Status of Women Committee on Oct. 17th, 2022

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

I know I don't have a lot of time left, and this is a very loaded question. I'm going to drive it to you, Sarah, because you addressed it a little bit in my first question. What needs to be changed in the Canada Health Act in order to make mental health care accessible to everyone?

[Sarah Kennell]

Thank you.

A reopening of the act and a clarification on the list of medically necessary services would go a long way to ensuring that the services that are now left out of the system are integrated. I mentioned counselling, psychotherapy, substance use health treatment—the services that we now rely on insurance or paying out of pocket for.

That is one avenue. An alternate avenue is to create a parallel Canada mental health transfer and an accompanying act that would create dedicated funding for those services that fall outside the system.

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

A dedicated $4.5 billion was promised by the federal government to mental health transfers. Where is that?

[Sarah Kennell]

That would be a question for Minister Bennett.

[The Chair, Conservative, Karen Vecchio]

Thank you so much. We will get back to you.

I'm now going to pass it over to Sonia Sidhu.

Sonia, you have the floor for six minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Thank you to all the witnesses for their insightful testimony.

Ms. Coelho, we know that eating disorder admissions are on the rise in the ER. What do you think is the role of social media around that? Do you think social media has also had an impact there?

[Dr. Jennifer Coelho]

As we're hearing some of my fellow witnesses highlight today, it's complex. When we talk about the perfect storm of eating disorders, the increased use of social media is one factor that has been highlighted. At the same time, we know that social media in and of itself does not cause eating disorders.

I think what's challenging is that we're also in a context of what is known as “normative discontent”. I think a lot of girls, young women, boys, and transgender and non-binary individuals have challenges with body image and may be trying to change their body image. It may not go to the point of an eating disorder. I think some of the witnesses were highlighting the importance of prevention in mental health. Body image is a factor of well-being that fits within that. I think that's where some of the main concerns around the impact of social media also lie, not only in clinically diagnosable eating disorders.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Professor Afifi, my colleague just raised the issue of education in terms of helping with mental health. When parents are open with their children about mental health, parents can support their kids, but there's also the educational side. How can we fill that gap?

[Dr. Tracie Afifi]

Thank you.

I agree with being able to focus on prevention, as was mentioned here already. We want to make sure that when children are having difficulties, the sooner they have access to care, the better. Again, repeating what other people have said, we don't want to wait for anyone—children or adults—to be in crisis before they get care, so it's about education in terms of how they can talk about their mental health and also giving them resources, both to the parent and to the child.

The parent and child have to be a unit to help the child. We can't just focus on giving skills to the child. The parent may also need skills in order to be able to handle even their own stress and concerns, perhaps, and then to also be a support for their child.

We need to make sure that access to care is early. We can't wait until a child is 12 years old or an adult of 18. We need to be starting really early. Then, when people have concerns with mental health and reach out, those services need to be in place across the country in all locations, because when you have an issue with mental health and you're told that you need to wait six months or 12 months, that's the worst news you can possibly hear, as a parent or as a child. When you need help, you need help now.

We need to be able to make sure that when people are asking for help those services are in place for everyone in the country.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

I want to go back to Dr. Coelho.

We know that the pandemic has created a demand for virtual care delivery for eating disorders too. Is virtual delivery a factor when it comes to eating disorders? I just wanted to know that.

[Dr. Jennifer Coelho]

There was a Canadian consensus panel that put out guidelines for treatment of pediatric eating disorders, and then last year there was an addendum. There was an analysis of virtual care for eating disorders with recommendations that there is emerging evidence to support this approach.

In fact, although there are challenges in some rural and remote areas in terms of Internet access, it may be an approach that allows more equitable access for individuals, because the eating disorders programs in Canada tend to be based in urban and suburban situations geographically.

Many programs are using this with great success, and there's emerging evidence about virtual approaches.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for Ms. Mechmechia.

You talked about racialized women and how they can get mental health services. We heard about some barriers to that, and we heard from Ms. Kennell about community-based programs. Where is that gap and how can the federal government improve that gap? Both of you can comment if you want.

[Abrar Mechmechia]

Thank you so much for your question.

Just to clarify, do you mean the gap in how the federal government can give funding to community-based resources or services to support racialized women and marginalized populations and young girls?

[Sonia Sidhu, Liberal, Brampton South, ON]

The first part is about how the community organizations can help newcomers or racialized women.

[Abrar Mechmechia]

That's a great question.

It's about supporting them with early intervention and mental health support that is catered towards the trauma they have and the culture they come from, for example, especially now that we are open to a variety of cultures like Syrian, Afghan, Middle Eastern, etc.

First is providing that type of support. The other thing is creating more safe spaces. The first support would be providing early intervention and peer support—

[The Chair, Conservative, Karen Vecchio]

Abrar, you're going to have to get back to that answer, because we're quite a few seconds over time. We will come back to you.

I'm going to turn the floor over to Andréanne.

Andréanne, you have the floor for six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

Thank you very much to the witnesses who are here this morning.

If I understood correctly, the guidelines are prevention, in other words, proactive work, and awareness, especially with young girls and children.

Since the 1970s, Quebec has been a pioneer in prevention and is proud of its community‑based model. Social pediatrics has developed significantly, and there are centres throughout the province.

I had a call this morning from the Centre de pédiatrie sociale en communauté Main dans la main, which is currently getting ready for its annual charity drive, scheduled for December. The centre is required to raise funds to finance all the services it offers. I would like to remind you that these workers do prevention work with the most disadvantaged families, where there is violence, and they do an exceptional job.

I also had a discussion this summer with a suicide prevention centre in my riding. This centre already has a prevention program in the workplace and in different locations, and it does mental health and suicide prevention. The people I spoke to told me about the labour problem they're facing, and they can't afford to pay the staff adequately.

These are some examples of projects and programs for which the Government of Quebec would like to provide more funding in order to help these community groups even more. In Quebec, this is done through the ministry of health and through transfers.

Ms. Kennell, you talked about the importance of having the means to provide financial resources to organizations. Beyond what is being done in our health care system, the entire community network works on the ground every day to do prevention and, often, to respond to emergency situations, filling in the gaps for people who don't know where to go.

So I'd like to come back to the importance of these transfers. As I said, there are already projects in place. Can you talk about the importance of avoiding the duplication that occurs when the federal government tries to impose conditions when programs are already in place? Could you also tell us more about the importance of financial resources?

[Sarah Kennell]

Thank you very much, Ms. Larouche.

I agree completely. I think it's about scaling up and supporting existing initiatives that we know are evidence-based and that we know get the results we want to see.

I will comment on two things. One is the salary equity issue.

Pay equity is really an extreme priority across Canada. Social workers aren't paid enough.

We have to create pay equity across our acute and non-acute hospital-based and non-hospital-based health care settings.

The other issue we are experiencing is that not only are our frontline mental health care workers who are working in the community working at a reduced salary; they're also experiencing higher levels of burnout and stress. They are leaving the profession, often going to the private sector, and leaving community-based organizations without the adequate staffing needed to sustain scaling up and bring sustainability to their programming.

When it comes to the Canada mental health transfer, as I said, we need to see 50% earmarked for community-based care. We know that investments are already going to hospitals and physicians through the Canada Health Act. The Canada mental health transfer has the opportunity to redirect resources to the sector, which has been starved of resources for decades now. That's a problem created by the Canada Health Act.

By creating a Canada mental health transfer, we can see an influx of resources to these organizations.

As you mentioned, Ms. Larouche, these organizations need money and resources to adequately support their prevention programs.

[Andréanne Larouche, Bloc, Shefford, QC]

That's interesting.

Ms. Kennell, when we asked you what was going on with the $4.5 billion of the original Canada mental health transfer investment, you told us to ask Minister Bennett.

Personally, when I hear about transfers and conditions, I often hear that funding is provided on a project‑by‑project basis, under certain threats. What community organizations, Quebec and the provinces are asking for is stable, permanent and predictable funding.

The $4.5 billion is fine, but it's more like a one‑time, project‑based amount. It isn't consistent with the demands of community groups on the ground and of Quebec, who want to plan for long‑term funding for their health care system and to know what portion of the funding is earmarked for mental health.

I'd like to know more about the importance of stable, recurring and predictable transfers and their substantial increase. At the moment, federal health transfers are barely equivalent to 21% of the total costs of the system, whereas we want them to be 35%. We've heard several figures this morning. How important do you think it is to reinvest massively in the health system?

[Sarah Kennell]

I'd like to clarify that it's a permanent transfer, not a one‑time transfer for five years. We hope it will begin next year, in the 2023 budget.

We want to create a parallel track of funding, because we're seeing organizations having to apply for short-term grants, often pilot projects, that prevent them from being able to build sustainability, retain staff, recruit staff, and pay them adequately. Rather than seeing community-based mental health as a charity that's offered by small donations here and there, we really want to institutionalize the system. We see it as part of our health care system—which mental health is.

[The Chair, Conservative, Karen Vecchio]

Fantastic. Thank you so much, Sarah.

We're now going to pass it over to Leah Gazan, for six minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much, Chair.

My first question is for Abrar Mechmechia.

You spoke a bit about one of the barriers being the cultural competency of the therapists providing care. You gave an example of the Islamophobic attacks that happened in Ontario, and the impact on mental health.

My riding of Winnipeg Centre is rich with diversity, but I would agree with you that we lack appropriate care, culturally competent care, particularly for newcomer youth and adult women, who have often experienced things like war trauma.

I want you to speak to that, but because I don't have a lot of time, I also want you to speak about art therapy. We have a program called Artbeat, which provides internships for people who are experiencing mental health issues.

Could you speak to the importance of art as a therapy?

[Abrar Mechmechia]

To comment on the first part, it's amazing that Winnipeg has diverse backgrounds and is doing great in terms of having more variety and culturally sensitive supports. In order to add to that, we need to have community-based organizations, as mentioned by Sarah, that provide early intervention and safe spaces for newcomer women and immigrants. They need to understand the trauma that these newcomers bring, speak their language, and be from their culture.

When you don't have the words, art is a great way to express yourself, and a great way to heal. We did find art therapy to be super effective when I used to work back home with war survivors, and currently. I have led many art therapy workshops with newcomer immigrants. Those who lead the art sessions are also from the same culture. Especially with a language barrier, art could be a really good alternative to give them the space to express their trauma and feelings.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much.

My next question is for Mary Bartram.

You spoke a bit about consumption. Our party, the NDP, put forward a bill regarding a health-based approach to substance use. It was defeated, unfortunately.

The British Columbia Centre on Substance Abuse said:

As well, we must end racism and sexism against Indigenous women, girls and two-spirited people as described in the Report of the Murdered and Missing Indigenous Women and Girls. In 2020, women accounted for 32 percent of toxic drug deaths amongst First Nations people in BC, twice the rate of the general population.

Another article stated, “The coroners service in British Columbia says more females are dying from illicit drug use.” I'm sharing this because I find that as elected officials, instead of taking a public health approach to toxic drug supply use, which is impacting certain groups more prominently than others....

Why is it important to take a health-based approach to consumption, rather than an approach based on stigma?

[Dr. Mary Bartram]

Absolutely, we need health-based approaches to the issues around deaths from toxic drug supplies and to the mental health and substance use impacts of the pandemic more broadly as well, which, as you know, has been closely intersecting with some of the issues you raised.

Again, a health-based approach with a focus on prevention, social determinants, reducing risk factors, adequate funding for equitable access to quality care that's culturally competent, and the importance of having the right capacity in the system to respond to those emerging needs.... All of those pieces are very much part of a health-based approach and very important.