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.