Health Committee on March 6th, 2012

[The Chair, Conservative, Joy Smith]

Good morning, ladies and gentlemen. Welcome to the health committee.

Today we have a very important bill before our health committee. It's Bill C-300, An Act respecting a Federal Framework for Suicide Prevention. It is my honour and privilege to introduce the sponsor of this bill, MP Harold Albrecht, who has worked extensively on this particular issue.

Mr. Albrecht will be presenting first, and then we have, from the Mental Health Commission, Dr. David Goldbloom and Ms. Mary Bartram. I understand, Dr. Goldbloom, you'll be doing the presentation. We have Ms. Tana Nash from the Waterloo Region Suicide Prevention Council. Thank you so much for joining us, Ms. Nash.

We will begin with my friend and colleague Mr. Albrecht.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Thank you very much, Madam Chair.

I need to say at the outset that this is my first time appearing at a committee on this side of the table, so I thank you for your warm welcome and your understanding.

A lot of misconceptions exist regarding suicide. A stigma surrounding suicide exists that prevents an honest conversation. There are a lot of questions to which we simply don't have answers. Studies say that 96% of Canadians believe that discussing suicide openly will reduce the number of suicides. We don't know how many Canadians are comfortable engaging in that conversation.

A stigma definitely exists. Since raising this issue in Parliament, many constituents, friends, and members of the media have asked me who it was I knew whose death by suicide had motivated me to table this legislation. I'd like to briefly share my journey with you.

In March 2008 a young woman from Brampton, named Nadia, was suffering from postpartum mood disorder and insomnia. A student here in Ottawa, she felt isolated, and sought help online. Instead of help, Nadia found a predator. Instead of comfort, she was encouraged to hang herself in front of a webcam. Instead of finding a friend who would encourage her to find help, she found a predator who entered into a suicide pact with her, a pact she completed four years ago this month.

It turned out that the young woman with whom Nadia thought she was communicating was, in reality, a middle-aged man—a middle-aged male nurse from Minnesota who posed under an online pseudonym, and was linked to numerous other suicides in several countries.

It seemed that the digital cross-border nature of the crime was impeding prosecution. When I met Nadia's family, I quickly understood their pain, how their pain was extended each day, and how they were denied closure.

At the time, I was a grandfather to eight beautiful grandchildren—now nine—growing up in a world where wired communication is the wild west. That led me to introduce Motion 388, which called on the government to address in the Criminal Code the barriers that law enforcement agencies faced in Nadia's case. That motion passed unanimously in the House of Commons in November of 2008.

Through discussions on Motion 388, I met many people working on the front lines, such as Tana Nash, who tried their best to educate me on these issues. I met many Canadians affected by suicide who shared their pain with me, and I started to pay attention in a different way. Obituaries for young Canadians that didn't list a cause of death stood out to me like never before. Then one day I looked at my BlackBerry to find an email from Tana with news that both brought a chill to my bones and turned my stomach. In the space of just one week, three students from Waterloo region schools had died by suicide in unrelated incidents.

If there were a single thing, one single accident, to which I would attribute my reason to introduce Bill C-300, it would be that conversation.

The need for Bill C-300 is obvious, and I thank Parliament for recognizing this by such a strong vote in favour of it. I shared many statistics during the debate on Bill C-300, but today I would like to take the opposite approach, and share the things we don't know.

It's estimated that on average 10 Canadians die by suicide each day. That number in and of itself is terrifying, but we don't know how accurate it is. We know that the stigma surrounding suicide causes under-reporting, but we don't know how severely.

We know that suicide is a public health issue, but we have developed no best practices to treat it as such. Teachers in a position to recognize suicidal behaviours are rarely trained to do so, and it's uncommon even for medical doctors and nurses to receive specific training in this area. We know that there exists, in our society, groups more vulnerable to the threat of suicide than the general population—veterans and aboriginal Canadians are notable—but we struggle to develop a suitable evidence-based response.

We know that suicide is most often preventable, as I stated in Bill C-300's preamble, by knowledge, care, and compassion, but we do a poor job of sharing the knowledge regarding suicide prevention, which we have accumulated with those whose care and compassion compel them to work to save lives.

Finally, we know that addressing this challenge will require collaboration across jurisdictional, geographical, and sectoral lines, and increased lines of communication between agencies. But we also know that, between 1993 and the most recent election, only one piece of legislation relating to suicide prevention was introduced, and that private member's bill never reached second reading.

That's not to say we haven't made progress.

I understand you will be hearing today from the Mental Health Commission of Canada. I've been briefed on some of the projects they have been working on, and I would say that the MHCC has built a solid foundation on which the goals of Bill C-300 can be achieved. I'm happy to respond to your questions, but I would remind you that I am not an expert on preventing suicide. I would ask you to refer the more technical questions to the expert witnesses who will be here today, and whom you will be calling in the future.

I'm not superstitious, but I notice patterns. The number of my bill is C-300. Three members of Parliament voted against it. This committee is devoting three days of study to it. I will close by noting that coincidence and thanking this committee for ensuring that Bill C-300 is ready for third reading. Somewhere along the way, I started referring to Bill C-300 as a message of hope. I thank you for sharing in that message.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Albrecht.

We'll now go to Dr. David Goldbloom.

[Dr. David Goldbloom, Vice-Chair, Board of Directors, Mental Health Commission of Canada]

Thank you and good morning. It's a great pleasure to be in front of this committee this morning.

My name is David Goldbloom. I am a psychiatrist. What a pleasure it is to be here today to discuss a topic that is of the utmost importance to me, both professionally and personally.

I'm here in my capacity as vice-chair of the Mental Health Commission of Canada, but I'm also here as a psychiatrist who has worked in the field of mental health for the last 30 years, dealing with individuals who are suicidal, and dealing with the aftermath of suicide for those families so profoundly and irrevocably affected by suicide. I'm also speaking to you as someone who's known suicide at a very personal level. Two physicians in my own family died by suicide. In my experience, everybody, in the course of their growing up, their personal lives, and their professional lives, knows someone who's been affected by this tragic outcome. I'm grateful for the opportunity that this hearing provides.

To provide you with a bit of background about the Mental Health Commission of Canada, I understand this is our first appearance in front of this committee as an organization. Just to remind you by way of brief history, the Mental Health Commission emerged from the Senate report on mental health and mental illness “Out of the Shadows at Last”, which came out in 2006, and among its 118 recommendations was the creation of a national mental health commission, enacted by the Government of Canada in 2007.

As a leading national mental health organization, the commission is working with a vast network of people, from mental health professionals like me to policy analysts, researchers, and scientists, but also and importantly, with people with lived experience with mental illness at every level in our organization, from the board to our front-line operations, as well as family members, because we believe that people with lived experience in their families are essential to driving change in mental health.

We have a 10-year mandate. We're now at the five-year point of the Mental Health Commission. It's an action-based organization, charged with collaborating with stakeholders and partners to transform the mental health landscape in Canada.

In our first five years of operation, the Mental Health Commission has focused its effort on several initiatives that were part of our initial mandate from the federal government.

The first is creating and implementing Canada's first-ever national mental health strategy. That mental health strategy is coming out in several months. I'm delighted that Mary Bartram, the director of our national mental health strategy, is seated to my left and has worked tirelessly in this regard.

The second is creating a knowledge exchange centre, whose mandate is to facilitate the development and mobilization of evidence-informed knowledge in the mental health community and in the community at large. Currently, we live in the world of web 2.0, where there's no filter for quality in terms of the information that people derive. This will be one-stop shopping on the web for all Canadians.

Third, our anti-stigma initiative, Opening Minds, is focusing on how to best fight the stigma associated with mental illness. Because until we achieve that kind of fundamental attitudinal and behavioural change in terms of discrimination, we're not going to be able to move the needle on advancing the experience of people with mental illness and their families.

More recently, our homelessness research demonstration project, At Home/Chez Soi, which you may know is the largest project in the world on intervening in the lives of people who are homeless and mentally ill, occurs in five Canadian cities: Vancouver, Winnipeg, Toronto, Montreal, and Moncton. That project concludes in 2013, having enrolled over 2,000 mentally ill Canadians, who found themselves homeless, in a really extraordinary intervention.

The commission, through its eight advisory committees, has also undertaken very specific projects in a variety of areas including: children and youth mental health; first nations, Inuit, and Métis mental health; workplace mental health; reforming our service system in mental health; looking at research in mental health; mental health and the law—given that our prisons now constitute the largest asylums in Canada housing people with mental illness; seniors' mental health; as well as issues that families and caregivers face when dealing with a loved one's mental health problems.

In all this work the commission is really fortunate, through its staff, its board, and advisory committee members, to have the input of Canada's leading experts in mental health and mental illness.

By drawing on the intellectual capital that represents, and by collaborating closely with the federal, provincial, and territorial governments, the commission is able to spark change in mental health from coast to coast to coast.

Now with respect to the bill that's being examined today by the committee, the commission clearly and obviously recognizes that suicide is a tragedy with a devastating impact on families and communities. Suicide and mental illness share many common risk factors. Over 90% of Canadians who die by suicide—and that's close to 4,000 Canadians a year—are experiencing mental health problems and illnesses. Worldwide, mental illness is the single most common determinant of suicide. That's why the Mental Health Commission is working now, through several initiatives, in partnership with the federal, provincial, and territorial governments, as well as leading individuals and organizations in the fields of mental health, public health, and health care in general, to catalyze reform and to improve systems in the area of suicide prevention.

We have active partnerships with the Canadian Institutes of Health Research, the Canadian Association for Suicide Prevention, and the Canadian Centre on Substance Abuse—substance abuse being one of the other big drivers of suicidal behaviour.

In addition, over 50,000 Canadians, coast to coast to coast, have been trained through our mental health first aid program. This program teaches people how to recognize the signs and symptoms of mental health problems and to guide a person to help. All mental health first aid courses include teaching on suicidal ideation. Mental health first aid is an evidence-based approach that we think is going to take off like a brush fire across the country.

So we welcome the focus and attention on suicide prevention, all the way from the local level in the Kitchener-Waterloo area right up to the national level, and we also believe there's an opportunity to address it as part of our national mental health strategy for all Canadians. This report that will be coming out within a couple of months is really unprecedented in scope and unprecedented in input. It's our first ever national mental health strategy, setting out a clear vision and priority for improving the mental health of all Canadians. We used the best available evidence and received the input of thousands of Canadians over the past four years, including many organizations working in suicide prevention. We've also drawn on the Canadian Association for Suicide Prevention's blueprint for a national suicide prevention strategy as well as other evidence-informed references in the field of suicide prevention.

We believe that this strategy, when implemented, will significantly advance suicide prevention in Canada, and we have very specific recommendations on raising awareness, education and training, promoting mental health in schools and workplaces, accessing help early when problems first emerge, improving access to treatments and supports, paying attention to the needs of high-risk groups, and strengthening our data collection.

The federal framework that's under consideration today will definitely advance the strategy's recommendations to mobilize leadership, to strengthen collaboration, and to strengthen the infrastructure that's required to improve mental health outcomes in Canada with a particular focus on suicide prevention. The commission is very encouraged by the dialogue happening here in our federal Parliament. We've had the opportunity to meet with some of you personally, and we look forward to working with you, and working indeed with all Canadians, as is our mandate, to catalyze change and to improve mental health outcomes all across this country.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Goldbloom.

Now we'll go to Ms. Tana Nash, please.

[Tana Nash, Coordinator, Waterloo Region Suicide Prevention Council]

Thank you. It's an honour to be here this morning.

I am here before you today as an advocate for suicide prevention and awareness, as the coordinator of the Waterloo Region Suicide Prevention Council but also as someone who has been bereaved by suicide.

During my first year of university, I lost my grandmother to suicide, and more recently I lost my only sister and sibling, Erin, to suicide.

Like so many advocates and grassroots organizations across Canada, I channeled that grief into something helpful, something hopeful and positive, so that others might not need to endure that same loss, that same needless and unnecessary loss.

In Waterloo Region there are many partners and volunteers breaking down stigma, raising awareness, providing education, and offering prevention and intervention solutions to reduce suicidal behaviours. And we are not alone.

Across Canada these efforts are fuelled by passion and a commitment to change, but are often disjointed, insufficient, and underfunded. So today is an important hour in Canada's history. As a government we are moving toward establishing a federal framework for suicide prevention, and by moving on this bill so quickly you are embracing Canada's need for quick action.

I am going to keep my remarks brief and make six key points, on why, in my judgment, Bill C-300 is so important for Canadians.

First, stating information about suicide prevention from a national, provincial, and a regional level is paramount. One new vision is using the workplace as a tool to do this, an area that has not been tapped into as strongly as we need to.

Bill Wilkerson and the Honourable Michael Wilson, released their final report for The Global Business and Economic Roundtable for Addiction and Mental Health this past December. The title is “Brain Health + Brain Skills = Brain Capital”. In it they talk extensively about the new workplace—the new neuroeconomic workplace—as a venue for suicide prevention.

The report says that the “NEW or NeuroEconomic Workplace is the workplace of the future. This NEW Workplace – as a venue for research, prevention and education – must be designed, managed and sustained to promote and protect the mental health of working populations as a straightforward duty of asset management”.

The report goes on to talk about how 85% of all new jobs now demand cerebral—not manual—skills, and what the report refers to as the advent of a brain-based economy wherein brain-based disorders are the leading source of disability.

I was asked to write for this report. I, too, call on Canada's business community to take a leadership role by offering prevention and intervention training in the workplace. Imagine mandating mental health first aid and gatekeeper suicide-prevention training such as ASIST or safeTALK, just as we have done with first aid and CPR, and providing employees with modules on what stress looks like, what depression looks like, what resiliency tools look like, and what the warning signs for suicide are. If we educate the workplace, we are also educating parents, just as we did with first aid and CPR.

I will add that both the Honourable Michael Wilson and Bill Wilkerson have expressed their support for Bill C-300 on behalf of the business community and asked me to bring that here today.

We can take this same model for disseminating information for suicide prevention in the workplace and apply it to other areas that affect thousands of Canadians, such as our national coaching certification. Our national coaches require first aid and CPR, but wouldn't it be great it they also were required to have mental health first aid and suicide-prevention training skills? And what about our future teachers and our education system? Currently they do not receive mental health or suicide-prevention training, although they are struggling with this every day.

The second point is promoting collaboration and knowledge exchange across regions. I can tell you from a grassroots organization that this is essential. We are all operating on shoestring and non-existent budgets, but we imagine a hub where all of us working across Canada can access tools, brochures, and ideas, and where we can simply add our own local crisis information, instead of reinventing the wheel.

For example, our region just completed a brochure entitled, “How Do I Write an Obituary When My loved One Died by Suicide?” I'm currently making presentations to all funeral homes in our region about the important role that funeral directors can play in breaking down stigma, as one of the first points of contact with family members; and what kinds of crisis or counselling services are available at the funeral service, because we know there will be other folks in the room who are skating on thin ice. I've also taken this presentation to the AGM of the Ontario Funeral Service Association, but we need to roll this out to all funeral homes across Canada.

My third point is on promoting the use of research and evidence-based practices. Implementing practical practices that work is essential to reducing the numbers of suicides. One example from the Waterloo region is the Skills for Safer Living group. This is a 20-week psychosocial, psycho-educational support group, but it's specifically for folks who have had suicide attempts and are still wrestling with wanting to die. This group was developed at St. Michael's Hospital with much evidence behind it that proves its success. It teaches things like emotional and coping skills, and how to gauge your own behaviour on a sliding scale, so that you know when you're escalating and how to reach out for help.

We are fortunate that this now runs in the Waterloo region, but when I talked to the Suicide Prevention Community Council of Hamilton last week, they hadn't heard about this great program. They are hungry to have such practical training in their region as well. It's another proven practice that can be rolled out across Canada.

My fourth point is on research as an essential part of Bill C-300. As the Wilson and Wilkerson report states, finding a cure for depression will stimulate the prevention of suicide on a large scale. It is estimated that as high as 90% of all those who take their own lives suffer depression at the time. Serving this purpose means saving the lives of kids.

The fifth point is on increasing public awareness. The stigma that still surrounds suicide prevails when it comes to advertising campaigns and awareness-raising. But as the Bell Let's Talk Day has proven, people want to talk about this issue. I can tell you that inevitably, time and time again, when I reach out to the community and start a dialogue, people want to talk about suicide. They simply need a leader to lead. They simply need the door to become open, because once it's open people want to talk.

I remember the first time I was at a local talk radio show and the producer was skeptical about having me on the program. She said she hoped I had lots of information to share, because nobody was going to call in. Well, 10 minutes into the 30-minute program, the phone lines were lit up. She popped her head in the door and asked if I could stay for an hour, because they couldn't believe the response. People want to have this dialogue.

Across Canada there have been all sorts of great public awareness events, such as the public service announcements that ran in Saskatchewan as a result of MP David Batters' death, and bus banners in Vancouver. Across Canada there are posters, information, and literature, but let's pull these all together so that we can roll out these models of success from coast to coast, so that all Canadians can have access to them. We can also look to other countries for their successes, such as the television commercials that were aired in Scotland aimed at middle-aged males, which is still the number-one mortality demographic for suicide—and that is true here in Canada.

Finally, let's be bold. It is not good enough to simply say we will do the above points, such as education and sharing of information. We need to actually take a stand as a concerned body and say the goal of the campaign is to cut the annual death toll in half, or to reduce suicides by 20% within the specific timeframe, as Scotland's Choose Life program has done. Consider this: if we aimed at reducing suicides in Canada by two-thirds over the next 10 years, we would save more than 30,000 lives and prevent some 200,000 self-inflicted injuries.

Without sufficient funding none of these initiatives will materialize. However, with a well-funded coordinating body, a national game plan to save the lives of fellow Canadians is more than possible, it is doable. Better yet, let's not just follow the initiatives of other countries, let's lead the world. It might have taken us longer than other countries to get to this point of implementing a federal framework for suicide prevention, but now that we're here, let's surge forward and be a leader. Canada has the resources, and Bill C-300 provides the vessel for this to be possible.

Thank you.

[The Chair, Conservative, Joy Smith]

I thank you very much. The committee and I give our condolences to you on the loss in your families. Thank you for all your work on this very important initiative.

We'll now go into our Q and A for seven minutes, and we'll begin with Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Chairperson.

First of all, thank you to the witnesses for coming here today.

Thank you, Mr. Albrecht, for coming to our committee and presenting your bill. I know you've done a lot of work on this. We appreciate you being here today. Obviously, the witnesses have a wealth of information, but your interest in the issue and your dedication is very much appreciated.

I have a couple of questions.

Because we have the Mental Health Commission here, welcome to the committee for your first appearance.

I'm interested to see how either you, Mr. Albrecht, or the commission see your bill in relation to the work that the commission's already doing. You've told us today that in a few months you are going to be rolling out your mental health strategy, which I assume will be a national strategy because you're a national organization. In fact, we've been hearing about it for quite a few months. I know there's significant interest in the work that you're doing. I'm curious to know what the differentiation is between the bill and what you're suggesting, Mr. Albrecht, and what work the commission is already undertaking. That's one question.

The second question is concerning a strategy as it relates to reform of health care delivery. We've had a lot of discussion at this committee about the need to reform health care delivery and the need to focus on integrated primary care, health promotion, and disease prevention. So in terms of developing a suicide prevention strategy, how do you see that being delivered? Is it important to have stand-alone services—and maybe Ms. Nash will be able to answer this? Or do you see it more important to integrate with other community-based health promotion services, so that it's a one-stop shop, and there's a comprehensiveness? Or do you think it's better to have more stand-alone services?

So it's those two questions.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Madam Chair, I'll begin just briefly.

[The Chair, Conservative, Joy Smith]

Mr. Albrecht.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

First of all, as it relates to the coordination with the Mental Health Commission, I've been in dialogue with them at various points along the journey. Certainly all of us around this table applaud the work they're doing. There's no sense of competition or of one getting ahead of the other. This is simply my effort as a parliamentarian to draw specific attention to the area of suicide prevention.

Dr. Goldbloom mentioned that 90% of suicides, generally speaking, are related to issues of mental health. But we all know that there is a small percentage of people who end their lives by suicide, where there does not appear to have been any history of mental health issues.

I'm very specific on the public health aspect as well. We need, as has been mentioned, front-line training for those who are on the front line. My initiative is simply to boost and share my passion for suicide prevention in the context of the overall Mental Health Commission's report. In my dialogue with them I'm very satisfied that they are in fact doing that. I met with them probably a month or two ago, and they went over some of their initiatives. It's quite encouraging to see their specific emphasis on suicide prevention.

As it relates to the access by groups to the information that may be available, my idea is not to have a top-down, mandated, “this is the way you have to do it” suicide prevention. My idea is to have a central repository of information, research, statistics, and best practices that communities such as Waterloo or Iqaluit, or you name the community in Canada, can contextualize the general principles that apply to their specific area. But obviously, they need to contextualize it in their own area and access the resources that are there.

But I defer to my experts.

[Dr. David Goldbloom]

Let me echo what Harold has said. I believe there is a huge degree of overlap. If you start to parse out the various elements of our soon to be released national strategy, you'll see the extent to which suicide prevention is effectively embedded in many of the initiatives.

If we look around the world at what the evidence tells us about suicide prevention. Whether it's the education of primary care physicians in the detection and treatment of depression as a common psychiatric forerunner to suicide; working with media around responsible reporting of suicide, which again is an evidence-based intervention; or training gatekeepers, who might be school teachers, co-workers, or family and friends, in the recognition of problems and encouragement of people with mental illness to seek help; these are all very much encompassed under the umbrella of the ongoing work of the Mental Health Commission.

I want to say something else about suicide prevention, which relates to thinking upstream. It ties in to your second comment. The ultimate reduction of suicide prevention—the narrowest thinking about suicide prevention—is the barrier on the bridge that prevents the person from jumping off that bridge. There actually is good evidence that putting up those barriers, whether they're on the bridges or in the subways, makes a difference. But it doesn't change one iota what brought that citizen to that point in his or her life when he or she goes to that bridge or subway.

We need to be thinking more broadly about upstream interventions. That's where talking about mental health promotion and prevention are really integral components to mental health reform, and they're integral components within the mental health strategy.

It's not simply making more services available. It's how you put into place those initiatives in mental health promotion at an early level, for children and youth. Take the issue of suicide, for instance, which is now the number two cause of death in Canada for people aged 15 to 24. If you're in that age group, the number one cause of death is a motor vehicle accident, and number two is suicide. That's an extraordinary and appalling statistic.

While it is true that men over the age of 55 are the highest risk group for suicide, they're also falling vulnerable to other illnesses that will end their lives. Young people aged 15 to 24 are generally a physically healthy group.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Goldbloom.

We'll now go to Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Madam Chair.

Thank you, witnesses, for coming here this morning.

Harold, I would like to congratulate you and thank you for your initiative.

With regard to how serious the issue of suicide is, I don't think there's anybody in this room who doesn't know someone who has committed suicide. I don't have any statistics on it, but even in my experience—I don't have anybody in my immediate family, but I had cousins who committed suicide. I had a school friend who fell victim to mental illness, and before he reached the age of 30 he committed suicide. The signs were there. He was watched by the family, and eventually he found a way to end his life.

We have a lot of people around the table who have a lot of knowledge and experience in the medical field. My professional background is in engineering, but I have a lifetime of experience. Harold mentioned that 90% of suicide cases are related to mental health. Well in my view, probably 100% of the cases are related to mental state, or the state of mind at the moment a person decides to take that action and end his or her life. Whether some cases are preventable or detectable is a question we can ask. In some cases there are no signs, and therefore preventing people from committing suicide in such cases is very difficult.

My first question is to Harold.

In your comments, Harold, you acknowledge the journey to introduce Bill C-300. I notice in the first point of the preamble that you take note of the spiritual aspect of suicide prevention. You didn't touch on this in your comments. I'm curious. Can you tell us more about what you meant?

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Well, thank you for noting that.

Those of you who were in Parliament the day I gave my first speech, in the first hour of debate, will recall that I acknowledged spiritual factors.

Obviously, there are biological, psychological, and physiological factors that experts here will know a lot more about than I, but one of my concerns is that we often, to our peril, ignore the spiritual aspect of our physical makeup, in terms of our attitudes towards ourselves and our self-worth.

Often it's the spiritual community that surrounds people in their hour of need. I can say, from my personal experience over this last year, having lost my wife, that the spiritual community was my first line of defence, if I can use that analogy. Actually, I had a personal conversation with Dr. Goldbloom a few months back, and he acknowledged the participation in a religious group as being one of what he refers to as the “upstream factors” in prevention.

I think it's important that we don't simply have that barrier. We use the analogy sometimes of people who have an ambulance stationed at the bottom of a cliff to take people to the hospital. Well, the next step is to put the barrier up above so that there is no need for ambulances at the bottom, but the best step is to go beyond that and hope that they won't get to that barrier.

For me, the spiritual aspect is important, and it is important that we acknowledge it. The leaders of many churches and religious groups, in our small towns especially, are equipped to have the compassion and the outreach mentality to help those who are struggling with self-worth.

All I'm asking is that we don't miss this key component. I'm not saying that it's the be-all and end-all. It's a key component of the prevention aspect, and of going as far upstream as we can and not simply putting a barrier up at the bridge.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much.

The second question I have is for Dr. Goldbloom, or maybe Tana.

What is your organization doing to reduce suicide or self-injury, and have you found a particular strategy or combination of strategies to be particularly effective?

Maybe you can also touch on what I mentioned about that group of people who show no signs of problems—silent sufferers, who don't show their emotions to anybody—who all of a sudden end by ending their life.

[Dr. David Goldbloom]

I think the suffering in silence that you're talking about is a very common experience, even in people in whom the signs of mental illness may be obvious to other people but where the stigma prevents open discussion about this common human experience, which affects six million Canadians every year. Every year six million Canadians experience some form of mental illness. It's in our workplaces, in our schools, in our homes, in our communities, in our faith organizations—wherever you want to look.

Again, some of the upstream efforts are to change the culture and climate, to change the dialogue around mental illness, to better train people in the community—non-professionals—to recognize of the signs of mental illness, and to encourage people to get help. Will there always be a group who are caught unawares by people who will end their lives by suicide whom nobody picked up on, nobody recognized? Yes, there will be, in the same way that there will be people who have heart attacks with no outward symptoms of cardiac disease before they die of a heart attack. This doesn't change the fact that there is a much larger group of people with whom we can intervene earlier.

The mental health strategies initiatives, if they're implemented by the governments that have the power and the authority to do so—because the Mental Health Commission does not run mental health services in any jurisdiction, but works collaboratively with the people who control the resources to do so—there is the potential to improve the detection, the recognition, the intervention, and the acknowledgement.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Goldbloom, for those insightful comments.

We'll now go to Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you, Madam Chair.

I want to thank everyone for coming today to share your information with us.

I wanted to also thank Harold very much for bringing forward this bill. As you well know, we have supported it from the beginning.

This was first flagged in the House of Commons by the Liberal Party when Mr. Rae mentioned that he himself had faced a certain amount of depression at a certain point in his life. The stigma, as we well know, is a big part of suicide prevention. I was shocked this very weekend to have a very dear friend of mine tell me that she had been battling with depression for quite a long time and that she was so ashamed to tell anyone about it. To meet her, you would think she was the life of the party; she was always full of fun. But it was interesting that she finally admitted it, and I think she did so because she was probably reaching a particular point in her life at which it was becoming too much for her to cope with alone.

I think that everything that you have said is very important, but I want to touch on a couple of parts that weren't discussed here today and that I'm sure are going to be discussed as we move on, later on. One of them, of course, is the high rate of aboriginal and Inuit suicide in this country. We know that we can compare ourselves to countries such as New Zealand and Australia in terms of looking at this issue. I wonder whether Dr. Goldbloom or anyone else, maybe Mary, can talk a little about what we can do to deal with that particular...because it's not as simple or as generic as if we were looking at other solutions for preventing suicides. I would like to hear somebody talk a little bit about the effective things one can do. There is a federal government program—we know that—and the question is whether it is working. If it isn't working, why is it not working? What are the specific initiatives we need to undertake to deal with this?

The other issue I want to talk a lot about, which no one speaks to, or which is only now beginning to come to the surface, is post-traumatic stress disorder, especially amongst our veterans. This is an issue I would really like us to touch on to consider how we can prevent it from happening. In many ways, if you want to prevent post-traumatic stress disorder in our veterans, the point is not to send them to a theatre of war, which is where they meet all those things. We know that isn't really a very practical solution.

What are the things that we can do, in those two groups, to address this particular issue and the specific problems that they face?

[The Chair, Conservative, Joy Smith]

Who would like to take that question?

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Could I just make a quick comment on it?

This is simply to point out that I intentionally did not include specific, identifiable groups within the bill, because the minute you do that, there's a potential that you've left out another group. If I identified the veterans, if I identified our police who are on the front lines, if I identified men over 55, inevitably there would be some group omitted.

In fact, my previous profession of dentistry has the dubious distinction of having the highest suicide rate among Canadians. We specifically didn't include that.

My idea is that as a framework is developed, as people such as the Mental Health Commission work on it, they will drill down deeper and get at the specifics.

But thank you for raising this. I did acknowledge it in my opening comments.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Yes, I actually am not commenting on whether you put it in or not, but am asking about those two specific—

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Right. I just wanted to point out that some have asked why it isn't there.

I defer.

[Dr. David Goldbloom]

Thank you.

As I mentioned earlier, one of the eight advisory committees to the Mental Health Commission is its first nation and Métis advisory committee. This issue has been very much front and centre both at the advisory committee level and also on our board, in which Manitok Thompson from Nunavut and Madeleine Dion Stout from Vancouver provide very significant first nations and Inuit voices at the commission.

I mentioned earlier mental health first aid. We are in the process of completing an adaptation of this that is specific to indigenous populations because of the elevated risk for suicide, recognizing that there are many social determinants of health and illness that play out in particular for our first nations, Inuit, and Métis people.

With regard to the military, we have had tremendous input from Lieutenant-Colonel Stéphane Grenier in the area of post-traumatic stress disorder and peer support, which has been a very powerful force within the Canadian armed forces. We have been developing, for the civilian population, a peer support initiative to help people that draws very heavily on the military experience, much as they have in the United States. The United States Air Force suicide prevention program is one of the finest in the world and draws heavily on the peer support element.

If I may, I'd like to ask Mary Bartram to comment specifically on the mental strategy with respect to these two issues.

[Mary Bartram, Director, Mental Health Strategy, Mental Health Commission of Canada]

Specifically on first nations, Inuit, and Métis suicide prevention, the mental health strategy will include a significant focus on the mental health issues of that population. The focus is on contextualizing that in the context of residential schools and the impact of colonization. The Truth and Reconciliation Commission, which is under way right now, is an important point of reference for this committee as well.

There's improving access to a full continuum of services for mental health problems that integrates the best of mainstream and traditional and customary knowledge from first nations, Inuit, and Métis traditions. Also, there's the importance of governance issues. There's been research undertaken around the importance of communities having governance over their own services and so on. The most clear findings from the research community around the importance of supporting communities to have governance over their own services and institutions is another critical part that will be brought forward in the mental health strategy.

We'll certainly be making those recommendations for uptake, and recognizing the ways in which a national mental health strategy in this country has to include a strong focus both on the contributions and the needs of that population group.