Status of Women Committee on Oct. 6th, 2022

[Dr. April S. Elliott]

If someone has HPV, which they could have acquired with sexual assault, there is definitely a link to cervical cancer—

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

You don't think the trauma that somebody experiences in those areas can lead to psychological trauma that leads to physical manifestations in that space. No?

[Dr. April S. Elliott]

No. I actually believe that trauma raises the cortisol in one's body, and there are many illnesses that can come from having a trauma or specifically a sexual assault. I believe there is a connection, but I don't know the literature around this, and that would be something I would need to look at: the correlation of that. I definitely think that any time the body is stressed, they're more at risk for illness.

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

Thank you very much. I'm sorry if my questions were a bit all over the place. A lot of these topics hit very close to home, so it's very hard to actually concretize my thoughts.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

That's why we're a committee doing this all together. Let's continue with this great work we're doing, and we can ask these tough questions together.

I'm going to pass it over to Andréanne for two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

Dr. Elliot, you mentioned a law earlier that exists in Spain. Can you tell us a bit more about that law?

[Dr. April S. Elliott]

I'd have to go back to look at the year that they put this forward, but I know of a law in Spain that says models need to be a BMI of, I believe, 18.5 or higher, but they cannot be below that. It may be 18. It is a law, so absolutely no models can be below that.

The other thing they have, which is incredible, is sizing that is consistent. I don't know if you've ever gone into a store that's been open for 20 years, but the sizing is not consistent. In Spain, there's a law that says a 30 is a 30 and a 32 is a 32. There are no fours that are eights.

This has a huge impact on body image for young women and girls, so it's also a law in Spain.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much.

Since the meeting is drawing to a close, I want to clarify a few things.

Ms. Simon, when we talked about digital tools, you said Europe had invested in this area. Can you give us some specific examples that we could draw on?

[Alisa Simon]

I think part of what we have seen, particularly over COVID, is people all across the world looking to e-mental health and digital health as a solution to their challenges. When we think about that stepped care model, digital health is fantastic for a lot of those lower acuity challenges, single-session counselling and things like that.

The thing that I think is worrisome is we have seen a flooding in the marketplace of for-profit companies within Canada, but even more so internationally. They're coming into our marketplace and offering digital services without a lot of efficacy or evaluated information behind them.

There's cost, so that we are creating a second tier of services that people can choose to pay for. When we talk about things like navigation, it is becoming incredibly difficult. Go to the Apple or Google store and put in “mental health”. You will see hundreds of apps, and that's just apps; that's not even talking about the other kinds of digital services.

I think we need standards for digital supports and to ensure that companies that are coming into Canada to provide digital services are able to demonstrate that there is efficacy and evaluation behind the products that they're offering to Canadians.

[The Chair, Conservative, Karen Vecchio]

Thank you so much, Ms. Simon.

We're going to move to Niki for two and a half minutes.

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

Thank you.

My first question is for Dr. Elliott.

You highlighted the fact that you work in Alberta. I really appreciate the insights you shared around working with girls and young women on eating disorders and anxiety disorders.

Similar to other questions that I've raised during this committee, is there any insight that you can bring in terms of the challenges particularly around anxiety disorders, but also eating disorders and working with indigenous communities?

Many indigenous communities face high food insecurity. The cost of a healthy and balanced diet is out of whack compared to in the rest of the country. Obviously, the resources are even fewer when it comes to mental health supports.

I'm wondering what insights you could share in working with indigenous young people, indigenous girls and women. Are there any concrete recommendations that you can make to our committee?

[Dr. April S. Elliott]

I've had the honour of working and developing a clinic with Wood's Homes, which is a not-for-profit in Alberta, and creating CATS clinic, the Calgary Adolescent Treatment Services. Very sadly and unfortunately, 30% of the youth who come are indigenous. I say that because only 3% of Canada is indigenous. I'm very saddened, because many of them are coming because they're anxious. They have experienced sexual assault or they've had other things that made them need to come to a clinic like ours.

However, the hopeful thing is that we have specialists in intergenerational trauma. We have people in the clinic who work with these youth and get them the right resources. I'm heartened that we have that available through Wood's Homes, but I'm very saddened that the percentage is still very high.

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

Thank you for sharing that.

I wonder if you would recommend that greater resources be dedicated to working with an obviously overrepresented community in this field.

[Dr. April S. Elliott]

Definitely. Marginalized communities, youth experiencing homelessness, indigenous or very diverse youth.... There's a lack of services. It isn't that they aren't there, but sometimes they're very nervous about asking for help. They do not want to go to big hospitals or other clinics, so we need specialized, accessible clinics for them, where they can feel there is no judgment.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

We're coming to our last round. What we're going to do—I'm so sorry, Jenna; I never do this for you, somehow—is pass it directly over to Sonia for her five minutes, so everybody has the opportunity to question our witnesses today. It's special treatment for the vice-chair. I'm sorry.

I'm passing it over to you, Sonia. You have five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair, for being generous with me.

Thank you to all the witnesses for their very valuable input.

As the mother of twin daughters, I want to ask a question that comes back to eating disorders.

You said, Dr. Elliott, that eating disorders are increasing. What is the main reason for these disorders?

[Dr. April S. Elliott]

In general, eating disorders are multifactorial illnesses. There are genetic underpinnings and serotonin receptors, and there's an environmental context—social media and screen time have been alluded to as impacts on body image. It's an anxiety-based illness.

Over the last two and a half years, during COVID, we have seen our wait times go from one to two weeks for a specialized tertiary care program to 56 weeks in 2021. I think they're now down to about 40 weeks. The basis for this seems to be loss of control and isolation. Many youth would say that when the pandemic hit, they needed to focus on something and control something, so they controlled their food. Once you become malnourished, the brain becomes malnourished. You go into rigid patterns, and then, all of a sudden, you have a youth who is starving and having all the complications of malnutrition.

Again, it's multifactorial, but COVID and isolation had a significant impact on this population.

[Sonia Sidhu, Liberal, Brampton South, ON]

Do you have any research on celiac disease, where they cannot eat food because they're so scared that if they eat gluten, there can be a cost?

[Dr. April S. Elliott]

I think what you're speaking to is a diagnosis called ARFID, which is avoidant restrictive food intake disorder. We can see that coming. Someone does not have a body image issue, but they've had a choking event or severe abdominal pain from, perhaps, celiac or other illnesses. They can then become very fearful of eating and quite malnourished, as well. We need more funding in that area specifically. It's quite a crossover of GI specialties, pediatrics and psychiatry, and there's such a lack of knowledge in the community around it.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for Ms. Simon.

Ms. Simon, you said that, over the age of 25, they are more in grief. Do you think they have anxiety or are there other reasons for mental health issues? You also said that suicidal thoughts start at ages five to 13. Is that true?

[Alisa Simon]

As I mentioned, we hear from young people between the ages of five and 13 who are thinking or talking about suicide. Again, the important thing to me about that is, when a young person reaches out, we have this unbelievable moment to help them—the fact they are willing to talk about it.

It's scary for us as adults, and it is shocking to hear about young girls who are reaching out about suicide. As a parent to a young girl, I feel that. I also want to really drive home that the fact that they're talking about suicide is okay, because it allows us to have that moment to talk to them about hope, about resiliency, about inner strength, about being present in their own life and about what coping tools they have. So yes, we are hearing from young kids about suicide.

Your other question was about older women, 25 years and over. Certainly, we see those young women talking about anxiety, depression, relationship issues and all of those things. We don't diagnose at Kids Help Phone. We have done evaluations where we've asked young people to take a scale called the Achenbach to get a sense of whether they have diagnosable challenges. Certainly, we see large numbers of young people coming to us who do have diagnosable conditions, but we deal more with what the feelings are in that moment. The feelings that women 25 years and over bring to us are high levels of anxiety, lots of depression and lots of feelings of their life being out of control.

As I said, what we have noticed for particularly those older young adults is that they bring in challenges around grief and around loss. Around the pandemic, we think about post-secondary students who haven't been able to go. We think about people who haven't been able to see their families and who are feeling isolated. That has continued in this new reality.

I would say that young people reach out about every issue, and every issue at every age, but those are some of the differences we see as young people age.

[The Chair, Conservative, Karen Vecchio]

Awesome.

I would really like to thank the panellists today. Thanks so much to April, Ryan, Alisa and Karla. This has been a phenomenal panel. Thank you for participating. As indicated, if there's additional information that you would like to send in, we are accepting that until November 1.

Everybody, we'll now be adjourning our meeting. I would like to say thank you and wish all of you a happy Thanksgiving. It's time to go home, put up your feet and enjoy a turkey or something with your family. I hope everybody enjoys it.

Are we ready to adjourn? Okay.

Today's meeting is adjourned.