I'd like very much to thank the committee for this invitation, which will allow me to discuss the issue of mental health and to speak to you about how the Government of Canada is supporting research to address the needs of individuals suffering from mental illness and substance misuse.
As this committee knows well, the Canadian Institutes of Health Research, or CIHR as it's often known, is the Government of Canada's agency responsible for providing health research support to ensure excellence in settings that are in universities, hospitals, and research centres across Canada.
To achieve its mandate, CIHR supports research in part through a unique interdisciplinary structure made up of 13 virtual institutes. The mission of CIHR's Institute of Neurosciences, Mental Health and Addiction, of which I'm currently the scientific director, is to foster excellence in innovation and ethically responsible research aiming to increase our knowledge of the functioning and disorders of the brain and the mind, as well as the spinal cord, the sensory motor systems of the body, and of mental health and mental illness and all forms of addiction that can arise from disorders of the brain.
Between the fiscal years 2006-07 and 2013-14, CIHR invested more than $475 million in mental health research and related behavioural conditions. This included a number of investments in major initiatives that are addressing the needs of populations most at risk of suffering from these conditions. One good example is CIHR's key initiative, which we refer to as the strategy for patient-oriented research, also known as SPOR. The primary objective of this initiative is to foster evidence-informed health care by bringing innovative diagnostic and therapeutic approaches to the point of care, as well as, of course, generating new knowledge that can improve the health of Canadians.
Through SPOR, CIHR is working with many partners to establish research networks to generate the research evidence and innovations that are needed to improve patient health and the functioning of health care systems. The very first SPOR network supported by CIHR is in the area of youth and adolescent mental health. This network aims to improve the care provided to young Canadians with mental illness issues by translating promising research findings into practice and policy. This initiative represents an investment of $25 million over five years, and importantly, it's a partnership between CIHR and the Graham Boeckh Foundation of Montreal, each of which has contributed $12.5 million.
CIHR is also working with partners to improve suicide prevention activities among aboriginal communities. For example, last March, CIHR in partnership with the Government of Nunavut, the Inuit Circumpolar Council, and other federal and international partners hosted a circumpolar mental wellness symposium on suicide prevention in the Arctic. This was held under the auspices of the Arctic Council. This unique gathering brought together researchers, community members, practitioners, policy-makers, and most importantly, youth from across the Arctic regions to identify and share best practices in order to promote mental wellness and to prevent suicide.
ln June 2012, CIHR also launched the pathways to health equity for aboriginal peoples signature initiative. This pathways initiative aims to support the development, implementation, and scale-up of interventions and programs focusing on improving aboriginal people's health and wellness in four key areas, one of which is suicide prevention.
For an example of an initiative in this area, we can point to Dr. Susan Chatwood at the Institute for Circumpolar Health Research in Yellowknife. She is studying existing mental health programs in the Arctic to determine what different regions can learn from one another to address this critically important issue.
CIHR also supports a number of initiatives aimed at addressing issues of substance misuse. Indeed on May 1, 2015, in Edmonton I had the pleasure to announce with the the creation of the Canadian research initiative in substance misuse. This will be a national network aimed at improving the health of Canadians living with issues related to substance misuse.
This initiative, which represents an initial federal investment of $7.2 million over five years, is unique in the sense that it focuses on the transfer and implementation of new evidence-based approaches to reduce the risk of substance misuse and its effects on health, including the development of addiction, overdose, and sadly, death. Researchers supported through this initiative will work closely with service providers and representatives of people living with substance misuse issues to better ensure the health outcomes for the people facing these problems.
ln conclusion, Mr. Chair, let me assure you that CIHR is committed to continue working with public and private partners in support of research in these important areas related to mental health and addiction. The overall aim, of course, is to improve the research and to translate this new knowledge into improved services, especially treatment, for those suffering from mental ill health issues.
Again, I commend you and your colleagues for taking up this study, and I wish to thank you for providing me with the opportunity to speak on this important issue. Of course, I will be pleased to answer any of your questions.
Thank you very much.
Thank you, Mr. Chair, for the opportunity to provide an overview of the programs and services supported by Health Canada in the area of mental health and wellness for first nations and the Inuit.
Health Canada recognizes that addressing mental health and addictions issues are important health priorities for First Nations and Inuit. Consequently, the department is investing more than $300 million this year on a suite of mental wellness programs and services.
Programming includes mental health promotion, addictions and suicide prevention, other crisis response services, treatment and after-care services, and supports to eligible former students of Indian residential schools and their families.
Health Canada is working with partners so that efforts to support individuals, families and communities around mental health care are coordinated and include family support, employment and training, education and social services.
Building on best practices, we know that efforts to support individuals, families and communities should be culturally safe and community-driven. We can find lasting solutions only if we work together with our partners, including First Nations and Inuit organizations and, most importantly, the communities themselves.
Mental health promotion and suicide prevention research emphasizes the need for comprehensive and multi-layered interventions across a continuum of wellness. Interventions at each of the individual, family, and community, and federal, provincial, and territorial levels have been found to be most effective.
We have worked with the Assembly of First Nations and mental wellness leaders to develop the first nations mental wellness continuum framework. Through this process, communities were engaged and brought their ideas to the table.
From these discussions, culture emerged as a foundational component. Community innovation, partnerships across government, collaboration and coordination across sectors, and linkages between programs and services were also identified as being crucial for moving forward.
This framework has been ratified by the Assembly of First Nations' chiefs of assembly and was released by the AFN in January 2015. We are now working with the Inuit Tapiriit Kanatami to develop a mental wellness continuum for the Inuit.
Health Canada is a partner in implementing the first nations mental wellness continuum framework, which calls for integrated models of service delivery that focus on community strengths and indigenous knowledge.
Moving forward, we will look at ways to strengthen the federal mental wellness programming with our partners to meet community-specific needs, such as moving away from siloed program approaches toward more coordinated and effective approaches, and through closer integration between federal, provincial, and territorial programs.
We are also supporting mental wellness teams, which provide specialized treatment to a group of First Nations communities facing mental health issues. These teams seek to increase access to a range of mental wellness services including outreach, assessment, treatment, counselling, case management, referral and aftercare.
Through the National Aboriginal Youth Suicide Prevention Strategy we support screening for depression in schools; education and training for front-line workers to reduce stigma and increase community awareness; referral and intervention training; crisis services; follow-up and support for at-risk youth; and cultural and traditional activities to promote protective factors and to reduce risk factors.
Since 2008, we have supported a range of services to former students of Indian residential school and their families so they may safely address emotional health and wellness issues related to the disclosure of childhood abuse. For example, in 2013-14 alone, Health Canada supported approximately 630,000 emotional and cultural support services to former students and their families, and 47,000 professional mental health counselling sessions.
On February 20, 2015, announced an investment to prevent, detect, and combat family violence and child abuse. Health Canada's investment will support enhanced access to mental health counselling for first nations victims of violence who are in contact with shelters, and will support the improvement of services to first nations and Inuit victims of violence so that services are better coordinated, more trauma informed, and culturally appropriate.
Thank you for your attention. I am pleased to take your questions afterward.
Thank you very much, Mr. Chair.
Thank you for the opportunity to highlight the Public Health Agency of Canada's work to improve the mental well-being of Canadians. We are working closely with our partners to contribute to the implementation of the Mental Health Strategy for Canada.
An important public health role is the monitoring of mental illness and mental health among Canadians. The agency's system for surveillance of mental illness tracks a number of mental illnesses, such as mood disorders and anxiety disorders. This system includes complementary data, such as self-inflicted injuries, for example, suicidal behaviour, and child maltreatment.
These data tell us that, as you know, mental illness affects many Canadians. In fact, our most recent data indicate that at least one in three Canadians will experience mental illness during their lifetime and one in seven use health services for mental illness annually. Furthermore, approximately 4,000 Canadians die by suicide each year, and there are many more suicide attempts.
In order to prevent duplication and to leverage work that is under way across the country, the agency participates in the mental health and addictions data collaborative with our colleagues at the Mental Health Commission of Canada and other national mental health data partners.
In budget 2013 there was a reallocation of $2 million of agency funding over a three-year period for the purpose of improving our data collection and ensuring that we were reporting as comprehensively as possible on mental illness and mental health. As part of these improvements, the agency is working with the Mental Health Commission of Canada to improve specifically the data we have and can provide to Canadians on positive mental health and well-being.
We now have a set of indicators of positive mental health for Canadians that forms the foundation for monitoring changes in mental health over time and the factors that influence these changes at the individual, family, community, and societal levels. These include measuring and monitoring personal coping skills among Canadians, positive family relationships, and supportive community environments. We know that 65% of Canadians have very good or excellent self-rated mental health and 82% are satisfied with life. Canadians also have strong ties to the community: 87% of adults believe that their neighbourhood is a place where people help each other. By gathering and analyzing these data, we will be able to share more information about the factors that help us take care of our mental health and help prevent mental illness.
Another important priority for the agency is suicide prevention. The enactment of in December 2012 served an important role in raising the visibility of this issue in Canada and underscored that suicide is a public health issue. The federal framework for suicide prevention will focus on improving information, collaboration, and resources for Canadians and on equipping those working to prevent suicide with the latest information on best practices.
Our discussions with our partners and stakeholders highlighted that fragmentation of information is one of the most important barriers to their work. Effective suicide prevention requires involvement from all sectors, including governments, non-governmental organizations, communities, academia, and the private sector. The framework will provide the basis for partnership on concrete activities, and we look forward to working with the Mental Health Commission of Canada in achieving the framework's objectives.
Public health also focuses on improving the mental well-being of Canadians before mental health problems or challenges begin to emerge. Another key role for the agency is leading national activities that promote positive mental health, such as the agency's programs that build resilience in individuals and communities. We invest approximately $112 million a year in community-based programs that serve families living in conditions of risk, including poverty, social isolation, substance abuse, and family violence.
These programs address factors that affect mental health, including parenting skills, early childhood development, healthy pregnancies, and mental health issues such as post-partum depression. When we create supportive environments, there is a positive impact on mental health.
Supporting innovation in mental health promotion is a priority for us. Large-scale projects are under way across Canada to promote mental health, reaching children, youth, and families across the country. These projects, still under way, have already shown us positive changes in child and youth resilience, self-esteem and self-image, as well as in coping and social skills. For example, some of our school-based interventions have reduced aggressive behaviour, relationship violence, and alcohol abuse. They've improved school environments, and have been implemented in teaching curricula.
Our work builds on our international commitments, including Canada's support of the World Health Organization's resolution in support of a comprehensive mental health action plan for 2013 to 2020. Reducing mental health risks, such as exposure to domestic violence and child abuse, is a priority. As my colleague just indicated, recently announced an investment of $100 million over 10 years specifically to address the health needs of victims of family violence. This investment includes support for community-based projects to help victims rebuild both their physical and mental health following experiences of family violence.
Our public health work in mental health and suicide prevention involves a wide range of partners who are leading initiatives to better serve mental health needs of Canadians. We are partners with the Mental Health Commission of Canada and our work aligns with the Mental Health Strategy for Canada.
Thank you for the question.
The meeting that was held in the circumpolar region I think revealed a very real and important truth, that there is no one size fits all to address this important question. It's very important that approaches be based and anchored in the traditions of the society, the elements of the society, in which the problem resides. It's very important that the communities become engaged in recognizing the issues at hand, recognizing some of the issues that may predispose someone to attempt to take their life. Very much the initial message is that the social and environmental determinants of these disorders need to be given very strong prominence.
Having said that, at the other end of the spectrum, when we're delving into basic biological issues that might explain tendencies to commit suicide, some of the best work in the world is being done in Canada at McGill University by Gustavo Turecki and his colleagues. They have evidence now clearly indicating that early childhood adversity can affect epigenetic factors. I won't give you a lecture on epigenetics, but the key here is that we now are gaining a better understanding of how environment can influence the way in which our genetic code is read out. It doesn't change the code, but it changes the way in which genetic information can influence the structure of the brain, and hence our thoughts and actions. This is really, really promising, because epigenetics also could lead to biomarkers of a tendency towards suicidal behaviour, and perhaps to, in the long run, interventions.
Finally, the other point I would make is it's very clear that there's a close relationship between depression and suicide in all elements of Canadian society. Recognition of the need to treat early and effectively the first incidences of depression I think will also be an important step.
I hope that answers, in part, your question.
That's good, because I think one of the problems we face in a country as large as this, and with our provincial and other jurisdictions, is that we have gaps in our research and we tend to overlap in research. I think the Mental Health Commission may not be doing “traditional” research, but a lot of the programs they've put in, like At Home/Chez Soi, etc., can tell us how it impacts communities. I'm glad to hear you're working with them.
I want to ask the Public Health Agency of Canada a question. It's not an in-your-face question. It's simply that you've been collecting all this data. You and Health Canada have been looking at a whole lot of things.
At the same time, UNICEF just posted its report. You talked about coping skills and you talked about the fact that young people have a tendency to be the happiest. Actually, that's not true. The UNICEF report said that Canada ranked 24 out of 29 of the rich countries of the world in terms of happiness in their children. Canada's children are among the unhappiest in the world, and they say they cannot talk to their parents. That ranks them at 25 out of 28 in the world.
I think this is an issue. You have to have some relationship with your family, as you talked about, and we've dropped seven places in terms of that happiness index for children and children's relationships with their parents. We also have 35% of children in Canada, ranking us 21 out of 29 in the world, who are complaining about being bullied not only at school, but everywhere in the community.
I know that Rome is never changed in a day, but the bottom line is that this has been going on now for quite a while. What do you see as the barriers to being able to get what you're doing, and the data you're collecting, and the groups you're working with, to translate into actually positive outcomes for Canadian children? Your data, you said, is very difficult to come by, but are you actually working very closely? This is a place where provinces, schools, etc., should come together and start looking at this. What are your challenges to getting this done? Why are we dropping so much in terms of children's happiness and children's relationship data, and what do you think should be done about it?
Yes. We have a number of very important partnerships.
I am responsible for the partnerships between CIHR and its counterpart in China, called the National Natural Science Foundation. We have established over a 10-year period a very effective partnership with China. It came as a bit of a surprise to me when I met with the head of that agency and asked what their most pressing issues were. I was thinking cancer, or whatever. He said that one of the most serious problems in China is heroin addiction, that they have more than one million people addicted, and that anything we could do to help them with that problem would be most welcome.
We also work very closely with the European Union. In fact, we're one of the few, other than Israel, I believe, non-European countries that has a formal research partnership with the EU.
On another dimension of mental health, dementia, the loss of cognitive functioning later in life, which of course is a mental ill-health issue, we're partnered with the European Commission on the joint program in neurodegeneration in dementia, and we have a very active research collaboration in that area.
International partnerships are very important for CIHR, and Canadians are punching way above their weight.
I have one final statistic on this is in terms of the research papers that are published in Canada. Over 50% of the papers we publish are in partnership with an international researcher.
From the point of view of what's happening in schools today, we hear from partners who are working in schools, who are teachers, and who are designing curricula for schools, that bullying is a significant issue affecting the health and well-being of schoolchildren. In fact, we have funded an organization called PreVAiL that works as a research organization to prevent violence and to develop curricula for teachers so that they can, in the school setting, do a better job of helping students both understand bullying and how to prevent it and cope with bullying.
From the evidence that we have, and from the evidence that comes from surveys, like the health behaviour in school-age children survey that the World Health Organization administers, there's a significant problem in our schools with violence and with children being bullied and threatened. It's something that we at the Public Health Agency take very seriously from the perspective of our role in helping equip communities, and schools as part of communities, with the tools they need to understand this issue and do something about it.
In the children's programs that we're responsible for, we're focused on kids who are in very vulnerable situations, single-parent families, those who may be living in conditions that are not conducive to them developing, as children, the skills that other kids that come from more advantaged circumstances develop. In those situations, what our funding programs do is support on-the-ground community programs for kids and families, so they can come into a safe situation, talk about the issues that are affecting them, and get the help and support they need to develop the positive mental health skills that will see them into the future.
The evaluations that we've done of these programs are showing such good effect for these kids. When you visit these sites, you see the caring environment that is safe and where other kids of the same age are working with counsellors, and their parents are learning how to deal with difficult situations, you can see the value and the need for communities to advance these programs for vulnerable kids.
We come at it in two ways.
Thank you. That is an excellent question.
There is the National Native Alcohol and Drug Abuse Program, or NNADAP. I am sorry, but I cannot think of the program's French name right now.
We use certain indicators for this program. At the end of a treatment, for example, we can see whether or not an individual has abandoned one or more elements of their substance dependence.
We look at the same result after six months in order to see how the person is doing with their dependency. Such indicators are very common in treatment programs. We stick to that.
However, it is very difficult to conduct long-term follow-up of clients. There are limits to what we can do in that regard. We monitor these types of indicators to determine whether or not the results of treatment centres or programs we support are as good as those that exist for the general population and those that serve a non-aboriginal population.
There are also more activity-based programs, such as the suicide prevention program. These are often activities that have been developed in each region of the country. We conduct campaigns specific to these activities or projects. We will develop performance indicators to determine how many people, youth and families were involved in the program. What was the type of intervention? We often have to obtain the participants' opinions to determine how the program impacted them. Does it reinforce or diminish the problems in their environment? Does it give them more opportunities to deal with the difficulties that may be related to mental health or dependency issues? There are those types of indicators.
There are evaluations, but it is extremely difficult to know the long-term effect of these measures. That is the reason for our work with the Assembly of First Nations. By building a mental wellness framework we can determine how to reorganize these programs.
Over the past 25 years, Health Canada developed siloed programs on a piecemeal basis. We also tried to develop programs that would be the same across the country.
In consultation and partnership with many partners and experts, we are trying to use best practices in the framework developed in conjunction with the Assembly of First Nations. We want to define the overall framework and the fundamental components in this regard.
For example, culture was defined as one of the foundational elements for building resilience and recreating the connection with the environment, history and family to give purpose or better sense of purpose to life in the community. It is a matter of putting culture at the centre of all this and inviting communities that manage these programs to reposition the programs that we fund. These programs are not defined. They could be adjusted based on needs if they work within this framework and if all components are involved.
The evaluations revealed another reality. We are convinced that it is extremely important for an intervention to be firmly rooted in the communities and to have community control in order for it to be successful. However, there are types of specialized services that need to be provided at another level. Thus, we have started investing in mental wellness teams that provide more specialized services that can support a number of communities. We have also started providing crisis response because we cannot expect the organizations to have the capacity to deal with major crises.
The evaluations also made it possible for us to identify the gaps in what we were funding. Programs were adjusted over the years to create this new type of intervention. Mental wellness teams help communities supplement the services offered. As a result of the evaluations We make changes to what is provided based on the evaluations. I would say that the mental wellness framework developed by the First Nations, with the support of Health Canada, is a guide for the short term. Across the country, this guide is being received enthusiastically with a view to developing and repositioning programs so that services are offered more effectively in the long term. Therefore, I would say that the evaluations are useful.
The lessons learned over the past 10, 15 and 20 years that gave us direction are entrenched in this framework. Thus, I would invite the committee members to take a look at this. We are very proud of having developed the framework with the Assembly of First Nations.
We are now doing the same thing with the Inuit. In fact, if we believe that culture is foundational, we must also respect the fact that the Inuit have a different culture. We must therefore establish a framework based on their reality and their culture. That is what we are going to do.
That is something else we have learned over the past 20 years. Programs developed in Ottawa where we try to do the same thing just about everywhere are limited if we are unable to adapt them to the realities of the communities, environments and cultures in which we work.
This is an excellent question. I think in the programming that we are offering there has never been a hidden agenda to say this is not an existing problem. It's an existing problem, but we have missed an element that appears now in this framework, which is moving forward with helping people to participate actively in their community and in the economy.
There was one thing that we fell short of in the program. We were dealing with the crisis, dealing with the addiction problem, but then not really looking much at the aftercare and the support in the community. This is something that we are adding to the program, because to deal with the pure element of stigma we need to help the clients, those who are affected by these problems, to take back their lives and be active on the economic side, by going back to school...supporting there.
The connection with the other types of programs in the provincial and territorial services is also very important, because if we only take a health approach to it, we deal with the health issue. Really if we want to bring those who are affected by mental health and addiction issues back into having control of their lives, we need to have a connection with these other programs to help people move forward in their lives after they have been dealing with a crisis or an addiction problem.
Maybe this is not a straight answer to stigma, because we are so immersed in trying to deal with the issue that the element of stigma is not always coming up front. I think the way to deal with stigma is the addition of these components into our intervention, which is to help the person to move ahead with his or her life after treatment and deal with the addiction problem or crisis.
Thank you and have a good afternoon.
Mr. Chair and committee members, I'm delighted to be here today.
My name is Louise Bradley. I'm the president and CEO of the Mental Health Commission of Canada. I'd like to acknowledge my colleague, Jennifer Vornbrock, the vice-president of our knowledge and innovation team.
Let me begin by providing you with a brief background on the commission and its mandate. The commission was created in 2007, prompted by the work of the Senate Standing Committee on Social Affairs, Science and Technology and its study “Out of the Shadows at Last”, which called for a national commission on mental health.
The commission has a mandate to improve the mental health system and change the attitudes and behaviours of Canadians around mental illness. The commission is a coordinating agent, aligning and promoting the interests of governments, organizations, and persons with mental illness and their families. Our work brings together leaders and experts in mental health and facilitates widespread uptake on ideas, policies, and programs.
I'm pleased to report that in the 2015 federal budget, the Government of Canada indicated its intention to renew the commission's mandate for 10 more years beginning in 2017. The commission is thrilled to have the opportunity to continue its work, led by our new board chair, the Honourable Michael Wilson. Mr. Wilson has used his considerable talent and influence to champion mental health as a private citizen. Given his accomplishments to date, we can't wait to see what he's able to achieve with the full weight of the commission and our many partners behind him.
The commission's work continues to be guided by the mental health strategy for Canada, which was released in 2012. The strategy lays out actions to improve mental health care and its associated systems through six strategic directions. Since the release of the strategy, the commission has worked hard to ensure the strategy's uptake, sharing its recommendations with stakeholders across the country and around the world. I've heard from provincial and territorial governments that the strategy has become a foundational document and is used by them to develop their own mental health plans and priorities.
The reach of the strategy has been incredible, but the commission knows there are still barriers to its implementation across Canada. To assist in the implementation process, the commission initiated its own review of the strategy. After speaking with stakeholders and government officials, the commission has determined that the following actions would help drive the strategy forward: the coordination of mental health services and resources, including the integration of mental health, primary care, housing supports, and substance use services; the creation of an action plan, based on common priorities from the strategy, that demonstrates the next steps for those trying to implement it; and the improvement of mental health data, which includes better monitoring of current trends and the identification of data gaps. The commission looks forward to working with stakeholders and government to carry out these actions over the next decade.
The commission has also taken every opportunity to capitalize on the strategy as a guide for the expansion of our work. The issue of suicide prevention is of paramount importance, and we have been working on this issue for years utilizing our anti-stigma initiative called Opening Minds, workplace mental health programs, and knowledge exchange to provide tools and promote best practices.
We know that there is widespread support for this issue among parliamentarians, demonstrated by the recently passed Bill , which had support from all parties. Many of you also know about the #308conversations initiative launched last year by the commission and championed by member of Parliament. The campaign called upon all 308 federal members of Parliament to host a meeting in their respective communities with a focus on suicide prevention. The goal was to get people talking and to gather information about what interventions are available in communities.
As the second phase of this initiative building on the work of our anti-stigma initiative Opening Minds, the commission is developing a community-based model for suicide prevention. This model aims to adapt and implement an existing and effective suicide prevention program in the Canadian context. The model, developed by Dr. Ulrich Hegerl, is a multi-level, community-based suicide prevention initiative that has shown to be effective in reducing suicide by more than 24% over two years in a test community. The commission is currently working with stakeholders to determine the implementation of this initiative across Canada.
The initiative will build on another key commission program, At Home/Chez Soi, a participatory research project. At Home/Chez Soi demonstrated positive, cost-effective results for the housing first approach to homelessness, which provides persons who are homeless and have chronic mental health issues with immediate access to subsidized housing. Its participants were some of the most vulnerable Canadians who are highly stigmatized and who reported feeling isolated and being at high risk for suicide. At Home/Chez Soi demonstrated that people with chronic mental illness who receive no-barrier housing are more likely to stay housed and to report an improved quality of life. It also showed that for every $10 invested in housing first services for high-needs participants, the community saved almost $22 in avoided costs.
Because of its success, the Government of Canada decided to invest $600 million in the housing first approach through its homelessness partnering strategy. Through its innovative research, the commission was able to offer tangible and cost-effective approaches to improving the lives of Canadians who are homeless and have a chronic mental illness.
As part of our leadership on mental health systems transformation, the commission has also placed an emphasis on knowledge exchange and the sharing of best practices. At the heart of this work is the commission's Knowledge Exchange Centre, KEC, which provides numerous information-sharing hubs both online and through in-person gatherings. The KEC shares information about the commission's initiatives and additional best practices, ensuring that the information gets to the right people and that they know how to use it.
The KEC is also dedicated to improving the data and resources related to mental health. Next month they will continue with their launch of a set of national indicators on mental health that will provide crucial data on self-harm rates, the prevalence of specific mental illnesses, suicide rates, and rates of access to services. This data also identifies mental health indicators for subpopulations, such as LGBTQ youth and new Canadians. This information allows us to gauge areas in which the needs of Canadians are being met and in which there's room for improvement.
As you can see, the commission is working hard, as hard as it ever has, and we are ready to start making long-term plans for the next phase of our work. The commission is currently seeking advice from the Government of Canada, Health Canada, and other key partners about our new mandate. We've also been consulting with stakeholders and provincial and territorial leaders across the country to discuss shared priorities.
These discussions will form the basis of the mental health action plan for Canada, which provides goals and priorities for the implementation of the strategy. Just as the strategy guided the last decade of work, the mental health action plan for Canada will set the tone for the next one. By following through on the action plan, the commission can address urgent mental health issues, including suicide prevention, access, mental health supports for first responders, seniors, diverse populations, children, and youth.
In closing, I commend the members of this committee for identifying future actions at the federal level. There is still a great deal of work to be done. As with the commission's renewed efforts, it is the perfect time to redouble our efforts. This new chapter marks a time of pivotal change in Canada's mental health landscape, with more energy for system transformation than ever before.
I look forward to working with all of you and all Canadians as we continue our work towards our common goal of improving the mental health of Canadians.
Well, we already are playing a coordination role, and the strategy is well in place. It is now reflected in approximately nine of the thirteen provinces and territories, so that work is well under way.
The strategy was actually developed with the consultation of thousands of people, including our important stakeholders, such as the Public Health Agency, Health Canada, and others.
One of the key pieces of the work we do is that everything we do is done in collaboration or partnership with somebody else. In fact, we have well over 250 partnerships. We have been asked to continue that role by our stakeholders, and by the provincial and territorial governments.
We have only been in existence for eight years. We've achieved a great deal, but I think we're headed in the right direction.
So the short answer is yes, there is a strong coordinating role for the commission. It's one we've begun and we hope to continue.
Thank you for being here today.
Ms. Bradley, any discussion of mental health ends up being about suicide and also ends up being about substance abuse, addiction, and prescription drugs. There is a whole range of prescription drugs that are known to cause suicide. The acne drug, Accutane, is one of them, but most of them are antidepressants, and all the big pharma companies have at least one SSRI and SNRI.
Antidepressants are well known to cause serotonin syndrome, which is agitation, rapid heartbeat, seizures, and death, if you happen to suffer from that. They cause alcohol and drug abuse. They cause suicide. They cause bizarre acts of violence. In every school shooting that I have researched, the shooter was either on antidepressants or was withdrawing from them. These things generally do not get covered in the news. In fact, the German pilot who just crashed a jet into a mountain in Europe was taking antidepressants. He intentionally did that.
The U.S. military in Afghanistan had more suicides than soldiers who died in battle. That was also true of the British military in 2012, more soldiers dying of suicide than being killed in battle. It was the same with the Australian defence force, more suicides than soldiers dying in battle. U.S. veterans coming back from Iraq at one point were committing suicide approximately one every hour, so it was about 22 a day, and apparently, one out of four soldiers in Iraq was actually on antidepressants while in battle or they had been taken off the battlefield.
During that time, which was 2001 to 2009, the military orders for antidepressants from the drug companies went up 76%.
These are pretty stunning figures, and of course, no previous wars had any number of suicides like this. Of course, they didn't have antidepressants during the Vietnam War or World War II. However, the correlation between antidepressants and suicide is quite obvious, yet no one is talking about it and no one is doing anything about it.
Our authorities are sitting back and watching it happen. Our military doctors are dishing out these drugs and watching the soldiers go into battle on drugs that say right on the label they might make you suicidal or violent, and they cause psychotic reactions that result in suicides and murders, especially when soldiers come home. The most dangerous time is when you stop taking the antidepressants or when you increase the dose, which I guess sometimes happens when soldiers come home.
Now antidepressants are prescribed very widely in Canada. In some age groups, one out of four Canadians is on an antidepressant. We're the third-highest users in the world of antidepressants.
I want to ask you whether anyone has, to your knowledge, conducted research on the correlation between people who are on antidepressants or have been on them and are withdrawing from them and suicide.
Before I ask any questions, I want to congratulate the Mental Health Commission of Canada on the excellent work you've done in eight years. In eight years you have improved outcomes in mental health more than any other thing that has ever been done in this country in the last eight years.
I was going to ask you a question about a 10-year renewal of your mandate, whether or not you knew what resources were going to be given to you, and how you were going to be able to move forward on that. You say you are currently speaking with the government, so I won't put you in the difficult position of asking you a question like that.
Again, At Home/Chez Soi and all the work you've been doing in decreasing stigma has moved things miles in the last few years. Do you do any work on bipolar disorders with groups like the Schizophrenia Society and work with people who have a pathology? If so, perhaps you can tell me what you see as the next step that one should take in dealing with not simply the hospitalization of people with pathological problems, but also the ability to look at how we can support them instead of—as we know some provinces are considering doing—going back into institutionalization, which everyone knows was not the answer. Have you done any work on that? What do you see as good recommendations with these particular groups?
The second thing I want to ask you about is the absolutely severe policy with respect to the very few people in this country who are in prison because they committed a crime of violence because of mental illness, and the whole concept that these people should be locked up and the key thrown away. Have you done any work with people who are in correctional institutions and who have a concurrent mental illness?
I wonder if you could tell me about anything you know about both of those areas and what you see as a recommendation for dealing with them, and what you see as the biggest challenges right now to moving that agenda forward.
With regard to the Schizophrenia Society of Canada and the various ones in each of the provinces, we do work quite closely with them. We work very closely with the Mood Disorders Society of Canada along with the, I think, 17 members of CAMIMH, the Canadian Alliance on Mental Illness and Mental Health, and I know that you're familiar with that. So, yes, we work very closely.
We have stayed away to some degree from specific diagnoses, although there's a recognition that schizophrenia and bipolar disorder are among the more complex and more difficult diagnoses to deal with. The one thing all of these have in common are issues like stigma, and so they have been part and parcel of the Opening Minds initiative that we've been carrying on since the beginning of the commission. We are continuing to do so with a focus on children and youth, the workplace, health care professionals, and the media. Certainly the way that media reports deaths by suicide and so forth is something that impacts all of these organizations. While we haven't taken a particular diagnosis or diagnostic category, we do work very closely with all of them and we know them all extremely well.
With regard to corrections or prison health, which I think you were referring to, and concurrent disorders, we know there is a much higher incidence of people with mental illnesses and substance use problems in the corrections population both provincially and federally. I'm hoping that during the next phase of the commission we may have an opportunity to look at that a little more closely. As I mentioned, we do have a large number of stakeholder groups. We've made more progress with some than with others. Going forward, that is a very large number, when you combine all of the provincial and federal institutions and then the people in the community who it impacts. We do recognize that it's an important area. We haven't really made that much headway, but we have been devoting our efforts to other areas. Certainly with At Home/Chez Soi, we followed the progress of that population as they went through the justice system including corrections, so in that one area I would say we have made some progress, but we do need to do further work.
Thank you to the commission for your work and for being here today.
Before I get into my questions, I have noticed an error. On page 3 of your briefing notes, I think there's a word that should not be there. In the passage “reducing suicide prevention by 24%”, the word “prevention” does not fit in that sentence. It should be “reducing suicide”, not “reducing suicide prevention”. That's just in case it's in the record forever.
Ms. Louise Bradley: Thank you.
Mr. Harold Albrecht: But again, thank you for your work.
Two words have come out today that I think are important. One is “stigma”, and the other, for me, is “hope”. I'm so glad that has been highlighted already.
The #308conversations campaign has certainly provided a venue for many of our community personnel who are working in suicide prevention initiatives and mental health fields, and for people who have actually experienced suicide in their families to come and talk. In my area, four members of Parliament came together and hosted one of these conversations. We had roughly 100 people there for an all-morning event. It was certainly important. The personal one-on-one conversations, the social media, the activity around that, and the print and broadcast media all helped to highlight and in that way remove a lot of the stigma that's evident. We had front-line workers, volunteers, hockey and baseball coaches, school board personnel in terms of training for teachers and so on—all were important. We finished the afternoon with a safeTALK model. We actually received personal training in that.
I have two questions relating to #308conversations. First, I think originally you were hoping to have it from May to August 2014. You extended it to May 2015. At this point, do you have a number on how many members of Parliament actually did participate in that initiative?
Thank you for that excellent question.
Yes, we have done quite a bit of work in this area. I will tell you about one recent initiative that we embarked on specifically for teenagers. With our Opening Minds, our anti-stigma initiative, we have something that's called Headstrong. Last spring we brought together about 130 teenagers from every province and territory in the country. We've learned from our research in anti-stigma that the most effective thing to reduce stigma and how we think about people with mental illness and more importantly discrimination, the behaviours that result from it, is contact-based education.
We had these kids together for a whole week. They were exposed to peers with mental illness. We heard their stories and then we equipped them with education and a tool kit to go back to their own high schools to conduct similar summits. I was at one just a week ago in St. John's where one of the participants brought together over 400 students from every high school in the province of Newfoundland and Labrador. There was also another one in B.C., where it was a much higher number of course. There are plans to hold individual summits. It's a bit like a spiderweb going across the country.
We also work collaboratively with things like the Jack Project and other groups.
We do target youth in particular. In terms of our strategy, by the way, for any of you who don't want to read through the whole mental health strategy for Canada, if you read the youth version, it's about a third of the length and is very direct and straightforward. The youth council took the entire strategy and rewrote it in youth-speak, so to say. They have caricatures throughout all of the strategy, and neither Michael Wilson nor I was particularly happy with ours, but it was a wonderful initiative by our youth to talk about the impact of them in their school system.
I can speak to the workplace specifically as well. I will first see if I have answered your question or if you would like me to elaborate more.
About a year and a half ago the commission, again the world's first and as far as we know still the only psychological safety standard in the workplace, was developed. We did this in partnership with subject-matter experts. We did it with the Canadian Standards Association, BNQ, and several other corporations. It addresses the whole issue of mental health in the workplace.
Once upon a time, and this probably still is for a large number, mental health was something outside that you did. It was separate. Yet the place where we spend most of our waking hours is fraught with mental health dangers, if you will, and the opportunity to have mental health promotion and prevention. The psychological safety standard for the workplace is designed just in the same way that we all have health standards in our workplaces. For example, we know that everybody in a construction site needs to wear a hard hat. The psychological safety standard actually looks at what's happening inside the hard hat. We now have a guide that shows companies, businesses, governments, and organizations how to implement the standard. It's a very comprehensive, easy-to-read, clear, outline as to how to do it. We're now halfway through a three-year study following 40 businesses and organizations that have implemented the standard to see about the costs, how it impacts morale, how it impacts disability, absenteeism, and that sort of thing. It's also been adopted in other countries around the world. We are continuing to pursue that, but it's a very promising initiative.
Thank you very much for hosting one of the #308conversations. That was very important.
With regard to the mental health action plan, we have now hosted round table discussions in all but two or three provinces and territories, and our intent is to hold them in every province and territory.
We're hearing from people as to what they think needs to go forward. We think we know, but we don't know for sure. It's been a while since we've consulted with them on the strategy. We also have an online survey. We also have a mechanism for consulting with average Canadians next month. That will give us information from people who haven't traditionally been invested in the topic, but we would like to see that.
We don't want the strategy to sit on a shelf and collect dust, as lovely a document as it is. Even though we're two years ahead of plans, I think it's really important to now look at what this means and what it would look like to have the mental health strategy. What priorities should we concentrate on now and in the long term in order to really bring the strategy to life?
We've done a bit of a provincial and territorial environmental scan to see how well it is or it isn't happening. Of course, not surprisingly, it's done differently in each of the provinces. That's not to say that one is any better or worse than the others. They're simply different.
Where should we concentrate next? I think that's in line with our work on mental health indicators, which is the first time that we've had them identified in the country. That will really put us in good stead to present to our board of directors in June the findings of the culmination of all of these discussions, the survey findings, and our citizens panel. I think that's really where we need to go during the next phase of the commission's work, along with all our stakeholders and partners.