Status of Women Committee on Sept. 26th, 2022

[Dr. Simone Vigod]

I'll answer in English, if I may.

Thank you very much.

I think that if we could fund community organizations where the people in those organizations had the ability to support their communities...we know from evidence that this can prevent postpartum depression and can treat mild and moderate illness.

This whole conversation also really made me think about how much more we can do federally with cross-training. If we had a national collaborative centre, for example, it would be okay if there was expertise in Quebec but not in Saskatchewan. We could cross-train. We could have licences that run across.

Finally, with respect to the other question, I would say that there was a pediatrician in the early 20th century by the name of Donald Winnicott, who talked about the concept of the “good enough mother”, and we now talk about the “good enough parent”, the thinking that it's okay not to be perfect. In fact, that's what we want to do. That's the example we want to set, so that people know that they cannot be perfect and can still be worthwhile and move forward.

In listening to all of this, I think that's the messaging we need to put forward.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

I'm now going to move to Leah for the next six minutes.

Leah, you have the floor.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much.

I just want to acknowledge, before I start, that this is a very difficult topic for many people around the table, so thank you, Andréanne and Emmanuella, for sharing. I know that these discussions can be very painful.

I want to start out with Children First Canada. Mégane, thank you for sharing your truths and your story. It was very powerful. Also, Sara, thank you for sharing. I think we need to normalize talking about mental health so we can get rid of the stigma and so that it's not based on shame but just telling and living our truths.

My first question is for you, Mégane. You talked a little bit about stigma and the stigmatization of young women being overly sensitive, hysterical—all of that. If you feel comfortable sharing, when you were going through mental health issues, did that result in minimizing your own experience as a result of the minimization that was happening around you?

[Mégane Jacques]

Absolutely. At some point, I wasn't even realizing that I still had mental health issues and I was still struggling, because everyone around me said that I had to be okay. I had to pretend to be okay; I had to just smile and continue walking, doing my thing. Those stigmas of just being too much of something or not enough of something always put you in a difficult place when you have mental health issues.

I would say that, for me, it led to my not taking care of myself as much as I had to and not seeking the help I needed, because I didn't feel that I was worthy of needing help or I didn't think that my issues were intense enough. I was waiting and waiting for the point of being really sick, because I had to be my perfect self out of the house and even in my house.

My friends were always telling me, “Well, I feel kind of stressed, too”, even if I said, “No, I'm not stressed; I'm very anxious right now. I have physical issues with my mental health.” People don't realize how much what they say has power over the mind. That point is really something that we should change among young girls and among adults as well. Even teachers at some point were trying to cheer me up and help me, but the very basis of what they said was solely that I should just continue.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much for sharing that.

The next question I have is for Dr. Vigod. I'm glad that we're talking about postpartum depression. I know that, when I was born, my mother wasn't allowed to talk about it, but when I had my son, I was, with the public health nurse. That was top of mind, asking how I was feeling and all that. I'm glad we're talking about it.

One of the things you brought up is concerning to me, looking at the Canada Health Act. There are a couple of things, but one is that we often talk of provinces, except that certain groups are not funded under the province, particularly populations of first nations, Inuit, federal inmates, Canadian Forces veterans and refugees, depending on status. This is concerning. You spoke about access, but also how it's more pronounced in remote areas. We know that remote areas have the lowest proportion of women and girls, 55.8%, who reported very good or excellent mental health.

With all of those factors, particularly prenatal care and women having to be shipped away from families to hospitals alone for a month, how does that intensify mental health issues?

[Dr. Simone Vigod]

With the lack of access to care, you have to remember that one of the biggest reasons for developing a mental health issue around pregnancy and postpartum is lack of social support. We could prevent it so easily with some pretty low-intensity, low-cost interventions. That's why I made the second point that I did, and Dr. Singla raised this as well, that short-term, structured psychotherapies can be delivered by lay individuals. They can be delivered by public health nurses. They can be delivered in remote areas. Because of virtual medicine and telemedicine, we can do supervision.

We have ways we can help people. People should receive care in their communities because the other issue, as you said, is that you want to understand the experience of being a refugee or the experience of being indigenous.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Picking up on that, according to the Canada Health Act, mental health services and treatments outside of a hospital setting by non-physicians, such as psychologists, social workers, occupational therapists and other mental health workers, do not fall under the purview of the act. The only coverage is for services that are provided by a physician or a psychiatrist. That contradicts what you just said.

Do you feel that we need to make changes to the Canada Health Act to be more inclusive of service providers for people experiencing mental health issues?

[Dr. Simone Vigod]

No. I am biased, but I see mental health as a medical issue and a health issue. Why would we deliver certain medical care and not certain other medical care?

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

We're now going to pass it over to Michelle Ferreri. We're in our five-minute rounds.

You have five minutes on the floor.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

You gave me an impossible task, Chair. I need a whole lot more than five minutes for this conversation.

Thank you to everyone.

Mégane, you are definitely a star in this committee. Everybody is outstanding, but you are definitely a star. Thank you for being here.

I want to say on the record that we need to acknowledge that if we're going to treat youth mental health in girls, specifically, we need to be mindful that we need to invest in mental health for parents, caregivers and men. If we are not doing this, we cannot help young girls. To your point, Mégane, if the people around you had known how to trust you and how to empower you to recognize your own feelings, I believe you would have been in a much better position.

I want to go right to Leslie Buckley, if I can. Leslie, do you know if there is any data on an intervention time period that determines the success of stopping addiction disorders?

[Dr. Leslie Buckley]

Thank you so much for that question.

There is an incredible interaction between substance use disorders and other psychiatric disorders—we're talking about depression and anxiety—and we can certainly see certain relationships and patterns. One example could be social anxiety in a young person which, if unaddressed, could lead to increased substance use at the time when people start socializing more outside of their house, at age 15 or 16, and that could escalate over time.

That would be one example of how a mental health issue can lead to a substance issue, but it can also happen the other way. Somebody may not be experiencing anything from a mental health side and may start using substances. Again, it's important to note that risk factors for substance use are a combination of genetic and social factors. It's about fifty-fifty. Everybody has a different experience with substances, and some people are much more at risk.

Let's say a young woman starts to develop a substance use pattern. That may lead to certain specific events, such as doing less well in school. Maybe it is an impact of, let's say, cannabis use, which is increasing in women. We could see an impact of increased anxiety or mood related to that cannabis. There's been very poor education in that realm. There's misinformation, in fact, where people think that cannabis may be helping their anxiety or their depression, but in fact evidence shows the opposite.

This young person may be developing an anxiety or a depression issue into their twenties and then struggling with other life events, like school or relationships, which, again, is that spiral downward. Often, we see substances and mental health issues spiralling together in that way.

There isn't an exact trajectory. I wish I could answer your question more specifically.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

That's okay. Thank you. There's a lot of data that I would like to accumulate, and I'm going to come back to that.

If I can, I'll go to Ms. Singla.

Daisy, you mentioned how we have such a huge gap and people do not have access, especially to talk therapy. Do you think there is room for modernizing health care to close the gap for access to mental health care—especially when we're targeting 12- to 24-year-olds—utilizing things like social media?

[Dr. Daisy Singla]

To clarify, I'm also a professor and can be addressed as Dr. Singla, if you wish.

In any case, with regard to social media, we know that with regard to psychological treatment, the most effective treatments are those involving a therapist. As we've emphasized, it does not have to be—

[The Chair, Conservative, Karen Vecchio]

Could we hold for one moment? There may be a problem with the translation.

There was a bit of a problem with the interpretation. Could you start that again, Dr. Singla?

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

If I can just get the answer fairly quickly, I have one more question I want to squeeze in.

[Dr. Daisy Singla]

Sure. You asked about the impact of social media. Certainly, we can leverage social media to improve access to psychological treatment.

However, we actually have the technology available—we're using it right now to connect with all of you in Ottawa from across Canada. We can use Zoom and other secure platforms to have therapists—again, they don't have to be psychiatrists or psychologists—deliver these effective treatments. They can be a whole wide cadre of non-specialists. We've done this around the world. We're doing it here in Canada in our SUMMIT trial to deliver these psychological treatments, so I would very much emphasize leveraging our—

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

I'm sorry, but I have only 20 seconds left, so I'm going to go to Ms. Austin quickly.

You called #codePINK, and fundamentally nothing has changed. There are $45.2 billion allocated for mental health. How will that best be used, do you think, to implement action right now for mental health in youth?

[The Chair, Conservative, Karen Vecchio]

Could you take that in about 10 to 15 seconds, Sara?

[Sara Austin]

I think it needs to focus on prevention and early intervention. It should look at prevention of mental health issues from the early years by looking at the effects of abuse and poverty and the systemic issues that are feeding into the poor mental health of girls and young women, but also the early intervention when young people are coming forward with their needs.

[The Chair, Conservative, Karen Vecchio]

That's perfect.

I'm now passing it over to Marc Serré.

You have five minutes, Marc.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you, Madam Chair.

I'd like to thank all the witnesses for being with us.

We could use more time. If the witnesses have any additional information for the committee, it's very important that they send it to us.

I don't really know where to start. In Sudbury, in northern Ontario, Denise Sandul started Crosses for Change. There are a lot of deaths of youth and other individuals in the community. Minister Bennett came to visit in the summer and we had round tables and meetings with individuals. We were talking more specifically about Ontario, but the conversation was around 6,000 different organizations. There seem to be some challenges with coordination.

When we look at the stats that you identified today, there is a massive issue, but there are still some gaps when we look at the federal, provincial, municipal and volunteers. We heard from Dr. Vigod that community funding is important. I wanted to ask.... Maybe we'll start with Dr. Pinto from Jack.org. When we look at negotiations right now with the provinces on bilateral agreements, how important is it to get this right with statistics and evidence-based information, as we heard earlier? There is a massive urgency right now to fund organizations on the ground, yet we have to find a way to look at best practices with provinces.

I'll go down the list of witnesses, starting with Dr. Pinto and maybe Dr. Buckley and Dr. Singla afterwards. What are the best practices that the federal government and provinces should be utilizing when we look at organizations?

[Rowena Pinto]

I'm not a doctor, just for the record, but thank you so much.

As you know, Jack.org engages thousands of youth across the country, and what we have really focused on is that upstream support for youth and their mental health. As one of the other witnesses mentioned, there is never enough money to go around in terms of accessing services, so how do we build resilience, take away the stigma and improve help-seeking behaviours among youth? We've really focused on peer-to-peer support, because often that is where youth, and young women especially, will go if they need help. Sometimes they don't know what services are available or can't access them, and that has been proven to help.

I would agree that more support can be given to organizations that already have the constituency and already have trust with different communities. I think that is definitely something that should complement whatever investment we make in the system as a whole.

[Marc Serré, Liberal, Nickel Belt, ON]

Dr. Buckley, go ahead.

[Dr. Leslie Buckley]

Thank you so much for bringing up the story of Sudbury, which has had one of the highest rates of opioid overdose in the country.

We can think about two clear directions, and I think that has come from this group today as well. It's clear that we need prevention and we need treatment. For the treatment side, I think there will be a lot of comments about that. I think Dr. Vigod spoke about having a champion group that may be made up of many groups that help to oversee and perhaps distribute information and supervision to community groups.

On the prevention side, there's a lot we can learn from the addiction world, because we've had, in some ways, more experience in prevention than the mental health side has. It's not enough to just talk about prevention or talk about disorders or identify them, because we found with research in addictions that education doesn't have the impact we thought it would. You need to have skills-based education. You have to help people understand the harms of substances, of course, but we focus too much on that. Sometimes even just bringing up substances has actually led to an increase in substances in low-use schools, although it would reduce it in a high-risk school.

It's complicated. We have to do it right. We need to think about the centralized prevention tools that we have. In addictions, the best is accessibility. If you increase the cost, if you have fewer store hours, if you have fewer stores, you have fewer substances. It's important that we know those indicators; we're not winning that political war.

I guess my last comment is not to forget about addictions in the treatment that we're talking about today, because it's an important part of young women's experience.

[The Chair, Conservative, Karen Vecchio]

Excellent. Thank you so much.

What I'm going to do is mess around with this a little bit, because I'm looking at the time, and there are so many great questions still left to come.

The Bloc and the NDP are next. I'm going to increase your time to three and a half minutes and then not give you a final round. I'll just give you some additional time now. Then we'll get the last two questions by Mike and Jenna, if that's okay. So you'll get three and a half minutes now rather than two and a half minutes. Then we'll go for three minutes to Mike Lake and three minutes to Jenna, and then that will be the end.

Kristina, you have three and a half minutes.