Debates of February 9, 2011 (day 36)

Thank you, Mr. Beaulieu. Ms. Lee.

No, we can’t say that we are substantially increasing the funding for suicide prevention.

I’m assuming that it would be a matter of the prevention and promotion services. In here it’s indicated that programs assist with emotional and social problems such as suicide, homelessness, and dealing with residential school issues. The majority of those, homelessness and residential school issues, are of course something that I recognize the department has to pay some attention to. I know that it is difficult to address the homelessness issue because it’s difficult to find absolute homeless people in the small communities because relatives take them in and they end up becoming relative homeless people, which is an actual term. So there are people that don’t have their own home but kind of drift from home to home. It’s a difficult area to work in.

Suicide prevention, on the other hand, I think is something more emphasis has to be put into. I think it actually virtually devastates a family. Even it happened a handful of times in Tu Nedhe since I’ve been elected as MLA and I’ve seen the devastating impacts on the families. It’s an area that’s difficult to work in and a lot of people just don’t know how to deal with that area. The department has resources to maybe explore some options, explore some services outside of what’s available now and put some extra resources into this area in order to assist the families.

I don’t remember the program CBC runs on Friday afternoons. Edts’ula or something like that. Actually, they had a program on people that were affected by suicide. This particular individual spoke on there that had two incidents in the family and said that had they actually received some support in between, they may have saved the life of the second individual in their family that committed suicide. I guess one life is worth more than anything else that we hope to save in a budget. To that family, it’s not an issue of cost.

I guess, again, I’d like to know if there is no increase, then the department may feel that there is a sufficient amount of money and resources, human and otherwise, human and financial to address this area. I’d like to know if that’s the case, if the department feels that they have sufficient resources.

As I stated, there is no substantial increase to anything in our budget because it’s, as people have called it, a status quo maintenance kind of budget under our fiscal circumstance.

With respect to suicide prevention work, we are doing some new work under this initiative. We have obtained some funding with the Mental Health Commission, which is a body set up nationally, and we’ve been getting some money for the last couple of years. This year we will be flowing $460,000 in federal funding for community-based suicide prevention projects. One of the initiatives that we are embarking on is to set up an NWT Suicide Prevention Steering Committee. This committee will be made up of the Department of Health and Social Services, Education, Culture and Employment, MACA, Yellowknife Health and Social Services Authority, Canadian Mental Health Association, and the national program Graduates and Trainers on Suicide Prevention, as well as Dene and Inuvialuit community members. We are working also on, they call it Mental Health First Aid: Training the Trainers for the communities. That’s the initiative that we’re working on. We have also always had some programs under the National Aboriginal Youth Suicide Prevention Strategy and Applied Suicide Intervention Skills Training, called ASIST, and those programs have been held in some of the communities as well. There’s not a substantial increase in the amount of money, but we are working on some initiatives to address this issue.

That’s good, actually. That sounds good, the money from the federal government. What is the plan to roll out the budget? Is it just filling budgets that are already at the community level or is this a little bit of new money? If so, what’s the communication strategy of the department to the small communities for this particular line item?

We’ll be floating this money into the authorities to work at the community level.

Does that mean that Yellowknife Health and Social Services Authority will get the money for Fort Resolution and Lutselk’e?

I need to have my deputy minister give the information, as it’s operational.

Thank you, Ms. Lee. Ms. Meade.

Speaker: MS. MEADE

So there are multiple ways that this can go but in the mental health and addictions funding, therefore the suicide funding, does go through the authorities and in the department. For the Train the Trainer model, we actually are using our own department resources to go out and train both staff at the authorities as well as the community.

We were unique in Canada that we got money from the Mental Health Commission of Canada to actually get the Mental Health First Aid Program and some trainers. Again, the money flows through the department and the authorities but they paid for some community representatives -- I know there were two out of Fort McPherson that come to mind -- to take that training. This is not money that is available for communities because the program is run through the authorities and connected to their ongoing mental health addictions and community wellness programs. We’re trying to do as much to also build community capacity and awareness. It’s not as much a money flow as trying to use the existing resources and people to do that expanded training. If it was an authority, then they’re responsible for their areas within their authority boundary.

Thank you, Ms. Meade. Mr. Beaulieu.

It’s very unfortunate that money can’t go directly to the communities. I think that the communities would have a better idea. I know that in speaking to the elders in the community -- I know I’m out of time, Mr. Chairman, I’ll be short -- the elders in the community indicate to me that their idea of trying to work with the emotional and social aspects around suicide prevention would be to be bringing people. I had asked the Minister on this on another matter, to bring people in that will work with the communities, like healers and so on that will work with the communities. I think that’s something that communities should have the option to look at.

Thank you, Mr. Beaulieu. More of a comment but I’ll go to the Minister for the question.

Thank you, Mr. Chairman. Healers and other initiatives that the Member mentioned would have to come from other sources of money. This is something that I’ve been communicating with the Member and it is an ongoing challenge for us to come up with those resources.

Thank you, Ms. Lee. Next on my list is Mr. Bromley.

Thank you, Mr. Chairman. The first thing I have on my list here is the Healthy Families Program. I wanted to say that I appreciate its expansion. Modest to what is required, but this is such a good program that every community we get it in is a major gain. I know it’s also expensive and the Standing Committee on Social Programs knew it was expensive when we made the recommendation to get this in every community. We also think it’s the very best investment we can make.

Could I just ask the Minister first of all, the $500,000 that’s provided for expansion, I believe that would be for a team in each community like a nurse or social worker and that social worker can work with about 30 families maximum. This will provide key support for about 30 programs in each of those two new communities. So I’m just wondering if I’ve got that right.

While the Minister’s at it, I’m wondering how long this program has been running. I’m wondering when we established the Healthy Families Program in the four communities that have it now. Thank you.

Thank you, Mr. Bromley. Minister Lee.

Thank you. Mr. Chairman, I am going to have to take that comment under advisement. I ‘m sorry; I’ll have to follow up. Thank you.

I assume that holds for how long the program has been going too. Jurisdictions that have had this, as I mentioned in a Member’s statement several days ago and I profiled the advances and benefits that have been achieved with programs like this, I am wondering have we an evaluation program in place. If we do, when can we get the results on that and, if not, can we get that in place? I think, again, possibly this is our single biggest opportunity for savings and gains in both lives and consequences. Thank you.

Right now our focus is to expand them, but I understand the need to evaluate and take stock, so I will commit to doing that. Thank you.

I appreciate that commitment. The strategic plan and implementation of it, I assume, will have some costs associated and I think the Minister is hoping to get that done in the next several months, so presumably the implementation of it will happen during the 2011-2012 budget year. Have there been dollars identified or will that implementation be expected to be from internal resources?

I don’t believe we get separate funding for implementing a strategic document. There will be programs that we will have to go through a business plan process or we would have to do it internally, thank you.

I am sure the Minister sees the dilemma that I am trying to sort out here that here we are putting a program together but not providing any dollars for it, even for its implementation. So you know we are preparing a plan that we could have to wait another year to implement, that is what I am wondering. I know the Minister has also mentioned in terms of the five community child and family services committees they were hoping to establish has been trying to get that going and sampling the water out there, working with communities. I am wondering if the community of Dettah or Yellowknife have been approached for establishing child and family services committees.

I can tell you that we are looking at the possibility. The Yellowknife Health and Social Services Authority, the CEO is meeting with a community group outside of Yellowknife, that being Dettah and N’Dilo to discuss the possibility of that committee. Thank you.

I appreciate that information from the Minister. I would encourage the Minister to look to the MLAs to help try and develop support and engagement with that process. I think that would be a legitimate request from a Minister and a legitimate role that you could expect an MLA to play, to do work in that area. So that is just a note.

I would like to move on now to the mental health program review started in November. I don’t recall having any input to the terms of reference for that review, but knowing my memory, that could be a plus or a minus. I would appreciate to know whether such a process would include the opportunity for Regular MLAs or committee to have input on the terms of reference. Specific to that review, does it include patient release and readmission policy; a review of those policies in the mental health program review? Thank you.

I will ask the deputy minister to give more details, but just to explain to the Members here, under the Foundation for Change, there is a work item there to review mental health programming. I was advised, after the deputy minister came on board, when she looked at all of the programs and we identified right away that this mental health program needed to be looked at very closely with a view of improving that and restructuring that, so we have undertaken those actions. I don’t know the process is in terms of getting the terms of reference reviewed and such. I don’t think that we do that for all reviews. There is always a question, but I just want to let you know that we internally identified to look at this programming for all the reasons you have mentioned. The acute program right down to all of the community services that are available, so it has been tendered and we are getting it reviewed. I feel that the real good work can be done by looking at what the findings are and how do we move forward from that. If there are any more details that you need on this review, I would be happy to have Paddy add on to it. It is up to you. Thank you.

I am very happy that this review is going forward. I think it is great that the department has had the initiative to do this. Again, I think this is probably a given that the Standing Committee on Social Programs would appreciate the opportunity to have input on the terms of reference for those sorts of reviews because I can say as an MLA for Weledeh, that I have had many issues and concerns from my constituents over the years in this area and have developed some concerns and an awareness of the sorts of things that are happening out there. I am very happy to see this review going ahead and I look forward to the results. I wanted to know, thanks to the Minister for her offer, one additional detail and that is whether the review covers the availability and effectiveness of addictions treatment programs in the Northwest Territories. Mahsi.

Thank you, Mr. Bromley. Ms. Meade.

Speaker: MS. MEADE

Many but not all people with addictions have comorbidities, they also have mental health or other issues, so we are including that group. There is also the difference between those that have manageable mental health issues, manageable meaning can be dealt with in the community, or those with severe psychiatric issues. So most of this review is connected to community mental health and addictions, but it is dovetailing with the work we are doing on our psychiatric intake and psychiatric management of patients at both Stanton and the Beaufort-Delta in the hospitals. It is also building on the fact that we do now have, finally, two psychiatrists, and while they are still on a locum contract, we are working to get them to be full time or permanent here, because that has been significant.

You had mentioned earlier about the issue of policies around release. This is very complicated because it also dovetails with issues around release of corrections. When you get a core group, it is not very large, it is significant as to how to manage them, and the actual cycle between justice facilities, both federal, by the way and not just territorial, and in-patient, and can be quite problematic in our hospital settings. Also on release of patients we have human rights and issues around how that happens, so we are dealing with some of that with our look at the psychiatric not covered here, but as they come together this will be dovetailed. I have raised the issue with the deputy minister of Justice that we need to look at some of this cycle between a correctional facility and not just in the Territories, RCMP holding and hospital-based, because it is a core group not unique to here and very difficult to manage.

Thank you, Ms. Meade. Next on my list is Mr. Hawkins.

Thank you, Mr. Chairman. Recently I have inquired with the Department of Health and Social Services to follow up on some costing and focus on what we do for the Quitline and that would, of course, be people who have quit smoking. As many of us know, I guess it is a cessation phone line you call to speak about your woes of smoking cigarettes. I haven’t called it myself so I don’t specifically know, but I believe it’s set up in that context.

As I’ve learned from the Department of Health and Social Services, the response from the Minister, I believe $24,000 has gone to radio advertising and there’s a contract, I believe an Ontario company called Sykes. I guess they take the phone calls. Now, I realize some of this is federal money, if not all of it is federal money. Under this heading of healthy programs, has the Minister looked at setting up phone lines here in the North that could deal with people to take their addictions calls in the same manner of in a follow-up treatment?

Now, I know there’s a mental health line. You hear that on the radio, where people can call if they’re having trouble, which I think is a great service because, obviously, it wouldn’t be up if people didn’t need it. I certainly hope that that’s the case, obviously, that it wouldn’t be there if people didn’t need it or use it. But that said, I’m specifically looking for the area of addictions treatment where people can call and talk about their addiction problems and hopefully avoid a relapse. Has the department set anything up or followed through on any particular follow-up treatment process in that type of regard? Thank you.

Thank you, Mr. Hawkins. Minister Lee.

Thank you, Mr. Chairman. There are lots of issues wrapped up into the Member’s statement there. The Quitline, that program is being delivered outside of the NWT because we could not cost-effectively man or woman that phone line and to give the kind of technical information to those who wished to quit smoking. It’s not just us but many jurisdictions across the country are using the same service provider so that you have people who are equipped to answer those questions. We expect that demand for that service will increase when the federal government launches a more aggressive campaign on the cigarette packaging.

The Member then asked questions about whether there is a phone line people could call about their addictions issues or aftercare and all that. I don’t think we can solve that by having a phone line. Those are things that our health care providers and social workers and everybody on the ground deal with. It was brought up earlier that we spend about $6 million in mental health programming with our community mental health workers on the ground. All of our care providers, whether they be doctors, nurses, social workers, they are the ones people need to go to get help in that area. Thank you.

My question really wasn’t about the radio smoking cessation Quitline. It was more to draw a parallel that this government has sought out in one manner or another whether the federal government came knocking or we went looking, as a government, looking for money to help sponsor that type of addiction treatment, which I think is good value for people. But by and large, the bridge I was trying to demonstrate in the sense of comparison is the government works to provide a phone line for people to talk, or I guess, talk out their problems about why they want a cigarette and perhaps someone on the other line talks to them and convinces them not to reach for that extra cigarette. What stops the government from investigating and proceeding with allowing, sort of, a follow-up line or a call line for people to speak to some of these service providers, whether they’re in the Lutselk'e region, the Beaufort-Delta region, or the Nats’ejee K’eh region, whatever the case may be? One that’s relevant to them and perhaps one that they’ve already been to. What’s stopping the government from setting up a follow-up line for people who have gone through these programs to be able to lean back onto for extra support when working through the struggles? What stops the government from doing that? Thank you.

Well, nothing stops us from doing that other than the fact that there is no real, I don’t think… I mean, the phone lines we’ve tried, like the Health Line, per cost basis it wasn’t the most effective service because our people still want to have face-to-face counselling. People don’t even like calling the RCMP on a phone line. Our people would like to have care providers face to face.

My point is we have those services available in communities for people to go to for their treatment options or aftercare or anything like that. I don’t think there’s anything stopping us. It’s one option, but it would be a whole new initiative. Thank you.

What’s stopping the department from making it part of the programming dollars we supply to various service agencies that provide addictions treatment and support for obligating them as part of the service agreement to provide an aftercare phone line for people to talk about, perhaps, the strains of fighting their addictions? If it’s good enough for Poundmaker outside of Edmonton to have a follow-up line where they actually do follow-up calls and whatnot to ensure the clientele have gone through their program so that they know they’re still supported outside once they’ve finished the program and while they continue to struggle with the addiction until they gain control, why wouldn’t it be a considerable effort that we’d pursue as a consideration of our service level agreements? Thank you.

Thank you, Mr. Hawkins. Ms. Meade.

Speaker: MS. MEADE

I think we need to clarify between a 1-800 quit line, call line, addiction line that are available, you know, the children’s line in Canada, for example, and the follow-up lines that treatment programs give to their clients, which often also happens in our own programs already. People who are also in addictions refer to some of the other groups like AA, NA and multiple groups like that, which also provide access through sponsors or call lines. I think the issue of setting up a 1-800 territorial-wide line is more complex and certainly we were able to do the Quitline because of federal funding.

The issue of being able to have our resources available to people for aftercare and when they need to talk, that’s a different issue. I think we do need to continue to encourage and support that through all our providers and to link with the other organizations like AA and NA. They are a highly successful organization for people that that program fits. Thank you.

Thank you, Mr. Chairman. What would stop the Department of Health from making this a requirement of the service level agreement we do sign with these agencies to set up a phone number where people, not just a phone number, but also requiring the counsellors to do follow-up phone calls with people who have worked through a treatment process? What would stop the department from doing that? If you made it part of your agreement, perhaps it wouldn’t cost significantly anymore for asking them to do some follow-up. Thank you.

Thank you, Mr. Hawkins. Minister Lee.

Thank you, Mr. Chairman. We couldn’t do that to authorities. We couldn’t ask them to do something unless we could provide the funding. To have a 24-hour phone line for every authority, going by the H1N1 flu line, those are very, very expensive program options. We have to make a decision. It’s a duplication of service. Yet nothing stops us from requiring the authorities as long as we are willing to provide the funding. A 24-hour phone line will require two to three staff. That’s, right away, $300,000, and that’s people with knowledge about addictions. If we were to do that to all six authorities, right there it’s at least a couple million dollars. I don’t have a couple million dollars sitting around. Thank you.

Mr. Chairman. Perhaps the more efficient way of doing it is making it a part of our service level agreements we’ve cast in...(inaudible)...some type of compromised negotiation in having the agencies that we actually negotiate directly with. In other words, the Department of Health directly negotiates and draws up service level agreements with certain groups. Why don’t we have them have these groups phone people as part of the Aftercare Program on a contiguous basis of some manner to make sure people are on track with their programming? Would it not serve some interest in everyone’s efforts, be it service agency or the government, in trying to find a way to stop them from coming back for further treatment in the future by a little proactive care? You just made the case of not doing a 1-800 number that’s not staffed 24 hours a day. I find that reasonable, but you could demand that we require a higher level of service. That could be done today if your department was willing to commit to it. Thank you.

We have, I believe, 62 positions dealing with mental health and addictions already. There is underground support for that work. Thank you.

Report of Committee of the Whole

Speaker: MR. SPEAKER

Can I have the report of Committee of the Whole, please, Mr. Abernethy.