Health Committee on Nov. 30th, 2020

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

Dr. Collins, the outbreaks and deaths in long-term care homes across Canada are one of the greatest tragedies of the pandemic, and likely one of the greatest tragedies of our lives.

The mental health impacts on those in long-term care must be profound. How can we support not only those living in long-term care but also those working in these facilities?

[Dr. Ann Collins]

That is a critical point in terms of those health care providers and all those who work alongside them.

Again, it's to have enhanced services within provinces, within those areas, to target the type of support those providers need. We need those people to be in good shape; we need them to carry on. They need to know they're supported; we need to show they're supported by putting boots on the ground and providing access to the care they need.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Fisher.

Mr. Thériault, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, I missed what you said. Since I was listening to the interpretation when you switched to French and your voice was very low, I didn't understand you.

I suppose it's my turn to speak?

[The Chair, Liberal, Ron McKinnon]

Yes, it's your turn, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

I'd like to thank all of you.

We have a general idea of what is going on in the mental health field. There are people around us who are depressed or anxious. We go out a little bit, though, and we get phone calls in our constituency offices. This morning, I found that reality was hitting hard.

In the first wave, witnesses told us that the pandemic was highlighting what we didn't do well, which was working on the first determinant of health: prevention. Our shortcomings are now jumping out at us.

If we want to engage in positive promotion, we have the opportunity to get our act together and make things right. We are in the middle of the second wave, and we should have a clear signal.

All you need are resources; it's not just a matter of coordination. Over the last 25 years, funding for health care systems has really deteriorated. Where there were always cuts was in mental health prevention. Mental health has always been overlooked in health care systems.

I imagine that you will be calling loud and clear on the federal government to give a clear signal now to restore health care networks and rapidly increase health transfers. There needs to be some catching up in this regard.

Please feel free to say so. This isn't playing politics. In our constitutional framework, the people who provide care are in the territories, in the provinces, in Quebec. These people have to be able to plan things.

Ms. Hetherington, you have great ideas, but it takes money to make them happen. Do you agree with me that the government should announce today, in its economic update, that it will significantly increase health transfers? It doesn't make sense anymore.

Who wants to respond to my remarks?

[Karen Hetherington]

You didn't ask a question.

More resources are needed. As I said, prevention and promotion programs will help to improve our health care system.

Our health care system is overwhelmed. We need to invest in prevention and promotion before the mental health of workers deteriorates completely. It is clear, plain and simple: the provinces need more money to provide services to the population. All prevention programs fall under provincial jurisdiction, and the provinces should have the money to deliver them. Promotion is a provincial responsibility, but it is also a federal responsibility.

I completely agree with you, Mr. Thériault. More money needs to be transferred to the provinces so that they have more resources. This time, it must be clear: we must invest in prevention and promotion.

[Luc Thériault, Bloc, Montcalm, QC]

We're talking about transfers, and people might say that a lot of money is being spent on COVID-19, but we need sustainable and structuring investments that will allow our networks to get back on their feet and correct the mistakes that have been made. We have the opportunity to start from scratch, to get back on the right foot.

Ms. Hetherington, in the document we received this morning, around 10:00 a.m., you say that one in five people will personally experience a mental health problem or mental illness. Your organization says the following:The Mental Health Commission of Canada (MHCC) estimates that the direct annual cost attributable to mental health problems and mental illness—health care, relevant social services, income supports—is at least $42 billion. By contrast, total direct costs for cancer care in Canada, which includes hospital care, was in 2012 estimated at $7.5 billion, while direct costs for heart failure are estimated at $2.8 billion per year. These costs parallel those in peer jurisdictions such as England and at the global level: the World Health Organization…

It's really not insignificant.

[The Chair, Liberal, Ron McKinnon]

Mr. Thériault, you have 30 seconds left.

[Luc Thériault, Bloc, Montcalm, QC]

Medical students are told that prevention is the number one determinant of health. But here are some figures that show that we would make very significant savings and efficiency gains if, once and for all, we turned the tide by investing squarely in prevention and, to do so, by increasing transfers.

[Karen Hetherington]

I absolutely agree with you. It's an opportunity we can take advantage of. The COVID-19 situation is very difficult, but it's also an opportunity for change. It gives us the opportunity to redirect trends and focus on prevention and promotion. There's not enough investment in this; it's clear, simple and specific. It's time to change that. Yes, it's time.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies.

Mr. Davies, go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you to all the witnesses for being here today and for their riveting and, I think, quite sobering testimony.

Dr. Fairbairn, I will start with you. It's been said quite often in the last little while that there isn't one pandemic in Canada; there are two. We, of course, have the COVID pandemic, but we have an entrenched opioid overdose crisis that has taken over 15,000 lives in the last four years alone in this country. Not to equate them, but that is more lives lost to overdoses than we've currently lost from COVID.

On October 28, Dr. Fairbairn, you co-authored an op-ed in the Canadian Medical Association Journal that said the following:

Swift and decisive action has been crucial to Canada's success limiting COVID-19. The same emphatic response is needed now [to] combat the overdose crisis.

Could you please outline what an emphatic response to the overdose crisis would look like in Canada?

[Dr. Nadia Fairbairn]

I completely agree. It's the stigma regarding addiction and the lack of acceptance of it as a medical condition that has resulted in chronic underinvestment in services for people living with addictions. All over Canada we are losing people who are very young to overdose.

We need investments within the health care system, which includes developing, for the first time, a comprehensive addiction system of care where we work up the silos, where prevention, treatment, harm reduction and recovery are all coordinated and people can access the system rather than consistently butt up against the system.

We need expanded access to pharmaceutical alternatives, given the fact that it's a poisoned drug supply. We need a real conversation, real consideration, regarding the decriminalization of drugs. We need to be able to fully move substance use out of the criminal justice system and treat it as the medical condition that it is.

Amendments regarding the Controlled Drugs and Substances Act are important. There were some really important amendments that were made at the beginning of COVID-19 to support people to access, for example, medications for opioid agonist treatment, so that was done quite quickly at the beginning of the pandemic. The revisiting of other ways that the CDSA can be amended to support people who are critically at risk for imminent death due to overdose is also really important in order for us to be able to have an addiction treatment system that people can come into.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you for that.

Have you noticed any increase during the COVID crisis in the number of people who are seeking treatment?

[Dr. Nadia Fairbairn]

Yes. We have noticed increased relapse rates. I should note that this includes people who are elderly, who are in the geriatric population. It's all ages. We are seeing increased relapse rates due to stress and isolation related to COVID, and we're seeing a downscaling of services for people. The combination is resulting in people increasingly butting up against the system without any services available for them. That includes treatment and recovery-oriented services, including harm reduction services, which are so crucial in preventing overdose every day.

[Don Davies, NDP, Vancouver Kingsway, BC]

I think it's relatively commonly accepted now that addiction has a unique feature to it, which is that when someone seeks recovery, there's a very limited window in which to get that person into recovery. Treatment on demand, I think, is something that is commonly accepted as required in order to tackle this issue. Can you give us a bit of a flavour of how Canada is doing in terms of access to treatment on demand?

[Dr. Nadia Fairbairn]

Unfortunately, treatment on demand remains the exception to the types of substance use services that are offered. Most of the time, if people are looking to access particular detox or recovery services, there can be a considerable wait. Those delays can result in adverse harms and deaths during the waiting period, given the crucial importance of having services available when people try to access them.

I would say that, in general, there's a huge gap there in terms of treatment on demand throughout the country. That delay has worsened during COVID-19. People aren't even able to become eligible for wait-lists, for example, because services are at capacity, given they're not able to accommodate as many clients as they would have been able to even before COVID-19. Treatment on demand remains highly limited. That includes evidence-based treatments like pharmacologic agents that can be really life-saving for people—methadone, buprenorphine, morphine formulations, etc.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

As you may know, the New Democratic Party has had an official policy of favouring decriminalization of drugs for some time. In July, both I and NDP deputy health critic Jenny Kwan sent a letter to the federal health minister requesting the implementation of a Canada-wide exemption from the Controlled Drugs and Substances Act to decriminalize personal possession of illicit substances as an urgent interim health measure. I think you made reference to the fact that the Vancouver city council recently sent a similar request for an exemption for the city of Vancouver.

How urgent is it, in your view—

[The Chair, Liberal, Ron McKinnon]

You're at six minutes. Can you wrap up, please?

[Don Davies, NDP, Vancouver Kingsway, BC]

—that Canada move towards an official policy of decriminalization so that we can treat substance use and substance use disorder as a health issue? There seems to be a resistance to do that at the federal level.

[Dr. Nadia Fairbairn]

I think it's urgent. I think it can be considered as part of the urgent second-wave COVID-19 response to be looking at decriminalization as a way of addressing the contaminated drug supply that's poisoning Canadians.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That brings us to the end of our questioning.

To the witnesses, thank you for sharing with us your time and expertise today. Thank you for your excellent answers.

With that, we will suspend while we bring in the next panel.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

We will now resume the meeting.

Welcome, everyone.

For this second hour we have, from Faces of Advocacy, Dr. Poon, founder and medical doctor; from Mouvement Santé mentale Québec, Madame Renée Ouimet, director; from Stepped Care Solutions, Dr. Cornish, psychologist; and from Women’s Health Research Institute, Dr. Brotto, executive director, and Dr. Ogilvie, associate director.

We'll now start with witness statements. Each group will have seven minutes.

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

[Dr. David Edward-Ooi Poon, Medical Doctor and Founder, Faces of Advocacy]

Thanks very much, Mr. Chair.

Mr. Chair, my name is Dr. David Edward-Ooi Poon and I'm the founder of Faces of Advocacy. We are a grassroots Canadian organization with over 9,500 members, established to safely reunite families in Canada during the COVID-19 travel restrictions. From my understanding, we are directly responsible for the extended family travel exemptions announced on October 2, 2020.

As Canadians brace for a second wave of COVID-19, government policies must ensure that families are reunited and kept together in order to abate the shadow pandemic of a mental health crisis.

These are the unedited statements from members suffering due to COVID-19-related family separation:

“Life doesn't feel worth living...fixing it is out of my control. I don't know how long I can keep going.”

“After 225 days apart and no history of mental health issues, my most recent panic attack was last night.”

“As a healthcare provider I have never fully understood addiction until the separation from my partner. The constant feelings of despair, hopelessness, sadness and anxiety [since March] gave me this unwanted lesson.”

“I cry. My son cries. He thinks it's his fault.”

“2020 is a rough year for all. Imagine going through it without your family.”

In our Faces of Advocacy mental health index, we surveyed the mental health of over 1,200 of our members using validated clinical tools. The survey showed a near doubling of suicidal/self-harm thoughts due to COVID-19-related family separation. Sixty per cent to 70% of respondents showed moderate to severe symptoms of anxiety, depression and/or PTSD, where 49% of respondents had never been diagnosed with a mental illness prior to the family separations. Only 34% felt they had adequate mental health support during the pandemic, and 84% responded that their mental health decreases the longer they are separated from their families.

A coordinated federal strategy must be implemented for all Canadians, including permanent and temporary residents. Our briefing includes six recommendations. I will highlight four.

Number one is Donna's rule. Donna McCall was a Canadian nurse and mother whose American children were not allowed into Canada as she died. She said goodbye to her children on FaceTime. The mental health sequelae of that moment spans a lifetime. Family reunification must be prioritized to protect the mental health of Canadians. This can be done through the ministry of health, alongside IRCC, Public Safety and other departments, to offer a reasonable path for family members to reunite at a time of crisis.

Number two is the last goodbye protocol. There must be a federal guideline ensuring reasonable accommodations—