Evidence of meeting #109 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was child.
A recording is available from Parliament.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
—women truly understand the potential of mental health issues.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Kitchen.
Mr. Jowhari, go ahead, please, for five minutes.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you, Mr. Chair.
Thank you to our witnesses.
First of all, I sincerely apologize that I cannot be there in person, but thank you for being there.
I'm going to start with Dr. Fairbrother.
In your opening remarks, you talked about how approximately one in five women in Canada struggle with their perinatal mental health.
Can you kindly expand on the most significant challenges women in Canada face in accessing maternal mental health support, care and evidence-based treatment?
Clinical Associate Professor, Department of Family Practice, University of British Columbia, As an Individual
I think it is absolutely the case that we're looking at 20% or more pregnant and postpartum people suffering from one or more mental health conditions during pregnancy and postpartum. A first step in care is adequate screening. For depression, we have great screening. For anxiety disorders, we have yet to identify appropriate tools. However, I'm very grateful to have a grant right now and we're working to change that particular situation.
When you look at pregnancy in particular, and a bit at postpartum with breastfeeding, perinatal people want access to talk therapy, because they are concerned about what it might mean to take medication while pregnant and how that may affect their developing infant. I would say that, right now, evidence-based talk therapy in Canada is funded in little, tiny corners here and there. I have an entire sheet in my lab for the little, tiny pieces people might be able to get after very long wait-lists. There isn't general access.
If I were to advocate for any subgroup of the population as deserving of access to evidence-based talk therapies, I think pregnant people qualify because of concerns about their infant.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you.
You also talked about evidence-based treatment and publicly funded CBT. What other types of evidence-based treatments are currently available in Canada? Also, how do we compare with any jurisdiction or international best practices, and how can we follow them?
That's for anybody.
Clinical Associate Professor, Department of Family Practice, University of British Columbia, As an Individual
I will let Liisa respond to this portion of the question.
Senior Scientist and Treliving Family Chair, Women's Mental Health, Centre for Addiction and Mental Health
I'll say—and I believe you heard this on Monday—that we don't have a Canadian perinatal mental health strategy in Canada. That was voted against for some reason. Australia, the U.K. and the U.S. have one. I think having guidelines and a strategy for perinatal mental health would go a long way for health care practitioners, so that we have that information, and for the people who are pregnant, so that they have that information.
In terms of CBT, you're better to answer that one.
Clinical Associate Professor, Department of Family Practice, University of British Columbia, As an Individual
Outside of reproduction, if you look at the data on treatments for anxiety and anxiety-related disorders, the strongest evidence is for cognitive behaviour therapy. Additionally, if we're talking about trauma-related cognitive behaviour therapy or therapies of that ilk, as well as mindfulness-based approaches, access is very limited.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Yes. I think talking about access is a great point. You also talked about publicly funded CBT. Unless you have private insurance...it's not available publicly.
Can you comment on that?
Clinical Associate Professor, Department of Family Practice, University of British Columbia, As an Individual
One of the reasons I started research in this area is because I feel very passionately about access to the highest level of health care. It is a very peculiar situation we're in, whereby the treatment of choice and the treatment that has the strongest evidence of effectiveness is generally not available.
If you're looking at access to medication for a mental health condition, you can probably secure that within a week. If you're looking for publicly funded talk therapy that's evidence-based, you're probably looking at a year or more.
Senior Scientist and Treliving Family Chair, Women's Mental Health, Centre for Addiction and Mental Health
At the Centre for Addiction and Mental Health, we have another womenmind-funded researcher named Daisy Singla. She just did a very huge study with Simone Vigod, whom you heard from on Monday, about talk therapy. They had some really great data showing that you can instruct another person, not necessarily a medical doctor or a formal health care practitioner, to do some of this talk therapy, and that works very well.
That's a very low-cost thing that Canada could adopt.
Clinical Associate Professor, Department of Family Practice, University of British Columbia, As an Individual
I think dedicated research looking at that would be incredibly helpful.
Liberal
The Chair Liberal Sean Casey
Thank you.
Ms. Larouche, you have the floor for two and a half minutes.
Bloc
Andréanne Larouche Bloc Shefford, QC
Thank you, Mr. Chair.
Since this is the last time I have the floor today, I will try to summarize everything that was said.
Ms. MacDonald, you talked a lot about trauma. You gave us the example of a woman being gang-raped after a hockey game. The Standing Committee on the Status of Women conducted a study and the main recommendation was to invest more money in research on women's health. Another mental health-related recommendation called for an independent inquiry that would shed light on the culture of misogyny and hatred of women in sport.
What do you think? How important is that recommendation? Why should it not be shelved?
Co-Founder, Persons Against Non-State Torture
I think it would be a valuable recommendation, but I would like them to also understand that torture would be involved in the—
Co-Founder, Persons Against Non-State Torture
Thank you.
Yes, I think that would be very important, but I also think that in studying misogyny and violence in sports, we should expand our understanding of the type of violence to include torture—especially gang rape—because there are different goals with abuse versus torture with perpetrators.
With abuse, the goal is to control the woman. With torture, it is to destroy the woman's sense of self. I think that's why it's so horrific for women who have been gang-raped to come forward. It's because they are so shattered. If you can imagine rows of men coming at you when you're incapacitated, it's a violation that needs to really be understood in the misogyny that happens in our country.
Bloc
Andréanne Larouche Bloc Shefford, QC
Coercive control is precisely the subject of the next study I will be bringing to the Standing Committee on the Status of Women. It will help us broaden the definition of what constitutes violence, which to me is very important.
I have 30 seconds left.
Ms. Enright and Ms. Sarson, in our report on the mental health of young women and girls in Canada, it was recommended that the government introduce legislation to combat online hate.
How important would such a law be to counter the hatred of women? Could we have a very quick answer, please?
Co-Founder, Persons Against Non-State Torture
It is hate against women. I think we have to keep naming it, and we have to keep saying that it's the system. The system does it over and over again. If we want justice, justice starts on the Hill. It starts with naming the crime so that people can tell the truth and be heard and believed. Misogyny prevents that.
Bloc
Andréanne Larouche Bloc Shefford, QC
Ms. Enright, could you quickly share your opinion on a law to combat online hate?
Coordinator, Community Engagement, Communications, and Fundraising, Kawartha Sexual Assault Centre
I think it's incredibly important. I think we see a lot more of that. I do a lot of work going into schools and talking to young kids about this, young men especially. It's starting younger.
When I go into high schools, people think maybe that's still too early. When I go into elementary schools, everybody is connected to the Internet. We need to have more information about that.
In particular, don't just talk to young women about this because they experience this more. Talk to young men about this as well, because oftentimes they are the perpetrators. We need to look at why that is and how we stop that from a young age.
Liberal