First Nations health system to get overhaul

New plan aims to give more power to Indigenous groups to administer own care

OTTAWA— The provincial and federal governments are promising to put an end to the “colonial health system” in some Ontario Indigenous communities, many of which have been rocked by waves of tragic suicides, and empower them to deliver their own services. Nishnawbe Aski Nation (NAN) Grand Chief Alvin Fiddler met with the Ontario and federal health ministers Monday to sign what the leaders described as a milestone “road map” to fix a health system that has failed for decades to stop recurring crises and service gaps in First Nations across northern Ontario.

The announcement comes as the Pikangikum First Nation grapples with the deaths of four young people — two 12 year olds and two 16 year olds — who have taken their own lives since Canada Day. Ontario has pledged 20 full-time mental-health workers for the community near the Manitoba border, at a cost of $1.6 million.

That additional funding was followed Monday by a ceremonial signing of an agreement to work toward “transforming” the way health services are delivered to 49 Indigenous communities that make up Nishnawbe Aski Nation.

The aim is to give more authority to the group to design and administer their own care.

“The colonial health system that was set up and currently exists . . . is not serving First Nations communities well,” Ontario Health Minister Eric Hoskins said.

Jane Philpott, Canada’s health min- ister, added that the Indigenous-led model is being looked at for communities elsewhere in the country.

“There is no question that the systems as they’re functioning now were not designed in the best interest of First Nations,” she said.

Following the signing ceremony in Ottawa, Fiddler said he is hopeful the stage is finally set for lasting change — even if he’d like to see the transformation described in the agreement implemented now.

“They are ready to take on health care for themselves, for their communities,” Fiddler said of the Nishnawbe Aski member communities.

“To me, this represents a return to what my late father used to talk to me about, that this is how we governed ourselves a long time ago. And it worked.”

While there was no firm timeline for the promised change to occur, Hoskins said on Monday the new system would come together over the coming “weeks and months.”

Earlier on Monday, a group of 23 doctors who work in NAN communities called on Prime Minister Justin Trudeau and Philpott to “immediately commit” to change the health system for Indigenous peoples in Canada.

The letter describes a “health-system failure,” where there is “virtually no access to child psychiatrists, child psychologists or similarly skilled therapists” and “arbitrary administrative denial” of health services still exists.

“Short-term crisis-response intervention cannot form the backbone of any health system,” they wrote.

Dr. Michael Kirlew, one of the letter’s signatories who works in the Wapekeka First Nation, has described a lack of basic supplies such as painkillers and asthma medication. He said he welcomes Monday’s agreement to transform the system, but said he is concerned that there is no concrete timeline for change.

He pointed out that communities already have plans to deliver their own services; Wapekeka had a $380,000 proposal for youth mentalhealth services rejected last year, just weeks before two young girls killed themselves in the community.

“We pay with lives (for) the extra time it takes. It’s very easy to say ‘wait’ when it’s not your children dying,” Kirlew said. “How many children have to die before the time is now?”

While Health Canada doesn’t keep track of suicides in First Nations, NAN says more than 540 people have taken their own lives in their communities since it started counting in 1986.

Nothing is more endlessly heart-scalding in human existence than the loss of a child. When that loss is to suicide, the grief is compounded by bafflement, guilt and shame. When youth suicide occurs in waves, the trauma to families and communities surely passes all understanding.

There is a health crisis in Canada. On remote First Nations reserves, Indigenous children are taking their own lives in appalling numbers.

This week, on the eve of a meeting with federal Health Minister Jane Philpott and Nishnawbe Aski Nation Grand Chief Alvin Fiddler to address the emergency, Ontario Health Minister Eric Hoskins announced some immediate help.

Hoskins said $1.6 million will be provided for 20 full-time mental health workers for Pikangikum First Nation, a community hit by the recent suicides of four children and in which hundreds of people have sought counselling in order to cope.

In the realm of Canada’s Indigenous affairs, almost all initiatives can be fairly described as too little, too late. But in this case, Hoskins met a crisis with appropriate urgency, irrespective of political concerns.

“This can’t be an issue of jurisdiction,” he told news media after hearing directly from the chief in Pikangikum how grave the situation was.

Still, experts in Indigenous health — who believe the health-care system as currently constituted cannot produce sustainable service — will be looking for further concrete commitments to flow from Monday’s meeting in Ottawa.

First Nations people simply do not receive health care equal to that elsewhere in Canada, experts say. In particular, they lack access to mental-health services, support desperately needed to address the consequences of residential schools and the physical, sexual and substance abuse that has flowed from that experience.

As well, First Nations leaders say chronic poverty, inadequate housing and overcrowding, and inferior education on reserve have all contributed to pervasive despair among Indigenous youth.

In an opinion piece in the Star last week, Philpott said “it took generations of discrimination to create the circumstances behind these suicides.” And there is recurring evidence that the problems are both systemic and situational.

In January, Quebec Coroner Bernard Lefrançois said Canada’s “apartheid system” of reserves was partly to blame for a string of suicides that devastated an Innu community in that province.

Also in January, leaders in Wapekeka First Nation, about 450 kilometres north of Sioux Lookout, Ont., said their pleas to help a group of suicidal children last summer generated action only after two more preteens had died by suicide.

ACanadian Human Rights Tribunal ruled last year that the federal government discriminates against First Nations children on reserves. Even though needs are greater, Ottawa provides significantly less support to children on reserves — for which it is responsible — than provinces do for Indigenous children living off-reserve.

The ruling was particularly troubling given the adoption of Jordan’s Principle — a federal policy (based on a resolution passed unanimously in the Commons in 2007) that stipulates no Indigenous child should suffer denials, delays or disruptions in health services due to jurisdictional disputes.

It was named after Jordan River Anderson, a young boy from Norway House, Man., who died in a Winnipeg hospital in 2005 while federal and provincial governments argued over who would pay for his care.

It is easy to imagine that as Eric Hoskins dispatched support to Pikangikum, he had Jordan Anderson in mind.