Human Resources Committee on Jan. 31st, 2017

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you, Chair.

Welcome back, colleagues.

Thank you to the witnesses for great presentations.

I am from Saint John, New Brunswick, and, obviously, I was thrilled when Minister Duclos came to Saint John on September 3, I believe, to announce that Saint John would be one of the cities in the tackling poverty together study.

Mr. Murphy, for the sake of the committee, can you elaborate briefly on the expectations of the tackling poverty together initiative and how you see that tying in, especially tying in mental health, with respect to the poverty reduction strategy?

[Doug Murphy]

The tackling poverty together project is really looking at qualitative research. It's talking to people, because we can't capture everything through quantitative statistics. It's to do a deep dive into how people in key Canadian communities are experiencing poverty, and how the current programming actually helps them, and where it can be improved.

As I mentioned, it's about talking to people with the lived experience of poverty, and as we know and as we've heard from several people, people with mental health conditions are disproportionately represented in that.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

I'll jump in.

Will you make sure, on the tackling poverty together initiative, that you are talking to a lot of lived-experience people? Is that a priority?

[Doug Murphy]

That's almost the key priority of the tackling poverty together strategy.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you.

Ms. Romano, thanks for the presentation. I thought it was great.

I'm a rookie MP, and we're learning, but one of the frustrations I have at times is that there is a federal initiative, and then it filters through to the province, and at times it gets lost from the province out to the front line.

In your opinion, can you tell me how important it is that the federal and provincial governments, number one, are aligned? Also, what innovations do you see that could actually improve things so that our priorities get to the front lines through the provinces?

[Anna Romano]

Thank you for your question.

I'll speak to some of the programming we have at the Public Health Agency, in particular the maternal and child health programs I referenced earlier. In those cases, we work very closely with provinces and territories. We have a number of joint management committees that determine the priorities for the programming dollars so that we don't have a situation in which there is overlap in what the federal level is investing in and what provinces and territories are investing in. In particular we try to align our investment dollars so there aren't any major gaps.

I think I mentioned in my remarks that our focus tends to be on the most vulnerable and on where we have found there just isn't enough provincial and territorial programming to go around to reach some of those more vulnerable populations.

In terms of innovative approaches, this sounds pretty bureaucratic, but having those joint management committees in which you work together with provincial and territorial colleagues to set priorities has tended to work over the last 20 years for these programs.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Are there any provinces you see that stand above the rest in delivering what's needed?

[Anna Romano]

Off the top of my head, one example is the age-friendly communities initiative that I spoke of earlier. We have an excellent working relationship with Quebec, which has really embraced that initiative. It's found in probably more communities there than anywhere else across the country. It's an example of having kind of led the way, whereas other provinces and territories might have different priorities.

I'm not sure if I totally answered your question.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

That's fine.

I'm going to switch over to StatsCan if you don't mind. I'll read a quick stat. It was in your slides too: “Eleven per cent of Canadians aged 15 to 24 experienced depression at some point in their lives, and fewer than half...sought professional help.”

When I was in my teens, I suffered greatly from anxiety. I can remember being at school, or university, or what have you, and I would never ever tell anybody that I did. If I was given a survey or something like that, or a call, I would never admit to that.

Can you share with me how comfortable you are that you are actually reaching those people. I know the slides are great. There's lots of good information there, but how are you really connecting with those people most in need? My fear in that case—and we'll talk about the homeless shelters in a second—and certainly with those who are experiencing anxiety and depression in their teen years, is that they don't come out. So how do you find them? How do you account for them?

[Dr. Jennifer Ali]

The sampling strategy that we use is a representative sampling strategy. The households are selected and then the people are selected from the household. So we haven't noted—

[Wayne Long, Liberal, Saint John—Rothesay, NB]

I'll just jump in.

I get that. We've been part of those—

[The Chair, Liberal, Bryan May]

Wayne, sorry. I have to cut you off a little bit there.

Can you make it really brief?

[Wayne Long, Liberal, Saint John—Rothesay, NB]

I'll get it the next round.

[The Chair, Liberal, Bryan May]

Okay. Thanks.

We'll move over to Madam Sansoucy.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Thank you, Mr. Chair.

I thank all of the witnesses for their presentations. They have explained very well how poverty can lead to mental health issues, and conversely, how mental health issues can lead to poverty.

Ms. Romano, thank you for your statement. It is always interesting to establish new definitions and to see that we are not reinventing the wheel. The World Health Organization has already documented these things very well.

As you pointed out, we have to remember the obvious, for instance the importance of understanding risk factors properly, whether it be poverty, inadequate housing, the difficulty of finding a job or being able to get an education; however, there are sometimes contradictions regarding these issues. I was surprised by a statistic showing that persons with higher levels of education were at greater risk. Information can sometimes raise questions.

You also said that it is important to look at root causes, because it is often tempting to only address the consequences. In the short term, we deal with the consequences, but as long as we do not deal with the causes of a problem, we will not solve it.

This leads in to my comments for the representatives of the Department of Health. Unfortunately, crises often remind us of the fundamentals, such as how to intervene, best practices, and long-acknowledged methods we need to implement. Unfortunately, crises are what remind us that we have to invest in this regard.

You concluded by speaking about the importance of constant, progressive co-operation, but it seems that there always have to be crises in order for us to remember that. I would like to hear you on the balance there should be between prevention and the necessary reactions to crisis situations. How can we be present on a daily basis in aboriginal communities, rather than waiting for a crisis to erupt before we decide to invest more? I need to hear what you have to say about this necessary balance.

[Sony Perron]

Thank you, very much. That is an excellent question.

I am going to try to provide a reply that is broad enough to address the scope of your question.

At the First Nations and Inuit Health Branch, our public health approach is to try to arrange things so that Inuit and first nations have institutions, or the capacity to provide services on an ongoing basis. I am not only talking about mental health services. Some services also target prevention, such as early childhood services. If we want a truly comprehensive mental health approach, we have to begin with prenatal health. We have to invest to help mothers, fathers, and families so as to provide them with the tools they need to support their children and foster their growth.

We provide a series of programs in first nations communities throughout the country. They are often delivered by the communities themselves. The early childhood programs include prenatal interventions intended to support families and parents. That is extremely important.

I spoke earlier about our direct mental health interventions. That component is extremely important. We have to support ongoing care and issue identification. Primary care in the communities helps to meet the needs as they arise.

The mistake that was made several decades ago was to believe that a sectoral approach managed by the government was the best way to organize services. We learned over time that self-determination, that is to say having the communities themselves control their programs and services, makes an enormous difference in quality and response.

Consequently we developed a mental health framework with the first nations, among others. We start with the basics, by trying to give hope and develop a sense of belonging and also a sense of making a contribution. These are crucial factors needed to repair the elemental fabric of the communities that was destroyed by colonization policies applied by our institutions for many years. And so broad-based action is needed for redress.

Over the past few years, our mental health approach has been to fund what we call mental health teams. They are comprised not only of social workers, psychologists or psychiatrists, but also include elders from the community. These grandparents or other persons intervene in a more traditional way. We try to combine all of the best health care practices used in the population. We integrate tradition and culture. We try to reconnect with the essentials. That is what was to some extent destroyed, and that is what undermines the resilience of families and communities.

I would say that 90% of the services provided and funded by the federal government in first nations communities are controlled by the communities themselves, through first nations organizations.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

That approach reflects well on you.

Earlier, with a great deal of diplomacy, Ms. Romano answered a question regarding areas of provincial health jurisdiction. Eva Ottawa, who was appointed chair of the Quebec Council on the Status of Women while she was the Atikamekw Grand Chief, told me how difficult that situation is. Whether we like it or not, even if supporting the health of first nations is an area of federal jurisdiction, the situation is not simple. In Quebec, for instance, because of the youth protection system, children from indigenous communities were placed in non-indigenous foster homes. And so those children were completely uprooted.

Given that health is a matter of provincial jurisdiction, one wonders how that goal of involving first nations in all areas can be realized. That remains to be seen.

[The Chair, Liberal, Bryan May]

We're well past the time, I'm afraid. I let you go on there. Maybe we can come back to that question in the next round. We'll move to MP Robillard, please.

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

Thank you, Mr. Chair.

My question is for Mr. Perron.

We know that there are specific cultural factors in each indigenous and Inuit community. Witnesses have told us that there is a direct link between the fact of being able to hold down a job, mental health and poverty reduction.

What is your opinion on this?

[Sony Perron]

It has been abundantly shown that employment conditions, education and social circumstances have an impact on mental health. That is clear. That is why the approach to mental health of the First Nations and Inuit Health Branch, developed with the first nations, is a comprehensive approach. Through it we attempt to cover all of these factors. We work with the communities, identify risk factors, and determine a service offer that aligns with all of that.

We cannot expect to solve mental health issues by only responding to crises or by deploying teams at certain given times. Services have to be available on an ongoing basis, and basic issues have to be dealt with. Housing, the level of available services in the communities, and education are essential factors if we are to achieve concrete results in improving mental health.

Specific, one-time interventions with mental health professionals will not bring about in-depth change in the communities. That is why Budget 2016 investments in the construction of new housing are an essential element. Indeed, when 15 or 20 family members live in the same swelling, additional problems will arise.

Investing in education is also extremely important. I think it is the responsibility of the Department of Health to work with the communities to ensure that mental health services are available. To obtain concrete results Canada-wide, it is crucial that we invest in the social determinants of health.

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

Thank you.

Mr. Murphy, the Housing First program of the Homelessness Partnering Strategy, or HPS, is targeted to persons who are either chronically or episodically homeless.

Is there a way of structuring a similar program aimed at persons who need similar mental health and other supports but are not yet homeless, in order to prevent them from falling into homelessness?

[Doug Murphy]

I'm just being handed something by my colleague.

The link right now is the homelessness issue. Whether that approach, like the wrap-around services, can be applied when homelessness is not the fundamental issue, I think is your question. That I will have to get back to the committee on. The Housing First approach, or the wrap-around services, dealing with the mental health conditions in the federal domain, has always been seen through the lens of homelessness, as the core aspect of our homelessness partnering strategy. To extend that when there isn't homelessness but there are mental health issues, I'm just not in a position at this point to respond. But it is an interesting observation.

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

Could you provide us with a complete answer further on?

[Doug Murphy]

Yes.

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

Mr. Chair, I am going to share my speaking time with Mr. Wayne Long.