Commentary: Overlooking, underfunding perioperative mental health threatens patients

Editor's Note

Amid a lack of focus and lack of resources on perioperative mental health, alleviating patient anxiety and preventing poor surgical outcomes requires creative solutions.

This is the central argument of a May 12 commentary in The Conversation by Renée El-Gabalawy, a clinical psychologist and associate professor at the University of Manitoba, who calls for Canadian health leaders to advocate for  a national strategy “to fund the research and ultimately routinely apply accessible mental health treatments for surgical patients.”

El-Gabalway cites various studies supporting the need for a broader strategy, emphasizing that growing surgical demand—driven by an aging population, chronic illness, and pandemic-related backlogs—has made the need for psychological support even more urgent.  As detailed in the article, anxiety and depression before surgery are associated with higher complication rates within 30 days and even elevated risk of death within a year. Patients also report that unmanaged anxiety is among the most distressing parts of the surgical experience, surpassing even postoperative pain. Despite this, mental health support remains largely absent from perioperative care in Canada.

Preoperative assessments provide an ideal opportunity to identify patients at risk and provide evidence-based treatments, El-Gabalway writes, specifically citing cognitive behavioral therapy (CBT), which can improve pain and functional outcomes. She also advocates for technology-enabled solutions. For example, a team at the University of Manitoba has developed a virtual reality (VR) program to help patients mentally prepare for surgery—one that patients have found useful and engaging. The article also cites other digital resources like the Power Over Pain Portal as promising, scalable tools to bridge gaps in care, especially for those enduring long surgical waits.

The full commentary offers additional context, as well as links to more information on cited research and technology initiatives.