Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 25 - Evidence
OTTAWA, Tuesday, July 5, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 9:02 a.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Welcome. Before we begin, I will comment on the status of the committee's report on mental health and mental illness. The goal has been to produce a report by the end of the year, although it may be in the first or second week of January. One chapter of the report will be devoted to the issue of mental health in the workplace. While the report will cover a considerable number of across-the-generations topics, two or three chapters will be devoted to mental health and mental illness in specific subgroups of the population such as children, seniors and workers. For those chapters, the committee has tried to convene a round table such as this to allow people from across the country to provide their best advice on what the federal and provincial governments and the private sector could do to improve the situation. The aim of the committee, similar to that of its report on the acute care system in October 2002, is to lay out specific courses of action for all participants. This committee is not given to generating platitudes, however relevant they are, such as saying that the real solution to children's mental health is to eliminate poverty. While that happens to be true, it is hardly operational. The report will be specific, so I would ask that the witnesses be as specific as possible in their comments.
Today's meeting will end at 3 p.m. to allow senators to attend a possible vote in the chamber. Therefore, I would ask that speakers limit their comments to five or six minutes, after which there will sufficient time for a general discussion. With that, I would ask for self-introductions around the table. I am Michael Kirby, Chair of the Social Committee.
Mr. Marc Corbiere, Assistant Professor, Institute of Health Promotion Research, University of British Columbia: Good morning. I am a researcher and assistant professor at the University of British Columbia in Vancouver. I am interested in mental health and workplace health, and more specifically, in the predictors of work integration for this clientele. I am also interested in the continuum of mental health problems or mental illness, not just severe mental illness but also depression, sporadic depression and other issues. More recently, I was working on the co-morbidity of musculoskeletal disorders with depression.
Senator Keon: I was a medical doctor prior to life in the Senate. However, my medical career was not very closely associated with mental health. I was a heart surgeon and a health administrator throughout my life.
Ms. Lucie France Dagenais, Researcher, Commission des droits de la personne et des droits de la jeunesse: Good morning. I am from the Quebec Human Rights Commission. I am a sociologist and have done some empirical research on mental health at work.
[Translation]
I study situations where psychological health is affected, more particularly in the workplace, pursuant to section 46 of the Canadian Charter of Rights and Freedoms, which guarantees healthy working conditions, that is to say conditions that do not undermine the mental and physical well-being of individuals. Today, I am presenting my research findings.
[English]
Senator Cochrane: I am a senator from Newfoundland and Labrador. My background was teaching before I became a senator and I am very interested in disabilities and schizophrenia, especially as it pertains to children.
Ms. Mary-Ann Baynton, Director, Canadian Mental Health Association, Ontario: I am with Mental Health Works, which is a business within the non-profit Mental Health Association Ontario. We are hired by employers to help create an accommodation for people with mental illness, or to train managers on how to accommodate or work with people who have mental illnesses.
[Translation]
Ms. Romaine Malenfant, Professor Researcher, Université du Québec en Outaouais: My background in sociology has led me to take an interest in changes in the workplace and their impact on mental health, more particularly the increasing employment and labour market insecurity in recent years, that is to say their impact on work-life and work- maternity balance.
Senator Pépin: I am a former nurse specialized in gynecology and contraception. I am glad you are taking part in our committee, particularly since I am convinced it is the best one we have in the Senate.
[English]
Ms. Lembi Buchanan, President, Communications Resources and Member, Technical Advisory Committee on Tax Measures for Persons with Disabilities: I am a mental health advocate. I was involved with the Technical Advisory Committee on Tax Measures for Persons with Disabilities. I got involved with this issue particularly because the federal disability tax credit was discriminating against persons with mental impairments. I will be speaking about that later.
My area of concern is making sure that people with mental illnesses are able to access the income security programs of the government as long as they meet the eligibility criteria. I am particularly concerned with the professional people who are having the greatest difficulty getting back into the workforce and are quite often rejected.
Ms. Elizabeth Smailes, Director, Mental Health and Organizational Development: I am with the occupational health and safety agency for B.C. Health Care. I am the director of mental health and organizational development. Our focus is on prevention. We are a bipartite organization with a board of employers and unions, so there is a strong push for prevention and healthy workplaces, as well as return to work, which Mr. Corbiere mentioned. We collaborate closely with him in a lot of our programs.
I am a psychologist and my background is in looking at selection causation — does work actually have an impact on mental health? The research that I have done has suggested that is the case.
[Translation]
Ms. Sylvaine Raymond, Research Coordinator, Centre de recherche et d'intervention sur le suicide et l'euthanasie, Université du Québec à Montréal: I am a community psychologist by training, and I conduct research on suicide in the workplace, more particularly the impact of suicide in our organization and among colleagues. I am studying suicide prevention solutions. I am a member of the board of directors of the Canadian Association for Suicide Prevention.
[English]
Senator Cordy: I am a senator from Nova Scotia. Before I became a senator, I was an elementary school teacher for 30 years, so I saw how mental health and mental illness affected not just young children but their families. I was also chair of the board of referees for what was then HRDC; that was for people who were appealing denial of employment insurance benefits. A number of people came through the system after they had been refused benefits because they quit their jobs on the spur of the moment when they could not take the stress any longer. Of course, the law said any number of things with which I am sure you are familiar.
[Translation]
Mr. Angelo Dos Santos Soares, Professor, Université du Québec à Montréal: I am a professor at the École des sciences de la gestion at UQAM. I am a psychologist by training. My research focuses on psychological violence, its effects on mental health, including bullying in the workplace, and the organizational aspects in the workplace that can make people physically or mentally ill. I became a Canadian citizen one month ago.
[English]
Senator Cook: I am Joan Cook, a senator from Newfoundland and Labrador.
Mr. Merv Gilbert, Psychologist, Mental Health Evaluation and Community Consultation Unit, Department of Psychiatry, University of British Columbia: Good morning. I am a psychologist with the Mental Health Evaluation and Community Consultation Unit at UBC. I am the co-author of the "Depression & Work Function'' manual, which has been distributed and that I am very glad to get rid of. It weighed a lot on the plane.
I have an interest in psychological functioning at work and creating psychologically well-functioning workplaces. I also have an interest in paying attention to the emerging workforce and ensuring that people coming up the ranks are as well as they can be.
Senator Callbeck: I am a senator from Prince Edward Island. My background is as a teacher, business woman and politician.
Mr. JianLi Wang, Associate Professor, Psychiatry, Community Health Sciences, University of Calgary: Good morning. I am an assistant professor of the department of psychiatry and community health sciences in the University of Calgary. My background is in epidemiology. I am a researcher and have been doing epidemiological research on mental disorders in the Canadian working population.
Ms. Nicky Pogue, Researcher, Library of Parliament: I help with research for this committee.
Mr. Howard Chodos, Researcher, Library of Parliament: I am the lead researcher for the committee.
The Chairman: We have a very eclectic group, both on the committee and among those of you from the outside. It is exactly that diversity of views that has enabled us to do a lot of the work that we have done on health.
I would just make an observation for those of you who are here today as guests. Given that what you see on television most of the time is the constant squabbling that takes place in the House of Commons, you should know that every report that we have put out on health, whether on the acute care hospital-doctor system or the work we have done thus far and the work we will do on our final report on mental health, is unanimous. We have not had a single disagreement based on partisan grounds since we began working in this field five years ago. Knowing what a controversial field it is, that says a lot for my colleagues.
It is not that we do not disagree on some issues, but we will disagree in a way that has absolutely nothing to do with partisanship. You can have reasonable disagreements. However, they are absolutely not along party lines. Indeed, I would challenge any of you to figure out who here comes from what party, because even we get confused.
I would like each of you to tell us what you think we ought to recommend that governments, private sector employers, organizations, et cetera, should do vis-à-vis the issue of mental health in the workplace.
Mr. Corbiere: I have prepared a document entitled "Action Plan for Mental Health in the Workplace.'' It is divided into several sections. The first section deals with the situation of people with mental illness or mental health problems who are working or seeking a job.
In the first section, I describe the workers' compensation board system for people who are developing mental health problems. The WCB is based on work-related principles. Consequently, we have to prove that the cause of the mental health problems stems from the work environment. This presents problems, because it is not always possible to establish a causal relationship between mental health problems and the workplace. Sometimes, factors stemming from both work and outside of work can explain the occurrence of mental health problems. Consequently, in my opinion, it is necessary to expand the principle of work-related mental health claims and no longer consider it solely linked to the workplace. I do not know what can be developed between WCBs and insurance companies.
The second part of this first section is about social assistance for people with disabilities. I have included a table on page 2 that represents the reality in B.C., Ontario and Quebec to give you a good idea of the amount paid per month to a single person with a disability or limited capacity for employment and the earning exemptions for each province.
There is not a strong economic incentive for people with mental health problems or mental illness to find full-time employment. The law is not flexible enough to help people return to work full time. The disability should be considered chronic, in my opinion. When people have the possibility to return to work, they should be encouraged to do so without negative sanctions when there is a relapse. When people who return to work have a relapse, they have to wait for a long period before again receiving a disability pension. That is a negative sanction for people with mental illness.
It is important to consider work accommodation for people with mental illness, which many authors have mentioned. In order to gather all types of work accommodation together, we developed a questionnaire to systematically assess work accommodation for people with mental illness in the workplace. We are assessing this survey of people with severe mental illness who are either seeking a job or trying to maintain a job. The survey is being used in a project in B.C. funded by CIHR. The purpose of this questionnaire is to help us evaluate the available accommodation in the workplace for the clientele.
In the fourth section, I give an example of system coordination and integration, with a strong focus on community- based delivery, that is, the supported employment programs implemented in B.C. and the rest of Canada. Thesupported employment program is recognized in the U.S. as an evidence-based practice. One principle of supported employment programs is that it is integrated with mental health treatment. It is possible to have coordination between mental health treatment, the workplace and mental health teams.
In section 5 I describe a few potential strategies for supporting collaboration between general practitioners and psychiatrists.
There is a list of strategies for collaboration on pages 5 and 6. The first dimension is organization of continuing medical education activities.
In your third report you asked what governments can do to increase awareness that mental health is as important as physical health. One possible answer is to start with mental health problems associated with physical disorders such as musculoskeletal disorders. Many studies have demonstrated a high co-morbidity of pain condition and psychiatric disorders. It is possible to intervene at this level. However, such research has not directly addressed mental health problems or mental illness, but has been focused on various physical health problems encountered in the workplace.
To in fill in the gaps, we developed a research project in B.C. and submitted it to the Michael Smith Foundation for Health Research. This project addresses key issues of importance to stakeholders such as identifying behavioural-based andsystem-based risk factors that could lend themselves to future intervention programs. We want to pave the way for future projects that could improve the existing programs by providing mental health and behavioural services. It is a possible way to intervene at this level.
Finally, I suggest a need for evaluation of employee assistance programs to learn about employees' needs and access, and also work outcomes as well as their well-being.
The Chairman: Thank you.
[Translation]
Ms. Dagenais: I want to point out to you that the Commission des droits de la personne du Québec has been interested in psychological health in the workplace for a few years now, more precisely since 2000, since section 46 of the Charter has led us to ask ourselves various questions. Section 46 states that every person who works has a right to fair and reasonable conditions of employment which have proper regard to his health, safety and physical well-being. Of course, we recommend that psychological health also be included in the section 46 definition.
The study that we have proposed is an interpretation of the law as applied to health and obligations in the workplace, as defined by the various international agencies I will refer to again. In fact, for research material, we have used our investigation files, which have enabled us to identify the harmful effects of conditions of employment on psychological health. In this research project, we have focused on the issue of damage to psychological health that was highly visible in the investigation files. We also conducted consultations with commission investigators dealing with those files. The basic objective was to make a connection between risk factors and situations in which psychological health was damaged.
The initial assumption, of course, is that personal predispositions to disease cannot be denied. Situations in which psychological health is damaged — all other things being equal — are viewed as the effects of the action of risk factors in working conditions. We ranked situations in which health has been damaged: the most serious situations, pathogenic situations and non-specific situations. From a review of the international literature, we identified indicators for an empirical study of our complaint files. The indicators include professional burn-out, depression, psychotropic drug use, somatic disorders, psychological distress and sleep problems. We also have pathogenic situations: stress, anxiety and irritability.The non-specific situations include dissatisfaction and absenteeism.
As regards risk factor indicators, there are two categories. The first are those related to social relations in the workplace. This includes violence, harassment, lack of social support and poor work relations. The second category includes those found in the work organization, which are much less known on an analytical basis. We identified work intensification, lack of flexibility,non-standard work schedules, lack of recognition, lack of expression groups, advancement on the basis of merit and flexibility. These are risk factors that we analyzed based on our investigation files. That's the diagnostic aspect.
I cannot talk about this in any detailed way because I do not have the time, but I want to point out to you that the diagnosis was made in a study on psychological harassment in 2000. The findings of our more recent study, in which we observed the connection between damage situations and risk factors, are included in the report, in an in-house commission document. The international literature review identifying the identifiers is presented in this summary that we produced.
In the second section of the main report, we also provided recommendations for maintaining care, improving ways of repairing damage to psychological health and improving prevention. We can have three action levels in applying the law to health. We defined an aspect of reaffirmation of the obligation to protect the right to physical and psychological health from the risk factors that we identified as the most virulent; here we are thinking of violence and harassment. There are currently statutory provisions in the act respecting standards. One year after that act was implemented, we observed cases that did not fall within the definition of psychological harassment as set out in the act. Authorities wonder how we can better identify this situation. In fact, the study we conducted yielded indicators and criteria that are helping us achieve a broader vision of psychological harassment.
There also has to be a reaffirmation of principles. There has to be a clear commitment from public authorities to their obligation to protect psychological health in the workplace that not only embraces cases of open discrimination and violation of physical integrity, but must also give precedence to values of health and integrity, both physical and psychological. There also has to be a reaffirmation of the fundamental obligation to protect the right to health, as the Charter should define it.
I would also like to talk to you about the obligation to protect the right to psychological health against risk factors in the organization of the workplace to identify reliable indicators. We currently do not have any reliable indicators. We have situations in which, for example, the Commission de la santé et de la sécurité du travail will use various practices to determine whether damage can be repaired, but we do not have a clear picture of the situation regarding damage to psychological health in Quebec, but definitely even less so in Canada. In identifying the risk factors in work organization, relative to morbid damage situations, we have observed that lack of flexibility creates problems of psychological distress, anxiety and somatic disorders. We have been able to make the connection between these factors. We also determined that non-standard work schedules are at times related to depression and that the supervision and control of cases in which people constantly have to compile the number of computer entries they have to make causes stress, anxiety, absenteeism and irritability.
We also recommend improving and reinforcing the effectiveness of remedial measures. We can more effectively base decisions on the question of remedies on known scientific instruments and current knowledge, and not merely leave those decisions to local compromises. This entails better relations between decision-makers and researchers so that research findings on situations in which damage is done to psychological health are considered.
In the context of an overall public project to improve work organization, we can — and this is very important — aim to humanize conditions of employment and relax work schedules, in particular to promote better work-life balance. Managers must be trained in the impact of sound management by involving the human aspect in organizations. An attempt must be made to improve reintegration mechanisms for individuals who have stopped work for reasons of mental illness. The purpose of all that is to optimize the effects of remedial measures.
We named the last major level "anticipation of the obligation to implement the right to health.'' The idea here is to take more effective preventive action by identifying risk factors that have a pathogenic effect on psychological health. We are talking about organizations where there are no expression groups. There are a number of places where people do not have the opportunity to express themselves, to state their achievements; so that causes stress, psychological distress and absenteeism.
We found that productivity, quality and quantity standards introduce a lot of somatic, anxiety and sleep disorders. We observed that the notion of work intensification results in a lot of dissatisfaction in the workplace.
I think the right to psychological health in the workplace must be reaffirmed as a fundamental right. The question of quality of conditions of employment, including aspects regarding regular workers, could be put back on the agenda. The idea would thus be to avoid premature wear-out, that is to say the aging of the labour force, and find mechanisms for preventing premature wear-out.
Better access to prevention and treatment should also be added here for non-standard workers. A national framework statute should be passed, including quantitative objectives, an implementation timetable and institutional responsibilities identified for implementation.
A public policy should be established for promoting psychological health and conditions of employment, not only to large businesses, as currently appears to be the case, but also to small and medium-sized businesses and to workers themselves.
There must be a commitment by organizations and businesses to work concretely to enhance the organizational working climate and to promote psychological health in the workplace. There must be objectives incorporated in corporate responsibility frameworks and more collective visions. Programs for promoting health in the workplace can be discussed in order to take organizational factors into account.
Worker representation and involvement must be improved to ensure that workers take part in decision-making where those decisions are likely to guide their development. Areas could include knowledge of duties, workplace culture and organizational systems.
In closing, I will mention the specific role of the Commission des droits de la personne in the defence of a health working environment and its applications. We have identified certain elements in our brief. I believe that the Commission, together with other stakeholders and authorities, can take charge of these matters concerning violations of the right to health and that it can play a central role in promoting this objective of the right to health in the workplace.
I have briefly outlined my research findings and a few proposals. I could come back to them in the context of your questions, if you would like.
[English]
Ms. Baynton: We take a balanced approach to mental health in the workplace because we recognize that employers are often caught between a rock and a hard place. They may have good intentions in how they deal with people who have mental illness, but they have no training or experience. Therefore, they are left to try to cope. We know that 75 per cent to 80 per cent of all managers become managers because they are technically astute, not because they have skills in dealing with people, and certainly not because they have skills in dealing with people who are experiencing stress or mental illness. For that reason, we always ask that we consider the right of the employee to an accommodation and their responsibility to collaborate in this process.
I was speaking to Mr. Corbiere earlier and I said that the real secret to accommodating people with mental illness is to involve them in it, to ask them what works, and to have them commit to rather than comply with an accommodation.
All of our recommendations are coming from the second perspective discussed in the first report, that of people who are already employed or are on disability at the moment but have a job. Although we absolutely endorse all of the other recommendations, know that ours is coming from that perspective.
Our first recommendation is that we start treating what is referred to under human rights legislation as a "poisoned work environment'' as the workplace hazard that it is. In the same way that we have mandatory hazardous materials training in workplaces, we need mandatory training in dealing with people, specifically in communications strategies and performance management. When we talk about performance management, we are talking about a collaborative, solution-focused approach to maximizing people's potential, not a punishment type of approach.
Our next recommendation is around unions. When we do our work we always involve the unions as a collaborative partner. It has to be holistic; it cannot be just about that individual; no more than bullying in the schoolyard can be about the victim and the bully. It must be a change in the culture, a change in the environment.
The union specialists we are recommending are people who represent the union's interest but also understand accommodation. The grievance process is often controversial, conflictual and adversarial. Putting someone who is experiencing depression or anxiety through this process will often exacerbate their symptoms. That is not to say the union should not fight for the rights of their members. We are saying have people in the union trained in this type of work so they can help somebody through it.
Our third recommendation is around employee assistance programs. We think that they are a great way to get people help immediately, but we are finding that very few of those involved are trained in the therapy that we know from research is the most effective, that being cognitive behavioural therapy. The reason we advocate this approach is that what someone needs in order to survive at work is a cognitive behavioural type of adjustment. We would like to advocate for EAPs to add this to the training of their counsellors.
The duration of the counselling through EAP is another issue that should be considered, because in some cases it is as little as three or four sessions, which we know will not be sufficient. In some communities, especially in Northern Ontario, the EAP is the only link people have to effective treatment. There are no psychiatrists or psychologists within a three-hour drive, so in many cases this is really important.
Our fourth recommendation is that we need research. Of course, at Mental Health Works we think we already have a good solution and a good approach, but we need evidence other than anecdotal evidence to back this up. We are pleased that research proposals are now being developed that will look at the approaches that various organizations take so that we can share our findings and every employer can put them into practice.
Our fifth recommendation comes about because ofexperiences that people have had in going from short-term disability to long-term disability and falling through cracks in the system.
We feel that there needs to be something in place that will help people to make this transition. Quite often, forms are not filled out and things are not done and people then are sent into financial crisis on top of what is already a mental health crisis.
That leads to the last recommendation, which is that we should have advocates. Many times, employers will say that they sent out the forms and people never filled them out or called back, they are not doing their part. The employers do not understand that the mental illness itself often makes it impossible for the person to get out of bed, never mind fill out a complicated set of forms. We are looking into having an advocate who can do this on behalf of people with mental health issues. However, it could be something that the EAPs or the employers themselves could provide.
One of the things we know from experience is that the barriers to employment for people with mental illness usually have little to do with equipment or building modifications. They have to do with workplace relations, and the only way we can affect that is through training.
When we talk to managers, one of the common reactions is guilt. They feel that they may have contributed to or made worse someone's mental health problem and it comes out in the training. We say, "You did the best you could with what you knew and now you know better. As a collective, we now know better and we can do better.''
The Chairman: Thank you very much.
[Translation]
Ms. Malenfant: Various perspectives can be adopted in addressing the issue of mental health in the workplace. Of course, there is the integration and retention of individuals suffering from mental health problems, but also work as a mental health factor, depending on the situation, and the conditions under which work can play a social integration and health protection role.
Regardless of which of these perspectives is adopted, it is important, indeed essential, to address this complex issue through the changes the workplace has undergone in recent years. My remarks are based on the findings of research conducted over the past 10 years on intermittent workers, both skilled and unskilled, young and old and workers with a certain degree of job stability within the public service network.
First, I would like to emphasize the need to ask questions about the place of paid employment among our social values. Worker status is still a primary criterion in judging a person's value, usefulness and recognition by others. Being deprived of an employment relationship influences the way we look at ourselves and the way others look at us. The values of competition, individual success, performance and financial, professional and social independence may become oppressive for people who, for various reasons, find it hard to meet current labour market requirements.
Work-life balance and work-citizenship balance have become a puzzle not only in the organization of everyday time, but also in lifestyle planning. Their impact on life has to be considered in financial terms and in terms of social recognition perceived by parents and citizens who have trouble entering the labour market.
We must understand the context in which work is performed. In fact, the conditions of access to employment, work organization, duties performed and social relations make work a structuring experience or, on the contrary, a harmful experience.
The increasing flexibility of work organization has opened the way to a diversification in forms of employment. These jobs, often called short-term jobs because they are determinate, on-call or flextime jobs, with little or nothing in the way of social benefits or employment relationships, are increasingly recognized as having a negative impact on health.
At the same time as these cultural changes, qualification requirements have risen and so-called social skills — ease of expression and communication, resourcefulness, personal appearance — have become assets that can play a decisive role in the hiring process. While some view this as a new challenge that must be met, others, on the other hand, feel less equipped to deal with the occupational and financial instability that accompany short-term employment and experience a sense of insecurity and diminished well-being as a result of this situation.
As a result, unsatisfactory work experiences affectidentity-building and relations with occupational life. The literature shows that the most harmful conditions are: lack of recognition, law wages, lack of respect and esteem by co- workers and line supervisors, unstable employment status, lack of independence and opportunities to use and develop skills, time restrictions and work intensification and complexity.
The vicious circle of short-term employment and the growing use of short-term employment must be broken. Research has shown that the casualisation of employment and casual employment itself lead to a decline in living conditions, which in turn undermines health and social life. In the most extreme cases, this can result in a gradual withdrawal from the labour market and permanent inability to work.
The working environment must be improved, and there are conditions that must be met in order to protect health in the workplace. While some experiences are harmful, it is through work, in conditions that give hope for the future and are conducive to trust in one's abilities, that health is gradually restored.
The support of family and friends and networks of contacts are of considerable assistance, in certain cases, in getting through tough times and reducing the impact on mental health, but they are not enough to enable workers to get a job, which protects them from the vagaries of the economy and the requirements of a highly competitive market.
The evolution of employment itself requires practical knowledge and a way of being that gradually eliminate workers who find it hard to acquire the necessary skills and qualifications or to be available enough to meet requirements. The inability to work as a result of negative work experiences can only be prevented by concerted, innovative and simultaneous action in the training world, in the workplace and in the standards and practices that govern the labour market.
A number of aspects must be considered: labour relations and employment protection, organization of working time and work autonomy, development and employability, as well as opportunities for occupational advancement.
More specifically, action must be taken on skills acquisition, the autonomy that makes it possible to build on acquired experience, support for workers in their employment, fairness in the management of conditions of employment granted to workers — whether permanent or temporary, young or old, male or female, skilled or unskilled — assistance provided by policies adapted to the changing labour market and current labour force recomposition — freedom to form unions and bargain collectively to counter the individualization and personalization of problems; job security and the labour climate in major periods of instability and restructuring; work intensity and its impact on physical and mental health and on the possibility of leading a full personal, family and social life; the training and development opportunities afforded by employment and prospects for advancement to more satisfying, more stable and higher paid employment; opportunities for taking part in organizational decisions, in particular in problem- solving; innovation and opportunities for taking personal initiatives on the basis of skills and knowledge developed to improve the quality of goods or services offered.
The means to achieve this must be secured through research and development. This is particularly true in the area of prevention in order to address the stigmatization of people who are coping with mental health problems.
If there were two priorities to identify, the first would be preparing young people for employment. A lot of businesses, during job shortages, hire more unskilled young people, then lay them off after a few weeks or months, without those young people really knowing what they contributed to the business. They thus find themselves at a disadvantage in a highly competitive labour market.
There are also periods of corporate restructuring and mergers. A number of businesses have experienced major upheaval in recent years. The human aspect has to be considered, not just the positions those people held when they were laid off or when they were redirected to a new workplace, so that these people experiencing major changes are supported.
Last, there is the improvement of employment and social policies, particularly in the area of protection from unstable employment, as well as policies on work-life balance, which working parents greatly need.
Research increasingly shows that we must not only counter the lack of work, or unemployment, in preserving mental health, but also preserve the quality of work so that work plays its full role in building identity and enabling people to achieve their full potential.
[English]
The Chairman: Thank you very much.
Ms. Buchanan: I sent around a handout on mental health in the workplace. Most of the recommendations are quite obvious, but I do want to highlight a couple of them.
The first one is that corporate support at all levels is fundamental to the success of any program. We need it from the CEO all the way down, and the board of the company also needs to understand the corporate culture regarding this issue.
I was speaking to a senior person with WSIB last week. That is Ontario's workers' compensation board. He said, "Well, we do not like to use the term 'mental health' in the workplace because it is too scary, so we call it work'' —
The Chairman: Scary for whom, for the WCB, or for employees and employers?
Ms. Buchanan: I think it is scary from the top level down. They call it "workplace balance.'' I have seen that term pop up a few times. They use it in terms of balancing the hours, et cetera. I do not want to get into that because I do not really understand it, but if we cannot use the term "mental health,'' we are all in trouble.
I wanted to highlight that in terms of an effective employee, the training and education of the front-line managers is the key. If your supervisor has no idea what mental illness is all about, that relationship will never work. Some companies provide facilitators or a nurse as a go-between when that training or education is not in place.
The other key issue that I have been involved with is providing information on all income security programs that may apply. My husband has bipolar disorder. We have had to fight in court for everything: CPP disability, disability tax credit from the federal government, and also long-term disability.
I wanted to talk about the group that I think is the last frontier in this issue and that nobody spends too much time talking about. These are the professionals. For these individuals, stress in the workplace has not been the factor precipitating the illness. These are individuals who obviously have a predisposition towards either bipolar disorder or major depression, or even schizophrenia, although that comes out usually in the teenage years, when education and workplace training are interrupted. It is quite often a family issue or other issues outside the workplace and then stress in the workplace may exacerbate it, but they have all made to it the top because they can cope with stress.
I have some case studies here that I want to refer to. These are all real individuals. Except for my husband, Jim, they are all pseudonyms.
My husband was employed as a public-relations professional. He has had a number of relapses. When he had the last relapse, I do not think the company could trust him any more in terms of information at the top level or expect him to handle public relations well, even though he had done it very well for 10 years and had had relapses prior to that. He had always been able to bounce back, except after his last relapse in 1990. We struggled for sources of income because he had a mental illness that is not well understood. It was obvious that he was quite disabled, but it just was not accepted very easily, even though once we got to court it was always obvious to the judge.
It is particularly hard at the top levels because you are in a different income bracket from someone at the bottom level, who perhaps will be on ODSP or some kind of support program. We had a house and two children in private school. We were living in Northern Ontario. For him to suddenly lose all income after short-term disability was devastating for us. It was very difficult to get through that time. The only reason we did was I had a house in Nova Scotia that I sold so that we had the income. The two private schools reduced their fees for our children so that their education would not be interrupted just because my husband had a mental illness.
I also have the DTC status at the bottom of each case study.
I want to go to the next case study, which is William, a lawyer with 25-plus years' experience with one of Canada's largest law firms. His major depression was a result of the law firm changing its corporate structure. There was an indirect issue, but certainly stress in the workplace had not been a factor in the previous 25 years. He desperately wants to go back to work. He is on a fair amount of medication to stabilize his major depression and he knows that he has limitations. Certainly people who have had a number of relapses simply cannot deal with stress any more the way the rest of us can. There is a change in the brain chemistry. My husband gets stressed out putting on socks. You can imagine that more important issues are quite difficult at times. William has gone back to his firm. He participated in a work adjustment program, and I know that because I was the supervisor of that program. He helped me greatly when I was on the technical advisory committee on the DTC. Thanks to William, we have a wonderful forum now that accommodates people with mental illnesses and other mental impairments. It was his brilliant legal mind that could sort through the language, et cetera. However, the law firm cannot find accommodations for him. They do not have the issue of financial hardship, obviously. He has hired a lawyer and the final outcome remains to be seen, but he just has no place to go back to. He is on long-term disability.
David is a more interesting case. David has had five-plus years with a small legal clinic. I was speaking at a function about the disability tax credit. He came up to me and said, "Well, that sounds really good, but I would never qualify.'' I said, "Why would you not qualify?'' He said, "Because I am employed full time and I am a lawyer.'' I said, "And then why do you think you might qualify?'' It turns out he has bipolar disorder and obsessive compulsive disorder. The OCD interferes with his daily life to the extent that it just takes him longer to do his work. His firm understands the problem and provides accommodations and flexible hours, but David qualifies for the tax credit because it takes an inordinate amount of time for him to do the work — more than it would if he did not have OCD.
Sandra was a senior employee of a large corporation with more than 500 employees. She had major depression because off marital problems and a break-up. Her husband was planning to kidnap the kids. Any mother would be distraught at that. She eventually did go to the EA program at the corporation. She is very grateful for all the support and help that they provided. She could not take a single day off work.
She was working in a team-oriented environment where people depended on each other. In such a situation, either you can or you cannot pull your weight. If you cannot, then you do not get the challenging opportunities or the chances for promotion.
She was fortunate to receive assistance with the assurance of confidentiality. With medication, support and counselling she managed to get through a difficult time. Of course, she does not qualify for the tax credit because she has made a full recovery and is able to return to her normal work duties.
Accommodations are very important at this level. We have a huge pool of talent out there. We do not know how many lawyers are sitting at home because there is no one out there to help get them back on their feet. These are able people. My husband is not able to work, but he generously volunteers much of his time to various committees. It does not mean that these people do not have the ability to make a contribution.
I want to ensure that people working for the EAPs are knowledgeable about the disability tax credit. Certainly at the lower level, for any employees who need accommodations to do their job, there is a good chance that they will qualify for the tax credit. For anyone with a taxable income, the credit is worth about $1,500 to $1,600 per year. For anyone with any disability, it is nice to have a little extra income.
Ms. Smailes: I will speak to recommendations. It is vital that governments send a clear message, because they are involved and such an effort would support the efforts of all other stakeholders. The government, being a large employer, could lead by example in terms of a focus on prevention and early return-to-work practices and by collaborating with stakeholders to develop programs. Those could then be evaluated and set as models for other work settings. The Canada Health Act should be amended to include psychologists to eliminate the funding gap. I was in the U.S. for 12 years, and while that system is not great, at least funding is available for psychologists. As someone mentioned earlier, we know there are effective therapies administered by psychologists, but they receive no funding under the Canada Health Act. Where does that put the psychologists in Canada? That affects the work setting, because EFAPs and EAPs are supposed to be short term, and with this gap in funding, there is no referral system for effective therapies.
We know quite a lot about employers and that process needs to be emphasized. It is not only what we are doing but also how we are doing it — efforts to determine how such things as strategic planning and the development of various programs are building and integrating into the workplace. We need to know within the work environments everything that is going on.
Involvement of stakeholders includes employers, unions, front-line workers and managers. We focus on prevention, developing healthy workplaces and having all stakeholders involved from the outset. That has been incredibly effective, because invariably when programs are instituted, barriers to their effectiveness can occur. We want to see programs through to the evaluation level, which can take quite some time, and barriers have to be overcome. The ideal is a committee that includes employers and union reps that can agree on what each organization can do to help. Then you can begin to see how things might work out and move forward on the issues. To meet with success, it is vital that both groups work together.
In terms of the process, it is important to have a good assessment, know where to begin and what direction to take, identify the gaps, to know the existing system and its effects, and whether an evaluation is in place for that system. Once the gaps have been identified, then implementation and evaluation can take place. We know this process works — involving stakeholders, getting commitment, doing assessments, developing the plans and seeing them through an evaluation. It is a long process to which to commit. One of our current projects in B.C. involves all six health authorities and pertains to healthy workplace initiatives across the province.
One of the benefits of funding and grants is that employers are assisted in their efforts to sustain the process. Strategic planning is involved with any grant program because the entire process must be laid out, including expected timelines. That is a serious commitment. An external group evaluates and supports this process, thereby adding a little weight to seeing the process through. Funding and grants are important, and in Canada the system is wholly inadequate. Initiatives have begun, but we are looking at $300,000 for team grants that would involve people across Canada. The system for funding and grants is inadequate, given that these interventions can be so effective.
Looking at the full spectrum, from prevention to return to work for employees, a number of programs are in place to assist. Again, the emphasis is on building and integration so that work environments are healthy. When unions are involved from the outset, they can be highly effective because of their level of understanding.
We rely on physicians to provide much of the mental health support, and so it is important to train them to identify problems accurately, although I do not know if they would diagnose, and make the appropriate referrals. The concept of shared mental health care plans is ideal for GPs and psychiatrists and should also be in place for psychologists. I have been involved with working teams of physicians, social workers and psychologists, and they are highly effective.
In the area of research, people with an understanding of methods and design need to be involved. Many people have great ideas for programs, but researchers need to be included at the various levels to develop good models through to evaluation. We must have trust in what we are doing so that when it is disseminated, other people will trust what we are doing. Can you expect employers to assess if researchers are not involved? If researchers are not involved, how can you understand what you are evaluating and the importance of it?
Groups such as occupational health nurses provide a cornerstone for our organization. Health care workers turn to such a group for a number of different issues and they provide a great resource for mental health. Again, they need training in identification and referral so they can continue to provide support, much like physicians do. People with mental health problems need to be supported and need ready access to psychologists who are trained to provide that support and to help sustain people through their return to work to reduce the potential for relapse.
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Ms. Raymond: Suicide is the primary cause of death among men 20 to 25 and 40 to 44 years of age and in women 30 to 34 in Canada. In Canada and most industrialized countries, 80 per cent of suicides are committed by men. According to the WHO, the suicide rate among young Canadians is the third highest among the world's industrialized countries. Every day, 11 Canadians commit suicide. The cost of one suicide in Canada has been estimated at $850,000, and that is not including suicide attempts. For every suicide, there are approximately 100 suicide attempts, the costs of which are very high.
In terms of hospitalization, every suicide attempt in Canada represents 160,000 hospitalization days. It is therefore easy to determine a cost for hospitalization alone. Naturally, when we talk about suicide, we are talking about the person who suffers, but there is also that person's family, friends and co-workers.
For every suicide, an estimated 10 to 50 individuals are also affected. Suicide in the workplace is a taboo subject. I conduct a lot of interviews in the workplace. I meet a lot of people, including managers. Suicide is a subject people do not want to talk about; they already find it hard enough to talk about mental health. The possibility that an employee or manager can commit suicide is a difficult subject to discuss. There is a terrible fear of being identified with suicide, that the workplace will be pictured in the media as being conducive to death or suicide.
What is the impact of suicide in the workplace? First, it has been observed that a general atmosphere of anxiety sets in after a death by suicide in the workplace, which results in workplace disorganization. Many people experience feelings of guilt, particularly managers in the case of plant closings. I have seen presidents and managers ask the question and feel responsible. They are often stuck between a rock and a hard place when they are instructed to close down and have to face employees. So they feel a lot of guilt when suicide occurs.
The same is true of employees. They feel guilty that they did not see it coming, particularly in the case of people with whom they've been working for 10 or 20 years. In addition to beingco-workers, the victims were often friends. Social relationships are very important in the workplace. So people experience sadness and a need to protect others.
One of the most significant effects of a suicide in the workplace, apart from the many others that could be documented, is the clear and documented risk of contagion. It is not unusual for there to be one, two, three or four more suicides within two years of a suicide in the workplace. This information is not documented once again because no one has any interest in it being publicly documented. In all my research, I am always asked not to name the organizations, only the industry in which the companies operate.
This contagion phenomenon, which really exists and is documented, is first attributed to the possible types of reactions. Obviously, not everyone reacts in the same way when a suicide occurs in the workplace. First, people may experience stress, which is a normal reaction, but that state can degenerate into acute stress or into post-traumatic stress disorders. We have been able to monitor people's progress. A per centage of people will experience stress, while another per centage will experience a standard situation of grief, because the person who died was a close friend. Another per centage will experience crises often related to personal weakness or the mirror effect. These people may feel they have been suffering from depression or a similar problem for a long time, but that they can pull through. Suddenly, they see that the other person appears to have committed suicide. How will they be able to keep trying to pull through?
So there are a number of elements. In a study we conducted in a workplace where there had been five suicides in two years — the studies began a year after the last suicide — 36 per cent of all the workers were still very much shaken, and 60 per cent of those were experiencing a high level of psychological distress. Of the latter group, half had been experiencing symptoms of these distress levels for more than six months, and the other half for more than a year. The impact was characterized as notable, first on their family and social lives, then on their ability to work. As regards absenteeism, the number of sick days had tripled in the previous year. As regards suicidal ideation, 27 per cent of workers had seriously considered suicide during the year. Of that number, three per cent had attempted suicide. These rates are two to three times higher than those in the general population.
In all the workplaces studied, we observed that men in distress were very reluctant to seek assistance or to talk about their problem. In both workplaces, that reluctance was warranted, because, when an employee requested assistance from the EAP, among other things, a note went to his file and there was a negative consequence. People even feared for their jobs if they dared say they were in distress.
Based on all this data, we made a range of recommendations. Naturally, you have already heard a number of them. First, improve conditions of employment and the climate in the workplace. Clearly, suicide is not necessarily related to the workplace, but working conditions can exasperate and make people even more fragile. The universal standard should be to suppress the negative implications in the workplace of requests for assistance. One of the ways we found to modify these negative implications is for management first to take a clear position on the matter. Managers should emphasize that it is important for workers to seek assistance and tell them that taking care of their mental health is a plus and that there should even be an excellent note in their file as well as a statement by them to the effect that they are also consulting in order to obtain assistance. That would result in a complete change in the phenomenon, particularly for men.
An effort should be made to avoid putting negative notes on file and to release employees for a period of time, with pay, for individual consultations with the EAP or other programs.
In three of the businesses where we went, the EAP was extensively used for family and financial problems, but not for distress problems. There was a marked reluctance to use this service. People felt that three or four meetings with the EAP were not going to help them.
Someone spoke earlier about the importance of care involving treatments that have proven to be effective. In our program and in our recommendations, we contend that it is important to develop real care that is longer than three meetings for employees who have mental health problems.
We also recommend mechanisms for joint action with resources. People tell us they are often stuck between a rock and a hard place; they go to the EAP and are told they have a serious problem, that they will be referred for psychiatric or other treatment, then begin long waiting periods.
Time must be allocated within organizations for the purpose of talking about problems and promoting sharing, whether as a result of difficult incidents such as suicide or as a result of other incidents. Team leaders must be supported and trained so that they can, if not facilitate, at least support the employees.
Then comes the whole range of training, awareness and education. Supervisors, team leaders, union representatives and employees should be trained in stress management, the importance of psychological health in the workplace and suicide awareness and prevention.
Every person in a business should be able to recognize a person who is suicidal and direct that person toward a resource without intervening in the case. Following a suicide or traumatic incident, intervention protocols should be established that are appropriate to the situation. Currently, they are absolutely not appropriate.
I would like to give you an example. The U.S. Armed Forces achieved a real feat in countering the fear of assistance through senior officers who said it was important to consult. This experiment was validated and has produced some convincing data.
In conclusion, I think it is important that the Government of Canada recognize the extent of suicide and the mental health problems associated with it and finally develop a Canadian suicide prevention strategy. We are one of the few countries that has no strategy.
It must be recognized that suicide in the workplace is a traumatic occurrence that has significant risk factors for contagion and the development of other subsequent mental health problems among employees.
A specific analysis must always be conducted of work situations, the workplace and its culture. The time has come to adopt effective guidelines and to adapt them or propose them to the workplace, while respecting the workplace, its culture and its organization, as well as the partners who are in it.
I would say there is an urgent need for more empirical research on the nature of the impact of suicide and on potential intervention necessary and interventions differentiated on the basis of the problems and the effectiveness of that intervention.
Mr. Dos Santos Soares: First of all, I would like to thank you for this opportunity to present our comments on this issue, which we consider very important and to which we devote all our research and teaching efforts.
I distributed the report I have written, but there are others that I could send you, including one on bullying. This is the first study that was done with teachers and health sector workers in Quebec and with the members of the Centrale syndicale du Québec. There is also another report on Hydro-Quebec engineers. These reports are public, and that is why I cite them. Other reports are not public because people are very reluctant to speak out.
I prepared a brief in which I have set out what I want to tell you in a little more detail, along with recommendations and ideas that I have for helping people.
One day, at one of his talks, someone in the audience asked Freud: What is a healthy life? The audience expected a long digression by the father of psychoanalysis in an effort to explain this central concern in our lives. His answer was brief: loving and working. That was his prescription for a healthy life and thus for developing behaviour that ensures human dignity, democratic ways of living and giving meaning to one's life.
Work has a twofold impact on mental health. While it can be structured, a source of pleasure and psychological well-being, it can also cause suffering and destructure people's psychological lives. Of course, work plays an important role in promoting mental health because it structures and organizes an individual's life at various levels.
In the interim reports of this Senate committee, the emphasis is on the structuring aspect of work, particularly for people suffering from mental health problems. This is a fundamental question; there is no greater truth than the fact that putting people who suffer from mental health problems into a workplace can appreciably improve their quality of life. I know of people with Downs syndrome who work and who have a quality of life and whose personal development has increased as a result of working.
However, the destructuring effects of work on mental health should not be underestimated. Unfortunately, work organization, management and conditions of employment can render inoperative these important structuring and mental health promotion roles played by work.
Of course, work is not the only cause of mental health problems, but, as a result of its privileged position in our lives, it becomes a major cause. Most of the studies and my research agree on a set of aspects associated with mental health problems, including work overload.
In the past 15 years, we have been doing more with less. This is not a valid strategy for individuals. Factors such as organizational unfairness, lack of independence and unreasonable control of work come into play. In many cases, we realize that people's washroom breaks are even timed; in one case, a toilet was even assigned to a person. That person could not go to just any toilet; he had to go to that one. I believe this kind of control is beyond understanding.
There are other aspects such as lack of recognition, unhealthy working conditions, declining cooperation in the workplace and violence on the job. There are various forms of violence, violence by members of the public, who throw products in the face of supermarket cashiers, who strike them and who verbally abuse workers; violence towards a physician who is stabbed in his office; violence toward teachers who are verbally abused by parents.
You must understand that it is impossible here to address all the aspects of work that have a negative impact on the mental health of workers, particularly since all these factors can have synergistic effects that will have an impact on people's mental health.
Since June 1, 2004, Quebec has had legislation guaranteeing all workers rights respecting psychological harassment in the workplace. It has been a year now. During that year, 2,500 complaints have been filed with the Commission des normes du travail, for non-unionized workers alone.
For unionized workers, there is a grievance mechanism. We don't yet have the statistics on all the grievances that were filed last year concerning psychological harassment in the workplace.
This is an insidious form of violence that undermines working conditions, mental health and individuals and poisons social relations on the job. It is a destructive and hostile process that may seem harmless, but the repeated nature of which ultimately breaks a person psychologically.
From the individual's standpoint, psychological harassment does serious damage. Career opportunities are broken, and mental health is seriously undermined. Then there is psychological stress, depression and post-traumatic stress, which, in some cases, can go as far as suicide.
My data show a correlation between psychological harassment and suicidal ideation. People think much more about suicide when they experience psychological harassment. Boys are much tougher and do not file complaints. They are less inclined than women to seek assistance. This form of violence affects the individual and the individual's family. Socially, it is a disaster.
However, it is important to understand that mental health problems in the workplace are not inevitable. In our view, problems arise when organizations try to deny the problem's existence and to use individual differences between people, such as sex, age, personality and ethnic background, as a scapegoat. Beyond a doubt, there are organizations that address these problems. It must also be understood that others, even today, still adopt what I call the Kleenex worker ideology: use it, throw it away, take a new one from the box and do the same thing that made the last person crack.
The problem also lies in the use of "Tylenol''-type approaches, which temporarly relieve the symptoms of the problem, though without eliminating the infection that caused the symptom. The result achieved is obviously temporary and becomes an aggravating factor.
The other danger is in believing that employee assistance programs can solve the problems. Employee assistance programs are important resources, but they have their limits. The scientific standards for psychological assistance are an example of this.
It must also be understood that, when a person needs an employee assistance program, the damage has already been done. The person and the organization have already felt the consequences because employee assistance programs are a source of tertiary prevention.
We think it important to reflect on the way in which management can promote mental health in the workplace. I do not think there's any miracle cure. You have to attack the source of the problem and use primary prevention strategies that will change work organization, organizational culture and employment conditions at the source, based on solid values: respect, trust, justice, fairness, participation, prevention and, especially, democracy in the workplace.
I have thought of a few ideas to help you improve mental health in the workplace. I think a federal statute on psychological harassment is necessary. It is really sad to see these days that we cannot help certain people because they are not covered by Quebec's labour standards act. A number of people from Ontario come and see me to get help, and I cannot do anything for them.
There must be an extensive national information campaign on mental health in the workplace issues concerning the general public, in particular for the prevention of violence on the job. This leads me to the matter of courtesy. We have to say "hello'' and "thank you'' in recognition of people's work and adopt rules of courtesy. People cannot be treated as though they were invisible.
We must break down the prejudices about mental health so that people can seek assistance without shame. Freud compared individuals to crystal glasses. We are all the same, but if you look very closely, there are some differences. If you drop glasses, they will not all break in the same place.
Like the Conseil de statut de la femme in Quebec, an "Isofamily'' award has been introduced for businesses with good work-life balance practices. This is very good because they are telling businesses that it would be positive for them to have these kinds of practices. This competition is organized by the union, management and government to underscore good practices associated with mental health in the workplace.
Employers, managers, unions and workers must be informed of causes, issues and signs of deterioration of mental health. There is information on the various forms of primary prevention, that is before problems occur, forms of secondary prevention, during problems or during intervention, and forms of tertiary prevention, that is to say what is done after problems have occurred.
A greater effort has to be put into drafting legislation on primary prevention measures, that is to say to eliminate mental health risk factors at the source. This means promoting measures designed to take action before the problem arises and to put a monitoring system in place to detect mental health problems longitudinally.
The workplace must not be forgotten. Sometimes there are statistics, but you do not know where people work. There must also be investment in research. Investments are being made, but in major projects. We need funds for small projects that serve the community. The results of those small projects are more conclusive than those of large projects that are hard to manage.
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Mr. Gilbert: Honourable senators, I have distributed my report. Many of my recommendations echo comments that have been put forth in the room thus far. I wish to speak briefly to that document, because it reflects in some ways Mr. Dos Santos Soares' points.
This report was put together through a collaboration of private sector insurance company, public sector employer in the university and so on. We put together a select group and did this off the side of the table, as it were, with very limited funding. We pulled in private sector and public sector folks to form a depression-in-the-workplace collaborative. We looked at the existing scientific literature, such as it was.
We looked at what was referred to as the fugitive literature, which is the literature that exists outside the traditional materials published in the popular press and in trade journals. I pulled that together to get some sense of what was being said about depression and work.
We then formed a series of focus groups of employers, employees, human resources personnel, occupational health professional providers and, I am pleased to say, some individuals experiencing depression, and tried to pull in their experiences. I am pleased with the work we came up with and would like to see it translated into French and disseminated more broadly.
Many recommendations stand alone. There is one aspect of the report that I believe would be worthwhile to continue. We had in here a hard copy, annotated list of resources for those who are interested in the topic. By the way, Mental Health Works is cited, as are several other programs. By definition, this is already dated. It has to be; it is hard copy. It is 2004, already some of the links are stale and there has been new information.
What has been suggested here in terms of the Canada Health Network I believe would be of considerable value, and again echoing Professor Dos Santos Soares' comments about a clearing house, perhaps an electronically based clearing house of best practices, empirically based practices, for companies and practitioners in addressing mental health in the workplace.
I have one last comment on the picture on the report, which is of the Port Mann Bridge in British Columbia. The metaphor of the bridge really did reflect our findings. There is an enormous gap between the mental health care system and the workplace. If there is to be any progress we need to bridge that gap.
I would like to turn now to some observations and then perhaps more of a wish than a specific recommendation. I would like to remind everyone of the observations of Marie Jahoda, a prominent European sociologist, who commented that work is actually good for your mental health. Work provides a sense of structure, social meaning, social supports, a place to go outside the home — but she did not mention this — and it also provides an income, which we do know is good for your mental health. Therein we have one of the fundamental paradoxes we face today: Work is good for your mental health and work can make you crazy. Those are the kinds of things we need to grapple with in this area.
The second observation is I fully appreciate that a disability for mental health reasons is a huge issue across the board, but in our findings and the epidemiological data we can pull out — we do not have great data — the majority of adults with diagnosable mental health disorders are at work, not on disability. There is this tip-of-the-iceberg phenomenon; the majority are at work, so we need to pay attention to those folks.
We may well be grappling with issues such as absenteeism, presentism, non-optimal functioning and the implications of that, but we need to pay attention to that segment. We need to do both. The best form of disability management must be prevention.
A third observation is that Canadians want to debate public versus private health care. To make a side comment here in regard to the public health care system, or certainly the public mental health care system, just as employers are poorly informed about mental health issues, the mental health providers are poorly informed about the workplace. Most mental health providers do not have a clue — I say respectfully — about what goes on in the workplace. Typical GPs faced with a patient coming in tears with a diagnosable disorder and being asked to make decisions about whether or not to stay at work, to return to work, how to deal with workplace issues, often are poorly informed. They may have a poorly written job description in front of them, if they are lucky, on which to make a determination as to whether that person should be at work, how the individual should be accommodated and what kinds of issues should be addressed. Therefore, I strongly suggest we need to educate the health care system as well.
That said, I will argue that the majority of services for a number of folks in the private sector happen in the workplace. They happen in the form of occupational health and safety programs, wellness programs, employee and family assistance programs, the provision of disability benefits, disability management, benefits to cover drug costs, and, rarely — I would agree with Ms. Smailes — the services of psychologists or social workers.
Much of that is happening in the workplace. The problem is that these programs are generally uncoordinated, often inadequate and rarely based on good evidence and evaluation.
My closing comment is a wish. Given these observations, my hope is that the results of these proceedings will help Canadian organizations large and small. We need to come up with solutions. They are as applicable to the small company, the two- or three-person organization operating in the small community, as they are to the large organizations in a large city. We need to help those organizations develop psychologically healthy workplaces where all individuals can accomplish meaningful and productive work; and when services or programs are needed for people who are experiencing mental health difficulties or addictions, they should be provided by both private and public health sectors as appropriate in a manner that mitigates disability and maintains or improves functioning, addresses the symptoms and be based on good science.
Mr. Wang: I am a researcher, so my recommendations and comments are mainly related from a research perspective. Prior to the meeting, I distributed two pages of results based on the data from our first national mental health survey, also called a CCHS 1.2. The first table is on the annual prevalence of mental disorder in the Canadian working population. I believe this is the first time we have had national data on that.
I will not go through all the numbers, but you can see from the table here the prevalence of mental disorder in the working population appears to be higher than the national figure. As reflected in table 2 and table 3, there are clear differences in the prevalence of mental disorder by occupational categories, and part-time workers are more likely to have had mental disorders than full-time workers. The workers at the lower occupational status are more likely to have had mental disorders than professionals and managers.
These numbers give us some understanding of the scope of the problem at the national level. However, we have limited knowledge of the determinants of workplace mental health problems and how the psychosocial determinants inside and outside a workplace interact with each other. Also, the lack of relevant knowledge makes the workplace intervention complicated and challenging. My first recommendation is that we need to do more research in the epidemiology of mental disorders in the working population.
Around the world, the best, perhaps the largest and the only major longitudinal study in this area is the Whitehall study, which started in 1967. As senators may know, the researchers, in collaboration with the cabinet office and the civil service unions, have made the findings of this study of the highest scientific value in terms of policy implications. Unfortunately, mental health is only a small component of that study.
In Canada, the CCHS 1.2 is our first and only national mental health survey. If the survey is repeated in the future by Statistics Canada, workplace mental health should be an important component and the design should involve decision makers, the policy-makers and the representatives of other stakeholders such as unions, employers and insurers.
My second recommendation is for more research in prevention and intervention. Workplace interventions need to take a comprehensive approach, but most existing interventions are individual based and not sufficient.
To maximize the impact of the intervention, experts agree that primary prevention is ideal. Primary prevention aims to eliminate or reduce workplace problems using a population health approach instead of focusing on specific disease.
However, workplace interventions using the whole-organization approach are rare. There are many reasons for this, including lack of leadership and commitment from the employers and top executives, and also some management issues. My personal view is that our limited knowledge of the epidemiology of workplace mental health problems is also an impacting factor, because without a clear understanding of the determinants of mental health and their interactions, it is difficult to plan an effective primary prevention program.
My final recommendation is about public advocacy. You may have heard this repeatedly in previous hearings. I regard it as an important step toward primary prevention and mental health promotion. Theoretically, people's behaviour depends on their knowledge and attitudes. If employers and top executives do not acknowledge that mental disorders are prevalent in the workplace and could affect their employees' work performance and productivity, they are less likely to take any action.
Similarly, if workers do not have sufficient knowledge about the symptoms, potential risk factors, consequences and available treatment, they are less likely to seek professional help. They are less likely to help themselves. They are less likely to be able to help others. Knowledge of symptoms and risk factors and attitudes toward treatment and mental disorder constitute a framework called mental health literacy. The Australian experience shows that improved mental health literacy is associated with increased mental health service use, better treatment adherence, enhanced ability of self-help and helping others, reduced stigma, and some studies show it may also reduce psychiatric symptoms. However, we do not know what Canadians know about mental disorders.
A public advocacy campaign aiming to increase awareness is a tremendous task. It has to involve all the stakeholders, and the government should take a leading role in this initiative. We also need to disseminate our research findings to workers in a timely manner so everybody can benefit.
The Chairman: As you can tell, we have had a considerable cross-section of views. I want to begin with Senator Cook because she is Chair of the Liberal Senate caucus and has to leave to chair a meeting. The rest of us will skip the meeting. I have been grouping the topics under five or six headings. We can come back to those.
Senator Cook: Thank you all for coming. When I get through this pile I have here, I am sure I will have found the answers to some of the questions I will now put on the table.
Mr. Corbiere, in the action plan for mental health in the workplace, there is a comma; it must be a decimal point. If I understand this graph, it is $786.42. There is a comma in there.
You have looked at B.C., Ontario and Quebec. As a person from Atlantic Canada, in particular Newfoundland and Labrador, I ask whether it is possible to produce a comprehensive table.
Mr. Corbiere: Yes, it is possible. Do you need this information?
Senator Cook: I personally do. One of my dreams is to look at that cap, which is a disincentive for people to feel good about working rather than be put into a system again. For me, that is important.
Mr. Corbiere: The other possibility is to find the information on the website. I do not have the reference here, but I can provide it.
Senator Cook: That would be helpful. We need a bigger sample, Mr. Chair. Looking at the cap, I see an urban focus here. My instinct is to look at the rural setting.
I have made some notes. We should be concerned about the figure of 50 per cent of depressed employees who do not receive appropriate treatment.
Mr. Gilbert: That is a fairly generous estimate, quite frankly.
Senator Cook: The other factor here is how practitioners are often uninformed about workplace issues. On page 47, in your conclusion in paragraph three, I would like you to see if there is some solution there.
I want to talk about barriers and unions. In my other life I was part of a family-owned automobile business for 25 years. Unions can be a barrier. I do not know how we can get around that fact. If you are not feeling good and your employer questions you, you will become increasingly tense. The employer then gets a grievance from the union, setting up a barrier between the employer and the employee that can be detrimental to solving a problem before crisis management is necessary.
Being a Newfoundlander, I am full of stories. We had a salesman who had a drinking problem. He was with us for many years. When I look back, I recall my late husband and the group rehabilitated that man on a regular basis. They would slip him a sale, because salesmen who do not sell do not earn money. There were things in my life at that time that I could not deal with as an employer because I did not know how.
There must be a way, if we are to put out a national mental health strategy, to connect with employees and employers so that this does not happen. I can tell you that if we were to walk out on our shop floor and ask a question, there would be a union grievance the next day. In our day, it was professionals. They were not unionized. However, as we evolved, unions somehow became the norm, and they were needed. We have to question why. We have to look at that barrier. When the union boss comes on the shop floor, he is not a very welcoming presence. The barriers go up. We have to consider those barriers here.
I see it written here: a good relationship among front-line managers. I do not know how one achieves it.
Mr. Dos Santos Soares, we hear a lot about legislation, or the lack of it. Given that we have a very close-knit federation — depending on what our needs are — called Canada, how do we look at provincial legislation that has an overriding federal presence? Somehow or other, we will have to legislate common sense, and I do not think that is possible. There must be something that can be done. Whether it is legislation or not, I do not know.
Mr. Wang, I am looking at page 2 of your report, and again I am looking for more information. The only seasonal occupation you have is farming. I come from a fishing community in Canada. That is a pretty big business on both our coasts, and indeed on our inland waters. The crab fishery in my province did not take place this year. Many people will be without income, and therefore stressed, and looking to their family doctors and elsewhere, all because seasonal work was not available. They have no government support unless politicians lobby for it. There are many dynamics there.
I also want to talk about the service industry, where the workers have little built-in support. They just get paid and go home. My daughter is a psychologist, and she has come back from focus groups saying that people are stressed and on the border of mental illness. People work at a dry cleaning plant or in corner stores. These people rely on the free samples in the doctor's office because they cannot afford medication when they are finally diagnosed.
As to the question of reapplying after three months, the last thing you want to do if you are feeling well is to fill out a form, much less when you are not feeling well.
These are my questions and observations, and I would thank you if any of you would like to comment.
The Chairman: Mr. Wang, do you want to comment on the service industry question? It is quite striking in your table 3. I would not have guessed that the service clerk category has a statistically significant higher level of mental illness than any other group. Some of us are inclined to think, obviously incorrectly, that the further down the chain you go, the less stress, and therefore how can you possibly have this problem. That, as well as the part-time, full-time issue, would suggest that the further down the chain you are, in fact you are under more stress. Is that correct, and if so, do you have any useful observation on what causes that number and the part-time number to be so much higher?
Mr. Wang: As I mentioned, this is the first time we have had national data about mental disorders in the entire working population by occupational categories. I also mentioned that we have limited knowledge of the determinants of mental health problems and disability. We observed that the service clerk category had a higher ratio of problems, but we do not know why.
[Translation]
Ms. Dagenais: That is not surprising in one sense, because the service sector, which is very multiple, is feeling the impact of new technologies and work intensification very strongly. However, there are various categories in the service sector. There are professional categories and workers with few skills. As regards the changes observed in the working world, that is where the transition is happening. It should not be forgotten that the service sector represents 75 per cent of labour in Canada. It is a majority of people; so it is logical that that should affect this sector on a priority basis. A lot could be said on that subject.
[English]
The Chairman: You are saying it is therefore partly driven by the rate of change?
Ms. Dagenais: Of course.
Ms. Smailes: I did my dissertation on young workers. They are involved in service. There is a fellow who looks at job strain, lack of control and high demand, and that is typically what is entailed in service jobs. I found across the board that there was a relationship with depression, anxiety and substance use.
There are different theories on work strain and stress. If you do not have control of decision making, there is a lot of demand on your time and you have to perform quickly, that can be very stressful. That is typically what you are seeing in that group.
The Chairman: You are not surprised by Mr. Wang's data?
Ms. Smailes: No.
Mr. Dos Santos Soares: I also did my dissertation on service workers. I studied supermarket cashiers. I compared workers in Brazil and Quebec in supermarkets. I have been studying service workers my entire life. It is not astonishing that we have these statistics because we underestimated all the competencies that are necessary in the service sector.
I would highlight the emotional labour that they have to do. We have to manage our own emotions in order to accomplish our work. If we are unhappy, we must still smile and be nice. This is a heavy emotional workload. My last research with teachers points out that when there is this emotional labour, it has an effect on stress levels. It is stressful to do emotional labour against the "feeling'' rules that exist in the workplace. The feeling rules are those that say you must act in a certain way emotionally. If you are a teacher or health care person, you must be nice, empathic and show compassion. The harder it is for the person to accomplish what they have to do, the more demanding it is. When you go against the feeling rules that exist in the workplace, it is a source of stress and burnout.
Mr. Gilbert: Our data on epidemiology of depression are not terrific. However, there are data that show depression seems to be on the rise in young people. I would suggest that the service industry often employs young people. It is a bit of a paradoxical finding in some ways. It may actually reflect the willingness of the younger population to come forward with this problem, and there is truth to your point about mental health literacy. There may be a bit of a silver lining to that cloud. We do not know.
However, that said, we also know that not only unemployment, but also underemployment contributes to mental health difficulties. I would again suggest that folks in the service industry certainly do not have employment security, and that may well be playing a role.
Mr. Wang: I want to refer to the first Whitehall study, which found disparity in occupational gradients in terms of heart disease and mortality. The higher your level, the less likely you are to have heart disease.
The Chairman: I looked at my colleague, Senator Keon, because he was the country's leading heart surgeon for a long time.
Mr. Wang: They started a second study, with basically similar findings. They tried to explain the disparity. There are several competing models for workplace mental health. Most of the reports say work stress is a risk factor for mental health problems in the working population, and I agree. We reached the same conclusion in our research.
However, there is something more than work stress. For example, my research shows the imbalance between work and family life has more impact on mental health.
The issue is whether this disparity can be explained by one factor or by a combination of various factors.
The Chairman: I would like to pick up on a second point raised by Senator Cook, on the legal environment. First, Ms. Dagenais and Mr. Dos Santos Soares referred specifically to section 46 of the Quebec Charter of Human Rights and Freedoms, which says nothing about mental health. I would have thought, then, that most judges referencing the Charter would assume that it did not include mental health. I am curious as to whether legal cases have been decided on that basis.
Second, both witnesses referred to "the act,'' but I do not know what act that is. Is there a specific act in Quebec that deals with mental health in the workplace? If so, could you provide the committee with that information?
[Translation]
Ms. Dagenais: As regards mental health in the workplace, Quebec offers services in the cities and regions for people with mental health problems. We identified weaknesses in the context of the act respecting psychological harassment in the workplace. One of the recommendations I made is that people in situations in their work in which their mental health is affected should be allowed to have access to health services, whether it be general services or professional services. Like every other province, Quebec has problems delivering health services.
In the context of section 46 that you mentioned, one of the things we did at the commission is a summary on rights and freedoms over the past 25 years. The commission's research team produced a report, and one of the recommendations was that the notion of psychological health be expressly stated in the Charter itself, because it isn't there. It should be included. We as a society have evolved in recent years on the subject of psychological harassment legislation. As I mentioned earlier, based on the data obtained one year after it was implemented, we see that this act is restrictive in the sense that a number of situations are not covered by it. At the first Canadian conference on mental health and the workplace, the authorities of the Commission des normes du travail mentioned that we needed to develop research in order to reach a more precise diagnosis and to include the mental conditions that do not form a whole under the current definition in the act, which is very limited. That is already progress, but it is limited.
[English]
The Chairman: In Quebec, there is a specific law that deals with —
[Translation]
Ms. Dagenais: — psychological harassment.
[English]
The Chairman: In the workplace?
Ms. Dagenais: Yes, it applies only to the workplace.
The Chairman: What is the name of the act?
Ms. Dagenais: Legislation on harassment in the workplace was passed in 2004.
Mr. Dos Santos Soares: It was approved in December2002, but employers asked for 18 months to adapt to the new environment. On June 1, 2004, the law became enforceable.
The Chairman: Senator Cook's point was that a large number of workers are covered by the federal Labour Code, not a provincial labour code, such as those working for railways and banks. Senator Cook suggested that the committee look at a national equivalent, which would be an amendment to the Canadian Labour Code.
Ms. Dagenais: I have a comment on this. Although Quebec has the harassment law, we have observed that people are requesting psychological support.
[Translation]
Whether it's harassment, violence or any other situation that undermines people's psychological health, dignity or integrity. These requests wind up at the Commission des droits de la personne, sometimes at the Commission des normes du travail — as regards the act respecting labour standards, as regards psychological harassment — and sometimes at the Commission de la santé et de la sécurité du travail.
That is why I proposed that we conduct a study comparing the various types of complaints we receive. Under the act, the definition seems airtight, but, in fact, when people have to file a complaint, it is not easy to know where to turn. These are issues that each of the Quebec agencies must apply or gauge. Since we are dealing with a social problem, we have to think about how to address it. I am not sure that, if a national anti-harassment act were passed, that would be a sufficient solution to the problem. Everything depends on the objective.
Quebec went through this thought process on psychological harassment in somewhat the same way as the European jurisdictions, in particular France and the Nordic countries, which had developed legislation on psychological harassment in the workplace. In France, the implementation of that legislation has had all kinds of consequences that no one had imagined. As a result, it is a solution, but it is not a panacea. You have to bear that in mind before making that kind of decision. It must be clearly understood that, when you are talking about a situation in which psychological health is damaged, that covers a number of situations, not just psychological harassment.
[English]
The Chairman: Allow me to clarify. The Quebec law would not apply to businesses that fall under the Canada Business Corporations Act. My point is that a gap exists.
[Translation]
Senator Pépin: When you say that people have trouble finding out where they can file a complaint — in Quebec, that is the law — why are the unions not involved? They're usually the first ones concerned.
Ms. Dagenais: One of the reasons the act was passed is precisely that it was observed that, in certain cases in which people had harassment problems, there was no channel for transmitting their complaints. This act was introduced, I will not say to circumvent the union jurisdictions, but to enable people who did not have access to a union or who did not have sufficient union representation, to have access.
But we must not be mistaken. Union representation is approximately 19 or 20 per cent. All remaining labour is not unionized — unless I am talking nonsense, I am not sure of the figure. In Quebec, I think it's one-third. It is much less than that in the rest of Canada.
Mr. Dos Santos Soares: It's 40 per cent in Quebec.So 60 per cent of workers are not unionized.
Ms. Dagenais: There you go; it is the majority.
Mr. Dos Santos Soares: As regards the Quebec act, it must be understood that it is an act against psychological violence. We cannot consider establishing an act for all psychological suffering in the workplace. That would be completely meaningless. In one way, you have to attack things in blocks because the legislation will act like a straitjacket; it will push businesses to adjust and to create conflict resolution mechanisms in order to improve working conditions and so as not to close their eyes when they see that two people are killing themselves. That is why it's important to have legislation.
With time, it will be more useful because things will adjust. New cultures will establish themselves. The Quebec act is different from the French act. It is much more focused on prevention and mediation. There are mediation mechanisms at the Commission des normes du travail enabling people to solve their problems. A very large number of the cases that were submitted this year were resolved through mediation.
In other words, if businesses had these conflict mediation mechanisms internally, it would not be necessary to go that far. To speak briefly about the unions, it must be understood that they are not a monolithic entity. They are at various levels of progress on the question. We did a lot of work with the SSQ; there are educational kits to make people aware about harassment, rights and remedies. Others did absolutely nothing; still others will harass their members. It is entirely uneven, but the unions as well are organizations.
The Quebec legislation covers everyone, unionized andnon-unionized workers. Even the unions have to deal with it and not permit harassment because workers can file complaints directly against the union and the employer. Those are the issues; it will take a certain amount of time before complaints start to fall off.
However, it is true that it is very difficult if you have other mental health problems. If you consider the CSST, it almost categorically refuses to accept mental health cases. The person has to appeal. The person has to have money, a lawyer or a union that pays for a lawyer, so that the person can go before the Commission des lésions professionnelles. When a person is suffering from burn-out or depression, he or she may not have the energy to go through the process. It is very important to be able to make this situation easier.
Ms. Dagenais: Just a clarification regarding the Commission de santé et sécurité: what we observed was a significant increase in the number of situations, of psychological injury complaints. This is a phenomenon that will probably exist in the other provinces of Canada. We still get physical injury complaints, but, since the nature of work is changing, we deal more with cognitive work situations, in services in particular; that results in a completely different configuration from the compensation applications to the CSST. They are trying to adjust and to start looking a little closer at psychological injury cases. This is a situation that must be examined and which is being studied.
Mr. Dos Santos Soares: This has increased; you see that the CSST statistics are rising, but it is the tip of the iceberg. The CSST does not record the cases of people who file claims and who are denied. If we had that statistic, we'd have a more accurate picture of the situation.
Mr. Corbière: I was wondering whether or not the cause of the problem has to be related to the work environment for there to be compensation.
Mr. Dos Santos Soares: By the CSST? Yes, there has to be proof, and that means expert opinions and second opinions in which people are had pressed. I see people, at hearings of the Commission des lésions professionnelles, who are crying their eyes out, and things go on as though they were not there.
Mr. Corbière: I have another question: what claims are allowed for mental health problems?
Mr. Dos Santos Soares: That is very difficult. That depends on the board members, and I do not think all the board members are well trained to understand the problems. Some are very sympathetic and will ask an expert to be there to advise them. Others feel they are capable of doing it. In one harassment case in which I intervened, the member said: there was no harassment. Two days after the sentence was dropped, the harasser went to see the person, at that person's home, to threaten and say: "You are going to get it now.'' If that is not harassment, I do not know what is. The union had to issue a demand for the harasser not to approach the victim. But that was a case in which there was deemed to be no harassment.
This is sometimes very harmful from a psychological standpoint because people want justice. When their case is not recognized in that tribunal, it's like telling them they don't have a problem.
Ms. Malenfant: I would like to comment a little more broadly. Talk about mental health in the workplace quickly turns to statutory measures concerning psychological harassment or possible legislation on mental health in the workplace, with which we cannot disagree, but it should not be forgotten that there currently are measures and statutes that can be improved and have an impact on mental health.
We are talking about statutes concerning labour standards. Earlier, we were talking about the high rate of psychological distress in the service sector, particularly among young people, who represent a high per centage of workers in the sector. The issue of intermittent workers and unstable employment has been a growing problem in recent years. Young people are particularly affected by the climate of insecurity in the workplace as a result of corporate restructurings and mergers. We tend at times to forget that these aspects could be an opportunity to take preventive action on mental health problems, among other things, to increase training when workers enter the workplace.
Young people often feel at a loss when they enter a new workplace, particularly since intermittent workers, who are used to entering and leaving the labour market, must, each time, adjust to a new environment, re-establish a network of relationships and master new work tools. This considerable ability to adjust that workers who don't have job security and who often change jobs must have is often underestimated.
Labour standards are not very adapted to these conditions.As regards the issue of wages, work schedules and, subsequently, on-the-job training, people in unstable employment don't have the same social benefits as those with permanent status. In the long term, this lack of job security has an impact on mental health. So it's by improving current employment policies that we can take positive action on mental health.
There has been talk in recent years about development, particularly during election campaigns, about legislation on work-life balance. We hear much less about that after elections. And yet the studies by Linda Duxbury of Carleton University clearly show the impact that work-life balance problems can have on the health of parents.
One should avoid turning everything into problems of psychological harassment in the workplace or mental health problems in order to take action to improve the workplace; we must look at our current policies and work-life balance, employment and citizenship measures.
[English]
Senator Keon: I have to take a short break at noon, but I will have more questions. This has been a tremendous presentation. I want to come back to the question of legislation as it relates to discrimination, harassment and so forth in the workplace, and the point that Senator Cook made. Once you go down the road of using legislation in dealing with grievances, you are into a real predicament.
For many years I managed a mid-sized operation of about 700 employees in mixed disciplines. In my experience, there are no winners if you cannot deal with a situation before a grievance is launched or a law is invoked.
We have heard many positive comments this morning. As in every other sphere of medicine, primary prevention and early intervention are important, because by the time you get to terminal cancer, you are really in trouble.
I hope that this comment will stimulate further discussion.
I want to return to Ms. Baynton's presentation. I am fascinated that your private delivery service provides services on a contract basis. I understand that your services are usually provided to a corporation, by which you are remunerated. Have you ever had the opportunity of providing the same service to and being remunerated by an organization covered by the health care system?
Ms. Baynton: No. Our payment has always been directly from the employer. I am not sure whether they are remunerated by other plans.
Senator Keon: This is very interesting. Like Senator Kirby, I have been convinced for a long time that we have to get some flexibility into our overall system. We have to break it down so that private delivery services can compete with each other and ramp up the system. We currently have a suffocating bureaucracy in health care in our country, and nowhere is it worse than in mental health, where we are treating about 30 per cent of those who should be getting treatment. Our biggest problem is resistance to change in the overall system.
What potential can you see for your kinds of services being provided to publicly funded institutions such as hospitals?
Ms. Baynton: We do work with hospitals. They are one of our clients as well as other private enterprises. Our work is around prevention. We teach managers how to identify signs and symptoms. We tell them that the manager's job is not to diagnose, treat or counsel, but simply to link clients to proper resources. However, it is also important, just as in any other relationship, that they understand how to communicate and what will allow people to function, even when they are not well. We agree that staying at work or returning to work is better for the recovery of most people with mental illness. The isolation at home on one's own can exacerbate symptoms.
We teach managers how to do performance management, which links back to the union issue. Most of the organizations that hire us are unionized environments and they have given up performance management because they link it so closely to discipline, in which case the unions will always intervene. We try to show them that performance management is about maximizing people's potential. It is not about discipline; it is about collaborating on what you need to do your job and asking the employees what they will commit to in order to make this work, which step is often overlooked. Finally, we must ask employees who are experiencing mental health problems what kind of approach they would like to see followed in the future when something happens, that is, to be forward looking.
Return on investment is anecdotal, but our clients have told us that it is significant. The training that was developed specifically to deal with people with mental health issues is transferable to anyone dealing with stress or emotional trauma in the workplace.
Senator Cook: This is about society today with respect to mental health, and more importantly, it is about tomorrow. So many of our young people have to work at any job they can get for as long as they can. Perhaps that is where the conditioning is taking place. They form attitudes in their first jobs that they take with them to their more permanent workplace, if there is any such thing today. We must be cognizant of that.
I may be more preoccupied than anyone with stigma and discrimination. I heard Mr. Gilbert use the lovely phrase "mental health literacy,'' and I want to thank him for that. That is a phrase that we should carry forward.
Mr. Gilbert: I appreciate that comment, and I would like to echo Ms. Baynton's comments. My consulting firm has been working with companies on mental health literacy and mental health awareness training, primarily with managers. Our main message is that if managers are not looking after themselves, they cannot look after others. There has been great progress in this area. CP Rail has instituted a depression awareness program, as have a number of other companies.
Further to the comments on the health sector, people may be aware that the Auditor General for B.C. wrote a report about a year ago slamming the health care system for not looking after its own. Mental health disorders are the number one cause of disability in the health care sector, particularly the community health care sector, in B.C. If the health care system does not look after the mental health of its own, it will not look after the mental health needs of our population.
The Chairman: All of the witnesses in one form or another stressed the importance of prevention by training front- line managers. I made a note of Mr. Gilbert's statement about mental health literacy. We are good at stealing people's lines, so we will use that. A related issue was whether there is a best practice for accommodating people who have a mental illness.
All of the witnesses raised the importance of training front-line managers to understand how to deal with people with mental illness. Someone wisely said that that does not mean a diagnosis or treatment; it means understanding that there is a problem and the need for a system to handle it.
We have heard in hearings across the country that employees are afraid to tell their employer that they are suffering from depression because it puts a black mark on their record. Even though the employer may be helpful, the reality is that somewhere in a file, it may be indicated that they cannot be moved further up in the system. It is only anecdotal, but we need to look at that.
Someone recommended that the training programs should be run by a WCB or some other body.
I have a two-part question. First, could you give us examples of the best training programs that we could quote in the report? I will separate the accommodation issue from the training program. In regard to the best training programs for middle managers and front-line managers, because we like to be practical in our report, if we need to simply say that one needs to run training programs for front-line managers, we will say that. However, it would be more important to be able to say there are three, four or five good examples that have been practiced and work so we can point people in the right direction. What are those programs, if they exist?
Second, I believe Ms. Smailes made the observation that they were using incentives to get companies to make the changes required. I would like to have some understanding of that. It is one thing to say training programs are available and here they are. It is another to get people to take them up. I would like to know how you do that.
There are two ways of getting people to do what you would like them to do. The first is the carrot and the second is the stick. The legislative route is the stick, in the sense that it says here is a law and you are required to meet its conditions, and therefore people feel compelled to do something.
I inferred from what Ms. Smailes said that she went the route of using a carrot to get people to do the right thing.
Most of the major policies from our work on the health care system have been adopted. As the Supreme Court decision of a couple weeks ago shows, our recommendations on waiting times will be adopted.
We think giving people an incentive to behave the way we would like them to behave is better than threatening them with the law or regulations, so we focus on that.
This question is directed to anyone who wants to speak on those two issues. Where are the good training programs and what are the good incentives?
Mr. Gilbert: I think Ms. Baynton's program is an excellent made-in-Canada program. There are some interesting international examples. I welcome comments from other people. The Health and Safety Executive in Britain has developed an interesting process for stress audits for companies. I believe they are like a WCB. At this point, it is more of a carrot. They are voluntary audits, with criteria and standards. It is like a workplace audit.
There is an extensive training program at various levels attached to that for the establishment of stress management and stress awareness programs.
My understanding is, and I may be mistaken, that at this point the carrot is about to become a stick. They have the power of legislation behind them, and just as compensation boards can mandate a physically healthy workplace, they can mandate having a psychologically healthy workplace and can threaten employers with fines and jail time.
Ms. Smailes: I believe they do have that power now, but I am not positive.
Mr. Gilbert: It may now be in place.
Ms. Smailes: We definitely use the carrot approach.
The Chairman: Who are the "we''?
Ms. Smailes: The "we'' is interesting because we try to work with a wide range of stakeholders. For example, "we'' can be OSA.
The Chairman: Is that is the occupational safety association?
Ms. Smailes: That is the Occupational Health and Safety Agency for Healthcare in British Columbia. Our role is to help improve health and safety within the health care industry.
One of the first things we do is to ensure that everyone is involved from the beginning so that there is a level of ownership as they move ahead. With regard to incentives, we make sure we evaluate everything. When you talk about best practices, an effective incentive is to be able to say, "Here are the data that show that this is a good thing to do and that you will get benefits from it.'' We rely heavily on our past successes, such as ceiling lifts, which had a huge financial impact. We had the PEARS program; financially, the impact is huge. We build on those to say, "Look, if you come on again, you have another opportunity to save a lot of money, and here is the track record.''
There is an incentive to have an outside funding source. Money is limited and a there is much pressure from everywhere to do many different things. If we have research to show what works, they can trust it will work when they implement it. If we can use research to take them through the whole process and get to that point, they will roll it out.
The Chairman: What kind of cost are you talking about per firm, ballpark? When you say you will give them funding to do the research, what dollar number are you talking about?
Ms. Smailes: We have a proposal currently for four years to do healthy workplaces across the province. It is $500,000 from the grant agency and $500,000 from the health authorities.
The Chairman: Is that a million dollars a year?
Ms. Smailes: No, that is across the four years.
The Chairman: That number is so small the federal government would not even recognize it.
Ms. Smailes: That is another issue. Part of the difficulty is not having the money to do the evaluations of good programs. The Canadian federation for health research and services is one of the first groups that I found that does give some money across the four-year program so you can do an evaluation, which is important.
[Translation]
Ms. Dagenais: I would point out that good practices are not absolute. You have to distinguish between what is done in large businesses and what is done in other Canadian businesses. In Canada, a number of large businesses have health strategies, while others have no strategies, but would have the means to establish them. However, most Canadian businesses are SMEs. However, those small and medium-sized businesses will not be able to implement good health practices without outside support. Programs are necessary to enable those businesses to establish employee assistance mechanisms.
In Quebec, studies have shown that those most affected by mental health problems in the workplace are those who work in interpersonal relations with patients and students. Consequently, the assistance we want to provide must be targeted by the occupational sector the hardest hit by stress on the job. We have to consider these characteristics before talking about good practices unilaterally.
[English]
The Chairman: Do you have any examples in Quebec of what you would call best practices or best training programs?
[Translation]
Ms. Dagenais: They exist. However, I did not survey them. The report I produced cites some examples of practices and policies. When it comes to good practices with regard to psychological harassment, you should not limit yourself solely to management; you have to have a more overall view of the phenomenon.
The other component is the link between working conditions and psychological health problems. We don't yet have public files on this matter.
[English]
Senator Cochrane: I worry about bringing in legislation when it comes to psychological harassment in the workplace, and I will tell you why. I had a firsthand experience with a large company in my area, Abitibi-Price. That company does business across Canada and North America. Abitibi-Price has a nurse on hand in the facility. She coordinates with all the managers of the various departments along with the hospital facility there. Her door is always open. I know of people who have gone to her for help with a medical disability. These people encounter the medical staff through her direction. I say to you, be careful about bringing in legislation, because we must not throw out the baby with the bath water. We cannot target everyone. This is my point. The human aspect is very important. Mr. Gilbert and Mr. Dos Santos Soares mentioned that. There are many things that can be done through the human element in management. That should be stressed, because without that you will end up with fines and jail time.
There will be lack of productivity because this will go right through the system. Everybody will lose their morale. There is so much to think about when you bring this in.
[Translation]
Ms. Malenfant: For the employer support service, first you have to find toolboxes before trying any miracle cures. With the resurgence of mental health problems in the workplace, we are also witnessing a resurgence in consultation services offered to businesses. But you should not also fall into the toolbox trap.
First, you have to identify the principles that must underlie mental health prevention in the workplace and make workplaces independent with regard to intervention. Once the research team and consultants have left, what happens to the work teams that have to take over and make permanent changes in the workplace? They have to be empowered to identify the problems and they have to be led to find their own solutions suited to their workplace. To do this, they often need to understand their organization in order to introduce decisive changes.
It is true that, in a number of businesses, the determinants, the causes of problems may be similar, but the methods for making those changes may differ, depending on the history of the business, the type of management, type of production and the economic problems encountered by the businesses. This requires financial resources to put things in place. You have to identify what does not cost a lot of money, but what is possible to do.
It is often forgotten in Quebec that, with the act respecting occupational health and safety, we have a public occupational health intervention network, and thus workers attached to the public network who have occupational health training and have the power to intervene in the workplace. However, they need increased training in order to intervene in the field of mental health in the workplace. These workers are already on the job. They are regional resources, and they must be empowered to intervene. Businesses should not always look to outside resources, which are costly for them, and do not necessarily ensurelong-term follow-up.
That is what I wanted to emphasize. You have to identify not only the means, but also the principles that must underlie intervention and ensure we find the most appropriate means.
[English]
The Chairman: Are there any good examples, other than the one or two that have been mentioned, that would tell us what those ways and means are? I agree that big corporations and small and medium-sized businesses are quite different. Frankly, my instinct would be that big corporations will generally be better than small and medium-sized businesses because they are more used to being regulated. Does anyone know of specific examples where it has worked well?
[Translation]
Ms. Malenfant: If I take the public occupational health network I just referred to, researchers in the field of mental health in the workplace have added workers from the public occupational health network to their teams in order to intervene in the workplace and to put in place what are called "intervention support groups.'' The idea is to intervene and make workplaces more independent of intervention by associating researchers with workers who, following the workplace introduction period, will be able to continue providing ad hoc support in the workplace.
These intervention support groups have begun to be introduced in the public health system. This is being evaluated and preliminary results are very convincing.
It is only through longitudinal studies that we will be able to know whether these positive results continue over the long term. Research funding can definitely assist in conducting these kinds of longitudinal studies, but we sense things are on the right track when resources already existing in the regions are included.
[English]
Ms. Baynton: I would like to speak to some of the foundational aspects of the work that then can be transferred to other programs. It is evidence based. We did use research to put it together. It also follows the current information about adult education, which includes the idea that in order for them to own it after you leave, they need to use it and interact with it while you are there.
In the workshop that we do, we stop seven times in the day to get people to apply the information that we have given them to exercises and role playing so that they are able to use it later.
We also understand that there is no cookie-cutter approach. We do a pre-presentation interview with the organization, with the employer, to find out about the culture, the relationship with the union and incidents of suicide or other experiences so that we are informed when we go in there to speak to the employees or the managers.
We take a balanced approach. We do workshops for only 12 managers at a time because of the need for interaction. We know that it is almost inevitable that one or more of those managers has experienced or is experiencing mental health problems themselves. Therefore, who is doing the training is important, because not only do we have to be knowledgeable about management practices, but also about mental health issues. We have to be knowledgeable about dealing with the stress and the triggers that come up in the room because of the training that we are doing.
We created the workshop with the understanding that 75 to 80 per cent of managers do not have a natural ability to manage people. It was developed specifically to reach the technically astute, linear-thinking managers.
To add to what Ms. Dagenais said, the workshops can be hosted through the chamber of commerce, trade associations or business improvement associations so that small-business owners can participate. The cost for the full day of training for managers right now through our organization is $210.
The Chairman: Per person?
Ms. Baynton: Per person. It is not a huge expense. We try to solve their problems on that day. It is not theoretical. It is not abstract. It is, "What do I say? How do I say it?'' Many of the questions are, "What about this? What about when this happens? What about when they are just crying all the time? When they give me the silent treatment or they will not talk to me, what do I do?'' It is very practical.
Senator Cordy: You talked about the importance of who will do the training. When you have a small group of 12 people interacting, do you determine at the end of the day which of them would be best to train other individuals within the organization, or how exactly does that work? That is extremely important.
Ms. Baynton: We are doing the training that day. At the end of the session, we suggest that the people network with each other. In most cases, we have human resource or occupational health personnel at our training sessions. They also take place so that they can support or change the processes that already exist.
We try to get them to form a committee to support each other in dealing with these issues.
Senator Cordy: Is there a follow-up or is it just one-time training? Do you go back in six or twelve months?
Ms. Baynton: Mental Health offers a variety of services, so it really depends on the situation. We offer a service where we go in and interview all of the employees to understand the stressors, the patterns and themes that exist in the organization. We make recommendations on how to make changes that will address those.
We do a workshop called the Complex Issues, Clear Solutions Workshop, which is a full-day workshop for managers. We also do interventions in particular cases where employees are having difficulty to come up with an accommodation for them and an agreement.
We do employee awareness, which the managers might think is great and want to put forward but claim the employees will not talk about it. We do not live in an accepting culture, so another component would be to change the way of thinking about this. In some cases, we provide coaching to managers who are experiencing difficulty. There is a broad spectrum of options, including one-day training that is taken by some managers who then apply it to the workplace and make the difference. We tell managers that they might not be able to change a large organization, but they can influence their own unit or team. An organization will usually listen to us because we interact with a vice- president or a CEO or a director of human resources about organizational change. However, when we talk to managers, we ask only that they participate with the members of their unit or team. That is all you can do.
Senator Pépin: I have one brief question. It is wonderful that such work is being done with managers and CEOs. Do you know anyone involved with university teachers? We see a need to look after our youth. We had a meeting with someone from McGill University who said that 50 per cent of first-year students experience mental disabilities, and so a university teacher must be aware.
We were also told that general practitioners and family doctors are not well informed about these issues at the emergency level in hospitals. Perhaps if better training were available at the universities it would help the students.
Ms. Baynton: We have worked at universities with professors on management training because many of them manage other people. They said that the skills they learned were transferable to their students, so it is possible.
Senator, you mentioned general practitioners. We often ask them to describe the limitations and not the work that should or should not be done. We ask them to leave it to the workplaces to develop the solutions because they are involved. We joke about it by saying if we get a letter claiming the person can only work Monday, Wednesday and Friday, I respond to that by saying when they show me the Tuesday-Thursday illness in the DSM that will be acceptable.
Ms. Buchanan: I was speaking with the VP of human resources at CIBC, where they have had a program in place for six or seven years. This is an example of how working from the top down in a company truly works. They have been able to reduce lost time by 30 per cent, which is huge, given the size of the corporation.
The spokesperson said that one of the most important things when someone goes on sick leave, which I have added to my submission, is to maintain contact with the individual. In that way, the individual continues to feel a part of the organization and does not lose a sense of self-esteem. She said that has been one of the key elements in enabling employees to return to work sooner than they otherwise likely would.
I want to comment on the money issue. From my understanding, the easiest place to find money is in the tax system. We have health-related deductions in the tax system for CPP disability and for health care costs, et cetera. Small and medium-sized businesses cannot afford to hire a nurse or a facilitator for an employee. However, such businesses could receive a tax break to pay for services like Mental Health Works and to bring in outside consultants to train the managers. Obviously, the funding required would be based on their specific needs. I would recommend that we look at tax money to determine a way to fund these kinds of efforts.
The Chairman: That meets our requirement for an incentive because a business that did not bother with it would not receive the tax break. Certain environmental expenditures these days can be written off, but you have to carry them out.
Ms. Buchanan: The other key component is that you are already advertising without spending any money. You are already letting people know across Canada that mental health in the workplace has some meaning. Even if people do not understand the term WSIB or find it scary, they might investigate to determine what is involved.
[Translation]
Mr. Dos Santos Soares: We at UQAM have created a modest course on violence and violence prevention for managers. All managers can take these courses at the bachelors level. I believe bad practices must be taught so that they are able to identify when things are not right. This is the equivalent of what happens at a medical school; if you only teach health, students would never be able to recognize disease. Instead of putting our heads in the sand, we are going to act, prevent and manage conflicts. There are solutions to problems.
There is a new masters level program on managing and preventing disabilities in the workplace. We are trying to start this kind of debate for the community from the university. Doctors, engineers and everyone needs this kind of knowledge, which is not necessarily part of the program.
In Quebec, we have a prize list of the best employers. It is very interesting to see that those at the top of the list are companies that have developed programs for managing mental health issues.
I do not know those companies personally, but I can name two of them. DLGL is a small business with fewer than 100 employees that produces human resource management software. It is considered the number one company in Quebec where everyone would like to work. There is no turnover rate, and the work-life balance and stress management strategies put in place are promising.
In Ottawa, there's MDS Nordion, which works in the pharmaceutical field and has developed a wellness program for employee stress management. That is very interesting because they offer tools. If people want to use them, they can. There is a gymnasium for training purposes, and there are all kinds of things for employees' psychological well-being.
Where I think things are dangerous is where, for example, large businesses have major mental health programs that are well done, but that, in some instances, exist only on paper and do not reach employees working at the bottom of the organization.
For example, in one large Quebec organization — without naming it so as not to offend anyone — they have highly reputed programs, except that you have to know the organizational context in order to understand. If I, as a manager, want to use those programs, I have to pay.
I can send my employees to mental health training, but it has to come out of my budget. If I am an engineer in a department where I have to hire people, buy computers and software and pay for mental health and depression in the workplace training, where will my priority be? So the programs aren't used. They are good, but they are not trickling down to the bottom of the line structure. That is what I call the Balashev syndrome; there's organizational resistance.
You have to beware. It is not the carrot or the stick. You need the carrot and the stick. The carrot for organizations is their image. It is not the discourse about suffering that will change people, but rather the cost of the change. When someone comes to my office with a copy of the Journal de Montréal and shows me a headline that says: You see, it has happened according to this newspaper. I tell them that prevention should have been done in order to avoid these kinds of extreme cases.
People who adopt good practices are not caught by the law. Most people who have filed a complaint with the Commission des normes du travail in Quebec were from businesses that had not adopted preventive measures. Companies that are involved in prevention and try to solve problems at the source have nothing to fear. The law is there in case prevention has not succeeded and it has not been done within the limits of the organization. People thus have recourse. Otherwise, they would have absolutely nothing. They can leave their jobs, but if they leave their jobs today, they are not entitled to employment insurance. So they have to accept the unacceptable. It is either that or economic distress for them. This is like a buffer to help people.
[English]
Mr. Gilbert: I have three comments, if I may. First, I had the privilege last year of being involved with the British Columbia Psychological Association in the Psychologically Healthy Workplace Award process. The American Psychology Association established this about 15 years ago, just taking healthy workplace award criteria and applying them in a psychological sense to deal with many of the things we have addressed today — demand and control, employee and family services, work/life balance, et cetera — basically doing an audit of a company. This was the first time that had happened in Canada.
One of the winners was Vancity, a large company that was declared the best place to work in Canada. By the way, Vancity got rid of sick days a couple of years ago. They have no more sick days; they have personal days. They are your own time; if you want to go fishing or to look after your sick child that is up to you. The absentee numbers have not gone up; it was a bold experiment.
I had the privilege of auditing a company that was another of the winners. It was a small public-sector program to deal with psychiatrically ill and brain-injured adults. They had a philosophy for their clientele that they applied to themselves. They were very open and receptive. I remember talking to them about turnover. They said "Yes, we lost Mrs. Smith last year; she retired.'' That was their only turnover. Those kinds of models are inspiring.
I strongly concur with Senator Pépin's comment about what I would call the emerging workforce and teaching people how to work. We teach the technical skills but we do not teach anyone how to deal with that — whether it is emails 24/7, bullies in the workplace or the ebb and flow of the demands of work. There are some programs that teach resiliency to kids — and adults, for that matter. B.C. has recently put through the Friends Program, an adaptation of an Australian adaptation of an American program that teaches kids basic problem solving, cognitive and behavioural skills at a grade 3 or 4 level. Teaching those programs at a university level would be prevention, ultimately teaching general coping skills.
My last comment is more of a cautionary one. I strongly concur that any programs need to be built within the organization. The drug companies have sponsored a number of awareness programs. I have been approached to develop one as well and it is terrific; but the point there is "Go see your family doctor and take our product.'' I do not think that helps. Awareness is a wonderful thing, but you have to be able to do something about it. I am still of the opinion that much can and should be done within the workplace, not within the health care system.
The Chairman: Would you say a few more words about the program aimed at the three- and four-year-olds? How is it delivered?
Mr. Gilbert: Through the school system.
The Chairman: They are not in the school system at that age.
Mr. Gilbert: These are grades 3 and 4. There are American programs called the Strong Teens Program and Strong Kids Program. It is the same kind of thing, developing cognitive behaviour therapy through a group-based program. It is not treatment.
The Chairman: Is it just added on?
Mr. Gilbert: It is going into the curriculum. Teachers are trained to deliver the program. It has been evaluated; it is evidence based. It did make a difference in kids' levels of stress as well as awareness. That seems to me a wonderful opportunity for intervention.
Equally important is building the resiliency or the self-care skills of our employee force in its own right. Many psychiatric conditions — depression being an easy example — are chronic and recurring. They are not one-shot. If we want to keep people in the workforce, we should be providing care for them, but also building their skills. There are better and better programs, particularly for remote communities and workers, to provide access to self-care.
Senator Keon: I have heard it said that there are eight basic behaviour patterns for kids when they start primary school that can be identified within the first or second year of school. If these behaviour patterns can be modified, virtually all of the difficulties that occur in classrooms over the years can be pretty well controlled. Do you know any more about that? Can you comment on it?
Mr. Gilbert: Only eight? I do not specifically know about that. I would suggest that a more realistic goal would be mitigating rather than eliminating problems; but certainly early intervention for a variety of disorders that we have identified around the table does make a huge difference. I cannot give you specific data, I am sorry.
[Translation]
Mr. Corbiere: I would like to react to a number of points that were made. The discussion is very full and very stimulating. I would like to cite an example of good practices. In Finland, the strategy is to conduct a monthly assessment of employees in order to intervene systematically. They are assessed on various points: family, work, hobbies, etc. At the end of the month, they are scored on each scale, and they can intervene in each specific case. Rather than provide a program that would be intended for a group of persons, they work on a case-by-case basis. That's interesting. In terms of costs, it appears that it is cost-effective over the long term.
There are also employment support programs. They have recently been introduced in Canada. This is recognized as an "evidence-based practice'' in the United States. They are evaluating this kind of interesting program because it provides job support for people who have more or less serious mental health problems. It is often identified as a serious mental health problem, but it can be seen very clearly that 50 per cent of the population has serious mental health problems. This kind of model could be adapted for people who are already employed and who need support in their work.
We have what is called an employment specialist who intervenes in the workplace, that is to say who provides support and assistance to people with mental health problems in entering the labour market. There is close cooperation between the employer, union, employee and the employment specialist. What is interesting is that the employment specialist does not just intervene in the workplace, but also in the community. This makes it possible to have a broader vision of intervention for these people.
We have observed that few people suffering from mental health problems agree to disclose the problem when they are looking for work. The specialized journals have revealed that approximately 50 per cent of people with mental health problems disclose this information to their employers or human resources. Something must therefore be done in this area. If these people do not report their problems, there can be no accommodation in the workplace. Intervention is necessary in this area so that people are no longer stigmatized as a result of mental health problems.
A number of people are afraid to disclose their mental health problems because they may immediately be labelled. Mental health problems are often invisible, and thus hard to identify. Backaches have the same characteristic. We could draw on models designed for musculoskeletal problems.
In Quebec, thanks in particular to the efforts of Dr. Loiselle and his team, a program was established to assist people with health problems in returning to the labour market. Perhaps grouping together the various programs designed for backaches and other hard-to-identify physical problems would be one possible form of intervention.
[English]
The Chairman: We had a witness, an employer, who said that he thinks complaints about excess stress have simply replaced complaints about lower back pain.
[Translation]
Ms. Dagenais: Some people hesitate to disclose their mental health problems to potential employers in the hope of being hired. So we are talking about a situation that occurs before people enter the labour market. However, the situations I wanted to raise this morning are those in which people suffer from mental health problems resulting from working conditions or poor labour relations. These types of situations call for another type of intervention.
Second, I would like to add to Mr. Corbière's comment on Bill 143 on the target groups in Quebec that we manage at the Commission des droits de la personne et des droits de la jeunesse. One of the problems is related to the fact that employers can't require persons with a psychological disability to disclose their disability. The act that will go into effect in December poses a problem in this respect. We want to help people and ensure that this target group of people suffering from a mental disability can enjoy better working conditions. However, to do that, they have to be required to report their disability. So we are faced with a problem in implementing the act.
We are trying to develop mechanisms that will enable people who wish to disclose their disabilities to do so. However, people who don't wish to disclose their disabilities pose a problem.
If the federal government developed a major strategy to say that mental health in the workplace and in general is important, the key argument in convincing businesses would of course be the cost of mental health problems for businesses. That kind of argument could foster the creation of a number of programs. However, we do not have enough data to assess the actual costs. We know how much absenteeism costs and how muchdepression-related problems cost. However, we do not have an overview of the costs associated with mental health problems. Only research can provide us with that information.
[English]
The Chairman: What is Bill 143?
[Translation]
Ms. Dagenais: The act we are implementing is designed to assist the target groups: women, persons with disabilities, Aboriginal people and visible minorities. However, part of the population is not yet included in the act's framework for the target groups or the framework of the Programme d'accès à l'égalité (PAE).
[English]
The Chairman: It is an affirmative action program.
You are saying you are looking for processes to help employees come forward. The best program I have heard of in the country is operated by the CIBC. It is a sophisticated program that involves the employee, originally the human resources department and, ultimately, the manager. I think it would be worthwhile for you to look at that.
Ms. Baynton: With regard to disclosure, people in the workplace get frustrated when they do not understand the diagnosis, as they think their ability to help is based on their understanding. We tell them that the labels, or the diagnoses, are not useful to them for a couple of reasons. First, 10 people who have been diagnosed with depression will all manifest different symptoms in the workplace. Also, science is evolving and it is a mistake for us to treat persons as the label rather than treating the human beings that they are.
We know that what people report as a disability is quite often masking their mental health problem. On one of our training tapes, an individual talking about her own experience said that she purported to be off work with a kidney infection. In reality she had severe depression, but she could not tell anyone that.
I know of a company that gives the title of "personal trainer'' to the people whose job is to rehabilitate those who are off on disability. That immediately takes the stigma away. Also, the personal trainers are trained in cognitive behavioural therapy. They do two things at once. They do physical activities with the individuals as well as helping them process whether they have other issues. I think that is a marvellous approach.
The Chairman: Can you tell us which company that is?
Ms. Baynton: It is ATF, an insurer.
Senator Cordy: You have said that we do not teach people how to work in a healthy way and create a good, healthy working environment. By the year 2005, technological change was supposed to have made the work environment easier for us. In fact, we now have no defined work space. We have our cell phones and BlackBerrys with us and a fax machine at home, and many people are now working out of the home. You do not close the door at five o'clock or six o'clock and enter a new environment. We talked earlier about a bridge. Unfortunately, this bridge just brings the work environment into the home situation. There was also discussion about balancing your job with your family life, which is getting more and more difficult.
Admitting that you are suffering from a mental illness, whether it is stress or any other condition, can still, in many situations, jeopardize your employment, or at least your advancement within a firm. As a few of you mentioned, this goes back to public education about stigma.
Mr. Wang mentioned that we do not even know what Canadians know, and we cannot develop a public education campaign based only on what a public relations firm thinks it should be. We still do not know what people know and should know.
Mr. Gilbert talked about mental health literacy. That is certainly a good point. Mental health literacy rates are extremely low. Everything we talked about today is interrelated. Education within the workplace and within Canadian society as a whole is essential.
Mr. Wang: I want to provide two additional references that may be similar to what Mr. Gilbert was talking about. One is called a hospital magnet program. The other one is the Canadian National Quality Institute that is working in partnership with Health Canada to provide healthy workplace criteria.
Mr. Gilbert: It recently incorporated psychological criteria into its wellness criteria.
Mr. Wang: Those criteria promote health awareness in the workplace and risk factors for physical and mental health problems. We probably just need to borrow the concept because that is the primary prevention approach.
[Translation]
Mr. Corbière: My first point is in reaction to Ms. Dagenais' remarks. In terms of cycles, I don't think there are two classes of employees with mental health problems: those looking for work and those who are already employed. I think that those who were previously employed and had a mental health problem wind up on the other side. It's not exclusive; it's more cyclical.
I'd like to draw a comparison and very briefly provide some information on what's going on in France and Germany. Businesses have a portion of their financial capital reserved in order to hire people with physical or mental disabilities. They have to meet a certain quota, which I believe is in the order of one per cent. If employers don't hire persons with disabilities, there is a financial penalty. This is an incentive for employers to hire persons with disabilities.
My second point is in reaction to an education campaign. To make Canadians aware of mental health problems, a television program could be produced in which actors would simulate various types of mental health conditions in their workplace.
Mr. Dos Santos Soares: I entirely agree that people have to be educated. However, if that canot be put into practice as a result of working conditions or work organization, we are dealing with a dual problem.
It has been proven that breaks are beneficial for both physical and mental health. But there is such a work overload that people prefer not to take breaks and to eat quickly at their desks so they can leave at five o'clock.
People are adopting practices that are not healthy. Studies conducted in the United States and Sweden show that, if you have to choose between your office and the bathroom to eat your lunch, it is better to choose the bathroom. The worst places for spreading bacteria and mites are the telephones and computer keyboards in our offices.
Businesses confirm that back problems are increasingly frequent. Even though they maintain contact with employees who are absent as a result of a back problem, the sooner employees return to work, the better. On the other hand, if I am suffering from overwork on the job and I am at home during my leave, if my employer starts calling me every week for me to go back to work, that does not work out. People will have more problems. I am not sure you can take back cases and compare them literally with mental health problems.
Social skills are more developed in England. For example, a business sends a sick employee a box of chocolates or a get-well card, or employees tell their sick co-worker they missed him at the last meeting and hope he is getting better. We have to reintroduce solidarity among co-workers.
All that is been done in the past 20 years in terms of new forms of management has had the effect of undermining solidarity among co-workers. Social support is very important for mental health.
Action has to be taken in this direction and to create this cooperation among people. According to one French sociologist, we can no longer say there is a class struggle, but rather a struggle for jobs because of increasing employment instability. People are struggling to keep their places in the business. They are ready to do anything to keep their places, even to take action that is not ethical or entirely acceptable.
That goes together with increasing employment instability. The problem will be solved when we address increasing instability. We will move into broader dimensions that will have an impact in the organization.
[English]
Ms. Smailes: I have talked about process within the work environment. Much of what I am hearing here in terms of best practices is that we do know there is a method of doing this. You are involving people. You are working from where they are coming from. You are also involving the executive; all the stakeholders are involved. You are making the intervention on a local level. Health care is a unit level; it is on a small level within the organization. It is transferable to small organizations.
That is a common theme. It is something that we do know works. It is important for that to be shared, because it is great learning and exactly what you are talking about. If you do a follow-up, which is a part of that process, you begin to see what is not working because of the dynamic within an organization and you can address it.
My second point is about dynamic sustainability. As we do these programs, we must have a way to look at them. I keep talking about evaluation, but I really mean being able to change them over time. Different influences always come into play and things change frequently. We need systems that can grow and adapt. That is the next step. Once we get to evaluation, then this dynamic aspect can enter into it.
The idea is to be holistic. We definitely need to educate. There are many stress management packages out there. I have done them and so has everyone. We have used cognitive behavioural skills to teach people to recognize what they can do for themselves and how to know when they need to go somewhere, how to refer their friends and that kind of thing. There is a great deal of material out there. It is easy to do. I have done it with high school students, college students and workers. People can engage in it, but you must have somewhere they can go and it has to work.
I am not saying you do not do education; you must do education, but you are also raising expectations, so you must be able to follow through on that, working holistically.
We were also talking about physical and mental health and this idea of dealing with the physical over here and the mental over there. They are integrated. We need to bring those together and work them into an integrated method.
We have an early-return-to-work musculoskeletal program. The optional therapies make adjustments to people's work environments, and then they expand it to the unit. We are looking at how you do it for the entire unit and on multiple levels in terms of communication and all the work stressors. Instead of just doing it on the physical level, they are doing it on the unit level so you have a more holistic approach. A number of groups in B.C. are also looking at this.
Ms. Baynton: Looking at the accommodation processes, the mediation-type approach, our experience is that it is not a level playing field when people with a mental health issue are asked to sit at a table with a manager who may have been partly responsible for the stress they have been experiencing in the workplace. The approach we take is more like shuttle diplomacy, where we sit all of the stakeholders down individually, the manager, the union rep, the human resources people, and we get the context and the limitations of the accommodation. Then we sit down with the individuals who have a mental health issue and give them the opportunity, in a safe environment, to speak about what will work for them.
The agreement we come up with for the employee has three components, the first one being, "What do you need to do your job?'' We take the strength-based approach. We are not asking, "What work do you want to get out of?'' Many employers look at accommodation as somebody doing less work. We encourage different work or work done differently, as opposed to less work, which cuts down on the hostility among the other workers, problems with the manager later and the lack of self-esteem.
The second part of the agreement is, "What will you commit to?'' We help the persons with the mental health issue to understand the impact they have on other people in the workforce, because that is usually a big part of the difficulty, and we ask them what they can do to work this out.
The last point, which I spoke about before, is being forward looking, at how we will deal with problems of performance or work issues in the future.
We need to think differently about mediation when we are talking about somebody with a mental health issue.
[Translation]
Senator Pépin: I have taken a few notes; someone mentioned that care should be longer than three visits to the doctor. How can it be determined that they only need three visits? Is it because insurance does not pay for more than that and that they have to bear the expense? I would like to have more information on this subject because I do not think three visits goes very far. I was surprised to see the violence there is in the workplace.
Someone suggested that we have unions, management and government together. How do you go about organizing all that? I would like research to be done on the subject.
Someone else mentioned Australia. Was that an experiment or a study done in Australia compared to us? Is it something that could be applied? These are the points I would like to see developed.
[English]
The Chairman: Even our federal health plan allows only six EAP visits. In other words, if you or a dependant, someone covered under your health plan, needed psychological counselling, up to six visits per calendar year are covered. They pay 80 per cent of the fee and you pay 20 per cent. If it is more than six visits, it is on your own hook. I have never heard of anywhere in the country that allows more than six. I know some companies allow three or four.
Mr. Gilbert: I believe the RCMP has unlimited EAP coverage.
The Chairman: So does the military, but that is related to what are perceived to be the unique stressors of the job. The military plan is different from the plan for everyone else employed by the federal government for exactly that reason.
Mr. Wang: Australia is the leader in mental health promotion and prevention. They started doing the research on mental health literacy in 1995. Last month, my colleague and I received a grant from the Alberta Heritage Foundation for Medical Research to study the mental health literacy in the Alberta population. We used the Australian instrument so we can compare our results with theirs at the end of the study.
The Chairman: When will you have it done?
Mr. Wang: In two years.
The Chairman: My guess is that you will find that the numbers will coincide with where Australia was in 1993, 1994, 1995. They have been running an anti-stigma program for a decade, with significant results. It would be interesting to compare, not Alberta today with Australia today, but Alberta today with Australia at the beginning of their program. My guess is that the culture in both places will be comparable.
Mr. Gilbert: I strongly agree. Australia has been an interesting experience. I will suggest we have more to learn in this area from some of the European countries and from Australia than we do from our southern neighbours, given the differences in the systems. Australia has been running a program called Depression Works, an awareness program for employers and the public. Given the similar size, large country, population spread thinly, I think we have much to learn from Australia.
The International Forum on Disability Management is holding its 2006 conference in Brisbane. The last one at which I had the pleasure of presenting was in Maastricht. It will be interesting to monitor that forum and learn from that.
The Chairman: Is that mental disability or physical disability?
Mr. Gilbert: It is both, and increasingly, just as we are seeing here, the mental component is getting bigger.
The Chairman: It is perhaps 10 per cent?
Mr. Gilbert: I would say higher.
With respect to EAPs, three sessions are not adequate. Most EAPs operate on an "assess and refer'' model, which is fine; they get a basic picture and refer on as needed. Most EAP providers are an important lynchpin in this, but they are not sufficient, and there is a real risk the company will say, "We have an EAP, so we have it covered.'' No, you do not. A survey out of Michigan showed that about 14 per cent of depressed workers had used their EAP. That means 86 per cent did not. Most EAP organizations, unless they are using regulated professionals, which very few do, have no particular accountability. Cognitive therapy is great, but going to a weekend workshop on cognitive behaviour therapy is no more effective than doing a weekend workshop on how to prescribe. We are relying on sketchy arrangements, and the evaluations of the EAPs are wanting. I do think EAPs are important, but the bar needs to be raised.
The Chairman: My wife ran the occupational health department of one of the national oil companies in Canada. Under their EAP program, you talked to her and she put you in charge; she gave you a range of people to pick from. This is a macho situation, oil rigs, the whole bit. The vast majority of employees did not work in the office. They were out on rigs. There was no way they would go to my wife and tell her they were suffering from depression. She would find out over the long term when something else happened. The resistance of the patient to seeking help is absolutely extraordinary, particularly in macho, male-driven industries. She found women were more willing to than men.
[Translation]
Mr. Dos Santos Soares: With regard to psychological consultations, I'd like to draw your attention to two points. First, the number of five or six visits is for people who have an employee assistance program. Ordinary people who work at a snack bar or have short-term employment don't have access to an employee assistance program, and so there's no consultation for them.
However, there is a loophole, which is employment insurance. Under the Employment Insurance Act — and I know this because people in Quebec use it instead of going to the CSST because it turns them down — health insurance is included in employment insurance. Perhaps there's a way of granting psychological assistance to people who go through employment insurance if they are suffering from burn-out, distress or depression.
This is very difficult; I see people in distress who come to my office for help, and I do not have much to offer them. I am not a psychologist, so I cannot take care of them.
First, I try to demystify the problems. I tell them they are not crazy, and I suggest that they go talk to a psychologist so they can better manage their pain and suffering. I can tell them to go to the CLSC and put their name on a waiting list, and that will take about six months, or to call the Ordre des psychologies, which may be able to give them the name of someone who can provide help at a low cost to them. It is very hard. It should be seen how psychological assistance can be introduced into the employment insurance program.
I used the term "tripartite'' earlier because I believe that everyone loses out in this area. Employers, unions and governments lose money. They are coming together in the search for a solution to these problems, and that is why I think we have to go through the three levels, that is to say the government, employers and unions.
Ms. Malenfant: I am going to hammer my message home once again. The challenge in mental health in the workplace is, of course, the entire issue of increasing job insecurity. Earlier someone raised the question of the gap between work required and what is set out in official job descriptions and the actual work performed in the workplace. Revealing this gap to employers in the workplace is already a major step forward.
Earlier someone mentioned the fact that employers are aware when this starts to cost the business money. I will not go back to that, but I would like to say that the even greater challenge — and I repeat this — concerns job insecurity and the quality, or lack of quality, of insecure employment. It is labour market action that must be considered. People talk about a labour market that has undermined the various types of employment status because there is increasing competition between businesses and, within those businesses, between workers.
There is still a group of workers that it is virtually impossible to get a clear picture of because they are not integrated into businesses, because they are non-unionized workers, temporary workers who don't have access to existing programs in the business.
Very little is also being said about contracting out, but large businesses increasingly do business with other businesses in subcontracting services. With regard to this class of workers, the study by Katherine Lippel on the right to work have clearly shown how these workers are not protected. These are workers who have few or no skills and are uninformed about the connections between health and work, who are thus somewhat outside all that and who, after numerous negative experiences, accept their failure, take responsibility for it or think it is their fault if they cannot enter the job market on a sustainable basis.
So little attention is paid to the problems of these workers. Nor do they have access to health services most of the time. We should not forget this group of workers or this problem of job insecurity, which affects the current labour market, or the way in which work is currently understood in our society.
Ms. Dagenais: Ms. Lippel has indeed conducted studies, but we recently completed an even more recent study in cooperation with the INRS on the risk factors involved in the fact that this marginal class of workers — there are a lot of women in this group — are not protected, even to the extent of having access to employment insurance maternity leave. If they have a problem getting maternity leave, imagine what happens when they have to find a job afterwards; this is basic.
This study is available from the INRS. The study in question contains recent data on sickness and disability programs to which self-employed workers do not have access.
I would also like to mention something about the marginal workers we're talking about. It must be said that job insecurity is one thing, but it has involved whole segments of the salaried labour force because contracting out means that stable segments have been taken and weakened. Recent data have been published to show the number of middle managers who have been shoved aside and eliminated.
In the corporate structure, if you want to introduce programs to provide assistance for mental illness, you have to ensure you do not have a traditional line structure. This puts pressure on employees at the bottom end, and there is a lack of communication with management as well. It must be understood that this is an impact of the restructurings of the 1990s, and the data on this matter are telling.
Ms. Raymond: The subject of job insecurity is an important one. I was even wondering how it could be addressed right now because, in all the institutions where I work, I work in universities where people have had special status for 25 or 30 years. I have worked in large organizations. There are 10,000 of us, and there are people who have been there for 30 years. My spouse has experienced the same thing; he had to change jobs as a result of a restructuring. He is still at the department, but now has special status.
There is also the entire issue of contracting out. It is a trend that is everywhere. I wonder whether the concept of permanent employment even exists today for young people starting out. I see a lot of professionals who are starting out and are working on contract. It is a fairly competitive workplace. If someone has a solution or a vision with regard to job insecurity, it is something that troubles me a great deal for future generations.
[English]
The Chairman: I must say that senators have one of the few secure employment contracts left.
Senator Keon: I want to come back to the suicide rate in men. Recently, I witnessed an unexpected suicide by a young man, although in retrospect, it should have been expected. He had not been as successful as his wife, and unable to cope with the stigma, he took the easy way out.
In the workplace, where the competition now between male and female is more intense than it used to be, do men remain too macho to recognize that they have a problem and find a way around it before they resort to such desperate measures? The statistics that you gave, which are quoted frequently, are truly alarming. The particular groups of people who commit suicide are so easily identifiable. It is males in that age group, Aboriginals and so forth. Yet we do not seem to have focused programs for them.
Ms. Raymond: The first point is that I did not call those men "macho.''
The Chairman: No, I did.
Ms. Raymond: I do not think it is true that men do not recognize when they do not feel well. They know it. They can feel it inside. In the last two studies — one with policemen and one with first responders in health; we do not want to call them high risk groups, even if they call themselves that — those men and women work with a team, they work in emergencies, and if they tell their colleagues that they are not feeling well, it gives the colleagues the sense that they are alone in a high-stress job.
To avoid traumatizing colleagues, they will say "I am all right,'' even if that is not true. They will not say that they are depressed, thinking of suicide or addicted to drugs or alcohol.
The one thing I noticed about those people was they do not have anywhere to talk about it, because they do not go home and talk about those things with their friends or family. It is too heavy. They do not talk about it at the office because it is too heavy. If you talk about it, you are a weak person. You have to be strong. They all have uniforms. When they put their uniforms on, they are supposed to be strong.
Men in that context do not express themselves. Even in other contexts, in factories working on a production line, for example, they can say that their car is not working, or their wife is sick or the kids are having problems — you can express those things — but they do not say as a man of 40, 45 or 50 that they are not feeling well. There are many barriers. It is not only the macho context; it is more a cultural issue.
In some at-risk groups or professions there is a link between the kind of work and the suicide rate. Everybody knows that psychiatrists are the leading profession in terms of suicide, followed by engineers, pharmacists, veterinarians and psychologists, all people who have a means to kill themselves easily. There is no rescue time; there is no stop time. When the impulse is there, they have a way to kill themselves.
Ms. Buchanan: There was a reference to the DSM-IV earlier, the psychiatric bible that outlines the signs and symptoms of the various illnesses. A syndrome called the Agnosia syndrome has been used with stroke victims. A lot of studies have been done. It means that someone has no insight into their illness at all. Some studies show that 40 per cent of people with serious mental illness do not even admit or have any insight into the fact that they have a mental illness; 20 per cent have poor insight. This helps explain why there is poor compliance with medications, even though we have newer medications with fewer side effects now. I am suggesting that of that 84 per cent who do not acknowledge that they are depressed or whatever, maybe half of them do not know it, even though people around them can see it.
To give you a concrete example, some people with a serious mental illness or substance abuse problem become alcoholics because they are self-medicating. It is also socially more acceptable to go for rehab for alcoholism than for mental health care. We have to recognize that there is that group out there that everybody may be aware has a mental health issue, but they themselves do not.
[Translation]
Mr. Dos Santos Soares: As regards job insecurity, Statistics Canada has revealed that 35 per cent of jobs in Canada are considered non-standard. That is a lot.
To tie in with the issue of suicide, I was reluctant to introduce this idea. I think it is important to take care of the people who care for people.
I am currently conducting a research project on compassion fatigue, a "secondary post-trauma'' reaction. People who provide care to other people handle mental health and violence cases. These people in turn develop post-traumatic stress problems. It is like the effect of second-hand cigarette smoke. It is not only the person who smokes who gets sick, but also those around the smoker who breathe the smoke.
The mental health issue is the one that has the greatest correlation with people who may suffer from compassion fatigue. It is important to care for the people who listen to other people because their mental health may be at risk.
[English]
Ms. Smailes: I have a couple of comments about the strong men. Two things have been found to work. One is call-in lines. In New Jersey they have a call-in line for the police manned by police or psychologists. It is all volunteers. That has had a good response and it is anonymous. Police can say what they want. They understand each other. It has been extended to paramedics. It is also being extended to other states.
The other effective method for paramedics has been to have psychologists dedicated to an area. They do not sit in their offices. They sit in the cafeteria every day, so you are not going to see the psychologist; your psychologist is one of your buddies and is sitting there. It is the same idea of integrating it in a way that people can have access.
The secondary post-traumatic stress is an interesting issue. I think UBC nursing school is looking at that. The idea is for nurses to be able to cope better with those kinds of stresses. How do you incorporate into the training a lot of these issues that we are talking about, such as the coping skills, expectations around healthy workplaces and communication? Making that part of the curriculum is being discussed.
The Chairman: I cannot remember in which Western province it was, but we met a lady who runs a program exactly like the one you described for police in New Jersey, only she is a farmer's wife and the program is for farmers and their families because of all the stress they are under through droughts and so on. She is a nurse practitioner.
All the people who answer the phone at the help line are members of a farmer's family. It is not just adults who call. Children realize the pressure that exists in their family. It has been extraordinarily successful. If you want a Canadian example, it may be worth looking at that one. We can ultimately find an exact reference.
Ms. Smailes: The power of call-in lines is phenomenal.
The Chairman: In this case, self-identification seems to help.
Ms. Raymond: The police in Montreal set up a program that has been evaluated; it is called the Blue Line. They have four types of lines: for homosexuality, violence, suicide, and drugs. If you want a reference, I can mail it to you.
Mr. Chairman, you were asking about a coping program for young kids. There is one called Zippy's Friends. It is run by Partnership for Children, which is an international agency funded in the U.K., I think. It has been evaluated in Norway, in Slovenia and the U.K. and it is starting to be evaluated in Canada now.
The Chairman: Where?
Ms. Raymond: In Quebec. I can send the information to you.
The Chairman: That would be terrific.
Senator Keon: Coming back to your concept of supported employment, Mr. Corbiere, if it could be officially enshrined, it could be very productive from every point of view: It could be productive for industries affected by inefficient employees and it could be tremendously beneficial to the employees.
I am not aware of any official designation of this concept. Can you identify any official government program that uses the terminology "supported employment''?
[Translation]
Mr. Corbiere: You can find this kind of program at the Canadian Mental Health Association in British Columbia. It is a provincial initiative to establish this program in Vancouver and the surrounding area. The concept is already established in Canada. At the Douglas Hospital in Montreal, Dr. Eric Latimer and his team have introduced an employment support program.
If you need references for more information on the components of employment support programs, I could easil e- mail them to you. If you have a specific question on employment support programs, I can answer it.
[English]
Senator Keon: I would appreciate it if you would send us what you can because it is the kind of thing we should recommend, that government become involved with this. Again, there is only so much the government can afford, but it could be a tax incentive or there might be some other way.
Rather than waiting for philanthropists or various institutions to do this, it is important enough for the labour force that it could be official.
[Translation]
Mr. Corbiere: I see there are a lot of hybrid programs in Canada, precisely to respect the economic, political and sociological context. It is also important to know that there is an employment support program model, but we need to adapt it to the Canadian context. We are studying all the initiatives that have been taken to introduce this kind of program in Canada and to compare the introduction of these programs at the level of the organization, the individual and the staff who work there to determine the best practices or best components for helping people with mental health problems enter the labour market.
[English]
Senator Cochrane: Like Senator Keon, I am interested in suicide. When you mentioned the topic, I could not help but think back to my school days. You did say that it was contagious.
Ms. Raymond: There is a risk of contagion. When people you know — or people you do not know but in the same setting — kill themselves, it sometimes has many effects. First, it can pull down the barrier of what can and cannot be done. That makes suicide a possibility.
Second, there is also what is called a mirror effect. For example, when Gaétan Girouard, a well-known reporter on TVA, killed himself in January 1999, a colleague at the University of Quebec published an article about the proven contagious effect, in that people who did not know him but who read about it in the newspaper or heard about it used the same method of suicide. They wrote his name and story in their suicide notes, for example.
It is identification with a celebrity or a person we like. People are thinking "If that guy, with all he had, could not make it, how can I, who have a lot of problems, try every day to keep going?'' There were a lot of further suicides identified with that suicide.
It is the same thing in schools. We have documented schools with a high number of suicides that could not be explained by simple statistics. There was a big one in B.C. two years ago. They are all over the country. There was one in Quebec, where five kids killed themselves in the same year.
First Nations people have one of the highest suicide rates not only in Canada but also in North America. I travelled to Iqaluit, and in many villages, everyone is a survivor because each person knows someone who has died by suicide.
Senator Cochrane: I was from a small town where, in one year, three teens committed suicide. The community could not understand what happened. It was awful.
Ms Raymond: It is not only the school, but also the community and the family.
Senator Cochrane: Do a large number of teens commit suicide today? Is the incidence of suicide in teens increasing?
Ms Raymond: Before 1970 there were no Canadian statistics on children under the age of 10 years. Now we have statistics onages 10-14, whereas before the statistics began at age 15. The rate has been stable in Canada over the last 10 years. Although it is high, it is not on the increase. The highest rates of suicide are found in Quebec and Alberta.
[Translation]
Ms. Dagenais: I would like to provide some additional information on employment support programs for people with mental and physical health problems and physical disabilities, and various target groups that were identified. The programs worked very well, but, for some reason, funding was stopped for this kind of program. This has previously been done; it might be interesting to restore this kind of approach.
[English]
The Chairman: When did they stop funding?
Ms. Dagenais: I left the ministry in 1992 and I believe the program stopped in 1987 or 1988. A great deal of money had been spent on it and was extremely helpful.
[Translation]
There were also former inmates and various target groups. People with mental health problems were targeted, and that was very relevant.
Mr. Dos Santos Soares: I think this is a problem that sometimes goes beyond the organizations. It is hard to see whether the organization has contaminated society or vice versa. This is the performance issue. People always have to perform to higher and higher levels. This is an ideology that manufactures winners and losers.
It is very troubling to hear child psychologists say that seven or eight children at Sainte-Justine Hospital are in such intense distress that they have stomach ulcers. They're always being asked to "perform.'' They are told: you have to do swimming, this and that. We are stuck in this hyper-performance model. That loses all meaning.
[English]
Ms. Baynton: In addition to Mr. Dos Santos Soares' comment, our analogy is that the increase in depression and anxiety is like repetitive strain injury. The work of Dr. Fraser Mustard in "The Early Years'' speaks to the fact that the stressors imposed on young children aged zero to six actually hardwire them in ways that do not allow them to cope with stressors later in life. In the workplace, we are continually asking people to do more. Human brains were not meant to be constantly stimulated the way they are in today's society.
Mr. Gilbert: I have two comments. A couple of years ago, there was an unfortunate incident in B.C. referred to as the "Kamloops incident,'' when as a function of government cutbacks, a manager was told to lay off several employees. He performed his duty and then discovered he was being laid off. He shot his union rep and his manager on the opening day of the Canadian Mental Health Association conference. It illustrates the very issues we are discussing today, the impact of workplace issues and the tragic outcome. Unfortunately, it often takes a tragedy to bring these things to people's attention.
To some degree, there has been a medicalization of psychosocial problems. Reference has been made to DSM-IV and DSM-IV-TR, the diagnostic manuals. There is, with the exception of post-traumatic stress disorder, no adjustment disorder, stress disorder, in DSM. There is no such thing as stress disability or a stress disorder. Once we move into that realm, we take many of these issues off the table. We have a dialectic that is, in some ways, crazy in its own right. We are talking about and treating the common explanation for depression — the happy or unhappy neuron caused by a chemical disorder. We do not say a person is depressed because he or she has an unpleasant workplace or too much work to do. Something about the fundamental dialogue around these issues needs to change if the problems of depression are to be effectively addressed.
The Chairman: Mr. Gilbert, you are suggesting that describing depression as a chemical disorder and treating it in the same way as diabetes is not the correct characterization.
Mr. Gilbert: I do not know whether it is correct because we do not know the causes of many mental disorders. Some are more neurochemical or biochemical, some are genetic and some are psychological. If we move it into the one realm only, we are taking the others out of the equation.
[Translation]
Mr. Dos Santos Soares: This is a big problem that must be pointed out. Problems are medicalized. You go to a doctor, and the doctor asks you whether you are working, whether you have any problems in the workplace, et cetera. He tells you: "Take this happy pill.'' If you look at the increase in the use of psychotropic drugs, it is extremely troubling, around the world, but also here in Canada.
You have to beware because some drugs cause extreme dependence. If people stop taking anxiolytics, it is precisely as though they were undergoing cocaine detox treatment. It is very hard to break out of this chemical dependence.
A lot of people go the medicalization route, whereas we do not know all the causes, which are chemical in some instances, but also psychological and social in others. It is very dangerous to fall into the trap of taking pills for all our probems.
[English]
Ms. Buchanan: I certainly agree with Mr. Gilbert that many issues have been medicalized. However, I want to caution that bipolar disorder and major depression are serious illnesses, and as I mentioned, in my case study not one individual became ill because of stress on the job — they had already dealt with that. They became ill because there was a genetic predisposition for a particular illness. This becomes a huge problem in the workplace, where we all want to make the diagnosis. We talk about someone who might not be functioning well or might be drinking too much after work. Perhaps he has other problems. It is easy to do and we have to be careful of the differences.
I cannot tell you how many times I have been depressed in my life, but it has not been the kind of debilitating depression that stopped me from getting out of bed or did not allow me to function.
The analogy I use frequently is pneumonia. Many of us have had pneumonia, and if we receive the right treatment quickly, we do fairly well. However, a small percentage of people who get pneumonia become very ill and might die despite treatment. That is how we have to look at major depression, for example, and keeping the separation there.
I have tremendous respect for the Canadian Mental Health Association and have worked closely with their executive directors. I admire so much the work that Ms. Baynton is doing with Mental Health Works. However, one thing has bothered me about the Canadian Mental Health Association. I do not know whether they are out there to help people with mental illnesses or to help well people not become mentally ill. This confusion exists. Senator Kirby, I admire that you have taken the concept of mental illness and stigma by the horns and admitted what it is. We have to continue fighting the stigma and not try to hide behind some kind of blasé term.
The Chairman: In the time remaining, could I have input from our witnesses on one other topic? Many of you in your opening comments spoke about the difficulty of someone suffering from a mental illness in receiving disability support. You spoke to the inability or the reluctance of any workers' compensation board to grant disability support in response to mental illness; to how short-term disability programs do not cover most mental illnesses; and to how long- term disability programs do not seem to be covered. We also heard that the CPP disability program puts up every conceivable barrier to offering support to individuals with mental illness. Although Ms. Buchanan gave examples of individuals who had been able to receive the disability tax credit, the reality is that far more people are denied than receive it when they apply.
Vis-à-vis any of the myriad programs designed to provide financial support to people who have a physical illness or have had an accident, does anyone have suggestions as to what can be done with respect to making those same programs applicable to people with a mental illness?
Ms. Buchanan: It has to do with guidelines. When my husband went from short-term to long-term disability in June 1991, we ended up in court for four days in February 1995, which was a long time.
At the end of the four days in court, I could understand precisely the positions of the company and the insurer. They did not have sufficient information to qualify him for disability. It became a matter of going before the court to air all the appropriate information. I cannot fault them, but the problem was that they did not provide us with any guidelines or tell us what information they required. They simply kept asking us to send more and more. If they had provided us with some guidelines or told us precisely what they were looking for, it would have been a simple issue. However, it became complicated and was delayed because we did not know the rules. That happened in the case of the CRA's disability tax credit as well. Now we have a form that provides appropriate guidelines for psychiatrists, psychologists and family physicians as to the interpretation of terms in the Income Tax Act such as "inability to think, perceive and remember.'' Prior to that interpretation being available, if you functioned in any way at all and called the CRA to ask a question, they figured you did not qualify because you had the wherewithal to call them. That is exactly what happened.
There is a fundamental lack of understanding on the part of insurers and many others of the reality of such illnesses, and a lack of guidelines. I was talking to someone who had dealt with a harassment issue. She said that if they had the same kind of guidelines for mental health that they have for harassment, it would be great, because everyone would know what they were talking about and what the eligibility criteria were. The bottom line is that most often, we do not know what the eligibility criteria are.
The Chairman: Ms. Buchanan, you said that your husband's case was about a decade ago, during the 1990s. Does anyone know whether the situation has improved over the last 10 years? Have better guidelines surfaced?
Does anyone have any idea what happens on the ground, so to speak?
Ms. Buchanan: I do not know what happens in reality, but my husband must re-qualify each year. I cannot tell you how stressful that is for him. He has to go to the doctor and ensure that the form is filled out correctly so that there will not be any question about it. This is a hugely stressful annual event. It is stressful for him and, talking about contagion, it is stressful for me. It is as though I take on that kind of stress too, because over the year, there is so much stress in coping with his stress that I cannot draw the line as to where his problem ends and mine begins. His problem is eventually my problem.
Mr. Wang: I want to comment on mental illness and disability. It is difficult to determine whether a disability is caused by a mental or physical disorder.
The Chairman: In light of all these programs, why does that matter? If people are disabled, they are disabled. What is the relevance of identifying a precise cause?
Mr. Wang: A mental illness, unlike a physical illness, cannot be reliably diagnosed with lab tests or biological markers.
The Chairman: I believe that I understand your point, but I am a little incredulous. You are saying that because there is no objective, measurable, quantitative test, the assumption is that the person is not telling the truth.
Mr. Gilbert: The same situation existed for multiple sclerosis until we could perform CAT scans. There were no organic findings to diagnose its presence. We see the same issue with fibromyalgia and other chronic pain disorders.
The Chairman: How are such cases handled?
Mr. Gilbert: People fight and are reliant on self-support. Disability means inability to function in a particular job, which depends on the criteria. The physical musculoskeletal comparison is whether the individual can perform the duties required of the job: For example, can the person lift the box 20 feet 20 times a day? Metaphorically and literally, what is the psychological equivalent? How un-depressed do you need to be to be a teacher, a physician, a psychologist or a senator? That is not an abstract question.
The Chairman: I understand.
Mr. Gilbert: We lack the measures to determine the answer to that question.
The Chairman: Is this unique to Canada?
Mr. Gilbert: No, this is a universal issue.
[Translation]
Ms. Dagenais: You are asking a very complex question. A number of aspects have to be considered. The doctor will have to determine whether the person is suffering from depression, stress or anxiety. Then he will have to refer to the DSM-IV to determine the class of the illness. It may be an adjustment problem or any number of other problems.
When the person subsequently files a claim with the CSST, the process is quite different and different criteria apply.
[English]
The Chairman: What does CSST stand for?
[Translation]
Ms. Dagenais: The Commission de la santé et de la sécurité du travail is a big part of the problem, and I believe that the next few years will show us that we have to adapt the legislation on psychological damage, particularly in Quebec.
This will become a very widespread problem in the labour market. The Commission will be overwhelmed, not because it will receive a lot of complaints, but rather because there will have to be new criteria for addressing complaints. It will not always be possible to deny people compensation for psychological damage.
[English]
The Chairman: Even though I absolutely agree, I asked what seemed like a simple question knowing there was no simple answer. If I am right, you are saying that there is an area that needs research so that we can begin to get measures. Yet as I listen to you — and a lot of you are academics — there are no data and there is no research on this question. It seems to me that that is important, particularly if you want to reduce the economic cost.
[Translation]
Ms. Dagenais: In my report, I say that we had to conduct comparative studies between the kind of complaints we receive in various organizations, the act respecting labour standards, the Commission de la santé et de la sécurité du travail and the Commission des droits de la personne. I did the Commission des droits, but I had to stop work for four months. I was able to conduct the study on the complaints to the CSST, since I myself was off work.
A study should be conducted on the complaints that the CSST receives. This is a grey area. If we could understand the exact nature of claims that are not granted, we could get a clearer picture of the current labour market, of the distress people are experiencing, and how to find solutions in order to help them. That is a fundamental point. Resources would be needed for that.
Mr. Corbière: Thank you for opening the door on musculoskeletic problems, which are a real problem in terms of costs. A lot of research is being conducted on these problems, more particularly on back problems because that is what costs the CSST the most money. Numerous studies are being done on this issue because it is invisible. Employers get to the point where they do not trust employees because the exact problem cannot be determined.
The problem of mental health and depression is similar. We took individuals who had chronic back problems and looked at their mental health problems. There is a very strong association between depression and musculoskeletic problems. There is a real need for intervention. The correlation is 0.90. That is very high. And that is a longitudinal study that enabled us to evaluate musculoskeletic and psychological problems at the same time.
In Quebec, the CSST has developed a method for monitoring people with back problems. Since those people are not believed, they are going to be monitored at home, by video, in their yards, to see whether they are able to bend over, for example. They are coming up with unthinkable mechanisms in an attempt to find a reliable measure on which to rely.
[English]
Ms. Buchanan: I am not sure where to start. I get anxious about legislation. In the U.S. a federal law has been in place for quite a while that provides that the Medicaid program does not have to pay for the drugs required by people with anxiety disorders, anorexia, panic disorder. These are all of the drugs in the diazepam class, most of them know them by the name of Valium, which has been overused, but there are other important drugs like lorazepam. They cannot even get access to them because, presumably, the legislators do not feel those mental health issues are as disabling as some other conditions. We have to be careful there.
I was disturbed when legislation was passed in Ontario to the effect that the WSIB will no longer compensate for stress in the workplace. They were not happy with how a key legal case worked out and they passed the legislation. Yet if you are a bank teller, someone approaches you with a gun and you suffer from post-traumatic stress, it is compensable.
One of the reasons they say they will not compensate for stress in the workplace is they cannot measure the stress over time, but there are many precedents for that. We heard about the back pain. I lived in Elliott Lake, a mining community; white hand, which comes from drilling over a period of time, was compensable. Hearing loss was compensable. Lung cancer was compensable because it is felt that people who work in uranium mines and smoke are predisposed to lung cancer. Where do you separate the cigarettes from the environment?
I have done histories of all the mines in Elliott Lake. I had a call a few weeks ago about when a particular mine closed because someone has brought forward a claim. The mine closedin 1960, and they are trying to determine now whether or not the disease or illness was caused by the workplace.
The Chairman: Forty-five years later.
Ms. Buchanan: Let us not say it is too difficult to do; let us find better ways to measure and determine and produce better guidelines.
[Translation]
Mr. Dos Santos Soares: I do not know whether you have taken the DSM-IV and read the definition. It is very hard to say whether it is this or that.
The attending physician uses the full extent of his knowledge to determine whether a person has a particular problem, but the CSST may not provide compensation for that problem, whereas it may provide compensation for a very similar problem.
You also have to read the DSM-IV with a very critical eye. Homosexuality was considered a mental illness in the last version of the manual. They removed it from the most recent version. In order to be suffering from post-traumatic stress, a person has to have faced death. But psychological death can trigger that as well as physical death.
However, since it is not written in the DSM-IV, when psychiatrists conduct their assessments, they say that, since the person was not facing death, there is no post-traumatic stress. And that is it.
You really have to take a critical look because you cannot consider these books as the bible, which determines matters with accuracy. It contains a body of vague knowledge which is constantly evolving and is therefore not black and white.
Ms. Raymond: I would like people to beware. The DSM-IV is not a bible. If you put a number of clinical practitioners together and present a specific case to them, each will look at it from a different point of view.
I am entirely capable of distinguishing between major depression and MDP disorder, where the symptoms areclassic. The current problem is related to the fact that cases of co-morbidity are increasingly frequent. People present with a depression problem accompanied by behavioural, alcoholism and, in some instances, substance abuse problems. In those cases, a diagnosis is not easy to determine. However, psychiatry as a whole should not be criticized as a result.
There are highly effective diagnostic tools that have been validated in the United States, Canada and Europe. Consider, in particular, the depression scales, anxiety tests, the validated scales for post-traumatic stress disorder and acute stress. The juxtaposition of these scales with clinical assessments achieves effective results.
So you have to beware not to make a hasty judgment. The DSM-IV classification produces excellent diagnoses. However, there are a number of good diagnostic instruments. We did not talk at all today about co-morbidity, despite the fact that increasing numbers of people in the workplace are suffering from a number of problems at the same time. These cases call for a different way of working and a specific assessment method.
Mr. Corbière: I entirely agree with the remarks of Ms. Raymond and Professor Dos Santos Soares. The DSM-IV is wrongly considered as a bible. At the conceptual level,DSM-IV's categories are very distinct, whereas, in my view, they are in fact part of a continuum.
In addition, in hospital emergency departments, they only take five minutes to reach a diagnosis. How can you reach a diagnosis in five minutes? And that person will bear that diagnosis for life.
There are a number of diagnostic tools. However, those tools take 45 minutes or an hour to use. So there is not enough time to use these diagnostic tools to get a clear idea of the person's behaviour, attitude and problem. So action has to be taken in this area.
We also talked about assessment needs for intervention purposes. I think you have to use the right tools and not reach a diagnosis in five minutes.
[English]
Mr. Gilbert: I appreciate the debate about DSM, but like MS Windows, it is an imperfect instrument and we are stuck with it until the game changes. That might not happen until DSM-V comes along. I discovered when I presented at a conference in Holland that Europe uses ICD-IX or ICD-X versions. We talked at that conference about how much depression there was in the workplace there. They said there was very little, which surprised me. They also said that the numbers of neurotic disorders are extremely high, but they are in a different diagnostic category. In Europe, they use the classification of depression to mean, for the most part, major depression that might include psychosis. The language is absolutely critical to determining qualification for disability, and so we have to learn from it.
My final comment is that DSM, for the most part, focuses on symptoms. Our discussion should be on function, which has different dimensions. In my opinion, DSM is poor at describing functioning. Axis V is supposed to look at global assessment functioning, and it is highly subjective and loose. Disability and getting along in the workplace have to do with how well you function and not whether you are unhappy. Many people are unhappy at work. The functional aspects of the psychiatric disorder make it or break it.
[Translation]
Ms. Dagenais: The co-morbidity factor is very important. In my analyses, I found that, if the risk factor and lack of flexibility were considered, there was just as much psychological distress, anxiety and somatic disorders. Some people suffer from sleep disorders, for example. Consequently, three types of psychological damage are caused solely by the lack of flexibility that makes people feel stuck.
It is quite rare to see a risk factor cause only one health problem. Each risk factor generally leads to one or two situations in which health is undermined. The notion of co-morbidity is thus an important factor.
In addition, we talked earlier about suicide. Suicide has always existed. Emile Durkheim wrote a chapter on this subject that was a standout in the field of sociology. Society today medicalizes psychological health problems to a great extent. Children take Ritalin, and the teachers who teach them take Prozac. In short, every generation has its problems with the use of drugs and, eventually, psychotropic substances.
One work that has just appeared is entitled Société sous influence. Suicide is violence against oneself. Harassment, violence in the workplace and every other aggressive attitude constitute violence against others. These indicators show us that we are living in a society that has problems that need to be solved.
Ways have to be found to resolve this tension that causes people to attack themselves, through suicide, or to attack others. The tension in the workplace is too high.
[English]
It seems like a war, and it is not good for the evolution of our society.
[Translation]
We have to be aware of this fact.
[English]
The Chairman: I want to thank the witnesses for appearing here to help the committee in its deliberations. To our guests from Quebec, if any of you happen to be talking to Minister Couillard, please tell him that the mental health plan put forward four to six weeks ago is a terrific document. Many of the ideas in the document will be in the report of this committee. Compared to what most provinces have put out, his document is in a different league and is quite superb.
The dilemma the committee now faces is how to develop recommendations for such a broad field. I would ask that over the next week or so, the witnesses send to the clerk of the committee three to five major questions on which research is needed. There is some benefit in the committee recommending a research agenda in its report, especially given the discussion on how to identify eligibility for disability plans and the amount of money spent on other research such as on cancer.
The committee adjourned.