Human Resources Committee on Jan. 31st, 2017

[Pierre Poilievre, Conservative, Carleton, ON]

The associational data is not particularly useful unless there's causation.

[François Nault]

I agree, but the limitation is, I think, mostly cost. Launching those surveys is very costly. They are long-term. We have run a number of them in the past, where we follow people every second year or every year, and so forth, but right now I think we only have one left, and it's more about—

[Pierre Poilievre, Conservative, Carleton, ON]

It would be a matter of finding out which comes first: unemployment or the disorder. If someone loses their job and then develops a disorder, then that's an indicator that the job loss was the cause and the disorder the effect, and vice versa.

A term used here is called “permanently unable to work”. There are 300,000 Canadians who are either severely disabled or very severely disabled who do work. How do we define “permanently unable to work”?

[Dr. Jennifer Ali]

In this survey, it was the people who are not in the labour force, unemployed, retired for reasons other.... Sorry, that's “No work”.

It's how they defined themselves and if they said they were “permanently unable to work”. It does not include people who are not in the labour force, unemployed, or retired for other reasons.

[Pierre Poilievre, Conservative, Carleton, ON]

Do we just ask respondents, “Are you permanently unable to work?”

[Dr. Jennifer Ali]

It was part of the questions about their labour force status.

[Pierre Poilievre, Conservative, Carleton, ON]

So just to be clear—

[Dr. Jennifer Ali]

If they said “Yes”, one of the response categories was “permanently unable to work”.

[Pierre Poilievre, Conservative, Carleton, ON]

Basically, the respondent indicates that he or she is permanently unable to work, and then you record it as such.

[Dr. Jennifer Ali]

Yes, they self-identify.

[Pierre Poilievre, Conservative, Carleton, ON]

According to your data there is a relationship between marital status and disorders. Have you done any longitudinal work to ascertain causality in that area?

[François Nault]

I'm afraid it is the same answer. As much as it would be fantastic to follow someone to see if someone goes from married to divorced, divorced to married, or single to married, and if the disorder has then changed or is reported changed. Again, we only have cross-sectional surveys.

[Pierre Poilievre, Conservative, Carleton, ON]

Back to the causality between unemployment and disorders, I realize the cross-sectional survey before us does not provide us with that causality. However, is there other data in the possession of Stats Canada that can be used or matched up to indicate such causality?

[François Nault]

That's a very good question. Stats Canada is exploring administrative data as much as possible and linking that data. For instance, we would have discharge abstract data from hospitals. If someone has been in the hospital, we know the reason, so we can probably monitor something in that sense with the information on the admin record.

[Pierre Poilievre, Conservative, Carleton, ON]

With the permission of the chair, given that you seem to be indicating that there might be such data and that such analysis might be possible, I would like to request that Stats Canada get back to the committee indicating its capacity to show levels of causality between unemployment and mental health disorders.

[François Nault]

I will look into getting it for you, but I'm a bit pessimistic that we will be able to show any causality. The exploration we are doing with admin data is really new, ongoing, and innovative in a way, but the information from administrative is also limited. So, I don't think that's so. On the file I described, the hospital data, I don't think there's anything about the person's employment. Can we link back to the census? Can we infer some causality if someone is employed on the 2011 census? If we find the person is hospitalized for a mental health reason, can we infer some causality there? I don't think that will happen.

But I will do my homework, and I will check with the analysts in StatsCan.

[The Chair, Liberal, Bryan May]

Thank you so much.

Now we'll go over to MP Sangha, please.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Thank you, Mr. Chair.

Thank you, everyone.

My first question is for Mr. Sony Perron.

You may answer or Dr. Patricia Wiebe may answer this question. During your submission you talked about first nations cultural involvement. You want to build resilience in the culture. You talked about putting the communities first to identify the issues. You also talked about the framework that you want to work with to do that.

The first nations mental wellness continuum framework has been jointly developed by first nations, the Inuit health branch of Health Canada, the Assembly of First Nations, as well as indigenous mental health leaders from the various first nations non-governmental organizations. This framework you're talking about is a coordinated comprehensive approach to mental health and addiction programs.

Can you give the committee further details of the main, key factors you are talking about for this framework that you are going to put into the community?

[Sony Perron]

Thank you.

I will say a few words to introduce this, and then I will ask Dr. Wiebe to maybe get into what is in this framework. First, following this committee appearance, we will bring to the clerk, if the chair agrees, a summary document that explains what the framework is about, because it's very comprehensive and we would not be doing it justice if we tried to explain in this room in a minute or two what the framework is about. We have a document we can give to the clerk for the information of the committee.

Second, we are basically using the framework to guide any of our actions. When we are putting new programming out, when we are working with partners to strengthen existing programming, we try to reposition this work in the framework. We are trying to revamp the old way of providing services and organizing programs and services in a way that is more comprehensive.

We did the co-development process with indigenous leaders. We worked with partners across the country to do that, and now we have a guide. There is less focus on what we should do and how we should do it. It's rather how we implement it now. This is what we are focusing on and we have a table that helps us to advance and support the communities to get the tools to do the work right under this framework.

I will ask Patricia to maybe talk a little bit about what is in this framework if the member of the committee is interested.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

I think it would be a good idea to give the committee the complete paper on the framework so that the committee can look into that. Thank you.

The whole framework will be helpful for the committee to look at the issues regarding the poverty reduction strategies, which we are studying now.

[Sony Perron]

I think while it's very specific to first nations, the notion of having a framework that is comprehensive and that looks not only at the services themselves but at how we bring together all the elements that have an impact on the wellness of individuals, families, and communities is very important in the end.

I think we should always approach this really sensitive work around mental health and mental wellness with an attempt to understand where those who are targeted by these programs and these services are coming from. I think this is an example that is first nations-based. We are working with Inuit organizations to develop a similar tool that is Inuit-based, recognizing that the culture is very different and it needs to be adapted.

There might be some commonality and there will likely be commonality, but I think it's the adaptation that makes the difference. Approaching everybody with the same kind of filter and lens doesn't get the right results.

Patricia, do you want to add anything on this?

[Dr. Patricia Wiebe, Medical Specialist in Mental Health, Population Health and Wellness Division, First Nations and Inuit Health Branch, Department of Health]

Thank you, Sony.

If there are specific questions on the details of the framework, I'd be happy to speak to those, but essentially it's grounded in the social determinants of health, with culture as the foundation. Ultimately, first nations' partners have identified evidence to support hope, belonging, meaning, and purpose as the outcomes of how culture underpins all that we do.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

So your main issue is that you want to go deep into the cultures and take the families with you and then involve them in the total framework and get things resolved?

[Sony Perron]

I think the basic principle within the framework is the recognition that people feel good, empowered, and well when there is a sense of hope for the future. This means that they contribute, that they are grounded, and that they can support their communities and their families. We have to work on these essential elements.

This comes with mental health support as well as with a number of other actions that will bring what we call “wellness” into these communities.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Prime Minister Trudeau recently met with the indigenous leaders in the north to discuss the growing suicide rates there. Across the country the rate of suicide among indigenous youth is five to seven times the national average, and it is eleven times the national average in Inuit communities.

Can you explain the factors contributing to the challenge of national aboriginal youth suicide prevention that he is faced with?