Status of Women Committee on Oct. 27th, 2022

[The Chair, Conservative, Karen Vecchio]

I know. You always push it. It's all good.

We're now going to go to our second round, switching to five minutes, and then two and a half minutes for Leah. I'll remind Leah that it's two and a half minutes for her.

We'll start with Anna Roberts for five minutes.

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

Thank you, Chair.

Thank you to all the witnesses. This is a very difficult topic.

I have some questions for Dr. Jetly.

Recently I spoke to a family, a single mother now, who had a child with disabilities, both autism and ADHD. The child was given medication. I don't know the exact numbers, but I know there are a large number of divorce situations when a child with disabilities is born. Usually, the mother ends up being the caregiver. In this particular situation, it's a culture thing, so the family—both families—felt that it was.... I guess they wanted to blame someone, and they always blame the woman. However, nobody thinks about the single mom who is trying to take care of the child.

All she was advised to do was to suck it up, buttercup, and move on. They provided her with medication. That wasn't the answer. She struggles each and every day. She had to finally break down and put her child in a home, because she felt that she was a threat to her child.

Have you seen any situations of that magnitude? If so, what can we do to recognize that, and how can we help them?

[Dr. Rakesh Jetly]

Our colleagues have alluded to this. As a physician, I was a generalist. I was a family physician with the military. Then I became a super specialized guy; I became the trauma guy. Later in my career, I became much more of a generalist.

I agree with what my colleagues were saying here, in the sense that there are determinants of health. Determinants of health are much more than health care. It's a societal thing. It's loving relationships, supports and things.

I do think the answer to this one.... It's a tragic outcome for the woman not being able to take care. Overall, the societal support or the cultural support has to be there. I do, sadly, see cases like this. I've had cases in my own practice like this, as well. Not to be the big bad psychiatrist, but I think medication may have been part of the answer for this child if there's a severe neurological disorder such as ADHD, but that's the beginning, not the end.

Unfortunately, the emergency room analogy that one of our colleagues gave about prescribing that young woman benzodiazepines or something like that isn't the end of her story; it's the beginning. I think that a more holistic approach that looks at well-being, employment, stable housing, occupation.... The mother probably needs respite—she can't look after a sick child herself all the time.

If we step back and look at what's really needed.... The Canada Health Act—I could go onto a whole other topic—isn't really a health act. It's to pay for medication if somebody steps on a nail. It never really accounted for mental health, psychology, social work and all the other paraprofessionals we have. We have psychologists, chiropractors and physiotherapists who aren't covered by the Canada Health Act. They're all part of health.

I think the issue we're facing here is that the answer isn't a magic bullet. The other answer is a much more complicated one, but we tend to kind of ignore it.

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

I guess what really boggled my mind, and I didn't understand this, was how the husband got away without paying for support, etc. and ended up leaving the country. The poor woman tried to get a job to support the child. It caused trauma to her. She didn't have the benefits to help the child or herself with therapy.

How can we ensure that this doesn't happen again? Let's be honest, most women are the caregivers.

[Dr. Rakesh Jetly]

Again, I mentioned earlier the advantages of team-based care. Back in the day—I know Diane has practised for a long time as well and I know her as a colleague—when somebody was hospitalized years ago, they actually got treatment in the hospital. Social workers and occupational therapists were there making sure they were safe and learning skills. Now you're hospitalized just to make sure you're not suicidal anymore, and then you're discharged.

I think, really, the paraprofessionals will teach us psychiatrists a lot. They will teach the patients a lot. It's really that team-based approach. There were centres throughout the place. There is George Hull Centre in Toronto, for example, that's been around, where you have the different professionals—social workers, occupational therapists, all those—who can work with the parents and the children.

Programs for a woman like this need to be very family-oriented to help the mother and child communicate with each other. They're quite extensive, but they used to work.

[The Chair, Conservative, Karen Vecchio]

Thank you so much, Dr. Jetly.

I'm now going to pass the floor over to Sonia Sidhu for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Thank you to all the witnesses joining us on this important study.

My first question is for Achēv. Thank you, Tania, for the work you are doing on the ground in Brampton and across the GTA.

StatsCan has a report that says, “Immigrant women have fewer...social connections” than Canadian-born women. In your experience, how do newcomer women benefit from early integration? The last time I visited there, you were talking about the career pathways program. Can you explain what that was and how a newcomer can benefit from that early intervention?

[Tania Amaral]

Sure, I'll address this one. Thank you so much for the question.

The overarching issue with newcomer women, social isolation and social integration is that we need to talk about the systemic racism that is entrenched in that aspect. Not only are they facing multiple barriers, not only are they incredibly stressed and mental health is something they cannot even talk about, but they encounter racism at every turn. The benefit of the early intervention with social connections is key, particularly when they are the backbone of their family. They are the ones who are responsible for taking care of the household and for the child rearing in those cases. In a lot of cases, particularly with some of our communities out in Peel, newcomer families are in multi-generational homes, so there is the added burden of senior care that comes with being a woman who also has to take care of children.

What importance, in that long queue of priorities, does social connection and reducing social isolation take? At first glance, of course, they don't see it as such. Women put others' needs ahead of theirs. Newcomer women, particularly racialized or marginalized newcomer women, will place the needs of others ahead of theirs.

Again, getting back to my earlier point about how wellness goes beyond the physical, making sure they're aware of that and making sure there are resources available to them when they come to access our services makes it okay. It's okay for you to think about yourself. It's okay for you to take some time to connect with other women or connect with other female professionals or female entrepreneurs. It's okay to take care of yourself. In fact, you need to take care of yourself in order to be the caregiver, which is expected of you when you return home.

I'm not sure if that really answers your question, but that's certainly something that comes out a lot, and we're incorporating that into our services. For example, concerning the career pathways program that you mentioned earlier, we make it a point to have a meetup group every month where women can connect with other women like them who perhaps look like them or have similar stories to theirs. They talk about wellness and well-being and can share stories and empower each other. The career pathways program is about finding a job, but we make a point to have those conversations at the table and have the women have these conversations with each other.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

We heard before that when newcomer women encounter discrimination, it creates significant psychological stress. Can you speak about the impact this can have and how we can make sure supports are reaching those who need them?

You talked about stigma; you talked about language barriers. How is Achēv making sure that early support can reach out to them?

[Tania Amaral]

I think an important factor, when you're looking at what programming is going to serve that community best, is looking at the cultural appropriateness of such intervention. If you're able to tap into that to get the buy-in from the user—and the user in this case is the newcomer woman—if they feel comfortable and safe to talk about things that perhaps they're not able to talk about at home, and you do that from the get-go by making sure, again, that it speaks to the specific needs of a newcomer, a marginalized, racialized woman, I think that—

[The Chair, Conservative, Karen Vecchio]

I'm sorry, Tania. Thank you so much.

We're now going to head over to Andréanne Larouche for two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Madam Chair.

Ms. Boucher, you said earlier that your group received its funding directly from Quebec's ministère de la Santé et des Services sociaux. You also gave a good explanation of how much federal health transfers, with no conditions and for up to 35 per cent of the costs of the system, would help you.

However, I would like to come back to the subject of violence against women and other factors, given the importance of prevention.

As you clearly explained, mental health cases have really exploded in the context of the crisis created by the pandemic, and we now find ourselves dealing with inflation, and so with a cost of living crisis. If we provide support for social housing, could we not invest more and also support women's health and safety?

[Anne-Marie Boucher]

Exactly.

In fact, these concerns are to some extent related, for example in the case of violence against women in a spousal or family relationship. The housing crisis exacerbates that violence, because it is extremely difficult for some women, at present, to leave the family home with children and find new accommodation.

I am not familiar with the situation everywhere in Canada, but in the case of Quebec, we are currently experiencing an unprecedented housing crisis. There are real problems with building enough social housing. The cost of housing has exploded and the housing available is no longer affordable. That is one of the determinants of mental health that is doing the most harm right now, with the rise in the cost of living.

Obviously, preventing violence against women and girls should be a priority when we are talking about women's mental health. Recently, I happened on a study of women hospitalized for psychiatric care. It stated that 90 per cent of the women had experienced violence and assaults during childhood or adolescence.

We are talking about the importance of preventing violence, but also of responding and of supporting people who have experienced trauma. We have to make sure that there are services that offer compassion and listening. We have to take individuals' history into account and not simply act on the symptoms, their expressions of anger, distress or suffering. We therefore believe that it is urgent that there be places that offer approaches that are sensitive to trauma and are readily accessible to women and girls.

[Andréanne Larouche, Bloc, Shefford, QC]

I am going to have to come back to this question on my next turn. There was actually a demonstration this weekend to denounce the violence committed against women. I will come back to that.

[The Chair, Conservative, Karen Vecchio]

Thank you so much.

We're going to move over to Leah Gazan.

Leah, you have two and a half minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much.

I want to continue on with the Northern Ontario School of Medicine.

Call for justice 3.4 of the National Inquiry into Missing and Murdered Indigenous Women and Girls says:

We call upon all governments to ensure that all Indigenous communities receive immediate and necessary resources, including funding and support, for the establishment of sustainable, permanent, no-barrier, preventative, accessible, holistic, wraparound services, including mobile trauma and addictions recovery teams. We further direct that trauma and addictions treatment programs be paired with other essential services such as mental health services and sexual exploitation and trafficking services as they relate to each individual case of First Nations, Inuit, and Métis women, girls, and 2SLGBTQQIA people.

From what you've shared, it's clear that that's not happening. Part of the issue is the funding structures. We saw that with the Canadian Human Rights Tribunal ruling where they said there was “willful and reckless discrimination” against first nations children on reserve by not providing the same funding as for kids residing off reserve—no reason. However, we also see this in the health care system, different allocations of funding.

Would either one of you say that that's an example of systemic racism?

[Dr. Diane Whitney]

I'll agree there. When something like that gets written but then is not implemented, why is that? There are examples in northern Ontario of racism within the medical system, to be honest about that. What is also done.... I was the program director of the psychiatry residency program for the Northern Ontario School of Medicine, and I actually had some of my psychiatry residents expressing concern and frustration. One of them finally made a complaint about the behaviour of an emergency physician at a facility in northern Ontario.

Unfortunately, it's still there, and it's still alive. It's nice to see the young doctors saying, “This isn't right”, and I support that resident's making that complaint.

[Leah Gazan, NDP, Winnipeg Centre, MB]

So, just to—

[The Chair, Conservative, Karen Vecchio]

We will make sure we get back to you, Leah.

[Dr. Diane Whitney]

Okay, perfect. Thank you.

[The Chair, Conservative, Karen Vecchio]

We're going to be starting our third round. We'll pass the floor back over to Michelle Ferreri for five minutes.

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

Thank you, Madam Chair.

I'll go back to Dr. Jetly.

I know you started to finish something you were doing in your testimony, and I want to give you the floor to finish that in terms of what you think we should be focusing on with regard to research and women.

[Dr. Rakesh Jetly]

Thank you very much for that.

First of all, I completely agree with my colleagues that medicine isn't always the answer, but sometimes it is. If we are going to medicate, we need to be careful to make sure that we are translating studies correctly.

Years ago, we used to think that children were just little men and women. We used to give them medication based on weight, without understanding their liver and things. Years and years ago, we used to exclude women almost all of the time because of menstruation, because they might get pregnant, because they might get.... We had very good justifications for not including them because you couldn't control for time of month and things like that, but then when the medications get released, we give the same medications to women as well.

The problem ends up being that, when we include and analyze by gender, we tend not to have enough money to have enough women, especially in military veteran studies, and then you don't really report on them because they're not significant.

There have been laws passed in the U.S., such as the NIH Revitalization Act of 1993, but I think these things haven't really been followed. In 2013, the FDA cut in half the dose of Ambien, which is like our zopiclone, because they found out that women were clearing the medication less, which means they had a higher dose in the morning when they were supposed to be up. Guess what? That's when you're driving the kids to school; that's when you're getting breakfast, and so mom is kind of stoned in the morning.

We have to really look at making sure that the studies...that we don't just GBA-analyze and say, “Yes, we've considered it” but actually report on the differences, because menopause happens; pregnancy happens; postpartum depression happens; menstruation happens. That yucky biology does make studies harder, but then we end up applying the medications to those people.

I just think that's really important for us to move forward. The funders can ask for it, but if we end up having 90 men and 10 women, and our differences aren't statistically significant, it's not helpful. That's one of the points I wanted to make, just from a pure biological psychiatry perspective.

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

Thank you, Dr. Jetly.

[Dr. Rakesh Jetly]

The brain studies are the same. We did right-handed men because that was easier for brain studies.