Finance Committee on May 11th, 2017

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

But if there is no money left.... For instance, we know that in 2017 we have $100 million. We don't know what's coming in the next years. Let's say there is no money left. What do you think the solution is? How can we move forward?

I like to see numbers. I'd like to hear what you have in your own statistics and how big the problem in general is going to be moving forward.

[Kimberly Moran]

I think it's a difficult question to answer in that way.

I would say that if governments are brave, they will try to make sure that they continue to restructure the health care system and invest more in home and community care to get the very short-term payback that I think they will see in acute care systems. You can still make progress on that front.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Okay, I heard the term “return on investment”. It's a pity to sometimes talk about return on investment when we're talking about health care and saving lives and improving the quality of life of our own citizens and taxpayers.

What I gather from this is that you haven't been able to sell the mental health strategy to the government. Is that correct?

[Kimberly Moran]

Well, all governments are listening to all of the people here at our table presenting these returns on investment, and I think we are seeing governments starting to listen and make commitments and progress on this file. That is heartening.

There is a long way to go, and I think that when we look at how we perform against other G7 nations, my colleague Patrick demonstrated what that gap looks like.

[The Chair, Liberal, Wayne Easter]

Mr. Brimacombe, and then Mr. Smith wanted in, I believe.

[Glenn Brimacombe]

I was just going to add that I don't think we need to sell a mental health strategy, because it already exists. It has been created by the Mental Health Commission of Canada. It's a very robust strategy, and it's a framework for us to think about how we invest across the board in mental health.

The strategic question now, if I'm the federal government, is figuring out how we engage the provinces to put those investments on the ground where they will have substantial impact improving access, quality, and outcomes.

[The Chair, Liberal, Wayne Easter]

Mr. Smith and then Mr. Boeckh, for two quick responses.

[Dr. Patrick Smith]

I was going to quickly add that when we're working with the provinces across the country, they often like to see how it has worked in another province, so that they have the actual evidence.

For Canada, you can actually see that with the U.K. It's not selling this kind of pie-in-the-sky idea; it's saying, “Don't show me what you're going to do. Show me what you did.”

If you look at these other countries, that is the best evidence that this kind of investment makes a difference. It does save lives and it improves the quality of life, but it saves money too. It gave them much more money out of the correction system, out of the acute care system, to continue to reinvest in health care. Don't take our word for it; ask the other G7 countries how it is working for them.

[The Chair, Liberal, Wayne Easter]

Mr. Boeckh, for a final comment.

[Ian Boeckh]

On the $100 million, I think what it can do is prime the pump. It can help to demonstrate some innovations that could be very effective. The provinces are all searching for these effective things, and if you can demonstrate them, there is a good chance they will back them and put more money into them.

Everybody is looking for a winner. If you can show the provinces that this is a winner, then I think you have a good chance of getting them to put their money into it and scaling it up. Otherwise, if you just sort of put the money piecemeal all around, it can be swallowed up and you won't see any benefit.

[The Chair, Liberal, Wayne Easter]

Thank you all.

Mr. Grewal.

[Raj Grewal, Liberal, Brampton East, ON]

Thank you, Mr. Chair.

Thank you to the presenters for coming today.

How many Canadians suffer from mental health issues? Anybody can answer my questions.

[Dr. Patrick Smith]

It is one in five, and the other four are the family member, the colleague, the co-worker. What we try to say, and as Prime Minister Trudeau so eloquently said in his post during Mental Health Week, mental health affects everyone.

Every one of us has physical health. Some days we feel better than others. Every one of us has mental health. When we talk about one in five, we're talking about people whose mental health problems have gone so far that they actually have a diagnosis.

[Raj Grewal, Liberal, Brampton East, ON]

Is it concentrated anywhere across the country? Are there certain regions in the country more affected by mental health as opposed to others?

[Dr. Patrick Smith]

There are certain areas because of the social determinants of health. Clearly, we know that in the indigenous communities and some of the areas where there's more poverty, there are going to be more stressors and therefore you're going to have higher incidence of mental health issues.

I know that the provinces and territories have talked about trying to make sure they're meeting the needs of their specific demographics.

[Raj Grewal, Liberal, Brampton East, ON]

Most of the testimony we heard congratulated the Prime Minister and the new Liberal government on the steps that have been taken, but there's probably a consensus that more needs to be done.

What is the one country that does it better? Why do they do it better, and how do they do it better?

[Dr. Karen R. Cohen]

The two countries that come to mind that have at least made headway and where the outcomes show the effectiveness of their interventions, I would say are Australia and the United Kingdom. The United Kingdom took a national approach to implementing enhanced access to a psychological treatments program that involved psychologists and other kinds of service providers to deliver care. The care is evaluated; the training is systematic, and the outcomes guide their development. They started with depression and anxiety, because those are the problems most likely to affect most people who have them, and then they scaled it up. I believe they're also now going to be offering similar programs to children and youth, as well as to those living with chronic disease.

Australia took another approach. Rather than investing in programs, they decided to invest in more providers. There are two first-line interventions for mental health. There are medications—and we don't have a pharmacare program. There are also psychotherapies, and we don't cover the services of the majority of providers who are delivering those. There are physicians who do psychotherapy, but there are a lot more psychologists, social workers, and counsellors.

That's the challenge: the interventions we need to address mental health problems in our current system are not funded.

[Raj Grewal, Liberal, Brampton East, ON]

So in Australia they're funded?

[Dr. Karen R. Cohen]

They have a program called Better Access, for psychiatrists, psychologists, GPs, and, I believe, other specialized providers. There are some social workers who participate as well.

[Raj Grewal, Liberal, Brampton East, ON]

Not to belabour to the point, but do the U.K. and Australia spend less per citizen on health care than Canada does? It goes back to Ian's point on the return on investment, so that would be a really interesting statistic to know.

[Dr. Karen R. Cohen]

I don't have the data on how much they spend on health care, but I can tell you that there's a cost offset to providing psychotherapies and interventions for people who need them in the order of 20% to 30%. Someone who is depressed and isn't treated is still going back to their family doctor and saying that they can't sleep, eat, or go to work. There are cost offsets when people receive the care they need.

[Raj Grewal, Liberal, Brampton East, ON]

Finally, is there any private organization that provides employees with help when it comes to mental health? Maybe there's a private organization that's done it right, because, as you mentioned, it's a whole- of-government approach. However, in my humble opinion, it would also do wonders for the bottom line of private organizations if they took this seriously as well.

[Dr. Patrick Smith]

I think Canada has some of the best leaders in that. When we went to the International Institute of Mental Health Leadership in Australia and were looking at some of the workplaces in corporate Australia and corporate U.K. People look to corporate Canada. Actually, because of the gap in publicly funded services in Canada, corporate Canada has picked up more of the slack here than other countries. We do have good examples like Starbucks Canada, which moved from $400 of coverage per person per year to $5,000. People know about Michael Wilson and the Global Business Economic Roundtable that was established in Canada decades before other countries were talking about this.

We do have a lot of good champions, but I think they're also realizing that they're trying to fill a gap for something that is fundamentally missing. It's almost as if you had a few good private schools but the education system in your country had major gaps.

[The Chair, Liberal, Wayne Easter]

Mr. Liepert.

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

Thank you.

I'd like to thank Ms. Boucher for allowing me to follow up on the question around fetal alcohol that I sort of threw out there at the end. I happen to have dealings with that. I was one of the four, not the one. You're part of the mental health treatment facilities, yet to me that's almost a whole separate field, because it is totally preventable.

Do you have any thoughts or comments on what could or should be done in that area? I have a couple of statistics, again going back to my time as minister. We had statistics in Alberta showing that something like 75% of the people in jails have some form of fetal alcohol syndrome. At that time, I was told there was one community in northern Alberta where 100% of the residents had fetal alcohol syndrome.

I'd like your comments on that.