Thank you, Madam Chair. I'd like to move on to the next item on the Mental Health and Addictions Strategy that the Minister spoke of yesterday in his opening statement. Last fall sometime, this House passed a motion calling for an alcohol and drug treatment centre and I'd like to know whether or not the Minister is in charge of responding to that motion and what he's done thus far in examining that option. Thank you, Madam Chair.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, we looked at the intent of the motion. This business plan, of course, does not carry any changes. We have indicated that we're going to take some of the federal money to go with year three of the strategy. There are no definitive plans underway to build four facilities that I think the motion referenced. We are working with, as well, the Salvation Army on the youth side to look at what services we could possibly develop on an institutional side with the Salvation Army. But at this point, there's no further capital planning that's been done on any specific facilities. One of the key issues being we need to quantify the need and the demand. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Thank you, Madam Chair. Given the interest and the significance that the Members on this side of the House have placed on the issue of alcohol and drug

addiction and the need for treatment facilities and such, was that issue not included in the facilities review that the Minister was talking about earlier? The Minister was talking about this review that he has undertaken on the acute facility side, long-term care side, as well as cognitive need side. Did any of that take any consideration about the need for an alcohol and drug treatment centre? Thank you, Madam Chair.

Thank you, Ms. Lee. Mr. Miltenberger.

No, Madam Chair, it wasn't included in the document that's now being discussed. Thank you.

Thank you, Mr. Miltenberger. Next on the list I have Mr. Menicoche.

Thank you very much, Madam Chair. I'm, indeed, very interested in one of the largest expenditures of our government, which is health and social services. I see that not too many initiatives have changed since last year and probably a lot of it was due to the fiscal restraint that Cabinet put in place, but there are new monies available. So I think that we may have an opportunity here to do things a little bit differently or else give more to the regions, Madam Chair. Some of the things I have been experiencing recently in the Nahendeh riding, particularly Fort Simpson in terms of elders' long-term care facilities, our demographics is that our elders are very old, Madam Chair. Just recently I've noticed that a lot of them had to go into long-term care and the facility in Fort Simpson especially has been maxed. In fact, there may be a waiting list and that wasn't there a year ago. It's just something that is a recent development and it concerns me too, because Simpson is listed as a regional centre, Madam Chair. So as the people in the outlying communities, there are five that are serviced by Simpson, including Fort Liard, one of the larger communities that doesn't have any long-term care facilities. I don't know if we can address that, but for now all the very old people are getting sick and they are making their way to Simpson and the facility is being filled up very quickly. I don't see anywhere in our documentation, the main estimates or the CAP, that's going to address some expansion that is necessary for Fort Simpson. Perhaps at the appropriate time, once I've concluded my statement, the Minister can speak to me about that.

Another thing that's coming to a head is our concept of the alcohol and drugs and how we deal with it as a government. There's a need for awareness and it's similar to the goals of ADAC in Alberta, I guess. I don't see what we, as a government, are doing in that respect, and perhaps the Minister can share some of his views in that regard too. We do have a Liquor Commission, but their goals aren't really to address the addictions side of our population, and I'm just wondering if it would be a health and social services mandate to look at something like that. Perhaps the Minister can engage in some discussion as to how he sees us addressing those needs that are out there in terms of taking care of our needs in addictions and drugs and alcohol and many of the other new scourges that are coming North, Madam Chair. With that, perhaps I'll ask the Minister to respond to the inquiries and comments that I had. Thank you.

Thank you, Mr. Menicoche. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, with regard to the concerns about long-term care, those are legitimate concerns and in the report dealing with facilities, we looked at the demographic projections and it is clear that there is going to be a need for additional spaces over time. We've looked at the numbers in all the communities, which is why we've tried to come up with some benchmarks. We're also recognizing that there's a need to make the facilities that are now in existence more user friendly for those people suffering from cognitive impairment and dementia, and we've tried to lay out a plan and the projected needs in this document. That document will be, of course, subject to ongoing review should the demand change.

For example, the Member has mentioned Fort Simpson, and I know that in my community, as well, at one point there was under usage of the long-term care and there is now a waiting list and I think nearly every community is facing the same situation. We know that in Yellowknife, with being the largest community with the biggest population and being a magnet community, it's facing those pressures as well, along with other communities. So we also are trying to look at ways as part of the plan, not only looking at the long-term care side, but to try to improve the homecare and home support so that we can assist people to stay in their own homes as long as possible and not necessitate the premature use of a long-term care bed, if there were those kind of support services available. So we're trying to come up with a full-spectrum level of service to try to deal with this issue.

With regard to the alcohol and drug practices, the Member touches on a very critical point and it's a source of philosophical debate or service debate of where is it best to focus our resources. Is it best to focus it on building $5 million or $10 million or $15 million worth of facilities? Is it best to follow out the plan that was laid out three years ago to put in community wellness workers and mental health and addictions counsellors at the community level, and make the serious effort to deal with families and individuals in their community using the treatment resources we have available, looking at beefing up the treatment or detox services we provide, an enhanced relationship with the Salvation Army possibly, and then continuing to focus at the community level?

There are schools of thought. The information I've seen, I've made reference to a document done by the National Aboriginal Health Organization, which is a fairly comprehensive review of northern services where they do a survey of literature and their suggestion is that the focus is best if you can put the majority of your efforts into the community level and focus on dealing with individuals and families. I was just at a workshop with Dr. Nordli from an Alberta hospital, who is an addictions doctor, and she made the same case in her practice. She was in Fort Smith last weekend and I went to a workshop with her there and she had the same suggestion.

So it is an issue of discussion and we know there's a concern that facilities be built, but the numbers we have tell us that Natse' Ejee K'eh could be better used, that our numbers of southern placements are relatively small. Before we say yes, we should build facilities, we should do a needs assessment and look at the analysis so that we could all make the best determination in terms of the projected numbers and the usage and the demand for that type of care, as opposed to spending those dollars in

other areas before we issue instruction that we're going to spend many millions of dollars on both capital and operations and maintenance. Thank you.

Thank you, Mr. Miltenberger. Mr. Menicoche.

Thank you very much, Madam Chair. That's some of the things that are coming out of my riding, is that they're saying all our elders are going to Fort Simpson and they're concerned that the facilities are filling up fast. There's already a waiting list. I kind of like that approach of increasing the home care for the elders. Is it possible to do that in the smaller communities like Nahanni Butte and Trout Lake? I'm not too sure. It's just there's probably a level of training or certification that has to happen with the field staff. Perhaps the Minister can address that. What are the long-term plans of training and upgrading the skills of the workers that we do have in the communities?

About a year ago I commended the Minister and the department for addressing the cross-cultural needs of our elders when they're dealing with Health and Social Services or the hospitals. There was a remarkable improvement. People aren't coming to me anymore saying they're really concerned that there's been some misdiagnosis. I'd like to commend the department on that. However, there are still needs that the elders see. When I visit them in the hospital, they're still saying that even though they're in the hospital...They have a couple words that they use with me in my language. In my language it's called nahetsandile, which means that they're not caring about what I say. It might be a language thing, Madam Chair. Also, tsighenealeh, which means coolly done or without regard.

I don't want to berate staff in the communities, but what happens is the level of care that's taken here in Stanton, there's probably a good reason for it, that it's hourly, it's always there for them. Or when they go home to the communities, there's one poor elder who was here, they were watching her on an hourly basis, then she went home to Fort Simpson and says nobody goes by her room to check on her. So I don't know what the difference there is. Perhaps she feels she has to be checked on more often or she felt that she's not being cared for. I'm not too sure of how the professional staff do it because I'm not in that field. For her, the patient sitting there, she's saying that nobody is watching her, nobody cares for her. She's here stuck in some room and nobody is really checking on her.

Anyway, just with those couple of comments there, Madam Chair, I'll just end my comments, if the Minister can respond or reply to that. Thank you.

Thank you, Mr. Menicoche. Mr. Miltenberger.

Thank you, Madam Chair. With regard to the issue of training for home support workers, we have started a process with the college to provide training for home support workers from the communities, and there are nationally recognized levels of training to bring their skills up so there's a common standard that people can be given. We are working on that.

I appreciate the Member's comments about specific concerns currently in the facilities in his riding. We'll be making a note of the concerns. We try to be as responsive as we can and we appreciate the detailed feedback. If there are issues of supervision or how rounds are done or contact with patients, we'll be following up with the Deh Cho authority to see what the specific issues are currently. Thank you.

Thank you, Mr. Miltenberger. Next on the list I have Mr. Braden.

Thank you, Madam Chair. It's general comments, so one comment I would like to offer is that I've been more and more impressed, Madam Chair, with the information flow and communication that this department has demonstrated with committee. The Social Programs committee is where most of that exchange takes place. I just want to put out a compliment here on their style and their responsiveness to committee and to a request. It's really a very good relationship and I want to thank the Minister and his people for that. That's not to say that there aren't differences on issues, as there should be. But when we do take something up with this department, I go into it with a pretty good sense of trust in that we're going to be able to get something done.

The whole area of addictions and treatment and the kinds of pressures that are on society these days has really captured quite a bit of attention in the news, in our dealings here as MLAs and, I'm sure, certainly in the clinics and the front lines of justice. This is something that's everywhere and the signals are that it is going to become even more of an issue. There is always a plea for more facilities, especially because we don't have a lot of dedicated facilities that say addictions treatment centre on every other street corner in the Northwest Territories. Quite the contrary. I would like to be able to look more at the design and delivery of programs at the street level, at the community level, as a way that we can really turn this corner.

Mr. Chairman, one of the things that I've come to look at with a very jaundiced eye is the tendency that we have to send people to addictions treatment facilities in southern Canada or outside of their community and the local environment here, and then they're declared treated or dried out or they've done as much as they can. They come back to the same familiar scenario here in the North and their community that probably had a lot to do with them falling victim to an addiction in the first place.

I'm coming to see, Mr. Chairman, my own bias is not to see that we build all sorts of institutions and treatment facilities. There's a place for that kind of thing, of course. But if we really want to make a difference, it has to be at the community level, the street level, in the schools, in the workplaces. That is my belief, Mr. Chairman. If there's an aspect of this that I'd like to get the Minister's view on or of his officials, where does best practice and current thinking in this area go? Are we better off to build these institutions or facilities and have things done on that basis, or does my way of thinking have some relevance to it, as well? Which way should we be going? Thank you, Mr. Chairman.

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, this discussion, if you look at the issue of health, not just specifically addictions, but including addictions and mental health. There has been a recognition in this House, there has been a recognition nationally that if we just look at trying to fix things once they're broken -- be it on the acute care side, be it with diabetes or all the alcohol-related diseases or diseases related to smoking -- if we just wait and don't do anything at the front end, we'll go broke. We will never have enough money to build the facilities necessary to look after the people, when we know that if we work on the front end side or if we invest in the communities, if we can get people to make the right personal choices -- be it drinking, smoking, exercise, what you eat -- and we provide the support services and we coordinate with education and we have the supports for home care, that's the only way we're going to be able to deal with the problems, especially in the territory here where our health indicators tend to be worse than the national average. So we do need facilities. But we've been told in this House -- and I remember with this committee -- the issue to talk about the prevention and the small portion of our budget that actually is put towards prevention is probably less than five percent. It's probably more like two or three percent and we're spending the vast majority of our budget on dealing with issues on the acute care side or fixing things when they're broken. We know that the costs are not undiminished. There are constantly forced-growth pressures. It is a very important point and my opinion is that we have to make a concerted and sustained effort on the side to work with the communities, to work with individuals and families, and put some serious resources over time on the prevention side. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

Mr. Chairman, that leads me exactly into the second area that I wanted to cover, which is how we're doing on the realization and understanding that we are lagging purely on the promotion and awareness aspect of things. Is this budget, Mr. Chairman, seeing any change in that priority, if you will, or ability or capacity to put more effort into that area? Is this budget turning us around? Thank you, Mr. Chairman.

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, this budget now before us attempts to sustain the initiatives that we have embarked on. If I can refer specifically, for example, to the addictions and mental health side to try to carry on with the third year of a plan that was agreed to following the report that came out -- The State of Emergency -- where there was great concern that the state of disarray and disrepair that we let those services fall into. We embarked on a plan and we've invested money and we've managed to tap into some of the federal funding to go ahead with year three. That is going to be an effort that we want to sustain.

We've had some success with some federal money again on the tobacco side. The tobacco strategy that we've come out with, the Don't be a Butthead campaign, the last count I saw in terms of numbers of commitments made by young children anywhere from eight to 19 or so is over 1,750. There is work being done in the communities this week, as we speak, in Fort Smith and Rae Lakes and one other community where they're going in. They've been going around the countryside with any number of creative, innovative ways that we think is starting to show results. In Yellowknife, the numbers have indicated that there's the start of a decline in smoking. We haven't had the same success in the small communities, but it's those types of sustained efforts that are going to see us through. We're working with Municipal and Community Affairs and with Education, Culture and Employment on the act of living and the physical exercise, and in the schools talking about alcohol and tobacco and right choices and healthy lifestyles and proper diet.

We're attempting to be as coordinated as we can with the social envelope Ministers. We're trying to do our piece on the health side, but it's sustained and it's long term and on the prevention side you may not see the success right away, but it's going to be over time. For example, if children don't start smoking by the time they're 14 or 15, chances are they won't start. It's those types of things that we have to continue to invest in. Thank you.

Thank you, Mr. Miltenberger. General comments. Mr. Yakeleya.