Bill C-277

National Strategy on Brain Injuries Act

An Act to establish a national strategy on brain injuries

This enactment provides for the development of a national strategy to support and improve brain injury awareness, prevention and treatment as well as the rehabilitation and recovery of persons living with a brain injury.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

I chose Brain Injury Canada because they have been doing phenomenal work. I don't want to double up on what Michelle already answered, but when I came out with the first version of this bill in the previous Parliament, it immediately got her attention. We've had a collaborative working relationship every step of the way in the development of Bill C-277.

I think part of the reason the bill has been so successful to date is that through Brain Injury Canada's contacts right across the country, they've been able to mobilize an incredible base of support. The brain injury community has been mobilized. They're aware of this bill and they're aware of what this bill hopes to do, in large part because of what Brain Injury Canada has been able to do.

I felt they were an organization that deserved to be named in this bill because of the work they're already doing and because of the close collaborative ties they have with so many other organizations.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you for the great question, Dr. Ellis.

This is truly an issue that is gripping so many communities right across Canada. I know we've had some very passionate debate in the House of Commons and at various committees on this subject.

As I said in my opening remarks, it can be a vicious cycle. You can look at the symptoms that many people with brain injury exhibit, and they can have poor judgment and poor impulse control and other things that may lead them on a path towards drug use as a way of managing what's going on inside their own bodies. If they get a hypoxic brain injury, then we have this vicious cycle starting.

With Bill C-277, I wanted to provide a positive legislative measure that, so far, we can all get behind to tackle some of the spinoff effects from this. From what I've heard around this table and in the House of Commons, we seem to have a lot of people in agreement that this could be helping that very serious problem in so many of our communities.

[Michelle McDonald, Chief Executive Officer, Brain Injury Canada]

Thank you so much for inviting me to speak with you today, and for the committee's support of Bill C-277.

A brain injury can impact every aspect of a person's life. This includes changes to their independence, abilities, work, and relationships with family, friends and the world around them.

An outdated statistic cites that there are approximately 1.5 million individuals living with the effects of brain injury. The true number is likely much higher.

A brain injury is not just a one-time event. For many, it marks the beginning of a chronic condition that they must navigate for the rest of their lives. Thanks to advancements in diagnostics and treatment, we are now able to keep people alive after severe injuries. However, we do not have a health care system that is built to support their needs over the long term.

While many people living with a brain injury are falling through the cracks, there are also many people who lead stable lives, yet still lack access to the services and supports they need to live well. The invisible nature of brain injuries poses significant challenges, as many face judgment, stigma and isolation. This invisibility can hinder access to necessary supports and accommodations, making it difficult for affected individuals to navigate daily life.

A brain injury is deeply intersectional, influencing and being influenced by a range of personal circumstances and systemic barriers.

In terms of mental health, individuals with a brain injury are at a higher risk of developing mental health issues, including depression, anxiety and PTSD.

The unemployment rate for individuals with brain injuries is significantly higher than the national average. This can lead to poor psychosocial outcomes, decreased community integration and economic dependence.

Stable and appropriate housing is a driving issue. Depending on the area, the wait time for brain injury-specific housing is anywhere from 10 to 20 years. Families often shoulder the care for a loved one when there are no appropriate housing options, and this is often done with little or no financial support.

For many, these barriers lead to homelessness. A recent meta-analysis found that 53% of homeless people report having experienced a brain injury in their lifetime. These people are not receiving any care or rehabilitation for their brain injury.

A brain injury can lead to opioid use, and an opioid overdose can cause a brain injury. There is an urgent need for a comprehensive strategy that promotes prevention, rehabilitation and support for these affected individuals, who are often younger in age, with a normal life expectancy, but face long-term challenges that are not adequately addressed.

There is also growing awareness about intimate partner violence and brain injuries. Up to 92% of women survivors of intimate partner violence may also experience a traumatic brain injury.

It is also essential to highlight the prevalence of brain injuries as higher among indigenous, first nations and Métis peoples in Canada when compared to the general population. They often face systemic barriers that limit their access to health care services, including geographical and financial barriers as well as cultural and language barriers.

A coordinated national approach to prevention, treatment and recovery in the form of a national strategy is long overdue for Canada. Accurate data is essential for saving lives and informing decision-making, yet Canada urgently lacks comprehensive long-term data. This gap hinders our understanding of the ongoing challenges faced by individuals living with brain injuries. A strategy would improve data collection and health care tracking and would provide valuable insights to shape effective policies at the provincial and territorial levels.

A national strategy would boost research funding, leading to better diagnosis and treatment and a deeper understanding of brain injuries as a chronic condition. This would facilitate the development of effective long-term interventions and robust community supports.

A national strategy would enhance awareness and education, equipping health care providers with the necessary knowledge, while raising public understanding to reduce stigma.

A national strategy would establish coordinated national guidelines for prevention, diagnosis and management, ensuring equitable access to quality care for all Canadians.

A national strategy would provide essential support for individuals and families navigating the health care system, including sustainability support for the 50-plus brain injury associations filling the gaps in the health care system.

Finally, a national strategy would allow us to leverage reliable data while prioritizing prevention and early intervention, ultimately enabling us to significantly reduce health care costs through proactive measures and community supports.

Investing in a national strategy is not only a moral imperative, but also a wise economic decision that could yield substantial savings for the health care system. Canada needs a national strategy on brain injuries to ensure that every Canadian has access to the resources they need to recover and thrive after a brain injury.

Thank you.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Chair and members of the Standing Committee on Health, thank you for inviting me to appear today.

This is a momentous day for me as the sponsor of Bill C-277, and it is truly a highlight of the journey I began six years ago in 2018, when I first discussed the idea of a national strategy on brain injuries with my constituent Janelle Breese Biagioni, the excellent witness you met last Thursday.

I also want to acknowledge and thank Tim Fleiszer of the Concussion Legacy Foundation of Canada, Elisabeth Pilon from Concussion Café Yukon and Professor Miriam Beauchamp of the University of Montreal, who appeared as witnesses and provided incredible testimony in support of the bill.

The first version of this bill appeared as Bill C-323, which I introduced in the final days of the 43rd Parliament. That bill immediately received the attention of Michelle McDonald and Brain Injury Canada. She is sitting with me here today and deserves a lot of credit for how far we've come.

After the 2021 federal election, we partnered together to craft the bill you see before you today, Bill C-277. Although I'm here as the sponsor of Bill C-277, I can in no way take sole credit for its success. The campaign supporting this bill has been the result of the efforts of people across Canada—those living with a brain injury, their friends, families and support networks, researchers and brain injury support organizations. They are the ones who have shared their personal stories, written to MPs across the country and pushed for action to deal with what is truly a national problem.

Municipalities that are on the front lines of the mental health crisis gripping our country have also been proactive. We received early support from Vancouver Island communities, and this has continued to grow. Recently, the Union of BC Municipalities endorsed a resolution in full support of Bill C-277. This passionate and committed advocacy resulted in the unanimous support of 324 votes in the House of Commons at second reading on June 12 earlier this year. I want to again thank members from all parties for this overwhelming support. The brain injury community has been watching, and they are feeling hope.

Why do we need a legislated national strategy? Colleagues, you've all seen the statistics. You can appreciate what a devastating impact brain injuries have had on Canadian society. While an immediate concern might be directed towards the lack of proper health care resources, we know that brain injuries affect our communities in much wider ways. We know that there is a high degree of brain injury among the homeless population. We know that people with brain injuries have become victims of toxic street drugs and that overdoses from these same drugs have caused brain injuries, resulting in a vicious cycle. We know that many people involved in the revolving door of our criminal justice system have brain injuries.

There are many cognitive, emotional and behavioural symptoms from brain injuries: anger management, processing information, high-risk behaviours, inappropriate emotional responses, lack of impulse control, memory impairment and poor judgment. You can all imagine how even a few of these symptoms can lead to negative interactions and problems in society if the cause is not understood. There is a poor understanding of brain injury and its consequences for both health and social care systems.

This is a problem that is bigger than any one province or territory can handle on its own. People are suffering. There is a desperate need for services right across the country. The enormous societal and economic costs of the status quo demand that we rise up to the challenge of the moment and meet it with a strong national framework and strategy that will help guide, not dictate, collaborative federal and provincial policies to support and improve brain injury awareness, prevention and treatment as well as the rehabilitation and recovery of persons living with a brain injury.

By legislating this requirement for a national strategy, we can truly start treating this major societal problem with the urgency and resources it needs. With proper treatment and support, many people with brain injuries can return to productive and engaging lives. Bill C-277 will provide a legislative framework to help with this goal.

Thank you very much.

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 132 of the House of Commons Standing Committee on Health.

Before we begin, I would like to ask all in-person participants to read the guidelines written on the cards on the table. These measures are in place to help prevent audio and feedback incidents and to protect the health and safety of all participants, including the interpreters.

In accordance with our routine motion, I'm informing the committee that Dr. Powlowski has completed and duly passed the required connection test in advance of the meeting.

Pursuant to the order of reference of June 12, 2024, the committee will resume its study of Bill C-277, an act to establish a national strategy on brain injuries.

I would like to welcome our two witnesses today.

We have Alistair MacGregor, the member of Parliament for Cowichan-Malahat-Langford. Representing Brain Injury Canada, we also have Michelle McDonald.

Thank you both for being with us. You'll have five minutes each for an opening statement.

Congratulations, Mr. MacGregor, on getting to this stage with your private member's bill. We're going to start with you. You have the floor.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Breese Biagioni.

Thank you to all of our witnesses.

I think that's a good note to end on.

We very much appreciate your bringing your lived experience and expertise. We admire you for your advocacy on this topic. As you can tell by the unanimous passage of the bill to bring it to committee, you have the attention of the Parliament of Canada. As you can tell by the constructive dialogue we've had, we all seem to be aligned in what we want. This is a good day. This is a good session. It's very much appreciated.

I'm going to indicate to our panellists online that they're welcome to stay, but they're free to go.

We have some housekeeping, colleagues, so please don't run away.

Ms. Breese Biagioni and Mr. Fleiszer, I would also encourage you not to go away, because I think we're going to get through this housekeeping fairly quickly, and I suspect there are some people around the table who want to shake your hand before you go.

Thank you to all.

In terms of housekeeping, colleagues, yesterday you would have received two study budgets, one for this study and the other for the examination of Bill C-368, a private member's bill. Unless there's a willingness to deal with these jointly, we'll deal with them separately.

With respect to Bill C-277, is it the will of the committee to adopt the budget as presented? Is there any discussion?

I see no discussion. Do we have consensus to adopt the budget as presented?

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Our conversation shows that the cornerstone of Bill C‑277 is research. Promoting research is a major part of this bill, and I think that it's vital. In my opinion, this should have been the central pillar of the bill.

We were talking earlier about access to treatment. It's great to have access to treatment. However, if the treatment is outdated or not entirely suitable, then we fall short of our objective.

Ms. Beauchamp, you said that funding should be increased. You spoke of a specific and direct investment in the brain injury issue. You also talked about collaborative Canada‑wide initiatives aimed at sharing expertise and developing a coordinated strategy.

However, you also referred to the recommendations made in the Bouchard report, meaning the report of the advisory panel on the federal research support system.

Could you elaborate on this topic?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you very much, Mr. Chair.

I'd like to turn this question to Elisabeth Pilon.

Ms. Pilon, thank you so much for recounting your personal journey through this.

When you look at Bill C-277, there are requirements as a part of this national strategy to promote information and knowledge sharing, specifically with respect to brain injury prevention, diagnosis and treatment, along with rehabilitation recovery. There is reference to national guidelines, which would include recommended standards of care that reflect the best practices that are out there.

However, there is also a requirement to develop and provide enhanced and integrated mental health resources for persons living with a brain injury. All of these are legislative requirements of a national strategy that the federal Minister of Health has to develop with provincial and territorial counterparts.

You've told a very personal story about what it was like with the lack of resources that you had, and the long journey you've had to go through. If this kind of strategy, with these kinds of requirements, had been in place at the time you needed it most, what difference would that have made for you personally? Can you speak about people who are just beginning their journey right now and what kind of difference it would make for them as well?

[Miriam Beauchamp]

Yes, of course. I am always pleased to talk about our work.

First of all, a lot of my research focuses on very young children, babies and preschool children. Today we have talked a lot about concussions from sports, but I want to remind the committee that head injuries occur at all ages. Children up to the age of five actually have the highest rate of head injuries, comparable to the rate in young adults. We are not talking about teenagers or older adults, but very young children. This fact is not well known, and I am not referring to head injuries from sports. They are the result of falls. Children fall down stairs, from change tables, grocery carts or scooters, for instance.

So a lot of our work focuses on this subgroup that has long been overlooked. We are very far behind in our knowledge about the effects of such injuries on very young children. So we are in the process of establishing initiatives compatible with Bill C‑277. Just last week, we launched a website with educational tools to raise awareness of this problem and to help people detect the signs of concussion in young children. The website also provides information about treatment, of course, which requires parents to help these very young and vulnerable children in their recovery.

We are also establishing digital health tools. For school-aged children and teens, our approaches are based on tools such as virtual reality and educational games, because we know that young people today have to be engaged by tools that are interesting to them. Those are the treatments and interventions we use for their rehabilitation, together with clinicians who have an overview of recovery in young people.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

I'm glad you mentioned homelessness, mental health issues and addiction, because Bill C-277 does reference those as part of the national strategy. I think it's important.

I want you to talk about how brain injuries interact with these really big societal problems. Do you believe the implementation of a national strategy in dealing with brain injuries will have a positive effect in dealing with the intersections with the criminal justice system and the obvious mental health crises that so many of our small communities have, and of course so many of our fellow citizens are suffering through addictions in our opioids crisis?

[Tim Fleiszer, Executive Director, Concussion Legacy Foundation Canada]

Good afternoon.

My name is Tim Fleiszer. I'm a retired athlete who played professional football in the Canadian Football League for 10 seasons. I also played soccer, hockey and rugby in my youth. My three young boys play soccer and hockey.

Today, I'm here as the founder and executive director of Concussion Legacy Foundation Canada.

Along with our sister organizations in the U.S., the U.K. and Australia, we are the leading global charity dedicated to brain injury for youth, military personnel, veterans and athletes.

As a football player at Harvard and during my time in the CFL, I witnessed many of my teammates suffer multiple brain injuries. Tragically, this has led to several of them struggling with severe mental health issues. Some have even taken their own lives. Far too many of these athletes were diagnosed with chronic traumatic encephalopathy, or CTE, after they passed.

CTE is the only neurodegenerative disease that is completely preventable. Our mission at the Concussion Legacy Foundation is to eliminate CTE by preventing repeated hits to the head, whether on the job, in combat or while playing the sports we love. Prevention and education are at the heart of what we do, and we are committed to raising awareness around this issue every single day.

I will devote the rest of my remarks to the subject at hand today, Bill C-277.

The CLFC supports Bill C-277 in its current form as a first step to significantly reduce incidents of concussion and related brain injuries in Canada. This legislation has the potential to protect young athletes, promote safer sports environments and contribute to the long-term health and well-being of future generations.

This includes improving return-to-play guidelines and raising awareness among coaches, educators, clinicians and all Canadians.

We believe in this initiative because we want to see our kids participate in sports without the risk of severe, life-altering brain injuries. We want to help our Canadian Armed Forces servicewomen and servicemen, who put their lives on the line to protect ours, return home to their loved ones with the health and dignity they deserve. We want to ensure that those suffering the effects from multiple head impacts have access to the best possible treatments.

CLFC is proud to partner with research groups such as the brain health imaging centre at CAMH. Dr. Neil Vasdev and his team are performing cutting-edge, “first in human” trials to diagnose CTE in living patients. I was honoured to be the very first scan for this groundbreaking study. Our partners at the Canadian Concussion Centre are performing autopsies to determine the prevalence of CTE in Canadians. This research contributes to our global brain bank, alongside that of experts in Boston, Oxford, Auckland, São Paulo and Sydney.

CTE is preventable. With the right strategies in place, we can ensure that our children, athletes and military personnel avoid the devastating consequences of repeated brain injuries.

Mr. Chair and all members of the House, I would be remiss if I didn't take a moment to thank you for your unanimous support of this critical bill. Like all of you, CLFC strongly supports Bill C-277, a pivotal piece of legislation that has the potential to enhance concussion safety through the implementation of a national strategy for brain injury prevention.

Following the swift passage of this bill, CLFC offers the following recommendations to the Minister of Health for inclusion in a national strategy to support and improve brain injury awareness, prevention and treatment.

One, implement age-specific regulations to prevent brain injuries in youth sports.

Two, mandate brain injury education and awareness.

Three, establish an advisory panel on neurodegenerative brain injury treatment and prevention.

Four, monitor and evaluate policies using evidence-based methods.

Five, implement the recommendations from this committee's 2019 report, “Tackling the Problem Head-on: Sports-Related Concussions in Canada”.

We can make this national strategy a reality and have Canada lead the world in preventing, studying and treating brain injuries.

Thank you.

[Miriam Beauchamp, Neuropsychologist and Professor, Department of Psychology, Université de Montréal, As an Individual]

Thank you very much.

Good afternoon, everyone.

My name is Miriam Beauchamp. I'm a pediatric neuropsychologist, full professor in the department of psychology at the Université de Montréal, and director of the brain and child development axis at the Sainte-Justine hospital research centre in Montreal. I'm speaking here as an individual, as a researcher. I will make most of my presentation in French. Since I also work with members of several pan-Canadian groups that support Bill C-277, I will conclude briefly in English.

I am honoured to have the opportunity to present to you today. I speak to you as a researcher supported by the Canadian Institutes of Health Research, the Fonds de recherche du Québec and the Canada Foundation for Innovation. I also hold the Canada research chair in pediatric traumatic brain injury. Therefore, I would like to start by thanking Canadians for supporting my research.

My presentation today has two objectives. First, I want to support Bill C‑277 for the well-being of people living with brain injury. Second, I want to demonstrate that the scientific ecosystem is key to achieving the objectives of the legislation, and thus to highlight the importance of increasing federal research funding.

For the past 15 years, I have been dedicated to advancing our knowledge on the prevention, diagnosis and treatment of brain injury in children from birth to age 18. In Canada, we do excellent research and are well recognized around the world, but our research is fragile. Conducting research is an iterative process that requires constant renewal of our projects and staying ahead of rapidly evolving technology. Undertaking high-quality research is therefore costly, and depends entirely on financial support from our government.

This funding is crucial in three regards. First, it is used to fund large-scale research projects that lead to concrete clinical action for people with brain injury. For example, in my group, we are following over 1,000 babies and preschoolers to understand the impact of brain injury on development. We have identified significant behavioural problems and are now testing family-based interventions to address them.

Second, the funding is important for having the best equipment and infrastructure and remaining competitive with other countries. For example, in my laboratory, we use mobile neuroimaging technology that enables us to obtain brain images on the field when youth sustain a blow to the head. We have also developed a virtual reality treatment to improve the mental health and social life of teenagers after a brain injury.

Finally, the funding is critical for supporting our teams, made up almost entirely of motivated, dedicated and passionate students and post-docs who devote up to 12 years of their lives to research, without pay. For example, in 15 years, I have supervised 48 students who depended entirely on government grants to pay their tuition, rent and groceries, so that they can concentrate fully on improving the future of Canadians with pediatric brain injuries.

Although progress has been made in recent years in the management of brain injuries, there is still much to learn about this complex, multi-faceted condition. Maintaining and increasing federal funding for research is essential to the full implementation of Bill C-277 and to saving the lives of Canadians with brain injuries.

Concrete recommendations include: direct investment in research funding that specifically targets brain injury across the lifespan, from birth to aging; implementation of the recommendations of the Report of the Advisory Panel on the Federal Research Support System; support for pan-Canadian collaborative initiatives, such as the Canadian Concussion Network and the Canadian Traumatic Brain Injury Research Consortium, which enable us to pool our expertise and develop a concerted strategy.

In summary, I recommend that the committee not overlook the importance of research in the proposed national brain injury strategy, Bill C-277, and ensure that federal funding is increased to guarantee the sustainability of all research groups that ensure the survival and well-being of Canadians with brain injury.

Thank you.

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 130 of the House of Commons Standing Committee on Health.

In accordance with our routine motion, I'm informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

You have these cards on the table. Everyone who's here in person, please read the guidelines on those cards. These measures are in place to help prevent audio and feedback incidents and to protect the health and safety of all participants, including the interpreters.

Pursuant to an order of reference of June 12, 2024, the committee will start its study of Bill C-277, an act to establish a national strategy on brain injuries.

I'd like to welcome our panel of witnesses.

We have, appearing as an individual, Dr. Miriam Beauchamp, neuropsychologist and professor with the department of psychology at Université de Montréal. She's with us by video conference.

We have Elisabeth Pilon, peer support worker with Concussion Cafe Yukon, who is also appearing by video conference.

From the Concussion Legacy Foundation of Canada, we have Tim Fleiszer, executive director, who is here with us in the room.

From the Constable Gerald Breese Centre for Traumatic Life Losses, we have Janelle Breese Biagioni, clinical counsellor.

Thank you all for taking the time to appear today.

Colleagues, we're going to leave a few minutes at the end. We have a couple of study budgets to adopt, but otherwise we will proceed in the normal fashion, beginning with opening statements, followed by rounds of questions.

We're going to start with Dr. Beauchamp.

Welcome to the committee. You have the floor.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Johns.

Thank you, Dr. Ghosh.

That concludes the rounds of questions for this panel. I want to sincerely thank you both for being with us. This has been extremely interesting and will undoubtedly be very valuable to us in our study. Thank you for being with us and sharing your expertise. You're welcome to stay, but you are free to go.

Colleagues, please don't run away. There's one update I have for you with regard to the calendar going forward.

Mr. Johns, I think, is going to seek to resume a motion that had been adjourned.

In terms of updates, this Thursday we'll commence the study of Bill C-277. That's a private member's bill from Alistair MacGregor. We will have a panel of witnesses that has been confirmed for Thursday. The sponsor of the bill will appear on October 10. Unless the direction of the committee has changed, we would propose to do clause-by-clause at a subsequent meeting, likely October 24.

With respect to the opioid study, we'll resume the opioid study on Tuesday of next week. We've gone with the work plan and invited the third panel. That's by way of update.

Now I recognize Mr. Johns, and then Mr. Doherty.

National Strategy on Brain Injuries Act

[The Deputy Speaker, Chris d'Entremont]

It being 3:20 p.m., the House will now proceed to the taking of the deferred recorded division on the motion at second reading stage of Bill C-277 under Private Members' Business.

Call in the members.