Status of Women Committee on Oct. 3rd, 2022

[The Chair, Conservative, Karen Vecchio]

Ms. Todd, I'm sorry. We've gone quite a bit over. You have so much to offer our committee. I'm feeling very rude, but we will be sure to get back to you.

Marc Serré, you have the floor for six minutes.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you, Madam Chair.

I want to sincerely thank all the witnesses for being here today and for the committed work they do in communities for all Canadians, but especially for young women and marginalized women. As they mentioned, it is very important.

Ms. Todd, I've had the opportunity twice before to hear you give evidence here. I have three daughters myself, and I want to thank you for the courage you've shown over the last 10 or 12 years. I thank you very much for providing solutions as well.

I had similar questions to my colleague, and you have already answered many of them. That said, I want to thank your organization, the Amanda Todd Legacy Society, for the work it does in raising awareness and fighting exploitation.

My question is for both Ms. Williams and Ms. Chimbganda.

Federal and provincial bilateral agreements are currently being negotiated. In 2017, a $5 billion, 10-year agreement was reached, and $600 million is being provided. However, we have heard clearly that in the past, some very specific needs have not been addressed with a view to the future.

My question is around the recommendations that you would have for the committee on negotiating bilateral agreements with the provinces. When we look at virtual care and eating disorders, previous witnesses have talked about shortages in psychiatry and at the first level. I want to get a sense from both of you of what specific recommendations you have for us in ensuring that we have those best practices in place when negotiating with the provinces to look at delivering the next step of services.

Dr. Williams, perhaps you can start.

[Charmaine Williams]

Thank you for that question.

My first thoughts are that, as I said in my remarks, we want to take advantage of the wisdom that's available within communities, which means a local focus. I would wonder about methods to really fund people who are closer to the site in terms of their knowledge of the issues and the capacities in various communities.

I would emphasize again that I think it's actually really important to be funding existing community-based organizations, because they have the credibility in the community, and often they have the innovations. Part of what we've heard about in today's remarks is innovations that have happened because somebody within the community, somebody with lived experience, took action. I think many community agencies have stepped into the gap, the gap that exists because we don't have accessible mental health care and mental health promotion services. We want to invest in those community-based organizations to really get the best results.

I can pass it to the other doctor now.

[Dr. Tapo Chimbganda]

Thank you.

I agree with Dr. Williams that, as I suppose we would be called a grassroots organization, funding is very difficult to obtain. A lot of funding requires us to have our charitable status, for example, which can take a while.

I've worked in community mental health specifically for quite a long time, and I know that in marginalized and racialized communities, for people to see a psychiatrist it has to be an advanced crisis, I will say. Normally what happens is that they look for information within their neighbourhoods and within their communities. They're looking for supports that are not quite as stigmatizing. When they do finally see a psychiatrist, it's at a point where things have gone on for way too long. Investing in grassroots organizations and supports will help mitigate some of those crises.

The other thing is that with psychiatrists, we do have a shortage, and it is good to increase funding in that area specifically, but most psychiatrists can't spend more than 15 minutes with a patient. As a therapist myself, the complaint I often get is, “You sat with me for a few minutes. The next thing I knew, you were giving me medication. I don't want to be on medication.” There's a disconnect in what is funded and how the people take up those services.

A lot of people also don't understand the difference between a psychiatrist, a psychotherapist and a physician. The system itself is quite confusing. They don't know that to see a psychiatrist, they need a referral, which means they need to see their family doctor first. A lot of people don't have family doctors right now. It's difficult to even get a family doctor.

So there are a lot of challenges along the way within the system itself.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

I'm now going to move it over to Andréanne.

Andréanne, you have six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

I thank the witnesses for being here. Their evidence is chilling and reminds us of the importance of working on this issue.

Ms. Todd, I have been a new mother for almost eight months. I can no longer imagine life without my daughter. So I offer you my deepest condolences.

We are also at the beginning of Mental Illness Awareness Week. It's a week that prompts us to think about what it brings and creates around us, as well as the importance of destigmatizing it and talking about it more. The witnesses have addressed this issue.

In this committee, we are also focused on solutions. My first question is for Ms. Assayag.

This morning on the radio, it was interesting to hear that we cannot work to provide more mental health services if we do not talk about funding. You made that clear. I also heard that there were projects in Quebec, but that they were on hold because of a lack of funding. In countries that operate according to different models, such as Australia, it has been proven that the more we invest in the prevention or treatment of mental illness, the more we succeed in reducing the number of people who suffer from it. It's simple math.

But how can we talk about all this without noting that mental health remains a provincial jurisdiction, in this case that of Quebec? As I said, Quebec has projects, but they are on hold because of a lack of funding. This shows the importance of investing in our health care system. What's more, as you said, the pandemic has exacerbated the problems. So we need to invest more in this area. The whole issue of health transfers is crucial.

[Lydya Assayag]

Thank you for the question.

Indeed, one of our recommendations is to double health transfers. However, money is not the only issue; we also need to rethink the health care system.

In its current state, the Quebec health care system is solely curative. Less than 2% of the health budget, which is substantial, is devoted to prevention, which is completely abnormal. We should follow the example of the European Commission, which devotes 34% of its health budget to prevention.

In short, we need a paradigm shift. It is not only a question of money, but also of operation. We must not wait for a crisis. To do this, we need to work in the schools, as Ms. Todd pointed out. We also need to work in the community, because people with mental health problems are often isolated. The people around them can also offer help.

I also come back to the recommendation regarding community networks. Our network includes a hundred or so community networks, and we see on a daily basis all the resourcefulness and innovation deployed to receive desperate people, for whom these networks are a last resort. Unfortunately, these networks are underfunded and too few in number. There is also a whole network of alternative community mental health resources that can act as a buffer before a crisis occurs.

[Andréanne Larouche, Bloc, Shefford, QC]

I would like us to come back to the issue of community resources, because they are part of prevention. In Quebec, they are also funded by the department of health and also require more funding.

At this point in the debate, I think it is important to point out that there are projects in Quebec that require funding. Representatives within the department would even like to invest more in health. The first step would be to provide resources. I'm obviously talking about financial resources. Then people could set up the organizations they want. But the question of financial resources is crucial.

[Lydya Assayag]

Yes, absolutely.

[Andréanne Larouche, Bloc, Shefford, QC]

We can come back to the issue of prevention during the second round of questions.

As part of all the work done by the Réseau québécois d'action pour la santé des femmes, your organization considered the fact that women feel mentally overloaded. In fact, their mental load is increasingly heavy. Women feel the weight of multiple responsibilities on a daily basis. When the mental load is too great, psychological problems can arise.

Could you talk more about the impact of mental overload, a problem that the pandemic also seems to have exacerbated?

[Lydya Assayag]

The pandemic has greatly exacerbated this problem, because the childcare and education systems have failed from time to time. When crises occur, it is always the women who are left with the work. We must also think about all the invisible work and task sharing.

I was talking earlier about collective factors linked to mental health. Obviously, women are the ones who help others: they are caregivers, they take care of children and friends. They form a natural network and they look after the health of others, while very often neglecting their own health. There is this overload due to the lack of equal sharing of housework and child-rearing. They take over from the flawed health care and school systems. They also take care of their parents. All this means that they have just too much to deal with.

[The Chair, Conservative, Karen Vecchio]

Thank you.

[Lydya Assayag]

Of course, it causes a lot of anxiety.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

We're now going to turn it over for the next six minutes to Leah Gazan.

Leah, you have the floor.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much, Chair.

I want to start by offering my condolences to Carol Todd. Thank you so much for your courage in sharing your daughter's story. It's truly touching, and I think a real gift to the world so that we can learn and so that other young people don't have to go through the same hurt, and parents through the same trauma.

My first question is for Sydney Levasseur-Puhach.

I think it's no secret that I've been a big advocate for Velma's House in Winnipeg Centre. You made a point during your presentation about how important it is for indigenous women and girls and gender-diverse folks to be in charge of their own care. One of the reasons why I was advocating strongly for Velma's House is the fact that it's a low-barrier safe space. For example, we know there is a direct correlation between people who use substances often and mental health.

Can you speak to the importance of offering low-barrier care, particularly for young people, that is readily available in communities 24-7, and why that's a life-saving measure?

[Sydney Levasseur-Puhach]

Absolutely. I think we need to prioritize whatever we can do to reduce red tape when it comes to accessing mental health-related and overall well-being services, and safety services specifically, because the last thing people need to worry about is how they are going to get this.

When people need support, when support is urgent, it needs to be there for them. That's something that Velma's House offers and that we want to make sure we have a lot of in our programming at Ka Ni Kanichihk as well. I think one of the ways to aid in that is to have funding that is available for multiple years with as few reporting provisions and requirements as possible, because things come up in life, and I think reducing red tape is critical so that we can offer support to as many people as possible who are in crisis and in immediate need.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much.

My next question is for Future Black Female.

You spoke in your testimony about how there are significant struggles for Black women and girls to access mental health supports. One of the things you spoke about was systemic racism in care. You spoke about the importance of representation and that representation matters so that people can see themselves in that care, and the importance of culture.

You also spoke about racism, and I know that in Manitoba, particularly with indigenous people, we've had significant issues with racism in the health care system, which has, in fact, sometimes resulted in death, with people literally dying in waiting rooms trying to get access, and a minimization of health care struggles.

Can you expand a bit more on what you think needs to be done to improve access and remove violence, systemic racism and stigma from systems that are servicing Black and indigenous people and people of colour?

[Dr. Tapo Chimbganda]

I think one of the main things, as I said before, is the system navigation. I think we need more representation across the health care system. I know that a lot of universities are now implementing recruitment strategies that attract and retain more physician trainees from marginalized communities, but we need to see this across the board, not just with physicians but with other health care providers.

The other thing is that, in 2016, there were about 6,000 registered psychotherapists in the province of Ontario, and that excluded indigenous practitioners. At the time, I was on the council for the College of Registered Psychotherapists of Ontario, and they made the decision to exclude indigenous practitioners because their system did not account for indigenous practices in mental health care. Indigenous practitioners were told, “Figure out your system, and let us know how you want to register your practitioners.” A lot of systems, when they're put in place, do not account for diversity from the get-go, so—

[Leah Gazan, NDP, Winnipeg Centre, MB]

I'm sorry; I have limited time.

Do you think it's because, when we're looking at health care like mental health care, it's still implemented through a colonial lens?

[Dr. Tapo Chimbganda]

Yes, absolutely.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Does that impact funding?

[Dr. Tapo Chimbganda]

Absolutely, yes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you very much.

My last question is for Emmanuel Akindele.

I was listening to you, and I was blown away. I don't know a lot about technology in terms of being able to create a system, especially for somebody who is kind of technologically not very efficient. You were talking about AI as a way to measure mental health. Who gets to see this AI data? How is that data protected? For example, in Manitoba, people used to be able to readily access child welfare files even when people were out of care, so how is this data protected?

[The Chair, Conservative, Karen Vecchio]

Emmanuel, you have about 30 seconds to respond.

[Emmanuel Akindele]

I'll be brief.

The first part of it.... It starts with being able to train the model. We need to bring in engineers. We also have young people annotating data, meaning strings of sentences—for example, “I'm having a bad day.” The young person can come in and annotate that data. You can also bring in psychologists to look at the overall data.

The main thing in terms of the data storage is that, when you train the AI model very effectively to detect signs of mental health—whether the language is neutral, sad or happy—you don't need to store the data. It's kind of like auto-correct or Grammarly. They're not storing all your emails; they're not storing your messages. Essentially, it's kind of filtering through the system, and it's able to get a score. On our end, what we have is a score on—