44th Parl. 1st Sess.
October 25, 2022 10:00AM
Madam Speaker, I want to thank my colleague for trying to bring forward solutions to the crisis we are facing, the mental health care and substance use crisis the country is facing.
We know the United Nations' Nelson Mandela rules provide that the quality of health care provided to incarcerated persons must be equivalent to that available to the general population. That is not happening right now. That is clear.
I am also concerned, as my Liberal colleague was, about the fact that this bill might prevent people who want help from accessing it. In its current form right now, the bill proposes to exclude individuals convicted of certain offences, including drug trafficking offences, from its scope. This ignores individuals who have substance use disorders who become involved in substance trafficking.
Maybe my colleague could explain why they are excluded in the current form of this bill, because it excludes a lot of people who need help.
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Madam Speaker, I want to thank my colleague who tabled this bill for bringing it forward and for recognizing that we must do more to support people dealing with substance use disorders.
As we know, Canada is experiencing multiple crises: a mental health crisis, a toxic drug crisis, a housing crisis and a worsening affordability crisis. There are links between these crises, and they are impacting the quality of life for Canadians in communities across the country. It is incumbent upon us, as parliamentarians, to present and debate solutions so we can move forward in the best interests of Canadians.
In developing possible solutions, I believe it is critical to listen to both experts and those with lived or living experience. Last year, I was honoured to be named the NDP critic for mental health and harm reduction. I promptly tabled Bill C-216, the health-based approach to substance use act. This bill was aligned with the recommendations of the expert task force on substance use that was commissioned by Health Canada to make recommendations on federal drug policy.
Earlier this year, as I travelled across the country to speak to Canadians about Bill C-216, I had the opportunity to meet with many individuals directly affected by the toxic drug crisis, either personally, through someone they love, or because they were working on the front lines. I consistently heard that we need more supports for people struggling with mental illness, trauma, problematic substance use and housing precarity.
I also heard that there is no silver bullet. We know these are complex issues that require multi-faceted solutions, such as investing in the social determinants of health like housing and income security, increasing the focus on prevention and early prevention, and making a full range of mental health and substance use supports available on demand.
While Canada is facing an intersecting crisis, we are not making adequate investments into urgently needed solutions. Relative to the disease burden caused by mental illness, and compared to some of our G7 peers, Canada is underspending on mental health. France spends 15% of its health care budget on mental health, whereas the U.K. spends 13%. By comparison, mental health spending makes up between 5% to 7% of health care budgets in Canada, depending on the province or territory, so underinvestment in prevention and evidence-based care has come at a tragic cost to our communities.
Canada has now lost more 30,000 lives since 2016 because of drug poisonings, in addition to more than 44,000 hospitalizations. This public health emergency has been escalating for seven years, yet the government has only committed $800 million to date for its substance use and addictions program. Meanwhile, the expert task force on substance use found that current ineffective policies are costing us billions every year in health care, policing and criminal justice expenses.
I appreciate the bill's intent. It seems to provide a route of access to treatment for those with substance use disorders and reduces the impacts of problematic substance use on individuals and their communities. However, I have some concerns about some of the assumptions that may have been made in formulating the bill, and I cited some of them earlier, as well as how it may play out in practice if passed.
In doing research and consultation on this bill, a theme that has come up consistently is that prisons are currently places of punishment and not care. The United Nations Nelson Mandela rules provide that the quality of health care provided to incarcerated persons must be equivalent to that available to the general population. However, concerns have long been raised about the quality of care in Canadian prisons and inherent conflicts that arise when correctional authorities are responsible for delivering health care.
Catherine Latimer, the executive director of the John Howard Society of Canada, has explained this conflict as follows, “Whenever you have correctional authorities delivering health care, there’s going to be irreconcilable conflict between the institution and the health-care needs of the individual”. She continues, “Security issues will always trump the health needs of the individuals.”
Emilie Coyle, the executive director of the Canadian Association of the Elizabeth Fry Societies, echoed that perspective in conversation in my office and commented that, if we try to insert care into prisons, people will continue to be harmed by our overly punitive prison systems.
Today, my office spoke with an individual with lived experience of opioid use disorder and criminal justice involvement. This individual is now doing advocacy work in recovery and shared the perspective, “Prisons do not breed success.” Indeed, the shortcomings of mental health care in federal penitentiaries has been well documented, such as reports by the correctional investigator and the final report of the National Inquiry into Missing and Murdered Indigenous Women and Girls.
Before establishing a regime of designated addictions treatment facilities in penitentiaries that will necessarily require significant investments, it is important to pause and ask: Where can someone get the best care? Where will they receive care that is evidence-based, trauma informed and culturally appropriate? Where are they most likely to achieve their treatment or recovery goals?
The answer we have heard consistently from those working with incarcerated individuals or with lived experience is that people are better served by accessing mental health and substance use care in their communities. Unfortunately, across Canada, there are barriers to accessing community-based mental health and substance use services, such as stigma, out-of-pocket costs, lengthy wait-lists, admission criteria and lack of detox facilities. Last year, the Expert Task Force on Substance Use recommended that the government make significant new investments to provide supports to people who use drugs, but that call has not been heeded, and the level of funding committed to date remains inadequate to meet the needs in communities across the country.
I welcome the opportunity to work with the member on initiatives that will remove barriers to substance use treatment and recovery services so that all Canadians can get the support they need in their communities. No one should have to go to jail to get help. That is just a fact.
I am also concerned that the bill may prevent people who want help from accessing it. In its current form, the bill proposes to exclude individuals convicted of certain offences, including drug trafficking offences, from its scope. This seems to ignore the fact that some individuals with substance use disorders become involved in subsistence trafficking. Exclusions in the bill could create barriers to accessing treatment in federal prisons.
Indeed, the individual with lived experience I spoke of earlier would not have benefited from the bill, having been convicted of trafficking. He was, fortunately, able to access treatment prior to sentencing and while in recovery, he has remained gainfully employed and involved in community service. After reviewing the bill, he asked how many people serving federal sentences might benefit from the bill, given the excluded offences. It is a good question, and a question that needs to be answered.
While I appreciate the bill's intent to create pathways to treatment, I think we must be careful to avoid introducing new barriers. We must also think about where we can make criminal justice reforms and investments in substance use services that will increase the likelihood of successful outcomes.
I really want to thank the member for prompting this debate. I look forward to further dialogue with my colleague and other colleagues in the House. We have to work together. This is a parallel crisis right now, which we have been dealing with throughout COVID, and the government has not paid enough attention to it. It has not acted with a sense of urgency. People's lives are at stake. This is impacting our communities, our health care system, penitentiaries, policing and the judicial system. Most of all, it is impacting people's lives and those of their families.
Again, I look forward to working with all members in the House to try to provide solutions so that we can tackle this crisis. It does require a sense of urgency and immediacy.
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