Good afternoon and welcome, everybody. We'll come to order now.
This is the Standing Committee on Indigenous and Northern Affairs. We're continuing our study of suicide among indigenous peoples and communities.
We're meeting today on the historical land of the Algonquin people, for which we're very grateful.
We have two panels today. The first is the First Nations Health Managers Association, who are seated with us in the room, and the second is the Canadian Indigenous Nurses Association, who are joining us by teleconference.
We're happy to have you all here.
The way this works is that each organization has 10 minutes to present. I see in both cases we have two people from each organization. You can share that 10 minutes between you any way that you see fit. When you get to around nine minutes, I'm going to hold up a yellow card. It means we're nearing the end. Then when you're out of time, I'll hold up the red card. I'd ask you to please finish up at that point, and then we'll move into questions from committee members.
With that explanation, I would welcome Marion Crowe, executive director of the First Nations Health Managers Association, to take the floor.
As mentioned, my name is Marion Crowe. I'm a Cree woman from the Piapot First Nation in Saskatchewan, and I'm here in the capacity of the founding executive director of the First Nations Health Managers Association.
With me, of course, is Mr. Calvin Morrisseau, board executive member and Ontario representative of the First Nations Health Managers Association. Mr. Morrisseau works as the executive director of the Fort Frances Tribal Area Health Services.
As you indicated, Chair, we are on Algonquin territory, and we would like to acknowledge that territory on which this hearing is being held today. We also want to send our condolences to the families who are impacted by and grieving due to the very reason we're here.
Our thanks to the Standing Committee on Indigenous and Northern Affairs for the invitation to speak and to provide our testimony related to life promotion strategies. It really is a responsibility we carry with humility and pride.
The First Nations Health Managers Association, which I will refer to as FNHMA, was founded in September 2010. We're a national professional organization providing certification and professional development opportunities to health managers and directors who work in and with first nation communities from across Canada.
We have over 300 members and a network of approximately 1,200 first nation health leaders, representing grassroots health professionals who administer, advocate, and in some instances are clinicians practising health services in our communities. There are over 100 certified first nation health managers across Canada designated by our organization. We are a certification program that is built on core competencies that were created and led by grassroots health leaders.
Right now we're the only organization in Canada that has a curriculum built around relevant health services and practices, and a governance that is actually reflected in our communities and incorporates and respects culture as part of our competencies. This makes us unique as we celebrate and share our inherent knowledge while balancing and maintaining management principles.
We have brought with us today evidence that speaks to our subject matter expertise in first nation health service delivery, and it will be distributed. It's the textbook written by FNHMA, largely authored by our certified members from across Canada.
We are uniquely positioned to share the experiences of grassroots health managers on the ground in our communities. The issue that has brought us here today is suicide prevention. We usually don't speak from a deficit position, so we'll refer to it as life celebration, please. We bring forward four recommendations for consideration as a really small part of the larger strategy required to make inroads into this issue.
Before we get into our proposed solutions, in reviewing previous witness testimony, we know you have had 42 witnesses prior to us, and we feel obligated to note that Thunderbird Partnership Foundation is absent from the witness testimony. Thunderbird Partnership Foundation is an FNHMA partner, and they are committed to working with first nations and Inuit to further the capacity in communities to address substance abuse and addictions. We would implore the committee to consider their participation in this very important work.
As regards the very first recommendation we bring to the committee, we already know from previous testimony, research, and academic studies that we are facing an issue that is pervasive in our communities. We are specifically speaking to the testimony that has already been provided on the first nations mental wellness continuum framework. It identifies a continuum of services needed to promote mental wellness and provides advice on policy and program changes that will enhance first nation mental wellness outcomes. This framework enables us to adapt, optimize, and realign mental health wellness programs and services based on our own priorities.
The framework includes a number of elements that support the health system, including governance, research, workforce development, change and risk management, self-determination, and performance measurement. Health services integration among federal, provincial, and territorial programs is critical to its success. Discussing how to implement the framework in our communities is really important to us as an organization and it will be a highlight at our national annual conference this year. Our delegates are at the forefront of life celebration, and suicide prevention will be a very valuable resource when discussing the implementation of this framework.
We also refer to previous testimony that cites the urgent need to implement the Truth and Reconciliation Commission of Canada's 94 calls to action in order to redress the legacy of residential schools and advance the process of Canadian reconciliation, but you have heard that already.
Our second recommendation that we bring increases the efforts in certification and accreditation in our communities. These are key elements to FNHMA. We see in health services accreditation recommendations all the time around governance and capital. Investments need to be made in our communities on capital assets to even be able to reach health services accreditation, investments such as the repairing of our existing facilities, and also the creation of new treatment and quality health centres. Having certified health managers in our communities will contribute to increasing accreditation goals made by this very government, Health Canada's first nations and Inuit health branch.
Our third recommendation is around strengthening the existing networks that are already in place, such as FNHMA and the Canadian Indigenous Nurses Association, who are also here to testify today, and the other national indigenous organizations that are leading capacity building in our communities. We have to reinvest in them and redress the cuts that were made in 2011. This will increase the supports to our health professionals who are on the ground, who are leading, advocating, and creating partnerships to implement the health services integration in our communities that's required. Our existing national indigenous organizations require equitable support to continue the journey of capacity building.
Thank you very much. Tansi
. Hello. Bonjour
[Witness speaks in Cree]
I want to thank the chair and the committee for this invitation to present on behalf of the Canadian Indigenous Nurses Association and to support the families who have lost loved ones.
I'd like to begin by honouring the traditional territory of the Algonquin people, as you've mentioned.
I am from Beaver Lake Cree Nation in Treaty 6 in northern Alberta, and as you mentioned, I am the president of the Canadian Indigenous Nurses Association. I have worked in health care service delivery my entire life, as a nurse. I am now an associate professor at the school of nursing at Thompson Rivers University. Today I have Lindsay Jones with me. She is one of our CINA nursing members and a student here at Thompson Rivers who is studying community health within indigenous communities.
Beyond the symbolic ritual of place, this acknowledgement signals the urgent challenges we face in the era of reconciliation. The struggle for human rights and equitable health care for our indigenous children and youth is a collective and vitally important undertaking, so I come to you today as a survivor. I am reminded of what our elders and traditional knowledge holders continue to tell us. As we continue to reflect on our own philosophy, the spirit of wellness and the struggle for self-determination, we have to know who we are and where we come from, while walking in the footsteps of those who have moved on to the spirit world at the same time of creating footprints for those who come after them.
It is clear that the health of indigenous youth is intimately related to the history of colonization and residential schools, removal of the child from their home and their culture. We know the statistics are grim and that one of the most difficult things to face in life is the reality that somebody close to you has committed suicide. This harsh aspect of life is all too real for first nations, Inuit and Métis families. What we know is that indigenous youth suicide is the most significant public health issue facing our societies.
Our brief presentation today will address how the Canadian Indigenous Nurses Association, CINA, can contribute to addressing the crisis by offering three recommendations for the committee's consideration. These recommendations address the sustainable funding, about which you've heard extensively, to improve access to high-quality culturally responsive and integrated health service delivery by increasing the number of indigenous nurses working with individuals across lifespans, across the nation, and across our northern communities, specifically where the elevated risk of suicide is at alarming levels.
You've heard about the productive factors. You've heard about the risks. We stand united in support of our other indigenous-led organizations and researchers who have undertaken extensive inquiries into this topic.
Our first recommendation is to advocate for sustainable funding for CINA as a national leader on behalf of our front-line nurses and the communities they serve. Firmly rooted in this recommendation is the belief that the Canadian Indigenous Nurses Association can significantly contribute to the overall wellness of our indigenous youth by supporting and fostering the human potential, in creating community capacity to deal with the issues at the local level with front-line workers.
Most do not realize that CINA is the longest standing professional indigenous health organization in the history of Canada. It is a non-profit voluntarily run organization that is governed by 12 indigenous nurses whose vision is to be recognized as a bio-expert advancing the health of indigenous communities, with an end view to improving first nations Inuit, Métis peoples health and well-being.
Our organization began as a political support to Monique Bégin when she started to take this on back in the early 1970s. CINA members are the doorway to the indigenous communities and delivers its core strength from its membership base.
Currently there are approximately 9,000 indigenous nurses in Canada, which represents a huge untapped and underestimated resource. CINA holds real potential to expand its work as nurse members.
Our CINA nurses continue to bring their unique and diverse languages, understandings of culture and healing traditions to their practice. Their roles as stewards of indigenous nursing knowledge informs the ongoing development of local, regional, and national indigenous health policy and service programs around the country.
CINA believes that addressing youth suicide can be achieved by putting the health of its youth back into the trusted hands of its families, communities, nations and nurses. This includes indigenous leadership by promoting the development of practice of indigenous health nursing that is grounded in indigenous knowledge and the expertise that our members hold.
In advancing our mission, CINA engages in activities related to recruitment, retention, member support, and consultation. For the past five decades, CINA has traversed this ever-changing environment.
What we are experiencing is an urgent call for action on reconciliation, decolonization, and incorporation of traditional approaches to health and wellness. We need to apply the metaphor “culture is medicine”.
Unlike any other national aboriginal organization, CINA receives no core funding. Equity funding is an important discussion that has not been explored fully to date. We support Dr. Cindy Blackstock's human rights fight for equity funding for indigenous children. It is currently needed, and we stand strongly beside her.
The greatest potential that CINA has is its ability to deliver primary health care by investing and supporting nurses who work in each of the 655 different communities across the country. What we do know from the Auditor General's report is that one in 45 nurses is adequately trained to work in these northern communities.
As a result of growing requests, we have been working on a collaborative indigenous partnership framework, which I can discuss later, but it really establishes how we are better prepared and situated to work with non-indigenous communities and partners.
Our second recommendation is to support the implementation, as you've heard about...the mental health framework stemmed from the collaborative work together. CINA was a major contributor to that work, and we stand by that report. It really addresses the six continuums of care: community development, early identification, secondary risk, active treatment, specialized treatment, and facilitation of care. That is where nursing is often underestimated. We have the skills, the abilities, and the capabilities to foster that.
Our third recommendation is to support the reorientation of health services to focus on health care closer to home, health care that supports capacity building and health, economic, and environmental sustainability by giving children and youth the skills and capabilities to cope with the impact of intergenerational trauma from dislocation and displacement from their families, so they are much better able to handle that systemic violence that continues to impact the health and well-being of our communities. There is ample evidence to show the point that systemic issues continue to contribute to these inequities.
CINA has been able to develop some much-needed training. We propose that the federal investment in indigenous health and education be used to support the new health accord, which calls for the reorientation of health services. This training can help reduce racism and discrimination, which is found to have a significant impact on people's health. A study with which I am closely involved is examining rural access to health care. It has revealed that people living in these rural settings are even further marginalized by bias-informed care.
With the evidence, it is clear that we need to put in a whole-of-government approach that supports the people and puts the power back in their hands, and while there are new and promising partnership models, such as the First Nations Health Authority here in British Columbia, there is a lot to be done for a comprehensive, holistic approach as services continue to be siloed.
Now I'd like to give Lindsay an opportunity to discuss health care closer to home.
Hi. I'm Lindsay Jones. I'm Nlaka'pamux from Kamloops, B.C. I'm a fourth-year nursing student attending TRU. I'm also a member of CINA.
I have three recommendations in response to the suicide epidemic among indigenous people in our communities.
Nursing understands that when working with such a marginalized and vulnerable population, it is salient to work on professional development with regard to building capacities within the communities. Nursing is more than psychomotor skills. It is a relational practice to work in culturally safe ways to build bridges to close the equity gaps.
Research shows that retaining highly trained and effective health care workers is important in providing quality, accessible health care to people living in rural areas. There also needs to be support systems in place for nurses providing care within these communities. Nurses know a community's strengths and how to build them, understanding that solutions come from within the community.
In the Truth and Reconciliation Commission of Canada, call to action number eight states:
||We call upon the federal government to eliminate the discrepancy in federal education funding for First Nations children being educated on reserves and those First Nations children being educated off reserves.
While the social determinants of the health movement has helped to shift some of the blame off the individuals to political and economic systems, the focus is still on what is under-provided in the community and how those deficiencies negatively affect children and families.
My last recommendation is to build on the idea of health care closer to home. As a foster parent, I believe that instead of removing children from their families and their culture, we as a country and as health care providers need to start fostering the families in the traditional, appropriate ways.
Research has found that adolescents may also be less at risk for suicide if they experience the neurophysiological benefits of connectedness, like believing in one of the values for care for and able to better regulate their emotions through social affiliation and attachment with caring adults.
Starting at the grassroots, nursing can support families to empower their children to build confidence and nurture their opinions so they have a voice and develop coping skills, fostering the families to provide an environment where children thrive, instead of removing these children instead of going from foster home to foster home, which only perpetuates the ongoing issue.
Thank you for this opportunity.
Yes, that's a really good question. I can't speak for the Indigenous Physicians Association as to what their numbers are, but I know nursing has definitely had growing numbers.
I know when the recruitment and retention strategies are out in the community, there is a focus on medical training. I'm often advocating that we need more support in terms of advocating for nurses training.
Right now that 9,000 is underestimated, but that number only represents the number of nurses working within our province. Those do not actually include numbers of nurses who are working in first nations communities, because that data came from the family survey which was off reserve, so that's a gross underestimate of that.
In terms of national standards, if you look at how many patients registered nurses are able to have first contact with as opposed to indigenous physicians.... I work a lot with communities and I hear all the time that they need doctors, and I say that actually, no, they don't need doctors. Yes, we need doctors, but nurses can really help support the whole focus of care. Not everybody needs to go to a doctor because of a temperature or some investigation. A registered nurse, adequately prepared, can actually streamline some of the priorities faster. We can get appropriate care faster to the people who need it most if you implement a nurse pathway program starting right from health careers, to LPNs, to registered nurses, to degrees in community health, and to nurse practitioners. Nurse practitioners are a really underutilized group of nurses who have amazing skills.
We have one in Maskwacis in Alberta, and I know there is one who splits her time between Paul Band and Alexander. They've actually shown that they've been able to reduce...and improve the efficiency and satisfaction with clients' heath care contacts.
Just to speak a bit more to that, in my own community of Beaver Lake, what our community is starting to do is that whenever we do any kind of health programming, we have a relationship with the child welfare people. The families that are left in the community, when the child's been apprehended, they'll bring the child so that they can support that family unit. That has been shown to be very effective to help this transition back home.
I totally agree with the message that Lindsay was providing. We need to support children so they stay in their homes. We need to reorient services to build capacity within the home, as opposed to spending millions and millions of dollars shipping families out across the country. We need to focus on building the family as opposed to just breaking down the family dynamics.
I think there are some good examples across the country where that is starting to give us some good indication. If you look at Bella Bella, and you probably heard about that, the youth are really reoriented back to the land, and the communities, and the family units. Evidence is clear on supporting family units.
I have to speak to my own survivorship. I think about how, when I was removed from my community of Beaver Lake and brought all the way over here to B.C., one thing that always kept me grounded, and striving, and having those aspirations, was that those foster homes always supported my getting to know who my family was. I think that link was really a key attribute to the success. You see that in my other siblings, who were all apprehended, and they weren't in families that did support their transition back to their family. You could see the clear differences in my immediate family on how they were affected by that removal system.
I would like to speak to that, please, Mr. Chair.
One of the recommendations that I've made right from the beginning.... I believe so firmly in this organization. The Canadian Indigenous Nurses Association is part of the solution. We are at the front line. We see these kids in immunization clinics. We see them in home visits.
We don't have a lot of support. We're focused on treatment right now under the current.... My own personal philosophy is that we are too focused on treatment. Our community health nurses are focused in that area, which leaves us health promotion. We need to put nurses back in the school system. We need to put nurses back in the community. I think the funding cuts....
I want to tell you a story about a little girl—her name is Cassey—whom I met in Yukon. This is very striking to me. As I said, I acknowledge that I am a survivor. Our family is working on a lot of healing. When I was in the community in Whitehorse a couple of weeks ago, there was a little girl no more than nine years old. She was out playing. It was late. I was scolding her. I was telling her to go home and I asked where her mom was. I was trying to be that community advocate. She turned around, really foul-mouthed, and let me know where to go. I thought, oh my God, she's only eight or nine years old. I was upset about this.
I was talking to my brother and sister-in-law in the house about this. How do we help this girl? We were talking about boundaries, family dynamics, and everything. Then my brother said to me, “Sis, I don't know why you're getting all worked up. Would you want to go in there if you knew that five of her immediate family members committed suicide in that home in the last five years?” Now she has her single mom, with this child growing up. No wonder. It really affected me.
When you talk about our priority, that's huge. We have eight- and nine-year-olds seeing this on a daily basis in some of our communities. If we don't step up now, this.... Suicide is a symptom of colonization, of a fractured system. I think it's an emergency state, as you've all said, which is why you are looking into this work.
I think about Cassey being eight years old not wanting to go into that home and rebelling. I can't say that as an adult I'd want to go back in there, but where else can she go?
I want to address this question a little bit from my experience. I've been doing this for more than 30 years.
I guess one of the things important to know is that you can't fix a system or a community that's broken without investing in the community. I think a lot of people believe that if we take children out of the community, it's going to benefit that community. I think what needs to happen, from my own personal experience, is that we need to invest in those communities.
One of the things I've noticed is that when a crisis happens, everybody is ready with a crisis team to go into the communities and deal with the crisis, but once the crisis is over, everybody leaves. I think there's a real disconnect there.
I think you need to really look at making long-term plans for the children and for the people in the community. I've known suicides to happen with the very young as well as with the very old, so it's not just one specific age group that's affected. It's the whole community sometimes that is suffering from the impacts of what occurred over the course of the last 500 years with our people.
I think it would be an immature thought that there could be one quick fix. There have to be massive investments into these communities. We have to go in there and talk with the children. We have to talk with the adults, the parents. We have to talk with the elders. We have to bring people together and start a discourse on how we're going to do this.
To me, this is the thing that's been lacking in a lot of the situations. A crisis team comes in. The crisis is over for a little bit, and then everything goes back to normal. Then another one pops up somewhere else, and the crisis team goes over there. There has to be some long-term planning for this.
The other part to this is that we rely on health directors in the communities, for the most part, to do this—and I'm hoping to speak more about that health director role later on. The health director is only one person in a larger system that's out there. I think that, if we really look to address the long-term needs of the communities in terms of what their social, recreational, and health activities are, then you'll begin to see some changes in terms of how people are acting out.
We have to give people hope. Without hope, these are the things that occur within our communities, and they're occurring far too often. That means we're not doing a very good job of providing that hope across the board. I think we should all be ashamed of ourselves for not doing that.
Thank you very much, Don, for the question. I'll do my best to answer it.
I can speak for our area. My understanding is that a health director is the one who's responsible for the health and well-being of the people in a community. There are a couple of things you need to know about that role of health director.
First of all, it's not a role that is paid for by the Government of Canada. Many first nations have to try to pool their money together to create that role.
It was originally put in place, I think, for reporting mechanisms. Somebody had to be responsible for reporting back to the government. But over the course of time, as our people began to find out about the horrendous discrepancies in our health outcomes compared to those of other people, the task of improving those health outcomes for our people began to fall to the health director. So when anything happens in the community, we look to the health director for guidance in how to deal with it.
One of the things with health directors is that there is very little support out there for them. They're kind of like a beacon out there doing the job all by themselves, and when things happen, when things go wrong, everybody looks to the health director to see what happened, and yet, the first nations and Inuit health branch has pulled back training for health directors and for health people across the board. The CHR, community health representative, training is almost non-existent now, and we see this across the board. Our people are left to try to find training wherever they can get it, whatever way they can get it. Thank God for people like Marion who has a program that's set up so that health directors can access it.
The problem then becomes where the health director gets the resources to improve his or her own set of skills. You have to understand that things are different from what they were 30 years ago. The complexities of the health determinants that affect our people are a lot different. We see chronic illnesses that come into our communities. We see mental health issues. It's no longer just alcoholism. It's alcoholism with bipolar, alcoholism with prescription drug abuse, and all of these things that are left at the doorstep of the health director, who is supposed to deal with all of these things. Then when we don't provide any training or any help for the health directors, we ask them what they're doing.
That's the situation we see in first nations. I was a health director. I spent most of my days dealing with crises, the daily crises that go on in my community. I had no time to look at what I could do in terms of planning, so that my people could get healthier. These are the situations that occur within many first nations, and until those inequities are addressed, we'll continue to flounder in terms of our own health outcomes. We'll see our young people dying at a greater rate than other people. We'll see all of these things that are occurring, and you don't have to look very far to see the horrid health outcomes that our people are facing. We have one person out there who is charged with trying to change this, and we provide no support to that person.
Great, Cathy. Yes, I'm very new to Thompson Rivers. I was very excited to come to the university here. They recruited me here very aggressively because of their program on indigenous health research.
When I look at health careers across the board, yes, you're absolutely right. I totally agree with you. Those whom we're targeting at 90%, sometimes book smart does not translate into a really good, awesome bedside nurse.
One of the things I advocate for is this pathway to health careers, starting them in grade 3 and 4, teaching them that medical terminology, levelling it up so by the time they get to grade 7 they have a little more knowledge. They do the anatomy and physiology. There's a really good way to strengthen that so we could create a pipeline from high school into a health career position. They do health career for 27 weeks. They work and take care of their families. They go back, and they do the LPN for two years. Then we create the pipeline further and extend it into the registered nursing program and the baccalaureate program.
Right now, as you know, Thompson Rivers has committed to developing the first indigenous master's program in the country. It will have a specific focus on indigenous nursing leadership. I think that's really telling. As I mentioned earlier, our indigenous nursing pool is a really untapped resource. You have an expertise here to fill a gap. We know they are the most trusted health professionals in our community. Our communities see that too. We are at the bedside, in the alleys, in the back of cars. We have that relationship with our youth. We have to start building that bridge strongly, looking at equity seats and equity funding.
I know TRU has an aboriginal health careers program here. Circulating in some of the communities here was interesting. I asked students how come we don't have more aboriginal students. They believe they are not smart enough. I talked to three or four adults in the last two weeks, trying to encourage them to go into an LPN program. They are mature students, and I always use my own life example.
I was a single parent with four kids, and I went through every health career program from the time I was 18, and I just finished my Ph.D. in 2014. I was able to be a better health care provider with the school because I was able to navigate around my classes. I ended up being at home for my children more so than if I were committed to doing a 12-hour shift.
That for me is a dream, and I think a lot of kids come with life experience already. They know how to get their grannies to the doctors, how to interact with the emergency services. They know all about emergency by the time they are 12 years old. They are already navigating the system and the health care system at a very young age. I think we can draw on those strengths.