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.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
I can start a little bit, if you'd like.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
As a psychiatrist, I have lots of colleagues who are family physicians, many of whom refer to me. The thing about having a family physician, especially when we're thinking about women, is that a family physician follows you throughout your whole lifetime. They know you. They know if something isn't your baseline, if something is off. They're watching things.
If we're saying that 20% or more of women across Canada have a mental health issue.... That's like saying that all of the cardiologists would manage high blood pressure. The truth is that the family physicians are likely the first line of defence for mental health issues, and it's the family practices, like the teams, where that first basic counselling starts.
One thing that was really interesting is that we did a model of care for perinatal mental health where women didn't need to go through their family doctors to come in. When they first came in, we did that stepped care that we talked about. We sent them for peer support. We got them psychological treatments in the community, which they didn't even need to see a doctor for. A small proportion might have actually needed medications, or something more, so we were able to have somebody like me, who knows about all the drugs in pregnancy and everything, go through some quick phone calls with the family doctors to figure out what the patients needed. Patients trust their family doctors. Out of the 50 people we put through our initial pilot, only two had to eventually come and see me.
Family doctors know when there's something that isn't quite right with their patient. It's almost like when a parent knows there is something not quite right with their child. The importance of primary care as the backbone and as the infrastructure of our health system, I think, can't be understated.
Conservative
Anna Roberts Conservative King—Vaughan, ON
One of the other things we have to do, when our own Canadian citizens leave to get their education elsewhere, is ensure that when they come back, we have them ready to be family doctors. I think we need to improve that. I really believe our blue seal program will help with that.
I agree with you that the family doctor probably knows you better than anyone else. That's the only way we're going to prevent these types of situations and deaths from happening. I'm glad you agree with that.
Liberal
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you, Mr. Chair.
Thank you to the witnesses for their testimony today.
Dr. Vigod, I'll direct most of my questions to you. As you know, in May 2023 the Government of Canada announced funding for three projects related to maternal mental health, one of which was Health Canada's funding of about $372,000 to Women's College Hospital to develop national clinician guidelines for perinatal mood disorders. How did this funding help Women's College Hospital advance the development of national clinician guidelines or perhaps support other initiatives in support of maternal mental health?
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
Sure. It's my pleasure.
Dr. Van Lieshout actually referred to these guidelines. This is a partnership between Women's College Hospital and an organization called CANMAT, the Canadian Network for Mood and Anxiety Treatments, which has been doing the guidelines for depression and bipolar disorder and the treatments that the evidence suggests we should be recommending. What we did with those guidelines, which I'm co-leading with Dr. Benicio Frey from McMaster University, is develop a group of scientists from across the country who had expertise in this area. We also worked on developing panels of experts who would help us. Actually, Dr. Montreuil is on one of those panels, and Dr. Hippman will likely be asked to talk with us as well. We have panels of research experts. We have panels of care experts, such as OBs and midwives and psychiatrists who do clinical work. We also have panels of persons with lived experience, in addition to two persons with lived experience on the committee.
So far we've done the evidence review. We started with 12,000 reviews of evidence that we systematically went through. What we do is classify that evidence and determine what evidence is there, for example, for various therapies or various medications. We are at the point where, at a meeting on March 1, we brought all of the people together from across Canada who were writing the guidelines, to start putting forward the recommendations. This week, we have our first writing draft together. We are hoping that by early June we will have everything out to our partners, and by early fall we'll actually have a publication.
We'll also be developing a guide especially for persons with lived experience and patients and their family members. We'll do that in co-development with persons with lived experience and their family members. We'll also have a reference guide for providers. The whole idea here—and Dr. Montreuil spoke to this—is that we need to have some guidance so that we can develop standards. This also has to do with the issue of how we identify disorders. What are these disorders? Whom are we supposed to be looking at? How are we supposed to provide treatment? People will know what they should be receiving, and then in each province we can actually measure whether we are living up to the standard of care. Only once you measure can you then improve.
That's where we're at. It has really been a privilege to be able to have some of that support, especially for the library services evidence review. I have to tell you that it's more work than I ever imagined. I have to give kudos to Dr. Van Lieshout, who's been reviewing all the medications that we need to use. I think the hours he has spent number in the three digits, I'm sure.
So that's what we're doing.
Liberal
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
I'm sorry if I took too long.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
No, that was great. I was hoping you'd get into some of the timelines. I thank you for that.
I have only about 30 seconds left, and I'm going to be a bit partisan here. Can you talk about the importance of developing the national clinician guidelines to treat perinatal and reproductive mental health, as opposed to allowing provinces to create their own approach for the care and screening? You touched on that a bit, but in your view, what role do you feel the provinces should play?
Thank you.
Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual
As we know, health care services are organized by province. What we should be able to do with these guidelines is say, this is the recommendation for treatment, and these treatments are all available in Canada. I'm talking about therapies and medications and how quickly someone should be seen, etc.
That might allow, for example—although this won't be under my control—for the Standards Council of Canada to say, “Okay, so you've done these treatment guidelines. Now what are the standards that need to be met?” Then, working in partnership with the provinces, they may be met in very different ways. Within Ontario, we've just been funded to take five different hospitals to work together to actually start to meet some preliminary standards on our own. Different provinces may do it differently.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vigod.
Ms. Bérubé, you may go ahead for two and a half minutes.
Bloc
Sylvie Bérubé Bloc Abitibi—Baie-James—Nunavik—Eeyou, QC
Thank you, Mr. Chair.
Ms. Hippman, how do mental health disorders such as depression and anxiety influence a person's decision to have children and parenthood?
Postdoctoral Research Fellow, BC Reproductive Mental Health Program, BC Women's Hospital and Health Centre, As an Individual
I'm sorry. It was a little quiet there with the translation.
Your question was about how mental health conditions can impact parents when they desire to get pregnant and then as they're parenting.
I have one story that comes to my mind. I worked as a psychiatric genetic counsellor for a while. I saw a woman who has bipolar disorder and who was very aware of all the risks involved in getting pregnant. She was very concerned about her own mental health, knowing that there is a higher risk for postpartum psychosis, for example, when you have bipolar disorder.
She was saying that she really wanted to be a parent but was worried about the pregnancy piece. She also saw that she might be disadvantaged in out-of-country adoption and that they wouldn't allow it with the medications she was taking. Within the country, she wondered if somebody would choose to make an adoption plan with her, knowing her history. She was also worried about the risk of passing on the genetic vulnerability of bipolar disorder to children.
We talked about it a lot. In the end, I wrote a letter in support of her having fertility treatments and having a donor egg. She felt better about removing some of that increased genetic vulnerability to pass that along. Then she had a really strong support team, with psychiatrists and other allied health professionals to support her. She did very well in postpartum.
I think it depends. This was a very well-informed woman. Others maybe don't have the same kind of insight, awareness and connections. Therefore, it would be really good to have additional supports in that area.
It can impact your capacity to engage in parenting, obviously. If you're experiencing depression, for example, everything is harder, but parenting is one of those things that are harder.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Hippman.
Next is Ms. Idlout, please, for two and a half minutes.
NDP
Lori Idlout NDP Nunavut, NU
Thank you.
I'll be asking my questions of Dr. Van Lieshout.
I'm very curious about the recovered peers you were mentioning. What are some of the protective factors that these individuals would have had to be able to become recovered peers?
Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
Thank you.
All we required was that they had recovered and had been recovered for more than a year. Then we asked them a few questions just about their openness to different treatment approaches. What we wanted, when we were selecting people who were going to work with mothers who were struggling, was openness to everyone's experiences and different treatment choices, so that those participants could feel good about that.
One of the singular joys of my career has been working with these peers. They are remarkable women—remarkably strong, bright and committed.
One thing we found—when they were trained and when they delivered the therapy and supervised each other in delivering the therapy to make the program sort of self-sufficient—is that they found that engaging in the helping work helped them solidify and complete their own journey and recovery from depression. Some people were worried that they would get worse, but treating or helping others actually led them to feeling stronger and more recovered.
NDP
Lori Idlout NDP Nunavut, NU
Could you give us a better sense of the context of these recovered peers? How many were considered recovered peers, and what is the possible expandability of using individuals such as recovered peers?
Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
They ranged very widely in age. Some had just recovered. Some were in their early twenties, and some were in their fifties, having had their reproductive journeys 30 years ago. We weren't very particular when we were selecting. We were interested in people from all walks of life and all experiences, so we were really inclusive when we selected them. They came from all walks of life, spiritual orientations, things like that.
There is a really big supply of people who've recovered from postpartum depression, unfortunately, because it means they've gone through it in the first place. But if one in five has gone through something like this, we have a really large supply of recovered peers who could help fill the gap that exists in terms of getting people treatment in a timely way.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Van Lieshout and Ms. Idlout.
Next is Dr. Ellis, please, for five minutes.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks, Chair.
Just give me a minute, if you would, witnesses, to indulge in some committee business.
I'd like to give notice of the following motion.
That, given
The Minister of Mental Health and Addictions has asserted that there is “no evidence of widespread diversion”, and yet the Health Canada data released today shows that police seizures of government-issued hydromorphone (Dilaudid) in British Columbia have increased fourfold, or 300%, since the implementation of “safe supply,” from less than 100 seizures per year to 408 seizures in 2023;
The Prince George RCMP reported the seizure of “thousands” of safe supply pills in an illegal drug bust of 10,000 individual prescription pills last month, and police in Campbell River, B.C. have reported the seizure of 3,500 diverted safe supply pills on the territory of the We Wai Kai Nation;
The chief of the We Wai Kai Nation has harshly criticized the so-called “safe supply” experiment;
3,656 people in British Columbia have received government-issued hydromorphone because of this dangerous experiment; and
There have been reports of diverted safe-supply drugs being sold in schools;
The committee call the following witnesses: the Minister of Mental Health and Addictions and Health Canada officials for no less than two hours; RCMP Commissioner Michael Duheme; Assistant Commissioner John Brewer of RCMP “E” Division.
That's the end of my statement. Thank you for indulging me. I appreciate that.
Dr. Hippman, when we first start talking about this, I'm wondering if we might make clear to all Canadians out there listening the difference that the Canadian Task Force on Preventive Health Care...the change in the recommendation, because I think maybe a lot of us here know what happened but we need to explain to Canadians in the easiest way what this really means. I don't want people to miss out on the difference this change will make to Canadian women out there.
Postdoctoral Research Fellow, BC Reproductive Mental Health Program, BC Women's Hospital and Health Centre, As an Individual
Sure. Are you talking about the task force recommendation that came out in 2022?