Evidence of meeting #108 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was women.
A recording is available from Parliament.
5:10 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vigod.
Next we have Ms. Thompson, please, for five minutes.
5:10 p.m.
Liberal
Joanne Thompson Liberal St. John's East, NL
Thank you, Chair.
I'm so pleased to be here today. I'm not normally part of this committee, but what we're speaking about is very near and dear to my heart. In my riding of St. John's East, there is tremendous work happening. It's not, clearly, where we need to be, but this is something that I'm very aware of and certainly continue to worry about as a mother and a nurse, and now in this role as a politician.
Dr. Vigod, I will go to you, but this really could be asked of anyone in the room. Could you go back to stepped care and drill down just a little bit more? In the back-and-forth, I still feel there is not a real understanding of what stepped care is, and the role of multidisciplinary primary health care in enabling someone to begin the supportive treatments without having to see a family physician.
Could you break it down for me, please, in a simple, tangible way?
5:10 p.m.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
I can try, and then maybe my colleagues will help me with that a little bit.
The whole concept of stepped care is the idea that, if people have very mild symptoms, you want to be able to give them the least invasive treatments first and the ones that are most easily available. Then, you would want to add on another, higher step—something that takes more resources, takes more of their time, or maybe has more safety issues associated with it—only if they really needed it.
What we normally think of as step one of care for perinatal mental health is education, self-guided treatments, and public health nurses' supportive counselling. There is so much evidence, for example, for peer support—as we talked about today—as well as for protecting people's sleep and dealing with all sorts of social issues that are happening, and the support.
If those things don't work, then you'd want to move to the next step of care, which maybe involves formal psychotherapy, like cognitive behaviour therapy or interpersonal psychotherapy. If that doesn't work, you'd want to move up another step, maybe to medications. Then, if something is very severe, you might be talking about hospitalization or different kinds of more serious treatments.
You also have to remember that in stepped care, depending on someone's level of severity, you might give them the step one things, but also realize that they need step two. If somebody is very ill—let's say, suicidal—you would move them to step four right away. Stepped care really is about what step they need. Sometimes you can go up a little bit, but sometimes, if someone is really sick, you might start them at step three.
Does that help?
5:10 p.m.
Liberal
Joanne Thompson Liberal St. John's East, NL
Absolutely. Thank you.
This leads me to the conversation around public awareness, which really links into so much of the challenge and stigma of why women tend to hide how they're feeling in the perinatal period.
What would a public awareness campaign program look like?
5:15 p.m.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
We've talked a lot about perinatal mental health today. From my point of view, we should be talking about women's mental health across the lifespan and all of those different, unique issues, because they're all related to each other. For women to even know that, biologically, if they are more likely to have mood problems around the time of their period, they're probably more likely to have mood problems when they deliver a baby and around perimenopause.... It's all linked together. What are the things that are different? Women should know that they might metabolize medications differently.
Given how many people struggle with mental health issues, a public awareness campaign doesn't need to talk about mental illness or mental disorders necessarily, but it can talk about mental health issues across the reproductive lifespan, so people can understand what is par for the course and what should suggest that they might need a little more help. If they need a little more help, what are the things they can expect from their treatment?
That's actually where I would start. Of course, 80% of what I do clinically is perinatal. The others here can also talk about perinatal. You could think about very specific things, but that's actually where I would start. I think that if we had more awareness about women's mental health more broadly, when people get to the perinatal period, they would be more willing and more able to realize that they might be able to.... Some of the shame and stigma.... It might help with that.
That's my view. Others may have different ones.
5:15 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you. That's your time.
We now go to Ms. Bérubé for two and a half minutes.
5:15 p.m.
Bloc
Sylvie Bérubé Bloc Abitibi—Baie-James—Nunavik—Eeyou, QC
Dr. Vigod, how do protective factors and risk factors for mental health change throughout women's lives, across different age groups, for instance, during menopause?
5:15 p.m.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
I was listening to the simultaneous translation. You asked about risk factors for mental health across a woman's life, and whether they change over menstruation, pregnancy, postpartum and menopause.
I think it is true that having a history of depression, a family history of depression or a mother or a sister who struggled with reproductive life events is a risk factor. Some women's brains are more sensitive to the hormonal shift. It's not necessarily a high or a low level of hormones but something about the shifting that some women's brains are more sensitive to, so that's a risk factor. Other risk factors are some of the things that I talked about. For example, early childhood trauma—physical, sexual or emotional abuse—is a major risk factor, and then there are other psychological and social risk factors, such as losses and transitions.
Related to the menstrual cycle, sometimes if people are in more stressful months, that will actually impact the premenstrual mood. We talked about the perinatal period. The biggest risk factor for perinatal depression is a lack of emotional and practical social support. Then, when you think about perimenopause, you're talking about transitions there as well—people are getting closer to ending careers, children are leaving the home—so there are really very similar risk factors and, I would argue, women-specific risk factors.
5:15 p.m.
Bloc
Sylvie Bérubé Bloc Abitibi—Baie-James—Nunavik—Eeyou, QC
What measures would you say the Government of Canada is taking to promote good mental health among women at different stages of their lives?
5:15 p.m.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
I will say again that the biggest thing we can do federally is to help women understand what they could face so that they know what they can expect from their mental health and from their treatment, and understand that there are some very specific things. There are different ways that we prescribe medication if somebody has trouble with their moods around the time of their period. Around the time of menopause, we get involved with reproductive endocrinologists and gynecologists, because we have to think about whether this should be hormone treatment or a different kind. I think awareness is important.
The second thing is, again, education. Approximately 50% of the people in the country are women, and yet it's not really in the core curriculum of training programs to talk about these women-specific things. Even when it comes to what dose of medication we should prescribe, we don't talk about how women absorb it more slowly, so it might fill up in their system higher and give them more side effects. We know these things, but we haven't.... The federal government could help us with integrating these things better as core components of curricular training.
Then, finally, we can always do more and more research that attends to sex and gender.
5:20 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vigod.
Next we have Ms. Idlout, please, for two and a half minutes.
April 8th, 2024 / 5:20 p.m.
NDP
Lori Idlout NDP Nunavut, NU
Qujannamiik. I'll direct my questions to Professor Vigod.
I represent 25 communities that are all fly-in, none of which can be driven to. Among the 25 communities, there's one hospital. Most of the communities have only nurse practitioners and a health centre. Most experience closures and will only open for emergency situations. Having understood some of these realities, I point out that there are too many risk factors for Nunavummiut, for women of Nunavut.
What are the investments that this federal government needs to make to increase protective factors so that Nunavut women can enjoy the same protective factors that other Canadian women experience?
5:20 p.m.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
You know, we speak a lot about the social and physical environment elements that underlie health. If people don't have the basics of what they need, then it's very difficult. Even in my practice in downtown Toronto, if somebody comes to me saying that she doesn't have enough food to feed her baby or that she doesn't have anyone to help her at all, I'm not going to make her better with therapy and an anti-depressant.
I would not pretend to have all the answers, but I think we're back down to what these risk factors are and how we ensure that people have the basics that they need in order to be able to build upon that and to have wellness.
5:20 p.m.
NDP
Lori Idlout NDP Nunavut, NU
Could you give an example of some of those basics? Would you agree that it's something like having a safe, comfortable home, having a place to do homework and having a place to take care of your mental health?
5:20 p.m.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
Absolutely.
5:20 p.m.
Liberal
5:20 p.m.
Conservative
Karen Vecchio Conservative Elgin—Middlesex—London, ON
Thank you very much.
I am going to go back to Dr. Vigod.
You mentioned the online patient aid you have available so that we don't all go to Dr. Google. Is this something that's available to all women or just to people who are patients within your centre?
5:20 p.m.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
The idea is that it will be available across. We've actually finished the clinical trial now, so we're talking with the Quebec government about French translations, and we're talking now about how we can start getting it out sustainably. Hopefully, we will have it available pretty soon.
5:20 p.m.
Conservative
Karen Vecchio Conservative Elgin—Middlesex—London, ON
That's fantastic.
I come from the dental health field. We used to have patients come in all the time, and you would say, “That's a sinus infection.” I understand that dental is about one or two days of the entire curriculum.
When we're talking about mental health and specifically about women's mental health during this period of perinatal care, what type of training would a general practitioner have during those first few years of school?
5:20 p.m.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
You know, there is a little bit in the core curriculum in medical training. Dr. Montreuil might be able to talk about psychological training, and Dr. Hippman about genetic counsellor training. I would say that there is a paucity of hours, relative to the proportion of the population that is affected.
5:20 p.m.
Conservative
5:20 p.m.
Postdoctoral Research Fellow, BC Reproductive Mental Health Program, BC Women's Hospital and Health Centre, As an Individual
Agreed. I have worked to create some curricula for genetic counselling programs on perinatal mental health and mental health generally, but it's still something that is a very small number of hours.
5:25 p.m.
Associate Professor and Scientist, Montreal Antenatal Well-Being Study, Québec Alliance for Perinatal Mental Health
We're testing it with the ECHO program right now. It's six sessions, so we're looking at, say, 90 minutes. It's already possible to increase the level of knowledge, and it's not just knowledge; it's the know-how. Sometimes, it's just validation of some information that people have gathered themselves, but having it in the context of formal training is enough to empower people to feel better about what they're doing.
There are existing programs out there. We just need to look at what's been done. If we look at the ECHO program specifically for the perinatal mental health, for example, one session is on screening and referral and who can do the screening and referral. We're talking about more rural areas. We have a screening and referral protocol we're now testing with midwives, which has been shown to work really well, and we're thinking it could be adapted to other types of health care professionals.
I think there's a minimum, such as asking, “What is mental health? How do I detect it? What are the tools?" and those types of things. I think it's enough to just give people information.
One thing we're realizing as well is our own biases about mental health issues. We're looking at change with our screening and referral. We're looking at educating people on basic.... We have a three-hour training. We're able to show that just by giving a three-hour training, we're able to change the way people feel about mental health. I think that is a big piece we're often omitting. We're giving tools, but we're not looking at the beliefs that people hold about people who consult for mental health issues. If we're able to change the care workers' or care providers' views on mental health, we're able to improve the quality of care.
5:25 p.m.
Conservative
Karen Vecchio Conservative Elgin—Middlesex—London, ON
Perfect. Thank you so much.
Going from what Lori said, there are 25 fly-in communities. They need the services. Everybody needs these services to be available to them, but we also have connectivity issues in these types of places.
What are some of the things we can do between now and tomorrow? What can we do immediately to help make changes for those people who deserve this support?
5:25 p.m.
Postdoctoral Research Fellow, BC Reproductive Mental Health Program, BC Women's Hospital and Health Centre, As an Individual
It's politically charged, but a universal basic income and having more financial stability would speak to food security and a lot of those basics that have that foundational wellness and can then enable additional insights.
Another thing is education. I think a lot of these things can be implemented now in terms of how you take care of yourself and how you promote your own mental health. That doesn't need anything additional, but you need to have the resources to feed yourself well.