Thank you again.

Good afternoon. I'm Dr. Ryan Van Lieshout, Canada research chair in perinatal mental health and the Albert Einstein/Irving Zucker chair in neuroscience at McMaster University.

I'm a psychiatrist and a clinician scientist who works with individuals struggling with their mental health during pregnancy and the first postpartum year, and whose research focuses on developing scalable psychotherapies for those with perinatal mental health problems. We also aim to optimize the delivery of these treatments to maximize their impact on offspring brain development. The primary goal of my work is to disrupt the intergenerational transmission of psychiatric problems from parents to their children.

My clinical expertise led to my invitation to co-author Canada's national practice guidelines for the treatment of perinatal psychiatric problems and Public Health Ontario's perinatal mental health tool kit. Throughout my career, I have seen the devastating effects that mental health problems occurring during pregnancy and the postpartum period have on children and families, and I have committed my work to reducing their impact.

As the other experts suggested today, perinatal mental health problems affect up to one in five women, but the disproportionate effects of the COVID-19 pandemic on mothers led these rates to increase to one in three. As previously mentioned, each case of postpartum depression alone is associated with costs of up to $150,000 over the lifespan, two-thirds of which is attributable to offspring.

Even though effective treatments can help both mothers and their children, as few as one in 10 pregnant and postpartum persons are able to access evidence-based care in this country. There are many barriers to the receipt of timely perinatal mental health care in Canada. One of the most significant of these is the current absence of coordinated care pathways that identify sufferers and match the right person to the right treatment at the right time. Second, since most individuals with perinatal mental health problems will respond to psychotherapy, talking therapies and/or medications, another significant challenge is the relatively limited knowledge possessed by frontline physicians about the safety of these medications during pregnancy and lactation. Finally, the profound lack of access to evidence-based psychotherapies, driven primarily by a lack of health care providers trained to provide them, prevents us from meeting our goal of becoming the best country in the world to raise a child.

However, there are many reasons for hope. A group of Canadian clinician scientists, of which Dr. Vigod and I are members, is working with the Canadian Network for Mood and Anxiety Treatments to prepare national practice guidelines for perinatal mental health problems, which can be used to help educate frontline providers and guide the creation and application of Canadian-specific care pathways. These structured care pathways—integrated systems that involve the detection of mental health problems, direct patients to the right resources at the right time, and provide treatment and follow-up—need to be tailored for the Canadian context and implemented.

Once these pathways are created, they will enable us to use evidence-based psychotherapies, developed and tested right here in Canada, to optimize treatment. However, there exists a substantial shortage of trained mental health care professionals required to deliver these interventions. To address this, our group has developed and tested several effective, scalable psychotherapeutic interventions that can be delivered by a variety of individuals, including public health nurses, with no previous psychiatric training or even individuals who have recovered from psychiatric problems themselves, also known as recovered peers.

These treatments can serve as both initial and more intensive steps in care models. For example, our one-day cognitive behavioural therapy-based workshop for postpartum depression can effectively treat up to 30 individuals at a time and be delivered online or in person by public health nurses or recovered peers. Our nine-week group cognitive behavioural therapy intervention has also proven effective, and its delivery has already been successfully task-shifted to recovered peers and public health nurses with limited to no previous psychiatric training. These have already been scaled up and are in use in Canada, Europe and the United States.

As Dr. Montreuil pointed out, we know that when mothers get these treatments, they help not only them but their offspring as well. Perinatal mental disorders are among the most common adverse childhood experiences. The research by our group and others has shown that treating mothers with postpartum depression leads to clinically meaningful improvements in mother-infant relationships, infant brain development and emotion regulatory capacity, and even the mental health of the older children in the home. This is in keeping with research from around the world that suggests that for every dollar invested in early childhood interventions, society reaps a $7 return.

Perinatal mental health problems in Canada can be prevented, detected and treated, and we already have the know-how to support mothers and disrupt the intergenerational transmission of mental disorders in families. The federal government can help by working together with experts to create Canadian-specific care pathways, scale the perinatal mental health workforce to meet the needs of mothers, and work together with the provinces to implement these systems. Such developments will enable our Canadian-made discoveries to improve the health and lives of all Canadians.