Health Committee on April 23rd, 2021

[The Chair, Liberal, Ron McKinnon]

I now call this meeting to order.

Welcome, everyone, to meeting number 31 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 COVID-19 pandemic, more specifically today, examining the collateral effects of the pandemic.

I'd like to welcome the witnesses. From the Canadian Mental Health Association, we have Rebecca Shields, chief executive officer for York and South Central Branch; from the Down Syndrome Resource Foundation, Wayne Leslie, chief executive officer; and from Focus Education Consulting, Kirby Mitchell. Moreover, from the Canadian Cancer Society, we have Kelly Masotti, vice-president, advocacy; David Raynaud, analyst, advocacy; and Stuart Edmonds, executive vice-president, mission research and advocacy.

With that, we will invite the witnesses to give a statement, starting with the Canadian Mental Health Association.

Ms. Shields, please go ahead, for six minutes.

[Rebecca Shields, Chief Executive Officer, York and South Simcoe Branch, Canadian Mental Health Association]

Thank you so much. It's an honour to be here with the honourable members of Parliament and my colleagues.

I'm going to get to the point and speak very honestly about what I believe are the top recommendations you know from the news, that mental health is an emerging crisis, but I really want to talk about what you need to think about.

In the proposed federal budget, you've looked at investing critical money into mental health services, particularly looking at vulnerable populations and our essential workers. I want to really emphasize two things. You have to invest today in the hot spots; you can't go across Canada. You have to look where it's proportionate, invest directly, and think about those communities. If COVID has taught us anything, it's that, if we aren't looking at the communities that are already impacted, then it's going to explode. The fourth wave will be a mental health wave, and we know from the data from past pandemics that those essential and frontline care workers are facing PTSD, and, for those people who are impacted by PTSD, they're 40% more likely to experience major depression and at more risk of suicide. These are the people who are saving lives today, and we need to be planning for the future.

My second recommendation is around how we plan for the future. It's great that you're using well-known, renowned hospitals and research centres, but the investments have to be in local community organizations that are trusted and have built comprehensive relationships with those communities where there are vulnerable people. When you look at the disproportionate effect of the COVID pandemic on marginalized individuals and BIPOC people, we need to look at those community agencies. Why? It's because those community agencies are the ones that provide the wraparound supports where people are vulnerable. Although you might want to do large Canadian institutions, you need to get the money on the ground so that it can be realized quickly for those individuals, because otherwise their vulnerabilities are only going to increase, which is what we have seen currently in the response to the pandemic in some communities.

My last point is that we have an emerging issue around substance abuse, particularly alcohol and cannabis. We know from the data that, for people who are using cannabis, over 50% report they are using more, and there is more binge drinking in other populations, particularly populations who have children at home, so binge drinking is going up.

My third recommendation, therefore, is that you need to have a public health approach to reducing the use of alcohol and cannabis. Look, I'm in mental health and addiction, and I'm telling you people are using more, and the long-term consequences of using more are that it's going to be harder to treat people as this pandemic continues to go on. We need to use the Public Health Agency of Canada to begin talking about that message to help people reduce the amount that they are consuming.

The Canadian Mental Health Association has done a lot of research through Polaris on the mental health impacts. It is disproportionate, as you know, for women and for women with children. Rates of anxiety are going up, and rates of loneliness are increasing for women. Now one in four women are reporting great anxiety compared with one in five men. It's still not great, but particularly for women with children, we're also seeing increasing rates of loneliness, particularly in the young people 18 to 39 years old. We're seeing also the impacts of social isolation and loneliness on our seniors. More and more, these impacts of loneliness, depression and anxiety are increasing, and people are feeling worse off. People are feeling less hopeful than they ever have; in fact, 80% of Canadians report that they no longer feel that their health is improving.

I will say that there are some good news points in here. People are feeling like they know how to access care, although they are very concerned about wait-lists and whether or not, if they access care, they're going to receive it. We need to make sure that those targeted investments are made so that there is easy access to quick supports.

One support we have in Ontario is the BounceBack program that's funded through the Ministry of Health. This is telephone-based cognitive behaviour therapy specifically designed to ease stress, worry, depression and anxiety. We're trying to promote programs like that to go across Canada. These types of services to help people manage and cope are going to be essential for the broad population.

I want to go back in my six minutes, which is getting less now, to what I really want to emphasize again. I want to talk about post-traumatic stress disorder, particularly in our health care workers and our frontline workers. It has a disproportionate effect on our nurses and hospital staff, our paramedics, our police, our long-term care homes, our home and community health nurses, and all of the staff that are working in congregate care settings. If this is a strain on the population now, it's going to have an impact on our other health services for Canadians. What we're seeing is that those people are beginning to suffer, and burnout is on the rise. If this happens, we are going to have a strain on our health care system. Again I want to urge you to look at those investments and at how we can invest properly.

Further to my recommendations, in my last few minutes I want to talk about trusted community relationships again.

I'm sorry, but I don't know what the yellow card means. Is that one minute left?

[The Chair, Liberal, Ron McKinnon]

Yes, but you're actually at six minutes, but take another minute to wrap up if you wouldn't mind.

[Rebecca Shields]

I'll wrap up with a final point about about improving access to virtual care through technology. We know that virtual mental health services are making a difference, but there's an equity-of-access issue. If we can't provide equity of access to those vulnerable, BIPOC, and multi-generational populations, we're not going to be able to provide timely care, and the crisis will grow.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you.

I should have mentioned the cards. I try to put up the yellow card when there's about a minute left, although sometimes I get enraptured by someone's statement and I forget. The red card indicates that someone is at six minutes. When they see that, they should try to wrap up.

Thank you very much.

We'll go now to the Down Syndrome Resource Foundation with Mr. Leslie.

Please go ahead, sir, for six minutes.

[Wayne Leslie, Chief Executive Officer, Down Syndrome Resource Foundation]

Thank you very much for the opportunity to be here today.

The Down Syndrome Resource Foundation provides health and education services for children, youth and adults with Down syndrome. Based in Burnaby, DSRF is British Columbia's leading own Down syndrome provider. We're also recognized for our work supporting families of people with Down syndrome across the country.

Classified as a developmental disability, Down syndrome is a genetic condition. It results in a third, “extra” copy of the 21st chromosome, which leads to health problems, developmental delays and learning disabilities.

In Canada, 45,000 to 50,000 people have Down syndrome, so even within the country's smaller disability population it is a small group that, because of their limited numbers, is often overlooked and marginalized.

These factors combine to make them especially vulnerable and disproportionately impacted by this pandemic.

For adults with Down syndrome, COVID-19 hospitalization rates are four times that of the typical population, and death rates are 10 times higher. Their developmental disabilities also make them more likely to contract the disease, because they struggle with or can't comply with safety practices such as masking and physical distancing. In a society where safety protocols are designed to protect the general public, not our most vulnerable, the only safe solution for these individuals is extreme isolation.

DSRF believes the main reason we have not seen higher COVID-19 hospitalization or death rates in our Down syndrome community is because they've been cut off from society.

One example is the education system. Due to the risk of more severe consequences if someone, even a young person, contracts COVID-19, many students have had to stay away from school completely. Attending in person, which is essential when you have a developmental disability, is too risky because school safety protocols are just not designed to protect the most vulnerable students.

It's a very similar situation for adults with Down syndrome or other developmental disabilities in the workforce. In many cases, they have had to stop working completely. Going to work is too risky. They often perform work that simply cannot be done remotely, so they end up completely cut off from employment.

DSRF recommends that efforts to combat this pandemic and other similar health crises should be based on protecting Canada's most vulnerable first. This includes individuals or persons with disabilities, and especially those with disabilities like Down syndrome that often carry significant co-morbidities. When schools, workplaces and communities are safer for individuals with disabilities, they're safer for everyone.

The pandemic has also disproportionately impacted families who care for individuals with developmental disabilities, like Down syndrome. Now more than ever, grassroots and on-the-ground organizations such as DSRF who work directly with these families see the holes, the inequities and the fragility of Canada's social safety net that put our families more at risk.

Children with developmental disabilities, and disabilities in general, are more reliant on their families regardless of their age. Adjusting to lockdowns is far more difficult when you have children with developmental disabilities whose support systems are either disrupted or lost completely. In normal circumstances, families of individuals with disabilities also face financial inequities due to the added cost for things like critical therapies.

As one parent said to me recently, the average Canadian lives in the green, generally good zone most of the time, periodically moving to yellow or caution, or even red, critical, when they deal with a crisis. Families of individuals with disabilities in Canada live in the yellow zone pretty much all the time, so when the pandemic hit, they went to red, and that's where they've remained. This takes an immense toll.

Not surprisingly, demand for DSRF services has increased, but requests for our mental health services have skyrocketed because families now are harshly reminded of just how fragile their situation is both emotionally and financially.

The reality is that the way Canada has approached its support of persons with disabilities for years has led to the current state where these families are disproportionately vulnerable both emotionally and financially, so they're less able to withstand the extended periods of hardship like those that are being created by the current pandemic.

DSRF recommends establishing things like a federal disability benefit to start changing this. With the added pressure that families of individuals with disabilities face, it's clear why current supports and benefits are falling short.

I will finish by saying that while our disability communities have faced significant challenges during COVID-19, you can use this crisis as a catalyst to make positive and very meaningful changes to how they are treated and protected going forward.

I believe the well-known quote from Mahatma Gandhi perhaps sums it up best: “The true measure of any society can be found in how it treats its most vulnerable members.”

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Leslie.

We go now to Focus Education Consulting.

Mr. Mitchell, please go ahead for six minutes.

[Dr. Kirby Mitchell, Focus Education Consulting]

Good afternoon, everyone.

Thanks for having me.

I'm representing Focus Education Consulting today. It's what I do. I'm an education consultant as well as a teacher. I'm also volunteering with the Worldwide Commission to Educate All Kids (Post-Pandemic), where I represent Canada. We currently have 50 countries involved in this commission. In our conversations when we refer to the kids who are living through this pandemic, we look at them using three buckets of schooling.

The first bucket is the physical classroom. That's the traditional classroom where kids usually spend most of their time. Then the virtual, online hybrid version is bucket two. Then there's bucket three: no longer in school.

The commission right now is focusing on bucket three, students living in that bucket where they are no longer in school. Right now the commission estimates that the number of students living in the third bucket is up to 500 million worldwide. More specifically, there are 10 million to 20 million in the U.S.; 60 million to 70 million in India; 24 million in Pakistan; three million to four million in Colombia; and here in Canada, the Institute for 21st Century Questions, the think tank connected to the commission, estimates there are 200,000 kids living in the third bucket between grades 1 and 2, which is about five million in total.

How did we come to this?

When I talk about this I try to paint the picture of a school experience pre-COVID. All of us take ourselves back, and I try to go there as well in this discussion, walking to school in the morning, taking the bus, showing up, standing in front of your school and then the bell rings. There are students who enter their classrooms for first period. Some people go to the study hall; some people go to the gym to work out and some people walk right through to the back of the school and exit. What's common, what's shared with [Technical difficulty--Editor] different experiences is a school space.

What we've moved away from because of COVID and the mandated restrictions is that space, the schools. Schools provide beyond just the sports and the relationships and the learning. These are commonly understood as to why kids come to school, but kids also come to school to avoid school. A huge bunch of kids come to that space and spend most of their time in avoidance and disruption and trying to find their place within a space that doesn't really welcome them.

What that allows for, however, is teachers, admin staff, anyone working in the school, friends, peers, an opportunity re-engage them because they're in a space and there are some barriers to leaving. We must understand students leave school mentally, spiritually, way before they leave physically. Online learning has made that speed of exit grow exponentially.

[Technical difficulty--Editor] classroom and they're in Mr. Mitchell's class. There's a tab with Mr. Mitchell's class and there's a tab a student will have for whatever former freedom they had. It could be gaming, it could be chatting, it could be exploring a new career. Now all they have to do when they're in Mr. Mitchell's class—and they don't have a relationship with me—is build walls first. For example, a student may be having a test in my class. The Internet goes down and they can't continue the test. They log back in, and because they don't have a relationship with me they feel they can't ask me for more time. Because of that they say that anxiety builds up. They say either they ask the teacher or they escape through this tab.

They close the Mr. Mitchell tab. They can't deal with that stress. They're not going to catch up. They'll never have a chance. They close it and they open that tab and they escape. That's the frictionless exit they experience nowadays because of the online space and the way the system has revisited online learning repeatedly over the last year and a half.

Pre-COVID, there were lots of advantages in coming to school. We had students who were engaged and who are still engaged. We had students who were “attenders”. They attended school, they showed up for class, but they really weren't really engaged. We also have the avoiders.

The third bucket is a combination of students who were avoiding and students who were on the margins, labelled as “behavioural”. Those students are often racialized—Black, indigenous, people of colour—and on the margins. They are excluded from school for behavioural reasons. Their behaviours don't follow the norm in terms of how they behave in class or how they behave in the halls. There's a slow-streaming push-out mechanism that doesn't allow them to be part of the classroom or maybe the school. They may be sent to a special school. Then there's an early exit.

That has been fast-tracked because of the easy exit due to online learning. We are seeing that grow at exponential rates. We now have 200,000 kids, and growing, in that population. Because of the recent closure, my concern is for the students that I usually work with and see walking around in school. That energy of avoidance and resistance is no longer there. It's an online space now, and you either fit in or you don't. There's no resistance. There's no place for them to sit. I don't see them in the halls and I don't see them online. I feel that even more kids, beyond those kids, are being excluded, and for various reasons.

[The Chair, Liberal, Ron McKinnon]

Could you please wrap up, sir?

[Dr. Kirby Mitchell]

Yes.

There are students who have ELDs or are learning English. There are students who have anxieties built up. There are students who are struggling with the new learning model, which is online learning. We're losing those students. There's also the “rich kid” paradox, where kids who are traditionally doing well and have all the resources are leaving school as well.

My concern is that with this last closure, it has been devastating. We're seeing it not only locally across Canada but also globally with ongoing closures and limitations due to the pandemic restrictions.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We'll go now to the Canadian Cancer Society.

Will Ms. Masotti be reading the statement?

[Dr. Stuart Edmonds, Executive Vice-President, Mission, Research and Advocacy, Canadian Cancer Society]

I will start, and then I will hand it off to Kelly halfway through.

[The Chair, Liberal, Ron McKinnon]

Absolutely. Go ahead.

[Dr. Stuart Edmonds]

Good afternoon. Thank you for the opportunity to present today, especially given that right now it's daffodil month, or cancer awareness month.

Unfortunately, cancer does not stop being a life-changing and life-threatening disease in the middle of a global pandemic. More than a million Canadians are living with and beyond cancer. While the impacts of COVID-19 will be felt for months and years to come, so too will the needs of people with cancer and their caregivers change as the impacts of the pandemic evolve.

While most provinces postponed elective surgeries in some form or another during the first wave of the pandemic, some have fared better in addressing this backlog. In certain areas, the surgical backlog continues to grow. According to data from the Canadian Institute for Health Information, during March to June 2020 most people with conditions requiring life-saving and urgent surgery received care. That said, nationwide, cancer surgeries were 20% lower compared with the same time period in 2019.

In Ontario nearly 36,000 fewer cancer surgeries were performed in the spring of 2020 as compared with the year before. Going into the third wave of the pandemic, Ontario had an accumulated a total backlog of over 200,000 surgeries across all categories, with some cancer surgeries again being postponed. In Quebec there were 6% less surgical procedures in oncology performed compared with last year. That represents around 2,200 surgeries.

Through trends in inquiries to our information and support programs and ongoing national surveys of people facing cancer, and their caregivers, we have a sightline into the continued impact that disruptions to care are having on people affected by cancer. A July 2020 CCS patient survey found that almost half reported having their cancer care appointments postponed or disrupted during the first wave of the pandemic. We are concerned that the third wave in parts of Canada will result in more disruptions to cancer care.

The severity of surgical backlogs must not be underestimated. Results of a study involving Canadian cancer patients published in the British Medical Journal suggest that people whose treatment for cancer is delayed by even one month have about a 10% higher risk of dying. Risk also increases the longer it takes for treatment to start.

I will now turn it over to Kelly Masotti.

[Kelly Masotti, Vice-President, Advocacy, Canadian Cancer Society]

Along with the immediate impact that COVID is having on cancer surgeries and treatments, we're concerned about a tsunami of cancers yet to be diagnosed. Since the start of the pandemic, global cancer diagnosis has seen a dramatic decline. It's estimated to be at about 40%.

In Ontario, from March to December of 2020, nearly one million fewer cancer screening tests were performed compared with the same period in 2019. In Alberta, more than 170,000 tests, including an estimated 40,000 mammograms, were suspended for two months starting at the end of March.

In Quebec, recent estimates predict that more than 5,000 Quebeckers may have cancer without having been diagnosed.

Screening programs help find cancer earlier, when it is easier to treat and outcomes are better. We are concerned that the disruption in screening programs will lead to cancer cases being diagnosed or treated too late. We must continue to encourage people to get screened and cancer systems must plan for the disruptions caused by COVID-19.

COVID-19 has also interrupted oncologic care across the spectrum of cancer care. A survey from the Institute of Cancer Research found that cancer researchers fear that advances for patients could be delayed by almost a year and a half because of the effects of the COVID-19 pandemic.

In Canada, clinical trials were affected to various degrees across the country. These trials can provide access to promising therapies for people with cancer. In many cases, patient recruitment was paused provincially due to assessment of available staff, health care resources and patient safety.

COVID-19 has also undermined public health efforts at disease prevention and health promotion. For example, local public health units have shifted staff and resources to work on COVID. A good example here is tobacco, with large numbers of public health staff who work on tobacco enforcement and smoking cessation redeployed to the COVID-19 response.

Through all of this, governments must lead the response with a comprehensive and coordinated plan of action to address the future burden of cancer in Canada. The response must include all levels of government, the public, charitable and private sectors, academics, policy-makers, politicians and citizens.

The impacts of COVID-19 on cancer control, as well as the increase in the number of cancer cases due to an growing aging population, highlight an increased need for health care services and providers, infrastructure, caregivers, family support and other types of programs and services.

There will be a need for more support for the increasing numbers of cancer survivors. Focus is required on the planning of cancer control programs for prevention, screening, early detection, treatment and palliative and other medical care. Research is needed to help plan for this increase in cancer cases and to identify more solutions for effective treatment and supportive care for those with cancer.

I'd like to thank you for the time you've given us today. We will be happy to answer any questions you may have. Thank you.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We will start our questioning now.

Mr. Barlow, please go ahead for six minutes.

[John Barlow, Conservative, Foothills, AB]

Thank you very much, Mr. Chair. Thank you for everyone's testimony today.

I want to start with you, Ms. Shields. It's good to see you again.

I had a phone conversation a couple of days ago with a constituent who called. It was a 19-year-old girl who was very upset. Her 20-year-old brother had committed suicide a few weeks ago. He was an apprenticing electrician who was laid off as a result of lockdowns. He had found a job in a restaurant, but lost that when lockdowns were extended. The isolation got the best of him. He couldn't handle the depression and he took his life.

I know that many of us in this Zoom meeting, as members, have had similar conversations with constituents. This is becoming an all-too-common occurrence with many of us—having these types of calls to our offices from people who are completely distraught. This suicide has certainly devastated this family.

I had a virtual town hall with a lot of business owners and community leaders with similar stories of depression, anxiety and suicides.

We spoke late last year. You were mentioning a recent study in December that showed that 40% of Canadians had said their mental health had deteriorated. We saw the numbers of the substance abuse and suicides up. That was in December.

You've talked about a mental health third and fourth wave. I've never heard it put that way, but that's very disconcerting. As these lockdowns and restrictions go on, what do you anticipate the impact is going to be on Canadians' mental health?

[Rebecca Shields]

We know from previous pandemics that it is going to increase. Let me explain the why of that. You're right in the sense that uncertainty and vulnerability are disproportionately impacting people. For example, communities that have precarious employment just like that.... I'm so sorry about that young individual. That economic stress and uncertainty can obviously lead to depression, anxiety and, of course, the risk of suicide. That's going to happen. We know that from past pandemics. We saw that from SARS. We saw that there are populations that are at a higher risk than others.

That's what I was trying to get at, the people who are at high risk. They are essential care workers, whether it's our hospital staff or the people who have been on the front lines. They are the people who have been impacted by COVID, and are absolutely at high risk. There are communities that have been highly impacted by COVID. I mentioned BIPOC people, so people who are precariously employed or have lost employment, or on the front lines, or who have suffered from COVID are at risk.

There is a general increase in anxiety and depression. Women, women with children, families with children, they are all tending to have higher levels of anxiety. We also have youth, and people have been touching on that. My colleague, Mr. Mitchell, was touching on the impact to young people, and the increase in anxiety.

What is that looking like in terms of impacts of social isolation? When social isolation becomes loneliness, that turns into chronic loneliness. When we get into chronic loneliness, that's where we have outcomes that are the equivalent of smoking 15 cigarettes a day, and my cancer colleagues will understand how serious that is.

So, you're right. This is what we are preparing for, which is the fourth wave. What are we trying to do? We're trying to increase immediate access to care, but we have to do it in two formats. First and foremost, we need to be planning and training early. I need people on the ground today, so that they're there tomorrow. I can't wait. We can't wait to have trained workers in language or cultural-specific communities available for people, because if they have to wait, the risk of suicide increases.

What we know, and it's really important to understand, is that somebody could go into a hospital and be discharged. The most at-risk period for suicide is that 30-day period following discharge from a hospital. We must have programs that are available right away to transition people, and that's where you need to bolster the communities. You need trusted community partners that can begin to wrap around supports for these individuals.

Organizations like ours provide counselling, employment, housing and food security. When you look at what we can do in terms of supporting navigation and community supports, we have to work with our hospitals and our acute care centres to stabilize people, but then we have to provide that ongoing care in transition. I know I'm talking to people who know and understand this.

You've got the national suicide prevention strategy starting. It's going to take a while, but my recommendation is that the $50 million investment has to come in immediately, and you've got to put it into the communities that are hardest hit.

[John Barlow, Conservative, Foothills, AB]

I want to build on what you said about having people on the ground immediately. I'm sure you're talking about the PTSD within frontline health care workers. How frustrating is it for them not having...? What I've heard is the concern about stops and starts: We're going to have vaccines; we're not going to have vaccines; we're going to have rapid tests; we're not going to have rapid tests.

How much of an impact has that had on the mental health of health care workers, of not having more of a clear path to accessing vaccines and rapid tests?

[Rebecca Shields]

Uncertainty is a trigger for all of us. Uncertainty leads to higher stress. We're dealing with people who are in acute stages of stress and chronic stress. What that means is that they're at a higher risk of trauma, which means they're at a higher risk of depression. Trauma and depression may lead to suicide. We're really trying to build out trauma-informed and trauma-specific services for our communities.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Mr. Van Bynen, go ahead, for six minutes.

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

Thank you, Mr. Chair.

Thank you to all of our witnesses for joining us today and sharing their experiences with and concerns about the pandemic.

It's a great honour to be able to welcome a constituent to the committee and have their voice reflected in the work we do here, so I will be directing my questions to Rebecca Shields from CMHA York Region and South Simcoe and acknowledge that she serves a population of over 1.2 million people across more than 10 different municipalities.

Firstly, Rebecca, I want to thank you for the many projects that you have undertaken in conjunction with community partners like York Regional Police or Southlake Regional Health Centre. You have put together teams to respond to situations that are urgent and often call for a police presence, but also will have the presence of your team so that you can respond effectively to these.

Last fall I moved a motion in this committee to study the impacts of COVID-19 on mental health and the well-being of Canadians. That was well more than four to five months ago. I referred to mental health as being the third pandemic, and it has become the fourth pandemic now, and I very much understand what your concerns are.

You supported the call for the study and said that to achieve full economic and social recovery, we must understand the true impacts of the pandemic on the mental health of Canadians. I completely agree with you, and I thank you for that support.

I know it's critical to invest in comprehensive community-based research to understand the impact and to identify the most promising strategies. You made some references to hot spots. While the scope and the scale of this committee is more broadly countrywide, how would you suggest we go about trying to identify the community-based strategies?

[Rebecca Shields]

It is really true that each province and territory addresses health care differently. Mental health affects us all, but we do have unique community needs. This is what we're seeing.

At the very basic level, we understand that COVID, which is a health care issue, has impacted different communities differently in disease with completely different impacts and outcomes. What we're learning from the research on COVID is that we have to translate that into local neighbourhood-based research. We can pull data from our hospitals around, and we do, and share that information, but what does it mean to have population-based research?

There are many components of that, and there are some great leading practices coming out of, for example, the Slaight Family Centre for Youth in Transition at CAMH, where they are looking at youth-specific research. One of the things they are sharing in co-design and co-participatory research is how COVID is impacting youth differently. Not all cohorts of youth are the same. Some might be thriving at home, and, as my colleague, Mr. Mitchell, said, some are not, and how do we understand and address that so we can be designing and delivering services that are effective so that we can take a health equity approach.

In community-based research what we want to have is the lens of health equity across that research, and then to be able to co-design and deliver services that are effective for those communities.

The research must be embedded in community, it must be co-designed, it must take into account a population ethnocultural lens so we can have a health equity approach, as well as addressing other cultural-specific groups like my colleague, Mr. Leslie, said: those with developmental disabilities, the 2SLGTBQ, and our indigenous communities and our Black communities.

All those communities have their own needs, so as we design and break down research, we need to not just stay at a global level, but to really take the investment to dig a little bit deeper because we know that responses must be designed to meet specific needs. The pandemic has shown us this. If we do not take in the specific populations, they get left behind, and without that health equity lens, they are disproportionately impacted.

We can do better, and that's what I would like to see us do.

Thank you again for your question. I hope I responded.

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

Thank you.

The access to mental health resources and supports has been key during this pandemic for many Canadians. Our government has stepped up with the Wellness Together Canada and the Kids Help Phone. I know that CMHA had its own telephone-based supportive counselling.

Was this service in place pre-pandemic? If so, can you elaborate on the changes, or the differences between before and during the pandemic, that your staff have noticed?

[Rebecca Shields]

First and foremost, obviously as did all mental health agencies, we switched to, as much as possible, virtual care. That allowed access to people. I mentioned that we need to ensure equity of access. We offered specific counselling for frontline health care workers and we offered a variety of walk-ins. We really tried to take away any sort of wait-list, so we offered a lot of walk-in or call-in services in order to address immediate needs. We expanded the access to the BounceBack program through an investment so that we would not have anybody waiting for that over-the-phone cognitive behavioural therapy that addresses—it's an evidence-based form—worry, low mood, stress and anxiety.

Those are the types of investments that we made to quickly address population health, and then we did deeper dives into specific vulnerable populations like our homeless population.

I see the red card, so thank you very much.