Human Resources Committee on Jan. 31st, 2017

[Sony Perron]

This is a really difficult question.

I would say that the historical legacy of Indian residential schools and those policies are at the foundation of this. That's why the focus on culture and rebuilding culture, and giving back control to first nations and Inuit organizations to build their own programs and services is very important.

The Prime Minister met with leaders last summer to talk about this. Since then, a number of sad events have happened. Of course, since last June we have been implementing additional investments in mental wellness across the country. This includes three important elements.

First is sending a mental crisis intervention team to be able to support communities that are facing a crisis. This is the surge capacity when there is a crisis.

Second are the mental wellness teams to build ongoing service and support; to develop strategies at the community level; to be able to deal with it, prevent it, redress it, and to deal with healing prior to a crisis. It's not only crisis response.

The third element was a crisis line to enable people to reach out in their language, in English, in French, in Inuktitut, or in Cree, and to be able to access a counsellor at all times, 24 hours per day, if they are facing a crisis.

There were a number of preventive actions taken last summer, but also a number of responsive actions to the stage of crisis that, unfortunately, exists in communities.

[The Chair, Liberal, Bryan May]

Thank you so much.

Sorry, we're well past the time.

We'll move to MP Motz, please.

You have five minutes.

[Glen Motz, Conservative, Medicine Hat—Cardston—Warner, AB]

Thank you, Mr. Chair.

First of all, I'm delighted to be here to study this particular issue. My 35 years in policing saw the issues of both homelessness and poverty front and centre operationally, for me personally and in my department. Also, serving on our housing board and being involved in our food bank has given me an opportunity to see first-hand how this is played out or not.

In the time that I have, I want to first address the department of health, and mostly Dr. Wiebe.

You spoke about the allocation of $300 million annually to first nations for health and wellness. How do you measure the impact of that money within our first nations reserves? Are you having success? If there are gaps in that service delivery, where are they? Are they by design, or are they in the community of delivery?

[Sony Perron]

I can start, and maybe ask Dr. Wiebe to complement it.

A large amount of this funding is going toward treatment centres for mental health and addictions. We are funding treatment centres across the country because it's part of the offer. We are measuring success in terms of indicators, one of which is quitting at least one substance after the treatment and after a certain period of time. We are monitoring that. These centres do as well, if not better sometimes, than similar treatment centres in the mainstream.

I would say it is very challenging. The target is not 100%, because sometimes there is need for retreatment. We have targets and measures on that to see how these treatment centres are performing. We are also measuring the demand and their capacity. There is need for more capacity in these treatment centres because the demand is high.

Communities are funded for prevention programs around mental health. We are targeting youth. Each community has a health plan that supports these programs. They have to report to us annually and every five years produce an evaluation of the performance of the programs. And because the program is not delivered exactly the same way in all communities, the assessments are done community by community.

We are monitoring macro-indicators, though, to see how the situation is evolving in Canada. The work that StatsCan is doing is really good, but as you can see in their statistics, they say they don't include first nations on reserve, for example. We are funding a regional health survey through a partnership with first nations across the country that produces data every, I think, three years to measure the evolution of a number of health and social factors on reserve to see how this is progressing. We see some progress there.

I'm not satisfied with this progress because the needs are so high, and we need to make some changes, but I believe the framework and the new way to approach mental wellness will bring some better results in the end, because we know that interventions that are grounded in culture, land-based interventions, are a huge success. Sometimes we have success evaluations on specific initiatives to try to identify best practices. It's not because it's a framework that is given to the community for them to plan. We are not developing tools to help them go to the right model.

I have to say that first nation and Inuit communities across the country are very creative, and they came with their solutions. Sometimes it's the propagation of these solutions and making sure we can extend them that is the challenge, because the real solutions are coming from them, and we are trying to encourage them with programs that are very flexible.

[Glen Motz, Conservative, Medicine Hat—Cardston—Warner, AB]

Thank you.

I have the distinct privilege of serving the largest first nations reserve in Canada. One of the things that I'm beginning to realize is that they are very progressive in their thought, yet very poor in looking after their own people. I spent a considerable amount of time before I got to Ottawa, and since then, speaking with specific individuals from that reserve, and they tell me something different from what we hear in the mainstream.

This may ruffle a few feathers, but they never tell me that the conditions on the reserve are tied to residential schools. They never tell me that they're tied to their history. They're telling me they're tied to how they're not being looked after now on their reserve, by their own people. That's their disconnect.

When I talk to the youth, they've lost hope. Even the adults have lost hope. It isn't because of their history. Some of it's tied to the loss of culture. I get that, and I respect it; I think there's an element of that. But it's about their own people not looking after their own people. That's what they tell me.

I'm interested to hear you speak about the way forward, and the best way forward is a collaborative approach. How do you see that playing out? How does that roll out? How does that actually look on the ground in the Blood reserve when you're going to be playing out some of these mental health issues to help poverty reduction, potentially with a group of elected officials who don't always provide the resources? They have lots of them; they just don't transfer those to the people who need it the most.

How do you do a collaborative approach in those sorts of environments?

[The Chair, Liberal, Bryan May]

We're actually over time, but I'm going to allow quick response on that.

[Sony Perron]

If you want me to speak briefly about the Blood reserve, there is one thing I will tell you.... I don't know the details about the operation, of course. I know only a portion of it. They have been very progressive in the strategy they have put forward on the opioid crisis, which is related to mental health and has caused devastation in their population. They have been very progressive in organizing the service and being really creative to integrate the pieces, taking what can come from the provincial government, what comes from the federal government, and organizing the service on their land.

I think the solution's being grounded there is what is important. It's to build plans that work in the community, trying to bring in all the assets and the strengths that are in the community. This is something they do really well. Not all communities have the same level of capacity. We are assisting them to advance their own plans. When there is a lack of capacity, we try to bring additional resources and capacity there to assist, but it's really a community-by-community approach.

This is probably as much as I can comment on that.

[The Chair, Liberal, Bryan May]

Thank you.

MP Sansoucy, for three minutes.

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

Thank you, Mr. Chair.

I began working in the social services area in the beginning of the 90s. At that time, the social determinants of health were crucial to the identification of the best interventions to improve the health and well-being of the population. That was put aside during the next decade because of budget considerations. People then focused more on structures. That is why it does me good to hear representatives from the health and public health arenas talking about the social determinants of health.

My question is addressed to the Statistics Canada representatives. Over the past 20 years, we were told that one person out of five would face some mental health issue in the course of their lives. And yet on page 6 of your brief, you refer to a third of Canadians.

Do the data you have explain that increase? We have gone from one in five to one in three persons who will experience mental health issues in their lives.

How did such an increase come about?

[Dr. Jennifer Ali]

It's in English.

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

That's okay.

[Dr. Jennifer Ali]

The statistic that you mentioned previously was based on the 2002 Canadian community health survey on mental health, which measured different disorders. We're not able to measure all of the disorders in our 60-minute survey.

In 2012, we measured this suite of disorders. It included more substance use. It also included generalized anxiety disorder. With this suite of disorders, the number came to 33%, so the true prevalence of disorders that people in the Canadian population have experienced in their lifetime is higher than 33%, because there are disorders that we were not able to measure in the survey.

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

On page 14, one reads that immigrants have half as many disorders as the Canadian-born.

Based on your data, do you see anything that explains that fact? That is after all a spectacular gap.

[François Nault]

We see that immigrants are in better health, not only in better mental health but also better physical health. I think that that can be explained in large part by the fact that those immigrants were selected. They underwent a health examination at the beginning. And so they are certainly in better health than the average. I think that after ten or fifteen years their health levels—and that is probably true for mental health as well—meet up with those of the Canadian-born population. That said, it is clear that the initial selection has an effect.

As Ms. Ali said, it would be interesting to separate out the immigrants from the refugees, or from economic immigrants. We would probably see differences. However, if I recall correctly, the physical health of refugees is good. Once again, this is due to the selection of immigrants headed for Canada.

[The Chair, Liberal, Bryan May]

Thank you. You'll get another shot, don't worry.

That wraps up that round. Just looking at the clock, I see we have time for six minutes from each. We do have a housekeeping issue that I want to leave a small amount of time for at the end.

Without further ado, it's over to Pierre Poilievre for six minutes. Are you going to share your time?

[Pierre Poilievre, Conservative, Carleton, ON]

I think I'm going to share my time.

[The Chair, Liberal, Bryan May]

Fantastic.

[Pierre Poilievre, Conservative, Carleton, ON]

Who would like to have my time shared with them?

[The Chair, Liberal, Bryan May]

I think Dan wanted it, but he left.

[Pierre Poilievre, Conservative, Carleton, ON]

Dan's gone. Glen, do you want to go some more?

[Glen Motz, Conservative, Medicine Hat—Cardston—Warner, AB]

I'll ask a couple of questions. Thank you.

Monsieur Robillard, you asked a question specifically about Housing First, and, Mr. Murphy, you responded. I can tell you that in the community I come from, Medicine Hat, which has a nationally recognized success in dealing with homelessness, Housing First works, and it works under its present structure. I would encourage you, as we explore what that looks like in Medicine Hat, on February 16, to ask the witnesses who will be available to specifically answer that question. Those who have gone through the program and those who administer the programs are.... It's remarkable how that particular type of strategy is making a difference in the lives of people who are impacted by both mental health issues and homelessness.

My experience has been that one usually precedes the other, and it's the same with employment. For the people I've dealt with professionally in my career, mental health issues usually preceded the loss of a job, homelessness, and poverty. As a nation, we have a significant amount of work to do. The largest number of new files or new caseload that we had, as a police service, when I retired a year ago, was mental health-related matters. Nothing grew larger on our stats than the time it took to deal with mental health issues.

Unequivocally, we readjusted our organization to respond to those issues, because we were ill-prepared. Our communities were ill-prepared. The supports we had were not adequate. We appreciate the words you used, Mr. Perron, about “collaborative approach”. As an organization, we had to evolve to be collaborative with mental health professionals and with other services, so that, together, we could change people's lives positively, so we no longer had people falling through the cracks. Mental health issues oftentimes led to criminality, but mental health issues do not make you a criminal. We tried to make sure that there was a distinction on that.

I'm sorry for taking the floor without asking a question, but I can tell you that the work this committee is doing.... I'm sorry. I'm emotional because I lived this. You have no idea about the impact that the decisions you make around this table moving forward are going to have on people's lives. We have to get it right. We can't just spend money. We have to involve agencies that want to make a difference. Everybody is fighting for the same dollar, and it doesn't always work. When you see.... You'll hear when you come to Medicine Hat—people's lives have been changed because a program worked, people cared, a difference was made. They were given a home first, and they had wraparound supports afterwards. When those things work, it changes communities. And when it changes communities, it saves money. It does. It saves vast amounts of money. If we do it right from this stage.... I dreamt of being here. When I was boots-on-the-ground in Medicine Hat, I dreamt of the decision-makers. I wished that you would do something different. Now that I'm here, I'm going to pinch myself. We have an opportunity to make a difference. Let's do it.

Thank you.

[The Chair, Liberal, Bryan May]

You are more than welcome, sir.

I think that everyone around this table agrees. I think that the reason we have embarked on this and given it the amount of time and energy we have—we couldn't have said it better—is to make the right decisions moving forward. I think on a lot of committees politics comes into play. I haven't seen that with this study and this committee. Regardless of the political stripe, we're all here to do what's right for Canada, to leave the country better than the way we found it. I thank you for your passion.

I'm really looking forward to this trip. This has been on the calendar for some time, and I've been staring at it. I can't believe we're about to embark on it, specifically Medicine Hat. We fought to make sure that one was on the calendar because of the work that is being done on the ground there. We're all very, very excited to see if it's something that we can take beyond the borders of Medicine Hat and replicate across the country. Sometimes small decisions and small programs solve big problems. I think my expectation is to learn a lot when we go there.

Thank you for that, sir. I don't know how you follow that.

For your very first question at this committee, MP Anju Dhillon, the next six minutes, or however much you wish to take, is yours.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Thank you, Chair.

There is no way to follow what MP Motz said. Thank you, MP Motz, for your very poignant and emotional words. You brought back home to us exactly why we're here, why we ran, and why we work so hard to help others. It's because we have the opportunity to do so. On behalf of everybody in this room, thank you so much for touching us emotionally.

My question is for Ms. Romano. You mentioned that breaking the cycle of poverty and poor health requires a multi-disciplinary approach. Could you please explain what kind of approach you think would be good?

[Anna Romano]

Sure.

I think, based on the number of experts you've had before this committee, you've already figured out that in order to do something about poverty and to make a difference, we have to come at it from several sectors. As I mentioned in my remarks, it's not just about income. In the case of, for example, a senior who is living on their own, whether they have a high income or a low income, if they can't actually get out to access some of the social supports that are around them and are feeling isolated, then that will be a factor in terms of their mental health.

You're linking it to mental health, which I think is, again, a wise thing to do. You've heard the statistics on the connections between mental illness and poverty. We've talked a little bit about employment. In my remarks I talked about family violence. There are some connections to the justice system and to the educational system.

What we have found in our programming is that it's most effective when you can come at it from.... When I think about our maternal and child health programs, it's not just about the program in place for that child. When the teen mom brings her child into the centre, that mom is learning something about relationships, resiliency, and building very important social skills. Then that mom might go back home and talk to her extended family about that. It's when you can get at issues either in a school setting or a community setting so that it's not just the individual intervention that you're actually impacting the child, the parents, and then the broader community, including the school system, etc.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

You also mentioned that those on social assistance develop mental disorders or that they are benefiting from social assistance because they have mental disorders. Could you kindly just maybe tell us the link?