Health Committee on Jan. 29th, 2021

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I want to thank all the witnesses for their contributions. This gives us food for thought and helps us find solutions to better manage these types of situations created by the pandemic.

Dr. Veissière, I first want to address the issue of psychosocial consequences as collateral damage of the pandemic.

Throughout our meetings, witnesses have warned us about the collateral damage of the pandemic, particularly for patients who don't have COVID-19. This includes offloading, late screening and cancellation of surgery. Without exaggeration, we can expect to see cases where, as a side effect, COVID-19 will result in the death of some patients or will have a very serious impact on their health, in addition to their mental health.

Last week, when you participated in a consultation conducted by the Quebec government, you clearly stated that, as part of the collateral damage of COVID-19, the psychosocial impact on the mental health of families was among the missing pieces of information that we would need to address.

Could you elaborate on this? If you feel inspired, could you give us some solutions?

[Dr. Samuel Veissière]

Thank you for the question. I'll respond in English.

It's an excellent question.

As you point out, we strongly suspect that excess mortality has been a problem. Excess mortality in turn is likely associated with a further psychosocial or mental health toll on those families negatively impacted by missed surgeries or by increased mortality not related to COVID or related to cancellation of hospital services.

The one dimension that is closest to my own area of expertise that I do want to speak on as well in terms of missing data is that there's a dire need for better evidence-based research on the impact of isolation, increased screen time and virtual and distance learning on the psychosocial emotional development of youth and on their mental health.

The last thing I also wanted to mention in response to the previous question—what can we do to help our youth?—is that we knew before the pandemic that the figures were alarming and that our youth are in distress. There's a confluence of factors that contribute to the increased erosion of resilience among younger people. One of them is increased screen time. We know this from the research.

What I would like to implore our government to do, because we cannot rely on big tech companies to do this for us, is to, at some point, treat screen time like a controlled substance—like tobacco, cannabis or alcohol, substances that we know negatively impact development—and have clear, evidence-based guidelines for its regulation.

In the short term, we can also communicate those guidelines, through family physicians and through our educators, for responsible screen time and responsible screen use. This, many of us in the community believe, is a public health emergency. It already was before the pandemic, and it is considerably worse now.

Thank you for your question.

[Luc Thériault, Bloc, Montcalm, QC]

You're talking about guidelines. Could you give us some ideas?

[Dr. Samuel Veissière]

Are you talking about guidelines for responsible screen time?

[Luc Thériault, Bloc, Montcalm, QC]

Yes. What does responsible screen time mean to you? In what context does it apply?

We're currently in a pandemic situation. As a result, virtual consultations are the preferred option. I imagine that, in your practice, this has certain advantages, but also disadvantages. You're in the process of compiling the differences that you're seeing on a therapeutic level. There are limits to what you can do when you meet with a patient virtually rather than in person.

In general, what could you say about these guidelines? In what situations should remote consultations be the preferred option? Can this practice be expanded? Will this create side effects or side issues?

[Dr. Samuel Veissière]

Thank you for the question.

I think it's important to point out that the work done by Ms. Hay, for example, is wonderful, and it is needed. There is in fact research showing that tele-therapy can confer some benefits for some patients who might otherwise have mobility or accessibility issues. It's important to continue to focus on these strategies. However, it's important to focus on prevention strategies as well. If we know that over one quarter of our youth prior to the pandemic required mental health care, this is a sign that our society is broken, in some sense. We need to focus on the strategies so that they do not need those services. Of course, those services are great, but hopefully people would be healthier.

Less screen time and more face-to-face activity would be better, as would good regulations for the amount of screen time on a developmental schedule, such as zero screen time for youth under six and then up to one hour a day with supervision, but also good guidelines for the kinds of content people consume and the kinds used. For example, we know that active communication with loved ones with social media is good. It's associated with increased well-being. Passive, mindless scrolling of anxiogenic information is not good.

There are plenty of those guidelines, but unfortunately, as I expressed to the National Assembly of Quebec last week, most of the protective factors that we can recommend do not presently apply under the current public health guidelines, which we know are required to protect our vulnerable population. However, moving toward, focused protection strategies targeting different groups with different risk factors where we know that young people really need these opportunities to connect, in particular in school and in universities, has also become an emergency.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies.

Mr. Davies, go ahead for six minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I'd like to thank all the witnesses for their powerful testimony. I want to direct my questions to the HEU.

Ms. Nederpel, Ms. Hackett and Ms. Dreyfus, I'd like to thank you in particular for your fierce advocacy on behalf of not only your members and those working on the front lines but also the patients they take care of. I'd also like to thank you for the service you're doing. It's well known that north of 70% of the deaths in Canada due to COVID occurred in long-term care facilities. It's your members, the staff and employees, who have been on the front lines of this, putting their health and their families at risk. I want to thank you for the incredible work you've done and the sacrifice you're making for all of our health.

Ms. Nederpel, it's been said that the conditions of work are the conditions of care in the long-term care sector. I'm just wondering what suggestions you have for the federal government to help prevent a health human resources crisis that I think is developing as a result of pandemic burnout.

[Barb Nederpel]

That is such a critical question, Mr. Davies. Thank you for that.

I have to say that right from the get-go, deep fragmentation happens here in British Columbia. There are hundreds of different collective agreements. Many facilities don't have any agreements whatsoever. It also changes from province to province. The impact of COVID has been pretty wide-ranging. Regardless, it has been devastating.

We have to go to the basics. We absolutely need to have national standards across this country about working conditions and the caring conditions that our residents are living in. That means we need to increase the federal transfer funds to provinces so that they can provide the dignified, unrushed care that our residents desperately need. Of course, those transfer funds must be provided, but with accountability attached to them. That's absolutely imperative. We need to address the very basics so that when emergencies such as COVID, SARS and other instances come along, we have the capacity to pivot as quickly as possible.

On top of that, we need to figure out how we provide sick pay for workers. I'm not sure if it's federal or provincial; you all need to figure that out. In the public sector agreement, workers get as many as 18 days a year for sick time. However, in the fragmented long-term care sector, we're lucky if they have five to seven paid sick days. One instance of where they have even one single symptom of COVID can wipe out their sick bank. Then what do they do? We're putting them in an untenable position where they have to feed their family and can't afford not to go to work. That's not okay, especially in this sector.

We need to have a strong sick pay plan. I think it's important to point out that new hires get none. A new hire during COVID works full-time hours alongside a fellow worker. They're getting no sick time. That's where we should really start.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

You sort of anticipated where I was going next, which is that my party, the New Democrats, have been calling for national standards in the long-term care sector, working in partnership with the provinces and territories to establish minimum standards on the minimum number of hours of care per day, increasing the wages and benefits and working conditions of everybody working in the LTC sector, and similar things.

We're hearing back that there is a noticeable difference in terms of the working conditions and care standards in for-profit versus non-profit or government care homes. What can you tell us about what you're noticing in that regard?

[Barb Nederpel]

I think it's important to really point out the difference between the private sector and the public sector, where we've had significant contracting out and contract flipping, which was designed to drive the wages and benefits down for workers. That has resulted in a dramatic gap in the wage between the public sector and the private sector, of as much as $7 an hour. That's not even including the disproportionate impact on their benefits and pensions.

What happens is that you have this recruitment and retention problem. As I mentioned earlier, we had a crisis in long-term care long before COVID even started, because of the significant wage gap.

Again, this province has done a good job, in the sense that it has brought the wages up so that everybody gets paid the same, but that is something that absolutely needs to stay permanent. But it's not just wages; it's all of the benefits. They have to be equal right across the board in this sector.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Dreyfus, the last word goes to you.

What would mean the most to you and your fellow workers to increase the morale and your enjoyment and your feelings of protection in the sector you work in? What advice would you give us?

[The Chair, Liberal, Ron McKinnon]

Go ahead quickly, please.

[Maria Dreyfus]

It would really mean a lot to us if we were able to do our job, direct care, without being rushed at work, and were able to spend time, quality time, with our clients.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

Thank you, witnesses, for sharing with us your time today, and of course for your expertise and basically all the labours of love you put in every day.

I would also advise that if you have any further information you would like to offer the committee, please send it to the clerk, and that will be incorporated into our study as well.

With that, we'll bring in the next panel, so we will suspend. Thank you very much, everybody.

[The Chair, Liberal, Ron McKinnon]

The meeting is resumed.

Welcome back, everyone, as we resume meeting number 15 of the House of Commons Standing Committee on Health.

The committee is meeting today to study the emergency situation facing Canadians in light of the second wave of COVID-19.

For the witnesses just joining us, I'd just like to remind you that you may speak in the official language of your choice. Interpretation services are available in the meeting. You have the choice, at the bottom of your screen, of floor, English or French. With the latest Zoom version, you may now speak in the language of your choice without the need to select the corresponding language channel.

With that, I will introduce our witnesses.

From the Camrose Women's Shelter, we have Ms. Nora-Lee Rear, executive director; from the Canadian Grief Alliance, we have Ms. Maxxine Rattner, member, and Mr. Paul Adams, member; from Homewood Health Centre Incorporated, we have Dr. Carlos Lalonde, executive vice-president of national medical services and chief of staff; and from the Mental Health Commission of Canada, we have Ms. Louise Bradley, president and chief executive officer.

Each witness group will have six minutes to deliver a statement. I would note that I will show a yellow card when you are at the five-minute mark, and a red card when you're at six minutes.

With that, we will start the statements, if you please.

For the Camrose Women's Shelter, Ms. Nora-Lee Rear, please go ahead for six minutes.

[Nora-Lee Rear, Executive Director, Camrose Women’s Shelter]

Thank you, Mr. Chair, for the opportunity to address the committee this afternoon.

The COVID-19 pandemic has created a spike in domestic violence, meaning an increased number of people seeking support. The need for mental health support for our clients surpasses what the current programming and staff can offer, and other counselling resources in the community often have wait-lists or cost more than our clients can afford.

Experiencing abuse contributes to many negative mental health outcomes, including depression, anxiety and PTSD. The additional stress, uncertainty and rapid changes of the COVID-19 pandemic put further strain on the women and children using our services. Access to quality mental health care is an important part of an individual's journey towards a lifestyle free of abuse. One of our main hopes is that by offering our services and increasing mental health supports for these women and children, we will begin to break the cycle of trauma and support clients' transitions to safe and independent lives. Fostering positive mental health is beneficial for the community overall, as better mental health is correlated to better overall wellness and the ability to function within society.

To this end, our organization designed an evaluation to understand the qualitative changes resulting from our program. The evaluation focused on individuals recognizing that they are not alone in the world or in their struggles. We used thematic analysis to discover key findings, and we believe some of those findings are relevant to this discussion today. We chose clients who were active as of September 11, 2020, providing a pool of 52 possible respondents, the majority of whom had become involved in our program since March 1, 2020.

While safety from abusers is a key part of our shelter services, numerous clients also identified the women's shelter involvement as a form of suicide prevention. Often there is a deep sense of loneliness that accompanies leaving a relationship, even an abusive one. This, combined with the logistical and economic complications that most women face and compounded with the mixed messages received during COVID, has created the perfect storm for abusers to capitalize on. Shelters state that they are the safest place to be, even during COVID, while public health messages lock down victims with their abusers, making it more difficult for someone in an abusive relationship to flee to a shelter during social isolation, because their partner may be more closely monitoring or limiting their technology use.

One interviewee said, “Through this program, I went from feeling like committing suicide to feeling like I had a lot of hope.” They went from feeling helpless to feeling they were powerful, with choices and independence. This increased sense of control led to greater mental resilience and the ability to move forward in adverse situations, even during COVID.

Many clients expressed that they had gained the ability to take back their power. Before being involved in our programs, respondents could not speak for themselves or their children, but they now report coming back to who they were before the abuse. They went from feeling helpless to feeling they were powerful, with choices and independence. One interviewee said, “Knowing I have help gets me through mentally.” Another said, “I know that when things get worse for me, the women's shelter is always there.”

A number of respondents shared the difficulty of addressing societal misconceptions about abuse. Those experiences included conversations with friends and family who were uncertain about how to respond to disclosures of abuse and who just didn't “get it”. The common theme that united these experiences was trying to explain abuse to those who don't get it. One respondent expressed, “It is very frustrating, because within my family, who are supposed to support me, someone will say, 'You're a liar', 'That didn't happen', or 'It wasn't that bad.'” These frustrations range from the systemic level to the personal level and are particularly difficult for someone who is trying to relate the effects of abuse on their mental well-being when no one believes them.

Respondents also described their own barriers to accessing services. Abuse can skew an individual’s relationship to help, including feeling undeserving of the help or fearful that assistance will be withheld. Respondents identified a fear of being told “no” when asking for services. One respondent was afraid to access human services as she feared it would be used against her by her abuser. The constant fear of what will be used against our clients is an ongoing reminder of the control abusers have, and COVID has exacerbated that.

During times of COVID, while the public is hearing pervasive messaging to stay home and stay safe for their physical and mental health, women also need to know that, one, shelters serving abused women and children are open and are ready to help, and two, that you don’t need to come to a shelter to get help. As they have done throughout their history, shelters have been innovative in their approaches to reach and support women and to support their mental health.

What COVID has done is to shine a spotlight on the many cracks and fissures in the support networks that women need on their path to healing. We know we can make a difference in women’s mental health, as well as their children’s, now and in the very difficult times that we know are coming.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Rear.

We go now to the Canadian Grief Alliance and to Ms. Rattner or Mr. Adams to give a statement for their group.

Go ahead. You have six minutes.

[Paul Adams, Member, Canadian Grief Alliance]

Mr. Chair and honourable members, thank you for inviting the Canadian Grief Alliance to speak to you today.

We're a coalition of grief experts and more than 150 leading health organizations, including the Canadian Medical Association, the Canadian Nurses Association, and the Canadian Psychiatric Association. We came together last spring to ask all levels of government to urgently turn their minds to the issue of grief in the context of COVID-19 and in anticipation of the deadly toll we have seen since.

Almost every one of us has suffered grief in our lives: the loss of a mother or father, a brother or sister, or perhaps a child or close friend. As profound as our grief may have been, what most of us suffered was the usual response of human beings to profound loss. Most of us, with the help of family and friends and the passage of time, rejoined the trajectory of our lives, even if the ache of loss never entirely disappeared, but what the research tells us is that when grief is complicated, when its circumstances prevent us from having the space or the support to grieve, it can transform into depression or anxiety, dependence or addiction, and self-harm or the thoughts of it.

Today, we're suffering a pandemic of grief. Nearly 20,000 Canadians have died of COVID-19. The image of a nurse holding an iPad at someone's deathbed is now a familiar one. Robbed of the chance to be with their loved one at their deathbed, the grieving may have a funeral replaced with a Zoom call. Instead of a house filled up with family and friends, the grieving may have a frozen lasagna dropped off at their doorstep—socially distanced, no hug, no touch, no lingering visit.

Nowadays, much of this is also true of those who grieve for the 25,000 people in Canada who die of heart disease, cancer or anything else in an ordinary month. More than two million Canadians are estimated to have been touched directly by death in their circle during this pandemic, and their experience is anything but normal. It's complicated grief, the kind that we know can lead to enduring mental health issues.

Specific communities are especially affected. Health workers are exposed to a scale of suffering that even they are unaccustomed to. The CGA also recognizes the generations of grief that indigenous people carry as the result of colonization and structural violence, which are often overlooked in public health policy.

Our existing system is not well equipped to deal with grief, in part because it is rightfully not regarded as a form of mental illness. Indeed, mental health advice that is sound for those suffering from anxiety or depression may actually make matters worse for the grieving. The grieving need dedicated support that understands the nature of their grief and how to guide them. That's why we at the Canadian Grief Alliance believe it's time for a Canadian grief strategy, whose aim would be to help Canadians avoid succumbing to enduring mental health challenges that will diminish their lives and take a toll on our society and our health care system.

I'll ask my colleague Maxxine Rattner to take it from there.

[Maxxine Rattner, Member, Canadian Grief Alliance]

Thanks so much, Paul.

Specifically, we are proposing a three-part emergency-based response as the first steps of a Canadian grief strategy. First, Canadians need expanded access to grief services where they live. Grief services that were largely under-resourced before the pandemic are now bursting at the seams, trying to meet skyrocketing demands. In many parts of the country, there are long wait-lists or a complete absence of grief services. Without sufficient grief services, the risks for mental health issues to develop will increase. Communities disproportionally impacted by the pandemic, including racialized and indigenous communities, are also being disproportionately impacted by grief. Grief support services and programs led by and for these communities are essential.

Second, we propose a national public awareness campaign to increase Canadians' understanding of grief and provide education and strategies to help Canadians grieving in isolation to cope. Such a campaign would also acknowledge our collective grief as a country.

Third, Canadians have never experienced this depth and breadth of grief and loss before. We propose a rapid national consultation in the immediate term, and dedicated research funding in the months to come that would allow us to better understand pandemic-related and affected grief. We have a model that would allow us to complete such a consultation within about two months, as we are very connected to organizations doing this work and are engaged with diverse communities across the country.

The emergency measures that I have just outlined are necessary but not sufficient to quell the rising tide of grief and its anticipated medium- and long-term social, economic and mental health impacts on Canadian society. Current mental health spending does not include grief services. Grief is falling through the cracks. We urge you to implement a Canadian grief strategy that brings together federal government departments, provincial and territorial partners and NGOs to build a coordinated, sustained and evidence-based response to the growing needs of grieving Canadians.

Grief cuts across the government's work in health and public health, from dementia to substance use, indigenous communities and children. We envision the strategy as having a lasting place within the framework of government. A Canadian grief strategy will help prevent significant mental health outcomes for individuals, families and communities across the country now and in the months and years to come. Canada has the opportunity to be a true leader by being the first country worldwide to commit to a grief strategy in the wake of COVID-19. On behalf of an ever-growing number of grieving Canadians, we urge you not to miss this opportunity.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Rattner.

We will go now to Homewood Health Centre, to Dr. Lalonde.

Please go ahead for six minutes.

[Dr. Carlos Lalonde, Executive Vice-President of National Medical Services and Chief of Staff, Homewood Health Centre Inc.]

Thank you very much for this opportunity, Mr. Chair.

The COVID-19 pandemic has contributed to an ongoing and expanding mental health crisis for Canadians and for the systems, institutions and professionals that provide mental health care across the country. The mental health impacts of the pandemic are both pervasive and severe, and, as always, the most vulnerable people are suffering the most.

I trust that we all recognize the truth in those statements and recognize that the rates of anxiety, depression, addictions and other mental health conditions have been on the rise. Rather than reciting specific statistics today, I hope to advocate for practical, inexpensive measures that we can implement now to make a significant and sustainable impact on Canada’s ability to address this mental health crisis and the ones that follow.

While I am the executive vice-president of medical services and chief of staff for Homewood Health, a national organization providing mental health and addictions care, I am also a member of the board of examiners for the Royal College of Physicians and Surgeons of Canada. I'm actively involved in undergraduate and postgraduate education within the Department of Psychiatry at McMaster University, and I am a practising psychiatrist with extensive experience in front-line in-patient and outpatient psychiatry.

With that background, I would like to speak about our front-line mental health workers. It’s not just our systems, institutions and resources that are stretched by the pandemic—it’s our people. At home, these people have been facing the same stressors as everyone else over the past year. In addition, they have been responsible for supporting those in need of intensive mental health supports while often being faced with increased risk of exposure to the virus on the front lines.

The pandemic has thus created a situation where our front-line mental health professionals—physicians, psychologists, nurses and other clinical staff—the people supporting our most vulnerable citizens and our exhausted medical professionals and essential workers, are also burning out at record rates. The result is that there are fewer qualified mental health professionals left to care for a growing number of patients. This has led to significant gaps in care and more burnout. I see it every day. In addition to the overall shortage of these professionals, these vital resources are distributed inequitably across the country. These individuals tend to practise more in urban areas and in certain provinces over others.

Concurrently, we are rightfully doing more to encourage people to seek help. Wellness Together Canada, for example, is serving thousands of Canadians and provides easy-to-access virtual and telephonic services within a stepped care model offering anything from peer support to short-term counselling based on an individual’s unique needs.

Unfortunately, experience gained over the course of this pandemic has further highlighted what many of us already knew: that the needs of many individuals cannot be fully met within the current system and that there is critically limited access to higher-level mental health practitioners, specifically psychologists and psychiatrists. Across the country, the availability of psychiatrists is particularly limited. There is a desperate need for these professionals, who are uniquely qualified to diagnose and treat those with more severe forms of mental illness through utilization of evidence-based psychotherapies, measurement-based care and, at times, medications.

What can we do? There are certain things we can do from an organizational level, but larger systemic change and national support are needed. In the long term, we can commit to making historic investments in mental health. We can train more mental health professionals, and we can incorporate virtual care requirements into training programs. We can work towards these types of initiatives down the road, but we need practical strategies that we can implement now to address the current needs during this pandemic.

I have three suggestions.

First, we need to make it easier to deploy expertise where we need it by reducing barriers between provinces to make it easier for qualified mental health professionals to practise interprovincially. With clinicians and patients becoming increasingly comfortable with virtual care, a licensed practitioner should be able to help patients in Alberta, Ontario and Nova Scotia in a single afternoon.

Speaking from personal experience, even for a Canadian psychiatrist with full licensure in one province, the process of gaining licensure in another province is onerous and can take months. The process is similar for those in other disciplines who report to their own provincial colleges. I am in support of the recommendations of the Royal College’s virtual care task force report, which spoke of the idea of a pan-Canadian licence.

Second, along with increasing accessibility to secure virtual platforms, I believe we should provide financial incentives for those services we need most, specifically consultations and the provision of virtual care, particularly in the most under-serviced areas of our country. I would also suggest that this incentive not be contingent on the use of a specific online platform like OTN, as is the case in Ontario for physicians.

Third, we can streamline the process for allowing foreign-trained mental health professionals to practise in Canada. Even highly experienced psychiatrists who have completed all of their medical education in the United States face significant obstacles to practising in Canada. This process seems unnecessary and can sometimes take years to complete, all during a time when our national need for these professionals is skyrocketing.

As a country, we need to take better care of the people working on the front lines of our mental health system. To help them help their fellow Canadians, we need to act swiftly to enhance our professional capacity and give those professionals the flexibility to practice where we need them most. If we can reduce interprovincial barriers, if we can increase access to secure virtual platforms and provide additional incentives for the most-needed services, and if we can accelerate the process of putting qualified non-Canadians on the front line, we will be better prepared as a profession, a system and a nation to help the people who need our help most.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Lalonde.

We'll go now to the Mental Health Commission of Canada, to Ms. Bradley.

Please go ahead for six minutes.

[Louise Bradley, President and Chief Executive Officer, Mental Health Commission of Canada]

Thank you, Mr. Chair and members of the committee, for having me here today. It's particularly timely, given that yesterday was Bell Let's Talk Day, about raising awareness about mental health. The year 2021 marks the 11th year for Bell Let's Talk, and it has a very different feel from what it had in previous years. Partly, that's because mental health has been top of mind since the onset of the pandemic, and the numbers speak for themselves.

A soon-to-be-released Leger poll conducted for the Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction spells out some very real concerns. The number of people in Canada reporting strong mental health has dropped by 23%, a drop from about two-thirds of the population to less than half since last March.

While awareness may be higher, the extent to which people with substance use and/or mental health concerns are accessing necessary treatments and supports is not keeping pace. Just 24% of respondents with problematic substance use and 22% with current mental health symptoms have accessed treatments since March.

On the heels of Bell Let's Talk, I think we can agree that it's time for some strong action. Don't get me wrong—five cents a text adds up to important community mental health funding, but to truly put our money where our mouth is, we have to be willing to invest the kinds of dollars that move mountains, quite frankly.

That's why we at the Mental Health Commission of Canada were so pleased to see Parliament unified behind the need for a standardized national mental health crisis hotline. It may be one small step, but any journey begins by putting one foot in front of the other.

Perhaps, though, there is a means to accelerate our progress. While old-fashioned thinking is one means to an end, we'll race to a place of mental health parity more quickly if we're willing to hit fast-forward by leveraging technology, which has shown in many instances to be as effective as face-to-face interventions.

Before we talk about virtual care and e-mental health, two game-changers the commission is strongly advancing, we need to realize that given the complexities of mental illness, there will never be one single adequate solution. We can't separate the mind from the body, nor can we divide mental wellness from the experiences that have formed each of us. As humans, we aren't made up of neat compartments that can be assessed and evaluated in isolation from each other. We tend to be a bit messy and complex, a mixture of biology and psychology, very heavily influenced by social determinants of health such as income, education, race, exposure to trauma, and the list goes on.

The question of equity is going to be central to any truly meaningful progress, and that means shining a light on gaps and building the bridges to span them. With a dearth of culturally appropriate care, dwindling broadband signals in rural and remote communities, tech hesitancy among seniors, and lack of access among people living in poverty, we cannot expect e-mental health to hurdle systemic societal problems that need to be addressed at the root cause.

That doesn't mean we should throw our hands up in the air—quite the contrary. Take Wellness Together Canada, which has just been mentioned. It is built on a framework championed by the commission and is an important example of how partnerships across jurisdictions can translate into meaningful services. Today, we can access free mental health supports through online services that were developed to meet a need, and this happened almost overnight. If we can accomplish that, a feat once thought impossible—if even imagined at all, in fact—imagine how bright the future could be. To date, half a million people have accessed that site, but we know the need runs deeper.

Pre-pandemic, 1.6 million people in this country reported an unmet need for mental health care. Given the precipitous drop in mental wellness, I think it's safe to say that this need has only grown. Yes, it's true that symptoms of anxiety and depression and suicidal thoughts are increasing, but that does not mean that we must accept an echo mental health pandemic as inevitable.

If ever there has been a time to knit a tighter safety net, it is now. Whether we focus on standardizing virtual care or investing in accreditation of mental health apps, there is a critical role for all of you to play as decision-makers with the capacity to champion innovation.

Our late board chair, the Honourable Michael Wilson, put it best when he said, “There needs to be significant funding earmarked for ramping up access to services, community care and suicide prevention. But there must also be latitude for proving the sound economics of creative approaches.” These creative approaches include leveraging new technologies to keep pace with our counterparts in New Zealand and Australia.

COVID has underscored the importance of mental health, highlighting the precariousness of our well-being.

I hope that you will engage in further collaboration and innovation. We look forward to partnering with you in these initiatives.

Thank you kindly.

[The Chair, Liberal, Ron McKinnon]

Thank you, witnesses, for all of your statements.

We go now to questions. We will have time for one round of questions.

We start with Ms. Rempel Garner.

Please, go ahead for six minutes.