Health Committee on Nov. 3rd, 2022

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you.

One of the other comments you made in your opening five minutes—and I know you were very limited there—was about culturally appropriate services, in contrast to the facility, which would be culturally appropriate as well if it were actually open and serving people.

I want to give it that credit, but there's another facility that is looking for some really small levels of funding. They would provide very culturally appropriate land-based treatment and, I would add, which you also mentioned, services that would include the whole family. I think it's absolutely central to us in solving the issue of mental health and wellness and addictions recovery that we include the whole family, yet an organization like that, which already has a facility and needs some really small investments, can't seem to get those investments.

I don't mean the question to be one about the negatives around the investment, but can you speak to how important that combination of culturally based, land-based and family-centred treatment would be in the context of mental health and addictions, please?

[Wendy Digout]

I think having the opportunity to provide clients different types of therapy—whether it is land-based, specific to their own culture or more western-based medicine—is really important, because sometimes people will surprise you.

When you make the mental health treatment about the one child, what happens is they become.... Everything seems to be around what they're doing wrong, instead of setting up what's happening within the family. Sometimes we can do that family work better when we're outside of the therapy room, doing home visits, doing something constructive and looking at the ways the family interacts and communicates with one another.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Dr. Black, do you want to comment on that as well?

I have 30 seconds left, so I'm not going to start another question.

[Dr. Tyler R. Black]

I'll try to be brief then.

Any time we have an opportunity to listen to indigenous voices and develop programs that work for indigenous people, we should embrace it. We should fund it. This would be an anti-colonial approach of centring power in indigenous hands. I would be in support of it.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you, Dr. Black.

Thank you, Mr. Vidal.

Mr. Jowhari, you now have the floor for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Thank you to the witnesses for your testimony and for your hard work on and advocacy of mental health, specifically children and mental health.

Dr. Black, I'll start with you. In your opening remarks you talked about federal standards for early care as one of your recommendations. Madam Digout also talked about early access. I would like to open up the conversation and the line of questioning to your recommendation of federal standards. How can we collaborate with the provinces to ensure that those standards are not only implemented, but measured and reported?

If you could demystify what those federal standards should be and give us some recommendations for collaboration, I would really appreciate it.

[Dr. Tyler R. Black]

It's probably well known that, politically, wait times are a thing. The publishing of surgical wait times and ER wait times is something that has a tremendous amount of political power. This generates ideas to improve the situation from all members of politics.

In the same way, I think there could be standards that would really.... When a child is in trouble, how long should it take for them to see a mental health professional? That's an example. The publishing and the encouragement of shorter wait times is something that could be not only a national standard but something that is well known. It relies on advocacy groups to talk about it. In Ontario, I think about three years ago, they published that some kids were waiting more than two years for treatment. We need these standards.

They should be based on tiers of care. When things are early, it doesn't require a tertiary emergency psychiatrist like me. There are many professionals in many areas who have excellent training and all sorts of therapies, but when they need help, they should be able to access help. When that group needs help, they should have access all the way up to the tertiary services that are the rarest and most expensive.

Scaling these in a way that works with tiers of service would greatly reduce wait times. I spend time assessing children who don't need to see me. Establishing standards of how to access care in a timely way would be really helpful.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

Go ahead, Madam Digout.

[Wendy Digout]

I agree with the importance of a tiered system.

Some examples from when I was thinking of early access.... Sometimes early access means a child who is starting to get some anxiety going to school, so it's being able to learn what that is, how that feels in their belly when they can't go to school and then some coping strategies around it.

That's a fairly quick intervention if we catch it early. If you wait too long, that child will have full school refusal. They may start engaging in withdrawing and become depressed because of isolation and withdrawing. If we can catch some of those things early, we have some amazing early intervention programs for children with developmental disabilities.

Getting speech therapy early on is crucial when we look at outcomes from a behavioural point of view and academic success. It's ensuring that when we need it, we can get it and with the appropriate person. A kid starting to get anxiety and a sore belly going to school definitely does not need to see Dr. Black. They need to learn some coping strategies.

[Majid Jowhari, Liberal, Richmond Hill, ON]

What I'm hearing is that access to the right care, in the various steps and a structured point of view, could shorten the wait time, which is a standard we are trying to recommend or measure. The standard is a multi-dimensional thing.

I only have about 30 seconds and probably 15 seconds to each one of you.

I want to get your feedback around a concept of integrated youth services. In a direct way, both of you talked about social determinants of health, social services and mental health support. What are your thoughts on that and whether there should be direct funding from the federal government for it or not?

[Dr. Tyler R. Black]

We have a model in B.C. that accesses some federal funding called the Foundry. It's building integrated drop-in centres for youth that include health and wellness as well as mental health access. I think it could be a really good role for funding, yes.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you, Dr. Black.

Thank you, Mr. Jowhari.

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

[Martin Champoux, Bloc, Drummond, QC]

Thank you, Mr. Chair.

I have to take issue with the questions asked by my colleague Mr. Jowhari, who suggested that the federal government should attach standards to the funding provided to the provinces.

Dr. Black, you answered very honestly, I agree, but it is a good idea to recall that 50 years ago, the federal government funded 50% of the cost of the provinces' health care services. Now, it's 22%. The premiers of all of the provinces and of Quebec and the territories have been calling unanimously, for a long time, for the federal government to increase health transfers to 28%, then to 35% of the costs, to restore some balance.

Dr. Black and Ms. Digout, you know, as do I, that the provinces' problem in managing health care systems is underfunding by the federal government. It is a lack of money. All the standards that the federal government might require in connection with increasing health transfers are already included in Quebec's and the provinces' ideas.

So the answer is not very complicated. It is not to attach standards to an increase in health transfers or allow the federal government to involve itself as it might like in the administration of health care services in Quebec and in the provinces and territories. It is simply to send the money to the people who have always managed the health care systems.

I just wanted to point this out, because we all want shorter wait times in emergency rooms. We all want better and faster treatment for patients and people who have mental health problems, in particular, who are often perceived and judged negatively and misdiagnosed. We all want these things. We all hope to have a more effective social safety net. However, I don't think we get that through discussions or standards that the federal government might impose on the provinces and Quebec for sending money here and there as it sees fit.

I also wanted to tell you that I support and admire your work. It is essential, and you are doing it in horrible conditions, in my opinion. You should be getting much more support, and that is what I hope we take away from this meeting. The money has to be sent to the right place and managed by the right people, based on the priorities and the urgent needs and specific needs in each of the regions of Canada, which are not all the same from one end of the country to the other.

This may be the last time I have the opportunity to speak to you today, so I will congratulate you and thank you very much for being with us and for your essential work.

I hope we will be able to provide you with better support.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you, Mr. Champoux.

Now we'll turn to Mr. Davies for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Dr. Black.

Again, in the 2018 “Ask Me Anything” Q and A interview, you touched on the concept of misconceptions about suicide risk, and you touched on that here today.

Can you tell us what you think some of the key misconceptions about suicide risk are, and maybe on the flip side, what the key risk factors are?

[Dr. Tyler R. Black]

Sure.

Some of the big misconceptions that I deal with regularly are the close tying and connection of suicides to mental health. There's a myth out there that all people who die by suicide, or 90%—and many advocacy organizations still have this number—have mental health issues. The way that we know this is by a method called psychological autopsies. There are some challenges with that.

Whenever we do coroner reviews, and I've been a part of those.... If we look at the National Institutes of Health in the United States, we see that mental health is a factor in about 56% of suicides, so this close linking between suicides and mental health doesn't address all of the suicide concerns we have. Some people have suicides because of issues that aren't related to their mental health: physical health, disabilities, socio-economic determinants of health and those types of things.

Another myth about suicide that I always like to battle is this idea that when we talk, ask questions or screen for suicide, we're somehow introducing risk into people. In fact, talking openly about it and having—I see the sign—the ability to interact with people on a human level about suicide actually protects. We have good research showing that people benefit from that.

If we think about major risk factors, there is a laundry list, but I would like to posit that we have our mental health, our physical health, systemic racism and exclusion, and in youth, we have discrimination on the basis of gender and sexual minorities, which is a large factor.

[Don Davies, NDP, Vancouver Kingsway, BC]

Touching on that, my next question.... You'll probably have little time for much else.

For decades, mental health has been regarded as less critical to our overall health and physical health. Is it time, do you think, that we should add mental health treatment as an insured benefit under the Canada Health Act?

[The Vice-Chair, Conservative, Stephen Ellis]

Answer in two seconds or less, please.

[Dr. Tyler R. Black]

It's more than time.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Digout.

[Wendy Digout]

Once again, I concur.

[The Vice-Chair, Conservative, Stephen Ellis]

You guys are great. This is the easiest job ever.

Thank you very much, witnesses.

Thank you, Mr. Davies, as well.

Now we turn the floor to Ms. Goodridge.

You have five minutes.

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

Thank you, Mr. Chair.

Again, I want to thank the witnesses. Having two witnesses for a two-hour meeting is a lot to ask.

I mean no disrespect in this, but one of the issues that has been very top of mind for me.... I'm a young mom. Through the course of this study and through the course of the last few months, I have on numerous occasions brought up the real, serious concerns that have been brought to me by a lot of parents—moms and dads, regular people, grandparents all across the country—who are struggling to find children's pain medication. We're at a crisis level. We're at a space where it's on the shelves in the U.S. in abundance—you can even pick your flavour—but in Canada, you can't find it anywhere. This is especially troubling in rural, remote and isolated communities, such as the one that I live in, because we're a long ways away from a children's hospital if something does go bad.

With that, I'd like to move a motion:

That the committee hold a meeting on Tuesday, November 15, 2022, to discuss the ongoing shortages of children’s pain medications to include an hour with officials from the Department of Health and a second hour to include one witness from each political party represented on the committee.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much for that, Ms. Goodridge. I'll just confer with the clerk to ensure it's all in order.

Thank you for that, Mr. Clerk.

Certainly, even though we would normally require a significant 48 hours for a motion, this is definitely related to the topic at hand. Certainly, it's something that affects everybody here, so I find the motion to be in order.

I now open it to debate.

Mr. Vidal.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Not being a regular on this committee, I think it's important that we hear from the right people when we do things like this. I would like to suggest an amendment that we include the Minister of Health to appear during the first hour of this meeting on November 15.