Health Committee on Sept. 29th, 2022

[Dr. Quynh Doan]

Yes. HEARTSMAP was designed for clinicians, but we also have a self-assessment version for youth and parents now. It essentially addresses 10 different areas of psychosocial wellness, namely the home, education, alcohol/drugs, thoughts/anxiety, etc. The families or the clinicians, depending on which tool we're using, score each section based on the information received through their assessment. It goes from no issues to severe issues. Those scores are mapped to different domains of mental health, as I mentioned earlier.

It's not simply a cumulative score, but it's also a pattern of score and it looks at acuity as well. Something may be severe but chronic, with already access to care, and something could be new, but mild.

The tool uses an algorithm that's been validated against a clinician's assessment—a psychiatrist's assessment—and was shown to be valid at triggering the recommendations that a family could use to access the right level of care.

Not everybody needs to see a psychiatrist in emergency departments right away. Many of them actually have behavioural issues, have social issues that could be worked through with a social worker, or with help from occupational therapy. The instrument does the assessment, but also guides the assessment, either for clinicians to refer or families and youth to explore and access in the community.

The screening version, the MyHEARTSMAP version, is currently publicly available online for families to use and screen and access services before it becomes a problem and they show up in emergency where a clinician would then use the HEARTSMAP tool.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Squires, Dr. Drake and Mr. Munter, as people who work in pediatric hospitals, I want to put some information to you.

We've heard at this committee, and according to the Canadian Dental Association, tooth decay remains the most common, yet preventable, childhood chronic disease in Canada. It is the most common reason for Canadian children to undergo day surgery. It is a leading cause of why children miss school.

I want to put to you this proposition I've been told about. The most common surgery performed on preschool children at most pediatric hospitals in Canada is treatment of dental decay. Is that your experience at your hospital? If so, would having a good dental care program focused on prevention at a young age of children help relieve the pressure on your ERs and your pediatric hospitals?

[Alex Munter]

Not the emergency department, but, yes, by volume, dental surgery is the number one at CHEO. It's the most frequent day surgery, and typically, children whose....

A large component would be genetic malformation and issues related to, for example, associated cleft lip and cleft palate surgery, but there is a very significant proportion that ends up at CHEO because of preventable tooth decay. Certainly, the Canadian Paediatric Society has been very supportive of a national dental care program that would ensure access for all kids, regardless of income, to dental care.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Munter.

Dr. Drake.

[Dr. James Drake]

Pediatric dental care is a high volume at SickKids, but we tend to see only the most complicated patients who require specific care. Much more dental surgery is actually done in the community, so I think we see a small subset of those patients.

We couldn't agree with you more that it's a really important issue, and particularly in northern communities, I think it's even more of a problem.

We're very aware of this, and we support what other methods could improve dental care for children because, as you've mentioned, it affects so many things in terms of their overall health.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Squires.

[Bruce Squires]

Thank you. Like my colleague, I haven't yet obtained that doctorate, but thank you for the faith.

The answer clearly is yes. It's just one example of the interconnectedness of the environment and all of the pieces of the health care system, but also the social community and family system in which children live.

The fact is that we can't focus on any one single piece to address the health of children. We need to really get at their mental health and their physical health, which includes dental health as well as, of course, their orthopaedic development. We need to get at their social and spiritual development, so often influenced by schools but also by their community interactions.

I point back to.... That's why we call for a child health strategy because it needs to look at it in toto, holistically, and ensure that we don't just target a single piece. Targeting dental care will make a difference, but that won't be sufficient. We need to look at home care, etc.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Squires and Mr. Davies.

Next we have Mr. Lake, please, for five minutes.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Thank you to all of the witnesses.

I'm struck, actually. As many of you would know, I have a son with autism. He's 26 now, but he was nine when I was elected. I've had the chance to work with almost all of your organizations pretty significantly. Alex, I've toured many times at CHEO.

I will say that as a parent of someone who's very vulnerable, we spent a lot of time in the emergency room in Edmonton because there was really nowhere else to take Jaden, a non-verbal child who couldn't explain what he was going through at times. As I'm listening to the conversation, I'm struck by how that would be also reflective of the challenges of many kids generally, who are too young or are not at that communication level to be able to explain what's going on. The importance of what we're talking about today really dawns on me even more than usual. Thank you for the work that you do.

I'm going to dive into a specific area of spending. This won't be a surprise to others on the committee. We're a country right now that's spending more money than we've ever spent by far, yet we're talking about these crisis areas of spending right here. I'm going to zero in on children's mental health specifically.

We talked a bit about this at the last committee meeting. On mental health, I believe we're 31st out of 38 countries in the UNICEF report. We have a situation where in the last election campaign one of the few things we agreed on as parties was that we need to invest more in mental health. All parties had significant platform commitments on that.

The party that won and that is now working with the NDP—the Liberals and the NDP—had a promise for a Canada mental health transfer that was to have delivered $225 million in fiscal year 2020-21 and another $650 million in this fiscal year. That's $875 million that was promised to be delivered by now to the provinces through a Canada mental health transfer. It's a total of $4.5 billion and we're supposed to be heading into year three of that funding, but we haven't seen a single dollar so far.

One of the witnesses the other day mentioned this and there seemed to be a little bit of debate whether 25% dedicated to children's mental health was enough or whether it should be more than 25%. The 25% that would have been delivered by now would be over $200 million spread amongst the provinces.

How much difference would it have made over the last year, heading into two years, if we had an injection of $200 million across the country on children's mental health alone?

I'll throw it out to anyone who wants to take it. Maybe I'll go to Bruce first, then Alex and then anyone else who wants to weigh in.

[Bruce Squires]

Thanks, Mr. Lake, for sharing your experience with your son. I know that all of us empathize with the challenges that presents.

Again, not surprisingly, the short answer is it would have made a significant difference. I want to be clear that what we do now, as Alex so eloquently described, will often play out as a difference five, 10, 15, 20 and 30 years into the future because we're talking about the trajectory for kids.

The services and the interventions that become possible when we focus additional resources on child and youth mental health, be they community resources, supports to primary care, school services or what we provide in the specialized children's hospitals for kids who are, in many cases, really at the crisis point where they require intensive treatment.... In all of those cases, additional funding at this point would have allowed more access to diagnosis and to treatment for children and youth now.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

It's fair to say, as we move to Alex, that a $200-million investment over this last period would have yielded generations of benefit in terms of reduced cost.

[Alex Munter]

Yes, it is fair to say that.

Anybody who knows me knows that I can certainly talk to you about how to spend $200 million or more.

One of every four children or youth, more typically youth, who end up in CHEO's emergency department in a mental health crisis has been there in the last six months. They come back. That is an indicator of an inability to access community-based mental health services.

For example, here locally, we've created something called 1Call1Click that brings together all 24 child and youth mental health and addictions organizations, including CHEO. There's one way in. All referrals from schools, starting two weeks ago, come in through 1Call1Click. We have nurses in schools. It's a central intake and it's a case coordination service. We think of it as catch and hold, so that as kids come into the system, they don't get dropped in the transitions between levels of care and different organizations.

That program exists because of the Royal Bank of Canada. It does not exist because of support from government. We have been able to stand that up thanks to philanthropy. We were able to convince RBC to commit to multiple years of funding.

We are not able to expand it to reach it's full potential without support from government. At the risk of generating more questions from Monsieur Garon about this, I would say that notional $200 million, whether the carve-out is 25% or more for child and youth mental health, I would want it to leave the Government of Canada, headed out in our case, Ontario, with some kind of reporting back so that you would be able to see that, in fact, 1Call1Click, if that's one of the places it ended up, was where it did end up. It did actually make a difference in terms of improving access and care for kids who need mental health services.

I'm still thinking about the fact that Jaden is 26, because in my mind he's 11. That's quite something.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Munter.

We'll have Mr. Jowhari, please, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair. Thank you to all of our witnesses.

I was going to take a different line of questioning. I'm going to continue on the path of mental health. As the founder of the all-party mental health caucus in Ottawa and someone who has personally dealt with mental health issues, I feel obligated to continue on that path.

Mr. Munter, in your remarks you said that despite some of the significant historical investments that were made by the federal government.... Specifically in 2017, a commitment of $5 billion was made, while a commitment of $600 million per year continues until 2027. About $128 million of that, I believe, is going to Ontario. That's aside from the $4.7-billion commitment that was made.

What measures should have been in place for us to be able to see the impact of that money? As you indicated, the investment was made, and we haven't seen the result. I'm really glad that you're supporting putting measures in place. Naturally, measures come with the ability to measure the right data at the right time and report it.

Perhaps you could shed some light on where you think that money went. How should that have been measured so we could see the result today?

[Alex Munter]

To be clear, I would also support the Government of Ontario's call for 35% of health care expenditures to be covered through the federal transfer.

If you think back to 2004-05, for example, the funding agreement that was put in place at that time was really focused on access to surgery, access to diagnostics, and had some very specific measures of access—those can be throughput; those can be wait times.

To Dr. Drake's point, if we get better at outcomes, measures.... Certainly in the child and youth mental health space and developmental space, we do track functional outcomes. Any combination of those I think would be effective ways to show value for money and to show impact—

[Majid Jowhari, Liberal, Richmond Hill, ON]

Would the concept of a strategic, need-based funding based on measures be something that would resonate with you?

[Alex Munter]

I'm not entirely sure what that looks like, but if what it produces at the end—

[Majid Jowhari, Liberal, Richmond Hill, ON]

What would it look like to you?

[Alex Munter]

I'm going to go back to the hospital after this, right? For me, it's all about being able to find staff, hire staff for stand-up programs and cut wait times. For me, very practically, very tangibly, it's about improving my ability to do that. It's about not having to rely on philanthropy for essential programs.

However we measure that and assess that in the context we're talking about, which is mostly access, the way to measure it in a really tangible way is measures of access which, fundamentally, are throughput and wait times.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Measures of access could be access to doctors, access to beds, access to surgeries and access to a group of proactive services. Is that correct?

[Alex Munter]

That's correct.

For mental health services, as we've talked about in Ontario, it's a 30-day guarantee that, if a child or youth needs access to mental health counselling where they shouldn't be in a hospital, ideally, but in a community-based mental health agency, they can access that within 30 days.

[Majid Jowhari, Liberal, Richmond Hill, ON]

I definitely support the community-based mental health approach. I have been advocating for that for a long time.

I have about 30 seconds left.

Who is collecting that data? I know hospitals, and you are here talking specifically about CHEO and saying we have all these numbers.

How do these numbers get to the federal government to be able to put the measures in? Would it be the hospitals or would it be the provinces that have to collect and collate this data and pass it on? We could put something need-based as well as a very measured focus on the funding that we transfer.

Thank you.

[The Chair, Liberal, Sean Casey]

Give a brief response, please.

[Alex Munter]

Mr. Chair, this is a challenging environment. I get these sweeping questions with 20 seconds to answer.

I think the Canadian Institute for Health Information is a receptor of data certainly around throughput and access from hospitals. There are some data gaps, but there is, substantially at the provincial level, the kind of data to be able to report on these matters.

[The Chair, Liberal, Sean Casey]

Thank you.

Mr. Garon, you have the floor for two and a half minutes.