Covid-19 Mental Health Report | Islamic Relief Canada

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Who gets to heal? The negative mental health outcomes of COVID-19 on racialized working women WHO GETS TO HEAL? THE NEGATIVE MENTAL HEALTH OUTCOMES OF COVID-19 ON RACIALIZED WORKING WOMEN

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Acknowledgements PRINCIPAL AUTHORS AND RESEARCHERS

Grace Barakat PhD Candidate | York University Dr. Brenda Spotton Visano PhD, University Professor | Economics and School of Public Policy & Administration Faculty of Liberal Arts and Professional Studies

EDITORS

Miranda Gallo Policy, Research and Advocacy Advisor | Islamic Relief Canada Zoe Sheikh Research Assistant | Islamic Relief Canada

This work was supported by Mitacs through the Mitacs Accelerate program.

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Table of Contents 2

Executive Summary

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Recommendations

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Introduction

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Why Focus on Racialized Women?

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Before the Storm: Pre-COVID-19

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The Uneven Implications of COVID-19

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What We Already Know: A Literature Review of Mental Health Impacts of COVID-19

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General Mental Health Trends

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Women and Racialized Mental Health Trends

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Theoretical Framework: Feminist Political Economy

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Methods

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Limitations of the Study

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Participant Demographics for the Online Survey

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Participant Demographics for the Online Interviews

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Results

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Discussion

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Band-aid Solutions are Not the Answer: Recommendations to Heal the Wound

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Appendix I: Endnotes

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Executive Summary Early into the pandemic, the United Nations raised concerns that the world was facing an unprecedented mental health crisis due to COVID-19. The World Health Organization responded to these reports by releasing guidelines on how to best protect mental health. Canada has not been immune to this crisis, as recent studies have revealed worsened self-reported levels of anxiety and depression across the country – some of which are the highest levels seen to date – with reports of severe depression increasing by 70% since the first wave of COVID-19. As reported in an earilier study by Islamic Relief Canada (IRC) entitled, “Unmasking COVID-19,” women — especially racialized women — have been hit the hardest by COVID-19. This follow-up report examines the negative mental health outcomes of COVID-19 on racialized working women in Canada. Through the use of surveys and interviews, we seek to better understand how racialized women are coping with the ongoing effects of the pandemic and the ways in which they can be further supported in both the immediate pandemic and long-term, post-pandemic stages. It is important to note that the conclusions of this report apply to participants in the study and cannot be generalized to the wider population.

Perhaps the most valuable insight gathered from the surveys and interviews was that the political economy of mental health matters. The harsh reality is that addressing mental health is a privilege and luxury enjoyed by a few. We cannot have discussions on ways to improve mental health without addressing the root causes of this societal problem: social, economic, environmental, and structural inequities. Our research reveals a stark gap between the causes of marginalized groups’ poor mental health and the capacity of mental health services to understand and respond to that. Our findings lead us to conclude that the only effective way to truly repair the deteriorating mental health of racialized women and other disadvantaged groups is to invest in our society and the people who make up its part. The need for affordable housing is immediate, as is the implementation of a living wage. These are the types of structural changes needed to improve the living conditions, and as a result, the mental health of racialized women and vulnerable groups. Without addressing the fundamental needs of individuals, mental health will continue to be a luxury. Despite present and structural shortcomings, there are other mental health related recommendations and policy implications that can add value to the lives of racialized women.

Key findings in this study: + The mental health of the racialized working women surveyed was poor before the pandemic, declined significantly when strict lockdowns were implemented, and rose slightly, but not to their pre-COVID levels when some restrictions were lifted. + There has been an increase in demands for mental health and basic needs services since March 2020 that prevails today. + Racialized women surveyed still face difficulties managing both childcare and paid work which, at times, can result in employment loss. + COVID-19 exacerbated the prepandemic deprivation of basic needs, worsening the mental health of racialized women. + Seeking mental health treatment is a privilege and luxury enjoyed by a few.

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RECOMMENDATIONS + Adopt a holistic approach to mental health that addresses the root causes of poor mental health outcomes including social, economic, environmental, and structural inequities. Combatting systemic injustices starts with eradicating the gendered and racialized wage gap, the glass ceiling, food insecurity, and labour market discrimination. + Raise the minimum wage to a living wage using the Canadian Living Wage Framework. + Ensure that the National Housing Strategy commits to new public, rent-geared to income (RGI) housing and expands the Rapid Housing Initiative (RHI) to adequately meet the needs of Canadians requiring immediate housing. + Incorporate clinical licensed social workers into public healthcare systems. + Add immediate targeted adjustments to the Canada-Wide Early Learning and Childcare System that subsidizes childcare options for racialized women and other vulnerable populations. + Adopt an intersectional and targeted mental health initiative to serve communities experiencing heightened levels of distress and inequity. + Ensure that mental health services are accessible, culturally sensitive to racial minorities, and offered in many different languages. + Integrate more culturally-sensitive public awareness campaigns into communities and educational spaces to end the stigma of mental health. + Broaden the understanding of mental health in Ontario’s Health and Physical Education curriculum for Grades 1-8 to include its connection to societal health. + Integrate community-based non-physician/psychiatrist mental health provider services into OHIP in a similar manner to other healthcare-related services (e.g., doctor appointments). + Remove caps and increase limits on employment benefit plans for mental health services. + Employers should incorporate more options to work-from-home or have flexible schedules into their return to work/office plans to alleviate some of the harassment/microaggressions experienced by women and racialized workers.

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Introduction This follow-up report to “Unmasking COVID-19” examines the negative mental health outcomes of COVID-19 on racialized working women in Canada. Through the use of online surveys and virtual interviews, we seek to better understand how racialized women are coping with the pandemic and the ways in which they can be further supported in both the immediate and long-term, post-pandemic stages. Taking a Feminist Political Economy (FPE) lens to mental health, we explore the structural causes of worsening mental health levels in Canada. Emerging research suggests that frontline healthcare workers1 and women2 are populations most vulnerable to experiencing severe mental health implications during the pandemic. Racialized and immigrant women make up an overwhelming majority of the frontline worker sector, accounting for a large percentage of positive COVID-19 cases amongst women in Ontario.3 The socioeconomic conditions of racialized

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women pose a huge threat to their mental health and well-being.4 Racialized women have been historically marginalized in the labour market. Prior to the pandemic, many were already dealing with the harsh working conditions of precarious employment. Since the onset of the pandemic, a stark increase in unpaid labour, notably among marginalized women, has developed.5 Domestic duties such as childcare are often the most burdensome for racialized workers in precarious situations, as many of their jobs entail emotional and physical labour, low wages, and do not offer paid sick days, thus impeding the ability of these women to access childcare or work from home.6 Reports also suggest that racialized women are subject to greater unemployment rates during the pandemic, with immigrant women losing their jobs disproportionately.7 These financial struggles alone can lead to devastating long-term effects. The gendered burden

of labour in conjunction with other factors such as precarious employment and economic inequity have been taking a toll on the mental health of racialized women for decades.8 Exacerbating pre-existing socioeconomic inequalities, the pandemic has created a mental health crisis across Canada that has the potential of causing prolonged damage. This report begins with a brief summary of the pre-COVID-19 conditions of racialized women and the economic and social impacts of COVID-19 from our previous report.9 Next, we scan the existing literature on the deteriorating mental health of Canadians resulting from the pandemic. The subsequent section contains the method, theoretical framework, and descriptions of the online survey and virtual interviews. Then results are disclosed, and the analysis follows. The report concludes with a critique of mental health research and offers policy recommendations.


Why focus on racialized women? + As a humanitarian organization, it is our mission to address the root causes of poverty & to help those most in need + Most likely to suffer from elevated levels of poverty + Disproportionately concentrated in precarious work + Hold many high-risk jobs in the healthcare field

+ Earn less than their non-minority female and male counterparts + Experience structural racism and discrimination + Encountered increased childcare responsibility resulting from school closures + Had higher levels of unemployment rates than other Canadians before the pandemic and especially during lockdowns

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Before the Storm: pre-COVID-19 Despite Canada’s status as a wealthy nation, poverty, and economic and social inequality, have and continue to be disturbing features of the Canadian landscape. Prior to the pandemic, economic inequality in Canada and many Organization for Economic Co-operation and Development (OECD) countries was on the rise and will likely worsen in the foreseeable future. Before COVID-19, Canada was experiencing an increasing wealth gap between the rich and the poor. We can identify several key trends that have played a role in the widening and embedding of economic inequality: the dismantling of the welfare state and the disinvestment of social welfare programs (the rise of neoliberalism), the implementation of austerity policies10, the shift in the labour market from industrialization to a service/knowledgebased economy, the growth of precarious work, and labour market discrimination and segmentation. These drivers have contributed to the economic inequality we see today.11

In Ontario, women of colour are the most disadvantaged in the labour market. They continue to hold higher unemployment rates (9.6%) than all other Ontarians and are making approximately 59 cents for every dollar that a white male earns.13 This trend has only slightly improved over time - by just five cents since 2006.14 In 2016, visible minorities had an unemployment rate of 9.2%, while white Canadians had a rate of 7.3%.15 Apart from women of colour, men of colour hold the highest unemployment rate at 8.8% and earn approximately 78 cents for every dollar earned by a white male.16 Labour market discrimination has undoubtedly marginalized certain groups of people. For example, despite having post-secondary education, racialized women were the only group17 with a university degree to not experience a rise in their rates of full-time, stable jobs in 2017.18 Since income is an essential component to overall economic welfare, those who experience structural discrimination are at risk of economic exclusion.

Poverty and economic exclusion are directly linked to the structure and organization of the labour market. If specific groups are being streamed into low-wage occupations, or if they are underemployed, they will face economic oppression. As women and visible minorities are concentrated in precarious work, low wages have pushed many into poverty and have held them there longterm.

Moreover, poverty is both coloured and female.19 The feminization and racialization of poverty refer to the increasing tendency of women and visible minorities to experience poverty.20 They have suffered from high levels of poverty well before the pandemic and are more likely to live in poverty than the white population.21

Labour market segmentation12 has streamed visible minorities and women into devalued and deskilled occupations.

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Statistics on poverty clearly indicate that women form the majority of the poor in Canada with more than 2.4 million living on a low income.22 Countless structural inequalities exist which put women at a disadvantage when it

comes to earning power and economic stability. Some women experience more severe economic inequality than others — including Indigenous women, visible minority women, women with disabilities, immigrant women, single mothers, and senior women.23 The gender wage gap has devalued the work women contribute to the labour market, earning them only 67 cents for every dollar non-racialized men earn.24 Women also form the majority of Canada’s minimum-wage workers.25 This has onethird of employed women making less than $15 an hour.26 Additionally, women are more likely to be working part-time.27 Because women spend a large amount of time performing unpaid domestic labour and raising children, many must take on part-time employment. Having to juggle both home and work life forces women to sacrifice their career progression and long-term economic security. Although most of the women suffering from poverty in Canada are employed, precarious and part-time work do not provide the compensation needed to lift them out of poverty. The feminization and racialization of poverty poses a significant threat to economic equality. The damaging nature of these trends continue to harm visible minorities, women and their children. With soaring pre-existing levels of economic inequality, COVID-19 will have the most devastating and long-lasting impacts on these particular groups.

A set of political-economic policies that aims to reduce government budget deficits through spending cuts, tax increases, or a combination of both.

“The labour market is segmented along racial lines, with racialized group members overrepresented in many low paying occupations, with high levels of precariousness while they are underrepresented in the better paying, more secure jobs. Racialized groups were over-represented in the textile, light manufacturing and service sectors occupations such as sewing machine operators (46%), electronic assemblers (42%), plastics processing (36.8%), labourers in textile processing (40%), taxi and limo drivers (36.6%), weavers and knitters (37.5%), fabrics, fur and leather cutters (40.1%), iron and pressing (40.6%). They were under-represented in senior management (8.2%), professionals (13.8%), supervisors (12%), firefighters (2.0%), legislators (2.2%), oil and gas drilling (1.5%), farmers and farm managers (1.2%)”

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In comparison to white males and females, and racialized males

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The Uneven Implications of COVID-19 Various sources reveal that the impact of the pandemic is not being felt equally by all Canadians.28 The outcomes of COVID-19, both economic and healthrelated, have disproportionately affected marginalized communities.29 Evidence continues to indicate that COVID-19 reflects and compounds the existing inequities embedded in our society. Not only do these communities have higher rates of COVID-19 infection and mortality, but they have also struggled with temporary job loss, unemployment, housing and food insecurity, and economic oppression.30 Mortality rates from COVID-19 in ethnocultural neighbourhoods located in British Columbia, Ontario, and Quebec are three times higher than the general public.31 Exposure to COVID-19 varies on the type of employment that workers and their families engage in. Large outbreaks are connected to unsafe workplaces, especially in long-term care facilities and food processing plants where workers did not receive adequate protective equipment.32 Systemic discrimination in the labour market has led to the concentration of racialized workers in many of these high-risk jobs. Black and Filipino female workers are overrepresented in the healthcare field and are typically earning substantially less than their white coworkers.33 Not only are these racialized women more at risk of contracting COVID-19, but they are also earning less money while doing so. Conversely, census data demonstrates that white workers are disproportionately represented in professional and managerial employment.34 This type of

work was able to quickly transition to working from home, which minimized the risk of contracting COVID-19. It also allowed these workers uninterrupted access to their regular incomes. Many lower-paid, hourly workers experienced job loss and went unpaid for a period of time.

Groups hit hardest by covid-19 + Women + Visible minorities + Arab, Black, Latin American, South Asian, and Southeast Asian communities + Households with incomes of less than $50,000 + Overcrowded households

Data also indicate that racialized workers and women have struggled with higher unemployment rates since the pandemic began.35 Women are experiencing disproportionately lower rates of employment than men, with racialized women, facing the greatest disadvantage.36 Those without savings and who depend on their income for survival are in danger

of not making ends meet.37 The ability to buffer income losses resulting from work interruptions is much more limited. Initial reports on the labour market suggest that one-third of workers in most groups experienced job loss or a reduction in working hours.38 Statistics Canada recently revealed that racialized groups are more likely to report strong negative financial impacts related to COVID-19 than their white counterparts.39 Furthermore, “the differences between most visible minority groups and white participants in the financial impact of COVID-19 remained large after taking into consideration their differences in job loss, immigration status, pre-COVID employment status, and other demographic characteristics.”40 Visible minorities are more likely to suffer from poverty and poor housing, and to be employed in precarious positions. All these compounded factors lead to worse economic circumstances. The pandemic has hit women particularly hard as many were among the first to experience job loss amidst the economic shutdown.41 The concentration of women in precarious work has been costly; many of the over three million jobs lost within the first two months of the pandemic were occupied by women.42 With women already suffering from higher rates of poverty than other Canadians, the suspension of income can have astronomical impacts on housing security and economic well-being.

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The Uneven Implications of COVID-19 CONT’D Furthermore, women with children have had to navigate the complexities of childcare and school closures while working from home or commuting to their regular employment. Some women, especially single mothers, are faced with choices between caring for children or continuing to work.43 For two-parent households, coping with the pandemic has reignited conversations about caring responsibilities such as “who cares, who works, and how”.44 Women have been performing more unpaid domestic and childcare duties in comparison to their partners prior to the spread of COVID-19.45 They are far more likely to spend their spare time cleaning, cooking, and caring for children and elderly family members than men.46 COVID-19 has exacerbated these domestic tasks for women, and many have struggled to balance them with their paid employment. The closure of childcare and schools has added a great deal of stress and anxiety on parents.47 By August 2020, the impacts of increased childcare and domestic duties had begun interfering with women’s attachment to the labour market.48 Additionally, it can leave women in unstable and vulnerable positions; they become dependent on their partners for financial stability. Being financially dependent makes it more difficult for women and their children to leave potentially abusive and dangerous households. COVID-19 has further entrenched the gendered inequalities in employment.

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+ Data also indicates that racialized workers and women have struggled with higher unemployment rates since the pandemic began. Women are experiencing disproportionately lower rates of employment than men, with racialized women, in particular, facing the greatest disadvantage.

Rise of precarious work

Feminization & racialization of poverty

Gender wage gap

Income & wealth gaps

Pre-COVID-19 conditionS

Labour market discrimination/ segmentation


What we already know: A literature review of mental health impacts of COVID-19 There has been a considerable amount of research conducted on the mental health outcomes of COVID-19 in Canada and globally. This topic has gained significant interest as lockdowns and restrictions have accelerated social isolation. Although effective in preventing the spread of COVID-19, social isolation and distancing caused an interruption to the lives of many. School closures forced parents to simultaneously manage paid work and childcare/domestic responsibilities leading to changes and disruptions in the mental well-being of individuals, similar to effects detected in the wake of previous natural disasters.49 Although much of the data have predominantly focused on the universal mental health outcomes of Canadians, they

are starting to reveal disproportionate outcomes and expanding health and social disparities between specific groups.50 The data have consistently shown that the mental health of Canadians has deteriorated over the course of the pandemic and continues to negatively impact their lives.51 Despite these findings, gaps in our understanding of whose mental health has been most severely affected and how we can confront mental health disparities moving forward remain. In addition, our report aims to update the mental health literature two years into the pandemic to assess whether mental health impacts have subsided, remained the same, or worsened over time.

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General mental health trends

Mental health of canadians, 2020 In Canada, studies continue to assess the mental health impacts of COVID-19, indicating a growing concern for the overall declining mental health of Canadians.52 Numerous studies indicate that Canadian adults self-reported higher levels of distress, anxiety and negative mental health in response to COVID-19.53 At the start of the pandemic in April 2020, Angus Reid Institute revealed that 50% of Canadians reported their mental health had deteriorated during the first lockdown, with over 40% citing feelings of worry and/or anxiety.54 Similarly, in May 2020, Statistics Canada had similar results revealing a 14% decline since 2018 in the proportion of the population classifying their mental health status as “very good” or “excellent”.55 The average

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life satisfaction in Canada was at the lowest level recorded since 200356 falling from 8.09 to 6.71, a decline of 1.38 points.57 In June 2020, less than half of Canadians (40%) rated their life satisfaction as 8 or above, down from 72% in 2018.58 Jenkins et al. surveyed Canadian adults to investigate the impact of the pandemic on their mental health.59 The survey was distributed via a national polling vendor to a random selection of Canadian adults and was stratified by Canadian socioeconomic characteristics.60 Results concluded that Canadians were facing declining levels in their mental health and coping strategies as a result of the pandemic.61 Moreover, Woodruff et al. investigated physical activity, inactivity, and stress

levels of Canadian adults between April and May 2020.62 Their surveys indicate that inactivity and stress levels increased at the cost of physical activity, which decreased as a result of the pandemic.63 In comparison, Zajacova et al. analyzed the health behaviour changes (e.g. diet and nutrition and screen time) in Canadians in 2020. Using data from the Canadian Perspectives Survey Series 1: Impacts of COVID-19 (CPSS-COVID),64 researchers discovered that more than half of the participants (60%) increased their screen time while 25% consumed more junk food during the early stages of the pandemic.65 Although methodology strategies used in the above studies differ, results are consistent in highlighting an overall decline in the mental health of Canadians.


Women and Racialized Mental Health Trends Although data have confirmed that the mental health of Canadians has suffered, there is a growing body of research addressing the gendered and racialized outcomes of mental health.66 Women, visible minorities,67 and recent immigrants have been identified as groups disproportionately at risk of adverse mental health.68 A recent study by Miconi et al. revealed that female participants reported worse mental health, which suggests that they are suffering to a higher degree than other groups from the negative consequences of the pandemic.69 Interestingly, in households with children, women’s mental health levels fared worse than men’s, with results being statistically significant.70 This may be attributed to school closures and the lack of access to childcare options. These findings can reflect the disproportionate increase in childcare responsibilities that presumably women shouldered.71 Comparably, a Statistics Canada report involving crowdsource participants recorded lower levels of mental health for women in comparison to male participants across all measures.72 The majority of female participants (57%) indicated their mental health is “somewhat” or “much” worse since social distancing began, while 47% of male participants agreed. Females were more likely to report symptoms associated with moderate/severe generalized anxiety disorder, and to feel “quite a bit” or “extremely” stressed.73 Once again, researchers linked these disparities to the potential increase in unpaid family work.74 In addition to school and daycare closures, other interruptions in services such as restaurants and dry cleaners could have added the usually outsourced workload onto women.75

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A study by Nienhuis & Lesser assessed the pandemic-related sex differences in physical activity and well-being and the ways in which barriers to physical activity may explain these differences.76 Through a quantitative analysis, results demonstrated that women were considerably less

Reasons women’s mental health has deteriorated + Increase in child care responsibilities + Less time for self-care + School and daycare closures + Less physical activity + Difficulties juggling paid work and unpaid work + Increase in domestic duties + Loss of employment + Economic hardships physically active than men, and were more likely to suffer from generalized anxiety.77 Women identified COVID-19 restrictions as barriers to their physical activity while attributing their generalized anxiety to changes to work or childcare provision.78 Women engaging in less physical activity reported significantly worse mental health scores (i.e., lower social, emotional and psychological well-being).79

Furthermore, women have been affected disproportionately by economic hardships and increased childcare responsibilities.80 Consistent with other studies, women with increased childcare responsibilities due to lockdowns and restrictions recorded higher levels of anxiety and decreased confidence in being physically active.81 Smith’s (2022) study discovered that tasks of juggling paid work and unpaid work, without childcare support in any capacity, resulted in high levels of stress and anxiety for female respondents.82 Some of the women interviewed spoke of “residual stress that’s just bubbling in the background,” feeling “powerless” and that “it is a nightmare.”83 Managing paid and unpaid work left little time for self-care, further increasing negative mental health outcomes.84 Another survey conducted by Statistics Canada explored the mental health of diverse groups through the comparison of racialized groups—South Asian, Chinese, Black, Filipino, and Arab—to nonracialized groups85 during the pandemic. Using crowdsourced data, three different measures of mental health were studied: self-reported mental health, changes in mental health since restrictions were introduced, and symptoms linked to generalized anxiety disorder. Results revealed that racialized groups have inferior mental health outcomes than white participants, although outcomes differed across racialized groups. Of the five most populous racialized groups in Canada (i.e., South Asian, Chinese, Black, Filipino, and Arab),86 South Asian participants had poorer mental health outcomes than other racialized groups.

Black, Indigenous, People of Colour

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Women and Racialized Mental Health Trends CONT’D Additionally, racialized participants were more likely to suffer from COVID-19related financial insecurity, a potential cause of their declining mental health. Miconi et al. also found racial disparities in mental health outcomes in their study of adults living in Quebec.87 Through an online survey, results indicated that mental health outcomes differed substantially based on socioeconomic status and ethnocultural group.88 Lower-income participants and Arabs participants reported greater psychological distress. In addition, exposure to COVID-19, pandemic-related discrimination, and stigma were correlated with poorer mental health.89 As a result, Black participants were more likely to suffer from higher mental distress.90

Data are exposing the unequal pandemicrelated outcomes and rising health and social disparities among racialized people, women, and recent immigrants. The social determinants of health,91 often hindered by structural inequities, are undoubtedly impeding the well-being and safety of disadvantaged groups. Although the methodologies adopted in the reviewed studies differ greatly, it is evident that the COVID-19 pandemic has negatively influenced individuals’ mental health, especially women and racialized groups.

FEMINIST POLITICAL ECONOMY (FPE) FPE analyses the politics of everyday life, with an interest in analysing how households, markets, states, and transnational women’s activism shape interrelationships between gender, race, and class. It recognizes the importance of social markers such as race and ethnicity, gender, citizenship, Indigeneity, and ability, in the understanding of oppression and social inequalities in the current social, political, and economic climate. Mental health must be examined in the context of the political economy. Health, both mental and physical, is “fundamentally related to the distribution of resources and power, which in turn are linked to gender and race—in short, to the political economy”.

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Theoretical Framework: Feminist Political Economy The political economy of mental health has always mattered. Feminist Political Economy (FPE) is the theoretical framework guiding this study. FPE is a strain of political economy (PE) that analyses the politics of everyday life, with a keen interest in analysing how households, markets, states, and transnational women’s activism shape interrelationships between gender, race, and class. It paved the way for diverse social markers, such as gender and race, to become central departures of analyses in the unpacking of the conflicts and contradictions of capitalism.92 FPE recognizes the importance of social markers such as race and ethnicity, citizenship, sexuality, Indigeneity, and ability, in the understanding of oppression and social inequalities in the current social, political, and economic climate.93 These social markers are not treated as independent categories, but rather as interconnected and historically situated. Health —both mental and physical — is “fundamentally related to the distribution of resources and power, which in turn are linked to gender and race—in short, to the

political economy”.94 This intersectional approach to the construction of inequalities has added significant insight and value to research exploring the complex lives and mental health outcomes of racialized women in the workforce. Since our study is focused on racialized women, FPE can recognize the “gendered divisions of labour” and “the many ways that multiple axes of oppression can come together to differentially frame women’s experiences, opportunities and choices”.95

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Methods This study used a mixed-methods approach to explore the mental health impacts of the COVID-19 pandemic on racialized women in the workforce. Both an online survey and online interviews were conducted. A cross-sectional, online survey through the platform Survey Monkey was used to probe answers relating to racialized women’s mental health over the course of rolling lockdowns96 across Canada. The survey was distributed via snowball sampling through local connections as well as social media groups involving racialized women. It was available for completion during a three-week period between February and March 2022. The online survey was selected as the preferred quantitative method because of its efficiency as a tool for gathering substantial amounts of data in a reasonable amount of time.97 Questions in the survey inquired about mental health, employment during lockdowns, childcare responsibilities, and coping mechanisms. The structure of the questions included multiple-choice, select all that apply, and a few open-ended questions. A descriptive statistical analysis was performed on the close-ended questions using Survey Monkey software.

For the qualitative portion of the study, we developed a semi-structured interview guide and collected data through interviews conducted via the online virtual video platform, Zoom Video Communications. We chose to use interviews for data collection because they are an effective method to generate information from the perspective of service-care providers. They also offer valuable qualitative insights into the lived experiences of racialized working women coping with uncertainties during the COVID-19 pandemic. Service-care providers who work directly with vulnerable communities were recruited for interviews. E-mails were sent to a wide range of non-profit organizations across Canada that support marginalized groups, including racialized women. Islamic Relief Canada has well-established partnerships with many community organizations that agreed to participate in this project. Five interviews were conducted with service providers ranging from caseworkers to directors of programs, to registered psychologists. Interviews were audiorecorded and transcribed immediately following the sessions. Pseudo names were assigned to protect the confidentiality of participants’ identities.

All interviews were held between January and February 2022, some of which occurred during a COVID-19 lockdown. The qualitative data from the semi-structured questions were downloaded into Excel and analyzed. Thematic analysis was used to explore the responses provided by participants from the semi-structured interview questions, providing insight into individual experiences and the contextual environment. Several broad themes were identified: the increase in demands for mental health and basic needs services; pandemic-related mental health outcomes; pandemic-related non-mental health outcomes; inaccessibility to mental health and basic needs services; childcare and/or domestic duties; pre-pandemic deprivation of basic needs; government intervention recommendations. These themes will be analyzed in the results section. This study conforms to internationally acceptable research and professional ethical guidelines. Research ethics approval was obtained from York University (ORE certificate #e2022-006).

Limitations of the study The findings presented below reflect the experiences and perspectives of a relatively small sample of racialized working women in a specific context. They do not intend to be representative of the population but rather aim to shed light on the lived experiences of racialized working women during the pandemic. It is

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anticipated that these personal accounts will add to the existing literature on the outcomes of COVID-19 on racialized women, by way of including the voices and struggles of this community. Future research is encouraged to include a larger sample, focus on experiences during and after the removals of many health

restrictions, and include the perspectives of racialized women working in health care industries that are often overlooked.98 While online surveys make it easier and more convenient to complete if one has easy computer and internet access, it may limit the participation of those who cannot afford computers and connectivity.

Lockdowns meaning stay-at-home orders, curfews, quarantines, and similar societal restrictions Frontline workers such as personal support workers, in-home care providers, long-term home staff, janitorial and custodial staff, lab workers, etc.

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Participant demographics for the online surveY The data was filtered for racialized women that are currently employed, or experienced bouts of unemployment due to COVID-19 (rolling lockdowns) residing in Canada; bringing the total number of participants to 103 from the 160 collected. The majority of participants, 58%, who completed the online survey were aged 18-30, while 40% were aged 31-50. Most racialized women were residing in Ontario (61%), while just under 40% were located in other provinces and territories across Canada. A large majority of participants were Canadian citizens, 40% by birth and 38% by naturalization. Of the remaining participants, a small majority were landed immigrants/permanent residents (18%). While most of the racialized women were married and residing with 3 or more people, excluding themselves, 60% did not have dependent children who were still under their financial and physical care.

Regarding employment, the women surveyed were mostly working full-time and were concentrated in jobs that have been or were deemed as an essential service during the COVID-19 pandemic at 60%. Of these women, most worked from home, however, close to 40% were working in person. A small majority, 12%, could not work for reasons related to COVID-19 (i.e., were laid off/receiving income supplements due to COVID-19, or contracted COVID-19, or had to quarantine/ self-isolate due to exposure or public health rules). Almost 50% of the racialized women surveyed reported earnings of less than $50,000. Approximately, 70% of participants had health insurance/ benefits and paid sick days through their employment, while 25% did not. In addition to their paid work, most women reported between 11-20 hours of unpaid work per week. A slight majority (51%)

ONLINE SURVEY PARTICIPANTS + 58% were aged 18-30 + 61% were residing in Ontario + The majority were Canadian citizens, 40% by birth and 38% by naturalization + 18% were landed immigrants/ permanent residents + Most women were married and living with 3 or more people + 60% did not have dependent children who were still under their financial and physical care + 49% had children and 40% were impacted by school closures + Most women reported between 1120 hours of unpaid work per week + Almost 50% reported earnings of less than $50,000

of participants did not have children in the home, and so were not impacted by childcare shutdowns and/or school closures during any of the COVID-19 lockdowns. Of the 49% of participants with children, most were impacted by school closures (82% of the women with children, 40% of all participants). Of those with children, 23% took care of their children while working from home, and 15% worked in-person but had family at home (e.g., partner, sibling(s), grandparent(s)) taking care of their children.

Participant demographics for the online interviews As aforementioned, five online interviews were conducted with service-care providers in non-profit organizations across Canada. Those interviewed held diverse positions in their organizations and included social workers, registered psychologists, and clinic and project managers. All five participants had valuable insight into the communities being

served and worked closely with racialized women. Three of the participants identified as females and two as males.

LOCAtion of participants

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Results The online survey reveals that racialized working women’s mental health deteriorated during the onset of COVID-19 lockdowns and slightly improved when some restrictions were lifted. However, the vast majority of their self-reported mental health outcomes have not returned to their pre-COVID levels. The results are consistent with the previous research that suggests that the mental health of young Canadians and racialized women has been disproportionately affected by the pandemic. When asked about their mental health prior to COVID-19, the majority of participants (54%) reported feeling anxious, while 47% suffered from depression. Half of the women surveyed (50%) described experiencing some form of mental/physical exhaustion and/or burnout before COVID-19. Some participants reported feeling alone and isolated (33%),

PRE-COVID-19 MENTAL HEALTH OUTCOMES

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while others had difficulties sleeping and resting (32%). Moreover, a quarter of those surveyed (25%), were experiencing detachment from their surroundings. Although most did not report trouble concentrating, 30% of participants did. A small minority of participants, 16%, struggled to remember the date/day of the week. Important to note is that almost 50% of the racialized working women suffered from anxiety, depression, and mental/ physical exhaustion and/or burnout preCOVID-19. During the COVID-19 lockdowns, the mental health of racialized women drastically declined as participants reported further deterioration in every negative mental health outcome. Findings reveal that 50% of participants were worried about contracting COVID-19 at the workplace.

During the lockdown, the majority of racialized women reported feeling anxious, rising by 14% from pre-pandemic levels to 68%. Depression levels saw a moderate increase rising 5% to 52%. The largest reported increase in negative mental health outcomes, by 23 percentage points, was mental/physical exhaustion and/or burnout, which comprised of almost three-fourths of the women surveyed (73%). Reports of isolation and trouble sleeping/resting were identical at 53%, with percentage point increases of 19% (trouble sleeping/resting) and 20% (isolation) respectively. Other increases include feeling detached from surroundings (17 percentage points) with 42% having trouble concentrating (14% percentage points) with 44%, and forgetting the date/day of the week (15 percentage points) at 31%.

COVID-19 MENTAL HEALTH OUTCOMES DURING LOCKDOWN


Results CONT’d After some COVID-19 restrictions were lifted, the majority of participants experienced a decrease in most negative mental health outcomes. However, the only exception was the worry of contracting COVID-19 at the workplace, which 51% of participants reported (decreased by 1 percentage point). Reports of feeling anxious declined by 11 percentage points to 57% exceeding pre-COVID levels. Those suffering from depression experienced the largest percentage points decrease, 18%, accounting for 34% of women, far below pre-COVID levels. The majority of participants still reported feelings of mental/physical exhaustion and/or burnout at 60%; although there was a decrease of 13 percentage points, it remained higher than its pre-COVID levels. A decrease of 17 percentage points in feelings of isolation was reported (34%), sitting close to its level

before the pandemic, but still exceeding it. Reports of trouble sleeping/resting declined by 16 percentage points accounting for roughly 37% of women, well above its pre-COVID levels. Other decreases included feeling detached from surroundings (7 percentage points) with 35%, trouble concentrating (7 percentage points) with 37%, and forgetting the date/ day of the week (11 percentage points) at 20%. All of these impacts remained higher than their pre-COVID levels. Although most negative mental health outcomes did decline, almost every outcome was still higher than its preCOVID level, with the exception of reports of depression. Not all reported mental health outcomes were negative, there were several positive outcomes identified.

COVID-19 MENTAL HEALTH OUTCOMES AFTER THE REMOVAL OF SOME RESTRICTIONS

The majority of participants (52%) had more free time, some (39%) were able to engage in leisurely activities (i.e., cooking, reading, running), and others reported an increase in sleep (30%). Perhaps the most interesting finding was that 30% of participants reported reduced harassment/microaggressions from the workplace, presumably because they were working from home or were temporarily unemployed due to lockdowns. This particular finding draws attention to the embedded racism in the labour market and the ways in which it functions to create a toxic work environment for racialized people. Future studies examining this issue are recommended. Furthermore, several coping techniques were used to manage the impacts of COVID-19. A large majority (66%) turned to screen time and increased food consumption (56%). Most racialized women found comfort in talking to friends and family (60%), while a minority (43%) engaged in physical activities (walking, exercising at home, etc.) as a coping mechanism. The reduction in physical activity may have been caused by the closures of community centers which offered free fitness classes and programs. Accessing professional help (i.e., talking to a therapist, social worker, etc.) to cope with mental health needs during the pandemic was not a strategy used by most participants; 60% did not receive any professional help, while 39% did. Of the 60% who did not receive professional help, 34% reported the social barriers/stigma of mental health/illness as the main reason, while 30% reported not having the time for therapy, 28% reported that therapy was too expensive, and 21% reported that their benefits do not cover mental health services.

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Results CONT’d The online interviews with service-care providers were extremely beneficial and gave researchers an intimate insight into the struggles, both mental health-related and non-mental health-related, that racialized women are facing. A thematic analysis of the interview transcriptions led to the development of several broad themes: the increase in demands for mental health and basic needs services; pandemic-related mental health outcomes; pandemic-related non-mental health outcomes; inaccessibility to mental health and basic needs services; childcare and/or domestic duties; pre-pandemic deprivation of basic needs; government intervention recommendations. All of the service-care providers interviewed unanimously spoke of an increase in demands for mental health and basic needs services since the start of the pandemic in March 2020. Katerina, one of the women interviewed, recalled the drastic increase in mental health services, with patients tripling or quadrupling after

March 2020. Similarly, Marana, another service-care provider, noted a 50% rise in mental health counselling referrals. Before the pandemic, there were only two in-house counsellors that handled the workload at Marana’s clinic, however after COVID-19 began, eleven new counsellors had to be hired to meet the growing demands of the influx of referrals. Many service-care providers spoke of the growing number of youth mental health counselling referrals & couples counselling referrals; a new trend that developed as a response to the pandemic. Several interviewees mentioned the need to create a waitlist to accommodate the significant demand for mental health services. Additionally, service-care providers, Zain and Leroy, identified a rise in the need for food distribution services, something that worsened during the pandemic and continues to prevail almost two years later. These testimonies are aligned with the online survey results which indicate an increase in negative mental health outcomes during the pandemic.

Positive MENTAL HEALTH OUTCOMES

The majority of those interviewed talked about pandemic-related negative mental health outcomes and symptoms. Katerina and Marana described an increase in clients suffering from depression, anxiety, isolation, stress, addiction, self-neglect, and avoidance behaviour, many of which stemmed from domestic violence. Others expressed that they noticed a rise in their clients’ levels of fear, loneliness, lack of routine, and exhaustion. Zain and Leroy emphasized that racialized and low-income communities are facing exacerbated mental health impacts because of their dire living conditions. Pandemic-related non-mental health outcomes were also reported such as feeling unsafe while commuting to work, going to the store, and running errands. Also mentioned were food insecurity, economic hardships, loss of employment, legal issues (divorce lawyers, immigration-related, etc.), and the struggles of being an essential worker.

PreCOVID-19 negative mental health levels were already high Significant increase in negative mental health outcomes during lockdowns

Slight decrease in negative mental health outcomes when restrictions removed. Still higher than preCOVID levels

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Results CONT’d Another theme identified across interviews was the inaccessibility to mental health and basic needs services. All servicecare providers spoke of the disruption of services, especially in-person, because of restrictions and lockdowns. Their clients experienced difficulties in accessing services that were shifted to remote support, citing a lack of technology and/ or technological literacy. Clients often expressed their absence of privacy and space to seek counselling or mental health services, especially during periods of lockdowns. Marana described the experience of her clients, “they were sitting in their garage, in their cars, talking to me, or they would make an excuse, they will go to do their grocery shopping and then they will sit in the parking lot and have their counselling session by phone”. This was seen as a barrier to mental health needs as many of the racialized women did not have the space or technology for remote services. Childcare and/or domestic duties was another topic discussed by the majority of service-care providers. This proved to be one of the most critical issues faced by racialized working women. Difficulties with childcare and/or remote learning, an increase in domestic duties, lack of family support, and having to leave paid employment because of school closures/ childcare were cited as challenges confronting racialized working women. Katerina recalled that, “So, we’ve had a lot of women coming in, who have said, you know, why is it that my work has to be sacrificed? Some women have quit because they don’t have a choice or they feel like they don’t have a choice, while other women have asked for leaves of absence. I’ve seen a lot of women who have been working ask for mental health leaves in 2021, especially because they were not able to handle the burden of

2020 at all, so a lot of teachers, doctors, lawyers, social workers, so basically a lot of professionals.” All interviews touched on the fact that these racialized women experienced many difficulties juggling paid work and childcare/domestic work. These racialized

REASONS FOR NOT SEEKING PROFESSIONAL HELP WITH MENTAL HEALTH NEEDS

women were particularly frustrated that it was their paid employment that had to be sacrificed. Katerina went on to say, “You need to bring in money, but you also need to take care of the home when we’re all there 24/7, it’s been really, really tough for women who have jobs to be able to find that balance”. Due to lockdowns, women were not able to rely on the help and support of their family and friends with childcare. This left many of them in a bind as the burden of looking after the children fell on their shoulders. Gabby, another servicecare provider mentioned that “women

started missing important appointments because they didn’t have any childcare options… no family or friends could watch them and there was no in-person learning”. The expectation that women must take on the primary role of family responsibilities and childcare continues to persist, especially for racialized women that come from more traditional cultures and backgrounds. The most critical issue identified by all five service-care providers was the prepandemic deprivation of the basic needs of their clients. Interviews were filled with discussions surrounding the dire living conditions of these communities pre-pandemic that continue to exacerbate the negative outcomes of COVID-19. Systemic barriers, racism, labour market discrimination, precarious work, low wages, food insecurity, and unaffordable housing were all deemed as drivers of inequity. Surprisingly, service-care providers urged researchers to acknowledge the privilege involved in access to mental health services. A significant portion of racialized women in need of mental health services simply do not have the time, resources, or luxury of pursuing it. Leroy stated that “beginning to address mental health must start with giving people access to the basic necessities they require for a decent and dignified life”. Interviews exposed the gap in mental health research: that the most vulnerable populations, especially racialized women, will likely not have the opportunity to focus on or address their mental health needs because they are too preoccupied with trying to survive and make ends meet. This point was emphasized several times in the interviews in different ways. Gabby for example emphasized this by stating,

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Results CONT’d Many don’t have the time to focus on their mental health because they are struggling too much, they are in ‘survival mode’. When I meet with people right now, like some of their main concerns are, of course, how will I pay for rent, how will I buy food, I’m a single mother, etc. And I feel that, when their basic needs are not met, they cannot focus on anything else, they cannot move

mentioned in all interviews. Servicecare providers felt that the governments should be more accountable in addressing the needs of racialized women. Some of the recommendations included a focus on improving people’s living conditions, making mental health services more accessible/affordable, incorporating more social workers into the mental health

+ “They were sitting in their garages, in their cars, talking to me, or they would make an excuse, they will go to do their grocery shopping and then they will sit in the parking lot and have their counselling session by phone”.

forward with anything else if their basic needs are deprived. They can’t even think about taking care of their mental health or any trauma that they have lived through, because they are too concerned with their survival and the survival of their family. Their basic needs haven’t been answered for many years, and they’re in survival mode, so this is what I feel when I meet with clients. The theme of being in survival mode was stressed throughout the interviews. Service-care providers were adamant on highlighting the need to take a holistic approach to mental health. Leroy stressed the importance of physical health (i.e., having basic needs met) on mental health through his statement, “mental health isn’t something we should examine alone, it’s attached to and dependent on the quality of life in general”. The last theme, government intervention recommendations was once again

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system, and additional training in how to deal with equity-seeking groups for governments, healthcare professionals, and legal systems. Recommendations included advocating for an upload of the responsibility of the mental and physical well-being of citizens onto governments, rather than the download onto community organizations. Support for mental health services to be available in different languages, accessible and affordable for all, and covered by provincial healthcare (i.e., OHIP) was expressed. “We should make mental health services accessible to everybody, no matter how remote or rural their location is. No matter their financial status, it really should be made accessible. We’ve seen so many people who aren’t able to kind of reach out for help because of the fact that they can’t afford it, or it’s too far. The biggest thing is just making it accessible for everybody in languages that people understand” (Katherina).

A significant portion of racialized women in need of mental health services simply do not have the time, resources, or luxury of pursuing it. Interviews exposed the gap in mental health research: that the most vulnerable populations, especially racialized women, will likely not have the opportunity to focus on or address their mental health needs because they are too preoccupied with trying to survive and make ends meet.


+ “So, we’ve had a lot of women coming in, who have said, you know, why is it that my work has to be sacrificed? Some women have quit because they don’t have a choice or they feel like they don’t have a choice, while other women have asked for leaves of absence. I’ve seen a lot of women who have been working ask for mental health leaves of absence in 2021, especially because they were not able to handle the burden of 2020 at all, so a lot of teachers, doctors, lawyers, social workers, so basically a lot of professionals.”

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+ “Many don’t have the time to focus on their mental health because they are struggling too much, they are in ‘survival mode’. When I meet with people right now, like some of their main concerns are, of course, how will I pay for rent, how will I buy food, I’m a single mother, etc. And I feel that, when their basic needs are not met, they cannot focus on anything else, they cannot move forward with anything else if their basic needs are deprived. They can’t even think about taking care of their mental health or any trauma that they have lived through, because they are too concerned with their survival and the survival of their family. Their basic needs haven’t been answered for many years, and they’re in survival mode, so this is what I feel when I meet with clients”.

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Discussion Mental health implications and many of the harmful outcomes revealed in this study are expected within the context of a pandemic and are likely transient. However, for vulnerable groups such as racialized women, difficulties may persist and lead to additional declines in widening mental health inequities. COVID-19 has exposed the patchwork mental health system in Canada that fails to support its population and that puts the most marginalized groups at risk. Participants interviewed described the increasing mental health challenges that their clients are facing due in part to pre-existing conditions that were exacerbated by financial precarity, loss of employment, and social isolation during the pandemic. Our findings are consistent with the literature on mental health in Canada, underlining the higher levels of negative mental health outcomes emerging from rolling lockdowns and restrictions. It is important to note that these conclusions apply only to participants in the study and cannot be generalized to the wider population. The online surveys provided a great deal of insight into the lived experiences and conditions of racialized working women. Results revealed that close to 50% of the women surveyed reported feeling depressed, anxious, and burned out before the pandemic. Although this finding is particularly troubling, it is not surprising given the social location of these women. The majority of the racialized women that participated were concentrated in a low-income quartile (i.e., earning less than $50,000 annually). Previous data has already confirmed that individual income is highly correlated with mental health status,­100 as well as ethnicity and gender.101 As evidenced in our previous report, Unmasking COVID-19: One year later102, racialized women were the group most likely to be employed in precarious work and to suffer from poverty. 103

This conclusion applies to participants in the study

107

Mental health and non-mental health

In the context of rolling lockdowns, including the most recent in early 2022 as a response to the Omicron variant, the self-reported mental health of racialized working women in the study significantly declined as participants noted an increase in every negative mental health outcome. Interviews with servicecare providers mirrored these reports. Service-care providers suggested that the increase in negative outcomes (i.e., anxiety, depression, social isolation, and mental/physical exhaustion) is attributed to factors such as loss of employment, food insecurity, childcare obligations, and managing both paid and unpaid work. When some restrictions were lifted, there were improvements made in the mental health of racialized working women, however, self-reported levels were still marginally worse than pre-COVID-19. These findings suggest two interesting phenomena. Firstly, lockdown measures had a profound negative impact on the mental health of participants.103 Secondly, lockdowns cannot be solely responsible for the worsening mental health conditions of racialized working women; negative mental health outcomes did not return to their pre-COVID-19 levels when restrictions were lifted, indicating that this could be a long-term effect. Another discovery made was that women with children struggled to manage their paid work and childcare responsibilities. Having to navigate the complexities of childcare and school closures while working from home or commuting to their regular employment was a challenge. Gender disparities may be accentuated, particularly for those employed, as women are disproportionately responsible for domestic tasks, including childcare.104 Some women were forced to make the difficult decision between caring for children or continuing to work. Interviews

These findings suggest two interesting phenomena: + Lockdown measures had a profound negative impact on the mental health of participants. + Lockdowns cannot be solely responsible for the worsening mental health conditions of racialized working women; negative mental health outcomes did not return to their pre-COVID-19 levels when restrictions were lifted, indicating that this be could be a long-term effect.

revealed that some women quit their jobs, even if employed in a professional occupation (i.e., doctor, teacher, social worker, etc.) to meet the caring demands of their families. Women have been performing more unpaid domestic and childcare duties in comparison to their partners prior to the spread of COVID-19.105 The pandemic has undoubtedly exacerbated these domestic tasks for women, adding a great deal of stress and anxiety to their lives. The expectation that they would be the ones to sacrifice their jobs illuminates the deep-rooted cultural traditions that continues to disadvantage women, especially in times of crises. Not only do employment gaps put women in marginalized positions financially, but also risk jeopardizing their long-term careers. Employment gaps have been negatively associated with future income, job satisfaction and prospects.106 Additionally, it can leave women, especially racialized, in precarious and vulnerable positions far after the pandemic comes to an end; historically, racialized women have less access to privileges such as affordable childcare, high-income employment, generational wealth, etc. Foregone earnings can further entrench a group with an increasing tendency to experience poverty. The struggles107 experienced by racialized women with children in managing both paid and unpaid work during lockdowns expose the underfunded, damaged, and weak childcare system in Canada. It also uncovers the critical role of reproductive labour108 in the capitalist system and the ways in which it continues to be devalued and ignored.

108 Unpaid activities that reproduce the work force - this includes daily activities as cooking, washing clothes but also bearing children. The term reproductive labour emphasizes the role of those activities within the production process, namely the reproduction of the work-force. digenous, People of Colour

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Discussion CONT’d Furthermore, despite the increase in negative self-reported mental health, the majority of racialized women (60%) did not seek professional help. The most cited reason being the barriers/stigma of mental health/illness. Even with the recent focus and promotion of the importance of mental health and the fight to eliminate the

work (which often excludes health benefits), childcare obligations/domestic responsibilities, and food and housing insecurity, among others, tending to their mental health needs (especially if it’s an out-of-pocket expense) may seem trivial and indulgent.

+ If communities are unable to find secure and affordable housing, stable and well-paid employment, long-term food sources, and proper childcare options, how could they be in a position to address their mental health and traumas?

stigma, it seems that racialized women are still apprehensive. Moreso, the majority of the racialized women surveyed were aged 18-30; younger generations have witnessed the mental health inclusivity movement. However, it seems that despite efforts to normalize mental health, the stigma persists. Other barriers identified for not seeking professional help included not having the time to pursue therapy, lack of affordability/not having enough money, and not having access through health benefits. The implications of these barriers reinforce the notion that addressing mental health is something of a luxury and is reserved for those with certain privileges. Not being able to afford mental health services is presumably a reality for a large portion of the population. With so many racialized women struggling with the loss of employment109, economic marginalization, low wages, precarious

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Additionally, the issue of inaccessibility to mental health services when shifted to a remote setting was mentioned in numerous interviews. Service-care providers recalled racialized women not being able to access online or phone appointments because of the lack of space/privacy and limited access to technology. Racialized women living in small accommodations surrounded by family members were unable to find a suitable space to have mental health-related appointments. Additionally, some women reported not having enough technology to be able to engage in online appointments. For those with children, computers and laptops may have been reserved for remote schooling. In spite of results consistently indicating a deterioration in the mental health of racialized working women in the context of COVID-19, the need to think critically in

the assessment of whom mental health is extended to is crucial. Through the data accumulated, an important question arose: is mental health and healing a luxury and privilege that is only accessible to certain groups, while simply out of reach for others? Service-care providers were adamant in expressing the urgent need to take a more holistic approach in researching and understanding mental health. It was made clear that the clients they serve were not just struggling with their mental health but struggling to survive. The pre-pandemic deprivation of basic necessities combined with the devastating impacts of COVID-19 created an environment that launched many into ‘survival mode’. With a large portion of vulnerable communities struggling to make ends meet110, focusing on mental health may not be a practical option. Those in ‘survival mode’ do not possess the resources required – time, money, technology, energy, childcare options – to deal with their mental health needs. If communities are unable to find secure and affordable housing, stable and well-paid employment, long-term food sources, and proper childcare options, how could they be in a position to address their mental health and traumas? With all the discussions surrounding the prioritization of mental health and initiatives to end the stigma 111,we have overlooked the fact that it’s not available or accessible to those who need it most.


Discussion CONT’d Despite IRC operating as a non-profit organization serving clients that include marginalized, racialized women, we were unable to reach the most vulnerable women for our sample112, a common problem in the world of research.113 As aforementioned, the majority of participants were engaged in full-time employment at the time of the survey and still cited lack of affordability, time, and health benefits as the main barriers to mental health care. As long as mental health is not treated or widely incorporated into our public health care system it will continue to function as a luxury that excludes a large group of people. If mental health care was offered in a similar way to other medical services, perhaps it would become more viable for disadvantaged groups. Until that time comes, we must acknowledge the reality that focusing on one’s mental health is a privilege. Moreover, service-care providers spoke of the need to take a more holistic approach to mental health. They urged researchers to look beyond mental health as a separate area of focus, and rather as one pillar to the overall well-being of an individual. Physical and mental health should not be studied in isolation; we must recognize their interdependent relationship. Physical health incorporates a plethora of factors such as access to a nutritious diet, a safe and stable environment, financial security, time for rest and recovery, etc. Since physical and mental health are contingent on one another, it is imperative to take both into consideration in the assessment of overall health.

112

The need to think critically in the assessment of whom mental health is extended to is crucial. Is mental health a luxury and privilege that is only accessible to certain groups, while simply out of reach for others?

Those without internet or technology, those concentrated in part-time work, those in shelters, etc.

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Band-aid solutions are not the answer: Recommendations to heal the wound Although this study is focused on the adverse mental health outcomes of racialized working women during the COVID-19 pandemic114, we cannot begin to make recommendations on how to improve mental health without addressing the root causes of this societal problem: social, economic, environmental, and structural inequities. Regardless of how many discussions take place on the best approaches and methods to tackle mental health, putting a band-aid over a deep cut will not stop the bleeding or heal the wound. Ignoring the real causes of poor mental health (i.e., poverty, food and housing insecurity, precarious work, labour market discrimination, racism, the double shift, gendered and racialized wage gap, etc.115) will not improve the well-being

Affordable & Safe Housing

of Canadians. The advice of a professional is not useful to a racialized woman who has lost her job as a result of the pandemic and now faces food and housing insecurity. Through this study, we believe that there is a gap between the causes of marginalized groups’ poor mental health and the capacity of mental health services to understand and respond to that. The only effective way to truly repair the deteriorating mental health of racialized women and other disadvantaged groups is to invest in our society and the people who make it. The need for affordable housing is immediate, as is the implementation of a living wage. People cannot afford to live off of minimum wage any longer. The elimination of the gendered and

Living Wages

Access to Nutritious Food

Mental Health Determinants

Financial Security

114 We acknowledge that mental health outcomes are fluid and will experience varying levels as the pandemic and government responses continues to rapidly change

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racialized wage gap must be implemented. An affordable post-secondary education system that does not leave Canadians indebted long-term should be realized. Precarious work must be replaced by employment that pays living wages, offers its employees health benefits, provides access to paid sick days and safe working conditions.116 These are the types of structural changes needed to improve the living conditions of racialized women and vulnerable groups. Without addressing the fundamental needs of individuals, mental health will continue to be a luxury. With that being said, there are still mental health-related recommendations and policy implications that can add value to the lives of racialized women.

Ways to improve mental health + Invest in our society and the people who make it + Replace precarious work with employment that pays living wages, offers its employees health benefits, provides access to paid sick days and safe working conditions + Provide an affordable post-secondary education system that does not leave Canadians indebted long-term + Subsidized childcare + Make housing affordable


Band-aid solutions are not the answer: Recommendations to heal the wound Cont’d No single policy will be able to address the various mental health issues of racialized working women. To adequately respond to mental health needs, a public health approach inclusive of mental health is needed. Although some resources have been allocated to address the ailing mental health in Canada,117 other countries have already adopted more effective policies through the expansion of their public mental health services.118 Clinical licensed social workers have been incorporated into public healthcare systems internationally119, which should be considered in Canada to help alleviate some of the pre-existing mental health outcomes and those exacerbated by COVID-19. The incorporation of clinical licensed social workers would be a valuable addition as they are uniquely trained to “improve the quality of life and well-being of others through direct practice, crisis intervention, research, community organizing, policy change, advocacy, and educational programs”.120 Their holistic approach to mental health considers social location, societal barriers and structural inequalities. Professionals that embody a critical perspective can make impactful differences in the lives of marginalized groups. The addition of clinical licensed social workers can make mental health services more accessible and culturally sensitive to racial minorities. The integration of community-based non-physician/psychiatrist mental health provider services into OHIP in a similar manner to other healthcare-related

services (e.g., doctor appointments) is recommended. If appointments with mental health providers are accessible, convenient, widely available, and subsidized through OHIP, more people will have the opportunity to address their mental health needs. This will help normalize mental health and reduce the stigma over time. As long as widely available mental health services remain outside of the publicly funded healthcare system121, it will not be a sustainable option for those who are economically disadvantaged. If governments are serious about bettering the mental health of Canadians, improvements to the current system must be made. As it currently stands, only those with certain privileges – time, money, energy, space, health benefits, childcare options, and support – can easily access mental health services if needed. Furthermore, these efforts should ensure that the mental health services are culturally sensitive to racial minorities and offered in many different languages.

expectations, and anti-Black racism. It is important to illuminate these differences through culturally sensitive public awareness mental health campaigns. This may help to end the stigma of mental health.

To end the stigma of mental health, it is recommended to integrate more culturally sensitive public awareness mental health campaigns into communities and educational spaces. We must be mindful of the fact that mental health will look different for everyone. Cultural and ethnic backgrounds, among others, will impact people’s experience of mental health. Some equity-seeking groups may be dealing with mental health effects related to culturespecific traumas and experiences such as Islamophobia, traditional cultural roles and

As indicated in our study, 21% of participants cited lack of employment benefits covering mental health services as a barrier to mental health access. Stemming from this discovery, we recommend that employers remove existing caps and increase limits on employment benefit plans for mental health services. This will encourage individuals to seek professional help should they require it without the financial burden.

122

The difference in earnings between women who do and do not have children

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An average of $10 a day

Additionally, we recommend broadening the understanding of mental health in Ontario’s Health and Physical Education curriculum for Grades 1-8 to include its connection to societal health. As it currently stands, in Ontario’s Health and Physical Education curriculum the topic of mental health is linked to physical health, but not societal. It is essential to begin educating our youth about the structural causes of poor mental health. Teaching children about the intersecting relationships between social, economic, environmental and structural inequities vis-a-vis poor mental health will help reduce the stigma and provide a better foundation for understanding mental health.

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Band-aid solutions are not the answer: Recommendations to heal the wound cont’d Moreover, resulting from our finding that 30% of participants found that workingfrom-home had a positive impact on their mental health because of the reduction of workplace harassment/microaggressions, we recommend that employers incorporate more options to work-from-home or have flex schedules in their return to work/office plans. Employers should incorporate these considerations into future hybrid or workfrom-home models to alleviate some of the workplace harassment/microaggressions experienced by women and racialized workers. The engrained systemic issue of workplace harassment must be addressed but protecting those suffering from it should be a priority. Regarding childcare, the federal government’s Canada-Wide Early Learning and Childcare System, announced in the 2021 Budget, is a good starting point to combat gender discrimination in the labour market, and the motherhood penalty.122 An

investment of $30 billion over the next 5 years will be put into the system which is meant to eliminate the high costs of paid childcare through the creation of $10 a day123 regulated childcare spaces across Canada.124 The federal government has committed to implementing the $10 a day regulated childcare spaces in Canada by 2025-26.125 Additionally, a 50% reduction in average fees for regulated early learning and childcare in all provinces outside of Quebec, was promised.126 This is to be delivered before or by the end of 2022. As outlined in this survey, the mental health of racialized working women was undoubtedly affected by the lack of access to childcare. This contributed to the high levels of stress and anxiety documented in their responses. If women must wait until 2025-26 to receive affordable regulated childcare, we can expect their

Monthly childcare fees across canada 2020

mental, social, and economic well-being will further deteriorate over time. Even with the 50% reduction in average fees for regulated early learning and childcare coming in 2022, the cost will still be far beyond the means of those suffering from economic inequity. Considering childcare is exceptionally expensive, with median toddler fees in Toronto averaging $1,578 monthly127, a 50% reduction will still cost close to $800 per month. Racialized women especially, due to their heightened social and economic marginalization, still may not have access to this essential service. Rather than introducing a universal policy in the interim, it is recommended that targeted initiatives be considered. Providing targeted affordable or subsidized childcare options to racialized women and other vulnerable populations (i.e., BIPOC128) immediately can help mitigate some of the devastating and disproportionate impacts of COVID-19 — including mental healthrelated impacts. Therefore, we recommend that immediate targeted adjustments be added to the Canada-Wide Early Learning and Childcare System. As previously discussed, the need for affordable housing is immediate. Although the federal government’s adoption of the National Housing Strategy129 in 2021 is encouraging, the ten-year plan may not meet the immediate needs of Canadians. For instance, the Budget 2021 provided an additional investment of $1.5 billion to address the urgent housing needs of vulnerable Canadians through the

128

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Black, Indigenous, People of colour


Band-aid solutions are not the answer: Recommendations to heal the wound Cont’d Rapid Housing Initiative (RHI).130 The Homelessness Partnering Secretariat (HPS) estimates that between 150,000 and 300,000 people experience homelessness in Canada each year.131 There were 2870 units built in Ontario between 2021 and 2022, however, statistics indicate that in Toronto alone there are over 10,000 people that are sleeping outdoors, in shelters and emergency respite centres, and in health and correctional facilities every night. In British Columbia, it was recently reported that 23,000 people experienced homelessness at some point in 2019.132 There were 1177 rapid housing units built in British Columbia between 2021 and 2022, far below the demand. Many Canadians cannot wait up to ten years to find safe and affordable housing. We recommend that the federal government expands the RHI to adequately meet the needs of Canadians requiring immediate housing.

revealed that racialized groups and women have been disproportionately experiencing negative mental health effects that have increased in the context of the pandemic.134 Since these groups are bearing the burden of the pandemic, they are at risk of developing long-term mental health implications. Offering free mental health services catered to the unique needs of marginalized communities can contribute to The political economy of the recovery and healing of a nation. Developing creative mental health matters. We ways to accommodate cannot improve mental health and support these groups without addressing the root is crucial. For those that causes of this societal problem: believe that politics and economics are beyond the social, economic, environmental, scope of a mental health and structural inequities. professional, we must recall that the body is not separate from the social worlds it exists in. Changes are needed in this increasingly unsustainable system.

Additionally, it is recommended that the National Housing Strategy commits to new public, rent-geared to income (RGI) housing. A federal policy until 1993, RGI sets rent at 30% of a household’s monthly Adjusted Family Net Income (AFNI) to assist those who cannot afford any level of market housing. RGI housing is available to some extent but has significant wait times for an applicant to receive housing.133 The final recommendation is that provincial governments should adopt an intersectional and targeted mental health initiative to serve communities experiencing heightened levels of distress and inequity. A plethora of studies have

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APPENDIX I: ENDNOTES 1. 2. 3.

4. 5. 6. 7.

8. 9. 10. 11. 12.

13.

14.

15.

16.

17.

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Ashcroft, R., Sur, D., Greenblatt, A., & Donahue, P. (2021). The impact of the COVID-19 pandemic on social workers at the frontline: A survey of Canadian Social Workers. British Journal of Social Work. 00, 1–23. doi: 10.1093/bjsw/bcab158 Moyser, M. (2020a). Gender differences in mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00047-eng.pdf?st=KtJ3P8fZ Guttmann, A., Gandhi, S., Wanigaratne, S., Lu, H., Ferreira-Legere, L.E., Paul, J., Gozdyra, P., Campbell, T., Chung, H., Fung, K., Chen, B., Kwong, J.C., Rosella, L., Shah, B.R., Saunders, N., Paterson, J.M., Bronskill, S.E., Azimaee, M., Vermeulen, M.J. & Schull, M.J. (2020). COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario: Characteristics of Those Tested and Those Confirmed Positive, as of June 13, 2020. International Credential Evaluation Service (ICES). https://www.ices.on.ca/ Publications/Atlases-and-Reports/2020/COVID-19-in-Immigrants-Refugees-and-Other-Newcomers-in-Ontario Kapilashrami, A., & Bhui, K. (2020). Mental health and COVID-19: is the virus racist?. The British Journal of Psychiatry, 217(2), 405-407. https://doi.org/10.1192/bjp.2020.93 Canadian Women’s Foundation. (2020a, March 14). Gendered Impacts of Coronavirus. https://canadianwomen.org/blog/gendered-impacts-of-coronavirus/ Canadian Women’s Foundation. (2020a, March 14). Gendered Impacts of Coronavirus. https://canadianwomen.org/blog/gendered-impacts-of-coronavirus/ Desjardin, D. & Freestone, C. (2021, March 4). COVID Further Clouded the Outlook for Canadian Women at Risk of Disruption. RBC. https://thoughtleadership.rbc.com/covid-further-clouded-the-outlook-for-canadian-women-at-risk-of-disruption/?utm_ medium=referral&utm_source=media&utm_campaign=special+report Smith, J. (2022). From “nobody’s clapping for us” to “bad moms”: COVID-19 and the circle of childcare in Canada. Gender, Work, and Organization, 29(1), 353–367. https://doi.org/10.1111/gwao.12758 Islamic Relief Canada. (2021, March 17). Unmasking COVID-19: One year later. https://issuu.com/islamicreliefcanada/docs/irc_report_unmasking_covid-19-update-v2/19 A set of political-economic policies that aims to reduce government budget deficits through spending cuts, tax increases, or a combination of both. Evans, B., & Fanelli, C. (2018). Ontario in an Age of Austerity: Common Sense Reloaded. The Public Sector in an Age of Austerity: Perspectives from Canada’s Provinces and Territories, 128-60 “The labour market is segmented along racial lines, with racialized group members overrepresented in many low paying occupations, with high levels of precariousness while they are underrepresented in the better paying, more secure jobs. Racialized groups were over-represented in the textile, light manufacturing and service sectors occupations such as sewing machine operators (46%), electronic assemblers (42%), plastics processing (36.8%), labourers in textile processing (40%), taxi and limo drivers (36.6%), weavers and knitters (37.5%), fabrics, fur and leather cutters (40.1%), iron and pressing (40.6%). They were under-represented in senior management (8.2%), professionals (13.8%), supervisors (12%), fire-fighters (2.0%), legislators (2.2%), oil and gas drilling (1.5%), farmers and farm managers (1.2%)” (Teelucksingh & Galabuzi, 2005, p.34) Block, S., Galabuzi, G. (2018, December). Persistent Inequality. Ontario’s Colour-coded Labour Market. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/sites/default/files/uploads/publications/Ontario%20Office/2018/12/ Persistent%20inequality.pdf.= Block, S., Galabuzi, G. (2018, December). Persistent Inequality. Ontario’s Colour-coded Labour Market. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/sites/default/files/uploads/publications/Ontario%20Office/2018/12/ Persistent%20inequality.pdf.= Block, S., Galabuzi, G. (2018, December). Persistent Inequality. Ontario’s Colour-coded Labour Market. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/sites/default/files/uploads/publications/Ontario%20Office/2018/12/ Persistent%20inequality.pdf.= Block, S., Galabuzi, G. (2018, December). Persistent Inequality. Ontario’s Colour-coded Labour Market. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/sites/default/files/uploads/publications/Ontario%20Office/2018/12/ Persistent%20inequality.pdf.= In comparison to white males and females, and racialized males

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APPENDIX I: ENDNOTES CONt’d 18. Lewchuk, W. (2018). Getting left behind: who gained and who didn’t in an improving labour market. Poverty and Employment Precarity in Southern Ontario. 19. Hou, F., Frank, K., & Schimmele, C. (2020, July 6). Economic impact of COVID-19 among visible minority groups. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00042-eng.htm 20. Block, S., Galabuzi, G. (2018, December). Persistent Inequality. Ontario’s Colour-coded Labour Market. Canadian Centre for Policy Alternatives.https://www.policyalternatives.ca/sites/default/files/uploads/publications/Ontario%20Office/2018/12/ Persistent%20inequality.pdf; Block, S., Galabuzi, G. E., Tranjan, R. (2019, December). Canada’s colour coded income inequality. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/sites/default/files/uploads/publications/ National%20Office/2019/12/Canada%27s%20Colour%20Coded%20Income%20Inequality.pdf 21. Hou, F., Frank, K., & Schimmele, C. (2020, July 6). Economic impact of COVID-19 among visible minority groups. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00042-eng.htm 22. Statistics Canada. (2016). Low-income statistics by age, sex and economic family type, 2016 data, https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1110013501 23. Sharma, R. D. (2012). Poverty in Canada. Oxford University Press 24. Block, S., Galabuzi, G. (2018, December). Persistent Inequality. Ontario’s Colour-coded Labour Market. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/sites/default/files/uploads/publications/Ontario%20Office/2018/12/ Persistent%20inequality.pdf 25. Sharma, R. D. (2012). Poverty in Canada. Oxford University Press 26. Sharma, R. D. (2012). Poverty in Canada. Oxford University Press 27. Sharma, R. D. (2012). Poverty in Canada. Oxford University Press 28. Statistics Canada. (2020). ‘Labour Force Survey, July 2020’, https://www150.statcan.gc.ca/n1/daily-quotidien/200807/dq200807a-eng.htm; Subedi, R., Greenberg, L., & Turcotte, M. (2020, October 28). COVID-19 mortality rates in Canada’s ethno-cultural neighbourhoods. Statistics Canada, https://www150.statcan. gc.ca/n1/pub/45-28-0001/2020001/article/00079-eng.htm 29. Subedi, R., Greenberg, L., & Turcotte, M. (2020, October 28). COVID-19 mortality rates in Canada’s ethno-cultural neighbourhoods. Statistics Canada, https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00079-eng.htm 30. Hou, F., Frank, K., & Schimmele, C. (2020, July 6). Economic impact of COVID-19 among visible minority groups. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00042-eng.htm 31. Subedi, R., Greenberg, L., & Turcotte, M. (2020, October 28). COVID-19 mortality rates in Canada’s ethno-cultural neighbourhoods. Statistics Canada, https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00079-eng.htm 32. Statistics Canada. (2020). ‘Labour Force Survey, November 2020’, https://www150.statcan.gc.ca/n1/daily-quotidien/201106/ dq201106a-eng.htm 33. Statistics Canada. (2020). ‘Labour Force Survey, November 2020’, https://www150.statcan.gc.ca/n1/daily-quotidien/201106/ dq201106a-eng.htm 34. Noack, A., Vosko, L. (2012). Precarious Jobs in Ontario: Mapping Dimensions of Labour Market Insecurity by Workers’ Social Location and Context. Report prepared for the Ontario Law Commission, Vulnerable Worker Project, Toronto: Ontario Law Commission, 1-60 35. Canadian Labour Congress. (2020, November 6). Canada’s unions say slowing job recovery necessitates urgent government intervention. Retrieved from https://canadianlabour.ca/canadas-unions-say-slowing-job-recovery-necessitates-urgentgovernment-interventioncanadas-unions-say-slowing-job-recovery-necessitates-urgent-government-intervention%20 36. Canadian Labour Congress. (2020, November 6). Canada’s unions say slowing job recovery necessitates urgent government intervention. Retrieved from https://canadianlabour.ca/canadas-unions-say-slowing-job-recovery-necessitates-urgentgovernment-interventioncanadas-unions-say-slowing-job-recovery-necessitates-urgent-government-intervention%20 37. I.e., not enough money to pay rent/facing eviction 38. Hou, F., Frank, K., & Schimmele, C. (2020, July 6). Economic impact of COVID-19 among visible minority groups. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00042-eng.htm

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APPENDIX I: ENDNOTES cont’d 39. Hou, F., Frank, K., & Schimmele, C. (2020, July 6). Economic impact of COVID-19 among visible minority groups. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00042-eng.htm 40. Hou, F., Frank, K., & Schimmele, C. (2020, July 6). Economic impact of COVID-19 among visible minority groups. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00042-eng.htm 41. Toronto Foundation. (2020, November). The Toronto fallout report. Retrieved from https://torontofoundation.ca/wp-content/ uploads/2020/11/Toronto-Fallout-Report-2020.pdf 42. Toronto Foundation. (2020, November). The Toronto fallout report. Retrieved from https://torontofoundation.ca/wp-content/ uploads/2020/11/Toronto-Fallout-Report-2020.pdf 43. Qian, Y., Fuller, S. (2020). COVID-19 and the gender employment gap among parents of young children. Canadian Public Policy, 46(2), 89-101. doi:10.3138/cpp.2020-077 44. Qian, Y., Fuller, S. (2020). COVID-19 and the gender employment gap among parents of young children. Canadian Public Policy, 46(2), 89-101. doi:10.3138/cpp.2020-077 45. Power, K. (2020). The COVID-19 pandemic has increased the care burden of women and families, Sustainability: Science, Practice and Policy, 16:1, 67-73, doi: 10.1080/15487733.2020.1776561 46. Power, K. (2020). The COVID-19 pandemic has increased the care burden of women and families, Sustainability: Science, Practice and Policy, 16:1, 67-73, doi: 10.1080/15487733.2020.1776561 47. Power, K. (2020). The COVID-19 pandemic has increased the care burden of women and families, Sustainability: Science, Practice and Policy, 16:1, 67-73, doi: 10.1080/15487733.2020.1776561 48. August 2020 in comparison to February 2020. Public Service Alliance of Canada. (2020, July 17). Women & COVID-19: Effects will linger long after the pandemic ends. http://psacunion.ca/women-covid-19-violence 49. Belleville, G., Ouellet, M. C., & Morin, C. M. (2019). Post-traumatic stress among evacuees from the 2016 Fort McMurray wildfires: exploration of psychological and sleep symptoms three months after the evacuation. International journal of environmental research and public health, 16(9), 1604; Tempesta, D., Curcio, G., De Gennaro, L., & Ferrara, M. (2013). Longterm impact of earthquakes on sleep quality. PLoS One, 8(2), e55936. 50. Baqui et al., 2020; Haynes et al., 2020; Laurencin and McClinton, 2020; Poteat et al., 2020; Power et al., 2020; Zhang and Schwartz, 2020 51. Findlay, L., Arim, R. (2020). Canadians report lower self-perceived mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00003-eng.pdf?st=1rcJHx22; Helliwell, J., Schellenberg, G., & Jonathan Fonberg (2021). Life Satisfaction in Canada Before and During the COVID-19 Pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/11f0019m/11f0019m2020020-eng.pdf?st=JYFYPmBq; Jenkins, E. K., McAuliffe, C., Hirani, S., Richardson, C., Thomson, K. C., McGuinness, L., ... & Gadermann, A. (2021). A portrait of the early and differential mental health impacts of the COVID-19 pandemic in Canada: findings from the first wave of a nationally representative cross-sectional survey. Preventive Medicine, 145, 106333. https://doi.org/10.1016/j.ypmed.2020.106333; Koziarski, J. (2021). The effect of the COVID-19 pandemic on mental health calls for police service. Crime science, 10(1), 1-7. https://doi.org/10.1186/s40163-021-00157-6; Saunders, N. R., Toulany, A., Deb, B., Strauss, R., Vigod, S. N., Guttmann, A., & Kurdyak, P. (2021). Acute mental health service use following onset of the COVID-19 pandemic in Ontario, Canada: a trend analysis. Canadian Medical Association Open Access Journal, 9(4), E988-E997. https://www.cmajopen.ca/content/cmajo/9/4/ E988.full.pdf; Scharf, D., & Oinonen, K. (2020). Ontario’s response to COVID-19 shows that mental health providers must be integrated into provincial public health insurance systems. Canadian Journal of Public Health, 111(4), 473-476. https://doi. org/10.17269/s41997-020-00397-0; Shillington, K. J., Vanderloo, L. M., Burke, S. M., Ng, V., Tucker, P., & Irwin, J. D. (2021). Ontario adults’ health behaviors, mental health, and overall well-being during the COVID-19 pandemic. BMC public health, 21(1), 1-15. https://doi.org/10.1186/s12889-021-11732-6; Statistics Canada. (2020a). Canadian Social Survey; COVID-19 and well-being 52. Findlay, L., & Arim, R. (2020). Canadians report lower self-perceived mental health during the COVID-19 pandemic; Shepell, M. (2020). Canadians are feeling unprecedented levels of anxiety, according to Mental Health Index.

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APPENDIX I: ENDNOTES CONt’d 53. Woodruff, S. J., Coyne, P., & St.Pierre, E. (2021). Stress, physical activity, and screen-related sedentary behaviour within the first month of the COVID-19 pandemic. Applied Psychology: Health and Well-Being, 13(2), 454-468. 54. https://angusreid.org/covid19-mental-health/ 55. Findlay, L., Arim, R. (2020). Canadians report lower self-perceived mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00003eng.pdf?st=1rcJHx22 56. For which comparable data are available 57. Helliwell, J., Schellenberg, G., & Jonathan Fonberg (2021). Life Satisfaction in Canada Before and During the COVID-19 Pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/11f0019m/11f0019m2020020-eng.pdf?st=JYFYPmBq 58. Helliwell, J., Schellenberg, G., & Jonathan Fonberg (2021). Life Satisfaction in Canada Before and During the COVID-19 Pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/11f0019m/11f0019m2020020-eng.pdf?st=JYFYPmBq 59. Jenkins, E. K., McAuliffe, C., Hirani, S., Richardson, C., Thomson, K. C., McGuinness, L., ... & Gadermann, A. (2021). A portrait of the early and differential mental health impacts of the COVID-19 pandemic in Canada: findings from the first wave of a nationally representative cross-sectional survey.Preventive Medicine, 145, 106333. https://doi.org/10.1016/j.ypmed.2020.106333 60. Jenkins, E. K., McAuliffe, C., Hirani, S., Richardson, C., Thomson, K. C., McGuinness, L., ... & Gadermann, A. (2021). A portrait of the early and differential mental health impacts of the COVID-19 pandemic in Canada: findings from the first wave of a nationally representative cross-sectional survey.Preventive Medicine, 145, 106333. https://doi.org/10.1016/j.ypmed.2020.106333 61. Jenkins, E. K., McAuliffe, C., Hirani, S., Richardson, C., Thomson, K. C., McGuinness, L., ... & Gadermann, A. (2021). A portrait of the early and differential mental health impacts of the COVID-19 pandemic in Canada: findings from the first wave of a nationally representative cross-sectional survey.Preventive Medicine, 145, 106333. https://doi.org/10.1016/j.ypmed.2020.106333 62. Woodruff, S. J., Coyne, P., & St-Pierre, E. (2021). Stress, physical activity, and screen-related sedentary behaviour within the first month of the COVID-19 pandemic. Applied Psychology: Health and Well-Being, 13(2), 454-468. 63. Woodruff, S. J., Coyne, P., & St-Pierre, E. (2021). Stress, physical activity, and screen-related sedentary behaviour within the first month of the COVID-19 pandemic. Applied Psychology: Health and Well-Being, 13(2), 454-468. 64. A cross-sectional survey administered by Statistics Canada 65. Zajacova, A., Jehn, A., Stackhouse, M., Denice, P., & Ramos, H. (2020). Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis. Canadian Journal of Public Health, 111(6), 953-962. 66. Almeida, Shrestha, A. D., Stojanac, D., & Miller, L. J. (2020). The impact of the COVID-19 pandemic on women’s mental health. Archives of Women’s Mental Health, 23(6), 741–748. https://doi.org/10.1007/s00737-020-01092-2; Arriagada, P., Hahmann, T., & O’Donnell, V. (2020). Indigenous people and mental health during the COVID-19 pandemic. Statistics Canada. https://www150. statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00035-eng.pdf?st=Le8BtuQW; Evra, R., Mongrain, E. (2020). Mental Health Status of Canadian immigrants during the COVID-19 Pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/ en/pub/45-28 0001/2020001/article/00050-eng.pdf?st=auKb075e; Guadagni, V., Umilta, A., & Iaria, G. (2020). Sleep quality, empathy, and mood during the isolation period of the COVID-19 pandemic in the Canadian population: females and women suffered the most. Frontiers in global women’s health, 1, 1-10. https://doi.org/10.3389/fgwh.2020.585938; Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/ bjo.2020.146; Moyser, M. (2020a). Gender differences in mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00047-eng.pdf?st=KtJ3P8fZ; Nienhuis, & Lesser, I. A. (2020). The Impact of COVID-19 on Women’s Physical Activity Behavior and Mental Well-Being. International Journal of Environmental Research and Public Health, 17(23), 1-12. https://doi.org/10.3390/ijerph17239036 67. Black, Indigenous, People of Colour

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APPENDIX I: ENDNOTES cont’d 68. Almeida, Shrestha, A. D., Stojanac, D., & Miller, L. J. (2020). The impact of the COVID-19 pandemic on women’s mental health. Archives of Women’s Mental Health, 23(6), 741–748. https://doi.org/10.1007/s00737-020-01092-2; Arriagada, P., Hahmann, T., & O’Donnell, V. (2020). Indigenous people and mental health during the COVID-19 pandemic. Statistics Canada. https://www150. statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00035-eng.pdf?st=Le8BtuQW; Evra, R., Mongrain, E. (2020). Mental Health Status of Canadian immigrants during the COVID-19 Pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/ en/pub/45-28 0001/2020001/article/00050-eng.pdf?st=auKb075e; Guadagni, V., Umilta, A., & Iaria, G. (2020). Sleep quality, empathy, and mood during the isolation period of the COVID-19 pandemic in the Canadian population: females and women suffered the most. Frontiers in global women’s health, 1, 1-10. https://doi.org/10.3389/fgwh.2020.585938; Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/ bjo.2020.146; Moyser, M. (2020a). Gender differences in mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00047-eng.pdf?st=KtJ3P8fZ; Nienhuis, & Lesser, I. A. (2020). The Impact of COVID-19 on Women’s Physical Activity Behavior and Mental Well-Being. International Journal of Environmental Research and Public Health, 17(23), 1-12. https://doi.org/10.3390/ijerph17239036 69. Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/bjo.2020.146 70. Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/bjo.2020.146 71. Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/bjo.2020.146 72. Moyser, M. (2020a). Gender differences in mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00047-eng.pdf?st=KtJ3P8fZ 73. Moyser, M. (2020a). Gender differences in mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00047-eng.pdf?st=KtJ3P8fZ 74. Moyser, M. (2020a). Gender differences in mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00047-eng.pdf?st=KtJ3P8fZ 75. Moyser, M. (2020a). Gender differences in mental health during the COVID-19 pandemic. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00047-eng.pdf?st=KtJ3P8fZ 76. Nienhuis, & Lesser, I. A. (2020). The Impact of COVID-19 on Women’s Physical Activity 77. Behavior and Mental Well-Being. International Journal of Environmental Research and Public Health, 17(23), 1-12. https://doi.org/10.3390/ijerph17239036 78. Behavior and Mental Well-Being. International Journal of Environmental Research and Public Health, 17(23), 1-12. https://doi.org/10.3390/ijerph17239036 79. Behavior and Mental Well-Being. International Journal of Environmental Research and Public Health, 17(23), 1-12. https://doi.org/10.3390/ijerph17239036 80. Behavior and Mental Well-Being. International Journal of Environmental Research and Public Health, 17(23), 1-12. https://doi.org/10.3390/ijerph17239036 81. Behavior and Mental Well-Being. International Journal of Environmental Research and Public Health, 17(23), 1-12. https://doi.org/10.3390/ijerph17239036

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APPENDIX I: ENDNOTES CONt’d 82. Smith, J. (2022). From “nobody’s clapping for us” to “bad moms”: COVID-19 and the circle of childcare in Canada. Gender, Work, and Organization, 29(1), 353–367. https://doi.org/10.1111/gwao.12758 83. Smith, J. (2022). From “nobody’s clapping for us” to “bad moms”: COVID-19 and the circle of childcare in Canada. Gender, Work, and Organization, 29(1), 353–367. https://doi.org/10.1111/gwao.12758 84. Smith, J. (2022). From “nobody’s clapping for us” to “bad moms”: COVID-19 and the circle of childcare in Canada. Gender, Work, and Organization, 29(1), 353–367. https://doi.org/10.1111/gwao.12758 85. Excluding Indigenous Peoples 86. As per the 2016 Census of Population 87. Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/bjo.2020.146 88. Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/bjo.2020.146 89. Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/bjo.2020.146 90. Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/bjo.2020.146 91. Gender, race and ethnicity, sexual orientation, disability status, employment, income, access to stable food and housing, social supports, etc. 92. Thomas, M. P., Vosko, L. F., Fanelli, C., & Lyubchenko, O. (Eds.). (2019). Change and continuity: Canadian political economy in the new millennium (Vol. 248). MQUP. 93. Thomas, M. P., Vosko, L. F., Fanelli, C., & Lyubchenko, O. (Eds.). (2019). Change and continuity: Canadian political economy in the new millennium (Vol. 248). MQUP. 94. Brophy, J. T., Keith, M. M., Hurley, M., & McArthur, J. E. (2021). Sacrificed: Ontario healthcare workers in the time of COVID-19. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 30(4), 267-281. 95. Creese, G., & Stasiulis, D. (1996). Introduction: Intersections of gender, race, class, and sexuality. Studies in Political Economy, 51(1), 5-14. 96. Lockdowns meaning stay-at-home orders, curfews, quarantines, and similar societal restrictions 97. Albudaiwi, D. (2018). Advantages and disadvantages of surveys. 98. Frontline workers such as personal support workers, in-home care providers, long-term home staff, janitorial and custodial staff, lab workers, etc. 99. Angus Reid Institute, 2020; Findlay & Arim, 2020; Jenkins et al., 2021; Mazza et al., 2020; Qiu et al., 2020 100. Gresenz, C. R., Sturm, R., & Tang, L. (2001). Income and mental health: Unraveling community and individual level relationships. Journal of Mental Health Policy and Economics, 4(4), 197-204. 101. Jenkins, E. K., McAuliffe, C., Hirani, S., Richardson, C., Thomson, K. C., McGuinness, L., ... & Gadermann, A. (2021). A portrait of the early and differential mental health impacts of the COVID-19 pandemic in Canada: findings from the first wave of a nationally representative cross-sectional survey. Preventive Medicine, 145, 106333. https://doi.org/10.1016/j. ypmed.2020.106333 102. https://issuu.com/islamicreliefcanada/docs/irc_report_unmasking_covid-19-update-v2

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APPENDIX I: ENDNOTES cont’d 103. This conclusion applies to participants in the study 104. Power, K. (2020). The COVID-19 pandemic has increased the care burden of women and families, Sustainability: Science, Practice and Policy, 16:1, 67-73, doi: 10.1080/15487733.2020.1776561 105. Power, K. (2020). The COVID-19 pandemic has increased the care burden of women and families, Sustainability: Science, Practice and Policy, 16:1, 67-73, doi: 10.1080/15487733.2020.1776561 106. Burke, R. J., McKeen, C. A. (1996). Employment gaps and work and career satisfactions of managerial and professional women. International Journal of manpower, 17(1), 47-55. Retrieved August 18, 2020 from http://dx.doi.org/10.1108/01437729610110611 107. Mental health and non-mental health 108. Unpaid activities that reproduce the work force - this includes daily activities as cooking, washing clothes but also bearing children. The term reproductive labour emphasizes the role of those activities within the production process, namely the reproduction of the work-force. 109. Ahmed, S. F., Quadeer, A. A., & McKay, M. R. (2020). Preliminary identification of potential vaccine targets for the COVID-19 coronavirus (SARS-CoV-2) based on SARS-CoV immunological studies. Viruses, 12(3), 254 110. Macdonald, D. (2018, July 31). Born to Win. Canadian Centre for Policy Alternatives, https://www.policyalternatives.ca/sites/ default/files/uploads/publications/National%20Office/2018/07/Born%20to%20Win.pdf; Maroto, M. (2016). Fifteen Years of Wealth Disparities in Canada- New Trends or Simply the Status Quo. Canadian Public Policy, 42(2), 152-167. http://www.jstor. com/stable/24883709 111. https://www.ctvnews.ca/canada/bell-let-s-talk-day-sets-record-raises-8-2m-for-mental-health-initiatives-1.5756734 112. Those without internet or technology, those concentrated in part-time work, those in shelters, etc. 113. Ellard-Gray, A., Jeffrey, N. K., Choubak, M., & Crann, S. E. (2015). Finding the hidden participant: Solutions for recruiting hidden, hard-to-reach, and vulnerable populations. International Journal of Qualitative Methods, 14(5), 1609406915621420. 114. We acknowledge that mental health outcomes are fluid and will experience varying levels as the pandemic and government responses continues to rapidly change 115. Also neoliberal capitalism, austerity policies, the decline of SER jobs 116. Among others 117. https://www.canada.ca/en/public-safety-canada/news/2022/03/federal-support-to-runnymede-healthcare-centre-forfeasibility-study-on-ptsi-for-public-safety-personnel.html 118. Scharf, D., & Oinonen, K. (2020). Ontario’s response to COVID-19 shows that mental health providers must be integrated into provincial public health insurance systems. Canadian Journal of Public Health, 111(4), 473-476. 119. Scharf, D., & Oinonen, K. (2020). Ontario’s response to COVID-19 shows that mental health providers must be integrated into provincial public health insurance systems. Canadian Journal of Public Health, 111(4), 473-476. 120. https://www.goodtherapy.org/blog/the-important-role-social-workers-play-in-mental-health-1214157 121. https://ontario.cmha.ca/news/wait-times-for-youth-mental-health-services-in-ontario-at-all-time-high/ 122. The difference in earnings between women who do and do not have children 123. An average of $10 a day 124. https://www.canada.ca/en/department-finance/news/2021/04/budget-2021-a-canada-wide-early-learning-and-child-careplan.html 125. https://www.canada.ca/en/department-finance/news/2021/04/budget-2021-a-canada-wide-early-learning-and-child-careplan.html 126. https://www.canada.ca/en/department-finance/news/2021/04/budget-2021-a-canada-wide-early-learning-and-child-careplan.html 127. https://www.canada.ca/en/department-finance/news/2021/04/budget-2021-a-canada-wide-early-learning-and-child-careplan.html 128. Black, Indigenous, People of colour 129. https://www.canada.ca/en/immigration-refugees-citizenship/corporate/transparency/committees/cow-jun-10-2021/ national-housing-strategy.html

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APPENDIX I: ENDNOTES CONt’d 130. https://www.canada.ca/en/immigration-refugees-citizenship/corporate/transparency/committees/cow-jun-10-2021/ national-housing-strategy.html 131. https://www.homelesshub.ca/about-homelessness/homelessness-101/how-many-people-are-homeless-canada 132. https://nationalpost.com/pmn/news-pmn/canada-news-pmn/b-c-provincial-data-shows-23000-people-experiencedhomelessness-in-2019 133. https://www.toronto.ca/community-people/employment-social-support/housing-support/rent-geared-to-income-subsidy/ 134. Almeida, Shrestha, A. D., Stojanac, D., & Miller, L. J. (2020). The impact of the COVID-19 pandemic on women’s mental health. Archives of Women’s Mental Health, 23(6), 741–748. https://doi.org/10.1007/s00737-020-01092-2; Evra, R., Mongrain, E. (2020). Mental Health Status of Canadian immigrants during the COVID-19 Pandemic. Statistics Canada. https://www150.statcan. gc.ca/n1/en/pub/45-28-0001/2020001/article/00050-eng.pdf?st=auKb075e; Miconi, D., Li, Z. Y., Frounfelker, R. L., Santavicca, T., Cénat, J. M., Venkatesh, V., & Rousseau, C. (2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych open, 7(1). doi: 10.1192/bjo.2020.146

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