Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 29 - Evidence - March 11, 2015
OTTAWA, Wednesday, March 11, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:14 p.m. to study Bill S- 208, An Act to establish the Canadian Commission on Mental Health and Justice.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie from Nova Scotia. I'm chair of the committee and I will start by inviting my colleagues to introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton, senator from Toronto and deputy chair of the committee.
Senator Merchant: Pana Merchant from Saskatchewan.
[Translation]
Senator Chaput: Good afternoon; I am Maria Chaput from Manitoba.
[English]
Senator Raine: Nancy Greene Raine from British Columbia.
Senator Beyak: Senator Lynn Beyak from Ontario.
Senator Wallace: John Wallace from New Brunswick.
Senator Enverga: Tobias Enverga from Ontario.
Senator Stewart Olsen: Carolyn Stewart Olsen from New Brunswick.
Senator Seidman: Judith Seidman from Montreal, Quebec.
The Chair: I will remind the audience that today we are going to begin our consideration of Bill S-208, An Act to establish the Canadian Commission on Mental Health and Justice. We will be starting with the sponsor of the bill, Senator Jim Cowan, who is here with us today.
By agreement, the steering committee has worked out that we will have 30 minutes for Senator Cowan, who will present a good overview of his bill from his point of view. Then there will be time for me to allow one question from each side, from Senator Eggleton and Senator Seidman. Then we will proceed to the witnesses that we have identified for the rest of the session.
Senator Cowan, it's a pleasure to welcome you to the committee, and I invite to you address us.
Hon. James Cowan, sponsor of the bill: Thank you, chair, and colleagues. I'm delighted to be here. I was chatting with the chair earlier and I told him how long I would like to have to explain the background of the bill. He assured me that I had 30 minutes that I could use as I wanted. But as you know, I'm around and I'm delighted to answer any questions any of you might have about the bill. Outside of that, we'll have a chance, I hope, to debate it when it comes back to the chamber.
I'm delighted to be here, chair, to launch your committee hearings on my private member's bill, Bill S-208, An Act to establish the Canadian Commission on Mental Health and Justice.
The bill deals with the intersection of mental illness and the criminal justice system. Most people who suffer from mental health issues never have any contact with the criminal justice system. But when you look at the people who are in the criminal justice system, far too many have mental health issues. Increasingly our prisons and jails are filled not with hardened criminals, but with people who suffer from mental health problems. Last year, according to the Correctional Investigator of Canada, 61 per cent of newly admitted offenders in the federal penitentiary system who were screened for potential mental health problems were flagged as needing a follow-up intervention. By the way, it's thought that due to stigma, fear and lack of detection and diagnosis, mental illness in our prisons is being under- reported. In other words, the figure is probably higher.
As I've said, most people with mental health problems never come into contact with the criminal justice system. That is important because we do not want to inadvertently add to the stigma around mental illness. But it is a disturbing fact that 40 per cent of people with mental illness have been arrested at least once in their lifetime.
Colleagues, when you receive a diagnosis that you're suffering from a stomach or heart disease, it doesn't carry with it an increased likelihood that you will face arrest or even jail time. But for those with the bad fortune to suffer mental illness, that is the reality. We are, as the Canadian Mental Health Association said, criminalizing mental illness. But our prisons are not hospitals and prison guards and other officials are not mental health practitioners. While they try to provide treatment services, that is not what they are designed for. Federal prisons are struggling to meet the needs of inmates. Indeed, just last Friday, the media reported on 515 acute care beds in our penitentiaries being transferred over to provide immediate psychiatric care, giving rise to concerns that we are, in effect, as the Correctional Investigator suggested, robbing Peter to pay Paul.
Beyond the hospital beds, the Correctional Investigator has found that the prison environment actually exacerbates mental health problems, causing people to engage in what he describes as disruptive behaviour, aggression, violence, self-mutilation, suicidal ideation, withdrawal, refusal or inability to follow prison rules or orders. He also describes how too often prison staff misunderstood what is going on with an inmate's behaviour and in turn respond with a range of inappropriate responses.
We're all aware of those examples. All of us are familiar with the heartbreaking stories of Ashley Smith and Edward Snowshoe, young people suffering from mental illness who each committed suicide in prison.
Ashley Smith was a teenager when she entered the correctional system. Her original crime was achieved through throwing crab apples at a postal worker. She believed he was deliberately not delivering welfare cheques. Her original sentence was repeatedly extended because of her conduct on prison. As Kim Pate of the Elizabeth Fry Society described Ms. Smith's history in The Globe and Mail:
Initially taken into custody at the age of 15 for breaching probation, Ms. Smith's subsequent inability to contain her feelings of fury — at being tasered, gassed, shackled, drugged and isolated — resulted in additional sentences and increasingly harsh conditions.
She was put in solitary confinement repeatedly.
As we all know, she never left prison. She killed herself in solitary confinement four years almost to the day after throwing those crabapples.
The coroner's inquest into her death issued 104 recommendations. The first one highlighted that Ms. Smith's case demonstrates how the correctional system and federal-provincial health care can collectively fail to provide an identified mentally ill, high-risk, high-needs inmate with the appropriate treatment, care and support.
Edward Snowshoe's story was the subject of a lengthy report in The Globe and Mail in December. He tried suicide four times, until at the age of 24 he was successful. He spent 162 days consecutively in solitary confinement. As described by Patrick White in the Globe:
His was a death foretold. Over three years in prison, Mr. Snowshoe had morphed from a shy but hale young man into a chronically suicidal inmate suffering from a dangerous brew of mental-health issues.
I hope that we have the opportunity in these hearings to explore the appropriateness of the use of solitary confinement for inmates with mental health problems.
On any given day, colleagues, there are some 1,800 inmates in solitary confinement in federal and provincial correctional institutions, with some half of them apparently suffering from mental health problems.
The Correctional Investigator, among many others, has repeatedly argued against this practice. Last September, he issued a report on suicide deaths in federal prisons, half of which took place in solitary confinement. He said:
I'm concerned that the Correctional Service of Canada continues to rely on long-term segregation placements as a means to manage symptoms or behaviours associated with mental illness, suicidal ideation or self-harming. This practice is unsafe and should be expressly prohibited.
But as the coroner's inquest said in the case of Ashley Smith, there is a collective failure here; it's our prisons, yes, and the use of solitary confinement, but it started much earlier.
Police now serve as front-line mental health workers, hardly the work a person thinks they're taking on when they join a police force.
Jim Chu, Chief Constable of the Vancouver Police Department, spoke to this issue when he was President of the Canadian Association of Chiefs of Police. He said:
We went from the agency of last resort to the mental-health service agency of first resort. . . . And that's wrong. That's failing those who are mentally ill and who deserve better care.
. . . the focus needs to shift from dealing with a crisis to preventing it in the first place.
Some more statistics: One in 20 police encounters involve people with mental health problems. In Toronto alone, every year the Toronto Police Service is dispatched to some 20,000 calls for services involving a person in crisis; that is, a person who is mentally ill who would later be described by police as emotionally disturbed.
While many of these encounters end peacefully, too many end in tragedy. Again, just looking at Toronto, because that's where the statistics were recently compiled, between 2002 and 2012, five people considered by the Toronto Police Service to be emotionally disturbed were fatally shot by police. One of those tragic fatal shootings, the case of Sammy Yatim, prompted Toronto Police Chief Blair to ask former Supreme Court of Canada Justice Frank Iacobucci to conduct an independent review of police encounters with people in crisis. Justice Iacobucci issued his report last July, over 400 pages long. He wrote this:
. . . there will not be great improvements in police encounters with people in crisis without the participation of agencies and institutions of municipal, provincial and federal governments because, simply put, they are part of the problem and need to be involved in the solution
In many ways, I have found this reality the most distressing societal aspect of my work on the Review. The effective functioning of the mental health system is essential as a means of preventing people from finding themselves in crisis in the first place.
Much later in the report he warned that unless we change our approach, we will not achieve the elimination of tragedies that have resulted.
I agree. That is an excellent description of why I introduced Bill S-208. The premise of the bill is set out in the first paragraph of the preamble:
Whereas a comprehensive approach to promoting positive mental health and treating mental illness would contribute to public safety, and would result in less crime, reduced incarceration rates, decreased costs, improved rehabilitation prospects, and better use of resources within the criminal justice system;
The bill proposes that Parliament establish a new Canadian commission on mental health and justice, with a detailed mandate specifically and clearly set out in the legislation. The purpose of this new commission is stated in clause 4, which begins:
The purpose of the Commission is to facilitate throughout Canada the development, sharing and application of knowledge, statistical data and expertise on matters related to mental health and the criminal justice system in order to contribute to the health, safety and well-being of all Canadians and to help establish appropriate, effective and just methods for addressing the needs of individuals who live with mental health problems or illnesses and are involved with the criminal justice system as young persons or adults . . . .
Colleagues, we have many different organizations, including the excellent Mental Health Commission of Canada, that each work on different aspects of mental health and the justice system. But we don't have a single organization dedicated specifically to the combination of these two issues, with a mandate to pull all those various groups, agencies, actors and reports together.
The bill goes into detail on how the commission is to achieve the purpose, beginning with a mandate to address crime prevention through initiatives that foster mental health and absolutely critically provide for the early detection and treatment of mental illness.
The commission would be mandated to promote and participate in the study and development of laws, policies and best practices that address the needs not only of those people suffering from mental illness who are involved in the criminal justice system, but also those who are at risk of becoming involved with the system, all to improve mental health, reduce crime and recidivism rates and to protect the public. I'm sure we all agree that everyone benefits when we can prevent crime from occurring in the first place, when we protect the rights of all Canadians to not become victims to begin with.
But I also want to point out that the bill would mandate the new commission to study the mental health needs of victims of crime and their families and look at ways at which the criminal justice system can better address those needs. It would look at mental health challenges, including job-related stress faced by police and corrections officers, issues that were also highlighted by Justice Iacobucci in his report.
The commission would develop training programs for various participants in the criminal justice system, including police, court officials, lawyers, judges and corrections officers. It would look at the detection, identification and assessment of mental health issues at all stages of the criminal justice process, including early identification and diversion programs, mental health courts, pretrial and pre-sentencing treatment programs, and alternative sentencing measures, to name a few.
Those are a few of the highlights. There is much more to the bill, which I would be happy to discuss with any of you during the remainder of my session, but I think the most important thing is for us to listen to the experts who will be coming before us over the course of the hearings on this bill.
One of the things that I specifically want to draw to your attention is that the commission would look at best approaches to providing treatment for individuals found not criminally responsible by reason of mental disorder. I know that Dr. Anne Crocker of McGill led a team that has done extensive, serious work on this issue. I'd hoped that she would have appeared before our Standing Senate Committee on Legal and Constitutional Affairs last year when we were studying Bill C-14, which changed the NCR system. She wanted to present the results of her research but unfortunately was not able to do so. I hope that this committee will give her an opportunity to be heard.
The last area that I want to highlight is the particular focus placed on collecting, analyzing and publishing statistics and other data relating to mental health and criminal justice. There are several sections addressing this much-needed function.
In terms of the structure of the committee, you will see that I propose placing the primary responsibility for choosing the members on the Minister of Health, with the concurrence of the Ministers of Justice and Public Safety. All three, of course, are critically important, but my suggestion reflects my belief that mental health is first and foremost a matter of health.
The commission would be assisted in its work by a mental health and justice advisory council that would include individuals who have personal experience of either themselves or an immediate family member living with mental illness while being involved in the criminal justice system. Justice Iacobucci emphasized the importance of the involvement of such individuals.
Colleagues, to restate this once again, most people living with mental health problems or issues never come in contact with the criminal justice system. Far from being perpetrators of crime, persons suffering from mental illness are two and a half times more likely to become victims of crime than any other group in Canadian society. But too many find themselves caught up with the criminal justice system, and our criminal justice system was never intended or designed to address an inmate population with mental health needs.
A Canadian commission on mental health and justice should be seen as an investment to better protect everyone from some of the consequences of serious mental illness. Since it is an investment to benefit all, I would certainly not anticipate that it would be funded by stripping away the already far-too-meagre resources we devote to mental health in our rich country.
I will end with a quote from a source that may surprise some of you, our Prime Minister. Last week, on March 4, Prime Minister Harper urged support for his new life without parole bill by saying:
. . . the suffering of the victims of such horrific crimes and the suffering of those who love them is bad enough.
But what if, when the whole truth is known, they should find out that the crime could have been prevented in the first place . . . .
That the perpetrator was someone who could have been, should have been securely behind bars.
When that is discovered, at that moment, their anguish compounded by disbelief becomes outrage.
Not just to them but to the entire . . . country.
And then we are all left to wonder what justice . . . means.
They, we, feel betrayed.
Let me ask you, what if, when the whole truth is known, victims and those who love them should find out that the crime could have been prevented in the first place, that the real cause of the crime was mental illness, and had it been identified and treated, then no crime would ever have been committed? To use Mr. Harper's words, when that is discovered, at that moment, their anguish is compounded by disbelief and outrage, "Not just to them but to the entire . . . country. And then we are all left to wonder what justice . . . means. They, we, feel betrayed."
I would be happy to entertain any questions that any of you might have here. I say, you know where to find me, and I'm happy to discuss this with you any time in the future.
Thank you, Mr. Chair.
The Chair: Thank you, senator. As per our agreement, I'm going to offer the opportunity to Senator Eggleton and Senator Seidman to at least get one question in before time is up.
Senator Eggleton: I want to applaud my colleague for bringing these important issues forward in this bill. They are issues that we very much need to be dealing with at the federal government level, at all government levels.
I want to do something a little unusual here, though, Mr. Chair. I would like to defer my question to Senator Chaput. Senator Chaput wants to ask a question about official languages. Rather than my asking the question, I'll let her ask the question. I know where to find the guy, as he says.
Senator Chaput: The question is very brief, Senator Cowan. It's in regard to the Official Languages Act and its requirements. I was wondering if this commission, in your mind, and in the bill itself, would respect the Official Languages Act and do what it needs to do in terms of requirements.
Senator Cowan: Thank you, Senator Chaput. You did mention this to me earlier in the afternoon. I didn't know the answer. I thought I knew the answer, but I checked, and there is a specific provision in the Official Languages Act that says that any commission such as this that would be established pursuant to federal legislation is covered by the Official Languages Act and would be obligated by all of the obligations that are set out in the act. So the answer to your question is yes.
Senator Chaput: Thank you.
Senator Seidman: Thank you very much, senator, for coming in front of us to deal with a very serious issue.
Following your second reading speech in the Senate Chamber on February 13, 2014, there was a question asked of you specifically about whether any existing institutions could address this particular mandate. I will take the liberty of reading the transcript of the last paragraph of your response, and then perhaps you would help us try to understand what you were getting at when you said:
We need a specific vehicle established with legislative underpinning, with a legislative mandate to deal with it. I think that this may not be the perfect vehicle, and there may be a variation of it that will do it. We may be able to adapt the mandate of an existing agency to cover this, but no agency has the precise focus . . . .
Senator Cowan: Yes.
Senator Seidman: There are two issues that you bring forward here that are pretty critical. One has to do with the legislative mandate and why you're going that route and what the implications are. The other has to do with the fact that there may be an already existing institution, for example, the Mental Health Commission of Canada, that has the mandate that would allow them to deal with this particular issue.
Senator Cowan: Let's put in a plug for the Mental Health Commission of Canada, which, as we all know, arose out of a recommendation of a Senate committee. It has done great work. I thank you for the opportunity to say that I do applaud the work that a number of existing agencies are doing. There is important work being done in this field.
As I tried to say in my speech in the Senate Chamber and again this afternoon, the purpose here is to provide a particular focus and to have one entity that would draw together all of this with a particular focus on the intersection between the criminal justice system and mental health. For example, the Mental Health Commission has done a lot of good work in this area. While there are two recent studies that I think we will probably discuss with them when they appear after me this afternoon, there's nothing in the published mandate of the Mental Health Commission that refers to criminal justice. They have done good quality work in that area, and I mentioned the work that Dr. Crocker has done on NCR, or not criminally responsible. This is quality work, and other agencies do that as well at not only the federal level but also at the provincial level. What I'm suggesting is that because of the magnitude of this problem, we need to have a single agency with the focus on this issue.
The other point that I would make is that, as you know, the Mental Health Commission is not established pursuant to a piece of legislation. It was given a 10-year mandate which expires in 2017, and that has not been renewed. We certainly all hope and perhaps expect that it will be renewed, but the government has not yet committed to renewing the mandate beyond 2017. I would hope that the government does that or a future government will provide that legislative underpinning or legislative framework for the Mental Health Commission of Canada.
One of the things that I am suggesting in the quote that you made is that a preferable way to accomplish my goal is to expand the role of an existing agency and give it that coordinating role with the additional funding necessary to enable them to do it, because I'm sure whatever agencies we hear about, they will tell us they are doing good work but have scarce resources. Every agency does. I'm not suggesting that we would take money away from any existing agency to fund this entity. If there is a better way to do it, then I'm open to that. I'm just trying to focus on a public policy issue which I suggest, through no fault of any of these agencies, is not being adequately dealt with.
Senator Seidman: The second part of that question has to do with the legislative underpinning, the legislative mandate that you're asking for. Why are you doing that? You say we need a specific vehicle established with a legislative underpinning, with a legislative mandate. Why do we need a legislative mandate? And what is the implication? Does that have some kind of implication in terms of conflicts in providing advice to ministers or provincial jurisdictional issues? I'm trying to understand the legislative mandate aspect.
Senator Cowan: In my mind, it provides a certainty or some predictability. Folks from the Mental Health Commission of Canada can speak for themselves, but I know from having talked to them in the conversations around this thing and they're not sure what happens after 2017.
So when you think about it, if you're beginning to plan your study schedule and say that this is a three-year project, well, just a minute now: Do we have three years left? Or you're hiring staff. Is someone going to leave another organization, say a university, to come work for an organization that only has two years left in its mandate?
I think that a legislative framework, a legislative underpinning provides greater certainty, greater longevity and an ability to deal with studies to hire staff and to engage in longer range studies. If you're coming up to the end of your mandate, at least part of your attention is devoted to trying to secure a further mandate. That's all I meant. I wasn't suggesting that it would deal, in any way, with any of the other issues that you mentioned about federal-provincial conflicts or advice to ministers.
Senator Seidman: It's just enshrining, using a bill, in a way to create a degree of permanency to a commission that deals with mental health and criminal justice as opposed to a commission that's set up that has a lifespan. Is that the issue?
Senator Cowan: That would be my view of it, senator.
Senator Seidman: Thank you. I appreciate that.
The Chair: Senator, you did raise the issue of cost, which I think you reasonably skillfully avoided for the obvious reasons of the Royal Prerogative. Since you brought it up, do you anticipate that this commission would incur significant cost expenditure? You mentioned inadequate funding or the difficulty of funding. How do you see that aspect?
Senator Cowan: I don't think there is any question that establishing a commission like this would involve the expenditure of public money. Appropriate amounts of money would have to be allocated to this function, whether it's to support the function of an independent body or if it is grafted on to the mandate of an existing body.
I think I have dealt with it, with the advice of our legislative counsel, to avoid the issue of the Royal Prerogative by saying that this, if it is passed and I hope it is, would not come into effect until there is an appropriation of monies recommended by the Governor General and such monies are appropriated by Parliament. I'm advised by people who know more about the Royal Prerogative than I do that that legitimizes this as an appropriate way.
I think the main point of your question was one with which I agree; that is, if this is to be effective, there would have to be an allocation of significant funds, otherwise I agree that there is no point in doing it.
The Chair: I'll leave it with the term "adequate" that you use so as not to get further down that debate.
Thank you, Senator Cowan, very much.
I'm going to introduce and identify our next witnesses. I didn't get a chance to discuss with them whether they had preferences, so I will call them in the order they appear on the agenda, unless I see a violent reaction down there.
Because of the numbers of you here today and the topic, senators often want to give everyone a chance to respond to their questions. Normally we would expect that if you have nothing new to say you would say, "I'm fine," but if you do have something new and different, signal me and I will recognize you to enter the conversation.
With that, I'm going to invite the Mental Health Commission of Canada as our first witnesses. I'm going to recognize Howard Chodos, Director, Mental Health Strategy for Canada; and Jennifer Vornbrock, Vice-president, Knowledge and Innovation.
Jennifer Vornbrock, Vice-president, Knowledge and Innovation, Mental Health Commission of Canada: Good afternoon, Mr. Chair and committee members. I want to thank you for the opportunity to speak with you today. My name is Jennifer Vornbrock, and I am the Vice-president with the Mental Health Commission of Canada.
Bill S-208 draws attention to the important issue of persons with mental illness and their interactions within the justice system, as well as the impact that these interactions have on their families and in their communities.
The Mental Health Commission of Canada shares your concern about the disproportionate number of offenders in the criminal justice system who are living with mental illness. We also share your goal of promoting mental health and treating mental illness within the system itself.
We would like to take the opportunity to update you on some of the work that coincides with the work that is going on within this bill and discuss ways that we believe we can work together going forward to establish shared goals. Let me first provide some brief background on the Mental Health Commission and its mandate.
The Mental Health Commission was created in 2007, prompted by the work of this committee, in fact, in its landmark study Out of the Shadows at Last, which called for a national commission on mental health. We have the mandate to improve the mental health system and to change the attitudes and behaviours of Canadians surrounding mental illness. We work with all levels of government, non-profit organizations, NGOs and persons with mental illness and their families from across Canada to coordinate and mobilize the mental health community towards common goals.
Our work is guided by the Mental Health Strategy for Canada, which was released in May of 2012. The strategy lays out actions to improve mental health care and its associated systems.
At this time, I would like to acknowledge my colleague Dr. Howard Chodos. Howard led the development of the strategy and during his previous tenure at the Library of Parliament was the lead researcher on the Out of the Shadows report.
The Mental Health Strategy has six strategic directions. Strategic Direction 2 speaks directly to the heart of the bill you are talking about today: the need to foster recovery and well-being for people of all ages living with mental health problems and illnesses and upholding their rights.
More specifically, priorities 2.3 and 2.4 of the Mental Health Strategy call for measures to prevent and divert persons living with mental illness from the corrections system; promote the rights of persons with mental illness within the justice and correctional systems; enhance policies and practices regarding persons with mental illness in the justice and corrections systems; and, finally, to provide appropriate supports for those involved in the criminal justice system.
The commission has the networks to bring together stakeholders and experts in the mental health, legal and law enforcement communities to work on issues related to the justice system and mental illness. The brief provided to this committee outlines some of the MHCC projects that line up with the specific measures called for in Bill S-208. I would like to take a moment to outline a couple of those key efforts.
The MHCC has worked very closely with the Canadian Association of Chiefs of Police — we refer to them as the CACP — since 2013. I would like to acknowledge Tim Smith, who is joining us here today, as one of MHCC's guests, but also as one of our strongest partners. Together we have held two conferences focused on mental health and police officers themselves.
The MHCC has also released a report called TEMPO, which outlines the training standards and curriculum for training police officers on how to deal with persons with mental illness. Many of our partners in policing have expressed a strong interest in utilizing the TEMPO framework, and we are now taking the necessary steps to develop an implementation plan.
The Mental Health Commission's National Trajectory Project led by Anne Crocker aims to improve the understanding of policy makers, clinicians and the public of the implications of the current regulation and practice for individuals declared not criminally responsible. Through a large longitudinal research study in Quebec, Ontario and British Columbia, the project has been examining the ability of the Criminal Code to balance the need to protect the rights of individuals living with mental illness with the need to protect public safety.
The MHCC At Home/Chez Soi project study of the Housing First approach to homelessness included participants who had high levels of interaction with the criminal justice system. The study showed, through the intervention, lower rates of interaction with the justice system for those who were housed, and it provided a new way of thinking about community safety.
As well, I would like to talk a little bit about the MHCC's Knowledge Exchange Centre, which shares a wide range of studies and incubates new knowledge related to mental health and justice. They also continue to support the work of an emerging national forensic mental health research consortium to develop a national research agenda funded by CIHR.
As you can appreciate, the commission is already doing some of the work called for in the bill and continues to expand this work as we seek a renewed mandate for the commission. Although the MHCC has some very specific projects related to mental health and justice, we believe that our whole-systems approach also benefits the broad objectives set out in the bill.
The MHCC has undertaken many efforts at the national level. We are first, of course, working on the critical issue attached to this conversation in Canada, which is the significant stigma that remains around mental health and mental illness. Whether it's at work or in homes, schools or even in our government halls and corridors, the Mental Health Commission is working alongside the many champions of mental health to provide real solutions to bring an end to stigma, such as our workplace standard, which was developed by the Canadian Standards Association and the Bureau de normalisation du Québec, and our broad exchange of ideas around mental health as well as Canada's Mental Health First Aid program, which has now trained more than 135,000 Canadians to better respond to those in crisis.
These efforts are just a few, and we have not stopped there. We are also developing innovative guidelines and training on things like peer support, mental health across the lifespan and suicide prevention.
We are taking a holistic and comprehensive view of mental health and in doing so can help address many of the intersections presented in this bill. We also help make connections between persons with mental illness, their families, law enforcement, government and the public to ensure that the measures outlined in this bill have the greatest benefit. With close to 300 partnerships on the books, the Mental Health Commission has a proven track record of collaborative, results-driven work.
Moving forward, the commission is seeking renewal and funding beyond 2017. We have proposed to the government an updated mandate inclusive of the pressing issues of mental health and the justice system. To that end, we are currently engaged in discussions with stakeholders across the country to create a mental health action plan for Canada which would guide our future work.
I have to share with you that our discussions with stakeholders in every single province and territory reveal a deep commitment to addressing these issues and a strong sense of leadership to find real solutions that work.
My concluding recommendation is that this is the right moment to discuss and explore future opportunities for the Mental Health Commission of Canada's efforts, including increased work in the area of mental health and justice.
Thank you.
The Chair: Thank you very much.
Mr. Chodos, I just learned of your previous role with this committee, so welcome back.
Howard Chodos, Director, Mental Health Strategy for Canada, Mental Health Commission of Canada: Thank you very much, senator. It's unusual to be at this side of the table.
The Chair: I will now go to Lori Spadorcia, Vice-president of Communications and Partnerships for the Centre for Addiction and Mental Health.
Lori Spadorcia, Vice-president, Communications and Partnerships, Centre for Addiction and Mental Health: Good afternoon, Mr. Chair and committee members. It's a pleasure to be here with you today to talk about this really important issue.
The Centre for Addiction and Mental Health, CAMH, is Canada's largest mental health and addictions academic health sciences centre. We provide care and treatment to over 30,000 clients per year through our inpatient and outpatient services. Our forensic mental health program provides care to over 30 per cent of Ontario's not criminally responsible accused, and we offer forensic early intervention services for inmates with mental illness in the Toronto South Detention Centre.
Through our provincial service collaboratives, CAMH works with regional experts to develop system-level responses to local mental health issues, including mental health and justice concerns. The Toronto Justice Service Collaborative is addressing housing and related support needs of people with mental illness leaving the criminal justice system, as an example.
CAMH's mental health and justice policy work has focused on improving police interactions with people with mental illness and educating government and the public on the benefits of the NCR regime. In 2013, we published a mental health and criminal justice policy framework.
We know that people with mental illness are overrepresented across the criminal justice system, including in interactions with police, the courts and the corrections system. We know that 40 per cent of people with mental illness have been arrested at least once in their lifetime.
People with mental illness are overrepresented in police shootings, stun gun incidents and fatalities. In the federal corrections system, 45 per cent of male and 69 per cent of female inmates require mental health services. The suicide rate in the federal corrections system is seven times the national average.
There are many reasons for the over-representation of people with mental illness in the criminal justice system. These include poverty, stigma, trauma and substance use, to name a few. A lack of access to appropriate supports and services is also a major contributing factor and continues to be a factor across the criminal justice system and a problem in the broader mental health system. In Canada we do not provide adequate access to mental health care and supports, and then we punish people for getting sick. We have criminalized mental illness.
Bill S-208 proposes to address the criminalization of mental illness through knowledge development and exchange and through improvements to programs and policies. CAMH strongly supports the activities proposed in this bill and believes they are essential for improving the lives of people with mental illness.
We also support the need for a national commission to lead these activities. As you just heard, the Mental Health Commission of Canada, created by the federal government, has a mandate to improve the mental health system and change the attitudes of behaviours of Canadians around mental illness. They have led several initiatives to introduce guidelines and standards and have been supporting the development of provincial initiatives to improve mental health systems across the country. They also have several current projects that focus specifically on mental health and criminal justice.
Focusing on an action plan through the recommendations in Bill S-208 makes good sense. We recommend the Government of Canada make a commitment to addressing the criminalization of mental illness and support the implementation of the activities outlined in this bill through the existing Mental Health Commission of Canada.
Thank you very much for the opportunity to be here today.
The Chair: Thank you very much.
I will now turn to the Canadian Mental Health Association and welcome to our meeting Peter Coleridge, who is National Chief Executive Officer, and Mark Ferdinand, who is National Director, Public Policy.
Peter Coleridge, National Chief Executive Officer, Canadian Mental Health Association: Thank you, Mr. Chair, and good afternoon senators and fellow witnesses. The Canadian Mental Health Association is very pleased to have the opportunity to speak with you about Bill S-208 and more broadly about criminal justice, mental health and mental illness.
The Canadian Mental Health Association is the largest and oldest provider of mental health services, with 110 locations across Canada. We were founded in 1918, and we serve thousands of people every day in hundreds of communities across the country. We rely on the work of thousands of volunteers and staff to facilitate access to the resources people require to maintain and improve their mental health, reintegrate into the community, build resilience and support recovery from mental illness.
CMHA is a front-line provider of community mental health services. We also actively promote positive mental health, ways in which people can focus on strengths, well-being and functioning in the community, at home, at school and at work in order to improve quality of life and respond to daily challenges.
CMHA shares the vision outlined in the preamble of Bill S-208, which calls for, among other things, a comprehensive approach to promoting positive mental health and treating mental illness. Thankfully, in the last 10 years alone, we have seen and continue to witness a sea change of conversations and profile around mental health and mental illness. But despite the progress, we still have many, many challenges in terms of people who need support and service gaining access to appropriate, high-quality, timely mental health support services and care close to their home and certainly within correctional facilities.
There continues to be many myths and misperceptions about mental illness in our society, so I want to emphasize that less than 3 per cent of violent offences can be attributed to people with mental illness when substance use is not present. In fact, as you've heard today from other witnesses and the senator, people who have mental illness are more likely to be victims of violence. As the bill states, the vast majority of individuals who live with mental health problems or mental illness are not involved with the criminal justice system. However, individuals with mental illness are overrepresented in that system. You've heard that from others here today as well.
With regard to prevention, CMHA shares the bill's assertion that access to timely and effective services, treatment and community supports for Canadians with mental illness would contribute to reducing their overrepresentation in the criminal justice system. We know we can't prevent all of the crime, but we can certainly adopt evidence-based actions to lower the risks of people interacting with the criminal justice system in the first place.
With regard to the correctional population, according to Public Safety Canada, 13 per cent of male offenders and 29 per cent of female offenders in federal custody self-identify as having specific mental health needs. To address these needs, CMHA supports the view expressed in the Mental Health Strategy for Corrections in Canada, which was created by the federal-provincial-territorial correctional services across the country. The strategy recommends a range of appropriate and effective mental health treatment and adjunct services. That range of services is essential to alleviate symptoms, including risk of self-injury and suicide; to enhance recovery and well-being; to enable individuals to actively participate in correctional programs; and to ensure safer integration of individuals with mental health problems into institutional and community environments.
As your committee continues its study into the issue of criminal justice and mental health, a number of facts already outlined in the bill are worth repeating. Mental illness is treatable. The effectiveness of treatment is enhanced, one, by early detection and intervention; two, adequate funding for mental health services; and, three, support for families and communities of mentally ill Canadians.
There is no doubt that the mental health, the corrections and criminal justice communities in this country have made important strides in reducing the discrimination and negative attitudes associated with mental illness, but there remains much work to be done to change the way the systems of education, training and skill building, support and care and corrections interact with each other to keep people healthy or help people recover from mental illness or addictions.
CMHA has several partnerships at the provincial level focused on maintaining and improving health and preventing health problems at home, in schools and at work. We also have experience working with correctional services in various provinces, for example, Newfoundland, British Columbia, Saskatchewan and Ontario. These partnerships involve diverting people to appropriate care at pretrial or following court appearance, or planning for release from custody and community reintegration.
As a result, we've got examples and models of collaboration and partnerships across sectors that establish appropriate, effective and just methods for addressing the needs of individuals who live with mental health problems and are involved with the criminal justice system either as young persons or adults.
Leadership and resources are required across governments and various sectors to expand and evaluate these partnership models across the country. An important step is support for the development, sharing and application of knowledge and statistical data and expertise on all matters related to mental health and the criminal justice system.
CMHA looks forward to continuing this progress with all Canadians, the federal government, and the many players here, including Justice, Correctional Services, Public Safety, Statistics Canada, the Mental Health Commission of Canada, as well as working with our many mental health and victims of crime partners across Canada.
Once again, thank you, and I look forward to your questions and our discussion.
The Chair: Thank you very much.
Colleagues, as you know, this meeting will end at 6:15. I am getting a fairly full list and we have 12 senators here today. I am going to invoke the one-question-per-senator rule, and we will go by rounds. You will ask your question and signify whether you want to be put down for a second round as well. As well, please identify the witness you would like to respond initially.
Senator Eggleton has kindly permitted his opportunity for a first question to be directed to Senator Cowan, who is the sponsor of the bill.
Senator Cowan, I invite you to ask the first question.
Senator Cowan: My question is for Ms. Vornbrock. I told her I was going to ask this question.
The mandate of the commission expires in 2017. Can you tell us where you stand in terms of your application for renewal, and will you provide us with a copy of the renewed mandate that you're seeking from the government?
Ms. Vornbrock: Thank you, senator, for the question. Thanks for starting with an easy one.
The Mental Health Commission has signalled its wish, its intent and its hope to be renewed by the Government of Canada through the pre-budget submission last August, through the Finance Committee. At that time we made public our intent to seek renewal, recognizing that in the work that has been done — and so eloquently talked about by my fellow witnesses here — a lot has been advanced in the conversation about mental health in Canada, but our feeling is that the work is not done yet.
Our intent in the pre-budget submission, and then in a subsequent presentation to the Finance Committee, we have asked the Government of Canada to consider an extension of the commission to 2025. We have identified early areas of interest, meaning that these are areas that our stakeholders, partners, provinces and territories have signalled could or possibly form the basis of a renewed or second mandate of the commission. Those include, related to this topic, the issue of mental health and the law, first responders, issues related to suicide prevention, a focus specifically on children and youth mental health, and also a focus on seniors' mental health. We've been looking at issues related to new Canadians. Then a final issue, which I know is near and dear to the hearts of my fellow witnesses, is the entire issue of access and how the Mental Health Commission, nationally, collectively and collaboratively, can determine more effective ways to improve and increase access and reduce wait times. Those have formed the basis of our ask to the government.
Since appearing before the committee last October, we have had a number of very promising and fruitful conversations with the Government of Canada and with other members of all parties in terms of securing everyone's commitment for the future mandate of the commission.
I wish I had good news and I had something to share today. We have asked for an early nod. I think part of that is to your point in your opening remarks, senator. We want to be able to actually move on the work and secure some new projects, new partnerships and carry on the good work that the Mental Health Commission has done and that all parties and the Government of Canada have done.
Senator Seidman: Thank you very much. My question is also directed to Ms. Vornbrock.
You've talked about Strategic Direction 2 in your Mental Health Strategy for Canada that was released in 2012, and you've given us a comprehensive overview of how connected you are to this intersection between mental health and criminal justice. I don't want to go to that at this very point in time, so I will take a second round.
It's a pretty interesting point of view that you put forward, and it might require some clarification for our colleagues around the table. Coming from the background that I come from, I understand what you mean when you talk about a holistic approach, but I think that it bears some conversation.
You say that you believe that your whole-systems approach benefits the objectives set out in Bill S-208, and that's the whole-systems approach of the existing Mental Health Commission of Canada?
Ms. Vornbrock: Correct.
Senator Seidman: Could you please explain to us around the table here, and to everybody watching, what that means and why that's important?
Ms. Vornbrock: Thank you for the question. I will start, and then I will turn to the author of the Mental Health Strategy to help me fill in the gaps.
What we wanted to emphasize in our opening remarks and our brief is that to address the issues that have been identified, we do have to think about things in terms of early childhood development — schools, support systems, family infrastructure, the workplace — all of those things that tend to create moments of vulnerability for individuals.
Our bedrock is the Mental Health Strategy for Canada. I'll turn it over to Howard to talk about the intent behind it, but it was to demonstrate how all these things are connected. Whether you're working on a poverty-reduction strategy, a housing strategy, a supported employment strategy, all these things are interconnected. To single out or isolate one issue, or to try to move down one stream, working with one system, I think you miss the opportunity for the cross- sectoral collaboration that is critical.
I have to say that in our conversations with provinces and territories, to quote our friends there, they have said that now they feel that mental health is everyone's business. I don't go into a room now where I don't have somebody from the school board, the police, corrections, the health system, housing, community services providers. That's the way that we work now. Taking that holistic approach is critical across systems.
If it's all right, I will let Howard Chodos speak a little bit about the underpinning and thinking of the Mental Health Strategy as well.
The Chair: Mr. Coleridge and Ms. Spadorcia wish to comment as well.
Mr. Chodos: I will supplement Jennifer's remarks. I think she addressed very well the whole-systems dimension, all the different components of government and agencies that have an impact on people's well-being, mental health, and the way all of what is often referred to as the social determinants of health impact people's well-being.
Maybe I will just say a little bit about the philosophical underpinnings of the Mental Health Strategy and what you referred to as a holistic approach to person-centred mental health. Part of the fight against stigma has been to encourage people to look at individuals who are experiencing mental health challenges as people, first and foremost, and not as their diagnosis, not labelling them as having a particular illness, but recognizing that people have many dimensions to their lives. If we want to assist people in a journey of recovery from mental health problems, we need to build on their own strengths, on their connections to their own families and communities, and so on. In that sense, a holistic approach is very much focused on the person, building on their strengths, understanding their connections to the world around them, the people and families who are there to support them.
That refers back to some of the context of the bill, speaking about a comprehensive approach. In the Mental Health Strategy and in all the work of the commission, we have certainly embraced the idea of a comprehensive approach in both senses: comprehensive for government and agencies, and comprehensive in the approach that we take to the mental health of the individual.
Senator Seidman: On the prevention aspect, I think we can't forget that. That's the very point that Senator Cowan made and that's the point that you're making now. Senator Cowan referred to prevention, before the crime is ever committed, which is the very point that you're putting forward in this holistic approach.
The Chair: You've clarified that. Thank you very much.
Mr. Coleridge: I mentioned in my remarks that over the last 10 years alone we've seen so much progress. This is one area, this notion of a person-centred versus systems-centred approach that a lot of organizations, including CMHA, have been calling on for probably the last 20 years. We have seen progress, but we have to continue to bring all the sectors together. This is a whole-of-government approach.
Mental health and addiction issues are complex and they require complex answers. It requires a multi-sectoral approach involving all the players. It's terrific that that approach is embedded in the national mental health strategy; it's a foundation. You see in provincial mental health and addiction strategies — and we have a strategy in every province now. Governments in every province have provincial mental health and addiction strategies, all of which also have a multi-sector, whole-of-government approach. I think this is fundamental if we're going to continue to progress and certainly to address the issues around corrections and mental health and the justice system.
Ms. Spadorcia: I wanted to reiterate this point because it's so critical, and we're seeing it in each province, certainly in the province of Ontario with their mental health strategy. The force behind it is a cabinet committee that brings together every ministry involved in mental health, and that's almost the entirety of the cabinet, to be honest.
I wanted to give a community-level example. One of the things we're doing at CAMH is working on what we call service collaboratives at the community level. The idea behind them was this cross-sectoral approach. We went into 18 communities and brought together community tables which we facilitated. At those tables are people in the community from police, schools, hospitals, social services, housing providers. We basically localized that cross-sectoral approach. We want to at the gaps in these communities, where we really need to intervene to improve the lives of, first, children and youth, because that was the initial focus of the strategy, and now moving into adults.
What we found, first of all, was not rocket science. A lot of these people had not necessarily communicated with each other before being brought together at these tables. As well, a lot of them had seen a lot of the same clients in different venues and had not really been connecting.
There is power in getting together and building an intervention together, being at that table and saying this is what we can all do together to improve said gap in this community. We're just at the point now where we're evaluating some of those programs and sharing that out across the province, and hopefully across the country as well. Even at the local community level, this cross-sectoral approach is proving to be the only way to actually make a difference.
Senator Eggleton: Out of the Shadows at Last has been mentioned a few times, and that is a product of this committee under our former chair Michael Kirby, and it resulted in the Mental Health Commission of Canada. It goes to show that studies done by senators at committees can produce some great results. We hope you get renewed.
I'm not sure who my question should go to, but I'll start with CAMH because it comes out of a statistic in their submission. The suicide rate in the federal correction system is seven times the national average. One of the most troubling, disturbing pieces of news we've been hearing in the last few years is about suicides of people in solitary confinement. Ashley Smith and Edward Snowshoe have been mentioned.
What is being done by your organization, starting with CAMH, to try to impress upon the officials involved in these institutions the need to make changes in the solitary confinement process? I understand it's probably one of the worst in the Western world in terms of length of time some people stay in these solitary cells, and it is a big part of this suicide problem.
Ms. Spadorcia: You're absolutely right, senator. This is a major problem. One of the issues that we are starting to deal with at the Toronto South Detention Centre is an early intervention service which we've partnered with them on, and it really is approaching it from that very early stage and introducing assessments at that entry point.
We need across-the-board training of people in these facilities around the prevention and management of aggressive behaviour. The people in these facilities are not necessarily trained to deal with the behaviours that may or may not arise. Certainly, as you've just mentioned, solitary confinement can trigger a lot of these behaviours.
There's a lot more that needs to be done, and investment to help train personnel across these institutions would really help to understand what the triggers are to those behaviours as a first step.
The Chair: Mr. Coleridge, did you want to comment on this?
Mr. Coleridge: No, I would agree with my colleague.
The Chair: Thank you very much.
Senator Nancy Ruth: Both CAMH and the Mental Health Commission of Canada have clearly said, "Let's take the proponents of the bill into our business." What is it in Senator Cowan's bill that you think you need to add to your business?
Second, do you do gender segregated data? Because you talk about, I know, "these communities" or "those groups" and I don't know who the hell you're talking about. I'm wondering if you do race, gender. What do you do?
Ms. Vornbrock: I want to pick up on a few themes of what has been talked about by Senator Cowan today. One in particular was the issue related to the work with front-line police officers. I had the privilege of working with Jim Chu for many years, being from Vancouver. I've Chief Chu speak many times talk about how police officers have become kind of on the front line of mental health.
Then at a conference we held together, Chief Chu stood up and asked everybody in the room — most of them were police officers and a few of us mental health folks were there together — how many of them got into policing to catch the bad guys. They all put their hands up. Then he said, "How many of you got into the business to work with the mentally ill?" Nobody put their hand up. He said, "I'm sorry; that's the new reality for policing in Canada."
For us, when we look at the bill, a lot of the work that has been outlined is work that the commission has started and is committed to working on. In particular, the knowledge exchange component, the information sharing, the training, all of that work, and at the heart of it, the really strong message about addressing the stigma related to mental health becomes a really critical component because we do want to improve. As my fellow witness was talking about, we want to improve interactions between people with mental illness and mental health problems and the justice system, whether that's in a correctional setting or a community setting.
To your question about research, whenever the commission undertakes new research, we work very hard to address all of the various components related to race, to gender, to ethnicity. In fact right now we're working with the Wellesley Institute in Toronto focusing on a critical project on the case for diversity. This is a really critical lens that the commission has, and it's also a component in a cornerstone of the mental health strategy as well.
I don't know if Howard wanted to comment on that as well.
Mr. Chodos: I would mention that there is a specific priority in the strategy for addressing the specific mental health needs related to gender and sexual orientation, so at least there is an acknowledgement. As with all of the recommendations of the strategy, they remain at a fairly broad level, but it's very much to acknowledge the different ways in which mental health problems can affect men and women, different ways they present. We know, for example, on suicide that more women and girls attempt suicide and more men succeed. Understanding those things is critical to being able to develop effective policies.
I think we certainly have that awareness. As Jennifer was suggesting, in all of the work that we do, we do try to integrate that awareness in recommendations and actions that we pursue.
Mr. Coleridge: It's important to note that from research and experience and models, we know what needs to be done. We know what the solutions to the problem are. The issue is the application of the new knowledge and the best practice, the actual sharing and support of multi-sector work.
This is complex. Getting all these players together and sorting through issues and coming up with how to implement a best practice requires resources and leadership, and that's what's missing that needs to go from this bill into either a new commission, the Mental Health Commission of Canada or some other organization. Without that, we're going to continue to talk about we know what to do but it's not happening.
Senator Stewart Olsen: Now you've confused my thought process on the question, Mr. Coleridge.
I'm struggling with the idea of commissions versus front-line services. If you have a pot of money and just so much money to go around, where do you think the first initiative should be? Where do you think the bulk of the money should go?
Mr. Coleridge: I think, as I commented in my remarks, supporting the implementation of those models that exist and evaluating those models, sharing that information and supporting the uptake of that in other provinces and communities is where it should start if there is limited money.
Having said that, the work of the Mental Health Commission of Canada and what's being proposed in this new bill, the synthesis work to gather the research and come up with standards and best practices so that a front-line organization like CMHA doesn't have to do that and can focus on front-line work is important work to do. It's a "both/and."
Ms. Spadorcia: It feels like the sector itself has been under-resourced for so long that that is a really difficult question to answer. Of course we need to provide care at the front lines. We can't take our eyes off of that.
We often say at CAMH that we need to take care of the patients today and the patients of tomorrow. The way to do that is to ensure we're well-resourced at the front lines of care, that we're well-resourced in research and education and that, as my colleague was saying, we're really developing those standards and guidelines and disseminating that knowledge. We're just not there yet because we have not been resourced to do that, so that's a tough question to answer.
Senator Stewart Olsen: I know it's tough.
Mr. Chodos: I think starting with the work of this committee 10 years ago we have seen a sea change in attitude towards mental health and illness in this country. I would support the idea of a "both/and" and that there is a role at a national level to maintain the focus.
An issue raised as well in Senator Cowan's bill is addressing questions of stigma. It's an all-encompassing problem in relationship to mental health and mental illness. I think there is a role for high-profile bodies to be able to galvanize a public conversation on how best to make conversations about mental health a normal part of public policy and personal conversations amongst individuals.
It is a difficult question to answer, but I would support Peter's sense of it being a "both/and" rather than an "either/ or."
Mark Ferdinand, National Director, Public Policy, Canadian Mental Health Association: Maybe to add a level of optimism, in Ontario you have a good example of the type of front-line service that has existed since 1997 to bring together different organizations in order to address a number of the issues that have just been discussed. The Human Services and Justice Coordinating Committee was established precisely in 1997 to help implement the Ontario government's policy framework for people who come into contact with the justice system and who have needs that can be met by one or more of the provincial human services systems.
Thank goodness the committee doesn't exist only at a provincial level but also across a number of regional committees. You have two things there. You have leadership, which I think is essential to bringing people together so they can solve problems and truly implement the research we already have. We know what works, but people do have to talk to each other.
We also need — and I think this is what Senator Cowan's bill identifies in subclause 4(m) — evaluation. The Human Services and Justice Coordinating Committee, before they establish protocols with front-line hospital workers, police services, social services workers, people who have lived the experience, they evaluate those standards and protocols to see whether they are achieving the outcomes they were designed to meet. I think evaluation is something certainly the federal government can do within its own sphere of jurisdiction as it relates to correctional services federally.
Senator Merchant: Thank you to the witnesses. I'm not sure to whom I should direct my question.
We have a finite pot of funds, and we have talked about the cost of policing services, the justice system, the prison system, and so much of it is directed to dealing with people with mental illness. Can any of you give us a guidepost on the financial, administrative and people cost of mental health and dealing with mental health crimes?
Mr. Ferdinand: Based on the research, just looking at youth in Ontario, I understand that it costs roughly $140,000 to house a youth, every year, in a detention centre. Compare that to, for example, the cost of admitting someone to hospital, somewhere between $1,200 and $3,000 a day, depending on the need. It could be a severe or not so severe case. It ranges between $1,000 and $3,000 a day.
Then you compare that against the cost of intervening early and providing services in the community, let's say preventive or health promotion services. Those run, on average today, in the under-resourced mental health system at roughly $3,000 a year. So there is a question to be asked around what we could be doing upstream to prevent or promote better health or keep people healthy at a cost that is far less than what it costs to house someone in a correctional facility.
Ms. Vornbrock: I think Mark has provided some of the important statistics. A lot of the research that we had uncovered through the national At Home/Chez Soi initiative is critical.
I want to pick up on an earlier theme. We know the strong business case for investment in mental health. We know that mental health costs the economy in Canada more than $51 billion every year. A strong cornerstone of both the Out of the Shadows at Last report as well as the Mental Health Strategy is to talk about the increased spending required in mental health to manage the burden of disease, not just on the health system but on the system overall.
I want to make the point that we know certain interventions work. We know that providing stable housing works. We know that providing good access to jobs and employment, to family supports, to good education makes a difference. Not only is it saving lives and is consistent with the vision of the Mental Health Strategy that Dr. Chodos talks about, but it also makes good financial sense in terms of good investment over time.
The business case for investment in mental health is strong, and it doesn't mean investing just in the health system. It means investing in all the other components across the continuum. It's that holistic approach again.
We know what needs to be done. The solutions exist. The innovations exist in this country and abroad that we know we can make work in Canada.
[Translation]
Senator Chaput: If the commission were to be created, can you describe for me the best way to design and structure it so that it can cooperate with other existing agencies, and so that it can fill the gaps that have been identified at present. There are gaps, there can be no doubt. One group cannot do everything for everyone. What would be the best way to structure the commission so that it can fill these gaps and so that it can collaborate with other stakeholders?
Mr. Chodos: Thank you for the question.
[English]
I will try to answer in English. As I understand your question, it would be if the commission, as proposed by Senator Cowan, were to be created, what would our view be on how it could most effectively work across the sector.
Reflecting on the experience of the Mental Health Commission in its efforts to do some of that work and connect with people across the country and build partnerships with people and stakeholders right across the country, we have always tried to bring the voices of people doing the work and engaging in work in the communities into the work of the Mental Health Commission.
I noted that in Senator Cowan's proposal there is a whole advisory committee structure. We had an extensive set of advisory committees that worked with the commission that provided expert advice on a whole range of topic areas that allowed us to connect with people on the front lines, people in the research community, and so on. In terms of building those relationships, it's important for whatever the commission looks like to be able to be structured so that multiple voices can be brought inside its ranks in order to understand the complexities of the issues and to be able to propose solutions that can then be driven outwards into communities.
Mr. Coleridge: To add to Howard's point, I think the focus of a commission should be as a catalyst and a facilitator, not as an implementer, to bring the professionals, players and sectors together, to determine solutions based on best practices, and to support the front line and professionals implementing that work across sectors.
Senator Enverga: Thank you for your presentations. My question is for Ms. Vornbrock.
I saw your website. You suggested improvements to health care for mental health and you listed the justice system as part of this. Can you tell us more of what you have done that is linked to the justice system and what you think of it? Have you done well or would you say it's not enough?
Ms. Vornbrock: Have we done enough? Not yet, no. As has been shared by all of the witnesses and I believe shared by Senator Cowan and perhaps a lot of you who we've spoken to in terms of where we are as a country on mental health, we have not reached the tipping point in the kind of sea change that I think Dr. Chodos speaks about.
We are optimistic about some of the early work, in particular some of the work that was already mentioned by Dr. Anne Crocker. I believe you will hear from Dr. Terry Coleman and Dorothy Cotton, who have done outstanding work for the Mental Health Commission on a report called TEMPO, which addresses a number of the issues related to interactions between individuals struggling with mental illness and mental health problems and the police.
This is speaking to what Ms. Spadorcia was talking about earlier, which is actually the stigma and mental health of police officers and those working in the justice system themselves. A critical part of the commission's work over the last number of years has been around the psychological health and safety of our workers in Canada. A job like policing or working in a correctional facility is an incredibly difficult and taxing job. How are we, as employers, taking care and consideration of those who are doing this job day in and day out and how are they caring for themselves?
We cohosted a conference with the Canadian Association of Chiefs of Police in Mississauga in February where we had over 250 police officers join us to talk about how they are managing and caring for their own mental health as well as the mental health of their officers. We heard a compelling story by Assistant Commissioner Roger Brown of the Nova Scotia RCMP who spoke about the shootings in Moncton. The kind of leadership being shown by our police leaders, corrections, the RCMP and others is starting to open up doors that didn't exist even two or three years ago. I'm incredibly optimistic about where we are going next, but I still think we have a ways to go.
Senator Wallace: Thank you for your presentations. The impression I get from what each of you has said is there is no lack of knowledge within each of your organizations to understand the issues, and there seems to be a commonality amongst you as to the approach needed.
Mr. Coleridge, I was interested in a comment you made when you were talking about the need to continue this cross-sectoral approach. You said that there are two requirements to actually implement solutions and not simply study. You said it calls for resources and leadership. When I think of that, leadership is of course at the nub of all success, I would say.
Ms. Spadorcia, with that in mind, in your presentation, you said that your organization supports the activities proposed in Senator Cowan's bill, but you then went on to say that your recommendation is that to address those activities, you believe they should be incorporated into the mandate of the Mental Health Commission of Canada. It would seem that you are asking where that leadership is going to come from. You seem to be comfortable with the Mental Health Commission of Canada.
With that build-p, I would now turn to Ms. Vornbrock. Do you feel your organization fully appreciates the activities and needs that have been identified in this bill and do you feel your organization is capable of providing that leadership?
Ms. Vornbrock: I would like to think we fully appreciate the work. We have had the privilege of working with Senator Cowan over many years. I know he has spoken to members of our board and our leadership. As we looked through it and spoke on the bill, we realized that most of the activities are things either that the commission has spoken about or heard about. We are quite confident that there is an opportunity there, but, again, I would say that the commission does not act alone. The metaphor we often refer to in terms of the commission is that it is a backbone organization. We are an organization upon which others stand on our shoulders. We do not implement or do. We try to lead and catalyze, to use Peter's language. It is important for us to work in partnership. To do so, we are engaged in conversation across the country on a mental health action plan for Canada.
As I said in my opening remarks, we do not go a table where we aren't talking about criminal justice issues. I feel quite confident that there is an opportunity, should we get a second mandate from the Government of Canada, to work with all parties in the federal government, with provincial and territorial governments who are essential to this conversation, and all of our stakeholders and people with lived experience and their families to make the necessary changes that we would like to see to achieve what has been outlined not only in this bill but also what's outlined in the mental health strategy for Canada.
Senator Wallace: You say your organization would work with all the parties. That's fine, but does that mean to provide the leadership needed to bring them together in focused way to implement effect solutions? Is that fair to say?
Ms. Vornbrock: That's fair to say. One of the powers of the commission is that we're a very powerful convener. We like to bring and we do bring folks together. We're very fortunate that when we invite people over, they tend to come.
Ms. Spadorcia: I feel the need to explain this since the context of the question was around my recommendation. I will speak for myself. We were excited to read the bill and really energized by the work that Senator Cowan did. Actually, lots of comprehensive work seems to come from the Senate on mental health, so we're really excited about that.
When we started to think about the bill, we do want to implement all those activities in the bill. We think the bill is going down the right path. From our point of view, it's really about whether we at a point where we want to create another structure. Can we build on what we already have? A lot of our organizations are doing a lot of work. We've already been convened by the commission to do a lot of work. We have provincial mental health strategies being implemented across the country. I think where we come from is yes, we absolutely need this.
We hope that the federal government decides to go forward with this, in whatever structure, which would be great, but we really want to focus on getting the work done versus creating another structure. At this point, the work needs to be done.
Mr. Coleridge: I agree with both sets of comments, but I want to emphasize that if this mandate ends up being part of the mandate of the Mental Health Commission of Canada, which I would support based on the comments made, let's not forget that it requires resources for them to provide the leadership and do the knowledge synthesis, distribution and sharing of standards and best practices, et cetera. Resources have to go to the front line in corrections in provinces and to organizations like CMHA and many others to implement the great work that the commission is doing. Whether that's new or realigned resources, I will not comment on, but let's not forget that that's a critical part of the equation.
Senator Raine: Thank you very much. This is absolutely fascinating, and it is really evident that everyone understands the link between mental health and people who get caught up in the justice system. Obviously we would like to see prevention be part of the pillars of any strategy around mental health and the justice system. My question is for Mr. Coleridge.
Did I hear you right when you mentioned mental health strategy for people in the justice system? Is there an existing strategy, or were you just connecting mental health strategy and then as it impacts people in the justice system? Do we need a separate strategy, or is it all part of one but we haven't focused enough on it yet?
Mr. Ferdinand: I know my colleagues at the commission can probably speak about this, as they provided advice on the development of this strategy. There is the Mental Health Strategy for Corrections in Canada. Not only does it have seven themes that cover many of the things outlined in Bill S-208, but in looking through the Mental Health Strategy for Corrections in Canada, I'm impressed by the targets and the expected outcomes that have been outlined within that strategy. Correctional Services from the provinces, as well as the federal government, came together with the help of the commission and others to actually work on this strategy, but more importantly, listen to people working on the front line and ask them what their needs were. When looking through the strategy, I was impressed with the honesty and the forthright comments that were made from members of the correctional and criminal justice community about the needs that were going unmet from an employee perspective or possibly from an employer or setting perspective, in addition to the unmet needs of obviously the people who are incarcerated.
It is a wonderful strategy. I think it would be something we can look to in terms of determining how we best get to the implementation that we so desperately need before people get incarcerated but also when they are in contact with the criminal justice system?
Senator Raine: Who has written the strategy? Obviously we need a copy of it.
Mr. Ferdinand: As I'm recalling the introduction to the strategy, it basically says it has been put together by representatives from these different correctional services. I personally don't know who has written it.
Ms. Vornbrock: I believe it is Corrections Canada. I think they had a working group put that together. That's my understanding as well.
The Chair: We have it.
We've got that and that covers that issue, and I'll now turn to Senator Cowan to be followed by Senator Enverga.
Senator Cowan: Thank you. I omitted earlier to thank you all for coming and taking the time to look at the bill and to comment on it.
I do have a question for Jennifer. I appreciate that you have come and expressed your view and I think it's a very persuasive view. I mentioned earlier the good work you had done both with respect the TEMPO project and also the Trajectory Committee and Bill C-14 that dealt with NCR, or not criminally responsible. I was anxious that the commission come and express its views on that bill, as they have done, and to come here to express their views on this bill. The response that I received from the commission was that they couldn't come because they were not in a position to directly lobby government. I would have thought that one of the roles of the commission would be to come and comment on bills before a house of Parliament, whether it's a private member's bill like this one or a bill like Bill C-14.
Can you comment on your view or your commission's view as to how you make the decision about which bills you will or will not appear on?
Ms. Vornbrock: I'll try. Thank you for the question.
The commission has had in its tradition and its history, in its last seven or eight years, advocacy and conversations with a small "a". But I would go back to my earlier comment about the way the commission works and functions, and that is in partnership. While the commission was not vocal or perhaps speaking out on the NCR bill, we were working closely with a number of organizations and individuals who were.
In particular, you mentioned earlier the work we have been doing with Anne Crocker through a research lens and also work that we done with Dr. Patrick Baillie and other members of a small coalition. The commission had offered support as appropriate.
Given that the research hadn't been completed on the Trajectory Project, the commission didn't have a strong position to share at that time. The decision was to offer Dr. Anne Crocker to come and speak as well as other members of the Mental Health Commission family, if you will.
We take each issue, bill or situation on a kind of case-by-case. We determine what research the commission has and what position, if any, we have. We think those through carefully and share that and talk with our partners about whether or not the commission is the right group to speak to about the issue or whether we would look to other partners around this table like the CMHA, the Schizophrenia Society of Canada, CAMH or in some instances researchers who are better positioned to deal with that. We don't try to always be the spokesperson or the spokes- organization on particular issues.
Does that help answer your question?
The Chair: Thank you.
Senator Seidman: If I could go back to the introduction to my last question that I didn't ask, it has to do with Strategic Direction 2 that you referred to in your presentation, Ms. Vornbrock. You say that it responds directly to Senator Cowan's bill because it talks very directly to the corrections system; specifically priorities 2.3 and 2.4. I don't necessarily want to read them all here, but you might want to speak to them, including the one that says "provide appropriate supports for those involved in the criminal justice system." You also deal with prevention, promotion and enhancing policies and practice. If you could you speak to that, I would appreciate it.
Ms. Vornbrock: I will do my best and perhaps let the author of the strategy speak to it. You have highlighted the ones that I would focus on, again going back to that theme of holistic care. What is not here in Strategic Direction 1 is that whole notion of prevention and promotion across the lifespan.
Strategic Direction 2.4 really does talk about increasing the availability. It goes back to this issue of resources, ensuring that what we know works is in fact available to individuals. It goes to that underling important theme of access.
I also want to underscore a couple of words in there that are critically important — appropriate services, making sure those services are appropriate and matching the needs of that individual whether it's related to gender, age, ethnicity or culture. A critical component of the Mental Health Strategy for Canada is working with diverse populations, recognizing that many Canadians are new to our country and there is a certain nuance and a way in which services need to be addressed.
I would want to underline the words in there around "comprehensive." This isn't just when you exit this door. We actually want to show you where the next door is so there is a continuum of care, which is often a theme that we want to talk about. It's comprehensive.
You'll see other words in there that are critical to us addressing the gaps that exist in the system. I've heard many of our stakeholders and partners in the community talk about how we don't really have a system. We have some really good services, but I'm not sure we are at a stage yet where we can say we have a comprehensive system of care that is well integrated and cross-sectoral to really achieve the things that we have outlined in the mental health strategy.
This strategy doesn't have a date on it. It continues to be aspirational, and it drives and motivates all of us working in the mental health field in Canada, including the Mental Health Commission and our partners.
Mr. Chodos: I think part of the intent, if you look specifically at recommendation 2.4.2, is that one of the aspects is ensuring everybody has a comprehensive discharge plan upon release into the community. That speaks to some of the connections that the bill speaks to as well, the importance of not just looking a person in a moment in time but recognizing that there is a pathway to recovery. That involves people who experience mental health problems coming back and being discharged into the community, and it ensures there are wraparound services to make the transition successfully.
Senator Seidman: The main point here is that you say very clearly your work is guided by the Mental Health Strategy for Canada released in 2012. These components, these priorities, are in that mental health strategy, and that point is crucial for us to understand. I thank you for that.
Senator Wallace: It's obvious to say that any effective strategy to deal with these issues has to involve not only the federal government but the provinces as well. Mr. Ferdinand, you touched on that. You gave an example of that cooperation between the federal-provincial groups to bring together a strategy.
I'm wondering, Ms. Vornbrock, if you could give us more detail on the relationship that your association, the Mental Health Commission of Canada, has had with the provinces in effecting a common strategy and coming to effective results — not just studies but effective results. Can you describe that for us in more detail?
Ms. Vornbrock: I know we have a very strong relationship with the provinces and territories. In fact, that's where our CEO is today. She is in Halifax meeting with the Premier of Nova Scotia and the Minister of Health, holding a stakeholder round table with a number of community organizations in that city.
We have worked very hard because we know that health is the jurisdiction of our provinces and territories. Influencing and effectively moving the needle on mental health in Canada requires a close relationship with the provinces and territories.
We have our provincial-territorial advisory group. We meet several times a year with the appropriate person in government, typically an assistant deputy minister of health or a director of health, across all the provinces and territories. We have very close relationships with them. But at the end of the day, what will really matter to the provinces and territories is real tools, real materials and real guides.
The strategy has been incredibly helpful for them. It has either helped them reshape their strategy or be guided by the strategy. Right now the Province of Newfoundland is in the process of rewriting its strategy and has seized the Mental Health Strategy for Canada as a cornerstone for that.
The most tangible example of where the commission has worked closely in partnership with the provinces and territories was the At Home/Chez Soi initiative where we picked five Canadian cities. That would only have worked with provincial-territorial buy-in because every single person that was housed as part of that initiative — 2,000 Canadians were housed — maintained their housing. That's because the provinces and territories stepped up and filled in that gap when we stepped back.
That was honestly a natural transition. It was a natural partnership between the Government of Canada and the provinces and territories wanting to make a real difference in ending homelessness in this country.
I'm quite proud of the relationship we have with the provinces and territories. It is a synergistic one. They challenge us. They tell us what is valuable and what is not valuable, and we try to be as responsive as we possibly can to the work they are undertaking.
Mr. Coleridge: I wanted to add that with the provincial CMHAs in a number of the provinces I talked about earlier, where we have programs and models working with provincial justice and corrections, for the most part those programs are funded provincially. But again, the federal leadership that Jennifer is talking about is so important to raise the bar and get these models happening across the country in partnership.
The Chair: Thank you all very much. I want to thank my colleagues for their very clear questions.
This is a very complex issue. The first thing I want to say is that I think we have all deeply appreciated how well and clearly you have articulated the answers to these questions on what is a complex issue. That's enormously helpful to us, getting all the questions in and answered. The more important part is for us to have the input that will allow us to hopefully make a good decision in the end.
I was particularly struck by the clear sense of cooperation and collaboration among the organizations represented here today. We don't always see that at this committee. It's often easy to tell when it's not real even if it is suggested, but I get a very clear sense of the ongoing, long-standing degree of interaction among the groups here and the cooperation among you.
That was also reflected in your common identity of the scope of the problem and of having cooperation among those organizations that are charged with mandates in this area, and that you come together and work collaboratively to move forward.
A major issue for us is trying to determine whether or not a new commission is necessary. You've all recognized that the elements identified in the bill are essential issues. You've even indicated that a number of them are already in your discussions and that you've had a number of strategies that are either partially evolved or evolving within these particular areas. So the critical issue for us is the appropriate way to move these issues forward.
I thought you were very careful in no one wanting to subsume everything to themselves, but I did sense that there is the opportunity for you all to work together on these objectives as they move forward and the clear issue of somebody, some organization taking the lead to lead these particular issues. I sense that that might be possible within existing mandates, but the objectives are clear and needed.
In the end, what has come through — I have also appreciated the way that you have referred to it — is the omnipresent need for more resources. This is a very complex issue and area. I gained a great deal of confidence in your ability to use resources effectively by the way you talked about the issues, how to bring groups together to focus on those issues, the need to understand them before you go off willy-nilly in trying to implement, and the complexity of the situation where you have mandates to deal with the synergistic issues here, but the implementation is through the provincial health organizations except for those jurisdictions over which the federal government has unique responsibilities.
It is, at the end of the day, an absolutely critical issue for society. It is essential that these issues be addressed in a holistic way. The individual approach and the community environment are critical to moving forward successfully on these issues. I think you have been enormously helpful to the committee in helping us to address the issues raised by Senator Cowan in his bill.
With that, on behalf of the committee, I want to thank you so much for your testimony before us today.
(The committee adjourned.)