I call the meeting to order.
Welcome to meeting number 53 of the House of Commons Standing Committee on Health.
Today we will meet for two hours with witnesses for our study of children's health.
Today's meeting is taking place in a hybrid format, pursuant to the House order of June 23, 2022.
I have a couple of comments for the benefit of our witnesses today.
For those who are participating on Zoom, you have interpretation available to you, and we know now that it is working. You have the choice at the bottom of your screen of either the floor, English or French. For those of you in the room, of course, you can select the desired channel.
Please don't take screenshots or photos of your screen. These proceedings will be made available on the House of Commons website.
In accordance with our routine motion, I'm informing the committee that all witnesses have completed the required connection tests in advance of the meeting.
I would now like to welcome the witnesses who are with us this afternoon. We have Dr. Tracie Afifi, professor at the University of Manitoba, appearing by video conference. From the Canadian Counselling and Psychotherapy Association, we have Ms. Carrie Foster, president-elect, and Lindsey Thomson, the director of public affairs; and from the Offord Centre for Child Studies, we have Dr. Stelios Georgiades, director, and McMaster Children's Hospital chair in autism and neurodevelopment. He's with us by video conference.
Thanks to all of the witnesses for being with us today.
Each of you has up to five minutes for your opening statement. We're going to begin with Dr. Afifi.
Welcome to the committee. You now have the floor.
The most recent UNICEF data on child well-being in high-income countries indicates that Canada ranks 30th out of 38 countries. This, along with our need to support children and youth to recover from the COVID-19 pandemic, emphasizes that now is when we need to fully invest in children and youth to foster healthy development and resilience. This requires several strategies.
First, it's recommended that we invest in long-term funding for youth and child health research. Second, it's recommended that we implement strategies to effectively translate this research into policy and practice. Third, it is recommended that we train and retain health care and social service professionals to develop a network in which systems can share information and collaborate. Fourth, we need to be able connect all children in a timely manner to health care and social services when needed.
However, we need to consider these recommendations within the context of children's environments, in which they live, grow, develop and learn. What does this mean? It means that for optimal health we first need to ensure that children's and youths' environments are both safe and stable. It requires an approach that includes addressing poverty, racism and violence.
Today, I would like to focus on violence and the home environment to demonstrate that healthy child development is actually not possible when children live in unsafe and unstable homes.
The Centers for Disease Control and Prevention in the United States indicates that safe, stable and nurturing relationships and environments are important for preventing child abuse and neglect and fostering resilience, but you might wonder why we need to prevent violence to improve health. The answer is that spanking and child maltreatment are associated with an increased likelihood of mental disorders, physical health conditions and many other poor outcomes. An individual cannot achieve optimal health if they experience violence.
How common is violence in homes in Canada?
Although we don't have representative data on spanking in Canada, we do know from community samples that hitting children as a means of physical discipline is common. We also know that conclusive evidence across decades and over thousands of studies indicates that spanking is related to mental disorders, physical health problems, substance use disorders and thinking about and attempting suicide in childhood and across the lifespan. Children who are spanked are more likely to experience severe physical abuse, sexual abuse, emotional abuse and exposure to intimate partner violence.
Our team has analyzed data from a nationally representative sample of Canadian adults who retrospectively reported on their childhood experiences. We found that 32% of individuals in Canada have experienced child abuse, including physical abuse, sexual abuse and exposure to intimate partner violence.
Let me repeat that: One in three Canadian adults has reported experiencing child abuse.
We further analyzed these data and found that individuals who experienced child abuse were more likely to have depression; bipolar disorder; generalized anxiety disorder; obsessive-compulsive disorder; panic disorder; post-traumatic stress disorder; phobia; attention deficit disorder; eating disorders; alcohol abuse or dependence; drug abuse or dependence; suicidal ideation; and suicide attempts.
Our research has also indicated that spanking, slapping, harsh physical punishment, child abuse and neglect are associated with increased likelihood of several physical health conditions, including hypertension, liver disease, diabetes, cardiovascular disease, gastrointestinal disease, obesity and arthritis.
Please recall the four recommendations that I began with: All these recommendations should incorporate violence prevention to achieve our greatest likelihood of improving health outcomes for children and youth.
To summarize, we have recommendation one: long-term funding for research.
We need ongoing data collection and infrastructure in place to be able to act quickly when evidence is needed, such as in the COVID-19 pandemic. We did not have these research mechanisms in place during the pandemic and we were not able to act quickly to produce the data to improve the health outcomes for children and youth. What is needed is ongoing, longitudinal nationally representative data collection that includes measures of health; violence; other social determinants of health; systemic barriers; access to care; and potential protective factors.
Recommendation two is for knowledge translation and mobilization to connect research to policy and practice related to improving health and preventing violence.
Recommendation three is for training and retaining. We need to train and retain health care and social service professionals and develop a network in which these systems can share information and collaborate.
Recommendation four is for timely access to health care and child protection for all children and youth when needed.
To conclude, violence prevention and early health intervention will yield the best outcomes for children, youth and families in Canada.
Good morning. Bonjour
. I am here in the capacity of president-elect for the Canadian Counselling and Psychotherapy Association, or CCPA. I represent more than 12,000 members who provide essential mental health services across Canada.
I would like to speak today about the significant mental health trends affecting children and how the government can take immediate action to relieve some of the burden to Canadians of the cost of mental health care.
Children in Canada are desperate for and yet are struggling to access mental health support. There is clear and growing need for help, but our system is failing these children. Long wait times demonstrate that the demand for services outweighs the capacity of providers.
Counselling therapists and psychotherapists can and are willing to meet the demand. These mental health professionals have had to be the most available during the pandemic, compared to other health professionals.
Strengthening Canada's mental health care supports by increasing accessibility to providers is essential to pandemic recovery and to a thriving and healthy society. Despite health care being a provincially regulated matter, there are small, actionable, and yet impactful federal policies and legislation that can be amended in order to improve supply and access to qualified mental health care providers in Canada.
At present, counselling therapists and psychotherapists are the only regulated mental health service providers that must remit tax on their services. Physicians, psychiatrists, registered nurses, registered psychiatric nurses, psychologists, occupational therapists and social workers are all exempt from GST/HST on their psychotherapy services.
Counselling therapists and psychotherapists are excluded from this exemption. This contributes to reduced access to mental health services for children by creating unnecessary financial pressure.
The profession of counselling therapy/psychotherapy meets the threshold for tax exemption in the Excise Tax Act, as it is regulated in five provinces. However, because the profession does not regulate the same title in all five provinces—title being a provincial decision—the Department of Finance does not accept that counselling therapists and psychotherapists are the same profession in order to meet that minimum threshold.
The profession is the same in all but name. Counselling therapists and psychotherapists across Canada share a common scope of practice, abide by similar codes of ethics and standards of practice, have a comparable training and education profile, and have a commitment and obligation to ongoing continuing education. They are qualified, competent, and available to meet the skyrocketing mental health care needs of children in Canada, and yet the additional cost of GST/HST tax on their services is limiting their capacity to serve their communities and those seeking care.
To ensure universal access to all mental health professionals, services provided by psychotherapists and counselling therapists should be tax-free.
This exemption would enable a child seeking care to access a few additional sessions over the span of a year. These extra sessions could make the difference between a child's ability to fully integrate their learnings and positive changes and habits for improved well-being. We call on the committee to support CCPA's recommendation to the federal government to legislatively amend the Excise Tax Act through a financial bill that adds the profession of counselling therapy and psychotherapy to the list of GST/HST-exempt health care professionals.
Thank you very much. I'll be pleased to answer your questions in French or in English.
Thank you, honourable chair and honourable members of this committee.
Today, I join you from the authentic and resilient city of Hamilton and its surrounding areas, in the province of Ontario.
I am here to represent the members of the Offord Centre for Child Studies, which is a multidisciplinary research institute dedicated to improving the lives, health and development of children and youth. The Offord Centre is affiliated with McMaster University, McMaster Children's Hospital and Hamilton Health Sciences.
Today, I will position my testimony on one strategy for child and youth health that enhances all other strategies related to that.
The late Dr. Dan Offord, founder of the Offord Centre for Child Studies, believed that tracking children's life trajectories was vital to improving their health and well-being. To Dr. Offord, a clinician and researcher who worked at McMaster University—the birthplace of evidence-based medicine—data were key. Data help us identify and understand problems, and lead to evidence that helps formulate, deliver, evaluate and refine solutions.
Our recommendations for the Standing Committee on Health's study on children's health reflect the belief that everything we do to improve, support and sustain the physical and mental health of Canada's children and youth can become more efficient, effective, equitable and sustainable through evidence that builds on high-quality research and data.
The recommendations in this brief are a single, overarching recommendation in five parts. A strong national commitment to research in child and youth mental and physical health needs to build on an infrastructure capable of supporting that commitment. I'm glad these recommendations overlap with the ones noted by Dr. Afifi, earlier today. This is the best strategic path to achieving a significant and sustainable impact on all aspects of child and youth health. That impact can be pervasive, enhancing programs and services at the federal, provincial, territorial and municipal levels, and within not-for-profit institutions nationwide. A single strategic decision can generate multi-faceted and lasting benefits for our children and youth.
I'm now going to outline five high-level recommendations.
Number one, establish long-term funding for research on child and youth mental and physical health as part of a national child and youth comprehensive health strategy.
Number two, establish a national research network to collect, coordinate and harmonize data related to child and youth mental and physical health in a research-accessible system.
Number three, invest in training researchers and frontline staff who can conduct research, translate research into policy and practice, and deliver care that reflects and contributes to research.
Number four, adapt our existing data-gathering practices to accommodate the specific needs of children and youth.
Number five, develop a learning health system in child and youth health to better connect research findings and evidence with the design and deployment of policy, care and training.
To conclude, we currently have inadequate information on a spectrum of health outcomes and factors ranging from child and youth mental health to race, ethnicity, child maltreatment and parental health. Many of the witnesses who testified before this committee have shared this.
Canada needs to invest in the coordinated effort and infrastructure required to generate the essential data, research and evidence leading to evidence-based policies and practices that foster healthier children and youth, a healthier society and reduced inequities. This kind of national investment—one that coordinates data gathering and analysis across provinces and territories—is a mandate that only fits with the Government of Canada. It is very timely within the larger context of the dialogue happening in our country, right now, in relation to health.
As a nation, we need to expand and enrich our ability to coordinate data collection, management and analysis. Then we need to embrace evidence-informed policy and practice to bridge the gap between research and the design and delivery of policy and practice that can improve the lives of children and youth and their families in this country.
I want to end by thanking all of you for your time, commitment and all you do for Canada's children and youth.
Thank you, colleagues, for that moment to reflect. I certainly think it's germane given the difficult topics we're talking about here and that we continue to discuss at the health committee.
Chair, I would like to start with Ms. Foster, specifically about the removal of GST and HST with respect to the services of counsellors and psychotherapists.
Could you just give us a brief idea of how that may affect accessibility and also how it may affect a practice? In my province it's 15% extra. Some people might not find that difficult. In my mind the argument is that sometimes the people that need the help the most are those who are suffering the most financially as well.
If you could provide some comments on that, I'd appreciate it. Thank you.
I can't give you the exact number, but I know that counsellors and psychotherapists nationally—and it differs from province to province—aren't necessarily all on par with the insurance companies that are out there. We are working with the the Canadian Life and Health Insurance Association to try to get them to include psychotherapists as much as they include psychologists and social workers.
Our membership, our indigenous folks.... There are creative arts therapists, there are those who work in social justice contexts and in schools. Not all of them will have access to counselling. That's a huge piece. That's a huge ask. We're not even asking for that today, but it's a big piece that needs to be looked at, in my humble opinion, as to how people can get access.
Yes, there is some availability. Not all counselling therapists and psychotherapists are admitted into all of the programs. At this point, we have been removed from the NIHB program. We were added during the pandemic. Presumably when and if the pandemic ends, we'll be taken out again.
That means that indigenous folks who work with us who have their Canadian certified counsellor permit will not be allowed to work in their communities, with their people, because they're CCCs.
I think it's really important that we look at what that is, so that we have not just early access to mental health, but also.... That gentleman in Laval...perhaps if he'd had help earlier on and had had access to services, he wouldn't have been doing what he was doing.
Absolutely. I'd love to.
Certainly, we understand that in Canada, there's a significant mental health crisis, with almost a third of Canadians suffering with their mental health. We know that the Liberal government has continued to promise a $4.5-billion Canada mental health transfer, which has not been actioned. In my mind, that type of money could be transformative, not only to the delivery of services, but obviously to the lives of the many Canadians who are suffering.
I wonder if you had a comment on how that may affect the delivery of services and the lives of the people you serve.
Absolutely, I can add to that.
I think the impact that it can have is beyond what we can possibly imagine. Some of the biggest issues that we're seeing are wait times. We know, depending on whether we're urban versus rural, we can be waiting for children's services for up to two and a half years. This is not to be dramatic, but this can literally be a life-or-death situation. We're seeing that the number of mental health struggles among children has increased exorbitantly due to the pandemic, lockdown and isolation and all they cause, as we are very social beings.
With that, it could help to increase standardization of service across the system. We know right now that there are some things that different governments are doing. For example, in Ontario, there's the structured psychotherapy program, which provides short-term psychotherapy and CBT, specifically. It's an amazing program, but let's see how we can bolster that and fill in the gaps.
For me, this is, absolutely, a great idea. It's a starting point to help increase the standardization of access to different services, while also ensuring that we're not only providing certain types of therapies. We have to be able to give people the choice they want. Just because a particular therapist is available, it doesn't mean that they're going to jibe with that client.
Therapy is all about that human connection and that relational connection. It's very different from what we might experience with going to see a physician who does a diagnosis of physical symptoms. We want to make sure it's not just, “Okay, this person is in front of you. Figure it out”, but giving them options to determine what's best for their needs, whether that's cognitive behavioural therapy, arts therapy, sand therapy or whatever that might be.
Right away I want to acknowledge my colleague's early intervention about the event that happened yesterday and thank him. I also thank you for the moment of silence.
Welcome to all of the witnesses today.
This is a very important topic. It's very important to me as the founder of the all-parliamentary mental health caucus. I am very much invested in this.
I'm going to start with Ms. Foster.
In your opening remarks, you talked about demand outweighing capacity. Naturally, when we look at the study that we are doing, the demand that we are focusing on is children, especially children at the early stages, and the capacity is now where I want to focus. Often when I talk to different professional service providers, especially on mental health and mental wellness, what they're talking about.... If we look at capacity in a much broader sense rather than just the psychotherapist or the counselling therapist and include intervention at the early stages, then we may not be in as bad a situation as we are.
I would like to know your point of view on that.
I think the earlier we can intervene, going down the road, the less....
I work with kids and families as a couple and family therapist. If I can intervene when they're four, five and six.... I have clients who have had trauma at that age, as the Laval kids will have at this point.... If we can intervene now, then perhaps when they're 12, when they're 20, when they're 40 or when they're 50, they won't need those many services.
The earlier we get to it, the less chance there is of children or young adults reaching a crisis level of need for therapy and not being able, once again, to get the service. Hopefully, in the long-term picture, we can reduce the number of sessions required per capita, if you want.
I will share that I am also a registered psychotherapist who has been in practice for many years.
I think we need to get a little bit more creative in how we look at psychotherapy practice. A big part of that, of course, is education of the public about the different therapeutic modalities that are offered. From the research I've done, there are over 200 different types of therapy that we could have available, and that is so important to what's available for Canadians.
As an example, I provide cognitive behavioural therapy. Carrie works with children, so it's going to be a little bit of a different angle. It's all about what works for your individual personality. I am a type A, so CBT works for me and for the clients I work with. Some other individuals might prefer to work with—I'll try to give an example—narrative therapy or internal family systems. I'm happy to provide definitions of what all these different therapies mean, because there are many.
When we offer up the scope of the different types of therapies provided, we're giving more access to Canadians at whatever stage they're at, whether they're struggling with substance use, whether they're survivors of domestic violence or whether they've gone through traumatic events. There are so many different types of therapies that research demonstrates do match this particular and unique need.
Another thing I'd like to add to Carrie's earlier point is that if we focus on early intervention and preventative care, that's going to have a huge ripple effect on the cost to the government in the long run, not just the government but also the workforce in terms of absenteeism, the effects on families and how they're able to give back to the economy and be able to participate in Canadian life.
I'm going to go to the partisan part of my question period.
My colleague Dr. Ellis asked how impactful that $4.5 billion could be. Indeed, it is impactful. However, having money thrown out there without having accountability, transparency and measures of where it's been spent has been a challenge. As you know, in 2017 our government spent $5 billion on transfers to provinces for mental health. You testified that you haven't seen any improvement in access. You haven't seen improvement in increasing capacity in dealing with that.
Therefore, I'd like to know your point of view on welcoming the $4.5 billion, as we agreed, and the types of measures you would really like to see that support transparency, accountability and, most importantly, access for our children.
In terms of measures it's definitely about having some kind of structure and standardization in place, and a set level of criteria of whom the money is being made available to. It's making sure that a certain percentage of the funds are being earmarked directly for community services and agencies to be able to support those who need it most, who don't have the extra 15% on top of the session fee to be able to afford more sessions. For me, it's really about about having structure and oversight.
It's also about having flexibility, because the need province by province is very different. Ottawa as an urban centre is very different from rural Manitoba. It's very different from the state of affairs in B.C. with the opioid crisis there. We really have to make sure that there's structure, but also flexibility, to have a good flow with it.
I join my colleagues in offering my condolences and thoughts to the parents and loved ones of the victims and to the affected community in Laval. This reminds us that our children are our most important asset. We need to think about them and take care of them. I think we are all united in that thought today.
Ms. Thomson, I'm going to pick up on my colleague's question about the partisan part, it seems. I thought it was a very good question.
Are there any standards, rules or measures in Quebec regarding the provision of psychological care for children?
It would be interesting if you could provide us with that information.
I've noticed that for a number of years people have been coming to Ottawa to ask for money, transfers and national policies in areas of provincial jurisdiction. That's true for psychologists, respiratory therapists, students and education. It's true in just about every field.
It seems to me that we've gotten into the habit of coming to Ottawa to ask for transfers because Ottawa is where the money is. Now, these transfers have policies and conditions attached to them to the provinces and to Quebec, with measurement tools and accountability, to try to verify if the money is going to the right place.
Don't you think it would be simpler if the money were in Quebec City and you went directly to Quebec City to say what you wanted and you would measure the results? Don't you think there's something wrong with all this?
A concrete example is that because we don't have good data before the pandemic, it's hard to ask and answer questions whether or not the mental health of children has changed due to or after the pandemic.
If we had long-term data collection in place, we could simply ask the questions of whether or not depression and anxiety increased and we could measure it precisely with data, if we had baseline data to compare it to.
We don't have those data structures and infrastructures in place for children in mental health, and with that we don't have a lot of measures of other things that are important that are related to mental health, such as poverty, racism, violence. All of that was also increased due to the pandemic, and the pandemic influenced different people in different ways.
If we had data in place before the pandemic, then we could easily compare to see if things decreased. Without the before data, we can just say what it is now. Can we say that it changed? We can say that this is what it is now, if we collect the data now, but we don't have the ability to compare differences.
Thank you to the witnesses for being here.
I would like to add my voice to that of my colleagues on behalf of the New Democratic Party to express our deep sorrow and grief over the recent events in Laval. Our hearts go out to the parents, families and all those affected by that unbelievable tragedy.
I'm going to start, Dr. Afifi, with you.
How solid is the connection between corporal punishment, or hitting children as a form of punishment, and subsequent mental health issues?
The evidence is 100% certain that if you hit a child, you're increasing the likelihood that they will have poor outcomes. That includes mental health and physical health. It also includes across the other domains of development—education, justice, etc.
Does that mean every child who is hit will have these outcomes? No. Some children will be more resilient, and we're learning about why that's the case, but with 100% certainty, there's no question with the decades of data and thousands of studies that if a child is hit, spanked, slapped, whatever word we use, you're increasing the likelihood of poor outcomes for that child. That child will be less likely to reach their full potential and less likely to be in optimal health. That's 100% certainty.
Importantly, there are no studies, not one study, that show that hitting a child is beneficial to the child.
I have one point, if I may add to that.
I would just further Carrie's point about absolutely increasing the availability of psychotherapists within the schools.
I have had the opportunity to do my bachelor's in education and actually be in schools. I learned that, as Carrie mentioned, there are guidance counsellors available, but often—at least in the context of my experience in Toronto—you'll have one guidance counsellor for five schools. If you have 500 to 1,000 children per school, how much one-on-one time are they actually getting? It's not just doing career counselling and seeing how their grades are, but seeing how they are actually doing in terms of their mental health. That's one piece.
The other piece I see, which would bring us in a whole different—
Thank you to all the witnesses. As has been the case in many of our panels, we have a variety of different witnesses with very different specializations. That makes it really difficult to try to figure out which angle we're going to go with this.
I think this is part of the struggle with this very vast study we have on children's health. Children are a large demographic in our country, and yet we're just studying children's health, which can be everything from autism to mental health to access to care and everything in between. I think it makes it very difficult for us as parliamentarians to figure out exactly how we're going to take this...because it's all important.
I'll start with you, Dr. Georgiades. I was reading the study that you produced in 2021 on screen use and mental health symptoms in children and youth. I thought that was extremely poignant. I'm just wondering if you could expand on that a little bit.
Autism is a great example of children with multi-faceted needs. We know, based on several studies, that early diagnosis and earlier access to intervention can certainly lead to improved and more optimal outcomes.
There is no doubt that the pandemic has limited the rate of diagnosis across our country, and the rate of diagnosis was already slow before the pandemic. I think some of your other witnesses talked about many of the issues being there prior to the pandemic and being exacerbated because of the pandemic.
At the same time, I will say that autism is also a positive example. It is one area in our country where I have personally experienced what collaboration and unity across scientists, clinicians, stakeholders, families and also politicians and policy-makers can do. There's a backlog. There's no doubt about that. But we are in the process of working with many stakeholders across Canada on developing a national autism strategy that will use innovative, effective and efficient ways to clear the backlog in the years to come.
That's an example of both a challenge and an opportunity in terms of what collaboration across jurisdictions, across political parties and across specializations can actually achieve.
Sure. I think it's to make it extremely concrete and simple. Early intervention is key. We can access children through schools early. That's really important. It's evidence-based. We need to make sure we're putting programs in schools. There are many out there, the good behaviour game, for example, where you can implement evidence-based practices in schools to improve the mental health of kids.
Early intervention, evidence-based and access to care: those are the things we need for all children. This is equal for every child who needs it. If we can prevent things from happening before they happen, then we're going to have better outcomes. Those are the things we need to do, and that's where data is involved. We have to make sure—
Also, to a previous question, how do we know we're making progress? How do we know we're improving things? It's data. Everything is based on evidence and data. If we don't collect the data, then we don't know if what we're doing works.
The recommendations I've made actually try to incorporate many of all the things we're talking about today: evidence, early access and more access to care.
I can speak to that. It depends on what outcome you're looking at.
For some children, the home environment they were captured in, for lack of a better phrase, may have improved. They may have received one-on-one, undivided attention from their parents, who were able to stay home and take care of their needs. Some things may have increased. For some children, their needs might have improved being in the home environment through the pandemic and home-schooling.
When we think of the families with the least amount of resources who couldn't provide that and were struggling, trying to do their job and to find adequate care and education for their children, those children would have suffered the most during the pandemic and perhaps have been left behind.
I think it depends on the circumstances and what outcomes you're specifically looking at then saying what went up and what went down.
Thank you, everybody, for taking the time to be here today.
I'm hoping to get to at least two themes in the five minutes I have here, so I'll start with the first one.
Both you, Ms. Thomson and Professor Afifi, touched on the importance of intervention with our children and the reasons for doing that at an early stage. I've had discussions with some policy-makers about things like ADHD and dyslexia and whether or not certain education systems should be looking at making screening for that mandatory.
From your research, Professor Afifi, and then to you here in the room, I'm wondering if there is some of it that falls into your realm and that you have seen has been a success. It may not necessarily be here in Canada; it could also be elsewhere. Since Ms. Thomson is writing, I'll go to you first, Professor Afifi, and hopefully get some of your thoughts.
I think we need to be careful with universal screening and not just implement it for a variety of things unless there's a proven reason that we should. First of all, screening needs to be done if we can adequately identify what the problem is.
Then, most importantly, if we're screening children, then we are obligated to connect those children who screened positive, for whatever it was, to services. If we don't have those services readily available and in place, the screening is for nothing, and it could cause more anxiety for families, because now we've identified that their child may have ADHD, but we don't have the resources at the school, in the province or in the community to support that, so now they have to wait two years to get access to care.
I think we need to think that through carefully. If early intervention connects to screening, then, yes, we should do it, but we should only do it if we are able to connect those services.
Think about for screening for cancer, for example. Imagine being screened for cancer, and you're told you have cancer, but then you're told that we can't give you services for two years and that you're going to have to wait. Imagine how much worse that situation is.
There's an obligation there, when we screen, to connect to services and make sure they're there. Again, all the recommendations tie together. Data, evidence-based...and translating the information into policy and practice. Train and retain people in an integrated system that talks to each other. Then make sure all of these services are accessible to every single child, not just a certain child or certain children, so that no one is left behind.
Okay. I'll get back to that question.
Don asked the question, and you've already answered. You would support the government providing and paying for the costs of this psychotherapy.
Dr. Georgiades said, “why wouldn't we?”.
I think the obvious answer is cost.
Have you, or any one of you, figured out what the total cost would be if the government were to provide these services as part of health care plans?
We have looked at that here. I did some research, because I was called in to this meeting on Monday, and I had full clients. I had to switch them all so that my Thursday was free, so forgive me if I don't have in-depth details.
Basically for every dollar you spend you would be saving $1.37 to $1.78, I think it is, from memory. I don't even remember where those numbers are from, but I'm sure we could get those to you.
I think the important part to remember—and we've spoken to this earlier—is that the more preventative measures we take in the long term, the more we're cutting back on costs.
The other most obvious answer is whether we can afford not to, as was already said. How can we put a price on people's and children's health and well-being? I have a really hard time with that.
Thank you to the witnesses for being here. I do appreciate your comments. Basically, we see practitioners versus academics and researchers at the table, and I do appreciate it. Having lived in that world before I became a politician, it's been very interesting. I was the registrar for the profession in Saskatchewan, as well as the president of the national regulatory body for Canada, so I understand a number of things.
I have so many questions I want to ask, but I'll start off with asking you, Carrie or Lindsey, this: Have there ever been any discussions with insurance agencies as to whether they would turn around...? When they say, for example, with $500 of coverage for psychotherapy, “We only cover the cost the practitioner charges and not the GST/HST”...? Has there ever been any discussion with those agencies at all?
I can speak especially for Quebec.
In Quebec, you can have a master's in social work, a master's in couples and family therapy and a master's in psychology, counselling psychology. That will get you into the CCPA. That will get you your psychotherapy permit in Quebec, but only if you have enough psychotherapeutic training, so for couples and family therapists, 100% or 98.8% of them are psychotherapists as well.
For social workers, you just need to have a B.A. to be a part of that order. They will not have their psychotherapy permits to the level of deep work. The psychological work they can do is limited.
Counselling and counselling therapy programs across Canada are at the master's level for entrance into the Canadian Counselling and Psychotherapy Association. Accreditation to get your certified Canadian counselling certification requires extra hours and making sure that you have all those checkpoints. They're pretty much on the same level as many of the others. In Quebec, we have so many orders that do or don't get their psychotherapy permits, but they're on par.
I have two master's degrees, one in science and one the creative arts—the first being in couples and family therapy. Most people I know have their psych education and another social work degree or something. They have four years of master's level courses to be able to work, and we have ongoing regulations with the CCPA to make sure that we have all of those add-ons. Those add-ons are things you need: the ethics course, the cultural awareness and so on.
Okay. That's great. Thank you very much for that.
On the issue of looking at a number of things, ultimately when we talk about children and mental health, we're talking about those aged zero to 18. On the tragic incident that happened yesterday in Laval, obviously there's a huge impact, not only on families but also on those siblings, etc., those young children.
I come from Saskatchewan, where, as you're well aware, the Humboldt bus crash happened. Unfortunately, I lost a very good friend in that accident, the head coach. Also, a number of hockey players who were impacted were, not from my community in particular. Young Adam Herold, who was 16 years of age and passed away in that accident, was from Montmartre, Saskatchewan.
These are tragic things that have impacted a lot of kids. On Tuesday, we heard about the value of sport, the value it provides to the mental health of young people when they get involved and active. These are things we need to look at. As a coach, I used to travel by bus all over northwestern Saskatchewan. I know that children getting on buses today—hockey players and those in other sports—are looking at this and asking, “Could something like this happen again?”
We recognize the need for accessing treatment as quickly as possible, the fastest we can do that. We look at the government saying that $4.5 billion is being put to mental health, yet it appears not even to have got to that stage. In fact, I think I heard that there's $825 million that was not even spent by 2022.
Where does that money go? How do we get that money out to the practitioners on the floor so that we put boots on the ground, so we can have that access, as opposed to putting it out there where it sits and creates more bureaucracy?
Thank you very much, Mr. Chair.
Thanks to all the witnesses. I echo the earlier condolences of my colleagues about yesterday's tragic crash.
I'd like to start by saying that I've emailed back and forth with a practitioner named Kevin Greene, who is a big advocate for the removal of HST on psychotherapy in Canada. I've read his emails and the deck that he sent me.
I've also had some conversations with folks in Finance, trying to understand the costs. Any time that a tax is eliminated, it is an obvious cost to government, and sometimes the cost to government is way bigger than the amount they invested. I think that's an important consideration, if we're talking about millions or billions of dollars here or there. I think personally that social costs in the long term greatly outweigh any investments we can make in kids today.
My questions are going to be primarily around resiliency and building resiliency in the early years for children.
First, is there any research indicating the impacts of access to sport, physical activity and recreation and positive team experiences for kids? Is there any research that indicates a positive influence on children and their resiliency, particularly around mental health, when they have access to sport, physical activity and recreation programs?
I'd note that it's Winter Health and Fitness Week right now. Tuesday was Ski Day on the Hill. I skied with...I would guess a 13- or 14-year-old girl named Ella. I asked her why she loves physical activity. She said exactly what you just said, that it helps her deal with anxiety and helps her set goals. She's met all of her friends through sport. It is that protective mechanism which I drew from that conversation.
Secondly, anecdotally, so perhaps more towards the clinicians—less on the research side, more in your experience—in dealing with kids who have equitable access to sport, physical activity and recreation, do you see better outcomes for those kids?
Very quickly, Dr. Afifi, you mentioned the legality of corporal punishment. You mentioned that the only legal way in the Criminal Code that people can hit each other is when parents hit their children.
I'd also note that there is a social permission in the game of hockey...which we're all allowed to watch and see. A lot of young kids really love hockey, and there's bare-knuckle brawling in the game. That's the main reason I don't watch NHL hockey generally. I find it incredible that grown men are punching each other and it's totally normal. If it happened in front of a bar, then they'd probably both be arrested. It's an interesting thing.
Mr. Robert Kitchen: What about boxing?
Mr. Adam van Koeverden: That's not bare knuckle. Thank you for the commentary, though.
Anyway, how does that impact young boys who watch hockey and love the game?
We've been told that this has never been done, that this is the first time a study has been done, that this is the first time a committee and a government have taken an interest in children's health. That's normal; we're in Ottawa, and it's not Ottawa's business. An expert comes and tells us that in committee.
He's before the committee, and I'm asking him if there are other documents, reports or studies of bills. Earlier, I referred to the Quebec government's 140‑page document entitled Plan d'action interministériel en santé mentale 2022-2026 — S'unir pour un mieux-être collectif. The answer I get is that he could look at that eventually, when it suits him and, incidentally, it takes national strategies for this and for that.
So I'll ask the question again to get a yes or no answer: before telling us that the work has never been done by anyone, including the governments whose jurisdiction it is, have you done the research? What is the basis for what you told us earlier?
Dr. Afifi, you touched on this issue of the exposure of people to imagery.
I'm curious about the association, if any, between the Internet and social media exposure of children to, say, age-inappropriate images, acts or concepts, and whether there's been any work done to link that to increased mental illness or psychological dislocations in children.
Thank you very much, Chair. I appreciate it.
I really appreciate the interesting discussion around the table.
I had a question for you, Dr. Georgiades.
My colleague talked a bit about transparency and accountability in funding, and its being the reason, of course, why $4.5 billion has not been sent with respect to the Canada mental health transfer. Anyway, I have a whole bunch of comments about that. I'll keep those to myself.
That being said, do you believe that at the current time we can find areas of interest in place that have enough data whereby we could actually stream funding to them that would make sense? Obviously, there's a significant need for funding in mental health. I find it difficult to believe that there are no mental health areas in the country that are transparent and accountable that could actually use money. I think there are lots out there that could, and they could fill that bill very quickly.
Do you have comments on that, Dr. Georgiades, please?
Through you, Chair, Dr. Afifi, we talked a bit about violence in hockey in particular. That is interesting. There are many other sports that are violent.
One of the concerns I've had as a family doctor for many years is the violence in video games. I would suggest that many more children are exposed to violence in video games, especially and, very sadly, in an isolated setting. What I mean by that is they would be playing video games and be often alone experiencing those things.
I'm certainly not sitting here arguing for violence in sports. That's not what I'm suggesting.
What I would suggest is that experiencing that very graphic violence in an isolated setting is perhaps something that is even more damaging, if there is such a thing.
Do you have comments on that, Dr. Afifi, please?
Thank you very much, Dr. Afifi.
Through you, Chair, the other day I was watching television in French. I noticed very clearly that on French television, there were commercials talking about violence in the home. Normally, I watch English television. I live in Atlantic Canada, and we don't see any of that advertising there explaining the inappropriateness of it and seeing the very straightforward messaging.
Do you think that style of messaging is important? Should that be something we see in both official languages, and of course in languages that would be appropriate for marginalized and racialized communities as well?
I want to thank everyone for coming today. This has been a really interesting discussion.
I want to pick up on the funding question and how that might follow through. We know that with the previous $5 billion transfer...or we don't know; I think the question is that we don't know a lot about where that money went. I haven't heard anyone, including the or the , say that we don't need more funding into mental health. It's a matter of how we ensure that it gets there and gets to where it's needed.
I for one am really looking forward to the bilateral health negotiations. I imagine that mental health will be identified as a priority area for most jurisdictions, if not all, when it comes down to that.
I'd like to follow up on some of the discussion about coverage with a question for Ms. Foster and Ms. Thomson, very briefly.
Do you think it would be reasonable to have access to counselling and psychotherapy on the table as part of what should be covered in universal health coverage when it comes to bilateral health negotiations?
A voice: Yes.
Mr. Brendan Hanley: It brings up another question. I know that when I talk to some clinics in my jurisdictions in the Yukon in settings that are similar to yours, they are facing similar circumstances. People who do not have coverage are taking a hit. That in turn seems to affect their ability to resource themselves. If they did have access to increased public health coverage, it might enable them to increase and build their capacity to meet the needs of the community—in other words, hire more people and have a fuller roster, as it were.
Would that reflect your own experience?
There's a lot of research that has been done in looking at how stress has an impact on the body and whether or not.... Some stress in certain situations is adaptive, healthy and good, but the thing is that we need to....
For some children, they experience chronic stress. They don't get relief from it. They don't have someone to help them process that stress or relieve that stress, so they're in a current state of hyperarousal or their nervous system is always engaged, so they always have that hyperarousal. When you live in that state, your heart rate is elevated, your blood pressure is elevated and you have many different impacts on your physical health and your mental health. Living in that constant state has a long-term impact on health.
There is a lot of evidence to show that it can have an increased likelihood not only of physical health conditions, but also of mental health conditions. Often, children who live in a home where they experience violence are always in that hyper state of arousal of chronic toxic stress.
Again, thank you to the witnesses.
When we were talking about the importance of sport and activity in children, it triggered something that's been pretty active in the news as of late. It's the very serious allegations of abuse that have been coming up, specifically around Gymnastics Canada.
Particularly, Ms. Thomson, when you were talking about eating disorders.... We've heard of so many situations from which some of this abuse has led to lifelong eating disorders in some of these gymnasts. There are allegations of sexual abuse.
I wonder as much as, yes, activity is very important for kids, in situations like this one when extreme abuse is being reported and alleged...how does it impact children?
It's nice to have some commonality around the table on this, because I think this is something....
As a parent to a young child, my little guy is still too little to be involved in any organized sport, but it's something that's very top of mind to me. What sport would I want to put him in?
My happy spot as a kid and my happy spot now as an adult is at the top of the slopes with skis strapped to me. That has always been my way of getting out, de-stressing and connecting with nature.
However, there are so many allegations of abuse and there are so many cases coming up of kids being abused by their coaches and sexually abused by their coaches, I think that makes parents...at least it makes me very nervous. What am I putting my child into? As much as I know there are tons of benefits, in the cases where there is abuse, I don't think there could be a single benefit.
Can you guys touch on that a bit?
That was a review paper we did in 2011. Since then, we've published many papers in the area. We focused on the children within their environments, because protective factors can come at many levels.
We also focused on things we can change. What is something we can change? At the individual level, it's important for children to feel they can be optimistic, in control and positive about their future—to have a plan. That's important, so they can envision their life in five years, instead of feeling they have no control in their life. That's very important.
We also find that parenting relationships are very important. Telling your children you love them, giving them hugs and spending quality time with them is very protective. Having an adult is very protective. That can even be found in a school. It can be a teacher, or a positive person in sport. If they are providing that supportive, healthy relationship, that is very resilient for for them, as well. Feeling safe in your neighbourhood and environment is very important for resilience.
We're starting to look more at neighbourhood- and society-level factors. That hasn't really been looked at yet. We're trying to look at all the factors at different levels, so we can understand the child within the entire context to which they belong and focus on protective factors at all of those levels.
You both talked about the emphasis on research and how research could guide us around some of the policies that we could develop, whether it's on regulation or government policies for providing better access to services.
Can you talk about some of those policies—specifically federal government policies? How could we marry the research that you've done, specifically around resiliency and protected categories, with federal government policies?
You both have about a minute and a half to go.
We can start with Professor Afifi.
I think it's really important that we translate the data into policy and practice.
How do we do that? We do that with having open partnerships with the people who are going to use the data. We develop the research questions at the very beginning with the community organizations, the decision-makers and the policy-makers, so that we're producing the questions that are relevant to those who need to use the data.
When I started research, I was just the researcher. I did the work, I published it and I walked away. That's not my job anymore. My job is now to take the data and put it into the hands of the people who can use it and make it come to life.
We still don't have that connection very well between doing the research and translating the research into both policy and clinical practice.
There are lots of mechanisms in place now where we can build those relationships so that we're all working together to produce the information that we need. Then when you ask me how we know if kids are doing worse because of the COVID-19 pandemic, we'll know this because we have data. Researchers are answering the questions that the policy-makers and the decision-makers want to know, so we can turn that data into policy and into practice.
Dr. Georgiades, I'm really glad we gave the extra 30 seconds. That was an excellent note on which to finish. Thank you so much for that.
Thank you, to all of our witnesses, for sharing your expertise and experiences on the front line. It will be of significant value to the committee.
There are a couple of administrative matters that I need to raise with committee members.
Witnesses, you are welcome to stay, but you're free to leave. We're very grateful to you for your attendance today.
I have three things to raise with you, colleagues. I know Mr. van Koeverden has something.
First of all, yesterday another private member's bill, Bill , was referred to us. I know that our plan is to complete the work on this study before we consider whether we're going to private member's bills, but just so you know, we now have three that are waiting.
The second thing is, during the meeting today I received a notice from the whip that the Board of Internal Economy is going to be meeting on February 16, which will bump our committee out of its time slot. How that's going to be resolved is not yet determined, but I just wanted to let you know that there may be a problem with the meeting on February 16. We'll work on it between now and then. That's just for awareness.
Mr. van Koeverden, you had something.
Thank you very much, Mr. Chair. I appreciate the indulgence.
I have two things, very briefly.
The first is just a point of clarification for all members of the committee and anybody else. All federal funding for Gymnastics Canada and Hockey Canada has been frozen by the in light of those allegations and investigations that are under way by the Office of the Sport Integrity Commissioner.
Second, this was an observation I made earlier in the meeting. I feel that when we have hybrid meetings with witnesses both online and in person, the natural inclination for us as MPs is to focus on the people here in the room, which is normal, but it puts people online at a disadvantage.
I would recommend that in the future, if possible, we dedicate one hour to the people who are online and one hour to the people who are in the room, or only host meetings that are online or in person, because it was challenging sometimes to engage. I know that hybrid meetings have their advantages, but it's an observation that I just make today and pose to the committee.