Health Committee on Dec. 4th, 2020

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Now, more broadly about immigrants generally, MOSAIC's recently released 2019-20 annual report said the following:

It's a shocking statistic: five years after arriving in Canada, the average newcomer is generally in worse health than when they first arrived.

Factors impacting the social determinants of health after migration include poor living conditions, social isolation, unemployment and challenges adapting to a different language and culture.

Clearly, COVID-19 would have exacerbated, I think, those factors. So, in your view, what steps should the federal government take to break down barriers to newcomer health more broadly?

[Saleem Spindari]

Recently in B.C. they have started a community health network, and for me that's a really great first step. MOSAIC has been really active in working with partner organizations and groups to be able to do that.

I encourage the federal government to work closely with the provinces and especially with the idea of having community health centres there, and to provide more funding to organizations so they can carry out the much-needed services for newcomers.

As you know, at MOSAIC the majority of our staff are people with lived experiences and we do have individuals with a background in the health sector. The senior manager of our specialized program, for example, is an internationally trained medical doctor. She is not practising here in Canada right now, but with the experiences of many others as well—

[Don Davies, NDP, Vancouver Kingsway, BC]

Could I just stop you there? I'd like to get one last question in, because I'm running out of time.

I want to turn to an important area with respect to mental health. In the first nine months of 2020 the Vancouver Police Department reported a 116% rise in hate crimes in Metro Vancouver compared with the numbers during the same period in 2019.

I'm just wondering, with many immigrants and refugees coming from different areas of the world and being from racialized communities, what the impact of that increase in race-based hatred has been, in your experience. Do you have any suggestions for what we could do to address it?

[Saleem Spindari]

At MOSAIC we do our best to raise awareness around issues of racism that people are targeting. I think recently the provincial government, for example, started Resilience BC, and there are many initiatives that are coming.

I encourage the federal government to do the same, to work with organizations that are there. Also, sometimes the messaging that comes from politicians contributes to rising tension. We know clearly that what happens down south has an influence on the messaging and the response that people here have as well.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That wraps up the questioning on this panel.

Thank you, witnesses, for sharing with us your wisdom, your expertise and your knowledge, and for sharing with us your time today.

With that, we will suspend as we bring in a new panel. Thank you, everybody.

[The Chair, Liberal, Ron McKinnon]

The meeting has now resumed.

I'd like to welcome our witnesses on this panel. Today we have, as an individual, Professor Charlotte Waddell, university professor, children’s health policy centre, faculty of health sciences, Simon Fraser University. From Natural High Fitness, we have Andrew Gustafson, owner, manager; from the Mental Health Research Canada, John Trainor, adjunct lecturer, department of psychiatry, University of Toronto; and from Statistics Canada, Jeff Latimer, director general for health, justice, diversity and populations, and Ron Gravel, director, centre for population health data.

Just for the benefit of the witnesses, you may speak in the official language of their choice. Interpretation services are available for this meeting, and you have a choice at the bottom of your screen of the floor, English or French. I would encourage people who wish to speak in either official language to make sure that when they're speaking in that language, they are on the corresponding interpretation channel.

Before speaking, click on the microphone icon to activate your own mike, and when you're done speaking, please put your mike on mute to minimize any interference. As a reminder, I note that all comments by members and witnesses should be addressed to the chair.

With that, we shall get under way. Witnesses will have seven minutes for statements. We will start with Professor Waddell.

Professor Waddell, please go ahead for seven minutes.

[Dr. Charlotte Waddell, Professor and Director, Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, As an Individual]

Thank you so much for the opportunity to speak with you this afternoon about COVID-19 and children's mental health in Canada.

One basic message, and perhaps the most important, is that pre-pandemic, children's mental health needs were extremely high. Looking at epidemiological evidence, we estimate that 13% of children ages 4 to 18 years at any given time—800,000 young people in Canada—were experiencing mental disorders pre-COVID that needed treatment. Those disorders include 12 common ones, such as anxiety, attention deficit, behaviour problems, substance use, depression, and autism through on to schizophrenia. We know how to intervene for all these disorders, but pre-pandemic, fewer than half of these children were actually receiving any interventions for these conditions, shortfalls we would never accept for physical health problems like childhood cancer or diabetes. Pre-pandemic, then, we already needed to double down on children's mental health services.

The second major point is that needs are expected to rise significantly during and after COVID. Based on data from previous disasters like SARS, or natural disasters like earthquakes or floods, we may see as much as twofold to tenfold increases in problems like childhood anxiety, depression and behaviour. Making things worse, some kids will be more affected than others. For example, families who were already experiencing economic hardship are expected to suffer more greatly, and already are, during the pandemic. Children who had pre-existing mental health and developmental conditions, even if they were getting adequate services, have now had disruptions in what they were getting.

Racism is another issue that affects children's mental health. It's a pressing issue for all Canadians, but there have been flare-ups during COVID—with anti-Asian racism, for example. Indigenous communities make up another group that will be severely affected. They were already coping with the legacies of colonialism with strength and resilience, but now they're coping with COVID with fewer resources than other Canadians. Needs were high before; needs will rise a lot.

Even though this is an unprecedented public health challenge in Canada and globally, there are still some unprecedented policy opportunities. I want to highlight three where federal policy leadership can be crucial and can make a huge difference to addressing these problems.

The first policy opportunity involves making a plan. We haven't done this. Make, implement and sustain comprehensive children's mental health plans nationwide. Comprehensive means covering all kids zero to 18 and covering all 12 common mental disorders, at a minimum looking at promoting healthy development, preventing disorders and treating all the kids with disorders as well as tracking outcomes. In my view, federal leadership is crucial, because it's the only way to coordinate efforts nationwide to keep kids on the national public policy agenda.

The federal government can also offer economic incentives for children's mental health programming to provinces and territories, building equitable access across the country. We've done this before very successfully. In the year 2000, the early child development accord led to funding going out to provinces and territories with strings attached. The benefits have been enduring. We need to do that now for children's mental health.

The second policy opportunity involves ensuring adequate budgets and effective services. If we're going to meet those pre-COVID shortfalls, at a minimum, again, we need to double down. We need to double children's mental health budgets. That's to treat all kids with disorders. We know how to do this. We know of effective preventions. The question is obvious: How do we pay for this?

Here's where the promise of funding new prevention programs also comes in. For example, preventing just one case of a severe childhood mental health problem, such as conduct disorder, can yield lifetime savings of up to $8 million. Similarly, a prevention program like Nurse-Family Partnership, which starts in very early childhood, has shown to improve child mental health and yield benefits of over $6,000 per child when you look at whole-of-government savings in services not needed because of this program. There is potential there to start to pay for some of the increased costs we need to incur. Addressing social disparities will simply help with all of this. The federal government has already been showing leadership there.

The third opportunity is to track our collective progress. To quote Clyde Hertzman, what gets counted counts, and we haven't been counting our kids very well. How else do we know how we're doing? Tracking child outcomes is essential.

It's also a way to measure success as we ramp up these new investments, presuming that we would be able to, and we have unique opportunities. Statistics Canada's very high-quality 2019 Canadian Health Survey on Children and Youth has one of the few data sets in the world with which comprehensive work was done pre-pandemic. We can and should repeat that survey on an ongoing basis. Doing that would position us as a global leader in being able to track those outcomes. The federal government is ideally situated to support that survey continuing.

Just to conclude, I recognize that there are many competing demands on public budgets right now, but I would say that if we don't address children's health now, we're going to have far greater societal costs down the road if these problems persist unabated and unnecessarily into adulthood.

Annual costs are estimated to be at $68 billion in Canada for mental health problems writ large, but beyond the economic costs, if we don't address this, we risk seeing a generation of young people scarred by this pandemic to our great collective detriment.

We need this generation. These are our future front-line workers, nurses, teachers, doctors, and parliamentarians. So children and children's mental health need to be at the front of the line in our pandemic response.

I'll just end with a quote from The Lancet medical journal: “Although the COVID-19 pandemic has threatened child health, it can also be a catalyst to start afresh. Children’s rights must be central in the recovery phase.”

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Professor.

We will go now to Mr. Gustafson, owner-manager of Natural High Fitness & Athletics.

Please go ahead, sir, for seven minutes.

[Andrew Gustafson, Owner-Manager, Natural High Fitness & Athletics]

Thank you, Mr. Chair and committee members.

Let me begin by saying that I have no licence to speak for business at large. I'm simply a business owner, and I really thank you for the opportunity to speak today about my experiences as a business owner and, more specifically, to speak to my state of mental wellness. Hopefully, my state and my story can bring some light to what others might be feeling as well. It is not something that I've really spoken about before, and certainly not publicly, but the mental health of business owners in 2020 is fragile, I think, and needs to be considered, so this is a great opportunity, and thank you for that.

I'll begin by saying that I am not fine. This is not a cry for help. It's just me being sort of vulnerable and truthful. I'm not fine. There are moments when I'm okay, but truthfully, I float on a spectrum anywhere between okay and completely miserable. That's not a description of my mental state between March and today. That describes me minute to minute, hour to hour and day to day.

Business owners are facing a myriad of emotions based on the ever-changing daily reality. People have their fingers resting squarely on their subconscious panic buttons, ready to push and explode at the smallest of triggers. We have a national heightened readiness for interpersonal conflict, so I'm walking an emotional minefield every day. One wrong word, misstep or misinterpretation risks an explosion of emotions, so we're all a little compassion-fatigued.

When speaking of mental health, the bigger terms that come to mind for me as a non-expert are “anxiety” and “depression”. While these words are sometimes a little too lofty or too clinical, they do, I think, accurately describe the current mental state of many in the small-business world.

Other words are emotional exhaustion, worry, doubt, loneliness, anger, frustration, insecurity and fatigue. These are words that describe the emotional roller coaster that I'm riding every day, and I'm a well-adjusted, well-supported, stoic and strong person. I believe that for a proud person like a business owner, one of the biggest challenges is to admit that times are challenging and to engage in a conversation about these types of feelings, so I believe that the situation is likely understated.

Dealing with my emotions is so low on the triage list right now that I risk spiralling, I think, because the more pressing matters at hand for me are supporting my kids and their now online school reality; sharing my office space with them, so that the time I do have to dedicate to creativity in my business is disrupted; supporting my household both emotionally and financially, such as paying a mortgage without a secure income; and, ensuring that the 30 staff and contractors who depend on my sound business management aren't themselves feeling the brunt of this crisis.

The primary weight of this is carried by me, as the owner, and let the truth be known: I'm only surviving right now due to the generosity of my landlords, a generosity that can't possibly last much longer, which piles further anxiety onto me at an almost suffocating level sometimes.

I see no clear and precise mental health picture that can be painted for this committee, because every corner of our nation and every demographic is facing different challenges and is equipped to deal with those challenges in different ways. I've heard over and over that we're all in the same boat. That is not true. We are in the same storm. Some are in a luxury yacht and others in a rickety and sinking canoe.

The important point to remember, in my view, with all respect to everybody else on the panel, is that this is not an academic exercise. This speaks to real people, real business owners like me, with real thoughts and feelings that I'm thinking and feeling.

My belief is that the best cure for this anxiety that I speak to is information. This has been sorely lacking. It's unclear to me, but it seems likely that biases in today's media are hindering the accuracy of the information reaching the public's consciousness. The burden of fact-checking currently rests in the hands of the populace, so the fact of or the lack of timely and possibly accurate information is the norm.

We've been told that before restrictions can be lifted we need mass vaccinations, but we don't have a timeline for that, so we ready ourselves for continued restrictions and the threat of further lockdowns. We have no cases at our business and no confirmed transmissions, yet we have further lockdowns. Perhaps more subsidy and relief are coming, but when and how much? The information we have is not enough to squelch this underlying anxiety.

All of this leaves me feeling very uncertain for my future, and not my long-term future, but the viability of my business over the coming few months. Do I follow my 10-year capital replacement plan and invest in needed infrastructure upgrades or sink money into repairs until such time as I regain confidence in my cash flow? I don't have enough information or trust in the information that I do have to answer that. At this point, our best prediction, if everything went fully back to normal today and my revenues and expenses returned to pre-COVID levels immediately, is that the borrowing, coupled with lost revenue of 2020, will require a seven-year recovery for us.

I have been applauded in my community over the years for being a generous supporter of local initiatives. I have long believed that business involvement is an integral part of the community fabric. That's not a reality anymore. I don't know when or if it will be again. I am losing my community perspective as I struggle to focus on anything beyond my bank account balance. What are the long-term community ramifications if more businesses are feeling that same pressure? These are the things that bring people together. They provide purpose and satisfaction, and pride in owning a business that makes a difference. Losing this is another trigger for further anxiety and possibly depression.

I have constant and real stress. I am consistently reinventing my business, which takes energy and resources and creates a stressful dynamic for my members and staff, who simply long for stability and job security. My staff and their families are depending on me to make this work. At this point, I have very little confidence that I can.

I need to feel confident that a lockdown is not forthcoming. I need my local, provincial and federal decision-makers to know that our actions and responses as business owners at large are virtuous and seek the right balance between our needs and the needs of the public. I need information, specific timelines and continued recognition of my financial insecurity so that I can regain control of my planning and hopefully mitigate some of the emotional exhaustion I've been suffering for many months. I need the powers who drive the messaging around COVID-19 to acknowledge the damage they've done to my entire industry through their destructive painting of my industry as dangerous, such as the recent misguided targeted measures aimed at restaurants and group fitness, specific to me.

These challenges are immense. The decisions are difficult. I understand that. But we can't come to difficult conclusions without the involvement of us—those who are affected. This hasn't felt like a common practice in 2020. To have this opportunity to speak feels like a step in that direction, and so I thank you for your attention.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Gustafson.

We go now to Mental Health Research Canada and Mr. Trainor, an adjunct lecturer in the Department of Psychiatry at the University of Toronto.

Mr. Trainor, please go ahead for seven minutes.

[John Trainor, Adjunct Lecturer, Department of Psychiatry, University of Toronto, Mental Health Research Canada]

Thank you very much. I appreciate being invited to speak with you today.

I am the chair of Mental Health Research Canada, which is a national charity dedicated to advancing knowledge on mental health, and today I offer some comments about mental health in the pandemic. I also want to outline the COVID-19 mental health polling project that our organization has been involved with.

In addition to my brief remarks, I submitted a report to the committee, and my organization would be happy to offer briefings to any committee member on further details.

First of all, let me applaud your committee for focusing these hearings on mental health and for listening to a wide range of views. Our organization is also fundamentally committed to listening to stakeholders as a way of determining what kinds of knowledge need to be developed to support mental health.

For us, stakeholders are not just professionals and researchers but a much wider range of people, including family members, those who directly experience mental illness, indigenous people, and people at high risk for reasons such as racism and discrimination, as well as many other examples.

I am sure that you, as members of Parliament, are hearing a great deal from your constituents about mental health issues, and this is extremely valuable information. Good information on how Canadians are coping is really essential to dealing with this crisis.

When the pandemic hit, we committed our organization to helping with the crisis. We launched the national polling initiative to provide good and timely data to governments and stakeholders on the mental health impacts of COVID-19. To date we have conducted three polls, and a fourth poll is being started today as we speak. When it's done, we will have engaged more than 10,000 Canadians and developed an extensive and complex dataset, and we plan on continuing this work every eight weeks into 2022 to monitor Canada's recovery.

Our work is enabled by its scale, because only with large samples can we be sure to get sufficient data in the many areas we explore. We're looking at a number of things. We're looking at types of distress people are feeling, fears they have, how they're coping, demographic data on such things as family status, income, employment, gender, and access to mental health supports as well as other areas.

Here are some headlines from what we've found. High levels of anxiety have quadrupled since the start of the pandemic and high levels of depression have doubled. Surprisingly, these levels have not moved substantially from April in wave one despite changes between the waves and then the onset of wave two. The levels of distress have remained pretty constant across the country.

High anxiety and depression levels are more prevalent in younger populations and in women, but there's a surge in levels in men at the very highest distress categories when we look at symptoms. We know from other work that men often do not report mental health challenges until they become quite severe.

Treatment is now harder to access. There has been a drop in one-to-one counselling, and visits to family doctors have been dramatically reduced. I should note that we are sharing all of the above information with governments and professional associations across Canada.

Looking broadly, we can see that levels of distress are not evenly distributed in the population. People working in certain sectors such as retail, front-line health care, teaching—and I would add small businesses, having heard Mr. Gustafson—are more anxious. Family situations are also important. We find that people living alone and those with small children are dealing with more anxiety. Finally, lower income levels predict more distress. We are taking and sharing that information with governments, professional associations, school boards and others.

People who are adhering less to social distancing guidelines are experiencing increased depression and negative mental health, particularly around the economic fallout of the pandemic. If we look at coping, we find that social media and watching the news do not help most people. Activities such as reading, exercising or interacting even virtually with friends were rated as helpful in the early stages of the pandemic, but are now losing their positive effect as we exhaust their use and find them repetitive.

Canadians now rate going outside or spending time in nature as the number one helpful activity, and we're sharing this finding with parks and recreation organizations, provincial and municipal governments and others across the country.

It's also important who is delivering the message. Canadians want to hear information about mental health from professionals. This includes doctors like those from the Public Health Agency of Canada or their provincial or territorial counterparts, but also local family health providers and doctors. The messages themselves need to be accurate but to emphasize hope and advice on how to cope.

What do we suggest in the long run or, I guess, in the medium term?

First of all, it's important to keep trust high. Our national response to this, looked at globally, has been quite coherent, especially and dramatically in comparison to the United States.

Also, continue to build knowledge. Our data is part of a mosaic of information that's being built by many organizations. From this, we now have a unique and replicable dataset on how specific groups, including at-risk groups, are responding to mental health stresses during the pandemic. We need to share this and to keep dialogue open. Those living alone, younger Canadians and lower-income Canadians, as well as those with pre-existing mental health challenges, are all groups that we need to focus on.

The work of Wellness Together Canada, which is serving as a hub with information and resources for those who need help and those who care for them, is an important resource that I know is supported by the federal government.

Let me say thank you very much for inviting us to appear. We will work with you in any way we can to help with the response to COVID and to support the mental health of Canadians.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We will now go to Statistics Canada for seven minutes.

Mr. Latimer or Mr. Gravel, please go ahead.

[Jeff Latimer, Director General, Health, Justice, Diversity and Populations, Statistics Canada]

Thank you very much, Mr. Chair. I appreciate the opportunity for public servants to appear before such a committee.

At Statistics Canada, we have been tracking the direct and indirect consequences of this pandemic on Canadians. One thing we've observed in the recent period is an unprecedented reduction in the self-reported mental health of Canadians, but this reduction is not felt evenly across the country.

My colleague, Mr. Ron Gravel, will present to this committee a series of statistics related to the varying impacts of the pandemic on particular population groups. I'd like to ask Mr. Gravel to finish the presentation.

Thank you.

[Ron Gravel, Director, Centre for Population Health Data, Statistics Canada]

Thank you.

Referring to the impact, it can be experienced in many different ways, including feelings of depression, grief, fear, panic and anxiety, which can be normal responses to situations where day-to-day routines are significantly disrupted.

It's important to note that today's presentation focuses on data collected in the first few months of the pandemic, that is, the first wave. The overall presentation provides a profile of how the impact on mental health has varied across a number of demographic and social groups. These include youth, immigrants, groups designated as visible minorities, gender-diverse populations, indigenous people and Canadians with disabilities.

I'm referring now to slide 2 of my deck. Since there are many graphs with details in this deck, I will first start with a summary of the key messages and then draw attention to select findings in each of the slides.

The first message—

[Luc Thériault, Bloc, Montcalm, QC]

Excuse me, Mr. Chair, but the sound keeps cutting out and the interpretation cannot be done. There is a problem with the sound and the interpretation has been interrupted for some time.

I'm sorry to interrupt you, Mr. Gravel.

[Ron Gravel]

Okay.

Is it better now?

[The Chair, Liberal, Ron McKinnon]

Mr. Gravel, I think you lowered your microphone from when the sound check was done. Maybe try that. Just say a couple of words to see if the translation works.

[Ron Gravel]

Does that work?

[The Chair, Liberal, Ron McKinnon]

Translation, does that work?

Maybe say a few more words.

[Ron Gravel]

Since there are many graphs with details, I will start with a summary of key messages and then draw your attention to select findings on the other slides.

[The Chair, Liberal, Ron McKinnon]

Mr. Thériault, is it working now?

[Luc Thériault, Bloc, Montcalm, QC]

Yes, it's better.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Mr. Gravel, go ahead, please.

[Ron Gravel]

Thank you.

Our first message is that the pandemic has negatively impacted the mental health of most Canadians. When we look at life satisfaction as an overall measure of positive mental health, we see that it has declined to the lowest since 2003. Whereas before the pandemic almost three-quarters of Canadians rated their life satisfaction as high, only 43% indicated such a level during the pandemic.

Finally, fewer Canadians are reporting being in very good or excellent mental health, with young Canadians showing the largest declines. The top graph in slide 3 illustrates that youth have experienced the largest declines in life satisfaction since the start of the pandemic. Focusing on the bottom graph, there are some suggestions of emerging inequalities for immigrants. Whereas levels of satisfaction were generally similar among immigrants and Canadian-born before the pandemic, it was lower for immigrants in June 2020.

Slide 4 looks at self-rated mental health, which is a powerful indicator of overall mental health status. As previously noted, a consistent finding across studies is that the impact on mental health has affected more youth.

The graph on slide 5 shows that the proportion of Canadians reported an increase in their cannabis, alcohol or tobacco use during the pandemic compared with before the pandemic began. This is an interesting fact, because it shows that, compared with other age groups, youth report increasing their use of cannabis the most. About 12% of them reported increasing their cannabis use during the pandemic. As well, the greatest increase in substance use was reported among those aged 35 to 54, with an increase in alcohol use.

Turning to slide 6, since the pandemic we see from crowdsourcing results that gender-diverse individuals were substantially more likely than female or male participants to report fair or poor mental health. Gender-diverse Canadians also were twice as likely as females and three times as likely as males to report some symptoms consistent with moderate and severe anxiety.

Looking at slide 7, past studies suggest that, generally speaking, immigrants arrive in Canada with better self-perceived mental health than Canadians, but this perception declines after a period of time in Canada. Results from our crowd-source survey suggest the opposite pattern during the pandemic—that is, 28% of recent immigrants who participated in the crowd-source survey reported fair or poor self-rated mental health, compared with 20% of established immigrant participants and 24% of Canadian-born participants. Recent immigrant participants were also more likely to report symptoms of anxiety than other Canadians.

[Technical difficulty—Editor] is one where it shows what was presented in the previous slide, and it reports essentially [Technical difficulty—Editor]. Overall—

[The Chair, Liberal, Ron McKinnon]

Pardon me, Mr. Gravel. Your sound is breaking up.

Maybe if you turn off your video, we'll get a little bit more bandwidth for the audio. We have your charts here.