- Member of Parliament
- Member of the National Security and Intelligence Committee of Parliamentarians
- NDP
- Vancouver Kingsway
- British Columbia
- Voting Attendance: 59%
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Mr. Speaker, in March 2023, legislation to extend by one year the temporary exclusion of eligibility for MAID where a person's sole medical condition is a mental illness received royal assent and immediately came into force. This means that persons suffering solely from a mental illness will be eligible for MAID as of March 17, 2024. Bill C-314, the bill before the House today, would remove this eligibility at least until we have satisfactory answers and guardrails to ensure that we can extend this profoundly permanent step with confidence. In my view, we do not have that necessary confidence today, and I think the majority of Canadians and health professionals, and the data, concur.
Data released in September 2023 from the Angus Reid Institute found that a majority of Canadians, 52%, worry that treating mental health will not be a priority when MAID eligibility is expanded to include individuals whose sole condition is mental illness. A vast majority of Canadians, 80%, are concerned with the mental health care resources available in this country, namely that they are not sufficient. Overall, one in five Canadians says they have looked for treatment from a professional for a mental health issue in the last 12 months, and in that group, two in five say they faced barriers to receiving the treatment they wanted. These obstacles appear to be more of an issue for women, among whom 45% of those who sought treatment say it was difficult to receive, and young Canadian adults aged 18 to 34.
A majority of Canadians support the previous rules governing MAID, first passed in 2016 and then updated in 2021, but there was more hesitation when it comes to this next step. Three in 10 say they support allowing those whose sole condition is mental illness to seek MAID, while half are opposed.
I will turn to some of what the professionals are telling us, starting with the Centre for Addiction and Mental Health. A survey recently of CAMH physicians found a lack of agreement on whether or not mental illness could be considered “grievous and irremediable” for the purposes of MAID and what criteria could be used to determine whether a person is suffering from an irremediable mental illness. The survey also found significant disagreement among physicians on whether or not a request for MAID can be differentiated from suicidal intent. These physicians also highlighted the concerns they had about access to mental health care in the context of expanded eligibility for MAID.
Canada's mental health care system has experienced chronic underfunding, leading to a significant shortage of community- and hospital-based mental health care across the country. Between one-third and one-half of Canadians with mental illness were not getting their mental health needs met before the COVID–19 pandemic exacerbated the mental health crisis and increased the burden on our mental health system and therefore on Canadians. The results of that survey replicate the findings from the Canadian Psychiatric Association's member consultations in 2020 and the conclusion of the Council of Canadian Academies' expert panel working group report in 2018.
Let me turn to the Canadian Mental Health Association, Canada's premier organization dealing with mental health:
CMHA's position, first articulated in a national policy paper in August 2017, and later, in testimony to the Senate in November of 2020, is that until the health care system adequately responds to the mental health needs of Canadians, assisted dying should not be an option....
First, it is not possible to determine whether any particular case of mental illness represents “an advanced state of decline in capabilities that cannot be reversed.”
Second, we know that cases of severe and persistent mental illness that are initially resistant to treatment can, in fact, show significant recovery over time. Mental illness is very often episodic. Death, on the other hand, is not reversible. In Dutch and Belgian studies, a high proportion of people who were seeking MAID for psychiatric reasons, but did not get it, later changed their minds.
Third is the issue of whether this distinction for mental illness vis-à-vis all other types of illness is inherently discriminatory. Denying access to MAID for mental health reasons alone does not [necessarily] mean that those with mental illness suffer less than people afflicted with critical physical ailments.
That is true. The statement continues, saying, “What is different about mental illness specifically, is the likelihood [or not] that symptoms of the illness will resolve over time.”
We do not have the benefit of appropriate guidance from the Supreme Court of Canada on this issue, and that is something we need to take into account.
It is also noteworthy that with only 7.2% of Canada's health budget dedicated to mental health care, Canada spends the lowest proportion of funds on mental health among all G7 countries. For example, in the U.K., the National Health Service spends 13% of its budget on mental health care. According to the OECD's recent analysis of spending on mental health worldwide, it concluded that even that is too low, given that mental illness represents as much as 23% of the disease burden. The historical underfunding of mental health has been most pronounced in community-based mental health services and I think that ought to be taken into account.
According to the Canadian Psychiatric Association, perhaps Canada's foremost experts on mental health diagnosis and treatment, its members are profoundly split on this issue. The CPA's most recent member consultations in 2020 found that 41% of respondents agree that persons whose sole underlying medical condition is a mental disorder should be considered for eligibility for MAID, 39% disagree or strongly disagree, and 20% were undecided.
According to CPA president, Dr. Grainne Neilson:
Balancing the commitment of psychiatrists to provide treatment, care and hope for recovery with a person's lived experience of suffering and right to enact personal choice in health-care decisions, including MAiD, is a fundamental challenge, particularly where death is not naturally reasonably foreseeable.
Equitable access to clinical services for all patients is an essential safeguard to ensure that people do not request MAiD due to a lack of available treatments, supports or services. Poor access to care is particularly relevant for people of low-socioeconomic status, those in rural or remote areas, or members of racialized or marginalized communities.
The Canadian Psychological Association, another very important group in this matter, states the following:
Many mental disorders are managed, not cured. Medications for mental disorders are largely palliative. While it is possible that medications and psychotherapy may successfully treat an episode which then doesn’t recur, it is often the case that mental disorders require management across a lifetime.
In assessing whether a condition is incurable and irreversible, consideration must be given to equity of access to interventions. Wait lists for publicly funded services are long. Services, like psychotherapy offered in communities by psychologists, are not funded by Medicare. Needed services are not always available in rural or remote communities. To fully address whether a condition is resistant to intervention, that intervention must be accessible.
It is not.
The mental functions required to give consent to MAiD are the very ones sometimes impaired with a serious mental disorder, despite the grievous and irremediable suffering the disorder imposes. Consideration must be given to how to assess capacity despite the impairment in thinking that can accompany serious mental disorders.
I believe that we must act cautiously and prudently, and we must take a phased approach in this area. As has been noted by all parliamentarians, this is an intensely sensitive issue with grave moral and consequential concerns.
Adequate time, in my view, is needed to facilitate a comprehensive national conversation about acceptable safeguards and the availability of medically assisted dying for those suffering from psychological or mental health conditions alone, so that we minimize negative impacts on people living with mental health problems and illnesses when they are most vulnerable, and on their caregivers and health professionals.
I think holding that national conversation must involve people living with mental health problems and illnesses, and their experiences because they play a central role. We must get their input into what mechanisms must be there to minimize the risk of wrongful death.
It is going to be my position to support this bill and I think we must move very cautiously. I do not think that we can say that we can never move into this area, but I think we can say with confidence that now is not the prudent time.
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- Jun/14/22 3:36:05 p.m.
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- Re: Bill C-5
Mr. Speaker, I guess what I am struggling with is there seems to be a relatively straightforward connection and a couple of principles that underpin this bill. One of them is that we have a very high percentage of people locked up in our country who are suffering from mental health or addiction problems. In fact, when I was the public safety critic for the official opposition and toured Canada's correctional institutions, that number was 70%. The second thing is that mandatory minimums operate on the principle that if we just lock people up for a longer time, the problem will be solved.
I would like my hon. colleague to comment on that. Does he believe that locking up people who are suffering from addiction or mental health issues will actually help integrate them into society or reduce recidivism, or does he agree with me that we need a better approach to actually help these people deal with their fundamental problems so that when they come out, they do not reoffend?
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Madam Speaker, it is a pleasure and an honour to rise in the House today to speak to this important bill.
By way of introduction, it is important to note that this bill was reintroduced from the 43rd Parliament. It is an almost identical copy, with no changes except for the omission of coordinating amendments, which made some changes to the Firearms Act and adjusted some penalties for firearms offences. The reason I point out that it has been reintroduced is that this shows how slowly sometimes very important legislation moves in this place. That is particularly regrettable when we see the profound impacts that this legislation has on communities and people in this country.
Bill C-5 is the result of the justice minister's 2021 mandate letter, in which he was instructed to “introduce legislation and make investments that take action to address systemic inequities in the criminal justice system, including to promote enhanced use of pre- and post-charge diversion and to better enable courts to impose sentences appropriate to the circumstances of individual cases.” This bill responds to that, in part, and it does so by proposing to eliminate mandatory minimum sentences for all drug offences. It would also remove mandatory minimums for some tobacco and firearms offences. It is important to note that all of these mandatory minimums were added by the Conservatives in their Safe Streets and Communities Act, Bill C-10, in 2011. This bill would also make conditional sentencing orders more widely available by removing the prohibition of using them for more serious offences, and it would make it possible for police and prosecutors to divert more drug cases from the courts.
This bill raises fundamental questions of effective criminal justice in Canada. It is fair to say that all parliamentarians across party lines share a number of goals in this area. We all want to see reduced crime, and we all want to keep people safe. We all want to protect victims, and we recognize that there is much more work to do in that area. We all want to reduce recidivism and make sure that in our criminal justice system, when people transgress and are part of the system, they come out and hopefully do not reoffend. Finally, we all want to address the root causes of crime.
I will pause for a moment and speak about the root causes of crime.
I was part of the public safety committee back in 2009 and 2010, when it conducted a study of mental health and addictions in the federal corrections system. In conducting that study, we toured federal corrections facilities across the country and went into federal penitentiaries to meet a wide variety of stakeholders. Among other facilities, we went into the Kent, Mountain and Pacific institutions in British Columbia. We went into an aboriginal healing lodge in British Columbia, as well as Ferndale. We went to an aboriginal women's corrections facility in Saskatchewan called Okimaw Ohci. We went to Kingston, an infamous Canadian federal penitentiary that is now closed. We went to Dorchester in New Brunswick and Archambault in Quebec. We also, by the way, went to the U.K. and Norway and toured institutions in those countries as well, to get a comparative example.
We talked to everybody in these institutions. We talked to offenders, guards, wardens, nurses, chaplains, families, anybody who had anything whatsoever to do with working inside a federal institution. What is burned into my brain to this day is a shocking number, which is that across all institutions in Canada, the common number we heard was that 70% of offenders in federal institutions suffer from an addiction or a mental health issue. Probingly, we asked everybody, including the guards and wardens, what percentage of those people they thought would not be in prison but for their mental health issues or addictions. The answer we got, again reliably and consistently, was 70%. What that told us was that we are not, by and large, locking up criminals or bad people. We are locking up people with mental health issues and addictions, and most of their crimes are related to those two issues.
I think it is important to pause for a moment and talk about social determinants of crime, because there are highly correlated factors, like poverty, marginalization, childhood trauma and abuse, and others, that go into that prison population. By and large, I did not see a lot of white-collar millionaires in a single one of those institutions. What I saw were a lot of poor, indigenous, racialized, addicted and mentally ill Canadians.
The other thing I think we need to talk about, when we talk about root causes, is how well Canada's justice system and our federal corrections institutions respond to that. At that time, the answer was “not very well”, and worse. At that time, the Conservatives did something that I consider to be politically worthy of condemnation, which is that they politicized the issue of crime for political gain. They pursued a tough-on-crime agenda, because they thought that by preying on people's fears and sense of victimhood, they could gain political points, and they used prisoners and the prison system as pawns in that regard. By doing that, the very small number of rehabilitative services in Canada's correctional system at that time were closed by the Conservatives.
For instance, when I was visiting Kent, I walked into a huge, dark room, and when the lights were turned on, I saw it was full of equipment, such as band saws, Skilsaws and all sorts of construction equipment. There was a program where federal offenders were taught basic vocational skills, and they were making things like furniture, which was then purchased by the federal government at cost. Not only were we teaching marginalized people actual skills that they could use in the workplace when they got out, since more than 95% of offenders in federal institutions come back into society at some point, but the federal government was getting quality furniture at a below-market price. It was a win-win. However, that program was closed by the Conservatives.
When I visited the Kingston penitentiary, and also Dorchester, they had extraordinarily successful prison farm programs where the people inside were able to earn credit for good behaviour and gain privileges to work with agricultural projects and farm animals. By the way, there was a prize cow population at Kingston. The bloodlines were fantastic, and it was an absolutely outstanding herd. Members should have seen the impact that these programs had on the emotional and rehabilitative personalities of the people inside. However, those programs were closed by the Conservatives.
To this day, I say that we are doing a terrible job in Canada's correctional institutions of actually responding to the real needs of most offenders and ensuring that when they come out they do not repeat their offence. Here is the bottom line: I am not saying this out of a sense of compassion only; I am saying this because I do not want a single offender in Canada's correctional institutions to come back into society and reoffend, and that is exactly what they are going to do if we do not adjust and respond to their real needs.
I want to talk quickly about mandatory minimums. The bottom line is that I, and my party, oppose mandatory minimums, except for the most serious of crimes, where, of course, they are appropriate. Why? It is because they do not work; they do not have any deterrent effect. It is because they have a discriminatory effect. It is because they are largely unconstitutional. All we have to do is look to the United States, which is the pioneer of using such sentences, to see what effect they have on crime. The United States locks up the largest percentage of its population of any country on the planet.
I support Bill C-5. It is time that we start adopting progressive, rational, effective policies to keep Canadians safe. Punishing and keeping people in prison longer without access to the services they need does not work. It is cruel, and it does not keep Canadians safe. It is time to have policies that actually keep Canadians and victims safe in this country. Let us adopt the bill and take a first step towards that.
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- Jun/9/22 1:14:18 p.m.
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- Re: Bill C-5
Madam Speaker, the bill before us raises some really fundamental questions about what is effective in terms of criminal justice. Of course, those of us on this side of the House in the NDP believe that the evidence is crystal clear that mandatory minimums are simply not effective in helping to reduce crime. One thing I think that we are well aware of is the very high degree of addiction and mental health issues among inmates in federal correctional institutions. In fact, we did a study about 10 years ago at the public safety committee, and found that about 70% of inmates in federal systems suffered from an addiction or mental health problem.
I am just wondering if my hon. colleague has any thoughts on whether it might be a more effective public policy, and help keep the public safe, if we directed resources toward trying to help people deal with their mental health and addictions issues while they were serving at the pleasure of the Crown, as they say, as opposed to simply making them stay longer in prison without any access to services.
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- Apr/26/22 10:37:13 a.m.
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Madam Speaker, I am pleased to split my time with my hon. colleague from Rosemont—La Petite-Patrie.
It is a great privilege to rise in the House today and speak in support of this budget. I want to say at the outset that no budget is perfect. There are many, many provisions in budgets with which we agree, and there are obviously many with which we disagree. This budget is no different in that regard, and the NDP will continue to push for all of the progressive policies that we have historically pushed for, that we know Canadians need and that, unfortunately, are not contained in this budget.
However, I rise today to speak in support of this budget, imperfect though it may be, for a couple of key reasons. As the health critic for the federal New Democratic Party of Canada, it is my unique privilege to be able to carry on the traditions of great health critics before me, going right back to Tommy Douglas, who is considered the father of medicare in this country. After examining this budget, I think that the absolutely most critical parts of it, and why all colleagues in this House should support this budget on a non-partisan basis on behalf of their constituents, are the historic elements it contains that would make Canadians healthier. I am going to focus on two parts of that: dental care and pharmacare.
All Canadians know that a year ago the Liberals in this House voted against dental care for Canadians. A year later, here we are in a minority Parliament, and because of the hard work of 25 New Democrat MPs and of the New Democratic Party of Canada, this budget includes funding of $5.3 billion over five years and $1.7 billion a year ongoing thereafter to move ahead with a dental care program for millions of families that do not have private insurance in this country, that do not have access to dental care, with an income of $90,000 or less annually, with no copays whatsoever for anyone with an income of $70,000 or less annually.
This budget includes funding to move ahead immediately on dental care for children under 12 years old, in 2022, and then next year, in 2023, expand it to all children under 18 years old, seniors, and persons living with a disability. By 2025, there would be full implementation for all individuals who meet the income criteria. This means 6.5 million Canadians, at least, would have access to primary dental care within the next 36 months because of this budget.
I want to talk for a moment about dental care. I think everyone knows intuitively, without being a physician or having health care credentials, that dental care is a critical part of overall health. In fact, it is inconceivable that we have a public health care system that covers our entire bodies but carves out a section of our mouths from the tonsils forward and says that this is not covered by our public health care system. That is not only logically incongruous, but it is actually medically ridiculous. Poor oral health is linked to other serious health conditions, including cardiac problems, diabetes complications and even low birth rate and premature birth in women. Poor oral health can even kill.
We pride ourselves in this country, I think across all aisles in this House, on having public health care, meaning that everybody, regardless of their station in life and their income, has access to primary health care. That is not true when it comes to dental care. When it comes to dental care, we have two-tiered, private access to health care in this country, and that is antithetical to our concept of what health care should be in this country.
I should also point out that it is not just limited to physical health. People with poor oral health or bad teeth suffer from enormous mental health challenges as well. There has been a lot of focus on mental health from all parties in this House. I want to commend my colleagues, even in the Conservative Party, who have raised a number of significant deficiencies in our public health care system when it comes to mental health. Just yesterday, a Conservative member rose in this House and made a passionate plea for a suicide prevention hotline in this country. Mental health for people who are missing front teeth, people who are living with chronic pain, and seniors who have no teeth in their mouth and cannot afford dentures has an enormous impact on self-esteem and mental wellness. We should be as concerned about that as about any other mental health issue.
There are, of course, economic impacts. People with poor teeth have their job and career aspirations interrupted. Members can imagine interviewing an applicant for a job who shows up and is missing top front teeth. We make judgments about people, and people are embarrassed about the state of their teeth, because they are in their face. It is what we present to the world. I think it is long past time that we brought dental care to every Canadian for economic, physical, mental and emotional health reasons.
Ironically, dental care was always intended to be part of our public health care system. Back in the 1960s, the Hall commission recommended that dental care be part of our public health care system, and the only reason it was not implemented at the time was not because of cost, but because it was felt that Canada did not have sufficient dentists in this country to provide the services. That is not the case anymore. What is the reality today? It is that 35% of Canadians, which is about 13 million Canadians, do not have access to any dental insurance whatsoever, and that understates the problem, because many more have insufficient, substandard or sporadic coverage with high copays, annual limits or high deductibles.
This budget, due to our work, aims to address this. New Democrats believe passionately and fervently in having universal access to public health care, so we consider this to be a down payment on our ultimate goal, which is universal dental care for every Canadian, regardless of the size of their wallet, through our public health care system, like every other medical procedure, whether it is a broken leg, heart surgery or cataract surgery. A broken tooth or an oral health issue should be no different.
I want to just briefly mention a couple of the key components that need to go into a dental plan. We need to create a plan with a good range of services, comparable to any normal plan in place now for Canadians, including the plans that we as MPs have. I want to see a proper fee schedule, so that all of the dental professionals who deliver these services are compensated fairly for their time and skill. We want to make sure that all dental professionals are involved in the creation of this plan: not only dentists, but dental hygienists, dental assistants, denturists and dental therapists. We want to build a system based on prevention of decay and oral disease, because ultimately, at the end of the day, that will save money.
Right now, we are fooling ourselves if we think that ignoring this problem is economically smart, because Canadians are, in record numbers, appearing in emergency rooms in every province and territory in this country every day with dental issues. In fact, I am told that the number one reason for children to enter emergency rooms in this country is poor oral health.
I want to speak for a brief moment on pharmacare, because this budget also includes steps, pressured by the New Democrats, to move toward universal and national pharmacare. This budget includes the requirement to table a pharmacare act by the end of next year and to task the Canadian drug agency to develop a national formulary, which were two of the steps recommended by the Hoskins report and part of the NDP's long-standing call.
New Democrats believe that comprehensive public drug coverage should be in place for all Canadians as soon as possible. Every year, as with dental care, millions of Canadians are forced to go without their prescription medications, simply because they cannot afford them. Again, there is two-tiered health care in this country. If people are rich, they can get medicine; if they are poor, they do not. That is contrary to Canadian values. One in five Canadians, which is seven and a half million citizens, has either no prescription drug coverage or inadequate insurance, and Canadians, ironically, consistently pay among the highest prices in the world for prescription drugs.
Under the agreement made between the New Democrats and the Liberals, we aim to fix this. We will do that by compelling the introduction of legislation, creating a national formulary for essential medicines and creating a bulk-buying program, so that we can start saving money.
I want to end by saying that pharmacare saves money. It would save $5 billion a year in this country; it would save businesses $16.6 billion annually; families would see their out-of-pocket drug costs reduced by $6.4 billion; and the average business would save $750, with families saving $350 a year. It makes good economic sense. I urge all my colleagues to support this budget.
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moved for leave to introduce Bill C-265, An Act respecting the development of a national perinatal mental health strategy.
He said: Mr. Speaker, I am pleased to rise today to introduce the national perinatal mental health strategy. I would like to thank the hon. member for Edmonton Strathcona for seconding this legislation and for her tireless advocacy in support of perinatal mental health.
Perinatal mental illness is a critical issue affecting nearly one in four Canadian families. However, programs and policies across Canada have not kept up with best practices, research or the overarching science. The services currently available to people experiencing a perinatal mental illness are largely inadequate.
This legislation would require the Minister of Health to address this by developing a national strategy to support perinatal mental health across Canada. The strategy includes measures to provide universal access to perinatal mental health screening and effective treatment services, combat stigma, promote awareness, improve training, support research and address the social determinants of perinatal mental health.
I call on all parliamentarians to help women, parents and their families by supporting this vital and overdue initiative.
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