Justice Committee on April 26th, 2018

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

Thank you.

Those are all of the questions I have, Chair.

[The Chair, Liberal, Anthony Housefather]

Mr. MacGregor.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Hello, Dr. Smith. Thank you for appearing before the committee today.

I was listening to your opening remarks, and I think what you alluded to, and what we've already heard through testimony and debate on this particular bill, is that correctional facilities are not very well designed for those with mental health disorders.

[Dr. Patrick Smith]

Yes.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Also, I think we can agree that providing a judge with as much information as possible is always a good thing. These are the people who are intimately acquainted with the offender, the crime they've committed, and the circumstances. To arm a judge with a report on the mental health status of an offender is a good thing.

However, I think there's another part that we're missing here. It may be all well and good to provide the judge with that information in a pre-sentence report, but are you confident that if the judge is then armed with that information we now have the resources in our community that would allow the judge to make a decision? Or will this judge still only have a correctional facility to use?

[Dr. Patrick Smith]

Well, that's a very, very good point, and I think that's the point we're making when we talk about our historic investment of about 7.2% of our health care budget in comparison to others that are doing 13% and 14%. It's a good question.

The judge at least has the option. We know from some of the early data around diversion programs, such as mental health court and drug courts, that it can have a huge impact for individuals but also significant cost savings for Canadians.

I echo what you're saying. Even with the investment of $5 billion over 10 years that the federal government has pledged for mental health, and even with the focus on trying to put as much of that as possible in the community, we're still playing catch-up to putting the basic services and supports in place. While it will be difficult for that judge to find those services, it's still a better place, most often, than a correctional facility.

We can do the math like they did in the U.K. They realized that you will have the money to invest in mental health services, because they talk about having closed down certain jail units and stuff that used to just house people with mental illness because there wasn't a better place for them. It's a very expensive and non-effective alternative.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

You may have alluded to this in some of your exchanges, so forgive me if I'm asking the question again, but we did ask Mr. Jowhari, when he was drafting the bill, about the use of the term “mental disorder”.

You've seen the text of the bill. It's not a very large bill. Given the expertise your organization has in this regard, are you okay with that term or is this something that we need to be cognizant of, potentially, when we're looking at amendments to the language?

[Dr. Patrick Smith]

Absolutely. One of the things our field is great at is debating language. We debate what we think about the words “mental disorder”. It come from a DSM diagnostic category that physicians are taught, which is to put things into a disorder—substance use disorder, depressive disorder—yet people in my own organization at the Canadian Mental Health Association sometimes bristle when they hear “mental disorder”.

I think the intent of talking about mental disorder is the scientific intent, connected to the diagnostic categories from the diagnostic and statistics manual. There's a debate about mental illness, mental health problems, and mental disorder.

I did hear a little bit of the interchange with Mr. Jowhari. I guess how I would say it is that there are Canadians who are vulnerable to mental health problems and who have not expressed those problems, but they may have greater risk. Then there are people with mild to moderate problems that may not meet the diagnostic criteria for a disorder. Then there are people with disorder. Mental illness and mental disorder, in the professional [Technical difficulty—Editor], but not everyone has a mental disorder or a mental illness.

So the diagnostic distinction between “mental illness” and “mental disorder” doesn't exist in the scientific community. People have different affinities with one term over another, but they're considered the same thing.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you, Dr. Smith.

Thank you, Mr. Chair.

[The Chair, Liberal, Anthony Housefather]

I have a couple of technical questions, following on from Mr. MacGregor, in terms of trying to get the right language for the bill. You may have heard, then, my conversation with Mr. Jowhari related to mental health programs and mental health treatment opportunities. He was saying that the word “programs” was more expansive, when I would have thought that “treatment” opportunities was more expansive.

What is your thought, Dr. Smith?

[Dr. Patrick Smith]

I enjoyed hearing that conversation, because I kind of understood where you were coming from.

Again, we have the same debates. The word “treatment” in the field of mental health has historically been equated to beds, especially with substance use disorder: “Oh, to go to treatment, go to your 28-day program.” They tried to expand it.

I don't think “program” is the right word in terminology in terms of expanding it. I think what we talk about is “full system of services and supports”. It's the most expansive. Sometimes those services and supports are in the form of a program, and sometimes people's understanding of treatment always goes to the most acute treatment, thinking “beds”.

I think the intent of this bill, from what I understand, is to encapsulate the full continuum of services and supports that are meant to be the primary mental health response. That can include services from your GP, a specialized peer support worker, or an addiction counsellor, all the way through to more formal programs and more acute treatment.

[The Chair, Liberal, Anthony Housefather]

Thank you. That's very helpful.

My second question comes back to the exact conversation you were having with Mr. MacGregor.

Currently the wording that's being proposed is “any mental disorder from which the offender suffers”. Let's say I were to introduce the words “any aspect of the offender's mental condition that is relevant for sentencing purposes”.

Would you prefer one over the other?

[Dr. Patrick Smith]

I would probably prefer the latter.

Instead of “mental condition” even, we would say “mental health condition”, or—

[The Chair, Liberal, Anthony Housefather]

So “the offender's mental health condition”.

[Dr. Patrick Smith]

I think because “disorder” is such a charged word, even though I grew up in the medical world and understand that it comes from the diagnostic manual [Technical difficulty—Editor], others aren't.

[The Chair, Liberal, Anthony Housefather]

Thank you. Those are my technical questions.

Does anyone else have any other questions? No.

Dr. Smith, you were incredibly helpful to the committee. I want to thank you very much for your testimony.

Once again, a very happy 100th birthday to the organization.

[Dr. Patrick Smith]

Thank you.

I wish I could provide you with some virtual cake.

[Some hon. members]

Oh, oh!

[The Chair, Liberal, Anthony Housefather]

Save it in the freezer, and maybe next time we'll get it. It will be like royal wedding cake: preserve it for the next time you come here.

[Dr. Patrick Smith]

There you go. It's a deal.

[The Chair, Liberal, Anthony Housefather]

Thank you so much, sir.

The meeting is adjourned.