Indigenous and Northern Affairs Committee on May 10th, 2022

[Marg Friesen]

Maarsii for the question.

To answer your question really succinctly, the program that we initiated was through COVID, and it was sustained by COVID support funds. It's not sustainable at this time, because of course the COVID support funds have been depleted. We've done very well to introduce that medical transportation, but as I mentioned earlier, there is a significant need. This project demonstrated the fact that people need access to medical transportation.

As you are aware—you're from Saskatchewan—there is no longer a public transportation system, so people have to rely on friends and family to get them to their medical appointments in an urban centre. Sometimes it's eight hours away, so that's a barrier. The geography and the lack of public transportation are definitely barriers. We are looking for more sustainable, committed funding for medical transportation.

[The Chair, Liberal, Marc Garneau]

Thank you.

Next is Mr. McLeod.

[Michael McLeod, Liberal, Northwest Territories, NT]

Thank you, Mr. Chair.

Thank you to everybody who presented here. As a Métis person, I was getting a little nervous when you started talking about Métis citizens dying earlier than the rest of Canadians.

[Voices]

Oh, oh!

[Michael McLeod, Liberal, Northwest Territories, NT]

In the Northwest Territories, we're in a little bit of a different situation, because we do have Métis Health, and it's a good program. It's oversubscribed, but every community also has compassionate travel.

We heard from the NWT Métis Nation here several meetings ago, when they talked about housing. Now, housing money has flowed to the national indigenous organizations. The NIOs have received money, but the NWT Métis Nation didn't get any of the housing money.

If the government decides to have money flow to the national indigenous organizations, which one of your organizations would get money? Could you give us just a short answer?

[The Chair, Liberal, Marc Garneau]

Is that directed at a particular person?

[Michael McLeod, Liberal, Northwest Territories, NT]

To all three—

[The Chair, Liberal, Marc Garneau]

No. We only have time for one.

[Michael McLeod, Liberal, Northwest Territories, NT]

Okay. It's for the Alberta guy, Lee.

[The Chair, Liberal, Marc Garneau]

All right, Mr. Thom. It's for you.

[Lee Thom]

Right now, for the Métis settlements, we don't have a national representation. We have a president who advocates for us and a lobbyist group in Ottawa. We are not included in that funding. Any funding that comes to Alberta through our MNA, our region, is not shared, and that's the truth of the matter. We don't get it.

As controversial as that might sound, it is what it is. I think we need to change our times and we need to focus on listening to land-based Métis. Our settlements are communities—living, breathing—with roads, schools and water, with everything that comes with a small municipality and are in dire need of funding. Right now, we are under-represented in Ottawa.

[The Chair, Liberal, Marc Garneau]

Thank you.

Go ahead, Mrs. Gill.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

Ms. Friesen, we talked about inequity. The lack of recognition is, of course, a huge inequity. You also mentioned a number of times how difficult it was to access care because of geography and the remoteness of communities.

Can you talk more about how geography makes it harder for people to access health care and what other effects it can have?

[Marg Friesen]

Thank you for that question.

Geography does play a great factor in accessing primary health care, acute health care and ongoing treatments for health and well-being. The approach we've taken is the same as that of both my Métis colleagues across the country. As Ms. Chartrand has stated, leave no Métis behind. It is the same as Lee has stated: Leave no Métis behind.

We would like equitable.... Just take medical transportation as an example. Yes, we would like it to be equitable so that if you live in the Far North you have access to a medical taxi, medical transportation or an ambulance to bring you to a centre where your needs are going to be cared for and where your health care is going to be addressed.

We would have more prevention and screening for people whose health needs may be undiagnosed, and where people are diagnosed too late we would like to prevent that from happening. Yes, they accept the treatment, but maybe not because it's too far to travel.

We need cancer spaces, cancer lodges, for community members and their families, their caregivers, to be able come to an urban centre where they can comfortably receive their treatment, live their life through their cancer journey and be well cared for.

[The Chair, Liberal, Marc Garneau]

Thank you.

Ms. Idlout, did you have a question?

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

I have no questions at the moment. I just want to thank you for your wonderful presentations, all of you.

It's become very clear that you have been left behind and there's a lot of catch-up you have to do. Do you have any final things to say to us? I would like to hear from you what's really important to you.

[Marg Friesen]

Maarsii for the comment.

We would like to be an equal partner at the table when we are discussing health care and non-insured health benefits for Métis citizens in Saskatchewan. We represent the government of Métis Nation in Saskatchewan. However, our citizens are saying this is a top priority for us. We would like to be able to sit at the table as an equal partner and not be left out of the conversation or the commitment or the financial obligations for indigenous peoples of this country.

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you very much. That brings our question period to an end.

I'm sorry it was not any longer, but I'd like to thank Mr. Lee Thom for being with us. I'd like to thank Minister Chartrand and Minister Friesen and her colleague, Adel Panahi, for your testimony today and for answering our questions. This is an extremely important and serious subject, and we very much appreciate your input and your frankness with us today. Thank you for coming. I hope you found it worthwhile.

With that, we will suspend momentarily and get ready for the next panel. Thank you very much.

[The Chair, Liberal, Marc Garneau]

Colleagues, we're now going to begin our second panel. This evening we have three witnesses and I'll name them. We have Rudy Malak, a pharmacist at Little Current Guardian Pharmacy who is here as an individual. We also have Angela Grier, who is with us in the room.

She is the lead for indigenous initiatives with the Canadian Counselling and Psychotherapy Association.

She's also here as an individual. Finally, we have Marceline Tshernish.

She is the director of the health sector for the Innu Takuaikan Uashat Mak Mani-Utenam community.

She is with us virtually this afternoon. I hope I didn't mess that up too much.

I would like to welcome our three witnesses as we continue our study on non-insured health benefits. We are really looking forward to your perspective.

I will ask Mr. Rudy Malak to speak first, and then the other two. You have five minutes.

Mr. Malak, if you are ready, you can start your presentation now.

[Rudy Malak, Pharmacist, Little Current Guardian Pharmacy, As an Individual]

Hello. Good afternoon, and thank you for having me today.

My name is Rudy Malak. I'm a pharmacist and one of the owners of three pharmacies on Manitoulin Island. I'm joining you today virtually from Manitoulin Island, which is the ancestral home of six of the Anishinabe first nations.

Thank you for the invitation to appear before the committee and to participate in the study of administration and accessibility of indigenous peoples to the non-insured health benefits program. I hope I can provide useful information that can be considered to improve the program and provide easier and quicker access to care for people who are in need.

I'm here to highlight some of the hardships that people go through to get the care that they need. Some of the things I'd like to discuss that delay access to care in the pharmacy world include the prior approval processes. There are limits to a number of eligible products and, sometimes, there are permanent conditions. Things should be indefinitely approved, especially if it's a permanent condition. Examples of that are ostomy supplies and having to renew them every three months.

Another [Technical difficulty—Editor] are the special authorizations processes. Some medications have limited-use paperwork involved. Examples are prescriptions written at an emergency department or prescriptions for chronic conditions.

Another thing that delays access to care is the wound assessment processes, which are very difficult to fill out and get approved. An example of that is that we deal with acute open wounds, but the process to fill out the paperwork for NIHB to accept it could take hours, weeks or days, so it's a very long process to get approved.

Another example is the diabetic flash glucose monitoring system. It is not covered, and I assume it's due to funding. Reducing complications of diabetes early will save a lot in the future. I believe the limiting factor is funding and allocation, but a lot of money would be saved in the long run if we reduced the burden on the health care system. That can be done through primary prevention and intervening before health effects occur.

Early education about health can prevent short- and long-term impacts. Continuity of care once diagnosed or discharged will reduce costs and improve outcomes. Home care will improve the quality to the individual and reduce hospital readmissions. Removing red tape that hinders progress will make things easier.

Due to the complexity in the processes and procedures, a lot of pharmacies are not able to serve NIHB clients. This is because of the time needed to complete one task, or because of the lack of funding to the provider. A major part of the day is spent dealing with a lot of paperwork or on the phone trying to get something approved, instead of providing direct patient care.

I'm sure every department and committee would like to provide the best possible care to our most vulnerable patients, but the amount of paperwork, phone calls and bureaucracy involved makes everything difficult, time consuming and financially not feasible.

I'm here to express my opinion and relay information of what happens at the pharmacy level on a day-to-day basis. I'm passionate about helping people and trying to provide the best possible care and service that I possibly can. I would like people to have a dignified life. A person who is already sick or has a medical condition should not have to worry about paperwork, approval processes, coverage discrepancies, expiry of approvals, etc. All that does is make them lose hope in the system.

I've only listed a few examples that may delay patient care. I'll leave the rest of the time to clarify or to answer any questions you may have.

Again, thank you for the opportunity to join you today.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Malak.

We'll now to go Ms. Grier.

You have five minutes.

[Angela Grier, Lead, Indigenous Initiatives, Canadian Counselling and Psychotherapy Association]

[Witness spoke in the Blackfoot language]

[English]

Thank you, Mr. Chair. I extend my appreciation for the invitation to participate today.

My name is Angela Grier, and I'm a proud member of the Piikani first nation of the Blackfoot Confederacy, where Alberta and Montana are situated. I'm the indigenous initiatives lead for the Canadian Counselling and Psychotherapy Association, CCPA, and a mental health practitioner whose career has spanned over 25 years working with indigenous peoples and communities.

I'm here to speak to the important issue of first nations' mental health and the current barriers to care upheld by the federal government since 2015.

In 2015 CCPA's Canadian-certified counsellors, CCCs, were delisted as mental health practitioners from the non-insured health benefits program, NIHB, for first nations and Inuit in provinces that had not yet regulated the profession of counselling. As a result, access to essential mental health services was restricted depending upon the province of residence.

Section 91(24) of the Constitution Acts 1867 to 1982 says the federal government has jurisdiction over “Indians, and Lands reserved for the Indians”, and this includes health. However, deferring to provincial regulatory authority and status to determine eligibility of mental health providers is unconstitutional.

In doing so, the federal government is excluding qualified and competent providers and creating a Jordan's principle scenario in which first nations peoples are falling through the cracks. By restricting access to CCCs, who are currently eligible providers in other federal health benefit programs as well as in the First Nations Health Authority, which is NIHB's counterpart in British Columbia, the federal government is not providing equitable access to mental health care for all indigenous peoples, nor at the same standard as they are providing it to non-indigenous Canadians. This policy also discriminates against CCCs who are first nations or indigenous practitioners like me.

As NIHB is the primary source of mental health funding, many cannot practise in their communities or traditional territories. The mental health needs of indigenous peoples are higher than average due to the harms brought about by colonization, residential schools, the sixties scoop and the reservation system. The TRC's calls to actions, UNDRIP and the national inquiry on MMIWG all call for an increase in access to mental health supports.

Early intervention is key to preventing substantial costs downstream. We know this. Related to delayed or lack of diagnosis, deterioration on wait-lists, psychiatric hospitalizations, medications, dependency issues and loss of life, indigenous people are twice as likely to reach out for mental health supports. The mental health component of the NIHB program is seeing the fastest growth. This highlights the significant need for intervention and prevention from culturally competent Canadian-certified counsellors.

These CCCs are an integral part of a solution to address this mental health crisis. They hold a master's degree, go through a rigorous evaluation and adhere to a robust code of ethics, including a section on working with indigenous peoples, communities and contexts. It's among the first of its kind.

In Treaty 7 alone, which is my treaty area, our first nations communities of Piikani, Kainia, Siksika, Tsuut’ina and the three Stoney-Nakoda nations work tirelessly to combat chronically acute health environments upheld by Canada's inequitable policies. The toll on staff, communities and clients includes pushing beyond human levels into toxic levels of stress to merely survive. Surviving is not thriving.

Our daily losses to the opioid war alongside leading global suicide rates indicate the maladaptive experience since contact. We were in pandemic states long before COVID-19. Help is needed now to save lives.

Mr. Chair, in the interest of equitable access to mental health services for indigenous peoples, CCPA urges the indigenous affairs committee to recommend that Indigenous Services Canada immediately reinstate CCCs in unregulated provinces under the NIHB program. This will add close to 1,500 providers in Alberta, Manitoba, Saskatchewan and Newfoundland and Labrador.

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Grier.

We'll now go to Ms. Tshernish.

Ms. Tshernish, you have five minutes.

[Marceline Tshernish, Director, Health Sector, Innu Takuaikan Uashat Mak Mani-Utenam]

Thank you for inviting me to speak to you today.

My name is Marceline Tshernish, and I am Innu. I belong to the Uashat Mak Mani-Utenam community, on the north shore. I am the director of the health sector, and I am here representing my organization, Innu Takuaikan Uashat Mak Mani-Utenam, or ITUM.

During my presentation, I will focus on some of the challenges around health care accessibility faced by members of my community, especially those families who are most vulnerable. The main challenges we face as members of first nations revolve around health care and services, as well as access to information regarding the benefits available to first nations communities.

The process to access health benefits is onerous, and the wait times, significant. Those wait times affect the quality of care received by community members. The red tape involved in accessing health benefits contributes to a lower quality of life for first nations members, who have to go through two levels of government in order to access care and services. For care that is not covered by the Régie de l'assurance maladie du Québec, members have to turn to the NIHB program for first nations and Inuit, and submit another claim. If their claim is denied, they have to initiate an appeal process, which is extremely complex, both for patients and for health care professionals. They may have to go through a number of steps and appeals.

As Mr. Malak pointed out, access to pharmaceuticals is a tremendous challenge for members of my community. The approval process for exception drugs under the NIHB program is hard to understand and involves so much red tape that it erodes access to pharmaceuticals, in contrast with the provincial process and system that apply to the rest of Quebec's population. This highlights the inequity between the two jurisdictions.

Access to information related to the benefits procedure is also a challenge for members of my community.

Mr. Malak gave examples of what members of the population experience when trying to access medical supplies and equipment. Generally speaking, these are patients with permanent conditions, who have to go through the claims process over and over again to access the care and basic equipment they need. That is extremely onerous.

In addition, when patients do receive information, it is often quite incomplete. The procedure for the supporting documents patients have to provide is not explained clearly. I would also say that the health care professionals, themselves, do not fully understand the procedures for the NIHB program.

Palliative care is another example where patients face restrictions in accessing pharmaceuticals. When a physician prescribes a medication such as a narcotic to alleviate pain, the pharmacy receives the prescription and must then send the physician a palliative care form to fill out and return. Finally, the pharmacy has to send the completed form to the NIHB program. That gives you a sense of the extensive red tape involved before the suffering of a patient at the end of life can be alleviated. In some cases, it can take up to 48 hours for the patient to receive the medication.

Now, I would like to turn to another aspect of the NIHB program, medical transportation. In Uashat Mak Mani-Utenam, we provide the coordination for that part of the program, but it is underfunded and coverage is limited.

We have neither the ability to tailor the eligibility criteria so that the services meet the needs of first nations members nor the ability to provide culturally safe services.

In many ways, the cultural safety dimension of health care is ignored because the eligibility criteria do not take into account the holistic approach advocated by first nations, including in relation to escort claims.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Tshernish.

If you would kindly wrap up your remarks, it would be appreciated.