Health Committee on May 26th, 2015

[Murray Rankin, NDP, Victoria, BC]

Just first nations, aboriginal people.

Many of those first nations people are living in our large cities—Vancouver, Regina, Montreal, Toronto, Winnipeg, as examples—and yet they're cut off from the cultural roots you talk about being so important to addressing some of these spiritual wellness issues. I wonder if there is anything you can think of that can be done, if you accept the premise that in the cities it's more difficult to reach people within their cultural framework and have the kind of healing you've talked about. Are there things that could be done, such as training counsellors? If there are fewer people in the aboriginal community involved that can work with them, would it help to have people, or would it be irrelevant to have people, who were trained in counselling but aren't part of that cultural tradition?

[Carol Hopkins]

Any access to mental health services will make some difference, but you're never going to make as much difference without culture. No matter where you live in Canada, whether you live on a first nations reserve or in an urban environment, access to cultural support is difficult. It's difficult because there isn't the evidence that people look for to provide funding to support them.

Just recently through the residential health schools support program first nations people have had access to cultural supports. They also have access to mental health support therapists, but they're inclined to use more of the cultural supports.

Whether you live on a reserve or off a reserve, you have, through the non-insured health benefits program, access to crisis counselling, which doesn't address the depth of trauma and the intergenerational trauma. Definitely the answer to that is an appreciation for the evidence that is founded in our culture and the cultural practices.

There are some good examples. For example, there are off reserve programs, such as the aboriginal healing and wellness strategy, funded by the Ministry of Health and Long-Term care in Ontario. The Wabano Centre is an example here in Ottawa that provides cultural types of programming and cultural interventions. That doesn't necessarily mean those kinds of supports are available if you live on a reserve. Access is challenged by acceptance of knowledge and evidence.

[Murray Rankin, NDP, Victoria, BC]

May I ask a very specific question about the ending of your presentation, Ms. Hopkins? You talked about the addictions management information system. You said it sounded like a valuable database and a tool that could be used, but your problem is that despite creating a few webinars, you don't have the resources you need to make those available to the people who could use those. Have you costed how much money that would take? Which department would be the one that you would expect to assist, if it's a federal department?

[Carol Hopkins]

There have been some regions of the first nations and Inuit health branch of Health Canada that have invested in training. For example, in the Quebec region, they provided $5,000 to five treatment centres so they could train all of their staff and invite community members in who would be using the system to make referrals and access to the assessment tools. So $25,000 for a whole region to be trained on this system is money well spent in terms of the data we would be able to collect over time.

[Murray Rankin, NDP, Victoria, BC]

Especially if you're saving lives.

[Carol Hopkins]

Yes.

[Murray Rankin, NDP, Victoria, BC]

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you.

Ms. McLeod, go ahead.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

Thank you to all of the presenters today. I think we're talking about some very important issues.

I'm going to date myself a bit, as I originally got into the health care field in the eighties. At that time, of course, every health card for a first nations person had a special identifier, so the data was readily available. However, if I recall, that drove some significant concerns about identifying individual personal concerns.

There was a real thrust at that time to say that this is wrong and we need to remove any identifiers that attach to our health care card. It goes to that personal ability to share information as you desire versus perhaps the desire of researchers and policy developers to have that information. That includes, to be quite frank, the national household survey versus having significant penalties attached to it. It's that voluntary nature that you, as a Canadian, you, as an aboriginal person, share that freely and willingly.

How do we square that circle in terms of very legitimate privacy concerns versus the value that data can provide?

Ms. Hopkins, could you start with that one?

[Carol Hopkins]

Dr. Smylie was talking about aboriginal organizations having more control over data, so there's a great appetite for information and data, and control and access and protection of data.

First nations governments, organizations, have developed capacity and interest since 1980 in terms of how information is collected and used. In the eighties, the concern was around discrimination and stigma related to the identifier. That kind of information was largely outside of the control and use of first nations organizations and first nations people. The further concern was about the analysis and the use of that information.

Now, for example, with the First Nations Information Governance Centre, which does the regional longitudinal health survey, we have first nations governance over information and data. We have the OCAP principles, and we have much more capacity now and much more interest. It's not enough, certainly.

There are some regions that have partnered with provincial governments and organizations to look at ways to have data sharing agreements and to structure governance around data information related to health so that it's accessible to first nations organizations to use.

I think the difference is around the control and use and protection of data and information.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

What I think I'm hearing is that we need to move along in partnerships and collaboration. Things like the federal government perhaps doing a mandatory survey is not a respectful way to move forward in that particular instance. I did hear the concerns expressed by our previous witness in terms of moving to voluntary...but, again, and I'll speak quite frankly, sharing of personal information is just that; it's very private for many people.

Having said that, part of the reason we're having these hearings is that the Mental Health Commission of Canada has taken mental health and put a real focus and a priority on it. As we've committed in this budget to renewing the mandate of the Mental Health Commission of Canada, can you talk about how you could see that mandate supporting you in the work you're doing?

[Carol Hopkins]

I think the support could definitely focus on the implementation of the first nations mental illness continuum framework—not doing it for us but in collaboration, taking leadership from first nations organizations. There is a national team that is focused on the implementation of that framework. It's a team that is reflective of the social determinants of health and a number of different federal government departments.

There is good opportunity there for collaboration. I know there was previous first nations involvement in the fifth strategic direction of the national strategy. As for where that's gone in terms of implementation, it's reflected in the mental wellness strategic action plan that was the predecessor to the first nations mental wellness continuum framework. But it is the continuum framework that defines what first nations people have said across the country in terms of the model to address suicide, depression, anxiety, and all of the issues that come out of institutional care, whether it's a residential school history, the child welfare system, or the justice system. It's a complex model that takes a population health approach and looks at collaboration across governments, across service sectors, and across national organizations.

The National Native Addictions Partnership Foundation, the Assembly of First Nations, and the Native Mental Health Association have had some conversation with the Mental Health Commission about the mental wellness continuum framework and expect to see it in the strategic action plan.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Okay.

I loved your reference to “life promotion versus suicide prevention”—some very powerful words.

Do I have any time left, Mr. Chair?

[The Chair, Conservative, Ben Lobb]

You have about 30 seconds.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Then I think I'll leave it, thanks.

[The Chair, Conservative, Ben Lobb]

Okay.

I'd like to welcome Mr. Easter to our committee. He's been so generous today, he's given his seven minutes to Mr. Toet.

Thanks, there, Mr. Easter.

[Wayne Easter, Liberal, Malpeque, PE]

I don't think so.

[The Chair, Conservative, Ben Lobb]

I'm just kidding. That was a little bit of committee humour there.

[Voices]

Oh, oh!

[Wayne Easter, Liberal, Malpeque, PE]

Lawrence may be my neighbour in the Justice building, but I won't give him my time.

I thank all the witnesses for coming. This isn't my regular committee—I'm on the public safety committee—and I can't help but sit here and think about the study we did on the economics of policing. One of the cost drivers in that particular study was that 70% of the people who are in prisons have a mental health issue to a greater or lesser degree.

From my perspective, expenditures in this area should be seen more properly as an investment in people's well-being, and probably a saving in terms of our social and economic infrastructure as a country. But before you can make those kinds of decisions, you need data to make them on. Two witnesses' key points related to data. I think more and more Canadians recognize that the loss of the long form census was a huge, huge mistake that set the country back years in terms of making decisions. Regardless, that decision was made; hopefully it will change.

Dr. Lalonde, you mentioned the availability of statistics and the fact that the federal government holds a lot of the information related to the aboriginal community. What's the problem in terms of getting that data? They would have the data. Why can you not get it?

[Dr. Chris Lalonde]

This goes back to the earlier concerns about privacy. As researchers, we don't want identifying data. We don't want people's names. And all we really wanted here was the rate of suicide in this particular community versus that particular community.

Now, there's been a huge movement, which I am strongly supportive of, for communities to have ownership, control, access, and possession of their data. It's extremely frustrating for communities when they say, “We think we have a cancer crisis in our community, but we don't know because we can't get access to the data.” I think that's understandably frustrating for communities. We need a system. If we're collecting all this data, if we're holding all this data, then we need to be doing something about it. We can't intervene in a situation until we know the size of the problem.

First we need the data. Then we need interventions that we know will actually work, so culturally based interventions, and we need all the infrastructure that's needed to support those things. At the moment, I'm not convinced we have that.

[Wayne Easter, Liberal, Malpeque, PE]

From your perspective, does the federal government have that data? Maybe they don't. Either Dr. Lalonde or Dr. Smylie, do they actually have the data?

[Dr. Janet Smylie]

No.

[Wayne Easter, Liberal, Malpeque, PE]

They don't.

[Dr. Janet Smylie]

No. There's a huge international double standard around indigenous data collection, and it's in a shameful state in Canada in terms of actual health assessment data.

We can have both. We can have indigenous communities in charge of the governance of our data, and we can have high-quality data. The reason is that health is run by the provinces and the territories. In a place like Ontario there's an Institute for Clinical Evaluative Sciences, where I'm an adjunct member, and unlike the rest of the people in Ontario, as aboriginal people we're hidden in that database.

I also need to remind the audience that 40% of the aboriginal population—30% to 40% actually—won't be identified by an Indian status card. There's no reason why in population health data we should be using only a federal registry that comes from a piece of legislation that's systemically problematic.

We do not have the health data. To get accurate rates of illness and death, you need to have vital statistics and hospitalization data. We do not have that in Canada for indigenous people. It's shocking.