Status of Women Committee on Oct. 27th, 2022

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

Interesting, thank you. There's lots of information to dissect there.

I hope to get two more questions in here.

I'm going to direct this again to you, Dr. Jetly.

A UNICEF report came out in 2020. It is really shocking and upsetting that Canada ranked 35th out of 38 in top “rich countries”—their definition—on their report card of rates of teen suicide. Why do you think we are getting so much worse when we're supposed to be this great country?

[Dr. Rakesh Jetly]

I think it goes back to the whole holistic society thing—well-being, social supports, the connectedness or disconnectedness of a society. From a treatment perspective, when we have a lack of access to care, a lot of times it's social things, but there are kids who become depressed, who become psychotic.

It's abysmal. In my city, Ottawa, it's a year-and-a-half wait for a psychiatrist for a teenager. I have kids that age. A year and a half is a lifetime at that age.

I just think that, again, it's that need-care gap. They'll go to the emergency room time and time again, and eventually they'll complete suicide. I think it's the whole thing, from societal things.... We talked about bullying. We talked about these things—a safe place where there is help and care by paraprofessionals—but that acute suicidality needs urgent psychiatric care sometimes, and we really don't have that.

We can talk all about universal health care if we want, but the reality is that it's abysmal how long kids have to wait. That's why my colleagues are phoning and asking me for help all the time.

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

It's true. Those are staggering statistics, and you said it really well. The other thing you said that I thought was really powerful was that social media is “traditional bullying on steroids”.

I have barely any time left. I'm going to direct this to Dr. Peter Ajueze.

I'm curious if there's data or research to say that an eating disorder is a symptom of trauma.

[Dr. Peter Ajueze]

There are definitely connections between eating disorders and trauma. Specifically, I know eating disorders are a big umbrella term. You have anorexia. You have bulimia. You have binge-eating disorder. You have avoidant/restrictive food intake disorder—

[Dr. Diane Whitney]

I'm going to help you out here, Peter.

I'd say, yes, most patients with eating disorders have a history of trauma. It's not all, but sort of like the numbers for borderline personality disorder: You're talking about 80% to 90%.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

I know that all of you have so much more information in your heads, so let's get in as many questions as we can.

We are going to Marc Serré for five minutes.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you, Madam Chair.

I want to thank all the witnesses very much. I would have liked to have more than five minutes' speaking time to ask each of them questions.

In the case of Dr. Ajueze and Dr. Whitney, it is important to put things in context. These two witnesses are talking about northern Ontario. However, Dr. Whitney is in Thunder Bay and Dr. Ajueze is in Sudbury, two cities that are 11 hours apart by road. The extent to which Canada is rural is remarkable. These two doctors cover nearly 90 per cent of the province of Ontario, where approximately 115 First Nations live and where the delivery of services is nowhere near comparable to what happens in Toronto or in the other major urban centres.

My question is for both of you. Specifically, we're looking at $4.5 billion to negotiate with the provinces. Yes, the federal government has a role to play with the provinces, but I wanted to get your sense of this.

When we look at the lack of training and the lack of professionals, and at innovation and obviously the video conferencing that you're utilizing, what can you recommend to the federal government for us to be negotiating on with the province to ensure we have the supports needed in terms of the massive gap that you have to deal with? Dr. Whitney talked about bereavement leave. It's just very difficult.

I'll start with you, Dr. Whitney, on recommendations to the federal government, and then Dr. Ajueze could chime in.

[Dr. Diane Whitney]

One is supporting infrastructure, including Internet access. Outside of Thunder Bay and Sudbury, it's not that easily available. That's number one.

I actually have a paper here if somebody wants it. It's from the Ontario Medical Association students who have solutions, including covering counselling for everyone—counselling that's universally covered or OHIP-covered, whatever you want to call it—so that people have access to proper counselling.

On a positive note, having been the former program director for the psychiatry residency program at NOSM, I will say that we've now graduated eight residents, two of whom are indigenous and practising in the north. Out of those eight residents, six are practising in the north, and one of them is living in northern Toronto but does all her work remotely.

Last is to support the medical school. We're trying to do some really unique things, I think, and we often attract people who finish medical school and who are from the north, and those are the people who are staying in the north—

[Marc Serré, Liberal, Nickel Belt, ON]

Okay. I have just two minutes left. I'm sorry, Dr. Whitney. I know you have a lot more to say, but I'm trying to get the time in.

Go ahead, Dr. Ajueze.

[Dr. Peter Ajueze]

Thank you to the honourable member.

There's one thing I wanted to add, because you rightly said that the vast area in the north.... From my experience working in England and in Ireland, they have a different model for mental health. Let's say that you had four psychiatrists looking after a community; that community would be divided into those sections, and each psychiatrist would have a multidisciplinary team of social workers and nurses. It is easier to track and to follow up with patients with difficulties.

I feel that because of the uniqueness of the north, this could be considered, whereby with those models we would have teams of health care professionals looking at certain areas and making sure that we don't miss any areas. Yes, it's good to have Zoom and virtual care, but that is not adequate. It's not the same. I see that when I come to it in person versus when I do Zoom.

We have so many doctors from the United States and from down south who are able to provide these Zoom services and prescribe medication, but I think we need more. We need teams and people who know the community and can follow patients and be able to.... I think that would be better care.

Thank you.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you.

I think I have 30 seconds left, and I wanted to mention the Northern Ontario School of Medicine and thank you for what you do. Since 2005, you've added 838 medical professionals; 65 doctors are indigenous and 171 are francophones. I know you mentioned infrastructure, so I wanted to look at what better.... I know that the federal government has been supporting it since 2005.

Maybe on a last note, as I know the chair is looking at me right now, on a personal note, there's something that I haven't said in 20 years or I haven't said to anybody. I just wanted to personally thank you, Dr. Ajueze, for the support you provided me over two years, many moons ago, and I just wanted to thank you for what you do for people across northern Ontario and across the country. Thank you for choosing Canada.

[Dr. Peter Ajueze]

Thank you, sir.

[The Chair, Conservative, Karen Vecchio]

Thank you very much, and thank you, Marc.

The time to get that opportunity to say thanks is sometimes when you have to do it, and I appreciate that.

I've messed around with the schedule—sorry about this, everybody—for Andréanne and Leah. I love it when the clerk looks at me and thinks, “What are you up to, Karen?”

I'm going to go with six-minute rounds to provide you with extra time. Instead of going back into a round and having to cut you off, we'll continue with six minutes. For Anna, it will be four minutes; for Jenna, four minutes; and for Emmanuella, four minutes. As chair, could I have three or four minutes to ask some questions? Is everybody good with that? Okay, fantastic.

I'm going to pass it over to Andréanne, for six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Madam Chair.

I want to thank the witnesses again for being here today.

Ms. Boucher, you talked about the question of social determinants in your remarks and you mentioned that when I asked my questions. What I understand from your testimony is that your groups need financial support. The question of transfers is therefore important, particularly for the workforce, to offer better pay for the people who staff your organization. I also understand that more investment has to be made in social housing, a field in which the federal government can also do something and one that we can look into.

I also wanted to talk about the issue of violence against women. My reason is that the Government of Quebec has published a very interesting report on combatting sexual violence and spousal violence, "Rebuilding Trust", which contains a number of recommendations.

At the end of last week, on Sunday, a demonstration took place to denounce spousal violence and the fact that men whose sentences are under the federal government's jurisdiction do not get the same treatment as men whose sentences are under Quebec's jurisdiction, particularly with regard to the notorious electronic bracelet question. When it comes to all these safety issues, the federal government needs to align its strategies to combat violence against women with Quebec's and prevent one of the social determinants that has consequences for women's mental health.

[Anne-Marie Boucher]

Excuse me, but what aspect did your question address, exactly?

[Andréanne Larouche, Bloc, Shefford, QC]

You work with community groups and you raised the issue of violence against women and the fact that the federal government should align its strategies with Quebec's recommendations.

One possible solution would be to align the programs to combat violence against women so that both levels of government are working together on that issue. How could that collaboration help to solve this mental health issue?

[Anne-Marie Boucher]

We think it is obvious that there has to be support for the actions taken by community groups, particularly regarding mental health, but also the activities of women's groups, violence intervention groups, and groups that support men who commit spousal violence. Those grassroots groups need support.

Obviously, what Quebec does has to be aligned with what the federal government does, to provide these groups with financial support so they are able to carry out prevention actions and support people who are experiencing problems.

[Andréanne Larouche, Bloc, Shefford, QC]

Briefly, regarding the last concerns you mentioned, specifically medicalization and cessation support, what do you expect from the federal government in that regard?

[Anne-Marie Boucher]

We believe the federal government could study the questions of prescription drug dependence and cessation support. It could do a Canada-wide study to see what is happening in terms of practices. It could make recommendations so that when a medication is prescribed, people receive the right information and health professionals are able to support them when they want to reduce or change the dose of their medication, or even stop using it.

These are the issues that we think need to be addressed. Health spending includes the cost of prescription drugs. We have to take a look at those costs to see whether everything being prescribed is always necessary, which is not always the case. However, cessation is really a hard road to take, and that means that the medication may stay in the pill box for a long time, even if the person no longer wants to take it.

[Andréanne Larouche, Bloc, Shefford, QC]

You're talking here about research at Health Canada.

Thank you, Ms. Boucher.

Dr. Jetly, you talked a lot about bullying on social networks and the fact that those networks are leading to an increase in feelings of isolation and an increase in online harassment, including cyber bullying. During the pandemic, that entire issue was exacerbated, and this has had consequences for women's and girls' mental health and self-image.

Could a law to combat this online hate help to moderate hateful comments and reduce the burden that this phenomenon places on women's and girls' mental health?

[Dr. Rakesh Jetly]

I believe so. I don't have the answer for it, but I do believe it exacerbates the anxiety. It exacerbates, sometimes, the loneliness and isolation. For example, when some of us were growing up.... If I did something embarrassing in class, seven or eight people who saw it might laugh at me and make me a bit embarrassed, but now, by the time I get home, it could be uploaded and everybody in my class, my school, and my town could see it. That might affect me in not going to school. My parents would take me to the doctor and wonder what's wrong with me.

I think there are lots and lots of positives with social media—don't get me wrong at all—but I do think it's very double-edged. It may involve helping young girls and women to separate the fantasy that is social media. I have daughters exactly that age, and every kid at that age wants to be a Kardashian and wants to be famous. That's the world they live in, unfortunately.

I do believe it's a problem. I do believe there are many benefits from it. If you are away, you can speak to your loved ones halfway across the world, so that's fantastic. You can also tease and bother them. I do think that some education.... If only they could feel comfortable going to an adult, for example, and saying, “This is difficult.”

[Andréanne Larouche, Bloc, Shefford, QC]

Dr. Jetly, apart from the field of education, how could a federal law tackle hate speech? As we can see, social networks are no longer this famous safe space that everyone talks about. The opposite is true: it is now a place of bullying, threats and violence.

A law designed to reduce, combat, and control the hateful comments a bit better is an initiative we could take, as elected federal representatives.

[The Chair, Conservative, Karen Vecchio]

I will allow a 15-second response, Dr. Jetly.

[Dr. Rakesh Jetly]

Absolutely. I'm stepping out of my expertise. I'm not a lawyer, but, absolutely. If we're encouraging.... If it's hate speech, we have legislation. Maybe some of this needs to be expanded to cover platforms, so that we keep up with the technology.

[The Chair, Conservative, Karen Vecchio]

Perfect. Thank you so much.

I'm now going to turn it over to Leah, for six minutes.