HALIFAX, WEDNESDAY, APRIL 13, 2022

 

SUBCOMMITTEE OF THE WHOLE ON SUPPLY

 

5:50 P.M.

 

CHAIR

Dave Ritcey

 

 

THE CHAIR: The Subcommittee on Supply will come to order. It is now 5:54 p.m. The subcommittee is meeting to consider the Estimates for the Office of Addictions and Mental Health, as outlined in Resolution E27:

 

Resolution E27 - Resolved, that a sum not exceeding $268,631,000 be granted to the Lieutenant Governor to defray expenses in respect of the Office of Addictions and Mental Health, pursuant to the Estimate.

 

I will now invite the Minister responsible for the Office of Addictions and Mental Health to make opening remarks up to one hour, and if they wish, please introduce their staff to the committee during this time.

 

HON. BRIAN COMER: Thank you, Mr. Chair. Before I proceed, I’d just like to introduce the members of my senior team who are joining me today: Associate Deputy Minister Kathleen Trott and Kristina King, the director of the Department of Finance and Treasury Board, who are supporting me in my capacity as Minister responsible for the Office of Addictions and Mental Health; and also Francine Vezina, my executive director.

 

I also have with me Donna MacDonald, Associate Deputy Minister of Communications Nova Scotia; and Managing Director of Corporate Services Angela Campbell. Dave Denny is also here, the managing director of marketing.

 

I am pleased to be here to highlight the work of the Office of Addictions and Mental Health and to speak about priorities for the upcoming year. As you know, the health and wellness of Nova Scotians is a key focus of this government, including addictions and mental health. In fact, our government was the first to appoint a dedicated minister to oversee this work - a role I am honoured to have been given. The office is responsible for setting the strategic direction of funding for the delivery of addictions and mental health care in the province.

 

We maintain a strong connection with the Department of Health and Wellness and the broader health care system. We also work alongside those in our education system, our justice system, housing, and our community services network on solutions that make a positive impact on the health and well-being of Nova Scotians.

 

The office works closely with both the Nova Scotia Health Authority Mental Health and Addictions program and the IWK Mental Health and Addictions program. This program is part of a broader system of care in which a range of mental health and addictions services are delivered using a stepped-care model. We also partner with numerous community-based organizations providing funding and supporting the delivery of important mental health and addictions services across the province.

 

The office is responsible for ensuring that harm-reduction and anti-stigma approaches are taken in delivering mental health and addictions care in Nova Scotia. We are also responsible for ensuring that Nova Scotians know how to access the care that they need at the right time and access to multiple services to streamline, making the system easier to navigate; that those in need have access to services in the same manner; and that there is consistency and integration of practices across the four health zones.

 

Our office has been delivered a significant and critically important mandate that includes tackling stigma surrounding mental illness and addictions, eliminating barriers to accessing care, and expanding access to the right services and supports needed for recovery. I look forward to advancing this work and improving outcomes for Nova Scotians across the province.

 

During my time as minister, as well as my time working on the front lines of addictions and mental health, I’ve had the opportunity to see first-hand the tremendous work and dedication of so many who work tirelessly to help those dealing with mental health and addictions. Their work encompasses the entire spectrum of support, from clinical care to advancing efforts to address stigma and promoting the resilience and the overall well-being of Nova Scotians.

 

These past two years have certainly increased the demands on our health care system, including addictions and mental health. I want to take a moment to acknowledge the unwavering dedication of so many on the front lines who have continued to be there to care for Nova Scotians in their time of need.

 

In addition to having responsibility and oversight of the Office of Addictions and Mental Health, I also have the responsibility for Communications Nova Scotia. I’d like to extend thanks to my deputy ministers, associate deputy ministers, and senior teams for their preparation of the office and agencies’ budget submissions and staff for their tremendous work throughout this very challenging year.

 

I will speak more to the work of Communications Nova Scotia a little later on, but first I’d like to speak a bit to the office budget.

 

Mr. Chair, the budget for 2022-23 is just over $268 million - a budget increase of $20 million, or 8.3 per cent compared to last fiscal year. The office’s budget is focused on advancing our commitments to Nova Scotians to improve access to mental health and addictions care, including investments in virtual care, withdrawal management, psychiatric services, and enhanced early intervention services for children with autism. I will get into further details on our budget and the work we have planned for the year ahead shortly.

 

First, I feel it’s important to give an overview of mental health and addictions services in the province. The delivery of services involves a collaboration among government, health authorities, clinicians, and community-based organizations. Collectively, we deliver a provincial system of care promoting mental wellness and addressing individual mental health needs. This system is built on a five-tiered model of care, which includes mental health promotion, self management and community care, and formal, more intensive care for those experiencing moderate to severe complex disorders.

 

Tier 1 supports are mainly focused on education and promotion of mental wellness. These might include efforts to increase awareness about the importance of looking after our mental health and our efforts to educate people on the harms associated with substance use.

 

Tier 1 supports also include efforts to address the social determinants of mental health, such as improving access to employment and education, expanding green spaces, addressing discrimination, and providing stable finances, food security, and housing. There are a broad array of sectors, institutions, and programs that impact population mental health, including religious institutions, volunteer organizations, workplaces, schools, recreational facilities, and social media influencers, just to name a few.

 

Cultural trends like an overreliance on social media are increasingly implicated in the increased prevalence of depression and anxiety among our youth. Major events can also impact populations’ mental health and well-being. We only have to consider the pandemic to appreciate how these events can impact us. They cause us to react with strong emotions like fear, sadness, loneliness, and frustration. Rather than seeking to eliminate our emotional responses to challenging life events, Tier 1 supports increase our resilience by allowing us to cope with our emotions.

 

[6:00 p.m.]

 

The largest need for mental health care in terms of population can be served through Tier 2 supports. These supports are typically provided by community-based organizations or in a primary care setting, such as supportive counselling provided by a family physician. It can also be delivered through self-managed or self-directed e-mental health modules or by those in helping professions who aren’t necessarily providing direct clinical care, like a youth drop-in centre staffed by peer support and non-clinical staff or volunteers. Organizations like Autism Nova Scotia, the Canadian Mental Health Association, and reachAbility are just a few of the groups that are delivering much-needed support to Nova Scotians.

 

Tiers 3, 4, and 5: The top three tiers of mental health and addiction care are focused on supporting those with moderate to severe illness. This population is who the formal mental health care system is focused on. These supports are provided through more intensive, specialized programs. They can include in-depth diagnostic assessments, medications, psychotherapy, or intensive interdisciplinary care involving occupational therapy, recreation therapy, and social work case management. It’s within these tiers that you’ll find in-patient care, intensive mental health and addiction day treatment programs, outpatient clinical services, and specialty care for illnesses like eating disorders.

 

People with moderate to severe mental health needs can always benefit from lower-intensity interventions like accessing nature, but people who require a lower level of support aren’t likely to benefit from higher-tier care. In fact, by labelling a person’s distressing emotions and suffering as a mental illness in the face of real-life stressors can do more harm than good.

 

Make no mistake: people who are suffering need support. They just may not need formal mental health treatment. Frequently, society will regard someone’s suffering as a signifier of mental illness that requires clinical care, and when the system doesn’t provide this for them, the conclusion they draw is that the system is broken.

 

Experiences over the past two years, including the events of April 18 and 19, 2020, and the pandemic have in many ways served to bring us closer together. We have shared the burden of suffering and worked to help each other. Just as Nova Scotians will continue to practise proper handwashing, staying home when we’re not feeling well, and for many, masking in congregated spaces, I’m confident that we will also continue to support one another to be mindful of our own mental health.

 

We need to continuously look for opportunities to support individual and community resilience. This means working with other departments and sectors to find opportunities to positively impact social determinants of mental health. It means supporting initiatives that promote individual resilience as well as a collaborative and collective sense of responsibility for our own mental health, and it means supporting organizations that provide localized community-based programming tailored to individual client needs regardless of a diagnosis.

 

It is a priority of government to increase and improve access to mental health and addiction supports and treatments for Nova Scotians. One of the ways we can do this is by working more closely with community-based groups to build community resilience and foster mental wellness. Many of the province’s community-based groups rely heavily on fundraising efforts to support the delivery of the programs.

 

The inability to host in-person events and the reduction of discretionary income for many Nova Scotians as a result of a job loss or reduced hours has meant that these groups have struggled to make ends meet. It has created challenges for groups, but the work never stops. In fact, demand for the critical supports and the programs they deliver has increased with the continued impact of the pandemic on the mental health of Nova Scotians.

 

During these long and challenging two years, these groups never gave up on the people who needed them the most. We have heard from many of them. They’ve shared their financial hardships and demonstrated the need for greater support to get them through this hump. This year, we were grateful to be in a position to offer that help.

 

COVID-19 also delayed the advancement of some initiatives this past year, leaving us with unspent funding that we were able to reallocate to support projects that we otherwise wouldn’t have been able to, including $3 million to the Mental Health Foundation of Nova Scotia. The foundation will use this funding to administer grants for eligible organizations that provide mental health and addictions services. The foundation will share more information and details about how to apply for these grants in the coming months.

 

I can tell you that the priority will be given to groups that serve Indigenous communities, members of the 2SLGBTQ+ communities, African Nova Scotians, newcomers, and persons with disabilities. We know that these populations often face barriers to accessing much-needed support. By directing funding to support marginalized Nova Scotians, we can help to remove these barriers and ensure equitable access to mental health and addiction supports.

 

We were also able to provide $2 million in funding Tajikeimɨk for the development of the first Mi’kmaw mental health and addictions strategy in the province’s history. This strategy will guide the development of a comprehensive and culturally appropriate First Nations mental wellness system, a system that will offer mental health and addictions supports for the Mi’kmaq of Nova Scotia.

 

We know that the First Nations communities must have ownership over these supports, and that they must be guided by their own cultural and traditional healing practices. The importance of placing services in community is grounded in the decades-long experience of intergenerational trauma.

 

In addition to supporting the mental health foundation of Tajikeimɨk, we have been able to direct funds to several other initiatives, including funding to the North End Community Health Centre for the purchase of a new van that will be used to support their managed alcohol withdrawal program. We have also provided funding to Family Resource Centres to support their home visiting program for vulnerable and at-risk families, along with funding for Pathways Cape Breton to empower more people with mental illness, substance use, and social challenges to live more independently within their own communities.

 

We have given more support to HeART, a mental wellness program based out of the Heartwood Centre for Community Youth Development in Halifax. I had the opportunity to meet with Kayla Bernard, the founder of HeART, who is one of Nova Scotia’s few Mi’kmaw recreation therapists. She and her team are doing amazing work helping the youth, connecting them with their peers and expressing themselves through art.

 

We were also able to reallocate funding to support the training of more peer outreach through the POSSE Project, a project in Windsor, West Hants, Shubenacadie, and Sackville. POSSE is an invaluable resource for youth who use substances and experience sexualized violence.

 

I’d like to take a minute to speak to the importance of ensuring our mental health and addictions services are representative and responsive to the diverse communities across the province. Over the past few months, I’ve had the chance to meet with the team at Eskasoni Access Open Minds Youth site, as well as the chiefs of Eskasoni, Wagmatcook, and Millbrook First Nations, and the health directors of community health centres of various Mi’kmaw communities across the province. I’ve also met with staff of the Mi’kmaw Native Friendship Centre and with Tajikeimɨk to discuss mental health and addiction issues among Indigenous peoples and resourcing within our communities.

 

My first official visit as minister was to Eskasoni, where I toured the community’s health centre, situated on the shores of the beautiful Bras d’Or Lake. I also had the opportunity to tour a garden dedicated to missing and murdered Indigenous women and girls - a beautiful project that was created by the youth of the community. I’d also like to note that as of yesterday, we would have made a first-time investment of $350,000 to cover the Eskasoni crisis line, which is utilized by First Nations communities across the province.

 

In February, the Premier and I visited the Wagmatcook wellness court, the first and only court of its kind in an Indigenous community in Canada. I learned how the court is structured to meet the cultural and healing needs of those who come before it. What these and other visits have taught me is that we need to truly engage within communities. We will continue to work alongside African Nova Scotian Affairs and L’nu Affairs, with members of the 2SLGBTQ+ community, with community organizations, and with individuals representing this province’s diverse communities to address the added barriers that these populations face and ensure that their mental health and wellness recovery needs are met.

 

This work will be supported by the hiring of a dedicated community liaison officer who will work within communities to support efforts to enhance community wellness and ensure that we are all striving for the same goal.

 

We recognize the impact that the Mass Casualty Commission’s hearings will have on Nova Scotians. Information and discussion of the horrific events that took place on April 18 and 19, 2020, will be difficult to avoid or ignore and will impact people in many different ways. Both the Mass Casualty Commission and the Department of Justice’s Victim Services have supports in place to comfort survivors, immediate families, and impacted communities. The supports don’t necessarily extend to all Nova Scotians.

 

Government has a role to play in supporting Nova Scotians and ensuring that they are aware of and can easily access existing mental health support. We appreciate that the multitude of supports can be difficult to navigate, especially given the very needs of those reaching out for help. We responded by partnering with 211 Nova Scotia to provide a focused point of access for available supports. 211 community navigators are available 24 hours a day, seven days a week to connect Nova Scotians with appropriate services, including mental health supports.

 

We will continue to support the delivery of community-based mental health and addiction programs. We will seize opportunities to enhance the specialized formal mental health system to ensure better outcomes for those who suffer the most. The formal mental health system involves a collaboration among the government, the Nova Scotia Health Authority, the IWK, and Tajikeimɨk.

 

There are many ways Nova Scotians can access the system, including through physician referrals and the Province’s central intake line. Central intake is a single point of access to these supports. The line is staffed by clinicians, including registered nurses and psychologists, who work with callers to assess their needs and provide referrals to the appropriate supports and treatment options. For example, help with anxiety could include distance-based intervention, connecting with an individual clinician for skills in managing anxiety, or a referral to an anti-anxiety group.

 

Through this stepped approach, our mental health and addictions system continues to ensure that quality interventions are provided. Government supports the central intake line with an annual $1-million investment. We recognize how important this resource is to Nova Scotians and know that it has been especially so over the past two years. Intake teams saw a 30-per-cent increase in demand for services in 2021-22. Government recognized early in COVID-19 that the measures undertaken to address the spread would impact the mental health of Nova Scotians. In fact, addictions and mental health has been a core component of Nova Scotia’s public health response to COVID-19.

 

We have and continue to work closely with the health authorities and community not-for-profit partners to mitigate the negative mental health impacts for Nova Scotians. We worked with the Nova Scotia Health Authority and the IWK to introduce e-mental health tools and virtual care, including virtual group-based cognitive behavioural therapy. We have engaged clinicians across the province. We have added capacity to meet demand in other zones. Our work to further expand these supports will continue this year.

 

We have increased funding this year for e-mental health and addictions care by more than 100 per cent. This year’s budget is just under $12 million. This will support collaboration with the Nova Scotia Health Authority, the IWK, and other government departments to develop a coordinated, integrated, and efficient e-mental health system that best serves the needs of Nova Scotians.

 

We have also invested an additional $3.4 million in this year’s budget to expand mental health virtual care, including hiring 22 clinicians over two years for community mental health and addictions, outpatient clinics, and enhancing virtual care services at emergency departments.

 

It is important to note that people who in crisis or require emergency care are seen right away. Our in-patient program ensures that everyone in need of a bed has access to one. No matter where they live in our province, no one is turned away.

 

Mr. Chair, we need to continuously be looking for ways to improve the delivery of care and ensure that we are meeting Nova Scotians where they are in their recovery journey. We know that there are many people who don’t require around-the-clock in-patient care who can safely and successfully recover from addictions while remaining at home and within their communities.

 

Earlier this year, we opened the province’s first recovery support centre in Dartmouth. A second centre opened in the Aberdeen hospital in February. These centres will improve direct access to support for people living with substance use and gambling disorders. They address that need while also linking people to increased or decreased levels of care based on their individual circumstances, including in-patient withdrawal management, opioid-use disorder treatment, community mental health and addictions programs, and online supports.

 

In total, 10 recovery support centres will be set up across the province over the next two years. This year’s budget includes a 55-per-cent increase of money for withdrawal management services, for a total of $3 million. This investment will provide continued support for the Dartmouth site and support the implementation of two new sites, one in North Sydney and one in Truro.

 

[6:15 p.m.]

 

Just as the recovery support centres provide outpatient care to those struggling with substance use and gambling addictions, the Province’s new mental health day hospital provides a similar pathway to support for people requiring intensive mental health treatment. We know that successful health outcomes depend on the ability of Nova Scotians to access appropriate supports and treatments.

 

Before the opening of this hospital, the only pathway to intensive mental health treatment was to be admitted to an in-patient psychiatric unit, but not everyone needs around-the-clock hospital care. The mental health day hospital addresses the gap and provides another way of providing intensive mental health treatment while allowing patients to stay closely connected to their families and to their communities. Patients are supported by an interdisciplinary team of mental health specialists, including a newly hired psychiatrist, nursing staff, and social workers. They attend the therapeutic group programs and receive psychiatric treatments during the day and continue their recovery at home in the evenings and on the weekends.

 

In-patient acute psychiatric units in Nova Scotia are functioning at very high occupancy rates. Occupancy rates in Central Zone regularly exceed 100 per cent. This means that more patients have needed to be transferred to facilities in Western, Northern, and Eastern Zones, putting patients further away from their families and support networks and placing greater strains on these facilities. These interfacility transfers also reduce the number of ambulances available to respond to health emergencies and other patient transfers. These impacts are costly and inefficient, and most importantly, they aren’t meeting the care needs of patients.

 

This new hospital will help to alleviate these pressures and free up in-patient psychiatric beds for those with more severe mental illness. This year’s budget includes just over $1 million to support the continued operation of the day hospital. We will be reviewing and evaluating the model over the next year to identify potential opportunities for expansion in other areas of the province.

 

The path to mental wellness is not a straight line with a clear start and finish. You must make sure that the right supports are available at the right time and the right place to meet Nova Scotians where they are in their recovery. We know that early intervention treatment will reduce the need for in-patient support. Our plan for universal addictions and mental health care coverage will make sure that people get the supports they need and that they get them sooner.

 

We will ensure that all Nova Scotians, regardless of where they live or what their income is, have universal access to mental health and addictions services. This is a significant piece of work. It will take time and considerable consultation to ensure that we get it right. I can assure you that work has been ongoing since this commitment and will continue to be a primary area of focus over the next year. We’ve allocated $500,000 in this year’s budget to support our work in developing universal mental health and addiction care.

 

We are breaking new ground. As the first in the country to undertake this work, it is on us to collect the primary data. We don’t have the luxury of leaning on lessons learned from other jurisdictions. We need to build this from the ground up. Evidence-based decisions and planning are critical to ensuring that we get it right, and that requires a comprehensive understanding of the population and community needs.

 

We will also be engaging with mental health care professionals, sector partners, patients, families, and others throughout all phases of this monumental initiative as we work to build the country’s first truly universal health care model for addictions and mental health.

 

The Office of Addictions and Mental Health has worked alongside key government and health system partners, including Nova Scotia Health Authority, who outlined a new community network model for sexual violence trauma therapy. This new model will ensure that services are available throughout the province, improve accountability, and ultimately enhance support for victims and survivors. It will provide consistency of services across the province for all genders and ensure that programs are responsive to the needs of African Nova Scotian and Indigenous populations.

 

It will also ensure administrative program and human resource coordination for trauma-specific therapeutic services across the province and across the gender spectrum. This work was informed with input from professionals, survivors, and community-based organizations that currently provide services to survivors of sexual violence. We also engaged African Nova Scotians, members of the Indigenous communities, immigrants, and newcomers to better understand programming needs for members of these populations.

 

We issued a request for proposals in the Fall to organizations, including those currently providing trauma-specific therapeutic counselling. The procurement process is still under way. We expect to be able to share some more details shortly. In the meantime, I want to assure Nova Scotians that there will be no disruptions in services as we transition to this new, improved model of care.

 

We recognize the importance of retention and recruitment in the delivery of existing and planned mental health and addictions care. There is no question that recruitment is a challenge here and across the country - a challenge that has been made worse by the pandemic. The new Office of Healthcare Professionals Recruitment has been created to put a dedicated, intense focus on recruiting and retaining the health care professionals needed in this province, including psychiatrists.

 

We recently announced a new Specialist Physician Incentive Program. This program offers incentives to specialists who establish a practice outside of the Central Zone. Those who qualify can earn up to $125,000. This includes $25,000 when they sign the agreement and $20,000 per year for five years.

 

This year’s budget includes $275,000 to add two mental health and addictions clinical assistants in the Eastern Zone, while psychiatrist recruitment is ongoing. We’re also investing $140,000 to add four psychology residents - two each at the Nova Scotia Health Authority and the IWK. Several other initiatives have been implemented to improve psychiatric recruitment and retention, including the introduction of virtual care options that allow psychiatrists more flexibility in being able to practise in areas of the province beyond where they live.

 

Another area of importance that the office is responsible for is preschool autism supports. We know how important it is that children with autism and their families have access to appropriate interventions and supports. We also recognize the value of early intervention for preschool-aged children on the autism spectrum and their families.

 

The Office of Addictions and Mental Health collaborates with partners in the community, including the Nova Scotia Health Authority, the IWK, Hearing and Speech Nova Scotia, the Department of Education and Early Childhood Development, and Autism Nova Scotia to enhance autism intervention services for children and their families. The current resources, programs, and supports available for preschool-aged children with autism do not meet the growing demand. Families have had to wait too long to get the support they need. In some cases, parents have had to choose between waiting for support and having their child start school with their peers. This is not acceptable.

 

Our budget includes $12 million to increase support for autism services. This investment will be directed to ensure that supports are tailored around the needs of the child and their families. We expect diagnostic assessments will be done more quickly and that navigating supports will be made easier. We expect to have further details to share on this investment in the coming weeks.

 

I’d like to also speak about one of my other portfolios: Communications Nova Scotia. Nova Scotians rely on government programs and services to support their health, education, and economic well-being. Every CNS employee understands that it’s their job to help get important information to Nova Scotians about how to access these programs and services.

 

Some CNS staff are very familiar faces in the House, but CNS do other important work behind the scenes every day. This year, and over the course of the pandemic, Nova Scotians have become more aware of that good work more than ever before. Nova Scotians counted on government for information they needed to stay healthy and safe.

 

People tuned in in record numbers to daily briefings - almost 200 of them - webcast live across the province. They visited our website in record numbers also - a website that sometimes changed hourly, knowing it was the most reliable source of up-to-date information on COVID-19 in our province. They followed us on Facebook, Twitter, Instagram, TikTok, and shared our posts with their friends and followers. They saw posters, stickers and ads pretty much everywhere they went - hospitals, grocery stores, hockey rinks - telling them to wear masks and keep six feet apart. Partners and stakeholders across all sectors and in all communities received twice daily updates at times.

 

CNS is also committed to accessible and inclusive communications. Every briefing included sign language and captioning. Graphic designers worked with African Nova Scotian partners to incorporate principles of Afrocentric design, and Public Health guidelines were translated into languages including Mi’kmaw, Arabic, Chinese, and Somali.

 

Reporters also had a very important job to do in keeping Nova Scotians informed. They received news releases and media advisories - sometimes two or more per day - not to mention responses to thousands of questions not covered in media briefings, news releases, or interviews. Before becoming minister, I appreciated everything CNS was doing to support Dr. Strang and to keep me and my family safe, even though I didn’t know it was CNS staff who were behind this work. I truly have a new appreciation now in a whole new way.

 

As minister responsible, I’m working with the people who manage those social media accounts, lead the research, write and translate those news releases, produce those briefings, capture the images and design the work, and manage each and every one of the 7,000 projects that go through CNS each year. This team rose to an incredible challenge, at times working seven days a week - evenings, weekends, and holidays - giving up vacations, sacrificing family and personal time in the interest of public service. This is the CNS team and the CNS way. These are the people behind the numbers and behind the scenes.

 

Of course, this is a budget, so I will speak briefly to those numbers. As a government, we are committed to digital transformation so Nova Scotians can access more services more easily online to put all web of the best digital minds together. The CNS web team has joined the digital services team at Service Nova Scotia to push excellent service delivery to new heights. Members will also see in our budget forecast that additional staff were needed for the COVID-19 response last year.

 

As we all learn to live with COVID-19, the communications efforts should ease. We have made adjustments in our budget and staffing to align with this. Even with these adjustments, I want to assure members of this House and all Nova Scotians that CNS will be there every day to meet its mission: to help Nova Scotians understand what their government is doing and why.

 

Before I conclude my remarks, I would like to take this opportunity to thank my staff who are all here with me - it’s greatly appreciated - the teams in the Office of Addictions and Mental Health and Communications Nova Scotia for their commitment to the people of the province. They accomplish great things every day, and I truly thank them for it.

 

I would also like to thank the many frontline staff at the Nova Scotia Health Authority, IWK, and community organizations across the province. Their dedication never wavered during these past two years. They continue to show up each and every day to support Nova Scotians when they needed them the most.

 

I look forward to the opportunity to respond to your questions. Thank you, Mr. Chair.

 

THE CHAIR: Thank you, minister. According to the practices developed in this Legislature, the Opposition caucuses take turns asking questions for approximately one hour each. During a caucus’s turn, the members within a caucus may take turns examining the minister on Estimate resolution. Only the minister may answer questions. Caucuses are also expected to share time fairly with the Independent member. We’ll begin with the Official Opposition.

 

The honourable member for Fairview-Clayton Park.

 

HON. PATRICIA ARAB: Thank you to the minister for those opening remarks.

 

Last year, the Premier campaigned and won the provincial election in part due to his plan to create universal mental health care and his pledge for an additional $102 million to deliver on that promise. The budget’s here, and quite frankly, I’m disappointed. The budget includes $268.6 million for Mental Health and Addictions, which is an increase of $20.6 million, but is also $81.4 million short to deliver universal mental health.

 

In your platform, the Premier said that he would make good on this promise as he said, they are investments that we cannot afford not to make. Can the minister please explain the gap between what was promised and what appears in this budget?

 

BRIAN COMER: I thank the honourable member for the question. I know this has probably been the most frequently asked question of myself since being in this first-time ministerial portfolio for the Province, I think, which is understandable.

 

As I kind of mentioned in my opening remarks, we’re the first jurisdiction in the country to undergo this bold initiative. We need to have proper data and proper evidence-based guidelines, and lay the foundation to do it once and do it right. To realistically say that can be done in seven months for the first time in the history of the province is probably unrealistic, to be quite frank.

[6:30 p.m.]

 

There’s a rapid process going on right now within the department, including a significant data analysis, engaging with stakeholders across the province - mental health care clinicians ranging from psychologists to social workers to counselling therapists to peer-support workers. I think it is noteworthy that we did make some significant investments in a very short time. I’m particularly quite proud of the Tajikeimɨk investment. It’s the first time in the history of the province that this initiative - well, the first time it’s ever been funded, basically. I think it’s a very exciting initiative.

 

The universal access piece specifically is very much - the underlying premise is that people who need the care can get it regardless of their ability to pay - very much like our primary health care system. I know there’s significant work under way right now. I’ll have much more to say about that in the near future.

 

PATRICIA ARAB: Thank you to the minister for that response, but the question is rooted in a promise, not in practicalities. There was a promise and a commitment that was made during an election campaign, and dollars and cents were attached to that promise. There was nothing in the preface of my question that expects the minister to have universal mental health care fixed in seven months, but there was an actual dollar amount that was promised and there is a shortfall in this budget.

 

My question is in the discrepancy between the dollar amount that was promised last year and the dollar amount that’s been committed to in this budget.

 

BRIAN COMER: As I mentioned in my opening remarks, we do have $500,000 in the budget to begin this foundational work, especially from a research perspective. The universal mental health care component is a key part. I would say it’s the most significant part of my mandate, being the first minister responsible for this.

 

I think I said this in the House on a number of different occasions, but I really feel a great deal of responsibility to do it once and to do it right. I think the foundation is actively being laid, and there needs to be a significant engagement, not just with clinicians but with Nova Scotians, specifically people with lived experience and their families.

 

PATRICIA ARAB: Again, just trying to get some clarity, is the minister saying that the $102 million that was promised is not going to be delivered? Is it going to be more than that? Is it going to be less than that? Again, I’m not speaking to the practicality of how much time it’s going to take and who needs to be consulted - what stakeholders need to be engaged. I appreciate that. The minister wants to do it properly, and I think that’s a sincere desire.

 

The question really is around the financial expectations - the promise of $102 million. We know that the Canadian Mental Health Association has called on the government to invest at least $230 million into mental health and substance care to meet the World Health Organization’s recommendation of spending at least 10 per cent of the total Department of Health and Wellness’s spending on mental health and addictions programs.

 

Again, this promise of $102 million - is that gone? Is that still in play? Why wouldn’t it be attached to this budget, since it was such a strong part of the election campaign last year and is half of what is asked for by the Canadian Mental Health Association?

 

BRIAN COMER: I think the 8.3 per cent increase over $20 million is significant for sure, whether you’re looking at autism services or virtual mental health and very important programs that can help people very soon. I think the universal mental health care piece is very exciting and challenging, and it’s something I’m very focused on.

 

I know I’ve had some very significant conversations with my federal counterpart, which I think has been very productive. I think the universal mental health care is something I’m fully committed to. Like I said, the foundation is being laid right now, and there will be much more to see in the near future.

 

PATRICIA ARAB: We’ll step away from this for a little bit, but you’re not off the hook yet, minister. We’re going to get you to give me a number. Again, the minister and I would not disagree on the good intention, the determination, or the capability of the minister in developing this and laying the foundation. There’s no argument there. The question that we talk about here is the cost. Again, maybe I’m going to push it one more time.

 

The $102 million that was promised by the Premier in the campaign last Summer didn’t come out of thin air. That must have been costed in some way. There must have been something. That dollar amount came from somewhere. Now that the minister is in the office and the groundwork is being laid, we have a shortfall of $81.4 million from what’s committed in this budget to that promise.

 

To confuse the matter even further, we have a challenge from the Canadian Mental Health Association, which is calling on the government to invest at least $230 million into mental health and addictions, which would be the 10 per cent number that the World Health Organization recommends.

 

What numbers are we actually playing with here? What is going to be the cost of universal mental health care - a ballpark? Given the research that has been done, given the work that has been done, this is a very serious and important platform promise. It’s a commitment of the minister and it is part of his mandate. What number are we looking at, in terms of universal mental health care at this point?

 

BRIAN COMER: I think it would be fair to say that we’re just getting started in many ways with this bold initiative. Like I said before, the foundation is being laid. There’s a very robust stakeholder engagement piece that’s ongoing right now with health care clinicians, citizens, with people with lived experience, and these things take time for sure. Whenever I feel confident that we have significant data and evidence and robust research to give a firm number, I’d be happy to do so for the member.

 

PATRICIA ARAB: Let’s talk about wait times. Our priority should be to ensure that those who need mental health and addiction services the most get their services as quickly as possible. People in crisis and require emergency care need to be seen right away.

 

Over the last year, how many clients were served through the Nova Scotia Health Authority and through the IWK mental health program? If possible, do you have a breakdown of the clients served by region?

 

BRIAN COMER: Basically, the way it works is that it’s actually broken down in specific programs: inpatient services, a community-based treatment, those sorts of specifics. It would be difficult to give a totality number, but if you wanted a specific program, I could see if the staff here could maybe find that for you.

 

PATRICIA ARAB: Yes, I’d like to know the numbers of all of the programs that are pertaining to the Office of Addictions and Mental Health, if we can get those numbers and a breakdown of the clients served by region. I understand if the minister or staff don’t necessarily have that tonight, but yes, if you could get that for the sake of the House, that would be appreciated.

 

BRIAN COMER: I’ll make a note with my staff here now and I’ll get them to follow up with specifics, if that’s okay.

 

PATRICIA ARAB: Yes, the delivery of those numbers is great. It’s okay if he doesn’t have it tonight.

 

Under the previous government, wait times for both adults and children, adolescents, triaged as urgent have improved substantially since 2018. The current government, when they were in Opposition, claimed that some Nova Scotians had to wait over 300 days for care, which we know is simply not true. Clients on average are seen within the seven-day national wait time standard for community-based services, which is excellent news.

 

Can the minister tell us what the median wait time is for children and adolescents, and for adults, and if there’s a regional breakdown on the wait times for urgent care? I would appreciate those numbers as well.

 

 

[6:45 p.m.]

 

BRIAN COMER: For provincial children and adolescents, the median wait time for Nova Scotia Health Authority is four days. The median wait time for IWK is five days. For non-urgent, which is a targeted 28 days, median wait for Nova Scotia Health Authority is 27 days. The median wait for IWK is 57 days.

 

In Q2, urgent median wait time for Nova Scotia Health Authority is three days, the median wait time for IWK is six days. For non-urgent, median wait for Nova Scotia Health Authority is 16, and the median wait for IWK is 59.

 

In Q3, urgent median wait time for Nova Scotia Health Authority is four days, median wait for IWK is seven days. For non-urgent, median wait for Nova Scotia Health Authority is 20, the median wait for IWK is 54.

 

Then for adults, urgent and Q1, median wait is three days; for non-urgent, median wait is 37 days. Urgent median wait is two days, non-urgent median wait is 18 days. In Q3, urgent median wait is five days, and non-urgent median wait is 33 days.

 

I do have just an additional comment for the member. I do think in the time frame that she mentioned, we were in the midst of a global pandemic. I think you’re looking at a significant increase in presentation to emergency departments with mental health issues - I believe over 30 percent. I can double check with staff here.

 

There’s been significant increases with children and youth with depression and anxiety, and eating disorders. I know crisis calls to the autism crisis line were up significantly, as they were with the provincial crisis line. I think in many ways we’re in - I don’t want to say an unprecedented situation, but we kind of are in an unprecedented situation in terms of mental health across the spectrum. That being said, I think the wait times are something I’m very focused on.

 

PATRICIA ARAB: Under previous governments, the Department of Health and Wellness has provided mental health and addictions at the health authorities with funding to improve wait time performance. This included an investment for central intake. That was six FTEs, an expansion of the community-based supports, which I believe was 35 clinical FTEs and nine clinical FTEs for First Nations communities. I’m not sure if those numbers would still be in play at this point or not. I’m curious: What’s the current FTE complement to reduce wait times?

 

BRIAN COMER: Just to clarify with the member, is she referring to the FTEs in central intake or from a provincial standpoint?

 

PATRICIA ARAB: Both.

 

BRIAN COMER: With regard to new and additional services, there will be 22.8 new FTEs focused for this.

 

PATRICIA ARAB: Maybe the minister can clarify that answer. He said 22.8 new FTEs - is that in addition, or is that the total?

 

BRIAN COMER: That would be net new.

 

PATRICIA ARAB: Can the minister let the committee know how many vacancies there are currently?

 

BRIAN COMER: The most recent data is 123 at Nova Scotia Health Authority. I think it’s important to add that health and human resource planning is something that I’m very focused on. There is an additional $300,000 too for strategic initiatives to really enhance this process.

 

I’ve had a number of very productive conversations with various mental health care professional groups across the province. I think there’s some real significant progress being made right now - very collaborative dialogue. I think in all of our planning, the HHR strategy is critical, whether you’re looking at psychiatry, psychologists, social workers, registered nurses, nurse practitioners, or occupational therapists.

 

We’re working very closely with Dr. Orrell and the Office of Healthcare Professionals Recruitment as well. I think it’s also highly beneficial having someone in his position with previous frontline health care experience as well, when he’s actively engaging and recruiting clinicians.

 

PATRICIA ARAB: Can the minister tell us how many of those vacancies are COVID-19 related?

 

BRIAN COMER: The 123 vacancies that we previously mentioned would be current vacancies. They wouldn’t have anything to do with illness due to COVID-19. We wouldn’t have the specificity of short-term illness for COVID-19 specifically for mental health and addictions programming in the province for staffing.

 

PATRICIA ARAB: Over several years, there’s been an expansion and improvement to the crisis and urgent care services, which is probably roughly $1.6 million annually. This includes the 24/7 provincial crisis line and the mobile crisis teams that are in Central Zone, urgent care appointments for patients discharged from EDs who require quicker follow-up than MHA community clinics can provide, and ER consultations.

 

Last year, funds were earmarked to enhance provincial crisis line phone infrastructure and hire an additional 13 positions to support the implementation of urgent care services the province. I’m curious if those 13 additional positions were hired and what work has been completed so far.

 

[7:00 p.m.]

 

BRIAN COMER: That was completed. There were two additional positions hired, and also an additional 13 positions were hired to increase and support the implementation of urgent care services across the province. I do think it’s also noteworthy from a provincial perspective to look at development of the recovery support centres opened in Dartmouth and at the Aberdeen, an acute day hospital, which are all very relative in conversation when you’re looking at urgent care.

 

I think one of the main goals of the office is to try to get folks when they’re in that Tier 2 and Tier 3 space, before they reach the Tier 4 and Tier 5 crisis space. We are seeing significant issues. Whether from the pandemic or other issues that are happening globally, people are having significant issues who have maybe never had them before. I do think that these are very significant investments.

 

PATRICIA ARAB: Maybe the minister could clarify. He said the 13 positions were filled, and then an additional two. Does that mean there were 15 positions filled? Sorry, I didn’t understand what he was referring to.

 

BRIAN COMER: There were 15 positions in total. I think that was the question.

 

PATRICIA ARAB: I’m good at math. I didn’t mean to indicate otherwise or make people assume otherwise.

 

Are we seeing a continuation in this budget for urgent care services? What is the expected reduction in wait times with those investments? I know the minister has highlighted a number of other things that he feels will help with urgent care services, even though they’re not technically urgent care services. What can we expect, or what is the hope of a reduction of wait times with these investments?

 

BRIAN COMER: I thank the member for the question. It’s a difficult question, kind of general, so I’ll try to get into specifics and answer a little bit more generally.

 

The primary focus is urgent care - people in crisis. We are meeting those targets, like when we reviewed the numbers earlier. An area that I really think a lot about is the non-urgent wait times, just with my experience before coming into this role. Oftentimes, non-urgent issues can turn into urgent issues if they’re untreated or not caught early, I guess you could say from a preventative standpoint.

 

I think a very aggressive goal is to really increase access as quickly as possible across the province for people who need it before it turns into a crisis. That being said, we still have to keep a close eye on the in-patient services, both for IWK and Nova Scotia Health Authority - a very close eye on those urgent and not-urgent targets, especially with the preliminary research that’s just starting to see the impacts the pandemic has had, especially on our youth. It’s definitely the youth population - not just the youth population, but that’s something I think a lot about. We do know that the vast majority of addictions and mental health issues come to be before the age of 25.

 

There are also significant investments in virtual care, looking at - virtual care can be done quite effectively with psychiatry, and not just psychiatry but also with a variety of mental health care professionals. I think there are some pretty innovative things we can potentially do for personal care, especially in the other more rural parts of the province because they become particularly challenging with lack of infrastructure - whether it’s internet or technology for folks to even be able to access various e-mental health resources.

 

With that being said, we’ve had some pretty significant uptake of the e-mental health tools that we’ve developed over the last little bit.

 

PATRICIA ARAB: Maybe we can talk about youth mental health for a little bit because prior to my entering into politics, my background was in mental health within the education system. Actually, my career started with preventative mental health.

 

We have a lot of things within the budget, within the system that we exist in, that are reactionary. Even when we talk about virtual mental health and e-mental health services, that’s in reaction to - and we’ll stay focused on youth because that was my background as well - youth who have entered or have crisis, or who have addictions issues.

 

One of the best ways that’s been proven to avoid crisis is by teaching our young people, and maybe ourselves at the same time, that everybody has mental health, and that mental health should be looked at the same way that we look at physical health, the same way we look at financial health, or spiritual health.

 

Most people don’t wait to have a heart attack before they start looking after their physical health, watching what they eat, exercising. I think most people, and I’ll be so bold as to even put a decade on it - in the 1970s and 1980s, there was a huge push within our public school system to promote physical activity as a means of prevention, so that you would prevent some of these physical ailments that lifestyle predisposes us to.

 

All that is to say - if we’re talking about our lives before politics - my life before politics was working with elementary-aged kids and implementing a preventative mental health program within their school system. I developed mental health curriculum with Senator Stan Kutcher for high school students - all of this to be prevention so that you give kids the tools they need so when they face a crisis that’s inevitably going to happen - we all face crises - they have the tools that they need to deal with them, and they can support each other and support themselves.

Is there anything within this budget, or is there anything within the Department of Education and Early Childhood Development’s budget that is promoting preventative mental health within our province?

 

BRIAN COMER: I actually didn’t know you did that in your previous life. That’s pretty interesting. Thank you for sharing that with me.

 

I can’t really speak to the Department of Education and Early Childhood Development budget. I’ll be just trying to get through my own this evening. In regard to youth services specifically, there’s just under $6 million - $5.84 million - in the budget.

 

I think just a couple good examples of programs that are probably very valuable and probably have to be seriously looked at for possible expansion in the near future, based on the data that we collect. I think some of these programs - SchoolsPlus is a great program. It’s at all the Nova Scotia schools, kind of includes mentoring, social work, afterschool programming, homework support, recreational, and justice services into schools so you can increase accessibility.

 

I know the youth health centre is something I really think a lot about. I know a couple of the nurses in Cape Breton do this. It’s a very busy spot to be right now in school systems in the province - much more so since the pandemic has impacted. Most of the concerns that I’ve been hearing from fellow health care professionals have actually been around mental health in the school system, and also a lot with food insecurity, issues like that.

 

The youth health centres are actually funded through Public Health. Their health promotion and youth engagement help navigate students. Once I got into this role, I think it’s something I had expressed interest in - adding more synergy between Public Health and Addictions and Mental Health specifically - because the two are directly related in my mind.

 

There are also the Adolescent Outreach Services, which is funded through our office. That’s really targeted at Grades 6 to 12, so the 12 to 19 years of age cohort really tries to identify poor mental health and potential addictions outcomes early and tries to get proactive and preventative personal skills building, coping mechanisms. To be honest, I do worry a lot about the youth right now in the province, given what’s happened during in the last number of years, so I think it’s something I’ll continue to focus on.

 

I do have to mention some of the great work done at the IWK. I think the IWK in many ways is very much a national leader in terms of integrated youth services in offering young people and their caregivers health and wellness resources and supports, whether that’s through single-session, individual, and family therapy, wraparound supports, virtual care.

 

I think these initiatives, with the integrated youth services are actually being implemented now. I think it’s also noteworthy that one of my first meetings was actually in Eskasoni at their health centre with Chief Leroy Denny and their health director at the time. They have probably one of the most unique and most effective, I would say, integrated youth services models that I’ve ever been to, to be honest. There are a number across the country through the Access to Open Minds. It very much looks at accessing supports much differently than we would do in the traditional health care system.

 

It could be as simple as going in to get a coffee or going fishing. You’re just speaking with elders in the community. It’s much more destigmatizing and people are much more likely to come forward with their issues if you’re not having to walk into the crisis centre, to be honest. I think they are probably a few programs that are worth mentioning.

 

That being said, do we have to do more? I’d probably say yes. It’s not an easy thing to do, but something I’ll definitely keep working toward.

 

PATRICIA ARAB: I’ll give you a little bit more history. I represent a riding that’s in Central Zone, but my career actually was on the South Shore, so it was in rural Nova Scotia where the school really was the hub of where services could be accessed. Actually, I’m very familiar with SchoolsPlus, because my school was one of the schools to pilot SchoolsPlus originally. It is a great program, but when you talk about the destigmatizing - or I like to say the normalizing - of mental health supports, those areas within a school still have a stigma attached to them, much like in other communities.

 

If we really want to be normalizing, if we want to have this idea of mental health being something that we all need to take care of - so there’s mental illness and there’s mental health, two different things - that prevention piece needs to start before high school. It needs to start before Grade 6.

 

I don’t expect you to know anything about the Education and Early Childhood Development budget, but I would challenge you to have conversations with the Minister of Education and Early Childhood Development because the program that is run in the South Shore - and it’s still running in certain elementary schools - is the PATHS program, which is Promoting Alternate THinking Strategies. It takes children from Primary to Grade 6 and teaches them how to name and identity their feelings, good and bad, and it teaches them healthy ways to work through those feelings.

 

It’s a whole school approach, so our bus drivers were trained, our lunch monitors were trained, our school yard supervisors, our parents. Everybody in the school was using the same language as these kids so they could be fully immersed in it and know it was the norm.

 

 

[7:15 p.m.]

 

It’s something that’s done exclusively throughout the State of New York, so every public school in the state runs this program. The hope is that by the time they reach adolescence, by the time these children get to Grades 6, 7 and 8, and crises happens, they have the tools that they need to deal with those crises. They know they have that skill set. Some will have it inherently, some you need to teach them, just like a times table or reading, but that’s the normalizing piece: there’s nothing wrong with you, everybody can use this. Everybody needs to do this.

 

I guess maybe I’ll leave that there. I’m taking away from my time, but I would challenge the minister to have that conversation with the Minister of Education and Early Childhood Development, and really see if this is something that could be implemented across the province, because it is a tool that is there, that’s easy to use, and has tested outcomes.

 

Let’s go back to my prepared questions - that was a little side note. Let’s talk about Cape Breton because I know it’s near and dear to your heart. I’m an honorary Cape Bretoner. If anybody asks, I’m from South Bar. I’ll tell you that story another time.

 

There were targeted efforts to improve non-urgent wait times in Cape Breton, which continues to be an area of concern. I’m curious if the minister can let us know what the current wait times are for urgent and non-urgent care in Cape Breton, specifically, for children, adolescents, and adults.

 

BRIAN COMER: It’s something that’s near and dear to me, for sure. Once upon a time, my first child was in in-patient mental health at Cape Breton. We actually had 16 psychiatrists at the time, probably about 9 or 10 years ago at this point. By the time I left, we had five. I’m not pointing fingers here, it’s not my nature, but there was significant deterioration, I think, of services in Cape Breton over the last decade.

 

I’m meeting with folks there on a monthly basis, for sure. They’re probably some of the most overworked - not just psychiatrists, but nurses, social workers, and recreation therapists, probably in the country, to be honest. Their call schedule there isn’t really fair and hasn’t been for a long time. There are some very active efforts on behalf of myself and Dr. Orrell to change that as quickly as possible.

 

I think it is also noteworthy that there have been two new clinical assistants who have been in the budget for Eastern Zone for this budget. The feedback with the assistance from staff has actually been quite positive and beneficial. There have also been some significant initiatives that I’m trying to do innovative things. It’s very challenging, not just in Eastern Zone, but also in the Western and Northern Zones in the province.

 

Just going back to your specific question, the non-urgent time would be 144 days right now.

 

PATRICIA ARAB: The question was actually urgent and non-urgent, and a breakdown of children, adolescents, and adults.

 

BRIAN COMER: The median wait days for Central Zone right now for adults is four days. For Eastern it’s four, Northern it’s two, and Western it’s two. For child and adolescent, for Eastern it’s five, Northern it’s two, and Western it’s four.

 

PATRICIA ARAB: The Department of Health and Wellness also had a Cape Breton wait times initiative, which was targeted at addressing wait time performance in Eastern Zone specifically. This included wellness check-ins with adult and child clients waiting to re-triage, other brief interventions as appropriate, and offering earlier appointments with community clinicians, maximizing clinical capacity and availability of clinical teams in other areas of the province and targeted recruitment to fill chronic vacancies.

 

In response to my colleague, the member for Sydney-Membertou, the minister said: I’ve sat across the table from them twice in the last eight weeks, looked them in the eyes - it’s going to get better, and there is a plan in place. Is the plan the one I just outlined? How much budget is being allocated this year to reducing wait times in Cape Breton specifically?

 

BRIAN COMER: I mentioned previously the addition of the clinical assistance, which I think will have a significant role in that regard. There have also been significant investments in enhancing virtual care, which means there can be community wait-lists in non-urgent care. It can actually be done through virtual care.

 

I think it’s also pretty exciting to have Dr. Vhari James as the first child and adolescent psychiatrist we’ve had in Cape Breton in close to a decade, I think. She has a situation where she sees patients in person certain days a week and also does a lot of virtual care with children and adolescents.

 

So there are significant investments, for sure, but there’s definitely more that needs to be done. I’ll definitely be working hard to address that.

 

THE CHAIR: To the honourable member for Fairview-Clayton Park, it’s 7:24 p.m., just to let you know. Your time ends at 7:30 p.m.

 

PATRICIA ARAB: Thank you, Mr. Chair. To the minister, we deal with concrete items in Budget Estimates - it’s not Question Period answers. You talked about the two so I’m going to keep on drilling down on you for actual specifics and numbers, as they’re reflected into the budget.

The two clinical assistants for Eastern Zone that are allotted in this budget - you mentioned them a few times. Have these positions been filled?

 

BRIAN COMER: Yes, once this budget passes, the hiring process will be very rapid.

 

PATRICIA ARAB: When they are hired, does the minister feel that this will be sufficient enough to address the current need, or how many more clinical assistants does he think are required in Cape Breton?

 

BRIAN COMER: I don’t think this is sufficient, to be quite frank. It’s more of a release valve to try to alleviate some intense pressure on the clinicians there now. That being said, I think there’s a great deal of value if you can get psychiatrists and clinical assistants. It’s a great environment possible for teaching, and depending on the situation, they can also work toward full license for themselves at some point, depending on their credentials. I think the main goal is to really get the proper complements of psychiatrists, in not just that zone, but also in the others as well.

 

PATRICIA ARAB: Has the minister entertained the usage of those individuals who are counsellors - they hold a Master of Education in counselling? Many people within the health care field feel that the M.Ed. in counselling actually prepares the individuals better for clinical work than an MSW does. Social workers are used frequently within the mental health system, as they should be. In looking at the different roles and the different mechanisms that can be used, have any entertained around that M.Ed. in counselling piece, those certified Canadian counsellors?

 

BRIAN COMER: My mandate letter identified three specific disciplines: psychologists, social workers, and registered counselling therapists. I’d be very surprised if there weren’t more. I’ve already talked to people outside of those three disciplines. There’s a very robust process right now that’s ongoing with health care professionals in the province.

 

I think that situation specifically could be interesting because they could have potential access in the school system. I’d be willing to have that conversation. To say anything definitively at this point would probably be premature, to be honest, but I think it’s an interesting point, for sure.

 

THE CHAIR: The honourable member for Fairview-Clayton Park with about 35 seconds to go.

 

PATRICIA ARAB: I’ll just use that 35 seconds to give a shoutout to my other M.Ed. counselling peeps. In all seriousness, when you have a system that is stretched thin and you’re looking for clinicians, it’s important to look at the skill set provided by these large numbers of clinicians who aren’t always working within a school system either, and having them be under this umbrella where they are needed and can be valued.

 

THE CHAIR: Order. Great job, member. Great job, minister.

 

We’re going to take a five-minute break, and we’re going to start again at 7:35 p.m. with the NDP caucus.

 

[7:30 p.m. The committee recessed.]

 

[7:38 p.m. The committee reconvened.]

 

THE CHAIR: It’s now time for the NDP caucus. The time is 7:38 p.m.

 

The honourable member for Halifax Citadel-Sable Island.

 

LISA LACHANCE: Thank you to the minister for being here tonight. I’m going to try to talk less and ask more questions. We’ll see how that goes, but if it seems like I’m just getting in there a little bit quick, I’m just trying to make the most of my time.

 

In the $20.6 million increase to mental health and addictions in this budget, I’m just going to walk through what I understand the breakdown is. There’s $12 million additional for early intervention for autism. I understand there’s an increase of $409,000 in administration, $1.2 million in addictions, and an increase of $7 million for mental health services.

 

With the mental health services though - that’s $7 million - what I understand is just over half of it is going into actual clinical care. So $3.1 million is for the 11 clinicians who have started, will start, are starting for virtual care, plus eight clinicians for the IWK. Then there’s $2.3 million for data collection, evaluation and analysis. That’s FTEs as well as $600,000 for consulting and evaluation in terms of models of care.

 

I’ll start my questions off by asking whether I got the increase right in terms of the breakdown. Given that the most major amount is for the autism early intervention services, can you break that out a little bit? Who’s coordinating this? Is this all going out to third parties for service provision? Is this going to be an ongoing increase year over year? What evaluation do you have planned?

 

BRIAN COMER: Thank you to the member for the question. I think I’ll just go through it line by line, if that’s okay. The admin comment was for four new FTEs - early interventions, IWK, there is additional funding for the brief intensive outreach service program, $370,000. I believe the member mentioned comments in regard to autism. That will be a new integrated model of care. I could have more to say about that in the days ahead.

For Addiction Services specifically, for withdrawal management hubs, there was $1.69 million. For problem gambling strategy, $443,000. For mental health services - so the Office of Addictions and Mental Health - there’s going to be some significant research and robust data collection in regard to laying the foundational framework for that. Mental Health and Addictions Services at the IWK - the FTEs in regard to data collection will help to guide clinical services with the IWK. Eight new FTEs to support enhanced virtual services through the IWK.

 

Mental Health and Addictions Services with the Nova Scotia Health Authority - implementation of data collection, this will be analyzing, FTEs and operational systems. There is $275,000 for clinical assistants in Eastern Zone. The day hospital is also included in that, and integrated mental health services as well. If there are any kinds of specific line items that the member wanted to ask - and I would just like to add the funding specifically for autism will be a permanent increase in their funding. It’s going to be done through the IWK in partnership with Autism Nova Scotia.

 

LISA LACHANCE: I do think that it will be important to be clear about what the $12 million looks like. I’m understanding that it’s a new model, which means that there will be, I would anticipate, some ramp-up time. I’m just curious, this year, what’s the goal? How many young people will be served?

 

BRIAN COMER: Traditionally, the office has given a grant to Autism Nova Scotia of $500,000 per year. There’s also an additional $300,000 per year for four years for autism resource sectors. Just touching on the specific question with the investment in the budget, this would very much focus on reducing the wait list, especially for diagnostic purposes, as quickly as possible. I’m sure many MLAs across the province have spoken with constituents and families who often have a significant delay in diagnoses, and it puts them in a very difficult situation before their children start school.

 

Really, it’s trying to look at it in the continuum of care, very much looking at the unique needs of individuals and families. Not just focusing on the EIBI aspect, but also on the very much needs-based assessment that would be specific for that individual family. This would take some time for implementation, for sure. It will be phased in this year. I think it’s exciting. Hopefully it helps a lot of families.

 

LISA LACHANCE: Thank you for that overview. I would be the first - maybe not the first, but I’d be amongst the first folks to say that support for autism is desperately needed in this province. I’m not going to ask you a question about this, but I am going to put out a marker that the needs for folks with autism and their families doesn’t end when they start primary school. In fact, actually, where we fall down as a province is supporting people through the elementary school years, keeping them in schools.

 

 

 

[7:45 p.m.]

 

I do hope that if we’re putting this much money in early intervention, that we keep on going, so that we think about the lifespan support that’s needed. Elementary school, high school, transition to adulthood, that sort of thing.

 

Speaking of phasing in, the honourable member for Fairview-Clayton Park spent a lot of time trying to get an answer about the $102 million pledge. I’m not going to spend too much longer on that, but I have a question about it. Is there a multi-year plan to get to $102 million a year?

 

BRIAN COMER: I know the universal access piece is very significant to many Nova Scotians and all of us as representatives, for sure. I think at this point, we’re very much undergoing a needs-based planning approach, very much focusing on robust data and quantitative planning addressing mental health and addictions systems in Nova Scotia.

 

I’ve had a number of very productive conversations with my federal colleague and other leading experts, I would say, in the province. We have a very unique opportunity in Nova Scotia to really be a leader in terms of research, development, and pilots especially. Speaking with individuals from the Canadian Institutes of Health Research and many of our colleagues in the province, I think there’s something significant there, for sure.

 

Something I think about is ensuring that once this begins to roll out, is that the people who need it most are getting services first. I think it’s going to be a significant mandate item. I hope that helps clarify the question.

 

LISA LACHANCE: That was a helpful answer. Thank you to the minister. I would say it didn’t clarify the question, because it was actually a yes or no question. This is why I was also asking about ramping up. I certainly understand the need for planning, implementing, and evaluating efforts.

 

I know that there’s $500,000 allocated for a study to explore this model. Is this a contract? Is it one contract? Who is it with? What work is being undertaken? You mentioned working with people with lived experience. How are they being included and compensated for their work?

 

BRIAN COMER: I think, to be quite frank, people with lived experience probably bring the most value of anyone to the portfolio and to this issue in the province. I think just working as a frontline nurse in psychiatry and inpatient withdrawal management - now thankfully called recovery support centres, which is much more appropriate - I actually like to personally talk to them myself as much as I can. I do have an extensive list of stakeholders whom I would have seen over the last few months. I’d like to really be out there talking to people.

 

I think something too that we’ve been hearing as we’ve been engaging with people across the province is there’s a really significant benefit to peer support, so that would actually be a potential also, not just to get a valuable insight, but also for a potential employment opportunity for these individuals.

 

I was part of a pilot project a number of years ago now in the Eastern Zone. We had peer support workers on in-patient acute psychiatric unit, and they would actually oftentimes disclose information to the peer support workers that they wouldn’t actually disclose to staff, which is very interesting. So I do see a lot of benefit to the peer support and people with lived experience.

 

LISA LACHANCE: Thank you for that. I’m going to repeat the questions that I asked in a minute, because I didn’t actually get any answers to those questions. In terms of this idea of people with lived experience, I think one of the things that I am worried about - and I am very pleased that you are committed to evidence-based decision-making and getting the data organized. I think in mental health research, planning, implementation, services, there’s a large body of evidence that we can access.

 

When it comes to engaging folks with lived experience and family engagement or in lived experience, youth engagement - sorry. Could I ask the members just to be a little bit quieter? Thank you.

 

Family engagement, youth engagement - there is a wealth of research that’s been done on that in this province, across this country, and around the world, and there are evidence-based standards that have been established by the Knowledge Institute on Child and Youth Mental Health and Addictions in Ottawa as well as through the Mental Health Commission of Canada. Going around and just talking to people is not engagement. You haven’t set standards, you haven’t got an organized approach, there is no way for ongoing feedback.

 

I think one of the really important principles around engagement of people with lived experience is actually recognizing their time and expertise, and providing adequate compensation and clear opportunities. I think I would encourage folks to pick up the standards that are available, which actually come with a whole evaluation strategy as well. It’s not even just the standards, but how you can evaluate them, and that’s just based on decades of work that’s been done.

 

Once again - $500,000 to study universal mental health care. Is there a contract in place with someone to lead that work?

 

BRIAN COMER: I think we have some of the best practitioners probably in the world. We talk to the IWK frequently. They are very familiar with family and youth engagement. I respectfully disagree about the value seen in having a minister talking to people with lived experience. To be honest with you, I think that’s quite the opposite, actually.

 

In regard to the specific question to the $500,000, once the budget concludes, it will be an RFP issue.

 

LISA LACHANCE: The current budget allocates $1.35 million for 11 FTEs to provide virtual crisis care through Nova Scotia Health Authority. Are those FTEs in place, and to grow to the 22-clinician promise, will there be an additional $1.35 million next year to bring it to a total of $2.7 million?

 

BRIAN COMER: It will be $1.35 million next year, and it will go up to $2.7 next fiscal, so we’ll be scaling up to get to those 22 FTEs.

 

LISA LACHANCE: Is 22 FTEs the target for providing virtual emergency care?

 

BRIAN COMER: It will be 22.8 this fiscal, plus 11 next fiscal.

 

LISA LACHANCE: They’re providing emergency virtual care. Can you describe how that’s happening?

 

BRIAN COMER: They’ll actually be doing virtual consults at emergency departments anywhere across the province. We talked to one of the psychiatrists a few weeks back who’s going to be doing this, especially in underserviced regions. It’ll be a very innovative approach actually - especially to help people who are kind of in mental health crises or in an acute situation.

 

LISA LACHANCE: The minister referenced an innovative approach. I guess one of the things that I’m concerned about is just really understanding how we’re getting the evidence that we base our programs on. This isn’t only in Nova Scotia, but there are some specific Nova Scotian aspects to it.

 

We do have amazing researchers. I can give a shoutout to our PhD committee who do a lot of work in mental health in this province, so I would not dispute that at all. At the same time, how that actually gets translated and what we actually understand is a complex process. For instance, we are talking about increased mental health needs because of the pandemic.

 

Actually, the research so far is inconclusive about what that looks like. I think eating disorders have clearly increased, but actually a bunch of studies just came out that were pulled together in a synthesis that looked at child and youth suicide actually decreasing in Canada during the period of the pandemic.

 

 

[8:00 p.m.]

 

A lot of times, you have to take it all together and have experts understand it, parse it out, understand what it means for methodology - and also, we’re not even out of the pandemic. I guess I worry when I hear different things are bandied about because I’m not sure that the evidence supports them.

 

You talked about increasing the research capacity within the office, I believe, or increasing the research and data analysis. How does your team connect with emergent research, like peer-reviewed research, and how is that deciphered into programs and policy in the office?

 

BRIAN COMER: For fiscal 2022-23, there’ll be an analyst, routine outcome monitoring, industrial engineer, data coordinator, data analysis, data collection. I think I should also say that there are some highly qualified and very respected individuals - not only within government, but within our province - who we do have a very collaborative, open, productive dialogue with.

 

With regard to the impacts of the pandemic, I don’t think they would have helped peoples’ mental health, anecdotally speaking. I think it’s probably a little bit early to conclude what the research is going to say. I’m not sure if the member was trying to say the pandemic had a positive impact on peoples’ mental health. I’m not too sure - that kind of sounded strange to me - but nonetheless, thank you.

 

LISA LACHANCE: I just want to clarify what I was saying because I definitely don’t want the minister to put words in my mouth. What I was definitely saying was that we need evidence-based mental health care. That’s what we haven’t had here across the country, globally. That’s what a lot of people are working toward.

 

I’m not using anecdotally that the pandemic - I’m not working in anecdotes. What I want to say is that we can’t presume until you have an evidence base what the effect has or hasn’t been. I’m certainly not pronouncing on it. I’m telling you what I’ve read and what I’ve looked at. Certainly, I would encourage you to have people within your department who can look through the longitudinal studies, look through the data synthesis, and develop information that’s useful for your department.

 

On that note, the universal access promise was about updating MSI billing codes, providing universal access through private providers. Before the election and during the election, I think that was how the party understood the problem of mental health in Nova Scotia.

 

Has there been any thought of actually bringing this together in a comprehensive mental health strategy that, not unlike the one the Liberals stopped implementing in 2014? That was really a structured approach to bringing together a vast amount of communities and community organizations, folks with lived experience, clinicians. The advantage to having a strategy - it sets out some key principles and some goals instead of throwing spaghetti at the wall with a bunch of different activities.

 

THE CHAIR: The honourable member for Halifax Citadel-Sable Island with an additional question.

 

LISA LACHANCE: I was just going to summarize what I had said. Has there been consideration of a mental health strategy?

 

BRIAN COMER: The universal addictions, mental health specifically, there will be a strategic plan and framework that will be laid out in the near future. It just takes a bit of time. It’s very significant. I don’t want to take this lightly.

 

I know I do get asked this question a fair bit, which is totally understandable. I know it’s very important to many people, but part of the research and the quantitative data collection will give us the strategic direction - not just for this year or next year, but hopefully for the future for Nova Scotia.

 

LISA LACHANCE: I was pleased to hear you talking about integrated youth services. I think I do want to clarify that there’s no way we’re the first jurisdiction in Canada to have integrated youth services. In fact, the fact that we’re lagging behind nationally was one of the reasons that I chose to study integrated youth services in my PhD research. I think they hold enormous promise. I think that there are a couple decades of research that’s gone into this, nationally and internationally. I think there’s been robust data collection, for instance, through the ACCESS Open Minds project that will certainly be helpful.

 

I know that the IWK is leading an initiative to implement integrated youth services in Nova Scotia. They recently posted for a senior position to lead that work. One of the key principles around integrated youth services is actually providing services that span the developmental period of youth - in general in Canada that’s 12 to 25 years old. This will require in Nova Scotia the collaboration of Nova Scotia Health Authority with the IWK. How is your office involved in supporting the establishment of integrated youth services, and particularly, the focus on the youth developmental period?

 

BRIAN COMER: We have a significant partnership with very frequent and ongoing dialogue. I just asked the department to get the investment figure for integrating services. I can just maybe review some of the specifics with the single-session, individual, and family therapy. That would be support that meets you where you are, so families can walk in and receive virtual individual or family sessions with a health care professional.

 

The investment is $1.3 million, to the member. There are also wraparound supports available. This will a hub that will provide opportunities to improve access at one location. Primary health, DCS, Justice, Education and Early Childhood Development, and community-based organizations will join the hub, so it very much creates a suite of services in partnership with the office.

 

There’s also evidence-based child and adolescent services, websites, and helpful mental health and addictions information, which is a digital knowledge hub, so virtual interventions which can be provided by professionals. There’s also coordination outreach and matching to appropriate services. They provide assistance, finding resources and supports that are right for the youth and the caregiver, really focusing on the unique needs of the family and individuals.

 

There are outreach services to support improved function in community overall wellness. There’s also a peer support aspect. The peer support will include social and emotional support and empathy, regardless of the circumstances. It’s delivered through groups and workshops, with also an option for one-to-one. The last part is the supporting others aspect, which will partner with community groups, primary health, and caregivers, to provide tools and tips just upon exiting the program.

 

There’s also a steering committee that’s actually run in partnership with the office for collaborative feedback. So the IWK Mental Health and Addictions planning team and our office come together to really try to ensure that these services really go right across the lifespan.

 

LISA LACHANCE: I want to make sure that I understand - is the $1.3 million going to support the IYS effort being led by the IWK?

 

BRIAN COMER: Yes, that’s right.

 

LISA LACHANCE: I’m wondering if the minister can also clarify if the minister and the office are committed to an integrated service system in Nova Scotia that spans 12 to 25 years old or whatever - you use the definition you want to use. Will the steering committee include family engagement and youth engagement?

 

BRIAN COMER: I think there’ll be a very thorough and rapid evaluation of this integrated youth services model with the IWK, something I’ll be watching very closely. I think the family engagement piece will be critical. It’s something that I think will be very important as we move forward.

 

LISA LACHANCE: I might come back, just to really understand if we’re going to talk about 12- to 25-year-olds, because in Nova Scotia, that requires some deep collaboration between Nova Scotia Health Authority and the IWK. Maybe I will come back to that question at a later time.

 

 

[8:15 p.m.]

 

I wanted to ask about the one-time investments that were made through the Mental Health Foundation from year end funds. I’m wondering if you can speak a bit about that. You’re saying that they’re going to be given to organizations that serve equity-deserving populations and communities, but how will that actually be mandated? How will that be monitored? How will the priority be determined and what will be the evaluation of the provincial investment?

 

BRIAN COMER: In order to provide that funding, I made sure there was a pretty extensive accountability framework in place, which will have to be reported back to me in the department on a quarterly basis. I agree there must be a very specific mention that it should be targeted for specific groups that need the supports the most: African Nova Scotians, First Nation individuals, 2SLGBTQ+, newcomers, and people in vulnerable situations.

 

I think if you actually reviewed some of their grant recipients in the past, it’s quite an extensive list. I went through every single one of them before I came up with a decision to provide the funding. They did work with ranging from eating disorders to early psychosis, to work with African Nova Scotian communities. The Canadian Mental Health Association does extensive work. The office also provides funding to groups as well. I just really thought there was a time sensitivity to get the money to these groups. Yes, I’ll be looking for that accountability framework, and they’ll be very focused on that.

 

LISA LACHANCE: Thank you to the minister for the explanation. I’m pleased to hear that there is an accountability framework in place to guide and monitor the investments.

 

Just to clarify, are organizations being given one-year funding from the year-end funding that was given to the foundation?

 

BRIAN COMER: This was a one-time investment. That being said, based on the accountability framework and based on the feedback from community organizations that received the funding and the impacts it has had on their communities, we’ll definitely be revaluating that, but this was a one-time funding.

 

LISA LACHANCE: I do hope that as the IYS model is developed and you start thinking about a mental health strategy and a strategic plan, that the role of community-based organizations will be considered, and to really move organizations off the one-year funding cycle.

 

It is really just so difficult for community-based organizations to make plans, to develop programs, to evaluate them. Basically, you’re not really getting evaluation data. You might get bums in seats - sorry, I can’t say bums - but you’re not getting long-term changes from a one-year program, or at least you’re not able to measure them or quantify them. I think it’s really important to think about longer-term funding frameworks that allow communities to build capacity, to build programs, and to actually see programs through that have long-term impacts.

 

Can the minister speak about what diversity equity and inclusion analysis is undertaken on the policies and programs of the office?

 

BRIAN COMER: The Department of Health and Wellness is putting some significant work into an equity and engagement consultation piece that will be completed in order to really develop an extensive health equity framework.

 

I just want to go back on the previous question, because I think it’s important. Within the office, we are actually going to be hiring a community liaison officer whose specific job will be to work with community-based organizations across the province, because that was in my mandate.

 

I would agree with the member for sure that these groups play probably much more of a significant role than we realize, to be honest, with addictions and mental health care across the province. I speak to a lot of these groups, and they do have issues with core funding, which is something we will look at as things progress, based on based on the accountability framework.

 

LISA LACHANCE: I had a chance to speak with the Minister of Health and Wellness during Estimates and talked a bit about the Office of Diversity, Equity and Inclusion that is being established at the Department of Health and Wellness.

 

I think back when I worked in the provincial government - so 2008, 2009 - there was a specific EDI consultant at the Department of Health and Wellness who was looking at 2SLGBTQ+ communities and health issues. Within the current office, there is no such mandate.

 

I’m wondering how the Office of Addictions and Mental Health will ensure that gap is filled in their analysis.

 

BRIAN COMER: I think that as this equity engagement framework is developed, the engagement and consultation of 2SLGBTQ+ individuals - and also with individuals in Nova Scotia who have had difficulties accessing health care services - will be consulted, so I think that’s going to be part of that process.

 

LISA LACHANCE: I want to talk about the new mental health day hospital model. I have a number of questions about the day hospital. In terms of budget allocation, I’m wondering if it is $1 million total? I’ll be honest that I think that seems low, so I’d be curious what the actual annual cost of the day hospital is.

I’m wondering what the difference is between the other day treatment programs that have been traditionally offered, like at the Abbie J. Lane Memorial in HRM for instance. I know that the Fishermen’s Memorial Hospital I think closed, but they also had a day treatment program. What’s different about this new day treatment program? How many people do you plan to . . .

 

THE CHAIR: Order. Please refrain from using you.

 

LISA LACHANCE: How many people does the day hospital plan to work with over the course of this coming year? I also have some questions around how care will be managed. For instance, that model relies on people being able to go home at night. How will the program support people who don’t have safe and secure housing? I can imagine a scenario where someone comes to treatment and actually isn’t safe to go home that night. We know that the inpatient units are at 100 per cent. What’s the planning around that sort of scenario?

 

BRIAN COMER: I went to the day hospital last week and met with senior leadership and clinicians, toured the unit. It’s been all positive feedback thus far from the patients and staff, which is good. There will be a very thorough evaluation on clinical outcomes, re-admission, and those sorts of things. The investment is a little bit over $1 million. That would include a new psychiatrist - that was $360,000. There’s also funding there for registered nurses, social workers, and support teams.

 

Basically, you have the flexibility of receiving intensive in-patient services for 12 hours a day - whether that’s psychotherapy, pharmacology, whether it’s specific, individual programming or group programming. If there is a deterioration in condition, where proximity is close to the in-patient unit, you could just be re-admitted. If you needed to step down, you could also be stepped down or connected with some community-based resources.

 

It’s very much in line with the recovery support centres, even though they’re more focused on substance use disorder and gambling. We’re looking at things in a continuum of care, so you can have a suite of services basically on one side being the most intense, and the far left would be the Tier 1 or Tier 2 individuals. I think in terms of cost effectiveness of health care, as we all know, it’s quite cost effective.

 

I’ve been speaking with some of the leaders in our province in regard to help with this. They’ve seen some pretty significant research in the U.K. and other jurisdictions that have had these places for some time. I think another part of it is that it will alleviate significant strain on in-patient beds in the other three zones and also impact, directly and indirectly, EHS transfers and hold-ups at emergency rooms, because we do have a provincial bed management system. If we have 100 per cent capacity in Central Zone, it means some of these individuals are going to be going to one of the other three zones for admission, away from their families and friends and that sort of thing.

[8:30 p.m.]

 

I think what’s challenging with the day hospitals - we have very rural parts of the province too, which offer their own unique challenges for people who are acutely ill at times, so it has to be very thoughtful and innovative for other parts of the province. But I do think, in the urban centres especially, there’s really a high level of effectiveness in helping people for relatively cost efficiency purposes.

 

LISA LACHANCE: Thank you for that answer. It seems like it’s designed to meet people where they’re at, but at the same time, I’m wondering, what’s the eligibility, and how do you judge when it’s time for somebody . . .

 

THE CHAIR: Order. Please refrain from using you.

 

LISA LACHANCE: How do the clinicians judge when it’s time to discharge someone? What about support with things like transportation, food security, substance use, and things like that? Is there an income replacement or funding for child care?

 

BRIAN COMER: In regard to clinical subjective decision-making processes, I think that would probably depend on the individual clinician, if they need in-patient admission or if they’re appropriate for discharge. I can’t really speak to that.

 

I think one of the key things that I wanted to see - not just in the day hospital but in the 10 recovery support centres that we’re going to be standing up across the province - is that people can actually get a suite of services when they go there. Whether it’s DCS, whether it’s Justice, or whether it’s food security, I really want an access point to connect you with the other departments of government that you would need in that way. Oftentimes things are much too siloed.

 

I think the accessibility piece is important too. With the recovery support centres, especially in Dartmouth, which I think is a very positive thing that you don’t often see in addictions and mental health care, that you can actually just walk in, which is quite unique and highly beneficial. I think increasing accessibility and self-referral is something I think we should probably continue to focus on. I hope that helps answer the question.

 

LISA LACHANCE: I’ll be back with more questions, but for the moment I’d like to cede the remainder of the time to the honourable member for Cumberland North.

 

THE CHAIR: The honourable member for Cumberland North.

 

ELIZABETH SMITH-MCCROSSIN: How much time?

 

THE CHAIR: Six minutes.

 

ELIZABETH SMITH-MCCROSSIN: I just have six minutes, so I’ll just probably get one question in. Maybe first I’ll just ask a more overarching, bigger question. I didn’t know until the Budget Estimates came out that the Office of Addictions and Mental Health is actually under Service Nova Scotia. It’s not under the Department of Health and Wellness. I’m wondering how you work with the Department of Health and Wellness. How do the relationships work?

 

Your office is dealing with in-patients, outpatients, community care. I’m just wondering if you can explain the relationship with the Department of Health and Wellness. If some of my constituents are having trouble accessing a psychiatrist or acute mental health service - if it’s hospital-based, should we be contacting the minister, or should we be contacting the Minister of Health and Wellness?

 

BRIAN COMER: I think we’re in a little bit of a unique situation. We do have three ministers in the health portfolios, which is something new in the history of the province. The way I look at things - and the way I’ve spoken to my colleagues, which is quite often - is that anything under the purview of addictions and mental health, I take responsibility for that in the province. Anything related to psychiatry, addictions, and mental health, I would say probably it would be me, to be quite honest.

 

That being said, Minister Thompson is just down the hall from me. We talk quite a bit about various issues and have very close contact. There’s also significant, frequent dialogue with Public Health also, because they have a significant role to play in health prevention and promotion, stigma reduction, those sorts of things. I hope that helps answer the question.

 

ELIZABETH SMITH-MCCROSSIN: I feel better. I was concerned about where the minister’s department was not under Health and Wellness, I was worried about if there was a disconnect there with the other health departments. That’s reassuring.

 

There are so many questions I could ask. I did have concern with a couple of things that the minister said in the opening statement. One in particular that really stood out to me was that no one gets turned away and that there are acute care beds for anyone in need. It would be great if the minister was able to come up to Cumberland sometime and meet with some of our stakeholders like law enforcement, those who work in addictions and mental health in Cumberland, because that certainly is not the case in Cumberland.

 

Because we rely on Truro for our acute care beds, and there’s most often none available, then most of the time our emergency room doctors are not able to provide acute medical care to those in mental distress. In fact, I just got a call last night around 11:00 p.m. from a very distraught mom. We definitely need a fix for those acute mentally unwell patients, especially the ones who are going through a psychosis or maybe suicidal. We see this in all ages, minister, including teenagers. It’s very concerning.

 

The IWK is a similar situation. We had a young teenager sent home even though she said she was scared she was going to harm herself. It was the same thing - she was discharged back to the community with no support services place.

 

I want to make sure the minister is aware that those comments are not true for the people of Cumberland, and we definitely have a deficiency in acute care mental health services. I’ve spoken with Sam Hodder, and initially the concern was there’s not enough housing. That is true. What we’re talking about, even if someone had housing, there is still a huge deficiency.

 

I’ll give you one example. This is a visual. This would be common, where a paramedic would bring somebody up to the hospital who has been deemed unsafe by law enforcement or someone in the community, like a physician, and before the ambulance leaves the driveway of the hospital, the patient has been discharged and is walking out the door because they’ve not received medical care. Often, it’s because the emergency department cannot provide the care that is needed.

 

I just want to make sure that the minister is aware of these very real deficiencies that we hear about in our office, sometimes daily. It’s very awful as an MLA, but even worse when you’re the parent, when you cannot find the support and the help that is needed for your loved ones.

 

THE CHAIR: Order. The time has run out for the Independent member. This time I will pass it back to the Official Opposition.

 

The honourable member for Cole Harbour-Dartmouth.

 

LORELEI NICOLL: Good evening, minister. You certainly do have your task cut out for you. It’s one that is critical, especially in Nova Scotia, and addictions and mental health are very cyclical. You have addictions, you have mental health, you go back to addictions. It’s a circular problem, and to quote you: you want to do it once and do it right, and you want to get everything done correctly.

 

I know the members who spoke earlier asked great questions, but from my understanding, you’re starting fresh as to what you’re establishing this ministry for. We need to do research, data collection once the budget is passed, and the RFP will go out, and you start from there. In your former profession, data must have been collected at that point. Technically, you do have some data to start from. You’re not just starting with a blank page and creating a data bank of patients and the needs.

 

I recall the conversation initially was to have a help line - and I missed the beginning of your entry so I didn’t know whether you mentioned that. Has that been scrapped? Is that still the plan going forward?

 

BRIAN COMER: When I talk about the starting fresh aspect, I would say that would be specifically pertaining to the universal access piece. We do know we have significant quantitative and qualitative data across the lifespan for many Nova Scotians in addictions and mental health, whether you’re looking at depression, anxiety, schizophrenia or psychosis. We have some of the best researchers in the country actually. It’s the foundational aspect for the universal piece is what I would be referring to.

 

In regard to the crisis line, we do have a provincial crisis line - 1-888-429-8167 - but I think what the honourable member was referring to probably was the three-digit crisis line. There’s a significant review right now within the federal government and the CRTC examining the feasibility of that. That’s something we’re doing in partnership right now. The three-digit line is something we’ll have more to say about in the future. It’s something that I think has to be done, to be quite frank.

 

I know this is a little bit off topic, I suppose, but this was done a number of years back in the United States actually. They had an exponential increase in call volume, for example. I think there also has to be significant planning with your human resource component. There would have to be a very thoughtful transition between the current crisis line and the new crisis line, just to ensure that people have accurate information before they’re in a crisis. I hope that helps answer the question.

 

LORELEI NICOLL: The reason I asked is because you were referring to urgent and non-urgent, therefore the people on this other end of the phone will be determining the urgency or not. I think you said earlier that many think they need mental health, but they don’t. In that regard, I just wondered how the assessments are going to be done, because it’s been my experience that anybody who truly has a mental health issue doesn’t seek help much of the time.

 

I just wondered how critical and how you’re going to actually do these intakes of assessments. Someone picks up the phone and starts talking - how do you do the assessment and who’s going to do the assessment?

 

BRIAN COMER: When you call central intake, there would be a highly trained, highly qualified mental health care professional on the line who would actually do a very thorough intake, and would actually triage you on the phone based on their intake. Having done these in an in-patient setting myself many times, you’re looking at everything from appetite, to sleep, to relationships with family, medical history, substance use history, general demeanor, suicidal ideation. It’s a very thorough and comprehensive assessment.

 

In my experience, speaking with many of these clinicians, is that if there’s ever a seed of doubt, they always usually err on the side of caution in regard to an intake just to ensure the safety of the individual. That being said, if anyone’s ever in an acute crisis, they should either call 911 or call the crisis line that I stated earlier. I think the training for the individuals who do that is really important.

[8:45 p.m.]

 

There’s also a significant piece in regard to mental health literacy, probably for all of us really, myself included, just to try to develop open and honest dialogue within our communities, especially with our community-based organizations. I hope that helped answer the question.

 

LORELEI NICOLL: There were 141 Nova Scotians in 2021 who died by suicide alone. Many more tried. You toured the province. I believe you participated with the Minister of Health and Wellness during the tour. You heard first-hand how mental illness and trauma is at a critical level in our province. Are you prepared to take immediate action to ensure people in crisis get the help that they need now, when and where they need it?

 

BRIAN COMER: I think they’re very staggering statistics when you talk about suicide and people losing loved ones. It’s very difficult.

 

I think something that was actually done this Winter, which I think is significant, was the mental health suicide research survey that was done online. We were actually able to collect fairly robust data from over 7,000 Nova Scotians speaking not just with their thoughts of suicide but about their perceived barriers to treatment in the system, potential issues that they see in their communities.

 

There’s a very robust analysis of that under way right now. That’s actually with Public Health. Long-term, something I would like to see is a very thoughtful approach to stigma reduction across the province. It’s a very difficult thing to do, but I think we have to try, for sure.

 

In regard to urgent care, we do have in-patient beds, high acuity units for people in acute crisis states for sure. Then we have our day hospitals, recovery support centres across the province, and also outpatient community-based clinics and things of that nature. I think there’s a really vast array of services. I think we definitely need to do better, for sure.

 

LORELEI NICOLL: You did some data collecting of 7,000 and you now understand the barriers to treatment. Is that a public document? What were the top barriers to this treatment?

 

BRIAN COMER: That actually sits with Public Health. I know there would be some highly sensitive and confidential information there with the survey itself. I think we could reach out to them and hopefully follow up with the member.

 

LORELEI NICOLL: You touched on rural Nova Scotia. It was discussed earlier, but those living in rural Nova Scotia must travel hours to access mental health clinics and counsellors. Many feel a day clinic in Halifax is not the answer for Nova Scotians, and the hotline number - people feeling those are scripted responses. Where is the government’s suicide prevention strategy in the budget and when will it be acted upon?

 

BRIAN COMER: In January 2020, the Province renewed its suicide prevention and risk reduction framework. These are actively continuing to be monitored. There are six key areas for action: improving suicide-related data monitoring and evaluation, extending access to services and supports in the community, addressing target social issues that would be identified as increasing risk, strengthening up stream prevention and promotion, and identifying supporting populations at risk.

 

I think it’s also worth noting that we do have a provincial crisis line and the Kids Help Phone, which I think are significant. I think the rural comments are quite accurate, to be honest, especially in Nova Scotia for youth with the IWK and where it’s located. I think if anyone’s ever been there - I had my son there when he was just 18 months old. It’s world class care. I think the issue we have is we need to figure out innovative ways to provide these services for youth in the other three zones, to be honest. Those are the kinds of conversations we’re engaged in.

 

LORELEI NICOLL: You did bring up the IWK quite often in your responses, and it is a great facility - I had a child who attended for mental health services. However they don’t see patients after they turn 16. Is there a plan to transition people who are seen for mental health at the IWK after they turn 16? Where do they go from there?

 

BRIAN COMER: My understanding is that the IWK would look after individuals until their 19. I can double check with the department here. There’s also actually what’s called a transition policy in place where if you’re turning 20, for example, you would have a concrete plan in place, whether it’s between clinician to clinician or community-based service to community-based service. There should always be a thorough discharge treatment plan, whether it’s going out of the health care system or whether it’s going to a different practitioner.

 

LORELEI NICOLL: To go back to the intake and when someone wants to be seen for mental health, can they still go to their family doctors and go that route, as far as being assessed and being referred or is that what we want to get away from? Do we want to complement it with a new method of reporting and getting people seen?

 

BRIAN COMER: I think that the short answer is yes. A family doctor usually would have to consult psychiatry, and then they would be able to determine if they required in-patient hospital admission. I know, in my experience that’s fairly rare - something we would classify as a direct admission.

 

Typically, people who need high acuity services to the point where they would need an in-patient admission, often the point of contact is crisis at the emergency room. That process would usually involve a medical clearance from an ER doctor. There’d be a thorough assessment by the crisis team, which is typically a social worker, a nurse, and a psychiatrist. Both those social workers and nurse would have significant experience and additional training in crisis. Then it would ultimately be up to the psychiatrist to determine whether it facilitates an in-patient admission.

 

One of the gaps that I’ve seen over the years is when they get to a situation where the person doesn’t really meet the criteria for an in-patient admission, but they don’t have adequate follow up in the community. That’s something that I think a lot about because oftentimes if you get people appropriate care at the right time, you can kind of get things at a point before they snowball to the point where they need a hospital admission, usually for weeks before they feel well.

 

I think the family doctor component is one part of it. I think we’ve also seen a lot of desire for expansion of scope and practice of other disciplines. I know whether you’re talking about social workers, occupational therapists, traditional disciplines you wouldn’t necessarily have seen in the space of addictions and mental health. We need to look at these disciplines. I’ve had some interesting conversations with pharmacists. Just something simple as just speaking with patients coming in for their medication to assess symptoms and side effects, you would be able to avoid unnecessary ER, family doctor visits. I think small things like that would have a cumulative effect.

 

THE CHAIR: The honourable member for Fairview-Clayton Park.

 

PATRICIA ARAB: I’d like to speak to the minister about recruitment and retention. I’m curious if the minister could let us know what the current staff complement at NSHA and IWK is that delivers mental health and addictions services - the full complement of licensed professionals offering services.

 

BRIAN COMER: The IWK is 384 FTEs, the Nova Scotia Health Authority is 1,848. I do not have a discipline specific right now.

 

PATRICIA ARAB: Could the minister let us know the current vacancies at NSHA and IWK within these FTEs?

 

BRIAN COMER: The Nova Scotia Health Authority is 123, and the IWK is 10.

 

PATRICIA ARAB: There’s $140,000 to add for psychology residents between Nova Scotia Health Authority and the IWK. Are these doctors currently in the queue and waiting for contracts?

 

BRIAN COMER: These four residency seats are in the budget, so once we finish up with the budget, we’ll be able to very actively recruit. I think something I definitely noticed as a significant gap is there are only five PhD clinical psychology seats at Dalhousie and the province of Nova Scotia, which is interesting. I think this is a welcome addition.

[9:00 p.m.]

 

I know that I’ve had some frequent conversations with Dr. Orrell and my colleague, the Minister of Advanced Education - not just in regard to psychology, but in regard to potential training opportunities for other professions, but those are the specifics with this one.

 

PATRICIA ARAB: In these conversations, has there been any discussion as to where these psychologists are coming from and where they’re going to go?

 

BRIAN COMER: Long story short is we just want to get them to Nova Scotia. Once we get them here, we can ideally see - if they’re domestic, that’s great. If they’re international, that’s great. With the HHR demands in our current health care system, not just in Addictions and Mental Health, but also in primary health and in seniors and long-term care. We have to be very innovative in recruitment and retention, whether that’s domestic, whether that’s in other provinces, whether that’s international.

 

I think there will also be a significant review right now through the Office of Healthcare Professionals Recruitment to identify areas of particularly high demand. I’m just using psychiatry as an example. We have identified demand in Eastern and Northern Zone. I know in speaking to many folks in Western Zone that there’s a real demand there for addictions services. They need to be increased. I think the needs will be thoroughly assessed, but I think the most important part is just to get the practitioners to the province.

 

PATRICIA ARAB: I will note that there is more money to hire clinicians and a really heavy focus on recruiting psychiatrists and psychologists - the professionals that Nova Scotians with complex mental health needs need, especially the vacancies and the need in all health zones in, including Eastern, which is what we talked about earlier.

 

The Canadian Mental Health Foundation has said, in reflection to this budget, that most mental health challenges are related to depression and anxiety and would be better served by community-based practitioners from a variety of disciplines who are equipped to address the broad spectrum of bio-psycho-social needs, and that there are no new funds to expand collaborative community health centres, which would have been, in their words, “fundamental to addressing physician retention.”

 

We talked about a few of those disciplines. My question to the minister is: Why were there no funds earmarked for this key retention strategy?

 

BRIAN COMER: That was an incredibly complex and very dense statement, I think. There are a lot of very valid points in there. I think there’s probably some truth to the premise of that. Setting it up, in practice, takes a bit more time and effort. With the collaborative care model and community-based treatment model, I see a great deal of value in that, for sure. I think there needs to be a really significant focus on the Tier 2 and Tier 3 services. More money doesn’t always necessarily lead to more effective clinical outcomes in addictions and mental health, specifically.

 

With Tier 2 and Tier 1, community-based organizations play an important role, for sure. I think the access piece in communities is definitely - I’d probably agree with that. I think the very comprehensive process to institute the measures that they would have referred to in that statement.

 

PATRICIA ARAB: By no means in my original statement was I saying more money is needed. I was pointing out that the budget, as it’s laid out and as it’s presented, is very focused on psychologists and psychiatrists - money for those disciplines - when the Mental Health Foundation talked about community-based practitioners, so looking at a wide variety of disciplines.

 

So the question isn’t, why aren’t you putting even more money in? It’s asking why money hasn’t been earmarked for those types of clinicians. Those aren’t not my words. It’s the Mental Health Foundation that has said such.

 

Again, is that something that will come? Is that something that can be presented midway through? I’m just curious as to why the money wasn’t earmarked for that type of community-based health centre.

 

BRIAN COMER: There’s extensive, quantitative needs-based planning that’s ongoing right now to really ensure that each clinician, regardless of their discipline, is maximizing their scope of practice. Typically, the psychologists and psychiatrists of the world treat the very sick people in society, generally speaking - they need that treatment at that time.

 

There are a variety of disciplines in the other tiers before that that also play a very valuable role. I think some of the significant investments in community-based organizations such as Tajikeimɨk, for example, are very significant because they really let the community guide the framework.

 

PATRICIA ARAB: Mr. Chair, one of the key drivers of universal mental health and addictions coverage that was outlined in the government’s election platform but not in this budget is around billing codes. At the time, the government said true universal access private practitioners will of course still carry on their traditional practices, but it will allow them to take on clients knowing that MSI will pay them a fair rate for services rendered.

 

However a few months later, Dr. Sam Hickcox, the chief of the Office of Addictions and Mental Health, said this to the Standing Committee on Health:

 

“. . . we are going to be very mindful of initiating a pilot that will examine the question of whether billing codes are the most appropriate and effective way to remunerate clinicians . . .

 

Billing codes . . . are on the table. Exactly to what degree . . . remains to be seen.”

 

This sounds like a bit of a disconnect, again, between what was promised and what will be delivered. Can the minister tell us the plan for the pilot? Is Doctors Nova Scotia engaged? What health zone will the pilot be rolling out in?

 

BRIAN COMER: As I mentioned earlier, there’s a thorough needs-based, quantitative assessment that’s under way right now. I think a significant part of this specific billing code question involves a significant dialogue with practitioners. We’ve been very actively engaged in those conversations, and we’ll continue to do so in the coming months, especially engaging Dr. Orrell’s office.

 

Those clinicians also have to have significant feedback from the membership in their various professions. The vast majority of health care professionals in general are self-regulated professions. They have standards in their college, they have certain educational requirements. Some of these individuals are in the public system, some are in the private, but those conversations are ongoing, for sure.

 

PATRICIA ARAB: There was some important work started under the last budget that will contribute to these universal addictions and mental health coverage. Single-session therapy was a new service in the mental health and addictions sector. This service would meet Nova Scotians at their point of need for those who are dealing with non-acute mental health issues like lower-grade anxiety, depression, things like that.

 

Last year there was $5 million budgeted toward that work. I’m curious if the minister could tell me what the plan is for this year. How is single-session therapy included in this planning for universal mental health and addictions health care?

 

BRIAN COMER: The single session is moving forward. The final vendor has been selected, so there’s just some contract negotiations that are ongoing right now. It should take a number of weeks, and then implementation’s looking tentatively like the Fall, based on progress in that.

 

I think I did have a couple of questions myself in regard to that. I think it’s highly beneficial to have the single-session therapy, but to make sure there’s proper processes in place if people needed an additional session or sessions.

 

 

 

[9:15 p.m.]

 

It’s something that did kind of jump out at me, but I think that’ll be a good thing. It’s part of the proposal that it’d be a provincial-wide, provincial-utilized service. It would be an extra case that they would be serving the province as a whole.

 

PATRICIA ARAB: In the election platform, this government was committed to introducing legislation that guarantees every Nova Scotian access to allied mental health professionals. I’m curious if the minister could tell me what the status of that legislation is and who is being consulted?

 

BRIAN COMER: I would say the status is active and ongoing in regard to consultation with health care professionals, people with lived experience. There’s a cross-jurisdictional scan from a quantitative and qualitative perspective. I could probably have a more fulsome answer, but I’d probably be here for a while for me to list every single person.

 

PATRICIA ARAB: I’m happy to have the minister provide that in a written document and table it in the House to save time, if he’s willing to do that. We’ll just leave that with him.

 

Let’s talk about addictions. I’m going to run out of time. Addictions withdrawal management hubs - I know the minister referenced them in his opening remarks. This is going to provide a number of complementary services, including an in-person assessment, withdrawal management needs, outpatient withdrawal management, psychoeducation, recovery skills, grief intervention, harm reduction. These hubs are great. We’re happy to see that the work continues under this government with $1.7 million, which was added to the budget for these services.

 

I know that there was a commitment to have these addiction hubs through all of our zones, but in this budget - and I am asking this on behalf of the member for Yarmouth - the Western Zone was not included. One was promised at the Yarmouth Regional where there is a huge need. When can Western Zone expect the withdrawal management hub to open there?

 

BRIAN COMER: I think they will be in all zones. Just to list a few spots here. There’s Lunenburg, Middleton, New Glasgow, (Inaudible), Sydney, and Yarmouth, just to name a few. That being said, I have heard concerns not just from your colleague from Yarmouth but my own colleagues in the Western Zones as well. There have been some gaps identified in the Western Zone in regard to addictions services, so I’ll be definitely going there probably shortly after this session concludes to speak to some clinicians and some folks in that area.

 

I think it’s important to know, I worked in addictions services. It was actually called in-patient withdrawal management unit. The name itself actually deterred people from coming to seek out the service in the first place, which is interesting when you think about it. I think even just having the names, recovery support centres, just adding additional programming for the staff, increasing accessibility very much focused not just on in-patient withdrawal management, allowing people to get appropriate treatment and return home.

 

I think there’s definitely some more work that needs to be done in the Western Zone for sure.

 

THE CHAIR: The honourable member for Fairview-Clayton Park, with less than five minutes.

 

PATRICIA ARAB: Let’s see what we can do in five minutes when we talk about telehealth and virtual care. I have a lot of questions on virtual care that are listed out, but I’m going to try to get to the crux of it. When we talk about virtual care for physical health, there are a lot of things that can be done remotely. You can do prescription refills. You can have a general consult with a physician. There is enough data that shows that people will continue to come back to a doctor, to a GP, if they are providing virtual care.

 

My concern is that virtual mental health care is looked at under the same lens as virtual physical care, and it’s a very different scenario. It’s a process that doesn’t always have buy-ins - an uncomfortable process. I’m concerned and I’m curious how we are measuring the determinants of success within virtual care, so virtual mental health care.

 

People who are accessing it right now - do we have data on how many people are continuing to log onto the app, who are not double-dipping by using the virtual care and then going into the ER. What kind of quantitative data do we have so far from the use of virtual mental health care that it’s actually helping individuals and also alleviating the stressors that are on the system?

 

BRIAN COMER: There are some provisions in the budget to curate an action plan to guide future investment - really good, collecting robust data to develop an understanding of not only the effectiveness of the care from a clinical standpoint but also from a patient perspective.

 

There are also some jurisdictional scans right now that are happening, not just across the country but globally. I think we also have very specific data and numbers to identify the usage of our e-mental health tools - so MindWell-U and Therapy Assistance Online, known as TAO. What’s interesting too is as the quarters last year progressed, we saw a significant increase in utilization of these services.

 

Just talking about mental health in general, people have different preferences or comfort levels of how they want treatment. Some want virtual, some don’t. Some clinicians won’t do it and some will. I think with mental health specifically, for psychiatric assessments, I think the virtual component can’t be done over the phone. I think probably minimally, just in my experience, you need to see the individual. However, if you have the right technology in place, I think that virtual care for this could have a lot of value. But we’ll see as we move along with the data collection.

 

THE CHAIR: Order. I’ll pass the time over to the member for Cumberland North. It is 9:24 p.m. and you have until 9:38 p.m.

 

ELIZABETH SMITH-MCCROSSIN: Thank you, Mr. Chair. Minister, you must be getting tired. Not too much longer.

 

A couple of questions for the minister around psychiatrists. I’m wondering if the minister would be able to share some numbers - and my apologies if you may have already shared this - around how many psychiatrists we currently have in each of the zones. How many more is the department actively trying to recruit? If the minister doesn’t have the information, we can table it.

 

BRIAN COMER: I think we do have current vacancies here by zone. These are kind of a point in time because some of them are contingent upon expected hires, which can fluctuate based on people’s circumstances. Typically, since I’ve been in this role, the highest areas of need have been in Eastern and Northern Zones. I think Northern Zone right now has a vacancy of approximately 7.6.

 

My goal would be to have every zone at a full complement, which is typical, but even a significant reduction in the number of FTEs that were there would be something I’m definitely working towards.

 

ELIZABETH SMITH-MCCROSSIN: Thank you to the minister for that information. That would be incredible to have 7.6 more psychiatrists in the Northern Zone.

 

I’m wondering if the minister can make a comment on what the department’s opinion is on psychiatrists being on call. I feel very strongly that there’s still huge stigma around mental illness. I still see huge deficiencies in the way that we’re funding mental illness versus physical illness. Personally, I think that psychiatrists should be on call 24/7, the same as internal medicine, the same as radiology, surgery, anaesthesia, obstetrics. Included in that is a mental health crisis team. I’m wondering what the minister’s opinion is on that.

 

BRIAN COMER: I think this on-call psychiatry would be 24/7. I know I worked through a transition period - just some experience where they would stop coming to physically be in the hospital after 6:00 p.m. or 7:00 p.m., I believe. They would always be available via telephone, or they would actually come in if it was an appropriate situation.

 

I think what becomes an issue - something I’ve heard about from folks, especially in Eastern and Northern Zones who work as psychiatrists - is that the call schedule can be quite demanding if you don’t have the adequate FTEs, because you can be on call quite frequently. It’s a vital resource that’s needed in emergency situations, but it also has to be wary because if you’re trying to recruit individuals in an under-resourced region, the call schedule has to be adequate and fair, I think.

 

I think the other part of this is we could look at innovative approaches, which we’re in the preliminary stages of looking at personal care options to take the strain off community mental health clinics in other regions. I think those would be my thoughts on that. I think anyone who needs access to a psychiatrist should have one, regardless if it’s 24/7 or not.

 

ELIZABETH SMITH-MCCROSSIN: I’m glad you made those comments and would love to see it. I believe we can get there too. We lost a lot of psychiatrists in the province when there were licensing changes with the college, and we haven’t been able to replace those.

 

I’m wondering with virtual care, is that also through Maple and will that be psychiatrists or just counsellors? If it’s psychiatrists, how will they prescribe the controlled drugs, where we have the prescription monitoring service and it’s written in triplicate? I’m just wondering how psychiatrists through virtual care will be able to prescribe.

 

BRIAN COMER: There are two parts to that answer. From a community mental health standpoint, it would be offered via social workers, psychologists - by a variety of disciplines. The specific question with regard to prescribing medication, with the psychiatrist in virtual care in the ER - it’s a good question. I’d have to find the answer out, to be honest with you.

 

In rare circumstances, as the member would know, you can take verbal orders, telephone orders, if you’re adhering to your college’s regulatory obligations. My guess is that would be what they’re doing, but I can have someone find the specific answer and follow up with the member.

 

ELIZABETH SMITH-MCCROSSIN: I don’t think you can do the controlled drugs through call-in, or at least it’s not been our experience.

 

My next question is around mental health crisis teams. In Cumberland, we do not have 24/7 crisis team. We have Monday through Friday, eight hours a day. My concern is that we’re not giving mental health the same priority that we’re giving physical health. When I did ask this question, one of the answers I was given is that there’s not enough demand. But I would beg to differ.

 

When you look at all the other people who are on call 24/7 for an X-ray, CAT scan, laboratory, respiratory therapy, they might get called once through the night once a week, but the fact is that our system is paying for them to be on call and available in times of a crisis or trauma. I believe that our mental health crisis team should be available 24/7 as well. It would alleviate a lot of the stress on the emergency department if they knew that there always was a crisis team to call up and help.

 

[9:30 p.m.]

 

It’s more of a comment than a question. When I hear someone from the Office of Addictions and Mental Health say that there’s not enough demand, that’s telling me that there’s still a stigma, even within our own health care system at the leadership levels. If we are funding physical health to be on call 24/7, we should be for mental health as well. I feel very strongly about that.

 

In relation to that, would the minister be willing to have someone take a look at that? Certainly, the people on the ground in Cumberland are telling me that the number one thing that would make a significant difference in patient care and in the lives of the people working in mental health and addictions, it would be to have a 24/7 mental health crisis team. Would the minister consider finding the funding to make that happen?

 

BRIAN COMER: It’s something I’ve thought a lot about over the last number of years. I think right now we are doing all models of crisis care across the province. I think what becomes particularly challenging in rural parts of the province, Western, Northern and Eastern Zones, the clinical composition of these teams and the mechanisms for how they’re able to get to people would have to be very well thought out.

 

I had the opportunity to work with a community outreach team in Cape Breton that had a registered nurse with additional training, and a police officer with additional training. They weren’t 24/7, which is also a gap, for sure. I could not commit to funding tonight, but it’s something that I’m definitely taking a hard look at for sure.

 

ELIZABETH SMITH-MCCROSSIN: Thank you to the minister for considering and taking a closer look at that. Right now, because we don’t have acute care beds at our hospital. I heard it’s going to change, but because our facility is not under the Involuntary Psychiatric Treatment Act, that even if we had enough psychiatrists to be on call, they technically, legally can’t do a psych assessment at our hospital, so they have to be transferred to Truro.

 

We are really reliant on the mental health crisis team. When an acute mentally ill patient comes into the emerg, if it’s Monday through Friday, 8:30 a.m. to 4:30 p.m., they do call the mental health crisis team. They come up and help the emerg staff and do the assessment.

 

I want to just emphasize, that is the number one thing that our mental health community team, as well as what I’m hearing from the staff in the ER - it would make probably the single biggest impact on improving care in Cumberland. I’ll leave my comments with that. Thank you to the minister.

 

THE CHAIR: The honourable member for Halifax Citadel-Sable Island.

 

LISA LACHANCE: I want to circle back on a few different issues, but one of the ones is around emergency care. I think as the member for Cole Harbour-Dartmouth said, as well as the member for Cumberland North talked about, I think I really have to just disagree with the statement that everyone who needs a bed gets a bed and that no one gets turned away. That’s certainly not my experience. It’s not the experience of many families who contact me and my partner to talk about their experiences as families trying to access child needs, mental health care.

 

One of the areas where there is a huge gap is with young people past the age of five and before the age of 19 who have autism and are severely dysregulated, are becoming violent at home, in the community, and at schools, and they have regularly been turned away from the IWK ER, even when transported by police or EHS. I can dig up a bunch of media articles to table for you, minister. I can find interviews that were done with Dr. Alexa Bagnell about this gap.

 

If we’re investing a lot more money in early intervention, how are we going to continue to support young people to be well? Would the minister commit to looking at emergency services for young people with autism?

 

BRIAN COMER: I thank the member for the question. I think there probably are some significant gaps in the five- to 19-year-olds continuum. I would agree with that. If I’m correct, I think we’re referring to the high-acuity, high-tiered situations. There is a full-service evaluation for the Halifax program that’s planned for this Spring.

 

The member also referred to Dr. Bagnell. I do have frequent conversations with her and the senior leadership team there as well. It’s something I would definitely be willing to look at.

 

LISA LACHANCE: Thank you. It’s exciting to hear openness to looking at that.

 

You referenced a full-service evaluation of the Halifax program. I’m just wondering, which program are you referring to?

 

BRIAN COMER: The review is for the Brief Intensive Outreach Service program.

 

LISA LACHANCE: Thank you for that clarification. I guess my concern is that perhaps that wouldn’t necessarily catch these particular gaps, but I’m glad to know that you’re willing to look at it.

 

You talked about high acuity, and I think when we’re dealing with folks with autism who are struggling, it is actually hard to talk about it in terms of mental health. It can absolutely lead to mental health challenges and there can be comorbidity and that sort of thing, but I think there are some very specific needs there. I think if we’re able to be supporting young people pre-Primary, then continuing that support is really important.

 

Continuing on the issue of emergency care, the minister and I have actually had a chance to talk about the work being done across Canada in different jurisdictions and around the world, looking at new models of emergency mental health crisis response - really trying to do a few things. One is, again, getting actual trained mental health clinicians face to face immediately and taking police out of the equation. That’s both for concerns about criminalizing mental health but also, I think it’s pretty universal that police don’t necessarily want to be on the front lines of the mental health crisis in Canada.

 

As the minister would know, I’ve been involved with an international working group that’s been collecting a lot of data and models from around the world. Certainly Toronto, Ottawa, Edmonton, Victoria - cities across Canada are looking at this. Is the minister looking at new models of mental health emergency response?

 

BRIAN COMER: I think there’s definitely a fulsome review happening now with emergency crisis response teams across the province. I have frequent conversations and reach-outs from police services across the province, families - I mean, we’ve just discussed with the previous question the potential for enhancing mobile crisis teams. There’s a lot to look at, for sure. I know something I think about a lot is trying to identify the appropriate training, and make sure they’re properly prepared to help people, especially in a crisis. These models of care are definitely being looked at within the department.

 

LISA LACHANCE: You mentioned a full review is being done. Can you elaborate on that in terms of timelines and what prompted the review? Also, what data is being gathered to look at this issue?

 

BRIAN COMER: Yes, there’s a robust jurisdictional data scan that will be finished in the coming months. Also, as part of my mandate, I have to look at the modalities of care across the province for access, not just for emergency crisis response team, but also with people right along the continuum of the step care model.

 

LISA LACHANCE: I have so many questions that now I’m just trying to choose one. Let’s keep going on modalities of care. I know that the budget allocated - I think I have $600,000 for the work being done around modalities of care for consulting and evaluation. Maybe you could talk about what that review is looking at specifically?

 

BRIAN COMER: There’s going to be a robust evaluation of all current modalities of care, and also a significant jurisdictional data quantitative review of also potential new modalities of care. I’ll just give you an example just to make it more tangible.

[9:45 p.m.]

 

I’m just using recovery houses as an example. It would be a very significant evaluation, I think, of recovery houses in the province, and just look at developing standards of care, making sure that there’s utilization of evidence-based practices, evidence-based harm reduction, just really streamlining it so people are really getting the best care that they can.

 

LISA LACHANCE: I think all that work sounds really exciting. I would perhaps hazard a guess, and the minister is welcome to dissuade me of this guess - really, what we’re looking at is the development of a strategic framework. Probably the answers are going to lead away from this commitment to universal access through changing the billing codes for virtual care. That would just be my guess, and I think it’s probably the right way to go.

 

I think it would be helpful for stakeholders perhaps to have a full list of what’s happening this year, what outcomes are being used, what assessment tools, just to have a sense of the breadth and depth of work that’s happening. I think the minister has invited members to have faith and that big things are coming. For folks like me who have been on the front lines, who are struggling for mental health care access, it’s sometimes hard to have faith, but understanding better what’s happening certainly helps that.

 

In the budget, I think there’s funding for two clinical assistants in the Eastern Zone. I’m wondering who these clinical assistants are. What is their professional role or designation? Is the minister looking at more use of clinical assistants?

 

BRIAN COMER: Oftentimes clinical assistants have potential pathways to full licensure based on their previous credentials, but sometimes they don’t - in my experience, having worked with a number of them. They can do a lot of very valuable work from a clinical perspective. My experience has been that typically they wouldn’t have the authority, for example, to make someone an involuntary patient.

 

They would have a lot of very valuable insight and capability for treating people with their medications, for people who are maybe not as high of acuity, and for taking strain off the psychiatrist and the folks who see the crisis and the higher acuity people.

 

LISA LACHANCE: Can the minister confirm how many clinical assistants are currently employed in the province, and if there’s a plan to increase those FTEs?

 

BRIAN COMER: There are currently six, so it would be two additional in Eastern Zone after this recruitment and training process is completed. As we get new information, we will make decisions accordingly. It’s something that I will be keeping a close eye on.

 

LISA LACHANCE: I apologize for jumping all over the place - back to virtual care. There is virtual care being offered in the province right now. I’m wondering - perhaps even taking the last quarter, say - if the minister could talk about the number of people who have accessed virtual care and how outcomes are being tracked. Is there a pre- and post-assessment tool used? What tool is used? How many modules are there, and if people complete that, but then need to come back, are they able to come back again for further treatment?

 

BRIAN COMER: Just to give a little bit of data, for last year, for Eastern Zone - I have each zone here and I’ll use Eastern Zone as an example. There are 299 total number of attended visits via virtual care platforms. The total number of attended visits via virtual care for one-to-one sessions, which are outpatient based, was 3,526. The total number of attended visits via telephone, which would also be out-patient, was 25,719.

 

That’s a pretty significant uptake. As I stated earlier, there’s significant data collection and analysis that will be focused in the coming months to determine the effectiveness of this on clinical outcomes.

 

LISA LACHANCE: Just to clarify, were there pre- and post-assessment evidence-based mental health tools used in the current program?

 

BRIAN COMER: Any kind of treatment that would be offered would be evidence based, regardless of the clinician. If I’m understanding this, the question is relating to the mechanisms to determine the effectiveness of the virtual care for clinical outcomes. That’s something that’s actively ongoing. In the coming months we should have some very specific data regarding that as well.

 

[10:00 p.m.]

 

LISA LACHANCE: I gather from the minister’s answer that, in fact, there haven’t been pre-imposed assessment tools used. I think the minister and I probably know what we’re thinking of - the types of standardized assessments. I know that is both a challenge and a necessity in care. I know more from the child and youth state of things in Nova Scotia that we actually have very little data that explores the clinical outcomes in young people. A lot of times that’s because people don’t finish their number of sessions that they’re supposed to have, or they don’t come back so you don’t get the post-assessment done.

 

I know that the IWK joined CORC - the Child Outcomes Research Consortium - based out of the U.K. We’ve only got one minute left - I might just leave it for further discussion - but how does the minister plan to increase the system-wide use of evidence-based clinical assessment tools?

 

BRIAN COMER: Just to maybe clarify a little bit, any kind of treatment, regardless of age or where you’re at in the lifespan with the evidence-based . . .

THE CHAIR: Order. The time is elapsed for this evening. It is now 10:02 p.m., and the House is set to adjourn at 11:00 p.m.

 

That concludes the subcommittee’s consideration of Estimates for today. The subcommittee will resume consideration when the House again resolves into a Committee of the Whole on Supply.

 

I ask you to return to your seats in the Legislative Chamber. The Committee of the Whole House must rise and report before the House concludes its business for the day.

 

[The committee adjourned at 10:02 p.m.]