44th Parl. 1st Sess.
February 15, 2023 02:00PM
- Feb/15/23 2:51:07 p.m.
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Mr. Speaker, invoking mental health is something that we should consider at all moments, but I will tell everyone what does not help mental health when the world is going through something as difficult as it is. It is to expand people's fears, to increase people's anxieties. The party opposite refuses to offer solutions. All it offers is fearmongering and pretending that Canada is an island alone while it goes through what the world is suffering.
That is not reality. That is not truth, and it certainly does not help those who are suffering from mental illness.
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Mr. Speaker, I thank my colleague for his question and comments. As he said, the report was tabled this afternoon.
During discussions at the Special Joint Committee on MAID, we heard from a wide range of partners, associations and people who had concerns. The discussions led us to make the decision to extend the delay for those whose sole medical condition is a mental illness. That way, we will have time to set things up properly and ensure that doctors and nurse practitioners are ready to provide MAID under these conditions. Things must be done properly to respect autonomy and freedom of choice.
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Mr. Speaker, I thank my colleague for this important question. There have been discussions on this issue. Should expanding MAID to people with mental disorders be delayed by six months, nine months or twelve months?
With guidance from the Minister of Justice and his team, and keeping in mind what we have heard, we do believe that one year will be sufficient, especially since the expert panel is already developing an accreditation program and standards of practice.
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Mr. Speaker, I am confident that, by having this legislation pass, we would be putting in place an opportunity to be 100% confident in the law. There is no hesitation on my part.
To add to that, I think it is critical that we understand and appreciate that what we are talking about are people who have been working with psychiatrists for years and for whom there is no remedy to their mental illnesses. It is a small fraction of people who would even qualify to put in applications. Then that process gets under way.
I think it is really important that people understand that. It is not as wide open as many are trying to give the impression of.
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Mr. Speaker, the Government of Canada just signed off on an agreement of over $196 billion over the next 10 years. That is there to support the Canada Health Act. Mental health is a part of the Canada Health Act, from my perspective and in the minds of many, because mental health is, in fact, health, just like breaking a leg is a health issue.
I suspect we will have to make sure there is a high sense of accountability to ensure that the provinces treat it accordingly.
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Mr. Speaker, I think a key distinction in this legislation is the difference between mental health and mental illness. People could have one or the other or both. Can the member opposite explain whether he understands this difference and why it is relevant to this legislation?
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Madam Speaker, virtually all medical health experts contend that mental illness is not irremediable. Why the delay for a year? What is going to change in this next year that should not be dealt with right now?
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Madam Speaker, I am glad the member raised this because it is really important to understand we are talking about this kind of slippery slope we are leading down when we talk about expanding this into mental health.
I mean, there are many veterans in this country who struggle because of the service they have given this country. They struggle with psychological injuries, mental injuries, and PTSD. They may feel that, if they go to Veterans Affairs, which is where they need to go to get the help they need, there is a chance that, instead, they might be counselled on how they could end their life.
This has happened. We know of at least six cases where it has happened, and who knows how many others there might be. However, if a veteran has to feel that way about going to Veterans Affairs, might that mean they will not get the help they need? We should never be in a situation where a veteran feels they cannot get the help they need from the government.
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Madam Speaker, there is one issue that has been raised many times in the House, and that is the issue of mental health. To date, the government has refused to make the investments needed to help people and to ensure that all Canadians who need mental health care receive it. This is not happening right now because of the lack of funding and resources.
I want to know what my colleague thinks of the government's mental health funding. Is it not important to make investments so that people will always have options when it comes to mental health?
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Madam Speaker, we are here for what is really such a deeply personal and complex discussion on Bill C-39. I want to start by saying the discussion tonight is about Bill C-39, and it has been the discussion here for the last few nights. I say this because some time ago, and I believe it was in November, we had a one-night discussion in the House, a take-note debate on mental health, in which I participated. Frankly, there were very few participants in that debate. A number of colleagues were here for that.
However, the discussion tonight is not about mental health. It is about Bill C-39, the legislation before us, to delay the implementation of MAID as it pertains to mental illness by a year. The core of the crux is that there is a mental health literacy discussing this problem in the chamber, and perhaps even across the country.
I want to start by saying what mental health is and what it is not. Mental health is really, at its core, in the day-to-day for all Canadians and all of us in the House, who work really hard and have stress for ourselves and our constituents. We have been going through a really challenging time these last two plus years through COVID.
Mental health is the ability to navigate and recover from a challenging situation and to be able to move forward with a sense of self. It does not mean that when we are stressed, when we have anxiety or when we are facing a tough period where there may be ebbs and flows of depression, we are struggling from mental illness. That is mental health.
We really need to start the conversation there. Truthfully, for any human being, and I have two teenage daughters, day-to-day things are up and down. We are not meant to always be happy all the time. We are not always meant to be in a positive state of being. There are ebbs and flows to life, just as there are for every Canadian across this country. Having two teenage daughters, I am sure many colleagues in the House can relate.
The truth of the matter is that mental health is not the opposite of mental illness. When I talk about people being diagnosed with a mental illness, I mean people who are diagnosed by a physician, which means a psychiatrist, a medical professional who is familiar with the categorizations of diagnosis under the DSM-5.
There are individuals with mental illness who are treated for it who have good mental health. Can members imagine that? One can have good mental health while one struggles through mental illness. That is a reality for many, many individuals who deal with mental illness. About 15% to 20% are medically diagnosed with mental illness.
There is a mental health crisis for many Canadians in this country, with many social determinants, whether it be poverty, housing or inflation, that are impacting the mental health of many Canadians, but they are not struggling with mental illness. I really feel strongly that is where we need to start the discussion.
Bill C-39 is not about mental health. Bill C-39 is about mental illness and those who have struggled with mental illness who have been presented treatment after treatment, have tried everything imaginable to address their suffering, and have not found relief. They have not been able to find that ebb and flow of life many of us experience in mental health. We need to acknowledge that.
I heard a lot of disturbing statements in the House, such as this legislation being euthanasia or medical treatment by death. Shame on them for disparaging the DSM categorizations of medical professionals and using fast and loose language in the House on what is a profoundly serious categorization of suffering for individuals in this country.
Frankly, this is a hard issue. MAID is a hard issue for so many of us. It is so hard for us to know people we love may be suffering from a disorder or a terminal condition there is no relief from.
I want to move now into what Bill C-39 is, because we need to go over that.
Bill C-39 is asking for a year. It is asking for a year to pause on allowing for mental illness as the sole determinant for an individual requesting MAID, so that it can be reviewed and so that it can be put into place well. What do we mean by “well”? We have a health care crisis in this country. We have gone through two years of COVID. Doctors, nurses and health care practitioners are exhausted, and they need to be trained on this. They need to understand the DSM-5. They need to understand what the treatment protocols are for those who suffer with mental illness. We are not there yet. We want to ensure that the best practices are in place, and done with compassion and with a deep sensitivity for the individual suffering.
It is about the individual. Many of us in the House have beliefs, which may be religious beliefs or personal beliefs, about how they feel about MAID in general or how they feel about MAID in relation to this particular categorization of mental illness. At the end of the day, it is about the individual. It is not about us. It is about them. We need to remember who is at the core of this legislation and why it has been put forward, and the compassion and time that have been put in by medical experts. One can present me with one panel or another panel. At the heart of this is human suffering. I would not wish on anyone in the House to know what it is to have a loved one who suffers from mental illness, because I did.
I had a 15-year-old nephew who suffered from mental illness. Every treatment was offered to him, every treatment, and he refused. I lost my nephew to suicide, not because we did not have hope, not because there were no resources, not because we did not try, but because everything that was put on the table, and trust me, I am a fierce mama, did not help him. I have to live with that loss, and the grief of that loss, of his choice. He did not make his choice in a medically assisted format. He chose suicide. We need to understand the difference.
Why do I share this? I share it because this is a personal issue. I also have a dear friend who had ALS. She suffered for years, but we put into place protocols for her so that when she knew it was enough, we would be by her side in her choice. There were friends who did not show up for her choice. There were many of us who debated about her choice, that it was gut-wrenching. Each step of the way, we had check-ins with her, even when she could only communicate through her eyelids. Was she sure that this was what she wanted? Was she ready? It was heartbreaking to leave that room that day, but it was her choice.
At the core of this, as hard as it is for members of this House to understand, it is about the individual. We have an obligation to provide every guardrail to every professional framework that is caring and compassionate, and that is why we need time to build it and set it out.
At the end of the day, these are professionals. This is mental illness. To the degree that individuals are suffering at that level, one should never have to watch individuals suffer to that degree.
Even if they go and ask for it from their psychiatrist, even if they are contemplating this, that is the beginning of the process. It is not an automatic decision. Then, their entire history of treatment needs to be reviewed, every protocol questioned. Every stone needs to be turned and reviewed by another professional. This is not even sober second thought, as we would have in the Senate. This is sober after sober after sober, three times, four times, five times, until every check has been done with the individual who is truly suffering.
I want to get out of the speak of professionals and all of that because at the core of this is the human being who is suffering. We need to know our language and be clear about that.
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Madam Speaker, there is one thing from the other side that I find confusing. They can correct me if they wish, but they seem to be saying that if in fact a year from now we allow mental illness as a sole reason for medically assisted death, those people would not be suicidal. By the very definition of medically assisted suicide, or MAID, that person is suicidal.
If we now allow mental illness as a sole reason for MAID, are we not making suicide easier?
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Madam Speaker, this is exactly the reason why mental health literacy is so important, because those who suffer with mental illness are not necessarily, by default, suicidal. I would be more than happy to educate the member on the determinants of that.
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Madam Speaker, that is a very important question. Canada is facing huge challenges right now with respect to mental health. We should double down on this and make mental illness a priority, because it is affecting hundreds of thousands of Canadians.
There are plenty of ways to add more resources to our health care system. The government could speed up the approval process for certain drugs. We can all be more open to new ways of thinking, working and living in society that would alleviate this problem. Let us hope the government will see it and show a little leadership on things like that.
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Madam Speaker, I understand I am the last member to speak on this debate. I doubt, however, that I will be the last word on this. I am not. I see that I am neither the last speaker nor the last word then.
I have been kind of reluctant, frankly, to engage in this debate because I do not consider myself to be an expert. I have not participated in committee hearings, and I have not had the benefit of listening to the expert witnesses. Therefore, the only thing that I bring to this particular debate is 25 years in and around the mental health system in the eastern part of the GTA. This is due to the fact that my son, technically my stepson, has schizophrenia.
The schizophrenia started to manifest itself when he was about 15 years of age; he is now about 40. As a family, we have been able to make some observations about the current state of the mental health care system in our neighbourhood. We are a well-resourced family; we have been able to access the best that there is on offer in and around the city of Toronto.
Our son has spent some weeks at the Whitby Psychiatric Hospital east of Toronto, one of the best that Ontario has to offer. He has also spent some time at the CAMH in downtown Toronto, which is possibly the leading health care facility in this particular area of health care. He has also spent time at our local Scarborough Health Network; this is a good health network, but my observation is that it is just absolutely overwhelmed.
The previous speaker talked about access in the order of 12 to 18 months. This has been our experience as well, even though we have supported him as a family. As I said, we are well resourced, and his mother, in particular, is fierce in her protection of him.
We started to notice his erratic behaviour when he was around 15. For three or four years, we really did not know what it was, in spite of taking him to various health care experts. When he went off to university, he had his first diagnosed psychotic break. If members know anything about schizophrenia, they know that when one is recovering from that psychotic break, one never regains everything. Over the years, he had a number of psychotic breaks, and each time, he did not fully come back.
The observation is that when one is around 40 years of age, that is as good as it is going to get. One neither gets any worse nor certainly any better. He fills the definition of somebody who has an irremediable condition. It is medically diagnosed, and he has had episodes where we had the police there and things of that nature. Fortunately, as I said, his mother is a fierce advocate for him, and we have been able to stabilize his housing. He is well housed and well fed, which has not always been the case. However, at this period of his life, he is stable.
Over the course of these 25 years, we have made some observations of the system. The first observation is that it is overwhelmed. If the general health care system in Ontario is at its maximum stretching point, the health care system is always stretched beyond that point. I will not say it is broken, but it certainly is stretched.
This is not a condemnation of the people or the personnel who are in the system. They are good-hearted, overworked and exhausted. It is the patients who suffer. I do not have a great deal of faith, based on my observations, that one year from now somehow we will have a better system than we have today. My guess is that it will be closer to generations.
One of my hon. colleagues from the NDP raised the issue of poverty, homelessness and all the other issues that people face. Again, it has been our observation that we as a family have been able to shield him from a lot of things that mental health patients face on a daily basis, such as how they are going to eat, where they are going to sleep, all that sort of stuff.
Therefore, from time to time, it appears that ending one's life is an attractive alternative. I fear that, primarily for those people who are not well resourced and not well shielded from the vagaries of life, who have no job, no relationships and a limited appreciation of their own reality, it would be an attractive alternative to end their life, and that will be made available to them and, I dare say, available a little too readily at times.
These are observations we have made over 25 years. We have made them in the context of a family trying to support someone who would fall within the specific categories that are delineated in the legislation. We frankly have no real faith that this might not be an alternative for our son. That would be tragic for us all because it would not be a death in isolation.
I would also make the observation that we are long on talk in this place and short on resources. We talk about fixing the system. We talk about making resources available. One can pretty well go back through the speeches in Hansard for the last year or two years or five years or 10 years, and each incident of legislation comes with a promise of resources. I wish that were true, but it is not. In our observation, it is only getting more challenging.
In some respects, this legislation is a way out of doing what we need to do to facilitate the health care challenges of our most vulnerable citizens. While I will, with colleagues, support this legislation, I frankly do not think things will change in a year. It may be that they will change in 10 years. I think this is the kind of timeline and horizon that we would be realistically looking at in order to deal with people who would fall within the specific delineated categories as set out in this legislation.
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Madam Speaker, the member's question will give me an opportunity to once again underline what the member is trying to get at, which is that this is wrong. Leadership is not just putting something to the courts and following a ruling. On this one, the courts were not even asking for mental health to be a factor in MAID.
Maybe this is the point where backbenchers and other parties, cabinet ministers or MPs can take these 12 months to consider all the arguments, for and against. I have a very tough time with including mental health. I do not think there is a single honest, good reason why someone should access MAID because of depression or other serious mental health issues.
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Madam Speaker, my understanding of mental health, the DSM, a lot of the mental health disorders and how they are diagnosed or rated is that there is a system where we ask the patient how they feel, on a scale of 1 to 10, in different categories. We kind of gauge where they are, and we have an understanding of the disorder or the mental health issue that they are facing. It is very subjective and difficult. It is not like they can do a blood test to find out if someone is positive or negative, or that there are other physical ailments that can actually be measured to understand that the person is not going to recover from them.
Mental health is different. There are also advances. This is the thing that should give hope. There are medical advancements that are treating people whom we never thought we could treat before, and a lot of that has to do with mental health. There are chances now that we can revisit some of these diseases and disorders with modern pharmaceutical solutions or therapies that have not been tried before in the western world. That is where we have to spend our energy.
We also have to put those extra resources into health care. That means a larger transfer. That means the Liberals' coming through on their $4.5-billion promise for health care in the last election. They have yet to deliver a single penny on it.
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