Evidence of meeting #10 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pandemic.
A recording is available from Parliament.
Liberal
The Chair Liberal Ron McKinnon
Excuse me, Dr. Poon. Could you slow down a bit to allow the translators to keep up with you?
Medical Doctor and Founder, Faces of Advocacy
My apologies.
In the last goodbye protocol, there must be federal guidelines ensuring reasonable accommodation for Canadian families to have an appropriate bedside presence. Even if families are allowed in the same city, hospitals do not have a uniform bedside process, particularly at the end of life.
In our briefing, we have a first-hand account of an ICU nurse detailing the mental health pains that families go through from this lack of clarity at end of life. Provided that sufficient resources such as personal protective equipment are available, hospitals must allow culturally sensitive and safe opportunities for some family to be present for critically ill patients.
The basic idea is that during COVID we had patients whose family maybe were in the hospital but could not say goodbye to their family member. We have PPE now. We can educate patients on how to do this safely. The mental health outcomes of not being there for a proper last rites ritual have long-standing repercussions and must be addressed for the mental health of Canadians moving forward through COVID.
Number three, there must be a federal mandate for virtual care under the Canada Health Act. This would protect virtual/phone billing codes for primary care and mental health physicians to ensure accessibility, comprehensiveness and portability of mental health care for Canadians. This mandate must consider that physicians licensed to work in Canada may be displaced during the pandemic but are still able to provide virtual treatment.
For example, a physician in Saskatchewan is able to call patients in Saskatchewan. If that physician is displaced during the pandemic and is in Ontario, that physician should still be able to call the Saskatchewan patients in order to provide care. This will ensure continuity and consistency with the Canada Health Act. So far, Saskatchewan operates like that, but Ontario doesn't. That is why there must be a federal mandate.
In point number six in our recommendations are the end-of-the-tunnel health strategies. What we require is a federally mandated and federally managed national COVID-19 vaccine program. Provincial distribution would be subject to possible inequitable distribution amongst the most vulnerable, and when that is seen by numbers of Canadians, that can really adversely affect mental health. We already see how the mental health of Canadians deteriorates given that they see other people flouting public health guidelines or not following masking mandates. Imagine what will occur if there is not a transparent, equitable process for a national COVID-19 vaccine program.
Immunizations for COVID-19, when available, must be equitably distributed at no cost; this includes the elderly and the immunocompromised. This must be paired with a modern countrywide surveillance system to ensure proper calculations of response and attack rates, immunity and outbreaks. The reason it is federal and not provincial is to ensure transparency as well as consistency across the entire program.
The other part of the end-of-the-tunnel health strategy is that, once COVID-19 testing is proven to be reasonably accurate, a federal inquiry into testing must be considered as a replacement for the 14-day quarantine. It is one of the largest barriers to family reunification at the moment, as some people are unable to take a full two weeks off to see their family member. A federal inquiry into the efficacy and usefulness of testing is needed.
Family is essential in life and in death. COVID-19 forces us to face mental health challenges in both. This briefing recommends strategies to reunite families safely and reasonably and to accommodate end-of-life reunification in a considerate manner while simultaneously promoting and protecting mental health.
Thank you, Mr. Chair.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Dr. Poon.
We're going to Mouvement Santé mentale Québec.
Ms. Ouimet, you have seven minutes.
Renée Ouimet Director, Mouvement Santé mentale Québec
Good afternoon.
Thank you for inviting us to appear.
I'm going to bring you to the field of mental health promotion and prevention.
We are a group of community organizations dedicated to promotion and prevention. We have member groups across Quebec and have been around since 1955.
Our mandate is to create, develop and strengthen mental health, that is, to take action to try to maintain a mentally healthy population at all times, whether in the population as a whole, in the workplace or elsewhere.
I didn't hear the witnesses speak earlier, but there's one thing I'd like you to keep in mind as you leave this meeting. Mental health is a good, positive thing; it's not mental illness. When we talk about mental health, we're talking about an individual and collective wealth. The World Health Organization tells us that without mental health, there is no health. It's important to remember this.
Mental health is a dynamic balance between the different areas of our lives. Clearly, these days, it isn't an easy balance to maintain. However, promoting mental health is really working to increase the collective well-being, on a daily basis, and to help the population develop its mental health robustness factors. It is happening all the time, everywhere, throughout the life course, from childhood to old age.
The pandemic has shown us that there are already many people who aren't doing well. There were many young people going to school with distress and intense anxiety, many teachers who lacked resources, and many people in the health care system who were out of breath. The pandemic allowed us—perhaps this will prove to be positive—to look at the situation through a magnifying glass and discover that many things weren't going well in our society. There are people who are bouncing back very well in this situation, but there are others for whom it is much more difficult.
Many people say we're in the same boat, but we are not. We're all on the same ocean, but there are people who have tiny little cardboard boats, and there are people who are on ocean liners. Even in the pandemic, we aren't all equal, in the same situation. It's important to remember that.
I hope lessons will be learned from this pandemic. In the area of promotion, there are two areas where it is important to act. First, there's action on the social determinants of health. Currently, we know that the poorest and most vulnerable people have more mental health problems. The fight against poverty and access to education must be tackled. It is also necessary to pay attention to political interventions so that they are always universal and to design public policies that integrate mental health. As I said at the beginning, without mental health, there is no health at all.
At Mouvement Santé mentale Québec, we've developed seven tips. We have described, in simple words, what we call the robustness factors in mental health. You'll find them on our website, in French and English. An American researcher did research with American soldiers who had been in prison for eight years and who came out of prison without post-traumatic shock. He wanted to find out what helped them, after suffering and being imprisoned, to avoid post-traumatic shock. What comes out of this is these protective factors, which involve taking action and creating important bonds, which are fundamental, as Dr. Poon mentioned earlier, to recharge, to discover, and so on. I invite you to visit our site to learn about all these protective factors that need to be integrated into our lives, in our policies, in our schools, with seniors, at all times.
I have read several pieces of research on mental health promotion in the context of the pandemic. One of the things that I've found, which I'm sure you've heard of, that stands out and is very protective of mental health is having confidence in our authorities.
During the first wave, there was less distress in Canada and Quebec than in the United States or other countries because people trusted the authorities. It is important to maintain this trust.
We must always have access to accurate information. According to research, having a strong sense of coherence protects our mental health. A strong sense of coherence is when we are able to understand what is happening to us, to have the information to deal with and make sense of it, and to decide what measures to take.
It's important to remember that we can all foster a sense of coherence in people by providing them with accurate information and examples of what makes sense, and by helping them find solutions when they cannot do so on their own.
Emotions have often been talked about. Recently, I heard a researcher talk about the importance of welcoming our emotions, whatever they may be, before they blow up in our faces. This is a protective factor in mental health. You also have to listen to other people's emotions, because they are like a barometer. Emotions reflect a need, and we have to respond to them. Sometimes there is social anger and we intervene. This has a positive effect on the public's mental health. There are many other emotions.
During the pandemic, it is important to nurture positive emotions and talk about people who are doing well. Some companies stand out and are finding innovative and extraordinary solutions. They are putting in place really interesting policies and it is important to name them, to ask—
Director, Mouvement Santé mentale Québec
Let me finish by stressing the importance of having caring workplaces that protect our mental health. We know that psychological distress in these environments decreases by 24%. Another very important protective factor is to break social isolation.
Thank you.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Ms. Ouimet.
We will now go to Stepped Care Solutions.
Dr. Cornish, go ahead for seven minutes, please.
Dr. Peter Cornish Psychologist, Stepped Care Solutions
Thank you very much.
I'm going to speak about the availability of mental health promotion programs, in particular focusing on Wellness Together Canada, which is a federally funded program that Stepped Care Solutions launched in partnership with Kids Help Phone and Homewood Health.
As a researcher, I'm also going to speak to the role of virtual care and increasing access during the pandemic. Having worked with provincial, territorial and federal governments, I'm also going to speak to the role the federal government could play in supporting provinces and territories.
My non-profit company, Stepped Care Solutions, is the lead partner for Wellness Together Canada. Our diverse team comprises psychologists, social workers, IT experts and, perhaps most importantly, people with lived experience of mental illness.
We originally developed the Stepped Care 2.0 model in Newfoundland and Labrador, and it is now scaled across the province, both in population health and in clinic-based settings. We're working now with the Northwest Territories to do the same kind of implementation. The model informed the development of Wellness Together Canada, which was implemented in April over a period of 10 days, a very rapid implementation of a virtual portal. We're now working on improving the user journey as informed by the stepped care model. The original structure being implemented very quickly was...really, we just wanted to get tools and counselling into the hands of Canadians.
We realize, in the virtual world, how important the experience of being on a portal is. How the portal looks and feels is really the equivalent of what we call in mental health the importance of the common factors for producing good outcomes, which have a lot to do with the relationship or, in more colloquial terms, the bedside manner. What we really want to emulate is the romantic version of the rural physician, who, by very essence and personality, invokes a sense of “Things will be okay. You're under my care.”
Anyone in Canada who visits the Wellness Together portal will have the choice of 11 independent evidence-based and evidence-informed programs available 24-7, including immediate mental health crisis tech support, but also self-assessment and tracking tools so you can monitor wellness, self-guided tools based on cognitive behavioural therapy, peer-to-peer support, coaching and e-courses, and one-to-one counselling.
To date, almost 700,000 people have accessed the program. Of these, approximately 60,000 have registered for ongoing care. Seventy-eight per cent of users whom we surveyed through a random survey a few months ago indicated they would recommend it to a friend, which is an indication that they are satisfied with the program.
Some national polling indicates that people do have some concerns about privacy and fears that the programming on the portal would cost money. This is not true, of course—it's free—but we know those perceptions are out there. Around privacy, we discovered some fairly simple things when we asked people what could make the experience better, what we can do on the portal, and we are redesigning it to address those concerns.
I want to turn to the role of virtual care in general and increasing access during the pandemic. Some recent surveys on virtual clinic care experiences, including surveys on Wellness Together Canada, indicate that help-seekers like telemental health much more than we previously thought. Clinicians, my colleagues, psychologists, social workers, psychiatrists and physicians are not as pleased with virtual care. I think we will need to invest in more training and support to bring them along. The population likes it.
Another thing I want to emphasize around what we've learned through the pandemic is that virtual care has much more potential. It's much more than teletherapy.
Teletherapy is doing what we normally do, but using a system like Zoom, where we can deliver psychiatric or psychotherapy care. We're finding that it's just as effective, but there's so much more we can do in the digital world to accelerate long overdue system innovations, such as continuing to develop and invest in things like portals such as Wellness Together Canada, population health programs, and what we call “one to many” solutions, where you'd have a webinar that can be delivered to thousands of people at once.
There is also continuous wellness monitoring—we actually don't do a lot of this—and putting that data in the hands of users in our health care system. This could be scaled up nationally in clinic settings, as we're doing with Wellness Together Canada.
There is more rapid access to care. With Stepped Care 2.0, people get access to a variety of care immediately. On the portal, they get it immediately, whether it's a counsellor or using self-guided programs.
What we're finding through some polls is that virtual care appears to promote more equitable access. We're finding that there's a much more even distribution along gender lines on the Wellness Together Canada portal than we see in clinic settings. Racial representation of users is more representative of the population.
I want to conclude with a few points where I think the federal government could take on a continued role. It's in investing in technology infrastructure. We know that in the north and most rural areas, broadband access is difficult and is often delivered by satellite. We need to change that, because you cannot access the Wellness Together Canada programs as successfully in rural and remote places in Canada.
We need to continue scaling population-level programming and develop more and improved self-guided programming. People really like it. That's the thing they're going to the most.
Liberal
Psychologist, Stepped Care Solutions
Finally, what I'd like to say is that the federal government can take a role in integrating municipal, provincial and national levels to fill the gap that exists with mental health. The gap is immediate care for people who need it most, including those who are homeless and suffering from addictions. This model and this portal can be expanded to provide that support.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Dr. Cornish.
We go now to Women's Health Research Institute.
Dr. Brotto or Dr. Ogilvie, please go ahead for seven minutes.
Dr. Lori Brotto Executive Director, Women’s Health Research Institute
Thank you for inviting us to speak with you today.
I want to acknowledge that our work at the Women's Health Research Institute is situated on the traditional, ancestral and unceded territory of the Coast Salish peoples, which includes the Musqueam, Squamish and Tsleil-Waututh nations.
With regard to COVID-19, sex-disaggregated data reveals a higher case fatality rate for males compared to females. Of note, however, there are exceptions in some countries, such as India, where case fatality is higher in females. In a comment published recently in The Lancet Global Health, the authors speculated whether these higher rates in females might be due to factors related to their gender. We already know that pandemics can compound differential exposure and outcome for women, girls, sexual and gender minorities, caregivers, and other essential workers in gendered occupations.
The Women's Health Research Institute designed a two-part study that combined a survey and an examination of antibodies collected by dry blood spot sample. In our remarks today, we will only focus on a snapshot of the mental health outcomes.
I want to acknowledge our full team at the Women's Health Research Institute, colleagues from BC Children's Hospital Research Institute, all of the students and trainees, as well as funding from our BC Women's Health Foundation.
Dr. Gina Ogilvie Assistant Director, Women’s Health Research Institute
Thank you, Dr. Brotto.
A significant strength of our project is that it draws from seven existing cohorts that are representative of women in B.C., totalling over 40,000 individuals who've consented to be contacted for future research. These individuals received an email invitation that described the study's aims and obtained their e-consent.
The link then took them to the survey, which consisted of one core module focused on a comprehensive epidemiological survey on COVID-19-related symptoms and risks, socio-demographics, medical history and vaccine attitudes. They then proceeded to four modules that focused on substance use; psychosocial outcomes and gender-based violence; underlying comorbidities, including HIV; and economic outcomes and health care disruption. Where appropriate, such as with the psychosocial outcomes, we employed validated clinical scales.
At the end of the survey modules, participants were invited to send the survey link to another household member who identified as another sex or gender. They were also invited to provide their address to receive a dry blood spot kit to measure antibody responses, and those are being prepared to be sent out right now.
Participants were stratified into nine five-year age strata from 25 to 69, with a target for recruitment of about 750 participants for each of those strata, for a total of 6,750 participants. The data we're going to discuss today are based on responses from about 5,300 individuals, out of an approximate 15,000 invitations sent out, so we had a response rate of about 30%.
Just to be clear, while we administered the survey at one time point, for some of the questions we asked people to think about their experiences for three specific periods of time: the three months before the pandemic or pre-pandemic; during phase one of the pandemic, which was mid-March to mid-May; and phase two, which started after the middle of May. Going forward, we are continuing to collect longitudinal data.
I would like to share some of our results.
The mean age of participants was 51, and most of the respondents, 87%, identified as female. In terms of gender, we had 59 individuals who identified as trans or non-binary; 31% were essential workers, and over half reported chronic health conditions.
For this presentation, we will report on rates of overall depression, moderate and severe depression, anxiety, loneliness, distress, intimate partner violence, and alcohol and cannabis use in the defined three phases of the pandemic.
We plan, in the future, to report on these analyses by gender, culture and ethnicity, including indigeneity and race, as well as other socio-demographic variables, once our target sample size is reached.
Executive Director, Women’s Health Research Institute
Thanks, Dr. Ogilvie.
Moving on to depression, first of all.... Comparing males and females, and consistent with what we would have predicted based on past pandemics, there was a significant increase in depressive symptoms that was quite a bit higher in females compared to males as we moved from pre-pandemic to phase one. As pandemic controls started to loosen, we found a decrease in those depressive scores.
When we separated the data by age and not sex, our data showed that the highest burden was borne by the youngest age group—those 25 to 30 years old—and among our sample of trans and non-binary individuals, the scores were clinically significantly higher than the females.
We then moved on to look at extreme depression. Females experienced a four times greater increase in their rate of extreme depression from pre-pandemic to phase one, which was clinically significantly higher than for males. With regard to the trans and non-binary group, their pandemic rates of severe depression also doubled from pre-pandemic to phase one.
Anxiety can be defined as the fear of the unknown combined with a loss of control, so using a validated measure of anxiety that taps into worries and anxiety, we found a very similar pattern to what was found with depression: significantly higher rates for females, and a significantly greater increase from pre-pandemic to phase one, with the highest burden being borne by the youngest age group, 25- to 30-year-olds. This was also found when we focused specifically on clinically significant anxiety: Nearly 20% of the females during phase one of the pandemic fell into clinically significant anxiety rates.
One facet of depression is loneliness, which we asked about in a separate question. Again, the sex-specific findings were replicated, and the highest burden was borne by the 25- to 30-year-olds.
With regard to intimate partner violence or IPV, emerging data do show that, since the outbreak of the COVID pandemic, reports of IPV have increased worldwide as a result of mandatory lockdowns. We asked about a list of behaviours like being hit, thrown, kicked, beaten, etc. Our data were based on only the female population in a relationship.
Liberal
The Chair Liberal Ron McKinnon
Pardon me, Doctor. You're at seven minutes. Could you wrap up, please?
Executive Director, Women’s Health Research Institute
Thank you.
There was a near-doubling of rates of intimate partner violence from pre-pandemic to phase one.
Finally, among alcohol and cannabis groups, we found that one-third of the participants reported an increase in alcohol use, and 40% of the youngest age group reported an increase in cannabis use.
In summary, our data show significant effects of sex, with females being disproportionately more impacted when it comes to depression, anxiety, loneliness, overall distress and significant increases in intimate partner violence. We recommend a sex- and age-specific tailoring of mental health resources based on these data.
Thank you very much.
Liberal
The Chair Liberal Ron McKinnon
Thank you.
We will start our round of questioning. We will have time for one round of questions, and we will go over the hour somewhat.
We will start with Ms. Rempel Garner for six minutes, please.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Thank you, Mr. Chair.
Dr. Poon, how many of your members do you think can afford to take the two-week quarantine period to reunite with their loved one?
Medical Doctor and Founder, Faces of Advocacy
We are thankful that the Government of Canada has allowed family reunification to occur, although much later than we expected. The question is this, though: How many of them can afford the two-week quarantine once they arrive in Canada, as well as the two-week quarantine when they go back into their home country?
Now, this is not to be disparaging and to be flippant about the health and safety of Canadians. There must be a safe pathway to do so. That is why in our recommendations we believe that there must be an inquiry into alternatives to the 14-day—
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Dr. Poon, my six minutes are going to go really quickly, so I'm just wondering—
Medical Doctor and Founder, Faces of Advocacy
That's all right.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Do you think many of your members can afford that two-week quarantine?
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Look, this is probably the first time I have ever done this in my time in Parliament, but I will get personal for a second.
I didn't expect a tall, dark and handsome American to come into my life. I'm glad he did. However, even in my position of privilege, it was over five months that I was separated from my husband this year, and it was only because of the Alberta pilot project that we were able to see each other. It's really hard. I don't get to see my kids. I don't get to see my mother-in-law, who has stage 4 breast cancer. It's hard.
This is me as a legislator sitting in this committee right now. Everyone on this committee knows that I'm as tough as nails—I know some of the names the Liberals call me—but every night when I come home alone, it's hard, and this is me.
I'm wondering if there are alternatives to quarantine that have better public health outcomes, like if we could test everyone at the airport, as opposed to letting four million people come in untested who may or may not observe the quarantine. I know there were quarantine exemptions for that many people over the last several months.
I'm just wondering, given that you are a clinician, Dr. Poon, if part of your recommendation is to expand systems like the one we're seeing in Alberta to other airports and other border crossings across the country so that it can aid in family reunification.
Medical Doctor and Founder, Faces of Advocacy
The system in Alberta, along with the pilots in British Columbia and Ontario for airport testing, will offer wonderful ways to increase the number of reunited families, particularly if we apply what's being used in airports to the land borders, which should be helpful.
Once again, we are not asking for open borders. We are just asking to be together and we want to be together safely.