Excise Tax Act
Date: 2023_04_25
Chamber: HOUSE OF COMMONS
Mr. Stephen Ellis : moved that Bill C-323, An Act to amend the Excise Tax Act (mental health services) , be read the second time and referred to a committee. He said: Mr. Speaker, it is a pleasure to be here this evening to introduce this bill, which would exempt psychotherapy and mental health counselling services from the goods and services tax. There is a mental health crisis in Canada. Unfortunately, these problems affect 33% of Canadians, from the youngest to the oldest. This is serious. It is a very serious problem. This evening I rise to address an extremely troubling issue for Canadians, which is mental health. It is very difficult to capture exactly what we are talking about when we speak of mental health. I will talk a bit about it, as we go forward, in multiple areas, using my experience as a physician over the last 30 years, and about what it means to me and those folks whom I have had the opportunity to treat with respect to their mental health. Before I start that, though, I want to read a letter I received today: Good morning Dr. Ellis, We met in April last year...and had a memorable discussion about the impact of the tax on psychotherapy and counselling therapy services on your constituents. I am now a full-time clinician working with children and youth, and our conversation especially touched on the main barriers to mental health care for these vulnerable young people in Canada.... I have followed this issue closely. I appreciate that you called [the Canadian Counselling and Psychotherapy Association] to speak before HESA, and your commitment to rectifying this issue through your Bill C-323 . As you likely know, our parliamentary petition e-4126 [has] been rejected by the Government due to semantics over the different regulatory titles of our profession in the various regulated provinces. Unfortunately, I now need to increase my fees in order to account for this unfair tax. I am deeply concerned about the financial strain it will have on my clients, and clients of all clinicians across Canada and in your constituency. Inflation has significantly increased the cost of psychotherapy and counselling therapy services. It causes me considerable discomfort to have to read that here and underscore the importance of the need to change the unfair Excise Tax Act. We know that many therapists who help to look after the mental health of Canadians do not charge tax on their services. For instance, psychologists, psychiatrists and family doctors do not have to charge HST on their services. The difficulty here is access. We all know that when someone is referred for treatment for mental health issues in Canada, it takes an inordinate amount of time to access those services. That is one of the things I have learned, having been a family doctor. Actually, I graduated from medical school 30 years ago this year, which is shocking since I was 12 when I graduated. Doogie Howser was my name. I am just joking; this is a serious subject. That being said, I think it is important to say that, as clinicians, one thing we understand is that when someone comes into our office and has finally made the decision and realized that they are suffering with a mental health problem, they want treatment and they want it now. The sad state of affairs that exists in Canada is that we are not able to provide that. Of course, delays may easily mean someone does not get the treatment they need, only to then slip further into the issues they have. That presents a significant difficulty. We know there is a significant range of mental health issues we can see from a clinician's perspective. Whether it is an issue with a young person whose relationship is breaking up, more severe depressive type symptoms or generalized anxiety disorder, there is a whole host of issues, all the way to schizophrenia and depression in later years in seniors. All of those things form the basis of what we understand as mental health. There have been considerable efforts made around the world, and in Canada in particular, to look at mental health issues and make it more acceptable to speak out loud about mental health so that people know speaking about it is what will allow them to seek out the help and services they need. However, those services may not be available. It would be an absolute shame if someone has made that decision and then is unable to receive the services they need. Mental health, of course, affects our physical health. Often, as a family physician, I would spend a lot of time in the office trying to understand exactly what was wrong with someone. A common presentation, like maybe insomnia, a lack of ability to sleep or feeling tired all the time, requires a significant amount of workup to ensure there is no physical health problem. Oftentimes, I would go down that road of understanding and try to convince somebody that their problem lies with an illness such as depression. Once they are convinced of that, which is not always the case, then of course the treatment regime is what follows. It could be medications, but counselling is an essential part of treatment to help people begin to undo some of the negative thought processes they have and help them with a more resilient type of thinking for the future. We know that those two things go hand in hand. They are essential. Again, there is a multitude of ways to receive that type of treatment, but we know that psychotherapy and mental health counselling can be a significant part of it. With the letter I read, we know very clearly that there is a significant financial burden on folks who are working in this industry and how difficult it is for people who are coming forward. Oftentimes, psychotherapy services and mental health counselling services, for those fortunate enough to have a health care plan, have a limit within a plan. Often there is no coverage, of course, for those not fortunate enough to have a health care plan. That means, specifically for these two types of services, that people are paying GST or HST on top of a significant amount, perhaps $150, $175, $200 or $250 an hour, to receive those types of services. Of course, as we all know by doing simple math, that can add up fairly quickly, which becomes a disincentive. If we do the math quickly, we can understand that if we remove this tax from these services, almost every eighth visit will be free for a person. To me, that is a significant issue. Another thing I want to mention is the breadth of Canadians who are affected by mental health issues. I had the opportunity to speak to some international medical graduates this past week in the Toronto area who were in this country from two years to 28 years. Unfortunately, as we know, with the systems that exist, all 15 folks I had the opportunity to speak with were unable to gain licensure here in Canada as physicians. They worked as lab techs, security guards and physician assistants, and some of them had moved on. One guy rose through the ranks to be vice-president of a company. They were all very well-educated and hard-working folks. The other part of this is that sadly, Canada, in the international medical community, has become known as the graveyard for doctors. That is the term they use. When they come here, they get in an interminable cycle that does not allow them to practise. Why am I talking about this? It is not because we have this great program called the blue seal program, which would eliminate these problems. It is because of the heart-wrenching stories I heard from these international medical graduates, who were very well trained in their own country. One of the telling stories I heard was of a gentleman who said his children knew that he was a physician, but when he went to work, they asked why he was dressing up in a security guard uniform. When we hear that, we can understand the heart-wrenching nature of the amount of effort that all of these folks put into their work, into their profession, which they are unable to practise here. I could tell that the tears were very close to the surface and ready to flow. That is an important story because we know, as I said at the beginning, that mental health can affect people of younger ages all the way to the end of life. We know that is a significant issue. We also know that there are other significant groups, such as racialized minorities, immigrants and people who identify as part of the LGBTQ community, that suffer with more mental illness than other portions of the population. We need to understand that mental illness affects everybody across every spectrum of the population in Canada. It is a very important thing we need to underscore. We also need to understand that the health care system is failing us. We know that in Canada, some services in mental health care are paid for, such as in my province of Nova Scotia, but we also know that for expenses in health care, Canada is ranked first among 30 OECD countries in percentage of health care spending as part of the economy. We know that we are severely lacking in doctors per 1,000 people, in specialist wait times and in access to resources. For this reason, we know that when the government has the opportunity to make changes on some very specific things, that could perhaps cross party lines if there is something we can significantly do about it. It behooves us to look at a few things regarding the way the pandemic has impacted the mental health of Canadians. We certainly know that youth have been significantly affected, more so than other segments of the population. Since COVID-19, fewer Canadians report having excellent or very good mental health. Prior to COVID, youth aged 15 to 24 were the least likely to report excellent or very good mental health, a sad state in and of itself, but they reported the greatest decline, a 20 percentage point reduction, from 60% pre-COVID to, sadly, 40% in July 2020. Inexplicably, it appears that seniors aged 65 and older have not experienced declines in mental health since the pandemic began. As I mentioned previously, women continue to report lower levels of mental health compared with men, from 52% to 58%. Another very important thing to note is that there are groups in Canada doing very good work. I will give a shout-out to my daughter, Allison Fitzgerald, who was on TV this morning talking about Kids Help Phone, which has done excellent work. It has some shocking numbers, though, when we think about it. Since the pandemic began, it has had 14 million interactions with youth in Canada. We know that is a significant issue that continues to come forward. The Canadian Paediatric Society put out policy briefs with respect to child and youth mental health, recognizing the significant issues associated with it. It said, "Accessible, evidence-based treatments can help mitigate long-term disabilities and support academic and occupational success." It also said, which we again need to underscore, "Those under the age of 25 have been uniquely impacted by the pandemic." They have had stress, anxiety, disrupted access to learning and identity-affirming activities, and reduced academic and economic opportunities. In conclusion, what can we do to help support all Canadians? We can modify the Excise Tax Act and eliminate the taxes on psychotherapy services and mental health counsellors. Even though we may say this is not a huge issue, we have an opportunity to do something. The government needs to look at opportunities so we can stop talking, make a difference and do something to help the health of Canadians.