Agriculture Committee on Oct. 23rd, 2018

[Katy Kamkar, Clinical Psychologist and Director, Badge of Life Canada, Centre for Addiction and Mental Health]

Good morning.

Dear members of the House of Commons Standing Committee on Agriculture and Agri-Food, I would like to thank you for the opportunity to discuss mental health supports for our Canadian farmers, ranchers and producers.

I am Dr. Katy Kamkar. I'm a clinical psychologist at the work, stress and mental health program at the Centre for Addiction and Mental Health, CAMH. I am an assistant professor within the department of psychiatry, University of Toronto, and director of Badge of Life Canada, which is a peer-led charitable organization for police and corrections first responders across Canada who are dealing with psychological injuries suffered in the line of duty.

I'm also a member of the Collaborative Centre for Justice and Safety advisory council, and I serve on the Canadian Institute for Public Safety Research and Treatment national policing research committee. I'm also part of the scientific advisory committee with Anxiety Disorders Association of British Columbia. I'm a founding and credentialed member of the Canadian Association of Cognitive and Behavioural Therapies, and I'm on the editorial board of the Journal of Community Safety and Well-Being.

I provide evidence-based psychological assessment and treatment for mood and anxiety disorders, trauma and post-traumatic stress disorders, occupational stress injuries in first responders and psychological distress in the workplace.

Providing mental health support, resources and treatment to our Canadian farmers, ranchers and producers is of utmost importance. Building awareness to have a better understanding of the various stressors they experience can also help build further resources related to their needs.

Our Canadian farmers, ranchers and producers experience a range of stressors related to their occupations that in turn affect their personal lives. They often face situations or circumstances with heightened uncertainty and limited control, in turn leading them to feel helpless and powerless, increasing their feelings of anxiety. For example, poor weather conditions can significantly impact the quality of their work and the financial outcomes.

Other stressors over which they have limited control but that can significantly impact their mental health and their work include natural disasters, or any changes, for example, related to government policies or regulations. Public dissatisfaction or negative media coverage around their work can as well significantly increase stress levels and feelings of demoralization. High work demands, working long hours often around the clock, can lead to mental, emotional, psychological and physical exhaustion.

Most importantly, the hard work might lead to negative outcomes and limited financial gains given that many factors are not within their control, increasing the risk for psychological health concerns such as feeling demoralized, hopeless, helpless, stressed, anxious and depressed, along with other psychological symptoms such as sleep disturbance, changes in appetite or energy level, feelings of worthlessness, and reduced self-esteem and self-confidence.

Stresses and pressures related to finances and family are common as a result of the factors I just noted, in turn increasing the risk for psychological health problems such as depression and anxiety.

Their work also entails working in isolation, limited contact with people and limited social support. Over time this can translate into feeling lonely, suffering in isolation and feeling withdrawn, making it more difficult to ask for help if in need.

There is also a culture that embraces high stigma around mental illness, and there is a perception of weakness and dependence if someone suffers or talks about any mental health concerns. Concurrent physical and mental health issues are also likely given the pain and physical health concerns that could result from the physical demands of the occupation, thus further exacerbating any psychological concerns.

Support and interventions aimed towards building awareness of mental health issues facing Canadian farmers are needed. These include gaining access to mental health education, stigma reduction, mental health promotion and building resiliency skills.

Having access to resources, support and psychotherapy are necessary. Given long distances, difficulty gaining access to therapy in rural areas and difficulty leaving their work, therapy—either in person or through other formats such as phone or Internet-based therapy—would need to be considered. Group therapy and a community of support should also be considered. There is a need for further research to gain a better understanding of the unique stressors faced by farmers, and for developing more targeted interventions based on research.

Dear members of the House of Commons Standing Committee on Agriculture and Agri-Food, I would like to thank you again for the opportunity to discuss mental health supports for our Canadian farmers, ranchers and producers. Providing mental health support, resources and interventions to our Canadian farmers, ranchers and producers, again, are of utmost importance.

Thank you.

[The Chair, Liberal, Pat Finnigan]

Thank you, Dr. Kamkar.

Now we'll start our questioning round.

Mr. Berthold, you have six minutes.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Thank you very much, Mr. Chair.

I thank our two witnesses.

I also want to thank Mr. Harvey, Mr. Dresshen, and Mr. Shipley for their testimony during the first hour. It is good to have people around this table who have been farmers themselves and can tell their stories. It was a really interesting hour.

Since the beginning of this study, much has been said about farmers in crisis, at the end of their rope. That is what we have talked about the most. However, not much has been said about prevention.

Ms. Kamkar, you work with different types of clients. Are all farmers likely to face mental health problems, or are only certain types of farmers at risk? That is something we have not really discussed so far.

Could you share your thoughts on that?

[Katy Kamkar]

Thank you very much for this important question.

Of course there are daily stressors that we need to expect. It becomes problematic when some stressors become chronic. We know that chronic stressors increase the risk for psychological and physical health concerns, so yes, there are certain chronic stressors specifically unique to our Canadian farmers—definitely, working in isolation. We know there is also this lack of control and tremendous uncertainty that they all go through. We know, as human beings dealing with uncertainty, we all have difficulties. We all know what that is, but the level of uncertainty that they have to deal with is almost chronic.

The limited control that they have over their occupation.... It could be working very hard. A lot of work demands working around the clock, as we know, but it's not knowing what's going to happen. I can put my hard work, my heart and soul into it but really not knowing what the outcome will be.... We know that if the outcome is not positive, it will lead to financial impact, therefore affecting family as well.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Ms. Kamkar, I would like to elaborate on my question.

All farmers and producers are facing those conditions. What is the trigger that leads to a producer experiencing distress at some point?

Why are some farmers able to do their job, endure all the stress their whole life without ever thinking about suicide or other ultimate solutions, while others end up in a funnel, a kind of a hole they keep sinking deeper into?

At what point can we identify that trigger, and how can we take action before it is set off?

[Katy Kamkar]

Yes. Definitely, as I mentioned, we need to further our research. We really need to build research to have a better understanding of the unique stressors and really at what point in time it would affect the individuals. It's very much individualized as well in terms of when a person might be more than someone else would be addressed. Certainly, I think here we need to appreciate that accumulation is very important. We know that accumulation of stressors.... Let's say that one person, chronically, one year after another, experienced weather problems, financial problems, difficulties doing the work on a daily basis. Then that person, maybe after a while, would have more difficulty and be more vulnerable to psychological problems than someone else.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Madam Kamkar, who will that person be?

How can we know before it happens? That's the problem. That's what I wanted to point out. How can we find out when farmers and producers will have to make a choice in their lives, when they cannot support it anymore?

[Katy Kamkar]

That's a good question.

I think the safest response is that we do not know. That's why this conversation becomes very important, because we simply do not know.

It also has to do with the heightened stigma about seeking help—keeping everything to oneself and this perception of being weak if we come forward. There are limited interventions, of course, with the isolation and everything going on, and the stigma and self-stigma make it even more difficult to come forward. It could be that by the time someone is reaching out for help they are at the burnout level.

If we encourage early intervention, awareness and prevention, it can very much further our understanding and provide some respectful response to that important question.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Mr. Chair, I think that the opposition's intentions were somewhat misunderstood during the first hour. That is why I will propose a new motion, which is very simple and has the same objective—to hear from the Minister of Agriculture and Agri-Food. I will move a new motion in a moment. I will give you a copy of it and let you to read it over. It is really very simple and reads as follows:

That the Minister of Agriculture and Agri-Food be added to the witness list of the study on the mental health challenges that Canadian farmers, ranchers and producers face.

It is a simple motion. Since the beginning, people have been saying that they think policies are problematic and talking about what we should do. So I think it would be important to hear from the minister. I will let you decide whether the motion is admissible before I talk about it.

[The Chair, Liberal, Pat Finnigan]

Thank you, Mr. Berthold.

Regarding the last motion, my role as chair is to ensure that we show witnesses respect, but also that we focus on the study underway. If a motion I did not have an opportunity to read in advance is moved, I read it quickly. I felt that the other motion was too broad. It talked about measures taken by the entire cabinet. My role is to make decisions while showing witnesses respect and taking time into account.

As I said, you certainly have every right to ask the minister to appear as a witness. So I will allow a debate on this motion.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Thank your, Mr. Chair. That's very nice. So I will talk about the motion if that's okay with you. It won't take very long, since witnesses are in attendance and we have to hear from them. I think this is extremely important.

A few moments ago, I talked to Ms. Kamkar about prevention and about a specific moment when a crisis may arise. In fact, since the beginning of the study, we have mostly been talking about crises. We have had an opportunity to hear testimony from people with a great deal of experience in the farming sector. We have heard from Mr. Harvey, Mr. Shipley and Mr. Dreeshen. In addition, the Minister of Agriculture and Agri-Food himself is a producer, a farmer. So he is also knowledgeable in that field. Since he is a minister, he has a unique role to play in defending producers and farmers.

Taking into account discussions that have taken place since the beginning of the study, it seems clear that we should prioritize farmers' and producers' mental health problems. I say that it seems clear because, when we asked officials what their mental health mandate was specifically, we saw that no such mandate existed. I don't know whether you remember, but that was at the very beginning of the meeting. If we recall the testimony, we know that there is no mental health mandate as such. That role does not exist. I remember very well that the deputy minister told us they were taking action because they wanted to help producers and farmers, but that was not written anywhere. It is not in the minister's mandate letter or in the department's letters of credence. The department has no actual obligation to consider farmers' mental health.

We just heard that there are many things we don't know about. I think that the role of the department of agriculture is to pursue this matter. In my opinion, no one is in a better position than the minister of agriculture to explain to us how he sees things, and especially what he thinks about this issue. Since I have been hearing testimony during this study, I have noticed that the situation is much more problematic than someone like me, a non-farmer, may have initially thought.

That is why, Mr. Chair, I will ask my colleagues for something very simple—to add the Minister of Agriculture and Agri-Food to the list of witnesses.

[The Chair, Liberal, Pat Finnigan]

Thank you, Mr. Berthold.

Mr. Shipley, go ahead.

[Bev Shipley]

Thank you, Mr. Chair.

We have an opportunity, colleagues. We've had some great testimony. We're actually coming to the end of the study, I think. I was just trying to find out the number of meetings. I think we're coming towards the end of it, unless we take an extension on it. Clearly there's been some movement of understanding of what we need to do on the peer-to-peer. How do we help those who are on the ground?

We've done a lot of research. There's an incredible amount of research. Back in the 1980s, some of us experienced that. The issues are the same. The one difference.... We haven't had a lot of discussion, but it will come up at another meeting. We did have some abuse of substance back in the 1980s, but not drugs—not out in the rural areas, anyway.

We have an opportunity with a minister who, I think all of us know very well, comes with that background. Not only as a leader around the cabinet table, but also as a leader in his community. Because he comes with that background, I think he could tell you that he also walked through, in the 1980s, changes in culture and life around the stresses that came at that time. I don't know where this will go in terms of the government, but for those of us, the farmers who we represent and the people in the agriculture industry.... It's much bigger than just the farmers. We have an opportunity to have him come before us and talk to us about the significance of this.

Where might he want to take us in terms of our understanding with this significant study? I have to be honest with you, at the start of it we knew that this was an issue. I don't think I had a grasp, quite honestly—even though I walked through some of this—that this was as big as it is across our country. It isn't just among the grain farmers. It's among all producers, whether you're in the supply-managed or not.

I would encourage the folks on the other side, with the government. This is about what can we find out and how we can best help those in our industry. It's also the ones who are selling us the inputs. It's also the ones who are selling to us and working for us. If we're in a situation were there are continual stresses, we need to get some peer-to-peer. Quite honestly, folks, my pressure is going to be, how do we get people in the industry who have actually walked it? How do we get those people to come alongside? We had that with Mr. Guest this morning. I think that was laid out strongly.

I won't take any more time. I know this study is coming to an end. I think if we don't have that opportunity to bring in a minister who is responsible for our industry and who lives it, has worked it, and who—I can almost be certain, although I have not talked to him about it so I don't want to be presumptuous—went through it in the 1980s.... I'll leave it at that, Mr. Chair.

Thank you very much.

[The Chair, Liberal, Pat Finnigan]

Thank you, Mr. Shipley.

Mr. Harvey.

[TJ Harvey, Liberal, Tobique—Mactaquac, NB]

Mr. Chair, I move that we now adjourn debate.

[The Chair, Liberal, Pat Finnigan]

We'll have a recorded vote on the motion to adjourn debate.

(Motion agreed to: yeas 5; nays 4)

Debate is now adjourned. We will continue.

[TJ Harvey, Liberal, Tobique—Mactaquac, NB]

As a quick point of order, Mr. Chair, on the subject we just voted on, I would like to say that, as somebody who is not a sitting member of this committee and as somebody who is a former agricultural producer and somebody who has been actively involved in advocating on behalf of agricultural producers across the country, although the debate was adjourned on this, it is an important issue and I would encourage the members of the committee—

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

That's debate.

[TJ Harvey, Liberal, Tobique—Mactaquac, NB]

—to try to find an avenue to have the minister appear on the subject.

[The Chair, Liberal, Pat Finnigan]

Thank you, Mr. Harvey.

Mr. Longfield, go ahead for six minutes.

[Lloyd Longfield, Liberal, Guelph, ON]

Thanks, Mr. Chair.

It's just unfortunate that we keep getting these distractions from the other side, who are playing political games when we're trying to study mental health.

I do want to get back to the study with Ms. Kamkar.

Congratulations on all the work you are doing. I see that you're working with Badge of Life Canada, working with our police forces and our emergency services. There are different groups that really need the attention of CAMH and other mental health support services—

[Bev Shipley]

I have a point of order, Mr. Chairman.

[The Chair, Liberal, Pat Finnigan]

Mr. Longfield, I have a point of order.

Mr. Shipley.

[Lloyd Longfield, Liberal, Guelph, ON]

I'm sorry, but they're calling a point of order on us again.

[Bev Shipley]

I'm sorry. I know Mr. Longfield well and I have the greatest respect, but when we're trying to advance the number of individuals to come and be witnesses. It is not political games. This is actually likely one of the most serious issues that we have discussed, and I think having the full breadth of intervention is important.

When you say we're playing political games because we are trying to bring witnesses in to advance this, I actually take offence to that.

Thank you.