Rose pursuant to notice of June 19, 2024:

That she will call the attention of the Senate to ongoing concerns with respect to mental health, substance abuse and addiction parity in Canada.

She said: Honourable senators, it is an honour and a privilege to bring forward this inquiry. On June 19, 2024, I rose here to draw the Senate’s attention to ongoing concerns with respect to mental health, substance abuse and addiction parity in Canada. I want to thank my team, the Library of Parliament research team, my Senate colleagues and the staff members who were so generous with their time as they patiently listened to my ideas and suggested ways to move this issue forward. In particular, I would like to thank Senators Lankin, Kutcher, Boyer, Hartling, Bernard, Cordy, Batters, Brazeau, Greenwood, Coyle, Black, Osler, Patterson, McCallum and Seidman, as well as my group, the Canadian Senators Group.

I also want to thank the organizations and individuals who generously shared their expertise and gave their time. Over the past six months, we met with roughly 200 people and 30 organizations. We reviewed 100 reports and spent over 600 hours working on this issue.

We consulted the Mental Health Commission of Canada, the Canadian Association of Social Workers, the Canadian Centre on Substance Use and Addiction, the Canadian Mental Health Association, the Centre for Addiction and Mental Health, the Public Health Agency of Canada, the Office of the Chief Medical Officer of Health of Ontario, First Nations and Indigenous organizations, universities and people with lived experience, to name but a few. Some of these stakeholders will be taking part in the round table on mental health parity on September 20 at 1 p.m. I invite you all to attend.

The round table will be moderated by Dr. Paul Roumeliotis, the chief medical officer for eastern Ontario. Paul and I were pediatric residents together 40 years ago at McGill University at Montreal Children’s Hospital. Who knew that all these decades later we’d be working together on such a monumental issue?

I want to salute former senator Percy Mockler. A few months after my appointment, he approached me just outside the chamber and, with that gentle voice and those piercing eyes, asked a crucial question: What did I want to accomplish here in the Senate? My response came right from the gut: “I want to work on mental health parity,” I said. And Senator Mockler responded, “No one will know who you are until they know what you care about.”

Let me explain why mental health parity is an idea whose time has come. At no other time in our lifetime has the pressing issue of mental well-being, mental health, substance use and addiction been on the minds and the lips of almost every Canadian. For more than 30 years, I was a pediatrician specializing in mental health. I saw first-hand the long wait times and lack of availability of in-patient and community mental and behavioural health services. I also saw the sometimes devastating consequences for children, teens and their families. I’ll share a couple of stories.

There was a suicidal child — who tried to jump out of a moving car because of not wanting to go to school — who, as it turned out, had a severe, undiagnosed learning disability. There was a parent grappling with substance abuse who was unable to obtain child care in order to attend outpatient addiction treatment services.

I’ve not only treated patients with mental health problems, like so many Canadians, but I’ve also experienced it in my own family. We immigrated to this great country from Jamaica in July 1976. We were full of promise, as both my parents were well educated, with English as our first language. They should have easily found good jobs in their particular fields, but, as many of you know, that transition is not as easy as it should be.

My father was a brilliant man, a gifted orator and a voracious reader whose library was filled with books ranging from John Kenneth Galbraith’s economics texts to ancient Greek history. But within four years of immigrating to Canada, he was diagnosed with a very severe depression and diabetes. Someone who was normally the first person up in the morning, who was impeccably dressed and extremely well organized and who never missed a day of work in his life could not get out of bed. Our family had never faced anything so daunting. However, thanks to a wonderful family doctor, who even made home visits, my father recovered in due course.

That experience stayed with me, and it was likely one of the reasons that I found myself answering the call in the 1990s to help build an in-patient and stabilization mental health and behavioural services program for children and families in my community, and later founding ADHD Windsor in 2006.

Many people have been working hard, trying to provide mental health, substance abuse and addiction care. But the outcomes that all of us desire — universal and equitable access to mental health and addiction services, a stepped care model, evidence-based treatment and support in the community, and better recovery outcomes — are increasingly out of reach.

The proportion of Canadians aged 12 and up who reported having poor or fair mental health doubled between 2018 and 2022. In a given year, 6.7 million Canadians — or one in five people — experience mental illness. By age 40, that number increases to one in two Canadians. Marginalized, Black and 2SLGBTQIA+ groups have an increased risk of mental health disorders. Indigenous communities are facing epidemic and record levels of mental illness, substance abuse disorders, overdose and deaths rooted in colonial, historical, residential school and present-day trauma.

As we should all know by now, 70% of mental health disorders start in childhood. There are 1.6 million children and youth in Canada who are estimated to have a mental health disorder, but Children’s Mental Health Ontario reports that 28,000 children in Ontario are on wait-lists for mental health services, and some wait more than two years to access appropriate care. That’s unacceptable.

A study by the Mental Health Commission of Canada found that the direct and indirect costs of mental illness in 2021 were a staggering $90 billion and are projected to rise to over $300 billion by 2041. The Conference Board of Canada reports that without timely investments, the lifetime cost of just one cohort of children with the onset of anxiety and depression at the age of 10 is close to $1 trillion — that’s trillion with a “T.” It also finds that investments in children’s mental health today, with a focus on accessible, inclusive programming for vulnerable populations, can save $28 billion annually. Moreover, a submission by the Canadian Mental Health Association notes that every dollar spent on mental health returns $4 to $10 to the economy.

It is because of my personal and professional experiences that I am committed to doing everything I can to keep this issue a top priority at the federal level and with all Canadians. I hope to spark legislation that will make mental health parity a requirement.

Colleagues, like you, I know that the role of the federal government is to show leadership in defining a problem, building a framework and targeting funds for possible solutions. Recognizing that health care delivery is largely within provincial and territorial jurisdiction, any federal legislation would have to be done in consultation with the different levels of government as well as Indigenous governing bodies.

In 2006, the Standing Senate Committee on Social Affairs, Science and Technology delivered a landmark report entitled Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. I was present when the committee chair, former senator Michael Kirby, brought those findings to Windsor. I now have the privilege of being a member of that very same committee, and I intend to build on that important work.

Over the course of this inquiry, I hope to hear from you, my esteemed colleagues, from your diverse areas of experiences and expertise about how we can raise the level of consciousness about the critical importance of mental health parity, how you define parity, and how we can connect the dots across the lifespan and the whole of society, as well as discuss the role of the social determinants of health, and how we can identify federal policies and legislative measures that can turn the vision of parity into reality.

What do we mean by parity? According to the Canadian Association of Social Workers, “parity” or “parity of esteem” means:

valuing mental health as much as physical health in order to close inequalities in mortality, morbidity or delivery of care.

In 1953, Dr. Brock Chisholm, the first director general of the World Health Organization, coined the phrase “without mental health there can be no true physical health.”

The stated objective of the Canada Health Act is to provide universal and comprehensive health care to promote the physical and mental well-being of Canadians, although its true meaning has never been actualized. This is why this inquiry is so important.

In fact, the research evidence is very clear. Mental health and physical health are fundamentally linked. Patients with Type 2 diabetes mellitus, for example, are twice as likely to experience depression as the general population. In patients who are depressed, the risk of having a heart attack is more than twice as high as in the general population. Children with medical complexity have a higher risk of neurodevelopmental and mental health conditions, and they utilize more health and social services.

The federal government has recognized the need to act. It has pledged billions of dollars and agreed to shared priorities with provincial, territorial and Indigenous governing bodies, but it has so far fallen short.

The 2021 mandate letter for the then health minister directed him to establish a permanent Canada Mental Health Transfer to increase the availability of mental health services, in line with the Liberal platform to:

. . . ensure that mental health care is treated as a full and equal part of Canada’s universal public health care system.

The 2021 Liberal election platform pledged an initial investment of $4.5 billion. The Youth Mental Health Fund announced in Budget 2024 was a good start, but $500 million over five years isn’t close to what is needed.

In June, the Canadian Mental Health Association sent an open letter to the Minister of Health Mark Holland saying that:

. . . Canada has failed to put in place a federal legal framework providing mental health and substance use health care equal to physical health care.

Both the U.K. and U.S. have mental health parity acts, and it makes a difference. Canada spends only 7% to 9% of health care dollars on mental health whereas the U.K. spends 13%.

There is no time like the present to seize the opportunity to keep this at the top of the public policy and legislative agenda. So today, as we stand on the shoulders of those who have gone before, let us grasp the baton, rise up to build on the Canada Health Act and the Kirby Report, take the next step and continue the work of making mental health, substance abuse and addiction parity a reality in Canada — out of the shadows at last.

I look forward to hearing your stories, ideas and insights, and I hope you will consider attending our round table co-sponsored by Senator Seidman and Senator Kutcher tomorrow, September 20.

Thank you, meegwetch.

Thank you so much, and thank you for speaking it into action. Tabling a bill, in the other place or here, that will be taken into account.