From Monday’s candidates forum on mental health and substance use care.

Although the virtual format didn’t allow for the kind of back and forth debate typical of a pre-election panel, candidates representing all three major political parties in Nova Scotia shared their party platforms and ideas on creating better access to mental health and substance use care.

Hosted by the Nova Scotia College of Social Workers (NSCSS) in partnership with the Canadian Mental Health Association (CMHA) Halifax-Dartmouth branch and the Canadian Mental Health Association Nova Scotia Division, the Monday afternoon panel was moderated by Sean Ponnambalam, CMHA Halifax-Dartmouth chairperson.

“There’s a high need for mental health and substance abuse care in Nova Scotia as we emerge from the COVID-19 pandemic, which has shaken our society and pointed to some of the deep structural inequities that have existed for decades now, that of course were made very obvious during the pandemic,” NSCSS executive director Alec Stratford said before introducing Ponnambalam.

“We’ve also seen rising rates of anxiety and depression among Nova Scotians, some of the highest in the country. And of course, we’ve seen long calls for reform from both our Black and Indigenous community members for systemic reform to address the colonial and racist policies that continue to harm and impact both mental wellbeing and care.”

The candidates participating in the event included Claudia Chender representing the NDP in Dartmouth South, Zach Churchill representing the Liberals in Yarmouth, and Brian Comer representing the Progressive Conservatives in Cape Breton East.

Churchill, minister of Health and Wellness, was the first to offer opening remarks. He said mental health and substance use care has been a priority for him and his legislative colleagues for a number of years. He argued that the Liberal government has made important progress on a few fronts, including youth access and wait times, and that they have a plan to further create more access points and provide people with the support they need when and where they need it.

Zach Churchill during Monday’s candidates forum on mental health and substance use care.

“We have been very focussed in this space,” he told the audience, pointing to three primary areas of focus for the past Liberal government.

Those included: increased supports for Nova Scotia’s youth who experienced a “pretty serious, demonstrable increase” in anxiety and mental health challenges; increasing access points for mental health in the province; and dealing with “really troubling” wait times to access support for non-urgent mental health needs.

“Where the bulk of the pressure has really developed has been on the tier two, the non-urgent side, so that has been a policy focus for us,” Churchill said.

“In our schools, we’re very proud of the fact that we have infused close to 400 new supports into our education system, from child and youth care practitioners to autism behavioural specialists to school psychologists, all geared to provide a better wraparound support network for our students.”

On the subject of creating more access points, Churchill said COVID-19 pushed them to use technology to “hopefully reach” its full potential by expanding e-mental health support over the last year especially.

“We know that mental health issues can’t be viewed in isolation of our broader health challenges,” Churchill said.

“Oftentimes, we have addictions issues as well as other health issues that are impacting mental health as well as social determinants and finances. We are bringing in addiction management hubs to every single zone in the province.”

While currently in the development stage, he said they’ll be available for both inpatient and outpatient supports for those suffering with addiction. They’re also “very close to procuring” sexual assault and trauma therapy services that will be available in every provincial health zone.

Churchill said they’re also looking at province-wide mental health walk-in clinics and mobile units staffed by mental health clinicians and nurses. He also said there has been a “pretty drastic” decrease in wait times, especially in Cape Breton where non-urgent mental health support wait times went from close to a year to a median of “about 28 days.”

“For urgent care, the wait time has been brought down to a medium of three days, so we have seen some demonstrable improvements to the wait times,” Churchill said.

“And of course that does need to continue. We have hired (Dr.) Sam Hickcox (chief officer for the recently created Office of Mental Health and Addictions)…and we have seen the benefits of leaning on clinical advice and expertise in the Department of Health.”

Comer was next to speak. He left a position as a registered nurse working in mental health and addictions to become an MLA. He said there are three key issues he’s been pushing with his PC colleagues since he was sworn in following a by-election.

Brian Comer during Monday’s candidates forum on mental health and substance use care.

“The first is parity, basically that mental health should be treated the same as physical health, which right now in Nova Scotia, basically across our country it isn’t, unfortunately,” Comer said, pointing to the most recent provincial budget having allocated about 6% funding for mental health rather than the World Health Organization’s recommended 10%

Comer also said the province has two types of care — publicly funded with long wait times and scare resources and burned out staff, and a private system only a handful can afford on a continual basis to resolve their mental health and addiction issues.

“Speaking from a Cape Breton perspective, there’s already been some preliminary data out that in the spring alone there’s been a 60% increase of urgent and crisis mental health calls here and appearances to our crisis department here at the emergency room,” Comer said.

Addressing social determinants of health, Comer pointed out that close to 10% of Nova Scotians don’t have access to a family doctor and that one in three Cape Breton children is living in poverty.

“It’s why I did present legislation last year to try to put something in place to provide a foundation to address this very critical issue…and work very closely, especially with African Nova Scotians, with First Nations groups, with newcomers to our province, who are disproportionately impacted by these poverty rates across our province,” Comer said.

Comer highlighted the urgency for more preventative work, something he described as critical with mental health and addiction use as the majority of issues are identified before the age of 25,

“We have a system currently where during a crisis you go to the E.R., you wait hours and hours and sometimes you don’t get seen and sometimes you do, and oftentimes you don’t get the follow up care that you need for your issue,” Comer said.

“So we need a significant shift and a focus to community-based prevention, in my opinion, especially with the 25 and under cohort, which oftentimes the earlier you can get this in a proactive manner the more positive the future life of these of Nova Scotians would be.”

Speaking about Cape Breton specifically, Comer described “significant issues” with a lack of resources with pediatric and geriatric populations.

“I think it’s critical that we do have a portfolio dedicated to mental health and addictions to create this accountability that someone’s responsible for wait times, that we know how many suicide attempts happened in the province last year, which we don’t,” Comer said.

“I mean, these are the sort of things that we need to know to improve our system.”
Comer also wants to see a three-digit crisis line number, “because a 10-digit crisis line is not sufficient when seconds do matter.”

Chender was the last to make opening remarks. She said mental health is health but we don’t treat it that way, something that became clearer in the wake of the pandemic. She said when looking at social determinants of health we need to look at primary care but also housing and education.

She pointed to a 2012 plan by the then-NDP government to create the first comprehensive mental health care plan for Nova Scotia, scrapped by the Liberal government when elected in 2013.

Claudia Chender during Monday’s candidates forum on mental health and substance use care.

“And subsequently, I think that notwithstanding comments about some expansion and attention to mental health and mental health supports, based on my view as an MLA, I can just say that the supports, at least in my community, which statistically has better support than some of the others are, are awful, frankly,” Chender said, noting she’s heard stories from many people struggling to find help.

Chender said the core issue, also identified by Churchill and Comer, is access.

“We do have a two-tier system here in Nova Scotia when it comes to mental health care, and actually, even if you can afford to pay, it’s difficult to access immediate care,” Chender said.

“But if you can’t afford to pay, the wait lists are simply unacceptable.”

The NDP platform, Chender said, is centred around a mental health bill of rights where people are treated with dignity and respect and entitled to prompt and appropriate treatment. Alluding to Comer’s comment that the health care budget has funding to the tune of 6% set aside for mental health, Chender noted we’re currently at 4%,

“Most provinces have not achieved that 10% goal, but we’re in the bottom of the pack,” she said, adding that if elected, the NDP would establish same day/next day mental health clinics and emergency health teams to respond to those in crisis provincewide. She also pointed to the need for more appropriate professionals, from social workers to psychologists, psychiatrists, and others who can help people in crisis.

Chender also addressed the need to destigmatize substance use disorder, beginning with the language we use. She said while the use of opioids and benzodiazepines, alcohol and other addictive substances are on the rise, our responses do not meet the scale of the challenge.

“For both mental health and substance use disorders, we need an integrated approach,” she said, advocating for the need to have a rapid, easily accessible way for people to access wraparound care.

“From where I sit four and a half years into elected office..the government just hasn’t done enough. People are falling through the cracks,” Chender said. “We have a compassionate, achievable plan to address this.”

Question 1:

Since the onset of COVID-19, we’re seeing an increasing the increasing amount of substance use really across the spectrum and at the same time we’ve seen some closure of 24/7 detox beds across the province and many NSHA staff are being pulled towards mental health services rather than addictions, which is understandable. How will your party approach substance use issues in Nova Scotia?

COMER:

Substance use disorders, whether you’re talking about alcohol or cocaine or various illicit substances, it’s a significant issue pre-COVID. I think now that we’re kind of coming, hopefully knock on wood, towards the tail end, we’re starting to see a little bit of an exponential increase in substance use across our province.

I think in Cape Breton specifically, where I’m most familiar with…typically people would be looking to get into beds, weeks, if not months, waiting to get inpatient treatment…and people don’t get necessary medical treatment to safely detox, especially from alcohol.

I think a significant component that I would like to focus on would be community-based treatment models to try to identify these individuals that need assistance before they got to the acute acute stage. I know oftentimes, too, you need those wraparound supports when you discharge somebody from an inpatient addiction setting in order just to ensure they have proper follow up.

I know in Cape Breton, for example, there’s a shortage of clinical therapists, for example, many who are unable to continue with their workload because it’s too significant and actually stressing out the staff to the point where they can’t do their job. So I think a big part of this is to attract appropriate health care providers that can provide the proper care at the proper time.

CHENDER:

Not only is the wait for detox long, but those detox beds are seven days and then you get released back out into the community, and this is a little bit of the integrated care piece that I was pointing to in my opening remarks. We need a spectrum of care for folks, particularly folks with substance use disorders.

I think there are different approaches. I think we definitely need community-based approaches. I think we need to look at safe supply. I think we need to look at harm reduction, and I do think we need to look at support for abstinence-based programmes.
I spoke with someone yesterday who felt that after several failed tries, they needed a longer abstinence-based detox programme. And she said, ‘Well, luckily, my mom had enough credit that she could take out another mortgage and get the $20,000 that it cost.

Twenty thousand dollars that someone has to pay just to access the most vital care that they need to be able to help themselves? This is someone who wants to help themself, and so we are just not providing the resources necessary. I do think it does on some level come back to a real wraparound approach and taking into account the social determinants of health. But when we get to that crisis stage, we need to have the supports available that people need.

CHURCHILL:

Obviously, this has become a bigger pressure on the system, particularly over the last year. Just looking at the central intake line, the crisis line that we did bring in, there was a 35% increase in need addressed through that service, which we did respond to with more clinicians being available on that. We responded proportionally with 35% more resources.

But there is a challenge right now in terms of finding certain professions in the field of mental health, even staff positions right now, particularly in psychology and psychiatry. Every province is dealing with that pressure right now, not being able to necessarily find the people that you need to fill these positions. So that does remain a challenge.
There has been an expansion of addiction services, particularly for those on opioids. That was a focus I know in our first term.

The plan we have right now to increase access is through the management hubs. These are going to be located in every single health zone in the province. This will be for inpatient and outpatient support, and in speaking with folks from from from this field and the Department of Health, there has been a shift to a greater focus on outpatient support as opposed to inpatient support, with the exception of those dealing with severe, severe alcoholism, where it’s literally life and death and the inpatient detox support is critical.

But the folks I’ve been talking to in that field have shifted their idea to having a more outpatient focus based on the potential for success rates. So getting people used to the triggers that are around them in their community, because as we all know, once someone comes out of detox, they’re then surrounded by all the potential triggers again and friends and stressors that have maybe contributed to their addiction to begin with. And so there has been a shift in approach here from strictly inpatient support to focussing more on helping those individuals cope and manage their addiction back in their home communities.

That has been a shift that I do believe can help us be more successful with this. And I believe with bringing these management hubs in and mental health walk-in clinics, that is going to take off some of the pressure that people are experiencing. Having peer to peer support organizations. We have a lot of good local organizations too that do really good work in their communities to help individuals. They’re on the ground, they know the folks that are struggling.

And we had a focus on providing some grants and support to those individuals that are doing addictions, support peer to peer addiction, support in their communities, as well as everything from helping people find shelter as well. There’s a variety of local organizations that we’ve partnered with to provide more robust supports locally as well.

There’s still a lot of work to do here, we know that. I’m very excited to get these management hubs in place to see how successful they’re going to be. And we are in the design phase of that but this will be rolling out in the not too distant future.

Question 2:

How would your party address the social determinants of mental health and what role do you see for the provincial government to play in pharmacare coverage more broadly?

CHENDER:

This is really where we focus as a party, so we believe that the core job of Nova Scotia’s government is to take care of its citizens, and as such, we need to address those social determinants of health head on. Often they are regarded as a cost centre, that’s how we hear them spoken about in legislative circles often. But they’re not. They’re an investment in humans and they’re an investment that pays dividends, in fact, in lots of ways, including economic. We know the dark side of not addressing these problems. But there’s a good news story on the other side when we do.

Our platform is focussed on alleviating poverty. That includes increasing the minimum wage. That includes ensuring that housing is treated as a human right, that everyone has a place to live, that rent control is not going to expire with the state of emergency, that we’re not going to face an even deepening eviction crisis when that happens, that we can create genuinely non-market, affordable housing.

It’s very difficult for someone to attend to any aspect of their health if they’re not housed and there’s much more, child care, etc. I could go on and on to the question of pharmacare. We absolutely support a national pharmacare program which our federal sisters…have been doggedly promoting. We’ve also been promoting this at the provincial level and have introduced legislation concurrent with that.

We’ve also announced that we would increase income assistance. We saw income assistance rates raised in this last budget, and we would do that again because as with wages currently, there are so many Nova Scotians who cannot afford to pay rent and feed themselves. And if you cannot afford those basic fundamentals of life, which also we could call the social determinants of health, then you cannot be expected to take care of much else, and that’s where the core of our focus is.

CHURCHILL:

We are working with the national government on a national pharmacare program. Nova Scotia is one of the provinces that is supporting this. Not all provinces are, particularly in the Conservative-held provinces of Ontario and Quebec for other reasons, as well as Alberta. They are holding back on this, but we are fully committed to this. We’ve committed to it publicly and have offered to work on the working group with the federal government as well to get this over the finish line.

On the social determinants of health, of course, poverty is a big major contributing factor to mental health challenges. It is linked to addictions and life outcomes. We have gone from having one of the highest child poverty rates in the country to reducing that significantly over the last number of years, which is really, I think, something that we can be proud of here in Nova Scotia. A big part of that was the partnership we’ve had with the federal government to enhance the support for families with children, and we are seeing some benefits of that right now.

But there’s some other provincial things that we’ve done, I think, that are contributing in this regard as well in a positive way. One is bringing in Nova Scotia’s first universal free pre-primary programme, which is accessible to every single family now in Nova Scotia. We all know how critical early learning is for not just academic outcomes, but for social outcomes as well. And we now have universal access. Sixty one hundred four year olds are in that program now. Before this program, only one in four of our of our pre-school age kids were accessing early learning. Of course the impacts that this has on a family budget, now that I have two kids and they’re in child care, I have a greater appreciation for the cost associated with that.

So having this option available, enhancing the affordability of our regulated child care space to partnering with the federal government to have $10 a day child care for Nova Scotians, this is all going to help families do a better job making ends meet. It’s going to help single parents get back into the workforce. And the social outcomes that these investments in our young people and our families are going to have, I think are going to be pretty profound on our society and are already actually impacting outcomes for our kids. The cohorts of students that we have that have come from pre-primary that are entering elementary school, according to the statistics, are already performing better in primary academically. They’re showing better emotional and behavioural control in our classrooms, and it is giving them the foundation to be successful in life and not just in school. I think that’s where we’re just starting to see the tip of the iceberg on the impacts that that program is going to have on our society.

Housing, of course, is critical. We do incentivize affordable housing development. We are seeing projects being worked on right now in partnership with the private sector to build new affordable housing units. Supply is the big issue here. That’s why I really do worry about policies like rent control, even though we have that in place for the last year, because that can impact supply and investment in that space. But we have to provide grants for developers who want to retrofit or build new housing spaces to increase supply.

We also have a rebate on the HST of the provincial portion because the housing pressure that we’re experiencing right now in the province, it is a crisis for certain people for sure. It can’t just be dealt with by government alone. We do need to have some market-based solutions to this as well, and our plan is continuing to partner with those that do the building of these spaces and work with municipalities on inclusionary zoning as well to ensure that we are building up that supply that we desperately need here.

COMER:

Addressing the social determinants of health starting off, I think the childhood poverty rate is still the highest in Atlantic Canada and it’s actually the third highest in the country. So I personally do believe that it needs to be legislated in our province, specifically focussing on poverty reduction and healthy childhood development. Or the provincial government would work with federal and municipal counterparts to develop a cohesive strategy with our First Nations communities, with our African Nova Scotia communities, with vulnerable sectors of the population.

These five-year targets would be reviewed annually in the Legislature, so it’d be very public, very transparent, and very quantitative. You could see if what you’re doing is working or if it isn’t, it’s pretty straightforward. In regards to pharmacare, it’s been painfully slow, not just for mental health medications in Nova Scotia, but across the country. It’s ridiculous, to be honest, that some of these medications, especially the newer medications which predominantly are in the field of mental health and addictions aren’t approved and oftentimes they can be non-formulary medications that families simply can’t afford.

They don’t have the physicians. They can’t get their paperwork filled out to even apply to get the medications, and then you get the same old run-around…So I think there needs to be significant effort to be especially focussed on this. And you can’t deal with child poverty without dealing with housing, without dealing with primary health care, without dealing with your culture. I mean, these things are interrelated and there needs to be a conversation started to focus on this.

Question 3:

There are specific challenges that face historically marginalized communities in Nova Scotia. Indigenous communities are continuously reminded of the destructive legacy of residential schools as more and more bodies are discovered across the country. Black Nova Scotians have known for years that they were discriminated against by police, a belief that was validated by the street checks report that came a couple of years ago, and they’ve suffered further indignities from institutions like the Home for Colored Children. How does your party support the specific mental health needs of black and indigenous communities?

COMER:

First and foremost, you have to consult thoroughly with these communities, with their community leadership, and actually go to meet with these people, discuss the key issues with them, let them guide your modality treatment. I think for far too long, a lot of these specific populations have been told what to do instead of being part of the process. I think they should be thoroughly engaged.

There should be community consultation, and I think there should actually be working groups within each community in our province, because what works in Eskasoni may not work in Dartmouth that may not work in Yarmouth. There’s significant differences and challenges that are unique to each community setting. So I think you have to really engage with the community leadership in these groups.

I do think that the conversation surrounding the social determinants of health would promote these conversations not just for mental health, but also for physical health and spiritual health I think in these communities, and I think this would be a significant foundational starting point on where to start to improve this in our province.

CHENDER:

That’s a big question to answer in two minutes, but I will say that I think that African Nova Scotian and Indigenous communities and other marginalized communities who have been actively marginalized have every reason to distrust government and government initiatives, and I have to say that I don’t actually think that consultation per se is the answer anymore.

I think that these are incredibly resilient communities (who in) many cases have come up with solutions for themselves. I think we’ve seen this with the African Nova Scotian community. The (African Nova Scotian Decade for People of African Descent Coalition) has done incredible work developing the African Nova Scotian Justice Institute, which after years and years of advocacy and frankly, being ignored, is finally looking like it may come to fruition. You mentioned the street checks report. We still have yet to see all of the recommendations from that report be accepted and activated by the government.

I think First Nations, again, have incredible resiliency and capacity. So I think I mentioned Eskasoni as one example of a community-based, integrated approach to mental health care. They are a pilot. They’re doing things their own way. All they need is for us to support that. Similarly, we could immediately implement the Truth and Reconciliation Commission’s calls to action for provincial governments. We’ve introduced legislation to that effect. That’s the foundation.

Beyond that, we can direct our attention and our funding to projects that can support that and that can create better understanding. In my own constituency, the Dartmouth General Foundation has done some amazing work around funding great research projects with incredible clinicians around health equity and access to health equity. Those are the kinds of things the government can fund and support.

But in many ways, I think what government needs to do is listen, see what capacity exists in communities, see what solutions exist in communities, get out of the way if needed, and support where asked, and we are absolutely ready to do that.

CHURCHILL:

One of the best speeches I ever heard in the legislature was from my colleague, Minister Tony Ince, speaking about this very issue. And he said what our community doesn’t need is someone telling us what to do, what we need are allies. And that’s certainly something that we have, I think, demonstrably done in many respects as a government. From providing a path of discovery and reconciliation and healing for the Home for Colored Children survivors, which was against every single legal advice that came in from from provincial lawyers but ended up being, I think, a great model for reconciliation and for addressing these painful issues together in the country, and others are looking at that, to creating the first Indigenous court in Cape Breton, whereby people are prosecuted and able to defend themselves in a more culturally responsive way.

I think those two things are great achievements that we’ve had as a government, in terms of partnership that are having, I think, and have had a very real impact on the lives of people when it comes to health.

We’ve had some good partnerships as well from partnering with the Mi’kmaq and our African Nova Scotia communities to have specific vaccination programs rolled out in those communities. (That) has been really part of our equitable access for vaccinations, and also having disaggregated race-based data so that we have a better understanding of what’s happening in our system, to whom, so that we can better and more properly respond from a policy and investment perspective are very key. And that is something that we did announce, I believe, a number of months ago.

Question 4:

Measuring wait times is important, but the ability of our system to move people quickly in and out doesn’t tell us if the mental health of our community has been improved. Measuring outcomes is critical. How would your party ensure the outcomes of treatment are monitored and improved?

CHURCHILL:

We really started this in our schools, and having wellness outcomes for our young people is absolutely critical to evaluating how well we’re doing and if the dollars we’re spending–which are scarce and which are limited–are having the desired impact that we want them to have.

So we have built these outcomes as part of what’s reported in our school system, and that allows us to better track how our systems are working. I think we have a model there that can be expanded to the broader public as well.

And having disaggregated data as part of our framework so that we have a better sense of what’s happening is absolutely key. If we’re not following the evidence, if we’re not following the data, we are bound to make the wrong decisions. Oftentimes in politics, you’re always responding to political pressure, and the hardest thing to do is to not pay attention to that and actually stay focussed on on what the facts are telling you. This is absolutely key to measuring our success and ensuring that we’re making progress in the right ways.

COMER:

When I think of outcomes I think of metrics, right? I think there’s a real lack of metrics in the province right now. For example, how many children the public school system last year needed a mental health referral? What’s the current wait time for children to see a psychologist in this public school system? It’s extensive, right? How many Nova Scotians went to the emergency room last year and left for mental health reasons that didn’t get seen?

These are the sort of questions we have to think about when we’re developing policy and implementation. I think even if you look at something like suicide attempts last year in the province, how many were there? I don’t know. These are the sort of questions we need to start to look at to answer to modify our policies in order to understand if they’re actually making a difference. I think there needs to be a significant focus on empirical data on an annual basis to see if the interventions that you’re using are actually working.

CHENDER:

I would certainly concur with my colleagues that measurement is important. There’s no question. But how do we measure if we’re not following people? This goes back to the conversation around integrated services. It’s not a ‘one and done’ situation where you have an appointment or you have an intervention and then everything is fine.

There’s a spectrum of response, and for some, hopefully that’s quite quick, and for many it’s not. Until we have that appropriate spectrum, we probably can’t measure. Those two things have to go hand in hand, where we know that people who require access to mental health care, access to treatments for substance use disorder, are being cared for, are being connected to either government or government partners, or community organizations that are able to attend to those needs.

That’s where we collect data, and so I think those two approaches need to go hand in hand. But I certainly do agree that we do need things to measure. But kind of a reminder that human lives are messy and sticky and hard to measure, so there are some things that we can measure and then there are some things that we need to attend to, maybe without the perfect measurement, just because we know that they are issues.

I’m not in the back rooms and I’m not in Treasury Board making these funding decisions, but I would suspect that this has been a barrier actually to appropriate funding to mental health care. We can’t measure it like we measure a broken knee or a fractured something or other. It happens and then it gets fixed and then you go to rehab and then you’re done. It might not work that way. And so we do need to find ways to measure it, but we also need to believe these first voices and the unfortunate statistics that we do have and attend anyway.

Question 5:

By our nature, we’re social beings with biological, psychological and social components comprising the whole person. How would your government make changes to our health care that emphasise the social component of healing and recovery?

CHENDER:

I think it is connected to the last question. So I think one of the things that we’ve talked about in health care generally, but also in mental health care and emergency mental health care is the idea of having big appropriate interdisciplinary teams that can really connect with people where they are and help people.

We have a huge primary care issue in this province. We have for the last eight years, we have 72,000 people without primary care. But if we can expand those teams, if we can have more nurse practitioners, maybe more physician assistants and other professionals that we’ve talked about, people can work to their scope, but patients can have that human connection and can feel that they’re being embraced by a health care team.

I think the same is true in the mental health context with this integrated care model where we have social workers and we have psychologists and we have all kinds of folks who have expertise in attending to people in crisis or experiencing trauma or challenge and can be met in that way as opposed to being funnelled into a very long wait to connect once with a specific professional who may or may not be able to attend to their needs.

We need to take a more expansive approach to what does health care mean and what are the access points into that system and how can we connect them together. As an elected official, one of the great frustrations, particularly as an opposition member–and it’s a systemic problem in all governments–is that we have such a siloed approach. We don’t connect our resources to each other, we don’t connect them to the person who’s using them, and we really need to change that. I think that’s the root of this question, how do we wrap the services we have around a person in a seamless and compassionate way? We need to shift our views so that that’s the goal, that that’s the approach.

CHURCHILL:

There is a big pressure that is there in our primary care system, and part of that is because family physicians are practicing very differently than they did previously. So where previously you have a doctor taking 3,000 to 5,000 patients on a fee for service model, you now have… doctors that are taking 300 to 500 patients and that does create additional pressure on our system.

We’ve actually done very well with doctor recruitment, but that challenge also gives us a great opportunity to really look at how we do collaborative practice in Nova Scotia and we have not reached the potential of what our collaborative care clinics and what collaborative care practices can look like. That’s where a physician is working with other health care professionals, nurse practitioners, potentially allied health care professionals as well to provide a more robust wraparound model of care to their patients. They’ll be able to take more patients on that way.

We are working with Doctors Nova Scotia right now on a different pay model that will incentivize this sort of practice and make it economical for the doctor and make it better for the patient as well. We do have increased pressure on our primary care system also because our population is growing really rapidly, 30% of people on that ‘need a doctor’ waitlist are new to the community that they’re living in.

We are benefiting from population growth and people looking at Nova Scotia as one of the safest places to be in the world and are moving here in a fashion that we haven’t seen before. And this was unanticipated, so that is putting additional pressure on our primary care system. But by utilizing our tools that we have in place, like virtual care, this is going to help provide better access points as well.

We’ve expanded scope of practice for pharmacists, we’ve doubled the amount of nurse practitioners we have in Nova Scotia, we are doing a better job connecting what are siloed departments in government to provide more collaborative and robust wraparound care for people in our schools, to people in our health care system, people in our justice system.

But we are really just getting to a point where we can fully look at a potentially newer and better model for primary care delivery that can incorporate social components into a person’s primary care as well.

COMER:

From a primary health care perspective…we’re talking about almost 50,000 people that don’t have access to primary health care. Something that probably doesn’t get talked about enough is health promotion, especially in our school system with our children. Things like sleep hygiene, things like healthy food, healthy breakfast, things like exercise. These sorts of incentives for young children to be active and develop these habits at a young age is absolutely critical.

There’s something else I’d like to touch on…the importance of peer support. I think in people with lived experience. I was lucky to be part of a pilot project out here in Cape Breton…that had tremendous success on patient outcomes. People seeking treatment are often more responsive to people with lived experience in their dialogue in the clinical setting, for sure.

Something else I’d like to talk about is stigma, something that I would be advocating for not only with my own colleagues (is) extensive effort for stigma reduction both at the federal and provincial levels. Significant research (shows) that stigma often delays seeking treatment, which leads to significant adverse health outcomes. Because of stigma (people) won’t even go to the hospital, they won’t tell a friend..they’ll just kind of suffer in silence, which is unfortunate. That is something that I personally will continue to work for.


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Yvette d'Entremont

Yvette d’Entremont is a bilingual (English/French) journalist and editor, covering the COVID-19 pandemic and health issues. Twitter @ydentremont

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