Thank you, Member for Yellowknife North. Minister of Health and Social Services.
Thank you, Mr. Speaker. I'd just like to take a moment to thank the MLA for researching my previous statements in this area when I was a Regular Member. I stand by my statements about the need for harm reduction and that addictions are not a moral failing; they're a health issue. Having said that, I am in support of managed alcohol programs. He referenced the fact that they were offered during the pandemic. That's the case. It was trying not to double the problem so that you had both people who were isolated because of the pandemic and then also in alcohol withdrawal.
At this point, alcohol is currently only being offered at the Spruce Bough, which is the new name for the Arnica Inn, and at the Aspen Apartments. Having said that, the Aspen program is not really a program. If someone is waiting for COVID test results or who needs isolation while they are recovering from COVID, they would be at the Aspen. If they needed a managed alcohol program, they would be provided one at that time. We do have a mandate priority as a department to establish a managed alcohol program in the territory, and we are currently exploring options to make that a reality. Thank you.
My point is that I don't want to lose the progress that has been made, and I know there are some questions about whether the Spruce Bough or the Aspen Apartments as physical infrastructure will continue to exist, but I would like to see the program model that is started there continue. I believe already some expertise has been developed. My question is: given that we've started some of this work already, has the department started to collect any data, and has it used any of this work that kind of organically started during COVID-19 to inform delivery of office?
The answer to the Member's question is: yes, the department is working with all locations where alcohol has been and is continuing to be provided during the pandemic. Together, lessons learned to inform the ongoing approach. That's not only the Yellowknife locations. There was also a managed alcohol program offered in Inuvik during the lockdown. The information is being gathered by interviews with providers, with users, and they have the classic questions of what worked, what didn't work, and what could we do better to create a formal managed alcohol program. We anticipate that this information will be analyzed and available in the spring of this year.
I'm very happy to hear that work is being done, and I look forward to seeing that information once it's analyzed. My main concern here is that a lot of the funding that established these programs was COVID relief funding. It's not necessarily money that has been budgeting and is found in the operations budget for Health and Social Services. Specifically, I know the Arnica program, they're hiring a manager to run this program. They are looking at best practices. However, their funding right now is COVID relief funding. My question for the Minister of Health and Social Services is: can I get a commitment that that program funding, regardless of the infrastructure and the larger COVID questions, for the managed alcohol program can continue past COVID-19?
We recognize the value of the program at the Spruce Bough. It manages two best practices together, which is the managed alcohol program, dealing with addiction and homelessness at the same time. The department has renewed its funding with the Spruce Bough until the end of September 2021. The idea is that in the next six or seven months the department will work with the Yellowknife Women's Society to explore options for continuing this program once the pandemic funding expires.
Thank you, Minister. Final supplementary. Member for Yellowknife North.
Thank you, Mr. Speaker. I am going to try to remember that the Arnica is now called the Spruce Bough. I thank the Minister for continually getting that correct. My last question is that the overall goal in this is to reduce hospitalizations due to alcoholism, which is what managed alcohol programs are proven to do, but can the Minister speak to how we are going to track the effect of these programs on actually reducing hospitalizations? Can you speak to the data we are hoping to collect there? Thank you, Mr. Speaker
There is kind of a two-part answer here. The specific commitment is to reduce the number of hospitalizations resulting primarily from alcohol use. That is something that is collected by the hospital and healthcare system, and that is ongoing. With respect to the Spruce Bough, the department is working with them to develop reporting and data-monitoring tools that could talk to us in more detail about the kind of services that have been provided connected to the outcomes of those services, so how those two things connect. This information is being collected now, and it will continue to be collected during the life of this program, which is at least until the end of September. The test here is whether this program has been effective. We like evidence-based decision making, so we are looking for the evidence that shows us that this program is helpful and worth continuing. Thank you.
Thank you, Minister. Oral questions. Member for Kam Lake.
Thank you very much, Mr. Speaker. My questions today are for the Minister of Health and Social Services. Every community has worked with Health and Social Services to create community wellness plans that are available on their department website. These plans not only identify the strengths of communities but also identify service gaps that communities feel exist. What role does the department play to ensure that, once a priority is set by the community, the community has the resources to achieve these goals? Thank you.
Thank you, Member for Kam Lake. Minister of Health and Social Services.
Thank you, Mr. Speaker. The department employs three regional community development and wellness planners who work with communities throughout the year to support actions and priorities under those wellness plans the Member mentioned. Their level of involvement is really community-driven. It can be very involved to not involved, depending on what the community wants and needs. There are annual allotments of funding to communities to realize their community wellness plans, and this funding is provided through flexible multi-year agreements. It's possible to carry over funds and move money around between fiscal years to meet the goals that they have set for themselves in their wellness plan. The fact they have a wellness plan and funding through that does not preclude them from applying for other pots of money, such as the anti-poverty fund and the NWT on-the-land collaborative. Those are some specific ways in which they are supported. The other thing is that community wellness plans provide a wealth of information to the department for planning services and programs in the future, so, for example, I know that we have staff now going through those plans in some detail to help us with the run-up to an elders' strategy. Thank you.
The plans as they stand right now online, they do not have actions or targets associated with them, so I am wondering if the Department of Health and Social Services and the specific positions that the Minister identified are working with the communities to establish any types of target for actions to go with those plans so that they have something to measure against and can identify when they would like to achieve certain parts of the plan and how.
It's my understanding that, in fact, these wellness workers do work with communities on actions and priorities with the community and then set up with supports needed to realize them. I realize that information may not be available online, but this is an ongoing and iterative program of supporting communities to realize their own goals that they have set in their wellness plans.
One of the things that we heard identified by the Minister today was that 19 communities have access to community-based community counsellors. If a community decides, as part of achieving their action plan and to achieve their goals, that they would like to see a resident counsellor, is that something that they can work with this person to achieve? Is it something that they can work with the Department of Health and Social Services to achieve? Is there room within the Health and Social Services budget to provide additional resources to the community outside of the Anti-Poverty Fund, outside of the anti-suicide fund to be able to provide additional resources to the community?
These are separate programs. The wellness is funded by the federal government. The community counselling program is funded by the territorial government. That does not mean they do not work together, but they are funded in different ways is what I am saying. I am not aware that at this point a community wellness plan could activate the appointment of another Community Counselling Program staff, but that is something that I can certainly check into and respond to the Member with more detail.
Thank you, Minister. Final supplementary. Member for Kam Lake.
Thank you very much, Mr. Speaker. No. Just to add to that, I appreciate that, and I think that many of the Members who serve in this House would like information on that, based on what resources are available because I think, to achieve your community wellness plan, it does not matter to a community member what funding pot it comes from, just the fact that they have access to services that are needed for the wellness, the overall wellness, of their community. Thank you.
Yes, thank you, Mr. Speaker. I will take that as a comment.
Thank you, Minister. Oral questions. Member for Frame Lake.
Merci, Monsieur le President. My question is for the Minister of Health and Social Services. In my statement, I referred to the conditions described in the Health and Social Services System 2019-2020 Annual Report. The report portrays some very mixed results here in the NWT, where we still seem to be lagging behind many other Canadian jurisdictions. Can the Minister describe for us how this tracking of some indicators feeds into planning and delivery of healthcare programs and services, particularly around mental health and addictions? Mahsi, Mr. Speaker.
Thank you, Member for Frame Lake. Minister of Health and Social Services.
Thank you, Mr. Speaker. The department uses monitoring of indicators as an ongoing means to both provide program oversight and to provide planning in all areas, including mental health and addictions. Some of the things we look at include usage rates, wait times, common presenting concerns, topics of prevention and promotion efforts and that kind of thing to get a feel for what is going on. The data that is obtained is used to monitor performance and also adherence to the program mandate: does the data show that the program is properly focused and delivering the services for which it was intended? We also find from the data that we are able to track trends and ultimately move that into system planning and professional development and staffing needs, so that our staff is up to date.
One of the areas in which we've had a lot of success and which I mentioned earlier today is stepped care. This is an approach where we overhauled the Community Counselling Program and decided that, instead of making a client a series of appointments over weeks or months, we would make appointments available on the same day so that there would be no waiting list. If you need an appointment, you could go and get an appointment. The waiting list or a long wait time would not be a barrier to being seen. This is the kind of innovation that was put forward in the mental wellness and addictions recovery plan and which we have now implemented, so that is an overview of how the data and the planning fit together. Thank you.
I want to thank the Minister for that. I know that she loves evidence and she loves making decisions based on evidence, so I appreciate that. Some of the more recent statistics during the ongoing pandemic paint a rather bleak picture of substance abuse, predominantly alcohol abuse, and overall health, mental health, and hospitalizations, family violence, child neglect. In June 2019, the Department of Health and Social Services released the mental wellness and addictions recovery action plan that the Minister referenced. Can the Minister tell us how this action plan is being adjusted to take into account findings of social conditions during the pandemic?
The current mental wellness and addictions recovery plan expires next month, so there is no point, at this point, to try to bring new actions into it. Instead, what we're doing at this point is we are looking at other ways to capture information and trends, as I mentioned before, and bring those into the everyday operation of the department. The Member referenced the social indicators that were produced for the first three months of the pandemic. It's my understanding that the department is getting ready to produce another of those reports. The thing about that first report is that it only covered three months, and so it wasn't a long enough set of indicators to really make firm policy decisions on. The intention is to continue repeating these social indicators over time, so that we get a good grasp of what needs to be done on a priority basis next.
I want to thank the Minister for that. As this year's budget address points out, though, 30 percent of GNWT operation spending is devoted to health and social programs and services, and in the budget that is proposed for next year, it is going to go up another $75 million. The Minister of Finance said the current expenditure pattern is unsustainable and that a plan was being developed to stabilize health and social services costs. I am quite concerned about what that plan is going to look like, and I don't want it to lead to a reduction in Health and Social Services programs. Can the Minister of Health and Social Services describe what is going on with this sustainability plan for the Northwest Territories Health and Social Services Authority and tell us when it's going to be available to the public?
There is no question that the Health and Social Services system is under enormous financial pressure. The accumulated deficit is $120.7 million. That is within the health authorities, the NTHSSA, the Hay River HSSA, and the Tlicho Community Services Agency. Sustainability is a very complex problem and, as the Member says, the place to start is not by cutting, but rather to look at what the drivers of spending are and what the value is we get out of that spending. This is really the core of the government renewal initiative, which my colleague the Minister of Finance has talked about, and also within the sustainability plan. What is going to happen is that there will be a dedicated group of three or four staff who will engage in looking at the detail of what we're spending money on and what value we're getting for that money and whether there are ways to reorganize ourselves to spend less money on those particular things.
I'm sure the Member is aware that fiscal sustainability is a problem in healthcare systems all across Canada and has been the subject of federal negotiations for an increase to the Canada Health Transfer, which we in the North don't get. We get our money through the FFT. However, we share this problem that they have. What we are going to do is look at, as I mentioned, internal costs containment, operation review in quality improvement, and the funding and service level so that we can get a grip on what we're spending and why we're spending it. This is not a public plan; this is an operational plan. We have offered to brief the Standing Committee on Social Development on a confidential basis about this plan and to answer questions that they have about that, and that offer still stands.
Thank you, Minister. Final supplementary. Member for Frame Lake.
Merci, Monsieur le President. I want to thank the Minister for that, and I look forward to getting that briefing, but I still think it should be made public somehow. In discussing ongoing wellness and mental health needs with some community leaders, there doesn't seem to be enough resources at the local level for planning and service delivery. Can the Minister describe what resources and services are available to communities for local solutions to mental health and addictions? Mahsi, Mr. Speaker.
We are now in year three of four of the children and youth care counselling program, which is a joint initiative with the Department of Education, Culture and Employment, and those counsellors are in place throughout Yellowknife and north to the Beaufort Sea. The last area that will be brought online is the South Slave. We have the Community Counselling Program, which is available in 19 communities, and then available in different ways such as telephone, virtual, and occasional visits to the remaining communities. We have the dedicated funds of on-the-land healing, peer support and suicide prevention. We have access to facility-based addictions treatment. We have a lot of programs and a lot of variety at our disposal. We're looking forward to having the results of the addictions recovery survey to get the on-the-ground look about whether the supports we are offering are those that are most needed at this point. Could we do things differently? Of course we could, but we do now have a pretty robust set of programs in place and we are interested in hearing from the public about what else they need. Thank you.
Thank you, Minister. Oral questions. Item 8, written questions. Oh, oral questions. Member for Kam Lake.
Sorry, Mr. Speaker. I was going to share some time with my colleagues, but I'm not going to let some time stay on the clock. My questions today are for the Minister of Health and Social Services. I am wondering if the Minister of Health and Social Services can let us know how many people Stanton can serve through medical detox at one time. Thank you.
Thank you, Member for Kam Lake. It seems like a theme day here. Minister of Health and Social Services.
I'd like to direct this question to the Minister of Lands. Just kidding. Sorry about the heart attack, Minister.
---Laughter
Mr. Speaker, there are no dedicated rooms for detox at Stanton. The rooms are made available as they are needed and they are made available to people who need medical management while they are withdrawing. For some people, that's a very important step. Withdrawal can be fatal if it's not managed properly. Other requests for medical detox are assessed one at a time. As I mentioned earlier in response to another question, most people actually do not need a medical detox. The vast majority of people do not need it, but there are some people who are very alcohol dependent for whom life and death really depends on a proper detox. Thank you.
If somebody presents at a health centre or a hospital, rather, in another community and wants to go through a medical detox process or if the nursing staff knows that this is somebody who would require medical detox, will that person be medevaced to Yellowknife in order to go through their medical detox here, or would they be able to stay in their home community to do that?
It could go either way, depending on the judgment of the nurse whom the patient sees. It may be necessary, depending on the level of alcohol dependency, to bring that person into Stanton, or they may be able to stay in their own community. I will just say again that the vast majority of people do not need the facilities at Stanton for detox, so it would really be however it's decided on a case-by-case basis.
I have had numerous conversations with constituents who have gone through different portions of treatment for addiction within the Northwest Territories and also outside of the Northwest Territories. One thing that has come up multiple times is the issue of every doctor in the territory not being able to refer somebody for an in-patient treatment facility. I am wondering if this is something that Health and Social Services is looking to change so that, regardless of the doctor who somebody sees, they are able to receive a referral for an in-patient facility.
I need to investigate that further before I can give a proper answer.
Thank you, Minister. Final supplementary. Member for Kam Lake.
Thank you very much, Mr. Speaker. I appreciate that. My next question for the Minister is in regard to protocols of care for people when they present at the emergency department within the Stanton Territorial Hospital. I am wondering if there are protocols for after-care for people once they do arrive at Stanton Territorial Hospital emergency with mental health challenges and if there is a protocol for either the attending physician or the attending healthcare staff or potentially people within primary care to then reach out to that person and to provide follow-up care. Thank you.
There is a medical social worker, at least one, maybe two, at Stanton Territorial Hospital, and they do discharge-planning with people who are leaving the hospital with all kinds of health needs, including mental health needs. The idea of the discharge-planning is to connect that person who is leaving the hospital with other supports that he might need or she might need, whether that is counselling, family physician, or other types of medical and counselling services that are relevant to them. They recommend it; whether the person decides to take that up is really up to them. When we are talking about adults here, the health system does not hound them to attend appointments. They make appointments for them. They may be reminded that they have those appointments. Of course, it's our hope that they obtain the care that they need, but at the end of the day, we can only set everything up; we cannot enforce it. Thank you.
Thank you, Minister. Oral questions. Member for Kam Lake.
Thank you very much, Mr. Speaker. I am going to just change direction a little bit there. I would like to ask the Minister of Health and Social Services again. I have heard from different people, and I am pretty sure the Minister has probably heard some of the same information, that people struggle with housing stability and affordability especially during after-care and post-treatment. What I have heard from people is: it's far easier to fall back into a life of addiction than it is to find support and remain in stable housing sometimes. I am wondering if the Minister of Health and Social Services will establish a relationship with her Minister to the back and two people over, for the Housing Corporation, to provide support to people struggling to maintain stable housing through their sobriety. Thank you.
Thank you, Member for Kam Lake. Minister of Health and Social Services.
Thank you, Mr. Speaker. I am of course delighted to work with my colleague from the NWT Housing Corporation. I really believe that housing is a key component to recovery, that people need to have their own space to provide for sober living and a sober social life and that without that it's very easy to relapse and go back into shelters and couch-surfing and to be exposed to all of those triggers that sent them into their decline in the first place. This is truly an integrated case management issue, where the person who is trying to retain their sobriety is going to need a number of supports. Housing is certainly one; counselling is another; and of course, income assistance and other measures, as well, to really stabilize the person in their recovery. Thank you.
