Mr. Davies.
Evidence of meeting #55 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was trauma.
A recording is available from Parliament.
Evidence of meeting #55 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was trauma.
A recording is available from Parliament.
12:40 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
I would like to thank all of the witnesses today for such trenchant testimony.
Madam Ugnat, I would like to start with you. You testified that the prevalence of PTSD in women—if I have your statistics correctly—doubled between 2002 and 2012. I heard your comment that the numbers are likely under-represented, so I take it that it's probably even higher.
12:40 p.m.
Executive Director, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada
Yes.
12:40 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
My research, if it's not mistaken, is that women are twice as likely as men to be diagnosed with post-traumatic stress disorder. I would like to ask if you're aware of any research that focuses on gender differences, or the prevalence of PTSD in women.
12:40 p.m.
Executive Director, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada
Personally, I'm not, but I would turn that question to Dr. Sareen, who does research. What we do is more a monitoring of conditions across Canada in order to establish the burden and describe the condition in terms of people, so more women than men. Sometimes we have access to risk factors, so we can make connections, but we don't always have that. We describe the conditions so that we can inform policy.
In terms of research, maybe Dr. Sareen would be better placed to answer.
12:40 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
The studies that have been done across the world show that women are twice as likely to develop PTSD compared to men. We're currently looking at this: in the general Canadian population and the Canadian military, if the person is exposed to the same traumatic event, are men more or less likely to develop PTSD? We are finding—and these findings are not published yet—that women, if they're exposed to the same traumatic event as a man, are more likely to develop PTSD.
12:40 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
I want to explore some of the other population groups a bit. I think you mentioned a couple of them, Dr. Sareen. You mentioned refugees and first nations. I want to start with indigenous people.
I have done some reading about, of course, the residential school experience, which was a period in Canadian history where I think we had trauma on people on a mass scale. I want to get your thoughts on the prevalence of PTSD in the indigenous population, and whether you think it's a significant issue that we should be looking to incorporate into this framework.
12:40 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
I think it's a very important issue to incorporate in this framework. At this time, we don't have any epidemiologic studies of mental health problems in first nations communities in Canada. The limited studies that are there are from the U.S., where they showed that about 30% of women on first nations reserves in the U.S. had PTSD. At this point, we don't have a mental health survey that's been done in first nations in Canada. We do know, as you've described, that residential school trauma and exposure to trauma in indigenous women is quite high, but we don't have estimates of PTSD in Canada.
12:45 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
I think one of the many virtues of the bill before us is that it calls for us to establish a national medical surveillance program to use data to track incident rates, as well as, I think, to increase diagnosis. Would that be something that you think would be particularly useful in terms of maybe gathering this data in communities, like the data the United States published?
12:45 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
Absolutely. I think it's really important to have policy that's driven by data. We know that the military and veterans have invested in state-of-the-art community surveys that are done by Stats Canada. Statistics Canada has great survey methodology. I think it's really important, if we're going to invest in treatment and recognition, to have a good sense of how common these conditions are.
12:45 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
I want to leave some time for Ms. Harris, but I have one quick question, if you can give me a quick answer.
Is there an intergenerational component to PTSD? I'm thinking of residential school survivors, and how that can express itself generationally. Is there such a thing?
12:45 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
Yes, there is evidence that trauma exposure is also genetically linked, that impulsivity. Also the impact on the child of a parent who's dealing with trauma or PTSD is very important. There's more and more understanding that exposure to traumatic events actually could change our biology and genetics. So there's that interplay.
12:45 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Ms. Harris, I just want to say that was incredibly courageous testimony. Not only was that profoundly affecting, but I can appreciate the unbelievable courage that you've expressed in being here, and I want to thank you for that.
I have a quick question for you. You mentioned that representation is very important—I wrote down your words—and that the “fear of not being heard” is particularly profound. This bills speaks absolutely importantly about the impact of PTSD on first responders, RCMP officers, veterans, and police officers. Would you have any objection to our broadening that to include women, indigenous people, and refugees to make sure that they're heard?
12:45 p.m.
Advanced Care Paramedic, County of Simcoe, As an Individual
No, of course not.
When I was in treatment, one of the biggest lessons I learned from a person who is a perfectionist was to realize that the first thing we need to tackle is progress versus perfection. I think, obviously, there's always room for improvement with anything; that's our human nature. What MP Doherty has on the table right now will allow us to start progress now. The more we can include, the better—100%. The more help we can provide to our Canadians, the better. I still think that what we have on the table is a great start.
12:45 p.m.
Liberal
John Oliver Liberal Oakville, ON
Thank you very much to all of the presenters.
Ms. Harris, thank you so much, as others have said, for the honesty and frankness of your testimony. I think, through you, we need to thank the RCMP, first responders, the military, corrections workers, and emergency response people, who, on behalf of our society, go into absolutely incredible circumstances. They witness events that none of us would want to witness in a lifetime, and there's mental health, stress, and anxiety that go with that work. I just don't think we often take enough time to recognize that grouping of people who do this voluntarily on our behalf.
12:50 p.m.
Liberal
John Oliver Liberal Oakville, ON
Bill C-211, as a bill, basically deals with tracking of the incidence of PTSD. It ensures that there's a standard diagnosis and treatment set to manage it, and then education, and dissemination of that information across Canada. While I support that generally, I'm wondering if it really gets to the heart of the issue. I'm wondering if, at the heart of the issue, there is the reluctance of many organizations to acknowledge PTSD because of the burden it might put on them financially, and some of the issues where an employer might resist wanting to acknowledge PTSD because of it.
In Ontario, for instance, you mentioned, I think, Bill 163. The presumption is that if you have PTSD and you're a first responder, or in that category of workers, without any challenge, that is a work-related illness. Much more quickly, the treatment starts, and you're very quickly into treatment processes. WCB in Manitoba and Saskatchewan are both working on presumption clauses, that if you have PTSD, the assumption is it is work-related. There is already, I think, some pretty good case knowledge and understanding of how to identify and how to treat PTSD. Is it about better education on those things, or is it really about the receptivity of employers and other WCB agencies, potentially federal government and the military, to recognize PTSD as having a cause originating from workplace activities?
12:50 p.m.
Advanced Care Paramedic, County of Simcoe, As an Individual
Again, that's a great question. I agree with both points. It's absolutely paramount that employers recognize that this is our injury, that post-traumatic stress injury should be presumed to come from our workplace. However, I think it will take some time, through data and evidence-based research, to really convince every workplace that this is what happens. Unfortunately, that does take time. I see that happening. With this being on the federal table, I don't think employers can turn away. They can't ignore it anymore, or hide behind the stigma that this is the truth, that this is what happens to people who put their lives at risk every day and are among trauma every single day. However, I am a huge proponent of evidence-based research as well, and bringing that forward, and using that for cost-effectiveness as well. I think, again, we have a long way to go in tackling progress versus perfection, and this is an excellent start.
12:50 p.m.
Liberal
John Oliver Liberal Oakville, ON
Anne-Marie or other witnesses, is there anything you'd like to add to that?
12:50 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
I think it is a complex issue: trauma, work, and the impact.
One thing I want to bring forward is the idea of equity. Whether you are a city police officer or a city paramedic, or you are in the Canadian military, you should have access to the same mental health services. Right now, because of the federal and provincial system and the complexity of work-related injuries, as you have brought up, it's hard for people to navigate the health system.
I think the presumptive diagnosis of PTSD has some benefit in that it reduces the onus on the patient to relate the PTSD to the workforce. We also have to be balanced, though. The aim is to try to help people recover to the best level of functioning.
This bill is very exciting, because it brings the federal and provincial people to the same table to have the conversation about PTSD and learn from what has been done with the Canadian military and veterans. We have been having conversations in Manitoba with the Workers Compensation Board to look at whether we can develop models of care similar to those that have been provided for veterans, because each person, each Canadian, should have the same access.
12:55 p.m.
Liberal
12:55 p.m.
Executive Director, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada
I would like to address the importance of evidence-based policy development. Being able to measure the magnitude of the problem, being able to look at it over time to see whether it is increasing or decreasing, being able to look at risk factors and who is most affected in the population, and learning from different communities and what they've done to address the issue are all extremely important. This would give us not only an estimate of the burden, but also an idea of what resources may be needed and where we need to target the resources.
12:55 p.m.
Liberal
John Oliver Liberal Oakville, ON
Thank you.
At the end of the day, we as a committee have to approve or amend Bill C-211. One of the clauses says that the federal framework should include “the establishment of a national medical surveillance program to use data collected by the Agency”, the Public Health Agency.
Anne-Marie, do you know whether the Public Health Agency is collecting data now that we would be able to create that from?