THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
EVIDENCE
OTTAWA, Wednesday, April 21, 2021
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4 p.m. [ET], by videoconference, to study the implementation and success of a federal framework on post-traumatic stress disorder by the Government of Canada, in public, as specified in Standing Order 12-7(9), and in camera to consider a draft agenda (future business).
Senator Chantal Petitclerc (Chair) in the chair.
The Chair: I am Chantal Petitclerc, Senator from Quebec, and it is my pleasure and privilege to chair this committee. First of all, let me thank our clerk, Daniel Charbonneau, and the entire team that is physically on site in Ottawa, for allowing us to conduct this meeting of the Standing Committee on Social Affairs, Science and Technology today by videoconference. We very much appreciate what you are doing for us.
Before we begin, I would like to make a few recommendations that are useful in the context of a videoconference, to help us have a productive and efficient meeting.
One thing that I want to share is that we will ask participants to have their microphones muted at all times unless you are recognized, and you will be responsible for turning those microphones on and off during the meeting. Before speaking, please give us a few seconds and wait until you are recognized by name. I will also ask senators to use the “raise hand” feature — so the yellow hand — in order to be recognized or to ask questions. Also, please pause for a few seconds to let the audio and translation catch up with you before you speak.
[Translation]
Should any technical challenges arise, particularly in relation to interpretation, please report it to the chair or the clerk, and we will work to resolve the issue as quickly as possible.
You have also been provided with a technical assistance number. So you can call this number.
[English]
Please note that we may need to suspend during these times. Of course, we need to ensure that all members are able to participate fully in this meeting and in the language of their choice.
Finally, I would like to remind all participants that Zoom screens should not be copied, recorded or photographed. You may use and share official proceedings posted on the SenVu website for that purpose.
[Translation]
I would like to introduce the members of the committee who are participating in today’s meeting. With us are Senator Poirier and Senator Bovey, vice-chairs of this committee; Senator Black, a member of the steering committee; Senator Mégie; Senator Omidvar; Senator Kutcher; Senator Forest-Niesing; Senator Moodie; Senator Frum; and Senator Manning. Thank you for being with us today.
Today we’re looking at the implementation and success of a federal framework on post-traumatic stress disorder by the Government of Canada. Without further ado, I would like to introduce the witnesses we are privileged to have with us.
The Honourable Patty Hajdu, Minister of Health, who is accompanied by representatives from the Public Health Agency of Canada, Mr. Iain Stewart, President, and Candice St-Aubin, Vice-President, Health Promotion and Chronic Disease Prevention Branch. From the Canadian Institutes of Health Research, we have Dr. Michael Strong, President. Madam Minister, I invite you to take the floor. Again, thank you for being here.
[English]
Hon. Patty Hajdu, P.C., M.P., Minister of Health, Health Canada: Thank you very much, senator. In the interests of translation, I’ll just give my remarks in English. Thank you again for welcoming me.
As I said in my sound check, I am speaking to you from the traditional territory of the Anishinaabeg people of the Robinson-Superior Treaty area. Obviously this area was contributed to by many Métis for many years, and I am very grateful to live, work and play here.
I am very pleased to talk with you today about the implementation of the Federal Framework on Posttraumatic Stress Disorder, and I’ll start with a bit of background.
As you know, in June 2018, the Federal Framework on PTSD Act became law, and the act led to a national conference on PTSD in April of 2019, where experts from across the country, including people who have experienced PTSD, people with lived experience, shared their knowledge and their views. With their involvement, we developed Canada’s first Federal Framework on Posttraumatic Stress Disorder.
The framework was released in February 2020, just before COVID-19 was declared a worldwide pandemic. Of course, as we see in the context of COVID-19, many more workers, many more Canadians in a variety of different sectors, are facing increased risks that might make them more susceptible to trauma and post-traumatic stress. I believe we’ve all seen some of those stories in our nightly newscasts and, indeed, heard from stakeholders and other people we interact with. We may not know for quite some time the full impact on mental health for Canadians because, of course, we know with PTSD it’s sometimes hard to determine if you have it, it’s sometimes hard to diagnose, and symptoms can vary depending on individuals. Understanding PTSD, its prevalence in Canada and how we help people get effective help early are very urgent priorities now, and I would say probably exacerbated by the experience our country is going through and the collective trauma of COVID-19.
The Public Health Agency of Canada and many other federal partners quickly pivoted to respond to COVID-19, but also scoped in an immediate need to address the mental health impacts and effects of the pandemic on Canadians across the country. However, the key themes of data and tracking, guidelines and best practices, education and collaboration that were explored at the conference and through the development of the framework are also very pertinent in the current context.
Now I’ll turn to some of the activities that are helping us better understand the impacts of PTSD across the country. Right now, the Public Health Agency of Canada works with Statistics Canada in undertaking two national surveys to improve tracking the rate of PTSD in diverse Canadians.
The first is the Survey on COVID-19 and Mental Health, which aims to assess the impact of COVID-19 on the mental health and well-being of Canadians, but it also includes questions on symptoms of PTSD. Results from the first data collection indicate that 6% of Canadians screened positive for PTSD and reported moderate to severe symptoms of PTSD. The prevalence was twice as high among women — 8% — than among men — 4% — and particularly high among women aged 18 to 34, 12%, as well as front-line workers, such as first responders, nurses and doctors — 10%. A second data collection of this survey is currently under way, and we expect to have results in the fall.
In addition, the Public Health Agency of Canada has also developed a more PTSD-specific survey with Statistics Canada, the Survey on Stressful Events and Mental Health. We’re currently collecting data on this tool, and we also expect those results this fall.
Finally, the Canadian Institutes of Health Research’s COVID-19 and Mental Health Initiative is gathering evidence to support decision-making on the mental health response to the pandemic, and they’re doing that in live time to help evolve the tools that we’re developing.
Of course, this work is being guided by an expert advisory panel, and the expert advisory panel is informing the CIHR, Health Canada and the Public Health Agency of Canada how to access and mobilize the best evidence so that we can support mental health systems and services across the country that are effective. The information and data collected from all of these activities will also provide us ongoing evidence to inform how we continually adapt, change, design and deliver mental health services and supports across the country.
I will also add that Budget 2021 proposes new strategic funding to the health portfolio and Veterans Affairs Canada that will specifically support PTSD and mental health programming. The budget proposes to provide $50 million over two years to Health Canada to support a trauma and PTSD stream of mental health programming, and this funding would help populations at high risk of experiencing COVID-19-related trauma manage and recover from that trauma.
The Public Health Agency of Canada would receive $100 million over three years for mental health interventions for those disproportionately affected by COVID-19 including, but not limited to, health care workers, front-line workers, seniors, Indigenous people, youth, racialized and Black Canadians, and, of course, we know that so many more across the country who are affected could benefit from specific mental health interventions that are culturally appropriate.
The budget also proposes that the health portfolio receive $45 million over two years to help develop national mental health standards — something that many Canadians have been calling for in one way or another for a long time. They may not actually say the word “standards,” but what they might say is that it shouldn’t matter which province or territory you live in, you should be able to access mental health that is quality care. These standards would obviously be developed with provinces and territories, health organizations and key stakeholders.
As well, the budget proposes $62 million for the Wellness Together Canada portal so this useful resource can continue into the next year, providing tools and services, all completely free for Canadians, to support mental health and well-being.
In closing, if PTSD was a challenge before, we have a new wave of people who might potentially be impacted by PTSD. And, of course, it doesn’t just affect the individual. It affects their families, their colleagues and their communities.
While we’re a little over one year since the federal framework on PTSD was announced, we continue to respond to both the legislated requirements of the federal framework and the COVID-19 pandemic because, of course, our government is not only inspired by legislation, but we are inspired by trying to support Canadians in real time right now to manage the collective trauma that the country is experiencing through COVID-19.
I do look forward to the outcome of this committee’s study of PTSD, the role that you see that the federal framework can play and suggestions from this committee on how to strengthen our supports for people across the country who have either experienced PTSD or who may be at risk of it.
Thank you very much.
The Chair: Thank you, minister, for being here and for being able to make this presentation. We do have questions for you.
[Translation]
Before we go to questions, I would like to remind you that, as is our practice, we will try to allow five minutes for questions and answers.
[English]
Senator Dasko, I forgot to introduce you, so apologies for that. Thank you for being here.
Senator Poirier: Thank you, minister, for being here. We greatly appreciate that you came to give us an update and answer some of our questions.
The focus of the framework is occupational-related PTSD, and in an appendix, it mentioned that survivors of physical, sexual or psychological violence may experience PTSD as well. Can you please explain to us how the framework will support those who suffer from a non-occupational PTSD when it seems to fall outside its scope?
Ms. Hajdu: I will make a general statement but then I’ll turn to our officials who are working on this.
What I can say is that those two things are not mutually exclusive, first of all. We know that many occupations face a higher risk of experiencing PTSD, but we also know that many people are working within occupations who also have these pre-existing traumas in their lives that predispose them to experiencing even worse impacts from PTSD.
I’ll also tell you a personal story. I have had the pleasure of leading an organization where people on the front line, that you might not necessarily scope in immediately, have faced an enormous rate of PTSD, and that was the homeless shelter that I ran just prior to entering politics. Many people who were attracted to work in that organization had experienced trauma in their lives themselves. Their motivation was to help other people who were experiencing that trauma, but they also brought with them the scars and, in some cases, the unhealed wounds of the trauma they had lived through in their own individual journey. That was often compounded by the ongoing exposure to the tremendous suffering of people that the organization served.
It’s a very important question, and I would turn to the officials if they have further remarks on distinguishing between those two groups.
Senator Poirier: Thank you, minister.
Iain Stewart, President, Public Health Agency of Canada: Good afternoon. Thank you for having us here.
The framework actually does, as the minister was saying, have a wider frame. If you look at survivors of gender-based violence who are at increased risk of PTSD and who face a unique set of circumstances, they are considered within the ambit of the framework. While the framework is focused on occupation-related trauma, application to other populations is also going to be considered in the implementation of the federal actions. This includes gender-based violence and family violence, for instance, which, of course, are serious public issues that can result in trauma of this nature. The government invested nearly $200 million over the last five years to establish the strategy to prevent and address gender-based violence. PHAC, of course, is doing a lot of work in this area as well. We see some shoulder activities and related synergistic activities also touching upon the framework as it goes forward.
I don’t know, Candace, if you would like to add to that.
Candice St-Aubin, Vice-President, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada: To add, I think what is critical is the timing. The framework came out just on the cusp of the pandemic. In its application and certainly as we work on presenting the implementation plan, it would be remiss not to look more broadly. Certainly, I know at the Public Health Agency, as we work with partners on that plan, it will, in fact, go beyond the primary focus to really capture those vulnerable populations writ large. Thank you.
Senator Poirier: Thank you.
Minister, you also mentioned a few minutes ago in your presentation that, in Budget 2021, about $50 million has been allocated to Health Canada over the two years. On that program, is that part of the financing to the Public Health Agency of Canada for the framework and the PTSD secretariat, or is it another initiative entirely? If it is another initiative entirely, why was it not integrated in the framework as a one-stop shop for all the PTSD related?
Ms. Hajdu: I’m smiling at the “one-stop shop” because this is the dream of all people who deliver services everywhere, but I will turn to my officials to speak to the specifics of the budget. Certainly I hear your underlying question, which is the sometimes confusing maze of programs and services that might be offered through the Government of Canada or streams of funding that different organizations that provide these services need to navigate. I’ll turn to Iain for more specifics on the particular the amount, or Stephen Lucas who I think is here.
Mr. Stewart: Thank you very much. The framework, at its heart, is meant to be about data, tracking, guidelines and best practices. It’s meant to be about education and educational materials. It’s meant to be about strength and collaboration. It’s meant to set out a framework to come at a topic, better understand it and mobilize a community around the key ideas in it.
On specific programming, I was trying to mention some of the programming that is on the shoulder and related, so rather than having just a single, one-stop shop kind of programmatic response, the idea is that we set out a frame and that the frame kind of reach widely and connect and steer things in a forward agenda. The recent announcements in the budget reflect that. There are specific topics that fit within this wider frame.
I don’t know, Candice, if you want to talk about some of the things that came out in Budget 2021. The minister, in her opening remarks, touched on specific examples. Maybe touch on those a little bit. I believe they fit within the frame that this sets out.
Ms. St-Aubin: Thank you for that.
Correct, there was $50 million that was identified for Health Canada specific to PTSD in light of COVID, understanding, of course, the moral injury that is faced by many health care providers in the current context. That is really specific to that lens. Again, as the president was saying, the framework captures multiple investments, so we did see some investments with Veterans Affairs Canada as well. Public Safety is also one of our close partners that did receive additional funding.
But with regard to the agency and more broadly on those vulnerable populations who are being impacted in COVID and who are not necessarily part of the front-line workers, we do have $100 million that was announced over three years to really go toward the programming in those areas around innovation based on a lot of the evidence and surveillance that our colleagues at CIHR are doing with their research. Again, $45 million with Health Canada and CIHR to develop those standards, which again, within mental health, are critical to ensure that the interventions are appropriate, best-placed and are effective. And how we evaluate and measure, those standards come to be critical on that.
Senator Poirier: Thank you.
Senator Bovey: Welcome, minister. I very much appreciate, as we all do, your being with us today on this critical topic, one that has been exacerbated through the pandemic.
Minister, I was very pleased to read the report of the supports through the budget for this, and I thank everyone involved. I was particularly interested in the $45 million over two years to help develop the national mental health service standards. My question relates back to the framework and three points of the four-point vision of the framework, and particularly, number two, the promotion of guidelines and sharing of best practices related to the diagnosis, treatment and management, and then it goes on to talk about education. I would like to know where we are in developing national standards for PTSD and how the working relationships are developing among the partners that are coming together to develop those standards.
Ms. Hajdu: First of all, developing standards across provinces and territories is like any other provincial-territorial work. It can be challenging at times because the systems are complex and there are different priorities across the country.
Certainly, COVID has disrupted that work. I can be quite frank with you that the health ministers have been almost solely focused, at our political table, on the COVID crisis. We’ve had the opportunity to talk somewhat about long-term care and somewhat about health renewal funding, as I’m sure you heard, but we haven’t had a lot of time, to be perfectly frank, to talk about some of these other issues. That’s not to say it is not happening at the working level tables, which are often more adept at being able to balance multiple priorities.
It is a priority for me personally. Having worked in and amongst this field for quite a long time and having quite a deep knowledge of how long and how significant trauma can impact people’s lives — and in fact not just their lives but the generations that come after them — I know that equity is an important aspect of the standards. This is a priority for me, and I am hopeful that we will be able to begin having conversations at the political level that are broader than COVID. Of course, when you’re putting out a barn fire, it’s hard to talk about other barn fires.
I’ll turn to Mr. Stewart to talk about what is happening at the deputy table.
Mr. Stewart: Thank you, minister.
Minister Hajdu is completely correct. Even though the COVID-19 pandemic has, of course, demanded the highest attention from Minister Hajdu and her provincial and territorial colleagues, at the working level, there is a lot going on. In effect, there are COVID activities that are related to fighting the pandemic that still fit within the structure of the framework, and our hope is that that work is synergistically advancing the framework itself. That’s true for the data and the tracking pillar. Minister Hajdu mentioned two surveys that are under way. That data analysis is going on and is already beginning to inform our understanding of the impact of trauma at this time.
Regarding the guidelines and best practices, there is a lot of activity around the national research consortium for post-traumatic stress injuries among public safety personnel, which my colleague Dr. Strong’s organization has been funding and leading. There are many other examples, to be honest. We are developing and sharing coast-to-coast evidence-based best practices for the treatment of PTSD among the veteran population. There is another project that is looking at the RCMP. These are examples in the guidelines and best practices.
Regarding the educational materials, staff are doing work with our collaborative partners. They are working on a national peer-to-peer mobile application, which has been piloted through National Defence’s research organization. Of course, we cannot forget things like the Wellness Together Canada website, which has been a major initiative and is a resource for the educational component of the framework.
I’ll stop there, because I am throwing a lot of things at you, but even in the paradigm of COVID impacting us, these are examples of how we’ve been trying to advance the PTSD framework with respect to strength and collaboration. As Minister Hajdu said, COVID has kind of blown us a strong wind, but we’re trying to continue the work within this context.
Senator Bovey: Thank you.
Senator R. Black: Thank you, minister, for joining us today.
One of the key themes highlighted in the federal framework was the disparity of access to care and resources, particularly in rural, remote and northern communities. Can you provide the committee with an update on how this government has worked to address this inequality?
Maybe you could also provide a quick update on the internet-delivered cognitive behavioural therapy pilot program, which is relevant because of all the issues with the internet now that we are all using it to work, live and play at home.
Thank you.
Ms. Hajdu: It’s a great question. As somebody who represents a semi-rural riding, I will say that the inequity in terms of accessing care pre-COVID was pretty profound, not only from a lack-of-service perspective but also from a lack-of-confidence-and-confidentiality perspective. I don’t know if you are from a small town, senator, but when everybody knows everybody, it gets hard to go to the counsellor.
Senator R. Black: Absolutely.
Ms. Hajdu: As a matter of fact, as someone who worked in the field of substance use and addictions for many years in public health, as my children went through various stages of life, as I worked through my own history of trauma and I became better known in my community, even as a working professional, it became harder to access services. That’s the reality.
There are a bunch of compounding factors, which is why I’m thrilled about Wellness Together. I can tell you, on a personal note, that for some people who have benefits even, it is somehow easier to go to a portal to connect with a professional in a completely different city from you, who you don’t know and who doesn’t know you. I’ve heard a number of anecdotal responses of comfort around this idea that there’s something there. Even though the person may not have a financial need, they have a need for privacy. In some ways, we’ve learned a lot through Wellness Together.
You are right that there are always challenges with the internet connectivity, which is why we’ve made the ability to connect by phone and other methods available to people. True, the first point of contact is through a web portal, but there are other ways that people can continue to get those supports not using the internet, trying to scope in those barriers.
It has been a huge revelation to me how wedded, pre-COVID-19, we were to non-digital supports — face-to-face counselling, which, for some people, is irreplaceable. For other people, it is a freeing moment for them to be able to ask for help in a way that’s non-threatening and where no one has to know that they reached out or they want to talk about their substance use.
On the question of the specific supports, I’ll turn to my officials.
Mr. Stewart: Thank you very much, minister.
On the IT cognitive project, senator, I have to admit that, being new to the position, I don’t know as much as I should about it, so I will turn to my colleague Candice who may have a great line of sight on this project.
Ms. St-Aubin: Thank you for that, president.
We have had discussions about the early results with Public Safety, who is lead on this project. Unfortunately, I do not have specific data, but I’m happy to provide it in writing so I can do it justice.
Dr. Michael Strong, President, Canadian Institutes of Health Research: Maybe I can provide more information on the research side of the equation. Beginning in April 2020, as part of the pandemic, we funded research to look at the efficacy of doing outreach and distance counselling across a number of different mental health services. The good news is that the evidence shows that it is effective. As the minister alluded to, it can actually replace face-to-face care for a population of individuals. That data is coming forward now to emphasize that it is, in fact, a very efficacious way to work.
Senator R. Black: Thank you. Thank you, minister and your colleagues.
Senator Omidvar: Thank you, minister and your colleagues, for being with us in these difficult circumstances.
Minister, you and your colleagues stated in your presentation and in other remarks that data and tracking are going to be central to fulfilling the promise of the framework. You provided us with some baseline data based on age and gender. Can I assume — or not — that the data you collect and will continue to use and analyze to provide appropriate services will also look at PTSD through the lens of race and intersectionality?
Ms. Hajdu: Thank you very much, senator.
Yes, the intention is to have as granular data as possible because, of course, we know that different groups of people experience trauma differently, and there are different outcomes as well. I’ll turn to my officials to speak a little bit about how that’s being designed, but the great news is that when we collect data ourselves, we can design how that data is collected. The bigger challenge, as we’ve learned through the pandemic, is when we are relying on provincial-territorial partners. Data is very hard to coordinate across levels at the granular level that you are suggesting. I will turn to my officials.
Mr. Stewart: Thank you, minister.
First and foremost, we do have a range of data gaps, as you can imagine, starting with which traumatic events are most associated with PTSD — just very basic kinds of gaps — and how a diagnosis of PTSD is related to screening positive on symptoms. There are data gaps with just understanding the mechanisms. The surveys that Minister Hajdu mentioned in her opening remarks are a way in which we hope to be able to try and shine some light on these topics — the survey of stressful events and mental health, for instance. In those surveys, we are trying to get content that gets into some of the issues that we’re missing data on — just the basic diagnostics — and the details of the events associated with PTSD symptoms.
That’s drilling down, senator, to your question into occupational groups but also into populations and social impacts of PTSD and social supports. I think we could look at the questions and make sure, as we’re going through this work, that we shine light in the areas that you are speaking to. In general, we just have a lot of data that we need to be gathering and focusing on these topics. It is an area where things have been incomplete. These new surveys are really going to help us.
Candice might want to jump in on this aspect.
Ms. St-Aubin: Thank you for that.
You’re correct. It is something that we always put on a broad lens because we do focus on those most vulnerable, regardless if they are front-line workers or not. The initial data pool that we did get from the survey showed 62% of Canadians are experiencing some sort of impact with regard to PTSD in light of COVID. That, ergo, just demonstrates the need to unpack and pull those layers back. With the second round that will be coming out this fall, we are again digging down to ensure that we cover the race, place, all ethnicities and geography as well, because we also know there are going to be social and economic impacts. It’s going to be a broad set of criteria. We’re working again with provinces and territories to ensure that we can get access to the data.
Senator Omidvar: Thank you. I certainly look forward to seeing this data.
Minister, I notice that specific occupational groups covered by the framework include first responders, firefighters, military personnel, et cetera, et cetera. I’m thinking of another group of people who also likely suffer from PTSD, and those are our humanitarian and international development workers who work overseas, often in times of disaster or war. From my reading, they are not included in the framework. Quick yes or no. Perhaps you will think about including them.
Ms. Hajdu: I’m not sure if they’re included, so that’s a great question. I am open to including any occupational groups that are experiencing trauma because personally, as a minister, I think sometimes we too tightly define which occupations experience trauma. I think of other occupations that may not be immediately apparent as experiencing trauma. Think about people that work with children. Think about teachers, for example. I don’t know if you have any teacher friends, but certainly I do. A story that was very compelling for me was a personal friend, who is a teacher, who said, “I knew some of my children lived in abhorrent conditions, but I had never seen inside their living rooms before I started Zoom teaching.” She could see the poverty and the neglect in a way that she had not been able to see just by classroom, really. I think about those kinds of statements all the time. I think that’s why there will even be groups that wouldn’t necessarily — maybe one could say teachers would experience post-traumatic stress just from the nature of their work, but perhaps in ways we couldn’t see as well. I think that’s a very important point. However, I will turn to my officials because I may not know that those professionals are scoped in, and I stand to be corrected.
Ms. St-Aubin: Yes, they are included, actually. That’s the beauty of the framework, right? We try to bring together all areas of the federal family, so those departments that support those workers who are going overseas, of course, will have a voice at the table. I can confirm that they are, in fact, included.
Senator Omidvar: Excellent. Thank you.
The Chair: Thank you for this confirmation.
Senator Moodie: Thank you, Minister Hajdu and your team of officials, for joining us today.
I want to continue this line of questioning around just who we are going to be looking at with this framework. My thoughts and my question are around refugees. Does this framework actually consider this population? We well know that refugees have significant mental health issues due to so many of the traumatic experiences that they encounter in their transition into Canada and from their prior lives.
The second question I wanted to address was around children. We maybe brushed past them just now when we talked about teachers, but will this framework really focus on children? Will we be able to understand from the data collected how we can support and lead policy to make decisions around children who are suffering from early childhood toxic stress and PTSD?
Ms. Hajdu: Within that question is an acknowledgment that many groups of people experience trauma and don’t get support, in some cases, early enough to be able to actually recover from that trauma at all, if not recover well.
First of all, I’ll say that this is primarily an occupational strategy, but I think there is an openness to understanding how those groups of people intersect. I will turn to Candice to talk about the populations you mentioned, with the understanding that we can’t be all things to all people or we run the risk of being nothing good to everyone. From my perspective as minister, I’d want to be thoughtful about how we are scoping people in so that we can actually achieve some of the goals set out by the original intent of the framework. I will turn to Candice to respond to your question in a little bit more detail.
Ms. St-Aubin: Thank you, minister, and you are right that the framework does focus predominantly or primarily on those occupations that would experience. However, that is not to say that there aren’t investments being made for vulnerable populations, including vulnerable ages. The $100 million that was announced in the budget on Monday does include programming that will do just that: look at children and look at those vulnerable populations, in particular those where there have been multiple impacts from either their space, place and base but also because of COVID. It may not be captured as a frame because the framework is just the organization collaboration strengthening to achieve some of those critical milestones, but also the program that currently exists, unfortunately, has been augmented because of the budget that was announced. Also, we can’t lose sight of those people like jurors, who are on juries, or those challenging situations. Of course, refugees was an issue that was raised at the annual conference in April 2019, so there is a section dedicated to just that, with regards to those conversations that happened there, in the framework themselves.
Senator Dasko: Thank you, minister, and thank you to your team as well for being here. It is great to see you again. I hope you are all well.
Before I ask my question, I just want to put in another comment about an occupation. I told a friend of mine that I was reading some documents on PTSD, and he said, make sure you’ve got tow truck drivers on your list. So I’m going to add that to your list. He said they really struggle, and they come across all kinds of horrible situations.
Anyway, I will just move on to my main question here. I want to drill down a little bit on the data measurement and data collection issues. I’ve been looking at some of the documents from the Public Health Agency, and there are a number of research issues that were raised. I would just like to see how far you’ve gone with these issues.
There was a comment about the measurement of symptoms versus diagnosis for PTSD. That is one of the research issues that you are dealing with.
There was also the issue of linked data and admin data. I am wondering what the purpose of the admin data is. I assume it is to try to link it up with provincial sources of information. What would the purpose of that be? Is it to be able to link with the provinces with respect to treatment options or with respect to incidence data? I’m not quite sure, but I would like if you could just clarify that a little bit.
Is PTSD measured on a spectrum, or is it a diagnosis of a condition? Where is it in that sort of dynamic?
Also, if I might ask, what is the goal of the data work that you are doing? Is it to come up with a definition as to how to measure PTSD? Is that what you are trying to do? Are you trying to come up with a measure that you can measure incidence with? You can report on incidence? Is that the purpose, to find a measure that you can put onto various collection vehicles down the road, whether it be to ask the provinces to collect data a certain way? What is the goal of the data-collection piece and the data-measurement piece?
Also, how far are you in the data collection and data measurement aspects of this? Are you close to saying, “A-ha. We’ve captured this. We’ve got this. We’ve got a measurement. We’ve got the best way to do it”?
I think back to the measurement of disabilities that took so many years for Stats Canada to come up with. I have served on their social conditions advisory committee at Stats Canada for many, many years. I remember there were so many different ways to measure disability. Then it went through so many iterations, so many years of looking at measurement issues and how to come up with the best measures. I’m thinking of that situation when I think of this and wondering if it’s the same kind of dilemma.
That’s a whole bunch of research data questions. You can also tell me if you’re looking at tow truck operators, too. I don’t mean to laugh. This is serious. Thank you very much.
Ms. Hajdu: Senator, I will, in general, comment and then turn to officials about deeper purpose in data collection and how that will inform next steps.
In general, I will just say, the more we understand about this, the better, and the more granular the data, the better we can design interventions or support interventions that are being designed at the community level. I am a big fan of community-level interventions, I have to say. Obviously, to better understand it is the driving, overarching goal.
To your point about tow truck drivers experiencing trauma, I actually think you can experience trauma in many, many roles that we perform for one another. When we are interacting with individuals, for example, in the case of a tow truck driver who is interacting in sometimes terrible situations, trying to help out in the middle of a crisis, of course, that person could experience trauma. I think we have to have a different framework and a different way of talking about that so that it becomes okay to be able to talk about the trauma and so that we know how to do it in a way that doesn’t re-traumatize the people that we love. Drawing back on my experience at the shelter, I spent the first three months really in a state of shock at how terrible people’s lives really were. I also spent those first three months unintentionally traumatizing my entire family as I tried to process what I was feeling with my partner and with my older children.
I say this because we sometimes minimize the amount of trauma people do experience in their lives and the lack of ways that they have to process that trauma. Not everybody who experiences trauma will have post-traumatic stress disorder, but that is the point about the data — to try to figure out what interventions are needed at every kind of intersection of people’s experiences with trauma. How do we get better faster? Again, not to harp on Wellness Together, but we need to have a quick hit sometimes with someone to be able to say, “I’ve just experienced something terrible and I need to talk to somebody about that,” or, “I need to figure out where to put all those feelings or how to manage all those feelings,” or, “Is what I am feeling normal?” Those are the conversations that we need to have in Canada, and we need better and broader tools.
On your specific questions around data, I will turn to the team, perhaps starting with Dr. Strong who is doing a lot of the research.
Dr. Strong: Thank you very much, minister, and thank you, senator, for the question.
Indeed, the minister is quite correct in the breadth of the work that’s being done. Your initial question really drives to the issue: Is it a single syndrome? Is it a single syndrome, a single disease? Is it syndromic in its nature and more broadly based? A lot of the initial research investment done — a little shy of $14 million over these last several years — has been directed specifically towards clarifying the breadth of the diagnosis. That will be of assistance, as we’re moving forward, to help advise with regard to health policy development, interventions and best practices in the community. All of that is being gathered. It was really modified, as well, in the face of the COVID pandemic because that’s now, yet again, another trigger, another different sense of how it’s been driven to have post-traumatic stress.
To return to an earlier question, we’ve also invested specifically in looking at the pediatric populations, to understand the impacts there, because they are not the same diagnostic tools or definitions to look at a stress response in a child.
All of this is being invested in and looked at very carefully to clarify really the core diagnostic component, to allow us to move forward on our recommendations on best practices. Thank you.
Senator Kutcher: Thank you, minister and all those who are here today.
We really very much appreciate that Canada has a PTSD framework. We do understand that it is still in early days and that there is a built-in five-year review. We hope that our time together may positively impact its utility.
I have one question with two parts, focusing on guidelines and on education. On the guidelines, we know that treatment guidelines are the responsibility of professions, and public safety organizations may not be comfortable with crafting operational guidelines. Guidelines, also, we know, require accredited training programs for them to be effectively applied and taken up. The question is, who will be creating those guidelines, and will they be linked to accredited training programs for maximum effectiveness?
The second part is that education for awareness building is very much appreciated, but we know it has limited impact. One of the things that it can do is actually increase the demand for treatment. That can be a problem when service delivery is already stretched. With the good work that’s being done on educational materials, how will the government link improving treatment access specifically for those groups for which it has jurisdictional inputs — Armed Forces, veterans, RCMP, Indigenous peoples — to go along with improving the awareness?
Ms. Hajdu: Thank you, senator.
First of all, let me personally thank you for the amount of help that you’ve provided us in terms of some of the tools that are available to Canadians. I do appreciate that.
I will have to turn to my officials for the conversation around guidelines, but I will say that your question around awareness and then access is an age-old, chicken-and-egg question that I’ve heard many times in my professional career. If we raise awareness, will it create a burgeoning need? I would say there is an opportunity that we could pursue because we are obviously in the early stages of the plan where we have an ability to raise awareness, and we have an ability to raise awareness of what warning signs look like prior to someone needing extensive treatment.
I think until I die I will be firmly in the land of prevention. You can’t prevent all traumatic injury and you can’t prevent people from getting really sick from a whole bunch of things, but you can help people recognize warning symptoms early. You can actually help people figure out how to better manage a very difficult job using tools that maybe aren’t as intensive at first. There are many ways that we can help people manage the pain of watching suffering, because ultimately, that is what we’re talking about. The majority of PTSD, I truly believe, is related to the experience of vicarious trauma. I note that we haven’t heard that phrase — maybe it’s out of style, I don’t know. But I certainly believe that it is real, and until it actually happens to you and someone identifies it, it just feels like something is broken inside of you.
When I first experienced vicarious trauma, it was in public health working with Indigenous kids on a photo-voice essay project, and their photos were so incredibly painful. I didn’t realize what was going on with me. I remember landing in my manager’s office one day, sobbing hysterically — and I was a functional employee, so this was really new behaviour for me. It was actually a public health nurse that said, “You know, you’re experiencing vicarious trauma.” There was no language in our public health agency, if you can believe it, about vicarious trauma at that time. There were some small projects percolating through the Ontario public health network, but there was nothing comprehensive. It may have changed now. Luckily I had a colleague who was able to help me identify what I was experiencing. What if I had not? What if I had gone on carrying that pain and not understanding that there were tools and supports to help me manage the experience of looking at other people’s pain so deeply?
That’s why I think awareness is not necessarily terrible if there aren’t supports. We have to get better at giving a broad range of supports for people so that we can actually talk about that trauma. We can talk about vicarious trauma. We can be open about it. We can encourage especially male-dominated sectors that have a hard time talking about feeling pain and get that support before it needs clinical intervention.
I hope that is not too much information, but I think it’s relevant, because I think there are abilities for us to do way more on the prevention end of things so that we can actually really focus that intensive treatment on folks that have had a high burden of psychological harm or need that more intensive treatment.
I’ll turn to my officials for the deeper dives on guidelines.
Mr. Stewart: Dr. Strong, in two instances, you have been funding and encouraging the creation of a hub, the Canadian Institute for Public Safety Research and Treatment as a hub for information. I mentioned earlier the National Research Consortium for post-traumatic stress injuries. These are both things that CIHR is playing a big role in. I wonder if they are getting at the senator’s question about the way we are mobilizing our research and information for guidelines and educational materials.
Dr. Strong: Thank you for that and thank you for the question.
I would also add to that CRISM as well as some of the support programs that are reaching out particularly to teenagers with mental health issues to make more of it accessible within communities for many of the reasons that the minister was already raising.
But to directly answer your question, indeed, we have been using the data that has been derived from several of these to create guidelines. A really good example would be a series of guidelines that came out very rapidly last summer in response to mental stress, the disorders that are being highlighted by COVID for practitioners directly. These didn’t go through a mechanism to ensure that they were actually brought into accreditation programs as part of curriculum yet or even as continuing education, but rather directly to the practitioners and those delivering care, so best practices in doing virtual care.
In response to this, Iain is correct and complements the answer of the minister. There is a lot of data being used and being put into educational tools, getting right into the hands of the practitioners. Ultimately the goal of getting it into an accreditation system so it’s well understood in our educational systems is a different story and will have to come in the future.
[Translation]
Senator Forest-Niesing: I have two questions, but I think one has been answered. My question was about vicarious trauma. It is comforting to hear you talk about it. Thank you for sharing your personal experience.
As a lawyer, I have acted in some very serious sexual abuse cases. These are facts that should not haunt anyone’s mind, because they have a real traumatic effect. This is the case for lawyers, among others. Although they are often not held in high esteem, lawyers suffer from these vicarious traumas. I am glad to know that this is on your radar and that you will take it into account in the measures you are considering.
You also addressed the issue of prevention. My comment follows up on my colleague Senator Kutcher’s question about the awareness that you are planning to raise with the federal government. Awareness is crucial. Access to information by the public in general will have a direct impact on the demand for services.
I always wonder about prevention. If we act upstream, at the onset of symptoms resulting from exposure to trauma that could lead to PTSD, I wonder if, in the long term, this would be an investment. While it may increase demand and put pressure on an already strained system, recognizing this condition would eliminate the demand for services in the longer term as the condition progresses to a much more advanced stage.
I was looking for the references you were alluding to regarding the measures you are considering in terms of prevention which, as we know, is a form of long-term investment.
[English]
Ms. Hajdu: I think there is a framework for managing PTSD, and then there is the work that we all need to do together to make workplaces safer and have that prevention framework in the front window. We need the framework on managing PTSD, but we also need to be bolder in pushing all our agencies to be focused on mental wellness, which is why I’m so thrilled about Wellness Together. There is treatment but there is also prevention. There is a self-assessment tool. There are tools online about how to re-centre and rebalance yourself and how to manage feelings of distress. I think we need that in broader workplaces, including federal workplaces. This is obviously a framework for the federal family, but we should be encouraging our provincial counterparts to do that.
For example, my local EMS and the first responders have a new text-based tool that they have been using for the last several years. They have natural peer mentors. If someone goes out on a call and they don’t necessarily want formal help but they want to say to a peer who understands their work that they had a rough call, they can send a text and actually choose who they would like to talk to from a list of the people who come up. Then they have a call within — I do not remember the number of hours — but within a couple of hours, they can debrief with a peer to say this was a really tough call.
It’s all about trying to drive down workplace injuries. We need to normalize that pain as part of many of these jobs. By normalizing that, we can actually come up with strategies that de-stigmatize getting that first aid response that happens when we experience those traumas.
To your point, of course lawyers would experience trauma. They are representing broken people, scared people, angry people, divorces; family law must be terrible. I can’t imagine going through family law. There is powerlessness to this, because you’re working within a defined system.
I think there is much more we could do in the space of prevention. I really appreciate you also sharing that your previous experiences have been hard on your heart. Thank you.
The Chair: Minister Hajdu, I thank you so much for being here. Those were all the questions that we had. I want to thank you for taking the time, Minister Hajdu and your team, for answering those questions for us today.
This will end the first part of our virtual meeting today. On that, I would like to ask my colleagues on the committee if they have any objections to now proceeding in camera. I see no objections, so we will move in camera. Again, thank you so much minister, and thank you, everybody, for being here.
(The committee continued in camera.)