N.W.T. Health Minister Julie Green responds to report criticizing addictions and recovery services

The N.W.T.'s health minister says a federal report criticizing addictions and recovery services in the territory was necessary to shine a light on gaps in the system that her department couldn't see.

The Office of the Auditor General of Canada released its report Tuesday. It found the territorial government is not doing enough to provide equitable and culturally safe services for addictions prevention and recovery, even though it promised to do so.

Among other deficiencies, the audit found services such as counselling varied over time and by location, and residents in most communities had to travel for detox services instead of being able to access those in all communities.

Health Minister Julie Green spoke on The Trailbreaker Thursday about the results of the audit and what her department is doing to address these concerns.

The Q&A has been edited for clarity and length.

CBC News: Is the criticism in the report a surprise, or did you have a sense that these gaps were there for people seeking addictions support? 

Julie Green: I would say that there was an element of surprise with some of the recommendations. They went into areas that I thought we were pretty solid in. I'll give you an example: our first cultural safety action plan was produced nine years ago. So to read that our cultural safety and anti-racism approach is not adequate was disappointing, but on reflection, we haven't addressed that particular issue of addictions, recovery and aftercare with [a] cultural safety lens. I think in general, the report and that recommendation points into areas where we might not have seen the gaps for what they were. We needed that outside perspective.

CBC News: Equitable access to services was identified by the department as an issue 20 years ago. Why is this still a problem?

Green: It's going to be a problem as long as we have 33 communities over a million square kilometres. We have attempted to address the issue by broadening our variety of supports, especially investing in community-based support so Indigenous and community governments are providing those services directly with Health and Social Services dollars. What I took away from the report is that we haven't been very deliberate about equity — we haven't got a definition of it, we don't have a set of principles about how it applies. It's something that we think we understand and apply, but do we really? This is an area that we need to go back into, and there is actually development of a model underway that is called a health equity impact assessment, which will look at the inequities that we know exist and test what we're offering.

CBC News: The report said hundreds of thousands of dollars from the department's on-the-land healing fund were left unspent, and administrative requirements made the fund too difficult to access in some cases. Is there work being done there?

Green: Yes. The evaluation of the administration of that fund would have happened while they were auditing. We asked the recipients of the fund how we could improve distribution of the money, and I think we've largely cleared the problem up by streamlining the application process and then following it up with personal conversations with the Indigenous governments. That money is allocated to healing — I want it spent down to the last penny. 

CBC News: The report found the territorial government is not doing enough to make sure services are culturally safe. How did we get here?

Green: As I say, I think we thought that we were doing the job, but it isn't specific enough. It isn't specific to addictions and recovery. One of the things we know we need to do is increase the proportion of [the] Indigenous workforce who are delivering services in the Health and Social Services system. Tomorrow, we have our plan coming out to address the shortage of staff working across our health care system. And it focuses on that as well — new ways to incentivize Indigenous people to think about having a career in health and social services by mentoring, by open houses, by school visits, and then as time goes on, bursaries and so on.

CBC News: Is there shorter-term work to fix parts of this as quickly as possible?

Green: Yeah, I think we we need to do more cultural safety training in orientation, especially with staff who come and go. We have our own HSS cultural sensitivity training program as well as the government-wide Living Well Together. So we need to make sure that is prioritized and that there is time allocated to the staff who are coming in temporarily to learn about the operating environment in which they are working and to know what we expect from them in terms of cultural safety and anti-racism, that this is an absolute requirement. It's like having your COVID shot — it's not optional.

CBC News: The report found that none of the health authorities measured the outcomes for addiction services, with the exception of Hay River Health and Social Services, which measured one of its services back in 2016. How is that going to change?

Green: The OAG has given us some specific suggestions about how to change that, that we can use more of the data we collect to measure outcomes other than, did people go to treatment, did they complete it, which is something that we measure now. It's important to say that the system is still working. More than 800 people finished their treatment program [during the audit period, August 2016 to July 2021]. But clearly there could have been more people. They could have had a better experience, it could have been more culturally appropriate. And one of the things that I'm particularly committed to is the whole situation around aftercare. I had a personal experience of touring those centres in the last assembly and people said they weren't coming home because the support wasn't here, nowhere to live, no aid group, no other supports. And we've agreed that we need standardized aftercare program, aftercare plans that are included in everybody's files so that they know and we know what we've committed to to help them continue on their recovery. 

CBC News: What will change to get feedback from people?

Green: It may be helpful for us to think of other ways to collect information, like focus groups, for example, where we have individual interviews to protect confidentiality. What they have to say is probably our most valuable, important evaluation tool — "is this working for you? If not, why not? How can we make it better?" And we could take up the auditor general's recommendation that we pay more attention to subpopulations of BIPOC people.

CBC News: You have said repeatedly that an addictions treatment centre in the N.W.T. is not on the table. Does this report change your mind?

Green: No. What I take away from all of this, especially the discussion about equity, is that our approach of providing a wide variety of services in a wide variety of formats is really the better choice than investing in one building in one community. I think using that money instead to fund the on-the-land-peer support program, the Addiction and Aftercare Recovery Program which is hiring new Indigenous wellness workers, that those are better options because the healing can take place right in the community. I don't think this report strengthens the case for a northern treatment centre. If anything, I think it says that equity needs to be as close to home as possible.