Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 13 - Evidence - April 21, 2005
OTTAWA, Thursday, April 21, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 10:45 a.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Honourable senators, we have here today two panels. The first is from Social Development Canada. They will read the volume that was put in front of you, from which you are likely to get a hernia if you pick it up. We are delighted to have with us Cecilia Muir, the Director General, and Georges Grujic, the Director of Programs, of the Office of Disability Issues of Social Development Canada. We will ask the witnesses to make those opening statements and we will then turn to questions.
This is the first time in quite a while that we have had someone from your department with us. We are delighted to have you here.
Ms. Cecilia Muir, Director General, Office of Disability Issues, Social Development Canada: Thank you for the warm welcome. We are very pleased to be here. We have talked a few times on the phone so I feel I have some familiarity with the committee already.
I will speak to the deck that I have given you. It is a reading deck, so I will go through it systematically.
I want to emphasize that I understand that the purpose for us being here today is to enable the committee to acquire a deeper understanding of the role of the federal government in the direct provision of mental health supports and services. I am here specifically to talk about the role of Social Development Canada and how mental health provisions are covered under that.
In the invitation, you asked specifically about what we could provide in five areas. First is detailed statistics. Second is the legislative basis. Third is which services are delivered directly by us. Fourth is the nature of the relationship with other levels of government. Fifth, could we provide a case study illustrating how a program might be delivered.
I will refer briefly to the binder of material that you have. In there you have fact sheets on each of the programs that we deliver in the area of disability. There is one on the Social Development Partnerships Program — Disability Component. There is one on the Community Inclusion Initiative that is part of the Social Development Partnerships Program; the Opportunities Fund; and the Labour Market Agreements for Persons with Disabilities with the provinces. There is a fact sheet on the Canada Pension Plan disability component. There is a case study of how we fund the Mental Health Association, and there are detailed statistics in volume 7.
We have provided a great deal of information to you there. We are very happy to take questions on that subsequent to my opening remarks.
The Chairman: One question of clarification so that I understand your terminology.
Does ``disability'' in the context in which you will use it include mental disability or only physical disability?
Ms. Muir: We use the term broadly and it most certainly does include mental disability.
The Chairman: Many of the regulations covering ``the disabled'' concern only the physically disabled.
Ms. Muir: In our context it covers both visible and invisible disabilities, including matters such as learning disabilities.
Thank you for asking that question because I want to be very clear about that.
There are two sections in our statistics. One is based on the participation and limitation survey done in 2001, the next of which will be done in 2006. The other is a very interesting public opinion survey that was released last fall, the first one ever done in Canada, on public attitudes to persons with disabilities, and there are particular references to mental disabilities.
Now that I have given you a brief overview of what is in your binder, I will proceed with my opening remarks. I will refer to the slide entitled ``Social Development Canada Approach'' at page 3 in your deck. There has been an evolution of approaches in thinking about person with disabilities, including mental disabilities, in Canada since approximately the 1950s. In the 1950s, we went from an era where the thinking was about institutionalization to an approach of medical interventions. In the 1980s and 1990s, the independent living movement began to take hold. In the 2000s we talk about moving toward full inclusion.
There has been an evolution since the middle of the last century from the institutionalization model toward the concept of full inclusion. The evolution in these approaches began in 1981, which was the International Year of Disabled Persons. That initiative was very broad in terms of the disabilities it sought to raise awareness of and included mental disabilities.
I want to clarify what I mean when I say ``inclusion.'' Full inclusion, which is our goal at Social Development Canada for all persons with disabilities, means that persons with disabilities will be full participants in all aspects of Canadian life and society and that we will seek opportunities, programs and services that help persons with disabilities, again including persons with mental disabilities, to maximize their well-being through access to required supports and the elimination of barriers.
There are two very important concepts with regard to inclusion. One is access and the other is participation. That is what I mean when I refer to ``inclusion'' or ``full inclusion.''
In terms of key legislation, we do not have a national act, as you are aware. However, there is a legislative framework, with three parts. In 1977, we got the Canadian Human Rights Act. In 1982, we got the Charter of Rights and Freedoms. By the way, Canada was the first country in the world to include clear reference to persons with disabilities in its Constitution. Third, we have the Employment Equity Act, which was first introduced in 1986 and revised in 1995. This covers all federally regulated employers. Therefore, we do have a legislative framework, although not a national act.
I will also clarify the size of the population. Our statistics are very sound, as we work with Statistics Canada on them. There are about 3.6 million persons in Canada with disabilities. That is a little over 12 per cent of the population. In addition, there are 2.8 million people who are caregivers, often family members, of persons with disabilities. That is a large proportion of our population and they are included in that number. Caregivers are an issue for persons with mental disabilities, so those are important statistics to remember.
Federal government expenditures in the area of persons with disabilities, which includes income support, funding programs, et cetera, were $7.5 billion last year. The largest chunk is income support. The Canada Pension Plan disability component makes up about $3 billion of that.
That gives you a sense of the size of the population we are talking about. It is more than 12 per cent. There are 2.8 million caregivers. Federal government expenditures were $7.5 billion last year.
The Minister of Social Development Canada is the lead federal minister responsible for persons with disabilities. That does not mean that he is accountable for every service or program in the federal government, as you know, but we do play a strong coordinating role and we do offer a number of services and programs. Our social policy goal is to work with other partners — and there are many of them — to achieve the full participation of Canadians with disabilities in learning, work and community life through citizen-focused policies, programs and services.
We take a number of approaches to this. We work through four streams of programs and instruments. They are: community development initiatives; employment and learning programs; income measures — under which the Canada Pension Plan is a significant contributory program — and knowledge development, policy and awareness initiatives. Knowledge development and awareness is a large aspect of working toward full inclusion of persons with disabilities, as you know. I understand that Michael Wilson has recently become a spokesperson for this issue. That is an important step in terms of raising awareness and championing public ownership of and understanding about disability and, in this case, mental disability.
I will explain our approach to disability issues and illustrate, with reference to each of those four streams of activities, specifically what we do at Social Development Canada with respect to mental health and mental illness.
We do deal with disability generally and mental disabilities are part of that. We do not have targeted programs for mental disabilities. I will go through each of our programs and draw a link to where we have done something of direct relevance to mental disability.
Slides 4 and 5 give you a sense of who else is involved and some of the formal structures that are in place to help us work horizontally. There are many players in the area of mental disability. You are probably aware of that already from the work you are doing. We work internationally. We work with the provinces and territories because so much is in their domain. We work closely and regularly with officials at the provincial and territorial level. We also work interdepartmentally to try to bring coherence to federal-level programming.
We work regionally as well. Some of our programs are delivered at the regional level because that makes the most sense. We also work closely with the disability community, particularly representatives of national stakeholder organizations. We are very involved on the United Nations convention on the rights of persons with disabilities, which is in the process of being developed.
That is on-going work with that right now. The Department of Foreign Affairs is the lead, but we are key players.
Page 5 shows a list of the government of Canada roles. It also shows provincial and territorial organizations, the new subcommittees of Parliament and non-profit organizations. This tells you the range of actors. When we laid this all out — I am relatively new to this job and I needed to see who everyone was — I was quite amazed. This is the picture that emerges.
The sheer number and complexity are very striking. I want to stress that although there are a lot of players here, it is not a mess. Everyone here has a legitimate role to play.
It says that the role of coordination and information sharing and linking amongst the players and the levels of government is crucial. That same truth applies, of course, to persons with mental disabilities. The importance of information being made available in an integrated way is extremely important. People live lives. They do not try and just access programs on a one off basis. There is a range of needs across the life cycle and it is important that there be continuity in programs and services.
This complexity and number presents huge challenges for persons with disabilities, their families and caregivers. We recognize this challenge, and the importance of making good solid knowledge available and of linking to other work going on in the field.
Many of the levers are in the provincial and territorial domain. I know that is something of which you are already well aware. It is comparable to what we do with the health sector.
The not-for-profit sector is very important. It delivers a lot of services for us through funding. I will leave that slide at that. That is the range of players.
The next five slides are snapshots of key Partner programs. They are covered much more fully in your binder. What is in the binder is user friendly. Basically, the Social Development Partnerships Program — Disability Component is a key program. It is $11 million a year. It is a grant and contribution program. Approximately, $5 million a year is given in grant funding that allows national organizations — there are 18 of them — to have some sustaining or capacity- building funds. One of these is the National Network for Mental Health. That is the only mental health organization that receives this core funding, and it is in the amount of $80,000 per year.
There are also 45 to 75 projects per year to get contributions. Some of them are around mental health. There are a couple of very good examples in your binder of projects that have been funded through this contribution funding. They are great products. One of them is Your Health, Your Future, put out by the Canadian Mental Health Association. Another one is, Mental Health and Highlights, a guide for students. Those are good examples of projects that we have been able to fund.
The next initiatives, on slide 7, are the community development initiatives. They are part of the Social Development Programs Fund, which provides $3 million a year. They are for persons with intellectual disabilities specifically. They are delivered through two national organizations. One is the Canadian Association for Community Living. The other one is People First of Canada.
You probably already know this. People First of Canada is a national organization that represents the interests of people who have been labelled as having learning, mental or psychological disabilities. There is information in your binder about this group.
Here are some stats for you. This community inclusion initiative is estimated to have directly involved 3500 families and 7400 individuals in the activities in 2003-04. That is an important piece of interest now. We will be able to take more questions on that once I am done.
The Labour Market Agreements for Persons with Disabilities are transfers to the provinces. There are $223 million a year. They are employment-oriented, but provinces all have the flexibility in those agreements to also orient these funds towards persons with mental disabilities.
That is another important program. The provinces actually match that funding as well, and in some cases are exceeding it. They can deliver services around employment or helping people become employable. They can address persons with mental health disabilities through this as well.
On page 9, we talk about the Opportunities Fund for Persons with Disabilities. That is a $30 million-a-year contribution program. It benefits about 3900 persons per year. It is broad, but there are some examples where we have helped persons particularly with mental disabilities. That is noted on the slide for you.
At the bottom of the slide, we talk about mental health organizations currently receiving what we call ``national project'' funding that includes both the National Network for Mental Health and the Canadian Mental Health Association. For example, the opportunities fund helped to finance the National Network for Mental Health project, Building Up Individuals Through Learning and Teamwork, BUILT. That project provides life skills, coping skills, customer service and computer skills to persons with mental health disabilities, to improve their successes in the job market. During the past year, nearly one third of the participants in that project became successfully employed.
Another example is a project managed by the Comité d'adaptation de la main-d'oeuvre pour personnes handicapées, CAMO, in Quebec. A wage subsidy was given to an employer to hire and train a person with an intellectual disability as a grocery clerk in a large store. The participant was responsible for stocking shelves and maintaining them in a presentable fashion at all times. In this case, the participant did so well that once the funding ended, the employer kept the individual on and found the person to be a really valuable employee.
On page 10, we talk about income measures that are primarily the Canada Pension Plan Disability component. That is a contributory program that you are all aware of, or with which you are familiar. That is for any person who cannot work due to a severe and prolonged mental or physical disability. It is basically an earnings replacement. We know that there is a significant number of persons with mental disabilities who receive that benefit, which is the longest long-term disability program, income program, in Canada. It started in 1966.
One of the interesting statistics I got — I am not responsible for that particular program — was with a program of my good colleague. She tells me that clients with mental disabilities represent the largest segment of the disability benefits recipients who are able to attempt to return to work. They are a significant group. Again, there are nice tables that are quite clear in your binder in the section on CPPD, which break out the number of clients with mental disabilities for you.
On page 11, we talk about what we do in the area of knowledge development in Social Development Canada. We put out a number of information products. We do this because we cannot measure progress towards inclusion if we do not know what the baseline is and what the numbers are. We put out, Disability in Canada: A 2001 Profile, which I referred to that is in your binder. There will be another one done obviously to reflect the 2006 participation in activity- limitation survey. That is important information that is used on delayed developmental learning, memory and psychological disabilities. That is an important source. It is used very broadly in the community. It is the single greatest and most definitive source of data about persons with disabilities in Canada. There are others, but this is the key one.
We also did the public opinion survey I mentioned at the beginning, which is the first ever survey of its type done in Canada. In the United States — I understand — this is done more regularly. In Canada this was the first one that we ever did. My office did it last year.
Again, the report reveals that persons with mental disabilities are more likely to be viewed as excluded, incapable and uncomfortable to be with, than other persons with disabilities. There are some interesting findings that I direct you to in that report.
We are in the process of doing some new forward policy planning and awareness building. We are getting some funds through the Government of Canada advertising campaign to raise awareness. We are working on the next participation activity-limitation survey with Stats Canada. There will be questions in there about persons with mental disabilities.
I do not need to say a lot more. My particular area, the Office of Disability Issues, is the focal point within Social Development Canada where we deliver a number of these grant contribution programs, that is, the Opportunities Fund for Persons with Disabilities, the Social Development Partnerships Program — Disability Component, and the Labour Market Agreement for Persons with Disabilities. We also work very closely with provinces and territories. We are developing new forward-looking policy approaches around income and supports for persons with disabilities. That is going to the Minister of Social Development in June. We produce and disseminate a lot of information and products, which we can speak more about. We make horizontal linkages within government. The importance of building awareness and building public ownership and commitment about the issues of disability and mental disabilities is hugely important. We have to look beyond the government-funding programs. Those are important, but we need to be doing the social marketing, education and awareness building as well.
Those are some pieces that we are trying to move forward on now. I will conclude there and take your questions.
The Chairman: I will ask a couple of factual questions. Your Disability in Canada: A 2001 Profile and Canadian Attitudes Towards Disability Issues: you said you are doing another wave of those studies in 2006?
Ms. Muir: Yes. We have statistics gathered through the Participation and Activity Limitation Survey, PALS. We are working with Statistics Canada right now. The next survey will be done in 2006.
The Chairman: What about the attitudes study?
Ms. Muir: We are doing some qualitative research right now. We did a number of focus groups in March with the public and employers to go further in-depth about attitudes towards persons with disabilities, and we will use that to help design a public awareness initiative over the next year.
The Chairman: I recognize we might not be able to quote it publicly, but I would be interested in the focus group reports because it would give us background that would be a useful thing, if that is possible.
Ms. Muir: I believe I can share that with you. We have summaries from the focus groups. I am happy to do that.
The Chairman: Could I ask you a second question about the Canada Pension Plan Disability, CPPD. In other hearings we have done, there has been very strong criticism of that program based on the difficulty of getting into it and the eligibility criteria. Because it is CPP, it applies only to someone presumably who was in the labour force at some point to begin with.
Are you aware of that kind of criticism? Is anybody looking at changing the program? Where does that stand?
Ms. Muir: I am aware of the criticism, and so is my colleague who is the director general of that area. Our minister was in front of the subcommittee of the House of Commons Standing Committee on Human Resources, Skills Development, Social Development and the Status of Persons with Disabilities last night. The subcommittee focuses on persons with disabilities, and he was on the Canada Pension Plan Disability component. It was a tough visit.
We are aware of the criticisms. It is a very stringent program, and the criteria for eligibility are tough. Changes would require legislative change. Those are significant.
The Chairman: That is not a reason for not doing it.
Ms. Muir: No. That is just the fact that I am putting before you.
There has been some truly great work. It is not the same as changing the CPPD, but there has been some great work done recently that has brought in a new feature called automatic reinstatement. This is a feature allowing people with recurring conditions, illnesses or disabilities — and a number of those are persons with mental disabilities — to try and go back to work. It does not always work out. Traditionally, getting back on CPPD has been a very daunting process to go through. With this new feature that came into force in January of this year — there was an Order in Council that went through — it is now possible for people to get back very easily onto the CPPD benefit without going through the process.
I acknowledge it is not a whole solution, but this is a huge step forward. This feature allows a person for up to five years not to have to go back through a reapplication and all the process that one would normally need to go through. This was seen as a huge step forward. The projections were that at least 300 persons a year would be able to benefit. Those are individual people.
Since the end of January, I do know there have been five individuals who have been able to take advantage of it, and the government is doing work to market this and make it better known.
Given the stat that I mentioned before that persons with mental disabilities are the most likely to try and go back to work, this is an important feature that has relevance for them. This is an important new feature, but no, it is not a complete overhaul. We are aware of criticisms. I will take that back, as we need to review what was learned from last night as well.
The Chairman: We made this observation in one of our earlier reports, and you said a couple of minutes ago, that the entrance requirements are very stringent. I say this as a public servant. Typically when people in government describe something as very stringent, it is unbelievably stringent because we always have a tendency to paint a good picture. It seems to me that when you look at a group of people as disadvantaged as what we are focusing on, the mentally disabled and the disabled in general, to design a program that is excessively stringent seems to be defeating the underlying purpose of the program in the first place. That is a viewpoint that all of us share; it is not just mine.
Ms. Muir: My colleague, Susan Williams, the Director General of the Canada Pension Plan Disability component, would be an excellent resource person. I respectfully propose that the committee spend a good session with her. I would be happy to come back with her for broader questions as well.
Senator Keon: Let me congratulate you on a tremendous amount of work that has been accomplished, and on your successes.
Drilling down to mental health in your large envelope of disabilities, we are recommending so far that there be a major focus on recovery in mental health. For people with disabilities to be eligible for your programs, you have to be able to somehow define recovery, when they have recovered to a point where they can get back into the workforce, or be placed partially back in the workforce.
One of the things I was not clear about is your evaluation process for doing this. I suspect it is a number of processes that you use for different programs. I would appreciate you expanding on the evaluation process, particularly as it relates to the evolution of recovery in the mentally disabled patient. How will you evaluate when a mentally disabled patient has recovered to a point that they can make either partial or total re-entry into the workforce?
Ms. Muir: Are you referring particularly to Canada Pension Plan Disability benefit or more generally?
Senator Keon: I am referring to the whole cross-section of programs you described, but specifically to the mental health portion of those programs and not the whole disability envelope.
Ms. Muir: I do not think we have done enough work in that area. We have not looked at that level of detail partly because our programs are so broad in their scope when it comes to disability. Mr. Grujic might be able to address some of that.
Mr. Georges Grujic, Director, Programs, Office for Disability Issues, Social Development Canada: Our programs are more focussed on the short-term intervention. For example, with the opportunities fund, the person tends to have gone through the recovery process and is ready to go into the employment market. We provide the short-term support: if they need some training or help to get wage subsidies or employers involved. Because of the limited amount of money, we tend to focus on that aspect of it. That is the only federal program we have to help integrate individuals on the employment side of it. The recovery is more for the provincial or health side, and then we take it from there to get them back into work, et cetera.
The person declares himself as being disabled but we do not track whether it is mental, hearing or other. In the opportunities fund, there are two or three organizations that have a mental health mandate to focus on that kind of clientele, if you wanted those numbers. They will support whoever needs that kind of support. The effort is to integrate them into the market and the labour workforce. We do not do the front end or the longer-term journey, as I call it, in terms of recovery.
Senator Keon: My concern about these programs, particularly related to mental illness but physical illness as well, is that we are not doing the individual any favour if they get involved in a program that sustains them. Because of their own loss of self-confidence and so forth, they can simply drift into oblivion in such a program. A key element must be an ongoing evaluation system, even if it simply brings them back into the workforce for a short period of time. They may have a relapse and require support again for a period of time but at least it provides some light for them along the tunnel of recovery. Could you tell us what you have now, or anticipate having, in that dimension?
Ms. Muir: I take to heart what you are saying. As Mr. Grujic mentioned, our programs have a more short-term focus right now. That being said, our instruments are not necessarily the full range of instruments that are needed. Our minister has made some public commitments to a long-term action plan. We have put together a strategy that we need to discuss with the minister. We need to revitalize our policy basis and, therefore, the instruments — the programs that we have — beginning now and over the next ten years. We need to include a much greater consideration of your focus today, to look at the shortcomings of the existing instruments and to determine how we can do much better. For instance, the concept of prevention is not necessarily in the older policy thinking. We need to incorporate that into our new way forward.
I cannot give you the kind of satisfactory answer I would like to give you right now because the reality is that we do not have that recovery element. However, we can build this into our thinking because we will revamp our entire policy basis and be quite ambitious about it. The timing is good for us to be getting advice from this committee.
Senator Cook: If I read this correctly, the Labour Market Agreement for Persons with Disabilities carries a price tag of $223million. How is that prorated? If I look at page 5 of your presentation, I see that the education supports and the employment program becomes the purview of the provincial and territorial governments. You provide oversight, and the detail is left to the provinces. That is where we might find the answer that Dr. Keon is seeking.
Ms. Muir: That would get you closer. In response to proration, I would ask Mr. Grujic who was involved in negotiating these labour market agreements with each of the provinces. He will give you a better sense of the process.
Mr. Grujic: The formula is on a per capita basis.
Senator Cook: I do not like that word because I am from Newfoundland.
Mr. Grujic: You are correct. Some provinces are more advantaged or disadvantaged. Also, there was a baseline. Each province had a baseline, which was about $600,000 in terms of those amounts, plus the per capita funding. There was some historical precedent as well such that the Maritimes might have some specific program still being integrated. That is how it was laid out.
The formula was agreed on by the provinces and the federal government. It was a negotiated approach in terms of the proration and the funding for that element. There is a six-year history to that element.
Senator Cordy: You have given us a huge volume of information to read. I will talk about page 5 and the mental illness aspect of disability. It is wonderful that all these groups and levels of government are working on disabilities and sharing the responsibility of disabilities. However, then I look at somebody who is looking for help, and some of them will struggle to ask: Where do I start? They could phone my office and I would ask: Where do I start to help them? It is so complex. How do you work someone through the maze? If the disability is a mental illness, how could someone possibly find their way through the maze to get help? Time after time they might be told: not my department. That could be more than frustrating than the illness. What do I tell someone who needs help where to begin?
Ms. Muir: I am glad you asked that because it is one of the things I feel most strongly about. How do we get information to the people who need it most in the most user-accessible and user-friendly way possible? It is a big problem. Yes, many people seek help from their representatives. That is the number one place many people start the search.
There are a number of community groups where people can start. Starting in our own community is always the best. I will talk federally about what is in place.
First, in terms of federal government there is the 1-800-Canada number for questions about disability; which programs and services are available and where. They are very good at directing people to the right place. We have given training to the front-line service staff in the federal government. My office has trained them in how to refer, the programs and services available, and how to get people there quickly and easily. Anything more complicated than that gets referred directly to my office. We provide direct back up about anything more detailed than, here are the existing programs and services. We take a number of questions ourselves in terms of, how do I find out more information.
You are all familiar with the new Service Canada initiative. The vision is, 12 departments will offer frontline services, eventually. Right now, it is really Social Development Canada and the Human Resources and Skills Development Canada frontline services, which are primarily in the area of income, education and labour markets. A lot of the services in the area of disabilities, including mental health disabilities, come there. We are working very closely with the Service Canada people to ensure there is an integrated approach. We are the first ones that have done this because we know that many of our clients, including persons with mental disabilities, do not have all the tools and efficient means for getting information as quickly and easily as other persons. We talked to them about how accessible is the information they provide, what is their manner like when they deal with persons with disabilities on the phone, the amount of patience that is required because sometimes it takes longer to get to the heart of what a person is looking for, and the need to explain to them what is available.
We have also put in place this principle of continuity of service so people do not have to repeat their story four or five times. We have been told this so much by our community, that it is frustrating for anyone to have to repeat their story when they are trying to get information from a service, but for persons with disabilities, it is much more of a burden. We are working with Service Canada to be an integrated service, to be very respectful and to ensure that people's information goes with them so they are not referred all over the place. We are doing that.
We put out some publications and I wish I had brought one. I should have put it your binder but I thought you might kill me if we put more stuff in your binder. We do put out something called Frequently Asked Questions, which is basically a guide to federal government services for persons with disabilities, including mental disabilities. We have gotten terrific feedback on that. We need to do more of that.
When our minister is doing some round-table discussions across Canada — and Senator Cook you were at the one in St. John's in February. We did one in Vancouver in the middle of March. There was a very young man who was a recipient of CPPD there. I am not sure what his disability was. It was not visible. He had this Frequently Asked Questions and he lifted it up and he said to our minister, ``If you really want to know what you can do that will change things, here is something that is very down-to-earth.'' He said it is so important and it is not sexy, but he said you need to put out more things like that. He said, ``I do not know how I would have found the services I needed, or my wife could have found them, if I did not have this.'' He said, please put out more things like this; so that is the importance of information about service and programs.
That is only at the federal level. This is where it is tricky. How do we then connect to the provinces and territories? There are websites that link federal stuff to the provincial stuff. We have done a tool kit for medical practitioners in terms of advice about services and programs. Very recently we have done this. That should be in the hands of medical practitioners to help them to refer people well at a key intervention point. There is a lot more to be done. Does that answer your question?
Senator Cordy: How do people get this information, Frequently Asked Questions? Is it at a doctor's office or a drop- in centre. It must be accessible. To say it is on a website is not helpful for a high percentage of the people who need the help.
Ms. Muir: This stuff is on our website. We are well aware that the dissemination must be broader than that.
Senator Cordy: What about discussions, even within federal government departments; do we have silos? In addition to that, in dealing with provincial and territorial non-profit private sectors, how does everyone get together to ensure that there is no redundancy, or there are not huge gaps that are not being filled?
Ms. Muir: There are some formal committee structures in place. We meet on a quarterly basis with about 30 departments that come together. People update each other about what is going on. We also have several working groups. One is on services and programs, one is on knowledge and information development, and one is on accessibility. That has just been formed. We have smaller working groups where we get together. We meet on a regular basis.
I meet with a federal, provincial and territorial working group regularly, every couple of weeks, by teleconference, and we have face-to-face meetings as well. The group is working on material that we are getting ready for the ministers' meeting in June. There will be options that we are putting forward on income and support so that we are in agreement on what we feel should be the programs and services that are delivered in those areas. We do it formally.
Senator Cordy: My last question is about the labour market agreements with the provincial and territorial governments and the funds to improve employment situations for persons with disabilities. Is this funding targeted, and does it have to be cost-shared?
Mr. Grujic: The areas where it is targeted are education and training. It is also used for employment participation. It is used for employment opportunities, connecting employers with persons with disabilities, and building knowledge. It is for persons with disabilities; it is targeted at that, those programs which are funded through the provinces. Yes, it is cost-shared to 50 per cent of the programs that the provinces have. It gives the provinces a chance to leverage their programs another 50 per cent. Right now the agreement is only with the provinces.
Senator Cordy: Not with the territories?
Mr. Grujic: No. There is an issue in terms of the transfer payments between the Department of Finance and the territories, so we are still negotiating that.
Senator Keon: Senator Cordy has again highlighted a situation that is coming up over and over. No matter how good your program is, it is no good if people cannot access it. We are thinking that the missing link in this whole business, every way you look at it, is the link between community health centres or the primary care centres and community services. Until we get those links, I do not see how many of these programs will function at all.
What is your comment on that?
Ms. Muir: Yes, I think you put your finger right on it. That link needs to be there. It is not strong enough now. We need to do a more comprehensive job of disseminating information. What you have said makes a lot of sense to me. What we also are doing right now is, we are sending all members of Parliament a kit with information in it, recognizing that many people go there looking for help and assistance in directing them to services. We need to do a lot better job of disseminating our information and being more strategic in how we do it.
What you are telling me makes perfect sense. We can do this; we can do it better.
Mr. Grujic: The other thing we do is part of our organizational funding. We provide funding to 18 national organizations, and they are partners with us. They are in the community and they get the information out also in terms of those elements. Three national disability organizations have a mental mandate and they have an opportunity to get that information. Also, in terms of the products they have produced, we have helped them to disseminate them in schools and in centres as you mentioned, those areas. They are a partner with us and we tend to work with them also in those elements.
Also, the Opportunities Fund for Persons with Disabilities has pamphlets, and those pamphlets are shared throughout the community in all these areas where there is a need in terms of those aspects, even at the provincial level. That is the one way we try to get out there. As Ms. Muir has mentioned, we have to be better at doing that and getting it out there. However, that is how we have been trying to work as a partner approach. It is not just the federal government, but includes the community on that side.
Senator Cook: I want to congratulate you on your mission statement. It is all inclusive and it is way over there. Over here I have a person that is double-challenged, mentally and physically. What I am seeing and hearing here is, it is all over the place. I am trying to get into perspective how, with a seamless simple delivery, do all these wonderful federal initiatives get to the consumer, with the least piece of clutter? How do they know about all of this? I have heard some of your responses. They are good, but we must do more.
There is a long term here. Would it be possible for us to access the formulas that the provinces use those agreements for, this big piece of money? The labour market agreement is $223 million and there are probably other pockets here.
As a volunteer with this client population for 25 years, I certainly did not know any of those good things existed. I figured that the gateway for me was through my provincial government agency. We really need to look at this. Your mission statement is wonderful. I see things such as non-profit and all the rest of the things, but I am looking at a person with two challenges; not one but two.
Where do we go? Do you think the specific nature of mental illness is adequately recognized or understood by the federal programs or the federal agencies that are setting them up?
Ms. Muir: To respond to your last point — what is the best way of putting this — persons with disabilities, including mental disabilities have been considered very important for a long time. It has not perhaps achieved the same level of priority as some other social policy areas, for reasons that are historical.
The time is here now for these issues, such as mental disabilities and other disabilities, to assume greater significance. It is very real to all of us now — growing to be more real — than it ever was before. This is due in part to early learning and child care that is a big, important priority. People really identify with that; they see it. Everybody relates to it, and owns it. Even if you do not have children yourself, you know somebody with kids and you understand it.
Disabilities have taken longer, due to people thinking it is always someone else. That is changing a lot. We all know people now with some form of disability. The disabilities are not just physical or visible ones. They are much broader than that. We all have a family member or friend. We have an aging demographic, so disability is increasing.
We all own disability or we are starting to own it in a different way. The sense of social ownership is growing. We will see this become something that is much more in the national consciousness. People care about it much more. We are just getting there now. What we are dealing with presently are tools, instruments and programs that maybe are a reflection of a time when it was not as important to society as it is today. I hope that does not sound too flowery, but I truly believe that the social ownership is here now in a way that it was not, and that we are seeing the shortcomings of the tools we have. This is the reason that this committee and the work you are doing are so important. The time is now to think about how we need to improve in this area and the programs or funding levels really needed to make a difference.
To return to some items you said, Senator Cook, I should be careful to stress that the federal government works primarily through national organizations and the not-for-profit sector, and supports the provinces and territories in delivering the bulk of the services and programs to individuals. The individual really fits in more at the provincial, territorial and community level, of course, with the not-for-profit sector. What I do in particular for an individual person is very limited because of that, because it is more appropriately delivered at that community level. We try to fund the community, provinces and territories to do that. Can we do more? We hope we can.
I want to be careful not to leave the impression that we actually look after all the individuals at the federal level. We do not. We try to build the capacity in the community.
Does that help?
Senator Cook: That helps me to see the way. Is either one of you familiar with the Independent Living Resource Centre in St. John's or would that be a provincial entity?
Mr. Grujic: We fund the Independent Living Resource Centre through the national funding, and they fund it through that side of it. They provide services.
Senator Cook: That is a good news story.
Mr. Grujic: There is always a need for additional funding on that element. Also, they do a lot of work with the province, Newfoundland and Labrador, and the communities. It is not just us, but we help them in terms of supporting.
Senator Cook: Some of your funding goes there directly?
Mr. Grujic: It flows through them. It goes through the national organization, who then allocates it to the independent centres.
Senator Cook: Are there any more of those across the country?
Mr. Grujic: There are 21. Another three are in progress. Technically, there are 24 in total.
Senator Cook: They do wonderful work.
Mr. Grujic: They are a good partner with us. We have a long history with them, since 1989.
Senator Cook: Me too.
[Translation]
Senator Pépin: Thanks to the wealth of information that you have brought, I can see that you are doing a wonderful job. My colleagues and I will now have to find some way of dealing with the practical aspect.
I will go back to page 6. Eighteen organizations receive 5 million dollars in grants. The National Network for Mental Health receives $80,000 per year. Is that enough? Is it proportional to the 3.6 million people who suffer from mental illness? Are you satisfied with this amount? It is earmarked for mental health. You say that it is the only organization that provides mental health services.
Mr. Grujic: I can honestly say that the demand exceeds $5 million. Among the 18 organizations, there are about 10 that are dedicated to helping disabled groups. Groups with mental disabilities are part of their mandate and their approach. When the groups joined us and decided how they were going to share the funds, we acknowledged that there was a mental health component, but that there were also other groups, as Senator Cook has indicated. The independent living centres also provide services to people with mental health problems.
They do receive $80,000. There are other individual groups receiving $1 million, but with that money, they provide help to all of the groups of disabled persons at the same time. We decided to subsidize one group, but other groups also have a mental health component.
Senator Pépin: Does the Office for Disability Issues operate with a particular definition of mental disability?
Mr. Grujic: No.
Senator Pépin: Could the fact that there is no set definition explain why the amounts are not appropriate?
Mr. Grujic: We have been associated with the community since 1997. The groups look after anyone who comes to them, whether that person is mentally or physically disabled. We help them become more self-sufficient.
As to the $5 million, the demand is three to four times greater than that amount. We can only provide funding to national groups. I receive applications from two to 300 groups per year. The demand is too great.
We have not worked with mentally disabled persons for the past three or four years as they have found other resources. We do, however, work in partnership.
Senator Pépin: I am very much involved with military families, and more particularly with the wives of servicemen. In your 2004 report, you mentioned a strategy to help veterans suffering from post-traumatic stress syndrome. In order to help me understand, could you tell me how many people were provided with treatment, what was the length of their stay and follow-up, and how the families were included.
Ms. Muir: You would have to ask the Department of Veterans Affairs.
Senator Pépin: The question relates mostly to our young soldiers who have returned from a mission and who have been involved with this program for the past year. Since you have similar programs, do you know if they are well accepted and are doing a good job, or is that the responsibility of another department?
Mr. Grujic: We provide information, but we do not track these programs because it is the department's responsibility. However, we are interested in their impact and we do keep an eye on what the department is doing. We began about two years ago.
Senator Pépin: I would be surprised if Veterans Affairs is responsible for these programs because these are young men in their twenties who are being treated.
Senator Gill: Do you have an Aboriginal component?
[English]
Ms. Muir: The answer is no. We do not have a specific thrust for Aboriginal persons. This is something that we will address in our new forward-looking policy work because there is a high need. The rate of disability with Aboriginal persons is much higher than the rest of the population, including the rate for persons with mental disabilities.
We are looking at what the strategy is specifically for Aboriginal persons in our forward-looking policy. In terms of data, we do not have specific data. I have talked about the population size, but it is not specific to Aboriginal persons. They were not over-sampled, so we do not have greater detail about the incidents in the Aboriginal population. We need that. Statistics Canada is starting an Aboriginal data initiative and we will be working with them to collect better information for Aboriginal persons.
You are probably aware that one of the factors around the high rate of disability and mental disability in Aboriginal persons has to do with the incidence of fetal alcohol syndrome, which raises diabetic conditions as well. The answer is no.
[Translation]
We do not have a component for Aboriginal people at this time, but we are very much aware of their situation and we will be looking into it.
Senator Gill: Mr. Chairman, I do not think you need statistics before beginning to act. We already know about all of the problems. They mirror what is happening with the rest of the population. Sometimes, it is even worse. It makes no sense not to include Aboriginal people in this type of program. I would suggest that you include that in your recommendations. Some lobbying is required.
Mr. Grujic: The Aboriginal people are included in the group, but there is no specific component just for them. We support them in all of our programs.
Senator Gill: Through other organizations?
Ms. Muir: Yes.
Senator Gill: But you do not have a specific program for Aboriginal people.
Mr. Grujic: Precisely. Aboriginal groups have projects and we provide direct funding so that they can undertake the necessary research to help their communities. We do not target any particular group. We recognize that our priority is to work with them. The social affairs, science and technology committee from the Department of Human Resources and Skills Development has a budget of about $3 million for Aboriginal groups. These are the groups on the reserves. About 79 organizations work with Aboriginal disabled people, but through another department.
We also work with Indian and Northern Affairs Canada, as well as with some 30 departments. We try to work in partnership, because our funds are limited. We are trying to develop one supranational Aboriginal organization to help Aboriginal people in their community, because the demand is extremely high. We are working with a British Columbia group to create an organization that could meet the needs of Aboriginal people living on and off-reserve.
Senator Gill: I am greatly concerned by the problem of reintegrating Aboriginal people who are physically or mentally disabled into society, because the reintegration begins in the non-Aboriginal community. In terms of employment, there is perhaps not enough follow-up. I hope that the employers will not let these people go when the subsidy runs out. That is a basic issue. I hope that our recommendations will go even further.
[English]
Senator Cochrane: I am also making a pitch here for my colleagues' idea of putting forth a community centre in various regions for the mentally disabled. I am saying that because, in hearing from those people that we have already seen, and we have witnessed these individuals personally because they appeared before us in Ontario when our committee was there, they were telling us that the best approach to helping each other in regards to improving their situation is within the social context. If they can talk about their problems and solutions with each other, what better context would there be but in a community centre? This will greatly improve their medical situation, their whole disability. They have told us that. To me, it is the direct contact with these people and the information we get from them that will help us improve any program we put forth. That is one point.
My other question was, do you think that the specific nature of mental illness is adequately recognized and understood, in federal programs benefiting persons with disabilities?
Ms. Muir: I cannot speak for any programs except the ones at Social Development Canada because I do not have the expertise. If I were to look at the programs that we have for persons with disabilities within Social Development Canada, they are not targeted to any particular disability. They are not huge programs in terms of dollars. They are limited. I would have to say, that reality does not recognize mental disabilities as a huge piece. That reality tells the picture that the funding programs are very limited for disabilities in general and that is a tough reality for us right now.
Senator Cochrane: Do you think mental disabilities should be first and foremost?
Ms. Muir: I do not think I can place a priority on one type of disability over another. They are individual, as you know. I know you need to ask me those questions, but I do not think I could place a priority on one over another. They are all very tough.
Senator Cochrane: How many persons work on mental disability in the Office for Disability Issues?
Ms. Muir: We do not allocate the work by disability. It is a broader approach. For instance, in Mr. Grujic's group, which is the programs area, we have program officers who deal with each of the programs, and none of them are specific to a certain type of disability. They handle all the applications that come in. They deal with whichever stakeholder organizations are involved in those applications. It is not done by type of disability.
We have about 84 staff, in general, at the Office for Disability Issues. That is for programs, policy work, the outreach and coordination work, and internal management. It is not a huge area. It has staff, but it is not enormous.
The Chairman: Thank you for coming. You have been so wonderfully candid, I would like to leave you with a question, which I recognize that you may not want to reply to in writing. I would be happy to have you sit down with me or with the committee staff. Here is the question; it is in response to Senator Cochrane's question.
The minute you bury mental disabilities with larger disabilities, inevitably because of what the word ``disability'' means, the mental side will get short shrift, not because anybody is doing something malevolent, but because that is just the way it is.
I would love your judgment when you think about it. Maybe the best analogy is affirmative action. Why was affirmative action started? Affirmative action was started not because the programs did not apply to everyone, but because it was understood that in order to begin to right the imbalance, because some groups were getting left out because they did not know how to deal with programs, affirmative action was necessary. The intention of affirmative action programs always is that once the balance is righted, then you do not need them any more.
In order to put mental disabilities into the same category as physical disabilities, do we need to begin for a decade or so with some separate programs akin to an affirmative action program, in order to begin to right the imbalance that clearly exists? I also ask that question to your colleague responsible for CPP Disability.
The reason I suggest you might not want to give us a written reply is, having been a deputy minister I know the process you would have to go through to get everybody to sign off to give us a written reply. I am interested in the personal judgment of the two of you and your colleagues, if you would not mind thinking about that and then talking to your staff. We are not quoting you.
That is a dilemma you face. On the one hand, you do not want to single out mental illness, and on the other hand, you have to right the imbalance. If you do not do some affirmative thing in the first place, how are you ever going to right the imbalance? We are wrestling with that. Because you have been so candid, your thoughts on those questions would be helpful to us.
Ms. Muir: I would be happy to reflect on that.
The Chairman: Perhaps you could talk to your colleague at CPP Disability as well.
Ms. Muir: I would be happy to do that. I have one word of caution. I am sure you have met with stakeholder organizations and representatives of the mental health field.
The Chairman: Yes.
Ms. Muir: We have many stakeholder organizations, and they are very passionate, as they should be, about what they do. You would need to be very cautious about how this would be received by other types of disability organizations, because they most certainly will be received. That is a note of caution.
The Chairman: The beauty of our position, of course, is that being popular is not a requirement for keeping our position.
Ms. Muir: It is not in your work description.
The Chairman: Our inclination, as it was in the previous report for which we got hammered — and now across the country, the Romanow report has disappeared and most of the pieces of our report are starting to happen — we recognize that some people will not like some of the things we say. We are not picking on anybody, but that is reality.
Ms. Muir: I am happy to reflect on this, and I will be back in touch with you.
The Chairman: Thank you. Senators, our last panel this morning is Phil Upshall, National Executive Director of the Canadian Alliance on Mental Illness and Mental Health, along with Dr. John Service, the chair of the board. We also have with us Bernice Downey, Executive Director of National Aboriginal Health Organization, and Larry Gordon, Chairman of the National Inuit Committee on Health.
Please keep in mind that because the Senate sits at 1:30, we have to adjourn at 1:25. I would like as much time for questions as possible. Please keep your opening statements short, because we can always read the material you gave us.
Mr. Larry Gordon, Chairman, National Inuit Committee on Health, Health Department, Inuit Tapiriit Kanatami: In my role as chair of the National Inuit Committee on Health, I would like to provide you with an overview of the Inuit perspective and some recommendations for your reports.
As Inuit, we are a young and growing population. There are roughly 50,000 of us living across the Canadian Arctic in 53 remote and isolated communities. This area covers approximately one-third of Canada. As a national organization, ITK works with the Inuit regions to improve living conditions and to help solve economic and social problems.
Today's topic is relevant in that mental well-being and suicide prevention has been the number one priority for Inuit nationally. As Inuit, we do not separate mental and physical health. We like to speak of the total well-being of a person. There is an immediate need for action on mental health in Inuit regions, as evidenced by our suicide rates, which are 11 times the national average. Inuit have embraced the federal commitment to a renewed relationship and believe that a further commitment for an Inuit-specific mental health strategy is important.
As believers in the holistic approach, total well-being cannot be improved by health services alone. Improvements to economic conditions, housing, education, environment, justice, infrastructure and relationships with many stakeholders are needed. Programs based on the unique cultural needs of Inuit regions and communities can and will address the factors that affect our mental well-being.
In many regions, housing shortages have reached crisis proportions in our area. The mental impact on families so crowded that people must sleep on the floors and in shifts cannot be underestimated in our region. Homeless people drift from relative to relative to find a spot for the night. A federal housing program in the Arctic Inuit regions would not only resolve the housing shortages, but it would also alleviate some of the social problems such as family violence and addictions.
Many Inuit, both young and old, face issues of food security. Unemployment rates are high. The cost of living is even higher. The cost of living for our traditional food has also gone up.
Our total well-being continues to be affected by past and ongoing societal transition, including relocation and residential schooling. Studies by the Aboriginal Healing Foundation have illustrated multi-generational damage to families and communities that arose from residential school.
We would like to ask the committee to consider the impact of these factors on mental well-being and to recognize that in order to improve mental health, we need to implement strategies both within the health system and outside. We need to work with many partners in equal and equitable relationships to improve our health. Policies and programs that work best for Inuit must be initiated, designed, delivered and administered by Inuit. Inuit knowledge and culture is central to our health and well-being. Inuit wisdom and ways must be incorporated into the health system. It is encouraging to see that recommendation 1.2 in Report 3 of the committee's interim report, Mental Health, Mental Illness and Addiction: Issues and Options for Canada is for culturally appropriate delivery of services and supports.
Because the Inuit live in such a wide range of Canada, our programs and policies must be broad-based and flexible in order to accommodate all regions in the Inuit world. As well, they should have an impact on women and men similarly.
In the committee's second report, Mental Health Policies and Programs in Selected Countries, we noted that the Australian National Health Strategy recognizes the different histories and circumstances of each jurisdiction and the need for plans to be based on analysis of local population needs. This approach is consistent with the Inuit-specific approach that we are advocating.
We want to work together and share information, experiences and expertise across jurisdictional barriers. At present, it is difficult for Inuit to surmount these barriers. Volume 3 of your report identifies how issues of jurisdiction affect Aboriginal people. Some of our strategies will offer ways to address these. One is the Inuit-specific mental well- being framework. This reflects recommendations similar to the committee's, including a culturally competent continuum of services that includes traditional knowledge and practices based primarily in the home, community or region.
For Inuit, issues of access and coordination are enmeshed. Inuit need culturally relevant programs, activities, resources and strategies. Coordinated service networks are needed in regions and communities from agencies accountable to Inuit. Families need support to learn how to discuss emotions and to develop coping skills.
As Inuit, we are also concerned about staffing shortages and the poor geographic distribution of mental health and addictions professionals. To deal with capacity issues, we must build on existing strength by including elders and by offering training and developing opportunities to meet regional and community needs.
We can promote and adapt Inuit traditional knowledge and knowledge from other sources to train both Inuit and non-Inuit in culturally appropriate healing practices. Technologies such as distance education and telehealth can be useful.
The key to capacity is adequate, flexible, ongoing funding for human resources and infrastructure as well as new program dollars. A variety of mechanisms are needed to coordinate and integrate the system. ITK has proposed to work with the First Nations and Inuit Health Branch to create an Inuit health directorate within the branch. If developed appropriately, the directorate could coordinate and integrate federal programs and services offered to Inuit.
Report 1 of the committee's interim report, Mental Health, Mental Illness and Addictions: Overview of Policies and Programs in Canada, noted the lack of data on Aboriginal mental health. For Inuit in particular, our information is missing or mixed in with the data that includes other Aboriginal peoples. Without the correct Inuit health stats, development and evaluation of programs and services will not be based on reliable evidence.
It is not possible to discuss mental health without discussing suicide. Our National Inuit Youth Suicide Prevention Framework was developed by our National Inuit Youth Council, NIYC, which represents Inuit youth under the age of 30. Suicide prevention is one of the priorities for our Inuit youth. The framework recognizes that people who are totally well will not harm themselves and, therefore, emphasizes the importance of developing and protecting mental well-being as a measure to prevent suicide.
The youth have suggested that Inuit work together across jurisdictions to network and learn from Inuit in all regions of the Circumpolar Arctic. We can develop our own definitions of suicide, depression, mental illness and mental well- being. We can do appropriate research in Inuit regions and establish treatment strategies. To do this, we need mental wellness resource people in all Inuit communities, regionally and nationally.
Government, Inuit elders, adults, youth and organizations must commit to listening to each other, and involve each other meaningfully in decision making. Schools can support the development of total well-being by providing academic development, healthy physical activity and teaching coping and relationship skills. Community youth groups can be active in role modelling cultural activities and can be trained in suicide prevention.
NIYC's solid commitment to addressing Inuit suicide has led to the creation of a dynamic suicide prevention public service announcement and a youth suicide prevention walk from Duncan, B.C., to Ottawa, which is now in progress.
The funding provided to Inuit youth for these important initiatives is provided year to year with no guarantees, despite the success the work had in outreach to Inuit youth who are the most at-risk population for suicide in all of Canada.
Our population is growing faster than any other in Canada. We must instill and retain pride in our culture by providing supports to insure Inuit values, language and traditions. The key to our culture is language. We need to preserve, promote and enhance Inuktitut across all Inuit regions. In some regions, we need to augment Inuktitut curricula. We need to promote life and well-being, build strong communities, add holistic suicide-prevention strategies, plus include employment and transitional programs, programs for trades and high school equivalency, housing for young adults and more. New and existing early childhood programs strengthen a child's foundation. Positive media campaigns directed at Inuit youth could encourage discussion and reduce stigma. Regional crisis lines and youth elder centres in each community could provide support.
In summary, Inuit will make their own decisions about maintaining and improving their total well-being, but we need individuals like you who are listening, writing reports and making recommendations to help us. We hope you have heard today what Inuit know about what is needed and are committed to addressing the issues of mental well- being and health. We need resources and partnerships that will implement positive change to our current systems.
The last two pages in the handout we have given you are the websites of other information on Inuit that you may require.
The Chairman: Thank you for your presentation. Next we have Bernice Downey, the Executive Director of the National Aboriginal Health Organization. Your organization testified before us earlier on and when we were doing our original acute care study. Thank you for coming back.
Ms. Bernice Downey, Executive Director, National Aboriginal Health Organization: I would like to thank you for this opportunity to present on this very important area of mental health. In the interests of time, the focus of the presentation will be on First Nations and Metis. Mental health, mental illness and addictions are of fundamental importance to Aboriginal peoples. These issues have consistently been identified as priorities that sadly continue to be in a state of crisis in our communities.
The National Aboriginal Health Organization, NAHO, is an Aboriginal designed and controlled NGO with membership of our five national political organizations: Assembly of First Nations, the Inuit Tapiriit Kanatami, the Native Women's Association of Canada, the Congress of Aboriginal Peoples and the Metis National Council. The organization is comprised of three centres of excellence being the First Nations, Inuit and Metis centres, as well as supporting units.
Our focus is on knowledge translation with development, implementation and dissemination of information related to awareness, health promotion, health careers, research and traditional knowledge. We have just wrapped up our first mandate of five years, and we are embarking on our second. We are detailing the finalization of that now.
As we are positioned in this next mandate, the wealth of information that has gone out from our three centres of excellence in a wide area of topics related to Aboriginal health is immense. We have embarked on strategies and products. I refer you to our website for further information. Relevant to this topic, currently our First Nations Centre is working on a suicide-prevention tool kit. Communities are asking for concrete solutions and help, and ways to deal with what is going on. They need something in the short term. Communities are encouraged to adapt these tool kits to meet their own needs. The tool kit provides information and research on suicide prevention to increase awareness and encourage discussion.
Another example is NAHO has recently published its second issue of the Journal of Aboriginal Health, which is a publication sharing in-depth analysis of Aboriginal health issues. In the most recent issue, mental health is addressed in some of those papers.
The Inuit centre has written a research paper on alcohol and problems in Inuit communities and recently launched an on-line health career database. NAHO hopes to undertake a project this year on the Summer Institute, a health learning institute, in order to address the wide range of topics that will advance some of the capacity-building that is required. Our activities are diverse and we are well positioned to inform the work of others.
Each of these centres collaborated on the preparation of the brief distributed. Each provided comments for analysis of the issues and options reports, as outlined in the committee's request. The strengths and weaknesses of the options provided with respect to First Nations, Métis and Inuit have been examined. Our comments and recommendations are also provided.
Critical to the whole presentation, as you will see in the briefs, is that while mental health, mental illness and addictions are issues that concern all peoples, we believe that the diversity that exists amongst Aboriginal peoples requires separate and specific analysis. Mental health is a priority in Inuit regions, but as Mr. Gordon outlined, there are several areas of priority that are required. I will not go into those in detail. He has outlined them very well.
The First Nations encounter specific access problems and receive services of diminished quality due to cultural and geographical barriers. The following options, in our opinion, seek to address these issues. The majority of professional education programs in Canada offer limited initiatives to support First Nations people. This undoubtedly contributes to the ongoing shortages of First Nations nurses, doctors and other professions. In addition, some of the professional programs offer only one or two seats, thus failing to provide First Nations students with a peer group that is necessary to effective learning. Further, given that education is a provincial responsibility, there is no national system or uniformity of access to such programs.
The Royal Commission on Aboriginal Peoples found that if they are to succeed in professional education programs, Aboriginal people require adequate financial support, academic support, personal and family support and professional support from a core group of Aboriginal students. The relationship between knowledge translation and the need for culturally appropriate delivery of services and supports is recognized in many communities. We know that the mainstream approach to health care service delivery, while it addresses some of the needs, does not address all of them.
Approaches that have been targeted towards Aboriginal communities over the last 25 to 30 years, we know are not working. We know that some of the health statistics are worse than they ever were. I am sure this group has heard much about that over the course of these proceedings.
Evidence-based community research on knowledge translation is necessary to determine the impact on quality of health services and products, and availability and use of cutting-edge research for community programming.
Linked to, but distinct from, increasing the number of First Nations health professionals, are the continued education and training for community workers: mentoring and training focussed on youth and the empowerment of First Nations capacity to design, deliver and control community mental health services.
As I said earlier, there is a very good network in communities of paraprofessionals and nurses, but we have a shortage overall as we do elsewhere in Canada, but it is that much worse in communities. There is a good network of community health representatives and mental health care workers, which, with resources to augment those services, education and training, definitely can make a major contribution.
Further, given that education is a provincial responsibility, there is need for a national system. The Royal Commission on Aboriginal Peoples found that if they are to succeed, this ongoing multi-dimensional element of support is needed.
Further to the First Nations perspective, Canada does not currently collect data on an ongoing basis on the prevalence of mental illness and addictions among Aboriginal people, nor does it have a national suicide-prevention strategy. The following options seek to address these issues. Seek information on the needs of community professionals and paraprofessionals such as health and social workers at the community level. A holistic approach is required, not one specific solution. For example, training programs, curricula and other educational and resource material and services must be available to front-line workers.
Building partnerships with communities is critical in research and program development, which supports First Nations-driven research initiatives. As stated in the First Nations perspective on the Healthy Living Strategy, First Nations-driven research is required on appropriate measures of First Nations health and effective practices for achieving health improvements. The right of First Nations communities to own, control, access and possess information about their peoples is fundamentally tied to self-determination and to the preservation and development of their culture. Far too many First Nations communities are facing crisis situations on a continual basis. I would like to comment that we undertook focus groups in the development of the suicide-prevention tool kit. While it was well received, there is a cry for concrete initiatives and support so that community health workers can address the needs of their people. There has been quite a wait for something that they can take away and use in their day-to-day work because they do not have the access to professional psychiatric services on a regular basis. In many cases, crisis management commands the lion's share of already strained community resources, and strategic planning or prevention activities are considered a luxury. It is really the need to get at those upstream initiatives and prevention.
While Metis represent about 30 per cent of the total Aboriginal population in Canada, according to the 2001 census, the Metis continue to receive only limited access to Aboriginal health programming delivered by either federal or provincial governments or departments. For example, Metis do not have access to non-insured health benefits offered by Health Canada's First Nations and Inuit Health Branch. There is a serious need for increased funding and capacity for Metis-specific research and knowledge-translation activities undertaken by, or in partnership with, Metis governments, organizations and communities. A comprehensive research strategy is also needed to determine the extent of mental health and addictions issues and incidents rates, for example, among Metis. Across the board, while we are gathering data and accumulating an evidence base for First Nations and Inuit, Metis lag far behind in gaining initial basic baseline data.
The report notes that the system is highly fragmented. This is a situation known too well to Metis groups. Part of the reason for this fragmentation is that Metis fall under provincial jurisdiction for health, which means as the report says, that Metis have access to programs and services on the same basis as other provincial residents. If you make the link back to the strong case in the previous presentation around the need for a culturally specific approach, that does not fit for Metis, nor does it fit for First Nations or Inuit.
At the same time, Metis have limited access to federal health promotion activities, for example, HIV/AIDS and diabetes initiatives, but not others, a situation that fails to consider the collective inherent rights of Metis as one of the three constitutionally recognized Aboriginal peoples of Canada.
Developing a comprehensive plan for dealing with mental health, mental illness and addictions amongst Aboriginal Canadians, inclusive of Metis, hinges on the awareness of the governments to acknowledge and respect not only the jurisdictional rights of Metis, but also the concept of health and wellness from a Metis perspective. This includes the provision of services in Aboriginal language and the inclusion of traditional knowledge and healing practices.
In terms of area of interest from the mainstream perspective, we are now receiving many inquiries about how traditional knowledge factors into developing new approaches. When we look back over hundreds of years when mental health was not an issue in the way it is today for Aboriginal communities, we know the link is to traditional ways of living and traditional knowledge and healing approaches that were evident then. We know that, as we speak to our elders and speak to our traditional healers and undertake ceremony and integrate both the traditional aspects of life and the current mainstream ways that assist us as well, that is definitely a link to improved mental health.
The understanding of that is not clear yet. There is not a whole lot of support in terms of traditional knowledge. There are lots of issues related to traditional knowledge such as intellectual property rights, and protecting them. NAHO has put a lot of effort over the last few years, from an Inuit First Nation and Metis perspective, into the area of traditional knowledge and gathering up from our elders and from our traditional healers what was making sense before and trying to integrate it into what we are doing today.
I will comment from the Inuit perspective. The Métis Centre at NAHO has undertaken many areas of emphasis in the area of health and mental health, and is working with the Inuit Tapiriit Kanatami and around research initiatives with other centres and NAHO.
In closing, I want to say that at the beginning we talked about mental health, mental illness and addictions that are of concern to all people, but that diversity is really the notion to which special attention must be paid. Just as we now know that the mainstream approaches do not work, are not totally effective, we know that a cookie-cutter application to the three constitutionally recognized groups is not the answer either. It must be specific to the Nations.
We have strived as an organization to respect this diversity as well. A number of shared concerns or themes arise from the specific analysis in your briefs. For mental health care services to be effective, they must be culturally relevant. Our colleagues in New Zealand, as you see in your reports, have identified that this is a matter of safety. It is not just nice to have. There is a certain element of harm being done by not applying culturally relevant approaches to care.
I draw on an example from an Inuit elder who participates regularly in our NAHO proceedings as a board member. She said it all for me one day when she talked about the suicide of youth in her community. In the experience of this youth in attending school, he did try. He was a young boy. He went to school. He could not identify with what was being taught to him. He felt — I guess I would summarize to say — that it impacted his self esteem. What he was learning did not make sense. His environment did not fit his learning needs. He came away with the idea that he was the problem. When you think about the impact on that child's well being and his ability to think that he can achieve something in his life, what happened in that situation was a tragedy.
Do we make the connection to that learning environment and how it contributed to his mental health? Do we understand the research that is needed to explore those kinds of things? It was a very poignant story that brought it all home as to the problems in the north.
To have a fundamental impact on the mental health of Aboriginal peoples, a number of changes or actions must take place. Policies, programs and procedures developed by the government need to be respectful and inclusive of all First Nations, Métis and Inuit concepts of health and healing. Research must be driven, and where possible conducted, by First Nations, Metis and Inuit communities and individuals in accordance with the concepts of ownership, control, access and possession, OCAP.
The development and training of First Nations, Metis and Inuit mental health paraprofessionals, professionals and researchers must be a priority.
The Chairman: We now have John Service, who is the Chair of the Board of the Canadian Alliance on Mental Illness and Mental Health, CAMIMH, and Phil Upshall, who is the National Executive Director.
Mr. Phil Upshall, National Executive Director, Canadian Alliance on Mental Illness and Mental Health: We have wonderful ongoing relationships with this committee and I am pleased to report that we will be there for you to the end. I did want to tell you, chair and the others, that we are currently working on the report on mental illnesses for 2005. It is a build up of the 2002 report. I raise it at this stage, outside our submission itself, because we have enhanced the report on mental illnesses to a large extent. It will include a chapter on First Nations and Inuit Mental Health. Health Canada's First Nations and Inuit Health Branch, FNIB, has contracted, and is funding, that process. Dr. Jeff Reading from the Institute of Aboriginal Peoples' Health of the Canadian Institutes of Health Research has agreed to do some of the funding as well. I thought you and our colleagues here would be interested in that.
I will cut much out from what I planned to say because it is all before you in the report and because I have had the opportunity to be here before, and Dr. John Service was here last night. He did an eminent job, as I understand. I wanted to emphasize for the record that the Canadian Alliance on Mental Illness and Mental Health, CAMIMH, is the largest and most comprehensive alliance on national metal health and illness issues. I have added an appendix with our new members. We have as one of our new members the Canadian Healthcare Association. Also, the chiefs of police have joined us in dealing with their mental health committee. We are pleased to have that broader characteristic available to us as we move forward.
In terms of the strengths and weaknesses of your report, I would be remiss if I said that there are no weaknesses. It is a truly strong report. At CAMIMH, we have analyzed it well and we think it hits the mark on almost every major aspect that you have attempted to deal with. We will not deal with the strengths.
In terms of the analysis that we have to talk about, the report based the discussion of mental health and mental illness on the needs of the population, which we think is the right way, and not the needs of institutions and providers. The patient must be at the center and you recognized that. There must be a partnership of some description between the services and the professionals. We have to recognize the consumer's voice as a legitimate contributor to the dialogue and to the implementation of any successful plan of action. The call for improved access to services is absolutely essential. You note obviously that there has been a historic underfunding. There are serious shortages in health, human resources and so on. You are right on.
Our major concern, if we have a concern, is that it is so good and detailed that governments of the day, provincial and otherwise, have the opportunity to cherry-pick some of your options. The Canadian Alliance on Mental Illness and Mental Health advocates for an overarching national action plan. Within that plan, all the elements of your report should exist. Our big worry is, and it has happened in other provinces and territories, the larger, more powerful voices come in and cherry-pick a particular program and say, ``This is great,'' and it is funded. A large majority, or a large minority, of people would say that you have looked after my interests, I will not worry about anybody else's. Our concern is that you continue to recognize the overarching necessity of a national action plan.
Our preferred option is a national action plan that is developed by a distinguished blue-ribbon panel including consumers, patients and families, which will advise the policy work of the federal, provincial, and territorial governments. We think that this is an essential element of a national strategy. It should be developed with the support of an office of mental health in the federal government that reports to a minister of state for mental health, who in turn reports through the Minister of Health to Parliament.
That is a suggestion. If we are able to get a minister of wellness similar to the minister of wellness in Manitoba, by persuading the federal government of the necessity for a larger, very powerful office that has the authority to bring everything together, such as health, social, disability, corrections and Aboriginal issues, that is what we would like to see.
We think the national strategy must be the result of a process of negotiation between federal, provincial and territorial stakeholders. The blue ribbon panel that is engaged in its inception should be an ongoing panel to give advice about implementation, and again it should be inclusive.
The national action plan and everything will fail if we do not have a modeled good behaviour by the federal government. It must take the initiative in setting the bar high for provincial and territorial governments to respond to the issues that our communities require.
If it starts to say, ``You have to do this and you have to do that,'' without addressing its own issues within the Aboriginal communities and other distinct federal jurisdictions, then we think the national action plan will fail. We believe that within the delivery of services and supports, a patient-centred model is the best way to go. I will now turn it over to Dr. Service, who will talk quickly about the delivery of services and supports.
I did want to tell you that we are in the process of undertaking focus groups across Canada in conjunction with the Canadian Collaborative Mental Health Initiative. I just got some interesting information from Whitehorse this morning, and I would be happy to provide the information to the committee at a later date.
The Chairman: When do you expect to have the results from the focus groups?
Mr. Upshall: Probably the first week of May. Once we complete that particular aspect, you might wish to meet with the group that has been out there.
The Chairman: That is where I was headed. Can I leave it with you to contact our staff?
Mr. Upshall: Absolutely.
Mr. John Service, Chair, Canadian Alliance on Mental Illness and Mental Health: I will keep this brief by saying that we have responded to all the sections in report number 3. We are prepared today to talk about funding, health, human resources specific to mental health, early detection and prevention, and the recovery model versus the population health model. Any of the questions that you have asked, we are prepared to respond to today.
[Translation]
Senator Gill: The definition of mental illness is probably the same everywhere, whether you are talking about the First Nations or non-Aboriginal people.
Because of the general context within which most people live, and the changing way of life, I wonder if, for First Nations, for the Inuit, we can use the same definition of mental illness that applies to those who are not Aboriginal?
We have seen results in Aboriginal communities, including my own — I live in northern Quebec — on the North Shore of the St. Lawrence, and in Labrador. My group, the Inuit, are from that area, and we have witnessed a large number of suicides in our community. It varies from one community to the next, but often, it is three, four, or even five times higher than the non-Aboriginal average. I do not think that this is necessarily due to mental illness. I think it is a modern malady that the Aboriginal people began to experience, a few years ago. I wonder if this is not due to the integration, or even assimilation policy to educate Aboriginal and First Nations people. We have seen a considerable mobilization of youth leaving the North to go to school in the south and then, they return to their respective environments without having adapted to the non-Aboriginal world. They are very disturbed. Integration has failed and young people have been torn from their environment. The way of life, the housing, economic development, everything was turned upside down. We have to understand the reason for the high suicide rate among Aboriginal people. I do not think it is because there is more mental illness there than elsewhere, although that may be the case now, because of some of the situations that I have just outlined. Nevertheless, suicide in our community is a terrible scourge. When it begins, there is an increase in suicides among young people, and particularly among young men.
In order to correct these problems, we have to know the reason for them. I would like to know what you think about that. Is it the same in northern communities, in Nunavik, in Nunavut, or in Metis or western communities? Is it not the same phenomenon: disintegration, attempts at integration and significant failures? Young people fall between the cracks, do not know what to do and feel completely devalued. There is no longer any hunting, fishing or trapping: the traditional ways no longer exist. What can be done about that?
[English]
Ms. Downey: Senator, I would have to say that in my travels with the work of NAHO, we engage on many different levels with health professionals and policy makers. If I started out every conversation with questions such as yours, we would be much further ahead. You have astutely acknowledged some of the key reasons as to why the situation is what it is. Your words are not too dramatic. There is a scourge. It is a crisis.
If we had these rates of suicide in some of our urban areas in mainstream communities, there would be headlines in the paper every day. While we have a general awareness, it is comments like yours that we need to advance the awareness for policy makers, for research, for our colleagues and for our partner organizations in this area. I commend you for really zeroing in on what some of the factors are related to.
I undertook an interview with a newspaper recently. Oftentimes I find myself in this situation, and I call it Cultural Factors 101 Related to Aboriginal People. While there is a peripheral understanding of the impact of assimilative policies over the last 300 years for Aboriginal people, we have to understand that many health professionals do not have an understanding and awareness of the relationship between what Aboriginal people experienced in relocation efforts, residential school systems, taking away their traditions, their languages and their way of life essentially, and how that translates today in the modern world. It is sometimes referred to as a trickle-down effect, and that must be taken into consideration.
When we look at what has to happen systemically, our health professionals need to be trained differently, which means that the governing bodies in universities and other institutions need to be aware. We need to have champions there. We need to have the licensing bodies of our health professionals aware so that they support it in that mechanism. We need to have opportunities in their training and residencies to undertake and work with these groups. That is one area of systemic change that needs to happen.
This newspaper reporter said to me, ``Did that not happen a long time ago? Why are we still talking about that today? What are the current reasons?'' It was well intentioned to try to get to the bare bones of it because that happened in the past, but we are still experiencing the impact of that. When you talk about mental health, you look at healthy families. You see they have ways to support themselves, a sense of purpose in their life, and a job that they feel they can make a contribution to. They can undertake their ways of life and not be restricted by restrictions on hunting, as an example, so that they can teach those traditions to their youth and their youth then can go forward. That is what mental health is all about for communities.
One of the activities we have undertaken at NAHO is the youth role-model program. We are in our second cycle of it this year where 12 youth from across Canada — First Nations, Inuit and Metis — have been chosen by youth to go out to community events and promote how they were successful in becoming a nurse, an athlete or obtaining degrees in education, so that they can bring that message to youth. It costs a lot of money to do that. The resources committed to it, while somewhat improved, are not enough. As we undertake our evaluation, we hope to put those things forward.
I also wish to comment that the flexibility in support is to know that different approaches will yield different results. My profession is nursing. Most recently I was asked to undertake, as part of my studies, an internship in an urban health centre. I was required to work within the health centre, and I proposed to take part in a First Nations women's drumming group. I wanted that experience to understand what the impact of that drumming group could have on the mental health of the women who were participating.
I have worked in mainstream mental health for over 20 years. There are approaches there, and medications and counselling that do work. What I wanted to understand is what can make a difference for these women. In the first four sessions, nobody talked about their problems. Nobody really talked too much about what was going on in their lives. Over the 12 weeks, as they learned to understand the traditions of drumming and singing and what that meant as part of their cultural background, what I had towards the end of the group was women who were weeping, who were then able to release and vent and talk about what has been making them depressed for many years, and why they have been through psychiatric cycles in the mainstream system where nobody seems to understand why they are not getting better.
At the end of the 12 weeks in this drumming group, you had a bonding amongst those women, smiles on their faces and a healthier approach to their life. I do not know the impact on a day-to-day basis because I did not go that far. I know that after 15 years of working in a psychiatric system, that I think does good work, what I saw made a difference. It is because that urban Aboriginal health care centre facilitated that. We had a room and money to buy drums for the women. We could offer snacks and child care for their families and bus tickets to go home. That urban health care centre is supported to do that. That is the initiative, innovation and support required. I am sure if we undertake a First Nations and Inuit strategy development, we can share those other success stories because they are out there. Working with our partner groups to integrate both of those approaches will make a difference.
Mr. Gordon: Just a couple of items to add on to what Ms. Downey said. The question that came up was the definition of mental illness. I know in the Inuit culture, we try not to talk about illness. We want to become mentally well. The terms do make a difference.
You spoke about taking students out of the North and flying them south to become educated in the South and then going back. Many times when people leave the North and come back, there is no work for them. They have received an education and a degree, but there is no work for them. They become engineers. The only work that they can actually do is in the South because of their training and background. We lose many people that way because there is no infrastructure or jobs available in their area of expertise.
For Inuit to work and become productive members of society, many times they have to move away from home. That dilemma is facing our young students now.
[Translation]
Senator Gill: I think it is very important to determine what the illness is before introducing remedies. It is important to get the right diagnosis. I think this is a major problem in assessing the situation facing First Nations communities.
Senator Pépin: In the document you presented, there is a reference to a national suicide prevention strategy. The paper states that this strategy should be developed jointly with the First Nations, health and social affairs professionals, seniors, young people and other interested parties. You say that the strategy should reflect particularly the needs of the First Nations people and should respect the knowledge that exists within each community.
Does that mean that at the moment, the proposal does not reflect what you call for in your brief? These strategies and developments would be determined by other professionals, not from the Aboriginal or Innu communities? That is at the top of page 9 of your presentation.
[English]
Ms. Downey: Your question, if I understand correctly, is about the statement that was made here that it must be done in conjunction with First Nations leaders. You are asking to clarify: Does that mean that it is not happening now?
Senator Pépin: Yes.
Ms. Downey: There would be a couple of factors. Oftentimes in federal initiatives, federal-provincial-territorial initiatives, that are quite complex, cumbersome, and expensive in some ways, the needs of First Nations, Inuit and Metis may come through and be a tag-on to that proceeding.
It is important to share that information together and to understand, similar to what we are doing here today. However, the enriched information you received, where it is specific to First Nations, Inuit and Metis, is much different. We need to continue to talk together, but the degree that you need to understand the specifics of the three constitutionally recognized groups is paramount as well.
[Translation]
Senator Pépin: My question is to the doctors. You state on page 7 of your brief:
[English]
Currently services are scarce and over-demanded and often they are not attractive to Canadians they aim to help. By consequence they are all too often avoided. This must change in all our communities across Canada.
[Translation]
Which services should be changed or improved? Further on in your brief, you talk about human resources. You say that you have a great deal of trouble attracting students in the area of psychiatry. You give a few reasons and you say:
[English]
As a result lower-income Canadians do not have the same access as the wealthy neighbour.
[Translation]
What difficulties are experienced by students who want to go into psychiatry or psychology compared to others who want to go into other areas of medicine?
[English]
Mr. Service: Your first question is extremely important. If we look at just one group, that is young adults, and we ask young adults why they do not access mental health services, they will often tell us it is because they are in large hospitals, because they are in settings that they feel very uncomfortable going to. They are not in the kind of settings you might get in a downtown service centre such as Operation Go Home or something like that, that is more designed for an older adolescent or young adult so that they feel comfortable in the surroundings. The way we position our services often dictates that they will not use them very effectively. That is a serious issue. You wanted to ask something.
Senator Pépin: I agree with you and I would like you to elaborate on what you just said, the way you organize the services.
Mr. Service: Another example that I could use from my own experience as a psychologist for 15 years with children, adolescents and families in Nova Scotia, is that we had difficulty getting children and their families to feel comfortable coming to the hospital. We negotiated with the county school board an agreement where we would offer our mental health services in the schools. That was much more effective. People felt much more comfortable coming and we had access to the teachers. That was ready to be signed except we had a change in government and you know what happens with a change in government.
You asked me a question about the human resource supply. I am a psychologist, so I am speaking outside of my realm here. Within medicine there is a need to attract more people into family practice and psychiatry. You should talk to the College of Family Physicians of Canada and the Canadian Psychiatric Association about those specific variables, because I am not a psychiatrist. They are finding it hard to find enough people, which is remarkable considering that most primary health care is provided by family physicians.
The second thing is, in psychology we will get anywhere from 100 to 150 excellent applications for every one spot. It is the other problem that you do not have enough spaces in order to accommodate the demand.
The third piece for us is, what is happening to psychology is that government policy and working conditions means more and more psychologists are choosing to go into the private sector. That makes it very difficult when there are not enough public services for lower- and middle-income Canadians because of the financial barrier.
Mr. Upshall: I would add to Dr. Service's point of view from the community organization point of view, whether it is Aboriginal mental health or community mental health in other communities, the best practice from our perspective is to have self-help peer support groups in community settings, which are adequately financed and which have appropriate facilitation opportunities. People are far more comfortable sharing their knowledge with their peers, whether it is with regard to the drumming issue that was brought up or otherwise.
The reality is, as your previous group, the Office of Disability Issues, will tell you, funding both at the national and the provincial levels for NGOs that provide those services has been dramatically cut back. That is an issue that you have dealt with and will deal with, but that is the reality of how we heal, how we recover our self-esteem and move forward. It is not something that the medical community seems to understand in a big way, in the sense that they are not there supporting, not only the institutional issues, which we support, the medication issues, which we support, but the community issues. which are so absolutely essential to the complete recovery, do not receive the kind of support they need to have.
Senator Cook: I will be brief. To the Canadian Alliance on Mental Illness and Mental Health, in your brief you say the initiative for designating funds for mental health has serious shortcomings. I would be interested in hearing what your alliance might approve.
I will go on then to Ms. Downey. The whole concept of traditional knowledge, is it oral? Is there anyone writing this stuff or retaining it for future generations? That will be critical for the future.
I am interested as a member of the United Church of Canada who had some knowledge of the impact of residential schools. I am wondering how many generations it will take, especially in the area of the parenting skills of the families of the day that lost their parenting skills as a result of their children not being with them.
I would like you to comment on equal partnerships. On page 5 of your presentation you say what is needed is equal partnerships. Could you help us with that and then I can see where the capacity building might need to be focussed in your journey?
Mr. Upshall: Again, from a community perspective, from someone who has seen it from the consumer point of view and who has been involved, particularly in the Province of Ontario, watching how mental health and other provincial funds are manipulated, my basic gut sense is, if you do not say spend it on community mental health and spend it on developing the services that are required there, you will be in a situation you have always been in — the heavy weights, the hospitals and the others will grab the money. That is a personal opinion. It comes from the ground up. It is something that I feel very passionate about. I recognize the issues that mitigate against that position and I honour those as well. It is something that CAMIMH will deal with in its brief in June when we file it.
Mr. Service: You put it best yesterday, Mr. Chairman, when you said you are between a rock and a hard place with these ringed funds. On the one hand, it can be cherry-picked in tough times. We know that has happened across the country. I have been in the game for 30 years and it has happened many times in my experience. Ringed funds are very vulnerable. They also are in a ghetto by themselves; they accentuate separation. One of the things that ringed funds and targeted funding can do is kick-start change. It can buy change. If it is done right and it is tied into the longer term and structural change that is needed, it can be helpful.
Using your earlier suggestion that it can buy some affirmative action; yes, it can. It can buy affirmative action if it is used to buy space and place within the current power structure. That then is shown to be a valuable service that does not have to compete with the bigger, tougher physical health side of that same money. Ringed funds and targeted funds are very helpful in the short term, but I am very scared of them in the long term. I have seen them too often picked off, reduced and eliminated.
Mr. Upshall: In two instances, the ring funding concept was tried. When cutbacks occurred, and we lost the money, we would say to the hospitals, how about the supports that were available, where are the psychologists who were supposed to be funded. The response was, We lost that funding so we fired that group and we have dropped that program. If it was part of the gross funding, and was part of the huge allocation that the hospital got, the other programs went on, such as the cancer support programs: all those other programs that were considered traditional. However, our programs that were specifically funded were just blasted away, and it was tremendously damaging to our community.
Ms. Downey: In the area of traditional knowledge, what you have identified is critically important. You have identified also your awareness that this has happened over the years in an oral tradition. That is so because that is how it has been done for thousands and thousands of years. It has identified the need to protect and ensure that traditional knowledge and elements of traditional healing are passed on and integrated. A large part of that is creating opportunities for that to happen.
In order to create those opportunities, we need adequate support and mechanisms to do that. We also need to build trust for those experts out there, the traditional healers and elders. They will not willingly share their information and write it down. What has happened to damage trust is that it has been done in the past and now we have pharmaceutical companies with information that has been passed down over hundreds of years. Protection is a major issue in that regard.
Optimistically speaking, one of my colleagues, James Lamouche, who is here today, has undertaken over the last four years to talk to these people and to write down what the issues are and what is happening. NAHO will be publishing a couple of very significant papers in the near future.
An example of how we are trying to affect some change can be seen in looking at curriculum and trying to have a situation where health professionals and community people have an opportunity to choose from both areas. There are success models in Canada today. Someone with diabetes can walk into a clinic in their community, turn to the left and see a traditional healer, and turn to the right and get their blood drawn to see what their blood sugar levels are.
Innovation in models approaches again is important. We are undertaking some innovation in terms of our own projects. We have entered into a memorandum of understanding with a group of Amazon traditional healers, the Yaja healing group, who have done much work in this area. We are hoping to look at how we can create a training initiative so that these elements of traditional knowledge can be passed on, but in a way that is safe and protecting of the knowledge, and that fits with what we need to put in place.
I hope that answers some of the questions you had.
Senator Cook: Yes, it does. That is where I was going with it. If we are to move forward together in collaborative program,s an understanding of each other will be critical.
Ms. Downey: Exactly. We hope to do some more work with NAHO. We have spent three years travelling the country and talking to traditional healers. We now hope to gather that evidence base and seek resources to continue that work and look at the curriculum changes, and to have dialogue with other partners to bring this knowledge to the table and to the discussion.
You also talked about the impact of residential schools and parenting skills. That is not something that will be changed overnight. As Mr. Gordon said in his presentation, it is a holistic approach. For parents in communities to gain an understanding to build those skills and to make the connections, they have to heal, mentally, physically, emotionally and spiritually. To undertake that, poverty must be addressed. It is hard to focus on anger management for your children when you are trying to figure out how to feed them or get them into a school so that it will help them make a difference in their life, or that you have had mould in your basement for 10 ten years and you have suddenly realized through the media that it is a health issue. Those are all health determinants that impact how we can get to that next level. There has been so much emphasis put on the emergency nature of the situation.
You have picked up on it. How can we get to the more upstream prevention type of initiatives by creating healthy families? It is very complex.
Senator Cochrane: Mr. Upshall, do you think that the specific nature of mental illness should be a separate entity, rather than linked with persons who have other disabilities?
Mr. Upshall: Speaking again from the perspective of the consumer who has been discriminated against and stigmatized for hundreds, if not thousands of years, it is time to have affirmative action, and have those particular issues dealt with. The reality is that they are a part of the overarching human being, part of a number of physical diseases that are present in the human being. In my view, we need to start by making mental illnesses a huge issue for all the reasons you have heard today, but overall after a few years I see it being accepted as part of a community and dealing with the issues that present themselves at that time.
However, the Office of Disability Issues I am sure will tell you their program clearly indicated that where Canadians will accept people with physical disabilities, they will not accept people with disabling mental illnesses. The rate is 66 per cent to 33 per cent. That is a reality that we deal with as a society and in government programs. The level of discrimination is high.
Dr. Service: I agree with Mr. Upshall. In the long term, one of the things you could do with your report would be to look at psychological mental illness problems in physical health. The way the report is written now, it focuses very much on mental illness, mental health and addictions as a stand-alone. For psychology, psychiatry and patients, there are many mental health issues dealing with cancer, respiratory illness, heart and stroke and others across the continuum of care. That normalizes mental illness, mental health, and addictions. It becomes far more a part of our normal daily activity.
We have this wonderful national program called Canada's Food Guide. What would be wonderful would be to have the Canadian mental health guide that would tell people how to deal with normal stresses, anxieties, depressions, and feelings that they have on a daily basis. Health Canada could do that. That would bring these types of issues into the normal understanding of people.
Senator Cochrane: To go back to Ms. Downey's incident of the drumming experience, I jotted down a few things that would be involved with this drumming exercise, and which can be done quite often within the Aboriginal community. These are a few factors that would improve good health.
They are releasing frustration, and sharing their problems. They have the ability to talk. They are part of a large group rather than being isolated. They share their solutions. They have peer support. These are a few of the things that can be done any day with a group like yours. That is wonderful, but you should spread the message.
Ms. Downey: Thank you for that. A really important part of these proceedings is speaking from the heart. What you see in the newspapers every day makes you become immune to the frightening statistics. We are used to seeing the horror stories. Talking to community people and hearing both the wellness promotion that is happening in addition to some of the success stories is critical to affecting change.
NAHO is in its infancy. We are working with our partners, both our Aboriginal organizations and our mainstream partners, but you have to have the funding committed to advance that work.We can identify it. We can take the surface layer off the work that needs to be done, but we need our organizations supported in order to do that, get that message out and work with the communities. That takes an investment and commitment on the part of the government to do that.
The Chairman: I would like to thank all of you for coming.
The committee adjourned.