Health Committee on May 12th, 2015

[The Chair, Conservative, Ben Lobb]

Thank you.

Ms. Moore.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Thank you, Mr. Chair.

My questions are for Mr. Perron and Ms. Elmslie.

What tools are used to evaluate your programs? How do you know if they are effective and if they meet the needs? Can you provide us with evaluations of different programs that have been carried out? Do you have examples of changes made to programs as a result of an evaluation?

You can go first, Mr. Perron.

[Sony Perron]

Thank you. That is an excellent question.

There is the National Native Alcohol and Drug Abuse Program, or NNADAP. I am sorry, but I cannot think of the program's French name right now.

We use certain indicators for this program. At the end of a treatment, for example, we can see whether or not an individual has abandoned one or more elements of their substance dependence.

We look at the same result after six months in order to see how the person is doing with their dependency. Such indicators are very common in treatment programs. We stick to that.

However, it is very difficult to conduct long-term follow-up of clients. There are limits to what we can do in that regard. We monitor these types of indicators to determine whether or not the results of treatment centres or programs we support are as good as those that exist for the general population and those that serve a non-aboriginal population.

There are also more activity-based programs, such as the suicide prevention program. These are often activities that have been developed in each region of the country. We conduct campaigns specific to these activities or projects. We will develop performance indicators to determine how many people, youth and families were involved in the program. What was the type of intervention? We often have to obtain the participants' opinions to determine how the program impacted them. Does it reinforce or diminish the problems in their environment? Does it give them more opportunities to deal with the difficulties that may be related to mental health or dependency issues? There are those types of indicators.

There are evaluations, but it is extremely difficult to know the long-term effect of these measures. That is the reason for our work with the Assembly of First Nations. By building a mental wellness framework we can determine how to reorganize these programs.

Over the past 25 years, Health Canada developed siloed programs on a piecemeal basis. We also tried to develop programs that would be the same across the country.

In consultation and partnership with many partners and experts, we are trying to use best practices in the framework developed in conjunction with the Assembly of First Nations. We want to define the overall framework and the fundamental components in this regard.

For example, culture was defined as one of the foundational elements for building resilience and recreating the connection with the environment, history and family to give purpose or better sense of purpose to life in the community. It is a matter of putting culture at the centre of all this and inviting communities that manage these programs to reposition the programs that we fund. These programs are not defined. They could be adjusted based on needs if they work within this framework and if all components are involved.

The evaluations revealed another reality. We are convinced that it is extremely important for an intervention to be firmly rooted in the communities and to have community control in order for it to be successful. However, there are types of specialized services that need to be provided at another level. Thus, we have started investing in mental wellness teams that provide more specialized services that can support a number of communities. We have also started providing crisis response because we cannot expect the organizations to have the capacity to deal with major crises.

The evaluations also made it possible for us to identify the gaps in what we were funding. Programs were adjusted over the years to create this new type of intervention. Mental wellness teams help communities supplement the services offered. As a result of the evaluations We make changes to what is provided based on the evaluations. I would say that the mental wellness framework developed by the First Nations, with the support of Health Canada, is a guide for the short term. Across the country, this guide is being received enthusiastically with a view to developing and repositioning programs so that services are offered more effectively in the long term. Therefore, I would say that the evaluations are useful.

The lessons learned over the past 10, 15 and 20 years that gave us direction are entrenched in this framework. Thus, I would invite the committee members to take a look at this. We are very proud of having developed the framework with the Assembly of First Nations.

We are now doing the same thing with the Inuit. In fact, if we believe that culture is foundational, we must also respect the fact that the Inuit have a different culture. We must therefore establish a framework based on their reality and their culture. That is what we are going to do.

That is something else we have learned over the past 20 years. Programs developed in Ottawa where we try to do the same thing just about everywhere are limited if we are unable to adapt them to the realities of the communities, environments and cultures in which we work.

[The Chair, Conservative, Ben Lobb]

Thank you.

Mr. Wilks.

[David Wilks, Conservative, Kootenay—Columbia, BC]

I thank the witnesses.

Each one of you in your speeches to us today didn't use the one word I wanted to hear, and that was “stigma”. As a person who is in long-term recovery, I would like to hear from each one of you what your agencies are doing to remove stigma from either addiction recovery or mental health recovery.

I'll start with you, Dr. Phillips.

[Dr. Anthony G. Phillips]

CIHR recognizes the importance of dealing effectively with stigma and the role that it plays as a barrier, obviously, to effective access to appropriate services. We have supported research at Queen's University with Dr. Elmslie, who is indeed a very well-known pioneer in creating a better understanding of stigma, how to diffuse it, and then how to assess whether or not there is a change in attitude that leads to better access to care.

This is an active area of research. There's a long way to go. But in the last five years, and this is now just a personal impression, I'm getting a very real impression that the stigma that's long been associated with both mental ill health and addiction is slowly weakening. That's a really promising sign. But we really do need to do more research. I apologize for not making that a high priority in our opening statement, but it is in practice, so thank you.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Mr. Perron.

[Sony Perron]

This is an excellent question. I think in the programming that we are offering there has never been a hidden agenda to say this is not an existing problem. It's an existing problem, but we have missed an element that appears now in this framework, which is moving forward with helping people to participate actively in their community and in the economy.

There was one thing that we fell short of in the program. We were dealing with the crisis, dealing with the addiction problem, but then not really looking much at the aftercare and the support in the community. This is something that we are adding to the program, because to deal with the pure element of stigma we need to help the clients, those who are affected by these problems, to take back their lives and be active on the economic side, by going back to school...supporting there.

The connection with the other types of programs in the provincial and territorial services is also very important, because if we only take a health approach to it, we deal with the health issue. Really if we want to bring those who are affected by mental health and addiction issues back into having control of their lives, we need to have a connection with these other programs to help people move forward in their lives after they have been dealing with a crisis or an addiction problem.

Maybe this is not a straight answer to stigma, because we are so immersed in trying to deal with the issue that the element of stigma is not always coming up front. I think the way to deal with stigma is the addition of these components into our intervention, which is to help the person to move ahead with his or her life after treatment and deal with the addiction problem or crisis.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Before I let you answer, Ms. Elmslie, I'd like to give one suggestion to each of you, which is that within your research, start involving those who are in recovery, because with all due respect, we think differently. If you're dealing with someone in recovery and you have someone who has gone through recovery, you can't bluff them. I would suggest that.

Thank you very much.

Over to you, Ms. Elmslie, on stigma.

[Kimberly Elmslie]

One of the things I learned at the Arctic Council meeting on suicide prevention was that hope and stigma reduction go hand in hand. The youth who were there really brought that home to me. It was something that really affected me, and I've been thinking about it a lot since then: how you do need to join up the ways that we think about stigma reduction by providing better information and engaging people in dialogue and on the hope dimension of a life after depression and a life that allows you to recover. Those are now fundamentals in the way, from a public health perspective as we design our mental health programs, we think about stigma.

It's not an isolated thing. It's part of the whole constellation of mental health and mental illness and recovery and prevention of suicide. Dialogue, for us, is part of the programmatic lens that we take to these things so that we're not separating and marginalizing the suicide discussion, the stigma discussion over here. It gets built into the programmatic development of the work that we do in public health.

[The Chair, Conservative, Ben Lobb]

Thank you.

Right on time, Mr. Wilks.

That concludes the first half of our meeting today. We're going to suspend for a couple of minutes and be right back.

[The Chair, Conservative, Ben Lobb]

We're back in session.

In the second hour of our meeting this afternoon, we have the Mental Health Commission of Canada. We have Louise Bradley and Jennifer Vornbrock here. They have 10 minutes to provide a presentation and then there'll be questions and answers to follow.

Go ahead.

[Louise Bradley, President and Chief Executive Officer, Mental Health Commission of Canada]

Thank you and have a good afternoon.

Mr. Chair and committee members, I'm delighted to be here today.

My name is Louise Bradley. I'm the president and CEO of the Mental Health Commission of Canada. I'd like to acknowledge my colleague, Jennifer Vornbrock, the vice-president of our knowledge and innovation team.

Let me begin by providing you with a brief background on the commission and its mandate. The commission was created in 2007, prompted by the work of the Senate Standing Committee on Social Affairs, Science and Technology and its study “Out of the Shadows at Last”, which called for a national commission on mental health.

The commission has a mandate to improve the mental health system and change the attitudes and behaviours of Canadians around mental illness. The commission is a coordinating agent, aligning and promoting the interests of governments, organizations, and persons with mental illness and their families. Our work brings together leaders and experts in mental health and facilitates widespread uptake on ideas, policies, and programs.

I'm pleased to report that in the 2015 federal budget, the Government of Canada indicated its intention to renew the commission's mandate for 10 more years beginning in 2017. The commission is thrilled to have the opportunity to continue its work, led by our new board chair, the Honourable Michael Wilson. Mr. Wilson has used his considerable talent and influence to champion mental health as a private citizen. Given his accomplishments to date, we can't wait to see what he's able to achieve with the full weight of the commission and our many partners behind him.

The commission's work continues to be guided by the mental health strategy for Canada, which was released in 2012. The strategy lays out actions to improve mental health care and its associated systems through six strategic directions. Since the release of the strategy, the commission has worked hard to ensure the strategy's uptake, sharing its recommendations with stakeholders across the country and around the world. I've heard from provincial and territorial governments that the strategy has become a foundational document and is used by them to develop their own mental health plans and priorities.

The reach of the strategy has been incredible, but the commission knows there are still barriers to its implementation across Canada. To assist in the implementation process, the commission initiated its own review of the strategy. After speaking with stakeholders and government officials, the commission has determined that the following actions would help drive the strategy forward: the coordination of mental health services and resources, including the integration of mental health, primary care, housing supports, and substance use services; the creation of an action plan, based on common priorities from the strategy, that demonstrates the next steps for those trying to implement it; and the improvement of mental health data, which includes better monitoring of current trends and the identification of data gaps. The commission looks forward to working with stakeholders and government to carry out these actions over the next decade.

The commission has also taken every opportunity to capitalize on the strategy as a guide for the expansion of our work. The issue of suicide prevention is of paramount importance, and we have been working on this issue for years utilizing our anti-stigma initiative called Opening Minds, workplace mental health programs, and knowledge exchange to provide tools and promote best practices.

We know that there is widespread support for this issue among parliamentarians, demonstrated by the recently passed Bill C-300, an Act respecting a Federal Framework for Suicide Prevention, which had support from all parties. Many of you also know about the #308conversations initiative launched last year by the commission and championed by member of Parliament Harold Albrecht. The campaign called upon all 308 federal members of Parliament to host a meeting in their respective communities with a focus on suicide prevention. The goal was to get people talking and to gather information about what interventions are available in communities.

As the second phase of this initiative building on the work of our anti-stigma initiative Opening Minds, the commission is developing a community-based model for suicide prevention. This model aims to adapt and implement an existing and effective suicide prevention program in the Canadian context. The model, developed by Dr. Ulrich Hegerl, is a multi-level, community-based suicide prevention initiative that has shown to be effective in reducing suicide by more than 24% over two years in a test community. The commission is currently working with stakeholders to determine the implementation of this initiative across Canada.

The initiative will build on another key commission program, At Home/Chez Soi, a participatory research project. At Home/Chez Soi demonstrated positive, cost-effective results for the housing first approach to homelessness, which provides persons who are homeless and have chronic mental health issues with immediate access to subsidized housing. Its participants were some of the most vulnerable Canadians who are highly stigmatized and who reported feeling isolated and being at high risk for suicide. At Home/Chez Soi demonstrated that people with chronic mental illness who receive no-barrier housing are more likely to stay housed and to report an improved quality of life. It also showed that for every $10 invested in housing first services for high-needs participants, the community saved almost $22 in avoided costs.

Because of its success, the Government of Canada decided to invest $600 million in the housing first approach through its homelessness partnering strategy. Through its innovative research, the commission was able to offer tangible and cost-effective approaches to improving the lives of Canadians who are homeless and have a chronic mental illness.

As part of our leadership on mental health systems transformation, the commission has also placed an emphasis on knowledge exchange and the sharing of best practices. At the heart of this work is the commission's Knowledge Exchange Centre, KEC, which provides numerous information-sharing hubs both online and through in-person gatherings. The KEC shares information about the commission's initiatives and additional best practices, ensuring that the information gets to the right people and that they know how to use it.

The KEC is also dedicated to improving the data and resources related to mental health. Next month they will continue with their launch of a set of national indicators on mental health that will provide crucial data on self-harm rates, the prevalence of specific mental illnesses, suicide rates, and rates of access to services. This data also identifies mental health indicators for subpopulations, such as LGBTQ youth and new Canadians. This information allows us to gauge areas in which the needs of Canadians are being met and in which there's room for improvement.

As you can see, the commission is working hard, as hard as it ever has, and we are ready to start making long-term plans for the next phase of our work. The commission is currently seeking advice from the Government of Canada, Health Canada, and other key partners about our new mandate. We've also been consulting with stakeholders and provincial and territorial leaders across the country to discuss shared priorities.

These discussions will form the basis of the mental health action plan for Canada, which provides goals and priorities for the implementation of the strategy. Just as the strategy guided the last decade of work, the mental health action plan for Canada will set the tone for the next one. By following through on the action plan, the commission can address urgent mental health issues, including suicide prevention, access, mental health supports for first responders, seniors, diverse populations, children, and youth.

In closing, I commend the members of this committee for identifying future actions at the federal level. There is still a great deal of work to be done. As with the commission's renewed efforts, it is the perfect time to redouble our efforts. This new chapter marks a time of pivotal change in Canada's mental health landscape, with more energy for system transformation than ever before.

I look forward to working with all of you and all Canadians as we continue our work towards our common goal of improving the mental health of Canadians.

Merci beaucoup.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Mr. Rankin, you may have seven minutes.

[Murray Rankin, NDP, Victoria, BC]

Thank you so much for your presentation.

You mentioned initially, Ms. Bradley, the issue of suicide prevention and the 24% reduction in a test community, if I heard you properly, which is an extraordinarily positive development. Was that community comprised of aboriginal and non-aboriginal people? What was the community you were referring to?

[Louise Bradley]

Actually, the first test site was in Germany. It was then replicated in 17 other countries, but not in Canada.

[Murray Rankin, NDP, Victoria, BC]

Is there a similar success record in Canada that you can point to?

[Louise Bradley]

Well, what we're proposing is that we would do that study in Canada and try to implement it here with a Canadian nuance. That is the proposal we are looking at for suicide prevention going forward.

[Murray Rankin, NDP, Victoria, BC]

Does part of your strategy address the unique cultural issues we heard about in the last panel that pertain to aboriginal and Inuit peoples?

[Louise Bradley]

I think we absolutely have to.

We know what some of the rates are. We know that approximately 12% of the 4,000 people who tragically die by suicide per year are children and youth, and we know those numbers are much more highly represented in the north.

Part of our research strategy going forward in looking at this would definitely include northern aboriginal communities.

[Murray Rankin, NDP, Victoria, BC]

I want to talk about that. Four thousand a year is such a staggering figure, and you said that 12% are children and youth.

There are two questions. One, are statistics kept on the number of suicide attempts, which I know are much more than that, and do you have that data? Two, do you break that out as regards aboriginal and Inuit peoples?

[Louise Bradley]

I will correct myself. It is 14% of those between the ages of 10 and 24.

We do have figures on suicide attempts as well as people who complete suicide. I don't have those exact figures, but I could certainly get them for you.

[Murray Rankin, NDP, Victoria, BC]

Do you have a breakdown on aboriginal and Inuit peoples?

[Louise Bradley]

We do have some of the geographical breakdown.

I think the key point here is that when we are looking at the 14%, or the 528 people who die by suicide in ages 10 to 24, a lot more work still needs to be done. In part of the going forward with our research, I think we would certainly be targeting and getting those specific numbers.

We heard the questions in the earlier session about stigma. I'm not sure that we know all of the numbers exactly due to the effect of stigma.

[Murray Rankin, NDP, Victoria, BC]

Do you have a statistical breakdown on first responders? We've heard a great deal about firefighters, police, and paramedics who are apparently taking their lives in record numbers. At least that's the data I've heard about from their representatives.

Do you track that information? Do you have data on first responder suicide rates and attempts?