Health Committee on May 12th, 2015

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

This leads me to the Public Health Agency of Canada.

You talked about doing some significant work in terms of data collection. It sounds like we might be heading in a good direction. What are your challenges still around appropriate data collection?

[Kimberly Elmslie]

As with most national data collection, we are always challenged by identifying comparable data across the country. For that reason, we work with our colleagues in the provinces and territories on developing specific indicators so that we can all collect the data in the same way and report on them in the same way.

We have, and have had for some time, good data on the occurrences of specific mental illnesses. We have started to supplement those data where we can, and Statistics Canada, of course, is a great help to us through the national surveys it does. When we want to know more about the factors that are affecting resilience or some of the more complex measures of positive mental health, that's where the work that we have started to do with the Mental Health Commission of Canada and with our other partners is really important to us. At the end of the day, what our experts tell us is that the ability of children, as they develop through early childhood, to develop those coping skills and the ability of parents to develop parenting skills are the precursors to the resilience to deal with life's adversities down the road and to develop positive mental health.

That is why we are focused now on work that will establish what indicators Canada needs to measure over the long term to be able to say that we are going in the right direction in developing our population so that we have positive mental health.

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

Something like the suicide rate.... Would you say that's not showing up on death certificates? Do we have a good sense of the suicide rate? I would think we should.

[Kimberly Elmslie]

Yes, we do, if the suicide is reported on the death certificate. That's the question that we look at when we are looking at the quality of our data. Are we getting good reporting that the cause of death was suicide? That's not always the case, and it's not always consistent.

The other thing we worry about is understanding attempted suicide and getting better data on those types of variables as well.

As you can imagine, in this field of mental health and understanding Canadians' mental health and the factors that influence it, there are many complications that affect the complexity of the data that we are working on now. I think that we'll see a lot of progress in this area over the next year. The Mental Health Commission has already released a framework of indicators, and from a public health perspective we are developing ours as well. These two pieces of work will come together. Our objective is that very soon we'll be able to report on the mental health of Canadians in a comprehensive way.

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

You said one in three. I've always heard the number one in five.

[Kimberly Elmslie]

Yes. Our most recent data indicate one in three. Those data come from the Statistics Canada Canadian community health survey. As this information gets out into the public domain more and more and is reinforced, you'll start to see that number change from one in five to one in three.

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

Mr. Phillips, the patient-specific research that is now happening, or SPOR, is a big shift. Are you doing things now that haven't been done in the past to really try to analyze this issue and move the bar on it? Is that a fair comment?

[Dr. Anthony G. Phillips]

SPOR, the strategy for patient-oriented research, is emphasizing the need for more translational research.

We invest about half a billion dollars a year in generating a better understanding of all the determinants of health, but obviously people are looking for the translation of that knowledge, where appropriate, into better diagnosis and better treatment. That's the overarching theme about SPOR. The way in which it is being transacted is through a partnership with many different groups in Canada, especially the provinces, which of course have responsibility for delivering the health care services to Canadians.

We have just finalized eight support units in different geographic regions of Canada that will provide an infrastructure for ensuring, for example, a better clinical trial structure or a better analysis of the effectiveness or ineffectiveness of interventions. The difference that you might be looking for here is a strong commitment by CIHR to more translational research. That's what SPOR represents.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Ms. Fry, go ahead.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I'm really glad to see that CIHR is doing work on SPOR. Transnational research is the kind of stuff that Canada can do very well, mainly because we have all that data based in the public administration banks in each province. I think that's really important.

Is one of the partners you're working with the Mental Health Commission of Canada?

[Dr. Anthony G. Phillips]

Sorry, is the question for me?

[Hedy Fry, Liberal, Vancouver Centre, BC]

Yes. Is one of the partners the Mental Health Commission of Canada?

[Dr. Anthony G. Phillips]

The Mental Health Commission of Canada, of course, is not in the research area, but obviously it's doing an extremely important job for Canada in terms of developing a national policy for dealing with mental health issues.

Shortly after its inception, I invited the executive of the Mental Health Commission of Canada to come to the advisory board meeting for our institute and that was really productive. At that very early stage, which was probably now about five years ago, I suggested and they certainly were open to this, that we should choose an area where we could work together collaboratively. That area was suicide research.

We then engaged the Institute of Gender and Health to partner with us, and there was an assessment of the extent of the problem. Fast forward, both with the Public Health Agency of Canada and also the Mental Health Commission of Canada and ourselves, we're hosting what I think will be quite an innovative workshop in Montreal in only a month's time, in which we're going to try to canvass the community. Very many different stakeholders are coming together to try to develop a strategy for research on suicide. That's a partnership with the Mental Health Commission and PHAC as well.

[Hedy Fry, Liberal, Vancouver Centre, BC]

That's good, because I think one of the problems we face in a country as large as this, and with our provincial and other jurisdictions, is that we have gaps in our research and we tend to overlap in research. I think the Mental Health Commission may not be doing “traditional” research, but a lot of the programs they've put in, like At Home/Chez Soi, etc., can tell us how it impacts communities. I'm glad to hear you're working with them.

I want to ask the Public Health Agency of Canada a question. It's not an in-your-face question. It's simply that you've been collecting all this data. You and Health Canada have been looking at a whole lot of things.

At the same time, UNICEF just posted its report. You talked about coping skills and you talked about the fact that young people have a tendency to be the happiest. Actually, that's not true. The UNICEF report said that Canada ranked 24 out of 29 of the rich countries of the world in terms of happiness in their children. Canada's children are among the unhappiest in the world, and they say they cannot talk to their parents. That ranks them at 25 out of 28 in the world.

I think this is an issue. You have to have some relationship with your family, as you talked about, and we've dropped seven places in terms of that happiness index for children and children's relationships with their parents. We also have 35% of children in Canada, ranking us 21 out of 29 in the world, who are complaining about being bullied not only at school, but everywhere in the community.

I know that Rome is never changed in a day, but the bottom line is that this has been going on now for quite a while. What do you see as the barriers to being able to get what you're doing, and the data you're collecting, and the groups you're working with, to translate into actually positive outcomes for Canadian children? Your data, you said, is very difficult to come by, but are you actually working very closely? This is a place where provinces, schools, etc., should come together and start looking at this. What are your challenges to getting this done? Why are we dropping so much in terms of children's happiness and children's relationship data, and what do you think should be done about it?

[Kimberly Elmslie]

That's a great question. One of the most important things we're learning as we do our surveillance and we bring the results of our analysis to those who are developing programs and making a difference in communities is that we need to be better integrated. We need to join up the efforts that we're making in surveillance with the efforts that communities are putting forward to address their own unique needs, because there is no one size fits all as you well know. That's where our focus is right now.

I talked to you about our investments in innovation in mental health promotion. We've decided to put a focus on school-based interventions. There are a lot of areas, as you can imagine, that you could focus on in terms of positive mental health, but we've decided that with our innovation money, we're going to focus on the school setting. Why? Because that's where many factors get integrated. That's where kids come into the school and they're either bullied by their classmates, or they may come from home environments that are not conducive to their positive mental well-being and it can be the school system that becomes the most supportive environment for them.

I think we've turned a page on the way we work together in mental health and the prevention of mental illness. We've turned that page because in Canada we have the Mental Health Commission which is really leading the way in helping us understand what needs to be integrated and why. As you know, data can be used in a variety of different ways. I am trained as an epidemiologist. When I look at comparisons among countries, I always say to myself, the context within which these data are collected and the way they are reported are essential to us having an accurate interpretation of what they mean. While we get good signals—

[Hedy Fry, Liberal, Vancouver Centre, BC]

Sorry, I was just going to say that I recognize that epidemiology is different and it involves comparing, but that's all we do. We compare and contrast all the time in Canada. We say, “Look, we're number one in the world.” So they're using the same thing that they can't criticize now.

The point is there were three questions that were subjectively asked of the children themselves. They were asked, “Are you happy?” and Canada ranked 24 out of 29.

I'm glad to hear that you're focused on school-based intervention, because I agree with you that this is really the most important place we can focus on.

You said that better integration of efforts is needed. I would really like to know what the barriers are to that integration of effort. Certainly as a federation, the provinces, territories, and the federal government should be able to work really closely in integrating that kind of information and not allowing this old thing of falling through the cracks to occur. What is the biggest barrier you see to this integration of effort?

[Kimberly Elmslie]

I think often the barrier is not having a clear agenda on how we want to move forward together. We now have a mental health strategy for Canada, and that's a really important foundation to get us all rowing in the same direction.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I'm hoping that the Mental Health Commission will not just be renewed for 10 years; it's doing such excellent work, I'm hoping it's going to get some of the money it was asking for as well.

[The Chair, Conservative, Ben Lobb]

Thank you very much. There was an extra minute just for you, Ms. Fry.

Mr. Lizon.

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

Thank you to all the witnesses for appearing before the committee and providing us with your valuable input.

The first question I have is for Mr. Phillips. You mentioned substance abuse or misuse several times. Are we making any progress in research to effectively address the issue?

[Dr. Anthony G. Phillips]

Yes, I think we are, and it comes in several different forms. Obviously, people would like to see a decrease in the misuse of these substances, and that's not happening right away. One thing I can say with certainty is that we have a much clearer understanding now of how the adventurous use of drugs can transform itself into a dependency and a very serious habit. We know the neurobiology of these processes now, which we didn't know, I'd say, 10 years ago. Once you know the underlying biological basis of an important transition such as the development of a habit or a dependency on drugs, then perhaps you can use other interventions to uncouple or change that habit structure. There's a lot of work going on in that area.

I'll just add that my counterparts in the United States have the National Institute on Drug Abuse in the NIH, and I work very closely with the director of that institute.

I made reference to something called CRISM, the Canadian research initiative in substance misuse. This is designed to be a partnership with the Americans, so that whether we make a discovery in Canada that shows promise in treatment of addiction or whether the Americans make a discovery, it can be rapidly translated into each community. I have a great deal of hope that the way forward is through partnerships not only with the researchers in Canada, but also internationally, so that we can quickly recognize breakthroughs and move effectively to bring them into practice.

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

That leads me to my second question. You mentioned that you collaborate and partner with the Americans. Are there any other researchers in the world that you partner with to exchange information or do joint projects?

[Dr. Anthony G. Phillips]

Yes. We have a number of very important partnerships.

I am responsible for the partnerships between CIHR and its counterpart in China, called the National Natural Science Foundation. We have established over a 10-year period a very effective partnership with China. It came as a bit of a surprise to me when I met with the head of that agency and asked what their most pressing issues were. I was thinking cancer, or whatever. He said that one of the most serious problems in China is heroin addiction, that they have more than one million people addicted, and that anything we could do to help them with that problem would be most welcome.

We also work very closely with the European Union. In fact, we're one of the few, other than Israel, I believe, non-European countries that has a formal research partnership with the EU.

On another dimension of mental health, dementia, the loss of cognitive functioning later in life, which of course is a mental ill-health issue, we're partnered with the European Commission on the joint program in neurodegeneration in dementia, and we have a very active research collaboration in that area.

International partnerships are very important for CIHR, and Canadians are punching way above their weight.

I have one final statistic on this is in terms of the research papers that are published in Canada. Over 50% of the papers we publish are in partnership with an international researcher.

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

Thank you very much.

My other question is on those personal coping skills you mentioned in your remarks. Maybe it's a very basic question. Can you help me understand how you help young people develop those skills? What is important?

Madam Fry mentioned bullying and difficult situations. I remember from my young years in school that bullying was there. However, I think the way society has changed is that parents now, and probably that includes me, have become more protective of their children.

My parents were not as protective. We were quite independent, and we had to deal with most situations on our own, sometimes with the help of friends or siblings. This was not put on the shoulders of a school unless it came to the point where the school had to step in and deal with it.

Can you elaborate on this? What are the issues? How can we go forward, and what's the best way to resolve it?

[Kimberly Elmslie]

I'd be glad to.

From the point of view of what's happening in schools today, we hear from partners who are working in schools, who are teachers, and who are designing curricula for schools, that bullying is a significant issue affecting the health and well-being of schoolchildren. In fact, we have funded an organization called PreVAiL that works as a research organization to prevent violence and to develop curricula for teachers so that they can, in the school setting, do a better job of helping students both understand bullying and how to prevent it and cope with bullying.

From the evidence that we have, and from the evidence that comes from surveys, like the health behaviour in school-age children survey that the World Health Organization administers, there's a significant problem in our schools with violence and with children being bullied and threatened. It's something that we at the Public Health Agency take very seriously from the perspective of our role in helping equip communities, and schools as part of communities, with the tools they need to understand this issue and do something about it.

In the children's programs that we're responsible for, we're focused on kids who are in very vulnerable situations, single-parent families, those who may be living in conditions that are not conducive to them developing, as children, the skills that other kids that come from more advantaged circumstances develop. In those situations, what our funding programs do is support on-the-ground community programs for kids and families, so they can come into a safe situation, talk about the issues that are affecting them, and get the help and support they need to develop the positive mental health skills that will see them into the future.

The evaluations that we've done of these programs are showing such good effect for these kids. When you visit these sites, you see the caring environment that is safe and where other kids of the same age are working with counsellors, and their parents are learning how to deal with difficult situations, you can see the value and the need for communities to advance these programs for vulnerable kids.

We come at it in two ways.