Status of Women Committee on Oct. 6th, 2022

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Madam Chair.

I want to thank the witnesses for being with us today.

In spite of their difficult experiences, they have solutions to offer. I thank them very much for their contribution to this study of the Standing Committee on the Status of Women. We are pleased that they took the time to participate. Their input is very valuable.

I said it at the beginning of the week and will repeat it now, because this is an important week: it is the week of the mental health awareness campaign of the network known as Réseau avant de craquer, and it is also Mental Illness Awareness Week. This year, the theme is that behind every face is a history... and in front of every person is a solution. Constructive action is needed to move forward.

This year, in response to the pandemic that affected the entire population, the campaign focused on people of all ages who are helping someone with a mental health problem by showing them it is possible to remain balanced while also being part of the solution. This is important; it is crucial.

I'm not sure who should take my first question, because I think all the witnesses could answer. I will direct it to Ms. Simon, from the Kids Help Phone.

Ms. Simon, the Kids Help Phone is a frontline resource for individuals with mental health problems. Your website provides a variety of interesting information.

As you indicated in your presentation, there has been a sharp increase in the use of your services since the start of the pandemic.

Can you tell us more about this increase? What changes in behaviour have you noted in women and young girls who have used your service over the past two or three years?

[Alisa Simon]

Yes, we have seen really significant increases in the volume of young people coming to us, and also in the ways they are coming. We continue to see very high volumes on our phone line, but we are the only 24-7 texting service in Canada, so we have also continued to see very high volumes in young people texting us.

Just as before the pandemic, our busiest times are when everything else is closed, so into the overnight hours we are very busy with young people who are reaching out. They are often reaching out with more serious and significant issues, particularly suicide. If you imagine a young girl where everyone in the family is asleep and they can't sleep, that is the moment they pick up whatever device they have and reach out to us.

Certainly at the beginning of the pandemic we saw large increases in young people reaching out about abuse and neglect. Again, everything was closed. The places that are often reporting abuse and neglect, like schools, were not able to do that, so young people were coming directly to Kids Help Phone.

Over the course of the pandemic, body issues—as was brought up earlier—and eating disorders came up in really high numbers, as did isolation and anxiety. Young people were increasingly talking to us about the challenges of missing out—missing out on graduation, on sports, on all of those things that they were used to, or they had been looking forward to.

As we have continued through COVID and things feel like they may be getting back to a little more normal—young people are often back in school now, face-to-face—we continue to see high levels of anxiety as young people are trying to figure out what the new normal is. Can you go to school with your mask or not? Are you able to hang out with your friends? When do you stay home?

Like many of us, young people are still navigating this new world. It's not back to normal. It is a new normal, and we don't know exactly what that is yet. As we, as adults, are anxious about that, certainly the young girls and young women in our lives are as well.

We continue to see a new normal in terms of volume, but in terms of the issues, there are some new things, again, around missing out and anxiety, but a lot of the challenges are the same as we saw prepandemic in terms of suicide, depression, anxiety and relationship issues.

[Andréanne Larouche, Bloc, Shefford, QC]

What you say is interesting, Ms. Simon. You offer a service by text. Technology can help young people stay in touch. Coincidentally, young people are also connected to their mobile devices 24/7.

You talked about stigmatization and body image issues. I think texting can help young people as much as it can harm them. In the middle of the night, for instance, a young girl can be in bed comparing herself to other young girls on social networks. Moreover, the number of cases of online assistance has increased.

How can these social networks, these spaces, influence the mental health of young girls? What protections could we implement? What could the Government of Canada do to make social media safer spaces, with much less online hatred?

[Alisa Simon]

You bring up such an important point. It's something that we've talked about for years as it relates to cyber-bullying.

Often, as a parent or a caregiver, your first response when a young person in your life is being cyber-bullied is to take away their device, or to say that they can no longer go on social media, yet social media is a double-edged sword. On the one hand, it provides incredible connection for young people. It allows them to feel less alone. We think about the trans youth who is living in rural Canada who finally, through something like our peer support service, is able to connect with other trans youth. It allows young people to reach out to services like ours. On the other hand, there is a tremendous amount of data about the danger and difficulty of social media, particularly for young girls.

I think—

[The Chair, Conservative, Karen Vecchio]

Ms. Simon, I know you're going to give some really amazing information, but I do need to go to my next questioner. However, I'm hoping that we can get all of that information as well.

I'm now going to pass it over to Niki Ashton, who is online.

Niki, you have six minutes.

[Niki Ashton, NDP, Churchill—Keewatinook Aski, MB]

Thank you, and thank you to our witnesses today.

One of the themes this committee has been hearing over the past few meetings has been the impact of sexual violence, gender-based violence and the lasting impact and trauma it has on women and girls who are survivors of this violence. One of the previous witnesses at this committee said that we will not be able to improve the mental health of young women and girls if we don't deal with sexual violence.

Ms. Andrich from Klinic touched on this. I'm wondering if Ms. Andrich and then Ms. Simon could talk about the lasting impact of sexual violence and what their thoughts are on the need to act to end sexual violence in our country.

[Karla Andrich]

Thank you so much for that question.

I think one thing that sometimes is not well understood is the systemic nature of gendered and sexualized violence. It's not simply interpersonal acts of physical violence. It's also the water that we swim in every day. It's the way in which women and girls are depicted in the media. It's the way that we speak about gender roles. The kind of bullying that happens is often gender-based as well. I think when it comes to fighting the impact of those things, it is more about a systemic approach.

Part of what we do at Klinic is to offer public educational training to school districts and schools. We have visited classes at medical schools, massage therapy schools and things like that. I think those kinds of programs could also be very helpfully extended into elementary and middle schools and high schools as well. I know that there are lots of programs where people come in and talk about consent and all those sorts of things. That should really be emphasized when it comes to fighting the systemic impact of sexualized violence.

[Niki Ashton, NDP, Churchill—Keewatinook Aski, MB]

Thank you for that.

I'm wondering, Ms. Simon, if you have anything to add on your end.

[Alisa Simon]

Yes. About 5% of our contacts for girls from age five to about 16 are specifically about sexual violence. I think one of the big things, which was just being spoken about, is around that education, particularly for younger girls, to even have the name that it was sexual violence, that it was wrong. It's quite difficult, particularly when we talk about what we were discussing earlier around social media, where we are often inundated with images as young women. It's very hard to understand where violence begins and ends and where the sexualization of young girls begins and ends.

I think we need to continue to look at investing around taking off the online sexual images of girls. Certainly Europe and some other countries have really invested in that. We need to ensure that girls and young women who are being victimized online have a way to stop that victimization. We need education so that girls understand what their boundaries are and the ability to say no, and understand that help-seeking is critical. You don't just keep that in. You actually reach out and talk to somebody. We know that talking to anybody, any safe and caring adult, is going to help that young person, whether it's Kids Help Phone, whether it's a parent or whether it's a friend's parent.

It's talking about help-seeking and then making sure that we have the right laws on the books to allow girls to adequately address this. Whether it is taking down an image, whether it is moving forward with removing somebody's licence or bringing a court case or whatever it is, we need to make sure that the legal system stands behind girls who are experiencing sexual violence.

[Niki Ashton, NDP, Churchill—Keewatinook Aski, MB]

Thank you.

Of course, we know that poverty has a detrimental impact on physical and mental health.

Ms. Andrich, you talked about working with communities that are on the margins, in particular indigenous communities, many of whom struggle in poverty here in our province. One of the things we've heard about from other witnesses is the importance of taking poverty seriously when we're talking about the mental health of children.

My colleague Leah Gazan, who is the usual member on this committee, has put forward legislation around a guaranteed livable basic income and the need to take concrete action to eliminate poverty in our country. I'm wondering if you think we should be looking at these kinds of measures as a way of also supporting the mental health of young women and young people in our country.

[Karla Andrich]

Absolutely I think so. As I said earlier, money is how we talk about what's important to us as a society, and money is often the key out of situations in which women and girls find themselves in danger. If everybody had the option of moving out and away from people who are dangerous to them, if everybody had the option of not working at a job that was dangerous to them, and if everybody had the option of that kind of freedom and the ability to support themselves, I think we'd see a lot of people in a lot better situations, absolutely.

[The Chair, Conservative, Karen Vecchio]

Ms. Ashton, you have 25 seconds left.

[Niki Ashton, NDP, Churchill—Keewatinook Aski, MB]

Okay.

I don't think I have time for an answer, but I want to share my appreciation for all the witnesses. I look forward to some more time for questioning.

Thank you.

[The Chair, Conservative, Karen Vecchio]

That's fantastic. Thank you so much.

We're going to begin our second round. I'm going to pass it over to Shelby Kramp-Neuman.

Shelby, you have five minutes.

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

Thank you, Madam Chair.

Thank you to the witnesses.

To start with disclosure, I'm the mom of two teenage girls, so this very much hits home for me. Our teenage girls are overwhelmed. Parents are overwhelmed. There are teachers who are overwhelmed. There are a lot of people in a dark spot right now.

Raising teenagers in 2022 is an entirely different experience from the one my parents had raising me in the eighties and nineties. Social media didn't exist. Talking about mental illness didn't happen. COVID hadn't happened. Eating disorders weren't trending. Bullying has always happened, but it's been taken to a whole new level. It's out of control. In some cases, teenagers are now even contributing to families' finances, because the cost of everything is outrageous. The pressure is extremely real. It's almost like it's the perfect storm.

I would like to pose my first question to Dr. Elliott.

I'd like to dive into the punitive damages that our young girls and youth in general are experiencing as a result of COVID. They're missing out on graduations. They're missing out on sports. They're talking about isolation.

Where do you think we can find additional accountability? What can we do differently? What can the government do differently next time, if there's another pandemic?

[Dr. April S. Elliott]

Thank you very much for that question.

I have to take a breath, because I have a lot of professional thoughts about this, but I also have a lot of personal thoughts about this.

Children were at the absolute lowest risk of impact from the disease, yet they were the ones who suffered the most. We wrote an evidence-based letter back in February 2021 to say that children should be returning to sports, that they were safe to do so and that we were very much supportive of kids being in school and doing their sports. Still, I saw in many jurisdictions that kids were limited.

This can never happen again. These restrictions and mitigations, we see now—parents will tell us; youth will tell us and the evidence is telling us—were related to isolation, lack of control, and an inability to meet their developmental milestones. With that, I would say this can never happen in this way again.

We can't undo what's happened, but going forward, I hope we use the evidence from families, from youth and from the evidence in the literature to never have these lockdowns again.

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

Thank you for that.

Continuously we have heard that we need to increase resources, that we need more support, that we need to address the people who are help-seeking, that we need more in-school support and that we need to increase spending. We have continuously heard this from our witnesses.

My last question is posed to Ms. Andrich.

Which barriers, if any, might young women and girls in Canada face from accessing specialized and specific mental health supports and services? I know we have the telephone helpline, but with regard to the Internet, what can the government do?

[Karla Andrich]

Thank you for asking that.

I think this is related to a lot of barriers people up north face, which is that the Internet is not a public utility like water or electricity. We are in an age of information. I think that being able to access the Internet is a human right, or it should be. It's one of the things that would help people access these services.

There is a question of geography, simply, when it comes to being able to talk with a counsellor or talk with advocates, or the things of that sort. That's definitely one of the things—

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

I'd like to acknowledge that, because in Hastings—Lennox and Addington, rural Internet is a concern. I'm sure it is for many of my colleagues around the room.

Thank you for addressing that.

[The Chair, Conservative, Karen Vecchio]

Fantastic. Thank you so much, Shelby.

Jenna, believe it or not, you're going to get your full five minutes today. I'll pass the floor over to you.

[Jenna Sudds, Liberal, Kanata—Carleton, ON]

Amazing. Thank you, Chair. It's my lucky day.

Thank you to all the witnesses, first of all, for the incredible work you all do, which is so important, and also for sharing your time and expertise with us today.

I'll add the caveat that I am also a mother of three teenage girls, so I live and breathe a lot of these struggles as well.

I echo one of my colleagues who was just saying how difficult COVID has been for parents and children, and young girls in particular. The provincial decisions when schools were closed were difficult decisions that we all lived through. One of the witnesses referred to the COVID generation, which I hadn't heard before. It is so accurate.

I'll direct my first question to Dr. Van Lieshout.

You had a few recommendations. One was around Canadian-specific stepped care pathways. I would appreciate if you could walk us through what you believe that should look like.

[Dr. Ryan Van Lieshout]

stepped care pathways are the systems by which we deliver and monitor psychiatric treatments so that the most effective and least resource-intensive treatments are applied at the right time.

In Canada, we have remarkable strength in perinatal mental health research, leadership and clinical work. There aren't many of us, but those of us who are here.... Well, my colleagues are great; I'm just okay.

When we're talking about a stepped care model, I think we'd be talking about starting with some quality standards around preconception information and prevention, as well as detection, assessment, intake and treatment. All of this would be, of course, measurement based.

We have lots of wonderful measures in the perinatal mental health space, like the Edinburgh postnatal depression scale and so forth. We'd be talking about trying to identify those individuals who require treatment and then identifying some low-intensity treatments that could be used by most.

There is a model within the Ontario structured psychotherapy program that could be used, whereby classes and self-directed psychotherapies.... CBT-based would usually be a low-intensity intervention. We would monitor responses to those interventions and determine if people needed more, if they had a poor treatment response, if the treatment wasn't good for them or if they didn't agree with it. Then we could move up to higher-intensity treatments, like individual or group-structured evidence-based psychotherapies, cognitive behavioural therapy, interpersonal psychotherapies and things like that. Then we go to medications and so forth.

[Jenna Sudds, Liberal, Kanata—Carleton, ON]

You also mentioned a national care standard. Is that a separate recommendation and if so, what does that look like?

[Dr. Ryan Van Lieshout]

I would see the national quality standards as setting the stage for the stepped care models. Quality standards across the care spectrum from detection through treatment could set standards for access, wait times and things like that. Once we have those quality standards in place, they could be used to identify human resource needs. They could be used to guide the coordination of different organizations that are already helping.

I sounded arrogant and obnoxious as a doctor there for a second when I said that we have lots of expertise. We have fantastic expertise and supports in community organizations around the country, but one of the struggles we have is the coordination of them. There are so many people doing so much good work, like peer organizations and community organizations. I think quality standards would set the stage for us to identify what we need and who we could coordinate with.

Those things would feed into those stepped care models and inform them so that we could decide which low-intensity treatments are the best that we can do in Canada at the present time. It would help us decide what determines whether people move up or down to lower-intensity or higher-intensity treatments.

[Jenna Sudds, Liberal, Kanata—Carleton, ON]

Incredible. Thank you so much.

I realize I don't have the time, but I wanted to go to Alisa Simon and dig a bit into one of her recommendations around in-school supports. I know the chair is not going to give me the extra time, unfortunately, but maybe one of my colleagues will pick it up.

Thank you.