Health and social services in the NWT have not adequately provided residents with “accessible, coordinated and culturally safe” addictions services, the Auditor General of Canada has found.
The auditor general’s latest report, released on Tuesday, examines addictions prevention and recovery services offered by the NWT Department of Health and Social Services, territorial and Hay River health authorities, and Tłı̨chǫ Community Services Agency between August 2016 and July 2021.
The report concluded there were “concerning shortcomings” in those services and officials had often not followed through on commitments to improve them.
“Overall, this audit demonstrates a need for improvement in the addictions prevention and recovery services available to Northwest Territories residents,” Jo Ann Schwartz, the principal responsible for the audit, said in a statement.
The report notes the NWT has some of the highest rates of addictions and substance use in Canada and the territory’s vastness and isolation make delivering services challenging.
What are the problems?
Issues identified include limited aftercare support, gaps in coordination of services across providers, limited efforts to ensure cultural safety, and insufficient monitoring and evaluation of outcomes.
Despite a promise by the department to better coordinate services across organizations two decades ago, the report states a system-wide process to help connect clients to addictions services is still lacking.
The audit found that neither the department nor any of the three health authorities had determined how, in practice, to ensure all NWT residents had equitable access to addictions services.
For residents who returned from treatment at facilities based in southern Canada, the report said aftercare supports were lacking. In a random sample of 32 clients who had attended a facility-based treatment program between 2018 and 2021, only two had an aftercare plan created before they left the NWT. In just 19 cases, counsellors tried to contact clients following treatment.
The department and authorities “did not take sufficient action” to ensure addictions services are culturally safe for Indigenous residents, like recognizing traditional experience and expertise in the hiring process, the report states.
While the department increased its on-the-land healing fund from $1.2 million to $1.8 million in 2019-20, some Indigenous governments said administrative requirements made accessing that funding difficult. The budget was not always exhausted, with $624,000 remaining unused in 2019-20.
“Indigenous people in the Northwest Territories disproportionately face challenges with addictions,” the report states.
“Increased cultural safety removes barriers to accessing services and helps to counter the effects of colonialism on the services that are available and on the way that they are delivered. This increases the likelihood that addictions services will meet the needs of Indigenous clients and help them achieve their recovery goals.”
The report found the department failed to assess the needs of subpopulations like refugees and non-Indigenous racialized groups, even though people from those communities had expressed challenges accessing care.
Finally, the report found the department and authorities did not know whether addictions services were effective because they did not sufficiently measure clients’ outcomes or use data to analyze trends. This is despite the territory in 2016 declaring the evaluation of outcomes to be a priority.
“Without measuring the performance of addictions services, the department and the health authorities cannot know whether the system helps clients achieve their goals or where to make changes to improve services for residents,” the report states.
The report did find some improvements in services between 2016 and 2021.
As of September 2020, the report stated, there were no wait times for initial appointments with a counsellor in six of seven regions. Services had been adapted in response to Covid-19 with expanded virtual and telephone care.
The department established an Indigenous advisory body to provide guidance on the health and social services system, and created a community, culture and innovation division to lead work on cultural safety. It launched a cultural safety action plan in 2019, although few actions had been completed at the time of the audit.
‘A solid roadmap’
The territorial government accepted all recommendations made by the auditor general to improve the delivery of addictions services.
The GNWT pledged to develop a standardized approach to aftercare, complete a gap analysis, and review standards and policies to identify barriers to cultural safety. The territory added it will review and adjust the screening process, core competencies and equivalencies required for key addictions services positions. It said it will meet all of those goals by the end of 2024.
Health and social services minister Julie Green said the report provides a “solid roadmap” for how the territory can improve addictions supports.
“Providing safe, accessible, and responsive addictions services, to help people heal, is a priority for the department and for the health and social services authorities,” she said in a statement. “We value the findings of the auditor general, and this report helps us understand where our programs are on track and where we need to do better.”
Green told reporters she’s confident the territorial government can address all seven recommendations within two years as some work is already being done but needs improvements.
She said her department and the health authorities had already developed a draft of an action plan that they plan to present to MLAs for review.
The report made no direct recommendation regarding whether the territory should re-establish a residential addictions treatment facility in the NWT, a hotly debated topic among politicians and residents.
Successive governments have rejected that idea, stating that travel to one of several treatment centres in southern Canada is the best option for residents.
Schwartz pointed out the report did find only offering services in certain locations could cause barriers, such as treatment not reflecting the culture of clients. She said the issue is something the department and health authorities will have to discuss when it comes to addressing how to provide equitable access to services for all residents.
“The government has said that they were committed to equitable access, but they haven’t actually figured out what that’s going to be in practice,” she told Cabin Radio.
“Our recommendation about equitable access isn’t explicit about the facilities treatment centre, but it touches on it in the sense that, if you don’t figure out what you mean by equitable access, you’re going to have difficulty in determining how to reduce some of those barriers that might exist.”
Green agreed that NWT government needs to define what equitable service means in the territory, but she said that won’t necessarily include a residential treatment centre.
“We can’t provide the same service everywhere but we can make sure there are no barriers to people accessing services,” she said. “That would be the goal there.”