Status of Women Committee on Oct. 6th, 2022

[The Chair, Conservative, Karen Vecchio]

Good afternoon, everybody. I'm calling this meeting to order.

Welcome to meeting number 32 of the House of Commons Standing Committee on the Status of Women.

Pursuant to Standing Order 108(2) and the motion adopted on Tuesday, February 1, the committee will resume its study of the mental health of young women and girls.

Today’s meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022. Members are attending in person in the room and remotely using the Zoom application.

I would like to make a few comments for the benefit of our witnesses and members.

Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mike, and please mute your mike when you're not speaking.

For interpretation for those on Zoom, you have the choice at the bottom of your screen of floor, English or French. For those in the room, you can use your earpiece and select your desired channel.

I will remind you that all comments should be addressed through the chair.

For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function.

I'm going to remind people that we do have all of our witnesses on Zoom today. They should all be showing up shortly.

If I start to interrupt you, witnesses, I'm going to ask if you could wind it down within 15 seconds.

This is a bit of a trigger warning. As we all know, this study is very difficult. We will be discussing experiences related to mental health that will be triggering to viewers, members or staff with similar experiences. If you feel distressed or if you need help, please advise the clerk.

I would now like to welcome our witnesses for today's meeting. As I said, everyone will be on the screen.

On the panel, we have, as an individual, Dr. April Elliott, adolescent pediatrician, and Dr. Ryan Van Lieshout, associate professor, McMaster University, and he too is here as an individual. From the Kids Help Phone, we have Alisa Simon, executive vice-president and chief youth officer, E-mental health strategy, and from Klinic Community Health, we have Karla Andrich, counsellor.

Each of you will be provided five minutes for your organization's presentation.

I'm going to give the floor to Dr. April Elliott for five minutes.

[Dr. April S. Elliott, Adolescent Paediatrician, As an Individual]

Hello, and thank you for inviting me to participate today.

For those of you who haven't met me, my name is April Elliott. I'm a devoted mother of two youths. My profession of 21 years has been as an adolescent pediatrician and founder and head of adolescent medicine at the Alberta Children's Hospital in Calgary, Alberta. I'm also a certified executive coach trained at the University of Berkeley, and I work with physicians to support their burnout and proactively support their career development. I also coach parents to be more successful in their parenting interactions with youth.

As a frontline clinician, I have witnessed a dramatic increase in morbidity and mental health decline in youth from 2001 to the present. The availability of developmentally appropriate resources has not kept up to the rise.

As we all know, the 2020 UNICEF report card shows that Canada is shamefully lower than other rich countries in providing healthy childhoods. Of comparator countries, concerning physical health, Canada dropped to 30th of 38, and for mental health, to 31st of 38.

There are myriad topics related to youth health. This brief statement will discuss concerns related to the mental health of young women and girls, more specifically eating disorders, as this is my area of expertise and it was drastically impacted over the last two and a half years.

In March 2021, I published a paper with Professor Deborah Christie, “A year supporting youth within a pandemic: A shared reflection”, in the Journal of Clinical Child Psychology and Psychiatry.

We summarized the impact of the COVID mitigations, school closures and the mental health impact on young people in the U.K. and Canada. The data began to emerge that the pandemic was causing a range of harms to children, including feeling isolated and lonely; suffering from sleep problems, anxiety and depression; and reduced physical activity.

Charities reported increased demand for counselling, with many young people talking about how lonely they felt. Calls to kids helplines increased fourfold from 2019 to 2020. There was also a risk in harm for those living with emotional, physical and sexual abuse.

Many colleagues worldwide described an “explosion” in eating disorders.

With regard to eating disorders, the prevalence of anorexia nervosa in adolescent females is 0.3% to 0.7%, with an incidence estimated at eight per 100,000. To put this in perspective, this compares to a minimum incidence of 1.54 per 100,000 per year of type 2 diabetes in Canadian youth.

Anorexia nervosa is a complex bio-psychosocial disorder that interacts with pediatrics and mental health. It is an illness that can be debilitating for patients and their families. The majority are young girls and women.

Eating disorders are common and are life threatening. Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Mortality is as high as 5% to 7%; some report as high as 18%. With these significant medical and psychiatric consequences, an individual is 10 times more likely to die than their healthy peers are.

Globally we have seen unprecedented numbers of hospitalizations related to new and severe cases. Patients are severely malnourished, with increased medical complications.

The COVID pandemic is a common precipitating factor noted by patients and families. They note school closures, loss of sports, and not being with peers. A recently published Canadian pediatric surveillance program supports this.

These are my recommendations:

One, it is very costly to treat in a hospital setting, so early recognition and treatment by primary care physicians is essential. This education needs to be mandatory in medical schools.

Two is increased resources for timely referral and access to trained and qualified health care providers in delivering evidence-based outpatient treatment modalities for eating disorders.

Let's suppose a young person needs hospitalization for a moderate to severe eating disorder. In that case, they need specialized units or staff on generalized units with integrated training carrying out these guidelines. These are few and far between, and many Canadian cities do not have them. The Alberta Children's Hospital has a catchment area of 2.5 million and has no specialized eating disorder in-patient unit.

With regard to general mental health for youth, I would recommend providing more support for young people. It was already significantly stretched. We must prioritize teachers, school mental health and increased resources. We need to focus on this COVID generation.

Parity of esteem for mental health alongside physical health care is an absolute priority. Health care has a long history of not integrating mental and physical health. There must be significant investment in ensuring timely mental health access for appropriate mental health care where the young person lives in cities or rural settings.

Finally, in addition to bolstering the investment in mental health programs for children and youth, we mustn't forget we need to ensure there is support in place to strengthen and champion increased human and financial resources for health care practitioners in these areas, who are also on the brink of immeasurable burnout.

Thank you.

[The Chair, Conservative, Karen Vecchio]

Thank you very much.

We're going to move to Dr. Ryan Van Lieshout.

Ryan, you have five minutes.

[Dr. Ryan Van Lieshout, Perinatal Psychiatrist and Associate Professor, McMaster University, As an Individual]

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.

[The Chair, Conservative, Karen Vecchio]

Thank you very much, Doctor.

We're now going to move to Kids Help Phone.

Alisa Simon, you have the floor for five minutes.

[Alisa Simon, Executive Vice-President and Chief Youth Officer, E-mental Health Strategy, Kids Help Phone]

Thank you so much to Madam Chair, members and staff of the Standing Committee on the Status of Women.

I am thrilled to be here today. My name is Alisa Simon and I am with Kids Help Phone.

For over 33 years, Kids Help Phone has been on the front lines hearing from young people from coast to coast to coast and from every single province. We hear from young people starting from about the age of five and we have no upper age limit. Young people come as long as they want and use our stepped care model to find the kinds of services and supports they need.

We have always been a critical part of the mental health infrastructure and system for young people, but since COVID, that need has exponentially grown. In fact, since the beginning of COVID, Kids Help Phone has supported young people over 12 million times, which is a significant increase from 2019 when we supported young people about 1.9 million times.

Of the young people who reach out to us at Kids Help Phone, 74% identify as female. They reach out about every challenge a young person experiences, from bullying, depression, anxiety and relationship issues to suicide.

Although we hear from young girls and women across the age spectrum, 46% of our users are in the age range of 14 to 17, which is a particularly important time in the development of young girls. We see that the challenges they're facing change over time, which makes sense for anyone who is around young girls and young women.

Not surprisingly, younger girls come to us in very high numbers about bullying and relationship challenges. In fact, girls aged five to 13 are 120% more likely to talk about bullying and cyber-bullying. That is quite detrimental to the well-being of young girls. We know that it can lead to anxiety, poor body image and lowered school performance.

It is also worth noting that younger girls are more likely to reach out to us about eating disorder and body image challenges. In fact, girls aged five to 13 are 34% more likely to reach out about those challenges.

As girls age, their challenges change. We see, for example, that 18- to 24-year-olds are more likely to come to talk about anxiety and stress. Interestingly, over the course of COVID, young women aged 25 and older have been coming 60% more often to talk about grief, which I think makes sense given so many of the losses we have all gone through over the course of the pandemic.

Perhaps most sobering is our data on suicide. Over the last five years, we have seen a significant increase in young people reaching out to talk about suicidality. In fact, about 23% of all girls and young women who connect with Kids Help Phone are reaching out about suicide. Of girls aged 14 to 17 who connect with us, 45% are talking about suicide. Perhaps even more surprising is that 21% of girls aged five to 13 talk about suicide. I think that is quite shocking to many people, as we don't anticipate that younger girls are even thinking about issues around suicide.

The good news I want to make sure I leave people with is that we are able to help the vast majority of young people who reach out to us. We are able to form a safety plan with them. Only about 2% of our contacts of people talking about suicide require an emergency referral.

I also feel it's really important to focus on equity-deserving populations, such as indigenous, Black and 2SLGBTQ+ people and newcomers. We know their experience in Canada and their experiences around social determinants of health are not the same. We know from our data that they are all struggling with one thing in common, which is isolation and feeling disconnected from others like them.

Social isolation can lead to a lot of negative outcomes and it seems particularly prevalent for equity-deserving populations. One reason we started our peer support service last year was specifically so that young people can connect to others.

Our data also demonstrates, for example, the incredible impact of racism and discrimination on young people from equity-deserving populations. After the murder of George Floyd in 2020, we found that young people who reached out and discussed racism were more distressed than any other service user, except for those who feared harm in their own home. They were more likely than any other service user to discuss suicide.

In closing, I have three recommendations.

We need to focus on equity-deserving populations and the specific needs they have.

We need more in school supports at every age along the spectrum to not only talk about mental health, but equally important, to talk about seeking help, what it means to not feel good and why reaching out is important. Kids Help Phone has been doing this in middle schools for many years, and just launched a high school program. Next year we will be launching an elementary school program.

[The Chair, Conservative, Karen Vecchio]

You have about 15 more seconds.

[Alisa Simon]

The last thing is that we have to continue to ensure that we are making investments in evidence-informed, non-duplicative services, so that we are ensuring that young girls and women can access high-quality services regardless of where they live in Canada,

I will end my comments here. Thank you so much.

[The Chair, Conservative, Karen Vecchio]

Thank you so much. I'm sure we'll get back to more comments from you as we go through today.

Finally, from Klinic Community Health, we have Karla Andrich.

Karla, I'll pass the floor to you for five minutes.

[Karla Andrich, Counselor, Klinic Community Health]

Good afternoon, honourable members and fellow witnesses.

Thank you for the opportunity to speak today. My name is Karla Andrich and my pronouns are she/her.

I am joining you today from the Treaty One territory, which is the traditional territory of the Anishinabe, Nêhiyawak, Oji-Cree, Dakota and Dene peoples, and the heart of the Métis Nation.

My personal relationship to those treaties is that I am a descendant of settlers. My great-grandparents and great-great-grandparents built their generational wealth from land that was never ceded. I carry the benefit of that wealth and also the responsibility to work toward justice and decolonization.

I am a counsellor at Klinic Community Health, an agency in Winnipeg, Manitoba. We've been in operation for about 50 years. We promote health and quality of life for people of every age, background, ethnicity, ability, gender identity and socio-economic circumstance.

I’ll be speaking today through the lens of my work, providing one-on-one trauma counselling with survivors of sexualized violence, the vast majority of whom are women, girls, and gender minorities, with the acknowledgement that indigenous and 2SLGBTQIA+ folks are disproportionately targeted by those who perpetuate sexualized harm.

I hope to bring your attention to three main points today: the harm that systemic sexualized violence perpetuates; the need for trauma-informed care within systems; and the need for greater funding.

Sexualized violence is a web of daily microaggressions, systemic inequalities and acts of overt interpersonal violence, which include sexual assault, sexual harassment, gendered discrimination, and also the backlash that women, girls and gender minorities face when they speak out. It is also an integral part of colonial harm. Indigenous women, girls and two-spirit folks are disproportionately represented among the people that we see at the hospital through our advocacy work.

I have personally sat with so many indigenous folks at the Health Sciences Centre here in Winnipeg, from mature women, matriarchs of their families, to girls just 12 and 13 years old. So many of them tell me that this is just a reality in their families, that their mothers, grandmothers, aunts, cousins and siblings have all experienced some form of sexualized harm.

Contributing to this is the systemic lack of trauma-informed care in the justice system, the medical system and other supports, such as EIA, colleges of physicians, and other peripheral systems that survivors may engage with. My first counselling job was at the University of Manitoba, and it broke my heart seeing the profound impact that experiencing this harm had on my clients.

Finally and crucially, access to counselling is underfunded. Many survivors can’t afford private therapy to help them recover from their traumatic experiences and spend months to years waiting for care at agencies like Klinic. This translates to months and years of greatly diminished quality of life, lost opportunities, lost jobs, education, relationships and contributions to their communities.

My suggestions for action today are that it is imperative we value the lives, futures and happiness of women, girls and gender minorities as equal to those of men and boys. We need to more deeply commit to implementing the 94 calls to action put forth by the Truth and Reconciliation Commission, especially calls to action 21 through 24, and 41. Trauma-informed training should become mandatory for any person or agency which provides care, reviews complaints or enforces laws or policies around sexualized harm. Finally, we need to greatly increase funding for survivors to access free counselling, legal support, system navigation support and advocacy.

My team at Klinic consists of just two full-time and two part-time counsellors. We have a coordinator. We have a few part-time advocates. We have volunteers of whom we ask too much, because the need is so great.

Essentially, we need more money. Every agency that provides this kind of care needs more money. We are stretched thin and constantly are trying to balance the needs of our crisis program, which intervenes for people in the immediate aftermath of a sexual assault, and our counselling program, which provides ongoing therapy and public education.

We are constantly stealing from Peter to pay Paul. Ultimately, it's the survivors who suffer. Money is how we as a society indicate how important a particular issue is to us. Canada needs to invest in our women, girls and gender minorities.

At Klinic, we deeply appreciate the money that has come to Manitoba recently to help bolster our crisis services. It would be very helpful to also get money to support the other half of our advocacy and counselling work, which is for ongoing support for people, as these kinds of experiences take time, effort, and support to recover from.

Thank you very much for your time today.

[The Chair, Conservative, Karen Vecchio]

Thank you very much for those words, Karla.

We'll go to our first round of questioning. Each party will be provided six minutes. We'll be starting this off today with Michelle Ferreri for six minutes.

Michelle, you have the floor.

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

Thanks, Madam Chair.

Thank you to our witnesses. It's great information that I'm sure will help in our journey here to get better resources, but better understanding and knowledge of contributing factors in youth mental health.

Dr. Elliott, that was great testimony. There's really a lot of information to unpack there. I'm curious to know if there's any data collected between developing an eating disorder and the consumption and use of social media.

[Dr. April S. Elliott]

There definitely is. I think many of my colleagues will agree as well that it's very challenging, because eating disorders are multifactorial. To be able to pull out all the confounding issues surrounding that gets very challenging. I am going to be preparing a brief to be submitted, and I will specifically look for something like that and add that to the brief.

As I said, it's very challenging because of all the confounding factors. We do know that depression and anxiety have increased exponentially since the introduction of the smart phone, and eating disorders are an anxiety-based illness, so there is a correlation there for sure.

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

Yes, it's very challenging when you have concurrent situations going on, but as a mom, and as parents, I think we can see what the consumption of social media and media in general does to our children when we look at anxiety and burdening our kids with adult problems, and then how that impacts their developing brains.

The data is going to be very powerful as we move forward, because this generation is in a completely different world than we were or any generation has ever been.

Dr. Van Lieshout, thank you for your presentation. I was really struck by one thing you said. It was about how you're focused on prevention.

Do you have a key on how we prevent postpartum illnesses, on how we prevent illnesses that develop into full-blown disorders?

[Dr. Ryan Van Lieshout]

Prevention is an integral part of the package of improving the perinatal mental health of pregnant persons, birthing parents, mothers and women. Three years ago, just before the pandemic, the United States preventive services task force recommended that all individuals who are at increased risk for developing postpartum depression be provided access to effective treatments. These treatments are not widely available generally, and they are, in their current packaging, a bit tricky to use, because a lot of pregnant people are still working outside of the home and existing treatment packages are 12 to 18 weeks long and require weekly attendance.

While prevention in higher-risk groups is likely to be helpful to prevent postpartum depression, anxiety and other common perinatal mental health problems, there's still a lot of room for innovation. A number of groups across the country are engaging in this, me included. We know who is at higher risk. We can identify them. We can support them. I think that part of any kind of national perinatal mental health strategy should involve a focus on prevention and for a variety of reasons: to prevent illness but also to substantially reduce costs financially.

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

You made some really great arguments around the cost savings when we invest. I think that's a really powerful stat.

If I may, I'll turn to Alisa Simon.

Alisa, one of the things that a lot of Canadians struggle with when they're looking at charities is making sure when they donate to a charity that the money is going directly to the charity. There are a lot of administrative costs or maybe there's a bureaucracy. Do you feel right now that the funding model is best set up to go directly to the resources you need to help kids?

[Alisa Simon]

That's a great question.

All of us in the charitable sector really appreciate funding that is undesignated, which allows us to use it in the ways we most need.

In order to be successful and build scalable solutions, you have to have a funding model that takes in government support, corporate support and donations. By doing that, you're able to, hopefully, bring together a model that allows you to pay for things that may be a bit less exciting. You have to pay for payroll and IT. Those administrative costs are real. However, what many donors want to pay for are the things they can see directly: a product being developed, or something that's directly going to young people.

The reality is that we have to be supporting charities to understand how to build a robust way to support themselves. Looking at all those different ways: government, corporate and philanthropic. Not all charities have the ability to do that, based on their fundraising staff or whether they even have fundraising staff to do that.

At Kids Help Phone, our ability to scale to meet COVID was partly due to shifting our funding model to accept more government funding, for example. We are incredibly thankful to partner with the federal government in so many initiatives. Without that, we would not have been able to scale to meet the huge demand that came in as a result of COVID.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

We're going to turn the floor over to Anita Vandenbeld.

Anita, you have six minutes.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Thank you very much.

Thank you, all, for your testimony. I have a question for each of you. In six minutes, I'll try to be quick.

My first question is for Dr. Elliott.

You've done a lot of work in burnout among practitioners, among nurses. The federal government has allocated $50 million for PTSD and trauma among frontline and essential workers impacted by COVID. I just made an announcement in my riding about long-term care workers.

I wonder if you could give us some advice about the best way to target and deliver that kind of funding.

[Dr. April S. Elliott]

First of all, I think the feedback and the study show that burnout comes from feeling a lack of influence or control in a scenario. I think, in the context in which we've been living for the last two and a half years, we've all been very uncertain. Often, if people have more control in their jobs, we see a reduction in burnout.

You don't want to look at programs that are just coming in to talk about wellness, but ones that are actually looking at the root—the values people have—and can work in that way. Well-being has many factors: financial, relationship, emotional and physical. Investing in programs that look at all those factors, not just a yoga class or something that people need to do around resilience.... There's much more than that.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

My next question is for Ms. Simon with Kids Help Phone.

Regarding what you said about equity-deserving—by the way, I love the term “equity-deserving”—groups, in particular, I want to ask you about newcomer children.

I know there was funding set aside by the federal government through Immigration for 100 languages to be accessible through Kids Help Phone. Particularly when we're seeing Afghan and Ukrainian refugees who have trauma.... How is that going? What is the impact of that?

[Alisa Simon]

Yes, up until a year ago, Kids Help Phone offered all our services in English and French. Because of a partnership with the federal government, we've been able to add Mandarin and Arabic. With the recent war in Ukraine, we've added Ukrainian and Russian. We also want to recognize that we have many immigrants, newcomers and refugees from Afghanistan, so we also offer Pashto and Dari. We are getting ready, right now, to trial two indigenous languages. We are moving quite quickly to provide more and more services to young people who speak other languages. We are on track to provide all our services in over 100 languages next year.

Our evaluations are finding that, in order to do this work, you have to first begin with deep relationships within communities. It is important that we are talking to the settlement and refugee organizations—any place where these refugees and newcomers are spending their time. The first thing is to build that relationship and trust, so they even know to come to us. Once they come to us...it's doing the ongoing evaluations we've been doing. Are we having good impact? Are we seeing reductions in distress? Are we seeing satisfaction levels?

Thus far, our numbers have been small. The output and evaluations have been quite strong in demonstrating that, when they do reach out, they are getting services in ways they've never been able to access before.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

My next question is for Ms. Andrich.

I'm picking up on something you said. You mentioned that sometimes young girls are waiting years before they can get help. We've been hearing, it seems, a trend in some of the hearings we've had about how, rather than prevention, the entry point is the ER, but even if they get to the ER, what happens is they may see a psychiatrist and they may get medicated, but then there's no follow-up if they don't have a family doctor. They don't even know what to do, if they're on medication, to get it renewed or monitored. The fact is that asking for help—and I think we heard this previously—isn't enough. What happens if you ask for help and the help isn't there or it takes years to get?

I want to direct that to Ms. Andrich, although I imagine the rest of you might have something to say about that as well.

[Karla Andrich]

Thanks so much for that question.

I think one of the things that many survivors struggle with when they come forward is the stigma of having experienced sexualized violence. Our program attends hospitals, but, of course, we have to be asked to come. There is a fairly good follow-through between folks we have seen at hospital and folks who use our crisis lines. There is a bit of a disconnect, I think, between those numbers and the demographics with respect to who comes to ongoing counselling, which I think speaks to sort of what Alisa was talking about in terms of engagement with community and knowing that the services are there so someone can even think about reaching out to them.

I think it goes back to money for engagement, as even Dr. Van Lieshout was talking about, in terms of preventive care. That is also about public education and building relationships with communities and having the funding to run programs like that and the ability to—given our own knowledge of what is needed on the ground floor, at the sort of boots-on-the-field level—direct money to where those things are going to make the most impact.

[The Chair, Conservative, Karen Vecchio]

That's excellent. Thank you so much.

We're going to turn the questioning over for six minutes to Andréanne Larouche.

Andréanne, you have six minutes.