Justice Committee on March 23rd, 2015

[Ève Péclet, NDP, La Pointe-de-l'Île, QC]

Yes.

[Dr. Jocelynn Cook]

I want to do that study too, though there are data that show the cost of an individual with FASD versus costs for individuals without FASD. Costs haven't been partitioned out in terms of justice versus...but they would run the gamut, including social services, child welfare, health, and those kinds of things. We know that individuals with FASD cost more, but comparing them to the folks who tend to revisit the justice system is a really great question. I'm excited for that study.

[Ève Péclet, NDP, La Pointe-de-l'Île, QC]

My second question has to do with the $4,000 we have to pay to assess someone. How does the cost to the state for assessing people and redirecting them to good resources compare with just saying, we're not going to assess them and we're going to put them in jail? I would be interested in knowing which policy is better for the state to have.

It's really interesting because my second question would be for you, Ms. Cook. I have a letter written to the committee by the Canadian Academy of Psychiatry and the Law. I'm going to read it in French because I have it in French. It says:

The proposed distinction in Bill C-583 is not supported by psychiatric diagnostic standards. In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, the North American authority in diagnostics, does not recognize FASD as a separate or distinct disorder, but rightly includes it with other forms of developmental delay.

I would just like to have your comments on that. Have you read the definition in the bill and what would you say about this paragraph in the letter?

[Dr. Jocelynn Cook]

Gail will have an answer for this too. In rewriting the diagnostic guidelines, we tried very hard to use terminology congruent with that in the DSM-5. We call it the psychiatrist's bible. This is for psychiatrists to diagnose behavioural disorders. FASD has lots of other aspects to it as well. It's neurodevelopmental. There is actual brain damage associated with it. Psychiatry is one part of it and one member of the diagnostic team is a psychiatrist, but FASD is bigger than psychiatry. That's how I would answer that.

Gail may have another take on that from a clinical perspective.

[The Chair, Conservative, Mike Wallace]

The floor is yours.

[Dr. Gail Andrew]

Thank you. I introduced myself as a developmental pediatrician. Developmental pediatricians are trained to look at neurodevelopmental disorders, and in fact in very young children and infants we can see some of the early signs of affect dysregulation. That is one difference between the professional distinctions. Psychiatrists predominantly look at mental health disorders. As developmental pediatricians, we look at neurodevelopmental disabilities such as brain injury and acquired brain injury. FASD is an acquired brain injury. We just didn't see the accident because it happened in utero.

[Ève Péclet, NDP, La Pointe-de-l'Île, QC]

Would you see a difference between other types of mental illnesses? My colleague talked about section 16, which talks about a “mental disorder”. Would you say that FASD would be a different type of mental disorder, or is the definition in section 16 broad enough to include that?

I know, Dr. Andrew, you said it would fall under section 16.

[Dr. Gail Andrew]

Maybe I can answer a little bit of this.

I would say that fetal alcohol spectrum disorder is much broader than a mental health disorder, because it impacts communication and all of those other brain functions. It is often comorbid with an anxiety diagnosis or a diagnosed depression or disruptive mood disorder, but FASD is much bigger than anxiety itself. If you have just anxiety, albeit a significant disability, and all of your other brain functions are intact, you are very different from somebody who has FASD and who has significant impairment across many areas.

[The Chair, Conservative, Mike Wallace]

Does anybody else want to comment on that?

[Dr. Jocelynn Cook]

I had to think about it.

Mental illness is here; FASD is here. The data are very strong and show that 95% of individuals with FASD have a diagnosed mental health condition such as anxiety, depression, those kinds of things, which are in the DSM. That's why we work very closely with having that addressed properly.

The other important thing is that traditional treatments for mental illness diagnosed by the DSM may not actually work for individuals with FASD, because their brains aren't built right sometimes and they don't work right sometimes. That's really important to remember as well.

It's just bigger—a lot bigger.

[The Chair, Conservative, Mike Wallace]

Can we get a brief answer from you, Professor Popova? You had your hand up.

[Dr. Svetlana Popova]

I just wanted to add that we recently conducted a systematic literature review. We gathered all available medical and epidemiological literature. We found that more than 400 disease conditions are associated with FASD, and the second-largest group was mental and behavioural disorders. A tremendous number of mental conditions are attributable to FASD. That's why we call it a spectrum; it includes a wide range of mental disorders.

[The Chair, Conservative, Mike Wallace]

Thank you for those questions and answers.

Finally, Mr. Wilks, from the Conservative Party, the floor is yours.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you, and thanks to the guests today.

My question is going to be more on the criminal side of it, because that's what I'm used to. I just wanted to touch a bit on NCR, section 16, that we seem to have latched onto a little bit. The challenge with NCR is in regard to how far down the Criminal Code you go. NCR is normally reserved for the gravest of the grave. It's not reserved for shoplifting. It's not reserved for impaired driving. The judge can deal with those through various different ways of sentencing, if they so choose. I've never seen an NCR on shoplifting or impaired driving, and I don't know if I ever will. I think we may be looking at something that doesn't really apply unless it's the gravest of the grave.

The other issue that I wanted to get to is section 13 of the code, which we don't talk about much, which states that no person shall be convicted of an offence in respect of an act or omission on his or her part while that person is under the age of twelve years.

I bring this to each one of you to give me a brief answer. As a police officer I dealt with the same 10-year-old over and over, knowing full well that there can be no criminal involvement whatsoever. The option for the police officer is to turn that child over to social services. That's really the only option they have, so that child is turned over to social services. The police officer knows that there's something going on there. The police officer also suggests to social services that the child should probably not go back into his or her home environment. The challenge is that the parents may be part of the problem, but there needs to be some form of investigation to do that. Then social services turns around and says they don't have the authority to do that, that their job is to integrate the child back into the family.

There is the cycle, until the child becomes 12, when the police can actually do something about it criminally. It seems to be the catch here that until the child is 12, nothing can be done. Once the child is 12, if they've been identified with FASD, as all of us in this room would probably agree, it's too late. They've now had to enter into the criminal justice system, whether we like it or not.

My question is to each one of you. We've all identified what the factors are for FASD. We've all identified what could lead to it. How do we intervene at a young age so that they don't get to the criminal stage?

I'll start with Dr. Popova, and go to Dr. Andrew, and then Dr. Cook.

[Dr. Svetlana Popova]

I will give just general answers to that—

[Technical difficulty--Editor]

[The Chair, Conservative, Mike Wallace]

We can't hear you now.

Dr. Cook is still here.

Dr. Cook, the floor is yours for now.

[Dr. Jocelynn Cook]

There was only one good study that was published in 1993 in the States, which showed the protective factors for improving outcomes for individuals with FASD. The top two were diagnosis before age six, because you can hopefully link to supportive services, and a stable home environment.

There is also lots of data that shows that kids with FASD who are in the child welfare system—or child whatever we call it in Canada—skip around to all different sorts of placements. That's not good and we know that. Depending on the family environment and situation.... Sometimes they're trying to be a stable family environment, but the kid has a lot of issues that are FASD related. Sometimes it's not a stable home environment.

I hear the same story. I have a friend who is a judge. She used to be in Saskatchewan and is now in B.C. She said, “I see the same thing. A ten-year-old kid is in front of me a hundred times in a year. I don't know what to do.”

That's significant.

[The Chair, Conservative, Mike Wallace]

Dr. Andrew, you're back.

Do you have an answer to that?

[Dr. Gail Andrew]

Actually I share everybody's angst and concern.

I spend a lot of time trying to look at the brain profile in preschool children who are prenatally exposed to alcohol. I may not necessarily give them a full diagnosis, but I get a pretty good sense of what they need in terms of services and supports. We try to put those in place, hopefully while the child is with their family of origin, and if the family of origin is not able to look after the child to then make recommendations for alternative placement. This is why we have to know the best interventions for those individuals.

We are currently doing some research here at the Glenrose in the young population, as we call it.

In fact, I referred previously to the Institute of Health Economics conference on legal issues in FASD from September 2013, and that was the exact question that the Honourable Ian Binnie had given me to address during those proceedings. What we presented in the proceedings was the need for a wraparound service for young children and then longitudinal follow-up of their developing brain, and supports across all transitions.

We don't have all of that data yet, but hopefully with longitudinal supports we can circumvent that child ending up in the law.

[The Chair, Conservative, Mike Wallace]

I want to thank all of our witnesses today. It was an excellent panel. I want to thank you for all of your expertise and work in this area.

I do want to remind committee members that we have four more witnesses. One is a repeat witness, who was here but not presenting, so there are three presentations, I believe, on Wednesday, for the full two hours. But I want to leave about a half an hour, if we can, to give direction to our analysts on the report writing that they need to do for us. I would ask that you give that some thought, and maybe even talk to each other in between times.

With that, I'll move to adjourn. We have a vote at 6:30.