Health Committee on Dec. 7th, 2020

[The Chair, Liberal, Ron McKinnon]

I call this meeting to order.

Welcome, everyone, to meeting number 12 of the House of Commons Standing Committee on Health. The committee is meeting today to study the mental health aspects of the emergency situation facing Canadians in light of the second wave of COVID-19.

I want to thank you, witnesses, for appearing today. You will have seven minutes for your presentations.

For the first hour, we have Dr. Kim Lavoie, professor, as an individual. We have Dr. Jitender Sareen, physician; and from the Overdose Prevention Society, we have Sarah Blyth, executive director.

I would like to start the meeting by providing some information following the motion that was adopted in the House on Wednesday, September 23, 2020.

The committee is now sitting in a hybrid format, meaning that 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, and so you are aware, the website 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. It is good to point out that if you are speaking in French and you have the English selected, sometimes it is difficult for people to hear what you're saying because the translation will tend to override you, so make sure you choose the proper channel for how you want to speak. Before speaking, click on the microphone icon to activate your own microphone. When you are finished 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. Any member who wishes to intervene on a point of order raised by another member should do likewise.

In the event of a debate, if a member wishes to intervene, they 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 the list pops up, you'll 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 a headset with a boom microphone is mandatory for everyone participating remotely. Should any technical challenges arise, please advise the chair and please note that we may need to suspend for a few minutes in such a case 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 the 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.

I should also note that I have a couple of cards. I will display the yellow card when you have one minute left, and I will display the red card when your time is up. When you see the red card, please wrap us as soon as you can and we will proceed.

With that, we will now go to our first witness, Dr. Kim Lavoie.

Professor, please go ahead. You have seven minutes.

[Dr. Kim Lavoie, Professor, Department of Psychology, Université du Québec à Montréal, As an Individual]

Thank you very much, Mr. Chair, and thank you so much for the invitation and the opportunity to be here. If I get any formalities wrong, I apologize. This is my first time, but it's a real pleasure to be here.

I'm going to go through each of the questions that were sent to me and respond to them in turn. I will basically be speaking about the results of an ongoing study that I'm leading here in Montreal. It's an international study called iCARE and I'm going to focus primarily on the Canadian data.

I'm going to report on what we've been seeing from the study basically since the outset of the pandemic in late March. We have data currently on 6,000 Canadians through a representative sample, and we have data on over 14,000 Canadians from a convenient sample.

The first question I'm going to address is any sex differences in the mental health impacts among Canadians. An analysis of our data reveals that women appear to be shouldering more of the emotional and behavioural burden of the pandemic, as well as experiencing greater job and income loss. As a result, they may or seem to be experiencing greater negative mental health impacts.

From the start of the pandemic through to the end of November, more women than men believed that adhering to public health measures is very important. This is when I'm speaking about the emotional burden. They also have greater COVID-19-related concerns, whether we're talking about the health impacts to self or others, personal financial impacts of the pandemic and its policies, or socio-economic impacts, for example feeling socially isolated and separated from family.

However, this potentially explains why women appear to be twice as adherent to public health measures or public health policies relative to men. When I'm speaking about the public health measures, I'm speaking about the big ones—handwashing, social distancing, avoiding social gatherings and self-isolating if they have COVID-19. This is what I'm referring to when I speak to the emotional and behavioural burden.

Now I'll speak more directly to the mental health impacts. Between June and November, significantly more women than men reported experiencing severe mental stress. By this I mean anxiety, depression, loneliness and frustration, as well as interpersonal stress. In our study, this was defined as experiencing more verbal and physical fights with family.

Rates are twice as high among women across all of these variables and appear to be getting worse over time. Again, I'll remind you that the period is between June and November. Significantly more women than men have cancelled medical appointments or avoided presenting to the emergency room due to concerns about COVID. After the first wave, more women than men reported losing their job or having their job hours cut.

To give you an example of the absolute percentage differences between men and women, in June 25% of women reported experiencing severe anxiety—and this is in the upper quartile—versus only 12% of men. In November, 27% of women reported experiencing severe anxiety versus 14% of men.

Speaking to how it is impacting various vulnerable groups, the pandemic seems to be exacerbating pre-existing health, mental health and socio-economic disparities across many vulnerable populations. This was evident in our study in June and has persisted or worsened through November.

Young people—I mean the 18-25 group, compared to those over age 25; visible minorities—that is, non-white; and those living under the poverty line, defined as having a total household income of less than $60,000 a year compared to over $60,000, report experiencing significantly more severe mental stress, such as anxiety, depression and loneliness, and higher interpersonal stress, such as verbal and physical fights with family.

To give you a sense of what this is among young people, in June, among those aged 18-25, 31% were in the upper quartile for anxiety, versus 23% of the 25-50 age group and only 10% of the over-50 age group. Across the board, rates of severe mental stress among young people are more than three times those of people over age 50, and it is worsening over time. Significantly more young people, visible minorities and those living under the poverty line also report consuming more drugs and alcohol, and this is again in the upper quartile range.

Significantly more young people, visible minorities and those living under the poverty line have had trouble or reported having trouble accessing non-COVID-related medical care. The same three groups report having lost their jobs, having their job hours cut or losing income and having trouble paying for housing. Again, these are all the upper quartile extremes.

It's unclear how accessible or well adapted mental health services are for these groups, but I suspect there are probably considerable knowledge gaps about what services may be available.

In terms of the next question, the availability of programs that can support mental health services and provide mental health services to people across Canada, what I want to speak about is the survey of psychologists in Quebec. This was run by the Order of Psychologists of Quebec. Across the board, psychologists here have been reporting that their patients are more distressed, that there's more anxiety, more depression, more requests for emergency services and a lot of requests for consultations for drug and alcohol abuse. Seventy per cent have been contacted by former patients, and 34% have increased their hours since the start of the pandemic. However, what I wanted to highlight is that 50% reported being willing to provide emergency services, and it was estimated that 7,000 hours per week could be added to aid the population.

This was done in the context of Quebec, but it brings me to the next question: How could virtual or teletherapy perhaps be leveraged to meet the needs of Canadians? Offering teletherapy options could be done, given the fact that there are so many psychologists in Quebec. We have a high volume of clinical psychologists in Quebec, and maybe we could consider leveraging the availability of these specialists to expand the reach and accessibility of needed services across Canada.

The last thing I want to mention is a program called Wellness Together Canada. This is a federally funded program to provide mental health services to people across the country. In my speaking notes, which I shared with the committee earlier today, I wanted to mention that it's something that I think we could do better at leveraging to get more of these needed services to people across Canada. As it stands, only 10% of Canadians surveyed had any awareness whatsoever that this program existed, so I think we can do a lot better there.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We go now to Dr. Jitender Sareen, physician.

Dr. Sareen, please go ahead for seven minutes.

[Dr. Jitender Sareen, Physician, Department of Psychiatry, University of Manitoba, As an Individual]

Thank you so much, Chair. It's a pleasure to be here.

Thank you, Dr. Lavoie, for your comments.

I think my comments will build on many of the comments that Dr. Lavoie has mentioned.

I'm a psychiatrist. I'm the department head at the University of Manitoba and provincial specialty lead. What I'm going to present is based on funding from CIHR.

The main summary of what I'm going to say is that we absolutely need a public health approach to manage the mental health sequelae of the COVID-19 pandemic. We need to look at it from universal strategies as well as targeted strategies for our vulnerable groups. As Dr. Lavoie was saying, there are lots of opportunities to enhance our virtual mental health care services, not only for elective services, but especially for our emergent services.

We also need to invest in appropriate infrastructure for isolation in the community for vulnerable groups. Success will only occur where there are strong partnerships among federal, provincial, community and private sectors.

I'm going to tell you the story of a 15-year-old boy living in a rural community in Manitoba who loses a friend suddenly in an accident. He is brought to the nursing station by his grandfather because he is suicidal. He has also been in contact with someone who is COVID-positive. He needs an emergency mental health assessment, but he does not want to travel to Winnipeg for that assessment, which is hundreds of kilometres away. Pre-pandemic and during the pandemic, the person would have to be brought to Winnipeg, stay in the hospital for a few days, and that would increase the risk of COVID transmission. I'm going to come back to the case in a few moments.

The COVID pandemic has impacted all Canadians. During the pandemic, Canadians have had an increase in distress, fear, anxiety, alcohol and drug use. We have to invest in appropriate media campaigns that focus on mental wellness strategies and remind people of the low-risk guidelines for alcohol and substance use. These media campaigns are extremely important to invest in because, as Dr. Lavoie says, people actually don't know some of these important strategies.

We need to improve pathways to accessing care. In Manitoba and other provinces, it is extremely difficult for a person to access mental health care in a timely manner. Whatever we can do to simplify access is going to improve the system.

We need to invest in virtual mental health care using a stepped care approach, using online screening tools, phone supports, and then having people be able to access services virtually, either individual or group therapy, based on measurement-based care. We need to appropriately staff these virtual mental health care resources, and we need to pivot towards measurement-based care so we're actually monitoring people's outcomes as they are going through the treatments.

I want to focus on the crisis in emergent population, which is at high risk. People in crisis often wait for long periods of time in the emergency department for a mental health assessment. Rural sites face greater access barriers for emergency assessment than urban sites, and during the pandemic, fear of acquiring COVID-19 in a hospital may prevent people from getting life-saving treatments.

In Manitoba, we have pivoted towards doing more emergency virtual mental health care. In partnerships with federal, provincial and community partners, we have implemented a pilot where there's a youth telepsychiatry emergent service that provides service across all rural EDs as well as rural first nations. The goal is simply to reduce the transfers of youth for assessment and reduce the need for hospital admissions. Over the last three months, we have already reduced one transfer to Winnipeg per week.

The adult crisis response centre has also transformed the majority of their crisis services for urgent mental health addictions assessment to a virtual platform, and we have also developed virtual wards where people can get daily assessments and supports at home with appropriate supports from their families so we can try to minimize the exposure to COVID.

Our University of Manitoba Ongomiizwin-Health Services has developed COVID rapid response teams that are designed to go into first nations communities to support the community leadership in identifying contact tracing, helping with isolation procedures and helping with rapid point-of-care testing to reduce the spread of COVID-19.

The last important project I'll talk about in Manitoba is the alternate isolation accommodations. We know that people who are exposed to COVID in homeless shelters and cannot isolate appropriately, as well as seniors and health care workers, are at significant risk of spreading COVID. Alternate isolation accommodations in hotels and apartment buildings have been utilized to help with isolation and health supports. Over 800 people in Manitoba have utilized these to reduce the transmission of COVID. The At Home/Chez Soi project that many of you are familiar with uses a harm reduction approach for our homeless population. That approach is also being used in our communities.

I'm going to come back to the story of the 15-year-old boy. He had come to the first nations community, in crisis, with his grandfather. He was exposed to COVID. He got a virtual telehealth assessment from Winnipeg, so he did not have to travel to Winnipeg for an assessment. There was no need for an immediate psychiatric admission. He was able to stay in his home community and be isolated in a hotel for a few days until the test results came back.

I'll end there.

I look forward to the questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Sareen.

We go now to the Overdose Prevention Society and Sarah Blyth, executive director.

Please go ahead, Ms. Blyth. You have seven minutes.

[Sarah Blyth, Executive Director, Overdose Prevention Society]

Thanks a lot for having me today. It's really an honour to be able to speak to you—

[The Chair, Liberal, Ron McKinnon]

Ms. Blyth, there's something wrong with your sound. It's very weak.

Can you check to see if the proper mike is selected?

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, if I may, I can hear her fine. I'm wondering if the problem might be your headset, because she is coming across very strong and clear.

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

I can hear her perfectly as well.

[The Chair, Liberal, Ron McKinnon]

Maybe it's just me.

Please go ahead, and while you speak, I'm going to check to make sure all my cables are plugged in properly.

Please go ahead for seven minutes.

[Sarah Blyth]

Thank you so much.

My name is Sarah Blyth. I'm representing the Overdose Prevention Society. We opened an emergency safe injection site in order to deal with the emergence of overdoses in the Downtown Eastside and all of the deaths that were happening in 2014.

We see up to 700 people daily in the Downtown Eastside. The OPS in the Downtown Eastside have collectively saved 6,000 lives in the past four years. Unfortunately, the drug supply continues to get more contaminated, and that contamination has spread across Canada. Overdose prevention saves lives in emergency situations, but in order to save lives we need to take immediate action or more people will die.

COVID has only complicated the situation. We are telling people to stay home, but more drug users are dying of overdoses than of COVID. In order to keep people home, we need to give them a safe supply, something that they're not buying from drug dealers on the street. It's something that doctors can prescribe so that they are not dying in their housing alone, so that they can stay home and so that they don't come out of hospitals. We've had a lot of people go into hospitals, then hotels, and then come right back out to the street with COVID to look for drugs because they're not getting what they need. It's just further causing harm and a difficult situation.

The overdose prevention site has become sort of a one-stop-shop for everything because of COVID. A lot of services have closed down. For any person who is homeless and using drugs, they come to us for housing support. We help people get housing. Once a week we usually get someone housing, though I have to say that there isn't really any housing right now. It's a very difficult situation. It's also really hard to go home at the end of the night and have people stay out in the cold, so we do what we can. Working on the front lines, as you can imagine, is very challenging right now.

We provide medical support. We deal with helping to clean wounds, provide wound care and all kinds of things. We also deal with mental health support. A lot of times people go in to get their mental health support from the hospital, but then they have to leave an hour later. It's the same with medical support. Usually they come to us, and we do our best to help people, but we're one of the only places. We distribute information. A lot of people don't have cellphones or television access.

We now distribute clothing, food, blankets and mats to sleep outside at night. We do pretty much everything as an overdose prevention site. I just wanted you all to know this because I think it's pretty important to know what these front-line services are doing and how much we're taking on due to other services shutting down.

I'm just going to tell you what we need from the federal government. We really need some sort of a national housing plan that would take immediate action. We need housing, and right now I can't get people into housing no matter how hard I try. Because I'm on the front line with people, I spend a lot of my time side by side with people who are crying, who are sleeping outside and who are getting sick needlessly.

We also need support. The City of Vancouver and council have passed a motion regarding decriminalization, and they need support. They understand the challenges. I really believe that the city council that we have, with Mayor Kennedy Stewart, understands the challenges that we're facing. We really need to—

[The Chair, Liberal, Ron McKinnon]

Pardon me, Ms. Blyth.

The clerk has informed me that your mike is just a little too close. It makes popping noises.

Could you move it away?

[Sarah Blyth]

Oh, I'm sorry, guys.

Is it better now?

[The Chair, Liberal, Ron McKinnon]

I'm not a judge, because I've had potential issues, but let's try that.

[Sarah Blyth]

Okay.

Mainly, it's just getting support for the City of Vancouver. I'm sure cities across Canada are facing this with COVID, especially since a lot of people who were near homeless used to be able to stay at other people's houses. Now, there is no way to have visitors, especially in social housing in the Downtown Eastside. There are hundreds of people who are out on the street who didn't use to be, so we're facing a really serious situation here and [Technical difficulty—Editor].

We really need safe supply. We need people to be able to stay home. All of these things may seem controversial, but really, in the end, if you do the right thing, you're going to save lives, and you're going to be proud of that in the work you do. You're going to make some big changes, and other parts of the world are looking at us to see what we do in these situations.

We can be proud of what we do, or we can let things on the overdose crisis stay as they are, and not be able to sleep at night. I don't know how people can sleep at night with so many people dying. You guys can do something about it, so we're asking you to help us.

It's desperate. I've come to the last one, where we weren't as desperate, but now we're really desperate. I am desperate. I am out on the streets helping people all day. It's every day. A lot of people aren't even social distancing or anything, because they have so many more problems than just COVID—housing, health care, all those things.

We can do a lot in many simple ways. I am willing to help. If any of you want to meet with me to try to come up with a plan, I am willing to do that. I am willing to be part of the solution. You can contact me.

That's basically it. We need your help. I think you can help us, so I am putting it out there that I am willing to be part of that.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Blyth.

We'll start our rounds of questions. I believe we will have time for one round of questions.

We will start with Mr. Barlow.

[John Barlow, Conservative, Foothills, AB]

Thank you very much, Mr. Chair.

I want to thank every one of our witnesses for their honest testimony and for painting us a pretty bleak picture of the state of Canadians' mental health as a result of COVID.

Dr. Lavoie, you were saying that only about 10% of Canadians know about a program. I missed the first part of that. Can you tell me which program you were talking about? It was near the end of your presentation.

[Dr. Kim Lavoie]

It's called Wellness Together Canada, and it's a very well-funded federal program that's been in place since the end of the summer. In my speaking notes, which I gave to Mr. Pagé, I provided the web link.

[John Barlow, Conservative, Foothills, AB]

I know the program.

[Dr. Kim Lavoie]

I just got it from a collaborator on our study, and he provided some information about the user statistics and things so far in the first few months of the rollout. One of the most startling things was just how few people were really aware of it. There is a lot of money that's already been pumped into this online program, so there is still a lot to be done to promote it and make it available to those people who need it.

I do want to add one other thing—coming back to something Dr. Sareen said, which is really important—which is the idea of providing stepped care. This kind of online Wellness Together program would be good for a lot of people who are having trouble coping, who are having a new onset or an increase in anxiety or depression or feeling isolated. However, there is a difference between providing care to those who might have an exacerbation of a pre-existing psychopathology—those who might have mood and anxiety disorders that may or may not have been well treated pre-pandemic, and what kinds of services those folks need—versus those who are developing new psychopathology, that is, clinical levels of anxiety and depression, and who can't get services, versus those who are just more stressed out and having trouble coping with day-to-day life.

This kind of stepped care idea is really important. I think we need to make sure that.... Some of these counselling-type online programs might not be suitable for those with more severe psychopathology. I'd be interested to hear more from Dr. Sareen, but I just wanted to clarify that.

[John Barlow, Conservative, Foothills, AB]

Sure. I appreciate that.

With that in mind, with regard to the Wellness Together program and with so few Canadians knowing about it.... The United States put in its 988 program as a suicide helpline. It has received a lot of publicity, and most people know about it.

Would something like that work here in Canada? We don't have anything along that line, but it just seems like everybody knows 911, so 988 would be that gateway, let's say, if you were in a mental health stressful situation. Would a program like that help as something that would be easily recognizable and that everyone would be able to get? Maybe it could be an introduction to the Wellness Together program.

[Dr. Kim Lavoie]

Absolutely. I think anything that has quick brand recognition.... Everybody knows what to do and where to go, and then the program will direct you to the services that you need as a function of your initial assessment. Absolutely, that would be a fantastic idea.

[John Barlow, Conservative, Foothills, AB]

It's my understanding that, with the program we have now, it's different in every region, and it's just an answering machine. I don't think that, in this crisis situation, what anyone wants to hear in an emergency situation is “Please call back” or “Leave your name and number”.

[Dr. Kim Lavoie]

Absolutely.

[John Barlow, Conservative, Foothills, AB]

We saw the results from the Canadian Mental Health Association survey that came out on Thursday or Friday, and the numbers were quite staggering.

The one that really caught my attention—and, Dr. Lavoie, you mentioned it briefly at the beginning of your presentation—was the impact that COVID has had on women. The number, I think, was that close to 13%—off the top of my head—of parents are now scared of domestic violence in some way.

Is that a significant increase from what you would traditionally see? Has COVID caused that much of a sharp rise in that issue?