Health Committee on Nov. 3rd, 2022

[The Vice-Chair, Conservative, Stephen Ellis]

Good morning, everyone. I call this meeting to order.

Unfortunately, Mr. Casey could not be here today for personal reasons, so there's a new sheriff in town.

Welcome to meeting number 41 of the House of Commons Standing Committee on Health. Today we'll meet for two hours with witnesses on our study of children's health. Today's meeting is taking place in a hybrid format, pursuant to the House order of June 23, 2022.

I would like to make a few comments for the benefit of the witnesses and members.

Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mike. Please mute yourself when you are not speaking. For interpretation for those on Zoom, you have the choice at the bottom of your screen of floor, English or French. For those in the room, you can use the earpiece and select the desired channel.

All comments should be addressed through the chair. Additionally, screenshots and taking photos of your screen are not permitted. The proceedings will be made available via the House of Commons website. In accordance with our routine motion, I am informing the committee that all witnesses have completed the required connection tests in advance of the meeting.

Before I begin, I would like to advise members that the topic of today's meeting is childhood mental health. Some of the discussions may be difficult for viewers, members or staff. If you feel distressed or if you need help, please consult the clerk for information on supports available through the House administration.

There is one other housekeeping item before we get going. Just so you know, I will hold up a one-minute sign when you have one minute left. It will help keep us on track a little bit. Hopefully, it will be helpful and we can avoid cutting people off mid-sentence.

That being said, I will now welcome the witnesses who are with us via video conference this morning. Dr. Tyler Black is a clinical assistant professor at the University of British Columbia, and Ms. Wendy Digout is a psychologist.

Thank you for taking the time to appear today. You both have up to five minutes for your opening statement.

Dr. Black, I would invite you to begin. You now have the floor for five minutes.

[Dr. Tyler R. Black, Clinical Assistant Professor, University of British Columbia, As an Individual]

I thank the chair and the members of the committee for the honour of the invitation and this opportunity.

As an introduction, I'm a clinical assistant professor and subspecialist child and adolescent psychiatrist. I've been in practice for 14 years. I was a medical director for a major psychiatric emergency unit at B.C. Children's Hospital for over 10 years. You've already met my colleague, Dr. Quynh Doan, an emergency physician with whom I co-created the HEARTSMAP, a psychosocial screening tool for youth. I'm also the creator of the ASARI, a leading practice tool for the completion of suicide risk documentation.

I'm passionate about teaching, suicidology and mental health research, but most of all, I'm extremely committed to the health and well-being of the over 10,000 child and adolescent patients who I've seen in emergency settings and the children and adolescents who I'll never get a chance to see.

Though my opening statement will not focus on these, I have submitted a briefing note for your consideration. Instead of drowning this committee with more wordy words, I've chosen to deliver graphs that demonstrate important data-driven perspectives that I consider to be crucial and neglected knowledge. I've also included five graphs to demonstrate the complexity of the data we are seeing in Canada for youth with mental health changes since the pandemic.

As a quick aside, I never imagined that my experience in suicidology would lead me to be mired in political battles, but during the pandemic my advocacy has led me to correctly cautioning against the proclamations of increasing rates of suicide due to the pandemic. In fact, they have decreased. I have been in public responding to the horrific use of children's mental health and suicide by politicians and non-mental health experts to justify resisting protections against a pandemic that has killed millions and has created over 10 million orphans worldwide.

I have published and will publish more data that challenges the dominant moral panic narrative that there have only been mental health deteriorations in youth. Some youth have thrived and we need to understand why that is.

To the larger issue of mental health, my clinical work involves assessing children in the emergency department for mental health complaints and consulting with colleagues across B.C. The impacts of lack of service are readily apparent to me. A significant percentage of my patients and their families are wait-listed for mental health services at the moment that I'm seeing them, leaving me with only the daunting option of calling to advocate for expediency or telling these suffering youth to keep waiting. Children who present to mental health teams across Canada are rejected for service due to exclusion criteria or put on tremendous wait-lists because it's not severe enough only later to present to me with a suicide attempt after months of unaddressed suffering.

I deal disproportionately with youth in government custodial care or indigenous youth in Canada, knowing full well that the systemic barriers, racism and colonization are the reason that I see this disproportionate amount. The moral injury I suffer on a regular basis is incredible. I'm just glad to be the type of person who works hard to do my best during adversity because if I ever were to stop and just survey the bleakness of some of the things that I see, it might just crush me.

There are many things I think the federal government could do to improve mental health care and outcomes for children, and a non-comprehensive list would include improving the social determinants of health, like poverty, abuse, education and systemic barriers; ensuring the highest quality of care to children who are minoritized, underprivileged or living in remote areas; providing cost-free access for families to pharmaceuticals and therapies; eliminating exclusion criteria from youth services, which only further systemic discrimination; ensuring federal support for youth with disabilities for all neurodiversities; ensuring federal standards for early access and timely access to care; providing money to provinces with agreement to create treatment centres with day treatment, “step up step down” and neurodiversity focuses; creating standards for school safety; and establishing science-supported ways to make school less stressful for children.

Psychiatrists are trained in a bio-psychosocial model, and from day one we're taught the importance of the social determinants of health. Frustratingly, I have few ways to prescribe or modify the social determinants of health to provide programs that would deliver services to youth who need them or to affect on a large scale the effects of colonization on indigenous youth, but the government does have those powers.

On behalf of the children I work with and the families and caregivers who love them, for all the youth I don't get a chance to see, I'm so grateful this committee is tackling this issue and I really hope that serious and substantive change will come from the fruit of these labours.

Thank you.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Dr. Black. I appreciate that.

I now invite Ms. Digout to begin.

You now have the floor for five minutes.

[Wendy Digout, Psychologist, As an Individual]

Good morning, and thank you for inviting me to speak to you.

My name is Wendy Digout, and I am a psychologist based out of Antigonish. I work in my own private practice in rural Nova Scotia, and I am also an associate with Hexagon Psychology.

Working in private practice, but also having past experience working in both school systems and mental health hospital settings, provides me with a unique perspective around children's mental health. However, trying to synthesize my thoughts on children's mental health into five minutes has been daunting.

The most obvious themes, however, when I think about children's mental health in Canada is around the gaps in service and ensuring that we keep in mind that in looking at children's mental health, we are also looking at families.

Accessibility, we all know, is a huge issue. Wait times in Nova Scotia are very significant. According to the Nova Scotia Health wait times website, 50% of all non-urgent child and youth mental health referrals can wait up to 77 days from referral to first actual treatment—that's actually the average for 50%, and there are many others that creep into several months.

If they're lucky enough to have financial resources and they either can pay per visit or have health insurance, many folks will look at private practice therapists as an option. However, thanks to the Association of Psychologists of Nova Scotia and the data they gathered in 2021, we know that even the wait-lists for private therapists are growing just as much. For the private practice psychologists in Nova Scotia who keep a wait-list, almost half have a wait-list of two to five months, and a further 35% have a wait-list of six months to a year. This is in the private system.

Living in rural areas, there are also functional issues regarding accessibility. Our local district health authority covers a large area from Cape Breton to Antigonish. Our regional hospital covers four counties. Some people have to drive for up to an hour or an hour and a half to get to the regional hospital for mental health services. That means a day off work, having to get child care for your other kids and gas money, which is substantive these days.

Although virtual services have been very helpful in allowing access during COVID-19, we still have issues of cross-jurisdictional practices between provinces, so this can cause accessibility issues. If you have access to a nationally based EAP program or to a private practice like Hexagon Psychology, you can only work with the people who are registered in your province. Nationally based referral programs are becoming more and more common in the last few years, so I think looking at cross-jurisdictional access is going to be more and more important.

In addition, many rural communities do not have consistent access to cell service or high-speed Internet. For example, people 10 minutes away from our university do not have access to cell service, and many do not have access to high-speed Internet. This makes virtual appointments not an option.

There are many other issues that I'd like to talk about, but I don't have time: the need for culturally responsive and appropriate services; the gaps in in-patient services for children; the gaps, in general, for children aged 16 to 19; issues of food scarcity, homelessness, unsafe homes and underserved populations; and the effects of COVID-19.

I want to spend my last minute or so talking about some potential solutions. I feel that we really need a collaborative approach that allows for the integration of services, where family doctors, therapists, psychiatrists, OTs, nutritionists and other specialists can work together to support families.

We also need to create, I think, a community-based case manager approach. We need someone who gets to know the family as a unit and their needs and can help them navigate through the system. We have some good examples like our cancer care navigators and the SchoolsPlus models in schools.

I think we also need to look at bringing regulated private practice professionals into a billing program such as the MSI billing program for doctors, and we need to look at cross-jurisdictional practice services.

In summary, I would like to ask that this committee continue to be creative in seeking a framework that can create equitable, accessible and timely mental health care for children and youth and their families in Canada that allows for enough flexibility that the strengths of communities can be utilized and areas of need can be addressed.

Please remember that when we're dealing with kids, we're dealing with families, so this really is a family and community issue.

Thank you.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Ms. Digout.

Both of our witnesses were bang on the time. Thank you very much for that.

We'll now start our round of questioning. Each party will have six minutes in the first round. We'll begin with the Conservative Party.

Ms. Goodridge, the floor is yours for six minutes.

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

Thank you, Dr. Ellis.

Thank you to both witnesses. I want to start by thanking you guys for the work you do to provide assistance to kids and families in our country. It's spectacular.

Ms. Digout, one of the things you said, especially right at the end, was about how this really impacts the entire family. It goes beyond the child. I could really relate to some of what you were talking about, being someone that represents the riding of Fort McMurray—Cold Lake, a rural riding that has a few more challenges that are probably very similar to your own. In many cases, people have to drive long hours to get specialized care, and we don't always have Internet capacity to have even some of the digital options available.

What could you add to that? Do you have any solutions? Perhaps you could expand a bit on that.

[Wendy Digout]

Thank you for the question.

It's interesting when you talk about Fort McMurray, because I think we have several families that go back and forth between our communities, so there's a whole other family issue of one parent often working away.

Locally, our Nova Scotia government has been working hard to try to make sure there is access to Internet services. It's just not happening fast enough. I think that during COVID we saw the impact of that in terms of disparity and what people were able to access for school.

Even with the cell service, I think there are attempts, but I'm not sure how much that has been happening for the pockets in the areas around us that don't have it. I think it needs to become an initiative from the government. Just from a safety point of view, families need access to Wi-Fi and to cell service these days.

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

You touched on the fact that there are long wait-lists. Even private providers are having exceptionally long wait-lists. How does it impact children when they do not get the care in a timely manner?

[Wendy Digout]

I think they end up seeing someone like Dr. Black.

If we can catch the issues early enough, both within the family and for the child specifically, because they don't live in a silo, so the parents and family also need support.... When we don't have access to services for our children, they do end up in crisis. They end up self-harming. They end up with maybe more intensive eating disorders. Something that may have started as a bit of emotional eating can turn into a full eating disorder. They end up being suicidal, and they end up in our ERs. The ERs don't know where to put them because there are so many wait-lists to try to get them in to see people.

I think Dr. Black's work is really important for that.

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

That's fantastic. I guess I will open this up to either of you. I am the shadow minister for addictions, and I know that anecdotally we've been seeing more kids presenting with addiction issues at younger ages. I'm just wondering if you guys can touch upon that and if you have any possible solutions.

[Dr. Tyler R. Black]

Thank you for the question. I'll start.

Contrary to that sort of feeling, we're not seeing increases in youth addiction. In fact, kids are using less substances over time. It has been going down. When you do a survey of kids, the number of kids who use certain substances goes down by about 2% to 3% per year. Of course, during the pandemic, we had this counter-thing because of the toxicity of the drug supply, where some drug overdoses increased. Mostly, youth were spared from that, but obviously for those 20-plus it hit quite hard.

The substance use issue is always one of access. Whenever I have a child who has a substance use issue, there are very few places that do co-occurring work. If you have suicidality and you have an addiction, many places will say they can't help you because you're suicidal. If you have addictions and you become suicidal, you're removed from the program. We need a lot more of what we call “concurrent disorders” care, because, of course, addictions, mental health issues and physical issues all work together.

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

I think that you highlight an important piece. We have a spectacular facility in Alberta, CASA House, that treats children who have concurrent issues. I was lucky enough, as the MLA for my riding, to get to help a couple of little kiddos get down to CASA House to get the help they needed.

However, it became evident that we don't have enough of these facilities and enough of these people. Do you think there is an issue in terms of the number of people working in this field being able to address the issue at hand?

[Dr. Tyler R. Black]

We have lots of dedicated and hard-working people, and I think it would be fair to say that we need more.

I work in a tertiary hospital where there are a certain number of hospital beds, but there's a group of children who aren't sick enough to require full hospitalization. They are really struggling, such that it's hard to get their day-to-day work done. Programs like day treatment models, outpatient facilities, home-based care, for these kids who are in the middle—these families dealing with escalating crises—that's where there's a huge lack of services and beds.

Of course, we also need more hospitals.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you, Dr. Black. We'll stop there. I appreciate that.

Now we'll turn to Dr. Powlowski.

Dr. Powlowski, you have the floor for six minutes.

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

Following up on Laila's question, I'm going to ask a somewhat similar question.

Dr. Black, you talked about what to do with children who have both mental health issues and were suicidal. Somewhere in there was also addictions, because you were responding to the problem of addictions. As I think you know, a lot of overdoses in youth are by people who don't necessarily have mental health problems.

We're studying children's health. I have a lot of kids, but I have a 12-year-old and a 14-year-old, and I think for most of us who have teenage children, one of our biggest fears in terms of their health is that they're going to overdose.

It's not that my kids seem likely to do it. However, when you're a teenager these days and drinking in a place like Thunder Bay, which I hear—I don't know if it's true—has a higher per capita rate of overdose deaths than Vancouver even, there's certainly a concern that at some party they're going to do something. All it takes is one time. The stuff they're doing is laced with fentanyl, and that's it.

What can both of you tell us as to what parents, teachers, schools or governments can do in order to address this problem to try to prevent overdoses amongst youth?

[Wendy Digout]

I'll go ahead.

I think it goes back to early access. When it comes to drug use with teens, they're getting education within the school, but I don't think they often hear it. I think they need more real-life experience type of learning and hearing from people who have experience.

When children are starting to dabble, whether its marijuana or whatever, sometimes somebody puts something in what they're taking and that ends up in an overdose. We need to be able to have open conversations with them about using marijuana, and in a non-judgmental way so that they can have open conversations.

We have a woman out of Dartmouth here in Nova Scotia, who several years ago lost her daughter. It was her daughter's firs time ever taking a pill at a party, and she died. She didn't wake up the next morning.

She is doing a lot of advocacy work. Her name is Dale Jollota, and she's done lots of advocacy work in schools and with government. I'm more than willing to pass on her information, if that would be helpful for folks.

[Dr. Tyler R. Black]

I think when we're working with children, especially in the teenaged years, we often have to recognize how important it is at that stage of their life to figure out who they are, what they're doing and to have autonomy and responsibility. That means, as a parent, when you have those worries, you're making sure that your children have the information and the access, so that if they ever are in trouble, the people they call are the people who love them the most.

I encourage families and systems to work in models that are non-judgmental, that use the evidence base of harm reduction, and also to work with children at the stage they are in. A 14-year-old can't be told what to do, but they can be guided on what to do. If you're non-judgmental with your children, you approach them with a caring compassion that says wherever you are, whoever you are, I'm here for you if you need me, then if they ever get in a situation where they're in trouble, you've opened a door that they can come to.

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

I think that's good advice.

This is mostly to Dr. Black. I know you work in Vancouver. I'm sure there's probably a fairly large indigenous population as well as people who are from more outlying communities coming to Vancouver. I wonder if you could comment—and perhaps both of you may have some comment on this—on the success or lack of success of the western psychiatric system in dealing with either mental health issues or substance abuse within the indigenous community.

I'm on another committee, which is INAN. Certainly in that committee, we had a bunch of witnesses from the indigenous community asking for more funding for non-insured health benefits to allow people who were more indigenous healers, for example, to be part of the process, perhaps, along with people in the western psychiatric system.

Do you have any comments on that?

[Dr. Tyler R. Black]

Absolutely.

I think that psychiatry and medicine and, generally, colonizing society has to come to grips with the fact that there's been significant trauma and mistreatment delivered to indigenous families on the basis of care. Indigenous families need a voice at the table. It's really important in any treatment facility to have indigenous representation in the design, in the feedback and when working with indigenous families, to make sure they have access to important cultural care. Systems need to be set up for indigenous care.

The situations I get in the emergency department are often big-time crises. When they happen, we invoke things such as the Mental Health Act. We invoke things such as section 28, under which the RCMP bring children in, so—

[The Vice-Chair, Conservative, Stephen Ellis]

Dr. Black, I'll stop you there.

Thank you very much, sir. I appreciate that.

Next up is Mr. Champoux.

Welcome to the Standing Committee on Health, Mr. Champoux. You have the floor for six minutes.

[Martin Champoux, Bloc, Drummond, QC]

Thank you, Mr. Chair.

It is my turn to thank the witnesses who are with us today.

Dr. Black, I understood just now that you said we had not necessarily observed an increase in drug use among young people.

Did I understand your statement correctly?

[Dr. Tyler R. Black]

If we're referring to the percentage of children who use substances, that number has been steadily coming down for years.

[Martin Champoux, Bloc, Drummond, QC]

Right.

Let's talk about teenagers in general, for example. My colleague Mr. Powlowski was just talking about his teenagers, and I have some of them at home too. We know that teenagers, by nature, are tempted to do all sorts of experimenting. We have all gone through that.

Dr. Black and Ms. Digout, have you observed, in your own practices, any change or increase in drug use among adolescent clients since marijuana was legalized in Canada and certain substances have been somewhat de‑demonized?

Have you observed that more young people are turning to those products rather than alcohol, which might have been more easily accessible at the time, whereas now it's easier to get hold of marijuana?

[Dr. Tyler R. Black]

Marijuana remains inaccessible to children, even under legalization, but of course, children, since the dawn of marijuana, have had access to marijuana through other routes. The statistics we're starting to get—and, of course, legalization is a recent phenomenon—suggest that we have a continuation of fewer and fewer kids using marijuana.

[Martin Champoux, Bloc, Drummond, QC]

Mr. Chair, I am told that the French interpretation is not working at the moment.

Okay. It's back.