Human Resources Committee on April 18th, 2013

[The Chair, Conservative, Ed Komarnicki]

We'd like to start as quickly as we can because we have some committee business to deal with at the end of the meeting.

We have with us representatives from the Mental Health Commission of Canada and the Centre for Addiction and Mental Health, as well as the Canadian Working Group on HIV and Rehabilitation.

We'll hear from each of you, and I believe we'll start with Aaron Levo, and then we'll move on to hear from Susan Eckerle Curwood. We'll try to keep you to within 10 minutes, but we understand you represent two organizations, so we'll be somewhat flexible on that.

Go ahead.

[Aaron Levo, Director, External Affairs, Mental Health Commission of Canada]

Thank you, Mr. Chair.

We'll try to be very brief to allow for a more lengthy Q and A session.

Some of you may be familiar with the Mental Health Commission of Canada. We were created out of a Senate committee study and received all-party support. We were capitalized with a 10-year mandate through to 2017 to deliver in four areas: to deliver the country's first-ever mental health strategy; to pursue work in the area of anti-stigma across the country; to provide capacity for knowledge exchange in the area of mental health and mental illness; and we also added to our mandate a very large research demonstration project in the area of housing and homelessness.

We advise and make recommendations to leaders and decision-makers, including government. Just yesterday our president was presenting to another standing committee here in Parliament. Unfortunately, Louise isn't able to be here today due to prior commitments, but we're very pleased to have with us Dr. Eckerle Curwood, from the Centre for Addiction and Mental Health in Toronto, to share her expertise with this committee on the study you have.

The Mental Health Commission works with experts in the mental health field and service providers and community leaders across the country, as well as people with a lived experience of mental illness. This is how we get our work done.

The commission, early in its mandate, struck eight advisory committees to help us generate the knowledge that would be required to catalyze change across this country.

The former workforce advisory committee of the Mental Health Commission of Canada worked on several initiatives to help employers change the way mental health is addressed in the workplace and saw the need for comprehensive research into solutions for helping people with severe mental illness find inclusion in the workforce. Among Canadians experiencing serious mental illness, up to 90% are not in the labour market.

This led to the development of the Aspiring Workforce project for employment and income support for people with serious mental illness. This is research led by the Centre for Addiction and Mental Health, and it's in partnership with the University of Toronto and Queen's University. This project will launch in the spring. A report will be provided in the spring, but we thought it would be prudent to come here today and provide Dr. Eckerle Curwood's particular expertise to the study you are currently undertaking.

The Aspiring Workforce project will provide recommendations aimed at helping reduce the high rates of unemployment among Canadians with serious mental illness.

The research addresses five key questions, which I will lay out for you, and then I'll pass it over to Dr. Eckerle Curwood, as time is of the essence.

The five key questions guiding this project are: one, how to effectively provide supports and services for people who want to work, and what services are likely to be most helpful; two, what systematic incentives and disincentives exist in returning to work; three, how to develop social businesses that, as part of their mission, provide jobs to people with mental illness; four, how to provide disability pensions that also focus on a person's capacities and abilities to work; and five, the key things people with mental illness need to know about succeeding at work.

This project will also provide a national inventory of social businesses across the country.

While we hope to be able to provide the committee with the full report prior to the conclusion of your study, we thought that in the interim it would be beneficial for Dr. Eckerle Curwood to come here today and offer some insight on particular aspects of the report.

[The Chair, Conservative, Ed Komarnicki]

Thank you.

Go ahead, Dr. Eckerle Curwood.

[Dr. Susan Eckerle Curwood, Manager, Research and Knowledge Development, Community Support and Research Unit, Centre for Addiction and Mental Health]

Thank you very much.

The piece of the Aspiring Workforce research that I'm going to focus on today is the challenges that people with mental health disabilities—those in the disability support system—face in navigating the very complex relationships between workforce participation and disability support policy. What we're seeing in Canada right now is a growing number of people with mental illness who are transitioning onto a disability income support program.

The percentage of CPPD recipients with a mental health disability increased from 12% in 1990 to 28% in 2008.

We know that up to 90% of people with serious mental illness in Canada are unemployed, and many of these are entirely detached from the labour market.

We also know that many people with mental illness do have the capacity and the desire to work. Many people with mental illness have intermittent capacity, so they can work, but perhaps only some of the time. Disability support programs could be adjusted to be more accommodating of intermittent illness. Right now, the requirement that people prove that they are in fact not able to work often creates fear in showing any capacity to work, despite the fact that many people do have the capacity and the desire.

Additionally, the rates provided by the income support programs don't always provide a decent standard of living, and the interaction among programs can create inequitable situations in which people with very similar levels of mental health disability are in fact living in very different financial situations.

Disability income program rules and their interactions with other support programs, such as housing support programs, can also cause people to actually wind up with less money and less security than if they do in fact obtain employment and work.

Reforms have been made in many jurisdictions in Canada, but in some cases they need to be better communicated. We found that people are often either unaware that rules have changed or that they don't trust the changes.

Our overarching policy recommendation is for a capacity-focused paradigm shift in which policies support individuals in their strengths, while also addressing the barriers they may face. We have several key recommendations in this area.

First, we recommend that disability support policies recognize that individuals with mental illness often have intermittent work capacity, and that the policies should provide flexibility. A good example that has in fact been recently implemented by CPPD is rapid reinstatement, which enables people who enter the workforce to quickly re-access the disability support system should they be unable to remain employed, rather than having to go through a lengthy process of re-establishing eligibility.

Second, we recommend early intervention to promote workforce engagement. People should be linked with employment supports immediately upon entering the disability support system. Early intervention should also include working with young people to ensure that their vocational trajectory is not lost and that people don't wind up graduating from high school directly onto disability support.

Third, we recommend that disability support policies seek to reduce disincentives to work. Examples of how this could be done include raising allowances for earning exemptions, establishing more opportunities to develop skills and access training, and ensuring that people with mental health disabilities who re-enter the workforce do not lose important access to prescription drug benefits and other health services.

Fourth, we recommend that policies ensure that funding is available for the development of evidence-based employment supports and training opportunities, including supported employment and social business formation. These are things that we know work.

Fifth, we recommend that people receiving disability income support be linked with case workers and other professionals whose roles extend beyond simply determining eligibility for a single program. People should have access to professionals with specific expertise in employment and also to benefits counsellors who can guide them through the intricacies of the complex impact that employment may have on the various disability supports they receive.

Sixth, we recommend that disability income support programs operate in collaboration with other stakeholders, including employment support and training programs, mental health service providers, and employers. The interactions between disability support policies and other policies, such as housing assistance policies, need to be carefully examined to ensure that unintended barriers to employment are not being created.

Seventh, we recommend innovation in disability support provision, employment support provision, and other services to develop new best practices for engaging people with mental health issues in the workforce on an ongoing basis.

Our final recommendation is that alongside reforms it's critical to develop effective communication strategies about these reforms. Reforms cannot succeed without clear communication to those individuals who are affected in order for the benefits of these positive changes to be reaped and recognized.

Thank you.

[The Chair, Conservative, Ed Komarnicki]

Thank you very much for that presentation.

We'll now move to Ms. Yates to start her presentation. Go ahead.

[Tammy Yates, Coordinator, Episodic Disabilities Initiatives, Canadian Working Group on HIV and Rehabilitation]

Thank you very much, Mr. Chair.

Good morning to members of the committee.

My name is Tammy Yates and I am the coordinator of episodic disabilities initiatives at the Canadian Working Group on HIV and Rehabilitation, which we refer to as CWGHR. With me is Elisse Zack, CWGHR's executive director.

We are here this morning on behalf of the episodic disabilities network, referred to as the EDN. On behalf of the EDN, we would like to thank members of the committee for leading this important discussion on exploring employment opportunities for persons with disabilities and for inviting the EDN to make this presentation.

We would also take this opportunity to applaud the government's commitment to improving labour market opportunities for Canadians living with disabilities, which is evidenced through the strengthened federal programming for persons with disabilities in Canada's economic action plan of 2013, the convening of the panel on labour market opportunities for persons with disabilities and its subsequent report, “Rethinking Disability in the Private Sector”, as well as the private member's motion M-430, introduced by MP Phil McColeman.

The EDN, which was formed in 2003, brings together a wide range of key stakeholders to collaborate on research, to advance public policy on employment and income support, and to promote the broader integration of people with episodic disabilities in Canada.

As you may recall, two organizational members of the EDN, the Canadian Council on Rehabilitation and Work and the DisAbled Women's Network Canada, have recently made presentations to this panel. Many of the points raised in those presentations would also have shed some light on the experiences of people living with episodic disabilities.

Often when people refer to disabilities, the first thoughts that come to mind are permanent disabilities. A person can live with both a permanent and an episodic disability, but there are clear distinctions between the two. An episodic disability is a long-term health condition that is characterized by periods of good health interrupted by periods of illness or disability. These periods may vary in severity, length, and predictability over time and from one person to another.

As Canadians are living longer, an increasing number of people are living with lifelong chronic illnesses that include episodes of disability—for example, arthritis, Crohn's disease, diabetes, hepatitis C, HIV, multiple sclerosis, and some forms of cancer and mental illness. I am sure that most, if not all, of you know someone or several people who are living with these types of conditions. You can therefore appreciate how these fluctuating episodes over time can wreak havoc on their work life.

Most recent statistics show that over 4.6 million Canadians aged 15 years and older reported that they had arthritis; 20% of Canadians will personally experience a mental illness in their lifetime; an estimated 95,000 Canadians live with multiple sclerosis; and there are approximately 71,300 people living with HIV in Canada.

Research supported by the Government of Canada has found 27 underlying conditions identified as episodic, and almost half of the working-age adults identified as having a disability in the 2006 participation and activity limitation survey reported having at least one of these conditions. As you can see, this is a significant percentage of the population.

The EDN has several recommendations for the Government of Canada related to the employment of people with episodic disabilities. We would like to share them with you and then have a brief explanation.

First, increase the flexibility of employment insurance sickness benefits, such as with units of 75 individual days or 150 half days, making it easier for people with lifelong episodic disabilities to stay in the workforce while being able to use EI sickness benefits on days or weeks when they are not able to work.

Second, there should be more program outreach to people living with episodic illness and disability through the CPPD vocational rehabilitation program.

Third, building on the recent work on episodic disabilities that the Government of Canada has been doing, further research should be undertaken related to the labour market participation of Canadians living with episodic disabilities to identify the impact of these illnesses, and more responsive income and employment services should be developed to meet people's needs. The EDN would also be happy to work with the newly formed employers disability forum to better understand and address the needs of people living with episodic disabilities.

Many people with chronic illnesses leading to an episodic disability have no alternative but to rely on disability benefits, such as EI sickness benefits, long-term disability, CPPD, and provincial disability and social assistance programs. However, most existing disability policies and programs do not accommodate the realities of a person living with an episodic disability. Rigid definitions and policies govern these benefit programs, as most people are either fully disabled or fully able to work, while many people with episodic disabilities fall somewhere along the continuum.

Eligibility criteria in some programs include that the disability must be severe and prolonged, a requirement that often excludes people with episodic disabilities. As a result, people may have difficulty accessing or maintaining benefits even when their disability prevents them from being able to work.

It is critical to have disability programs that are flexible enough for people with episodic disabilities to enter, leave, and re-enter the paid workforce easily when the episodes of disability fluctuate, without putting their income security at risk. Existing policies make it difficult for people who are receiving benefits to work part-time or when their health allows. Some people could contribute greatly if they had the opportunity to work part-time over a longer term, if they could earn a part-time income when their health allows and also be able to receive part-time disability benefits for the portion of time when they are not able to work. This would enable them to maintain some level of income security. Flexible units of EI sickness benefits could be one of the mechanisms to address this issue.

It is clear that we need to find ways to provide employment support to help people manage the impact of illness and disability on their work. People with illness and disabilities often experience stigma and discrimination due to the fear of illnesses, disabilities, and differences inherent in our society. It is critical that our systems promote inclusion and respect.

It is also critical that our systems recognize the disproportionate impact that living with a disability has on women. For example, the unemployment rate for women with disabilities is 74%, and while there is currently no specific data on women living with episodic disabilities, we deduce that their situation is not much better.

The EDN has worked collaboratively with HRSDC to research the impact that episodic disabilities have on workforce participation and to identify and promote opportunities to address the needs of Canadians with episodic disabilities. The EDN has also worked to raise awareness of the need for reforms to EI and federally provided income support programs to better support Canadians with episodic disabilities.

Just yesterday, the EDN convened a forum and policy dialogue on workforce participation for people living with episodic disabilities in Canada. The goal of the policy dialogue was to develop a multi-stakeholder-informed strategy and action plan to promote workforce participation for people living with episodic disabilities. The session brought together government representatives, policy-makers, employers, and unions, as well as people living with episodic disabilities and their representatives. Two of the major highlights of the policy dialogue were the opening remarks by MP Phil McColeman and the keynote lunchtime speech by MP Bernard Trottier.

In conclusion, I would like to say that life is unpredictable. While you or I may not be living with an episodic disability today, that does not mean that tomorrow our life circumstances may not change and we may then be diagnosed with an illness that is episodic in nature. To this extent, therefore, the policies and programs, or revisions to policies and programs that we have suggested, don't only work for people living with episodic disabilities; flexibility works for every Canadian.

The Government of Canada's economic action plan shows a commitment to improving the labour force participation of Canadians living with disabilities, many of whom are people living with episodic disabilities. If more people with episodic disabilities are able to participate in the workforce when their health allows and without putting their income security at risk, many people who are currently excluded will have an opportunity to both contribute to the labour force and become economically independent, which in turn will be a win-win for all Canadians.

Thank you.

[The Chair, Conservative, Ed Komarnicki]

Thank you very much for that.

I guess it is our own Phil McColeman who is being referenced there.

I also hear that flexibility is a fairly important issue, for sure. Certainly, fluctuating episodes can wreak havoc. I think everyone around this table would appreciate that at one time or another during their careers or lifetimes.

We'll start the rounds of questioning with Madame Perreault.

Go ahead.

[Manon Perreault, NDP, Montcalm, QC]

Thank you, Mr. Chair.

I will start with Ms. Yates.

From what you've told us, it is clear that the programs currently in place do not meet the needs of those with episodic illnesses. And, of course, there are a great many episodic illnesses. I am going to ask you a number of questions in a row, and then I will let you answer them.

Are there more men or women with episodic illnesses in the workforce? Are there certain illnesses that really prevent the individuals living with them from returning to the labour market for fear of losing the few benefits they currently have? Earlier, you mentioned the flexibility of having 75 individual days or 150 half-days, but how could that measure be implemented so as to really help people and support them if they want to return to the workforce? I have one last quick question. I'd like to know where the biggest problem lies.

[The Chair, Conservative, Ed Komarnicki]

Okay, we'll have to wrap it up.

[Manon Perreault, NDP, Montcalm, QC]

Briefly, Mr. Chair. Earlier, you mentioned adding flexibility to the program. Are the eligibility criteria the problem?

I am done, Mr. Chair.

[The Chair, Conservative, Ed Komarnicki]

There are four questions. Two of them are related, but go ahead in whatever order you wish.

[Tammy Yates]

Okay. Of course, I'll ask my colleague Ms. Zack to contribute as well.

With respect to the question on whether there are more women or men living with episodic disabilities, we've recognized that it definitely is an area for more research. I would not venture to say that we have that data, as it stands at the moment, but it is an area we've already recognized as requiring extensive research. And we are prepared to do that.

[Elisse Zack, Executive Director, Episodic Disabilities Network, Canadian Working Group on HIV and Rehabilitation]

I would like to add that, anecdotally, it appears that more women than men are living with many of the illnesses that we have identified. We don't know that for sure; it's just anecdotal at this point. We definitely need more research.

[Tammy Yates]

With respect to the second question, which is whether there are some illnesses that prevent persons living with episodic disabilities from returning to the labour market, there are 27 underlying conditions that fall within the category of episodic disabilities. There are some illnesses, depending on where you are along the continuum, that may actually prevent you from returning to the workforce.

The key message we are sending, though, is that the majority of these 27 underlying health conditions do not prevent you from withdrawing completely from the workforce. And because of the episodic and fluctuating nature of most of these illnesses, the priority to ensure that we are able to contribute to persons returning to work is to ensure that programs and policies reflect that flexibility.

Elisse, would you like to add anything to that?

[Elisse Zack]

Yes. I would like to add that in some conditions it varies, as Tammy mentioned, depending on the individual and where they're at in the continuum of their illness. Some illnesses become worse over time, and other illnesses stay fairly steady, with episodes of illness and wellness. Some episodes are worse than others but do not necessarily get worse over time. You may be able to work your whole life with these episodes of disability. If you've been living with an illness for 30 years, it doesn't necessarily mean you're going to be worse at the end of it. For example, some people with episodes of certain kinds of mental illnesses do not necessarily get worse over time. Some people with multiple sclerosis have episodes; some get worse over time, and some don't. It varies from person to person. It's the flexibility that's the most important thing.

[Tammy Yates]

The question on EI, Elise, can I pass it to you?

[Elisse Zack]

On the question of the EI, the 75 units, if I understand your question correctly, it's not re-entering the workforce that's the issue. Somebody's currently working and they've been paying into EI and then they get sick. Their episodes of illness are unpredictable. Some people, because of medications or the way their specific illness impacts them.... If they take their medication in the morning, they can work, but they can't start until noon. If they had the capacity to have disability or EI in the mornings, they could work afternoons, or they could take two days off a week if they were really sick, without necessarily having to break their attachment to the labour force. They could accumulate the equivalent of 75 days in a row. It's for people who are currently in the labour force who may have this sporadic capacity to work.

Other people may be able to predictably work half time. Because of extreme fatigue, they can only work half days, and they may be able to work over a longer period of time if they don't have to work full days. They can be completely productive during the time they are at work. So it really varies. We're not talking about returning to the workforce. We're talking mostly about people who are already in the workforce. Rather than having to leave completely and re-enter, this could enable them to stay attached to the workforce during these shorter episodes of disability.

[The Chair, Conservative, Ed Komarnicki]

Thank you for that.

Dr. Eckerle Curwood, did you have any comments?

[Dr. Susan Eckerle Curwood]

With regard to psychological disability, we know that there are more women than men who report psychological disability. That doesn't necessarily mean more women than men have the disability, only that more women report the disability. I agree with my colleagues that many of the issues they describe are relevant to psychological disability, as well as to many of the other disabilities.

One of the things we know about disability supports in general, particularly with people with mental illness who transition to disability support systems, is that it's very hard to transition off again. As a part of our research, we spoke to key informants in the Ontario disability support system, and they indicated that the two most common reasons for people leaving that system were that they either became eligible for CPPD or they died.

[The Chair, Conservative, Ed Komarnicki]

Thank you for that intervention.

We'll move to Mr. McColeman. Go ahead.

[Phil McColeman, Conservative, Brant, ON]

Thank you, Mr. Chair, and my thanks to the witnesses for this very enlightening testimony.

Based on the research you've done and what you told us today, I think one of the observations would be that there's a lot of work to be done here. If we, as a committee or as a government, could move the yardsticks ahead just a bit, that would be progress. I think having the expectation that we can change this overnight is something that you would agree—you're nodding yes—is going to take a considerable amount of work.

My first question would be to both organizations represented here. In your research, have you looked at other jurisdictions, other countries, other examples? You both emphasized flexibility as one of the key elements here. Do you have examples of best practices from other jurisdictions that you could tell us about?

[Dr. Susan Eckerle Curwood]

I'm happy to begin.

Actually, yes, we did work in consultation with experts from the OECD on our research. As a part of our research we examined efforts that a number of other jurisdictions have made toward a capacity-focused paradigm shift.

I would say that the most successful example that we are familiar with as of this time is in Australia. In the summer of 2006, Australia introduced a job capacity assessment, which was an effort to assess people not on the basis of how disabled they are or how much they're unable to work, but instead to look at how much they are able to do. This program is still fairly new, but in an evaluation that was done by Australia's Department of Human Services, along with Centrelink, which is the Australian agency that handles the disability support provision, the first 100 referrals were examined. At the time of referral to the job capacity assessment, over 80% of the recipients were on income support exclusively, with no work earnings whatsoever. After the first 12 months, that figure was reduced to only around 30% of the participants who did not have any income from work.

Additionally, around 70% of the clients had earnings. Some of them were no longer even receiving disability benefits, due to their employment.

We really feel that this is one innovative model that could be examined by Canada. It does show promise in increasing the labour market attachment of people with mental illness and reducing the dependence upon the disability income support system by that population.

[Elisse Zack]

The issue of flexibility speaks to some of the challenges. It seems that the onus for making the accommodations ends up being either with the employer, with the employee, or with the government programs. What we're saying is that we would like to see changes within each of the stakeholders there, that everybody has a role to play.

There may be some specific workplaces with some flexible opportunities where people are able to work part time and they've been able to work it out with their private insurance, compounded with CPPD.

Again, through the OECD report...the Netherlands has come up with an extremely interesting model. In cases where there is private insurance, a government program that's combined, as CPPD is, with private health insurance, and the employer...they all pay into a pool of resources that the employer and/or the stakeholder can draw on when illness happens. In that way it doesn't become an onerous burden on any particular stakeholder, but everybody shares the responsibility for promoting opportunities for people to work when they're able to do so. This is a model that we would like to emulate here in Canada.

[Phil McColeman, Conservative, Brant, ON]

I appreciate both of those examples. I think it will behoove the committee to research those even further to find out...who knows, maybe Australia is in the cards. Rodger likes that.

The other part of my comment, and I'd like your response to it, is that many of these things, from a government point of view, involve both provinces and the federal government. It's the coordination part. Through my life experience as a parent of someone in this category, I find the departments don't communicate with each other, federally and provincially. As well, the provincial governments are all different. As a result, what you have are these disincentives being built in as an unforeseen consequence of one level of government thinking it's doing a good thing in producing new programs and new supports.

That relates to my comment earlier about the massive job that needs to be done on this file. Many of these things are provincial, more so even than federal, as I think you would agree.

I would like you to provide some insights as to how at the federal level, as legislators, we can move this process forward. There are the obvious things, of course, to start talking to the provinces, but it isn't that easy. I guess what I'm asking is should we take more control of this agenda, where one level or another kind of backs away while the other takes care of it? There are many disincentives in the program, as we all know, that really do need correction.

I would appreciate your comments on that. I will end with you responding to those comments.

[The Chair, Conservative, Ed Komarnicki]

We'll conclude with those responses. Your time is up, but we want to hear the response to that.