Bill C-211 (Historical)

Federal Framework on Post-Traumatic Stress Disorder Act

An Act respecting a federal framework on post-traumatic stress disorder

This enactment requires the Minister of Health to convene a conference with the Minister of National Defence, the Minister of Veterans Affairs, the Minister of Public Safety and Emergency Preparedness, provincial and territorial government representatives responsible for health and representatives of the medical community and patients’ groups for the purpose of developing a comprehensive federal framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of post-traumatic stress disorder.

[Anne-Marie Ugnat, Executive Director, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Mr. Chair and honourable members, thank you for the invitation to address this committee regarding its study of Bill C-211, an act respecting a federal framework on post-traumatic stress disorder.

Let me begin by reiterating a statement by the World Health Organization in 2004: that there is no health without mental health.

Mental illnesses, including post-traumatic stress disorder or PTSD, are recognized, medically diagnosable illnesses that result in the significant impairment of an individual's cognitive, affective, or relational abilities. Mental illnesses are the result of a complex interaction of biological, developmental, and psychosocial factors. Environmental factors, such as exposure to trauma, can precipitate the onset or recurrence of a mental illness.

Mental health in Canada is a complicated issue that has both direct and indirect impacts on a significant number of Canadians every year.

The federal government has a role to play in the coordination and collaboration of mental health activities. It also has a role in understanding scientific evidence related to the scope of the challenges and what works best to address them. This evidence informs the development of resources for information on best practices and innovation.

While the federal government also has responsibility for mental health services for specific federal populations, such as serving members of the Canadian Armed Forces, veterans, serving and former members of the Royal Canadian Mounted Police and the Correctional Service of Canada, indigenous populations, newcomers—including refugees—and federally incarcerated individuals, the Public Health Agency of Canada, where I work, is mandated to serve the broader Canadian population. As such, we work with other government departments, stakeholders, and partners in the promotion and monitoring of mental health for all Canadians.

Several federal and national partners play a role in mental health promotion.

Statistics Canada has a federal responsibility to collect data on the Canadian population, including through the census and population surveys. The Canadian Institute for Health Information, CIHI, holds and manages national-level health administrative data, such as hospital billing data. Health Canada manages the Canadian drug strategy, which includes the monitoring of the use of illicit substances. The Mental Health Commission of Canada coordinates a network of partners through the Mental Health and Addiction Information Collaborative, of which, we, Statistics Canada, CIHI, Health Canada, and other partners are members.

The Public Health Agency of Canada contributes an important piece to the understanding of mental health in Canada by conducting national monitoring of mental health, mental illness, self-harm and suicide, and family violence, and related risk and protective factors. These areas often have strong associations with PTSD, either as potentially precipitating factors in the case of the trauma experienced with family violence, or as outcomes with mental illness and even suicide.

Mental illness monitoring is a core public health activity relying on population surveys, such as those conducted by Statistics Canada, and on administrative data collected by the provinces and territories, which includes physician billing claims and hospital discharge records linked to health insurance registries.

Bill C-211 proposes improving the tracking of the incidence rates and the associated economic and social costs of PTSD. Currently, monitoring of PTSD in the general Canadian population relies on data from national population surveys conducted by Statistics Canada, such as the Canadian community health survey of 2012 on mental health.

In 2012, 1.7% of the population aged 15 and over reported that they had PTSD. This is an increase from 2002 when 1% reported that they had PTSD. This increase is primarily due to an increase in prevalence among women. It went from 1.2% in 2002 to 2.4% in 2012. It is important to note that estimates of self-reported diagnosed PTSD from survey data are thought to underestimate the true prevalence of the disorder.

Another consideration for the monitoring of PTSD is the use of provincial and territorial health administrative data, which has been successful for other chronic conditions, through the Canadian chronic disease surveillance system. The CCDSS is a collaborative network of provincial and territorial chronic disease monitoring systems led by the Public Health Agency of Canada and relying on linked physician billings and hospitalization data.

For PTSD specifically, physician billings are not available in all provinces and territories as not all provinces or territories go to the same level of specificity. Coding standards are jurisdictional issues in which CIHI plays a role. However, it could be possible to conduct monitoring for a few provinces and territories that can currently identify PTSD. At the national level it may be possible to establish monitoring using administrative data for broader categories, for example, adjustment disorders that include other conditions related to adjustment reactions to stress, such as but not limited to PTSD.

PTSD is often treated through therapy methods that are outside the publicly funded health care system, such as occupational therapy, psychologists' services, and social work. Therefore health care administrative data would underestimate the disease prevalence and be an indicator of health service utilization rather than disease prevalence. Currently no monitoring system captures data from community-based services outside the health care system.

It is important to note that while national population surveys have previously asked respondents to indicate whether they have PTSD, estimates based on self-reported diagnosis are thought to underestimate the true prevalence of the disorder as people may not have been diagnosed or may be unwilling to divulge their diagnosis.

Surveys that rely on the reporting of individual symptoms consistent with PTSD rather than self-reported, physician-diagnosed PTSD however, may be able to provide accurate information on the prevalence and the impacts of living with the condition for the purpose of monitoring. For example, in 2001 McMaster researchers conducted a study using symptom-based survey tools and reported a lifetime prevalence of PTSD of 9.2%, which is higher than the prevalence reported from the Canadian community health survey of 2012 on mental health. Due to the large sample of respondents that would be required as well as survey content and length, this would be costly to conduct.

Moving forward, as I've outlined, there may be opportunities to enhance the monitoring of PTSD using surveys and/or administrative data.

The Public Health Agency of Canada is committed to working with partners and stakeholders to develop ways of measuring and reporting on the burden of PTSD in Canada.

Thank you for your attention. I would be pleased to answer any questions you have.

[The Chair, Liberal, Bill Casey]

I call this meeting to order.

This is meeting number 55 of the Standing Committee on Health.

I want to thank all our witnesses for coming today. I apologize for the delay; these things happen here. I hope it doesn't inconvenience you too much, and I want to thank you for your patience. We will go later than we had planned. I hope that's all right with everybody.

Today, first we'll be studying Bill C-211, an act respecting a federal framework on post-traumatic stress disorder.

Our witnesses today include Dr. Anne-Marie Ugnat, executive director of the centre for surveillance and applied research in the health promotion and chronic disease prevention branch of the Public Health Agency of Canada. Welcome.

By video conference, we have Dr. Jitender Sareen, professor of psychiatry at the University of Manitoba. Thank you very much for taking the time to do this.

As an individual, we also have Natalie Harris, advanced care paramedic in the county of Simcoe.

We'll offer you the opportunity to make a maximum of 10 minutes of opening remarks, and after that we'll go to questions.

We'll start with Dr. Ugnat.

[The Chair, Liberal, Bill Casey]

We will come back to order.

I want to make sure everybody knows that we're going to do drafting instructions for this thalidomide study. If anybody has recommendations on changes or recommendations that we want in the report, we should have them prepared for May 18. That's a week from today. We're also going to do clause-by-clause on Bill C-211 that day. We're going to have witnesses for Bill C-211 on Tuesday.

That's it, but again, if you have some thoughts on this issue, we'd sure like to have them.

Mr. Webber, I understand you have a motion.

[The Chair, Liberal, Bill Casey]

The clerk sent around a list of proposed witnesses this morning for Bill C-211 and needs our approval of the witness list, so that we can make sure they're invited and they get here on time.

Is the list all right with everybody, or does anybody have a question or want to make a change on it? The witnesses are all based on recommendations from the committee members. This is for meeting two on May 16.

Do we have the approval of the committee?

[John Oliver, Liberal, Oakville, ON]

I thought we had agreed that we were doing one day on Bill C-211.

[The Chair, Liberal, Bill Casey]

We have a bit of committee business to do.

We have some budgets to talk about for the thalidomide study. Do I have a motion to approve $4,700 for witnesses and testimony?

(Motion agreed to)

Now we have the budget for Bill C-211, respecting a framework on post-traumatic stress disorder. We've proposed $10,100 for witnesses, travel, a video conference, and working meals.

(Motion agreed to)

We want to talk about the schedule. Two meetings are locked in. That's the thalidomide meetings for next week. The clerk has just reminded me that today is the last day for witness lists for Bill C-211. I'm proposing that we do Bill C-211 on the 16th and have witnesses. Then on the 18th, we'll do clause-by-clause. With everybody's agreement, the 16th and 18th will be on Bill C-211.

We're proposing consideration of M-47 for May 30 and June 1. Is that in order for everyone?

Mr. Oliver.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Bill C-211 relates to PTSD, while the House of Commons Standing Committee on Public Safety and National Security examines operational stress injuries, which includes PTSD, as well as anxiety, depression, and other mental health issues.

Have you considered broadening the scope of the bill to include OSIs more broadly, rather than just focusing on PTSD?

[Colin Carrie, Conservative, Oshawa, ON]

Thanks for sharing that. Do not apologize for getting emotional. I think all of us around the table here have either friends or family who put their lives on the line for us. All of us owe those individuals more than can ever be paid.

I'm so impressed with what you have done here. It is so rare that a private member's bill receives unanimous consent like this at any stage of the legislative process.

Can you take a moment and explain to those who are listening why you think Bill C-211 received support from all sides of the House?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

There are many. I get emotional when we.... As I said, there's a heavy burden when you're listening to these stories. You have people you consider heroes who are pinning their hopes on what we're doing. I used to think that I handled stress very well, but I think the weight of the world has been placed on our shoulders, and that speaks volumes to the issue and the need for us to do something.

I will answer the question. I developed a challenge coin with respect to my bill. I don't know if anybody has seen it. Mr. Chair, if it's okay.... On one side it has my parliamentary crest. On the other side it has the shields of first responders and our troops.

At Christmastime we were back in our ridings, and I was walking through a lobby. As you know, our days are fairly busy. Our schedules are not ours anymore. I saw a friend of mine who is in the RCMP and whom I've known for a very long time. As I was going by, I patted him on the shoulder and said, “Thanks for everything you're doing.” I kept going, but I was drawn back. I don't know why. I went back and said, “I'm really sorry to bother you.” He was meeting with his team at that time. I said, “I don't know if you know, but I have a private member's bill with respect to PTSD. It's called Bill C-211. I have a challenge coin that I want to give you, and I just want to say thank you for everything you're doing.” Then I left and went on my way.

We went away for Christmas. When I came back, there were emails, voice mails, and messages from this gentleman. Finally I phoned him and I said, “What's up?” He said, “I just have to tell you. I don't know if you believe that things happen for a reason.” This is very altruistic, for those who are here. He said, “I want to ask you if you remember when we saw each other before Christmas.” I said, “Of course I do.” He said, “Something drew you back to see me, and you gave me your challenge coin. Nobody knows this, but I was at my darkest point. I was essentially saying goodbye. Nobody knows this. Since getting that coin, I've come out to my wife, and I've sought treatment. I want to be the face of your bill, because you are saving lives and that day you saved my life.”

You can see how emotional it is. That's just one. We had a gallery filled with people. Every day they send us the same. There are so many. We can save lives.

Sorry. I'm a big baby, but this is real. It's not made up. A simple pat....

When 284 members of Parliament stood unanimously on March 8, 56 days ago, there was a giant of a firefighter suffering from PTSD who was emotional and was crying. He said, “For the first time, I have hope.” To me, that's shocking. I'm sorry, but that's unacceptable for us as leaders within our country. We have to do better, and we have to be better.

Is there one story? There are many stories. That's one. His story.... It was released that day. His name is Kent MacNeill, staff sergeant for the RCMP. Every day, I'm inundated with the same. We have thousands of stories that are the same, whether it's a survivor or a wife, as I read earlier. It's crazy.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

I really appreciate your comments.

Every government comes out with a mandate, and they choose to allocate funds and move forward with it. We know from the nature of government and from the nature of the day-to-day that sometimes we fail or we lose sight of our best intentions.

My bill came out before the mandate letters did and we moved forward with those. Bill C-211 calls for a national framework to be developed, working with our provinces, working with legislators, working with industry and academics from across our nation. There are groups that are doing some incredible work. There are provinces that have followed through with different pieces of legislation.

But as we stand today, there are still inconsistencies in what is being delivered from one end of our nation to the other. Leadership needs to be seen. This is calling for a piece of legislation so that irrespective of government, there will be a line item to ensure that the responsibility to our warriors and our front-line workers will be maintained and that as we move forward, we're moving forward in lockstep and taking care of those who serve their communities and their country.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Chair, I just want to say thank you for the opportunity to be here today. Thank you to you and thank you to my colleagues for allowing me to be here to speak with respect to Bill C-211, an act respecting a federal framework on post-traumatic stress disorder. I'd also like to thank all members of Parliament for their support at second reading, when all 284 MPs present voted in favour of sending Bill C-211 to this committee. I'm hoping that we can see the same show of support at third reading.

I think we've done something unique in this Parliament. We've been able to show support across all party lines for a very worthy cause, and that is getting our warriors the support they need and deserve when it comes to post-traumatic stress disorder. Bill C-211 seeks to establish a cohesive and coherent national framework to ensure our military; first responders, including firefighters, paramedics, police personnel, and emergency dispatch; our veterans; and our correctional officers timely access to the resources they need to deal with PTSD and mental health injuries.

We're only just beginning to understand the term PTSD. In truth, even in the three years of working towards getting elected and tabling this legislation, the discussion has grown even louder. This is good, but it is very easy to forget that it was only 30 years ago that there was no classification and no name given to the demons we now know to be PTSD.

When I first started doing research for this bill, I was shocked to read that PTSD wasn't even officially recognized until 1980, when the American Psychiatric Association added it to the Diagnostic and Statistical Manual of Mental Disorders. There are generations of individuals who have lived this nightmare that we are only now starting to talk about publicly. There are generations of individuals who have struggled with PTSD who we have lost.

I know some of you in this room better than others, but I think we all have one thing in common, and that is, at our very core, when we chose to put our names forward, it is and it was because we hope to inspire change and to do better for future generations than had been done in the past, irrespective of party lines.

I was told from the outset that the likelihood of getting Bill C-211 passed was slim to none, that I shouldn't get my hopes up, and that, since I am an opposition member, the government would never let this pass. As I met with people first from my riding, then from all across this country, and indeed, across party lines, I began to see what I already knew. This is not a Conservative issue, it's not a Liberal issue, nor is it an NDP issue. I've heard very real stories from our brave men and women who have made sacrifices. I also heard from the families and colleagues of those who lost their fight and those who are still in the thick of this terrible disease.

Colleagues, by getting Bill C-211 to committee today, we've already beaten the odds and the naysayers. We have proven that we can put aside party politics and work together to leave a legacy, or have we? Will C-211 die at committee stage? That's the message we've received, that this is a feel-good moment, that the box has been checked off, but it now affords the excuse that there was no consensus at committee.

We've heard that before in this Parliament, haven't we? I apologize for this comment, but you have to understand that lives are at risk here. Every minute we delay or decide that we need to study something further, lives are lost. It has been 563 days since those around this table were elected. It has been 556 days since I first landed in Ottawa with the background for Bill C-211. It's been 462 days since I first tabled C-211, and 57 days since we stood together. In all that time, we have lost lives.

Mr. Chair, I offer to you that a mere one year ago, only about 800 metres from here, an RCMP member chose to end his battle mere steps from the front of Parliament. We need to be better, and I challenge all of you that we can do better. There is so much work that needs to be done. The message we have delivered to this point has been that we have heard the stories, that we believe the stories, and we will act. In doing so, we have given our warriors hope, and this, indeed, is a heavy burden to carry.

We have an opportunity before us today to get this bill through committee because as it stands, the standard of care, education, and even our terminology, be it OSI or PTSD, still varies from one province to the next.

Our government has said that PTSD is a priority and it is outlined in the mandate letters of the Ministers of Public Safety, Veterans Affairs, and Health. This is our chance to align all of our work done to date on this issue and get a line item on the federal books, so that no government, present or future, will be able to move forward without our warriors.

A national framework would ensure that every year a conversation is happening on best practices, on treatment options, and on how best we can help as a society, so that no one is left behind.

I have said this before and I'll say it again. We have received many emails, many of them full of heartbreak and tragedy as a result of careers. I'd like to take a moment, if you will, to read one that I received a little over a year ago.

“As I write this, I'm trying hard to hold back the tears. The truth is I'm unsure how I even have tears left. I've cried every day since his death and it's been over a year. I can only manage a day at a time, and even that at times is too much. I don't know what tomorrow will bring. I guess no one really does. We were only married three years and he was my one true love. He would have been 30 this year. Our son will never know his father. He will never know the incredible man he was. My husband only wanted to serve and to save. Sadly, no one could save him. It's odd how everyone gathers around you at first, then life goes on. I don't get the invites anymore. It's like other wives don't want to be reminded of this, of how this could have been them.

“Mr. Doherty, your bill is too late for my family, but I hope you will be successful. My pain endures and I'm not sure there is a fix. I will tell my son that his dad was a hero and saved lives. I believe if my husband knew of you and your efforts, it just might have given him enough hope that he would have reached out, that he would have hung on. Please keep fighting for this. For us it is too late, but you and your colleagues will save the lives of others.

“Thank you.”

Mr. Chair, this is one of hundreds, maybe even thousands, of emails, messages, and comments on social media we have received and private meetings we have held, since tabling our bill. It truly is overwhelming. We have heard the stories of those who are struggling today, those who are receiving help, and those who are left behind to somehow pick up the pieces.

We have to come up with solutions, so we don't lose another life to PTSD. I'd like to ask the committee members—and I also mentioned it in my speech at second reading—if the cost of action on the national framework for PTSD is too great for our government, be it the federal government or the provincial government, what then is the alternative? What is the cost of inaction? How many more lives are we willing to lose before government steps up to the plate? What value do we place on those who we ask to serve our country without hesitation, to answer our call without hesitation, to run into burning buildings, to run towards gunfire? When we call, they answer, any time, any place, and for any reason, with no questions asked, but have we been there for them? Have we answered their call?

These are all questions we need to be asking ourselves today, for all of those who are still fighting. When they talk to one branch of government, are they then referred to another or a different office, or a different phone number, or shuffled to the next wicket? Have we turned a blind eye and said, “It's not my problem”? For those who have a friend, family member, or loved one who has lost someone to PTSD through our inaction, are they spending their lives on hold waiting for someone to listen to them?

This is unacceptable. We must and can do better for our fellow men and women. This begins with education and a willingness to learn. It begins with the bold action of saying, “Enough is enough”, so that regardless of our party politics, we can and will finally do something about this terrible disease.

Let's stop making excuses. Let's not further delay or deny action. Those of us, around this table and in this House, can do this. It is the federal government that can set the tone and provide leadership right across our nation on this terrible disease.

This issue has been studied by other committees. We can build on their work and move this legislation forward. Only through bipartisan support and co-operation can we hope to achieve effective and viable strategies, terminology, and education to help deal with PTSD. Let's choose to give back in the one small way that we are able to by ensuring that our protectors have the opportunity to receive basic, standard care and treatment to deal with their PTSD, and by ensuring that our terminology and laws are consistent across the country, and that our heroes in the east are treated the same as our heroes in the west, because for too long, we have left our first responders, our military, and our veterans behind.

Mr. Chair and colleagues, it has been an interesting spring session. I read earlier, from the wife of a fallen officer. One line sticks out, “I don't know what tomorrow will bring. I guess no one really does”.

For those who have been following our journey, those who are in the room with us today, and those who are watching across our nation and internationally, tomorrow is just another excuse for delay. Sometimes, tomorrow is too far away. Let's not wait for tomorrow, Mr. Chair and colleagues. We can make a difference today.

I'm asking for your support to ensure that Bill C-211 moves forward in a timely manner, because it will save lives. At second reading, we proved to our community of warriors that we stood in solidarity with them. I'm telling you today that this committee and our House collectively have the power to leave an incredible legacy.

With that, I'll end. I just want to say, once again, thank you, and I appreciate and will take your questions.

[The Chair, Liberal, Bill Casey]

I call this meeting to order. Today at our health committee meeting we're going to talk about two bills, and then we're going to do a little bit of committee business at the end of the second bill.

The first issue we're going to talk about is Bill C-211, and we have as witness MP Todd Doherty, who is going to give us opening remarks on Bill C-211.

Mr. Doherty, the floor is yours.

[The Chair, Liberal, Bill Casey]

We're going in camera to talk about witnesses for the thalidomide study, and we have to talk about Motion M-47, as well as Bill C-211 very briefly.

[Proceedings continue in camera]

[The Chair, Liberal, Bill Casey]

We have passed a motion now. That meeting is cancelled, so we'll have to adjust our schedule on that.

We have to take our meeting from the 13th and we're going to move it to.... Are you proposing that it be May 4? That means our sickle cell study and Bill C-211 will be moved to May 4.

We'll move on to the next thing. We've passed around a budget for M-47 that totals $27,700. I need a motion to support that.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

I think I'm trying to keep it fairly structured.

Our colleague Mr. Ouellette asked me to mention my bills that I came to the House with. As I said, I took the nomination back in 2014. I had the year to work to getting elected. I arrived in the House two weeks after being elected. I had the framework for Bill C-211, but I also had a framework or some ideas for three other bills I wanted to do.

One was with respect to a national appreciation day for first responders. The other one was a bill that dealt with prolific offenders and their release, making sure that it wasn't just up to a judge to decide whether the community or the victims were notified upon their release, that it was mandatory that if high-profile offenders, schedule III, were being released, we didn't rely on the whim and whimsy of a judge to decide: it would actually be mandated.

The other one was to deal with the Canada Evidence Act and a standardized date format with respect to evidence. Mr. Chair, let's say you were pulled over. Maybe there was something in your car that was untoward or what have you and it was entered into evidence. If the well-meaning RCMP officer or police officer at the time entered it into evidence as “010103”, what date is that? Is it January 1, 2003, or is it March 1, 2001? There's an issue. That was another one of the bills.

Then, of course, there's Bill C-211 that I entered and that we are moving forward with.

I hope that satisfied—