Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 48 - Evidence - October 24, 2018
OTTAWA, Wednesday, October 24, 2018
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:15 p.m. to examine and report on issues relating to social affairs, science and technology generally (topic: study on child and youth mental health).
Senator Chantal Petitclerc (Chair) in the chair.
[English]
The Chair: Good afternoon. Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[Translation]
I’m Senator Chantal Petitclerc from Quebec. I’m pleased to be chairing the meeting today.
[English]
Before we give the floor to our witness, I would like my colleagues to please introduce themselves, starting with the deputy chair on my right.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Eaton: Nicole Eaton, Toronto.
Senator Ravalia: Mohamed Ravalia, Newfoundland and Labrador.
Senator M. Deacon: Marty Deacon, Ontario.
Senator Dasko: Donna Dasko, Toronto, Ontario.
Senator Marshall: Elizabeth Marshall, Newfoundland and Labrador.
Senator Omidvar: Ratna Omidvar, Toronto.
[Translation]
The Chair: I want to thank my colleagues. Today, we’re continuing our study on child and youth mental health.
[English]
I would like to introduce our first witness. We are very pleased to have with us from Nanaimo, British Columbia, via video conference, Ms. Elizabeth Newcombe, Board Member, Crisis Services Canada.
Welcome, Ms. Newcombe. It is a pleasure to hear from you today. I would ask that you begin with your opening remarks, please.
Elizabeth Newcombe, Board Member, Crisis Services Canada: Madam Chair and members of the committee, thank you for inviting me to speak to you today. It’s a pleasure to be here remotely from Vancouver Island to share information about the Canada Suicide Prevention Service. In addition to being a board member of Crisis Services Canada, I’m also Executive Director of the Vancouver Island Crisis Society, one of the crisis centres that answers interactions on the national line.
Crisis Services Canada is a collaboration of non-profit distress and crisis services from across Canada. We incorporated in 2017. The network has formalized the organizational structure with a focus on strengthening regional service delivery to address nationwide gaps in service.
We launched the new Canada Suicide Prevention Service on November 28, 2017. This service enables callers to access suicide prevention and support using the technology of their choice, whether that be voice, chat or text, in French or English.
Canada Suicide Prevention Service will not replace existing local distress and crisis line services or phone numbers across Canada; it will only complement local service. Canada Suicide Prevention Service uses a new multimedia, contact centre platform to link existing local/regional service providers who deliver crisis support already. We’re a nationally available, regionally delivered service.
Canada Suicide Prevention Service provides anyone who is thinking about suicide in Canada with 24-7 support. Why a national service? One number across Canada, easy access for people. The goal is to save lives, not time, hence conversations compared to other contact centres could be considerably longer. On average, a phone conversation is 20 minutes; chat or text can be up to 60 minutes long. We provide coverage to areas that previously were without support.
The routing technology allows for quick access to 9-1-1 intervention nationwide. We leverage shared best practices in assessing the risk of suicide, providing support, offering resources and, most importantly, developing a safety plan and dispatching emergency intervention if necessary.
We avert unnecessary, expensive EMS visits using the least intrusive intervention possible. We offer follow-up calls to people experiencing thoughts of suicide and third-party outreach calls to those impacted by other suicide ideation.
To give you an idea of some of the interactions and stats that we’ve received since launching, from November 2017 up to September 6, 2018, we received 17,878 contacts for support from people in need across Canada. Fifty per cent of those were voice, 24 per cent were from chat and 26 per cent were via text. As well, 3,965 service users confirmed thoughts of suicide at the time of the interaction, 47 suicides were in progress and 192 active rescues were completed, and 110 follow-up calls were arranged.
We get calls and interactions from across the age spectrum, but I want to highlight that 2 per cent of the calls come from children under 12, and 26 per cent of our interactions were from youth between the ages of 13 and 18. Eighty-six per cent of the service users under 19 years of age choose chat and text as their medium of preference, which is not surprising to us.
In terms of our collaboration with other stakeholders, we support the “no wrong door” approach to accessing support. So the Canada’s suicide prevention service is committed to working with Kids Help Phone and First Nations and Inuit Hope for Wellness Helpline to advance research, knowledge, sharing and advocacy so that every person in Canada can access the suicide prevention support they need, when they need it and how they need it. We continue to work collaboratively with provincial and regional organizations.
I want to end with a couple of brief stories. We had one woman who was walking the train tracks with thoughts of suicide. On her phone, she called the national line, and she was given support, a safety plan was put in place and a follow-up call was offered. Later on that day, the follow-up call was made, and the woman mentioned to the call responder that she didn’t know that anybody cared. There was a life not taken that day.
Another story is from our own distress centre here on Vancouver Island where a youth was talking and texting via Facebook. Her friend sent a message that she was going to take her life. So she called the distress centre, and the call responder coached the youth on what to say to her friend via Facebook. Within an hour, we were able to locate that youth and get mental health crisis services in place for that person.
I thank you for having me here today, and I’ll try my best to answer your questions.
[Translation]
The Chair: Thank you, Ms. Newcombe, for all that information.
[English]
It is time for questions. There are many. I would like to remind my colleagues that we do have five minutes for questions and answers. We will start with our deputy chair.
Senator Seidman: Thank you very much for your presentation, Ms. Newcombe. In describing the service you offer, you said it uses a new multimedia contact centre platform to link to existing local regional service providers who deliver crisis support. Then you go on to say that you have a routing technology that gets people in need to the supports as quickly as possible.
I’d like to know if you could help us understand what this new multimedia contact centre platform is, what that routing technology involves and whether you use an integrated model that involves a full range of care professionals.
Ms. Newcombe: Yes. Routing technology is not new, but there is cloud technology, if I can call it that. When a call comes in to that number, the platform knows where the call is coming in, and then, when call responders log in, they will direct that call to the closest call responder. For example, if it’s coming from Ontario, it will go to a call responder in Ontario first. If they’re busy supporting another call, it will route to the next available call responder. Call responders log in to the platform and calls are routed accordingly.
We can work toward routing calls based on skill set. If the person is French or English, we can route according to that. If the person is a military person, we can route according to that particular expertise.
The technology, although we’ve just started with it, has the capability to do a lot more than what we’re presently using it for.
The other thing it does is that instead of having all these distress centres across Canada that do great work, we can leverage it in a different way. We use Northern911, for example, where we have one centre to call for 9-1-1, and they are familiar nationwide, rather than going to our local 9-1-1s and having them try to figure out where that person lives in Canada. The technology itself does a lot of the work in integrating the regional distress centres.
Senator Seidman: Is this technology new, because you say it’s a new multimedia contact centre platform?
Ms. Newcombe: Yes. Some of the technology has been leveraged. Rogers has done a lot of work. They were instrumental in listening to what we needed and to developing this routing technology.
We have some routing technology in different provinces already. For example, there’s APPELLE in Quebec; we have technology for 1-800-SUICIDE in B.C. But the routing is very basic — for example, we’re limited to four routes already — whereas this new technology is beyond that.
Senator Seidman: Who is at the other end of the phone to deal with the callers? Are they people who are part of a system of trained, integrated, allied health professionals? Is there some way to triage what kind of professional person needs to speak with?
Ms. Newcombe: The call responders come from regional distress centres, and they have intensive training. Some are staffed; some are volunteers. The training is leveraged. It’s based on best practices, with an accreditation. We model after the American Association of Suicidology, which does the accreditation for a lot of crisis centres. The training is best practices based on that.
All call responders go through that intensive training in order to be able to take crisis calls.
Senator Seidman: Were you part of the suicide framework developed in 2016 in Canada?
Ms. Newcombe: Are you talking about the blueprint for suicide prevention? That came out of CASP, the Canadian Association of Suicide Prevention. I’m a CASP member, and a lot of distress centres are. When that came about, that information flowed through distress centres, and we used that as a platform in developing our programs going forward.
Senator Eaton: Thank you for your heartwarming presentation — not heartwarming in a good sense, but heartwarming in a frightening sense.
Do you do demographic breakdowns, looking at mental illness, addiction and sexual assault? Do you classify them?
Ms. Newcombe: We don’t necessarily classify, but we have unified call reporting. So with our statistics, we know that, for instance, 47 per cent of calls have a mental health component. We know that 10 to 15 per cent of our call volume has a suicide component. This is for distress centres, generally.
For the national line, when someone calls, we know whether it’s regarding addiction or connected to the opioid crisis, for example. The information as to the reason for calling comes from the caller. They may want support because they’re going through a divorce.
Now, the national line is a suicide prevention line, so we do focus in that area. We do ask about suicide because it is a national suicide line, but suicide is connected to many issues. It’s a long trajectory during one’s life. Someone could be dealing with a mental health issue and have suicide ideation or they may not.
We do keep statistics in terms of the major reasons people connect with us.
Senator Eaton: I read somewhere that education and faster intervention could prevent many suicides. Would you agree with that?
Ms. Newcombe: Absolutely. One of the things about leveraging distress line centres for the national line is that we can refer people back to their regional crisis lines for support after we’ve supported them with their suicide ideation. When we refer them back to their local crisis lines for support, a lot of these distress centres have other programs beyond their crisis lines. For example — I only speak for my distress centre — we have community education programs in the schools. When we’re in a school doing a presentation, we educate about the crisis line service. At times, we’ve even done a mock call in the classroom so they can see it’s not so scary. What can they expect when the call responder is talking to them? They can ask questions in the classroom. We’ve done that locally at our regional centre.
When you get in one-on-one with the youth in the classrooms, that’s where a lot of that education happens. Not all distress centres have those programs in the schools but many do.
Senator Eaton: You said that when somebody calls in, you help them right away and there is often a follow-up call. Do you ever worry that after the follow-up call that a person just falls off your radar? I guess you’re limited by how much you can do for the person, but after the follow-up call, is there a concern that you will not hear from that person again?
Ms. Newcombe: Absolutely. The reason for the follow-up call is that we’re concerned about that person. There are set protocols for setting up a follow-up call. If we’re not able to de-escalate, connect them with supports or they’re not with a family member, the follow-up call is meant as a safety net. Perhaps the follow-up call is done within an hour and maybe there’s another follow-up call after that hour. There could be multiple follow-up calls. We’re looking at dealing with the immediacy of the situation. So usually there’s an imminent attempt, something here and now and we need that follow-up call in place.
Maybe it’s three o’clock in the morning and services aren’t open yet. We’re 24-7, so we’re like the safety net that catches everything. That follow-up call is there in the interim until we can get them connected to supports.
Senator Seidman: Thank you very much, and thank you for what you do.
Senator Ravalia: Thank you, Ms. Newcombe. My question is related to demographics. You talked about the age demographic that you serve. Do you maintain a geographical demographic? In particular, are you able to tell if your calls come from a racialized or ethic group?
Ms. Newcombe: We can tell where the calls are coming from — city, province, location. We can’t say whether someone is Indigenous or not. We’re an anonymous service, so that information would come from the caller. If they present themselves as Indigenous and we need to refer them to resources in their community, then we would have statistics regarding the fact that we had an Indigenous caller. But if they don’t reflect that in the call, we wouldn’t know that.
The statistics regarding specific demographics of the population would be as good as what they’re giving us in the call. There would be a lot of unknowns, but we do keep what we are presented with.
Senator Ravalia: Is there a particular part of the country where there would appear to be a greater vulnerability or a higher volume of calls?
Ms. Newcombe: I would say for populations, LGBTQ, Indigenous populations and men who are middle-aged or just retiring. There are certain demographics that are at a higher risk for suicide. We’re trying to reach out to the male population to reach out for help.
We get more calls from females. There’s a one-third to two-thirds ratio of female to male people that access services. We’re aware that it’s societal in terms of reaching out for help. It is not a sign of weakness; it is a sign of strength. We’re getting that education out there and getting rid of some of the stigma.
There are certain populations we’re continuing to try to educate to reach out for help. Through a lot of studies, we know that the Indigenous population and LGBTQ individuals are at higher risk, so we try to target those populations to reach out for help.
We’ve done no marketing at this stage for the new national service, but when that marketing starts to unveil itself, we will be targeting certain populations that are at higher risk.
Senator Ravalia: Thank you.
Senator Omidvar: I have a number of questions that I hope I will get in. I thank you for your work.
We’ve been hearing witnesses on this study, primarily from health care service providers or associations. They have made an impression on me that the system is fragmented, is not coordinated, and is different from jurisdiction to jurisdiction. They have recommended that improved access to mental health services could be achieved through a single point of entry proposal. That would help address the fragmentation and disjointed nature of the services. That the single point of entry would come from a referral through either a school or a primary care service worker.
But you have said that you have a “no wrong door” approach. On the one hand, we have specialists and advocates suggesting a single point of entry, and you have a much more open process of no wrong door. Can you help us figure out the tension between these two?
Ms. Newcombe: Yes. I don’t think it’s tension or one or the other. I think they complement each other. There is a lot of fragmentation, and I think for the service user or anybody negotiating to access help, one point of access does help. There’s one number or one place to go, and then that person or place can refer from there.
However, you don’t want to have only one access, because what if there’s a problem with that access? Let’s say you don’t like a counsellor and you want another counsellor, or an Indigenous person may wish to speak specifically to someone from their community, but someone else may not want to, for different reasons. So allowing that “no wrong door” allows for choice or for multiple access points. It’s not fragmented, but it allows for multiple places to connect.
Senator Omidvar: Single door but lots of other corridor doors? I think that’s what you’re saying, a single front door but then you go through others.
Ms. Newcombe: Yes. I think one access point is so that the person doesn’t have to think or be confused or have to call this office or that office. There are rules for this office — under 19 here or this one is over 18, that kind of thing. They don’t need to think about that. They can have one number that has some information that can say this is the person or this is the mental health office where you need to call. They have more of the information, but one central access point offering everything is pretty hard to do. There are differences across the country and provincially, as well, to honour those cultural differences.
Senator Omidvar: You said that you had 17,878 contacts. By contacts, I imagine you mean people in distress, contemplating suicide. Do you keep a record of the main causes of their depression or anxiety, whatever you may call it? Is it addiction, bullying, social media or family dysfunction? Do you have a sense of that?
Ms. Newcombe: I wouldn’t say we keep track of what caused it or is bringing them to the suicide ideation, but we do keep the reason for the call or the chat. If they call because they are in a domestic violence situation, we would have that and the fact they are suicidal. I cannot say that domestic violence is causing the suicide ideation, but the reason for the call was domestic violence and there was a suicide component. We cannot determine whether there is a causal relationship. We do keep track of the major reasons why people connect with us.
Senator Omidvar: Are you able to share the major reasons with us?
Ms. Newcombe: Yes. Right now we are providing that data to the Public Health Agency of Canada, which has been one of our funders. We have given those reports on a quarterly basis since we have launched. Those would probably be made public at certain points in an annual report or how many calls you got about this or that. Yes, they would be provided.
Senator Omidvar: Thank you.
Senator Marshall: Thank you, Ms. Newcombe, for a very interesting presentation.
Are you able to give us information on the funding sources for your organization? I am interested in knowing the sources and magnitude of the funding, the adequacy or inadequacy, and where you see the trend line going in the future. Speaking to people, it’s on an upward swing. Could you set the stage with that information? That would be appreciated.
Ms. Newcombe: The Public Health Agency of Canada invested about $3 million over the last couple of years to get this initiative off the ground. We did get some money from the Mental Health Commission of Canada as well. We are in a position now of seeking public and private initiatives and fundraising in order to have sustainable funding.
Because we are leveraging local crisis line services, my centre, for example, is funded in many ways: the United Way, different grants and health authority contracts. Each distress centre in Canada is funded differently depending on their area. If we are to leverage their support by taking calls on a national line, that is what we are looking at. What would someone benefit by answering calls on a national line? Where is the remuneration? How can we support the local crisis lines? So we are in a position now of looking for funding in order to on-board more centres and increase our capacity. That requires money, so we are trying to educate as many people as possible about our existence. Funding is definitely important and crucial at this point.
Senator Marshall: When you talk about the 17,000 contacts, you also talked about $3 million. That does not sound like a whole lot of money, but that funding was used for the 17,000 contacts; is that right?
Ms. Newcombe: The $3 million was used primarily to build the technology, first, for the multi-contact centre and to set it all up. The funding was primarily to build it and to on-board centres to start the project. That was the start-up money. Now we are looking at a model where we need sustainable funding in order to continue its operation.
Senator Marshall: The staff that was referenced in an earlier conversation, are they paid? My understanding is that they are professionally trained. Are they paid staff?
Ms. Newcombe: Crisis Services Canada has a small staff of four that is now running this national service. From there, we have a board of directors and they are leveraging distress centres.
Each distress centre is a little different. For example, in Ontario they primarily use trained volunteers, but they need a paid staff training coordinator in order to train those volunteers. Each crisis centre needs money to train, whether volunteers or staff.
My centre is a hybrid. I have 13 paid crisis line workers and volunteers as well. My paid responders are paid from a health authority contract because we have a local crisis line service. With additional money that comes from the national service for us, I can leverage the call responders answering calls on our local line and also the national line; so the money is coming from two sources.
Senator Marshall: Regarding the follow-up services that you spoke about, people make their initial contact and most of these people are in crises. What kind of services are you able to provide on the limited funding you have?
Ms. Newcombe: The follow-up service comes from us. We are connecting with that caller from the regional distress centres that are funded from their own local community and the national line. The follow-up calls are done by us on the national line. If anything is needed beyond that, we have a resource database and we link them. For example, if a call came in from Victoria and went to the national service and we end up taking it, we have a database and would refer them to mental health in Victoria for further support.
We are not providing additional pieces other than the follow-up call — the phone contact — in order to keep them going until they can be connected in their community with a face-to-face person.
Senator M. Deacon: Thank you for being here on video conference this afternoon.
You are at the front end of that call and that first step for some of our youth in crisis. In talking to so many youth over the last 10 or 15 years, they are getting better now at making the call. I think they are getting better at the awareness. It’s there; there’s something; they have it. They also have their cellphones which, in the deepest crises, become incredible tools for being found, quite frankly, when it becomes escalated with the police, et cetera.
In many, the cycle has been formed and perhaps they’ve been taken to the hospital for the safety of themselves or others, and now they are in a medical setting. For many of our young people, that becomes almost cyclical. They are in, stabilized, and then they are back home. They are in again, stabilized and the family has respite. Everyone is looking for support and some kind of next step that will help them to be healthier and stronger and get out of this cycle in which they lose hope, which is another factor.
From your perspective, you are the first step. From what you have watched, listened to and used as baselines over the years, have you developed any judgment or perspective on that next part? You see these young people and may be able to track some of them. Do you have any thoughts on the cycle? You know it repeats. How can we work better in breaking that cycle of them having to call you again and again?
Ms. Newcombe: We do see that revolving door, absolutely.
It is not a single contact most of the time when someone is in crisis. They can be in crisis for six months. It is an ongoing thing sometimes. If we can get that initial contact, we try to encourage the youth and create rapport. We try to empower them to use us.
They may be in counselling and be connected with the mental health system already, but they are not there at two o’clock in the morning when those thoughts come. If they have that number, they can use it as they need it as part of their safety planning.
Their safety plan could have many components to keep them out of hospital. It may be calling their counsellor during the day or seeing the school counsellor. Having that national number — text number — handy, they can use it when they need it.
The other part to that is distress centres do a lot of community education programs in the schools themselves. That is something beyond the national line.
Connecting them to their local support systems — and I can only speak to my area — we do a lot of work in the schools themselves. We have had stories of youth coming up after we do programs in the schools. We have a GRASP program — Growth, Resilience, Acknowledgment, Suicide Awareness, Prevention and Personal Planning. It is a 12-hour program. Within that time, we try to impart skills on youth to be able to access help — not only that, but to deal with their life. Life is difficult; it is ups and downs. It is giving them tools and coping skills to navigate that.
We do that in the classroom one-on-one. We have had youth come up and say, “I am not cutting anymore as an unhealthy coping tool. I am using something else now.” It is heartwarming when you hear that.
We look at it as one youth at a time. It is just one person at a time. If you can make that connection, it is rapport building. Someone can see someone two or three times and not have that connection, or they can see someone once and have a strong connection. It is building those connections.
Our youth being in the social media world, they are used to the online connection and not so much the personal connection sometimes. It is trying to bridge that.
We need face-to-face. The school is a good place to do it. A lot of distress centres have those extra programs. That is something beyond national, but we can put them in touch with regional services.
Senator M. Deacon: I am from Ontario, in the Waterloo region. Over the past three years, we have taken in to our community what is classified as the highest percentage of new Canadians, of Syrian refugees.
You were talking about baselines, demographics and data collection. I wonder if at this moment there is any baseline or benchmark for our refugees, our new Canadians, where they fit in this need for acute help.
Ms. Newcombe: That is a demographic that we are looking at. We have access to LanguageLine services that have over 300 different languages. Say someone is speaking Spanish, Punjabi or another language. We can access an interpreter on the national line that helps us do that with someone. That is one step to helping a refugee who doesn’t have English as their first language.
Second, a lot of communities have programs in place for refugees. Having that in a database where we can connect them, perhaps there is a program that they are not aware of and we can educate them about.
From the national line, we are leveraging distress centres and connecting them at that next level so they can find out if there are programs in their community to assist them.
Senator Dasko: Thank you for your presentation. It is very interesting. I have a couple of questions regarding how people learn about your service.
In answer to Senator Ravalia’s question, you started to talk about a plan or program or funding you have to promote your service. I am interested in that because I am a great believer in health promotion and activities in just about every area.
I want to try to understand how you will do that. How have you designed that program? Where will it be targeted? Who is it targeted to? Clearly you would want to target it to groups, regions, sectors — whoever they may be — that you don’t already connect with.
What is your thinking and the research behind your promotion campaign?
Ms. Newcombe: Right now, we haven’t done any marketing. The reason is we just launched, and we had capacity issues. We didn’t want to be inundated and not be able to provide service. That is why we didn’t market. We are still holding off on that.
We have had a lot of people wanting to use that number. For example, the Canadian Association for Suicide Prevention, in the first weeks, put that number on their website. It was like, “Whoa,” and we had them take it down.
We were in the first year of launching it. We had to test technology and ensure protocols were in place. We had a lot ofwork to do. That is why we have been holding back on announcing that number.
But without any marketing, people are hearing about it, just through social media. It is being shared with local distress centres. Even without any marketing, you can see how many interactions we are getting without even telling people the number exists.
Going forward, sustainable funding is a priority. Then it is on-boarding centres, increasing the capacity and then marketing that number. That would be done with staffing through the national line. It is limited staffing, but the Public Health Agency of Canada and other agencies would definitely support helping to get that word out, what the messaging would be, and posters.
The whole marketing plan, at this stage, has not been detailed out. Sustainable funding and capacity are the two major issues before that, because even without any marketing, we are reaching capacity already. We need to on-board more centres.
Senator Dasko: Are you suggesting that the marketing will be done mainly through local agencies that will be getting the word out?
Ms. Newcombe: Right now I answer a provincial 1-800 suicide line in B.C. I add that number to my existing cards. A doctor’s office might put that number on their card for an after-hours call. Other people will be putting that national number out there and spreading it. That would be one way. Social media is another big one.
We will probably try to leverage as many free outlets as possible, but there will be some targeted dollars in the future toward marketing. We will probably work that out. I have not seen a detailed plan at this stage. The headquarters staff of national is looking at that.
Senator Dasko: Thank you.
Senator Munson: Thank you for being with us. This is important information to receive from you.
A quick question and an observation, because our time is running out. The question follows that posed by Senator Omidvar when she asked about the reason for a suicide call. You mentioned data is sent to Health Canada. Do we get access to that information, or is it possible for senators to get access to that information, or the public, so we can have a better feel of what these calls are all about so we know which direction to go in as we do our study on youth suicide?
Ms. Newcombe: I can bring that question forward to our board. We are meeting weekly with the Public Health Agency of Canada. How that information flows to this committee and what kinds of reports there are, I can bring that forward through the Public Health Agency of Canada or whatever process, depending on which report is needed. Getting that information out is something I would encourage.
Senator Munson: We appreciate that very much.
I do a lot of work in the health field and with children with intellectual disabilities, you name it. You said, “We are looking for more funding.” How many times have we heard that? “We have a grant. We have a public partnership, a private partnership, different grants.”
Are you in a position to have a budget ask to this present government since you are a national crisis centre? This is the time to do it, by the way. If anyone in the government is watching this committee meeting, I am making a pitch to the federal government — in order for you to do what you maybe could be doing — to help alleviate some of the stresses you have to go through. Across this country we have so many good organizations that have to go out and get money from every corner of their community.
It’s good to have community involvement, but there is, to me, a fundamental federal government responsibility in the health field, especially with regard to a national crisis line.
Ms. Newcombe: That’s being worked on right now. We just got support from the Public Health Agency of Canada to hire a CEO for the national line. One of the first tasks is to narrow that down, get the details regarding that ask to the federal government. That is being working on right now.
Senator Munson: I wanted to have that on the record. Thanks very much.
The Chair: On that note, I want to thank you very much, Ms. Newcombe, for taking the time to share this expertise. We wish you the very best with the very important work that you are doing.
[Translation]
We’ll continue this meeting on child and youth mental health with our second witness.
[English]
Our next witness, also by video conference, is Ms. Nancy Moreau Battaglia from Toronto, Ontario. Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
You are a board member from the Canadian Association for Suicide Prevention. I would ask that you start with your opening remarks and then we will follow with questions.
Nancy Moreau Battaglia, Board Member, Canadian Association for Suicide Prevention: Good afternoon, chair and committee members, and thank you for the invitation to speak today. It is a pleasure to participate with you remotely from Toronto on behalf of the Canadian Association for Suicide Prevention.
As mentioned, I am a member of the board of directors for the association and a registered psychotherapist working on the front line with children, youth and survivors of suicide loss.
The Canadian Association for Suicide Prevention, more commonly known as CASP, is a decades-old national organization whose mission is to reduce the impact of suicide on the lives of those within our country. Our areas of focus include suicide prevention, intervention, “post-vention” and life promotion. Like many not-for-profits in this sector, we struggle for funding and have the equivalent of only one full-time staff member, yet we endeavour to fulfill CASP’s strategic priorities of leadership, partnership and collaboration, fostering connections and supporting communities.
Our membership is comprised of people with lived experience, service organizations, mental health professionals, researchers and policy-makers, and they represent communities and regions across Canada from coast to coast to coast.
As we all recognize, suicide is a critical public health issue in Canada. Rates have been increasing over the past 60 years, and suicide is one of our top leading causes of death.
Today in Canada, 10 people will die by suicide and up to 200 more will attempt to do so. We must ask ourselves many questions about this, in particular, for how many of them might the pain that led to this act have been generated during childhood? It is plausible that since your discussions last week, on October 18, approximately 60 Canadians have died by suicide and 8 of those would have been youth.
For every death of this nature, more than 100 individuals will be impacted, dozens of whom will be affected for much, if not all, of their lives. In fact, in the aftermath of a death by suicide, survivors are at higher risk themselves of dying prematurely by suicide. I introduce these points in order to highlight the significant impact that suicide can have on children and teens with regrettably lived experience.
Suicide is the second-leading cause of death for children, youth and young adults, and no matter how alarming that statistic is, the true number of youth suicides within our Indigenous communities is nothing short of tragic.
When our youth present at hospital with suicidal ideation and/or suicide attempt, it is too often that a discharge scenario exists of an anti-anxiety pill and maybe a referral to an overtaxed agency where it can take weeks or months to secure service.
It is too often that they are released to exhausted, ill-equipped caregivers who lack knowledge, skill and particularly information and resources to support their loved ones and themselves through this crisis.
We are generally a death-denying society. Suicide is scary, and that combination of factors leads to an overwhelming majority of people who don’t want to talk about it. There is a common yet mistaken belief that if we don’t talk about it, they won’t do it. We need to talk about it. We need to talk about suicide, and we need to talk about mental health and wellness. These conversations are vital, as 90 per cent of those who died of a self-inflicted act were struggling with issues of mental health and wellness, whether formally diagnosed or not.
CASP has focused its mission on suicide, yet our work is inextricably interwoven with services, formal organizations and grassroots communities that are addressing mental health and wellness. Within our sector, there is broad-based research and an understanding that the interconnections between mental health and the social determinants of health are critical to understanding and responding to the continuum of issues related to suicide.
With one in five Canadians struggling with mental health issues at some juncture in their lives, we must understand that when looking at our mental health crisis, it is patently clear that suicide needs to be included in any discussion of mental wellness. You cannot talk about one without the other.
CASP regularly engages with multiple stakeholders and, as such, has been able to chronicle a number of issues that community members have identified as barriers and opportunities to effective suicide prevention. These include: a fragmented and uncoordinated system of mental health care that is challenging if not impossible to navigate; the underfunding of community resources with long waiting lists and unexpected closures; gaps in service in rural and suburban communities; lack of readily accessible information written in plain language; the need for mental health and suicide prevention education for gatekeepers and laypersons; a focus on stress management and resilience building; the need for wraparound services; the importance of having people with lived experience at policy and funding tables; the need for cultural competence training; the need for more peer support and community-specific resources for those living with struggles of mental health and wellness — those who are at high risk, primary care providers and survivors of suicide loss; and our need to acknowledge that the stigma of mental health struggles and suicide remains strong and often inhibits identifying needs and imposes a significant barrier to help seeking.
CASP, as a national organization, strongly advocates for a national suicide prevention strategy in which a comprehensive and coordinated response framework can be implemented with sustainable dollars. Thank you.
The Chair: Thank you very much for your presentation. It does bring to light all the challenges and everything that still needs to be done when it comes to youth and mental health. We do have questions for you.
Senator Seidman: Thank you very much for your presentation and for being with us today on a really important issue.
I’d like to understand your organization. I think you said you have members that are associations. Do they also include people with lived experience?
Ms. Moreau Battaglia: Yes, a vast majority of our members are those with lived experience.
Senator Seidman: What about associations across the country? Who provides services? Do they join your organization as well?
Ms. Moreau Battaglia: We have some individuals from local mental health agencies. The vast majority of members are individuals who are passionate about the cause because their life has been touched by suicide or issues of mental health. There are a lot of really wonderful, grassroots community organizations out there doing great work and who are also members. The problem is connecting them all.
Senator Seidman: You’ve been around for 10 years?
Ms. Moreau Battaglia: No, for about 40 years.
Senator Seidman: Four times as many as 10. That’s even better.
Canada does have a federal framework for suicide prevention.
Ms. Moreau Battaglia: Yes.
Senator Seidman: I’d like to know if you were involved in its development and whether you were involved in an ongoing evaluation of where it’s going and how it is succeeding in its mission.
Ms. Moreau Battaglia: The executive director who was with CASP at the time, Tana Nash, was one of the individuals who happens to have lived experience and fundamental if not instrumental — whatever word you’d like to use — in drafting and advocating for that particular framework.
To my knowledge at this point, we don’t have a measurement system to address how that is going. What we still lack within that is an actual strategy. We’re one of the few first-world countries that don’t have one.
Senator Seidman: If I read correctly, the framework has three strategic objectives: to reduce stigma and raise public awareness; to connect Canadians, information and resources; and to accelerate the use of research and innovation in suicide prevention. What you’re saying is that we don’t really have a way to assess whether those objectives are being met. Is that correct?
Ms. Moreau Battaglia: It would be my experience that there are no legs to that.
Senator Seidman: Do you have suggestions or recommendations about how we could give that framework some legs, as you put it?
Ms. Moreau Battaglia: We could look back to what those grassroots, community organizations are doing and have those people who are right on the front line providing input say, “This is what we need.” One of the pieces that is so necessary that we always get asked for is a central repository of tools and resources. That is still lacking.
We do have the national hotline, but it has endured its own number of challenges. CASP fields lots of calls from families who find themselves in crisis because they don’t know where else to go. We don’t provide crisis service, but there are no easily accessible materials out there.
Senator Seidman: Nor public education programs so people know where to go.
Ms. Moreau Battaglia: Exactly. That’s the kind of thing we’re talking about.
My comments about attending at the ER and being given the prescription and referral do not in any way imply that our medical practitioners are negligent. It’s that there are no supports. There are no pamphlets or handouts to do this, look at that. There is no safety net, and it’s something that those care providers consistently search for.
Senator Seidman: Thank you so much.
Senator Ravalia: Thank you very much for that very thought-provoking presentation.
We’ve had a number of discussions about this subject. I think we all recognize that the traditional medical model is broken. We’ve talked about disruptive innovations. Are you aware of any cutting-edge research or innovations that you think could begin to impact on picking up on these issues at a germinal, early phase in our youth and children to reduce the burden of suicides?
Ms. Moreau Battaglia: It’s such a complicated issue. We’re treating the symptoms while we’re trying to investigate cause.
One of the easy fixes from a symptom-management perspective is the genetic testing that’s available to understand which family of antidepressant an individual will respond to. There was a time, when that study was being fostered in Canada, that individuals could sign up to participate. I recently made that suggestion to two families that I’m working with and find out from them that the cost of the test, at least in Ontario, is $400. I understand there are associated costs, but what’s the cost of that youth or child showing up in the emergency room because their antidepressants weren’t effective?
I understand that there are responsibilities provincially versus federally. I think that is such an easy fix from my perspective; so if we can get them in that right framework.
One of the pieces of research we do know is that there’s about a four-year lag between the initial suicidal ideation of an individual and a first attempt. That, again, is average. But we’ve got a big window there to intervene if we can provide an environment where talking about that suicidal ideation right upfront can be addressed.
I’m not sure I fully answered your question.
Senator Ravalia: You certainly did. Thanks very much.
Senator Eaton: You talked about prevention and intervention in your presentation, did you not, the four steps? Senator Ravalia was talking about innovation.
We heard from some psychologists the other day that if we had psychologists in every school that could look at children who are having trouble or being bullied, who might have a terrible home situation, if you could start working with a child at school, where they play, where they work, it would be quite effective. What do you say to that?
Ms. Moreau Battaglia: Facetiously, I can say that psychologists cost a lot of money. But do I believe that we need circles of care? Yes.
I was at a trauma conference last week and heard from a social worker who works in the school board in Manitoba. She is responsible for 1,800 children. You just can’t do that. As we colloquially might say, “That dog don’t hunt.”
I absolutely believe that a couple of issues could be addressed within our education system. One is greater education for teachers and school administration. I often see that everyone is focused on the behaviour without understanding that people communicate through behaviours. A child who may be looked at as a troublemaker in class or a bully or labelled with a conduct disorder, there’s a reason behind that. It’s typically because there’s pain.
If we don’t have people, as you said, where the children go to school and where our teens might be working, who can say, “Ah,” then we are missing out.
There are huge gaps. I don’t want to repeat what everyone else has said, but what happens once that child is identified? I’m not big on labels, but I say “identified” as having a need. If they get put into a queue for service provision within a community, that’s where we can see those huge lags.
The Health Canada FNIHB program has individuals apply as service providers. As service providers, individuals then go on a registry. People who are of First Nations ancestry who need support can connect with individuals on that registry — I apologize if you know this — and get 10 to 15 hours of counselling that is paid for by the federal government under the overall health care act. Would it be an expense for the provincial governments? Absolutely. But why can’t we have something like that, a bridge, for families who can’t get into some of the bigger organizations in Ontario like Kinark, CMHA or New Path? Let’s have a place where these families can take their children without having to spend hundreds and potentially thousands of dollars.
Senator Eaton: Weeks and weeks and months and months.
Ms. Moreau Battaglia: Absolutely.
Senator Eaton: Are there countries we could learn from?
Ms. Moreau Battaglia: From my understanding, Australia has a great model. It’s put out there as the “I wish” country — “I wish our country was like Australia.” I don’t have all the nuts and bolts of their model.
Senator Eaton: It is something we can research now that you’ve told us.
Ms. Moreau Battaglia: Yes, I would be looking at the model in Australia. As far as I know, that’s the one that people think is the best.
Senator M. Deacon: We all appreciate you addressing these real issues this afternoon — fragmentation, knowledge, access points, gaps in sources. It is the bridge part you talked about that keeps me awake at night. That is the one big, super-duper challenge as a result of a lot of other pieces and little things.
In Ontario, in 2012, in our minister-driven education system, developing a mental health framework and strategy was mandatory. Funds had to be shifted. You had to find ways to ensure that every student, teacher and parent was educated on look-fors, disclosures, all of those pieces that helped the education piece.
We move over the bridge at this end, but we still suffer with the stigma over here at this end. Now we have awareness and understanding and enough information — these aren’t doctors — to be that first, trusted person.
As we work through that stigma problem, that is still paralyzing beyond the age of 10. I’m wondering if you wouldn’t mind addressing that piece based on your perspective, which is incredible based on the work that you folks have been doing.
Ms. Moreau Battaglia: Thank you.
I don’t know who put together the “See Something, Say Something” campaign on harassment, but I was giving that some thought. I have thought a lot about the opportunity to speak in front of you today. Bell “Let’s Talk” has done marvellous things in terms of awareness and finding high-profile individuals across the country to whom people can relate. I had to pause and say to myself, “Why can’t we do that? Why can’t we do ‘See Something, Say Something’ when it comes to watching individuals struggle?”
For teens, there is the pack, that group they travel with. It’s like a wolf pack. There is a piece around that where we need to somehow ingrain the idea of “I’m okay if you don’t like me as long as you’re still alive.” What so often happens is that when parents go back and have an opportunity to talk with peers, peers have knowledge that parents and caregivers don’t.
We have done a good job with anti-bullying campaigns. Although we know it is still an issue, there is awareness. People are talking about it.
Senator M. Deacon: There are lessons to be learned.
We hear about funding every day, at every table, everywhere. I know that is significant, and it is a heartbreaker. But if we are not looking at funding, we also know there are improvements we can make that aren’t based on money.
Could you comment on that? “We don’t need a lot of funding to do the following, but it is something we should be considering.”
Ms. Moreau Battaglia: Yes. I would go back to a couple of things. We don’t need a lot of funding, I don’t think, to go to medical schools and encourage — potentially demand — that they have a more comprehensive base in terms of academic study from a psychological perspective, outside of the few hours that they get. I honestly think that having physicians do rotations outside hospital environments is an interesting concept. Put them into community-based mental health clinics. By the time someone is hospitalized, most people, trained or not, could recognize that there is a severe mental health issue. The problem is that we are not able to identify it early enough. Part of that would be because they are not always trained in what to look for. A thing like male depression does not manifest in the same way female depression does, so you will not see some of those classic symptoms.
I don’t know how much it would cost to have a central repository, a government website that has actual resource listings and, as we said, materials to put in the hands of laypeople. Those materials exist. The Kitchener-Waterloo suicide prevention organization or the county — I’m not quite sure, I apologize — has marvellous materials, but how does someone in Victoria, B.C., know that’s out there?
Senator Omidvar: You are really an excellent and compelling witness. I am kind of stunned by some of the things you have told us about the high numbers and the increasing rates of suicide. I cannot think of anything more tragic that a parent faces outside the death of a child, and then the death of a child by suicide. I simply can’t get my head around that.
I want to ask you if there are services for parents. I am sure there are and that they are fragmented and there are not enough. I’m curious whether you encourage the development of support groups of parents, and whether there is any spillover on the suicide ideation to siblings and family. I am concerned about whether it is a knock-on effect, and not in a positive way.
Ms. Moreau Battaglia: Yes, there are some programs for individuals who would identify as survivors of suicide loss. There is one from the Toronto Distress Centre. It is the largest program of its kind across the country. It offers a peer-to-peer support model. My experience is that bereaved parents will network if they are lucky — I am sorry to use the phrase that way — and can find a network. Some organizations exist. They are primarily for bereaved moms, and sometimes those are not specific to suicide loss.
Senator Omidvar: I know.
Ms. Moreau Battaglia: In one second I will tell you a story, if I may. But what we find is that suicide, the navigation of the path of grief post-suicide, and the attempt to integrate and come back into society is so different for bereaved parents — for any survivor of suicide loss, but for parents in particular. There are so many factors, but there is a stigma of “If you had been a better parent . . . .”
I used to facilitate groups at a not-for-profit organization in Barrie, Ontario. There are only two in Canada. One is in Barrie and one is in Oakville. They offer long-term support for bereaved children and youth. At our Barrie location, we had a children’s group and a teen group specific to survivors of suicide loss. The way we ended up with the teen group was that — and I don’t mean to say it this way — I developed and then ran the only long-term teen survivor-of-suicide program in Canada. I did that because was I was working with a group of teens of mixed loss. One young woman in her pain, having lost her mother, looked at another participant and said, “Yeah, but my mom didn’t choose to die and your dad did.” The heartbreak that I felt and the silence in that room is when I realized that even at such a young age, they see a difference.
The bulk of my clients in private practice are parents who have lost a child to suicide, and children, even adult children, who have lost a sibling. One of the unfortunate things that happens is that when we don’t support those parents, they become incapable of parenting their surviving children. That’s where we have the multiplier effect or the spillover impact that you are talking about.
The other piece is that — tragedy upon tragedy — many of the young people with whom I work experience the trauma, then the vicarious trauma, and then the trauma they face because they found the deceased.
I have yet to meet a bereaved child, whether by suicide or by other circumstances, who doesn’t have some kind of developmental stall, whether it’s physical, psychological, academic or social. Those children and teens impacted by the suicide of a parent, sibling or someone within their social circle can often show dramatic impairment.
Senator Omidvar: Thank you.
Ms. Moreau Battaglia: You’re welcome.
Senator Dasko: Thank you for your very compelling presentation. I agree with what Senator Omidvar said about some of the examples you gave and the stories you told.
My question is basic and practical. Toward the end of your presentation, you offered a list of issues and a list of needs. Since we live in a world where we will never have funding for everything — even though, as a country, we are not doing all that well in this area — from the list you provided, what would you say would make the most difference in terms of funding? What area, need, service or issue do you think would give us the best return on the dollars that we have or that we would be able to provide, knowing that we can’t fund everything?
Ms. Moreau Battaglia: Can I facetiously ask what the budget is? What is the budget you will give me?
Senator Dasko: No, I don’t have a budget. I am just asking you to be a practical person, knowing that we don’t live in a perfect world of funding.
Ms. Moreau Battaglia: I understand.
Senator Dasko: What would make the biggest difference?
Ms. Moreau Battaglia: I think that would be the piece we were talking about earlier, namely, if you see something, say something to get the conversation started. We need to have individuals who are high profile within our communities and our countries who have experience to speak out about that. I will be diplomatic and won’t reference a few of those who might come to mind within our government system, but those kinds of things can make a difference.
One of your honourable colleagues talked about education in the schools six years ago. That is the problem: It was six years ago. Teachers and students have moved on. Not everyone has been captured around how to identify and engage in that discussion.
There are two things I don’t think would be difficult to build into our school curriculum. I think we could start by providing kids at a young age the opportunity to learn the language of emotion and that there is so much more than happy/sad.
There is a particular program called Skills for Safer Living, developed by Yvonne Bergmans, one of my colleagues. That program is geared to individuals who have had more than two suicide attempts. These are young adults all the way through the age span. One of the things she has to go back to is teaching them the language of feelings, because if you don’t learn the language of feelings within your community or your household, you don’t know how to express them. If you can’t communicate what you are feeling, then that is an automatic barrier.
The second piece is to build stress management into curricula and core components of building resiliency and what resiliency is and looks like.
I am being cognizant of time for all of you who are probably getting hungry. We have to look after base needs.
Senator Dasko: Thank you.
The Chair: Thank you. You are being very relevant.
We have time for one last question.
Senator Marshall: I want to go back to the funding for your organization, which sounds like a small organization; I think you said you had one paid staff member. How does your organization approach funding? Are you happy with what you are getting? What is your source of funding and what would you like to see for your organization? I know we talked about the schools and funding for bereaved parents, but for your organization, just bring it down to that level.
Ms. Moreau Battaglia: We operate literally on a wing and a prayer. We have a half-time executive director, an eight-hour-a-week administrator, and then a person who does web-based support for us.
A chunk of our funding comes from our national conference, which is going to be next week in Newfoundland. We are seeing more and more donations where individuals are talking about how a child, spouse or father died; we are getting memorial donations that way. And on World Suicide Prevention Day, there is a music festival that runs across the country. Our money comes from small donations, grassroots organizations and individual fundraising campaigns.
I am sure that CASP would like to be the central repository as a connector piece for those documents and resources we were talking about. What do we need? We need a full-time executive director. We need a couple of people who can actually address the concerns that get called in and help to smooth our process along. We wouldn’t ask for the world, but we would certainly like some money to create this ability for communities to come together, because that is by far the biggest message that we get.
Senator Marshall: Is your organization a registered charity?
Ms. Moreau Battaglia: Yes.
Senator Marshall: That would be a help.
Ms. Moreau Battaglia: We are a not-for-profit, yes.
Senator Marshall: This is really a health issue, in my opinion.
Ms. Moreau Battaglia: Yes.
Senator Marshall: Services are so fragmented, and a lot of organizations like yours are operating on a wing and a prayer, that governments have to come to the realization that this is a big problem and has to be resourced.
You are meeting in Newfoundland, you said, this month.
Ms. Moreau Battaglia: Yes.
Senator Marshall: Will that be something you would be discussing? It seems that everyone is trying to do a little bit on a wing and a prayer. Is there a master person trying to bring it all together and have an integrated approach to this problem?
Ms. Moreau Battaglia: I think there are a number of different organizations. The unfortunate reality is that there is some kind of jockeying for dollars and positions. CASP is trying to get there. It’s slow. With a variety of stakeholders, we are now starting to understand what it is they really need and want. Certainly, it is our intention to get there. Can we get there fast enough? What is fast enough?
Senator Marshall: That is right. Maybe we are past that point already. Thank you very much.
Ms. Moreau Battaglia: Thank you.
The Chair: Thank you so very much, Ms. Moreau Battaglia. I know that we do have to let you go, but we have truly’ have appreciated not only the time that you took but the relevance of everything that you brought to this committee.
[Translation]
I want to thank my colleagues. This concludes our meeting.
(The committee adjourned.)