Health Committee on March 6th, 2012

[The Chair, Conservative, Joy Smith]

Thank you.

I understand that the speakers have all gotten together and have a certain order they want to speak in. Is there a reason for this?

[Marla Israel, Acting Director General, Centre for Health Promotion, Public Health Agency of Canada]

No, not at all. With respect, it's just because the Public Health Agency has been involved in a lot of upstream promotion efforts, so there was a sense of having the Public Health Agency start. That's all.

[The Chair, Conservative, Joy Smith]

Okay. Well, I've just been informed of this. It's fine with me. It's kind of nice to know a little ahead of time so we can get started.

We'll start with PHAC, the Public Health Agency.

Ms. Israel, go ahead.

[Marla Israel]

Thank you very much.

Thank you so much, Madam Chair and honourable members, for the opportunity to discuss the important topic of suicide prevention.

In my remarks today, I will provide a brief overview of suicide prevention and the actions taken by the Public Health Agency of Canada to address suicide and mental health promotion. I will also highlight the work currently being done by Health Canada on suicide prevention in First Nations and Inuit communities, as well as the research efforts of the Canadian Institutes of Health Research in mental health promotion and suicide prevention.

I am pleased to be here with Ms. Langlois, who will answer questions later.

Of course, my federal colleagues are here as well, and we'll be happy to speak to their issues.

Suicide, suicidal thoughts, and suicidal behaviours have devastating impacts on families and communities across the country. Probably the hardest issue to confront after a child, a friend, or a parent has taken his or her own life is the feeling of disbelief that a person could feel so terribly alone with their pain and suffering that the only way out is ending their life.

Through this bill and the efforts of the Mental Health Commission of Canada, media, stakeholders, parliamentarians, etc., the issue of suicide and the importance of positive mental health at earlier ages and stages is being confronted head-on. All of us—families, caregivers, levels of government, and community leaders—have a role to play in preventing suicide and in reaching out to individuals, families, friends, and communities who are struggling with this issue.

The statistics are telling. Canada has a suicide rate of about 11 people per 100,000. Approximately 3,700 individuals take their lives each year. In general, boys and men commit suicide at a rate 3 to 4 times greater than girls and women. In addition, suicide is not just a problem for the young. Older men, for instance, have particularly troubling rates of suicide.

Further, for certain populations within Canada, rates of suicide are disproportionately high. This includes Canada's aboriginal population. While some communities, thankfully, have little experience with suicide, others struggle on a daily basis. Suicide accounts for 22% of all deaths among First Nations youth 10 to 19 years of age, and 16% among First Nations adults aged 20 to 44 years. The suicide rate in regions of Canada with a high proportion of Inuit residents is approximately 11.5%, which is 6 times higher than for the rest of Canada.

From a public health perspective, suicide prevention begins with a solid foundation of positive mental health—resilience, solid relationships, sound parents, positive self-esteem, confidence in oneself, and good supports. Initiatives that begin early in life and encompass a person's whole environment will reap solid rewards later in life, when stress is high and when anxiety and depression take shape.

I would like to take a brief moment to highlight the efforts under way in the health portfolio to address suicide prevention. Activities at the Public Health Agency employ a population health perspective to promote healthy living and to understand the issues that can lead to poor mental health, including suicide.

Our work promotes public health prevention and promotion. We work with provinces and territories and with Statistics Canada to provide surveillance information and reports such as “A Report on Mental Illnesses in Canada”. We provide grants and contributions to researchers, academics, and community organizations to better understand interventions that may serve to prevent suicide at later stages. We deliver children's programs that are heavily focused on creating a better start and being better able to confront the transition to the school setting.

Approximately $114 million is spent on the Canadian prenatal nutrition program, the community action program for children, and the aboriginal head start program in urban and northern communities. As well, $27 million goes towards the innovation strategy, which contributes to the development of protective factors for improving the health of children, youth, and families.

In an effort to promote mental health and prevent suicide among seniors, the agency funded the development of the first evidence-based national guidelines on seniors' mental health, which are used to address a number of mental health issues, including depression and suicide prevention. Also, of course, we collaborate with provinces and territories.

The First Nations and Inuit Health Branch of Health Canada works closely with its partners to support First Nations and Inuit communities, investing $245 million per year in community-based programs and services associated with the mental wellness of First Nations and Inuit. Culturally based, community-driven programming is a significant contributor to positive health outcomes among First Nations and Inuit communities, families and individuals.

In specific response to the challenge of youth suicide amongst Canada's aboriginal peoples, in 2005 the aboriginal youth suicide prevention strategy was launched with an investment of $65 million over five years.

The strategy was renewed in 2010 with an investment of $75 million over an additional five years. The strategy supports first nations and Inuit families in over 150 communities to prevent and respond to youth suicide. The national anti-drug strategy is contributing to protect youth and families against the harmful effects of illicit drug use, with $9.1 million annually to improve access to quality addiction services for first nations and Inuit.

The Canadian Institutes of Health Research is increasing our understanding of suicide, helping to build the knowledge base as well as the capacity to respond more effectively by providing resources, treatment, and supports. With over $315 million since 2006, of which $25 million has been specific to suicide prevention research, it has allowed a significant contribution to scientific knowledge.

The work of the health portfolio is not, however, the only work of the federal government in this domain. Next you will hear from colleagues at the Canadian Forces, Veterans Affairs, and Correctional Services, about the work they are doing to advance the promotion of positive mental health and to prevent suicide for the populations they serve.

Bill C-300 serves as a useful instrument to promote dialogue, education, and awareness among federal partners. The potential development of a federal framework on suicide prevention will also carve the way for greater federal integration of initiatives, programs, and services, and will assist in greater collaboration among partners.

To conclude, the health portfolio is committed to contributing its expertise and knowledge toward the prevention of the loss of life to suicide and to help those impacted by it. Our efforts continue through partnerships and in collaboration with others to make a difference in the mental health of Canadians.

We look forward to the outcomes of this parliamentary process.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Ms. Israel, I understand that you had amalgamated with Health Canada, so I want everyone to know that Ms. Kathy Langlois is an expert in first nations and Inuit health. So during question period, at least, they can zero in on her.

Thank you so much for this direction and for your insightful comments.

Now we'll go via video to Ms. Janice Burke, Veterans Affairs. She can begin now.

Thank you.

[Janice Burke]

Thank you, Madam Chair and honourable members. I thank you as well for inviting me to discuss the very important subject of suicide prevention. In my remarks today, I will provide an overview on the issue of suicide in our veteran population and address suicide prevention efforts under way at Veterans Affairs Canada.

Canada's veterans and their families are not immune to the problem of suicide. With the increased tempo of military operations in the 1990s and onward, Canadian military personnel veterans have been deployed to hot spots around the globe and have been increasingly exposed to operational stress, which has led to mental health problems on the part of some.

Of the approximately 700,000 veterans in Canada, more than 200,000 are Veterans Affairs clients. Most telling is that since the year 2000, the number of individuals who have received a disability benefit for a mental health condition has increased from 2,000 to approximately 15,000. Of those, 71% are receiving benefits related to post-traumatic stress disorder, and 17% have served in Afghanistan.

Determining accurate suicide rates in the Canadian veteran population is difficult. Because of the stigma, it is under-reported. But I think we can all agree that one suicide is too many, and research indicates that veterans are vulnerable. Suicide prevention is a challenge for all involved in mental health treatment and prevention.

In an effort to be more informed on the issue of suicide in the military and veteran population, Veterans Affairs Canada and National Defence recently requested that veterans, as well as Canadian Forces members, be highlighted in the cancer and mortality study conducted by Statistics Canada. Released on May 31, 2011, this study analyzed mortality data for CF members and veterans who enrolled in the Canadian Forces between 1972 and 2006.

The study reported that persons with a history of military service, who enrolled between those years, had the same overall risk of suicide as the general population. However, released male veterans had a 1.5 higher risk of suicide than men in the Canadian population. Released female veterans had the same overall risk of suicide as the general female population.

The problem of suicide is complex and multifactorial. We work closely with National Defence to ensure an effective transition from military service to civilian life, and intervene early with injured or ill releasing members. This early intervention is greatly aided by the recent co-location of Veterans Affairs and National Defence staff at integrated personnel support centres located on or near major CF bases.

Every releasing member participates in a transition interview, often with their family included, to help identify needs, both physical and mental health, related to their re-establishment in civilian life. We connect them to a range of programs and services available from Veterans Affairs Canada as well as from provincial governments and community organizations.

The new Veterans Charter was implemented in 2006 to help meet the transition needs of releasing Canadian Forces members and their families. It provides individualized programs and services designed to support their wellness, and physical and mental health, including suicide prevention. Its features include a focus on the achievement and maintenance of wellness for the veteran and his or her family; provision of comprehensive medical, psychosocial, and vocational rehabilitation; application of modern disability management principles; provision of disability benefits for service-related injuries; and a whole suite of programs and services supported by individual case management and mental health services.

Veterans Affairs Canada's mental health strategy focuses on promoting the mental health and recovery of veterans and their families. Its goals are to ensure access to a comprehensive continuum of programs and services to meet the mental health needs of veterans and their families, to build capacity across the country to provide specialized care to veterans with mental health conditions, and to strengthen the role of Veterans Affairs as a leader in the area of mental health.

It is based on determinants of health such as economic, social, personal, physical, and health services, and promotes positive veteran and family well-being. These include case management for clients with client needs. We have a specialized network between Veterans Affairs and National Defence, with 17 mental health clinics across the country. We have a crisis 24-7 assistance service to provide short-term, professional counselling. We have a specialized clinical care manager service, which makes a professional clinician—psychologist, nurse, or occupational therapist—available when and where needed for at-risk clients and clients with complex mental health needs.

In terms of VAC's initiatives in the area of suicide, we have been very active in suicide prevention among veteran clients.

Together with the Canadian Forces we share an integrated suicide prevention approach. The VAC suicide prevention framework that was implemented in 2010 is an evidence-based suicide pathway framework for suicide prevention at VAC, developed by both VAC and CF health services. It includes components such as knowledge exchange to raise awareness of VAC mental health services and supports, and how to access them, and improvements in screening, assessment, and crisis intervention. Front-line staff situated in 60 points of service across the country have been trained in suicide intervention using the applied suicide intervention skills training model.

Protocols consist of cues for referral and suicide screening questions. They're also in place for front-line staff to assist veterans and other clients who may be at risk of suicide.

[The Chair, Conservative, Joy Smith]

Ms. Burke, your time is just about up now.

Can you conclude, please?

[Janice Burke]

Sure.

Essentially, we also have a number of social supports in place. Our programs are also geared to overcoming barriers to care. This means we have a lot of collaboration with other government departments, non-government associations, and community agencies.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Burke.

That's very useful to know. If you can submit your paper to the clerk, we can get it translated and distributed to the members. I'd really appreciate that.

We will now go to the Department of National Defence with Colonel Jetly, please.

[Col Rakesh Jetly]

Thank you very much for this opportunity to speak on Bill C-300.

Lieutenant-Colonel Bailey and I represent the Canadian Forces, more specifically, Canadian Forces health services.

The CF has placed a particular emphasis on suicide prevention for many years. In the interest of time, we'll limit our discussion to current efforts.

As already discussed today, suicide is a public health problem and a major cause of death among young people in western societies. The Canadian Forces rate has remained consistently below the age-match rate within Canadian society; however, the CF position remains that even one life lost to suicide is one too many. We grieve the loss and, as an organization, ask out loud, “Could we have done more?”

In September 2009, the Canadian Forces hosted an international expert panel on suicide prevention in military populations. In addition to our own internal experts, we consulted experts from academia, and from allied military such as those of the U.K., U.S., Australia, and the Netherlands. We have brought copies of the expert panel report, in English and French, and could make PDF versions available if necessary.

The overarching recommendation of the panel was that effective suicide prevention must indeed focus upstream with the effective treatment of mental illness. The three cornerstones or pillars of an effective mental health suicide intervention program are excellence in mental health care; leadership; and an engaged and aware military population or any population that one is dealing with.

To expand on the above, we continue to strive toward a mental health treatment program that is second to none. This means timely access to multidisciplinary expert care, evidence-based treatments, no co-payments for medication, and no limits on interventions such as psychotherapy, provided they are clinically indicated.

We also continue to implement measures to enhance early identification and treatment in primary care settings of conditions that are known to contribute to suicide.

The unique role of leadership in the Canadian Forces context cannot be understated. For example, the leader-subordinate relationship in the CF is much more than employer-employee. As well, leadership is responsible for all aspects of a member's well-being, including provision of their health care.

Leaders ultimately create and fund health systems, but more importantly, they create a workplace climate conducive to judgment-free discussion about mental health issues, including suicide. Many of the barriers that may have discouraged care-seeking in the past can be overcome through effective leadership. This idea is best exemplified by the current CDS's “Be the Difference” campaign in which he has charged all CF leaders to be facilitators and partners in the mental health of soldiers. He essentially reminds us that mental health is everybody's business and responsibility.

The third cornerstone involves ensuring that the CF members themselves are provided with sufficient information to recognize when they or someone else may be struggling, and that they know when and where to seek help if required. We provide education and training throughout the career and deployment cycles, starting at the recruit level, for both Canadian Forces personnel and their families in order to give them the tangible knowledge and skills to help themselves, to seek care, and to help their peers.

Many other specific topics and recommendations are discussed in the reports including the fact that since April 2010 we have begun what we call a medical-professional-technical review of every suicide, for which we will send a senior mental health professional and a family physician to the site of the suicide, and on behalf of the Surgeon General, do a detailed review of the circumstances surrounding the event. Those include the mental health of the individual, any care that was provided, workplace circumstances, and other stressors.

This process provides us important lessons learned from every single suicide that occurs within our organization, and this new and valuable process will give us near-immediate feedback and identification of any trends that emerge.

There were 61 recommendations in the report. I'll highlight just two of them. We also have ongoing concerns regarding the responsible reporting of suicides in the media, and we take every opportunity to educate reporters and journalism students on the very real risks of contagion and imitation with regard to the reporting of suicides.

To conclude, the Canadian Forces is committed to contributing its expertise and knowledge towards the prevention of the loss of life to suicide, and to helping those impacted by it. Our efforts continue through partnerships and in collaboration with others to make a difference in the mental health of Canadians. We look forward to the outcomes of this parliamentary process.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you so much, sir, for your input.

We'll now go to Ms. Wheatley from the Correctional Service of Canada.

Ms. Wheatley, I notice that your presentation is very long. You're going to have to compress it a bit.

[Jennifer Wheatley, Director General, Mental Health, Correctional Service of Canada]

Yes, we've cut it down.

[The Chair, Conservative, Joy Smith]

Thank you. Please, begin.

[Jennifer Wheatley]

Good morning, Madam Chair and honourable members of the committee. I'm very pleased to have the opportunity to speak to you today about the ways in which the Correctional Service of Canada has undertaken a multifaceted approach to suicide prevention.

CSC employs over 19,000 employees across the country in 57 institutions, 16 community correctional centres, and 84 parole offices to keep our citizens safe. On an average day, we're responsible for over 13,000 federally incarcerated inmates and 8,700 offenders in the community.

In accordance with the Corrections and Conditional Release Act, CSC provides inmates with essential health care, including reasonable access to non-essential mental health care that will contribute to the rehabilitation and successful reintegration into the community.

Improving our capacities to address the mental health needs of offenders is a key priority for CSC. As part of our overall mental health strategy, which was approved in 2004, CSC's approach to suicide prevention includes staff training and education, suicide prevention information for inmates, screening, assessment, monitoring, treatment, and reviews. I'll just briefly expand on a few of these.

CSC front-line staff are provided with initial and ongoing suicide prevention training in order to help them recognize and intervene appropriately for offenders at risk for suicide. In addition, we provide suicide prevention information and reference materials to inmates, which includes access to the inmate suicide awareness and prevention workshop. This workshop assists inmates in recognizing the signs and symptoms of suicide and promotes the services and supports available to them.

Moreover, CSC has a comprehensive screening process to identify inmates at risk for suicide. This includes, at intake, five separate screening processes to identify those who are at an elevated rate. It includes an initial screening while offenders are still in provincial custody, screening within 24 hours, a preliminary nursing assessment within 24 hours, a comprehensive mental health screening within 14 days, and a more comprehensive nursing screening within 14 days.

CSC is also embedded in policy based on best practices, such as the requirement to formally screen any time there's a significant change in the offender's status, such as transfer to a new institution or admission into segregation. Inmates identified at risk for suicide are referred to a mental health professional for a more indepth assessment. If a mental health professional is not immediately available, the inmate is monitored in person until a mental health professional can assess the level of risk and appropriate interventions.

Based on best practice literature, CSC has standardized monitoring in communication protocols, while still allowing for appropriate clinical judgment. This helps support an interdisciplinary approach to the management and intervention of inmates at risk for suicide.

Inmates identified at risk are provided with treatment appropriate to their level of need. This could include what's commonly referred to as outpatient treatment in the community, where they receive services and treatment from a mental health professional in their institution. Or it could include in-patient treatment at one of CSC's five treatment centres. The service has five treatment centres, which are all independently accredited health care facilities for the treatment of our most acutely ill inmates. We also have a partnership with Institut Philippe-Pinel, a psychiatric in-patient facility in Quebec.

Finally, CSC investigates the circumstances surrounding all inmate suicides in order to learn and help prevent further suicides in the future.

Recognizing that more needs to be done, in 2008 CSC joined with other provincial and territorial correctional jurisdictions to collaborate in the area of mental health. Mandated to develop a mental health strategy for corrections in Canada, one of the key areas of focus for this group includes reviews and best practice recommendations to prevent suicide and self-injury in correctional environments.

In closing, CSC recognizes that even one inmate suicide is too many. As an organization, we are continuously looking to enhance our prevention and intervention strategies to respond to the issue of inmate suicides through the integration of best practices, collaborative partnerships, evidence-based interventions, and investigations into all incidents.

Thank you very much.

[The Chair, Conservative, Joy Smith]

I have to congratulate you. You organized yourselves so well. This is a chairperson's nightmare, to get everybody's testimony in. I want to thank you for that pre-organizational method you used. I caught on really quickly as I got the pattern. Thank you very much for doing that because everything you did was very logical, and we have the maximum amount of information now that we can start with.

We're now going into our first Q and A. This a seven-minute round with both the Q and A encompassed in that.

Ms. Burke, again, if you want to say something, raise your hand, please, so I don't miss you. Thank you for helping me out.

Dr. Morin, you're first.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much for your presentations.

I have a number of questions. The first one is for Ms. Burke.

When I was first elected, a veteran and his wife paid me a visit at my office. The veteran was in his forties and had tried to commit suicide a few weeks prior. He came to see me because he was at the end of his rope. He had suffered a serious accident while on a mission abroad and was living with a disability. When he told me his story, he talked about the blatant lack of compassion from the officer handling his file, the trouble he had getting the department to reimburse him for numerous medical expenses and the debilitating disability that had pushed him into trying to end his own life.

My question is a general one. What tangible measures are you taking to ensure that veterans are not pushed to the breaking point and that Veterans Affairs does everything in its power to help them, instead of being uncompassionate as was the case with this veteran?

[Janice Burke]

Thank you for your question.

I'm actually very concerned with the case that you just described. I can assure you that at Veterans Affairs Canada our front-line staff and case managers are very knowledgeable and passionate staff, and are very aware of the many complex issues that our veterans experience, as well as the impact that has on families.

Essentially, what our strategy is in working with the veterans is to ensure that we have early intervention. We begin that at the point of their transition from military to civilian life. We ensure that we meet with every veteran who is transitioning. We include the family in that interview. We work with them to put case management plans in place to ensure that their benefits are in place when they release, so that there's a continuity of support and there are no gaps in their treatment.

We work very closely with them in terms of their care plans and in the rehabilitation program. We have a number of operational stress injury clinics across the country where our veterans get very quick access to psychologists, psychiatrists, and social workers. In addition, we have a peer support program. What we find is that sometimes, because of stigma, our veterans are not coming to programs that would benefit them.

We have a number of peer support coordinators, who have lived the experience of mental health conditions, working with veterans and getting them into our programs. When they are in their programs, care is provided for all of their health care needs, whether it's treatment for mental health or physical conditions. We certainly work closely with them. Across the country we have over 200 case managers who provide that dedicated service.

In conclusion, certainly the case you describe concerns me greatly. If cases like this arise, please to not hesitate to contact our district office immediately. We will definitely have our case managers look into that.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much. I appreciate your answer.

My next question is for the Health Canada and Public Health Agency of Canada officials.

When the previous group of witnesses appeared, I asked about the GLBT subpopulation, which has a higher risk of mental illness and suicide than the general population. Could you describe the specific actions being taken or the department's current approach to target this specific population?

[Marla Israel]

Thank you for your question. It is an extremely important concern. Right now, we are continuing to study the risks that exist within vulnerable populations. One of the biggest challenges when it comes to the gay and lesbian communities is the stigma that is often attached. I think we can help vulnerable populations, especially youth.

One of the Public Health Agency of Canada's projects targets students and focuses on the importance of preventing bullying. This has always been the case; the reality is that gays and lesbians often exist in silence. That is something that must be addressed in schools particularly.

The agency is also working with the Douglas institute in Montreal, which is developing a method that can be used to gain insight into vulnerable populations and to determine what distinguishes people who have the skills to cope from those who do not. Does the agency understand the challenges? We are continuing to study them so we can come up with projects and methods to help vulnerable populations like the gay and lesbian community.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you.

Ms. Quach has a brief question.

[The Chair, Conservative, Joy Smith]

I'm sorry. We're out of time now.

Thank you. And thank you for the question, Dr. Morin.

We have to go to Ms. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I would like to welcome all of you here today.

I also want to take the opportunity to acknowledge and congratulate our colleague Mr. Albrecht for introducing Bill C-300. He has been a relentless advocate on this issue. In fact he started with motion 388 in the last Parliament.

I'm not sure, but I don't think he mentioned today that he was also a founding member and co-chair of an all-party parliamentary committee on palliative and compassionate care. It studied four different areas, one of them being suicide prevention. Last fall that group managed to introduce their report called “Not To Be Forgotten”. I encourage you to take a look at it, and specifically at the chapter on the work you're doing.

Today when Mr. Albrecht was here, he mentioned he was intentional about not identifying any one particular group in his bill. As we can see here today, we have many different groups represented. So perhaps there's an understanding that strategies can transcend age and context, while recognizing the unique challenges you face within the different areas you are representing.

I am a member of a family that has survived suicide. It was many years ago—24 years ago, in fact. I lost my youngest brother. It was his third attempt. As family, obviously there was something we did not access or that was not available to us to try to work through what might have been creating this need in him, and certainly he did end up taking his own life.

Ms. Israel, I want to focus on something you mentioned earlier in terms of framing the issue. You said, “Suicide, suicidal thoughts, and suicidal behaviours have devastating impacts on families and communities across the country.” Then you stated, “All of us—families, caregivers, levels of government, and community leaders—have a role to play in preventing suicide and in reaching out to individuals, families, friends....”

I know you are actively working on strategies to help avoid the risk factors for suicide in children, and that you have developed national guidelines for seniors. I'd like to give you an opportunity to speak to both of those.

Also, if there's anything you are working on in terms of providing assistance to families who are survivors of suicide, would you speak about that as well?

[Marla Israel]

Thank you so much for the question, and thank you for sharing your story. I think it's important for us, as officials, to never lose sight of those stories. It's what guides our work.

Let me start with the second half of your question, which was about specific care for families when it comes to those surviving suicides. Unfortunately, we're not, to my knowledge, working on something specifically for families, per se.

One of the things you mentioned was the population spectrum. You are dealing with children and their needs, and seniors and their needs. It's interesting, because yesterday, the researcher at the Douglas Institute in Montreal, who is working with us on this study on the diagnostics, was telling me that in the course of his research he's come to find out that the most important thing to be looking at is how you parent and how you recognize those signs you were talking about. Many of us take it for granted that we would be able to recognize those signs. But even physicians in primary care, and even teachers, for example, who spend so much time with children, don't necessarily, or wouldn't necessarily, recognize those signs.

Our efforts are around working with researchers, and working with parents and their children. Much of the work being done through grants and contributions is in the community setting. They are pilot-testing initiatives that look at better resilience, and at better relationships and how you forge relationships. Even something like social skills can provide a child with better resilience when confronting something later on in life.

With seniors, for example, the challenges are a bit different. Seniors experience isolation. There, again, primary care providers may take it for granted that a person is an adult and is responsible, and should be okay to manage his or her own health at that age. On a personal note, my mother, for example, is experiencing a lot of challenges in her eighties. The Public Health Agency developed a series of guidelines on seniors' mental health for physicians. They are on recognizing the signs and on the means for intervening appropriately and sensitively but nevertheless firmly, so that people are not left feeling that they're alone and unable to confront the challenges in their lives.

[The Chair, Conservative, Joy Smith]

You have one minute.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Okay. I guess I just want to reflect, again, on what I shared and the fact that I think perhaps what might have guided our lack of action with my brother, although it might have been subconscious, was the stigma around suicide. I know that I said this happened 24 years ago. I'm just wondering if any one of you would be willing to comment on how far we've come since that point in time. I think you all also mentioned stigma.