Thank you very much. I hope you can hear me loud and clear. I apologize. This has been my most embarrassing Zoom call so far this year. I apologize for that, but we've managed to get on.
Thanks very much for allowing me to speak today. I'm honoured to be here.
As you know, I was the chair of the 2018 report by the CCA on MAID and mental disorders as a single underlying medical condition. I was also a member of The Halifax Group, which published a paper on MAID safeguards. Both the CCA report and the Halifax Group report wrestled with the same issues as Health Canada's 2022 expert panel on MAID and mental illness. Those main issues are the ones I've heard you talking about already: eligibility, capacity, suicidality, the intersection between MAID and the social determinants of health or structural vulnerability, and safeguards.
I know you've read the reports, and I'm happy to discuss those, but I thought I would use just a minute or two to draw attention to three things: the possible impacts of COVID-19, social determinants of health, and racial inequity on MAID for mental illness.
To explain the assessment of suffering in mental health problems, it is partly a link to the adequacy of treatment. Also, the social impact of the illness, the social exclusion and the feeling that you have a difficult future ahead of you increase the perception of suffering.
The suffering of people with mental health problems is likely to increase because of COVID-19. We had a crisis of increased rates of illness, increased rates of mental health problems and inadequate access to care and supports before COVID, and things have gotten worse because of COVID itself. That's because of the increased need for services, but also because of staff burnout and decreased capacity of services. We have a greater imbalance between service provision and need.
If the number of people who are not able to access appropriate treatment increases, we have increased numbers who are suffering. Therefore, if we have increased numbers of people suffering, we have to consider what that means for MAID and mental illness.
COVID-19 isn't the only stressor. We have the affordability crisis and curbs on government spending that will impact the suffering of people with mental health problems, because they're making unrealistic, comparative appraisals of where they are in their lives compared to others. As the social safety net comes under pressure and affordability becomes more of an issue, perceived suffering may increase.
Then, there's racial inequality. We all know that COVID-19 has hit indigenous, Black, and other racialized groups hard, but these groups were previously underserved by mental health services. Those disparities are likely to increase. They are also less likely to get the social supports they need. Again, we have a differential increase in suffering.
So far, none of the reports I talked about have properly discussed the differential impacts of MAID on different racial groups. I note that the Health Canada report does suggest that there needs to be consultation with indigenous populations in the implementation of the safeguards, but did not recommend that Black and other racialized groups should be specifically also consulted. I think that's an error.
I'm suggesting that we need to be thinking about an increased focus on how to ensure that every person who is considering MAID, where mental disorders are the single underlying medical condition, would have full access to appropriate and effective medical support. At the moment, we say they need to know about it, but the question is, do we ensure that they actually have full access?
Of course, it's clear that we need to build a system that doesn't only offer the medical support, but also makes sure that people with mental health problems are not socially excluded, living in poverty and believing that they have no future. We have to ensure that people accessing MAID have had proper access to social supports.
Last, we need to ensure that this group, our expert panels, and other groups that are thinking about MAID law have full and considered engagement with Black and other racialized groups so their needs are properly reflected in the transformational laws we're talking about.
All in all, my concern is that our safeguards should focus on ensuring that people have had proper equitable access to all of the treatments and social supports they need to decrease their suffering. This is to ensure that we're not creating an off-ramp for social suffering through MAID.
Thank you very much.
