Health Committee on April 11th, 2024

[Dr. Liisa Galea]

I don't know about the perinatal classes, but I can tell you, because I did this little analysis very recently, that we looked at the books that are written. I'm sure that you might have heard about this on Monday as well. So much attention is paid to the pregnant person and, once the baby is out, all the attention moves to the baby. Very little attention goes to the birthing parent, and that's a problem.

Another problem is that mental health is still such a stigma in our country, but one in two of us will experience mental health issues in our lifetime. This means that either us or someone we love dearly is going to go through that.

I never understand this stigma. We have to break it up with a conversation. We have to make it clear that it's okay to talk about mental illness. Obviously, there are repercussions for talking about it when you're pregnant, but it's a very susceptible time. There are a lot of biological signatures during the postpartum period that match what happens during pregnancy, so it makes sense that this would be a very particularly vulnerable time.

[Dr. Nichole Fairbrother]

Certainly, one of the things that we notice within the area of perinatal health is that there is so much focus on the infant, which obviously is terribly important, but the focus on the infant sometimes comes across in such a way that a woman, the birthing parent, is no more than a vehicle to producing a healthy child. The woman, herself, is not perceived as having authentic and independent needs separate from the needs of the child. Mental health is a really great example of that, because we're so focused on infant development.

For example, it would be very difficult, I think, to get a lot of attention for mental health difficulties of the birthing parent, the mother, if there were no implications for fetal development, because there's such an orientation around the infant. When you talk about prenatal education around mental health, this is one of the issues for me, personally, because this is my area of work.

When we talk about postpartum harm thoughts, most parents, most pregnant people, have no idea that this can happen to them. Part of the reason for that is once it does, they're terrified to tell anyone in case somebody reacts in such a way as to take their child away. They think they're demonic. We've had people come to us in the lab saying they tried to give their baby up for adoption, because they were so afraid of these thoughts, or they became suicidal, because they were afraid of these thoughts.

Had they received education prenatally around these mental health concerns, even tip sheets or fact sheets, it would have made a difference to them going into this experience, and kind of knowing what's coming.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Fairbrother.

Now it's over to Ms. Larouche for six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Mr. Chair.

I'm not sure where to start. This hits me like a ton of bricks. Your accounts touch me deeply, Ms. Enright, Ms. Sarson, Ms. MacDonald, Ms. Galea and Ms. Fairbrother. Thank you very much for that.

It's true that there is a lot of stigma, and that obviously leads us back to our lived experiences. In my own family, there are people living with mental health issues, with depression. They are probably going to need medication and monitoring their entire lives to keep them from going off the rails.

[The Chair, Liberal, Sean Casey]

Excuse me, Ms. Larouche. I hesitate to interrupt you, but there is no interpretation on Zoom, if I understand correctly.

We'll stop the clock until we get this resolved.

[The Chair, Liberal, Sean Casey]

I call the meeting back to order. I understand that our technical problems have resolved, so thank you again to the IT professionals for making that happen.

Ms. Larouche, thank you for your patience.

You have five minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Mr. Chair.

As Ms. Galea mentioned, one in two people will experience mental health issues in their lifetime. If someone is not affected directly, it will be a person close to them, so I want to acknowledge the work of the witnesses. Unfortunately, I've experienced suicide in my own family, and as the mother of a two-year-old daughter, I am worried for her.

I want to acknowledge the work of organizations back home. I would like to thank Oasis santé mentale Granby et région, which does exceptional work with families. Every year, I make a point of going to their fundraising brunch to support them. It's taking place at the end of the month. Also, the Centre de prévention du suicide Haute-Yamaska Brome-Missisquoi is celebrating its 40th anniversary this year.

I began my career as an MP in 2019 with a speech that commemorated the 30‑year anniversary of the Polytechnique massacre, an act caused by misogyny, the hatred of women. I have also been a member of the Standing Committee on the Status of Women since February 2019. Every time this committee does a study, we see how women are affected in different and disproportionate ways. I find it hard to understand.

Ms. Fairbrother, you talked about the matter of indigenous women. The Standing Committee on the Status of Women is currently studying the creation of a red dress alert system in Canada. You talked about how indigenous parents experience mental health differently.

Could you tell us more about that?

[Dr. Nichole Fairbrother]

Sure. I'm sorry, but I will answer in English. I hope that's okay.

I cannot speak about all of the various mental health conditions that may affect people who are pregnant or postpartum. I also acknowledge with deep humility that as a white colonial settler person, I have to tread carefully in this area. I can't speak with authority on some things.

However, I think that when we talk about phenomena such as postpartum harm thoughts, which is a core area of my research, if I were an indigenous parent in Canada, I could not imagine ever disclosing that to anyone. We know from talking to white mothers that this is a hard thing to talk about, and there's a lot of secrecy around it. I can only imagine that, for an indigenous parent, with our history of child removals in Canada specific to indigenous parents, this would be near impossible. What that means is that if one is having that kind of experience, there will be hesitation to talk about it.

I do think that hesitation to disclose mental health difficulties very likely encompasses a broad range of mental health problems because of fear of consequences, authority figures and the health care system in general.

Recently I had an email from someone who reached out to me, because they had been experiencing thoughts of harm related to their infant. She shared with me that, at the hospital, there was quite a warm and cordial response initially. There was some discussion, and her family physician had sent her to emergency because, she was told that would be the quickest way for her to then get sent to reproductive mental health services.

Just for context, I'll tell you that she puts blonde highlights in her hair, as does her mom, so that people don't immediately know she's indigenous, because that makes her feel safer. That's just to show how much thinking goes into who you are as a person.

Once she disclosed her indigenous ancestry, she said that immediately reactions changed. She was left alone in a room for a period of time. The consequence of this was that she didn't have any contact with mental health services. She was referred to child protective services. Her whole family had to move for a period of two to three months so that they could be monitored for potential child abuse, because they couldn't provide that monitoring in her own city.

I am now in contact with various health authorities and working to provide some education and training around this, because this was so traumatic for this person.

I think that, while this example is specific to harm thoughts, a really big area of non-disclosure, there are similar things happening with respect to other mental health conditions.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Larouche. That's all the time you have.

Ms. Gazan, please go ahead. You have six minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much, Chair.

My first question is for Dr. Fairbrother.

You spoke about the apprehension of children potentially resulting in greater levels of depression in mothers. One of the things we're still dealing with in Manitoba, for example, to build on what Madam Larouche spoke about, is birth alerts, particularly for parents who have histories with child welfare; if there are concerns, their files are opened immediately, even before anything happens. We still have kids being apprehended from hospitals without allowing the parents the chance to be able to parent.

Can you speak to this? We know, as the research is very clear, that among women whose children are apprehended, there's a drastic decline in mental health, and it becomes harder for them to parent in terms of consequences of mental health issues like addiction or trauma.

[Dr. Nichole Fairbrother]

I'm also going to invite Liisa to pitch in if there's anything she might want to add.

My knowledge of child apprehensions is limited to my own area of research on postpartum harm thoughts. However, I think one of the things we have underappreciated is the attachment trauma that happens when a mother is separated from her infant. We have lived with the assumption that, even for children, moving a child from an unhealthy situation to a healthy situation is only a good thing. When we have a close attachment relationship with somebody, being taken away from that person is traumatic; it's traumatic for children and traumatic for parents, and it will very likely result in fallout in terms of mental health difficulties.

First of all, I think the problem we're having is, in many ways, obviously linked to systemic racism and the history of indigenous people in Canada. However, there are also the issues of threshold and process. Our threshold is set at a level that assumes removal will not be damaging, and that it will only be helpful. Consequently, we're setting the bar in the wrong location.

[Leah Gazan, NDP, Winnipeg Centre, MB]

I have a question about that. We know that the first two years are the most critical for developing an attachment to another person. Is there a connection between the removal of children and the potential for attachment disorders developing later on in life?

[Dr. Nichole Fairbrother]

I wish I knew the answer to that. If you were asking me to guess, I would say yes, but I can't speak with authority on that.

[Dr. Liisa Galea]

I would say the same thing. I don't know, but my guess would be...

[Dr. Nichole Fairbrother]

I don't know how many people in this room have children, but if you remember your child when they were one or one-and-a-half years of age—it's going to bring tears to my eyes—I think you will all remember the love and the intensity in that relationship. I think it is very hard to imagine there would have been no consequences.

[Leah Gazan, NDP, Winnipeg Centre, MB]

I have a question about the fact that we always have to measure women's health against that of men. It's just so ridiculous. One of the things that I know many universities and polytechnics are pushing for is more funding for research in academic institutions. How is the lack of research funding provided to academic institutions impacting women's health?

[Dr. Liisa Galea]

It's having an enormous impact. We have so little of it in the first place. Let's be clear: Our funding levels have been low and they are declining in comparison to the G7 and G20; our health research funding is going in the opposite direction to that in many other countries. We have that against us.

We then also have this extreme lack of attention being paid to women's health factors, which were the subject of 6% of funding in 8,000 federally funded grants over 11 years. That's a pretty small piece of the pie; we need a larger pie in general.

I'll just say that a lot of our costs for research are funding people. The costs for Ph.D. students, research assistants and labs are all going up, so we can do less and less research with the money we have.

[Leah Gazan, NDP, Winnipeg Centre, MB]

We often talk about violence within domestic relationships. We don't talk about violence against women who fall outside of domestic relationships. We know that, often, women will use substances to deal with the violence they're experiencing as a way of coping.

I've been pushing for more low-barrier spaces for women. Why is it critical to have low-barrier spaces, such as 24-7 spaces and shelter spaces, for women?

[The Chair, Liberal, Sean Casey]

Give a brief answer, if you could. We're out of time.

[Dr. Liisa Galea]

I'm going to speak to what I know. With concussions, we all think about sports injuries, football players and hockey players. It is more than a thousandfold more with interpartner violence from domestic violence with girls and women.

[The Chair, Liberal, Sean Casey]

Thank you.

We'll go to Ms. Vecchio, please, for five minutes.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Thank you very much.

It's wonderful, having the opportunity to ask questions. I usually don't get that chance.

I have five minutes, so I'm going to make it really quick. Nichole and Liisa, I'll start with you.

I believe one of the ways to break the stigma is to talk about things like the menopause. To everybody, menopause, here we come—here I am.

What should we be warning my other colleagues about when we talk about mental health and all of those different things, such as the hormonal changes, as well as the lost time? I think of being here for the last nine years, and I think I've seen dips in things. When we're looking at lost wages, we know there is absolutely not enough done on menopause. Women are struggling, but we just keep plugging along, because that's what we know to do.

What are some of your recommendations when it comes to menopause and some studies that we should be doing? If we were to invest money into a later stage of a woman's cycle, what would you recommend?

[Dr. Liisa Galea]

Can we have more time? We know so little.

In fact, I was just listening to a podcast called “This Podcast Will Kill You.” The title of the podcast episode was, “Menopause is whatever you want it to be”. It made me both angry and happy to listen to it. They talked about all the different symptoms that occur during perimenopause, which is the two- to 10-year period prior to menopause, the cessation of menstrual cycles.

We just know so little about it. I think there's 0.5% of research on the female brain during the menopause, which is really low, so we don't really have a lot of information.

There are so many different symptoms that we can experience. Everybody thinks about hot flashes, but there are many more than that. I think that's why people drop out of the workforce. They don't realize what's happening. It's musculoskeletal. I'm now getting arthritis in my joints, and it's a menopause-related symptom.

Sometimes, people will say, “Well, it's just aging.” There's a bit of that, but think about the loss of ovarian hormones. In ovarian hormones, we have estrogen receptors and progesterone receptors. They're everywhere across our body. They're not just in the parts that we cover with a bikini; they're everywhere. It makes sense, then, that when we lose these hormones, we're going to experience many different kinds of symptoms.

We need research, research, research.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

I know I want more, but I have two more questions that I need to get out, so I will go to Jocelyn before I get to Jeanne and Linda.

Jocelyn, we talk about coercive control. We know that 30% of women may show up, showing signs of abuse, such as bruises, but a lot of that other 70% is coercive control that is controlling an individual.

What do we need to do when it comes to coercive control? We know the impact is all mental. What can we do there?

[Jocelyn Enright]

Thank you. That's an excellent point.

Sometimes, we get caught up in looking at the physical symptoms of things. Unfortunately, I think we live in a society in Canada that follows a lot of the same guidelines of policing, so, “I need this hard evidence. I need to see it with my eyes in order to believe it happens.” Meanwhile, our centre, and all of the other sexual assault centres, are operating on the basis of, “If this is your experience and if these are the emotions you're feeling, that is the evidence I need to support you.”

A lot more work, even if it is in physical health spaces, needs to just be around how we can create a more trauma-informed space. How can we make sure that everybody who walks through the door feels as safe as possible, so that even if they don't show a physical sign of injury—they mention, “I'm not allowed to go here, because of this,” or, “My partner holds onto my phone”—we don't just ignore that? We know how to ask some more probing questions about that and provide space for them.