Status of Women Committee on Oct. 27th, 2022

[The Chair, Conservative, Karen Vecchio]

Welcome to meeting number 35 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. 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, you can click on the microphone icon to activate your mike. Please mute yourself when you are not speaking. For those on Zoom, for interpretation, you have the choice at the bottom of your screen of floor, English or French. Those in the room can use the earpiece and select the desired channel.

I remind you that all comments should be addressed through the chair. If members in the room wish to speak, please raise a hand. For members on Zoom, please use the “raise hand” function. The clerk and I will manage the speaking order as best we can, and we appreciate your patience and understanding in this regard.

In accordance with our routine motion, I am informing the committee that all witnesses have completed the required connection tests in advance of the meeting. As we noted, anybody taking part in the meeting must have one of the headsets. Thank you so much.

We are doing a very difficult study, so I'm going to remind everybody.... Before we welcome our witnesses, I would like to provide this trigger warning: This will be a difficult study. We will be discussing experiences related to mental health. This may be triggering to viewers, members or staff who have similar experiences. If you feel distressed or need help, please advise the clerk.

I would now like to welcome our witnesses for today. Everybody is on Zoom today.

From Achēv, we have Karen McNeil, senior vice-president, programs and services, and Tania Amaral, director, women, employment and newcomer services. Appearing as an individual today we have Dr. Rakesh Jetly, who is a psychiatrist. From the Northern Ontario School of Medicine University, we have Dr. Diane Whitney, assistant dean, resident affairs and Dr. Peter Ajueze, who is an assistant professor and a general child and adolescent psychiatrist, Health Sciences North, Sudbury. From Regroupement des ressources alternatives en santé mentale du Québec, we have Anne-Marie Boucher, head of communications and co-coordinator of socio-political action.

We'll provide each group with five minutes for opening comments. I'll be interrupting, usually within the first few seconds, if it goes over.

Today, as you know, we started late. We will be extending a bit, but we'll be playing it by ear, as a committee, as we go through. I hope some of you will be able to stay with us a bit after 5:30. Thank you so much.

I'm now going to turn it over to Karen and Tania for five minutes, for their organization's opening remarks.

The floor is yours.

[Karen McNeil, Senior Vice-President, Programs and Services, Achēv]

Good afternoon. Thank you for the opportunity to speak today.

My name is Karen McNeil. I'm the senior vice-president of programs and services at Achēv. I'm joined by my colleague Tania Amaral, director of women, employment and newcomer services. She has some intimate program knowledge.

For more than 30 years, Achēv has provided free services to Canadians and newcomers to Canada. Today we're one of the largest non-profit providers of employment, newcomer, language, youth and women's services across the GTA, with programming across Canada. Each year, more than 50,000 women and girls access Achēv's services in person, virtually or through a hybrid format. Our approach recognizes the unique barriers women face in securing employment, settling in a new community and building the networks they need to thrive.

Today we'd like to speak about immigrant women and girls, who represent almost half of our women clients. It's estimated that by 2031, one-third of the Canadian female population will be immigrants. We know that immigrant and racialized women in Canada face numerous barriers to meaningful employment. These barriers have been exacerbated by the pandemic, and include a lack of work-related networks, family caregiving responsibilities, sometimes language barriers and gendered or racial discrimination. Even when women immigrants are employed, they're more likely to be underemployed, work part time or in precarious employment situations, and be poorly paid compared with their Canadian-born counterparts. This has a significant impact on these women's everyday lives and their mental health.

Our clients experience many challenges when they move to Canada. Newcomer women in particular often face multiple stressors on their mental health and well-being. They often have the primary responsibility for establishing a new home, getting their kids into school, caring for elderly parents and finding a job. It's really not easy. Many are socially and linguistically isolated, and lack self-esteem and financial security. We've also seen the unique struggles that international students are facing. These include young women living far from home, some with enormous pressure to succeed, facing loneliness and limited financial resources and supports.

Every woman brings her own story of her personal struggle, and I'd like to share one with you today. Priya is a single mother. She obtained a master's degree in economics from her home country, but was working as a cashier at Walmart. Priya was stressed, tired and worried about how she would be able to handle her life and parenting. She couldn't leave her survival job, because that was the only source of income for her family. She was heavily depressed due to this dilemma. Her employment coach at Achēv was able to share a lot of resources and connect her with a woman's wellness program offered by a community partner. This enabled Priya to receive the support needed to improve her well-being and successfully secure a new and better-paying job where she felt respected.

One of the biggest issues we've seen in addressing the mental health needs of newcomer women and girls is the stigma around mental illness in their communities. In some cultures, mental health-related issues are highly stigmatized. As a result, sometimes it's difficult for them to acknowledge that they're dealing with mental disorders and should seek help. This leads to longer-term suffering. We've heard from some young women that, even when they've gathered the courage to tell their parents that they're struggling mentally and need help, they often don't know where to turn.

This is why we believe that integrating more mental health supports into newcomer, settlement, language and employment programs are critical to address the stigma and provide culturally appropriate intervention. More awareness of mental health with our newcomer communities will help women and girls access the supports they need, bridge the generational gap and encourage family conversations.

We're proud of the mental health wraparound support that we're able to provide women in some of our programs, including inviting mental health service providers into our workshop sessions, incorporating self-care practices into programs and sharing open resources, but these programs are not enough. We recommend more multi-year government-funded opportunities for community-based organizations like Achēv to include these wraparound supports for every woman or girl who needs them. We've seen first-hand the power that sharing real lived experiences and creating safe spaces to discuss mental health has had on the betterment of our newcomer women clients.

Thank you for the opportunity to share our insights today. We look forward to answering any questions you might have.

[The Chair, Conservative, Karen Vecchio]

Thank you very much.

I'll now turn the floor over to Dr. Jetly for five minutes.

Dr. Jetly, you have the floor.

[Dr. Rakesh Jetly, Psychiatrist, As an Individual]

Thank you, Madam Chair.

In my opening comments, I would like to share my thoughts on several topics, including mood and anxiety difficulties in girls and young women, the challenges of being a young woman today and a little about substance use, as well as my concerns regarding psychiatric research and knowledge translation.

Many have discussed the epidemic of mood and anxiety, particularly in young people, attributed to the COVID-19 pandemic. However, as a psychiatrist, and as evidenced by some of the testimony you've already heard, I feel that youth mental health has been a significant issue for many years.

Several times a month a colleague reaches out for help because of mental health needs within the family. I noticed very quickly that, about 90% of the time, it was a case of a daughter or a niece with anxiety difficulties. This is not a study but rather my own experience. It is particularly concerning when a 16-year-old often faces an 18-month wait to see a psychiatrist. Recently, I've been asked to help care for a young woman sexually assaulted after being slipped a hypnotic during a university social event.

There's an interesting double-edged aspect regarding psychological difficulties in young people. Never have we had a generation with such a positive attitude towards mental health and help seeking. Our generation struggled with stigma. Programs such as the military's road to mental readiness and Bell Let's Talk helped destigmatize and to some extent normalize mental health and help seeking.

This generation of young people does not need encouragement to talk. They have spoken and feel much less shame in raising their hands. While this is an encouraging societal trend, it results in even greater need overall in the system and a worsening need-care gap. Vast numbers of young women and girls acknowledge not feeling right but are unable to have timely access to evidence-based care.

My second general observation is the amplification of peer pressure, bullying and so on that social media allows. There are undeniable pluses to social media platforms. They have allowed us to stay connected, celebrate birthdays and even attend funerals during the lockdowns and the pandemic. However, there are also studies suggesting that, for some young women and girls, social media can make individuals feel more isolated and exacerbate mental health conditions such as depression and anxiety. There's a suggestion that some aspects of social media may increase the sense of inadequacy about one's life or appearance.

Online bullying also, to some extent, is traditional bullying on steroids. Depending on the study one reads, about 40% of young people under 19 years of age report being the victim of bullying online. Interestingly, girls are most likely, in most studies, to be both victims and perpetrators of cyber-bullying. Victims of cyber-bullying are at increased risk of both self-harm and suicidal behaviours. Most who witness cyber-bullying do not intervene, and perhaps only one in 10 report the bullying to a trusted adult.

I also wish to switch and just briefly address recreational and social use of substances. Clearly, the opiate crisis warrants attention, and young people are not spared. However, we also need to address the most common substances abused by young women and girls, namely alcohol, cannabis and tobacco.

We can educate regarding alcohol's potential harms, but it may also help women to understand how we can separate having a drink with friends celebrating a birthday from drinking alone when feeling sad, lonely or anxious. The effects of alcohol on cognition, consent and capacity must also be ingrained.

As a society, Canada has done a great job educating our youth about the risks and harms of tobacco, and a consistent downwards trend of smoking tobacco continues among our youth, including girls. However, cannabis use among young Canadians finds our youth—depending on the study again—typically as the number one, two or three consumers in the world. While decriminalization, legalization and medical use of cannabis increases worldwide, we require a study with respect to the health of girls and young women.

There are many active ingredients within cannabis, some which can aggravate mood and anxiety and even cause psychosis. We have learned some important lessons from smoking tobacco and its impact on one's health, respiratory and otherwise. However, according to some sources, about half of the cannabis used in Canada is smoked.

There is confusion and blurring between medical use and recreational use. I will not discuss the limited evidence supporting the medical use of cannabis, although I encourage the ongoing high-quality studies that need to be done. I do, however, feel that recreational and medical use of the same substance creates an attitude that sometimes this naturally occurring plant is either good for you or at least not harmful.

My final point is—

[The Chair, Conservative, Karen Vecchio]

Dr. Jetly, I'm going to give you about 20 seconds to finish. I know that you have a few more paragraphs. Go for it.

[Dr. Rakesh Jetly]

My last point, really, is on research specifically looking at women and young girls. Quite often, I've sat at the table myself. Sometimes it's complicated because of biological differences between men and women. We have often stuck to right-handed males who are relatively healthy and then we're forced to knowledge-translate that to women, so there are some concerns about the studies. Even if we ask for the gender, do we actually analyze the studies based on gender? We just use excuses like “the sample size is too small”.

I'll stop there. Thank you.

[The Chair, Conservative, Karen Vecchio]

Thank you so much. I really appreciate that.

I now will move it over to the Northern Ontario School of Medicine and Dr. Diane Whitney and Dr. Ajueze.

You have five minutes.

[Dr. Diane Whitney, Assistant Dean, Resident Affairs, Northern Ontario School of Medicine University]

I'll start by saying that I'm a community-based psychiatrist in Thunder Bay, and I treat depression, anxiety and trauma. My practice is 80% women. My colleague is a child psychiatrist in Sudbury, so we bring some different perspectives.

First of all, I'll talk about the north. Individuals in northern Ontario typically have poor mental health and, in urban areas, higher rates of depression and twice the rate of hospitalization, usually for suicidal concerns, in a very fragmented mental health system—if there is one.

I'm always amazed by how far my patients will travel to get care. It has changed somewhat with COVID, but it hasn't cured everything. I have a lady who comes from a small reserve. Depending on which season it is, she takes either a boat or a ski-doo to the train, which is often six to 10 hours late, and then a van to get into Thunder Bay. Things have improved for her with the different accesses with COVID, but not all of the remote communities have Internet access.

If we move specifically to women, certainly intimate partner violence is a significant issue and is at a higher rate in northern communities and smaller communities, as are issues around transportation and emergency housing. The lady I just mentioned was assaulted by her partner, who was intoxicated, and she held him down until he passed out. It took five days for the police to get to the reserve to take the report—five days. It's a small isolated community of 30 people, just so you know.

On their experience of violence and abuse, there's such a high rate of trauma in the population in general, but in the north it's estimated that 78% have a history of child and/or adulthood trauma, and 16% develop PTSD leading to suicide and self-harming behaviour. We could talk for hours about that. Also, in our indigenous population, we see high rates of depression, with much higher rates of psychological distress, suicidal ideation and suicide attempts compared with men.

Finally, there's the impact of COVID. There have been some benefits, but certainly there have been disadvantages, and there has been disconnection as well. I was seeing one of my patients remotely through what's called the Ontario tele-video network, and what happened in the community was that the office she was using to see me virtually was taken over as a COVID testing centre, so then I had to revert to the phone.

The challenges have been many. I'm going to turn it over to my colleague. He has a few comments about eating disorders, which are a challenge to treat in the north.

[Dr. Peter Ajueze, General, Child and Adolescent Psychiatrist, Health Sciences North, Sudbury, and Assistant Professor, Northern Ontario School of Medicine University]

Thank you, Dr. Whitney and Madam Chair.

I have been the consulting psychiatrist of the eating disorder program in the north for the past 10 years, since I immigrated to Canada from the Republic of Ireland.

There are four key points that I want to bring up to the committee. First is the increasing number of hospitalizations that we've seen in the north around eating disorders. Second is that we have absolutely no in-patient eating disorder treatment facility in northern Ontario. Third is the increasing comorbidities and mortalities with regard to eating disorders, and fourth is the lack of adequate training of health care professionals in eating disorders.

I will briefly give a specific case of a patient I had who had a BMI of less than 10. To provide context, BMI stands for body mass index, for those who may not be familiar with it. The normal BMI is between 18.5 and 25. For extreme anorexia, we're talking about a BMI of less than 15. This young lady had a BMI of less than 10, which is almost not compatible with life. For such a person, you would think that it's going to be an emergency and a referral down south, but because of the lack of available beds.... There was no bed anywhere, irrespective of the fact that her BMI was less than 10. She ended up in the ICU twice with refeeding syndrome and almost died. Luckily, we were able to keep her in the hospital. She stayed in the hospital for a long time, six to eight months, and luckily she recovered.

Since COVID, we're definitely increasing in number. Again, to provide context, between 2017 and 2018, the number of hospitalizations of females was about 1%. During the peak of COVID in 2021, it rose to 3.2%. As we speak now, as of July, the percentage has gone up to 4.3%. We have people waiting to be transferred to the United States.

I'm going to stop at this point. I know there are probably going to be a lot of questions with regard to eating disorders.

I have also seen, during the course of my research, that there has been a big focus on eating disorders on the part of this committee

Thank you for this opportunity.

[The Chair, Conservative, Karen Vecchio]

Thank you very much.

For our last witness, I'm going to turn the floor over to Anne-Marie Boucher.

Anne-Marie, you have the floor for five minutes.

[Anne-Marie Boucher, Co-coordinator and Head, Communications and Socio-Political Action, Regroupement des ressources alternatives en santé mentale du Québec]

Good afternoon. I would like to thank the committee for inviting me to take part in its study.

The Regroupement des ressources alternatives en santé mentale du Québec represents some 100 Quebec community groups. The fact that those groups operate independently in carrying out their missions has enabled them to adjust quickly and effectively to circumstances during the pandemic and to provide high-quality support despite the health restrictions that were put in place.

The historical underfunding of these groups in Quebec is a proven fact that increasingly restricts our ability to recruit and retain personnel, thus restricting our ability to carry out our missions. Many of our groups plan projects that are designed for young adults.

Today I would like to outline some of our concerns regarding the mental health of young women and girls, who are still more likely to suffer family violence and assaults and to be economically dependent.

We can't discuss the mental health of women and girls without considering their living conditions as they relate to their ability to exercise the right to the best possible mental and physical health. This involves the fight against poverty, violence prevention and access to a diverse range of mental health resources and services.

In the context of the pandemic and associated social isolation and disruptions in the education and employment sectors, family conflicts and insecurity have exacerbated the psychological distress of many individuals, including young people. A study conducted by the Université de Sherbrooke in the summer of 2020 revealed that both male and female adolescents were experiencing twice as much severe psychological distress as before the pandemic.

According to another survey conducted in March of this year on the psychological health of persons 12 to 25 years of age, 25% of youths attending a secondary or vocational school perceive their mental health as average or poor. That percentage is even higher at the post-secondary level. Furthermore, girls and persons who identify as neither male nor female were much more likely to report poorer mental health.

This general increase in the incidence of negative feelings in young people coincides with more restricted access to public mental health services, particularly in Quebec. According to many reports that we receive, young people find it hard to access support quickly even in a crisis.

In this context, doctors have no choice but to rely on medication to address their symptoms, since they can't attack the causes of individuals' living circumstances. Consequently, there has been an increase in the use of psychotropic drugs since the pandemic began

This increase has been particularly pronounced among young girls. In March 2021, Le Devoir published an article stating that, according to data from Quebec's health insurance plan, antidepressant use had grown sharply among girls under 18 years of age, with numbers rising 15% since the start of the previous school year. Furthermore, by September 2020, the number of girls in that age group using antidepressants had increased 11% since the same month in 2019.

There has also been a similar rise in the incidence of attention deficit disorder, or ADD, and attention deficit hyperactivity disorder, ADHD, as well as in the number of prescriptions written to treat those conditions. The largest quantities of psychostimulants have been prescribed in Quebec

Mental health experts are concerned about the growing use of psychotropic drugs without psychosocial services that are respective of patients' rights being readily accessible in all communities. The Mouvement Jeunes et santé mentale, to name just one citizen movement, has been demanding since 2016 that a parliamentary committee be struck on the medicalization of the issues young people are experiencing and that psychosocial services be made available. The latter demand has also come from the Quebec organization Force jeunesse, which released a study calling for such services this past summer.

In short, we need to avoid medicalizing the impact of the health crisis and to provide upstream assistance with people's living conditions.

Which brings me to a few courses of action that we propose.

We believe authorities must exercise caution with regard to the medicalization of the stress responses to health crises and the impact of experienced violence. In one documented example, a large number of young women suffering from borderline personality disorder, or BPD, were assaulted and subjected to sexual violence. According to an English study, women are seven times more likely to be diagnosed with this condition than men presenting with the same symptoms. We also know that 81% of individuals diagnosed with BPD reported that they had experienced trauma in their lives.

Individuals who have experienced violence or trauma currently receive diagnoses that can help them but that may also stigmatize them, which may divert attention from the actual problems or trauma experienced and focus it on the individuals' symptoms.

In short, people must have access to mental health services even if they have not been diagnosed, and authorities must introduce approaches that are sensitive to trauma, something that few public services provide. Solutions other than medication must also be made available, along with support in reducing, and withdrawing from, the use of drugs.

We believe there is an urgent need to to consider providing support for deprescription in mental health cases, particularly support in withdrawing from antidepressants. Numerous initiatives are under way in England to ensure better documentation of dependence and the effects of withdrawal from psychotropic drugs. I am thinking in particular of the work that Public Health England and the All Party Parliamentary Group for Prescribed Drug Dependence are doing on the effects of medication use and the importance of withdrawal management and support. We believe that Canada would do well to draw on those efforts.

Lastly, we realize how important it is to increase federal health transfers in accordance with provincial jurisdictions. We urgently need those transfers to be increased and granted to the provinces unconditionally so they can take prompt action on mental health issues. We are currently experiencing a crisis in access to care. Improving access to services and investing in the social determinants of health, poverty and housing will change everything.

Thank you.

[The Chair, Conservative, Karen Vecchio]

Perfect. Thank you so much.

I'll just let all the members of the committee know that, looking at the fact that we have had a time change, we are taking our committee business, which we were supposed to do today, and postponing it until Monday so that we can have time with our witnesses instead.

We will now begin our first round of six minutes.

I'll pass the floor over to Michelle Ferreri.

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

Thank you, Madam Chair.

Thank you to all of our witnesses. That was powerful testimony as we delve into this study looking at mental health in young women and how we close these gaps.

It's very nice to see my friend Dr. Rakesh Jetly as a witness here.

Rakesh, it's great to see you here. I know that you have a wealth of knowledge that can really help this committee and help the federal government make better policy decisions to help our youth with mental health.

Dr. Jetly, you've talked about this, and you addressed it in your testimony. We have this great movement where our youth are more comfortable asking for help. We've done a lot of work on the stigma, and it's paid off. But when they go to get help, there is nothing there. The resources aren't there. What's your suggestion on how we close the health equity gap?

[Dr. Rakesh Jetly]

Thank you very much for the question. It's a huge question.

My colleague just mentioned what is not the answer—that is, to continue to prescribe medication without psychotherapy and without counselling, and to just give these kids some stimulants and antidepressants. That's probably not the answer.

Realistically, I think we have to reconsider how we provide care. That's something we've struggled with over the years. The idea that every single person who has psychological difficulties or difficulty fitting in will have access to one-on-one psychotherapy, once a week, for one hour, for six months or eight months, probably isn't realistic, even if it was ordered. I think leveraging technology is one of the ways to do it, as is developing group-based therapies. Different kinds of platforms have been developed, such as cognitive behaviour therapy for insomnia, where one clinician can be magnified and see 12 people an hour instead of one. I believe it's multimodal. I think it's education and resources and more programs.

Clearly, the very ill, such as those with eating disorders, will need hospital beds and things, but I think, with that general wave of mood and anxiety that we're seeing, people are going to walk-in clinics or seeing their family doctors, getting prescribed meds and not really getting help.

That's not a great answer, but I think we need to rethink how we structure access and really get away from the traditional model of this one-on-one psychotherapy for everybody.

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

Thank you for that, Dr. Jetly.

We know that we have a labour crisis across this country. Frontline workers like you—psychiatrists, psychotherapists, counsellors, doctors—are not immune to this labour crisis. They're not immune to the burnout. The demand is so high for people needing help. We see these increased rises of depression and anxiety. We need more access to counselling.

How do we protect you, the frontline workers, from burnout? How do we close that gap and meet the demands of those asking for help but also protect frontline workers?

[Dr. Rakesh Jetly]

I think those are incredibly difficult questions as well. We have colleagues who are working 60- to 70-hour weeks, working until 10 o'clock with a patient in crisis. Most of us who are in practice don't turn our phones off, which we probably should. We're trying to balance the work and what we know about burnout and depression in our own professional lives and provide the care.

In terms of boosting the care available, I really believe in leveraging technology and having team-based approaches to care. Too often the burden is on one clinician, which probably isn't a great thing. I am a firm believer in team-based approaches and the efficiency of finding the right professional for the right person when there is time.

Clearly, we need to educate and protect our frontline workers, be they mental health or otherwise health workers, but that won't necessarily address the gap. The gap has to be addressed with probably an increase in funding, but then finding an efficient way to use that funding, not just continuing to throw resources at a problem that is struggling.

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

Thank you, Dr. Jetly.

I see one of our witnesses has their hand up.

[The Chair, Conservative, Karen Vecchio]

Peter, did you want to add on to that question? Is that what it was?

[Dr. Peter Ajueze]

Yes, Madam Chair, I don't know if I just have a minute. There was this point about the burnout. I found this question very interesting, because I think lots of health care professionals, including me, may have experienced some level of burnout in the past few years.

I've thought about this quite a lot. I was listening to Dr. Jetly when he talked about our not turning our phones off, which is what most people do. I just came back from vacation and every time I'm on vacation, I find my phone is constantly on...especially from colleagues whose kids I'm looking after. I find it causes a lot of stress. It's easy to turn off your notifications for emails when you're going to be away, but when it comes to phones you can't do that.

I think we should really start talking to medical students, because there are lots of mistakes that we made that are hard to undo now when it comes to boundaries. For me, the big message is boundaries and learning from the onset about protecting one's boundaries and being mindful about those. For a lot of us, especially when I started, we were saying, “Okay, health care providers, you do anything to support your other colleagues,” but when there are no boundaries, then we find it has that a domino effect, and we end up burning out. It's hard to now tell the same people, “Please, don't do this at this time.”

I think at this point that could be one of the things that we could look at with our medical students. When they start, they shouldn't make some of the mistakes we made.

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

Perfect—

[The Chair, Conservative, Karen Vecchio]

Michelle, we'll get back to you for another round. Thank you so much.

Anita, you have the floor for six minutes.

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

Thank you very much, and thank you to all of our witnesses.

My first couple of questions are for Ms. McNeil, specifically around newcomers and immigrants. One of the things that you mentioned is that there are various different stressors on immigrant women, some of them relating to things that they went through before they came to Canada. We know that in many parts of the world where there's conflict or war, immigrant women, when they were in their home countries, were subject to rape as a weapon of war.

This sometimes doesn't come out until decades later when they then start to talk about it for the first time, but at that point, they're here in Canada.

Is this something you've seen in your practice? If so, what kinds of supports might be available for those women, given that's an experience that not many practitioners in Canada would have experience with or necessarily know how to handle those kinds of disclosures?

[Karen McNeil]

I'd like to pass that over to Tania, if that's okay.

[Tania Amaral, Director, Women, Employment and Newcomer Services, Achēv]

Thank you, Karen.

That's such a great question. As an organization that provides services to women with respect to employment, settlement and language services, it's something that typically does not get disclosed, because there is, as mentioned in Karen's opening remarks, this strong stigma around.... They don't even know how to label what they are feeling. It doesn't get disclosed, because they don't even know how to talk about it. It's something that is to be kept hidden. There is intense shame that comes with that. It's not even considered a priority. When they come to us with employment needs or language needs, all of that is just suppressed and is typically not disclosed unless there is a strong rapport built between the client and their respective counsellor, coach or employment coach.

That's why at Achēv we try very hard to instill the idea of wellness as beyond physical. That is an important aspect of your life and touches every aspect of your life. If you want to be successful integrating into the workforce, you have to look at that piece. Oftentimes it is not disclosed, and because we are not mental health service providers ourselves and not experts in that arena, unfortunately, we rely on informed referrals for these women who might be in those situations.

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

Thank you. That might be an area of further study for our committee.

The other question I have for you is around international students. You mentioned isolation, and I imagine during COVID-19 this was probably even worse because of the limitations on travel.

I know that sometimes international students don't have access to the same kinds of counselling services that other students do. Do you see that as a gap? What would you suggest we do about that?