; can afford phones/computers; and have access to the internet.

Practice Adaptations

Despite the need for enhanced mental health and substance use supports, most agencies/organizations have either shut down their services entirely or (more commonly) moved them all off-site. This is understandable given the requirement to align with pandemic-related public health measures; however, the implications for young people who depend on these services – especially the most marginalized (e.g., transgender, refugee, and street-entrenched young people) – are worrisome. Additionally, as we head toward the winter season and the weather becomes colder, the demand for on-site services will likely rise.

Promising and Transformative Approaches

Despite the unprecedented challenges brought about by the COVID-19 pandemic, front-line providers have adapted remarkably. While there is still a great deal to learn about the effectiveness and sustainability of these adaptations, we believe some may hold promise as a better way of addressing the mental health and substance use needs of young people who are experiencing or have experienced homelessness. Notably, almost three quarters of providers believe their mental health adaptations hold post-pandemic promise. However, when asked about adaptations related to substance use, only about half of providers believe their adaptations hold post-pandemic promise and 40% are unsure – the latter notion of uncertainty a narrative that kept emerging during our data analysis specific to substance use.


  • Youth
  • Homelessness
  • Substance use
  • Mental health
  • Interventions
  • Health equity
  • 2SLGBTQ (two-spirit, lesbian, gay, bisexual, queer)
  • Socioeconomic inclusion
  • COVID-19
  • Pandemic


  • Nominated Principal Applicant: Naomi Thulien, NP-PHC, PhD, McMaster University School of Nursing
  • Thulien, N.S., School of Nursing, McMaster University, Hamilton, ON; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON
  • Noble, A. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON; Covenant House Toronto, Toronto, ON
  • Daley, M., The Lived Experience Lab, Toronto, ON
  • French, D.,  A Way Home Canada, Toronto, ON
  • Hwang, S.W., MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON; Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON; Dalla Lana School of Public Health, University of Toronto, Toronto, ON
  • Kidd, S, Department of Psychiatry, University of Toronto, Toronto, ON; Psychology Division, Centre for Addiction and Mental Health, 1001 Queen St. W., Unit 2-1, #161, Toronto, ON

For more information, please contact: Dr. Naomi Thulien,

Related Syntheses


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Vulnerable or At-Risk Populations


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