Justice Committee on March 23rd, 2015

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

You are touching on my second point.

If I understood your presentation correctly, you are in fact saying that Correctional Service Canada does not identify those people who, unfortunately, really have greater needs and who differ from the majority of offenders in federal penitentiaries.

What do you think of the idea of providing at least a general framework for the guidance of the courts in diagnosing fetal alcohol disorders? That would not only be consistent with our principles of criminal justice and sentencing, but it would also be of benefit to Correctional Service Canada, which could also work in parallel to identify those individuals. In your opinion, then, the general framework of the bill would work for everyone.

[Dr. Ivan Zinger]

Yes. When correctional services receive an accused who has been given a sentence, they have to look to see whether the judge has expressed any reservations or documented any problems. If so, they have to take them into consideration when the sentence is administered. In that case, clearly there would be a benefit. However, we feel that we cannot put all our eggs into that kind of basket in an attempt to solve the problem. It is always better to be proactive.

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

Now you are touching on my third point.

In the Canadian Bar Association's brief, they deal with sentencing and the discretionary power of the courts. They say that mandatory minimum sentences are unfortunately more and more frequent in the Criminal Code. When judges are dealing with people with fetal alcohol disorders or other neurological or psychological conditions, this takes away the judge's discretion and makes victims out of the people who have to be put into prison, resulting in even more injustice.

In the document, they call for an exemption to section 718 of the Criminal Code “to avoid the mandatory minimum if an injustice would result”, especially for those with FASD or other mental health issues.

What do you think of that proposal?

[Howard Sapers]

There is a contradiction between a mandatory minimum penalty and the discretion that's called for in section 718.2. On the one hand the code prescribes judicial discretion to be used and to seek alternatives. On the other hand sections in the code prescribe mandatory minimum penalties. That's hard to reconcile from a sentencing position.

[The Chair, Conservative, Mike Wallace]

Our final questioner for this panel is Mr. Dechert from the Conservative Party.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Thank you, Mr. Chair, and thanks to our guests for joining us today.

Mr. Sapers, in your opening comments you mentioned that the estimates of prisoners in the federal corrections system that suffer from FASD ranged from between one in 10 to one in four, I believe you said.

Is one in 10 the number of people who are actually diagnosed with FASD and one in four an estimate of the total population? What's the relation between those two numbers?

[Howard Sapers]

The 9% to 10% is really based on the most recent study that was published by the Correctional Service of Canada. They did a prevalent study in June 2011. There are other studies that have generated retrospectively; in other words, they have gone back afterward and looked at populations and they've said, okay, we find the prevalence to be 22%, 23%, 24%. There are different studies using slightly different methodologies to determine the population.

The Correctional Service Canada prevalent study that found the 10%, or the just under 10%, also found another 15% where file information was incomplete. People exhibited many of the characteristics, but they couldn't confirm or deny a diagnosis. Even in the CSC study, which only finds 10%, they suggest it could be another 15%, bringing you back to the one in four or 25% for the prevalence of FASD.

Interestingly, they also found 45% of offenders, who weren't FAS-disordered, had other neuropsychological deficits.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Okay.

I think one of you mentioned that the percentage of the aboriginal population in federal institutions is approximately 25%, or just under 25%. Do you have any idea what percentage of the aboriginal population suffers from FASD?

[Howard Sapers]

I don't.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Okay.

Some of our other witnesses—especially the promoter of this motion, Mr. Leef—have suggested that for some people who suffer from FASD, having structure and routine in their lives is actually beneficial.

I understand that there aren't programs in the federal system. There may be some programs in provincial systems that deal with FASD. If you could combine an appropriate program within the correctional system to provide that structure and stability, do you see any benefits in approaching it in that way?

[Howard Sapers]

Yes, probably, but keep in mind that program success is as much about the multiple modes of program delivery and information delivery and support as it is just about structure. Running up against rules and not following instructions is a problem, so structure without all of the other supports that an individual needs in order to achieve success.... They are very important.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Yes, so there may need to be some flexibility in the way the rules are enforced, maybe in a special unit of an institution.

You mentioned that people with FASD are often more impulsive, often show less judgment in particular situations, and are perhaps more violent, as we've heard from some. That would suggest to me that leaving them out in the community is perhaps not the best answer, but there has to be some institution with a special knowledge of how to deal with them.

I want to go on to your other point about the need for some recognition of mental illness in general. I think you said in your opening remarks that the approach should include all forms of mental illness and not just people who suffer from FASD.

Can you compare for us some of the other forms of mental illness that you see can be identified among the prison population and how those with these mental illnesses compare with people with FASD in the way they're treated within the prison system, or in the way they respond to the rules and structures of the prison system?

[Dr. Ivan Zinger]

As I indicated before, the demand for services is extraordinary in corrections. I mentioned that a little more than 60% require psychological and psychiatric services.

In terms of diagnosis, more than half of those who suffer from mental health issues have a diagnosis of a substance abuse disorder—that's a really significant one—and there is a high prevalence of mood disorders. There are also anxiety disorders, and of course the more serious disorders, such as schizophrenia and major depression.

The service is equipped to deal with a variety of these issues by providing even psychiatric hospitalization for the more acute, more problematic cases. They are now attempting to expand their intermediate care services and then there is also primary care, so—

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

I'm going to cut you off.

Does it make sense to delineate just people with FASD, as distinct from people with any other form of mental health issue, in terms of sentencing?

[Dr. Ivan Zinger]

Given the prevalence, I think that in order to raise awareness among judges so that they can better tailor their sentences and maybe even provide guidance to the correctional service, you would be better off to broaden it to any cognitive deficit as well as any relevant mental health issue.

[The Chair, Conservative, Mike Wallace]

I appreciate that.

Thank you for those excellent questions today.

Thank you for being here from the Office of the Correctional Investigator. You did a fantastic job of giving us really good input into the study we're doing.

We're going to take a three-minute break until we get our folks on video conference lined up. We'll suspend.

[The Chair, Conservative, Mike Wallace]

I will call this meeting back to order. We're the Standing Committee on Justice and Human Rights.

For our second panel, we have three folks here via video conference, and Ms. Cook has joined us here live.

Professor Popova gave her presentation already. She's from the Centre for Addiction and Mental Health, and is on video conference from Toronto. She can answer any questions you may have that you didn't have time to get to. From the Society of Obstetricians and Gynaecologists of Canada, we have with us Jocelynn Cook, scientific director. From Edmonton via video conference we have, from Alberta Health Services, Ms. Gail Andrew, medical director, fetal alcohol syndrome disorder clinical services, and site lead, pediatrics, at the Glenrose Rehabilitation Hospital. By video conference from Whitehorse, Yukon, we have Rodney Snow as an individual.

As is listed on the agenda, I will go first to Ms. Cook. The floor is yours for 10 minutes.

[Dr. Jocelynn Cook, Scientific Director, Society of Obstetricians and Gynaecologists of Canada]

Thank you.

I think you all should have a PowerPoint deck. I'm a scientist, so you're going to be stuck with doing things the scientist's way. I also submitted a brief.

I am the scientific director of the Society of Obstetricians and Gynaecologists of Canada. I was formerly the executive director of the Canada FASD Research Network, which is a national research network that facilitates policy-relevant research in Canada. I also worked for the public service for about nine and a half years—all within FASD. I also have had a scientific research career in the field that I've been in for—I counted this morning—23 years. I'm starting to feel a bit old.

Thanks for having me here.

Dr. Popova and Dr. Andrew and I exchanged slides so we shouldn't have any duplication, so that's good. We know that your time is valuable.

Today I'm going to take a bit of a different approach and talk a little about the context around women and alcohol. We know that women do drink during pregnancy and we know that no woman actually wants to harm her child.

There are a lot of different reasons why women do drink during pregnancy. The first slide shows some of those reasons: prior history of alcohol consumption; family background of alcohol use; history of in-patient treatment for problematic alcohol substance use or mental health problems; previous birth of a child with FASD; unplanned pregnancy; emotional, physical, or sexual abuse; low income; limited access to health care.

The burning question in the field since I've been in it for a really long time is: how much alcohol is too much? How much can a woman drink that's going to be absolutely guaranteed to keep her fetus safe? The answer is that we don't know. We can't scientifically figure out an absolute safe amount or an absolute risky amount. The amount of alcohol required to cause damage differs, based on the individual, on the fetus, and their interactions in the womb together.

We know that the dose of alcohol is important. Research does show that binge drinking is more harmful. When your blood alcohol level goes up and stays up high for a while, like frat party drinking, and then goes down, that's more harmful than sipping on a beer all day long.

We know that pattern and timing of exposure during pregnancy is important. As the baby develops, when alcohol is a factor, what's developing at that time can be specifically influenced. The important thing to know is that the brain is developing throughout gestation and is always susceptible to alcohol. We used to be able to give alcohol to mice on a certain day of gestation—just one day—and they'd be born with limb and kidney defects. You can give it on a different day and they'll have facial features. But the problem, as I said, is that the brain is always susceptible.

We know that genetics play a factor. We know that smoking and other drug use comes into play. General health, nutrition, stress, trauma, and age of the mom are all factors on how susceptible that fetus is to prenatal alcohol exposure and the damage. There's recent data now that I think is very exciting, probably more than others, that shows that stress and nutrition factors in mom, even before she's pregnant, can have a susceptibility factor on her developing fetus. That's called epigenetics, and it's very fascinating. There can be brain changes in moms that can be passed on to babies and affect their susceptibility as they're developing.

We always say that no alcohol is safe because that's the truth; we don't know any different.

The next slide talks about some of the data from the Canadian community health survey about alcohol use among women. It is a problem in women of child-bearing age. You can see that moderate alcohol use is very high in the 19-to-34 age group, and this age group accounts for about 80% of the pregnancies in Canada. We know that about 50% of pregnancies are unplanned, so alcohol use among women in Canada of child-bearing age who are at risk for being pregnant is significant.

The Canada FASD Research Network has a first-ever database of individuals with FASD. We have 289 individuals in that database, and we're collecting information around their brain function and what kinds of interventions have been suggested, so we can try to figure out what the best match is. The gentleman earlier talked about the importance of mental health and brain function and how we can match that to programs or treatments that improve and maximize outcomes.

This data hasn't been published yet. It's new. It's hot. It's exciting. But the characteristics of adults with FASD in our database—alcohol problems, marijuana use, drug problems, past or current trouble getting and keeping a job—are for greater than 50% of the adults. Eighty-five per cent have trouble living on their own. There are some who could be homeless. Eighty-five per cent had no high school diploma, 63% were a legal offender, and half were a legal victim. Many of the patients were institutionalized at the time of assessment or in the past. Fifty-seven per cent had been in the hospital, and 40% in jail. These are the adults in our Canadian database. There are lots of challenges with daily living, social-skill deficits, and the majority had family abuse problems as a victim, aggressor, or both.

These individuals are very affected. Their brains are much more affected than we initially thought they would be, but diagnosis really does matter. Many of you may have heard of the diagnostic guidelines that the Canadian Medical Association published in 2005. We've revised those guidelines, thanks to funding from the Public Health Agency of Canada, and they're being published, hopefully in June. We just resubmitted them to the Canadian Medical Association Journal. The guidelines talk a little bit more about screening and how to recognize when alcohol use during pregnancy may be a problem.

We know that diagnosis improves outcomes, the earlier the better. Part of that is because people understand the implications of FASD, what it means, and we can try to develop integrated care teams to get families the supports and services that they need. Diagnosis is important. It identifies neurodevelopmental strengths and weaknesses so that we can better match, as I said, treatments and interventions. It's complex, and I will mention that we do have an initial diagnostic database that could be very powerful.

So why doesn't any of this matter? We know that women drinking alcohol during pregnancy is still a significant issue in Canada. Prevention in the current social context is key. Drinking alcohol is sexy in a lot of ads. It's very socially acceptable. Helping women to understand not just the harmful effects of alcohol on fetal growth and development but also the harmful effects of alcohol on health in general....

Individuals with FASD have neurodevelopmental impairments, which you heard about this morning—and Dr. Andrew will talk more about those—that put them at risk for adverse secondary outcomes, such as trouble with the law and mental health issues. A study by Jacqueline Pei, who I think is going to talk to you next week, showed that 95% of individuals with FASD had diagnosed mental health issues. They have brain structure differences and brain function differences. That's very important when you think about treatment of individuals with neurocognitive impairments. Diagnosis is critical to understanding brain function, and adaptive programming can improve outcomes for affected individuals and their families.

We know that brain impairment really does affect outcomes. We know that in our database individuals had more central nervous system impairment than was anticipated. Consensus from experts in the U.S. and a few Canadians who populated the panel suggested that treatment approaches that rely on assumption of normal cognitive functioning are likely to be less effective with individuals with FASD, and that makes sense. That's what you heard from the other individuals who spoke just now.

We also did an interesting study where we worked with mental health centres and substance abuse treatment centres. We did some education with the front-line workers, and we taught them to screen for possible FASD. We collected some data from that. We're analyzing that now to see, if they understood that parental alcohol exposure may be a factor, how they interacted with these individuals and how they changed what they were doing so that they could better improve outcomes.

In terms of what we really need, we need access to capacity for diagnosis, because that's so important. We need standardized data collection or we're never going to be able to make any really good evidence-based decisions on what works and what doesn't work, and what the specific characteristics and matched treatment approaches are. We need training in education. We learned in our study that front-line workers felt a lot more comfortable dealing with individuals who had FASD when they understood the implications of FASD and that these people weren't misbehaving because they meant to. We need more research on specific interventions or supports that improve outcomes for affected individuals and families across the board—across services and across systems.

Thank you. Was I on time?

[The Chair, Conservative, Mike Wallace]

That was six seconds over, but we'll give it to you. That's okay.

Thank you, Dr. Cook, for that presentation.

Now we will go to the video conference from Alberta Health Services. Dr. Andrew, the floor is yours for 10 minutes.

[Dr. Gail Andrew, Medical Director, Fetal Alcohol Syndrome Disorder Clinical Services, and Site Lead, Pediatrics, Glenrose Rehabilitation Hospital, Alberta Health Services]

Thank you very much for having me today.

I'm a clinician, researcher, and I also do a lot of education and training around fetal alcohol spectrum disorder and other neurodevelopmental disabilities, as I am a developmental pediatrician.

What I'm going to talk about to you today is more from that clinical, medical, diagnostic perspective. I think we've heard from our other presenters that FASD is common, maybe in up to 5% of the population, it's very expensive, and it is overrepresented in the justice system. As I've worked across the lifespan, it's overrepresented in children who are in the foster care system as well. It's a lifelong disability, and I strongly feel it is a mental disorder. In the DSM-5, which is the diagnostic and statistical manual, it is currently being considered for psychiatry use, so it is definitely recognized as a mental disorder caused by damage from prenatal exposure to alcohol.

It is an invisible disability because we only see the dysmorphic face of full fetal alcohol syndrome in about 10% of the population. As Dr. Cook explained, we create FAS in the laboratory rat models and we know it's just a small window of time, three days, in human gestation where that face is a result of the teratogenic effect of alcohol. It's not surprising then that we don't see the face in most individuals affected by prenatal exposure to alcohol.

We also don't have any biomarkers, such as a blood test. There are some biomarkers of interest in the research world, such as eye movement, but we have a lot of research ahead of us before that becomes a clinical tool. Right now we need to assess 10 different brain domains in the clinic in order to make a diagnosis of fetal alcohol spectrum disorder. It's also a differential diagnosis. We consider many other factors.

We also know that prenatal exposure to alcohol is often not the only factor. Dr. Cook mentioned some of the maternal stress factors, maternal nutrition. There's also genetic endowment. We also know that postnatal stressors, especially in the early years—exposure to trauma, maltreatment, toxic stress, and so on—can also have a long-term impact on brain development that is not necessarily reversible by simply optimizing the environment if we've lost that window of time in the early years.

Currently, we don't have diagnostic capacity in Canada, although we're far ahead of many other countries to provide the diagnosis. There's less diagnosis available for the adult population. There are some good models of diagnostic clinics embedded within the justice system that I think need to be followed as examples of good practice. The diagnosis is not just a label of a four-letter word. It must lead to a constellation of strengths and challenges for that individual so that we can design the appropriate intervention programs.

I'm going to talk a little bit about the scientific evidence we have from both the animal models, as well as from the human neuroimaging and neurochemical techniques that support that alcohol exposure prenatally does indeed cause brain damage.

We know that alcohol can alter the brain cell development in the neurons by causing simply cell death, or it can interfere with the neurons migrating to the right level of the brain where they need to be for functioning and then connecting with other neurons, because that's how information is conveyed from neuron to neuron. It can interfere with myelination, which is an important part of that conductivity of those pathways. It can cause epigenetic changes and it can alter neurotransmitter activity. Neurotransmitters are those chemicals that go from one brain cell to the other in brain functioning. The brain neurotransmitters impacted are dopamine, serotonin, and glutamine, which are implicated in almost all of the mental health disorders that we know of. It can also alter the stress response through the hypothalamic-pituitary axis and cortisol, so if you have the normal stress responses, you can see in certain situations the right outcome is not going to happen.

One of the exciting parts is neuroimaging studies. A clinical MRI that I do today on my clients shows me usually no abnormalities in structure unless we have abnormal neurological findings that I find on my clinical exam. But in our lab we're able to do very highly refined imaging and we do see abnormalities, specifically in decrease of brain volume and abnormalities in cortical thickness. There's actually less thinning, so less pruning goes on. Pruning is important in normal learning and development.

We see reductions in key pathways connecting one part of the brain to the other, especially the frontal lobes of the brain, which are the seat of our executive functions. Those pathways are reduced, and we've seen, in our own research lab at the Glenrose, a direct correlation with one pathway and difficulties with reading.

Functional MRIs have shown that there is a difference in function in different areas of the brain. One study showed that the frontal lobe of the brain was working harder as the task got more complex, but it was less efficient and it led to early mental exhaustion. Again, harder work doesn't necessarily get you a better result.

We talked a little about the adverse environments that can be compounding the effect of prenatal exposure to alcohol, and I think this is an area of.... I'm always looking for opportunities for prevention intervention. When we look at adverse life experiences and we look at why women drink, they're all rooted in the social determinants of health and this is an opportunity to put in place interventions and preventions to break this multi-generational cycle.

I'm going to quickly go over some of the brain assessments that I can do in my day-to-day clinic.

An average assessment costs about $4,000 and you can see from the number of domains that we test why this is an expensive assessment, but it's worth the money and investment to inform best practices moving forward. Intellectual ability is one area that we use as a baseline, but IQ does not define the disability and level of impairment in individuals with FASD. Often their IQ levels are within the average range. We need to move beyond the basic testing into assessing memory, attention, executive functioning, and adaptive functioning.

One problem with an IQ above 70 is that currently you do not qualify for any of the supportive funding or housing systems as adults, and in most cases as children and teenagers, you don't qualify for extra educational supports. What happens is that you then transition to adulthood without essential academics, training, or employability options. You have no funding. That can lead to homelessness and unemployment. Food as a commodity is scarce. You're in a homeless situation. You can see this person coming in contact with other people who may drag them into becoming involved with the law. We know when we look at intellectual abilities, often individuals with FASD are slower at processing, so this has implications in a very fast-moving court scene, arrest situation, where they may not be processing all the information.

One of the areas we also look at is academic abilities, learning. Reading disability is very common when we do our academic assessments. They may have superficial reading abilities, so that they can read the words but they lack the comprehension and understanding. You can see how somebody reading their parole conditions or reading a document that they need to sign to say this is what happened.... Don't necessarily leap to the conclusion that they have understood what they have read. This may explain a lot of our breaches.

Math disability is really important, which impacts both money and time management and understanding. No wonder our individuals don't show up on time for an appointment or they don't understand the financial value of items and they aren't able to handle their own money for budgeting and daily living without extensive mentorship and other external supports.

Attention issues are another I'd like to cover. It's very common, about 65% of individuals with FASD also get a diagnosis of attention deficit hyperactivity disorder. They have problems focusing on what is relevant, inhibiting responses to what is not relevant. They're easily distracted by extraneous cues in their environment. Having a short attention span impacts your ability to learn in the academic world, but you also can't learn from day-to-day experiences. If you have FASD with a short attention span, you may not be paying attention to all the information in your environment. You can't put the information into your memory and retrieve it when you want it, and then you can't use any of this information for the right decision-making at the right time. This can help explain a lot of them not being able to learn from their mistakes or the consequences of their actions. Don't assume the individual with FASD who appears to be listening is attaining and processing the information.

Memory problems are also significant, both in verbal memory and in visual-spatial items. Short-term memory and long-term memory can be impacted. If you have an impaired memory, you may not be able to remember and use the information that you were taught in your group therapy session in order to use it in that moment in time when you need to use it. Memory deficits and FASD are especially more noticeable in an emotionally charged situation, such as being interrogated for a crime or being a witness on the stand when you're a victim. Problems with memory can lead to confabulation.

Executive function is a really core deficit. Executive function refers to higher order processes that result in goal-directed behaviour, such as planning, organizing, impulse control, inhibition, flexible thinking, working memory, reasoning, and so on. We can measure all of these in our clinic situation, and we look at all those core deficits. They can certainly explain why somebody is not able to control their impulses and make the right decision at the right time.

Communication deficits, which I've already alluded to, are significant. They can present well, talk a lot, but don't always understand at a higher level. We analyze, in our clinic situation, inferencing, predicting, social communication deficits. All are implicated in getting into trouble with the law. Social communication deficits are also implicated in making bad social choices, getting in with the wrong crowd, and then being led and becoming more of a victim rather than a perpetrator.

All of these deficits lead to impaired adaptive functioning, which at the end of the day is how you function safely in life and independently. We often say our individuals with FASD are maladaptive, but really they just simply can't use all of the information from their environment to make that right decision at the right time. We need to put in place good strategies.

We've already talked about the overlap with mental health, and when you reflect back on the fact that our neurotransmitter systems are changed by the prenatal exposure to alcohol, there's no wonder that we have a higher level of mental health disorders associated with FASD.

In my briefing notes I did provide a reference to the legal conference that was held in Edmonton on the legal issues of FASD. It has been printed through the Institute of Health Economics website and I would refer the members of this committee to have the opportunity to both look at the consensus conference and the document that was developed as the result of that. Many learned individuals contributed.

Thank you.

[The Chair, Conservative, Mike Wallace]

Thank you, Doctor, for that presentation.

Our final presenter before we go to the rounds of questions is Mr. Snow, as an individual from Whitehorse, Yukon.

The floor is yours, Mr. Snow, for ten minutes.

[Rodney Snow, As an Individual]

Thank you, Mr. Chairman.

I am, as you say, Rod Snow. I work as a lawyer in Whitehorse in the Yukon, but I appear today as an individual and not on behalf of any client or organization.

Let me start with full disclosure. I'm not an expert. I'm not an expert in criminal law and I'm not an expert on FASD, but over the last 10 years I have taken part in the national conversation on the treatment of individuals with FASD in the criminal justice system. Today I want to tell you about some of what I've learned and about how you can make a difference, I think, in the lives of individuals with FASD.

At the risk of repeating some of what you may have heard already, let me start with some of the key facts that have framed elements of this national conversation. First, FASD is a permanent organic brain injury. There is no cure, although outcomes can improve with treatment. Second, characteristics of individuals with FASD include impaired executive functioning, lack of impulse control, and difficulties understanding the consequences of their actions, so they often don't learn from their mistakes. Third, criminal law assumes that individuals make informed choices, that they decide to commit crimes, and that they learn from their own behaviour and the behaviour of others. Fourth, these assumptions are often not valid for individuals with FASD, so our criminal justice system fails them and it fails us.

So what do we do?

I start from the proposition that nobody is more morally innocent than a baby born with a disability. When that baby grows up and is unable to meet a legal standard of behaviour because of his or her disability, the state does not deliver justice by punishing, yet that is what we do in Canada.

The tools that Parliament has given crown counsel and judges are limited. If you speak to people who are working on the front lines, you will hear the same story over and over again. It goes something like this. They will tell you that too often children with FASD start out in the child welfare system. They proceed into the youth criminal justice system as teenagers, and then move into the adult criminal justice system, where the cycle starts all over again. They know that jail time will not rehabilitate, deter, or cure the individual with FASD, but they have few tools to stop this revolving door. Eventually everyone gets out, but the time in jail has done little to help the individual or to improve public safety. This is where you come in, as members of Parliament. We need you to support changes to the Criminal Code and our corrections system so that they are smart and effective on crime.

We know that the old approach is not working. We need a new one that's designed to succeed. I think it was Einstein who said that doing the same thing over and over again and expecting a different result is the definition of insanity. There's a broad consensus that law reform is needed. In 2010, with the support of crown prosecutors and defence lawyers, the Canadian Bar Association supported initiatives in this area by federal, provincial, and territorial justice ministers and called for measures to decriminalize FASD. Then justice minister Nicholson quickly said FASD is a huge problem in the justice system—“huge problem”, his words, not mine.

Provincial court judges support the bar association's call for reform. FPT justice ministers committed to dealing with FASD as an issue of access to justice, and in August of 2013 Justice Minister MacKay made a public commitment to act on this issue. So I was excited when Ryan Leef introduced Bill C-583.

Bill C-583 has three main elements. First, it defines FASD. Second, it allows a judge to order an assessment, and third, it allows FASD to be considered a mitigating factor in sentencing. All three elements are important, but I want to draw your attention to the section that allows a judge to presume that the cause of FASD is maternal consumption of alcohol if there is good reason why that evidence is not otherwise available. We want to avoid situations where everyone knows that FASD is involved, but an assessment remains inconclusive because this evidence is missing.

I don't have to tell you, Mr. Chair, that Bill C-583 received support from all parties. I sat on the Yukon legislature when Yukon MLAs unanimously passed an NDP opposition motion to support Bill C-583, and I understand that MP Casey has introduced Bill C-656 that adopts much of Bill C-583 and goes further in the areas of external support orders and corrections reform.

I was disappointed when Bill C-583 was withdrawn. Many of us thought that, with support from all parties, it had a chance. Now we turn to you and your committee, because we feel that it's the best hope for reform. I urge you to listen, and listen carefully. Please consider action that can be taken to prevent FASD, to encourage assessments, and to improve outcomes for those in the federal penitentiary system.

I also encourage you to hear from people with this disability and their families. People with disabilities have often said, “There should be nothing about us without us.” When you report, please do not confuse the need for more medical research or scientific study with the value of Bill C-583. Do not say that this is a complex, intractable issue, and therefore, Bill C-583 or its equivalents need more study before action. It needs more political courage and leadership.

I think Ryan Leef has done his part, with limited resources. It is now time for Minister MacKay, with the resources of the Department of Justice at his disposal, to honour his 2013 commitment to act.

When you report, say that the criminal law needs to be reformed and that Bill C-583 is a good start. Please say that unequivocally and unanimously. Do not sacrifice the good in the pursuit of the perfect. If you back Bill C-583, you'll make a positive difference in the lives of individuals with FASD.

Parliamentary leadership matters. By doing so, you will encourage further action in our communities, provinces, and territories, and that, too, is good.

Thank you very much.

[The Chair, Conservative, Mike Wallace]

Thank you for that presentation, Mr. Snow.

Now we are going to the question-and-answer portion, and a reminder that we have Professor Popova with us from the Centre for Addiction and Mental Health. Please, because we are doing video conference, make sure all the individuals know which one of them you're asking the question of, and it will be much easier.

With that, the floor goes to Madam Boivin of the New Democratic Party. The floor is yours.

[Françoise Boivin, NDP, Gatineau, QC]

Thank you so much.

Thank you to all the witnesses. This is very interesting.

I first have a few comments for our colleague Rodney Snow.

I totally agree with you. In a sense, it's kind of disturbing, because I did think that we would advance with this. It's rare in this committee that we have unanimous consent for something, so it was pretty uplifting to see that we would advance in the sense of what have been some recommendations, either from the Canadian Bar Association or promises from two justice ministers. I feel as though we're back to square one, if not a bit further back, but anyway....

I appreciate tremendously the scientific experts, because this is not my field of expertise. I deal with law. I take to heart your last comment that we shouldn't sacrifice the good to try to strive.... It's always better to go for the best, but at the same time, if striving for the best means that we're totally frozen and not acting, there's a big problem. I appreciate my colleague Sean Casey's bill, but since he already had his turn, we will not be debating his bill either. I don't exactly know how we'll be able to move this faster in this legislature, but anyway, we'll do our part.

I'm not a medical specialist, obviously. I'm a lawyer, with all that that means, which sometimes is nothing.

[Voices]

Oh, oh!