Indigenous and Northern Affairs Committee on May 6th, 2022

[Orpah McKenzie]

I can probably speak to that.

I worked as a health director for 10 years, when I first went to KO. That was one of the biggest issues we experienced. There were a lot of issues around travel and being able to be heard, I guess, in the area of providing escorts, especially for the elderly and young children, and also for people who were suffering mental health issues, and those kinds of things. That's what we were hearing.

I know it's still ongoing. We are on the line between the north, Sioux Lookout, and Winnipeg. Many times, when I fly, I see patients who are there. There are young moms who are struggling with small children and the elderly who are struggling to get in and out of planes and stuff. There is no one there to help them or there are inadequate people to help them. The other thing is that, basically, the whole of vision care is uninsured. When you speak about vision care and the lack of services in the communities, that's always been an ongoing thing.

I know that transportation.... I know the Sioux Lookout First Nations Health Authority. I'm a board member there too. We get a lot of complaints from people who are experiencing difficulties in the area of non-insured when they need to travel out for medical care, especially for care that's far from home.

In Thunder Bay, especially for people who have not had the experience of going out and being placed in...especially the hotels. There are hostels there. Even the hostels may sometimes have their issues, but being placed in hotels that are very foreign to them, a very foreign environment, and not having somebody there to provide support for them, has also been a major issue as well.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. McKenzie, and thank you, Ms. Idlout.

We'll start a second round and get as far as we can within the time allotted.

We'll start with Mr. Schmale for five minutes.

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

Thank you very much, Chair.

Thank you to the witnesses for their testimony. It's a very interesting topic we're talking about, and we're hearing more interesting testimony today.

I might start with the First Nations Health Authority. It might be a bit off-topic, but it was kind of brought up in the opening testimony regarding mental health and addictions. I was very interested to hear about your two-eyed seeing program.

Could you expand on that? I know it's a bit off-topic, but I'd love to hear more about that and the results you're having.

[Richard Jock]

Two-eyed seeing is actually a concept that is very broad. It really refers to the ability to deal with the overall Canadian context, but also to see things from a first nations context. It does apply to our approach to mental health. It applies to our medical officers in how we provide our services to first nations people. It applies to the general notion that there's a first nations perspective on health that's equally important as we approach health matters, and that we look at things through that lens.

When we're delivering our programs—and we do have an array of services that have been provided through virtual means because of the pandemic—part of what has been a critical element to that is making sure that our services are culturally grounded. At minimum, the providers have gone through our prerequisites in terms of training, so that we screen out those who are not interested or not capable of providing culturally safe services.

That's a general context. It applies to research, and it applies to data. It really applies quite broadly across what and how we do our services.

Colleen, would you have any additional comments?

[Colleen Erickson]

The first nations people we serve are very much front and centre and remind us quite often that this is the critical part of all our programs, especially in regard to mental health programs, that it has to be applicable to who we are at this moment. Two-eyed seeing is a very critical part of that. It also creates real innovation and.... I'm not sure what the word is, but it very much strikes home to who we are as first nations people and it goes further to the healing. It's much faster.

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

In terms of Indigenous Services, the department itself, how much interaction does your organization have with it?

[Richard Jock]

The partnerships we have include our continued partnership with ISC, the Ministry of Health in the province and also the Ministry of Mental Health and Addictions.

I would say there is an ongoing relationship. We have, for example, a letter of mutual understanding that we sign every year with the ADM of Indigenous Services Canada at the first nations and Inuit health branch. Folks like Valerie Gideon were really instrumental in helping us launch and implement our approach.

I would say there's a continued relationship and a need to address some of the continued systemic barriers that we see and also to deal with the sustainability of our approach.

[Colleen Erickson]

We also have the tripartite agreement, whereby we meet with the federal government and the provincial government twice a year to share what's happening in the FNHA and reaffirm our partnerships.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Schmale.

We'll go to Mr. Powlowski for five minutes.

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

Thank you.

I'd like to address my questions to the two people from NAN.

Before I became a member of Parliament two and a half years ago, I was an emergency room doctor for 17 years in Thunder Bay. Back then you didn't have your program of virtual mental health services. I'm happy to hear you started that, but I want to ask you about the in-person services. I gather you've applied for funding for that, but as of yet you have not received it.

I shouldn't tell you a story, because whatever I say doesn't get in as witness testimony; it's your testimony that does. Working in the Thunder Bay emergency room for a lot of years, there were a number of people who I got to know pretty well because they were pretty consistently in the emergency room. They were people who were homeless, had alcohol addiction problems and were from NAN communities. When I saw them repeatedly and they had increasingly high levels of alcohol, it was pretty clear to me that if something wasn't done quickly, they wouldn't be coming in anymore. It happened pretty frequently with the homeless people that you got to know them, but eventually you'd hear that one of them had died. It was almost always related to alcohol.

I have to say, Thunder Bay emergency didn't do a very good job with these people. Maybe they're doing a better job in the last couple of years, but as far as I know, we did very little. I don't know what addiction and mental health services were available. Detox certainly exists. The nursing stations in the communities exist and there are treatment programs, but I would occasionally phone up the nursing station from the communities these people came from and suggest they should think about flying them back up to their community to try to straighten them out before it was too late. Often, that was the case.

Could you tell me a little bit about what existing programs are available for such people from your communities—often, they're down in Thunder Bay—in order to address their addiction and mental health problems?

[Carl Dalton]

Thank you for your questions.

In terms of what existing programs are available, just recently and throughout the pandemic the communities have taken it upon themselves to build land-based treatment detox centres and wellness centres. Your advice when you were calling up nurses' stations a few years ago, that's exactly what's happening with the building of camps and working away at wellness piece by piece, when they can.

We're also hosting pretty innovative detox programs ourselves that are led by the community or chief and council. We're bringing in health care practitioners. I know that some innovative programs have been renting hotels for a couple of months to do a grand detox and do a lot of community development work in the meantime. By that, I mean they're finding housing for people, making sure there's food and making sure there are opportunities for a family to join them or for care. We're trying to make sure there's an aftercare plan once we go through this piece.

The reality is that many people still go through the public detox system, which means we do our best. We're building the technology to know the wait times for beds. When something opens up, doctors can start to call in and ask for that. That's something an emergency doctor often calls us about. As soon as we started the program, we heard from doctors right away in the hospitals. We started to pick up some of the aftercare so that, when they were released, there at least was a contact.

In the last two months, we've had a proof of concept with delivering in-person services under the NAN Hope piece. We have a lot of virtual care navigation, but we actually have people in the urban centres now who can go and pick people up after an emergency, get them to a hostel or housing component, and make sure they have food. We've had great feedback in the last two months. We applied for a year's funding and we received two months—

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

Who did you apply to for the funding?

[Carl Dalton]

The federal government had public health measure surge capacity funding available to us, which we were made aware of. We worked together with our partners to apply for it.

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

You're certainly welcome to follow up with my office. I can kind of follow up with that and try to encourage the government to do that.

The other thing—

[The Chair, Liberal, Marc Garneau]

Mr. Powlowski, we're at our limit, unfortunately.

Go ahead, Mrs. Gill. You have two and a half minutes.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

I'd like to ask Ms. Messier another question. Earlier, she mentioned the idea of improving communications, collaboration and consultation between all parties. She named the federal government, among others, but also the Government of Quebec and the first nations. I would simply like her to tell us more about that.

[Jessie Messier]

Clearly, right now it's essential that mechanisms be put in place to facilitate the creation of a true continuum of care. The fact is, each province has a health care network in place, and it's often the primary network providing primary, secondary and tertiary services. This network provides some services in its facilities that are funded by the provincial government. There is no real connection between services, when patients are discharged, for example, to facilitate the continuum of care. Therefore, no link is necessarily made with the community. The workers who release patients are not necessarily aware of the services the federal government provides. Sometimes people will leave the facility without the proper dressings, and it can take a while for authorizations to come through.

Therefore, I think we need some reflection on that, so that each of the stakeholders can play their role. The federal and provincial governments have a role to play, but the communities also have a central role to play. We need to make sure that we optimize the involvement of each of the stakeholders to be able to create a true continuum of care, so that patients don't run into barriers when they have to navigate a system to receive care. That system really needs to break down all the barriers that patients can face when multiple jurisdictions are involved.

[Marilène Gill, Bloc, Manicouagan, QC]

Ms. Messier, I'd like to ask you another question about health care funding.

We know that health care gaps currently exist in Quebec and any of the provinces. Do you feel that increasing health transfers could also be beneficial to first nations people? This does not preclude my question about all the other changes that should be made. Having said that, do you believe that an increase in health transfers could have a positive impact on first nations people?

[Jessie Messier]

It could have a positive impact, as long as it comes with an obligation for the provincial government to provide real services to first nations. Currently, the Quebec government doesn't offer any services within first nations communities, except for medical services. I exclude the Cree Nation from this, because it has a special agreement with the province. With respect to the other first nations communities, the government does not provide occupational therapists or other health care professionals within the communities, for example.

So we can increase the budget, but if it doesn't come with a real commitment from the provincial government to provide meaningful services to first nations people, regardless of where they live, the impact may not be as great.

[The Chair, Liberal, Marc Garneau]

Thank you, Mrs. Gill.

Ms. Idlout will finish off the round of questions.

Ms. Idlout, you have two and a half minutes.

[Lori Idlout, NDP, Nunavut, NU]

Thank you so much.

I just have a quick question to follow up on MP Powlowski's questions and experience as a doctor, and what I'm sure is much of the experience of the health care system that provides services to first nations, Métis and Inuit.

Would each witness agree with me that what they experience as service providers when they see first nations, Métis and Inuit patients is the direct result of the deep impacts of colonialism? Because of that direct impact of colonialism, it is now more important than ever that the federal government has the responsibility to provide holistic, culturally appropriate and sustainable funding to address these mental health issues so that we can ensure that the impacts of colonialism are being reduced.

Qujannamiik.

[The Chair, Liberal, Marc Garneau]

Thank you.

It's a big question, but please give short answers. We'll start with the FNHA.

[Richard Jock]

I would just say that there are two aspects to colonialism. One of them is that you really need to focus on the residential school context and to realize that we need to look at trauma-based services, that we need to refocus much of what we do to look at nation-based approaches and to have these models of trauma-based services and healing. I think this is totally consistent with the Truth and Reconciliation Commission, but I would say it is also based on what we're experiencing here in B.C. with Tk'emlúps and their discovery of 215 graves. Also, this is really widespread and affecting every community in B.C., and I would assume across Canada.

Colleen.

[Colleen Erickson]

I would just concur with your comments, Richard, and just say that the FNHA has, since the discovery of the graves, had to be very diligent in our partnerships with the ministries and with all agencies to deal with the crisis that was before us. I think that, going back to two-eyed seeing and the fact that we see things and we deliver innovative programs that are designed to address colonial structures and the institutionalized programs that we received, they've been innovated. I think that our response has been a little bit more comprehensive.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Erickson.

Did you want to add something, Ms. Messier?