THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
EVIDENCE
OTTAWA, Thursday, September 29, 2022
The Standing Senate Committee on Social Affairs, Science and Technology met by videoconference this day at 11:30 a.m. [ET] to study the Federal Framework for Suicide Prevention.
Senator Ratna Omidvar (Chair) in the chair.
[English]
The Chair: Honourable senators, I call to order this meeting of the Standing Senate Committee on Social Affairs, Science and Technology. My name is Ratna Omidvar. I’m a senator from Ontario and chair of this committee.
Today our committee begins its study of the Federal Framework for Suicide Prevention. We welcome the Honourable Carolyn Bennett, P.C., M.P., Minister of Mental Health and Addictions; Candice St-Aubin, Vice-President of Health Promotion and Chronic Disease Prevention Branch with the Public Health Agency of Canada; Heather Jeffrey, Associate Deputy Minister with Health Canada; Suki Wong, Director General, Mental Health Directorate, Strategic Policy Branch, Health Canada; Rhonda Kropp, Associate Vice-President, Research-Strategy from the Canadian Institutes of Health Research; Stephanie Priest, Director General, Centre for Mental Health and Well-being, Health Promotion and Chronic Disease Prevention Branch with the Public Health Agency of Canada; and Dr. Tom Wong, Chief Medical Officer of Public Health, Indigenous Services Canada. Thank you for joining us. Your time is really appreciated.
I invite the minister to provide opening remarks. Minister, you have done this many times. You know you have five minutes allocated for opening statements with lots of questions coming to you afterwards. Please proceed, minister.
The Honourable Carolyn Bennett, P.C., M.P., Minister of Mental Health and Addictions: Thank you, Madam Chair and honourable members of the committee. I am extraordinarily pleased to be here to participate in this extremely timely study on the Federal Framework for Suicide Prevention.
[Translation]
I would like to begin by acknowledging that I am speaking to you today from the unceded traditional territory of the Algonquin Anishinaabe people.
Suicide affects people of all ages and backgrounds across the country. It also continues to be the second leading cause of death among young people in Canada. The pandemic has added a further layer of complexity to this issue.
[English]
Over the last two years, many people across Canada have reported an increase in stress, anxiety, depression and loneliness. We also know that the prevalence of suicidal thoughts was significantly higher in 2021 than in 2019, before the pandemic began. As you all know, the suicide prevention framework was developed almost six years ago in accordance with the Federal Framework for Suicide Prevention Act, a private member’s bill that became law in December 2012 — close to ten years ago.
The purpose of the framework was to align the federal activities in suicide prevention with three objectives: reducing stigma and raising awareness; connecting people, information and resources; and advancing knowledge and evidence to better understand suicide and to inform prevention, treatment and recovery.
We are currently developing a national action plan on suicide prevention to update the Government of Canada’s approach to this issue and are hoping to share the plan next fall.
Over the coming year, we will be engaging across federal departments, with provinces and territories, with Indigenous communities and people with lived and living experience, to move the existing framework to a much more action-oriented, evidence-based, comprehensive plan.
We are really grateful for the invitation to participate in your truly important and timely study as we work towards a national action plan for suicide prevention to replace the framework. Today’s discussion and your insight and recommendations will be absolutely crucial to inform the development of this new approach. As most of you know, we’re committed to implementing a 988 number for suicide prevention and mental health crisis support by November 30, 2023. Its planning is under way with partners across the country, but crisis support, as you all know, is only part of an effective suicide prevention plan.
I look forward to hearing your views on where we need to focus and specifically on the need to ground our approach in evidence. What has worked? What has not worked? We are looking at outputs versus outcomes and the need for early detection and intensive treatment for those with mental illness and substance use and the need for enhanced training for family doctors.
[Translation]
Our focus also needs to include moving upstream to address the risk factors such as child maltreatment.
We need to improve protective factors, for example, by raising the bar for mental health literacy so people can identify and help others at risk.
[English]
We have made significant investments to implement the pan-Canadian suicide prevention service called Talk Suicide Canada. Budget 2019 invested $25 million over five years to support the sustainability and implementation of this service, and we have made other upstream investments in mental health promotion and illness prevention, as well as family- and gender-based violence prevention. But these investments, we admit, have not been specifically aimed at reducing suicide rates.
With the help of this committee’s study and the work under way on the national action plan, we are committed to maximizing the knowledge of experts, communities and people with lived and living experience to implement a truly effective strategy that would be grounded in evidence.
People have heard me say before, a strategy has to be “what, by when and how?” It can’t just be a laundry list of things we’re already doing. Suicide is too serious an issue to be funding ideas at the expense of evidence-based programs that actually save lives.
With your help, I am committed to building an effective, comprehensive and evidence-based federal suicide prevention action plan. I look forward to a much-expanded conversation through your questions and the outcome of this committee’s study. Madam Chair, we will perhaps want to have ongoing dialogue with you as we share what we have been hearing and how we can go forward with the ideas we have before we finalize the action plan.
The Chair: Thank you, Minister, for your comments. It is gratifying to note that our study comes at a timely point. To that end, I will ask senators to address their questions to the minister or anyone else in the panel. As always, colleagues, you will have five minutes for your question and for the answer you will get.
The first question will go to the deputy chair of the committee, Senator Bovey from Manitoba.
Senator Bovey: Madam Minister, it is wonderful to see you. Too bad we’re talking about such a difficult topic. It is an issue that has affected all of us very closely in one way or another. As you know, I am just back from another trip to the Arctic. You know the effects of suicide in our North are horrific, although they are very serious across the country as well.
This study is to develop a framework. As you have said, the current federal framework was developed six years ago. You are taking that framework and putting it into action. Yes, some very important steps have been taken.
As we focus on the framework now, though — as you say, at this timely moment — from your perspective, what would you like to see this framework deal with that has not been dealt with in prior frameworks?
Ms. Bennett: The most important thing in an action plan is that we need to be focusing on accountability for outcomes. We have to fund what works and stop funding what doesn’t work but maybe makes us feel good.
I think that was the worst of the public health approach; it was almost a reflex approach: “We must do something. This is something. Let’s do that.” We need to be able to evaluate it, but we also need to be very accountable for what is happening in the federal family.
As much as we work with provinces and territories on this very important issue, we have some of the worst outcomes in the people for whom we have direct responsibility: First Nations, Inuit, Métis, the military, RCMP, Corrections. We actually have to be accountable across all government departments as we go forward.
That is one of the things that the deputy and the vice-president are trying to do, with the same seriousness that we had toward the response to the TRC, the Truth and Reconciliation Commission of Canada, and the MMIWG, the National Inquiry into Missing and Murdered Indigenous Women and Girls. The tools are often in other departments. We need to be effective as a federal government because, otherwise, how do provinces and territories take us seriously if we’re not actually dealing with and getting results for the populations for whom we have responsibility?
Senator Bovey: With the time I have left, may I just ask one more question based upon my experience? During COVID, I would get calls at all times of day and night, primarily from artists who were obviously on the brink. As my colleague Senator Kutcher knows, I did not know how to advise them or what to do except to stay up all night and talk to them. I would suggest they start painting again, right? Let’s get that action.
Should this framework deal with awareness for those of us who are not doctors, who are not in the mental health care system? How are we to know how we can help an individual in crisis?
Ms. Bennett: The work that Dr. Kutcher has done on mental health literacy and helping people have the tools to identify people at risk but also to help them navigate to real help will be hugely important.
You mentioned artists. We now know that racialized communities want help that is specific for them. Farmers want help that is specific for them. We actually have to say that the averages do not tell the real story, because there are certain sectors of our society who are doing very badly and where lives are being lost in much greater numbers.
Senator Patterson: Thank you, minister. We are very grateful that you have appeared at the start of this study which we are undertaking.
You played a big role in the Inuit-Crown Partnership Committee table when you had that responsibility. I know that you are well aware that ITK, Inuit Tapiriiit Kanatami, has done significant work on an Inuit-specific suicide prevention strategy, which has been funded through the Crown partnership table by the federal government.
I think you hinted at this in your remarks: In order for a national framework to be effective, there does need to be close coordination between service providers and provincial and territorial governments who provide the on-the-ground services, not a siloed approach.
When I look at all of the moving parts with regard to the North, I see Minister Hajdu is in charge of additional services for Nunavut’s 86%-Indigenous population. Minister Miller holds the mandate for the Inuit-Crown Partnership Committee; Nunavut Tunngavik Incorporated, NTI, and ITK advocate for Nunavut’s Inuit beneficiaries; and then there’s the all-important primary service provider, the Government of Nunavut.
Could you elaborate on how you are coordinating important work in mental health, where suicide is a big element, within the federal family and, I say most importantly, with the territorial and provincial governments who are providing services on the ground?
Ms. Bennett: What a great question. There’s also Minister Vandal who has the direct responsibility with the premiers.
On Friday, we did the National Summit on Indigenous Mental Wellness with Minister Hajdu. It was really exciting to see the Inuit-specific breakout sessions, which really spoke to the need for coordination and integration.
I am meeting with Minister Main next week. We will have a meeting this month with my counterparts in mental health and addictions in all of the provinces and territories, as well as with ministers of health where there isn’t a separate minister. Then we will move to the health ministers’ meeting in November.
It is really clear that the provinces and territories have identified six priority areas they want to work with: integrated youth services, better training for family doctors in mental health, the use of digital, health and human resources, substance use treatment and complex mental illness. So many people have a mental illness but also end up with substance use and can end up taking their lives. Those were the six areas that the provinces and territories chose. We are trying to develop national standards on those so that no matter where you live in this country, you can get care.
We are also hearing about bottom-up successes, like Rebecca Kudloo’s program in Baker Lake. We need to know what is working in those communities so we can coordinate to support the things that are working and free up some dollars to move to evidence-based solutions.
Everybody wants to work together and is committed to working together, but an action plan must take into consideration all of the leadership, but particularly community and those with lived and living experience, if we are going to get this right.
Senator Patterson: Very helpful, minister. The committee welcomes your idea of giving you our feedback as your action plan develops. We are all very concerned about making progress on this issue. Suicide rates have not really gone down, sadly, and I do not need to tell you about the problem amongst the Inuit. Thank you.
Ms. Bennett: You know, from colonization to intergenerational trauma, that there are specific issues to be dealt with.
Madam Chair, maybe later in the year, we could have an informal dinner or breakfast, as we have done before, to just share ideas in a more informal setting. I would really enjoy it.
The Chair: Thank you for that offer. We will certainly take you up on it.
Senator Kutcher: Thank you, minister and senior people, for being with us here today. It’s very appreciated. I want to recognize, minister, that your historical appointment signals how important mental health and addictions are for all Canadians.
I was very pleased to hear you speak about the idea that this is a timely meeting, that there is a plan to move the framework to an action plan. I applaud that.
One omission from the current framework is an evaluation strategy. We know that suicide rates in Canada have not changed since the framework has been created.
How will the new framework create an evaluation component? I am not saying “if.” I am saying “how.” Will it focus on the key outcome indicators, which are rates of suicide, hospitalizations because of an attempted suicide and emergency room visits because of a suicide attempt? Those are the key indicators for impact — not whether we took a program and feel better. Will the plan be focusing on those areas?
Ms. Bennett: Absolutely. It is the way we are moving from evaluation to applied research. The tethering to the academy has been hugely important in the work that we’ve been doing to date. You and I believe we should start with research and then have the knowledge translated into a policy and then find the political will to get to the practice. But then you must have applied research on what you’ve put in place to make sure you are getting better research questions, to make sure we are asking the right things. I think those questions are, “Are we saving lives? Are we dealing with this in a real way?”
Flipping the switch on the 988 number means that we’d better have the capacity in place so that when people call that number — and this is what we have heard — we have competent people taking those calls. Do we have a team that would respond if they had to? Do we have a place to take them? We actually must have a comprehensive strategy. That means that with the help of researchers and with the accountability and transparency of the data, we can determine whether we are winning or losing on saving lives.
Senator Kutcher: I am very pleased to hear you speak about how important that applied research link to policy directions is for that three-digit number. We want to know whether it has actually decreased suicide rates in Canada or just been another crisis number. That would be really important.
To slightly switch the question here: Will there be an opportunity, as this action plan is developed, to commission, or get in some other way, an independent expert review of the private sector’s involvement in suicide prevention? There are all sorts of these programs for sale. People with good intention buy them. However, I am not sure that the people with good intentions sell them. The evidence for many of them is lacking. Will there be a chance to have a critical lens put on that kind of activity in Canada so that Canadians can be certain that if they are actually taking a program that is said to involve suicide prevention, it is actually preventing suicides?
Ms. Bennett: I am really interested in those answers because I think that we have seen industries build up around this. When I was doing Indigenous affairs work, literacy programs that don’t work were dumped into a band office. Again, this is not about us feeling that we are at least doing something.
I have seen examples of some of those programs working in a prison. At Stony Mountain, the lifers were trained how to identify the new people coming in and to buddy with them. That took their suicide rate down. But I also want to know what else has been successful.
With the help of this committee, if there’s something you want to suggest that we do and will tell us how to do it in terms of external review of some of the industry players in suicide prevention, I would very much welcome that.
[Translation]
Senator Petitclerc: You may have read or heard the very tragic story of a young woman in Quebec, Amélie Champagne. She tried to kill herself and wound up spending a few days in emergency in a hospital in a different city. She was sent to Montreal, and she went on to commit suicide. I’m not asking you to comment on that specific case, but it really highlights the gaps in the system when it comes to prevention, as well as access to emergency medical attention and health care. Obviously, Quebec has countless challenges around access to emergency medical attention and health care.
What do you think the federal government’s role is in ensuring those gaps are closed in order to prevent similar tragedies?
Ms. Bennett: That’s a good question.
I think good outcomes absolutely hinge on the provision of care after a visit to the emergency room. It’s also very important that the information be shared with family doctors.
In the health care system, information about an emergency room visit always has to be shared with Integrated Youth Services. Ensuring communication with Integrated Youth Services is key to the provision of quality care afterwards.
Senator Petitclerc: Thank you very much.
[English]
Senator Brazeau: Thank you, minister, for being here. First, for full disclosure, I am not a member of the committee yet but perhaps because of this study I may become a member.
I was very happy when you were named last year. I communicated with your office. Unfortunately, I have not heard from you yet. However, I am glad that you are here today.
I tried to commit suicide on August 2, 2014 and again on January 18, 2016. Just because I am a man and I’m an Indigenous person — because of those two facts — I have more chances of committing suicide than anyone else in this room.
On November 16, 2021, a story broke in the papers about 12 attempted suicides in Rapid Lake, Quebec, a community just north of my Algonquin community, north of Kitigan Zibi. Twelve attempted suicides; two people died.
Your government has talked consistently about truth and reconciliation, truth and reconciliation. Let’s get to that reconciliation because the truth is too horrible. We know that Indigenous peoples have increased chances of committing suicide. With everything that we know about the intergenerational trauma of residential schools, what is your government doing? In order to get to reconciliation, we need to do reparation. We need to help people who are hurting.
I am a senator of Canada. I was hurting. I tried to commit suicide. But I’m lucky because I’m here talking to you today about an issue that is very important to me. What is your government going to do for those Indigenous peoples, once and for all? It is time to stop with your bureaucratic bull crap about what we need to do for outcomes. No. What are we going to do?
Between 2017 and 2019, my office worked on a study about suicide prevention. We know that 75% of suicides are committed by men. That number increases if you are an Indigenous person. Inuit communities in Canada are home to the biggest suicide rates in the world. We know that. What my office did with that study is we contacted every provincial government. We wanted to know what they were doing in terms of suicide prevention.
Here is the key — and it is not a fight between men and women —but 75% of suicides are committed by men, but when you look at what provincial governments are doing in terms of programs or assistance for men and women, there is a huge disparity. Today, I don’t know where to go if I need help. I know where to call, but the number is so long. I tried to commit suicide twice, and I still don’t know the number. Now we’ll change it to a three-digit number. That may help. If we know that men, Indigenous peoples, are the ones who are committing suicide, why aren’t we focusing our programming on men? That is my question.
Ms. Bennett: It is such a powerfully important question. Your feeling that people do not know the truth is also part of it. People don’t know the truth about intergenerational trauma, child abuse or all of the things that predispose people to feeling that there is no other way than to take their lives.
I think that what we are learning is that we need culturally competent care, trauma-informed care. The Indigenous Physicians Association of Canada and Dr. Nel Wieman are doing really important work. Nel is really the first female Indigenous psychiatrist and a member of the Governing Council of the Canadian Institutes of Health Research, or CIHR. We have to do, “Nothing about us without us.” It’s going to be solved by us really learning about the role of Indigenous professional leadership on this, including knowledge keepers and elders.
One of the most recent CIHR studies on substance use at Kílala Lelum, on Vancouver’s Downtown Eastside, shows that people who are in touch with their language and culture are less likely, in terms of recidivism, to go into the street for their drugs. There is a hugely important understanding that we must support what the Indigenous communities know will work.
I agree with you. It is a fact that men, unfortunately, are more likely to achieve suicide than women, and we have to deal with those numbers. We need an action plan that responds to those numbers and responds to the fact that it is unlikely that someone sitting on a distress line from wherever will be able to meet their needs. How do we make sure that it’s culturally safe, that the Hope for Wellness Helpline is the one?
I met with Alvin Fiddler this week, and NAN, the Nishnawbe Aski Nation, has its own distress line. We have to make sure that there’s no wrong number, no wrong door. The reason we have had to wait on the 988 number is that places with the highest suicide rates don’t actually have the technology to be hooked up. How could we start something that wouldn’t deal with the most seriously affected?
We hope that you’ll stay with us on this. I would love to know anything that you have learned in your outreach to provinces and territories. Anything that you’ve got, I’m sure that this committee would love to have it in the study. We will make sure that all of your lived and living experience comes in, in our design of the plan.
Senator Brazeau: Thank you very much. As a quick supplemental, obviously this is not about me. It’s about those who are continuously hurting. I guess my question is this. You’re a doctor. With everything we know about post-generational trauma and all the harms that the Government of Canada has done to First Nations people — my question is simple — does the Government of Canada believe, and do you personally believe, that it is the responsibility of the federal government to enter into a reparations phase for the wrongdoings that were done when we are talking about mental health and suicide prevention so that we may get reconciliation?
I am a bit forward-thinking. I have a few years left here, 20 some-odd years. If we don’t do something here today — and I know elections come and go — I will make a bold prediction that, in 20 years from now, we will be talking about the same thing again. Indigenous people will be overrepresented in suicides. They are not going to have the help that they need. This is what we need to do. We need to put something in place. I know there will always be suicides, but the key is to try and prevent them as much as possible.
Here is the opportunity that we have so that in 15, 20 years from now, we are not talking about the same thing. Because 15, 20 years ago, when I started my career, we were talking about the same thing. I wasn’t born yesterday.
Ms. Bennett: I think what you’re saying is what everyone in this room believes: We don’t want to be having this conversation again in 20 years. We actually want to be putting in place things that work and the things that understand intergenerational trauma. I think people don’t understand it, whether it’s the epigenetics or the parenting gaps. All of the things that we know are part of people belonging, that secure personal cultural identity, your resilience — all of those things got completely extinguished during residential schools.
The Indian Residential Schools Settlement Agreement is there, but let’s get on and do the kind of work that will lead to, and bring real acceleration to, a healing journey, work that is designed by First Nations, Inuit and Métis. We will be there to support whatever we can do to get people along their healing journey faster.
The Chair: Senator Mockler ceded his time and, as you can see, Senator Brazeau used it well.
[Translation]
Senator Mégie: Thank you for being with us, minister. Forgive me for being late. You may have already addressed the question I’m going to ask.
In response to Senator Brazeau’s question, you said a plan was needed. I would add that it has to be tailored to Indigenous communities. Can that be achieved under the Federal Framework for Suicide Prevention? I have a second question. How can we understand what is happening in Canada’s cultural communities if the provinces aren’t collecting the information? Does the framework allow for that?
Ms. Bennett: That’s an excellent question. I think the plan has to take into account not only the specific realities of First Nations, Inuit and Métis communities, but also the differences between First Nations. That means the differences around geography and location, as well as capacity. A one-size-fits-all approach won’t work for all First Nations.
Developing a responsible and transparent plan means taking into account community diversity, data and evidence. I think the first time I sought information on emergency room visits, hospitalization and intensive treatment by province and territory was during the pandemic. Identifying the differences between the areas of responsibility and jurisdictions gives Canadians transparency. I also think it’s extremely important to provide transparency regarding the outcomes for the different communities, and to take into account the reality and the stigma facing people of South Asian and African descent. Mental health issues are associated with a great deal of shame in those communities, and my fellow members have spoken to me about how important it is to ensure that intensive treatment is available to people in those communities. Foreign students also experience a high suicide rate.
[English]
As we say in English, if you measure it, you know it, and if you know it, you have to do something. Right?
[Translation]
I think it would be helpful to have a plan that takes into account the figures for the diverse communities across Canada.
[English]
The Chair: Thank you, minister.
Senator Dasko: When I was in the public-opinion-research business, I worked on many files for Health Canada, so it is really great to see you still doing that valuable work. Thank you for being here.
So we’ve been talking about a particular segment of Canadian society. I want to talk now about the Canadian public. You have reducing stigma and raising public awareness as one of your goals. Could you describe what progress you have made in this area to date? What are the indicators you have that might show whether you’ve made progress? That’s the first question.
Second, from the academic research — and I’m not very familiar with this area — but what is the relationship between raising awareness and reducing stigma and suicide prevention? Is there an actual relationship between the two, and how does that operate? Could you describe what that is?
Ms. Bennett: It is something that we all play a role in. As we said at the beginning, COVID has made things worse. However, perhaps on stigma, it’s improved things a little bit. Because we were all struggling, people have been a little bit more likely to admit they are struggling, both in mental health and in substance use.
If we can take those gains to say that “mental health is health” — You wouldn’t be embarrassed to tell somebody that your blood pressure was up. But how do we move forward on that?
Also, we’re hearing from the South Asian and African communities that the stigma is so high that they won’t even tell their parents or their families, including foreign students. We’ve got to get leaders in those communities to be able to lead on this. A lot of the members of Parliament have come to me from the South Asian community saying that I don’t know how bad it is in their community. When I met with the African community in Edmonton, the third-biggest Black community in Canada, they have a network of Black therapists who can help.
If there is a huge stigma, people don’t seek help. They are too embarrassed to seek help or to admit they are struggling. We want to see people able to access care for mental health. It is why we are hoping to work on the kind of work that Dr. Kutcher has been doing on mental health literacy. How do you let people know that it’s okay to not be okay and to seek help? We’re seeing in substance use that people really aren’t telling the truth. In regard to people who have mental health struggles and substance use and, therefore, end up taking their lives, we have to deal with all of those parts.
Senator Dasko: So can I interpret from what you said that the focus really isn’t on public awareness, but it is on target groups where there are particular circumstances?
Ms. Bennett: We want mental health literacy in high schools. Senator Kutcher was saying that they even take it into public schools in Alberta. We need people to understand that mental health is health, and just learning about reproductive health when you are in grade 10 is not going to be enough. We need to have people understand their feelings.
Residential schools really drummed out — In the medicine wheel there’s mental, physical, emotional and spiritual quadrants, and the emotional quadrant of emotional — Not being able to admit your feelings, not being able to describe your feelings, is deadly. People can’t admit how they are feeling because of stigma or because they have no experience or were never taught it was okay to cry or to express that they are struggling.
[Translation]
Senator Mockler: Minister, I want to commend you. Your interest in the Federal Framework for Suicide Prevention is very welcome.
Madam Chair, I also want to acknowledge your leadership on this issue as well as Senator Kutcher’s ongoing dedication in this area.
[English]
Thank you for the time, and I cede the balance of my five minimums to Senator Kutcher.
The Chair: Senator Kutcher will have to wait for the second round. Thank you, Senator Mockler.
Ms. Bennett: Madam Chair, because of Senator Mockler’s point, one of the things I didn’t mention in my opening remarks is the importance of national licensure for the francophone community, for the Indigenous community, for young people who already have a counsellor but go to school somewhere else — for them to be able to maintain that continuity with their counsellor. It’s the same if they have a francophone counsellor, if they want an Indigenous counsellor — that’s one thing that Minister Duclos and I will be pushing hard for at the health ministers’ meeting.
I think the provinces and territories want to do it, and I think the colleges have been a little bit in the way. We need to find a way through.
Senator Moodie: Thank you, Minister Bennett, for being here today. I always love the discussions we have around health care.
I want to shift to access of care. As a pediatrician, both in the past and currently, access to care is probably the biggest problem that we face for children. Access to emergency care and access to post-event care continue to be the biggest problems. We’re here to evaluate the current framework, so let’s talk about what we know.
What do we understand about the state of access to care, both acute and post-event care, based on what we’ve learned from the current framework?
Second, as we move toward a national action plan, is there discussion under way with the provinces to get their agreement to collect outcome data? That would help us understand access to care. That way we can really get a real picture of where we stand.
Ms. Bennett: I think the report will be scathing on this, and we can’t do this without the data.
Access to care is really important. We’ve heard from the pediatricians, the pediatric psychiatrists, in a lot of the previous work, even being able to identify early psychosis and to actually have people with the appropriate treatment — A lot of the deaths we have seen, both in suicide and overdose — sometimes a young person with schizophrenia ends up with substance use and then takes their life, either accidentally or on purpose — When a child with needs is identified, we need to get them to help right away.
That kind of wait-list data is imperfect, unfortunately. As a family doctor, sometimes I have seen that the wait time only started when the person got to the cardiologist. The cardiologist said how long it took to get the patient to surgery, not how long I waited for the patient to see the cardiologist.
We need to make sure that, as we look at this data of access, that it is from the first moment or maybe even from the first time they called a line. That’s why the IYS, the Integrated Youth Services, is so important. Because the kids sign up and they are prepared — I mean, for some reason, children and youth are prepared to share their data. They want their counsellor to know that they were in the ER last weekend. They are prepared to have that kind of integrated chart that allows us to really look at what the time frames are between them presenting with concerns and when they actually get that kind of help.
As we look to stepped care — from peer counselling, to family doctors, to social workers, psychologists, the high-powered specialists in psychiatric care — we also need to be able to measure how long it took them to get through each of the steps. As we’ve seen with the tragedy of perinatal mental health and with Dr. Simone Vigod’s study that of the 40 people who came asking for help, only two needed the perinatal highly specialized psychiatrist. Most of the others were helped at some other level of care. As you know, suicide is a very grave risk in people who are postpartum who are not getting the kind of support they need.
The Chair: Minister, we all have talked about coordination and how important and critical it is. Let’s leave out the provinces for a minute. I know the way that conversation would go. My question to you is about coordination at the federal level, with federal departments and agencies. Let me assume that even though coordination will be there, it can always be improved. How would you like to see it improved? Would you consider the creation of a high-level ministerial round table to deal with the crisis of suicide?
Ms. Bennett: Yes, and I think in the next hour you will hear what the officials have been doing on exactly that issue. I have conversations with Minister Anand, Minister Hajdu and Minister Mendicino on corrections, which is one of my things. I think that the issue around prison is huge as well.
I want to start with your first question. I have coveted the U.K.’s NHS, National Health Service, approach where, as a family doctor, I could just go to the computer and get the young person in front of me an appointment for the next day for mental health supports. I think we can aspire to systems that would work, but I do think that we have a responsibility across the federal family to have this coordinated more. I was quite surprised speaking to Scott McLeod, who is head of the regulatory authorities and came out of the military. The military, on therapy, has an expected response curve, and if people aren’t meeting that curve, then they get a second opinion or something comes in.
So I think there are modalities that are being used in other departments that could be helpful or shown not to be helpful if we could actually get the kind of research and evidence that we think we need across the whole federal family.
The Chair: Thank you, minister. Let me pivot to my people, the South Asians in Canada. There are 1.6 million of them. Research has shown they suffer from high rates of anxiety and mood disorders and their rates of suicide are high. You mentioned the social stigma attached to disclosing, let alone counselling. Has the framework, as it is, has evaluated appropriately the depth of the problem in the South Asian community, and what it has advised you to do that you can actually translate into your action plan?
Ms. Bennett: I think Ms. St-Aubin will talk a little bit more about how things are evaluated. When I was in Peel this summer learning about the South Asian distress centre that received $150,000 to deal specifically with that community in a distress line. I think we want to know what happened to that money. Has it worked? How do you measure what works? The money that we gave to TAIBU in Scarborough to evaluate primary care across the Black community — are they getting enough supports? It’s the same with the Harriet Tubman Institute at York University evaluating the mental health supports for Black post-secondary students across the country.
I think we are starting with CIHR and other parts of the academy to actually get the kinds of answers that this committee is asking for, and that will be the basis for a serious action plan that will get results.
The Chair: Thank you, Minister. Let me remind you and your colleagues that 85% of South Asians are less likely to seek treatment than others. Let’s just leave it at that.
Senator Kutcher: Minister, in your thinking about the action plan, one of the things that we have found from recent literature reviews by Mann, Dillon and Mustafa, for example, is that probably the only robust intervention in suicide prevention is the training of primary care physicians to identify and treat. That leaves out all the other physicians and leaves out nurses and clinical nurse specialists. Will the action plan really focus on ensuring that all human service providers have the capacity to be able to — that’s teachers, counsellors, everybody who is a human service provider, not just a few family physicians. That kind of training across the board could go so far to be able to assist early identification and early treatment. It has to be in the medical schools, in nursing schools, in social work schools and in postgraduate training programs. Is that plan going to be thinking about that?
Ms. Bennett: Absolutely. As we hear from the College of Family Physicians of Canada, their plan is to extend its two-year residency — which I took, taught and examined — to three years because they are worried that the people that they are turning out are not comfortable in mental health, addictions and pain. So it would be interesting for the committee to ask them to explain how they see that third year.
I know that what I’m hearing in some of the addiction clinics is that when a resident comes in and gets first-hand experience with this, they kind of like it and are prepared to go on. It’s the same as with family physicians. We need more generalists who feel comfortable in those areas. I agree that it is the same across the health care provider spectrum. Everybody needs to be better at this. We cannot just have the emergency department thinking that someone is just trying to get attention, taking kind of dismissive approach that has caused lives to be lost.
I also think, Senator Kutcher, of the work you’ve done on barbers, hairdressers, taxi drivers and bartenders who can actually also have mental health literacy. Raising the mental health literacy of all Canadians is, I think, our ultimate goal as we go forward. Everybody should know how to recognize somebody who is not themselves today.
The Chair: Thank you very much, minister, for your time. We really appreciate it. We will take you up on that invitation for breakfast.
We will continue our meeting now with questions to the officials. There are no opening statements, so that will give us a lot of time to dig into the substance. Our first question will, as always, go to our deputy chair, Senator Bovey, from Manitoba.
Senator Bovey: Thank you, Madam Chair.
I have to say that the discussion with the minister was very important and very enlightening.
I will come back to something that I asked her and that Senator Kutcher developed in a much more articulate way than I did. It is on public awareness and training for all of us who have any kind of public role: teachers, nurses, whoever is in touch with people. How do you see this updated framework and your action plan developing that, knowing the cultural specificity and uniqueness of the many cultures that make up this country? I am talking Indigenous people, immigrants and those who were born in Canada but come from multiple cultural diversities.
I would be interested in your taking that further.
Heather Jeffrey, Associate Deputy Minister, Health Canada: As the minister was saying, for us, a critical part of the framework is prevention and early intervention. Ideally, greater awareness and greater training in mental health literacy, such as the work that Senator Kutcher is doing, will help reduce stigma and help people seek assistance earlier. That is really critical to preventing suicide. We need to have crisis lines. We obviously need to have those emergency supports. However, that broader awareness is critical. Stigma reduction in particular communities is important.
One of the areas where we have moved a long way in the last ten years is in the collection of disaggregated data. That kind of analysis at a much more specific level, whether it is by gender or by community, is critical to effective evaluation of programs, given how differently community cultures respond to some of these issues and the particular challenges that are faced in communities as a result of some of the trauma that minister Bennett was alluding to.
Senator Bovey: Do you feel that fear of seeking help is another thing? I think that is different from stigma in seeking help. I have no qualifications for this at all, but with the experiences that I have been thrown into, it seems I have been hearing from people who are very fearful.
Ms. Jeffrey: That is definitely a key ingredient. One of the areas of work where we found interventions to be the most effective is in peer support and peer counselling, for example, in integrated youth services. But across the board in different sectors, people feel most comfortable speaking to people who share their experience.
In the pandemic, the loss of social connection was one of the major factors in some of the higher rates of anxiety and crisis that we saw. A variety of tools will be required to reach out to those people. I want to turn it to Candice to speak to the specifics of the framework.
Candice St-Aubin, Vice-President, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada: Thank you, senator, for the question.
Just to build on what Heather was saying, the framework was first created several years ago, but now we have come through two-plus years of pandemic. The framework was structured at the time as more of a coordination function, federally. Since we’re now coming to the work that’s happened with the pandemic, and being able to finally access the critical information and data as best we can in our surveillance to find out the unique disaggregated realities of those sub populations, we have some lessons learned. We also have the work of this committee and, certainly, the work of Senator Kutcher around the literacy so that people are aware and can articulate what they are experiencing.
There is a fear. I think about the care system. I think of what has just happened with Ms. Echaquan and changes in Indigenous populations — that fear of going into an institution and what will happen, the cultural sensitization, the linguistic realities. Making sure that these issues are accommodated and reflected upon is part of the conversation.
We have a starting point with the federal framework now as it is. We need to go above and beyond. We have certainly heard Minister Bennett say, “Who is going to pick up the phone? Who will answer those questions? Where will that individual go?” These are portions that have to be explored in the continuum of services. There are issues potentially of fear, not just stigma, but even fear of who is going to be where I end up going to.
The Chair: Honourable senators, I will remind you that we also have witnesses online. They include Stephanie Priest who is with the Public Health Agency of Canada; Rhonda Kropp from the Canadian Institutes of Health Research; and Dr. Tom Wong from Indigenous Services Canada.
Senator Patterson: First, could PHAC, the Public Health Agency of Canada, submit to the committee a list of suicide prevention programs or interventions funded by the federal government for the period 2016 to 2020, indicating the amount funded and criteria used, if any, to assess whether a significant and sustained decrease in suicide rates in the population targeted has been achieved?
Secondly, under the framework act, PHAC must report to Canadians on its progress and activities relating to the framework every two years. You have done so in 2018 and 2020. When do you plan on tabling the 2022 report?
Third, we have heard Minister Bennett clearly say that the framework is going to be, as I understood it, almost replaced by an action plan. Will there be any interaction between the framework and the action plan when the action plan is launched?
Ms. St-Aubin: Thank you for your question. We’ll be aiming to table the next progress report in December of this year; if not, then we are into 2023, so we have to get that done. The action plan was also a member’s bill that was passed unanimously by Parliament. It does not necessarily replace. I think that it adds to, to put in place the framework and making it tangible and measurable, which is what we are all hoping to achieve; this is where it is really important.
Of course, we’re happy to provide in writing our programs, but are the suicide prevention programs the federal programs? I want to make sure because we, in fact, only funded the crisis lines.
Senator Patterson: Funded by the federal government.
Ms. St-Aubin: From all the departments — yes, we can do that. You bet.
Senator Patterson: That would be useful, thank you.
Senator Kutcher: Thank you, chair. Following on from Senator Patterson, I also have three questions. The first one is for the people here and then the other two are for the people online.
Currently, the framework does not identify or promote any of the good evidence of the effectiveness of interventions — zero. It also promotes activities that don’t work. A lot of those are promoted in the framework. Will the new action plan focus on promoting what we know works, studying what we don’t know and not promoting what we know doesn’t? That’s one question.
Now to CIHR. What is the strategy for directing research in suicide prevention at CIHR? Will the focus be simply through INMHA, the Institute of Neurosciences, Mental Health and Addiction or will there be a pan-institute approach; and if so, how will that be developed and how will what the federal government is doing inform that strategy, if at all?
The next one is for Dr. Wong. In a sad study by Pollock et al. at BMC Public Health, they noted that in about a decade over $108 million was spent on the National Aboriginal Youth Suicide Prevention Strategy, but an evaluation of that program could not provide outcomes only outputs. Will we have comfort that future programs will actually be evaluated for their outcomes and not their outputs?
Ms. St-Aubin: Yes, thank you for that. Certainly, the action plan is just that. Using an evidence base to determine what works and what does not work, as well as how we scale up appropriately. This is where these conversations come in, and certainly the recommendations that will come from this study will help to inform that, as well as ongoing conversations and what the minister is doing with her round tables across provinces and territories and meeting with Indigenous leadership and communities themselves. Yes, it is toward that. Thank you.
Dr. Tom Wong, Chief Medical Officer of Public Health, Indigenous Services Canada: Thank you very much. This is Tom Wong. May I address the question on outcomes?
The Chair: Absolutely, please do.
Dr. Wong: Indeed, evaluating outcomes is most important for us and our partners. One of the things that we are currently actively working on — with all of our Indigenous partners, First Nations, Inuit and Métis — is supporting Indigenous-led evaluation of outcomes, including working with Dr. Carol Hopkins and Dr. Brenda Restoule, among others. Thank you.
Rhonda Kropp, Associate Vice-President, Research — Strategy, Canadian Institutes of Health Research: Thank you so much, senator, for the question. To answer your first question regarding our plan and whether it sits only within INMHA: no. While our institute for mental health and addictions plays obviously a very key role in the research that we do, both in mental health and suicide prevention, given the nature of the topic, this has to be addressed across all of our institutes. It touches on everyone, and we spoke already today about the diversity of populations that needs to be taken into account. So the over $500 million that we’ve invested over the last five years has not just been focused within that institute but has been across the institutes.
I will note to your second question that we are here and will be and already are supporting our colleagues at the Public Health Agency as they move forward with the action plan to ensure that it is based upon the best-possible evidence, some which is CIHR funded, some which is outside of our funding realm. We want to ensure as they move forward in thinking about how to evaluate that action plan, that we look at different methodologies for evaluation and how best to do those so that the information on what is working and what isn’t is collected very rapidly and can be put into practice really quickly, like the learning health system model, in terms of the research that we fund.
Senator Petitclerc: My question is quite precise. I am not sure who can answer it.
When we think about the younger population — young adults and teenagers — when it comes to awareness and reaching out, of course, we want to focus on what they need in terms of information and content. I am wondering, are we being mindful on how they want to be reached? I am saying that because we spoke about that emergency, quick phone number, and I think it is great, but we also know that teenagers do not use their phone this way anymore. They want to be on social media or in a chat room. I heard a story somewhere about the chat emergency boxes. Are we being mindful of exactly what media they need in order to maximize what content we want to share with them? I am not sure who can answer that.
Ms. Jeffrey: It is a really great question. I think the world and landscape of technology and communications has evolved really rapidly. There isn’t a one-size-fits-all solution. The spectrum of youth services runs the gamut. There are integrated youth services, like Foundry and others across the country, where we’re on the path to a national standard and there is broadly accepted guidance for how to do in-person, direct treatment and peer counselling — a wraparound suite of services. That is one way of accessing service in a way that has been very successful.
During the pandemic, there was a big effort to find new ways to reach out to people who were distanced because of the demands of COVID. We launched at that time Wellness Together Canada, which is an online platform to offer alternate opportunities for Canadians who felt isolated and needed information or counselling to respond. When we looked at the disaggregated data, we found that youth did in large numbers choose to use the chat and text functions of that outline. Our crisis lines are also enabled for text and communications. Also, to use that then to tap into an actual online, in-person counsellor when required.
A lot of advances have been made in a very short amount of time. I think that one of our big challenges is completing working with CIHR and others the evaluation and monitoring of those new approaches. How effective are they? Based upon the numbers and the real-time data that we have, it seems like there was a need and a thirst for that. But the effectiveness of all those channels for different populations is something that is going to be a big part of our action plan moving forward.
[Translation]
Ms. St-Aubin: Thank you for the question, senator. I would add that we are also concerned about Indigenous young people, Black young people and other young people. We have funding that we give to research centres and communities. Mental health initiatives that target Black Canadians come to mind; we have dedicated funding for that community. For example, we have a basketball initiative for youth involving a community centre. We received advice from leaders in the Black community. We have to do testing to gather the data so we can determine whether the initiative resonates with that population, specifically, as compared with other youth across Canada. We have a number of ways to find out how it’s working and who it’s reaching. Language, culture and geography are also key factors.
Senator Petitclerc: Thank you.
Senator Mégie: I think my question is for both Ms. St-Aubin and Ms. Priest. Both of you talked about assessing what works and what doesn’t. When you find something that isn’t working, do you go further to figure out why it’s not working and what can be done to fix it?
Ms. St-Aubin: Thank you, senator. That’s a very good question. My colleague Ms. Priest is nodding her head to indicate yes.
We have funding, and we proceed on a step-by-step basis. The first step is to look at what is and what isn’t working. If something isn’t working, the initiative is terminated. The second step, however, is to look at why. I’m going to let Stephanie provide more information on that.
Stephanie Priest, Director General, Centre for Mental Health and Well-being, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada: Thank you. That’s a great question. I’m going to switch to English, if you don’t mind. My French skills are a bit limited.
[English]
Regarding the question that you asked, it is not only about understanding what works and doesn’t; the “why” is also a critical component. We need to ensure that when we go forward with our new actions in suicide prevention, as Candice has said, we’re not just looking at what doesn’t work, but we’re looking at why, because some things will work in some populations and some things will work in others; it is not always the same. So having an implementation science component that is attached to interventions that can be evaluated at the same time is absolutely critical. As Candice said, we do have some experience with that. Some of our existing mental health promotion programming looks at studying the implementation — why something works, why something fails — and communicating that so we can build on that experience as we design our suicide action plan. It is a very good point. It was one I had noted as well during that conversation.
[Translation]
Senator Mégie: Mental health is home to many different professionals, including psychiatrists. Family doctors, however, are the ones on the front lines. They are the ones patients turn to when they have a mental health problem, and even in cases where patients don’t report having trouble, their family doctor may detect otherwise.
Do you have any plans to work with colleges of physicians to promote mental health training among family doctors? I realize that your involvement is federal, but colleges of physicians rely on your guidance somewhat, do they not?
Do you have an answer to my question?
Ms. Jeffrey: Yes, the role of family doctors is very important. The bond a person has with their family doctor plays a significant role in how successful a treatment program is.
[English]
We’ve been working with The College of Family Physicians and others in general as part of our Health Human Resource action plan. As we all know, the system is under great strain. It is very important that all of the different members of the health care family, which extends far beyond physicians and nurses to psychologists, peer counsellors — there is a full range, as we were discussing earlier, of different professions that contribute to integrated care.
As I think Minister Bennett mentioned, The College of Family Physicians is extending their training program by an extra year, precisely to ensure that new family doctors feel confident and well versed in the mental health and addiction space, that it is not only referrals to specialists, who are in short supply and may not be required by all.
So in that stepped care model, the idea is that an individual seeking assistance would come, ideally, to a family doctor or their health care provider and be referred to the appropriate level of care within that system. They would have ready access to those services so that recourse to an emergency room is precisely that, only for emergencies, in a state of real crisis. People experiencing different levels of distress could be intercepted much earlier on in their distress and be referred to the appropriate point. That is a critical part of being able to cope.
Senator Dasko: I will go back to my question about public awareness and it being an important goal to raise public awareness, knowledge and reduce stigma.
Could you tell me whether public awareness changed over whatever period you might have studied? Has stigma been reduced? Has knowledge been increased? If you have done such research, could you describe the findings and how that question may have been addressed?
Ms. St-Aubin: Thank you, senator, for the question. What I can say is that in terms of measuring of reduction of stigma and measuring of increased public awareness and knowledge, there is no measurement attached to the framework. This is why the action plan is critical: to ground it. There are multiple programs that do invest in knowledge mobilization based upon various interventions being tested. There could be research. I would have to turn to my colleagues at CIHR to speak to it. We have to look at a series of anecdotal evidence.
Can I specifically say it has gone down by this percentage? I cannot, to be very frank. We do have, in the past few years, with our newer intervention programs in mental health promotion — looking at what good mental health is — as opposed to suicide prevention. There has been included in these programs a component of knowledge mobilization, of knowledge translation, and it has been done by focusing on equity deserving groups or those we have identified through the data and surveillance at being most at risk.
So there has been a purposeful inclusion of having that information dissemination there, because information is important to give, but it has to be founded upon evidence. It has to be based on what is working and not just continuing to promote what is not working.
Ms. Kropp: I will only add to what Candice mentioned to say that in terms of data, research studies will show different results, of course, depending upon which populations they are studying. If we, as a country, would like to be able to measure those outcomes consistently over time amongst very diverse populations, we need to make an effort to have some consistent standards against which we do those measurements.
Yes, we can summarize research findings to show what different research studies will do, but to Candice’s point, the important of the action plan is, in part, to be able to articulate the outcomes we want to mention and to determine how we are going to measure them.
Ms. Priest: I can also add on to Ms. Kropp’s and Candice’s comments here.
No, we don’t have those kinds of outcome measurements, as has been already described, but we did do some work that we should be able to include in our progress report later this year, looking at some of the areas where we have research gaps in the area of suicide prevention. We did do what we call a spotlight on the impacts of stigma and some of the gap areas that might be of interest for future research.
What we saw in that is the importance of reducing stigma from a perspective of help-seeking. We talked about how stigma can encourage behavioural norms of shame and fear. These are very individual.
One of the gaps that was raised in this work was also around structural stigma, which we have not talked very much about. This is about understanding more about some of those other broader system barriers and how they impact different groups in help-seeking in particular, but also on how that affects suicide prevention and accessing services.
[Translation]
Senator Mockler: My question is for the Health Canada officials.
[English]
I was reading the report sent by the Clerk of the Privy Council and Secretary to Cabinet to the Prime Minister. On the particular page on how we deliver programs, I am going to quote Ms. Charette. She says to the Prime Minister:
Mental health is deeply personal. What is a difficult situation for one person may seem quite manageable to another. What seems easy one day can feel impossible the next.
In my experience as a parliamentarian, she is right on that.
I know that there is an app associated with the Wellness Together Canada website, which was mentioned as a resource. Could you please provide to this committee, through the chair, the outcome data that Wellness Together Canada has been collecting, as well as the usage data of the application? Do we have an agreement on that?
The Chair: I think that I saw you nod your head in agreement, that you will send it to us. Thank you very much.
Senator Mockler, you have time left, or would you prefer for me to move on?
Senator Mockler: No thank you, Madam Chair.
The Chair: Okay. We’re going to go to Senator Moodie before we begin the second round.
Senator Moodie: Thank you to the witnesses today.
I want to return to this system barrier called access. We heard from Senator Brazeau a little bit about being in crisis himself. We heard from Senator Petitclerc an example of a very sad situation, and there are numerous ones like that; all of us who work in health care know them.
My question is around the acknowledged shortages of specialists. It is great to have an escalated system of care, where we can escalate care as needed through all levels of available care. However, when we need the specialist to take over care and to continue care, post-event, what we are facing in reality — and I hope you can share with us — is there data to document that, in fact, there is a limit or a restriction to care at that level? Because that’s one of the problems we need to solve. We need to track it carefully, we need to unmask it and we need to be demonstrating how actions to change that restriction of care at that level are working.
Is that part of the action plan for the future?
Ms. Jeffrey: One of the key parts of the action plan is to map access challenges. That’s one of the areas of greatest interest for Canadians and the federal government. It is not the same for all specializations across the health care system; some are in shorter supply than others. There is a need in the area of mental health and addiction, in particular, to assess a wide spectrum of the different specializations that have an impact on mental health care. There are a variety of health care streams and types of providers that can serve those needs.
Access is something that is a broader issue across the health care system. The federal government has funded mental health transfers and bilateral agreements with the provinces over a 10‑year period. We’re about halfway through that period, and access to care is one of the key areas of priority for that funding. Provinces and territories are now setting the next five years of their priorities, going through to 2027.
Again, this year, it is a very important time to be reassessing where we are at in terms of those shortages and looking not only at how to increase the number of specialists through additional recruitment and training, but there is also the issue of the retention of the health care providers that we have. During the COVID-19 pandemic, in particular, but also because they are front-line health care providers, to Canadians, it is a period of great strain and difficulty. In many areas of the profession, the attrition rate of people leaving the professions early and moving to alternate professions is also a high risk.
Our health care strategy will have to reflect all of those different dimensions that are impacting the number of providers we have for services. I would say that road map of human resources to support mental health care needs to be an important part of our action plan but also part of our broader plan for health care in Canada.
Senator Moodie: As we talk about mental health, I am particularly interested in knowing what concrete strategies are part of your action plan to move forward on well-recognized shortages. We know about it. We are even changing the definition of acute care. I see a kid, and I hear suicidal ideation; I want to send them somewhere, but there is nowhere. That is a problem that we all face.
They serve a very important role. We are not looking at school counsellors; we are looking at specialists here.
The Chair: Before we go on to the second round — and yes, Senator Mockler, I have you on the list — I will ask a very brief question to our witnesses online.
Ms. Priest, you commented on structural stigma. Perhaps you could elaborate a little on whether the framework has been helpful in identifying and addressing expressions of structural stigma in our system and communities and what you think the action plan should focus on in terms of structural stigma.
Then, if I have a minute, I have a question for Dr. Wong.
Ms. Priest: Thank you for your question.
The first part of your question is about what the current Federal Framework for Suicide Prevention is doing about structural stigma. It is not focused on structural stigma. We have not put a focus on structural stigma; our focus has been more on raising awareness and looking at stigma more from an individual perspective. We’ve done some work on safe messaging, and other government departments have done similar work. So, no, we have not had that focus.
I think is the next part of your question is around there being an opportunity for us to look at this in a national action plan. The answer is “absolutely.” It is one of the reasons why I put it on the table. I think there is lots we can draw upon with respect to structural stigma in some of our other work, whether that be around the prevention of substance-related harms and stigma around substance use and in other areas.
There is much work to be done there, and we would like to see more research in that area. We are open to ideas and views of the committee and other experts on how that can be addressed as part of a suicide prevention plan.
The Chair: Thank you.
Dr. Wong, from your seat in Indigenous Services Canada as the Chief Medical Officer of Public Health, I wonder if you could comment on the state of coordination between ministries, ministers and departments, and whether and how you think that could be improved.
Dr. Wong: Thank you.
At this point, with Public Health Agency of Canada, Health Canada, Correctional Service Canada and other federal departments, there are intensive and ongoing working groups and committees involving all of the different departments.
However, where I do see an opportunity for further work is to establish a table for federal, provincial, territorial, First Nations, Inuit, Métis and other racialized and marginalized groups, in a collective, t have those discussions. Currently, there are federal-provincial-territorial discussions. There are federal-federal discussions. There are federal-Métis-First-Nations-Inuit discussions. We need a table for federal, provincial, territorial, First Nations, Inuit, Métis and other marginalized groups. Thank you.
The Chair: Thank you. That was very helpful — both of you. Now we go to the second round.
Senator Bovey: I want to thank all of you. I think this has been a very helpful and important discussion.
I want to follow up with a question about something the minister said, if I may. I don’t mind who answers it.
Minister Bennett commented positively on the NHS. I am wondering if there are specific practices or lessons from the U.K. that we can learn regarding children, issues around diversity and suicide, stigmas and fears or outcomes and coordination.
I will be personal for a minute. I have children who live in the U.K., and they are not always so positive about the NHS. Are there positive lessons to be learned, or are there, in their data and outcomes, things that we should avoid?
Ms. Jeffrey: I can speak to that in part, and my colleagues can also weigh in.
As we go about this national action plan, one of the things is to learn from our international counterparts. We have an upcoming global mental health summit that we will attend that will afford additional opportunities to engage directly in person and to have international round tables on many of these key issues. This is a continuous learning process. In the NHS, they obviously have a very different structure than we do. It is not a federated system like we have in Canada, but I think this has allowed them to move forward in some of these more centralized approaches with more integrated care systems.
Just because we have a federal system doesn’t mean we can’t aspire to that, as the minister laid out. Certainly, we are engaging with them and with our other counterparts. We met quite recently with the U.K. body that is involved in setting standards and guidance. We are looking at how they do those processes. We are sharing best practices between ourselves.
I think that even though their system may not be directly comparable, some of the advances they have been able to put in place in select areas are definitely things we can draw on in terms of digital health and the sharing of health records and access. These are some of the things we are looking at.
Senator Bovey: I’m talking about a different disease, but I am aware, in a very personal situation, that the NHS has four different disciplines in the medical community working together and being on deck for the issue that my family is facing. Would the kind of teamwork that is in place in the U.K. for mental health and suicide be helpful for us?
Ms. St-Aubin: Stephanie Priest has a closer relationship with the U.K. and what we’re doing in the area specific to mental health. But when it comes to teams and the interdisciplinary coming together around mental health, we are already starting to see some of those pockets happen in Canada — very small. Certainly, we are learning about that through some of the 988 discussions we’re having and internationally as well. We’re working closely with the United States. We’re in lockstep, actually, as they’ve just rolled out theirs. The U.K. is one area, but we’re actually working with other countries as well — to do just that. It can’t be just one. It has to be multidisciplinary.
Senator Patterson: To the Public Health Agency, your progress report 2020 discusses work being done on the national suicide prevention action plan, which followed that unanimous motion from Parliament in 2019. It talks about continuing to facilitate coordination and collaboration.
Could you update us as to where work currently stands on the national suicide prevention action plan?
Ms. St-Aubin: Thank you, senator, for that question. Yes, we have an ongoing federal coordinating committee that brings together the federal departments. They report back to us, and we’ve been gathering that information in preparation for our 2022 release in December.
I will turn to Stephanie Priest, who actually chairs that committee, to provide a bit more of an update on where we are with the status.
Ms. Priest: The federal coordinating committee was established when we put together the Federal Framework for Suicide Prevention, and its main focus currently is information sharing and helping to develop the progress reports for the framework. Your question about the national action plan — I think that’s related to the Motion M-174, which received unanimous support in 2019. That’s why it was mentioned in the 2020 progress report. This was an opportunity for us to move forward. Then COVID happened, and we shifted a lot of our work into the response to COVID from a mental health perspective as well as in other areas, of course.
This action plan that we’re talking about is the action plan that Minister Bennett was also referencing. This is our opportunity to move the general pieces in the Federal Framework for Suicide Prevention. As I mentioned, there are six prescribed elements in the legislative framework, organized in three objectives. But they are very high level. When you bring in the requirement to implement an action plan around some key elements — around evidence, guidelines and best practices — this is, in fact, our opportunity. We just started to re-engage with key organizations and others to talk about how we move forward with the action plan effectively. Again, that’s what Minister Bennett was talking about in her opening remarks. For this committee, as well as others, and for our international partners, this is a great opportunity to make this into something more concrete and more directed toward those outcomes in evaluation.
Senator Patterson: Thank you. I note that the 2020 report stated, with reference to the national suicide prevention action plan, that there were no new resources attached to the action plan, which I thought was notable. So just a question here: Do you have enough resources to do this work?
Ms. St-Aubin: Thank you, senator. You are correct. Both the framework and the actioning of the national action plan have no identified resources. That said, we are still working on what this action plan will look like. Certainly, our hope is that conversations with partners across the board and from this study today could present an opportunity to seek additional resources if needed.
Coming out of the pandemic, we note that suicide mortality has been stable, which is not good enough. Again, while we have funding to do what we are currently doing, there is always a need for additional funding if it is something that is deemed a priority. I think we all feel that these conversations are that priority.
Senator Mockler: I have a question that was prompted when I heard Dr. Wong. I want to congratulate Dr. Wong. When you talk about FPT — federal, provincial and territorial — meetings, we are all mindful of provincial jurisdictions. That said, with my experience of 24 years in another chamber — in the New Brunswick Legislative Assembly — we all know how important those jurisdictions are.
I have a few questions. The minister earlier mentioned that in November — I believe it is this year — there will be an FPT meeting. Will this order of reference be on the agenda of the FPT meeting of ministers? Do you have any push-back from provinces or territories on that order of reference or that framework we are looking at? Do we have all of them buying into the program?
Ms. Jeffrey: I can answer that. Obviously, the provinces and territories are the providers of health care in Canada. It is critically important that we work together. The federal government has a role in many different aspects — regulatory, providing standards, setting guidance, research, funding — but provinces themselves are implementing care on the ground and are closest to the needs that they see.
I have to say that with the appointment of Minister Bennett, we have been able to shine a spotlight on mental health and addiction, and she has direct counterparts in many of the provinces and territories. We’ve been engaging with them and will have a dedicated meeting where these issues will be squarely on the agenda. There will be the broader meeting in November where these issues will also figure into the agenda.
These issues are critical. Coming out of the pandemic, provinces and territories acutely feel the need for improving and advancing mental health and addiction services. They are also feeling the health and human resource pressures that Senator Moodie was alluding to earlier. There is a unique opportunity as we move forward in this action plan with this revitalized interest and awareness of the challenges that we’re facing. Quite to the contrary, we’ve received no push-back. Provinces and territories proactively identify these issues as critical priorities to forward.
Ms. St-Aubin: Senator Mockler, that’s a very good question. Most, if not all, provinces and territories have some sort of suicide prevention framework, strategy or programming, but it is happening on such different levels. As the federal government coming in as an interlocutor, we have to ensure that we do not seem to want to take over what they are doing. Rather, we need to look at how we can support, coordinate and learn from each other. We’re certainly learning that with 988 and the suicide crisis lines as well. We have conversations with our provincial and territorial counterparts where they have their own programs — Quebec, et cetera. We want to make sure that we are trying to do it in a complementary way.
Senator Kutcher: As an overall question, I wonder if you wouldn’t mind sharing with us your thoughts — later on, not at this point — on areas that you think our report should not forget to focus on. This gives you an open opportunity. We have had lots of different discussion here, but from your perspective, what do you want to make sure that we don’t miss, because you are actively engaged in this?
The second part is on data. We will all fondly, or not fondly, remember the data discussions during the pandemic when we found to our dismay that there was no substantive data on the mental health of the population that we could take to the bank. There was no collaborative, collective administrative data on mental health utilization, and there was absolutely no data on outcomes.
Would our focus on data be useful to you in bringing forward the absolute need for that? Also, do we have anything like a national suicide surveillance program in place, or are you planning to put that in place? Would something like a national suicide surveillance program be useful in terms of helping us inform what we are doing and how?
Ms. St-Aubin: You are talking my language. This is wonderful. Just to start with your last portion around a national suicide surveillance system. I see Rhonda Kropp, a former colleague of mine, who led in having conversations about what pan-Canadian suicide surveillance data would look like. Certainly, there isn’t such a system that is national in scope. COVID has allowed us some opportunity because we had to be proactively strategic in how we try and access data from our provincial and territorial counterparts, and we have done it in the opioid space. Part of my team have parachuted in surveillance officers in chief coroner’s offices and chief medical examiner’s offices to try to get access to opioids mortality data. We are also doing the EMS and ER visits. Just from what COVID taught us, and opioids where we had to get in there — because the opioids were a crisis before the pandemic. We are now looking at how does that look and translate into the suicide realm? How do we access suicide data in a timely fashion? And exactly what you were asking the minister about EMS and ER visits.
You asked what I would like to hear and see from your study — it is those types of innovations. And from what you’re working on, I would love to see it explored a little bit more and how we can make that happen.
I will turn to Rhonda to talk about the first portion of your question about data, which we are always happy to see.
Ms. Kropp: Thank you very much for that question. This is near and dear to my heart as well.
There are a few things that may be quite helpful for the committee to consider as you do your own deliberations and your study. One is that we have the opportunity to look at evaluation beyond what we currently do and its current context. Often what you will see in reports is, “We need to evaluate and have outcomes.” This does not necessarily mean that we need to do evaluative research at one point in time, write a report and put it away. I think there is an opportunity for us to think about building evidence and building evaluation into care itself so that it is evidence producing, evidence generating and evidence using in a quicker manner than we currently have.
There is always benefit to evaluative research where we get a study done and then we try our best to work with partners to ensure those findings are taken into care. When we actually embed research into a learning health system, if you will, it is so much closer to the care; it’s part of the integrated team, and we are able to reduce the time from findings to adapting our care, our systems or our models.
One thing I would suggest is, when we are thinking about evaluation, can we think broader? Can we think about models that allow us to use that evidence more quickly so that our care is more cost-effective and more effective for Canadians as a whole?
The second thing I would note, to build on Ms. St-Aubin’s point on data, I think we also need to be careful to note that what we need is to be able to answer certain questions. Different data will be needed to answer different questions. In some cases, surveillance data will serve that. In some cases, research data will serve that. In other cases, we just need other methodologies. If we continue to think about the questions and ensure that the data form follows that function, we will be in a much better position, rather than getting data and then hoping that it fits the bill to answer the questions.
[Translation]
Senator Mégie: I’m not sure who can answer this, but most of you are from Health Canada. As far as the leading causes of death are concerned, the figures show that accidents result in three to five times more deaths than suicide, which is described as a self-inflicted injury. Is it possible that some deaths are being miscategorized and that, as a result, the statistics aren’t revealing all suicides because they are being concealed unintentionally? Is there a way to fix that, to obtain more detailed data on the subject?
Ms. St-Aubin: Thank you for your question, senator. Yes, we agree that the data may not be exactly perfect. Was a death the result of an unintentional accident or suicide? The same can be said of the mentality around opioid or substance use. Are there opportunities to correct that? Yes, I think the discussions.... As Ms. Kropp pointed out, it’s important to ask the right questions to obtain data that are specific enough to capture the real figures. I don’t have the information with me now, but yes, I think the discussions — including with senators — on the issue of indicators, the appropriate way to measure them and their definitions are important. Something we haven’t discussed today is how suicides, accidents and so forth are defined. That is so important….
[English]
To really have a true impact and measure that impact, we must define it and ask the right questions. So yes, you are correct.
Ms. Jeffrey: I think that the research we have seen shows that there is a large amount of under-reporting of suicide data, and it comes from a good place where coroners or care providers are trying to spare the family the pain of that conclusion. It is well documented that there is under-reporting. The size of that would have to go into the broader data strategy and the definitional component that Ms. St-Aubin was talking about, but it’s a real issue.
Ms. Priest: I just wanted to add to the conversation to say that our surveillance team at Public Health Agency of Canada is working at strengthening relationships with coroners and chief medical examiners to address the matter or misrepresenting certain deaths, how they are categorized and how they are coded. That is, of course, a work in progress.
We need to measure deaths, of course, but there are other aspects of this that we would want to look at to be able to understand what is really going on. Once we have the data, all kinds of data, there is a big part of this work about how we use that data to influence and inform our policies and our actions. So the translation of that data, I would just put on the table, is critical as well.
The Chair: Thank you very much. I did have a couple of questions, but our time is sadly over.
Colleagues and witnesses, I would like to thank you very much for your time here. It has been extremely useful in advancing our deliberations on this report.
Honourable senators, our next meeting will be Wednesday at 4 p.m., where we will continue our study on the Federal Framework for Suicide Prevention. I understand that the subject of this study can be difficult. Therefore, I would like to remind senators and their staff that the Employee Assistance Program is available and provides free, short-term counselling for both personal or work-related concerns on a 24-7 basis, in addition to crisis counselling.
If there is no further business, honourable senators, this meeting is adjourned.
(The committee adjourned.)