Indigenous and Northern Affairs Committee on Oct. 24th, 2016

[Michael McLeod, Liberal, Northwest Territories, NT]

Thank you for your presentation. It was very informative.

I see a lot of interesting graphs and I see a lot of things that we really should make note of across the country.

I come from the Northwest Territories and we have issues in the north, not only in the Northwest Territories, but right across the north, and we have huge issues with suicide. There are so many things that you talked about that we've identified. We can add to those the economy, the lack of housing, and all of these other factors that are causing the issue to grow. When you said today that the situation is getting worse with suicidal thoughts, that really concerns me even more, even though that was something that we acknowledged.

We have had programs up to now. For the most part, they were really being cut and some of them were done away with: the friendship centre program and the aboriginal Head Start program, programs that were organized and run, for the most part, by aboriginals. In the Northwest Territories, we had the Healing Drum Society, which was part of the programs funded by the Healing Foundation.

You talked a little about the friendship centre in Halifax and I'm wondering if those programs had any effect. Were they helping the situation at all? We know that they weren't dealing with all the issues and they didn't have all the resources, but were they playing a role through what they did and the programs they delivered?

[Dr. Amy Bombay]

I'm working with the friendship centre in Halifax, as an example. I've been working with them only recently and trying to get more mental health supports, because they say that is what they need, and that's the one thing they can't get any funding for. They really don't have any mental health programs, even though that is the main thing they want.

I think where there is a lot of evaluation is with respect to the programs from the Aboriginal Healing Foundation. Their program evaluations did show that these community-driven approaches were very effective, and that they were reaching people who they had not previously seen, who had not gone to them for help. This culturally appropriate approach did reach some of those people who I think would otherwise never have gone for help. So they really do meet the unique needs of some communities, and there is evidence to support that, for sure.

[Dr. John Haggarty]

I can add to that, Mr. McLeod.

I'd like to point out two things. The Anishnawbe Mushkiki clinic was a place where people felt invited because of their cultural identification. And it's usually the opposite: “Don't bother coming here if you smell or if your clothes are old”, and so people don't feel welcome. This is actually just down the road from where I work, and where Don's office is, and I think it really creates an environment that says, “We're here to engage with you, and your cultural identity matters.”

The other place is in Fort Frances, at the tribal councillors' group where I visit. They had to overcome things like wanting to have a sweat lodge in their backyard, being able to do smudging and other traditional things, and they said, “We're asserting ourselves here. We're in the town but we're also doing traditional practices”, and I really felt that, again, it was an invitation to say, “If that's what you'd like to engage with, we're running it every week. This is when we do these ceremonies.”

I think it has been a really important part for the individuals who access it, who are interested in traditions. It's important for those of us with non-traditional interests as well. We need to learn that. I'm thinking of the residents, medical students, and trainees in social work. This really matters. If we don't start having these things as visible and really existing..., then we won't be able to even understand what these mean. They'll all end up being just a museum experience. I felt Fort Frances was exemplary. There's a sweat lodge on CAMH's campus, at the medical school in Thunder Bay, and in Sudbury, I believe. I think we're starting to change and to be more welcoming of those.

[Michael McLeod, Liberal, Northwest Territories, NT]

I want to ask about the comment you made on stable primary care systems. In the Northwest Territories we're quite challenged with having the facilities, the services, the experts located in the north. We spend a huge part of our budget on travel—millions of dollars—and we have for the most part only locums who come as doctors and nurses; there are virtually no specialists. We used to have five hospitals in the Northwest Territories. We're down to three—two hospitals have been downgraded. And we have poor Internet service.

The Government of the Northwest Territories has been looking at how to deal with this situation and how to deal with the number of issues around addictions. They've been talking about remote and on-land programs and mobile services. Many people think that's better than nothing, but in your opinion, does it work? Is it consistent enough? Is it something that can work—having people come in for periods, holding courses, and going on the land?

[Dr. John Haggarty]

Is the question whether it's valuable to do these cultural-based approaches to connecting to things such as the land, or are you trying to connect it with primary care?

[Michael McLeod, Liberal, Northwest Territories, NT]

It's bringing in the experts, the mental health workers and going out, whether into the community or on the land. These things are intermittent and few and far between. Do they really work?

[Dr. John Haggarty]

They work in this way. The issue is termed capacity building, supporting local individuals. When I did my first several-week study in Pond Inlet, the question was who the local leaders were on the mental health front. They might have been high school-educated. That didn't matter so much; what mattered was that they were the leaders. They were the ones who were asking the good questions, such as you folks are asking, saying, help me to understand this epigenetic stuff. There was no lack of interest.

I think you can have someone fly in as an expert, but at the end of the day I want my expertise to be theirs. It depends on the nature of that relationship; that matters most. If I just go in and run a clinic, I've done my job but I've not really helped to build up the local resources. To me, that's the critical thing.

[The Chair, Liberal, Andy Fillmore]

Thank you.

That's the end of the seven-minute questions. We have time for just one question in the five-minute round, from Arnold Viersen.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Thank you, Mr. Chair.

Thank you to our guests for being here today.

My question is for Dr. John Haggarty.

You mentioned systems such as RACE and ECHO. Have you done any work on putting those all together? You talked about a pyramid shape. Do you have anything that you can submit to us in terms of what that is?

[Dr. John Haggarty]

I do.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Are there any gaps in that pyramid?

[Dr. John Haggarty]

It was constructed to ensure that from the point at which I'm calling somebody for sure because a person has to be on a Form 1—they're suicidal and they might harm themselves or someone else—to the point of that being elective, I've tried to make a patch as to whether I call somebody in two hours or have somebody see them in two to seven days. The model tries to fill in as many of those options as possible, all the way down to a case review once a month. I do have this conceptually and I will be sharing it with Michelle after I'm—

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Okay. Is this an idea, or is it in place, or is it a patchwork across the country?

[Dr. John Haggarty]

It's a composite. No one place has taken all of these together. In Ontario, Ottawa will take on the e-consultation; B.C. has.... They each have between four and seven years to implement those two initiatives, and the case reviews have been in place for some time.

ECHO is an Arizona- or New Mexico-based model for their rural and outlying areas. Each of these initiatives has been trial-run for close to a decade, and so there's not a composite of those things. We've learned to try to steal as many good ideas from elsewhere as possible.

Some of these we're already doing, but as a formalized structure at a government level, no, this has not been all put together in one place.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

One thing we run into all the time is that some things are provincial and some are federal, and sometimes even the friendship centre is doing a big chunk of it. Is your pyramid able to move among those different jurisdictions?

[Dr. John Haggarty]

No, it's not, and that is one of our struggles. When you go to Meno Ya Win in Sioux Lookout, it's almost half-and-half federal and provincial. I don't make those distinctions myself. I confront the federal funding challenges, such as wanting to use a long-acting injectable anti-psychotic for an individual schizophrenic who is first nations, which I can't get because of funding issues.

No, this model does not give consideration to those.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Does it run into hurdles because of that?

[Dr. John Haggarty]

I would anticipate that it would, yes, but I think there are ways around that. We can make it work by co-operating in between the lines. I think that will have to happen.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

For sure. I wish I had it in front of me so I could have a look at it. That's particularly what I was interested in hearing some more about.

I'm currently working on a similar process when it comes to human trafficking: who to phone first. That's one of the things. In Alberta it's called “211”. For any health or human services you need, you call 211. It branches out from there.

Is that something we could incorporate within your pyramid, or is it specifically for suicide prevention?

[Dr. John Haggarty]

No. It was meant to be for a primary care provider who needs access to what we call “stepping up” to a specialist opinion. Let's say I need to speak to a psychologist or psychiatrist or brain surgeon about their patient who's now returned to my community. I can't wait seven days or thirty days to have them fly back to—

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

So at the bottom base it's more a professional than a family member or something like that. Is that correct?

[Dr. John Haggarty]

Correct.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Okay. Interesting.

Do you know of any work that's being done on the one layer before the bottom of your pyramid? How do we get family members tied in, or just even get them to a professional or something like that?

[Dr. John Haggarty]

I sense you're talking about peer- and family-based issues.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Yes.