Health Committee on Nov. 30th, 2020

[The Chair, Liberal, Ron McKinnon]

I call the meeting to order.

Welcome, everyone, to meeting number 10 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the second wave of COVID-19, with a focus on mental health aspects.

Witnesses, thank you for appearing today. You will have seven minutes for your presentations.

For the first hour we have, as an individual, Dr. Victoria Dawson, medical doctor. From the British Columbia Centre on Substance Use, we have Dr. Nadia Fairbairn, clinician scientist. From the Canadian Medical Association, we have Dr. Ann Collins, president, and from the Canadian Mental Health Association, Quebec division, we have Karen Hetherington, president.

For the second hour we will have, from Faces of Advocacy, Dr. David Edward-Ooi Poon, founder. From Movement Santé mentale Québec, we will have Renée Ouimet, director. From Stepped Care Solutions, we will have Dr. Peter Cornish, psychologist, and from Women's Health Research Institute, we will have Dr. Lori Brotto, executive director, and Dr. Gina Ogilvie, associate director.

Today's meeting is taking place in a hybrid format. I would like to start the meeting by providing you with some information following the motion that was adopted in the House on Wednesday, September 23, 2020.

As we are now sitting in a hybrid format, this means members can participate either in person or by video conference. All members, regardless of their method of participation, will be counted for the purpose of quorum. The committee's power to sit is, however, limited by the priority use of House resources, which is determined by the whips. All questions must be decided by recorded vote unless the committee disposes of them with unanimous consent or on division. Finally, the committee may deliberate in camera, provided that it takes into account the potential risks to confidentiality inherent to such deliberations with remote participants.

The proceedings will be made available via the House of Commons website. Just so you are aware, the webcast will always show the person speaking rather than the entirety of the committee.

To ensure an orderly meeting, I would like to outline a few rules to follow.

For those participating virtually, members and witnesses may speak in the official language of their choice. Interpretation services are available for this meeting. You have the choice, at the bottom of your screen, of floor, English or French. Before speaking, click on the microphone icon to activate your own microphone, and when you're done speaking, please put your microphone on mute to minimize any interference.

I remind everyone that all comments by members and witnesses should be addressed through the chair. Should members need to request the floor outside of their designated time for questions, they should activate their microphone and state that they have a point of order. In the event that a debate occurs, members should use the “raise hand” function. This will signal to the chair your interest in speaking and create a speakers list. In order to do so, you should click on “participants” at the bottom of the screen, and when a list pops up you will see next to your name that you can click “raise hand”.

When speaking, please speak slowly and clearly. Unless there are exceptional circumstances, the use of headsets with a boom microphone is mandatory for everyone participating remotely. Should any technical challenges arise, please advise the chair. Please note that we may need to suspend for a few minutes as we need to ensure that all members are able to participate fully.

For those participating in person, proceed as you usually would when the whole committee is meeting in person in a committee room. Keep in mind the directives from the Board of Internal Economy regarding masking and health protocols. Should you wish to get my attention, signal me with a hand gesture or, at an appropriate time, call out my name. Should you wish to raise a point of order, wait for an appropriate time and indicate to me clearly that you wish to raise a point of order.

With regard to a speakers list, the committee clerk and I will do the best we can to maintain a consolidated order of speaking for all members, whether they are participating virtually or in person.

We will now go to the witnesses.

Welcome, witnesses. We will start with Dr. Victoria Dawson.

Please go ahead, Dr. Dawson, for seven minutes.

[Dr. Victoria Dawson, Medical Doctor, As an Individual]

Thank you so much for inviting me today, honourable members of the committee, and thank you to all the witnesses.

I am Dr. Victoria Dawson. I work in rural Ontario in Wasaga Beach and Collingwood. I have a family practice. I'm here today to talk about the impact of the COVID second wave on our seniors primarily, since that's the majority of my population. I felt it was important to get the community aspect of what's going on. I do nursing home care, plus I have a clinic.

I had quite a number of meetings with my clientele. There's a lot of concern. There is limited help for seniors. I realize that a lot of virtual care has been going on with regard to mental health. However, unfortunately, my seniors are 80 and 90 years old and unable to access things like smart phones or Internet or even use a computer. Many of them have been left alone at their nursing homes because they're isolated from other members.

Our seniors have multiple health issues, such as dementia. They are unable to recognize people over video. They do better with in-person visitations. We have patients with COPD who are breathless, who can't necessarily hold a conservation on video or they can't make enough sound to be heard, so it's very difficult for them to speak on the phone or on virtual media.

Deafness is a huge one. I find that when I do telemedicine, my patients cannot hear me, so when they're trying to connect with other seniors or with their family members, they cannot hear anything, which is very problematic, and it's very difficult to overcome. There are even speech disturbances. It's very difficult sometimes to be heard, as we figured out with my microphone. With visual disturbances, they can't see their family members. Maybe they have a distance field deficit and they're not able to see their family members.

These seniors have communicated to me that they're very lonely. A lot of them are expressing suicidal ideation. They're wanting to die because they just can't face another month or two months without being able to communicate with or see their family members.

There are different community members who are trying to reach out to seniors and who have expressed some concerns as well. One of the concerns is about smart devices. They're unable to access care.

Fear is the other issue, because they don't have access to different resources, as you and I do, to tell them what's going on in the community. Unfortunately, the media is driving a lot of the fear. I'm finding that a lot of my seniors are not coming in to be seen or have their medical problems treated because they are just so scared to go. I had a really nice lady who sat with abdominal pain for eight months, and then we found out she had advanced cancer. Unfortunately it was diagnosed in the emergency department because she was too scared to go anywhere else for months.

With regard to COVID, there's a general lack of nursing home attendants protecting these patients. They've been completely neglected. In trying to protect them, we're also harming them.

I'm here to see if we can do something for these patients and try to find a balance so they're able to communicate with the outside world, create social circles for them because they thrive on being able to talk to other people.

I'm here to say that we need better mental health services for our seniors. A lot of the mental health is great, and I have referred people to virtual care like BounceBack Ontario. But seniors are not able to communicate through those devices, so they're often left with nobody to talk to. The nursing homes are understaffed. A lot of family members were going in and helping their seniors, whether it's cooking them meals or helping them get dressed, and now they're left in their rooms not able to communicate or get the extra help they need.

I'm here to speak for this forgotten population. In protecting them, we have also harmed them. I think that as a committee, as humans, as health care providers, we really need to reach out to that community and make sure they're well protected.

Many of them say to me that they have one or two good years, and they want to spend their one or two good years with family. How can we make that happen?

I know that I'm running out of time, and I also want to touch on our middle-class communities, working-class communities and family members who are not able to make ends meet. I've had a significant increase in this community in drug abuse and alcoholism. That's actually amongst the seniors as well, and people forget that this is how they're trying to deal with their problems as well. I understand why businesses are closed, but they have their entire lives invested in them.

We're seeing the reverberations in the children. The children are in turbulent environments. They're not able to cope with this. We're seeing a high rate of depression and anxiety in those as young as five or six years old when they're realizing what is happening to them. They don't necessarily understand what's going on at school. They understand about a virus, but they can't understand why mom and dad can't pay their bills, or why, not knowing where the next paycheque is going to come from, they have to go to the food bank this week.

I've also had some families who have become homeless during this, and there's no support for them. I'm really spinning my wheels in my community and trying to make sure that everybody is well taken care of, but frankly, I don't have the resources for these patients. I'm at a loss as to what to do. I've talked to other members in my community, and they're also expressing the same concerns. The high rate of suicidal ideation and the amount of mental health...coming in through the emergency departments are something that we can't even handle.

In the rural communities, we really need help. Seniors are number one. They're the ones who are suffering the most. I just want to highlight what we are dealing with from a family medicine perspective on getting these patients some help. Maybe it's financial assistance. We need something.

[The Chair, Liberal, Ron McKinnon]

That's seven minutes, Doctor. Could you wrap up quickly?

[Dr. Victoria Dawson]

Yes, thank you. I'm done.

[The Chair, Liberal, Ron McKinnon]

Thank you very much.

We go now to Dr. Nadia Fairbairn, clinician scientist at the British Columbia Centre on Substance Use.

Go ahead, Dr. Fairbairn, for seven minutes.

[Dr. Nadia Fairbairn, Clinician Scientist, British Columbia Centre on Substance Use]

Good morning, Chair Ron McKinnon, Vice-Chairs Luc Thériault and the Honourable Michelle Rempel Garner, and members of the Standing Committee on Health.

My name is Dr. Nadia Fairbairn. I am a clinician scientist and an assistant professor in the department of medicine at the University of British Columbia. I am here on behalf of the British Columbia Centre on Substance Use, a provincial organization with a mandate to develop, help implement and evaluate evidence-based approaches to substance use and addiction throughout the continuum of care, from prevention to treatment to harm reduction to recovery.

I've been invited to speak here today with regard to the impact of COVID-19 on mental health and substance use for Canadians. I will focus on substance use, while acknowledging the intersectional impacts of this pandemic on population levels of depression, anxiety, domestic violence and adverse childhood experiences, among others.

Let's look at alcohol, our most commonly used substance in Canada and one that was responsible for $15 billion in health and social costs in Canada in 2018. Alcohol intake in excess is linked to increased mortality, cancer risk and other chronic conditions, although many Canadians and clinicians are unaware of Canada's low-risk alcohol drinking guidelines.

A recent Nanos poll found that pandemic-related alcohol consumption is increasing across all age groups in Canada. A recent CIHR study found that nearly one in four respondents reported consuming more alcohol, both in quantity and frequency, during the pandemic. The issue is particularly pronounced among 18- to 34-year-olds, with nearly half reporting an increase. Nearly one in 10 Canadians who drink alcohol says that they have had issues with controlling their ability to stop drinking since the start of COVID-19.

Due to time limitations, I'm not able to comment on other legal drugs, such as tobacco or cannabis, but these are also responsible for mounting health and social costs and harms during COVID-19. We know with certainty that increased consumption of substances is associated with an increased burden of social harms, health harms and dependency.

Why is this happening? Consuming substances like alcohol is a way for some people to manage or control their stress, as well as symptoms of depression or anxiety, during the pandemic. In addition, recognizing our societal dependence on alcohol and fearing the fallout from restricting access to alcohol during times of public health lockdown, most provinces, except P.E.I., declared liquor retail an essential service. This was a sound decision, given that, without proper care, alcohol withdrawal can be a life-threatening condition. In order to ease the financial burden on the hospitality industry, municipalities also relaxed restrictions on access to liquor by permitting restaurants to offer alcohol for takeout with take-away food. Retail markups on liquor were also reduced.

In the case of illegal drugs, the situation is dire. The overdose crisis continues to have a significant impact on Canadian communities and families. With an average of 11 deaths and 13 hospitalizations every day between January 2016 and March 2020, it is one of the most serious public health crises in Canada's history.

During COVID-19, overdoses and fatal overdoses across Canada are occurring at the highest rates ever recorded. Deaths in British Columbia hit new highs over the spring, including a monthly record of 181 illicit drug toxicity deaths in June. Five years into the declaration of the public health emergency in the province, the province is now on pace to see the highest number of overdoses in one year. Alberta revealed in September that 301 people in the spring died due to overdose—also a record. In Ontario, overdose deaths jumped by nearly 40% in the first months after COVID-19 hit the province, on pace to extend to 2,200 overdoses—the highest on record. Overdoses have taken far more lives than COVID-19 has in these three provinces, which are the hardest hit by the opioid crisis, yet our response has been muted in comparison. Even more so than with mental health, the unmet needs, already large, are increasing.

On a personal note, this has been the most challenging time to practise addiction medicine. I have had to make several calls to families and loved ones following the loss of a patient to overdose during the pandemic, and my heart goes out to each of them who are suffering and grieving. It is every community in Canada that is being affected.

There are many reasons why overdose deaths have gone up during the pandemic. First, contamination of the illicit drug supply with synthetics, fentanyl and its analogues, as well as other poisonous substances, such as the very potent benzodiazepine etizolam, has driven the overdose crisis in Canada since 2016.

During COVID-19, changes in the illegal drug supply, as supply chains have been disrupted by travel restrictions and border measures, have led to further poisoning of the drug supply in Canada. At the same time, there has been less access to supports and services for people who use drugs, as well as hesitancy to seek treatment through the health care system due to concerns regarding COVID-19 risk in health care settings.

This has led to reductions in the use of harm reduction services such as supervised consumption sites, as well as reduced access to treatment services such as detox and recovery beds. Substance use, including relapse rates, has increased as many struggle to cope with stress during this difficult time.

There are a number of actions that can mitigate the increasing harms we're seeing due to substance use during the COVID-19 second wave in Canada.

We need to raise awareness of the potential harms of alcohol use and encourage people to follow safer consumption and lower-risk drinking guidelines.

We need to understand and anticipate that the pandemic may lead to an increased risk of relapse for those in recovery from substance use disorders. We need to improve screening and treatment of people at risk for relapse to substance use and to improve access to evidence-based treatments and recovery-oriented services as part of a comprehensive system of care for addiction.

There is a pressing need for more evidence-based clinical guidance and more training of health professionals to equip them with the knowledge of care for substance use and addiction to build capacity in the health system. Access to pharmaceutical alternatives is needed to prevent overdose and other severe harms caused by a contaminated illicit drug supply.

Finally, I agree with the chief public health officer of Canada, the Canadian Association of Chiefs of Police, and Moms Stop The Harm, a network of Canadian families impacted by substance use-related harms and deaths, that to mitigate the pressing harms of substance use and in order to be able to treat addiction as the medical condition it is, the decriminalization of people who use drugs is essential, as was unanimously endorsed by Vancouver City Council just last week.

I would like to thank Ms. Cheyenne Johnson and Dr. Perry Kendall at the BC Centre on Substance Use, B.C. Minister of Health Adrian Dix and B.C. Provincial Health Officer Bonnie Henry for their leadership in B.C. during this time of need.

Thank you very much for your attention.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Fairbairn.

We go now to the Canadian Medical Association, with Dr. Ann Collins, president.

Dr. Collins, please go ahead. You have seven minutes.

[Dr. Ann Collins, President, Canadian Medical Association]

Thank you, Mr. Chair.

It's my honour to appear before you today. My name is Dr. Ann Collins. In a three-decade career, I have taught family medicine, run a full-time practice, served with the Canadian Armed Forces and worked in nursing home care. Today, as president of the Canadian Medical Association, I am proud to represent our 80,000 members, so many of whom have been working all out for over nine months and counting.

Our health systems and the people who work in them were stressed well before then. Now we are at a tipping point. I am deeply concerned about the mental health of Canadians. I am deeply concerned about my physician colleagues and health care providers who work alongside them. Psychological trauma is anticipated to be the longest-lasting impact among health care workers in the post-pandemic environment. After almost a year on the front lines in untenable circumstances, burnout is a grave concern. We are sounding the alarm.

When Canadians banged their pots and pans, they shouted their support for those risking their lives on the front lines. The pots are now nestled in the kitchen drawers, but the pandemic has not stopped. It's worse. The risk to front-line workers persists.

At the pandemic's onset, a lack of coordination of emergency supply stockpiles among federal and provincial governments led to inadequate deployment of such supplies as ventilators and a widespread void of sufficient PPE for front-line health care workers. Physicians were faced with the ethical dilemma of being unprotected while treating patients and potentially putting their families at risk, in addition to having to make decisions about allocating life-saving intervention.

The explicit anxiety haunting front-line physicians is palpable. They are at high risk of developing symptoms of burnout, depression, psychological distress and suicidal ideation. Gruelling work hours, uncertainty, fears of personal and family risk, experiences with critically ill and dying patients—these conditions create unprecedented anxiety.

Physician burnout was a nationwide challenge long before the COVID-19 pandemic emerged. In 2018, 30% of physicians reported high levels of burnout. The outcomes of human health resource issues, system inefficiencies and overcapacity workload create a culture of sustained burnout. No amount of therapy, yoga or mindfulness will make it go away. The consequences reach much further. They lead to bad patient outcomes.

We are calling on all levels of government and health authorities to work together to protect Canadians and health care providers during the second wave of COVID-19 through a series of four strategic investments and actions.

The first is that all governments recognize and raise awareness of the need to support health care providers as part of their public education messaging on COVID-19. There is nothing benign about remaining mute on this subject. Patient safety depends on the mental health stability of medical professionals.

The second is that the federal government invest in the creation of a mental health COVID-19 task force that mobilizes national mental health associations and professionals to support the mental health needs of care providers during and following the resurgence; and that the government increase funding to jurisdictions, enhancing access to existing, but strained, specialized mental health resources for health care providers.

Third, our vulnerable populations and people living in rural and remote areas are disproportionately affected. The federal government must fund and implement sustainable, evidence-based mental health services and supports to respond to the increased demand for mental health care resulting from COVID-19. We must also intensify access to critical social support services and embed virtual care. We welcome the commitment to expand broadband across the country. It has the capacity to create equitable access to virtual care. But the success of digital health care relies on not only broadband expansion but also the development of digital health literacy programs and measures to ensure equity of access for marginalized populations.

Lastly, we simply cannot ignore the risk of a health care shutdown. Avoiding this is absolutely critical. Following public health measures is needed, as well as federal investment. A health care and innovation fund of $4 billion in federal funds would address the backlog of medical services, expand primary care teams and boost the capacity of public health.

These measures don't exist in a vacuum. It is their combination that blazes a path to Canadian health security.

Canadians need the confidence that their health care system is there for them, that the physicians and front-line health care workers are in good shape. With burnout becoming the most significant challenge to the health care system, we face a degradation of care for our patients.

Every tipping point needs a steadying hand. Canada is reaching out for it. Great victories require two elements: a common enemy and solidarity. We have a common enemy—it's viral—but without solidarity there will only be more harm and loss. This virus doesn't care about politics. It doesn't recognize federal, provincial or territorial lines, and it doesn't care about a perceived stake. These case numbers aren't numbers; they are lives, and we must fight for them, all of us, together.

Mr. Chair, let me thank the committee for the invitation to share the convictions of Canada's physicians.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We'll go now to the Canadian Mental Health Association, with Ms. Hetherington, president.

Please go ahead for seven minutes.

[Karen Hetherington, President, Canadian Mental Health Association – Quebec Division]

Good morning, everyone.

Thank you for the invitation to appear before you today.

I'll speak in French, so I hope the interpretation is working.

I'm the president of the Canadian Mental Health Association. I'm here to speak on behalf of the Quebec division.

I won't waste my time talking about statistics, since Dr. Fairbairn, Dr. Dawson and Dr. Collins have explained the effects very well. I'll focus on what we can do. I'll talk about possible solutions to the crisis we're experiencing.

Everyone is affected by COVID-19, but everyone is affected in a different way. The question is how can this be changed to have an overall effect on the Canadian population. In 2019, the Canadian Mental Health Association released a document entitled “Cohesive, Collaborative, Collective: Advancing Mental Health Promotion in Canada”. In our view, mental health promotion is the final frontier. It is the file to be explored and developed.

Promotion differs from prevention. Prevention focuses on reducing symptoms. Promotion focuses on positive mental health. Positive individual and collective mental health must be cultivated. These interventions must be made throughout the lifespan. This includes all populations, including youth and seniors with different life experiences. Promotion can take place in different settings, such as schools, local settings and workplaces. The good news is your mandate. The federal government has that responsibility. It can provide focused leadership in the current crisis.

Mental health promotion is inclusive. It reaches the rich, the poor, people already diagnosed with mental illness and people at risk. It allows for the development of a campaign that respects these differences and addresses the issue of the ever-changing nature of this crisis.

At the beginning of the pandemic, people across Canada posted rainbows, and people often said, “It's going to be okay”. It was very comforting in March, April and May, but December is tomorrow. Is it as comforting?

Mental health promotion is a complex thing. What speaks to me may not speak to you and may not speak to the most vulnerable population.

At the Quebec division of the Canadian Mental Health Association, we believe that a community mental health approach is needed to ensure that the campaign will reach the most vulnerable in many different ways. Community organizations have an intimate knowledge of the vulnerability of individuals, families and communities. They have experience with the other layer of exclusion that these groups are currently experiencing. The speeches of all the witnesses before me are proof of this. The most vulnerable people in our community are experiencing another layer of exclusion that is really difficult.

What can be done?

In our opinion, the only way is through community organizations. We already have campaign models. Mental health week has been carried out by the Canadian Mental Health Association for 70 years now. Five years ago there was the get loud campaign. This year, because of the pandemic, we feel we really need to talk about it. There's a need for comprehensive campaigns and very targeted interventions that reach out to the different needs of the population. The only way to do that is through mental health promotion and through community organizations across Canada.

For example, Quebec has the Vieillir en bonne santé mentale program. People can't stay connected or they don't have access to technology. You really have to be innovative. As I said, it's a complex issue. You have to mobilize community agencies that can respond. All community movements have an advantage.

They can change on a dime, and this COVID virus gives us the opportunity to live continuous uncertainty and we need to turn on a dime.

My recommendations are very clear. The government must commit to mental health promotion. It must not be limited to impact. It has been proven that it will have an effect, not just on the impact of COVID-19, but on the entire health care system and health care needs.

Therefore, I recommend that the federal government support community mental health across Canada with a specific mandate to develop mental health promotion programs that are innovative and adapted to the current context.

These programs should foster positive mental health through positive messages delivered to our diverse communities and promote the connectivity of citizens, whether at home, at school, in the community at large, or at work.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Hetherington.

We will start our questioning now, but we will only have time for one round of questions on this panel.

We will start with Ms. Rempel Garner.

Please go ahead for six minutes.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Chair.

I had a bunch of questions prepared, but I have to say that what I just heard, particularly from Dr. Fairbairn and Dr. Dawson, is very sobering. I would frame what I heard from the two of you this way. First of all, I acknowledge that COVID-19 is serious and we all have to work together to prevent it. I'm not putting any question there, but the prolonged impact of the measures we've seen has had significant corollary health impacts. I heard everything: mental health issues, isolation and suicide risk, opioid deaths, increase in substance abuse, the delays in surgery, increase in domestic violence and increased rates of depression. However, I think the line that stuck with me the most is “In trying to protect them, we're also harming them.”

This is what's been keeping me up at night as a policy-maker. How do we protect the public from COVID-19 and at the same time understand that we may be causing harm? It's an area I don't know how to talk about as a legislator because I don't want to diminish the severity of COVID-19, but at the same time there's a serious problem here.

I'm going to divide my time between the two of you, Dr. Fairbairn and Dr. Dawson, because you're on the front lines right now.

For each of you, what are three short-term recommendations? I know, to what Dr. Collins and Dr. Hetherington said, we need longer-term solutions to deal with the health care system in Canada. I couldn't agree more. But Dr. Fairbairn and Dr. Dawson, if you were sitting in my role right now, what are the three things you would do to make a short-term change to get to that nexus where we're protecting people from COVID-19 but also addressing some of the concerns you raised?

I will start with you, Dr. Fairbairn. I only have four minutes, so if you could keep your comments very short that would be helpful.

[Dr. Nadia Fairbairn]

Thank you so much for that question.

It does feel as though COVID-19 has pulled back a layer of what was already not adequate within the addiction treatment system. When it comes to areas of urgent need at the intersection of COVID-19 and addiction, first we need an urgent scale-up of service access to evidence-based services for addiction. That includes harm-reduction services, like supervised consumption sites and naloxone. That also includes detox and recovery beds. I've had numerous clients who want to access detox who relapsed during COVID-19, and those services are all scaled down because of COVID-19 precautions. Scaling up all services that are needed for addiction treatment would be first.

Second, we need an expansion of access to pharmaceutical alternatives to the drug supply. Fentanyl is not going away. The contaminated drug supply has only gotten worse with COVID-19 and this is not going to miraculously resolve itself. We really need to be able to offer people who want to prevent overdose and fatalities for themselves, and the impacts on their families and communities, urgent access to these medications.

Third—

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Dr. Fairbairn, I have only two minutes left—I've been going so fast—and I want to give Dr. Dawson a chance to get in with her perspective on rural and remote treatment right now.

[Dr. Nadia Fairbairn]

Sure.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

As Dr. Fairbairn said, what are the most urgent things at that nexus between the COVID policies that we have right now and the corollary health impacts? What could change? What could we be doing differently right now to stop some of the issues you're seeing?

[Dr. Victoria Dawson]

I think we really need to start connecting our seniors with some sort of mental health care and try to do it in a safe way by accessing rapid testing so that people can actually go in and see these seniors. They live for their families. We need to reconnect them. We need to get counsellors or anybody to see these patients face to face.

Unfortunately, unlike those of us who are in the digital world and can connect with people, seniors never grew up with this. They maybe were introduced to this 15 years ago. That's not enough. They need to be able to connect, to see people, to see facial expressions and to see their grandkids or their family members.

I think it's about accessing the rapid testing so that this can happen, and about creating a safe bubble community for our seniors: having five or six people that they once again can connect with safely. Once again, it's about using things like rapid testing. Fifteen minutes in their world is fine, but we can't wait days, weeks or months for testing to come back.

I am seriously concerned about the amount of alcohol that is being used by seniors. Just as younger persons are, they are using it to deal with this. Patients have come to me—they finally broke down and came to the office—and have said, “Dr. Dawson, I can't do this anymore.” They saw an article and they say, “I want to be referred to MAID because my whole life is my family.” They see those articles and they say, “I don't want to live anymore.”

What do you do with these seniors who can't reach out? They can't use BounceBack in Ontario because they don't have a computer. We really need to try to create a group for them, whether it's a social-distancing coffee hour for seniors to talk about things or getting them connected with their families, to try to stop that wheel of fear.

Family members don't want to go visit grandpa and grandma because they're scared of causing them to die. The realistic aspect is that they'll probably die sooner from something else other than COVID, especially if we put proper checks and balances in place.

[The Chair, Liberal, Ron McKinnon]

Can you wrap up your answer, please?

[Dr. Victoria Dawson]

Thank you.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you to you both.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Rempel Garner.

We will go now to Mr. Fisher.

Mr. Fisher, please go ahead. You have six minutes.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you very much, Mr. Chair.

Thank you so much to all of our experts here today. We really appreciate your testimony and your opening statements.

I'm going to focus my comments and questions on Dr. Collins, a fellow East Coaster.

Thank you, Dr. Collins, for your service in the Canadian military.

It's so clear that mental health issues have spiked during COVID-19. I'm wondering, Dr. Collins, if you could talk about some of the key populations you're most concerned about and how the government can better support these people during COVID-19.

[Dr. Ann Collins]

Thank you very much for the question.

First, I am here representing the 80,000 members of the Canadian Medical Association, who have been on the front line tirelessly for the last nine months. I want to thank them and acknowledge their service and commitment.

I also want to emphasize and acknowledge what they are currently dealing with. They have already had high levels of burnout, as we showed earlier in 2018. However, during this pandemic, they've had to deal with uncertainties around PPE, and we hear that this still exists in some parts of the country. They have concerns for their families and for themselves. They care daily for people with COVID-19, but also for people impacted by what you've heard from previous speakers about COVID-19.

For them, we call upon government to establish a COVID-19 virtual care task force to look at their impacts, and to make a strong commitment with public education messaging around the need for support for health care providers.

Other populations that have been profoundly impacted—and you've heard most eloquently from previous speakers—include our seniors.

I want to put some emphasis on our youth. In my practice, in the last 30 years, I saw an increasing level of anxiety among adolescents and even pre-adolescents. That impacted their schooling, their relationship with family and their relationship with friends. I and their parents struggled to find adequate resources to serve their needs.

I can only imagine what COVID-19 has done with that age group in terms of the disruption in the types of schooling they're having, in terms of loss of social contacts with concern about the pandemic, and in terms of who's in and who's not in their bubble and whom they can or cannot see.

Again, we're calling upon enhanced social supports and services in a coordinated way, between all levels of government and health authorities, to service this population, as well as seniors, our indigenous communities, and people living in rural and remote Canada.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you, Doctor.

One of the first things this government did, during the renegotiation of the health accord, was invest an additional $5 billion over 10 years specifically dedicated to mental health.

Are you seeing the results of this investment yet in health care systems across the provinces and territories?

[Dr. Ann Collins]

We support investments that have been made to support mental health in the past, and investments that have been made to support what's happening now in the pandemic and what's been happening since March.

Our need today is to emphasize—regardless of what's been done in the past—what's happening now, and to be very acutely aware of what's happening with our health care providers, as well as our vulnerable communities and Canadians across the country, in general. We need to look at ways, collectively and collaboratively, to improve the delivery of service, access to service, and the number of professionals providing that service.

First of all, we need to look to now, in part to control what's going to happen from the mental health perspective, but also, let's not forget, to control the transmission of the virus right now, and what the needs will be in the short term and the long term as a result of this.