Health Committee on Nov. 29th, 2018

[Dr. Sheri Fandrey]

The Winnipeg Police Service has indicated to me that about 80% of our supply is coming from Mexico, from the Mexican cartels. To a large extent, it's being shipped by semi-trailer. It lands in British Columbia outside of international waters. It's brought into secluded places and then is brought across the country for distribution. A small amount of it seems to be produced in British Columbia as well. These are super-labs producing vast volumes of methamphetamine of a very high potency.

[The Chair, Liberal, Bill Casey]

I'm sorry I have to end that even though it's very interesting.

Ms. Mathyssen.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you very much, Mr. Chair.

Mr. Johnston, Dr. Poulin, Mr. Young and Dr. Fandrey, thank you for your advocacy. It's very clear to me that you are advocates that we desperately need, so I'm very grateful for what you do in terms of community and talking to folks.

I'm going to ask my first question to Dr. Poulin, but please feel free to jump in and add things.

Doctor, I hear that you're a rock star in your community because of your advocacy. You talked about the fact that most of the services are in the south, not available in the north. There has to be a tremendous cost in terms of accessing, bringing people from the north to the south. I wondered if you could talk a bit about your advocacy in that regard.

[Dr. Ginette Poulin]

Certainly when we look at cost for northern transportation, it's astronomical, and typically has been, but even the ease of that process.... Persons might have to go from The Pas, down to Winnipeg, and then get up to Thompson, so there's a lot of rerouting. We know opportunities are always lost the moment that people are not essentially handed off door-to-door, so I think that is a growing concern. We're continuously advocating for, certainly, more services and more ability.

I always say we need to not only have the local service, not just transportation, but we also need to have the expertise supported within those regions. One thing that we're doing is within our RAAM clinic models. We haven't really spoken about those yet, but those are rapid access to addiction medicine clinics. We are providing services for crystal meth as well as other substances. We have those five pilot sites located in Thompson, Brandon and Selkirk, and then in Winnipeg.

We're trying to infiltrate within those areas and start building capacity. One of the areas that I do other work in is with international medical graduates, who are a large portion of the providers within our rural areas within Manitoba. Building connections and support through that avenue is another way to assist with that. Again, I think we need to consider when it comes to finances that aspect as well.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you.

Mr. Johnston, I notice you're wearing the moose hide. I want to thank you for making it very clear that the concern here in regard to violence against women and girls is very much a part of this.

You described cutbacks in terms of the Manitoba budget. I'm sure you're not an expert in terms of exactly what that budget said, but I wondered in terms of those cutbacks whether there is any idea where the money is going. You said that health dollars are being redirected. I wondered if you could comment on the fact that the federal government doesn't make requirements of provincial governments. There has to be, I think, strings attached.

Who is benefiting from all of this money that is flowing? What would you like to see in that regard?

[Damon Johnston]

The first thing is more transparency to the public about where those monies are going.

Something that may be affecting some of that is that when the new government came in, in Manitoba—I think they're in mid-term now, or just a little past—they announced a major effort to transform our health system.

I view some of that as positive in the sense that, for example, many practitioners and those of us who are closer to mental health and addictions, appreciate that they often co-occur in individuals. I'm on the board of CMHA Manitoba and Winnipeg, and I have been for a while. For a long time there's been a consensus that we need to bring those two closer together in the health system structure. That's good news.

We had the Peachey report, we had the Virgo report, and I think I understood the government has now set up an implementation committee. Many of us are hopeful that the health transformation in Manitoba will lead us to a better place, but that transformation causes system challenges because people are trying to adjust and they're trying to appreciate in a real sense what all that change means. It affects morale and that affects the performance of people in their jobs. This is a big thing.

[Dr. Ginette Poulin]

I think that's where we're left questioning when we see the Peachey report on having a focus on mental health and addictions, the Virgo report saying we need increased funding, and then we're being asked to cut back annually—1% to 4% over the past few years—not only with Addictions Foundation of Manitoba, but other delivery of mental health and addictions as well. It leaves us a little perplexed as to where the money is coming from for us to help augment our services. It just highlights that.

I think one of the asks that would be helpful is if you could provide the means to allow mechanisms to provide more certainty and sustainability, as I was saying earlier, with the accountability coming to health organizations such as ours so we could see the money coming more directly for those of us providing the services.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you.

In 1996, Roy Romanow said that mental health care services were the orphan of the health care system and it sounds as if the orphan is still a reality there.

I wanted to talk a bit about the impact of poverty. As you know, we now have a new measure for poverty, the market basket measure. Based on the old system, there used to be a reckoning that 19% of seniors lived below the poverty level and now with this changeover to the market basket, it's fewer than 5%, magic by manipulating numbers.

I wonder about the impact of poverty on these traumatized populations: indigenous populations, those people who need interventions. How are you seeing poverty contributing to this malaise?

[Dr. Ginette Poulin]

Absolutely that is a contributing factor and is concerning, given that we have a higher percentage. I think we're facing this issue of poverty dependency more and more in our social system.

Again, a lot of trauma is surfacing in many ways. We know that. Again, in literature these people are more likely to experience it, given that it's a large risk factor in addictions and substance use. When we look at strategies that include things like housing and other social supports that are basic requirements, I think that is a crucial part of the solution.

[The Chair, Liberal, Bill Casey]

Time's up.

We're beyond time now, but I'm going to go for one more question from Dr. Eyolfson.

Doctor, could you ask your questions quickly?

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

The only one that comes to mind right now.... We've talked about this a lot, we've had a lot of drug issues, and I found this in my previous career. There's a huge interplay between mental health, drug addiction and substance abuse in general. We know that a very large proportion of drug use is by those with underlying and as yet undiagnosed mental health issues who are attempting to self-medicate, even teenagers.

We've diagnosed schizophrenia in teenagers brought on because of their drug use, and it turns out they were taking drugs because they were hearing voices. In this population it's very hard to track meth in particular, and as you said, Dr. Young, these people are often under-represented in surveys.

Do we have any idea of the proportion of those who are addicted to methamphetamine right now that have underlying mental health issues, whether it's a severe mental health diagnosis like schizophrenia, bipolar illness or anything like that?

[Dr. Matthew Young]

We don't really. We have some one-off surveys or one-off studies, but really, we don't know.

One of the recommendations in here was that we need to invest in what my colleagues from Health Canada were talking about, which is a good national drugs observatory, so that we truly understand the nature of the issue. I've heard it referred to. I forget where, but it's said that most drug crises are really a crisis of despair mapped upon an unsafe drug supply. When you put those two things together, you get a very toxic mixture that does great harm to our communities.

[Dr. Ginette Poulin]

Anecdotally, we're certainly seeing high percentages of persons who have co-occurring conditions. One of the innate challenges that we have is that, because our system is siloed and funded, mandates are based on someone dealing with mental health and someone else dealing with substances. They present to the door for services for mental health and are told they need to go deal with their addictions before they can access the services for mental health, and then it's the chicken and the egg. They are bouncing back and forth, and we're missing the mark grossly. Again, we need to have strategies that can look at this collectively and address the issues as a whole. That way, we can break it down and move past this silo strategy for addressing this, because it is not working.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

You're making me perversely nostalgic for my previous job because we found the same thing. Someone would come in and say, “I have mental health issues. I have addiction. The addiction people won't take me in until I get help for the mental health. The mental health people won't take me until the addiction—

[Dr. Ginette Poulin]

Unfortunately, we're still in that position today.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

We're still there.

Okay, that's all I have to ask.

Thank you to the committee for it's forbearance on this extra time.

Thank you very much for coming.

[The Chair, Liberal, Bill Casey]

It wasn't extra time. You were entitled to that time.

I want to thank the witnesses so much. I want to thank you for what you do too, because you have a tough job. You're talking about lives, health, young people and enormous problems, so thanks very much for what you do.

The meeting is adjourned.