Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 37 - Evidence - February 28, 2018
OTTAWA, Wednesday, February 28, 2018
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:29 p.m., to continue its examination of issues relating to social affairs, science and technology generally, and child and youth mental health, specifically.
Senator Art Eggleton (Chair) in the chair.
[Translation]
The Chair: Honourable senators, I now call the meeting to order. Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
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I’m Art Eggleton, senator from Toronto, and I’m chair of the committee. I would ask my colleagues to introduce themselves.
Senator Seidman: Judith Seidman, Montreal, Quebec, deputy chair of the committee.
Senator Poirier: Rose-May Poirier, New Brunswick. Welcome.
[Translation]
Senator Mégie: I am Marie-Françoise Mégie from Quebec.
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Senator Dean: Tony Dean, Ontario.
Senator Omidvar: Ratna Omidvar, Ontario.
[Translation]
Senator Petitclerc: I am Chantal Petitclerc from Quebec.
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The Chair: This meeting is what we are calling a preliminary meeting on the issue of youth mental health. The committee had a meeting a while back, and this came out as an area of interest for the committee to study. There’s a lot of work going on. You’re doing a lot of work, and others are doing work throughout the country. We don’t want to duplicate that. We want to determine what the focus is; how should we handle this issue? What would be the most useful things we can do with respect to the issues of youth mental health?
The numbers are alarming to us in many respects, and that is why the committee felt we should be seized of this matter and study it. We need your direction on this issue, and that’s the reason for the meeting today.
We have three entities here. We have the Mental Health Commission of Canada, which I always say was created as a result of the study of this committee when Senator Michael Kirby was chair, who also became the first chairman of the Mental Health Commission. Louise Bradley and Nancy Reynolds are here from the Mental Health Commission of Canada. Then we have the Public Health Agency of Canada: Stephanie Priest, Executive Director, Mental Health and Wellbeing Division. Finally, we have The Ontario Centre of Excellence for Child and Youth Mental Health: Purnima Sundar, Director, Knowledge Mobilization; and Heather Ennis, Manager of Communications.
Let me start with Louise Bradley, the President and Chief Executive Officer of the Mental Health Commission of Canada.
Louise Bradley, President and Chief Executive Officer, Mental Health Commission of Canada: Thank you very much for inviting the Mental Health Commission of Canada here today. As you point out, this feels a bit like a homecoming to us, having been conceived from this committee in 2006. We’re delighted to be back here again. Thank you very much for the creation of the Mental Health Commission.
We celebrated our tenth anniversary, if you can believe that, just last year. From there, we got a two-year renewal from Health Canada. We were quite pleased to be in yesterday’s budget to receive a further five-year funding with additional funding to study the impacts of cannabis legalization and regulation. That is very much an issue for youth, in particular, teenagers and young adults.
Anti-stigma campaigns like those carried out by the commission have resulted in Canadians becoming more aware of their needs than ever before. I think everyone would agree that we are hearing more about mental health on an almost daily basis than we ever have. However, it remains true that 40 per cent of parents would not admit to anyone, not even their family doctors, that their child is experiencing a mental health problem or illness.
So stigma remains a problem, and we have to keep fighting it.
In the meantime, new challenges have emerged. As stigma has been decreased with increasing awareness, this has led to an increased demand for service, and many of those services are just not there. It’s somewhat of a hypocrisy when governments call for people to get mental health care when they need it, only to present themselves for treatment and be told they’ll be put on a waiting list of 18 months. That is not an uncommon occurrence. We have heard it from child mental health clinics, and these are children that we’re talking about. They’ve been told to wait a year and a half, and when you’re that young, it seems like a lifetime. Even when one is not so young, it is a lifetime.
We are missing a crucial opportunity to intervene early, which we know is a predictor of better outcomes. In Canada, roughly 1.2 million children and youth have a mental health problem or illness, but fewer than 20 per cent get the help that they need.
Big funding commitments represent promise, but critical gaps remain, and more funding is needed not only to address today’s problems but to look for a made-in-Canada solution. We have innovations to address tomorrow’s problems as the demand continues to rise. That’s why it’s heartening to see programs springing up looking at children’s well-being. An example of that is Ontario’s early intervention program, Better Beginnings, Better Futures, which saves the system nearly 25 per cent in publicly funded services per person. These savings stem from fewer physician visits, and lowered social welfare and education costs.
In Nova Scotia, there is the Strongest Families Institute, which represents similar promising innovations. The commission has proven time and again through its series of making the case for investment that mental health spending pays dividends.
Other early intervention programs like our HEADSTRONG initiative are ways that governments can invest in youth mental health early, at very reasonable cost and yield dividends down the road.
Honourable senators, I would continue to elaborate on the promising programs and practices — and I promise to do so during questions and comments — but I want now to pass the floor to my colleague Dr. Nancy Reynolds to provide you with some different points to consider. Thank you.
Nancy Reynolds, Chair, Child and Youth Advisory Committee, Mental Health Commission of Canada: Thank you, Louise. Honourable senators, child and youth mental health is a collective responsibility. It requires the engagement of parents, educators, health professionals and community organizations, as well as youth themselves.
The mental health strategy for Canada, Changing Directions, Changing Lives, gives priority to increasing the capacity of families, schools, post-secondary education institutions and community organizations to promote mental health among children and youth, and prevent mental illness and suicide wherever possible.
Improving the mental health of young people in Canada will require action on multiple fronts. Action must go beyond health, considering social, cultural, economic and environmental factors. This need is especially pronounced in chronically underserved remote and rural areas, and in Indigenous communities in particular. Indigenous youth die by suicide about five to six times more often than non-Aboriginal youth. This is a generational crisis.
Current innovations, such as e-mental health, have the potential to leverage resources and provide access to information and even some interventions. Evidence-based technology applications will empower youth and families, and enable self-help. National leadership is needed. For our part, the Mental Health Commission is amplifying the voice of emerging adults in informing the child and youth mental health agenda.
The consensus statement on emerging adults —“emerging adults” being the term that they chose in preference to youth — authentically engaged youth from the co-creation of the design of the consensus process through to the final report. It contains many recommendations on the key issues related to mental health for those transitioning to adulthood, a very critical period of time for those experiencing mental health issues.
But the pathway forward is not entirely clear. We lack data, specifically the reliable comparable data sets needed to assess cross-country needs and address them in a meaningful way.
The Canadian Institute of Health Information has done extensive work on this collection. However, to build a solid evidence base for child and youth mental health, we require data sets from across sectors: children’s services, Social Services, education, justice as well as the health data. Cross-sectoral relevant data sets remain elusive and should form the basis of any study into the mental health needs of children and youth.
The Mental Health Commission continues to push forward with some promising innovations, and Louise has mentioned a few, and is striving to support improvements to the current system with the resources available. A recent example is the commission’s suicide prevention partnership with the Government of Newfoundland and Labrador called “Roots of Hope”. This was started just last month, but the project will be rolling out over the next five years and it will include some of the most promising innovations in the field.
The goal is to reduce the impacts of suicide and increase the suicide prevention evidence base and to potentially make this project national in its scope.
Honourable senators, we believe we are at a turning point in our history in Canada. The government’s commitment to addressing mental health, in addition to the commitment to building true partnerships with Indigenous peoples, represent truly promising signals for improving the mental health of our young Canadians.
It’s our pleasure to be here today and to help guide your study. We await your inquiries. We are your commission.
Stephanie Priest, Executive Director, Mental Health and Wellbeing Division, Public Health Agency of Canada: Thank you for the opportunity, senators, to be here today to discuss youth mental health in Canada.
My remarks will outline the Public Health Agency of Canada’s role in improving and maintaining the mental health of Canadians with a focus on our work in suicide prevention.
Let me begin by highlighting the importance of positive mental health as an integral part of overall health. A state of well-being is important for all Canadians to thrive, enjoy life and cope with everyday stresses and life experiences. This is particularly important as well for youth. However, we know that one in three Canadians will experience a mental illness over their lifetime and we’re also seeing some very concerning trends among our youth.
I thought I would give you a few samples from some of our data outlining this. We are seeing less than half of youth ages 15 to 17 reporting high levels of coping. One quarter of students in grade 6 to 12 reported that they had been bullied by other students in the past 30 days. Close to 30 per cent of youth aged 15 to 17 indicated they have a family member who has problems with their emotions, mental health or with drugs or alcohol.
At the Public Health Agency of Canada, we work across the life course to strengthen factors to protect our mental health, such as building resilience and coping skills and reduce risk factors for mental illness and suicide, such as preventing intimate partner violence and child maltreatment.
A life course approach pays particular attention to key transition periods, including early childhood and the transition to school, adolescence and the transition to high school, young adulthood and the transition to independence.
Our work also includes surveillance of mental health and suicide, testing mental health promotion interventions for children, learning what works and why for youth and families in different communities and in different settings, and supporting community-based programs for vulnerable children and parents.
With respect to suicide, we apply a public health approach, which means that we focus on prevention across the entire population and draw upon the knowledge and experiences of multiple sectors.
We know that on average 11 people die by suicide every day in Canada, accounting for more than 4,000 premature deaths each year. Suicide is the second leading cause of death amongst youth between the ages of 10 and 24 years old.
These data are just the tip of the iceberg when it comes to understanding suicide. First of all, not all deaths are classified as suicides and data collection differs across jurisdictions. Existing data on mortality do not tell us about the context in which suicide has occurred and we do not have access to standard real time data for Canada. For every suicide death, there are many more people affected, such as by experiencing thoughts of suicide, attempts or grieving the loss of somebody. Unfortunately the stigma associated with mental health means that many people never reach out for help. There is no single cause for suicide. A combination of biological, psychological, social and cultural factors all play a role. The co-occurrence of depression, anxiety, problematic substance use, exposure to abuse or trauma along with personal, familial and cultural stressors and life experiences can affect one’s mental health and risk for suicide.
We also know that there are key social determinants of health that have an impact and those include housing, education, employment, early child development, access to health care and community self-determination as important factors.
At the Public Health Agency, our suicide prevention efforts are guided by the federal framework for suicide prevention, which lays our guiding principles to align our federal activities in suicide prevention, complementing work underway by our partners. It is underpinned by the Act Respecting a Federal Framework for Suicide Prevention, which came into force in December 2012. Our efforts are focused on three strategic areas or objectives. The first is reducing stigma and raising public awareness. Second, connecting Canadians to information and resources. And third, accelerating the use of research and innovation. We have work underway on all of these objectives.
To give you some examples, we are working with key partners like the Centre for Suicide Prevention as well as people with lived experience in the development of practical tools that will support Canadians on how to talk openly, safely and responsibly about suicide.
We’re also working on supporting Crisis Services Canada to deliver a Canada Suicide Prevention Service which will integrate regional distress lines across Canada and will provide Canadians with suicide crisis service access toll free 24-7 from trained responders in the technology of choice. That would be text, chat or phone.
And then, finally, under accelerating research, we’re working very closely with the Mental Health Commission of Canada to establish a national research and knowledge translation agenda for suicide prevention. This agenda will identify gaps and priorities related to research and knowledge sharing for practical use by communities, researchers and policy leaders across Canada.
We are also working to optimize our existing data and exploring new data sources.
We look forward to providing an update on these activities and our other activities across the federal government in our next progress report, which is expected by the end of this year in December 2018.
In closing, I would like to underline the importance of our collective efforts across the continuum of mental health promotion, prevention and treatment, including early identification and treatment of mental illness.
Really, for these efforts to be meaningful and effective, particularly when we are looking at youth mental health, it is imperative that we engage Canadian youth and people with lived experience in the development and implementation of solutions that are impacting their health.
With that I will leave it. If there are questions at the end, I would of course be happy to answer. Thank you.
Purnima Sundar, Director, Knowledge Mobilization, The Ontario Centre of Excellence for Child and Youth Mental Health: Thank you, Mr. Chair and honourable senators of the committee, for the opportunity to speak with you today.
Since 2004, our centre has been bringing people and knowledge together to support the best mental health and well-being for Ontario’s children, youth and families. At that time, just 14 years ago, it was not uncommon for people to believe that it was simply impossible for children to experience mental illness. As you know, times have changed and this committee can be credited for much of that progress.
In 2006, the Out of the Shadows At Last report sounded the alarm about Canada’s failure to address one of our nation’s most pressing social and economic challenges — the unmet mental health needs of Canadians from cradle to grave. Since then, we have seen an unprecedented amount of public attention directed towards mental health issues and an explosion of dialogue and debate about how to do more.
In 2018, there is no doubt that people are talking about mental health. That’s a good thing, but it has come with an unintended cost to people, communities and systems. Our experience in Ontario suggests that those long overdue conversations have left already under-resourced services buckling under the burden of increased demand, as my colleagues have already mentioned. They can’t keep up and we have to do more, but perhaps more importantly, we have to do better.
We sit here before you as a centre of excellence. We have supports research, innovation, evaluation, learning and engagement activities that have helped to bring the child and youth mental health sector forward by leaps and bounds, but excellence across the system still remains elusive. So we need to be able to define excellence. We need to be able to measure excellence and we need to make sure that everyone supporting the mental health and well being of children and youth have the tools and resources they need to relentlessly pursue excellence. That takes an investment — an investment of time, money and attention.
Mental health challenges among children and youth serve as a barometer of the overall mental health and well-being of our families and communities. The personal, social and economic costs of inaction are enormous, but the return on investments in this area will pay dividends for generations to come. When it comes to investing in child and youth mental health, the possibilities are endless, but we’d like to talk about four strategic opportunities that, with government attention, can clear the path towards excellence.
We need to invest in children. We need to invest in data. We need to invest in quality, and we need to invest in innovation.
You’ve heard the statistics. About 70 per cent of lifetime mental illness emerges before the age of 18, but 50 per cent of those begin before the age of 14. We know that getting our smallest people off to the best start in life and intervening early when troubles arise is our best chance at promoting lifelong health and reducing long-term costs to individuals, families, communities and service systems.
There’s been a lot of great progress in recent years in the area of youth mental health. However, our recent experience suggests that even that may be too late. Early childhood is when brains are built and the window to the future is wide open. It’s a time when anything can happen, good or bad. When we do infant and early childhood mental health well, we change the face of the entire system. It is the foundation of an effective, efficient and accessible system for everybody. A system that does not systematically support infant and early childhood mental health is failing to adequately promote lifelong mental health. By reducing risk factors and promoting resilience in the smallest Canadians, we can reduce the need for costly intensive services later on and nurture the next generation who are well poised to lead our nation to a healthy and prosperous future.
As my colleagues have mentioned, it’s also time to invest in data. Mental health may be out of the shadows, but most service providers, particularly those who serve children, youth and families, are still operating in the dark. You’ve heard a lot of statistics today and we use them too. But the truth is that the data available is often out-of-date, or obtained from regional studies conducted using inconsistent measures and definitions. In Ontario, we are proud to be part of an ambitious initiative to modernize the child and youth mental health data and reporting systems in the province.
To define excellence, we need to measure what matters, and governments need data to make evidence-formed investments. Communities need data to plan and implement integrated services and agencies need data to understand who they’re serving, if they’re helping and how to do better on a day-to-day basis.
We need consistent and integrated systems that support continuous quality improvement from the front line all the way to the PMO. Our centre recently examined how prepared Ontario’s child and youth mental health agencies are to collect, manage and use data to shape a service system that delivers results for the children, youth and families that they serve. The good news is it’s clear that there is universal support for the need to use high-quality data to inform service planning and delivery. Unfortunately, we also learned that agencies do not have the right infrastructure, people or processes in place to succeed.
So it isn’t just about technology. A data-driven system also requires people with the right training and time to make it better. It’s also time to invest in quality. We know that only a small minority of children and youth who need mental health services actually receive them. Current estimates are in the 20 to 25 per cent range. Unfortunately, even for those accessing services, there is no guarantee that the interventions provided are effective or based or on the best available evidence. Canada needs a universal understanding of what works for whom and why.
Evidence-informed services are based on the best available research evidence enhanced by expert wisdom and judgment of clinicians and respects the individual needs and preferences of children, youth and families. While one size may not fit all, there are evidence-based, effective interventions that should be available to all Canadians. We need a national register of interventions that are effective in the Canadian context, coupled with a comprehensive system, to ensure clinicians and agencies have what they need to implement them.
Finally, it’s time to invest in innovation. We need to identify pockets of excellence and nurture them. Canada doesn’t have an innovation problem, but we do have a hard time sustaining innovation long enough for Canadians to reap the benefits. In child and youth mental health alone, there are numerous examples of small-scale initiatives delivering big results for the people who have access to them. To grow excellence, innovators need access to resources to spread their discoveries and deliver programs and models that work to more Canadians.
An effective child and youth mental health system requires applied, not just theoretical, research. Children, youth and families facing mental health challenges need help now, and bridging knowledge gaps with immediately relevant evidence is crucial.
Thank you very much for your time and consideration of our perspectives. We certainly look forward to the conversation ahead.
The Chair: Thank you very much to all of you. Let me, if I may, start off with the first question because I want to zero in again on what is useful for this committee now to do, because you’ve given us a lot of very shocking statistics. We’ve heard some of them before. You can give us more. There is a lot of work you’re doing, good effort you’re putting up, but there is a lot more that needs to be done. I need to know what are the specific gaps, either in knowledge or in action.
Regarding knowledge, we certainly heard quite a bit about the data gap. In knowledge or action, it needs to be pursued in order to improve the services and access to the services for youth. Can you further comment on that so we can zero in on what this committee can usefully do in that regard, to complement and supplement what you’re already doing. Who wants to start with that? I’ll go to Louise Bradley.
Ms. Bradley: I’ll start with some general remarks and leave it to the experts to give you some further ideas.
I want to point out the great need for innovation and creativity. To keep providing the same services in the same old way will simply not work. Having said that, there is a funding gap in Canada. Canada spends the least amount of health dollars on mental health of any developed country. In Changing Directions, Changing Lives, the mental health strategy for Canada, we have called for an increase in funding from 7 to 9 per cent, which is pretty modest considering that countries like the U.K. and Australia spend between 12 and 14 per cent.
I applaud this government’s attaching mental health funds as part of, dare I say, the accord agreements for each of the provinces. I think that was absolutely necessary. My experience as a hospital administrator over the years has been that you have to fight for dollars within health care. When you’re at the budget table and you’re looking for funding for mental health or a Da Vinci robot for the OR, you can bet it is the robot that is going to get the funding.
I think this recent effort is certainly a step in the right direction, but I referenced in my remarks the cost for investment which is on the commission’s website, or I would be happy to share with each of you. All of the evidence is there which speaks to a level of structural stigma.
For the purposes of this committee here, I wanted to point out there is a strong funding gap. Until that gap is reduced, I think we are going to continue to see the need for services grow more than it already has.
Ms. Sundar: In Ontario, in order to understand how we’re doing, people need to measure things in the same way. They need to have consistent tools and measures. That’s the only way we’re going to understand what our current state is so we can assess whether we’re getting better or we need to improve. Right now, things are being measured inconsistently and with different tools. There is a lack of alignment in how often those tools are used, and so on. I think investment in an infrastructure that allows everybody within the sector to be measuring the same kinds of outcomes, using the same tools, will give us a good picture where we are now so we know where we go next.
Heather Ennis, Manager of Communications, The Ontario Centre of Excellence for Child and Youth Mental Health: Concerning your question about the gaps, at a more fundamental level, I think it’s really difficult to understand and quantify the gaps unless we have the data at this point. Right now, the number one thing I think in the short term would be for us to figure out where we are. That’s a tough thing right now, given our current systems, our data and the way that we understand information.
In the long-term, I’ll refer to what Purnima was talking about in regard to infant mental health. That is a long-term strategy to change the face of mental health in Canada. If we can support a generation that doesn’t require the same level of intensive services that we need to provide right now and frankly aren’t able to, I think that’s a long-term strategy that we really need to look at.
Ms. Reynolds: I would reinforce the need for the data piece and to put us in a place where we understand what we have to be able to join up work across the country. There are great pockets of work and innovation that are going on, but we don’t have strong mechanisms to bring those pieces together and to create some synergy across the country. Again, part of that is because we don’t talk the same language in terms of data or how we collect data and how we move that forward. It’s really critically important.
The other area in terms of infant mental health that is rapidly becoming part of the dialogue is understanding adverse childhood experiences; that is, the impact of adverse childhood experiences on the developing brain. We know that this is a very key feature moving forward. We need to understand what we can do to prevent those kinds of experiences that really will create mental health challenges for those children moving forward. They also create intergenerational challenges. If we ever want to get in front of this, we have to begin to look at the intergenerational transmission of trauma.
Ms. Priest: Actually, that was almost what I was going to say, but you said it much better than I did. It strikes me that there are all kinds of great pockets of work. We see that in public health as well. We keep having the same conversation about how to connect it, how to scale it up. We have, in the Public Health Agency, a program that is looking at studying scale-up for mental health promotion, but it’s also understanding why things don’t work as well.
So as far as collecting data, I think there’s data that we look at as far as surveillance data and use of services data, but there’s also looking at our experiences in some of our programs and really starting to look at them to see what works and why they work, not just that a program worked, but why didn’t a program scale properly? What are the conditions that we need to be looking at for successful scale-up of effective mental health interventions?
My second point — and Nancy kind of covered it a little bit as well — it strikes me that one of the challenges is trying to find the right balance of where you put your investments and your capacity from the perspective of access to mental health care services and treatment, which, of course, are critical for people who are in crisis and in need, going into early intervention, which we know can change trajectories. Then, as my colleagues here are talking about, looking very upstream with infants and a good start in life.
The real challenge that I see is when you’re faced with, I’ll say, a dollar or $100 and how you make that decision on how much of your investment you put into accessing treatment versus how much you’re investing in the long term and where you find the right balance is a question that I haven’t really seen answered anywhere.
I don’t think there’s an easy answer, that it’s 50/50 or 60/40. I think there are some conditions that probably we would have to look at, and it is a question, I think, even internationally, that we’re hearing about. If we’re ready, we’ve had all of the conversations. We’re starting to get the better data. We have an idea of what we want to do. There’s another step there going forward to actually getting an intervention off the ground, scaling it up and measuring the kind of impact it has.
Senator Seidman: Thank you for being here to help us with this kind of brainstorming.
In fact, my question was very much the type of question that our chair just posed to you. I’d like to take that a step further, if I might.
I know that anything to do with health, given all of the jurisdictional issues, is rather complex for us at the federal level, but this committee has done some very meaningful work in the health field, be it the mental health issue, the pharmaceutical issue, obesity, dementia. So here we look at the whole issue of child and youth mental health.
It’s an opportunity for us to say to you and really put you on the spot — at least this is how I see it — if you were sitting at a brainstorming session and someone said to you around the table: If you could dream up the best possible study that would really help the Canadian scene in child and youth mental health right now, what would that study be? What would that study look like from a federal legislator’s point of view?
Just sort of think about it for a moment. Think of your favourite subject or how you might attack it or what that would be. What would it be? What would your study objective line read, for example?
Ms. Sundar: I think that, for me, it really is about a longitudinal look at where young people’s lives are going. We talk a lot about the importance of investing in early years, but really understanding the full impact of that investment I think would be really helpful in maybe shedding some light on what you referenced, Stephanie, around understanding where best to invest. So what percentage of dollars do you invest at the early years, and what is for later on.
I think, for me, a longitudinal study would be really important and also one that draws data from across boundaries. Young people, we all know, live their lives not just in one sector. So it’s really important for health, education, community-based child and youth mental health and so on all to be collaborating. Right now, in our province, we have multiple lines. So boards have different lines. Child and youth mental health is focused on different lines. So aligning all of those and making sure that the young people are the focus and not necessarily the boundaries and so on. That is not necessarily as clear a research question, but I think that might be the approach that I would want to take.
Ms. Bradley: I’m not going to answer your question. I’ll probably just add more to the complexity of it. But you did mention, at the beginning of it, that it’s very difficult in a federated system, and I know that, when we were writing the mental health strategy for Canada, we were trying to think of ways to figure out, “Well, how will we know if this has improved?” To my colleagues’ points about collection of data, it’s really difficult. I’m not exactly sure; I think there are ways, if somebody was given the mandate and the challenge to do it, to be able to collect data across the provincial-territorial boundaries. Because, otherwise, you’re not even comparing apples and oranges. I don’t think they are even in the fruit category.
So it’s really difficult. We said to provinces at the time, “We’ll collect data.” They said, “Yes, we’ll give you data.” Then it was, “Oh, but you’re not going to produce a report and compare us with the province next door.” So we couldn’t get them to agree to it. So it’s very difficult to do that. Until we can find some way around that, it’s really going to be hugely problematic.
Ms. Priest: To your question of what it would be titled, I don’t have a good title, but maybe, at the end of our brainstorming today, something will come.
I think I would recommend that you take a very comprehensive look. Sometimes what happens is that we focus in one area of mental health, not looking at the role of the social determinants of health and the impact that that has on youth, on childhood development, on our life course.
I think that’s a really important piece that we miss. To your point around what the role is at a federal level, recognizing that we don’t have all of the levers, but there are levers and particularly if you start to scope out and look at what the roles are of some of the other social areas at a federal level that maybe we haven’t thought of before with respect to how they may be improving income or how they may be improving housing and coming back to my colleagues here talking about data. Are we able to look at data or the impact on mental health of our youth and kids in some of these other large programs? It’s a question mark. I’m not saying that would be easy, but it may be a way to start looking at mental health more comprehensively, not just at the federal level but at all levels of government, because I think there’s a real opportunity not only with our provincial and territorial colleagues but municipal colleagues as well. There’s a lot going on at a city level with respect to mental health in our environments and our built environment and our social programs that are around us.
So that’s not ours, federally, but I think that, together, we may be able to get a more holistic approach that might be a little different than what’s been done before.
The Chair: Good points.
Ms. Reynolds: Just actually building out on that a bit, one of the things that I think is critically important and where there is an opportunity and a need for federal leadership is around being very clear about what our shared outcomes are in this area, what then become the performance measures and indicators that are going to help us move forward. Without that shared language, without that shared sense of direction, it becomes very difficult to unpack many of these complex issues.
When I say “shared outcomes,” for me that’s not just about the health system. What are the outcomes that are meaningful for youth? What’s meaningful for families? What’s meaningful for communities, schools? Everybody has a place.
I think when you can start talking about those shared outcomes, build a language around the data and start building the capacity to collect the data, then you can really begin to have a dialogue about where we need to be investing, what’s the difference we are making, and how do we move forward together around such a significant issue for our young people and our families today.
Senator Petitclerc: You all talked about data and outdated data. I want to focus more in that same direction but I want to hear about research. I think you mentioned that 14 years ago, people didn’t even think that youth mental health issues existed. So I’m guessing that a lot of the research that has been applied comes from studying adults and we apply it to youth, or maybe we don’t have enough age-specific research. Is that correct, or is that an area that would need some focus? I don’t know. Who wants to answer that question?
Ms. Reynolds: I’ll start, but I’m sure others have contributions to this.
There certainly is an expanding evidence base around child and youth mental health. One of the big challenges is that often the research is not well joined up. Again, it often is not bringing together the social sector, the education sector, the health sector. Even at a research level, the researchers tend to take a relatively narrow scope to the question. And that’s important, certainly, for getting gold standard evidence, but we have a need to understand what are some of these more collective impacts.
I wanted to mention that there are two examples of joined up data across sectors, data sets available. In both Alberta and Manitoba, there are data labs that basically acquire the data across different sectors. It’s anonymized but linked. It creates an ability to begin to do retrospective longitudinal analysis where you can begin to cut that data and take a look at the policy impacts that can happen. It’s a very powerful pool. It’s very complicated to put together, but the information that you get out of that is really significant and would help advance.
One of the challenges with the research in this area is that, again, it is very difficult for the researchers sometimes to get the data. So there is a bit of a chicken and egg as well.
Ms. Sundar: I can echo what Nancy said about the growth and knowledge now specifically related to child and youth mental health. My area really focuses on how you get that research into the hands of the people delivering the service. That’s where the gap is.
The evidence exists. It’s just not digestible for many of the people who are working on the front lines. We’re investing a lot of our energy in making research that can sometimes feel very academic, very full of jargon and distilling it into the practice elements that people need to understand as deliverers of service. It’s also taking into account the experiences of the young people and families who are receiving those services, and having their experiences shape further research questions.
So it’s making sure that the research is generating practice change and that practice change is being evaluated, and what we’re finding from those evaluations is now informing new research questions. It’s an ongoing kind of cycle.
Senator Petitclerc: To put it in perspective and define how important that possible study could be, you mentioned that suicide is the second cause. I want some perspective. What does that mean internationally and maybe more generally, with youth and mental health, are we better than other countries? Are we worse than other developed countries? Is it standard? Perhaps give us some perspective on that.
Ms. Priest: I’ll start on that. I don’t have the comparators for youth across other countries, but one thing I can say about our data on suicide, first of all, is that it’s way out of date. So by the time the data is available, whether it’s through community health surveys or vital stats, it’s usually about three years out of date. But if you look at the trends, our trends haven’t really changed in suicide at a national level. It’s not looking at specific populations where we know that that may be changing but at a national level, it has stayed pretty consistent.
What you’re starting to see in some of our data on youth is the second leading cause of death only to motor vehicle accidents for kids. So as interventions for motor vehicle accidents are changing that rate, you’re starting to see a trend potentially moving suicide up. How that compares with other countries, it’s hard to say. I don’t have that data. I don’t know if my colleagues do.
Ms. Ennis: I don’t have it here. It does exist, and I have seen a few things on it but I hesitate to say something out loud right now out of fear of it being wrong.
The Chair: If you have any information that can you find later, please send it to the clerk.
Ms. Ennis: I did see something recently where something had changed, actually.
Ms. Sundar: I have one final addition to what you’ve shared, Stephanie. We know that prevention is important and we hope prevention works. It’s really difficult to measure the extent to which investments and prevention are preventing suicide because you can’t measure something that hasn’t happened. We hope it doesn’t happen.
That’s another data-related issue where we need to figure out how best to measure preventive efforts.
Senator Poirier: Thank you all for your presentations. I have a couple of questions. The first one was on the presentation of Ms. Bradley. In your presentation, at one point you mentioned that for people to get treatment, there could be a wait time of up to 18 months. In the paragraph below, you talked about roughly 1.2 million children and youth have a mental health problem or illness but less than 20 per cent are getting the help that they need.
That rang a bell for me, sadly, because I thought if we have 20 per cent and they’re waiting 18 months, obviously if we would have 50 per cent or 30 per cent or 40 per cent, by the time the wait time would come, have we already lost them? That’s really scary, when I think of that.
Why the 18 months? Is it because it’s a lack of funding to pay the people, or is it because it’s a lack of the trained expertise out there to be able to give the service to the people who need it in mental health? And compared to urban and rural Canada, is there a difference in the wait time? I’ll round that into that first question.
Ms. Reynolds: That’s a very good question. I think it’s a combination of all of the things that you have outlined. There’s a huge shortage of psychiatrists in this country. Ontario is the first step up to the plate to look at funding for psychological services because we have a huge group of people who aren’t covered under the health plan.
So it’s a combination of not having enough within the scope of the health plans, and it’s also, as I mentioned in my remarks, a way of innovation. We have some e-mental health programs. I know the commission is looking very closely at some of those. For example, the one I mentioned, Strongest Families in Nova Scotia, has cut down on the wait time dramatically. It allows families who have children with difficulties to be able to access help and support at their own time without having to take time off work, and it’s been evaluated and shown incredible results. It’s been replicated in a few provinces, not all. It’s being replicated in New Zealand, but not in all provinces.
So it’s a combination of the way in which we are doing business, the numbers of professionals not taking advantage of things like peer support services and other innovations like e-mental health. So it’s a combination. Others may wish to comment on that.
Senator Poirier: I’m also Deputy Chair of the Official Languages Committee. One of the things we’re hearing is that accountability, transparency in the federal transfers can be an issue. From what we’re hearing from the other committee, they often question whether the federal transfers for French education going into the provinces have a lack of accountability and transparency. The provinces receive the funding, but there’s no way to know if they’re using it for the designated purpose that it’s supposed to be used for. Are there any transparency or accountability issues or measures in place to know if you are getting the amount that you should be getting for mental health funding and if it’s going to where it needs to be going?
Ms. Priest: My short answer is I can’t answer that question today, but I could take that back to the department and see if there was an answer for you.
Senator Poirier: If so, could you please provide it to the clerk of the committee? Are the transfers that are being made from the federal to the provincial, if the provinces are actually giving it to you and if there’s a record of the accountability?
Ms. Priest: That’s an excellent question.
Senator Poirier: Thank you, chair.
[Translation]
Senator Mégie: I’m going to ask my question in French, but you may respond in English if you wish.
I’d like to draw your attention to a specific issue that is having an impact on the data. Owing to certain taboos, some parents do not want to take their children to see a professional out of fear that they will label their child as having a mental illness. I am not sure whether you have heard about that. Are there ways to reach those children, either in school or at home? If not, is it something the commission could look into? It’s a phenomenon I’m hearing a lot about.
[English]
Ms. Bradley: Again, that is also a very good question, and a difficult one. We already know the impact that stigma is having in terms of the general population in Canada not seeking help because of the stigma and discrimination associated with it.
I think when you compound that with diverse populations, the difficulties are growing exponentially. This is true for children and youth as well as adults. It is an area that at the commission we have begun to look at in the last couple of years, working with diverse populations and trying to understand what some of those cultural taboos are. They are very real. It makes it exceptionally difficult. Not only that, if you do get somebody to a centre where they can get help, it’s probably not going to be in the language that they understand.
It’s wonderful that we are seeing so many immigrant refugees, ethnoracial people in Canada, but when you’re looking at providing mental health services to them, it already is a huge problem. We’ve just begun to look at it. We have a wonderful advisory committee that’s helping us from different cultures and populations, but it’s not going to be an easy fix for sure. So it’s a very relevant topic that you raise.
Ms. Sundar: I can respond. We know it’s an issue. In terms of crafting a response, there really needs to be an engagement with those cultural communities to try and really understand how best to support young people but in a way that’s culturally respectful, that actually partners with faith communities, partners with cultural groups and leaders within those communities.
For young people who are growing up in this kind of environment, as second-generation Canadian youth who come from racialized backgrounds, it’s a unique situation because you’re growing up as a Canadian, but also experiencing a cultural history that is very well entrenched in your family.
There needs to be different kinds of solutions. I would see an investment in that kind of research or in those kinds of practices to try and understand how best to partner with those communities in supporting their youth. When you meet people in a partnership, you remove some of the barriers and that can sometimes remove some of the stigma as well.
Senator Omidvar: Thank you all for being here.
I want to focus on a demographic group within young people, and that has to do with their experiences of race and racism. We know the correlation between race and health. We also know the correlation between racism and mental health. I wonder if you have evidence that you can cite to us. I wonder what you think can be done and by whom. I wonder if you can tell us what this committee should do precisely about that particular question.
Ms. Sundar: My own area of research years ago was in this area around second generation young people who are racialized and how they move within systems in mental health in particular. One of the things that I found that was really interesting was that young people are incredibly resilient. If you give them the opportunity, they will rise to the occasion and they will deploy different strategies based on what’s required in this situation.
Any kind of intervention with practitioners needs to respect the fact that young people aren’t just their race. What I heard in the past from practitioners is that you really need to adapt your service to that particular cultural community. Understanding one particular cultural community and then deploying a particular set of practices isn’t really the answer because individuals are unique and their race and culture and their language and their agenda and their sexuality, all of these different factors of their identity are at play, including their mental health. An approach that is attending to all of the different elements of their identity is critical. At the centre we’ve adopted an anti-oppressive approach to practise and we work to support agencies to use an anti-oppressive approach.
That would be one of the strategies that would be used. I do think there needs to be a deeper understanding of the specific experiences of young people because racism is most definitely something that young people say that they experience when they’re seeking mental health services, and when other elements of their identity intersect with that like their gender or their sexuality, that becomes even more problematic. Pair on top of that the stigma that they experience within the home or within their other communities, it becomes very messy.
Anything that focuses specifically on that individual and tries to address it using an anti-oppressive lens is a really important way to approach things.
Ms. Bradley: I think you have the wrong group here to answer that question. You may have already done this, but I’m a firm believer in something we utilize as a principle throughout the commission, hearing from people with lived experience. I really think that asking people who are in that position, you will get a very different kind of answer.
If we can be of help in doing that, we have the most exuberant youth council at the commission, and from diverse backgrounds as well. We can help with that. If you haven’t done so already, I would really encourage that.
Senator Omidvar: The anti-oppression lens that you use, I was going to ask you to explain it, but I won’t because so many other senators are asking questions. Could you send us a reference to that lens for our committee work?
Ms. Sundar: Yes, absolutely.
Senator Omidvar: That will be helpful. Thank you.
Senator Dean: Thank you for being here. I have a couple of questions, one I should think will be relatively easy. Can you tell us about the global annual national spend on mental health services in Canada? Could you also give us an indication of what the cost of inaction is downstream of not treating mental health in childhood?
While you’re thinking about that, the second one is you talked about lighthouse examples of innovative programming in this area. Could you give us a sense of the indicators of success in those lighthouse examples? It’s something in which I’m particularly interested.
Ms. Bradley: I’ll try to address your first question. As I mentioned — I think this is what you’re referencing, but if not, please stop me — Canada does spend a good deal less on mental health than other developed countries.
The case for investment, which I would be happy to send you either copies of or the link, we used a modelling approach, which was able to show us that in 30 years’ time what it would cost us to do nothing. It also shows that one small intervention, particularly with children and youth, can have quite a dramatic impact.
If you want somebody to come and speak to you about those documents, I would be happy to provide that for you, but it answers that question about the cost of inaction.
Now it costs Canada over $50 billion every year in lost productivity and so forth. In 30 years’ time, we’re looking at trillions for doing absolutely nothing. That document speaks quite well to it.
Senator Dean: Could you select a lighthouse example and tell us about that? Pick one of those innovations and tell us what made a difference in that situation. You talked about it being difficult to scale up. I don’t want to hear about that. I want to hear what made one of those innovative examples innovative and what were the success factors and why was it successful?
The Chair: Who will tackle that?
Senator Dean: If you want to follow up with paper later, that’s fine. It is a question of interest.
Ms. Priest: From the Public Health Agency of Canada, we can follow up to provide you with some examples of some of our mental health promotion programming under our innovation strategy. It might be helpful to give you that as a take-away. They are small programs in some ways but their focus is studying the scale-up. And some of them are working particularly in a school setting. I would be happy to send you an overview of that.
One example, though, as you asked is the fourth “R,” which is a well-known program in schools that is looking at relationships as the fourth “R,” taking a program that was in Ontario and looking at how this program could be scaled up and adapted in different provinces and potentially in different groups.
I would be happy to provide some information about the conditions for the successful scale-up and what they’ve seen in the program. I can share that with the committee if that would be helpful, just in the interests of time.
The Chair: Yes, that would be. Thank you.
Ms. Priest: And there are some others that we all have as well, I’m sure.
Senator Dean: The scale-ups are interesting — the success factors — but I would like to learn about some of the innovations themselves, the micro-innovations and what made those successful.
Ms. Bradley: One that comes to mind for me are school-based mental health programs, and that is providing mental health services right in schools. There is a very good example of that in New Brunswick. There is an integrated school program where they’re not only working together, but they’ve actually joined together the various budgets for education, for social services, for health care, and they’ve combined the budgets. That’s a pretty brave thing to do. People like to hang onto their own budgets. But the integrated school-based program they’re doing there is one example that I’m aware of that I think is really well worth taking a look at.
Senator Dean: The right thing to do but a necessary thing to do when we’re breaking down silos.
Ms. Bradley: Yes.
Senator Bernard: Thank you all for your presentations. I have a couple of questions that are linked to questions my colleagues have asked. I’d like to go a bit further with them.
Senator Dean was asking about innovative programs. I’m thinking about trans-youth and Indigenous youth as examples. When you’re giving us examples, if there are any particular programs that are reaching those communities that have such a high suicide rate it would be useful.
The other point picks up on Senator Omidvar’s comment around race and racism and the impact on mental health. You, Ms. Priest, talked about social determinants of health. Racism isn’t listed as a social determinant of health. Do you think it should be?
Ms. Priest: Excellent question.
Senator Bernard: Let me rephrase the question.
Ms. Priest: Okay.
Senator Bernard: Are there any arguments for or against making it a social determinant of health?
Ms. Priest: That’s an excellent question. I’m thinking about how to answer that because I’m trying to think of an argument against making it a determinant, but to be frank, I would have to bring that back to some of the experts in the field around that. There may be elements that I’m not aware of but it’s thought provoking to me.
Senator Bernard: There has been research done suggesting that racism is a social determinant of health, but I would like to hear the experts who are working in this field speak to it.
The Chair: You said you would get back to us.
Ms. Priest: I will take that back as well. Within the Public Health Agency of Canada we have a team looking at the social determinants and also looking at how you measure disparities in health and some tools that we’ve recently developed with respect to looking at disparities, including in mental health and suicide. I would have to get back to you with respect to whether they’ve disaggregated that and what their views are on that. That’s a good question.
Senator Bernard: That’s one of the other points I wanted to raise is around this aggregated data. A couple of you referenced Indigenous youth in your presentations, but I didn’t hear any other disaggregation of data. I don’t know if that’s happening. If it isn’t, do you think it should be, and how would you make that happen?
Ms. Ennis: I’m not sure I am going to answer your question, but I wanted to talk about a project that we’re excited to be involved in in Ontario that might start to give us some of the information we’re talking about right now. You may have heard of it, but it’s the Youth Wellness Hubs Ontario project. I’m not going to be able to say a ton and I’m happy to follow up with you but the announcement has not yet been made on this project. But it’s an exciting project cross-ministerial between the Ministry of Health and the Ministry of Children and Youth Services, which in Ontario that’s the awkward bureaucratic funding line where child and youth mental health services are funded by the Ministry of Children and Youth Services and everything else is funded by the Ministry of Health, so a different ministry altogether.
They are working together on this project to build a suite of wellness hubs across the province, regardless of geography, where services for young people aged 12 to 24 will all exist under one roof. That’s social services, housing, community services, mental health, primary care, with all youth services in one place. The interesting thing about this project is since the beginning there has been an expressed and very deliberate emphasis on making sure that issues of equity seeking communities are addressed because it’s a research project as well.
So Indigenous communities and francophone communities in Ontario are equity-seeking groups as well as racialized communities. So it’s an express priority to generate some information about how these services can work in those communities. So there are no answers. It hasn’t started yet.
Senator Bernard: I walked back into memory lane this evening because I worked in children’s mental health 40 years ago. It was a residential treatment program. The intervention itself was traumatizing. As a social worker, I was always very frustrated about the way we were doing business. A lot of the issues you’ve raised tonight are issues we were looking at 40 years ago.
We tried to do a lot of work with parents. I have not heard you mention parents. In addressing children’s mental health needs, parents and caregivers are a necessary component of that. In fact, in the work that I’ve done over the years, children’s mental health issues often lead to family crisis issues and to those children ending up in foster care and group home care. For many of them, they transition into the criminal justice system. Can any of you provide suggestions on how we can intervene more effectively and in a more holistic way with families?
Ms. Sundar: Our centre has worked in close partnership with an Ontario-based parents’ group called Parents for Children’s Mental Health. They’re an advocacy group that focuses on working with child and youth mental health agencies to promote family engagement. Our centre has brought the research-evidence-implementation-evaluation lens to what is growing as best practices in family engagement.
We’ve co-developed a model with families to support agency providers to view parents really as they should — as experts in their children’s lives and mental health and key players in supporting their mental health. So not seeing the parent as either interfering or external to the client relationship when you’re doing child and youth mental health service provision but seeing the whole family as the unit of focus and focusing specifically on how best to support families to be engaged in their child’s treatment planning and recovery and so on.
So family engagement means engaging with families at all levels of a child and youth mental health organization, from the treatment level all the way to governance and policy-making within the agency. We know that family voice embedded at all those levels promote positive outcomes for children and youth.
Ms. Bradley: I would like to comment briefly on that. It’s extremely important. I mentioned Strongest Families out of Nova Scotia which does an extraordinary job. They work totally with families of children. As I mentioned, it allows people to be able to keep children with parents and for them to provide the interventions themselves. So it’s a superb program.
Senator Bernard: I will have to look at it.
Senator Petitclerc: I have a quick question. When it comes to stigma and youth and mental health, do we do enough in terms of education and awareness, for example, in schools? You spoke about the family a bit. Do we do enough? Do we have enough money to do it? Is it happening? Should it be happening?
Ms. Bradley: Thank you for asking that question. I’ve been hoping somebody would.
We have a program called HEADSTRONG, and it was developed on the basis of the research that we started 10 years ago. One of the areas of our mandate was to study stigma and discrimination.
So we picked four target groups. One of the groups was children and youth. More out of necessity than good thinking at the time, we thought maybe there are some anti-stigma programs that already work. So we put a call out, and we were amazed at the response. We then proceeded to evaluate them because a lot of things sounded like they were great ideas, but we didn’t know if they actually worked or not.
The one that we found that consistently worked for children and youth is called “contact-based education.” That means that I, as a nurse, could give you the signs and symptoms of depression. I can also say, by the way, that my experience has been as a person with lived experience and delivered in a certain way. That has the longest-lasting impact.
So we took that information and developed a program that the youth themselves called HEADSTRONG. About four years ago, we brought together youth from high schools from every single province and territory for a week. What we did was exposed them to other kids that had mental illnesses. Then we equipped them with a toolbox that they could take back to their respective schools. Some of them did amazing programs in reaching out to other kids.
There are now over 200,000 kids that we have reached. We don’t have funding for it. So the answer is no, there is not enough funding. We are now reliant on getting funding from other provinces, school systems, businesses, sports and that sort of thing. So we do have something that works, and it has actually created a bit of a spiderweb across the country.
We would love to see it grow. It is something that has proven to actually reduce the stigma around children and youth, and it is an excellent program.
Ms. Sundar: I want to highlight something that is happening in Ontario. There is an initiative called School Mental Health-Assist. It’s important to reduce stigma and improve awareness among students themselves, but the educators living with these students every day also need support because they were trained in schools to be teachers, not necessarily mental health providers. But if we are looking at the whole child, we need to acknowledge that mental health surfaces in schools.
School Mental Health-Assist is a partner of ours. They are funded by the Ministry of Health. We’re funded by MCYS. But we work in partnership to ensure the same kind of language is being used and to support the implementation of evidence and form practices in the schools. So School Mental Health-Assist really does focus on ensuring that everybody in a school setting understands some level of mental health knowledge, and then a certain segment, who actually are specific teachers or school social workers, have a bit more of a deep dive into that content knowledge and that they’re at the top tier. There are some people that are trained to deliver very deep and more sustained mental health supports.
It’s a tiered model that focuses on general awareness, literacy and expertise. Again, we partner quite a bit on youth suicide prevention activities and also to implement different evidence-based practices within a school setting that we know work in the community as well.
Ms. Ennis: I wanted to speak on the notion of stigma within the youth population as well.
One thing that I don’t think we’ve heard anyone say yet today is we’ve asked young people, time and time again, whom they talk to when they’re experiencing distress. While we’d love to say that they would say their family doctor or their mom or their school counsellor, the fact is they’re not talking to any of those people. They’re talking to each other.
So when you’re talking about stigma efforts, I think there is a real need to pay attention to where those messages come from and that young people are going to listen to them. We have pretty clear evidence that says that they’re listening to each other, so we need to arm young people with the information and supports that they need to be able to support each other.
Senator Poirier: Again, in one of the briefings here that we received, it was mentioned that suicide is the second-leading cause of death among youth between 10 and 24. At another place in the same briefing, it talked about there being no single cause for suicide and it’s a combination of many different things. You’ve listed them all there.
Then, again, I notice that you mentioned that close to 30 per cent of youth ages 15 to 17 indicate that they have a family member who has problems with emotions, mental health, drugs or alcohol. So it seems to be a combination of many things.
Knowing that, I’m just looking to see if I can have your thoughts on whether you have any concerns. We’ve heard a lot lately about the risk for youth under 25 with using cannabis, and I’m just wondering what your concerns are, or even if you have any concerns, and if you think there could be an increase in mental issues because of the cannabis issue. If yes, are we prepared to deal with it, and do we know how we’re going to deal with it?
Ms. Priest: With respect to cannabis, it is an area where we are working quite closely with our colleagues across government, particularly in public health around public education, starting with the facts with respect to the impact on a developing brain for kids under 25 and what kind of messages need to be in place for that population.
Coming back to the comments that Heather made about where youth get their information, a big part of that work is ensuring that youth are engaged in that messaging and that any kind of messaging that might be developed by government is in collaboration with and developed by youth.
So we are looking at public education. There has been work undertaken looking at low-risk cannabis use guidelines and how you would take those guidelines and make them accessible or translate them into useful information for youth, but also for parents. That’s work that is underway.
I’m turning to others on the panel here, if you would have anything more to add.
Ms. Bradley: I really do have concerns, having worked as a clinician over the years, that in youths 17 to 25 who have first break psychosis, it is often as a result of the use of cannabis. I don’t have the expertise to state whether it causes it, but it certainly exacerbates it.
That is why we were delighted with the announcement yesterday in the budget. The commission has just received $10 million over five years to look at the effect of the legalization of cannabis on the mental health of Canadians, and I’m pretty sure, even though it’s not been 24 hours yet, that we will be looking at that particular group — youth and teenagers.
Senator Poirier: Regarding cyberbullying, we know that is becoming a bigger issue with our youth that, and it’s an issue with the social media, and it seems to be getting bigger and bigger.
In your notes you said that among the students from Grades 6 to 12, a quarter reported that in the last 30 days they had been bullied. And we’re hearing more about cyberbullying.
How can the government better help you to tackle the issue of cyber-bullying? What is successful? What has been done? What needs to continue to be done to deal with the speed at which this is going right now?
Ms. Bradley: I can’t answer that question, but I am wearing pink today because it is anti-bullying day. Beyond that I can’t contribute, so hopefully my colleagues can.
Ms. Priest: I think it comes back to some of the things we’ve said across our panel at the beginning with respect to not looking at some of these issues in silos. What is going on with respect to some of the root causes, whether they be risk factors or protective factors, that are impacting our youth and youth behaviour, including cyberbullying and problematic substance use? We’ve talked about cannabis and others.
We are looking at the Public Health Agency of Canada and some of the work we’re doing across the federal government on addressing gender-based violence, including teen dating violence. We’re going to be exploring that with respect to some of our programming and trying to understand what kind of interventions are working.
I don’t have a succinct answer for you except to bring it back, as I said, to where we started in not looking at the silos but starting to look more at some of the crosscutting root causes, protective factors and risk factors that are implicated in some of these behaviours, whether it be cyberbullying, suicide, thoughts of suicide and attempts, poor mental health and violence.
Ms. Sundar: There is a group in Kingston, Deb Pepler and Wendy Craig, who are researchers who received Networks of Centres of Excellence funding to establish PREVNet, which is an organization that really does focus on mobilizing the latest knowledge on bullying and preventing bullying. They’ve developed a number of resources that are aimed at different audiences to try and help equip practitioners, parents and young people themselves to address some of the issues related to bullying. There is a deep focus on cyberbullying and web-based and how you support that in young people.
Senator Omidvar: I’m sorry Senator Dean is leaving right now, because this is a question that will interest him. As you know, we are looking at cannabis legislation, and the legislation will not criminalize young people under the age of 19 who possess five grams or less of cannabis. There have been a lot of excellent presentations from pediatricians, doctors, et cetera, who have talked to us about the impact of cannabis on the development of the brain and on their psychosis.
I wonder if you can give us some advice as senators who will be looking at that bill. This committee will look at that bill. I wonder if you could give us your perspective on the impact of cannabis usage — maybe not periodic use, but steady use — on the minds of young people and what you would like to see in the bill as it pertains to mental health, cannabis use and young people.
The Chair: You may get called back as witnesses, you never know. We are the committee that will be doing with that.
Ms. Bradley: As I mentioned earlier, there is a direct link between first break psychosis and cannabis use. It needs to be studied more. It really, truly does. Beyond that, I don’t know what else I can say today. I don’t know that we know the full impact of it, but it really does need consideration and further study.
Ms. Sundar: There are people working in Ontario. So our organization is going to be partnering with a number of different groups, including folks from the CCSA, the Mental Health Commission and others who have been doing some work in this area. Our particular focus is establishing knowledge and training resources for child and youth mental health practitioners. We know that there are many young people who currently use cannabis illegally who also present with mental health problems, and we know that this is going to become a bigger problem when cannabis is legalized.
I think that they’re trying to get ahead of this right now in developing some tools and resources for practitioners on how to recognize when there is an issue, how to respond, where some supports might be ongoing and so on. There are some people who are doing some work in Ontario, and we can certainly help make some of that information available to you.
Ms. Ennis: I think one of the things we’re saying, too, as part of that work, is that in some cases we’re not sure. We just don’t know at this point. But part of it will be taking a look at jurisdictions that have already done this. There are not that many who did it a long time ago but taking a look at Colorado and some other jurisdictions and inviting them to teach us what they’ve learned in the last few years after having legalization. That will be a part of that process, but what you’re hearing from us is that there are a lot of unanswered questions. The next little while is going to be a real attempt to try to answer some of those questions.
The Chair: It will be done right here at the committee.
Senator Dean: Louise, I’d like to follow up on the late-teen psychosis in 17- to 25-year-olds. I’m aware from work that was done 40 years ago that the prevalence of late-teen psychosis has been known for decades. It’s been studied as part of the nature versus nurture debate, environment versus inherited traits. It far predated the prevalence of cannabis use in Canada and other jurisdictions.
Would it be fair to say that there is an association between cannabis use and late-teen psychosis but not necessarily causality? What’s your reaction to my comments?
Ms. Bradley: As we said, we need to study it more. I think there’s enough information that it causes us concern that there is a linkage, to be sure.
Senator Dean: Is that association or causal?
Ms. Bradley: I honestly don’t know.
Senator Dean: I needed to hear that. Thank you.
The Chair: This is not the Bill C-45 debate.
Senator Dean: I didn’t open up the discussion.
Senator Omidvar: I did. I opened it.
The Chair: I allowed that out of interest myself, to tell you the truth.
I’m going to close off with a question about other jurisdictions within Canada or globally. Jurisdictions would be provinces, municipalities or other entities that have implemented — and this gets to the best practices kind of question — effective strategies on child and youth mental health within Canada. Ontario is one of them, of course.
Let me ask Louise to start with: Either within Canada or globally, things that stand out as the implementation of effective strategies on child and youth mental health?
Ms. Bradley: I’m afraid I’m going to have to say that I think it is Ontario that is probably taking the lead within Canada. It really is. You can speak to it far better than I can.
Just about every province and territory now has a mental health strategy, and within that, children and youth are certainly a priority and targeted.
There are varying efforts in different places across the country, but I am sure nobody has gotten it quite right just yet. There needs to be more emphasis on prevention in children and youth. Anything we can do to help promote that is beneficial. I do think the efforts that are currently and most recently being made in Ontario really does make them leader of the pack. As a Newfoundlander, it pains me to say that.
Ms. Sundar: To build on what you were saying, Louise, the changes that have been happening in Ontario, we are in year four of transitioning our child and youth mental health system. I’m not sure how much information folks have. We can certainly make more information available, but we’ve adopted a lead agency model where the province has been divided into 33 different service areas. Within each of those there is a leading agency. That community-based child and youth mental health agency ensures that within that area there is a continuum of core services that have been defined all the way from prevention to crisis intervention.
The implementation of that, you can imagine, is quite a lofty undertaking. As I said, we’re in year four, and 31 out of 33 lead agencies are operational. There are still two communities that are outstanding.
Within those service areas, services are starting to become less duplicative, more aligned, fewer gaps. We will know in time whether it was successful, but I think our early learning on this topic is that this is working to the very best degree that it possibly can right now.
Ms. Ennis: The other thing we’re learning is that this is hard work, and it’s messy and difficult. A lot of the things that you’ve heard people talking about around data and performance, just a quick example: Our centre went through almost a two-year process now around the definitions that Purnima just spoke about, where we defined this set of core services that needs to be available in every community to every family, every child and youth.
The problem is that communities across the province were defining those services differently, so they weren’t able to count in the same way or measure in the same way. Even getting agreement across the provinces on what therapy means, what brief services mean, what crisis services mean, so we’re all counting the same thing, has taken almost two years.
It’s a very complicated process but totally worthwhile. We’re also involved in the data system, which again is on year three or four. This is just Ontario.
The Chair: Are there any other provinces or municipalities that have got particularly good strategies that are worth noting? Again, I said globally as well, so I’m talking about other countries.
Ms. Bradley: I don’t know the answer to that, but I can get some information and send it to you. I don’t know it off the top of my head. I think other knowledge exchange centres could probably help you with that.
The Chair: I’m sure you all learn from other practices and other places.
Ms. Bradley: I’ll see what I can get, and we’ll send it to you.
Ms. Ennis: I can say, for all of our talking about all of the gaps and the needs, in the international work that we’ve been involved in, despite the gaps, there are many areas where Canada is looked to as a leader. Child and youth mental health is a challenge across the globe. Certainly youth and family engagement, there are some strengths in Canada. We work tightly with our colleagues in Sweden, Britain, Australia and New Zealand, but we all have our own strengths. There is some real strength here in Canada, for sure.
Senator Omidvar: One clarification, because now I’m a little confused after the last question.
Ms. Bradley, you said that Canada ranks very low on global spending on mental health issues. Yet, when you are asked a best-practice question, the best practices are in Canada.
You say you don’t have enough money, and yet with little money, the best practices are in Ontario. Could you help me with my confusion here?
Ms. Bradley: It goes to the point that just throwing money at something doesn’t necessarily fix the problem. To your point, there are some leading practices in Canada. I’m part of a group that’s called the International Initiative for Mental Health Leadership, which is eight countries combined. Stephanie and I both represent Canada on that group.
It befuddles us, to be quite honest, so I can understand why you’re confused. We sit around the table and they look to us, certainly in the areas that I can speak to, as leaders in workplace mental health very much, and we are. We’re the only country that has a national psychological safety standard for the workplace, and it has been adopted in several other countries.
Our knowledge exchange centre and our approach to knowledge translation and exchange is considered to be a world leader. Imagine what we would do if we had more money?
The Chair: Thank you very much to all of you, and also to Nancy Reynolds, who had to leave, for being here and forming our discussion on this matter. We will be taking it further as to determining how we are going to proceed. A lot of it will be based on your input. Of course, you’ve also said you’ll provide more information to the clerk that can be helpful in determining that.
To members of the committee, there will not be a meeting tomorrow. However, the steering committee will meet, so Senator Peticlerc, Senator Seidman and myself will be here tomorrow. The reason there isn’t our regular meeting is we had hoped to have the Disability Tax Credit and the RDSP report ready, and there is a draft of it in one language but not in the other language. So it’s in translation, as they say. In that way, we will not be able to deal with it in committee tomorrow, which is what we had hoped to do.
The next meeting of the committee will be Tuesday, March 20 at 7 p.m. That is outside our normal time frame. The reason for that is that we had agreed to do the adoption mandate for unmarried mothers in postwar Canada — that’s the subject — we’d agreed to do that in four meetings. We cut it down to three meetings and we’ve had to put in this one special meeting on the Tuesday night so that we can get it all done that week, by Thursday.
The reason for that is because the next week, after that, we have Bill C-45 coming. So we’ve had to condense it a bit and put one meeting outside our normal time frame.
The meeting will be roughly 7 to 9 on the Tuesday evening of March 20. That is worth being at because that’s where we’re going to have these mothers coming and talking about the traumatic experiences they’ve gone through.
I might also point out that I have a motion before the Senate to authorize our sitting for the Tuesday night. We’re allowed to sit; it’s just if the Senate goes over we’re not allowed to sit. It’s an insurance thing. It may not be needed but it’s an insurance motion. It will probably come up tomorrow in which I’ll say adoption of the motion in my name. They are frequently done.
So there is no meeting tomorrow except of the steering committee.
Tuesday, March 20 at 7 p.m. will be the first of the three meetings all that week. The other two are in the regular time slots of Wednesday and Thursday on the adoption mandate for unmarried mothers in post-war Canada.
The meeting is adjourned.
(The committee adjourned.)