Thank you, Mr. Speaker. I would like to table the following documents: Tabled Document 21-12(4), my letter to the Minister of Social Services dated June 9, 1993 regarding the Alcohol and Drug Services Board of Management.

Tabled Document 22-12(4) is the Minister's response with subsequent information with regard to the alcohol and drug board of management. I'm sure it will be of interest to the Members. Thank you.

Item 13, tabling of documents. Item 14, notices of motion. Mr. Koe.

Mahsi, Mr. Speaker. Mr. Speaker, I give notice that on Friday, November 26, 1993, I will move the following motion.

I move, seconded by the honourable Member for Nunakput, that Tabled Document 11-12(4) titled Report from the Fort Providence/Cambridge Bay Strategic Planning Workshops be moved into committee of the whole for discussion.

Thank you, Mr. Koe. Item 14, notices of motion. Item 15, notices of motions for first reading of bills. Mr. Todd.

Mr. Speaker, I give notice that on Wednesday, November 24, 1993, I will move that Bill 2, an Act to Amend the Charter of Communities Act, be read for the first time. That's on the wrong...Sorry, my mistake. Mr. Speaker, I move, seconded by the honourable Member for Mackenzie Delta, that Bill 2...

Mr. Todd.

---Laughter

Thank you.

This is notices of motions for first reading of bills.

---Laughter

Item 16, motions. Mr. Todd, your cue is coming up. Mr. Todd.

---Laughter

Item 17, first reading of bills. Mr. Todd.

---Applause

Mr. Speaker, I move, seconded by the honourable Member for Mackenzie Delta, that Bill 2, an Act to Amend the Charter Communities Act, be read for the first time.

Mr. Todd, your motion is in order.

---Laughter

All those in favour? Mr. Todd, you can vote too.

---Laughter

All those opposed? Motion is carried.

---Carried

Bill 2 has had first reading. Item 17, first reading of bills. Mr. Todd.

I move, seconded by the honourable Member for -- it hasn't got it here -- Mackenzie Delta, that Bill 3, an Act to Amend the Cities, Towns and Villages Act, be read for the first time.

Your motion is in order, Mr. Todd. All those in favour? All those opposed? Motion is carried.

---Carried

Bill 3 has had first reading. Item 17, first reading of bills. Mr. Todd.

Motion is in order. All those in favour? All those opposed? Motion is carried.

---Carried

Bill 4 has had first reading. Item 18, second reading of bills. Item 19, consideration in committee of the whole of bills and other matters: Minister's Statement 3-12(4), Sessional Statement; Bill 1, Appropriation Act, No. 1, 1994-95; Committee Report 1-12(4), Talking and Working Together and Committee Report 3-12(4), Report on the Review of the 1994-95 Capital Estimates, with Mr. Whitford in the chair.

Mr. Chairman, it was the wish of the Members to address the Sessional Statement by the Premier, but we've recognized that the Premier is out. I believe she's gone to a Premiers' conference. It was also the intention yesterday to address the Special Committee on Health and Social Service's final report, although we've allowed the Department of Transportation to go first because there wasn't enough time. So, I think it was the intention of the committee to start addressing the Special Committee on Health and Social Service's final report and then -- recognizing we'll be here till 10:00 pm tonight -- we may eventually get into the Department of Transportation. Thank you.

Agreed.

---Agreed

Mahsi, Mr. Chairman. Mr. Chairman, many people told us that our health and social services do not reflect their culture, traditions and healing practices. We heard a number of aboriginal residents, in particular, saying that they are even afraid to seek medical care because the system seems so unfamiliar to them. This seeming lack of sensitivity on the part of our own government is totally unacceptable.

Our system must be relevant to the people it is supposed to serve if it is to have any credibility and serve any meaningful purpose.

We heard of at least three ways in which the cultural sensitivity of our health and social services can be increased.

First, front line workers from outside the community should receive formal cross-cultural training before taking up their duties. This could ease the process of adjustment that workers and local residents experience as they become acquainted with one another. It could help workers gain the trust and confidence of local residents. It could give workers a better understanding of the traditions and practices that are important to the community. It may also lead these workers to serve longer in their positions within the same community. This could result in a more personal and positive relationship with local residents.

Second, our health and social services should include more traditional healing practices. It is an important aspect of treatment for many people. For example, a healing circle was offered to front line workers attending a recent conference in Hay River. The circle was so popular that a second one had to be added. Workers attending a conference from two Inuit communities were so impressed that they started healing circles in their communities when they returned home. Traditional healers report that they are swamped with requests for their help from communities across the north.

Finally, people support a program designed to increase the number of northern and especially aboriginal front line workers, government officials and students in health and social services. At the same time, we were told that this goal should not be pursued at the expense of the skills, quality and standards of care people expect of these services.

This can be achieved in part by developing career paths for northern personnel. Candidates could first be recruited into entry level positions. They could then be provided with the training, support and continuing education that would allow them to advance their careers.

We Heard That Our Front Line Workers Need More Support

Mr. Chairman, we heard many positive comments about the majority of our front line workers. Most of these men and women are seen as able, professional and dedicated to their work. They are clearly viewed as a tremendous resource in most communities. And a number of these workers have developed very strong ties to the people they serve.

Our survey of 280 front line workers revealed that 73 percent of them have lived in the north for 20 years or more. They have lived in their communities an average of 19 years. A typical worker has at least five years of front line experience and has been in the current position for about three years.

From information provided by the public and front line workers, it is clear that the people who deliver our health and social services face a number of tremendous challenges in doing their job. Here are just some of them:

First, they are asked to do much with too few resources. Most of their time has to be spent dealing with immediate crises or balancing the range of services they must provide. As a result, they have little or no time to conduct follow-up and prevention work. Most front line workers we surveyed said that this lack of resources was the greatest problem they face in performing their jobs.

Second, there is a concern over the kind of training they receive. We heard that better training might reduce the need for visits to the communities by various specialists. Front line workers themselves, identified the issue of training as the second greatest professional problem they face. They are concerned that a number of formal job descriptions may not reflect the actual needs of the community.

Third, people are concerned by the high rate of turn over among doctors, nurses, dentists and specialists serving their communities. This degree of change makes it difficult to establish effective health professional/patient relationships. Quite simply, people want to see more of the same health care personnel. At the same time, we heard that these workers would consider staying longer if they received greater support from local residents.

Fourth, workers experience "burn out." This is caused by heavy case loads, changes in cultural surroundings, stress, low compensation, the lack of other workers in the community with whom to share information and the accumulated burden of their responsibilities.

Finally, some people told us they didn't like the daily clinic hours of their community health centres. We heard that health workers receive fewer requests for appointments during the morning hours. Patients seem to prefer evening visits, when most centres are closed. People told us that clinic hours should better reflect the needs of the community.

People Expressed Concern That The Confidentiality Of Information Be Respected

Mr. Chairman, the confidential nature of patient and client information is one of the most important features of any health and social service system. We heard concerns, both about the inappropriate sharing of information between front line workers and community members, as well as the lack of communication between government departments.

People are concerned about the possibility that information about themselves might be revealed to members of the community. This concern is explained, in part, by the fact that local workers may be close friends or even relatives of the patient. People want to be assured that any sharing of confidential information will be limited to professional staff and not made available to the community.

On the other hand, people feel that more sharing of information is required between government departments in order to better serve the needs of clients. Present confidentiality procedures require client consent for the disclosure of information. There is support for encouraging workers to obtain consent for the disclosure of information so that this problem may be remedied.

There Is Concern About Specialist Services In The Communities

Mr. Chairman, we heard that our system's reliance on specialists may not always provide the best level of service to the communities. Part of the problem is that the need for these services is seen to reflect a lack of support and resources available to front line workers. People told us that these workers should be able to involve other local resources, such as respected elders, in providing some of the services currently provided by specialists.

People mentioned a number of concerns about specialists. Communities may not have enough input into the process of assigning specialists to various locations. They do not visit often, and when they do, it may only be for a few hours at a time. People may not even be able to meet with them if these hours are not convenient. These brief visits are not seen as providing enough time for the specialist to develop an understanding of the community. This problem is made worse by the lack of follow-up to these visits. We also heard the view that specialists do not have -- or do not take -- the time to provide instruction and training for community front line workers.

We Became More Aware Of The Important Role Of Volunteer Organizations

Mr. Chairman, we heard a number of positive and useful programs provided by volunteer organizations across the north. People told us that these activities reflect their desire for greater responsibility over their lives and over the services provided their communities. We heard that these groups should be recognized and encouraged to expand their involvement.

We also heard that increased voluntarism reflects the view that government workers and professional health and social service workers are only a part of the solution.

People Told Us That Public Officials Are Expected To Act As Role Models

Mr. Chairman, public officials, community leaders and workers who provide health and social services are recognized members of the community. A number of them are also viewed as role models. People want them to follow a high standard of behaviour, especially on such matters as sobriety and violence. These role models are also expected to recognize and acknowledge any problems they may have and to act responsibly in dealing with them.

At this time, Mr. Chairman, I would like to ask Mrs. Marie-Jewell to continue.

Thank you, Mr. Chairman.

People Expressed Concerns That Offenders Should Not Be Treated Better Than Their Victims

Mr. Chairman, people in a number of communities believe that those who commit physical violence and other forms of abuse within their families should not be treated better than their victims. At the same time, people are concerned that offenders seem to benefit under the current system. This concern is based on a number of factors.

First, it is usually the female partner and children who have to relocate following a violent incident, while the offender remains in the family home. The victims may even have to leave their community in order to find appropriate shelter. Women feel further victimized when they have to relocate in this way.

We heard significant support for the view that the offender, rather than the victim, should have to suffer the inconvenience and other stresses of leaving the home.

Second, the victim often experiences even greater inconvenience, through no fault of her own. Once she leaves the family home, her name may be dropped to the bottom of the list of those hoping to qualify for future housing space. This happens even if the woman was born in the community and has lived there all her life.

Third, we heard that the victim of abuse may even be reluctant to assist the justice system in bringing charges against the offender. This reluctance is caused by a lack of understanding of the process itself or by a fear of retaliation. Some people told us that bringing charges against an offender simply guarantees repeat acts of abuse.

Finally, people are concerned that the judicial process fails the victim, even when the matter goes to trial. There is a perception in some communities that the courts are too slow in dealing with such acts of violence. We also heard the perception that juries are too lenient with offenders even if they are brought to justice.

Appropriation Counselling For Offenders And Victims Is Necessary, According To Many People We Heard From

Mr. Chairman, we heard people support the use of community-based counselling, intervention, mediation and other family support services for both the victims and offenders, in cases of domestic violence. People also support programs to assist families in the possible reintegration of abusers into the home.

Abused women, in particular, face a number of challenges in locating and obtaining assistance. They simply may not know anyone to talk to. They may not know of the legal steps they can take. Or they may not know the other sources of help that may be available to them.

People told us that the abuser also faces a shortage of counselling and support programs. Since abuse is an offense that is often repeated, it is just as important to provide counselling for the offender as it is for the victim and other family members.

We Heard That Midwives Are An Accepted Part Of Community Care

Mr. Chairman, we heard general support for programs that would give women the opportunity to deliver their babies in their own communities. This would enable women to choose to remain at or close to home, as opposed to having to travel to another community. It would make life easier for expectant mothers who already have other children to care for. It would also ensure that young expectant mothers have a chance to learn about the birthing process in secure and familiar surroundings. Midwives, home births and local birthing centres were mentioned as community-based means of achieving these results.

We Heard That Mental Health Issues Deserve Greater Attention And Support

Mr. Chairman, we heard that there are very few meaningful mental health services available in the Northwest Territories. This applies to clinical psychiatric services and a more holistic approach to healing. While the Department of Social Services has authority in this matter, there are very few resources available to back it up.

People identified a number of obstacles to treating those with mental health problems. These obstacles include a shortage of proper facilities, not enough home care, too little training, too few visits by specialists and a lack of other support in the community. We also heard that even when suicidal patients are sent outside the community for assessment, they are often quickly returned because they have no clinically diagnosed illness.

There is clear support for culturally appropriate counselling services, such as the use of respected elders as lay counsellors. Ongoing service training for social workers and the pooling of local resources to provide better treatment of mental health problems are also needed. People also want greater cooperation between the departments of Health and Social Services in an effort to ensure that patients receive the care they need.

Mr. Chairman, I would like to ask my colleague, Mr. Patterson, to continue. Thank you.