Human Resources Committee on Dec. 8th, 2016

[Ricardo Tranjan]

Thank you for the question.

On top of the programs that I already mentioned—the social procurement program, our youth employment programs—the Toronto poverty reduction strategy has directed its staff to develop a job quality assessment tool. Next spring we'll be bringing to council a framework on how to better assess the quality of jobs in the city, and also some recommendations on how to move forward on improving those jobs.

The strategy also endorsed the concept of a living wage, and staff have been working on, studying, and examining the feasibility of further promoting a living wage in the city of Toronto.

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

Thank you.

Ms. Murphy, do you have anything? Others around the table may respond as well.

[Kelly Murphy, Policy Development Officer, Social Development, Finance and Administration, City of Toronto]

Thank you.

I will add to Ricardo's observations about the job quality tool that when we look at the literature internationally, we recognize that the dimensions of a job that make for well-being for the employee include wages and the benefits associated with the job. With the increase in the precariousness of work, we're seeing fewer and fewer opportunities, particularly for young people, to access benefits that would include a medicare program.

The level of a living wage is an algorithm that links wages and the benefits that are attached to that job. If there were opportunities for the federal government to provide a basic safety net associated with pharmacare, that would give more flexibility to employers to have a range of wage levels that would make it.... In an economy like Toronto's, there is anxiety in the employer community about raising wages too much. If the federal government were providing a pharmacare program, that would balance the benefits package to some extent.

[The Chair, Liberal, Bryan May]

Thank you very much.

[Michael Creek]

Could I add quickly to that?

[The Chair, Liberal, Bryan May]

Sure. I'll give you a couple of seconds. Go ahead.

[Michael Creek]

I think pharmacare is a wonderful idea, but I think other priorities should happen first, given the tremendous number of homeless people that we find now with mental health problems and addictions. A pharmacare program wouldn't help them at all. I think you have to look at what you're going to ask for first. I think there are a whole series of things you would have to go through at the federal level that should have priority over a pharmacare program at this point.

I'm only speaking from my experiences of living in poverty and being homeless. The pharmacare program is important, but nobody at this table has mentioned anything about recovery and non-medical practices, which are extremely underfunded but have shown extremely good practices within mental health and addiction. I think those programs also need to be funded. They would fall into a pharmacare program.

[The Chair, Liberal, Bryan May]

Thank you for adding that.

Now we have MP Robillard for six minutes.

[Yves Robillard, Liberal, Marc-Aurèle-Fortin, QC]

Thank you, Chair.

I would like to thank all our witnesses for joining us this morning.

My question will be in French, and I will share my time with Mr. Sangha.

My question is addressed to Mr. Mantler and concerns aboriginal communities.

Every aboriginal community has its own particular issues. In an effort to innovate, the government encourages the common use of exemplary practices, but we can do much better.

My question is simple. Recognizing the need to promote better mental health, how can the federal government encourage innovative approaches to fight poverty among aboriginal people? Moreover, how can the federal government help to provide better mental health services and programs to those same communities?

[Ed Mantler]

The At Home/Chez Soi project that I spoke about earlier took place in five pilot sites across the country. The pilot site in Winnipeg was one that had a particular focus on indigenous communities, due to the demographics of that population. It was successful because it was done in partnership and with the leadership of the indigenous community walking alongside, rather than by imposing interventions.

Through that process, we learned a lot about cultural humility, about how to work in partnership, and about the spirit of good partnership with the indigenous community. We've taken that learning and have worked on other specific initiatives alongside indigenous communities. Headstrong I spoke about, mental health first aid, the development of specific programs for first nations and Inuit communities.

Seeking innovative solutions means going to those communities and looking at what can be found within the community and within indigenous knowledge, whether it's remote rural communities or urban communities, and it must be pursued in partnership as the Mental Health Commission seeks a process of reconciliation within indigenous communities. We stand ready to work alongside the national, provincial, and local indigenous organizations, if and when invited.

Those are the two keys. The learning that I think the federal government can also take some knowledge from is that it's not an imposition: it's walking alongside, and it's done by invitation.

[Yves Robillard, Liberal, Marc-Aurèle-Fortin, QC]

Thank you very much.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Thank you, Mr. Chair.

My question is to Vicky, from the Centre for Addiction and Mental Health.

Immigrants and refugees coming to Canada are going through rough challenges. They're coming here after persecution in their countries due to war and other experiences. After coming here, they are under trauma. According to St. Michael's Hospital in Toronto, 20% to 50% of refugee children and youth suffer from post-traumatic stress disorder.

My question is, what program do you suggest we can implement to combat PTSD in this early stage? Could you talk about low-income families? You talked about how it is more common in low-income families. What do you suggest to the committee?

[Dr. Vicky Stergiopoulos]

Thank you for your questions.

Immigrants and refugees to Canada are at a higher risk of experiencing poverty as well as at a higher risk of experiencing homelessness and mental health sequelae, both from the experiences that brought them to Canada as well as from the difficulties in adjusting to Canada.

Easy access to mental health supports is instrumental for these communities, as are the other strategies that we talked about for combatting poverty and enabling social inclusion. Better access to treatment for post-traumatic stress disorder and better access to structured psychotherapies that are culturally informed and that are working are key. It is also key that we prepare our workforce, our mental health workers, to give them the cultural competency they need. We also need to use a variety of approaches, including approaches that are informed by anti-racism and anti-oppression frameworks of practice, so that we see people we work with as equal partners in recovery.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

You talked about how the federal government should work with the provincial and municipal governments in order to achieve better outcomes in poverty reduction. What do you suggest for how the federal government should align a reduction in poverty with the other provinces, municipalities, and territories? How do you think the federal government should align with them?

[The Chair, Liberal, Bryan May]

Give a very brief answer, please.

[Dr. Vicky Stergiopoulos]

I think that the opportunities for the federal government to align are through two initiatives. The first is the national housing strategy, which gives us an opportunity to invest in affordable, supported, and supportive housing. The other opportunity is through the health accord. Mental health services have been underfunded for years in Canada. I think it is about time that we corrected this inequity.

[The Chair, Liberal, Bryan May]

Thank you very much.

We'll go to Filomena Tassi for six minutes, please.

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

Thank you to all the witnesses.

My first question is to Dr. Stergiopoulos. The Canadian Mental Health Association states that 10% to 20% of Canadian youth are affected by some form of mental disorder or illness. As a youth counsellor, I think that's conservative.

My question to you is, what do you think the federal government can do for vulnerable transitional youth with mental health issues who are at risk of falling into poverty and homelessness? Please give specific recommendations and suggestions. I know you've talked about investing, but what does that look like?

[Dr. Vicky Stergiopoulos]

I think it's about investing in programs that are aimed specifically at this population.

You are correct that 70% of mental health conditions emerge in youth and young adults. I think targeted investments in this particular age group can go a long way.

First of all, we need to help them stay in school, finish school, secure employment training, have access to jobs, and have access to the mental health supports they need to succeed in these endeavours. CAMH has three innovation centres focusing on children and youth. Some of them have a national scope in trying to understand how we can serve transitional youth, address those social determinants and mental health conditions, and succeed. We're happy to share the work that we're doing across Canada in this area.

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

Do you have any recommendations for youth? I know a number of youth who struggle with mental health issues but who don't come forward and voice those issues. How do we help those who, because of the stigma or because they're just embarrassed, come forward and share their issues so that we can offer the help they need?

[Dr. Vicky Stergiopoulos]

I think there are a number of avenues to do that. First of all, it's to have a no-wrong-door policy that mental health can be talked about at school and be supported at school, at work, or at the places where youth go, such as community spaces and social spaces.

The other opportunity that has emerged is through social media. The future of mental health care will be relying heavily on engaging affected people through web-based applications, so that they can anonymously find information about mental health and can get counselling around mental health. We can develop innovative ways of engaging individuals who may otherwise be reluctant to engage.

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

Thank you.

My next question is for Ms. Khalid.

We know that more women than men live in poverty, so I'd like to hear from you what role you believe community-based mental health services play in ensuring housing stability and homelessness prevention for women.

[Lubna Khalid]

Thank you very much for the question.

I think it's about awareness in the community. The more we have awareness, the more people are engaged in listening to each other. I also think the peer-based approach is something we need to focus on more, because coming from a South Asian community, I know it's easier for us to relate to each other if we are seeing one person doing something or talking about something and being engaged. It motivates the other person. I think that needs to be focused on more.

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

Thank you.

I know there are many great shelters for women. I represent Hamilton, and I know the YWCA there does some fabulous work for women. They have a variety of programs designed specifically for women.

I would like your comments with respect to whether the federal government needs to amplify these sorts of programs and how investing in shelters helps women's mental health. One of the frustrations is that the sustainability of funding seems to be a problem. Ms. Khalid and Dr. Stergiopoulos, could both of you comment on that?

[Dr. Vicky Stergiopoulos]

I can start.

When we look at the unique needs of women, it's important to recognize intimate partner violence and the need for women to be able to escape abusive relationships. What we see now is that women tend to stay in these relationships and put themselves at risk for fear of actually experiencing homelessness, so supports around that and supports for women who are living in an abusive situation are instrumental, as is raising awareness of intimate partner violence and supports available to women.