Question Period Note: Mental Health Supports for Young Women and Girls

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• Our Government recognizes the significant mental health challenges faced by young women and girls in Canada, and is committed to promoting their mental health and wellbeing.
• That is why we have invested $5 billion over ten years (from 2017 to 2027) to support provinces and territories (PTs) to improve access to mental health and addiction services in their jurisdictions.
• We continue to fund Wellness Together Canada, an online portal, which offers a variety of resources to support the mental health of young women and girls. A few examples of relevant resources include general information and healthy coping mechanisms for the most common mental health concerns that affect women, such as depression, anxiety, stress and eating disorders
• Moving forward, the federal government has committed to developing a permanent, ongoing Canada Mental Health Transfer to help expand the delivery of high-quality and accessible mental health services.

Young women and girls in Canada are struggling with their mental health. In comparison to male peers, a number of metrics display a disparity between the sexes.

Self-reported mental health among girls and young women is considerably lower than their male peers. The proportion of girls and young women reporting excellent or very good mental health in 2020 was 13-19% lower than male peers for the age groups 10-14, 15-19, and 20-24. Less than 50% of young women 15-24 reported excellent or very good mental health in 2020. COVID-19 has likely exacerbated the problem. In 2020, a positive screen for generalized anxiety disorder was almost 2 times higher among women than men in the 18-34 age group (24.5% and 13.0% respectively), over 2 times higher for posttraumatic stress disorder (11.5% and 4.6%), and almost 1.5 times higher for major depressive disorder (22.7% and 18.3% respectively).

Emergency room visits for anxiety and depression in 2021-2022 show a similar pattern; the rates of young women visiting the ER for anxiety or depression are 2 to 4 times higher than their male peers, depending on the age group and diagnosis. Young women aged 15-19 and 20-24 visit the ER for anxiety or depression at the highest rates among all age groups (175 to 177 visits per 100,000 population).

In addition, young women and girls starting from age 10 are more likely to be hospitalized for anxiety or depression than their male peers. In 2021-2022, females aged 10-14 were hospitalized at a rate 6.2 times higher than their male peers for depression in 2021 (37.2 discharges per 100,000 population as compared to 6.0 discharges per 100,000 population), and 4.7 times higher than their male peers for anxiety (42.5 discharges per 100,000 population as compared to 8.95 discharges per 100,000 population). This pattern of increased risk of hospitalization due to depression or anxiety holds for young women 15-19 and 20-24, with rates 2.4 to 3.2 times higher than their male peers.

Rates of dispensation of mood and anxiety medication suggest that the pandemic has affected young women and girls more dramatically than their male peers. While dispensation of these medications has increased in all age-sex groupings from 2016-2021, a disproportionate increase was seen for females in all but the youngest (5-9) age category, as compared to their male peers.

Dispensation of antipsychotics has also disproportionately increased among young women from 2020-2021. In all age groups with the exception of children (5-9), an increase in the rate of antipsychotic dispensation was seen from 2020-2021 for young women, while the rate remained stable for young men.

The population of young women and girls in Canada is also one that is largely overrepresented among those hospitalized for eating disorders. From age 10-19, young women and girls are hospitalized for eating disorders at a rate 10 times that of their male peers, reaching 21.2 hospitalizations per 100,000 population for those aged 15-19 in 2021-2022. This rate drops sharply for those aged 20-25 and 25+, highlighting the need for care among female youth.

Wellness Together Canada

In response to the global public health challenge of COVID-19, in April 2020 the Government of Canada launched an online mental health and substance use support portal, Wellness Together Canada (WTC). The portal provides free, credible information and supports available 24/7 to individuals across Canada in both official languages to help address their mild to moderate mental health and substance use issues.
WTC offers a variety of resources to support the mental health of young women and girls. A few examples of relevant resources include general information and healthy coping mechanisms for the most common mental health concerns that affect women, such as depression, anxiety, stress and eating disorders.

WTC offers information and support on sexual and family abuse, and information on self-harm and suicide.

WTC offers peer to peer support communities and counseling services for young women and girls who want to exchange with other individuals or with a counsellor.

WTC users have access to more in-depth materials when they create an account, including a 2-week session course on choosing a major or occupation, a 5-week program on anxiety and stress, and a 65-minute course on handling disappointments.
Federal Investments to Provinces and Territories and Integrated Youth Services
The Government of Canada is also committed to supporting the mental health of young women and girls, as evidenced through investing $5 billion over ten years (from 2017 to 2027) to support provinces and territories (PTs) to improve access to mental health and addiction services in their jurisdictions. This investment is in accordance with the Common Statement of Principles for Shared Health Priorities (CSoP), which was jointly agreed to by federal, provincial and territorial (FPT) Ministers of Health (with the exception of Quebec) in August 2017. In the CSoP, Ministers of Health agreed to prioritize expanded access to community-based mental health and addiction services for children and youth as one of three priorities for the federal funding.

Eleven out of thirteen provinces/territories have identified youth focused initiatives, which could include integrated youth services, as part of their bilateral agreement action plans. Three provinces have specifically identified integrated youth services (IYS) as part of their action plans.
IYS models of care provide locally relevant, effective, youth-focused and integrated services for mental health/substance use within the community. IYS locations are easily accessible community-based “one stop shops” that provide an integrated suite of services, which can include peer support, mental health and primary care support and employment counselling, as well as support for navigating these systems of care. Each site leverages existing services and reflects the needs of the local community, so the suite of available services varies by location. There are currently 50 operational integrated youth hubs across Canada and 60 under development.
All 13 provinces and territories have developed or are developing an Integrated Youth Services (IYS) network in their regions. Additionally, there is an Indigenous IYS network in progress. These hubs are easily accessible community-based “one stop shops” that provide an integrated suite of services, which can include peer support, mental health and primary care support and employment counselling, as well as support for navigating these systems of care.

There are approximately 50 operational integrated youth hubs across Canada and 60 under development. Three of the most developed networks are in British Columbia (Foundry), Ontario (Youth Wellness Hubs Ontario), and Quebec (Aire Ouverte), with British Columbia and Ontario specifically identifying the use of bilateral funding to support these networks. This demonstrates how the federal government can work constructively with provinces and territories to spread and scale evidence-based practices in the mental health and substance use space.

The development of an Indigenous IYS network was driven by the participation of Indigenous communities across Canada. These First Nations and Inuit communities led efforts to shift youth mental health towards culturally competent care through the Access Open Minds Indigenous Council. Several Indigenous communities are currently participating in an emerging Indigenous IYS network.

National Standards for Mental Health and Substance Use Services

Budget 2021 provided $45 million over two years, starting in 2021-22, to Health Canada, the Public Health Agency of Canada, and the Canadian Institutes of Health Research to help develop national mental health service standards, in collaboration with provinces and territories, health organizations, and key stakeholders.

On March 14, 2022, Health Canada announced a partnership with Standards Council of Canada (SCC) to develop national standards for mental health and substance use services, to help fulfil commitments made in Budget 2021. Standards will be evidence-based and developed through consensus-based processes that engage experts, health organizations, people with lived and living experience, and other key stakeholders. Standards are tools for supporting health providers in the delivery of high-quality and equitable mental health and substance use services, and will help to ensure a consistent level of care is provided. They will also help to formalize what Canadians can expect in terms of the quality of services, while providing an evidence-based framework for service delivery in priority areas.

SCC is coordinating the development of an integrated suite of national standards for mental health and substance use services in priority areas that align with the Common Statement of Principles on Shared Health Priorities (CSOP), which includes Integrated Youth Services. The Government has emphasized the importance of engagement with diverse stakeholders and promotion of health equity principles, which have been incorporated into the development process.

2021 Mandate Commitments

The Government of Canada is committed to working with provinces, territories and other partners to promote access to high-quality mental health and substance use services for Canadians with a range of needs.

In support of this aim, the Minister of Mental Health and Addictions has been mandated with:
• Ensuring mental health care is treated as a full and equal part of the universal health care system;
• Understanding and addressing health inequities, including for Indigenous people, Black Canadians and vulnerable Canadians;
• Leading a whole-of-society approach to address problematic substance use in Canada; and
• Working in collaboration with provinces/territories
To realize these objectives, the Minister will deliver on a comprehensive set of new and ongoing commitments, including establishing a permanent, ongoing Canada Mental Health Transfer to help expand the delivery of high quality, accessible mental health services, including for prevention and treatment.
Budget 2022 reaffirmed the intention of engaging provinces and territories on the development of a CMHT, which would provide a permanent and ongoing source of funding for mental health services.
Support for the Mental Health Needs of Those Most Affected by COVID-19
Budget 2021 provides support for populations most affected by COVID-19 in dealing with mental health challenges. The Government will provide:
• $100 million over three years to support projects that promote mental health and prevent mental illness in populations disproportionately impacted by the COVID-19 pandemic, including health care workers, front-line workers, youth, seniors, First Nations, Inuit and Métis, and Black and other racialized Canadians.
• $50 million to support projects to address posttraumatic stress disorder (PTSD) and trauma in frontline workers and others who are most affected by the COVID-19 pandemic.
Support for the Mental Health Needs of Children & Youth
Under the Health Care Policy and Strategies Program (HCPSP) at Health Canada, the federal government is providing funding to the following projects:
• $2M from 2021-2024 to the Canadian Mental Health Association (CMHA) to develop and pilot a national specialized peer support certification program for use by post-secondary institutions to support student mental health.

• $6.8M from 2019-2024 to Foundry to help organizations implement integrated models of youth mental health care. This complements $9M in funding to Frayme from 2019-2024 to promote broader implementation of integrated youth services in Canada.

• $2M from 2021-2026 to the Children’s Hospital of Eastern Ontario (CHEO) to increase the spread of the Aaniish Naa Gegii: the Children’s Health and Well‐being Measure (ACHWM), co-developed with Indigenous partners to help measure the health and wellbeing of Indigenous children.
Promoting Mental Health and Preventing Mental Illness
Through the Public Health Agency of Canada’s (PHAC) Mental Health Promotion Innovation Fund, the Government of Canada is investing $39 million from 2019-2028 to address multiple risk and protective factors to promote mental health for children, youth, young adults and populations susceptible to mental health inequities (e.g., low-income families, immigrants and refugees, First Nations, Inuit, Métis, LGBTQ2+, people living with disabilities and people with other socio-economic risk factors).
On March 29, 2020, the Prime Minister announced an investment of $7.5 million to Kids Help Phone to provide crisis supports for children and youth during the COVID-19 pandemic.
In addition, the 2020 Fall Economic Statement announced a $50 million investment to bolster the capacity of distress centres, which are experiencing a surge in demand during the COVID-19 pandemic. PHAC is administering an initial round of grants to 57 distress centres in winter/spring 2021. A portion of funds will support an additional round of grants in fiscal year 2021-22. In addition, $2 million of this funding will support the development of resources to assist distress centres in meeting the needs of diverse and vulnerable populations.
Teen Dating Violence

PHAC funds programming to prevent teen and youth dating violence, including community and school-based initiatives that teach skills for healthy and safe relationships based on respect and consent. In addition, PHAC funds initiatives to support the health of survivors of family violence, including trauma-informed physical and mental health promotion for youth.

Suicide Prevention

The Canadian Radio-television and Telecommunications Commission (CRTC) recently announced that it will adopt 9-8-8 for Canadians to call or text when in need of immediate mental health crisis and suicide prevention support. This will be launched across Canada on November 30, 2023.

In parallel, the Public Health Agency of Canada (PHAC) is preparing for implementation of a three-digit number for suicide prevention from a service delivery perspective. On August 31, 2022, PHAC announced that the Centre for Addiction and Mental Health (CAMH) was selected to lead coordination of 9-8-8 service delivery, building on its experience delivering Talk Suicide Canada. As a first step, CAMH will develop collaborations with key organizations to start building capacity, and engage with stakeholders to inform the scope and requirements of a timely, quality service. In addition, PHAC is engaging stakeholders from a range of sectors, including Provinces and Territories, Indigenous partners, public safety officials, People with Lived Experience, on the scope and service delivery elements, including working to understand anticipated demand for 9-8-8. Finally, PHAC is learning from international experience, including the United States, which recently introduced 988 in July 2022.

The Government of Canada is investing $21 million over five years in the Centre for Addiction and Mental Health (CAMH) to implement and sustain a fully operational pan-Canadian suicide prevention service with its partners. Talk Suicide Canada currently provides 24/7 suicide crisis support via the phone (1-833-456-4566), in English and French, 24 hours a day, seven days a week and by text (45645), in English and French, in the evenings, to people in Canada.

The Federal Framework for Suicide Prevention was released November 2016. It focuses on raising public awareness, reducing stigma, disseminating information and data, and promoting the use of research and evidence-based practices. Progress Reports on the Framework are available on Canada.ca, with the next report planned for release in December 2022. In response to motion M-174, which called on the Government of Canada to establish a national suicide prevention action plan and was unanimously supported by parliamentarians in 2019, the Public Health Agency of Canada is developing an action plan that aligns with the Framework.

Mobilizing Data and Evidence to Underpin Initiatives

Between 2016-17 and 2020-21, the Canadian Institutes of Health Research (CIHR) invested over $413 million in mental health and behavioural disorders research.
CIHR, in partnership with the Graham Boeckh Foundation, is supporting ACCESS Open Minds, a national project that is transforming the way youth aged 11-25 access mental health care by developing and testing evidence-informed approaches into IYS. There are currently 17 sites operating in 7 provinces and one territory. These sites have transformed youth mental health services in diverse ways based on local context. For example, in Ulukhaktok, a remote community in the Northwest Territories where professional service providers are not always available, the site is evaluating a model where lay health workers are trained to provide support to youth in distress.
The IYS Network of Networks Initiative ($1M over 1 year), was also launched by CIHR in April 2022 to create a Canada-wide network of provincial and territorial learning health systems for Integrated Youth Services for mental health and substance use.
In addition, CIHR committed $6.25M over 5 years to the Mental Health in the Early Years funding opportunity in March 2022, with a focus on mental health initiatives for young children (ages 0-5), Indigenous Peoples, as well as transforming mental health with integrated care.
CIHR is also leading the COVID-19 and Mental Health Research Initiative (CMH) in collaboration with PHAC and Health Canada. This initiative supported 101 research projects, of $13.5 million from CIHR and partners. This work is guided by an Expert Advisory Panel composed of leading Canadian experts in mental health and substance use. New knowledge generated through these projects will be mobilized to ensure it will inform policy making in a timely manner.
Statistics Canada developed and administers a web panel survey, the “Canadian Perspectives Survey Series”. Each month, approximately 4,600 people in the 10 provinces have been responding to the new iteration of the survey. In addition, in collaboration with Statistics Canada, PHAC funded two cycles of data for the Survey on COVID-19 and Mental Health (with a third cycle in development) to better understand the wider impacts of the pandemic on mental health in Canada. A special collection of research articles based on the first cycle of data was released in the Health Promotion and Chronic Disease Prevention Journal on September 27, 2021. The Canadian Community Health Survey also resumed in September 2020. The Canadian Community Health Survey provides data on a variety of mental health indicators, and has been collected for many years prior to the pandemic. It will allow for ongoing measurement of changes in mental health of the Canadian population as the pandemic continues and as Canada recovers.

Additionally, the 2019 Canadian Health Survey on Children and Youth, with a second cycle planned for 2023, explores issues that have an impact on the physical and mental health of children and youth (aged 1-17 years). As well, the 2022 Mental Health and Access to Care Survey, focuses on the mental health status of Canadians aged 15+ years and their access to and need for services and supports. This survey also intends to assess the impact of the COVID-19 pandemic on population health as well as evaluate changes in patterns of mental health, service use and functioning in the last ten years.

Mental Illness Surveillance

As part of its mandate, the Public Health Agency of Canada (PHAC) is pursuing ongoing surveillance of mental illness in the Canadian community, including in young women and girls. It uses multiple data sources to provide the most up to date evidence available, including the Canadian Chronic Disease Surveillance System (CCDSS), the Canadian Health Survey on Children and Youth (CHSCY) and the Canadian Community Health Survey (CCHS).

The CCDSS is a collaborative network of provincial and territorial chronic disease surveillance systems, supported by PHAC. It identifies chronic disease cases of all residents who are eligible for provincial or territorial health insurance, and contains aggregated data that can be stratified by age, gender and geographical locations. In 2010, the CCDSS was expanded to track and report on health services use for mental illness overall, as well as for mood and anxiety disorders in the Canadian population.

The 2019 Canadian Health Survey on Children and Youth (CHSCY) is a national, cross-sectional survey that provides health-related information on Canadian children and youth. The survey is representative of the Canadian population aged 1 to 17 years as of January 31, 2019, living in private dwellings in Canada's ten provinces and three territories.

As well, to help address data gaps around the impact of the COVID-19 pandemic on individuals, families, and communities in terms of their mental health (including symptoms of anxiety and depression, and of post-traumatic stress disorder [PTSD]), PHAC partnered with Statistics Canada in the development of the Survey on COVID-19 and mental health. The survey contains information on the proportion of Canadians who screened positive for these conditions by age group and gender, and look at the more at-risk groups. These surveys were conducted at various times during the COVID-19 pandemic and provide timely information on the impact of the pandemic on the mental health and well-being of Canadians.

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