Bill C-300 (Historical)

Federal Framework for Suicide Prevention Act

An Act respecting a Federal Framework for Suicide Prevention

This enactment establishes a requirement for the Government of Canada to develop a federal framework for suicide prevention in consultation with relevant non-governmental organizations, the relevant entity in each province and territory, as well as with relevant federal departments.

Mental Health

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, over the past 11 years I have spent much of my time focusing on the issues of mental health and suicide prevention. Motion No. 388, targeting online predators, passed unanimously in November of 2009, and Bill C-300, calling for a federal framework for suicide prevention, received royal assent on December 14, 2012. These are two initiatives I am proud to have championed.

I was encouraged in February of this year to receive a letter from Noah Irvine, an exceptional young man from Guelph, who unfortunately knows this issue all too well. In his letter to all members of Parliament, he challenged us to champion the cause of mental health, and to stand up for Canadians suffering with mental illness. His story of personal loss, and his ongoing courage in overcoming these trials are an example to every one of us.

Noah is visiting Ottawa today. It has been my privilege to meet him, and sense his ongoing commitment to this important cause. I thank Noah for his message of hope. May he keep up the good work.

[Philip Upshall, National Executive Director, Mood Disorders Society of Canada]

Thank you, Chair, for the opportunity to appear before you. My associate executive director is with me.

Just at the outset, I'd like to say I've appeared before a large number of standing committee meetings over the last 40 years of my activities in Ottawa, and I am so happy to see the members taking such a terrific interest in this topic. Frequently, standing committees show up with four or five members and it's rather impromptu. It's obvious you take this seriously and I'm really happy to see that.

Mood Disorders Society of Canada is a national, not-for-profit charity managed and membered by people with lived experience in their families. We are active at the national level only, and we have been around since 2011. We are active in many areas, some of which Dave will mention. We become engaged when we think there is an opportunity to do something for the people who need help. Those are the people who live with mental illnesses, whether they're on the street, whether they're veterans, whether they're first responders—whoever we can be involved with to help.

We've focused on that primarily because you can become involved in Ottawa with an awful lot of meetings and a lot of consultations, a lot of round tables, that produce not a whole lot of effective knowledge translation that will assist the people who need help. The material is important, and if you're involved in that stuff, that's fine; it's just not our bag.

One of the things we have done in the past, and we currently do, is become involved with the research community. We became involved with them initially when CIHR came into existence and with Bill C-300. We sat on their institute advisory board for many years. We're founders of the Canadian Depression Research and Intervention Network. The reason we did that is because there is a lot of research out there that I'm sure you've found is not translated into helping people who need help. We try to motivate the researchers and the community generally to pick up what we know will work and get it working, and still support research.

In 2004, we worked to help people with mental illness improve their quality of life. In 2011, we hosted a round table at the War Museum on PTSD. It was called Out of Sight, Not Out of Mind. The entire proceedings are on our website. It involved 75 people from all walks of life, including the Minister of Veterans Affairs, the military chief of staff, and a lot of people who were involved in the then-nascent discussion that PTSD is important.

Out of that came a report and many suggestions for improvement of our attention to PTSD. The recommendations presented in the report included addressing stigma; enhancing the knowledge of physicians and health care providers, which we think is number one on identification and treatment of PTSD; educating PTSD sufferers and their families on available support networks and resources; and promoting ongoing collaboration and dialogue among government and leaders in the field of mental illness specializing in PTSD.

We've looked at the presentations you've had in the last few days and they're terrific. You have a lot of really good information before you and there is no sense our repeating that information for you.

From our perspective, in order to address PTSD and prevent suicide, we would suggest you might look at early diagnosis of mental illness. Early diagnosis of mental illness will help us stop the movement into PTSD and into suicidal ideation. Early diagnosis requires the attention of the medical community to the issues of mental health, which is pathetically lacking at this time.

We would recommend that you increase mental health education among health care providers for the reason I just mentioned.

We strongly believe that peer support needs to be number one on your agenda. Whoever you talk to will tell you that it's the human touch, the human element. Research tells us that peer support needs to be there for you.

I'm going to turn it over to Dave Gallson to give you a bit of an overview of some of our programs.

Canadian Human Rights Act

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Madam Speaker, I rise today to speak to the government's Bill C-16.

In its current form, I cannot support this bill for a number of reasons. Let me assure all of my colleagues in this House and, indeed, all Canadians that I do not oppose this bill because of any hatred for, any fear of, nor any malice toward anyone who is dealing with questions of gender identity.

Before I outline my concerns about the potential negative outcomes of Bill C-16, allow me to say clearly that I am supportive of any initiatives that will protect persons from hate speech. I am supportive of the need to guarantee equal rights. I also agree that there can be no tolerance for bullying or violence of any kind, or for any reason.

Parliamentarians and all Canadians have a duty to prevent bullying, hate speech, violence, or any such behaviour, but I am wary of the demands of any government-imposed value systems that would change fundamental definitions and principles of society. The imposition of fundamental value system changes of this magnitude must be viewed with some degree of skepticism. Too much is at stake for us to proceed without caution, if we proceed at all.

I am supportive of equal rights for all, but in my opinion this bill goes far beyond equal rights into the territory of granting extra rights or special rights for some; and in the process of granting those extra rights for some, we automatically diminish and deny the legitimate time-honoured rights of many others.

Relating to Bill C-16, I have a number of concerns. Some of the concerns address immediate potential negative repercussions, while others relate to the potential for long-term effects and outcomes of the enactment of this bill.

My concerns lie in four areas. I am concerned that this bill would cause fear for many Canadians, fear that they would not be able to even discuss public policy issues, such as this one, on which they may disagree with the government-imposed agenda. I am concerned about the potential harm to innocent children and youth as a result of the possible invasion of their privacy. I am concerned that the terms gender identity and gender expression are very subjective terms, far too subjective to be used in the context of legal documents, particularly in the Canadian Human Rights Act or the Criminal Code of Canada.

Finally, I am concerned that, when government adopts dramatic changes to public policy as it relates to gender identity and sexuality, with minimal research or support, the results could be harmful for all members of society, but especially for those we are actually trying to help; that is, transgendered children or youth.

Let me address these points in reverse order. Would this bill inadvertently harm those whom we are trying to help? There have been many eminent scholars, medical practitioners, psychologists, psychiatrists, and professional organizations that have raised legitimate concerns about the current treatment of the transgendered person and are especially concerned about long-term negative effects of hormone treatment and reassignment surgery.

The American College of Pediatricians urges educators and legislators to reject all policies that condition children to accept a life of chemical and surgical impersonation of the opposite sex. They point out the biological medical dangers associated with the use of puberty-blocking hormones and the follow-up use of cross-sex hormonal medication—testosterone and estrogen—which are needed in late adolescence. These are known to be associated with dangerous health risks including, but not limited to, high blood pressure, blood clots, stroke, and cancer.

There is another sobering statistic, and that is the increased suicide rate. During my 10 years here in Parliament, possibly the one issue that has received most of my attention has been suicide prevention. Motion M-388, dealing with Internet predators, and Bill C-300, An Act respecting a Federal Framework for Suicide Prevention were private members' business initiatives that I tabled and worked on diligently for many years.

The research is clear that the suicide rate for adults is 20 times higher for those who have used cross-sex hormones and undergone sex reassignment surgery, even in Sweden, which is among the most LGBTQ-affirming countries.

The American College of Pediatricians states that:

Conditioning children into believing that a lifetime of chemical and surgical impersonation...is normal and healthful is child abuse. Endorsing gender discordance as normal via public education and legal policies will confuse children and parents, leading more children to present to “gender clinics” where they will be given puberty-blocking drugs. This, in turn, virtually ensures that they will “choose” a lifetime of carcinogenic and otherwise toxic cross-sex hormones, and likely consider unnecessary surgical mutilation of their healthy body parts as young adults.

Research reported by the American Psychiatric Association in Diagnostic and Statistical Manual of Mental Disorders, fifth edition, clearly shows that the large majority of boys and girls who experience gender dysphoria will not experience the persistence of these feelings following adolescence.

I also urge my colleagues to listen to Dr. Ken Zucker, professor in the department of psychiatry and psychology at the University of Toronto, and to Dr. Susan Bradley, psychiatrist in chief at the Hospital for Sick Children and head of the division of child psychiatry and professor emeritus at the University of Toronto. They state:

It has been our experience that a sizable number of children and their families can achieve a great deal of change. In these cases, the gender identity disorder resolves fully, and nothing in the children's behavior or fantasy suggest that gender identity issues remain problematic.

In light of the input from these groups and experts in psychiatry and psychology, at the very least it is important that government does not legislate ideological conformity on this issue. We need to take a stand for good public policy as it relates to gender and sexuality, and to base our decisions on scientific research that will help protect against devastating lifelong negative consequences.

Another major concern for me in Bill C-16 is the issue that the terms gender identity and gender expression are very subjective terms, far too subjective to be used in the context of legal documents. Would policies protecting people on the grounds of gender identity and expression merely provide safety and protection—that is, provide a shield against against abuse—or would they be used to drive a broader agenda? As legislators, are we simply trying to protect the sexual minority from verbal and physical abuse, or are we also intending to impose a cultural shift in our very understanding of human sexuality and gender expression? What would the impact be on immigrant groups and faith groups, the majority of which are at odds with gender fluidity concepts? Would they have the freedom to teach their children and practise their beliefs without being accused of hate speech or a human rights violation?

For me and the millions of other Canadians who acknowledge the supremacy of God, as the first words of our charter affirm, there is the reality that our faith journey is the foundation of our world view. If freedom of religion is to be embraced, then it is of paramount importance that Bill C-16 not infringe upon that fundamental freedom. It is important that government clarify the nature of the protection being afforded and how it expects terms such as gender identity and gender expression to be interpreted. The implications are too unpredictable. Far too much is left to interpretation that would result in unnecessary accusation of human rights violations as well as litigation and endless court cases to further tie up our court system.

Another concern is the potential harm to innocent children. As I stated earlier, I am in total support of equal rights. Therefore the question needs to be asked: Where are the equal rights? Is it equal rights of the boys or girls and of the young men or women who expect to find only those of their same gender in their change rooms? Is it fair to have their rights trampled upon by this imposition of extra rights for some? Common sense dictates that the potential for abuse of this new freedom to self-identify with a change room of one's own choice could very well lead to bullying, harassment, and even sexualized violence in these public spaces. One of the pitfalls of Bill C-16 is its failure to recognize the potential that heterosexual predators who, while not transgendered themselves, would take advantage of the protection of this bill to hide behind their predatory pursuits.

Yes, I am concerned for the safety and well-being of young children and youth, who deserve their right to privacy.

Finally, I am concerned about the fear this bill may cause for many Canadians. I fear they will not be able to even discuss public policy issues such as this one, on which they may disagree with the government agenda. Any law that limits legitimate discussion and debate of closely held beliefs presents a danger to freedom of expression, a fundamental value held dear by people across the political spectrum. The right to disagree must be viewed as sacred in our society. It is the lifeblood of both new ideas and age-old protections.

I am simply asking that those who support this bill respect my right and the rights of millions of Canadians not to be charged with human rights violations because we make our views known or because we disagree with others' views. We can and must respect each other even in spite of holding opposing views. It is my hope that we can openly disagree without labelling each other.

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Madam Speaker, I will be splitting my time with the hon. member for Sherwood Park—Fort Saskatchewan.

I have had the privilege of following, from a distance, the proceedings in the Senate over these last days. I am disappointed that a number of the options that were given to the Senate were not adopted.

Senator Plett's amendment to make it a criminal offence for anyone to compel an individual, organization, or medical practitioner to provide medical assistance in dying or to refer was rejected by the Senate.

I wish I could share the optimism of our Minister of Health when she assured me a few minutes ago that no one would be compelled to participate in this. I do not share that optimism. I am hopeful I am wrong on that. I am hopeful there will never be a case where a medical professional, a health care worker, a health care institution will be obligated to participate or to refer for this practice when they find it morally objectionable.

The other amendment Senator Plett put forward was adopted by the Senate, however, rejected by the government today in its response. That is the amendment relating to not allowing a beneficiary of a person who is seeking medical assistance in dying from assisting that person.

It seems quite clear to me that if we are to protect vulnerable people, this was one of the key points that needed to be adopted. By rejecting this amendment that was passed by Senate, we are actually increasing vulnerability. That is a sad result of rejecting this amendment.

It goes without saying that this is a very sad day, a disappointing day for me. This is a day when choices will be made that will affect generations to come, and it is without question the most important choice that I and most of my colleagues will make in our parliamentary careers.

It is disappointing on two points. First, it is disappointing to see the activism of the Supreme Court. I mentioned earlier in my comments on this topic that it was unfortunate the Supreme Court of Canada had taken it upon itself to force legislation to be written which would overturn hundreds of centuries of our understanding of the intrinsic value and dignity of every human life. The Supreme Court has done this, completely rejecting the fact that as elected members of the House, we have rejected initiatives to legalize physician-assisted suicide on at least 15 occasions since 1991, the most recent one in 2010 by a vote of 59 to 226.

The other reason this action is disappointing for me is because of the many years I have worked on the issue of suicide prevention. I have worked with people who have been left to suffer the aftermath of suicide, parents who have lost children, children who have lost parents, and more. To know there are groups across Canada today that are working very hard to prevent suicide, to save lives, and to see we are now, in a way, normalizing suicidal behaviour is disappointing.

Bill C-300 was an initiative that the House passed almost unanimously, calling on the federal government to initiate a federal framework for suicide prevention. Just a few weeks ago, the Minister of Health indicated that the bill was almost ready to be fully implemented by the Public Health of Canada.

On one hand, we are working as hard as we can to prevent suicide, which I applaud and will continue to give my efforts to. On the other hand, it appears that we have given up and we are allowing those who are losing hope to actually access assisted suicide.

Ten Canadians each day lose their life to suicide. In Canada, groups are working hard on the ground to prevent suicide. Mental health care workers, experts, are providing safe talk training so front-line workers, such as teachers and our volunteers in our minor sports programs, can observe these first signs of suicidal ideation, and intervene with the intent of restoring hope to that person who has lost hope and is now in despair. Their motivation has always been to save lives.

Now, to turn 180 degrees and begin the path towards normalization of suicide, is a tragic course, a tragic course of action for all of Canada.

Again, I want to quote from an expert in this field. Aaron Kheriaty, an associate professor of psychiatry and director of the medical ethics program at the University of California, Irvine school of medicine, states:

The debate over doctor-assisted suicide is often framed as an issue of personal autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who — assuming they are of sound mind — are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences.

What if it turns out that the individuals who make this choice in fact are influencing the actions of those who follow?

Professor Kheriaty goes on to report that in states where physician-assisted suicide has been legalized, there has been an increase in suicides of 16.3% overall, but among those over 65 an increase of 14.5%. He further states:

[These] results should not [be surprising to] anyone familiar with the literature on the social contagion effects of suicidal behavior. You don’t discourage suicide by assisting suicide....

...Aside from publicized cases, there is evidence that suicidal behavior tends to spread person to person through social networks, up to three “degrees of separation” away. So my decision to take my own life would affect not just my friends’ risk of doing the same, but even my friends’ friends’ friends. No person is an island.

Finally, it is widely acknowledged that the law is a teacher: Laws shape the ethos of a culture by affecting cultural attitudes toward certain behaviors and influencing moral norms. Laws permitting physician-assisted suicide send a message that, under especially difficult circumstances, some lives are not worth living — and that suicide is a reasonable or appropriate way out. This is a message that will be heard not just by those with a terminal illness but also by anyone tempted to think he or she cannot go on any longer.

Debates [around] physician-assisted suicide raise broad questions about our societal attitudes toward suicide. Recent research findings on suicide rates press the question: What sort of society do we want to become? Suicide is already a public health crisis. Do we want to legalize a practice that will worsen this crisis?

I believe life is to be chosen over what some would call “death with dignity”. There is nothing dignified about deciding someone's life is not worth living. If a patient has a need, let us address it. Our goal should be to eliminate the problem, not the patient.

It is my firm belief that the House and the current government should be invoking the notwithstanding clause in order to protect Canadians. For thousands of years, all caring societies have agreed that it is not okay to kill another human being. We can try to soften that language. We can call it physician-assisted death. We can call it medical assistance in dying. We can use any euphemism we want, but the reality does not change.

Today, we are intentionally throwing away the wisdom of our faith foundations and the wisdom of centuries of civilization. My fear is that in a few short years, we, our children, and our grandchildren will live to see the folly of allowing physician-assisted suicide.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Thank you.

Thank you very much to both of you for being here. The incredible grasp you have on this is very humbling for me, I'll tell you.

I had the opportunity to look through the outline of the “Resiliency Within” paper you've done. I certainly applaud many of the initiatives here. I could go through the eight chapters and list many of them. I think it's a great program.

In regard to this, has there been any consultation with the Public Health Agency of Canada in the development of the federal framework for suicide prevention, which is to be implemented sometime later this year? The Public Health Agency of Canada was charged with the responsibility of implementing Bill C-300, the federal framework. I'm wondering what kind of collaboration happened between the Government of Canada and the Government of Nunavut in terms of developing your program.

Certainly I wouldn't want to imply that the framework should supersede or even be over it. In fact, that's one of the reasons we chose the word “framework” rather than “strategy”. We wanted something that was available to be contextualized in different communities across Canada, but I think there should have been, and I'm hoping there was, some degree of consultation with the Inuit community.

Situation in Indigenous Communities

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, I will be sharing my time with the member for Cariboo—Prince George.

I want to thank my colleague from Timmins—James Bay for opening up this opportunity to discuss this important issue tonight.

I rise in the House this evening to lend a voice to a topic which lies heavily on my heart and I know the hearts of all my colleagues on both sides of this chamber. This is not the time to debate what could have been done or what should have been done, but rather, we need to come together with a solution to the issue we are currently facing. There is no time to waste on partisanship when lives are at stake.

Canadians need us to lead by example by coming together and rallying around this hurting community to help them in every possible way. In that spirit, I use the word “discussion” rather than “debate” because I am convinced that the House is eager to take action on the national tragedy that suicide represents.

This is an epidemic that is larger than Attawapiskat and unfortunately, it is growing. It is not okay that the leading causes of death for first nations people under the age of 44 are suicide and self-inflicted injuries. It is not okay that first nations youth die by suicide five to six times more often than non-aboriginal youth. It is not okay that suicide rates for Inuit youth are among the highest in the whole world. This issue needs to light a fire inside all of us to do all that we can to not allow this epidemic to continue.

There are many views on how this is best done, and I share my view from some of the experiences I have accumulated over the past 10 years serving as a member of Parliament. There have been many good steps taken to address this tragic issue of suicide, but much more needs to be done.

As co-chair of the all-party Parliamentary Committee on Palliative and Compassionate Care, I, along with NDP and Liberal colleagues, conducted a study on the complex issue of suicide prevention and our findings are recorded in the report called “Not to be Forgotten”.

What became clear is that suicide is a complex phenomenon with multiple, often intertwining and overlapping causes. The complexity of suicide makes it obvious that solutions cannot be reduced to a mental health approach alone, but must take all aspects of the person into account, including physical, social, cultural, and spiritual factors.

One witness who appeared before our parliamentary committee was Dr. Antoon Leenaars, a psychologist and suicide researcher. He shared with the committee:

Suicide is multi-determined. The common psychological factors...are unbearable pain, cognitive constriction or tunnel vision, ambiguities about life and death, a mental health disorder, a weakened ego, a disturbance in a relationship or some other ideal like one's health or youth, rejection-aggression, and a desire to escape. This complexity calls for diverse suicide prevention strategies. This is necessary to not only solve what is sometimes assumed to be primarily a “medical problem”, but also to address the deep taboo and its stigma, and to address the problem with specific vulnerable groups, such as First Nations and Inuit people, armed services personnel, youth, and elderly (especially those facing end of life issues). The complexity of suicide dictates the necessity of a parallel complexity of solutions. There is never the solution. Therefore not only a mental health approach, but a public health approach, is urgently needed.

Research done by the Royal Commission on Aboriginal Peoples, as recorded in our committee report, found that the culture of first nations peoples was thrown into turmoil by the policies of colonialism. In this report it was clear that the whole complex of relationships, knowledge, languages, social institutions, beliefs, values and ethical rules that bind people together and give a collection of people and its individual members a sense of who they are and where they belong plays a profound role in mental health and well-being.

Prior to the breakdown of their culture, suicide was rare among first nations people. However, as I previously stated, today, suicide among first nations youth is at epidemic proportions. The development of a sense of healthy identity is profoundly related to one's culture and its ability to reproduce itself in its members. Thus the anthropological and sociological dimensions can have a deep impact upon the psychological.

It is important to be reminded that suicide intervention really does work and many lives are saved every year. Despite this fact, Canadian response is mainly due to the efforts of individuals and private groups who strive against the tide with very few resources. We have many great examples of local groups across Canada that are doing heroic work in preventing suicide.

When I first heard the news of the 11 suicide attempts in Attawapiskat, my heart sank and I immediately remembered an incident from 2011 when I was contacted by Tana Nash of the Waterloo Region Suicide Prevention Council. She informed me of the fact that three suicides had occurred in three different high schools in Waterloo region in one week. Help was urgently needed. At that moment, I knew that I wanted to do something to deal with issues; albeit, I knew my attempts would be less than adequate. I knew that something must be done to address the tragic loss of hope, especially among our young people. To that end, I embarked upon drafting Bill C-300, an act respecting a federal framework for suicide prevention.

As a nation, we have not done enough to implement a coherent program of suicide prevention. Some provinces have begun to make great strides, especially Quebec. Yet, in general, efforts to prevent suicide are still a patchwork, depending upon the generosity of individuals, many of whom have been personally impacted by suicide.

This is why it is so urgent that the government implement the federal framework on suicide prevention as soon as possible. With its immediate implementation, we would be able to give to the groups on the ground the much needed tools and resources they so desperately need.

When fully implemented, Bill C-300, through the Public Health Agency of Canada, would provide guidelines to improve public awareness and knowledge about suicide. It would disseminate information about suicide, including information concerning its prevention. It would make publicly available existing statistics about suicide and related risk factors. This is one of the weak points that many of the groups which came to our committee pointed out: the statistics relating to suicide are so old and so out of date that there is really no way to plan forward in going ahead. The bill would promote collaboration and knowledge exchange across domains, sectors, regions, and jurisdictions. It would define best practices for the prevention of suicide. It would promote the use of research and evidence-based practices for the prevention of suicide.

The principles embodied in Bill C-300 could be contextualized and individualized to communities, depending upon their unique circumstances. I want to underline that fact. This is not a bill that would tell communities how to do it. My colleague earlier pointed out that we need to give communities the ability to contextualize within their own communities.

Furthermore, safeTALK training for all front-line service workers and volunteers on reserve would be a major investment in proactive prevention of suicide. Community members, such as teachers, doctors, nurses, coaches, pastors, club leaders, and many more, are in a unique position to recognize the early warning signs and would be able to ask the right questions that could very well lead to saving a life.

I am certain that everyone in this chamber can tell us how they, their families, or a member in their community, has been negatively impacted by suicide. Each of us knows someone whose sense of hope was overcome by despair and who ended his or her life by suicide. However, we know that suicide does not end the pain. It simply transfers it to the family, to the friends, and to the community.

This particular community that we are discussing tonight is currently in extreme pain. Now is the time to do all that we can to deliver hope.

Evidence is accumulating that when aboriginal communities design their own interventions, typically based upon traditional cultural values and practices, the efficacy of these interventions is high. Therefore, there is hope, but much more needs to be done. We need to offer hope to those who are facing this unbearable pain and who subsequently descend into a state of hopelessness and despair.

Hope is dependent upon having a sense of connection to the future, even if that future is short term. Hope is the oxygen of the human spirit. Without it, the spirit dies.

I am a person of hope. The very fact that this important discussion is happening tonight in the House of Commons in Canada is a huge step forward in providing hope.

We stand with our brothers and sisters in Attawapiskat to provide immediate practical help. We want them to know that they are in our thoughts and prayers. I pray they will know that their lives have value and meaning, that they are loved by their families, their friends, their fellow Canadians, and their Creator.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Thank you, Mr. Chair.

Thank you to our witnesses for being here tonight.

I was particularly encouraged to hear you, as professionals, openly declare your concerns about some of the subjective nature of the language that is being used—“irremediable”, “intolerable”, “enduring”. I think this underscores for us as committee members the severe nature of this topic that we're dealing with and how important it is for us to deal with it seriously and to move with extreme caution.

Over the last number of years, I've devoted a fair bit of my time to dealing with mental health issues and suicide prevention. I know that since 1991, there have been no fewer than 15 initiatives in Parliament to authorize physician-assisted suicide. All of these have been defeated. Parliament, in fact, in the last couple of years, has strongly supported some suicide prevention initiatives. Currently the Public Health Agency of Canada is undertaking the job of creating a federal framework for suicide prevention, which is a result of the passage of Bill C-300. In fact, today the Bell Let's Talk initiative is all over Twitter. I don't know how many thousands or millions of tweets have gone out.

Society is concerned about continuing their concerted efforts on suicide prevention. For me, then, it's something of a paradox that we have these initiatives to prevent suicide going on in our country and our health agency, yet here we are, looking at ways to give greater access to suicide.

It's quite clear that physician-assisted suicide is an irreversible act. We know from some of the mental health studies that have been done that people go up and down and that people's minds change over time. We also know that depression is by and large a treatable condition, and you pointed out in your testimony, Dr. Gaind, that there are varying degrees of success.

One of my concerns is that in terms of giving access to people who may be suffering with mental health issues or depression, what additional safeguards should this committee be looking at to make sure we are protecting some of our most vulnerable at the most vulnerable times in their lives?

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Thank you, Mr. Chair, and thanks to our witnesses for your presentations today.

Since 1991 there have been at least 15 initiatives in Parliament regarding implementing physician-assisted suicide, and in all of those cases members of Parliament have chosen to reject them. Some of the recent initiatives involved work on motion M-388 and Bill C-300, which calls on the federal government to implement a federal framework for suicide prevention, so I find it somewhat ironic that we're here talking about physician-assisted suicide at the same time that our federal government, the health department, and the Public Health Agency of Canada are actively working on implementing a federal framework for suicide prevention.

It's quite clear that physician-assisted suicide and euthanasia are irreversible actions, yet studies have shown that many patients who were interested in assisted suicide or euthanasia often change their minds. Certainly one of my primary concerns in the work that I've done on suicide prevention over the last number of years has been exactly that: protecting the most vulnerable Canadians at the most vulnerable points in their lives. We all know that depression is, by and large, a treatable condition, and it's questionable whether anyone in that condition is capable of making a rational request to have his or her life ended.

I want to refer to some of the jurisdictions that currently permit some form of assisted dying. Individuals who have mental health issues that affect their decision-making capacity are treated differently. For example, in the Netherlands individuals can use an advance directive to outline their wishes while they are still competent, but all of the U.S. states that allow physician-assisted suicide do not allow that, and I understand from Mr. Ménard today that Quebec is also in that group.

Mr. Hogg, in terms of access and in terms of protecting vulnerable people, from a legal perspective, what are some of the dangers of allowing individuals who do not have decision-making capacity to access physician-assisted suicide, and what protections could be put in place? You mentioned the waiting period. That is one possible protection, but I'd like you to outline others.

Then, are advance directives an appropriate way to ensure that individuals who lack this capacity are able to access physician-assisted suicide?

[Louise Bradley, President and Chief Executive Officer, Mental Health Commission of Canada]

Thank you and have a good afternoon.

Mr. Chair and committee members, I'm delighted to be here today.

My name is Louise Bradley. I'm the president and CEO of the Mental Health Commission of Canada. I'd like to acknowledge my colleague, Jennifer Vornbrock, the vice-president of our knowledge and innovation team.

Let me begin by providing you with a brief background on the commission and its mandate. The commission was created in 2007, prompted by the work of the Senate Standing Committee on Social Affairs, Science and Technology and its study “Out of the Shadows at Last”, which called for a national commission on mental health.

The commission has a mandate to improve the mental health system and change the attitudes and behaviours of Canadians around mental illness. The commission is a coordinating agent, aligning and promoting the interests of governments, organizations, and persons with mental illness and their families. Our work brings together leaders and experts in mental health and facilitates widespread uptake on ideas, policies, and programs.

I'm pleased to report that in the 2015 federal budget, the Government of Canada indicated its intention to renew the commission's mandate for 10 more years beginning in 2017. The commission is thrilled to have the opportunity to continue its work, led by our new board chair, the Honourable Michael Wilson. Mr. Wilson has used his considerable talent and influence to champion mental health as a private citizen. Given his accomplishments to date, we can't wait to see what he's able to achieve with the full weight of the commission and our many partners behind him.

The commission's work continues to be guided by the mental health strategy for Canada, which was released in 2012. The strategy lays out actions to improve mental health care and its associated systems through six strategic directions. Since the release of the strategy, the commission has worked hard to ensure the strategy's uptake, sharing its recommendations with stakeholders across the country and around the world. I've heard from provincial and territorial governments that the strategy has become a foundational document and is used by them to develop their own mental health plans and priorities.

The reach of the strategy has been incredible, but the commission knows there are still barriers to its implementation across Canada. To assist in the implementation process, the commission initiated its own review of the strategy. After speaking with stakeholders and government officials, the commission has determined that the following actions would help drive the strategy forward: the coordination of mental health services and resources, including the integration of mental health, primary care, housing supports, and substance use services; the creation of an action plan, based on common priorities from the strategy, that demonstrates the next steps for those trying to implement it; and the improvement of mental health data, which includes better monitoring of current trends and the identification of data gaps. The commission looks forward to working with stakeholders and government to carry out these actions over the next decade.

The commission has also taken every opportunity to capitalize on the strategy as a guide for the expansion of our work. The issue of suicide prevention is of paramount importance, and we have been working on this issue for years utilizing our anti-stigma initiative called Opening Minds, workplace mental health programs, and knowledge exchange to provide tools and promote best practices.

We know that there is widespread support for this issue among parliamentarians, demonstrated by the recently passed Bill C-300, an Act respecting a Federal Framework for Suicide Prevention, which had support from all parties. Many of you also know about the #308conversations initiative launched last year by the commission and championed by member of Parliament Harold Albrecht. The campaign called upon all 308 federal members of Parliament to host a meeting in their respective communities with a focus on suicide prevention. The goal was to get people talking and to gather information about what interventions are available in communities.

As the second phase of this initiative building on the work of our anti-stigma initiative Opening Minds, the commission is developing a community-based model for suicide prevention. This model aims to adapt and implement an existing and effective suicide prevention program in the Canadian context. The model, developed by Dr. Ulrich Hegerl, is a multi-level, community-based suicide prevention initiative that has shown to be effective in reducing suicide by more than 24% over two years in a test community. The commission is currently working with stakeholders to determine the implementation of this initiative across Canada.

The initiative will build on another key commission program, At Home/Chez Soi, a participatory research project. At Home/Chez Soi demonstrated positive, cost-effective results for the housing first approach to homelessness, which provides persons who are homeless and have chronic mental health issues with immediate access to subsidized housing. Its participants were some of the most vulnerable Canadians who are highly stigmatized and who reported feeling isolated and being at high risk for suicide. At Home/Chez Soi demonstrated that people with chronic mental illness who receive no-barrier housing are more likely to stay housed and to report an improved quality of life. It also showed that for every $10 invested in housing first services for high-needs participants, the community saved almost $22 in avoided costs.

Because of its success, the Government of Canada decided to invest $600 million in the housing first approach through its homelessness partnering strategy. Through its innovative research, the commission was able to offer tangible and cost-effective approaches to improving the lives of Canadians who are homeless and have a chronic mental illness.

As part of our leadership on mental health systems transformation, the commission has also placed an emphasis on knowledge exchange and the sharing of best practices. At the heart of this work is the commission's Knowledge Exchange Centre, KEC, which provides numerous information-sharing hubs both online and through in-person gatherings. The KEC shares information about the commission's initiatives and additional best practices, ensuring that the information gets to the right people and that they know how to use it.

The KEC is also dedicated to improving the data and resources related to mental health. Next month they will continue with their launch of a set of national indicators on mental health that will provide crucial data on self-harm rates, the prevalence of specific mental illnesses, suicide rates, and rates of access to services. This data also identifies mental health indicators for subpopulations, such as LGBTQ youth and new Canadians. This information allows us to gauge areas in which the needs of Canadians are being met and in which there's room for improvement.

As you can see, the commission is working hard, as hard as it ever has, and we are ready to start making long-term plans for the next phase of our work. The commission is currently seeking advice from the Government of Canada, Health Canada, and other key partners about our new mandate. We've also been consulting with stakeholders and provincial and territorial leaders across the country to discuss shared priorities.

These discussions will form the basis of the mental health action plan for Canada, which provides goals and priorities for the implementation of the strategy. Just as the strategy guided the last decade of work, the mental health action plan for Canada will set the tone for the next one. By following through on the action plan, the commission can address urgent mental health issues, including suicide prevention, access, mental health supports for first responders, seniors, diverse populations, children, and youth.

In closing, I commend the members of this committee for identifying future actions at the federal level. There is still a great deal of work to be done. As with the commission's renewed efforts, it is the perfect time to redouble our efforts. This new chapter marks a time of pivotal change in Canada's mental health landscape, with more energy for system transformation than ever before.

I look forward to working with all of you and all Canadians as we continue our work towards our common goal of improving the mental health of Canadians.

Merci beaucoup.

[Kimberly Elmslie, Assistant Deputy Minister, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Thank you very much, Mr. Chair.

Thank you for the opportunity to highlight the Public Health Agency of Canada's work to improve the mental well-being of Canadians. We are working closely with our partners to contribute to the implementation of the Mental Health Strategy for Canada.

An important public health role is the monitoring of mental illness and mental health among Canadians. The agency's system for surveillance of mental illness tracks a number of mental illnesses, such as mood disorders and anxiety disorders. This system includes complementary data, such as self-inflicted injuries, for example, suicidal behaviour, and child maltreatment.

These data tell us that, as you know, mental illness affects many Canadians. In fact, our most recent data indicate that at least one in three Canadians will experience mental illness during their lifetime and one in seven use health services for mental illness annually. Furthermore, approximately 4,000 Canadians die by suicide each year, and there are many more suicide attempts.

In order to prevent duplication and to leverage work that is under way across the country, the agency participates in the mental health and addictions data collaborative with our colleagues at the Mental Health Commission of Canada and other national mental health data partners.

In budget 2013 there was a reallocation of $2 million of agency funding over a three-year period for the purpose of improving our data collection and ensuring that we were reporting as comprehensively as possible on mental illness and mental health. As part of these improvements, the agency is working with the Mental Health Commission of Canada to improve specifically the data we have and can provide to Canadians on positive mental health and well-being.

We now have a set of indicators of positive mental health for Canadians that forms the foundation for monitoring changes in mental health over time and the factors that influence these changes at the individual, family, community, and societal levels. These include measuring and monitoring personal coping skills among Canadians, positive family relationships, and supportive community environments. We know that 65% of Canadians have very good or excellent self-rated mental health and 82% are satisfied with life. Canadians also have strong ties to the community: 87% of adults believe that their neighbourhood is a place where people help each other. By gathering and analyzing these data, we will be able to share more information about the factors that help us take care of our mental health and help prevent mental illness.

Another important priority for the agency is suicide prevention. The enactment of An Act respecting a Federal Framework for Suicide Prevention in December 2012 served an important role in raising the visibility of this issue in Canada and underscored that suicide is a public health issue. The federal framework for suicide prevention will focus on improving information, collaboration, and resources for Canadians and on equipping those working to prevent suicide with the latest information on best practices.

Our discussions with our partners and stakeholders highlighted that fragmentation of information is one of the most important barriers to their work. Effective suicide prevention requires involvement from all sectors, including governments, non-governmental organizations, communities, academia, and the private sector. The framework will provide the basis for partnership on concrete activities, and we look forward to working with the Mental Health Commission of Canada in achieving the framework's objectives.

Public health also focuses on improving the mental well-being of Canadians before mental health problems or challenges begin to emerge. Another key role for the agency is leading national activities that promote positive mental health, such as the agency's programs that build resilience in individuals and communities. We invest approximately $112 million a year in community-based programs that serve families living in conditions of risk, including poverty, social isolation, substance abuse, and family violence.

These programs address factors that affect mental health, including parenting skills, early childhood development, healthy pregnancies, and mental health issues such as post-partum depression. When we create supportive environments, there is a positive impact on mental health.

Supporting innovation in mental health promotion is a priority for us. Large-scale projects are under way across Canada to promote mental health, reaching children, youth, and families across the country. These projects, still under way, have already shown us positive changes in child and youth resilience, self-esteem and self-image, as well as in coping and social skills. For example, some of our school-based interventions have reduced aggressive behaviour, relationship violence, and alcohol abuse. They've improved school environments, and have been implemented in teaching curricula.

Our work builds on our international commitments, including Canada's support of the World Health Organization's resolution in support of a comprehensive mental health action plan for 2013 to 2020. Reducing mental health risks, such as exposure to domestic violence and child abuse, is a priority. As my colleague just indicated, Minister Ambrose recently announced an investment of $100 million over 10 years specifically to address the health needs of victims of family violence. This investment includes support for community-based projects to help victims rebuild both their physical and mental health following experiences of family violence.

Our public health work in mental health and suicide prevention involves a wide range of partners who are leading initiatives to better serve mental health needs of Canadians. We are partners with the Mental Health Commission of Canada and our work aligns with the Mental Health Strategy for Canada.

Thank you.

[Krista Outhwaite]

Yes, thank you. I'd be delighted to.

As you know, the Public Health Agency of Canada is busy these days working on the implementation of bill C-300, An Act respecting a Federal Framework for Suicide Prevention. This is where our relationships with colleagues such as National Defence come into play very significantly. They're working with us and developing this suicide prevention framework at the federal level, the federal framework, and being very helpful in that respect.

They are also partnering with us to look at what tools and innovative developments can be brought to bear to meet the needs of mental health promotion generally, but also specifically for military families and DND personnel. It's a very important area of work, and we are delighted that they are coming to the table in the way they are to work with us on this.

Suicide Prevention

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, once again, I thank the House for passing Bill C-300, my legislation on suicide prevention. The situation in Neskantaga only reinforces the need for a federal framework, the need to overcome the stigma that prevents conversation about suicide.

Over the past year, there have been 7 deaths by suicide and 20 attempts in this community of only 421. Our government has sent additional nursing and counselling assistance, but more needs to be done at Neskantaga and right across Canada. Suicide prevention programs must be delivered by more than just nurses and counsellors. It takes people who are able to recognize the warning signs, people brave enough to engage in conversations.

Teachers, coaches, paramedics, pastors and police officers, even members of Parliament, we all must do our part as members of a caring community. Do not be afraid to start the conversation. It will shine light and expose hidden fears that can finally be addressed. A simple conversation can bring hope, the oxygen of the human spirit.

Message from the Senate

[The Acting Speaker, Conservative, Barry Devolin]

I have the honour to inform the House that messages have been received from the Senate informing this House that the Senate has passed the following bills.

Bill C-50, An Act for granting to Her Majesty certain sums of money for the federal public administration for the financial year ending March 31, 2013;

Bill C-36, An Act to amend the Criminal Code (elder abuse);

Bill C-300, An Act respecting a Federal Framework for Suicide Prevention;

Bill C-45, A second Act to implement certain provisions of the budget tabled in Parliament on March 29, 2012 and other measures.

Suicide Prevention

[Bruce Hyer, Independent, Thunder Bay—Superior North, ON]

Mr. Speaker, the second petition is with regard to suicide.

It gives me pleasure today to present a petition on behalf of the residents of Thunder Bay and Ottawa on the topic of suicide in Canada. Suicide kills ten Canadians every single day. It is the second biggest killer of Canadian youth. Canada is the only industrialized country in the world without a national suicide prevention strategy, and therefore these petitioners urge Parliament to act on Bill C-297 and Bill C-300, dealing with suicide.

World Autism Awareness Day Act

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

moved that the bill be read the third time and passed.

Mr. Speaker, I have been blessed with many joys in the House. Seeing hon. members unanimously pass my motion targeting Internet predators, Motion No. 388, was an occasion where we rose above partisanship.

When an overwhelming majority of hon. members united to deliver a message of hope to vulnerable Canadians everywhere by voting to pass Bill C-300, my legislation on suicide prevention, I felt humbled to once again be part of an occasion where our normal partisan rancour was put aside.

Today, I stand as sponsor in the House of Bill S-206, a bill from the other place, calling for recognition of World Autism Awareness Day. Once again, I feel blessed because I sense unity on this issue.

Through the study at committee and through the debate at second reading, not a negative word was spoken about this effort. Instead, we have used our time to educate each other on the very real need to promote autism awareness and to share some very personal stories about how autism has touched our lives.

I mentioned the experience of my friend and colleague, the member for Edmonton—Mill Woods—Beaumont. I thank him for his very personal sharing of his life with parliamentarians. The way the member and his family care for Jaden and bring him to the House to allow us to interact with Jaden has been one of the joys that I have personally experienced as a member of Parliament, and I think all of my colleagues would agree.

Also the member for Portneuf—Jacques-Cartier shared some experiences from her own family. Some hon. members want more to be done, but no one has disputed that every effort to promote autism awareness is a worthwhile effort.

During study of the bill at the Standing Committee on Health, the hon. member for Saint-Léonard—Saint-Michel asked Mr. Richard Burelle, the executive director of the Autism Society of Canada, if the passage of Bill S-206 would be helpful. Mr. Burelle's reply was:

Keeping autism in the forefront is always a good thing. As Senator Munson said, the fact that we're piggybacking on World Autism Awareness Day is great. Any kinds of forward steps we can take in order to keep autism in the forefront, to create that awareness, are steps in the right direction.

There is no controversy here. There is no federalist-sovereigntist division, no left-right divide. In truth, I do not believe there is any reason to continue debating the bill. Rather than spending our time agreeing with each other, I would ask hon. members to allow debate to collapse and to allow Bill S-206 to pass on a voice vote today.

This effort did not begin with this Parliament. Previous efforts enjoyed similar support, but never became law, due to election calls.

Families coping with autism spectrum disorders have waited long enough, since 2006, in fact, for the House to simply acknowledge an awareness day.

Given the broad level of support the bill enjoys from all quarters, I ask that we stop talking about recognizing World Autism Awareness Day and just get this done.