Evidence of meeting #34 for Indigenous and Northern Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was communities.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Sony Perron  Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
Lynne Groulx  Executive Director, Native Women's Association of Canada
Amy Nahwegahbow  Senior Manager, Partner for Engagement and Knowledge Exchange, Native Women's Association of Canada

3:35 p.m.

Liberal

The Chair Liberal Andy Fillmore

Good afternoon, everyone. Welcome to the House of Commons Standing Committee on Indigenous and Northern Affairs. Today we are continuing our study of suicide in indigenous communities.

In the first hour of the committee meeting, we will have with us the Minister of Health, who is going to be speaking with us both on her mandate letter and on the suicide study itself, on those two purposes. Joining her today from the Department of Health are Sony Perron and Simon Kennedy. This appearance will be for the first hour of the committee meeting.

Minister Philpott, you probably have seen these yellow and red card devices before. I'm happy to give you the floor for 10 minutes. At nine minutes, I'll show you a yellow card, and at 10 minutes a red one. Please feel free to share the time in any way you see fit.

There is a second panel with NWAC in the second hour, and we'll have a brief recess between.

Without any further discussion, I'm happy to give you the floor. Thank you.

3:35 p.m.

Markham—Stouffville Ontario

Liberal

Jane Philpott LiberalMinister of Health

Thank you very much, and good afternoon to all of you.

I am happy to be here with you.

I thank the chair and the members for the invitation to spend some time with you this afternoon, and I want to thank my officials who have joined me here today.

The importance of the work you're doing in this committee for Canadians can't be overestimated. I want to thank you in particular for undertaking this very serious study, and I very much look forward to hearing the results of all of the hard work you've been doing over these past weeks.

I'll start my comments in relation to the fact that you have been undertaking a study on suicide in indigenous communities. I think it would be fitting for me to express first my recognition of and my condolences to the families and the communities who have been most seriously affected by this issue and who have lost family members, friends, and community members to suicide. They need to be at the forefront of our minds as we have these conversations. I am sure—

3:35 p.m.

Liberal

The Chair Liberal Andy Fillmore

I beg your pardon, Minister. The bells are now ringing, so I need to ask committee members for unanimous consent to proceed for a few more minutes.

We have a 30-minute bell, so we can at least get through your presentation if we have unanimous consent for that.

3:35 p.m.

Some hon. members

Agreed.

3:35 p.m.

Liberal

The Chair Liberal Andy Fillmore

I'm sorry for the interruption. Please proceed.

November 16th, 2016 / 3:35 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Thank you.

As I was saying, I want to express my condolences to the families and let it be known that, like it is for you, these are the people who are on our minds as we have this conversation. We've all been heartbroken, I think, by the tragedies that we've heard about across the country in so many communities.

I see the high rates of suicide in indigenous communities affecting youth in particular, I think, but it's not entirely the youth who are affected. It's a public health crisis and, therefore, a very important part of my mandate. I join you in the search for an appropriate response, knowing that no single person has all of the answers and that we must work together on something like this.

A number of issues of social inequity form the basis of the challenges I face in my portfolio in Health, but I think that when we look at social inequity in health and in mental health, the stark realities are nowhere more obvious than in the inequities that exist between indigenous and non-indigenous people.

When we look at the matter of suicide in first nations youth, I don't think I need to remind the members here of, for example, the rates of suicide among first nations young people, whether on-reserve or off-reserve, and among their non-first nations counterparts. I brought with me a lot of statistics, but I think you've probably heard a lot of them before. I think that statistics sometimes confuse us and sometimes even take us away from the fact that every single statistic represents a person, a person who is a loved one, a family member, and a community member.

Really, I wanted to focus on the fact that these disparities, the gaps in health outcomes, and the tragic statistics we read about have their roots in long-standing social inequity, and we can point to the causes. I'm not sure if we can say that we can find all of the causes, but I'm sure you've heard what many of them are. Some of them are historical. Many are ongoing. The roots of this crisis lie in colonialism, racism, assimilation, residential schools, intergenerational trauma, poverty, and so many other issues. The ongoing causes behind a crisis include things such as the bullying that exists among young people, issues of low self-esteem, overcrowded housing, unemployment, and lack of recreational activities. These are some of the reasons, which I'm sure you've heard about at this committee, as to why young people turn to self-harm and sometimes suicide.

The traumatic impact of losing cultural practices, losing the roots of communities, and losing languages, and the disruption of family structures and of social support networks, all affect the health and well-being of those communities, and we find that one of the most serious results is the high rate of suicide.

I know that you've heard many moving stories. I've heard many of them myself. I think about this summer, when I spent time in Alberta visiting Treaty 6, 7, and 8, and in one of those communities, I met a bright young man. He was talking about his battle with addiction and the fact that earlier in his life he had attempted suicide nine times. He became addicted to fentanyl. Getting treatment was very difficult for this young man, but eventually, with the assistance of a clinic that was supported by his band, he got the treatment he needed. He's now on Suboxone therapy and is slowly decreasing his dosage of Suboxone. He's on a path to healing. He said to me that he was becoming a better father and a better person, that he wants people to know that there's a way out, and that he wants them to know they can overcome this.

I am convinced that governments have an essential role in the strategies that we need to collectively gather to give hope and to give life to the ambitions of a young man like him. Change is only going to happen, though, when we work in partnership. Of course, that partnership has to include indigenous leaders. It has to include every level of government and, of course, many sectors of society far beyond the health sector.

My mandate includes making sure that I work with indigenous leaders. That includes the National Chief of the Assembly of First Nations, Perry Bellegarde. It includes the president of the ITK, Natan Obed. It includes working with chiefs and councils. Of course, I need to work with my provincial and territorial counterparts and multiple stakeholders to address health gaps that exist between indigenous peoples and other Canadians.

I believe that at its root this requires us to renew relationships in Canada and to ensure that relationships with indigenous peoples are based on a recognition of rights and on respect and co-operation. The healing process that I suspect you are finding your way toward as you have these conversations involves implementing the calls to action of the Truth and Reconciliation Commission.

What can government do? Much of what we are already doing is itself centred on righting some of those past wrongs and on addressing the long-standing challenges that have left this legacy of despair amongst young people. For example, we are supporting an annual assessment and support for the national aboriginal youth suicide prevention strategy. This is a strategy that helps to reduce risk factors through a focus on prevention, outreach, education, and crisis response.

We also have worked to support the national native alcohol and drug abuse program, another community-based program that includes residential in-patient treatment facilities.

We're supporting mental health counselling services through the non-insured health benefits program, through multi-disciplinary mental wellness teams that are driven and designed by communities. We're supporting the Indian residential schools resolution health support program, which has been successful in providing support through some of the residential schools discussions. It helps both former students and their families.

We're investing in research into mental health promotion and suicide prevention. Some of that is done through the Canadian Institutes of Health Research. It includes things such as the pathways to health equity for aboriginal peoples initiative and the Arctic Council initiative.

But we need to have new federal measures as well. As I have learned more about the challenges communities face, I've been deeply troubled by them. Communities face challenges in securing some of their basic necessities such as housing, water, and access to good education. Thus, as with all other parts of health, mental health needs go far beyond the provision of health care. It involves looking at both the causes and the consequences, which have deep roots and devastating effects on families and communities.

All levels of government, and, I believe, all departments of government, have a responsibility to look at the social determinants of health.

Have I already reached the yellow card? My gosh.

3:45 p.m.

Liberal

The Chair Liberal Andy Fillmore

Yes, I'm sorry to say.

3:45 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

I think a lot of the things that I want to say are going to come out in the discussion. I think the biggest focus that I want to share off the very top is that I come here very happy to share what our department is doing, and I am very pleased to be able to work with my colleagues at the first nations and Inuit health branch, as well as the Public Health Agency of Canada. However, I come here saying that I don't have all the answers, and I look forward to learning, working with you, and, where possible, responding to all the good suggestions that I know will come out of this committee.

I very much look forward to responding to the questions you have this afternoon.

3:45 p.m.

Liberal

The Chair Liberal Andy Fillmore

Thank you very much for your remarks, Minister Philpott.

I'm going to divert the conversation for a moment in terms of managing the vote. According to my math, the vote will be at 4:07. I expect that most members will be happy to stay in the room until 10 minutes prior to that. Can I just see if that's comfortable for people? We'll have a recess at 3:57, in 10 minutes. With walking back and forth, the vote will probably take, about 15 minutes, and we can be back here by 4:15 to continue.

Is it the committee's pleasure to maintain our 5:30 end time, therefore, shortening the time of one of the panels, either the minister's or NWAC's? There is an alternative. I would draw your attention to one of our routine motions, which is around flexibility of end-of-meeting times when there are circumstances out of the committee's control, which is the situation we're in today. The alternative is that we could simply stay beyond 5:30 for the number of minutes that we will lose for the vote, which I expect would be about 15 minutes.

Let me phrase it as a question. Are committee members willing to stay until 5:45 today to get through all our witnesses in their fair amount of time? I think I see assent there. Fantastic. We have a plan.

We'll have 10 minutes with you now before we go, please, and then we'll come back and continue with you. We'll go right into the first round of questions, starting with seven minutes for Mike Bossio.

3:45 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Thank you, Chair.

Thank you so much, Minister, for being here today. We greatly appreciate your input and feedback on this important study.

We recently came back from a trip in which we went to Vancouver's Eastside, visited a friendship centre and UNYA, the youth association across the road, and then went on to Sioux Lookout and visited a hospital and the indigenous health authority.

Everywhere we went, resources were the number one issue that so many are dealing with, especially at the indigenous health authority up in Sioux Lookout, where their building was fairly packed. They were in tight quarters. It was a smaller facility and an older facility.

We were in a brand new hospital up there, a spectacular hospital, which seemed to be providing very good services, but most of the people there were non-indigenous workers. The indigenous health authority is all indigenous workers, and they were in a facility that is not nearly as nice, and like I said, very.... You could tell that there was a lot of frustration and a lot of potential burnout amongst the workers there. This seemed to be a common thread: that they're burning out very quickly, and in some instances, a year or two into the job.

Has your department looked at the numbers that we need to hire and train to properly support places like Sioux Lookout and Vancouver's Eastside, both for counsellors and as health assistants in nursing in these remote communities?

3:50 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Thank you very much for the question.

In fact, you've actually raised a whole series of issues there. It doesn't surprise me. As I think you've been discovering, you've come up with a list of some of the real challenges.

At the very beginning, you alluded to the programs themselves that are often under-resourced. I think that's one of the realities they're facing, and I'm not here to deny that many programs in indigenous communities are under-resourced. That's something that I'm certainly working very hard to address: the fact that in many areas there has not been appropriate support for programming. It's something I'm working on with the department to make sure that we respond to it.

You talked a bit about the facilities themselves, not just the programming, but what I call the “health infrastructure”, which requires that facilities are available. You may recall that in budget 2016, for example, we were able to get investments of $270 million to help with health facilities for first nations. That was fantastic, but it was actually only a drop in the bucket in terms of what the need is. One of the areas that's been severely under-resourced over a number of years is having the facilities available, but I think the bulk of your question actually related to human resources, which is certainly part of the whole picture.

The programs are not what they ought to be and the facilities are often in need of repair or in need of being built in the first place, but it is the human resources where I think we see some of the serious gaps, both in terms of having adequate people available and in terms of training. If people are there to work, often they feel overwhelmed and exhausted by the very difficult work environment they're in.

I will tell you that every single one of those areas has come to my attention repeatedly and that we are working on them. I've had the opportunity to speak across the country at a number of meetings that involve health care providers and people who work both to educate health care providers and in health facilities. I raise the issue of indigenous health, and particularly human resources for indigenous health, at every single opportunity that I can. That's the kind of thing that we're not going to fix overnight.

You asked a about the data a bit in terms of how big those gaps are. Like it is many other parts of my mandate, we don't have the kind of good data that we should have. We know for certain that whether you're talking about physicians, nurses, or other health care providers, there are challenges in terms of the absolute numbers of human resources that exist in these facilities and often also in terms of people who are not particularly trained in providing care to indigenous communities. Very often, the people who are providing care are not indigenous, which doesn't necessarily mean that they are not able to provide care, but it is sometimes part of the challenge.

Those are all things that I'm certainly working on. I've been very impressed with the work of the Canadian Indigenous Nurses Association and the Indigenous Physicians Association. I've been impressed with the work of the College of Family Physicians of Canada and other organizations that are working hard to find ways to prioritize getting indigenous young people into educational programs so that they will seek careers, and then we need to find the ability to make sure they get to the places where they're needed.

I hope that adequately answers your question.

3:50 p.m.

Liberal

The Chair Liberal Andy Fillmore

You have one minute remaining.

3:50 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

What we've very clearly discovered in a lot of our witness statements all the way along is the absolute need for long-term and stable funding for a lot of these programs. Yes, it's about getting the necessary data to determine the size of the problem we're dealing with, especially from a human resources and infrastructure standpoint, but also, one of the biggest problems that we've seen through the witness statements is that this really needs to be community driven.

Do you see that? Is that how you're directing your department as well, which is to focus on community-driven projects that have the type of funding necessary in order to bring them forward?

3:55 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

I'm very glad you brought that up, because I think it's absolutely essential that any solutions being discussed are community driven. Again, I really want to attest to the fact that people are working very hard in these communities. I know that the folks in the first nations and Inuit health branch work very closely alongside community leadership to ensure that the programs are in fact designed by communities and respond to the needs of communities. I think we have to underline the fact that they have to be community driven.

3:55 p.m.

Liberal

The Chair Liberal Andy Fillmore

Thanks for the question and the response. I said we'd go until 3:57. It's just about 3:56 now. I think rather than getting into a new question, we'll suspend now.

Before we suspend, I invite the panellists to come back as promptly as possible after the vote, and I extend the same invitation to the committee members.

Thanks to the members from NWAC for their patience and understanding. We'll suspend and see you soon.

3:55 p.m.

Liberal

The Chair Liberal Andy Fillmore

We're coming back from our suspension. It looks like the number of minutes we're going to add to the end of the meeting is around 27, so we'll go until three minutes to six.

3:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

I have a 5:45 that I can't miss.

3:55 p.m.

Liberal

The Chair Liberal Andy Fillmore

Well, we'll have to stop the proceedings for you, Mike. I'm kidding, of course.

3:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

No, I—

3:55 p.m.

Liberal

The Chair Liberal Andy Fillmore

We'll go right back to the questions, with the next questions from Cathy McLeod, please.

3:55 p.m.

Conservative

Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC

Thank you, Chair.

Thank you, Minister, for joining us today.

I also appreciate the leadership that you're going to be taking later this week in terms of the opioid crisis. In British Columbia especially, it's absolutely a critical area that we have to deal with.

My first question is in terms of the fentanyl deaths. Do you have any sense of how many deaths are through injection versus inhalation versus ingestion? What percentage of the deaths relate to the different mechanisms of delivery?

3:55 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Thank you for the question, and thank you for the raising this matter, because it is an important one. I am looking forward to our meetings on Friday and Saturday of this week, where we will discuss this.

The point you've raised brings up one of the real challenges on the opioid crisis, which is that there is actually not the kind of data and surveillance we would like to have, even in terms of the total overall number of overdoses and overdose deaths. Increasingly, a number of agencies are doing better at that. There's actually a report that came out today from the Canadian Institute for Health Information, which gave some new information, but one of the things we will be talking about is how we can get the appropriate agencies together to get that information.

In terms of types of overdoses, whether they're through injection, inhalation, or ingestion, we don't actually have really good data on that. I think that's the short answer.

3:55 p.m.

Conservative

Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC

Thank you, Minister.

My next comment or question is that you talked about someone you met during the summer whose life turned around with treatment. Certainly, my experience is that treatment is not available or is very expensive, so really in terms of our indigenous people who are having challenges, this person was lucky that they had a band member who would support them in treatment.

Would you agree—just a yes or no—that there is a lack of opportunity for people who are looking to deal with their addiction? It's not easily available. Would that be accurate?

3:55 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

I think it would be accurate to say that there is a shortage of treatment facilities and programs.

3:55 p.m.

Conservative

Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC

My next area of focus is that the health minister in British Columbia has indicated that it's important that you repeal the legislation we have around communities and the establishment of injection sites.

Again, these questions are going to be for a bunch of yes's or noes, because suddenly the communities are seeing safe injection sites as the cure for these horrific deaths. To be quite frank, with the data I've seen, or the anecdotal experiences on ingestion, I don't necessarily see that people will be going to safe injection sites from a wedding to ingest their drugs, so I don't believe the safe injection sites are going to be a panacea for solving this issue.

I have a quick question. Do you believe—just a yes or no—that a letter from the provincial minister should be part of an application? Again, I'm going to run through a number of these. Should a letter be part of an application?