Question Period Note: Perinatal Mental Health

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• Our Government is committed to promoting the mental health and wellbeing of mothers and children.
• We have made significant investments in programs that support the mental health of pregnant and postpartum individuals, including funding for improving community-level access to supports, and $26.5 million annually for the Canada Prenatal Nutrition Program (CPNP), which serves approximately 240 projects with over 45,000 participants.
• Through such investments and the development of health promotion resources, we are ensuring timely access to perinatal mental health services, when and where needed.

IF PRESSED ON 2021 MANDATE COMMITMENTS (88 words)

• The mandate of the Minister of Mental Health and Addictions is to ensure that mental health care is treated as a full and equal part of our universal health care system, working in close collaboration with provinces and territories, and to lead a whole-of-society approach to address problematic substance use in Canada.

• Our Government is committed to ensuring timely access to perinatal mental health services, and remains committed to establishing a permanent, ongoing Canada Mental Health Transfer to help expand the delivery of high quality and accessible mental health services, including for prevention and treatment.

IF PRESSED ON SUPPORTS CURRENTLY AVAILABLE TO ADDRESS PERINATAL MENTAL HEALTH AND SUBSTANCE USE CHALLENGES
• Supporting the mental health and well-being of Canadians is a priority for our Government.
• In April 2020, our Government launched an online mental health and substance use support portal, Wellness Together Canada (WTC), which 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.
• In addition, via PocketWell, the WTC companion app, and individuals can access resources ranging from self-assessment to customized support based on their assessment and can link seamlessly to the supports and services on the portal.  

IF PRESSED ON PROGRESS MADE TOWARDS PERINATAL MENTAL HEALTH COMMITMENT
• Health Canada has been working closely with Canada’s leading experts in the field to gain a better understanding of wise practices, gaps and opportunities with respect to perinatal mental health services in Canada.
• On March 9th, 2022, a roundtable was held with a range of different stakeholder groups, to encompass multiple perspectives, including clinical experts and practitioners, individuals with lived and living experience, policy-makers and researchers/academics.
• This session will help inform further policy development and stakeholder engagement by the Health Portfolio as we considers approaches to make progress in this important policy area.

The perinatal period includes both pregnancy and the postpartum period. Perinatal mental health is a state of well-being in which a pregnant or postpartum person realizes their own abilities, can cope with the normal stresses of life and work productively, care for themselves and their newborn, and is able to make a contribution to their community and society.

Perinatal mental illness refers to mental health conditions experienced “around” pregnancy. This includes pre-existing mental health conditions, but can also refer to new or different mental health concerns arising around this period.

Maternal stress, anxiety and depression are significant public health issues, increasing the risk of poor mental and physical health outcomes for mothers along with potential impacts for children and families. If untreated, consequences include prolonged maternal depression, paternal depression, partner relationship dissatisfaction and conflict, impaired parent-infant interactions and attachment, risk for impaired cognitive or psychosocial development for the child (and increased risk of later child psychopathology) and, in extreme situations, maternal suicide or infanticide. Maternal deaths with a mental health component, by suicide or drug toxicity, are increasingly recognized as making up a significant proportion of all maternal deaths.

Current national data collection surrounding mental health does not allow identification of individuals in the perinatal period. However, it is possible to identify currently pregnant females.

Among pregnant females overall, self-rated mental health was higher than the self-rated mental health of non-pregnant females (2019-2021). This holds for all age groups with the exception of teen pregnancies (15-19), where the self-rated mental health among those who were pregnant was slightly lower than for those who were not. Pregnant teens were also significantly more likely to report anxiety than their non-pregnant peers.

Pregnant females 20 to 44 were significantly less likely to report anxiety or depression than their non-pregnant peers. In contrast, pregnant women 45-54 were significantly more likely to report anxiety or depression than their non-pregnant peers.

The 2018/2019 Survey on Maternal Health provided a snapshot of the mental health of new mothers (5 to 13 months after giving birth) in Canada. The survey found that almost one-quarter (23%) of new mothers reported feelings consistent with either post-partum depression or an anxiety disorder. A higher proportion (30%) of mothers under the age of 25 reported feelings consistent with depression or an anxiety disorder compared to mothers aged 25 and older (23%). The survey also found that nearly one-third (31%) of mothers who reported feelings consistent with either post-partum depression or an anxiety disorder had previously been told by a health professional that they had depression or a mood disorder prior to being pregnant.

The literature suggests that additional research is needed to determine the long-term mental health experiences of teenage parents, particularly studies controlling for confounding effects of demographic, socioeconomic, environmental, and health related variables. One Canadian study identified that among Indigenous mothers, social and health factors were more important for predicting long-term mental health outcomes than experiencing teen pregnancy.

In recent years, some stakeholders have called for greater federal action in the area of perinatal mental health. On May 13, 2020, a petition was brought forward to create a national perinatal mental health strategy that would provide direction, policy, and funding to develop specialized, comprehensive perinatal mental health care services. This includes universal screening and timely access to treatment for all people during pregnancy and the postpartum period.

On May 5, 2021 (World Maternal Mental Health Day), various MP’s offices sent a request to the former Minister of Health’s Office on behalf of their constituents regarding a National Perinatal Mental Health Strategy. It was brought forward by MP Heather McPherson (Edmonton-Strathcona).

On June 3, 2021, MP Don Davies (Vancouver-Kingsway) put forward Bill C-306, which calls for a National Perinatal Mental Health Strategy that includes mental health screening and treatment services during the full perinatal period. This Bill died on the order paper when Parliament was dissolved in August 2021.

On March 31, 2022, MP Don Davies (Vancouver-Kingsway) put forward Bill C-265, which again called for a National Perinatal Mental Health Strategy Act that includes measures to provide perinatal mental health screening and services and reduce barriers to care, as well as measures to increase perinatal mental health awareness, training and research.

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 and 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.
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 pregnant and postpartum individuals. A few examples of relevant resources include general information and healthy coping mechanisms for common mental health concerns, 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 pregnant and postpartum individuals 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.

Perinatal Surveillance

The Public Health Agency of Canada’s (PHAC) Canadian Perinatal Surveillance System monitors and reports on maternal, fetal and infant health outcomes while conducting targeted epidemiological research to address emerging issues. This program has focused largely on indicators of physical health, some of which can be associated with maternal mental health (e.g., fetal/infant mortality, maternal chronic diseases, smoking,). However, formal indicators concerning risk and protective factors for maternal mental health have yet to be established, as there are presently no routinely used national sources of data on maternal mental health or maternal access to/use of mental health services.
Budget 2022 will bring significant investments towards developing the evidence around the perinatal period, including perinatal mental health. PHAC will be investing approximately $4.5 million over three years to support the development and collection of a national parental experiences survey, with a focus on mental health during the perinatal period as well as other key issues such as breastfeeding, substance use, etc. This survey will address a critical data gap, particularly around parental mental health and access to mental health services.

Canadian Task Force on Preventive Health Care’s guideline on screening for depression during pregnancy and the postpartum period

The Canadian Task Force on Preventive Healthcare (Task Force) is an independent arms-length body of up to 15 clinicians and methodologists established and funded by PHAC. In 2022, the Task Force published “Recommendation on instrument-based screening for depression during pregnancy and the postpartum period” in the Canadian Medical Association Journal.

The Task Force’s guideline on screening for depression during pregnancy and the postpartum period is based on the best available scientific evidence. The guideline considered the benefits and harms of screening for Canadian individuals who are pregnant and up to one year postpartum. The Task Force recommends against screening using a questionnaire with a cut-off score and advises clinicians to inquire about the mental health and well-being of pregnant and postpartum patients as part of usual care during visits.

PHAC Policy and Program Activities

The Health Portfolio undertakes a number of activities to promote maternal and child health, which includes supporting positive maternal mental health during the perinatal periods. PHAC makes significant investments to support perinatal mental health through programs aimed at improving community-level access to supports for prenatal and recently postpartum people, new parents and young children facing barriers to health equity. In particular, the Canada Prenatal Nutrition Program provides $26.5 million annually to improve the health of at-risk pregnant individuals, with a focus on mental health, nutrition, and the promotion of positive health behaviours during pregnancy. Through approximately 240 funded projects, the Canada Prenatal Nutrition Program serves more than 45,000 participants across Canada each year.

PHAC also supports the development of several resources promoting the positive mental health of pregnant/postpartum individuals. These resources provide guidance and advice for both healthcare professionals and individuals that may face poor mental health during the perinatal period, including Family-Centred Maternity and Newborn Care National Guidelines; the Mothers’ Mental Health Toolkit; and ‘Your Guide to a Healthy Pregnancy’.

To provide rapid support for new parents during the COVID-19 pandemic, Health Canada and PHAC have recently developed resources to support the mental health of those who are pregnant or have recently had a baby.

• According to a 2018/2019 Government of Canada survey, almost one quarter (23%) of mothers who recently gave birth reported feelings consistent with either post-partum depression or an anxiety disorder. These reports varied across provinces, ranging from 16% in Saskatchewan to 31% in Nova Scotia. Studies conducted in Ontario and Quebec show that about one-fifth of pregnant and/or postpartum women use mental health services.

• Covid-19 has exacerbated the problem; as the rates of perinatal mental health issues and the need for services has increased, the availability of services has decreased due to shutdowns.