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View Wayne Easter Profile
Lib. (PE)
View Wayne Easter Profile
2017-05-11 15:32
We'll come to order.
Pursuant to an order of reference from the House, we're continuing our look at Bill C-44, an act to implement certain provisions of the budget tabled in Parliament on March 22, 2017, and other measures.
We have a number of witnesses here this afternoon. We appreciate your coming forward to give your views on Bill C-44.
First, we'll turn to the Canadian Mental Health Association, and Patrick Smith, the national CEO, and Teresa Gerner, the national coordinator, administration and government relations.
The floor is yours, Patrick.
Patrick Smith
View Patrick Smith Profile
Patrick Smith
2017-05-11 15:33
Thank you, Mr. Chairman.
Good afternoon, members of the committee.
Thank you for inviting me here today. My name is Dr. Patrick Smith. I'm the national CEO of the Canadian Mental Health Association.
Celebrating 100 years in 2018, we are a Canada-wide organization, with more than 15,000 staff and volunteers, in every province, in more than 300 operational locations across the country. We're often described as the community-based mental health organization with boots on the ground.
The Trudeau government has demonstrated unprecedented leadership in recognizing and working to redress dramatic gaps in mental health. Prime Minister Trudeau has signalled his understanding of the whole-of-government approach, with specific mental health deliverables included in multiple ministers' mandate letters.
The 2017 budget demonstrated a commitment to beginning to close the many gaps in proportional funding and to begin to transform our country's response to mental health and mental illness.
CMHA called on the federal government to target and earmark dedicated funds for mental health in its transfer of funds to the provinces. With budget 2017, CMHA was pleased to see funding through the Canada health transfer earmarked for mental health and to see this government's targeted funding for high-need communities, such as veterans, active duty military and military families, indigenous peoples, caregivers, children and youth, and individuals living with substance-use disorders. However, there is still some way to go before mental health care is funded on par with physical health care in Canada, and in proportion to the burden of illness.
Canada spends the lowest proportion of its health spending on mental health among all G7 countries. This historic underfunding has led to significant gaps in access to basic mental health services and supports. This gap wasn't created overnight, and it will take concentrated effort and ongoing commitment to address it. The Canadian Mental Health Association calls for continued investment in mental health, especially in community-based services and supports, to bring Canada in line with other G7 countries, where it still lags behind. We’re calling for dedicated funding to be focused on five key fundamental areas in which we are furthest behind other G7 countries and where, with targeted investment, will achieve the greatest impact on people's lives. These investments in community-based services and supports will improve outcomes and reduce the need for hospital beds and acute care services.
There is one fundamental issue in Canada that needs to be immediately addressed, and that is who is funded or covered in our publicly funded system. I’m going to shamelessly quote two of my well-respected colleagues here today. Dr. Karen Cohen has helped us to understand that, in Canada, we have universal medical care, not universal health care. When it comes to primary mental health care, the very basic evidence-based services such as counselling, widely accessible structured interventions based on cognitive behavioural therapy and other psychotherapies, and other basic community-based mental health services and supports that other G7 countries take for granted and rely on as fundamental to their mental health response are mostly not available in Canada unless you can pay.
Starbucks Canada made the news when it modified its coverage for its employees and moved from $400 per employee to $5,000 to cover basic mental health services. In a country that has universal health care, you get basic mental health care if you're lucky enough to be a barista at Starbucks Canada.
Ian Boeckh says that mental health reform is a team sport. He's right, and he's one of the best role models for that, but in Canada the vast majority of the most valuable team members that other developed countries have in the game are sitting on the sidelines. Psychologists, social workers, specialized peer support workers, addiction counsellors, we have them here in Canada, but they're mostly sitting on the sidelines outside of the publicly funded system. Most Canadians are surprised when they find that out. Getting them in the game, as they are in other developed countries, practising to their full scope of practice and funded to do the work they're trained to do, will have a dramatic, immediate and formidable impact.
CMHA acknowledges and applauds this government's proposal to support the services of traditional indigenous healers to address mental health needs. We also call upon the federal and provincial governments to work together to ensure that primary mental health care professionals are also included and supported.
I'm hoping that we'll have a chance to more fully discuss the stepped care model that you see today, but in a nutshell, the tiers at the bottom, the foundational components of a properly resourced mental health system, are the most dramatically underfunded in Canada. Earlier access to services at the lower tiers is more cost-effective and can prevent individuals from needing more cost-intensive and time-intensive intervention. We treat cancer before stage four.
Better outcomes are possible with earlier intervention. We need to do the same in mental health; hence, for targeted mental health funding, we're not talking about building more mental health hospital beds. If that's all we have in the system, it's no surprise to think that we need more. Instead, what we need to do is to invest in the basic services in the community and redefine primary care when it comes to mental health to include primary mental health care providers.
View Wayne Easter Profile
Lib. (PE)
View Wayne Easter Profile
2017-05-11 15:39
Thank you very much, Dr. Smith.
We're turning then to Ms. Moran, who is the CEO of Children's Mental Health Ontario.
Kimberly Moran
View Kimberly Moran Profile
Kimberly Moran
2017-05-11 15:39
Thank you very much. My name is Kim Moran. I am the CEO of Children's Mental Health Ontario. CMHO is the association that represents over 100 publicly funded child and youth mental health centres in Ontario, providing expert treatment and support to children, youth, and families throughout Ontario.
We want to thank the government for their explicit attention to child and youth mental health, and their commitment to mental health in Bill C-44.
As a chartered professional accountant, I understand the difficulties in budgeting and in making ends meet. After working at UNICEF, where we designed health care systems around the world, I have some sense of how to make things effective as well. However, as a parent of a child with a severe mental illness, I have a strong consumer voice to add to the public policy perspective.
Every week there is another headline about youth suicide. Canada's youth suicide rate, we all agree, is much higher than it should be, and we know how to prevent suicide for the most part. Expert report after expert report all say that providing psychotherapy and other intensive treatment when kids need it can avert a crisis. However, the current provision of mental health services is almost entirely focused on waiting until kids become acutely ill to provide services.
My daughter was having suicidal thoughts, and we were told to wait until she had a suicidal plan until we could get treatment. It's like telling a kid with cancer to wait until it spreads all over the body. It just doesn't make any sense.
We do know how to reduce suicides. It requires a number of tactics, using a population-based strategy. It starts with promoting mental wellness to all kids.
The second effort is to provide easy-to-access counselling services for those kids with mild mental health issues to ensure they don't get worse. We need lots of services like these in lots of places, because there are lots of kids. We know one out of five kids has a mental health issue. Primary care doctors need to be at schools, colleges, universities, in communities, on the phone, wherever kids are.
The third effort needs to be about delivering high-quality treatment to those kids with a moderate to severe mental health issue, and provided by specialized child and youth mental health experts.
Just to be clear, these problems can be solved with three strategies. The first is to promote mental wellness. The second is to provide easy-to-access counselling services for kids with mild mental health issues. The third is to provide expert, specialized mental health treatment for kids with moderate to severe mental health issues.
Both the Canadian Public Health Association and Ian Boeckh are going to be talking later. They can talk about solving the access problems around counselling services for kids with mild mental health issues. I am going to talk today to some data that has been brought to our attention, and that's on kids who are going to hospital and are most likely to die by suicide, the kids who have a moderate to severe mental health issue. They comprise 12.6% of all kids in Canada right now.
CIHI, the Canadian Institute for Health Information, recently released new data that shows a staggering 56% increase in kids going to emergency departments, and a 47% increase over the last decade in hospitalizations of kids with mental health issues, at a time when hospitalizations for every other childhood disorder dropped by 18%. This data signals that we have a really serious crisis.
We all know that to control spiralling health care costs, investment in home and community care both to prevent and divert kids from hospitals makes good financial sense; but the data shows that the health care system is failing to provide the right services in the community. We've estimated the cost in Ontario at $175 million annually, and over the next five years it will cost us $1 billion, unless we change the way we do things.
CMHO has reported long wait times throughout Ontario for basic counselling and therapy for kids with moderate to severe mental health issues. In Ottawa, kids will wait up to 18 months. In the Toronto GTA, they'll wait up to two years. It doesn't make any sense.
My daughter was 11 years old when she rapidly became very depressed. She needed a full interprofessional team to provide care, with psychiatrists, psychologists, social workers, and child and youth workers. But we couldn't get the care we needed, and from depression she rapidly became suicidal as she waited for specialized child and youth mental health treatment.
We need a long-term, intensive treatment program for those kids, and it has to be in the community. They can't access it now. There simply is not enough capacity.
We were encouraged to see the government's commitment to mental health in this year's budget. We know by investing in community care for kids like mine that we'll save about $175 million annually in Ontario, but we need your help to ensure that this money goes where it needs to go: directly to the service providers who are delivering therapy treatment to children and youth who are waiting for help.
Kids can't wait, nor should they have to, so we need your help. We know that the federal government wants to see wait times for child and youth mental health treatment go down. You've been explicit about this in your communication. Instead of simply prescribing in a bill that funding for mental health and home care services must be calculated according to provincial population, we want to see an additional calculation that ensures a proportionate amount of funding is earmarked for children and youth, and further, to ensure that the community-based agencies that deliver treatment to these kids are properly resourced to do this job and do it well.
We would welcome the opportunity to be involved in the development of indicators to ensure that happens.
Thank you.
View Wayne Easter Profile
Lib. (PE)
View Wayne Easter Profile
2017-05-11 15:45
Thank you very much, Ms. Moran.
Turning to the Canadian Alliance on Mental Illness and Mental Health, Mr. Brimacombe and Ms. Cohen, go ahead.
Glenn Brimacombe
View Glenn Brimacombe Profile
Glenn Brimacombe
2017-05-11 15:46
Thank you, Mr. Chair.
Good afternoon, everyone.
The Canadian Alliance on Mental Illness and Mental Health, known as CAMIMH, is very pleased to be with you today.
My name is Glenn Brimacombe, and I am joined by Dr. Karen Cohen.
We lead associations that are both long-time members of CAMIMH. In my day job I am CEO of the Canadian Psychiatric Association and Dr. Cohen is CEO of the Canadian Psychological Association.
CAMIMH is the national voice for mental health in Canada. Established in 1998, CAMIMH is an alliance of 16 mental health groups, comprised of health care providers and organizations that represent people with mental illness, their families, and caregivers.
CAMIMH organizations came together to educate and inform by engaging Canadians in conversation about mental health and mental illness. Informed conversations create awareness, reduce stigma, and call for the services and supports that one in five Canadians need each year. Our vision is a Canada where everyone, no matter their state of wellness, enjoys good mental health. Our mission is to advocate for a Canada where all who live with mental health problems and illnesses, their families and caregivers receive timely, respectful, and effective care and supports.
Today we direct our comments to division 9 of Bill C-44. CAMIMH welcomes the $5 billion over 10 years that the federal government has committed to mental health initiatives. This is a historic investment that recognizes that Canadians need better access to mental health services and supports. In Bill C-44 $100 million has been set aside to be transferred to the provinces on a per capita basis for mental health initiatives in 2017. This represents a modest 2% of the total $5 billion to be invested over the next 10 years.
It also represents an important opportunity for governments to take the time they need to consider how the remaining 98% should be invested in 2018 and beyond. CAMIMH stands ready to work with both levels of government so that Canadians receive timely access to effective mental health services and supports.
As set out in Chart 3.1 of the budget, funding for home care and mental health will increase to $1.5 billion in 2021-22. However, we are not yet aware of how these funds can be spent. We urge governments to clarify how funding for home care and mental health services over the remaining nine years will be allocated. Doing so not only allows for accountability and transparency, but gives the provinces and territories the predictability necessary for planning and implementing complex services and supports.
It is our understanding that the federal government is currently in discussions with the provinces about where the monies could be invested and what accountability mechanisms could be put in place to ensure that the dollars are invested where there are service gaps, that the services that are implemented are evidence-based, and that metrics are in place to measure the ongoing effectiveness of the services provided. CAMIMH understands that you cannot manage what you cannot measure.
When it comes to mental health care, considerable service is not covered by our public health insurance plans, and there are data gaps in both the public and private sectors. In our view, much more needs to be done to make care accessible but also to better understand what care is received. This can be done in collaboration with the Canadian Institute for Health Information and the Canadian Life and Health Insurance Association.
Karen R. Cohen
View Karen R. Cohen Profile
Karen R. Cohen
2017-05-11 15:49
In September 2016, CAMIMH released “Mental Health Now!”, which identified a five-point plan focused on the federal role in advancing the mental health of Canadians.
Mental illness has been a poor cousin of the health care system. Considerable mental health care is delivered by health providers other than physicians outside of publicly funded facilities like hospitals, and consequently it is not funded by our public health systems.
CAMIMH recognizes that budget 2017, and in particular Bill C-44, is an important step in meeting the government's mandate to make quality mental health care available to those who need it. Hopefully, Bill C-44 is a down payment on the greater investment we need to make in Canada's mental health. The Mental Health Commission of Canada has called for an increase in funding for mental health care from 7% to 9% of total health spending, so our work at all levels of government is yet to be done.
More can and must be done to expand the capacity of our public health systems to better deliver needed and effective mental health care. CAMIMH members are committed to this goal and stand ready to make their contributions.
In our “Mental Health Now!” document, we call on governments to provide support for the growth of innovative pockets of care that our systems currently fund, and to consider adapting mental health initiatives that have been effectively and successfully implemented in other countries. There is much effective care that our publicly funded systems need to work harder to make available. This speaks to the importance of establishing a mental health innovation fund that can support better access to care that we know works, and fund the research necessary to growing our understanding of mental illness and the effectiveness of its treatment.
In closing, mental health matters to all of us. There is no health without mental health, and in the view of CAMIMH, Canada's current and future wealth depends on its mental health.
Thank you.
View Wayne Easter Profile
Lib. (PE)
View Wayne Easter Profile
2017-05-11 15:51
Thank you, both.
Turning to the Canadian Public Health Association, we have Mr. Culbert, the executive director.
Go ahead; the floor is yours.
Ian Culbert
View Ian Culbert Profile
Ian Culbert
2017-05-11 15:51
Thank you very much.
Good afternoon, and thank you for the opportunity to appear before you today.
Since this is the finance committee that is studying investments in health, I'd like to start with an interesting financial fact. For every dollar spent on mental health and addiction services, we save seven dollars in health costs and $30 in lost productivity and social costs. That's an incredible return on investment of 3,600%. If you're a banker, you'd be jumping for joy, but it represents a really smart investment by government.
From a public health perspective, I'm very pleased to see some other smart investments in budget 2017. The additional $7 billion over 10 years for high-quality, affordable child care spaces would yield an ROI of 800%; the investments in building, renewing, and repairing Canada's stock of affordable housing would result in an ROI of 200%; and the $47 million over five years to develop and implement a national action plan to respond to health risks posed by climate change could yield an ROI of 300% or more. So where did these returns come from? In addition to avoiding illness and injury, as a result of these investments people become more resilient, have less need for medical and social services, are absent from the workforce less, and are therefore better able to contribute to our economy.
Upstream investments are what public health is all about, creating the necessary conditions so that Canadians can lead healthy lives and reduce the demands for the acute care system to fix them when they're broken. Public health focuses on the implementation of policies and the provision of services to prevent or address issues from a population-based, health-promoting perspective. As the returns on investment indicate, these approaches can have a significant influence.
When looking at mental wellness, you see that the government's direct financial contribution in budget 2017 is important for those who are facing challenges today. However, it is the other contributions to poverty reduction, housing strategies, and support for indigenous communities that will have a much greater effect on future generations. Poverty, food insecurity, and unstable or unaffordable housing are demonstrated risk factors for mental illness. So, in addition to the Government of Canada's direct investment in mental health services, budget 2017 demonstrates its commitment, as Patrick mentioned, to a whole-of-government approach to improving the mental wellness of Canadians.
While we support the investments in this budget, we encourage the government to look at additional upstream investments in healthy, resilient communities that support and nurture all of their members to provide an environment that supports both physical and mental wellness. We also know that informal caregivers are essential to sustaining Canada's health care system, and their economic contribution was estimated at $25 billion in 2009. As such, it's reassuring to see the new Canada caregiver credit under the Income Tax Act, supporting caregivers in general, as well as the changes to the Veterans Wellbeing Act, supporting veterans' caregivers.
While hospitals play a crucial role in the overall health system, we know they are the most expensive and least effective location for the delivery of most mid- to long-term health services. The government's commitment to support the provinces and territories to enhance home care services is an important step in fundamentally restructuring where and by whom mid- and long-term health services are provided, and a crucial step in supporting the sustainability of the acute care system. In Canada today, the acute care system continues to absorb the majority of health sector resources, with less than 3% of health spending allocated towards health promotion and disease prevention. If we want a sustainable health care system, we have no choice but to value health and invest more in creating conditions that support physical and mental wellness.
I will leave you this afternoon with this thought. Since the early 1900s, the average lifespan of Canadians has increased by more than 30 years. Twenty-five of those years are the result of advances in public health such as safer and healthier foods, universal immunization programs, tobacco control strategies, motor vehicle safety, safer workplaces, and taking concrete actions to address the social determinants of health. In the 20th century, we increased our lifespan. In the 21st century, the goal should be to improve the quality of those years. In order to do so, we need strategic upstream investments that will make the biggest difference for future generations. Budget 2017 is a step in the right direction. Thank you.
View Wayne Easter Profile
Lib. (PE)
View Wayne Easter Profile
2017-05-11 15:56
Thank you very much, Mr. Culbert.
Now turning to the Graham Boeckh Foundation, we have Ian Boeckh, president. Go ahead, Mr. Boeckh.
Ian Boeckh
View Ian Boeckh Profile
Ian Boeckh
2017-05-11 15:56
Thank you very much for having me speak today.
My name is Ian Boeckh. I'm the president of the Graham Boeckh Foundation, a private family foundation dedicated to improving mental health services in Canada. The foundation is named after my brother Graham, who had schizophrenia and died in his early twenties from complications due to his medication. Our family felt that the system let him down badly, and that moved us to create a foundation.
Our foundation focuses on youth mental health. We have several large joint ventures with Canadian governments, provincial and federal, to create a new mental health care system for youth aged 12 to 25.
Let me tell you why I think Bill C-44 is a historic opportunity.
If you look at where we've come from, we recognize now the huge burden of mental illness. Research and statistics have pointed out both the social and the economic cost. We've made progress in reducing stigma, and huge numbers of people are now coming forward for help.
What we haven't done is create the services to help them. I think there's a possibility this bill could do it if the money is used properly. It could be a catalyst to finally having good services for people with mental health problems in Canada.
My colleagues here have talked very well about the shortcomings of the system. I think we have wonderful programs in Canada. We have wonderful professionals to help people. What we don't have is an organized system that uses our resources well and that suits people.
Our mental health care system was thrown in with other things and developed haphazardly. Nobody looked at creating a well-organized system that would be really suited to helping people with mental health problems. That's what we need to do now.
We need to take a systems approach, which you've heard my colleagues talk about here. This will be critical for making sure this opportunity is captured. Until now we've taken a piecemeal approach. The issues around mental health are complex and multi-faceted.
Minister Philpott, the Minister of Health, has talked eloquently about the need to address the issues of child and youth mental health; 70% of illnesses begin when people are children or youth or young adults. It doesn't make sense to wait for people to get really sick before we help them. So I think a focus on children and youth is really important.
In conclusion, this is a historic opportunity. It won't come again for a long time, so we can't blow it. We need to use this money from the health transfer, the $5 billion, not only to have better funding for services but also to create a system that makes sense, is well organized, and serves the people it's supposed to serve.
The federal government is going to have to work with the provinces. We hope they'll be able to work together in a constructive way to build a system. The provinces and territories are responsible for the mental health care system in this country.
One of the things people don't realize is that there is a consensus on what we need to do to improve the system, and I think you could hear that today. We need to go ahead and do it. We don't need to have endless consultations, or things like that. I think the path forward is reasonably clear, and we can get on with the job.
View Wayne Easter Profile
Lib. (PE)
View Wayne Easter Profile
2017-05-11 16:01
Thank you very much, Mr. Boeckh.
Dr. Smith, I didn't cut you off. You didn't finish your paper. Was that where you wanted to end, or were you transferring—
Patrick Smith
View Patrick Smith Profile
Patrick Smith
2017-05-11 16:01
No, I'd be happy to continue.
View Wayne Easter Profile
Lib. (PE)
View Wayne Easter Profile
2017-05-11 16:01
I thought you had finished. Okay, if you were transferring over to Ms. Gerner, go ahead.
Patrick Smith
View Patrick Smith Profile
Patrick Smith
2017-05-11 16:01
No, actually, she was just doing the timekeeping.
We talked about five areas needing investment. They are based on the tiered model and the stepped care model, very much in line with what people are saying here. We are a proud member also of CAMIMH, and we support the recommendations in their paper.
What we know, though, is that the area that has been the most significantly underfunded in Canada—it isn't across the board when we compare ourselves to other countries—is the basic community-based services. It's there that we have the biggest gap when we look at ourselves compared to other G7 countries.
If we were to say where you would get the biggest impact from giving a focus to the provinces, the first of the five areas would be structured, community-based interventions. They're widely accessible. They break down barriers. Many are provided through e-mental health and telephone services, and they are having the largest reach. But it's by specialized, trained, peer support workers who are themselves supervised by clinical psychologists.
I'm a clinical psychologist, but we're not going to have one in every backyard. I think we need to have people working to their scope of practice. We have examples of other countries that have found themselves in exactly the same position as Canada and have made dramatic improvements by getting these services out there. It has saved them money. There has been a wave in the WHO toward using a shared care model, recognizing that GPs and family practice clinicians are less expensive than psychiatrists. However, they're in fact less effective and more expensive than psychologists, social workers, and other people trained to do the work.
The next big wave of research in the World Health Organization is interdisciplinary primary care, and that's the second piece. Don't have doctors and nurses try to deal with all of the mental health problems in Canada. Include all of the people who are trained in specialty mental health care.
Third is community-based services and supports—and budget 2017 did make investments in housing, community, and employment supports. We need to make sure we have the housing and employment supports so that people who have received services can thrive in a recovering community.
Fourth, there are those people who have serious and persistent mental illness who are going to need the wrap-around services. But if you're doing all of these other things, you're going to find that fewer people are going to be waiting on supportive housing lists.
Fifth is the full continuum of illness prevention and health promotion. I'll just reiterate that when we're talking about healthy communities, think about where kids spend their time: schools. There are really good evidence-based programs in mental health promotion and social and emotional learning that we could invest in upstream in schools—and for adults, invest in work places.
The Canadian federal government also has an opportunity to show real leadership as the largest employer in Canada to truly implement psychological health and safety standards in the workplace. That's one of the things the Canadian government can do that can actually demonstrate clear leadership for corporate Canada.
Finally, I would say that people have recognized the federal government's leadership on this. It hasn't been popular everywhere that the federal government is trying to have a say in what needs to happen, but every one of the organizations I've heard from has told the federal government that they need it to demonstrate this leadership.
What we at CMHA would say is don't back down. Continue to demonstrate real leadership at the federal level, and most of the provinces we talked to off-side are actually pleased with having this focus on mental health. Don't get lost in the debate. Canada needs it in addition to the earmarked funding for mental health in the Canada health transfer
We're an organization that's part of CAMIMH, and we're changing the name from “innovation fund” to “transformation fund” because of Jane Philpott. She asked why 2017 can't be the year that we transform mental health and mental health funding in Canada. We're saying, if you actually recognize the years of lack of investment and how big the gap is, the first job is to actually accept how far behind we are.
Indeed, it's not as much an innovation fund as a transformation fund. We need to take deliberate action to transform the mental health system, and this government can do it.
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