Finance Committee on May 11th, 2017

[The Chair, Liberal, Wayne Easter]

Mr. Smith.

[Dr. Patrick Smith]

I was head of the addiction psychiatry division at U of T, and then also founding head of the addiction psychiatry program at UBC, so addictions have kind of been my career. Fetal alcohol syndrome is, as you're saying, completely preventable. One of the things, though, that we have to recognize in Canada is that, when we talk about how one in five Canadians will have a mental illness, Canada has separated out alcohol and drugs from other mental health issues more than any other country. Actually, substance-related disorder is the second most common mental health disorder diagnosed in Canada, but when we talk about mental health in Canada, we say mental health and addictions. It's the second most common mental health diagnosis in Canada, and although it's in the data for the call to action for investment from the Mental Health Commission, there's absolutely nothing in there that responds to the needs.

We have great examples in Canada, such as CARBC, and some of the research that's been done. Some of the best research in fetal alcohol syndrome anywhere in the world is happening in Canada. But, again, there's that need to invest in the upstream and to make sure that addictions aren't separated out from mental health, because it is the second most common form.

[The Chair, Liberal, Wayne Easter]

Do you want in, Ms. Moran?

[Kimberly Moran]

Thank you.

When you think about the four, as you mentioned, about family, caregivers, and siblings who are living with a child who has FASD, I think what we all have to remember is that they're actually the best reason to have a very strong home community care system right there. As you well know, if you take a child with FASD to a hospital when there's a problem, that's not where you're going to get the care you need. The kind of care that is really needed is usually in the community, and it trains both the family and the kid how to really optimize the life they can have. When we can help a child with FASD right from birth, if we can intervene right in the very earliest years, we're seeing much better outcomes than if we intervened later. I think it really shows that return-on-investment piece that we've been talking about: that if you invest in children and youth and catch it as early as possible, you'll see much better results for both the family and the child.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

I think what has transpired over the last 30 years is that identification at the earlier stage. That wasn't there 30 or 40 years ago.

I'm good, thank you.

[The Chair, Liberal, Wayne Easter]

Okay. Thank you.

I'll just mention that I sat on a committee that studied the economics of policing—and this relates to your statistic, Ron.

During that study, it was found that 72% of the people in jail were there due to mental health issues and addictions to alcohol or drugs. Jail isn't the place to deal with mental health issues, I'll tell you, from what we've seen.

Mr. Fergus will be the last questioner.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Thank you, Mr. Chair.

I would like to thank the witnesses for their presentations. I am pleased to see that all the governments and the Canadian society are increasingly recognizing the importance of mental health.

My question is for Ms. Moran, in particular, since she mentioned Starbucks' investment in mental health twice. I apologize, it was Dr. Smith who mentioned it, but there is a connection with what Ms. Moran said.

Starbucks increased its investment in mental health services from $400 to $5,000 per employee. I imagine that's an annual amount.

The amount allocated to these services is $100 million in this budget. If I divide this amount by the 7 million people who may need mental health services, I see that we aren't spending enough in this area, far from it. You said that Ontario alone would require an investment of $100 million.

Should investment in mental health be considerably increased?

[Kimberly Moran]

Well, absolutely. Certainly we look at this as a good first step, but there is much more to do. I think that if we really want to fundamentally change how we deliver health care to people with mental health issues, it is going to require investment. If we can take that first brave, courageous step, then we will see, as my colleagues have said, that you will have an impact on other health care costs throughout the system.

You will find that by making that investment, there will be reductions in other areas. We've talked about corrections, I've talked about child welfare, and we've talked about acute care systems. I think that if we can make that brave and courageous step to make this investment, you will see a very significant return on investment.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

What do you think Dr. Cohen?

[Dr. Karen R. Cohen]

Yes, I also want to make the point that there is research showing that for the average person who successfully benefits from a course of psychotherapy, it usually takes between 10 to 20 sessions, which cost from $3,000 to $3,500. The Starbucks provision should enable them to get that. The $100 million for Ontario over two years is not going to buy that, obviously, for every citizen in Ontario—although not every citizen is necessarily going to need it.

The other point I want to make is that one of the things we do in mental health that is a great disservice and that we don't do in physical health is that we address it as if it's one homogenous problem. We don't have a physical health commission that treats every physical health problem in the same way. There is a range of mental health disorders and needs that do not all require the same kind of assessment or intervention. I think we forget that when we have these kinds of conversations.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

You raise a valid point.

I would like to know approximately how much Australia and the United Kingdom spend annually per person using these services.

Do you have that information? If not, could you send it to us so that we can include it in our report?

[Dr. Karen R. Cohen]

Yes, to be precise, I will do that. I will follow up and send you the data.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Dr. Cohen, you said that there wasn't a solution to all the problems. Having said that, can you give us an idea of how much we should be spending?

Once again, if it's true that $100 million would meet the needs in Ontario only, then the investment should be two-and-a-half times higher for all of Canada.

[Glenn Brimacombe]

In the report we referred to, “Mental Health Now!”, we calculated that if we're to move from 7% to 9% of all public health spending going to mental health, and assuming that the federal share is 25%, it would mean that annually there should be an additional $780 million invested across the provinces on a per capita basis.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

There's the crux of the problem.

[The Chair, Liberal, Wayne Easter]

That ends our questioning.

Are there any quick last comments anyone wants to make? Are we okay?

Then thank you all very much for your presentations. We appreciate your coming in and laying out your thoughts and responding to questions.

We'll suspend for a couple of minutes for the next witnesses from the Privy Council Office.

[The Chair, Liberal, Wayne Easter]

We'll reconvene. We're turning to part 4, division 7.

From the Privy Council Office, we have Allen Sutherland, assistant secretary, machinery of government; and Don Booth, director, strategic policy.

I would expect that you have an opening statement, and we'll go from there.

Welcome, gentlemen.

[Allen Sutherland, Assistant Secretary to the Cabinet, Machinery of Government, Privy Council Office]

Mr. Chair and members of the committee, I am very pleased to be here this afternoon to explain the technical aspects of the text in section 7 of Part 4 regarding the Parliamentary Budget Officer and the Board of Internal Economy.

I will start with the proposed legislative amendments for the Parliamentary Budget Officer.

The proposed legislation fulfills the government's commitments to ensure that the parliamentary budget officer is properly funded and independent, with a mandate focused on accuracy and transparency in costing.

The parliamentary budget officer, as we know, supports Parliament by providing an expert and objective source of research and analysis on fiscal and economic matters. These amendments will strengthen this important resource for parliamentarians in several ways, and I'll lay out a couple of them.

First, it would establish the PBO as an independent officer of Parliament, separate from the Library of Parliament, with his or her own dedicated office.

Second, it would appoint the PBO to serve a term of seven years, removable for cause, rather than serving at the pleasure of the current or sitting government, with the appointment and removal of the PBO subject to parliamentary approval, meaning both the Senate and House of Commons.

Three, it would ensure that the work of the PBO is responsive to the needs of parliamentarians and parliamentary committees.

Four, it would provide the PBO with wider access to relevant government information to better inform the research and analysis provided to Parliament.

Under the proposed legislation, the PBO's mandate would also include for the first time the costing of election platforms and proposals at the request of political parties, providing a credible non-partisan way of assessing a party's fiscal plans and encouraging informed public dialogue. These changes would provide parliamentarians with the information and analysis they need to best serve Canadians and effectively hold the government to account.

Regarding the Board of Internal Economy, the proposed legislative changes are part of the government's delivery of its commitment to more open and transparent government. The government is proposing to end the secrecy that surrounds the Board of Internal Economy, which, as you know, is the body that makes decisions and provides direction on the financial and administrative matters of the House of Commons. The proposed legislative changes would make the board's meetings open by default. This means that in all cases but those involving sensitive or personal information, the business of the Board of Internal Economy would be made public. It is important to note that the proposed changes would not change the role or the composition of the board. All recognized parties would continue to be given representation on the board.

With those introductory remarks, we would be happy to take any questions you might have.

[The Chair, Liberal, Wayne Easter]

Thank you.

Mr. Liepert.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Whose idea was it to include this as part of the budget implementation bill?

[The Chair, Liberal, Wayne Easter]

I don't know if you can answer that.

[Allen Sutherland]

Yes, that is significantly outside my area of knowledge.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Was this recommended by your department or was it decided politically that it be part of the budget implementation bill?

[Allen Sutherland]

Ultimately, the decisions about what's in the budget rest with both the finance minister and the Prime Minister.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Okay. I want to ask a few questions related to some of the concerns that were expressed by both the current and former parliamentary budget officers before this committee yesterday, I guess it was.

Number one is about the requirement to have the approval of the two Speakers. Can you comment on why that was deemed to be necessary?