A health summit will be held this fall in the Nishnawbe Aski Nation, a collection of remote Northern Ontario reserves beset by a youth suicide crisis and a perpetual lack of decent medical care.
Ottawa and the Ontario government announced that each will contribute $150,000 to the summit after federal Health Minister Jane Philpott, Ontario Health Minister Eric Hoskins and Alvin Fiddler, the grand chief of the Nishnawbe Aski Nation (NAN), met on Monday to discuss long-term plans for a "transformation" of the health system in NAN communities.
The trio signed a five-page "charter of relationship principles," that is intended to eventually give First Nations control over how health care is delivered in the territory, which is home to about 45,000 people spread over 49 communities.
They also agreed on an emergency action plan for Pikangikum, a fly-in reserve near the Manitoba border where four young people, including a pair of sisters, have taken their own lives this month.
The plan could see the Department of National Defence erect tents or other pop-up facilities to accommodate the hundreds of people seeking mental-health support in the community of about 2,800 people, Mr. Fiddler said.
"One of the things [front-line workers] keep saying over and over again is the need for safe space in the community for counselling to happen," Mr. Fiddler said in an interview after the meeting. "That's something that the federal government is prepared to address through the Department of Defence to ensure that they build space in the community for that work to happen."
Dr. Hoskins said Sunday that his government planned to dispatch an additional 20 counsellors to Pikangikum at a cost $1.6-million.
Right now, there is a local crisis co-ordinator and eight mental-health workers on the ground, including two counsellors sent from Fort Frances, Ont., on Friday. There are also two elders providing traditional healing support, according to a spokeswoman for Health Canada.
Before the meeting began, a group of more than 20 doctors who care for patients on the isolated reserves in Northwestern Ontario called on the federal government to find a permanent, Indigenous-led solution to the escalating health crises there.
"There is virtually no access available to child psychiatrists, child psychologists or similarly skilled therapists [on the reserves]," the physicians wrote in a letter to Dr. Philpott and Prime Minister Justin Trudeau. "Health Canada's [Non-Insured Health Benefits] program often blocks patients from accessing services out-of-community, for arbitrary administrative reasons."
The letter, signed by 23 doctors, goes on to ask that "immediate steps" be taken to ensure children in the territory get the help they need until the underlying system is fixed.
Michael Kirlew, a family doctor in Sioux Lookout, Ont., and a signatory to the letter, said in an interview that the health-care system in NAN territory needs to be "fundamentally transformed."
He travels monthly to provide medical care in Wapekeka, a small reserve about 450 kilometres northeast of Sioux Lookout, where three 12-year-old girls have died by suicide this year.
The province announced on Monday that it would spend $400,000 on more emergency supplies, youth supports and four additional mental-health counsellors for the reserve.
The federal government, in the meantime, emphasized that it has committed more than $7-million so far this year to support crisis response and mental-wellness teams in NAN territory, as well as $4.4-million for a NAN program called Choose Life, aimed at helping children and teens at risk of suicide.
Dr. Kirlew said that despite the grim state of health care in Wapekeka, he was amazed by the strength of the community on his last visit a few weeks ago.
"It's really inspiring to see that level of resilience," he said. "Because it's hard. They've lost three youth, three beautiful children in the past six months. That is incredibly tragic."
This year has been the worst in recent memory for suicides in NAN territory. At least 24 people have taken their own lives so far in 2017, the most since 2006.
Eight of the victims were between the ages of 10 and 14, the most NAN has recorded in that age bracket since it began tracking self-inflicted deaths in 1986, according to a NAN spokesperson who added that, even among the youngest victims, hanging is the most common method of suicide.
The rash of suicides has drawn attention to the underlying problems on the remote reserves, including entrenched poverty, opioid abuse, unsafe drinking water, dilapidated housing and an overly bureaucratic health-care system.
Mr. Fiddler declared a public-health emergency in February, 2016, a move he hoped would force the federal government to provide clean drinking water and respond to a 2015 federal auditor-general's report that highlighted shocking shortcomings at the nursing stations on reserves in Northern Ontario and Manitoba.