Health Committee on Oct. 10th, 2024

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

There is one thing that I think every member of Parliament goes through when they're contemplating the drafting of a bill. When it came to raising awareness about brain injuries, the recommendation that was put to me through Janelle's work was to develop a national strategy. In terms of what that looks like, it's very open to interpretation. If you look at the first version of my bill, you see that this version is very different because of the collaboration with Brain Injury Canada.

Mr. Thériault, what's important to remember with a national strategy is that we're not seeking to dictate. It's really seeking to build an atmosphere of collaboration with all of the stakeholders who are named.

The reason I chose a legislated national strategy is that this issue is incredibly important. I wanted to have those legislative guardrails in place so that no matter the political persuasion of the government of the day, this would still be a requirement that would be in place in law for a federal government to follow.

I think the brain injury community has been waiting long enough. We know what the gaps are like. We know how this problem is affecting our communities. I wanted this to be a committed action plan for the federal government to act upon in consultation with provincial governments and everyone else who is listed there. That is why I chose this particular method and listed all of these details.

[Luc Thériault, Bloc, Montcalm, QC]

We recognize the need for an action plan. But does that mean we need a law? I'll leave that question there for now.

I'm not sure your answer has convinced me. That wouldn't prevent me from voting for a bill. The provinces and Quebec also have action plans in place. So it's about coordinating, so to speak, and sharing best practices, and that's what's going to enable us to better respond to this problem.

There is one aspect of the bill that I consider to be key, and which I stressed during our discussion with Ms. Beauchamp, who recently appeared before committee. I'm talking about research. However, it falls under federal jurisdiction.

We absolutely need to know more about brain injuries. In my opinion, research is one aspect of the national strategy that really needs to be front and centre. The more we invest in research, the more we'll know. That way, we'll be better able to reduce stigma and better understand the problems people face in general.

Furthermore, paragraph 2(2)(b) of the bill, which is part of the section outlining the national strategy, mentions that this strategy must include measures to “identify the training needs”. Given what you've just told us about collaboration—and I'll take your word for it here—I'm sure you'd be open to the moving of an amendment specifying the need to collaborate to identify training needs.

In my opinion, this would make this national strategy a little easier to swallow for those provinces that are currently struggling to provide care, because they don't have the necessary resources, which the federal government should have transferred to them.

If we want the strategy to succeed, the provinces need to be treated as partners right from the start and not feel like, suddenly, choices will be made for them by the omniscient federal government.

The success of this strategy depends on collaboration. So let's work together to identify needs, rather than determining them for the provinces. They will have things to tell the federal government, because they're the ones on the ground.

Finally, I wonder why an organization is targeted in a bill. I've rarely seen that. I'm not saying the organization is irrelevant or isn't extremely relevant, but why put its name in a bill?

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

I think that if you go to my exchange with Mr. Naqvi on that, you'll see that it's because Brain Injury Canada has had such an incredible number of relationships with so many people who are doing this work right across the country, and they were extremely important in helping me draft the version of the bill that you see today.

I have always seen Brain Injury Canada as a natural hub for this kind of discussion. They have been incredibly important in allowing me to meet with some of the people who are working on the front lines of dealing with this crisis.

[The Chair, Liberal, Sean Casey]

Thank you.

Mr. Julian, please go ahead. You have six minutes.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you very much, Mr. Chair.

Congratulations, Mr. MacGregor. You've beaten the odds in terms of getting private members' legislation to committee, so congratulations are in order. There is still a way to go for sure.

I'll come back to you in a moment. I want to start with Ms. McDonald.

You've talked about the issues around prevention, treatment and recovery, and admittedly those are very complex issues. What do you hope this bill achieves in terms of getting it passed and the next steps?

[Michelle McDonald]

That's a great question.

I hope brain injury achieves the same recognition that cancer or diabetes has as an impactful and lifelong condition requiring dedication and attention from our federal, provincial and territorial health care systems.

We need standardized data, so I hope it would lead to standardized data on the incidence and the prevalence of brain injury so that we can inform policy and improve the allocation of health care dollars to where they're needed most.

We need more education and awareness specifically with regard to brain injury about prevention and treatment, and more education for newcomers to Canada and newcomers in the health care realm on the challenges faced by those living with brain injuries so that they can provide more informed and customized care.

Research dollars need to be dedicated specifically to brain injury rather than to the brain as a whole; we need to differentiate. Research should be focused across the lifespan, from acute to chronic, and should be multi-centred, and we need more research into community-based interventions.

We need to address the intersections of mental health, homelessness, legal systems, education, prevention and the implementation of prevention measures.

Most importantly, all of this has to be driven by those with lived experience. They are the true experts, and often we forget that when we're developing policy and programs. Everything we do needs to be developed with the individuals who are living with it every day and with the family members who are caring for them.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

That is very eloquent.

You talked earlier in your presentation about brain injury impacting every aspect of the person's life. I know from personal experience, with a member of my family who's been living with a brain injury, how exact that is. It does touch on every aspect. I appreciate your response on what the bill should achieve.

We've also talked a bit about other questions around toxic drug use. We have a substance use crisis in this country.

Can you discuss how this issue intersects with brain injury and how a national strategy could play a role, both in prevention and in effective treatment?

[Michelle McDonald]

Yes, very often we talk about the stats, but there are real people behind these numbers. I want to talk briefly about Jacob Wilson.

In August 2018, Jacob was 21. He was hit by a pickup truck as a pedestrian and suffered a catastrophic brain injury. In the three years that followed, he struggled with psychosis and turned to drug use. In November 2021, Jacob died of a fentanyl overdose after having been turned away twice from the hospital in the 48 hours before he died.

To quote his mother, Shirley, the same health care system “that rescued him and stabilized him” and kept him alive when he was run over “turned him away at the emergency department when they could have saved his life.” If we're going to save people, we need a health care system that's going to treat them well and ensure they can live well afterward.

We need integrated care models, as I mentioned, that address both the substance use and the brain injury. They need to be built to be accessible for people with brain injury. They need to take into account the information processing challenges, the memory impairments. For example, 12-step programs are effective, but if someone can't remember two steps in a sequence, then that is a huge barrier.

We need more community support. We don't want to wait until people are in crisis. We very much do crisis medicine, crisis reaction, but we need to not wait until people get there. We need to provide the supports and services that they need so that they don't get to that point and they don't have to turn to drug use to feel better.

Then we also need to have more data and research on this specific topic for those who do survive. We focus on the deaths, but those who do survive are living most likely with hypoxic brain injuries and are not always getting the care they need. We need to create a health care system that provides that care. A lot of it can be done in the community, which is cost-effective. It keeps people in the communities where they have their networks, their social systems and the resources that are going to help them thrive.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you very much for that.

In your presentation you referenced some of the population groups that have a higher incidence of brain injury. Could you speak more to that now, the disproportionate impacts of brain injuries on certain groups in Canada?

[Michelle McDonald]

Yes, I can, absolutely.

I mentioned that indigenous people have a higher representation in brain injury and are not getting the same health care. They have poorer health outcomes. They have a low income, and it can lead to brain injury. They live in riskier environments, less safe environments, but they also don't have access to sustained care and supports.

In terms of women, there was this parallel pandemic that happened during the COVID-19 pandemic of women who suffered intimate partner violence. We also know that women have different health outcomes because of hormonal challenges and just having to be caregivers.

Also, newcomers to Canada don't have the same access to resources. They don't perhaps have the same knowledge of our health care system or of brain injury.

There are so many groups. We're probably almost at our time. It is so impactful.

There are the homeless and people in the prison system. Statistics have said that over 80% of people within our prison system have self-reported brain injury. That is an astonishing number.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. McDonald.

You were right when you said we're at time.

[Voices]

Oh, oh!

[The Chair, Liberal, Sean Casey]

Go ahead, Ms. Goodridge, please, for five minutes.

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

Thank you, Mr. Chair, and thank you to both of our witnesses here today.

I have one really quick question, and I think I will build off some of the good points that were raised by Mr. Thériault.

My one question to you, Mr. MacGregor, is what would happen if Brain Injury Canada ceased to exist if they're designated as a partner?

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

Yes, that's a good question.

Certainly, this bill is in your committee's hands to figure out the language.

One thing I would like to note is that last week, when we had Tim Fleiszer here as a witness from the Concussion Legacy Foundation of Canada, I believe he said that he, representing his organization, supported the bill as written. That's another major organization that does incredible work across Canada, and even they recognize that the wording of the bill is good as is.

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

I'm simply asking that as a question, because that is the one question I had. Clearly, everyone around this room supports this bill. I'm simply asking a question.

[Michelle McDonald]

Yes, absolutely. I think that if you look at the wording of the bill, you see that Brain Injury Canada is a partner in a knowledge hub. The Government of Canada has already invested in a three-year grant on the development of our resource website. We developed this through a grant from Employment and Social Development Canada. We developed this because people were using Google to do research, and there's so much marketing and keyword finessing. We've already developed this. It's 600 pages. It's available in English and French. It's overseen by a scientific advisory committee. Every page of the site has been overseen and has been reviewed by a clinician or a researcher, so I guess it's this: Why reinvent the wheel? We're getting over 16,000 visitors per month. It's already there. We want this to be something that's adopted nationally.

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

I appreciate that. It's just that I have very little time.

You've talked about how many are treated for overdoses but not necessarily for their brain injuries. If someone has a brain injury and an addiction issue, what is the best course of treatment?

[Michelle McDonald]

It's programs that are built to support both. That would be a program that is built to treat their addiction but is in a format that's accessible to someone with memory impairment, with cognitive processing challenges. It is customized to their needs and is done in the community setting so that this person doesn't have to leave the supports that they have.

It also has to be long term; it's not just for a few weeks. It needs to be something through which they're supported. There are brain injury associations that are ready to step up. They need better funding and they need more support, but they're ready to step up to fill this gap.

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

Given your experience, would giving large quantities of opioids to people who have both brain injuries and addiction issues be a good idea?

[Michelle McDonald]

Do you mean as a form of treatment?

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

Yes.

[Michelle McDonald]

I'm not a doctor. I don't feel comfortable answering that. I'm not a physician.

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

I was just curious if you were aware of what the research says on this. You guys have compiled 600 pages' worth of research.

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

I'd just like to add that this is such an important issue for so many of our constituents and communities, and that's why I'd like to draw your attention to paragraphs 2(2)(h) and 2(2)(i), which specifically make reference to the mental health crisis and addictions. We identify those as key components of this national strategy, given how important they are and how important the intersection is with brain injuries.