Status of Women Committee on Oct. 6th, 2022

[Alisa Simon]

I'll quickly add two things.

One is that, while it is a provincial responsibility when we think about health care and mental health care, I think there is a critical role for the federal government to end inequities based on where you live and to end duplication in spending.

I actually don't know that we need a gigantic amount of more funding. We do need some more funding for mental health, more focus on mental health. However, we also need to be better at spending the dollars where the evidence shows it works and moving people from the most expensive services to potentially less costly services that will meet the needs.

We have to ensure that we are spending our money—and that's where we get to the stepped care model that Dr. Van Lieshout spoke about—in a way that makes sense to that end-user. Often that can be a lower cost, a lower step, on that stepped care model.

That does require national thinking. Otherwise, we set up many different, diverse provincial and territorial spends that all have costs, duplicate and aren't necessarily using the resources that already exist or the evidence that already exists.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you.

Alisa Simon, you also mentioned schools.

What kind of role could the federal government play with the provinces to try to get where the youth are, for delivering mental health services within schools? We've heard this several times from different witnesses, and I know you get several calls. What kinds of recommendations do you have along those lines?

[The Chair, Conservative, Karen Vecchio]

You have about 30 seconds.

[Alisa Simon]

Thank you.

I think one of the things would potentially be for the federal government to recommend programming within schools. There are examples in the U.K. Their helpline, Childline, is in every single classroom in the U.K.

Right now, with a program like what Kids Help Phone offers, or others, we have to go jurisdiction by jurisdiction or work with the ministry of education in that province or territory to try to get into schools.

We could have a much more streamlined approach from a recommendation by the federal government that every single young person, for example, is connected with Kids Help Phone three times through their education, or that every single young person receives education on help-seeking, stigma and mental health. Those kinds of recommendations could go very far down into ministries of education and be able to get these things into schools.

[The Chair, Conservative, Karen Vecchio]

Perfect.

Thank you so much. We're now going to Andréanne Larouche for six minutes.

Andréanne, you have the floor.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

My question is for Dr. Van Lieshout.

Unlike my colleagues, I do not exactly feel like Superwoman right now. I am trying to balance my job with being a mother to an eight-month-old little girl. As I already said, I am even wondering if I can do a good job as a mother and also as an MP. So I understand the tremendous importance of mental health for young mothers.

I would like to get back to the fact that we all agree that we need more investments in mental health. Someone said that it might not be huge amounts, but we still need to invest. You said so earlier, as the community organizations did at our last meeting. They do outstanding frontline work with people grappling with mental health problems. They need help and funding, because of the massive growth in demand and in needs. One way to help these organizations is of course to recognize that they need more funding in order to hire more people and extend their hours of service.

Dr. Van Lieshout, how important is it to recognize that health transfers represent an investment in health and that the federal government is working to inject more money into the system to give our departments larger budgets? How can that help organizations on the ground respond to growing demand?

[Dr. Ryan Van Lieshout]

Thank you.

Congratulations on the birth of your eight-month-old. You seem to be doing an awfully impressive job as a mom and MP, but I will stop being ingratiating.

There are a lot of remarkable people doing remarkable work across sectors at the municipal level, at the provincial level and at the federal level. Public Health in Ontario does a lot around perinatal mental health, these community organizations, hospitals and so forth. I think part of the setting of quality standards by the federal government would be to implement the need for measurement-based care. Ms. Simon alluded to that.

It's important that we coordinate and collaborate together, but also measure what we're doing and assess how well we're doing. Organizations that are able to help us produce the best outcomes could be one way to determine how things are allocated and so forth.

A part of quality standards in the stepped care models, of course, is measurement. There are cheap scales available in the perinatal mental health space that can be used to benchmark and create standards and do those sorts of things.

I hope that answers the question you asked.

[Andréanne Larouche, Bloc, Shefford, QC]

I think rapid investments are urgently needed. In that regard, I hear what you said about avoiding duplication and time wasted on these agreements.

Right now, the provinces and Quebec are all asking for a health transfer of up to 35%, precisely because they know there are projects within their borders that will never get off the ground owing to a lack of funding. So we also need to find a way to accelerate these transfers.

Let me turn to you now, Dr. Elliot. You are a pediatrician and work with adolescents. Having adolescents in my life, I know they are very worried about the environment; it is called eco-anxiety. We have not talked much about this in our study thus far. I would like to know the potential impact on the adolescents you work with.

The government must definitely address environmental issues. That might, among other things, provide some relief to these young people and address their concerns.

[Dr. April S. Elliott]

I want to go back to what a few people have discussed. Let's bring it back to the family, and let's bring it back to the schools and into the community.

One of the things that really is curious to me is why, after two and a half years of such significant increase in mental health concern—and we all spoke about it—school counsellors and psychologists have either been let go or are not deemed necessary. I heard several examples of this just in Calgary. We need that force in the resources in the schools.

I also think we need to take it back. I love the prenatal or the early childhood where we teach parents how to regulate their own emotions. They can have the highest IQ, but if you haven't learned emotional regulation, when the avalanche is coming you may start doing things that you wouldn't typically do. I think we need training at different areas—community, places of worship, within schools—where we help parents learn techniques such as mindfulness, emotional regulation. This will help them with many of those things to help adolescents. If you're not in a grounded environment, you cannot ground yourself.

My approach a lot of the time is to work with the parents to help the youth, to coach them to be in a better place and then to deal with the crises.

[The Chair, Conservative, Karen Vecchio]

Fantastic. Thank you so much.

We're going to pass it over to Niki.

Niki, you have six minutes.

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

Thank you.

My question is for Dr. Van Lieshout.

You talked about the impact of mental health being passed down from mothers to their children. For indigenous women and girls, we know that there's intergenerational trauma that transfers across generations, trauma that is caused by colonization, the impacts of residential schools, trauma caused by systemic racism, ongoing violence and genocide.

Could you talk a bit about any research that you're aware of, or that you have been involved in, that is focused on indigenous women and girls? How can we best support these communities whether it's in terms of the national standards you have talked about, or other measures when it comes to prenatal and postpartum care?

[Dr. Ryan Van Lieshout]

I actually live about 2,000 metres from the Six Nations reservation here in Caledonia, Ontario, so we've been fortunate enough to develop links with the Six Nations birthing centre and a group of local indigenous midwives to try to understand the unique struggles faced by first nations people here locally.

In addition, I do clinical work and have had the honour of working with first nations people from Ohsweken, Six Nations, Rama near Orillia and so forth. The stories are striking. As you point out, the intergenerational transmission of many things is quite striking.

We did a study during the COVID-19 pandemic working with the Six Nations midwives. We found a number of challenges that have been described by other members of the panel, such as access to health care and other things. What we also saw was remarkable strength and remarkable resilience among these individuals. We think, of course, it was within them as well, but also because they have this amazing birthing centre.

It's having first nations-specific supports, peers who have recovered.... We have to work together—no health for us without us. We have to work together to understand these unique challenges that are being faced, and develop tailored, unique strategies that meet those needs, whether they relate to intergenerational trauma, water security, food security, or things like that.

We've been doing that work. We're trying to help train the midwives. I'll be doing some training with the midwives soon. We look forward to continuing that partnership and understanding it better. I have great teachers, and I'm very lucky to have that.

I hope that helps with the question.

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

I really appreciate the experience you've shared. We can all agree that the work you're doing is very important, and hopefully, work that can be replicated in other centres with and for first nations and indigenous communities across the country.

I want to move to another topic. Ms. Simon, I'm not sure if you might have something to share on this.

We're hearing a lot more about young people who are extremely anxious and increasingly anxious about climate change. We've already seen the impacts of climate change on our communities. Personally, I represent communities that have been evacuated and have experienced long-term evacuations as a result of historic wildfires just in the last couple of years. We know that mental health issues have been further exacerbated.

I'm wondering, though, through your work with Kids Help Phone, what you are hearing from young people when it comes to what is termed as eco-anxiety, or anxiety around climate change.

[Alisa Simon]

That is such an important question.

It's interesting. We are not seeing young people name it eco-anxiety, or climate change anxiety right now. What we are seeing, certainly, when we experience any kind of disaster related to climate, whether it is wildfires or flooding, we see an increase in contacts from that area. We will continue to see young people reaching out about that as we continue to see those disasters occur.

It is part of our role at Kids Help Phone to start helping young people name that and think through what it means and what they can do. A lot of the work that we do is helping young people understand what they can control and what their role is. When it comes to climate change, young people have to understand they have a voice and that they can use it. Supporting young people to use that voice, whether it is writing letters or talking about the impact of climate change, is some of the work that we still have yet to do at Kids Help Phone.

I want to also connect that to some of the conversations we were talking about just a moment ago about indigenous people. Certainly, at Kids Help Phone we've done a lot of work with a distinctions-based approach for first nations, Métis and Inuit youth. We are seeing there are significant concerns from our indigenous young people around the climate, around what's happening to their communities and the planet we live on.

Being able to have those conversations.... We piloted last year, and have continued, where we trained indigenous volunteers for our texting line—that's our volunteer service—so that when young people text Métis, Inuit or first nations, we can try to connect them with a volunteer of the same background, so they can actually have those conversations about climate change or anything else that's concerning them with somebody who actually understands that background. That's been incredibly powerful.

[The Chair, Conservative, Karen Vecchio]

That's perfect.

Thank you so much for that.

For our next five minutes, we're now going to Michelle Ferreri.

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

Thank you, Madam Chair.

Thank you to all of our witnesses for answering some really great questions about how we do that bilateral funding and how we amalgamate mental health into our health care. I think we have made huge progress on that, quite frankly. People are now asking for help. However, when they do ask for help, there's nothing there to help them. There's a very huge health equity gap there.

Dr. Elliott, I might be your new biggest fan. I'm really enjoying your testimony and a lot of what you have to say. You touched on one area that I'm particularly interested in personally and very passionate about. That is the education piece of self-regulation—arming our children with the tools, because the toothpaste is out of the tube. We're not going to put social media away. We're not going to reverse and go backwards. This is where we are. Now we have to give our kids the right tools to manage their feelings, give them the language to manage their feelings, but also not confuse them—I think we also see this—into thinking they might have something they don't. They've seen this imposter syndrome as well, which is dangerous.

I'm curious as to what you think would be the return on investment when we look at investing. I'm going to name a doctor whom I adore, Dr. Stuart Shanker. I don't know if you are familiar with his work, Dr. Elliott, when we are looking at self-regulation and teaching children and teachers to recognize the why of their behaviour.

Why do we see it and why now, Dr. Elliott?

[Dr. April S. Elliott]

I'm really thrilled that you're aware of self-regulation and those topics.

Recently I did a program called Reset to Reconnect. It was with six families with adolescent boys. We did an initial kind of education. Then they went to it with their families, calling out their families on different things and setting their own plans for their families. After it was done, the feedback was that they recognized they had better sleep. They were more emotionally regulated. They were more connected to their family. They had more time to do other things that really social media and screens took away from them.

We're also seeing a really significant uptick in somatic symptom disorders, which involve someone's experiencing a physical presentation because of an underlying psychological event. For this, we have now seen on social media something called TikTok tics. When young people are watching a lot of TikTok, they start to get physical symptoms.

To go back to that, if we can teach parents early to regulate and teach young people to be in an environment of regulation, whether it's in schools, places of worship or other places, then everyone is going to have the same language and the same ability to take a breath before they respond. In so many situations, things are “figureoutable” if you're able to regulate.

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

It's Marie Forleo's saying, “figureoutable”. I know it well. It's a good one.

I think we're really on the same page. I think what we haven't addressed, really, in this round is parents' inability to self-regulate, which is downloaded to the child. There is parents' use of maladaptive coping mechanisms such as looking at their screens, just basically tuning out and also scrolling. I think we need to give a name to this, because I actually do think it is comparable with, say, alcoholism or some kind of addiction, where you are tuning out so you don't have to deal with the stresses of life.

We have an affordability crisis. We have both parents working and not able to afford to put food on the table, who, at some point.... I have parents now writing to me. They make over a $100,000. That's a lot of money. Now they can't afford that because the cost of groceries and housing are through the roof.

My question, Dr. Elliott, is whether there is data—because that's ultimately what determines funding—on investing in giving parents the tools they need to self-regulate as well.

[Dr. April S. Elliott]

Maybe some are aware of the Palix Foundation in Calgary. It has done a lot of work on the Brain Story. There is a plethora of evidence on early childhood education and prenatal development. They're really helping individuals understand how the brain works, in a very simplistic way, so that everyone has the same language.

I think in Calgary, in Alberta, they have done a lot of work that way. I'm already seeing that when I work with my youth who are experiencing homelessness and with other communities, we're all using the same language to describe the young person. Someone is no longer a difficult youth; they are a youth with challenges. The language is important.

[The Chair, Conservative, Karen Vecchio]

That's awesome. Thank you so much. I absolutely agree.

We're going to pass it over to Emmanuella.

Emmanuella, you have five minutes.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you, Madam Chair.

I'd like to thank our witnesses for being with us today to answer a lot of our questions and for giving us so much great information.

On my first question, we heard at several of our meetings, including today's, that there is a lack of support and there just isn't enough help for the amount of help that is needed, whether that means trained therapists or people who are actually considered psychologists. There aren't enough of them around. Even if there were enough around, it's quite unaffordable for many Canadians.

What do you think our government—specifically, the federal government—can do to help make mental health care more accessible to Canadians across the country? I'm talking specifically about costs, but also about getting more people into this field and making sure that in the future we are more prepared to deal with this type of crisis.

Anyone can answer.

[Karla Andrich]

The first thing I can think of is making mental health care a part of our health care system.

Right now, if you want counselling, you go through your work EAP, or you go to a free agency, like Klinic, or you pay out of pocket. If you are looking at EAP, those sessions are very limited. Some people have as little as six, which is not a lot of time to work on any kind of mental health issue. At free agencies like mine, the wait-lists are quite long, and for private care, it's quite expensive.

Integrating mental health into our health care is definitely a piece of that puzzle.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Does anyone else want to chime in?

[Dr. April S. Elliott]

The Royal College of Physicians and Surgeons said quite a few years ago that all physicians should be educated in mental health and physical health: It doesn't matter if you're an orthopedic surgeon, a brain surgeon or a pediatrician. I was on a Royal College subcommittee, and I have yet to see this actually happening.

We are seeing more and more physical presentations of psychological issues. People say, “I don't know what to do.” Other physicians, other people...they're very much physical versus mental health. It needs to be integrated. That education has to start in medical school. It has to start in nursing school. It has to start in all of the schools where health care is being trained. They're not separate. There's not a dualistic system. We come into a room with our brains and so we need to really support that from the education perspective.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

This might be a little far-fetched, but you've raised it, so I'll go along with it and take further what you're saying. I've heard that there is a link between sexual assault and cancers—specifically, reproductive cancers. I'm wondering if this is something you've also read about in your research, if you've seen that and if what you're saying right now can also lend itself to that kind of work.