Status of Women Committee on Sept. 26th, 2022

[Dr. Leslie Buckley]

Okay.

Is that better?

[The Chair, Conservative, Karen Vecchio]

That's great. Thanks.

[Dr. Leslie Buckley]

Thank you so much for your patience.

My name is Leslie Buckley, and I'm the chief of addictions at CAMH, the Centre for Addiction and Mental Health. I've been an addictions psychiatrist for many years, mostly focusing on women.

What I'm going to focus on today is the current landscape of substance use for young women and girls, and I will talk about why we need to worry about substance use and what we can do. I'll speak about these subjects separately.

I'll start with alcohol.

Alcohol is extremely important, because we know of the significant harms that are related, whether it's accidents from falls, head injuries, etc., or legal issues, violence, crime, drinking and driving, or its important role for young women in sexual assault. There is a double impact from substance or alcohol use by the perpetrator, which is more common. Also, sometimes they target women who are using substances. They are more often the victim in sexual assault in that context.

All of this, of course, is in addition to the chronic harms that we know about to the liver and the cardiac system, and more recent information highlighting the impact on cancer and elevated rates associated with alcohol. We know all of those chronic harms happen faster in women who are more vulnerable to alcohol.

In terms of trends, we've seen that over the last 20 years, there has been a slight reduction in alcohol use among youth. That is according to the OSDUHS, the Ontario student drug use and health survey that CAMH runs. What's interesting with alcohol, and cannabis as well, is that although we see boys decreasing their substance use, women have not decreased theirs to the same degree. What we're seeing is that they're meeting and we've diminished the gap between young women and young men.

At this point, I see that I'm two and a half minutes in, so I'm going to pass it over to Dr. Singla for her portion.

[Dr. Daisy Singla, Independent Scientist, Centre for Addiction and Mental Health]

Thank you, Dr. Buckley.

Thank you so much for the invitation to speak today. My name is Daisy Singla. I am a clinical psychologist by training and very much a global mental health researcher at heart. I've worked in some of the most remote areas of sub-Saharan Africa and South Asia, only to learn that many of the lessons that we have implemented and learned abroad are completely applicable to our context here in Canada.

As my colleague Dr. Simone Vigod said, one in five pregnant and postpartum women experiences common conditions of depression, anxiety and trauma. If they are left unaddressed, there are long-term negative consequences for the woman, her child and future generations.

In my travels and in my research, I have learned three key lessons to address these common problems.

The first is that brief talk therapy works. Some of you may have heard of cognitive behavioural therapy or interpersonal psychotherapy. These brief talk therapies are among the most effective treatments in medicine, yet fewer than 10% of women have access to these psychological treatments.

The second is the power of telemedicine to deliver these treatments. COVID has catapulted our health care systems to reconsider how mental health care can be delivered. Telemedicine allows pregnant women and new mothers to overcome common challenges of finding transportation and child care and allows for flexibility.

Finally, we will never have enough psychologists or psychiatrists to address the mental health treatment gap. Thankfully, there is a growing literature demonstrating that non-mental health specialists—individuals without a specialized degree in mental health, such as nurses, midwives, peers and teachers—can be trained to deliver these effective treatments.

As I mentioned, all of these lessons can be applied to our context here in Canada. In 2020, we launched SUMMIT, the largest talk therapy trial for pregnant and postpartum women in the world. We are funded by a U.S. organization called Patient-Centered Outcomes Research Institute, which asks whether nurses and midwives are as effective as specialist providers and whether telemedicine is as effective as in-person talk therapy.

Our trial is showing promising preliminary results, and the full results will be available in January 2024. The results will ultimately inform the stepped-care model that Dr. Vigod referred to and the delivery of effective patient-centred talk therapy for pregnant and postpartum women.

Today I want to invite all of you to be stakeholders in this exciting initiative to ensure that our results materialize into service and also to invest in the stepped-care models that Dr. Vigod referred to earlier today. Psychological treatments are effective. Innovative solutions, such as telemedicine, exist to improve access.

In summary, I believe we can do better as clinicians, researchers and policy-makers and as a society to serve women and other populations with these effective treatments.

Thank you.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

Finally, for our last presenter, we have Dr. Charlene Senn, professor and Canada research chair in sexual violence, University of Windsor.

Charlene, you have the floor for five minutes.

[Dr. Charlene Senn, Canada Research Chair in Sexual Violence and Professor, University of Windsor, As an Individual]

Thank you very much, Chair and honourable members.

I'm Dr. Charlene Senn, professor of psychology at the University of Windsor and a tier 1 Canada research chair in sexual violence. I'm a social psychologist whose research focuses on prevention of sexual violence on university campuses and for younger high school-age girls. I'm an expert on sexual violence prevention generally and on sexual assault resistance and bystander education interventions particularly.

Your committee's work is focused on girls' and young women's mental health. My testimony to you today, in a nutshell, is that unless and until we address the realities of sexual violence experienced by girls and young women, and put efforts into preventing sexual violence, our country will not be successful in improving girls' and women's mental health.

Sexual violence creates numerous physical and mental health consequences, some of which are specifically named in the motion. If we focus only on mental health supports, then we are mitigating harm but not preventing more citizens from experiencing the harm in the first place.

I care deeply about and want to combat all sexual violence. However, the vast majority of victims are girls and women, our focus today. Cisgender men and boys are 98% of the perpetrators of sexual violence against girls and women, and most are known to the victims, not strangers.

How big is this problem? Young women are at higher risk of sexual assault than women over 25. By conservative estimates, on university campuses one in five women will experience sexual assault before graduation. However, research shows that 50% of the rapes that women experience occur by the time they are 18, which means we need to start earlier in our prevention efforts.

In a recent study we conducted in Ontario with teen girls, we asked about their experiences of unwanted sexual contact and rape since the age of 14 by male peers. For this study, male peers included boyfriends, friends, classmates and strangers who were not adults, so these are underestimates.

One in three girls reported experiencing unwanted sexual contact as a result of the guy telling lies, threatening to end the relationship or spread rumours about her, making false promises, showing displeasure, criticizing her or getting angry. Almost one in four girls had experienced oral, vaginal or anal rape accomplished with threats of force, force, or alcohol or drug facilitation; and one in five had experienced attempted rape.

Young women also report being repeatedly asked, pressured or coerced into sending nudes. In a recent U.S. study, between 12% and 40% of teen girls reported sending a sexual message or image because they were pressured to do it. We know this can have mental health consequences, especially when these images are then shared without their consent. We call this image-based sexual abuse.

The physical health effects of sexual violence include unwanted pregnancies, sexually transmitted infections, increased cigarette smoking and alcohol and drug consumption, and many others. Psychological effects include depression, PTSD, suicidal ideation, lack of sexual enjoyment, and fear. Fear of rape also affects the quality of life for young women who are not sexual assault survivors, leading them to restrict their movements as a precautionary strategy and limiting their employment, education and recreational opportunities.

Research clearly supports the need for increased resources for sexual assault crisis centres and other experts in providing trauma-informed care to survivors to address the varied physical and mental health outcomes of sexual violence—but this point is often made. I am directing your attention to the fact that prevention of sexual violence is equally important.

The Flip the Script with EAAA program that I developed for women in university is an example of the impact we can have. Participation in the program reduced the risk of attempted and completed rape in the next 12 months by 50% and reduced self-blame, which is linked to worse mental health outcomes if women did experience rape. An adapted version of the program for girls 14 to 17 is being tested in a randomized control trial starting in January with Public Health Agency of Canada funds.

You should know that research also suggests that providing comprehensive sex education supports prevention efforts. Sexual violence prevention takes time, resources and expertise, and requires dedicated investment.

Thank you.

[The Chair, Conservative, Karen Vecchio]

Thank you very much.

We'll now start with our rounds of questions. The first round will be six minutes, and we will begin with Shelby Kramp-Neuman.

Shelby, you have the floor for six minutes.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Thank you, Chair.

Thank you to all the witnesses for their testimony today.

We can all acknowledge that, growing up, there are rapid development changes physically, and clearly, very deep emotional changes happen. For a lot of girls, this can be very exciting. For other girls, this is very daunting, confusing and uncomfortable. My first point is about why this is happening and what some examples are. Then I'll get to my actual question.

As parents, aunts and grandparents, I think we need to be watching for social cues. We need to be watching for how they're eating and how they're sleeping. We need to be watching for patterns with their relationships with other girls, with coaches, with parents, with other adults, with teachers, with themselves, with food and with their social media. Self-esteem and body image are huge. There are bullying, pressures, trends, drinking, smoking and cyber addiction. This is not news to any of you.

In the midst of my comments, I'd like to acknowledge you, Mégane Jacques, because I think it's brilliant that you are here speaking with us. Thank you for being open. I agree that being part of the solution is paramount. In my opinion, youth are the most important people to be talking about this. My one question for you would be this: Do you feel that there are enough youth actually involved in being part of the solution?

Second, taking the mom hat off and putting on the hat of the legislator, I think there was a comment made by Ms. Austin with regard to new budgets, promises made and nothing being done. To me, that's the disturbing part. It's brilliant that we're all here talking about it, but it's pathetically alarming if all we do is talk about it and not actually do anything about it.

My question, perhaps to Sara as well, is with regard to prevention and intervention. What specific mediums are we using to get to these young adults and actually help them?

Thank you.

[The Chair, Conservative, Karen Vecchio]

Ms. Jacques, you can start.

[Mégane Jacques]

Thank you for the question. I believe there are actually more youth who are interested in speaking up and working toward better mental health, but there's a kind of barrier where we're not always trusted to make our own decisions or make our own choices regarding the issue. That's scary for a lot of teens. I was lucky enough to find an organization that was ready to listen to my voice and accompany me during my process, but not all teens or youth have that opportunity or that luck.

That's something we should definitely work on in order to harness the full power of youth engagement. If it's too much of an effort to actually stand up for yourself...because sometimes that might be a little bit difficult, especially if you have mental health issues like a lot of youth who advocate for mental health have. For example, with my own anxiety, it was very hard to reach out to an organization or just be in the group and talk about it, because I was so anxious in every way and everywhere. Having a place that feels safe would definitely help regarding youth engagement.

I think the young Canadians' parliament that we're working on exists for this very purpose. Every young girl, every young boy and every youth work together with the government to find solutions and protect our rights, because we're ready and we want to make a change.

Thank you.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Thank you.

Sara, I'm not sure how much time you have left.

[The Chair, Conservative, Karen Vecchio]

[Inaudible—Editor]

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Thank you.

[Sara Austin]

Thank you, Madam Chair and honourable members.

Thank you to Mégane for her courage and bravery today, and to many young people like her who are speaking up asking for help.

Far too often we see that when young people do have the bravery to ask for help, they simply don't have that help available to them. In the province of Ontario, for instance, kids can be on wait-lists up to two and a half years waiting for mental health supports. When we think about the issues and the gravity of things like self-harm, substance use disorders and suicide, to expect a young person to wait for so long for mental health supports is unacceptable. This is partly why we see such a rise in young people seeking mental health supports in emergency rooms. They need to know that they can go there if they're in crisis, but they should be receiving supports within a clinical setting within their communities and within their schools.

We are proud to have been able to launch the young Canadians' parliament at the very beginning of the pandemic to provide young people with a platform to be heard by parliamentarians and to be able to speak up for themselves in decisions that were being made in real time throughout the pandemic. However, we are dismayed at how slow it has been for funding to flow, and funding that has been announced has not often been directed to young children and adolescents. There has been funding for organizations like Kids Help Phone, which is very important and we have commended those efforts, but other funding has been slow to flow. We continue to call for designated funding for children and youth to start in the early years, to start with prevention, but of course also to provide the crisis support that's needed for children.

I urge and reiterate the point that was made around data collection, that we don't have systematic data collection at the federal level from coast to coast to coast, so we're often operating on limited information around different provinces or territories or municipal-level studies, so—

[The Chair, Conservative, Karen Vecchio]

Thank you, Sara. I'm going to have to interrupt so that we can get to our next line here.

I'm going to pass the floor over to Emmanuella.

Emmanuella, you have six minutes.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you, Madam Chair.

I'd like to thank all of our witnesses for being here with us today, especially Mégane for being so brave and coming to testify here on behalf of all the young women she's representing here today.

A lot of people mentioned the higher amount of attempted suicide, depression and anxiety that is reported in young girls. I think it's two to one; that's the statistic that I heard around the table. I'm wondering if you can let me know, based on research that you have done, whether or not that might be because boys don't necessarily come out and express themselves as much. Are we missing that part? Apparently, according to research, there is a higher rate of suicide among young boys than there is among girls. I don't know if anyone around the table can confirm that, but I wonder if you can speak to this notion. I think that quite a few of you have touched on this subject.

I'm going to start with Mr. Szatmari, because I think he was the one who mentioned specific stats around the ratio.

[Dr. Peter Szatmari]

It's important to distinguish suicidal ideation and suicidal attempts from completed suicide. There's no question that young girls experience suicidal ideation or make a suicidal attempt that's non-fatal two to three times more commonly than boys, and young boys do complete suicide more commonly than young girls.

What's quite disturbing is that the gender gap on completed suicide—boys completing more commonly—is narrowing over time, not only in Canada but internationally as well. The gender gap where boys are more commonly affected—like antisocial behaviour, substance use and completed suicide—is narrowing over time, suggesting that the mental health of girls is being differentially impacted by things that are happening not only in Canada but globally.

I don't think it's a matter of reporting, because boys do report depression and anxiety, but certainly nowhere near as commonly as girls do. I hope that answers your question.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you. In some ways it does. I appreciate your answer.

I'm sorry; this is a hard topic for me.

Mégane, earlier, when you were giving your testimony, I was wondering if you wanted to finish your comments, because I don't think you got to finish them. If you want to take the floor, go ahead. I know you already answered a question, but if you'd like to finish what you were saying in your opening statement, I'd like to give you an opportunity to do so.

[Mégane Jacques]

Thank you.

What I wanted to conclude on earlier was actually that I would like to ask this committee to really recognize girls as experts in our own lives and to respect our right to be involved in a decision that affects us. I want to say thank you to all of you, because you've been welcoming and open to the fact that there is a younger girl sitting at this table just as you are. I think it's a really good first step for making true change. Perhaps you could just continue in that way and listen to different girls of different backgrounds all the time.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you so much.

Dr. Vigod, you are in the room. You spoke about perinatal mental health problems. No doubt, parenting style has a lot to do with how kids turn out and how well supported they feel at home, and obviously intergenerational trauma has an effect on kids and childhood trauma has an effect on kids throughout their life. Do you think there is enough support out there, and if there is, do you think it is accessible? What can the Canadian government do to help support mental health across the nation? I know that it's mostly a provincial jurisdiction because it falls under health. What can the Government of Canada do specifically to help the situation and make mental health supports more accessible to the most vulnerable?

[Dr. Simone Vigod]

Thank you for the question.

In answer to your other question about the 2:1 ratio, between menarche and menopause, depression and anxiety are twice as common in girls and women as they are in men. It's thought that this is because of some of the unique reproductive issues we were talking about related to menstruation and pregnancy, as well as because of the fact that women and girls are disproportionately affected by risk factors for mental illness, as we've heard today, like violence, poverty, lack of education, etc. That's what feeds into that.

Unfortunately, as you said, a healthy parent means a healthy baby. We talk about how the years before five last the rest of their lives. You actually need to take a step even further back and say that if we could make our young parents well during pregnancy, that could prevent issues in children and youth's mental health down the road. When I talk about the fact that we know that in Canada as few as one in five pregnant and postpartum people have the support they need, that's a big problem.

What can the federal government do? One of the things would be—and this has been done before—to fund community organizations across the country to deliver peer support to specific populations—adolescents or indigenous populations, for example.

My time is up, but if I had to prioritize one thing, I would say that if we could do that, we could make a huge inroad.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

We're now going to pass it over to Andréanne.

Andréanne, you have six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

I'd like to thank the witnesses for being here today to talk about this issue.

I agree that this is a very sensitive issue, Ms. Lambropoulos. We've heard some very moving testimony from some of our witnesses about the impact mental health issues can have.

For the sake of transparency, I'd like to say that I lost a cousin during the pandemic. He committed suicide. He was in the age group we're examining today. I also have family members experiencing mental health issues.

Dr. Vigod, I have a seven‑month‑old daughter, so I have experienced perinatal mental health issues. What we're talking today is very close to home for me.

Thank you for your testimony, Mégane. You mentioned the double standard for young women, and I'd like to sharing something a colleague said to me. She told me that now that I'm a mother and an MP, I'll always feel that I'm not being a good enough mother on the one hand, and that I'm not doing my job properly as an MP on the other.

I'd like you to talk about this double standard and how it can affect young women and girls' mental health.

[Mégane Jacques]

We always feel like we're walking on eggshells. We never know how we're supposed to act or how society expects us to act, which makes us even more anxious. Like any other young person, we want to please our peers and adults and find the gang we belong to. But that's almost impossible because different messages come in from all sides. They tell us to be this, or that, or the other thing. That makes us feel disappointed or ashamed all the time. No matter how we act, there's always someone who's going to be disappointed. This applies to girls more than boys, because we're always held to higher standards as girls.

So not only does that uncertainty make us more anxious, we also constantly feel inadequate, like we're not good enough or we're not doing enough, and that there's just no place for us in this society. That's one of the most damaging things, especially because when we try to talk about it, many times we're told it's not a matter of being a girl, and we're just more sensitive. When we bring up the situation, what we say often gets swept under the rug. It's really sad when young girls are undervalued like that.

[Andréanne Larouche, Bloc, Shefford, QC]

I feel we can all agree that there needs to be more support. Dr. Vigod, you talked about community organizations and the health care system helping young people like Mégane. Many other witnesses have brought it up too.

I'm proud of what's already being done in Quebec. I'd like to point to a community organization in my constituency, for example. I did a day camp tour this summer under the Canada summer jobs program. I visited community organizations like the Centre de prévention du suicide de la Haute‑Yamaska, as well as youth centres. Everyone said anxiety and mental health issues were on the rise.

However, we do have some great initiatives. For instance,where I'm from, a youth centre in Waterloo works very closely with École secondaire Wilfrid‑Léger. People in these organizations say they need more support. They do get support from the Quebec health care system. A cross‑party committee on sexual matters has also studied how sexual assault can affect young women's mental health, all in a non-partisan way in Quebec. As I say, the community organizations and health care system that help them need support.

I'd like to hear what Dr. Vigod or another witness has to say about this important issue, the need for more funding in the health care system. The organizations and the system could sure use it. We're establishing good local initiatives, but to do that we need a transfer. Quebec and the provinces are all asking for a 35% health transfer. We need the financial resources to help our young women and girls.

Dr. Vigod, do you want to tell us a bit more about the effect more funding for community organizations would have and what that might mean in terms of prevention?