Indigenous and Northern Affairs Committee on Nov. 2nd, 2016

[Patricia Vickers, Director, Mental Wellness, First Nations Health Authority]

I thought it was going to be 10 minutes split between the two of us.

[The Chair, Liberal, Andy Fillmore]

You don't have to use all the time, if you don't want. You can use it for questions as well.

[Patricia Vickers]

Okay.

Distinguished leaders, I'm from the village of Kitkatla. I'm from the Eagle Tribe. I'm from the house of Gilaskmx. It's an honour to be here today. I'm especially looking forward to our discussions.

In 2007, in Hazelton, B.C., in Gitxsan territory, the hospital staff recorded 57 suicide-related incidents, including completions. In 2006, I was asked by the First Nations Summit and the children's commission to gather information from youth in Haida, Tsimshian, and Nisga'a territories following a number of suicide completions and attempts in Tsimshian territory. In 2005, matriarchs of Ahousaht directed the hereditary and administrative leadership to address the drug dealers and bootleggers, giving them an ultimatum of treatment or banishment. The chiefs and community set up a six-month treatment and cultural rehabilitation program and 22 of the 23 identified community members chose to attend the community-based treatment program. During the six months—it was a six-month treatment program—there were no suicide attempts in Ahousaht. During the six-month treatment program, the drug dealers and bootleggers disclosed that they had sexually assaulted others. The victims were brought in and included in the healing program.

Mental health services, through non-insured health benefits, has its roots in the Indian problem. The results of that conditioning is the challenge that we, as Canadians and North Americans, need to take on because we are human beings. Suicides in first nations communities are not random acts, but rather, there is a thick line that connects suicide with intergenerational trauma through physical, emotional, mental, spiritual, and sexual atrocities and violations against first nations children. Mental health has been described as the scarcity model that focuses on disease rather than historical facts that are now published in the Truth and Reconciliation Commission and the “Report of the Royal Commission on Aboriginal Peoples”. The scarcity model makes a covert statement that the situation will not change. They are Indians after all. This is a terminal disease. However, we have heard through commissions like this one of violence against first nations in Indian residential schools, federal day schools, Indian hospitals, foster care, the justice system, and through land loss.

The decisions to be united as Canadians must be founded on human values and principles that are the foundations of the First Nations Health Authority, gathered from ancestral law. They include respect, discipline, relationships, fairness, excellence, and honouring our ancestors through following traditional protocol. The strength of first nations people is in the simple fact that we exist today. We live knowing and learning our traditional songs, dances, protocol, art, and understanding the importance of the unity of heart and mind. The First Nations Health Authority is working to respond to the youth, who clearly said at the Prince Rupert gathering in 2006, “We want the abuse, addictions, and violence to stop” in our families and we want culture. Prevention comes through facing facts with compassionate understanding in families, tribes, communities, and nations, with seeing the past clearly, without the distortion of believing we are the Indian problem. This is a Canadian endeavour and requires commitment and unity of all.

In the previous panel I came in near the end and there were discussions around prevention. Prevention comes from a disease model when we look at prevention, and we need to work towards preventing.

If we're looking at families, we'll see that working with families is in itself prevention. When we look at the fact that cultural protocol already exists in the communities, we're not really accessing that yet as first nations people here in British Columbia, for many reasons, but they all relate to our history as Canadians.

Probably one of the biggest issues that we're facing today is sexual abuse; it's intergenerational incest. So, getting to that is not an easy task because, as I mentioned earlier, it's a matter of looking at these facts and how these facts have impacted us as a people.

First, what we're looking at is connecting with the values and principles that come from our ancestral teachings, or what I say is ancestral law. As we do that and follow that, then that's our responsibility as first nations people.

We're looking to our partners, the Ministry of Health, in mental wellness particularly, to be working with us in doing this, not to fit the indigenous protocol into the mental health model, but for us to be working as partners, so that when they come in, they're following cultural protocol, or when we go into a community, we're following cultural protocol.

Here I am. I'm Tsimshian and I'm in Coast Salish territory. I want to recognize that because I'm not from this territory. My last words are for peace in all of the Coast Salish territories here.

Thank you.

[The Chair, Liberal, Andy Fillmore]

Thank you very much for that.

Shannon, please go right ahead.

[Dr. Shannon McDonald, Deputy Chief Medical Officer, First Nations Health Authority]

My name is Shannon McDonald. I am a Nishnawbe Métis from southern Manitoba and I live as a guest on the territory of the Coast Salish people in Victoria. Prior to joining the First Nations Health Authority a year ago, I had worked for the Ministry of Health in B.C. as the executive director of aboriginal health, and prior to that as a regional medical officer with Health Canada. So I'm well aware of all the different ways in which we have tried to do this work.

Personally, my family has been deeply touched by suicide; two of my immediate family members have taken their own lives. For me, this is more than just a file.

Suicide needs to be understood in a broad context of mental health and wellness. The First Nations Health Authority has worked very hard to develop a perspective on wellness that includes social determinants of health, that includes environment, partnerships, but most importantly, the family and community. The work that we do reflects the things that Patricia has said in supporting those individual families and communities to find wellness.

It's a different way of looking at things. After medical school, I trained in psychiatry as part of a residency, and I lasted two years because the model that they were teaching was strictly biologically focused. It was all about medication; it was all about incarceration, for lack of a better term. It really wasn't about teaching people to find their own wellness. I really struggled with that. Is that a cultural statement for me, that this doesn't fit with the culture of my understanding of healing? I went to see an elder, and the first thing the elder said went after my ego, “It took us 500 years to get this sick; what makes you think you're going to change that in a short period of time?” I said, “Oh, okay.”

The second thing that was said was that you need to learn the difference between curing and healing. The western medical model is very based on curing—here, there's something wrong; cut it out; give it medication changing it biochemically. That's not about healing the spirit, healing the person, or healing the family or community in which they live.

We understand that our work has to be culturally grounded. It has to be guided by the ancestral teachings. However, we also have to work in partnership with an acute care system that will serve those individuals in our community who need that curing care, who need biochemical support, who may need safety in a place where they can heal without hurting themselves or others. We understand that we are part of a much broader continuum. The acute care system starts from here and goes to discharge or sending people back to the community. Our work is intended to wrap around people, long before they get to the hospital, and definitely after they've gotten out.

The work that we do with our provincial partners is challenging. The work has to do with providing culturally safe and humble services to individuals as they enter the system, understanding the history that may have brought them there and truly listening. That hasn't always been my experience. There are systemic barriers within our health systems, and a lot of people have grown up to believe that indigenous people are just going to be that way. I trained at Health Sciences Centre in downtown Winnipeg, and for those of you who don't know that area, more than 60% of the patients in that hospital are indigenous people who come from elsewhere in the province. The only indigenous people that my colleagues ever met were the sickest of the sick. They never saw families who were well; they never saw communities that were intact; they never saw cultural celebrations or elders teaching, so they never understood the rest of the holistic picture.

I can sit here and quote suicide statistics in the province; they have improved slowly. The numbers are small, thank God. We know that about 10 years ago, Chris Lalonde did a study that tried to connect community strengths—solidarity, self-determination, and some of the things that provided strength in communities—to suicide.

He found that 90% of the suicides in the youth in B.C. happen in 10% of the communities. The assumption that there's a suicide problem in every community is incorrect. That tells us that there are things going on in those communities, in those families, that we need to support. We need to support change.

Since the transfer of responsibility for health from Health Canada to the First Nations Health Authority, we've created regional mental adviser positions to work with communities and to act as a liaison between health authority services and those we provide at a community level. But those people are stretched very, very thin. We have some new funding through Health Canada programs to increase our ability to respond to the mental health needs in communities, but communities continue to identify to us at every opportunity that they need more. They need more at home. They need more available in the school. They need more available in the health centre, and they need it available in their homes.

Since the transfer we've also created a program called hope, health, and healing. It is a tool kit that supports communities in understanding the resources and strengths they already have to identify what they may need to come to a fuller place of wellness and ability to support those people in distress. We're also working with the B.C. Ministry of Health, the Ministry of Child and Family Development, and other cross-government groups to ensure that whatever programs are out there are culturally safe for the individuals accessing them.

But the stories don't always work. Not so long ago I was called to support a family who had a really disturbing incident occur. They had cut down one of their family members who was trying to hang himself. They called an ambulance. The individual was taken to a hospital about an hour away from the community where he waited for four hours. The family weren't there with him. He waited in triage. He was seen by the emergency doctor, cleared medically, and sent home. He never saw mental health workers. No arrangements for follow-up were done. He had no coat, no shoes, no money, and no way to get home. The family was horrified, and rightly so. The doctors in the emergency room all looked at each other and said, “I thought you did that.” It was obvious at that time that the wraparound service that we talked about in all of our partnership accord discussions wasn't quite hitting the ground yet. So I do work now with doctors in B.C. helping them understand what the situation of those patients is before they walk in and how they need to walk out in way that they are supported and headed towards wellness.

In partnership with the Ministry of Health, we now have 30 projects going on in our communities in the province through something called joint project board, and it was part of the partnership agreement with the Ministry of Health. Many of those projects have a mental wellness focus. We are looking at developing a trauma-informed program to make sure that all of our front-line staff have had significant training and are able to provide trauma-responsive care.

Last, but not least then, as I have very little time left, I just want to say that the services that are available are woefully insufficient, and I am always being called by communities to come to help. But there is only one of me, and there are 203 communities in the province. We need to be able to do this in partnership with our provincial and federal partners, but we need to be able to do it in a systemically organized way and a culturally safe and responsive way that reflects the actual needs of the communities and the people we serve.

Thank you.

[The Chair, Liberal, Andy Fillmore]

Thank you both very much for that. We'll move right into questions from the committee members with the first coming from Mike Bossio, please.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

Thank you, Chair.

Thank you both so much for being here today. I've been going first all day, and I have to say I'm trying to listen to what you're saying, and then trying to devise questions in my mind as I'm going along. So bear with me as I kind of meander through this.

How many resources do you have?

[Dr. Shannon McDonald]

How many resources...?

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

How many bodies do you have working on the initiatives that you are—

[Dr. Shannon McDonald]

Specifically on mental health?

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

Yes, mental health or mental wellness.

[Patricia Vickers]

We're growing.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

I'm glad to hear that.

[Patricia Vickers]

My position was vacant for two years, and I just started on December 1, 2015.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

It was vacant for two years?

[Patricia Vickers]

Yes, looking for someone who, from what I understand, had cultural knowledge and was also a psychotherapist. I had both.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

How many staff do you have as part of your organization?

[Patricia Vickers]

I didn't get that far.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

Sorry.

[Patricia Vickers]

In Indian residential schools, we have Virginia Toulouse, who is the head of that, and Yvonne Rigsby-Jones, who is the addictions specialist and works with the treatment centres in the province. We have Pamela Watson, who's working with youth suicide and also addictions, and right now Meghan Kingwell is on contract working with us on crisis response. We also have five mental wellness advisers who are in the five regions of the province.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

You're not responsible for feet on the ground, but you're responsible for helping to devise the programs that then are delivered through other partnerships with different organizations.

[Patricia Vickers]

Right, but that's slowly changing.

We have the Interior region, which is now hiring counsellors to work in the community, but largely we're referring to services that already exist.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

How many of the people in your organization have an indigenous background?

[Patricia Vickers]

I don't know, I think it's about 20%?

[Dr. Shannon McDonald]

Oh no, it's more than that, we're almost 60 now. One of the other things that happens through the first nations health benefits program, or NIHB, in transition, is that there's also some money for mental health crisis support. Unfortunately, it only allows for 10 one-hour sessions for individuals. Many of the individuals we're speaking of are people who have been really traumatized, and 10 sessions is often only enough to open the door and leave people really vulnerable and without a solution.