Evidence of meeting #28 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.
Executive Director, First Nations Health Managers Association
Yes, that's the aboriginal health human resources initiative.
Conservative
Arnold Viersen Conservative Peace River—Westlock, AB
Okay, and you're saying that would be one clear way we could make a difference, to change perhaps the percentages of the two streams of the funding on that. Would that be a correct assessment of your recommendation?
Executive Director, First Nations Health Managers Association
Thank you for that question. I think that's one very specific and concrete way we could look at developing the competencies within community-based workers. There are two streams that are identified, and that's one, supporting scholarships and bursaries to people who are going into health professions, such as nurses and doctors.
However, the one we focus on and that's available to a health director, for example, is if they wanted professional development or to achieve certification. They would be applying to the second stream of that funding that's now available, through the community-based worker. It's community-based workers, when you look at the program compendium: diabetes workers, all those unregulated allied health workers who are competing for those funds. Right now, that's $1.5 million spread out throughout the country through the FNIHB, first nations and Inuit health branch, regional offices.
Conservative
Arnold Viersen Conservative Peace River—Westlock, AB
I liked how you said we're talking about life promotion strategies, and I'll stick with that.
You talk about a Thunderbird strategy. This is the first I've heard of this. Perhaps you could lay that out for us and maybe point us in the direction in which to go looking.
Executive Director, First Nations Health Managers Association
Sure.
The Thunderbird Partnership Foundation was formerly known as the National Native Addictions Partnership Foundation, so it has a long history in Canada in being a leader in addiction services. That's primarily funded through community-based worker training dollars out of Health Canada. They have that long-standing history, and as I was saying, they would be key in having this discussion, because they advocate for mental health services as part of their mandate.
The piece around supporting the framework is actually one that's not unfamiliar to this committee. That's the first nations mental wellness continuum framework, and I know you've heard that in testimony from Chief Day, as well as a number of other witnesses, such as CINA.
Conservative
Arnold Viersen Conservative Peace River—Westlock, AB
Dr. Bourque Bearskin or Ms. Jones, you mentioned something about dealing with children who are taken out of their parental care and placed in foster care. Could you elaborate on that and perhaps give us an example of where you've seen something that has worked, rather than the traditional methods?
Indigenous Nursing Student, Canadian Indigenous Nurses Association
Yes, I would like to speak to this.
There have been a couple of scenarios where a child has been taken out of the home.
I really believe that we need to start helping families build their cultural competencies back up within their homes and in the communities instead of removing them from the home. We're just giving them back and forth, over and over again.
Indigenous Nursing Student, Canadian Indigenous Nurses Association
If we can, just start at the grassroots. There have been situations where if we know of a young female who's pregnant, then we start at that stage to teach her how to look after the baby once it's here, its proper needs, and the roles and responsibilities within the families, instead of just instantly taking the child away. I think that it is a huge step in the right direction by starting right at the grassroots.
President, Canadian Indigenous Nurses Association
Just to speak a bit more to that, in my own community of Beaver Lake, what our community is starting to do is that whenever we do any kind of health programming, we have a relationship with the child welfare people. The families that are left in the community, when the child's been apprehended, they'll bring the child so that they can support that family unit. That has been shown to be very effective to help this transition back home.
I totally agree with the message that Lindsay was providing. We need to support children so they stay in their homes. We need to reorient services to build capacity within the home, as opposed to spending millions and millions of dollars shipping families out across the country. We need to focus on building the family as opposed to just breaking down the family dynamics.
I think there are some good examples across the country where that is starting to give us some good indication. If you look at Bella Bella, and you probably heard about that, the youth are really reoriented back to the land, and the communities, and the family units. Evidence is clear on supporting family units.
I have to speak to my own survivorship. I think about how, when I was removed from my community of Beaver Lake and brought all the way over here to B.C., one thing that always kept me grounded, and striving, and having those aspirations, was that those foster homes always supported my getting to know who my family was. I think that link was really a key attribute to the success. You see that in my other siblings, who were all apprehended, and they weren't in families that did support their transition back to their family. You could see the clear differences in my immediate family on how they were affected by that removal system.
Liberal
NDP
Georgina Jolibois NDP Desnethé—Missinippi—Churchill River, SK
Thank you for the terrific presentations. I have those similar discussions in my riding. I come from northern Saskatchewan. I'm the MP for Desnethé—Missinippi—Churchill River riding.
Recently in my riding we had three completed suicides by kids who were between 12 and 14. I have had these discussions with other physicians, aboriginal physicians, and nurses in the riding about the need for cultural relevance for those children who are removed from families and communities.
How far do we need to go to push this idea about making the real change at the core? Our youth are hurting. Our families are hurting. We know that, day in and day out. For culturally relevant physicians, and nurses in every province and in my province, we struggle. The province struggles with adapting this very concept about cultural appropriateness.
Nationally, how can we ensure that we push this and continue to do the work, so that at the grassroots level we have community-based, culturally relevant approaches?
President, Canadian Indigenous Nurses Association
I would like to speak to that, please, Mr. Chair.
One of the recommendations that I've made right from the beginning.... I believe so firmly in this organization. The Canadian Indigenous Nurses Association is part of the solution. We are at the front line. We see these kids in immunization clinics. We see them in home visits.
We don't have a lot of support. We're focused on treatment right now under the current.... My own personal philosophy is that we are too focused on treatment. Our community health nurses are focused in that area, which leaves us health promotion. We need to put nurses back in the school system. We need to put nurses back in the community. I think the funding cuts....
I want to tell you a story about a little girl—her name is Cassey—whom I met in Yukon. This is very striking to me. As I said, I acknowledge that I am a survivor. Our family is working on a lot of healing. When I was in the community in Whitehorse a couple of weeks ago, there was a little girl no more than nine years old. She was out playing. It was late. I was scolding her. I was telling her to go home and I asked where her mom was. I was trying to be that community advocate. She turned around, really foul-mouthed, and let me know where to go. I thought, oh my God, she's only eight or nine years old. I was upset about this.
I was talking to my brother and sister-in-law in the house about this. How do we help this girl? We were talking about boundaries, family dynamics, and everything. Then my brother said to me, “Sis, I don't know why you're getting all worked up. Would you want to go in there if you knew that five of her immediate family members committed suicide in that home in the last five years?” Now she has her single mom, with this child growing up. No wonder. It really affected me.
When you talk about our priority, that's huge. We have eight- and nine-year-olds seeing this on a daily basis in some of our communities. If we don't step up now, this.... Suicide is a symptom of colonization, of a fractured system. I think it's an emergency state, as you've all said, which is why you are looking into this work.
I think about Cassey being eight years old not wanting to go into that home and rebelling. I can't say that as an adult I'd want to go back in there, but where else can she go?
Board of Directors, Executive and Ontario Representative, First Nations Health Managers Association
I want to address this question a little bit from my experience. I've been doing this for more than 30 years.
I guess one of the things important to know is that you can't fix a system or a community that's broken without investing in the community. I think a lot of people believe that if we take children out of the community, it's going to benefit that community. I think what needs to happen, from my own personal experience, is that we need to invest in those communities.
One of the things I've noticed is that when a crisis happens, everybody is ready with a crisis team to go into the communities and deal with the crisis, but once the crisis is over, everybody leaves. I think there's a real disconnect there.
I think you need to really look at making long-term plans for the children and for the people in the community. I've known suicides to happen with the very young as well as with the very old, so it's not just one specific age group that's affected. It's the whole community sometimes that is suffering from the impacts of what occurred over the course of the last 500 years with our people.
I think it would be an immature thought that there could be one quick fix. There have to be massive investments into these communities. We have to go in there and talk with the children. We have to talk with the adults, the parents. We have to talk with the elders. We have to bring people together and start a discourse on how we're going to do this.
To me, this is the thing that's been lacking in a lot of the situations. A crisis team comes in. The crisis is over for a little bit, and then everything goes back to normal. Then another one pops up somewhere else, and the crisis team goes over there. There has to be some long-term planning for this.
The other part to this is that we rely on health directors in the communities, for the most part, to do this—and I'm hoping to speak more about that health director role later on. The health director is only one person in a larger system that's out there. I think that, if we really look to address the long-term needs of the communities in terms of what their social, recreational, and health activities are, then you'll begin to see some changes in terms of how people are acting out.
We have to give people hope. Without hope, these are the things that occur within our communities, and they're occurring far too often. That means we're not doing a very good job of providing that hope across the board. I think we should all be ashamed of ourselves for not doing that.
Liberal
Liberal
Don Rusnak Liberal Thunder Bay—Rainy River, ON
Thank you all for your presentations today. I'm sure the analysts will take what you said and get the information in our report.
What hit home for me was what Dr. Bearskin was saying about taking the child out of the community and not having that family connection, that cultural connection. We see that far too often. We're getting into child welfare agencies and what they've been doing over many years. I don't know the exact stat, but I've heard over and over that there are more children in care today than ever during the residential school situation in our country. That's deplorable, in my view.
I want to hear more from Mr. Morrisseau regarding the health director role in the community. I don't understand the role. Is it for an individual community? Is it for a number of communities? Can you explain exactly what that role is?
Board of Directors, Executive and Ontario Representative, First Nations Health Managers Association
Thank you very much, Don, for the question. I'll do my best to answer it.
I can speak for our area. My understanding is that a health director is the one who's responsible for the health and well-being of the people in a community. There are a couple of things you need to know about that role of health director.
First of all, it's not a role that is paid for by the Government of Canada. Many first nations have to try to pool their money together to create that role.
It was originally put in place, I think, for reporting mechanisms. Somebody had to be responsible for reporting back to the government. But over the course of time, as our people began to find out about the horrendous discrepancies in our health outcomes compared to those of other people, the task of improving those health outcomes for our people began to fall to the health director. So when anything happens in the community, we look to the health director for guidance in how to deal with it.
One of the things with health directors is that there is very little support out there for them. They're kind of like a beacon out there doing the job all by themselves, and when things happen, when things go wrong, everybody looks to the health director to see what happened, and yet, the first nations and Inuit health branch has pulled back training for health directors and for health people across the board. The CHR, community health representative, training is almost non-existent now, and we see this across the board. Our people are left to try to find training wherever they can get it, whatever way they can get it. Thank God for people like Marion who has a program that's set up so that health directors can access it.
The problem then becomes where the health director gets the resources to improve his or her own set of skills. You have to understand that things are different from what they were 30 years ago. The complexities of the health determinants that affect our people are a lot different. We see chronic illnesses that come into our communities. We see mental health issues. It's no longer just alcoholism. It's alcoholism with bipolar, alcoholism with prescription drug abuse, and all of these things that are left at the doorstep of the health director, who is supposed to deal with all of these things. Then when we don't provide any training or any help for the health directors, we ask them what they're doing.
That's the situation we see in first nations. I was a health director. I spent most of my days dealing with crises, the daily crises that go on in my community. I had no time to look at what I could do in terms of planning, so that my people could get healthier. These are the situations that occur within many first nations, and until those inequities are addressed, we'll continue to flounder in terms of our own health outcomes. We'll see our young people dying at a greater rate than other people. We'll see all of these things that are occurring, and you don't have to look very far to see the horrid health outcomes that our people are facing. We have one person out there who is charged with trying to change this, and we provide no support to that person.
Liberal
Don Rusnak Liberal Thunder Bay—Rainy River, ON
In your area, which is on the western part of my riding, as I understand it, the area that you cover is a number of first nations.
This question is for Marion.
Is it typical that health directors cover a wider area, a bunch of first nations, or do individual communities have individual health directors who are seemingly the on-the-ground experts in terms of the health needs, including the mental health needs of the communities?
Executive Director, First Nations Health Managers Association
Thank you for the question. I appreciate that.
In relation to our organization, we look at the health director position in terms of the community. Depending on whose stats you use, there are 630 to 650 communities across Canada. The first nations and Inuit health branch identified that there are potentially 500 health directors across Canada. Those are health directors in communities. Then you have health directors who are in charge of tribal health services. Then you take it to the PTO level, with the provincial and territorial organizations. Health director is a very key role in terms of the community individually, and that one person who employs doctors, nurses, and all the paraprofessionals. Then take it to the tribal council, and they could be looking at providing services to a number of communities in the surrounding region. That includes treatment centres as well. Treatment centre directors as well belong in terms of health director management.
Liberal
The Chair Liberal Andy Fillmore
We're out of time on that one. Thank you very much for that.
We're moving now to five-minute questions. I'll invite both members and witnesses to try to come to the point quickly so we can fit as many points in as we possibly can.
The first five-minute question comes from Cathy McLeod, please.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
I'd like to welcome some Kamloops colleagues at the table. Of course, we had Dr. McCormick not so long ago. We've certainly been very well represented in this study.
I'll start by picking up on the nursing issues. The nurses can be a key player, absolutely, as one of the types of care providers who tend to be in the communities and not flying in and out.
I'll date myself. I went to my 33rd nursing reunion two weeks ago. The dean of nursing was proudly saying people now need 90% to get into our programs. I think we all looked at each other in shock, for one thing, and said that you don't need 90% to be a good nurse. For young girls and boys from indigenous communities who want a career in nursing, have we swept some of the barriers out of the way? Ninety per cent is ridiculous, to be quite frank.