Health Committee on Oct. 3rd, 2024

[Elisabeth Pilon]

That's a good question.

I don't fully know, but what I do know is that we need to know more. I hope that this bill will provide access to methods of data collection to understand more of where the gaps are, like Janelle said, what's working and what's not, and to figure out how to pinpoint that to provide more education to frontline medical practitioners across the fields of mental health, substance use, etc. Those are some things that come to mind.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Hanley.

There are eight seconds left. That's certainly not enough time to pose a question and get an answer.

Mr. Thériault, you now have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I thank the witnesses for their very interesting testimony.

In rereading the bill and listening to the witnesses, I thought to myself that it was quite surprising, upsetting, even astounding, to see that the cerebral cortex, the organ that enables humans to hold the highest position on the species ladder, is the one on which we know the least.

In testimony, the word “research” kept coming up, much more so than in the study of many bills. Without research, this bill…. There was a time when it was taboo to talk about sports-related brain injuries. That's not insignificant.

Ms. Beauchamp, I was shocked by what you talked about. I don't want to make a pun, but I've always thought that Canada, as a G7 country, should invest heavily in research in order to keep the brains here. You said that, in 15 years, you had supervised 48 students who survived solely on grants—I don't know the amount of those grants—and who, by devotion, had to continue doing research in this field in Canada.

Can you tell us more about that?

[Miriam Beauchamp]

Thank you for the question.

Before talking about students specifically, I have to explain something. People often forget that any treatment or clinical intervention is the fruit of many years of investment in research. If a medication is used to treat something, if there are digital health applications or questionnaires…. All such treatment or assessment tools had to be validated before being used on patients, and it is through research that those tools are validated.

Someone said that, not long ago, the recommendation was for people to stay in a dark room to recover. Recent research has shown however that people who do that develop symptoms of depression as a result of being isolated and without social interaction. That is detrimental to their recovery. It took years of research and investment to be able to prove that.

I wanted to point that out to remind people that research underlies all clinical initiatives approved by Health Canada.

Now I will talk about students. If they do not have a bursary, they need to work. Most of them no longer live with their parents. Their lives are not necessarily structured and they are in school or in training full time. If they don't have a bursary to rely on, they will have to work, which reduces the time they can spend on research. That also delays their graduation. In many cases, it exhausts them and they can't make adequate progress. So they depend on those bursaries, which in some cases are below the poverty line. The bursaries aren't enough to cover tuition fees and living expenses. The bursary amounts were increased recently, but people must really be given adequate support because they are the ones who are advancing research.

[Luc Thériault, Bloc, Montcalm, QC]

We would not be having this conversation today were it not for advances in science and data. We talked about data earlier, but there are no data without research.

Do you think research on brain injuries is making good progress in Canada?

Does the government's funding or investment allow you to keep up with or compete with other countries? In other words, is it enough for you to keep your people, even though you are very nice?

[Miriam Beauchamp]

It certainly isn't enough. As I said in my introductory remarks, research is extremely expensive and is becoming more expensive because the technologies we want to use are on the cutting edge and are extremely expensive.

I mentioned neuroimaging, among other things. As Mr. Fleiszer said, taking an image of the brain to see what is happening is expensive in itself. Doing that for hundreds of individuals in order to collect data on what is happening functionally or structurally in the brain would therefore be extremely expensive, as you can imagine.

When we are conducting research, it costs about $500 or $600 to take an image of the brain. If you multiply that by 200 or 300 individuals, to enable the researchers in my lab to conduct a sound study, the cost of the research project would be exponential. We want to be on the cutting edge in our field. We need to work with researchers in other countries, but we also have to compete with research conducted elsewhere in order for Canada to be a leader, to pursue the best research questions and ultimately to find the best treatments.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault and Ms. Beauchamp.

Next we have Mr. MacGregor, please, for six minutes.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you very much, Mr. Chair.

It's certainly a unique experience for me to be at a committee questioning witnesses on the bill that I introduced. I want to thank all of my colleagues for their unanimous support of this bill at its second reading.

I also want to thank each of the witnesses who are with us today for their opening statements. I think it's really important for us to hear the personal stories that are behind lots of these things. I really appreciate how you're helping guide this committee through its study of this legislation.

Ms. Breese Biagioni, I'll start with you, given that you are my constituent. Thank you for sharing how personal this issue is for you. I do well remember back in 2018 when we had that meeting. I believe you had just come from a conference called Heads Together. One of the recommendations from that was the establishment of a national strategy on brain injuries. That was the idea that led us to where we are today.

I wanted to ask you this. When you look at all of the ways that provinces and the federal government could tackle this issue, why is it important to you that we actually put in a legislative requirement for a national strategy? Why did that strike you as being an important item for the Parliament of Canada to address?

[Janelle Breese Biagioni]

Thank you, Alistair.

You know, I didn't start out to be a clinical counsellor. I was actually studying to be an accountant when my husband was injured. Going into clinical counselling and being able to work with families and survivors, seeing how they were struggling, and then looking at what was happening in communities where these crises in mental health, homelessness and criminality were on the rise, and understanding how people were getting there, I was seeing that there was nothing to address the challenges people were facing to prevent them from going further or spiralling down. It became quite a concern for me.

I was also realizing that from province to province, and in the territories, there was not provincial representation. The little organizations that were coming together were struggling for guidance and looking to the provinces. In some of the provinces, or in the territories, as Lis has so eloquently said, those services and supports were not there.

I knew that our federal government was responsible for brain injuries with our indigenous communities and with our veterans. That's why I came to you to say that this can be the north star, where all the provinces must come together, have the conversation, look at what's working and what's not working and share the information, but be accountable and move forward with strategies that every jurisdiction can put into place to safeguard our Canadians from going further into these challenges and not having the life they deserve.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

I'm glad you mentioned homelessness, mental health issues and addiction, because Bill C-277 does reference those as part of the national strategy. I think it's important.

I want you to talk about how brain injuries interact with these really big societal problems. Do you believe the implementation of a national strategy in dealing with brain injuries will have a positive effect in dealing with the intersections with the criminal justice system and the obvious mental health crises that so many of our small communities have, and of course so many of our fellow citizens are suffering through addictions in our opioids crisis?

[Janelle Breese Biagioni]

What's really important to know is that the very first thing that will be taxed with brain injury for that individual and their family is their mental well-being. There is nobody I've ever worked with who's gone through this experience, including me, who didn't use the words “anxiety” and “depression”. When you don't have those supports to help you understand what's happening, you're left to navigate a very siloed system.

In British Columbia especially, we see that people can't access services outside of something. If you have a brain injury, you are denied services for mental health or addiction. It's considered too complex. They don't know how to handle it. But those intersections are real. When we don't address what a person is going through with their mental health, and they turn to substance use to cope, or they're on prescription medications that can lead to those addictive cycles, it gets out of control. We just leave them in this ocean of emotion without any safeguards. That then leads to further complications.

Certainly for families that are taxed, trying to navigate the system and get support when they're not even included is exhausting. We often see families fracture and these relationships end. The person then often ends up on the street. We've now clearly been able to see from the research that with all these intersections, the root cause is often brain injury. That's why I say it lives at the forefront but also in the aftermath.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you.

Mr. Fleiszer, I'd like to turn to you for my last minute here. Your organization does incredibly noble work. There are so many organizations that are involved in this field, all with such noble goals. I'm wondering if you could give your opinion on how a national strategy will maybe build up a culture of collaboration among all these great organizations that are doing this important work across Canada.

[Tim Fleiszer]

One of the great lessons you learn from team sports is how to play with others. Working with others, you're able to accomplish so much more than you can on your own.

I'm pleased to report that it's already happening. We've tried from the beginning to be inclusive rather than exclusive. There's absolutely a role for all the different organizations to play in a cohesive national strategy. We just need somebody to lead that strategy. We're so thrilled that you have us here today to talk about that.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Fleiszer.

Mrs. Goodridge, you have five minutes, please.

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

Thank you, Mr. Chair.

I want to thank all the witnesses for being here.

As I was preparing for this meeting, I was reviewing the correspondence that has come in. An exceptionally large amount of correspondence has come in to each one of us as members of Parliament from people right across the country who have written in to the health committee to share their experience. I just want to acknowledge that I appreciate that. It helped me as I was coming up with my deliberations over this. Those things do get read by somebody. You are heard.

Ms. Breese Biagioni, I'll start by expressing my sincere condolences. Thank you for taking your grief and turning it into something to keep your husband's legacy alive. I think that's a commendable space.

Should this bill succeed in getting through the House, what do you hope to see as an outcome from this?

[Janelle Breese Biagioni]

First and foremost, I would hope this comes together to bring together the lived experiences and the voices of survivors and family members to talk about what's needed and collaborate, because there are things that are working in this country and there is a lot that's not working. It's to be able to have that conversation to share the education and information, and develop some guidelines and best practices we can all work from. Also, determine what future research is needed. We have a lot of great research that has been done. There's a lot more that still needs to be done.

It's guidelines, education, prevention and the training of health care professionals. When I say “training”, it's from the nurse and the doctors to the frontline workers and our police officers, who are really becoming our social workers on the streets, so they're able to respond in an efficient way and to know where to turn and where to send that person.

I'm hoping that coordination can come through with all of us. I really believe in my heart that unless we have collaboration and conversation across the country, that won't be there.

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

Thank you. I appreciate that.

Tim, I really appreciated the opportunity we had to meet back in June. I learned something that I thought was actually quite shocking, how soccer is one of the things for youth that are actually far riskier than I had thought.

You have an opportunity here to speak to Canadians. Can you explain a little bit about the work you guys are doing to keep kids safe?

[Tim Fleiszer]

If there's one single policy change we can make in sports in Canada to protect kids' brains, it's eliminating headers in soccer for kids under the age of 12, certainly, and probably under the age of 14 would be even better.

Just for context, there are 550,000 youth hockey players in Canada and 750,000 youth soccer players. By participation, it's by far the largest sport. The majority of the exposures in soccer happen in practice with an adult lobbing a ball at a child, so it's entirely preventable. As a former athlete, I actually don't really buy that kids need to learn to play the ball in the air so much that it should equate to a factor of an activity that we know gives them brain injury.

When you think about CTE and CTE risk, it's important to understand that it's not the number of concussions that athletes have sustained; it's the number of total impacts that athletes get during the course of their career.

In the United States, they banned headers for soccer in 2016. They've recently done it in the United Kingdom. We're now behind.

One interesting thing with this is that, if you're talking about athletic performance and reaction time, some of the research that's been done just down the street at Western University has looked at those impacts and reaction times. It's found that for football players who see exposures in practice and games during the course of a season, it sometimes makes them 15% to 20% slower during the course of the year in terms of their reaction time.

Even if you don't care about the health of these kids and if you don't care about the ethics of exposing children to an activity that potentially gives them brain injury, just for pure athletic performance, we shouldn't be hitting kids in the head.

Thank you for the question.

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

I would assume everyone around this table agrees that we shouldn't be hitting kids in the head. As a parent, I think that's so important. I want as many Canadians as possible to know, because that will guide best practices as we go forward.

I think my time is up.

[The Chair, Liberal, Sean Casey]

Thank you, Mrs. Goodridge.

Next I have Dr. Powlowski, please, for five minutes.

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

I have six kids. Two kids are in minor hockey. Speaking about trying to prevent your kids from getting hit in the head, that has to be a concern of all parents who have kids in minor hockey, especially when they're over 13, which is when they start allowing contact.

You have kids in hockey, too, Mr. Fleiszer. Let me ask you, do you think the NHL is doing enough to prevent head injuries and forms of behaviour on the ice that lead to head injuries? I assume you watch the playoffs.

[Tim Fleiszer]

I do.

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

We all watch the playoffs. Kids emulate NHL hockey. We all emulate hockey. I don't know about the rest of you, but I grew up wanting to play in the NHL. I never wanted to become a member of Parliament. That's some kind of sick ambition for any Canadian. To want to play in the NHL is the ambition of every Canadian kid.

We all watch hockey and all the kids watch hockey. They emulate what's in the NHL. I don't know about you, but I'm a little concerned with what's happening in the NHL. In the playoffs in particular, it seemed to me that they weren't calling a lot of boarding, charging or roughing. They call high sticking and they call tripping, but there seemed to be a lot of people being hit three or four feet from the boards and going head first into the boards, and there were no calls. Not only were there no calls, but there was no commentary from the commentators saying that this was a dangerous hit, which they usually do.

I wonder what your opinion is on that. Do you think the NHL is doing enough to discourage kinds of behaviour that lead to head injury?