Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 49 - Evidence - October 31, 2018
OTTAWA, Wednesday, October 31, 2018
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:17 p.m. to examine and report on issues relating to social affairs, science and technology generally (topic: study on child youth and mental health); and for the consideration Bill S-248, An Act respecting National Physicians’ Day.
Senator Chantal Petitclerc (Chair) in the chair.
[English]
The Chair: Welcome, everyone, to the Standing Senate Committee on Social Affairs, Science and Technology.
[Translation]
My name is Senator Chantal Petitclerc, senator from Quebec, and it is my pleasure to chair this meeting.
[English]
Before we give the floor to our witness — and we thank you for being here today — I would like to ask my colleagues to introduce themselves.
Senator Seidman: Judith Seidman from Montreal, Quebec.
[Translation]
Senator Poirier: Welcome. Senator Rose-May Poirier from Saint-Louis-de-Kent, New Brunswick.
[English]
Senator Ravalia: Mohamed Ravalia from Newfoundland and Labrador.
[Translation]
Senator Mégie: Marie-Françoise Mégie from Quebec.
[English]
Senator Munson: Jim Munson, Canada.
Senator Dasko: Senator Dasko from Toronto, Ontario.
[Translation]
The Chair: Thank you. For the first hour, we continue our study on child and youth mental health.
[English]
I would like to start by introducing our witness today. I am pleased to have with us tonight Dakota Laliberte, Aboriginal Youth Council Representative, National Association of Friendship Centres. Welcome.
I remind you that you have seven minutes for your opening remarks followed by questions.
Dakota Laliberte, Aboriginal Youth Council Representative, National Association of Friendship Centres: I am Metis from a small northern committee called Ile a la Crosse, Saskatchewan. I am a representative of the Aboriginal Youth Council of the National Association of Friendship Centres. Before we start, I would like to acknowledge the Algonquin unceded territory that we are meeting on today. I thank you for the opportunity to discuss children and youth in mental health, more specifically to give an urban Indigenous perspective.
According to the 2016 census, more than 61.1 per cent of Indigenous people are living in Canadian cities, and the Indigenous youth population are among the fastest-growing population in Canada. The urban Indigenous perspective is often forgotten in the nation-to-nation approach.
I want to say thank you for allowing me to present the following.
First, I would like to share three things: one, a very short overview of what the Friendship Centre Movement is; two, major mental health barriers I have seen and that our Indigenous youth has reported on; and, three, some ways Friendship Centres address these barriers and solutions that we’ve heard directly from youth.
Friendship Centres are Canada’s most significant off-reserve Indigenous services delivery infrastructure and are the primary providers of culturally enhanced programs and services to urban Indigenous residents and those temporarily visiting cities.
For over 60 years, Friendship Centres have been working with and for the urban Indigenous communities on a status-blind basis, and youth is at the very heart of the Friendship Centre Movement.
Friendship Centres have been supporting urban Indigenous people for over 1,800 different culturally enhanced programs and services in health, housing, education, recreation, language, justice, employment, economic development and culture and community wellness. In 2015, there were 2.3 million client contacts. With this, there were over 16,000 youth client contacts.
The services are based on the needs presented by each person who walks through our Friendship Centre doors. This includes addressing mental health barriers that urban Indigenous youth face. Our youth’s culture and identity must be kept at the core of any of our initiatives.
A resolution was passed by NAFC in 2016 addressing mental health stating that the NAFC engage and secure funding for appropriate mental health services to be contained within the Friendship Centres across Canada to assist our brothers and sisters affected by these diseases.
Through our collaboration with the AYC and NAFC, a nation-wide Indigenous suicide prevention initiative has been initiated through our Friendship Centre Movement.
During the 2014-15 fiscal year, approximately 19,000 clients accessed mental health-related programs. This is evidence of the significant need for Indigenous-specific mental health supports.
I want to share some key priority mental health barriers for Indigenous children and youth, which are, first, the Indigenous youth suicide epidemic. Many Indigenous youth attempt or die by suicide and suffer from suicide ideation, particularly in remote northern communities. The attempts or suicide pacts are often communicated, expressed and sometimes broadcast on social media.
Indigenous youth in crisis and their families are often sent to urban centres for mental health services due to lack of support in their own home communities. Friendship Centres can provide a direct link to culture services when youth are transported to these urban centres.
For myself, I work as a primary care paramedic in northern Saskatchewan, and seeing both youth and adults in crisis is very common. I’m the person who responds to these calls. I’m the person’s temporary solution to something much bigger than them. First-hand, I’ve seen the system shipping youth and adults south because we lack the resource to help these individuals.
Going forward, the report of the Standing Committee on Indigenous and Northern Affairs — Breaking Point: The Suicide Crisis in Indigenous Communities, June 2017, had reported tangible recommendations from many witnesses, which included Indigenous youth.
The standing committee made 28 recommendations, and two notable recommendations are Recommendation No. 14:
That the Government of Canada ensure Friendship Centres receive adequate funding over multiple years to enable continuous programming, services and investments in infrastructure to support Indigenous peoples.
Recommendation No. 24:
That the Government of Canada makes available safe spaces to support youth and their families in case of a crisis to ensure youth can recover from distress or suicide attempts.
The current strategies working toward the Indigenous youth suicide epidemic have not yet reached the amount of community support that is needed. Friendship Centres can provide safe spaces and have the community networks to support this.
The Indigenous Youth and Community Wellness Secretariat was created in July 2017 to help address ongoing safety crises and the high rates of youth suicide in First Nations communities and northern urban centres. They have estimated that the cost of one youth suicide is $1 million. It is imperative to invest in the lives of Indigenous youth.
Two, another barrier is inaccessible mental health facilities for urban Indigenous peoples.
When seeking medical and mental health support, there is a lack of non-distinction-based programming, often a lack of beds and a lack of cultural linkages when seeking medical and mental health support.
The reality is that the Assembly of First Nations, Métis National Council and the Inuit Tapiriit Kanatami do not represent or serve all Indigenous people. The majority of Indigenous people are not status Indigenous living on reservecannot trace their heritage back to Metis homelands or do not come from Inuit territories.
If Canada’s policy-makers continue to employ a distinction-based framework, then urban Indigenous people will have no access to Indigenous programming.
Three, the main barrier we are seeing in addressing mental health is that there is no current youth-specific core funding stream to address mental health issues, cultural services and programming in urban centres.
Urban youth programming, youth councils and youth involvement haven’t been supported as they could have given that Friendship Centres have received core funding specific to youth since 2014 from Cultural Capacity for Aboriginal Youth.
There hasn’t been a specific funding stream since this time and Friendship Centres need youth specific support.
Urban Indigenous youth within our Friendship Centres have directly advised us that they want programs that support positive mental health and decrease suicides; support for youth councils and encourage youth engagement; gender equity and representation of LGBTQ2 spirit, non-binary and transgender; opportunities to learn Indigenous language; and cultural activities such as land-based learning.
None of this can happen at the capacity we need it unless there is a multi-year youth core funding stream specific for Indigenous youth accessing our Friendship Centres.
We ask the government to implement the TRC Call to Action No. 66, stating:
We call upon the federal government to establish multi-year funding for community-based youth organizations to deliver programs on reconciliation, and establish a national network to share information and best practices.
We need a youth coordinator in each Friendship Centre. This will encourage youth engagement and address the considerable number of Indigenous children and youth facing mental health issues.
Thank you for your time and for allowing me to present to such amazing people.
The Chair: Thank you, Mr. Laliberte. We do have questions for you.
Senator Seidman: Thank you so much for being with us today to help us understand some of the big issues.
I’d like to understand about health services and the way they are delivered, especially to urban youth. You said that 61 per cent of youth live in urban areas.
First, I’d like to try to understand, do they live and stay in urban areas or do they tend to move from one area to another, back up to reserve, down to urban areas? If so, what are the jurisdictional issues here? Are there problems of too many different jurisdictions, parties, municipal governments, provincial governments and federal governments? Are there problems coordinating these services?
Mr. Laliberte: From observation with my own community — because I am from a rural community — I find a lot of our youth but also adults are heading down south to our urban centre for their resources, to take their kids to school or for services like that. Can you add more about what you mean by “jurisdictions?”
Senator Seidman: Who coordinates the health services that you need? Are there different levels of government involved in trying to provide those services in the urban areas?
Mr. Laliberte: We will have to get back to you on that question. I’m sorry, but I can’t answer that today.
Senator Seidman: Could you then perhaps be more specific to help us understand the kinds of services that youth specifically living in urban areas really need?
Mr. Laliberte: When speaking on mental health and services going along with that, I think it’s important to have these services in urban centres. Working as a paramedic, we are constantly shipping people down south because we don’t have the resources to take care of and look after them ourselves.
There is no opportunity for culturally based mental health services in urban centres. That wouldn’t be only for people getting shipped to urban centres but for youth already in the urban centres who need a place to go and someone to be a listening ear.
Senator Seidman: For the youth living in urban centres, you are talking about safe spaces for youth. But you are saying that these safe spaces for youth to feel comfortable in, a culturally familiar environment with professionals helping them in ways that they feel comfortable with, doesn’t exist right now?
Mr. Laliberte: For myself, I lived in Regina, Saskatchewan and I didn’t have a place to call home, I did not have a place to go to, I didn’t have my own people to go to. Creating these safe spaces in urban centres would benefit people like me. I lived in the city, and it gets really lonely sometimes.
Senator Seidman: Thank you so much. That is very helpful.
Mr. Laliberte: Thank you.
Senator Munson: Thank you, Dakota, for being here. That figure you used at the beginning was 61 per cent?
Mr. Laliberte: It was 61.1 per cent.
Senator Munson: Living off reserve?
Mr. Laliberte: That is with our Friendship Centres.
Senator Munson: I always think there has to be a balance in our approach to how we are looking at Indigenous youth and the issue of those living off and on reserve in Saskatchewan, in particular. I say that because it is the fastest growing population in Saskatchewan, right?
Mr. Laliberte: Yes.
Senator Munson: Within that, there are so many success stories. There are so many going to universities, lawyers, youth like yourself as a paramedic.
How would you describe the Indigenous youth who are off to university and have figured things out and those who have not? Is the majority doing well? Do you have numbers on how that works?
Mr. Laliberte: I want to touch on the 61.1 per cent. That is how many Indigenous people are living in Canadian cities.
Can you ask that question again? I don’t fully understand.
Senator Munson: That is okay. It was probably a poorly framed question.
I think that within the Indigenous community, there are many young men and women who are doing well, yet there are many who are crying out for help. I am trying to seek a balance in my question of those who are doing well within the community. Are they helping those who are not? Are they part and parcel of working with other Indigenous youths who are lonely and lost within the city? Does that take place through the Friendship Centres, in terms of volunteerism, to say that there is another way to get through some of the mental health issues you may be going through?
Mr. Laliberte: Okay. Your question to me is just asking if successful youth —
Senator Munson: Do people look at people as mentors or peers and that perhaps with the help of the academic community, within government, within social services, there is a coordinated effort with people for those who feel lost and feel that they have to take their lives? Is that disjointed or an integrated thing that happens within the province?
Mr. Laliberte: I will use myself as an example. I try to help as many people as I can. One of the reasons why I became a paramedic is that I would consider myself as a success story because I left my home community. Now I am back in my home community offering my services. I am also on my local Friendship Centre board and other boards surrounding mental health issues and other health issues. I sit on my community mental health wellness group with doctors, nurses and members of the community. I am trying to give back as much as I can. There are others like me. I am mentoring other youths to help the community.
That is one first great step into something great.
Senator Munson: As a separate question, are you familiar with the Congress of Aboriginal Peoples, the CAP?
Mr. Laliberte: Not necessarily, no.
Senator Munson: They are a national organization that represents Metis off reserve. It was born of the Native Council of Canada with Harry Daniels and moved to a new name called CAP. You are not familiar with them. I thought they would have some role in dealing with the issues we are talking about today, but it wouldn’t be fair of me to ask you that question if you are not familiar with what CAP does.
Mr. Laliberte: I have heard that name, but I am not 100 per cent sure what CAP does.
Senator Munson: You talked about a person lost in a city being lonely and so on, and that person is contemplating suicide, taking his or her life. You talked about it in your opening address. Within the system, is there somewhere for that young person to go to say, “I am feeling like this?” Is there any way that issue can be addressed before that act has taken place within the community that you are working in?
Mr. Laliberte: I am not necessarily saying that they are contemplating suicide but it could definitely lead to that.
Senator Munson: To depression.
Mr. Laliberte: Just having the feeling of loneliness and such a foreign place to someone. Having services and programs for Indigenous youth to go to. I didn’t have that. All I had was my Indigenous student services at Saskatchewan Polytechnic. I went to hang out there. I didn’t tell people how I was feeling or anything. It felt like home to me in a way. It definitely could lead up to depression. That’s how I felt sometimes.
Senator Munson: Thank you. I’ll maybe pursue other questions after. Thank you very much.
Senator Poirier: Thank you, Dakota, for being here and sharing some of your experiences and knowledge with us. It’s greatly appreciated.
I know you touched on it a bit, but I’d like you to elaborate on the challenges that face individuals when they move to an urban centre. What kinds of programs and resources are available to assist them in that transition period?
Mr. Laliberte: Like within our Friendship Centres?
Senator Poirier: Yes.
Mr. Laliberte: Right now, my local Friendship Centre doesn’t have anything to help with that transition. I do believe that some Friendship Centres do help youth, transition into the urban centres.
I can definitely get back to you on that question. I don’t want to say something that is wrong.
Senator Poirier: The biggest challenge that the Friendship Centres are faced with is delivering culturally adequate services for mental health programs. Right now, what kind of help does the federal government offer the Friendship Centres across the country and is it sufficient? If not, what more could they do?
Mr. Laliberte: I don’t think it’s sufficient. There are a lot of youth all across Canada who don’t have a place to go, even rural communities. In urban centres, youth have movie theatres, pools, all that kind of stuff to go to. Indigenous youth have some places where they can go, but our Friendship Centres do not provide sufficient mental health services.
I believe, our whole council believes that we should have mental health services within our Friendship Centres, or even a youth coordinator to help these youth transitions — moving to the city or helping with things along those lines.
Senator Poirier: Do you get any type of help from the federal government for the Friendship Centres?
Mr. Laliberte: Any federal help?
Senator Poirier: Yes. Either by manpower, by money, in any way? Do you get any type of help at all?
Mr. Laliberte: I have to get back to you on that question. I could answer this: For my youth council there is this funding, I’m pretty sure it’s called — I’ll have to get back to you on that. Sorry about that.
Senator Poirier: That’s okay.
I want to know what the difference is in terms of services that you offer. In Ottawa, they have a Friendship Centre and the Aboriginal Health Access Centre. What’s the role and what’s the difference between the two? Do you know?
Mr. Laliberte: I’m unfamiliar with the Aboriginal one. With our Friendship Centre, we don’t fully offer those kinds of programs or services to Indigenous people.
Senator Poirier: What’s the main thing that your Friendship Centre is offering right now across the country? The ones in the urban centres, what’s the main thing that you’re offering when an individual comes into an urban centre and walks into your Friendship Centre?
Mr. Laliberte: I’m not sure what every Friendship Centre offers but there are programs such as community support worker, court workers. I’m unfamiliar with the other ones as well. We can definitely get back to you.
Senator Poirier: These workers, are they provided by the provincial governments or by the federal government, or are they volunteers?
Mr. Laliberte: I’m pretty sure court workers are provided by the provincial government. Community support workers, I’m pretty sure that one is the federal government. Yes.
Senator Poirier: Thank you.
Senator Ravalia: Thank you, Dakota. You alluded to culturally based health services. If you had unlimited resources in front of you, what specific things would you like to establish in your Friendship Centre that you think could help the mental health of your youth? Are there things that you wish you had or areas that you wish had resources for?
For example, would Indigenous health workers, Indigenous teams, Indigenous support groups relay and relate better to your community than having people who don’t fully appreciate the culture?
If you had a complete desire to have a team working with you, what do you think that would look like?
Mr. Laliberte: I think that would look just tremendous, to have all the kinds of resources that our Friendship Centre could ask for. I think a lot of youth — not only specific to youth but people in general — to have a mental health worker, to hire an Indigenous person to be the mental health worker or youth coordinators. A lot of our youth centres don’t have a youth coordinator to run programs for them, so there’s a lot of people that don’t have anything to do.
Senator Ravalia: Sort of recreational supports?
Mr. Laliberte: I find recreational support is really good for mental health. It’s good for me. I like recreational sports and working out and things such as that.
Senator Ravalia: In terms of provision of an actual health team, do you feel that a nurse or a team of individuals who are familiar with the Indigenous culture would better adapt to working in a Friendship Centre than a traditional visit to a doctor’s office?
Mr. Laliberte: I would find that to be more comfortable for myself as an Indigenous person, to go into a Friendship Centre and have someone available to talk to. It doesn’t necessarily have to be a nurse. Mental health workers, to be that listening ear to someone who is hurting, to someone who needs support.
Senator Ravalia: Thank you very much.
[Translation]
Senator Mégie: Good afternoon. I would like to know whether you have anyone at the friendship centre who keeps track of the number of young people who come there for services. To make a budget request, you have to know how many young people come to you, what are the results of your involvement, what worked and what did not work. Is anyone in charge of doing that?
[English]
Mr. Laliberte: Is anyone looking towards counting youth coming through our doors? Yes, there definitely are people keeping count of youth. Because youth, like I stated, are at the heart of our Friendship Centre. They are one of our many priorities, so we definitely have someone keeping track of which people come through our door. It doesn’t matter if they are elders or youth.
[Translation]
Senator Mégie: You could find out whether they are satisfied with the services, whether the services were a complete success. It is important for you to have statistics like that if you want to obtain grants.
[English]
Mr. Laliberte: There are a lot of successful programs within our Friendship Centre. At my Friendship Centre, for instance, we have a lot of successful programs like community support worker and court worker. We have child care workers. There are a lot of programs within the Friendship Centre that work. The services that they provide are outstanding.
It’s one of the many reasons why I joined up with the Friendship Centres; it’s such an awesome organization.
[Translation]
Senator Mégie: Thank you.
The Chair: We will follow up to try to obtain those statistics. They will help us a lot.
[English]
Senator Dasko: Thank you for coming here today.
I want to ask a question that’s a variation on what Senator Ravalia asked you. He asked what you would do with unlimited money. In the real world, we know that any amount of funding you’re going is a set amount, so where would you put that money? What would the first place be you would put it to help the mental health of the clients and the young people who come into the centres? What would you do with it?
Mr. Laliberte: Where would I put it and what would I do with it?
Senator Dasko: Where would be the place to put the money that would be the best, most effective way to use it to have results and help people the most?
Mr. Laliberte: Definitely with the Indigenous mental health worker. I’ll continue bringing up the mental health worker. They do not only Indigenous mental health, but the work that they do is amazing. I’ve spoken to friends who talked to these people and it helps a lot. It helps with what they are feeling and their depression.
Since mental health is such a big issue in our country, that’s where I want to direct those dollars, to help not only youth but people in general. I see mental health issues in people from ages 10 to 80, and that’s crazy. We would offer that kind of service through our Friendship Centre, which is a nice, comfortable and free space to come, talk and have coffee or tea with people you trust in your own Indigenous circle.
Senator Dasko: So that person would be a counsellor and would just help people who come in through the door to talk through issues with them? They would be a trained person, right? They would be a social worker or a psychologist?
Mr. Laliberte: Yes.
Senator Dasko: Do you see differences between young men and young women who come into the Friendship Centres in terms of the issues they’re facing?
Mr. Laliberte: Yes, I do. Speaking with young women, I find that social media is their outlet and their saving grace. If they don’t get many “likes” on a picture or comments on their photo, just surrounding relationships, things like that really bring down their self-esteem.
With young men, I find the problems more often start with their family. Their parents are drinking a lot or selling their stuff to get the next high. For me, working as a paramedic, I find that females more often have mental health issues.
Senator Dasko: More serious?
Mr. Laliberte: Definitely more serious, yes. Guys don’t really like to talk to people. I don’t really like to talk to people, but it has to be done, so there is that difference between the boys and the girls. The boys don’t really like to speak up about what they feel, and the girls expressively show it.
Senator Dasko: It’s kind of a guy thing, right?
Mr. Laliberte: Yes.
Senator Dasko: Thank you.
Senator Eaton: Thank you, Dakota. I’m trying to imagine how hard it would be. It’s hard enough moving from one city to another in a culture you’ve grown up in. But if you come from a community in the North of 300 or 400 people and move into a very different culture in Ottawa or Toronto, I would imagine there are many issues that a young person would face, even if he has a job or is going to school.
If I came from one of the Indigenous communities in northern Manitoba, for instance, and I was going to the University of Ottawa, would there be a mentoring system if I came to the centre? I could meet with other people my age, obviously, but is there a form of mentoring system for people who have gone through it that can help?
Mr. Laliberte: That is one of the reasons why we want to secure funding for that kind of opportunity. A lot of the workers will just put down what they’re doing and speak to this individual because they trust them. They’ve met them in the community and that’s a person that they can talk to and they can trust about anything, really.
Senator Eaton: A person who has gone through what they have gone through?
Mr. Laliberte: Yes.
Senator Eaton: Did you come from an Indigenous community outside a city, or were you always urban?
Mr. Laliberte: I lived in a rural community with about 2,000 people. I moved to Regina, Saskatchewan, which is an urban centre and our capital.
Senator Eaton: Was it a big cultural change for you?
Mr. Laliberte: It definitely was. I experienced a lot of racism and that sent me in a downward spiral. I wasn’t doing well in my classes because of it.
Senator Eaton: Did they have a Friendship Centre in Regina?
Mr. Laliberte: They do, yes.
Senator Eaton: Did it help you?
Mr. Laliberte: I didn’t contact them because I wasn’t really aware of Friendship Centres at the time.
Senator Eaton: Do you think it’s the case for a lot of young people coming from northern communities that they do not know of your existence? Or do they know of your existence?
Mr. Laliberte: Most people know about our existence. I was aware of Friendship Centres but not fully aware of what they were.
Senator Eaton: We’re studying suicide. At your Friendship Centre, are there trained mental health experts, or people with enough training in mental health, that recognize the signs of someone who is about to commit suicide or wants to or is thinking about suicide?
Mr. Laliberte: Right now no mental health experts, but we have people who take prevention training or safeTALK or ASIST. Just having those workers take that, they can notice signs of people who walk through our doors who are having that depression, those thoughts and suicide ideation.
Senator Eaton: Do you deal with addiction at the centres too?
Mr. Laliberte: I believe at some centres we do but not all.
Senator Manning: Thank you, Dakota, for your time here today. Do the Friendship Centres collaborate with each other and share best practices, concerns or issues they have? Does your centre collaborate with others so you can implement some of the things that are working in some centres that you may not be aware of in yours?
Mr. Laliberte: Definitely, yes, we do collaborate a lot. We listen to each other and ask each other, “What is working with your Friendship Centre?” We have tried it when it didn’t work with us. There is definitely a lot of collaboration and talking between Friendship Centres and our PTA. Yes, there definitely is.
Senator Manning: There is an old saying that an ounce of prevention is worth a pound of cure. Do Friendship Centres reach out to the community? Sometimes getting youth to come in and express their problems to you, seeking help, there is a stigma related to that so they stay away from it, especially if someone is going through a difficult time. They may not be aware of what is available, as you touched on earlier. Do Friendship Centres have a way to go out in the community, do outreach, offer services and talk to the young people about what is available at the Friendship Centre and what they can take part in?
Mr. Laliberte: We definitely have community events. We are constantly sharing on our Facebook page or posting posters throughout the community and inviting community members to come to our functions and events. We do a lot of advertising of our Friendship Centre.
Senator Manning: Do you find, when you collaborate or talk to other Friendship Centres, that the resources you are lacking or the services that you are unable to provide because you don’t have the financial resources to do so, are they similar to the other Friendship Centres? Are the concerns you have in your centre, in relation to services, similar to other Friendship Centres that you talk with?
Mr. Laliberte: I don’t understand that question fully.
Senator Manning: You have issues in your Friendship Centre and things you would like to provide, funds you would like to secure so you can provide those services in your community. When you collaborate with other Friendship Centres, do you find they have the same issues in regard to providing those services?
Mr. Laliberte: I can share that communities do have a lot of the same concerns surrounding suicide, depression and mental health issues. There are some programs that work for some but not all.
Senator Manning: Is that because of lack of resources?
Mr. Laliberte: Definitely, yes.
The Chair: This is all the time we have, Dakota. Thank you. Meegwetch. Everyone appreciated the time that you took, and it has been valuable for our study. Thank you for being here.
[Translation]
We are now going to continue our consideration of Bill S-248, An Act respecting National Physicians’ Day.
[English]
I am pleased to welcome our two witnesses. We are happy to have by video conference from Toronto, our former colleague and former chair, recently retired, Senator Art Eggleton.
It is a pleasure to have you and a little strange, I might say, because it has been not too long since you retired and you were in this seat. You were first sponsoring this bill in the Senate. With you is, Dr. Sandy Buchman, President-Elect of the Canadian Medical Association. Welcome to you both. We will begin from Senator Eggleton.
Senator Eggleton, you know the drill. You have seven minutes for your opening remarks.
Hon. Art Eggleton, P.C., former senator, former sponsor of the bill, as an individual: Yes, I know that drill. Thank you very much. I wish I was there in person, but I am pleased to reconnect with my favourite committee of the Senate.
I am pleased to speak to Bill S-248, the National Physicians’ Day Act, which would declare May 1 each year as National Physicians’ Day. I am grateful to Senator Cordy, who is picking up the sponsorship of this bill for me.
May 1 is the birthday of one of the most influential individuals in Canadian medical history, Dr. Emily Stowe, the first female to practise medicine in Canada and a founder of the country’s women’s movement. Dr. Stowe was born in Norwich Township, Oxford County, Ontario, in 1831. She was inspired to pursue a career in medicine following a loved one’s illness from tuberculosis. However, at the time no Canadian college or university would accept a woman, so she was forced to earn her degree in the United States from the New York Medical College for Women. Following her studies, she went on to open a medical practice in Toronto.
It was during her time in the city that she also founded the Toronto Women’s Literary Club, which would quickly evolve into the Canadian Women’s Suffrage Association. When the Dominion Women’s Enfranchisement Association was founded in 1889, Dr. Stowe would become its first president.
Dr. Stowe set an inspiring example for the generation of physicians who followed. Throughout her career she pushed boundaries, challenged conventions and paved the way for more women to practise medicine in Canada. Her legacy lives on. Today the medical profession is closer than ever to being gender balanced. Two thirds of family physicians under age 35 are female. We can see the same trend among students and residents as well.
Medical students, residents and practising and retired physicians are an inherent and essential component of our health care system, one of the most cherished social programs.
They make a difference in the lives of Canadians every day, through their work in hospitals and other care facilities and communities, both urban and rural, in schools and in universities. They not only play a vital role in caring for patients and ensuring that they get the care they need, they also contribute to medical innovation, helping Canadians live longer, better, healthier lives and ensuring our health care system is effective, efficient and sustainable for the future.
Canadian physicians have contributed to innovations in stem cell research, the discovery of insulin and world-leading medical technologies, to name a few.
On the advocacy front the Canadian Medical Association, the national organization representing doctors, has played a huge part as well. In 2017, the CMA marked 150 years of advocating for the health of Canadians; they are the same age as Canada. They advocated for public health during the Spanish influenza, the AIDS epidemic and the SARS outbreak. They were among the first to recognize the devastating effects of cigarettes, issuing their first public health warning in 1954. They founded the Canadian Cancer Society, among many other achievements. These examples are merely a fraction of what the medical profession in Canada has done and will continue to do to improve the health of all Canadians.
Medicine is extraordinarily rewarding work. The impact that physicians have on lives is tremendous, but the practice of medicine, like all professions, comes with its own challenges, such as difficulties achieving work-life balance, heavy workloads and increasingly high expectations.
Senator Seidman in her remarks to the Senate in supporting this bill indicated a study showing that 54 per cent of physicians were at or near the burnout level.
Amidst all of these challenges of our country’s doctors, they are saving lives every day and working hard to give Canadians the best in health and health care aid. It is time, I would say, to officially say thank you for all their contributions and sacrifices on behalf of all Canadians.
Now, Ontario and Nova Scotia already hold their own celebrations on May 1. I believe that a national day, however, should be created to celebrate the Canadian medical profession and its contributions to history and national identity. This would be in keeping with many other countries who already officially declare a doctor’s day such as Brazil, Cuba, India and the United States.
In short, a national day of recognition in Canada is long overdue. Declaring May 1 as National Physicians’ Day would allow patients and all Canadians to show their appreciation for the hard work and dedication of our more than 125,000 physicians, residents and medical students. I hope you will join me in calling for this recognition and celebration of the medical profession in Canada. Thank you.
The Chair: Thank you.
Now to you, Dr. Buchman.
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Dr. Sandy Buchman, President-Elect, Canadian Medical Association: Thank you, Madam Chair. I am Dr. Sandy Buchman. I am pleased to be here as President-Elect of the Canadian Medical Association.
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I am a family physician practising in palliative care, and have been a staunch advocate for my patients, my community and the health care system since the beginning of my career.
As the national organization representing more than 85,000 physicians and physicians-in-training, the CMA has a mission of empowering and caring for patients and a vision for a vibrant profession and a healthy population.
As the representative of so many talented, dedicated and hard-working doctors and medical learners, I am pleased to be speaking here today in support of this legislation.
As Senator Eggleton has highlighted, it is very fitting to choose May 1 as the date for National Physicians’ Day. Again, as you all know, it is the birthday in 1831 of Dr. Emily Stowe, Canada’s first female practising physician. Without Dr. Stowe’sdetermination, we would not have the diversity and the vibrant medical profession that we have today.
Whether we’re talking about Dr. Stowe or the many medical students, residents, practising and retired physicians in our country today, one thing remains the same: They are all fuelled by the same passion, and that’s the passion for medicine and helping others.
It is important that we take the time to recognize and be thankful for the hard work and achievements of our physicians and medical learners. I personally have deep gratitude and appreciation to be a part of such a community.
On May 1 of this year, we at the CMA decided to go ahead and host our own special day of recognition for our members. We took this opportunity to celebrate all of Canada’s physicians and physicians-in-training and reflected on the value and the work that they do.
There are so many inspiring examples of doctors who are paving the way in health care today. A few examples. Dr. Christy Sutherland, she is a family physician working in Vancouver’s downtown east side, providing care for the homeless; and she goes above and beyond it treating her patients, often working a full seven days a week to provide care and break down the stigmas for those living with addiction.
Resident Dr. David Kim, who is a young emergency doctor working in Vancouver. Although he is now dealing with the long hours and heavy workload of residency, he is also making the time to build supports for his colleagues so they can stay physically and mentally healthy.
Dr. Keith MacLellan from Pontiac, Quebec, is one of the several thousand committed physicians working in Canada’s rural and remote areas. He has been awarded the Order of Canada for helping lead the way in rural medicine and for his role in co-founding the Society of Rural Physicians of Canada.
Finally, Dr. Linda Dalpé in rural New Brunswick, who has spent her career examining the impact of poverty on health. In her retirement, she has been championing a tool that helps care providers screen for poverty so they can better provide care to their most vulnerable patients.
This is just a small fraction of the outstanding doctors who are shaping the face of health care today in our country — not only patient care, but research, teaching and innovation as well.
We can’t wait to get all of Canada in on the celebrations with us next year.
On behalf of the CMA, let me express my collective appreciation to our physicians and medical learners from coast to coast to coast. I wish to thank them for what they do, each and every day.
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Together, we can continue to build our vision of a vibrant profession and a healthy population.
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I am available to answer any questions that you may have.
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The Chair: My thanks to both of you. Now we continue with the time for questions.
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Senator Seidman: Thank you, Dr. Buchman, for being here with us. And Senator Eggleton, it is great to see you, even if it is only via video conference.
As you said, I was the critic for this piece of legislation. However, I wasn’t criticizing the legislation, because I think it is a good one, indeed. I say that because we often think of physicians as professionals who provide health care services to us, but we don’t think of them, their lives, their needs and the impact their profession might have on them. It is possible that a physicians’ day would help us put some emphasis on the impact that professional practice has on the lives of physicians.
As you say, the CMA did a survey and found that 54 per cent of physicians are showing signs of burnout and fail to have the kind of work/life balance that would allow them to provide the highest level of care to their patients and allow them to have good mental health in order to function well for all of us.
I don’t really have a question for you. Perhaps I might ask you, Dr. Buchman, if it is your thought that, as we celebrate physicians, we also look at a system that is overburdened and how we might move forward in that system to ease some pressure on physicians.
Dr. Buchman: Thank you for your comments, Senator Seidman. You are right; everything you said was right on.
One of the ways to handle the poor physician morale that exists throughout the country, in these times, would be to have a national physicians’ day as recognition. That would be incredible to lift the spirits and indicate that their work, dedication and devotion are recognized. We’re human beings caring for human beings. We do it because we care about that.
But as humans, too, having that recognition and appreciation from Canadians would go a long way — just that recognition — along with all our other health care providers we work with in our team-based care. That would be a real statement from Canadians that I know all physicians would appreciate.
Senator Seidman: I might ask Senator Eggleton if he has something to add to that point.
Mr. Eggleton: Your remarks are well put, Senator Seidman, as they always are. I would add that this not only gives the opportunity to recognize the sacrifices they make and the passion they have for medicine and helping Canadians, but this could also be an opportunity to focus on some of the issues that are of concern about the medical practice. The CMA, for example, could hold a function on Parliament Hill in which it could bring in a speaker to talk about some of the issues. It is an opportunity to learn and focus on issues facing the practice as well as recognizing the history and the good work that is done.
Senator Seidman: Thank you very much.
Senator Cordy: Thank you to both of you for being here today. It is really nice to see you, Senator Eggleton.
I agreed to sponsor this bill, readily, when Senator Eggleton asked me, because I think it is a good bill. I remember a number of years ago, I used to wonder if days were actually productive and worthwhile. I sponsored — and luckily in the Senate they passed it quickly — a bill for Sickle Cell Awareness Day. I know the kinds of things we did to celebrate the first one last year. I am glad to see that my Province of Nova Scotia has a Physicians’ Day, as does Ontario.
What kinds of things could you envision happening by having May 1 and focusing on May 1 as National Physicians’ Day? What kinds of things do you envision happening, or have you thought that far, in order to bring recognition to Canadians, that this is a special day and time to pay tribute to our hard-working doctors?
We take it for granted they are going to be there, and that is not always the case. They are getting older, and a lot of them are trying to balance their lives with young children — those who are just coming into the field are trying to balance it. But Canadians just expect them to always be there.
Have you thought of the things to focus to make Canadians show more appreciation for the job our doctors are doing?
Dr. Buchman: I agree with Senator Eggleton. Senator Eggleton raised that this is an opportunity to talk about issues and celebrate physicians. Within the CMA and our national education colleges, we have physicians of the year awards and that type of thing. It is incredible how communities get behind their physicians — the relationship physicians have in looking after the people in their communities. I see a national physicians’ day as an opportunity to bring those issues to the attention of the public, but also as an opportunity to celebrate across the country the contribution that physicians make as part of their health care teams.
Our first focus was just getting a national physicians’ day established, but I think it could lead to such ideas about what could be done.
I think about the issue that was raised — the issue of physician health — is key. I do not think the public really understands the stresses and burnout issues physicians are experiencing, whether it’s in the inner city or rural and remote areas.
As the public sees us, again, as humans caring or humans, they may recognize the issues about the working conditions we have and how things are negotiated may change. Healthy doctors mean healthy patients, but unhealthy doctors lead to poor quality of care. Again, it is an opportunity to raise issues like that, but I would like to focus, too, on the celebration of how lucky we all are.
Senator Cordy: I love why you chose me first, by the way, because I didn’t ever hear of Dr. Emily Stowe before.
Dr. Buchman: That is a good example of bringing it forward.
Senator Cordy: I love it. Thank you very much.
The Chair: Do you want to add something to that Senator Eggleton?
Mr. Eggleton: The committee has done a lot of studies relevant to health care. A few years ago we did a statutory review of the health accord. There were all kinds of issues that came out of that study involving physicians. It is an opportunity to look at those issues. It is also an opportunity, if there are awards given by the CMA, bring those people up to Parliament Hill and let’s hear their stories. That better informs people at the political level and the public.
Senator Munson: I want to give a shout out with a list, Dr. Buchman, to Dr. Jeff Turnbull. You had a list of four people who have done so well. He is here in Ottawa. Can you imagine, the former head of the Canadian Medical Association, the former Chief of Staff of the Ottawa Hospital, head of academia here at the University of Ottawa? A year or so ago, he gave all that up to work in shelters here in Ottawa. He is an amazing man who does amazing things. If this physicians’ day passes, which it will, then I will work hard with him to show that doctors are not only doing the work we see them do but are in the alleyways of our cities, helping out the homeless. I think it is admirable to see that.
When it comes to days here, I had a bill that became law, Autism Awareness Day, April 2. The same questions were asked, “What does that mean? We just care about autism on one day?” No. It took three years, by the way, to pass that bill; that was a difficult time. But it’s there. What happened is that there is now a sensitivity in thousands of schools across this country — and I’ve been to many of them — where the youth inside that school knows that their friend right beside them has Asperger or is on the spectrum.
I’m thinking that when you talk about celebration, one way of celebrating is to capture the hearts and minds of young children. I had a young woman in grade 6 or 7 in to see me yesterday from Diabetes Canada. She has diabetes type 1. She made a presentation to me, which was directed towards Bill Morneau, the Minister of Finance, to keep up the Disability Tax Credit and to do more. In five minutes — I don’t think a politician could match her intellect, the way she expressed herself at the age of 11, in that fashion — yes, I tweeted about it, I took a picture with it, I sent a message to the Minister of Finance to pay attention to this young woman in the next budget.
I’m wondering if while you and the CMA are celebrating across the country you can personally bring those messages. With these young women doctors, when you talk about the demographics, it’s wonderful; it’s just that first impression thing. It does happen in Grade 5, 6, 7 and 8, so I’m just suggesting that as one of the options. As you celebrate, you still have to work.
Dr. Buchman: Thank you for that comment. Thank you for recognizing Dr. Turnbull as an example. Many of us know that he is my mentor and a good friend. It’s important. Here is an opportunity, a day like this, when we can recognize great people like Dr. Turnbull.
You gave me another idea, actually. I’m going back to the earlier question. When you brought up the national day for autism and the impact that it has had and the stories coming forth. We had a young man here from the Indigenous community. How important could it be to have Indigenous physicians celebrated and serve as role models and mentorship for young people like the gentleman here earlier, Dakota, and be available and see what’s possible?
It’s imagining the possible. A national physicians’ day can do that because we can highlight people like that. I have several colleagues of Indigenous background. That celebrates our diversity, our inclusion, but to have these physicians celebrated as role models on a large scale says so much. We see that in sports, for example, when they can celebrate celebrities, and people from marginalized communities have these kinds of things to aspire to. They can be mentored from high school on with the motivation to stay.
I think something like a national physicians’ day can absolutely lead to something and have these kinds of impacts. Thank you for bringing up those examples.
Senator Munson: Thank you very much.
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Senator Mégie: When I took part in the debate in support of this bill, a colleague asked me why we were not considering a health professionals’ day instead. But I know that nurses already have a week, that there is a week for nursing assistants, and so on.
Did your board think about that on your end, as you worked towards establishing a national physicians’ day?
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Dr. Buchman: I have thought about that, and we have thought about that. We are so team-based now. We work inter-professionally. I could not do my job as a physician every day without the help of a full team—nurses, nurse practitioners, social workers, pharmacists, personal support workers, everyone together. We strongly support the celebration of each one of those professions because no one does it alone. And they have been recognized. We can look at the precedents. There is a national nursing day or week, I believe, later in May. There is something for pharmacists, et cetera.
We don’t feel that celebrating physicians or having a national physicians’ day takes away anything from that. It would be wonderful to actually have a health professionals’ day as well, but I see the importance of celebrating the critical role that physicians have as part of the team.
We all care for patients. We are all passionate, but physicians also have a unique role within the health care system, and I think for some of the reasons mentioned already that having their unique day—I know that my nursing colleagues, social work and pharmacy colleagues would be thrilled to have a day celebrating our discipline, our profession as well.
Senator Manning: Thank you, Dr. Buchman and Senator Eggleton.
On Nova Scotia and Ontario, is there provincial legislation for physicians days in those provinces?
Dr. Buchman: Yes.
Senator Manning: I strongly believe this bill will pass, but what happens then? Do we just override the provincial legislation? How does that work?
Dr. Buchman: I’m not sure I have the answer to that. I think Senator Eggleton may have.
Senator Manning: Senator Eggleton, I’m asking you the question.
Mr. Eggleton: They could both go hand in hand. It would be up to the provinces whether they want to rescind and put their day into the national day or just keep it as their own day.
It’s not a holiday per se in the way we know holidays. It’s a day of recognition. It can be recognized at either level. I don’t see it’s in conflict. They can sort that out, I’m sure.
Senator Manning: It’s pretty well the same legislation.
I want to touch on a couple of comments that Dr. Buchman made in regard to human beings helping human beings.
I know my experience is that doctors that serve us in Newfoundland and Labrador are equal to others; they are extraordinary human beings. I think about Dr. Kevin Melvin who gave both my parents 10 years of extra life in regard to quadruple bypass surgery he performed on both of them.
I think having the opportunity to recognize physicians is a great thing. I would suggest that you make sure that the opportunity to educate people across our province about the roles that the CMA plays in regard to physicians so that people can participate in National Physicians’ Day with you. I know it’s important here to do something in Ottawa, but I think it would be—and I know it would take time to do so—important to make sure that there’s a function or activity of some sort sponsored by the CMA that would happen in every province and territory in Canada on May 1, so people are aware that this is an opportunity for them to show gratitude and participate in the day.
I just throw that out as a suggestion. Sometimes we get wrapped in the bubble here in Ottawa, but the whole world doesn’t stop here.
Dr. Buchman: Actually, I thought that was Toronto, where I’m from. Your comments are really important.
I don’t think the Canadian public knows that much about the CMA as the voice of physicians across Canada, so I think that would be huge. For example, part of our strategic plan called Vision 2020 is partnership with patients. We strongly believe that collaborating and partnering with patients leads to a much improved health care system. There’s a lot of evidence that supports having patients at the table collaborating, co-designing and visioning a health care system.
Even to raise that point and have discussions about that this National Physicians’ Day can highlight that patients have a role. We now have a program called CMA Patient Voice, as an example. We have patient representatives from across the country who are now coming together to help plan and work with us.
That is an example, relating to your idea of educating the public, of taking the opportunity as to what we can do together to improve the health care system in Canada.
Senator Manning: That’s a good point.
The Chair: Thank you very much. Before we go to one question on second round, I have a quick question for you, Senator Eggleton.
During second reading, some senators mentioned the fact that some recognition days do exist via the leadership of organizations, or the initiative of organizations, and are not in a bill. I want to have your thoughts on why it is important that it becomes a bill.
Mr. Eggleton: Senator Mégie also mentioned nurses. There is a National Nursing Week; it used to be National Nurses Week, and then in 1993 it was changed to National Nursing Week. That was done at the behest of the Canadian Nurses Association. They asked for it in the week of May in which May 12 falls, because May 12 is the birth date of the Florence Nightingale. They asked the minister to make the declaration. So the minister, year in and year out, makes this declaration as opposed to it being in a bill, as I’m suggesting here.
I think the advantage of it being in a bill is that it brings all people, different political parties and different organizations into the fold as being part of it and not just the government of the day. So I think in that way, it is best to have it in the way of a bill. But the Canadian Nurses Association decided to go a different route and that’s fine.
Dr. Buchman: I think that states it very well, thank you.
Senator Munson: Thank you again. It is an opportunity to bring up an issue of family doctors.
I have two years and nine months to go in the Senate. If you look back in time, growing up in Campbellton, New Brunswick, we had family doctors and you remember the names forever: Dr. McClellan, Dr. McPherson, Dr. Swan, Dr. Rice. You could always see these family doctors going back and forth at the two hospitals, but in between making house calls. It was perhaps a golden time in the sense of physician service.
Today we hear from people who say, “You’re lucky or you’re fortunate; you’ve got yourself a family doctor. You’re a senator, I guess you have a way to get a family doctor.” But with all of this celebration, in our country today there are thousands and tens of thousands of people who go to good doctors at clinics but must line up and be there. In this process of celebration, do you see the day that every Canadian would have access to a family doctor, and would this physicians’ day help facilitate that?
Dr. Buchman: That’s an excellent question. My vision and passion: I am a family doctor all my career. I made house calls. I worked down the streets with the homeless. I tried to provide access to my patients all the time.
I’ve been president of the College of Family Physicians of Canada. My vision and our vision, through the college and through the CMA, is that every Canadian has access to their own personal family doctor. Medicine, family medicine in particular, is about that personal relationship between the physician and the patient and their family or circle, however family is designed. It’s that social dynamic.
What an opportunity to be able to push for this. This is my personal dream. This is a dream of all our Canadian medical organizations that every Canadian has access in their hometown, in their community to be able to develop that relationship. That’s actually the most cost-effective health care and that’s where more lives are saved within a superb primary health care system.
The answer is yes, what an opportunity to be able to encourage and push that, and have our governments across the country see that that should be a goal that we seek to attain.
Senator Munson: Thank you.
Senator Cordy: I’d like to go back to Senator Manning’s question about what happens in Nova Scotia and Ontario when they’ve already got a physicians’ day. My province of Nova Scotia also had a Sickle Cell Awareness Day before I brought in the bill. It just meant it was a bigger celebration, it was on the same day, and I think that the same thing will happen in Nova Scotia if we have the national bill. It will be just a bigger celebration and more awareness.
To the points that have been made around the table, I think that this will draw attention to the jobs that physicians do that we’re not aware of. We think about going to the doctor’s office, but Senator Munson was talking earlier about the doctor who is looking at homeless people and the examples that you gave. I think it’s a great initiative.
Dr. Buchman: Senator, you triggered my thoughts about something. I’m thinking about a big province like Ontario and even Nova Scotia. In some areas of our country, the territories, for example — I’ve been up to Nunavut and the Northwest Territories as an example — it’s more difficult for them to develop this kind of celebration. By having a national physicians’ day, which is inclusive for the country from coast to coast to coast, says something beyond our individual provinces.
We have a national vision for many things and to be able to do that, particularly for those areas of our country that are less able to do this with far fewer physicians or resources, makes a statement as well.
The Chair: Dr. Buchman and Senator Eggleton, thank you so much for your presentations and taking time to contribute here today.
For your information, we do expect to proceed to clause by clause of this bill at our next meeting, so tomorrow morning is when it should happen. Until then, thank you very much.
Mr. Eggleton: I want to say that I very much admire the expertise and professionalism with which you conducted the meeting. I want to congratulate you on succeeding me as the chair.
The Chair: Coming from you, I really appreciate it. Thank you so much.
(The committee adjourned.)