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THE STANDING SENATE COMMITTEE ON ABORIGINAL PEOPLES

EVIDENCE

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WINNIPEG, Friday, March 23, 2018

The Standing Senate Committee on Aboriginal Peoples met this day at 1:58 p.m. to study the new relationship between Canada and First Nations, Inuit and Métis peoples.

Senator Lillian Eva Dyck (Chair) in the chair.

[English]

The Chair: I'd like to welcome our first panel this afternoon. We're continuing our study of the new relationship between Canada and First Nations, Inuit, and Metis peoples. One of the specific topics this afternoon is the effect of cannabis legislation on Indigenous communities.

I am happy to welcome, from the Manitoba Metis Federation, Mr. Jack Park, Minister, Energy and Infrastructure, and, as individuals, Dr. Catherine Cook, Melanie MacKinnon and Dr. Ian Whetter, all from the University of Manitoba.

We have an hour altogether. First we'll hear comments from the panel, and then there will be questions from the senators.

Mr. Park, please begin.

Jack Park, Minister, Energy and Infrastructure, Manitoba Metis Federation: Thank you for allowing us to present to you this afternoon, on behalf of the Manitoba Metis Federation government in Manitoba, and for the kind introduction.

I should elaborate a bit further in regard to my role with the government of the Metis nation in Manitoba. Not only am I the Minister of Energy and Infrastructure, I am also the chairman of Metis N4 Construction. It's a for-profit arm of the government. We had submitted a proposal on the cannabis opportunities in Manitoba, which we'll elaborate on a bit later. I wanted to get more into the nation-to-nation relationship with the Government of Canada and our position as it is to date.

I can tell you, from the comments I hear from our president, David Chartrand, it is fantastic news. The recent budget is a prime example of the government's commitment to the Metis people of Canada as a whole. We're very pleased that the government has seen now the impact that the Metis people can make if we're given the opportunity to participate in the economy.

We haven't been given that opportunity in the past. We've had to struggle and fight for every inch that we could get under previous governments. I am thinking of the solidification of section 35, with the Metis people being included in the Constitution in 1986. It took a long time to come to fruition. We believe it's there now. We're very thankful to Prime Minister Trudeau and his government for the relationship they've built and continue to foster in terms of benefits for our people.

I can also say that we're very pleased with the participation of the senators from Manitoba who continue to support us in our endeavours within the province. I am sure you've all heard the news of the last couple of days. It hasn't been a very pleasant time for the Manitoba Metis Federation and our relationship with the province. I don't want to elaborate too much on that because we're not here to talk about the province. We're here to talk about the Government of Canada.

Overall, we're very pleased. We're quite excited to be given the opportunity to prove ourselves. Over the past probably four years we've established our own Metis pharmacy across the street from our headquarters there at 150 Henry Avenue. We thought that would be beneficial to our Metis citizens. Because of the economic opportunities we've been given for the last 2.5 years with the Manitoba Hydro project, we have made a lot of money. We're now returning it to our Metis citizens by ensuring our elders don't have to worry about their medication anymore. The president has made a commitment to our elders that he will ensure that they get their medication for free. They just have to meet a few little stipulations, but he has ensured our elders that they will never have to worry about whether they can afford their hydro bill or afford their rent. The medical burden on our elders has been immense. We're very pleased to have the opportunity to give back to our elders who have guided us thus far. We're very pleased with that.

I don't want to take up too much more time. Let's give the other people the opportunity to speak. I am very pleased with the relationship the Government of Canada has with the Metis Nation as a whole across Canada.

Dr. Catherine Cook, Vice Dean, Indigenous Health, Rady Faculty of Health Sciences and Head, Ongomiizwin, Indigenous Institute of Health and Healing, University of Manitoba, as an individual: Thank you for allowing us the opportunity to speak to you about some of the issues we consider important in the relationship among Canada, the provinces, and the First Nations, Metis and Inuit populations specific to health services, education and research.

Our current health system, as well as other systems such as education, child welfare and justice, is largely based on historic legislation and policy of the federal government. That identified specific Indigenous issues as separate, distinct and the responsibility of the federal government. As the systems evolved further with the provinces and responsibility was given to the provinces, the separation and the restrictions imposed through the federal directives, such as the Indian Act and the Indian Health Policy, resulted in some significant inequity and disparities in some provinces as a result of jurisdictional ambiguity. There's also some reluctance by some provinces to take financial responsibility for some of the health services and benefits for First Nations, despite the fact that they are actually members of the province as well as First Nations.

First Nations have also wanted to hold the federal government accountable for the commitments and often do not have a strong relationship with provincial governments. The colonial systems reinforce Canadian society's perspective that it's acceptable to exhibit racist and discriminatory behaviours toward Indigenous people, while also implying that Indigenous people get everything for free and don't take care of anything, while living unhealthy lifestyles plagued by drugs and alcohol.

Multiple policy barriers exist as a result of jurisdictional ambiguity and health care. Some of these include the access to provincially run services, the dialogue between the two systems, access to health benefits, transportation, and the impression by health care workers that there's a parallel system for primary health care for First Nations, Metis and Inuit that is fully funded by the federal government. These systems will frequently exclude or marginalize Indigenous people, undermine our abilities, undermine our contributions, and assume Indigenous peoples are takers and not capable of managing our lives. I will get a little more positive in like two minutes, so relax. Basically recognizing that inequities exist in access to and entry to most services, there are some significant disparities between provincial and federally funded systems and there are some actions that can be taken.

At the University of Manitoba, over the last few years, recognizing that First Nations, Metis and Inuit people may have had dispirit or inequitable access to appropriate education as a result of fiscal and human resource disparities, the University of Manitoba has worked to support communities and students through a variety of activities. The vice provost for Indigenous engagement has a leadership role in promoting Indigenous awareness, Indigenous engagement and Indigenous achievement in multiple venues.

At the Rady Faculty of Health Sciences, which is where we all belong, with the support of our allies and our colleagues we've created a senate-approved Indigenous institute of health and healing. We call it Ongomiizwin. It supports Indigenous health in those three pillars of research, education and delivery of health services. Our models are influenced or developed by community. We do this with our faculty reconciliation action plan guiding the work that we do.

The establishment of a vice dean of Indigenous health for the RFHS, which is me, has provided the ability to develop the infrastructure to better address these inequities, certainly in access but also in the disparities, resources, supports and Indigenous mentors, staff and faculty.

At Ongomiizwin education we support Indigenous students in achieving success in the health professional degree programs of medicine, nursing, pharmacy, rehab sciences and dentistry, as well as graduate students in Indigenous health research. This has been achieved through addressing inequity in the admission processes, working to create culturally safe spaces through the development of a robust Indigenous health curriculum, engaging in the community, and providing community practicums and training opportunities.

Ongomiizwin research continues to strengthen their relationship with Indigenous research partners and Indigenous communities by focusing on research that is meaningful to our communities. We've forged some very strong relationships with CIHR and its researchers. Our health services, formally the Northern Medical Unit, have a 40-plus year history of providing health services to communities. Recent engagement with the community on the development of service models and enhanced engagement has resulted in a physician charter. I've actually brought copies of some of the work that we've done, if you would like to have those as resource material.

Within the Winnipeg Regional Health Authority the reason that is important is that all of our health care professional degree students are educated at the university, but the practicums are all done within the Winnipeg Regional Health Authority. We've had a parallel system where we've created the Indigenous health programs so that we can support First Nations, Metis and Inuit patients and families receiving health services. That involves the interpreter services in multiple dialects. Looking at discharge planning was always a huge challenge for some of our people. Being discharged back to communities with the assumption that certain resources existed that did not, people were more likely to decompensate fairly quickly in the community.

We also have a specific Indigenous patient advocates to address issues as they arise. Most common were the challenges around accessing resources that would support clients. How do you access your non-insured health benefits, housing, accessibility aids and medical transportation? People are frequently treated badly or misunderstood within the health care system, as in other systems. We wanted to have a safe place for people to come and express their concerns. We offer to walk through the process with them and look at mediating or mitigating the challenges that people have had, but it doesn't always work. We are there for people. Certainly we are very skilled and knowledgeable in what is the recourse for anybody who has had challenges within the health care system.

Also important is the development of a workforce that is representative of the community. We are looking at increased hiring of Indigenous people and at the need for education of our current staff. It was paramount for Indigenous people and our issues that a culturally safe education and training program be provided. We've developed that. It's in process right now, along with several workshops. We have set up a system so that individuals can have access to traditional healers and elders within our sites, if that's what they choose. That has been working very well.

The Truth and Reconciliation Commission calls to action provided an opportunity to have the RHA come on board and the university more fully in their commitment to the Indigenous community. As a framework for action, we have measurable targets and deliverables to guide our work. The action plan is not something that Indigenous people have to do. This is about all Canadians, all staff, all faculty and all students. I have shared some of the examples with you such as the university's reconciliation action plan. The Ontario government has a reasonably good one. Their progress report on an annual basis is focused on the themes that they've delivered. We're looking at doing the same thing in Manitoba.

We have a Path to Reconciliation Act. We've submitted our first progress report for this year through the Government of Manitoba. We'd like it to be a little more structured and more than just the minister's office responding to what has been done, so that each and every person involved in providing service can take part. The policy barriers essentially are those jurisdictional barriers, and challenges to funding health care and health benefits. It has always been a big challenge in Manitoba.

I will finish up with a question that I have. Maybe we can just discuss it. With First Nations health programs now under Indigenous Services Canada, how will they roll out or take responsibility for the health services mandate formally articulated through the operational and strategic leadership of Health Canada? There are many things we can do internally if we have the very committed leadership, allies and people in authority who will work with you side by side to make sure that they happen.

We have worked very hard to ensure that our communities are on board, as are our students and as are our faculty. We've made some small inroads into some of the challenges we faced as a result of the legislation and policy barriers.

Melanie MacKinnon, Executive Director, Ongomiizwin Health Services, University of Manitoba, as an individual: Thank you for having me and us as a team. It is quite an honour and privilege. I will speak more to nation-to-nation relationships, in addition to what Dr. Cook has shared. I want to offer it from a personal perspective as well.

My background is nursing. I am Cree. I am originally from Misipawistik Cree Nation. All my clinical work has been done on reserve in remote or isolated communities. When the clinical practice phase of my career was finished, I was into management and policy analyst roles with the Assembly of Manitoba Chiefs, and then more into the health services and academic roles with the university. I am quite honoured to have the robust career that I have had, and all of it has been in Indigenous health.

In addition to what I've done from an intellectual, professional or academic perspective is what I've done with myself, for myself and for my family from a personal perspective. I am also a sun dancer, a traditionalist and a ceremonialist. I am honoured to be able to work with Dr. Cook, who allows me to bring my whole self into the capacity that I serve in my particular role.

It was important I share that because I want to talk about health from a holistic perspective. As a workforce we can't expect our colleagues, our professionals and our staff to leave part of themselves at home, as in their spirit or their emotional health and wealth. Some of the work we've been able to do at Ongomiizwin is to incorporate our teaching ceremonies from our elders into our particular organizational design. We believe that culture can change culture and make it a very healthy place to be. As Dr. Cook has mentioned, we have made significant investment into training culturally safe and competent health care practitioners. We are increasing those numbers every day, annually. Those practitioners also want a safe place to work. They want a culturally safe organization. What that means to us is actually redistribution or rebalance of power.

When I talk about relationships, I will talk about them in relation to power. First and foremost was the ability of our vice dean and our vice provost to actually hire a critical mass of Indigenous health leaders in multiple different clinical areas. As a critical mass we were able to inform, shape and influence policy procedures to get us to the point where we created the Senate-approved Indigenous Institute of Health and Healing.

A lot of work behind the scenes happened. One of our foundational principles was respecting the nation-to-nation relationship. As an academy or as a university we are not in a position to negotiate on behalf of communities. We want to enter into bilateral relationships and signatory relationships with them over the services we provide, not necessarily more than that. We have to respect what those original principles are as they relate to relationship reparation.

To us, there are six Rs in that regard. Many of them are familiar to you with respect to respect, reconciliation, cooperation and partnership. With respect to reconciliation we had to understand that there were multiple levels and the first part was within ourselves. That goes back to hiring workforce and being your whole self when we come into the place we are creating. Just as Prime Minister Trudeau said, reconciliation is between myself and yourself and between my spirit and your spirit. That is definitely the spirit within the cultural context of our organization.

We have a few other considerations in a service delivery modality: the creation of reflective programs for the communities we're serving; recruitment and retention of culturally safe practitioners, professionals and allies we talked about; and an anti-racist approach. We continue to be led by the principles from a First Nation perspective of the former late Grand Chief Dave Courchene in Wahbung: Our Tomorrows, which was written in 1971 as a response to the white paper and informed the national red paper, as many of you are familiar with. Some 47 or almost 48 years later we're still working on those principles. In half a century not much has changed. How we change things from the inside out is our locus of control is within the academic university or the academic centre.

With respect to health, we know that we will never have full health without wealth. We've been focused on a health care paradigm or a health care system for a number of years and its responsibilities in our health and wellness. We know from a population health perspective and a health equity perspective that we have to think much bigger than the health care system. What that looks, what that vision is and what those scenarios are up for discussion. That is the work we all have to do in the future as we move forward.

I did want to share a quote with you from Shaun Loney, a social entrepreneur, and his book An Army of Problem Solvers: Reconciliation and The Solutions Economy. From our perspective we're really trying to look at our health through the social determinant lens and the population health lens and how we are to make improvements outside of the health care system. He stated, alongside the Canadian government's efforts to “take the Indian out of the child” was a range of other policies to “take the Indian out of the economy.” Too many of those policies persist today. Prosperity is the antidote to poverty. Without wealth, we will have poor health.

That's the lens we want to continue in our collective efforts with our partners and in our regional and national relationships to always have a bigger picture of what health truly looks like. I'll leave it at that.

Dr. Ian Whetter, Medical Lead, Ongomiizwin Health Services, University of Manitoba, as an individual: I am a family doctor. I have had the privilege of working in a number of Indigenous communities in Canada. During my training I happened to be able to work in Cambridge Bay, Nunavut. I did my residency training in Newfoundland and Labrador. I was able to work in some of the Inuit communities of Nunatsiavut, as well as the Inuit communities of Sheshatshiu and Natuashish. Then, as I came back across the country once I finished my residency, I worked in the Inuit communities in Nunavik of Kuujjuaq and in Quaqtaq on the Ungava coast. Then I moved back to Manitoba and worked through Ongomiizwin Health Services and then the Northern Medical Unit in Little Grand Rapids, Pauingassi, Barron River and Norway House.

In my time in those communities, I met some really incredibly powerful teachers who opened my eyes to the fact that there is a glaring truth in the country that those of us who are non-Indigenous settlers have to come to terms with before we are to move forward.

Coupled with that experience, I grew up on a farm in southwestern Manitoba. That farmland was very clearly Indigenous land that had come into my family's possession. The story of how that came to be isn't a story told in my family, but it's really clear that there are stones placed in very specific ways. There are piles of stones that are clearly grave sites. My dad remembers in the 1950s going down to the shores of a lake in southwestern Manitoba and seeing teepees in a travelling encampment. That wasn't true in my childhood, so the colonization process was really fresh in my family and we didn't talk about it at all.

When I looked back through my family history, I was also reading a note that my great-grandmother had written about my Scottish farming ancestors who came to the Minnedosa area. There was an uprising of the Ojibwe people in Rolling River, Manitoba. They didn't like that their land was being taken away and that fences were being built. They were essentially being pushed off their land. My family members, my direct blood lineage volunteered to take up weapons to quell that uprising and to essentially assert their power over the Indigenous people of this land. I also see in my family history that those same Scottish farmers volunteered to take up arms when the North-West Mounted Police wanted to hunt down Louis Riel. They didn't have to do it, but they thought it was important to their own survival on this land.

Those aren't stories my family tells. When we get together every year we curl and we golf because we're a Scottish family, but we don't celebrate the horrors that our family participated in. This is something that we as Canadians will have to do. I know it's complicated for people because some of us in Canada have a Scottish side and a Cree side. How do those things come together in one's own body?

The Truth and Reconciliation Commission is telling that those terms come together in that order for a very specific reason and that we can't get to reconciliation without going through truth. Those of us who are non-Indigenous Canadians want to get to reconciliation without going through truth. We need to look really deep inside ourselves. We need to hold our families close as we engage in really painful conversations about that truth and about the ways in which our families historically were complicit.

To paraphrase, Leslie Spillett, a very powerful Indigenous leader in this community, was not asking us to take responsibility for what our ancestors have done. She was asking us to dismantle this power structure created that keeps power flowing toward us. That is really how I see our responsibility. As non-Indigenous health care providers going into communities, we've been accused of being miners of Indigenous misery who are going in to extract a resource, and that resource is the suffering of Indigenous people. If that accusation is not accurate, then we have to behave very differently. I think that different behaviour will look like a reckoning of the fact that we've been in an abusive relationship. As abusers in that abusive relationship, we will actually have to come to terms with that and we will have to do our own healing.

My Indigenous colleagues and my Indigenous advisers have been saying, in the most generous and caring way, that non-Indigenous settlers need to heal and need to heal together. We really do collectively need to heal, with an acknowledgement of not everybody will have a history that is as clear of colonial abuse as my family's history is. I still think that many of the benefits and much of the wealth we have as non-Indigenous Canadians accrue directly from complicity in the colonial project and the destruction of Indigenous people and Indigenous lives.

Our wealth really comes directly from that. None of us are innocent. We are all complicit. We either have an option to be complicit or to actively work against it. If we're not actively working toward decolonization in Canada, we are complicit with the extraction of the wealth from Indigenous lands into the pockets of non-Indigenous people.

That leaves us with how we try not to be complicit, how we try not to be anti-racist, and how we try to heal as non-Indigenous Canadians and come to a place of reconciliation having done our own work. I don't think we can shortcut to reconciliation, reach out our hand and expect to get a warm handshake until we do that hard work of our own. I think that work will look like a total revamp of the national school curriculum in a way that Germany had to do post-Holocaust.

When you talk to Germans about how the Holocaust happened, they can identify nationalism. They can identify the ways in which a public was willing to vilify a group of people when there was a charismatic leader who was speaking in that way. I think we as Canadians need to be able to identify the roots of colonization and the way that power is used in violent and aggressive ways even today, and to recognize, as Patrick Wolfe says, that colonization is a system and not an event. We can't think of it as something that happened in the past. It's the foundation on which we stand and the lattice on which we stand.

We need to see a fundamental reorganization of our education system. We need to let go of the reins of the economy and know that there will be no resource extraction from Indigenous lands without the free prior, informed and ongoing consent of Indigenous people. Decisions as to what gets extracted, whether or not it gets extracted, where those resources flow and how they get used have to stand in the hands of Indigenous people. To be honest, I know that many non-Indigenous Canadians are terrified of that prospect. I've only ever seen generosity. I've only ever seen a willingness to live together on this land, but it's with the principles of the Two Row Wampum and non-interference that we will coexist together on this land in a good way.

Healing will also need to mean recognizing racism and the ways we're all complicit in it and actively working toward decolonization. When we've done that at the university through this physician charter, it's actually had spectacular results. We've articulated what we're doing as: “We are doing anti-racist work. If you want to be a doctor with us, you must commit to doing work in an anti-racist way. If you want to be a doctor with us, you must commit to working toward centring community self-determination.” When we've done that, we've attracted a whole bunch of doctors. We had a discussion today in our meeting, and for the first time in the history of the Northern Medical Unit, we actually don't have any space to hire people. We are full. There are not many northern jurisdictions in Canada that can say they don't have room to hire more physicians. A spirit in that has really caught on for people. They're excited about it, but we've hit the limits of our box now.

We've stacked these communities with all of the physician services the province is willing to pay for. Yet, health determinants are not changing because I think we're bumping up against undrinkable water. We're bumping up against rotting houses. We're bumping up against a lack of economy. There are also some very specific ways in which the federal government has been a barrier to health and wellness. Despite our efforts to do good work, there has been a specific barrier.

In Manitoba we have phenomenal provincial critical incident legislation. If something untoward happens to you in the health care setting in Manitoba, there's a system that will flag that. There's a system that will track that. There's a system that will expect within 90 days you've done a report. Almost immediately you've notified the family and then 90 days after that you've followed up on the recommendations of the report.

That legislation does not exist in the federal system. If a person has something untoward happen to them in a nursing station, there is no organized system to make sure that that untoward medical event actually gets adjudicated, gets followed and gets tracked. We had a problem in the provincial system in Manitoba where sepsis wasn't being noticed early enough. There was overwhelming infection, so they actually rolled out a whole education program for the doctors in Manitoba to say, “You should recognize sepsis earlier than you are. Here are some ways you could do that.” That same tracking system doesn't exist on the federal side and it needs to.

Next is federal privacy legislation. In Winnipeg, if you have a heart attack and an ambulance comes, the EKG from that ambulance will be sent wirelessly, immediately, to a cardiologist's phone. The cardiologist will look at the phone and will say, “Yes, give that person clot-busting drugs,” and the person will receive their clot buster before they arrive at the Saint Boniface emergency department.

In our federal nursing stations they forbid nurses from transmitting electronic images. You can't be a nurse in a nursing station, take a picture of an EKG and send it to a cardiologist. That is forbidden. Even though we have the technology that's accepted by the Province of Manitoba, the federal government says you cannot do it because of federal privacy legislation. That is a real barrier to equitable care for Indigenous people.

I have two more points. One is standards and accreditation. None of the federal nursing stations are accredited. The Auditor General's report of 2015 basically identified a whole bunch of problems in the federal nursing station system in Manitoba and in northern Ontario. The federal government didn't disagree that there were problems. They were asked to articulate the basket of services they provide, and that has not been done. If we can't articulate the basket of services that we provide, then we can't actually assess if it's good or not.

Another is that provincial standards don't apply on reserve, so there is substandard care occurring on reserve. We should expect the federal standards either to be stronger or as good as provincial standards and they're not. One of the risks is when you have a provincial government that is interested in austerity and looking to trim provincial budgets. They will trim from the people who are least likely to complain loudly. The people who are least likely to complain loudly live in tiny communities scattered all over northern Manitoba. We need some legislation to protect people from having their basic substandard services trimmed even further.

The last piece is that I would like to see funding based on outcomes, so that we track outcomes in First Nations communities and fund them accordingly. If we want to see perinatal mortality go down in communities, then we should track perinatal mortality and fund accordingly. We can't even track the data for First Nations people, as compared to other Manitobans. That is a real serious problem.

I have one last comment about cannabis legislation. Canada has one of the highest youth cannabis rates in the world according to UNICEF. The horse is out of the barn. We are not going to stop youth cannabis use. It is happening, so what we need to recognize is that our current laws disproportionately criminalize Indigenous people and other vulnerable groups, but specifically Indigenous people. Our jails, as everyone here knows, are full of Indigenous youth who have been criminalized on drug charges. That is a harm that comes from our current legislation. We hardly even know the medical harms of cannabis use. We can’t study it because it's illegal.

When there was a rash of youth suicides in Attawapiskat, they asked the youth what they wanted. If you look at the poster boards they wrote out, you will see what they wrote. They want a gym that is open 24/7. They want a hockey rink. They want a swimming pool. They want to go on the land with our relatives. They want to spend time with our elders.

What we gave them was a multi-million dollar crisis intervention psychiatrists and psychologists. What they've done in Colorado and Washington states where they've legalized cannabis is that they've plowed all of the tax revenue from cannabis in those states into schools, into playgrounds, into pools and into hockey arenas.

There's a real opportunity for the Brokenhead Ojibwe Nation, one of the approved cannabis sales groups in Manitoba. There could be some legislation to support them in plowing that money back into youth resources. We could see something happen like what happened in Iceland where they essentially stopped youth drug use in Iceland by investing heavily in playgrounds, swimming pools and whatnot.

In conclusion, Natan Obed, President of the Inuit Tapiriit Kanatami, said that we had the highest suicide rates in the world among our youth and we had the highest tuberculosis rates. We in Canada either need to address this or acknowledge that we have a gaping hole in our moral fabric.

Senator McCallum: Can I put in my application to join your team? You're doing an awesome job.

This is a question for whoever wants to answer it. My understanding is that most of your work involves the provincial and federal governments, but it seems like you're able to make inroads with the provincial government and less so with the federal. Would you say that? You did a report to the province but there didn't seem to be a report to the federal government.

All the work you do is for Indigenous peoples. What would you recommend to make that connection between you, the province and the federal government so that you can do even more?

Dr. Cook: Let me see if I understand your question. My background is Scottish and Cree. I am a member of the Metis Nation in Manitoba. I started as a family doctor in the remote communities. I very quickly realized that there were huge gaps in my ability to address the needs of our patients and the communities. Then I went into public health and population health because I thought I could reach a broader audience. I quickly realized that wasn't going very far either and that we really needed a commitment from all levels of government.

I don't pretend to understand all the dynamics around the politics of the First Nations, the Metis and our growing number of Inuit. My only observation over the last 30-plus years I've been working is that there is a real resistance for the federal and provincial governments to come together on anything Indigenous. It appears to be that there's a challenge within the provincial government on how their relationships evolved with the Metis government, the First Nations government and the Inuit representatives here. There also seems to be a real fear of the potential for huge fiscal responsibility if that dialogue occurs.

We can do much work at the clinical level. With the opportunity for shared health coming in right now, we're hopeful that the relationship between the provincial and federal governments may improve. Although currently it's anybody's guess, I guess, particularly around health. It absolutely has to happen. I mean so much is being done in B.C., Ontario, Quebec and the Maritimes that isn't even remotely close to happening in Manitoba. We don't have good data because we don't have ethnicity indicators. We're working on that as well.

It's not the people who challenge the system. It's the inability to overcome some of those really significant policy barriers with constant turnover of individuals within the different positions. It would be really nice if the federal and provincial governments would make a commitment to address these issues. Failing that, we've looked at how we can address some of it through our reconciliation action plans.

Ms. MacKinnon: I could offer a concrete example of what that looks like and how shared jurisdiction operationally unfolds. Policies and legislation are very much applicable to the work that we do. The CHA obviously supports physician services, diagnostics and hospitalization as far as insured services. We went through an era in probably the last decade where our federal regional office has expended considerable effort in ensuring that the province is responsible for all provincial responsibilities under the Canada Health Act. We saw a bit of “delisting” of what the federal government had previously had in practice or had afforded as far as a program.

In essence, Ongomiizwin Health Services, formerly the Northern Medical Unit, act as a broker on behalf of the community. We receive a physician’s salary or annual remuneration per physician. In our case it's 30.5 FTEs. That's all the province will pay for. We still have to get the physicians into communities. There are per diems. There are accommodations. There are other costs. Health Canada steps up in that regard and supports, through the Non-Insured Health Benefits Program, access to primary care through itinerant services. Then there's a coordination or administrative effort to actually deploy 200 health professionals any given week.

It's quite substantive. Some live in communities; some are more itinerant. We are constantly mitigating the relationship between the provincial and the federal government and advocating for more increases. In that regard, our actual allocations have not changed since 1996. Regardless of population growth and health status indicators going in a backward direction, there has been little to no investment into non-nursing clinical services by either the federal or the provincial government in our context in this region.

Dr. Cook: I have one quick example of how the gaps between federal and provincial can be a challenge. Jordan's Principle has resulted in some significant investment in the province. Lots of people have been hired to address those issues. I've had tribal council, health directors and nursing leadership ask if we can help them sort this out. The communication between governments is very limited. It could be amazing, but we just haven't had the communication. Their ability to provide a continuum of service between the two authorities is limited by a lack of communication about process.

Senator McPhedran: Thanks to each and every one of you for your presentations. They are very much appreciated. As someone who has worked in health and human rights for most of my career, I want to ask a question that I already know does not have an easy answer. Nor is it an easy question to ask.

You referenced tracking and responding to medical conditions that we're all very familiar with and that are very openly acknowledged and discussed in our society: tuberculosis, heart disease and diabetes. I'd like to invite you to share with us what you would consider to be best practices or what you've seen as good practices in relation to the range of sexual exploitation or sexual abuse that patients endure across classes, across cultures and across all the various characteristics that we could list. We're here to talk about the well-being of Indigenous peoples. In your response could you also include, to the extent that you have knowledge, effective responses when that sexual exploitation is at the hands of regulated health professionals?

Dr. Whetter: As to the breadth or depth of the problem, it is a very big problem. It runs across cultures and it gets back to some of the fundamental education around consent in general. We have a massive gap. I don't know if anybody is doing it well, but there's certainly a gap in the degree to which we teach people about what a consensual sexual relationship is, period.

When you mix substance use as a coping mechanism for distress with substandard education around consent, it is a powder keg for sexual exploitation. We see that. One of the ways where I see that manifested is in the numerous people seeking care for depression or anxiety. We are inadequately seeking answers as to whether or not sexual exploitation is a part of their history. Obviously that needs to be done in a very careful way. When they looked at benzodiazepine or tranquillizer use among Indigenous women, almost 100 per cent of Indigenous women being prescribed benzodiazepine had some history of sexual abuse. That suggests we're using tranquillizers to treat sexual trauma. I think we need a different approach than that.

In terms of approaches that work, we need to have baseline trauma-informed care training for all of our health care providers. Then what do we do once we've created a space that's safe enough for people to express that it has been a part of their history? My limited experience in Manitoba has been that connecting people to spirit and connecting people to traditional healing have actually been most effective things I've seen for people who are trying to recover from sexual trauma.

On your specific question about what happens when it's at the hands of a health care provider, I understood the question, but could I get you to repeat the piece of information you're looking for?

Senator McPhedran: We have a general dynamic that operates across all the various characteristics we could use to describe groups of people. It's a power dynamic. It's a dynamic that is underscored by authority. In environments where people have to receive care, and in order to receive the care they need, they basically have to trust. The way in which institutions are responding and the way in which the regulatory bodies are responding, kind of mesh with each other as part of addressing it. Somehow we seem to be much better as a society at identifying heart disease, diabetes, dental issues and thinking in terms of institutional responses and program responses. This seems to be a much more complicated and difficult area for us to sort out.

My question was as much geared to anything that any of you have seen. I don't think it's limited to the medical practitioner, frankly. This is about many different kinds of health professions and an institutional environment where you have many professions working together. It was really to ask whether you would recommend that more attention be paid to any good practices or ways of responding that you've seen.

Dr. Whetter: I'll just take the one piece which is specifically in response to sexual assault. There is a specific program within the Winnipeg Regional Health Authority called the Sexual Assault Nurse Examiner program. It is about creating a very safe and comfortable space for people who are seeking care sort of immediately post-sexual trauma, as opposed to having them go through an emergency department. I mean they go to an emergency department, but there's a different program they get swept into fairly quickly to reduce the trauma of that immediate post-exposure care. That's one significant positive that has had some good feedback from people who have experienced it.

Senator Patterson: Thank you very much for your compelling presentations. I am from Nunavut. I've actually toured all 25 communities of Nunavut on the impacts of and views on the legalization of marijuana.

Dr. Whetter said that we couldn't study the harms from medical marijuana because it’s illegal. I think there have been other studies in other jurisdictions linking marijuana use to having an impact in some users with schizophrenia, psychosis, anxiety and depression. I was amazed that many people in Nunavut where marijuana is widely used, even though it's insanely expensive, are quite familiar with these impacts. I've had unilingual elders at some community meetings talking about schizophrenia.

This is about the Northern Medical Unit. Maybe it has a new name now. I understand 15,000 or so Inuit a year are treated in Winnipeg or in Churchill. The folks I spoke to really feel that it's unfair to have to send people who want treatment for addictions far away from home and family and their familiar cultures. I've even heard of Inuit that have gone to Poundmaker's in Edmonton where they have sweat lodge and sweetgrass, which doesn't work for Inuit.

You talked about building Indigenous content into your services and culture. What services are provided to Inuit for mental health and alcohol and drug treatment through the Northern Medical Unit?

Dr. Cook: The Northern Medical Unit largely provides itinerant physicians into communities, along with a whole range of specialists that includes psychiatry and mental health providers. Interestingly, a lot of the physicians that work for Ongomiizwin Health Services, our new name, also work part of the time with Addictions Foundation of Manitoba through a couple of the different programs.

In Manitoba we have a very fragmented system when it comes to treating mental health and addictions. They're completely separate programs. The only component of addictions treatment that is part of the mental health program is the withdrawal unit, which is a volunteer entry program at the Health Sciences Centre.

We have just undergone a significant review of mental health and addiction services over the last year. The report is due at the end of the month. We've all participated in that. We firmly believe that those services need to be brought more closely together. There needs to be a significantly more focused effort at cultural awareness and cultural safety within the addictions programs.

I can't answer your question any better than that. It's an area that's significantly lacking.

Dr. Whetter: We don't provide the primary care physicians into Nunavut anymore, but we do provide the specialist services. One of our psychiatrists runs a program in conjunction with a community in Naujaat, formerly Repulse Bay. They've brought elders and community members into the forefront of their approach to addressing mental health and addiction concerns.

One of the elders was saying to me that she was the person on call 24/7 actually. People don't want to go to the nursing station for anything with the term mental health associated. They don't want to go see a psychiatrist because of the stigma associated with that. She's the person who is up in the wee hours of the morning with the youth who are suicidal or with the person who is struggling with depression or anxiety. What they've tried to do is really formally recognize those caregivers as part of the health system. If we could think of a way to actually formalize that and pay those people for that role, it would be a really powerful intervention.

Senator Patterson: That's helpful. I have heard people in Kivalliq say that people with addiction problems have gone to Selkirk, Manitoba. I don't know what's there. I can imagine it's maybe not too culturally supportive of Inuit. That's very helpful.

Dr. Whetter, you have reiterated what I've heard. Unless mental health services are provided closer to home, at least for the initial outreach for help, by familiar people and respected people who can speak Inuktitut and are trained elders, people will not reach out to transient services or even the local health centre. I thank you for that.

That was more of an observation but I've a quick question. Mr. Park, what was in the recent budget that made you so happy? I am curious about that.

Mr. Park: For the first time in the history of Canada I can tell you that $500 million was in the budget for the Metis Nation of Canada, which is a huge step forward in terms of the government's commitment to the Metis Nation. It was never there before. This is the first time in history. It took a third budget from the Liberal government but we're finally there. We're very pleased with that.

It's broken down into mostly education, including early learning childhood, and health services. There are a lot of benefits coming out of this budget.

Senator Christmas: I have to extend my congratulations to your faculty of health sciences because this is one of the most inspiring and positive responses to the TRC I've heard in a long time.

The part I would like to explore a bit more may have been Dr. Whetter’s statement. Part of your reconciliation action plan was developing a culturally safe learning environment in which you said there's recognition that there is racism and that there must be a commitment to anti-racism. I am very intrigued by that. I am very intrigued that you have faced the problem of racism, not only within the medical health care system but in society as a whole. I assume not only your faculty, but your learners and all those involved with the faculty of health sciences, must recognize that and must commit themselves to anti-racism.

My question is: How do you do that? What steps do you take to challenge racism and to have people commit themselves to anti-racism?

Dr. Cook: We've started using the word racism, which was a huge accomplishment. People used to panic when you said the word racism. It now flows off the tongue of most people without creating any kind of anxiety or hysterics. We're proud of that. We've had a multi-pronged approach, certainly through our central administration at the Fort Garry campus, which is our main campus. The vice provost has taken a lead role in Indigenous awareness, engagement and achievement, and certainly in profiling the successes of our young Indigenous First Nations, Metis and Inuit people. We have very few Inuit in Manitoba, but they are an increasing population.

We also have multiple things through the faculty. For example, four years ago, the dean of our faculty committed to having an anti-racist approach to Indigenous health curriculum in the first four years of medical school. We went from having 12 hours of teaching to more than 70 hours of teaching in Indigenous health. That includes both the didactic lectures and the clinical practicum training. We are spending more time in the community. We have a whole variety of different teaching mechanisms. We have workshops that address the issue of racism. It isn't just Indigenous health, although we're very careful to point out that racism against Indigenous people is very different from racism toward other people. The reason is because of the colonial history in our country. Our systems have made it acceptable to be racist against Indigenous people, so there's that piece of it.

Another thing we've done jointly with the Winnipeg Regional Health Authority is that we've partnered with B.C. on their online training program. The Manitoba Indigenous Cultural Safety Training program is eight to 10 hours of online training. It is mandatory for all of our high level. We have a hierarchy of people, if you will: the leaders of the WRHA and the university. That has expanded to Manitoba Health, First Nations and Inuit Health Branch, the regional health authorities, except northern, and cancer care diagnostics. All of our key institutions in health have committed to a number of seats per year. Looking at the senior leaders, moving down to the directors, the frontline managers have specific contact, like emergency and security workers. They are all prioritized for this training.

It's not the whole answer. People find ways of not paying attention to the things they're not comfortable with. It's a start and it has been very well received in Manitoba. The modules we developed in Manitoba are specific to our Manitoba population, as B.C. is to theirs and Ontario is to theirs. Those are some of the steps we've taken.

Senator Christmas: My congratulations on those efforts. Do you think that approach or those modules are transferable to other professions, be it education or law?

Dr. Cook: They absolutely are. When B.C. was developing their modules, they had one for the child welfare system. I haven't reviewed those because they weren't my primary interest at the time. There's a certain whole block of modules that are very basic factual information about Indigenous history in Canada. That's definitely transferable.

When you get into the specifics around health, clinical care and those kinds of things, it wavers a bit.

The Chair: We've come to the end of our time. On behalf of the committee I thank all of you for your testimony this afternoon.

For our final panel of the day, from the Manitoba Advocate for Children and Youth, we have Ainsley Krone and Daphne Penrose. You have the floor, ladies. After your presentation we will then open up the session for questions from the senators.

Daphne Penrose, Children's Advocate, Manitoba Advocate for Children and Youth: Meegwetch and thank you for inviting our organization to speak with you today on Bill C-45.

The Canadian Council of Child and Youth Advocates is a national organization of 11 provincial and territorial child and youth advocates, representatives, ombudsmen and commissioners appointed by our legislatures. The CCCYA members share a common commitment to the well-being of Canada's children and youth. In our distinct effort, as well as in our collective undertakings as a national council, we especially recognize the overrepresentation of Indigenous peoples in many of the public service systems. They are legacies of failed past policies but are also the result of ongoing inequities faced by Indigenous children and youth across Canada.

Having extensively studied Bill C-45 and discussed the potential impact that the passage of the bill would have on Canada's children and youth, the CCCYA members which to express some concerns. Given that article 33 of the United Nations Convention on the Rights of the Child states that governments should take all appropriate measures, including legislative, administrative, social and educational, to protect children from illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties. The CCCYA believes that the proposed legislation fails to provide adequate protection for young peoples.

In addition, article 3 of the UN CRC states that in all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interest of the child shall be the primary consideration.

The UN Committee on the Rights of the Child also recommends that a Child Rights Impact Assessment be conducted relative to such actions. The CCCYA strongly advises that these elements be taken into consideration during the study of the bill.

It is recognized that cannabis criminalization and conventional anti-drug messaging have failed to stem the use of cannabis by young people. The end of the prohibitionist framework for cannabis is an opportunity to engage appropriate public health and public safety mechanisms to protect the health of children and youth. A public health oriented approach to cannabis can support a pragmatic approach by focusing on the harms of drug misuse rather than on the use itself. An appropriate public health framework can prioritize the reduction of health risks and social problems over goals such as punishment and drug abstinence. A public policy framework for cannabis can also focus on promoting public health through regulations of access, use of evidence to inform public health messaging, restrictions on advertising and promotion, and monitoring surveillance functions.

On July 5, 2017, the Canadian Council of Child and Youth Advocates provided recommendations to the Right Honourable Prime Minister Justin Trudeau and to Premier Rachel Notley as chair of the council of the federation respecting analysis of and recommendations regarding Bill C-45.

As independent representatives of our respective provincial and territorial legislative assemblies, the members of the national CCCYA appear today to offer this committee the voices of children, youth and young adults to consider in your information gathering and subsequent deliberations on how to proceed as our country faces the significant change to public policy.

The CCCYA believes all levels of government need to ensure the protection of children and youth from the potential harms of legalized cannabis under the proposed legislation and any accompanying provincial regulations. This not only includes protection from the effects of consumption, but protection from the unintended consequences related to possession stipulations and definitions of criminal activities.

Although the letter we submitted in July spoke specifically about the impacts of the legislation on children and youth in Canada, special attention must be made to the circumstances of Indigenous youth in our country. Many of the public health and criminalization concerns are heightened in Indigenous communities based on overrepresentation in a multitude of government-provided systems, such as mental health, addictions and justice.

The recommendations of the CCCYA examine issues of consequence to children, youth and young adults in Canada, including the effects of cannabis on the developing brain; youth access to cannabis; supplying cannabis to minors; the need for consistent regulations across Canada; the need to designate a portion of taxes to fund research, public education and treatment; the potential for the overcriminalizing of youth; and special considerations respecting Indigenous children and youth.

On the effects of cannabis on the developing brain, the current version of the federal legislation does not fully account for the potential harms of cannabis on the developing brain. These concerns are particularly acute for children and youth with mental health challenges. This issue is of particular concern with respect to Indigenous children and youth given the significant disparities in the inequitable access to mental health resources and supports in many First Nations communities throughout Canada.

As such, the Canadian Council of Child and Youth Advocates recommended that the harmful effects of cannabis on young and developing brains be addressed by setting potency limits for cannabis products by either federal or provincial regulation, and that cannabis quantities and potency be restricted to those under the age of 25. Similar to what has already been proposed for alcohol products, we recommend that higher taxation levels be applied to higher potency products. The Canadian Council for Child and Youth Advocates also recommend that to minimize the potential harms of cannabis for youth, public health principles should be integrated into the regulatory framework which is applied consistently across Canada.

On youth access to cannabis, one of the stated intentions of the federal legislation is to decrease youth access to cannabis. The CCCYA believes that regardless of how cannabis is legally regulated, some youth are still likely to find ways to access the substance and that there is still high risk of youth becoming dependent on cannabis or driving while under its inference.

In Ontario, for example, cannabis-impaired driving is now more common than alcohol-impaired driving. Research also suggests that cannabis-impaired driving increases the risk of being in a motor vehicle accident. As such, the CCCYA recommended in our letter a nationally created and funded public health information strategy accompanying the legal regulations of cannabis.

This strategy should have a specific youth component informed by the latest evidence of what actually works to moderate the use of substances by youth. The strategy should in particular focus on informing youth about the health implications of cannabis and the safety risk of driving under its influence. The CCCYA also recommends that a program for a routine roadside detection of cannabis be developed and implemented and that suitable consequences be determined for youth who are found under the influence while driving.

On supplying cannabis to minors, Bill C-45 makes provisions for sanctions for adults who supply cannabis to minors. However, we would suggest that the measures set out do not provide sufficient deterrence and will not help to prevent adults from selling or distributing cannabis to children and youth. As such, the CCCYA made the recommendation of sanctions for adults who supply children and youth with cannabis via a strict and escalating system of penalties similar to that which is in place regarding the sale of tobacco in some jurisdictions.

On the need for consistent regulations regarding retailers of cannabis across Canada, we are concerned that Bill C-45 leaves some aspects of the regulation of cannabis retailers to the provinces with the risk of creating inconsistent regulations across Canada. We are heartened by the restrictions on promotion, particularly the restrictions on the promotion of products in such as a way that they could reasonably appeal to youth and the restriction on the use of cannabis products to promote events and activities. However, we would urge additional restrictions on retailers be included and be consistent across Canada.

As such, the CCCYA recommended the development of federal regulations stating that cannabis products cannot be sold in retail outlets that children and youth are permitted to enter, such as grocery stores or drug stores, or that they must be sold only in retail outlets that are highly monitored and controlled; that plain packaging must be used to discourage child-friendly packaging for children; and that packaging should contain information on potency and potential harm effects similar to that which you see on cigarettes and tobacco.

The CCCYA also recommended that retailers be subject to restrictions on the sale of cannabis in any form that would be attractive to children, such as candy. Further, we recommend that retailers be subject to restrictions on promotional signage, hours of operation, days of sale and density of outlets in communities.

On the need to designate a portion of taxes to fund research, public education and treatment, Bill C-45 does not earmark a specific use for the taxes that will be collected from the sale of cannabis products. We feel it would be important to ensure a portion of that revenue is designated to ensure Canada is a leader in scientific research, public education, treatment and harm-reduction efforts respecting cannabis. As such, the recommendation from the CCCYA with respect to this is that specific percentages of tax collected from the sale of cannabis products be prescribed in legislation to support this research, education and treatment.

Additionally, equitable access to programs and services related to primary health, mental health and addictions, varies widely among Indigenous communities and is of heightened concern for on-reserve communities. While Bill C-45 has been outlined as a harm reduction method serving to increase public health, the unique circumstances of on-reserve and remote Indigenous communities and their access to research and supports must be considered. Resources must be allocated to allow Indigenous communities to provide addictions treatment options, mental health support and public education at the same level as other communities across the country.

On the potential for overcriminalization of youth, we have concerns about section 8 of the proposed act regarding criminal offences for cannabis possession as they relate to youth. The proposed legislation makes it an offence for youth to possess more than 5 grams of cannabis, while for an adult an offence does not occur unless they possess 30 grams. While we support the objective of reducing youth exposure to cannabis, we have concerns that this could lead to heightened criminalization of youth. Sections 8 and 9 outline the prohibitions on possession and distribution of marijuana and how young people ages 12 to 18 years can be uniquely criminalized and charged with possession and distribution for the same quantity of cannabis. The legislation identifies that if a young person contravenes the prohibitions, they are subject to the youth sentence under the Youth Criminal Justice Act.

Although I have not had an opportunity to consult with my colleagues on this, I would certainly recommend that the federal government amend Bill C-45 to remove this status offence which will increase the number of children encountering charges under the Criminal Justice Act. Indigenous overrepresentation in the criminal justice system is a recognized concern throughout Canada for both adult and youth populations. When looking at the previously mentioned concerns about youth criminalization for marijuana possession and distribution, there are concerns about how Indigenous youth will be subject to increased criminalization over their non-Indigenous peers. Equitable access to necessary diversion programs and support services will influence the potential for Indigenous youth to be criminalized at a higher rate for possession and distribution of cannabis.

Therefore, the CCCYA recommended that the enforcement of cannabis regulation should be treated similar to the current regulations related to tobacco and alcohol, and that steps should be taken to avoid the criminalization of youth by allowing for non-criminal sanctions such as ticketing and confiscation.

On special considerations respecting Indigenous children and youth, the legacy of colonialism has resulted in health and social disparities for many Indigenous children and youth. These same disparities can result in poor access to services, including substance use services, as well as health promotion strategies that do not take into consideration local conditions and the cultural needs of Indigenous children, youth and their families.

The Assembly of First Nations released a statement in October 2017 stating that they would be initiating a work group focused on the impacts of the proposed cannabis legislation. The statement further identified the working group would look at issues related to the impact on Indigenous people for public health, justice, public education and awareness, and the social impacts. Information arising from this work group would be essential to consider as First Nations move to define the impacts Bill C-45 may have on their communities.

Therefore, CCCYA recommended that provinces should fulfil their inherent obligation to consult meaningfully with Indigenous bands, nations and communities, as well as Indigenous youth, on adapting legislation, regulations, health promotion, prevention and treatment programs to meet the needs of Indigenous children, youth and their families.

While the proposed act states objectives including preventing young people from accessing cannabis and protecting public health and public safety, the Canadian Council of Child and Youth Advocates believes these objectives are not met in the current form of the proposed act and ask that our council's recommendations contained herein be seriously considered on the proposed act.

On behalf of the council, we respectfully submit these comments and recommendations for your consideration.

Senator Patterson: Thank you for the very thoughtful presentation. I am very pleased with the suggestion that tax money be diverted and that resources be provided for addictions treatment for Indigenous people at the same level as elsewhere. I come from a huge region with no treatment facilities whatsoever in Nunavut.

You said that you presented recommendations in July to Prime Minister Trudeau and Premier Notley. Was that in person or was it by letter. I see you are indicating that it was by letter.

You’ve suggested some improvements to the bill. As the first part of my question is, did you get a response to those recommendations? As the second part of my question, I am wondering if you have the wherewithal, perhaps not, to have developed proposed amendments.

Ms. Penrose: To answer your first part of your question, to my knowledge we have not heard back as of yet from the Prime Minister or Ms. Notley. The answer to the second part is that I do not have the ability to suggest the amendments. However, to some degree, especially with respect to sections 8 and 9, we certainly would suggest looking at charging a child or a youth from the age of 12 to 18 with possession and distribution if they are caught with more than 5 grams.

Distribution carries a heavy connotation for a child to be charged with that kind of offence. How that is enacted upon by our policing will be very different across the country. My fear is that without diversion programs on communities, like there are in other areas, we will see more children and youth going into custody because of these particular charges. If the decision is to legalize cannabis, to do this at 5 grams versus 6 grams is significant. If kids don't know the difference between 5 grams and 6 grams, then this could lead them into a criminal arena. That's a very serious issue. Our suggestion is to remove that and put other consequences in such as confiscation, a ticket, or something similar to tobacco.

Senator Patterson: We heard recently from a physician with the Manitoba Health Services that the states of Colorado and Washington have put revenue from cannabis into schools, gyms, pools and youth resources. We also heard that Iceland stopped drug abuse with those kinds of programs.

Is this what you're recommending? Were you looking at examples from other jurisdictions?

Ms. Penrose: We weren't looking necessarily at examples from other jurisdictions. We were primarily looking at the ability to make sure that, when there are treatment needs in communities, some of this revenue is directed at those treatment needs in communities.

Certainly, I believe that other areas have diverted some of their money to schools and so on. The more important part isn't necessarily where the money we get from the drugs is coming from. It is: How we are rolling out this legislation? What will the impact be on children? How do we make sure, as we're doing that, it's done in a way that tries to divert children away from using cannabis and coming to understand the harmful effects that cannabis can have on their developing brain, on their health and on their mental well-being.

The framework we use to introduce this legislation is really important, as well as the revenue or the money made from the sale of cannabis being used to treat some of what we will see as this drug becomes readily available.

Ainsley Krone, Children's Advocate, Manitoba Advocate for Children and Youth: Following up on a comment that you had made in the earlier presentation, Senator Patterson, I would add that there's a real need in community for treatment and for access to resources. We see, all the time here in Manitoba, that young people who require basic support services are frequently taken out of their community to access those in urban centres.

I mean the need is there. If there is an opportunity to divert some of the tax revenue to creating opportunities for young people to get the support they need within their home communities where they're connected to the people who know and love them. That would be something we could probably all agree would be in the best interest of young people. I just wanted to add that comment.

Senator Christmas: I want to follow up on the comment about the discrepancy of services for Indigenous people who live on reserves or in communities compared to those for non-Indigenous people. Given the current situation, I perfectly agree with you that young people, or even adults, sometimes need specialized mental health or addiction treatment services. They have to endure the alienation and the stress of leaving their communities for an extended period, which I am sure doesn't help their healing or their treatment.

I am searching for alternatives to that discrepancy. Is it possible to treat young people who have developed addictions without the necessity of going to distant facilities where there would be professionals? In other words, is it possible to treat addictions closer to home by individuals who may not have professional designations but obviously know how to help young people to overcome their addictions? Is there another community level of care to help people with addiction treatments without having to send them hundreds of miles away to find professionals?

Ms. Penrose: Yes. When we look at our young people who have addiction issues, there are various ranges of addictions. For sure, some kids will need fairly significant interventions. The only place I can speak from is Manitoba where we see a group of children right now being addicted to methamphetamines at a rate that is quite stunning. Oftentimes, if children are using this level of drug, they require some professional help that is at times beyond that of families because a lot of these children's lives are at imminent risk while they're using.

The other issues that go along with their use, such as gang involvement, sexual exploitation and other criminal activity, present significant trauma for these children as they are trying to find their way through a very serious disease. I believe there is capacity at community levels and in the development of programs in the communities that can assist addictions, promote healthy living and provide options to families who perhaps are not addicted to a narcotic that will sometimes physician-assisted withdrawals from the drugs they are using.

I believe there is capacity to provide some mental health, wellness and treatment in community and to support the community to do that; but not all the time for all different types of drugs that kids are addicted to.

Ms. Krone: To follow up on that, I would say we need to see treatment and resources on a continuum or on a spectrum. As Ms. Penrose was saying, some young people require really intensive therapy and treatment to deal with what's going on with them. Usually the addiction is the result of other things that have been happening to them and for them.

There is a lot of capacity at the local level to work with young people. There's also a lot of openness to additional training in communities. If certain resources or expertise are needed, I think that would be a wonderful away to invest money in the local community.

A wise friend once told me that programs don't change people but relationships change people. I always think about that when I think about what kinds of recommendations we make or do we need to be making. We need to be building and investing in the places where young people trust folks and where those relationships already exist. If they exist at a local level with family, with community leadership and with elders, that's where we need to make some of those investments.

Senator Patterson: Hear, hear.

Senator Christmas: That's exactly the answer I was looking for, Ms. Krone. The analogy that pops into my head is young people, for instance, trying to kick the tobacco habit. They would seek out an aunt, an uncle or an elder who would work with the young person in overcoming their tobacco addiction. I hate to say this, but I know that is sort of like a minor addiction. I know how hard it is for those kids who go through it. When you talk about other drugs, and even marijuana, I know of kids who smoked it for a long time. They want to go to university or to school, and they want to get rid of this habit. They go to someone in the community that they know and say, “How do I get over this?” They are sort of counselled through it. These are not individuals who are professionally trained, so to speak. They probably have gone through the experience of overcoming those habits, and so they know what it is.

In the face of legalizing marijuana, this would now come out in the open. If people seek treatment, I am trying to find a way for at least on-reserve kids to comfortably turn to someone in the community and say, “Can you help me with this problem?” I am trying to find another level of care and healing at the community level that may not necessarily need a professional, I suppose.

Ms. Penrose: One thing that would be incredibly beneficial is to talk to the youth. They will be able to tell you. I was talking to a gentleman friend of mine who is from the community. He is a recovered alcoholic. He has two other siblings who are also recovered. How they found sobriety in each of them was very different. One found culture, one went to the church, and one went to AA.

Every child is unique. When I go to government departments and I talk about a continuum of care for children, every child can come into that continuum of care where they're at. If children who need a residential treatment facility to withdraw, or are unable to make any safe and healthy decisions because the drug has totally consumed them, it's a very different place than for children who are starting the process of medicating themselves because they have had something bad happen to them.

How will children want to connect? Really, the answer will be found with the kids. What is it that they would connect to? What can we do to help them? How do we mobilize that for them, without taking them from their families, from their communities and from the people that they love? We can hear their voices. Children are brilliant and they will tell you what they need if they are not so consumed in their disease that they can't see safety for themselves.

Ms. Krone: I spent about 10 years as a youth worker before I came to Manitoba to work at the advocate’s office. I learned one of the best lessons I learned as a youth worker because it was my job to develop programs to deal with issues. I've developed a lot of different kinds of programs, but I learned really earlier on was to start from a place, similar to what Ms. Penrose was saying, just to create space for young people, a consistent place that they can come to. Over time, the program that's needed will become really obvious because they will tell you what it is that they need. First, they need to know they can trust whoever is in that building or in that location. Second, they need to know, on that Friday night when they're ready to go and ask a question, to ask for help or get a meal, that the place will be open and available and the doors will not be closed to them because they're not totally sober, just had a fight, come in with a black eye, or anything like that.

On that continuum of services that are needed, part of starting it is to have a space for kids to be able to go where they are not only actually safe but where they feel safe to be. That will not work for all of the ones who maybe need a more intensive residential treatment centre, but it will work for those who need support and to be told that they have an important place in the community.

Senator McCallum: I want to talk about the reconciliation tied to Bill C-45. You said that the bill would violate articles 33 and 3, which are looking at the adequate protection of children and at the interest of the child as a priority. With reconciliation, human rights are a foundation of that relationship.

Then you went on to talk about how, if this bill were passed, it would increase criminalization of the youth if that continues. I know that preventive programs don't work in community. The health crisis continues despite all the money and all the interventions. There's discrepancy in programming right now, and a lot of the help we need goes beyond professional help.

Would you say that Bill C-45 is discriminatory against Indigenous people?

Ms. Penrose: I would say that the impacts this bill will have on young Indigenous people will be discriminatory because of the lack of services in community. For example, you brought up one situation around criminalization. If you get charged in Winnipeg, you can be sent to diversion programs and then you won't have a charge and a sentence. On community that will not happen because many communities don't have diversion programs. Therefore, the same opportunity will not be available to the child. There will be an inequity there.

If the services are not equitable, then the impact on the children will not be the same. It is similar to mental health services. I can only speak from Manitoba's perspective here, and that's what I am doing. When we do our special investigations into the deaths of children, we see over, over and over again children who need mental health services in their community and are unable to access those services because they're not available. When children use cannabis and their mental health issues are exacerbated, the lack of access to mental health resources will compromise their mental health.

That's not to be mistaken with the fact that I think mental health services are going well here in urban Winnipeg because they're not. They're not readily available to kids here, but there are centres they can go to in an attempt to get that help. If they are in the acute phase, they can access that help.

The services will definitely create a lot of issues for Indigenous children and families that will not occur for children who are not living on community or in isolated communities.

Senator McPhedran: Thank you both for being here and for the really thoughtful answers to our questions.

Last week, I was able to be at the premiere of a film called 1200+. It was filmed almost entirely exactly where we are in Winnipeg. It is produced by Grand Chief Sheila North. That film says a lot about addiction at a very early age. It says a lot about the correlation between being sexually exploited at a very early age, linked to and leading to various kinds of addictions.

There was recently work done by Global TV here about interviewing some gang and former gang members who were explaining that they anticipated the legalization of marijuana for some time now and that this would interfere significantly with their revenue stream. The strategy laid out in this media piece directly from organized crime was to switch to a range of amphetamines and to go for children as young as possible to make sure that it would be a long and guaranteed revenue stream, targeting the most vulnerable and most exposed children.

Having said that, have you or your offices been consulted by the Manitoba government and/or the federal government and/or Indigenous leaders on what you're seeing in terms of this impact on children in this province?

Ms. Penrose: The answer to that is, no, we haven't. There is another consideration to something that you're saying. When these gangs are talking about their new strategy, the one strategy that you didn't mention is the exploitation of girls and how much money they can make off one girl over the course of a year. It can be upward of $200,000. If you can exploit a young girl and make that much money, why would you be selling drugs?

Sexual exploitation and the link with use of drugs is a very serious issue. We see it here in Manitoba. It is very concerning as we move forward and drugs are more readily available. There's a heavier presence with trying to sell a heavier type of drug in place of the revenue that used to be generated from cannabis for these gangs. With their capacity to now exploit girls or young people to do that, the concerning piece is the younger the child the more profit they make, which is very concerning for us in Manitoba.

Senator McPhedran: I would just add to that. I doubt very much that the business is about either/or. I think we're probably talking about every possible source of revenue and every possible source of exploitation to produce that maximum revenue.

Senator Patterson: Could your letter to the Prime Minister and the Premier and your thoughtful presentation today be made available to the committee? I haven't heard of a Child Rights Impact Assessment. Could you elaborate a bit on what that would be? The big concern I am hearing in my region is about youth and the impact on youth. I'd like that lens to look at this bill. How would that be done? Who could do that?

Ms. Krone: Really excellent frameworks and mechanisms have already been developed and are in place in small measure in different pockets around the country. I can't remember which province it is out east. It might be Nova Scotia that has done a bit of pilot testing in terms of using Child Rights Impact Assessment, or CRIA, with respect to any sort of legislative amendments or changes made within their provincial legislature.

There are developed frameworks. Basically the process is that you take a look at whatever it is that you want to introduce and put through an assessment of what will be the impact on young people. Are there any pieces of the proposed changes that would violate the United Nations Convention on the Rights of the Child? As you know, Canada is a signatory to that international treaty. There are some frameworks.

In addition to providing Ms. Penrose's opening comments and the letter from the CCCYA, we could certainly provide the committee with some examples of what that might look like in some follow-up correspondence. Absolutely.

The Chair: We have come to the end of our time for this afternoon and for this particular meeting of the Standing Senate Committee on Aboriginal Peoples. On behalf of the senators here, I thank our witnesses this afternoon from the Canadian Council of Child and Youth Advocates. Thank you for your excellent answers to the questions by the senators.

(The committee adjourned.)