Evidence of meeting #143 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.
A recording is available from Parliament.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Do you think the federal government is doing enough to actually ban these precursors and find and dismantle these super labs?
Associate Professor, University of British Columbia, As an Individual
My area of expertise is mental health, public health and psychiatry. I think the enforcement area is a fundamental one, but it's outside of my area of expertise.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Okay, but you deal with people who have addictions, and I'm sure they share some of the information.
Do you think that the Government of Canada is doing enough to deal with the precursors that are coming into our country and allowing criminals to profit off the drug issue and make fentanyl?
Associate Professor, University of British Columbia, As an Individual
To be clear, everything that could be done to prevent those precursors from being in Canada and available to drug traffickers and producers should be done. No expense should be saved, and no effort should be avoided, because that is ultimately what would allow us to curb this crisis.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Dr. Knight, what are your thoughts? Do you think the government is doing enough to ban precursors in the country?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
The enforcement area is not my area of expertise, and I'm not going to comment on it.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Knight. Thank you, Ms. Goodridge.
Dr. Powlowski, go ahead, please, for five minutes.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
We're trying to come up with recommendations out of this committee. With that in mind, I think certainly one thing we want to do is reduce the number of deaths due to overdose and try to help people get their lives back on track.
I would suggest that one thing I'm thinking of in coming up with recommendations is how we address the deteriorating situation we see in so many downtown cores, where you have increased numbers of homeless people and people with clear psychiatric problems and substance abuse problems.
Dr. Knight and Dr. Vigo, how much do you think we would benefit from having more ACT teams, with psychiatrists who could assess and, where appropriate, put people on long-term antipsychotics if necessary? Is part of the equation that we ought to be trying to gear up those services and to address the mental health issues we see on the street?
We'll go to Dr. Knight and then Dr. Vigo. Please make it quick, because I have a couple of other questions, too.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
Sure, I'll try to make it as quick as possible.
I think the ACT teams make a lot of sense. Dr. Vigo has talked about them. I saw great work from them when I was in Vancouver.
I do think it's important to also highlight that we're often talking about downstream, severe treatment. We do need to think about prevention and early intervention as well.
Associate Professor, University of British Columbia, As an Individual
My answer is a categorical yes. We need to expand ACT teams. We also need to expand long-term psychiatric rehabilitation beds, and we need to expand housing options for folks who require intensive services. We need that continuum of care: the ACT teams, the in-patient beds and the approved homes.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
That's a perfect segue to where I want to go next.
How much of the answer is just more supportive housing? You mentioned the closure of Riverview as contributing to the number of people living on the streets. Should we also be contemplating reopening some long-term psychiatric institutions?
I know supportive housing is probably better, but when we have large numbers of people with similar kinds of problems, should we be thinking about opening more long-term psychiatric beds for people?
For example, in Thunder Bay, we closed down those long-term hospitals with the advent of long-acting antipsychotics.
Dr. Vigo, you mentioned it first. Then maybe we can quickly go to Dr. Knight.
Associate Professor, University of British Columbia, As an Individual
The answer is another categorical yes.
Yes, we need to open decentralized units with long-term psychiatric rehabilitation beds. We need to also have them in a continuum of care with housing.
This is not like rocket science. I mean, that's the same thing that happened in the U.K. In the U.K., they closed all the old psychiatric hospitals, and now they've reopened a whole bunch of decentralized units that exist throughout the country. They have created thousands of beds, which is what we need.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Dr. Knight, would you like to add, on the same issue?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I don't have anything to add to Dr. Vigo's comments.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
The last question is on involuntary treatment. Somebody has an underlying mental health disorder, and under the Canada Health Act they qualify for involuntary treatment. How about, though, when somebody has—and I don't know how often this happens—a pure substance use problem? They don't have underlying psychiatric problems, but they are using drugs in such a way that they are clearly either trying to harm themselves or indifferent to harming themselves.
Is there scope for that, and should we be using existing psychiatric legislation? I'm a long-time emergency doctor as well. When somebody is suicidal, you have a duty to bring them into the hospital to try to prevent them from harming themselves. Should we be using that existing psychiatric law on people who are abusing drugs and either actively trying to kill themselves or indifferent to their deaths?
Maybe I'll start with Dr. Knight.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
Thanks. This is an ongoing debate among health care providers, for sure. In my view, substance use disorder is a mental disorder. It's classified under the DSM-5. For somebody who does have severe disease and is incapable of making treatment decisions, I would argue that our mental health acts would cover that. They are not being applied in that way, so there needs to be conversation around that.
Again, in talking about involuntary treatment, we know that the only way to use involuntary treatment appropriately is if we have access to voluntary treatment for people who want treatment.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Knight.
Thank you, Dr. Powlowski.
Next up is Dr. Ellis, for five minutes.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks, Chair. These questions would be for Dr. Vigo, Dr. Knight and Ms. Brett, if we have a bit of time at the end.
My colleague talked a little about prevention. It's certainly something that's incredibly difficult and not talked about very much.
Dr. Knight, in a few minutes could you give us your thoughts on the prevention of substance use disorder and difficulties, which, realistically, we are not spending any money on at all in this country.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
Thank you for bringing it up. We are often focusing on the downstream effects in the people with very severe disease.
There are some evidence-based prevention tools out there in other jurisdictions that we can look at, and we've outlined some of them in the CSAM policy brief we submitted.
Really, a lot of it comes down to supporting the fundamental social determinants of health, access to safe housing, to activities and to education; and supporting the growth of people—young people, in particular—who are able to develop in a positive way and not rely on the use of substances early on in their lives, which lead them to develop substance use disorders later.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you very much for that, Dr. Knight.
Dr. Vigo, do you have any comments you might want to add to that?
Associate Professor, University of British Columbia, As an Individual
Absolutely.
We have evidence-based interventions that we could deploy at every school in Canada for a relatively inexpensive investment—developed here in Canada, by the way.
The preventative intervention is one example. It has shown that when you intervene early enough, in ways that can be delivered in one or two sessions in a school, that has effects many years afterwards and decreases the risk of substance use.
This could be implemented, and it should be implemented, because, as everyone here has said, our best bang for the buck is in preventing the damage to those children's brains.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks very much, Dr. Vigo.
Ms. Brett, might I ask you a couple of questions?
Obviously, we're talking a bit about prevention now. One of the contentions we've heard is that nobody is born wishing to become addicted to drugs as they age. Would you echo those comments? If you could, give a comment with respect to what you think the benefit of treatment might be for younger children.
Assistant Editor, The New Westminster Times, As an Individual
Thank you.
Yes. You know, Jordan has never seen himself as an addict. He was a football star. He was an amazing athlete on many fronts. He was also using drugs quite early, at age 14—pot, alcohol. It was known to the school system that this was the case, and they placed him in a special after-school program, which he aged out of.
Now, when he looks back, he claims that was an effective way for him to manage the impulses he was feeling at that age. It's such a shame that there was no alternative and continuing program.
For him, with 26 treatment engagements and most failing, we were perplexed beyond belief, but the fact that those treatment centres existed was a reprieve from the street for him, in a way, and potentially saved his life. It helped him to accrue clean time.
We're really grateful for what existed at the time when he needed it, but he was undiagnosed with a severe mental illness in spite of engaging with mental health routinely. This is a crime in itself. I'm not saying it's a “crime” crime. It's just a sad reality of inefficient resources applied to him.
I'm not sure if I've answered your question.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
That's great, Ms. Brett. I appreciate that.
I have about a half a minute left.
What advice would you give to other parents and families who are going through what you have with your son Jordan? What advice would you give to the Canadians out there listening?
Assistant Editor, The New Westminster Times, As an Individual
Don't abandon your children. There is always hope. When it's the bleakest, when it's the darkest, go alongside them. Walk in their shoes.
Walk beside them, see what they see and know what they know. Bring them into whatever facility and support there can be, where there's dialogue, where there's a counsellor, where there's someone who can become a listening post and who can generate whatever resources are available. It's the only way.
We have to pound on the door of the services available to us and bring our kids with us. Don't leave them behind. Join them in their misery, because you need to be witness to it. You need to speak when they can't. In my case, Jordan was not able to describe in any real way, except to me, privately, the terror of what he was experiencing. He couldn't express it in public or in a counselling session of any kind.
We need to be there for them, and we can see them through to a better place, along with the aid of doctors like Daniel Vigo and the change in our B.C. government's intentions here, it seems, although I have no evidence that there are going to be new and effective beds made available for involuntary care. If that were to occur, there would be a significant change.
I just pray for that day. We need it. Our children are dying.