Human Resources Committee on April 30th, 2009

[The Chair, Conservative, Dean Allison]

Thank you, Jayne. And Glenn, thanks again for being here today.

We're going to move to the last questioner of this round.

Mr. Komarnicki, you have seven minutes.

[Ed Komarnicki, Conservative, Souris—Moose Mountain, SK]

Thank you, Chair.

Thank you, Dr. Kirby and presenters. Certainly you exhibit a lot of passion and an abundance of knowledge and understanding. I do appreciate that you're doing further research on the ground to see how things are going, and that's good. I certainly see you as helpers, encouragers, and facilitators. It's certainly good for us to shift from a crisis-driven approach to something that's more comprehensive, as you've mentioned.

There are a couple of areas on which I have some questions. You mentioned one, which I read about in the spring 2009 issue of MHCC News. You started your anti-stigma, anti-discrimination campaign at a journalism and community services student group. I wonder if that was strategic or not.

Secondly, how did that go, and what are the underpinnings of your campaign as you go forward?

[Michael Kirby]

I'm going to ask Mike Pietrus, who is responsible for that campaign, to answer.

[Micheal Pietrus, Director, Anti-stigma/Anti-discrimination Campaign, Mental Health Commission of Canada]

Thank you.

It's very interesting, because initially we were hoping just to reach journalism students. The media play such an important role in shaping people's public opinion and views about mental illness, in the language they use, for example. It's the language that becomes so hurtful to people when they're dealing with stigma.

We know from work that has been done in Australia, for example, that you begin right at the source where you can have the most impact in influencing young journalism students. So we approached Mount Royal College as a pilot test site, and lo and behold, we were very, very pleased to find out that in fact a number of other faculties—for instance, the faculty of health and community studies, which includes nursing, social work, and the justice program—were also very interested and asked if we could put on a second session for their students as well.

We brought in four experts to talk about it from different perspectives. We also invited two consumers, people who had personal experiences, who could tell their stories. Again it's that direct contact with people who have experience with a mental illness that is so successful at breaking down those stereotypes and many of the myths surrounding mental illness.

I'm pleased to say that it was very successful. It's one of the initiatives we're looking at moving forward, trying to do this in other universities across the country, and perhaps even taking it down to the high school level where we're introducing it at an even earlier age.

Our senior consultant, Dr. Heather Stuart, at Queen's University, prepared a pre- and post-survey so we could begin to see what people's opinions were going into the conference or symposium, and how they may have been affected coming out.

Just to give you an idea of how successful the program was, Mount Royal College then came back to us and asked if we would do this on an ongoing basis and use its students, to a degree, as test subjects to see how in the course of the three-year journalism program, for example, and the three-year community services program they would change their opinions and how their views might change over the course of being introduced to stigma-reducing education programs in the curriculum and things of that nature. By getting in early, they're hoping many of their teachers and professors will be able to actually introduce that into the curriculum.

We think it's a great area to intervene.

[Ed Komarnicki, Conservative, Souris—Moose Mountain, SK]

Thank you.

There are many barriers, but the stigma is probably one that pervades all the other areas. So it's good to see that initiative and other initiatives that you may have going forward.

The other area that is of interest, of course, is your “housing first” model. I've always been of the view that if you have a roof over your head, a bed to sleep on, and food on your table, you can start tackling some of the other problems that are facing you. It's not a problem particular to one group; it's common to everyone. Your “housing first” model obviously focuses on providing a place to live. Having a job is another important aspect to give you the support or the structure you need to move forward.

I'd like to know, first, where you are in terms of your research and how far you have gone on the ground on this issue.

Secondly, and maybe you don't know yet until you've done your research, but how is the availability of housing stock? Is it more than just physical availability? Do we need to be looking at assisting by way of income supplements, in addition to housing stock, to provide a basis from which a person can start to work?

Maybe one of you can comment on that. I understand Vancouver is perhaps one of the places you're going to start.

[Jayne Barker]

Thanks for the question.

You're right. The “housing first” model is really exciting, and it's just common sense that having a decent, safe place to live is a really significant step in creating stability in someone's life, whether they're mentally ill or not.

The challenge of finding suitable apartments in the various cities—and it is a challenge—is one that we're just starting to tackle. As Mike said, we received the funding about a year ago and really started from nothing. It's taken the last year to develop relationships with the service providers and researchers in each of the five cities. We've worked hard to work collaboratively with the organizations in each city. We didn't want to come in and say, this is how you have to do it, but we wanted to develop coalitions of researchers and service providers to work with us, and we have achieved that in every city.

An RFP was posted at the end of September, and we have now gone through a process where, in each city, we have identified service providers and researchers. The funding has started to flow.

We haven't actually started collecting data. We expect to do that at the end of the summer. The actual research will take place over the next four years; it's early yet. We don't yet have results or anything like that, but we're very excited to be where we are and have started to deal with the challenge of finding suitable housing.

You mentioned Vancouver, and because of the Olympics, of course, Vancouver has some unique challenges. To find an apartment right now, no matter your income, is difficult in Vancouver. But the whole area of providing rent supplements is an important one to focus on, because the kind of housing you can afford when you don't have that kind of supplement is often substandard, and it doesn't provide the kind of safety and stability that people with a mental illness need to get on with getting better. So that's part of what we're looking at.

[Ed Komarnicki, Conservative, Souris—Moose Mountain, SK]

I guess we're running out of time. There are other questions I'd like to ask. Obviously, having had some of the funding to establish the commission and then the funding to operationalize it, it would be very interesting to see, in a few years from now, the fruits of that labour. It will probably have some specific direction then.

I notice that you've mentioned various advisory committees, and I would say there are some issues that pervade all aspects of this. But I gather from what you've done in your set-up that there are specific issues for specific groups that need to be addressed particularly. I'll leave that with you to comment on somewhere along the way, but not necessarily now.

[The Chair, Conservative, Dean Allison]

You can catch that the next time.

[Michael Kirby]

Could I just make one comment on that?

[The Chair, Conservative, Dean Allison]

Sure.

[Michael Kirby]

You're right, a lot of the issues we work on actually cross among the different advisory committees, and we actually have a mechanism for getting more than one advisory committee together collectively to do that.

Let me just make one other comment about the role of the federal government, because one of our approaches to the homelessness issue was to take the federal government's money and lever it, that is to say, to use it to get other people to come to the table with cash. We've actually managed to do that. We're running some 25% ahead of the amount of federal money we received, through a variety of ways. We have the provincial governments, we have the regional health authorities, and we have the private sector coming to the table.

You mentioned the Vancouver example. Just as an interesting illustration, the private sector in Vancouver—just as the private sector is doing in Montreal, Toronto, Calgary, and other places—is paying for supportive housing for a group of people for whom we will then pay their mental health services. Since we don't have to pay for their housing, we're able to treat a lot more people.

This is an interesting area, and the nature of the questions around the table absolutely prove that it's a non-partisan issue. It's a non-partisan issue in the bigger sense that everybody out there seems to be willing to put aside the traditional jurisdictional lines and say, we have a problem and let's all pitch in and help.

That's one of the very encouraging things about this. There are people from the private sector, governments, and a variety of services who all seem willing to say, “We won't do the usual business of operating only in our own square box; we're willing to look more broadly.”

[The Chair, Conservative, Dean Allison]

Great. Thank you very much.

We're now going to move to the second round of five minutes for questions and answers. We'll start with Madame Folco.

[Raymonde Folco, Liberal, Laval—Les Îles, QC]

Thank you, Mr. Chairman. I wish to thank the four of you for this extremely interesting presentation, especially for me, because I have a private member's bill aimed at episodic illness and at offering to people suffering from this problem the possibility of accessing various benefits. I focussed mainly on employment insurance, but you have mentioned other benefits that I will be wanting to look at.

I would like to begin by saying that this is the first time that I have heard talk of this. I would perhaps be interested in meeting with you, in exchanging documents, in order that I might incorporate into what I have in mind the element that you have targeted in this debate, at the very least, and perhaps even the categories of persons who would be affected by this bill, if ever it found its way to the House of Commons. This is obviously something that is very dear to my heart.

You talked about a project, Mr. Kirby. I am presuming that it is a pilot project. I would like to know more about it. In other words, I would like you to keep me abreast of what you are doing in this area so that I might, in due time, integrate it into my work and do something more serious with it given that it would apply to a much broader clientele. I believe this is important.

What you have also clearly done is try to remove other taboos in our society, and we are very greatful to you for that.

I would like to hear your thoughts regarding two aspects. I know that the clock is ticking. First of all, you mentioned in passing that the government of Quebec is not a partner in this project. I would like you to offer us not recommendations but rather suggestions in order for us to get the provincial government to come on board, despite the respect I have for provincial and federal jurisdictions.

Secondly, I would like to talk to you about women and recent immigrants. You discussed the homeless and those suffering from mental illness. I would have liked to hear you speak in general terms about the issue of women and recent immigrants, and I would like you to tell us how you view the cultural issue, especially with regard to recent immigrants, because in certain communities, this is very highly charged matter and people's reaction is to keep the person suffering from a mental illness completely hidden away.

I will stop there because I really want to hear your response.

[Michael Kirby]

That's right. Thank you for that.

Before turning to my colleagues, let me respond to your first point. I did not know you had the private member's bill. Afterward, let's make sure we know how to keep in touch, because that's really critical.

What I said about the pilot project, though, is that I'm hoping to have conversations in the relatively near future with HRSDC about running a pilot project on exactly the kind of thing you talked about. So keeping each other mutually informed would be helpful.

I'm going to turn to Howard and then to Jane on the multicultural issue.

[Howard Chodos]

Thank you for the question. With regard to our relations with the government of Quebec and the ministère de la Santé et des Services sociaux, Quebec's department of health and social services, as Mr. Kirby mentioned at the outset, we have with the government a bilateral relationship so as to be able to share information and keep up to date, on both sides, in the mental health area. That is the first thing.

Secondly, as we explained, one of the sites for the pilot projects on homelessness and mental illness is in Montreal, and we are working closely with advocates in this sector. In a way, we are trying to develop, to the extent possible, both our relationships with the representatives of the government of Quebec and our relations with service providers in the sector, so as to better understand the situation in Quebec and allow for information sharing throughout the country on what is being done in English-speaking Canada, supplying this information to stakeholders in Quebec and vice-versa.

It is our hope that, given the fact that we will be faced with similar questions throughout the country, this process based on information sharing will allow us to develop relations with the government but also to establish for the Commission a certain presence in Quebec in order that people be able to benefit from it.

[Raymonde Folco, Liberal, Laval—Les Îles, QC]

What about the cultural communities?

[Howard Chodos]

For now, we have no specific project targeting the cultural communities. However, in our document, we propose a framework for resolving these types of problems and providing a safe environment for people to deal with their mental health problems, while recognizing that there are tremendous differences from one community to the next.

[Raymonde Folco, Liberal, Laval—Les Îles, QC]

Before giving the floor to Ms. Barker, I would like to make a suggestion. I am deeply involved in this area, and if I could be of any help to you, I would be very pleased to do anything I can.

Ms. Barker, would you like to add anything?

[Jayne Barker]

Thank you for the opportunity to speak to this.

Through our advisory committees we have two projects that are specifically focused on the needs of multicultural communities. One of the projects is assessing the barriers to accessing mental health services once people come to Canada. The other project is looking at and is actually developing tools for mental health practitioners to use in a variety of languages, incorporating very culturally appropriate and specific approaches.

The experience of different cultures is very different, both how they experience mental illness and how they interpret it in a cultural sense. In the Chinese language, there isn't even a word for mental illness. So there are some really significant differences. It's one of the challenges as Canada increases the number of people from different ethnic backgrounds in our population. We really haven't shifted the mental health system to provide appropriate services to all of those groups. Through these two projects we're trying to develop materials and to understand what the exact barriers are in more depth.

[Raymonde Folco, Liberal, Laval—Les Îles, QC]

I repeat my offer, Madam Barker.

[Jayne Barker]

Thank you.

[The Chair, Conservative, Dean Allison]

Thank you very much.

We're now going to move over to Mr. Lobb.

You'll have five minutes, sir.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you.

And thank you very much for coming today. It's been a pleasure to hear what you're advocating for.

One puzzling piece for me as we've journeyed along in our study on poverty is that we've had a number of different groups come in—in fact just the other day we had groups come in—describing poverty reduction strategies. What's really mind-boggling to me is that in virtually every case there's no mention of mental health or addiction in these presentations. There's lots of discussion around employment insurance, guaranteed income supplements, and child tax benefits, but in the document we have here there's not one mention of mental health or addiction. I think it's a real shame that there are groups advocating to reduce poverty and homelessness without referencing this. I'm curious about why these groups don't mention it.

[Michael Kirby]

I can't speak for them, but I will tell you what my guess is, and it's probably pretty accurate. The stigma that is attached to mental illness and substance abuse is sufficiently strong that most of them don't even necessarily provide services to those people. In other words, there is a feeling that if you have a mental illness and a substance abuse problem, you're kind of “over there”, and we will deal with the broader population of poor or low-income Canadians.

I don't know that this is the answer, but I will tell you that the way the system is structured, it's what happens.

In fact, it even happens between substance abuse and mental health. If you have both problems, which is not uncommon, and the first person you go to for help is a mental health worker, it's not uncommon to be told, “Go and fix your substance abuse problem and come back and see me”, or the other way around, if your first stop is related to substance abuse. The reality is that the two problems are so intertwined you can't separate them.

So I would suspect that the real issue is that people are trying to pretend it's not out of the shadows for them.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I appreciate those comments. It's pretty obvious to me and others that you can increase the amount of funding to these people, but unless the other issue is dealt with, it's just going to manifest itself and spiral out of control.

I know our time is running short, but I'm really excited about your demonstration sites and your “home first” program. We will be doing some outreach in different cities further to our study on poverty, and it would be great if we could talk to the individuals in maybe not all but in some of the cities and hear what they're doing right at the ground level.