Status of Women Committee on Sept. 26th, 2022

[The Chair, Conservative, Karen Vecchio]

I call the meeting to order.

Good morning, everybody, and welcome to the 29th meeting of the House of Commons Standing Committee on the Status of Women. Pursuant to Standing Order 108(2) and the motion adopted on Tuesday, February 1, the committee will commence its study on the mental health of young women and girls.

Today's meeting is taking place in a hybrid format, pursuant to the House order of June 23, 2022. Members are attending in person in the room and remotely using the Zoom application.

I would like to make a few comments for the benefit of the witnesses and members.

Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mike. Please mute it when you're not speaking. For interpretation for those on Zoom, you have the choice, at the bottom of your screen, of English, French or floor. For those in the room, you can use the earpiece and select the desired channel.

I would remind you that all comments should be addressed through the chair. For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function. The clerk and I will manage the speaking order as well as we can, and we appreciate your patience and understanding as we are going through this.

Today, we are starting a really important study that we have all talked about. It's going to be a very exciting panel. I would like to welcome our guests for our first panel.

From Children First Canada, we have Sara Austin, founder and chief executive officer, and Mégane Jacques, youth representative on the youth advisory council and the young Canadians' parliament.

From Jack.org, we have Rowena Pinto, president and chief executive officer.

From the Centre for Addiction and Mental Health, welcome to Dr. Leslie Buckley, chief of the addictions division, and Dr. Daisy Singla, who is an independent scientist.

As an individual today, in the room, we have Dr. Simone Vigod, professor and head of the department of psychiatry at the University of Toronto's Women's College Hospital. Also as an individual, we have Dr. Peter Szatmari, senior scientist and director of Cundill Centre.

As an individual, we have—only for the first hour, so if you have questions specifically for this person, make sure to get them in during our first hour—Dr. Charlene Senn, professor and Canada research chair in sexual violence at the University of Windsor.

What we'll be doing is providing each organization with five minutes. When you see me frantically start moving my wrist in the air, that means your time is coming up and I will cut you off, probably within 15 to 20 seconds, because we have such an exceptional panel and so little time today. We will be doing committee business, so our questioning period will be only 90 minutes in total today with our presentations.

To get started, I would like to welcome Children First Canada for their first five minutes of presentation.

[Sara Austin, Founder and Chief Executive Officer, Children First Canada]

Thank you, Madam Chair, for this opportunity.

My name is Sara Austin, founder and CEO of Children First Canada. CFC is a national charity, and we are a strong, independent and effective voice for all eight million kids in Canada. I'm so pleased to be joined by Mégane Jacques, the chair of CFC's youth advisory council and a member of young Canadians' parliament. Mégane is also a recipient of the inspiring youth award from Canada's Pandemic Heroes for mental health.

As a national charity that engages children and youth, we publish research, raise awareness and mobilize action. We can speak about the mental health crisis facing girls and young women in Canada and also about the innovative and evidence-based solutions that are needed. We do so through an intersectional lens focused on the inequitable impacts of mental health on girls who are racialized; first nations, Métis and Inuit youth; 2SLGBTQIA+ and girls with disabilities.

I also speak as a woman who has experienced poor mental health as a girl and throughout my life, as a parent of a child who has experienced poor mental health, and as someone who has witnessed this crisis unfolding in the homes of families across the country. Our aim is to share our personal perspectives, together with the evidence gathered through CFC's years of experience doing research, youth engagement, policy influence and engagement with the Canadian public. We bring a unique perspective on the challenges at hand.

In April 2021, at the height of the pandemic, when many schools remained closed, CFC joined with children's hospitals across the country in declaring #codePINK. It's a term used for pediatric emergencies. We called on federal and provincial governments for an emergency response. There was overwhelming evidence that children and youth, and girls in particular, were facing threats to their survival. Rates of suicide, depression, anxiety, eating disorders, substance-use disorders and self-harm were alarmingly high.

This #codePINK unleashed a tidal wave. We were flooded by calls, emails and messages from girls and youth, parents, teachers and grandparents across the country who were experiencing this crisis in their homes and who joined us in calling on governments to take action.

Yet, here we are over a year later, and fundamentally nothing has changed for the better. New budget commitments have been announced and promises have been made, but the reality for girls and for young women, and for kids and youth more broadly, remains the same; #codePINK remains in effect.

In our latest “Raising Canada” report on the top 10 threats to children, poor mental health is the number two threat. The data for the top 10 threats is examined through the lens of equity, diversity and inclusion, and we can share with you ample evidence that shows that the threats to children, and to girls in particular, are growing. Many of the top 10 threats, such as poverty, child abuse, systemic racism, discrimination, bullying and climate change, are known as adverse childhood experiences that directly impact the mental health of girls and young women.

From coast to coast to coast, many girls do not make it to their 18th birthday. Suicide remains one of the leading causes of death for children and youth between the ages of 10 and 18. These devastating statistics are too alarming to be ignored. Every girl, and in fact every child, deserves the right to survive and thrive.

We urge this committee to consider the need for prevention and intervention for the mental health of girls from the earliest days of life. Half of all cases of mental health issues begin by age 14, and three-quarters by the age of 24. We urge you to work with a sense of urgency. Every day, every hour, every minute matters in the life of a girl. We urge you to work with girls and young women in defining the problems and the solutions. They have a right to be heard.

On that note, I cede the floor to Mégane to share her perspective.

Thank you, honourable members, for your commitment to address the mental health of girls. I'm hopeful that more deliberate action will be taken in the very near future.

[The Chair, Conservative, Karen Vecchio]

Mégane, you have one minute.

[Mégane Jacques, Youth Representative, Youth Advisory Council, Young Canadians’ Parliament, Children First Canada]

Thank you.

I believe that society sends very contradicting messages to women: They should look pretty, but not too pretty; they should share their feelings, but not be too open; they're told to strive to be self-reliant and powerful, but simultaneously reminded that they are weak and inferior to men. This causes, as Sara mentioned, an internalizing of their feelings and negative comments towards themselves.

The stigmas regarding girls' mental health—as just being a teen, or full of hormones, or overreacting, or too emotional—are terribly damaging. In fact, women and girls attempt suicide one and a half to two times more often than men and boys.

Now, these women and girls who are struggling are not weak. They just need our support to pick themselves back up, just as I needed when I was told I was too sensitive, rather than anxious, or too intelligent to have depression after I tried to kill myself at 15, 16 and 17. I wasn't asking for big changes then. I just wanted someone to believe me and work with me to make it better.

I am here today to ask you to take action, but also to show you that I'm part of the solution. All girls are part of the solution. As an advocate for mental health, I am leading changes in my community and across the country—

[The Chair, Conservative, Karen Vecchio]

Mégane, I'm sorry; I have to cut you off. I did let you go a little bit longer there. We'll make sure that some of this can be asked through the questioning.

I'm now going to pass it over to Jack.org.

Rowena, you have the floor for five minutes.

[Rowena Pinto, President and Chief Executive Officer, Jack.org]

Thank you.

Good morning, honourable members.

As mentioned, my name is Rowena Pinto, and I am the president and CEO of Jack.org, a national not-for-profit organization with the mission of improving mental health for youth across Canada.

I speak to you today from Toronto, located on the indigenous territory of the Huron-Wendat, the Haudenosaunee and the Mississaugas of the Credit, which is covered by the Upper Canada treaties and is part of the Dish with One Spoon treaty.

Thank you very much for having me here.

Jack.org provides upstream peer-to-peer mental health education and capacity building for youth in their transition years, aged 15 to 24. We believe that the best way to improve mental health for youth is by engaging them directly, precisely because youth are in the best position to identify their mental health needs and speak to the issues they are facing. Jack.org engages thousands of young people across the country to educate their peers and promote mental health in their communities.

As of 2021, around three-quarters of the young people in our network identify as young women, and 60% identify as having lived experience with mental illness or a mental health struggle.

Looking at the broader research around mental health, we know that suicide has long been the leading health-related cause of death among youth in Canada. Youth aged 15 to 24 experience the highest rates of mental health distress of any age group in Canada.

Over the past decade, and especially during the pandemic, youth have been increasingly reporting worse perceived mental health. This trend is particularly true for young women, who experience higher rates of both diagnosis and reported symptoms of anxiety and depression relative to young men, and have also experienced higher increases in these experiences over time. Black, indigenous and LGBTQ2S+ youth also experience particular vulnerability to mental health distress even as they face greater barriers to care.

The factors influencing youth mental health distress are complex; however, since beginning to survey youth in 2019, our network has consistently identified certain factors as common mental health stressors. Perceived and objective financial strain, academic pressure, and lack of employment and educational participation were raised as particularly salient mental health stressors. Youth have raised that we must also not forget about stress related to minority status for equity-deserving groups and the emerging stressor of climate anxiety.

As you can see, the mental health challenges faced by young women and girls in Canada are prevalent. The underlying stressors are persistent, and the impacts are profound.

What troubles us at Jack.org is that the majority of youth do not seek help when they are experiencing mental health distress. While rates of help seeking are somewhat higher for young women than for young men, just 16% of young women seek mental health support from a professional, while 32% seek informal support from friends, family, the Internet or others in their social networks. We need to pay greater attention to this persistent gap in help seeking while acknowledging and addressing the clear preference for young women to seek informal mental health support.

Fortunately, there are some signs of hope. Investment in upstream youth mental health education to destigmatize mental illness, encourage help seeking, and increase mental health literacy can ensure that young women and girls experiencing mental distress receive the help they need.

Our key recommendation is to broaden federal attention and resources beyond clinical mental health services to focus on the larger mental health-promoting environment. [Technical difficulty—Editor] where young women and girls live, learn and work.

What this looks like is efforts to build the capacity of young women and girls to identify signs of mental health struggle in themselves and their peers, engage in effective coping when they experience stressors, and access a range of mental health services when needed. As we bolster their ability to seek help, we must also ensure that they are met with services that align with their needs and preferences. Consistent with youth's preference for informal support, peer-to-peer mental health services can be valuable, provided that youth are equipped with the appropriate education to support one another.

As a final word, too often we speak of these solutions without engaging the voices of the young people we seek to support. We recommend meaningfully engaging young women and girls in efforts to strengthen mental health supports in the way that serves them. They know what is best, what their needs are and what solutions will work for them. There is no substitute for their voices around the decision-making table, and the thousands of youth across Canada who make up our network are keen to offer their insights to better support mental health for themselves and their peers.

Thank you.

[The Chair, Conservative, Karen Vecchio]

Perfect, thank you so much.

I'm going to pass it over to Dr. Leslie Buckley, but before we carry on, I just want to do a quick sound check because we see that you have different earpieces in. I'm going to pass you to the clerk just for a sound check.

[The Clerk of the Committee, Ms. Alexie Labelle]

Dr. Buckley, would you mind just saying a few words? I'm just going to check with the interpreters if the sound is okay.

[Dr. Leslie Buckley, Chief, Addictions Division, Centre for Addiction and Mental Health]

It's a great pleasure to be here today to present to this esteemed group. I look forward to informing the group about substance abuse disorders in young women.

[The Clerk]

Your microphone is not properly selected. Would you mind going to the bottom left corner of your screen? There's an arrow where you can select the correct microphone. Once you've selected your microphone, would you mind just bringing it closer to your mouth and we can try that?

[Dr. Leslie Buckley]

I'm not sure what you mean there, but I certainly don't want to interrupt your proceedings. Are you able to hear me now?

[The Clerk]

Yes, we can hear you, but we just want to know the choices you have to select the microphone. Right now it seems like it's the audio from your device and not from your microphone.

[Dr. Leslie Buckley]

This is now from my device instead of my microphone.

[The Clerk]

I'm just going to wait for the interpreters to confirm if it's okay.

[The Chair, Conservative, Karen Vecchio]

Is there a way we could do that off-line so I could go to the next panellist?

[Andréanne Larouche, Bloc, Shefford, QC]

I have a question, Madam Chair.

[The Chair, Conservative, Karen Vecchio]

Go ahead, Ms. Larouche.

[Andréanne Larouche, Bloc, Shefford, QC]

Did our witnesses have the opportunity to test their mikes before the meeting, as is usually recommended?

[The Chair, Conservative, Karen Vecchio]

They did, but unfortunately Dr. Buckley was right in between and we had started the meeting right on time.

What I'm going to do is ask, Dr. Buckley, if we can come back to you. I'm going to pass it over to Dr. Simone Vigod in the room, and perhaps we can work with you off-line for a moment.

I'll get back to the Centre for Addiction and Mental Health, but now I'm going to welcome Dr. Simone Vigod, professor and head of the department of psychiatry.

We're going to pass the floor over to you for five minutes.

[Dr. Simone Vigod, Professor, University of Toronto, and Head, Department of Psychiatry, Women’s College Hospital, As an Individual]

Thank you for welcoming me today to assist with your study on the mental health of young women and girls.

Thank you for inviting me to appear before you this morning.

As a medical doctor, psychiatrist and researcher, I have spent my career focused on the mental health of women and girls across the lifespan. While there are so many important aspects to this that deserve our consideration, I see pregnancy and the first postpartum year, the perinatal period, as a crucial time for action for our young women.

You may not know that perinatal mental illness affects up to 20% of Canadian pregnancies. This means that it affects up to 80,000 Canadians annually, posing serious risks to young mothers and children at a crucial juncture in both of their lives. But this is also a time of great opportunity. If we successfully treat a young mother's mental illness in the present, we not only improve her well-being, but we may also prevent her child—her girls, her boys, her children—from developing mental illness in the future.

Unfortunately, as few as one in five people with perinatal mental health issues receive the treatment they need to get better in this country. The gap is largest for equity-seeking groups, including our indigenous populations and our youngest women. We know what will help, and that is a stepped-care approach. For mild symptoms, low-cost interventions like trained peer support are highly effective. So are short-term structured psychotherapies, which we have shown in our own research can be delivered by non-mental health specialists like public health nurses, midwives and even lay people. For more severe illnesses, we need to go up a step, where specialized therapies adapted for the perinatal period and medical treatments are also highly effective. People must be seamlessly transitioned between the steps, depending on their level of need. There are so many opportunities to close this one-in-five gap.

At Women's College Hospital, I lead a Canada Foundation for Innovation-funded women's virtual care laboratory. Our CIHR-funded research is supporting the argument that virtual care can be used to complement our face-to-face services, which is especially important for traditionally hard-to-reach populations. We've even studied a virtual stepped-care approach where a care coordinator works with patients who access a platform that we developed to help them determine which of the stepped-care options is right for them. It recommends specific virtual and in-person care opportunities in their communities. The platform then automatically provides follow-up and monitoring so that people don't fall through the cracks.

At the end of six months, three-quarters of the patients in our study of this approach were better, versus only half in a comparison group who received the usual available care from the health system.

In March 2022, invited by Dr. Carolyn Bennett, Minister of Mental Health and Addictions, I chaired a national round table on perinatal mental health. It was attended by individuals with lived experience and health care providers with multiple and diverse perspectives from across the country. What did we hear? We heard about gaps in peer support, lack of trained therapists and a “postal code lottery” of specialized services. There are only about 10 specialized clinics across the country and a lack of consistent approaches in other places. We heard about the fundamental importance of equity, diversity and inclusion in any systems solution.

With this in mind, I believe the greatest impact on a national level would be to invest in the following five concrete and actionable priorities.

One, fund community organizations across the country to increase daytime and weekend access to paid virtual and in-person peer support, allowing for targeting to specific groups, such as indigenous populations, Black and LGBTQ2S+, young adults and more, so that no matter who you are across this country, you click, you phone, you go to a safe community space, and you have inclusive, personalized experience.

Two, fund training of perinatal health care and lay providers in short-term structured perinatal mental health psychotherapies, so that perinatal mental health care would be integrated like treatment for diabetes or blood pressure in pregnancy, conditions just as serious but 10 times less common.

Three, fund the training of personnel for new specialized perinatal mental health teams for underserved regions and end this Canadian postal code lottery for specialized care.

Four, to support this, invest in the technical infrastructure of these virtual stepped-care platforms that can be used to coordinate nationally or by provinces and regions.

Five, establish Canadian national guidelines for the prevention and treatment of perinatal mental illness, and work with the Standards Council of Canada to develop and monitor national standards. This is a mechanism to ensure a national shared understanding of what care needs to be delivered, and standards against which we can measure our progress.

I believe a national coordinating centre for perinatal mental health could deliver on the training and supervision required to action these initial priorities and establish a national network for sustainable education, research and monitoring of progress going forward.

Thank you so much for listening this morning.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

We're now going to move over to Dr. Peter Szatmari, from Cundill Centre.

Peter, you have the floor for five minutes.

[Dr. Peter Szatmari, Senior Scientist and Director, Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, As an Individual]

Thank you very much.

Good morning, honourable members.

My name is Peter Szatmari. I'm a child and youth psychiatrist and director of the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health.

Thank you so much for the invitation to present to the Standing Committee on the Status of Women. I am very pleased to see that you are addressing an issue that I and many of my colleagues see as a major public health problem in Canada: the mental health of young women aged 12 to 24 years and the widening gender gap in mental health, not only in Canada but also globally.

Sex and gender differences—for simplicity I will refer to gender only—are pervasive in youth mental health. Three disorders—anxiety, self-harm and depression, which very often occur together in a cluster—represent the main causes of adolescent disability worldwide as reported by the World Health Organization. Data in 2014 from Ontario, the only province for which population-based data exist, estimated that up to 20% of adolescents experienced a mental health disorder, again, predominantly anxiety, depression and self-harm.

This triad of conditions shows striking gender differences, each disorder occurring roughly two times more commonly in adolescent females compared to males. Again, data from that 2014 survey show that 10% of adolescent girls report a major depressive disorder, compared to 5% of boys, and 20% of adolescent girls report an anxiety disorder, compared to 10% of boys.

What is even more alarming is that, not only in Ontario but also in most high-income countries globally, rates of these three mental health conditions have increased over time, particularly among girls. The gender gap for this triad of mental health conditions is not only large but becoming greater over time.

The reasons for these gender-based inequities are not clear and are likely to be complex. Some risk factors for anxiety, depression and self-harm are more common in girls, while girls appear to be more vulnerable than boys to the impact of other common risk factors. Female hormonal changes associated with puberty have a profound effect on the developing brain, and early puberty, something that is becoming more common worldwide, is a potent risk factor for depression. Other risk factors for this widening mental health gender gap include the increasing prevalence of sleep disruption among girls and the higher rates of sexual abuse and bullying experienced by adolescent females compared to males.

We know that, during the pandemic, Canadian adolescents reported alarming rates of worsening mental health. Statistics Canada reported that at one point roughly 50% more adolescent girls than boys judged that their mental health was somewhat or much worse compared to prepandemic times.

We are likely to experience even more population-level risk factors in the future, whether that is another pandemic or the challenges associated with the climate crisis. I have only to point to wildfires on the west coast and cyclones in the Atlantic and their impact on the mental health of young people. The mental health of young women in Canada is at heightened risk in the face of these and other similar yet unforeseen disasters.

I have two recommendations that I believe are within the federal mandate for health and that might go some way toward mitigating these challenges.

First, young girls and women throughout Canada should have ready access to consistently high-quality services tailored to their gender, culture and other aspects of identity. The federal government can play a role in encouraging the provinces and territories to come together and support this unified vision, as well as in advocating for a common platform of measurement-based care and outcome monitoring to ensure that gender-based inequities in mental health do not widen further.

Second, Canada is the only G7 country that does not have a population-based survey of the mental health of children and youth that includes repeated measurements over time. As a result, we do not have population-based data on the health, including the mental health, of young people. As a result, we cannot say with confidence that rates of actual disorder or that mental health inequities have truly increased postpandemic, compared to prepandemic. The Canadian health survey on children and youth—

[The Chair, Conservative, Karen Vecchio]

Dr. Szatmari, I am going to have to cut you off. You've passed your time. I will cut you off right now and then we'll get back into the questions.

I'm now going to pass it back to the Centre for Addiction and Mental Health. Dr. Leslie Buckley and Dr. Daisy Singla, I'll pass it over to you.

You have five minutes.

[Dr. Leslie Buckley]

Thank you so much, Madam Chair and honourable members.

It's a privilege to be able to—

[The Chair, Conservative, Karen Vecchio]

Before you get started, could you put the microphone closer to your mouth?