Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 27 - Evidence - Morning meeting
OTTAWA, Tuesday, September 20, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 9 a.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Welcome. I thank all our guests for coming such great distances to appear before the committee today to provide their views on these important issues.
The committee is in the process of completing its study on mental health, mental illness and addiction. The report of the committee will be out in January, 2006. Senator Gill, who still lives on-reserve in Quebec, and other committee members deemed it important to have one extra day focused solely on the situation of Aboriginal issues. We were appalled by the evidence that we heard in terms of incidence rates; and it is important that we hear viewpoints from across the country.
I ask the witnesses to introduce themselves and provide the committee with three to five key recommendations to improve the state of mental health, mental illness and addiction services for the people with whom they work. That section will be followed by a discussion. The forum today is designed to receive input from, and ask questions of, all witnesses on issues that are of interest and concern to the committee. A number of formal briefs have been submitted to the committee that will be read ultimately. However, for the purposes of discussion, it would be useful to hear those recommendations today. Ms. Gideon, please proceed. I ask that you limit your comments to five to ten minutes.
Valerie Gideon, Director of Health and Social Secretariat, Assembly of First Nations: We had the opportunity to speak with you on National Aboriginal Day, June 21. You have my notes from that discussion in which we provided a general overview of some of our ideas and recommendations. Today, we intend to provide specific points around the four questions that the committee provided in its interim report.
The first questions are about the top priorities that the federal government must act upon as it begins the process of changing the way it delivers mental health services and addictions. At our last annual general assembly in July, a resolution was passed by the chiefs that called for the Government of Canada to be made accountable for its decision to allocate very limited resources to youth suicide prevention without fostering, over the longer term, the involvement of First Nations in that strategy development. Also, the resolution demanded that the federal government provide additional support for a comprehensive and holistic First Nations wellness strategy. Certainly, that strategy would have mental health and suicide prevention as a key point of focus. It would look at a holistic approach for mechanisms that would enable communities to have the flexibility to allocate resources toward priorities and make linkages with some of the health determinants that are fundamental, such as education, housing, and social and environmental issues. Regional Chief Shawn Atleo, as a portfolio holder for the Assembly of First Nations on housing, would like to discuss some of those related issues.
The resolution also supported the need for appropriate funding for First Nations to develop and administer regional treatment facilities for drug addictions and solvent abuse. We have several outstanding proposals submitted by First Nations to look at developing or creating new treatment centres that would have a broad mandate beyond strictly alcohol, for example, or some of the more well-known drugs to look at some of the emerging addictions, such as crystal meth, for example, that play a pivotal role in mental health and suicides in our communities.
The Chiefs in Assembly demanded that the federal government begin to narrow the jurisdictional gap on services by supporting and promoting First Nations community-based strategies and planning for their membership. The Chiefs in Assembly also demanded that each respective First Nation be afforded the ability to select appropriate local urban organizations establishing those linkages while recognizing that the majority of our populations live off reserve and in urban settings where they face high levels of poverty and other social and health-related issues. Finally, the Chiefs in Assembly demanded that the Government of Canada provide First Nations with approved services for their communities to build their capacity to effectively and sustainably manage ongoing issues such as the legacy of residential schools and to recognize the various approaches to youth suicide prevention within diverse First Nations communities.
The resolution resonates with some of the recommendations from the Romanow report and the Royal Commission on Aboriginal Peoples that had specifically recommended an increased transfer of funding to First Nations communities to develop and maintain their own health centre facilities and, underneath that, the mental health services with strategic linkages to provincial and territorial jurisdictions. We think that this approach is aligned with the recognition of the nation-to-nation relationship and First Nations jurisdiction in health that currently exists.
A collaborative action plan and wellness strategy between federal and First Nations leadership would immediately address the mental wellness crisis in a manner that is collaborative, comprehensive and culturally relevant. Critical to the success of this wellness strategy is the long-term renewal of the Aboriginal Healing Foundation. Dr. Gail Valaskakis will provide more information about those activities. We believe that the momentous work of this organization over the past several years should be leveraged to expand and sustain community healing projects. The substantial increase in the number of trained front-line workers and an increase in the number of First Nations mental health and addictions professionals is fundamental to this work.
The second question your interim report asked related to the appropriate structures to ensure that First Nations have adequate input into the design of services they need. I have answered to some of those concerns in my earlier points. First Nations governments must be recognized in their current role in the delivery of health services as well as in the expanded role they are seeking, which they believe stems from their inherent right to self-government that was asserted in the political accord signed between the national chief and the Honourable Minister of Indian Affairs and Northern Development, Andy Scott, on behalf of the Government of Canada at the cabinet retreat, May 31.
I will not go into detail with respect to data-related recommendations. I have already suggested that the First Nations regional longitudinal national health survey be looked at as an option and a vehicle for responding to data needs of First Nations.
I am glad Donna Lyons is here. She is currently managing that initiative and will be able to provide you with more detail. The assembly fully supports that initiative as a data source and an ongoing monitoring of the equality and access of mental health services in First Nations communities.
The involvement of traditional healers and the inclusion of elders in any approach to provide a balance between scientific and traditional approaches to mental wellness services is critical. I wanted to recognize that, in 2002, the Government of Canada through Health Canada, the Assembly of First Nations and the Inuit Tapiriit Kanatami undertook collaborative development of a First Nations and Inuit mental wellness framework that remains relevant today.
Your third question asked how the federal government could better organize itself to deliver services in a more efficient and effective manner. The involvement of First Nations communities in that progress is fundamental, including in all aspects of policy development as well as their inaction in reporting and funding structures. These structures should be transformed so that they are enabling tools rather than barriers to the implementation by communities of holistic approaches to mental wellness. An example of that transformation is multi-year flexible funding arrangements and reporting based on outcomes versus administrative data.
Shawn Atleo, Chief A-in-chut, B.C. Regional Chief, Assembly of First Nations: I feel strongly that the particular question is really how the government should support First Nations people in their own communities, and how to empower the leadership and the experts in the communities who have the solutions.
I appreciate Ms. Gideon providing some consistency with the last report, but upon her conclusion I should like to intervene specifically with regard to my community situation, which I believe has broad implications.
The Chairman: Certainly.
Ms. Gideon: I wish to emphasize that collaboration with Health Canada, the assembly and ITK continues in this area. In the last couple of months we have created a First Nations and Inuit mental wellness advisory committee. The committee is looking into developing an action plan and a strategy over the short-, medium- and longer-term to continue to work collaboratively. The plan will address some of the priority areas of action and will develop specific proposals for the federal government with respect to how to move forward. We would appreciate the support of your committee in that initiative as well as any opportunities that you can offer to us to bring profile to that initiative through the upcoming First Ministers Meeting on Aboriginal issues.
Your fourth question in the report was with regard to whether First Nations would support financial incentives to encourage Aboriginal Canadians to become mental health workers. We fully support such financial incentives. The key to success will be the mentoring of First Nations and ensuring a direct link with First Nations communities in those types of training and education initiatives. Communities can then foster their youth to enter into these professions and can continue to support them through the cycle of their education and training so that they can come back to the communities to work and provide support throughout the seven generations to come.
It is fundamental to ensure that there is that link and that those financial incentives do not reside strictly with non- First Nations institutions and organizations.
I will conclude on that point.
[Mr. Atleo spoke in his native tongue]
Mr. Atleo: I come from the house of Klakishpiitl in the Ahousaht First Nation on the West Coast of Vancouver Island. I am otherwise known as Shawn Atleo. My last name, ``Atleo,'' is an historic Ahousaht name. ``Atleo'' comes from the word ukleatlo which is the cedar branch. The atliuu is a twisted rope made out of cedar root that was used in whale hunting. My great-great-grandfather was the last to go out hunting in the Ahousaht tradition. The atleo itself talks about the pursuit of resources for the people. It talks about the spiritual preparation, physical preparation and pragmatics around going out to get a great whale. It takes months of planning and preparation and much community teamwork.
When a whale comes in to the village, each Ahousaht has a predetermined right to a piece of that whale. It is a form of governance that we still have today in our names and our practises of government. As far as we know, I am the twenty-third generation hereditary chief of my people. Therefore, I come to the practice of governance honestly in terms of it being a family event.
I am also co-chairman of the Nuu-chah-nulth Tribal Council, representing 14 First Nations on the West Coast of Vancouver Island. For the last year and a half, I have been working as Regional Chief for British Columbia.
I appreciate the opportunity to have Ms. Gideon present to you. She is the national coordinator on the issue of health for the Assembly of First Nations and she is doing a tremendous job. I appreciate the opportunity to provide some insight on, and to emphasize, this critical issue. I cannot understate how important it is. It is a real crisis.
I will turn 39 years old soon, and I must be honest and say that I did not expect to make it to this age. I have been celebrating for 10 years now, because I thought achieving the age of 29 might be a great success. It is good that I can laugh about it now, and I do, because I certainly enjoy life. However, only 50 per cent of those in my age group from my village are still living. Of the kids I used to go fishing with, and play with on the beaches of my village, most are gone. Tragically, most have died through suicides and other forms of violent deaths.
The most recent attempted suicide in my village was last weekend. It was an attempted hanging by a young person. However, the young people are not the only ones attempting suicide. People in their mid-fifties and children as young as eight are attempting and committing suicide.
For years, I did not want to go to funerals. For years I went to funerals where people did not talk about the situation. That has changed in my village, the village of Ahousaht. There were over 60 attempts in six months after a successful suicide in December. As I mentioned, there was another attempt only this last weekend. It is critically important that you take the time to engage with our experts and our organizations to study this issue, because it has been exploding.
I brought along some additional information from my own village on the issue of suicide that I hope we can share with the committee. Through the 1990s, we saw a decline in suicide attempts and completions amongst the Nuu-chah- nulth . While there is no one factor that we can point to, I know that the work of the Aboriginal Healing Foundation was tremendous for our people. The foundation allowed for community-based design and delivery of healing. We make absolutely no bones about the fact that our community, I think it is fair to say, is in a post-traumatic stress state.
People such as my father attended the Alberni Indian Residential School for 12 years, and he had all of the worst abuses of the residential school thrust at him, including pricking the tongue when he tried to speak his language. I remember some of the best things about living in my little village; the fishing and the culture. I also remember the worst — the abuse, the violence, the murders, the rapes, the massive suicides and the heavy addictions that in many ways still continue in many of our communities.
In my village of Ahousaht, when the workers started to say to the leaders, ``We can't do this any more and we are getting burnt out,'' it started a broader discussion and, in fact, hit the media on the west coast. Some of you might have seen some of the pieces done about the suicides in Ahousaht. Our village has 90 people living at home. There are 1800 of us. Our young people are in a state of despair. The responses that Ms. Gideon has given provide that broad scope, that national scope, that is required. We are losing people, and people are in a deep state of despair.
I was at the Nisga'a legislature recently. As many of you know, they are now on their fifth year of implementation of their treaty. I talked to their director of health, who was sharing with me that in the last calendar year they had 16 attempts at suicide out of 6,000 people in the Nisga'a. They were quite concerned about that. I shared what the Ahousaht alone had experienced in six months. Only 1800 out of 8,000 Nuu-chah-nulth, only 1800 in my community, had experienced it. It is critical that our experts look at where this issue flares up.
Our communities are always clear about what it would take. It would take community-designed and community- driven solutions. It takes the authority that my late grandfather said I could never divest to anyone, that of a chief. The communities need to have their jurisdiction properly recognized.
In the words of people such as Minister of Justice, Irwin Cotler, we are in an Aboriginal rights revolution. Some academics talk about legal pluralism and First Nations law needing to be recognized in this country. That idea rings true for people such as me who serve 200 communities in British Columbia.
We have gatherings coming up that I think hold a lot of hope. We are meeting next week to talk about a provincial contribution in B.C. to the national health blueprint. We have the First Ministers Meeting coming up in November. We had the Canada-Aboriginal Peoples Roundtable last April. Most recently, we had the cabinet retreat where we heard the Prime Minister talk about recognition of inherent rights. In British Columbia, we are coming to an agreement called A New Relationship document between the three provincial first nations political organizations and the provincial government. Historic words have been spoken by Premier Gordon Campbell that, to us, undo 140 years of lack of recognition by our provincial government on the west coast. The signs are there of a recognition of the need for our people to be able to take care of and govern ourselves — tremendous signs, historic really, at the centre of government. What is required is support of those expressions of political will, such as indicated by Ms. Gideon, that down the lines of various government ministries, particularly in this case, room be created for First Nations to be active designers of responses to issues such as suicides.
Make no mistake about it. This particular issue is a crisis. We are losing people. We have way too many funerals happening. On the west coast, we have no oral history of suicide in my culture. The elders say that as far as they know there is none, and we have lots of elders who are well-connected with our past and have strong teachings.
We are encountering a modern phenomenon that has to do with the legacy of the residential schools. My father is one of the first in Western Canada to achieve an academic doctorate degree. We have survivors and people who have come through the system. We also have many who have said that the residential schools were okay and they did not feel harmed. In fact, they feel that it was good. However, overall, it certainly is a shameful past. This particular issue is an expression of what people like my father, my family and our community have gone through. Ahousaht is just a microcosm of what we know to be a reality right across Canada. For that reason, I appreciate the opportunity to contribute personally to this presentation, along with Ms. Gideon, on behalf of the Assembly of First Nations. Thank you for the time.
Onalee Randell, Director of Health, Inuit Tapiriit Kanatami: The Chairman of National Inuit Committee on Health, Larry Gordon, an Inuvialuk from Inuvik, spoke to this committee earlier in the year, so I will not repeat what he said about the incidents and issues related to mental health that Inuit communities are facing. I will talk about some of the challenges and recommendations that have been made as a result of the challenges.
One challenge that continues to impact the services and delivery of programs for Inuit is access, or the lack of access, to a coherent, integrated system and the jurisdictional issues related to the planning and delivery of mental health and mental wellness services. There continues to be discussions around responsibility — whether the federal, provincial or territorial governments have responsibility. The outcome is that those discussions are taking precedence over the delivery of services to Inuit communities and preventing those well-needed services from being delivered. It is also resulting in poor communication and coordination between not only health service providers from one region to another or from one community to another, but also from the intergovernmental departments. The housing people do not ever want to talk about how housing impacts mental wellness. The education people do not ever want to talk about how to revise or change curriculum to assist students to have the self-esteem and coping skills they need.
At a community level, the impact of the lack of integration is apparent. Individuals sent out for addictions treatment are returned to the communities without health or social services being notified of their return or any follow-up of the outcomes of their treatment. Children and youth who have had suicide attempts and are sent out of their communities for medical attention are returned to the communities with no follow up and, in some cases, no notification of health centre nurses who sent them out.
Human resources continues to be an ongoing issue. Inuit communities have identified the need for trained Inuit health care providers. There continues to be inadequate, inconsistent training and supports for the front-line workers. Often a mental wellness worker in a community is the only mental wellness worker in the community. She often deals with situations that involve family members, either indirectly or directly, and certainly people with whom she is familiar, with no supports or links to others who can provide the support she needs.
We have had an example that has been used in Labrador around how to support people entering training, and the unique problems that people face who enter the health field, and mental wellness specifically.
If you are an Inuk woman with six children who is trying to obtain education to be a mental health worker, you will be told you have to leave your community for two years. You take your six children with you. Few of the financial supports that are available recognize the real costs and challenges for that person. In many cases, the whole family must relocate, whether or not there are employment opportunities. Those supports have not been looked at in the current supports that are available for Inuit who want to enter health fields.
There is lack of training in regions for many Inuit who want to participate in education. They have to leave at least their home community, and often their home region. An Inuk living in Nunavik in northern Quebec who wants to attend nursing school has to go to Montreal or farther.
Some of the current programs provided by the federal government do not address the realities that Inuit face. I will talk briefly about the non-insured health benefits, which has a crisis intervention component. We just completed an analysis of 2003-04 financial expenditures on non-insured health benefits. We found that in that year approximately $60,000 was spent on mental health for Inuit communities: $60,000 for communities that have up to 11 times the national average for suicide. There seems to be an inequity. The program is designed to provide short-term crisis counselling. In some communities there are no counsellors who can provide that short-term crisis counselling, and in many cases the communities choose not to access the short-term crisis counselling. People come in after a suicide, they spend three days in the community, and then they leave. The community is left with no additional resources and no way to deal with the suicide following the three days.
The short-term unstable and uncertain funding causes incredible barriers to the delivery of mental wellness programs. I will repeat some of what Ms. Gideon said: Multi-year flexible funding is required. It is difficult for small communities to develop programs and not know if those programs will be funded the next year. Programs also need to be community-based.
We seem to be in an era of federal funding that is not community-based; it is regional funding involving specific communities. In areas of mental wellness, this funding is insufficient. How do you define which community requires mental wellness programming? Is it the community that does not have the suicides or the community that has had four, five, six or seven suicides in that year?
With respect to the issue of short-term and unstable funding, I will use the example of the Aboriginal Healing Foundation. It took Inuit communities almost three years to develop the capacity to apply for the funding. Now the funding will end in 2007. Every day we get requests for more money. I am sure the Aboriginal Healing Foundation gets the same number of requests. For the first three years of that funding, communities tried to figure out what they needed and how to implement it, and even to get assistance with writing the proposals, which the Aboriginal Healing Foundation provided. By the time initiatives with three- to five-year timelines are operational in communities, the funding has run out. It is hard to get qualified staff to give up permanent jobs to go into a project that may end in two years.
The lack of Inuit-specific data makes it difficult for Inuit to work together across Canada. We have community-level data provided by regional boards on suicide incidence. There is no national reporting for Inuit suicide. It is anecdotal from the communities. We do not have the same level of data on incidence of attempts or incidence of mental illness. There is a great need for data so that communities can make decisions.
What are Inuit looking for? They are looking for a culturally competent continuum of services that incorporates traditional knowledge and practices that are based in their home community or, at a minimum, their home region; a continuum of services that provides supports for individuals and families; and services that breach the barriers and addresses both the medical and non-medical determinants of mental wellness, including economic and environmental matters, and housing and education.
Housing is a particular priority for Inuit. The data indicates that the majority of Inuit are living in overcrowded houses that would be unacceptable for mainstream Canadians. For the impact on mental wellness, you just have to think about having 14 people in a two-bedroom house, four generations, and maybe one or two of those people with full-time jobs.
We are also looking for Inuit-specific programs based on the current realities in Inuit communities. I will not talk about the Aboriginal Healing Foundation because we have someone here to talk about that. Inuit reviewing the Aboriginal Healing Foundation program see the need to expand it, to have it not only focus on residential schools and the negative impact of those schools relating to abuse but also the negative impact relating to language loss, cultural loss and the loss of parenting skills. This information is from Inuit who have provided information that they were not abused in residential schools; they believe the schools were a positive experience. However, they did lose their language. They feel some loss of culture. There are currently not as many programs to it deal with that issue.
There is the issue of relocation. For Inuit communities, relocation happened within the last 50 years. Whole families were uprooted from one region to another. The impacts of that have never been fully addressed by any programs.
We have been working closely with the National Inuit Youth Council. It is unfortunate that the council is based in Iqaluit and Cambridge Bay and representatives could not make it here to present. The council has created a National Inuit Youth Suicide Prevention Framework. We have distributed copies of this initiative. This incredible initiative was done completely by youth in Inuit communities. They have made the following recommendations: Culture heals, therefore we need to identify Inuit perspectives on suicide and depression; to develop Inuit-specific screening tools and treatment strategies; and to train Inuit to provide the services in our own communities. We need to support communications, and form networks of supports in communities between formal and informal systems, and between Inuit across the circumpolar north. We need to make the materials available in clear, accessible and relevant languages.
The impact and awareness-raising that resulted from two Inuit girls doing the Aboriginal suicide prevention walk has impacted the entire Arctic. On September 10, International Suicide Prevention Day, 200 youth walked in Cambridge Bay to show the need for awareness and to promote life in their community.
Youth have clearly indicated that they want to be involved and engaged in the planning and delivery of programs. They want to be involved in providing cultural awareness to non-Inuit who are working in their communities. They want to be given forums to discuss suicide prevention openly.
They want to take a holistic focus on the positive and quit talking about the negative aspects of mental wellness. The National Inuit Youth Suicide Prevention Framework is called ``Embrace Life,'' and they prefer not ever to use the words ``suicide prevention,'' but to talk about how to embrace life.
They want programs that will enable healthier lifestyles through recreation programs, role models, cultural activities, addressing housing issues and providing economic development opportunities for youth, thereby giving youth hope. If you are a youth in a community and you do not believe you will have a job when you finish school, it is difficult to be motivated to stay in school.
The board of directors of the Inuit Tapiriit Kanatami, ITK, developed recommendations specifically related to alcohol and addictions in Inuit communities. There is a need for culturally appropriate community-based alcohol and addictions counselling programs that are based on several models; both harm reduction and abstinence strategies. There needs to be an increased number of Inuit addiction counsellors and early interventions. We need to have after- care and follow-up services in communities. No longer are people happy with going to six-week treatment centres and then coming home to the same situations; the same overcrowding, the same high costs and no supports.
The need for increased residential treatments has been identified. Currently, only two treatment centres provide culturally appropriate Inuit addictions programming. One of them happens to be based in Ottawa.
Nunavut has indicated that it is the only provincial or territorial jurisdiction in Canada without a treatment centre. Nunavut Tunngavik Incorporated has identified a treatment centre as a priority and would like to work with the federal government and the territorial government to create one.
In developing all these programs and implementing the recommendations developed by Inuit, it is important to recognize that in all Inuit land claim regions, land claim agreements have been signed that demand certain responsibilities of the federal, provincial and territorial governments, including Inuit control in the development, design and delivery of programs for Inuit.
Donna Lyon, Director, National Aboriginal Health Organization: Although I represent the First Nations Centre, I am also here on behalf of the National Aboriginal Health Organization, NAHO, and our organization has a mission to improve Aboriginal health. Our core business is knowledge products. We do many reports and analyses of health issues, and we also facilitate and form debates among practitioners and policy-makers. Many organizations of our board members are here today. We have the ITK on our board, as well as the AFN, the Native Women's Association of Canada, the Congress of Aboriginal Peoples, and the Métis National Council.
Within NAHO we have three centres of excellence: the First Nations Centre, the Inuit Centre and the Metis Centre. Each centre is in touch with health policy issues relevant to its clientele, and each has contributed to my brief. Many groups we deal with have the same type of issues.
Within the First Nations, there always seem to be the jurisdictional issues in terms of who delivers the health services. We have the provincial and the federal, and when there are issues of who pays for what service, many people fall into the cracks and many necessary services are not provided. Much of the mental health funding is provided based on affordability and not need. There is a need to increase the funding for this type of service.
Many other groups indicated that the suicide rate is high. It is high amongst First Nations, Inuit and possibly Metis communities. There are many problems accessing those services. Some reserves are in remote areas or in geographical areas that make it hard to access urban services. We have a great deal of difficulties in that area as well.
There has been insufficient funding for addiction services. There are long waiting lists to attend counselling and insufficient funding for patient transportation. Much of the funding is prioritized toward acute care operations and short-term crisis intervention.
We have a shortage of First Nations mental health practitioners delivering services to our own people, and a shortage of psychologists and counsellors visiting the communities.
There is intolerance to the traditional approaches to healing, which is what we are moving to a lot more.
Patients are sent out to provincial facilities when they have crises, and although it saves Health Canada treatment costs, the costs of patient transportation would be better invested in community mental health measures. Patients often return to the community after treatment and sometimes are stigmatized or medicated, and there is a lack of follow-up. We have to break that rotating-door cycle.
To move forward and reiterate what Ms. Gideon has said, we emphasize developing a strategic First Nations mental health strategy or a wellness strategy. It has to be in consultation with First Nations people and our delivery partners. We need adequate funding for federal research, prevention and intervention to be included in suicide prevention strategies. We need partnerships with communities that support First Nations research initiatives.
As Ms. Gideon mentioned, we have the regional health survey within the First Nations Centre at NAHO, and the survey is a community-based survey. It is unique in that it is the only survey that goes on reserve and collects data on First Nations people. There is certainly an opportunity to use this type of system to collect mental health data, which seems to be lacking.
We also need protocols and adequate funding to support communities in crisis. As Ms. Randell mentioned, the National Indian Health Board, NIHB, has an emergency mental health policy. However, we also need to build up the capacity within communities to respond to their own emergency crises.
To follow up on another point Ms. Randell mentioned, there seems to be a shortage of health professionals and mental health workers within the communities. There is certainly a need to promote people to get into health careers. That is an area in which I have worked in the past. What has not been mentioned today is that people in those positions who are working in the communities with suicide and in areas of high crisis also need to be supported. Many of them are burnt out, overwhelmed and get to the point where they cannot effectively deliver the services because they are always in a stage of crisis.
I also have some points that have come from our Inuit Centre within NAHO, perhaps reiterating some of the points made today. Mental health is a priority concern to Inuit. The services training or resources are limited and perhaps non-existent. They are also fragmented and often difficult to access. The exceptional geographic isolation and extreme unemployment contribute not only to the problems but to the solutions.
The mental health initiatives that exist tend to be long distance and dominated by non-Inuit. The people lack the cultural understanding and language for these initiatives to be effective. This is a serious problem.
Inuit involvement is necessary to ensure cultural relevance and effectiveness of Inuit mental health services. We need an increase in Inuit mental health practitioners and Inuit control measures for Inuit surveillance, data collection and analysis, knowledge translation and dissemination of accurate information, all of which are essential for early detection and effective intervention.
Certainly, Inuit input into a federal suicide strategy is necessary. We need a coordinated multidisciplinary, multi- agency approach which includes recognition of the socio-economic challenges that have special impact upon Inuit health.
In terms of ways forward, we need to target special needs and difficulties. Thus, we need Inuit-specific measures. We cannot assume that measures for the general population will work in the Inuit context. We need to target special needs and difficulties related to professional and community capacity development and to enable Inuit to provide effective, culturally appropriate, community-based intervention with Inuit mental health practitioners.
To return again to the topic of funding, we need investment in long-term sustainable funding.
Within the Metis Centre, some 30 per cent of the Metis people make up the target of our Aboriginal population. Some issues that Metis people face are the following: They are not included in many of the initiatives available to First Nation people and possibly Inuit people as well. They are not included in the National Indian Health Board program. They have no access to the National Native Alcohol and Drug Abuse Program. There is certainly a limited amount of Metis-specific health data and research. No funding is provided for that type of research.
The First Nations Centre has the regional health survey, which can be used as a model for other groups as well to gather this type of data.
There is fragmentation of the health care system to be considered. Metis people have access to selected federal health promotion activities, for example, the HIV/AIDS and diabetes initiative, but not acute or chronic curative services.
As to the way forward, the Metis people require culturally appropriate mental health care services. They need increased participation in mental health professions, the same as the Inuit and the First Nations. Under the jurisdiction regarding Metis, they need an increase in services provided to them. They also need to resolve the jurisdictional situation so that they are no longer denied access to Aboriginal federal or provincial mental health and related programs.
In conclusion, governments must respect and include First Nations, Metis and Inuit concepts of health and healing in the development of their general application programs. Mental health research driven by First Nations, Metis and Inuit themselves is required.
We need more people trained to deliver health services and mental health services. We also need federal recognition that health programs to all three Aboriginal peoples is a federal, constitutional or treaty obligation as the case may be.
We also need meaningful progress toward addressing the disparities in mental health conditions and access to quality services, which requires federal leadership and acknowledgement of responsibility to achieve results.
Dr. Gail Valaskakis, Director of Research, Aboriginal Healing Foundation: I would like to make a few general points, many of which echo what we have heard around the table. Much of what you are hearing reinforces what we think of as probable solutions to a number of issues that have been raised already.
First, it is important to support a health-determinants approach to understand mental health in relation to physical health, housing, treaty rights, employment, environment and a whole lot of other issues. That is essential to understanding this problem and to addressing the issues in relation to it.
Second, we must integrate approaches to mental health and understand that we cannot stovepipe them in relation to physical health and to addiction services, in their provision across the country.
Third, as we have already heard, we must equalize services across the country, with particular regard to crisis counselling. These services are variable in regard to what is paid for, what is available and who is available to provide them across the country. This is a critical issue.
Fourth, we must recognize the importance of Aboriginal design and implementation, control and participation in every aspect of the provision of mental health services. It is extremely important that we understand that. We can demonstrate and document it now because of the work of the Aboriginal Healing Foundation.
Fifth, we must recognize that the effectiveness of services that we see over and over are related to Aboriginal approaches and even to traditional approaches; to the use of elders and healing circles, as well as to the use of indigenous knowledge. We must recognize how important that is in the provision of any kind of mental health service.
Sixth, we need to look again at the fact that we must have training in Aboriginal communities right across this country in regard to mental health services. Once again, that is something very much left out in terms of understanding. The training need not be just for nurses and doctors. It is training of Aboriginal people by other Aboriginal people. It is the provision of services that allow Aboriginal people who are working to get some rest and support at various times and not be overworked.
We have heard over and over again that we need multi-year funding. It is really a disservice to set up a program and let it run for a year or two. Again, it is an issue of boom and bust, the raising of expectations. It is totally ineffective. In fact, it may be exactly what we should not be doing. We must fund projects multi-year, or not fund them at all, in my view.
We must always remember those who are invisible. I refer to the people who are not sitting here and who will never sit here — the homeless and the incarcerated that are often forgotten.
Finally, we must support the development of an integrated approach to a mental health strategy, a process that has begun through the work of Health Canada, ITK and AFN.
Since I had the opportunity to speak to this committee on June 21, I do not want to go over in detail any of what I said at that time. However, I would like to point out a couple of things because, as you know, the Aboriginal Healing Foundation is beginning its wind-up phase. That is because the funding has all been allocated and because we are now at a point where we have a draft of our three-volume final report. I have highlighted some points that have emerged from that report in the handout I have given you today. The draft report and these points have already been submitted to Judge Frank Iacobucci, who is looking at the wider issue of residential schools and how those issues may be resolved in the larger context of a number of factors.
The Aboriginal Healing Foundation was funded in 1998 and given a 10-year mandate. It was given one year to set up and four years to allocate its funding on a multi-year level. It is now fully funded. We have given 1,346 contribution agreements to communities to do community-based healing projects. Within this context, we have an estimated 86,000 people who are survivors of residential schools who are alive today. In addition to that, if we extrapolate the figures based on the regional health surveys, the Aboriginal peoples surveys, the census and the information we are able to obtain, approximately 287,350 have been intergenerationally impacted by residential schools. That totals 373,350 Aboriginal people in this country, many of whom have yet to receive services. Extrapolating from our three national surveys, we determined that about 204,564 have been involved in healing projects, almost all of whom have been involved in the first stage of providing healing in terms of trauma and the effect of historic trauma related to residential schools. We know that not more than one third of them have ever been involved in a healing project before, and that almost 50,000 people have been involved in training projects through the Aboriginal Healing Foundation.
Based on these surveys, our focus groups and case studies, we know that healing takes about 36 months — to identify a time when you can move through what you recognize as the issues at hand, to establish outreach and to initiate a therapeutic healing program in respect of mental health. Less than one third of the projects at the Aboriginal Healing Foundation have had 36 months to go through that process. To date about 55 per cent of the people have gone through a first-stage healing process through the Aboriginal Healing Foundation. We know that healing is a long-term process that occurs in phases. In my handout, I have suggested some images that depict both the community process of healing and how it progresses through phases, and the individual process of healing. The two are different but very related. We know the issues that surround residential schools and its legacy, the understanding of that legacy, and the awareness and building of the level of team capacity to involve people in healing. There is a reticence in getting people involved in healing, as we mentioned earlier, and readiness to heal is an important issue in respect of mental-health healing. Approximately 20 per cent of the communities are just beginning their healing; 65.9 per cent of the communities that we surveyed — from the three surveys mentioned earlier — have accomplished a few goals but they have much work to do; and 14.1 per cent of the communities said that they accomplished many goals. Those communities were funded for the 36-month period or longer. The participants told us that their goals changed over the course of attending activities, and that they improved their self-awareness, their relationships with others, their knowledge and their culture reclamation. The majority said that they felt better about themselves because they found strength, were able to improve their self-esteem and were able to begin to work through their trauma. Those measures sound like general factors but they are critical in terms of truly recognizing and dealing with the issues of residential schools.
I have two graphs that show that importance. I believe I spoke to this in the hearings on June 21, but it is important to mention it again. When asked what services they accessed most often, more than 1,400 individual participant respondents said healing services, legacy education and workshops. At the bottom of that list was western therapies. When we asked them what services they rated most effective, at the top was elders, ceremonies, one-on-one counselling, healing and talking circles and traditional medicine. Aboriginal people have always known this but it had not been documented. Now it is documented in this survey of more than 1,400 people who responded to participant questionnaires. Traditional healing approaches are effective and they must be considered. Certainly, western therapies are integrated in some way in some approaches when dealing with mental health. We do not know enough about that — we should know more — but traditional approaches are effective, and we do know that.
We estimate that it takes a community an average of 10 years to reach out, to dismantle denial, to create safety and to engage participants in the therapeutic healing process. We know that process is affected by the level of community awareness, the readiness of individuals to heal, the availability of organizational infrastructure and the access to skilled personnel. In that respect, the projects funded by the Aboriginal Healing Foundation have played a critical role in beginning the healing process, in providing partnerships, in identifying and filling the gaps in services and in involving survivors and those who are intergenerationally impacted.
Two studies are critical in terms of the relationship between mental health services and the larger picture. The first one is the Canadian Incidence Study of Reported Child Abuse and Neglect by the Law Commission of Canada, which the committee should look at if it has not done so. The study indicates that child abuse is extremely costly to this country in terms of employment and education issues, as well as other aspects of life. When applied to the residential school issue, it shows that Canadian society pays about $440 million per year on incarceration, social services, special education and health. That figure is merely an extrapolation of the Law Commission's study on child abuse.
The second study was co-funded and partnered by Aboriginal Corrections Policy Unit , under the Solicitor General of Canada, and the Aboriginal Healing Foundation. The study looked at healing in relation to incarceration on the Hollow Water Reserve and found that healing is more cost effective than incarceration, and actually lowers the incarceration rates. For every $2 spent on the community holistic healing circle program at Hollow Water, the federal and provincial governments save $6 to $16 on incarceration fees. That is a conservative estimate that was done by holding the cost of the system constant and adding the cost of one person to the system. If we factored in the cost of the system, the federal government would save a great deal more money. Healing is cost-effective, personally effective and socially effective.
The Aboriginal Healing Foundation has suggested a way that healing could be supported on a long-term basis — the investment in healing as shown in the last three slides of this presentation. An endowment of $600 million would support a 30-year healing strategy with a 2.5 per cent inflation rate and a 5 per cent return on that investment. Thus, $28.7 million per year would be available for community-funded projects. This would mean that by year 30, the Aboriginal Healing Foundation would have invested $1.2 billion in healing.
The importance of that in relation to what we have not yet accomplished is as important as what we have accomplished. Inuit have been late in coming into the programs, and are now active in the projects supported by the Aboriginal Healing Foundation. Metis have been even more difficult to reach and are a target. Many areas of society that are invisible to all of us, such as the homeless and the incarcerated, have been difficult to reach as well, and much of what has begun on reserves across this country and in urban areas will be lost due to lack of funding for the projects of the Aboriginal Healing Foundation. The funding priorities should be the continued outreach to the underserved and special needs Aboriginal communities and the provision of opportunities to begin the healing process in areas where that has not happened. As well, support should be continued to Aboriginal communities and communities of interest with the funded projects for an average of 10 years. Another priority should be to continue to document and evaluate effective healing practices and to share those with all stakeholders. There is much to be done in those areas. Another priority should be to support self-determination and self-reliance in Aboriginal communities through culturally appropriate healing services through training and networks.
Therefore, we recommend that the Government of Canada renew the mandate of the Aboriginal Healing Foundation for a period of 30 years. We recommend that the renewed mandate address the legacy of abuse and social, psychological, cultural and spiritual injuries, including intergenerational impacts. We recommend that the mandate be designed to complement and advance the interrelated goals of acknowledgement, redress, healing and reconciliation, the formation of a new relationship — an extension of ``Gathering Strength'' in many ways — and the recognition of Aboriginal relationships with non-Aboriginal people in Canada. We also recommend that the AHF be funded to support a public education role to conduct research and to share knowledge related to the legacy of abuse and to promote healing and reconciliation in that fashion. Finally, we recommend that a $600-million, one-time grant be invested to generate income to be expended over 30 years to fulfil a renewed mandate of the Aboriginal Healing Foundation.
Jennifer Dickson, Executive Director, Pauktuutit Inuit Women's Association: Thank you, senators. I will not mention adequate, long-term, less-onerous funding even once.
Pauktuutit Inuit Women's Association is a national organization that represents all Canadian Inuit women, both in the Arctic and the southern regions of our vast country. Pauktuutit is pleased to have this opportunity to share ideas and to contribute recommendations to this important Senate of Canada initiative.
I would like to introduce my colleague, Leesie Naqitarvik. She is the manager of several of Pauktuutit's abuse files. We know that abuse of all kinds is endemic and persistent in the Arctic. It is an issue that powerfully impacts on and is impacted by the mental health of all Inuit.
Pauktuutit is truly northern and works under the direction of a 13-member board of directors made up of Inuit women drawn from every part of the Arctic, including youth and urban representatives. We are active in a wide range of programs in the Arctic, including the legacy of residential schools, gender equity, abuse prevention, protection of cultural and traditional knowledge and economic development.
On the health side, we are engaged in long-term advocacy and program work on substance abuse, HIV/AIDS, hepatitis C and other sexual health issues, diabetes, tobacco cessation, suicide prevention and respite for caregivers, to mention only a few.
Since women hold in their hands our most vulnerable citizens and our hope for tomorrow, Pauktuutit has always emphasized the well-being of children in all our work. Traditional midwifery, maternal and infant care and prenatal programs, teen pregnancy, youth suicide and child sexual assault are among our child-related programs.
That is Pauktuutit in a thimble. I will give you one or two other facts for context.
Canada's Inuit are one of the earliest human civilizations in North America. Their people and culture have occupied the circumpolar regions of the world for more than 5,000 years. The majority of Canada's 47,000 Inuit live in 52 remote Arctic communities extending thousands of kilometres from the Alaskan border in the west to the eastern shores of Labrador, making up about a third of the land mass of Canada. It is a young and rapidly growing population. This vast cultural and geographic heritage will soon be in the hands of our precious youth. Canadian Inuit now have an average age of 20, compared to non-Aboriginal Canadians who have an average age of 38. Imagine if the average age in this room was 20.
We prepared a beautiful slide show for you and I am sorry that you will not get to see it. Perhaps I will email it to everyone.
The Chairman: That would be a good idea.
Ms. Dickson: Thank you.
Today's topic is particularly relevant to Inuit women, as their well-being — physical, emotional, economic and spiritual health — are key factors in the mental health of themselves, their families and their communities. We know that with regard to number, quality and effectiveness, services to Inuit women and related supports to their children do not yet even approach services provided to Canadians as a whole.
If we are serious about strengthening mental health in the Arctic, the challenge must be approached holistically and with consistent long-term interrelated policies and programs.
You may think that the four of us got together and made up one agenda today, but these are truly serious issues.
Economic opportunities, adequate and effective housing, improved education, gender equity, actions to protect the environment and attention to justice issues are some of the issues that cry for a strong, holistic approach. Further, to be effective, programs need to reflect the unique circumstances, culture and needs of Inuit communities.
I will not describe in detail the seriousness of the situation. You have heard the facts and statistics. I looked at the transcripts of your previous meetings and was amazed at the comprehensiveness of the facts you have collected, so I need not scare everyone by going through them again.
The consultations you held with our ITK colleagues last spring and this roundtable today are evidence of your concern. However, lest we become complacent, let us remember that past and ongoing societal transition, including forced settlement, relocation and residential schooling, have placed the social and economic conditions in many remote communities in the Arctic at the extremes of many of Statistics Canada's indicators. They include the highest rates of unemployment, the lowest income, the highest cost of living, the worst housing conditions, the highest rates of communicable diseases and the shortest life expectancy of all Canadians.
We have some recommendations on what we can do about this.
Let us employ community-based decision making much more than we do at present. As with most public policy implementation, policies and programs that work best for Inuit are initiated, designed, delivered and administered by Inuit.
Let us ensure that all programs are culturally relevant. Unique traditional knowledge and culture is central to Inuit health and well-being. Inuit wisdom and ways must be incorporated into all programs if we are to affect individual and community health positively. As your interim report states, the goal is to have a ``culturally competent continuum of services that includes traditional knowledge and practices based primarily in the home community or region.''
Third, let us improve and build new service networks so that colleagues can work together and share information, experience and expertise across the vast geographic, technical and jurisdictional barriers of the North. Coordinated service networks are necessary in northern regions and communities.
Let us build capacity. Inuit families are aware of severe staffing shortages and the ``geographic maldistribution of mental health and addictions professionals.'' That is also from the report. However, there are important resources already in the communities as well. For example, let us build on existing strengths by including elders and by offering training and development opportunities that meet remote community objectives. Let us promote and adapt Inuit traditional knowledge and knowledge from other sources to train both Inuit and non-Inuit in culturally appropriate healing practices in the North.
Let us use the up-and-rising distance education and telehealth in capacity development. The key to capacity is adequate, flexible and ongoing funding — I was not going to say that — for human resources and infrastructure, and for continuing and new programs.
Let us coordinate and integrate the system. Pauktuutit is on record as offering to assist with coordination and integration of federal, provincial and territorial programs and services offered to Inuit.
Let us improve the numbers. Only with current Inuit-specific statistics can implementation, development and evaluation of programs and services be based on relevant, reliable evidence.
This is key: Let us follow the Inuit youth. As mentioned above and elsewhere at this table, the average age of the Inuit today is 20. The National Inuit Youth Council, NIYC, has developed an ongoing, engaging and holistic youth suicide prevention framework. Ms. Randell provided you with a copy of that, which describes in detail many of the concepts and recommendations outlined in my presentation and elsewhere around this table. If you do nothing else, get on the NIYC website, because what the youth have done is amazing.
People who are happy and well do not harm themselves. If we enhance and protect mental well-being, the effect will be a strong measure to prevent suicide.
Let us make certain that there is a healing centre in each of Canada's remote Arctic communities. Well-trained mental health resource people must be available. These centres might provide places where Inuit elders, adults, youth and organizations could truly listen to each other and involve each other in meaningful interventions and traditional healing.
Schools can support the development of total well-being by providing not only for academic achievement but also healthy physical activity, and coping and relationship skills. Community youth groups can be active in role modelling and cultural activities, and they can be trained in suicide prevention.
Let us be serious about supporting culture. The Inuit population is growing faster than any other in Canada. Youth needs supports to ensure their values, language and traditions are maintained. One key to culture is language. We need to preserve, promote and enhance Inuktitut across the Arctic. We need to promote life and well-being, and build strong communities. Holistic mental health strategies must include employment and transitional programs, programs for trades and high school equivalency, housing for young adults and more. New and existing early childhood programs strengthen a child's foundation for total well-being. Gender-based analysis will go far to ensure equity for Inuit women. Regional crisis lines and healing centres in each community can provide access to support personnel.
Inuit women are truly the agents of change in Canada's Arctic. If motivated, included, franchised and supported, they can and will contribute substantially to strong, stable, healthy and happy communities. On their behalf, I invite questions.
The Chairman: Thank you to all for the thought you have obviously put into your presentations. It is helpful to us that there is an element of consistency of view. It makes it much easier for us to develop recommendations.
I would like to ask one general question that many of you touched on before I turn to Senator Gill. I find it a little confusing. Many of you raised the issue of interdepartmental fighting between either departments in Ottawa or between the federal government and the provinces in terms of initial funding and also ongoing funding. In the case of on-reserve First Nations or Inuit, I am not sure why the provinces are involved. I know you go to some of their hospitals to get services, but I would have thought the funding issue for those two groups was entirely federal. Is your dispute between the Department of Indian and Northern Affairs, on the one hand, or the First Nations and Inuit branch of Health Canada, on the other? Apropos of that, if anyone has any views on whether those two ought to be merged so the health funding comes out of a single pocket, I would like to hear them.
I think it was Ms. Randell who made the extraordinary statement that funding for mental health is based on affordability, not need. One of you used that phrase, and it certainly stuck in my mind. Other than the stupidity and the outrageous nature of that situation, it would be interesting for me to understand whether or not mental health funding is always the last thing to get funded. In your view, is it that we fund everything else in health and if something is left over we throw mental health a crumb, or is it, in fact, a dramatic underfunding across the entire spectrum?
Ms. Randell: Your first question related to the provincial-territorial-federal responsibilities related to health care delivery. For Inuit communities, there is a definite role for both. For example, in Nunavut in the Northwest Territories, the federal government transferred health care delivery in 1988 to the N.W.T. and then, when Nunavut was created, that transfer went to Nunavut. The First Nations and Inuit Health Branch provides prevention and promotion programs and in some cases, limited care and treatment programs to Inuit communities through the two territorial governments: for Inuit living in Nunavut and Inuvialuit, through the Nunavik Health and Social Service Board for Inuit in Quebec, and through the Labrador Inuit Health Commission for Inuit in Labrador. In Nunavik, for example, in northern Quebec, if someone requires significant mental health services, they are transported by Medivac to Montreal, to a provincial hospital, where they have developed a partnership or an agreement. In fact, Nunavik has one bed dedicated for Inuit in Montreal for mental health services.
The Chairman: Is that cost paid for by the federal government?
Ms. Randell: I think it is covered by the provincial government.
Senator Gill: It is charged to the federal government after that.
Ms. Randell: Labrador has just recently signed their land claim agreement, but the province of Newfoundland and Labrador still provides health services. They run all the health centres in Labrador. Under the terms of the agreement, that will change within the next 10 years but, at the current time, the hospital-based services or health-based services are provided through the province.
Ms. Gideon: It is a complex question. At the First Ministers Meeting coming up on November 25, one key area on which we aim to provide recommendations is that of clarifying roles and responsibilities on Aboriginal health through the blueprint process. Over the past year, many of us in this room have had a full-time job in developing this blueprint on Aboriginal health. The clarifying roles and responsibilities discussion is only happening now because of the complexities with respect to federal, provincial and territorial governments and our organizations putting our cards on the table and saying, these are our areas of confusion and this is how we need to clarify them. Again, it requires some jurisdictions to take on more responsibilities, financially and otherwise. There is a price tag associated with roles and responsibilities, so there is bit of reluctance to take them on, but I will do my best to indicate areas of activity and confusion now.
At the federal level, territories and provinces receive funding for health and social transfers for First Nations residing in their territory and province, but there is no accountability to First Nations as to how that money is spent. It is difficult to get a sense of how the money is utilized, when you look at the proportion of dollars and expenditures. We have been able to pull some of that information, but, again, there is little accountability.
The Chairman: Are you talking about on-reserve or off-reserve?
Ms. Gideon: I am speaking about both. They are part of the population that resides in the province. The federal government through Health Canada, and through some health-related services provided by the Department of Indian and Northern Affairs, offers some support on-reserve for promotion, prevention or primary care services. Even some basic nursing services will be utilized in the context of mental health, wellness or suicide-related issues. It is not clear- cut. There are some community health programs such as Brighter Futures, Building Healthier Communities, where the majority of the funding is utilized for mental health services. There are also non-insured health benefits, which are clearly funded by Health Canada. As Ms. Randell stated, little of that money goes to mental health services for the Inuit population. Our analysis shows that there is an average of 7.3 per cent annual growth in mental health expenditures for First Nations people within the context of the non-insured health benefits program. I do not have the specific dollar figure here but I could find that for you if you want a sense of proportion. It is a bit of a hodgepodge. Some of the community health programs now, such as Brighter Futures, are designed to be flexible for communities. Communities that have negotiated a health transfer agreement, which is the majority of our communities — I am talking here about on-reserve — do have some flexibility as to how they can allocate some of those dollars for mental health. The issue is that it is not nearly enough.
Another issue is that there is very little coordination between some of the community-level health services and what the province would be expected to support at the secondary and tertiary care levels. Even if there is some coordination, First Nations have little say over how the provincial-level services are provided.
Especially in provinces where much of the decision-making is devolved to fairly independently operating regional health authorities, First Nations communities have to take on their responsibility to push the regional health authorities to be accountable to them for the type of services they provide to their members. The reality is that they do not have the capacity for that. Very few of the regional health authorities reach out to First Nations communities in their areas to develop relationships.
That is the rationale behind the blueprint on Aboriginal health on which we have been working. I am trying to bring it full circle. I wish I could contribute specific recommendations here that I expect will be endorsed around the issues of mental health and wellness at that meeting, but we are not there yet. On our end, we have been promoting what I have presented today, which is a community-driven approach, a holistic approach. This approach looks at the basic administrative mechanisms that the federal government can put into place to enable and support that kind of approach. That is what we have been trying to work on collaboratively among Health Canada, AFN and ITK.
Ms. Dickson: I will add a bit to the first piece of your question, about the interdepartmental lack of cohesion. I was scribbling while others were talking and I counted six independent federal departments with whom we deal on a weekly basis for various programs, policy and projects: Canadian Heritage, Indian and Northern Affairs Canada, FNIHB at Health Canada — that is First Nations and Inuit Health Branch — Status of Women Canada, Social Development Canada, Indian Residential School Resolution Canada, IRSRC, and Canadian Tobacco Control Research Initiative, CTCRI. As well, we deal with two private-sector foundations: McConnell Foundation and Lawson Foundation. You can imagine the complication when every one of them has different dates when they need reports and proposals provided, they need completely different formats, tables, models and templates with completely different types of information filled in, and reporting and proposal-writing requirements that are onerous. I was writing one on Sunday afternoon. One of my brothers was at my home and asked if I was buying IBM, because this proposal was already 46 pages long without one extraneous word. I still have not presented it because I am not yet finished. Here is the sad part of it: It would be funny except that the issues we are working on are critical. Anyone who travels to the remote isolated communities will come back and say, ``What are we doing?'' Yet the national organization that represents the women — I cannot speak for the others, but I see you smiling in agreement — are treated as though we have done 10 things badly, and therefore we need to be watched because we might misappropriate funds or might not complete our undertakings.
This is not about transparency or accountability. Why not come in and do a comprehensive audit once, and then say that we seem to be squeaky clean over the last 20 years? Maybe then we can have a three-page report or a one-page report.
Let us say we are doing work on residential schools. We have put in a five-year proposal. We have finished the first year and completed a report. It is now time for second year. Do you think somebody would let us refer to that five-year proposal and see what it says about year two? No, we have to do another proposal about the year two thing with a whole bunch of reporting. It makes you crazy, not just because of quantity but also because of what it insinuates about the integrity and capacity of the people we are serving. It is unacceptable on the integrity side.
That is what I wanted to say. On the government departmental project manager side — the people with whom we actually deal, as opposed to who else is senior to them who make the policies — they are as frustrated as we are. All those with whom we deal tear out their hair and are so sorry and apologetic. They try to be helpful, but they refer to their finance department, Treasury Board, God or someone, I do not know who.
Last week, and this is the good news, Treasury Board held a week-long meeting that several of us were able to attend for three or four hours. Their objective was to try to figure it out. They had all the departments there. They will do what they call lateral management where they will try to develop a template that everyone could share. I could attend for only a short while, but my financial officer attended some of it, as did Ms. Randell's. Is it discretionary or mandatory when the Treasury Board makes up the new template and the departments participate? They look sheepishly at each other and say it will be discretionary.
There is another week spent. It is onerous and probably consumes 30 per cent of my time. It is not a productive use of our abilities at all.
The Chairman: It is too bad that the written word does not reflect the frustration that is so obvious. Thank you very much.
Senator Gill: I will express myself in French.
[Translation]
I want to thank everyone who made a presentation as well as everyone who contributed to this meeting. You have accomplished a tremendous amount of work. I agree with almost everything that has been said. The suggestions are very realistic and the solutions advanced are geared to people's needs. I began my public life in 1956 and I have been hearing about these problems and witnessing them first-hand for 49 because I go back to my reserve in the Lac Saint- Jean area every weekend.
I would like to thank senators for taking the time to examine the issues of mental health and drug addiction. The task was not an easy one. More specifically, I want to thank the Chairman for organizing cross-country roundtables. The role of a committee such as this one is to inform our colleagues and to make representations to the House of Commons.
The Committee chair decided to take the bull by the horns. He was the one who encouraged me to take part in these proceedings and who told me that any information gathered would be passed along to all levels of government and that concrete steps would be taken to address the problems brought to light in the course of discussions. If our upcoming report is well received by all First Nations, the Inuit and others, and our findings challenged by our peers in government, that will be taken as a good sign. It is not easy to initiate reform in this area, but reform is critically important in we are to foster harmony in the nation and ensure that aboriginals feel included and are able to lead full lives in a country that belongs to them as well.
Information on this subject is sorely lacking. Is our government aware of this fact? It should come as no surprise that there are no fast solutions. We have failed to resolve aboriginal problems in this country. The history of this people is well known. Things went wrong from the beginning. We need to work on integrating services. Various departments at both the federal and provincial levels have proposed various solutions.
When I was with Indian Affairs, I heard the same thing over and over: the aboriginal question comes under federal jurisdiction. Education, on the other hand, is a provincial responsibility. How do we reconcile these two realities? Health care is a provincial responsibility. That issue needs to be clarified. In the late 1930s, the Supreme Court ruled on the question of jurisdiction over the Inuit, as each level of government was seeking governance rights. Provincial governments were very interested, but were they really interested in the Inuit, or more in the natural resources on aboriginal land?
Aboriginal groups have made numerous representations on the issue of governance. Some measure of success has been achieved by communities, band councils and the Inuit through treaties. The same holds true for education. Substantial progress has been made, but today, according to comments from various sources, problems persist. Criticism has been leveled against certain band councils and unfortunately, some generalizations have been made. In these particular instances, mismanagement has plagued the bands and the education process. The message that is being conveyed is that placing one's trust in aboriginal peoples does not always guarantee success.
If we recommend in our report that responsibility for managing services be assigned to aboriginals, we run the risk of hearing the same response given on the question of education and governance, namely that this might not be the right solution in light of past failures.
Currently, Indian Affairs retains complete control over education and governance. The department endlessly demands reports. Therefore, it is incorrect to state that responsibility rests in the hands of First Nations.
We need to do more than just turn management of companies over to aboriginals. We need to give them full control, working through departments. Laws adopted by Parliament must not fall into the hands of public servants, not because public servants are bad, but because their job is to control. If we do not follow through on our actions, we will end up in the same boat again.
[English]
The Chairman: Would anyone like to pick up on any of those points?
Mr. Atleo: Senator Gill, I appreciate your intervention, especially around the notion of where the control really lies. I was thinking, as I was listening to the outstanding presentations, that the committee would probably do well to hand over the management of this whole issue to the presenters here, and maybe we can add that to the list of recommendations because the theme has been consistent.
It strikes me that if we had one of the elders from my community here, they would say in my language — [speaks in native language]. There is a process in our history on the West Coast — [speaks in native language] — and a literal translation of it is, ``facing up to the reality and sweeping away the badness.''
That is the exercise that is reflected in the presentations. It is about coming together and asking: Is the understanding out there? Maybe it is not. Is education required? I believe so. My 16-year old daughter has, for the first time in our school system, a First Nations study book which is relevant and up to date.
I talked to three different deputies from three different departments over the last week about the housing situation to which I referred earlier. Morris Rosenberg from Health Canada came to visit my village. During his visit, we saw a boat coming out of the mist just offshore. I explained to Mr. Rosenberg that when I was young I used to go out all the time with my father — all of us did. The water was teeming with boats. I talked about whaling and the role it played in my community. I talked about governance, well-being and caring for the people and the territories. We have been disconnected from those responsibilities. There has been a disconnect from the responsibility and authority that comes with my name. ``A-in-chut'' means to provide for the people. We have to find new ways to go out and get the whale, so to speak, to provide for the people. There needs to be a reconnection made. Mr. Rosenberg understood what I was trying to say about fishing. We are involved in a fisheries litigation case. After 10 years of unsuccessful negotiations to pursue a role in the fisheries, we only have three licences left in Ahousaht, which is a community of 900 people.
I referred earlier to the number of suicide attempts that were made over the course of the first six months of this year in my village. That was the same time that Canada came out with a statement of defence against our fisheries litigation case in which it stated as an opening defence that Nuu-chah-nulth people do not exist.
Juxtaposed with the good centre of government political will that we are hearing from the Prime Minister and the Premier of British Columbia we still have the on-the-ground work that continues to reflect the history of denial and extinguishment. That is the challenge. If one of my elders were here there would be so much that would not be understood. However, the exercise is the same. It is facing up to reality. It is having that long-term perspective. It is bringing the right people together. It is not being afraid to make bold decisions and choices.
As we have this conversation, which is really important, I wish also to ask: How is it that the work of this committee intersects with the Prime Minister's bold pursuit of transformational change to overcome the shameful conditions that others have referred to in the communities?
The Chairman: I will comment on that issue. This committee undertook this work after we finished our previous health care study. Thanks to the Supreme Court of Canada, and other decisions by provincial governments, the vast majority of recommendations in that study have been put into place. We were working on this issue before the present Prime Minister became prime minister. We started this study some time ago.
Inevitably, as to the results of this issue, I will endeavour to ensure that where we stand on that issue is understood by the Minister of Health and the Prime Minister prior to the First Ministers Meeting. What they decide to do with it is obviously up to them. I will ensure that they know where we stand, as a committee.
In our previous report we stated that we did not agree with the Romanow philosophy of simply throwing money at the problem. We suggested that we actually try to make change on the ground, something for which we were soundly criticized by all kinds of people including, in my case, members of my own party. The reality is that the consensus now in the health care field is that we actually faced up to reality and tried to come up with some practical solutions. We will do the same thing here. We will also be criticized here. We understand that. Our challenge here is to try to make progress; it is not to be popular. That is why I was encouraged by the consistency of the comments made around the table. That makes it much easier for us to come to a conclusion.
The other interesting thing is that this committee has never had a non-unanimous report. There is no partisanship here. You could not tell from anyone asking questions to which party they belong. That is not an issue for this committee at all.
Ms. Valaskakis: I would like to follow up on what Senator Gill has said. We have appreciated his work over the course of the last 40 years.
In academic support of the points that have been made in relation to control and culture, there is the work that is so important that I mentioned before but which I will mention again. I refer to the work of Michael Chandler, a professor at the University of British Columbia and Christopher Lalonde, a professor at the University of Victoria. In relation to suicide, they asked: What is happening in communities where there are no suicides? They have now done 30 years of empirical research looking at the statistics on this subject. They found that in communities with no suicides, something which has been consistent over time, is a tremendously high level of control. That translates into a cultural continuity over a period of time. Their premise is that you cannot envision a future if you do not have a past. That past is essential. It is envisioned and acted out in things like control over your education system and involvement in your treaty process, land claims and Aboriginal rights. It is found in control over systems of policing, health, housing and participation in your community.
That is critical work. They are now extending it in Manitoba and, hopefully, in Inuit country. We will see if the same thing holds. Their work says that we cannot forget that this is the critical factor and may be an answer to the problem and the issue of suicide, which is plaguing Aboriginal communities right across the country.
Senator Keon: First, I would like to thank all the presenters. It was tremendously interesting to listen to you. Over the last couple of years, this has been a tremendously interesting education on this whole subject. The more I learn about it, the more embarrassed I am to be a non-Aboriginal Canadian because I think the situation is abysmal.
Having said that, we cannot leave it at that. We have to try to assist you, in some way, to change the situation. Chief Atleo, I was interested in your presentation. I thought it was superb. You have such a tremendous understanding of the situation.
I had the great privilege of being in Iqaluit when a whale came into the bay. I watched the residents of Iqaluit descend on the bay with all their individual containers. The whale was divided within a matter of an hour or two. It really was quite a sight to see.
I do not know to whom I should address my first question. I will ask Ms. Dickson because she has a framework that we may be able to include in our recommendations to assist all of you to develop a framework that has indeed worked in our country. In some ways, the Aboriginal situation is a microcosm of Canada itself. Our country is vast and has a small population with many different community needs. When we try to organize centrally and create a top-down administration, we kill local initiatives and do not fulfill the needs of communities. Although I do not understand the situation as fully as you, I believe that it is a question of how you can be assisted to come together to share information and resources while preserving your community and local Aboriginal autonomies.
Ms. Dickson, I noted that your organization is for all Inuit. That is a tremendously interesting concept that should be supported and pursued. My admiration for women began when I was young in that I was the thirteenth child in our family and I was raised by a widowed mother from the age of six. She was a school teacher. Can you imagine a woman being left with so many children, all of whom received a university education? I have been struck by the initiatives coming from women throughout my life. Would it be a good idea to expand this tremendous initiative to include all Aboriginal peoples?
Ms. Dickson: I agree that as go the indigenous peoples, so goes the country, if that is what you mean by the term ``microcosm.'' One could say that it is a microcosm of a global situation.
It is interesting that you would ask about expanding the mandate to include all Aboriginal women in Canada because I have been working hard to collaborate closely with the Native Women's Association of Canada, NWAC, who, unfortunately, could not be here today. I speak to this for the first time: Last Thursday and Friday, their annual general meeting unanimously passed a draft of a partnership agreement that we will sign in a ceremony at our annual general meeting. It speaks to how the two organizations will work closely to benefit the women in our mutual communities. Having said that, I do not know if it should go as far as amalgamation into one organization. Inuit are as different from First Nations as Japanese are from Chinese: not just culturally, linguistically and geographically but racially, historically and in terms of sensibility. Although good collaboration could happen, there are many things about the Inuit in the North of Canada that are more in common with other highly northern communities around the circumpolar region than with others. However, that does not mean they should not unite; I think the women of the globe should unite. It is time we took over because we could not do any worse than the men have done. For example, just look at what has been happening in Louisiana.
There are many things in common and we have found that close collaboration is possible without either amalgamation or a kind of hierarchy being set up. We are able to come together on issues of mutual interest and not of interest elsewhere. For example, we have a long, strong history on abuse issues, such as the events at that pig farm outside Vancouver. In the wake of that, a program called Sisters in Spirit was initiated by the NWAC and we are partnering in it. We can bring the practical, on-the-ground, how-to-make-it-happen advice and they can bring the broad, cross-national and southern sensibilities to the program. As well, the funding came about after NWAC approached the federal government. Furthermore, NWAC is able to speak on many issues on our behalf for reasons that are arcane and somewhat beyond me. The federal government has yet to recognize Pauktuutit as a ``national Aboriginal organization,'' of which there are six in Canada. Five are recognized but we, the sixth, are not recognized. What part of ``national'' or ``Aboriginal'' or ``organization'' are we not? We receive many strange answers on an issue- by-issue basis but the bottom line is that someone thinks there is a pie with five slices and if they have to make six slices then everyone receives less, which is not true. Most of our efforts involve policy work, and more people at the table could broaden the base of support and not do the contrary. We are often excluded or deliberately marginalized from policy tables across the country. NWAC sometimes carries our flag for us when discussions are specifically geared to women's perspective.
I will emphasize the other point you made about your mother raising six children. By the way, my mother also raised six children and she is still at it. Women do not necessarily bring women's issues to the table. Rather, women bring a women-specific take on all issues. I know that the women senators here are well aware of that, as most women are. However, it is amazing how often it has to be said. People will ask what Pauktuutit must be involved in: Is it breast cancer, midwifery, daycare and maybe some equity issues? We answer yes, all of the above, as well as nuclear waste management, environmental integrity, international affairs, traditional knowledge and intellectual property. Their eyes glaze over and they wonder what we are talking about. We must continue to say that this is not only about women's issues but also about women's takes on all issues.
In the North, Inuit women are amazingly wise and practical. Some things they say and do when franchised to do so, by which I mean empowered, are lessons to us all — nationally and globally. Does that help to answer your question sufficiently, senator?
Senator Keon: Yes, it does. Thank you.
Chief Atleo, tell us how you perceive the large, blanket networks. I am not talking about organizations with top- down administration, but of networks that can assist you in obtaining the needed resources in your community to deal with suicide and other issues. In my view, you cannot raise that kind of intellectual and health professional expertise in every little community. Therefore, the understanding has to be pervasive but the resources will have to be shared in some way. Would you expand on that comment?
Mr. Atleo: I will do my best. I want to support Ms. Dickson's comments as well, and that was part of my reason for supporting the delegation of the responsibility to this committee. It connects with your earlier question around collaboration. As I alluded to earlier, as A-in-chut, I have the responsibility to act in the jurisdiction that I was born into just as my grandfather was. We have the constitution that recognizes three distinct groups. We are in that transition phase of sorting out multi-jurisdictions and the concept of more than one sovereignty — a legal pluralism — as I mentioned earlier. In that respect, it is an exciting time.
I think I understand what you are asking. Part of what I believe to be possible, and I am hoping part of where we are headed in the near future, is a collaboration of retaining autonomy while sharing resources and information, and supporting one another in perhaps a framework developed within which communities can be provided the support to retain the autonomy to have the recognized jurisdiction. I know this is talking about a First Nations perspective over 600 communities. It is a challenge. In British Columbia, we have 32 language groups, each of which requires respect and support to be a community that flourishes with the retention of their languages and teachings. I may go out for my whale soon. It would be a huge controversy in the middle of Clayoquot Sound. The way of our ancestors is to face up to the reality of controversy. I am concerned for the safety of my people, but I do not want to have anything misunderstood about the importance of what was observed on the beach in bringing in the whale, to the health and well-being of a people. Just the dietary part is critical. That is an exercise of jurisdiction that currently we are trying to work out through negotiations. I mentioned the fishing issue. The fishing and the whale are inextricably linked in terms of an example for my home territory.
In my province of British Columbia, for the first time in 30 years, the three First Nations provincial political organizations came together this spring to sign a leadership accord. That had not happened before. The reason is fairly simple: Over the last 30 years, we had diverse approaches to the pursuit of the expression of self-government. You can call it a spectrum, from pursuing outright sovereignty and nation-state status to one elder standing up and saying, ``We should declare war and declare bankruptcy, build cars and apply for foreign aid. That is how we should pursue expression of self-government.''
We now have a national chiefs approach of constructive engagement without losing sight of the overall objective, and that respects what my late grandfather left for me. We are required to find a way to give expression to governance, but there are 32 different terms for it in British Columbia, and over 60 expressions of governance across Canada. We have the words of the Prime Minister: The inherent right of indigenous peoples of this country are already there and do not have to be proved in a court of law. It is a great statement that I alluded to earlier. The realities are quite different on the ground right now. We have multiple jurisdictions. Ms. Gideon gave an excellent synopsis of the funding scenario that my community faced. I was doing everything in my role as regional chief to support the extreme lack of capacity.
I am sure that Ms. Gideon was involved as well in supporting some interim crisis. To come full circle, I believe that the establishment of frameworks that can support the expression of autonomy and jurisdiction and authority of First Nations has to be looked at.
I believe personally very strongly that we must realize the reality that there are organizations out there that have acquired the skill, expertise and ability to address issues, whether they are for women or whether they are in the urban setting. More and more, from the Assembly of First Nations and from my role as B.C. regional chief, I am anxious to get to work on ensuring that we have close working relationships, for example, with urban Aboriginal organizations so that we can have a much more comprehensive response to things like health service delivery. Just because my people have left the reserve, I still have a responsibility to my people. That does not disappear because of the reserve boundaries.
Senator Cook: I think it is time for a story. Ms. Dickson prompted me to tell it. Many years ago, I was at a United Church conference. The theme of the conference was ``Mending the World.'' The question was: Who will mend the world? In our group was an Ojibway leader by the name of Art Solomon. We all put our answers on the table except him. He said he would need to think about it and would give us his answer in the morning. In the morning, he said this: It will be the women, because they broke it in the first place. I am a little like Art Solomon. I will need to think about all the things you have said to me today. If you could follow my observations and comment on how I have to understand what you have said, that will help me.
The first word I wrote on my pad was ``jurisdiction.'' I then wrote ``needs'' and then ``integration and how we get there.'' From my perspective, the South has come to the North, in all its complexity. We have to make our way there, as Ms. Dickson says on the last page of her presentation, ``to build strong communities'' if we believe that people have a right to live wherever they wish. How do we do that?
From a government department perspective, the Library of Parliament provided me with a little document that talks about public social community housing and addiction. The federal department agencies are there and, in fairness, Health Canada, public health and Canadian Heritage, whatever, are in housing. However, when I go over to ``addiction,'' I only see two departments. One is Health Canada, and the other is Correctional Services of Canada. I am left wondering about the mandates of the various government identities and the fragmentation that ensues when looking after the people of the North to build a strong and vibrant community, and their right to live where they are.
My mind then takes me then to my home of Newfoundland, where nurses go to the North to take care of people and where teachers go to the North to educate the next generation. I believe the children will be the North of tomorrow. I am wondering what programs are in place for those people to make them culturally sensitive. I suspect that if we look, there is not much there. I spoke with a teacher the other day. She said, ``I am going to Iqaluit.'' I said, ``Why?'' She said, ``The money is good.'' I am sure she is a good teacher, and I am sure she will do good work, but that was the first piece that I heard. She is paid by the federal purse.
I look at a fragmentation from a monetary perspective. When we had that awful problem at Davis Inlet, an infusion of federal money came to the provinces to look after that program. Those children went back home without any support. I, as an individual, as a Canadian like them, do not know what happened to them. I see a gap in the service. I can only talk about what I know and where I live. The community of Davis Inlet was relocated at an awesome cost to the federal government. I am told that the conditions — the living conditions and the social and cultural well-being of those people — are no better now than before.
We are not doing something. We are at both ends of a spectrum, and there is something in between that we are missing. I am searching for that. Is it a partnership with the governance of the nation that is called Canada? Is it within the Department of Indian and Northern Affairs? Is it within Health Canada? At the end of the day, there has to be a partnership of two, between the people and those who would, of necessity, in part, control their destiny.
That is where my mind is with this. We have moved away so far, Mr. Chairman, from mental health issues. We have broadened the concepts this morning to the whole of what it is to live, and the challenge to live in the North — a harsh environment — and how to be your own person while living in a global village. That is the tension, is it not? That is the stress that we see here. There are too many agencies, too many people and too many organizations trying to look after the one thing.
Being a member of the United Church of Canada, I am familiar with the residential schools. Back in the 1980s, when the church struggled to understand its responsibility, and to put in programs and practices, the women were asked to raise $1 million over a two-year period for the healing fund. Then in the early 1990s, we were blessed with Stan McKay, who was a Cree leader who helped us understand. We who lived in Newfoundland had no concept of the abuse in residential schools. We had to undertake a learning process before we could get into it.
I have not heard anything around the table about non-governmental organizations and aboriginal healing. From my perspective, there has been a great deal by that particular NGO. If you can comment on my remarks, it will help me understand when we draft our report.
Ms. Dickson: I cannot wait until the person who told you she was going to Iqaluit to teach because the money was good goes into the local Northern and tries to buy an orange. There is a reason the money is good.
I was thinking what a government or a society could do, rather than throwing in money and forcing a community to move itself from one place to another, which is very ill-conceived. That is one end of the spectrum. The other, which we have all mentioned today, is the short-term project type funding: Put in your proposal, get your money, go away and do three things, come back and report, it drops off the map, and let us try again next year. Somewhere between those two is a calm, medium, long-term commitment to getting some things done. If the federal government wanted to show leadership they could try something like that. That would be to build a model that included a strong fiduciary, governance and partnership framework, one which included NGOs, which you mentioned. That is what we are doing, or whoever they considered to be their best implementers of public policy in the North are doing, with stability both in the relationship between that organization and the government and the financial side between that organization and the government, even if it has to go through nine departments; get them collaborating. If you can pull off something like that, an organization could plan strategically and develop long-term results-oriented activities rather than immediate-success-oriented activities. That would make a big difference.
I will give an example. One part of our biggest program is called sexual health; one piece of it is HIV/AIDS. Our funders are continually asking us about results. We keep saying that the results are that fewer people get it, so how do you quantify that to a funder who is thinking about not funding you next year? Perhaps we could figure out how to capture the whole thing in a longer-term commitment. An average Canadian pays taxes to the government, which decides how to spend it in our best interests. That is what democracy is. Perhaps you could include the indigenous people in that process, so that they and the organizations working with them and for them are not constantly thinking that at the end of this fiscal year or at the end of this project they will be outside the tent begging again. It makes you feel non-Canadian, non-franchised or non-legitimate somehow: trying to understand whether we are welcome or not; whether we are real or not. Much time is spent proving or insisting on your historical right to be here and all your traditional entitlements. If that could be a given, then we as a collective in Canada could say we will do this for the long term, for 40 years or 400 years.
It is not acceptable that anyone is abused. It is not acceptable that anyone has HIV. It is not acceptable that anyone is so far under the poverty level that participating in their community life is a non-starter, whether indigenous or non- indigenous. Then we might move along. It is somewhere in the middle between projects and throwing big pots of money.
Ms. Valaskakis: In regard to what Senator Cook mentioned, there are a number of efforts underway that we should support. One is the mental health strategy that is currently being developed by Health Canada, ITK and AFN. That is important in addressing the problems in a unified, coordinated way.
The second is the blueprint for health being developed by AFN. That has to be the centre of what emerges.
In terms of aspects of NGOs and their involvement, all of what is going on in relation to residential schools now involves the Aboriginal Healing Foundation, the Assembly of First Nations, other organizations and all the churches. The churches are very much involved with Judge Iacobucci and the processes associated with that. We appreciate the cooperation and concern the churches have had and the work they are doing in relation to that.
It is important to do ``cross-cultural'' training in regard to people who go North, and go to reserves in general and work in these areas. There is more attention to this. I will tell a story about how important that is. I was asked to speak to the second-year medical students at the University of Ottawa. As I launched into my residential school talk a hand went up in the back and a woman asked, ``Excuse me, but what are residential schools?'' There was not a soul there who knew, nor was there a soul there who was Aboriginal, of course. There is an effort on the part of the University of Ottawa to change that, which I appreciate.
We have to recognize that in all of Canada, while we do not know how many Aboriginal doctors there are, we estimate there are about 200, and that there is one Aboriginal psychiatrist in Canada: Cornelia Wieman. She is the second. Clare Brant from Tyendinaga was the first, and he is no longer with us. That is the extent of all the Aboriginal psychiatrists we have had in Canada.
While it is important to focus on non-native training in terms of people who go North, it is much more important to focus on the training of Aboriginal people in professional areas. We have certificate programs everywhere, but let us get degrees going. Senator Gill and I were involved 30 years ago in developing Manitou College. That need is still there today in regard to Aboriginal education.
There is enormous need to support the kind of growth in Aboriginal education that we are seeing now, and to support it in terms of graduate school and professional development. Ten years from now, we will have many more doctors. If we had done in the medical services what was done in the legal area through the provision of education in the Saskatchewan Indian training program, we would have medical doctors. We would not be sitting around the table saying we have one Aboriginal psychiatrist. The Saskatchewan program worked. We have all sorts of native lawyers. Because of the Inuit law program in Iqaluit, we have now many more Inuit lawyers. If we could do the same thing in the medical area, we could do a tremendous job. That is extremely important.
Senator Callbeck: Coming from Prince Edward Island, this discussion has been a real education for me. Following on what Dr. Valaskakis has said, many of you today talked about the lack of health care workers and trained people in First Nations, Metis and Inuit. What is the federal government doing right now? Are we going in the right direction? Are we improving? Should we do more of what we are doing now? How should we change our method of trying to get more First Nations Metis and Inuit into the health care field?
Ms. Lyon: That is a very good question. In terms of having more Aboriginal people in health careers, the federal government provides funding through Indian and Northern Affairs, INAC, for education, but it has not kept up with the population. Therefore, you have many people who cannot access funding, and when they do, sometimes a living allowance is provided, which is often not adequate. You have families living on maybe $1,100 a month, and then they go to school.
Where I worked before, we used to administer the Native Nurses Entry Program out of Lakehead University. People came into town in Thunder Bay from the northern communities with families of six kids and many social issues in terms of relocating, going into an urban community and so forth. Often, that sort of thing is not supported. It is hard to get through a degree. Even in my own situation, it takes five times the effort to get through. Aboriginal nurses who have gone through four or five years of university are very determined individuals, and once they get into the workforce, very strong people are working there.
Basically, it is a lack of funding. We also have to provide more education around health careers. Having worked in that area for quite some time, we find, as with the shortage of physicians and nurses, everyone is jumping on the bandwagon to promote health careers. We have promoted health careers for 15 years now through the Indian and Inuit Health Careers Program. That was an initiative by an Aboriginal physician who works out of Thunder Bay now. In some ways, we have been ahead of the game, but we also fall behind in terms of the funding provided. We need to have more funding to get more people in these programs.
Senator Callbeck: You said at the beginning that some of them cannot access the funding. Why are they not able to access it?
Ms. Lyon: If you think about medical students, the tuition per year is an average of $15,000, as opposed to some other program of $5,000 or $6,000 a year. There are more resources going towards that. It is my understanding that they have a cap for four-year funding, so to get into medical school, the first degree required is an undergraduate degree, and that takes four years. You are already at a point of not being supported.
It is the same with the native nurses program. There is a preparation program, and by the fourth year, the fifth year is not supported. Those are issues as well. The communities that control the education funding have to look at priorities in terms of making that funding available. There just simply is not enough.
Ms. Randell: To add to what Ms. Lyon has said, for Inuit communities, one of the biggest barriers to health human resources is that our high school dropout rate is 76 per cent across the Inuit regions. If you do not make it through high school, chances are you will not make it into any post-secondary schools.
The federal government is looking at some health human resources strategies, specifically, Inuit ones, and that was part of the $700 million announcement. It has been an incredible barrier and taken a lot of time to convince people who have decision-making powers for those monies that maybe the best place to start spending that money is not in university, and that we need to keep kids in school. The curricula offered in Inuit communities need to respect Inuit education needs. Many communities do not offer the academic levels of math, science and English. Significant upgrading is required if people do pass through the high school. With respect to the relevance of the curriculum from an Inuit perspective, the curriculum in Nunavut is based on the Alberta model. From talking to Inuit students, the number one reason they drop out of high school is boredom. There is a need for community-based programs and for some of those certificate programs. There is a role for accreditation and for regional training opportunities, and I will use the example of midwifery. Go to the birthing centres in Nunavik or Rankin Inlet and look at the traditional midwifery practices. They did not learn it from any university.
In health human resources, another issue that has come up over and over again is the need for mentoring and providing resources to people who make the decisions, and for developing progression. If someone wants to become a community health representative and works with the community, then the support is to help that person become a nurse or mental wellness counsellor or continue to advance through the system as he or she wants. The role of mentoring has to be identified in any human resource strategy.
We are in the process of the federal announcement of developing a health human resource strategy, and our focus has been on the kids. We have been told to focus on the kids. They are the future and if you can keep them in school, they will be your workforce.
Mr. Atleo: Briefly, I know that my father, Dr. Richard Atleo, did an education research project in British Columbia 15 years ago looking at school completion. He likes to remind me that for thousands of years the Nuu-chah-nulth First Nations were highly successful in terms of preparing people for life for all the roles for a balanced, healthy community. It is really only the last 140 or 150 years on the west coast of Canada that we have experienced lack of success unheard of in our history. I have to again emphasize that my father is recognized as one the first First Nation men in Western Canada to achieve a doctorate degree. I think it is always important to keep a perspective about how far we have to go, but also how far we have come.
What I found really helped me was connectivity, even the ability to dial up and take my master's degree in my traditional territories and not have to go to the University of British Columbia. My degree is a four-university degree; I took it from the University of Technology, Sydney, Australia, University of the Western Cape, South Africa, University of Linköping, Sweden and University of British Columbia. It is a master's degree in education, focused on global change and adult learning.
That is what I think this is; this is a learning exercise we are going through about what are the gaps and what are the problems. One thing that could be part of the solution is connectivity. If we can support access to proper high speed connections, our people can stay in their context, and not be removed. That way they get to integrate their learning, preferably in a democratic education environment that values First Nations teachings and traditions as equal to scientific inquiry, for example. I think this could pose one of the many solutions. Again, courses need to be designed by First Nations and I was interested to hear about the psychiatrist numbers. My daughter is aspiring to become a psychiatrist and I will let her know that she should follow that path.
[Translation]
Senator Pépin: My question is for Ms. Randell and Ms. Gideon. In my opinion, your communities should offer training opportunities. However, how to proceed is the question. It is difficult for a person with two children to spend two years in Montreal. Children need to stay in school and to have a mentor.
I knew from the tender age of eleven that I wanted to become a nurse. Two nurses who were close acquaintances inspired me to choose this career.
When I visited Iqaluit and Kujuak, I observed that women, for instance, gave birth at birthing centres instead of calling on an obstetrician. What steps could we take to provide conventional nursing training in your communities?
Education and mentoring programs are important. What steps do you suggest be taken to ensure that a person does not have to relocate to Montreal or Alberta for two years in order to receive training?
Ms. Gideon: It is difficult to answer that question. If we knew the answer, we would already be taking steps in this direction. In my view, we must start at the community level by setting up schools boards. First Nations do not have a school board to support primary schools and to forge ties with provincial secondary schools. Most of our members must leave the community in order to attend high school. Ties must be forged with these schools with a view to developing and implementing programs to help students interested in nursing.
At the post-secondary level, we need to set up institutions in areas with a greater concentration of First Nation communities. Technology is also needed to facilitate communication with remote areas, as suggested by the regional chief. A student would thus be able to complete most of his studies at home and have his work supervised by videoconference. One example of this technology is Telehealth. These technological tools would be very practical to have.
Dr. Vlaskakis gave a very interesting example, namely that of Dr. Weiman, a member of the Six-Nation reserve. Dr. Weiman returned to her community to practice medicine. However, the community could not afford to pay her a proper salary because it lacked the money to offer remuneration commensurate with her training and expertise. Dr. Weiman has courageously spoken out about this state of affairs at several forums.
One of the human resources priorities that we have identified in the health field is the importance of competitive salaries. Communities need help to be competitive in order to attract professionals. However, they are not receiving any such support at this time.
Ms. Randell mentioned that $100 million investment strategy announced in September of 2004. Funding under the strategy has not yet started to flow and only central agencies have been targeted. Health Canada refuses to recognize the need to devise specific strategies for each First Nation and Métis community. Consequently, the concept of an aboriginal strategy does not include funding that is accessible to communities. Agencies, for the most part, non- aboriginal agencies, rely on funding to set up programs geared to aboriginals. It is impossible to gauge the extent to which communities will be involved in these initiatives. This measure will not succeed in bringing the process full circle, that is seeing students leave home to study and later return to their community. At some point, this artificial strategy leads to a communications breakdown. The strategy recognizes the existence of aboriginal peoples, but fails to take cultural differences into account.
To forge and strengthen ties between the communities and the education sector, communities should receive direct funding and should have decision-making authority over strategy development. This point bears mentioning.
[English]
Ms. Randell: There are a couple of things to make realistic and relevant community-level programs. First, you have to create the demand and that starts with the school system: having kids say I want to be a nurse, I want to be a doctor, I want to be an astronaut — whatever they want to be even if it is not in the health care field. If they have goals and aspirations, they will be mentally much healthier so it will have a big impact on the health.
Looking at jurisdictional issues, they have to be looked at from a health-human resource point of view. We have the health system saying we have a responsibility to improve and increase the number of Aboriginal or Inuit people working in health but we better stay out of the education system because that is a provincial responsibility. There is such a barrier. We are shot down out of the strategy that Inuit have put forward. We have already been told that many of the recommendations cannot be implemented because they would be the responsibility of the departments of education of the provinces and territories.
Look at programs that work, such as the Iqaluit law program. There are lessons to be learned from that. The educators went to the community and the students stayed in the community. Students were funded. They were paid a salary to go to school so they could afford to go to school and continue to support their families and live in an area with a high cost of living.
Look at the nursing program. There was a need in the nursing program to have a pre-year to get up to the education requirements to start the university components. Four students in, I believe, Pelly Bay wanted to do that, so they moved that program to Pelly Bay and allowed those four students to stay there for that year and take the education that way.
Another thing is to look at regions. The Inuit communities are very realistic. They understand that in a community of 200 or 400, chances are there will not be a nursing program or even a certificate program for mental wellness. The population does not support it. However, they have asked us for regional and national-based programs. The Inuit in Nunatsiavut want to work with the Inuit in Nunavik to develop an addictions program based on the Inuit culture and values. Right now, it is difficult to share that information and the resources because of where those jurisdictions get their federal dollars from. The Inuit in Nunatsiavut get it from Altantic Region, and the Inuit in Nunavik get it from Quebec region, and never the two shall meet. It is a barrier, but it is important to say that there is a recognition that not all the training can be at a community level. There is a long way to go to make it at a regional level.
Senator Gill: I want to reinforce what was said about education and different institutions. Ms. Valaskakis mentioned that we did something in the field of law but not much in other fields. One thing that causes problems for most of the people is that although we would like to have more services, how do we work with the Indian people from more than 600 communities across the board? How can we find a solution for each of them? People do not start anything because they do not know what to do.
For a long time, we had Indian Affairs and the Indian Act, and the only institution recognized in the Indian Act was the band council. I am Innu, so my nation is on the North shore of Labrador. If you want to get organized, politically speaking, or in other fields, it is impossible. You are not recognized. The only way is through your band council. I do not want to start a debate here. My band, for example, is a member of a nation. There are 12 bands in the nation. In Quebec, for example, there are nine nations, not 42 First Nations. We are 42 bands, but we are nine nations. If we recognize this in the institution we want to create, it will be easier, but that has not happened so far.
When talking about health, education, culture, et cetera, we cannot get organized to have different jurisdictions at different levels — that is, some power at the nation level, some power at the band level, some power at the provincial level and some power at the national level. The AFN is my representative. They are my chiefs. They represent my nations. However, in the eyes of the government, it depends. If the chief is dealing well and gets along well with the minister, perhaps we will get something. However, there is nothing legally established between the government and those people. We need institutions organized by our people, by First Nations and by Inuit, and then those institutions must be recognized. We would then be able to cope with what we need in health, such as doctors, and we will be able to have our own programs and institutions. Perhaps we can do so with universities and with others, but people will be able to get what they want and start to do something for themselves. I wanted to share that with you.
The Deputy Chairman: We will now break for lunch and return at one o'clock sharp.
The committee adjourned.