PROCEEDINGS IN THE
DOUGLAS FIR ROOM

Committee of Supply

ESTIMATES: MINISTRY OF
MENTAL HEALTH AND ADDICTIONS

The House in Committee of Supply (Section A); S. Chandra Herbert in the chair.

The committee met at 2:32 p.m.

On Vote 35: ministry operations, $4,941,000.

The Chair: Did you have a statement or introduction?

Hon. J. Darcy: I do. It’s a great pleasure to be here today for the budget estimates for the first Ministry of Mental Health and Addictions in British Columbia.

I’d like to introduce the staff who are here from my ministry to support our discussion today: Deputy Minister Doug Hughes; Keva Glynn, assistant deputy minister, policy monitoring and evaluation division; Melanie Stewart, assistant deputy minister, strategic planning, partnerships and research division; and Dara Landry, executive director and chief financial officer. I want to thank each of them for being here today and for all the work that they’ve done, over many, many weeks, with the business of setting up the ministry and getting ready for estimates today.

I’d also like acknowledge Dr. Perry Kendall, the provincial health officer, who is also here to assist as needed. I’m very grateful for his support.

With the establishment of the new Ministry of Mental Health and Addictions, we now have a team in government dedicated to focusing on what we need to do to save more lives in the overdose crisis and what we need to do to put in place a seamless, coordinated system for mental health and addictions, a system where people living with mental health or addictions are provided the same dignity and respect and care as people living with physical illness.

We now have a minister and staff tasked with taking action to significantly improve our mental health and addiction services, giving this area the focus and attention it badly needs. We cannot have our discussion today without acknowledging the stark reality that we are in the midst of the worst public health emergency in this province in decades, and my ministry’s first and most urgent focus is to take immediate action to combat the overdose crisis.

[2:35 p.m.]

I don’t have to tell you that this public health emergency is acute, widespread and epidemic. If today holds to this year’s pace, four British Columbians will lose their lives due to illegal drug overdose before the day is done. They may be young or middle-aged or old. They may be living on the streets, or they could be earning a middle-class salary. We know that many are people who are living with long-term addictions. Some are occasional drug users. For others, it began with painkillers after suffering a workplace injury.

We know that trauma, social and psychological trauma, is an enormous factor in the development of addictions. We know that Indigenous people are disproportionately affected and are dying in numbers three times greater than the population at large, the result of intergenerational trauma caused by colonization, racism and residential schools.

We also know that these deaths are preventable. That’s why tackling the overdose crisis has been the number one priority of my office and a top priority of our government since we were sworn in just 12 short weeks ago, together with taking the first steps to create a better system for mental health and addictions.

There is no more tragic illustration of the need for change across the system of mental health and addictions than Joshua’s story, which we heard about a couple weeks ago in a report released by the Representative for Children and Youth, Bernard Richard.

At the age of two, Joshua began to harm himself, and his mother first sought help. He didn’t get the early intervention that he needed. At the age of eight, he said he wanted to die. He told people that in his school. His first suicide attempt came at age 11. Joshua and his family fell through the cracks repeatedly, from when he was a toddler until he tragically took his own life at the age of 17, after having spent 122 days at B.C. Children’s Hospital because there was nowhere else to provide him the support that he needed. Joshua’s life is a stark reminder of why we’re here today and how critically important it is for us to get to a seamless coordinated system of care.

We have fully accepted the representative’s recommendation to build a strategy for a comprehensive system of mental health and addictions care for children and youth. It will form a critical part of our overall strategy to transform the larger system for mental health and addiction care in British Columbia.

I’ve had the opportunity to meet with people working in mental health and addictions across the province in the last 12 weeks, and I want to acknowledge the amazing work that people do in this field every single day and the real and lasting difference that they make in people’s lives. They show up every day, and they give their all in a system that doesn’t make it easy.

We know that the system for mental health and addiction challenges is fundamentally broken. It is fragmented. It is uncoordinated. It has huge gaps. There is a lack of early intervention, prevention, coordination and follow-up. But saying this is not intended to criticize the skills, experience, dedication and hard work of those working in this area across the system. We need to make it easier for them to help people the way they know they need to be helped.

We know there are significant barriers to access to care: the stigma that portrays people with mental illness or addiction as weak or as having made bad choices, criminalization, cultural barriers, racism, homophobia, language barriers, geographic barriers, isolation and financial barriers. In so many respects, we effectively have a system of two-tier care when it comes to mental health and addictions. And we know that in the present system, too many people fall through the cracks and can’t access the care they need.

Our goal is that we get to a place where we have a seamless, coordinated system for mental health and addictions where, if you ask for help once, you get help fast. That’s the goal. You get the follow-up you need and access to a full continuum of care.

To that end, I’m working with my colleagues across government to develop a comprehensive mental health and addictions strategy for this province. We are taking all-of-government approach.

[2:40 p.m.]

We’re working with the Ministries of Health, Children and Family Development, Education, Housing, Poverty Reduction, Public Safety and Indigenous Relations and Reconciliation, as well as with community service agencies and local governments, with the federal government and, very importantly, with First Nations. And very importantly, we’re working with people who have firsthand experience accessing the system or people who are supporting loved ones within in the system.

We know this strategy will need to focus on improving access to care, investing in early intervention and prevention and, critically, in child and youth mental health. We also know that we need to address the social factors that contribute to the challenges of mental illness and addiction, from homelessness to poverty reduction and culturally appropriate care.

As we develop the elements of this strategy, we will be relying heavily on the knowledge of front-line workers, patients, researchers and people with lived experience. The voices of people and families, organizations and associations and those working on the front lines will help us shape a better system for mental health and addictions that works for all British Columbians.

I’m honoured and privileged to be leading this ministry in this work, and I look forward to answering your questions today.

The Chair: Just prior to moving to questions, I wanted to let everybody know that joining us today are some guests from the Parliament of the Cooperative Republic of Guyana. At the table here, we have Claudia Daniels, the Clerk of Committees, and in the public gallery are Cheryl Ann Archibald, Hansard senior editor, and Eton Moses, documentation and preparation assistant, from that parliament.

They’ve come to the Legislature of B.C. on a staff exchange to observe our proceedings. Please make them welcome.

J. Thornthwaite: Thank you to the minister for your warm introduction. Thanks to the guests that have come many miles to come and join us. Thank you to the staff that the minister has around her to help with the questions that we will be asking, and also her colleague the Minister of Health.

I’m looking forward to this afternoon and getting some questions answered that I’ve had. Obviously, you know I have been very interested in this topic for several years. It’s exciting that we do have a separate ministry that, as I think the minister is quoted as saying, “wakes up every day with mental health and additions on her mind.” We appreciate that focus, certainly, from your minister and your ministry.

I’d like to also introduce my colleagues that are going to be assisting me today. Next to me, right here, is my colleague from Coquitlam–Burke Mountain. She’s going to be asking some questions to yourself, but maybe the Minister of Health as well. Also, our colleague from Peace River South and my colleague from the Abbotsford-Mission area — I’d like to introduce them and welcome them as well.

My first question is for the minister. Your budget is nearly $5 million, as you mentioned. Can you outline how that will be spent?

The Chair: I’ll start right here just to remind members to go through the Chair, as opposed to “you” or “your.” Same for ministers, please — through the Chair.

Hon. J. Darcy: Thank you very much, hon. Chair, and to the member for her questions.

The ministry budget, as reflected in the budget update that was approved in the Legislature last month, is a total of $4.941 million for 2017-2018; and then going forward, $9.983 million, 2018-2019; $9.983 million, 2019-20; for a total of just under $25 million over three years.

Would the member like me to break down the salary? Yes?

J. Thornthwaite: Yes. That was going to be one of my questions. If you wanted to break it down — and, also, the salaries — that would be helpful.

The Chair: I’m sure the minister and the member can work that out through the Chair.

Hon. J. Darcy: I will remember that.

Salaries and benefits total…. Well, this is a ministry that, the member is aware, is not responsible for operations. The delivery of these services is in the Ministry of Health and in the Ministry of Children and Families, for child and youth mental health.

[2:45 p.m.]

In the budget, the $4.941 million is for salary and benefits, travel, professional services, information systems, office and business expenses, Legislative Assembly and other expenses. If you’d like, I can certainly go through those. For salaries and benefits, $4.085 million; travel, $235,000; professional services, $300,000; information systems, $117,000; office and business expenses, $193,000; Legislative Assembly, $5,000; and other expenses, $6,000.

J. Thornthwaite: In the Vote 35, ministry operations, document, I see that there is a description of policy development, research monitoring and evaluation. Perhaps the minister could describe how those are going to be indicated, from a financial perspective.

Hon. J. Darcy: The ministry currently has 36 FTEs, not including five staff in the minister’s office itself. The breakdown of that is: in the deputy minister’s office, there are three permanent staff; in corporate services, there’s, at the present time, one temporary appointment; in strategic planning, partnerships and research division, there are 17 positions; and in policy monitoring and evaluation, there are seven permanent and, at this point, eight temporary appointments, for a total of 15.

J. Thornthwaite: Are there more plans for the ministry to add more staff in the future?

Hon. J. Darcy: Yes, there are. As you can imagine, this ministry was created after July 18, the election. We will be staffing up further, but our mandate, as the member is aware, is to develop a strategy to create a better system for mental health and addictions, to respond to the overdose crisis as an immediate priority, and — already part of my mandate but reinforced by the Representative for Children and Youth, and he’s given us a timeline on it, a year from when the report was issued — to have a strategy for implementing a better system for child and youth mental health and then to begin implementing that a year after that.

Our staffing is very much going to be driven by the mandate that has been set out for my ministry, and we will be continuing to staff up further in order to meet that mandate that has been given to our ministry by the Premier.

J. Thornthwaite: That’s kind of a vague answer with regards to how many staff that you’re planning on getting in the near future. What I also want to know is: will there be increased staff in other ministries to accommodate your strategies — like from the Ministry of Health, Ministry of Children and Family, Social Development, Housing, etc.? I’m wondering what the connection is between your mandate and the staffing in other ministries.

[2:50 p.m.]

Hon. J. Darcy: Thank you to the member for her question. We are already working across ministries, and as I indicated in my opening remarks, we are taking an all-of-government approach. Obviously, if we’re going to build a better system for mental health and addictions, it takes all of those pieces. It takes poverty reduction. It takes reducing homelessness. It takes very close collaboration with the First Nations Health Authority, with the Métis Nation, with Indigenous organizations representing status and non-status Indians.

We will be working across ministries. We’re not in a position to say what staffing might be increased in other ministries in order to implement this strategy because the strategy hasn’t been developed yet.

One thing that we were very clear on in establishing this ministry was that our objective is to put in place an effective system for mental health and addictions and a far better system for child and youth mental health, and the structure will follow that. The resources will follow that. We look forward to developing that plan and then determining and bringing forward to the Legislature, I’m sure, subsequent budget items that relate to implementing that plan both in our ministry and in other ministries.

J. Thornthwaite: Will the ministry’s office also be seeking advice from other outside sources, outside of government, to lead them in their work?

Hon. J. Darcy: Thank you for the question. I’ve been consulting since day one. Literally, on my fourth day on the job, I was in the Downtown Eastside. I was in Surrey. I’ve been in Victoria, in the Cowichan Valley, in Nanaimo and in Prince George, as well as having dozens and dozens of meetings. I am listening and learning. I’m finding people are very, very appreciative of the fact that there is this new ministry. They believe it’s long overdue. People are overflowing with ideas, and we are certainly taking all of those into account, and we will be. We’re involved in our early stages of consultation, but consultation will be an ongoing process.

I hosted a consultation last week, last Wednesday or Thursday, with about 70 people from as many organizations, representing individuals and organizations and people with lived experience that are involved in the mental health and addictions system in one way or another.

It was a very, very exciting day. People gave me lists and lists and lists of their ideas. We’re going to be distilling those, and we’ve really asked them to focus on what the early actions are that we can take that can inform what we do, going forward, in the short term as well as what we need to do in the longer term to build a better system for mental health and addictions.

J. Thornthwaite: I just want to get this straight, then. Your ministry and your ministry office are…

The Chair: Through the Chair.

J. Thornthwaite: …in an advisory role, or a recommendation role, but you don’t have the actual staff to actually do the boots on the ground, the work. Is that correct?

Hon. J. Darcy: I think I indicated already in my remarks that our objective here was not to create parallel structures. The last thing in the world that we need is more silos.

I’m working in partnership across ministries. Ours is the lead ministry in developing a better system for mental health and addictions. But I’m developing this in partnership with a working group of cabinet that I chair, called the mental health and addictions working group, and the other ministries that I’ve referred to are part of that committee. So we are working absolutely in partnership every step of the way, because if we’re going to be effective in developing a better system for mental health and addictions, they all need to be partners in doing it.

[2:55 p.m.]

Whether that’s the Ministry of Health, which is where the majority of mental health and addictions services are now delivered, or it’s the Ministry of Children and Families, where child and youth mental health now resides, or the Ministry of Social Development and Poverty Reduction, which is an absolutely critical piece of addressing this issue so that we are creating pathways to hope for people.

We know that so many of the people who are living with addictions have experienced deep social and psychological trauma and that homelessness only reinforces that. If we are able to support people and treat people and they go back to living on the streets, we’re not going to be addressing the fundamental issues that are related to this.

We are working in partnership. These services are being delivered through other ministries, as we’ve spoken to. It is my role to develop the strategy and to bring that strategy to cabinet for approval and then bring forward for budgetary consideration.

J. Thornthwaite: I have another question. In the Green platform, there was mention about…. I’ll just quote: “We must eliminate the financial incentive for trafficking in illegal drugs. This requires the decriminalization of drug use and possession and effective government programs to support and rehabilitate addicts.”

Does the minister have any plans to implement this as government policy?

Hon. J. Darcy: Thank you to the member for her question. I think the first thing that we need to remind ourselves of is that four people a day are dying. We need to be bold in our approach to addressing the overdose crisis, which this government has committed to doing. We’ve committed $322 million over the next three years, with a priority on the overdose crisis and the first steps in building a better system for mental health and addictions.

I think when we talk about people living with addictions, our objective is to get to a place in our system of care where we treat people who are living with mental illness or addiction with the same dignity and respect and the same quality of care that people receive for any kind of physical illness. The member may have heard me say this before. We’ve certainly heard the Premier say it. If you break your leg in this province, we know what to do. You’re taken to an emergency room. The pathway of care is very, very clear, and you get sympathy, not stigma. We have enormous stigma attached to mental illness and addictions.

Speaking just about addictions, the member knows that the issue of decriminalization is a federal matter. Having said that, we think this is an important discussion that we need to have in this country. We are not the first people to say that. We have chiefs of police, people involved in public safety across the country, drug policy experts and addiction experts who are all encouraging that we have the courage to have this conversation in this country. But it is a matter of federal jurisdiction.

[3:00 p.m.]

In British Columbia, we are doing everything we can to support people within the framework of the current federal legislation. We have, in this budget, expanded harm reduction considerably; an anti-stigma campaign, targeting society at large but also people who use alone; the Foundry youth and mental health hubs, which the member is very familiar with and has been an advocate for.

We also, however, know that the treatment options that have been available up until this time do not work for everybody — meaning Suboxone and methadone, the medications with which we treat people with opioid addictions.

I approved last week a guideline that had been developed by the B.C. Centre on Substance Use in collaboration with every health authority, the Ministry of Health and leading drug policy experts, and which has been internationally reviewed.

[B. Ma in the chair.]

We released a guideline that will guide the use by health care professionals of prescription medications, like prescription hydromorphone, which is an additional treatment option for those people who have not been successfully treated with the options that are now available.

We are pushing the envelope. It is a federal matter. We are pushing the envelope to whatever extent we can in order to provide legal alternatives for people within the present system.

J. Thornthwaite: On that note, that would be taxpayer-funded heroin for addicts. Is that correct? If that is correct, can you tell us how much money is in the budget for the Crosstown Clinic?

Hon. J. Darcy: I think I have the numbers here. I’m happy to share them with the member. I think it’s important that we have a bit of historical perspective on this form of treatment. There were some trials that were conducted, referred to as the NAOMI trials, in 2003.

[3:05 p.m.]

The federal government intervened when the Crosstown Clinic was first established. The federal government intervened in order to stop it. There were community organizations who took the federal government to court over this issue. The Supreme Court of Canada reversed the position of the Harper government on this issue on compassionate grounds, making the case…. I don’t have it here, but I’m happy to share that Supreme Court of Canada case with the member opposite if she or her colleagues would like to read it.

As a result of that Supreme Court decision, the treatments that were being offered at the Crosstown Clinic were reinstated and have been in place now for at least three years under the previous government. What is offered at the Crosstown Clinic is both prescription hydromorphone as well as prescription diacetylmorphine. Those have both been offered at the Crosstown Clinic under the previous government, and they continue to be offered under this government.

This budget update foresees expanding the treatment that is offered at the Crosstown Clinic as well as now implementing the guideline that we approved last week for injectable hydromorphone. It has been found, through clinical trials, that prescription hydromorphone, for most patients, is as effective as prescription diacetylmorphine. So it is largely prescription hydromorphone that we will be going forward with.

The member is no doubt aware that hydromorphone is a prescription drug that is used in this province and elsewhere and globally as a prescription pain medication, especially for people who are experiencing severe pain post-surgical, and so on. So we will be expanding the current injectable opioid agonist treatment services. The budget item for that is $4.74 million, and the expansion of the injectable opioid agonist treatment is $2.99 million.

J. Thornthwaite: I didn’t hear the first number. You said the $2.99 million. Then what was the number before that?

Hon. J. Darcy: As in the budget documents, current injectable OAT, opioid agonist treatment services, $4.74 million. A significant amount of that is current cost pressures, costs that were being incurred already at the Crosstown Clinic that were actually…. They were being incurred. They were authorized, but some of that funding had actually not been allocated, even though Crosstown was administering these services. So it’s an unfunded liability of the previous government that we are now carrying forward and funding. For injectable opioid agonist treatment expansion, $2.99 million.

J. Thornthwaite: So that would be the amount of money for the actual substance.

Can you tell me how many people work at the Crosstown Clinic — how many nurses, how many doctors? Or is that included in there?

Hon. J. Darcy: The number of staff who work at the Crosstown Clinic…. We would have to look into that information from the Ministry of Health because they’re involved in service delivery. This is a health authority clinic.

I would say, though, that I think it’s important for us to humanize this. It’s really easy to engage in fearmongering and scare tactics about prescription medication. I visited the Crosstown Clinic. If the member hasn’t, I would certainly encourage her to.

[3:10 p.m.]

I would encourage the members opposite to actually meet with people who are patients of the Crosstown Clinic. It really opens your heart and opens your mind to the health services — and I want to really underline the health services — that are being provided there.

I met a young man by the name of Kyle who is in his mid- to late 20s. Kyle was in foster care. Kyle became addicted to street drugs at an early age, about 15. He was incarcerated repeatedly. His life had spiraled downward, out of control. He actually visited the Foundry on Granville and was referred there by Dr. Steve Mathias, who really is the architect of the Foundry youth hubs in British Columbia, which the member is very familiar with. He was referred from the Foundry youth hub to the Crosstown Clinic.

I had an amazing conversation with Kyle when I visited the Crosstown Clinic. He described his life to me, and he described, more importantly, how he had gotten his life back because he’s getting the treatment that he needs to cope with his addiction and is not having to go to street drugs to cope with his illness.

He told me about going back to school and getting his cook’s diploma and how he’s now working and earning a living and cooking in some of the programs on the Downtown Eastside. Then he told me that he is now going back to school to get his hairdressing diploma. I said: “Wow, Kyle — two diplomas.” He said: “Well, you know, a guy’s got to have choices in life.” This is a guy who turned his life around. Most importantly, this is a human being who will have his life back and will be, and already is, a hard-working and productive citizen.

Also, think about the costs that we’re saving. He’s working. He’s paying his rent. He’s also getting support in supportive housing, which really speaks to the need for us to have a cross-government approach. He is no longer being incarcerated, with all the costs involved in that. The health care system is no longer incurring the enormous costs that it was incurring before.

This is an example of what it does involve. This isn’t for everybody. This is for a very small number of people, in the province of British Columbia, for whom there are no other options to save their lives, to prevent them from overdosing. The greatest number of people who are overdosing are from that population. He’s getting his life back. He’s a productive citizen. If we’re going to save lives and if we’re going to build a better system, we need to be bold.

J. Thornthwaite: Thank you for that.

How many people does the Crosstown Clinic serve, and do you have a cost per person for the program?

Hon. J. Darcy: There are currently 135 patients being served at Crosstown. Crosstown has a total capacity of 200 patients. The average cost per patient at the present time is $26,200. Patients from this population who are not engaged in treatment are estimated to cost our society in the range of $45,000 per year.

[3:15 p.m.]

The estimate that we have, from experts in the field, is that the treatment that is being offered at Crosstown would provide an estimated savings to society of $20,000 per patient, per year, due to the reduction in costs to health, law enforcement and criminal justice services.

Let me say something about a couple of other people that I met at Crosstown that really illustrates this in a very powerful way. At the same time that I sat in a circle with Kyle, there was also a worker who had been injured in the forestry industry and a construction worker who had been injured.

You may have seen stories in the media over the weekend that indicated what…. We still don’t have hard statistics, but anecdotally we know that there are a significant number of people who end up living with addictions — and, in many cases, overdosing — who were injured workers. It certainly reminds me of work that I have been involved in, in the past, in occupational health and safety. Everyone who works for a living is just one accident away from being an injured worker.

We see from what’s happening with the overdose crisis that a lot of people began with an injury, a workplace injury. They were, maybe, on prescription pain medication. Maybe they were cut off. Maybe it wasn’t strong enough to deal with their pain, and they turned to street drugs and eventually became addicted to very dangerous drugs that are now poisoned.

In the case of these other two gentlemen that I met that day, that was exactly their story. It began with injuries and then becoming addicted and street drugs and their lives spiraling out of control. And they also now have their lives back. They also now are contributing to their community. One of these men told me that he had been hospitalized literally dozens of times in the year before he ended up being treated at Crosstown.

J. Thornthwaite: Can the minister please tell us what the exit strategy is for patients who are taking this government-supplied heroin? Are they on it all the time, forever, or are there opportunities for them to get treatment and help for recovery to get off the drugs for good?

Hon. J. Darcy: Let me just say, first of all, that at the Crosstown Clinic, people are being treated with legal prescription medication. The prescription diacetylmorphine is only used as treatment with the authorization from the federal government. Prescription hydromorphone, which is the area that we are going to be expanding, in particular, with the new guideline that has been approved, is, as I’ve already mentioned, a prescription medication that is widely available in the province of British Columbia for the treatment of pain.

I don’t think the member opposite expects me to be a medical expert, but we are relying on clinical experts. The guidelines for the use of prescription hydromorphone, for instance, which I approved last week, were drafted by the best people in the field, in every health authority in British Columbia, in the Ministry of Health and in the field of addictions medicine, and it was internationally reviewed.

One of the things that we find far too often…. People, certainly, on the front lines of the overdose crisis, literally everyone I’ve spoken to, says: “We save somebody’s life” — with naloxone, for instance — “and then we often aren’t able to get them into treatment.” You’ve heard the Vancouver police chief and many others say: “We don’t have treatment on demand.” We don’t have the ability to say, after someone has been released from hospital, that we will immediately be able to put them on a path to treatment and then recovery. And that recovery is going to look different for different people.

[3:20 p.m.]

That’s exactly why we have decided as a government to create a Ministry of Mental Health and Addictions and to create a better system for addictions, where we don’t have the huge gaps, where we don’t have the waits that we have now. People can wait weeks or even months to get into treatment.

The answer to the question that I think the member is asking is that we absolutely need to get people to that place. But recovery is going to look different for different people. Some people are able to get into treatment immediately. Some people have been prescribed Suboxone or methadone and then are able to get into a recovery program and to eventually not be using drugs at all. For others, their treatment plan may take a longer period of time.

But we need to have those treatment options available, because the bottom line is that we can’t get somebody into treatment if we don’t first save their lives. Our approach is to put an enormous priority on saving people’s lives in the overdose crisis and by expanding the number of treatment options available for them, including with the new guideline that we released last week for injectable treatment.

J. Thornthwaite: In the treatment options that you’re saying will be expanded, will that include recovery options as well?

Hon. J. Darcy: Of course it will.

J. Thornthwaite: Do you have any information on the cost for any of these programs or what’s going on right now at Crosstown for people to get into recovery?

Hon. J. Darcy: I think the member opposite will understand that what a particular pathway to treatment and recovery looks like is a clinical decision, and it looks different for different people. Some of the people from Crosstown will no doubt transition to Suboxone or methadone. The treatment options need to be varied, but first and foremost, they need to be available, because if people have to wait weeks or even months to be able to avail themselves of various treatment options, the opportunity is often lost.

We’re looking to expand a wide array of treatment options and recovery options. There are some very good models in British Columbia. There are some very good models elsewhere in the country and in the world, and we will be looking very closely at that. We’re not talking about reinventing the wheel. We’re talking about creating a seamless and coordinated system so that when you ask for help once, you get help fast. That’s the goal.

I do want to emphasize, though, that a critical part of the path to recovery is those other social supports. The young man by the name of Kyle, who I referred to and who I met at Crosstown Clinic…. I also had the opportunity to meet, later that day, with people who work at RainCity Housing, with a housing support worker who actually works in the building — is the support worker in that building — who helps to support Kyle. Those supports are absolutely critical if Kyle is going to continue on his pathway to hope and if other people are going to as well.

[3:25 p.m.]

We are working across ministries. A recovery plan is, yes, about treatment, but it is also very much about a poverty reduction strategy. It’s very much about reducing the cultural barriers that exist for Indigenous people in British Columbia and making sure that the programs and services that we offer are culturally appropriate. It means ensuring that we begin to reduce the financial barriers that people have. We also have serious, serious challenges.

If you make a very good salary or if you’ve got a big bank account or a good employee assistance plan or good extended health plan, you can have access to some of the best treatment and recovery programs in the world. If you don’t, your access could be very limited. So we need to be dealing with these social, financial and cultural barriers if we’re really going to offer pathways to hope and recovery.

J. Thornthwaite: To paraphrase the answer, I think this is what you said — that you are expanding treatment and recovery options.

My question, then, would be: would those recovery options, or some of those — all of them, actually — be licensed? Or would the government be licensing them?

Hon. J. Darcy: As the member may or may not be aware, this is a process that has been underway. The Community Care and Assisted Living Act, as you know, was amended a year and a half ago, I would venture — I think it was about a year and a half ago — but that only deals with recovery homes that offer a certain number of services. You know that the changes in the act enable assisted living facilities to offer more services than they have in the past.

There is a consultation that is underway. There were regulations that were developed, I understand, that have not been enacted yet and a consultation that is underway with the sector. There are no regulations in place yet. Consultation is being carried out in the sector. The next phase is to move to drafting a set of regulations for the sector, but that only deals with the issue of licensed recovery homes.

I suspect that the member may be asking questions about unlicensed recovery homes, which, as the member’s office will be aware, has been a subject of considerable controversy over the last number of years. This isn’t something that started 12 weeks ago. This is something that people in the sector have been calling for, for a long time — that we take a harder look at recovery homes, some of which are doing a wonderful job and are providing excellent care and recovery programs for British Columbians and others of whom are not worth the name “recovery homes.”

We will be taking a look at that. That is something that was initiated under the previous government that has been languishing for some considerable time. It is one of the things we will be looking at as part of developing a strategy for mental health and addictions going forward.

J. Thornthwaite: The Select Standing Committee on Health, which I believe the minister was on, reported its findings and recommendations in March 2017, including 25 recommendations that were generated, in part, with consultations with addiction recovery treatment providers.

Can the minister advise whether or not any or all of these recommendations will be implemented and, if so, any timeline or any suggestion as to how that would be funded?

[3:30 p.m.]

Hon. J. Darcy: I was appointed to this position, and this ministry was created 12 weeks ago. Our most urgent priority has been responding to the overdose crisis, and we have invested $322 million over three years in responding to the overdose crisis and in putting the building blocks in place for a better system for mental health and addictions.

We absolutely recognize that we need to look at recovery homes and recovery programs. That will be part of our plan going forward, building a better system for mental health and addictions. I hope that the member would agree that for something that the previous government did not address over 16 years in power, it would not be a reasonable expectation for this government to have solved it 12 weeks after this ministry was created.

J. Thornthwaite: The coroners’ data tells us that 80 percent of the people who are fatally overdosing are being found in private homes around the province. Given the success with the Crosstown Clinic, does the minister plan to expand any more of those types of clinics in other areas around the province?

Hon. J. Darcy: The minister asked about people dying alone and then about expanding the Crosstown Clinic. I really think that we’re perhaps mixing apples with oranges here. We have a number of responses that are part of our action plan, our escalated actions in response to the overdose crisis, that speak to people using alone and then dying alone. The main reason that people use alone is stigma.

We are ramping up access to harm reduction sites. We have opened seven new sites just in the last number of weeks. Health authorities have been directed to examine all of the places where the greatest need is, across the province, in order to provide greater access to harm reduction sites and to naloxone, which we are increasing the distribution of, and training more people to administer naloxone. We are implementing drug-checking technology in a number of places because experience shows that if people are aware of what’s in the drugs that they’re consuming, they’re less likely to use as much of the drug.

We are also going to be launching a very, very aggressive public education campaign — a marketing campaign, if you will — a public awareness campaign, both to reach the public at large so that we stop treating addiction as something that is shameful and that should be hidden and, instead, treat it as an illness, which is a critical step that we need to get to in order to support people who are living with addictions. We’re also going to be doing a very targeted campaign, trying to reach people who use alone, and reaching them where they are, in language that they understand, in order that they fully appreciate the risks, and in order to encourage them to not use alone, to encourage them to access the services and programs and treatments that are available to them.

On the issue of injectable medications that we talked about earlier, since we approved the guideline last week, last Wednesday, we have asked health authorities to come back to us with implementation plans for the use of injectable prescription medication by the end of the month.

[3:35 p.m.]

J. Thornthwaite: So there’s no plan to expand Crosstown-type clinics in other areas in the province at this particular point.

Hon. J. Darcy: The guideline that was approved last week…. As I’ve mentioned, we’ve asked health authorities to come back to us by the end of the month with an implementation plan of the guideline, which I’m happy to share. Well, it’s a public document. It’s on the B.C. Centre on Substance Use website. It can be found many other places. It speaks to different models for delivery of treatment. One of those models is that this kind of treatment of injectable medications would be integrated into another health care setting. Another option is stand-alone clinics. The third option is through pharmacies.

We have not decided in advance what models it is that are going to be used. We’re asking health authorities to come back to us with implementation plans in order to ensure that the particular patient population that has not been able to benefit from other treatment plans would have access to this treatment plan. So we’ll be hearing from them what they think the best way is to implement it in communities in various health authorities.

J. Thornthwaite: For the folks that are using alone, a lot of times the reason is stigma. I guess what I was getting at is…. You’ve kind of answered it with regards to a marketing program. Obviously, these people are using alone and don’t want to be detected. How would the ministry’s office suggest that an education program would get to those people that, obviously, do not want to be detected as using any kind of drugs, particularly if they are alone?

Hon. J. Darcy: The details of what that marketing campaign looks like are being worked on as we speak. I think it’s important that the members opposite know that aside from working with really good communications experts in the field, we’re also consulting with people with lived experience, and we’re consulting with people who are now using drugs and using drugs alone. We want to make sure that the message reaches the people that it needs to reach in order to save lives and, by saving lives, hopefully be able to get people on a pathway to treatment and a pathway to recovery.

[3:40 p.m.]

One of the things that we’re doing…. I go back to this issue that I mentioned earlier about the building trades, for instance, and the high number of deaths in that field. We are establishing partnerships with WorkSafe B.C., the B.C. Building Trades Council and others who will be coming on board in the near future. We are also working with the B.C. Restaurant and Food Services Association in order to be able to reach people who are availing themselves in the hospitality sector.

We are going to use every means we can to reach people. We now know…. Because of the work of the coroner and the work of our task force and the public health officers, we are gaining a better sense of who the people are who are affected. We know that these are largely men between the ages of 30 and 59 who are using alone, that many of them are people who have been addicted to street drugs for some time, but there are also people who are occasional drug users, and there are people who became addicted as a result of workplace injuries.

We’re taking not just an all-of-government approach. We’re taking a whole-province approach to this issue. I am speaking to business leaders and union leaders and faith organisations and sports organisations and cultural organisations. We need to involve everybody in this. Everybody needs to step up to the plate.

That’s the approach that we’re taking in order to address this crisis. We can’t do anything less than that, because four people a day are dying.

J. Thornthwaite: Thank you for your efforts on that. I just wanted to leave that part of the discussion with the fact that there are people that are addicted and are addicts that we don’t know about that are functioning quite well in our society. Many are professionals. Who knows? In this building, there are probably people that are here, as well, that are afraid to be found out.

Those are the types of people in your educational efforts that need to be reached as well. So I commend you in your efforts with regards to the labour movement and, certainly, the tradespeople.

Obviously, we’ve got to get to the kids in the schools from a preventative perspective. Certainly, the group Moms Stop the Harm has done a lot of work with regards to educating parents with regards to the possible usage by their young folks.

I really think that if there is going to be an educational strategy out there for the general public, we have to have it very, very broad, when we have people dying alone in their homes. For a lot of these people, nobody knew that they were taking drugs at all, let alone being addicted.

The reach should be much greater than, for instance, the targets that you’re talking about. Did you want to comment on that?

Hon. J. Darcy: Perhaps the member missed what I said. When we’re talking about a public awareness campaign, we’re talking about reaching the public at large as well as the specific population of people who use drugs alone.

I think it’s really, critically important that all of us take on this responsibility. There is nowhere that I go, there is no reporter that I speak to, there is no audience that I speak to, there’s nothing I post on social media on this subject where I don’t say things to the effect that addiction is not a moral failure. I don’t say….

I would encourage all the members opposite to go back to your colleagues and encourage them to be carrying the same message. Elected officials can play an important role in this as opinion leaders, as community leaders, in conveying the message to all of our constituents and to the province of British Columbia that we have to bring this issue out of the shadows.

That means that just as we do with mental health — bringing these issues out of the shadows and encouraging open and honest and courageous conversations — we need to do exactly the same thing with addiction, not treat it as a moral failure.

[3:45 p.m.]

Treat it as the health condition that it is, which requires intervention, support, love and care and, most importantly, options for treatment and for recovery.

J. Thornthwaite: I have one more question before I’m going to let my colleague ask a few. It’s about the methadone program. Can the minister tell us how many British Columbians are on the methadone program, what the cost is and if she has any evaluation techniques to determine its success rate and how effective it is?

Hon. J. Darcy: The methadone maintenance program increased from approximately 1,900 clients in 1995-96 to 17,750 clients in 2016-2017.

J. Thornthwaite: Do you have any idea about what the cost of that program is in British Columbia, and do you have a measure of success rate and whether or not it is achieving sobriety at all in those people?

Hon. J. Darcy: PharmaCare’s methadone maintenance payments were $46 million in 2016-2017, and the total related expenditures have grown at an average annual rate of 6.4 percent.

On the answer of effectiveness of methadone treatment, that is something that we will be consulting clinical experts on. This program has been in place for many years in British Columbia, as the member is well aware. It was not just initiated 12 weeks ago. Of course, we will be evaluating all treatment options — their effectiveness — as we go forward.

Certainly, we do know that methadone and Suboxone have been effective treatment options for people being able to transition away from dangerous street drugs, drugs that are now poisoning people at a rate of four a day. It is certainly a program that we foresee continuing into the future because it does, indeed, save lives. And unless we save lives, we’re not able to support people to build a better life.

J. Thornthwaite: On that note, can the minister tell me whether or not you know how many lost their lives to a fatal overdose when they had methadone or Suboxone in their system at the time of death?

[3:50 p.m.]

Hon. J. Darcy: In the last two years, there have been 60 prescription opioid deaths. One in five of those people had some methadone in their system, I’m told. But they have very often been taking methadone in conjunction with other drugs, with benzodiazepine, with antidepressants and other psychotropic drugs.

This underlines the importance of one of the things that we have brought forward in our budget and in our response to the overdose crisis, and that is that we need a far more effective prescription-monitoring program in place in the province. We have provided funding for that in this budget.

J. Thornthwaite: Sorry, I’m not quite finished, because every time you answer a question, I have another one.

Hon. J. Darcy: Please don’t ask me about psychotropic drugs.

J. Thornthwaite: No.

Hon. J. Darcy: Thank you.

J. Thornthwaite: You said better management of prescription…. I can’t remember the term you used. But my question is directed to: does that mean that there will be more training for doctors in prescribing pain medicines, etc.?

[3:55 p.m.]

Hon. J. Darcy: Yes, education and training for physicians and health professionals is definitely something that needs to be increased in the province. We are working closely with Pain B.C. to ensure that that happens, and with physicians and other health care professionals.

The College of Physicians and Surgeons, you’re no doubt aware, brought in guidelines a year and a half ago for prescribing of opioids. One of the concerns that we’ve certainly heard, and we certainly hear a lot, is that people have…. We’ve gone through a period of, certainly, significant overprescribing of opioids, and the guideline is designed to reduce that. But we are now also hearing that people are often not being tapered off appropriately. There are not appropriate withdrawal management strategies and that has been a factor that has led to people then turning to illicit drugs in order to deal with their pain. So we need to be addressing both aspects of that.

The B.C. Centre on Substance Use has developed guidelines for the appropriate prescribing of opioids for addiction management, and as I said, the College of Physicians and Surgeons is responsible for the guidelines when it comes to non-addiction prescribing of opioids.

One of the things I do want to highlight in the budget that we have approved…. One of the initiatives that we’re going to be taking is substance use centres in various communities across the province, really beginning with those communities where we are seeing the most deaths through overdose or, proportionately, the most deaths through overdose.

Establishing more robust pain management services in British Columbia is an important priority, but we will be starting with these substance use centres in key communities across the province because we think that’s a critical part of both preventing overdose as well as supporting patients’ journey in recovering from a wide variety of things they may be dealing with, like surgery or other serious illness.

J. Thornthwaite: Of course, my next question will be: have you identified the key communities yet? Then a related one is: can the minister describe how much money is focused on programs in the Downtown Eastside versus other areas of the province?

[4:00 p.m.]

[R. Glumac in the chair.]

Hon. J. Darcy: We have not yet identified the communities where we will be developing these substance use centres, but as I mentioned already, we will be focusing on the areas where the overdose crisis has been worst.

On what’s being spent in the Downtown Eastside…. Frankly, we would have to examine budget lines of a dozen ministries within the government of British Columbia, because the services that are being provided in the Downtown Eastside vary widely.

There are housing services. There are health care services. There are services from the Ministry of Social Development, and from Children and Families, from Public Safety and other wide variety of services that are provided in the Downtown Eastside. I’m not in a position to say how much money is spent on services to people who live in the Downtown Eastside.

J. Thornthwaite: I’m going to let my colleague ask a few questions. But to clarify something that the minister had mentioned earlier on that reflected in the record of the previous government’s last 16 years…. Although we all admit that more can be done — certainly, we all admit that now — the previous government did have in their budget, for health alone, $1.42 billion spent on mental health and addictions.

Certainly, I was involved in the last four years of many new investments, including Foundry, which keeps coming up a lot, which we’re all very, very happy about. But certainly, Foundry — and the 11 sites that were announced — was something that was instigated on our government’s watch, in addition to other facilities, hospital facilities.

One of the ones that I’m the most proud of is the HOpe Centre — not only the HOpe Centre for adults and all age groups but also the third floor dedicated to children and youth. I’m very proud of my involvement in that too.

It wasn’t that there was nothing going on over the last 16 years. We recognize that more has to be done, and that’s what we’re investigating here, but it would be remiss, I think, of me or anybody else that was part of the previous government not to recognize that there was a lot of work that was done over the last 16 years.

Hon. J. Darcy: My comments were in response to questions that suggested that this government, after 12 weeks in office, should already have been able to fix a myriad of problems that have existed in this province over many years. There are, unquestionably — and I said this in my opening remarks — an awful lot of people working very hard on the front lines of mental health and addictions. There are many excellent programs that serve people with mental health and addictions. What we do not have is a seamless and coordinated system for mental health and addictions.

We have a fragmented system, an uncoordinated system, one that has huge gaps and one where access is limited for many different groups of British Columbians for a wide variety of reasons, from cultural barriers to financial barriers to racism and the legacy of colonization, and so on.

Our objective is to build on what we have; to learn from other jurisdictions; to dust off some of those reports that have been sitting on shelves, which recommended what action was required by government, including the recommendation to create a Ministry of Mental Health and Addictions — which, yes, absolutely, was recommended unanimously by the bipartisan committee that the member chaired. But it took this government to act on it and to create a mandate to create a seamless, coordinated system for mental health and addictions.

[4:05 p.m.]

M. Bernier: I’d just like to ask a question, then, to the minister. I appreciate her comments there.

She keeps saying “seamless.” I look at the minister’s budget. I look at the mandate letter. I look, actually, at the NDP platform that we had in front of us. I’m hoping the minister can stand up and maybe elaborate a little bit more on how she feels this ministry, this sole ministry, which is supposed to be taking so much of this important issue underneath one umbrella….

As the minister was talking about how we’re going to try to make this seamless, maybe the minister can explain what she really means by “seamless.” She said at the onset that this is across so many ministries. I have yet to see, within the mandate and what she’s going to bring forward, how this is going to make it seamless to help people, which is what we’re trying to do here.

Hon. J. Darcy: Member, thank you for your question. I think the member perhaps missed my opening remarks in which I indicated that our immediate priority, the most urgent priority of this ministry, is to respond to the overdose crisis, which is where we have focused most of our efforts — I think, understandably, when we’re living through the most severe public health emergency we’ve experienced in British Columbia in decades.

Having said that, we are putting some of the building blocks in place for that system for mental health and additions, that seamless, coordinated system. It is a central part of my mandate to work with other ministries and to create that system. To suggest that we have the answer now to what that looks like…. If the answer were clearly there, then perhaps the previous government would have acted upon it already.

I have been listening very actively over the last 12 weeks. We are consulting with people who have lived experience in mental health and addictions. We’re consulting with people who work on the front lines, people who work in the ministry, all of the experts in the field in order to develop that system, and we will be working on that over the coming months and over the coming years.

In particular, we have a mandate…. Part of my mandate was also to focus on early intervention for child and youth mental health. And as the member knows, the Representative for Children and Youth, two weeks ago…. His single recommendation in his report about Joshua’s story was that a year from now there should be a plan in place for child and youth mental health, and two years from now we should begin implementing it.

M. Bernier: I want to ask the minister then, again, if she can…. First of all, I appreciate what she’s trying to accomplish here. I think both sides recognize that if it was something easy to fix and accomplish, yes, it would have been done a long time ago, and the attention needs to be there.

One of the things that I’ve been hearing, though…. We keep talking about it, especially under this ministry, and I’m wondering if the minister can maybe explain or maybe differentiate, even a little bit…. We as government continue to talk about mental health and addictions, and they’re actually, in a lot of situations, separated. I’ve heard from a lot of people who are concerned that we as government keep lumping it in together.

So I’m curious. What’s the minister’s position on this within her mandate, within her ministry? I do acknowledge her comments about working at the most important issue that we seem to be facing right now. But even going forward, there are a lot of people that I’ve spoken with who have differentiating severities around mental health issues but don’t have any addictions issues, and they get troubled that we seem to, as a government, lump them in together. I’m curious on what the minister’s position is on that and her mandate going forward.

[4:10 p.m.]

Hon. J. Darcy: I want to just return to the issue of seamless, for a sec, before answering this particular question.

One good example of what a seamless system looks like is that…. I mentioned earlier, I think perhaps before the member arrived, that in the mental health and addictions working group of cabinet, which I chair, we also have the Minister of Housing, the Minister of Social Development and Poverty Reduction, a number of ministries.

When we are developing our plans to address homelessness, for instance, we ensure that every time we do that, there are also services in place, either on site or nearby in the community, to support people living with mental illness and addiction, because a very, very high percentage of the homeless population in our province are folks who are, in many cases, living with both mental illness and addiction — one or the other, or both. It’s an example of seamless, and there are many others that we will be working on over time.

On the issue of lumping mental illness and addiction together. First of all, there is something enormous that they have in common, and that’s stigma. We need to bring both mental illness and addiction out from the shadows and be willing to have open and courageous conversations about it and talk to British Columbians, talk to our families about this in a way that we begin treating both mental illness and addiction as health issues that deserve the same dignity and respect and quality of care that any physical illness does. That’s something that they have in common.

It’s estimated that one in five British Columbians is living with mental illness and that 30 percent of those people have concurrent disorders, meaning they’re dealing with both mental illness and substance use issues. So there is significant crossover.

Of course, there are people who are dealing only with mental illness, and there are people who are dealing only with addictions. But we also know that mental illness, if not treated, if not supported, can lead to addictions because people self-medicate. All of the evidence says that addiction is most often rooted in social and psychological trauma, and a critical part of the care and treatment is trauma-informed practice.

We also know that it’s…. People who work in treatment and recovery for addictions certainly say to me that the process of recovering from addictions can also…. We have also seen mental illness develop there. So one can lead to the other. It can go in both directions.

When we’re talking about prevention and early intervention and starting with our kids, it’s critically important….

[4:15 p.m.]

As the former Minister of Education, I’m sure the member is very well aware of this. We need to intervene much earlier with our young people in our schools so that when we’re seeing mild mental health issues…. We don’t want to see those. They need to be supported early on. We need early identification and early support so that mild mental health issues don’t become more severe mental health issues and young people don’t, in turn, turn to self-medication and become addicted.

There is also considerable research and evidence, both nationally and internationally, that shows the best practice is to develop service delivery models that address both of these — of course, with clinicians who specialize in substance use and clinicians who specialize in mental illness. The best practice is, nationally and internationally, to ensure that we deal with both of them.

J. Isaacs: Thank you, Minister, for your responses so far. I’d just like to move back to the opioid crisis and your statement that it is very devastating. I think we can all agree on that.

Actually, just a few weeks ago I attended a funeral for someone that had overdosed. This is a young man who was 28 years old, just starting his life. At the time of the funeral, we had word of yet another young man that, on the exact same day…. It is definitely a crisis, and we have to come to terms with how we’re going to deal with it.

As you say, it’s very comprehensive. There are a lot of complex issues. There are a lot of things that lead to opioid addiction and abuse, and it’s been going on for some time. Despite, of course, those warnings about taking drugs alone, it continues that people are not understanding the message of the dangers and are willing to accept the risk of taking drugs alone. So I welcome the education campaign. That might be sent towards a broad range of people so that everyone is aware and actually takes some action — to think twice before they start taking drugs that they are unfamiliar with and don’t have any direct knowledge of where the source came from.

The previous government did declare a public health emergency under B.C.’s Public Health Act in response to this significant crisis. At the time, there was a Joint Task Force on Overdose Prevention and Response that was put in place. The task force was assigned seven key areas. I wonder if the minister might be able to elaborate on what those seven key areas are and, maybe, just what the scope of responsibility is in those particular areas.

Hon. J. Darcy: The task force, as the member mentions, oversees six health-related task groups — treatment, surveillance, public engagement, naloxone, supervised consumption services and drug checking, and logistics and psychosocial supports — in order to support the provincial response.

And I am happy to read the priority areas into the record. I’m also happy to provide the member with documents that explain them. I’ll give you the categories, and if you would like me to do all of the bullets that appear below the categories, I’m happy to do that as well.

(1) Immediate response to an overdose by expanding naloxone availability and the reach of supervised consumption services in the province.

(2) Preventing overdoses by improving treatment options for people with opioid dependence and exploring drug-checking services and improving health professional education and guidance.

(3) Public education and awareness about overdose prevention and response through public awareness campaigns.

(4) Monitoring, surveillance and applied research by improving timely data collection, reporting and analysis to inform action, evaluating implementation and applied research.

(5) Improving the scheduling of substances and equipment under the Controlled Drugs and Substances Act and the Precursor Control Regulations by regulating drug manufacturing equipment such as pill presses, regulating precursors.

[4:20 p.m.]

(6) Improving federal enforcement and interdiction strategies by working with the Canada Border Services Agency to increase enforcement activities and to prevent the importation of illicit drugs.

(7) Enhancing the capacity of police to support harm reduction efforts related to street drugs by providing training to support safe fentanyl identification and handling practices.

J. Isaacs: Thank you, Minister. I appreciate you reading that all out. It shows how large the tentacles go to…. In order to get to this comprehensive strategy, we need multiple partners that are going to work together, especially if we want to get to that seamless position that you were talking about.

The task force is about a year old now. Can you tell me if the task force has raised any issues that would lead you be concerned with the work that they’re doing or if there needs to be anything else that’s added to that task force?

The Chair: Just a reminder, Member, to direct your questions through the Chair.

Hon. J. Darcy: Thank you for the question. Let me first say that the task force has done really remarkable work. The task force was co-chaired, as you know, by Dr. Perry Kendall, who is with us here today, and the Deputy Minister from Solicitor General and Public Safety. They made a number of recommendations. They’re in a public document. We’re certainly happy to share them with you. They were quite extensive recommendations.

I met with Dr. Kendall, I think, my very first week on the job, and we discussed those extensively. I’m very happy to say that we are funding the recommendations that were made by the task force about what the task force felt we needed to do going forward.

One of the things that the task force called for was a more comprehensive approach. As I mentioned, we had Health and we had Public Safety and Solicitor General, and they called for a more comprehensive approach that really worked across ministries, that also addressed the social factors and that called for a comprehensive mental health and addictions strategy.

There are a number of specific recommendations, like stronger surveillance, meaning making our data far more robust so that we are in a better position to prevent deaths by understanding who it is who died and what their journey was, and so on. So we’re working on stronger surveillance. There’s something about that in this budget.

[4:25 p.m.]

They called for us to expand the range of treatment options available for people with opioid use disorder, and we are certainly doing that. I think it’s fair to say that we are acting on all of the recommendations of the task force going forward.

J. Isaacs: I keep hearing different amounts of how much has actually been spent on the opioid crisis. Can the minister confirm how much has actually been spent on the opioid crisis?

Also, it looks like there’s an additional $57 million that has been allocated in the interim budget. Would the minister be able to tell us where that $57 million will be spent and if part of that $57 million will be funding the recommendations?

Hon. J. Darcy: In order to wrap our minds around the question, I wonder: when you say, “How much has been spent so far on the overdose crisis…?” The overdose emergency was declared a year and a half ago. The overdose crisis has been developing, however, over a number of years, with a steady increase in the number of deaths by overdose. So is the question about how much has been spent by previous and present Ministries of Health, previous and present Public Safety and Solicitors General?

If you could give us some sense of the scope of the question. I’m certainly in a position to answer specific questions about our budget and what’s being allocated to what program areas, but it’s a pretty broad question. We’d have to look into…. Anyway, it’s pretty broad.

J. Isaacs: Sorry if that was too broad. Probably just from the time that it was declared a public health emergency. How much money has been spent since then? And just what is the plan going forward on how any money coming in will be spent?

Hon. J. Darcy: The information that I have, updated as of the last couple of days, is that in 2015-2016, there was a total of $5.75 million that was spent. In the year 2016-2017, $34.988 million was spent. In this current fiscal year, from the beginning of the budget year, including the budget update, to the end of the fiscal year, $106.8 million. That includes the Coroners Service, naloxone community action initiatives, health authority spending, expanded access to Suboxone, the joint task force, the establishment of the B.C. Centre on Substance Use.

[4:30 p.m.]

The budget that we’ve approved going forward in a variety of areas: B.C. emergency health services, 65 surge beds, on top of the existing beds, which were funded temporarily and that we are continuing to fund; outpatient treatment spaces; public awareness campaign.

J. Isaacs: I’m thinking of the $116 million that was put in place after the crisis was considered to be a public emergency. You’ve mentioned a number of different partners. But how much of that money was actually allocated towards the task force?

Hon. J. Darcy: I just want to be clear. The $106.8 million is this budget year. That’s not the total for the previous years. That’s just this year.

In answer to your question, the people who served on the task force were all doing this as part of their other responsibilities, sometimes taking over most of their desks, sometimes off the side of their desks. And they did an amazing job.

There is not a separate budget for the task force. There were initiatives that were taken by the task force that were program initiatives that were critical in saving lives. If it had not been for the work of the task force over the last year and a half, we would have seen far more people die in the province of British Columbia. But there wasn’t a budget per se for the functioning of the task force. Rather, there was funding for initiatives that were taken by the task force.

The Chair: We’ve had a request for a brief five-minute recess. We can reconvene here at 4:39.

The committee recessed from 4:34 p.m. to 4:40 p.m.

[R. Glumac in the chair.]

J. Isaacs: I thank the minister for her last response. I’m still not quite clear, though, on where the $100 million has been spent. I guess my question is how much money has been spent on the actual task force. How much money was allocated to them?

Hon. J. Darcy: My understanding is, and I’m really just repeating what I said before, the task force had people — Dr. Perry Kendall, people from Public Safety and Solicitor General, involved people from health authorities, had various working groups — on different aspects of its mandate.

Those people were carrying out their other functions, and they were also bringing their expertise to the task force. The task force initiated various programs, certainly, that were instrumental in saving lives. I don’t think there’s any question that without the work of the task force, the costs would actually be far greater to our health care system, our social services system, our justice system, and so on.

These people were carrying this responsibility in addition to the other, very, very important tasks that they perform — the public service that they perform in this province.

J. Isaacs: I am in no way diminishing the work of the task force.

It’s very valuable work, and I know they’ve been working in a number of different areas to collectively and collaboratively work together to beat this crisis, so in no way is it diminishing the work of the task force. It’s mainly I’m just trying to figure out how much money is actually being spent in what areas. We’ll leave that for now.

It’s also my understanding that there was $10 million that was announced by the federal government, which was going to support the provincial government’s efforts in responding to the emergency. My understanding is that funding was allocated to the task force and was to be distributed to expand access to opioid agonist treatment, to support the anticipated operation of expanded supervised consumption services and improvements to the capacity to provide toxicology laboratory services.

My question, then, would be: of the $10 million of funding, can the minister advise how much has been spent by the task force and in what percentage of those three areas?

[4:45 p.m.]

Hon. J. Darcy: We’re just taking a minute to get the answer, because this is federal government money that was for the overdose crisis and that was allocated to recommendations from the task force. The money didn’t go to the task force.

The money went into various program areas that were administered by the Ministry of Health — you know, cost recovery for the Ministry of Health for programs that were being administered through health authorities and various agencies. So we’re going to get a breakdown of that. But it was not money spent by the task force. It was money where the task force…. It went to programs that the task force recommended it was required for. We’ll get that information for you.

M. Bernier: Maybe I can help the minister here. If this is actually one that would be under the Minister of Health, we can always try to canvass that tomorrow and save a little bit of time.

Hon. J. Darcy: As I indicated already, this was not money spent by the task force. This was money…. They made recommendations about where it should be spent.

Of the $10 million, $1 million of it went to Public Safety and Solicitor General, including for strengthening the services of the coroner of British Columbia, and $9 million went to health authorities to offset their costs in a number of areas, including opioid agonist treatment and lab costs.

M. Bernier: Not to go too deep on this. I just want to clarify. Was that $10 million from the federal government put into the Ministry of Mental Health and Addictions budget or the Ministry of Health budget?

Hon. J. Darcy: We’re talking, in this case, about money that was allocated last year by the previous Minister of Health. So there is money that has been allocated this year by the federal government. We are presently working to determine which programs that we have taken forward that we will be using those federal funds for. That’s an ongoing discussion with the federal government, because they have specific uses that they consider appropriate uses of that money that is allocated.

[4:50 p.m.]

The question that I was asked was: what was received previously, and how was that spent? That’s the question that I was answering: $10 million had been allocated. That was to Public Safety and Solicitor General, and it was to offset costs in the health authorities to implement various programs like the opioid agonist treatment, lab costs and others.

M. Bernier: I appreciate that. Do we anticipate any more federal money coming in? If so, do we anticipate that actually going into the Ministry of Health or other areas, or into the newly formed Ministry of Mental Health and Addictions?

The reason why I’m asking this is, again, trying to clarify, as the public is trying to clarify, whose roles and responsibilities are where. Obviously, with the minister, as she said, trying to make things seamless, we’re just trying to ensure where the money is going to go.

Hon. J. Darcy: This year we have $13 million that has been allocated by the federal government for mental health and addictions — so not specifically for the overdose crisis. That money will be flowing through the Ministry of Health, because service delivery is occurring for mental health and addictions through the Ministry of Health. That money will not be going into the new ministry.

We are responsible for…. To the member opposite: this is a discussion we had at the outset of the session today. Our ministry is responsible for providing leadership and developing a strategy for mental health and addictions and leading the province’s response to the overdose crisis. We are not directly involved in service delivery. The service delivery will continue to occur where it occurs now. Our objective is not to create a parallel structure. It is to bring the work of various ministries together.

We continue to both collaborate with and push the federal government hard on increased funding to deal both with the overdose crisis and for a more effective system for mental health and addictions.

The Minister of Health and I will both be attending the federal-provincial-territorial meeting of the Ministers of Health next week. One of the items on the agenda is the overdose crisis. We’ve met with the previous Minister of Health, the current Minister of Health, and we will be continuing to advocate for a strong partnership with the federal government and increased resources for the area of mental health and addictions because the federal government says that this is an important priority for them. We want to make sure that it is and that we have more resources from the federal government for mental health and addictions in British Columbia.

M. Bernier: I’m just curious what the plan is, then, within the ministry, within the budget. What if there is no more federal money? Right now we know that the federal government has recognized this as an issue right across Canada and specifically here in British Columbia. But there’s a concern, obviously, if the federal government turns off the tap, so to speak. What’s the plan within the Ministry of Mental Health and Addictions, probably more to Health, if the federal government does not come through in the next 12 months?

[4:55 p.m.]

Hon. J. Darcy: There is, as the member is probably aware, a ten-year commitment from the federal government, and that is both money allocated to home care and money allocated for mental health. I can either read this into the record, or we can provide you a copy of it. It’s a public document.

For the year ’17-18, there is the $13 million, which I’ve already referenced, which is for mental health and addictions. They have indicated…. The next year goes to $32 million, almost $33 million; the next year close to $59 million; then $78 million and $78½ million going forward for the remainder of those ten years. The federal government has indicated that there is flexibility, and they’re open to discussions about what proportion of that is allocated to mental health, what proportion is allocated to addictions and what proportion is allocated to the overdose crisis. So that’s a matter of working closely with them.

In answer to the question about what our government is doing, we have a very detailed plan, $322 million over three years, largely for the overdose crisis but some of it for some of the building blocks for building a better system for mental health and addictions. Those include the substance use centres that I referred to earlier, which will be located in various communities across the province, and it also includes expanded funding for the Foundry centres, the Foundry youth hubs.

In addition to that — and I’m happy to provide this detail — our commitment going forward is under different categories. Under saving lives, overdose prevention services, $2.8 million; supervised consumption services, $3.34 million; drug checking, $1.2 million; take-home naloxone, $2 million; for a total of $9.34 million in this 2017-2018 budget year.

Ending stigma, which is communications and public engagement, which we discussed earlier, $2.36 million. Rebuilding the network of mental health and addictions, including plan G Suboxone and methadone change, is $4 million. Slow-release oral morphine: $3 million. Opioid use disorder treatment, $11.97 million. Current injectable, $4.74 million. We canvassed some of these numbers before. Injectable opioid agonist treatment expansion, $2.99 million. Access to pain management services, just over $1 million. Increased support for hospitals and emergency departments, who are under incredible pressure, $1.35 million.

Outreach. The outreach refers to having the supports in place in community, like housing, like social services, like counselling for people whose lives are being saved and who we’re trying to get into treatment and recovery. So outreach programs. Surge activities, which is funding the surge beds, beds that were allocated — so funding going forward. Opioid agonist treatment in correctional facilities. We know that there is a high percentage of the population of folks who are incarcerated who are also suffering from addictions. We both need to give them better support and ensure that there is a better transition into outside of prison and to prevent relapse and to put people on a better path.

[5:00 p.m.]

The Foundry centres, $1.5 million. These are all figures in this budget year. Professional education and training, which was a question that was asked about earlier, $1.54 million. Pharmacist training and opioid agonist therapy, half a million dollars. That’s for a total of $36.12 million on rebuilding the network.

Addressing the full range of supports. There is money allocated for psychosocial supports for first-line responders.

Data-driven responses. Enhanced prescription monitoring systems. We’ve discussed many of these earlier today, and each of these is broken down in some detail. I can read the rest of them into the record if you like.

Interjection.

Hon. J. Darcy: You’re good? Okay.

J. Thornthwaite: I wanted to follow up on the question that my colleague had brought up with regards to the federal government. I’m just going to quote something from the Premier: “This is a problem that is of national scope, and we need the national government to step up. I have commitments from Mr. Trudeau that he is going to do that, and we are just waiting for the cash to flow so we can get it into the health authorities so they can put in place programs to help people.”

[B. Ma in the chair.]

My question is — and I’m sorry if I missed it in your other answer: where, specifically, is that federal money going? I’m assuming you’ve answered the question — that it’s going to Health. But specifically, in which hands, which programs, where and when?

Hon. J. Darcy: Just to clarify, the $13 million is money…. Well, any of the federal funding, any of the federal money, involves collaboration and negotiating about how this money would be allocated.

[5:05 p.m.]

The $13 million that I’ve already referred to is this year’s instalment of money that is going to flow over a ten-year period. We’ve confirmed that that $13 million is available. But all of these things need to be done in partnership, so we will be working with the federal government in order to determine which of the programs that we’re initiating can have the costs offset by federal funding.

There are a number of programs that I just outlined and that I read into the record. There are more that I could also read into the record. We’ve committed $61 million in this budget year, $322 million over the next three years. That’s just mainly for the overdose crisis. This money is mental health and addictions. Again, we’ll be collaborating with them. This is a partnership, and we’ll be determining which of these programs we can use that money towards.

M. Bernier: Thank you to the minister for those clarifications. I guess the question and the uncertainty around the Premier’s statement versus the budget is really not around the $322 million — obviously, that’s a good step towards helping solve the crisis — and the other funding and the other programs that have been mentioned.

I guess the question, really, that we’re seeking an answer to is…. By the Premier’s statement, it would lead one to believe that the $322 million is not enough resources, and we need the federal government to come to the table with more resources. Or is it that we’re hoping to receive funds to offset the $322 million?

That’s really, I think, the salient question we’re trying to get an answer to here. It’s not specific programs and dollars. But is that broad $322 million indeed the plan? Or is the hope — to pull a number out of the air — a $500 million program, and that’s what we actually need the federal government to come to the table with? That’s where the confusion, I think, is starting to be at play with the statement from the Premier around making sure that the federal government comes to the table, in light of the fact that there’s already $322 million in the three-year budget.

I hope that maybe clarifies what we’re seeking an answer around in terms of: is there sufficiency and confidence that that $322 million is in fact enough to deliver the programs and services that are needed? Or is it an additional injection of dollars that is truly needed, and the government’s hoping to see that from the federal government?

Hon. J. Darcy: I think it is always the role of a provincial government, the Minister of Health, myself as Minister of Mental Health and Addictions and the role of the Premier to try and get as much support as we possibly can from the federal government for programs going forward. That’s what the Premier was speaking to.

As I’ve mentioned, $13 million is the first instalment of funding over a ten-year agreement — a ten-year agreement that, I should mention, was signed off on by the previous government.

There is also a $100 million research and innovation fund that the federal government has introduced. That’s not a funding envelope that’s divvied up proportionately across the province. This is an envelope for which you have to apply with specific projects that meet the test of being research-oriented and innovative. We are certainly going to be looking for whatever opportunities…. There are already a number of proposals in from British Columbia. It’s not restricted to governments applying for that money. So we will be exploring every avenue in order to get resources out of that.

We are doing some very innovative things, and if we can get support from the federal government to do it, we will do that. Will we continue to press the federal government for more resources? Of course we will.

J. Isaacs: Just since the time period that the B.C. Public Health Act declared an emergency, just going back to that time period — and I thank Dr. Kendall for all his work in getting that through and his efforts there — can the minister advise how many naloxone kits have actually been distributed and to what organizations?

[5:10 p.m.]

Hon. J. Darcy: Since the B.C. Centre for Disease Control launched the B.C. take-home-naloxone program — this goes back to 2012 — more than 55,000 naloxone kits have been distributed at no charge to people at risk of overdose. Those, most likely, respond to an overdose. More than 27,000 of those were in 2017 alone. We’d have to break it down since the public health emergency was declared in April of 2016.

Naloxone kits and overdose recognition and response training are available at 590 B.C. sites, including all emergency departments, correctional facilities and public health units, as well as 85 First Nations serving 97 communities. This is up from about 100 distribution sites in 2015.

In December 2016, the B.C. Centre for Disease Control launched the facility overdose response box program to better equip community organizations that work with populations at risk of overdose, like emergency shelters, friendship centres, and so on, with publicly funded naloxone emergency response supplies, and overdose recognition and response training.

As of August 18 of this year, there are 397 registered facility overdose response box sites across B.C. I do not have a list of every organization that has it, but I think you have some sense of the scope of it and the kinds of organizations that have it.

While we’re on the subject, I would certainly encourage…. I had the opportunity to take part in naloxone training myself a number of weeks ago, during Overdose Awareness Day here in Victoria. I think that’s something that’s very important for us to do as public opinion leaders and community leaders, because it also says to people: “This is something that is very important that you do. This can happen to anyone. This can happen to someone that you love, and we all need to be prepared.”

J. Isaacs: You mentioned that the naloxone kits were being provided free of charge in 2012. Are they still being provided free of charge, and what is the actual cost to the taxpayer?

[5:15 p.m.]

Hon. J. Darcy: Yes, the kits are free of charge. In 2016-2017, understanding that we’re just partway through this budget year, Provincial Health Services Authority naloxone supply expenditures were approximately $1.747 million, of which $459,000 was for naloxone drugs, meaning the medication itself, and $1.288 million was for kit supplies — syringes, masks, information materials, and so on. We’d have to get out a little calculator to figure out exactly what that is per kit. It also depends on how much is in the kit.

J. Isaacs: Thank you for that information. It is helpful.

Can the minister advise how many injection sites are across the province, and where they’re located in the province?

Hon. J. Darcy: Health Canada has provided exemptions under section 56 of the Controlled Drugs and Substances Act for eight supervised consumption sites — three in Vancouver, two in Surrey, and one each in Kamloops, Kelowna and Victoria. And another two, one each in Vancouver and Victoria, are currently under review. Northern Health is examining the feasibility of supervised consumption services for Prince George.

Island Health is in the planning stages for a supervised consumption site in Nanaimo. And the B.C. Centre on Substance Use has developed operational guidelines for supervised consumption services based on available scientific evidence, policies and procedures in place in British Columbia.

J. Isaacs: The cost of the replacement therapies, the drug therapies — is there a huge variance between the opioid prescription and the cost of that prescription or street drugs versus the replacement therapy drugs? Does that make sense?

Hon. J. Darcy: I wonder if I’m not understanding your question. I don’t know what street drugs cost.

J. Isaacs: I guess, the replacement therapy drugs. Are they more expensive or less expensive than what the traditional opioid drugs would be?

[5:20 p.m.]

Hon. J. Darcy: Do you mean is injectable hydromorphone, for instance, more expensive than Suboxone and methadone?

J. Isaacs: Yes.

Hon. J. Darcy: Okay, thanks.

The cost depends on these different opioid agonist treatments. They have varying costs, so they don’t all cost the same. Buprenorphine naloxone, commonly known as Suboxone, costs $1,485 per year per patient. Methadone, $3,141; Kadian, $5,870; hydromorphone is $25,428.

I would underline that the objective of approving a guideline for the use of injectables, for instance, is not that people who are now on Suboxone and methadone are to be transferred to this treatment. This treatment is for people who are not able to benefit from the other treatments. They’ve been proven to be not effective. They’ve tried them, they haven’t worked, and this is the treatment that can put them on a path to recovery and a better life.

I want to also repeat the figure that I mentioned earlier, which is that it is estimated that the cost of untreated opioid addiction is between $45,000 and $50,000 a year, which means that for every person we treat with prescription hydromorphone, for instance, we are saving $20,000, at least, in health care costs, social services costs and costs to our justice system.

Just one other thing. Part of the clinical guidelines…. It’s very clear that there are certain criteria that need to be met, medical criteria determined by addiction experts, for why someone would be put on this treatment as opposed to Suboxone or methadone. It’s not that the patient decides to do this. This is based on clinical evidence and clinical advice.

J. Isaacs: I’d just like to thank the minister for spelling out all those drug-replacement therapies for me. Thank you kindly.

Hon. J. Darcy: We’re all learning.

[5:25 p.m.]

J. Thornthwaite: I have a question for the minister, but I’m not too sure whether or not it’s this ministry. It’s about the Safe Care Act and Kimberly’s Law. Is that your ministry, or is that MCFD? I’m not too sure exactly where it would fit.

Hon. J. Darcy: MCFD.

J. Thornthwaite: Okay, so all the questions that I have that might pertain to other issues, including education, would go to MCFD? It’s under that act.

Hon. J. Darcy: I don’t know what your remaining questions are, so I’m not able to answer that. Secure care, the issue that you just raised, would be MCFD.

J. Thornthwaite: I will canvass the questions with regards to the Safe Care Act, then, through MCFD.

My other question that I would like to ask the minister is about Foundry. As the minister knows, I’ve been very involved in Foundry and worked with Dr. Steve Mathias for several years before we were able to bring the whole, entire program to fruition based on the inner-city Granville clinic.

I heard in my briefing this morning, kindly from your deputy minister, that there are plans to increase the scope of Foundry, not just to the youth that would be serviced by Foundry, but more of an emphasis on addiction and possibly, in future, to adults. I’m wondering if you could explain to me where the next phase of the children and youth Foundrys, of the 11 that were initially announced, were going to go, and then the ones that haven’t, obviously, been announced, if you have that information. What other expansions would be occurring with Foundry across the province in other scopes or age groups?

[5:30 p.m.]

Hon. J. Darcy: In this budget, we have increased the funding for Foundry by a total of $2.8 million this year, which includes $1.8 million for what’s called the backbone support. I know that the member knows, but for other people, there is a provincial organization that provides the backbone. It’s like the core organizational structure that supports the creation of these Foundry youth hubs across the province. It’s $1 million, plus $1.8 million in new funding. We will be working with Foundry central, Foundry backbone, in order to establish what those other locations are. There is also ongoing evaluation that is built into the Foundry project.

The evaluation is ongoing, but we know that what works so well with Foundry is that it is absolutely built around clients’ needs, built around the needs of the youth who come in for service. No matter what issue it is that brings them to Foundry’s door, whether it’s mental illness, whether it’s substance use, whether it’s challenges that they’re having in the school system, whether it’s employment or just seeking help, we know that they get connected with other services. So in that sense, the coordination of services….

What I’ll say is that every door is the right door, which is a phrase that the Canadian Mental Health Association uses all the time when they’re describing how we need to get to a coordinated system of care and a seamless system of care, where every door is the right door, which is certainly what Foundry does, and then connecting youth with a variety of other services, and peer support services are very much a part of that.

When we’re looking at strengthening or transforming our mental health and addictions system more broadly, those are some of the things that we need to learn from. Those are some of the things we want to build upon.

Does that mean that we’re creating adult Foundry hubs? No, but it means that there are many things that we can learn from this model and from other similar models to ensure that when people are seeking help, they are connected with the services that they need and the supports that they need.

J. Thornthwaite: Is there a timeline to find out when these new Foundrys are up and running?

Hon. J. Darcy: We’ll be collaborating with the Foundry organization on that.

J. Thornthwaite: What role will the minister play in supporting mental health and addiction services in schools?

Hon. J. Darcy: Well, early intervention is an absolutely critical part of the plan that needs to be developed. We know that there are too many kids in schools who are suffering, who are feeling tremendous isolation, who are experiencing early stages of mental illness, whether that’s anxiety disorder or depression, or whether they’re living with ADHD, and they aren’t getting the support that they need now.

We know that if those challenges remain untreated, unsupported, these can develop into far more serious mental health issues and also into substance use issues as young people self-medicate. We also know that about 70 percent of mental health issues develop when people are young, before the age of 25.

We need to start early intervention in our schools, greater supports, mental health workers, mental health professionals working as part of a team or supporting the teams in schools. Supporting teachers, supporting resource staff, supporting special education assistants, and so on, is a critical part of the plan that we need to put together, going forward, and that’s certainly something that the Representative for Children and Youth spoke to, very powerfully.

[5:35 p.m.]

We know that in the case of Joshua, his mother reached out for help starting when he was age two, and we know that when he was age seven, he was already talking about wanting to die and saying that in the context of school. We know his first suicide attempt was at age 11, and he was age 17 when he tragically took his own life.

While the education system stepped in, they also stepped back. They stepped in many times, and they stepped back. Children and Families stepped in, and they stepped back. The health care system stepped in and stepped back. The lack of coordination was very serious — the lack of an integrated approach to supporting Joshua and his mother, who reached out for help repeatedly.

The representative did not say that better services would have saved Joshua’s life, but he did say that Joshua would have stood a much better chance of still being alive if there were better services. We fully appreciate that that needs to start early. That’s why we will be working very closely with the Ministers of Education, Children and Families, Social Development, Health, Indigenous Relations and Reconciliation.

We know that the crisis for mental health and the crisis for addictions are very severe amongst First Nations communities and Indigenous peoples. In the overdose crisis, Indigenous people are dying at a rate three times the population at large. Certainly, during the First Nations Leaders Gathering just a few weeks ago, when I met with leaders of 35 or so First Nations communities across the province, there wasn’t one First Nations leader that did not talk to me about the crisis amongst their youth, about the epidemic of suicide, about their feelings of hopelessness and despair. So a critical part of our strategy is working very, very closely.

In this budget, we have approved significant resources to partner with the First Nations Health Authority but also to partner with Métis Nation and with native friendship association centres so that we reach status and non-status Indians and Métis people in the province of British Columbia. We have to do a lot better, and we need to do that in collaboration.

J. Thornthwaite: But my question was: what role will your ministry provide to ensure that these services are provided in the schools?

Hon. J. Darcy: My role is a leadership role, as I explained at the outset and as I have repeated several times. But I’m happy to repeat it again.

The Ministry of Mental Health and Addictions was created in order that there is one person in government, one person in cabinet, whose focus each and every day is on building a better system for mental health and addictions. That means that I have a lead role in bringing together the other social ministries, if we can call them that, in order to develop an effective strategy to propose what those programs are and to bring those forward to Treasury Board, to cabinet, for budgetary approval.

We will also be building in mechanisms for evaluation of all of our programs as we go forward so that we can adjust, when need be, and so that we get the best possible value for the money that’s being spent in order to ensure that the resources that we’re investing really are the most effective possible in building that better system.

My role is to lead all of that.

J. Thornthwaite: The minister’s role is to lead and, I would assume, after consultation with experts, put forward recommendations. How will you ensure that what your recommendations are is not only implemented in, say, the Ministry of Education but also paid for within the Ministry of Education or another ministry?

Hon. J. Darcy: We will be building in accountability for all of the programs that we initiate. The mental health and addictions working group, which I chair, will be both approving as well as reviewing those programs on an ongoing basis.

[5:40 p.m.]

J. Thornthwaite: In your research component of your ministry, you have…. The ministry has it in a mention in the budget outline with regards to research. Will the ministry be researching different models to provide integrated mental health systems in schools?

Hon. J. Darcy: The short answer is yes, of course we will be researching best practices, both in British Columbia, across Canada and internationally. The Representative for Children and Youth referred to a model that he was involved in developing in the province of New Brunswick that we will certainly look at. The Foundry model that is now building in British Columbia, originated in Australia. And we will certainly be looking at jurisdictions around the world.

I think what came out of the report from the Select Standing Committee on Children and Youth on mental health was the importance of an integrated model. There are different ways of doing that. There are school hub models. There are community hub models.

We will be exploring…. We want to build on best practices so that we give our children and youth the best possible support that we can at the earliest possible age.

J. Thornthwaite: Has the minister read the Select Standing Committee for Children and Youth, that special two-year project that I chaired along with the bipartisan committee?

Hon. J. Darcy: Yes, I have. It’s a good report.

J. Thornthwaite: Thank you. The reason why I ask is because I’ve got some questions pertaining to that report, so I wanted to make sure that you had the people around to advise you.

One of the committee’s core recommendations, in addition to having a separate ministry for mental health, was the one child, one file for the youth mental health system. I would like to know whether or not the one child, one file system is going to be implemented in whatever school system model that you are going to advance forward.

[5:45 p.m.]

Hon. J. Darcy: As far as some of the core recommendations, as the member has pointed out, it was that select standing committee that reported a year and a half ago, if I’m not mistaken. Am I correct?

J. Thornthwaite: Yes.

Hon. J. Darcy: That report was presented and approved by the Legislature a year and a half ago, including a recommendation to create a separate ministry. I would point out, though, that it took this government to put that recommendation in place.

On the issue of one child, one file…. There are a number of recommendations. I’m mandated to develop a strategy for child and youth mental health. The Representative for Children and Youth specifically underlined that. He recommended that a year from when his report was issued, we have a plan in place and that within two years of his report being issued, we begin implementing that plan.

We’re not going to be doing this piecemeal. We are going to be developing that plan and the pieces that flow from it, and that’s not going to happen overnight. It wasn’t overnight that we got to the place that we are, where there are some huge gaps and some serious lack of coordination and serious fragmentation in the child and youth mental health system, and it’s not going to be overnight that it’s going to be fixed. But we do take the recommendation of the representative very, very seriously, and we will meet his timeline to have a strategy in place in a year and begin implementing it a year after that, as he recommended.

J. Thornthwaite: One of the key issues that we found on that committee when we were consulting with people, and in particular, with the New Brunswick model, is communication, and communications about specific individuals — i.e., children and their families — between ministries. There was a lack of communication. One of the tragedies that occurs with these children and families is that they are then, therefore, forced to tell their story time and time again — their same story, time and time again — which makes them, essentially, victims over and over again.

The different professionals within different ministries, health authorities, schools or school counsellors, whatever the case may be…. They have to keep repeating it and repeating it and repeating it. One of the recommendations that the New Brunswick model had…. They actually did introduce legislation to allow for the privacy considerations that would allow sharing of information that would prevent these children and families from being victims over and over again.

My question is.... Within this research, you did mention the New Brunswick model a couple of times. Obviously, I know that our new Representative for Children and Youth is from New Brunswick and is very familiar with this. Is this going to be one of the key things that you are going to be looking at?

Hon. J. Darcy: The member is absolutely right that communications between staff and ministries is sorely lacking. That does lead to a situation where children and, frankly, their parents as well are having to repeat it over and over and over again.

[S. Chandra Herbert in the chair.]

That is clearly a serious problem, and it’s why we need to overcome this fragmentation and we need to build a system that has far greater coordination. As I mentioned earlier, it didn’t happen overnight that we got to this place, and we are going to be doing this in a coherent way.

We’re not going to be doing it with one-offs. We’re going to be putting in place, doing the serious consultation, the serious research, looking at evidence, looking at best practices in order to develop the best possible system. Obviously, how information is shared would be part of that.

[5:50 p.m.]

But I’m not going to second-guess or foreshadow what might or might not come out of the serious, serious work that needs to happen over the next year to develop that strategy.

J. Thornthwaite: Just before I leave this particular issue, if it was determined that this ministry would support the New Brunswick model and the ideas that they had with regards to the interjurisdictional communication, would this government canvass the idea of actually having legislation that would affect the privacy of the citizens to be able to share this information cross-ministry to help these children and families so they didn’t have to repeat their stories over and over again?

Hon. J. Darcy: There are many models that we’re going to be looking at. New Brunswick is one, but we will be examining models elsewhere in Canada and internationally in order that we put in place a system that will work well in British Columbia that is informed by experiences and best practices elsewhere. I am not in a position…. And, frankly, it would be irresponsible, as we are just embarking on the research and the investigation and the consultation of developing a plan. It would certainly be premature to talk about what changes in legislation might or might not happen as we go down that road.

J. Thornthwaite: One of the comments that I got when we were doing all of the research…. There is a very prominent alternative school on the North Shore called Mountainside. I don’t know whether or not the minister is familiar with Mountainside, but one of their concerns is the connection of what’s going on in the school.

They do have Vancouver Coastal Health services in their school, but what they were worried about is getting that connection, again, between, say, now the new Foundries — they’re obviously very pleased with the new Foundry there — and being able to get the connections between the schools and the school services.

We do know that if there is a child or a youth in a school who is seeing somebody in the school and they have to make an appointment to see somebody down the road six weeks from now at four o’clock on Tuesday, the chances of that happening are quite low.

What they had asked me at the time was if we could get some sort of connection between the school system, if that was a person or a body or a position, the school district — in this particular case, Mountainside does help and service at least two, maybe three, school districts on the North Shore — and the connection to Foundry and perhaps other services that will be popping up, these one-stop shops, in the near future.

Hon. J. Darcy: I heard a statement. I don’t think I heard a question.

J. Thornthwaite: I’m babbling on. I don’t know. My question is…. One of the challenges with having services going on here in the school, services going on here, say, at Foundry — although we are really elated that this is all moving forward very well — is that the connection between the services with the school districts…. Because Foundry is not physically connected to a school…. How will we be able to connect the services that children are getting at the school and at the school systems with the services they might be obtaining later through either Foundry or other health care providers?

[5:55 p.m.]

Hon. J. Darcy: Those questions have not been answered yet. Presumably, if they were already answered, the previous government would have acted on them already. We certainly recognize how critical it is that school districts and educators are connected — that there are more supports in schools, that they are connected to supports and services in the community and that schools and other services work in an integrated way.

One of the exciting things, when I visited Foundry on the North Shore, was there’s a suite of offices there that can be used by any of the partners. That included the school district, and I believe there was someone there from the school district when we were there. That’s certainly in the Foundry opening in Prince George. One of their partners there is the school district. That will be the case, I believe, with this model across the province.

What that looks like exactly, what that coordination looks like is what needs to be developed. Foundry is a good example of it. We need to ensure that coordination and that connection is established in building our better system for child and youth mental health across the province.

J. Thornthwaite: Carrying on with another recommendation from the committee report, one of the recommendations was to establish targets “to ensure that children, youth and young adults identified as exhibiting signs of behavioural, emotional or mental health issues are assessed within 30 days and begin receiving treatment over the next 30 days.” This is a reflection of our significantly reducing waiting lists, identification of children early, and then not only identifying them and perhaps diagnosing them but actually getting them the help within a required amount of time.

I’m wondering if the minister is in support of that, and if so, would that be, again, one of the recommendations that she would put forward for the Ministry of Education, I guess?

Hon. J. Darcy: There is no question that the waits for assessment are a very, very serious problem. I certainly hear about it in my community regularly, and I’ve certainly heard about it an awful lot since I was asked to serve as the Minister for Mental Health and Addictions.

It is heartbreaking for parents and for children to have waits that are…. I’ve heard of kids who have waited over a year to get the proper assessment, and in the meantime, their problems become more severe. They can develop into serious behavioural problems in the school. Kids can end up getting suspended from school when, frankly, being suspended from school is something that a lot of the kids who are suffering from mental illness…. They’d be happy not to be there, because it’s not an environment that’s working for them unless they get the supports they need.

We certainly recognize that early assessment is critically important. We have an objective, as the Representative for Children and Youth said, to develop a plan within a year and begin implementing a plan a year from then.

[6:00 p.m.]

The targets for assessment and for ensuring that support is in place, treatment within 30 days…. Sorry. The targets for assessment and the targets for treatment would be part of that plan.

J. Thornthwaite: Thank you for that. Then my other question is…. One of the other recommendations was to “support connectedness initiatives in schools and expand existing school-based programs that are proven effective for promoting children’s resiliency.” Is the minister familiar with the FRIENDS program, and would she be supportive of supporting those programs to be expanded in the schools?

Hon. J. Darcy: I’ve heard very good things about the FRIENDS program. I have not had the opportunity to delve into it in any depth at this stage. It’s certainly one of the things that we’ll be looking at.

We are at the beginning of this process of developing a plan and an effective strategy for child and youth mental health. We will be looking at all of the best practices in British Columbia and elsewhere as we develop that plan.

J. Thornthwaite: I’m very happy to hear that, because the FRIENDS program has been around for several years. It was fully funded by the MCFD but with partnerships with the school districts. In my personal, humble opinion, I didn’t think that it was gathered up enough in the school system. For lack of a better term, no sense in reinventing the wheel, sort of thing, to seriously investigate that.

One of the nice things about that program is that it is delivered by trained teachers to the school classroom. What that means is they’re not pinpointing individual students. It’s actually resiliency and anti-anxiety training for the entire classroom, so everybody benefits and nobody is singled out. Certainly, it would be something that I would support — more support and more promotion in a program that is basically already there. You don’t have to do anything else. Thank you for your positive comments about that.

I have another question. Is there any thought to make mental health education in schools mandatory?

Hon. J. Darcy: That’s an issue we will be discussing with the Ministry of Education.

J. Thornthwaite: And then, of course, this goes on in the same vein about making parent training and cognitive behavioural therapy support services available to all parents.

Hon. J. Darcy: At the risk of repeating myself, it’s been 12 weeks since we created this ministry and I was appointed to be the Minister for Mental Health and Addictions. Our immediate priority has been responding to overdose crisis, at the same time as beginning to put building blocks in place for a better system for mental health and addictions.

[6:05 p.m.]

We will be developing a plan for child and youth mental health over the next year, and we will be beginning to implement it a year after that. All of the recommendations that flowed from the select standing committee on child and youth mental health will be taken into consideration. As well, the experiences elsewhere in the country and internationally will be taken into account in developing that plan.

J. Thornthwaite: Recognizing that my time is running out today, I have one more question then.

Interjection.

J. Thornthwaite: Oh, two. Okay. Well, we’ll see how long the answer is. With regards to the…. Now I’ve forgotten what my question was.

Hon. J. Darcy: And I’ve forgotten my answer.

J. Thornthwaite: We can blame the Chair.

With regards to these services in the school, obviously…. What I’m hearing from you, then, is that the priority is on the opioid crisis and the current budget increases in certain health issues. But there is nothing, now, to go into early prevention and intervention for young children or children and youth in the schools.

Hon. J. Darcy: At the risk of repeating myself, the budget was presented in the House on September 10. That was six weeks after this government was sworn in. If the member actually thinks it’s possible to develop an effective child and youth mental health strategy that begins in the schools in…. The member is no doubt familiar…. You bring forward submissions to Treasury Board. Then, after that, they go forward to the budget. So the idea that a full-blown plan, including for early intervention in our schools, could be developed in that short a period of time…. We would not be doing justice to what we need to do.

There are serious, serious problems with our child and youth mental health system as it exists right now. The committee that the member opposite chaired — and the Deputy Chair, who is now the Minister of Finance — heard from people across the province. They worked very hard, and they developed a number of good recommendations.

That was a year and a half ago. A large number of those recommendations, a year and a half later, have not been implemented. So the notion that this government, six weeks after having taken office, could bring forward a full plan, first of all, and a fully costed plan for approval in a budget I don’t think does justice to how serious the problem is and to the serious work that needs to go into building a better system for child and youth mental health.

I would add that the Representative for Children and Youth did not say to the government: “Why didn’t you do this yesterday?” The Representative for Children and Youth said: “We have serious, serious problems with our existing system. We’re glad there’s been a designated ministry created. We’re glad you’re going to be working across ministries with an all-government approach to addressing this issue. We’re asking you to have a plan a year from now and begin implementing it a year after that.” And that’s what we’re going to be doing.

J. Thornthwaite: I’m certainly not expecting you to come up with a plan in 12 weeks. What I am asking is for some sort of commitment that in addition to dealing with the immediate crisis management that we all agree needs to be done with the opioid crisis, there is going to be an equal emphasis by this new government on prevention. The number one place that we want to start with prevention is when kids are little. It’s better to get them when they’re little, as you’ve indicated, as opposed to waiting and waiting and waiting, and then these issues exacerbate.

I just wanted to know whether or not there was going to be a commitment soon on increased preventative services for children in the schools.

Hon. J. Darcy: A critical part of my mandate in developing a better system for mental health and addictions is early intervention. The member will know that from reading my mandate letter. It’s early intervention. It’s prevention that starts with our kids. Absolutely, that will be a huge focus and a huge priority for our government.

[6:10 p.m.]

We know that if we do not start early with our kids, we will see many more problems develop, as we are seeing now. Very early identification of mental health issues is critical. Early support is critical.

I’ve said this at least five times already today, but I will say it again. We fully recognize that we need to increase early identification and early intervention in our schools to support our kids so that those problems do not become more severe and thwart the opportunities that our young people have for a full, happy, healthy and productive life and, also, to prevent mental illness from becoming substance use issues. So many kids end up self-medicating when they’re dealing with anxiety disorder, depression, ADHD or a variety of other conditions that we know can become far more severe.

We’re seeing the results of some of that today. We do not have the kind of system in place to support people who have developed full-blown addictions and who have now turned to street drugs that are poisoning them. That’s about an immediate response, but it’s also absolutely about putting in place the early identification, the early intervention and the early prevention. That’s an absolutely clear part of my mandate.

The Chair: As described in Standing Order 36, a member of the Committee of the Whole or the Committee of Supply should address the committee through the Chair at all times, rather than “you” and “yours.” The reason that the rule exists is to try and take the heat. We’re all passionate people. Please reflect on that so that when we come back here tomorrow, I don’t have to remind you of that again.

Hon. A. Dix: I move the committee rise, report progress and ask leave to sit again.

Motion approved.

The committee rose at 6:12 p.m.