Evidence of meeting #13 for Status of Women in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A recording is available from Parliament.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Thank you.
Dr. Tasca, I believe at the beginning you said only one-third of those who need mental health care receive it. Briefly you mentioned it was because of provincial and private plans. Could you expand on that, and what the recommendation is to this committee, please.
Research Chair in Psychotherapy Research, University of Ottawa and the Ottawa Hospital, Canadian Psychological Association
Dr. Votta-Bleeker, perhaps you could speak to that.
Deputy Chief Executive Officer and Director, Science Directorate, Canadian Psychological Association
Yes, I can take that one.
We commissioned a number of economists to do our report, so that's how we looked at things from a private and employer perspective. If I even just use employers as an example, Canadian employers could expect to recover $6 billion to $7 billion with attention to prevention, early identification, and treatment of mental health problems. We have upwards of $20 billion in costs when people are going off on medical sick leave, on stress leave, things like that, so the early prevention is key. If you can build that into the insurance programs, whether it's those by employers or whatnot, that's where you're going to see the greatest returns on investment.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Okay. You mentioned another recommendation to this committee, which is that psychologists should be part of the primary care team. Is that correct? Do you want to expand on that?
Deputy Chief Executive Officer and Director, Science Directorate, Canadian Psychological Association
I think as you've heard us all say, including Ms. Phoenix, the multidisciplinary approach is really the most comprehensive way that we're going to address a disorder such—
Deputy Chief Executive Officer and Director, Science Directorate, Canadian Psychological Association
Absolutely, and it's multidisciplinary. We all have a role to play in this because it needs the nutrition, it needs the education, it needs the family counselling, it needs the psychological interventions, it needs the medication.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Is everything you've mentioned part of the recommendation? It's the multidisciplinary team, including everything you've just mentioned.
Deputy Chief Executive Officer and Director, Science Directorate, Canadian Psychological Association
Psychiatrist, Canadian Academy of Child and Adolescent Psychiatry
If I could just add, when we talk about the fact that the vast majority of girls with eating disorders need outpatient treatment, and there's a lack of that, the problem is that the only available outpatient treatment is expensive private psychologists. That needs to be funded for the families.
Psychiatrist, Canadian Academy of Child and Adolescent Psychiatry
To have free psychologists available to do the treatment for youth with eating disorders, for sure.
Deputy Chief Executive Officer and Director, Science Directorate, Canadian Psychological Association
It goes back to making it a basic health service, the provision of psychological care by psychologists.
NDP
The Chair NDP Hélène LeBlanc
Thank you. That is very useful.
Mrs. Truppe, you have the floor for seven minutes.
Conservative
Susan Truppe Conservative London North Centre, ON
Thank you, Madam Chair.
I'm going to share my time with my colleague, Madam Crockatt, since she only had a couple of minutes there at the end.
My first question is for Dr. Spettigue. We had talked about, when our time ran out, working with groups and families versus individuals. Then you just mentioned sharing data at the conferences across Canada, I think it was. I just want to find out what type of data are you sharing? Is there something you found that could be a best practice that could be shared with other health professionals, because it sounds like you're doing conference calls and conferences, so there must be something good coming from there that's maybe being done somewhere else, whether it's here or in other parts of the world? Did you learn anything that we can share with anyone?
Psychiatrist, Canadian Academy of Child and Adolescent Psychiatry
It's hard to know where to start, but one of the things that we did in our monthly conference call was get all the pediatric in-patient programs together and say, if the evidence is for outpatient family therapy for youths with severe eating disorders who are medically stable, then what should we be doing with our in-patient programs? Do we just medically stabilize, or do we offer group therapy? Is group therapy effective? We really didn't have the answers because the research hasn't been done.
But what we did decide was to go more towards a model where we would have shorter hospital stays. Our program got rid of our group therapy. We just have parents stay by the bedside. We discharge them sooner to outpatient family therapy, and that was based on a provincial decision of all of the programs that they're going to go more towards that model, rather than longer stays where you do lots of group therapy in the hospital.
Conservative
Susan Truppe Conservative London North Centre, ON
That's good, thank you very much.
My next question is for Dr. Tasca. I don't think I heard this yet, so I hope you didn't already talk about it. What we've learned from a lot of the previous witnesses is that a lot of times the only time something is getting looked at is when they, the patients or individuals, are deteriorating so much they then finally get to the hospital. So I was wondering, do you offer some type of outpatient or day programs for those who are not at that danger level yet? Maybe they're just at the beginning of this stage, I'm not sure, but is there something that could be done before they get to that deteriorating stage and they go to the hospital?
February 24th, 2014 / 5:05 p.m.
Research Chair in Psychotherapy Research, University of Ottawa and the Ottawa Hospital, Canadian Psychological Association
We're a tertiary care centre, so our referrals come from family physicians. By the time the patients get to us, they are already moderately ill in terms of severity. Our program does have an outpatient component to it. We get about 150 to 200 new referrals a year of adults. We triage the referrals in terms of what level of care they require: either in-patient and day hospital or outpatient.
We do provide some outpatient care for some of the individuals who are mildly to moderately severe in terms of eating disorder, but it's fairly limited. Because the more severe individuals require more care, they tend to get bumped to the front of the line. There are many more resources that go to our in-patient and day hospital program as opposed to our outpatient program, and that's just the reality of the current situation.
Research Chair in Psychotherapy Research, University of Ottawa and the Ottawa Hospital, Canadian Psychological Association
Yes.
Conservative
Susan Truppe Conservative London North Centre, ON
Thank you.
My final question before I share my time is for Ms. Phoenix.
In your opinion, if you were only going to pick one, what's the largest obstacle in treating eating disorders?
Nurse Practitioner, Canadian Federation of Mental Health Nurses
Just one, really...?
I was trying to interrupt before to say that I think people are really being clear that, optimally, care is offered by a multidisciplinary team to treat the complex medical, mental health, psychological, and emotional needs, and also the family and partner support needs that are part of an entire system. But that needs to happen in a continuum of care.
I think that's the other piece that's really becoming evident by your questions, in that a continuum of care isn't just an in-patient setting. I think our London program for southwestern Ontario is a good example of a new funding model, where we are an outpatient, day treatment, and residential program with a very exhaustive aftercare program, with that full model. Because you're right, it's not just the sickest of the sick who require treatment. It's those individuals with mild to moderate symptoms who really should be seen, because we know from evidence that those folks who are treated sooner rather than later do best and don't move on to the severe level of symptomatology.
Conservative
Conservative
Joan Crockatt Conservative Calgary Centre, AB
Thank you very much.
I wanted to go back to you, Dr. Tasca, to one point you were making, just to clarify. You were talking about budget cuts. I wanted to clarify whether you were talking about provincial or federal budget cuts. I'm sure you're probably aware that the federal government has given 6% increases to all of the provinces for health care.