Debates of Oct. 29th, 2024

This is page numbers 1335 - 1400 of the Hansard for the 20th Assembly, 1st Session. The original version can be accessed on the Legislative Assembly's website or by contacting the Legislative Assembly Library.

The word of the day was know .

Topics

Oral Questions

Members Present

Prayer

Healthcare System Sustainability Unit

Investing in Healthy Food for Learning

Our Land for the Future: Advancing the Northwest Territories Project Finance for Permanence

Medical Records Transfer Technology

Sustainable Community Government

RCMP Services and Mental Health Outcomes for Underhoused Women

Regional Medical Travel Coordinator and Medical Escorts

Housing Waitlist

Non-medical Escorts for Elders during Medical Travel

Mackenzie Valley Fibre Line

Efficacy of Health Care Sustainability Unit

Employee Satisfaction related to Bureaucratic Processes

Bourque Report and Decentralization

Sustainable Communities and Affordable Housing

One-Year Anniversary of Passing of Adam Yeadon

Recognition Of Visitors In The Gallery

Committee Report 16-20(1): Standing Committee on Social Development Report on the Statutory Review of the Mental Health Act

Committee Report 17-20(1): Standing Committee on Procedures and Privileges Report on the Review of the Rules of the Northwest Territories Legislative Assembly

Committee Report 18-20(1): Standing Committee on Procedure and Privileges Interim Report on the Report of the Chief Electoral Officer on the Administration of the 2023 Territorial General Election

Committee Report 19-20(1): Standing Committee on Government Operations Report on the Statutory Review of the Cannabis Legalization and Regulation Implementation Act

Committee Report 20-20(1): Standing Committee on Government Operations Report on Committee's Initiation of the 10-year Review of the Northwest Territories Heritage Fund Act

Targeted Amendments to Waters Regulations

Mackenzie Valley Fibre Line Backup

Updates to Diagnostic Imaging Medical Communications System

Online Physician Booking Service

Engagement regarding Formula Funding Challenges

Housing Waitlist

RCMP Oversight and Services

Medical Travel Coordinator Position and Non-Medical Escort Support

Healthcare Sustainability Unit and Potential Service Cuts

Approval of Non-medical Escorts and Review of Medical Travel Policy

Self-determination of Indigenous Governments

Targeted Amendments to Waters Regulations

Fort Smith Correctional Centre Layoff Notices

Tabled Document 205-20(1): Operating Plans for Northwest Territories Education Bodies for the 2024-2025 School Year Ending June 30, 2025

Tabled Document 206-20(1): Northwest Territories Liquor and Cannabis Commission 70th Annual Report 2023-2024

Tabled Document 207-20(1): Northwest Territories Liquor Licensing Board 70th Annual Report 2023-2024

Tabled Document 208-20(1): Northwest Territories 9-1-1 Service 2023-2024 Annual Report

Tabled Document 209-20(1): Report of the Auditor General of Canada to the Northwest Territories Legislative Assembly - Stanton Territorial Hospital Renewal Project

Reappointment of Executive Director of the Human Rights Commission

Performance Audit of the Management and Governance of the Northwest Territories Health and Social Services Authority

Reappointment of Executive Director of the Human Rights Commission

Bill 15: Northwest Territories Indigenous-led Conservation Fund Establishment Act

Bill 12: Business Day Statute Law Amendment Act

Bill 11:

An Act to Amend the Motor Vehicles Act

Consideration In Committee Of The Whole Of Bills And Other Matters

Tabled Document 193-20(1): 2025-2026 Capital Estimates - Health and Social Services- Deferral of Department

Tabled Document 193-20(1): 2025-2026 Capital Estimates - Housing Northwest Territories - Deferral of Department

Report Of Committee Of The Whole

Orders Of The Day

Members Present

Hon. Caitlin Cleveland , Mr. Edjericon , Mr. Hawkins , Hon. Lucy Kuptana , Hon. Jay Macdonald , Hon. Vince McKay , Mr. McNeely , Ms. Morgan , Mr. Morse , Mr. Nerysoo , Ms. Reid , Mr. Rodgers , Hon. Lesa Semmler , Hon R.J. Simpson , Mr. Testart , Hon. Shane Thompson , Hon. Caroline Wawzonek , Mrs. Weyallon Armstrong , Mrs. Yakeleya

The House met at 1:33 p.m.

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---Prayer

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Prayer

Prayer

Page 1335

The Speaker

Shane Thompson

Thank you, colleagues. I'd like to thank elder Jonas Lafferty for the opening prayer and reflections here today.

Ministers' statements. Premier .

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Minister's Statement 75-20(1): Healthcare System Sustainability Unit

Ministers' Statements

Page 1335

R.J. Simpson

Hay River North

Mr. Speaker, the cost of delivering health and social services is increasing faster than our resources can handle, at a time when our government is also facing additional costs related to climate change and inflationary pressures. This is why the delivery of sustainable health and social services is an important part of this government's mandate and the priorities of the 20th Legislative Assembly.

Through the mandate letter I provided to the Minister of Health and Social Services , we are addressing several initiatives that aim to deliver a more sustainable health and social services system. The initiatives are complex and multifaceted, and not something the Department of Health and Social Services or the health and social services authorities should undertake alone. Consequently, on July 15th the health care system sustainability unit was created within the Department of Executive and Indigenous Affairs.

The focus of this unit is to provide a deeper understanding of which health and social services programs and services should be core to the NWT, analyze how these programs and services can be delivered more efficiently, and determine how these programs and services should be funded within our limited fiscal framework. The goal is to achieve all this while still working to provide our residents the highest quality of care. This work will require careful coordination with the Department of Health and Social Services, as well as our three health authorities.

It will also require analysis of a lot of information, including information gained from reviews that have already taken place, and engaging with those who are contributing most to our system - frontline workers and operational staff.

Previous reviews of the health and social services system were foundational in guiding operational changes based on our current service delivery, but they did not examine whether these services are fundamental to what our health system should provide.

If we expect a transformative change to happen, Mr. Speaker, we need to define and prioritize what programs and services are core to the Northwest Territories by using evaluative data, including our current population and demographics, legal and policy frameworks, and technological advancements. We are no longer able to keep expanding our health and social services to meet our growing needs; instead, we need to transform the way we provide health care and social services in a fiscally sustainable manner.

Moving forward with this initiative will better position us to actively respond to these challenges in real time and consider recommendations that can be implemented more quickly than others. We will engage the people who will be affected by change in the work of understanding challenges and identifying solutions and ensure our work is informed by northern expertise and lived experience, as well as wise and emerging practices within the sector. This will assure our unique fiscal, political, and legal factors are considered in any changes.

The work will be challenging. I am committed to working closely with the Minister of Health and Social Services and look forward to providing progress reports to Members of this House on a regular basis as we engage on this initiative for the benefit of all residents of the Northwest Territories. Thank you, Mr. Speaker.

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Minister's Statement 75-20(1): Healthcare System Sustainability Unit

Ministers' Statements

Page 1335

The Speaker

Shane Thompson

Thank you, Mr. Premier . Ministers' statements. Minister of Education, Culture and Employment .

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Minister's Statement 76-20(1): Investing in Healthy Food for Learning

Ministers' Statements

Page 1335

Caitlin Cleveland

Kam Lake

Once signed, this new agreement will provide a significant and important boost to the program, creating real results for students and families across the territory. Since 2015, the territorial government has continually invested $650,000 annually into this program. This agreement is part of Canada's broader national school food program plans, which will invest $1 billion over five years across the country, with the goal of providing meals to up to 400,000 children every year.

With the high cost of groceries, the new funding agreement will help provide relief to families experiencing pressures of food insecurity and socio-economic challenges. All 49 NWT schools, and all junior kindergarten to grade 12 students will have access to the Healthy Food for Learning Program as needed so families can feel confident that their children will receive substantial and nutritious meals and snacks at school.

Mr. Speaker, I would like to conclude my statement today in French.

[Translation] ... The schools have shared wise practices for what successfully a food program for them. This has included partnering with the local grocery stores, government departments and businesses, enabling students to play an active role; for example, in growing the food in school gardens. Elders and community members have also been involved in traditional food preparation.

Ensuring that all students have consistent access to healthy meals is vital as we work towards improving the students' outcomes and providing all Northerners with the best possible start in life. We want to make sure that all residents will have the best outcome. I am happy to conclude this agreement, and I will explain all of the details with the Canadian government in the next few weeks. Thank you, Mr. Speaker. [Translation Ends]

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Minister's Statement 76-20(1): Investing in Healthy Food for Learning

Ministers' Statements

Page 1335

The Speaker

Shane Thompson

Thank you, Minister of Education, Culture and Employment . Colleagues, before we go any further, I'd like to recognize some special people here today. Range Lake North School, grade 8 class, welcome to our Legislative Assembly. We really appreciate you being here. As well as their teacher and chaperones. There's just one teacher or -- four teachers. I thought it was four so, yes, the four teachers. So thank you very much for bringing your students here today. As well as our students from Aurora College, thank you very much for being here today. Thank you very much.

Ministers' statements. Minister of Environment and Climate Change .

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Minister's Statement 77-20(1): Our Land for the Future: Advancing the Northwest Territories Project Finance for Permanence

Ministers' Statements

Page 1335

Jay MacDonald

Thebacha

Mr. Speaker, the Government of the Northwest Territories is committed to maintaining ecosystem health while supporting sustainable economic growth for our communities. A key part of this is the NWT Project Finance for Permanence Agreement, now known as the Our Land for the Future Agreement, which will help to fund Indigenous-led conservation initiatives.

The NWT Project Finance for Permanence Agreement provides participating Indigenous governments and Indigenous organizations with the funding to do the things we agree to do together in our shared conservation work plan Healthy Land, Healthy People. The GNWT has negotiated a separate agreement with Canada to fund its own needs.

Mr. Speaker, since 2018, the GNWT has been seeking long-term funding solutions to support the management of protected areas like Thaidene Nene while creating jobs in nearby communities. The NWT Project Finance for Permanence Agreement is an innovative model that brings both funding and partnerships to ensure Indigenous governments and Indigenous organizations lead in the protection of important lands while creating local jobs and economic benefits through initiatives such as Guardians programs, eco-tourism, and sustainable development activities.

The funding supports progress on shared conservation priorities and will also contribute to Canada's goal of protecting 30 percent of its land and waters by 2030.

The NWT Project Finance for Permanence Agreement is an Indigenous-led initiative that includes 23 Indigenous governments, the GNWT, the federal government, and three private donors. It works within our existing land management process and laws, including the Mackenzie Valley Resource Management Act, and established land-use planning processes, ensuring that decisions about the land remain in the hands of the people connected to it. It does not override these frameworks but provides funding to support Indigenous-led initiatives we agree upon through these decision-making processes.

The Healthy Land, Healthy People plan continues to guide our conservation efforts, and the agreement helps provide the resources needed to accomplish these shared goals.

Mr. Speaker, in April of this year, the federal government announced $300 million to support the NWT Project Finance for Permanence Agreement, enhanced by an additional $75 million coming from private donors. The agreement includes a strategic plan and financial plan, which outline how the funds will be used to ensure proper oversight and accountability. These plans are designed to ensure that the funding will be directed toward Indigenous-led conservation and stewardship efforts and related economic development activities. The agreement also creates an endowment that will ensure the long-term sustainability of these transformative benefits into the future.

Mr. Speaker, the GNWT recognizes the importance of maintaining a balance between conservation and economic development. The NWT Project Finance for Permanence Agreement will contribute to a strong, diversified economy that includes new, culturally supportive opportunities in the conservation economy, alongside continued investment and development in the resource sector. By ratifying the agreement, the GNWT is taking a significant step to deliver its mandate commitment to promote reconciliation and responsible land management while supporting economic diversification in small communities.

This agreement will help to support our shared conservation goals while ensuring that the land and water of the NWT continue to provide diverse opportunities for future generations. Thank you, Mr. Speaker.

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Minister's Statement 77-20(1): Our Land for the Future: Advancing the Northwest Territories Project Finance for Permanence

Ministers' Statements

Page 1336

The Speaker

Shane Thompson

Thank you, Minister of Environment and Climate Change . Ministers' statements. Members' statements. Member from Range Lake .

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Member's Statement 386-20(1): Medical Records Transfer Technology

Members' Statements

Page 1336

Kieron Testart

Range Lake

Mr. Speaker, the digital age dawned so long ago that now our kids are almost born with a smartphone in hand and could not ever contemplate a world without high-speed internet. Indeed, our kids are now teaching us how to use our own laptops and phones. Yet, here in the NWT where the latest generation of health care professionals enter the workforce, they are forced into the way-back machine to relearn obsolete technology. Why? It's because NTHSSA still sends most diagnostic imaging onto CD-ROMs while other jurisdictions continue to upgrade dedicated medical communication networks.

Using CDs to transmit and store vital data circumvents secure medical communications and therefore poses risks to both patients and medical providers, like leaking confidential information or opening the door to ransom ware attacks at a time when health care institutions are increasingly targeted. It should come as no surprise, then, that health technicians in other provinces are fed up with the NWT's backwards system.

Those aren't the only risks outdated systems have to our patients, however. Our cumbersome medical communication often prevents physicians down south from even accessing data at all. A patient sent for a CT scan in Edmonton would need their imaging sent to Calgary to be finalized and then sent back to Yellowknife to be burnt onto a CD for NTHSSA only to be sent back down to the appointment in Edmonton, on a CD I might add. That data may not arrive on time or be damaged resulting in physicians missing vital information and having to order whole new sets of CT scans which can bombard patients with 500 times more radiation than a simple chest x-ray.

That level of unworkable obsolescence is only matched by medical professionals here having to deal with three different charting systems, some still only available on paper. Sure, endlessly printing charts and burning CDs might save us from Y2K if it was 1999, but it's 2024 and we need to get with the times if we want more efficient public service. Our doctors and nurses can't keep working in the past; we need to bring them into the future. Thankfully, we don't need Doc Brown's DeLorean; we just need a Minister willing to work to bring our health care system into the 21st century. Thank you, Mr. Speaker.

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Member's Statement 386-20(1): Medical Records Transfer Technology

Members' Statements

Page 1336

The Speaker

Shane Thompson

Thank you. Members' statements. Member from Monfwi .

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Member's Statement 387-20(1): Sustainable Community Government

Members' Statements

Page 1336

Jane Weyallon Armstrong

Monfwi

Thank you, Mr. Speaker. Municipal funding gap. Mr. Speaker, on May 29th of this year, the Standing Committee on Accountability and Oversight tabled a report in this House that noted the municipal funding gap under the current formula would not work without substantial investment. Members discussed a funding formula that equalizes the gap for communities across the Northwest Territories. The government responded on June 13th, noting that MACA recently updated its community government funding policies to, one, provide a more equitable distribution of funding by basing allocations on a needs-based formula.

The new funding policies came into effect in 2024-2025. Allocation will not be implemented until 2025-2026 to allow time to engage with community governments.

Mr. Speaker, I would like to know how the government plans to engage community governments. These changes will not only affect Tlicho region but other small communities as well. The change will have the greatest impact on small communities with population under 500 people. Mr. Speaker, I fear this formula change will negatively affect our Indigenous communities. We have been told that allocations will be implemented over a three-year transition period.

The Minister has noted that funding sustainable community government services is a shared responsibility across all levels of government. But, Mr. Speaker, what have the community government told MACA about the implementation of these new formula funding policies? How have the community government been engaged in decision-making? Mr. Speaker, I will have questions for MACA at appropriate time. Thank you.

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Member's Statement 387-20(1): Sustainable Community Government

Members' Statements

Page 1336

The Speaker

Shane Thompson

Thank you, Member from Monfwi . Members' statements. Member from Great Slave .

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Member's Statement 388-20(1): RCMP Services and Mental Health Outcomes for Underhoused Women

Members' Statements

Page 1336

Kate Reid

Great Slave

Mr. Speaker, today I would like to speak to reviewing policing outcomes. As discussed in this House many times, including our last sitting, with a motion on supporting mental health response, the NWT relies a great deal on the services of the RCMP. The NWT asks more of them than what is truly their role, Mr. Speaker, and I don't believe it's fair to treat them as social workers.

RCMP services are one of the last places we should be asking people to do more with less. I'm glad that there is some change on that front, for instance through partnerships between NGOs and multiple levels of government. Crucial services have begun to be supported, such as Street Outreach here in Yellowknife.

I believe everyone in this House is familiar with the Yellowknife Women's Society's report Overpoliced and Underprotected. It examines the relationship between unhoused Indigenous women in the NWT and their interactions with the RCMP. A key recommendation from this report asked the Minister of Justice to support a comprehensive review of policing practices in the NWT by the federal Civilian Review and Complaints Commission. Notably, such a review must be requested by the Minister of Justice, and it would be at no cost to the GNWT.

When some Members have put this recommendation forward to the Minister in correspondence, he has responded that such a review would be too narrow in scope and take too long to see results.

There has also been interest in investigations on RCMP actions and whether they can be impartial without an independent external agency review. Currently, in the NWT the RCMP investigates the RCMP, albeit it from detachments from other jurisdictions, as we have seen in a recent inquest on a death in custody. Cabin Radio recently wrote an

article discussing whether it is time to consider an oversight arrangement like that of the Yukon and the Alberta Serious Incident Response Team, a civilian police oversight agency allowed by the federal RCMP Act.

Mr. Speaker, I realize I'm speaking about reviews about systemic problems and serious incidents and that these will likely require different approaches and processes, and that is fine. Residents need assurance that if there are negative outcomes in our current policing structures that an impartial review is possible for both serious incidents and systemic issues. I will have questions for the Minister of Justice at the appropriate time. Thank you.

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Member's Statement 388-20(1): RCMP Services and Mental Health Outcomes for Underhoused Women

Members' Statements

Page 1336

The Speaker

Shane Thompson

Thank you, Member from Great Slave . Members' statements. Member from the Sahtu .

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Member's Statement 389-20(1): Regional Medical Travel Coordinator and Medical Escorts

Members' Statements

Page 1337

Daniel McNeely

Sahtu

Thank you, Mr. Speaker. Mr. Speaker, I raised the a Sahtu issue of recruiting a regional medical travel coordinator during our past spring sitting. Mr. Speaker, the NWT health care system is in high demand. It seems, Mr. Speaker, today's society is impacted by many challenges beyond our control.

Mr. Speaker, the NWT is resilient in many ways to the challenge that it faced and is facing. One can only view the reactive approach to climate change impacts.

Mr. Speaker, I had the opportunity during the week of September the 23rd for an invited ministerial tour of the Sahtu region. During this tour, many Sahtu residents raised the need for a medical travel coordinator and improvements to our medical escorts.

Mr. Speaker, after some research, the Sahtu region, in particular Norman Wells, there exists 24 funded vacancies. Can we restructure to create one or two medical travel PYs?

'Mr. Speaker, I have engaged discussions with many private sector enterprisers, workforce recruitment is a national concern particularly in the trades sector. Similar challenges are faced by the Government of the Northwest Territories. Later, Mr. Speaker, I'll have questions for the Minister of Health and Social Services . Mahsi.

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Member's Statement 389-20(1): Regional Medical Travel Coordinator and Medical Escorts

Members' Statements

Page 1337

The Speaker

Shane Thompson

Thank you, Member from the Sahtu . Members' statements. Member from Mackenzie Delta .

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Member's Statement 390-20(1): Housing Waitlist

Members' Statements

Page 1337

George Nerysoo

Mackenzie Delta

Mr. Speaker, the Government of the Northwest Territories isn't doing enough to ensure a path forward for people in need of housing. Indigenous governments are doing what they can, Mr. Speaker, to leverage federal funding and develop housing solutions for their participants and beneficiaries. Just last week, Mr. Speaker, the Standing Committee on Social Development received a public briefing from representatives of the Gwich'in Tribal Council on their new and innovative programming that is putting homes on the grounds in communities and housing families. But they can't do it all, Mr. Speaker.

The Government of the Northwest Territories must meet its obligations for delivering on public housing programs.

Mr. Speaker, I won't speak on the capital estimates investments in the housing as it is before Committee of the Whole. But what I will say is that housing is a human right. This Assembly passed a motion to acknowledge and affirm housing as a fundamental human right, and I will state again that housing is a priority in this Assembly. And I will have questions for the Minister responsible for Housing NWT . Thank you, Mr. Speaker.

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Member's Statement 390-20(1): Housing Waitlist

Members' Statements

Page 1337

The Speaker

Shane Thompson

Thank you, Member from Mackenzie Delta . Members' statements. Member from the Deh Cho .

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Member's Statement 391-20(1): Non-medical Escorts for Elders during Medical Travel

Members' Statements

Page 1337

Sheryl Yakeleya

Deh Cho

Thank you, Mr. Speaker. Mr. Speaker, today I would like to talk about medical travel in the Northwest Territories. As residents, we may all come to rely on the health and social services medical travel program at some point in our lives for health care that isn't available in our home communities. Travel is necessary, Mr. Speaker. This is a reality in our territory with 33 communities spread across the vast land. With little access in and out, limited services are available.

A principle of the medical travel policy is that the cost of medical travel should not be an economic barrier to access insured health services. Many patients who require medical travel also require non-medical escorts to accompany them for many reasons. For example, elders who travel south or to a larger centre may face language barriers and unfamiliar terrain. This makes it difficult to communicate and navigate in these settings. They need an escort to ensure their appointments go well because of the language barrier. Without this support, the service itself is at risk.

The criteria for non-medical escort says escorts can travel with a patient to provide

interpretation if needed. When it comes to the government policy, Mr. Speaker, I hear from residents that they're often not allowed an escort even though one is needed. I often hear that doctors and practitioners approve an escort for medical travel but then the health care centre staff arranging turns around and says no, and their request is denied. I would like to know who is making these decisions on behalf of our elders and why they are being denied non-medical escorts. One of the principle of the medical travel program is that it should be transparent and accountable. I will have questions for the Minister of Health and Social Services later. Thank you.

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Member's Statement 391-20(1): Non-medical Escorts for Elders during Medical Travel

Members' Statements

Page 1337

The Speaker

Shane Thompson

Thank you, Member for the Deh Cho . Members' statements. Member from Inuvik Boot Lake .

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Member's Statement 392-20(1): Mackenzie Valley Fibre Line

Members' Statements

Page 1337

Denny Rodgers

Inuvik Boot Lake

Thank you, Mr. Speaker. Mr. Speaker, the Mackenzie Valley fibre line was completed in 2017 -- oh, sorry -- Government of the Northwest Territories. Mr. Speaker, this was welcomed news for the residents on the anchor tenants, the Inuvik satellite station facility, and the new north networks and their satellite station facility as well.

The Government of the Northwest Territories has made a long-term investment to improve telecommunications service and to support economic development along the Mackenzie Valley. Mr. Speaker, with the ability to handle greater volumes of high-speed data traffic with increased reliability, the link provides better access to health, education, and many government services in the Mackenzie Valley communities.

For the town of Inuvik, Mr. Speaker, the benefits of being connected to the Mackenzie Valley fibre link are immense. The connection allows Inuvik to strengthen its position as a base for satellite ground stations in Arctic research organizations and additionally qualified local contractors have been able to participate in contracts related to the long-term physical maintenance of the fibre optic link.

Mr. Speaker, I also understand that the second line, the redundancy line, is now complete. Once the 778-kilometer Dempster fibre line to Dawson becomes operational, it will offer backup. That means if one line goes down, the other can pick up the load. But, Mr. Speaker, businesses and commercial entities in Inuvik are questioning whether or not it's truly redundant given that our line, Mr. Speaker, runs from Inuvik down to McGill Lake and on through to High Level and into Alberta. The line that's being proposed on the Dempster Highway runs down as far as Fort Nelson.

Now, I do understand that there is a potential to have another link go from Fort Nelson over to McGill Lake but, again, that's creating a loop and to get true redundancy, Mr. Speaker, I think we're going to need that link from Fort Nelson into Alberta as well. So, Mr. Speaker, those are the concerns that have been brought to my attention, and I will have questions for the Minister of finance later. Thank you.

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Member's Statement 392-20(1): Mackenzie Valley Fibre Line

Members' Statements

Page 1337

The Speaker

Shane Thompson

Thank you, Member from Inuvik Boot Lake . Members' statements. Member from Yellowknife North .

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Member's Statement 393-20(1): Efficacy of Health Care Sustainability Unit

Members' Statements

Page 1337

Shauna Morgan

Yellowknife North

Thank you, Mr. Speaker. Mr. Speaker, health care sustainability should not be about cuts to services. It is unfortunate that that's the message that the media took away from last Wednesday's public briefing on the new health care sustainability unit. From the perspective of those working on the frontlines of our health care system, we have neither the Cadillac nor the Ford Focus that the Premier was referring to but, rather, a vehicle with the wheels coming off that is running on fumes.

Yes, the health care system has expanded over the years but let's put this in perspective. This is not just about the addition of noncore services. Some of the positions that have been added that remain unfunded include pediatricians, a fifth emergency room nurse. These are not frills or nice-to-haves. The tool that we need here is not an axe but it's a screwdriver to tighten things up. And if we're using the vehicle metaphor, we need to first know what our destination is and then take the right amount of fuel for this journey, so we don't keep ending up stranded on the side of the road out of gas.

Our quest for health care sustainability must fundamentally be about delivering the basics right. There is resounding consensus that we need to focus on delivering primary care right. It's about using our resources wisely to offer the best possible care as efficiently as possible.

Now, last March, the NWT Medical Association offered valuable recommendations about how we can reduce medical travel and medevacs when someone could receive better care at home. In small communities, community health nurses can be assigned a physician to work with on a regular basis who would act as kind of a consultant. We can embrace the full potential of Telehealth. Now, frustratingly, the recent primary care reform ignored what doctors have been calling for many years and missed the opportunity when rearranging the team assignments to assign doctors to small communities.

Mr. Speaker, the fuel we need for this journey is our health care staff. We need this new unit to center its work around the insights of frontline staff. The Premier referred to how complex this initiative is but actually we need to focus on a simple goal. We need to figure out how to ensure we have the right amount of staff, the right kinds of staff, doing the right things. Thank you, Mr. Speaker.

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Member's Statement 393-20(1): Efficacy of Health Care Sustainability Unit

Members' Statements

Page 1338

The Speaker

Shane Thompson

Thank you, Member from Yellowknife North . Members' statements. Member from Frame Lake .

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Member's Statement 394-20(1): Employee Satisfaction related to Bureaucratic Processes

Members' Statements

Page 1338

Julian Morse

Frame Lake

Thank you, Mr. Speaker. Mr. Speaker, in July 2024 the GNWT released the 2023 Employee Engagement and Satisfaction Report and attached an employee satisfaction action plan to that report. I do note, with some disappointment, that favourability scores were noted to decline across all indices relative to the 2021 survey. A couple of items I'd like to highlight, Mr. Speaker:

Only 58 percent of staff felt that innovation was valued in their work.

Only 52 percent said they felt valued as employees or that commitment to quality was a high priority.

Overall, morale lowered by 4.9 percent since the last report was done.

I do note that an action plan was published with the report, and I support all those action items; however, I do wonder if a few items were missing. One of them that I'd like to highlight today is the prevalence of overly burdensome bureaucratic processes and how those can, over time, grind people down and reduce morale. I've spoken to staff who have had to go through processes of multiple weeks to get approval to do something like respond to a comment on Facebook.

The other thing that I wonder needs more emphasis is the need for empowerment. I would note, Mr. Speaker, that when employees apply to the GNWT, they go through an incredibly burdensome hiring process where they have to do exams, they have to go through sometimes multiple interviews, and provide pretty serious qualifications only to get into a position sometimes where they have very little decision-making power and very little power to act without oversight by management. So I think reduction of micromanagement needs to be looked at as well.

Another quote that has stood with me, and I wanted to share today, is something that someone said to me the other day when I was chatting with them about how things are going at work - If you truly care about your work, your time at GNWT will be limited. That's an unfortunate sentiment for someone to hold in their job.

Mr. Speaker, I believe that we have an excellent, excellent public service. We have excellent staff at the public service. I request unanimous consent to finish my statement.

---Unanimous consent granted

Thank you, Mr. Speaker. So, Mr. Speaker, I believe that we are going through processes that ensure that we have excellent people in their roles, and then often we're in that role putting them through processes which effectively tell them that their expertise isn't as valued as it could be. So I want us to be looking at that when we're thinking about employee satisfaction, and I want us to be looking at our processes and empowerment of staff, I think it could help us save money over time as we build up our internal capacity for decision-making, maybe we don't need so much management. Thank you, Mr. Speaker.

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Member's Statement 394-20(1): Employee Satisfaction related to Bureaucratic Processes

Members' Statements

Page 1338

The Speaker

Shane Thompson

Thank you, Member from Frame Lake . Members' statements. Member from Tu Nedhe-Wiilideh .

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Member's Statement 395-20(1): Bourque Report and Decentralization

Members' Statements

Page 1338

Richard Edjericon

Tu Nedhe-Wiilideh

Mr. Speaker, the clock is ticking to get started on the Premier 's 50-year vision for the future of the Northwest Territories, a vision of decentralization of services and power to Indigenous self-governments. The vision is supported by the action of the previous Assembly which is committed to implementing the United Nations Declaration on the Rights of Indigenous People, a declaration that internationally mandates the right to self-determination.

Furthermore, decentralization of services for Indigenous governments was mandated in the devolution process passed a decade ago. As well, in fact, these rights have been pursued for generations. Yet, today, we stand here in this Assembly, year after year, with no real progress towards goals once more.

The cost of inaction is seriously holding our communities back. Indigenous governments alone passes the knowledge, traditions, and perspectives that are needed to solve our health and housing crisis, and they need access to the resources to make it happen. Indigenous governments are allocated $1.6 billion out of the $2.2 billion budget this government gets on an annual basis.

Mr. Speaker, but, yet because of the stages of the colonial remain in place, much of those funds don't make it to our small communities or are allocated through restrictive policies that don't work for our people. A new deal for the North that respects Indigenous governments would therefore give them the resources and empower them are largely entitled so their communities can thrive. This new deal for the North will take a lot of effort and a lot of time, but thankfully a lot of that work has been done already.

In 1992, as the Northwest Territories was on the cusp of division, a report was commissioned in the Future of the Government of the Northwest Territories written by the late Jim Bourque that outlined the solutions of the North, needs for the fair future, and this Assembly is committed to working towards. The biggest solution offered in Jim Bourque's report was the NWT Constitution which would clearly outline the role and functions of Indigenous governments and have governance in our territory. Unfortunately, despite all the time and money spent on the research, a Constitution to produce the report, it was never enacted and instead it was shelved for generation.

Well, Mr. Speaker, I can call on this government to take another look at the Jim Bourque report. We need to work as soon as possible as the claim is being settled. Mr. Speaker, I seek unanimous consent to conclude my Member's statement. Thank you.

---Unanimous consent granted

Thank you, Mr. Speaker. Thank you, colleagues. To do so, we must work together to figure out a process to achieve these goals through the Council of Leaders and working group and committee to make this progress that has been promised for decades. As Canada makes its way for a long journey towards justice and reconciliation for Indigenous people, the North can -- sorry, the North can use this critical junction we are striving for as an opportunity to develop a model of governance. Mr. Speaker, I would have questions for the Premier at the appropriate time. Thank you.

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Member's Statement 395-20(1): Bourque Report and Decentralization

Members' Statements

Page 1338

The Speaker

Shane Thompson

Thank you, Member from Tu Nedhe-Wiilideh . Members' statements. Member from Yellowknife Centre .

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Member's Statement 396-20(1): Sustainable Communities and Affordable Housing

Members' Statements

Page 1338

Robert Hawkins

Yellowknife Centre

Thank you, Mr. Speaker. In economics, there's a phrase called Jevons paradox which occurs when technology progresses in a manner to increase efficiency but the resources actually inversely further demanded because we've lowered the cost. So in order, Mr. Speaker, historically governments have been trying to find ways to be more efficient, but in turn, people -- efficiency gains enthusiasm which increases consumption. This is called the rebound effect of Jevons paradox.

So a good example is when you make fuel efficiency vehicles, Mr. Speaker, people tend to drive more and hence consume more fuels. Mr. Speaker, in the end it results that just because you make something cheaper and solve a problem, you don't necessarily take into the greater consideration of the demand it's now created.

Now the EU has noted, Mr. Speaker -- and this is where it's important -- that this principle of efficiency on economics also applies to government policy, and it can apply to us. So how does it apply to the GNWT?

Well, take the encampment, for example, Mr. Speaker. Are we addressing the cause or are we addressing the system of some of these problems? By fixing it with a Band-Aid solution, Mr. Speaker, is the government temporarily making things worse? Are we empowering people? That is really addressing the cause. Are we finding ways to create sustainable communities and independent people? I'm not so sure.

Mr. Speaker, I agree something needs to be done, hands down. I would definitely stress that, you know, things -- solutions like Aspen Apartments, you know, fixing it up is not a terrible solution in any way. But for 38 units, 38 potential families waiting for a solution between one and two years away from now, has done nothing to solve the problem.

Mr. Speaker, you know, sometimes I say a four door Corolla could solve our problems; why are we buying Escalades? We don't need them, Mr. Speaker. There's nothing wrong with Aspen Apartments that couldn't House people today. In other words, we could be saving and changing the lives of 38 people -- 38 families. By sewing these seeds, possibly we'd be getting the right effect.

Mr. Speaker, we also have other temporary solutions when we're scrambling for them. The government has the Territorial Treatment Centre, the TTC, right across the street from the encampment. We could be partnering with the women's society, we could be partnering with the YWCA, or even the Salvation Army to temporary solve the solution. Let's not bring a hammer when we don't need one, Mr. Speaker. We could work with our communities in partnership with our social agencies. And I'll have questions for the Ministers during question period later today. Thank you, Mr. Speaker.

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Member's Statement 396-20(1): Sustainable Communities and Affordable Housing

Members' Statements

Page 1339

The Speaker

Shane Thompson

Thank you, Member from Yellowknife Centre . Members' statements.

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Member's Statement 397-20(1): One-Year Anniversary of Passing of Adam Yeadon

Members' Statements

Page 1339

Shane Thompson

Nahendeh

Colleagues, it has been over a year since Adam Yeadon passed away on the fire line while protecting his home community of Fort Liard. Family members, residents and fire crews led a small, private ceremony in Fort Liard in remembrance of Adam. Colleagues, He leaves behind a partner, a young daughter, dad, brother and sister. And many cousins and nieces and nephews.

I can tell you it weighs on us a lot of his passing, and it is my understanding that firefighters across the territory doing the same difficult work Adam did, are thinking of him and how he lost his life. When you hear the message that the fire crew staff heard each day, the safety of your team must always be the first priority, it brings it home about the critical importance of safety in the field.

The family, his friends, community, would like to thank NWT Fire for creating the scholarship in Adam's memory for people in post-secondary education in forest-related fields.

This past fall, Adam was remembered by the Canadian Fallen Firefighters Foundation at the Canadian Firefighters Memorial in Ottawa. The family would like to thank the department for all its support to get there and be part of this event as well for having the Minister attend.

In closing I would like to use the words of Adam's partner, Keanna McLeod's word: He was such an outgoing person. Everyone liked being around him, and he was loved by all his friends and family. He liked being outdoors, being on the land, discovering new places, experiencing new things and more importantly meeting new people.

In closing, I wish to use the quote I heard from NWT Fire: Though nothing will repair the hole his absence leaves in the lives of those who knew and loved him, our steadfast support remains with his family and friends as they navigate the difficult path forward.

Members' statements. Recognition of visitors in the gallery. Member from Monfwi .

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

Jane Weyallon Armstrong

Monfwi

Masi, Mr. Speaker. Mr. Speaker [Translation] ... Anita Wedzin, Diane Lafferty, Deniza -- and Linda Mantla, they're all here; they live here in Yellowknife, going to school. They want to, they are looking to further, to education. I know that their parents and their family members and also a lot of these young kids, I don't know who they are from the school, I am happy that they are here, I do believe, and also they are here with their teachers as well, the ones that are here, masi cho. [Translation Ends]

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

The Speaker

Shane Thompson

Thank you, Member from Monfwi . Recognition of visitors in the gallery. Member from Range Lake .

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

Kieron Testart

Range Lake

Thank you, Mr. Speaker. Mr. Speaker, I'd like to recognize Ms. Tarlson's grade 8 class from Range Lake North, which is a school in my riding. Great to see you here today, and it was lovely to speak with you before the session. Go Hoyas.

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

The Speaker

Shane Thompson

Thank you, Member from Range Lake . Recognition of visitors in the gallery. Member for Tu Nedhe-Wiilideh .

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

Richard Edjericon

Tu Nedhe-Wiilideh

Thank you, Mr. Speaker. Mr. Speaker, I would like to recognize a constituent of mine, Verna Abel Catholic. I just want to say welcome to the Assembly. Also to all the students from the college and the students from Range Lake as well. Thank you.

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

The Speaker

Shane Thompson

Thank you, Member from Tu Nedhe-Wiilideh . Recognition of visitors in the gallery. Member from Mackenzie Delta .

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

George Nerysoo

Mackenzie Delta

Thank you, Mr. Speaker. Today I would like to recognize my CA, Georgina Neyando, who has travelled down with me from Fort McPherson to be here to take in some -- do some work here in the Assembly on my behalf. I'd just like to welcome Georgina. Thank you, Mr. Speaker.

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

The Speaker

Shane Thompson

Recognition of visitors in the gallery. Member from Yellowknife Centre .

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

Robert Hawkins

Yellowknife Centre

Thank you, Mr. Speaker. Mr. Speaker, I'd like to recognize the students of Aurora College. That's an excellent campus downtown in the Yellowknife Centre riding. It's not exclusive in Yellowknife. Yes, we have a campus college in Fort Smith and Inuvik, but today we have the Yellowknife students. Hooray.

Also, Mr. Speaker, I'd also like to recognize a constituent, Corinna -- it looks like Puskas. I haven't met her but that said, I'd like to -- or Puskas, my apologies. Corinna Puskas and our -- seeing our proceedings before the House. Thank you very much.

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

The Speaker

Shane Thompson

Recognition of visitors in the gallery. Member from Inuvik Twin Lakes .

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

Lesa Semmler

Inuvik Twin Lakes

Thank you, Mr. Speaker. Mr. Speaker, I'd like to welcome Amy Lee, a long-time colleague of mine way back when. Thank you, Mr. Speaker.

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Recognition Of Visitors In The Gallery

Recognition Of Visitors In The Gallery

Page 1339

The Speaker

Shane Thompson

Thank you, Member from Inuvik Twin Lakes . Recognition of visitors in the gallery.

If we've missed anyone in the gallery today, welcome to your chambers. I hope you are enjoying the proceedings. It's always nice to have people -- or see people in our gallery.

Recognition of visitors in the gallery. Reports of Committees on the Review of Bills. Reports of Standing and Special Committees. Member from Monfwi .

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Committee Report 16-20(1): Standing Committee on Social Development Report on the Statutory Review of the Mental Health Act

Reports Of Standing And Special Committees

Page 1339

Jane Weyallon Armstrong

Monfwi

Your Standing Committee on Social Development is pleased to provide its Report on the Statutory Review of the Mental Health Act and commends it to the House.

And, Mr. Speaker, I move, seconded by the Member for Mackenzie Delta , that Committee Report 16-20(1), Standing Committee on Social Development Report on the Statutory Review of the Mental Health Act, be deemed read and printed in Hansard in its entirety. Thank you, Mr. Speaker.

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Committee Report 16-20(1): Standing Committee on Social Development Report on the Statutory Review of the Mental Health Act

Reports Of Standing And Special Committees

Page 1339

The Speaker

Shane Thompson

Thank you, Member. The motion is in order. To the motion.

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Committee Report 16-20(1): Standing Committee on Social Development Report on the Statutory Review of the Mental Health Act

Reports Of Standing And Special Committees

Page 1339

Some Hon. Members

Question.

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Committee Report 16-20(1): Standing Committee on Social Development Report on the Statutory Review of the Mental Health Act

Reports Of Standing And Special Committees

Page 1339

The Speaker

Shane Thompson

Question has been called. All those in favour? Opposed? Abstentions? Motion passed.

---Carried

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Committee Report 16-20(1): Standing Committee on Social Development Report on the Statutory Review of the Mental Health Act

Reports Of Standing And Special Committees

Page 1339

Jane Weyallon Armstrong

Monfwi

Standing Committee On Social Development Report On Statutory Review: Mental Health Act

Executive

Summary

The Standing Committee on Social Development (Committee) was tasked with undertaking the first statutory review of the Mental Health Act (Act). Committee sought feedback on the Act to inform its statutory review.

Committee appreciates everyone who offered their feedback at public meetings and in written submissions. Committee thanks the Department of Health and Social Services for their willingness to work with us, and for providing great insight on the current operations of the Act, including challenges and strengths. Committee believes the fourty (40) recommendations listed in this report will help improve the Act and its operations.

Recommendation 1: The Standing Committee on Social Development recommends the Government of the Northwest Territories conduct a comparative analysis of the Northwest Territories' Mental Health Act against other jurisdictions' mental health care legislation, to significantly reduce and mitigate the administrative burdens and procedural complexities of the Mental Health Act (including Forms under the Mental Health Act) and present constructive amendments to the Mental Health Act for consideration.

Recommendation 2: The Standing Committee on Social Development recommends the Government of the Northwest Territories allow flexibility to the Mental Health Act Review Board to hold hearings outside of the current notice requirement of seven days with the consent of all parties by reviewing

Section 70(1) of the Mental Health Act to remove the seven-day notice requirement and defer the minimum notice requirement to the Mental Health Act Review Board Regulations.

Recommendation 3: The Standing Committee on Social Development recommends the Government of the Northwest Territories review

Section 10(2) of the Mental Health Act to determine a more realistic timeline to issue a Certificate of Involuntary Assessment, in consultation with the Royal Canadian Mounted Police and physicians including psychiatric professionals.

Recommendation 4: The Standing Committee on Social Development recommends the Government of the Northwest Territories review

Section 17 of the Mental Health Act and compare to similar provisions in other jurisdictions to determine the appropriate length of time before a certificate expires in order to issue a renewal certificate.

Recommendation 5: The Standing Committee on Social Development recommends the Government of the Northwest Territories assess the addition of a provision added to the Mental Health Act for the Mental Health Act Review Board to review a certificate after a cancelled hearing based on best practices and national standards.

Recommendation 6: The Standing Committee on Social Development recommends the Government of the Northwest Territories review Sections 66(1)(

a) and

Section 74(1)(

a) and (

b) of the Mental Health Act to remove the ability to apply to the Mental Health Act Review Board to cancel Form 2 - Certificate of Involuntary Assessment.

Recommendation 7: The Standing Committee on Social Development recommends the Government of the Northwest Territories review the Mental Health Act and its regulations (e.g.

Section 16(1) of the Mental Health Act Review Board Regulations) to reflect timelines in days or business days, rather than hours, where appropriate.

Recommendation 8: The Standing Committee on Social Development recommends the Government of the Northwest Territories work with the Mental Health Act Review Board to clarify where and how the

Interpretation Act applies to the Mental Health Act and determine if the current two-day timeline in

Section 67(2) remains a challenge despite the flexibility afforded by the

Interpretation Act.

Recommendation 9: The Standing Committee on Social Development recommends the Government of the Northwest Territories work with the Mental Health Act Review Board to find ways to streamline the hearing process and evaluate the time it takes to conduct a hearing and reasons why the hearing process may be deemed too long.

Recommendation 10: The Standing Committee on Social Development recommends the Government of the Northwest Territories review and expand the role of the cultural advisor under

Section 71(5) and

Section 68(1) of the Mental Health Act including adjusting the wording “to a review panel” in the Mental Health Act to “a time deemed appropriate for patient needs”.

Recommendation 11: The Standing Committee on Social Development recommends the Government of the Northwest Territories include a specific provision in the Mental Health Act that outlines that the Mental Health Act Review Board panel may disclose information to the cultural advisor to the extent the panel deems necessary or wording that outlines how and when the cultural advisor will receive information.

Recommendation 12: The Standing Committee on Social Development recommends the Government of the Northwest Territories provide training to staff and Mental Health Act Review Board panel members on the disclosure of information provisions held within the Mental Health Act, and the processes that follow them.

Recommendation 13: The Standing Committee on Social Development recommends the Government of the Northwest Territories review, compare and adjust

definitions and terminology in the Mental Health Act against healthcare operations and language to promote appropriate and streamlined operationalization of the Mental Health Act.

Recommendation 14: The Standing Committee on Social Development recommends the Government of the Northwest Territories review the suitability of the Inuvik Regional Hospital and the Hay River Health Centre as designated facilities (including an analysis of environmental and staffing capacity) under the Mental Health Act and review the ability to add different classes of designated facilities within the Mental Health Act and its regulations, using other jurisdictional models as an example.

Recommendation 15: The Standing Committee on Social Development recommends the Government of the Northwest Territories review and expand the definition of “mental disorder” in the Mental Health Act by conducting a jurisdictional review of

definitions.

Recommendation 16: The Standing Committee on Social Development recommends the Government of the Northwest Territories establish an ongoing territorial working group with involvement from the Royal Canadian Mounted Police and health staff/professionals to ensure legislation, mandates and processes align in administering the Mental Health Act and providing services for mental health crisis emergency response in communities.

Recommendation 17: The Standing Committee on Social Development recommends the Government of the Northwest Territories evaluate whether the definition of the acceptance of a patient after conveyance can be moved to the Mental Health Act's regulations.

Recommendation 18: The Standing Committee on Social Development recommends the Government of the Northwest Territories review the definition of “health professional” within the Mental Health Act to determine if the list can be further expanded where appropriate.

Recommendation 19: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review provisions related to the apprehension, conveyance, and transfer of patients under the Mental Health Act, including consulting with Royal Canadian Mounted Police and medical staff to have agreement on proper protocols and the development of a flow diagram for the transport of patients under the Mental Health Act in and out of territory.

Recommendation 20: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review provisions of the Mental Health Act and its regulations related to the apprehension, conveyance, and transfer of patients to specify the responsibility of peace officers in these processes.

Recommendation 21: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review provisions related to Short Term Leave in the Mental Health Act, especially related to the enforcement of a lack of compliance and streamlining administration so that Short Term Leave is less burdensome on staff, and that the review of these provisions be done with the lens of reviewing similar provisions in other jurisdictions.

Recommendation 22: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review

Section 52(1.2) of the Mental Health Act,

Section 7 of the Apprehension, Conveyance and Transfer Regulations, and other sections of the Mental Health Act related to the temporary detention of patients, and bring forward changes to the Mental Health Act that provide solutions to issues related to the temporary detention of patients. This review should be completed in collaboration with the Royal Canadian Mounted Police, designated facilities, and relevant staff.

Recommendation 23: The Standing Committee on Social Development recommends that the Government of the Northwest Territories create a strategy to analyze and close the gap in pediatric psychiatric care in the Northwest Territories.

Recommendation 24: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review and amend the Mental Health Act to specify an authority who is responsible for oversight of the Mental Health Act, while also allowing flexibility to the Minister of Health and Social Services to designate such responsibility.

Recommendation 25: The Standing Committee on Social Development recommends that the Government of the Northwest Territories significantly reduce the administrative burden on the Director of Designated Facilities as defined in the Mental Health Act through legislative amendments and regulatory change.

Recommendation 26: The Standing Committee on Social Development recommends that the Government of the Northwest Territories consider amending

Section 9.1 and

Section 28(2) of the Mental Health Act after evaluating their capacity and operational effectiveness.

Recommendation 27: The Standing Committee on Social Development recommends that the Government of the Northwest Territories provide additional education materials and training support to staff responsible for providing patients with information about their rights under the Mental Health Act.

Recommendation 28: The Standing Committee on Social Development recommends that the Government of the Northwest Territories explore the possibility of an independent rights advisor or neutral party that vocalizes and reviews patient rights under the Mental Health Act with the patient, including whether this responsibility can be added to the cultural advisor role.

Recommendation 29: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review, amend and simplify Form 1 - Notification of Patient Rights and Other Information using an operational lens and a lens of persons with lived experience while also evaluating the benefits of creating a separate form specific to patient rights, as depicted in Alberta and British Columbia's mental health care legislation.

Recommendation 30: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review

Section 37(6)(

d) of the Mental Health Act and in particular, the use of the word “willing” within this section.

Recommendation 31: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review and amend the requirement of assessment and appointments for patients under Assisted Community Treatment and Short Term Leave prior to the expiry of a Certificate of Involuntary Assessment or a Renewal Certificate to ensure better coordination, streamline information, and reduce the number of forms and administrative tasks.

Recommendation 32: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review and amend provisions in the Mental Health Act related to Assisted Community Treatment to expand Assisted Community Treatment to align with Community Treatment Orders as seen in other jurisdictions, including:

Removing the requirement that a person be an involuntary patient to qualify for Assisted Community Treatment;

Ensuring that care is decentralized from an institutional setting, and;

That there is a greater commitment to culturally safe and decolonized practices in health care.

Recommendation 33: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review

Section 40(1)(

b) of the Mental Health Act to ensure clear information on the extent to which housing and income supports are available to patients under Assisted Community Treatment.

Recommendation 34: The Standing Committee on Social Development recommends that the Government of the Northwest Territories ensure external stakeholders involved in community care understand their obligations to support the operationalization of Assisted Community Treatment under the Mental Health Act, including increasing awareness of obligations to ensure efforts are made to inform patients of non-compliance and the consequences of non-compliance.

Recommendation 35: The Standing Committee on Social Development recommends that the Government of the Northwest Territories establish more supports and funding to action Assisted Community Treatment as defined in the Mental Health Act in small communities across the Northwest Territories.

Recommendation 36: The Standing Committee on Social Development recommends that the Government of the Northwest Territories establish the addition of a public facing navigator role for Mental Health Act processes.

Recommendation 37: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review the role of the psychiatrist during hearings under the Mental Health Act and provide information about their role to the Mental Health Act Review Board, psychiatrists and other staff to ensure there is a clear understanding of their role.

Recommendation 38: The Standing Committee on Social Development recommends that the Government of the Northwest Territories create internal processes to mitigate concerns regarding discharging mental health patients under the Mental Health Act too early by working with physicians.

Recommendation 39: The Standing Committee on Social Development recommends that the Government of the Northwest Territories improve on the ability to cancel certificates on involuntary assessment issued under the Mental Health Act through policies, procedures and legislative change.

Recommendation 40: The Standing Committee on Social Development recommends that the Government of the Northwest Territories embrace technological change by implementing procedures for Forms under the Mental Health Act to be signed electronically or verbally, as well as implementing secure file transfer processes for Forms under the Mental Health Act.

Introduction And Background

The Mental Health Act (Act) requires the Legislative Assembly or one of its committees to commence a review of the Act, and any other related legislation, policies, guidelines, or directives considered appropriate by September 1, 2023, and every five years thereafter (s.105).

The Standing Committee on Social Development (Committee) has conducted the review process for the Act's first statutory review.

The Northwest Territories (NWT) Mental Health Act was passed on October 8, 2015, and came into force September 1, 2018. This Act repealed and replaced the Mental Health Act from 1985, which came into force January 1, 1988.

The Act sets the processes and rules that must be applied to the way people living with a mental disorder receive care and treatment. The Act aims to protect and support the rights of people living with a mental health disorder and those acting on their behalf.

Public Engagement

Between March 2024 to April 2024, Committee engaged the public.

On March 25, 2024, Committee received a public briefing from the Mental Health Act Review Board (MHARB). Committee also received a technical briefing from Department of Health and Social Services (the Department) on the Mental Health Act. The MHARB and the Department's presentation is included in Appendix A.

Committee also received written submissions from:

Association of Psychologists of the Northwest Territories

Royal Canadian Mounted Police - G Division

Canadian Psychiatric Association

Raymond Pidzamecky - Registered Social Worker

Department of Health and Social Services - Materials to support the review of the Mental Health Act and Technical Briefing

These submissions and presentations are included in Appendix B.

Committee appreciates everyone who offered their feedback at public meetings and in written submissions.

Committee categorized public comments received into ten (10) themes.

Before presenting each theme, Committee would like to note the importance of

an Act that both protects the rights of individual patients and others, while also ensuring that its' administrative processes are streamlined and avoid instilling more burden on the health care and emergency services sectors. Committee believes that the Mental Health Act is in need of numerous updates and therefore presents its first recommendation:

Recommendation 1: The Standing Committee on Social Development recommends the Government of the Northwest Territories conduct a comparative analysis of the Northwest Territories' Mental Health Act against other jurisdictions' mental health care legislation, to significantly reduce and mitigate the administrative burdens and procedural complexities of the Mental Health Act (including Forms under the Mental Health Act) and present constructive amendments to the Mental Health Act for consideration.

The themes are listed below:

Issues with timing

There were a few issues in the Mental Health Act raised to Committee that were related to timing.

Firstly, the MHARB and the Department both highlighted that as currently legislated, the 7-day requirement to hold a hearing is very stringent, and more flexibility is required. The MHARB emphasized that a review of

Section 70(1) is required to allow for the process of scheduling a hearing to proceed at a quicker pace which in turn would make greater strides in addressing the needs of the patient. Their recommendation was to remove the wording “give seven days” and replace it with “on consent of all parties”. Whereby the consent of all parties cannot be obtained, their recommendation was for there to be a minimum wait time-period set in the Act's regulations.

As noted above, the Department presented similar concerns regarding the seven-day notice requirement and recommended that a shorter time period be set out in regulations, with an added ability to shorten the notice period with the consent of all parties.

Committee notes these concerns and presents the following recommendation:

Recommendation 2: The Standing Committee on Social Development recommends the Government of the Northwest Territories allow flexibility to the Mental Health Act Review Board to hold hearings outside of the current notice requirement of seven days with the consent of all parties by reviewing

Section 70(1) of the Mental Health Act to remove the seven-day notice requirement and defer the minimum notice requirement to the Mental Health Act Review Board Regulations.

The second issue related to timing is related to timelines in issuing a Certificate of Involuntary Assessment. The Royal Canadian Mounted Police (RCMP) noted to Committee that there are issues when no involuntary assessment can be reasonably issued within 24 hours, and as it is currently required under the Act. They presented that the current 24-hour requirement may be an issue for nursing stations that are busier and/or with minimal or stretched resources.

The Canadian Psychiatric Association (CPA) noted that the 24-hour requirement seems to be excessively short, and that in many jurisdictions it is one week. They described an example whereby a health professional may conduct an assessment, conclude that a person may meet the criteria and want more information before completing a certificate. They note that attempts to contact a secondary person to obtain collateral information can easily take a few days.

Committee would like to mitigate these concerns and therefore presents the following recommendation:

Recommendation 3: The Standing Committee on Social Development recommends the Government of the Northwest Territories review

Section 10(2) of the Mental Health Act to determine a more realistic timeline to issue a Certificate of Involuntary Assessment, in consultation with the Royal Canadian Mounted Police and physicians including psychiatric professionals.

Another issue related to timing relates to Form 4 - Renewal Certificate, which can only be issued within 72 hours of the Certificate of Involuntary Admission or previous Renewal Certificate expiring. The Department made it clear to Committee that in other jurisdictions, renewals may occur within seven days of the form expiring.

Committee therefore presents the following recommendation in hopes that this review will be conducted with an operational lens and the review will analyze data respecting the length of admissions to inform appropriate timelines:

Recommendation 4: The Standing Committee on Social Development recommends the Government of the Northwest Territories review

Section 17 of the Mental Health Act and compare it to similar provisions in other jurisdictions to determine the appropriate length of time before a certificate expires in order to issue a renewal certificate.

Another issue raised to Committee by the MHARB is that they would like to determine or understand why hearings are being cancelled. They note in their presentation to Committee that out of approximately 70 applications received in the past five and a half years, they have conducted approximately 15 hearings while the rest of the applications were cancelled before a hearing occurred - and three quarters of those cancellations occurred within 48 hours of the hearing date. It was noted by MHARB that they currently have no authority to review a certificate after its cancellation, and because of this they lack statistics and research that may be helpful to strengthen the hearing process.

Committee therefore recommends:

Recommendation 5: The Standing Committee on Social Development recommends the Government of the Northwest Territories assess the addition of a provision added to the Mental Health Act for the Mental Health Act Review Board to review a certificate after a cancelled hearing based on best practices and national standards.

Currently under the Act, applications can be made to the MHARB to cancel any certificate issued. Due to this ability, patients admitted under Form 3 - Certificate of Involuntary Admission could potentially be required to apply to the MHARB twice within the span of only a few days if they had applied for their initial Form 2 - Certificate of Involuntary Assessment to be cancelled. In short, the review of Form 2 - Certificate of Involuntary Assessment would not result in an automatic review of their Form 3 - Certificate of Involuntary Admission as it is currently legislated.

The Department noted to Committee that there have been several instances when a patient on Form 2 - Certificate of Involuntary Assessment has applied to the MHARB; however, a hearing could not be arranged due to the legislated timelines for the review as well as the short duration of the certificate (currently 72 hours). It was suggested to Committee by the Department that the ability to apply to the MHARB for a review of Form 2 - Certificate of Involuntary Assessment be removed as it cannot be reasonably provided.

Noting the above reasons and issues related to the timing of certificates, Committee presents the following recommendation:

Recommendation 6: The Standing Committee on Social Development recommends the Government of the Northwest Territories review Sections 66(1)(

a) and

Section 74(1)(

a) and (

b) of the Mental Health Act to remove the ability to apply to the Mental Health Act Review Board to cancel Form 2 - Certificate of Involuntary Assessment.

The Department let Committee know that the timelines for screening applications to the MHARB may be too short, especially if a weekend or holiday intervenes. Currently, the Act requires that the chairperson of the MHARB review an application within two days of receiving it, and either refer it to a review panel or dismiss it. Committee clarified with the Department that the

Interpretation Act currently applies to the two-day timeline set out in

Section 67(2) of the Mental Health Act. Although, it was emphasized by the Department that work is needed to confirm with the MHARB that the

Interpretation Act applies were there is a time of office closure during the two-day timeline. Another piece of clarification is needed to determine whether the two-day timeline remains a challenge despite the flexibility afforded by the

Interpretation Act.

Committee notes that timeline requirements stated in hours versus days, may lead to confusion and inconsistent application. Committee therefore recognizes that the Mental Health Act and its regulations requires review to change timelines of hours to business days or days, where appropriate.

Committee presents the following two recommendations:

Recommendation 7: The Standing Committee on Social Development recommends the Government of the Northwest Territories review the Mental Health Act and its regulations (e.g.

Section 16(1) of the Mental Health Act Review Board Regulations) to reflect timelines in days or business days, rather than hours, where appropriate.

Recommendation 8: The Standing Committee on Social Development recommends the Government of the Northwest Territories work with the Mental Health Act Review Board to clarify where and how the

Interpretation Act applies to the Mental Health Act and determine if the current two-day timeline in

Section 67(2) remains a challenge despite the flexibility afforded by the

Interpretation Act.

Another issue related to timing brought to Committee by the Department is that hearings need to be shorter, especially because longer hearings have an impact on psychiatrists, patients and families, and their time. The duration of hearings is not set out in legislation, but Committee finds it important for the Department and MHARB to work together to streamline the hearing process. Committee therefore presents the following recommendation:

Recommendation 9: The Standing Committee on Social Development recommends the Government of the Northwest Territories work with the Mental Health Act Review Board to find ways to streamline the hearing process and evaluate the time it takes to conduct a hearing and reasons why the hearing process may be deemed too long.

Cultural support

Currently under

Section 71(5), on request by a patient, by their substitute decision maker or by the medical practitioner, the MHARB shall engage an Elder or cultural advisor to a review panel. During their public meeting with Committee, MHARB emphasized that cultural advisors can make an important contribution to the patient-centered approach and help the MHARB conduct its business in a culturally sensitive manner. It was brought forward to Committee by MHARB that the role of the cultural advisor is not clearly delineated and the procedures for their duties during a hearing are not set out.

During their presentation, MHARB suggested to modify the wording in

Section 71(5) of the Act, specifically the wording “during the hearing”, to afford the MHARB the flexibility in bringing in the cultural advisor at a time deemed more appropriate for patient needs. The Department also suggested to Committee that clarity is required regarding the role of the Elder/cultural advisor, specifically that the current “vagueness” of their role could be addressed by expanding

Section 68.1 in the Act so that they can be engaged to the extent for any purpose(

s) requested by the patient.

Committee understands the importance of an Elder/cultural advisor to support the patient, and therefore presents the following recommendation:

Recommendation 10: The Standing Committee on Social Development recommends the Government of the Northwest Territories review and expand the role of the cultural advisor under

Section 71(5) and

Section 68.1 of the Mental Health Act including adjusting the wording “to a review panel” in the Mental Health Act to “a time deemed appropriate for patient needs”.

It was brought to Committee's attention by the Department that information being disclosed to the Elder/cultural advisor may be too broad, and at this point, they may receive every relevant or relied upon record which could be interpreted as being the patient's chart. It was noted that this disclosure of information could be detrimental to the patient - and requires review to determine how the disclosure of information fits within the cultural advisor role under the Mental Health Act and in accordance with the Health Information Act.

The MHARB suggested that a provision be added to clarify that the panel may disclose information to the extent the panel deems necessary for the cultural advisors to perform their role. Related to the same issue, the Department suggested to Committee that a provision be added to outline what information may be disclosed to the cultural advisor, and that consent of the patient or their substitute decision maker be required prior to disclosing information. It was also proposed by the Department that staff and MHARB members may need education on the disclosure of information provisions and processes for withholding information.

Committee hears these concerns and presents the following two recommendations to help mitigate challenges related to the disclosure of information:

Recommendation 11: The Standing Committee on Social Development recommends the Government of the Northwest Territories include a specific provision in the Mental Health Act that outlines that the Mental Health Act Review Board panel may disclose information to the cultural advisor to the extent the panel deems necessary or wording that outlines how and when the cultural advisor will receive information.

Recommendation 12: The Standing Committee on Social Development recommends the Government of the Northwest Territories provide training to relevant staff and Mental Health Act Review Board panel members on the disclosure of information provisions held within the Mental Health Act, and the processes that follow them.

Clarification on terms and

definitions

It was highlighted to Committee during the Department's briefing, that a review and clarification of terms and

definitions within the Act is required, and more specifically to review and compare terminology for consistency with current operational language. It was reiterated that some of the language in the Act can be quite confusing operationally. For example, under the Act, a patient can be Involuntarily Assessed or Involuntarily Admitted. Therefore, if they are Involuntary Assessed , they are admitted to the hospital, but they are not admitted as a patient under the Act. It was suggested to Committee by the Department that there needs to be an assessment of the Act for clarity and simplification of

definitions for the ease of appropriate operationalization. In hearing this feedback, Committee recommends:

Recommendation 13: The Standing Committee on Social Development recommends the Government of the Northwest Territories review, compare and adjust

definitions and terminology in the Mental Health Act against healthcare operations and language to promote appropriate and streamlined operationalization of the Mental Health Act.

The Department made Committee aware of concerns regarding “Code Gridlock status” - meaning that bed allocation is over capacity and may impact the ability of healthcare staff to provide critical care services, especially at Stanton Territorial Hospital (Stanton). This can be seen as a barrier to transferring clients from a designated facility to receive acute psychiatric treatment at Stanton, which has the only inpatient psychiatric unit in the NWT. Committee notes that there are challenges in providing appropriate standard of care for inpatient psychiatric treatment when there are consistent fluctuations in environmental and staff capacity at designated facilities across the NWT.

For this reason, the Department suggests that there be a review of the suitability of the Inuvik Regional Hospital and the Hay River Health Centre as designated facilities under the Act, with an assessment as to whether their designations need to be revoked. It is recommended by the Department that the Act be evaluated to consider different classes of designated facilities based on the levels of service provision available, standards of inpatient psychiatric treatment and care, and levels of responsibility.

Committee takes in this feedback, and presents the following recommendation:

Recommendation 14: The Standing Committee on Social Development recommends the Government of the Northwest Territories review the suitability of the Inuvik Regional Hospital and the Hay River Health Centre as designated facilities (including an analysis of environmental and staffing capacity) under the Mental Health Act and review the ability to add different classes of designated facilities within the Mental Health Act and its regulations, using other jurisdictional models as an example.

It was recommended by the Department at the public technical briefing that the definition of “mental disorder” in

Section 1 of the Act be reviewed and compared against Alberta's recent new definition. It was suggested to Committee that changes to the definition could be reviewed against other jurisdictions where recent changes have occurred to determine if updates should be made to the NWT's legislation. Committee notes this suggestion, and presents the following recommendation:

Recommendation 15: The Standing Committee on Social Development recommends the Government of the Northwest Territories review and expand the definition of “mental disorder” in the Mental Health Act by conducting a jurisdictional review of

definitions.

In a written submission by the RCMP, they note that there is no clarification as to what the meaning of the word “accept” is, when conveying patients to a designated facility under

Section 90(

d) of the Act. The RCMP state that it is their position that “accept” means that the patient has been conveyed to a designated facility and that it is up to the facility to safeguard the patient as a duty of care. They go on to emphasize that often RCMP personnel have been required to remain at the facility as the patient is not deemed to be “accepted” until they have been fully assessed. In their submission, the RCMP stress that this is a medical situation, and the involvement of the police should end with the conveyance to a designated facility.

Similarly, the RCMP also note that the term “other authorized persons” listed in numerous sections of the Act requires review as there is no definition of “other authorized persons”. In response to this uncertainty and need for clarification, the Department suggests that consideration should be given to the establishment of an ongoing territorial working group to ensure legislation, mandates and processes align in administering the Mental Health Act and providing services for mental health crisis emergency response in communities. Committee therefore presents the following two recommendations:

Recommendation 16: The Standing Committee on Social Development recommends the Government of the Northwest Territories establish an ongoing territorial working group with involvement from the Royal Canadian Mounted Police and health staff/professionals to ensure legislation, mandates and processes align in administering the Mental Health Act and providing services for mental health crisis emergency response in communities.

Recommendation 17: The Standing Committee on Social Development recommends the Government of the Northwest Territories evaluate whether the definition of the acceptance of a patient after conveyance can be moved to the Mental Health Act's regulations.

It was brought forward to Committee by the Department that there are challenges for health and social services professionals who are not authorized to complete forms under the Act in reporting mental health crises to the RCMP. Committee was informed that in some cases, despite the

summary of concerns of persons meeting the criteria for involuntary assessment under the Act, the RCMP's assessment overrides the health and social services professionals' concerns.

It is suggested by the Department that this issue could be addressed by reviewing the definition for “health professional” under the Act to better determine if the list can be further expanded - whether it be in the legislation or its regulations. This review may require the evaluation of the scope of practice of various health and social services professions to determine if it is within their scope to issue a Certificate of Involuntary Assessment. In particular, it was noted that there is no guidance or process for a Community Mental Health Nurse or other health professionals to fill out forms.

There may also be a lack of awareness or support for registered nurses and registered psychiatric nurses to issues forms under the Act and this leaves a gap in facilitating emergency mental health care in communities. It was suggested by the Department to Committee that a jurisdictional review to evaluate how other health and social services professionals are able to complete forms under their legislation, may also be of value. The Association of Psychologists in the NWT suggested that there may be some confusion over the terms “Health Professionals” and “Medical Practitioner”, which may be helpful in clarifying.

It was also suggested by the Department that a review of the current Standard Operating Procedures and scope of the Community Mental Health Nurse and/or other Registered Nurse roles be conducted in relation to the implementation of the Mental Health Act.

Noting the above, Committee presents the following recommendation:

Recommendation 18: The Standing Committee on Social Development recommends the Government of the Northwest Territories review the definition of “health professional” within the Mental Health Act to determine if the list can be further expanded where appropriate.

Responsible custody, transfer, and detainment of patients

In their written submission, the RCMP note that

Section 23(1) of the Act does not specify who is responsible for the transport of the patient to a designated facility or to another health facility. They also note that when “authorized persons” is not described within the Act, it tends to default to the police. The RCMP also brought forward to Committee that

Section 10(3)(

a) of the Act does not state who the patient should be delivered to, and they suggest that there could be a provision whereby peace officers turn over the patient to a specific person to take over custody. They provide an example that other provinces have an Institution Safety Officer who takes over custody of the patient.

The Department was also made aware that it is unclear whether or not a peace officer remains with an involuntary patient who has been apprehended and is being conveyed/transferred to a designated facility. Moreover, no one is specified as responsible for the “care” of the patient while they are being conveyed, only until they have arrived at a designated facility. Committee notes that this responsibility could be given to the peace officer, but also understands the importance of not overburdening the police with more responsibilities.

Committee therefore finds it important to use the word “supervise” in replacing the word “care” in relation to the duration of the conveyance of the patient to a designated facility and the role of the peace officer under the Act, as to balance the responsibility to the patient and the ongoing duties of peace officers.

Related to the comments by the RCMP, it was brought forward by the Department that the transportation of patients under the Act from the Inuvik Regional Hospital to Stanton Territorial Hospital and/or a facility in Edmonton is reasonably common and unreasonably complex. It was suggested that a dedicated flow diagram be created to help explain the processes for the transport of patients under the Act - both for in and out of the territory.

Committee notes this feedback and presents the following two recommendations:

Recommendation 19: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review provisions related to the apprehension, conveyance, and transfer of patients under the Mental Health Act, including consulting with Royal Canadian Mounted Police and medical staff to have agreement on proper protocols and the development of a flow diagram for the transport of patients under the Mental Health Act in and out of territory.

Recommendation 20: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review provisions of the Mental Health Act and its regulations related to the apprehension, conveyance, and transfer of patients to specify the responsibility of peace officers in these processes.

In their written submission, the RCMP mentioned to Committee that there is no clearly defined role for who enforces lack of compliance if there is an Absent Without Leave (AWOL) person during Short Term Leave. They highlighted that

Section 47(2)(

a) and 52(1) of the Act place the responsibility for compliance on the police, and suggest that health professionals should be the first consideration. They continue by saying that decisions to release patients rest with health professionals, while the consequences of non-compliance defaults to the police.

t was also brought forward by the Department that processes related to Short Term Leave are administratively burdensome, often requiring multiple passes to allow involuntary patients to leave the facility for short periods of time for walks, smoke breaks, etcetera. It was highlighted by the Department that provisions related to Short Term Leave were created to allow leave from the facility for up to 30 days, but do not account for shorter leaves of absence that most, if not all, patients should have for daily fresh air breaks, errands, to attend appointments, etcetera.

Committee presents the following recommendation:

Recommendation 21: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review provisions related to Short Term Leave in the Mental Health Act, especially related to the enforcement of a lack of compliance and streamlining administration so that Short Term Leave is less burdensome on staff, and that the review of these provisions be done with the lens of reviewing similar provisions in other jurisdictions.

In their written submission, the RCMP note that

Section 52(1.2) of the Act was written without their consultation. They note that the default in the circumstances of temporary detainment of patients under the Act, is the incarceration of patients in jail cells, even though in most cases they have committed no crime, and this is strictly a medical situation. The RCMP emphasize that this

Section should be either repealed or reworded to emphasize that this should only occur if there are criminal circumstances associated to a particular situation. They also highlight that there may be medical alternatives to control unruly or intoxicated patients awaiting conveyance.

It was also brought forward to the Department that there is a lack of safe and appropriate space to hold clients during waiting periods for conveyance to a designated facility, especially from rural and remote communities.

Committee hears their feedback, and presents the following two recommendations:

Recommendation 22: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review

Section 52(1.2) of the Mental Health Act,

Section 7 of the Apprehension, Conveyance and Transfer Regulations, and other sections of the Mental Health Act related to the temporary detention of patients, and bring forward changes to the Mental Health Act that provide solutions to issues related to the temporary detention of patients. This review should be completed in collaboration with the Royal Canadian Mounted Police, designated facilities, and relevant staff.

Committee believes it is a significant issue that there is no youth psychiatric unit in the NWT. The lack of a designated unit may relate to staff and institutional capacity issues; however, it has concerning impacts on the quality of youth patient care. It was also brought forward by the Department during this statutory review that there are concerns about the safety of pediatric psychiatric patients both under the Act and not under the Act at Stanton, as well as the suitability of the Pediatric Unit at Stanton to provide care to psychiatric patients under the Act.

Committee believes that not having a suitable youth psychiatric unit in the NWT is a serious problem, and therefore presents the following recommendation:

Recommendation 23: The Standing Committee on Social Development recommends that the Government of the Northwest Territories create a strategy to analyze and close the gap in pediatric psychiatric care in the Northwest Territories.

Oversight of the Mental Health Act

During their presentation to Committee, the MHARB suggested that there should be an authority with a specific oversight role for the Mental Health Act. The Department also noted to Committee that this suggestion warrants further review, and added to it by mentioning that a larger oversight role could allow for more comprehensive reporting to identify trends and outcomes, identify gaps in the healthcare system, and inform future service delivery improvements.

The MHARB also requested statistics and data that may inform whether the number of applications they receive seems reasonable, which correlated with the Department's recognized need to substantiate data that could help inform MHARB's annual reports to the Minister of Health and Social Services . Committee notes that this information could be part of the role of the body charged with oversight of the Act.

Therefore, Committee makes the following recommendation:

Recommendation 24: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review and amend the Mental Health Act to specify an authority who is responsible for oversight of the Mental Health Act, while also allowing flexibility to the Minister of Health and Social Services to designate such responsibility.

The Department informed Committee that there is overall concern about the role of the “Director of the Designated Facility”, and specifically what roles can and cannot be delegated or shared. The current processes and roles may cause delays in the review of forms and is administratively burdensome. Committee believes it is important to clarify and streamline their role to prevent burnout, and presents their recommendation as follows:

Recommendation 25: The Standing Committee on Social Development recommends that the Government of the Northwest Territories significantly reduce the administrative burden on the Director of Designated Facilities as defined in the Mental Health Act through legislative amendments and regulatory change.

Patient rights

In their written submission, the Canadian Psychiatric Association (CPA), notes that while unusual,

Section 9.1 of the Act is “good from a rights perspective”. They highlight that many patients are discharged prematurely, and a case could be made for giving families more of a say in the timing of discharge and perhaps a substitute decision-maker could be given the same right to ask for a second opinion. They provide insight that there may also be a downside to this

section at the system level, where there is already a trend of too few psychiatric beds.

The CPA also commented that

Section 28(2) of the Act seems unnecessarily restrictive. Currently, the provision requires a second medical opinion before administering emergency treatment, and they go on to note that in an emergency, even the time required to contact a second physician could result in a bad outcome. The CPA suggests to Committee that they review this provision as it could be problematic, and at the least consider the word “readily” be inserted before “available”. Committee hears their concerns, and presents the following recommendation:

Recommendation 26: The Standing Committee on Social Development recommends that the Government of the Northwest Territories consider amending

Section 9.1 and

Section 28(2) of the Mental Health Act after evaluating their capacity and operational effectiveness.

The Department told Committee that postage of information about patient rights under the Act as a permanent part of the individual space may not be appropriate, particularly for the Pediatric Unit rooms that are designated for psychiatric admission at Stanton as they are adaptive spaces that may be utilized for acute medical treatment as needed. The Department also informed Committee that it is unclear whether patients are being informed of their rights to retain and instruct counsel without delay, and whether their access to counsel is being facilitated.

It was suggested that it is critical that patients know their rights upon admission - and in particular, that it is communicated to the patient that should they wish to be discharged and there are any immediate safety concerns, they may be held involuntarily for further assessment. The Department suggests that further education and awareness is needed for staff who are responsible for providing patients with information about their rights under the Act.

A suggestion was brought to Committee by the Department to establish an independent rights advisor, as patients may be too upset at their doctors or physicians to fully understand their rights under the Act. The Department described that the explanation of rights often falls onto the responsibility of nurses to provide, and issues arise when high turnover of staff causes issues in ability to adequately provide this information.

The Department also notes that there have been operational challenges in cases where patients on a voluntary hold are then placed on an involuntary hold if they want to or try to leave - which can create a false narrative for patients who may not understand that the Act balances addressing acute mental health needs with the safety of themselves as patients, and of others.

To help with the explanation of rights to patients and to help monitor change in patient status and potential interventions, it is suggested to review and amend Form 1 - Notification of Patient Rights and Other Information to simplify language and layout, and consider including information on how to access advocacy and/or legal supports. A suggestion by the Department was to create a separate form specific to patient rights, as depicted in Alberta and British Columbia's mental health care legislation.

It was also noted that when reviewing Form 1, attention be made to including the ability to monitor change in patient status and potential interventions. They also suggested to make it standard that the patient is given a copy of the patient rights poster along with Form 1.

Committee presents the following three recommendations related to patient rights:

Recommendation 27: The Standing Committee on Social Development recommends that the Government of the Northwest Territories provide additional education materials and training support to staff responsible for providing patients with information about their rights under the Mental Health Act.

Recommendation 28: The Standing Committee on Social Development recommends that the Government of the Northwest Territories explore the possibility of an independent rights advisor or neutral party that vocalizes and reviews patient rights under the Mental Health Act with the patient, including whether this responsibility can be added to the cultural advisor role.

Recommendation 29: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review, amend and simplify Form 1 - Notification of Patient Rights and Other Information using an operational lens and a lens of persons with lived experience while also evaluating the benefits of creating a separate form specific to patient rights, as depicted in Alberta and British Columbia's mental health care legislation.

Community Treatment Plans

In relation to

Section 37(6)(d), the Canadian Psychiatric Association raised that the use of the word “willing” is very problematic. The CPA noted that in Ontario, the wording is “is able to comply”. The word “willing” could suggest to clinicians that the person is consenting and that if they do not agree then they are not eligible for Assisted Community Treatment. They highlighted to Committee that if this is the intention of this Section, then the Assisted Community Treatment has a very limited function. Committee recommends the following:

Recommendation 30: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review

Section 37(6)(

d) of the Mental Health Act and in particular, the use of the word “willing” within this section.

The Department brought forward to Committee the issue of administrative burdens related to the required coordination of assessments prior to the expiry of a Certificate of Involuntary Assessment or Renewal Certificate, as well as the assessments and appointments required under the Assisted Community Treatment Certificate are needlessly cumbersome and often results in more appointments than is necessary.

It was noted that this issue could be addressed through reviewing current process and assessment requirements in the Act and its regulations to allow for better coordination of timelines and requirements, streamlining information and the duplication of administrative tasks. Therefore, Committee proposes this recommendation to the Government of the Northwest Territories (GNWT), in an effort to streamline administration of the Act:

Recommendation 31: The Standing Committee on Social Development recommends that the Government of the Northwest Territories review and amend the requirement of assessment and appointments for patients under Assisted Community Treatment and Short Term Leave prior to the expiry of a Certificate of Involuntary Assessment or a Renewal Certificate to ensure better coordination, streamline information, and reduce the number of forms and administrative tasks.

The Department raised the issue that a patient, under the NWT's Mental Health Act, must be involuntary admitted in order to be eligible for Assisted Community Treatment (ACT). Furthermore, this restriction has been causing confusion for patients and their families, and distress to staff. The Department informed Committee that the issue may be that Assisted Community Treatment, as stated in the NWT's Mental Health Act, is sometimes being equated with Community Treatment Orders, as seen in legislation in southern jurisdictions. In comparison, Community Treatment Orders (as depicted in southern jurisdictions) are designed for ind