Health Committee on Feb. 9th, 2023

[Dr. Tracie Afifi]

Yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'll go to the Canadian Counselling and Psychotherapy Association.

What portion of overall health care spending is currently allocated to children's mental health services in Canada? Maybe can you give us a general idea of how we compare to similar jurisdictions in the world.

[Lindsey Thomson]

That is a very good question that I did not prepare for today, so I will get back to you in writing.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay, thank you.

According to CIHI, more than one quarter of children and youth hospitalized for mental health conditions lived in the least affluent neighbourhoods in 2020.

I wonder if there is a link between poverty and poor mental health among children and youth.

[Carrie Foster]

In the research that I've read over the years, yes. Definitely immigrant populations, racially diverse or any of the cultures that aren't necessarily at a high economic standard.... Poor neighbourhoods tend to increase that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Again according to CIHI, rates of mood and anxiety medication use by children and youth were twice as high for females than males in 2020.

I wonder if you can tell us a little bit more about perhaps some gender differences in mental health among children.

[Carrie Foster]

It's interesting because also, statistically, when they reach adolescence, boys are more likely to have a higher rate of suicide, especially in Quebec.

I think it's just perhaps how we socialize our girls and how we socialize our boys—the boys to be strong and the girls perhaps to.... There's a higher availability of sensitivity, perhaps, that we find. That's how we socialize. That's work that I certainly do in my practice with regard to self-esteem, here and in the other countries I've worked in.

[Don Davies, NDP, Vancouver Kingsway, BC]

We've talked a lot about upstream interventions. I think that is self-evident and that probably everybody in this committee would understand and agree with that.

Can you give us an example of a concrete, pragmatic, practical upstream intervention that you would recommend the federal government champion to start actually making that concept real?

[Lindsey Thomson]

Just let me confer for a second.

Can you verify what you mean by “upstream”?

[Don Davies, NDP, Vancouver Kingsway, BC]

I mean more preventative or early intervention. Is there a way to get better assessment and treatment among children, let's say in our primary schools?

If we want upstream interventions to reduce the rate of hospitalizations and kind of get to it early, how do we make that real? What do we do?

[Carrie Foster]

In this country, we have a heavy emphasis on diagnosis, as opposed to just assessment and evaluation. Counsellors and psychotherapists are able to assess. If we brought in that ability....

Guidance counsellors are also a part of the CCPA system. Perhaps if we can broaden that, then we won't have to wait for one psychologist per school board to make it to all the different schools. I think that would be one way of getting early diagnoses earlier on.

Clients call me looking for help for their children who have ADHD. For me, it's whether they need actual special input in the school and special parameters put around their learning and their learning difficulties so that they can achieve or is it that they just want to work on some of the psychotherapeutic things and need the counselling aspect. They can't see me for the diagnosis, but they can see me for the betterment and for the mental health care.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Foster and Mr. Davies.

[Lindsey Thomson]

I have one point, if I may add to that.

I would just further Carrie's point about absolutely increasing the availability of psychotherapists within the schools.

I have had the opportunity to do my bachelor's in education and actually be in schools. I learned that, as Carrie mentioned, there are guidance counsellors available, but often—at least in the context of my experience in Toronto—you'll have one guidance counsellor for five schools. If you have 500 to 1,000 children per school, how much one-on-one time are they actually getting? It's not just doing career counselling and seeing how their grades are, but seeing how they are actually doing in terms of their mental health. That's one piece.

The other piece I see, which would bring us in a whole different—

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Thomson. We want to try to make sure that everyone gets a chance here, and we're well past time. You'll get a chance to come back to it, I'm sure.

Mrs. Goodridge, you have five minutes, please.

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

Thank you, Mr. Chair.

Thank you to all the witnesses. As has been the case in many of our panels, we have a variety of different witnesses with very different specializations. That makes it really difficult to try to figure out which angle we're going to go with this.

I think this is part of the struggle with this very vast study we have on children's health. Children are a large demographic in our country, and yet we're just studying children's health, which can be everything from autism to mental health to access to care and everything in between. I think it makes it very difficult for us as parliamentarians to figure out exactly how we're going to take this...because it's all important.

I'll start with you, Dr. Georgiades. I was reading the study that you produced in 2021 on screen use and mental health symptoms in children and youth. I thought that was extremely poignant. I'm just wondering if you could expand on that a little bit.

[Dr. Stelios Georgiades]

I want to start with your comment about how broad child health is and how challenging it is to come up with an action plan that may also attach to screen use and mental health, especially during the pandemic. I agree with that. I've been in Canada for 27 years. I have to say that, in my opinion, I have never seen a study like the one being undertaken by your committee right now. You have experts and witnesses who testify, but your committee and your teams now have information and testimony that can certainly guide us on the way forward. Even though it's broad and challenging, I am very encouraged by the work of this committee and the opportunities that may come out of this study.

In terms of screen use and mental health, that is not my expertise. That study was actually co-led by another Dr. Georgiades at McMaster, Dr. Kathy Georgiades.

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

My apologies. I will skip past that, then. I clearly did not prepare as well as I should have.

To go back a bit, you definitely are a specialist in autism. One thing we've heard very clearly is that early diagnosis is important. What are you guys seeing in terms of backlogs, especially in terms of COVID and how that has impacted being able to diagnose children earlier?

[Dr. Stelios Georgiades]

Autism is a great example of children with multi-faceted needs. We know, based on several studies, that early diagnosis and earlier access to intervention can certainly lead to improved and more optimal outcomes.

There is no doubt that the pandemic has limited the rate of diagnosis across our country, and the rate of diagnosis was already slow before the pandemic. I think some of your other witnesses talked about many of the issues being there prior to the pandemic and being exacerbated because of the pandemic.

At the same time, I will say that autism is also a positive example. It is one area in our country where I have personally experienced what collaboration and unity across scientists, clinicians, stakeholders, families and also politicians and policy-makers can do. There's a backlog. There's no doubt about that. But we are in the process of working with many stakeholders across Canada on developing a national autism strategy that will use innovative, effective and efficient ways to clear the backlog in the years to come.

That's an example of both a challenge and an opportunity in terms of what collaboration across jurisdictions, across political parties and across specializations can actually achieve.

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

Thank you.

I don't want to interrupt, but I think I have about a minute left.

No? All right.

[The Chair, Liberal, Sean Casey]

No, you had five, and that's five.

Thank you very much, Mrs. Goodridge.

Next we're going to Ms. Sidhu, please, for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

I want to express my condolences to the families and friends of those affected by yesterday's tragedy in Laval.

My first question is for Dr. Afifi and Ms. Thomson.

You talked about how for five schools, there's one guidance counsellor. What role can schools play? How can early childhood education programs be designed to help support healthy development and resiliency in children?

[Lindsey Thomson]

For that, I'll say I'm not an expert, so I'll be going based on the research that I've read and my experience in thinking about working with children from a mental health perspective.

The thing I can think of and that I've heard from our school counsellor educators through the CCPA is actually having part of the curriculum be learning about what it means to be human: how to be able to regulate our emotions; how to be able to communicate; how to be able to express anger, frustration in a healthy way. It's making some space for that type of education so we're not left until, “I realize I have an anxiety disorder. I don't know what I'm doing. I'm 30 years old and starting therapy for the first time trying to figure it out,” while also managing maybe a single-income household with two kids.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Dr. Afifi, do you want to add to that?

[Dr. Tracie Afifi]

Sure. I think it's to make it extremely concrete and simple. Early intervention is key. We can access children through schools early. That's really important. It's evidence-based. We need to make sure we're putting programs in schools. There are many out there, the good behaviour game, for example, where you can implement evidence-based practices in schools to improve the mental health of kids.

Early intervention, evidence-based and access to care: those are the things we need for all children. This is equal for every child who needs it. If we can prevent things from happening before they happen, then we're going to have better outcomes. Those are the things we need to do, and that's where data is involved. We have to make sure—

Also, to a previous question, how do we know we're making progress? How do we know we're improving things? It's data. Everything is based on evidence and data. If we don't collect the data, then we don't know if what we're doing works.

The recommendations I've made actually try to incorporate many of all the things we're talking about today: evidence, early access and more access to care.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

I understand there's a stigma in certain cultural communities. How can we reduce stigma and support a more open conversation about mental health? If you could both add on that point, and what do you think about integrated services as well?