Health Committee on Feb. 11th, 2014

[Carol Hopkins]

The impacts of colonization through reserve systems, loss of income, a change of economy, residential schools, and the child welfare system have perpetuated over generations. It has left significant mental health issues amongst first nations people.

Now you have generations of whole communities that don't understand the impacts of the Indian Act, they don't understand the creation of reserve systems, and they don't understand residential schools. With the Truth and Reconciliation Commission of Canada, first nations people are just now talking about their experiences in residential school systems. We've had four generations of people and families, whole communities, who have never talked about their residential school experience, whether it's physical abuse, sexual abuse, loss of family, loss of their language, loss of connection to their culture. So they are marginalized in mainstream society and they are also marginalized in their own community.

They don't have an understanding of the context, so they take on and they internalize that oppression and have a negative perception of themselves as first nations people. They believe that the issues they are facing are simply because they're native.

There is nothing in our education system that talks about colonization, until perhaps you're lucky enough to go to post-secondary education and you're in a first-nation-specific program. It's the first time you're learning about colonization or residential schools or the scoop of the 1960s. In programs, whether they are on reserve or they have been primarily through the national native alcohol and drug abuse program, that context is given. But it's given also with the teachings from first nations culture so that our own truth, which is connected to our stories of creation that talk about the strength of who we are as a people, is used to replace the negative images.

It's a transition of belief about self from this negative image, so that you have some context to our evidence that is held within our creation stories that says the Creator made us to be these whole, healthy people. So I can now replace one image for another and have a sense of hope that I can create a different future for myself, that I don't have to be all of the issues that you might see in a community.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Mr. Wilks, please, you have five minutes.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thanks, Mr. Chair.

I thank the witnesses for being here today.

You talked about elders in the first nation communities, which brings me back to a story from 1984 that I need to allude to. I was stationed with the RCMP in New Aiyansh. At the time, a constable by the name of Alex Angus was in Greenville. I went down to Greenville one day to talk to Alex and went into the detachment there. Inside one of the cabinets was a big bag of dope. I asked Alex where he got it. He said that he took it from a young fellow. I asked him what he did and if he had charged the young fellow. He said, “No, we went for a walk”. I said, “A walk?” He said, “Yes, a three-day walk”. I said, “A three-day walk? And...?” He said, “He won't do it again.”

This brings up the fact that in our society, in our white society, we don't recognize the value of elders and the opportunities that bring us forward. I want you to talk a little about the importance in your culture of healing circles and of sweat lodges, from the perspective of how we can use that to—“influence” is a bad word, but I'm going to use that word—influence the youth to understand where the elders have come from, from the past, and how they can learn from it.

[Peter Dinsdale]

Maybe I'll start.

I think the first thing we need to acknowledge is how diverse all the nations are, so I think it's their own cultural traditions that are most important. It's the raising of.... To decolonize or to bring back our culture to the youth will raise their self-esteem, and they will be proud of their culture and become traditional dancers and have different roles in their communities. I know that in the Ahousaht and communities like that there is certainly a hereditary chief system, which is a great way for them to get young people back in and engaged and to have leadership positions. It does so many things.

The nations are so diverse. It's important that we don't try to go to Ahousaht and bring them a sweat lodge, because they don't sweat. It's similar across the country. That shows the importance of going out and really engaging with that local community and of bringing elders together to ask them what the best approach is, to ask them how to constitute it. It may seem weird that they hold a community meeting or a forum, or that they go and do the ceremony somewhere, or that they ground it spiritually before they go out and do something else, but it's a process we have to do to respect our laws and our traditions and how we move forward as well.

[Carol Hopkins]

The youth solvent addiction program, as I said earlier, has shown promising results with youth who participate in culture, and recently we have become involved in a CIHR-funded research project that looks at culture as an intervention.

We do have various cultures across the country. There are 11 different language families. Within those language families, we have a number of different nations. All of those nations have their specific ways of practising. It's tied to their language, it's tied to their land, and it's tied to the nation of people that they are.

However, through this cultures intervention research project, we've talked to elders and cultural practitioners from coast to coast, and we've been able to identify at least 22 different descriptions of common ways in which culture is practised. We are looking at those 22 different ways of intervening, supporting, and promoting wellness through culture to develop a broader understanding.

In the youth solvent addiction program, I used to be the director of a youth treatment centre. In Canada, for youth who go into residential treatment, at best at least 50% of them will complete. In the program I ran, there was 100% completion. These were kids who had high rates of suicide ideation, had been involved in the justice system, had issues of sexual abuse, had been in treatment at least three previous times, and had high rates of substance use, including prescription drugs. They completed treatment, and 86% of them maintained their wellness post-treatment at three-, six-, and twelve-month follow-ups, because of the cultural interventions they participated in while in treatment.

Treatment and the introduction to culture can't ever replace what they're encouraged to go home and find in their own nation, but it certainly is an introduction. The introduction to culture, based on strengths, gives them a new perspective, and there are many different cultures. Like I said, there are 22 different ways in which culture has played a role in supporting wellness.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you. That was very interesting.

Moving to the next round, we have Ms. Davies. She may share her time with a colleague, but it's five minutes.

[Libby Davies, NDP, Vancouver East, BC]

I'll try to ask a question briefly.

First of all, with regard to the Royal Commission on Aboriginal Peoples from 1996 or 1997, one recommendation that always stood out in my mind was the one that said there should be 10,000 first nations health care providers trained to be part of local community health and wellness. I've often wondered, how far did we get? Did we even get up to 500? I don't know. That's just a little bit of history that I remember.

I want to come back to the issue of pain management. It seems to me there's a very fine balance here. On the one hand, we're dealing with prescription misuse. But if we come down too hard, rigidly taking away drugs, or don't make them accessible to people, or don't believe people, actually, when they are in pain....

This is a huge issue for people with addictions. People don't believe them when they say they're in pain. It's like, “Oh, you just want to get drugs.” So if we come down too hard, we're actually not creating a better situation, we're making it worse.

How do we create that balance? That's one of the things I think we have to struggle with. To me, part of the answer might be, and I'm interested in your opinion here, where those decisions are made. I mean, you could say there's some big national decision to take away this drug, or take away that drug, but the more local we make it in terms of that individual and what they need, are we not then striking a better balance?

Pain management is a real issue. If you take it away from people, then yes, they'll turn to illegal means. What else do they have? People are suffering.

I just wondered if you could respond to that. How do we approach this question of the right balance between not being too rigid and not having a system that's so open that, yes, it can be abused easily?

[Peter Dinsdale]

I certainly agree with your suggestion that the more local, the better. I think for the people in the community, partnerships with community health nurses and with the community members themselves are likely the best approach from a first nations perspective.

The closer we can get to that model, where it's not just “take your pills and go” but a matter of ongoing maintenance, conversation, and observation, frankly, in the community, the better off we'll be.

[Carol Hopkins]

Better prescriber education; cultural competency; standards for prescribers that will lead to better prevention, better monitoring systems, and better screening; brief interventions tools specific to first nations people so that there's better understanding around the differences between psychological pain and physical pain; and better access to opiate replacement therapy will certainly make a difference as well.

[Libby Davies, NDP, Vancouver East, BC]

Thank you.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I'd like to end with a brief question. Both of you spoke briefly about the holistic approach. In Canada we are used to a different medical approach. Could you add anything that you haven't spoken about on the holistic approach that Health Canada should help you facilitate?

[Carol Hopkins]

The example I can give—it's currently being researched for its impact—is from northern Ontario, where first nation communities purchased Suboxone because it was easier to manage and also provided land-based treatment. Out on the land, returning to culture, working with elders, such culture-specific interventions as sweat lodge ceremonies, the use of natural medicines for withdrawal management—those are all examples of that holistic approach. It attends to the individual within their family and their whole community, their connection to their land, their connection to their identity, their connection to culture, and it manages as well the physical symptoms with withdrawal.

That has also been followed up with reintegration back into the community by helping those individuals find meaningful roles within the family and the community so that they're contributing. There might not be enough economy to support employment, but if they can find ways to volunteer and contribute back to communities, they've found some success.

[The Chair, Conservative, Ben Lobb]

That was perfect, five minutes right on the dot.

Mr. Lizon, you have five minutes.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Mr. Chair.

Thank you, witnesses, for coming here this morning.

On this prescription drug abuse, we've been conducting this study for several months. We've heard from doctors and law enforcement officers, and now, thank you for coming.

It is a problem. I don't think it's a problem that's occurring only in Canada.

However, the first question I have is very specific to prescription drug abuse. In your presentation, you gave us a wide scope on substance abuse and other problems related to it, but can you tell this committee if there are any initiatives within first nation communities to monitor prescription drug use? That's not abuse, necessarily, because at some point if a person has a medical condition that needs certain medication—whether it's something natural that the community knows about or, in this case, opioids—it has to be prescribed by the doctor. Of course, the danger is that the person may get addicted to the medication.

Can you elaborate on this? What is your approach? Is there anything the communities are doing to prevent addiction to opioids that are needed to treat medical conditions?

[Carol Hopkins]

The non-insured health benefits data program collects information about the types of drugs that are being prescribed to members of a first nation community, and that's shared. Non-identifying information about the types of drugs that are prescribed to members of the community is shared with the communities themselves.

In the Atlantic region, some communities have worked with pharmacies and physicians to limit the number of prescription pills in the community at any one time. They've partnered on the way medication is shared. For example, changing from a prescription bottle to a blister pack helps them to monitor the number of prescription drugs in the community.

Again, partnering with provincial health authorities, so that opiate replacement therapy is delivered within the community in partnership with the first nations health programs and services, has been beneficial in terms of the community getting a better grasp on the level of prescription drugs available in a community at any one time.

Those initiatives have demonstrated a reduction in crime in the community, in that people are no longer into the addiction behaviours and the criminal activity to obtain the prescription drugs, because they have the availability of opiate replacement therapy.

[Peter Dinsdale]

The only other thing I'd add is that of course while first nations sometimes get information on an “after” basis, I think the ability of first nations to have better access to and control of the program from the outset is also a critical factor to look at. Again, I'd point to the B.C. health transfer that is taking place as having a great potential to do just that.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Is there anything that the communities are doing on the education side, especially for young people, to inform them about the potential dangers of drug use, drug abuse, and substance abuse?

[Carol Hopkins]

Yes. There was a program, the drug utilization prevention project, and it invested in Atlantic Canada, Ontario, and Alberta. Those programs were geared to, once again, a coordinated approach, with coordination and collaboration between first nation communities and provincial health authorities. A variety of initiatives under that drug utilization prevention program proved to be beneficial.

On a national level, is there a coordinated program? No, there isn't.

[The Chair, Conservative, Ben Lobb]

Thank you Mr. Lizon.

Ms. Murray, you have five minutes.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

It's been very helpful to hear the thinking that you've expressed around colonization. It occurs to me that just as with serving armed forces members, where we are wrestling with some percentage—15%, say—who respond to trauma with PTSD, post-traumatic stress disorder, it seems that there's a percentage of the community that is struggling with post-colonization stress disorder. When it can be really recognized that there is a systemic trauma that people are responding to, that helps, then, in moving forward.

In “Take a Stand”, the analysis of the chiefs of Ontario, vulnerable groups were identified, including youth, of course, and people in chronic pain, seniors, younger males, people with mental health issues—

[Carol Hopkins]

And pregnant women.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

—and pregnant women.

When you're talking about the culture-centric approach to prevention and support, and when you're talking about this being community driven, how are these different vulnerable groups addressed individually? Are you advocating or are you developing programs that address specific vulnerable groups, or is it a core approach with culture at the centre? In other words, do you adapt the approach for the groups or is it a...?

[Carol Hopkins]

Certainly, there are needs specific to pregnant women, so there is advocacy at this time to look at how we might address the specific needs of pregnant women. One of the projects that we had planned but got stalled because of funding cuts was to develop care pathways, so that service providers and communities would know how to best meet the needs of pregnant women who are at risk for opiate use or who are using opiates.

Looking at social determinants of health, all of the different programs in first nation communities that might come in contact with pregnant women would have a better understanding of how to provide brief intervention and referral services to other more appropriate care options. It's the same for youth.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

So you're saying that the community-based, culture-based programs are being adapted to the specific groups as best as possible, given the resources.