The Nova Scotia Legislature

The House resumed on:
September 21, 2017.

HANSARD

NOVA SCOTIA HOUSE OF ASSEMBLY

COMMITTEE

ON

PUBLIC ACCOUNTS

Wednesday, June 23, 2010

LEGISLATIVE CHAMBER

Department of Health

Mental Health Services

Printed and Published by Nova Scotia Hansard Reporting Services

PUBLIC ACCOUNTS COMMITTEE

Ms. Diana Whalen (Chairman)

Mr. Leonard Preyra (Vice-Chairman)

Mr. Clarrie MacKinnon

Ms. Becky Kent

Mr. Mat Whynott

Mr. Howard Epstein

Hon. Keith Colwell

Hon. Cecil Clarke

Mr. Chuck Porter

[Mr. Sid Prest replaced Mr. Mat Whynott]

[Hon. Murray Scott replaced Mr. Chuck Porter]

WITNESSES

Department of Health

Mr. Kevin McNamara, Deputy Minister

Ms. Patricia Murray, Acting Executive Director

Ms. Linda Penny, Chief Financial Officer

In Attendance:

Mrs. Darlene Henry

Legislative Committee Clerk

Mr. Jacques Lapointe

Auditor General

Ms. Evangeline Colman-Sadd

Assistant Auditor General

Mr. Gordon Hebb

Chief Legislative Counsel

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HALIFAX, WEDNESDAY, JUNE 23, 2010

STANDING COMMITTEE ON PUBLIC ACCOUNTS

9:00 A.M.

CHAIRMAN

Ms. Diana Whalen

VICE-CHAIRMAN

Mr. Leonard Preyra

MADAM CHAIRMAN: Good morning, I'd like to call the meeting of the Public Accounts Committee to order. To begin for the day we are meeting this time as our last meeting scheduled for this year. We're pleased to have with us the Department of Health - we have Mr. McNamara, the Deputy Minister of Health, to talk about mental health services. I'd like to begin the meeting with introductions if I could.

[The committee members and witnesses introduced themselves.]

MADAM CHAIRMAN: Thank you very much. As is our practice - and I know, Mr.

McNamara, you've been here a number of times this year - you have the opportunity to begin with an opening statement for us.

MR. KEVIN MCNAMARA: Good morning. I'm pleased to be joined by Patricia Murray, who is the Acting Executive Director of the Mental Health and Addiction Treatment Branch and Linda Penny, our Chief Financial Officer. It is my pleasure to speak to you this morning about mental health services in Nova Scotia.

An audit of mental health services was recently completed and released by the Auditor General. In that report the Auditor General concluded that the Department of Health has not shown sufficient monitoring and evaluating processes for mental health services that are being delivered throughout this province by district health authorities and the IWK. As well, there were concerns that the standards set by the department were not being met.

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The Department of Health has accepted all 19 recommendations made by the Auditor General and has already begun work in some areas. Over the past 10 years the mental health budget has increased. For the 2010-11 fiscal year, the mental health budget is $121.9 million, or 3.4 per cent of the overall budget for the Department of Health. However, it is 8 per cent of the funding provided to district health authorities and the IWK.

Over the last few years there have been several enhancements to mental health services. In 2005, the Early Intensive Behavioural Intervention program was introduced. This is a program to treat preschool-aged children with autism spectrum disorder. The program has been independently evaluated with very positive results. Currently, the program serves about 60 per cent of eligible children.

The Adolescent Centre for Treatment at the IWK, which provides rehabilitative mental health in a 24-hour residential setting, has increased its bed capacity from 12 to 18. The Mobile Crisis Team, which is a partnership between the IWK, Capital Health, EHS, and police was expanded to provide 24/7 service to all of HRM, where initially it only served the metro area. As well, crisis/early intervention response has been enhanced in all other districts.

The Involuntary Psychiatric Treatment Act came into effect in 2007. It was designed to balance involuntary admission with patients' rights. In addition, there was the option of community treatment orders, which allow for involuntary patients to be treated in their own community. As a legislated component of the Act, the Patient Rights Advisor Service was established, as well, in 2007. The role of the patient rights advisor is to ensure patients understand their rights and to assist at patient review board hearings.

We know that the IWK Health Centre has a long wait list for regular referrals to mental health services. While there have been several innovative programs introduced to address the wait list, the complexity of the referrals is increasing so it will continue to be a challenge to meet the established wait times for regular referrals. We are also working on a wait times project. We are at the stage of validating the data and the first information will be flowing from this system this Fall.

In the Throne Speech government made a commitment to revamp mental health services in the province, and the recent announcement of the co-chairs for an advisory committee that will develop a mental health strategy will help meet this commitment. We hope to announce the full committee and the terms of reference in the near future.

The community-focused living initiative will be part of this strategy by providing Nova Scotians who are recovering from mental illness with the proper accommodations to facilitate the transition from hospital to the community. The completion of this facility and its 40 beds will also give Capital Health more flexibility as they make changes to improve both in-patient and community-based services. The mental health strategy will also look at

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the need for community-based supports accessible across the lifespan. Having the right resource and supports in communities can reduce the number of readmissions and improve the quality of life of patients.

We are also working with Acadian Affairs to ensure we are able to reach French-speaking people in Nova Scotia as mental health information has been identified as being important for all to access. We've also provided some funding to the Health Association of African Canadians. As we put more emphasis on primary health care services and encourage a collaborative team approach to the delivery of these services, we are working with the primary health care branch to be involved in collaborative and shared care services which will enhance access to mental health services.

In closing, I want to say how committed as a department we are to making sure Nova Scotians have access to the mental health services they need, when they need them. I'd like to thank you for this opportunity. Patricia, Linda and I look forward to answering your questions.

[9:08 a.m. Mr. Leonard Preyra took the Chair.]

MR. CHAIRMAN: Thank you, Mr. McNamara, and welcome back to the Legislature. As I was saying to you earlier, you've been in this Legislature so often in the last year that we should name that seat after you.

In any event, it's 9:08 a.m. and, as is our practice, we're going to start with the Liberal caucus, 20 minutes. Ms. Whalen will start.

MS. DIANA WHALEN: Thank you very much, Mr. Chairman. Again, welcome this morning to Mr. McNamara and your staff. This is a subject, of course, that has had a lot of interest in the Legislature as well. Mental health is something that affects one in five Nova Scotians and one in five Canadians at some time in their lives. We know it's pervasive and it is an issue that has been largely overlooked because of societal issues, because of stigma, and probably for many reasons it hasn't had the same attention that other diseases and other illnesses have gotten. For that reason, we're glad to see that the Auditor General has done a report on it so that we can bring it here today and look at it in more detail.

Certainly some of the findings were troubling. We've talked about the lack of resources in the past for mental health and the fact that it needs to increase. I'm pleased to see in your opening statement - and I may go to some of the figures you've given us because you indicate that there has been an improvement, but we're still looking at 3.4 per cent, I think is what you said for this year's budget on the spending for mental health.

The other concern that was raised in the Auditor General's Report, under Significant Audit Observations, was the information denied during the audit. I just wanted to ask a few

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questions about that before I go into some of the other initiatives and spending items that are currently underway. I really wanted to ask you specifically, how were you notified that you were not to give information on the budget requests that were made to Cabinet?

MR. MCNAMARA: My understanding is the advice came from the clerk of the Executive Council.

MS. WHALEN: Would it have come to you directly, though, Mr. McNamara, as deputy minister?

MR. MCNAMARA: It would have come to my predecessor and to our staff.

MS. WHALEN: So the request was made before you were in place?

MR. MCNAMARA: I believe so.

MS. WHALEN: But you've been in place this entire year, have you not? You were acting as deputy minister.

MR. MCNAMARA: I've been here 11 months now, yes.

MS. WHALEN: So you began in August of last year, is that right, or July?

MR. MCNAMARA: July.

MS. WHALEN: July, okay. I wonder if Mr. Lapointe could tell us when the audit might have begun for mental health.

MR. JACQUES LAPOINTE: I would say October or November of last year.

MS. WHALEN: In 2009?

MR. LAPOINTE: Yes.

MS. WHALEN: That sort of challenges the timeline a little bit. I know as members of the committee we often are not aware of the work that the Auditor General is doing or what timeline he's on, so that is why I did ask that question.

If, in fact, it was happening in October or November, could you perhaps clarify what the communication channel would have been to make such an important decision not to release information?

[Page 5]

MR. MCNAMARA: My understanding is that this has been a consistent practice, through advice from the Executive Council over the past number of years. I don't think there's any change in policy from the past and as I understand, it's being worked on and will be rectified for the future.

MS. WHALEN: I understand yes, there will be a change in legislation perhaps to clarify things, but I understood that the Auditor General has always received information like that in the past, that this was unusual?

MR. MCNAMARA: I can't answer that question. I don't have that information.

MS. WHALEN: His report seemed to indicate that it was unusual not to receive information that would have been budgetary in nature. Would it be possible if I could just ask you once more - are you able to tell me how this was communicated to you and the department, that you would not be releasing that information?

MR. MCNAMARA: There was a discussion with the Executive Council, with all deputies, about information that was considered privy to Cabinet and which was available to be released and it was part of that advice, overall.

MS. WHALEN: So would the advice have been just through a meeting? It wasn't written advice?

MR. MCNAMARA: No, it was through a meeting with deputies. Through our normal deputies meeting.

MS. WHALEN: I know you're in your first year of being a deputy minister, but would you normally have made that kind of information available if you had not had that advice? With the Auditor General doing an audit in your department, I would assume the attitude is to facilitate the work that the auditor is doing.

MR. MCNAMARA: That's normal. What we do is, I would seek advice on certain activities whether it was from our legal counsel, through others, depending on the information that is asked for.

MS. WHALEN: In the absence of that directive to all deputy ministers, would you have seen a problem in providing that advice? What he was looking for was just budget requests.

MR. MCNAMARA: It would depend on the question that was asked - I'm not being evasive, it depends on the question that's asked of us. I do know, for example - in the sense of having even worked through a district health authority - information that goes to Cabinet,

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even a budget request from a district, is considered confidential to Cabinet and has been in the past.

MS. WHALEN: Further on that budget question, this similar idea, it was said that there were specific requests to Cabinet for the mental health budget. Are each of the budgets done individually to Cabinet or would you not have a global figure that's going up to Cabinet?

MR. MCNAMARA: In preparing a budget through to Cabinet, we would put a number of things through that we would like to advance for consideration or give options. For example, we would prioritize some of the options that we may have. We may look at, for example, whether you're dealing with funding a new drug, whether you're funding a new program, whether you're funding the expansion of a certain service, so you go through a number of options. Through that, we end up eventually with a budget that we can approve and go forward with.

MS. WHALEN: So if indeed you had some additional spending in mental health, that would have been highlighted then because that would have been one of the options to be changing or introducing new programs under mental health - that would have highlighted it?

MR. MCNAMARA: I think it's safe to assume that there be requests for expansion of funds in a number of different areas, including mental health, throughout the budgetary process.

MS. WHALEN: If there hadn't been any new initiatives it would really have been highlighted because it would have been static, isn't that right?

MR. MCNAMARA: That is correct.

MS. WHALEN: That wouldn't have been one of your kind of options or formulas that you could be playing with if it was going to stay static?

MR. MCNAMARA: If your question is if we ask for specific program expansions or specific areas, we do.

MS. WHALEN: And I would be safe to assume, I think I heard you say that mental health would be one of the areas that you would have requested additional . . .

[9:15 a.m.]

MR. MCNAMARA: It could be many of the programs that we would have that we would be looking for direction and advice on going forward for expansion.

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MS. WHALEN: Among the mental health?

MR. MCNAMARA: Among the mental health.

MS. WHALEN: Well, that's something in itself. All right, I appreciate that. Again, looking at some of the recommendations that are in the report, there were a number of them that - I would be looking at dollars again - I wanted to ask you about the costs associated with the DHA compliance to the mental health standards.

As you know, a lot of the report talked about the standards that were set in 2003, I think. At the time, there was a $20 million budget or expected cost if you were going to achieve those standards and be able to monitor those standards. The Auditor General looked at it again in 2007-08 and it had risen to $23.5 million. What I'm wondering is if you have a cost today in 2010-11 that would be associated with meeting those standards?

MR. MCNAMARA: I'm going to ask Linda Penny to speak to that.

MS. LINDA PENNY: In looking back at the budget that we had in 2003-04 and the increases since then until the 2010-11 budget, we've actually added $26 million in additional programming costs to mental health, so any of those programs would help advance the standards.

MS. WHALEN: So you're saying that the overall spending increased by $26 million.

MS. PENNY: The overall spending actually increased by about $29 million and there would be wage increases in that number but the actual program increases were $26 million.

MS. WHALEN: So if you took the salary increases out, it was $26 million in new programming.

MS. PENNY: Yes.

MS. WHALEN: I wonder why in 2007-08, the Auditor General is still saying there was a cost of $23.5 million, that the cost to meet all your standards had risen to $23.5 million. It sounded like there was still a gap, that he was indicating a $23.5 million gap. Would you read it the same way?

MS. PENNY: I would certainly read there's still a gap. When a $20 million number is set 10 years ago, inflationary costs would impact that.

MS. WHALEN: And have you tried to look at what the gap is today, or in this budget year?

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MS. PENNY: I think I'd have to defer to Patricia on the gap.

MS. PATRICIA MURRAY: Information for this budget year?

MS. WHALEN: Is there a recent year that you would have looked at it, like the year before or perhaps . . .

MS. MURRAY: I think the $23 million would be the most recent that we have.

MS. WHALEN: That was 2007-08. Okay, well that gives us some idea exactly.

I had a specific question for Mr. McNamara about the Department of Health and I just ask you again if the Department of Health did approach Cabinet with a request for additional monies to ensure compliance of the mental health standards; I mean, knowing that that was something you set seven years ago?

MR. MCNAMARA: I think that would be part of the advice from Executive Council.

MS. WHALEN: So that's sort of private advice, okay, confidential advice. I just had to ask.

Can you tell me what specific actions the department is undertaking to ensure the mental health standards, if any, are being implemented, if you have any actions? I'd like to know the specific actions.

MR. MCNAMARA: I can give you some. What we have done initially is, we went through the recommendations from the Auditor General and, first, identified those actions that we could ask of each of the DHAs. A letter was sent to each CEO, requesting them to comply with those as best as possible, or to identify - and when I'm meeting with them this coming Friday we'll identify if there are any issues or any difficulties with meeting those but I haven't had the feedback at this point in time. Also, the branch is reviewing all the recommendations and seeing how we can move things forward.

The minister has made a commitment that not just through this year but through the mental health strategy, to ensure that we incorporate the recommendations from the Auditor General's Report into that.

MS. WHALEN: So really your actions right now have been to ask the different directors in each of the DHAs for their plans to meet the Auditor General's recommendations?

MR. MCNAMARA: As it relates to each of them, correct. Secondly, as through our department, we will also be reviewing all the recommendations and what we can advance

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forward and also looking through the mental health strategy that we're bringing forward, how we can meet the Auditor General's Report.

There will be a report at the end of that that we will be taking to government, which will obviously include a request for some resources.

MS. WHALEN: So even though we adopted those standards seven years ago, in 2003, we don't seem to have any implementation plan even today within the department, is that fair to say?

MR. MCNAMARA: I'm going to ask Patricia to respond to that.

MS. MURRAY: We have been implementing standards ever since they were introduced, so all of the DHAs are aware of them and everyone has a copy of them. Any new staff are made aware of them: hiring practices, the competence level of the clinicians hired. All of those things are laid out in the standards and those have been followed ever since they were introduced.

I might also say that there was a huge group of people who contributed to the standards, from consumers to clinicians to psychiatrists, administrators and department staff, so we got a good sense of what they should look like on the ground when we began. The expectation was that they would be implementing them all along, so we do assess that every year to see how close they come to meeting the standards. With no additional funding, they are only able to meet them to a certain degree but I can certainly assure you that every DHA is aware of them and they are implemented to the best the DHA is able to do that.

MS. WHALEN: I'm sure you're aware of the very low compliance rate when they did the audit and did a sampling of over 300 different files, I think, to see how many of them were meeting the standards. It wasn't even 20 per cent that they found met the standards.

Would you say that some of the standards are too vague or too difficult to even monitor? I think that the Auditor General found something to that effect, that some of them they weren't even really able to test.

MS. MURRAY: Yes, I would say that probably is a challenge. I would say we are the first province in Canada to introduce mental health standards so we were sort of breaking new ground when we developed them in the first place. We were trying to ensure that everyone had a good understanding of the ones that we did begin with.

I would think that now is a good time to take another look and to come up with more specific performance measures, which I would say the current standards aren't always clear on, so that we're comparing the same thing across districts. We're in the midst of doing that now, actually. We'll meet monthly and we'll make sure that we go through all of the

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standards, to make sure that they are easy to measure and easy for districts to know if they are compliant.

MS. WHALEN: Okay, so you're going to review the measures now.

MS. MURRAY: Yes.

MS. WHALEN: And I'm gathering that would be because the Auditor General has pointed out that some of them really aren't measurable, or certainly would be a challenge to measure.

MS. MURRAY: They are a challenge to measure and I think some people may interpret them slightly differently. We have had feedback every year but it has been more anecdotal than actually being able to measure, so I think there would be a challenge in being able to make those connections.

Given the low compliance rate, they did look at hundreds of files but there are thousands all across the province for mental health clients. Given some of the specific ones they looked at and given that they were challenged in terms of how to measure them, I would say it would be hard to come up with a true compliance rate.

MS. WHALEN: In defence of the report, though, it did say that they eliminated the measures they felt they couldn't track and so they just eliminated those and tried to go to the ones that were more hard and fast; even in that regard, they found there was a very low compliance rate. That would be looking at wait times and there's quite a list of standards that are in the report, on Page 61. I know you have been through it, I have no doubt about that.

With this setting of standards, and I appreciate that we were first in Canada to do that, but with the setting of standards, it should have ensured that we get the same level of service in each part of the province. If you set a standard and you're trying to keep everybody to that, then you'd have equal access, which is really important, and a consistent provision of service.

What I'd like to know and I guess the question would be for the deputy minister, in your own opinion, is there equal access and provision of mental health services today in our province?

MR. MCNAMARA; It is different in different districts, for various reasons. For example, if you take the Cumberland region it does not have in-patient beds, which would be different. I think that's something we have to look at - how we can best provide resources around the province, not based just on the districts but also on the resources that are available, to be able to ensure the services there.

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It is one thing to say, I have a service in a place, it's another thing to have the appropriate staff to make sure you carry out that service. There are strong mental health services in enough districts to be able to ensure patients do get access. We do know that individuals who require emergency services are well looked after. Where we have some difficulties is in some of the wait lists for those who are trying to get in and aren't at that crucial stage yet. That is one of the things we have to work on so that we can prevent more people getting sicker while they are on a wait list.

MS. WHALEN: So given that if you had an emergency or crisis, you said that no matter where you live in Nova Scotia, you would be seen and helped at an emergency department.

MR. MCNAMARA: And transferred to an appropriate facility.

MS. WHALEN: Is there any corner of the province where you feel they are disadvantaged, beyond Cumberland? I'm hoping that in-patient beds are made available at neighbouring DHAs.

MR. MCNAMARA: They are made available at neighbouring DHAs but we do have some challenges in staff in some areas. For example, the opportunity to see a psychiatrist in

Yarmouth is not as great as it is in some of our other districts. So when you have one psychiatrist, it is very difficult to ensure you have full-time service. We supplement it by family practitioners who have some expertise in mental health. This is something we have to work on and see whether we can continue to provide that service in that similar way or look at a different model, to ensure people can get access to the appropriate services.

MS. WHALEN: Okay, I do understand and I'm sure there will be more questions about Cumberland since I see my colleague is here from that area. What I did want to go into as well - I know I have just a few minutes left in my round - would be the transition from child mental health services to the adult system. The Auditor General has pointed out that it is not always consistent from one DHA to another. He mentioned some of the DHAs allow a smooth transition and others put you back on a wait list when you become an adult and you then have to wait again for service, which could really have somebody completely derailed if they're doing well - they're receiving the services they need and then they suddenly have no support. I'm wondering if that would be a critical area for you to be looking at right now in light of this report and what steps you're taking to do that?

MR. MCNAMARA: It is definitely an area we have to review and make sure that we make the service seamless for patients between child and adult age. We also are working with our partners at Community Services on how we can deal with complex cases because that also creates some issues for us when individuals change age and how they may be looked after. Some may be under the purview, for example, of the Department of Community Services and then transferred as an adult to the Department of Health. We're working with

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them on how we can improve that system for the future. There's a bit more work to be done, but we have started a process of how together we can better look at individuals and make the service seamless.

MS. WHALEN: I'd just like to say that certainly, even in my own riding and with people I know, this has been an issue here in the Capital Health District. I didn't know if it was isolated or more pervasive, but I think it is an urgent matter because we know there are a lot of young people where mental illness presents itself - and I realize, Ms. Murray, you deal with youth. Those critical years, when they're in their late teens and early 20s, really become a critical time to ensure that they are able to get a handle on their illness and function fully.

I can't stress strongly enough that I think it is really important that that not be an issue, that we not have people left without service. I think it's really unconscionable to put them back on a waiting list at that point. I just think that we need to be cognizant of the continuum of care. That's silly if we have a great IWK system, which we love - if we have that in place, we shouldn't lose it as we're moving into the adult system. I'm very keen that we look at that.

I think I have less than a minute left, am I right?

MR. CHAIRMAN: About 15 seconds.

MS. WHALEN: I think I better just say thank you and I'll have some more questions in the next round.

MR. CHAIRMAN: Thank you, Ms. Whalen, we'll move next to the Progressive Conservative caucus and Mr. Clarke.

[9:28 a.m. Ms. Diana Whalen resumed the Chair.]

HON. CECIL CLARKE: Thank you, Mr. Chairman. I want to extend a welcome and greetings to our attendees here at committee today and as you've indicated, there have been familiar faces for the last little while here at Public Accounts.

One of the things I just want to look at is with regard to revamping your mental health services and thus the strategy around it - how much statistical analysis and data has been presented or is provided with regard to persons with addictions that have mental health issues? Is there a charting of that or statistical analysis?

MR. MCNAMARA: I'm going to ask Patricia to answer that.

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MS. MURRAY: Are you asking what information we're using as we go forward with the strategy or just what information we have available or . . .

MR. CLARKE: Well, the correlation for mental health services and the fact that oftentimes, persons with mental health issues also have addictions related to that that are either compounded or result because of either behaviour or patterned activity. I'm just wondering, is there a body of information that has analyzed that?

MS. MURRAY: There is information on that and I don't think I can pull the statistic out of my head at the moment. I'm thinking 30 per cent to 40 per cent possibly - it's quite high. There's a high correlation between addictions and mental illness for sure.

MR. CLARKE: One of the things that we currently have ongoing, I know looking at gaming in the province and the gaming addiction, this House has had much discussion about that and while this committee has precluded the Gaming Corporation coming here for consideration, I would have been happy to ask them about statistical information that they would hopefully have had at their disposal of what they currently are doing and, more importantly, if another strategy is being undertaken by the government.

[9:30 a.m.]

My question is, with the new gaming strategy, what level of engagement has occurred to this point on that new strategy with relation to mental health services?

MR. MCNAMARA: I will respond to that. In the new gaming strategy, both the Deputy Minister of Health Promotion and Protection and myself will be part of the larger team that is going to be looking at this. It is in the preliminary stages, I can't tell you any output from that committee at this point, but we will definitely be involved and advocating on behalf of both mental health and addictions as we move forward.

I think it's also fair to say that there are many things that do interrelate between addictions and mental health; for example, a sexual assault of individuals also is a high proportion of individuals who end up both in addictions and in mental health as well. We have to try to do a better job of getting at the earlier stages and gaming, obviously, is one of them.

MR. CLARKE: Just for the record, there has not been any formal engagement at this point?

MR. MCNAMARA: The committee is being set up and we are to be part of the strategy, but I haven't been to a meeting as yet.

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MR. CLARKE: So the outside consultant that has been hired to undertake that - former deputy minister Ron L'Esperance - has had no discussions at this point with you?

MR. MCNAMARA: Not as yet, but understand one will be upcoming in the future.

MR. CLARKE: In advance of that, what has been the level of involvement by the Department of Health with the Gaming Corporation, with their current or existing strategies at this point?

MR. MCNAMARA: It has been more through Health Promotion and Protection than through the Department of Health. But in moving this forward, one of the things in talking to the Deputy Minister of Finance is making sure both departments are involved - meaning Health Promotion and Protection - as well as Health on the go forward.

MR. CLARKE: With regard to some of the next steps, if we go back to the fact that we're in a situation where we haven't had the benefit of having the Gaming Corporation - that would have been helpful, I guess, to be a preamble to the discussion here today. That's not the fault of anyone that is presenting as witnesses to the committee today, but it is part of the issues that we have to contend with within committee in dealing with the government, to deal with an established process that we would have hoped to have had in place to properly consider these matters. Having those matters voted out at committee level is not for the witnesses issue here today.

With the Gaming Corporation, we've all known and when dealing with addictions - but again, tying that back to mental health services and where those dots connect. You had referred to the Deputy Minister of Finance - can you detail what the role of the Deputy Minister of Finance has been with you and your colleagues?

MR. MCNAMARA: As I indicated, in our discussions we are to be part of the committee to look at it, but we haven't had a meeting, so I can't give you any further details other than I will be at the table.

MR. CLARKE: So what you're saying is, other than the statement made by the minister and, I guess, the Minister of Finance being responsible for the Gaming Corporation, other than the statements that the government has made at the political level, there has been no engagement at a civil service level?

MR. MCNAMARA: Not at my level and not for my involvement. There may be other civil service involvement that I'm not aware of.

MR. CLARKE: Do you have a list of the departments that are participating as part of that strategy on the working committee?

[Page 15]

MR. MCNAMARA: I know Health Promotion and Protection, ourselves, Finance and possibly Community Services and Justice. I'm speculating on the last two, so I don't want to be perceived as giving a fact that may not be correct.

MR. CLARKE: I'm just wondering if the deputy might be able to provide, through his colleagues, a list of who's participating with regard to that strategy, just as an information request to the committee?

MR. MCNAMARA: We shall do that.

MR. CLARKE: One of the things that, I guess, relates to dealing with strategies and this is more a core, overarching issue of which your efforts, which are very important, relate to and that is one of the concerns about government cherry-picking of topics in terms of what strategy moves where. One of the difficulties is looking at what the connections are between the various strategies.

As we all know it cannot be helped with governments that we talk about the silos and working committees are very important and deputies working at that level should be applauded. One of the things that we're trying to come to terms with is what is the overarching aspect of this? Obviously, the Department of Finance, aside from the minister being involved with the gaming, would have an interest in this, but the financial resourcing of supports and services for mental health issues, as they relate to other sub-tiers. So we have an area where we're trying to help people, but at the same time the people being helped are being drawn upon to finance through the Gaming Corporation, by virtue of an addiction, revenue streams for the province, so I think there is an interesting connect about how governments deal with problems that are presented in society that they're putting money out to try to correct or service a problem and at the same time are drawing revenues from those same individuals who are being impacted by the addiction.

I'm just wondering, when you work at the deputy level, is there a discussion about the cost or what's really the value of doing certain things in terms of government pursuing gaming? With mental health services, if you talk 30 per cent to 40 per cent of people that would have related addictions, of course, alcohol drugs, gaming and, in fact, probably a combination of all of the above would be impacted there. I'm glad to hear that Community Services, hopefully, will be engaged because that affects another tier of people who are further impacted.

From your point of view, are there recommendations that have come forward from Mental Health Services that are involving activities of government that you recommend should no longer be pursued?

MR. MCNAMARA: As I indicated, we haven't had a meeting as yet, so there has been no discussion on the topic. I would say from a personal point of view what we will be

[Page 16]

trying to advocate for are the patients we look after, trying to recommend the best that we believe will improve their life on a go-forward basis. But until we have the first meeting, I can't give you any more details.

MR. CLARKE: I'll accept that and not pursue that angle any further, other than to say that I think with regard to Mental Health Services, it is something that we'll be looking at eventually whenever this committee should have the Gaming Corporation come before it and whenever the working committee and the outcomes flow to this group.

One of the things I would note - and again, not with our witnesses, but for the committee's edification - is that there is a connection here about why the government did not want the Gaming Corporation before this committee. It's obvious what was stated as something that was well along the way of process is actually not in process at this point. It's not the fault of our witnesses, but it is something that's telling about the agenda-setting of this committee, the issues we've had to debate at this committee, with regard to where the government said they were versus where we are in dealing with topics.

Before passing over to my colleague - I know he has some regional issues, as was referenced in the last round - I know a lot of efforts within the Cape Breton district, a lot of good initiatives have been transferred out to a regional basis. I'm very pleased that today the Premier is down and they're opening up the new cancer centre, all of those transfer services that can be done on a regional level. Can you just provide some updates of where we would have had more centralized services in terms of progress being made of getting a wider level of service out into the regions? Do you feel like you've been able to mark a good measure of progress for regional services and mental health services, but really getting to the local level of helping individuals within their districts?

MR. MCNAMARA: I'll ask Patricia to answer.

MADAM CHAIRMAN: Ms. Murray.

MS. MURRAY: The way we've designed our services is through a network model. We're aware because of our small population and generally rural population, that to provide equal access and to provide adequate services around the provinces is challenging, especially for the more serious mental illnesses.

We have a network model set up which means that in every DHA there's someone identified who had an interest in that specific area - say eating disorders, early psychosis, that kind of thing - and they meet regularly, either through teleconferences or providing educational sessions. They keep their skill level up, and they also have a network of colleagues that they can call on if they get into a particular difficulty with a client. All of those have specialty clinics located in Halifax where they're close to an academic setting, but they're able to refer their clients in for a second opinion for additional assistance with

[Page 17]

treatment suggestions to clarify a diagnosis. That model has actually worked very well and we have it in place for all of our specialty services.

Otherwise, we have mental health clinics around the province and we have up to 50 clinics both in major centres and in other smaller areas through satellite clinics, so folks aren't generally very far from home when they can access services.

MR. CLARKE: I'm pleased to hear that. I know that even with the last topic, with regard to gaming and mental health services, that even Justice would be at the table because with mental health services, the Justice Department has played a role.

I know the previous government, which we were proud to be part of and my colleague sitting next to me - the honourable member for Cumberland South - started with our Boots on the Street. One of the things we understood from hearing the community was the need, on a policing level, for people to be educated and better adept and able to deal with persons with mental health issues as they are impacted or have to be engaged with the justice system. I am sure that as a result of the Hyde inquiry, we will have a number of other things that will flow out that we're going to have to put in place.

One of the things we were able to do was put a policing officer in place who worked and trained with the DHA, with the Mental Health Services, and we were committing further, through the Boots on the Street initiative, to add to that other level of officers who then could be training other officers with regard to that but also somebody within the system who could be engaged to help and to hopefully be ahead of. In some ways it was initiated. I am sure the Hyde inquiry will provide us with a number of recommendations but we'll also have working models now within mental health services that are going and are working.

Regrettably, the government has chosen to cancel the Boots on the Street program and the additional officer who was to be hired within the Cape Breton District Health Authority, I don't believe will be put in place. So one of the resourcing issues is that it is multi-faceted and I'm just wondering, have you had any further discussions, when it comes to Mental Health Services, with Justice, about the connection of providing policing service with service providers within the Department of Health?

MS. MURRAY: I know with our mobile crisis team within the Capital District, policing is actually part of that team. They have trained with the team, they have gained a better understanding of mental health issues and they go out on calls, if they are required to assist people right in the community.

I also understand there's an on-line policing resource available that Dr. Bianca Horner developed that I think any police officer has access to around the province that they can do, as they are able, through an on-line education system. So I think there's a lot of recognition that policing is a very key part and I think the policing resources themselves have identified

[Page 18]

that it is a need so it has been provided in a couple of different ways and I would say that that is ongoing.

MR. CLARKE: Well it's my hope, Madam Chairman, that there will be an ability for the department to look at where the model has worked currently and where we can include that because one of the things is to recommend to the government that they actually come back and bring back the Boots on the Street program so that these types of what other people thought were discretionary decisions were actually strategic investments to provide policing services so that they actually are a mental health provider navigating the justice system, to get better outcomes for everybody.

That's an aspect. I know it's not for our witnesses to do that but they do work with their colleagues and we will be calling upon the government to reinvest in that and hopefully the Hyde inquiry will give us further insight that the government will have a plan forward and to link these pieces together yet again. So with that - how much time is left, Madam Chairman?

MADAM CHAIRMAN: Four minutes.

MR. CLARKE: I just defer to my colleague for Cumberland South.

MADAM CHAIRMAN: Mr. Scott.

HON. MURRAY SCOTT: Thank you, Madam Chairman. As well, I want to thank our guests for being here today. It is a tremendous opportunity, I believe, to discuss an issue that is very important to many people. I know myself, almost 13 years I've been a member of the Legislature, one of the most frustrating issues that can come before an MLA is someone who is desperately seeking some help, who is suffering from an illness that, for the most part in society, is something that is not taken on as it would if it was cancer or many issues that we see so much public outcry over. I know it is very frustrating for myself and extremely frustrating for those who are suffering from that illness, and for their families.

[9:45 a.m.]

I think it is a great opportunity to be here today. I do have some questions around Cumberland County. The deputy minister mentioned there was a discussion earlier about beds. The first question is around beds for Cumberland. Presently, and I'm sure you would agree that someone who is suffering from this type of illness who can't even find that type of resource close to home, it's a further stressor for them - as challenging as the illness itself - financially, it's a long way to travel to find that resource in another county. Presently, without beds in our area, I'm sure you agree that that further compounds the issue.

[Page 19]

My first question is, with the additional long-term beds that are being allocated throughout the province - thanks to the previous government - I'm wondering if someone could answer the question around, for example, All Saints Springhill Hospital, we see now that we've allocated additional long-term care beds it should free up some bed space in some of our local hospitals, is it possible your department could consider a small number of beds, at least for Cumberland County, for example in All Saints or in one of the other hospitals in Cumberland?

MR. MCNAMARA: I think what we have to do - well, part of the strategy is to look at what resources we presently have and then what resources we can utilize and also looking at what resources are already available in our province, no matter where it is.

I know when I look at Cumberland County, a population of probably 32,000 and five hospitals, there are certainly opportunities for us to look at how we can allocate some resources versus some other districts that wouldn't have the same ratio of beds to our facilities to the number of individuals. I can't give you the specific answer today but I think we have to look at all options.

One of the things we believe in is that first you try and do service as close to home as possible but also, at the same time ensuring you have the appropriate resources to support the person you have there. It is no good having a resource without having the appropriate trained personnel - i.e. psychiatrists and others - to provide the treatment.

MADAM CHAIRMAN: You have a minute.

MR. SCOTT: One minute? Hopefully I'll come back later.

MADAM CHAIRMAN: You will.

MR. SCOTT: I appreciate that, deputy. One of the challenges I think we face in rural Nova Scotia when it comes to attracting professionals - and I use GPs for example in my own area - a lot of times general practitioners will come to an area, like Cumberland, for example, but they have a spouse who is a professional as well and that spouse is looking to follow their career choice as well and a lot of times those opportunities aren't there.

I'm wondering if the lack of ability to attract the type of professionals for mental health in Cumberland could possibly be attributed to that scenario? If it is, is it something your department is looking at, at some ways they may help to alleviate that?

MR. MCNAMARA; It is one factor. There are numerous factors but sometimes the spouse not having an opportunity for a position is definitely a factor.

[Page 20]

MR. SCOTT: So would you agree that the government has a role to play, whether it is education, health, or it could be transportation? Other departments have a role to play to try to ensure that for us to be able to attract professionals, for example in an area like Cumberland, other departments are going to have to get involved as well to ensure that if the spouse is a professional - there may be opportunities for other departments. Would you agree that the government should have the department involved in those issues as well, particularly in rural areas?

MR. MCNAMARA: From a former CEO in a district, we used to explore every opportunity, whether it was with government departments or private employers, to find positions for individuals and most districts do try that.

MADAM CHAIRMAN: Your time has elapsed. Mr. Scott, you will have another opportunity in the second round. I'll turn the floor over to the NDP. We'll say it is 9:49 a.m. - you have 20 minutes. Is it Mr. MacKinnon?

MR. CLARRIE MACKINNON: Thank you very much, Madam Chairman. It is great to have these witnesses before us this morning on this very important subject matter.

Wherever possible, I like to advocate for rural Nova Scotia. What I'd put forward this morning is, how do we ensure that services are available to rural Nova Scotians, remote communities in the areas of mental health and that support is there for their children who need mental health services?

MR. MCNAMARA: As I was saying before, the first opportunity is to try and provide services as close to home as possible, and that includes rural communities. It is important for the department to ensure that when we do provide a service, that we provide the appropriate service with the correct standard.

You heard earlier that we talked about standards for the Auditor General in that meeting. Some of that we can probably say that we may not have the appropriate resources; i.e., individuals in place to make some of these things happen. I think we have to look very carefully at making sure, first, that when we provide a service that we provide a quality service that individuals are going to get the appropriate treatment.

MR. MACKINNON: And efforts are being made in relation to outreach to those communities that I am talking about that are somewhat remote.

MR. MCNAMARA: Correct. Some of our rural districts provide a very good mental health service; they do different strategies to make it happen. Some of them have great relationships with other departments. For example, when we were talking earlier about the Justice Department, I can think of my former district where the police department, the RCMP, the mental health services, and myself met on a regular basis to figure out how we

[Page 21]

can make things best for patients who might be impacted by the justice system and also so that we didn't become a liability to the police. Sometimes, for example, with a difficult patient if you use the police as your security, it impacts on what service they can provide the rest of the community, so we used to work hard together to try to reduce the frustration for both sides and yet treat the patient with dignity.

MR. MACKINNON: We have 13 First Nations in the province, a very integral part of our population demographics, and First Nations with a growing population as well. What I'm asking this morning is, are there outreach or special services targeting Aboriginal Nova Scotians, in particular Aboriginal youth?

MR. MCNAMARA: I'm going to ask Patricia to answer that.

MS. MURRAY: I believe that through the Aboriginal Health Transition Fund several new projects were developed. Many of them were related to mental health and several of those were related to children and youth. I know that some of our district health authorities are working very closely with the First Nations communities in their area. I know Cape Breton works very closely with Eskasoni. I know in the Colchester area they work closely there, as well, and I believe down in the Valley too.

I think there's a growing recognition that that's certainly a need so I think all the directors of Mental Health Services are certainly aware and they're reaching out to their Aboriginal communities to try to make that happen.

MR. MACKINNON: Thank you for that. I'd like to talk for a moment about the partnering that takes place sometimes with the Department of Community Services and the role of the Department of Community Services in relation to funding of some mental health area programs. I use as an example the Schizophrenia Society of Nova Scotia recently seeking some funding from the Department of Community Services. What I'm talking about is the relationship that exists between the two departments.

In my constituency an advocate for the Schizophrenia Society of Nova Scotia, Cecilia McRae, is taking great leadership efforts with that society and is becoming a real activist and lobbyist on behalf of that society. So what is the role of Community Services in relation to mental health?

MR. MCNAMARA: I'll start and I'll get Patricia to finish. One of the things is we are working with Community Services, in particular the deputy, Judith Ferguson and myself, as to how we break down the silos of what has happened in the past. Not that there haven't been some partnerships, but we're trying to do it through a number of issues as we move forward. We do have individuals who we would consider - and I'll use the words "complex cases" - and how we ensure that that individual has a good experience through the whole continuum of care, whether it's transferring from them to us.

[Page 22]

One of the issues you're always struggling with is, who does this patient belong to? Is it a Community Services client or is it a Department of Health one? We're also breaking down those silos, so it doesn't matter who pays for it, let's figure out how we'll provide the best service for the individual, then we'll figure out the payments as we go forward.

We are working, with some assistance, with individuals from the government policy board to develop a go-forward policy on those types of cases. I would say it is a partnership, it is getting better, and our commitment is to do the best we can for Nova Scotians. Maybe I can ask Patricia to answer a little bit of what has happened in the past.

MS. MURRAY: We tend to say that the Department of Health is responsible for funding health services and the Department of Community Services funds support services such as housing and assisting with daily living skills and that sort of thing. So it gets to be a challenge when you have a particularly ill individual who stresses the Department of Community Services group because they're not always comfortable managing that illness. It may be that the person with the illness doesn't need to be hospitalized, and so to be fair to them they need to be managed within the community. But that's where some of the difficulty comes in.

To be fair to the staff in DCS, it's a particular skill set that you would need to have to handle some of these more difficult clients. I know the Nova Scotia Community College is introducing two new programs that should assist with that and they will provide the adequate training that these folks will need to actually be able to manage them in a home-like setting, so I think that will really enhance the quality of life for these folks and help with the working relationship so that mental health can provide the mental health piece and Community Services can provide the housing and support piece.

MR. MACKINNON: Thank you for the clarification. I think the more we can do in a lot of areas to get rid of the silos, the better it will be for the province and the people of the province.

What I'd like to move to now is sort of looking at what's happening in some of the other provinces to ascertain what kind of dialogue is taking place between provinces and what best practices may be emerging from some of those dialogues that are taking place. I assume that there is regular interaction between provinces to ensure that we all advance in this area.

MR. MCNAMARA: Thank you for that question. One of the things that we're trying to look at - and we have regular discussion at ministers' and deputies' meetings on a national basis - is how we can work together. One of the things that we will be doing this Fall is holding a mental health summit here in Nova Scotia for Atlantic Canada, which will involve all Ministers of Health for the four provinces, and getting some individuals who can give us some ideas on looking at how we can work together. We've also talked about how we can

[Page 23]

try to do some of our strategies more closely, working together, because some of our individuals cross our borders on a more frequent basis. But it isn't as easy as we would think, working with different governments and different provinces. Sometimes it's hard enough just working with the different DHAs, but we are moving that forward.

The second thing that I can say is that the Mental Health Commission of Canada has been working on identifying things that we can work together on. I happen to be in the fortunate position of representing Atlantic Canada on the Mental Health Commission that's led by Michael Kirby and the executive director is Louise Bradley, who used to work in this province and well knows our issues here. As a matter of fact, the minister and I are meeting with both of them this coming Friday just to talk about some ideas on a go-forward basis. So, yes, we're trying to learn from others, but there's still a lot of work to be done.

MR. MACKINNON: We all have important questions here today on an issue that is so vital to the province and its people. However, I must share my time and I pass it off to the member for Halifax Chebucto.

MADAM CHAIRMAN: Mr. Epstein.

MR. HOWARD EPSTEIN: Thank you very much, deputy and staff, for being here. Like my colleagues, I also regard this as a serious matter, but I wondered first if we could start with trying to clarify some of the terms that have been used. I wonder if you have your copy of the Auditor General's June Report with you and if you do, I direct your attention to Page 50. This is the initial section in which the Auditor General starts to discuss Mental Health Services.

If you have that you'll see that in Paragraph 4.4, there's a reference to the Institute of Health Economics which suggested in a September 2008 report called How Much Should We Spend on Mental Health?, there's documentation that mental illness accounts for more than 15 per cent of the disease burden in developed countries like Canada. Then the paragraph goes on to say that in Nova Scotia, really we only spend about 3.4 per cent of health expenditures. I'm wondering if you have any comments on those numbers, particularly the 15 per cent disease burden. Can you help us understand what's being said there?

[10:00 a.m.]

MR. MCNAMARA: I don't have the science on that, but what I can say is that yes, it's 3.4 per cent of the total Department of Health budget, it's 8 per cent of the district health authorities spending, but we all know that there are more resources required in order to move this forward. We're also looking at, as I mentioned in my opening comments, how we can tie primary care more into mental health services, how we can utilize what is there.

[Page 24]

One of the things that isn't recognized even when we talk about the percentage of expenditures is the percentage that is provided by other individuals out in the community, for example, through general practitioners. We know that they meet with some individuals who have mental health problems and do treat them. That's not part of the expenditure part that we would be showing or identifying but, again, I'm not a health economist, I just know it's there, it's an intuitive, and I don't know if Patricia can add anything further to that or not.

MADAM CHAIRMAN: Ms. Murray.

MS. MURRAY: The disease burden would be broader than just Health, so DCS picks up a piece of that, Justice picks up a piece of that, and Education does. Our funding is a certain portion, but they would all be contributing to assistance for persons with mental illness as well, so I think it's spread more broadly than just Health.

MR. EPSTEIN: Yes, my concern about this paragraph in the Auditor General's Report is not that it directs us appropriately - which it does - to the need for some more spending when it comes to mental health issues, it's the proportion. The casual reader of that paragraph would come away thinking that we really have to quadruple our spending because of the term "disease burden" which is used in this report from the Institute of Health Economics. But I went back and looked at that report from the Institute of Health Economics and when it talks about disease burden, what it means essentially is a shortening of life. It's really an economics term and it's far from clear that that's the appropriate measure in terms of numbers of dollars that any particular provincial government in Canada should be spending on a particular topic.

When you read through the whole of that report from the Institute of Health Economics, they come down at the end - and I think there are copies available for you and others there and I'll pass copies down to the Opposition Parties - that really, the bottom line for the Institute of Health Economics is that the appropriate measure is still to be determined and that when you look at different ways of approaching it, it looks like maybe 6 per cent, maybe 7 per cent, and Nova Scotia isn't really much out of line with what the other provinces are spending. Is that your understanding that Nova Scotia is about in line with what the other provinces are spending?

MR. MCNAMARA: If we look at the report that came out from IHE on how much we should spend on mental health, it shows that across the country it's about 8 per cent in total that's spent on mental health. So if we were using our funding to the DHAs, we are in line, but I think it's also recognized that in every province we need to improve our services to mental health patients.

MR. EPSTEIN: I was certainly agreeing with that, I wasn't disagreeing with that. I think that's the starting point for everyone. The worry that I had when I read that paragraph in the Auditor General's Report was that in linking the 15 per cent number or taking that 15

[Page 25]

per cent number as a starting point, there was a strong suggestion in the report that that should be the benchmark. I have to say that I see nothing in the underlying report that would support that. Anyway, moving on, I do have some other points and questions.

One is, I didn't hear, deputy, in your opening comments a reference to the Early Psychosis Program, which I think is run at the Capital Health District. I wonder if you could just bring us up to date as to the current status of that program.

MR. MCNAMARA: I'm going to ask Patricia to respond.

MS. MURRAY: Thank you. The Early Psychosis Program is alive and well, it is based out of the Capital District Health Authority. It's supported with psychiatrists, a GP with a particular interest in psychiatry, and other mental health professionals. I believe it addresses the needs of youth and young adults, so from 14 to 24 to 26. The idea with early psychosis is if you can identify it early you can make a profound impact on someone's life, so it's a critical service to provide and I think they do a very good job of it.

We also have some folks out in the community who are closer to the ground and able to identify some of these young people. We have a nurse who used to work out of Phoenix House that now is associated with the IWK and she works with a homeless population. She's able to identify when those young people are quite ill and she can get them into the services that they require. The idea is to get them treated almost with their first episode of psychosis and then the outcomes are very much more positive for them. If they're not treated early then the outcomes are much more negative and very serious harm can happen in those early years that prevents them from really making a full recovery or taking as great advantage of the services that are available as they're older.

MR. EPSTEIN: One of the well-recognized problems associated with the overall system for dealing with people with moderate to severe mental health problems is housing accommodation. I'm just wondering about your linkage with the Department of Community Services and service providers in the community that do have housing programs available. Is this something that's left entirely to DCS or is it something the Department of Health has some involvement in as well?

MS. MURRAY: We certainly have some involvement in that too. We work quite closely together between the Department of Community Services and the Department of Health. From the Department of Health's point of view, we are putting in the community- focused living units in Dartmouth and that's 40 beds that will accommodate those coming out of the hospital setting and transitioning them into the community. Community Services call on us sometimes because they have many facilities that house persons with disabilities and they may need our assistance with managing some of those people, so we're always open to working together with that and making sure the individual gets whatever services they

[Page 26]

require. If they require mental health services when they're living in a Community Services facility, they certainly have access to that.

MR. EPSTEIN: I'm wondering if the department has a model or favours what I would call supportive housing, rather than just housing? By supportive housing I'm meaning housing that has perhaps in place - whether it's 24/7 or for a shorter period - someone who is able to work with the residents and try to meet their needs beyond merely the housing needs?

MS. MURRAY: Yes, they have a variety of services available so they do an assessment of anyone coming into their system to determine what actually they need. Some of them need very little support, but they do need a place to stay and they need people checking on them, and some of them need much more 24/7 support. I would say that they determine their level of need and then they have a variety of settings that are able to provide a variety of levels. Mental Health Services fits into that in terms of what the mental health need might be and so that's provided as well.

MR. EPSTEIN: In the various projects that exist it's not clear to me where the funding responsibility might be divvied up. Are there some housing projects for those with mental illness that are the financial responsibility of your department and others that are DCS and if so, where's the dividing line?

MS. MURRAY: Generally the housing piece is DCS.

MR. EPSTEIN: So is there any money coming from your department? I had the impression there was, but I wasn't sure how it gets divvied up?

MS. MURRAY: More and more we're trying to sort out that piece, like who should be paying for what. Sometimes, as the deputy has said, it's less important about where the funding comes from, but we just want to make sure that the person gets the services they require. I would say on an individual basis when we have particularly challenging cases, the complex cases, we certainly do that and we share those costs. The community-focused living units may well involve a piece from DCS and there may be other things coming down the road.

MR. EPSTEIN: Thank you. I see, unfortunately, my time is up. I'll have to yield my 12 seconds.

[10:08 a.m. Mr. Leonard Preyra took the Chair.]

MR. CHAIRMAN: I believe we are going to move into the second round of questions. We have 14 minutes for each round, starting with Ms. Whalen.

[Page 27]

MS. WHALEN: There are still many questions to be asked, I know as the other members have said, this is an area of great concern to all of us, again, because of the prevalence of the incidence of mental illness and also the fact that there are long wait lists and difficulty in accessing services.

I wanted to go to the subject of communications and that was also highlighted in the Auditor General's Report about how well people can find their way through the system, whether they can find the right numbers to call and how to reach people. Although there are a lot of numbers of the Web site, I think we have to recognize that a lot of times when people realize they need to get help, they are in a crisis or things have come to a head and they often are not going to be in a position to wade through the Web site to find the different possibilities in their DHA.

One of the things that I'm often struck with is that people don't even know which DHA they're in. If they were to look at a list of the DHAs, it's not always clear and certainly not by their numbers. What I'm wondering is, how we are going to address that in the future? One of my questions would be that with the new nursing number that you can call - the Telehealth number, the 811 - that people are beginning to use that. If a person were to call that when they were in distress, either for themselves or for a family member, what information would they be getting for mental health and has the department addressed this?

MS. MURRAY: Yes, absolutely. We gave the nursing group a bit of an orientation before they started answering the calls and we have some plans to continue to do that. We're going to provide them with mental health first aid training so that they have a better appreciation themselves.

We've also identified in their directory all of the appropriate numbers that they can be referred to and the people that they are to call to simplify it for them and they have a whole protocol to know how to proceed. If it happens to be a crisis situation, they can quickly get them to where a crisis assessment can be done in whatever DHA they're from, through 911 and through getting them into the emergency department. If it's less pressing, then they can send them to the one contact number within the district that they are to call and then it's sorted out then - their level of difficulty and urgency and when they need to be seen.

I think that will be hugely helpful and I think they are getting more and more calls. We've been very careful to have that directory accurate and up to date, so that the information they're given is the best and the most efficient way to get into the services.

MS. WHALEN: I'm glad to hear it is up to date as well because things change so quickly that this is important. Have you any sense yet of how often this is being used? I realize the Telehealth just began in July 2009 - I believe it was July it was launched - so have we got any statistics or any sense of how often you're getting mental health calls through that number?

[Page 28]

MS. MURRAY: I asked the same question in the past week, actually, of our 811 folks. We're not quite there yet, but they are looking at it because they are recognizing that they are getting more mental health calls, I think, than they thought they might. Anecdotally it has certainly been identified. Something will be coming out once they've completed their first year, which is coming up, so we will get more information on how often that's used and I think it will just increase.

MS. WHALEN: Can I ask, are they tracking their calls so that they know what sort of issues people are using the Telehealth for?

MS. MURRAY: Yes, I think they have a very sophisticated tracking system where they can easily identify who's calling in about what.

MS. WHALEN: So that should be clear then if it's a mental health issue, it should be very clear what the numbers are at the end of the first year?

MS. MURRAY: The one challenge will be that people will call in, not specifically that they have a mental illness, but may call in for something else. The idea would be if it is possible to give them suggestions for a variety of things they may access, or help them understand what service might be most helpful. Generally, if someone certainly calls in with a mental health issue, it will be identified as that.

MS. WHALEN: Thank you very much. Maybe for Mr. McNamara, we'll go back there to the issue around having up to date information. It was noted in the report that the service and program information was not always communicated to physicians, so they didn't have up to date information. We talk a lot about the physicians and the primary care being, again, your first opportunity often to identify mental illness and that the family doctors need to be better prepared. What has been done in regard to that, Mr. McNamara, to address the communications issues with doctors?

MR. MCNAMARA: That is an issue that we will be addressing and we'll try to make sure that that is available to all physicians. We have to do some work to get it all together, so we're in the process, it's not complete yet.

MS. WHALEN: Had doctors complained that they don't have up to date information? Had that ever come up to you, previous to the Auditor General's Report?

MR. MCNAMARA: Not through me as a deputy. Going back to my days as a CEO, at times you would get queries from physicians saying, can I be made aware of all the services that are available, or sometimes how do they get access, even when the service is known because they felt - talking from a GP perspective - sometimes the response was not as quick as they would have liked.

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MS. WHALEN: I have a specific question around the amount of remuneration that we give family doctors if they're dealing with a mental health issue. We know that doctors are paid a set amount for each visit that they have, but if you're talking to somebody who had mental health issues you can't write them a prescription necessarily and send them out the door in five minutes. You really do have to sit down and do some time with them.

[10:15 a.m.]

I recently visited a primary health office, a doctor's office, and was told that they are limited to something like four times a year that they can see a patient on mental health issues. Can you tell me anything about that and if not, maybe could you get the information for us? They were allowed a higher fee for seeing somebody if it was to do with mental health and I think they were allowed to spend half an hour or 20 minutes - I'm not sure of the exact amount, but a longer period of time can be allocated. But if they do spend it with them one time they can't see them again for two or three months, which isn't really an effective way to use our doctors as a front line of delivering mental health services.

I hear more and more about the shortage of psychiatrists and the psychiatrists are saying a lot of times you don't need to see us and you don't need to see a psychologist. You need somebody who had mental health training, as you suggested, even our front-line Telehealth medicine, they can also know how to intervene in a mental health issue, by having special training. I think our family doctors just need some professional development, perhaps, and they would be able to do a lot of this and provide the hands-on care that a lot of people need in the community, but not if we don't pay them to do that, not if we don't allocate it in their fee structure.

It is certainly a lot cheaper to have a family doctor spend time with a mental health patient than it is to send them for an hour with a psychiatrist, which is going to be a much higher cost; they are specialists and also harder to get in to see because of the wait list. I am wondering if you are aware of this, if you could comment on it and if you don't have the information, if you'll get it back to me.

MR. MCNAMARA: None of the three of us here are aware of it so we'll have to follow up on it for you. I will add that as we're trying to change more into collaborative practices, as we're trying to move people more to an alternative funding program, we can ensure that the individuals get the time they need with the physician.

I do recognize, as some physicians will, for example, see people within a very short, limited period of time, based on the fee-for-service schedule but I also know that other physicians spend the needed time with their patients, regardless of how they're paid. It is something we have to work on and improve but I will check that fact, I don't know.

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MS. WHALEN: I've simply been to quite a few of the conferences and I'm sure it will come up when you do your conference in the Fall, about trying to use the other people in our health care system to do their maximum contribution, really, towards the care of mental health. If we're doing that, we have to look at how it's going to be structured and whether we can allocate the proper time for family doctors in particular.

I know there is more and more being said about that, even about counsellors in schools. There's a pilot project, I believe in Digby, that I think we should note today that is trying to empower teachers to identify early psychosis or mental health issues and intervene early. I hope that is working well so that we can expand it to other schools because I think it's a way that can be done in a very cost-effective way to identify and help people at an early stage, when it hasn't become a full-blown crisis for families.

MR. MCNAMARA: You have no argument from this department on that.

MS. WHALEN: Can you tell me, with the conference that's coming up in the Fall, if that is part of your mental health strategy? Is that tied into what you want to do, in terms of mental health strategy?

MR. MCNAMARA: It wasn't meant to be part of the mental health strategy. You're talking about the summit . . .

MS. WHALEN: Yes.

MR. MCNAMARA: . . . which came up at our first meeting of Ministers of Health in Atlantic Canada, after the minister came in and myself as deputy. At our first meeting the minister proposed that we look at trying to do something on an Atlantic basis.

The intent of the summit is to try and use - it's an opportunity to bring in some outside experts to give us some information, to think about how we can expand our services on a go-forward basis, to look at some of the new trends that are coming up in mental health. We know, for example, that there are vulnerable populations that we sometimes don't think about; some are surprising. For example, I can give you one example from an individual I heard speak, who was talking about individuals are doing quite well and if they lose their position or job, that they are more vulnerable, sometimes a suicide of individuals who have, so to give you an example.

MS. WHALEN: Absolutely, yes. With the recession, exactly. On the mental health strategy, I'd just like to ask what amount of money you have allocated to begin the study. I realize it is just mapping out a plan but still, can you tell us the budget for the mental health strategy?

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MR. MCNAMARA: The individuals who will be serving on the committee will be doing it on a gratuitous basis. The budget we're probably looking at in terms of the support that will be necessary is probably in the $100,000 range but again, that is a soft figure at the moment.

MS. WHALEN: Very good. Can you give me a timeline for when we'll see a mental health strategy announced or rolled out?

MR. MCNAMARA: I believe next July is the date that we're aiming for.

MS. WHALEN: So a full year, it will take a full year of study. Okay, that's fair.

MR. MCNAMARA: One of the things behind it, I wanted to mention, is we want to make sure that it is research-based with evidence, that it is not just based on opinions, it has some solid information behind it.

MS. WHALEN: Would that $100,000 include any consultants that you might be engaging to support the work of the board?

MR. MCNAMARA: It will not be consultants, in terms of consultants. We hope to use the research foundation to provide the evidence to help us move forward.

MS. WHALEN: Very good, I appreciate that. On the issue of the finances, and I know we don't have time to dive right into it but the difference between the 3.4 per cent that you say of overall budget of the Department of Health and the 8 per cent that the district health authorities are spending on mental health, I'm wondering if you can provide to the committee, because I know you can't go over it all right now, but can you later give us a breakdown of the spending on mental health in each of the DHAs and then your overall dollar spending here in the department as well? That way we'll get the total number of, I think you've got there $121.9 million is being spent on mental health. Perhaps you even have it - was it provided in our package? Oh, very good, maybe you'll just give me a copy afterwards. We get overwhelmed with our packages, they give us so much at once. I definitely wanted to have that breakdown so I appreciate that.

On the issue of finding your way through the process, I think I have just a minute or so left but I wanted to ask about the idea of a navigator for mental health. It has been tremendously successful with cancer care, and you would be aware of that from your previous experience. I know that the patients find that invaluable, to have somebody who walks them through what can be a maze of different specialists and offices and locations.

I think with mental health there's a real problem about finding the right services, knowing who to call. I think there's still a question that people who are better educated or better connected can find their way into the system a lot easier than a person who just picks

[Page 32]

up the phone book or goes on the Web site and tries to find where to get help, so we need a navigator. Have you looked at that?

MR. MCNAMARA: Not per se, in terms of mental health. I think what we have to do is utilize all the health care workers who are out there as navigators, regardless of when people show up in our system, whether it is through a primary health care network, whether it is through our acute care system or to one of our mental health branches. I think individuals can be navigators to everyone if we provide them the appropriate information.

When we become more specific or specialized, we tend to lose some of the importance of being able to deal with individuals across a number of services. For example, let's talk about some individuals may have addiction, some have mental health, some have some chronic diseases and how do we do this together. I think we have to stop doing things in silos and start looking more collaboratively.

MS. WHALEN: Well I do agree with that but you're not supporting the idea of a navigator at this time, then?

MR. MCNAMARA: Not at this time, no.

MS. WHALEN: The cost would be, I think, quite manageable if you look at just a few in the system that could do that.

MR. MCNAMARA: Every service that comes up is manageable until I start aggregating them up and then it becomes difficult.

MS. WHALEN: I think what was pointed out . . .

MR. CHAIRMAN: Ms. Whalen, I'm sorry, your time has expired. Thank you. We'll now move to the Progressive Conservative Party and Mr. Scott, you have 14 minutes.

MR. SCOTT: Thank you, Mr. Chairman. I just want to begin, I want to pick up where I left off with the deputy and his staff. I wanted to ask the Auditor General, if the Auditor General in his review and audit of health care monies, if he looked at whether he felt the amount of money spent on mental health per capita is fairly spent between rural and urban Nova Scotia, considering the large geographic area obviously of our province? Did you actually look at whether you believe that the amount of money spent through health, for mental health per capita, was fairly distributed throughout the province?

MR. JACQUES LAPOINTE: That wasn't part of what we were examining so I wouldn't really have any information on that at all.

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MR. SCOTT: Thank you, Auditor General. Do you ever do that in your review of departmental spending? Do you ever look at what is spent in the central part of the province versus what is spent in the outlying areas and how budgets are distributed, whether they are through other parties such as DHAs and whatever?

MR. LAPOINTE: If we were looking at that it would likely wind up being outside of the area in which we could give opinions. Quite often the decisions on that kind of spending and the allocation of spending would likely be areas of policy and other practicalities. It would be very hard for us to make decisions as to whether it was appropriate or not.

MR. SCOTT: Thank you for that. Just back to the deputy, I guess, and the staff. There were a couple of articles, one article, it's in the Evening News of October 1, 2009, I'm just going to quote Dr. Stephen Ayer, Executive Director of the Schizophrenia Society of Nova Scotia said that because of the stigma associated with mental illness there has been no push from the public to focus on improving the system.

I wonder if you could tell me, deputy, does the department very often receive concerns from throughout the province in regard to the non-availability of services in certain parts of Nova Scotia, from either mental health patients themselves or their families?

MR. MCNAMARA: We do receive concerns from individuals and from organizations. Dr. Ayer is a very strong advocate and appropriately so. I think one of the things that we need is more people advocating. Even as my predecessor had said, I think, when you are in government individuals should be advocating stronger for mental health services which helps government and us to respond to those needs, so we do welcome that. There are areas where individuals are impacted, that they make sure they let us know of the impact on them or their lives.

MR. SCOTT: Again in a Halifax ChronicleHerald article of March 9, 2010, the headline says: "The long road to mental health. Services sparse or non-existent in rural parts of the province."

I wonder, deputy, if you could tell me in regard to the priorities for your department with regard to mental health, where would you say - that statement says a lot and I'm wondering if you could tell me, in your list of priorities, where you would see providing services.

I heard you say earlier about closer to home and I was really pleased to hear you say that. You know if the answer was easy, it would have been done long ago. Obviously it is a huge challenge, I understand that and I will tell you if you and your staff are able to address this longstanding problem, I'll be the first to congratulate you because it is something that has been longstanding for many years now and I understand that.

[Page 34]

I'm really interested to hear where you believe that statement, that services are sparse or non-existent in rural parts of the province - where in your list of priorities for mental health, where do you kind of see that issue fits?

MR. MCNAMARA; Well I think the first issue is on the first point of contact. For example, if I use Yarmouth as an example, they do have an in-patient unit where you have one psychiatrist. Then, for example, you don't have the services that could support a full 24/7 type of service if individuals need it because you have one individual who can't obviously work those types of hours, so that does create an issue for us.

We do know that there are parts of the province that, because of the resources available to us, we do not have the services we'd like to have. If we can work better through primary care, work better at getting to individuals earlier - and we are exploring some opportunities. Are there some new ways, for example, of being able to deal with our youth? We know, for example, that many young people access information differently than we, in my age group - for example, I read the newspaper, they use Facebook. We have to look, are there ways that we can use those new modalities to try and get the young people earlier, to let them know first of what services are available or how they can connect into the assistance that might be available or even how they can work together as self-support groups.

MR. SCOTT: Thank you. I have to keep referring to Cumberland but I think Cumberland County to me would create the same challenges. For example, you just mentioned Yarmouth; a lot of times these communities or counties that are not surrounded by other Nova Scotia counties just in itself is a challenge for them when it comes to attracting professionals and providing services because they don't have the opportunity to reach out around them. You really have only one direction to go if you're going to stay within the province.

I also want to say as well that the district health authority in Cumberland County does a tremendous job. Bruce Quigley is the CEO, he has a wonderful staff, they have a great board and they do a fabulous job. They face a lot of challenges as well.

I believe the amount of monies allocated for Cumberland County is $2.4 million, does that sound right, for mental health?

MS. PENNY: Yes, $2.460 million.

MR. SCOTT: Thank you. Could you explain to me how that works? Do you allocate that $2.460 million as part of their global budgets and then are there core programs that are identified by Department of Health where money has to be spent, or is there some discretion - do they have some discretion in regard to how they may spend some of those dollars?

[Page 35]

MS. PENNY: They can't spend it outside of the mental health field so there are some core programs that have to be spent on those particular programs, which Patricia could speak to specifically. Then there would be a non-portable mental health block of funding which would give them a bit more flexibility, so it's all within mental health.

MR. SCOTT: It's all within mental health. Are those dollars each year, annually, are they always spent, the full amount allocated to the DHAs?

MS. PENNY: I would say very close.

MR. SCOTT: I'm sure they have lots of places for it as well. I mentioned earlier about All Saints Hospital to you, deputy, and All Saints Hospital is a hospital that also has addiction services, which to me would seem to go hand in hand, if there was an opportunity, to reserve at least a couple of beds in that facility for mental health. My question is, if the DHAs saw fit, would they be able to allocate some of those mental health monies they receive through their budgeting to enhance the opportunity for other services, for example, All Saints, whether it was a couple of beds or whether it was to provide professional services? Would they have the flexibility to do that?

[10:30 a.m. Ms. Diana Whalen resumed the Chair.]

MR. MCNAMARA: I can answer that. As Linda Penny said, the money that's allocated for mental health is non-portable, but they can take funds from a portable budget and enhance their mental health budget. So they do have that option.

MR. SCOTT: I'm not suggesting that they have additional funds that they don't have a place for and they can do that. I was just curious if they saw fit, and there was an opportunity, would they be able to use those for mental health services in Cumberland, but maybe in a different way than normally is being done today?

MR. MCNAMARA: My understanding is almost every district supplements the non-portable money with portable money.

MR. SCOTT: Yes, I'm sure they do because they're very creative there, as well, in regard to finding dollars to support programs that they see a need for in the county.

I just want to talk a little bit about Corrections. Cumberland County is unique, as well, in that we have the only federal men's institution in Nova Scotia in Springhill, in excess of 400 inmates, where the federal government would actually provide for federal services of all types. One of those would be psychiatric and other issues that inmates would face as they spend time in that institution. I'm wondering, has your department ever looked at the possibility of sharing services in Cumberland County for residents with the federal government?

[Page 36]

MR. MCNAMARA: Obviously we haven't to date, but it's a suggestion to look at.

MR. SCOTT: I appreciate that. As I said, we have a federal institution there. Presently, we have a provincial institution, as well, until this present government saw fit to remove that service from Cumberland County, thinking that the residents of Cumberland County no longer need that, which is obviously an issue of disagreement among us. As well, those incarcerated provincially require services as well.

My understanding is there may be some contractual agreement between the province and the feds with regard to using those federal services. It would make sense to me if we have an issue around bed space, if we have an issue around being able to attract professional services, for example, in a rural area like Cumberland County, and there are other service providers - in this case the federal government is providing that service - it would make sense to me to look at forming some sort of partnership.

I know in my discussions over the last couple of years, the federal government was very interested in forming partnerships in regard to providing services for provincial and federal, both inmates who were incarcerated as well as staff, they were very interested in pursuing that. I'm sure they'd be very interested, as well - I believe they would - in regard to providing services through the community, whether it's through a contract or whatever. I would ask, deputy, that you at least take that under advisement and at least have someone in your department follow up to see if there is an opportunity. There may be an opportunity to provide a service in Cumberland that's not there today but is in a very secure setting, and that's at the federal institution.

I'm asking if you would consider taking it to the deputy level in regard to looking at the challenges in rural Nova Scotia in regard to attracting those professionals I talked about earlier. I'm asking you if you would take it to the table, to the other deputies, in regard to looking at opportunities to try to help rural communities find opportunities for spouses as well as for professionals.

Over the past week I had an opportunity to talk to one of the organizations in Nova Scotia that represents a group of professionals. They do a tremendous job and I didn't realize until I actually spoke to them what they will do in that regard. I just think there are probably opportunities there today, but I don't think there's a link presently that would kind of marry those issues together.

I think at your level, if you could bring that to the deputies' table, whether it's psychiatrists for Cumberland County or whether it's a GP for Yarmouth, I think you would find that there probably are resources out there that somehow we could bring those together. Again, I know these are huge challenges and if they could have been easily resolved it would have been done a long time ago and it wasn't. I do applaud the efforts of your department if

[Page 37]

you could follow up on some of those concerns of mine on behalf of the residents that I represent and try to find some solutions.

It was mentioned earlier about Community Services. Does Community Services actually receive any direct amount of monies in their budget, that you're aware of, for mental health? For example, in Cumberland County, would they have any monies that would come from your department, but flow through maybe their own budgeting process that would be allocated for mental health services?

MR. MCNAMARA: I'm not sure of what's in their budget, but it would be through their own resource. I can't answer that question for you, I'm sorry.

MR. SCOTT: But none from your department that you're aware of.

MR. MCNAMARA: It wouldn't come from us to Community Services.

MR. SCOTT: Maybe the strategy will take a look at this issue but . . .

MADAM CHAIRMAN: You have just 30 seconds.

MR. SCOTT: Very quickly, I think there are other issues that face professionals locating to rural areas. In this article in The ChronicleHerald - I think it was this one I looked at - they talked about transportation issues, no affordable transportation, so there are many issues like that. It seems like a lot of the time the solution is very simple, but very often it's very complex, and I don't know if the strategy will take a look at these other issues as well. Could you tell me, deputy, if you believe there are other issues in rural Nova Scotia besides just the issue of mental health?

MR. MCNAMARA: We'll look at as many issues as we can get in there.

MR. SCOTT: We'll see that you have those, thank you. Thank you for your time.

MADAM CHAIRMAN: I'll turn the floor over now to Mr. Preyra from the NDP caucus.

MR. LEONARD PREYRA: Madam Chairman, it's a fascinating area and so complex. I have just a few questions. I wanted to go back to the Auditor General's Report as it related to performance measures. It seems to me that there's a great deal of value in that report because the Auditor General says on one hand he has been tasked with the idea of looking at whether government expenditures are done in accordance with established standards and processes and what the Legislature has approved, and on the other hand you have standards that are fairly vague to the point where they're almost unenforceable if not immeasurable.

[Page 38]

I thought I heard you say that you're going to go back to revisit those standards to see whether or not they're accurate, whether or not they're realistic, whether or not they conform with the evidence you have since those standards were set. I'm wondering, how are you doing that? It doesn't seem to me that it's something that's peculiar to Nova Scotia and whether or not you have some international or national measures that you're using or can use to sort of meet what the Auditor General is saying, clarify those standards, make them measurable so that we can actually understand to what extent we are meeting the standards we have self set.

MR. MCNAMARA: I'm going to turn it over to Patricia to talk about the specifics, but from a department point of view, what we've been working hard on is trying to come up with areas where we can measure and hold accountable DHAs or other entities that we're working with. We've been working hard to make sure that accountability is an important part of the department's work - whether it's for dollars, whether it's for programs, it is a lot of work.

In the past - not that it was done with bad intentions, but I think we moved from one project to the next without going back to make sure we crossed all of our t's and dotted all of our i's, so we are changing our system, our philosophy and culture to make sure that's included. For the specifics of your question, I'm going to ask Patricia to answer.

MADAM CHAIRMAN: Ms. Murray.

MS. MURRAY: Thank you. The standards we developed, just to clarify, our service delivery standards as opposed to clinical practice standards, they outline things like what type of professionals need to be delivering the service, and we're quite clear about that and I would say those standards are well respected. For example, we don't have anything lower than a master's-prepared clinician offering individual treatment and doing so autonomously. We also have set out specific wait times and those are quite measurable and that's what we're beginning to look at more carefully now that we have computer programs and that sort of thing in place, that we can actually take a close look at that across the province and be able to compare it. The standards have been in place for quite some time and people are well aware of them, the districts are well aware of those.

What we're doing now is sitting down with the standards and going through them statement by statement to see if there is any way we can sort of operationalize that and really come up with a clear measure of what we're doing. The first ones we looked at, for example, were our prevention, promotion, and advocacy ones and what specific things we can do to assist with that. We've become quite involved with the Mental Health First Aid program so we can say that we can ensure there are Mental Health First Aid trainers in every district, and we can make that available and offer so many sessions a year and that kind of thing. So those kinds of things are more measurable and we'll just walk ourselves through all of the

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standards and wherever we think we can put closer parameters around them and make them more measurable, we will do that.

They have been reviewed on a regular basis and they are certainly best practice in terms of service delivery, so I wouldn't want to give the impression that we haven't looked at them since 2003. We look at them regularly and we bring together a group of people to sort of edit and update them every three to five years. So we have gone through all of them, I believe, just to make sure they're very solid in terms of the content. Now we have to go back and see okay, how can we define even the language around it and the specifics, to make sure they are easier to measure?

MR. PREYRA: So it is a work in progress and I guess you have to be commended for trying and striking out at that time and establishing benchmarks to provide for accountability but it's clearly both - I mean it's something the Auditor General has flagged but also from an accountability question, we need to know whether or not we are delivering services in the most effective way.

The member for Cape Breton North asked a number of questions about related strategies. It seems to me just in listening to his questions and the subsequent questions from other members that the mental health strategy is connected to so many other strategies. Although it seems desirable that we deal with all these silos and break down those barriers, at the same time there's just so much complexity and there are so many people involved that it's difficult to attach how much we're actually spending on mental health issues.

I have a more specific question about the Child and Youth Strategy, particularly issues relating to young people in junior high and our ability to identify kids at risk early. At the time, at least at the time of the Nunn inquiry, he said there was a real gap there between what the Department of Education was doing and what the Department of Health was doing and they didn't seem to know that there were services available. Can we expect or are we seeing any progress in that part of it and making sure that we detect these issues early and provide support where it's needed, for kids at risk?

MR. MCNAMARA: Again I'm going to get Patricia to talk to specifics but just to go back to my previous role as a CEO, before coming in as deputy for South Shore Health, mental health services were actually in the schools working with the staff to try to identify issues, working with teachers, working with teachers' aides and then also from that, working with the individuals who did require assistance, so some work is being done in the districts, From a provincial perspective, I'll let Patricia answer it.

MS. MURRAY: There is a SchoolsPlus pilot project in place, I believe, in four areas around the province: I think South Shore is one of them, I think Cumberland might be one of them, the Strait Regional School Board, and in Halifax. The idea behind that is to have a lot of services that children and youth require available either in the school or have it

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accessible through the people at the school. There's a coordinator in these schools and they connect with all of the various resources that might be available, including mental health. I know mental health has played an active role in that to make sure that they are identified early. If they could be treated in the school, fine, through some programming they have there, or they are referred on to the more formal clinic.

There are teen health centres. They're not always in junior high. Sometimes high schools are junior and senior high in more rural areas so they may cover both. I know there has been a push on to have as many teen health centres as possible available around the province in schools. I think that has been a huge help. They do identify that mental health is one of their larger topic areas that they deal with.

I also know that the Department of Education is introducing a new curriculum, a mental health curriculum that has been developed by Dr. Bianca Horner. I believe it can start in elementary school but it certainly starts in junior high. It's not mandated but it is an option. It has a very clear curriculum guide for teachers who may not be comfortable or familiar with mental health issues, then it has workbooks for the students themselves. We've reviewed that and that's actually a very excellent resource and the Department of Education has introduced that into the schools.

[10:45 a.m.]

I think there are lots of things ongoing. I think the Child and Youth Strategy certainly shone a light on the needs of children and youth, really from conception on. So the strategy itself has tried to fund pilot projects and then carried those forward across those various age groups and are continuing to do so.

MR. PREYRA: Thank you. I have a couple more questions about - well, just follow-up questions from questions that were asked earlier. Mr. McNamara, you were asked to comment on the Boots on the Street program and I know that is not in your area of expertise, but I did want to correct a statement that the member for Cape Breton North made.

The Boots on the Street program has not been cancelled and there are officers who have been allocated to Cape Breton. In fact, there are seven officers who have been put in place in the Cape Breton Regional Municipality. It's the first time that I have seen the Boots on the Street program referred to as a mental health strategy, as a component of the mental health strategy. In any case, I did want to correct that because I know you couldn't be expected to answer a question in that area.

I also had a comment about the request for the various parties involved in the gaming strategy, and I think that's a question that is more appropriately answered by the Department of Finance as to who would be consulted and who would be involved in that strategy. It's

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kind of you to agree but I assume that you will be part of the strategy but not leading that strategy.

MR. MCNAMARA: Just on that, just for Mr. Clarke's benefit and that of the committee, I did mislead a little bit. I thought I might have when I said - but the individuals who are involved are deputies from Finance, Health, Health Promotion and Protection, Labour and Workforce Development, as well as CEOs from the Office of Aboriginal Affairs and the Nova Scotia Gaming Corporation. So that's who the committee members are.

MR. PREYRA: There you go, I got it clarified for you, I believe, which is useful. I think we do need to find out who the parties to this agreement will be and it's just more properly directed to the Department of Finance. We try to help the Opposition from time to time as well.

Ms. Murray, I'm really glad you mentioned the teen health centres because I have personal experience with them at J.L. Ilsley. That's a fabulous program, to get kids directly involved in peer counselling and learning to help their classmates is just wonderful. I've seen the success there so I think it is a good idea and I applaud you for supporting that and for mentioning it.

While we're on the subject, I also should say that the mobile crisis unit in my constituency and I guess across Nova Scotia - I don't know how widespread it is - does a fantastic job of dealing with issues as they arise. You get a call from someone saying they are contemplating suicide and the mobile crisis unit is right there to give you advice and support and to deal with it. So where people reach those services they're just exceptional and the question is, how do we expand it? Similarly with Direction 180 and Phoenix House, and the Department of Education has its own programs. I know we tend to sometimes look for more that you can do but what is being done is also pretty commendable.

I had a question about the connection to emergency response services and, again, it's another example of different things that are all going on simultaneously. Dr. Ross is looking at mental health in part, as well, and mental health treatment in emergency rooms. Are you able to comment on what we are looking for there and where we might go - not to anticipate Dr. Ross . . .

MR. MCNAMARA: I can't anticipate, but one of the things we did ask him to look at is how individuals showing up in emergency access the service and how they get referred appropriately, once they arrive at an emergency room. One of the difficulties at times is that individuals requiring mental health services need to be looked at in a different way in order to ensure that they are safe, they're protected and they get the appropriate treatment as quickly as possible. That's one of the things that we've asked Dr. Ross to look at.

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MR. PREYRA: I believe I have a minute. I have a question - actually, I don't understand the answer to the earlier question. There was a $23 million gap identified in 2007-08 between what was expected to be provided and what, in fact, was provided. Does the Auditor General have access to information in terms of how much a program will cost relative to the department's budget?

The Department of Health is a huge, complex department and I'm wondering, how do you identify gaps in particular areas, given that you're looking at an overall budget, as well, that has fairly significant gaps and needs?

MR. MCNAMARA: My understanding is the information that was provided to the Auditor General by our department was based on our best projections, based on the standards that were outlined and what we thought it would cost to get there. Again, it's not 100 per cent accurate, but it's our best estimate on a go-forward.

MR. PREYRA: I believe I have one second and it's done.

MADAM CHAIRMAN: That's it, thank you very much, Mr. Preyra, I appreciate that. That concludes our questions today for the witnesses on the Mental Health Services issue. As is our practice I'd like to give you a couple of minutes if you would like, Mr. McNamara, just to sum up or have some concluding remarks.

MR. MCNAMARA: Just very quickly. First I'd like to thank the committee and the Auditor General for bringing mental health to the front of mind. I think it's important that as we look at the options that government is going to deal with on a go-forward basis, as well - with the support of all Parties - how we can allocate any resource that we may have available to us.

One of the issues around mental health is with the stigma, as many people have talked about. Sometimes when you're looking at whether you'll spend your money on a new drug, a piece of equipment or a new program, mental health doesn't get the priority. Sessions such as this help the department, help the minister in moving that agenda forward, so we do appreciate that.

We also appreciate the support of many of the advocates and it was mentioned, Cecilia McRae and I know Stephen Ayer and others - that is very helpful to us as well in trying to look at what we can do in the future.

I can tell you there's a sincere commitment from the minister, from the department and our staff to advocate for mental health services as we go forward. Thank you.

MADAM CHAIRMAN: Thank you very much, Mr. McNamara. Also, I think I speak for the whole committee in saying that we're very pleased to see it getting more prominence,

[Page 43]

the whole issue of mental health services. The fact that a mental health strategy is beginning is a very positive thing and I know we'll all wait with anticipation to see what suggestions are made. I think we do need to be bold in identifying the best practices and trying to improve Nova Scotia's services for people who need this help with mental illness.

There were a couple of requests for information - I think we may have had an answer on the gaming strategy question. The other question I had was if you could check with Doctors Nova Scotia and see what the contract allows, if there is a special provision for mental health visits at a family doctor, so that's very important as well.

With that we have a little bit of committee business, if you'd like to leave, that's just fine. Thank you very much, again, for joining us today.

On the committee business, before we adjourn for a few minutes and then come back for agenda setting, I just wanted to draw your attention to the three items of information that we have received from previous meetings. One is from the Workers' Compensation Board, which is quite extensive, one from South Shore Health, and the third is from the Sydney Tar Ponds. If everybody has received those, that's just to draw your attention to it.

I'd like to adjourn, just until 11:00 a.m. and have the full committee back for agenda setting at that time. With that, could I have a motion to adjourn?

MR. MACKINNON: So moved.

MADAM CHAIRMAN: Thank you very much and we'll return.

[10:53 a.m. The committee recessed.]

[11:04 a.m. The committee reconvened.]

MADAM CHAIRMAN: We have our full committee before us so I'd like to call this meeting back to order. This is the full committee of the Public Accounts Committee but we're meeting to look at agenda setting, which has been a recent practice that we have begun. As the members are aware, we have had a little break in that and we're coming back hopefully to reconstitute the process and to move forward with the Public Accounts Committee.

As is our practice, I'd like to begin with everybody introducing themselves once again, for Hansard. I should say before you begin, Mr. Epstein, welcome to the full committee of the Public Accounts Committee. I gather you are coming back to the Public Accounts Committee again as a member of the committee.

MR. EPSTEIN: I am and thank you.

[Page 44]

[The committee members introduced themselves.]

MADAM CHAIRMAN: Thank you very much. As I mentioned, we have returned to see where we will go with the agenda-setting for this committee. When we adjourned on June 9th we did not have an agenda in place for the coming year, which was a concern. Today's meeting with Mental Health Services was our last established meeting that has been set so we have only one item on our agenda that has been approved at this point, that would be the Gaming Corporation which has not been set and will now fall sometime into our new year, beginning in September.

In the interim, I had written to the Speaker, asking him as Chair of the Committee on Assembly Matters, if he could rule on or provide some guidance to the committee. Then, at the same time, our Leaders have met to talk about a go-forward strategy as well for the committee. My hope today is that we will be able to chart that course and move forward and see that in September we have a direction and, hopefully, items on the agenda so that we can begin and continue to be effective in the work that we do, which is really on behalf of all the people of Nova Scotia, to review programs, to look at spending and so on. It's an important accountability committee. Mr. Clarke.

MR. CLARKE: Thank you, Madam Chairman. I'm just wondering, given that there's discussion, for the benefit of Hansard and clarification, I'd ask that you would read - I know it's a two-page letter but I would ask that you read the content so it can be part of the Hansard record and I would ask that the Clerk would read the response from the Speaker, so that it can be a basis of further discussion here today.

MADAM CHAIRMAN: Well, I think - Mr. Preyra.

MR. PREYRA: Madam Chairman, if you could table that, I think that would be preferable and we can get on with the business that we are about.

MADAM CHAIRMAN: Mr. Colwell.

HON. KEITH COLWELL: Yes, Madam Chairman, I would also like to have it read into the record.

MADAM CHAIRMAN: Well, with the request, I think there's no harm in reading it into the record, other than the time that it takes, so if the members will bear with me - I know you've just been given a copy yourselves. Mr. Preyra.

MR. PREYRA: Madam Chairman, we all have copies of this letter and I should add that the letter was written without the approval of the committee itself so there's a question about whether or not this is a letter from the committee. I would say that since we do have copies of it, the letter should be tabled and we should move on.

[Page 45]

MADAM CHAIRMAN: Mr. Clarke.

MR. CLARKE: Well, with all due respect to the honourable member, Madam Chairman, I've asked you to read this into the record for the benefit of Hansard and in light of the previous discussions - and here we go again. If the member doesn't want to do that, I have motions to move and I'll read it myself into the record as part of the clarifying and response to a motion.

I've asked you, and I think it's the prerogative of the Chair, I've asked you to read into the record. I don't see what's wrong with that.

MADAM CHAIRMAN: Mr. Preyra, when I arrived today, it wasn't my intent to read it into the record but I think there is nothing lost by doing so and I think that it would be better not to argue about it. I think we could do it simply as part of the record it stands and, as you say, the letter would be tabled anyway. Mr. Preyra.

MR. PREYRA: Madam Chairman, you know this meeting has been organized to help facilitate the process of moving the agenda forward. This is a letter that we had no warning about, we had no inkling of it. It was sent forward, it was received and in fact for all we know, it would never have been tabled today. So if we want to move forward in the spirit of good will and constructive co-operation, I think we do need to table this report and we do need to move forward.

I think it does, in a way, carry over from the last meeting where clearly things have been put on the record here for cheap, partisan advantage and grandstanding and we seem to be back to that. My question is, if we want to move forward on agenda setting, we should table this letter and move on to agenda setting. This is an agenda-setting meeting.

MR. CLARKE: Okay, Madam Chairman, as part of following up - here we go again by the deputy chairman of this committee. When we have tried to have an open and transparent process and, as I indicated to you coming in here today, that we would like to have motions that follow up on the discussion by the three Party Leaders. Part of that, before we moved on to agenda setting, was to acknowledge what the Leaders discussed and looked at the mechanics with regard to process of follow-up to what I understood was consensus by the three Party Leaders yesterday. The reason being is that part of the process to move forward is that it does take into account what you have sent to the Speaker, his response to you in relation to one of the mechanisms that was a direct outcome of the meeting yesterday. So I would just say to the honourable member, I have a motion to move and if he doesn't want to have you and the clerk read those, I will read those aloud as part of my motion.

MADAM CHAIRMAN: Ms. Kent.

[Page 46]

MS. BECKY KENT: I was not at the meeting, unfortunately, when this occurred, although your letter reflects perhaps what had happened. What I would like to know, as suggested by my colleague, and in the effort of establishing openness and transparency in the process of this committee - can you tell me if you were directed by the committee to write this letter to the Speaker regarding this?

MADAM CHAIRMAN: No, I wasn't. When the committee ended its meeting on June 9th, it had actually ended very suddenly with no go-forward plan, no agenda was set and I was, in fact, concerned and I know the members who were here probably shared my concern about the direction and the continuation really of our work. As Chair, one of my very first responsibilities, which is written in the mandate of the committee, is to ensure that we meet on a regular basis and that the committee is going forward and so I was appealing to the Speaker to help me in that.

MS. KENT: All right, I just wanted that to be on the record that we were not aware of the nature of the letter. I accept your explanation and I think at this stage that it would be recommended that we do move forward. I don't know that there's anything and perhaps if legal counsel is here, to suggest that there's any reason why we can't have this read into the record. But, again, I would like to note that this was not a direction of the committee, this was you as the chairman and move forward from that.

MADAM CHAIRMAN: I appreciate that. I do think there's merit in putting it in the record. I had not reviewed the letter, but I know that when I wrote it my intent was to let the Speaker know we had come to an impasse and that I was looking for some direction and assistance. Maybe, Mr. Clarke, you would read that into the record as you suggested. You made that suggestion that you would like to as part of perhaps a following motion.

MR. CLARKE: Yes.

MADAM CHAIRMAN: My intent, as I said, in writing the letter, just beforehand, was certainly to see that we ask the Speaker and whatever powers that be to help us to stay on track. So, Mr. Clarke, if you'd like to do that, we'll get the answer from the Speaker and then we'll move forward.

MR. CLARKE: Madam Chairman, I was proposing to move a motion here today that deals with the outcome of the discussion that was held by the three Leaders yesterday to come to a resolve that they, I understand, had consensus on.

One of the things around that would be a change with regard to Rules and Forms of Procedure. One of the mechanisms would have been through the Committee on Assembly Matters. In your prerogative as the chairman of the Public Accounts Committee wrote to the Speaker looking for guidance which I think, given the situation at hand, was very appropriate.

[Page 47]

[11:15 a.m.]

On June 10, 2010, you wrote to the Honourable Charlie Parker, as Chairman of the Committee on Assembly Matters, who serves in that capacity as Speaker of the House of Assembly and of which you wrote regarding Public Accounts Committee challenges. I would read into the record:

Dear Mr. Parker:

I am asking you to call a meeting of the Committee on Assembly Matters no later than June 18, 2010, to deal with the very serious situation which threatens the ongoing work of the Public Accounts Committee.

The Public Accounts Committee is the most significant committee of the legislature; there's no established Western parliamentary democracy that operates without one. The Committee provides an essential function to the people of Nova Scotia by examining activities of government and helps to ensure better accountability, transparency, and value for money. Without the Committee operating at full capacity, the Legislature, and indeed the Province, suffers.

Our Committee is currently at an impasse and is unable to function.

The Public Accounts Committee has had a difficult year maintaining its momentum and getting cooperation from the government members in setting the agendas. At the Public Accounts Committee meeting on June 9, 2010, these issues came to the forefront and resulted in Mr. Clarke, the Conservative member, walking out of the Committee. Mr. Colwell moved that the meeting adjourn with no agenda items approved for September.

This specific problem arose during a public agenda setting session of the full Committee. The NDP members put forward a motion to cancel the scheduled witnesses for the June 16, 2010 meeting - with only four business days of notice. This sudden motion to cancel on such short notice was unprecedented and unprofessional. However, with a majority of members of the Public Accounts Committee in the NDP caucus, the motion was carried despite strong objections to the contrary.

Making matters worse for the Committee, the scheduled witness was Marie Mullally, President and CEO of the Nova Scotia Gaming Corporation (NSGC). Throughout this year the Committee has had difficulty in scheduling this witness. The Committee unanimously requested that a letter be sent to Ms. Mullally expressing our collective frustration at her seeming lack of

[Page 48]

availability. This letter was supported by all members of the Committee and should serve as evidence that the Committee felt strongly that this was an issue of importance - all members of the Committee agreed that further delay was not warranted.

Clearly, the NDP caucus members on the Committee supported the scheduled date of June 16, 2010. Both the Auditor General's scheduled date of June 3, 2010 and the NSGC date of June 16, 2010 had been approved agenda items for quite some time. This is why it was so shocking and frustrating to see the NDP caucus members of the Committee push through such an abrupt and last minute change.

There have been numerous times throughout the year that our Agenda Setting Sub-Committee was frustrated and in fact hampered in our duties to keep the Committee business moving forward. This frustration lead (sic) directly to a motion to make the agenda setting process a public one. I had hoped that meeting in public would improve the level of support for the work of the Committee. Clearly, this has not happened.

It is urgent that the Committee on Assembly Matters be convened to review the situation that has developed at Public Accounts. This is clearly a case where the work of the Legislature is being obstructed. This is an affront to the efficiency and effectiveness of the House of Assembly.

I ask that you set a meeting date for this Committee no later than June 18, 2010, and that the Public Accounts Committee crisis be the first order of business at that meeting.

I look forward to meeting you soon to help resolve this unacceptable situation that has diminished the intended scope and power of this Committee.

Sincerely,

Diana Whalen, MLA

Chair of the Public Accounts Committee

To which, Madam Chairman, on June 14, 2010, a letter was sent to you, as Chair of the committee, written by the Speaker, which reads:

Dear Diana:

Thank you for your letter of June 10, 2010 concerning difficulties being experienced in the Public Accounts Committee. I thought it best to

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send to you a preliminary letter to allow you to ponder the best course of action available to you as Chair.

You have requested a meeting of the Committee on Assembly Matters. The mandate of this Committee is set out in Rule 12A. The basic role of the Committee is to examine the Rules and Procedures of the House. It can do no more than make recommendations for Rule changes. It has no power to discipline, to issue directives to other committees or to hear questions of Order of Privilege.

If the House were in session, then the complaints you speak of could come forward either on an appeal to the House on a point of order or possibly even a matter of privilege. The House will likely not meet until the fall, as you know.

In the meantime, you could make the issue more publicly visible by engaging the media directly through the written or spoken word and/or call together the PAC to debate the very issue. The Sub-committee may also be an avenue of resolution.

Does this provide any assistance to you?

Sincerely,

Charlie Parker

Speaker

So, Madam Chairman, with that and in looking at the concerns that we've already heard raised, subsequent to that and moving the Leaders - I believe it was the Liberal Leader had made a request to the Premier that the three Leaders have a meeting to discuss what you refer to as the impasse at the committee level.

One of the things that I understand of that meeting was a recognition that we should go back to the subcommittee structure to allow for a dialogue and a vetting and hopefully, a consensus-building process, so that the full committee could work forward in a better manner - even though I think what we were trying to do at full committee was to have that so it was very transparent and clear to all, but I accept that.

The other component that I believe was recognized by the Leaders - and at this point I say it's a gentlepersons' agreement - was that any committee agenda-setting matters, if a matter has been set by the agenda, that there would be no votes allowed to overturn that agenda item unless it was a consensus of the committee for obviously overlying reasons that would be provided that would require a change in agenda. That's my understanding of that.

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As a result of that understanding, it does not exist - Mr. Hebb, as our Legislative Counsel - it does not exist right now, other than a gentlepersons' agreement. One of the issues that we've dealt with that has brought us to where we are today is various opinions on the interpretation of what the practice and procedures should be in the functioning of this committee. So by the very matter of the Speaker saying he didn't believe it could go to the Committee on Assembly Matters to make a rule change as he has indicated, it could be.

The Leaders have come to a decision that affects a rule change by that, so it could have gone there but given that the Speaker has not convened and will not convene the Committee on Assembly Matters, then you have to look at a resolution that can best accommodate that.

With that, I would make a motion that the Public Accounts Committee recommend to the House that a resolution be accepted that would amend the Rules and Forms of Procedure of the House to accommodate the resolution agreed upon by the three Party Leaders.

MR. COLWELL: Yes, I'd second that motion.

MADAM CHAIRMAN: Okay, fair and good. Mr. Preyra.

MR. PREYRA: Thank you, Madam Chairman. As you know, I am also a political scientist and there is no parliamentary system in the world that would allow a subcommittee to establish the agenda of a committee that refers business to it. Any item that is recommended by a subcommittee is that - it's a recommendation - and the committee itself has the complete right to discuss and debate and approve and reject and there is no agreement in the world that can change that.

The Agenda and Procedures Subcommittee is just a courtesy and that is something that we have to respect. It is a well established principle of parliamentary government.

The other principle that is important here is that a committee has a right to do whatever business it deems appropriate. It has the right to accept, it has the right to reject, it has the right to approve. We cannot put a rule in place, even if the Leaders agree to it, we cannot have a rule in place that takes away the right of a legislative committee with authority that comes from the Legislature itself to, in fact, amend the rules. These rules are not subject to Party agreement - these are rules that come through the parliamentary system and through the parliamentary process, especially the Public Accounts Committee.

It is an important principle that is being violated here, apart from the question of whether or not there is agreement among the Leaders - I have not heard anything to that effect. What I'm recommending is that we adjourn the meeting, the Agenda and Procedures Committee get together and set an agenda for the Fall. Thank you, Madam Chairman.

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MADAM CHAIRMAN: Thank you. On that discussion, Mr. Scott.

MR. SCOTT: Madam Chairman, first of all I just want to say that in my six and a half years as Speaker I recall an occasion, and I believe I'm correct on this - the chairman of this committee made a representation to myself to intervene when there was a logjam that couldn't be resolved at this committee, so it is very appropriate for you to contact the Speaker, as Chair, to try to find a resolve. Otherwise, we can't get an agreement here, there is no resolve and the committee has to be able to do its work and move on.

I just want to say that I want to commend you for taking it upon yourself, as chairman, to contact the Speaker. That is an absolutely appropriate thing to do in this case. Members may not agree with that but that is fact.

The second thing is this, I just heard the honourable member say about rules. I was always of the understanding that the House can agree to anything it wants. If we have an all-Party agreement, regardless of the rules, regardless of a precedent that has been set - if we have a three-Party agreement in this House and members agree, basically this House can do as it so wishes.

If I understand this motion right, what is being asked is that this committee would agree to what the three Leaders agreed to yesterday, that is forward this on to the House for consideration of the House. The honourable member seems to think that this committee is going to be telling the House what we will do in the future and that is absolutely not true. This committee cannot do that, nor would, I am sure, the committee want to do that.

The committee is asked to support what was agreed to by the three Leaders yesterday and forward this to the Legislature and let the Legislature agree to a rule change that would then solve this issue and settle this issue for the future.

I think that it is appropriate. A lot of times this committee finds itself in disagreement amongst its members. This may help the members, it may help the House and it will also help future committees.

I am speaking in support of this motion that has been made by my honourable colleague and I think the honourable members to our left there should consider the fact that what we're doing is asking the House to consider what the Leaders agreed to yesterday - simply that's it. Thank you.

MADAM CHAIRMAN: Ms. Kent and then Mr. Epstein.

MS. KENT: Thank you, Madam Chairman. Again I am at a bit of a disadvantage because I wasn't here during that meeting but to help me understand what is happening here today and to be very clear for everyone to consider, it has been suggested by the honourable

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members of the Opposition that these meetings took place, which I have no doubt have and great respect and thankful for the discussions that have been had but it has been suggested that there was a resolution that we are going to vote on that we now have to consider, yet I have nothing here showing me that.

The gentlemen's agreement - while it is good to hear that those discussions have been had, we're a committee of the House and we have accountability. To seriously consider a motion I would need to see the wording, I would need to see something before me. So if the honourable members can give me something that we can further consider, I would appreciate that.

MADAM CHAIRMAN: Thank you. Okay, I've taken that comment. I had asked whether the motion was written in a form we could share but it is handwritten and so we hadn't done that. The intent is clear (Interruption) you don't want to hear it read again, okay.

MS. KENT: No, we need something before us.

MR. CLARKE: Madam Chairman . . .

MADAM CHAIRMAN: Mr. Epstein is waiting to speak.

MR. EPSTEIN: There's a legal term that I think is relevant here. The term is "void for vagueness". If a term or a phrase is so ambiguous that no reasonable person can understand what it is intended to mean, the courts will tend to regard that work or phrase as void, on the basis of vagueness. I think that applies to this motion.

As I heard the motion, all it says is we will implement the Leaders' agreement. I have to say that Ms. Kent is exactly correct. Unless we have a document in front of us that makes a suggestion, that has content, that has various points attached to it, that can give some direction to the committee, then we're no further ahead. I don't see that we can possibly vote in favour of such a motion. It's not even clear to me really that it's a motion that is a legitimate motion but even if it is, it's one that has really no content to it and we would essentially be trying to agree to follow an agenda, the content of which we don't know, that may evolve, that may change.

I'm not saying that it's not relevant what the Leaders have discussed amongst themselves. Obviously it is relevant but it is not adequate to have the results of that discussion communicated to the three different Parties from their three Leaders, through whoever knows what number of intermediaries, through whatever telephone and BlackBerry conversations might have taken place. That's not a very useful way for this committee to try and do its business.

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Now we do have one item of business in front of us in this session which is to set the agenda for our future sessions. That is obviously a serious piece of business, we do have to take care of it. We may not have to take care of it immediately, today, but we should certainly turn our minds to it before everyone disappears, if they are going to disappear during part of the summer.

Having said that, I recognize that in agenda setting there is flexibility, maybe flexibility to the point of some minor morphing, I mean that does happen where there is back and forth. Certainly we will turn our minds to that issue but this motion I think is really not helpful.

[11:30 a.m.]

Having said that, I want to add just one other comment. Even though we've heard your letter and we've heard the comments from the Opposition members and last week the government members voted down various motions - we do, nonetheless, recognize the importance of the Public Accounts Committee as a central mechanism of democratic accountability. That's absolutely true, that's a fundamental starting point and it's also true that it's most effective, perhaps, during times of minority governments, when the Opposition can have control of the agenda. But it's also an important instrument of democratic accountability, even in situations of majority government.

In practice, what I think that means is that a majority government will, in effect, give very serious consideration to the proposals of the Opposition Parties for topics. It's not our intention to block the central function of this committee. I think it's important that we put on the record that that's not our intention and that won't be the way that business gets conducted here.

Nonetheless, going back to the main point of this motion, I don't see that we're any further ahead with it in either voting against it and voting it down, or asking you to rule it out of order. I think that we're not meaning that we won't move to reasonably assume to set the agenda, that's going to happen. Thank you.

MADAM CHAIRMAN: I know I've got Mr. Colwell and Mr. Preyra.

MR. COLWELL: I'd like to suggest that the solicitor rule whether or not this motion is in order to start with and then I have a couple of other comments.

MADAM CHAIRMAN: Mr. Hebb, I wonder if you could add your comments to this and answer Mr. Colwell's question.

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MR. GORDON HEBB: First of all, it's not for me to rule on anything, but to give advice which the chairman and the committee can take or not take. I don't see how the motion is out of order.

MADAM CHAIRMAN: Thank you very much. I think you've said it all, have you?

MR. HEBB: Yes.

MADAM CHAIRMAN: Thank you. I believe I had only seen or heard of this motion this morning, but I did understand from Mr. Clarke, that he had checked to see whether it was in order to begin with.

Mr. Preyra, would you like to speak before Mr. Clarke?

MR. PREYRA: Yes, I just want to speak to the accuracy of the letter itself and to put on the record the fact that this committee (Interruptions) Sorry, I'm happy to cede the floor to the member for Preston, if he'd like.

MR. COLWELL: I wasn't finished.

MADAM CHAIRMAN: I'm sorry, Mr. Colwell wasn't finished. I didn't realize that, I thought it was the question from the solicitor. Thank you very much, Mr. Preyra.

Mr. Colwell.

MR. COLWELL: I'd like to thank Mr. Preyra for that courtesy. I think this motion is in order based on all the disruption we've had in the past. We've moved away from the agenda-setting committee because the government would come here after they agreed to an agenda item and they would argue against it then and vote it down.

Hopefully, if you're going to go back to - and I don't know what the outcome of the committee is going to be today - if it goes back to an agenda-setting committee that the government will agree to something and will stick with it. It's wasting our time here in the committee and there are so many important topics.

The government has refused to give information to the Auditor General, that's what this is all about, that's the bottom line of what we're talking about here today. Hopefully, they will change their minds on that quickly and move this forward.

I think that this is an attempt to make sure that the committee will continue to work efficiently and be able to work on a weekly basis as we have, except for summer recess and some other short recesses we do for whatever reason. It was already said by my colleagues here to the right that anything that's agreed to unanimously by the members of the

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committee, or the Legislature, or the Leaders of these Parties is acceptable in this Legislature. I've seen it for many years and I've never seen that actually voted down in my many years that I have been here. I'm probably the longest-sitting member in this House sitting here today and I've never seen this before.

It's time, I think, that the government realized that we're serious about this, we want to get information. There was nothing today that came out of the Mental Health Services, which was one of the items that the Auditor General had, that will cause any embarrassment to the government, I don't know what they're worried about with the rest of it.

I would suggest that indeed this is in order, I'm going to fully support this and when the time comes, I'm going to ask for a recorded vote.

MADAM CHAIRMAN: Mr. Preyra. And then Mr. MacKinnon.

MR. PREYRA: I'm not sure I understand that final comment. The mental health strategy was a chapter in the Auditor General's Report; I believe it was suggested by the Progressive Conservative caucus and we supported it. In fact, I think they had forgotten about it and we said, why don't we bring that back in. We have no problem with putting the chapters of the Auditor General's Report before this committee and that is part of the issue at hand, we would like to see those chapters come forward.

In terms of the overall work of the committee, this committee has met 28 times since last June, since the election - that is 10 more times than it has met in any previous year before. So, it has met more often than any other Public Accounts Committee and that can be checked. Over three-quarters of the topics on this Public Accounts agenda have come from the Opposition and the other topics have largely come from the Auditor General's Report.

So the committee has functioned, it has functioned effectively and the government has allowed the Opposition, in fact, encouraged the Opposition to bring forward issues and encouraged the Auditor General to bring forward issues because we have seen this committee as an important part of the Legislature, in terms of holding the government accountable, in terms of monitoring government expenditures, in particular. To say that the committee has broken down because one of the Opposition's topics didn't go forward or has been deferred is to mislead and misunderstand the work of this committee itself. Thank you.

MADAM CHAIRMAN: We won't be arguing how often we've met. I think we've had a good year in terms of the number of meetings, but it has been difficult setting the agenda and keeping on track; that has been my point. I think that Hansard and the record speaks on that, but what we want to do is move forward and I'm hoping Mr. MacKinnon has some comment on that.

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MR. MACKINNON: Not in relation to moving forward, it's in relation to what the member for Halifax Chebucto talked about in relation to vagueness and the interpretation of what was agreed to or not agreed to by the three Leaders.

With the number of staff and advisers available to all three Leaders, you would think that something could, in fact, come to us in some kind of written form. I just find this scenario to be a bit disturbing on the interpretation from BlackBerry messages or wherever they have come from. Thank you.

MADAM CHAIRMAN: Ms. Kent.

MS. KENT: I think that any motion that comes forward from an honourable member of the Opposition or from the government members clearly needs to be debated and considered. I think that's fair and that's something that we want to be clear about what we're considering. I think it's due diligence, it's incumbent upon us to understand what we're voting on. So I'm wondering if it would be in order, Madam Chairman, to defer the motion with the intent that communications from the Leaders - relative to the resolution that we've been asked to vote on, a motion - are brought to us, so that we are voting on something that we're very clear about.

I would like to consider it. I think that when Leaders meet, they are there for a reason, they do give us guidance, they do give us their insight into the situation, and give us, as members of their caucus, things to consider.

I would like to know, I'm not sure if there's a mechanism by which we could do that, if we amend the motion to suggest that it come forward at a later date. At this point I can't consider something, I could not support it if I don't know what I'm seeing.

I'm sorry, but it's not enough for a member of the Opposition to suggest to me what the Leaders are talking about, suggest to me that there's a resolution out there that this committee can consider seriously without seeing it before me. So if you could offer comment about what would be a mechanism by which to get that information to us so that we can clearly consider it appropriately.

MADAM CHAIRMAN: I certainly take your point that there is nothing in writing from the meeting of our three Leaders. Again, we had asked them to come together to give guidance and to move it forward. I had spoken directly to the Leader of the Liberal Party, so I had an opportunity to hear his response.

The idea that on June 9th - it was two weeks ago - when we came to an impasse it was largely over the issue of an established item on the agenda being removed or bumped and that hadn't had a precedent and that it had offended the Progressive Conservative Party and the Liberal Party as well, that it had been established. So the intent was - and I believe one

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of their understandings was - that wouldn't happen unless it was for a good reason that everybody accepted, that we wouldn't be changing agenda items that were set and witnesses that were set. That really is the motion that Mr. Clarke has wanted to formalize. I appreciate what I believe he is trying to do is formalize and only make a recommendation to the House.

I have a couple of speakers. Ms. Kent. Then we'll go to Mr. Preyra and then we'll go to Mr. Clarke.

MS. KENT: To be very clear, the motion that was put forward and the prelude - or I'm not even sure now if it was captured and perhaps we can have it read back to us - was that it referenced very specifically a resolution of the discussion that was held around the Leaders.

I recognize that that's an important conversation and I want to know about it and I recognize that you have spoken to your Leader and we've had dialogue. But we've been asked to vote on a motion that is referencing that particular resolution. We do not have that before us to have in the record of what we're voting on. We're voting on basically a suggestion that a member of the Opposition is telling us that's the way it was.

I'm sorry but I can't trust that. I won't trust that, I won't vote in favour of that but I am asking you, as the chairman - can we defer that motion until that comes before us?

MADAM CHAIRMAN: Perhaps I'll go to Mr. Clarke because it is his motion so I am going to ask Mr. Clarke if he would be willing to defer or even have a short adjournment, I would suggest if we could adjourn for even 10 minutes, but I'll leave it to you, Mr. Clarke, to respond.

MR. CLARKE: Thank you, Madam Chairman. This goes to the root cause of the very problem that brought the Leaders together yesterday. They met out of good will and what they agreed to would effect a rule change. That rule change, which we've articulated - and this was about this committee basically agreeing to the spirit and intent of what the Leaders have decided, came to consensus on, that as a basis of that we don't have the resolution before the House because that's what the role of the House Leaders would take on to come to that consensus of what the Leaders had spoken about in bringing it forward.

My motion was that the Public Accounts Committee recommend to the House that a resolution be accepted that would amend the Rules and Forms of Procedure of the House to accommodate the agreement of the three Party Leaders. In other words, we accept that our Leaders - on the requests that were made - got together, came to a consensus in a meeting that took place at the Premier's Office.

What I can say to the honourable members when they talk about paperwork, they need to look at their own government's practice and procedures because in the first public

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meeting of the Internal Economy Board the government moved significant motions, regulation changes affecting large sums of money that had no paperwork attached to them, no prior notice of any of that information to the other Parties. I am saying that if they want to talk to that, Madam Chairman, they need to look at their own practices.

I will say this, in getting to this point, following the meeting yesterday - it was Mr. MacKinnon who talked about all of the staff and communication ability if that was the case. Well following the meeting yesterday, our Leader, Karen Casey, convened a conference call with our caucus, to go over with her chief of staff what took place in that meeting, to ensure that the consensus that was achieved at that meeting was accepted and acceptable to our caucus to come here today.

We accepted that, we provided public notice through our communications division that we would attend this meeting today to build on the spirit and intent and to try to move this process forward. That is what occurred in that meeting yesterday.

I know that the Liberal caucus has spoken to their Leader with regard to that. Mr. MacKinnon's comment is very disturbing and is very telling. The reason for this, in trying to build on fear and intent, speaks to the lack of trustworthiness that we have with the government. If the Premier, who has more staff than any other Leader, if the government caucus, which has more staff than any other caucus and communicators to the point that Mr. MacKinnon had raised, if this issue was seeking a resolve then why, with the Premier's chief of staff in that meeting, why the Premier himself did not communicate to his caucus - it is very telling and disturbing that what we had at the last meeting that we took offence to continues to be perpetuated here again today by the government members and obviously the disconnect.

To this motion, if the Premier and his chief of staff don't have the common courtesy to try and reflect that and to try and move forward - and all we're saying is that there is a consensus decision of the Leaders that this would come forward. All it says is that this committee supports moving forward with a resolution to actually effect the change that was agreed upon.

Obviously we have a committee that is not willing to do that and it speaks to the trustworthiness of what the issue was that caused the original issue and it also speaks - it's very serious, Madam Chairman - about how serious is the Premier in seeking resolve or was yesterday window dressing?

MADAM CHAIRMAN: Mr. Clarke, I don't think you've had an answer for Ms. Kent's question. Ms. Kent would like to ask the question again.

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[11:45 a.m.]

MS. KENT: Thank you, Madam Chairman. It's disappointing to suggest here in the meeting that we would allow for the opportunity for this kind of grandstanding around something that we're saying is in keeping with the direction that the members of the Opposition have suggested. We recognize that those meetings are important that the Leaders have had. We recognize that there was an intent to help improve the process here today. To bring in all of the other associated issues is grandstanding.

Madam Chairman, I'm asking you to give me an answer around my question about deferring the vote. We recognize that there was a meeting. We need to see something. That member has asked for us to vote on a resolution of the Leaders' discussion. He is asking us to vote on something that he has articulated, as an individual, that we - it's our responsibility to our caucus to have that before us. That's not new news, that's not unusual in a committee's business to see something before us. It's not good enough for hearsay, to vote on a motion because I tell you, that's the way it is. It's not good enough.

Please, Madam Chairman, can we defer the vote until we have something here before us? If we can, I would put a motion on the floor to defer this vote until that communication has been brought to us from the results of those meetings of the three Parties.

MADAM CHAIRMAN: I would like to ask Mr. Hebb first about the deferral, just to get the rule on that. Without the approval of the mover of that first motion, are we able to defer?

MR. HEBB: Any member of the committee can move a deferral motion at any time on the motion.

MADAM CHAIRMAN: That's the rule of it then. I certainly want us to be doing this according to the rules at all times and Ms. Kent has made a motion to defer the motion made by Mr. Clarke. So that's the motion before us, to defer, and we will begin with a recorded vote.

We've had two members ask for a recorded vote.

[The chairman calls the roll.]

[11:48 a.m.]

YEAS NAYS

Mr. Epstein Mr. Colwell

Mr. Prest Mr. Scott

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Ms. Kent Mr. Clarke

Mr. MacKinnon

Mr. Preyra

MADAM CHAIRMAN: I will say no myself. At the same time, I hope we can move forward now. That motion may come back at another time.

MR. CLARKE: It doesn't solve the impasse.

MADAM CHAIRMAN: Well, the next order of business is, I would have appreciated it if we could make a recommendation for what had caused our problem last week but I do appreciate that members of the committee want some time, particularly the NDP members, to caucus this, to speak to their Leader, I guess to get direct information on what occurred at the meeting yesterday. I do appreciate that that's important so I would hope that we could still make this recommendation before the House sits again.

Your motion, Mr. Clarke, to ask that this become a Rule of the House, that that could come back at a future meeting again. It's only deferred so you will bring it back then when the full committee meets in the future.

MR. CLARKE: But what are we meeting for again?

MADAM CHAIRMAN: Well, if you could, we also - yes, Mr. Clarke, I can give some direction on that. Mr. Clarke.

MR. CLARKE: Madam Chairman, we're right back where we started from in dealing with the government and dealing with issues about agreements that have been struck, agreements that have been made, and the government members overruling it by motion. We witnessed the very concern that we had, we just saw the backbench government members disconnect an agreement - no, this is an agreement by the Premier and the fact that the Premier is not trustworthy enough to have his act together to be able to communicate to his own government members when the Leader of the Liberal Party and the Leader of the Progressive Conservative Party understood that consensus, I say, what is the Premier's sincerity, what is the government's commitment to this committee when they won't even come here informed about what went on with their own Premier?

MADAM CHAIRMAN: I'd like to interrupt you if I could. Mr. Clarke, I appreciate what you're saying (Interruption) That's good, I'm glad I had the opportunity to interrupt you. My point is that we need to move forward with the committee and we do have another avenue to move forward. That was another part of the agreement with the Leaders of the Parties, that we reconstitute our Subcommittee on Agenda and Procedures and that we work to make that committee move smoothly, work effectively, and serve this committee by bringing forward lists of agenda items that can be adopted by the full committee and that is very important.

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I had mentioned at an earlier time that the instructions we had gotten from the training on Public Accounts Committees was that the most effective Public Accounts Committees do have active subcommittees to set the agenda and to hammer out a lot of differences at that level. I would like to see us at least work on that again and to bring forward items here that can be accepted by the full committee. That is my intent, that we can work out some of these differences there.

MR. CLARKE: On a point of order, Madam Chairman. I don't disagree with what you're saying, in fact, I'm in full support of what you're trying to do, but we've now just had a matter where the three Leaders agreed that if an agenda has been set, this committee will not use a majority vote to disrupt the work of this committee and to delay the consideration of matters before this committee and/or the witnesses associated with those matters.

We have not moved forward. How can we possibly go to setting up subcommittees when the very principle of what I think and commend the Leaders in getting together is not even being recognized and the government members are not even aware of what their Premier discussed with the other Leaders? So I don't know how we can discuss other business at this time.

MADAM CHAIRMAN: Mr. Clarke, as chairman, I would ask for your co-operation in moving forward with the subcommittee and this item could be an item that goes on the subcommittee's agenda, as well.

MR. SCOTT: On a point of order, Madam Chairman. It's obvious that some members of this House have been made aware of what was discussed yesterday and agreed to, and some haven't. If we don't have full agreement as to what the Leaders have agreed to on how we'll move forward, I don't know how we're going to agree to an agenda. Once we get into a disagreement over the agenda again, we're going to be right back where we were.

I would suggest - I know we have a motion before the House now, but I'm going to make a motion later that we adjourn this committee until such time as the three Leaders' intentions are known to all three Parties and that the committee then reconvene in regard to what was agreed upon by the three Leaders. (Interruptions)

MADAM CHAIRMAN: You have seconded that, Mr. Epstein?

MR. EPSTEIN: I second that.

MADAM CHAIRMAN: I'd like to see this committee end today with the agreement that we can reconstitute the - I would like a motion to reconstitute the Subcommittee on Agenda and Procedures. I guess I'm appealing to the committee to say that we need that as a go-forward because once the committee is reconstituted, we can then call a meeting after

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everybody has seen and communicated with all the people they need to communicate with before we hold that meeting. Mr. Scott.

MR. SCOTT: Madam Chairman, as you know, a motion to adjourn is always in order, it's not debatable, and I've made a motion that the committee adjourn.

MADAM CHAIRMAN: There you go, and it has been duly accepted and seconded.

Would all those in favour of the motion please say Aye. Contrary minded, Nay.

The motion is carried.

We stand adjourned.

[The committee adjourned at 11:53 a.m.]