Human Resources Committee on April 30th, 2009

[Michael Kirby]

Just get hold of Jayne.

I go back to where I started. We have to get everybody in on this, and any help we can provide to any of you, either collectively as a committee or individually, we'd be more than happy to give.

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

Thank you.

If you were going to summarize, what is the single most important thing this committee should take away, from the mental health aspect, from your perspective, that we should make sure we don't omit in this report?

[Michael Kirby]

The single most important thing for dealing with individuals with a mental illness, frankly, is more supportive housing. If you look at the Senate committee report, we recommended a very significant increase over a decade in supportive housing units. That would be number one.

Number two would be, as I said in response to Mr. Savage's question, a redesign of all the federal programs that are designed to help people, so that they're designed effectively or uniquely to take into account the differences between a mental illness and a physical illness, and not doing it by simply tinkering with the individual programs but by producing a single program, so that you're not overlapping all the time and are not dealing with different people.

Those are, right off the top of my head, what I think are the two most important things.

The other thing we ought to think about is whether you ought to be offering some form of incentive to employers. We did this way back—I guess, looking around the table, none of you were here—when I first came to Ottawa. Back in the 1970s, we launched a couple of pilot projects to encourage employers to employ the physically disabled. Look where that is today: access to public buildings with ramps, bathrooms—we've come a long way in this country in 25 years with respect to physical disability. A lot of it began with incentives from the federal government originally to employers, and then the feds deciding that they would change access to public buildings, and so on. We have to do the same thing with respect to mental illness.

The fact is that 80%-plus of the people who have a mental illness are employable. You may have to make some adjustments. If you have someone who has an episode of depression and they are away from work for two or three days, that's okay; you're going to have to make some workplace accommodations. But you could go a long way to starting us down the road we've already come with respect to physical illness and physical disability by recommending some pilot projects that deal with that sort of issue, so that we could begin to find out what works and what doesn't work, which is exactly what we did with respect to physical handicaps.

[The Chair, Conservative, Dean Allison]

Thanks, Ben.

Thank you, Senator.

We're going to have to move over to the Bloc.

Madame Beaudin, you have five minutes, please.

[Josée Beaudin, Bloc, Saint-Lambert, QC]

Thank you very much.

Thank you for being here today.

We receive so much information all at once. I will begin by saying that I am very pleased to have heard you say that housing should be a priority. There are at present various federal housing programs targeting, among other things, homelessness. You even stated that housing is one thing, especially when dealing with homelessness and those people suffering from mental illness, butt that all of the support that goes hand in hand with housing is equally essential.

In my community, there are several organizations that work with the homeless. You can have the most wonderful federal housing program, but if the street workers, the psychologists, the resource persons who support those people were not there, these programs would not succeed. We would not be able to save those homeless people who, often, are not ready, from one day to the next, to go and live in an apartment. I consider this to be important.

In your document, I was impressed to see that 70% of adults develop a mental illness before or at the age of 18 years. You therefore are giving priority to children and adolescents. Congratulations! This is a matter of prevention and I would like to hear you speak more about this. In terms of prevention, how might we reach out to children and adolescents?

[Jayne Barker]

I agree with your comment that simply providing a place for people to live is very often not the answer. They can't maintain the housing, the landlord gets frustrated, and it becomes a vicious cycle. Providing adequate supports is exactly what needs to happen.

Mike mentioned that one of the things you may like to include in your report is more supportive housing. We're not just asking for regular housing, but for housing with supports attached to it, because that's what really helps people to stabilize. It's the combination of those two things. Supports on their own don't provide the safety and the stability that people need either; they need that combination.

[Howard Chodos]

With regard to prevention and mental health promotion, one of our objectives, in the context of the development of a strategy, is the promotion of mental health in the general population. We recognize that the measures aimed at promoting mental health within the general population can also contribute to the prevention of mental illness. Unfortunately, we do not quite know how to go about preventing mental illness, but there is conclusive evidence that targeted interventions in specific areas, be it in schools or elsewhere, are the best route to developing prevention programs. We hope to be able to integrate prevention and promotion in all of the initiatives undertaken in this area, in order that these activities not be stand-alone.

[Josée Beaudin, Bloc, Saint-Lambert, QC]

I do not know if you have looked at the situation of the elderly, our young people, the Inuit, the Metis and the First nations' peoples. Is there a segment of the population that is more affected by mental illness than the others?

[Michael Kirby]

Given your comment, I'm going to ask Mike Pietrus to comment on the anti-stigma program. Ideally, I suppose, if you told me that we could put money into only one segment of the population, I would put it into children, and I would put it into children for two reasons. One, you would stop the problem when they become old, you would get it early; and secondly—and this is an amazing comment—only one in six, only 17%, of Canadian children who need professional help get it. There's no other part of the health care system in which 84% could not be served without there being an outcry. Part of that...and this leads to the stigma thing that I want Mike Pietrus to comment on. This will amaze you: 40% of Canadian parents, that's two out of every five sets of parents, would not tell anybody if their child had a mental illness. They would be too embarrassed by it. So 40% are not going to get help because their parents aren't going to look for it. And then there are another 40% who don't get served because we don't have a way to serve them.

Do you want to comment?

[Micheal Pietrus]

Reaching children is so important, because they don't know a lot about mental illness and also because of the stigma around mental illness and coming forward to seek help. Early intervention, as Mike said, is so important and can make such a dramatic difference in terms of somebody's life later on.

One of the areas we're looking at with the anti-stigma initiative is to identify programs across the country that are working very well, particularly those aimed at children and youth, whether they're educational in nature, operating already within the school system, whether they're in the arts, whether they're on the Internet, for example--different ways of approaching young people so that they can learn more about mental illness and become more comfortable with it. But there's also engaging the people who influence young people: educators, people within the guidance community, and especially parents. So again, you're trying to engage all of these people. That's what we're doing.

When we identify some of these programs that are successful, we're going to evaluate them, see how we can also help improve them, if that's necessary, and then begin to try to replicate these programs elsewhere across the country so that communities aren't starting from square one, so we're not reinventing the wheel, for starters. As phase two goes along, what we're hoping to do is build on those programs that may require more work, more funding. And then ultimately, phase three would look at those things that people haven't thought of before, that really haven't had an opportunity to be developed, and then take some of those programs and move them forward.

Again, the whole idea behind this is not reinventing the wheel, but providing people with toolkits and programs that they can pick up on so that they're not starting from ground zero.

[The Chair, Conservative, Dean Allison]

Sorry, that's all the time we have.

Thank you very much, Mike.

We're now going to move to Mr. Vellacott for five minutes, please.

[Maurice Vellacott, Conservative, Saskatoon—Wanuskewin, SK]

Thank you very much.

I appreciate very much our panel being here today. This is an issue that I know seizes all of us. Some around the table here, myself included, know this kind of more from a first-hand or family basis, too, so we understand the broader piece through support groups, that kind of thing, and on a fairly direct basis, too.

The one thing I was going to suggest, and maybe it's more of a comment, and you can respond.... I have four different questions along the lines of denial, stigma, that whole range of things; the paranoia around mental health issues, and why some are on the street that way; and then there's also this issue of employment and the stressor that sometimes is, and I think you've inferred that; and then lastly, because you made the statement about family care, which I think will always be a key kind of component of it, the nature of those who they trust around them more. My question is what can we do in terms of changes in the tax code. That's where I'm going with the four questions.

Around the issue of denial and stigma, I know there's the stigma issue, and I'm well aware of this piece of it, but there's also the denial thing. I don't know in terms of this study and so on that you folks have done, but in that aspect, as you would be well aware, sometimes the higher the IQ of the person, the greater the denial. Maybe it's stigma, but it's also as much that person.... For instance, who around this table wants to say, there's this part of my life that is not functioning as it maybe should? So there's that aspect. I don't know if you have any quick comment on that.

And I don't know how you'd change it, because until somebody comes to the point of accepting that they have this, that it can be worked with, that it's not a terrible dark secret in society, or whatever...and I guess that's where society comes in for the difference. But I don't know how you can change that. And believe me, I speak of this on a fairly knowledgeable basis. If people deny it, it's hard then to get the help.

[Michael Kirby]

Of course, and the only way you can really deal with that problem is indirectly, and it is by reducing the stigma to the point where people don't feel they have to deny it.

The problem now is that people are so afraid. If someone has a mental problem and they are so afraid that their friends, their family, will say to them, get over it, there's nothing wrong with you, etc., then they're afraid to raise it with even their closest friends. So you can't attack their problem directly; you've got to change the environment, which makes it safe for them to talk about it.

[Maurice Vellacott, Conservative, Saskatoon—Wanuskewin, SK]

Yes. In other words, it's like when somebody has colitis or diverticulosis or some other issues, and this is one of a range of things. We all have our different....

[Michael Kirby]

By the way, just to give you an example, 30 years ago breast cancer was exactly where mental health is. Thirty years ago, a woman with breast cancer wouldn't tell anybody. Indeed, the newspapers wouldn't report it because they weren't allowed to use the word “breast” in news stories. It's kind of interesting, but we just have to change it.

[Maurice Vellacott, Conservative, Saskatoon—Wanuskewin, SK]

Yes, exactly.

Let me jump to my third thing here. I'll come back if I have time at the end.

It's the issue of employment, which I know you stress as important in terms of mental health and the restoration of things and so on. I think you did allude to that fact as well, and you're well acquainted with it, no doubt, but for some people employment--and maybe it's a cyclical thing, episodic, as you say, it comes around--is a stress in itself and it sometimes requires an entirely different, more pastoral, calmer outdoor country setting, or whatever. Yes, we can restructure employment situations and so on, but maybe there just has to be some guarantee of support there, without it being, as you say—

[Michael Kirby]

Right. Look, a “normal” job isn't going to work for some people, there's no question. On the other hand, at the present moment, what happens is that if you have a mental illness, if you suffer from depression and so on, employers are inclined to simply not hire you, even though the fact is that 90% of the time you could do a very good job. So I'd like to get some incentive to get over that. There will obviously be some people for whom that doesn't work and for whom you've got to have a network of supports, absolutely.

[Maurice Vellacott, Conservative, Saskatoon—Wanuskewin, SK]

I'll go to my last question very quickly.

There's the issue of family care, and as you well put, it's people they trust, and even then they have to come to the point...there's more trust in some family relationships than in others. But if you could recommend any change by way of the tax code to assist those other caregivers, those supporters...is that a line of thinking you've pursued?

[Michael Kirby]

Yes, we have, although we haven't looked at the exact numbers. When the Senate committee looked at that issue, we came to the conclusion that you needed to find a way—whether through a tax deduction or some income-tax-driven measure—that would recognize, frankly, that governments are getting an awful lot of free service, because if the family members didn't exist, a lot of these people would have to be institutionalized, which would cost the federal and provincial governments a lot of money.

To some extent, there ought to be a recognition of that, and in particular, you need an element of respite care. I'll give you an example, because I was on the phone with someone early this morning. An 84-year-old woman looking after her mentally ill 87-year-old husband desperately needs a break or she's going to crack. Yet, not only do the facilities not exist, but she couldn't afford them if she had to buy them because they're not covered under medicare.

That example, by the way, is not a random example. There are examples like that. The same thing is true for people with mentally ill children, when the wife drops out of the workforce in order to stay home to look after the child. The family income has gone down substantially, yet that's not recognized in the tax system, though it is saving the health care system a lot of money.

[The Chair, Conservative, Dean Allison]

Thank you very much, and thank you, Mr. Vellacott.

We're going to move to Mr. Pacetti.

Welcome, sir. You have five minutes, though you said you were only going to need a couple.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Thank you, Mr. Chair.

Hopefully it will only be a couple. It's a very interesting topic. I'm used to being on the finance committee, and this is a change of pace. I think we're getting into a subject that normally we touch upon very briefly at the finance committee. Groups come before the committee asking for money, but we're not so sure that we understand the problems in-depth.

My question is the same question you have been asked, but I guess it's from a different perspective. In terms of services, are services ultimately getting to people who need them? We see a lot of groups coming before the finance committee representing different things and providing different services. I'm not so sure they provide services--because isn't the ultimate service provider the health side at the provincial level? Are the groups just there? They seem to be asking for programs, but there are a lot of administrative things involved. Is there money clogged up and not being used for the ultimate beneficiary?

[Michael Kirby]

Yes, and I have two comments.

Is the system inefficient? It's colossally inefficient. It's inefficient because there are so many service providers operating in any given municipality that the same number of services are provided by a large number of service providers.

Do I think you could ultimately redesign the system so it would be a lot more efficient, and with the administrative numbers more money would fall to the bottom line? Absolutely. That's what the mental health strategy will do.

Let me be clear. For an average person with a mental illness, less than one-third of the public money that is spent on them is spent by health departments. The rest is spent by housing, by training, by social services, and so on. If someone has a heart attack, it is all spent by the health department. You not only have the fragmentation at the service delivery level, you have the fragmentation at the provincial level and at the federal level.

There is no minister in the federal government responsible for people with a mental illness. The funds the feds spend come out of a lot of different pockets. The same thing is true provincially, and the same thing is true on the ground. Clearly, you're right. There's a huge element of duplication.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

I don't mean to interrupt; it's just that our time is short.

We have constituency offices, and a lot of people who come to see us are going through hard times—and some have permanent hard times. It depends on what they're there for. We try to channel them in the right direction, but in fact it's not necessarily towards the traditional health institutions. The local Quebec MPs--we have CLSCs—will refer them to a CLSC, and sometimes there is a follow-up, but there just don't seem to be enough resources. Sometimes we'll get good success, but there doesn't seem to be the 100% hit rate. I'm not even sure what the hit rate is.

The other part of the question is about funding. I think you spoke about it in terms of proper programs from the government point of view. What I've been seeing is that businesses have been taking responsibility for certain items. When we were in Victoria last year with the finance committee, the chamber of commerce from Victoria got together with the homeless, and there seemed to be an initiative so that they were going to work on it together. When we got to Halifax, it was still the social workers versus the chamber of commerce. There wasn't that linkage. I'm wondering what your perspective is. Is there some collaborative work being done? Mental health is an issue in the workplace. And let's face it--a lot of times employers, rather than dealing with the issue, will try to find a way to get rid of this guy or this woman so that they don't have to deal with the person.

[Michael Kirby]

That certainly happens. The reality is that there's growing recognition now among at least the major employers in the country that there's a real need for them to begin to deal with it. We have a workforce advisory committee that is working with a number of companies now on pilot projects to figure out--I'm going to use the same word as we use for people with disabilities--what workplace accommodation is required for them to be able to employ people.

We're making progress on that, and it is hugely economically beneficial to the company. When someone goes off on short-term disability, they continue to pay the salary during the short-term disability. So to the extent that you don't have to send that person off, or they're off for a much shorter period of time, the money that would otherwise be spent is now going to fall directly into the profit line.

So there's a huge economic incentive. The more progressive employers in the country are starting to recognize that. I'm going to ask Jane to comment specifically.

We're hoping to really make some progress on that. I will tell you, interestingly enough, that governments and government agencies are not anywhere near among the best people to deal with this issue.

[Jayne Barker]

I was going to pick up on your comment about where the responsibility for the homeless population rests in communities. You talked about Victoria as an example, where the business community was seeing themselves as having some responsibility for the homeless community or for outcomes for homeless people.

There are several communities in Canada, and Calgary is a very good example, where business leaders and others in the community have come together. In my experience, and with the exposure I've had to this issue, I think until every Canadian takes some responsibility for the homeless and recognizes that they have a part in making it different, there isn't going to be the kind of lasting change and commitment to change that we need.

The business community is a very important player in sustaining long-term change.