Thank you, Madam Speaker. It's going to be another long one today. Madam Speaker, Your Standing Committee on Government Operations is pleased to provide its Report on the Review of the 2022 Audit of Addictions Prevention and Recovery Services and commends it to the House.
On May 31, 2022, the Speaker tabled an audit report entitled Addictions Prevention and Recovery Services in the Northwest Territories. This performance audit was conducted by the Auditor General of Canada, who is also the Auditor General for the Northwest Territories.
The performance audit looked at whether the Department of Health and Social Services, the Northwest Territories Health and Social Services Authority, the Hay River Health and Social Services Authority, and the Tlicho Community Services Agency provided addictions services to meet the needs of Northerners. This audit matters because the NWT has a high rate of substance use and addictions have widespread impacts on the lives of individuals, families, and community members.
The audit found that the department and the three health authorities:
Had not figured out how to achieve equitable access to addictions services;
Did not do enough to ensure addictions services were culturally safe for Indigenous residents;
Provided only limited aftercare services;
Had gaps in coordinating addictions services; and
Did not do enough to collect and analyze data to know whether their addictions services were effective in helping residents achieve their desired outcomes.
The audit made seven recommendations to improve addictions services. The department and health authorities accepted all seven recommendations. In response, they developed the Addictions Prevention and Recovery Services Workplan. The workplan highlights new actions the department and health authorities are taking to address the audit recommendations.
Committee is responsible for reviewing the audit and the department’s response. The review ensures that government is accountable to correct deficiencies, implement recommendations, and execute policies and programs in line with the Legislative Assembly’s intentions.
On October 6, 2022, committee held a public hearing on the report. Officials at the Office of the Auditor General and the department briefed committee. They explained key audit findings and the department’s workplan.
In response, committee developed thirteen (13) recommendations. Our recommendations reinforce accountability and request additional actions to improve programs and services that help Northerners avoid and heal from addictions. If implemented, these recommendations will:
Provide immediate supports to young men;
Ensure healthcare services are culturally safe;
Secure federal support to set up healing centres in the NWT; and
Strengthen the followup process.
Committee is pleased to submit these recommendations and looks forward to their implementation.
On October 3, 2022, the chief coroner took the unprecedented step of releasing data earlier than usual on suicide deaths. The data points to a health crisis: In the first nine months of 2022, 18 Northerners died of suicide, more than in any full year in the last two decades.
In releasing these statistics early, the the chief coroner hoped to spur the government to respond. Indeed, the Minister of Health and Social Services has indicated that "a wholeofgovernment response is needed."
Committee also sought to respond to the chief coroner's report in the context of this audit review. The chief coroner's report includes a statistic that potentially connects suicide deaths to addictions services – that is, the number of suicide deaths with alcohol as a contributing factor.
To get a better understanding, committee examined more than twenty years of data on suicide deaths. Committee found that.
Since 2001, 212 Northerners have died by suicide
Alcohol was a contributing factor in over one in every two deaths, 112 in total.
Males under age 40 made up over one in every two deaths, 114 in total.
The age profile of the NWT's suicide deaths is younger than Canada’s. Here, men in their twenties and thirties are most likely to die of suicide. Across Canada, men in their forties and fifties are most atrisk.
These statistics, and the loss of life that they quantify, are deeply upsetting. Each life lost is a tragedy that extends to families, friends, and communities.
The link between many suicide deaths and alcohol points to the urgency of the audit’s focus: to provide addictions prevention and recovery services that meet the needs of Northerners.
The department’s workplan commits to promising plans to improve addictions services. But many planned activities, even if implemented successfully and to the full, have timelines of a year or more. Processdriven activities, such as revising hiring practices by the end of 202324, will take longer still to influence service quality.
While committee supports all the department’s planned activities and understands this work takes time, committee wants to see actions with immediate impacts. Incorporating these immediate actions into the work plan would enhance its relevance, effectiveness, and credibility. Committee’s recommendations for immediate actions focus on the demographic group most atrisk of living with suicidal thoughts or behaviour: young men.
I will now turn it over to the MLA for Thebacha. Thank you, Madam Speaker.
Thank you, Member. Member for Thebacha.
The On the Land Healing Fund helps Indigenous governments and organizations provide landbased addictions treatment, including aftercare programming.
However, the Auditor heard from some Indigenous groups that administrative requirements make accessing the fund difficult. In both 20192020 and 20202021, the department failed to distribute $500,000 to $600,000, almost one third of the fund’s $1.8 million budget. Committee therefore recommends:
That the Department of Health and Social Services review and relax administrative requirements to access the On the Land Healing Fund, with a view to ensuring full uptake of budgeted funds in 20222023, and report on whether the funds were dispersed.
More generally, the GNWT should ensure that all budgeted dollars that support men’s wellness are spent each year. Effective programs should receive increased support. Committee therefore recommends:
That the Government of the Northwest Territories increase funding for grants and contribution programs that target men’s wellness.
In October 2022, the Meadow Lake Tribal Council in Saskatchewan hosted a men’s wellness conference. The conference discussed the root causes of issues facing some Indigenous men and solutions for change. Over 200 men participated.
Media reporting of the conference includes testimonies that highlight numerous positive outcomes. Participants opened up, shared painful experiences, gained emotional understanding, used humour to balance heavy talks, and recognized that they were not alone. Organizers hoped the men would bring lessons and renewed hope back home, launching their own groups to support healing and change.
Committee wants to see a similar conference in the NWT and believes it could be organized within six months. Committee therefore recommends:
That the Department of Health and Social Services, in consultation with Indigenous governments, and by the spring 2023, sponsor a men’s wellness conference. The conference should focus on hearing, learning, and sharing about the root causes of issues facing some men, such as racism, trauma, isolation, violence, and addictions.
The department’s work plan is broken down into seven priority areas, corresponding to the Auditor’s seven recommendations. Considering that suicide deaths occur disproportionately among young men, committee wants to see an eighth priority focused on people aged 29 years and under.
This new priority area should bring together relevant activities focused on young people from the rest of the work plan into one spot. Potential examples include:
Equitable access to addictions services for youth in child and family services;
Disaggregating data on young people; and
Reviewing job descriptions to hire more Indigenous graduates as youth counsellors.
This youth priority area should also add two new commitments. The second commitment, on sports and recreation, requires the collaboration of the Department of Municipal and Community Affairs. The Minister of MACA has said that sport and recreation programming is important, especially to youth, for its health and social benefits, including mental wellness. Committee agrees, but is unclear whether MACA sees its role in mental health promotion in collaboration with other GNWT departments and agencies. Committee therefore recommends:
That the Department of Health and Social Services, in collaboration with the Department of Municipal and Community Affairs, add an eighth priority to the Addictions Prevention and Recovery Work Plan focusing on people aged 29 and under. This priority area should include clear commitments and performance measures to:
Increase access to and uptake in counselling and healing supports; and
Increase youth participation in sports and recreation, including measures to improve access to facilities and programming.
The Auditor’s definition of cultural safety was "an outcome where Indigenous people feel safe, respected, and free from racism and discrimination when accessing health and social services programs." Cultural safety is important to remove barriers to accessing services and make it more likely these services will meet Indigenous clients' needs.
A key challenge to ensuring cultural safety is effective measurement. Measurement is important because programs intended to boost diversity, equity, and inclusion, can have varying levels of effectiveness and must be assessed with evidence. But since cultural safety is an outcome inherent to the Indigenous client, departmental reviews of standards and policies is not enough to ensure cultural safety. Insight from Indigenous clients is required. Committee encourages the department to set a goal toward defining how culturally safe outcomes are measured. This work should be done in collaboration with the NTHSSA Leadership Council. Committee therefore recommends:
That the Department of Health and Social Services implement. An approach to measure whether users and nonusers of the Government of the Northwest Territories addictions services find those services to be culturally safe and provide a timeline for implementation.
I will now turn the document over to the MLA for Kam Lake.
Thank you, Member. Member for Kam Lake.
Thank you, Madam Speaker.
The importance of cultural safety extends beyond addictions services. Committee wants to see work to understand, enhance, and measure cultural safety applied to other areas at the health authorities and in the GNWT. The department should outline how it will build on its most recent cultural safety action plan, Caring for Our People, in the months and years ahead. Committee therefore recommends:
That the Government of the Northwest Territories conduct a wholeofgovernment review of cultural safety in all standards and policies associated with GNWT programs and services and provide a timeline for implementation. This review should identify barriers to cultural safety to inform efforts to remove or reduce identified barriers.
The work plan aims to revise hiring practices for addictions positions that formally recognized the value of Indigenous qualifications by 20232024 fourth quarter. Members believe this work should be completed sooner.
Work on job descriptions and hiring practices should have already been underway before the work plan was developed. The Department of Finance’s Indigenous Recruitment and Retention Action Plan contains five action items to increase Indigenous representation at all departments and agencies, including at the health authorities. That plan was launched almost one year ago, in November 2021. The department and health authorities should collaborate with the Department of Finance to expedite this work plan commitment. Committee therefore recommends:
That the Department of Health and Social Services and health and social services authorities, in collaboration with the Department of Finance, prioritize their commitment to revise hiring practices for addictions positions to recognize the value of Indigenous qualifications. Committee further recommends the timeline for this work to be moved up by six months, to the second quarter of 20232024.
While the work plan commits to revising the hiring process to recognize the value of Indigenous qualifications, it does not explicitly extend that logic beyond the hiring phase and specifically to standards of practice. Western medical standards create barriers to cultural safety for Indigenous residents. They make it harder for Indigenous people to gain accreditations to become healthcare providers within the system. They also distort the measurement of outcomes. Indigenous people lead different lives than nonIndigenous people. The desired healthcare outcomes for Indigenous people do not always match those defined by Western standards.
Indigenous standards of practice are also a matter of rights. Article 24.1 of the United Nations Declaration on the Rights of Indigenous Peoples declare that "Indigenous peoples have the right to their traditional medicines and to maintain their health practices." Committee therefore recommends:
That the Department of Health and Social Services and health and social services authorities review and adjust standards of practice to recognize the value of Indigenous knowledge and provide a timeline for implementation.
To complement the work plan's topdown, holistic approach, committee proposes a bottomup mechanism for healthcare staff to identify improvements. This will empower frontline staff to develop, implement, and communicate creative solutions in real time while the larger policy approach is in development.
Committee is not aware of any such mechanism, available systemwide, to drive bottomup change. Frontline workers have an important perspective on the challenges in service delivery. They may be able to propose outofthebox solutions not conceived elsewhere. Committee therefore recommends:
That the Department of Health and Social Services and health and social services authorities set up a distinct method for frontline staff to identify barriers to care and cultural safety or propose better practices and policies on an ongoing basis and provide a timeline for implementation.
A key concern for committee is overcoming barriers to risk at each individual who does not access addictions services. The Auditor highlighted the need to gather data from individuals who are not service users. Committee believes the work plan can go farther to reach atrisk individuals and therefore recommends:
That the Department of Health and Social Services collect and analyze data from residents who do not use GNWT addictions prevention and recovery services, to identify creative ways to remove barriers and make services more culturally safe and provide a timeline for implementation.
Members have heard repeated cries for one or more interritory healing centres. Right now, Northerners who want to access facilitybased addictions treatments must leave the NWT to receive this service. Neither the audit nor the work plan provide a determination on whether the NWT should set up interritory healing centres. The auditor noted that the lack of interritory facilities could create barriers for some clients, including those concerned that southern treatment may not reflect their culture. However, the auditor stopped short of recommending a healing centre. The work plan is silent on the matter.
By contrast, the Truth and Reconciliation Commission’s Call to Action No. 21 is quite clear. It states: "We call upon the federal government to provide sustainable funding for existing and new aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority."
The federal government recently made good on this Call to Action for Nunavut. Canada is providing nearly $50 million to support up to 75 percent of the construction costs for the Nunavut Recovery Centre. Nunavut’s centre will be based on Inuit cultural practices and provide a range of treatment and healing interventions. Canada will also provide $10 million in ongoing annual operating support.
Between Call to Action No. 21 and Nunavut’s recent precedent, committee believes it's time for the GNWT to secure federal support for one or more healing centres in the territory. This should include immediate access to detox centres in each region. Committee therefore recommends:
That the Government of the Northwest Territories, in collaboration with Indigenous governments, pursue federal funding to help set up healing centres in the Northwest Territories.
Committee wants to ensure that the department demonstrates its progress towards achieving the work plan's expected results. One potential risk, in this regard, lies in the lack of disclosure on performance measures. The work plan that the department presented at the October 6th public briefing contained activity measures to describe what work would be done. The work plan also included highlevel statements on expected results. But missing were specific performance results that are easily measurable.
Committee is aware that the auditor required the department to comply with word count limits. More detailed aspects of the work plan, like performance measures, may not have fit within the publishing constraints. Committee wants to see performance measures and regular public reporting on progress towards associated targets. Committee therefore recommends:
That the Department of Health and Social Services present performance measures for each activity in the Addictions Prevention and Recovery Work Plan and provide a timeline for implementation. The department should report on progress with:
A webbased tracker, similar to ECE’s Action Plan to Improve Student Outcomes Progress Tracker, on a quarterly basis; and
A public briefing at committee, in spring or summer 2023 before the 19th Assembly ends.
Madam Speaker, I would like to pass the final reading of this report back to the MLA for Yellowknife North. Thank you.
Thank you, Member. Member for Yellowknife North.
Thank you, Madam Speaker.
Committee’s recommendations aim to reinforce existing commitments in the work plan and initiate additional actions to enhance addictions prevention and recovery services.
Committee wants to see the department respond more substantially than with a standard tabled response and sooner than in 120 days. Committee therefore recommends:
That the Department of Health and Social Services make changes to its Addictions Prevention and Recovery Work Plan, as soon as possible, to reflect the recommendations contained in this committee report
This concludes the Standing Committee on Government Operations' Report on the Review of the 2022 Audit of Addictions Prevention and Recovery Services. Committee looks forward to the government’s response to these recommendations.
The Standing Committee on Government Operations recommends that the Government of the Northwest Territories provide a response to this report within 120 days.
Thank you, Madam Speaker.
Reports of standing and special committees. Member for Yellowknife North.
Madam Speaker, I move, seconded by the honourable Member for Thebacha, that the Standing Committee on Government Operations Report on the Review of the 2022 Audit of Addictions, Prevention and Recovery Services in the Northwest Territories be received by the Assembly and moved into committee for further consideration. Thank you, Madam Speaker.
Thank you. The motion is in order. To the motion. Member for Yellowknife North.
Madam Speaker, I seek unanimous consent to waive Rule 9.4(4), and ask that Committee Report 3719(2), Standing Committee on Government Operations Report of the Review of the 2022 Audit of Addictions Prevention and Recovery Services in the Northwest Territories, be referred directly to Committee of the Whole for consideration later today. Thank you, Madam Speaker.
Sorry, we have to go back to the unanimous consent of thank you. So the motion is in order. To the motion.
Question.
DEPUTY SPEAKER:
Carried
Reports of standing and special committees. Member for Yellowknife North.
Thank you, Madam Speaker. I'm seeking unanimous consent, again to waive Rule 9.4(4), so that this Committee Report 3719(2) can be referred directly to Committee of the Whole for consideration later today. Thank you, Madam Speaker.
Thank you. The Member is seeking unanimous consent to waive Rule 9.4 (4) and have Committee Report 3719(2) referred directly to Committee of the Whole for consideration later today. Are there any nays? There are no nays. Committee Report 3719 (2) will be referred directly to the Committee of the Whole for consideration later today.
