Evidence of meeting #63 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was ptsd.
A recording is available from Parliament.
3:30 p.m.
Conservative
The Chair Conservative Ben Lobb
Good afternoon, ladies and gentlemen. We're following up on our study and have two panels today. We're going to get right into it.
Go ahead, Mr. Young.
3:30 p.m.
Conservative
Terence Young Conservative Oakville, ON
Thank you, Chair.
I'd like to ask the committee for unanimous consent to move a motion with regard to a follow-up report that the Canadians for Safe Technology attempted to get in on time to be included in the analysis of our evidence, but missed the date. The motion would be that the analyst be allowed to include that in preparing her report for the committee.
3:30 p.m.
Conservative
The Chair Conservative Ben Lobb
Is everybody clear on what Mr. Young is asking?
Do we have unanimous consent for that?
Go ahead, Ms. McLeod.
3:30 p.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
I just have one question for the analyst. I just wanted to make sure this is not going to impede her ability to do the analysis and still get her report done on time. I just wanted to check that one piece with her.
3:30 p.m.
Marlisa Tiedemann Committee Researcher
I haven't seen the document. I don't know how long it is, but my goal is still to meet the deadline.
3:30 p.m.
Conservative
The Chair Conservative Ben Lobb
Making sure of our procedure, now that it is on paper, how do you want to vote on this? Do you want a show of hands or do you want to go member by member? What do you want to do?
3:30 p.m.
An hon. member
A show of hands—
3:30 p.m.
Some hon. members
Agreed.
3:30 p.m.
Conservative
The Chair Conservative Ben Lobb
(Motion agreed to [See Minutes of Proceedings])
The motion is carried and the analysts are clear on what they have to do.
That's about the shortest business we've had in probably two and a half years, or maybe four years. It was most efficient, for sure.
We have three guests here now.
Mr. Phelps, you can go first.
3:30 p.m.
Fred Phelps Chair, Public Affairs Committee, Canadian Alliance on Mental Illness and Mental Health
Thank you, Mr. Chairman.
Thank you for the opportunity to present to this committee. My name is Fred Phelps. I'm the executive director of the Canadian Association of Social Workers. The CASW is a proud organization in the Canadian Alliance on Mental Illness and Mental Health, better known as CAMIMH. It is on CAMIMH's behalf that I present to you today.
CAMIMH is a non-profit organization comprising 16 national health care providers as well as organizations that represent individuals with lived experience of mental illness. It would be remiss of me not to acknowledge today that both the CPA and the Mood Disorders of Canada organization are also members of the Canadian Alliance on Mental Illness and Mental Health.
Established in 1998, the alliance provides collaborative national leadership to assure that individuals living with mental illness receive the services and supports they require for recovery. CAMIMH also advocates for government policies aimed at reducing the impact of mental illness on the Canadian population and economy, a negative impact estimated at more than $50 billion annually or almost 3% of GDP.
Our coalition's members span the entire spectrum of mental illness and care in Canada, representing patient groups and professional service provider organizations such as my own. As such, we have a unique and strong voice for the one in five Canadians living with mental illness and, more often than not, without adequate access to services to address those illnesses.
CAMIMH was exceptionally pleased with the recent announcement in Budget 2015 that the mandate and funding of Canada's Mental Health Commission would be extended for a further 10 years to 2028. The Mental Health Commission of Canada played the leading role in developing Canada’s first national mental health strategy. CAMIMH advocated for the establishment of the Mental Health Commission of Canada and has long pushed for its mandate to be extended beyond the originally funded 2017-18 timeline.
CAMIMH and its members look forward to engaging with the government, the Minister of Health and, indeed, this committee on establishing the terms and objectives for the second decade of the Mental Health Commission of Canada’s mandate. Though we all agree that there has been much talk about mental health and mental illness in recent years, which is undeniably a good thing, what is needed now is to shift from talking into action. Moving from awareness to action means investments in policy development and, yes, financial resources dedicated to ensuring these vital objectives are met.
Today I am here to present four recommendations on behalf of CAMIMH.
First, as per recommendation 3.1.1 of the national mental health strategy, we would like to see a mental health innovation fund established at the federal level in the amount of $50 million to help foster and disseminate best practices currently taking place across the country.
While we know there are many pockets of excellence when it comes to providing Canadians with access to leading-edge innovative mental health services and programs, the reality is that there's a lack of national coordination and resourcing to ensure that they spread across the health system effectively and equitably. Though the delivery of health care services is largely a provincial and territorial responsibility, CAMIMH knows there is a catalytic role for the federal government to play when accelerating and adopting those proven innovations in mental health.
Secondly, to provide the leadership on workplace mental health, we recommend that the federal government implement the Mental Health Commission of Canada's national standard for psychological health and safety in the workplace—the standard—in a major federal department. In our view, the standard can play an important role in improving overall workplace health and increasing productivity.
While the standard is currently piloted by a number of public and private organizations under the auspices of the Mental Health Commission of Canada, our hope is that it will be widely adopted by public- and private-sector employers across the country. As the country's biggest employer, the federal government should lead the way. While the standard does not expressly address the needs of those working with mental illness, it does support a workplace environment in which all people can work to the best of their abilities.
Our third recommendation concerns the measurement and evaluation of mental health systems in Canada as a basis for improving quality. In the area of mental health, we need a set of system performance indicators to effectively assess and improve the performance of Canada's mental services and systems.
At present, there are no agreed-upon mental health indicators that provide a clear picture of how mental health systems are performing, particularly in terms of measures of access to and the appropriateness and outcomes of services. Additionally, where data is available, it focuses on acute care hospitals, and not community programs and services. This is unfair to people who need and receive services in communities, in the venues where many of Canadian mental health problems are most effectively treated and where, unfortunately, services are insufficiently covered by public and private health insurance plans.
While we are pleased to see that important work has been initiated in the area of mental health indicators and expenditures by the Mental Health Commission, the Public Health Agency of Canada, and the Canadian Institute for Health Information, work on mental health performance indicators needs to be advanced as a national priority to ensure accountability and results. CAMIMH is of the view that the federal government, working in close partnership with the provinces and territories, can play a groundbreaking role in terms of developing the national mental health performance reporting and quality improvement initiatives.
Finally, though health care delivery is constitutionally a responsibility of the provincial and territorial governments in this country, there are several large and under-serviced groups for which Ottawa is directly responsible—veterans, first nations, and RCMP members, to name a few.
Our final recommendation is to establish and implement a mental health strategy to better provide services to the populations for which the federal government has direct responsibility. Recognizing that the populations for which the federal government is responsible face unique mental health challenges and that the services currently provided are inadequate, the government has an opportunity to lead by example by providing a more robust set of mental health services to these groups, and can help demonstrate that in the long run, enhanced investment in mental health pays fiscal and economic, as well as social and human, dividends.
Our needs are great, but so are our resources. Canada is one of the most prosperous and fortunate nations on earth, yet too many of our citizens lack the mental health services they need. Increasing the availability of these services is a social and economic imperative we can no longer afford to ignore.
Thank you for your time. I look forward to any questions you may have.
3:35 p.m.
Conservative
The Chair Conservative Ben Lobb
Thank you very much.
Next up is the Canadian Psychiatric Association.
Mr. Carr or Mr. Brimacombe, go ahead.
3:35 p.m.
Dr. Padraic Carr President, Canadian Psychiatric Association
Good afternoon, Mr. Chairman, and thank you for the opportunity to present to this committee.
My name is Padraic Carr and I am the president of the Canadian Psychiatric Association. I'm joined by Mr. Glenn Brimacombe, the CEO of the CPA.
The CPA is the national voluntary professional association for Canada's 4,700 psychiatrists and 900 residents, and is the leading authority on psychiatric matters in Canada. As the national voice of Canada's psychiatrists, the CPA is dedicated to promoting the highest quality care and treatment for persons with mental illness, and advocates for the professional needs of its members by promoting excellence in education, research, and clinical practice.
The CPA is pleased to see that the standing committee has identified mental health as an issue that requires study from the perspective of the federal government's roles and responsibilities.
While the organization, delivery, management, and funding of health care is largely, but not exclusively, a provincial and territorial responsibility, the CPA shares the view that there are a number of important ways in which the federal government can play a strong leadership role in advancing the mental health of Canadians.
First, let me begin by applauding the federal government for its commitment in Budget 2015 to renew the mandate of the Mental Health Commission of Canada, beginning in 2017. While more discussion is needed to clarify the strategic objectives and outcomes of its mental health action plan, the CPA looks forward to building on the commission's impressive track record of achievement.
We know there is a significant amount of time, energy, and resources invested in developing the commission's mental health strategy, “Changing Directions, Changing Lives”. It should be viewed as an important document that provides a road map in addressing the mental health needs of Canadians.
Over the course of the commission's current mandate, it has developed a series of projects that look to reduce the stigma of mental health—for example, the opening minds project and the mental health first aid initiative— to improve workplace mental health through the National Standard of Canada for Psychological Health and Safety in the Workplace, and to develop a set of pan-Canadian metrics to better view and understand the mental health of Canadians, to name a few of the projects.
Combined, these and other initiatives are essential in moving forward when it comes to improving our collective mental health. While these efforts are necessary, they are not in and of themselves sufficient. More can and must be done to deepen the impact of the commission's strategy and to strengthen the role of the federal government.
There are four elements that can impact the work of the federal government and the MHCC. We need to adopt evidence-based innovations; we need better integration of services; we need to evaluate how the system is performing; and we need adequate funding to make that work.
While one may be tempted to think that the answer to those four elements lies with the provinces and territories, the reality is that there is a substantial leadership role for the federal government to be an active partner, facilitator, and collaborator.
One area where the federal government, through the commission, has played a clear leadership role is with the At Home/ Chez Soi program, which proved to be a sound investment for those who are homeless and suffering from mental illness. Given the savings that were generated for those with high and moderate needs, there is an opportunity for federal leadership to move beyond a pilot project and to expand the project across the country on a sustained basis.
To make this happen, those four elements of innovation, integration, evaluation, and funding must be addressed.
When it comes to mental health and stigma, we know the adverse effects of stigma on those with mental illness have been well documented. They include delays in seeking treatment, early treatment discontinuation, difficulty in obtaining housing and employment, and adverse economic effects. Stigma has been described, actually, as the primary barrier to treatment and recovery. Stigma is a well-documented obstacle to receiving adequate medical care and is only one factor in diminished life expectancy.
While the Mental Health Commission of Canada has made some important inroads through its opening minds project, more needs to be done.
Finally, I would like to turn to the role of research dissemination and best practices for mental health care and suicide prevention. As an evidence-based profession, psychiatry relies on access to the latest research and best practices as they apply to our clinical decision-making process. ln that regard, the Canadian Psychiatric Association plays a very important role in having a number of vehicles to ensure that our members have real-time access to clinical information through our peer-reviewed journal, continuing professional development courses, and at our annual conference.
As we think about how we can improve the sharing of timely clinical information with providers, the CPA is well positioned to assist the government in its study.
At the same time, though, there are other important collaborative opportunities to consider. The CPA is a founding member on the Canadian Alliance on Mental Illness and Mental Health, CAMIMH, and there are various unique opportunities to reach a broad range of mental health providers and those with lived experience.
From a provincial and territorial perspective, there are opportunities to better leverage the work of the Council of the Federation's health care innovation working group. Similarly, we work in closer strategic partnership with those national health agencies whose mission is focused on the provision of quality health care. For example, here I include the Canadian Institutes of Health Research, the Canadian Institute for Health Information, Statistics Canada, the Canadian Agency for Drugs and Technologies in Health, the Canadian Foundation for Health Innovation, and the Canadian Patient Safety Institute.
There are opportunities for these agencies to collaborate more effectively when it comes to focusing on the different dimensions of quality, which include access, appropriateness, cost-effectiveness, and patient and provider satisfaction.
Another way to spread leading practices would be to create a time-limited, issue-specific, and strategically targeted mental health innovation fund. Such a fund would look to invest in proven innovations that have had success in improving access, quality, and health outcomes.
ln closing, Mr. Chairman, some very important, positive steps have been taken by the federal government. However, there are other opportunities that should be considered to improve the mental health of Canadians.
lt's time to see greater parity between resources devoted to physical and mental health. The federal government can play a critical role. As the national voice of psychiatry, we look forward to working with you and others in findings innovative and sustainable solutions that put Canadians first.
Thank you.
3:45 p.m.
Conservative
3:45 p.m.
Dave Gallson Associate National Executive Director, Mood Disorders Society of Canada
Thank you very much. Thank you for the invitation for the Mood Disorder Society of Canada to present at this very important committee.
My name is Dave Gallson. I am the associate national executive director for the Mood Disorders Society of Canada. I have to give my regrets for my colleague, Phil Upshall, who is unable to attend with me here today.
I know that many of you are already familiar with what our organization does and the role we play in mental health care, but I'll just begin by providing a bit of background.
We're a national, not-for-profit, consumer-driven, voluntary health charity. We are committed to ensuring that the voices of persons with lived experience, family members, and caregivers are heard on issues related to mental health and mental illness, particularly when it comes to depression, bipolar illness, and other associated mood disorders, as well as PTSD and suicide.
MDSC was formally launched and incorporated in 2001 with the overall objective to provide people with mood disorders a strong, cohesive voice at the national level to improve access to treatment, inform research, and shape program development and government policies to improve the quality of life for people who are affected by mood disorders. Over the past 15 years, MDSC has been a dedicated and effective leader in efforts to revamp and improve health care on a national basis.
We partnered with the Public Health Agency of Canada to produce the first report on mental illness in 2002, as well as a second report in 2006, “The Human Face of Mental Health and Mental Illness in Canada”. We aIso played an important support role as a key resource to the Standing Senate Committee on Social Affairs, Science and Technology, which was chaired by Michael Kirby and the Honourable Marjory LeBreton. The committee's report, “Out of the Shadows at Last”, resulted in the current government's creation of the Mental Health Commission of Canada.
As a proven and trusted partner to the Government of Canada when it comes to helping Canadians who are affected by mental illness, MDSC is ideally positioned to share our experience and knowledge with the Standing Committee on Health as it undertakes this national study on mental health in Canada. There are a couple of areas outlined in the study's framework where I believe our input could be particularly useful for the committee. I'm referring to section D, how to coordinate the efforts of stakeholders at the national level to improve care and best practices for mental health care and suicide prevention.
MDSC prides itself on our record of collaboration. We have developed programs and resources, and educational programs such as continual medical education programs with such organizations as the Canadian Medical Association, the Canadian Psychiatric Association, Bell, the Mental Health Commission of Canada, Corrections Canada, the Canadian Bar Association, the Canadian Nurses Association, regional health centres, and the list goes on and on. We are truly a strong collaborator in Canada.
We have just signed a new collaborative agreement for our national peer support program with the Public Service Health and Safety Association, which has 1.6 million members. Our national peer support program consists of 17 serving and ex-members of the military, RCMP, and regional police forces. They go across Canada and they teach police forces and organizations how to implement and set up a peer support program to support their members.
ln a major national initiative aimed at ensuring that the Canadian mental health and addictions systems respond collaboratively and appropriately to the unique needs of first nations, Inuit, Métis, and other persons with lived experience and their caregivers, MDSC and the Native Mental Health Association of Canada, with support from the federal government, launched “Building Bridges: A Pathway to Cultural Safety” in April 2009.
As part of this groundbreaking initiative, both national organizations and allied stakeholders across the country collectively developed a comprehensive planning framework on cultural safety that would allow programs and services to deal more effectively with major systemic issues and barriers such as labelling, discrimination, colonization—
3:45 p.m.
Conservative
The Chair Conservative Ben Lobb
Excuse me, Mr. Gallson. I'm sorry to ask this, but could you slow down a little bit? They're having a tough time translating it as fast as you're saying it.
3:50 p.m.
Associate National Executive Director, Mood Disorders Society of Canada
I'm sorry. I'd rather slow down, to tell you the truth. It's the seven-minute thing.
3:50 p.m.
Associate National Executive Director, Mood Disorders Society of Canada
Perfect. Thank you very much. I appreciate that.
As I was saying, they collectively developed a framework that would allow programs and services to deal more effectively with major systemic issues and barriers such as labelling, discrimination, colonialism, racism, stigma, and discrimination in a planned and progressive manner in the years ahead.
ln terms of supporting other mental health organizations, we developed the only national multi-organizational mental health fundraising and anti-stigma and awareness campaign in Canada, called Defeat Depression. It is now taking place in over 55 locations across Canada and supporting local mental health organizations. As you will see by our extensive collaborations, we know that working collectively is the only way to move forward to address mental health and stigma in Canada.
Regarding the coordination of stakeholder efforts, MDSC strongly recommends that this committee consider selecting the Mental Health Commission of Canada as the principal national coordinator. Since the commission was created, it has brought a greater focus on the work of all mental health NGOs, professional health care associations, health care providers, and government departments. While each of the stakeholders has its own legitimate mandate and vision, the MHCC has demonstrated that it has the capacity and the community respect required to bring stakeholders together for a common cause.
The development of the mental health strategy for Canada has helped persuade all levels of government and Canadian society generally to pay greater attention to the huge economic and social burden of mental illness and to the benefits that positive mental health can have for Canadian society.
ln terms of research and the dissemination of findings, MDSC has helped pave the way nationally in the development of a national mental health research agenda, including the availability of statistics. For instance, MDSC was an active contributor to the discussion concerning the legislation that ultimately resulted in the then Government of Canada's creation of the Canadian Institutes of Health Research. MDSC's national executive director was an original member of the institute's advisory board, and MDSC was rewarded a CIHR partnership award in research for its various research activities associated with the institute.
ln Budget 2012 this government entered into a contribution agreement with the Mood Disorders Society of Canada to develop, in partnership with the Mental Health Commission of Canada and the Ottawa Royal's Institute of Mental Health Research, the Canadian Depression Research and Intervention Network, CDRIN. This is to develop a world-leading, patient-focused, engaged national research collaborative network, and we've now reached out to seven hubs across Canada with over 50 research institutions and community organizations involved in the network.
When it comes to the issues surrounding mental health care and suicide, this complex and devastating issue will require a multi-pronged approach involving all members of providers of care within all communities. We know that we are losing a person every two hours to suicide. We can't delay. By the time this meeting is completed today, another fellow Canadian will have taken their life.
As the members of this committee know, we have the experience, we have the will, and we have the reason to move ahead. Now we need to coordinate our approach, join our forces, and properly resource our efforts.
While we have come a long way in improving mental health care, there is still more that needs to be done, particularly in the areas of suicide prevention, the diagnosis and treatment of depression, and the diagnosis and treatment of PTSD. The benefits to the health care system and our economy are clear. As the government continues to position Canada for long-term success, it must aIso recognize and work with its partners to help alleviate social issues that impede our economic prosperity. Mental health issues, PTSD, depression, and suicide in particular, are three areas that must continue to receive attention and support as public policy is developed.
Once again, MDSC is grateful to this committee and wishes to work with you closely as we move forward.
Thank you.
3:50 p.m.
Conservative
The Chair Conservative Ben Lobb
That's great. Thank you very much.
The first round of questions is going to be from Ms. Moore.
You're going to get those questions in French, so if you need to put your earpiece in and do a test run just to make sure that you're hearing what you want to hear, we can do that first.
Ms. Moore, do you want to test that out?
3:50 p.m.
NDP
Christine Moore NDP Abitibi—Témiscamingue, QC
Thank you, Mr. Chair.
Is everyone who needs simultaneous interpretation able to hear me in English?
3:50 p.m.
An hon. member
It's perfect.
3:55 p.m.
NDP
Christine Moore NDP Abitibi—Témiscamingue, QC
I'm a nurse. Until recently, I worked in emergency and intensive care. I regularly saw patients with chronic or serious mental health problems requiring hospitalization. They were given appropriate care. Afterward, there was follow-up, and they consulted a psychiatrist during their time in hospital.
However, the situation is different for people with acute mental health problems who do not necessarily need hospitalization. Acute mental health problems can stem from adjustment disorder, a difficult event in one's life or other somewhat less serious situations. Being from a small region, I know that these people are often looked after by a family doctor or GP who provides emergency care.
Time is an important factor. Consultation and medication selection happen very quickly. I get the sense that, in many cases, that choice does not necessarily take side effects into account. Over the past 30 years, many new medications have come on the market. In 95% of cases, they're the same two molecules. In my region, citalopram and venlafaxine are the ones we see all the time. However, as everyone knows, compliance is one of the key factors here.
How can we take better care of patients whose cases are slightly less serious and ensure that they are prescribed medications with the least harmful side effects? How can we ensure that we are not neglecting people whose clinical situation is a little less serious than that of others?
3:55 p.m.
President, Canadian Psychiatric Association
You bring up three interesting areas in your question. One is about the training of professionals and who is most qualified to look after what type of patient. There's also the issue of patient access to resources, and the issue of patient compliance. I think all three are laudable objects of any study and, potentially, this study.
To answer your questions a little bit more in depth, in terms of the training of professionals, all medical doctors are trained in psychiatry. They all have training in the various medications and various other types of therapy, whether it's from a biological, psychological, or social model. All doctors should be able to do that. Sometimes the best follow-up for a patient is with their family doctor. Sometimes they have a relationship with their family doctor. If their doctor feels comfortable in those types of treatments, then that may be the best working relationship. Certainly psychiatrists are specifically trained to deal with mental illness and all of the different medications out there. Most family doctors are required to keep their continuing medical education up to date, so they should be aware of what medications are out there and the various options available.
I'm sorry that your experience is that sometimes there seems to be a lack of choice in terms of medications. I can't speak to that, but in general, family doctors are very well-trained professionals, as are psychiatrists.
In terms of access, that's an issue across the country. It's probably a bigger problem in rural areas than urban. That's been talked about by many groups. It's not a problem unique to Canada, either. The U.S. has exactly the same difficulties. Take my own hospital as an example. I work in a major hospital in a major city, and I will discharge patients from hospital. Even though I have a community practice, it's very difficult for me to see all the patients I admit. There is a problem with access in terms of who will follow up with the patient once they leave the hospital.
Access isn't limited just to psychiatrists. Psychiatrists more and more are working in multidisciplinary teams, and very often it's difficult for them to access the teams. Part of that is coordination. Part of that is a lack of funding, just not having the resources out there. In our city we have a really good mental health support team, but the waiting list to get into that team is still two months after you're discharged from hospital. That makes it very difficult.
Your last comment was on the issue of compliance. That's a separate issue. Many factors are related to compliance. It may include a patient's pre-existing ideas toward medication. It may include their family's ideas about medication. It may include what they've heard from other people. It may include the relationship with their treating professional in terms of whether or not the medication or treatment has been adequately explained. That's something that needs to be addressed as well. Compliance is a complicated issue. Again, that may be something that this study wishes to look at.