Health Committee on May 14th, 2015

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

I'd like to add something to that.

Sometimes I get the impression that when people have a chronic illness, such as schizophrenia, they get excellent care from a team, and all of the resources are deployed because those people have severe health problems.

However, if someone is having trouble coping after a separation and is not seen as needing hospitalization or is not a suicide risk, their case is treated cursorily and they're sent back home quickly. They're prescribed antidepressants after an assessment that lasts about 10 minutes. Their situation is not considered an emergency, and they're not considered to be in need of psychological follow-up.

There are still lots of people without a family doctor. Usually, people who don't have a family doctor are in good health and are not considered priority clients. A man in good health who goes through a separation at the age of 40 might not have a family doctor. I get the impression that it can be harder to provide care for less severe mental health issues because so many resources are allocated to severe cases and people who have many more problems.

Do you see that in your day-to-day practice?

[Dr. Padraic Carr]

First of all, I think resources are allocated differently in different jurisdictions. In my city, for example, for the type of patient you describe, the patient who is not severely mentally unwell and doesn't require hospitalization but really does need some kind of follow-up, there is actually that resource in my centre. The difficulty with it is the amount of resources that have been allocated to it. That's where we have the two-month waiting list, and it's for that type of patient you're describing, the one who needs some kind of follow-up care but not really the super intense care.

It's different. Different regions emphasize different points. So it really depends on which province you're in and where in that province your are the kind of follow-up care that is available to you. In some jurisdictions the type of care you're talking about does exist and is very good. In some jurisdictions it exists but there are long waits, and in some it doesn't exist at all.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up for seven minutes, Mr. Albrecht. Go ahead.

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

Thank you, Mr. Chair.

Thank you to all of our witnesses for being here today. I've had the privilege of working with all of your organizations over the last seven or eight years in different capacities in my work on suicide prevention, palliative care, and many of these initiatives that have been forwarded, and you've been very cooperative. All of your groups have been extremely helpful.

The one thing that I did notice in all of your comments was your commendation of the government for having extended its funding and support for the Mental Health Commission over the next 10-year period. I appreciate that because I do think, as Mr. Gallson pointed out, that it is the one single national coordinator and has the capacity and respect to bring stakeholders together.

Mr. Phelps, you mentioned in your opening comment, as you acknowledged the extension of funding for the Mental Health Commission, that now is the time for a call to action in addition to simply research. I would just like your opinion on two of the calls to action that I think the Mental Health Commission has done and is embarking upon. The first was the #308conversations that were engaged in by many parliamentarians and community people over the last year in many communities across Canada. I'd like your opinion on the effectiveness of their goal in reducing the stigma around mental health issues and suicide prevention.

Then, secondly, at the last meeting we had Louise Bradley from the Mental Health Commission here, who pointed out the second phase of an initiative developing a community-based model for suicide prevention. The model aims to adapt and implement an existing and effective suicide program to the Canadian context. It's now developed by Dr. Ulrich Hegerl, in a multi-level, community-based suicide prevention initiative that has been shown to be effective in reducing suicide by 24%. I think as committee members, as parliamentarians, this is our goal. We want to see action. We want to see measurable improvements in mental health and reductions in numbers of suicides and attempted suicides.

Could you comment, Mr. Phelps, and then I'll see if we have time for some of the other panel members to respond on those two questions.

[Fred Phelps]

Thank you very much for the questions.

Speaking on behalf of the Canadian Alliance on Mental Illness and Mental Health, CAMIMH has been very supportive of the #308conversations. I think that any movement in the sense of educating people about mental illness and mental health is useful, because we all need to be educated a little bit about that. Raising the level of understanding across the country and raising the level of understanding for our elected officials and bringing that to the community level, I think, is making a huge impact.

As well, I don't know and can't speak specifically to the community-based suicide prevention. But I know that, with regard to the Mental Health Commission of Canada's rolling out of national programs and national standards and looking to put those into an action plan, we're very supportive of that moving forward.

What we're discovering on the local level that as mental health has become something that we can talk about openly and can disclose in the workplace, there aren't the repercussions that there were 20 or even 10 years ago. However, sometimes there are barriers to accessing services on a local level when somebody discloses or feels he or she is in an environment, such as one with something like a #308conversation, where they can open up.

So, from a Canadian Alliance on Mental Illness and Mental Health perspective, it's about moving that to action, taking a national plan, and taking that national plan and applying funds, so that across the country we can apply those performance indicators for the best practices, lift the best practices from communities, and ensure that there is access across Canada. I think that's really the next stage for the Mental Health Commission of Canada.

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

That might lead to another question. In your comments you also called, I believe, for a $50 million investment. Was that over a 10-year period?

[Fred Phelps]

It's five years.

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

It's over a five-year period.

I guess my question on that would be this. With the amount of money that's been invested in mental health initiatives through many of the organizations we've listed, would that appear to be duplicated by other organizations? In other words, we're responsible for effective use of taxpayer dollars, for investing dollars in the Mental Health Commission of Canada. Then there's this other fund, $50 million. How far can we go in what appears to be, at least at first glance, duplication of efforts?

[Fred Phelps]

Yes. That's a very good point.

As the national government has provided national leadership in developing a national plan for mental health, each of the provinces and territories has really looked internally at how they're going to address that. At this point with the federal government, we're looking at a $50 million mental health innovation fund, a one-time five-year funding. In looking at those innovations, it's very similar to what At Home/Chez Soi has done in looking at leveraging those evidence-based best practices, so that the provinces and territories potentially could end up taking them on their own. However, the Mental Health Commission of Canada has a next step to be able to lift those best practices that are happening in the provinces and territories and ensure that they're spread out across Canada.

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

Do I have a little more time?

[The Chair, Conservative, Ben Lobb]

Yes, you have a minute-and-a-half.

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

Dr. Carr, I want to follow up a bit the question by Ms. Moore about the person who may not necessarily have what we would call a classic mental illness but faces a sudden life reversal, whether that's a separation, the death of a spouse, their loss of a job, or myriad issues that will cause a temporary despair or loss of hope.

I've always felt that a large number of those who die by suicide probably have had continuing, ongoing, and perhaps prolonged mental health issues. But there are a number of times where it appears to me, as a non-professional in the mental health field, that people are just faced with insurmountable temporary issues and just lose hope in that context.

Do you have statistics to let us know what percentage of people would be in the category? Apparently they are totally healthy, and yet suddenly we hear that they snapped—to use that term—and something happens?

[Dr. Padraic Carr]

There are different rates of suicide, depending on psychiatric diagnoses. So, if we look at the totality of people who have committed suicide, it's estimated that about 90% of those will have suffered from a mental illness.

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

A longer, ongoing....

[Dr. Padraic Carr]

Right, some type of mental illness....

So, it's really only 10% who do not.

As well, you'd think that people who commit suicide must be depressed, and it's only 80% of people who commit suicide who actually suffer from depression, as well.

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

It's only 80%.

[Dr. Padraic Carr]

Yes, it's about 80%.

There are many illnesses that are associated with suicide. For example, it's estimated that about 50% of people with schizophrenia will attempt suicide at some point in their life, and 10% will actually succeed and eventually die by suicide. So the numbers are very high, and it's not necessarily just people who have depression.

Now, what you're talking about, I think, is the person who has faced an overwhelming stress and has been totally healthy his or her entire life prior to that. Very often those people can be suffering from what we call an “adjustment disorder”. So, someone has a catastrophic reaction to a bad event and can be suicidal based on that.

There are resources in the community that do help with that. For example, local mental health care clinics are designed to address those types of scenario. So, there are resources available, too, for those people who don't necessarily have a chronic illness.

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

I would like to point out that it's important that we don't lose sight of the fact that suicide prevention is not just a mental health issue but a public health issue and that it takes in the entire community.

[Dr. Padraic Carr]

You're absolutely right.

[The Chair, Conservative, Ben Lobb]

We are way over time. We're going to have to take time away from Mr. Vaughan, we're so over time. No, I'm kidding.

Mr. Vaughan, seven minutes. Welcome to the committee.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

Thank you very much.

Mr. Phelps, with the innovation fund you speak of, where would you see that best expanded and what programs do you think need investment?

[Fred Phelps]

I think, with the $50 million, we would be looking for that to flow through the Mental Health Commission of Canada, and CAMI would be looking at the expertise of the national plan and the action plan to move that forward.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

You cited housing first as one of the programs you helped form. I'm wondering if the housing component is one of the areas you focused that support on.

[Fred Phelps]

I think in this recommendation CAMI members were looking more at the mental health piece. At home/Chez Soi is looking more at concurrent disorders and then looking at social determinants of health. That's a larger upstream issue that I think needs addressing as well, but for this $50 million we'd be looking at lifting up best practices when it comes to addressing access to mental health services.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

In many centres, particularly in large cities, it's morphed more into a rent supplement program than it is a mental health or addiction service program. I'm curious as to what you think about the way in which the program has hit the ground and whether or not it is providing medical support for the afflictions that it's aimed at as opposed to simply providing shelter support for them. In other words, have the wraparound services arrived at the same time as the rent supplements?