Our visit to Yellowknife afforded an opportunity to ‘walk on water’ – or more accurately ‘run’ back against a howling wind after visiting the Ice Castle on Great Slave Lake at night, following our day of consultations. The experience certainly brought home to us what advocates for housing  in the north mean when they say that people  facing temperatures of – 50 degrees have an acute need for housing  and food security before they can even begin to contemplate recovery from mental health problems and illnesses.

This was just one of many realities about living in the north that we heard about over the course of the day.  Others included:

·         The acute lack of services.  For example, there are no psychiatrists in the whole of the Northwest Territories. In fact, services are so limited that people are not able to access care until their needs are acute. This means that families are often the primary caregivers of very ill family members and that nurses, social workers and others provide most mental health care. Some are completed overwhelmed by the complexity of problems individuals are facing and truly ‘do not know where to begin’ to offer hope.

·         The large distances to travel for specialized services. This results in high transportation costs for the person who needs care, and for an escort when required.

·         The special needs of aboriginal communities, as well as of children, youth, and elders in those communities. There is often a traditional suspicion of any services offered by the ‘government’ and therefore a particularly important role for non-government community-based organizations. The need to send people south for services was described as a newer form of ‘residential schooling.’ Some people may get sent from place to place in Edmonton and Yellowknife from age 16 to 34.

·         A lack of integration between community-based services  and fly-in specialist services. Community services often work with a patient for many years and know them well,  while a fly-in locum or psychiatric consultant often has only a brief encounter with patients. There is a need for visiting specialists to give credibility to community organizations who can help them to understand the lives of northerners and to understand the person’s history and context.

There was also concern raised that the focus in the north has been on the negative; on broken people, and broken services. It is equally important not to miss all the things that are working and the natural helpers who have been doing work in the communities for decades and centuries. It will be important that a northern strategy build on the strengths that always have been there.

Similarly, there is a need for community organizations which do exist to learn more about each other and how to work together when serving the same clients, in order to improve the services being offered. Such networking could also strengthen the voice of community organizations across the territories in policy-making.

As in other regions, there was strong support for the goals in the early voting. It was clear during the plenary discussion that there was a huge appetite to understand HOW the goals will be implemented. The need for a feasible, sustainable, cost-effective approach was underscored because of the scarcity of resources and associated capacity for reform in the Northwest Territories.  Several important questions were raised in the discussion:

·         Is there a need for a health human resources strategy for the north? In the Northwest Territories, most communities do not have psychiatrists, psychologists, addictions counsellors or mental health workers. Providers who relocate to the area usually do not stay because of differences in culture and lifestyle, including isolation, and the overwhelming needs of the people they are trying to help. Different professional categories, with different education levels may be required and there may be a need to expand informal support networks, and use more peer counsellors.

·         Are we medicalizing what are ‘normal’ responses to stress and other challenges in the north?

·         How can the Mental Health Commission help to overcome the’ long-standing tradition in this country of focusing on major cities and ignoring the north?’ How can the Mental Health Commission recognize the unique needs of the north while not treating the north as an ‘add-on’ to the overall strategy?

Recovery

There was considerable concern about the concept of recovery as described in the document.  The description of recovery as ‘a journey’ was seen as negative,  because a journey often takes a ‘very long time’ and can be quite onerous. This was contrasted with a ‘path’ that would involve fewer steps. The real concern was that we not present recovery in a way that seemed too overwhelming, or it would destroy hope. This is a particular concern in the north, where there is a long history of having no hope.

Other suggested concepts were wellness, wholeness or a ‘vision of where people want to be’ and then asking people for their ‘vision of how they will get there.’ A vision was seen as something that could continue to expand over time with each success.

Prevention/Promotion

This goal was strongly supported. As we have heard elsewhere, some felt it should be expanded to include educators to encourage them to move away from punitive approaches so that children get the right support and the encouragement they deserve. We also heard a need to develop programming for young people, and social outlets, to help them feel they can be successful. One participant also stressed that with a 10-year mandate the MHCC has an opportunity to examine medical, community, and cultural models on a longitudinal basis to measure outcomes.

Cultural Safety

There was particular support for the cultural safety goal in a community like Yellowknife, where there are more than 110 different cultural groups. One participant stressed that this can’t be just a ‘touch-up’; it needs to be a real shift in attitudes and approaches.  At the same time, many questions were raised:

·         Will funding bodies recognize traditional practice as a legitimate approach?  How will traditional healers be recognized as legitimate?

·         How can issues of gender be given more prominence? Treatment has left women very vulnerable and many have been assaulted in treatment.

·         If we are truly to develop culturally safe services, will communities need to be given the resources to develop and deliver their own services?

Family

There were a number of concerns raised about this goal being too idealistic. First, the goal needs to recognize that some family environments contribute to the mental health issues of family members. Other questions were:

·         How do children get to select who’s on their team? At what age do children get to choose?

·         What does this goal mean for the elderly?

·         How can families cope with the fact that a family member must be sent somewhere else for care when there is a crisis?

Access and Integration

This was seen as a great goal, but people questioned whether it was realistic in the north.  One participant said it’s ”not practical that we will have seamlessly integrated system that will provide services that support their needs. It’s not possible. Who’s going to make it possible?”

Research and Outcomes

Participants felt that in order for research to be effective, it needs to involve the community and ensure that the community knows how the results will be used.

Stigma and Discrimination

There was strong support for this goal, but a sense that it should have a more positive spin by describing what we want to move toward, rather than what we want to eliminate.

Social Movement

The concept of a social movement was not well understood by participants at first. After discussion there was recognition that we all have a role to play by simply talking about mental illness in order to open up a dialogue, educate others and allow other people to speak of their experience.