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March 7, 2016 episode transcript

STORIES FROM THIS EPISODE

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Prologue

Host: Laura Lynch

SOUNDCLIP

We would like to move to our own house as soon as possible to learn the language and to start communicating with the Canadian society.

LAURA LYNCH: After years spent surviving the bombs and bullets of war then living in exile uncertain of their future, they are here. Syrian refugees have arrived in Canada, many with the same hopes, the same dreams; but some seem to thrive while others struggle. We’ll take a closer look at what helps and what hurts. As those we welcome here adjust to a new life. Also today…

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VOICE 1: Mr. Kirkland, you are out of order!

VOICE 2: You’re out of order! You’re out of order! The whole trial is out of order! They’re out of order! That man - -

LL: You have seen it in the courtroom dramas, the seemingly testosterone laced confrontations between a witness and an aggressive no holds barred lawyer. Well Al Pacino may be a little over the top, criminal defense work remains largely the realm of men in Canada. We seek to find out why women walk away from the practice. But before that, in our second half hour…

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The assumption is, well you're 80-something years old no wonder you're dizzy, no wonder you're forgetful. When in fact, it may not be because you're getting old, it may be because you're having a drug side effect.

LL: Are seniors, particularly those with dementia, taking too many drugs? There's a growing movement to cut down on the prescriptions written for the elderly. One seniors residence in Ontario has done just that with some surprising results. I'm Laura Lynch sitting in for Anna Maria Tremonti and this is The Current.

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Government-sponsored Syrian refugees face harder time adjusting to life

Guest: Catherine Rolfsen

[Music: Theme]

LAURA LYNCH: This week the federal government will reveal how many refugees Canada plans to accept by the end of the year. The Trudeau government has already welcomed more than 25,000 Syrian refugees and the outpouring of support has been well-documented. But teary airport arrivals and carefully crafted photo opportunities don't necessarily translate into happily-ever-afters for refugees. In many ways, the real work for Canada is just beginning, making sure the refugees do more than just survive in this country. CBC story producer Catherine Rolfsen has been covering stories of Syrian refugees for the past three months and she's found that not all refugees get started in Canada on an equal footing. And that those without private sponsors are having a much harder time settling in. Catherine Rolfsen joins me from Vancouver. Hello.

CATHERINE ROLFSEN: Good morning, Laura.

LL: So where are you taking us first?

CATHERINE ROLFSEN: We're in Abbotsford, a far flung suburb of Vancouver. I'm with a Syrian refugee family and some members of the group that's privately sponsoring them.

SOUNDCLIP

VOICE 1: Is there a place to lay her down?

VOICE 2: Yes.

CATHERINE ROLFSEN: Mohammad Almostafa, Heba Alzouabi and their 10-month old daughter Jana – who you can hear has fallen asleep in the car there - have been in Canada just over a month. And today, their sponsors are taking them for lunch at a friend's home.

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VOICE 1: The name is Fateh

VOICE 2: Is that chickpeas in there?

VOICE 1: Yes. Chickpeas.

VOICE 2: And what else?

VOICE 1: I made it with yogurt and garlic.

VOICE 2: Do you do your own yogurt?

LL: Okay that is making me hungry. Who are we hearing here?

CATHERINE ROLFSEN: That’s Goly Pourmokhtari; she's been helping as an interpreter for the sponsorship group. She's Iranian, and prepared a beautiful feast in honour of this new Syrian family. She made a blend of Persian and Syrian cooking, complete with home-made pita bread and falafel. And you're also hearing Lynn Gamache, one of the sponsors, doting over Heba.

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VOICE 1: I think she maybe needs a bigger coffee pot. Do you need a bigger coffee pot?

VOICE 2: Yes.

VOICE 1: Yeah. I think so.

LL: I’ve got to say that Lynn sounds like she cares so much about this family and she’s completely invested in them and I’ve seen that myself when I’ve done stories about refugees and the people who are sponsoring them. It’s incredibly inspiring, they do whatever it takes. So who’s involved with this group?

CATHERINE ROLFSEN: Well it’s a big group. Heba, Mohammad, and Jana are being sponsored by a group of about 25 people through the Abbotsford Interfaith Refugee Project. They have retired doctors onboard; Lynn is a former ESL teacher. They set up subcommittees to help with everything from finances, to paperwork, to literacy.

SOUNDCLIP

When they were still at our house, I had little signs I put around for sink, for stove, for curtains, whatever. So we actually already started at our house.

CATHERINE ROLFSEN: Lynn and her husband Ron hosted the family for its first few days in Canada – and they’re still trying their best to make them feel at home.

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VOICE 1: Have you had falafel in Canada yet?

VOICE 2: Yes, with Lynn and Ron.

VOICE 1: Pretty good?

VOICE 3: I thought it was good.

VOICE 2: Yes.

LL: That sounds like there the family is getting all the support it needs. Is that pretty typical?

CATHERINE ROLFSEN: Well, yes and no. Yes, there are scenes like this playing out across the country right now, of private sponsors really digging in to help new refugees.

LL: Okay. We’re talking about privately sponsored. How many refugees were privately sponsored?

CATHERINE ROLFSEN: More than 11,000 Syrians have arrived under the private sponsorship program - or under a blended system where sponsors share the financial responsibility for refugees with the government. But Laura that means the majority - around 15,000 - arrived as government-assisted refugees.

LL: And just to be clear, this is the 25,000 Syrian refugee program that the government promised in the campaign.

CATHERINE ROLFSEN: Right.

LL: And made good on. Now they’re saying they’re going to bring in thousands more government-assisted Syrian refugees by the end of this year.

CATHERINE ROLFSEN: That's right. And from what I've seen, government-assisted refugees are having a harder time than privately sponsored ones. Here's how Mohammad puts it, with some help from Bayan Ajjeh, my interpreter.

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From what I've heard with Government sponsorship, you have multiple families that are asking their needs from one person. Whereas with a private sponsor, you're one family asking from a group of people so you get a lot more help and support that way. We have become almost like a family. So we’ve become friends, we go over to each other's houses, we go for visits. They always invite us over for tea or for food and I assume that this will be a life-long relationship.

LL: Now I’ve seen that before too, that these do tend to become life-long relationships. The sponsorship groups get to choose which refugees they help. But that sometimes means randomly picking names off a government list so it must feel like a bit of luck for Mohammad and his family?

CATHERINE ROLFSEN: Yes. The remarkable thing about Mohammad's story is - because of a miscommunication - he didn't realize that his family was being privately sponsored until he arrived.

SOUNDCLIP

There were about eight people that were at the airport. They had a poster and it was written, “Welcome to Canada,” in Arabic and in English. It had my name, my wife's name, and Jana's name as well. It was a very happy experience. It was a very happy moment for us. It was a nice feeling that we were going to start a new future and there would already be people who were welcoming us.

CATHERINE ROLFSEN: We're back at Mohammad and Heba's apartment now, where several more sponsors have gathered. This is Sue Head.

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VOICE 1: We’re all just really excited. We didn’t know who they were or what they looked like. We knew there was a baby. I was told how to say welcome in Arabic, which I forgot, but we were told that women don't shake men's hands, women shake women’s hands. But the first thing I did was put out my hand to shake hands [laughing]. It’s cultural, but he’s become quite Canadian with that.

VOICE 2: They are forgiving when we make mistakes.

VOICE 1: And becoming more Canadian, which is good.

CATHERINE ROLFSEN: Everyone is sitting on the floor and on second-hand furniture. And baby Jana is stealing the show.

SOUNDCLIP

Patty-cake, patty-cake, baker’s man! We feel like they're our family and I think they feel like we're their grandparents almost. And because they left grandparents, I think this was important, even that we were older. And one funny thing, one night at supper the conversation changed. Mohammad said, do you like – we thought he said – do you like Queen Elizabeth? So we started saying, yes, we like Queen Elizabeth. He said, no, you look like Queen Elizabeth [laughter].

LL: I’m not quite sure how Lynn would’ve felt about a compliment like that. So that's a portrait of a private sponsorship though. Tell me how that situation compares with the government-assisted refugees?

CATHERINE ROLFSEN: To find out, we'll head across the city now. It's a typical March morning in East Vancouver, the crows are out, and the rain is falling.

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VOICE 1: Do you want me to open the umbrella?

VOICE 2: It’s not that bad, no.

CATHERINE ROLFSEN: I'm working with a new translator, her name is Reem Youssef. We're walking through the soggy grounds of an old motel. And not just any old motel, it's the place where so-called millennium bomber Ahmed Ressam assembled explosives almost 17 years ago. These days, it's become a temporary home though for government-assisted refugees from Syria who are waiting to find a permanent home.

LL: And that's a huge challenge, especially on the West Coast, where - as know - affordable housing has become an oxymoron.

CATHERINE ROLFSEN: You’re telling me. Right now the majority of Syrian government-assisted refugees in BC are still waiting to find permanent housing.

SOUNDCLIP

[Sound: Knock on door]

CATHERINE ROLFSEN: We're at the door of one of those families.

[speaking in alternate language]

CATHERINE ROLFSEN: Fayza Alsidawi guides us behind a curtain and into a dimly-lit living room.

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CATHERINE ROLFSEN: Is it possible to turn the TV off?

[speaking in alternate language]

CATHERINE ROLFSEN: Fayza, who's a widow, has five children between the ages of 15 and 26. Two of her daughters are sitting on the floor; their legs are draped across the green carpet. They have a nerve problem called Neurogenic atrophy - meaning they have little to no movement below their shoulders.

SOUNDCLIP

[speaking in alternate language]

TRANSLATOR: We have two problems. The first one is that the girls need a special bathroom, the shower area or the bathtub needs to be big enough to fit the girls so we can carry them to the bathroom. Most of the apartments that we’ve seen have a very tiny space for bathing. The second thing is that we need to be close to services, to supermarkets. Not to be far in the forest because it's very hard for us to move around.

LL: Now wait a second, there’s that phrase there, “Far in the forest.” Now as far as I know the government isn’t putting refugees in the wilderness.

CATHERINE ROLFSEN: No, no it was a strange expression.

LL: What did she mean by that?

CATHERINE ROLFSEN: Well I asked Reem later and she said Fayza was using an Arabic expression that lost a little bit in translation. But what she was getting at was isolation because Fayza's family, they’re from the city, so they're worried about being resettled in a remote area, especially when they can't afford a car to transport her daughters.

LL: To me, that’s completely understandable. How long have they been waiting to get a permanent home?

CATHERINE ROLFSEN: Her family’s been in Canada nearly six weeks, so that’s a little bit longer than Mohammad, Heba and Jana, but they're still waiting to get started.

SOUNDCLIP

[speaking in alternate language]

TRANSLATOR: We would like to move to our own house as soon as possible. And would like to move to our house to learn the language and start communicating with Canadian society.

CATHERINE ROLFSEN: That's Hatem, he’s the eldest son and he's really anxious to get established, so he can enroll in English courses and find a job.

SOUNDCLIP

[speaking in alternate language]

TRANSLATOR: I am the only one who will be able to have a job in my family. My sister and my mother will be staying home taking care of my other sisters, so yes we will need help.

LL: Clearly this family is facing challenges, it’s also presenting some challenges to the system but that’s not unusual is it? Government-assisted refugees tend to be the tougher cases.

CATHERINE ROLFSEN: That's right, they’re usually larger families, most have between five and eight people so that’s caught settlement service workers off-guard. And most privately sponsored refugee applications in comparison have between just one and four people.

LL: And then what about language skills?

CATHERINE ROLFSEN: Well about a quarter of government-assisted Syrian refugees say they know some French or English. Over half of privately sponsored refugees do. And government-assisted refugees tend to have less education than privately sponsored ones. One refugee advocate I spoke to says government-assisted refugees are basically just "dumped" in Canada. But personally, Laura, from what I've seen in my reporting, I think that's a bit of an overstatement.

LL: And I would tend to agree with you based on what I’ve seen in my work on the same sort of files and same stories. So they are getting some help from government-contracted agencies?

CATHERINE ROLFSEN: Definitely. Agencies are trying. Fayza is quick to acknowledge staff from the Immigrant Services Society of BC, or ISS, for their help in trying to find them a permanent home. But like Mohammad said, its many families looking to a few for help, rather than the other way around. And there's certainly nobody taking this family out for a homemade Persian-Syrian feast.

SOUNDCLIP

[Sound: Food being chopped]

CATHERINE ROLFSEN: Lunch is a large pot of instant noodle soup - Fayza added some donated meat and lentils. But she's not complaining.

SOUNDCLIP

TRANSLATOR: The food needs 10 more minutes and then it will be very tasteful. You’re a growing boy, you're a teenage boy; do you get enough to eat? Sometimes.

LL: Does the amount of help refugees get though actually matter? I would think it does, but do we know if it makes a difference down the road?

CATHERINE ROLFSEN: There are differences. According to the federal government, only about 14 per cent of government-assisted refugees find work during their first year in Canada. More than half of privately sponsored refugees do.

LL: As you already pointed out, government-assisted refugees are the tougher cases to begin with.

CATHERINE ROLFSEN: Right. So it's hard to say what exactly is behind those differing success rates. But I spoke to an immigrant employment worker and she was emphatic that the on-the-ground support system that privately sponsored refugees enjoy is a real important factor in their success.

LL: So now that we are expecting even more government-assisted refugees this seems to be key. Is there anything being done to build more of that on-the-ground support system for government-assisted refugees?

CATHERINE ROLFSEN: Yes and that help is beginning to materialize now. I met some government-assisted refugees a few weeks ago, they told me they were struggling with things like accessing emergency dental care, or signing up for federally-funded English courses. One of them, Laura, was so desperate that he was asking me for help. So I headed back to the same housing complex - it's one I've visited several times - where a number of Syrian families have found affordable housing. I'm back with my first interpreter, Bayan. Manel Okla isn't wearing her headscarf, but when she sees its just two women at the door, she welcomes us into her sparse but clean apartment.

SOUNDCLIP

VOICE 1: I was here a few weeks ago, the first day that you moved here.

VOICE 2: Yes.

VOICE 1: I want to see how you’re doing since arriving, and how you're feeling?

VOICE 2: I feel good. My family is happy and my children here, the life is very good for us here.

VOICE 1: Yeah?

VOICE 2: Yes.

VOICE 1: And your English is even better than before.

VOICE 2: Not very much. Just a little.

VOICE 1: And how about money, and finances? Do you feel that you have enough to be able to buy groceries, and to pay your rent here?

[speaking in alternate language]

TRANSLATOR: We’re trying to make it work.

LL: I can hear that strength in her voice. It sounds like Manel’s family is getting by.

CATHERINE ROLFSEN: Yes, and they say they are getting enough help. She feels that refugees in Canada have nothing to complain about.

SOUNDCLIP

[speaking in alternate language]

TRANSLATOR: I came here and I found a better life here and they have given us a lot. I thank the government for that.

LL: She seems positive. She’s also sounding like she doesn't want to come across as ungrateful. Do you think though that you’re getting the full story?

CATHERINE ROLFSEN: To a point. That’s a kind of thing that a lot of Syrian refugees have told me. They’re so grateful to Canada, they don’t want to complain. But government-assisted refugees still have challenges accessing dental care. There are really long waits for formal English lessons. And unlike Mohammad's family, Manel's family doesn't have a personal brigade of doctors and teachers helping them navigate the system. But, like I said, help is emerging. Volunteers with a Muslim food bank are now holding informal English classes for women in Manel’s building.

SOUNDCLIP

VOICE 1: Just a teacher in Vancouver; comes Saturday, Tuesday and Thursday. Three days a week.

CATHERINE ROLFSEN: And, Manel has been paired with a volunteer from the Immigrant Services Society.

SOUNDCLIP

VOICE 1: She’s come now.

VOICE 2: Today?

VOICE 1: Yes.

VOICE 2: Oh, what time?

[speaking in alternate language]

TRANSLATOR: About 3:30.

LL: Well that’s good to hear. Did you get a chance to meet her?

SOUNDCLIP

VOICE 1: Lucy, she's come. Sit.

CATHERINE ROLFSEN: Yes, Lucy De Pieri showed up right on time, and she brought with her a set of plastic measuring cups.

SOUNDCLIP

VOICE 1: She wants to make this, which is angel food.

CATHERINE ROLFSEN: Manel has a box of Betty Crocker instant cake mix.

SOUNDCLIP

VOICE 1: So today you want to learn how to make an angel food cake?

VOICE 2: I don't know how to make this. She helps me.

VOICE 1: Canadian cake.

VOICE 2: Yeah!

LL: Canadian cake from a box! So Lucy sounds great. Are there many volunteers like her?

CATHERINE ROLFSEN: She is one of thousands of volunteers that the Immigrant Services Society is training up right now and they’re sending out to help government-assisted Syrian refugee families.

SOUNDCLIP

CATHERINE ROLFSEN: Can I just ask you, Lucy, why you wanted to be a volunteer for Syrian refugees?

VOICE 1: I have seen over the news, so much tragedy, and I thought if I can help just one family, it will just make all this sadness, this trauma a little bit less. And when they get better, they will talk to their friends and they will have some hope and that just spreads.

CATHERINE ROLFSEN: Do you feel like these families that are in this building here are getting enough support and getting enough help?

VOICE 1: Maybe, I don’t know. I think that the structure that needs to be in place is not totally there.

LL: Again, Lucy just sounds like someone who cares so much and in this case it sounds as though the structure is starting to fall into place.

CATHERINE ROLFSEN: And that’s the hope for other government-assisted refugees; it’s what everybody wants. For Manel, she just seems happy to have Lucy to share an afternoon with, learning to bake something new in her new home.

SOUNDCLIP

CATHERINE ROLFSEN: Well I'll let you get back to your cake. Thanks for talking to me.

VOICE 1: Yeah, I think this is awesome!

LL: And did you get any of the cake?

CATHERINE ROLFSEN: I didn’t get a chance. Left it for them.

LL: Well, Catherine, you did so much great work on this, so interesting to hear the differences between the two groups. Thank you.

CATHERINE ROLFSEN: Thank you, Laura.

LL: And that was Catherine Rolfsen from CBC Vancouver. Go to www.cbc.ca/thecurrent and you can see some photos of the people she spoke with. Now, we requested an interview with John McCallum, the Minister of Immigration, Refugees and Citizenship, but he was unavailable. Across the country, 60 per cent of government-assisted refugees are now living in permanent housing. In BC, less than half have moved on from temporary accommodation. If you’ve got any stories about refugees settling in your community, let us know. Tweet us @thecurrentcbc or me @lauralynchcbc. Visit us on Facebook, or email from our site, again that's www.cbc.ca/thecurrent.

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Canadian seniors dangerously over-medicated, advocates call for change

Guests: Heather Brown, Barb Farrell, Sharon Jackson

LAURA LYNCH: Hello, I’m Laura Lynch sitting in for Anna Maria Tremonti and you’re listening to The Current.

[Music: Theme]

SOUNDCLIP

MIKE GIOVANIAZZO: He was off in a room by himself and kind of comatose, couldn't see his hand in front of his face, no recognition of anybody around anything like that, huge difference. Now, he's more, you know, interactive and talkative and the whole bit. Previously, you couldn't even communicate with him. There was no, you know, trying to get a word out of him was difficult.

LL: That's Mike Giovaniazzo, whose 79-year old father Vincent has dementia and lives in a Kitchener, Ontario nursing home. Like many seniors in care, Vincent was routinely taking anti-psychotics, drugs commonly used in nursing homes to help residents keep calm. But, critics say they're often overused. Anti-psychotic drugs are just part of a larger problem of over-prescription for seniors. According to a recent study, 42 percent of the seniors in homes in one Newfoundland jurisdiction are taking medication they don't need. And other research has shown the problem exists across the country. In a few minutes we'll hear from health care advocates who are calling for over- prescription in Canada to be cut down, cut in half. But first, let's start in Newfoundland and Labrador where the Central Regional Health Authority has the highest rate of anti-psychotic overuse in the province. Heather Brown is a Vice President at the organization and is leading the push to change that. We’ve reached her in Grand Falls-Windsor, Newfoundland and Labrador. Hello.

HEATHER BROWN: Hello, Laura.

LL: Let's just start off with the basics first. Can you tell us what does it mean to say seniors are being over-prescribed?

HEATHER BROWN: Anti-psychotic medications were created to treat conditions of psychoses. In our long term care homes, 55 percent of our residents do have dementia, and that is not a psychosis. Unfortunately, people with dementia do have behavioral and psychological symptoms that are sometimes difficult to understand and manage. In the past, we certainly had an over-use of medications to treat those behavioral, psychological symptoms. In the past, there has been a lack of knowledge and oftentimes for families, as well as staff providing care, there has been frustration in wanting to help the individual with dementia when they exhibit symptoms of dementia and help them to be more calm and have an improved quality of life. However, we haven't been as aware of other non-pharmacological interventions.

LL: Who is prescribing the anti-psychotic medications to seniors who don't actually need them?

HEATHER BROWN: In the community, they can certainly be prescribed anti-psychotic medications to help with behavioral and psychological symptoms. As well, we also find that oftentimes people are admitted to acute care and while they're waiting, they are prescribed anti- psychotic medications in acute care because they're in an environment whereby being able to care for them safely and manage any behavioral psychological symptoms, is very difficult and it becomes, unfortunately, the first choice. Sometimes the ability to provide other things to do, good assessments, it may be very difficult and we also know that one of the most important pieces of treating individuals with dementia is understanding that individual, understanding their individual needs, and meetings those needs, and that takes a lot of work and a lot of commitment. It also--

LL: So, that suggests that they don't have the time or they don't want to make the time to do the proper assessment.

HEATHER BROWN: I think there is a willingness and a desire to make the time, but it involves a multi-pronged technique and it certainly involves a team being able to look at other alternatives. We just need to prioritize and we need to increase the awareness.

LL: Tell me how anti-psychotic drugs affect seniors if they're taking them unnecessarily.

HEATHER BROWN: Well, we do know that the use of anti-psychotics have several risks, can lead to excessive sedation, a dizziness, a non-steadiness, some cardiovascular problems, a restlessness, reduced wellbeing and social withdrawal, particularly as these medications can often cause a person to be less alert. Some of the other impacts that can result as well, are increased fractures for example, as the person finds it more difficult to ambulate. So certainly, we also have noted exhilarated cognitive decline. We do know that there are many risks and it is very, very important to change this.

LL: And you have started doing that. You've started a pilot project to decrease the use of unnecessary anti-psychotic drugs in your nursing homes. Tell us briefly what you're doing.

HEATHER BROWN: In that particular project, we aim to see a 15 percent reduction in the use of anti-psychotic medications in the cohort that was selected. We did physician education, family education and staff, and those were all very, very important to create the awareness to talk about the risks and to introduce some of the tools and techniques and to train. So, we've introduced the gentle, persuasive approach which is really how to appropriately work with and interact with our residents with dementia. And we created more of an individually based, resident based technique whereby each individual resident, in collaboration with their families, are assessed and we really want to learn more about that individual and understand what their past has been like what, their interests have been and--

LL: Heather, I have to say that, everything that you're doing, it sounds so much like just taking more time, being more patient, and being more caring with people. It seems to come down to that.

HEATHER BROWN: I think that there's a big piece of that, you're absolutely right. Yes, care needs to be individual, it needs to be loving as you said, good communication and being respectful. And then, from an individual perspective, we did create intervention kits for each of our individuals in our call ward, things in those kits that would help them when they exhibited behavioral and psychological symptoms of dementia. Some of the things that would help them create a sense of calm and increase their quality of life. For example, a lady who had lived at home and was a homemaker, she may have enjoyed doing housework, that sort of thing, there may be things in her kit, or even just a staff member giving her some laundry to fold. That would be something that would be familiar that she would have always done. Some people have been musical so certainly being aware and making sure that the type of music that they like for example, is available for them. You know, a carpenter may have some different sorts of small tools and that sort of thing, or gadgets and things that they would have used in their trade that would have certainly been a part of their past.

LL: You talked about the importance of education. I'm wondering, through that education, what were some of the biggest misconceptions that you think you've been able to tackle?

HEATHER BROWN: Understanding that the behaviors are symptoms, they are not the person, and the importance again of understanding that individual.

LL: I thank you so much for telling us about it and good luck with the challenges of it as you move forward. Goodbye.

HEATHER BROWN: Goodbye, Laura. Thank you.

LL: Heather Brown is Vice President of Rural Health at the Central Regional Health Authority in Grand Falls-Windsor, Newfoundland and Labrador. Now, my next guest is part of a group of medical workers and advocates who want the number of prescriptions used by Canadian seniors cut in half by 2020. Barb Farrell is a scientist with the Bruyere Research Institute and a pharmacist in geriatric day hospital at Bruyere Continuing Care in Ottawa. Hello.

BARB FARRELL: Hello, thanks for having me.

LL: You were just listening in to Heather Brown. What's your reaction to what she had to say?

BARB FARRELL: My reaction is that everything they're doing sounds like very good care and like they've really made it a priority to individualize care for their patients and to try to reduce these anti-psychotics, which resulted in the kind of thing that your previous guest said in terms of his father becoming more able to interact and to move around and talk with people.

LL: I wonder if you can give us a sense of the scope of this issue across the country. How big is the over-prescription problem?

BARB FARRELL: Well, we know from data that CIHI has produced for us—

LL: CIHI?

BARB FARRELL: The Canadian Institute for Health Information. Their data shows that about two-thirds of people over the age of 65 take more than five medications. About 39 percent of those over 85 take more than ten medications, which is quite a bit, and about 60 percent of patients in long term care are taking ten or more different drug classes.

LL: Wow. That is a lot. I know you're reluctant to place blame, but how do how do these patients end up on such long lists of drugs?

BARB FARRELL: Well, I think it's a complex issue. I think over the last several decades, we've become as a society, very used to expecting prescriptions for our ailments. It is generally difficult for clinicians to stop medications that other clinicians have started. For example, if a specialist or hospital starts medication, the family doctor may be reluctant to stop it. There is not always good, clear information about the purpose of each medication and how long the patient should keep taking it provided to people. Sometimes it's hard to know when the intention was to have stopped medication and it's also difficult to identify symptoms as side effects of medication, so sometimes a new medication will become started to treat the symptom of another medication, or the side effect of another medication, and we call that a prescribing cascade. Gradually, over time, people acquire more and more drugs and as they get older they develop more chronic conditions so more medications get started and guidelines are very good at telling us when to start drugs but they're not very good about telling us when to stop drugs.

LL: I understand you have firsthand experience with this. When did you first realize it was a problem?

BARB FARRELL: I've been working in our geriatric day hospital for 17 years now, and it was very clear to me early on that many of the patients who are coming to us with falls and cognitive impairment, were taking many, many medications. I see people taking 15,20,25 medications, and we found that over time, if we reduced the doses of their medications, or even stopped a few of them, those that were most likely causing falls and confusion, that they would actually stop falling and become less confused. That, coupled with an intra-professional team approach and using non-pharmacologic approaches to reduce the reliance on medication, seemed to really help people improve in terms of their quality of life.

LL: Some say that these anti-psychotics are being used to make it easier for nursing homes to manage seniors, particularly those who may have some aggressive behaviors. What do you say about that?

BARB FARRELL: Certainly some of them are very effective at managing aggression and agitation, and that can be a very difficult situation for people to manage. And so, they are often started for that reason. I think there's been more attention in recent years to periodically try to stop the medications once the behaviors are under control, or to minimize doses. And, we're seeing decreases in different areas around the country that have initiated programs like Heather was describing earlier.

LL: So, when is it appropriate to have a senior on an anti-psychotic or a host of medications?

BARB FARRELL: Well, just in terms of the anti- psychotic issue, it may be appropriate if they have a condition like schizophrenia, or another type of condition that has psychotic symptoms, or if they are having a delirium or aggressive behavior that puts themselves or other people at risk. Certainly that's considered appropriate and it's considered for the latter group, appropriate to reduce the doses and stop the medication. Something that I wanted to mention, is that we're starting to see an increased use of anti-psychotic medications used as sleeping pills, and where we're seeing that more commonly in the community, not necessarily on long term care. And so, that's a concern as well because they haven't necessarily been shown to be good for insomnia, but they do cause sedation. People may feel like they may be sleeping better but there's concern of course with the same kinds of side effects that we see in the long term care patients.

LL: What kind of reactions do you get when you tell the staff who work in nursing homes, or hospitals, or even families, that you want to reduce the seniors’ dependence on drugs?

BARB FARRELL: A very positive reaction. We've just completed a study here in Ottawa. We developed, in my research group, a de-prescribing guideline to help clinicians make decisions about when and how to stop an anti-psychotic medication and I have to say that the how part is often the challenging piece. When people are stopping medications, they're not sure how quickly they can stop a drug or what to monitor as they're stopping the drug. And, we found in our study, which in three long-term care homes here in Ottawa, was that each home found patients that were suitable for using the de-prescribing guideline and they were able to stop the medications. There are a number of projects going on around the province and in the country to reduce the use of anti- psychotics so, people in long term care are very aware that this is an issue and they're making an effort.

LL: Just briefly then, is 2020 a realistic goal for you to cut it in half, by 2020?

BARB FARRELL: I think it is a realistic goal, certainly one we're working towards. I want to clarify though, we're not [coughs], excuse me [pause]

LL: Take your time. You have a little cough there.[laughs]

BARB FARRELL: We're not looking at reducing all medication use by half. We're looking at reducing the potentially inappropriate medication. These are the ones that are causing, or have the potential to cause more harm than benefit. And, I think that's important and also important for listeners to understand that this is not something where you go out and just stop taking your medication. It's really a team approach that you would work with your health care provider to have a conversation and a medication review or to look at what might be able to be reduced and then to do that in a supervised manner. There are some drugs that even when you're stopping them, can have some withdrawal effects so you would have to do that with doctor supervision.

LL: Barb, I'm going to stop you there, we want to get our next guest. Thank you very much. Barb Farrell is a scientist with the Bruyere Research Institute and a pharmacist in the geriatric day hospital at Bruyere Continuing Care in Ottawa. Now, Vincent Giovaniazzo, whose son we heard from earlier, isn't the only resident at the Trinity Village Care Centre who is now off anti-psychotic drugs. The long-term care facility in Kitchener, Ontario has been trying to use other means to deal with patient behavior problems. Things like art, music, and bingo.

SOUNDCLIP

[Italian singing in the background]

VOICE 1: We can put the music on first thing morning because we know that the music is going to make them happy. And that just trickles down to getting up and starting the day off better, than being agitated, you know instead of seeing her quite withdrawn before, you know now it just brings her forward and makes her shine.

VOICE 2: How are you today?

VOICE 3: Okay.

VOICE 2: Why don’t we go downstairs and have a coffee in the cafeteria?

VOICE 3: Yeah.

VOICE 2: Okay. He's spent a lot of time in bed, refusing to get out of bed, and his family was very happy when he started coming out of his room more and interacting a little bit with some of the other residents and the family.

VOICE 4: She has 21, Irene, do you have 21 under I?

VOICE 1: She couldn't stay for the duration of the program often because she'd want to go home, she was afraid of how she would get home, where her room was, that we forget her.

VOICE 4: Do you find that you're more relaxed, Irene and that you're feeling better?

VOICE 5: Yeah, I feel better.

VOICE 4: Close to Bingo. What kind of programs do you like, Irene?

VOICE 5: I like drawing.

VOICE 4: You like drawing.

VOICE 5: I got some good marks.

VOICE 4: You got some good marks?

VOICE 5: Yeah.

LL: Sharon Jackson is the Behaviour Supports lead at Trinity Village Care Centre and we've reached her in Ayr, Ontario. Hello.

SHARON JACKSON: Hello.

LL: Art, music, and Bingo. There we heard it all, that sounds like fun. What happens in the programs?

SHARON JACKSON: Well, basically the residents are brought in for programs and they're given choices of what programs they want to be part of and once they're in programs, they're given choices of what they want to do and that sort of thing. So, it's really all about—it is really resident-centred, and what they want to do and what makes them happy and helps to fulfill them.

LL: But what does it provide for them from a treatment perspective, then?

SHARON JACKSON: Well, from a treatment perspective, when you're looking at the alternatives, where in the past often they were on medication to help keep them calm and that sort of thing, to reduce anxiety, to reduce behavioral and psychological symptoms of dementia. Now, they're engaging more in these programs and we're able to use these programs more as on a therapeutic level to keep them engaged and keep them happy and that sort of thing so that they're producing less of these behavioral symptoms.

LL: So, these activities are just part of it, though. This is much broader. What's the bigger change you brought in in terms of your approach to residents?

SHARON JACKSON: Well, we have done a lot of training. We, through our behaviour support team, we have spent a huge amount of time one-on-one with staff, in groups with staff, just teaching them how to approach a resident. What is their best chance at decreasing the potential of triggering some of the behaviors that you see often in dementia. They're helping the staff to understand that these residents, their brains are failing and they're not doing any of these behaviors on purpose, it's just how their brain processes the world around them. So, we've spent lots of time basically educating all of our staff on how the brain works and how to decrease the chances of triggering these behaviors.

LL: I'm interested in this virtual dementia tour that you've given to your staff. Tell me about that.

SHARON JACKSON: Last year we started another program in conjunction with the anti-psychotic program. And, basically we found that we really wanted to increase our staff’s empathy for our residents, and really help them to understand what a resident with dementia goes through on a day-to-day basis. So, we basically put them through a virtual dementia tour. We put chickpeas in their shoes to give them a little bit of the pain that our residents go through on a day-to-day basis, just with aging bones and muscles and that sort of thing. We put goggles on their eyes, smeared with Vaseline so that their vision was limited. They wore iPods that played ringing noises and different noises to distract them. We put gloves on their fingers, on their hands with rice in the fingertips.

LL: Those are really vivid ways to bring it home. Did it help alleviate any resistance staff may have had to doing this, to do the de-prescribing?

SHARON JACKSON: Absolutely. Some of the reactions that I got from staff, and we put about 160 staff through this process, and some of the reactions that I got from staff were quite extreme. We had some staff finishing this process in tears, saying they had no idea that it could be as bad as it was. And, we really saw change in many of the staff and their patience with the residents. I mean, there's nothing like really understanding what someone is going through and putting yourself in someone's shoes—

LL: [chuckles] Literally.

SHARON JACKSON: Yes, just for a little while, and we explained to them as well, that they're dealing with this with a healthy brain. Taking away all their senses and everything, they have a healthy brain and to have someone whose brain is a deteriorating and processing the world around them very differently—

LL: So, tell me about the results. What have they been like?

SHARON JACKSON: Well, we started off before we started the project, with anti-psychotic usage rates and inappropriate use of anti-psychotics was at 33 percent. That was almost two years ago now, and now for the last six months, we've been hovering between 11 and 13 percent.

LL: That is a big, big drop. A lot of Canadians are looking after relatives with dementia, it isn't just something that professional caregivers are dealing with. I wonder what advice you would have for those who are dealing with difficult behaviors without using drugs.

SHARON JACKSON: It’s really about patience and understanding for that resident, understanding that whatever they're doing, they're not doing it on purpose. Their brains are failing and they're processing the world around them very differently. And, we really just have to take our time and have patience with them and allow them the opportunity to make the choices that we all have the opportunity to make on a day-to- day basis.

LL: And what about that fear though that they will become aggressive?

SHARON JACKSON: That is always a possibility, but if you follow the approach, the respect and approaching them in a very respectful way and announcing yourself before you come to them explaining to them exactly what you're going to be doing and allowing them the time to process. Then your chances of triggering those aggressive behaviors diminish greatly.

LL: It will be interesting to see how this carries forward across the country. Sharon, thank you very much for talking to us.

SHARON JACKSON: Thank you.

LL: Sharon Jackson is the Behaviour Supports lead at the Trinity Village Care Centre. She was in Ayr, Ontario. We want to hear from you, now. Are you concerned with the number of prescription drugs you or your elderly family members are taking? Let us know. Tweet us @thecurrentcbc or me @lauralynchcbc. Find us on Facebook, post the story or e-mail us by clicking on the contact link at www.cbc.ca/thecurrent.

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Women leaving criminal defence law due to discrimination, new report says

Guests: Breese Davies, Jessyca Greenwood, Jordon Furlong

LAURA LYNCH: Hello. I’m Laura Lynch sitting in for Anna Maria Tremonti and you're listening to The Current. Well, criminal lawyers play a crucial role in the justice system, but the Criminal Lawyers Association is releasing a report today that suggests women are leaving the practice at a higher rate than men. The trend has been persistent. A study in Ontario in 2008 reported the profession was losing some of its best and brightest as women left in, quote, “droves.” This new research wanted to get a better understanding of why that was and what could be done to reverse the trend. It found problems ranging from paid to parental leave to outright sexism. To fill us in further, I'm joined first by Breese Davies. She is the Vice President of the Criminal Lawyers Association of Canada, and joins us from Bracebridge, Ontario. Hello.

BREESE DAVIES: Hi, Laura.

LL: When we talk about women leaving criminal law what kind of numbers are we talking about?

BREESE DAVIES: Well, we followed, or the study followed two cohorts. One of women called in 1996 who were doing criminal law when they started and we found that by 2014, 72 percent of the women who started practice in 1996 doing criminal law had left. And then just by sheer coincidence, the other cohort that was studied was my year of call and there were 50 women in my year of call that started in criminal practice and of those only 22 of us are left.

LL: Well, those are big numbers. How does that compare with other fields of law?

BREESE DAVIES: I'm not sure we have good statistics on that. We know that women are leaving all areas of practice more than men, but this is obviously a huge number, you know, ranging from 72 percent to 56 in my year.

LL: Okay. This study was aimed at trying to find out some of the reasons. What did you learn about that? For example, there are financial challenges.

BREESE DAVIES: Yeah, I think we've really identified three key areas that are causing women to leave criminal defence practice in particular. One is the inability to sustain a practice when you're largely dependent on legal aid. Most defence lawyers rely on legal aid. There is chronic underfunding of the legal aid system. There’s also major structural and policy problems with the way that legal aid pays criminal lawyers in particular. One of the biggest challenges is that criminal lawyers are only paid a fraction of the time that they reasonably have to work on files. The other problem is that we know that the number of certificates for criminal work is down. And we also know that—

LL: Certificates for criminal work?

BREESE DAVIES: Number of legal aid certificates for criminal work is down over time and the amount of money that legal aid is allocating to criminal certificates has gone down despite increases in the overall legal aid budget. So there are financial problems and an inability to have a secure financial future is a big factor of why women leave. The other two factors that I think are really important from this study is the inadequate support for women who are going to leave practice for a period of time to have a family or care for a family and want to come back. The inadequacy of those supports was identified as a reason. And then the third one is the differential treatment of women within the justice system. And when you put all of those together and women ask themselves whether it's worth it to stay, sadly, a lot of them are saying it's not worth it.

LL: Let's just break it down a little bit more. You talked about what happens when somebody wants to go on parental leave. How does support for women in criminal defence practice differ from other lawyers or even other professional women?

BREESE DAVIES: Well, obviously, if we compare ourselves as criminal defence lawyers to Crown attorneys, the difference is stark because criminal Crown attorneys are government employees and they have the benefit of a year-long maternity leave with top ups. They also have the security of their job being there when they come back and files and work being there when they come back. There are obviously challenges in the Crown system, I don't want to say that it's perfect, but there's much, much, much more security in terms of your income, your job security, and your work security. Compare that to defence lawyers, we’re running businesses, small practices by ourselves largely or in association with one or two others. We actually have to shut the door when we go on leave. There isn't a system in place where, you know, our files are necessarily going to be looked after, our work is going to be there when we come back, even our office may not be there when we come back, so you're faced with the prospect of having to restart your business when you decide to take a leave.

LL: And the third factor- The report is calling it sexism. What kind of sexist behaviour are lawyers reporting?

BREESE DAVIES: Well, in this study there’s examples of women being mistaken for students and interpreters and assistants. So it seems that there isn't a presumption that when a woman walks into a court room she's a lawyer, which is a problem. We also have examples where women aren't treated with the same level of respect. They aren't given the same level of deference as their male colleagues. I've certainly experienced that over my career with judges and Crown attorneys and defence lawyers quite frankly.

LL: And have you have you pointed out when you've experienced it?

BREESE DAVIES: Sometimes. I sometimes feel that I'm able to do that, but in some circumstances I don't feel like I'm able to do that. You know, if I'm before a judge that I know I'm going to be before again, it's not easy to stand up and say look I think you're treating me differently because I'm a woman. And, you know, it takes a lot of confidence to know or to think that that's what it's about and to not second guess that you're not good enough or your male colleague must of done something better or, you know, it's a very insidious part of the culture and it's hard to address.

LL: And again, for you, the other the other factors we spoke about, in terms of parental leave or working conditions, have you experienced those as well?

BREESE DAVIES: Sure. I mean, the financial insecurity of defence practice is a real, real challenge. You know, not knowing whether or not you're going to be able to make a living doing this is a real challenge. And I don't have children so I haven't gone through that sort of additional burden, but absolutely the combination of the financial insecurity, the differential treatment, I have certainly questioned whether I should stay or not. I've stayed because I love it. But I stayed despite the challenges.

LL: Okay. You do love it. I'm wondering why this matters to the rest of us. What are the consequences of women leaving criminal defence law?

BREESE DAVIES: Sure. This is an issue about diversity. And I think we are at a point in time where we all understand that diversity is important to get the best result in whatever field we are in. Judges in Canada, in large part, make the law and interpret the law. So diversity of perspective in the decision making process in the legal system means that our laws will reflect a broad perspective of society. And that's really important to ensure that we have confidence in the decisions that get made and we have confidence in the administration of justice. Because remember that the women who are lawyers today or the people who are lawyers today are the people who will be judges five or ten or 15 years in the future and if we're losing diversity at the front end, we're going to lose diversity when it comes to the decision makers in years to come. And it also matters – let me just add - because people lose the ability to have a diversity of lawyers to choose from. You know, there are clients you want to be represented by a woman who think their interests will be better protected. And it's a big loss to the women who have invested years of their lives, in terms of education, and the profession who have invested in these women gaining expertise and they're leaving at the peak of their career.

LL: All right. I'm speaking with Breese Davies, Vice President of the Criminal Lawyers Association of Canada. I want you to stay with us, Breese. I’d like to bring Jessyca Greenwood into the conversation. She's also a criminal defence lawyer and she's with me in our Toronto studio. Hi.

JESSYCA GREENWOOD: Hi, good morning.

LL: How much of what Breese is saying resonates for you?

JESSYCA GREENWOOD: It resonates with me a lot. I totally agree with what Breese is saying and I've experienced a number of these issues myself.

LL: Tell me about what stands out for you when you hear about these things.

JESSYCA GREENWOOD: What one of the things that stands out for me was the decision to have a family and practicing criminal law as a sole practitioner. And not only the time constraints of how you would balance that, but the logistics about being a sole practitioner and what would happen to your practice while you were gone.

LL: So, what happened to you?

JESSYCA GREENWOOD: I was able to plan ahead and was able to give away a number of my files, but that meant there was less financial security for me. And I certainly did feel that I had to rebuild twice.

LL: Because you’ve had two children.

JESSYCA GREENWOOD: That's correct.

LL: Yeah, so you had to come back from maternity leave and start building up your practice again?

JESSYCA GREENWOOD: That's right. And it wasn't just those issues, those logistical issues. But I also felt that senior lawyers and male lawyers sort of took an attitudinal shift and they felt that I would now be distracted with mom duty and not as interested in my criminal law practice, which just wasn't true. And I noticed that senior lawyers stopped referring as much work to me and they sort of asked me questions about what was going on at home and not about what was going on in my cases.

LL: Do you know whether your experience is different from anyone else who is running their own business or who is self-employed?

JESSYCA GREENWOOD: Well, the difference between being a criminal lawyer who's a sole practitioner and just having any entrepreneurial business is that in criminal law you are the product, so you can't just hire someone else and delegate the work to them. Our relationship with our clients is a very intense one. It’s one where they want you. They want to know that you are fighting for them and they aren’t going to settle for anyone else filling in.

LL: Do you do you think it would have made a difference - you're practicing on your own - if you had actually been a part of a firm? Would it have been a more supportive environment?

JESSYCA GREENWOOD: I think it can be a more supportive environment if the culture in that firm is supportive of women.

LL: So, why are you practicing on your own?

JESSYCA GREENWOOD: Well, in criminal law we tend to be lone wolves who are out there practicing as the underdogs who are fighting for our clients. But, practically speaking, the nature of criminal law, there are a lot of conflicts that arise and so you tend to practice more on your own to avoid conflicts. And I think that the other, one of the other factors is that it's the type of business where you can be entrepreneurial and set up your own shop and be successful. And for me that was one of the draws.

LL: How long have you been practicing now?

JESSYCA GREENWOOD: I'll be seven years completed in June. So I was called in 2009.

LL: So, have you ever considered leaving the practice?

JESSYCA GREENWOOD: There was a period of time after I had my daughter where I considered leaving the practice of law. I toyed with the idea of going to the Crown's office. And I spent a little bit of time working in the Crown's office on a per diem basis. And certainly the security, the financial security and the support of having colleagues who were also in the same boat was very appealing to me because I did feel, after I had my daughter, that it was hard to come back and rebuild that practice.

LL: But you stayed.

JESSYCA GREENWOOD: I did stay.

LL: Why?

JESSYCA GREENWOOD: I love the work. I'm absolutely passionate about what I do. I specialize in representing people with mental health issues. I feel it's such an important area to advocate for clients and not just impose our views on them, but actually give them a voice in the system when they're being marginalized and I just can't think of a better job.

LL: So can you see yourself still in this kind of practice in five, ten, 20 years?

JESSYCA GREENWOOD: I'm committed to it. I'm not going anywhere.

LL: So what would your advice be then for young women who are starting out in criminal defence or women who are like you, who might be considering leaving?

JESSYCA GREENWOOD: I think that women need to support each other. It can start there, but it also starts as a culture shift within the profession. Lawyers, judges, Crowns can do better to support each other and if we did have that culture shift I believe that all women would feel more welcome in the profession, especially when they're going to take a parental leave. One example I can give you is that a lot of women are responsible for childcare - dropping their child off at the daycare. Are the wheels of justice going to grind to a halt if we start court at 10:00 instead of 9:30? They're not. And so that's one way that women can be both the caregiver and the lawyer.

LL: And I've got to ask you what I also asked Breese, which is, have you had personal experience of sexism in the courtroom?

JESSYCA GREENWOOD: I have. And it's not just in the courtroom. It's also outside of the courtroom.

LL: Give me some examples.

JESSYCA GREENWOOD: Well, I went for drinks with some male lawyers a few years ago and we're all sitting around at the table and one of their friends came to join and asked whose wife I was. So that's outside of the courtroom, but inside the courtroom we see judges not wanting to take breaks or wanting to sit late. And sometimes when you're pregnant as I have been - I worked until the very last day that I could - it was very uncomfortable. And it's hard to raise that because you don't want to be seen in the courtroom as the weakest link when you're supposed to be the advocate for your client.

LL: Just very briefly, when it came to your maternity leave, how much time did you actually take?

JESSYCA GREENWOOD: I took twelve weeks both times.

LL: That's a short mat leave.

JESSYCA GREENWOOD: That would be considered quite short.

LL: Because? Why did you keep it so short?

JESSYCA GREENWOOD: I had a practice to maintain. I didn't want to lose my clients and that was the extent of the parental leave program that's offered by the Law Society.

LL: Okay, Jessyca Greenwood, I want to bring in one more guest. Jordan Furlong is a principal at Edge International where he works as an advisor to major law firms and legal organizations on how they can change their behaviour and he is in Ottawa. Hello.

JORDAN FURLONG: Hello, Laura. Good morning.

LL: Good morning. How much concern over these issues do you see from the people who are leaders in legal organizations in criminal law or other areas of the law?

JORDAN FURLONG: In fairness, we actually are seeing a growing amount of concern. When you look at organizations such as the law societies, the Canadian Bar Association, certainly the CLA, I think, deserves great credit for pioneering this report.

LL: Okay, the C—

JORDAN FURLONG: Sorry, the Criminal Lawyers Association.

LL: Right.

JORDAN FURLONG: I think you're really starting to see leaders take this more seriously than perhaps they would have maybe 15, 20 years ago. And I think it's, I mean it's to their credit that we were seeing this kind of progress, but obviously, as Breese and Jessyca have made clear, there's a long way to go.

LL: Well, then, so how do firms try to address the issue?

JORDAN FURLONG: A lot of firms will make efforts to say, what is it we can do in order to develop more leaders amongst women in our in our firms? Because a lot of the problem is that in a lot of law firms’ compensation and promotion and leadership roles develop from and are based largely on the number of hours that you bill and the amount of business you bring in. And both of these criteria, of course, will require investing massive amounts of time and effort in the firm. And the firm is usually quite clear to lawyers - you know, you need to put the firm before everything else. And as the report has pointed out, women are still more likely to be the primary caregivers and administrators of their household, so women lawyers in many cases simply don't have the same hours to give to the law firms that men do.

LL: So what changes do you think need to happen?

JORDAN FURLONG: I think what has to happen is a couple of things. First of all, firms have to take it seriously at a strategic level. They have to understand the tremendous - inefficiencies isn’t even the right word. It's the loss of so much potential. If you look at Moneyball, one of my favourite books, Michael Lewis's book, and he talks about market inefficiencies that smart organizations can exploit. And when you look at the law, the extraordinary market inefficiency in law is a failure of this profession to fully appreciate and utilize women lawyers to the same extent that they utilize men lawyers. It's a huge inefficiency.

LL: But do you have concrete suggestions for what could change?

JORDAN FURLONG: The first thing I think that has to change is law firms need to take a serious look at the means by which they produce their work, deliver their work, and value their work. And that may seem a little odd, but the problem is when in law firms you make the decision to say, we are going to base our pricing and our compensation and everything we do around the issuance of labour, the time you spend. Not only is that deeply unfair and structurally, culturally inimical to encouraging women in your firms, it's also not good for clients. It's also not really all that good for lawyers. So I think we're going to have to see, and we will see it in in very short order, is the entire business model for law firms is going to develop differently. The model we have today developed in a very different profession that we have now.

LL: Are there any examples of places that are doing that job right, that are managing to keep women in practice?

JORDAN FURLONG: It is difficult for large law firms to really make an impact here. I am seeing some firms, both in the US and here in Canada, that are taking it seriously and pushing forward. Not to single out any one firm, because it implies that others aren't doing it, but I know McCarthy Tétrault, for instance, has been really paying close attention to this for quite some time.

LL: And that is one of the biggest firms in the country.

JORDAN FURLONG: That's correct. And again when I talk to the leaders affirms they do recognize it's an issue. It is something which is being taken seriously, but the amount of cultural inertia within law firms is extraordinary and the larger the firm, the more inertia that there is. The other difference, I think, Laura, that we're going to see is generational change. The Boomer generation, I think, really had a tremendous impact on the way law firms are structured, the way the culture around compensation and pricing developed. And that generation, for better or for worse, slowly is moving out of law firms and the Millennial generation - we hear so much about it and all the talk of flexibility in family time and so forth - they're starting to move in and we are going to see a culture shift take place within law firms over the next ten or 15 years as a result of that.

LL: It will be interesting to see if that does happen. As you said, this problem has been around for a very long time. Breese Davies, I want to bring you back in. What do you think of these kinds of ideas that Jordan Furlong is talking about?

BREESE DAVIES: Well, I think it's important-- I mean, obviously I think all of those initiatives are great and important, but it is important to remember that the experience of women in defence practice is profoundly different than the experience of women in large firms where there are challenges for sure, I'm not trying to minimize those, but there’s a structure in place there's more job security. There's much more financial security if you're working for a big firm. You know, there are supports for people going on leave. That is vastly different than the experience of women as sole practitioners in defence practice where they're trying to navigate all of these barriers and problems really on their own. And so while I applaud all of the efforts that are being made by law societies and big firms, those aren't the same problems that we're having and so we need to make sure that-- And that's why we commissioned our own study so that women defence lawyers don't get lost in the bigger conversation about women in private practice because--

LL: So what are the main changes you want to see?

BREESE DAVIES: So, really, I think there are four main recommendations that come out of this report. There are others, but there are four main ones. One is more sustainable funding to the legal aid certificate system for criminal matters. And we, the Criminal Lawyers Association, we're going to work very hard and we hope that the government and legal aid will work with us to make the changes that need to be made to ensure that the funding structures and funding policies aren't driving women out of the profession.

LL: So, that you get paid more and paid more efficiently?

BREESE DAVIES: Paid more quickly, paid more for, paid for the work that we do, and get paid reasonably for the work that is required on files. So that's one big change. The second is mentoring, which I’ve talked about already. And mentoring for women the Criminal Lawyers Association has already created a mentorship program for women, well, for all our young lawyers. So, we are certainly doing our share to improve on that issue and we have a mentorship program that we’ve started, but that needs to be a bigger initiative as well with legal aid in the Law Society. The third recommendation that we will be working hard on is making changes to the parental leave assistance program that Jessyca talked about. There are real limitations to that program that make it so that many women who would want to take advantage of it don't even qualify. And there are real imitations on what you have to promise not to do in order to get the funding. So we’ll work with the Law Society. Hopefully, they'll work with us on that. And then the last big area is education for judges and lawyers - defence lawyers aren't excluded from that - to reduce and eliminate the differential treatment of women in the practice.

LL: Jessyca, what do you think needs to change?

JESSYCA GREENWOOD: I agree with all of that and one of the other recommendations that I think is key is a better use of technology to decrease the bureaucracy that we see in the practice of law. There are a number of ways that we could use technology for set date type appearances or administrative appearances that could reduce the burden on women and all the lawyers to make it easier for access to justice for our clients.

LL: What Jordan said about the Millennials coming up, changing the system - do you agree with that?

JESSYCA GREENWOOD: I do agree that there has to be a shift, that within the profession people have to start to take this caregiver role seriously. It's something that affects all primary caregivers, whether you're a same-sex couple or you're caring for an elderly parent, and I think that the younger generation will hopefully start to value that caregiver role. And if that happens, I think it would be a positive change.

LL: Okay. We’ve just got a couple of minutes left. As we said before, these aren't new issues. I'm wondering how much resistance you see coming down the road. I gather there's been resistance in the past. Do you see much resistance coming to changing the system for women criminal defence lawyers? Jordan, do you want to start with you?

JORDAN FURLONG: You know, I do think that we've seen a lot of resistance historically. I do also believe though that resistance is going to start fading away. I'm an optimist in this regard. But you see so many changes in so many other areas of society – industry, markets, business. Law has been a laggard in a lot of these areas for a long time. I think that's changing and I think this is just one of the areas in which it will change.

LL: Breese?

BREESE DAVIES: Well, what I'm hopeful about is that, if you read the study, we had a lot of cooperation from both the Law Society and legal aid in terms of giving us information that led to many of the findings that are in the report. So I'm hopeful that they will read the study, recognize the importance of it, and continue to work with us. We, the Criminal Lawyers Association, can't make these changes alone. We do need the support and we need others to sort of roll up their sleeves and do the work, including the government legal aid and the Law Society. So, we're hopeful that their participation in the process so far will encourage them to buy into the recommendations and make the changes with us that need to be made.

LL: And, Jessyca, based on your experience, what do you think?

JESSYCA GREENWOOD: I think that's the most important thing is we're here now having a dialogue about these issues and I think that that's the fundamental starting point and that if we can bring all the players to the table and get some change from the top down, that's what needs to happen.

LL: Just wondering, finally, for you, Breese. I asked this of Jessyca and she maintains her love for the criminal defence system will keep her in the game for years to come. What about you?

BREESE DAVIES: I don't envision myself going anywhere. I love my job. It's a very difficult job. There are lots of challenges, but I can't imagine doing anything else.

LL: All right. Thanks to all three of you. Bye bye.

BREESE DAVIES: Thanks, Laura.

JORDAN FURLONG: Thanks, Laura.

JESSYCA GREENWOOD: Thank you.

LL: Breese Davies is Vice President of the Criminal Lawyers Association. She's also the founder of Breese Davies Law. She was in Bracebridge, Ontario. Jessyca Greenwood is a criminal defence lawyer and runs her own firm, Greenwood Defence Law. She is in Toronto. And Jordan Furlong is a partner at Edge International and he was in Ottawa. Well, that is our program for today. This week Anna Maria Tremonti is in Newfoundland talking to people about its changing economy and how it's changing their lives. She’ll bring you those stories on Wednesday and Thursday when she hosts two editions of The Current from St John's. Now, earlier in the show we heard about the struggles of government-assisted Syrian refugees and we thought we'd end with a small update from one of the very first refugees to come to Canada on a government chartered plane, though he was privately sponsored. Today's Last Word goes to how to Ghattas Kaskas, a Syrian who is now living in Montreal. I'm Laura Lynch sitting in for Anna Maria Tremonti. Thank you for listening to The Current.

SOUNDCLIP

You know, I can't compare my country and Canada because there’s different cultures between here in Canada and Syria, my country. But, you know, everything is different here. I like Canada. An new life, you’re going to get to this a new life. You know, step by step everything is going to be okay. But, you know, I’m working for one more month. I really have a great time with a friend and I get to live a safe life, you know. Look, what I see in this country, that they like Syrian people. I want to thank all the people, Canadians, because they’ve taken this huge number of Syrian refugees. And, yeah, I just want to thank everybody that Syrians feel happy and smile and they say good chances, they start to say it’s a good country. And they support me. So, yeah, I want to thank every part of the government who supports these people.

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Mar. 7, 2016 Episode Transcript

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