Health committee  I'm trying to think of how we can have healthy babies with unhealthy mothers. I'm not really seeing how that can be. I think we need mentally healthy mothers to have healthy babies. This hasn't really come up today, but I think it's worth nothing that if you look at the data on unpaid domestic labour in Canada and who is doing this unpaid labour, it is still largely women.

Health committee  I have not developed online interventions.

Health committee  What I could say is that, maybe in large measure as a consequence of COVID, I think there's been a realization that we can broaden access to mental health treatment by having Internet-based e-health interventions. This is particularly important for people who live in rural and remote communities, who historically would have to travel long distances to access specialized care.

Health committee  Yes, I do think that it would be helpful to have increased representation within health care for women's health, absolutely.

Health committee  I will let Liisa respond to this portion of the question.

Health committee  Outside of reproduction, if you look at the data on treatments for anxiety and anxiety-related disorders, the strongest evidence is for cognitive behaviour therapy. Additionally, if we're talking about trauma-related cognitive behaviour therapy or therapies of that ilk, as well as mindfulness-based approaches, access is very limited.

Health committee  One of the reasons I started research in this area is because I feel very passionately about access to the highest level of health care. It is a very peculiar situation we're in, whereby the treatment of choice and the treatment that has the strongest evidence of effectiveness is generally not available.

Health committee  I think dedicated research looking at that would be incredibly helpful.

Health committee  I think it is absolutely the case that we're looking at 20% or more pregnant and postpartum people suffering from one or more mental health conditions during pregnancy and postpartum. A first step in care is adequate screening. For depression, we have great screening. For anxiety disorders, we have yet to identify appropriate tools.

Health committee  My research lab is trying to move in that direction. As I think some of your colleagues in this room will really appreciate, as a white person, treading into that sphere is a little more complicated and requires a lot of collaboration with indigenous scholars. One of our next moves is to try to get some data on that.

Health committee  I'll give it a try. I wish that I were more of an expert in this area. What I can say on this is that the trauma that a mother experiences when losing her child has heavy implications for the child. This is not just an either-or question. That mother-infant is a duo, and in some ways they exist as a unit, so what happens for the mother has implications for the child.

Health committee  A number of different investigators have looked at this—Jonathan Abramowitz, in particular, and then me. I focus specifically on harm thoughts. I have two publications on this. The first was about 100 people, and the second was about 400 people. The first time it was 49% who reported unwanted intrusive thoughts of hurting their babies on purpose.

Health committee  It is very upsetting for some people. Some people are able to cope with those thoughts, but for a lot of people, that is very distressing. What we know is that obsessive-compulsive disorder, which is the mental health condition most likely to arise as a result of these kinds of thoughts, may impact as many as 17% of postpartum people.

Health committee  No. It's not non-existent, but it is far from common. Many health care practitioners, unfortunately, know very little about these thoughts, and they are either not mentioned or not responded to, as if all thoughts of hurting one's baby on purpose are harbingers of child abuse, which is not the case.

Health committee  You're absolutely right. Major depression and postpartum psychosis are probably the two mental health conditions that have received the most media attention, the most research, etc. They are the two conditions that people know the most about. Postpartum depression, as a major depressive disorder, affects approximately 6% of new moms, versus anxiety disorders, which affect 21%.