Human Resources Committee on Dec. 8th, 2016

[The Chair, Liberal, Bryan May]

I call the meeting to order.

Good morning, everybody. Pursuant to Standing Order 108(2) and the motion adopted by the committee on Monday, June 13, 2016, the committee is resuming its study of poverty reduction strategies. I'm going to forgo my preamble this morning to wish one of our colleagues a fantastic...it's your 30th birthday, right?

[Dan Ruimy, Liberal, Pitt Meadows—Maple Ridge, BC]

Yeah. How did you know?

[The Chair, Liberal, Bryan May]

Fil, do you want to start us off?

[Dan Ruimy, Liberal, Pitt Meadows—Maple Ridge, BC]

Oh God, no.

Some hon. members: Happy birthday to you,
Happy birthday to you,
Happy birthday, dear Mr. Ruimy,
Happy birthday day to you.

[The Chair, Liberal, Bryan May]

Thank you very much for indulging me on that. It's a pleasure to have you join us. We're not usually this silly this early in the morning.

From the Mental Health Commission of Canada, we welcome Ed Mantler, who joins us here in Ottawa.

Cedars Society via videoconference in Vancouver, British Columbia, is not here quite yet, so I'll skip Marshall.

Also via video conference from the Centre for Addiction and Mental Health in Toronto, Ontario, we have Dr. Vicky Stergiopoulos.

Did I get that right, or close enough?

[Dr. Vicky Stergiopoulos, Physician-in-Chief, Centre for Addiction and Mental Health]

Perfect.

[The Chair, Liberal, Bryan May]

Also from the City of Toronto via video conference, we have two groups, and I like the fact that you're sharing your time today.

We have Ricardo Tranjan, manager of the poverty reduction strategy office, and Kelly Murphy, a policy development officer, both from the City of Toronto.

Then, from Working for Change, we have Michael Creek, director of strategic initiatives, and Lubna Khalid, coordinator.

Welcome to all of you.

We are going to get started right away because we have a full slate of witnesses today. I would ask that the witnesses keep their comments as close to seven minutes as possible. We're going to start off with Ed Mantler from the Mental Health Commission of Canada.

The next seven minutes are yours, sir.

[Ed Mantler, Vice President, Programs and Priorities, Mental Health Commission of Canada]

Thank you, Mr. May, and my thanks to the committee for inviting the Mental Health Commission of Canada to speak here today.

This week in Canada 500,000 Canadians have called in sick to work because of a mental illness. This week isn't special. The same thing happened last week; the same thing will happen next week. While it's not the same 500,000 people every week, some are. Some will be experiencing a protracted illness, and some will not be able to return to their work. Not being able to sustain employment leads, of course, to financial difficulties, which can spiral into poverty and homelessness.

The timing of my being here today is excellent, because it comes on the heels of the release of the final sustainability study on At Home/Chez Soi, released in November. As many of you may know, At Home/Chez Soi was the largest research project of its kind in the world and has since been replicated internationally. It involved more than 2,000 participants in five cities across the country over five years, and proved beyond a doubt that a Housing First approach can rapidly end homelessness for those experiencing mental illness, who account for approximately 64% of homeless people.

The study proved beyond doubt that Housing First works and has had an impact on improving housing policy, especially as it relates to reducing poverty. I can't stress strongly enough how gratified we are that our voice has been heard. In fact, earlier this year the mayor of Medicine Hat announced that a Housing First approach has been used to eradicate homelessness in that community in Alberta.

Access to safe, affordable, secure housing has been proven to be cost-effective. In fact, we know that it costs less to provide stable, permanent housing augmented by social supports. It's not housing only; it's Housing First, and even with supported housing and subsidized housing and the augmentation of intensive case management or assertive community treatment, it's still cheaper than having people cycle through shelters, temporary accommodation, emergency departments, and even incarceration.

Just yesterday, our president and CEO, Louise Bradley, released a statement congratulating the federal government for engaging Canadians in the development of a national housing strategy. When we are crafting a national plan, the urgent challenges faced by people living with mental health problems and illnesses must be top of mind, since the need for affordable housing among this vulnerable population is nearly double that of the general population. We know that safe and secure housing has a profound and life-changing impact on a person's health and well-being, which is why it's enshrined in the mental health strategy for Canada, Changing Directions, Changing Lives.

At the commission we often say that everyone needs a home, a job, and a friend. That's of course an oversimplification of the broader social determinants of health, but I mention it here because housing is only one component of the puzzle. Recovery from mental illness is not only possible, it's expected. When I say “recovery”, that always raises some eyebrows, because people sometimes hear “cure”. I don't mean cure; I mean recovery—leading a full, healthy, fulfilling life despite some limitations in much the same way that people with chronic physical illnesses do.

I myself have a heart condition. I had a heart attack in 2006, yet when you look at me, I hope you don't see a heart patient. I hope you see a fully functional Canadian. I'm healthy and I'm recovered, but I'm not cured. I will always take medications every morning. I will always have a regular exercise regimen. I will always see a cardiologist. I will always lie to my cardiologist about my diet.

[Voices]

Oh, oh!

[Ed Mantler]

I'm recovered, not cured. I lead a full, productive life. I have a good job, with responsibility. I have friends and family who care about me. I have hopes and aspirations that I work towards. Recovery from mental illness is exactly the same—it's expected.

We know that poverty compromises the ability of Canadians to be well and to recover. Poverty exacerbates the symptoms of mental illness and can bring them out. At the same time, mental illness can sometimes make it difficult to sustain employment and therefore leads to poverty. It's a vicious cycle.

When we think about recovery from mental illness, that means taking a long-term view and making meaningful investments in programs that extend well beyond the health care sector, such as programs that support people living with serious mental illness to get and keep meaningful employment.

So what happens to those 500,000 people I talked about earlier?

We know that some of them will recover quickly and return to work, but we know that a large percentage of those with serious mental illness will not. Someone off work on illness leave for six months only has a 50/50 chance of returning to employment. After a year away, the chance of returning drops to 10%, and for that reason 90% of the Canadians who are experiencing a severe or serious mental illness are unemployed. That accounts for about 3% of the Canadian population.

People with mental illness are capable of contributing tremendously to society, yet a troublingly high proportion of those who are homeless suffer from mental illness. We need to improve policy that rewards and supports people who return to work, rather than penalizing or failing to incentivize earned income.

At the commission, we call that population “the aspiring workforce”. They are those who have left work because of mental health problems or those who have never entered the workforce because their mental health problems struck early in life.

It's interesting that there are many organizations that work with those individuals to help them—help them build resumés, help them gain skills, help them get training—but it's very hard to find organizations working with employers to make the workplace culture, policies, and practices more accommodating and more accessible to people experiencing mental illness and mental health problems.

The commission has done a pre-budget submission this year for a demonstration project as an example to support employers—hopefully to support 200 employers across the country—to learn what works and what doesn't, to determine the best practices for changing the culture of workplaces, changing the policies and practices in order to keep those with mental illness in the workplace, have them return to work as early as possible, and help those who have never entered the workforce be able to find meaningful work and jobs.

Taking it one step further, we should make a concerted effort to advance the research that informs our knowledge and understanding of the social determinants of health and the links between mental health and overall health. Collectively, we must work harder to provide services that address the social determinants of health. If the mental health system does not take into account social inequity and poverty, then the time and energy that we're spending will be wasted and the results diminished.

Efforts to address the social determinants of health must be collaborative and involve different systems, including all levels of government, ministries, and sectors, and must involve those with lived experience of mental illness. These efforts must apply a health equity lens, be evidence-informed, and focus on upstream initiatives as well as downstream services and supports for people living with mental illness.

I'd like to thank the committee for giving me the opportunity to be here today. Thank you.

[The Chair, Liberal, Bryan May]

It's our pleasure. Thank you very much for being here.

We're going to quickly move over to the Centre for Addiction and Mental Health and Dr. Vicky Stergiopoulos, physician-in-chief, coming to us via videoconference from Toronto, Ontario.

Welcome. The next seven minutes are yours.

[Dr. Vicky Stergiopoulos]

Thank you, Bryan and members of the committee, for your work on poverty reduction strategies and for giving me the opportunity to appear before you today.

As you mentioned, I'm the physician-in-chief for the Centre for Addiction and Mental Health in Toronto.

CAMH is Canada's largest academic mental health and addictions science centre. We combine clinical care, education, and research to transform the lives of those affected by mental illness or addiction. We have over 500 beds, more than 3,000 staff, over 300 physicians, and 100 scientists. We work together to support over 30,000 patients each year.

For our patients and for Canadians with mental illness, poverty is a major concern. People with mental illness have lower incomes, are less likely to participate in the labour force, and are less likely to have adequate housing when compared to people with other disabilities and to people with no disabilities. Poverty can further exacerbate their physical and mental health conditions.

While evidence-based clinical care is essential for mental health recovery, CAMH also recognizes the importance of the social determinants of health and their impact on improving the conditions of living for people with mental illness across their lifespan. Therefore, we offer the following three recommendations to reduce poverty among people with mental illness.

First, we need federal investments in affordable, supported, and supportive housing. In Canada there are over 520,000 people with mental illness who are inadequately housed. Among them, almost 120,000 are absolutely homeless. Many of these individuals are able to live independently in the community, and improved access to affordable housing would assist them to move out of poverty.

Other Canadians with mental illness require support to find and keep housing. For them, access to affordable housing and evidence-based clinical support will provide the opportunity to maintain housing stability and to exit poverty.

There are some patients we see at CAMH and elsewhere in Canada who have more severe psychiatric disabilities. For them, access to high-support housing, housing with around-the-clock supports, is what is needed to maintain successful community tenure. Research has shown that access to housing can improve personal health and social outcomes for people with serious mental illness. Unfortunately, there is a shortage of these types of housing in Canada.

In 2012 it was estimated that 100,000 new units of housing would be needed across the country over the next 10 years just to begin to address the housing needs of people with mental illness. In Ontario, people with mental illness can wait up to six years for housing.

In our submission to the national housing strategy, CAMH recommended that a portion of all federal funding for affordable housing be reserved for the development of new supportive housing units. We also recommended an increase in funding for Housing First, which is an evidence-based supported housing model for people with mental illness who are homeless. We believe that these investments in supported and supportive housing will help reduce poverty among Canadians with mental illness.

Our second recommendation is that the federal government support initiatives that assist people with mental illness to find and keep employment. Most people with mental illness can and want to work, but up to 90% of those with a serious mental illness are unemployed due to stigma and discrimination, inadequate job supports, and problematic income security policies. People with mental illness who work are heathier and have higher self-esteem and a better standard of living. They're also less likely to use high-cost health and social services.

With federal government support for evidence-based employment supports and alternative employment options, in addition to the work the Mental Health Commission of Canada is doing to address stigma and discrimination in the workplace, poverty among people with mental illness can be reduced.

Finally, we recommend that the federal government work with other levels of government to implement a basic income guarantee to support Canadians with mental illness who cannot work and those who cycle in and out of work because of the nature of their illness. Current income support systems are inadequate and create disincentives to work. A basic income guarantee, along with housing and employment supports, could dramatically improve the health and standards of living for people with mental illness.

Poverty is a challenging and multi-faceted problem, and CAMH commends the government for making it a priority. We are also glad to see that you are recognizing the unique needs of people with mental illness and addictions as you shape the strategy.

We hope that our recommendations can be helpful to you.

Thank you. I'd be happy to answer any questions.

[The Chair, Liberal, Bryan May]

Thank you very much.

Now from the City of Toronto, coming to us via videoconference from Toronto, we have Ricardo Tranjan, manager, poverty reduction strategy, and Kelly Murphy, policy development officer.

The next seven minutes are yours. Go ahead.

[Ricardo Tranjan, Manager, Poverty Reduction Strategy, Social Development, Finance and Administration, City of Toronto]

Good morning, Mr. Chair and members of the committee.

First I want to thank you for having invited us today and for giving us the opportunity to discuss the developments, achievements and challenges of the Toronto Poverty Reduction Strategy.

We also want to take this opportunity to thank the Government of Canada for investing in social and affordable housing in phase 1 of the infrastructure plan.

We are happy to contribute to the work of this committee and to the development of a federal poverty reduction strategy which will be informed and supported by provincial and municipal strategies.

In 2015 Toronto City Council unanimously approved TO Prosperity, the Toronto poverty reduction strategy. This strategy is based on thorough research and a year-long community engagement process co-led with community organizations and people with experience in poverty, and it involved more than 2,000 city residents.

In adopting this strategy, the City of Toronto has acknowledged the importance of municipal leadership in poverty reduction and the need to commit resources to ensure the economic, social, and environmental prosperity of Canada's largest city. TO Prosperity is a system strategy that focuses on five key issues: housing stability, transit equity, service access, food access, and quality jobs and liveable wages.

We have three overarching objectives.

The first is to address immediate needs. We want to ensure that vital services are well funded and coordinated and meet the needs of those living in poverty.

Second is to create pathways to prosperity. We want to ensure that the city programs and services are integrated, client-centred, and focused on early intervention.

Third is to drive systemic change. We want to leverage the economic power of the city to stimulate job growth, support local businesses, drive inclusive economic growth, and tackle deep-rooted social inequality.

At the City of Toronto we firmly believe that tackling poverty must be a collective effort. In some areas, the City of Toronto has the tools, resources, and authority to lead the way, and it is doing so. In other areas, the city must collaborate with other orders of government, the private sector, labour, and community organizations to reduce poverty and promote inclusive economic growth. Siloed policy development, uncoordinated services, piecemeal programs, and intermittent investments often exacerbate poverty and vulnerability.

In year one of the poverty reduction strategy, the city invested in student nutrition programs, employment programs, social housing, shelters, child care fee subsidies, recreation centres where programs are free, and public transit, which is now free for children 12 years of age and under.

In 2016 the city council also approved the new social procurement policy and program that will increase access to city contracts for businesses that are owned by, employ, or provide employment training to equity-seeking communities and low-income residents. Last week, the executive committee approved the creation of the low-income transit pass, which will be brought to council next week.

Finally, city divisions introduced innovative approaches to program development and delivery, including pilots that will use intensive case management strategies to improve services and outcomes for social assistance recipients facing barriers to employment, such as mental health challenges.

We're proud of these achievements, but there is much more that needs to be done, and the Government of Canada can play a crucial role in helping us move forward. Significantly reducing poverty in urban centres requires major investment in social and affordable housing, child care, and both the building and operations of public transit. Our efforts to prioritize limited municipal resources and to find innovative and effective ways to support low-income residents will not yield the desired outcomes without adequate funding for housing, child care, and transit. These are the key pillars of socio-economic stability and inclusion. Without them, residents cannot fully participate in economic and civic life.

The city applauds the recent investments in these areas through phase one of this infrastructure plan and hopes that phase two investments in the national housing strategy and, of course, the Canada poverty reduction strategy will further advance that.

I would also like to briefly talk about monitoring and evaluation.

It is widely known that the currently used low-income and poverty measurements—LIM, LICO, and MBM—have major methodological limitations. In this regard, we would like to echo previous witnesses who appeared in front of this committee and recommended that the federal government task Statistics Canada with the collection and dissemination of non-monetary poverty data, including material deprivation data. Our ability to monitor and evaluate our poverty reduction efforts would increase significantly if we could combine monetary low-income measures with a material deprivation index.

Once again, I thank you for this opportunity to address you this morning.

My colleague Kelly Murphy and I will be pleased to answer your questions, to the extent of our knowledge, of course, and to put any material that can be of use to the work of the committee at your disposal.

It is a pleasure for us to work with our federal government colleagues on the development of a poverty reduction strategy for Canada.

Thank you very much.

[The Chair, Liberal, Bryan May]

Thank you very much.

Now, from Working for Change, we have Michael Creek, director of strategic initiatives, and Lubna Khalid, coordinator of Women Speak Out, both via videoconference from Toronto.

Welcome, both of you. The next seven minutes are yours.

[Michael Creek, Director, Strategic Initiatives, Working for Change]

Good morning.

On behalf of Lubna and myself, I want to say that we are happy to be here with you today. Having heard other people speak, I'd like to mention right off the top that 99% of the people who work in our organization are people with mental illness or addictions, or people who have experienced poverty or been marginalized in some way in society, which makes us a rather unique organization.

Thank you for the invitation to appear before the committee today and to share the work that we do at Working for Change and the systemic work we undertake around mental health and addictions in regard to employment opportunities, poverty reduction issues, housing, etc. We believe that people with lived experience are experts and need to be consulted in areas of policy development by the federal government.

There is still a serious stigma attached to the words “mental illness” and “addictions”, although society's views around other disabilities have changed somewhat. People from my community are still facing huge barriers to employment, housing, and social inclusion. The unemployment rate for people with disabilities remains extremely high—some believe as high as 70%—and for people with serious mental illness it is as high as 90%. We know that 45% of people entering the Ontario disability support program have mental illness or addiction disabilities. The cost of this program could become unsustainable in the future.

Why is it that we continue to see this increase? Everyone on ODSP lives in poverty, some in very deep poverty that often compounds their inability to recover their health. Many whom we speak with are looking for a way out of poverty, but we have not developed the pathways to help them out.

[Lubna Khalid, Coordinator, Women Speak Out, Working for Change]

The work that the Mental Health Commission has undertaken over the last 10 years has made some inroads into making our communities feel stronger—that there is a place for us and that Canada and Canadians are willing to make the investments in housing, social supports, employment opportunities, and choice. We still have a tremendous amount of distance to cover; we believe that we can get there together.

Here are a few of the areas where we have found success for our community in the work we have undertaken over the last 10 years.

Over the past several years, we have developed different leadership and pre-employment programs that have assisted people in gaining access to employment and moving out of poverty. In 2005, we developed a program called Voices from the Street, which was designed to have people with lived experience of poverty, mental health issues, and addictions provide education on these issues to members of the public and sit at the table where policy-makers were making decisions. Over the past decade, members of Voices from the Street have spoken to thousands to people, including students, nurses, resident physicians, social service workers, psychiatrists, and policy-makers. Women Speak Out, our women speakers bureau, adds a gender lens to issues and includes the voices of women who have experienced domestic violence, poverty, and newcomer or refugee challenges.

As our speakers bureau grew, we also found that many of our graduates desperately wanted to find employment, particularly in the social services area. We now offer two pre-employment programs. One trains people on social assistance to work in the food services or horticultural fields. The second program offers relief worker training to people with lived experience of poverty so that they can find employment in drop-ins, shelters, and social housing settings. Our intensive 12-week programs combine sessions that recognize the struggles that people living on social assistance face with sessions that build their confidence. Participants then learn very practical skills for employment in food services, horticulture, or social services, as well as job search techniques. To date, approximately two-thirds of our graduates have found full- or part-time employment.

[Michael Creek]

People can find pathways out of poverty. We need the federal government to take on this important role with the provinces and municipalities in poverty reduction. The cost of doing nothing or saying we can't afford to make investments in these key areas of employment and housing for people with disabilities must end.

According to a recent report on the cost of poverty in Toronto, the health and social costs of poverty, combined with lost revenues, are between $4.4 billion and $5.5 billion. Repeat these amounts across all of our cities, towns, and villages, and those costs rise dramatically.

A poverty reduction strategy must address a modern employment strategy that will target particular populations, of course including people with mental health and addictions issues, youth, and indigenous people. It should be integrated into provincial and municipal poverty reduction strategies, addressing economic, housing, health, and wellness issues. Most of all, it must recognize that far too many people with mental health and addictions issues are denied employment opportunities and choice.

We think we have shown that by having high expectations of people, we can and do succeed. At Working for Change we champion that every person deserves a home, a job, a friend, and social change.

Thank you.

[Lubna Khalid]

Thank you.

[The Chair, Liberal, Bryan May]

Thank you very much, all of you.

Unfortunately, Mr. Smith from the Cedars Society has informed us he's not able to attend this morning, so we will move on to questions.

Before we do that, I want to thank everybody, both those who are present here and those who are present via video conference, for being able to present today with such short notice. I know some of you have had to, in some ways, move heaven and earth to be here today to contribute to this study. I really do appreciate that.

We'll move to questions. First up is MP Zimmer.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Thanks again, everybody, for appearing at committee this morning. I know that for some of you it's early. I guess it's not too bad for us. It's about 9:20 a.m. now.

I want to start off by speaking specifically to Ricardo. You mentioned a few curious things that I would say are definitely paths that I see as important to take in terms of poverty reduction. It's the prevention side of things. Instead of dealing with a condition that already exists, we'd like to prevent that incident from happening. The example that I would use is a car accident. It needs an ER to address the immediate concerns, but there's also a reduction component with education, being in schools, and showing that this is what's going to happen if you drink and drive, etc.

You mentioned you have a section called Pathways to Prosperity. I want you to expand on what you mean by pathways to prosperity. Again, keeping in mind that this is a poverty reduction strategy, can you speak to that?

[Ricardo Tranjan]

Sure. Thank you very much for the question.

Yes, we are in full agreement that there needs to be a focus on both. We have to address immediate needs of residents who do not have enough to eat or don't have a shelter or don't have any way of addressing their basic needs tonight. They need that tonight and not tomorrow, not next week. There's a focus on improvement, and every time doing more for residents in that particular situation. Then there's also a focus on creating pathways to prosperity.

There is an understanding that there are things governments can do to improve and better support those who are taking their first steps toward being a little more stable in their economic and social lives. At that crucial crossroads point, governments need to be in and need to be helping. We need to be providing whatever is necessary.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Ricardo, I'm going to ask for a bit more substance when you're answering that question. You talk about things, but what do those look like? We've heard a lot of the same kinds of conversations about governments needing to do x, y, z. What, specifically, are you suggesting to do? We're looking at real and tangible....

You talked about pathways to prosperity. What do those pathways look like?

[Ricardo Tranjan]

Here are a few examples of the things the City of Toronto is investing in right now and working on.

We have ever more programs focused on youth employment to make sure that kids who are getting out of high school or vocational training or even university can be easily integrated into the job market. We work with our workforce development strategy, which was approved a few years ago. The focus is working on both sides, supply and demand, to make sure that they knit and that everyone benefits from those economic opportunities.

We have a social procurement program, which I just mentioned recently. The idea of a social procurement program is to channel a portion of the city's economic power—or more directly, the money the city spends every year procuring all sorts of services and goods—to organizations that employ mostly, or that provide opportunities for, low-income residents and vulnerable populations.

The transit fare equity pass that the executive committee just approved last week also comes within that package of programs. It will offer to low-income residents looking for jobs, trying to access services, or trying to access programs that can have long-term positive impacts on their lives the opportunity to do so without being impeded by the cost of transit.

Finally, one thing we're working hard on as well is human service integration. It's the idea that our housing services, our child care services, and our social assistance and employment services ought to be integrated. Residents need to be able to walk into one city office and receive all those supports at once and not be sent to different doors or be asked to call different phone lines or fill out different forms. We're trying to integrate these.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Thank you.

I want to ask another question, this time to Ed.

Credit goes to you. This is the mental health section of the poverty reduction strategy meetings that we're having, and you spoke to that. We've asked and you've seen me ask what you see as one of the biggest obstructions on the pathways to prosperity, in terms of mental health. You talked a bit about various aspects, but what would you say are the top two obstacles related to mental health to getting people out of poverty?