Thank you, Madam Chair.
Good afternoon. I'm Dr. Ryan Van Lieshout, the Canada research chair in perinatal mental health and Albert Einstein/Irving Zucker chair in neuroscience at McMaster University.
I'm a member of the Royal Society of Canada and a perinatal psychiatrist whose research focuses on developing scalable psychotherapeutic interventions for those with perinatal depression and anxiety, and optimizing their impact on offspring brain development. The primary goal of my work is to disrupt the intergenerational transmission of psychopathology from parents to their children in Canada and around the world.
My clinical expertise led me to be invited to lead the development of Canada’s national practice guidelines for the treatment of perinatal depression and Public Health Ontario’s perinatal mental health tool kit for public health units. Throughout my career I have seen the devastating effects that mental health problems occurring during pregnancy and the postpartum period can have on children and families, and have committed my career to preventing these.
Perinatal mental health problems affect up to one in five mothers and birthing parents, rates that increased to one in three during the COVID-19 pandemic. Every case of postpartum depression alone is associated with costs of up to $125,000 over the lifespan, or $2.5 billion for each single year of births in Canada. The offspring of mothers with postpartum depression are up to five times more likely to develop a clinically significant behavioural problem, and up to four times more likely to develop depression in their lifetimes. Even though effective treatments can help both mothers and their children, as few as one in 10 pregnant and postpartum persons are able to access evidence-based care in Canada.
There are many barriers to the receipt of timely perinatal mental health care in this country. In addition to time, child care, travel and a lack of providers, most individuals prefer talking therapies or psychotherapy over medications, particularly during pregnancy and lactation. Even though Canada is a world leader in the development of scalable psychotherapeutic interventions for perinatal mental health problems, there is still a lack of providers, national quality standards, stepped care models and coordination.
However, there are many reasons for hope. Stepped care pathways, those that match individuals to the right treatment at the right time, could substantially increase the number of women receiving effective treatment, as can the application of scalable Canadian-made interventions and the task-sharing of psychotherapy delivery with non-physician health care professionals like social workers, psychologists, occupational therapists, and individuals who recovered from postpartum depression and anxiety, often referred to as recovered peers.
Our research group alone has developed and tested several effective scalable interventions that can be delivered by health care professionals or recovered peers, and it can serve as both initial and later more intensive steps in stepped care models. For example, our one-day cognitive behavioural therapy-based workshop for postpartum depression can effectively treat up to 30 individuals at a time and be delivered online or in person by health care professionals or recovered peers. Our longer nine-week group cognitive behavioural therapy intervention has also proven effective for those with higher symptom severity, and its delivery has already been successfully task shifted to recovered peers and public health nurses with limited to no previous psychiatric training. These scalable group interventions have proven effective being delivered in person or online, and a half a dozen public health units in Ontario, including those in Niagara and Prince Edward County, are now being trained to deliver them to mothers living in the community.
We and others have also shown that treating mothers not only benefits them, but their entire family. Up to 70% of the costs associated with perinatal mental disorders are due to their downstream effects on daughters and sons. Recent research by our group has shown that treating mothers with postpartum depression leads to clinically meaningful improvements in mother-infant interactions, infant brain development and emotion regulatory capacity, and even the mental health of older children in the home. This is in keeping with research from around the world that suggests for every dollar invested in early childhood interventions, society reaps a seven-dollar return.
Perinatal mental health problems in Canada can be prevented, detected and treated, and we already have the know-how to support mothers and disrupt the intergenerational transmission of mental disorders in families. The federal government can help by working together with experts to create national quality standards and to develop Canadian-specific stepped care pathways that can support the training of professionals and lay people in the delivery of treatments. Such developments will enable our Canadian-made discoveries to be scaled to improve the lives of women, girls, and all Canadians.
I look forward to working together with you to help make Canada the best country in the world to be a woman or girl.
Thank you.