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.

On the agenda

MPs speaking

Also speaking

Marlisa Tiedemann  Committee Researcher
Fred Phelps  Chair, Public Affairs Committee, Canadian Alliance on Mental Illness and Mental Health
Padraic Carr  President, Canadian Psychiatric Association
Dave Gallson  Associate National Executive Director, Mood Disorders Society of Canada
Glenn Brimacombe  Chief Executive Officer, Canadian Psychiatric Association
Scott Marks  Assistant to the General President, Canadian Operations, International Association of Fire Fighters
Vince Savoia  Executive Director, Tema Conter Memorial Trust
Zul Merali  President and Chief Executive Officer, Royal’s Institute of Mental Health Research and The Canadian Depression Research and Intervention Network , As an Individual

4:10 p.m.

Chair, Public Affairs Committee, Canadian Alliance on Mental Illness and Mental Health

Fred Phelps

I can't speak as an expert on each At Home program across Canada. I think in different programs the mental health piece may be stronger, but the backbone and the driver behind At Home/Chez Soi was the recognition that much of what was exasperating a person's mental health or mental illness issue was systemic, from poverty and not having the basic resources to be able to address mental health needs. By addressing the fundamental needs, the shelter and the food, they were able to have insight and manage their mental health illness.

4:10 p.m.

Liberal

Adam Vaughan Liberal Trinity—Spadina, ON

As a program, have you been able to figure out where the best practices are emerging, given that the program is present in many communities but is radically different from community to community? Is there a best practices assessment to see where patient outcomes were stronger as well as savings for other levels of government?

4:10 p.m.

Chair, Public Affairs Committee, Canadian Alliance on Mental Illness and Mental Health

Fred Phelps

I have to look at my panel because I'm not aware of any in-depth research.

Dave.

4:10 p.m.

Associate National Executive Director, Mood Disorders Society of Canada

Dave Gallson

I can talk a little about that.

There is a variety of best practices out there that are extremely well developed. What happens is that when programs are developed mental health and wellness have to be looked at as part and parcel of each other. Mental wellness is not just going to a psychiatrist or a doctor and getting a diagnosis that you're better again. It's a whole life spectrum. You have to have your employment. You have to have your volunteer. You have to have your family life. You have to be part of the community. All of that is meant to become wellness, and if you're missing parts of that, then you're missing part of your wellness.

I've worked with thousands of people with mental illness. I developed a program years ago that put back to work over 1,200 people who had been out of work for longer than three years. What I found was that if you give them some hope and give them some training and you get them a job, then they walk, they talk, and they live differently. They have a reason to go to sleep at night, they have a reason to get up in the morning, and it gives them something to look forward to.

I think when you take a look at the components of what wellness is, this innovation fund should be supporting those kinds of programs that are already created in communities across Canada and should be replicated because they have good health outcomes. That's my opinion anyway.

4:15 p.m.

Liberal

Adam Vaughan Liberal Trinity—Spadina, ON

I have one final question. You also talk about populations that the federal government has a direct responsibility for, and you didn't list immigrants. I know there has been a fairly important study out of CAMIMH in Toronto that looks at the fact that for the first time in our country's history immigrants are doing worse after five years in Canada than when they first landed. Even though we have the pick of the crop in terms of having a very aggressive immigration policy seeking out individuals with high skills and high levels of health, when they land in Canada, they do progressively worse because of lack of supports. I'm curious as to whether that federal population is being tracked, whether there are direct recommendations on how to attend to that issue, and what your assessment is of the study that discovered that.

4:15 p.m.

Chair, Public Affairs Committee, Canadian Alliance on Mental Illness and Mental Health

Fred Phelps

Thank you for enlightening me about that study. I'm in the role of CAMI, so I'm not speaking on behalf of my own organization. In that sense, we wouldn't have a position or understanding, but our overall understanding would be that the federal government, whether it be with new immigrants, first nations, aboriginals, or the RCMP, use best practices to lead by example.

Our recommendation would be, if that is the case, the federal government should provide the services that could be the standard for which the provinces and territories have—

4:15 p.m.

Liberal

Adam Vaughan Liberal Trinity—Spadina, ON

So you have no problem with our reading into that “and immigrant populations and refugees coming to Canada”.

4:15 p.m.

Chair, Public Affairs Committee, Canadian Alliance on Mental Illness and Mental Health

Fred Phelps

If there's a direct responsibility of the federal government to provide services, then no, I don't think we'd be in opposition to that.

4:15 p.m.

Liberal

Adam Vaughan Liberal Trinity—Spadina, ON

Thanks.

4:15 p.m.

Conservative

The Chair Conservative Ben Lobb

You have a minute and a half, if you'd like.

Mr. Young.

4:15 p.m.

Conservative

Terence Young Conservative Oakville, ON

Thank you, Mr. Chair.

I thank everyone for coming today.

Dr. Carr, thank you very much for coming today. I wanted to talk to you about the relationship between medicines and suicides. We don't hear a lot about it.

Dr. David Healy, in his book Let Them Eat Prozac, believes that 25,000 suicides happened from patients being on Prozac, suicides that otherwise would not have happened over the period Prozac has been on the market. All antidepressants have very similar adverse effects. There's a list of about 200, including serotonin syndrome, which can be life threatening; nightmares; sexual dysfunction; psychosis; and about 190 others, including akathisia, which is described as when you feel so horrible that you want to crawl out of your own skin.

My concern is with suicides, particularly of young people, which rarely hit the media, because the media doesn't write about them for good reason—because they're afraid of creating a copycat. I hear about them, because I worked on drug safety for years. In my own town of Oakville, there was a 15-year-old girl who lay down on the GO tracks with her puppy. Her mother is quite sure that she changed a lot and believes that the antidepressants her daughter was on caused that.

Sara Carlin, who took Paxil for three months, quit everything she did. She was captain of her hockey team. She had a job. She was at Western University. She went downhill, including substance abuse. Then she came home and hanged herself at three o'clock in the morning after taking her makeup off—a very violent and relatively rare form of suicide, especially for a woman.

Brennan McCartney was 24 years old. He was depressed because he had split up with his girlfriend. The doctor gave him a free sample of Cipralex, so he didn't even get a chance to talk to a pharmacist. He went out four days later and with a rope around his neck jumped out of a tree in a public park.

I hear a lot about these, but I never hear the media talk about them. I think that's because on U.S. television, where you might hear a lot about it, the number one advertiser is the pharma companies. The news companies depend on them for their business success.

When you see young people committing very violent suicides and you see a warning on the label—not a clear warning—that warns against suicidal ideation, this is really a vague way of saying “This drug may make you want to kill yourself.” This is really what I think they should be warned about. Every label for every antidepressant says that patients should be monitored closely. But I have never seen that. I have never heard of it.

What doctor has time to monitor a patient closely? How can that occur? How can your members monitor patients closely? How do they? How can family doctors, who are so extremely busy and have a huge volume of patients, possibly monitor their patients closely so they know that if they start to think about killing themselves, they say “Hey, my doctor warned me. I better call my doctor right away.” They know that when they change their dose it's the most dangerous time. When they start it and when they stop it are other very dangerous times. How can we monitor patients closely and make sure they understand and get a clear warning of the risk of suicide?

4:20 p.m.

President, Canadian Psychiatric Association

Dr. Padraic Carr

That is a long discussion, but I'll try to summarize it as best I can.

First of all, all medications have side effects. If you read in the CPS, or the Compendium of Pharmaceuticals, about the side effects for Aspirin, you'd probably be amazed at some of the side effects that are listed there.

4:20 p.m.

Conservative

Terence Young Conservative Oakville, ON

I wrote a book about it, so I understand about having an effect—

4:20 p.m.

President, Canadian Psychiatric Association

Dr. Padraic Carr

Fair enough.

All medications are going to have side effects.

It's long been known that for people with depression, as they start to get better, very often one of the last things to improve is their subjective mood.

There's another dangerous time you didn't mention, and that's as patients start to improve and when they're discharged from hospital. Very often as their mood is improving, their energy is improving, and their concentration is improving, sometimes when they've had suicidal ideation from being depressed, what can happen is that now they have the energy to carry out those plans they originally had.

4:20 p.m.

Conservative

Terence Young Conservative Oakville, ON

They feel empowered.

4:20 p.m.

President, Canadian Psychiatric Association

Dr. Padraic Carr

So you're right, it's imperative that there is close monitoring of patients. The way that's done is by asking patients how they're feeling and what is going on, and monitoring their symptoms. Some will use rating scales to help monitor those risks. But it really does require regular follow-up to do that.

In terms of the antidepressants themselves, some people feel an increase in impulsivity. That can include self-harm acts and other things. Again, you have to adequately warn patients about that ahead of time. Let them know what the side effects are to the medication they're taking. I would hope every doctor who prescribes medication does that with their patients.

4:20 p.m.

Conservative

Terence Young Conservative Oakville, ON

They don't. The family docs don't. They're so busy. They have a room full of patients and, frankly, they often don't understand the risks themselves. Why would someone give somebody a free sample of Cipralex and then just say “go ahead and let me know how you feel”? This stuff is going on all the time.

What should we do to try to reduce suicides that are actually caused by drugs that are supposed to be helping patients?

4:20 p.m.

President, Canadian Psychiatric Association

Dr. Padraic Carr

In general, I would have to disagree with you. I would say that most family doctors are very good in speaking to their patients, discussing side effects of medications, and explaining risks and what we really should be monitoring for.

There are certainly tragic anecdotal cases where things have perhaps not been done properly or where there perhaps was a tragic outcome despite everyone's best intentions. When those cases come to the fore, I think what's best is maybe something like this study looking at how we can prevent suicides, including whether there are better ways of managing or better protocols that we can do. However, that's really going to need to be done with medical associations, and with colleges as well, in terms of what those standards should be.

4:20 p.m.

Conservative

Terence Young Conservative Oakville, ON

Do I have more time, Chair?

4:20 p.m.

Conservative

The Chair Conservative Ben Lobb

You have a minute.

4:20 p.m.

Conservative

Terence Young Conservative Oakville, ON

Thank you.

Dr. Carr, if you had a wish that was going to come true and you wanted to improve mental health in Canada, what would it be?

4:20 p.m.

President, Canadian Psychiatric Association

Dr. Padraic Carr

I guess it would be providing the right treatment for the right patient at the right time.

4:20 p.m.

Conservative

Terence Young Conservative Oakville, ON

How do we make that happen?

4:20 p.m.

President, Canadian Psychiatric Association

Dr. Padraic Carr

Start by looking at the problems. Are we providing adequate services? Also, I think looking at new innovations is extremely important, as is monitoring systems to make sure those innovations are working, as well as providing adequate funding to make sure we can do those jobs right.

4:20 p.m.

Conservative

Terence Young Conservative Oakville, ON

So you're talking about funding for psychology and psychiatry?