Indigenous and Northern Affairs Committee on April 29th, 2022

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Does that NAN program have funding from NIHB and would they be willing to finance something similar in your communities?

[Vice-Chief David Pratt]

They may use them if there's an attempt. They provide the individuals, if they are not successful with the wraparound supports that they need....

I believe the choose life program was funded by ISC and partially by the first nations and Inuit health branch. However, I believe they are now using a prevention program to create these life centres in each of their first nations.

I don't want to speak on behalf of my good friend, Chief Derek Fox, but I recognize a good program that's working for them. We need to look at that and incorporate it all across our regions. We will see the numbers come down, and we will be able to provide those supports to each of our member nations.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Quickly, you talked about people opting out of NIHB. I can see that people might get frustrated having to deal with the bureaucracy and getting paid through NIHB, but doctors aren't allowed to opt out of the publicly funded health care system.

Should people be allowed to opt out of the NIHB?

[Vice-Chief David Pratt]

I don't think so.

I will give you an example right now. Some optometrists in the Saskatchewan region are no longer taking NIHB. People have to prepay and then they have to submit their receipts to NIHB, because the optometrists will no longer submit them for them. That's one example of a broken system that needs to be fixed.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Would you agree that we shouldn't allow people to opt out of NIHB?

[Vice-Chief David Pratt]

No. I don't think people should be allowed to opt out of NIHB.

A lot of the time, they look at our own independent job service health programs first, before they even go to NIHB as a last resort. I guess it's because of the challenges of getting paid, or whatever the issues are there.

The system needs reform. I believe we can fix it if we work together on it, but the government needs the bureaucracy to step back and listen to the experts on the ground who know the issues that are going on with first nations people.

Meegwetch.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

If I have any time, Natan, do you have any response to allowing people to opt out of NIHB?

[Natan Obed]

Thanks for the question.

This is one of the great concerns about the way in which NIHB is delivered across Inuit Nunangat and across Canada for eligible Inuit. I would imagine it's the same for first nations and Métis.

Depending on the service provider, you might have to pay up front. Maybe it's the pharmacy, the optometrist or the dentist. In other cases, there is a wraparound system, so the client, the person who is eligible for a service, doesn't have to pay any upfront costs and the system takes care of that. It depends on where you are in the country, and that is entirely inequitable, especially when we're dealing with a population that has such poverty as the Inuit population, in relation to other Canadians.

Sometimes Inuit don't have credit cards or other methods of payment, so if they are in a setting where they would have to pay for their dentist or their glasses out of pocket, that is a huge barrier to accessing health care, and it's health care that they are eligible for. That is entirely inequitable.

This program should be reformed to ensure that those types of scenarios don't happen.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

Mrs. Gill, the floor is now yours for two and a half minutes.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

Earlier, I asked a question about traditional counsellors. Mr. Pratt generously agreed to answer and, of course, I would also have liked to hear the comments of Mr. Obed and Ms. Caron, who represent the Inuit nation and the Métis, respectively.

I therefore give them the floor.

[The Chair, Liberal, Marc Garneau]

Mr. Obed, if you remember the question, why don't you go first?

[Natan Obed]

Yes. I believe this was in relation to traditional counsellors.

There are many different types of mental health services that can help an individual. From an Inuit perspective, there are clinical mental health services that some Inuit may need, and then there are more traditional or culturally specific mental health supports and services that Inuit need. Those two systems can live together and support one another in a diagnosis and in treatment. In many cases, the decision-making about the cost for those and whether or not an individual is eligible has not been equitable.

We are seeing the federal government recognize Inuit cultural and technical mental health supports in a much broader way than we did prior to the Indian Residential School Settlement Agreement and the programs that were mandated out of that particular settlement. We have seen over a decade of Inuit-specific mental health supports and services being provided through federal funds that have helped thousands of Inuit.

We hope that the NIHB program can seamlessly accept those types of mental health supports alongside clinical supports.

[The Chair, Liberal, Marc Garneau]

Thank you.

Ms. Caron, would you like to add anything?

Did you want to respond to that question?

[Cassidy Caron]

Yes. There are a lot of Métis health researchers across the Métis homeland right now, and they're doing a lot of looking into and researching access to health services for Métis people. They're looking into different areas, specifically in mental health or other types of services, and largely, the number one recommendation that's coming out of those research reports is the need for more Métis health care providers. That means actual Métis people entering the health care or mental health care profession to be able to weave our ways of knowing into these systems in ways that work for our people, to deliver culturally responsive and culturally safe care to our people.

For example, we recently travelled over to Rome to meet with the Pope. We brought a Métis psychotherapist with us. That person has been trained in the western ways of clinical psychotherapy; however, being a Métis woman herself and a practitioner of our traditional ways, she weaves those pieces into the systems of working with our people in a way that traditional health care systems do not and cannot.

It largely comes from increasing supports to promote the health care profession with our people and within our communities, and I think that's a model we can look at, extending health care education into our communities so that people are wanting to go toward those paths.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

We'll conclude with Ms. Idlout. You have two and a half minutes.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut as follows:]

ᖁᔭᓐᓇᒦᒃ ᐋ ᑕᒪᑦᓯ ᑭᐅᔪᓐᓇᕈᑦᓯ ᐋ ᓇᑖᓐ ᐱᒋᐊᕐᓗᓂᖃᐃ, ᖃᓄᕐᓕ ᐃᓱᒪᕕᑦ ᓄᓇᖃᖅᑳᖅᓯᒪᔪᐃᑦ ᐃᓅᓯᖃᑦᓯᐊᕈᑎᖏᑦ ᐱᐅᓯᕚᓪᓕᕋᔭᕐᒪᖔᑦᑕ ᐋ ᑖᒃᑯᐊ ᓄᓇᖃᖅᑳᖅᓯᒪᔪᐃᑦ ᐃᓅᓯᓕᕆᔩᑦ ᐊᑭᓕᖅᑐᖅᑕᐅᖃᑕᐅᓐᓂᖅᐸᑕ ᐋ ᓇᓕᒧᔪᒥᒃ ᑖᒃᑯᐊ ᖃᓪᓗᓈᑎᑐᑦ ᐃᓕᓐᓂᐊᖅᓯᒪᔪᕕᓃᑦ ᐃᑲᔪᖅᑏᑦ ᑕᐃᒫᑎᒋ ᑕᐃᒫᑎᒋ.

[Inuktitut text interpreted as follows:]

Thank you for your reply. Could you all respond to me, with Natan first?

What do you think of aboriginal people? Would their lives improve regarding mental health issues if the aboriginal counsellors were paid like mental health workers and were recognized like mental health workers?

[English]

[Natan Obed]

Absolutely. The services that, in our case, Inuit counsellors provide, provide just as much support as the clinical services provided by non-indigenous people and also are just as complex. They rely on just as much knowledge. It's just that it has been passed down or the people have learned it in a very different way. So, absolutely, much more work needs to be done to ensure pay equity and basic recognition of Inuit counsellors.

[Cassidy Caron]

I have nothing more to add. I absolutely agree with everything President Obed just said within the Métis context.

[Vice-Chief David Pratt]

I totally concur with President Obed. Definitely, we need our people to be recognized. I'll give you an example here. With the funded FNIHB, non-insured health benefits, for mental health counsellors here in Saskatchewan there is a list where you have to declare, you do your services and you submit billing. There's an example we're dealing with right now with a traditional healer who listed herself as a psychotherapist prior but now changed the designation of her position and her practice as a spiritual healer. Now, because she changed the designation of her title, there's an issue with FNIHB or non-insured health benefits not paying her. We're actually dealing with that right now as we speak—our staff at FSIN.

There are issues around that. If she had a Ph.D., or a mental health master's, psychologist, boom, no problem, she'd paid right away, but the minute she changed her designation on the NIHB list of qualified mental health therapists, she was denied billing. It's an issue that has to be addressed. We have to reform this system, members of Parliament. We have to get this right and to make sure that our two systems can exist side by side with mutual respect and not one being higher than the other or recognized as superior. Thank you. Meegwetch.

[The Chair, Liberal, Marc Garneau]

Thank you very much, Ms. Idlout.

That brings our panel to a close.

On behalf of the committee, I'd like to thank Vice-Chief David Pratt, President Obed and President Caron for your testimony today. Thank you for answering the questions on our study of the NIHB. You were the kickoff meeting, a very important meeting. We very much appreciate your taking the time to be with us today.

We'll now suspend momentarily, so that we can go in camera and continue with committee business.

Thank you very much.

[Proceedings continue in camera]