Health Committee on Dec. 7th, 2020

[Dr. Kim Lavoie]

Yes, and I think it's also one of the reasons why we're seeing a huge increase in the number of separations and divorces. You can just imagine how stressful a divorce is in normal times; imagine trying to work out separating, finding a new home, and child custody. It's absolutely shocking how much separation and divorce is happening.

I think it is really being fuelled by the fact that a lot of couples, who are used to a certain balance in their relationship, are now being thrown together, spending 24 hours a day together. All the gender roles are getting mixed up. You have moms and dads at home with kids who might be doing online learning. Certainly, there are the effects of the widespread lockdown that happened more in the first wave.

All of that is to say that I would suspect that it's probably more than 13%, because I would suspect that those who are probably experiencing it the most and the worst are not the ones who have the time or the luxury to respond to some of these surveys, so I—

[John Barlow, Conservative, Foothills, AB]

I'm sorry, Dr. Lavoie. I only have a few seconds left, and I just want to ask a quick question of Dr. Sareen.

You were talking about access to psychiatric help and accessing the resources we have there. Would that 988 number work on that? Would that be a way, as well, to have those professionals be working as part of that program as a first step for Canadians to access that type of assistance?

[Dr. Jitender Sareen]

Absolutely.

I think the 988 approach is excellent, but having the next steps is really important at the provincial level.

In China, they also implemented online screening so that you can have.... We're used to ordering food online. We should be able to do some level of online because the volumes are just going to be out of control. You can't build a system that has enough people on the phone. You have to integrate it with online self-assessment, self-screening tools, and then have the next pathways to care after the assessments. They have to be integrated, or people will not show up to the line because they'll say, “Well, you know, I didn't get an answer” or—

[John Barlow, Conservative, Foothills, AB]

Or “I'm scared to go the hospital because of COVID....”

Thank you very much. I appreciate it.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Barlow.

We go now to Mr. Van Bynen.

I understand that Mr. Van Bynen will be splitting his time with Mr. Kelloway. I will show you the yellow card at three minutes.

Go ahead. You have six minutes.

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

Thank you, Mr. Chair. I will be splitting my time with Mr. Kelloway.

I'd also like to say thank you to our witnesses for joining us today and for sharing their perspectives and expertise on what I believe is an incredibly important topic.

Dr. Lavoie, I was a bit taken aback by the fact that only 10% of the population is aware of the Wellness Together website. When I see that 680,000 Canadians have already used the service, with close to 1.8 million separate web sessions, it really does give me an important scope and a scale of the crisis we're faced with, so I appreciate your bringing that forward. We need to find ways to make sure that more people are aware of that program.

I will be asking Dr. Sareen my question.

Dr. Sareen, since the beginning of the pandemic, it has become clear that COVID-19 impacts certain communities disproportionately and that race, gender and socio-economic status are some of the factors that can amplify these impacts. Based on your experience with first nations communities, could you please share with the committee some of the mental health effects and challenges that indigenous peoples are facing as a result of the pandemic?

[Dr. Jitender Sareen]

Some of the key things are what every Canadian is facing, which are fear, anxiety and stress. The additional barriers, if people are living in on-reserve communities, are poor access to sites in urban settings, and stigma if somebody has had COVID. Right now, we know that having COVID increases the stigma for all people who have had COVID. There is more stigma and there is discrimination that can also be faced.

Coming back to Dr. Lavoie's point, I think many people are scared to get care for chronic health conditions unrelated to COVID, and that can also have a major impact as far as mortality goes. We know that our first nation communities have significant health disparities. People are less likely to come for appropriate care. We have the tools to be able to provide telephone or video conferencing assessments, and we really need to do this so that people can feel safe to access care in their home communities.

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

Thank you.

When you appeared before the committee in 2017, you mentioned that you were working with a team of researchers who were examining the impact of trauma and PTSD among Canadians. The current COVID-19 pandemic has taken a physical and emotional toll on many people in Canada and across the globe, particularly on our health care workers and first responders, whose jobs during this pandemic have been essential but also more demanding and emotionally draining than usual.

Do we currently have any research that shows the impact of the pandemic on their mental health, and what can be done to support those on the front lines?

[Dr. Jitender Sareen]

There are groups that are working on understanding the health impacts. We know that health care workers, as well as first responders, are at a higher risk of developing mental health difficulties because of their daily stress, as well as seeing the traumatic events. There is work that is being done to look at those interventions.

In Manitoba, we have also developed prevention trials, where we are providing a randomized trial to look at cognitive behaviour therapy to reduce depression and PTSD among well public safety personnel. That's a trial that we've been doing because it's really important to try to prevent mental health difficulties in our population.

[The Chair, Liberal, Ron McKinnon]

Thank you.

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

Have I hit my three minutes, Mr. Chair?

[The Chair, Liberal, Ron McKinnon]

You're well over.

Mr. Kelloway, you have a minute and a half.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Mr. Chair.

Thank you to the witnesses for being here today and to MP Van Bynen for his advocacy and leadership on the mental health supports for Canadians.

Dr. Sareen, my question is for you. About a month ago, our government announced the rapid housing initiative. That's a program of $1 billion to help address urgent housing needs for vulnerable Canadians. Given your expertise with vulnerable populations, I'm wondering if you can speak to the importance of a housing initiative like this and how it will address mental health needs for Canadians, especially on our path to a COVID-19 recovery.

[Dr. Jitender Sareen]

Yes. I think we know, as Ms. Blyth mentioned, that housing is extremely important in terms of helping our people with severe mental illness. I was involved with the At Home/Chez Soi project, which really showed that providing housing, along with harm reduction approaches and mental health supports, is extremely important.

The alternate isolation accommodation in Manitoba, led by Sharon Kuropatwa, is really based on exactly that model. People who are being tested for COVID or who are COVID-positive and are homeless have difficulty being able to isolate, and we need to provide them appropriate supports. I think housing is a major issue. As Ms. Blyth said, that's the biggest challenge for our most vulnerable Canadians.

We could do a lot around virtual mental health care. I always say that in Winnipeg we don't spend a lot on PPE in mental health. If governments can support virtual care platforms, appropriate electronic health records and appropriate outcomes, we would save a lot of PPE and people would get care at home. Housing is extremely important in being able to support people in their own homes. Otherwise, they're going to be coming to the emergency rooms. They're going to have negative sequelae.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

Now it's your turn, Mr. Thériault.

Go ahead for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I wanted to thank all the witnesses for contributing to our understanding of the mental health impact of this pandemic.

I'll start with a brief comment.

Ms. Blyth, I'd like to express my gratitude and admiration for the harm reduction work you're doing on the ground despite very limited resources. We see that mental health problems and mental illness aren't a recent phenomenon, according to Dr. Lavoie's studies and the many interviews she has given. Her contribution during the pandemic has been remarkable.

Prevention, first and foremost, is the key to improvement. It's also the primary determinant of health in general, but one would think mental health has always been the poor cousin of health systems. The pandemic has had a mirror effect, putting this reality squarely in our face and making it seem worse.

What are we to do about that? We have Dr. Lavoie's compelling data. However, I'd like to take this a little further. We'll have to make decisions as legislators.

Dr. Lavoie, based on your experience, why do you think psychotherapy isn't universally available? Why is it that investing in mental health and mental health promotion isn't considered necessary, when we know very well that mental disorders can cause physical disorders and chronic diseases such as cardiovascular diseases, obesity and so on?

What, in your view, are the reasons why that investment hasn't been made, and is it a mistake to continue underinvesting in mental health prevention?

[Dr. Kim Lavoie]

Thank you very much for your question.

I'm going to speak in English, because I said I would. I hope that's okay. It's weird whenever I'm addressing someone in French, but I can speak in French as well. I just want to make sure it's okay with the translator.

The main reason is the availability of funds and, to some degree, bias that still exists in medicine that a lot of mental health is in your head and doesn't affect the body. There's a disconnect there, but by and large, it's something we've been struggling with for years.

I'm a clinical psychologist. One thing that still exists to this day—and there's a particular problem in Quebec—is that we have a lot of interns, who are the equivalent of medical residents, who do not get paid for their psychology internships, which is not the case in other provinces. The only explanation I can really give you is that it hasn't been prioritized all this time. It has certainly been deprioritized when you look at the funding set aside for mental health services, and I think more needs to be done.

As someone said earlier, this pandemic has only accentuated the disparities and the gaps in the available services for people who need them in terms of mental health services.

I couldn't agree with you more. It's great to have great physical health, but without mental health.... I'm sure everyone would agree that it's the primary reason a lot of people actually consult their doctors. They don't feel good; they aren't sleeping and they can't function in daily life.

I don't have anything more than that we're dealing with a history of bias and a history of deprioritizing mental over physical health. Definitely, more needs to be done.

[The Chair, Liberal, Ron McKinnon]

If you want to speak French, please do. We have good interpreters.

We are listening, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, would you please tell me how much time I have left?

[The Chair, Liberal, Ron McKinnon]

You have a minute and a half.

[Luc Thériault, Bloc, Montcalm, QC]

You said the message has to be much clearer, more perceptible and comprehensible, for measures to be appropriate, effective and efficient. There are differences in the way the age groups comply with health measures.

What might be an effective message to send to people both over and under 25 years of age?

Based on past experience, people will definitely let their guard down as the holidays approach.

[Dr. Kim Lavoie]

That's an excellent question.

It reminds us that people don't comply with health restrictions for the same reasons. What concerns young people doesn't concern older people. Young people are asked to make greater sacrifices than the ones I'm asked to make.

Telling young people not to go to university, not to see their friends and not to go out with boys or girls at this time in their lives is a lot to ask. You have to understand what motivates people and what young people's concerns are. We need a specific approach and messages targeting those people to make them understand that, if they comply with health restrictions, their social lives, university and jobs will all come back.

I think what they hear focuses too much on protecting the health of their families, the elderly and the sick. That doesn't resonate with young people. The message needs to be changed.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

Mr. Davies, please go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses for their testimony.

I also want to add my voice to Mr. Thériault's, to Sarah Blyth in particular, for the outstanding work she does every day with very limited circumstances and in trying conditions. I know you're saving lives, and that's an astounding statistic that your overdose prevention site has saved 6,000 lives in four years.

I'm going to direct my questions to you, Ms. Blyth. I think you mentioned that you've been in operation since 2014. Do I have that correct?