Speech on Yukon Mental Health Strategy

The following is the transcript from Liberal Leader Sandy Silver speaking to motion No. 893, THAT this House urges the Government of Yukon to follow through on its commitment to develop a mental health strategy, delivered in the legislature on April 29, 2015.

On April 2, I raised the issue of mental health services, a topic that I’ve been hearing a great deal about in my community. I would like to paint the picture here of the timeline.

Back in 2011, the Premier committed to spending new federal money to design a mental health plan. In 2012, a former Yukon Party Health and Social Services minister told a local radio station that the government was planning a mental health strategy as well. In 2014, the former minister told Yukon — and I quote: “We’re working on a mental health strategy and when it’s available I will be only too happy to present it to this Legislature.” As the clock struck 2015, Yukoners had a new Minister of Health and Social Services, but still we await a mental health strategy. We are one of only two jurisdictions in Canada without such a strategy, which shows in my mind where mental health lies on this government’s priority list.

 In 2013, the government released a needs assessment for the newly built hospitals in Watson Lake and in Dawson. The report said — and I quote: “That the implementation of a territorial mental health prevention and treatment strategy be a priority that includes local support workers who maintain contact with those in need...” A full 18 months after receiving the report, the recommendation has not been acted upon.

Just over a year ago, the government released a report called A Clinical Services Plan for Yukon Territory. One of the report’s key findings was quite blunt and it said — and I quote: “Mental health services are in a significant deficit outside of Whitehorse.” The report went on — and I’ll quote again: “Not addressing … mental health services in Yukon Territory risks failure for a clinical services plan.

“Central to a clinical services plan of value to the residents of Yukon Territory is the expanded resourcing of ADS and mental health services, especially in the communities. There is no greater need.”

Finally the report went on to say — and I’m quoting again: “No provider or service interview conducted during the study was silent on the enormity of the problem with, and impact of, the management and challenges of mental health services in Yukon Territory.

“The full spectrum of mental health issues is prevalent and generates a huge burden on available resources and family members.”

“…not a single interview during this study was silent on the critical need for expanded and re-tooled…” mental health services “…to be central in service planning.”

Mr. Speaker, there has been no response from the government in the year since it received this report — this $200,000 report on how it plans to address the lack of mental health services in rural Yukon. The overwhelming message from the government’s own report is that things need to change. Unfortunately, the new minister stood in this House and continued to defend the status quo. The basic message is that we’re putting money here, we’re money putting here, everything is fine — and he refused to acknowledge that more needs to be done. Without a plan to implement, it’s hard to assess whether or not we’re hitting those marks.

I would like to speak to the rural experience for a minute if I can, as I think this is where some of Yukon’s biggest deficiencies lie. We need to consider the importance of understanding the reality of rural community living and the opportunities and challenges that are provided, based on this reality. We also need to acknowledge that there are gaps in health and social services to rural communities and that finding solutions to creating equitable services does not necessarily mean looking at our Whitehorse model for guidance. Blanket policies for both rural and urban Yukon are not necessarily working for rural community needs. Again, a comprehensive mental health strategy should be able to address this issue.

I want to talk a bit about the mental health nurses. There are two — two mental health coordinators, two mental health nurses for the rural communities. One is based in Haines Junction, the other one in Dawson. They both have huge areas for which they are responsible. The one in Haines Junction deals with Watson Lake and southern Yukon and then Old Crow. The Dawson coordinator is responsible for Ross River, Mayo, Faro, Carmacks and Pelly Crossing. In each community, the nurses told that the services they can provide are different, based on the additional services that a specific community may have access to. Some communities are fortunate enough to have a Many Rivers counsellor — but not all of them — who can deal with severe mental conditions — Dawson being one of those communities that’s extremely fortunate to have the Many Rivers counsellor.

In Ross River and Faro, Many Rivers’ services are not provided, so the nurses will carry that responsibility. Child abuse treatment services are available, but only if the family signs into the program. Otherwise, in these communities, it’s back to the mental health nurses. It gets a little confusing, depending upon what community you’re living in, as to who provides what services. Imagine if you moved?

In Dawson and in other communities, depending on the other services available, the mental health nurse is told to only see patients with severe mental illnesses, such as schizophrenia, and not patients with severe depression or suicidal tendencies, because that would fall under the jurisdiction of the Many Rivers counsellors. The problem is that doctors are referring patients to the mental health nurses, while the department is telling the nurses that they cannot see these patients, because they don’t fall within the mental health mandate for the Dawson area.

The Many Rivers counsellors are effective — absolutely — but often become overwhelmed and, sometimes, clients fall through the cracks. Imagine being the mental health nurse who is sitting there listening to the doctors, who are saying, “We need your services”, and then having to say, “Well, my hands are tied.”

If the mental health nurse steps outside of her working hours, or any other minor infraction, to help a patient who may have been self-admitted, they are slapped on the wrist for overstepping their mandate. This confusion over patient responsibility is creating turmoil and preventing patients from receiving the help they need.

So they’re being slapped on the wrist in Dawson for a service that they would provide in Faro. You can see how without an actual plan and without a strategy that this gets really confusing, Mr. Speaker.

Policy tends to be developed to prevent these community mental health nurses from building trust within the communities as well. Nurses are being discouraged from speaking too much with the locals when travelling to the communities, when the opposite needs to happen in order to form trust in the relationships to be in place for nurses to effectively help the community. These nurses are being told, “Don’t pat the dogs, don’t talk to people in the streets; do your job and move, because you have such a schedule.”

It’s really hard to gain people’s trust if you’re not part of the community, and imagine being a travelling rural community nurse, who has to go to Dawson, check in at Dawson with the RCMP and with the caregivers there and, on the same day, to Stewart Crossing, and check in there with care providers, and on the same day to Pelly, and the same day to Carmacks and the same day to — you can see how it’s hard enough to develop the trust of the community when you’re just dropping in from time to time.

So why not coordinate the services? It doesn’t matter who I talk to, Mr. Speaker, whether it is parents who are dealing with mental health issues with their children, or with their young adult children still staying at their homes, or people suffering themselves from anything — like alcohol abuse, and wanting to get into some after-care — or the service providers, or the EMS — it doesn’t matter who I talk to, coordination of services is so important. So why not coordinate the services?

Resources should be shared to develop proper implementation of services, based upon need, instead of quotas from the department that dictate the rules based upon administrative ease. Again, we’re heeding our information from Whitehorse to deal with the problems in the rural communities. Too often, these can be very counterproductive and, in some cases, insensitive to the communities’ needs.

The second topic that I would like to approach here today is the use of health NGOs to Yukon’s communities. Rural communities benefit only marginally from NGOs whose core funding comes from the territorial government to meet the needs of our Yukon population. Since rural Yukoners struggle to be able to access most of the NGOs’ services, it might be possible that we need the government to re-evaluate its services in rural communities, taking into consideration the lack of NGO services. When NGO services are available, it has been reported that these services have been essential in supporting individuals who would otherwise have no or little options. When government and/or NGO services are withheld — as in the case of where it takes over six months to a year in some cases to replace essential services like mental health practitioners, counsellors and social workers — this leaves the communities with little to no appropriate preventive or reactive services.

Some of our rural communities have risen to the challenge of limited resources and have come together to support communities. For example, some self-governing First Nations have established programming in rural communities to support positive development in youth. These programs are not limited to First Nation youth. That is one thing that I love about First Nation governments — they don’t limit their services to just members of their own First Nation. They support the whole community.

In addition, opportunities for inter-agency collaboration and integrated services are high in rural communities. Where there may not be enough work for one individual in one specific government agency, there will become room for that individual to work in two different government agencies to do the same amount of work — again, collaboration of services, Mr. Speaker. Neither government agency is able to provide enough full-time funding for an FTE, but together this might be possible. It is also difficult to provide equitable services when the services are all based in urban settings. In some cases, this is all that is possible, but there are individuals ready and willing to work in rural communities who are not being utilized because the current system does not allow for decentralization of those services. Creating rural hubs for specialty work has also been successful in some of our rural communities. Developing a plan to increase this type of service availability seems to me to be extremely justified and justifiable.

To try to wrap up here on some of the rural issues, there have been hundreds of thousands of dollars commissioned to assessments of health care needs — for example, the McMaster report, the Peachey report and others — all of which have basically come back with relatively the same conclusions — but their suggestions are not being acted upon. Instead of paying workers to travel such distances, there should be improved collaboration between Mental Health, addictions, Many Rivers, et cetera — the stakeholders. Having workers based in more areas, as suggested, would improve support for rural communities and would lessen the anxieties of the populace and the health workers. Even if employees were hired for part-time work, I am sure that they would be more interested in and able to recruit for other positions.

Mr. Speaker, we are in an interesting situation with our rural mental health nurses, where I am extremely afraid that burnout is going to happen. Imagine — I mean, dealing with one school as a teacher is enough — going to all of these communities and keeping track of not necessarily just the individual people who are suffering from mental health, but the families and the interconnections between the communities. It is amazing.

For a mental health worker to drive from Dawson to Faro to Ross River for one week per month and to pay travel time of eight to 10 hours each way — not including meals, meal breaks and also depending upon road conditions — it doesn’t seem like good financial management and could lead to extremely unsafe work conditions. I could only image the stress of thinking that you just cannot be effective enough in these situations and the people who you’ve missed, or the ones who you should have reconnected with, but don’t have the time. It has been suggested to the department that it would be more effective for our rural mental health nurse to do the work trip over a 10- to 14-hour day period to better serve the communities.

Now there is a major lack of semi-independent and supportive living accommodations for people with severe mental health and dual diagnosis in the Yukon. To access such places in Alberta or B.C. is extremely difficult, but there is a serious need, as is obvious by the number of people with mental health, FASD and addictions who end up in the care of the criminal justice system, residing in the correctional facilities. The biggest thing that we can do is work toward the collaboration of services in our communities through shared positions and intergovernmental relationships with different departments and NGOs.

Mr. Speaker, there are a number of issues that I have heard from concerned Yukoners about and I am not going to have the time — I could filibuster away the day with all of these issues if I wanted to, but I really do want to have the debate here today, sir. I would like to highlight a few more areas of concern before I sit down and listen to my colleagues.

By the minister’s comments last week, it seems that, in his opinion, mental health services are needed for at-risk people, but mental health is much more complicated than that. One example of this is postpartum depression. According to the Pacific Post-Partum Support Society, postpartum affects one in six women and one in 10 men and is likely to strike affluent, well-educated parents. PPD does not discriminate — it can happen to women who have no history of mental health issues, to women who are successful in many aspects of their life and to women who are looking forward to becoming mothers. How are we helping Yukon’s new moms?

Another idea I would like to speak to is child services. Mental health does not discriminate by age. Recently there have been parents who have gone public with the issues that they have had in securing an education assistant. When they broke the story, parents from the school in question said that they did not have enough resources to support the education assistant’s needs and the department disagreed with that statement — not to mention the teachers are not prepared to deal with students with mental health issues — or the EAs for that matter. If we want to give everyone the chance at success, then we need to be able to identify these issues early on. We need to ask the question of the education system: What is the secondary school completion rate for students with mental illness? What steps can we take to increase that?

Mr. Speaker, there are a number of other topics and areas that could be addressed by talking about a comprehensive strategy and as I noted with speaking to Education, a mental health strategy should not be limited to Health and Social Services. It should have implications for every department.

Just to sum up here, I would like to go back to something that the Minister of Health and Social Services said last week I believe — I’m quoting here: “A Clinical Services Plan for Yukon Territory was released in April 2014, as you know, and sets a long-term plan for the evolution of health and social services delivery in our incredible territory. While the report’s recommendations have not been accepted by government, the department continues to utilize the plan as a foundation for innovative, evidence-based decision-making and maximizing system efficiencies.”

Mr. Speaker, the point of developing plans and strategies is to look at the recommendations and make smart decisions based on needs identified — not to put them on the shelf or to put a checkmark by a box. I’ve tried to use my time here to highlight some of the deficiencies in our current health care system. I do not see how a government that has continued to promise a strategy could vote against this motion, although I wouldn’t be surprised.

I know the minister will likely respond to tell the House that the government is spending money, and they are. I imagine he will also tell me, as he has before, that I should be ashamed of myself for questioning the services being provided, as this has become his default reaction to this topic this session here in the Legislative Assembly. But the reality is that Yukon still does not have a mental health strategy. It’s one of two jurisdictions in Canada without one. A strategy would identify the mental health needs in the territory and give direction to the department on where to spend its money.

It would also — and this is so important — assesses that implementation. Isn’t that the most important part of any strategy or plan — the assessment? We’re all going to make mistakes. We’re going to have failures as we try our hardest and then we’re going to reassess. We’re not going to blame; we’re just going to pick ourselves up and we’re going to continue down that road — but without a plan, Mr. Speaker.

I guess I’ll just end by saying that, as it stands, the minister is spending money and the government does have deep pockets, but by not building a long-term plan, it’s so hard — it’s so hard for these individual people who are working to get their ideas implemented and to make sure that we have the same access to services in the rural communities as we enjoy here in Whitehorse — not to say that there aren’t problems here in Whitehorse as well, but obviously I’m speaking a lot more on the rural side of things right now.

With that, Mr. Speaker, I thank you for the time here today. I look forward to an open and honest debate about this issue and, for a government that has promised a mental health strategy, I would assume that this would be a great motion for all of us to agree upon — and hopefully amendment-free.