Health Committee on Dec. 4th, 2020

[John Barlow, Conservative, Foothills, AB]

By the sounds of it, you're talking about a lot of the unknowns—just not knowing what's going to change, and when the changes do happen, how quickly they'll happen. We see that other countries have access to rapid testing, home-based testing, and now we see the United Kingdom and the United States ready to roll out their vaccines and have them distributed to their citizens.

What kind of difference would it make to you as a business owner if you had access to rapid testing, if Canadians had home-based testing, and if you were able to see a pathway to recovery and keep your business open in a more predictable way?

[Lisa Watts]

It would be immeasurable. For obvious reasons, what we're looking for is for the public to feel confident in whatever decision they're making. That comes with knowing that they're healthy and that the people around them can determine if they're healthy. That is a critical piece of the puzzle.

[John Barlow, Conservative, Foothills, AB]

Thanks, Ms. Watts.

Dr. Kurdyak, you were talking about some of those mental health statistics. What is the impact of that lack of information, not knowing when access to a vaccine will be available, for example, or the inability to have home-based tests? Is that having an impact on the mental health of Canadians? I mentioned the statistics that were released yesterday. I find them very disconcerting. We need to provide solutions.

[Dr. Paul Kurdyak]

I think you've heard lots of testimony today about the impact of the general uncertainty of the pandemic, the consequences of social isolation. Ms. Watts testified eloquently about the financial stresses of small business owners, and the financial stresses of most households, to be honest.

Obviously, the certainty of knowing when this will end would help immeasurably. To me, this is a tough question to answer because of course this is also a public health crisis. Balancing needs is kind of what contributed to Ms. Watts' roller coaster.

[The Chair, Liberal, Ron McKinnon]

Thank you very much, Mr. Barlow.

We go now to Mr. Van Bynen, please, for six minutes.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair. I offer a special thank you as well to our witnesses for sharing their experiences and their expertise with us.

I was happy to hear Dr. Kurdyak talk about the importance of accurate data. I think it is critically important that we do have this new infrastructure, so that we are making sure that we're doing the right things as much as we are making sure we're doing things right. That's a very critical decision point that we need to give some consideration to.

We certainly are facing a harsh narrative, but the situation itself is very harsh. We're facing an unprecedented pandemic, so it's important for us to be strategic and surgical in the way we approach things.

My first question is to Dr. Kurdyak. I recently met with members of our youth council, and during introductions I asked each of them to outline the areas of concern to them. As you can imagine, most of them said mental health.

It is my understanding that CAMH has recently released a report outlining the results of a survey on youth mental health in Ontario. Could you please share with the committee some of the findings of the survey and, based on these findings, what some of your recommendations would be?

[Dr. Paul Kurdyak]

The first thing I would say is that CAMH is a large place. I wouldn't know the specific details of that survey, so perhaps you could share them.

What I can say is that before the pandemic, we had been closely monitoring the youth. I think what's happening with youth is complicated. I suspect there was something going on pre-pandemic with the weird circumstances of this generation being steeped in social media like we were not. Sociologists and anthropologists have more to say about that than others, but we definitely noticed around 2019 a dramatic uptick in help-seeking behaviour amongst 16-to-24-year-olds that just keeps going up and up.

I work in a psychiatric emergency department. In my clinical work, we are also seeing dramatic increases in presentations amongst youth. The issue is that, as I said, the mental health system has never been particularly responsive to need. The entirety of the work that came out of my team in Ontario suggested that there really isn't a system.

You could choose many populations to focus on. I think transition-aged youth is as good as any because of the work that has been documented by surveys and by the phenomena that we're observing in our provincial data.

I think the equally important thing is that if we choose to intervene in a particular area, we have to do so in a way that allows us to iteratively measure—in other words, to learn consistently as we go, like we do for cancer.

Every cancer patient in Ontario not only benefits from evidence but contributes to it, precisely because information is routinely collected and used to constantly improve. That's kind of what we would like to see happening and what we are building towards in Ontario.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

I see you're referencing the ICES, and I have received a summary of their report. I'm wondering if you might just expand on the mental health and addiction system, and their performance indicator that's included in the material that was circulated.

[Dr. Paul Kurdyak]

There are many indicators, but essentially what we see at a sort of middle level, in Ontario and in every province and territory, is that there's a fixed number of hospitalization beds, so hospitalizations are going up a little bit, but because they are a fixed resource, the only way they can go up is if you reduce the length of stay. We're seeing a slight increase in hospitalizations, with a slight decrease in length of stay over time. If that gets squeezed more and more, we're going to start seeing adverse consequences, “bounce backs” and so on.

We're seeing a relatively flat rate of outpatient care, to the extent that we can measure it. I have to apologize; we do not have information from psychologists like my colleague Dr. Grou and others have discussed. This is just physician-based care in Ontario for which we have data, but it is flat.

Then we come to the emergency department, and we have seen—between 2009 and 2017—a 35% increase in demand. In that 16-to-24-year-old category, we see a 100% increase, a doubling. All that tells me is that the system is constrained. There are not enough resources, and people are going to the only place they know, the open door of the emergency department, which, by the way, is not a particularly therapeutic environment for people in crisis.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

I think this goes back to reinforcing the importance that you place on data in order that we are strategic and surgical so that we get the best results for the resources that we apply to that.

I'd also like to now go to Mr. Spindari.

In an effort to slow the spread of COVID-19, we're encouraging people to stay physically distanced, stay at home and stay connected virtually. As discussed in a recent interview with CBC Vancouver and MOSAIC CEO Ms. Stachova, some families and individuals in vulnerable communities face a digital divide. How has COVID-19 impacted these families and this divide, and what impact has that had on their mental health?

[The Chair, Liberal, Ron McKinnon]

Please give a quick answer.

[Saleem Spindari]

Thank you for the opportunity.

This is one of the challenges when we are told to maintain physical distancing. For you and me, it's easy to do. We stay indoors from our offices. For migrant workers that's not a possibility because they tend to live in group settings, and the accommodations normally are not huge.

We have done, within our organization, in terms of the digital inequity that exists, is to partner with great organizations such as the BC Technology for Learning Society to provide free, refurbished desktop computers to refugee families and to migrant workers to be able to use that.

After our CEO, Olga Stachova, issued the plea for people to donate, we've received really great support from the community to provide used smart phones so that people have access to technology and are able to access online programming.

[The Chair, Liberal, Ron McKinnon]

Thank you, sir.

I will now turn the floor over to Mr. Thériault for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

My thanks to all the witnesses for shedding specific light on this issue.

First and foremost, I would like to address the representatives of the Ordre des psychologues du Québec.

Thank you for accepting our invitation. I assume that we will have access to your speaking notes a little later. I am very much looking forward to reading them again. I found the literature review very interesting.

Before we get to the heart of the matter, I would like to ask Dr. Marleau a question.

We have all these data on adults, but how are our younger children and toddlers doing? Do you have data on that as well?

[Dr. Isabelle Marleau, Director, Quality and development of the practice, Ordre des psychologues du Québec]

We have significantly fewer data on children and adolescents. However, the trend is the same as for adults, meaning that there are many more mental health issues. We are looking at anxiety and depressive symptoms. For adolescents, there is some partial data. In fact, those data still come from a few studies or small samples over the last five to six months.

In any case, the trend is quite clear. For adolescents, we have some data that are consistent with the data for adults. I think there are concerns about substance use in this population as well, and that could become a major issue.

Dr. Grou could complete my answer.

[Luc Thériault, Bloc, Montcalm, QC]

Okay.

Otherwise, I have another question.

You talked about telepractice. Your members consider it to be effective, but there seems to be a problem—the word may be a bit strong—with respect to interaction during treatment. In other words, it's better than nothing, but in the long run, it may not be a comprehensive approach to helping people.

Could you elaborate on that?

[Dr. Christine Grou]

Telepractice actually has some advantages. For one thing, it provides a secure environment. Second, it is helpful for some individuals who have difficulty getting around and who would otherwise not seek consultation. So telepractice still has some advantages.

Almost all of our members have switched to telepractice. That said, 60% to 65% still find that it has an effect on the relationship and the communication. Of course, it depends on the clients, the comfort with technology and the health issue. In addition, the situation is most likely different when the relationship with the patient is already established and the treatment continues through telepractice, compared to situations when a relationship is established entirely through telepractice.

I think we need to conduct further research on telepractice. However, the preliminary data tell us that, while there are some advantages, there are some disadvantages. But it does, in fact, meet the needs of the general population.

[Luc Thériault, Bloc, Montcalm, QC]

I assume that the situation where patients are in a helping relationship with their therapist in the therapist's office can be very different from telepractice, where the patients are in their living environments, surrounded by family members who come and go.

[Dr. Christine Grou]

That has been one of our challenges during the pandemic. For people who were confined to their homes with spouses and children, it could be difficult for them to have an appointment virtually. You still need to have a confidential, calm and quiet space during a session. It has been a challenge.

It certainly has advantages for some people. Let's take a single mother, for example. She can put her children to bed at night and have an appointment without the need for a babysitter. Think of a farmer who would normally drive two hours for an appointment. Telepractice allows him to have a consultation without losing half a day's work.

However, telepractice can be more difficult for a person with severe mental health issues, for an elderly person who is not well versed in technology, or for a person who has a greater need for closeness in the relationship.

In general, telepractice has proven to be positive, to the surprise of some.

[Luc Thériault, Bloc, Montcalm, QC]

You suggested that it is important to make access to psychotherapy universal. In a pandemic, lessons must be learned.

Can you remind us why access to psychotherapy is not universal?

[Dr. Christine Grou]

You have to understand that mental health, compared to the rest of health, has always been sort of a poor cousin. But we have to look at health globally. We cannot underestimate the effects of mental health on people's overall health.

Right now, there are two ways to get treatment in psychotherapy. First, it is possible through the health network, but these services are difficult to access. Second, it is possible to have access to services in a private office, but unfortunately not everyone can afford it. Therefore, there should be funding so that anyone with a mental health problem can be treated.

[Luc Thériault, Bloc, Montcalm, QC]

Of course.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We now go to Mr. Davies.

Mr. Davies, please go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and to all of the witnesses for their testimony.

Mr. Spindari, thank you for your testimony about the impact of COVID on the mental health of some very vulnerable populations: refugees, international students, migrant workers and immigrants.

I know that in June MOSAIC launched a survey seeking input from refugee claimants in British Columbia to gather information on how to enhance services during COVID-19. Can you tell us whether services are currently meeting the needs of refugee claimants and their families and, if not, what steps the federal government can take to enhance them?

[Saleem Spindari]

Thank you very much, Mr. Davies.

We did issue the survey, and the response was really great from the refugee claimant population. Throughout the province of B.C., we tried to reach out to as many people as possible.

As you know, refugee claimants are still not eligible for services funded through the federal government. They rely on provincial funding to do that. Maybe the best thing to do is for the Government of Canada to extend services that are offered through IRCC to refugee claimants as well so that they have access to it.

We heard loud and clear that there is a huge need for mental health support. We did hear that housing is one of the big things that refugee claimants encounter when coming here, because, upon arrival, it would take them a while to get documentation from the Immigration and Refugee Board, IRB. As you know, the board is moving toward virtual services, and for the refugee claimant, it was an additional challenge not having access to technology or being able to reach out to somebody in person at the Canada Border Service Agency office or the Immigration and Refugee Board to get an ID document. It caused a a huge delay and impact on refugee claimants being able to access services and, of course, later to get work permits so they could find employment in British Columbia.