THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, April 29, 2024
The Standing Senate Committee on Official Languages met with videoconference this day at 5:01 p.m. [ET] to study minority‑language health services.
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: Good evening, dear colleagues. I am René Cormier, a senator from New Brunswick and chair of the Standing Senate Committee on Official Languages.
Before we begin our discussion, I would like to remind all senators and other in-person meeting participants of the following important preventative measures: To prevent disruptive — and potentially harmful — audio feedback incidents during our meeting that could cause injuries, we remind all participants to keep their earpieces away from all microphones at all times.
As indicated in the communiqué from the Senate Speaker to all senators on Monday, April 29, the following measures have been taken to help prevent audio feedback incidents: All earpieces have been replaced by a model which greatly reduces the probability of audio feedback. The new earpieces are black in colour, whereas the former earpieces were grey. Please only use the approved black earpieces. By default, all unused earpieces will be unplugged at the start of a meeting. When you are not using your earpiece, please place it face down on the middle of the round sticker on the table, as you see on the image.
Ladies and gentlemen of the witness panel and dear colleagues, you have cards on your table to consult guidelines on preventing audio feedback incidents.
Please ensure that you are seated in a manner that increases the distance between microphones. Participants must only plug in their earpieces to the microphone console located directly in front of them.
These measures are in place so that we can conduct our business without interruption and to protect the health and safety of all participants, including the interpreters.
Thank you all for your co-operation.
I now wish to invite committee members participating in today’s meeting to introduce themselves, starting on my left.
Senator Moncion: Good evening. Lucie Moncion, Ontario.
Senator Aucoin: Good evening. Réjean Aucoin, Nova Scotia.
Senator Mégie: Marie-Françoise Mégie, Quebec.
The Chair: I welcome all of you, dear colleagues, as well as viewers across the country who may be watching. I would like to point out that we are taking part in this meeting on the unceded traditional territory of the Algonquin Anishinabe nation.
Tonight, we continue our study of minority-language health services by welcoming researchers and organizations able to address the theme of health care professionals and postsecondary institutions, one of the seven themes of our study.
For our first panel, we welcome in person Danielle de Moissac, professor at the University of Saint-Boniface, and by video conference, Suzanne Harrison, director at the University of Moncton School of Nursing. Welcome to our meeting, Ms. Harrison.
Good evening to both of you and thank you for accepting our invitation. We are now ready to hear your opening remarks. They will be followed by questions from the senators. The floor is yours, Ms. de Moissac.
Danielle de Moissac, Professor, Saint-Boniface University: Thank you for giving me the opportunity to highlight research on the shortage of health professionals able to offer health services in the minority language in official language minority communities (OLMCs) and on these professionals’ linguistic capacity. My name is Danielle de Moissac. I’m a professor at Saint-Boniface University and for the past 20 years, I’ve conducted research on French-language services for francophones outside Quebec. As I’m more familiar with these populations, my comments will focus on them.
The issue of lacking professionals able to offer services in French recurs in scientific literature describing user experience. They report a lack of services in French. Is this lack entirely attributable to a shortage of bilingual professionals? Not necessarily, according to many bilingual professionals with whom I had the privilege of discussing the matter in the course of my research.
Two major findings are clear. First, professionals who speak both official languages do not declare their bilingualism for a number of reasons. For some, bilingualism means extra work, personal and legal risk, a feeling of linguistic insecurity, feeling isolated, a lack of needed tools and support to make an active offer and barriers to career advancement. Despite a sense of pride and commitment to their francophonie, bilingual professionals consider offering services in French to be a burden.
Second major finding: Bilingual professionals are not known by the general public, the staff of a facility or its managers. Since the number of bilingual professionals on staff is unknown, this makes it difficult to create networks for them and offer support. Few health care systems and professional associations systematically collect the languages spoken by their employees or members. It’s therefore very difficult to measure the proportion of bilingual professionals other than those in designated bilingual positions. What’s more, these designated bilingual positions do not exist in all Canadian provinces and territories and are relevant only to public services.
To address the shortage of bilingual professionals, three categories of people should be targeted. First, for those born in Canada who are naturally bilingual, priority should be granted to promoting health professions from a young age, as well as recruitment into French-language professional training and employment opportunities in OLMCs. For bilingual individuals from French immersion programs, supporting their linguistic security is a must. French-speaking health care professionals from Quebec and abroad need support in the form of coaching and financial assistance throughout the entire process of prior learning assessment, recertification and integration into a predominantly English-speaking workplace. This necessarily includes learning English. The process must be simple, transparent and fast, and include a transition program to facilitate integration into the workplace.
What can the federal government do? Four things. First, financially support professional training of bilingual people in the health sector through scholarships. Second, offer a bilingualism bonus to recognize the extra work and risks incurred by bilingual professionals. Third, increase funding offered to the Consortium national de formation en santé and to the 16 networks of the Société Santé en français. They have already contributed significantly to French-language professional training, supporting bilingual professionals and networking.
They know the communities and have good partners. They need additional funding to meet new needs, which include raising the profile of health professions among young people; setting up professional training programs, specifically in mental health and gerontology to better respond to the needs of OLMC francophone populations; targeting bilingual students for recruitment into these training programs; supporting international professionals, specifically with language training and professional integration; and researching new strategies to determine if they can address the shortage of bilingual professionals.
The fourth and final point involves more support for the Canadian Health Workforce Network and the Canadian Institute for Health Information to develop and maintain data collection and analysis infrastructure on human resources in health, taking into account the linguistic variable for health professionals. This would make it possible to plan capacity and resource allocation for official language resources in OLMCs.
Thank you for your attention.
The Chair: Thank you very much for your testimony, Ms. de Moissac.
Ms. Harrison, you have the floor. You also have five minutes for your statement.
Suzanne Harrison, Director, School of Nursing, University of Moncton: Thank you very much, honourable senators. My presentation is entitled “Identification des morceaux du casse‑tête nécessaires pour la livraison des services de santé en français dans la province du Nouveau-Brunswick malgré un temps de pénurie hors pair.”
You’ve probably all done puzzles before. You start by carefully examining the picture on the box, taking the pieces out and sorting them by colour. But what do you do if there is no picture, if the pieces aren’t the same size or if some of them are missing? How do you start? How do you ask for help? Do we all end up with a clear vision of what to build? Let’s do a brief overview of what I think are the big pieces of this puzzle.
Linda Silas, Director of the Canadian Federation of Nurses Unions, stated that nurses hold our health care system together thanks to their courage, their determination and a shocking amount of overtime. They propose to legislate the amount of overtime hours, as pilots do, and improve the workplace by establishing a better nurse to patient ratio, rather than putting band-aids on deep wounds, which is what happens when we fall back on travel nurses or overtime. Finally, she recommends that the federal government be encouraged to offer more money to the provinces.
Moncton University and the Nursing Network School agree with Vice-Dean Cormier in saying that stable and predictable nursing program funding is a must, rather than relying on special programs. The Vice-Dean and Vice-Chancellor Prud’homme were both correct in telling you that it’s necessary to accelerate recognition of foreign professionals’ credentials and consider eliminating the registration exam for accredited programs.
The University of New Brunswick offers a nursing degree with a double degree in collaboration with Manipal, in India. The Network School, along with the University, is starting to look into the possibility of a similar collaboration with Morocco.
The Société santé et mieux-être en français du Nouveau-Brunswick (SSMEFNB) is a national role model because of its innovative projects. It offers some puzzle pieces, such as developing points of access, actively offering health and wellness services, active citizen and community participation, and the language variable.
As one of the first members of the Groupe d’infirmières et infirmiers francophones du Nouveau-Brunswick (GIIFNB) in 2020, in light of the disastrous NCLEX exam results, I can tell you that I am a fervent advocate of GIIFNB’s mandate. It fosters francophone nurses’ growth and is also committed to representing their professional interests and those of the public. Specifically, it defends the right to a correctly translated practice examination, with enough French-language preparatory materials that reflect Canadian nursing practice.
The Canadian Association of Schools of Nursing’s annual report on training for nurses reveals a continuing upward trend in the number of admissions to the degree program, in spite of a staff shortage in care sectors and training programs. Offering high quality training, rather than producing nurses as quickly as possible, is also encouraged.
The Canadian Nurses Association has a new initiative entitled “Take action and help fix Canada’s health care crisis: Canada’s health care system is failing Canadians.” The initiative presents seven key facts, which I do not have time to describe in detail. However, one of its recommendations is to ensure that all levels of government strengthen and invest in Canada’s nursing workforce.
In 2023, academic experts Bauman and Crea-Arsenio stated that the pandemic accelerated demand for health services and increased their complexity due to the high number of sick days, cases of professional burnout and retirements. The article includes several pieces of the puzzle, such as establishing a stable and permanent workforce rather than relying on temporary solutions such as employment agencies; monitoring the reliance on unregulated workers, such as personal support workers; and securing funding to increase the number of seats and professorial succession.
Missing puzzle pieces appeared in a Times and Transcript article published in 2019. It describes the importance of improving the profession’s image and adding specialized training to prevent the closure of rural care centres, such as emergency rooms, operating rooms and delivery rooms. I think there are enough pieces there to put the puzzle together and face the situation head-on to ensure safe health care delivery. Due to time constraints, I can tell you about the other missing pieces during questions and answers.
Thank you very much.
The Chair: Thank you very much, Ms. Harrison, and thanks to both of you for keeping to your allotted time. I’m sure your testimony will lead to many questions from my colleagues.
Senator Moncion: Thank you very much, ladies, for your testimony and thank you for being here with us this evening.
My first question is for Ms. de Moissac. Last week, during my flight between Ottawa and Montréal, I found myself next to a lady who represents Canadian doctors, I think. We were actually talking about problems in Canada’s health system and training offered to doctors from abroad. In your province of Manitoba, I think there’s a one-year accelerated program to requalify people from abroad. Are you aware of the existence of such a program?
Ms. de Moissac: I’ve heard about it, but evidently, it’s only offered in English.
Senator Moncion: Based on what I was told, it seems that it has been very successful, given the increased demand for this type of program. This person also told me that those who qualify for the program in Manitoba agree to continue practising in Manitoba’s health system.
You told me that the program is offered only in English. Couldn’t Saint-Boniface University consider creating such a program to facilitate requalification? Currently, I think the program is intended only for doctors. However, has anyone considered going in this direction to offer it on Saint-Boniface’s francophone side, for example?
Ms. de Moissac: As far as I know, it hasn’t been considered, and that’s for several reasons. First of all, medical training isn’t offered at Saint-Boniface University. One has to go to the University of Manitoba to get it. Our young people who want French-language training go to Ottawa University. At Saint-Boniface University, available professional programs include nursing and social work. That means training would probably be limited to those two programs. Also, we don’t have the staff available to launch a new program. However, the opportunity is there in both of those fields.
Senator Moncion: As far as nurses are concerned, you have a program specifically for them. That would be something to look into, because there are also situations where nurses come from other countries and they want to be able to work in Canada, but they have to redo their entire program. Not just one requalification year, but the entire program. So, many choose not to redo the program and go into other fields instead.
I understand that the resource issue is real and that there is a lack of professorial staff, which means the program can’t be launched, but it would be a great solution.
Ms. de Moissac: It would indeed be a great solution.
Senator Moncion: Thank you. You talked about the bilingual staff shortage, but you also talked about bilingualism being associated with overwork. I find that interesting and I’d like to hear more from you about the extra workload associated with the fact that people have more work because they are bilingual.
Ms. de Moissac: They have more work than the rest. A nurse has six patients, her colleague has a patient who is francophone and needs care in French, so that nurse will help because that’s their colleague. When it happens often, it becomes a problem because she already has her own workload and has to take on care for one more patient. It’s a type of overwork.
Another type of overwork would be, for example, conducting an interview with a francophone patient using an English‑language form. Simultaneous translation is needed. They’re not necessarily trained to do that. It takes time to word the questions in the right language, and then reformulate what the patient said into English and correctly document everything, so that everyone is aware of what happened.
There’s a lot going on in that reply, but it takes a lot more time and energy and people aren’t necessarily trained to do it. That’s why professionals consider it overwork.
Senator Moncion: Thank you very much, that’s very interesting. My next question is for Ms. Harrison.
You talked about nurses being forced to work overtime; is that still the case today? Have any short or medium-term solutions been considered to re-establish a certain balance in the system?
Ms. Harrison: Yes, it’s still happening, and Linda Silas was talking about it, in fact.
I have a son who’s been a nurse for less than two years and he said it’s not even a matter of deciding whether he wants to work overtime, he has to do it. Nurses are required not to abandon their patients.
In collective agreements, even if it can potentially create an environment of fatigue, it’s very rare not to ask a nurse to stay for four more hours, to do one more shift, to keep going. In New Brunswick, we already tried the temporary solutions Linda Silas spoke of, but it just puts a bandage on a gaping wound. Nursing agencies created a whole host of inequities when it comes to salary and workload.
In New Brunswick, we are in fact looking for solutions, but it leads to other problems, specifically depending too much on people who aren’t regulated, such as those who offer personal care, known as “personal support workers” in English. This leads to triads with nurses, the nursing assistant, the orderly and even the care aide. Since the nurse is at the top of the pyramid, she has to delegate a great deal, but ultimately, she is still responsible. Even if the solution is to reduce nurses’ overtime hours, it leads to other difficult issues.
If I may, regarding the training of health professionals coming from outside New Brunswick — it’s probably because we’re a bilingual province — but we worked very hard to quickly assess skills among those who come from elsewhere. We are setting up training systems and modules. In fact, a few weeks ago, I asked the Nursing School if it wanted to offer online training modules for people from different African countries that could also help people in Manitoba.
Senator Moncion: Thank you. I will have questions in the second round.
Senator Mégie: You talked about overtime. I was wondering if this is all the province’s initiative, because normally, the issue falls under the provincial government’s jurisdiction. You said it was included in the different points you made, about what the federal government should do. That was part of it, and one point encouraged the federal government to give more funding. I think there should be more funding, but it should always be done in collaboration with your province. Was it your province that took the initiative to regulate overtime and new courses?
Ms. Harrison: Is that question for me?
Senator Mégie: Yes, the question is for you, Ms. Harrison.
Ms. Harrison: That was Linda Silas’s wish, the President of the Canadian Federation of Nurses Unions. That does not mean it has happened yet, but it’s what every union wants, since it does indeed have an impact on professional burnout.
On the federal level, I think improving the profession’s image is what’s needed. It’s one thing to train a lot of nurses, but once they’re in care sectors, do they stay? There needs to be retention efforts, both for my students in the degree program and for working nurses. Better systems need to be created to reduce overtime or enhance the profession.
I really like the bilingualism bonus. I’ve been a nurse for a long time, since 1990, and already had that problem. I worked at Moncton Hospital and I got the impression that I was the only bilingual nurse in the building. Today, 34 years later, that hasn’t changed.
Senator Mégie: My question is for both of our witnesses. Have any initiatives been undertaken to track health workers willing to declare that they are bilingual? Ms. de Moissac, you said that some, in fact, don’t want to declare that they are bilingual because of the burden that represents for them. Are there other ways for the province and health services to track them, to see what resources they have available?
Ms. de Moissac: It depends on the profession. Some colleges or professional bodies do track their members according to their language. For example, pharmacists do it. As a member of the general public, I can go online and find out who the bilingual professionals are. It’s not the same, it’s not regulated. It’s really up to that body’s choice, they decide.
Senator Mégie: It’s the professional body’s choice. How is it on your side, Ms. Harrison?
Ms. Harrison: Coming from a bilingual province, when I talked about puzzle pieces, there’s the Société santé et mieux‑être en français du Nouveau-Brunswick. My colleague also talked about the importance of networks throughout Canada.
We worked very hard on active offer, specifically with our degree program. At Moncton University, the only large-scale francophone university east of Quebec that offers a nursing degree, all our students are bilingual by the end of the degree. I can’t necessarily say the same thing for my colleagues at the University of New Brunswick or elsewhere. We were trained to offer a service in both languages.
However, there is no list. You can’t go on the nursing association’s website and see “Suzanne Harrison, bilingual,” or “Gabrielle Savoie, bilingual,” but we do put it directly on our badges.
Senator Mégie: Thank you very much.
Senator Aucoin: Thank you very much for being here. You mentioned the challenge of people not declaring that they are bilingual because of an overload of work. You have explained it well, and we understand the situation. Among the solutions, you mentioned that the federal government could support initiatives with a bilingualism bonus scholarship. I believe that all of these solutions are under provincial jurisdiction, right?
What could the federal government’s role be, and how could it support the provinces other than through funding? If funding is given to the provinces with no strings attached, will it produce results?
Ms. de Moissac: I don’t know to what extent transfers are made between the federal and provincial governments. I think that when it comes to official languages, it is a Canadian obligation that must be respected throughout the provinces. A fair amount of work has been done to promote official languages.
My idea was that, in order to ensure the maintenance of official languages across Canada, the federal government could provide grants and ensure that funds were directed to initiatives and strategies that would make that possible.
Senator Aucoin: Are you referring to a national strategy that could be developed in accordance with the Official Languages Act, sections 41 and 42, for example, which contain certain measures that the government or elected officials can take?
Ms. de Moissac: In my opinion, it would be a national strategy, because there are francophones everywhere. In some provinces, like Manitoba, we’re fortunate to have some social capital and infrastructure. We’re all together, but in the western provinces, like Saskatchewan and Alberta, francophones are widely scattered. That’s not to say there aren’t a lot of them—there are probably more than there are here—but they don’t have the support we’ve had for many years. I think this should apply to all provinces and territories.
Senator Aucoin: You mentioned missing pieces. I think you wanted to talk more about that, but you ran out of time. What were the missing pieces you wanted to talk about?
Ms. Harrison: I agree with my colleague on the idea of a national plan. Gabriel Cormier, my vice-president of administration and human resources, appeared before you and said that this doesn’t require specific items. I was able to use funds from the Official Languages in Education Program, or OLEP, to develop a qualifying year program and get my students into my program more quickly. We’ve received money from the OLEP to conduct NCLEX exams to help our students by offering them resources; these are things we share with the federal government, but it’s very ad hoc. A more continuous investment would be a piece of the puzzle that we wouldn’t always be losing.
As for the other pieces of the puzzle, I agree with Dr. Prud’homme that we should explore whether an entrance exam is really necessary for the programs. We did touch on the NCLEX issue, even though I know that you already talked about it. Even when it comes to tuition, I’m thinking of more initiatives and faculty succession. I’m really concerned, because they say 54% of professors for bachelor’s degree programs are currently over the age of 50, including me. There’s a major shortage coming. If there is no one to teach nurses, how are they going to provide services in French? I think the federal government could play a role by providing more funding to the Consortium national de formation en santé, or CNFS, to grant more funds to various programs and partner universities to free up colleagues to go to school. That would be my gem, something I’d like you to keep in mind.
I think there are some really interesting initiatives, and we could work together to share our resources when we talk about the entrance exam or new educational strategies. At the national level, there really is a structure in place, like the CNFS and the Société Santé en français. I was a long-time member of the New Brunswick training and research network. There are systems in place, but they must be better funded so that they can train professionals who can provide these services in the minority official language.
The Chair: Ms. de Moissac, I’m quite troubled by the fact that bilingual professionals don’t want to declare that they are bilingual. This leads me to two questions I’d like to ask you. My colleagues have already expressed the need for a national network, a network of bilingual professionals that would allow them to identify with each other and express their needs. Is this an initiative that the federal government could, and should, support to try to bring bilingual professionals together?
How could the federal government help with this? Are there any challenges in terms of the data available to these professionals? We can’t paint a clear picture based on data we don’t have. My question is for both witnesses. Is there enough data to identify bilingual professionals and work with them directly to recognize their profession?
Ms. de Moissac: Santé en français has already done some work to try to recognize bilingual professionals. I don’t know if you’re familiar with the OZi portal. It’s a new system in place in Ontario and Manitoba to list these bilingual professionals. I think it’s mainly for people in positions that are designated bilingual. It doesn’t include all bilingual professionals because they’re not all in designated positions.
There is certainly a lack of information. Santé en français in Manitoba tried to create an inventory where people could self‑identify as bilingual professionals. It didn’t work very well, because people don’t want to share that they’re bilingual. It needs to come from somewhere else, and it needs to be associated with people’s language skills, because if they don’t feel confident in their language, they won’t identify themselves as bilingual. If these professionals think that they’re going to be intimidated because they’ve said they’re bilingual and it wasn’t accepted by the other person, they won’t want to advertise this. It’s a question of linguistic security and the recognition of what self-identifying as bilingual can bring. Right now, there’s nothing more than saying you’re a proud francophone, but that’s as far as it goes in the workplace, unfortunately.
Ms. Harrison: We have to start with basic training programs. We talk about active offer, we encourage them, the Société Santé en français will say, “Wow, I received money to talk about them, but the Franco Doc project offers English-language training programs, and we go and do activities with them in French.” There’s Café de Paris for health care professionals who want to enrich their French in a safe environment.
With the CNFS, there would be initiatives and tools that would encourage basic training programs to tell them that it’s important. You have a responsibility to offer these services, and here is the impact if they’re not offered. There are great tool kits. People just need to use them.
The Chair: The Action Plan for Official Languages 2023–2028 includes funding for the following:
$6.5 million over four years to support the training and integration of new, bilingual health personnel, in collaboration with post-secondary institutions, by increasing the number of bilingual enrolments and bilingual graduates in nursing and personal care, and by offering integration grants to English-speaking health graduates —
Your scholarship project comes to mind.
— in order to provide these communities with better access to health services in the official language of their choice.
Do you think these investments are sufficient?
Is there a case for the federal government to further target its support? It’s an ecosystem, in fact, and what we understand from your comments is that it affects the entire health care ecosystem, not only physicians.
Would it be appropriate, in terms of priorities for the federal government… In your opinion, which of the priorities you’ve outlined should be the federal government’s priorities? Ms. de Moissac, you talked about the different origins of bilingual professionals, those who come from immersion or from other countries. Is there any way to identify key priorities that would allow the federal government to act more incisively on health care needs?
Ms. de Moissac: Apart from what I’ve already mentioned, a more effective way of achieving this would be to target certain professions, those working closest to people, working in the field, such as nurses and caregivers. Our official language minority communities (OLMCs) include many French-speaking seniors. We need to identify the needs. We need to target those professions first and then build on that.
Ms. Harrison: I would add — and this is because I’m nearing retirement and someone has to replace me — that there’s a need to recruit new faculty, because if you don’t have anyone to teach… Student recruitment is going well, but we need teachers. We have to think about retention. The Consortium national de formation en santé (CNFS) has invested considerable money in recruitment, but when we send them to work in hospitals, 18–20% of new nurses leave before the end of their first year. This is truly important; the Canadian Association of Schools of Nursing (CASN) has created a new residency program for new nurses. I think we’re missing the boat. The loss of every student at the undergraduate level grieves me, because I tell myself that was a future nurse. The nursing community needs to do the same thing: For every new nurse who leaves before retirement, something must also be done.
I would also encourage ethical recruitment. I mentioned that the University of New Brunswick was offering a dual degree with Manipal. That’s a very good idea, because they offer a bachelor’s degree there that helps India and helps a small number of students who come to us. I look forward to seeing if we can do that in New Brunswick. It will require additional funds and I’m not sure our province has those funds.
Those would be my three wishes, my three pieces of the puzzle.
The Chair: Thank you very much.
Senator Moncion: My question is for both witnesses. Have any recent successes in your respective programs or educational institutions had a positive impact on the services offered in your communities?
Ms. de Moissac: Let me tell you about a new psychology program we’re setting up; a clinical psychology program.
Our community has a tremendous need for this; there are many mental health challenges in schools, but also across the board. There is considerable interest, young people are diving in headfirst and they’re highly committed to it. I think it’s been quite a journey. The fact that we’ve had professional programs in nursing and social work shows that at Université de Saint‑Boniface we’re in a position to offer professional programs in French that already meet a need in the community. It allows us to build on our numbers. I think it’s a success story.
Senator Moncion: What about you, Ms. Harrison?
Ms. Harrison: Our nurse practitioner program celebrates its 20th anniversary in a few days. At first, for a long time, we only had two or three nurse-practitioner graduates per year, and now we have between 14 and 16 students graduating per year, and they have an incredible success rate on the national registration exam. Almost all of these nurses remain in the province, and many of them work in rural areas, where health needs are tremendous, because the population is aging and people in rural New Brunswick are much more francophone. This is one of our great success stories.
Senator Moncion: Thank you. I’m glad to hear that, because I know that nurse practitioners are increasingly valuable and sought after, precisely to serve in communities that are sometimes smaller, where they are able to offer services and physicians are not always available to do so.
This brings me back to your new clinical psychology program. I know that in the wake of the pandemic, we always talked about post-traumatic stress disorder, but now we’re experiencing postpandemic stress disorder, which has gained significant proportions. My question is for both of you: To what extent have you seen changes in enrolment in health care programs at your educational institution?
Ms. de Moissac: I think it’s remained steady in terms of enrolment, but I’ve found, in researching the mental health of young people at my university in particular and at the Université de Moncton, that mental health has taken a nasty toll on these young people and they’re having a hard time coping. They have trouble getting help. It’s hard for them to call and make an appointment. That’s really the bottom line, and we need a lot more health services in postsecondary settings to support these students and show them how to manage their mental health well in the future. This goes back to what Suzanne was saying. Retention in the workplace is difficult for young people, because they don’t necessarily have the right tools to manage stress and anxiety in the workplace. I think there’s much work to be done in that regard.
Ms. Harrison: I completely agree about the importance of providing services; we do good work, but even psychologists are in short supply. It’s hard for our students to access services, but sometimes there are peer services or different ways of going about it. I totally agree, it’s a harder cohort to teach; the attendance rate for classes has dropped. People aren’t as connected as they used to be. In our profession, we have to be connected and relate to others, so it’s not easy.
In our early years of practice, it’s very difficult to form supportive relationships with people. When you can’t help yourself, it’s hard to help others. We’re aware of this situation, we’re working a lot on the concept of resilience, and we’re providing training in this area. I’m much more positive — it’s my blood type, which is B-positive. We try to work on building resilience and coping strategies; instead of talking about stress or exhaustion, we try to empower them to be more engaged.
Senator Aucoin: Thank you. Following up on the discussion with Senator Moncion, am I wrong to suggest that the COVID-19 phenomenon has only accelerated or exacerbated the process? Or does the fact that the new generation hasn’t necessarily developed the tools we had make these young people even more vulnerable? That would be my first question, because I find it hard to believe that so many young people have these needs. I don’t know if you want to comment on that; I have another question afterwards.
Ms. de Moissac: It’s curious, because I’ve been studying young people’s mental health since 2012, and then in 2018, 2020 and 2022. I found a decline in mental health between 2012 and 2018.
We were already seeing a negative trend in health long before the pandemic if I can put it that way. The pandemic was a good experience for some, but for most, I’d say it brought them down to a lower level and they’re struggling to get back on track. The 2022 data shows that we’re back to 2018 levels. We’ll get through it, certainly, but it will take time.
Ms. Harrison: The pandemic exacerbated the shortage. Some nurses nearing retirement might have carried on, but when you look at the statistics, many decided to leave the profession before the situation became more complicated. One of my A+ students, who may have had a little too much wine at the graduation banquet, said to me, “Suzanne, at first I was stressed, but now I’m on medication and I’m able to work.” I thought to myself: “Poor thing, you need medication to do your job as a nurse.” Unfortunately, that’s also the reality.
Senator Aucoin: Thank you. With all that we’ve discussed and the solutions you’ve provided, would it be appropriate for the federal government to amend the Canada Health Act to include minority communities, as was done with Indigenous funding? Wouldn’t this require the federal government to give more money to the health network, universities and provinces, to create scholarships and take other steps? What do you think?
Ms. de Moissac: Indeed, a number of studies show that francophones in minority situations are in poorer health than anglophones in the same province. There would certainly be a case for identifying us as another vulnerable population. Access to care in one’s own language is a big problem. One in five people will not seek health care if it’s not available in their language. It’s a key issue that affects a significant proportion of the population, in my opinion. It would be an interesting approach to take.
Ms. Harrison: I think so too, and immediately thought of Barbara Losier. Perhaps you know her? She’s heavily involved in the health of French-speaking minority communities. She would agree that there are many opportunities to involve the community in research projects to find solutions. They are the experts who know their own needs and can work on that aspect. I’d also encourage you to think about community experts, who sometimes know a great deal more than researchers or pedagogues.
Senator Aucoin: Thank you.
The Chair: On April 17, 2023, Minister Duclos put forward solutions. He mentioned three areas: immigration, training and recognizing foreign credentials.
As to immigration in the francophone immigration policy, the FCFA had suggested setting up an accelerated gateway to enable professionals from other countries to come to Canada. What do you think of this idea, and should the federal government review its policy in this regard?
Since there are people coming from out of country, francophones coming from several regions, is the issue of being culturally appropriate and adapted taken into account, both in terms of training and service delivery?
With regard to the recognition of foreign credentials, do you have any potential solutions or findings regarding the barriers imposed by professional bodies that prevent professionals who could be practising from doing so?
Who would like to begin answering on these three areas?
Ms. Harrison: I’ll begin with training, because that’s what I do all day long.
Cultural safety, culturally appropriate care, what’s outlined in item 24 of the Truth and Reconciliation Commission of Canada: Calls to Action report, these are things our people are asking us to do. We have to prove that this is part of our university culture. It’s a big concern, and the democratic profile of our students has changed a lot. It’s quite different from what it used to be.
With regard to foreign credentials, Rector Prud’homme spoke about this and I also think it’s important. I don’t think it’s the same in the English-speaking world. Nurses from the Philippines or India can easily come and work in New Brunswick. It’s not the same for nurses from Haiti or African countries. That’s why we’re quite keen to work with Morocco and Côte d’Ivoire to offer upgrade courses, so that when a nurse wants to come to New Brunswick or elsewhere, she can have access to these courses.
Often, in African countries, some of the training is more specialized. There’s a nurse anesthetist, a nurse midwife. They’re not general practices, whereas in New Brunswick and Canada, a general bachelor’s degree is required. Training institutions have a major role to play in upgrading skills. Yes, our professional association is sometimes a little less avant-garde than it could be, but it’s always a question of safety, and their role is to ensure public safety. They don’t want to allow people to have a work permit if they don’t have the required skills. There is a desire to make the process swifter and more efficient.
As for immigration, I’d like my colleague from Manitoba to add her own comments. We work hard and we have to welcome people and help them get into programs. I often have doctors starting a bachelor’s degree in nursing who are unhappy, but that’s the reality.
The Chair: Thank you.
Ms. de Moissac: I fully agree with what Suzanne is saying. New Brunswick is a bilingual province and Manitoba isn’t. You have to have excellent knowledge of English to work in health care. It’s a must. It has to start there. Language training could be done remotely, before the individual arrives in Canada, and that should be a priority. That’s key: learn the language first, and then get your skills recognized. Getting recertified only happens later, because everything after that happens in English. Learning English has to be the priority.
The Chair: Thank you.
Ms. Harrison, Ms. de Moissac, thank you very much for being with us today. You’ve provided the committee with a lot of information. I think it’ll be useful for our report. I want to thank you for all the work you do to improve Canadians’ access to health care in the official language of their choice. Thank you very much for your contribution.
We now welcome in person Dr. Bernard Leduc, previous President and Chief Executive Officer, Montfort Hospital, and Didier Pilon, French Language Services Lead, Health Sciences North, in the Sudbury area. By video conference, we have Antoine Cantin-Brault, Chair of the Board of Directors, Centre de santé de Saint-Boniface.
Good evening and thank you for accepting our invitation. Let’s start with your opening remarks.
Dr. Bernard Leduc, Previous President and Chief Executive Officer, Montfort Hospital: Thank you for the invitation to testify today. This subject is particularly close to my heart, as I was head of Hôpital Montfort, the only francophone teaching hospital west of Quebec, from 2010 to 2023.
The human resources crisis in health is a perfect storm, unfortunately entirely predictable. I’ll quickly give you some numbers.
In 2009, the Canadian Nurses Association published a report predicting a shortage of 60,000 registered nurses by 2022. A study published in 2018 estimated this number at 117,600 in 2030. That was prior to the pandemic, so you can imagine the scope of the problem. We note a considerable decline in human resources as compared with service-related needs.
The ratio of nurses per 1,000 seniors fell from 59 in 2013 to 52 today. A similar decline was observed among family physicians and specialists.
We saw historical vacancy rates in 2022-23 between 18% and 25%, depending on the profession, and those vacancy rates are equivalent to 13,000 full-time positions. The sick leave rate increased to 17% in 2021-22, compared to an average of 3% over the previous five years.
Previous witnesses have mentioned that. According to a study by the Registered Nurses’ Association of Ontario, a very worrying fact in Ontario is that 13% of nurses aged 20 to 35 are considering leaving the profession. If we lose a significant portion of that population aged 20 to 35, I don’t know what the future will hold.
We’re also living through a primary care crisis, with over 4.7 million Canadians without access to a family doctor. Interest in the profession has dropped significantly in recent years for a number of reasons that I won’t belabour. The results for the last residency program match, in 2024, show that 91 out of 528 positions in family medicine went unfilled at the end of the first round. After the second round, 75 of the 87 vacant positions were in family medicine, or 86% of vacancies.
A number of studies have demonstrated the negative impact of linguistic discordance on complications, length of hospital stay, number of medications and tests and extended hospital stays, all of which entail increased costs.
According to Statistics Canada, outside Quebec and New Brunswick, only 1 in 10 workers knows French. This means that, when we try to recruit, our recruitment pool is extremely limited. Our pool is just 10% of that of all the other hospitals that don’t need to worry about minority language services. If recruiting is difficult for Montfort, I can’t imagine how impossible it is for smaller, more remote organizations to recruit French-speaking staff.
In the absence of a national federal policy, whereby 100% of Canadians would be fully bilingual, here are a few recommendations to try to address the problem.
We talked about training, so it’s about not only supporting, but also really improving French-language training at post-secondary institutions providing employee health care programs. We talked about the Consortium national de formation en santé, which you’re familiar with. It’s not enough to maintain it. Rather, in my opinion, its services have to be improved.
The federal government could take immediate action on immigration. Since the aim is to increase francophone immigration, newcomers should represent an increasingly larger percentage to change the demographic weight of francophones in Canada. We need to focus on that and prioritize health care workers, as well as working with the provinces and professional associations to shorten prior learning assessment and certification processes.
We also need to work with organizations. I know of one, Talent Beyond Boundaries, but there may be others. Relying on immigration poses an ethical dilemma, since we’re looking for health care workers in places where they probably need them just as much. Talent Beyond Boundaries is an organization working with people who are already displaced and are in refugee camps. As you can imagine, there are all kinds of people, from all professions, in those camps. If we could create an inventory of their skills, match them with employers and facilitate their immigration, we’d also be resolving a humanitarian problem and killing two birds with one stone.
Third, capturing the language variable is absolutely essential to service planning, be it for health care workers, patients or anyone who has access to the health care system. Canada should draw inspiration from Ontario, which, in 2009, adopted an inclusive definition of a francophone as a person whose mother tongue is French, or whose mother tongue is neither French nor English, but who has a good knowledge of one official language and uses it at home. Someone whose mother tongue is Somalian but speaks French would, under this inclusive definition, be considered a francophone. It is therefore essential to work with the provinces to have data on the language variable collected as part of the health card issuance process, so that the Canadian Institute for Health Information captures the language variable in its analyses.
Fourth, Canada is a key player in health care research funding. In a country with two official languages, it is inconceivable that funding should be granted for research that does not require the collection of language variable data, in the same way as the collection of gender data, which has been mandatory for several years now. At present, with the introduction of virtual care, it is essential to develop and deploy a pan-Canadian virtual care program for official language minority communities.
Thank you for your attention. I look forward to answering your questions.
The Chair: Thank you, Dr. Leduc. Mr. Pilon, the floor is yours.
Didier Pilon, French Language Services Lead, Health Sciences North: Mr. Chair, honourable senators, it’s truly an honour to be here today to testify before the committee. Today’s linguistic perspective is very important. The role of the federal government is undeniable.
My name is Didier Pilon, and I am the French Language Services Lead at Health Sciences North. We are the second‑largest hospital designated under Ontario’s French Language Services Act and the largest fully designated hospital. As regional hospital for northeastern Ontario, we provide care to over 122,000 francophones.
According to the most recent data available to me, Health Sciences North, or HSN, as we call it, has 4,274 employees, including 1,477 employees who identify as francophone. That’s approximately 34% of our staff. We have 1,513 designated positions, which equals approximately 35% of all our positions, in a geographic region where the demographic weight of francophones is only around 23%. Approximately 26% of our doctors, or 127 out of 494, are able to provide services in French. Although that’s higher than the demographic weight of francophones, we continue to aim for 30% in order to better serve the community.
Despite our efforts, shortages in a number of care units and specific specialties remain. Approximately 400 of our designated positions are currently filled by employees who don’t meet the language requirements for the position. When we talk about recruitment, particularly francophone recruitment, there are a number of issues needing to be addressed. We can certainly look at the aging of the population in northeastern Ontario, where approximately 30% of the population over the age of 65 is francophone, but only 16% of the population between the ages of 25 and 35 is francophone.
Like Dr. Leduc, we can talk about immigration and how difficult it is for people to have their prior learning recognized, as well as the fact that not all newcomers will be able to work in an environment where the working language is English, once their skills have been recognized. That subject, however, is a little outside my expertise as French Language Services Lead for Health Sciences North.
What I wanted to emphasize instead is that being a designated health care provider in Ontario reflects the commitment of facilities to meet the linguistic needs of their community. It’s a completely voluntary process, as you know. At Health Sciences North, this designation wouldn’t have been possible without the leadership of Denis Roy and Dominic Giroux, our former CEOs, who launched and strengthened the designation over the past 10 years, or without the continued support of our new CEO, David McNeil, who ensures that we continue to improve those services. It is also essential to recognize that the very existence of French‑language services at HSN is the result of the efforts of hundreds or even thousands of employees who, over the past 10 years, have implemented our labour standards and provided care in both official languages.
Undertaking a designation means accepting additional responsibilities and costs, without any corresponding funding. This translates into organizational and individual challenges. When it comes to the organization, our commitment means putting in place policies, procedures, training and resources to ensure that the linguistic rights of our francophone patients and families are respected.
To that end, we also created the position of French language services lead — my position — to coordinate, supervise and sometimes even create the resources to ensure the provision of French-language services. These efforts have associated costs. On an individual level, employees in designated positions are required to have additional skills and take on additional responsibilities. Let’s take the example of a French-speaking nurse. Not only must they master French and English to communicate with patients, families and so forth, but they must also be able to provide support to their unilingual colleagues. They often find themselves assigned to beds that are farther away, and they have to facilitate conversations with doctors or teams of associated health care professionals, including physiotherapists, speech therapists and social workers. Consequently, these positions are very difficult to fill from a bilingual perspective, since these people often work alone or in very small teams. What’s more, these nurses may face additional restrictions. For example, if they wish to trade a shift with a colleague, they must ensure that French-language services are adequately covered in their absence.
Despite those challenges, many employees accept these responsibilities with pride, recognizing the importance of providing quality services to the francophone community. However, their compensation does not reflect that extra work. In short, if we really want to counter recruitment difficulties, the lack of financial incentives certainly has to be considered. It would appear that an ongoing commitment on the part of the federal government, in consultation with provincial and territorial governments and health care institutions, is required to put in place incentives and supportive policies to attract and retain health care professionals in institutions serving official language minority communities.
Thank you.
The Chair: Thank you, Mr. Pilon, for those opening remarks. Mr. Antoine Cantin-Brault, the floor is yours.
Antoine Cantin-Brault, Chair of the Board of Directors, Centre de santé de Saint-Boniface: Thank you.
Members of the Standing Senate Committee on Official Languages, first, I would like to thank you for giving me the opportunity to address the committee today. I sincerely commend your willingness to discuss the shortage of health professionals in facilities serving official language minority communities with a view to identifying lasting solutions.
My name is Antoine Cantin-Brault, and I am a full professor of philosophy at the Université de Saint-Boniface. I will be echoing some of what was said by my colleague whom you heard from earlier, Danielle de Moissac. I am appearing before you today as the Chair of the Board of Directors of the Centre de santé de Saint-Boniface, which is very close to downtown Winnipeg.
The Centre de santé Saint-Boniface opened in 1999 thanks to three founding members, namely, the Réseau Compassion Network, the Université de Saint-Boniface and the Société de la francophonie manitobaine. It is a primary health care facility with a mandate to deliver services to the French-speaking population of Winnipeg and surrounding areas, namely, St. Boniface and St. Vital residents. The centre is therefore officially designated francophone, but because the St. Boniface and St. Vital population is partially anglophone, we are required to deliver our services in both official languages.
For the past few years, our clientele has stabilized at 70% francophone and 30% anglophone.
It’s no secret that there’s a general shortage of health care professionals and that it has gotten worse since the pandemic. For those of us in a minority setting, the problem is even more acute. The centre is no larger than other primary care facilities in Winnipeg: We have a dozen family physicians, eight nurse practitioners, 10 primary care nurses and several other community health professionals, such as a psychologist, a social worker, a pharmacist, and so on. We also have a management team and a team of administrative assistants, for a total of about 80 employees.
The centre’s catchment extends beyond Winnipeg’s boundaries, and its mission makes its importance hard to quantify. The staffing shortage is having a major impact in many ways. We have recruitment issues across the board, but they’re most pronounced in four areas in particular.
The first is access to a French-speaking family physician. Our team of doctors is overwhelmed, so it’s getting harder and harder for our patients to get timely access to their physician. More doctors wouldn’t hurt.
Second, it’s very difficult to operate our walk-in clinic properly. According to our operating model, our walk-in clinic has to be staffed by nurse practitioners. We haven’t been able to fill the positions required to operate the walk-in clinic, so we have to close it a few days a week. Our walk-in clinic plays an important role in our centre.
Third, demand for psychological care has increased significantly, so we need to expand our offering.
In Manitoba, it’s very hard to find clinical psychologists or any mental health professionals who speak French.
Lastly, we have trouble finding administrative assistants who can perform well in the health care environment. This has a direct impact on how clients are received at the centre and on how their care is managed.
We’ve already taken several steps and are doing what we can to recruit people. The centre is very important, of course, but it’s not huge.
To address some of these difficulties, we’re hoping for systemic solutions that are broader in scope than the centre’s mission.
None of these solutions are novel, but it’s important to name them. I’ll go through the solutions we think are very important.
The first is education and training. We need more French-speaking health care professionals to be trained in Manitoba and in Canada in general. Many of the recruitment problems we face could be solved with additional support for the Université de Saint-Boniface, Western Canada’s only French-language university. There are francophone campuses in Western Canada, but ours is the only francophone university.
As my colleague said, we don’t have a medicine program, but we do have psychology and nursing programs; we also have professional studies programs that train administrative assistants to work in health care.
It might make sense to facilitate all of these things nationally, especially physician training, and to allow greater mobility within Canada so people can be trained elsewhere and then come back to Manitoba.
The second is credential recognition. This has been discussed. I know it’s nothing new. Obviously, Manitoba’s French-speaking population is becoming more and more diverse. That’s obviously because we have a growing number of immigrants here, which is a very good thing for diversity. Some of these immigrants have health care training and were working in the field before coming to Canada.
For one thing, we must make it easier for these people to get up to speed so they can get back to work in health care. What our centre needs most is nurses. For another, we need to check with professional associations to see if their requirements, which may be overly stringent, are depriving us of a valuable workforce.
Third is promoting and recognizing the use of French in health care. We know that many French-speaking individuals who received health care training in Manitoba do not work in designated bilingual or francophone positions. I know that about 60% of designated bilingual in Winnipeg positions are filled, so that means 40% of those positions are vacant.
The Chair: Please wrap up, sir.
Mr. Cantin-Brault: Sorry, I was done.
The Chair: Okay. You can say more during questions and answers.
Thank you for your testimony. We’ll move on to questions, and I’ll give the floor to the vice-chair, Senator Poirier.
Senator Poirier: I want to thank the three of you for being with us this evening. My question is for all three witnesses.
Dr. Leduc, in your opening remarks, you said that not only are there not enough people to fill all the positions, but also many people are leaving or will soon be leaving the profession. It wasn’t clear if their departure is due to age or other reasons.
Aside from recruitment and staffing, are there any other challenges you’re facing? How might the federal government help overcome these challenges?
Something happened last week that really made me aware of the situation. I’m from New Brunswick, where the population is between 30% and 33% francophone. Something happened to me last week, and I had the opportunity to speak with people working in the field. They told me that one of the big problems is that there are more vacancies every year than there are graduates to fill those positions. So, there’s a real challenge there. For example, there’s a clinic that’s open from 8 a.m. to noon, but they have to close it at 9 a.m., because there’s only one person on and the waiting room is full; they know they can’t take any more patients.
Some days, they can’t offer X-ray appointments because they have no staff and the staff they do have need to be available for emergencies.
What I asked them, and what I’m asking you, is this: Is there any recruitment going on in schools to encourage young people to pursue their studies in health care? The people I talked to couldn’t answer because that’s not the level [Technical difficulty—Editor] working on it, but they did say that they know the population is still growing, but for other reasons, whereas for those of us in a minority community, it’s still shrinking.
One of the witnesses who appeared by video conference also pointed out that things have gotten worse since COVID.
Can someone tell me about other challenges you’re facing? How might the federal government help you?
Dr. Leduc: That’s a very complex question. I’ll try to untangle it.
This was all foreseeable, but the pandemic threw everything out of whack. After 30 years of poor public policy and planning, we saw it coming. My hope is that we won’t have another 30 years of bad public policy and health care planning.
In the late 1980s, people were sent into retirement; in the 1990s, there were fewer admissions, because we had enough doctors. The people in charge failed to consider a number of things, such as the fact that the new generation would never want to work as hard as the older generation — and rightly so.
An old doctor retiring today had 2,000 to 3,000 patients. New doctors only want to take on 800 to 1,000. That means it takes two or even three doctors to replace one doctor.
This was all predictable. Multiple reports sounded the alarm. Recommendations were not followed. You’re right, there’s a mismatch between the needs of the population and the number of people admitted to programs.
Now, we’ve got some catching up to do, because the pandemic collapsed the house of cards. We were heading straight for a wall; the pandemic just brought it closer, and we crashed right into it. We need to make up ground.
The Montfort Hospital has some initiatives. One is the FOCUS program, which sparks high schoolers’ interest by bringing them to the hospital to spend some time with health care workers. The University of Ottawa’s Faculty of Medicine has a Mini Medical School, which offers courses to raise awareness and familiarize students with the field. However, there’s still a lot of work to be done in this regard.
Mr. Pilon: I’ll speak to working with post-secondary institutions in the regions. We definitely do this. We work with Collège Boréal and Laurentian University. There are a lot of internships. We’re also working with the newly created Northern Ontario School of Medicine University, of course.
Getting back to my central point, the challenge is that many francophones no longer want to work in French. These people are clearly francophones, but during the hiring process, they don’t present themselves as francophones, and they lack confidence in their language skills. Even if they’re trained at Collège Boréal and then at HSN five years later, they’re not necessarily capable of serving people in French. Since doing so requires more work with no incentive, it’s not always to their advantage to do so.
Mr. Cantin-Brault: I agree. We don’t have a problem with opening hours. We don’t have to cut jobs, except in the walk-in clinic. Our centre is always at max capacity. We actually need a second site. The main problem is the lack of appreciation and funding for French-language health care. We’re practically penalized for working in French in a French-speaking community, because we have to do more work and our resources are stretched. That’s why a lot of people don’t disclose that they’re francophone. As Dr. Leduc mentioned, we’re going to come face to face with a number of problems in the near future. French-speaking doctors will soon be retiring, and we’ll probably have to take over their roster, and that’s going to hit us hard.
Senator Poirier: Could new technologies help bridge the gap until we catch up? Have you used these new technologies to connect with people via video conferencing or a site that does translation? Are your institutions doing this now?
Dr. Leduc: Regarding translation, the pandemic accelerated the adoption of new technologies and virtual care. Previously, people were talking about it, and the platforms existed, but the funding wasn’t there. Out of necessity and urgency, people turned to virtual care, and it’ll be tough to turn back the clock and withdraw those services altogether.
The question now is whether funding will be maintained. I said earlier that the provinces have a role to play. Does the federal government have a role to play in setting up a pan‑Canadian virtual care network to support people in minority language communities? At the end of the day, there are only so many people available to do the job. It all depends on what gets support and how people are encouraged to move in the right direction. The technology exists. Remuneration is a big part of the problem. For example, professionals are paid on a fee‑for‑service basis; they’re not salaried. So, for example, if I’m not paid to do a certain task, even if it’s for the good of the public and society, I won’t do it, because I’m not paid to do it. This area isn’t under federal jurisdiction, but it’s important to look at changing the way professionals practise so they can deliver care with the technology that exists in 2024.
Mr. Pilon: For a while during the pandemic, there was an online emergency clinic. This project was led by a French‑speaking physician at Health Sciences North. The service was available in both languages, and I used it myself.
Where technology also comes into play is with interpretation services. We have access to video conferencing interpretation services, but it’s not my preferred way to deliver care in French. It’s great if, for example, we have a tourist who speaks only Dutch, since we’re not obligated to serve them in that language. When it comes to delivering care in French, I’m concerned that something could be lost in the interaction with health care professionals to the extent that the connection is mediated by technology. People who speak to their health care professionals face to face feel more comfortable asking questions and end up understanding their care plan better and getting better results.
Yes, these tools are useful, but they’re last-resort solutions, and I wouldn’t want us to go that way in the future.
The Chair: Mr. Cantin-Brault, do you have anything to add about the use of new technologies?
Mr. Cantin-Brault: We’re probably starting to head in that direction, but we’re at a very embryonic stage. Again, health is a community thing that’s tied to where people are. It would probably be a good idea to have a pan-Canadian program, but folks need to be able to talk to people they trust, people who understand their issues where they are.
Senator Moncion: Dr. Leduc, in your opening remarks, you talked about the importance of capturing language and gender. I believe you said that gender is captured, but language isn’t, necessarily. Can you explain the impact of not capturing language?
Dr. Leduc: Once you invest in research and the research is done, you can use the results of that research and drill down into different characteristics. People have to do the gymnastics of finding the percentage of francophones. Asking “what is your mother tongue?” for any health research protocol funded by the Canadian Institutes of Health Research seems to me, naively perhaps, disconcertingly simple.
At the time, an official languages committee had been abolished, because it was thought that things would happen horizontally and transversally for each of the research pillars and at CIHR. But we know what happens then: There is no focus and things don’t happen.
Another factor: French-speaking researchers feel very uncomfortable. The percentage of research grants awarded for applications written in French is well below the majority. Researchers are therefore encouraged to present their projects in English. This phenomenon is probably due to the fact that expert panels are not capable of making an assessment, or that there is a lack of personnel to make such assessments in research. Several years ago, the CIHR required researchers to collect gender demographic data in research projects. I find it hard to understand why the same cannot be done for mother tongue.
Senator Moncion: Is there a funding issue, so that if we don’t collect the language data, we take it for granted that there aren’t that many francophones? So we don’t have the statistics, whereas if we did, we’d be able to say that there are a lot of francophones using the services? All this is now lost in the maze of two languages and we don’t attach any importance to this factor?
Dr. Leduc: It’s hard for me to tell you what the rationale behind this is. Of course, it doesn’t help that we don’t have the data. You can’t improve what you don’t measure. If we don’t measure, is it an oversight, negligence or is it intentional, because we don’t want to see the results? We spoke earlier about the OZi portal, which was developed in Ontario. At that time, there was leverage, because with local health integration networks, the designation plan had to be updated.
So, instead of doing it in an Excel file, we did it in an online file. This made it possible to identify the designated positions. It didn’t necessarily mean that there was someone with the requisite language ability sitting in that chair, but with OZi, if you were looking for early childhood language services in such‑and-such a zip code, we could tell you there weren’t any, and we were able to make that match.
This has been repatriated by the province, and we don’t know exactly how this data is used. Once this data is public, it’s hard not to act. Maybe it’s better to control the data to make sure it’s not available.
I don’t want to lend intent to governments or people who make public policy. But I come back to the principle: The federal government gives grants to do health research where no linguistic data is collected; in my opinion, this is an aberration.
Denis Prud’homme, who was my mentor on this side, used to tell me that for research to be valid, there has to be a slight overrepresentation in terms of sampling. So, if there’s 2% of the population, you collect the data, but no candidate qualifies, you have to go a little higher.
It certainly requires effort and is more difficult for researchers, but the benefit that could be gained from the data and how to interpret it to use this information that’s already there, in my opinion, is well worth the inconvenience.
Senator Moncion: Thank you.
The Chair: May I ask a follow-up question?
Senator Moncion: As long as you don’t encroach on my speaking time.
The Chair: No, I’ll keep your time intact.
What I understand is that in federal health transfers to the provinces and territories, there should be an obligation on the part of the provinces and territories to provide evidence to the federal government. In other words, should this be done through language clauses in agreements, for example? Is this your vision of how we could help solve this challenge to obtain evidence?
Dr. Leduc: Data from Statistics Canada are used that produce this element. In my opinion, there are much more robust mechanisms that could collect this data.
The one proposed by the Alliance des réseaux, in Ontario, is the collection made when the health insurance card is renewed.
It’s important to understand that a francophone who goes to an emergency room in Ottawa, whether in Montfort or elsewhere — in Montfort, there’s greater security, because they’ll be served in French — has to decide whether to ask for services in French or English. Francophones are afraid, when they’re vulnerable, to ask for services in French, for fear that they won’t be accessible, that they’ll have to wait longer, or that the services will be of lower quality.
The language in which you want to be served isn’t necessarily a good indicator of whether the person is French-speaking or not, whereas when we’re at home filling out our health care card form, we’re not stressed or in a vulnerable situation. When we mention our mother tongue — and in Ontario, according to the inclusive definition, if it’s not French or English, we have to use French at home — at that point, we’d be able to…. We could have this data after five years, once the renewal cycle has been completed. This is a proposal that the Assemblée de la francophonie de l’Ontario has been making since 2010 for Ontario. Again, mother tongue is something that all provinces capture on their health cards; from there, we could collect demographic data on utilization and type of service; at least we’d have reliable data.
The Chair: Thank you, Dr. Leduc.
Senator Moncion: I like the complementarity of your question, Mr. Chair.
I’ll have questions for the other two witnesses, but I have another question for Dr. Leduc. You mentioned that 4.7 million Canadians don’t have access to a family doctor. I’d like to know what impact this has on hospitals.
Dr. Leduc: In light of this, the hospital becomes a resource of last resort, and this increases emergency room traffic, because there is no availability.
It’s also sad to see people who need medical follow-up, like diabetics, losing their doctors. Doctors have to retire at some point, and when they do, there’s no one to take over. Nobody buys a medical practice these days, because the demand is just too great. Many patients become orphans as doctors retire. There’s a crisis in Sault-Saint-Marie, where a dozen doctors are leaving.
These are scenarios that are happening all over Canada. People can turn to nurse practitioner clinics, but there aren’t enough of them. No flying saucers are going to arrive with hundreds of thousands of health care workers tomorrow morning. Yes, we can train them, but a nurse takes four to five years to train; a doctor, a minimum of six years; specialists, ten years. If we don’t think about what’s coming in here and what’s going out there, and what the needs are, we’re going to miss the boat and we’re going to keep missing the boat.
Senator Moncion: It makes you wonder if this was done on purpose.
I think I’m running out of time, but I can come back to this in the second round.
Senator Mégie: My question is for Dr. Leduc. In your opening remarks, you mentioned an organization that could recruit health professionals in refugee camps. Has this ever been done? If so, has there been any success, given the obstacles these professionals face anyway when they set foot in the territory, with colleges of physicians or nursing faculties, for example?
Dr. Leduc: It’s a much more complex problem, because it takes a village to accommodate these people. It’s not just about finding someone a job, but you have to find the whole social support process to do it.
When I left Montfort, we were working with this organization to get a few people back into non-regulated positions where, at the time, we didn’t need to get prior learning assessment. It doesn’t solve the problem on the medical side, for nurses and health professionals, but we wanted to give it a try and see what the process would be like, and if we’d be successful. It seems to me an excellent solution on a global scale. These people were professionals before, and now they’re in tents somewhere. Are we able to reach out and get them out, rather than cannibalizing other jurisdictions that also need their health care workers?
Senator Mégie: We’ve been talking about enhancing the value of the profession of family doctor for a long time. I’ve been hearing about it for a long time, and so far, nothing’s been done, or it hasn’t yielded any results. I’m sure you’ve thought about this with your colleagues. Are there any solutions, apart from what you said earlier about the plan the federal government might put in place? Are there other elements that would concern peers, the population, that could be put in place to ensure this enhancement?
I can ask the other witnesses to answer for the other health care professionals. What needs to be done if we want their profession to be valued?
Dr. Leduc: I don’t want to hog the microphone, but I think it’s teamwork that people want to see, that we develop models where there’s teamwork, and we won’t have a choice. What we’ve had to develop in terms of modifying hospital service provision today to make up for the nursing shortage is going to become the care model of the future, because unfortunately I don’t see any movement that allows me to be optimistic that there won’t be a shortage or a problem in three years’ time. It took 30 years of bad decisions, in my opinion, in terms of public policy, and it will take 30 years of good decisions to fix the problem.
What we’re doing now in terms of innovation on the service offer, ways of organizing services with technology and maximizing the practice profile of each of the stakeholders, is probably going to become the model of care that’s going to settle in and stay in the future.
Senator Mégie: Mr. Pilon, do you have anything to add on this subject?
Mr. Pilon: Certainly, the issue of valuing health care professionals is much broader than French-language services. It affects absolutely all our staff. As a result, I’m perhaps not the best person to answer that question.
Senator Mégie: Mr. Cantin-Brault, do you have a comment on this matter?
Mr. Cantin-Brault: I don’t think I’m the right person to discuss this at my level either. However, I’d like to add that our centre puts a lot of emphasis on valuing work in French and showing that working in French is a strength and an asset; we’re working on that. We’re also part of a research project with the Réseau Compassion Network in Manitoba, Santé en français and other organizations. We’re going to conduct a real survey over five years to see what the real needs of the French-speaking population are. We plan to cover French-speaking health professionals. In light of this, we’ll have a better idea of how to enhance the professions, but it’s a bit too broad for me at my level. Valuing French in the profession is really important. We shouldn’t see working in French as a penalty or a problem.
Senator Aucoin: I have two questions, but the answer to the first will have to be very short so I can ask my second one.
Did you talk about people who refused or didn’t want to declare their bilingualism? Are there any studies on this subject that deal with what you were talking about? Does it come from studies that could be used or is it known in the field?
Mr. Pilon: At my level, it’s definitely more anecdotal. We have a committee on French-language services that’s looking at the issue of language insecurity right now among our health care professionals, because we have a lot of people here who could speak French, but don’t feel their level is good enough. That’s our theory at the moment. It would have to be the subject of a study.
Senator Aucoin: Would it be appropriate to have a study that could clearly and scientifically show what exists and explain why?
Mr. Pilon: If we had data and explanations, it would help guide us when trying to solve certain problems.
Senator Aucoin: Thank you. If there were something you could do to start turning the tide in the right direction, what do you think the federal government could do as an action? You’ve listed so many things to do, but where do we start?
Dr. Leduc: I’ll let my colleagues answer first, if they have any solutions to offer.
Mr. Pilon: I took a rather particular angle after listening to the other witnesses who appeared before me and I took note of their testimony. When Mr. Carl Bouchard testified, Senator Moncion asked whether it was a problem to encourage health care providers to seek designation. I can say that in Ontario, in terms of long-term care, there are a handful. Many offer services in French, but they’re not designated. My colleague Dr. Leduc mentioned the OZi portal earlier. The OZi portal only provides information on health care workers in designated institutions; others don’t have to fill it out. I think we need to review the incentives for designation. I could talk about this for a long time, but I’ll let the others have their chance.
Mr. Cantin-Brault: Yes, speaking of studies, I believe my colleague Ms. de Moissac has conducted studies on why people didn’t want to go into a designated bilingual profession. Perhaps you should ask her about this.
So, I think we need to provide help for immigrants to get up to speed and provide help even before these people arrive in Canada.
For education, we’re small, but we’re very important and we depend a lot on the Université de Saint-Boniface. In fact, not so long ago, federal and provincial grants were awarded to several programs at our university, but they could be strengthened. I’ll stop here.
Senator Aucoin: Thank you.
Dr. Leduc: For me, the greatest leverage the government offers is with the university, indeed. So, we really need to have a channel to encourage immigration processes for health care workers, and I’d like to qualify the word “ethical”. When we talk about ethics, we’re talking about people who are already displaced, who are already on the move. We’ve talked about refugees, but there are over 128 million displaced people who aren’t necessarily in refugee camps and who have all kinds of skills. If we could get to know them, capture them and have a quick gateway for them to integrate here, that would be the biggest leverage you could have; we’d also need to enhance training offerings like CNFS.
The Chair: As time is running out, I will recognize Senator Moncion and Senator Poirier and if you are succinct in your answers, I may ask one last question.
Senator Moncion: Mr. Pilon, you have an executive director who is English-speaking at Horizon Santé-Nord. What impact does this have on the service and on the working language within the hospital? Does it have an impact or not?
Mr. Pilon: We’re very lucky. Our new CEO, David McNeil, married a francophone and raised his children in French. He’s not just an anglophone. He’s someone who really takes the issue of French-language services seriously. I’m lucky enough to work for an extraordinary vice-president, Nathalie Aubin, who has a doctorate in the field and is personally involved in these issues. We’ve set up a committee on French-language care. I like to tell people that they are my bosses. I report to them frequently, they are members of the community and some internal people. We’re in a position to take the issue of French-language services more seriously than ever. There are also greater challenges than ever, notably the aging population.
Senator Moncion: When you were talking about recruitment in your percentages…. I’m glad to hear it, because Sudbury is perhaps one of the regions, one of the large cities where there are the most francophones outside Ottawa. The next one, I think, is Timmins, and then there are smaller communities that are much more rural. The importance of French is so great, especially for management, because it’s often what makes the difference inside the hospital. Thank you for this information.
Mr. Cantin-Brault, I believe you’re more focused on community health. What are the unique challenges faced by the Centre de santé Saint-Boniface in offering services in French, the greatest challenges or the biggest challenge?
Mr. Cantin-Brault: Scarcity aside, the biggest challenge is our geographic location. It’s certainly a challenge, because our ideal goal is to have a clientele that is 75% French-speaking. We’re closer to 70% — now it’s 69% — but it’s always around that. Our location means that we have to serve the population around us. I don’t have the data to determine whether it’s increasing with more anglophones or francophones, but anglophones are definitely joining our centre.
Our biggest challenge is to fit it all in one place. I salute the staff at our facility. You have to be extremely creative and stretch resources a lot. It becomes another problematic situation. It means that people are perhaps less inclined to come and work with us, because they think they’ll have to do a lot. Our population is increasingly vulnerable. We’ve developed a new bridging program for people in our area who don’t necessarily have a home. We welcome them and put them in touch with doctors and health professionals.
Let’s face it, it’s not a huge number, but they’re almost all English speakers. We need to do this on a community scale, and it’s certainly a challenge. For the future, it’s our big challenge to maintain this francophone aspect and keep 70% and eventually 75% of the population francophone. It’s a challenge.
The shortage is a big challenge. For us, it’s mainly for nurse practitioners. The Université de Saint-Boniface is starting a program for nurse practitioners, but we’re still in the early stages. It’s going to take a lot of investment in these programs, that’s obvious — for us, anyway.
Senator Moncion: Thank you.
Senator Poirier: I realize that we’re doing a study on minority-language health services, but many of the challenges we’re hearing about from all the witnesses we’ve welcomed are related to a lack of staff, whether it’s doctors, nurse practitioners or people doing blood tests or X-rays; it’s the same thing. I also realize, listening to the news sometimes, especially in New Brunswick, where the population is more anglophone than francophone, that even people on the anglophone side have the same challenges as you. There are small English-speaking hospitals in English-speaking regions that have been forced to close the emergency room for weeks on evenings and weekends, because there wasn’t enough staff.
Are there any discussions between the two French and English regional boards? Are these discussions that you have together, to see if there might be things you could share to help the other party, such as ways of working or ways of offering a service to each other, even if you’re in a minority situation? Are these discussions taking place? Many challenges are the same on both sides. My question is for all of you.
Dr. Leduc: We collaborate a lot with our partners. We’re not in New Brunswick, so we don’t have the networks, but we work together. Even then, when there was a major shortage, because we closed the emergency department once, there are a lot of rules about collective agreements and labour mobility, which are huge barriers to…. We need to find volunteers at that time, people to come and help these environments. It’s not easy.
Mr. Cantin-Brault: We’re part of the WRHA, which is the Winnipeg Regional Health Authority, so we always work in English with other community access centres. We have similar purchase of service agreements, so there are discussions that take place, but certainly when there are emergencies and great needs…. I say it like that, but we don’t necessarily feel that the francophonie is a priority. That’s a bit of a challenge. Of course, there are well-meaning people. I don’t want to accuse anyone in particular, but…. There are good decisions being made, but it’s certain that when you have to move fast, the francophonie isn’t always a priority.
Senator Poirier: On the translation side, if the ER suddenly has to close for an evening, whether it’s on the French minority side or the English minority side in Quebec, can the others provide at least one person to do the translation, so that the patient can receive care in a hospital, rather than not going to the hospital at all?
Mr. Cantin-Brault: In our walk-in clinic, it’s a possibility. We thought: Should we bring in people who speak English with translation services? I don’t think that’s what our population wants; that’s also the issue. Even if we did provide them with services, I think it would be a kind of affront; and rightly so, I think. It’s as if we were saying we’re going to fix all this and slap something together. That’s the big issue. We’re wondering whether it’s better to close for a few days, but have French‑speaking employees when it’s open, or to open every day with services that are a bit rough and tumble. For now, we’ve made the decision to close for a few days; we think it’s better, but in the long term, I don’t know.
Senator Poirier: I meant just in case of an emergency, certainly not to replace anyone. I totally agree with you about having services in the language of one’s choice in a minority situation. Thank you.
The Chair: To conclude, I would ask you this question. First, let me give you some context. In fact, this issue of labour shortage, which is chronic and constantly recurring, is such that…. I get the sense that we’re deluding ourselves if we believe that we’re going to solve the labour shortage problem in the short term. Yes, there is the solution of immigration; yes, there is the solution of accelerated bridging; yes, there are solutions. In terms of innovation…. I’ll give you an example and ask my question afterwards.
For example, on the question of family doctors, we delude ourselves into thinking that we’ll all have a family doctor. It seems that, in reality, in the region where I live, this is impossible. A group has formed, they’ve stood together as health care professionals and they’ve developed a climate of trust with patients, so even if the patient doesn’t see the same doctor, in this context, they’ve created a dynamic that makes people feel safe.
Is there a role for the federal government in fostering innovation? I know there are a lot of innovative initiatives going on, but shouldn’t there be additional support to help rethink all that? You mentioned the model, Dr. Leduc, but we may be at a time when we need to completely rethink the health care services model. In your opinion, will the federal government have a role to play in this dynamic?
Dr. Leduc: There’s always a possibility…. I think the situation is so catastrophic, without wanting to be dramatic, that people owe it to themselves to innovate and try different things. There’s also a validation and study aspect that I think is important along the way. How can the federal government support the documentation of these innovative practices and catalogue them so that they can be shared? Here again, a vehicle like Société Santé en français, if we’re just talking about minority languages, could develop elements and play a slightly bigger role in sharing innovative practices. What we’re going to develop for the minority situation — maybe we’ll develop more solutions, because we have to — can certainly be of use to the majority.
The Chair: Are there any other comments on that?
Mr. Pilon: It’s beyond my expertise, but I had the opportunity to speak to a woman named Michelle Anawati a few weeks ago. She’s a physician working in the Faculty of Medicine at the University of Ottawa. She’s exploring the idea of practising medicine the way it was done in the old Renaissance paintings, where you see doctors walking around with their charts. She’s someone I’d recommend you invite. She’d certainly have some interesting things to tell you. She’s a francophone from Sturgeon Falls, I believe.
The Chair: Thank you. Dr. Leduc, Mr. Pilon and Mr. Cantin-Brault, thank you very much. It was a very rewarding exchange. We identified both very clear problem situations and possible solutions that will undoubtedly help us a great deal in our study and report.
Colleagues, we’re going to suspend the meeting, just long enough to welcome our next witness. Once again, thank you for your work and your commitment to official language minority communities. Thank you.
Colleagues, for our third panel of witnesses, we now welcome Mr. Michel Rodrigue, President and CEO of the Mental Health Commission of Canada. Welcome and thank you for accepting our invitation. Let’s begin with your opening remarks, which will be followed by questions from the senators. Mr. Rodrigue, you have the floor.
Michel Rodrigue, President and Chief Executive Officer, Mental Health Commission of Canada: Honourable senators, my name is Michel Rodrigue. I have the honour to be President and Chief Executive Officer of the Mental Health Commission of Canada.
Since its creation in 2008, the commission has really focused on improving access to mental health care in the culturally appropriate language of choice. It should not be forgotten that the commission was created following the report entitled Out of the Shadows at Last, published by the Standing Senate Committee on Social Affairs, Science and Technology, which had criss-crossed Canada to take the pulse of mental health, mental illness and addiction in Canada at the time.
We believe at the commission that every person should have the chance to realize their full health potential. To this end, we conduct research, programs and training that promote people‑centred values, such as past and present experiential knowledge. Since then, we have trained over a million people in Canada in mental health knowledge development, especially in the workplace. We offer two programs: Mental Health First Aid and The Working Mind.
We understand that obtaining health services in one’s mother tongue is a major challenge for linguistic minorities, particularly in more isolated areas or smaller communities. We also know, as Dr. Leduc reported, that poor communication can lead to misdiagnosis, errors and inappropriate treatment, and can also hinder access to preventive and follow-up services.
For francophones in minority settings, access to mental health services in French should be not only a fundamental right, but also a necessity, to ensure effective, safe care that respects their culture and linguistic identity. The data we’ve gathered indicate that nearly three million French-speaking people outside Quebec have difficulty obtaining services in their mother tongue, due in part to the lack of French-speaking professionals or professionals who are able to speak French.
That’s why we’ve identified two recommendations for you tonight. First, we need to implement programs to identify, train, recruit and retain mental health service providers who are able to speak the language of minority language communities. This may seem obvious, and you’ve heard it many times. But perhaps we should be looking at pan-Canadian licensure, so that professionals in New Brunswick can provide health services in Winnipeg or Sudbury. I think this is one area where the federal government could play a leading role.
Secondly, we need to invest in the development and implementation of e-mental health services, i.e., training e‑mental health providers to ensure that their programs and services are culturally competent; raising public awareness of e‑mental health; demystifying the issues on this side; ensuring that there are significant benefits to obtaining mental health care services in the language of one’s choice.
At the Mental Health Commission of Canada, we are committed to strengthening our response to the mental health needs of official language minority communities.
In conclusion, the committee is committed to ensuring that every person, no matter where they are in Canada, has access to quality mental health services in the first language of their choice. We appreciate the committee’s attention to this critical issue, and we look forward to continuing to work with you to achieve this goal. Thank you.
The Chair: Thank you very much, Mr. Rodrigue. We’ll now move on to questions from committee members.
Senator Poirier: Thank you for being with us today; we’re pleased to welcome you. My first question is this: Do you receive funding from the federal government to develop programs, provide training or conduct research on improving access to mental health care in the minority language? If so, where does this money come from?
Mr. Rodrigue: We don’t have any amounts set aside specifically for francophone and Acadian communities in Canada or for anglophones in Quebec. However, that is part of our role. So we receive core funding that has remained the same for the past 13 years, and I’ll digress for a moment. If you go grocery shopping, you don’t buy the same things now that you could afford to buy 13 years ago. Our spending capacity has been reduced, but since the commission was created, we have developed programs with and for the francophone and Acadian communities, and even for the anglophone communities in Quebec.
Senator Poirier: If I understand correctly, you developed that with the same funding you’ve been receiving for the past 13 years. Is that right?
Mr. Rodrigue: Yes. All our programs are developed using the funding we receive from Health Canada or through a service offering where users pay for the training costs. For us, those are two ways to provide services.
Senator Poirier: Aside from the labour shortage, which we know is a widespread problem, what would be the other barriers that prevent people with mental health problems from accessing services? Are there any other barriers apart from the labour shortage?
Mr. Rodrigue: Thank you for the question. There are indeed other issues. A stigma is still prevalent today. When it comes to mental health issues or mental illness, that stigma is a major barrier on several levels.
If I stigmatize myself because I’ve been instilled with the notion that it’s inappropriate to have mental health issues, that prevents me from seeking services. In health care, there are structural stigmas that mean that physical health is prioritized over mental health. So a number of barriers exist that affect francophone and Acadian communities, and even the population as a whole.
Chronic underfunding is another element. What’s noteworthy about mental health is that we mustn’t forget that most people access their mental health services through the plan provided by their employer. So it’s not the state that pays, it’s the employer — in this case, private companies.
Finally, when talking about mental health, we have to take into account both public and private payers because right now they provide much of the mental health services in Canada.
Senator Poirier: Is the challenge greater in rural areas compared with urban areas?
Mr. Rodrigue: Yes, especially in cases where mental illnesses persist. In this respect, it is much more difficult when the cases are more complex.
Senator Poirier: Thank you very much.
Senator Moncion: Welcome, Mr. Rodrigue. You talked about e-mental health and said it was an important issue. Could you elaborate on your thoughts about e-mental health?
Mr. Rodrigue: In terms of definition, we could be talking about consultation over the telephone, by video conference or over the internet. All these measures can also exist in the form of an application that enables health care professionals to cross borders and offer a consultation using those means.
It was shown during the pandemic that this could be done, that it was as effective and more efficient in terms of service provision, as there are fewer missed appointments. Without saying that it’s a panacea and without suggesting that it’s for everyone, I would say that, for many of us, it’s an excellent way of accessing health care services.
If that’s paired with national licensure, it means that, if I’m a mental health provider, I can provide services regardless of the province or territory. It’s one of the ways to overcome borders. When we don’t limit ourselves to our provinces and territories, we set the distance aside, and that enables us to access services. I can tell you that I’ve already experienced it, and it’s excellent.
I’m not claiming it’s for everyone, but it’s a big part of the solution. That was shown during the pandemic, and Dr. Leduc referred to certain barriers that fell at that time. What the commission is doing is training health care professionals to be more skilled in providing their e-mental health services and to provide those services in a safer space. We have developed standards for assessing applications, as not all applications are validated by evidence.
Senator Moncion: Many programs are developed by men and women who have had life experiences and provide wellness or better living services.
Are you at all involved in the provision of those services? We know that people spend large amounts of money to participate in those programs. Many people find solutions or learn to live better. Do you have any control over the provision of such programs?
Mr. Rodrigue: We don’t have control over those. I don’t want to pass judgment on those services. Besides, I don’t see the fact that people are spending more on their well-being as an affront because if they’re spending on well-being and paying attention to their mental and physical health, so much the better for them.
What I do know, however, is that every week we hear about the best app being developed, and studies have shown that out of 800 wellness-related apps, there are maybe 3 that are substantiated by evidence.
So we’re left wondering whether the developers have good intentions or whether, at the end of the day, it’s a scam and they want to make money. However, I have to add that we have developed a method for assessing the quality of those applications. It’s possible to create libraries that people can access, whether it’s the general public or health care professionals.
There’s a whole movement in the wellness field, with some very good material, and I’ll stop here.
Senator Moncion: You talked about the use of e-mental health during the pandemic, and I think that’s excellent. Are any studies being carried out into the deteriorating health of our young people as a result of the negative impact of social networks on their well-being?
Mr. Rodrigue: At the Mental Health Commission of Canada, with other partners, we assessed the level of anxiety and depression in young people during and after the pandemic. Unfortunately, very early on in the pandemic, we saw an increase that has remained at the same level ever since.
The effect of the pandemic is still being felt in the general population. As far as young people are concerned, we know that isolation has had a major impact on them. I believe that, as a society, we need to invest in mental health care services for young people in particular, and this investment must be significant.
When it comes to the impact of social networks and video games, data is coming out. We know that research is being carried out at universities and that the data is not always clear in that area. For example, it was thought that playing video games was very harmful for young boys. It can be, but it can also be beneficial. People have developed applications that reflect the game so that young people can take care of their mental health.
So, there are good and not-so-good things that we must learn to manage, and I think that addiction must be avoided.
Senator Moncion: I come back to what you were mentioning in relation to the pandemic. Are we going to call this level of anxiety “postpandemic traumatic stress”?
Mr. Rodrigue: I’ll let the experts provide the wording when it comes to that.
This is of the utmost concern to us. With our young people becoming anxious and much more depressed since the start of the pandemic, I must say I think that deserves sustained attention on a societal level.
Unfortunately, the impact of the pandemic will last a long time, will be complex and will have to be addressed over a longer period. The good thing is that we know what works and that those efforts were made during the pandemic. We can’t go backwards and lose that ground.
Senator Moncion: Do you have the money to continue working on that?
Mr. Rodrigue: We don’t, and neither does the sector. I think investments need to be made. I would use a quote attributed to Albert Einstein: “Insanity is doing the same thing over and over again and expecting different results.”
I think that, in health and mental health, we really need to change our methods.
Before the pandemic, we approved a stepped care approach in Newfoundland and Labrador. The right service is provided to people when they need it. Waiting lists have been reduced by almost 70% in a number of clinics. We did the same work last year in the Northwest Territories, where waiting lists for mental health care have been reduced in communities by 80%.
This means increasing the number of professionals who ensure that psychiatrists are reserved for clients who need them most and for more complex cases. Peer support workers and applications are provided.
So doing things differently is one way to overcome the restraints caused by the lack of resources that will persist for several more years in mental health and health.
Senator Mégie: I thank our witness for being here to enlighten us.
You talked about e-mental health and you said, among the good things, that it enabled twinning with health services in other provinces. Did I understand correctly?
Mr. Rodrigue: Yes.
Senator Mégie: If things were done that way…. There have always been restrictions on mobilizing professionals from one province to another. So it would be beneficial. But how did you manage to do that?
Mr. Rodrigue: It wasn’t us who did it. Agreements between provinces and territories made it possible for health professionals to provide services in another territory or province. That was due to the pandemic. Those were pilot projects, so it wasn’t us.
However, I think there is a need in that area to create national standards and standardization so that practitioners can provide their services in different jurisdictions. If we take the step and accept the fact that e-mental health is a solution, then we need to take the other step and say that we shouldn’t impose undue constraints on health care professionals by telling them where they can provide their services.
I believe that, for francophone and Acadian communities — but this is also true to a lesser extent for anglophone communities in Quebec — we must ensure that they are provided with services in the language of their choice.
If I may digress, I was raised in the Sudbury area. My dad had a chronic illness called COPD, or chronic obstructive pulmonary disease. Imagine if at times you felt as if you were breathing through a straw. That disease is accompanied by anxiety. It was very difficult to get services in French. My father wasn’t able to understand everything when he was provided with services — as great as they were in English. If he didn’t have someone with him, it was simply impossible for him to get the services he needed.
I think this is a concrete example from my life that proves that providing services in French is more than a case of “it would be nice”; it’s really a matter of life and death. People can be misdiagnosed if health care professionals are unable to communicate with them in their mother tongue. For many of us, when we’re in crisis, when we’re talking about a mental health disorder or mental illness, we cannot easily transfer that information into a second language.
Senator Mégie: Is the pilot project that was implemented in Newfoundland and Labrador over or is it ongoing?
Mr. Rodrigue: The stepped care service offering is ongoing, and I’m really proud to say that we’re supporting the progression of that offering in other Atlantic provinces and other provinces in Canada.
As for the pilot project that enabled health care professionals to provide services in another jurisdiction, to my knowledge, once the pandemic ended, people went back to their best practices.
I hope this committee will look at ways to credit people who provide mental health services or health services. I think that really opening up licences nationally would help avoid problems. I heard a witness speak earlier, and it’s true that some services need to be provided locally; that’s clear. For mental health issues that are transient, I think the most important thing — and we know this — is to get a service on offer as quickly as possible, since people are currently put on waiting lists too often.
The Chair: I’ll also ask Mr. Rodrigue a few questions.
You talked about the stigma surrounding mental health. Does the federal government support the need to collect data-based evidence on marginalized populations in francophone and Acadian communities that have become more diverse?
Are you able to obtain data to identify marginalized populations, be they racialized communities, 2ELGBTQI+ communities, seniors or women?
Do you have clear enough data to identify the type of services these communities need, and the training needed to deliver those services? It’s a matter of language, but it’s also a matter of competence in relation to very specific issues within marginalized communities.
Mr. Rodrigue: The answer will be short: No, we don’t have data-based evidence. Studies are being carried out by researchers, but we don’t have the evidence base that would enable us to assess whether progress is being made using the interventions that have been implemented.
In that regard, I think Dr. Leduc hit the nail on the head. We really need to oversample in francophone and Acadian communities to make sure we have enough information to do the sampling you’re referring to, but we just don’t have it.
The Chair: In your vision of the commission, you say that high-quality mental health services are stigma-free, recovery‑oriented, evidence-based services that respect cultural values and are linguistically equitable and inclusive.
Adapting care linguistically is one thing, but so is adapting it culturally. We live in a society where we are welcoming more and more people from all over the world, and that is part of the solutions to our shortage challenges.
What role does the commission play and what role could the federal government play to take into account these cultural differences or cultural adaptability?
Mr. Rodrigue: Thank you for the question.
We realized very early on that the stigma around mental health issues or mental illness differs from culture to culture. On the one hand, in some cultures, it’s still taboo and isn’t discussed.
On the other hand, therapies have usually been developed for people like you and me. There is work to be done there. We’ve done work for black communities, assessed certain elements and made improvements for people from South Asia.
Approaches, training and advice have been adapted for practitioners who provide the services. We also looked at the cultural impact of the service offering and what the impact is when we try to enlist community support to help people destigmatize themselves.
We’ve done that work, but there’s still a lot to be done because we need to adapt our approaches. One piece of data that made me smile was the fact that practitioners who came from the community had better results, but that we could also train people who didn’t come from the community to provide these services. You’ve identified an area where we can make significant progress by adapting the service offering and including links with the community, because they can be important stakeholders in changing the situation on the ground.
The Chair: Thank you for your answer.
Senator Moncion: My question has to do with violence against women and the mental health care needed for men, because a man who is violent toward a spouse is not in a good place.
There are two things I’d like to know about the commission. Do you have a role, say, in publicity in this area to make people aware that people who commit violent acts against others aren’t well? Is there any outreach? Does the commission have that kind of mandate?
I understand that your resources are extremely limited and haven’t been increased for 13 years. I’d like to hear what you have to say on these issues. We know what we have to do financially, but what should we do beyond that?
Mr. Rodrigue: You raise an important issue. We haven’t worked specifically with abused women. We haven’t done any sustained work in this area. The sector is doing important work with resources that, unfortunately, don’t meet the demand. We hear this on a regular basis, and it’s a problem.
People who are going to cause harm through psychological or physical injury certainly need support. Personally, I believe that we need to invest in prevention as a community and as a society.
When we think of francophone and Acadian communities or English-speaking minority communities, the problem is even more striking, first of all because there is a lack of services — and there’s often a lack of specific services; the services people need are very specific in that regard.
I don’t have a great answer for you. It’s something that needs a lot of work, and it’s not an area we’ve been involved in since the commission was launched.
Senator Moncion: Has the commission’s mandate been reviewed? You’re still coming up with solutions, and you have issues. That’s part of the other question I have: Is there no place for that in the commission’s work? Isn’t that part of your strategic planning? Or is it that the commission isn’t really called upon to intervene in this area? I’m thinking in particular of the mental health of the men who commit these acts, because they’re the ones who are sick.
Mr. Rodrigue: I think you’re right. The commission’s mandates have been updated, but I don’t think they were widely consulted. It was a cabinet decision, and they announced that in a budget. I think the mandate on this side is broad. This is really the time to discuss the commission’s mandate and what is appropriate for Canadians and Quebeckers. In that respect, I’m in complete agreement with you.
The way we operate is very simple. We work upstream to assess the situation and analyze where there are gaps and where we could play a role. We prioritize certain sectors with the resources at our disposal. Among the sectors prioritized are e‑mental health, because that can have an impact, as well as suicide prevention, which we can also have an impact on. We’ve developed a made-in-Canada approach to community-based suicide prevention; I’m very pleased with the impact this approach has had in New Brunswick, where it’s been implemented. That’s sort of how it’s identified.
We also identify needs that can’t be met; we add those needs to the issues to be addressed if we can get additional funding. There’s work to be done when it comes to violence against children and women, and the people who perpetrate it.
Senator Mégie: I’d like to come back to e-health apps, given that the commission may have limited resources to validate all of this. You said there were 800 apps, of which only three have been validated to help people.
Would it take validation committees to evaluate the others? There has to be oversight; there’s also the misinformation that everyone knows about that goes through that same channel. Is there a way to carry out oversight, without playing a police role?
Mr. Rodrigue: Yes, absolutely. Over the past four years, we’ve developed app standards. These standards have been validated and, since we’re not reinventing the wheel, we’ve established a partnership with a company in Great Britain that has already deployed an app assessment in several countries. We’re now in the process of evaluating apps in one province as part of a pilot project. With funding, we’ll be able to do this work across Canada.
The way it works is quite simple. App creators submit their apps, with a modest fee. Then they receive a category-by-category report, where a 70% score, for example, would indicate that the app is safe overall, but that there is room for improvement.
They can then work on their app and resubmit it. Apps must be resubmitted every six months because they need to be updated for use by health care professionals or the general public and to ensure they remain safe.
As for what I quoted earlier, this is a study, not an evaluation. They looked at apps that were available in the Apple Store and other stores; of those apps, they identified 800. There were only three that were evidence-based — three out of 800. There are tens of thousands of apps. That doesn’t mean that we have to evaluate all apps, but we have to work with the providers and the people who develop them to raise their awareness, so that they develop sound, evidence-based apps, effective apps that enable you to do a good job.
Senator Mégie: Thank you very much.
Senator Poirier: I just want to make sure I’ve got this right. You said earlier that during the COVID-19 period, the rate of mental health issues among young people went up and then remained stable. You also talked about programs that gave them access to help. You said that, in severe cases, they may have access to an individual or a doctor who can work with them, but that many problems have been solved thanks to certain programs they have access to. Did I understand correctly?
Mr. Rodrigue: You’ve clearly understood that it’s part of the solution — not the only solution, but part of the solution. Sometimes you need a supportive consultation with peer support groups or an individual, and afterwards, with a validated app, it helps me to get through the moment I’ve experienced, which was difficult, and to get through the recovery. It will support people in that process.
Senator Poirier: That brings me to my next question. To access these programs, you have to go through a doctor. Can they access the programs? The reason for my question is that I’ve been hearing a lot, especially in recent years, that a lot of young people with mental health issues tend to be in school. We realize this when young people open up to certain teachers who are close to them, rather than talking to their parents. That’s what we’re hearing. I wonder to what extent these programs are available. Do schools know that they’re available and that young people can access them? They have social workers in the schools. Are the programs available or do you always have to go through a doctor to access them?
Mr. Rodrigue: Excellent question. I think in an ideal world where everyone had a family doctor, it would be great to have that door. However, that’s just not the case, so you don’t need to go through a doctor. Tiered service provision means that you won’t see a doctor until you reach a certain level. First, you’ll have seen various people who can provide support, such as social workers, psychologists, and so on. So there are other health care providers who are able to support users, including apps and artificial intelligence, which is making great strides in mental health. Sometimes it scares us, but there are significant advances.
Senator Poirier: Thank you for the good work you do.
Senator Aucoin: Could you explain these electronic apps a little more? You said that out of 800 applications, only three were evidence-based. What does that mean, and how do these apps actually work? I just want to understand a little better.
Mr. Rodrigue: In terms of evidence, this means that there is research that has followed the development of the app and, through this research, we can determine that the app is effective, whether it’s to support someone who has a mood disorder or is experiencing the onset of burnout or depression. That’s kind of the approach.
The way it works…. That’s a very broad question. I can give you an example. You can have someone with you who asks you questions to find out how you’re doing. This will give you tips on how to change your habits. For example, things may seem pretty dark when you get up in the morning. It doesn’t replace a person, but through e-mental health, there are also virtual consultations such as phones, videos, chats and text messages. Young people use this a lot. There are some great programs that allow young people to access care whenever they want. One example is Kids Help Phone. It’s really important for them, and it saves lives every day; it’s important to say so.
Senator Moncion: I want to go back to what you said about the provincial interswitching that existed during the pandemic. What made that happen during the pandemic and, as soon as the pandemic was over, it didn’t exist anymore? Everyone’s gone back to their own little corners, and it’s back to provincial turfs.
Mr. Rodrigue: That’s a difficult question to answer. I’ll give you my own view.
Human nature is such that we’ll always go back to our old habits, because it’s comfortable.
Second, we’ve been talking about e-mental health for 10 or 15 years. We were able to deploy these services in real time at the start of the pandemic. Why? Because there were no other options. I think it’s important to emphasize that. Practitioner remuneration is important in that regard. Again, it’s more effective. Using practitioners, people who are trained, is more effective. There are fewer missed appointments. For some people, if you don’t have a car, you have to rely on public transit to get to an appointment and miss work without getting reimbursed. There are major advantages for people. If there’s a place where consultations can take place, you don’t have to live with the taboo of going into a psychiatrist or psychologist’s office. There are other advantages there, and that’s why it works well and is effective in mental health.
Senator Moncion: But it’s the inter—
Mr. Rodrigue: To be honest, the health ministers have set a target for physicians, but I think it really needs to be extended to other professionals who provide mental health care, to make sure that someone practising in Quebec can provide services across the border, whether it’s in Ontario or New Brunswick, and vice versa. We’ll never have enough health care professionals in the communities where they’re needed. If it’s a choice between not getting services or getting quality, culturally appropriate service, my choice is to get service when I need it.
The Chair: Thank you very much. First of all, thank you for your testimony and for answering our questions. At the same time, it’s quite troubling to see that mental health issues are growing in Canada and among young people, and that your organization isn’t receiving the necessary funding. If you were the main negotiator between the federal government and the provinces on health agreements — some have been signed recently — what would you negotiate more solidly to take mental health needs into account?
Mr. Rodrigue: I think that, in that regard — with all due respect to the provinces and territories, because they’re closer to the people and are more familiar with the needs — one thing I would put forward is to ensure that a percentage of mental health investment goes toward addiction disorders. Too often, because of the stigma I referred to, which is also present in health care, people will prioritize physical health over mental health.
If I were at the table, that would be one of the lines I would draw.
The Chair: Thank you very much for your testimony and your work.
Colleagues, thank you for your insightful questions. This concludes our meeting this evening. Thank you, and have a good evening.
(The committee adjourned.)