Status of Women Committee on Oct. 17th, 2022

[The Chair, Conservative, Karen Vecchio]

Good morning, everyone. I call this meeting to order.

Welcome to meeting number 33 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 the 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 yourself when you are not speaking. There is interpretation for those on Zoom. You have the choice, at the bottom of your screen, of floor, English or French. Those of you in the room can use the earpiece. You also can choose floor, English or French.

For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function. The clerk and I will manage the speaking order as well as we can, and we appreciate your patience.

We are already halfway through the study on the mental health of young women and girls. It was previously agreed that the committee would undertake, as its fourth study, a study on human trafficking of women and girls and gender-diverse individuals for sexual exploitation in Canada. We're asking everybody to send in a prioritized witness list. The date for that is Friday, October 28. I see a nod there, so it looks as though everybody in the room knows that.

I remind everybody that we are welcoming our witnesses, and I would like to provide a trigger warning. This will be a difficult study. We will be discussing experiences related to mental health. This may be triggering to some viewers, members, or staff with similar experiences. If you feel you are distressed, please advise the clerk.

I would now like to welcome the witnesses we have with us today. We have, from ABRAR Trauma and Mental Health Services, Abrar Mechmechia.

Go ahead.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Chair, have all the witnesses participating by videoconference done a sound test to ensure they can be heard by the interpreters?

[The Chair, Conservative, Karen Vecchio]

Yes. Thank you very much.

We also have here today, as an individual, Tracie O. Afifi, professor. From the BC Children’s Hospital, we have Jennifer Coelho, psychologist, provincial specialized eating disorders program. From the Canadian Mental Health Association-National, we have Sarah Kennell, national director, public policy. From the Mental Health Commission of Canada, we have Michel Rodrigue, president; Mary Bartram, director, policy; and Shaleen Jones, executive director, Eating Disorders Nova Scotia.

Each group will be given five minutes. If there's more than one who would like to speak, please divide that time. For the first five minutes, we will have Ms. Abrar Mechmechia.

Abrar, you have the floor for five minutes.

[Abrar Mechmechia, Founder, Chief Executive Officer and Mental Health Counsellor, ABRAR Trauma and Mental Health Services]

Good morning, Madam Chair and honourable committee members. Thank you so much for inviting me to speak today. It's such a great honour.

My name is Abrar Mechmechia. I am a Canadian Syrian mental health counsellor with expertise in working with trauma since 2014, back home and in Canada. I am currently leading an organization that is dedicated to providing affordable, trauma-informed, art-based and culturally sensitive trauma and mental health support for diverse newcomers and immigrants. Our services are carried out through professionals with lived experience and those who speak our clients' first language. Our main focus is usually women and youth.

I am speaking today from both my professional and personal experience, as a young woman dealing with layers of past trauma while striving to make a living and build a future with limited support. I'm not the only one out there.

As shared in our “Together Towards Recovery” report, during the pandemic my team led a national advocacy campaign focused on understanding the barriers to mental health support and services faced by marginalized youth. We undertook research to determine the impact of COVID on youth, especially those who come from under-represented communities. Of the 308 total research participants, the majority were female.

Our research showed that the primary barrier to accessing mental health support was inaccessibility. Many did not know where to seek long-term support. Even if they did, they were deterred by the unreasonably long waiting time. This relates to geographical and mostly financial inaccessibility of the service. Those who did get access often felt that it was generic. They did not feel that they were understood. They felt that the care provider lacked cultural competency, failing to understand their gender identity, their experience, the trauma they carried with them and the context.

One time I had a conversation with a young woman who told me her therapist said to her, “Well, if you would just try to loosen up, you could probably fit in or feel more included.” She was referring to her hijab and the way she dressed. It was really heartbreaking for me to hear that such a young woman, 17 or 18 years old, was facing that type of discrimination within the health sector.

Women, especially immigrant women, face a disproportionate amount of discrimination and racism on a daily basis, which leads to an increased prevalence of anxiety, depression, loss of esteem, body image problems, isolation, and the pressure to fit in and feel that they belong, all added to the layers of trauma they face, and yet there are very few services they can reach out to for help.

These findings informed our vision to provide culturally sensitive, trauma-informed services for marginalized populations, especially newcomer and immigrant women and girls. Throughout the last two years, besides our “In This Together” campaign, we have launched three projects focused on providing needs-based early intervention for newcomer and immigrant women.

For example, “Brave Space” was an early intervention support group that was created to support Muslim women after the Islamophobic attack that happened in London, Ontario. This project's goal was to support women who felt threatened after what happened. It was piloted in Hamilton, Ontario, with the support of community organizations like HCCI and SACHA, and Nrinder Nann, a city councillor. We hope to relaunch this project again with some support.

Another project was “Friends & Coffee”, our first virtual support group, 12 sessions, in partnership with the Syrian Canadian Foundation to support Arabic-speaking women throughout the early stages of the pandemic.

Lastly, there's our Dil Ba Dil project, which launched this month with the support of a lot of women, the Mental Health Commission of Canada—who are present today; thank you so much—and the Future Ready Initiative.

I think my time is nearly up.

What we hope to see is free, trauma-informed, culturally sensitive mental health support for marginalized women and young girls, especially newcomers and immigrants who have gone through a lot of trauma and still deal with discrimination every day. Canada is a country of immigrants, and we lack a lot of support that understands migration trauma and the marginalization experienced in total.

Thank you so much for giving me the time and the platform today to represent the many voices I'm carrying. It's such a responsibility.

Thank you so much for listening.

[The Chair, Conservative, Karen Vecchio]

Thank you very much. We are truly delighted to have you here today to be that voice.

I'm going to pass it over to Professor Tracie Afifi.

Tracie, you have five minutes. If you'd like to start now, you have the floor.

[Dr. Tracie Afifi, Professor, As an Individual]

My name is Dr. Tracie Afifi. I'm a professor at the University of Manitoba in community health sciences and also in psychiatry. I'm a tier 1 Canada research chair.

We know that mental health disorders among women and girls are prevalent in Canada. When someone begins to have mental health problems, it can significantly reduce one's well-being and quality of life. Mental health problems can persist across the lifespan, as well as create a substantial burden on society. Over time, mental health problems can worsen and lead to mental disorders, substance use problems, thinking about suicide, and attempting suicide. Mental disorders can be hard to treat, and wait times for treatment can be long. Overall, access to mental health care in Canada is limited and often inequitable.

If we want to make large gains in improving mental health among women and girls in Canada, we need to focus on prevention and understanding the role that violence plays on poor mental health. Violence prevention is critical for improving mental health in Canada among women and girls.

For some children, their first exposures to violence is in the home. We don't have good Canadian data to tell us how many parents spank or hit their children. However, we do know that hitting children as a means of physical discipline is common. We also know that there is conclusive evidence across decades and thousands of studies that indicate that spanking is related to poor outcomes, including mental disorders, substance use problems, and thinking about and attempting suicide in childhood and across the lifespan. Children who are spanked are also more likely to experience severe physical abuse, sexual abuse, emotional abuse, and exposure to intimate partner violence.

Our team analyzed data from nationally representative samples of Canadian adults who retrospectively reported on their childhood experiences. We found that among women, 21% experienced physical abuse, 14% experienced sexual abuse, and 9% were exposed to intimate partner violence. Overall, 30% of women in Canada have experienced physical abuse, sexual abuse, and/or exposure to intimate partner violence.

Sex differences were noted, with women compared to men being less likely to be physically abused and more likely to be sexually abused and exposed to intimate partner violence. Gender-based violence is an important consideration when understanding the mental health of women and girls.

We further analyzed the data and found that individuals who experienced physical abuse, sexual abuse, and exposure to intimate partner violence were more likely to have depression, bipolar disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, phobias, attention deficit disorder, eating disorders, alcohol abuse and dependence, drug abuse or dependence, thinking about suicide and also attempting suicide.

Importantly, other research has shown that those who experience violence in childhood are also more likely to experience violence in intimate partner relationships in adolescence and adulthood. For some, violence may also continue across generations when children who were abused in childhood grow up, become parents, and continue the same patterns with their own children.

We know that violence is not the only reason why people develop mental disorders. Genetics, environment, and other experiences are important contributors to mental disorders. However, our research team hypothesized that childhood adversity played an important role in understanding who was more likely to have a mental disorder.

To test this hypothesis, our team used data from the United States and computed statistical models that were designed to estimate what proportion of mental disorders and suicidal behaviours in the general population could be attributed to experiencing child abuse. In other words, the statistical modelling estimated how much mental disorders and suicidal behaviour prevalence might be reduced in the general population if the child abuse did not occur.

What we found was that if physical abuse, sexual abuse, and exposure to intimate partner violence could be eliminated, then it is estimated that mental disorders among women might be reduced by approximately 22%-32% in the general population. Suicidal thoughts may be reduced by approximately 16% among women, and suicide attempts among women may be reduced by about 50% in the general population. Even if we couldn't prevent all child abuse, making gains to reduce child abuse would likely correspond with dramatic increases in the reduction of mental disorders in Canada over time.

Of course, we can't focus on prevention alone. We also need to invest in evidence-based treatments for mental disorders, substance use problems, and suicidal thoughts and attempts. We need to reduce wait times for care and provide better access to treatment for all Canadians. An improved and targeted combined intervention and prevention approach is needed.

If we want significant improvements in mental health, we need to work towards reducing all types of childhood violence, including spanking. Preventing childhood violence is difficult but possible, and it is critical for better mental health outcomes among women and girls in Canada.

Thank you.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

I would like to introduce to you Jennifer Coelho, psychologist, provincial specialized eating disorders program, BC Children's Hospital.

Jennifer, you have the floor for five minutes.

[Dr. Jennifer Coelho, Psychologist, Provincial Specialized Eating Disorders Program, BC Children’s Hospital]

Thank you so much, Madam Chair and committee members, for inviting me here today.

I'm coming here from Vancouver, which is the traditional unceded territory of the Musqueam, Squamish and Tsleil-Waututh people. In addition to representing the BC Children's Hospital eating disorders program, I am the president-elect of the Eating Disorders Association of Canada.

Back in 2014, the Standing Committee on the Status of Women published a report on eating disorders in girls and women in Canada, which references the services for eating disorders being in a state of crisis. The pandemic has really exacerbated this crisis and created a perfect storm of factors that has led to increased presentations of new eating disorder diagnoses across Canada, as well as internationally.

We know that biological and genetic factors interact with psychosocial challenges in the development of eating disorders. The psychosocial challenges in the context of the pandemic—including disruptions to daily routine, decreased opportunities for physical activity and increased social media use—are thought to be contributing to the surge in eating disorders.

In terms of the details of the surge, a report published by the Canadian Institute for Health Information reported that hospitalizations for young girls and women with eating disorders between the ages of 10 and 17 years increased by nearly 60% during the pandemic. Data from different Canadian eating disorders programs report similar or even larger increases.

Although the study is currently focused on mental health in girls and women, I want to highlight that eating disorders are diagnosed in people of all genders, all racial and ethnic groups, all body shapes and weight, and all socio-economic backgrounds. Eating disorders are a health crisis that can be fatal and, in fact, have one of the highest mortality rates of all mental health diagnoses. Because of that, intervention is really critical to prevent lifelong fatal consequences.

People with eating disorders experience a lot of barriers in accessing services. These barriers can include exclusion criteria for referrals or challenges in finding health care professionals who offer services for some eating disorder diagnoses. For example, services for an eating disorder called avoidant restrictive food intake disorder, also known as ARFID, which is a newly emerged eating disorder diagnosis, vary depending on where an individual lives, and typically are focused on pediatric services. Individuals with ARFID may present in a variety of mental health settings outside of specialized eating disorder services. Research from our group has demonstrated that health care professionals, particularly those who do not specialize in eating disorders, report very low confidence in providing clinical care for individuals with ARFID.

In looking for a path forward, we can look to our international colleagues who have developed innovative service models that can be adapted for a Canadian context. For example, Australia has created a national institute for research, translation and clinical excellence in eating disorders. In 2021, it released a national research and translation strategy for eating disorders. I would argue that the development of these national resources has contributed to innovative service models, including models that have focused on early intervention.

Similarly, in the U.K. there's a new intervention known as the first episode rapid early intervention for eating disorders model, or FREED, which focuses on rapid response to referrals with benchmarks for service provision, including telephone screening within 48 hours of referral and assessment in less than two weeks of referral.

As the committee looks for pathways forward, I want to highlight the existence of the “Canadian Eating Disorders Strategy”, which was published in 2019. It's a 10-year strategy outlining 50 recommendations for improving outcomes for individuals with eating disorders. These recommendations remain relevant today. They were developed in collaboration with the four national Canadian eating disorders organizations together with input from stakeholders.

Thank you so much.

[The Chair, Conservative, Karen Vecchio]

Thank you for your intervention.

We'll now go to the Canadian Mental Health Association. We have with us today Sarah Kennell, national director, public policy.

Sarah, you have five minutes.

[Sarah Kennell, National Director, Public Policy, Canadian Mental Health Association-National]

Thank you very much, Madam Chair.

Good morning, esteemed colleagues.

The Canadian Mental Health Association is the most established and extensive community mental health organization in Canada, providing advocacy, programs, supports and resources that prevent mental health problems and illnesses and that support recovery. We reach 330 communities in every province and the Yukon, engage 11,000 volunteers and employ over 7,000 staff.

Age and gender are major determinants in accessing mental health supports. According to Mental Health Research Canada, women under 25 are overrepresented among those with anxiety, stress and depression, and are less likely to seek out mental health supports, citing an inability to pay or not having enough insurance to cover them as barriers.

In the past 10 years, suicide rates among women have overtaken men in the 10- to 14-year age range. Girls are six times more likely to develop general anxiety disorder than boys, and there is a marked increase in the incidence of major depressive episodes among girls over the age of 13, compared to boys.

Structural inequalities in our mental health system exacerbate these gender-based inequalities. Canada's universal health system isn't universal at all. For services to be covered, they must be deemed medically necessary under the Canada Health Act. Mental health and substance use health services delivered outside of hospitals and by physicians are not considered medically necessary. This means that services like counselling, psychotherapy and substance use health treatments, for example, fall outside of our public health system, leaving people to rely on limited insurance benefits or to have to pay out of pocket to get the care they need.

Many turn to not-for-profit organizations to access these services. Long wait-lists, geographic barriers, system navigation issues, cost-prohibitive care and lack of access to community-based supports compound and intersect along gender and age lines.

From speaking with young women with lived experience of mental illness and the frontline mental health care providers who support them, we know that young women and girls face particular challenges navigating the system. They can feel a lack of agency and powerlessness, and that recovery depends on the privilege of income and time. Speaking to interactions with the acute care system as young women, they describe needing to be in crisis or sick enough to get the care they need, and being left to navigate the system by themselves, without access to community-based supports once discharged.

Power dynamics rooted in patriarchy perpetuate harmful gender stereotypes that permeate the mental health care system. When seeking mental health supports, young women can be perceived as “overdramatic”, resulting in barriers in access to care. One woman spoke about the gendered ways in which physicians can impose judgment and pressure to adhere to treatment plans, saying specifically that they promoted medication over therapy-based treatments, despite concerns raised about risks associated with such medications, including suicidal ideation. Speaking specifically about eating disorder treatments, we heard about young women being released from treatment if they were non-compliant or if they failed to meet treatment goals.

On the issue of suicide among young women and gender-based stigma, research suggests that they're “attention-seeking” or “manipulative” and not taken seriously. Current responses to suicidality often fail young women by not creating the supportive environments to truly meet their needs when they are seeking help.

Upstream mental health promotion initiatives delivered by community-based organizations—like social and emotional learning, mental health literacy and comprehensive sexuality education—lead to healthier relationships, reduced bullying and improved self-esteem by addressing toxic masculinity and harmful gender stereotypes. These programs critically meet the most vulnerable in our communities and yield strong returns on investment. Connection, wraparound supports, follow-up and gender-sensitive and age-appropriate care are equally important.

The existing supply of such programs cannot meet the rising demand, but the federal government can help. Most critically, the federal government can create the promised Canada mental health transfer. CMHA is calling for the equivalent of 12% of provincial and territorial health expenditures—or $5.3 billion expensed annually—with 50% earmarked for community-based services, accompanied by a Canada mental health and substance use health act to bring permanency and accountability to the transfer.

Bringing an intersectional, gendered lens to mental health helps us better understand the different needs of women, girls, trans women and non-binary people and how best to respond to those needs. Left unaddressed, mental health issues experienced at a young age can turn into more serious mental health issues later in life.

As a country, we’ve failed to invest in mental health and substance use health, and it shows. CMHA looks to this committee for support in making mental health a priority now.

Thank you.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

Finally, from the Mental Health Commission of Canada, we have president and chief executive officer Michel Rodrigue.

Go ahead. You have the floor for five minutes.

[Michel Rodrigue, President and Chief Executive Officer, Mental Health Commission of Canada]

Thank you again for your time on this critical issue. I'm honoured to be able to appear before you to discuss such an important subject, the mental health of young women and girls.

The Mental Health Commission of Canada leads the development and dissemination of innovative programs and tools to support the mental health and well‑being of Canadians.

With regard to your committee’s study, the commission’s researchers have noted a gender paradox, where men are more likely to die by suicide; however, women are more likely to attempt suicide. For us, there is a clear opportunity to support women and girls early on in their lives, so that they have the tools they need for mental well-being during their entire lives.

In 2023, the commission will be embarking on a suicide prevention effort among women and girls. We would be pleased to come back to this committee to share some of the findings.

I am also happy to see ABRAR Trauma here today. The MHCC was pleased to recently partner with them on Dil Ba Dil, a program for Afghan newcomer women.

I would now turn to my colleague, Dr. Mary Bartram. As well, we have Shaleen Jones online, who is a member of the commission's Hallway Group. It's composed of people with lived and living experience of mental illness. She is also the executive director of Eating Disorders Nova Scotia.

I'll pass it over to you, Mary.

[Dr. Mary Bartram, Director, Policy, Mental Health Commission of Canada]

Thank you, Mr. Rodrigue.

Good morning, everyone.

I am pleased to be here to provide a bit more information about the Mental Health Commission of Canada's research and programming.

Findings from our COVID polling with the Canadian Centre on Substance Use and Addiction were very clear and concerning. Mental health and substance use concerns were greater for youth overall and differed significantly by gender. We'll table a more detailed report soon, but here are a few highlights.

Half of young women aged 16 to 24 and one-third of young men reported moderate or severe anxiety symptoms. Again, that's half of young women and a third of young men over the course of the pandemic.

When it comes to substance use health, two in five young women who use cannabis reported problematic use, as well as three in five young men. These impacts are compounded for youth who identify as 2SLGBTQ+, report low incomes and are from ethno-racialized communities.

The MHCC is developing a lens for mental health policy and programming that integrates sex and gender, as well as intersectionality, anti-racism and decolonization, to name a few. Again, we would be pleased to come back to share more with this committee as that work develops, as it may be of interest.

We also have several programs that are making a difference for young people, including young women and girls. For example, over the past year, over 800 teenage girls participated in our Headstrong anti-stigma summits. We also offer training on mental health first aid supporting youth, and we work with campuses across the country to adopt and implement the national standard for mental health and well-being for post-secondary students.

I am pleased now to turn things over to Shaleen Jones, who will speak more on an important mental health priority, which is eating disorders.

Thank you.

[Shaleen Jones, Executive Director, Eating Disorders Nova Scotia, Mental Health Commission of Canada]

Thank you all so much for inviting us here to speak about this really important issue.

I want to echo what we've heard from a lot of the panellists. I am a survivor of an eating disorder, and we know that eating disorders are complex, common, serious illnesses with the highest mortality rate of many mental illnesses. In the mental health community, we've been calling the alarm on eating disorders for 20 years, and we are in a grave situation. Indeed, this is a crisis point. We know that, with rapid access to early intervention, treatment and support, people can and do go on to lead fulfilling lives and are able to fully recover from this illness, but too many are denied the opportunity to recover.

I want to call upon all aspects of our community to enable several recommendations, again, streaming from the work done by the national eating disorders groups. We need rapid access to low-barrier support, including peer support, support for families, training for clinicians and training on early intervention for primary health care providers, and finally, funding for community-based organizations, which are picking up an incredible burden supporting folks with eating disorders.

Here at my organization, Eating Disorders Nova Scotia, we have been providing peer support to folks of Nova Scotia for the past 20 years. We're now extending this across Canada because the demand is so great.

I look forward to working more on this issue collectively with you all. Thank you.

[The Chair, Conservative, Karen Vecchio]

Thank you very much, Shaleen. Thank you very much for being here and supporting what we're doing.

We are going to our rounds of questions. To start our first round, each questioner gets six minutes. I'm going to pass it over to Michelle Ferreri for the first six minutes.

Michelle, the floor is yours.

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

Thank you so much, Madam Chair.

Thank you to all of our witnesses. It's nice to see some familiar faces here.

If I may, I'm going to address this question to two groups, so I'll give one person a chance to think about it. The other person will have to answer it right off the hop.

Sarah, may I call you Sarah?

Michel, may I call you Michel?

I'll start with you, Sarah. I think we've made great strides in convincing people not to be afraid to ask for help, so now we have a lot of people who have overcome that hump and they're ready to ask for help, in particular children or parents of children. They're ready to access help. They take that brave, courageous step, and then there's nothing there for them when they do ask.

What is the number one thing we can do as a federal government to close that gap in access to treatment for mental health supports?

[Sarah Kennell]

I couldn't agree more. We've done much great work on raising awareness, breaking down stigma and addressing the discrimination associated with mental illness and substance use health, but the challenge really is in where you go for help. We shouldn't have a country where, in order to get the help you need, you need to be in crisis. Crisis means going to hospitals to get the care you need. We need to have more cost-effective and community-based care.

The role of the federal government is, in my opinion, in directing resources to provinces and territories to fund community-based organizations. That's that out-of-hospital care that people rely on in community. It's culturally appropriate. It's trauma-informed. It's age- and gender-sensitive. It's integrated youth hubs, for example. Really, it's about ensuring that we're allocating those federal dollars, both through the health funding that is transferred to provinces and territories, and through direct investment through grants and contributions from federal departments to those community-based organizations doing that work.

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

Thank you so much.

Michel, do you want to add to that?

[Michel Rodrigue]

Sure, thank you for that.

I will readily say that it's complex, but a couple of things really come to the forefront. The first is still the need to continue on prevention, and part of that is making sure that, in elementary school and secondary school, people learn how to speak about mental health and mental illness. Mental health literacy is so key.

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

May I add to that? That was one of my next questions. Do you think mental health first aid should be readily available to everyone who is working with children—caregivers, coaches, etc.—as well as age-appropriate mental health first aid for young children in the education system?

[Michel Rodrigue]

I very much think so. I think it's time for that to be pervasive throughout our workplaces for whoever works with children and teenagers, and it's time to create safe post-secondary campuses.

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

I'm a big ambassador of mental health first aid.

My next question for you, Michel, if you don't mind, is about the tax on psychotherapists. For people who may not be familiar with this, right now there is a tax that psychotherapy is getting that other service providers like psychiatrists are not.

Have you had an answer from Finance Canada as of yet as to why psychotherapists are being taxed and other providers are not?

[Dr. Mary Bartram]

I'll take this one. Thank you.

The whole issue around the regulation of psychotherapists is a priority in Canada. We have five provinces that are regulating psychotherapy or counselling therapy. The issue of tax is tied to the regulatory status of psychotherapists. If we can complete the regulation of psychotherapy across the country, I think this issue will work itself through to be on par with other types of health care providers.

I can add as well that the issue of a need for a national mental health and substance use health workforce strategy that addresses this among a range of other issues, as part of the prioritization of the health workforce right now, is another area where the federal government could have a role to play in making sure that the focus on the health workforce includes a variety of issues related to the mental health and substance use health workforce as well.

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

Do you know what the holdup is on why the regulation hasn't happened for psychotherapy?

[Dr. Mary Bartram]

Again, these are complex issues that get played out at the provincial level in terms of whether it advances or not. Most provinces have pre-regulatory bodies in place, so a federal push might be something that could be of assistance in getting those processes over the hump.