Health Committee on Oct. 10th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 132 of the House of Commons Standing Committee on Health.

Before we begin, I would like to ask all in-person participants to read the guidelines written on the cards on the table. These measures are in place to help prevent audio and feedback incidents and to protect the health and safety of all participants, including the interpreters.

In accordance with our routine motion, I'm informing the committee that Dr. Powlowski has completed and duly passed the required connection test in advance of the meeting.

Pursuant to the order of reference of June 12, 2024, the committee will resume its study of Bill C-277, an act to establish a national strategy on brain injuries.

I would like to welcome our two witnesses today.

We have Alistair MacGregor, the member of Parliament for Cowichan-Malahat-Langford. Representing Brain Injury Canada, we also have Michelle McDonald.

Thank you both for being with us. You'll have five minutes each for an opening statement.

Congratulations, Mr. MacGregor, on getting to this stage with your private member's bill. We're going to start with you. You have the floor.

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

Mr. Chair and members of the Standing Committee on Health, thank you for inviting me to appear today.

This is a momentous day for me as the sponsor of Bill C-277, and it is truly a highlight of the journey I began six years ago in 2018, when I first discussed the idea of a national strategy on brain injuries with my constituent Janelle Breese Biagioni, the excellent witness you met last Thursday.

I also want to acknowledge and thank Tim Fleiszer of the Concussion Legacy Foundation of Canada, Elisabeth Pilon from Concussion Café Yukon and Professor Miriam Beauchamp of the University of Montreal, who appeared as witnesses and provided incredible testimony in support of the bill.

The first version of this bill appeared as Bill C-323, which I introduced in the final days of the 43rd Parliament. That bill immediately received the attention of Michelle McDonald and Brain Injury Canada. She is sitting with me here today and deserves a lot of credit for how far we've come.

After the 2021 federal election, we partnered together to craft the bill you see before you today, Bill C-277. Although I'm here as the sponsor of Bill C-277, I can in no way take sole credit for its success. The campaign supporting this bill has been the result of the efforts of people across Canada—those living with a brain injury, their friends, families and support networks, researchers and brain injury support organizations. They are the ones who have shared their personal stories, written to MPs across the country and pushed for action to deal with what is truly a national problem.

Municipalities that are on the front lines of the mental health crisis gripping our country have also been proactive. We received early support from Vancouver Island communities, and this has continued to grow. Recently, the Union of BC Municipalities endorsed a resolution in full support of Bill C-277. This passionate and committed advocacy resulted in the unanimous support of 324 votes in the House of Commons at second reading on June 12 earlier this year. I want to again thank members from all parties for this overwhelming support. The brain injury community has been watching, and they are feeling hope.

Why do we need a legislated national strategy? Colleagues, you've all seen the statistics. You can appreciate what a devastating impact brain injuries have had on Canadian society. While an immediate concern might be directed towards the lack of proper health care resources, we know that brain injuries affect our communities in much wider ways. We know that there is a high degree of brain injury among the homeless population. We know that people with brain injuries have become victims of toxic street drugs and that overdoses from these same drugs have caused brain injuries, resulting in a vicious cycle. We know that many people involved in the revolving door of our criminal justice system have brain injuries.

There are many cognitive, emotional and behavioural symptoms from brain injuries: anger management, processing information, high-risk behaviours, inappropriate emotional responses, lack of impulse control, memory impairment and poor judgment. You can all imagine how even a few of these symptoms can lead to negative interactions and problems in society if the cause is not understood. There is a poor understanding of brain injury and its consequences for both health and social care systems.

This is a problem that is bigger than any one province or territory can handle on its own. People are suffering. There is a desperate need for services right across the country. The enormous societal and economic costs of the status quo demand that we rise up to the challenge of the moment and meet it with a strong national framework and strategy that will help guide, not dictate, collaborative federal and provincial policies to support and improve brain injury awareness, prevention and treatment as well as the rehabilitation and recovery of persons living with a brain injury.

By legislating this requirement for a national strategy, we can truly start treating this major societal problem with the urgency and resources it needs. With proper treatment and support, many people with brain injuries can return to productive and engaging lives. Bill C-277 will provide a legislative framework to help with this goal.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. MacGregor.

Next, on behalf of Brain Injury Canada, we have Michelle McDonald, chief executive officer.

Thanks for being with us, Ms. McDonald. You have the floor.

[Michelle McDonald, Chief Executive Officer, Brain Injury Canada]

Thank you so much for inviting me to speak with you today, and for the committee's support of Bill C-277.

A brain injury can impact every aspect of a person's life. This includes changes to their independence, abilities, work, and relationships with family, friends and the world around them.

An outdated statistic cites that there are approximately 1.5 million individuals living with the effects of brain injury. The true number is likely much higher.

A brain injury is not just a one-time event. For many, it marks the beginning of a chronic condition that they must navigate for the rest of their lives. Thanks to advancements in diagnostics and treatment, we are now able to keep people alive after severe injuries. However, we do not have a health care system that is built to support their needs over the long term.

While many people living with a brain injury are falling through the cracks, there are also many people who lead stable lives, yet still lack access to the services and supports they need to live well. The invisible nature of brain injuries poses significant challenges, as many face judgment, stigma and isolation. This invisibility can hinder access to necessary supports and accommodations, making it difficult for affected individuals to navigate daily life.

A brain injury is deeply intersectional, influencing and being influenced by a range of personal circumstances and systemic barriers.

In terms of mental health, individuals with a brain injury are at a higher risk of developing mental health issues, including depression, anxiety and PTSD.

The unemployment rate for individuals with brain injuries is significantly higher than the national average. This can lead to poor psychosocial outcomes, decreased community integration and economic dependence.

Stable and appropriate housing is a driving issue. Depending on the area, the wait time for brain injury-specific housing is anywhere from 10 to 20 years. Families often shoulder the care for a loved one when there are no appropriate housing options, and this is often done with little or no financial support.

For many, these barriers lead to homelessness. A recent meta-analysis found that 53% of homeless people report having experienced a brain injury in their lifetime. These people are not receiving any care or rehabilitation for their brain injury.

A brain injury can lead to opioid use, and an opioid overdose can cause a brain injury. There is an urgent need for a comprehensive strategy that promotes prevention, rehabilitation and support for these affected individuals, who are often younger in age, with a normal life expectancy, but face long-term challenges that are not adequately addressed.

There is also growing awareness about intimate partner violence and brain injuries. Up to 92% of women survivors of intimate partner violence may also experience a traumatic brain injury.

It is also essential to highlight the prevalence of brain injuries as higher among indigenous, first nations and Métis peoples in Canada when compared to the general population. They often face systemic barriers that limit their access to health care services, including geographical and financial barriers as well as cultural and language barriers.

A coordinated national approach to prevention, treatment and recovery in the form of a national strategy is long overdue for Canada. Accurate data is essential for saving lives and informing decision-making, yet Canada urgently lacks comprehensive long-term data. This gap hinders our understanding of the ongoing challenges faced by individuals living with brain injuries. A strategy would improve data collection and health care tracking and would provide valuable insights to shape effective policies at the provincial and territorial levels.

A national strategy would boost research funding, leading to better diagnosis and treatment and a deeper understanding of brain injuries as a chronic condition. This would facilitate the development of effective long-term interventions and robust community supports.

A national strategy would enhance awareness and education, equipping health care providers with the necessary knowledge, while raising public understanding to reduce stigma.

A national strategy would establish coordinated national guidelines for prevention, diagnosis and management, ensuring equitable access to quality care for all Canadians.

A national strategy would provide essential support for individuals and families navigating the health care system, including sustainability support for the 50-plus brain injury associations filling the gaps in the health care system.

Finally, a national strategy would allow us to leverage reliable data while prioritizing prevention and early intervention, ultimately enabling us to significantly reduce health care costs through proactive measures and community supports.

Investing in a national strategy is not only a moral imperative, but also a wise economic decision that could yield substantial savings for the health care system. Canada needs a national strategy on brain injuries to ensure that every Canadian has access to the resources they need to recover and thrive after a brain injury.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. McDonald.

We're going to proceed with the rounds of questions, starting with the Conservatives.

Dr. Ellis, you have six minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

Thank you, Mr. MacGregor, for being here, and Ms. McDonald.

We've heard from expert witnesses on this issue. We've identified some knowledge gaps as well. One of the things that we asked many witnesses was to present to the committee with respect to symptoms that individuals may suffer, regardless of the type of injury they received, and it seemed difficult to present that.

One of the things we heard from witnesses was specifically related to children who have had head injuries. It doesn't matter the cause, whether it be birth-related or related to injuries. Sadly, sometimes it's related to things like shaken baby syndrome or, moving on through the years, to sporting injuries.

Is it part of the hope that we'll be able to unpackage some of those symptoms for parents and/or caregivers to enable them to better identify when children may have had a head injury, for instance, or simply, but not so simply, also be suffering from a mental health issue? Sometimes there is significant overlap.

I wonder if both of you might comment on that. You can decide between yourselves who's going to go first.

[Michelle McDonald]

Thank you very much.

Children do experience brain injury, and for the very young, it's hard to vocalize their symptoms, and it's often subjective; you look at the symptoms to diagnose it. However, those with more severe injuries are going to....

As I mentioned, it's a chronic condition. This injury is happening to a developing brain, and that will impact their long-term trajectory, so we need long-term care for them, not just until they're 18, when they come out of the pediatric system. We need to support them over the long term, and that support needs to be individualized, not a one-size-fits-all. It needs to be customized to that individual as well as to their family. Their families need customized supports as well to help these children through these conditions over their lifespans.

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

There's a lot of expertise out there in the field, Dr. Ellis, and I think we've heard it earlier at this committee. My job with this bill was really to try to create that legislative space that helps them do their job in a coordinated fashion.

We're a big country. We're very regional, and some provinces may have more resources than others, but they're all feeling the effects. With children, because they have a developing brain, the long-term consequences can be quite profound. In addition to what you just heard from Ms. McDonald, Mr. Fleiszer last week was also talking about the work his organization has been doing, especially with respect to kids in sports.

Thank you.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thanks very much for that.

I had the opportunity to speak to Mr. Adrian Dix, who's the provincial minister of health in British Columbia. As we know, it's the epicentre for the safe supply drug experiment, which we're talking about in this committee as well.

That said, one of the concerns he raised was related to hypoxic brain injury for individuals who suffer from substance use disorder and who have perhaps been, very sadly, revived many times. I know that both of you spoke about that particular type of injury, which, sadly, is becoming more prevalent. Is that something that you'll be very directive towards with this framework, in terms of asking people to look at this burgeoning new type of brain injury?

The other difficulty is housing those individuals. It's not appropriate to house those individuals with senior or geriatric patients suffering with things like dementia. Do you have any hopes that housing will specifically be a part of the framework?

Maybe we'll go in the reverse order. Mr. MacGregor, maybe you could start.

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

Thank you for the great question, Dr. Ellis.

This is truly an issue that is gripping so many communities right across Canada. I know we've had some very passionate debate in the House of Commons and at various committees on this subject.

As I said in my opening remarks, it can be a vicious cycle. You can look at the symptoms that many people with brain injury exhibit, and they can have poor judgment and poor impulse control and other things that may lead them on a path towards drug use as a way of managing what's going on inside their own bodies. If they get a hypoxic brain injury, then we have this vicious cycle starting.

With Bill C-277, I wanted to provide a positive legislative measure that, so far, we can all get behind to tackle some of the spinoff effects from this. From what I've heard around this table and in the House of Commons, we seem to have a lot of people in agreement that this could be helping that very serious problem in so many of our communities.

[Michelle McDonald]

Opioids can cause brain injury, and brain injury can lead to opioid overdose. We need integrated care models that address both the substance use and the brain injury. We can't treat one without the other. These people fall into a grey area. They'll be treated for their overdose, but they are not always treated for their brain injury over the long term. They don't know where they're going for support.

We need to treat this over the long term.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Next we'll have Mr. Naqvi for six minutes.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Thank you very much, Chair.

Thank you both for being here.

Mr. MacGregor, I'll come to you in a moment, but I want to ask a few questions of Ms. McDonald.

You mentioned a data point in your opening remarks: 53% of people who are homeless have a brain injury. That number is staggering.

Can you talk to us about that study and what they found?

[Michelle McDonald]

I can, absolutely.

It is staggering. This was done out of the University of British Columbia. They looked at a series of Canadian data on homelessness. That 53% is a staggering number, and 25% of those are moderate to severe brain injuries.

These people are living on the street. They don't have access to care. Most of them don't even have health cards. How are they supposed to get treatment and recover? We need to understand the path to homelessness. A brain injury can lead to homelessness, and homelessness can lead to brain injury. We need to understand how people with a brain injury get there and then develop supports and preventive strategies so they don't get to that point.

We also need to decrease the stigma around homelessness and support these people where they're at. We need housing programs geared towards people with brain injuries. They're often excluded because of behaviour impairments. We need to create programs specifically built for people with brain injury, rather than trying to house them in long-term care settings, where they're not getting the supports they need. Really, how can we expect someone to seek addiction services, or any kind of service, if they don't have a place to shower, clean clothes or a bed to sleep in?

We need to address it at its core. This needs to be a community effort, with many different stakeholders.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Thank you.

I've been told by many folks who work in the housing sector and deal with homelessness that we have more of a health care crisis on our streets than a homelessness crisis. Brain injury is a big part of it.

Can you quickly tell us about the breadth and scope of Brain Injury Canada as an organization? What kind of work do you do? I'm assuming that you work in collaboration with other organizations across the country and perhaps internationally as well.

[Michelle McDonald]

I can respond, absolutely.

We're the national charity. There are 50 brain injury associations that are all independent, and we all work together in a network. Brain Injury Canada is overseen by a scientific advisory group of 35-plus researchers and clinicians from different academic institutions and hospitals across Canada. We bring all that knowledge into one hub.

We also have a 600-page resource website that was funded in part by the Government of Canada. That's what people come to us for. We're a knowledge mobilizer for the brain injury community. We act as that connection. There are so many different stakeholders; our role is to bring everyone together to ensure we are communicating—clinical, research, allied health and all of these community supports.

Our role is to bring everyone together so we're furthering the cause of brain injury and prioritizing it within the health care system and among policy-makers.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Thank you.

I'll come to you, Mr. MacGregor.

First of all, congratulations. We've spoken about this bill. I'm supportive of it. I want to thank you for highlighting this very important gap in our health care system.

I noticed that in the legislation—it's kind of rare—you named Brain Injury Canada as the source, in terms of websites and information.

I'm wondering why you chose to do that in this bill. What about other organizations, as Ms. McDonald mentioned, that also contribute to the work and the repository of information that exists when it comes to brain injuries?

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

I chose Brain Injury Canada because they have been doing phenomenal work. I don't want to double up on what Michelle already answered, but when I came out with the first version of this bill in the previous Parliament, it immediately got her attention. We've had a collaborative working relationship every step of the way in the development of Bill C-277.

I think part of the reason the bill has been so successful to date is that through Brain Injury Canada's contacts right across the country, they've been able to mobilize an incredible base of support. The brain injury community has been mobilized. They're aware of this bill and they're aware of what this bill hopes to do, in large part because of what Brain Injury Canada has been able to do.

I felt they were an organization that deserved to be named in this bill because of the work they're already doing and because of the close collaborative ties they have with so many other organizations.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Are there other organizations or information sources, whether academic or community-based, that you have referenced in your bill, or is it just Brain Injury Canada?

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

It's just Brain Injury Canada, because we believe that they act as an important hub for all of those other organizations and researchers. It really has been a great organization to bring everyone together. Through my relationship with Brain Injury Canada, I have personally been introduced to so many of those other individuals and organizations that are doing this important work from coast to coast to coast.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Thank you.

My last question is in terms of consultations.

Assuming this bill will pass and get royal assent and that the important work of developing the framework will happen, in your vision, what kind of consultations are needed to develop this framework when it comes to the provinces, territories and indigenous peoples? All of those unique elements are extremely important, and in my view, it is important that they be considered a factor in the development of this framework.

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

That's a great question. That's why I felt it really important in clause 2 of the bill to spell out exactly what is going to be expected of the federal minister of health. While we do have a fairly prescriptive list of what we'd like to see included in the national strategy, I think a lot of those sections are still open enough to interpretation to allow some wiggle room, because we know not all parts of the country are the same.

I feel very confident in terms of the consultation that I've done. This bill actually came about as the result of consultations. Janelle Breese Biagioni had done lots of consultation. This was one of the recommendations from some of those conferences, but even since this bill has been tabled, through Brain Injury Canada, I have met with people from right across the country who are heavily involved in this work and are absolutely supportive of all the measures that are contained in this bill.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. MacGregor.

Mr. Thériault for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Chair.

Mr. MacGregor, you know that, ultimately, we agree on the need to better understand all the problems associated with brain injuries. More work also needs to be done in the area of prevention and awareness.

I'd like to ask you a question of principle. How is legislation to develop a national strategy on brain injuries more effective or essential than, say, a strategic action plan?