Status of Women Committee on Oct. 17th, 2022

[Dr. Jennifer Coelho]

Absolutely, right now researchers in Canada look primarily to international colleagues. We know that eating disorders receive significantly less funding than many other mental health conditions, disproportionately in terms of the number of people who are affected, as well.

One factor that was highlighted in the eating disorder strategy is the existence of some costing reports, for example, that have been performed in the United States, Australia, and the United Kingdom. They are arguably part of what provided the impetus for some of the changes in service models in order to understand the economic impact of eating disorders and to then better plan services.

We don't yet have this type of study in Canada, although there are some national colleagues who have come together, receiving funding from the Canadian Institutes of Health Research in order to start informing about the economic impact of eating disorders.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much.

Ms. Mechmechia, you talked about the hatred that some women experience and the pressure put on them on social media, which is a very difficult space for women because it puts additional pressure on them in terms of their self‑image.

So it's important to legislate and address the issue of online hate. A federal bill on this issue is currently being studied. What could such legislation mean?

[Abrar Mechmechia]

A lot of work has been done to ask the federal government to move forward toward implementing any type of legislation to prevent hate speech, especially on Facebook, Instagram and Twitter. Yet, I don't think any action has taken place. Speaking about Bill 21, many bills in our legislation reinforce that type of hate globally and nationally, as well.

I don't know what else to add, but yes, we need action to be taken in terms of social media, and absolutely, in terms of our own legislation and work environments. We also need to have a more diverse presentation for the publishers we work with, especially at the policy-making level.

[Andréanne Larouche, Bloc, Shefford, QC]

I just came from an international summit where this issue was discussed, and I offered my full support to the Iranian women who spoke out against their treatment. I would remind members that a woman was killed because she wasn't wearing her veil properly. It's horrible that this could still happen in 2022.

My time is up, but I'd like to again offer my full support to Iranian women in their fight for equality and freedom.

[The Chair, Conservative, Karen Vecchio]

Fantastic.

Leah, you have the floor for six minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much.

I want to very quickly follow up, and then I want to go to Sarah Kennell afterwards.

You made a very good point about Bill 21. What I've said is that it's about choice, about a woman's choice—what they want to wear and what they don't want to wear—and about taking the ability to choose. I ask that because I feel there is growing Islamophobia in the country. I certainly worry about the many women and young women in my riding who have experienced in Manitoba increased levels of Islamophobia.

Would you say that these kinds of debates about taking away a woman's right to choose what to put on her body and even reproductive rights, with the whole debate we're having about Roe v. Wade—I mean, it's the time—are impacting women's mental health?

[Abrar Mechmechia]

Absolutely they are, because we don't feel that we are in control of our choice. Regardless of what a woman wants to wear or doesn't want to wear, it is definitely her choice. I've been reading the news about Switzerland recently. I think they now fine you 10,000 euros or something if you wear this in public or at a workplace.

At the end of the day, it's a woman's choice. I think because we're still in a masculine society, we still have men making decisions on what a woman can and can't wear. I think that's the main reason behind it.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Yes. Thank you so much.

I want to talk about eating disorders. Jennifer Coelho made a statement, as did Shaleen Jones from the Mental Health Commission. One thing that we know contributes to body distortion is the hypersexualization of young women and girls. We know that's an issue. I'm hearing very clearly from the witnesses today that this is just part of the equation. I've heard very clearly that in care we need low-barrier support.

Sarah Kennell, you spoke about mental health supports in terms of income and time, and I would say geographical as well.

I'm wondering if the three of you could maybe speak about that low-barrier care and not just focusing on one element that might be a factor causing eating disorders, and then speak about access to care and what that low-barrier care looks like.

We'll start with you, Jennifer, and then we'll move quickly to Shaleen and then Sarah.

Thank you.

[Dr. Jennifer Coelho]

I've heard some of my fellow witnesses highlight options in terms of integrated youth hubs, which exist in provinces across Canada, although not in all provinces. I think one of the aims of the early intervention work I've highlighted of some of our international colleagues is to take the services outside of hospital-based services and try to bring them to community and primary care.

I will hand it over to my fellow witnesses.

[Shaleen Jones]

Thanks, Jennifer.

The issue of access is so critical. It's one that I'm really passionate about. The work we've done here in Nova Scotia has been exactly on that. It's been looking at removing barriers to access to care for folks with eating disorders. What we found to be working in our province is having a suite of low-barrier, low-intensity programs consistent with the sub-care model. Locally, we offer text-based chats; Zoom chats; peer support programs, including one-on-one mentoring; groups led by professionals; groups led by peer supporters; and clinical support from therapists and dieticians. We find this works really well in connecting with folks where they're at. They may not be ready to access a therapist, but we want to catch them where they're at. When they reach out for help, we want them to know that support is available. There's no wait-list. It's immediately accessible. No diagnosis is required.

We have really tried to remove barriers. We've had so much success with this here in Nova Scotia that we're now rolling out this peer support program nationally. Folks from across Canada can access a variety of peer support programs for that immediate and highly accessible support. We can then help them access more accelerated treatment should they need that.

[Sarah Kennell]

I would build on my colleague's comments by adding consideration around the social determinants of health. That's recognizing that, in order for us to access care, we also need income supports, reliable and safe housing, and food security. That's just to add that, often, mental health concerns and problematic substance use intersect when we don't have those needs met. In addition to ensuring that we have access to care, it's about providing those supports alongside it.

[Leah Gazan, NDP, Winnipeg Centre, MB]

I'm happy to hear you say that. One of the things that I've pushed for is a guaranteed livable basic income, in addition to current and future government programs and support.

I've often said, especially around indigenous peoples and first nations communities, that we're often pathologized. When you don't provide proper housing, it's bad for mental health. When you don't have clean drinking water, it's bad for mental health. If you don't have a toilet, it's bad for mental health—

[The Chair, Conservative, Karen Vecchio]

We're done.

I have to watch Leah. She knows that with me, she can usually inch out another minute or two. We have to watch out.

We're now going to turn to our next round. We're going to do five minutes and five minutes, and then we'll go for two minutes and two minutes. We'll then come back for a question from Wayne Long and a final question from Michelle.

I'm going to pass it over to Anna.

Anna, you have the floor for five minutes.

[Anna Roberts, Conservative, King—Vaughan, ON]

Thank you, Madam Chair.

My first question is for Abrar.

We all know that the IRGC is a terrorist group. I attended a rally recently, where I met a young woman from Iran. I mistook her daughter for her sister. I was very appalled by her story. She finally escaped Iran and came here with her daughter. She was 12 years old when she was forced into marriage. Her daughter was 12 years old. We have this young woman, who is 24, with a 12-year-old daughter. She managed to escape and come to Canada, and she is still dealing with mental health issues from that whole process.

Would you say that the $4.5 billion that was promised could help when we talk about culture and culture-based situations? Would you say that money could help this mother and child, whom I mistook for sisters?

[Abrar Mechmechia]

Absolutely it would, especially if it's an early intervention, such as upon their arrival. We can, at least, prevent them from escalating and ending up in the ER. That's the first thing: direct support.

The other thing is to have more training on cultural competency and cultural sensitivity for other care providers, because they are working on a daily basis with this population and with these communities. Having that training to be.... For example, a while ago, we provided training for Kids Help Phone, to train their counsellors on how to work with newcomer youth through a cultural sensitivity lens. That was a great step. We want to see it happening more with other care providers.

[Anna Roberts, Conservative, King—Vaughan, ON]

Thank you for that.

I don't know if Jennifer or Tracie can help me with my next question.

Last December, with the help of our local communities, the youth corps decided to raise money for blankets, towels and equipment, and funds to go down to feed the homeless. This is a very shocking story, so I apologize up front to anyone who's going to be upset by my sharing this story with you. Although these types of events are rewarding, they're also very depressing. I came across a young boy who was 10 years old and living on the streets.

We talked about violence. Earlier, it was said that parents are the best resources for children. As much as I agree with that, I sometimes think that it's not always the case. This young boy was in several different foster homes and he kept escaping. The only way for him to survive was to sell drugs from the local drug dealer, so that he could afford the bare necessities of life. It was very sad for me to see that. He is addicted. He admitted it. He is addicted to the drugs of choice, but he had no choice.

How do we educate and help social workers to identify these situations, so that we don't continue to have 10-year-olds living on the street?

I don't know who wants to take that question.

[Dr. Tracie Afifi]

I can jump in really quickly.

Again, prevention of violence and adversity is key. If we could have prevented those early life experiences from happening, then this person may not have ended up trying to escape the foster care system.

Child welfare also requires huge reform in our country. It happens at the provincial level across our country. I do think we need a national approach to child welfare, because it is failing our children. Having better supports for social workers to be able to identify issues and support families to keep children intact with their families, supporting those families for better outcomes, is ideal. Really, we should think of foster care as the very last resort.

[Dr. Jennifer Coelho]

Maybe I can add to that. In the context of the past question, when I was referring to parents, I was referring to a question relating to mothers. In fact, family-based therapy considers all caregivers. That might be grandparents. That might be a strong individual in that person's life who is not a parent but is there as a support person. Family-based therapy can be effective with adults who are supporting a person but aren't necessarily a biological parent.

[The Chair, Conservative, Karen Vecchio]

Thank you.

I am just going to give Abrar a chance. I know she's been trying to answer this question.

[Abrar Mechmechia]

Since I work with lots of group homes, I wanted to add that, instead of just revisiting child welfare, we also need to listen to these kids. There is not much counselling and support in the school and also in the foster care homes. The first approach they take is medication. It's heartbreaking for children to be on medication for their mental disorders.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

I'm now going to turn it over, for the next five minutes, to Anita Vandenbeld.

Anita, you have the floor.

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

Thank you very much, Chair.

I have a couple of questions. My first question is for Ms. Kennell.

I'll pick up on something you said, and also on the fact that in all likelihood our recommendations from what we're studying here will inform the new Canada mental health transfer and how it should be structured in our negotiations with the provinces, which as you know are ongoing. You really focused on there already being transfers for acute care and that it really needs to be in the community.

You painted a very alarming picture of what happens to young girls navigating the system. They have to be “sick enough”. They present at emergency. They're treated, I think you said because of the toxic masculinity, as if they're attention-seeking, manipulative or overly dramatic, which we know is a gender stereotype. They're given medication and sent home, but there are no follow-ups. You mentioned some of the medication. There may be effects that might actually make their condition worse, but nobody is following up in terms of modifying that medication, especially if they don't have a family doctor. You're portraying a very alarming picture.

I would like a little bit more about that recommendation you made in terms of getting it out of acute care. We talked a lot in previous meetings about prevention. If the Canada mental health transfer is going to be focused on community care, how would you see that being structured? Also, how would that potentially interact with and benefit our other programs?

[Sarah Kennell]

Thank you very much for the question, Ms. Vandenbeld.

We know where the Canada health transfer goes. It goes from the federal coffers into provincial budgets, and it ultimately gets spent on services deemed medically necessary. Those are hospital-based care, psychiatrists who are in the community—but again, you need a referral to get to see a psychiatrist—and family doctors. We know, sadly, that family doctors don't have the time or the training to be delivering comprehensive mental health and substance use health supports.

We see opportunity with the Canada mental health transfer to direct resources into areas of the sector that have been underfunded yet, as we know, are so critically needed. It's those wraparound supports that help people transition out of hospital if they've been in crisis care through either an emergency department or a psychiatric ward. It's really about ensuring that they have the supports needed to advance along a recovery journey, whatever that looks like for them. It's not only the preventative upstream interventions that we see but also that long-term ongoing support for people dealing with mental illness and substance use health concerns throughout their life course. It's really about ensuring that people get the care they need, when they need it, wherever they are.

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

I appreciate that. We'll note that for our recommendations. Thank you.

All of you mentioned a bit about the impact on people on the front line, workers who are often women.

I want to direct a question to the Mental Health Commission. Recently you were in my riding. Out of our $50 million for PTSD frontline and essential workers due to the trauma from the pandemic, we were able to get some funding for frontline long-term care workers.

Generally, you were talking about particular programs like The Working Mind, where you can modify programs that can then be replicated across the country to help frontline and essential workers, who, as Ms. Kennel and others have mentioned, are leaving the industry because of the trauma of this kind of work. Can you elaborate on how that funding is having an impact? What would you recommend going forward?

[Dr. Mary Bartram]

There are two prongs to this.

One is better support for the mental health of the health workforce, including PSWs and people who work in long-term care, and the importance of attending to moral injury and psychological support for the comprehensive health workforce.

Second, we need to pay attention to the mental health and substance use health workforce in and of itself to make sure that the critical role it has to play in improving access to high-quality care isn't overlooked in the very important focus on the mental health of the broader health workforce.

They are both very important. We can't improve equitable access to mental health services unless we have more people trained and able to provide those. That's where the need for that comprehensive mental health workforce strategy is so important.