THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
OTTAWA, Wednesday, June 3, 2020
The Standing Senate Committee on Social Affairs, Science and Technology met by videoconference this day at 11:30 a.m. [ET] to study the government’s response to the COVID-19 pandemic.
Senator Chantal Petitclerc (Chair) in the chair.
The Chair: Honourable senators, before we begin, I would like to remind you of a few items.
First, senators are asked to have their microphones muted at all times, unless recognized by name by the chair, and will be responsible for turning their microphones on and off during the meeting.
Before speaking, please wait until you are recognized by name. Once you have been recognized, please pause for a few seconds to let the audio signal catch up to you. When speaking, please speak slowly and have the microphone close to your mouth. If you have chosen an interpretation channel, I would ask that members speak only in the language of the channel. Should any technical challenges arise, particularly in relation to interpretation, please signal this to the chair, and the technical team will work to resolve the issue. If you experience other technical challenges, please contact the committee clerk with the technical assistance number provided.
Finally, please note that if the committee decides to go in camera, the use of the online platforms does not guarantee speech privacy or that eavesdropping will not happen. As such, all participants should be aware of such limitations and restrict the possible disclosure of sensitive, private and privileged Senate information. Participants should do so in a private area and be mindful of their surroundings so that they do not inadvertently share any personal information that could be used to identify their location.
Good morning. Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
My name is Chantal Petitclerc, and I’m a senator from Quebec. It’s a pleasure and a privilege to be chairing this virtual meeting.
Before we give the floor to our witnesses, I would like to introduce the senators who are participating today in this meeting. We are happy to welcome Senator Jim Munson, Senator Julie Miville-Dechêne, Senator Kim Pate, Senator Patricia Bovey, Senator Patti LaBoucane-Benson, Senator René Cormier, Senator Diane Griffin, Senator Donna Dasko, Senator Fabian Manning, Senator Jean-Guy Dagenais, Senator Josée Forest-Niesing, Senator Judith Seidman, Senator Marie-Françoise Mégie, Senator Ratna Omidvar, Senator Rose-May Poirier, Senator Rosemary Moodie and Senator Stan Kutcher. Welcome to the meeting that we are happy and pleased to have today.
On April 11, 2020, the Senate adopted a motion to authorize the committee to study the government response to the COVID-19 pandemic. A month ago, as part of this response, the federal government announced an investment of $240.5 million for the development, expansion and launch of mental health help tools.
Today, in the first panel, we will hear from witnesses representing the interests of individuals with mental health challenges. In the second panel, we will follow with witnesses speaking to the interests of children and youth.
Without further ado, let me introduce our first witnesses for today’s meeting. We have with us Dr. Vicky Stergiopoulos, Physician-in-Chief of the Centre for Addiction and Mental Health, Dr. Patrick McGrath, Chair of the Board of the Strongest Families Institute, and Dr. Georgina Zahirney, President of the Canadian Psychiatric Association.
We will begin with opening remarks from Dr. Stergiopoulos, followed by Dr. McGrath and Dr. Zahirney.
Dr. Vicky Stergiopoulos, Physician-in-Chief, Centre for Addiction and Mental Health: Thank you for the opportunity to appear before you today to provide input into the government’s response to the COVID-19 pandemic.
I’m the Physician-in-Chief for the Centre for Addiction and Mental Health in Toronto. As Canada’s largest mental health and addictions academic health sciences centre, CAMH is grateful that governments at all levels have recognized the impact that COVID-19 can have on mental health and are responding with resources and supports for people struggling at this time.
Many of these individuals are experiencing a normal stress response to the health, social and economic crisis that we are facing, and it is important that they have access to mental health resources and supports to help them cope.
Those directly affected by COVID-19 — health care workers and those with pre-existing mental health problems — are at greater risk of experiencing more severe difficulties and deserve special attention and timely access to mental health care. While we consider how to protect and improve the mental health of the population and those most at risk at this time of crisis, it remains imperative that all people with mental illness are able to access the right care and supports when and where they need them.
The pandemic, while highlighting the importance of mental health promotion and timely access to mental health supports, is also magnifying the ongoing mental health crisis that we are experiencing in Canada, especially for those with serious mental illnesses, including addictions.
Unfortunately, people with serious mental illness continue to be under-served by the mental health and social service systems, and, for many, their lives have become even more precarious during the pandemic.
People with serious mental illnesses, such as schizophrenia, are not only likely to experience deterioration in their mental health due to the pandemic and the limitations it puts on their access to services, but they may also be at greater risk of getting infected and suffering worse health consequences. The clinical characteristics of psychotic disorders, such as delusions, hallucinations, disorganized behaviour, cognitive impairment and limited insight, can put these individuals at higher risk of COVID-19 infection.
Social characteristics, such as poverty, few social supports, stigma and discrimination and poor physical health — which are common among people with serious mental illnesses — can put them at greater risk of adverse outcomes if they get infected. We have seen the tragic consequences of the COVID-19 pandemic in psychiatric units in various countries.
Most importantly, a major challenge putting many people with serious mental illness at risk during the pandemic is the inability to adhere to physical distancing guidelines because they are homeless or living in congregate settings, such as shelters or group homes.
The precarious living situations of people with serious mental illness are not new and have persisted in Canada for years, despite evidence from the national At Home/Chez Soi final report that providing these individuals with their own apartments and access to supports is a successful and cost-effective solution to homelessness. While the federal government committed $2.2 billion over 10 years to reduce homelessness by 50%, actual on‑the-ground solutions have been slow to materialize until recently.
Since the onset of COVID-19, creative solutions to addressing homelessness has been developed and implemented quickly. People living in shelters and on the streets have been offered their own units in empty hotels and apartment buildings. Toronto’s city council just approved the development of 250 units of modular housing by the fall of 2020. While it should not have taken COVID-19 for people who are homeless to be housed, these are extremely encouraging developments and the momentum needs to continue as we move through COVID-19 and beyond. Homelessness is a choice — our choice.
Therefore, it is my recommendation to the federal government that you continue to encourage and support the rapid development of evidence-informed solutions to homelessness for those with chronic health conditions, and that you continue to provide funding to ensure that people with serious mental illness have an affordable place to live with the supports that they need, a place where they are not only safe during the pandemic and able to survive, but where they can also focus on their recovery and thrive. By highlighting the importance of safe, affordable housing for people with serious mental illness as part of the government’s response to COVID-19, you will demonstrate that the health of all Canadians is your priority.
Dr. Patrick McGrath, Chair of the Board, Strongest Families Institute: Thank you for the opportunity to speak to you. Actually, I reflect many of the same concerns that Dr. Stergiopoulos has just talked about. The first thing is that COVID-19 has affected all of us. There are really these two truths that I want to put forward to you: COVID-19 affects everyone, and we are all dealing with the difficulties. There has been a slight decrease in our quality of life, and it has been a little more difficult for each of us, but indeed, we’ll recover and do fine.
COVID-19 is also the great multiplier. People who have pre-existing difficulties, especially pre-existing serious mental health problems, have become much more disadvantaged. It is not simply an additive effect; it has become much more disadvantaged. The already very poor mental health system has not responded and cannot respond to the current situation.
As Dr. Stergiopoulos has put forward, the marvellous work done on homelessness and research on how supplying homes actually makes a difference has to be highlighted, so I would very much commend that.
We also have to look at the fact that there are just not enough psychiatrists and psychologists to do the work required. Oftentimes, psychiatrists and psychologists don’t work with the most severely impaired, or even with people who are moderately impaired. A study in Toronto showed, for instance, that many psychiatrists are working with people intensively over long periods of time, but these people are relatively wealthy, come from the highest social class and don’t really need care as much — not that they are not suffering — as refugees, people who are in poverty, people with pre-existing mental health problems and people with despondency and suicidal thoughts.
I would be negligent if I didn’t emphasize the fact that children and youth are at particular risk. The Strongest Families Institute that I founded and for which I am now chairman of the board was founded to provide alternatives for significantly impaired children and their families to get help. It is all done by e-health and it has been successful. We have seen over 36,000 families. We see about 8,000 or 9,000 families per year now. We have won several awards for innovation.
The key issue is not only is it all done by distance, but it is all done with paraprofessionals: highly trained, highly monitored individuals who can provide interventions effectively over the distance. CIHR has funded much of this work, and we are continuing to develop new types of interventions, including PTSD interventions for first responders moving into the adult range, and the most deprived individuals in children’s mental health, who are often kids with neurodevelopmental disorders and mental health problems.
The issue is we have a serious problem. Most of the response has been self-management, which works very well for people like you and me, who can learn a lot from self-management approaches, but people who have very significant problems need much more than that.
I would make a couple of recommendations. First, continue to offer self-management options for those distressed by COVID-19. They are not a bad thing, and they are helpful. We should develop specific interventions for anxiety and for drinking to excess. E-mental health has to be a standard option available, not just during COVID, but always. It has to be part of the fabric of our mental health system.
We have to develop alternatives to the reliance on very scarce psychologists, psychiatrists and paraprofessionals embedded in the system. Actually following protocol and getting the support and monitoring that’s necessary would be valuable.
With respect to scalable systems, we can’t just turn on Zoom and do it. We have to have scalable systems of care rather than just individuals. Much of our mental health system is based on the individual choice of therapists.
Finally, recognizing that mental health and services are a provincial affair, I think that the federal system can provide something like getting standards right so there is a mental health bill of rights for Canadians so we would have the right to appropriate mitigation of the determinants of poor mental health, the right to adequate mental health care in a timely way and the right to be involved in the delivery of all programs and services. We need those who have the problems helping to design the systems.
Dr. Georgina Zahirney, President, Canadian Psychiatric Association: Good morning. I would like to thank Senator Petitclerc and all committee members for inviting the Canadian Psychiatric Association to speak today. It sounds like we all have very similar themes.
I am Dr. Georgina Zahirney, and I am President of the CPA. We are the national voice of Canada’s 4,800 psychiatrists — we are glad to hear you want more — and our 900 psychiatry residents. We are also the leading authority on psychiatric matters in Canada.
We are an evidence-based profession, and CPA provides advice on the most effective programs, services and policies to help achieve the best possible mental health care for Canadians. I am also an assistant professor at McGill University, and I practise at the McGill University Health Centre as well as in a community mental health team that is involved with many refugees and immigrants in mental health.
We are all aware that COVID-19 has required governments to implement a variety of rather exceptional public health measures to control its spread, but we also need to recognize that such measures have contributed to mental distress among the general population due to illness, anxiety, social isolation and job losses.
This pandemic, though, has also impacted our essential workers, who face an increased risk of disease exposure and heightened work demands. However, these necessary measures against COVID-19 have also exacerbated and highlighted existing and long-standing structural inequities in our health care system, particularly for people with mental illness. Notwithstanding recent commitments, mental health care in Canada has been systematically underfunded for decades.
These ongoing issues are things such as bed shortages, scarce or non-existent community supports and unstable or inappropriate living situations, which have all disproportionately affected the mental health of some of the most vulnerable Canadians, including those with severe physical, mental, intellectual, cognitive or sensory impairments, and, evidently, our child and adolescent population as well. Other vulnerable groups, such as Indigenous persons, inmates and forensic psychiatric populations, as well as people in abusive living situations, have been adversely impacted.
Right now these individuals are even more at risk due to the difficulty of obtaining the necessary physical, psychological, social or financial resources to respond to the additional stressors post-COVID — we are still in COVID — and to the lack of appropriate access to supports and services. Furthermore, concurrent diagnoses — and we have to speak about substance use disorders and ongoing physical health conditions — can amplify these vulnerabilities for certain Canadians.
This being said, the CPA recommends four priorities for Canada in addressing these unmet mental health needs in the pandemic era.
The first is increased evidence-based approaches to housing, such as Housing First, to shift people from crisis and institutional services to appropriate options in the community that are flexible, available, affordable and titrated to the needs of the individual. More than 500,000 Canadians living with a mental illness are inadequately or inappropriately housed, and among them as many as 119,000 may be homeless.
This pandemic has exposed the problems of inappropriate or inadequate housing for vulnerable Canadians, especially the elderly, the mentally ill and those who live in communal living situations or institutions. Certainly you can’t self-isolate if you don’t have a home. The potential for universal basic income to replace a patchwork of existing government housing programs should also be explored.
Our second recommendation is that Canada needs more appropriately resourced acute psychiatric beds. Outside of Quebec and Nunavut, there are 7,242 designated mental health beds, yet the estimated daily mental health occupancy is over 8,300. Extended stays for people who no longer require the intensity of inpatient care but who cannot be safely discharged back to their housing situation also further impedes access to acute hospital resources. Evidently the COVID-19 infection-related prevention measures and treatment provisions have further restricted access to some of these precious beds, but the needs of the population have not changed.
Third, we need enhanced community-based programs and support services such as assertive community treatment and intensive case management to assist those with mental illness to transition successfully from inpatient care, institutions or homelessness to the community. And community-based services for people with psychosocial disabilities were already overstretched before this pandemic era and many have closed or have been severely restricted due to COVID-19 despite significant ongoing and increased needs.
Fourth, we need enhanced research into the efficacy of virtual care as a mode of intervention for people with psychosocial impairments. To optimize outcomes, attention must be paid to the practical aspects related to the provision of virtual care both from the provider end and from the user end. Increasing use of virtual care became necessary during the pandemic, and evidently for the government as well, but remains possible only for those who can afford telephones, internet connections or access to these modalities.
Many regions of Canada do not have reliable access to high-speed internet. People who are homeless or of low income may not have phones or rely on public spaces for internet access that are now either closed or restricted. Furthermore, the evidence base related to the efficacy of virtual care is not fully established for those with psychosocial impairments, although we encourage further research in this area.
In conclusion, while the COVID-19 pandemic has led to new mental health support initiatives and increased public awareness about the impact on psychosocial stress on mental health, it has also highlighted shortcomings within our mental health system and has underlined the precarious situation in which many disadvantaged Canadians live in our society. The CPA therefore urges the government to act immediately to remedy these issues. I thank you for the opportunity to appear and I’m open to your questions. Thank you.
The Chair: Thank you to our witnesses. We are ready to move on to questions. I do want to remind you that you have five minutes for questions including the answers, so please try to be specific with questions and with providing your answers as well to the witnesses.
If you do have a question, I would ask that you use the raise-hand function in Zoom, and the same thing goes if one of our witnesses wants to add an answer; that’s very helpful. When you are asking a question, please identify the person to whom it is directed or if the question is for the entire panel.
Senator Poirier: My question is for the CPA. A term we have often heard is “echo pandemic” to describe the potential surge of people struggling with mental health issues. In your opinion, is this a real possibility? If so, has the federal government put in place the services and funding needed to answer a potential echo pandemic at this time?
Dr. Zahirney: Thank you for the question. We have some preliminary data that has come out of previous disasters but the evidence base for actual epidemics such as this is somewhat less.
Rather than calling it an epidemic, we are concerned with the increased mental health needs post-pandemic or in the recovery and reintegration phase to some sense of normal life.
I think we have to distinguish between increased levels of distress and depressive or anxiety symptoms, whereas we know the majority of the population will not be presenting with more depression or anxiety disorders.
We need to monitor some of our mental health care workers or those exposed to some of the worst traumatic events of the pandemic in Canada, for PTSD may be foreseen. The greatest concern right now is there certainly can be increased rates of substance use disorders. It is well documented. Increasing rates of intimate partner violence and, potentially, child abuse are also well documented and have been seen in previous countries.
Our concern is balancing the needs of those who have acute distress — which is a normal reaction to very abnormal circumstances — and distinguishing the most vulnerable populations who are most at risk of having relapsed or significant exacerbation of their ongoing mental health challenges.
Senator Poirier: Thank you. My second question is for the Centre for Addiction and Mental Health. In your recent survey you state that nearly one quarter of the respondents reported engaging in binge drinking at least once in the past week, while those who are very worried about the impact of COVID-19 on their personal finances were especially likely to engage in binge drinking.
What has the government done to reduce substance abuse and binge drinking during the pandemic and especially after the pandemic?
Dr. Stergiopoulos: I’m not aware of any specific responses to the issues of increased substance use during the pandemic. The Government of Ontario has developed hubs of mental health supports both for the general public as well as those at high risk, which includes front-line workers, people affected by COVID and providers not just in hospitals but also in long-term facilities that may be most at risk.
I’m not aware of specific addictions-related responses in any of our provinces.
Senator Poirier: This is my first question for the CPA. I know you explained what needed to be done. Has the federal government put in place during the pandemic the services and funding needed to respond to the echo pandemic?
Dr. Zahirney: Certainly we welcome some of the recent and early announcements in terms of income support, because loss of income can be a risk factor for the development of depressive or anxiety symptoms. More recently, the increased investments for our Indigenous population in terms of helping as well with the concerns over intimate partner violence are the [Technical difficulties] so far that I am aware of.
I have also seen a great mobilization from many of the NGOs, such as the Mental Health Commission of Canada, who are providing those kinds of resources to help decrease mental distress and give people increased coping mechanisms to deal with this because everyone is dealing with the stress of the new times. Those investments are interesting but, again, different from the ongoing chronic issues of unmet service needs in the Canadian health care system. Those still need to be addressed.
Senator Poirier: Thank you.
Senator Griffin: Thank you to the panellists. This is extremely interesting. I have one question and I’m directing it to Dr. Zahirney.
I live across the river from Hillsborough Hospital here on Prince Edward Island. In December there were three vacancies in the psychiatric staff at the hospital. Now, I know that’s not unusual in rural areas or smaller urban areas, but my question for you is this: Has the COVID-19 crisis exacerbated this issue of trying to get help in the rural areas?
Dr. Zahirney: Yes. Interestingly enough, the greatest numbers of COVID-19 cases have occurred in the urban areas. I work in Montreal. There’s been a huge concentration in both Vancouver and Toronto. My understanding is that generally they have been less hard hit in the rural areas, but that required a large mobilization.
I agree with you that there are long-standing resource distribution issues both for psychiatrists and teams between rural areas, which are chronically understaffed, and urban areas. If half your team is in self-isolation or COVID-positive, that would impact the ability to provide service.
For a long time I worked in the Abitibi region in the north of Quebec as the chief there. I am aware there are huge disparities that could have been exacerbated, but it sounds like so far they have been well managed. However, if there is another wave of physical infection, we always have that risk of service disruption.
Senator Griffin: Thank you.
Senator Dasko: Thank you so much to the witnesses today for your presentations. They were very interesting, and I’m learning a lot.
I’m interested in the topic of virtual care as mentioned by two of the witnesses today. I would like to drill down a little bit with respect to that.
The use of these services has obviously increased a lot during the pandemic. I wonder if the witnesses, especially Dr. McGrath and Dr. Zahirney, think this is going to continue.
I’m also interested in the client and therapist experience with virtual services, if you could shed a little light on that experience. I’m sure a lot of people are interested in whether that experience is as good as the normal interaction between therapist and client, and in which circumstances it’s worked especially well. That’s my first question for Dr. McGrath and Dr. Zahirney. Could you elaborate? Thank you.
Dr. McGrath: Yes. About ten years ago, Dr. Trish Pottie and I did several studies on the therapeutic alliance in the Strongest Families Institute, which is all virtual. We found that the levels of therapeutic alliance are equal to, and perhaps even a little bit better than, face-to-face care.
You have to understand that you have to think of the whole context. In face-to-face care, typically someone has to travel to the centre where the therapist is. One of the other things, of course, is that care is usually done on a 9 to 5 basis — not exclusively, but too often done only from 9 to 5 at the convenience of the therapist. We found that there were equal levels of therapeutic alliance in those.
There are individual differences. Some people do not like virtual care. I think that the preferences of patients should be taken into account. But most patients love virtual care. It allows them to get the help they need from the convenience of their own home. There is a serious problem, though, because of the level of homelessness, and those people obviously don’t have a comfortable home within which to seek care.
Senator Dasko: Dr. Zahirney, can you elaborate on virtual care in your view, coming from your profession, with thoughts about that and professional boundaries and so on?
Dr. Zahirney: Yes. I think this is a good opportunity for Canada to learn to improve our service offer in terms of telehealth. There have been large programs. There was a large push. I was on the McGill mental health committee to try to get uptake. It has been slower than we would like. There are a lot of systemic issues related to that.
I agree with our previous speaker that there is evidence that it can be equivalent for certain patient populations who would otherwise not have access to care. For example, at McGill University we have an eating disorders unit that has been using telehealth for many years to reach populations across the province.
Some barriers still exist. There are some populations for whom it is not ideal or appropriate. I work in a crisis service, so I have been doing either face-to-face or telehealth evaluations. If we are concerned that the person is psychotic, disorganized or in severe distress and alone, the process of an interview can also bring up issues so that you want to ensure safety.
There are certain factors that we have to take into consideration, but for much of the population this is certainly a way to increase access to care. Again, it has to be the patient’s choice. We have offered both evaluations in person, obviously with appropriate protection, or over platforms.
With this rapid need to move on a large scale to telehealth, we’ve realized that our structures are not adapted from the provider or the user end. From the provider end, there is the need for appropriate office spaces that are confidential, soundproof, Wi-Fi accessible or at least have high-speed internet or webcams, and the infrastructure of Canada has long been criticized for not being up to date in terms of these electronic platforms. Then, there is the matter of electronic medical records. If I’m providing a service from a home or office, I would also need access to be able to update prescriptions and fax reports via secure electronic means. We have a lot of investment and work to do to upgrade our system capacity.
Dr. Stergiopoulos: I wanted to highlight that some of the geographical barriers that exist regarding access have been addressed by virtual care, but virtual care has introduced other barriers along the socio-economic spectrum.
With regard to what we know about satisfaction through our own research, our own virtual care capacity in March and April increased 850 fold. We did over 5,000 assessments across the province in May, including Indigenous and rural areas. So this is lovely. However, this again is limited to those who have access to the internet, who can connect and are well enough to be organized and participate in this.
I can’t stress enough that we need to look at the new gradient of inequity that virtual care can introduce in research, and not only assess whether virtual care works as well but for whom it works and for whom it doesn’t.
I suspect the new normal after the first phase of this crisis will be a new balance, definitely with more virtual care but not to the exclusion of in-person care for those who need it. I think it’s central that patient preference is taken into account. Thank you.
The Chair: Thank you.
Senator Kutcher: Thank you to all our witnesses. We appreciate you being here. My first question is for Dr. Stergiopoulos and Dr. Zahirney. I appreciate you reminding us of the needs of people who have severe mental illness and addictions and the importance of ensuring that electronic means of care are fully integrated into ongoing means of care to get good outcomes.
The Wellness Together Canada portal was created by the federal government to address the mental health care needs of Canadians. There are three parts to the question: First, in your opinion, does its content meet the needs of people with severe mental illness and addictions? Second, does the method of its deployment enhance the delivery of mental health care in the population? Third, are you aware of any mental health services that have integrated it into their care approaches? I also have a question for Dr. McGrath following that.
Dr. Stergiopoulos: Thank you. I haven’t had the opportunity to examine the portal. We worked very hard to create a portal at the Centre for Addiction and Mental Health, which is available across Canada and is based on the stepped care model. We developed a set of resources including self-help and psychoeducation to provide information about how to virtually access support groups of various kinds and, finally, to create through the Access CAMH portal one single point of access for referral and self-referral of anyone who needs help, and we’re able to provide help virtually.
In Ontario, we focused a lot on the five regional hubs that are providing support to this population. We’ve tried very hard to integrate the work of these hubs and the stepped care model into the province. We do meet regularly to make sure that our responses are coordinated and that areas of the province receive access to some of the same support. Unfortunately, I have not had an opportunity to look at the Wellness Together portal. I’m not aware of how that’s being integrated into services. Thank you.
Dr. Zahirney: I remember the reminder. Thank you. Actually, no, I’m not aware of the Wellness Together portal. Maybe it’s a blip because I practise in Quebec, which has its own set of portals and access. I agree it is important to use that stepped care approach. This is more what I’m understanding at the population level of distress: anxious symptoms, sleep disruption, and these kinds of self-help tools. All of the psychiatric associations across Canada, when we met with them, felt that from the population level people are able to access self-help care. The issue is more with those chronic problems with accessing services for those who have a diagnosed mental illness or chronic mental illness.
Senator Kutcher: Thank you very much. For Dr. McGrath, the Harvard digital psychiatry group with Dr. John Torous, who is one-half Canadian, have done an awful lot of work on electronic health care delivery, focusing on apps and online psychotherapeutic interventions. They have recently noted there was a lack of standardized evaluation for these approaches to give us comfort that they are effective, safe and where they fit in terms of clinical utility. What advice would you have for the Government of Canada in order to address a framework that would evaluate these different methods of delivery so that Canadians would have comfort that they are effective, safe and useful?
Dr. McGrath: We don’t evaluate most mental health services and should. It would be good to evaluate the ones that are digital because it is a lot easier to do some of the evaluations if you have a whole system. Again, this speaks to the notion of having a system where you have automatic evaluation, rather than it depending on somebody doing something extra, especially a very busy clinician doing something extra. There’s a great need to have reviews of systematic evaluations.
In fact, in Strongest Families we evaluate every client automatically. Every encounter is evaluated and then the course of treatment is evaluated. I think that’s a minimum requirement if you’re really going to improve it.
In most hospitals there are very small numbers of patients who actually get to evaluate what their treatment is. Yes, you need that evaluation. CIHR is a mechanism if they move towards doing more pragmatic trials and putting money into pragmatic trials. There are some very positive developments in terms of the SPOR, Strategy for Patient-Oriented Research, doing pragmatic trials, but it’s hard to do those and they’re not that popular. Thank you.
Senator Munson: There are so many issues and so many questions, from refugees to housing to disability. I’ll focus very briefly on disability.
How do you work with the disability community right now, especially those with intellectual disabilities? If anything, those with autism like a routine, and there is no routine today. There has always been a comorbidity issue, anxiety and depression, that type of thing. Can you tell me, from the perspective of the Canadian Psychiatric Association, what is happening on the ground today? How are you dealing with this very serious issue? I feel they are the forgotten people in the disability community.
Dr. Zahirney: I think at this point we are not dealing adequately with the situation, but I certainly share your concerns that, as you outline, this population may have many barriers to be able to access care online or telehealth, and yet with the restrictions on having people come into your home and distancing, they’re essentially receiving very minimal and supportive interventions via phone or over the internet to the family members. As you said, for those individuals it’s going to be very difficult.
This is part of the push when we’re saying we really need an increase in those community-based teams so that we can reach out to vulnerable individuals like that and get them back into a rehabilitation setting, because, as you said, a new routine is going to be very, very difficult to break and to reintegrate them. This is also creating a great burden on families and family members who are now taking over the care and may be working from home but have a child, an adolescent or even an adult with developmental disorders and needs. I think this is an unaddressed area of chronic underfunding within Canada.
Senator Munson: Thank you very much. I’m very worried and very concerned about this because there are 500,000 people with autism alone in this country, let alone others with intellectual disabilities.
Briefly, Dr. McGrath, on refugees, people have said there are not enough psychiatrists or psychologists. Our Senate Human Rights Committee a few years ago talked about refugees and the lack of access to new Canadians who cannot speak English or French and it has taken time to have access to a psychologist or a psychiatrist. We patted ourselves on the back for doing so much in bringing refugees from Syria, but I worry and hear stories today that in terms of mental health issues it’s very serious. Is there anything being done to step up to help Canada’s refugees or new Canadians?
Dr. McGrath: There are scattered projects across the country that are effective. Indeed, there are not enough psychologists or psychiatrists or social workers who have the language skills to do that. I think you have to understand that many of these interventions, when they’re structured and they’re under proper management with proper protocols, can be done by native speakers who are trained paraprofessionals.
For example, on PTSD, I’m currently working with a group from Germany and I have a post-doc from Germany. We’re developing an e-health for PTSD using paraprofessionals. We have funding for firefighters and also for parents of children with neuro-developmental disorders, the group you were talking about before. Many of these interventions, if appropriately supervised and appropriately monitored, can be done by somebody other than psychiatrists or psychologists. There are simply not enough psychologists or psychiatrists and no prospect for this number to be increased dramatically.
We have to consider the needs of the population before the governance of the professions, who tend to be very closed in terms of trying to move forward. There are great exceptions to that, but we need to look broader in terms of finding solutions.
Senator Munson: I think that’s my time. With the refugees, talk about trauma before and now experiencing perhaps a double and triple trauma. Thank you very much.
Senator Forest-Niesing: I’d like to thank all the witnesses for sharing their expertise with us. My first question — of many — is for Dr. Stergiopoulos. It’s inspiring to hear you talk about the success of the emergency homelessness actions. I understand you recommended that the federal government continue those efforts. However, there probably won’t be as many vacant hotel rooms or empty buildings available once the economy recovers. Assuming there’s enough political will to keep the positive responses to homelessness going after the COVID-19 pandemic, how are you planning to go about this if you can’t secure as much accommodation, either in hotels, apartments or empty buildings? Will we need additional infrastructure?
Dr. Stergiopoulos: Thank you for this question. We first need to outline that we need a range of housing solutions to make sure we respect our patients’ preferences. But we have shown that we don’t necessarily need to build new infrastructure, or at least not as much as we think we do. The At Home/Chez Soi study that we did in five cities across Canada shows if we give people with serious mental illness who are homeless an income supplement so they can access market rent in private market rent buildings and supports — it’s not just the housing or the income alone, but a combination of the housing and the right level of support — they can succeed and thrive. Does it require investment? Absolutely, because, unfortunately, rents in Canada are unaffordable for those with psychosocial disabilities. It will cost the government money. The question was that if this resource was found during the pandemic, it is our decision to make sure it is sustained after the pandemic.
Senator Forest-Niesing: In light of your answer, I’m going to change the order of my questions. My next question will be for Dr. Zahirney.
Dr. Zahirney, in your presentation, you mentioned the problems of inappropriate or inadequate housing for vulnerable Canadians, especially the elderly, the mentally ill, and those who live in communal living situations or institutions, such as inmates and health service users. Since housing is so important to a person’s well-being, as each of your presentations made clear, you indicated that you would be in favour of a guaranteed basic income to replace the patchwork of existing government programs in order to ensure access to housing. Could you tell us more on that subject?
Dr. Zahirney: We don’t have a specific policy related to that, but from a public policy perspective we see that homelessness is aggravated in urban areas where rents might be higher, yet a provincial welfare cheque is the same across the province. Accessing services might also be more difficult in an urban versus a rural area. I think this needs to be looked into for all the vulnerable populations, but I don’t have further data on that.
In terms of the housing, our concern is, again, if the homelessness problem is touching an urban population, then without an income supplement, any kind of program would be inaccessible to them.
Senator Forest-Niesing: Dr. McGrath, for those living on the margins of society, COVID-19 has widened the gap between them and the mainstream. We are well aware that Indigenous people are disproportionately poor, live in overcrowded, unsafe housing and experience problems with tainted water. The pandemic has exacerbated these many issues.
What would you say are the main differences between the challenges faced by Indigenous families living in urban areas and those faced by families living on reserve?
Dr. McGrath: I’m afraid I’m not an expert in that area, and my observations are limited. It depends on the specific situations. Some reserves are very well developed. They’ve taken control of their own lives, and they have very well‑developed infrastructure and support for individuals. Those reserves are doing well. They developed an economic base, and they control their schools and health system. In those situations, the Indigenous people on reserves are doing well.
In contrast, other reserves are dismal and worse than third-world conditions. We know enough about where we have to go in terms of the control having to shift from the patronizing approach we’ve used with the Indian Act to a different approach where we have a partnership with our Indigenous citizens.
In terms of the urban areas, again, there are many Indigenous people working and living in urban areas, but there are also many who are poor and living on the street and have all of the problems of poverty and real lack of opportunity. We need systems that recognize the rights of the Indigenous nations to their self-determination. We need ways of moving forward with proper housing and proper income supplements so that no Canadian is treated as if they’re a less-valued person. I think that’s the major issue.
We’ve seen this explosion in the last 10 days in the United States. That has spoken to all of us here in Canada, as our Prime Minister has said, that there is a serious problem with racism here and we have to address that. The issues are varied and we have to look at each individual community.
Senator Forest-Niesing: Thank you so much.
Senator Mégie: Thank you to the witnesses. My question is for Dr. Zahirney, following up on Senator Forest-Niesing’s question about access to housing for the homeless.
We’ve talked about a guaranteed income program, but facilitating access to housing is a complicated aspect of that issue. Back in 2017, the federal government announced it would be injecting about $40 billion over a 10-year period. It’s been three years since then, but you could still say it’s early days. Do you think that money could help, while we wait for a study on a guaranteed income program?
Dr. Zahirney: As with any investment, we want to know that investment is going directly to evidence-based programs and is attached to services for those vulnerable populations. Hence, in a project like Housing First, which the other witnesses have talked about, we have the evidence that this helps to stabilize people. It was a pilot project over two years which showed, in 2,000 participants over five cities, good effects in terms of stabilizing both mental health but also leading to more stable housing for these individuals. Again, a project ends, and if we are targeting funding towards a very specific evidence-based program, yes, that can be beneficial, but part of this program was an income supplementation to facilitate that stable housing situation, and also tied to increased community supports, so community treatment teams or intensive case management teams.
We need both the housing that one person can afford as well as that team support.
Senator Mégie: I just wanted to find out if you knew where that initiative could be headed. This measure was adopted before COVID-19. Maybe more of that money will have to be used because of the COVID-19 pandemic. I don’t know if you’ve heard anyone around you talking about that. Would it be enough or not?
Dr. Zahirney: I don’t have those figures at this time.
Senator Mégie: Thank you.
I’d like to come back to self-management tools. I think someone already asked a question about them. Do you have some idea of what proportion of people use these tools? So far, no studies have found any self-management tool that works better than the rest. People who can use them do, and if the tools work, they’re happy. Since it can be hard for people to use them due to poverty and all kinds of other social inequalities, do you know roughly how many people have used these tools to date?
Dr. Zahirney: I’m not aware whether the access to those programs has been studied. There do exist, from the pre-pandemic era, certain self-management tools that have been analyzed. There is the B.C. program BounceBack BC, which other provinces have tried to have uptake for, but for the actual current tools out there, I’m not aware of the data.
I agree there needs to be programs that have been studied to be efficacious. They are an important part of stepped care. We are behind that in terms of other countries. The NHS in Australia certainly had implemented programs as part of a stepped management approach to care. Actually, I used one of the Australian sites prior to the pandemic. I think these need to be implemented and studied, but I’m not aware of studies on them at this date.
Senator Omidvar: Thank you to our witnesses. Dr. McGrath, this committee’s mandate is to examine the government’s response to the COVID crisis. I wonder if you could help us do this through the lens of mental health and the families that you serve. Would you be able to grade this government’s response? Is it too hot, too cold, just right, none of the above?
Dr. McGrath: It’s okay; it’s not great. Much of it has focused on self-management. Self-management has its place. We don’t have any data yet from the portal that was developed. I don’t know how many people have used it.
One of our programs is on that portal. We certainly have had an increase. One of the Strongest Families’ programs is available through the portal, but it is still a self-management program, and we just don’t have enough data on that portal to know whether it works.
The problem is that COVID is a great magnifier. For people with not even necessarily severe mental health problems but significant mental health problems that are interfering with their lives, self-management will not be enough. That’s the problem.
Senator Omidvar: Dr. Stergiopoulos, you have already mentioned the underlying social and economic conditions that contribute to poor and exacerbated mental health conditions. I will quote a sentence from a publication by Rochelle Burgess from University College London:
A woman who has lost her job and cannot feed her family will find little relief from a meditation app. Advice such as ‘stay off social media’ will do little to ease the anxiety of a young black man in constant fear of being kicked out of shops by security guards for wearing a face covering, or abused . . .
Let me add to what we heard from Dr. McGrath, that even if you are given advice to engage a psychiatrist or psychologist, it may well be out of your financial means.
What, in your view, is the best way of dealing with mental health conditions of marginalized communities, and how can the government best support these initiatives?
Dr. Stergiopoulos: My answer will have two parts. First, what are we doing for the crisis now, and what do we need to put in place so that these individuals who are currently facing severe and multiple sources of disadvantage have better access to care and supports? For the crisis now, different communities have come together in different ways to support vulnerable populations, from providing support and capacity-building opportunities for professionals who work in the field. Whether it is for professionals working or intellectual and developmental disabilities, there are programs that build skills on how to manage COVID and to help support the population during COVID. That’s an example. There is another program I’m aware of that, again, builds capacity on managing other disadvantaged populations that live in Indigenous communities.
That’s one part of the response to the question: What do we do now? Build capacity; help our helpers do their best given the circumstances; and improve access to coordinated and comprehensive supports through centralized access points, that one-stop access. This is what we’ve tried to do, definitely in the Toronto region, and this is what Ontario is trying to do. Unfortunately, I’m not aware of what is happening in other parts of the country and how the different steps in the stepped-care model are coming together to support those who are vulnerable.
In addition to those efforts that we’re doing, I’ll give you my experience. I still work in a shelter. We have adopted group homes and shelters in each geographical region. Hospitals and providers with more resources are stepping into those settings to support those populations.
So that is the crisis component of our response. But in the long term, the investments — as you heard from all of us — in adequate income in whatever form, adequate housing and adequate access to evidence-based community supports are going to be helpful. Until people with mental illness have adequate housing and until our psychiatric units are adequately resourced, we will not be able to address these issues.
Senator Omidvar: Doctor, if I may follow up, you mentioned a few programs. I know there are programs that are different and differently available and differently valuable across the country. Would you like to see the federal government take a more encompassing approach to developing national standards and a framework for the provision of mental health services to marginalized communities across the country, not just in those lucky places where there are points of light?
Dr. Stergiopoulos: Absolutely. It is lacking. Some of the provinces have entities or provincial organizations that try to develop and support the implementation of standards, but that is not happening consistently. To have a national organization that is focused on standards and quality in mental health services is a priority.
Senator Omidvar: Would you add data to that basket of goods that a national effort would undertake?
Dr. Stergiopoulos: Absolutely. That’s something that I and other colleagues from Quebec and British Columbia have already suggested to the federal government year after year.
Senator Omidvar: If I have time, I will ask my third question. Otherwise I’m happy to wait for the second round.
The Chair: Yes, you did use your time, but I’m pretty confident we will have time for a second round. I’ll put you on the list.
Senator Manning: Thank you to our witnesses today.
I believe we would all agree there has been an increase in requests for mental health services. I know here in Newfoundland and Labrador, we’ve seen increases in intimate-partner violence issues. We are heading into some major job losses announced in the last couple of days in relation to our oil and gas industry.
Have any of your groups utilized the government’s announcement of $240 million to implement programs to educate the public and promote the services that are available? Based on inquiries into my office, I know there are people, especially out in small rural areas, who are not totally aware of the services available whether online or in person. Has anything been put in place to promote the services and educate the public on what is available? Thank you.
Dr. Stergiopoulos: I can start. I definitely would have done that at the Centre for Addiction and Mental Health. We spent a lot of time and a lot of our own resources to develop a comprehensive website for the general public that gives tools and information about how to access supports, as well as health professionals, and finally an access portal for those who require more than the access to self-help resources and information, but need actual access to care.
We have taken on the coordination of access to care throughout the region and beyond, working with our provincial partners to make sure that, no matter in what part of the province, individuals can have seamless, self-referral one-point access, and they can be matched to the level of support they need as close to home as possible either in person or virtually. That is what we have done at the Centre for Addiction and Mental Health. We would be happy to share anything that might be helpful to the rest of Canada.
Dr. McGrath: Speaking from the Strongest Families point of view, Newfoundland and Strongest Families have a long-standing and very productive relationship. Strongest Families has been made available to many different families in Newfoundland. The government has been very strong in promoting that.
As an organization, we do not promote our own efforts, but we rely on our provincial contract with Newfoundland, and we work very closely with them.
Senator Manning: Dr. McGrath, in regard to the announcement made by the federal government in March — and I know we have a situation now where people are working from home, with extra anxiety on the parents and the children — is any program being developed through your organization to give children and youth an opportunity to use your services? Is there any program to promote that?
Dr. McGrath: We have Strongest Families programs that we do offer in Newfoundland and elsewhere. For example, the anxiety program works directly with children and youth and with their parents, if that’s appropriate, depending on the age of the child. We have seen a strong increase in that. More funds have been made available on different provincial contracts.
So, yes, we have. I’m sure we’re not meeting the full need. Many people just are not aware of that. It is the responsibility of the provincial governments, because they have the primary responsibility for health, to continue to advertise and to make available these services. But, yes, we are in Newfoundland, and we are working very closely with the Newfoundland government on that.
Senator Manning: My last question is for Dr. Zahirney. I’m wondering about the increase in intimate-partner violence calls. Can you give us any idea of the percentage of increase and the concerns that have been raised? I know that, here in Newfoundland and Labrador, we have local media outlets who are doing stories on those. We are seeing some major increases. Can you give us an idea across the country?
Dr. Zahirney: I don’t have data specifically across the country, but we certainly have indicators from the media that there have been increases in calls to help lines. One of the perfect-storm situations is also the comorbid increase in substance-use disorders, which is another risk factor for increasing violence. You were speaking about those other psychosocial losses, such as jobs.
We have better data out of the United Nations. In March, they actually issued a statement about their great concern about widespread intimate-partner violence increase, post-COVID, and there are studies coming out of several other countries about the increase, but I don’t have the specific data for Canada. It is more of an observational situation.
Senator Manning: Thank you to our witnesses.
Senator Seidman: Thank you very much to our witnesses for all the wisdom they have to impart today in this really important area of mental health. If I could pose this question and have a response from each one of you, if my time allows, that would be good.
Because of these momentous times of the pandemic, in many ways we are experiencing natural experiments all across this country. There are undoubtedly many lessons that we can learn from our ability to respond and about the types of needs that are being expressed. Is your organization engaged in collaborative research around the impact of COVID-19? And is the government providing resources for that kind of research?
Thank you. Perhaps we can start with Dr. Stergiopoulos.
Dr. Stergiopoulos: Thank you for this question. During the COVID-19 pandemic and while all research was put on hold, we made the decision, according to the guidelines given to us by the province — Public Health Ontario — to continue research efforts and allow not only essential research related to COVID-19, but also permissible research that could be done virtually without putting staff or clients or participants at any risk.
We are working very hard during this pandemic to maintain the momentum and prepare and submit the grants of our organization to study both the needs of the population — of providers, patients and communities — as well as potential evaluation of what is on offer currently. We have been successful and have received a number of peer-reviewed grants both through the Ministry of Health and through the Canadian Institutes of Health Research. We anticipate we will hear more results about our submission in the next week or so.
There are several studies under way at the Centre for Addiction and Mental Health right now, including, as you pointed out, the survey that we started doing to assess in real time periodically the mental health needs of the population.
Senator Seidman: Thank you very much.
Dr. McGrath: Much like others, my research and my group are all on distance interventions. Although we had some difficulties, we have been able to continue all of our research. We are running randomized trials on several different populations, children with neurodisabilities and mental health problems. That trial, funded by CIHR, is collecting data as we speak.
There is another trial on caregivers of people with acquired brain injury funded by the Province of Nova Scotia. It has just received final ethical approval and should begin in the next two weeks.
We are doing work on PSTD in two populations. Those trials have received ethical approval and we are doing the training now.
We have submitted to CIHR, Canadian Institutes of Health Research, and have had a rapid response effort. The adjudication of the second round of those has been delayed about a week or two and should be out in the next couple of days.
The research establishment — people who have been hit very hard or people who require face-to-face interactions for their research or in their labs — many of these labs have been shut down and are now beginning to open up again.
I think the need for rigorous evaluation and trials of interventions is always going to be important. We have to keep funding CIHR and related groups to make sure that we have the right opportunities to know what is evidence-based and then continue to evaluate. You shouldn’t stop evaluating just because you are finished the trial. All of our services should be evaluated all of the time.
Dr. Zahirney: As a medical association, we do not ourselves do the research, although several members are actively involved at this point more in reviews of the literature. We did have pre-pandemic — it’s in the press and should be coming out soon — a paper on intimate-partner violence and practice guidelines which would not incorporate the pandemic phase, but we lay this point focusing more on the best practices coming out from other countries’ data. As I said, we do not ourselves do the primary research.
Senator Seidman: Thank you very much.
Senator Moodie: Thank you to the witnesses today for your enlightenment. My question is directed to all three witnesses today.
I want to take a step back. Of the $240 million that the government has invested to develop, expand and launch mental health tools to create digital platforms and applications generally to improve access, can you give us a sense of who was consulted during the process of making the decision on this investment? Dr. Zahirney, was your organization, the Canadian Psychiatric Association, consulted?
To the best of your knowledge, what guidelines have been applied to how this money can be spent in terms of understanding the appropriate evidence of efficacy and outcomes of the tools that might be developed or used?
To your understanding, are we tracking access and outcomes sufficiently well? What will we come out of the end of this experience knowing?
Dr. Zahirney: Was the $240 million you’re referring to from the Canadian Health Infoway?
Senator Moodie: I think it was the investment made on May 2, where the government made it available to develop and expand the digital platforms, applications and so on.
Dr. Zahirney: We were not specifically consulted on that. However, we do agree and have made previous recommendations to the government about the importance of having these national standards and tracking outcomes and tracking where the money goes to a very specific evidence-based program and they have the national standards.
Our concern is also having outcomes that are clinical. For example, are the people getting these programs benefiting from them rather than administrative data that many of the higher level — either at the provincial or federal level — indicators in the past have focused on? It’s to look at what is happening on the ground. That is one of our main recommendations in terms of national standards.
Dr. McGrath: We weren’t consulted. I don’t know how they came with up with that. Part of the problem is these things were done quickly and sometimes, when they are done quickly, they are not done with the best mechanisms.
We do have a mechanism in Canada for health research in the CIHR. Although I am not always happy with the results, and I have been rejected by them frequently, though they have given me a lot of money as well, it is the mechanism that I hope would be used for research, and research that moves to practise.
There needs to be accountability. I hope your committee can dig up that accountability and find out what is going on to ensure, as Dr. Zahirney was saying, that these services go to people who need them and the outcomes are of clinical importance. Thank you.
Dr. Stergiopoulos: I’m not aware that we were consulted on this investment. I am not aware of the details of this investment or of its focus.
However, over the last 10 years we have worked with philanthropic support to develop standards for virtual care and virtual care training. This is why we were able to ramp up and multiply our services and increase our access to virtual care by 850 times in the period of two months.
I fully agree that we need to be monitoring what access is like and who is accessing in real-life outcomes. I would like to stress that it also points to the gaps in quality of the mental health services, the lack of measurement-based care and the lack of looking at outcomes — and not just clinical outcomes but real-life functional outcomes — for people with mental illness. If we were to move in that direction and this data was routinely collected after every clinical encounter, I think that would be a welcome development.
Senator Moodie: The second part is we have talked about the difficulties that some people encounter accessing and using virtual care.
There’s another area of increased access that has been made available to clinicians: the use of the telephone. How much is that being used in care now? Can you comment on whether this modality is effective for your population of patients? Is it being used? Have you seen an uptake in the use of telephone care?
Dr. McGrath: Perhaps I can respond to that. Most of the services that are delivered by Strongest Families are delivered on the telephone. In fact, all of them are at this point in time. For some in development we’ll be using video. The important thing is not to let technology be the tail that wags the dog; we should do what care is needed. Telephones have been around for a hundred years. They’re very reliable most of the time, although sometimes my cellphone goes down. Most of our work is done on the telephone.
I think that we have to look at what is appropriate for the situation, not what is the glitziest type of technology, so telephones should always have a very important place.
Dr. Stergiopoulos: I can add to that because I actually use the telephone to provide care to the people I work with who do not have access to other virtual means or the internet. Some of them actually prefer telephone over other means of virtual care.
I think for those whom I have a good relationship with and I’ve known over time, for at least a few months, the telephone is not a problem. I think that care can be delivered in a positive way and in a way that’s experienced positively; at least this is what my patients tell me.
I have to be honest that the first-time assessments by telephone for a patient suffering from severe mental illness can be quite challenging. The telephone also has limitations for people who are not known to us and are quite ill.
Dr. Zahirney: I agree that we have switched within Quebec when most practitioners have switched to telephone follow-up for known patients. Part of that was actually to ensure that bandwidth was not taken up and to focus on new evaluations by Zoom, which is pretty much consistent with the practice, from what I hear, across Canada.
The Chair: Thank you. I would like to ask a specific question to you, Dr. Zahirney.
I’m from Quebec also, and kids and youth in Quebec have been out of school for three months. I’m thinking about youth with developmental neurological disorders or disabilities and the impact on their lives. I know many pediatricians have been talking about the impact of not going to school, not having the expert care they need to develop and be as well as they can possibly be.
I’m wondering if your organization has some comment or if you are also worried, like pediatricians are starting to say they are, about the impact it will have if we don’t reconnect them with the services they need.
Dr. Zahirney: Certainly the CPA shares the concern over the prolonged period of isolation where it’s been going on longer. As I said, I practise in Montreal, so we’re in the second month and people are very tired. The parents are tired and, as you said, the children are being deprived of that necessary connection and structure. This is even felt more acutely for the population dealing with developmental or other types of disabilities.
The data that we have is more coming out of the NHS. They have expressed deep concern about the harm, exactly as you said, of isolation and the protected school placements for children where they maybe get a meal or social stimulation. Parents may not be able to provide that, and they actually may be in homes that are unsafe, as I mentioned in the concern over intimate partner violence, which has been seen in the past to go up during prolonged periods of isolation or traumatic events.
We are deeply concerned. These are the issues that are mostly dealt with at the provincial psychiatric association level, but certainly I know that the AMPQ in Quebec has been active as well about this issue. We’re deeply concerned about balancing the risks of prolonged isolation with the effects on both parents and children.
The Chair: Thank you. This is a conversation we will continue this afternoon. We have a panel of experts on youth and children.
Senator Dagenais: I have two questions for Dr. McGrath. Here’s my first question: after your presentation, you mentioned that psychiatrists discriminate in choosing their patients, preferring those who are less severely impaired and more wealthy. Why does this happen, and what solutions are there? Is the onus on the government to fix this problem? I see it as more of an issue for a professional body to address.
Dr. McGrath: The data is for psychiatrists in private practice. I know that my colleagues in the mental hospitals and the mental health institutions treat all comers and the whole range.
When psychiatric care is being paid for by the government because it’s part of medicare, I think there is a responsibility to the public purse to treat those who are most in need. Unfortunately, that appears not to be happening as much as it should. I do think it’s a very difficult situation to try and figure out how to right it. The professions generally plead they will use their clinical judgment, and their clinical judgment is that these people need help, whereas if you look from an epidemiological point of view, oftentimes the people who need the most help are not those who are getting it.
This occurs across the professions, not only in psychiatry but also in my own profession, psychology. It is quite easy to get private practice psychological services because one must pay for them. If you have a job that has a strong mental health plan — and that’s a good idea — you can get the services. But if you’re on welfare or in a low-wage job that does not provide those benefits, it’s very difficult to do.
I think we have to consider whether people being paid in particular by the public purse have an obligation to treat those most in need, and that is a political decision. It will be hotly contested by the professions who prize their ability to make their own decisions. I think we have to balance the needs of the professions to make their own decisions with the needs of the general public.
Senator Dagenais: I want to squeeze in one last question. Dr. McGrath, as you know, there have been thousands of deaths in seniors’ residences, especially in Quebec. It’s being said that they were lacking in care and attention, and the government was well aware of the inadequate care before COVID-19. Given what’s happened to seniors, could you tell us what’s motivating you to speak out about racism in the communities, which you mentioned earlier on?
Dr. McGrath: My expertise in older people is only because I’m an older person myself. I’m a child psychologist by training. People whom we undervalue are not given equal access. COVID has become a magnifier of these disparities. The disparities of wealth are growing in Canada, not as fast as in some other countries, but the disparities of wealth and access to care are growing. If we believe in a society where everybody should have access according to their need, then that is the role of government to put mechanisms in place.
It’s not an easy thing to do though, because there are always unintended consequences. When medicare was introduced, that was an effort to make the whole system more evenly accessible. We can see that made a great advancement, but there are continuing problems in our system that we have to keep changing and tweaking and making better.
The Chair: Dr. Stergiopoulos has raised her hand. Did you want to speak on that?
Dr. Stergiopoulos: My hand was raised on a previous question.
Related to long-term care, I can tell you from first-hand experience — because I’m trying to figure out how best to support the sector in Ontario — what we’ve witnessed is a lack of infrastructure for them to manage appropriately an infection in their setting, a lack of basic knowledge of infection control prevention, poorly trained staff and inadequately supervised staff. I think the governments in each province would need to make significant and substantial investments to change how care in long-term care facilities is delivered.
Senator Bovey: I want to thank all the witnesses. This has been a very important discussion. Dr. Zahirney, I would like to ask you about access to mental health care in the Arctic and in our northern communities. We’re seeing increased critical situations due to COVID isolation in overcrowded homes on top of the ongoing geographic isolation of the communities themselves. The health units we know were overburdened before COVID. We are now seeing an increase in the issues of violence across the Arctic since COVID. Of course, virtual care is not possible or reliable in many areas in the northern and rural parts of the country.
Dr. Zahirney: We shared this concern about reaching the most northern communities. At McGill University, we do have teams that go up to the far North as well. Telehealth has been used to some extent, but as you’re saying, those issues require high-speed internet, a safe space to live and a confidential space to talk.
We have more individual psychiatrists going up, but there is also the issue of team-based care. Often people who are living in these northern communities are burning out fast because of the demand and the needs, which are very intense. Again, psychiatrists or physicians can go up and be flown in and lodged, but it’s not always that entire team. I think there are different models we have to look at. How can we adapt our care to give better and equitable care to these communities in the North?
Senator Bovey: I do know it’s a very serious issue and has come up a number of times in my work in the last couple of months. I look forward to us all coming up with solutions.
Dr. McGrath, has your research included the North and Arctic communities?
Dr. McGrath: Yes. We’ve just signed a contract with the Northwest Territories government funded partially by Bell Let’s Talk and partially by the telephone company in the Northwest Territories to provide these services in the North in those territories. We’re just beginning. Of course it requires, as Dr. Zahirney has said, some conditions that are not always available.
Now the Strongest Families Institute has a presence in the Northwest Territories and we continue to develop that.
It also requires a cultural sensitivity and an understanding of the systems in the North — the family systems and the cultural systems. So, indeed, we’re trying to meet that need.
Senator Bovey: In some of the domestic violence issues I’ve heard of, I gather the RCMP has either been slow or has not responded. Do any of you have, in your work, connection in those instances with the RCMP?
The Chair: Does anybody have an answer specifically?
Dr. Zahirney: No, we don’t specifically. We are not a service provider, but certainly we’re concerned about the increase in intimate partner violence.
Senator Miville-Dechêne: I want to get back to the issue of unequal access to psychiatry as a public service. My question is for Dr. Zahirney, and I’d like her to tell me about the situation in Quebec specifically.
Earlier we heard Dr. McGrath say that the most vulnerable and least fortunate don’t get priority access to these services, even though they’re taxpayer-funded, which puts them in a very difficult situation. As an association that represents psychiatrists, what are you doing to make sure you offer more equitable access to your services? I do realize that there’s a shortage of psychiatrists and that the ideal thing would be to hire more. However, until that happens, don’t you think that, as professionals, you should be giving priority to people who can’t afford private services?
Dr. Zahirney: Once again, our role is in this federal association, obviously, and it is the provincial associations that are actually making the negotiations with the government. We share the concerns about access to psychiatrists. We do have a responsibility to improve access to care for the population, and access to the most vulnerable, and that equity is one of the most important principles of that care. Physicians need to look at this judiciously.
Prior to the pandemic, it was a question that has been frequently discussed and raised at the level of our board. We have a committee that is looking into defining and making best-practice guidelines for psychiatrists in Canada about what we recommend is the role of a psychiatrist in our system. We’re working on that.
I agree that in terms of access to different provinces, if you look at our recommendations, we are strongly recommending team-based care, which is not integrated care within a health care system. So we’re focusing on the system so that psychiatrists are working with a multi-disciplinary team. We can’t automatically and magically increase our numbers, but we can increase our efficacy by having teams that share the knowledge and care of the individual, and can increase access so the psychiatrist is doing part of the role but those responsibilities are shared with the team.
I believe strongly in improving access to care. We have had discussions with the provincial psychiatric associations in terms of practices we would promote in terms of building negotiations with government. In the different provinces, we do need that negotiation with the government in terms of fee schedules. We would encourage using the fee schedules that are promoting best practices and promoting care to those most in need. We are an association, so we’re not the ones in that negotiation.
Senator Miville-Dechêne: I think Dr. Stergiopoulos has something to add. Please go ahead, because the issue of access is very important to me.
Dr. Stergiopoulos: It’s important to learn from what happened in medicine and surgery and the success of programs like webcams for cataract surgery and for hip and knee surgery. It took two key ingredients to improve access and decrease wait times for the services. The first was measuring wait times and tracking wait times over time. The second was having centralized access points so they could process all referrals so they could have accurate data and prioritize and distribute referrals in a geographical area. This has never been implemented in mental health, and I think it’s long overdue that we measure wait times for different types of mental health services, as well as centralized access points.
Senator Miville-Dechêne: Would it be a solution, Dr. McGrath and Dr. Zahirney, to centralize demands so we could go to the cases that are needed most?
Dr. McGrath: I think there is no one solution. We have to understand that the state of mental health and access to mental health is a reflection of the way we value different groups of people in our society. Those changes may be helpful if they’re done right, but they’re not going to be a universal solution.
We have to think about what our goal is and how we move toward it. If our goal is access, then we have to have a greater number of services delivered because there are simply not enough psychiatrists and psychologists available to do that. We have to think about the fee structure and that the fee structure will support access that is appropriate. The Canadian Psychiatric Association and the Canadian Psychological Association are very much in favour of increasing access.
It’s not going to be any one solution. Centralized tracking of wait times is a good idea, but what about the people who never get on the waiting list because they don’t have a family doctor? What about the people who don’t get on the waiting list because they don’t feel the services will be appropriate for them or they don’t feel comfortable going into a hospital or clinic? We have to think broadly about this, track these issues and do many different things to try to improve access.
Dr. Stergiopoulos: Various provinces have implemented centralized access points. There are certainly good data that this may facilitate access, particularly for those who have family doctors and where the flow of patients and information is coordinated and integrated in the system. Certainly in Quebec they have implementation. I work in one of the centralized points.
It’s not a perfect solution, again. I think there has to be an idea of promoting centralization of access and integration of services. There also needs to be coordination and it has to be in touch with local realities, services and resources.
The Chair: Thank you for this. It’s very helpful.
Senator Cormier: Thank you to the witnesses. My question is for all of them. COVID-19 is obviously affecting the mental health of many individuals, but it’s also affecting the mental health of communities. Some are saying there is now a collective trauma associated with the pandemic.
I’m particularly interested in how this pandemic is affecting the health of rural communities. We’re seeing major changes in public behaviour between individuals in small communities. People are making less conversation and less eye contact, and they’re more nervous and not as confident. This is becoming more and more obvious in the workplace, especially in hospitals and seniors’ residences. What can we do to restore the confidence needed to preserve the health of our villages and towns? Arts and culture organizations in those communities are wondering what kinds of strategies they should be using to draw audiences back in.
Towns and health care are primarily areas of provincial and territorial jurisdiction, but how can the federal government help measure the short-, medium- and long-term impact of COVID-19 on the health of rural communities? What can the federal government do to help the provinces, municipalities and associations implement collective measures, programs and activities that will restore the social fabric of communities hit by the pandemic?
The Chair: Who wants to take on that million-dollar question? Senator Cormier, you’ve backed our witnesses into a corner.
Senator Cormier: Okay, I’ll be a bit more specific. My understanding is that there are measures and programs for individuals. You’ve named a few so far during this meeting. But there also seems to be a need, as is often the case following societal trauma, for community-based measures that enable people to come together again, to gather, to speak to one another and to rebuild their shared sense of trust. That’s the gist of my question. Maybe this meeting isn’t the best place to be asking that question though.
The Chair: If the witnesses don’t have anything to say about that, we’ll try to find an answer to your question somewhere. Generally speaking, are we aware that there will be an impact on everyone, not just on individuals and populations dealing with mental health issues? Are your organizations conscious of the fact that society as a whole will probably be in shock and that we’ll all have to recover from it?
Dr. Zahirney: I could speak briefly to that, in more of a metaphoric way. As we know, the front-line health care workers and physicians were some of the first to be impacted by the difficulties and life disruptions of COVID-19. What we have seen from the medical population is that the creation of peer support groups, so peer to peer — I’m in a group with several colleagues from my hospital — with that kind of integration and knowing someone who is facilitating those peer support groups has been helpful for physicians. In that sort of stepped approach, there are other resources for people who are experiencing significant dysfunction and distress. This is a model that could potentially be explored for other sectors of the Canadian population that are experiencing difficulties. There are certainly techniques to improve resiliency among groups and equip them with tools to pass through this kind of crisis. I think we can be hopeful that peer support would help.
The Chair: Thank you for taking the plunge with that answer.
Senator Cormier: Thank you.
Senator Omidvar: This is an incredibly rich discussion. My last question is to Dr. Zahirney, and it pivots to the role of employers. What do you think is the appropriate role of employers in supporting their employees who are at home or who may, in fact, have been laid off as a result of this crisis? The Calgary Chamber of Commerce, for example, has encouraged its members to provide help.
What do you think employers can do? And what do you think the government can do to help employers provide these supports that are so essential during these times?
Dr. Zahirney: Even prior to the pandemic there has been the promotion of a set of standards for psychological health and well-being in the workplace. Certainly with the tensions and increased workloads of people — there may be only a few people in the office and people not there — we have to pay attention to that in terms of creating a safe work space, and ensuring that, as an employer, you are aware, perhaps, of the impact of isolation and the economic impact of changes in roles or even increasing roles.
I’m hearing that a lot of people have been furloughed. Many of my patients are saying there are two on sick and I’m the only one and just back from sick leave and have an increased workload. There have to be some kind of standards in terms of reasonable workloads and working conditions for people.
It’s variable, people who have access to a formal employee assistance program. That is where, even in terms of the government, how do we ensure that any worker who is experiencing distress has access to some kind of assistance program, be it public or private? There can be great differences in quality, length of treatment and access.
Senator Omidvar: Can you tell me, Dr. Zahirney, whether employment assistance programs are mandated by the federal government across federally regulated employers?
Dr. Zahirney: Are they mandated?
Senator Omidvar: I’m asking you.
Dr. Zahirney: No, I don’t think they are. Absolutely not. Small businesses —
Senator Omidvar: Federally regulated employers, which are usually not small.
Dr. Zahirney: Federally regulated would, but a lot of the smaller corporations will not have access to benefits for employees. In the shorter term, the government has stepped in, but what will happen in the long term? People who are without benefits are basically left to the mercy of the quality of services locally available to them in the public system.
The Chair: On that note, I want to thank our witnesses for your participation today. Your participation and assistance today has been very helpful and truly appreciated for us to conduct this study.
On that, my esteemed colleagues, thank you for your cooperation.
Without further ado, let’s continue our study of the government’s response to the COVID-19 pandemic. This afternoon we will be hearing from the following witnesses: Sara L. Austin, Founder and CEO, Kiah Heneke-Flindall, Youth Advisor, and Kamil Kanji, Youth Advisor, from Children First Canada. We will also have Emily Gruenwoldt, President and CEO of Children’s Healthcare Canada. Lastly, we’re pleased to have Katherine Hay, President and CEO of Kids Help Phone, with us today.
Today, to begin this panel, we have the pleasure to have with us, for their opening remarks, three individuals sharing their youth experience. Ms. Austin and Ms. Heneke-Flindall and Mr. Kanji will be sharing their time. They will be followed by Ms. Gruenwoldt and then Ms. Hay.
You have the floor.
Sara L. Austin, Founder and CEO, Children First Canada: Good afternoon. Thank you so much, Madam Chair. Thank you, honourable senators. In the famous words of Nelson Mandela:
There can be no keener revelation of a society’s soul than the way in which it treats its children.
Even prior to the COVID-19 crisis, the state of childhood in Canada was deeply worrisome. Over the past decade [Technical difficulty] from twelfth place to twenty-fifth place amongst OECD countries for the well-being of children according to UNICEF. The current crisis has exposed the problems that previously existed and exacerbated the problems.
For 8 million kids in Canada, their childhood has been interrupted. School closures have impacted the physical and mental health of children with short- and long-term implications. As we prepare for the summer months, I worry that the situation of children could get worse due to the closure of schools and a lack of other available supports to help children outside their homes. Children First Canada has urged parliamentarians to consider the unique ways in which children are impacted.
We have provided you with a copy of our submissions but, in short, we have focused our advocacy on three major areas. First, our Council of Champions released a joint statement calling for a federal investment of $250 million to be allocated to children’s physical and mental health, their protection from violence and their resilience. Second, we have called for the establishment of a commissioner for children and youth to ensure the protection of their rights. Third, we have advocated for the government to directly engage children and youth in the crisis response. To that end, we recently announced the formation of the Young Canadians’ Parliament to provide a platform for children and youth to engage with their peers and with parliamentarians to ensure the protection of their rights.
We have been encouraged by the initial investment made in front-line organizations and by the Prime Minister’s efforts to directly engage children. These early efforts have been greatly appreciated but much more is needed.
As the government moves from a crisis response to an economic recovery plan, a sustained and impactful investment in children and youth is critical.
According to the World Bank, investing in the early years is one of the smartest investments a country can make to break the cycle of poverty, address inequality and boost productivity later in life. Early interventions in children can have enormous payoffs in the future both for them as individuals and for the country as a whole.
Now, more than ever, Canada needs strong federal leadership to ensure that no child is left behind. The federal government has the primary responsibility to lead a coordinated national response and ensure equitable care and support for all children. Children are not objects of our charity; they are citizens with rights. Every single day matters in the life of a child and they cannot afford to wait. I urge the federal government to act without delay.
I want to thank the honourable senators for your commitment to address the impact of this crisis on children. I am hopeful that more deliberate action will be taken in the very near future. Children First Canada stands up for children, and we empower children to stand up for themselves.
On that note, I am pleased to be joined by two of our youth advisors, Kamil and Kiah, who will speak from their own perspective as to how they and their peers have been impacted and to share their own recommendations. Thank you.
The Chair: Thank you. I think we are ready to hear from both youth representatives. We are happy to have you with us. We will begin with Ms. Heneke-Flindall.
Kiah Heneke-Flindall, Youth Advisor, Children First Canada: Thank you to the chair and members of this committee for having us. I feel very privileged to be here today.
I also feel that I have been privileged throughout my life to have had opportunities like this one available to me. Growing up, I have had access to a safe, supportive household and my voice has been empowered and encouraged. That is why I am here today.
What I see, though, is a cycle with privileged young people growing up to be privileged adults time and time again and leaving the most vulnerable individuals out of the conversation.
So many young people are being left out of the picture, and even the ones I’ve spoken to are not being educated on how they can have their voices heard. How is that fair that children don’t even know they can make a difference?
If we are truly looking to build a better future, we need to start with the empowerment and inclusion of all of our nation’s emerging leaders leaving no child behind.
In these difficult times, critical issues that impact young people are being amplified. These tough conditions pressurize challenges with mental health, especially among already vulnerable youth who are lacking a safe space to learn and connect with their support systems. Further, parents and caregivers are facing similar struggles, leaving those they are caring for exposed to increased stress, instability and abuse.
Young people have to start being included in decision-making about issues surrounding children and youth, because ourselves, our siblings, our friends and our peers are the ones that are experiencing these challenges and can give the best insight on how to tackle them.
Let this difficult time be an opportunity to keep moving forward for action and change with regard to the well-being of Canada’s young people rather than a time to fall miles behind.
What I have seen from my experience working with other youths and from being a young person is that we are capable and inspired leaders.
When given the chance, young people can truly contribute creativity, diversity, sustainability and justice through a perspective of tomorrow to the framework of our political systems.
The Chair: Thank you.
Now to you, Mr. Kanji.
Kamil Kanji, Youth Advisor, Children First Canada: Hello, Madam Chair and members of this committee. Thank you so much for having me today.
As a young person living in a low-income community, I have seen the impacts that this pandemic has had on my peers first-hand. Children are suffering now more than ever.
Due to the closures of recreation facilities and schools, people with whom I have gone to school every day and people I have spent my whole life playing in the park with or going on bike rides with no longer have access to the breakfast programs that they relied on in the mornings, and their mental health is on a rapid downward decline as they are forced to endure endless verbal abuse from economically challenged parents.
As the days drudge on, my peers become more and more isolated from their communities, lose their routines of an active and healthy lifestyle and, worst of all, lose hope in their futures. In a country as great as ours, this should not be a reality we accept but rather a challenge we face together.
After many years of service and thousands of interactions with passionate young Canadians, I have seen the amazing leadership capabilities of my peers. It is clear that we feel as though people in power disregard our opinions because they feel we are too young.
On behalf of my 8 million colleagues across the country, I urge every person in a position of power to stop underestimating the capacity of youth and thinking that just because we are young we are incapable of creating change. As a matter of fact, it is the exact opposite. I call on every parliamentarian to utilize our skills and assist in uplifting us into positions in which we can work together to create real solutions.
Youth is not a weakness but rather one of the greatest strengths of our nation. I urge leaders to use it so that we as children can resolve our pain and restore our happiness. Thank you.
The Chair: Thank you. Let us hear from Ms. Gruenwoldt.
Emily Gruenwoldt, President and CEO, Children’s Healthcare Canada: Good afternoon, senators. It is a pleasure to be invited to speak here today.
My name is Emily Gruenwoldt and I am the CEO of Children’s Healthcare Canada. I am also the Executive Director of the Pediatric Chairs of Canada. We believe that while kids have been among those least likely to fall seriously ill because of COVID-19, Canada’s children and youth have been the most affected by our response to the pandemic.
As many of you will know, earlier last month Children’s Healthcare Canada, the Pediatric Chairs of Canada and Canada’s children’s hospital research institutes submitted a proposal to the federal government urging emergency funding to expedite the roll-out of virtual health care services in hospitals and within the community, as well as funds to sustain the child health research enterprise heavily impacted by the economic slowdown.
These recommendations were endorsed by the Canadian Paediatric Society and their 3,400 members across Canada. Collectively, we are pleased with the government’s initial response to both requests. We continue to work with federal officials as well as Canada Health Infoway and the Canada Research Coordinating Committee to ensure children’s providers and researchers receive an equitable allocation of this funding.
Today, I would like to focus my time speaking to how COVID-19 continues to impact the health and wellness of children and youth across Canada and the role of the federal government to build back better — that is, to facilitate a nation of vibrant, healthy children and youth.
Last week, Children’s Healthcare Canada surveyed 60 executive physician and administrative leaders of Canada’s children’s hospitals, community hospitals, children’s treatment centres and home care and respite care providers. We also surveyed our Family Network, comprised of over 100 family partners. In addition to continued support for the implementation of virtual care and funding to sustain Canada’s children’s health research community, two clear priorities emerged: enabling access to essential health care services, including addressing the backlog and wait times for elective procedures; and facilitating the return to school for children and youth. I will address both of these issues in succession.
It has been 11 weeks since the most non-urgent and elective procedures abruptly came to a halt in hospitals across this country. At the same time, many essential services delivered in the community or the home were also shut down.
While the virtual delivery of some of these services provided an important stopgap measure, the time has come to facilitate the reopening of these services for children, youth and their families.
The capacity of our health systems to thoughtfully and safely ramp up services in the days and weeks to come will be critical to reducing morbidity and ensuring positive health outcomes for Canada’s children and youth.
Dr. Andrew Lynk, Chair and Chief Pediatrics at Dalhousie University, has observed the focus on the backlog of services in the adult-care sector, but worries the same attention has not been given to the impact this shutdown has had on children.
If we want to mitigate the negative outcomes associated with delayed or deferred services, or the related wait times patients and their families are now experiencing, we will require additional federal resources to bridge the gap, allowing children’s hospitals to operate at a higher capacity than which is possible with current operating budgets.
It is estimated that children’s hospitals will require up to a 20% increase in resources to address the growing backlog of non-urgent and elective procedures.
Beyond surgical and elective procedures delivered by our children’s hospitals, many children, youth and their families continue to experience significant gaps in services. The majority of in-person visits have been postponed for children with medical complexities, as has their access to community-based services, including speech language pathology, physical therapy, occupational therapy and social work.
While the disruptions were an inconvenience in the short term, many families now fear their children are experiencing an irremediable loss of functioning and are observing significant behavioural challenges, in particular in children with neurodevelopmental diseases.
Families of children with complex impairments, developmental challenges and disabilities are also struggling with decisions around the continuation of home care and respite services. Many have cancelled nursing services because they are worried about increased infection risk from individuals coming in and out of their homes, while others simply do not have the space to accommodate home care workers or those providing respite care during this time when parents and caregivers are working from home. In some instances, parents and caregivers have had to forego employment to care for medically fragile children and putting additional strain on their family.
Jennifer Churchill, the CEO of Empowered Kids Ontario said:
Further complicating matters is the fact that staff at child development and rehabilitation centres who are preparing to resume in-person services face a child-care crisis created by the coronavirus pandemic that threatens to undermine our ability to deliver services — including expanded virtual services — and the reopening of local economies.
Public schools are closed in nearly every province, and many camps will not open this summer. Child care providers remain closed or open only for children of designated essential workers. The informal network of relatives and friends that many of us rely on for child care has collapsed in this world of social distancing.
The role of the federal government, working in close collaboration with the provinces and municipalities responsible for public health, includes sourcing a reliable supply of personal protective equipment for health professionals, young patients and their families; enhancing testing and tracing capacity to facilitate the reopening of our essential health care services; ensuring adequate infrastructure to facilitate delivery of virtual care where appropriate; facilitating the reopening of child care spaces to enable the return to work for health service providers; and importantly, funding to increase hospital capacity to address the backlog of elective services.
The second issue I would like to quickly address is the return to school for children and youth. As evidence evolves internationally, we are developing a better understanding of the relationship between children and the coronavirus. While the pediatric community watches closely the developments associated with multi-system inflammatory disease in the context of COVID-19, the research still tells us that children are less likely to contract coronavirus.
Researchers at Great Ormond Street Hospital in London, England, have found that children appear to be 56% less likely to contract the virus than those over the age of 20, a finding that supports the idea that children are unlikely to play a major role in spreading the disease. In fact, the balance of evidence to date suggests children are the safest group to be out in the community. They have the lowest prevalence of infection, and the risk of death or severe infection from COVID-19 remains exceptionally low. Many of Canada’s children’s hospital leaders agree and favour a return to school given the well-documented impact of social isolation due to physical distancing measures.
Dr. Ronald Cohn, the CEO of SickKids, said:
We need to accept that this virus will stay with us for a long time and we have to learn how to live with the current situation, reduce and mitigate risk as much as possible, yet acknowledge that we likely won’t be able to eliminate risk altogether for some time.
Dr. Kathy Bigsby, a pediatrician in Charlottetown, Prince Edward Island and a board member of Children’s Healthcare Canada states:
We must acknowledge and address the risks to healthy physical and mental development of children in the face of prolonged school and camp closures, and home confinement. Children are missing out on the critical social interactions with friends, classmates, and teachers that are essential for their healthy growth and development.
This perspective is echoed by Kathy MacNeil, CEO of Vancouver Island Health Authority:
The risks to the mental well-being of children and youth are compounded by the stress of an ongoing pandemic and changes in routines and structure. As schools work to reopen across Canada, we must not overlook the necessity to make available mental wellness resources, whether face to face or virtual, in particular for vulnerable youth.
For Canada to successfully reopen their schools, the health and education sectors must work together along with children, youth and their parents to develop innovative policy and pedagogy solutions to enable a fulsome and safe return in September. These solutions need to be guided by community-level evidence and, where relevant, pan-Canadian and international experience. Special considerations and a unique strategy will be required for children with disabilities and medical complexities, or other vulnerable children — a strategy that must be co-designed with family partners.
The federal government has a leadership role to play. We require, yet again, enhanced testing and contact tracing. As children return to school, we must have the capacity to monitor the spread of this virus with vigilance. We also require financial support for the education sector to develop and implement a strategy to ensure a safe and effective learning environment for all of Canada’s children and youth.
In conclusion, Children’s Healthcare Canada and the pediatric chairs believe that children have been the silent victims of this COVID-19 pandemic. Earlier this spring, UNICEF released a report that recognized the unprecedented impact of COVID-19 on the lives of children and youth. There has been a perception amongst many that because children are less likely to experience severe symptoms, they are less affected. We know this not to be true.
The next several weeks and months will be defining times for all Canadians, including our children and youth. Children and their families cannot afford to wait months or years for essential health services, including surgical procedures, outpatient therapies or home care, nor can they afford to wait months or years for school to return so that they can socialize with their friends and learn in a safe environment. Children are by nature resilient, but the time has come to implement solutions to ensure their health and well-being.
Canada’s federal government, working in close partnership with its provincial and municipal counterparts, plays an essential leadership role in this COVID-19 recovery and more broadly in the delivery of compassionate, safe and effective health care for all Canadians. Let’s not lose sight of the burden this pandemic has had on our children and youth and our responsibility to build back better.
Katherine Hay, President and CEO, Kids Help Phone: Good afternoon, everyone. Thank you, Madam Chair and honourable members of the committee.
For over 31 years, Kids Help Phone has been Canada’s only virtual e-mental health support for young people across Canada in French and in English, 24/7, 365 days a year in every province and in every territory. In 2019 alone, over 1.9 million young people reached out to our service across all our direct service and service programs.
Every day, young people reach out to us about every challenge they face, from anxiety to bullying, relationship difficulties, to suicide. So it should be no surprise, as Canada and the world was struck by a crisis — a pandemic — fundamentally changing our daily lives, that young people are reaching out to us more than ever.
Since March 12, when COVID-19 became a stark reality across Canada, Kids Help Phone has seen a steady increase in conversations with demand for our texting service up by 61% and demand for professional counselling services up by 55%. Also, the issues young people are contacting us about have changed. Pre-COVID-19, issues like depression and suicide were among the top reasons young people reached us; now, those reasons are eating disorders and body image; isolation; emotional, physical and sexual abuse; grief; and substance use.
While we continue to be the go-to place for young people experiencing suicidality, I am pleased to report to this standing committee that we have not seen an increase in those conversations over the last few weeks. We continue to conduct on average nine active rescues every single day. While that number thankfully has not grown since the beginning of COVID-19, it should be noted it does mean we have conducted over 650 active rescues since mid-March.
It is important to note that young people are not all the same, and the challenges they face can differ by culture, race, age and location. Today, this is particularly evident, as we are witnessing the continued challenges our black Canadian youth are facing.
For Kids Help Phone users, those who speak about racism are among the most highly distressed texters, second only to those who fear harm from someone in their home. Texters who report experiencing racism are more likely to discuss suicide than all other texters. This is going on while COVID-19 is impacting our young people.
Among some of the other differences we are seeing, young texters aged 5 to 17 are contacting us at increasing rates to talk about body image and eating disorders — young texters. Young men are reaching out with more frequency to talk about relationships. Young people from Nova Scotia are, unsurprisingly, talking more about grief than anyone else in the country. In Quebec, conversations about anxiety and stress are higher than the national average. In British Columbia, conversations about abuse are higher than in all other provinces and territories right now. This is important real-time data that will inform service policy and advocacy.
The day-over-day increases in demand for service came while we were also grappling with the financial toll of the pandemic, like so many other charities across Canada. Kids Help Phone is grateful to our partners in the federal government that this need was recognized.
In mid-March, our request to the federal government through the Prime Minister’s office and the Public Health Agency of Canada was graciously and quickly heard. This support and financial investment ensured there was no service disruption. In fact, it enabled us to expand our service to meet the growing demand, with wait times under five minutes. But there is more that should be done; more investments in other youth charities need to be made. That is essential.
As well, Kids Help Phone supports the growing request for the appointment of a national commissioner of children and youth. Children, youth and young adults make up a quarter of Canada’s population, yet they have no independent voice to represent their rights and interests at a national level. This representation was needed before the pandemic, and now the urgent need cannot be ignored, particularly for our most vulnerable youth.
We need to increase support to youth in care. Kids Help Phone has been incredibly concerned with the increase in context we have been receiving from young people experiencing abuse. Since March 12, there has been a 35% increase in conversations about emotional and physical abuse, and 36% involving sexual abuse. Canada must ensure that youth in care and young people experiencing abuse continue to receive support from the systems meant to protect them. When many safe places for youth remain closed, such as schools, new entry points into child protection systems need to be developed.
Finally, as I discussed before and given what we are seeing and hearing in addition to COVID-19, we need to ensure we are finding solutions to address the systemic racism black Canadian youth are facing. This includes ensuring economic and educational opportunities and increased mental health services and support. Kids Help Phone would welcome the opportunity to work with government and other organizations to leverage our data and find meaningful solutions to support racialized youth across the country with youth at our side.
We need to take these recommendations, and those of my esteemed colleagues at this meeting today and in this sector, and align them with important recommendations made, even before the pandemic, for improvements to the mental health and well-being of young people in our country. Now, more than ever, we need to be mindful of the identified gaps and inequities to ensure we level the playing field for all youth in Canada.
I thank you for the opportunity to share with you what young people share with us every day.
The Chair: Thank you to our witnesses for their very valuable opening remarks. We do have some questions for you.
Very briefly, I want to remind my colleagues to please use the raised-hand function to signify that you want to ask a question, and please make sure that you identify who you want an answer from.
Senator Poirier: My first question is for Kids Help Phone. The Government of Canada announced a support of $7.5 million to support Kids Help Phone, and in your presentation, you said it was over 21 months during increased capacity. Have you started to receive the funding promised by the government? And why is it spread over 21 months?
Ms. Hay: Thank you for the question, senator. Kids Help Phone is most appreciative of the support from the government. We have started to receive the funding. We’re working with the Public Health Agency of Canada on that.
For us, we understand that the impact of COVID-19 is not going to be over when school begins in September or even this time next year. In our discussion with the Public Health Agency, we asked: How do we take this funding and make sure it keeps us sustainable while we are grappling with the increased volumes? We don’t anticipate our volumes will drop, actually. We pulled it out over a period of time to make us more sustainable.
Senator Poirier: Thank you. How exactly have these funds that you have started receiving helped you during the pandemic?
Ms. Hay: Thank you for this question, senator. Like all charities in Canada, our funding model is a combination of mostly philanthropic support, Canadian corporate support, mass fundraising in various communities across the country and government support. At Kids Help Phone, a maximum of about 40% of our total budget is government support, and mostly provincial support, actually.
The reality is that when the pandemic hit and impacted the economy in Canada, our revenue lines were going to be down. That was a piece of the discussion that we had with the Prime Minister’s office and the Public Health Agency of Canada. Things like our national Walk so Kids Can Talk is a $4 million annual budget line for us to support our service. So there is a drop in revenue that we recognized, and there was also the increased demand for service that we knew was coming our way.
We support our regular service and our professional counselors. We have about 120 of them in Canada. We moved them remotely, and then we were able to hire some more. As well as that, we need to expand our texting program. What is extraordinary about that is our crisis responders are trained volunteers who are already on a dynamic technology, so it is scalable. We were able, with this funding, to expand the scalability of it, make sure we had the right professional counselors who oversee this service, the right number of coaches and trainers training more Canadians to be crisis responders and a focus, with this increased capacity, on underserved populations in particular.
Senator Poirier: Thank you. Ms. Hay, in a recent interview on a CBC broadcast, it was reported that Kids Help Phone had expanded its support to adults, which speaks loudly to the lack of access and services for mental health, especially during this time.
You have expanded your service by text for adults and front-line workers. In your opinion, has the federal government invested in the direct help for mental health services for adults and front-line workers, which in turn allows you to fully focus on youth and kids during COVID-19?
Ms. Hay: Thank you for this question, senator. It’s a very important one.
First, I would like to share with the committee that about, pre-COVID, 10% to 15% of our Crisis Text Line texting platform, powered by Kids Help Phone, was adults 30, 40 and 50 years old, because at 2 a.m. in Canada there is not another national service that is there for crisis response. Kids Help Phone is it. On our professional counselling service, we will often get adults who reach out to us and say, “I know this is a service for kids” — and I’m going to be overly dramatic — but they will say something along the lines of, “I feel like my life is worthless and I’m walking toward means for suicide,” and at the end of the day, we would help them.
That’s just a lay of the land pre-COVID-19. We have the technology in Crisis Text Line, our texting platform, to be able to spread and scale that. Our training is not youth-specific, though we do have modules specific to Indigenous youth. We have the technology, we have the infrastructure and we knew that we could scale this. At this time, it was the appropriate time to do so.
As it relates to funding from the government, we actually expanded Crisis Text Line All Ages through Wellness Together Canada, which is a new portal for mental health and substance abuse funded by the federal government as a result of COVID-19. We are one of the partners and one of the e-mental health solutions within that portal, and the funding came to Kids Help Phone through that to launch Crisis Text Line All Ages, so it did not take funding from Kids Help Phone proper to launch Crisis Text Line All Ages.
I would like to make one point in support of my colleague, Dr. Emily Gruenwoldt. Virtual care is an important addition to mental health services. When Kids Help Phone launched Crisis Text Line, in 2019 we handled more than 200,000 texting conversations in every province and territory, with wait times of less than five minutes. It has a neural network and AI machine learning, so if a person is in crisis they are served within 40 seconds. It’s not first-come, first-served; it’s based on acuity. We ran that entire service in Canada for about $3.5 million. That is incredible return on investment for Canada.
Senator Poirier: Thank you very much.
The Chair: Thank you, Ms. Hay.
Senator Griffin: I’m going to follow up on a question that Senator Poirier asked in regard to the adults who are using the Kids Help Phone. Do you see the service continuing after the pandemic is finished?
Ms. Hay: Yes, indeed. In fact, I encourage the standing committee to support that, as well as the government, and expand the service well beyond the immediate pandemic, because the echo pandemic is a reality. We know what trauma does in the long term, and so therefore Crisis Text Line All Ages most definitely needs to continue. Wellness Together Canada needs to continue and I believe it will, though I have no promise of that.
Senator Griffin: Thank you. My last question is for Ms. Austin. In your brief, you mentioned the proposed commissioner for children and youth. Could you give me more detail about that idea and how it interfaces with the current COVID-19 crisis? Should our committee have as one of its observations for the study that we indeed recommend the establishment of a commissioner for children and youth?
Ms. Austin: Thank you, senator.
There certainly has been a lot of discussion about the need for a children’s commissioner going on well over 30 years. Its time is long overdue.
The vision we have at Children First Canada for our country is making Canada the best place in the world for kids to grow up. We looked at what the world-leading countries are doing, their best practices in terms of laws and policies and what they have done to help ensure the protection of children’s rights to help all children in their countries not only survive but thrive.
One of the common denominators is the presence of an independent office for children, known as either a children’s commissioner or a children’s ombudsperson. They exist in well over 60 countries around the world in a variety of different contexts, and they are a proven and effective strategy for moving the needle for children. The U.K., for instance, going back several years ago, was lagging behind other OECD countries in children’s well-being. They put in place children’s commissioners in England, Scotland and Wales and established an independent office that had the mandate to promote the rights of children, listen directly to children, be able to conduct studies, hold government accountable and drive a national plan of action. In the case of the U.K., they rapidly moved up the OECD rankings for children’s well-being by well over 10 points.
Meanwhile in Canada, while this issue has been debated for so many years, we have, sadly, never been able to cross the finish line with the establishment of a children’s commissioner. In the meantime, we have dropped from twelfth place amongst OECD countries to twenty-fifth place.
We can take the U.K. as a meaningful example of what can be done and look to what is being done in countries around the world to move the needle. In a country like ours, where we need to look at made-in-Canada solutions, the need for a children’s commissioner needs to evolve within the context of nation-to-nation relationships, so, of course, there is a need for the federal government to work in dialogue and with meaningful consultation with First Nations, Métis and Inuit peoples and their national organizations, and to develop this in direct consultation with children themselves. I know the Senate Human Rights Committee has studied this before. There have been countless recommendations, yet, sadly, this has never crossed the finish line.
This current crisis has revealed the cracks that existed previously in terms of the well-being of children and the lack of protection of their rights. Now, more than ever, it’s important that we actually move forward with the children’s commissioner. Canada is about to appear at the UN Committee on the Rights of the Child in terms of the lack of progress we have made over the past five years. This would be a meaningful step forward to demonstrate progress in children’s rights and prepare for those hearings. Even right now, in the middle of this crisis, we are seeing that children don’t have a meaningful way to be engaged with the government. We have developed the Young Canadians’ Parliament as one way for children to have a platform, but there needs to be an office in government that’s independent, free from political influence and has no other agenda than to promote the rights of children and to be their advocate and focal point.
Senator Griffin: Thank you.
The Chair: I see that both Ms. Hay and Ms. Gruenwoldt want to add something. I can give you a few seconds if you want to add something to this. I know we will cover it later on as well, but if you want to add your voice to this specific question very quickly, I will let you proceed.
Ms. Hay: Thank you, senator. Kids Help Phone has a National Youth Council. We have two voting members reserved on our board of directors for the youth members. We also have an Indigenous Advisory Council made up of 50% Indigenous youth. It would make no sense to Kids Help Phone to make decisions on their well-being and what kids in Canada need without the youth voice at our table, so we fully support that.
Ms. Gruenwoldt: Just to add to Ms. Austin’s comments, this is an idea that is widely supported by many other children’s health organizations across the country. We have spent months, if not years, advocating for and researching the role of a commissioner. This is not a single organization’s idea. There is great support for the idea of a children’s commissioner across the country.
The Chair: Thank you very much. How appropriate that the next senator on my list is Senator Moodie, who is also very supportive of this.
Senator Moodie: Thank you to the witnesses today for joining us.
Thank you for giving me the opportunity to not have to ask this question, because you’ve provided all the responses to an area that is very dear to my heart, which I support strongly and look forward to talking about more.
I’m going to focus on funding. One of the big challenges that COVID-19 has unmasked for us is areas in our system of care for children where funding has been lacking, but also where COVID-19 needs have created a surge in the need for funding. Sadly, I’m going to ask all of you to comment on this. It is my understanding that the response to funding for children has been limited.
The first part of my question, Katherine Hay, is this: What process did you use to lobby the PMO and Public Health Agency of Canada for the $7.5 million funding that you received? Speak to the obstacles you navigated successfully and what you think might be causing issues for other groups.
The bigger question, to Ms. Austin and Ms. Gruenwoldt, is this: Can you please comment on what the funding has been like for children and children-related organizations in this COVID-19 pandemic?
Ms. Hay: My comment around the process for Kids Help Phone and the Public Health Agency is that we’ve had a long‑standing relationship. We haven’t been a recipient of major federal funding in the past. We have a phenomenal relationship with Canada Health Infoway, as the technology charity that we are. However, we are always at round tables, we provide real‑time data and we work with them as advocates for children, youth and young adults.
When the extraordinary times of COVID-19 hit, I’m proud to say that our government and the people I have the pleasure of speaking with at PHAC and the PMO stopped and listened. COVID and the circumstances surrounding it are certainly unlike anything I have experienced in my life, and I am closer to the end of my working life than many people here.
I was proud, as a Canadian, that they heard what we needed. They heard that if we had to turn down our service, if we had to go dark, that would be a problem.
The process was iterative. We put forth a robust proposal to government, PHAC and PMO. Actually, it was PHAC and Kids Help Phone who went through the specific budget lines that were impacted by a reduced revenue. When we had to enact our business continuity plan in response to COVID-19, like everybody else in the country, we had to send people home. We didn’t have the technology in place to send 130 counsellors home. We had to do that at the same time. They heard all of that, and the process was simple: transparency, clarity, brevity and proof — trust in Kids Help Phone and in what we do, and the proof in terms of how we were going to spend the funds.
Senator Moodie: Thank you so much. And in terms of comments on what the needs have been and still are, Ms. Austin, would you like to start?
Ms. Austin: Thank you, senator. At the beginning of the crisis, we consulted our Council of Champions and looked to the advice of my colleagues who are testifying here today, as well as many others who represent some of the leading children’s charities and hospitals. We worked to identify the front-line needs to be able to serve and support children immediately, but also anticipating there would be needs for months, and in some cases years, to come.
The resounding feedback was that there were urgent needs around the physical and mental health of children. We have identified significant funding needs around virtual care, mental health supports, research to look at the needs of children in this crisis and beyond, as well as the need to enable the voices of children and youth in decision making that affects their lives. We identified funding needs around the protection of children from violence, looking at, for instance, the role of child advocacy centres, which are multidisciplinary teams that serve and support children who are victims of abuse and in need of supports for their healing and recovery from trauma. We also worked with Boys and Girls Clubs to identify funding needs, particularly around supporting resilience of children and youth to enable their support virtually throughout this crisis and beyond.
The funding needs we identified amounted to about $250 million. We provided proposals and had extensive discussions with multiple ministers, their staff and departments in trying to navigate a web of funding channels to secure the timely release of the funding.
We certainly continue to hear from all government stakeholders about the recognition that the needs we’ve brought forward are valid. There is a recognition that these needs exist and that the agencies identified to help meet these needs are credible, trustworthy and have the capacity.
However, we continue to deal with what I would describe as red tape. For instance, the federal government doesn’t typically fund children’s hospitals in the best of times. So how do we work within this crisis response to enable the 13 children’s hospitals, as well as other hospitals that serve and support children, to deliver a national mental health program that will look different in each province?
There are real challenges around how to navigate existing funding channels and meet urgent needs. In some ways there is a recognition that the needs are valid, that the proposals being brought forward are sound and that the organizations that could meet those needs are credible and trustworthy and include some of the best experts in the country to be able to do it. However, we continue to face challenges around how to unlock that funding and get it released in a timely way.
Ms. Gruenwoldt: Amplifying much of what Sara and Katherine mentioned, we spend an inordinate amount of time reminding our elected officials that children are not little adults. When it comes to health care, they have unique needs and unique funding is required to support their health care services.
We have been encouraged by investments in virtual care and in health research more broadly. We continue to work with the federal government to ensure they understand the unique needs of children in both those portfolios. That’s an ongoing conversation. To Sara’s point, there has been a lack of recognition more broadly about investments in children’s health and well-being in the context of COVID.
Senator Dagenais: My question is for Ms. Hay. You talked about problems affecting children in different parts of the country. I can tell you that COVID-19 has hit my part of the country, the Montreal metropolitan area, particularly hard. Schools there are still closed. Kids’ sports are cancelled. We are still in lockdown, and I can tell you that kids in my neighbourhood are out of ideas. So are their parents.
The things you’ve been hearing are crucial to effective intervention. Is the information you’ve been gathering being shared with other health and support services so that everyone can make appropriate preparations for the changes we’ll be seeing because of this crisis?
Ms. Hay: Thank you for that question, senator. Our data shows that Quebec is experiencing enormous stress from a young person’s perspective, as well as from adults. The data I’m glancing at now coming out of Quebec is disconcerting.
We consider our data to be not just ours; we share it freely. In fact, we will be launching a public data site, at no cost to anybody, within the next six weeks or so. We work with public health agencies across the country, as well as provincial jurisdictions and territories, to share this data. We work with them directly through round tables to make sure that when they are reviewing what they might need to do, they have real-time data directly from those impacted.
The answer to your question is: Yes, we could do more. We have a call centre and quite a significant presence in Quebec. We partner with Tel-jeunes as well.
The Chair: Before giving the floor to Senator Mégie, we will hear from our two youth advisers, Kiah and Kamil. So far you’ve been listening. We’re talking about investments from this government and different programs at so many levels. We’ve talked and you’ve read about the level of anxiety, distress and mental struggles. Kiah, you might want to go first: Are all these existing programs reaching you? For you and the youth around you that you talk to and know, is it easy to connect and know where to go when someone feels that kind of anxiety and distress or needs help? Basically, is it working, and is it reaching the ones that it’s supposed to reach?
Ms. Heneke-Flindall: Yes, I definitely think that it’s a start. The work that you guys are doing is incredible, and there are a lot of really strong programs that are setting down a foundation for this kind of thing. There needs to be more widespread effort in terms of awareness of how to access these kinds of programs and making sure that there’s less stigma and fewer barriers in reaching out to help programs or being able to talk about it with others and having people they trust to be able to talk to. I really think a consistent way of doing that could be through some more school-implemented programs.
I know that during COVID-19, it’s tons and it’s not as easy, but if there was more of a base in past times, before we got to this point, of having consistent in-class programs of people coming in and making sure we know how to use these things and access these resources and making presentations so people and their peers feel comfortable doing it, that would make a difference.
The Chair: Thank you. Kamil, did you want to comment on that?
Mr. Kanji: Yes, thank you, senator. I agree with Kiah. There is excellent work being done by various organizations. However, I’m going to take this question as more of an approach that I’m familiar with, and that would be the racial disparities that exist.
Within certain ethnic groups and racial minorities, there’s a very large stigma around mental health that makes people feel like it’s not appropriate to talk about your feelings, so just get over it and move on; figure it out. Often younger people in different ethnic groups are trained that talking about your emotions is not okay and reaching out to these organizations is a sign of “weakness,” which is completely flawed. There needs to be more education in that realm and there needs to be specific targeting toward different groups that may be impacted by the stigmatization a lot more than others. That’s where the education campaign needs to start.
There’s a lot of great work being done. But at the end of the day, if there were systems such as the Young Canadians’ Parliament that Children First Canada is working on, by providing a direct line of communication to leaders through the Young Canadians’ Parliament, there would be more and easier communication about the various needs of younger people specifically in terms of mental health.
The Chair: Thank you both for these comments. If I go by the number of nods that I see on my screen, I think you have been heard.
Senator Mégie: I’d like to thank the witnesses. My question is for Ms. Austin.
Earlier, you were asked a question about a special commissioner for children’s rights and youth protection. You also suggested a youth parliament. You are aware of the Prime Minister of Canada’s Youth Council. Would the purpose of the youth parliament you are proposing differ from that of the existing youth council?
Ms. Austin: Thank you for that question, senator. We have some material about the proposed Young Canadians’ Parliament which is making its way to you and you will be receiving shortly.
When we looked around the world to see what other countries are doing to enable the voices of children and their participation and the promotion of their rights, the Young Canadians’ Parliament that we are establishing in the middle of this crisis is in direct response to the input and ideas of children themselves.
All the mechanisms that I’m aware of by the federal government right now to engage children and youth typically start at the age of 15 and often go up into the early 20s. Youth councils tend to enable the voices and provide a meaningful platform for older youth to be heard, but it really speaks to the needs and interests of older adolescents and, in many cases, young adults.
We have been consulting children and youth through our programs and the creation of the Children’s Charter several years ago, and children as young as 8, 9, and 10 years old were saying they wanted a platform to be heard. This idea of a Young Canadians’ Parliament is youth-initiated, youth-designed, will be youth-led and will enable the participation of all Canadian youth below the age of 18 to participate in an open forum. Right now the mechanism is that we will be meeting monthly. It will be an open forum for any youth under the age of 18 who wishes to participate. They will be hosting monthly sessions on different topics. The first session will be held on June 18 focused on mental health and the immediate needs of children and youth as they prepare for the summer. Each month they’ll be talking about issues that affect them. Youth themselves will be the experts and they will be inviting parliamentarians in to listen to them, to hear their concerns and to respond to their questions and concerns.
We’re developing this now in the middle of the crisis to enable children’s participation in this crisis response, but ideally it should be something that’s sustained well beyond the crisis to involve the ongoing participation of youth in policy development that affects their lives so that youth themselves can bring forward policies that they themselves want to see enacted, but also to be a sounding board for government as the government moves forward with initiatives to directly consult children and youth of all ages.
I should defer to my younger colleagues, Kamil and Kiah, who have been involved with the consultations to design this, if they want to comment further.
Mr. Kanji: I would like to touch on the fact of the shadow cabinet and the Prime Minister’s Youth Council.
I find that youth councils and bodies already put in place for youth advocacy on the federal level are often only for the most qualified, the most astute or the most active youth within their communities to have a seat and a voice at the table. The voices of the vast majority of youth, who are maybe not as engaged and not as involved in different leadership activities, are often not heard at the federal level. The Young Canadians’ Parliament is a platform for those voices to be heard. It’s a platform for a 12‑year-old who has just finished their schooling to have a voice at the table and to contribute their ideas of what they would like to see in the country. Normally a 12-year-old or someone who is 13 or 14 would not have the opportunity to speak as openly at a shadow cabinet or a Prime Minister’s Youth Council meeting.
Ms. Heneke-Flindall: I wanted to support Kamil and what he said. I agree. Starting younger is always a better idea because then more children and youth are going to become involved in the future and become those highly active, engaged youth that you’re going to be finding in those types of councils. We need to have both parts of the system for the whole thing to work seamlessly so as many people as possible feel like they can be involved and have their voices heard to really represent the population of our country, rather than hear little patches from different people.
The Chair: Thank you for that.
Senator Mégie: Ms. Austin, earlier you talked about virtual care, and this morning, we talked about inequalities with respect to accessing the virtual world.
Could the federal government nationalize virtual infrastructure to ensure more equal access to the network no matter where people are?
Ms. Austin: It’s certainly opening up a big can of worms around this idea of nationalizing programs. I don’t have an opinion on that at this time. There is certainly a role at this time for the federal government to work with the provinces and territories to ensure equitable care and services, taking, for instance, the issue of mental health supports for children and youth right now and where they would be regionalized, whether it’s provincial or local programs being designed by children’s hospitals and other hospitals and health organizations serving and supporting children to be able to meet the mental health needs of children. Releasing federal funding to support national programs like that through the children’s hospitals would be a very powerful way to support that.
With respect to virtual care, I think my colleagues Emily and Kathy could probably comment on this, as well. We are currently seeing that there is a gap when it comes to federal leadership and there are inconsistencies from one province to the next, not just on virtual care but a whole host of things related to children. We lack that federal leadership to ensure the continuity and consistency of care for children across the country. Canada does have that accountability through the UN Convention on the Rights of the Child to ensure that every child receives the best quality of care and support.
The Chair: Ms. Hay and Ms. Gruenwoldt, you have raised your hands for this specific question. Maybe very briefly, if you want to comment, we can then move on to Senator Munson, who also has questions.
Ms. Hay: I’ll be brief. Kids Help Phone is actually a pioneer in virtual care since we have been doing virtual care for 31 years. We’re national. It might definitely benefit from national oversight, but our not-for-profit charitable sector and the NGOs of Canada need to make sure they drop their silos and work together and not own technology. I’m not sure I’m being articulate.
During COVID-19, as a good example, Kids Help Phone has opened up our technology through keyword partnerships with the Boys and Girls Clubs of Canada and Big Brothers Big Sisters of Canada because those kids don’t have the supports they normally need, and that’s through virtual care. There is a great power in us working together; it’s not just about federal officials supporting.
Ms. Gruenwoldt: This is actually a really complex question that’s hard to answer succinctly.
We can’t look at virtual care as a panacea for all of the challenges our health care system faces with respect to equity, but it certainly has provided a number of solutions to communities and to families who would otherwise have difficulty receiving care face to face. It’s interesting because, on the one hand, it has certainly opened many doors to support families, but on the other hand, of course, the broadband internet connection challenges, the access to the technology itself and the hardware are certainly limiting factors.
From an equity perspective, the other area where we’re seeing gaps is with respect to the ability of some of our organizations across the country to roll out virtual care very quickly in response to the COVID-19 pandemic, whereas some of our other smaller organizations in the community haven’t had the sophisticated resources or infrastructure to do the same. So there are many gaps for referral from our hospitals into the community where those services are not available, and as a result, families are left without.
To my point earlier in my presentation, there are some very real concerns about the loss of functioning as a result of the stoppage of those essential services. We could spend hours talking about this alone. I will stop there just to point out a couple of different perspectives.
The Chair: Thank you very much for that.
Senator Munson: I’ve been sitting here listening to the conversation, and I’m still troubled by what happens to a number of children in this country. I listened to the testimony, particularly about the Kids Help Phone. I’ll read you a headline from 2015 in The Globe and Mail where it reads: “Liberals agree to revoke spanking law in response to TRC call.” Of course, the argument is that reasonable force to inflict pain on a child seems to still be okay in this country. Fifty-four countries have banned it and 56 countries have said they’re willing to ban it. The bill is in a stagnant place in the Senate of Canada.
When we talk about the health and well-being of the child, can I briefly get your viewpoints — I want to get to another subject — on this bill itself? To me, it makes us look like a nation we shouldn’t be when we’re talking about the care of a child. Maybe you can start, Ms. Hay.
Ms. Hay: Thank you, senator, for making that point. I don’t know this bill specifically, but I will say emphatically on behalf of Kids Help Phone that we do not believe that corporal punishment is an appropriate parenting tool. It does damage.
When we’re in the COVID-19 pandemic and kids are in isolation and I see the data in front of me right now, young people are not necessarily safe in the homes where they should feel safe. It is not okay for parents to have that kind of permission. Whether that was articulated or not, thank you for bringing it up.
Senator Munson: Ms. Gruenwoldt and Ms. Austin, may I have your thoughts as well?
Ms. Gruenwoldt: I’m not sure I have that much more to add. If you were to speak to emergency room physicians across the country, they are certainly seeing some evidence of an increase in physical child abuse, which is, of course, inappropriate. I’m not familiar with the bill either, Senator Munson, but I’d be happy to review it afterwards.
Senator Munson: Thank you.
Ms. Austin: Children First Canada has long supported the repeal of section 43 of the Criminal Code. We believe that no violence against children is justifiable and that all violence against children is preventable. Children are the only members of Canadian society against whom legally sanctioned physical violence is permitted, so we do support the repeal of section 43 of the Criminal Code. It was called for in the TRC Calls to Action. It is long overdue and needs to be repealed.
We certainly understand that beyond legal recourse and legal change that’s required, of course, there is much more needed around public education and equipping parents with skills and tools to be able to raise their children with non-violent means. We certainly support legal action but also the need for public education and resourcing for parents to be able to raise their children in non-violent ways.
Senator Munson: Thank you for talking about the TRC, the Truth and Reconciliation Commission. They had 94 recommendations.
Speaking about the Truth and Reconciliation Commission, the systemic racism that Ms. Hay brought up earlier in the conversation, what is taking place in the United States of America and the idea that somehow Canada feels it is immune to this — and we’re not — what will it take? Will it take a commission? Where does the debate really begin?
In the autism community, we have self-advocates who seem to tell us stories that we think we know better about autism. But what will it take? Will it take a Truth and Reconciliation Commission to deal with systemic racism in this country, to deal with the issue of minority groups? You have the schoolyard bullying. You have all the work that every group in this country is doing. Everybody wants to do something for the child or to make our society a better society. I’m sitting here kind of frustrated trying to figure out what needs to take place. Is it as big as a new commission? Can action be about causing this conversation to erupt, so to speak, all across the country? It’s really dangerous, what’s happening.
The Chair: Ms. Hay, I am happy to hear your answer. I want to ask my colleagues to be mindful that, while we’re having some very interesting discussions and hearing some very valuable testimony, I want us to focus on the mandate of this study. We need to get back to the impact of the government response in terms of COVID-19. I know there are many links to be made, and they have been made. Thank you, Senator Munson.
Senator Munson: I agree with you, chair, but if we take a look at the areas of the country and the communities where COVID-19 has really erupted in a horrible way, it is in those areas. That’s why I think it’s all part and parcel of the same argument.
The Chair: Absolutely. Ms. Hay?
Ms. Hay: Thank you, senators. I don’t have the answer to that, but I do know that the real-time data that Kids Help Phone has and is receiving right now will be invaluable for us all as a country to understand where we need to invest in youth to solve the problem around racialized youth.
I do say that we have to give a voice. That’s what we hear from the young people. I will send quotes to you from young black Canadians who are saying they need a voice. They were saying that to Kids Help Phone as recently as yesterday.
On the other side, I certainly support a commission, but I also support action. We need to make sure that if we see racism, we do not accept racism in Canada. I am pontificating; I could go on forever. Kids Help Phone will stand as a partner, however you need us.
Mr. Kanji: Thank you, senator. This is an issue that I’m very passionate about. If we look right now at the state of our country and of the United States, we can see the majority of protesters who are coming out are from my and Kiah’s generation. That’s because of the almost entire loss of voice for young black Canadians and the loss of what young people have been trying to advocate for.
This action plan to eradicate racism has been something that many of my peers have been calling for throughout many years. However, because there’s been no voice put in place, we’ve been unable to have any action taken. This is where the Young Canadians’ Parliament and a federal commissioner for children could come in. They could form a direct line to the federal government to address these issues before they escalate to the places they’ve gone to now. That would have been extremely beneficial in the past, but we can always grow. Now is the time when, by implementing these various programs, we can provide that line of conversation for young people to address the issues that they’re facing.
The Chair: Thank you. Kiah?
Ms. Heneke-Flindall: To build on what Kamil said, having more platforms for engagement will work from the bottom to make progress. The newer generations would be able to tackle these issues so the issues don’t continue for as long as they have. Again, if we’re bringing it back to the mandate, we need the Young Canadians’ Parliament and the children’s commissioner. I have been listening to what a lot of young people have to say. I have been working at different events where we brainstorm these issues. Many young leaders have so many innovative ideas. They really can see the future of the issues; they can see real change and hope for the future. They see different and unique ways of eradicating racism and empowering communities who are usually oppressed or left out of the conversation.
In supporting youth, a lot of other issues will be taken in a new light. We will be able to make more progress on those kinds of things through that empowerment.
Senator Munson: Thank you. Sorry, chair, if I moved the conversation. I get passionate about these issues. It all comes to the same place somehow.
The Chair: Exactly. It does. Thank you all.
Senator Forest-Niesing: Such beautiful youth! Senator Munson, there’s nothing wrong with being a bit passionate. It keeps us grounded in reality and enables us to focus on our goals.
My question is for Ms. Austin. In your document, you made recommendations with respect to the crisis. One was to adopt an approach based on Jordan’s Principle, which is about putting children’s needs first. According to Jordan’s Principle, government organizations should be responsible for covering costs with the aim of reducing administrative formalities to ensure fast, effective service delivery.
In February 2015, the Assembly of First Nations released a report by the Jordan’s principle working group that identified a number of ways in which the principle was not being applied.
Given those shortcomings, do you think there have been notable improvements in applying Jordan’s Principle since the COVID-19 crisis? If so, do you think there will be a place for this approach post-crisis, possibly in a way that applies to all children?
Ms. Austin: Thank you, senator. I cannot speak with a lot of expertise on whether Jordan’s Principle is being used to the full extent within the context of COVID-19. I would defer to other colleagues, particularly the First Nations Child and Family Caring Society and others who have greater expertise in that area. But I would say that, in general, there are still gaps with the implementation of the principle and around the idea of ensuring that the children are served first and not caught up in the government bureaucracies around who is paying the bill. There are ongoing challenges with that principle even in the best of times. I presume it would still be true right now in the context of this crisis.
Our organization was founded with a children-first principle. We need to think about children first in all of our decision making. We need our federal government particularly to be working with the provinces and territories to put our children first and to think about them in all of the decision making that affects their lives. In policies that directly serve and support children, children need to be consulted, as well as in broader policies like our federal budget and broader health initiatives that often have unintended consequences for children, like the decision on the closures of schools.
While the decision to close schools was made in the best interests of all Canadians, children have certainly paid a hefty toll for that. When we take a children-first approach or a Jordan’s Principle type of approach, it changes the way we think about our decisions. When we involve children in that conversation, we come to different conclusions.
Senator Forest-Niesing: I have another question for Ms. Hay. Since March 12, you have observed a 35% increase in conversations about psychological and physical violence and a 36% increase in conversations about sexual violence.
Yet this is happening at a time when many child protection organizations are indicating they’re receiving fewer reports.
How do you explain this very worrisome difference? How can we make it easier for young people to report abuse when they’re in vulnerable situations? Ms. Hay?
Ms. Hay: Thank you for that question, senator. It’s very important to have this discussion. The reality is with schools closed, which is an enormous access for children or young people who are in abusive environments or struggling like that, schools and places like that are often a safe haven for them. They are mostly closed. They are also in an environment that is not necessarily safe for them.
This is why our statistics and our real-time data are showing an increase. Often a young person might not be able to speak in their home because it’s not safe, but they might be able to text and get us on the other side of the text. When they do — and the conversation is reminding you that in an acute situation they are not first-come, first-served — they get escalated. So 40 seconds is really what it takes, and in the worst case, five minutes.
We work through a whole safety planning. We actually work with child welfare agencies and RCMP because we are national and we can get through the RCMP and through their child welfare to make sure we are doing a physical safety check with a young person. We do mandatory reports every single day.
Senator Forest-Niesing: In addition to the services you provide, do you think the government should implement other measures to help children in vulnerable situations?
Ms. Hay: Thank you, senator. It is a great question. Yes, there are many more tools. In addition to what my colleagues Ms. Austin and Ms. Gruenwoldt and our two youth advisers have said, having the voices of young people right at the table in making decisions might really help — not for advocacy, but for real policy-making. Who knows better than a young person?
Access is incredibly important, and that is access through various means. If it is technology, then access through the internet and cellphones are all ways a young person can reach out for help.
I can string that into your earlier question about Jordan’s Principle and Indigenous youth in Canada. Kids Help Phone launched our Finding Hope strategy, which is our response to truth and reconciliation. In many communities in the northern part of Canada, access is huge. There is no cellphone service in many communities and there is not necessarily child welfare at hand. So that’s where I think there should be big investment.
Senator Forest-Niesing: Thank you very much. I assume my time is up. I have a third question, but I’ll wait until round two, Madam Chair.
The Chair: Absolutely. Thank you for your cooperation.
Senator Seidman: Good afternoon and thank you for all of your very valuable testimony this afternoon.
I have to say that there are a lot of issues that have come forward that really need more discussion. The funding issue especially around charities is a major concern right now because we need them so desperately. They are struggling because the money they depend on through donations and the work done by charities by volunteers is not getting done right now. That’s a huge concern.
The other thing I hear from you is there are short-, medium- and long-term impacts of COVID-19, but there are fears that the medium- and long-term impacts will be somehow forgotten and really won’t be dealt with. We are all looking at the short-term impacts now.
I will put that out there in a tantalizing way because then I will cut to the chase and ask the question I really want to ask and that I think this committee is concerned with. Your organizations have written to the government and have made requests with regard to the pandemic. So now, if you have this opportunity to suggest two recommendations that you would like this committee to consider for our final report, what would they be? I’m going to put Dr. Gruenwoldt on the spot because I’m going to start with her.
Ms. Gruenwoldt: Absolutely. A point of correction for the record. I am not a physician nor a PhD. I am just Ms. Gruenwoldt.
What would be the two priorities? We remain concerned about funding and sustainability of the child health research enterprise. Children’s health research is a small community making significant contributions internationally to the health and well‑being of children. The request we made to the federal government was $28 million specific to children’s health research. Our colleagues at HealthCareCAN submitted a request in the range of $650 million. We are grateful that $450 million was funded, but it is insufficient in terms of meeting the immediate needs to sustain our health research community, which really drives practise change and bedside care. I think that remains a significant priority for our community.
Looking to the emerging needs, we are absolutely very concerned across the country about our ability to address the backlog of health care services which are continuing to be deferred. Our best estimate is it could take 12 to 18 months to address the backlog, not even to address those surgeries in the queue since it began, which in the life of a child is very significant in their developmental trajectories. We would prioritize extraordinary funding in the amount of 20% to support meeting these needs above and beyond what the provinces are currently able to fund our children’s hospitals with.
Ms. Austin: My first recommendation would be to support the funding needs that have identified by the Council of Champions, which would include the funding needs that Emily has identified but more broadly speaking serve and support the front-line organizations serving 8 million children across the country.
The second would be that the government support sustainable mechanisms to ensure the protection of children’s rights. I will be a bit cheeky here, but I will include the children’s commissioner and the Young Canadian’s Parliament as being two very meaningful things to support in a sustainable way to ensure the protection of children’s rights in this crisis and for years to come.
Senator Seidman: You are being so concise and focused. That is wonderful.
Ms. Hay: I have two recommendations. My nickname is Chatty Kathy. I support Ms. Austin’s cheekiness and giving a voice where it counts, where decisions happen for the young people of Canada. I think it is a critical recommendation.
I want to point out that at Kids Help Phone we have young people as young as five reaching out to us every day. Voice is important.
Action and support are the other recommendations. Kids Help Phone enjoyed great support recently through COVID-19. We have a long journey in front of us. I would encourage this committee to reinforce the need to fund the other youth-serving agencies, including Kids Help Phone, not in the immediate, because access is a barrier for youth and mental health and kids in care and Indigenous youth. Access is a barrier. We know if they have access, they feel better. We know that at Kids Help Phone more than 70% of young people tell us something they would not have told anyone else. That’s reducing barriers. So we recommend voice and action, which is funding.
Senator Seidman: Thank you very much. My question is for Ms. Gruenwoldt. You wrote a letter to the federal government on March 23, in which you said that additional funding is urgently needed from the federal government to address “healthcare system needs and to support mitigation efforts, including access to testing, equipment, and enhanced surveillance and monitoring.”
I’m wondering if you could explain what you mean. Thank you.
Ms. Gruenwoldt: In the early days, we were especially concerned whether there was appropriate testing to support identification of COVID-positive children. As the research has evolved and we understand that children are less likely to test positive for COVID-19 and/or transmit COVID-19 to others, that has been less of a concern.
In the context of the two priorities we addressed today with respect to the reopening of schools and the ability to ramp up health service delivery, that is absolutely a priority in general, whether that is for health care professionals, the families accompanying our patients or for the patients themselves.
To be rapidly able to identify where those positive cases are and to contact trace back to mitigate the spread would be exceptionally important, especially in what we are seeing in a recent outbreak in some of the schools in Quebec since they reopened. I would say the context has changed a bit since March 23, but it remains a priority.
Senator Seidman: In terms of getting to the next stage, if we can imagine reopening schools in the fall in Quebec where I live, this would be important.
Ms. Gruenwoldt: Absolutely.
Senator Seidman: Thank you.
Senator Manning: Thank you to our witnesses. Excuse me if any of my questions have been asked in French. I have been following as best I can.
My first question is for Ms. Austin. Has Children First Canada been involved in consultations with the federal government in the development of the virtual care and mental health tools that were announced on May 3, 2020? If so, can you describe your involvement? If not, have you offered your expertise on this?
My second question is for Ms. Hay with Kids Help Phone. I have been amazed at some of the statistics that you have put forward today. I would like to know what differences you have seen in your calls, not the number of calls but the detail of the calls, before COVID-19 and during COVID-19. Thank you.
Ms. Austin: Thank you, senator. To your question about consultation on the development of the virtual tools, no, we have not been directly consulted. We have been in dialogue with representatives of the Public Health Agency of Canada and with Minister Hajdu’s team to advise around the needs that have been identified by the Council of Champions and the recommendations that have been made, but we have not been directly consulted on the virtual care tools.
Ms. Hay: Thank you, senator, for the question about the difference in calls pre-COVID and what we are experiencing now. I want to point out that kids reached out to Kids Help Phone — 5 years old to about 26 is the age range — pre-COVID with all kinds of issues: depression, anxiety, suicide, bullying and cyberbullying, so move into COVID-19 and overlay all of that onto it. COVID-19 did not remove all those mental health challenges from the young people of Canada; it exacerbated them. We are seeing an increase in depression and anxiety, a huge increase in isolation and fear, and, as we spoke about, an increase in sexual, physical and emotional abuse.
I could say there is a silver lining in there. There is someone on the other side of the text or phone when they are reaching out, but the silver lining specifically, which I alluded to in my remarks, is the fact that when COVID-19 began, 20% of what we normally do at Kids Help Phone was around suicide and suicidal ideation. Seeing our call volumes increase the way they were, we were prepared for a significant increase in suicide across the country. We even worked with our RCMP partners in preparation for it. In fact, we did not see an increase in suicidal ideation. We have seen a bit of a decrease in that and in cyberbullying and bullying. Those are silver linings. We will work with our research partners at various institutions with this data to actually understand why.
I don’t know if that answered your question fully, but we are seeing a definite difference because of COVID.
Mr. Kanji: I cannot agree more with what Ms. Hay has said. Based on personal conversations with a number of my peers across the country, it is evident that mental health issues have been amplified tenfold, especially with senior students. Losing half of your year is detrimental to student mental health, and it affects people in adverse ways.
The best way to address issues that have gotten to the levels that they have within COVID-19 is through the implementation of a youth solution for youth issues, such as the Young Canadians' Parliament that has been discussed multiple times throughout this hearing, by providing youth with a voice to tackle their own issues and providing them the support of senators, such as yourselves, who are experienced in policy-making. The ability of Canada to improve from twenty-fifth in terms of children’s well-being to first is very possible.
Senator Manning: Thank you. I have another question for Ms. Austin. A couple of years ago, your organization spearheaded the development of the Canadian Children’s Charter. I know first-hand because my daughter was one of the people who attended there. From that, have you made inroads into building relations and opportunities for youth to be involved in policy-making at the federal government level?
Ms. Austin: Thank you for the question. The creation of Canadian Children’s Charter was an incredible process of consulting thousands of children and youth across the country about the protection of their rights and involving them. We see the Young Canadians’ Parliament as being the next stage of giving children and youth the platform that they have been asking for to be heard. It is a program designed and led by youth and will be the next iteration in carrying forward the concerns that they identified in the Canadian Children’s Charter and helping keep that charter a living and breathing document. Ultimately, they want to see action in federal policies and investments made to protect their rights.
Senator Kutcher: Thank you to all our witnesses, particularly to Kiah and Kamil. It is the first time that we have seen you, but I have a feeling it won’t be the last. My first question is to Children’s Healthcare Canada, and my second is to everyone else.
We know that mental disorders arise primarily in young people, with about 70% onsetting before age 25. They are the most common chronic illnesses of youth, with substantial morbidity and high rates of all-cause mortality, yet rapid access to the best evidence-based care is lacking everywhere in Canada. What specific measures are you aware of that were undertaken by the federal government to assist these young people and their families to obtain the mental health care that they desperately require during this COVID time? If there have been none, what should be considered?
Ms. Gruenwoldt: That’s a million-dollar question. I am not aware of any specific front-line initiatives or investments by the federal government to our health care delivery organizations across the country with respect to mental health. I do know there have been investments in health research and the impacts of COVID-19 on social isolation and short-, medium- and long-term impacts on our children, youth and their families, but I would suggest that’s insufficient.
What should the investments be? We have seen some steps forward with respect to our ability to deliver mental health care services virtually. Those seem to be pockets of investment and certainly not sustainable or substantial enough to serve the demand that is in the community today.
To your point, I know you’ll be quick to point out that we don’t know the efficacy of these services as they are delivered virtually, so certainly that would be a priority from a research perspective as well, to ensure investments in virtual health service delivery have substantive evidence to suggest it is a path forward.
I would be interested if any of my panellists have any other suggestions, but I would park it there for right now.
Senator Kutcher: Thank you. The recent Vanier Institute child and youth survey noted that, since COVID-19, about 60% of young Canadian people report feeling sometimes or often sad. At the same time, however, 86% report feeling happy. These are responses that we would expect from a general population survey. But — and this is the important “but” — these do not tell us much about vulnerable youth who are at greatest risk and thus in need of greater assistance.
What could the federal government be doing or should have done during this time to identify and proactively intervene to reach out to the most vulnerable children and youth that we know are at the highest risk and, for example, are living with family violence, living in poverty and with food insecurity, racialized, marginalized, First Nations, et cetera?
Ms. Hay: Thank you for this question, senator. It is certainly a complex one, and the “but” makes all the difference. What they could do proactively is interesting, in particular, around vulnerable children and youth. I can speak only for the role that Kids Help Phone plays in that realm, and for me it is about ensuring access 24/7, and it’s multiple tools — not just texting — around ensuring a young person has access to shelters, food banks and mental health organizations. It is a fragmented market out there for a young person experiencing mental health challenges, in particular, our vulnerable children.
Access is everything, as far as I’m concerned, and virtual care technology and funding are important.
Ms. Heneke-Flindall: If we are thinking proactively and in response to another situation that could arise, having youth engagement platforms is always a better way of setting up representation of what young people need, if we had a platform where a group of youth were representing their individual community, and diverse communities as well. We need to make sure that you have individualized advice right away and an understanding of where these young people are coming from. These people will be able to see how their friends are doing and how they are feeling in these kinds of situations. We don’t need any more advisory councils of people judging from an outsiders’ perspective. This is the time to see how that isn’t effective and how we need it from the people experiencing these challenges. Why not just ask them and have a funded platform to be able to speak out and give direct advice to people who can make a change? That would be through our Young Canadians’ Parliament or something like that. That would be my recommendation.
Senator Kutcher: Thank you.
Mr. Kanji: I wanted to concur with what Kiah mentioned. When youth are given the voice to specifically talk about the issues that are affecting them the most, such as mental health — because as you mentioned, Senator Kutcher, the statistics are overwhelming as to how students are reeling from the mental health crises that are occurring now — by providing a platform, such as the Young Canadians’ Parliament, it would provide an opportunity for younger people to develop a standing committee, such as the one we’re in right now, that is specifically focused on mental health and that invites younger people to have a robust conversation about different policy recommendations.
I find young people are very knowledgeable about the various policies that the government puts into place and have always had recommendations that are never brought to a level where they can be brought into change. By providing a platform for the Young Canadians’ Parliament, we would allow younger Canadians to have a platform where they can learn about building tangible policy and work with the people in positions of power to implement something real and effective.
The Chair: Thank you so much for this input.
Senator Omidvar: I was just commenting to myself and to all of you that the beauty of going last is all the wise questions have been asked. Nonetheless, I have a couple of questions, and my first one is for Ms. Gruenwoldt and I want to comment on that beautiful poster behind your face. It is extremely cheerful and certainly lifts our spirits, so thank you for that.
My question is about schools and camps and other children’s activities that are so essential to their mental health. Mental health practitioners have underlined again and again that the social isolation of children, even when they are with parents, has real implications on their mental health.
Quebec opened its schools outside of Montreal a couple of weeks ago, partly based on concerns around children’s mental health issues. But then right afterwards, numbers of cases of children and staff being infected were identified. B.C. will open its schools, I believe, very soon. Ontario has not made a definitive decision, although I don’t expect Ontario schools to open until September.
Ms. Gruenwoldt, can you help us find a way forward in this report to make an observation or a recommendation, keeping in mind that we don’t want to get into jurisdictional sniping?
Ms. Gruenwoldt: Absolutely. I think there are lots of considerations about how we keep our students, their families and their teachers safe and how we support a return to school for some of our medically fragile children as well. This is not a simple solution. It requires collaboration across the health and education sectors and great partnership with families and their children and youth.
You have heard terrific ideas brought forward today from Kamil and Kiah, and their unique perspectives can help inform what a safe school space looks like, and how they can still have the benefit of connecting with their peers while keeping their teachers and themselves safe.
We have to learn from and watch carefully what is happening in British Columbia this week. They have been leaders, arguably, across the country in this pandemic. We also need to learn from Quebec, which is in a very different situation. There is also international experience we can leverage. Of course, there are many nuances in the international context and environment, but there are still lessons to be learned, and our ability to share and be transparent about experiences can help us shape a path forward.
I don’t have a simple answer today, but we can work with you to create recommendations going forward.
Senator Omidvar: Should the federal government have a role in putting forward some guidelines for provinces to follow? I know Ontario is doing that, but I’m always concerned. People travel, as we well know; they go from province to province and they will start doing that. Does that create a greater risk for children and their parents when there is such a diversity of measures in our country?
Ms. Gruenwoldt: I think it’s going to take extraordinary measures and some creative and innovative solutions, which will also include virtual delivery of education as well. These come at a great expense. There is a leadership role for the federal government to play from a financial perspective, supporting our provinces to enable those solutions. They can be a visionary and a leader in terms of moving the needle to progress us toward a safe reopening in September.
Senator Omidvar: My next question is to all three of you. I believe your three organizations are really important and essential in this constellation of children’s services. Have you experienced a drop in charitable donations since the crisis started? You’re all charities, and not-for-profits. And if so, to what extent has the government’s support enabled you to carry on your work? I know Kids Help Phone has received a lot of support for special measures, but I don’t know if the support extends to keeping a roof over your head and staff employed through the Canada Emergency Wage Subsidy, but enabled you to deliver your services in a completely new context.
Ms. Gruenwoldt: We do not qualify for any of the subsidies that the federal government has announced to date. Our funding absolutely has been impacted. Our revenue is generated through philanthropy from a number of different charities, including children’s hospital foundations and other not-for-profit organizations. We also have membership revenues and the ability of some of our members to contribute revenue through their membership dues has been significantly reduced. Absolutely, our funding model has been significantly impacted.
Ms. Austin: Thank you for the question. Children First Canada is currently registered as a not-for-profit organization. We applied for charitable status last summer and are still waiting for a decision. That has limited our ability to secure charitable funding, not only to support our ongoing operations, but also to support our current response to the COVID-19 crisis. We have experienced a drop in overall sponsorship and donations to support our work. We are grateful for the wage subsidy, which is helping to support our ongoing operations, and also for the recent grant we received from Heritage Canada that will partially fund the launch of the Young Canadians’ Parliament.
We, along with most of our counterparts across the country, see a need for a stabilization fund for the charitable sector to help enable our organizations to continue the work for the weeks and months to come because the charitable giving will be not only something we experience this month, but we will continue to see the impacts of that for months to come.
Ms. Hay: Thank you for that question. I do want to echo my colleagues here. The funding needs for this sector are critical for the well-being and future of Canada.
As far as Kids Help Phone, we are a long-standing brand. We have long-standing supporters who are standing beside us right now. We have seen a drop in philanthropy, for sure, and a drop in community events. There is a lot of participation and lots of volunteer engagement, which I think is a silver lining.
But from a financial perspective, in the short term Kids Help Phone is not worried. It is why, when the government provided us with sustainable funding, we were able to span it out over one and a half fiscal years. That was important for us to ensure we had sustainability.
On behalf of my colleagues and my peers, I don’t think there’s a crystal ball as to what’s going to happen in the economy. We do know in the charitable sector — we’ve been a charity for a long time; I’m a former banker who’s worked in charity — one of the last things that people give up out of their disposable income is their charitable donation in tough times. It is yet to be seen what kind of impact this will have from an economic, long-term standpoint.
The other thing we do know, which is hopeful, is one of the first things people put back into their disposable income, including corporate Canada, are their charitable investments. We need the federal government right now to help charities coast through and come out the other end of this crisis so that we can continue to provide the essential service to Canada that the sector provides.
Senator Bovey: I want to thank all the witnesses and especially our youth who are with us today. I want to thank Ms. Hay for her analysis of the differing issues from across the country. Instead of asking a question, I want to give hope, if I may. If people want to respond, that would be wonderful.
My focus today has been on the Arctic and the North. We know how vulnerable these youth are at the best of times. I can assure you, based on the work I’ve been doing with them, that their vulnerability is even greater now. My question to the youth is: Are there youth participants in the Arctic in the work that you’re doing? Their voices need to be heard desperately. I may be wrong. I’d like your viewpoint.
Mr. Kanji: Thank you, senator. I could not agree with you more. The more we can do to elevate the voices of all youth, the better. With the launch of the Young Canadians’ Parliament, including voices from the North and the Arctic will be an extremely important way to access the most vulnerable communities in our nation at the moment. I look forward to the work we’ll be able to do with that. We must support all youth in any way that we can, specifically within the Arctic, as you’ve mentioned. They are struggling in the best of times. How must they be faring now? Including that voice is the first step of many in resolving the issues that they’re facing.
Ms. Heneke-Flindall: I completely agree. They’re disproportionately being affected in the Arctic communities. From some of the work I’ve done with the Canadian Children’s Charter, there were definitely participants from Nunavut and various places up North, but it was limited based on being able to come all the way down to Ottawa, where we were meeting. It should be a focus point to make sure that everyone is being represented who is vulnerable in these cases. I definitely agree that more needs to be done. Hopefully we would be able to be as diverse as possible when creating these platforms for engagement.
Senator Bovey: Thank you.
Senator Cormier: I’d like to thank the witnesses, especially the young people. My question is for Ms. Hay of the Kids Help Phone, and it’s about sexual abuse of young people by family members and the isolation of LGBTQ2+ youth during the pandemic. Ms. Hay, I’m especially concerned about these issues in rural areas. I just want to know how national organizations like yours are working with provincial and territorial organizations to address these issues. What kind of help could the federal government provide or should it provide to support that networking because we know these issues are deeply rooted in the regions and in communities, especially rural communities?
Ms. Hay: Thank you, senator, very much for bringing that forward about our rural youth and people of rural Canada. We were doing some work with a partner about three months ago responding to the need in rural Canada. What was staggering to us, because we do speak about all the real-time data we have, is we don’t have that much data anywhere in North America on mental health and people in rural Canada. In fact, if stigma is alive and well in urban environments, it is extraordinarily alive and well in rural Canada.
We are doing work with 4-H as an example. We are working with some great corporate partners that do business in northern Saskatchewan, Alberta and Nunavut. But the point you make is really important: The light needs to shine on the well-being and mental health of rural Canada because it is underserved. When I think of underserved populations, I can think of a geographic map as well, and rural Canada would be the first on that.
Senator Cormier: Thank you.
Senator Pate: Thank you to all the participants and thank you to the youth. I’m interested in whether there are groups of children and families whom you have identified who are falling through the laudable and extensive benefits that have been created by the government in terms of income supports. For example, following this call, I have some calls with young people who are from care, some of whom were involved in basic income projects, who are wanting support to try to lobby for that kind of initiative.
Have you heard from those groups as well? Do you have positions on guaranteed livable income approaches or other recommendations? If there’s not enough time, if there are positions you can point us to, we would be happy to receive those in writing. Thank you.
Ms. Gruenwoldt: I think we remain quite concerned about parents who have medically complex children living at home and the lack of support that is available to them, whether that’s home-care support or respite, and the resources for their families who are facing extraordinary expenditures associated with those children. We do hear a lot from our family network about the economic impact that is having on their families, let alone the mental wellness of their families and their ability to cope not only to care for that child, but potentially for other siblings as well.
There does seem to be a gap for those families in subsidies available to them. I will have to get back to you in terms of what the specific restrictions are that they are facing accessing that funding, but they certainly seem to be a population that is underserved at this time.
Ms. Austin: In addition to what Emily has shared, we’ve also been hearing concerns about children and youth aging out of care and real gaps around their ability to access supports, because there has been a relative inconsistency. Some provinces have had a moratorium on youth aging out of care; others have not. Their ability to access really basic supports like food and shelter, let alone other needs they might have, has been a great concern, along with the supports to assist families who are at risk of losing their children because of the economic pressures they are facing right now. Organizations like Children’s Aid Foundation of Canada, the Ontario Association of Children’s Aid Societies and other organizations like that have really been trying to rally to meet the urgent needs of families that are at risk and help keep families and kids safe at home right now.
Ms. Hay: I agree with both my colleagues. In the work that we’re doing with Children’s Aid Foundation of Canada, right now we’re providing keyword partnerships at no cost to our partners and absolutely no cost to the youth who are aging out of youth in care. There are most definitely gaps for children and kids and families in care and out of care. I guess my point is partnership, dropping silos and working together will certainly help in the short term.
The Chair: A huge thanks to each and every one of you.
Thank you to our witnesses for bringing your valuable knowledge and help to this study. Many thanks to Kamil and Kiah for bringing a little bit of the voice of Canadian youth to us. I know that you will continue to do so in many ways in years to come. We thank you for that also. And on that, I want again to say thank you for your participation. It is very much appreciated.