Human Resources Committee on Dec. 13th, 2016

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Do you think these programs add any value to the national poverty reduction strategy?

[Tracy O'Hearn]

I think we need more time to assess that.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

I have a second question. You said you are going to give copies of the website to us, but it suggests that more than 70% of the 53 Inuit communities across the Canadian Arctic do not have safe shelters for women. It further suggests that mental health is the main health concern facing Inuit communities. This includes a variety of issues associated with violence, abuse, and unresolved trauma.

In your opinion, how effective is this program? What further initiatives can we implement to create accessible mental health services for first nations and Inuit communities?

[Tracy O'Hearn]

The recent Inuit suicide prevention initiative is a great start. I know mental health has been identified by the Inuit regions as the number one priority for a number of years, but there hasn't been an investment of resources to develop programs. We need to look at innovative ways of delivering services. For example, in Akulivik, as Mr. Robillard mentioned earlier, it's not realistic to have a full range of mental health supports and other supports, so we would welcome an opportunity to look at innovative delivery. Telehealth is used to a certain degree in Nunavik. It's not face to face, but at least it's a bit of a bridge between somewhere like Akulivik and specialists in Montreal.

We need a mental health strategy for this country, and we need a first nations-, Inuit-, and Métis-specific component to a national mental health strategy.

We need a national housing strategy and program in Canada. That would certainly contribute to a comprehensive and informed approach to increasing even simply the number of housing units available.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Do you think the steps taken by the federal government at this time are working?

[Tracy O'Hearn]

They're a start. We're only a year past the election. You know, it takes time. It took time for Minister Philpott to work with partners including the Inuit Tapiriit Kanatami. It took time for her to work with those partners to develop the national Inuit suicide prevention initiative. They are now just starting the delivery, so it's too early to say. Any such initiative would be only welcome and helpful.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Do you have any suggestion for children with mental health conditions that can be improved in due course?

[The Chair, Liberal, Bryan May]

I'm afraid that's time. I'm sorry. If you had a brief answer...but I think that would have been more of an in-depth one.

[Tracy O'Hearn]

My answer would be that I'm not a clinician, and that there are other experts who would be more than happy to speak with you.

[The Chair, Liberal, Bryan May]

Fair enough.

Excellent.

We move now to Mr. MacGregor for six minutes.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thanks, Mr. Chair.

Ms. O'Hearn, your organization has done some really important work in the area of HIV/AIDS. We know it's a serious issue in northern and Inuit communities, and I think it's obvious that it's, in some ways, connected to mental health and poverty. There's a real stigma attached to it and so on. From the important work that your organization has done on this front and the on-the-ground expertise that you have, can you tell this committee what the federal government should be doing on this front to support Inuit women and communities, please?

[Tracy O'Hearn]

Thank you for that very specific question.

We hope the federal government will continue working with us, because unfortunately, as of March 31 next year, 20-plus years of Pauktuutit Inuit-specific work on HIV and sexual health will come to an end. We're trying to hold discussions with Health Canada and other officials. There's a need, as there is with any population, to continue raising awareness and providing information, resources, and tools each year to youth who are coming up, entering maturity, and becoming sexually active. That has to be sustained. It cannot be done through an annual project-based approach, which is also subject to the changing criteria of funding departments.

Broadly, I believe in Health Canada with regard to its 90-90-90 commitments around HIV, and globally, with regard to its contribution to the UN AIDS fund at the recent global pledging conference. We would look for the same level of commitment to addressing HIV and STBBIs, sexual health broadly, and mental health as it relates to sexual health and conversely, as it contributes to increased risk behaviours that can lead to unprotected sex. We know there's a lot of unprotected sex going on in Inuit communities as evidenced in part by the highest STBBI rates in the country. We hope the federal government will continue to work with us.

Thank you very much for your question.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

I'm doing work on another committee, the Standing Committee on Justice and Human Rights, and our current study is looking at access to justice and specifically at legal aid. We have heard testimony and we've received briefs regarding the strong correlation between access to justice and how marginalized groups really don't have that.

When you look at the clients you serve, the communities you serve, what's the status of access to justice in northern communities and how does that affect poverty? Is that a poverty reduction strategy that could be employed? I'm talking about the current funding and whether you believe it's adequate for the people you serve.

[Tracy O'Hearn]

Our funding is not adequate. I wish I could be more informed for you, but we haven't had a working relationship with Justice Canada or Public Safety Canada for a number of years at this moment. We're not a service delivery organization. We work nationally. One thing we're very good at is communicating and developing plain language resources in English and Inuktitut that, hopefully, people across the Arctic can use. We would welcome appearing before the committee for a fuller discussion. I think there are absolutely links between mental health, poverty, crimes of opportunity, and crimes of necessity, but that's a subject for a much fuller discussion. Speaking for our organization, I will say that we need more evidence around that.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Yes, because one of the things we've seen is that there's been more of an emphasis on legal aid for criminal cases than civil cases. Of course, women tend to be involved a lot more in civil cases, as in the defence part of it, getting legal aid to try their civil cases.

I am just wondering if, in that aspect, you have seen any results among Inuit women.

[Tracy O'Hearn]

There's extremely limited access to justice in the communities. Nunavut is primarily served by the circuit court system, so that's a major obstacle to access to justice, for not only women. There's a shortage of judges in Nunavut who are able to hear and dispense of cases. There are some really fundamental issues around access to justice across Inuit Nunangat.

I would be remiss if I didn't take this opportunity to at least touch upon the issue of human trafficking, the commodification of sex. Far too many Inuit women find themselves in cities like Ottawa, Montreal, Winnipeg, Edmonton, without the education or contemporary survival skills for life in the city. They are far too often very vulnerable, frankly, to being preyed upon by human sex traffickers and being forced into marginalized and very risky circumstances.

That absolutely links to the administration of justice. I can't really speak to legal aid. I'd welcome a further conversation.

[The Chair, Liberal, Bryan May]

Thank you very much.

Now, for six minutes, We have MP Tassi, please.

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

Thank you, Mr. Chair.

I'd like to go back to Dr. Fitzgerald and your comment about mental health being of national interest. There's no question about that, and also the connection made here by a number of witnesses between mental health and poverty. We know in terms of mental health that there's a moral argument as well as an economic argument for investing in it. I'd like to focus a little on the economic advantages to early intervention.

For you, as well as Dr. Lipman, can we talk a bit about the economic advantages of early intervention, in essence convincing a government to invest because at the end of the day they save by early investment? Then, secondly, what about the the innovative strategies? What can you say to us, as a federal government, in the way of coming up with a strategy or an idea that will give us the best result for our money?

Dr. Fitzgerald, I liked the idea that you mentioned about best practices and the sharing of those practices. That may be one example. Does that go on, and if not, why?

The two questions essentially for the two of you are, the economic advantages of early intervention, and innovative strategies in this area to give us the best result for our investment.

[Dr. Peter Fitzgerald]

I'll maybe tackle the first part, and Dr. Lipman can tackle the second.

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

Very good.

[Dr. Peter Fitzgerald]

We know now, and have known for probably over a decade, that most mental illnesses begin in early childhood, so intervening early and aggressively gives us the best outcomes, whether it's in the childhood years or as young adults and beyond. The investment has to happen early. We need to get upstream of this problem. Once we get to older teenage years or young adults, we've lost that window of opportunity. We haven't lost it completely, but it's going to cost a lot more. You're going to have impacts on the justice system at that point, the welfare system. Early intervention really is the key piece, as we've pointed out earlier.

With regard to overall strategies, I'll let Dr. Lipman chime in. However, I would again say that's not an easy answer. You need the evidence to see where your best opportunities are. I think a national approach to that is important.

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

Dr. Lipman.

[Dr. Ellen Lipman]

In thinking about strategies, it makes sense to think across a whole variety of levels. I think some of the strategies may be things that are already in place. For example, in Ontario and in other parts of Canada and also internationally, there is the early development instrument. One of the leaders of that is in Hamilton at the Offord centre, Magdalena Janus.

That basically is an opportunity to assess kids in senior or junior kindergarten to see where they're at compared with what you would expect of someone of that age and stage, academically, socially, and those sorts of things. I think there are monitoring systems that can be put in place so you can at least identify kids early, who may be having some difficulties. This is one idea.

Again, I see it as a pyramid. Things can be available in the community that can help many parents that have to do with evidence-based parenting programs and other sorts of educational things that all parents can go to, any parent who is unsure about what's going on, or parents whose kids have significant difficulties at that stage. Then you move up the pyramid to other kinds of more specialized services. Everyone doesn't need to get to the top of the pyramid, but we need more opportunity to offer stuff broadly to people in the community who are feeling the need to get it and then move up so that the specialized services are used in the way that makes the most sense.

I think we also need to think about the fact that everything does not have to be a face-to-face interaction. I think there is definitely a lot of good and bad information on the Internet. There are evidence-based interventions that people can use to start to think about how they manage their anxious or depressed thoughts. I think the idea of using the Internet, and sometimes Internet-based interventions, can be helpful as well. We really need to move in that direction.

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

Yes, my personal experience is that the stigma around mental health prevents a lot of youth from accessing the support. In my own community we had a young woman who lost her life to suicide and there was no call for help from that particular young girl. A lot of students would walk by my office and not come in, and I think it is the stigma around it.

What specific things can we do to help alleviate or get rid of this stigma? Some of the suggestions you're making are wonderful in terms of parents and the Internet. Do you have any other specific suggestions?

[Dr. Ellen Lipman]

I think that having it as part of the curriculum at school makes sense. If you're in high school, in grade nine you get this, or you get it in grade 10 or grade eight or something, and it's talked about in the same way as history, health education, or that sort of thing.

My personal experience is that I had a patient who went to something in high school where they talked about it and then he went to his guidance counsellor and said he thought he had a mental health problem, so that was a way for him to seek help. If it's part of the regular curriculum, I think that could be helpful.