In Attawapiskat, failed mental-health project a tale of waste

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Three years before Attawapiskat First Nation was hit with its latest suicide crisis, the regional health authority that serves the community launched a federally funded suicide-prevention project – an $800,000 mental-health initiative that fell far short of the ambitious vision declared at the outset.

The Weeneebayko Area Health Authority's two-year project began in April, 2013, and was supposed to harmonize existing but fragmented mental-health services, enhance local access to care, and coordinate "overlapping" services across six predominantly indigenous communities, according to a description of the project contained in a Weeneebayko document.

In the end, the health authority said, the project resulted in a contact list of service providers in the region, the adaptation of an existing suicide risk-assessment tool to make it culturally relevant, two suicide-intervention training sessions for front-line workers, and what one of the project evaluators described as "intangibles," such as raising awareness.

"At least something came out of it," said Deborah Hill, the Weeneebayko authority's vice-president of patient services and chief nursing executive. She said the People's Strength in Mental Health and Wellness project got "sidetracked" after what she described as the sudden departure in mid-2014 of her predecessor, Rachel Cull, who was the initial team lead.

Ms. Cull, now the executive director at the Misiway Milopemahtesewin Community Health Centre in Timmins, Ont., said she could not speak to the outcomes of the project because she was not there when it concluded. It is unclear how the $800,000 was spent, but Ms. Cull said some of the money went toward travel expenses and salaries for two project positions.

The urgent need for better mental-health services in Northern Ontario's James Bay coastal region was explicitly laid out in the health authority's 2014 Request For Proposal, which solicited bids for the evaluation of the project. "The impact on the families in the Weeneebayko region has been devastating," the document says. "This devastation is demonstrated through the loss of youth and adults to suicides, tragic deaths and chronic disease prevalent in epidemic proportions."

In Attawapiskat, the devastation continues. The community declared a state of emergency on April 9 after 11 people – 10 of them youth – attempted suicide that Saturday alone. Two days later, police thwarted what they believed to be a suicide pact. At least 18 additional mental-health workers have been deployed into the typically resource-strapped community of about 2,000. At the same time, youth were being airlifted to urban centres for further treatment.

The tragic news has underscored the challenges of providing adequate health services in the country's remote north, let alone in a region that has undergone a health-care restructuring and is working through the growing pains.

The People's Strength project was funded through Health Canada's now-defunct Health Services Integration Fund, which was aimed at improving health-care delivery to First Nation and Inuit peoples. A December, 2014, update posted on the Weeneebayko website said the project team – by then led by the manager of the authority's mental health and addictions program – had done the following: conducted interviews with providers in the communities and created a "resource map" of services; crafted the culturally relevant suicide risk-assessment tool, which was slated for piloting in January of 2015; and held a suicide-intervention training session for front-line workers, with a second one planned for January of 2015.

Ms. Hill, who took on her position in January of 2015, said the pilot of the risk-assessment tool went well but that the tool has not yet been as widely distributed as she would like (it is currently being used in Attawapiskat). She said there remains a need to improve the coordination of services so that, for example, providers with waiting lists are aware of openings elsewhere. Ms. Cull, for her part, said she had envisioned the project culminating in "more formal pathways to service." She also said that bringing people together to talk about suicide prevention was a "huge accomplishment on its own."

In mid-2014, two consultants were hired to evaluate the project, with their work set to begin in September of that year. The evaluation work laid out in the Request For Proposal was different from that described in the actual contract because elements of the project had been scaled back, consultant Mariette Sutherland said.

She said the idea that there was overlap of services – that there were "people falling over each other" doing the same work – was "wishful thinking" to begin with. She also said the piecemeal, unpredictable nature of government funding presents a continuing challenge. "A project like this one, which was very worthwhile, which really, really could spell the difference and do some important things, was stymied by … that feeling that it's not [going to be] given the necessary, long-term strategic focus that's needed," Ms. Sutherland said. "That's a problem."

In 2010, as a result of tri-partite negotiations between local leaders, Health Canada and the Ontario Health Ministry, a provincial and a federal hospital were merged and integrated into the new Weeneebayko authority. The move was meant to improve co-ordination and enhance the cultural appropriateness of health-care services.

Health Canada provides $12-million annually to the regional authority and, in the case of Attawapiskat, provides roughly $1.2-million each year for community-based health programs, including for mental health and wellness. Provincial ministries, such as health and child services, also fund mental-health supports in the region, some of which are delivered by indigenous organizations.

"It's hard enough when you have one funder, to try and co-ordinate things, let alone that many," Ms. Hill said. "This is going to need, I think, higher-up ministry involvement on bringing the collective funds together … That goes directly in the face of First Nations wanting to be autonomous. There are a lot of political land mines and feet you're going to step on to try and integrate this."

The results of a recent five-year evaluation and operational review of the integration are not yet public, but Health Canada assistant deputy minister Keith Conn told The Globe that, "collectively, we need to look at a more solid financial regime going forward."

As for Attawpiskat, its only full-time, provincially funded mental-health worker starts on Monday; the position had sat vacant for many months, in part because of a housing shortage. The local hospital was also operating for several months without a director of patient care – a critical position that was recently filled. The director is scheduled to start May 16.