Human Resources Committee on Dec. 8th, 2016

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

It's a great suggestion. Thank you very much, everybody.

I think I'm out of time.

[The Chair, Liberal, Bryan May]

You are. Thank you, sir.

Now we have Ms. Ashton for six minutes.

[Niki Ashton, NDP, Churchill—Keewatinook Aski, MB]

Thank you very much.

Perhaps going to the team in the City of Toronto as well as Working for Change, one of the areas that we broached more broadly—not necessarily our committee, but certainly as parliamentarians—is that adequate supports don't exist for those who are struggling with mental illness and with addictions as well. We know that harm reduction is an important way of empirically helping people who are living in these situations, but we know that there are immense challenges, certainly legal ones, when it comes to providing the kind of harm reduction services that are required, whether it's safe injection sites or whether the kind of medical work that needs to be done. Of course, as we know, when there isn't that help, the cycle of poverty, addiction, and mental illness continues for people in these situations.

I'm wondering if, perhaps, you see the need for the federal government to further support harm reduction and lift the legal barriers and the legislation that's in place that prevent safe injection sites from opening. Is this an important way of dealing with poverty and mental health?

[Kelly Murphy]

As you know, the Board of Health and the City of Toronto have endorsed a harm reduction approach across many domains and submitted an application, I think the second in Canada, to establish safe injection sites in Toronto. We've identified, through research, the cost-effectiveness and the safety and the health benefits of having safe injection sites in Toronto in three different locations. We welcome the lifting of the restrictions and welcome the opportunity for the federal government to provide further leadership in supporting this direction for urban and rural environments and communities that need the support that has come through harm reduction.

[Ricardo Tranjan]

As well, more broadly, we welcome the general approach of trying to work together to find practical solutions to issues that often fall through the cracks where there is no jurisdiction for them. I think the federal government has already indicated that the collaboration of the Canada poverty reduction strategy review involved a lot of community engagement and engagement with stakeholders such as the City of Toronto. Overall, their approach is a great one, and we are looking forward to participating more actively in answering very concrete questions like this, and others related to poverty reduction.

[Michael Creek]

I'll quickly add, because I'd like to hear what Dr. Vicky has to say, that one of the things I see still reoccurring is the stigma that is attached to addictions and approaches around harm reduction. I think we still need to do a lot of education with physicians and health care professionals, but also with society in general, about what addictions really are and how we view people.

Often we attach blame to individuals who find themselves addicted, and I think that if we're going to find success, if we don't address the addiction issue, we'll get a lot of resistance from the general public to funding these programs, and those programs are essential for the wellness of those people in those communities.

[Dr. Vicky Stergiopoulos]

I think there is definitely a great aim to include harm reduction strategies in greater and bigger addiction strategies. I think we have a lot to learn from B.C. and the progress they've made in their supervised injection site. In Toronto, we had the first managed alcohol program in a shelter. Since that, others have been developed in different cities in our country.

However, I agree with Mike. We have a lot more work to do to combat addiction stigma and discrimination for people who use drugs. If people with mental illness experience discrimination, it is much worse for those whose main issue is substance use.

[Niki Ashton, NDP, Churchill—Keewatinook Aski, MB]

Thank you, Doctor.

I'm not sure, Mr. Mantler, if you have any comments on the need for support on harm reduction from the federal government.

[Ed Mantler]

When it comes to the interplay between mental health and addictions or substance abuse issues, we work in partnership with our sister organization, the Canadian Centre on Substance Abuse. If the committee has not heard from that organization, I would advise that it may be something to consider.

[Niki Ashton, NDP, Churchill—Keewatinook Aski, MB]

Thank you.

[The Chair, Liberal, Bryan May]

You have about 30 seconds.

[Niki Ashton, NDP, Churchill—Keewatinook Aski, MB]

Thank you for your thoughts on that front.

If you know of others who could send in a submission to support the message around the need for federal support for harm reduction and safe injection sites, please let them know to send us a written submission as well.

[The Chair, Liberal, Bryan May]

Excellent. Thank you.

Ms. Tassi, you have six minutes, please.

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

Thank you, Chair.

Mr. Creek, I loved your suggestion about incorporating seniors into university campuses and residences.

As a chaplain, I've connected youth with seniors through shopping trips. At Christmas we've connected the two together, and we've also gone to homes for seniors. I have to tell you that what happened there was absolutely magical.

However, Mr. Mantler, I recognize your point about the diagnosis. What often happens with seniors is that there's no indication that depression or loneliness is going to hit. They live healthy lives, and then all of a sudden their friends pass away and they're on their own, and this is what happens. The diagnosis part is so important, but the other frustration is that the waiting lists are too long with respect to psychiatric care for seniors.

Can you offer some suggestion with respect to that? How do we engage more people to take this up as an area of interest, to pursue education in this area, or to have people come to Canada who have expertise in this area to help our seniors?

[Ed Mantler]

I would say that more impactful than bringing in specialized seniors care providers would be to better equip family physicians, general practitioners, the broader range of health providers, and the broader range of people who work regularly with seniors, even outside of the health care realm, to recognize the signs of possible mental illness and know what to do with them.

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

Okay. Thank you.

This question is for each of you to comment on.

We have connected mental health with poverty because we've heard from some witnesses that it's the single most significant contribution to poverty. Not everybody would agree with that statement, so in our recommendations we have to be assured that we can say mental health is an issue that needs to be addressed in a poverty reduction strategy. Can you provide evidence, through either numbers or experience, that makes that link very clear?

Mr. Mantler, would you like to go first?

[Ed Mantler]

Among homeless individuals, 67% are experiencing a mental health problem or illness.

[Dr. Vicky Stergiopoulos]

We know from research that people with mental illness have lower incomes, are less likely to work, and are less likely to have adequate housing compared to people with other disabilities or to people without disabilities. We can send you these studies.

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

Thank you.

[Michael Creek]

As a person who has experienced poverty, it played a role in my mental health.

I can't imagine any person I've talked to who has lived in poverty who hasn't experienced some sort of mental health difficulty through that whole process. It's just impossible for it not to happen. You become so dehumanized in the process of poverty that all of these mental health issues or addiction issues rear their ugly head. I'm a survivor of cancer, and I can tell you that poverty caused me more damage than my cancer treatment or other illnesses I've faced. In itself, poverty could be described as an illness also.

[Lubna Khalid]

I just want to add violence against women as one of the factors causing poverty for women and children.

Again, there is a need for more shelters for women who are fleeing abuse. Every given day, there are more than 300 women and children in Toronto who cannot find a place to sleep.

[Ricardo Tranjan]

In Toronto, 18% of the adult population lives in households with an income below the low-income measure. That figure goes up to close to 30% for residents who have physical or mental disabilities, and there are good reasons to believe that this is an underestimation.

[Kelly Murphy]

We know that people with mental health issues are overrepresented among low-income Canadians. We can give you the statistics.

We can also give you the stories. The 2,000 community members who helped design the poverty reduction strategy in Toronto have shared their narratives about living with the stigma of mental illness and the stigma of poverty, and how those compound. We can share those narratives with you.

[Filomena Tassi, Liberal, Hamilton West—Ancaster—Dundas, ON]

That would be great. Thank you.

Mr. Tranjan, you spoke earlier about StatsCan and the importance of their also studying non-material poverty data. Can you expand on that point a bit for us?

[Ricardo Tranjan]

Yes. We now use the low-income measure or LICO as indicators of poverty in our cities. They capture part of the story, but they don't capture the entire story.

As has been mentioned before, there are other aspects of both material deprivation and social inclusion. There are key components of the fuller experience of poverty that right now are not adequately addressed or captured in the statistics that we are using.

I think previously you had witnesses who referred to the Caledon Institute who mentioned the same issue. They have been doing really good work that demonstrates the need to combine income-based indexes and material indexes to have that full picture that will help us work better and evaluate the work we are doing, especially.