Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 29 - Evidence - December 10, 2012
OTTAWA, Monday, December 10, 2012
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 3 p.m. to examine Bill C- 300, An Act respecting a Federal Framework for Suicide Prevention.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
My name is Kelvin Ogilvie, a senator from Nova Scotia and chair of the committee. I will ask my colleagues to introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton, senator from Toronto and deputy chair of the committee.
Senator Cordy: Jane Cordy, a senator from Nova Scotia.
Senator Duffy: Mike Duffy, a senator from Prince Edward Island.
[Translation]
Senator Maltais: Senator Ghislain Maltais, from Quebec City.
[English]
Senator Seth: Asha Seth, Toronto, Ontario.
Senator Enverga: Tobias Enverga, a senator from Ontario.
Senator Martin: Yonah Martin, from British Columbia.
Senator Seidman: Judith Seidman, from Montreal, Quebec.
The Chair: Thank you, colleagues. We have three sessions today. Is it agreed that the second session will start not later than 4 p.m. and the third session not later than 5 p.m.?
Hon. Senators: Agreed.
The Chair: Thank you. We will get our first session under way. We are pleased to welcome the sponsor of this bill in the House, Mr. Harold Albrecht. With him are two officials. We have Marla Israel, Acting Director General, Centre for Health Promotion, Public Health Agency of Canada, and we have Kathy Langlois, Assistant Deputy Minister, First Nations and Inuit Health Branch of Health Canada.
Harold Albrecht, Member of Parliament for Kitchener-Conestoga, sponsor of the bill: Thank you Mr. Chair. I will start by staying that I am not used to sitting on this side of the table, so I hope that you will treat me gently. Thank you for your warm welcome. I would like to thank Senator Ataullahjan for sponsoring this bill in the Senate.
I would like to begin by briefly describing the journey that led me to Bill C-300. In March 2008, a young woman from Brampton was suffering from postpartum mood disorder and insomnia. A student here in Ottawa, she felt isolated and sought help online. Instead, she found a predator. Instead of comfort, she was encouraged to hang herself in front of a webcam. Instead of finding a friend who would encourage her to get help, she found a predator who entered into a suicide pact with her, a pact she completed four years ago this month. It turned out that the young woman with whom she thought she was communicating was, in reality, a middle-aged male nurse from Minnesota who posed under an online pseudonym and was linked to numerous other suicides in several countries.
It seemed that the digital nature of the crime was impeding prosecution. When I met her family, I quickly understood their pain, how that pain was extended every day and how they were denied closure. That led me to introduce Motion M-388, which called on the government to address, in the Criminal Code, the barriers that law enforcement agencies faced in her case. That motion passed unanimously in the House of Commons in November 2008.
Through discussions on Motion M-388, I met many people working on the front lines who tried their best to educate me on these issues. I met many Canadians affected by suicide who shared their pain with me, and I started to pay attention in a different way.
Obituaries for young Canadians that did not list the cause of death stood out to me like never before. Then, one day, I looked at my BlackBerry to find an email with news that, in the space of just one week, three students from Waterloo region schools had died by suicide in unrelated incidents. If there is one single occurrence to which I would attribute my introducing Bill C-300, it would be that conversation.
I have learned so much about suicide, its causes and prevention methods through this time. I would like to focus now on what we do not know. It is estimated that, on average, 10 Canadians die by suicide each and every day. That number, in and of itself, is terrifying, but we do not know how accurate it is. We know that the stigma surrounding suicide causes under-reporting, but we do not know how severely or in which communities the under-reporting is most severe. We know that suicide is most often preventable, as I stated in the preamble to Bill C-300, by knowledge and by care and compassion. However, we do a poor job of sharing the knowledge accumulated regarding suicide prevention. We do a poor job of sharing it with those whose care and compassion compel them to continue working to save lives.
Finally, we know that addressing this challenge will require collaboration across jurisdictional, geographical and sectoral lines and increased lines of communication between agencies. However, we also know that, between 1993 and the most recent election, only one piece of legislation related to suicide prevention was introduced, and that bill never reached second reading. This is a national issue, and we struggle to define the appropriate federal role.
I was pleased to see that you also have legitimate experts appearing. I am not an expert in this field, only an advocate for the experts, the volunteers and the counsellors working on the front lines. I remain grateful for this opportunity and for the work that you do. It is my hope that, through the timely passage of Bill C-300 into law, hope will be given to the many prevention and recovery groups already doing great work on shoestring budgets. We can increase their knowledge, expand the awareness of suicide as a public health issue, define and promote best practices and finally begin to collect accurate data and statistics.
The statistics that we have are understated, yet overwhelming nonetheless. There are, on average, more than 4,000 deaths by suicide in Canada every year. There are 400,000 attempts. There are 20,000 hospitalizations due to suicidal behaviours and 88,000 emergency room visits. The average Canadian is seven times more likely to die by suicide than by homicide. Just last week, The Ottawa Citizen printed a story about Dennis Pharoah, who was struggling with many issues and considering death by suicide. He reached out for help to friends who got him checked into a hospital. Barely 24 hours later, he died by suicide. This story, while spectacular in some of its details, is all too common. We know that suicide is a public health issue, but we have developed no best practices to treat it as such. Teachers in a position to recognize suicidal behaviours are rarely trained to do so, and it is uncommon even for doctors and nurses to receive training in this area. We know that there exist, in our society, groups who are more vulnerable to the threat of suicide than the general population. Veterans and Aboriginal Canadians are notable. However, we struggle to develop suitable evidence-based responses.
Through good prevention initiatives, hundreds of Canadians who may be vulnerable and may find themselves temporarily in desperate circumstances will find the hope to continue, instead of making an irreversible mistake trying to solve their temporary sense of despair.
I have often quoted Margaret Somerville, who said, ``Hope is dependent on having a sense of connection to the future, even if that future is very short-term. Hope is the oxygen of the human spirit; without it our spirit dies.''
I believe that Bill C-300 will be a foundation on which to build that hope for vulnerable Canadians. Just as important, its passage will deliver a message of hope to those working on the front lines of suicide prevention.
The Chair: Thank you, Mr. Albrecht. I will open the floor up to questions, starting with Senator Eggleton.
Senator Eggleton: Mr. Albrecht, congratulations on this work. You cited many statistics and know the great need for this. You also pointed out the previous effort, Motion M-388, back in 2009. I would also add to that Bob Rae's endeavour in October of last year and the Liberal Opposition Day motion, which was passed by the house unanimously. There is a coming together of all parties in a non-partisan way to address this critical issue.
I will ask you about the bill. The final two paragraphs say that within 180 days of the coming into force, the Government of Canada must enter consultations, et cetera. Clause 4 says that within four years after coming into force and every two years thereafter the entity designated — as in clause 2(b) — must report to Canadians. It seems like a long time to wait to get that first report. Would anything happen between the consultation and the four-year period in terms of the development of this framework that might come up for public discussion at committee or in either house?
Mr. Albrecht: I thank you for the compliments on the efforts. I acknowledge that it certainly was not an isolated effort on my part. I am indebted to so many people who shared their pain with me in the aftermath of suicide. I cannot imagine the added dimension of grief that one goes through at such a time. I also acknowledge the great cross-party support as this was a non-partisan effort throughout all discussions.
As it relates to the implementation of the bill, I am aware of the need to give the government an opportunity to get it right. We want the plan in place and want it implemented. I am sure there will be dialogue prior to the four-year time frame. There will not be silence. However, it is important that we allow adequate time to do a formal report back to Parliament; so four years is what we came up with.
Senator Eggleton: Would the reporting to Canadians be done directly or through a minister? Would it be done to Parliament first?
Mr. Albrecht: My understanding is that there would be a report to Parliament.
Senator Eggleton: In the main section, clause 2(b) says ``designates the appropriate entity within the Government of Canada.'' Do you have any thoughts as to who that might be? Would that be Health Canada or the Public Health Agency or perhaps a special group or coordinating body? Do you have thoughts about that?
Mr. Albrecht: I have thoughts on it, and that is why I was careful in the bill not to create a specific mandate as to which entity it had to be. It could be Health Canada, the Mental Health Commission or an existing separate agency. You are aware, senator, that a private member's bill may not commit the government to spend additional government funds; and I was very aware of that. However, by highlighting the issue for Health Canada or the Mental Health Commission or the Public Health Agency, it is quite clear what the intent of Parliament is and that one of those agencies will implement the principles contained within the body of the bill.
Senator Eggleton: In clause 2(b) of the bill, there are many references to awareness, knowledge, disseminating information, sharing information, promoting, collaborating, defining best practices, and promoting the use of research and evidence-based practices. Do you see within that the development of specific goals and timetables with respect to prevention programs or intervention programs?
Mr. Albrecht: One suggestion I received in the drafting of the bill was that we include a percentage reduction in the number of suicides. For example, if there are 4,000 per year, let us aim for a 50 per cent reduction over a 10-year period. I resisted that suggestion in part because I am not sure that is a wise way to measure, and 2,000 is too many, so we want to work hard at reducing it. The calls we have had from many suicide prevention groups currently on the front lines in suicide prevention are from the groups that have called out most loudly for this bill — a federal framework to give them the resources and statistics they need so they are not reinventing the wheel repeatedly. When I hear such groups say that this bill will help them in their initiatives, it gives me encouragement.
I said in my statement that this is a foundation for work that needs to be built. The Public Health Agency or the Mental Health Commission or Health Canada — whoever is charged with this task — will create a framework that I hope will not be a top down mandated template that people have to use. There could be a community in northern Ontario or Nunavut that has to contextualize the available resources. We will not tell communities how to do suicide prevention. We want to give them access to tools without their having to search through multiple sources. We want a central repository of up-to-date statistics, which we are not good at, and best practices to minimize the need for reinventing that wheel.
Senator Cordy: Mr. Albrecht, thank you for the work you have done. I was part of this committee when Senator Kirby was its chair and we did our report on mental health and mental illness and addictions called Out of the Shadows. It was ultimately the reason for the Mental Health Commission being set up; and I thank you for continuing this. When we studied the issue many years ago, one province had a suicide hotline that was open between the hours of 9 a.m. and 5 p.m. That was fine if the person decided to commit suicide during daytime hours. We looked at the studies and found that certainly would not be the high time for suicide rates. Things are starting to change, and I have looked at your bill, which contains some excellent suggestions. There are some defining best practices and excellent work across the country by the provinces and territories.
You also talked about stigma, which goes along with the whole idea of mental health and mental illness. We have come a way, but we have a long way to go. If we were to get rid of the stigma for mental health and mental illness, people would get the help they need before they reached the stage of wanting to commit suicide. Thank you for this. The bill is a great idea to bring forward.
When we look at who is most likely to commit suicide, we find that it is younger people — teenagers and young adults. We all understand that. I remember being surprised when we did our study to learn that the elderly were not high on the list. However, once we did the study, I understood.
Aboriginal groups are a federal responsibility. Even without this bill, what is the government doing? You have already said that this is not your area of expertise, but perhaps departmental officials could answer the question. Aboriginals and First Nations are a federal responsibility, and we know that the numbers who commit suicide or attempt to commit suicide are extremely high.
Mr. Albrecht: I will start the answer and then gladly defer to the experts on my right. There are two things I want to comment on. First, it is critical that we have the resources in place for youth. All of us have gone through periods of discouragement and maybe even despair, but we know from life's experience that you ride those valleys and life improves again. A young person does not have that long-term perspective. It is important to help our young people to understand — to have someone come alongside and offer that hope through those challenging times.
I do not mean to be negative, but you may have noticed in my opening comments that I did not use the term ``commit suicide.'' Suicide groups working in the area of prevention are quite sensitive to the terminology. They would much prefer the term ``die by suicide.'' I was educated throughout this process as well. I had frequently used ``commit suicide'' until someone mentioned to me that ``die by suicide'' is a more accurate and compassionate way to describe it. Please understand why I say that.
Senator Cordy: It is important to learn new things every day, and I appreciate that.
Mr. Albrecht: Our government has invested large dollars in prevention efforts among our Aboriginal youth. My colleagues have more expertise on that.
Marla Israel, A/Director General, Centre for Health Promotion, Public Health Agency of Canada: I will turn to Ms. Kathy Langlois, Assistant Deputy Minister, First Nations and Inuit Health Branch. You are quite right in that some of the things we are looking at are precisely the need for better data and better information. That is a big part of the battle. Another part is the reticence of people to admit that they are suffering mental illness or living in fear, et cetera.
It is Canadians aged 40 to 59 who have the highest rate of suicide in Canada, which is perhaps surprising. I wanted to ensure the committee was aware of that. There is no doubt that among senior men, this is something we are watching closely given demographics, the age of population and why older men are trending in terms of high rates of suicide. However, I will turn to Ms. Langlois now.
Kathy Langlois, A/Assistant Deputy Minister, First Nations and Inuit Health Branch, Health Canada: Before I start, I want to clarify the statistics that Ms. Israel shared; they are the general population overall Canadian numbers. However, when drilling down to specific subpopulations, it is accurate to say that suicide and self-inflicted injuries are the leading cause of death for First Nations youth and adults up to 45 years of age. Suicide rates in regions with high proportions of Inuit residents are 11 times higher than the rest of Canada and are thought to be the highest in the world. Canada has a major issue that the government has taken very seriously. In response to these kinds of numbers, the government introduced the National Aboriginal Youth Suicide Prevention Strategy in 2005. This strategy was renewed in Budget 2010. The program is looked at every five years to ensure it continues to be relevant to the needs. We are providing approximately $15 million this year to support First Nations in over 150 communities to prevent and respond to suicide.
I could speak more about what we have learned in the period of time that we have had this program if you would like me to get into that level of detail at this time.
I want to pick up on the point about stigma. This strategy has certainly increased awareness around the issue of suicide and has led to discussions of the issue of suicide in communities, therefore dispelling the stigma. It has allowed communities to reach out to establish partnerships with surrounding communities — for example with the RCMP, local hospitals, regional health authorities and with Boys and Girls Clubs — to begin to look at the root causes in communities where we have high rates of suicide attempts.
In our 150 projects we fund annually, there are wonderful success stories. We have seen examples where high rates of suicide attempts and completions have literally been stopped in their tracks by a coalition of groups of people coming together to address the issue within communities where leadership and youth are engaged. Solutions are developed based on local realities and understanding what is needed in that context to move forward. Perhaps I will stop there.
Senator Cordy: One of the things we discovered in our study, and with the witnesses we had from First Nations, was the tremendous shortage of medical personnel for the North and for First Nations groups. Overall, that was a general category about the shortage of health care workers, but particularly related to working with those who have poor mental health. There was a shortage of psychologists and psychiatrists, and a particular shortage of people from Aboriginal communities who were able to come back and help. Is that changing?
Ms. Langlois: Yes, there is good news on than front for sure. I should have mentioned that our $15 million annual suicide prevention strategy aimed at Aboriginal youth sits within the context of about $250 million in annual spending focused on mental health and addictions. A program that has contributed to the increase of Aboriginal workers in this area is the Indian Residential Schools Resolution Health Support Program. We are supporting access to professional counselling, but also to emotional support. Aboriginal people who have been through the healing path of the residential school experience now work in communities helping others to heal. This has led to a significant increase of Aboriginal mental health workers, many of whom who speak traditional languages, working in communities to help people with the effects of residential schools.
Senator Cordy: Are you suggesting peer counselling?
Ms. Langlois: Yes, but some of the workers have professional or paraprofessional types of designations — family therapists, et cetera — and are able to provide a higher level of support as well.
Senator Cordy: Are there incentives to encourage people to go into the medical field?
Ms. Langlois: Yes. I do not have all the details here, but the government has introduced an Aboriginal Health Human Resources Initiative that provides scholarships and bursaries through Indspire, which is the new name for the National Aboriginal Achievement Foundation. We have had a significant number of scholarships and bursaries to bring Aboriginal people into the health workforce since 2005.
Senator Martin: Congratulations on this very important initiative. I want to follow on what my colleagues have said. My question relates to the federal framework that is articulated in all of the different responsibilities of the entity and how this may be executed. We have such regional differences, and statistics show that there are higher rates in some regions, and it ranges and differs depending on the at-risk groups.
I am curious about how the regional differences will be considered and captured in the design of this federal framework and the types of conversations that have taken place. Could you give us maybe a few key points on that?
Mr. Albrecht: I am not qualified to comment on the differences or how the agencies would address them. I want to go back to what I said earlier. The federal framework will provide the repository of best practices and statistics, and it will be up to the individual jurisdictions to develop a contextualized approach to suicide prevention that best suits their area.
As I said in my opening remarks, the Waterloo Region Suicide Prevention Council has a model that works for that region, but whether that could be replicated by other parts of country is open to question. If those ideas were centrally located so that groups in Manitoba, British Columbia or Nunavut could access them, there would be a good chance to contextualize, take the modules from the framework and implement them. It is possible that the group charged with creating the framework would come up with regional issues to help more specifically. I do not want to go down that road and speculate on what the framework will look like. I hope that is helpful.
Senator Martin: It is. Thank you.
The Chair: Senator Eggleton has a clarification.
Senator Eggleton: I actually have a couple more questions.
Ms. Langlois, you mentioned the National Aboriginal Youth Suicide Prevention Strategy. I believe it started in 2005 and was renewed in 2010, but still we see that suicide is the leading cause of death amongst young Aboriginals. What has this program accomplished? What can you tell us about what it has done?
Ms. Langlois: I think that is a very important question, and there are a couple of things at play here. Number one is the state of our data. The data we are using tends to be fairly old, and we are doing a lot of work to try to get much more relevant data. For example, we are hoping to drill down into that data from the First Nations Regional Longitudinal Health Survey for 2008-10 to get more relevant statistics.
I am giving you very old data when I give those numbers. The data actually predates the introduction of your suicide prevention strategy, but it is the best data we have. Some of the challenges we have in the Aboriginal context are that some provinces and territories do not have Aboriginal identifiers. The one province that does is British Columbia. We are challenged in getting statistics for Aboriginal identifiers, so we have work to do in figuring out high populations where Inuit or Aboriginals are residents. This is a new strategy we are using, and hopefully we will get new data soon to be able to track what the impact has been.
Second, I want to comment that addressing suicide is something that, while you can see immediate impacts in a community to stop attempts and completions in an immediate way, in terms of national statistics, they gloss over hot spots where perhaps the rate is not four times the mainstream population; it might be 20 or 50 times. You can deal with those. However, on a grand scale, to bring that rate down will take sustained effort over a long period of time to address the conditions, building those protective factors that are needed in communities, so that youth feel that they have self-esteem, feel engaged and have a plan for their future as opposed to many of the precipitating factors for suicide being in existence in communities.
You have to work at both. These are things that take a longer time. We are in this for the long haul.
Senator Eggleton: I am surprised that the federal government, as it has prime responsibility for Aboriginal people, would not have a better handle on the statistical analysis of the situation.
Can you give me any anecdotal information as to any evidence that this money, the $65-million five-year strategy that started in 2005 and now is $75 million over five years, is paying dividends for the money that is put into it?
Ms. Langlois: We are working at increasing protective factors, which are things like resilience of children, problem- solving skills and reducing risk factors like substance abuse, criminal justice encounters and breakdown of cultural values. When I talk about these 150 community-based suicide prevention projects, some of them are reporting local impacts around decreasing youth delinquency. Therefore, as a result of these 150 projects, there is decreased youth involvement with the law, decreased use of substances, increase in youth participation in school and community and improvements in youth leadership skills. We also see the capacity for mental health workers, as I have discussed, to detect, prevent and intervene in cases where suicides might be in the offing. For example, there is higher recognition of suicidal behaviour in communities now. Communities are talking about having to work on their protective factors and address the risk factors, which is not a conversation that we have had previously. It is interesting to see communities talking about it in this way.
We have also seen increased crisis response protocols in communities by communities reaching out to other jurisdictions. For example, engaging the RCMP to engage with youth to provide positive role models and beginning to move forward in that way. We do see the improvements in the protective factors and a reduction in the risk factors in very challenging circumstances, as I am sure you can appreciate.
Senator Eggleton: Has there been any independent evaluation of the program to this point?
Ms. Langlois: The program is subject to an evaluation and has been part of one where we have recently had an evaluation completed. Basically, it is an evaluation saying things like the program is relevant to the needs of the community; it is highly valued by the communities; and they are increasingly participating in them.
Senator Eggleton: Is that available? Can we get a copy?
Ms. Langlois: All the evaluations are ultimately posted online, along with the management response and action plan.
Senator Eggleton: Perhaps you can provide a copy to the clerk.
Ms. Langlois: I will provide you with a copy when it is public.
Senator Eggleton: Mr. Albrecht, a few moments ago you referred to a depository of information, and you said that programs on suicide prevention would be worked out on a community level. This is more of an information gathering and dissemination than a national strategy on prevention.
Mr. Albrecht: To answer the question, I think the strategy would come from the group charged with that responsibility. I think the key part of that strategy would involve having good statistics and best practices available to be shared across the country.
Senator Eggleton: What would you see as the ongoing federal role in this?
Mr. Albrecht: The one that you just mentioned, the updating of statistics on a regular basis and re-evaluating the actual success of the best practices as they are defined.
Senator Eggleton: Thank you.
The Chair: Mr. Albrecht, in fact, listening to the last interventions and the response particularly to Senator Eggleton's questions suggests, again, the reason for your bill in terms of taking the information that is being developed and putting it together in an overall strategy.
As well, I think we are anxious to hear from the very groups you indicated that we want to hear from today. Thanks to our questioning here, I think, we, as a committee, would like to now hear from those particular groups.
Mr. Albrecht: May I make a few more comments?
The Chair: Yes, go ahead.
Mr. Albrecht: I referenced briefly in my opening remarks that it is a public health issue, and we need to recognize that this is a problem all of us have ownership of. Government will never solve this problem. Each of us has the responsibility of being aware of our co-workers and their challenges and struggles and being open to listening and offering to find the help that they need, if we are not in a position to give that help. Whether it is coaches coaching minor hockey or minor ball, or whether it is teachers and co-workers, they are people that could be better trained to recognize the warning signals.
Finally, there are three topics that twigged my interest over the last number of months as I studied this. The first is the importance of having the conversation. I think the fact that we are actually having this conversation is almost as important as the legislation itself — having people be willing to talk about it.
I attended a seminar at which Dr. David Goldbloom spoke, and he made an interesting comment on mental health. He said one of the best protective factors for improving mental health is for families to have a meal together. I thought what a simple solution, not that it will solve all the problems, but it is a part that is maybe too often overlooked.
Finally, we should not overlook the spiritual dimension of suicide prevention. Too often we look at the psychological, social or biological factors, but, to our peril, we ignore the spiritual dimension, and I want to encourage us not to ignore that.
The Chair: Thank you. Ms. Israel, would you like to take us through the highlights of the document that you provided to us?
Ms. Israel: I recognize others are here and will provide their perspectives, but perhaps I can talk about a couple of things.
One of the things I think are important is that despite understanding who is at risk — there are those in society who are at higher risk for suicide — there is at the same time insufficient understanding of why certain people with those risk factors may be at higher risk to commit suicide and, in fact, even how these risk factors may fit together.
Among the encouraging things that have taken place in recent years is the creation of the Mental Health Commission. That has provided a focal point for bringing greater discussion to bear on some of these issues.
At the Public Health Agency of Canada, we understand, as Ms. Langlois has said, that one of the most important things is building resilience and the importance of relationships. I cannot overemphasize that enough.
We have about $27 million that the agency is investing now in nine mental health projects and suicide prevention projects across the country. There are 250 communities involved now. What I love about those projects is that we are learning from the community what works, for whom and under what conditions.
[Translation]
In French, I would add that the innovation strategy for funding is helping to create and strengthen community partnerships and enhance the knowledge and skills of children, adolescents and parents. It is beginning to influence current practices in a number of jurisdictions.
[English]
For the Public Health Agency of Canada, there is a core to our work: the importance of surveillance, the importance of data, that we work within provinces and other jurisdictions at what works, that we do not reinvent wheels and that we take whatever aspects of the IT age and ensure that we are working on knowledge dissemination. Regardless of where you are, whether you are a public health professional, a teacher or a community worker, you understand that you have a role to play in understanding how important it is to communicate, to talk, not to be fearful and not to be scared. This is the core to the work of the Public Health Agency of Canada.
The Chair: Thank you all very much. I am sure you will be interested in the next witnesses to appear before us. Of course, Mr. Albrecht, we invite you to stay around, if you can.
I welcome our next witnesses, whom I will identify as I invite them to present. I will start with Alisa Simon, Vice President, Counselling Services and Program, Kids Help Phone. Would you please make your presentation.
Alisa Simon, Vice President, Counselling Services and Program, Kids Help Phone: Hello. I am with Kids Help Phone. I am pleased today to present in support of Bill C-300. I will not read the remarks I gave you because I do not have enough time, so I will just try to hit on some highlights.
For those of you who do not know, since 1989, Kids Help Phone has been Canada's only national phone counselling service for young people, supporting their mental health and well-being. We have three ways to reach a professional counsellor: via phone; an online web posting service, where a young person receives a personalized response from a counsellor; and just this year via live chat, which is an IM instant message chat with a counsellor.
Since our inception, we have provided our services to millions of young people 24 hours a day, seven days a week, 365 days a year, from urban, rural and remote communities, from every walk of life and in both official languages. Our professional counsellors are there when other services and supports are not there, when young people are between appointments, when services are not available where they live or when they are just too scared to reach out for help. We hear from kids every day who are experiencing the loneliness of depression, the paralyzing fear of anxiety, who are feeling the pressure to succeed and to compete, and all too often we hear from kids directly who have lost all hope and who are considering self-harm or suicide.
In 2011, young people reached out to our professional counsellors 5,000 times a week, and approximately 20 per cent of those contacts were related to mental health or drug and alcohol use or abuse, and 5 per cent were directly related to suicide.
We make the submission in part today because we want to provide the standing committee with the real words of young people. One thing I think is critical in any discussion that relates to the health and well-being of young people is to have their voices and experiences heard, so I am here to try to help do that today.
I have given you some examples of posts that young people have submitted to us, in their own words, about what is happening in their lives. From a male, aged 14: ``I wonder why I'm even alive `cause I know I won't be successful or do anything good.''
From a female, aged 13:
I've been having alot of strong suicidal feelings recently. i dont know why . . . my grandpas in the hospital . . . i just dont know what to do . . . the only thing keeping me alive right now is that my friends would be really sad if I committed suicide. even so, sometimes i forget about them and i just feel like killing myself. I've attempted suicide twice. Once overdosing on tylenol, which didn't work and again trying to strangle myself. I still have bruises from that. I need help. I dont want to die.''
There are many more examples of posts in the information that you have from boys and girls around Canada who are telling us that they are desperate for help and support.
I want to talk a bit about what we believe are some of the ways we can make inroads on this issue. One is we need to address the gap in young people's understanding of mental health. We have seen in recent years that young people who call us or contact us in another way are increasingly using the language of mental health and illness and mental ill- health and disorder in part because of important work being done around increasing mental health literacy and awareness.
However, unfortunately, we are finding — and we did a survey in 2010 with 1,400 responses from kids around Canada — that while a large number of them understood mental health and a lot of words and concepts used, half of them said they would not seek help because they did not want to feel socially rejected or misunderstood, they had a fear of being a burden, they did not want their concerns minimized and they felt they could not trust the people around them.
We have to be committed to reducing stigma related to mental health, but we also have to be committed to reducing stigma related to help-seeking and to helping young people identify both the internal and the external resources and supports available to them and to demystify the formal help-seeking that we know so many young people need.
In my submission, I get into the importance of hope. I think it is very important, but I will leave it to you to read.
I will now talk about a few things we think are critical in continuing to look at this issue. One is the importance of providing anonymity and confidentiality to young people. Kids Help Phone has been able to demonstrate that the primary reason young people contact us — in fact, 75 per cent of youth who were part of an evaluation of our live chat service — 75 per cent said the reason they contacted us was because they knew that it was safe because it was anonymous and confidential. In fact, young people are telling us through live chat that it feels more anonymous because even their voice cannot be heard, so we are seeing the number of young people turning to us for suicide-related concerns as well as for serious self-harm and mental health concerns going up. We have more contacts related to those issues through live chat than through our phone.
Another thing that is really important to understand is around the fact that there are multiple perspectives, that Canada is home to a diverse community of people from different social strata and cultural, racial and ethnic backgrounds, and some of these groups may hold different understandings of self-harm, suicide, grief and loss and may have their own traditions and beliefs about how to build a protective community, as well as methods in prevention and response to tragic losses. We have to listen to this myriad of ideas, thoughts and social identities.
We also have to understand that suicide and self-harm are complex issues that are difficult to talk about in five minutes and that affect personal relationships, individual and community health, and societies. We must also realize that only through consultative and collaborative efforts will we be able to give a voice to young people, parents, community organizations and governments and really have lasting change.
We also know that young people are at a loss for what to do. A wide spectrum of behaviours comes under this umbrella of suicide. We have self-injurious suicide behaviour, suicidal ideation. Many different things must be addressed if we are to develop a strategy that will support young people in Canada.
As I said earlier, they have to have a voice. The research has shown that no one has their finger on the pulse better in terms what they need than young people themselves, but young people also need adult allies, and so effective policy has to be grounded in the recognition that young people are the experts in their own lives and that adult allies are there to provide the tools, structures and resources needed to accomplish change.
Another piece of information that Kids Help Phone would like to put on the table in this discussion is that social inequity is important to recognize when talking about this. We know that different forms of oppression, racism, homophobia and sexism create a qualitatively different experience for young people in Canada. While some suicide prevention strategies can be overarching, it is also important to ensure that with different experiences come potentially different needs and methods to address these needs.
Globally, suicide is highest among low-income people in developed countries, and as we talked about earlier, in Canada, suicide is nine times higher among First Nations youth than among non-First Nations youth, and LGBTQ young people are at greater risk. We just finished an evaluation of our phone service at Kids Help Phone and found that 10 per cent of our calls are from First Nations, Aboriginal or Metis-identified young people. LGBTQ youth made up 16 per cent of our calls, which was tremendous to us. We did not know, because we are anonymous and confidential, that those were the types of numbers we were getting from those particular populations. However, we need to recognize that a national strategy must represent the needs and voices of these special populations, in addition to low-income young people, people of colour and others.
Another piece I want to touch on is the important role that the press plays in either suicide prevention or promotion. There was an article in The Globe and Mail this week talking about this. As suicide continues to affect people across the country, it is admirable that the media is addressing the topic; however, in their zeal to raise awareness, the media often misses the fact that extensive, graphic and emphatic coverage of suicide is counterproductive because young people read this. In the aftermath of the suicide of Amanda Todd in British Columbia, Kids Help Phone has received quite a few calls from young people who have stated that they are considering suicide because they know that is the way you make bullying stop. We have to get the media to understand that there is one reporting method that has been shown to have a dramatic and immediate reductive effect on suicide, and there is information in my submission about it.
In Austria they engaged in safe reporting, and within five years of implementing the guidelines, the number of Austrians who died by suicide dropped significantly.
Finally, I want to also talk about the fact that cross-disciplinary collaboration is needed. We need to get people together, as I said, young people and adult allies; but we also need people from prevention, from public health, mental health experts, educators to come together so we can provide a continuum of care that really wraps around the needs of young people in Canada. We do not want to continue to provide treatment in silos and to put suicide off as one problem that we have to deal with as opposed to all of the supports that young people in Canada really need.
In conclusion, Kids Help Phone is pleased that the Senate is looking to develop a national suicide strategy. We recognize that any strategy moving forward to address suicide must be premised upon the experiences and realities of young people. We are committed to supporting the future development and implementation of national strategies, policies and programs through our access to young people and their lived experiences, and we hope that a national strategy will take into account the importance of developing new services and supports for young people and their families while also supporting those services that already exist and that have research to demonstrate that they are having an impact.
Every day we help young people learn that when they feel helpless and hopeless they have to reach out, that there are places where they will be accepted for who they are, no matter what their issue is or their state of mind. It is the responsibility of all of us as adults to ensure that every young person in Canada has a safe place to turn for help. Thank you.
The Chair: Thank you very much. I will now turn to Mr. Upshall, National Executive Director, of Mood Disorders Society of Canada, please.
Philip Upshall, National Executive Director, Mood Disorders Society of Canada: Thank you, honourable senators for the opportunity to speak with you, although much more briefly than I had anticipated when I saw the full hour allocated to me, but I will try to keep it as short as I can.
I have had the privilege of appearing before this committee in its various configurations since the days of Senator Kirby and Senator LeBreton. It is a pleasure to see Senator Cordy here, one of the last remainders, I guess, of the early days. It has been a real treat to have the opportunity to see how this committee has managed to bring to the attention of the Canadian public the issue of mental health and mental illness. It is wonderful that you are taking the time today as well.
I wear many hats. I am a survivor of suicide myself. I am the executive director of the Mood Disorders Society of Canada. I am the special adviser to the CEO of the Mental Health Commission of Canada. I am an adjunct professor at Dalhousie University in the psychiatry department, although they will not let me do any operations. I have been the executive director of the Canadian Alliance on Mental Illness and Mental Health, I and managed Mental Health Awareness Week, and I have also had the opportunity to manage the Canadian Collaborative Mental Health Initiative, a primary health care transition fund activity that allowed us to redo the primary health care system in a way that permitted us to use psychiatric services much more effectively.
I have had the privilege, finally, of working with Kathy Langlois and the FNIHB group very closely through our jointly funded Building Bridges activities with our Aboriginal partners.
I will not get into the statistics; I have a little more to say. I apologize for not providing anything in writing, but I had the chance to spend my time this weekend with my grandchildren, and while you guys are really important, they are too.
My friend, when I first started to understand suicide, had committed suicide by cancer. He wrote a set of poems under the title The Hanging Tree. It will take me one minute to read this. He says:
Outside of Port Arthur there was a famous tree called The Last Stop because that's where the Finns hanged themselves. It seems that almost every week someone was hanging there from his neck. They were considerate, you know. If somebody was missing, you knew where to look for them first. It was much more difficult to go to the forest and find the pieces of those who had shot themselves. Wild animals often got there first. But when you know one is hanging from a tree branch, this isn't such a problem. Life was so rough — unemployment, hunger, churning in the stomach, lonely men, not even enough money to go home. You can see why they would choose to kill themselves. When you are a foreigner, your life isn't worth a damn and soon you start to believe it too.
The sentiments that are expressed by my departed friend are all too frequently expressed to me through my various roles, and particularly through Mood Disorders Society of Canada.
When I first came to Ottawa to start advocacy on behalf of mental illness, I was surprised to learn that mental illness issues and generally mental health issues were not considered to be part of the federal responsibility. Ministers Rock and McLellan at the time suggested that I retreat to the provinces and that the provinces were responsible for delivering mental health services, particularly for people with mental illnesses, and that under the Canada Health Act, which if I could read I would understand, would be everything.
I did read it and I disagreed with them. Over time, the federal government came to agree that mental illnesses required the attention of the federal government. As a result, with the help of Senator Kirby and others, and with the help of a woman by the name of Dr. Paula Stewart, who happened to be with the chronic disease surveillance branch of Health Canada, we started to pull statistics together. Dr. Stewart and I wrote, along with a large group of advisers, A Report on Mental Illness in Canada.
As we moved through that document and the preparation of the data that was contained in it — it was the first compilation of data that was undertaken at the federal level — we got a number of communications from Health Canadian saying that this will not be a Health Canada document. They said we were on our own with this. We ended up preparing it through the surveillance department, but I ended up selling the advertising on the back of the report on mental illness in order to get 10,000 of these reports published.
In 2006 this document was redone by our group, and at that time it became an official Health Canada document and Minister Clement kindly gave us a letter of support.
I am getting signals that I should put my mind to Bill C-300.
The Chair: In the few minutes that remain.
Mr. Upshall: The Mood Disorder Society of Canada and everyone I talk to support the intent of Bill C-300. It is wonderful to see the unanimous collaboration of the Senate and the House of Commons in such a marvellous undertaking.
Because the bill will not be a funded bill, we understand we will have the opportunity to discuss with the federal government and Health Canada in future time how this process works out. Our concern is that we not develop any more silos. Our concern is that suicide is certainly a very important topic and there should be a strategy associated with the undertaking of its reduction. However, that strategy, we feel, should be part of our attack on mental illnesses generally, particularly given the fact that the majority of suicides are related to depression.
We acknowledge that suicide is preventable by knowledge, care and compassion, but we also know that the person with suicidal ideation needs to have hope. Mr. Albrecht mentioned that, as have others. We think that is an essential element of any attempt to reduce the number of suicides.
We also really need to advocate for better access to primary health care services for people with mental health problems, generally, and who may be thinking of suicide. Access is incredibly difficult, and if you have issues at the emergency ward, the wait time for people showing up with mental illnesses are compounded by the triaging process that the Canadian Association of Emergency Physicians has developed. We ask you to consider that.
One key thing for the Mood Disorders Society of Canada is the fact that peer support is absolutely, in our view, on the same level as medication and psychological assistance. Peer support is mentioned time and time again as the thing that brings people back from the edge. Peer support is something spoken about in Fred Doucette's book, Empty Casing, who is of the army. Colonel Stéphane Grenier, whom many of you know from the Canadian Armed Forces and PTSD issues, talks about peer support as the thing that saved him as well.
We are happy with the bill and we will support it. I am happy to answer questions because I know I am over time. I would like to reinforce the fact that there must be collaboration here.
To add one more thing, the federal government in its last budget committed $5 million to the development of the Canadian Depression Research and Intervention Network. That $5 million is being managed through the Mood Disorders Society of Canada. The instruction given by the federal government was to structure, with the help of Canada's mental health researchers, of whom we now have over 140 enlisted, and develop a depression research network to focus on suicide and PTSD.
We are doing and finishing up the Health Canada contribution agreements now. We will be moving into an active phase early in the New Year. Coincident with that we will be working with the CMA to develop a continuing medical education program for doctors on PTSD, which follows the one we have done on stigma and mental illness.
I want to point out that Minister Aglukkaq, in her comments about the structuring of the Canadian depression initiative network, said the $5-million investment was to develop a national network of patient-focused depression research and intervention centres. The issue now is patient-centredness: putting the patient at the forefront, the person whose issues are most impacted by research, and allowing them to be engaged in the process at the very beginning.
Senator Eggleton: Thank you for being here. Both of you have used the phrase ``national strategy.'' This document is called a ``framework,'' so I am not sure whether your thoughts about what a national strategy should be would necessarily be covered by the bill. We applaud, as you do, the intent of Mr. Albrecht and this bill. However, there may be a question of whether it goes far enough.
What would you like to see as a federal role in terms of suicide prevention?
Ms. Simon: That is a very good question. A few things come to mind. As I said in my remarks, I think there needs to be a bringing together of all of the different parties, including young people. That is the perspective that I am speaking from. Too often, whether it is the federal or provincial government, we make rules and strategies and laws that impact the lives of young people without bringing them to the table to find out what will actually be effective.
We certainly need much better and more up-to-date statistics to understand what is happening if we have to rely on data that is as old as we are. That is a challenge to being able to see whether or not any of the things we are working on actually have an impact if we have to wait five or ten years to get good data.
The reality is there is not enough funding now for mental health services and supports. It is always one of these interesting things when you talk about young people, particularly in adolescence. One of the characteristics of that age group is that they do not have a lot of patience. However, we ask young people, who are sometimes in serious distress, to wait often months and months to get in to see someone about a mental health challenge they are having. In the meantime, what often ends up happening is that challenge escalates. We do not have enough services or supports that can help support young people before they are even in need of a traditional mental health service. All of those things need additional resources from the federal government.
From a Kids Help Phone perspective, I would say the services currently available need more services and supports. We are working in a model now where everybody in Canada would like to put our name on every piece of outreach material they could and get us into every school. We would like that as well, but we also have to be sure that we will able to answer that call within 40 seconds, that we will be able to get back to the young person who sends a web post within 72 hours. That takes support.
When we look at agencies like Kids Help Phone, where government support is less than 10 per cent, there is a role for the federal government to support us and others that are doing work where evaluation has shown we are providing real service and are having an impact.
Mr. Upshall: ``Strategy,'' for us, at the federal level would be a useful word to use. We probably look at it as a strategy that would supplement the mental health strategy that the Mental Health Commission recently announced and that included discussions about suicide.
The strategies we like to see at the federal level are ones that collaborate with the provinces and local and regional communities, particularly with regard to suicide, and doing the work that the federal level does best, which is developing data sets, bringing people together, determining best practices, and knowledge translation. What is shocking is that there is so much really good stuff going on in Nova Scotia, in the Yukon and in British Columbia, and we do not get that information passed back and forth well enough, if at all.
We need to develop that kind of knowledge exchange capacity, and I think that is part of the strategy. The federal government is moving forward. As you know, Statistics Canada has the mental health survey out now. New data sources are coming forward as we speak.
Senator Eggleton: On this question of developing strategies, the United Nations, in 1996, provided some guidelines on this. Do you have any thoughts on how instructive those guidelines could be in developing whatever plans come under this bill?
Mr. Upshall: I just finished talking to Dr. Michelle Funk, the head of the World Health Organization's mental health side of things. They have developed a mental health strategy as well. They have just gone through the second draft. They have done some other very good stuff on mental health disabilities.
The problem is always the same: The ideas and the philosophy are wonderful, but if you are not going to fund it or give people the tools they need to move a strategy forward, you might as well not do a strategy. Her own department, which used to have 12 people, as of January will be down to her, and she is struggling to find money.
The United Nations and the World Health Organization are wonderful places. If you are looking for other sources, the National Mental Health Commission of Australia recently released its report card on the mental health strategy and suicide prevention. They linked the mental health strategy and suicide prevention together. I have just made copies of the report, which I will leave with the clerk. It is an eye-opener as well, and a lot of it has to do with opening up the discussion and funding the right activities.
Senator Eggleton: We can learn a lot from other countries, then?
Mr. Upshall: Yes, particularly from Australia. We can learn a lot from British Columbia, too, in terms of its suicide prevention strategy.
Senator Eggleton: Does Ms. Simon have some comments?
Ms. Simon: I would echo looking to Australia as a place that is really doing some incredible work related to suicide and to mental health. We visited Australia about a year and a half ago, related to some of our mental health supports we offer at Kids Help Phone, and they are ahead of us in many ways in relation to this work.
Senator Eggleton: Let me ask one more question about something that gets talked about a fair bit, although we have not talked about it in this context, and that is the social determinants of health. For example, home anchors a person; it gives them an opportunity to be able to get on with life, either in the workforce or at school or whatever. There are other conditions of isolation and poverty. All these things can lead to greater depression and distress, which of course can then lead to suicide.
Should the social determinants of health be a part of whatever framework or strategy is developed here?
Ms. Simon: I would say that you can never ignore the social determinants of health, and we do that at our own peril. If we want to develop a framework or strategy that will be meaningful and where we will see an impact, then we have to take into account the social determinants of health. I talked about this in my presentation, that people come with qualitatively different experiences, and it is important to recognize those, whether it is because of poverty, ethnic identity or gender identity. We have to recognize those, because it is only by recognizing those that we can start to have an impact in developing prevention and post-prevention strategies that will be meaningful.
Mr. Upshall: I would agree. The problem with bringing the determinants of health into the discussion is cost. The determinants of health should be there. However, if you quantify them and say we need billions of dollars for a program, it puts us so far beyond the ability of government to move quickly, or move at all, that we exclude ourselves from the discussion. If I could find a way to advocate for mental illness treatments and access, and include the issues of lack of a home, lack of a job, and lack of hope, and if I could quantify it, I would. However, quite frankly, I have to stay within the parameters of what is doable.
James Bartleman, the former Aboriginal Lieutenant-Governor of Ontario, spoke eloquently about the fact that he grew up beside what took him 20 years to find out was a dump, in a large family, with two or three rooms, south of Barrie. His presentation was so powerful that I had to rethink where the priority should be in growing up.
Senator Munson: I have a few questions. One is a general question. Thank you so much for being here. I like this bill; I really do.
First, on Kids Help Phone, where are you? Whom do you reach out to? Is it across the country? The reason I ask is because we have statistics in front us that are quite startling for the difference between them. The Yukon, for example, has a suicide rate of 5.7 out of 100,000; right next door is Nunavut, with a rate of 56.9 out of 100,000; and out of men, 89.1. It is north of 60. I would like to figure out how the outreach works and why the difference between the two.
Mr. Upshall, I will give you an opportunity to think about this question. I do not want to be intrusive while Ms. Simon is answering this question, but I always believe that shared experiences are important. We have spent too much time in the shadows in many facets of life. If you would like to share, perhaps you can tell us what we can learn from you.
You mentioned in your statement that you are a survivor of suicide. What can we learn from you about how you survived? Since this is being broadcast, I think some of your insights would be invaluable as we work toward this framework together here.
Ms. Simon: In terms of outreach, there are a few different ways. I talked a lot about the direct services that we provide through our professional counsellors, how a young person can directly connect with a counsellor. We also have what we call indirect services. We have four websites, two for kids and two for teens, two in French and two in English, which have information on over 50 topics that have all been clinically vetted.
We have a knowledge mobilization department within Kids Help Phone that does all the research, looking at the best practices research happening on a topic like depression around the world and then in Canada. That, then, becomes information that goes into our knowledge mobilization system that a counsellor can access so that if they are on a call or they are live chatting with a young person, they can pull it up — and tips, how young people are talking about something. It is also then translated by a youth writer, and with youth engagement, into things on our website.
Our website last year got 5 million page views by young people across Canada. Not only do they get to read the information that, as I said, is written in age-appropriate language — so the kids' website is very different from the teen website — they can read about something like depression or self-harm.
They also can read all of the web posts we get. When a young person sends a web post to us, like the ones that I read, part of their doing that is that that will then be put back up on the website. For every person who sends a web post to us and gets an individualized response, about 50 young people come and view those. Young people will often say that before they want to call us or before they want to post themselves, they want to read what a counsellor says.
In addition, we do direct outreach to youth, mostly through schools. In 2011, we distributed materials through our youth awareness campaign to 14,000 schools and non-profit organizations in Canada. About a million wallet cards and 200,000 pamphlets were given to young people. We do it in every province. We are Canada-wide. Our counsellors are located in Montreal and Toronto, and we are open 24 hours a day to receive calls and do live chats and web posts from every province. One of the challenges is that our counsellors are physically located in two provinces, so much of our mental health outreach has been focused on those two provinces. It is difficult to get a counsellor to Yukon or to Nova Scotia.
Currently, we are piloting a new mental health outreach program over the phone with teachers and their classes in four provinces as a way to figure out how to be there for young people who are not in Ontario and Quebec where our counsellors are located. We receive contacts from across Canada. We have 90 per cent brand recognition among young people, so people know about us. However, when they have a chance to talk in a class setting with one of our counsellors, they ask questions about what it is like to call and who calls. They are more likely to feel comfortable doing that. We have developed this outreach program.
The last thing I would like to say about it is that we have decided to focus our mental health outreach specifically on the issue of seeking help. Many people do mental health literacy, which is important, but we have found that an increase in literacy without an understanding that you have to reduce stigma around help-seeking does not get us where we want. The program focuses on getting young people to recognize the resources they have around them and that if they do not have resources around them, Kids Help Phone is always a resource.
In many remote Aboriginal communities there are no resources available, so we become the place that they call. For other areas in Canada, we have the largest resource database for youth-serving programs and supports in Canada. We have 37,000 places to which we refer young people across Canada. In parts of Canada there are no resources, so the resource is: Call us back.
Senator Munson: There are no resources available for Aboriginals. I still do not understand that gap in Yukon and in Nunavut. Perhaps you and Mr. Upshall could offer some advice.
Ms. Simon: It is not that there are no resources in Aboriginal communities because it depends on the community and urban versus rural versus remote. Certainly, it is not new information that the suicide rate is much higher in remote parts of Canada and among remote Aboriginal populations in Canada than it is in other areas.
The reasons for that would take much longer to explain than the one-minute answer I could give you. It is very complex. Certainly, Kids Help Phone and other agencies that provide services and supports probably need to do a better job to ensure that we are known in rural and remote areas. When we did our phone evaluation, we were shocked to learn that only 9 per cent of our calls are coming from Aboriginal and First Nations young people. We need to do a better job of reaching out to young people that we know are most at risk and ensuring that they recognize they can contact us.
We did a project last year. We went to remote Aboriginal areas in Ontario and showed our materials to young people. We asked, ``What do you know about Kids Help Phone?'' and ``Would you call us?'' They said, ``No, this does not speak to us at all.'' We did a contest with young people in Aboriginal communities in remote Ontario. They came up with posters that they felt spoke to them. We then put those posters throughout Ontario. A grant from the Ontario government allowed us to do that. We went out and spoke directly to young people to ask what it is about Kids Help Phone or any other service that is a barrier to their making contact and what would make it easier for them to make contact. Our posters that went out are radically different from anything else we do for the rest of Canada. If we were to do that same work in Quebec, in the Yukon or in all the other provinces, we would find that the imaginary, the words and the way in which we talk about our service would need to be changed for all the different populations.
Mr. Upshall: I have two comments on the First Nations issues. Mood Disorders Society of Canada is fortunate to have as one of its directors Mr. William Mussel, Chairman of the Native Mental Health Association of Canada in Chilliwack, B.C. He is a highly regarded First Nations mental health and lack-of-mental-wellness expert. We have done a lot of work with Aboriginal communities through our Building Bridges programs.
Some people try to make it a difficult issue; but I am not so sure it is as difficult as we like to make it. So many communities do not have hope. So many children do not have jobs or the appropriate education. There is hardly any cultural competence on high-suicide reserves. There is a lack of First Nations and Aboriginal people to provide the services, so it is always some White guy coming up. It is pretty simple. It can bring up issues around a home, a job and residential schools. While people say it is not generational, it obviously is generational; and we are not dealing with those issues.
One other item in my backpack of issues is that if we truly want to confront them, we could confront the issues. Much of it also requires the attention of the First Nations and Inuit leadership because the issue of hope for the younger generation must be addressed. In rural and remote areas, those issues frequently do not reside in the communities where their parents lived.
It is an easy list to run down, but it is a difficult task to address each of the items on the list. However, the difference in numbers is basically the difference in hope.
Senator Munson: On the issue, I talked about shared experiences. I am not sure whether you want to talk about that. I ask the question in the framework of what we see in terms of a new hope and a collaborative approach in Parliament to deal with the personal issues that you have had to deal with.
Mr. Upshall: I seldom speak about my issues because I am not a storyteller. Some people are good storytellers, and we use those stories as exemplars of our issues. I prefer to be an advocate and put forward another's story. Having said that, you are entitled to know that my experience comes from being a lawyer, one of the youngest QCs appointed by Mr. Bill Davis, and a community activist in my town, and from being very active in church, the Salvation Army, and, generally speaking, community leadership.
In 1990 I attempted suicide. If you read the stories of people and depression or suicide, you find that it is a much longer process than can be compacted into a few days. There is a pain associated with depression that is beyond belief. There is a sense that it is hard to impart when you are in the manic phase of bipolar disorder. Your powers are, quite frankly, greater than Jesus Christ — you feel so powerful. I had no idea about mental illness when I attempted suicide. I was in a depressive phase of my manic depressive disorder, as we call it, at the time. As it turned out, in my manic phase of that I had taken advantage of my trust account, so I was charged with fraud. During my suicide attempt, which I thought was very well planned, I was discovered, by the greatest of quirks, and taken to the hospital. It took four days, with my significant resistance, to get me back into a life position. I then went on to a psychiatric ward for close to two months. By virtue of the fact that I had so many good friends, I was able to access a psychiatrist right away.
The circumstances in which I found myself are not the normal circumstances. The other circumstance that I had that was my string between homelessness and not homelessness was a known occupation insurance policy that I had. The minute that I was charged, the minute that I was sent off to jail — and I spent time in jail — I was disbarred, but being disbarred prevented me from going back to work as a lawyer and, therefore, I had the insurance policy there.
My experiences are not overly unique, in accordance with Senator Dallaire's issues, and those of others. The one thing that was there for me any time I went through any issues was a friend. Yes, I had excellent medication — I was very heavily medicated for many years. However, there was always a friend and a helping hand.
When I got into the Mood Disorders Society of Canada and the peer support there, that provided the safe place. I am not sure if it was Mr. Albrecht or someone else who mentioned the words ``safe places.'' Safe places are absolutely essential to have for people recovering from mental illness. Peer support groups were safe for me. The colleagues that I work with today are all safe, where I am very safe and I can work very comfortably. My home is the safest place I have ever had, which was not the case in my earlier life.
Experience-wise, definitely peer support, definitely friends, friends who understand — I came away from that experience with no friends from the past and moved forward. That is essential for the community to understand that that support is necessary.
Senator Munson: I want to say that you are a special person. It is important for us to know this — really to know this — because this is the kind of information we all need. You are a great person.
The Chair: Thank you, senator.
Senator Dyck: Thank you very much to our witnesses. Ms. Simon, I was struck by your comments when you were talking about the diversity of the youth who attempt to or do die from suicide, and you get 10 per cent of your calls from Aboriginals. However, it sounds as though the services you provide are still in their infancy in terms of reaching Aboriginal youth.
In terms of the bill, then, if it is a federal framework, do you think that framework will take into account the diversity? I am speaking specifically of Aboriginal youth, although there are many other groups that should be looked at as well. Do you think there is enough in the bill that will ensure that the different groups get the attention they deserve? Clearly, there are differences, and the types of services and strategies that we have vary according to the group that we are looking at.
Ms. Simon: I cannot say whether I think the bill specifically has enough information about diversity because I am not sure how much would need to be in there to ensure that it was a place holder and that it was going to be addressed. I would say that that is critical if we want to have a framework that will meet the needs of young people in Canada.
Potentially, we do need to add more to the bill to be explicit about the fact that we understand that young people have different experiences and that those different experiences need to be taken into account. I speak for young people, but I would think that is true for all people, particularly, as we were saying, when we know that there are particular populations such as Aboriginal or LGBTQ youth that are at higher risk for suicide. Not enough services are reaching out to those young people. It is probably worth looking at adding some language to ensure that if the bill is passed, the framework does address that.
Senator Dyck: With respect to your Kids Help Phone and the other facilities, you said that right now it is based out of Montreal and Toronto. With the phone counsellors that you have, or even those that address web-based or phone questions, do you have a reflection of that diversity in the staff that respond to questions?
Ms. Simon: Our staff is very diverse and represents diversity not only in terms of where they are from and the ability to speak both French and English. They also come from all sorts of different helping professions. In order to be a Kids Help Phone counsellor, they must have a degree and at least three years direct experience working one-on-one with children and youth. Many of our counsellors are part-time, so they might work in the juvenile justice system or in child welfare. We bring a lot of different expertise to the table.
In addition, all of our counsellors receive training from Kids Help Phone. We have a counselling framework that we work on that is based on providing brief solution-focused therapy that has incredible research to back it up. All of our counsellors spend a significant amount of time receiving training and listening to counselling calls before they are allowed on the phone. It is the same thing with live chat and with web posting.
Much of our training does focus on cultural competency. We received training this year on lateral violence within the Aboriginal community, looking at bullying specifically. The year before, we had a more general training in the social and emotional challenges that Aboriginal young people are facing. We bring in external trainers, and we also have our knowledge mobilization department that does training on issues. Honestly, when a Kids Help Phone counsellor picks up the phone, he or she does not know if it is a six-year-old who is calling because he or she is mad that the mom has grounded them, or an 18-year-old who has somehow self-harmed himself, or herself or a group of 14- year-olds who are testing us, laughing and playing a joke. We have to ensure that our counsellors are prepared for all of those different experiences and all the ones I did not mention.
All of our counsellors currently receive in-house suicide training in order to be able to best assist young people. As of February, they will all be assist-trained, which is one of the national programs related to suicide prevention.
Senator Dyck: Thank you.
Senator Cordy: Thank you very much to both of you. You are both doing amazing work in the field of mental health and mental illness. Mr. Upshall, you have been around the Senate for a long time helping us out with our reports and legislation dealing with mental health. Thank you specifically for that.
The bill calls for consultation with relevant non-governmental organizations and relevant entities within the governments of the provinces and territories and the federal government departments within all levels of government.
You both spoke about the need for young people to be involved in this, particularly Ms. Simon. I am wondering if perhaps we should consider suggesting to the government with an observation that it also include young people.
Senator Dyck and Senator Munson also asked a lot of questions about Aboriginal youth and the need to include Aboriginal groups within it.
Police agencies, I think, are often left out. Often, they are the front-line people who deal with the escalated situation of someone who may have poor mental health where a police agency is called in. They tend to be the first people, even more so than a health official.
Also, you mentioned LGBTQ representation.
You also mentioned, Ms. Simon, a need for including the media when we are determining a national framework in the case of the bill, or what I would think would have a little nuance and differ in terms of a national strategy.
Should we make an observation to the government that those groups are not forgotten? When I read ``non- governmental organizations'' or ``government departments,'' they are not the groups that I would think of first.
Ms. Simon: I think it would be wonderful to put that in the bill and to reference that incredible work is being done right now on some of the populations we have talked about. Egale Canada has been leading a national suicide prevention strategy for LGBTQ youth and brought together people from around Canada about eight months ago to talk about the issues facing that population.
There is also a group of young Aboriginals that has been trying to come up with a strategy specifically for Aboriginal youth and suicide. Our clinical director of English-language services sits on that group.
People within those two communities in particular are really concerned about this and have great ideas about this, whether they are young or not. It would be worthwhile to put someplace in the bill that those people, and others, need to have a voice in developing this framework.
Senator Cordy: Should we have further legislation in terms of having a national strategy for children and youth who have poor mental health? They would be included in this bill, but should we look specifically at that? I used to be an elementary schoolteacher, and I guess that is why this is occurring to me. Mr. Upshall mentioned that often the services are not there. I can remember as a teacher giving a referral and being told there is a six- to eighteen-month wait. You are thinking, ``But this child needs help today or tomorrow, not in six months' time.'' Should we consider that?
Ms. Simon: It will be very challenging and potentially not possible to develop a framework for suicide prevention in Canada. Potentially, we have to be thinking about frameworks. Certainly one of those would be what is needed for youth. I would even split that out to say that there is a real difference when we are talking about a 10-year-old versus a post-secondary student or a 24-year-old. We know that suicide is the second leading cause of death for Canadians in the 10 to 24 age range. It is obviously something that we need to be paying attention to. However, the lack of hope that is so critical and that Mr. Upshall talked about is really different when you are a kid versus a teenager versus an emerging adult. When we are thinking about a suicide framework, it really is important to recognize that probably one will not be enough. We should be looking at ages but also overlaying the different populations as well as risk factors and things like rural or inequities. I do not think it is realistic that we will be able to come up with one framework that really touches on all people in Canada. I imagine seniors will have very different needs than what we are talking about when we are talking about children and youth.
Senator Cordy: Certainly there are differences with regard to information that we would give to each particular group. You are absolutely right.
Mr. Upshall: I am sure that the chair knows, and others around here may know, that CIHR is developing its patient- oriented research proposals. The first grant will be associated with mental illness. It now looks as if the $25-million grant over a five-year period will be associated with children and youth mental health. It is a pet project of Anthony Boeckh through the Graham Boeckh Foundation, with whom CIHR are partnering. It may well be that there are activities under way in the community that will identify relevant people who should come to the table rather than trying to make a long list of relevance.
I would like to put a plug in and endorse this legislation as is. Maybe give your notes to it, but I hope you would not suggest any amendments that would hold it up.
Senator Cordy: I agree with you. I am talking about observations, because we all certainly agree with the intent of the bill and moving forward with it.
We hear a lot of publicity about cyberbullying and the increase in suicide of young people because of cyberbullying. Is the health department collecting data on what we can do? It appears to be a tremendous problem. The Internet has changed. You spoke about the positive aspects of it, where people can chat online. That is a positive thing about the Internet. However, in the olden days, if you were teased in school, you went home to a hopefully safe environment and left that behind. Now it is 24-7 if it is online bullying. Are we collecting the data and discovering what we can or should be doing?
Ms. Simon: I thank you so much for that question because bullying and cyberbullying are things that Kids Help Phone is incredibly concerned about. With cyberbullying in particular, as you mentioned, there is often no escape. It used to be that bullying happened within the schoolyard, and then you could go home. Now, young people tell us they feel like they are bullied from the moment they wake up until the moment they go to sleep. Often, when they are sleeping, they are still being bullied, but they just do not know until the morning.
There is not enough data on the prevalence and incidence of cyberbullying. We know from data we have collected with Kids Help Phone users through our website that a significant number of young people say they have been cyberbullied. Amazingly, the majority of them said they would not tell anyone within their life because their parents do know what cyberbullying is and people do not take it seriously. There are no marks to show as when you were beat up. That actually was something you could go and show a teacher. Adults do not know what to tell you.
We actually just added new information to both our kids' and teens' websites in both English and French related to cyberbullying, including a safety planner. There are videos we added specifically around Facebook and how to keep safe on Facebook. Bullying and cyberbullying are relationship issues, and it is about recognizing and teaching young people empathy. We have a new interactive at Kids Help Phone on our kids' website. It is fantastic, if you have a second to look. It is called ``Inspector Emotion.'' They show pictures and videos and give scenarios, and you recognize what feeling they are having. Part of that is about showing the effect of cyberbullying. Someone reads something about themselves on Facebook, and how does that leave them feeling?
There is not a quick answer for cyberbullying. Parents and others often say, ``You need to get off the Internet.'' Young people's live and all of our lives are deeply connected with technology, and we cannot just say, ``Stay off the computer.'' We have to be able to recognize that it is about relationships and power differences and not having empathy, because it is really easy to cyberbully when I am sitting in my home with my friends and I think it is funny and not think about the person down the street reading what I write.
This past year, the Supreme Court of Canada had an amazing court case that Kids Help Phone intervened in to talk about the importance of anonymity and confidentiality around cyberbullying if you want people to access resources and supports, whether it is through services or through the court.
Senator Cordy: That was Nova Scotia.
Ms. Simon: It came from Nova Scotia, yes. Certainly there is an increased understanding about cyberbullying and the importance of it.
As I said during my submission, I do think, however, it is important that we start to tease away bullying and cyberbullying from the discussion of suicide, because what we hear from young people is that they are now seeing them as connected. When young people call us and the counsellors say to me they just got off the phone with someone who said that from what they have seen in the newspaper, that is how you stop cyberbullying, by self-harm or suicide, I think we have a real challenge on our hands. We have to take bullying and cyberbullying seriously. We have to recognize that, unfortunately, there are some young people who do take their lives by suicide as a result, but we do not want that to in any way become connected in the minds of young people.
Senator Cordy: That is a good point. Thank you.
The Chair: Thank you very much. You have covered an extensive range of the issues, both of you, with regard to this discussion. You have mentioned there is yet another major category, namely the elderly. In our next session, we will have representatives from seniors' mental health. We will get to that now. I thank you very much.
We are pleased to have two more witnesses with us for this session. I will introduce them in the order in which they appear on the agenda list. That would mean, Ms. Wilson, that I will welcome you first. Ms. Wilson is Executive Director of the Canadian Coalition for Seniors' Mental Health. Please make your presentation.
Kimberley Wilson, Executive Director, Canadian Coalition for Seniors' Mental Health: Good evening and thank you, everyone, for inviting me to take part in this consultation on Bill C-300. I am very pleased and honoured to be here to represent the Canadian Coalition for Seniors' Mental Health.
As a brief introduction, the CCSMH is a national coalition with approximately 3,000 members from coast to coast to coast, representing a full range of health disciplines, sectors, government and administrators, as well as older adults, caregivers and family members. Our mission is to promote the mental health of seniors by connecting people, ideas and resources. Our primary strategic goal is to ensure that seniors' mental health is recognized as a key Canadian health and wellness issue. With that goal in mind, I commend your lifespan perspective on suicide and suicide prevention, as evidenced today by our inclusion in this consultation.
I often find that people are surprised, even those who work in the field, when I speak of the high suicide rates in late life. As noted in the Chief Public Health Officer's 2010 report:
Suicide is often associated with younger people, but men over the age of 85 have — on average — higher suicide rates than all other age groups. Although the rate of suicide deaths are lower among senior women, they have an overall higher rate of attempted suicide compared to senior men.
Research consistently has shown high rates of suicide in the oldest age cohorts for men; plus, adults over the age of 65 use the most lethal means of self-harm. We also know that the baby boom generation is a group that has a high lifetime suicide rate. This statistic, coupled with the aging demographics in Canada, will likely mean a greater number of older lives lost to suicide in the future.
Older adults also face the unique double whammy of stigma — both ageism and the stigma associated with mental illnesses. We know that ageism and stigma may create barriers to accessing care, to proper detection and assessment, and to a good public discourse.
Given these statistics, suicide prevention is one of the key topics we have focused on at the CCSMH since 2005. With funding from the Public Health Agency of Canada, we led the development of the first-ever national interdisciplinary guideline, The Assessment of Suicide Risk and Prevention of Suicide in older adults. These guidelines were authored by a team of researchers and health care providers from across disciplines who reviewed international and national literature and synthesized the evidence into 38 recommendations in the areas of risk and resiliency; detection, assessment and diagnosis; treatment and risk management; and systems of care. Since their release in 2006, thousands of copies have been disseminated both electronically and in print across Canada and in over 60 countries.
To support the knowledge translation and implementation of the guideline recommendations, again with support from the Public Health Agency of Canada, we were able to create a variety of companion tools, including a pocket card, a resource guide for family members, and a case-based training DVD and tool kit for health care providers.
The CCSMH nominated two of the leads on this project, Dr. Marnin Heisel and Dr. Sharon Moore, for the CIHR Institute of Aging Betty Havens Award for Knowledge Translation in Aging, and in 2008 they were recognized with this award. Funds from this award have allowed Drs. Heisel and Moore to offer workshops and training in suicide prevention in late life to nearly 200 health care providers in Ontario, Alberta and British Columbia, and they were able to evaluate the impact of these workshops in terms of providers' knowledge and attitudes towards working with at-risk older adults, adding to our knowledge base in this area.
I give you this context about the work of the CCSMH so you can understand our strong support for Bill C-300. It is time that Canada has a national framework for suicide prevention across the lifespan. The stakes are too high to wait any longer. As the committee moves towards clause-by-clause consideration, I urge you to ensure that this bill is action-oriented and has measures for accountability and leadership embedded in it. Understanding that private member's bills have restrictions regarding public expenditures, I would like to echo the suggestions from my colleagues at CASP and also from the Canadian Alliance on Mental Illness and Mental Health, known as CAMIMH, of which we are a member.
We suggest that a national coordinating body is essential to the success, one that will support collaboration and eliminating fragmentation, and thus we support the creation of a distinct national coordinating body for suicide prevention that would report back to Parliament on an annual basis. We suggest that providing not only guidelines but also implementation strategies and support are necessary to improve public awareness, knowledge, education and training about suicide prevention across the lifespan. Enhancing publicly available information systems and improving surveillance systems about both suicide and risk-related factors, and defining best practices and supporting implementation of these practices in the area of suicide prevention, intervention and post-intervention, are crucial.
I would also encourage language that ensures a lifespan perspective throughout the framework and building upon existing evidence-informed research, guidelines, strategies and initiatives. We also remain hopeful that future federal budgets will include appropriate and necessary funds to establish and resource a comprehensive suicide prevention strategy for Canada.
Again, I would like to thank you for this opportunity to represent the CCSMH and look forward to answering any questions you may have.
The Chair: Thank you very much.
I will now turn to Dr. Alex Drossos, Board Member of the Canadian Association for Suicide Prevention.
Dr. Alex Drossos, Board Member, Canadian Association for Suicide Prevention: Thank you for the opportunity to speak today, on International Human Rights Day, in fact, on this very important issue for Bill C-300, which we, of course, strongly support the intent and spirit of. I would also like to thank the honourable Harold Albrecht. Without his passion and commitment, we would not be here today on truly the threshold of a landmark event in Canada.
We have heard some statistics: Every year, about 4,000 Canadians die by suicide. That is more than the total number of fatalities from all intentional injuries and homicides combined. That ranks Canada in the top third of all countries in terms of its suicide rate. It is also estimated that 3 million Canadians, 10 per cent of the population, have been affected by the tragedy and trauma of suicide. Sadly, when someone dies of suicide, the pain is not gone; it is merely transferred to others — family, friends, communities; and their injuries are largely invisible and suffered mostly in silence.
As you know, suicide is not the result of a single cause; it is complex. Suicide prevention, therefore, requires a multi- faceted approach, including a united effort across all systems and jurisdictions. At its core, suicide is the result of overwhelming pain that overcomes the hope that life has, in the sense of the meaning and purpose of life. Suicide is the result of a complex interaction of biological, psychological, social, spiritual and cultural factors — all the things that we have heard about. These can include social isolation, traumatic life experiences, family violence, poverty, substance misuse and physical and mental illness.
As a physician training to be a psychiatrist and working in part at the Centre for Addiction and Mental Health in Toronto, I see these factors unfolding in a variety of ways every day. For the most part, however, suicides are preventable. The Canadian Association for Suicide Prevention is made up a group of dedicated volunteers who, for over a decade, have been advocating for a national suicide prevention strategy and asking federal governments to acknowledge suicide as a national public health priority. In 2004, CASP authored its first blueprint for action for a Canadian suicide prevention strategy and updated it in 2009.
Over 15 years ago, the United Nations and World Health Organization recognized suicide as a major public health problem. In 1992, the UN created those guidelines and asked Canada to take a lead role in developing them. The UN and WHO guidelines asked that each country establish a national suicide prevention strategy and a national coordinating body. To date, all developed countries have endorsed these international guidelines and have created such a strategy and a body, with the exception of Canada; but we are almost there.
Bill C-300 is a good and critical step forward, but in its current form it is not a national strategy, as we have discussed, and falls short of the UN guidelines that Canada helped to create. This is an incredible opportunity before us that we cannot pass up. Let us do it right because thousands of lives depend on it.
In addition to Australia, which was mentioned earlier, Scotland and England have good strategies from which we can learn. Scotland's Choose Life: A National Strategy and Action Plan to Prevent Suicide in Scotland was launched in 2002 with clearly identified objectives and an overall aim of reducing suicide by 20 per cent over 10 years. England's national strategy, also launched in 2002, had a similar aim of reducing suicide rates by 20 per cent by 2010. By 2008, there was already a 20 per cent reduction in suicide rate — the lowest annual rate ever recorded in England. Thus, they met their original target two years early.
Two major barriers are identified consistently in Canada. One is the lack of a formally recognized and funded national strategy and another is the lack of nationwide coordination. Suicide prevention in Canada is fragmented and lacks a national vision. Bill C-300 can be the catalyst to and the source of that unification and collaboration. Of course, as we have also heard, many great things are happening across the country in the field of suicide prevention. However, one region does not know what the others are doing, and there is no system in place to share and exchange that information and best practices, to coordinate or synchronize research and to cross-pollinate ideas.
The first litmus test for any country when it comes to judging its efforts and commitment to suicide prevention is whether there is a national coordinating body. Canada has yet to pass this test. This is where the federal government's role is crucial. Since Bill C-300 was tabled in Parliament, CASP and many other organizations have suggested specific improvements to strengthen this important piece of proposed legislation. Therefore, once again we are suggesting that the following improvements be considered seriously. It is a top 10 list. Some pieces have been incorporated since the original tabling.
First, appoint and adequately fund a national suicide prevention coordinating body and a national strategy; second, support the creation of a national collaborative for suicide prevention; third, establish clear and measurable objectives similar to Scotland's national strategy; fourth, develop policies targeted at reducing access to lethal means; fifth, develop guidelines to improve public awareness, education and gatekeeper training, including national media guidelines for the reporting of deaths by suicide; sixth, improve support for those impacted by suicidal behaviour and completed suicide; seventh, support and enhance information systems to collect and disseminate suicide prevention information; eighth, encourage research to advance evidence and form knowledge and program evaluation; ninth, establish Canadian suicide prevention guidelines, certification and accreditation; and tenth, support the creation of networks and communities of practice, including a national distress line network and a national suicide bereavement support network.
I ask each of you to ensure that Bill C-300 has a solid foundation and creates the necessary structures so that we may better learn from each other, support one another and share our resources to the benefit of all. I am certain that Bill C- 300 can do and be all of these things.
Senator Eggleton: You have very good suggestions. Both of you are saying that this bill is a nice start as a framework but that we need something more in the form of a national strategy, specific goals and timetables — elements of a strategy that are not foreseen in this bill at this time.
Dr. Drossos, I will ask about the blueprint that your association prepared. Has there been an uptake in the provinces or local communities? Have you been going across the country to get some take-up on the strategy?
Dr. Drossos: Primarily, it has been at the community level, as well as some provinces. Mr. Albrecht noted the suicide prevention group in Waterloo. In my native Hamilton, a local suicide prevention coalition has a suicide prevention strategy primarily based on that blueprint. Other jurisdictions were noted, such as B.C.; and Manitoba is working not quite at the provincial level but at the big-city level of Winnipeg and other regions and has used the blueprint contents. The blueprint is based, by and large, on the UN and WHO guidelines with some specific Canadian components.
Senator Eggleton: I asked the last group of presenters about the social determinants of health because I believe they play a big part in terms of the stress and depression that can exist for so many people who do not have proper housing or, like some of our Aboriginals, do not have potable water and live in deplorable conditions. These elements show up in the statistics for Aboriginals and the Inuit. Can either or both of you comment on the necessity of addressing this question of social determinants of health in terms of this issue?
Ms. Wilson: I had taken some notes when you asked that question of the previous panel. My initial reaction, without question, was that the social determinants of health have to be embedded in this bill, particularly for seniors in consideration of lifetimes of vulnerabilities that add up over time. We need to consider things such as social inclusion and social exclusion, which are key in terms of people feeling connected to their communities — as Mr. Upshall said: having a friend and a hand throughout.
Also, there are many negative life events and transitions in late life that are linked closely to the social determinants of health that need to be considered in an adequate framework or strategy for suicide prevention. The Mental Health Commission of Canada has done a nice job with their strategy in linking the social determinants of health to mental health and mental wellness. We could build on that, in particular with the suicide prevention lens as well.
Dr. Drossos: I do not have much more to add because they are critically important, and much has already been said.
As I already mentioned, suicide is not only related to mental illness, but we can rename and call them the ``social determinants of mental health,'' and it is primarily the same list. You can add a couple of things to that list, but it is made up of the very same things.
Senator Eggleton: The Mental Health Commission of Canada in its report is developing a strategy and indicating it will roll out factors of this strategy in the coming months. There is that effort and then there is this bill here and its time frame. How do you see them meshing? The Mental Health Commission's report is more immediate than this time frame.
Ms. Wilson: I have been lucky to have been actively involved with the Mental Health Commission throughout their five years. I was a member of the seniors advisory committee for all five years that there was the advisory committee structure. This is certainly something we have talked about at great length, namely, how we integrate different strategies while taking advantage of the timing and opportunities that come up.
I think if you talk to colleagues from the Mental Health Commission, they feel as if they have landed in a place where their strategy includes suicide prevention but is certainly not adequate to address all the issues related to suicide prevention.
Moving forward, the strategy is out and has been well received. The implementation piece will be key, and that is where there is the opportunity to ensure we are dovetailing the strategy with the new framework for suicide prevention.
Dr. Drossos: Clearly, having a national mental health strategy was a huge accomplishment and long overdue. As I mentioned in my last comments, suicide is not only a result of mental illness. We know by and large that it is perhaps one factor in most situations, but it is never the only factor. Mental health or mental ill-health is one piece of the puzzle. There needs to be coordination between a body that is involved at the federal level in suicide prevention and the Mental Health Commission of Canada, and there will be significant synergies there, but they should be separate bodies as well.
Senator Munson: Thank you for being here. My mother passed away two years ago at 97; she was in a seniors' home, and it was a good life. I spent five years almost every day being there with my mom.
Our researchers gave us this question: In your opinion, is the psychological distress among elderly men well understood by suicide prevention workers? I would like to add to that question: Is it well understood by those who run seniors' homes?
We see pictures on television or ads of happy seniors doing happy things, and the activities are there. There are all kinds of wonderful activities, and it is almost stay busy but do not think why you are busy or who you were and where you are and how you feel.
In your work, could you give us some thoughts on that? Is enough being done, and would this national coordinating body you talked about be helpful in terms of working with seniors' homes across the country and dealing with the issue head on each and every day?
It is almost childlike in some respects in that you keep a child at the age of four or five busy, and now it is an opportunity to make sure the 90-year-old is busy, but are you really engaging the person's mind?
Ms. Wilson: You have picked up on a lot of the issues we talk about in our day-to-day work. One important differentiation is, perhaps, that the people you see in the commercials on television are a population moving into retirement communities and are often quite different from the population who live in long-term care and nursing homes. Typically, they are the most frail or vulnerable older adults in terms of their physical and mental health.
The recent data out of the Canadian Institute for Health Information show that almost 50 per cent of all older adults in long-term care homes have symptoms or a diagnosis of depression. We know that most people who live within long-term care have a mental health issue. When you add that to the cognitive impairments, we are looking at 80 per cent to 90 per cent of the population with a mental health condition.
In terms of people working within the facilities having the right resources and skill sets, I will preface by saying most people who work in these facilities are well-intentioned, overworked and under-resourced. The reality is that, unfortunately, there is not a lot of education at that level of care about mental health issues. We have good evidence about what types of interventions work. Social and recreational activities are some of them, but they are not the only ones. There is not always access to the right types of treatment.
A lot goes back to the issue around ageism and stigma and that we sometimes lose the feeling of hope that there is still quality of life for people who have severe mental illness or degenerative disorders such as dementia, and that feeling can trickle down in terms of the opportunities that are available for older adults. That sense of hope is important for that population as well, and understanding that quality of life and meaningful activity can still occur in settings like long-term care homes. It is a place where there is a lot of opportunity to improve.
Senator Munson: Do you believe Canada should adopt a strategy of another country, or should it be a made-in- Canada kind of policy approach?
Dr. Drossos: I think at any time it is good to learn from others who have preceded us and who have succeeded and sometimes failed or failed a little bit. We can only make ours better.
It only makes sense that just like individual cities, provinces and groups of populations within Canada need to determine for themselves what a suicide prevention framework and strategy means, at the national level, we need to consider what it means for us here in Canada.
Ms. Wilson: In terms of good principles of knowledge translation, three components people talk about are facilitation, evidence and context. Context is probably one of the most important, and, certainly, learning from other countries and using their evidence is a great starting point, but adapting to the context is probably the most crucial piece to make it resonate with communities.
Senator Cordy: Thank you for excellent presentations. Dr. Drossos, you spoke about a national bereavement centre; I believe ``centre'' is the term you used. You said that in death by suicide, the pain is not gone but transferred to others, and I think that is a valid way of saying what actually happens. Those who are left behind are in tremendous pain afterwards wondering what they could have done differently.
Are there national bereavement centres in other locations that you have seen that work? When a teenager dies by suicide, we have crisis teams that go into the schools, but that seems to be for the first couple of days. I am not sure how long-term it is. Do we have good best practices in Canada that are working in bereavement for those left behind after a suicide?
Dr. Drossos: We have a couple of examples of that. You asked about other jurisdictions, other countries, perhaps, and I am not aware of any in other countries, but it is not an area in which I am an expert. The person originally slated to here from CASP probably could have answered better than I.
We do have groups working in this area. On our board, we also have another individual who was to be here, who is our survivor chair. She has experience with a loved one dying by suicide and coordinates a body within the membership of CASP, and non-members, for that matter. This is not an acute piece; this is the longer-term connection and supports.
At an acute stage, you are right to say that for young people and their families, we do a better job, but not as much as for other ages, and I think Ms. Wilson can add to that.
Ms. Wilson: I would agree. Again, going back to that piece around ageism and stigma, part of it is the juxtaposition that young people are not supposed to die. That is something that we talk about a lot. Death is part of growing older, so sometimes it is swept under the rug when there is a case of suicide. There is evidence showing that coroners are less likely to rule a suicide if it is someone who is older. In that family piece, people are left behind who do not necessarily have that network that they may have in other age groups. We have had the great fortune of working with the previous CASP survivor chair who helped us understand the issues, as both of her parents, who were older, died together by suicide. It is certainly a gap you have identified.
Senator Cordy: I think you said it very well. Younger people are not supposed to die early. When you look at seniors, we do not seem to be getting the information about suicide. We have statistics that we can look at, but you tend to look at the under-25s. When you look at the rate of suicide among older men, particularly, it is astonishingly high, and yet it is not talked about a whole lot. Are we doing enough in that area to educate the public about suicide among our older citizens?
Ms. Wilson: There are people who are doing excellent work, and there are pockets across Canada, and we are privileged to work with many of the leading experts, but we are not doing enough. Particularly as we talk about the aging demographics, we know 2011 was the first year that the baby boomers turned 65, so the time is now. We certainly need to talk about this more and raise awareness in the public, but also for people who work with older adults so they understand what risk factors there are as you grow older and how symptoms manifest differently in older adults compared to different populations. When you look at the current cohort of older people, it will be different from our baby boom generation and following generations. They grew up in a time where the stigma was even more significant than it is now, and it was not necessarily socially acceptable to go say that you are feeling sad or depressed after a loss or after a life change. The way we deal with the current generation may very well look different from how we deal with future generations. It is certainly a place where there is an opportunity to improve our response.
Senator Cordy: Is there a difference in the way that a senior would die by suicide than someone who is younger? We have heard stories where they stopped eating, for example. Do you have statistics on that?
Ms. Wilson: Again, what we talk about more is the fact that older adults use the most lethal means. There are cases of passive suicide where they maybe stop eating or taking medication, but those are the ones who may not be ruled suicide as explicitly as the ones where we are talking about more lethal means. What is probably equally important or maybe gets people's attention, and therefore that is where we start, is the fact that particularly older men use the most lethal means. There are fewer attempts and more successful suicides.
Dr. Drossos: I would add that based on age, and since we are speaking about particularly older men for the moment, the signs that one might be at risk of suicide in that age group are identified less by health care professionals of all stripes. It is almost because we do not suspect it. We should be doing screening, especially in known types of conditions, neurodegenerative conditions and other conditions that will eventually be fatal. Those are the kinds of people in particular that we should be watching for and asking every time we see them as clinicians, ``Are you feeling depressed? Are you feeling suicidal?'' We do not do a good enough job of that. There are good examples of where it is done extremely well, but, uniformly across the country, we have room for improvement.
Senator Cordy: There was a study in Nova Scotia, I think at least 10 years ago, on rates of depression in older seniors. I think you are absolutely right. We just have to know what to look for.
Dr. Drossos: The symptoms of depression in older men and older people in general tend to be different from the classic description in a textbook, or even what is used in public awareness campaigns.
Senator Cordy: Perhaps we should have more public awareness campaigns.
Dr. Drossos: Exactly.
The Chair: Thank you very much for appearing here today. I think you have fleshed out the range of things we have heard this evening on this subject. On behalf of the committee, I thank you for your appearance and the frankness and straightforwardness and clarity of the answers you have given us.
Colleagues, I will call us now into clause by clause. I need to put the question directly to you: Is it agreed that the committee proceed to clause-by-clause consideration of Bill C-300, An Act respecting a Federal Framework for Suicide Prevention? Is that agreed?
Hon. Senators: Agreed.
The Chair: Shall the title stand postponed?
Hon. Senators: Agreed.
The Chair: That is agreed. Thank you. Shall the preamble stand postponed?
Hon. Senators: Agreed.
The Chair: That is agreed. Shall the short title in clause 1 stand postponed?
Hon. Senators: Agreed.
The Chair: That is agreed. Shall clause 2 carry?
Senator Eggleton: I will speak on clause 2 because clause 2 is the meat of this particular bill. As we have heard from our witnesses, particularly the last two, there is a difference between what is in this bill, which is called a framework, and what some of them say it should be, which is a national strategy. A national strategy is something that the House of Commons actually passed unanimously in October of last year. That is not what we are getting here.
There has to be federal leadership in this, and there needs to be a national strategy as soon as possible, as the House of Commons asked for. However, I do applaud Mr. Albrecht for bringing this forward because it is a move in the right direction. It does establish in clause 2 a number of important items that need to be addressed. It is what it is, and I will support it. I think it is a good move, and I applaud him for doing that. I am hoping that this will open the door to going further into these issues and moving toward what our witnesses talked about as a national strategy.
With that, I will support clause 2.
Senator Seidman: I want to respond, because I totally agree with you. I would say that, in essence, when I look at this framework response, the framework will provide the very thing that these people sitting in front of us today requested. Therefore, the framework, to me, when I look at this, will integrate all the different strategies across the country. It will consult widely across the country with NGOs, professionals, regions and provinces. It will also define and promote best practices. In essence, we are going to get from this framework one step closer to what everyone wants. I think it is a very positive thing. All the testimony we heard today will be on record, and that hopefully will also inform the framework.
I, too, will strongly support this moving forward.
Senator Cordy: I would also like to congratulate Mr. Albrecht for bringing forward what is a national framework, but I think that we have to recognize that it was unanimous in the House of Commons that we have a national strategy. I would like it to be a government bill that we have a national strategy, with accompanying funding to develop a national strategy. The framework, I agree with Senator Seidman, will certainly lead to discussions and consultation and those kinds of thing. I think the ultimate goal is — if Canada is the only country that has not passed the UN, perhaps I would not want to say ``only'' as that is a pretty broad statement, but it is one of the leading democracies to not have a national strategy, and that is very important.
Having said that, I would like to congratulate Mr. Albrecht for the work he has done, because I think this is a first step, but I would like the national strategy to be a government bill.
The Chair: I will put it again. Shall clause 2 carry?
Hon. Senators: Agreed.
The Chair: Agreed. That is carried.
Shall clause 3 carry?
Senator Cordy: May I have a comment on clause 3, please?
The Chair: Certainly.
Senator Cordy: The idea of within 180 days after the bill or this section comes into force makes me nervous, because sometimes bills come into force quickly, and that would be great that we have the consultation within a six-month period. I hope that is the case. I certainly would not bring any amendments in, because I think it is important that the first step go along quickly.
For this particular area, I would like to bring in an observation. I am not sure if you want me to say it now or later.
The Chair: No, when we come to that part.
Senator Cordy: I think what we heard is that we have to be inclusive in terms of who will be consulted.
The Chair: Yes. I want to make a note of that ``coming into force.'' Thank you.
Shall clause 3 carry?
Hon. Senators: Agreed.
The Chair: Carried.
Shall clause 4 carry?
Hon. Senators: Agreed.
The Chair: Carried.
Shall clause 1 carry?
Hon. Senators: Agreed.
The Chair: Carried.
Shall the preamble carry?
Hon. Senators: Agreed.
The Chair: Carried.
Shall the title carry?
Hon. Senators: Agreed.
The Chair: Carried.
Shall the bill carry?
Hon. Senators: Agreed.
The Chair: Carried.
Does the committee wish to consider appending observations to the report?
Senator Eggleton: Actually, I think I have the same observation, but maybe I could explain. I have written out an observation here that certainly fits with what Senator Cordy was just talking about.
My concern here is timing, because it says in clause 3 that ``Within 180 days after the day on which this section comes into force, the Government of Canada must enter into consultations,'' et cetera.
Clause 4 says within four years after the coming into force of the act, then a reporting procedure starts, but it does not say when the bill will come into force. Most bills come into force upon Royal Assent or shortly thereafter, but not all bills. Some bills can sit around for months or years before they come into force. The suggestion that I have — and maybe Senator Cordy will have a better one — is the following: ``That the government be requested'' — very soft language; it is an observation — ``to bring the bill into force within a few days of Royal Assent,'' which is the normal thing. It is normal, but it is not always done. Because if it is not done for some time, then this clock does not start ticking, and it is a very urgent matter to get on with this suicide prevention framework.
The second part of that observation would be that ``in relation to clause 4, efforts be made to report progress to both houses of Parliament before the four-year time frame is reached.''
What we are saying there is clause 4 says that within four years after the coming in and two years thereafter, but I think a gentle nudge is needed to say: Bring some progress reports on how this sharing of information and this knowledge dissemination is occurring so that we will know that some progress is being made and we can, if we want to, have a hearing on that. We do not have to, but at least we would be kept in the loop as to how this thing is progressing rather than waiting as much as four years.
My observations are strictly on the question of timing, and they are to request the government to bring it within a few days of Royal Assent, and for whatever the body is that ends up coordinating this, to report it a little sooner than the four years so that we can see that progress is being made. Those are requests; they are not amendments.
The Chair: Senator Cordy, are yours in a similar vein?
Senator Cordy: Actually, no, but I think it is extremely important what Senator Eggleton has said in terms of reporting to both houses of Parliament. I think that should be part of the observation. If I were to make an amendment to the bill, that would have been one of the amendments, that it be to both houses of Parliament. However, I think we should put it in an observation so that we can get things moving quickly.
Mine is strictly related to clause 3 and to inclusion.
The Chair: Let us get the issues on the record.
Senator Cordy: ``The government should consider including such groups as young people, members of the LGBT community, Aboriginals, including young Aboriginals, and media in the consultation process.''
Senator Munson: And those incarcerated?
Senator Cordy: Yes. We did.
The Chair: Are there any other suggested observations? If not, these two items are on the table for discussion. My only overall observation is somewhat along the lines that Senator Seidman has already indicated. Frankly, I was quite pleased with the list of items under clause 2, because the pursuit of those will, I think, actually inform a national strategy really well. In fact, if we listen to the witnesses today, many of the things they were requesting came to items that are even specifically mentioned in here; and the one that we heard even in the health accord that we reviewed, the issue of identifying best health practices and having them disseminated across jurisdictions is a critical area.
With regard to the time, I will certainly not argue with the basis of Senator Eggleton's request, but I frankly would be astounded if this was not a bill that comes into force quickly, based on the overwhelming support for this concept and, indeed, the government's own —
Senator Duffy: From all sides.
The Chair: — actions to date with regard to issues that underlie this, the mental health issue and so on. That is just an observation.
Senator Duffy: Mr. Chair, the other thing that strikes me is that when we start making a list, we will always leave someone off. I think there is goodwill here. I think there is a sense of urgency. If the government does not move and proclaim it quickly, as Senator Eggleton has raised concerns about, I am sure the media would be interested in hearing from the senator on his concerns about possible delays.
I think that the more ornaments we hang on this tree, the more in danger we are of confining rather than expanding the base of the work. We want to keep the momentum going and not delay it.
Senator Cordy: These are not amendments; these are observations.
The Chair: I understand. They need to be translated to get into the chamber.
Senator Duffy: Ornaments on a tree.
The Chair: Any other comments?
Senator Eggleton: What about the second one about progress reports? Is that one okay? Within the four-year time frame?
Senator Duffy: Again, I think it is one of these things where individual senators or this committee could send an interrogatory to the group to ask: How are you making out? However, to put it on as an ornament on this document —
Senator Cordy: It is not an ornament. I think it is an extremely important step.
Senator Duffy: It is an addition. Everything that we add on has the potential to slow it down, and I think we do not want to slow it down.
Senator Cordy: No.
The Chair: Let us move.
Senator Cordy: I think it is extremely important that the reporting be to both houses of Parliament. I think that has to be an observation.
The Chair: Any further discussion on this?
Senator Munson: Just briefly, chair. I have never seen where observations slow anything down.
Senator Cordy: I agree.
The Chair: I will take your request for observations as a motion for observations. Is that reasonable?
The motion is before us to append observations. Those in favour?
Some Hon. Senators: Agreed.
The Chair: Those contrary, if any?
Some Hon. Senators: Against.
The Chair: I had better count. I declare it defeated, six to four.
Senator Cordy: Why did you not ask questions?
Just a point of clarification. An observation will not slow down the bill; and if there were concerns, perhaps the other side could have asked questions during the debate.
The Chair: Is it agreed that I report this bill to the Senate?
Hon. Senators: Agreed.
The Chair: That is agreed.
Thank you very much. I declare the meeting adjourned.
(The committee adjourned.)