Status of Women Committee on Oct. 27th, 2022

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much, Chair.

I want to talk about call for justice 3.4. One of the problems I asked about was systemic racism. I want to expand on that, because one of the things that were shared earlier by Dr. Ajueze was that people often have to leave their communities. I know that Dr. Whitney often experiences systemic racism in hospitals. We know this exists, certainly in the city of Winnipeg. I have a picture of an indigenous man who died in the waiting room, waiting for help, because they thought he was intoxicated. He literally died in his wheelchair. We hear stories like that all the time.

I am asking this, because people dealing with complex mental health have to go to places where they experience systemic racism. Compiled with that, they are now away from their loved ones and support systems.

Can you explain how these disparities further exacerbate mental health issues?

[Dr. Diane Whitney]

They do, in the way we've been talking about social determinants of health, isolation from family and support. COVID-19 exacerbated that even further. At a NOSM event, recently, some indigenous patients shared their experiences of being in hospital during COVID-19, and it was actually quite frightening.

My question is, is there a way to provide those patients with some type of support in hospital from their own cultural point of view, from an elder or an advocate, or whatever word you want to use? Would that be helpful? Would it have to be 24-7 support? It can't just be Monday to Friday.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Building on that.... That's wonderful, and we absolutely need that support and care in hospitals. I want to go back to what my good colleague, MP Serré, was talking about regarding the importance of training, so that people can stay in their communities and get the help they need in their communities. Would that be a better solution?

[Dr. Diane Whitney]

I can't disagree with that, but the challenge is with some of the really small communities. For example, my patient is on a reserve with 30 people.

Why can't we have a hub-and-spoke type of approach to it, where we have more than just a hub in Thunder Bay and Sudbury? That's a long way for people to come. Can we not offer some basic services closer to home?

[Leah Gazan, NDP, Winnipeg Centre, MB]

We can have more holistic mental health care, rather than just in bigger urban centres.

[Dr. Diane Whitney]

That's right. It's also about, as my colleague Dr. Ajueze mentioned, actually having a team. I'd love to have access to a psychologist, a social worker or an occupational therapist. I practise alone in the community, by myself. I have residents, and my husband runs my office, but that's it. I don't have a social worker. I don't have an occupational therapist. It doesn't mean that I need to have one full time. It just means that I need access to one.

I don't think that's just a northern issue. It's an organizational issue.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Yes. It's also a funding issue, I would argue.

I have time for one more question, and I want to move on to Achēv.

Many immigrants and refugees who come to Canada have trauma and other complex mental health issues like PTSD, especially if they're coming from places where there's war, for example, and are leaving situations of conflict. In 2021, a report released in the International Journal of Environmental Research and Public Health, which was entitled “Refugee Women with a History of Trauma: Gender Vulnerability in Relation to Post-Traumatic Stress Disorder”, found this:

After a review of the different studies, it seems clear that the higher predominance and severity of PTSD in refugee women is related to gender-based traumatic experiences, such as rape, sexual assault and abuse, or genital mutilation, among others.

People who come here with diverse experiences often don't have care that they can access with people who actually understand their experiences. It's clear that there's not enough culturally responsive and culturally safe trauma care.

How do you think that needs to change immediately to ensure that immigrant and refugee women and girls receive the mental health care they require?

[Karen McNeil]

I'll let Tania answer that too, but I will just say that there's also the language barrier. Many people have difficulty not just with culturally appropriate counselling and resources but also with interpretation and translation, ideally with somebody who even comes from their own cultural background or community and speaks their own language. That would be extremely important.

Perhaps Tania can add to that.

[Tania Amaral]

Thank you, Karen, for saying that.

Actually, I've been thinking about what my co-witness Ms. Boucher said about project-based funding. To your question about what we can do to have this happen immediately, I think one of the things is to put less emphasis on project-based funding, because it is quite restrictive. Just when you're about to have a breakthrough and you have some momentum, you feel like suddenly the rug gets pulled out from underneath you and you can no longer provide service.

[The Chair, Conservative, Karen Vecchio]

Thank you so much, Tania. That's fantastic.

We will now go into the four-minute round.

Anna, you have the floor for four minutes.

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

Thank you.

Dr. Ajueze, you mentioned Ireland. My colleague Michelle shared with me the reference of the top three countries: the Netherlands, Denmark and Norway. How can we learn from other countries on how we can develop the same programs here that would benefit our community?

[Dr. Peter Ajueze]

Thank you, honourable member.

I was born in Nigeria. I grew up there and I did my medical school, and then I moved to Ireland, where I trained as a psychiatrist before moving to England to train as a child psychiatrist. Then I moved to Canada, so I've had the opportunities to learn from different countries and different practices.

I must say that every country is unique in its approach with regard to mental health. One thing I noticed when I first came to Canada was that there was a different approach. It was more like specialists. We have different mental health professionals who would focus on an area of special interest. For example, mine is eating disorders. We have people for addictions and different areas, which is good.

In those other countries, specifically Ireland, I found that the approach was different. It had its own advantages when it came to this team approach and being multidisciplinary, with social workers and nurses who would know almost everybody in a community. They'd have a team assigned to one community. They would know when there was a family moving out and a new family moving in. It was easier to monitor.

We find that generally in Europe. You mentioned the Netherlands. That's where sometimes you see a lot of research. It's easier to monitor and do longitudinal studies—even for 10 years and even when people move to a different province—because there is a team of health care professionals who are quite close to them. They know them and the families are comfortable with their health care providers. They know almost everybody.

I don't know how practicable it is to incorporate some of this model, but I think it is definitely worth trying. There are a lot of advantages to using that approach.

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

One thing we heard in the budget was that the government promised $4.5 billion for mental health. I'm not sure where that money's gone yet.

What is the cost, per capita? Would you know that information—probably not—about what other countries are spending compared to Canada?

[Dr. Peter Ajueze]

No, unfortunately, I don't.

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

I don't expect you to.

I'm curious about how we can rank so poorly, being one of the richest countries—or so they tell us. Why can't we learn from other countries how to better assist our own communities here in Canada? There's a lot of learning there to have, just as you explained to us about what's happening in Ireland. It has a lot of rural areas, and so do we.

We're hearing today from different witnesses that the rural areas don't have Internet and they don't have access to the infrastructure. What is it that we can learn to implement those same procedures here in Canada?

[Dr. Peter Ajueze]

That's a good question. One of your colleagues mentioned mobile services for indigenous areas. That was the first time I heard about it. I have been working in this community that I came to for the past three years now. I've never heard of anything like that.

I know somebody had asked if it was a form of institutional racism. I couldn't say that, but I wonder. I think, maybe starting with accountability about where that money is—

[The Chair, Conservative, Karen Vecchio]

Perfect. Thank you so much, Doctor.

I'm now going to move over to Jenna for four minutes.

[Jenna Sudds, Liberal, Kanata—Carleton, ON]

Thank you very much, Chair.

Thank you very much to all the witnesses for their testimony, but more importantly for the work they do every day.

I'd like to direct my first question to Dr. Jetly.

You made the comment a few times that right now it's a year and a half or an 18-month wait for someone to see a psychiatrist here in Ottawa. Throughout this study and in some of the testimony we've heard from other witnesses, when we've been talking about mental health, in particular relating to young women and girls, we've heard about the impact of psychotherapy. We've heard about how useful talk therapy has been for young women, as well as that peer-to-peer discussion and having peer support.

I'm wondering if you can speak to that.

[Dr. Rakesh Jetly]

Thank you for that. Those are good points.

One thing with the 18-month wait is that we have the psychiatrist as the holy grail. You get to see a psychiatrist and are suffering till you get there, but the psychiatrist doesn't have all the answers. The idea is to have more of a team-based care, exactly as Peter spoke of.

I think that, yes, it starts with the community. It starts with peer support. It starts with trusted adults, trusted peers, mentors and mentees who create this community where discussing how they feel has been normalized. It's something we worked on in the military for 20 years. If your colleagues know you when you're well, they'll notice that subtle change and have the courage to tell you to go get help.

I think we've done a good thing that way. The lack, of course, is that we don't always have the help when people.... I've always looked at soldiers, veterans or children the same way: You have a window that's open. That window is open briefly and you need to get the help quickly for that.

[Jenna Sudds, Liberal, Kanata—Carleton, ON]

That's incredible. Thank you.

[Dr. Rakesh Jetly]

I do believe it starts with community. It's a community thing, for sure.

[Jenna Sudds, Liberal, Kanata—Carleton, ON]

Thank you very much.

To quickly turn to Ms. Boucher, I was really struck by some of your testimony around the use of psychotropic medication and the medicalization of young people. I'm wondering if you can expand upon that, particularly on any observations you may have over time. How has this perhaps changed or evolved one way or the other through the pandemic?

[Anne-Marie Boucher]

In 2016 in Quebec, before the pandemic, the realization of the problems young people were experiencing in connection with medicalization led to the creation of the Mouvement Jeunes et santé mentale. That movement focused particularly on marginalized youth and observed that in situations where young people who were in distress or were suffering had little access to support or help to improve their living conditions, what we had to offer them was medication. That movement held consultations and published data about these facts.

For example, a marginalized youth who has experienced disaffiliation, family breakdown or homelessness has a much higher chance of ending up with multiple medications than a youth who is living in more favourable circumstances. As well, we have observed that the pandemic led to accelerated prescribing of anti-anxiety medications, antidepressants, and even medications for attention deficit disorder with or without hyperactivity.

The question we ask ourselves is to what extent that medication is being used to make up for a deficit in public services and support. Some people today explained how difficult support services were to access. Often, the public is not very familiar with the other services that are accessible, such as peer support groups. People automatically want to look for psychological support, but because that is not always accessible, the doctor will prescribe medications.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

We're now going to pass it over to Emmanuella Lambropoulos.

Emmanuella, you have four minutes.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you, Madam Chair.

I'd like to begin by thanking our witnesses for being on the panel today and for the incredible work they do in their communities to help those in need.

Of course, every single session we've had with panellists has been very difficult to hear, because we know to what extent Canadians are feeling pressure right now and are experiencing mental health issues.

I'm going to ask my first question of Dr. Whitney.

You mentioned that there is twice the rate of suicidal hospitalizations in the north and that 78% of people experience childhood or adult trauma in the north. Obviously, the need is greatest there, yet there are fewer resources there than anywhere else. You also said that, during the pandemic, things got a little bit better because you were able to speak to more than one person at a time. You did sessions and you were able, within an hour, to help heal up to 12 people—I don't know if you gave a number—but this obviously created a barrier to accessibility for a lot of people who don't have an Internet connection, and this is another really big problem.

Can you speak to the importance of getting Canadians in the north Internet connectivity, as well as the infrastructure that needs to be in place in order to get people from place to place more quickly in order to get these services faster if they're not going to be in their communities?