Health Committee on May 12th, 2015

[The Chair, Conservative, Ben Lobb]

Good afternoon ladies and gentlemen. It's 3:30. We're going to begin our committee meeting.

We have two panels this afternoon. We have three guests in our first panel. We're going to go right to our first guest, Dr. Anthony Phillips, who is appearing by video conference.

Go ahead, sir. You can begin your presentation.

[Dr. Anthony G. Phillips, Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research]

I'd like very much to thank the committee for this invitation, which will allow me to discuss the issue of mental health and to speak to you about how the Government of Canada is supporting research to address the needs of individuals suffering from mental illness and substance misuse.

As this committee knows well, the Canadian Institutes of Health Research, or CIHR as it's often known, is the Government of Canada's agency responsible for providing health research support to ensure excellence in settings that are in universities, hospitals, and research centres across Canada.

To achieve its mandate, CIHR supports research in part through a unique interdisciplinary structure made up of 13 virtual institutes. The mission of CIHR's Institute of Neurosciences, Mental Health and Addiction, of which I'm currently the scientific director, is to foster excellence in innovation and ethically responsible research aiming to increase our knowledge of the functioning and disorders of the brain and the mind, as well as the spinal cord, the sensory motor systems of the body, and of mental health and mental illness and all forms of addiction that can arise from disorders of the brain.

Between the fiscal years 2006-07 and 2013-14, CIHR invested more than $475 million in mental health research and related behavioural conditions. This included a number of investments in major initiatives that are addressing the needs of populations most at risk of suffering from these conditions. One good example is CIHR's key initiative, which we refer to as the strategy for patient-oriented research, also known as SPOR. The primary objective of this initiative is to foster evidence-informed health care by bringing innovative diagnostic and therapeutic approaches to the point of care, as well as, of course, generating new knowledge that can improve the health of Canadians.

Through SPOR, CIHR is working with many partners to establish research networks to generate the research evidence and innovations that are needed to improve patient health and the functioning of health care systems. The very first SPOR network supported by CIHR is in the area of youth and adolescent mental health. This network aims to improve the care provided to young Canadians with mental illness issues by translating promising research findings into practice and policy. This initiative represents an investment of $25 million over five years, and importantly, it's a partnership between CIHR and the Graham Boeckh Foundation of Montreal, each of which has contributed $12.5 million.

CIHR is also working with partners to improve suicide prevention activities among aboriginal communities. For example, last March, CIHR in partnership with the Government of Nunavut, the Inuit Circumpolar Council, and other federal and international partners hosted a circumpolar mental wellness symposium on suicide prevention in the Arctic. This was held under the auspices of the Arctic Council. This unique gathering brought together researchers, community members, practitioners, policy-makers, and most importantly, youth from across the Arctic regions to identify and share best practices in order to promote mental wellness and to prevent suicide.

ln June 2012, CIHR also launched the pathways to health equity for aboriginal peoples signature initiative. This pathways initiative aims to support the development, implementation, and scale-up of interventions and programs focusing on improving aboriginal people's health and wellness in four key areas, one of which is suicide prevention.

For an example of an initiative in this area, we can point to Dr. Susan Chatwood at the Institute for Circumpolar Health Research in Yellowknife. She is studying existing mental health programs in the Arctic to determine what different regions can learn from one another to address this critically important issue.

CIHR also supports a number of initiatives aimed at addressing issues of substance misuse. Indeed on May 1, 2015, in Edmonton I had the pleasure to announce with the Minister of Health the creation of the Canadian research initiative in substance misuse. This will be a national network aimed at improving the health of Canadians living with issues related to substance misuse.

This initiative, which represents an initial federal investment of $7.2 million over five years, is unique in the sense that it focuses on the transfer and implementation of new evidence-based approaches to reduce the risk of substance misuse and its effects on health, including the development of addiction, overdose, and sadly, death. Researchers supported through this initiative will work closely with service providers and representatives of people living with substance misuse issues to better ensure the health outcomes for the people facing these problems.

ln conclusion, Mr. Chair, let me assure you that CIHR is committed to continue working with public and private partners in support of research in these important areas related to mental health and addiction. The overall aim, of course, is to improve the research and to translate this new knowledge into improved services, especially treatment, for those suffering from mental ill health issues.

Again, I commend you and your colleagues for taking up this study, and I wish to thank you for providing me with the opportunity to speak on this important issue. Of course, I will be pleased to answer any of your questions.

Thank you very much.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

We have two more panellists before we get to the questions. If you could stay tuned until 4:30, that would be great.

Next up is Sony Perron.

Go ahead, sir.

[Sony Perron, Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health]

Thank you, Mr. Chair, for the opportunity to provide an overview of the programs and services supported by Health Canada in the area of mental health and wellness for first nations and the Inuit.

Health Canada recognizes that addressing mental health and addictions issues are important health priorities for First Nations and Inuit. Consequently, the department is investing more than $300 million this year on a suite of mental wellness programs and services.

Programming includes mental health promotion, addictions and suicide prevention, other crisis response services, treatment and after-care services, and supports to eligible former students of Indian residential schools and their families.

Health Canada is working with partners so that efforts to support individuals, families and communities around mental health care are coordinated and include family support, employment and training, education and social services.

Building on best practices, we know that efforts to support individuals, families and communities should be culturally safe and community-driven. We can find lasting solutions only if we work together with our partners, including First Nations and Inuit organizations and, most importantly, the communities themselves.

Mental health promotion and suicide prevention research emphasizes the need for comprehensive and multi-layered interventions across a continuum of wellness. Interventions at each of the individual, family, and community, and federal, provincial, and territorial levels have been found to be most effective.

We have worked with the Assembly of First Nations and mental wellness leaders to develop the first nations mental wellness continuum framework. Through this process, communities were engaged and brought their ideas to the table.

From these discussions, culture emerged as a foundational component. Community innovation, partnerships across government, collaboration and coordination across sectors, and linkages between programs and services were also identified as being crucial for moving forward.

This framework has been ratified by the Assembly of First Nations' chiefs of assembly and was released by the AFN in January 2015. We are now working with the Inuit Tapiriit Kanatami to develop a mental wellness continuum for the Inuit.

Health Canada is a partner in implementing the first nations mental wellness continuum framework, which calls for integrated models of service delivery that focus on community strengths and indigenous knowledge.

Moving forward, we will look at ways to strengthen the federal mental wellness programming with our partners to meet community-specific needs, such as moving away from siloed program approaches toward more coordinated and effective approaches, and through closer integration between federal, provincial, and territorial programs.

We are also supporting mental wellness teams, which provide specialized treatment to a group of First Nations communities facing mental health issues. These teams seek to increase access to a range of mental wellness services including outreach, assessment, treatment, counselling, case management, referral and aftercare.

Through the National Aboriginal Youth Suicide Prevention Strategy we support screening for depression in schools; education and training for front-line workers to reduce stigma and increase community awareness; referral and intervention training; crisis services; follow-up and support for at-risk youth; and cultural and traditional activities to promote protective factors and to reduce risk factors.

Since 2008, we have supported a range of services to former students of Indian residential school and their families so they may safely address emotional health and wellness issues related to the disclosure of childhood abuse. For example, in 2013-14 alone, Health Canada supported approximately 630,000 emotional and cultural support services to former students and their families, and 47,000 professional mental health counselling sessions.

On February 20, 2015, Minister Ambrose announced an investment to prevent, detect, and combat family violence and child abuse. Health Canada's investment will support enhanced access to mental health counselling for first nations victims of violence who are in contact with shelters, and will support the improvement of services to first nations and Inuit victims of violence so that services are better coordinated, more trauma informed, and culturally appropriate.

Thank you for your attention. I am pleased to take your questions afterward.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

From the Public Health Agency of Canada, we have Kimberly Elmslie. Go ahead.

[Kimberly Elmslie, Assistant Deputy Minister, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Thank you very much, Mr. Chair.

Thank you for the opportunity to highlight the Public Health Agency of Canada's work to improve the mental well-being of Canadians. We are working closely with our partners to contribute to the implementation of the Mental Health Strategy for Canada.

An important public health role is the monitoring of mental illness and mental health among Canadians. The agency's system for surveillance of mental illness tracks a number of mental illnesses, such as mood disorders and anxiety disorders. This system includes complementary data, such as self-inflicted injuries, for example, suicidal behaviour, and child maltreatment.

These data tell us that, as you know, mental illness affects many Canadians. In fact, our most recent data indicate that at least one in three Canadians will experience mental illness during their lifetime and one in seven use health services for mental illness annually. Furthermore, approximately 4,000 Canadians die by suicide each year, and there are many more suicide attempts.

In order to prevent duplication and to leverage work that is under way across the country, the agency participates in the mental health and addictions data collaborative with our colleagues at the Mental Health Commission of Canada and other national mental health data partners.

In budget 2013 there was a reallocation of $2 million of agency funding over a three-year period for the purpose of improving our data collection and ensuring that we were reporting as comprehensively as possible on mental illness and mental health. As part of these improvements, the agency is working with the Mental Health Commission of Canada to improve specifically the data we have and can provide to Canadians on positive mental health and well-being.

We now have a set of indicators of positive mental health for Canadians that forms the foundation for monitoring changes in mental health over time and the factors that influence these changes at the individual, family, community, and societal levels. These include measuring and monitoring personal coping skills among Canadians, positive family relationships, and supportive community environments. We know that 65% of Canadians have very good or excellent self-rated mental health and 82% are satisfied with life. Canadians also have strong ties to the community: 87% of adults believe that their neighbourhood is a place where people help each other. By gathering and analyzing these data, we will be able to share more information about the factors that help us take care of our mental health and help prevent mental illness.

Another important priority for the agency is suicide prevention. The enactment of An Act respecting a Federal Framework for Suicide Prevention in December 2012 served an important role in raising the visibility of this issue in Canada and underscored that suicide is a public health issue. The federal framework for suicide prevention will focus on improving information, collaboration, and resources for Canadians and on equipping those working to prevent suicide with the latest information on best practices.

Our discussions with our partners and stakeholders highlighted that fragmentation of information is one of the most important barriers to their work. Effective suicide prevention requires involvement from all sectors, including governments, non-governmental organizations, communities, academia, and the private sector. The framework will provide the basis for partnership on concrete activities, and we look forward to working with the Mental Health Commission of Canada in achieving the framework's objectives.

Public health also focuses on improving the mental well-being of Canadians before mental health problems or challenges begin to emerge. Another key role for the agency is leading national activities that promote positive mental health, such as the agency's programs that build resilience in individuals and communities. We invest approximately $112 million a year in community-based programs that serve families living in conditions of risk, including poverty, social isolation, substance abuse, and family violence.

These programs address factors that affect mental health, including parenting skills, early childhood development, healthy pregnancies, and mental health issues such as post-partum depression. When we create supportive environments, there is a positive impact on mental health.

Supporting innovation in mental health promotion is a priority for us. Large-scale projects are under way across Canada to promote mental health, reaching children, youth, and families across the country. These projects, still under way, have already shown us positive changes in child and youth resilience, self-esteem and self-image, as well as in coping and social skills. For example, some of our school-based interventions have reduced aggressive behaviour, relationship violence, and alcohol abuse. They've improved school environments, and have been implemented in teaching curricula.

Our work builds on our international commitments, including Canada's support of the World Health Organization's resolution in support of a comprehensive mental health action plan for 2013 to 2020. Reducing mental health risks, such as exposure to domestic violence and child abuse, is a priority. As my colleague just indicated, Minister Ambrose recently announced an investment of $100 million over 10 years specifically to address the health needs of victims of family violence. This investment includes support for community-based projects to help victims rebuild both their physical and mental health following experiences of family violence.

Our public health work in mental health and suicide prevention involves a wide range of partners who are leading initiatives to better serve mental health needs of Canadians. We are partners with the Mental Health Commission of Canada and our work aligns with the Mental Health Strategy for Canada.

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

We've had our presentations. Now we'll go into our question round.

First up is Mr. Rankin. Go ahead, sir.

[Murray Rankin, NDP, Victoria, BC]

Thank you to all of the witnesses, both remote and here. We appreciate it. This is the first day of our study of the mental health issue in Canada, and I'm very grateful to you for leading it off.

Dr. Phillips in Vancouver, you spoke about SPOR, the strategy for patient-oriented research. You talked as well about the Arctic symposium dealing with issues of youth suicide in the north, and then the pathways initiative about aboriginal people. One of the issues you mentioned is suicide prevention. We've heard that there are 4,000 suicides a year in Canada, of which I suspect a large number are aboriginal peoples.

What best practices have you been able to identify from either of those initiatives that might help us better understand the suicide issue among aboriginal youth?

[Dr. Anthony G. Phillips]

Thank you for the question.

The meeting that was held in the circumpolar region I think revealed a very real and important truth, that there is no one size fits all to address this important question. It's very important that approaches be based and anchored in the traditions of the society, the elements of the society, in which the problem resides. It's very important that the communities become engaged in recognizing the issues at hand, recognizing some of the issues that may predispose someone to attempt to take their life. Very much the initial message is that the social and environmental determinants of these disorders need to be given very strong prominence.

Having said that, at the other end of the spectrum, when we're delving into basic biological issues that might explain tendencies to commit suicide, some of the best work in the world is being done in Canada at McGill University by Gustavo Turecki and his colleagues. They have evidence now clearly indicating that early childhood adversity can affect epigenetic factors. I won't give you a lecture on epigenetics, but the key here is that we now are gaining a better understanding of how environment can influence the way in which our genetic code is read out. It doesn't change the code, but it changes the way in which genetic information can influence the structure of the brain, and hence our thoughts and actions. This is really, really promising, because epigenetics also could lead to biomarkers of a tendency towards suicidal behaviour, and perhaps to, in the long run, interventions.

Finally, the other point I would make is it's very clear that there's a close relationship between depression and suicide in all elements of Canadian society. Recognition of the need to treat early and effectively the first incidences of depression I think will also be an important step.

I hope that answers, in part, your question.

[Murray Rankin, NDP, Victoria, BC]

It does. It's very helpful.

I have a short amount of time, Mr. Perron, and I'd like to ask you a question.

In your remarks you talked about the fact that the legacy of Indian residential schools, to no one's surprise, is a great contributor to this issue of mental unwellness. You said that in 2013-14 alone, Health Canada supported approximately 630,000 emotional and cultural support services to former students. What is the nature of the support that you're alluding to in your remarks?

[Sony Perron]

As part of the Indian residential school resolution process, part of the commitment from the federal government was to support emotional support during the resolution process. This goes in different ways. We are funding professionals, like social workers, psychologists, and psychiatrists to support and do one-on-one or family consultation services. We also have provided funding to local and regional organizations to organize culturally appropriate support.

This will involve local health workers and traditional healers supporting the community to try to help people go through this difficult process.

[Murray Rankin, NDP, Victoria, BC]

Substance abuse was one of the areas referred to by Dr. Phillips. I think you would agree, and I'm sure Ms. Elmslie would agree as well, that's a contributing factor, or a cause and effect; who knows which. I'm sure there are people who can argue that for a long time.

I live in Victoria, British Columbia. Across the way we have in Vancouver the Downtown Eastside harm reduction process, the needle exchange program that has saved so many lives. We are unable seemingly to get one in our community. Has there been a study that Dr. Phillips and the CIHR may have done on the issue of the benefits, if any, of harm reduction processes like the Insite centre? Have you looked at it? Has the Public Health Agency examined the impact of these on the substance abuse crisis in cities like mine?

[Sony Perron]

Maybe I will begin by adding two things. First, there is a recognition that we are dealing with a problem that is multi-faceted and involved in terms of substance abuse. Years ago in the first nations and Inuit health branch, we were talking about alcohol abuse and our programs were all geared towards that. Over the last 10 years we have reformed a lot of our programs to take a multi-substance and multi-addiction approach, because the reality has changed. People are facing often multiple abuses.

[Murray Rankin, NDP, Victoria, BC]

Have you examined the reality of safe injection sites? That's the question.

[Sony Perron]

No, we haven't done that. The reality is our operation is mostly on the reserve. We do not have a program in the cities.

[Murray Rankin, NDP, Victoria, BC]

Has the Public Health Agency looked at this? Has the Public Health Agency done a cost-benefit, a best practices, or some analysis of these?

[Kimberly Elmslie]

No, we have not. That would be a research question that we would look to our colleagues in the research community to address.

[Murray Rankin, NDP, Victoria, BC]

Dr. Phillips, you live in Vancouver, I presume. Could you talk about any research you might have done?

[Dr. Anthony G. Phillips]

There are published papers, some of which have been supported by CIHR, that point to a clear health benefit from reduced overdoses. That's a different issue than you're alluding to, which is harm reduction. There is evidence and I could send you the appropriate papers, if you wish.

[Murray Rankin, NDP, Victoria, BC]

I would appreciate that.

Thank you, Mr. Chair. Am I out of time?

[The Chair, Conservative, Ben Lobb]

Yes, you are.

Ms. McLeod, pour cinq minutes.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I have a number of questions for all of our panel members. Thank you, first of all, for some great presentations.

Mr. Perron, I'm going to start with you.

Back in the 1980s I was a fairly new graduate nurse and took one of my earlier jobs in a first nations remote community. In the first week I was there, and I remember this so clearly, there were three suicides. It was one of those sort of clusters. It was very difficult and very traumatic for the community.

Do we have statistics? We're hearing about a lot of programs and a lot of attempts to support mental health and suicide prevention. Are we making a difference yet?

[Sony Perron]

I think we are. We have in terms of surveillance of that specific problem of suicide. It's something that is a challenge and it's a challenge throughout Canada in general. It's even more of a challenge in first nations or aboriginal communities because the mechanisms to report and track, and say that a suicide was in a first nations community, or in an aboriginal community, or that it's an Inuit person, are weak. We need to invest and do better there.

In some regions of the country, we have better data than others to track this reality. What we can do is measure the success of some of the initiatives on the ground. For example, we have youth suicide prevention programs, and the initiatives that have been run in various regions of the country that have changed the dynamic in some communities and curbed some of the problems. You were mentioning the number of suicides. We see these phenomena happening. Now there is a better resilience to respond to this reality. We have some mental crisis intervention teams that can help them cope.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

You wouldn't say that in the 1980s you had an incident right here and it's now here. You don't have that information.

[Sony Perron]

Unfortunately, the data are not strong enough to do that.