Indigenous and Northern Affairs Committee on May 6th, 2022

[Jessie Messier]

In closing, we believe that efforts must be made to support first nations in asserting their self‑determination. The necessary support and resources must be made available to them to analyze and improve the current service offering and, therefore, eliminate any form of systemic discrimination toward our populations.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Messier.

I would like to give everyone a quick reminder. I know there's a lot to say, but it's important not to speak too quickly because we must allow our interpreters to do their job.

We'll now go to the third group.

Mr. Carl Dalton and Orpah McKenzie, you're in the room. You have five minutes for whichever one of you wishes to speak.

Thank you.

[Orpah McKenzie, Director, Keewaytinook Okimakanak eHealth Telemedicine Services, Nishnawbe Aski Mental Health and Addictions Support Access Program]

[Witness spoke in Severn Ojibwa]

[English]

I greet all the people who are joining us from a distance and all those here as well.

I'm asking the Lord to help us and bless us. I thank Him that He's given us a beautiful day today. I thank Him also for health and well-being.

Good afternoon.

We are honoured to have the opportunity to appear before you today to share the incredible effort of the NAN Hope mental health and addictions support access program in providing care to the 49 communities of the Nishnawbe Aski Nation in northern Ontario.

My name is Orpah McKenzie. I am the director of e-health services at Keewaytinook Okimakanak eHealth Telemedicine, a provincially integrated telemedicine network that provides access to thousands of physicians, nurses and allied health care providers for 26 NAN communities. I am joined by Carl Dalton, CEO of Dalton Associates, a mental health organization that offers a culturally safe and attuned clinical workforce as well as mental health program development and management expertise. In partnership, our organizations designed and deliver NAN Hope.

NAN Hope began as an innovation in response to the NAN COVID-19 task team’s investigations that revealed a high need for mental health and addictions support for the NAN region, given the challenges that were caused or exacerbated by the pandemic and resultant restrictions. To this day, NAN Hope is the only NAN-wide mental health and addiction support program, and we are honoured to have served over 1,000 NAN citizens since launching in August 2020.

NAN Hope strives to create a safe and trusting environment for the people and communities we serve. The fact that NAN Hope has been able to grow and expand is precisely because we have worked hard to build trust and shared care within the NAN region and have proven ourselves to be exceptionally responsive when needs arise that impact mental health and addictions at a community or individual level.

I'll turn it over to Carl.

[Carl Dalton, Chief Executive Officer, Dalton Associates, Nishnawbe Aski Mental Health and Addictions Support Access Program]

To meet the needs of NAN citizens in both remote and urban settings, NAN Hope offers a virtual, holistic, rapid-access approach to mental health, addictions and crisis support that is available 24 hours a day, seven days a week and 365 days a year by telephone, web chat, video and text messages.

NAN citizens have immediate access to crisis counselling, long-term counselling, navigation assistance and ongoing case management, all of which has resulted in our ability to save lives in real time in partnership with our community partners.

Our program is distinct from many existing services because we maintain relationships with clients, remote nursing stations, doctors and community-based organizations. We accept referrals and conduct outreach. We don't wait for calls to come in.

We offer barrier-free services in English, Ojibwa, Oji-Cree and Cree. We have a strong roster of respected and experienced counsellors, many of whom are indigenous and all of whom are regulated health professionals or trained in indigenous cultural healing and helping practices. Uniquely, NAN Hope also hosts regular virtual healing circles and virtual community cultural gatherings, which have been well attended during the pandemic time.

Currently, we are launching a mapping tool on the NAN Hope website, after having extensively mapped existing local and regional mental health and addictions services. This will take the onus from NAN citizens who must often navigate confusing pathways to access services in settings outside of their homes. With this application, we can better fill gaps, ensure against duplication and identify existing services.

In addition to the virtual support offered by NAN Hope, we do receive calls from communities for in-person mental health services. Recently, we received some additional funding to answer this call. However, our request to extend that funding and to continue offering in-person services in remote communities that are in crisis has not yet been approved. We recommend that the Government of Canada invest in the growth of NAN Hope, so that we can deliver critical crisis and mental health services in remote or fly-in communities when called to do so.

We wish to own space to deliver services in the urban centres of Thunder Bay, central Ontario and Timmins, Ontario—where many NAN citizens reside—to receive in-person services and primary health care services.

NAN Hope was originally funded for only one year; however, we have obtained an extension to March 31, 2024. We are grateful for the additional two years of funding. However, we would like assurance that we're putting infrastructure in place over these years to deliver a longer-term mental health and addictions support access program in the north. We request longer-term, increased funding for at least five years to allow NAN Hope to truly take root, grow and gain sustainability.

We appreciate your time and attention to these critical matters. This is an essential next step for continuity of mental health care in the NAN region.

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Dalton.

We'll now proceed to a round of questions, beginning with the Conservatives.

I believe it's Mr. Shields for six minutes.

[Martin Shields, Conservative, Bow River, AB]

Thank you, Mr. Chair.

Thank you to the witnesses for being here today and for sharing their information and stories with us.

I would like to go to the witnesses here in the room who just finished.

You used words like “trust”, “shared”, “relationships”, “referral” and “outreach”. Obviously, there must have been some groundwork ahead of time on what you've done before you started this program. This just didn't start out of the blue.

You have developed these things before. Is that right?

[Orpah McKenzie]

Yes.

There were established partnerships from KO eHealth. KO has been in existence for about 30 years already, so we do have an established relationship with some of the communities. I would say there are about 26, at least for those we currently have telemedicine sites in. Telemedicine was established about 20 years ago.

[Martin Shields, Conservative, Bow River, AB]

Right, so you've done a lot of the work in the past, which allowed you to take the next step.

You ended talking about funding, in the sense that you're program funded and you need more of a guarantee of that funding. It's one of the things that I do talk about on this committee.

You're talking about a program that's taken years of work to get to the stage where you are implementing the next stage, but funding is the key for this to continue.

[Carl Dalton]

That's correct. We have built relationships for the last 25 years, and we work in remote communities in different ways alongside community members. When the pandemic happened, there was a COVID-19 mental wellness task team representing communities across the NAN region. They made a request, at that time, to the federal government for a pandemic fund for, essentially, a 24-7 crisis service, and we entered into that.

That service gained and built trust over that year, and was probably needed for many years before this. As the uptake and partnerships grow, there's a consistent call for service from the communities themselves—both urban and remote communities.

[Martin Shields, Conservative, Bow River, AB]

The need was there. You developed a program that was beginning to work and you have outcomes that are working. You have some positive outcomes, but the challenge now is understanding how you're going to fund this ongoing. That's what you're facing.

[Carl Dalton]

That's correct. We've heard clear feedback, and we believe this program should stick around for many years to come and continue to evolve and be responsive to the needs of the communities.

[Martin Shields, Conservative, Bow River, AB]

You established it with the sense of mental health and addictions. Those are huge and growing problems.

[Carl Dalton]

That's correct.

[Martin Shields, Conservative, Bow River, AB]

You identified it and you found a solution.

Do you find other people coming to you and asking how you did this?

[Carl Dalton]

Yes. We worked with the government and communities to get the funding approved, and we started the program in 30 days, sir.

[Martin Shields, Conservative, Bow River, AB]

You started it in 30 days.

[Carl Dalton]

Within 30 days, we had the counsellors and workforce available, and we built the infrastructure. It evolved over time so that, now, not only are the communities reaching out for services but well-trained, experienced indigenous clinicians are reaching out to us and asking how they can be a part of it.

[Martin Shields, Conservative, Bow River, AB]

You mentioned that a number of indigenous people who understand the cultures, communities and geography are involved in this. Are you attracting more, as you say, to these types of programs?

[Carl Dalton]

Yes, I think we're appealing to a workforce that is there, but they want to use their own choices and voices, because they know how community operations happen. They know how healing happens. They want a say in that. Our program allows for that flexibility, and for a responsive budget rather than a strict mandate.

[Martin Shields, Conservative, Bow River, AB]

It's proactive in the sense that this is going to lessen the costs in the future, as well as save lives. That's what you're looking at.

[Carl Dalton]

That's correct.

[Martin Shields, Conservative, Bow River, AB]

That's fantastic.

Thank you, Mr. Chair.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Shields.

We'll now go to Mr. Weiler.

You have six minutes.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Thank you, Mr. Chair.

I'd also like to thank the witnesses for joining us today to provide their knowledge and experience to today's important meeting and to the study we're doing.

I'd like to begin by acknowledging that I'm streaming from the ancestral, unceded territory of the Musqueam, Squamish and Tsleil-Waututh peoples.

We were quite fortunate, earlier this week, to have Dr. Evan Adams join our committee to share some of his thoughts on his lived experience in the early days of establishing the FNHA. However, I'm very interested today to hear from Ms. Erickson and Mr. Jock about the FNHA's experience in delivering health care with your approach focused on wellness.

Maybe we can start with a general question. Perhaps you could describe the experience of the FNHA in delivering the non-insured health benefits program in British Columbia.

[Richard Jock]

One of the key elements is trying to focus on the patient, the client, the person. I would say what we've done with the immediate set of transformations is base our work on that and make the work accessible and transparent. The pharmacare program is one that we have designed in partnership with the provincial government, which mirrors the types of therapeutics that are available to all people in B.C. The other part of that is that we also still own our program and we are able to adjust that program to our specific needs and interests. I would say that's one aspect.

With dental and pharmacy, what we've done is work with providers. One of the things we've been able to do is get the almost universal buy-in of the providers for this. We have also moved from a very slow and cumbersome paper process to electronic processing. We follow 100% of the fee guide, and it's one that, as I said, is done in partnership with and fully endorsed by the dental association of B.C. Those kinds of relationships are also important.

Simple or smaller things, like eyeglasses, and transforming them so that there are no longer waits or predeterminations enables quicker access to things that are really needed.

I would say that's been our approach. It has taken time and it requires us to have a continued partnership with the national program, because there are some areas that continue to need resolution, and there are new things like devices, which were mentioned earlier, as well as things like new drugs and biologics, which are new and very expensive. We need to look at ongoing and future solutions if we're going to have a sustainable approach to this.