During pandemics older adults with chronic physical conditions are a particularly vulnerable population for unmet mental health needs. This is a consequence of a number of factors which include decreased access to their doctors because of restrictions in visits in order to decrease risk of disease transmission and because doctors are seconded to provide medical services in areas of high priority. Since Public Health authorities worry that pandemics may be a reality of the future, this study is being operationalized during the present COVID-19 pandemic in order to see what can be learned about different ways to provide mental health care under such constraints.

The study offers evidence-based approaches to managing feelings of anxiety or depression that may have existed prior to the onset of a pandemic, or that have arisen during a pandemic. It uses principles of cognitive behavioural therapy in which participants are offered self-care tools to help them develop strategies for dealing with their various symptoms. These tools have already been shown by the team to be effective in other contexts in studies DIRECT-sc (Effectiveness of a supported self-care intervention for depression compared to an unsupported intervention in older adults with chronic physical illnesses) and CanDIRECT (Effectiveness of a telephone-supported depression self-care intervention for cancer survivors).

The present study, PanDIRECT (Assisting Family Physicians with Gaps in Mental Health Care Generated by the COVID-19 Pandemic), aims to answer the following questions:

1. Can these tools be used in the community care of mental health problems during pandemics?
2. Are they acceptable to patients?
3. Using a randomized control trial, does lay-coaching of use of these tools improve their use and patient outcomes?
4. Do family practitioners value patient information sent to them at the end of the trial

Inclusion Criteria:

• 65+ years old
• consented to be recontacted (participant in a previous study)

Exclusion criteria:

• moderate to severe cognitive impairment (using BOMC a brief cognitive screen) -unable to read in English or French (self-reported); hearing impairment (as judged by research staff);
• currently receiving counseling or psychological therapy (as these treatments may conflict with the self-care interventions)
• currently living in a long term care or other medicalized facility,
• presenting suicidal intent (as identified through the final item of the PHQ-9 which will be asked at screening).