Thank you to the chair and the committee for inviting me to present today on the topic of the mental health of women.

By way of introduction, as you've heard, I am a psychiatrist. I'm the head of the department of psychiatry at Women's College Hospital in Toronto, where I also hold a research chair in women's mental health. I am also a professor of psychiatry in the Temerty Faculty of Medicine at the University of Toronto. For the past 15 years, my clinical practice and research have focused on women's mental health.

What I wanted to talk to you about today is how and why I believe that the mental health of women is a major public health issue for you to consider.

From menarche—the time when people get their periods—to menopause, women are two to three times more likely to develop common mental health problems such as depression and anxiety than their male counterparts. Mental health problems in women, of course, affect their well-being and productivity. Because women are often caregivers of all others in their sphere, when they are unwell, this can also negatively impact their children and families.

When I talk to my students, partners and the community about this, I usually say there are issues of mental health that are unique to women. You've heard about some of those today, including pregnancy, of course. Then, there are issues that disproportionately or differently affect women. Biologically, there are unique considerations. For example, mood problems that fluctuate with the menstrual cycle might require different treatments or different medication regimens. We've heard quite a bit about pregnancy already today. I would add that treatment decisions in pregnancy, and when someone's breastfeeding, require us to think about the potential for impact on a baby. Also, even the way women absorb and metabolize medications, they do this more slowly than men, so a dose of a medication, for example, that was established for an often larger or heavier man in the clinical trials might lead to toxic side effects.

Of the issues that disproportionately affect women's mental health, one of the biggest is physical, emotional and sexual abuse and assault, which is much more common in girls and women. You probably know that trauma changes the brain. It increases the risk for depression, anxiety and post-traumatic stress disorder substantially. In fact, we now know that more than 50% of women with mental illness report having experienced prior trauma.

Women are also at elevated risk of poverty, isolation after immigration, and stress due to caregiving, among other factors, which can not only increase their risk for illness, but also increase the barriers to their receiving care.

I thought I would tell you a bit about how our department of psychiatry at the University of Toronto at Women's College Hospital has addressed this. Dr. Van Lieshout works in a very similar program at McMaster University. We are one of the University of Toronto's main academic health sciences centres, and we've really taken these considerations to heart.

Our department comprises clinical programming as follows. First, a reproductive life stages program for women who experience mental illness related to the menstrual cycle around the time of pregnancy is very important, as you've heard today, as well as around the time of perimenopause. Second, we have programs that cater to women from at-risk populations, including immigrants, refugees, indigenous women and women experiencing addiction. Third, we have a trauma therapy program for women who've experienced emotional, physical and sexual trauma and now are experiencing complications of mental illness.

Within these programs, because we're a university hospital centre, we're dedicated to expanding knowledge beyond our walls, via research and education. We study causes of illness, such as in our Canada-wide study of postpartum depression genetics. We identify novel treatments, as well as how best to use existing ones. For example, we're using non-invasive neural stimulation to treat depression in pregnancy for women who are worried about using anti-depressant medications. Also, we just received funding from the Canadian Institutes of Health Research to look at ADHD medications in pregnancy, because this is dramatically increasing in use among women. We also, as you've heard today, develop and test innovative models of care to improve access in the pregnancy period, but also to expand access to trauma-focused therapies.

Finally, we train clinical providers across all disciplines—not just psychiatrists, but also social workers, psychologists, midwives and people in multiple other areas of medicine that are related to ours, such as endocrinologists and gynecologists—so that those who are new providers and those who have been in practice for many years can help to better treat the 50% of their patients who are women.

However, as you've heard from my colleagues today, while we're making excellent progress, the goal of having all women with mental illness in Canada receive timely, effective mental health care has not quite yet been achieved.

I believe some great impact on a national level would be to invest in the following concrete, actionable priorities in women's mental health. First, I would recommend a mental health awareness campaign about women's mental health, to empower women to know what they can and should expect about their mental health and from their treatment. The second is to really champion the education and training opportunities in women's mental health, such as those that we, Dr. Van Lieshout's team and others have developed across the country. The third is to increase the targeted research opportunities to both improve the experience of care for women with mental illness today and to develop prevention and cures for the women of the future.

Given the large number of Canadian women affected by mental illness, even small gains in meeting the mental health needs of women across their lifespan have the potential to lead to a large positive impact on the health of all people in our communities.

Thank you.