‘The big advantage of being Irish is we always look out for each other’

The Irishman looking after the mental health of frontline medical workers in Toronto

Mícheál O’Rourke, from Co Armagh, lives in Toronto, in Canada, where he is a mental-health clinician on the frontline of the coronavirus pandemic. There are 30,860 confirmed cases of Covid-19 in Ontario and 2,450 deaths.

When and why did you leave Ireland?
I left Ireland on June 25th, 2014. My partner, Leah McCullough, and I flew straight to Toronto and have stayed here ever since. There were a number of factors to emigrate. I was finding it a challenge to find a job specific to my education, psychology. I did have a full time job working in Newry but wanted to explore this further. Living abroad always attracted us, and we wanted to live together and become more independent.

Does living in Toronto have any similarities to living in Ireland?
There are not many comparisons if truth be told. Toronto is a large urban area and much different to South Armagh. The city is the financial hub of the country,  and the local towns and cities form what is known as the Golden Horseshoe. It's a pretty large urban and industrial corner of Canada. Toronto is also extremely diverse in its cultures. It's a country that has embraced the positive attributes that immigrants can provide. I've many friends and colleagues from continents across the world. The weather in Canada definitely plays a part in what you can and can't do. Ireland's weather does not have the extremities as Canada. What Ireland and Canada do share is access to beautiful countryside. Just an hour out of the city, you can get lost in some of the best parks and outdoor activities that you could ask for.

How has Covid-19 affected Toronto?
Coronavirus shut down the city. Toronto has a big population, almost three million, and the metropolitan area is the fourth largest in North America, with only New York, LA and Mexico City larger. The population size meant there was a need to be extremely cautious about containing the spread of Covid-19. The Ontario government acted quickly on the Emergency Management and Civil Protection Act, which gives the premier of Ontario the power to declare a state of emergency to protect the health and safety of the public. It has rarely been used before. This act has been extended to June 15th.


I believe Toronto might have had an advantage in being ready for this as the Sars pandemic in 2002 had a huge impact on healthcare, the economy and particularly our hospitals here. My staff often reminisce about this time. There are many differences to coronavirus, but because of Sars, the hospitals had emergency procedures in place if another pandemic occurred.

Where do you work?
I work for University Health Network (UHN) in Toronto. I work at one of five sites within the network, a place called Toronto Western Hospital. I'm a registered psychotherapist, and a team lead for English and Spanish mental health programmes here at the hospital. I also work for the Irish Canadian Immigration Centre here in Toronto. The centre offers support and information on immigration and employment. I've been involved in the social service support. I also have a private practice and provide supervision for qualifying members to the college of psychotherapy.

What have you noticed to be the main issues frontline workers have experienced during this pandemic?
The first is the long hours some have to endure. Lack of sleep, fatigue, tension among peers, which is constantly on repeat while coping with the uncertainty of when this will all end. Moral injury is a term that has been used to describe what frontline workers are experiencing. This is when their values are tested to the extreme, having to make some really difficult decisions that are at times the difference between life and death. All of the training and beliefs they have, not just about their jobs but also other factors in their life, are not making sense right now.

I'm surprised at how resilient people are. This is a very real crisis psychology situation people are working in. So many of the workers I have spoken to demonstrate an amazing capacity to tap into their own strategies to cope. Now and again a little reminder of not to forget the basics is all that is needed.

What does your day look like now?
I'm juggling a lot right now. I travel to work every day. As an essential staff member at a hospital, it is all hands on deck to support in anyway way we can. First and foremost, my role is still as a team lead. I support other mental health clinicians, but also learn from them too. I also still see my own patients virtually or through telephone but the number of people I see has significantly reduced since Covid-19 measures came in. The hospital has restricted non-essential services to prevent people coming to hospitals. There is also a new internal support line set up within the hospital to support our frontline workers. The hospital is large with almost 16,000 employees, so they need to be supported l emotionally at this time.

Since the pandemic started I’m involved in screening patients and visitors coming through the hospital doors for Covid-19 like symptoms. I also spend time most evenings and weekends being available to support the Irish community across Canada for Irish Canadian Immigration Centre.

What support to workers in the health service are you involved with?
When the pandemic broke out, I became part of an internal hospital initiative for a peer-to-peer support line for frontline workers. The line is an anonymous option for any staff within UHN. We provide emotional support and a listening ear. I counsel frontline workers and lead a team to give support any issues that come through the door.

The mental health programme I work in also has a specific Spanish, Portuguese and Asian languages speaking programme for the local community as the city is very multicultural. It’s a diverse city, but this unfortunately means that there are also many people disconnected from their families abroad because of the travel restrictions.

Outside of my hospital work, I’m also part of a wider mental health support network in Ontario. We are a volunteer network of Ontario-based mental health professionals dedicated to supporting frontline Covid-19 workers during the evolving crisis.

How has people's mental health been impacted by coronavirus?
It's uncertain when the Covid-19 pandemic might end and how far things return to normality again, if at all. This heightens stress levels and humans need a sense of certainty, it makes us feel safe and secure. Then there is the need to have control over most things in your life. Covid-19 has taken some of this away, but not completely.

How we respond to stress in life is typically dictated by three factors – how much you can predict the outcome of that event, how much control you have over it and how much importance you attach to it. The Covid-19 pandemic ticks all of these boxes and that’s why some professionals have said that it is the perfect storm for anxiety.

First comes health anxiety and the possibility of contracting Covid-19. This extends to your concerns for others such as family, friends and colleagues. You also have to look at what measures this pandemic has needed, such as physical distancing. People are more frustrated, it creates uncertainty about when you might return to your work or office. Your normal routines have been completely smashed and you don’t have that spontaneous freedom that we had pre-Covid.

The biggest concern for me is that people are more isolated because of the physical distancing. There is a lot of research to explain how not having human connection and attachment can create multiple problems.

Covid-19 isn't all negative though. I think we are going to be able to learn a lot about ourselves because of it and embrace these changes for good. I would like to think that people are not going to have their heads down and be stuck to their phone, because as we now know human bonds and connection are what we really miss during this time, not so much how many people like our Instagram or Facebook posts.

What can people can do to look after their wellbeing?
The first thing I will say is humans are incredibly resilient. Don't doubt this. There is always going to be that tussle between what your emotions are trying to tell you and your logical mind. Sure isn't that what makes us distinctly human?

So if we can’t change this, it is a matter of being able to control it just that little bit better. I encourage everyone to be aware of the presence of any anxiety. The key then is not to eliminate all of your problems, as this might lead to an uncontrollable spiral of worry, but to control it. Starting with accepting and tolerating the emotion. It may feel like you have lost control of many parts of your daily routine, but this isn’t completely true. You can still exercise, you can set up Zoom meetings with family, friends and work colleagues, you can spend more time cooking and eating, reading and,you can also control how much time you choose to spend on social media. All of these behaviours also help you to turn off your fight or flight system and tap into your “rest and digest” system.

What I finally will say is to not hide how you are feeling. You have to allow yourself to speak about your experiences. When we share our thoughts, it helps us feel validated and also, perhaps an alternative perspective to what you are thinking now and again is helpful in developing psychological flexibility.

Does being Irish count at the moment?
Absolutely. One of the most important protective factors from developing mental illness at a later stage in life is connection and a community of support. This as you can imagine is a big distinct advantage of being Irish, we always look out for each other. Across Canada during the pandemic, leadership has come to the fore within the Irish community and many have run towards this fight. As an Irish person living in Canada, I take a lot of comfort and reassurance when I see people being visible and supportive at a time like this.

Is there anything you miss about Ireland?
All my family and friends at home. I do of course miss all of them and the connections I have. My family and Leah's both have farms, and so we  certainly miss that space right now. I also crave to go down to my local GAA club and spending hours kicking a football about under the shadow of Slieve Gullion.

However, I take comfort in knowing that the Covid-19 pandemic is a global experience and whether I was at home in Ireland or working here in a hospital in Toronto, our experiences are similarly shared.

How do you think Covid-19 pandemic will impact people after it is over?
I think Covid-19 has created so many challenges and threats to our wellbeing that for many people, it will be another "where were you when 9/11 happened". Covid-19 will be etched in our memory like a bookmark that we will easily be able to jump. I think the pandemic will likely have a much wider impact on the world going forward behaviourally as  I'm not too sure if there are many people who haven't felt a negative impact of all this

What has been really pleasing to see is that although Covid-19 has forced us to stay further apart, many people have now come together and leadership has come to the fore.