Public Safety Committee on Sept. 26th, 2017

[The Chair, Liberal, John McKay]

Ladies and gentlemen, let's commence our meeting.

Before I formally welcome our witnesses, I wanted to suggest to the committee that, because of the uniqueness of this meeting, we be a little less formal than we would otherwise be, and conduct it as more of a caucus-like meeting rather than a meeting where we go formally from side to side, etc. I just want to make sure that this is all right. Okay.

Also, the subcommittee did meet, and the subcommittee's report is now obsolete. It appears that we will not be receiving Bill C-21 in a timely fashion, so we will not be commencing our review of that bill. The consequence of that is that next Tuesday, we have two choices: to continue with the migrant information that we may receive on Thursday, with a joint meeting with the immigration department, or we may start the indigenous studies meeting. I am not going to ask for commentary just now. I'm going to let you ruminate about that, and possibly toward the end of the meeting, call the meeting a little early and see what the will of the committee is.

With that, I'd like to welcome our witnesses. There has been some discussion as to how this presentation will take place. I don't know the order, but to Michel Rodrigue, Nicole Boisvert, and Liane Vail, welcome all. We look forward to what you have to say, and what order you have to say it in. I'll let you proceed from here. Thank you very much.

[Michel Rodrigue, Vice-President, Organizational Performance and Public Affairs, Mental Health Commission of Canada]

Mr. Chair, and distinguished members, thank you for the time that you have allocated in your busy schedule this morning.

The Mental Health Commission of Canada is thrilled to be able to present a snapshot of a program that we deliver for first responders, police forces, and health care practitioners, to help build resiliency in the work they do.

I will shorten my opening remarks to allow my colleagues to speak to you more directly about the programs offered.

With that, I will turn things over to Ms. Vail.

[Liane Vail, Master Trainer for Road to Mental Readiness, and retired Royal Canadian Mounted Police, Mental Health Commission of Canada]

Thank you very much, Mr. Rodrigue.

Good morning, ladies and gentlemen.

Thank you very much for your invitation to the Mental Health Commission of Canada.

I'll tell you a little about me. I am a retired RCMP officer. I did all my service in New Brunswick. I am originally from Montreal, and so when I got to a little place called Neguac, New Brunswick, it was quite a rude awakening, to say the least. After my 13 years on the road, I went into VIP work where my unit was the first to have a full security detail on the Premier of New Brunswick, who at the time was Bernard Lord. After a couple of years of that, I derailed more into looking after the members themselves, and became the EAP coordinator for the division in the province of New Brunswick for a few years, and then I moved on to being the return-to-work coordinator. I also finished my master's in counselling psychology at UNB.

I noticed a big gap, not for those who were getting the help they needed, but the walking wounded, those out there who didn't know where to get help. Essentially, I became involved in this program years ago, and I have a lot of passion for it. I believe in it, and I can certainly answer any questions in French or English.

The other representatives from the commission can answer your questions as well.

To start, I would like to tell you about the Mental Health Commission of Canada.

Essentially, the Mental Health Commission was created in 2007 based on a report on mental health, “Out of the Shadows At Last”, which came out in May 2006.

As you can see on the screen, it is a non-profit organization funded by the Government of Canada, but operating at arm's-length. There are key areas in mental health: workplace, recovery, peer support, suicide, first nations, Inuit and Métis, and opening minds. Today, I'll be discussing the road to mental readiness, R2MR, which is directed to the workplace, in particular to first responders.

Some of the projects and initiatives we have been involved in include the mental health strategy for Canada, as well as the national standard of Canada for psychological health and safety. We often look at the physical health and safety, but more and more research has shown us that we have to look at the psychological health and safety as much as we do for the physical.

Opening minds is an initiative where essentially we looked at all.... They didn't want to reinvent the wheel. They wanted to look at what is out there to determine what is of value. They looked and took an evidence-based approach. They didn't reinvent things that were already out there, like the R2MR. The four target groups they looked at were health care providers, youth, news media, and the workplace. Specifically, R2MR is in the workplace. However, it has a secondary effect of bringing the tools and things they'll learn through this program home to their spouses and their families, which quite frankly is the secondary advantage of having this program rolled out.

Why is mental health important? This is where I'd like this to be a little interactive. Before we start some of the questions with some statistics, we're going to look at a video.

[Technical difficulty—Editor]

[Nicole Boisvert, Manager, Business Planning and Operations, Mental Health Commission of Canada]

Is there sound?

[Liane Vail]

Having done this presentation many times, I can give you a Coles Notes version as you look at the video.

[Nicole Boisvert]

We'll animate it for you.

[Liane Vail]

Yes, we will definitely animate it for you. It's pretty straightforward.

There's a gentleman going across the road and he gets hit by a car. If that was a physical injury, you would have people running up to him, looking at him, and looking for help. What you see here is a group of people. Some people are standoffish, while some are hands on. They're saying things like, “Look at him. He's not even bleeding.” “I don't have time for this.” “What am I supposed to do?” “He's probably faking it.” These are all things that affect somebody with a mental illness. It's the stigma that's attached that makes people not want to say anything because of those exact words. At the end, it says, “Imagine if we treated everyone like we treat those with mental illness.”

The next slide is going to be a little interactive. It gives you the answer. However, one in five Canadians will struggle with a mental illness throughout a year. We do the math. There may be 20 or 30 people here and one in five of us will be affected directly or indirectly. Are we going to develop a mental illness? Not necessarily, but one in five will be affected directly or indirectly.

Here's one. You saw the circle. What percentage of adults living with mental illness say the onset occurred before the age of 18? Do you have any guesses?

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

I would say 85%.

[Liane Vail]

It's 70%. In other words, 70% of adults who suffer from symptoms had already experienced them before the age of 18.

What percentage of parents say that they would not admit to anyone that they had a child with a mental illness?

[An hon. member]

I would say 60%.

[Liane Vail]

Why do you think that? Why do you think it's so high?

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

It's because they feel ashamed.

[Liane Vail]

Right.

They're embarrassed. They're ashamed.

[An hon. member]

The stigma.

[Liane Vail]

There's the stigma, absolutely.

What percentage of youth under the age of 25 that have been treated for a mental illness reported being affected by stigma?

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

It depends on what generation we're talking about. The percentage might be much lower for the current generation, given that it is accepted in schools, but I think it would be 60% for our generation.

[Liane Vail]

That's right.

I'll give you the example of my 12-year-old son.

He came to me one day, and he said, “Mom, I'm going to kill myself.” Having the experience I have, I asked him the appropriate questions.

There's the way of doing it and there's the thought. A lot of times people will say suicide is the end all and be all, but there is suicide ideation.

So, I asked the appropriate questions and I said, “Okay buddy, you have a plan. You know how you're going to do it.” Off we went to the hospital. Of course, that's when you need the special care. That's when you need the specialists to come in. I'm not afraid to disclose that because he is now a champion. He is now out in the school telling his story, that it's okay not to be okay all the time, and that there is help out there.

It's important, and it's like you said. The younger generation are more free to tell you how they feel, how they're thinking. Oftentimes, I ask my son what his heart says, how he is feeling. We often negate our feelings and hide them. What happens is that we are scared to come out and say what is wrong. The biggest factor is stigma.

Only 13.9% of Canadians talk to their health care professional about their mental health. Stigma is the number one reason, if not the largest reason people don't seek professional help. What would you say are the worries of stigma? Stigma is a very large umbrella with many factors underneath it, but why would stigma be a factor for somebody with a mental illness?

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

This can have an effect on the empowerment of a person in the labour market or on access to better positions, such as management positions.

[Liane Vail]

The number one worry is what people are going to think.

The importance of reducing stigma is actually like opening a door or a floodgate, and there is a wave attached to it. When we reduce stigma, we get early intervention. We get a better prognosis and outcome. We increase productivity. Oftentimes, we hear about absenteeism. There is also what we call presenteeism, where somebody shows up at work, does about three tasks for the day, and is done. Why? It's because that person feels obligated to go to work, but is not well enough to be at work. Essentially, there is the positive financial impact of increasing productivity.

There's also a cultural shift in thinking and attitudes. When we introduce this program, especially to managers, what I notice is light bulb moments. The shift in thinking and attitudes is not just black and white. We'll show you a little bit about that later on in the slides, but there is a shift because it's not a black-and-white topic. There's a lot of grey in the middle. Basically, there's a continuum model that is colour coded to simplify and to increase the anti-stigma, and there are positive outcomes for those with mental illness because they're a lot more open and they feel safer and comfortable in disclosing to their peers, to their managers, what's truly going on inside them.

This is a great analogy. People often ask, “Why does it take so long for somebody with a mental illness to come back to work?” Quite frankly, they don't know that they're not well for a very long time. You look at an incident, let's say a sprained ankle or a broken leg, and you're looking at the injury. Well, the injury can happen simultaneously. If a police officer goes to a car accident and gets injured at that car accident, he has a physical injury and he has a mental injury, because of the trauma he was exposed to. However, that physical injury is going to be looked after, diagnosed and treated, and he's likely to go back to work. But is he well when he comes back to work? Has he dealt with the trauma? Maybe not.

You see a very much longer line that goes under the mental injury going to the diagnosis. Why is that? There's a lot of reasons: they don't know themselves; they haven't identified it; they don't know where to go; they don't know what to look for. Essentially, when it gets to the diagnosis, there's a longer term of being not well emotionally that is going to take quite some time to get better, compared to a physical injury where it's one thing after another and you're back to work. The treatment will happen and there will be a return to work. However, it takes that much longer based on the fact of not knowing what to identify, not knowing what to look for.

Some numbers and figures that are quite alarming is that 500,000 people in Canada will not go to work this week, based on the fact that they're struggling with symptoms or signs of mental illness. There's a $51-billion cost to that. If you were to compare a mental illness to a physical illness, like a respiratory illness, you're looking at a cost of $8,000 to $9,000 for respiratory care and 11 days off. If you were to compare that to a mental illness, you're looking at $18,000 per case and 65 days off. How do we fix that? What's the solution?

These are some stats. Oh, I skipped one. This research was done by a group, a case study, and again I've really explained the difference between respiratory and mental illness. You're looking at the number of days, which is 11 days, based on a respiratory infection as compared with a mental illness.

Do you have any questions so far?

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Yes, I have one.

I imagine that the statistics relate to a definition of mental illness. What symptoms are included in the definition?

[Liane Vail]

We'll talk about that in a few moments. I will describe the set of symptoms and warning signs. The commission has divided this into different parts. We will talk about the warning signs and symptoms and describe the information that officers receive during training.

Let us look at the prevalence rates of PTSD in Canada. You'll see the general population is 7% to 12%. This was taken by the Royal Ottawa Health Care Group in 2016. Essentially, police and military are at 8% prevalence rates, and then you have fire, and you have corrections, and paramedics. Quite honestly, if I speak to this slide, I have to thank the commission for doing their due diligence in the police world, because when it first started, one of the employees, Sue Mercer, was at the forefront of targeting police. I truly believe that it's thanks to the commission and the hard work they've done so far that has decreased that percentage in the policing world.

As far as the military goes, R2MR has been around since 2009 and I truly believe it has made a difference.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

A study that was just done had the self-identified rates much higher than that. We heard in our study, as well, that the prevalence rate of both operational stress injuries and post-traumatic stress disorder was considerably higher than the numbers shown there. Because there really aren't any statistics across Canada, one of the things we recommended was that we should be looking at it. The Royal Ottawa Health Care Group is tremendous and at the forefront of this, but I don't know if those numbers for the police at 8% are representative of police across the country.

[Liane Vail]

I agree. There is a lot of research being done in separate entities, but nothing has been correlated together. You are going to get a variance in percentages. This is one group saying that they've looked at it; they've done their study, and they think it's 8%.

I'll give you an example. I was heavily involved after the Moncton shootings, when we lost three members and two members were injured. The year before, we had the R2MR in place, and we followed them afterwards. We used the OSI clinic in Fredericton to partner with and do some research. Based on just that incident, it was at 14%. Your statistics are going to vary, but I truly believe that this program really makes a difference in self-management.

After Moncton, we had seven days to prepare for the funerals. There was a lot of admin being done, but my job was to look after the membership, the trauma, and the crisis. We actually had a university wing that was a drop-in centre for all first responders who were directly or indirectly.... Just because I wasn't part of the shooting, that doesn't necessarily mean I was not affected. We had debriefings. We had psychologists, doctors, and so on. There is a perfect example that I use. This very big, rough and tough officer came in. I said, “What do you need?” He looked at me, and said, “I don't know what I need, but I know I'm not well.” That's what really touches me. The self-management tool of this really helps identify early intervention faster so that they can get the help they need. It's not a miracle cure, and not everybody is going to buy into it. I know that, but what I can say is that it has made a huge impact on a lot of people.

[Nicole Boisvert]

I'll just speak for a second, if I could. I think part of the difference that you are seeing with the statistics.... The recent study, if we're talking about the same one, was, as you said, self-reported. Those numbers are not actually representative of diagnostics, because there was no mental health professional involved. It was purely a screening tool; whereas these ones here, done by the Royal Ottawa, are actually diagnoses by a mental health professional. I think that's why you're going to see a discrepancy. Those that are self-reported are going to be a lot higher, potentially because there are more people involved.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Also, this is just looking at PTSD.