Evidence of meeting #32 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 community.
12:50 p.m.
Liberal
Mike Bossio Liberal Hastings—Lennox and Addington, ON
To open the wounds.
What about feet on the ground in mental wellness in B.C.? You said that you are woefully short of resources in that area. Where are we at, and where do you feel we need to get to in order to truly address the problems today and to continue with that wellness path in the future?
12:50 p.m.
Deputy Chief Medical Officer, First Nations Health Authority
I couldn't quote numbers for each of the regional health authorities. They each have a mental wellness or a mental health department much more clinically focused. I do know that our youth wait an average of six months to a year for services from that side of the world, and that treatment beds and beds for individuals in mental health crisis are very difficult to access. My experience has been that most of our individuals who are in a mental health crisis, or early psychosis, or some other severe depression will present to an emergency room, and if they are lucky, then they will get a referral to a follow-up crisis team in the community.
We have funded a province-wide, 24-hour crisis line. It started in one group of communities on Vancouver Island, and it is now available across the province. They do really good work, and they try their hardest to access local resources where they are available, but it is really challenging. The wait-lists for anxiety and depression programs such as cognitive behavioural therapy, are very long—
12:50 p.m.
Liberal
Mike Bossio Liberal Hastings—Lennox and Addington, ON
Once again, though, a lot of the stuff you're pointing toward is really—how did you refer to it—preventative, and institutionally oriented rather than culturally consentative, right?
12:50 p.m.
Liberal
Mike Bossio Liberal Hastings—Lennox and Addington, ON
One of the things that we're constantly dealing with is long-term stable funding, self-government, self-defined programs, indigenous-defined programs, and community-defined programs. Today it sounds like none of it is being community defined except for, as we heard this morning, a very small program that started, that has $160,000 in funding, and that is really focused on the youth cultural aspect of a community-defined program.
We know that it's in a very bad place today, but are people starting to get it? Are they starting to understand that this is the direction we need to head in?
12:50 p.m.
Director, Mental Wellness, First Nations Health Authority
Shannon spoke to one thing, the immediate needs we're facing at the First Nations Health Authority. At the same time, we're doing groundbreaking work in mental wellness, in that we have to develop what we understand mental wellness is in line with our cultural teachings. The entire protocol for crisis intervention is based on culture and working with hereditary leadership in communities.
12:50 p.m.
Liberal
Mike Bossio Liberal Hastings—Lennox and Addington, ON
Do you feel you're moving in a direction now? Is there a mandate today that says we have to hire 50% of indigenous people delivering services directly to indigenous communities? Is there a mandate that even says that's where we want to get to?
12:55 p.m.
Deputy Chief Medical Officer, First Nations Health Authority
I think the mandate is as many as possible, recognizing that it took 13 years for me to finish my training. I don't know, Patricia's probably close to the same amount of time. Having people come out of whatever it was in communities that challenged them in the first place to become strong enough, and then to go through a program, takes time. We understand that the natural helpers in communities are often hired as community health workers or work in the band office or do other things, and take on those roles. To provide the level of education that's really needed for people to succeed in those roles without burning out, to have the support they need to be able to do the work, is very challenging.
12:55 p.m.
Liberal
12:55 p.m.
Conservative
David Yurdiga Conservative Fort McMurray—Cold Lake, AB
Thank you to the witnesses for participating in our study.
We have heard from many indigenous youth that hospitals are ill-equipped to deal with attempted suicides, and in many cases they sit there for hours and hours and hours, waiting to see a mental health professional. Once they see them, they are given medication. It doesn't seem as if there's follow up. They're sent off on their own.
Can you describe how you feel the program should work after an individual is released from the emergency room? Can you describe what you'd like to see happen? Obviously it's not happening. As Shannon mentioned earlier, they're left to their own devices, and sometimes, or in most cases, it's not a good situation.
12:55 p.m.
Deputy Chief Medical Officer, First Nations Health Authority
One thing we're working on with our health authority partners is increasing the amount of communication. We have been very limited. I won't go through the technicalities, but between a public system and a private system, with regard to privacy legislation, it gets very complex. Often community health services, even if there is a mental wellness worker in the community, aren't informed that somebody in the community has gone to the hospital, is suicidal. No discharge abstract gets sent to the community with follow up that says this person has an appointment on Tuesday afternoon, can you make sure they get there and they have a family member with them, or provide them transportation? That whole piece is missing.
One thing we have to do is make sure there is a continuity of service between what we support at the community level and what's supported in the acute care system, and that those blend to support the individual so they don't fall into those gaps in between. Then if things aren't going well in the community, they have a way to go back to the acute care system, requiring a higher level of support.
12:55 p.m.
Director, Mental Wellness, First Nations Health Authority
I could give you an example of something that worked well. There was a suicide attempt. He was 26, from the Interior, and was in the hospital in emergency in Vancouver and Surrey. I'm not certain who it was; it might have been the aboriginal liaison who contacted his family member from his community. That person, who's a community leader, mobilized the family in Vancouver. Our mental wellness adviser worked with Fraser Health to ensure that emergency let the family in, notified them. He went from there into treatment. There's an example of when it works well, and that we're working with the protocol of where he's from, even though he was living in Vancouver.
12:55 p.m.
Deputy Chief Medical Officer, First Nations Health Authority
It's very common for our folks...the terminology we use is at home and away from home, and we're working very hard with our partners to help work with the community members who are away from home. Like me; I'm here in B.C. my family are all in Manitoba, but there may be other ways to support me through some of the programs like the aboriginal patient liaison program.
1 p.m.
Conservative
David Yurdiga Conservative Fort McMurray—Cold Lake, AB
Another challenge for the medical profession is privacy. A lot of times in my opinion they're gagged, they don't have the freedom to notify family. How do we deal with that? That's a big challenge. With a young adult parents don't have the right to know what kind of treatment they're getting. Is there a way we can go around that? Obviously, you just mentioned that in certain cases families were notified, which is good. But in most cases nobody is notified because of the privacy issue.
1 p.m.
Director, Mental Wellness, First Nations Health Authority
I think it's also because we're really just beginning to follow cultural protocol. Once our people understand that's what we're doing at FNHA and hopefully as well our partners, the Ministry of Health, when they understand how we're working, we'll have more co-operation.
1 p.m.
Deputy Chief Medical Officer, First Nations Health Authority
There's also risk. In some individuals it may be the family members who are part of the problem. It takes some sensitivity in working with an individual in crisis to know, and to ask, who their supports are, who the positive people in their lives are, and have a conversation about communicating with them. There are exceptions, and often people who are very unwell will just say, no, I don't want anybody to know. It's something we have to work through.
1 p.m.
Conservative
David Yurdiga Conservative Fort McMurray—Cold Lake, AB
For example, a young individual comes in who has attempted suicide. Would a mental health professional ask the pertinent questions of who can we contact, and say, if you have nobody we can recommend this group to assist you? Does that happen, or are they just in and out?
1 p.m.
Director, Mental Wellness, First Nations Health Authority
The example you gave was about in and out.
1 p.m.
Deputy Chief Medical Officer, First Nations Health Authority
Ideally, yes, that happens. Does it happen every time? No.
1 p.m.
Conservative
David Yurdiga Conservative Fort McMurray—Cold Lake, AB
Another thing is you mentioned a six-month treatment program that was developed and implemented. Is that an ongoing program, or was it a one-time program?
1 p.m.
Director, Mental Wellness, First Nations Health Authority
No, it was a one-time program in Ahousaht and it was funded by the Aboriginal Healing Foundation and Vancouver Island Health Authority. They're developing another program for the youth I believe.
1 p.m.
Conservative
David Yurdiga Conservative Fort McMurray—Cold Lake, AB
I'm very interested in it. If there's any documentation about the program and how the program worked and outcomes, I think it would be very important for this committee to see that type of report because maybe it could be duplicated in other communities.
1 p.m.
Director, Mental Wellness, First Nations Health Authority
Definitely. The contact there is Dave Frank from Ahousaht.
1 p.m.
Deputy Chief Medical Officer, First Nations Health Authority
It's really interesting because that community where the treatment occurred was on a island, and the island used to have a residential school on it. That's the building they're using so in some ways all things come around. There have been several circumstances over the last while where a single elder has gone out to the island with individuals in crisis and stayed out there for weeks at a time, but there isn't a formal program anymore.
1 p.m.
Liberal
