Thank you, Mr. Speaker. Thank you, Mr. Moses.
Aboriginal Culture and the Role of Elders
In an eloquent statement at the public meeting in Fort Providence, Chief Joachim Bonnetrouge said, “The Mental Health Act should be written for the people it serves.” The committee wholeheartedly agreed and made a point of incorporating provisions on Aboriginal culture and the role that elders play in promoting mental and emotional wellness.
The preamble to the current act, which was not carried over into Bill 55, recognizes the many cultures of the peoples of the Northwest Territories and stipulates that an elder must be consulted when an assessment is being made about the mental state of an Aboriginal person. The committee asked why the preamble had been removed, and the department responded by citing concerns that it might be used to interpret the legislation in outdated or unintended ways. The committee disagreed with this logic, asserting that respect for culture is never out of date. The department also noted that the Official Languages Act, which came into force after the current Mental Health Act, carries obligations to provide interpretation services and deliver services in a culturally sensitive manner. Accordingly, the department argued that any mention of culture in the new Mental Health Act is unnecessary. Once again, the committee strongly disagreed. Sidestepping the problem of the preamble’s ambiguous legal status, the committee sought instead to incorporate a number of legally binding principles, including the principle of respecting people’s culture, language and religious upbringing. Another culturally relevant addition to Bill 55 is the requirement that the chair of the review board appoint an elder as a cultural advisor if an applicant requests it.
Principles of the Act
As mentioned, the committee introduced a motion to incorporate legally binding principles that will assist in the interpretation and administration of the act. These principles respond to a wide range of stakeholder concerns. The first asserts that there are to be no unreasonable delays in making or carrying out decisions affecting a person under the act. The second asserts that decisions under the act should respect a person’s cultural, linguistic and religious upbringing. The third states that least restrictive measures should be used, taking into consideration the safety of the patient and other people. The fourth speaks to the importance of family and community involvement in the care of people with mental health issues. The fifth speaks to the matter of mental competence, asserting that patients should be supported in making their own decisions for as long possible. The sixth and final principle pertains to personal privacy, underscoring the fact that information about a person’s mental health is, whether we like it or not, fraught with stigma and should be handled with the utmost respect for privacy. At the clause-by-clause review, the Minister concurred with this motion and confirmed that these principles are consistent with the intent of the legislation.
Failures and Gaps in Mental Health Services
Over the course of the review, dozens of people described their lack of trust in the government’s provision of mental health services. Fighting back tears, one community advocate bravely asserted, “Silence means approval, so I can’t be silent.” In another troubling case, a young man who suffered a brain injury following a motor vehicle accident has been placed in the North Slave Correctional Facility because there is no suitable care facility in his home community. The man’s father is overwrought with frustration because service gaps have effectively led to his son’s criminalization rather than his rehabilitation.
Accounts like these line up with the data the committee received on the Community Counselling Program. Over the past five years, roughly 30 percent of its front-line positions have been vacant for 12 months or longer. Three of these so-called permanent positions in Wekweeti, Aklavik and Fort Resolution respectively, have been vacant for five consecutive years. With such inconsistent coverage, the number of resulting service failures is virtually incalculable. All too often, residents have no one to approach for guidance, counselling or after-care. All too often, referrals for other mental health services simply do not happen. This is unacceptable. The department must renew its efforts to recruit and retain qualified workers.
The proposed legislation, like the currentact, does not give patients the right to receive services. Rather, it allows for the provision of voluntary services on a discretionary basis. The committee identified serious concerns in this area. A tragic illustration is the case of a teenager who died of self-inflicted injuries in April 2015 shortly after being discharged from Stanton Territorial Hospital. He had repeatedly sought mental health services, but his symptoms were dismissed and he was sent away without a plan for follow-up treatment. A second illustration is the case of a young woman who attempted suicide and was brought to a nearby hospital. She was treated and admitted overnight, only to be released the next day with no apparent plan for follow-up care or counselling. These cases point not only to gaps in the provision of community-based mental health services but also to possible deficiencies in clinical practice standards.
On a positive note, community-based services, when available, can make a significant difference. One resident described going through a bad patch of depression and anxiety attacks. "I went to the doctor and got pills, even though I’m not much of a pill-popper. But there was a mental health worker and for three years I got counselling. She really helped me a lot.” The committee is therefore calling for substantial enhancements to the Mental Health and Addictions Action Plan, as indicated in the following recommended actions.
Mr. Speaker, I will now turn the report over to Madam Groenewegen to continue reading.