Good afternoon, everybody. I'm calling this meeting to order.
Welcome to meeting number 32 of the House of Commons Standing Committee on the Status of Women.
Pursuant to Standing Order 108(2) and the motion adopted on Tuesday, February 1, the committee will resume its study of the mental health of young women and girls.
Today’s meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022. Members are attending in person in the room and remotely using the Zoom application.
I would like to make a few comments for the benefit of our witnesses and members.
Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mike, and please mute your mike when you're not speaking.
For interpretation for those on Zoom, you have the choice at the bottom of your screen of floor, English or French. For those in the room, you can use your earpiece and select your desired channel.
I will remind you that all comments should be addressed through the chair.
For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function.
I'm going to remind people that we do have all of our witnesses on Zoom today. They should all be showing up shortly.
If I start to interrupt you, witnesses, I'm going to ask if you could wind it down within 15 seconds.
This is a bit of a trigger warning. As we all know, this study is very difficult. We will be discussing experiences related to mental health that will be triggering to viewers, members or staff with similar experiences. If you feel distressed or if you need help, please advise the clerk.
I would now like to welcome our witnesses for today's meeting. As I said, everyone will be on the screen.
On the panel, we have, as an individual, Dr. April Elliott, adolescent pediatrician, and Dr. Ryan Van Lieshout, associate professor, McMaster University, and he too is here as an individual. From the Kids Help Phone, we have Alisa Simon, executive vice-president and chief youth officer, E-mental health strategy, and from Klinic Community Health, we have Karla Andrich, counsellor.
Each of you will be provided five minutes for your organization's presentation.
I'm going to give the floor to Dr. April Elliott for five minutes.
Hello, and thank you for inviting me to participate today.
For those of you who haven't met me, my name is April Elliott. I'm a devoted mother of two youths. My profession of 21 years has been as an adolescent pediatrician and founder and head of adolescent medicine at the Alberta Children's Hospital in Calgary, Alberta. I'm also a certified executive coach trained at the University of Berkeley, and I work with physicians to support their burnout and proactively support their career development. I also coach parents to be more successful in their parenting interactions with youth.
As a frontline clinician, I have witnessed a dramatic increase in morbidity and mental health decline in youth from 2001 to the present. The availability of developmentally appropriate resources has not kept up to the rise.
As we all know, the 2020 UNICEF report card shows that Canada is shamefully lower than other rich countries in providing healthy childhoods. Of comparator countries, concerning physical health, Canada dropped to 30th of 38, and for mental health, to 31st of 38.
There are myriad topics related to youth health. This brief statement will discuss concerns related to the mental health of young women and girls, more specifically eating disorders, as this is my area of expertise and it was drastically impacted over the last two and a half years.
In March 2021, I published a paper with Professor Deborah Christie, “A year supporting youth within a pandemic: A shared reflection”, in the Journal of Clinical Child Psychology and Psychiatry.
We summarized the impact of the COVID mitigations, school closures and the mental health impact on young people in the U.K. and Canada. The data began to emerge that the pandemic was causing a range of harms to children, including feeling isolated and lonely; suffering from sleep problems, anxiety and depression; and reduced physical activity.
Charities reported increased demand for counselling, with many young people talking about how lonely they felt. Calls to kids helplines increased fourfold from 2019 to 2020. There was also a risk in harm for those living with emotional, physical and sexual abuse.
Many colleagues worldwide described an “explosion” in eating disorders.
With regard to eating disorders, the prevalence of anorexia nervosa in adolescent females is 0.3% to 0.7%, with an incidence estimated at eight per 100,000. To put this in perspective, this compares to a minimum incidence of 1.54 per 100,000 per year of type 2 diabetes in Canadian youth.
Anorexia nervosa is a complex bio-psychosocial disorder that interacts with pediatrics and mental health. It is an illness that can be debilitating for patients and their families. The majority are young girls and women.
Eating disorders are common and are life threatening. Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Mortality is as high as 5% to 7%; some report as high as 18%. With these significant medical and psychiatric consequences, an individual is 10 times more likely to die than their healthy peers are.
Globally we have seen unprecedented numbers of hospitalizations related to new and severe cases. Patients are severely malnourished, with increased medical complications.
The COVID pandemic is a common precipitating factor noted by patients and families. They note school closures, loss of sports, and not being with peers. A recently published Canadian pediatric surveillance program supports this.
These are my recommendations:
One, it is very costly to treat in a hospital setting, so early recognition and treatment by primary care physicians is essential. This education needs to be mandatory in medical schools.
Two is increased resources for timely referral and access to trained and qualified health care providers in delivering evidence-based outpatient treatment modalities for eating disorders.
Let's suppose a young person needs hospitalization for a moderate to severe eating disorder. In that case, they need specialized units or staff on generalized units with integrated training carrying out these guidelines. These are few and far between, and many Canadian cities do not have them. The Alberta Children's Hospital has a catchment area of 2.5 million and has no specialized eating disorder in-patient unit.
With regard to general mental health for youth, I would recommend providing more support for young people. It was already significantly stretched. We must prioritize teachers, school mental health and increased resources. We need to focus on this COVID generation.
Parity of esteem for mental health alongside physical health care is an absolute priority. Health care has a long history of not integrating mental and physical health. There must be significant investment in ensuring timely mental health access for appropriate mental health care where the young person lives in cities or rural settings.
Finally, in addition to bolstering the investment in mental health programs for children and youth, we mustn't forget we need to ensure there is support in place to strengthen and champion increased human and financial resources for health care practitioners in these areas, who are also on the brink of immeasurable burnout.
Thank you, Madam Chair.
Good afternoon. I'm Dr. Ryan Van Lieshout, the Canada research chair in perinatal mental health and Albert Einstein/Irving Zucker chair in neuroscience at McMaster University.
I'm a member of the Royal Society of Canada and a perinatal psychiatrist whose research focuses on developing scalable psychotherapeutic interventions for those with perinatal depression and anxiety, and optimizing their impact on offspring brain development. The primary goal of my work is to disrupt the intergenerational transmission of psychopathology from parents to their children in Canada and around the world.
My clinical expertise led me to be invited to lead the development of Canada’s national practice guidelines for the treatment of perinatal depression and Public Health Ontario’s perinatal mental health tool kit for public health units. Throughout my career I have seen the devastating effects that mental health problems occurring during pregnancy and the postpartum period can have on children and families, and have committed my career to preventing these.
Perinatal mental health problems affect up to one in five mothers and birthing parents, rates that increased to one in three during the COVID-19 pandemic. Every case of postpartum depression alone is associated with costs of up to $125,000 over the lifespan, or $2.5 billion for each single year of births in Canada. The offspring of mothers with postpartum depression are up to five times more likely to develop a clinically significant behavioural problem, and up to four times more likely to develop depression in their lifetimes. Even though effective treatments can help both mothers and their children, as few as one in 10 pregnant and postpartum persons are able to access evidence-based care in Canada.
There are many barriers to the receipt of timely perinatal mental health care in this country. In addition to time, child care, travel and a lack of providers, most individuals prefer talking therapies or psychotherapy over medications, particularly during pregnancy and lactation. Even though Canada is a world leader in the development of scalable psychotherapeutic interventions for perinatal mental health problems, there is still a lack of providers, national quality standards, stepped care models and coordination.
However, there are many reasons for hope. Stepped care pathways, those that match individuals to the right treatment at the right time, could substantially increase the number of women receiving effective treatment, as can the application of scalable Canadian-made interventions and the task-sharing of psychotherapy delivery with non-physician health care professionals like social workers, psychologists, occupational therapists, and individuals who recovered from postpartum depression and anxiety, often referred to as recovered peers.
Our research group alone has developed and tested several effective scalable interventions that can be delivered by health care professionals or recovered peers, and it can serve as both initial and later more intensive steps in stepped care models. For example, our one-day cognitive behavioural therapy-based workshop for postpartum depression can effectively treat up to 30 individuals at a time and be delivered online or in person by health care professionals or recovered peers. Our longer nine-week group cognitive behavioural therapy intervention has also proven effective for those with higher symptom severity, and its delivery has already been successfully task shifted to recovered peers and public health nurses with limited to no previous psychiatric training. These scalable group interventions have proven effective being delivered in person or online, and a half a dozen public health units in Ontario, including those in Niagara and Prince Edward County, are now being trained to deliver them to mothers living in the community.
We and others have also shown that treating mothers not only benefits them, but their entire family. Up to 70% of the costs associated with perinatal mental disorders are due to their downstream effects on daughters and sons. Recent research by our group has shown that treating mothers with postpartum depression leads to clinically meaningful improvements in mother-infant interactions, infant brain development and emotion regulatory capacity, and even the mental health of older children in the home. This is in keeping with research from around the world that suggests for every dollar invested in early childhood interventions, society reaps a seven-dollar return.
Perinatal mental health problems in Canada can be prevented, detected and treated, and we already have the know-how to support mothers and disrupt the intergenerational transmission of mental disorders in families. The federal government can help by working together with experts to create national quality standards and to develop Canadian-specific stepped care pathways that can support the training of professionals and lay people in the delivery of treatments. Such developments will enable our Canadian-made discoveries to be scaled to improve the lives of women, girls, and all Canadians.
I look forward to working together with you to help make Canada the best country in the world to be a woman or girl.
Thank you so much to Madam Chair, members and staff of the Standing Committee on the Status of Women.
I am thrilled to be here today. My name is Alisa Simon and I am with Kids Help Phone.
For over 33 years, Kids Help Phone has been on the front lines hearing from young people from coast to coast to coast and from every single province. We hear from young people starting from about the age of five and we have no upper age limit. Young people come as long as they want and use our stepped care model to find the kinds of services and supports they need.
We have always been a critical part of the mental health infrastructure and system for young people, but since COVID, that need has exponentially grown. In fact, since the beginning of COVID, Kids Help Phone has supported young people over 12 million times, which is a significant increase from 2019 when we supported young people about 1.9 million times.
Of the young people who reach out to us at Kids Help Phone, 74% identify as female. They reach out about every challenge a young person experiences, from bullying, depression, anxiety and relationship issues to suicide.
Although we hear from young girls and women across the age spectrum, 46% of our users are in the age range of 14 to 17, which is a particularly important time in the development of young girls. We see that the challenges they're facing change over time, which makes sense for anyone who is around young girls and young women.
Not surprisingly, younger girls come to us in very high numbers about bullying and relationship challenges. In fact, girls aged five to 13 are 120% more likely to talk about bullying and cyber-bullying. That is quite detrimental to the well-being of young girls. We know that it can lead to anxiety, poor body image and lowered school performance.
It is also worth noting that younger girls are more likely to reach out to us about eating disorder and body image challenges. In fact, girls aged five to 13 are 34% more likely to reach out about those challenges.
As girls age, their challenges change. We see, for example, that 18- to 24-year-olds are more likely to come to talk about anxiety and stress. Interestingly, over the course of COVID, young women aged 25 and older have been coming 60% more often to talk about grief, which I think makes sense given so many of the losses we have all gone through over the course of the pandemic.
Perhaps most sobering is our data on suicide. Over the last five years, we have seen a significant increase in young people reaching out to talk about suicidality. In fact, about 23% of all girls and young women who connect with Kids Help Phone are reaching out about suicide. Of girls aged 14 to 17 who connect with us, 45% are talking about suicide. Perhaps even more surprising is that 21% of girls aged five to 13 talk about suicide. I think that is quite shocking to many people, as we don't anticipate that younger girls are even thinking about issues around suicide.
The good news I want to make sure I leave people with is that we are able to help the vast majority of young people who reach out to us. We are able to form a safety plan with them. Only about 2% of our contacts of people talking about suicide require an emergency referral.
I also feel it's really important to focus on equity-deserving populations, such as indigenous, Black and 2SLGBTQ+ people and newcomers. We know their experience in Canada and their experiences around social determinants of health are not the same. We know from our data that they are all struggling with one thing in common, which is isolation and feeling disconnected from others like them.
Social isolation can lead to a lot of negative outcomes and it seems particularly prevalent for equity-deserving populations. One reason we started our peer support service last year was specifically so that young people can connect to others.
Our data also demonstrates, for example, the incredible impact of racism and discrimination on young people from equity-deserving populations. After the murder of George Floyd in 2020, we found that young people who reached out and discussed racism were more distressed than any other service user, except for those who feared harm in their own home. They were more likely than any other service user to discuss suicide.
In closing, I have three recommendations.
We need to focus on equity-deserving populations and the specific needs they have.
We need more in school supports at every age along the spectrum to not only talk about mental health, but equally important, to talk about seeking help, what it means to not feel good and why reaching out is important. Kids Help Phone has been doing this in middle schools for many years, and just launched a high school program. Next year we will be launching an elementary school program.
Good afternoon, honourable members and fellow witnesses.
Thank you for the opportunity to speak today. My name is Karla Andrich and my pronouns are she/her.
I am joining you today from the Treaty One territory, which is the traditional territory of the Anishinabe, Nêhiyawak, Oji-Cree, Dakota and Dene peoples, and the heart of the Métis Nation.
My personal relationship to those treaties is that I am a descendant of settlers. My great-grandparents and great-great-grandparents built their generational wealth from land that was never ceded. I carry the benefit of that wealth and also the responsibility to work toward justice and decolonization.
I am a counsellor at Klinic Community Health, an agency in Winnipeg, Manitoba. We've been in operation for about 50 years. We promote health and quality of life for people of every age, background, ethnicity, ability, gender identity and socio-economic circumstance.
I’ll be speaking today through the lens of my work, providing one-on-one trauma counselling with survivors of sexualized violence, the vast majority of whom are women, girls, and gender minorities, with the acknowledgement that indigenous and 2SLGBTQIA+ folks are disproportionately targeted by those who perpetuate sexualized harm.
I hope to bring your attention to three main points today: the harm that systemic sexualized violence perpetuates; the need for trauma-informed care within systems; and the need for greater funding.
Sexualized violence is a web of daily microaggressions, systemic inequalities and acts of overt interpersonal violence, which include sexual assault, sexual harassment, gendered discrimination, and also the backlash that women, girls and gender minorities face when they speak out. It is also an integral part of colonial harm. Indigenous women, girls and two-spirit folks are disproportionately represented among the people that we see at the hospital through our advocacy work.
I have personally sat with so many indigenous folks at the Health Sciences Centre here in Winnipeg, from mature women, matriarchs of their families, to girls just 12 and 13 years old. So many of them tell me that this is just a reality in their families, that their mothers, grandmothers, aunts, cousins and siblings have all experienced some form of sexualized harm.
Contributing to this is the systemic lack of trauma-informed care in the justice system, the medical system and other supports, such as EIA, colleges of physicians, and other peripheral systems that survivors may engage with. My first counselling job was at the University of Manitoba, and it broke my heart seeing the profound impact that experiencing this harm had on my clients.
Finally and crucially, access to counselling is underfunded. Many survivors can’t afford private therapy to help them recover from their traumatic experiences and spend months to years waiting for care at agencies like Klinic. This translates to months and years of greatly diminished quality of life, lost opportunities, lost jobs, education, relationships and contributions to their communities.
My suggestions for action today are that it is imperative we value the lives, futures and happiness of women, girls and gender minorities as equal to those of men and boys. We need to more deeply commit to implementing the 94 calls to action put forth by the Truth and Reconciliation Commission, especially calls to action 21 through 24, and 41. Trauma-informed training should become mandatory for any person or agency which provides care, reviews complaints or enforces laws or policies around sexualized harm. Finally, we need to greatly increase funding for survivors to access free counselling, legal support, system navigation support and advocacy.
My team at Klinic consists of just two full-time and two part-time counsellors. We have a coordinator. We have a few part-time advocates. We have volunteers of whom we ask too much, because the need is so great.
Essentially, we need more money. Every agency that provides this kind of care needs more money. We are stretched thin and constantly are trying to balance the needs of our crisis program, which intervenes for people in the immediate aftermath of a sexual assault, and our counselling program, which provides ongoing therapy and public education.
We are constantly stealing from Peter to pay Paul. Ultimately, it's the survivors who suffer. Money is how we as a society indicate how important a particular issue is to us. Canada needs to invest in our women, girls and gender minorities.
At Klinic, we deeply appreciate the money that has come to Manitoba recently to help bolster our crisis services. It would be very helpful to also get money to support the other half of our advocacy and counselling work, which is for ongoing support for people, as these kinds of experiences take time, effort, and support to recover from.
Thank you very much for your time today.
That's a great question.
All of us in the charitable sector really appreciate funding that is undesignated, which allows us to use it in the ways we most need.
In order to be successful and build scalable solutions, you have to have a funding model that takes in government support, corporate support and donations. By doing that, you're able to, hopefully, bring together a model that allows you to pay for things that may be a bit less exciting. You have to pay for payroll and IT. Those administrative costs are real. However, what many donors want to pay for are the things they can see directly: a product being developed, or something that's directly going to young people.
The reality is that we have to be supporting charities to understand how to build a robust way to support themselves. Looking at all those different ways: government, corporate and philanthropic. Not all charities have the ability to do that, based on their fundraising staff or whether they even have fundraising staff to do that.
At Kids Help Phone, our ability to scale to meet COVID was partly due to shifting our funding model to accept more government funding, for example. We are incredibly thankful to partner with the federal government in so many initiatives. Without that, we would not have been able to scale to meet the huge demand that came in as a result of COVID.
Thanks so much for that question.
I think one of the things that many survivors struggle with when they come forward is the stigma of having experienced sexualized violence. Our program attends hospitals, but, of course, we have to be asked to come. There is a fairly good follow-through between folks we have seen at hospital and folks who use our crisis lines. There is a bit of a disconnect, I think, between those numbers and the demographics with respect to who comes to ongoing counselling, which I think speaks to sort of what Alisa was talking about in terms of engagement with community and knowing that the services are there so someone can even think about reaching out to them.
I think it goes back to money for engagement, as even Dr. Van Lieshout was talking about, in terms of preventive care. That is also about public education and building relationships with communities and having the funding to run programs like that and the ability to—given our own knowledge of what is needed on the ground floor, at the sort of boots-on-the-field level—direct money to where those things are going to make the most impact.
Thank you, Madam Chair.
I want to thank the witnesses for being with us today.
In spite of their difficult experiences, they have solutions to offer. I thank them very much for their contribution to this study of the Standing Committee on the Status of Women. We are pleased that they took the time to participate. Their input is very valuable.
I said it at the beginning of the week and will repeat it now, because this is an important week: it is the week of the mental health awareness campaign of the network known as Réseau avant de craquer, and it is also Mental Illness Awareness Week. This year, the theme is that behind every face is a history... and in front of every person is a solution. Constructive action is needed to move forward.
This year, in response to the pandemic that affected the entire population, the campaign focused on people of all ages who are helping someone with a mental health problem by showing them it is possible to remain balanced while also being part of the solution. This is important; it is crucial.
I'm not sure who should take my first question, because I think all the witnesses could answer. I will direct it to Ms. Simon, from the Kids Help Phone.
Ms. Simon, the Kids Help Phone is a frontline resource for individuals with mental health problems. Your website provides a variety of interesting information.
As you indicated in your presentation, there has been a sharp increase in the use of your services since the start of the pandemic.
Can you tell us more about this increase? What changes in behaviour have you noted in women and young girls who have used your service over the past two or three years?
Yes, we have seen really significant increases in the volume of young people coming to us, and also in the ways they are coming. We continue to see very high volumes on our phone line, but we are the only 24-7 texting service in Canada, so we have also continued to see very high volumes in young people texting us.
Just as before the pandemic, our busiest times are when everything else is closed, so into the overnight hours we are very busy with young people who are reaching out. They are often reaching out with more serious and significant issues, particularly suicide. If you imagine a young girl where everyone in the family is asleep and they can't sleep, that is the moment they pick up whatever device they have and reach out to us.
Certainly at the beginning of the pandemic we saw large increases in young people reaching out about abuse and neglect. Again, everything was closed. The places that are often reporting abuse and neglect, like schools, were not able to do that, so young people were coming directly to Kids Help Phone.
Over the course of the pandemic, body issues—as was brought up earlier—and eating disorders came up in really high numbers, as did isolation and anxiety. Young people were increasingly talking to us about the challenges of missing out—missing out on graduation, on sports, on all of those things that they were used to, or they had been looking forward to.
As we have continued through COVID and things feel like they may be getting back to a little more normal—young people are often back in school now, face-to-face—we continue to see high levels of anxiety as young people are trying to figure out what the new normal is. Can you go to school with your mask or not? Are you able to hang out with your friends? When do you stay home?
Like many of us, young people are still navigating this new world. It's not back to normal. It is a new normal, and we don't know exactly what that is yet. As we, as adults, are anxious about that, certainly the young girls and young women in our lives are as well.
We continue to see a new normal in terms of volume, but in terms of the issues, there are some new things, again, around missing out and anxiety, but a lot of the challenges are the same as we saw prepandemic in terms of suicide, depression, anxiety and relationship issues.
Of course, we know that poverty has a detrimental impact on physical and mental health.
Ms. Andrich, you talked about working with communities that are on the margins, in particular indigenous communities, many of whom struggle in poverty here in our province. One of the things we've heard about from other witnesses is the importance of taking poverty seriously when we're talking about the mental health of children.
My colleague Leah Gazan, who is the usual member on this committee, has put forward legislation around a guaranteed livable basic income and the need to take concrete action to eliminate poverty in our country. I'm wondering if you think we should be looking at these kinds of measures as a way of also supporting the mental health of young women and young people in our country.
Thank you, Madam Chair.
Thank you to the witnesses.
To start with disclosure, I'm the mom of two teenage girls, so this very much hits home for me. Our teenage girls are overwhelmed. Parents are overwhelmed. There are teachers who are overwhelmed. There are a lot of people in a dark spot right now.
Raising teenagers in 2022 is an entirely different experience from the one my parents had raising me in the eighties and nineties. Social media didn't exist. Talking about mental illness didn't happen. COVID hadn't happened. Eating disorders weren't trending. Bullying has always happened, but it's been taken to a whole new level. It's out of control. In some cases, teenagers are now even contributing to families' finances, because the cost of everything is outrageous. The pressure is extremely real. It's almost like it's the perfect storm.
I would like to pose my first question to Dr. Elliott.
I'd like to dive into the punitive damages that our young girls and youth in general are experiencing as a result of COVID. They're missing out on graduations. They're missing out on sports. They're talking about isolation.
Where do you think we can find additional accountability? What can we do differently? What can the government do differently next time, if there's another pandemic?
Thank you very much for that question.
I have to take a breath, because I have a lot of professional thoughts about this, but I also have a lot of personal thoughts about this.
Children were at the absolute lowest risk of impact from the disease, yet they were the ones who suffered the most. We wrote an evidence-based letter back in February 2021 to say that children should be returning to sports, that they were safe to do so and that we were very much supportive of kids being in school and doing their sports. Still, I saw in many jurisdictions that kids were limited.
This can never happen again. These restrictions and mitigations, we see now—parents will tell us; youth will tell us and the evidence is telling us—were related to isolation, lack of control, and an inability to meet their developmental milestones. With that, I would say this can never happen in this way again.
We can't undo what's happened, but going forward, I hope we use the evidence from families, from youth and from the evidence in the literature to never have these lockdowns again.
Continuously we have heard that we need to increase resources, that we need more support, that we need to address the people who are help-seeking, that we need more in-school support and that we need to increase spending. We have continuously heard this from our witnesses.
My last question is posed to Ms. Andrich.
Which barriers, if any, might young women and girls in Canada face from accessing specialized and specific mental health supports and services? I know we have the telephone helpline, but with regard to the Internet, what can the government do?
Amazing. Thank you, Chair. It's my lucky day.
Thank you to all the witnesses, first of all, for the incredible work you all do, which is so important, and also for sharing your time and expertise with us today.
I'll add the caveat that I am also a mother of three teenage girls, so I live and breathe a lot of these struggles as well.
I echo one of my colleagues who was just saying how difficult COVID has been for parents and children, and young girls in particular. The provincial decisions when schools were closed were difficult decisions that we all lived through. One of the witnesses referred to the COVID generation, which I hadn't heard before. It is so accurate.
I'll direct my first question to Dr. Van Lieshout.
You had a few recommendations. One was around Canadian-specific stepped care pathways. I would appreciate if you could walk us through what you believe that should look like.
stepped care pathways are the systems by which we deliver and monitor psychiatric treatments so that the most effective and least resource-intensive treatments are applied at the right time.
In Canada, we have remarkable strength in perinatal mental health research, leadership and clinical work. There aren't many of us, but those of us who are here.... Well, my colleagues are great; I'm just okay.
When we're talking about a stepped care model, I think we'd be talking about starting with some quality standards around preconception information and prevention, as well as detection, assessment, intake and treatment. All of this would be, of course, measurement based.
We have lots of wonderful measures in the perinatal mental health space, like the Edinburgh postnatal depression scale and so forth. We'd be talking about trying to identify those individuals who require treatment and then identifying some low-intensity treatments that could be used by most.
There is a model within the Ontario structured psychotherapy program that could be used, whereby classes and self-directed psychotherapies.... CBT-based would usually be a low-intensity intervention. We would monitor responses to those interventions and determine if people needed more, if they had a poor treatment response, if the treatment wasn't good for them or if they didn't agree with it. Then we could move up to higher-intensity treatments, like individual or group-structured evidence-based psychotherapies, cognitive behavioural therapy, interpersonal psychotherapies and things like that. Then we go to medications and so forth.
Thank you very much, Madam Chair.
Thank you all for being here this afternoon. These conversations are very informative.
I will start with you, Dr. Van Lieshout.
You said we need to work to make Canada the best country in the world for our women and girls. I thinking everyone shares that wish.
You suggested that such well-being starts long before the baby is in the cradle.
I am concerned about women who suffer from postpartum depression. What are the potential negative effects for newborns when their mother suffers from postnatal depression?
How long does it affect the child? What effects have you observed?
Thank you, Madam Chair.
Many thanks to all the witnesses for being here.
My questions pertain to national standards. We all know of course that health is a provincial matter, but I want to state clearly that the federal government also has a role to play. We have to find a way to work with the provinces and reach bilateral agreements, which are currently under negotiation. These agreements represent $4.5 million in funding over five years.
We heard from the Royal Ottawa Health Care Group a few weeks ago. You touched on that briefly today, namely, that the system has gaps and it is very difficult for parents and individuals to navigate through the system.
I am trying to get a better understanding of certain aspects, specifically services relating to community expansion, mental health, addictions, youth aged 10 to 25, and early intervention. I am not necessarily asking all four witnesses.
Dr. Van Lieshout, you also mentioned the lack of coordination among the various organizations. For example, I was in Sudbury with for a round table discussion. The groups in attendance said there were about 6,000 organizations—an exaggeration—and very little coordination.
I'll start with Dr. Ryan Van Lieshout and then go to Dr. Elliott.
What can you inform this committee about on best practices, evidence-based, to finalize these bilateral agreements so that the money could flow with the provinces and the federal government? Maybe you could answer in a minute each.
Thank you very much. I really appreciate the question.
We have to look at where the most expensive care is, and the most expensive care is in hospitals.
When we can work with community to make guidelines that include the amazing work they do, move things into community and partner with community agencies, such as for community beds, or beds where young people do not need to be in a clinical setting but maybe still need some high-level care, those are the places I think we need to start.
We need to have a national standard for that, so that each program in each province isn't developing their own standards, because it's costly. I think this is essential.
I'll quickly add two things.
One is that, while it is a provincial responsibility when we think about health care and mental health care, I think there is a critical role for the federal government to end inequities based on where you live and to end duplication in spending.
I actually don't know that we need a gigantic amount of more funding. We do need some more funding for mental health, more focus on mental health. However, we also need to be better at spending the dollars where the evidence shows it works and moving people from the most expensive services to potentially less costly services that will meet the needs.
We have to ensure that we are spending our money—and that's where we get to the stepped care model that Dr. Van Lieshout spoke about—in a way that makes sense to that end-user. Often that can be a lower cost, a lower step, on that stepped care model.
That does require national thinking. Otherwise, we set up many different, diverse provincial and territorial spends that all have costs, duplicate and aren't necessarily using the resources that already exist or the evidence that already exists.
I think one of the things would potentially be for the federal government to recommend programming within schools. There are examples in the U.K. Their helpline, Childline, is in every single classroom in the U.K.
Right now, with a program like what Kids Help Phone offers, or others, we have to go jurisdiction by jurisdiction or work with the ministry of education in that province or territory to try to get into schools.
We could have a much more streamlined approach from a recommendation by the federal government that every single young person, for example, is connected with Kids Help Phone three times through their education, or that every single young person receives education on help-seeking, stigma and mental health. Those kinds of recommendations could go very far down into ministries of education and be able to get these things into schools.
Thank you very much, Madam Chair.
My question is for Dr. Van Lieshout.
Unlike my colleagues, I do not exactly feel like Superwoman right now. I am trying to balance my job with being a mother to an eight-month-old little girl. As I already said, I am even wondering if I can do a good job as a mother and also as an MP. So I understand the tremendous importance of mental health for young mothers.
I would like to get back to the fact that we all agree that we need more investments in mental health. Someone said that it might not be huge amounts, but we still need to invest. You said so earlier, as the community organizations did at our last meeting. They do outstanding frontline work with people grappling with mental health problems. They need help and funding, because of the massive growth in demand and in needs. One way to help these organizations is of course to recognize that they need more funding in order to hire more people and extend their hours of service.
Dr. Van Lieshout, how important is it to recognize that health transfers represent an investment in health and that the federal government is working to inject more money into the system to give our departments larger budgets? How can that help organizations on the ground respond to growing demand?
Congratulations on the birth of your eight-month-old. You seem to be doing an awfully impressive job as a mom and MP, but I will stop being ingratiating.
There are a lot of remarkable people doing remarkable work across sectors at the municipal level, at the provincial level and at the federal level. Public Health in Ontario does a lot around perinatal mental health, these community organizations, hospitals and so forth. I think part of the setting of quality standards by the federal government would be to implement the need for measurement-based care. Ms. Simon alluded to that.
It's important that we coordinate and collaborate together, but also measure what we're doing and assess how well we're doing. Organizations that are able to help us produce the best outcomes could be one way to determine how things are allocated and so forth.
A part of quality standards in the stepped care models, of course, is measurement. There are cheap scales available in the perinatal mental health space that can be used to benchmark and create standards and do those sorts of things.
I hope that answers the question you asked.
I think rapid investments are urgently needed. In that regard, I hear what you said about avoiding duplication and time wasted on these agreements.
Right now, the provinces and Quebec are all asking for a health transfer of up to 35%, precisely because they know there are projects within their borders that will never get off the ground owing to a lack of funding. So we also need to find a way to accelerate these transfers.
Let me turn to you now, Dr. Elliot. You are a pediatrician and work with adolescents. Having adolescents in my life, I know they are very worried about the environment; it is called eco-anxiety. We have not talked much about this in our study thus far. I would like to know the potential impact on the adolescents you work with.
The government must definitely address environmental issues. That might, among other things, provide some relief to these young people and address their concerns.
I want to go back to what a few people have discussed. Let's bring it back to the family, and let's bring it back to the schools and into the community.
One of the things that really is curious to me is why, after two and a half years of such significant increase in mental health concern—and we all spoke about it—school counsellors and psychologists have either been let go or are not deemed necessary. I heard several examples of this just in Calgary. We need that force in the resources in the schools.
I also think we need to take it back. I love the prenatal or the early childhood where we teach parents how to regulate their own emotions. They can have the highest IQ, but if you haven't learned emotional regulation, when the avalanche is coming you may start doing things that you wouldn't typically do. I think we need training at different areas—community, places of worship, within schools—where we help parents learn techniques such as mindfulness, emotional regulation. This will help them with many of those things to help adolescents. If you're not in a grounded environment, you cannot ground yourself.
My approach a lot of the time is to work with the parents to help the youth, to coach them to be in a better place and then to deal with the crises.
My question is for Dr. Van Lieshout.
You talked about the impact of mental health being passed down from mothers to their children. For indigenous women and girls, we know that there's intergenerational trauma that transfers across generations, trauma that is caused by colonization, the impacts of residential schools, trauma caused by systemic racism, ongoing violence and genocide.
Could you talk a bit about any research that you're aware of, or that you have been involved in, that is focused on indigenous women and girls? How can we best support these communities whether it's in terms of the national standards you have talked about, or other measures when it comes to prenatal and postpartum care?
I actually live about 2,000 metres from the Six Nations reservation here in Caledonia, Ontario, so we've been fortunate enough to develop links with the Six Nations birthing centre and a group of local indigenous midwives to try to understand the unique struggles faced by first nations people here locally.
In addition, I do clinical work and have had the honour of working with first nations people from Ohsweken, Six Nations, Rama near Orillia and so forth. The stories are striking. As you point out, the intergenerational transmission of many things is quite striking.
We did a study during the COVID-19 pandemic working with the Six Nations midwives. We found a number of challenges that have been described by other members of the panel, such as access to health care and other things. What we also saw was remarkable strength and remarkable resilience among these individuals. We think, of course, it was within them as well, but also because they have this amazing birthing centre.
It's having first nations-specific supports, peers who have recovered.... We have to work together—no health for us without us. We have to work together to understand these unique challenges that are being faced, and develop tailored, unique strategies that meet those needs, whether they relate to intergenerational trauma, water security, food security, or things like that.
We've been doing that work. We're trying to help train the midwives. I'll be doing some training with the midwives soon. We look forward to continuing that partnership and understanding it better. I have great teachers, and I'm very lucky to have that.
I hope that helps with the question.
That is such an important question.
It's interesting. We are not seeing young people name it eco-anxiety, or climate change anxiety right now. What we are seeing, certainly, when we experience any kind of disaster related to climate, whether it is wildfires or flooding, we see an increase in contacts from that area. We will continue to see young people reaching out about that as we continue to see those disasters occur.
It is part of our role at Kids Help Phone to start helping young people name that and think through what it means and what they can do. A lot of the work that we do is helping young people understand what they can control and what their role is. When it comes to climate change, young people have to understand they have a voice and that they can use it. Supporting young people to use that voice, whether it is writing letters or talking about the impact of climate change, is some of the work that we still have yet to do at Kids Help Phone.
I want to also connect that to some of the conversations we were talking about just a moment ago about indigenous people. Certainly, at Kids Help Phone we've done a lot of work with a distinctions-based approach for first nations, Métis and Inuit youth. We are seeing there are significant concerns from our indigenous young people around the climate, around what's happening to their communities and the planet we live on.
Being able to have those conversations.... We piloted last year, and have continued, where we trained indigenous volunteers for our texting line—that's our volunteer service—so that when young people text Métis, Inuit or first nations, we can try to connect them with a volunteer of the same background, so they can actually have those conversations about climate change or anything else that's concerning them with somebody who actually understands that background. That's been incredibly powerful.
Thank you, Madam Chair.
Thank you to all of our witnesses for answering some really great questions about how we do that bilateral funding and how we amalgamate mental health into our health care. I think we have made huge progress on that, quite frankly. People are now asking for help. However, when they do ask for help, there's nothing there to help them. There's a very huge health equity gap there.
Dr. Elliott, I might be your new biggest fan. I'm really enjoying your testimony and a lot of what you have to say. You touched on one area that I'm particularly interested in personally and very passionate about. That is the education piece of self-regulation—arming our children with the tools, because the toothpaste is out of the tube. We're not going to put social media away. We're not going to reverse and go backwards. This is where we are. Now we have to give our kids the right tools to manage their feelings, give them the language to manage their feelings, but also not confuse them—I think we also see this—into thinking they might have something they don't. They've seen this imposter syndrome as well, which is dangerous.
I'm curious as to what you think would be the return on investment when we look at investing. I'm going to name a doctor whom I adore, Dr. Stuart Shanker. I don't know if you are familiar with his work, Dr. Elliott, when we are looking at self-regulation and teaching children and teachers to recognize the why of their behaviour.
Why do we see it and why now, Dr. Elliott?
I'm really thrilled that you're aware of self-regulation and those topics.
Recently I did a program called Reset to Reconnect. It was with six families with adolescent boys. We did an initial kind of education. Then they went to it with their families, calling out their families on different things and setting their own plans for their families. After it was done, the feedback was that they recognized they had better sleep. They were more emotionally regulated. They were more connected to their family. They had more time to do other things that really social media and screens took away from them.
We're also seeing a really significant uptick in somatic symptom disorders, which involve someone's experiencing a physical presentation because of an underlying psychological event. For this, we have now seen on social media something called TikTok tics. When young people are watching a lot of TikTok, they start to get physical symptoms.
To go back to that, if we can teach parents early to regulate and teach young people to be in an environment of regulation, whether it's in schools, places of worship or other places, then everyone is going to have the same language and the same ability to take a breath before they respond. In so many situations, things are “figureoutable” if you're able to regulate.
It's Marie Forleo's saying, “figureoutable”. I know it well. It's a good one.
I think we're really on the same page. I think what we haven't addressed, really, in this round is parents' inability to self-regulate, which is downloaded to the child. There is parents' use of maladaptive coping mechanisms such as looking at their screens, just basically tuning out and also scrolling. I think we need to give a name to this, because I actually do think it is comparable with, say, alcoholism or some kind of addiction, where you are tuning out so you don't have to deal with the stresses of life.
We have an affordability crisis. We have both parents working and not able to afford to put food on the table, who, at some point.... I have parents now writing to me. They make over a $100,000. That's a lot of money. Now they can't afford that because the cost of groceries and housing are through the roof.
My question, Dr. Elliott, is whether there is data—because that's ultimately what determines funding—on investing in giving parents the tools they need to self-regulate as well.
Thank you, Madam Chair.
I'd like to thank our witnesses for being with us today to answer a lot of our questions and for giving us so much great information.
On my first question, we heard at several of our meetings, including today's, that there is a lack of support and there just isn't enough help for the amount of help that is needed, whether that means trained therapists or people who are actually considered psychologists. There aren't enough of them around. Even if there were enough around, it's quite unaffordable for many Canadians.
What do you think our government—specifically, the federal government—can do to help make mental health care more accessible to Canadians across the country? I'm talking specifically about costs, but also about getting more people into this field and making sure that in the future we are more prepared to deal with this type of crisis.
Anyone can answer.
I think part of what we have seen, particularly over COVID, is people all across the world looking to e-mental health and digital health as a solution to their challenges. When we think about that stepped care model, digital health is fantastic for a lot of those lower acuity challenges, single-session counselling and things like that.
The thing that I think is worrisome is we have seen a flooding in the marketplace of for-profit companies within Canada, but even more so internationally. They're coming into our marketplace and offering digital services without a lot of efficacy or evaluated information behind them.
There's cost, so that we are creating a second tier of services that people can choose to pay for. When we talk about things like navigation, it is becoming incredibly difficult. Go to the Apple or Google store and put in “mental health”. You will see hundreds of apps, and that's just apps; that's not even talking about the other kinds of digital services.
I think we need standards for digital supports and to ensure that companies that are coming into Canada to provide digital services are able to demonstrate that there is efficacy and evaluation behind the products that they're offering to Canadians.
My first question is for Dr. Elliott.
You highlighted the fact that you work in Alberta. I really appreciate the insights you shared around working with girls and young women on eating disorders and anxiety disorders.
Similar to other questions that I've raised during this committee, is there any insight that you can bring in terms of the challenges particularly around anxiety disorders, but also eating disorders and working with indigenous communities?
Many indigenous communities face high food insecurity. The cost of a healthy and balanced diet is out of whack compared to in the rest of the country. Obviously, the resources are even fewer when it comes to mental health supports.
I'm wondering what insights you could share in working with indigenous young people, indigenous girls and women. Are there any concrete recommendations that you can make to our committee?
As I mentioned, we hear from young people between the ages of five and 13 who are thinking or talking about suicide. Again, the important thing to me about that is, when a young person reaches out, we have this unbelievable moment to help them—the fact they are willing to talk about it.
It's scary for us as adults, and it is shocking to hear about young girls who are reaching out about suicide. As a parent to a young girl, I feel that. I also want to really drive home that the fact that they're talking about suicide is okay, because it allows us to have that moment to talk to them about hope, about resiliency, about inner strength, about being present in their own life and about what coping tools they have. So yes, we are hearing from young kids about suicide.
Your other question was about older women, 25 years and over. Certainly, we see those young women talking about anxiety, depression, relationship issues and all of those things. We don't diagnose at Kids Help Phone. We have done evaluations where we've asked young people to take a scale called the Achenbach to get a sense of whether they have diagnosable challenges. Certainly, we see large numbers of young people coming to us who do have diagnosable conditions, but we deal more with what the feelings are in that moment. The feelings that women 25 years and over bring to us are high levels of anxiety, lots of depression and lots of feelings of their life being out of control.
As I said, what we have noticed for particularly those older young adults is that they bring in challenges around grief and around loss. Around the pandemic, we think about post-secondary students who haven't been able to go. We think about people who haven't been able to see their families and who are feeling isolated. That has continued in this new reality.
I would say that young people reach out about every issue, and every issue at every age, but those are some of the differences we see as young people age.
I would really like to thank the panellists today. Thanks so much to April, Ryan, Alisa and Karla. This has been a phenomenal panel. Thank you for participating. As indicated, if there's additional information that you would like to send in, we are accepting that until November 1.
Everybody, we'll now be adjourning our meeting. I would like to say thank you and wish all of you a happy Thanksgiving. It's time to go home, put up your feet and enjoy a turkey or something with your family. I hope everybody enjoys it.
Are we ready to adjourn? Okay.
Today's meeting is adjourned.