Health Committee on April 11th, 2024

[The Chair, Liberal, Sean Casey]

Mrs. Goodridge, in spite of your personal connection and your passionate presentation of the motion, the motion is actually not in order because we are currently undertaking a study, and the motion calls for us to undertake a new study.

We can accept your motion as notice of a motion to be debated at a later date, unless there is unanimous consent to adopt the motion as is, which would thereby dispense with the need for notice but would also not allow for any debate.

Shall we take it as notice, or are you seeking unanimous consent?

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I'd like to seek unanimous consent, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Is there unanimous consent to move the motion?

[Some hon. members]

Agreed.

[The Chair, Liberal, Sean Casey]

I'm now advised that, because she has unanimous consent to move the motion, it is debatable. If anybody wants to speak on it, the floor is open.

Dr. Powlowski.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I think we want to get back to the witnesses, so we support the motion.

[The Chair, Liberal, Sean Casey]

Are there any further interventions on the motion? No.

(Motion agreed to [See Minutes of Proceedings])

Thank you, Mrs. Goodridge.

That also concludes your time and brings us to Dr. Powlowski for five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I'd like to ask all of you questions, but I'm going to concentrate on Dr. Fairbrother.

You cited that 50% of women had thoughts of harming their babies. Can you quickly give me some citations? What's the sample size?

[Dr. Nichole Fairbrother]

A number of different investigators have looked at this—Jonathan Abramowitz, in particular, and then me.

I focus specifically on harm thoughts. I have two publications on this. The first was about 100 people, and the second was about 400 people. The first time it was 49% who reported unwanted intrusive thoughts of hurting their babies on purpose. In the second iteration of somewhere between 400 and 700 people—I'd have to look at the exact numbers of who reported this—we had 54% report unwanted intrusive thoughts of hurting their babies on purpose.

We have, in both of those studies, looked at whether or not the people who reported these thoughts of hurting their babies on purpose were actually harming their infants, and whether or not that was happening more often in that group than in the group of people who did not report thoughts of hurting their babies on purpose. To date, we have found zero evidence, and the raw numbers would suggest that the people with those thoughts may—possibly, if we had a large enough sample—be slightly less likely to hurt their infants.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I would take it that this is very stressful for women who have these thoughts.

Is there evidence that this contributes to depression and anxiety in women? How much would that be alleviated by the fact that they could talk to somebody about it without having to worry about losing their children?

[Dr. Nichole Fairbrother]

It is very upsetting for some people. Some people are able to cope with those thoughts, but for a lot of people, that is very distressing.

What we know is that obsessive-compulsive disorder, which is the mental health condition most likely to arise as a result of these kinds of thoughts, may impact as many as 17% of postpartum people. That is not exclusive to the thoughts of hurting your baby on purpose but also encompasses thoughts that the baby may be harmed by accident.

As a first step, what we really want to know is this: If we educate people prenatally about these thoughts, how much of that will be mitigated? I think that's the most important first step because you may be able to get a long distance from just doing that. Those, then, are the people who are going to require some treatment postpartum.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I've worked a long time as a doctor, and I've delivered a lot of babies. However, my involvement in prenatal care has been blood pressure, protein in urine and those kinds of things, and it's mostly been in developing countries.

In Canada now, is this part of the discussion that most practitioners looking after pregnant women are having with mothers?

[Dr. Nichole Fairbrother]

No. It's not non-existent, but it is far from common. Many health care practitioners, unfortunately, know very little about these thoughts, and they are either not mentioned or not responded to, as if all thoughts of hurting one's baby on purpose are harbingers of child abuse, which is not the case.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I would have thought that these kinds of thoughts would be most stressful to people who, themselves, either experienced child abuse or had seen siblings experiencing child abuse. I want to get to the next part of the question, which is about differences as to how mothers are treated according to their race. I would think there is probably a higher incidence of intervention when indigenous women report such things.

I've worked in a lot of emergency rooms. I'm pretty sure that if you had an indigenous woman, routinely, the doctor would refer the case to child care services. It would depend on whether you have indigenous child care services, as we have in Thunder Bay. Other places don't. My guess is that if you're an indigenous woman who says that you're having these thoughts—especially if you, yourself, had a history of child abuse—your chances of having that kid taken away are really a lot higher, but is there evidence for that?

[Dr. Nichole Fairbrother]

My research lab is trying to move in that direction. As I think some of your colleagues in this room will really appreciate, as a white person, treading into that sphere is a little more complicated and requires a lot of collaboration with indigenous scholars. One of our next moves is to try to get some data on that. I think you're absolutely right; that's going to play out very differently, and child removal is almost inevitable with that, but that is anecdotal at this point, and I don't have the data yet for that.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I have a quick question. When the courts look at child custody, the best interests of the child come first, but certainly, we have heard today of the trauma to the mother of losing a child. When the courts establish that balance between the interests of the parent and the interests of the child, do you think they are generally doing that right? Second, does that balance change according to whether you're indigenous or non-indigenous?

Having said that, let me quickly say that as a medical practitioner, you see people who have a real drinking disorder coming to emergency all the time with high levels of alcohol. They are homeless. You tell them that they're killing themselves, and they say they know. You ask why, and often losing a child is, in my experience, one of the most common things you hear.

Do the courts get the balance right? I know this is very difficult for the courts, but is there a difference between indigenous and non-indigenous cases?

[The Chair, Liberal, Sean Casey]

Excuse me for one second. That was Dr. Powlowski's idea of a quick question, and he's well past time.

If you could answer much more succinctly than he posed the question, that would be helpful.

[Dr. Nichole Fairbrother]

I'll give it a try. I wish that I were more of an expert in this area. What I can say on this is that the trauma that a mother experiences when losing her child has heavy implications for the child. This is not just an either-or question. That mother-infant is a duo, and in some ways they exist as a unit, so what happens for the mother has implications for the child. Her ability to regain custody of her child diminishes as a consequence of that trauma, so no, I'm not sure we're getting it right.

[The Chair, Liberal, Sean Casey]

Thank you.

Dr. Kitchen, you have five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair, and thank you all for being here.

Today, when I first sat here, the chair announced at the beginning of the meeting a warning about what we would be experiencing today. He made that announcement for those watching and listening. I thought that it was the first time I had ever heard a warning being given out, yet it has been one of the most compelling meetings I have ever been at in my nine years, to hear about the experiences and the huge impact.

I have so many questions, but I will try to be as quick as I can.

I looked around the room, and I saw expressions on people's faces. What we heard was astonishing. I've lived in Afghanistan, Pakistan and Iran. I have been places where people have had their hands cut off, where there have been hangings, and what I heard today was more compelling to me than things I've ever heard. I appreciate it, and I thank you all for what you do. It's a huge area.

Ms. Enright, you brought up an issue about recognizing that it's the provincial government that provides your support, and that perhaps the federal government could at least show some discretion in the sense of advocating for that. You talked about four people who are helping your organization.

How many of them are actually making the diagnoses before the people come to you? Are they coming to you with a diagnosis or being referred to you by practitioners?

[Jocelyn Enright]

Basically, anybody can come through our door. They don't require a diagnosis of anything to receive our services.

However, anecdotally, many of our clients have been to other sorts of therapy and received different diagnoses. Then they come in. For some people, it's helpful to receive a diagnosis. However, for a lot of other people.... Women, especially, feel that, a lot of times, they go into the medical system and are told, “You have this disorder, so here's a pill and goodbye,” or, “Okay, you're being dramatic and hysterical”—the things we typically hear about women.

Then they come to our centre and talk through the trauma and realize that, yes, who wouldn't develop anxiety? Who wouldn't develop depression? Who wouldn't need some sort of substance to cope after going through something terrible? Am I not just acting the way any human being probably would towards this? Yes.

That's what we're seeing.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

I apologize for interrupting, but I have a short amount of time.

Dr. Galea and Dr. Fairbrother, your comments were tremendous, especially when you talked about depression versus anxiety.

I am a practitioner, and mental health is not my area of expertise. However, when I had patients come to me, I would always try to make those referrals, whatever the situation may be. You pointed out the fact that, a lot of times, women do not get the diagnoses they deserve and do not get the referrals. For example, cardiovascular disease is a leading cause...in women—more so than in men—and it's not recognized.

One thing I've pushed for quite a bit is how to educate practitioners. I know that, when I graduated, I knew everything. The reality is that, once you get out into various areas....

How do we educate them? Granted, we have a continuing education system that's supposed to be there, but how do we ensure this is actually happening?

[Dr. Liisa Galea]

I'm going to try to start.

As far as I'm aware—because I'm not a medical doctor, as you know—there is not much taught about women's health, specifically, in medical school. I think there's a morning for menopause and a week or so for pregnancy. I'm not sure, but I'm sure it's not necessarily about the mental health of pregnancy or those susceptible times. We absolutely need more education. To get the education, we still need that research. We still need that compass and map, and we need more specialties in this.

If you have perimenopausal symptoms like night sweats, you go to the gynecologist and get some hormone therapy if you're a good candidate for that. However, in my experience—anecdotally, but also through my expertise—they don't have all the information they need and that's because we just don't have the research on it.

If I can segue, another point I want to get in very quickly is about databases.

People say databases are great. We get millions of people we can look at. We've tried to do some of this work—looking at hormone therapy and how it might affect the brain, and different kinds of hormone therapy. That information isn't in the database. It will just say “hormones”.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

I apologize again, timewise.

One of the other aspects that I think gets missed is educating women to truly understand what could be there. That education needs to come from practitioners as well as through other means, like public health, etc., such that—

[The Chair, Liberal, Sean Casey]

Thank you.