Human Resources Committee on April 30th, 2009

[The Chair, Conservative, Dean Allison]

Pursuant to Standing Order 108(2), our study on the federal contribution to reducing poverty in Canada, I would like to offer a warm welcome to Mr. Kirby. We thank you very much for taking time out of your busy schedule to be here. The committee believes that mental health is not only a serious issue, but it's an issue that people don't know enough about. We appreciate your coming here in the context of our study on poverty to talk about it.

Mr. Kirby, I'm going to ask you to introduce the guests you brought with you, and then I understand you have a 10- to 15-minute presentation. You understand the way things work around here. We'll have some time for some questions, and we'll go around the room in that way.

Welcome, sir. The floor is yours. Do you want to introduce your colleagues, and then we'll get started?

[Michael Kirby, Chair, Mental Health Commission of Canada]

I will do that, Mr. Chairman. Thank you very much.

May I also say it is kind of neat that you asked someone who spent so many years in the other place to come and talk on this side of the building. So thank you very much.

I have with me today the three people who are directing the institute's main programs. Dr. Howard Chodos is responsible for the study on mental health strategy for Canada. Dr. Jayne Barker is the director of policy and research for the commission. Micheal Pietrus is both the director of communications and the director of the anti-stigma program.

I believe my opening statement has been circulated in both languages to people. I won't read it precisely; I will more or less talk to it.

I really am delighted that a committee of the House of Commons asked the commission to come and talk to it about the issue of mental illness in Canada, because not only is this an important issue, but it is very much a personal cause of mine. So I'm delighted to be able to take you through, in my opening statement, a very brief outline of the work of the commission, and then to turn it over and prepare to answer your questions on any mental-health-related issue you might have.

I think it's important to put the issue of mental illness in perspective. This year seven million Canadians will experience an episode of mental illness. That is one person in five, although I will tell you there are those in mental health, professional researchers, who actually think the number is moving fairly rapidly toward one in four as opposed to one in five. In other words, the percentage is increasing. We know that during the recession the incidence of mental illness among Canadians will increase significantly.

Many of these people, unfortunately, will not get any help. That's for two reasons. One is that nowhere in the country is there an adequate supply of mental health services. The second reason is that they're afraid to come forward because of the stigma associated with mental illness. Indeed one of the biggest barriers to people getting adequate treatment is stigma. Stigma and discrimination exact a huge toll on people with mental health problems. In fact, many of the people you talk to will tell you that the stigma and discrimination they face from family, friends, and co-workers is actually greater in terms of its impact on them than the symptoms of their illness itself. I want to emphasize that the stigma they face is not the stigma from the general public, which exists but they basically don't see; it's the stigma they face from people who are closest to them--from their family, friends, and co-workers.

In economic terms, mental illness costs the Canadian economy an estimated $33 billion a year. To put it in perspective, by the way, that's roughly half the Ontario budget. More strikingly, I think you'll be surprised to know that more hospital days are spent by people in hospital with a mental illness than by people with cancer or heart disease combined.

That number sounds almost unbelievable, so let me explain it to you. If someone has a mental illness that is severe enough that they have to be hospitalized, the impact of that is that they are usually in there for a considerable period of time, frequently months. Typically, someone in the hospital for heart disease or cancer is in for a much shorter time. But it helps to explain, when you look at mental illness increasing and the length of time someone with a mental illness is required to stay in hospital, why we're finding a shortage of hospital beds in the country.

If you talk to employers, you find that the most rapidly increasing part of health care costs to employers--that's short-term disability and drug costs--is due to mental illness. In fact, somewhere between 4% and 12% of payroll costs are now being spent on mental illness. The exact number varies, obviously, from employer to employer.

More interestingly, pharmaceuticals for depression and anxiety and other mood disorders have overtaken cardiovascular drugs. I think, for example, of Lipitor and other drugs like that, which have overtaken cardiovascular drugs as the principal or main drug being paid for by drug plans.

The Mental Health Commission begins with a very simple view, which is that someone with a mental illness deserves the same level of service as anybody being served anywhere else in the health care system. We're not saying that every person with a mental illness has to have the problem treated instantly, any more than anyone with a physical illness has to have it treated instantly. We know that's impossible. But what is happening is that the service accorded to people with a mental illness is very, very significantly worse than is accorded to people who have a physical illness.

As I think you know, the commission was created out of a report from the Standing Senate Committee on Social Affairs, Science and Technology, which I chaired. The report was entitled, Out of the Shadows at Last. We used the words “at last” very deliberately because of stigma. This issue has been in the shadows for far too long. Indeed, if you ask me in a sentence what is the real goal of the commission, it's to keep the issue of mental health out of the shadows forever; that is to say, to not let it slip back into the shadows.

We are structured legally as a not-for-profit corporation. We're not a service provider. We are a catalyst. We have a board that consists of 18 members. Twelve, including myself, are non-governmental members, which is to say representatives or individuals in the private sector across the country. Many of them are service providers. Three of them actually are people living with a mental illness, to ensure that we get the consumer perspective. The other third of our members are governmental members, one from the federal government and five from the provinces and territories.

We have the active support of all the provinces and territories except the Province of Quebec. With the Province of Quebec, in fact at their request, we've now set up a bilateral relationship. The issue there is that they view us as a federal institution, which we are not. I repeat, only one out of 18 board members is appointed by the federal government. They clumped themselves, if I could put it that way, in the intergovernmental constitutional context.

On the other hand, on the ground in the province of Quebec, in Montreal--and Jayne Barker can comment on this, if you want--we have the enthusiastic support of service providers to people needing mental health services and so on. Indeed, there are representatives of the government on the steering committee for our Montreal homeless project. So the reality is that while at the sort of very high level of constitutional niceties there is an argument from the Government of Quebec, on the ground, where it really counts, because our objective is to try to help people, we have very good support, even in Quebec.

We have eight advisory committees that are really designed to ensure that we have the best possible advice on a whole series of issues. To give you a couple of examples, we have children and youth, we have seniors, we have a family advisory committee, and a family caregivers advisory committee.

Let me say parenthetically, by the way, about the family issue, that the vast majority of mental health services in this country are actually provided free by family caregivers. What I mean by that is that the amount of work they have to do looking after someone at home with a mental illness is enormous, and it's all volunteered, because they are people doing it at home for their loved ones.

The need for respite care, for example, for people in those very stressful positions is an issue that no government has yet touched. We have one on the law and mental illness, because there are some very quirky things in the law, and we will be proposing some changes with respect to that. They largely affect the way in which police and others handle 911 calls related to a mental episode.

As an interesting aside, if you talk to the chief of police in any major city, you will find that on the order of 50% of their 911 calls are actually mental health calls. In that sense, in many ways our police officers are the ultimate front-line mental health workers in a time of crisis.

What is our objective? Our objective is really to offer people a sense of hope that the system can be changed and will be changed for their benefit, which really leads to the first issue, the one Dr. Chodos is working on, the mental health strategy for Canada.

We've done two things. We're doing it as a two-stage process. The first is to figure out where we really want to go. That is to say, if you could revise the system, what would it look like at the end point? To that end we've produced a document, and we have copies in English and French if people want them. It's a framework document. It's been widely consulted on. Howard and his team visited 13 cities across the country, and more than 1,300 Canadians responded to our online consultation, including many organizations, so the number is actually a lot bigger than that.

We are basically at the point of having a final version of the framework, which will have very strong support across the country from all interested parties--from governments, from individuals with a mental illness, from caregivers, from service providers, and so on.

The second step will be the more difficult one: if this is where we want to go and this is where we are today, how do we get from one place to the other? The reason that's the most difficult, by the way, is that we've been able to get people to agree on where we want to go, but to get from here to there, a lot of those people are going to have to change what they're doing and change the way they do it, so the difficulty will be in persuading people to change. It's very much symptomatic of the Mark Twain comment that “Everybody is in favour of progress; it's just change they don't like.”

We've agreed on what constitutes progress; the change issue will be more difficult. We will work on that over the next couple of years.

I won't read the brief outline of the framework, which is there for you in eight bulleted points. Instead let me turn to the second of the four big pillars we have, which is the one dealing with homeless mentally ill people.

In the budget 15 months ago or so, the federal government asked the commission to undertake five pilot projects to try to understand how we could provide service to the homeless mentally ill. It is an issue that has bedevilled governments in all industrialized countries. Jane can talk in some detail about the exact studies. They're now just under way, which is remarkable, since it took us only 12 months to go from a dead stop to actually having researchers out in the field. The results are going to be helpful in not just Canada; the international organizations responsible for providing homeless services are very much involved.

To put it in perspective, by the way, although nobody knows the exact number, somewhere around 50% of the people who are on the streets have a mental illness of some kind. A lot of them also have a substance abuse problem. The incidence of mental illness and homelessness is very high.

For those of you who have not read the book, go see the movie The Soloist, and you will understand. It just came out last week. It is a story about a homeless person with schizophrenia on the streets of Los Angeles. It's worth seeing because it will put the problem in perspective.

Our third initiative is our 10-year anti-stigma or anti-discrimination program, which Mike Pietrus is running. This will be the first systematic attempt in Canada to change public attitudes.

It's obviously very difficult to do, but we know from the experience in Australia, where they've been running an anti-stigma program for nearly 15 years now, and New Zealand, where they've been running it for 10, and England and Scotland, where it's been under way for some time, that a properly targeted program—and by that I don't mean your classic public service announcement ads on television, but a program targeted at very specific groups of people—can in fact be very effective.

So we've decided to target two groups, initially, for very specific reasons. One is children and youth because the attitudes of children are, frankly, a lot easier to change than the attitudes of adults. We also know that 70% of adults who have a mental illness had their first episode of that mental illness when they were under the age of 18. So if we can begin to embed in the next generation of Canadians positive attitudes towards people with a mental illness, that will be critically important. The results in other countries have shown that in fact you're likely to get a fair bit of success in doing that.

The second group we're going to target will be health care providers, and particularly mental health providers. Now, many of you may say—because this is certainly what I myself said at the beginning—why would you do that? Surely someone who's a doctor or a nurse will think that if you have a mental illness they should treat you the same way they would treat someone with cancer or heart disease or whatever. The fact of the matter is that isn't what happens. The fact is that the health care professions and people in the health care business have the same negative attitudes towards someone with a mental illness that every other profession has and that every other Canadian has. So in an attempt to at least deal with the issue of someone feeling stigmatized by going to seek help from a health care provider, we hope to change those attitudes.

Finally, let me make a comment on the issue of poverty, since that is an important part of your work, and let me make it in two contexts. The first is that while mental illness affects people of all ages, the reality is there's lots of data that shows the lower your income, the greater the incidence of mental illness. There's a bit of a chicken-and-egg issue there: your income may be down because you had the mental illness, but the reality is that there is a very clear linkage between income and mental illness. The Canadian community health survey, the one done by StatsCan, shows very clearly that socio-economic status and mental illness have a very strong linkage.

There's a second issue that's coming down the road. The incidence of mental illness among Canadians is going to increase significantly during the recession. It always does, because when people are suddenly out of work, they have a problem, there's a huge stress in families, and the impact on the family and children is very staggering.

Just to give you a couple of instances, in the first three months of this year, in Oshawa—and I'm saying Oshawa just because I happen to know the numbers—the number of people seeking help for mental health problems increased by 20% over last year. We know that in a place like Windsor, the numbers are substantially higher than that. We know it's also, unfortunately, having a very significant impact on children, because the impact of increased stress in the house as a result of layoffs—in some cases of both breadwinners—is such that it adds huge stress on the family and huge pressure on children.

So there is a clear linkage on the income side, and we have started to ask ourselves if there is anything that could be done to begin to look at trying to help reduce the impact of mental health problems on individuals during the recession.

By the way, this is not a uniquely Canadian problem. There's data from New Zealand that shows the suicide rate jumps dramatically, for example, during a recession. People just give up and they just can't take it.

Let me go back to the beginning, in winding up. All the commission can do is be a catalyst for reform. We don't actually provide services. We can cajole people, we can talk to them, we can raise the issue, we can spur people on, and we can give them ideas of what to do. But in the end, the ultimate success of the commission is going to depend entirely on the response of individual Canadians, and I say to you and all your colleagues in Parliament that we really need the support of you people, because you are leaders in your communities.

To have you doing events with us, speaking out on the issue, and simply indicating that it's now okay to talk about mental health, that it's not stigmatized...there are a lot of surprising little things you can do that don't cost money and that would be very helpful to us in our work.

I was delighted that you asked us to come here today, Mr. Chairman, and I very much look forward to working with you and your colleagues down the road.

Thank you very much.

[The Chair, Conservative, Dean Allison]

Thank you, Dr. Kirby. As we embark on this study on poverty, I think one of the things is trying to find out some of the things we can do, and you can obviously educate us on some of these issues.

We're going to start with our first round, which will be seven minutes for questions and answers. I'm going to start with my colleague, Mr. Savage.

You have seven minutes, sir.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Thank you, Chair.

I certainly want to thank all of the witnesses for coming here today and talking to us about the work that's being done.

I would be remiss if I didn't single you out, Dr. Kirby, for the work you have done in health and health care in this country and the work you did in the Senate. If anybody doubted that the Senate served a useful function in Canada, you are a shining example of what kind of work can be done. The work you've done both in public life and in private life has been very important. As a Nova Scotian, I would expect nothing less of you, as somebody who has spent most of his public life in Nova Scotia.

I can honestly say that in the work I do in poverty and with mental health groups in my area there are people who I think have your picture on the wall now. You wouldn't overstate the impact of the work you've done, but to people who have been in the shadows for so many years, it's very significant. Congratulations for that.

I'd like to talk a little about something you touched on, which is what I refer to as the social infrastructure of Canada. It seems to me that a lot of the social infrastructure that we have to protect, and also the enhanced opportunities for people, whether it's employment insurance or other programs, are not very well designed for people who have mental illness.

If you break your arm, you know what to do. You get it fixed and you know when it's fixed that you go back to work. I wonder if you, or any of you, have any thoughts on that specifically, and also on what we could do. Should there be a special social infrastructure that takes people with mental illness and deals with them entirely separately, for example? Or should we modify some of the programs we have to deal with people who are either in poverty or headed towards poverty and who don't have the kind of support they need?

[Michael Kirby]

Thank you for that question, and thank you for your opening comments.

I remember when I was chief of staff to the Premier of Nova Scotia a very long time ago, if anybody had had my picture on the wall, they would have been throwing darts at it. So this is maybe a step forward.

I will make a couple of comments, and then I am going to ask Jayne to add on.

If you step back and look at the package of federal programs, particularly the HRSDC programs, whether it is EI sickness benefits or CPP disability, etc., they were all designed for people who had a physical illness. That is what people had in mind when they were designing the programs.

Frankly, they don't work very well for mental illness. Let me just give you an illustration, and you will know this better than I do. I think it's 15 weeks. When you get to the end of 15 weeks, you lose the EI sickness benefits. Fifty per cent of the people who are still sick at the end of that fifteenth week are sick with a mental illness. In other words, half of the people who get to the end and still need help but don't have help because they have run out of sickness benefits are there with a mental illness.

The second thing is a lot of mental illness is chronic or episodic in nature. You will have a bout of depression. You will get better, you will be fine, you go back to work, and then you'll have another bout. Frequently the time between those two episodes is not long enough for you to be able to again get back into the EI program. Again, that is simply because on the EI sickness benefits, the thought that people had, logically, when they were developing it was, what to do with someone who has an illness? They are going to get better, as Mr. Savage said, and go back to work. So that's one problem that needs to be looked at.

CPP disability benefits are another thing. While technically, legally, they apply to mental illness, all of the tests you have to pass in order to get CPP disability benefits are clearly geared toward a physical ailment. You will be incapacitated for some period of time, but the incapacitation is a physical limitation, not a mental one.

In general, if you look at the programs, it would make a lot more sense to me to say, let's not keep trying to twist and tinker with a program that is designed for a physical illness; let's take mental illness out of those programs and design a single program to deal with the unique characteristics that mental illness has, which is, typically, longer to get better, sometimes episodic, and the nature of treatment is also different.

So I think the answer to your question is that I would actually favour looking at a new way, in some sense, a set of programs designed for people with a mental illness.

Now that CPP is allowed to run pilot projects, which they weren't until the last couple of years, I think you have a vehicle that would make experimentation possible. You'd have to be very careful that any changes to the programs are not street-smart. What I mean by street-smart is, I really want to know what's going to happen on the ground. I say this as a policy wonk myself. Sometimes I completely fail to anticipate how people are going to react, given a program. But with CPP you can now do experiments.

Do you want to add anything?

[Jayne Barker, Director of Policy and Research, Mental Health Commission of Canada]

No, I don't really want to add anything. I think Mike has covered the topic very well. I would just say it is a real interest of the commission to look at the programs that are currently available and to help define what a new program, what a different approach, could look like.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

So what would be your intent, then? And I know I do not have much time, Chair.

You would make some recommendations to HRSDC as to how they--

[Michael Kirby]

The officials in HRSDC are in fact being very positive on this, so I don't have any problems at all with the department, but what we need to do is work with them to develop a program, to then run a pilot project on this.

I would hope, frankly, that we could get that started sometime in the next six months. I place a very high priority on that, simply because it would get rid of a lot of the really stressful problems that people with a mental illness have trying to work their way through a maze of programs that aren't designed for them in the first place.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Thank you very much, and thank you, Mr. Chair.

[The Chair, Conservative, Dean Allison]

Thank you.

We're now going to move to Mr. Lessard.

Seven minutes, please.

[Yves Lessard, Bloc, Chambly—Borduas, QC]

Thank you, Mr. Chairman.

I also want to thank the guests who are here this morning. We greatly appreciate your contribution to the area of mental health. We are getting to share your experience this morning.

I am very pleased by several aspects of your work, especially your focus on health care providers. They play a crucial role in supporting the mentally ill and raising awareness of their contribution to society.

You also say that we must be able to give hope. Before me, somebody said that being poor is not only to lack money but also to lack hope. But I believe that you are able in some measure to give new hope to some people. I am not only talking about the research you are doing, but also the initiatives you have launched, for example these eight advisory committees that you set up in order to reflect on these issues and come up with ideas regarding certain groups in our society.

Do you already detect among the Canadian public a consensus as to the direction in which you want to go?

[Michael Kirby]

Because Howard has just finished national hearings on exactly that issue, I'm going to ask him to answer the question.

[Howard Chodos, Director, Mental Health Strategy, Mental Health Commission of Canada]

Thank you.

I think it may be a little too early to say there is a consensus throughout the country, but nevertheless we have now met with hundreds of Canadians in 13 cities during the 15 meetings we have held. We have also launched an on-line consultation through which we gathered over 1,700 detailed answers to our framework document aimed at developing a mental health strategy for Canada.

Insofar as a consensus is possible on a such a complex issue as mental health, we believe we have received significant support from the stakeholders in this area. We have gathered in a room representatives of the various provincial and territorial governments, of health care providers and people with mental health problems. We have had detailed discussions on the eight objectives we are putting forward in our framework document and asked the participants to vote on each objective using a grading scale from 1 to 5. For all objectives, the resulting score was between 4 and 5. There seems to be significant support for all these objectives. Participants also made suggestions for improving our document or some aspects of our work that they found weak. There were also suggestions about ways to improve our approach to those issues.

Generally, we feel that people want to cooperate with the commission and that they support the work we have done up to now. We recognize this is only a beginning. We are looking to a better future in the area of mental health, but we know that we still have lots of work to do before we can determine the best way to reach these objectives. Based on the consultations we have held and which were completed last week, we conclude that our general direction enjoys a great degree of support.

[Yves Lessard, Bloc, Chambly—Borduas, QC]

In order to understand how things might change, it may be necessary to target specific groups. We did a study on employability which showed that there are segments in our population that have less access to employment and are less able to hold down a job. This has a direct impact, just like unemployment, on mental health. I am thinking specifically about First nations' people.

I want to return to a comment of Mr. Kirby, when he talked about the sometimes unequal contribution between provinces. I would like you to elaborate on the role of the federal government in mental health. In your view, what main measure should the Committee recommend in order to make a difference in the results achieved by the federal government's actions vis-à-vis First nations people for example? This would give us an insight as to what should be done.

[Michael Kirby]

Thank you.

I will comment directly on the aboriginal one, before you go back to Howard.

When you look at the data on mental health for first nations, Métis, and Inuit, all Canadians ought to be embarrassed. When you look at the suicide rate among children under 24, for first nations and Inuit in particular, it's appalling.

If you look at the suicide rate among Canadian youth, it is the second biggest killer of our children between the ages of 15 and 24, second only to cars. If you look at the data for first nations and Inuit, for which the federal government has responsibility, it is somewhere between five and seven times higher than the national average.

As a Canadian, I'm embarrassed by that. I think a considerable effort needs to be made to improve mental health services for first nations, Inuit, and Métis, on reserves, which is a direct federal responsibility, but frankly, also in the cities. There are more first nations children living in Canadian cities—that is, off reserve—than there are living on reserve. All of the problems of mental illness and of substance abuse are colossal. The fact is that we have a unique opportunity in the world to do something.

We know it can be done. We know, for example, the work that Australia has done with its aborigines and the work that New Zealand has done with the Maoris has had a very significant impact over the last decade in terms of improving their mental health. I think, frankly, it's not only time; the time is long gone when we as Canadians should be making that same effort.

So, Mr. Lessard, I'm completely in agreement with you on that.

Howard, do you want to comment on the other pieces?

[Howard Chodos]

Thank you. I think with respect to the role of the different levels of government, and in particular the role of the federal government, the commission was set up to be able to work with all levels of government and to address some of the complex jurisdictional issues that arise, especially in areas with respect to indigenous populations in this country. Mike was referring to on reserve and off reserve, where needs for services cross jurisdictional boundaries and people have a great deal of difficulty finding the appropriate places for them to have service.

It's premature for us to be able to say specifically the one central measure we would recommend, but we have tried to begin a process of engaging with people from the different indigenous communities and listening very carefully to what they have to say. The commission has a first nations, Inuit, and Métis advisory committee. In particular, they have encouraged us to adopt what they call a perspective that would allow people to be treated in an environment of cultural safety, where we take into account not only the linguistic or cultural requirements but that we acknowledge with them the whole environment—the socio-economic and political environment—to be able to establish partnerships that will enable people to get the kind of care they need to enable them to heal and get better at confronting mental health challenges that are particular to their situations.

Our first step has been to try to listen as carefully as possible to understand the reality. Part of our cross-country visits with respect to our document took us to the north. We were in Iqaluit and Yellowknife, and I can tell you this was my first opportunity to visit those parts of the country. The challenges there are enormous. When we talk about the inadequacies of the system in the south and in the more populated regions of the country, I'm sure you know as well as we do that the challenges in the north are starting from next to zero, where services are simply not available.

We have to have realistic expectations about what can be accomplished. At the same time, the challenge is absolutely immense, and we are committed to working with the indigenous populations to work through how to move forward on this front.

[The Chair, Conservative, Dean Allison]

Thank you very much. That's all the time we have for this round.

We're now going to move to Mr. Thibeault. Welcome to the committee, sir. We're glad to have you here. You have seven minutes.

[Glenn Thibeault, NDP, Sudbury, ON]

Thank you very much.

Thank you for coming today. As a former front-line worker for 10 years on the streets, I've been scribbling notes because I have so many questions I'd like to ask.

One of the things we've been able to witness time and again in different communities is what I call the cycle: the cycle of poverty and the cycle of mental illness that people get stuck in. It starts with mental illness. If they have a mental illness, they lose their job and become homeless. Through unfortunate circumstances and because of the mental illness, they get caught with addiction to some type of substance, which then continues to spiral.

There are so many fantastic organizations out there. In my community of Sudbury, I can think of the Canadian Mental Health Association, Centre de santé communautaire de Sudbury—there are so many of them. However, we're trying to come into this cycle from so many different points. We're trying to come in from the homeless avenue, from the mental health avenue. We get four or five different case files opening up, all trying to find this person one support system.

In your opinion, have you been able to find any way we can stop this cycle, and is there something the federal government can do to unite all these great organizations with that one access point and stop that spinning cycle so we can provide the support at that point?

[Michael Kirby]

Mr. Chair, I'm going to ask Jayne to comment on that and then I'll come back and make an additional comment.

[Jayne Barker]

I agree with you. It's interesting that you've spent years on the front line. That resonates very closely to my heart. It's where I've spent most of my career, too.

One of the opportunities that is part of the mental health and homelessness research demonstration projects, from the money the federal government provided to the commission, is a real opportunity to work with the homeless mentally ill population in five cities across Canada and take a careful look at what approaches work best.

We know, not from research done in Canada but from research done in other countries, that what's called a “housing first” approach has some very promising aspects to it, but it has never been tested in the Canadian context. That's an approach where client choice is what drives the services a person gets, where they are provided with not only adequate housing but also with a variety of health supports and mental health supports and services, so they can become functioning citizens.

The early indications are that people who participate in that kind of program can become contributing citizens again and have housing stability and health stability. We're hoping that out of the research demonstration projects that we're doing we'll get some solid policy evidence we can bring to the government that will have recommendations to address exactly what you're talking about.

[Glenn Thibeault, NDP, Sudbury, ON]

Fortunately, if you're looking for an example, again, my community of Sudbury has implemented something similar, and we've been looking at ways to get federal government funding. We've been looking at a “housing first” initiative. We've been creating an alliance of community stakeholders, even talking to the hospital. You mentioned before about how much time and services, ambulance services, police services, that are going into this.

I also had the opportunity of living in Vancouver for a while. They had a great pilot program. I'm not sure if it's still around. I believe it was called “Car 87”, where they had a police officer going around with a mental health nurse. Those are great ideas that we could be bringing forward into other communities. I know at the time it was the Vancouver police, but the RCMP were saying it would be great if they could have some of those resources to provide those types of services.

[Jayne Barker]

Yes, absolutely.

[Michael Kirby]

Let me make one other comment about the on-the-ground problem. If you have a physical illness, what do you do? Let's assume for a minute it's not an emergency. You go to your GP and your GP then steers you through the system, if you need a test or if you need to see a specialist. In effect, your family doctor becomes your system navigator, your case manager. No such thing exists in mental health.

You get into the system somewhere. It is complex, to say the least. Once, a few years ago, I actually tried to trace out, to draw a diagram of all the places you would have to go to get all the services. I gave up. It was too complex to understand.

Clearly, some of the changes that are needed...and this will come into how we get to our end point. There has to be some element of a case manager, system navigator, or something. There has to be someone who does for the person with mental illness what the family doctor and the family doctor's office does for the physically ill, no question.

[Glenn Thibeault, NDP, Sudbury, ON]

I have a minute and a half. I like coming to this committee. This is great.

One of the things that we also need to look at when we're setting up federal services--and I look forward to your comments on this--for an individual who has been homeless, or who has an addiction, who's in poverty, who needs to access services in a building that they may not seem so comfortable in accessing.... It comes down to the pride of the person and the stigma that's associated with mental illness, or being a homeless person; all of a sudden they get this epiphany that they want to stop the drugs or they want to get off the streets, and they walk into a door and they're not allowed into the building because they haven't been able to shower in two weeks. How do we ensure that our services are accessible to people with mental illness?

[Jayne Barker]

Again, that's something that does happen fairly well in lots of communities. Lots of communities have street outreach workers and people who actually go on the street and meet people where they're at. Car 87 is a really good example of a pilot in Vancouver that works quite well. But those programs are few and far between. It takes a lot of creativity in terms of fundraising and putting together bits of funding from different places to have that kind of a program in a community.

You're right, it can be a real barrier to accessing service, to go into an office that's intimidating and often won't let you in. That's one of the things we're learning more about through our study on homelessness, and looking at the kinds of approaches that are needed to support the unique needs of people with different ethnocultural backgrounds, where language and customs can add increased barriers. People from an aboriginal background who are coming to services that are predominantly for white people can be very intimidated and it can create real barriers.

That's part of what we're hoping to learn.