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House Hansard - 184

44th Parl. 1st Sess.
April 25, 2023 10:00AM
Context: House Hansard - 184 - Apr/25/23
Mrs. Élisabeth Brière (Parliamentary Secretary to the Minister of Mental Health and Addictions and Associate Minister of Health, Lib.)
Mr. Speaker, I am pleased to be able to take part in today's debate on Bill C‑323, an act to amend the Excise Tax Act with regard to mental health services. I want to thank the member for Cumberland—Colchester for bringing forward this important subject. The MP for London—Fanshawe also introduced a bill on this subject. The bill would exempt psychotherapy and mental health counselling services from the goods and services tax and the harmonized sales tax. I would begin by pointing out that our government has been taking meaningful action to support mental health care services for Canadians since 2015. These investments include $5 billion over 10 years to provinces and territories starting in 2017 to improve and increase the availability of mental health and addiction services. The toxic drug and overdose crisis claims the lives of 20 Canadians a day, on average. Many of them are homeless and have mental health problems. That has a major impact on our communities, our health care systems and our social services. To address this crisis and save lives, we have invested more than $800 million since 2017. We have restored harm reduction as an essential pillar of our strategy and work to support a compassionate and evidence-based response to the overdose crisis and the stigma associated with it. Since 2020, we have also invested over $270 million in the Wellness Together Canada portal, which gives Canadians free tools and support for their health and well-being. Starting in 2021, we began delivering $100 million over three years to support projects for innovative mental health interventions for populations disproportionately impacted by COVID, including health care workers, frontline workers, youth, seniors, persons with disabilities, indigenous people and racialized communities. Since last year, we have begun investing $1.5 billion over six years to support trauma-informed, culturally appropriate, indigenous-led services to improve mental wellness, including over $825 million through budget 2021 and budget 2022 to support distinctions-based mental health and wellness strategies with first nations, Inuit, and Métis peoples. Building on these historic investments, budget 2023 proposes significant new funding to build upon and complement the substantial existing investments for mental health and substance use supports for Canadians. On February 7, we announced an investment of nearly $200 billion over 10 years to improve health care services for Canadians, including mental health care services. This commitment includes billions of dollars in additional federal funding transferred to the provinces and territories to improve health and mental health care over the coming years through a combination of an increase in the Canada health transfer and an additional $25 billion over 10 years to support bilateral agreements with the provinces and territories. The new FPT bilateral agreements include an integrated inclusive approach to mental health in family health services, the health workforce, as well as data and digital tools. These investments will support the health and mental health needs of Canadians and will require provinces and territories to produce detailed action plans. This approach is the most effective way to integrate mental health and substance use services into the health care system, including primary care, and to ensure transparency and accountability on the part of the provinces and territories as to how this funding is spent and where it is spent. In addition, budget 2023 proposes to provide a total of $359.2 million over five years starting in 2023-24 to support a renewed Canadian drugs and substances strategy. Budget 2023 also proposes providing $158.4 million over three years, starting in 2023‑24, to support the implementation and operation of the new national suicide prevention line, 988. We have partnered with CAMH to oversee the implementation of this new crisis line and we are working closely with our U.S. counterparts to learn from their four-year implementation process for the similar service they launched last year. We know that the fundamental principle of Bill C‑323 is to make mental health services more accessible and that is a principle we support. However, our government also appreciates that tax changes, like those proposed in Bill C-323, should ideally be undertaken through the budget process, extensive debate and in discussion with provinces and territories. This enables us to fully consider trade-offs, balance priorities, close potential loopholes and undertake new fiscal commitments only to the extent that they are fair and affordable. In short, this approach ensures consistency with the tax framework and the uniformity of the entire tax system. Making a tax exemption through the ad hoc passage of a private member's bill such as Bill C-323 has the potential to undermine this process. Viewed through this lens, this bill raises a number of issues. Because health care is essentially a provincial responsibility, the federal government uses provincial funding and regulatory practices as criteria to determine which services should be considered basic health care services for taxation purposes. In this regard, if a service is covered by the health care plan of two or more provinces, it may be considered basic health care and exempted from the GST/HST in all provinces. Likewise, if a profession is regulated as a health care profession by at least five provinces, the services of that profession may be exempted from the GST/HST in all provinces. However, psychotherapy and mental health counselling are not currently covered by the public health system in any province and are not regulated in at least five provinces. This means that exempting the GST/HST on psychotherapy and mental health counselling services as proposed by Bill C-323 could undermine the long-standing criteria established for determining the GST/HST status of health care services. Consequently, this could make it more difficult to make objective decisions about any possible future efforts to exempt other services. While psychotherapy and mental health counselling services do not currently meet any of the long-standing criteria that were established to determine which health care services supplied by health care practitioners should be exempt, psychotherapy services provided by a psychologist or other regulated health professional such as a physician, nurse or social worker do meet the criteria and are already exempt if the services are within the scope of practice of their profession. We look forward to exploring these issues through the legislative process. In particular, whether the bill would apply in the same way in each province is an important issue to be explored through debate. This is a basic question of fairness for Canadians. We look forward to exploring these issues through the legislative process and, in particular, whether the bill would apply in the same way in each province. That is an important issue that should be discussed in this debate. Canadians deserve to have access to the mental health services they need. Canadians deserve to have access to the mental health services they need. That is why our government is committed to ensuring that mental health care is treated as an equal and integral part of Canada's universal health care system. While we do support removing barriers to Canadians' access to mental health support, it is my hope that the considerations that I noted earlier will be addressed through parliamentary debate and review.
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