HALIFAX, TUESDAY, APRIL 19, 2022

 

SUBCOMMITTEE OF THE WHOLE ON SUPPLY

 

3:56 P.M.

 

CHAIR

Dave Ritcey

 

 

THE CHAIR: Order. The Subcommittee of the Whole on Supply will come to order. It’s now 3:56 p.m. The subcommittee is continuing to meet to consider the Estimates for the Office of Addictions and Mental Health as outlined in Resolution No. E27.

 

From our last meeting, we had some time remaining for the NDP caucus for questions on Estimates to the minister. I will now pass it to the member for Halifax Citadel-Sable Island, and it’s now 3:57 p.m.

 

LISA LACHANCE: Thank you, minister, for being back. My understanding was that perhaps I’m going to ask some Communications Nova Scotia questions, and then go back to mental health. Does that fit with the minister’s understanding?

 

THE CHAIR: The honourable minister for Addictions and Mental Health.

 

HON. BRIAN COMER: That’s okay if the member does that. I’ll just await the first question.

 

LISA LACHANCE: We’ve had some conversation about this in the House, and I’m wondering if we could go back over it. The Let’s Get Back Out There campaign - how was that developed? Was Public Health involved? What was the cost? What are the metrics that you’re using to evaluate its success?

 

BRIAN COMER: The total cost was $101,200. The campaign just ended, so there will be an analysis that will be completed in the next little bit. Some of the analysis will include metrics for social media, other platforms. Public Health was aware of the campaign. The actual campaign itself would be from the Minister of Economic Development, so specific questions about that would be for that department.

 

[4:00 p.m.]

 

LISA LACHANCE: I also want to touch base on a current campaign that’s being run - the Help Wanted campaign for workers. I’m wondering if there was an equity analysis done of that campaign, how much is budgeted for the campaign, and how impact will be assessed.

 

BRIAN COMER: I think what the honourable member is referring to was the skilled and health care workers recruitment campaign. The primary goal was to attract skilled trades workers and health care professionals living in Canada to relocate to work in Nova Scotia by highlighting opportunities like lifestyle and other aspects of the province. The total cost was $2.5 million, which is broken down into creative development production, media agency fees, social media management, and microsite development.

 

I think in regard to the equity piece, that would be a conversation for the Minister of Labour, Skills and Immigration, as the program is being facilitated through that department.

 

LISA LACHANCE: I am aware of how Communications Nova Scotia works within the Nova Scotia government, and I know that there are standards that are followed. Is there an equity analysis that CNS does with regard to its stock images, its video images, and how it portrays Nova Scotia in the world?

 

BRIAN COMER: There have been significant conversations with CNS with diverse groups across the province in the past. There’s much more work that needs to be done on this aspect specifically. There’s pretty significant engagement taking place now, and it will be continuing forward as we move along.

 

LISA LACHANCE: That’s great to hear that that work is ongoing. I will say that description of the work was relatively obtuse, so I wonder if you can be a little bit more specific. I’m aware of some of the work that was done a long time ago in 2009-10 around diversity. In fact, I think I might have done some photos for those - anyway, whatever.

 

My question is about what communities - what’s the goal, what’s the timeline? Is it a project that has a project charter in terms of updating our understanding of how they represent Nova Scotia? What’s the goal here? What do you anticipate creating?

 

BRIAN COMER: If it’s okay with the member, maybe I’ll just use an example that I think may be helpful. I’ll just use the pandemic, I guess, as the most recent significant example to highlight some of the great work done by the department.

 

Communications Nova Scotia worked with really important partners across the province throughout the pandemic to make sure that important Public Health information was reaching those communities in an equitable fashion. Just a few partners that we’ve developed good working relationships with that have been really noticeable over the last couple of years are the Association of Black Social Workers, the Health Association of African Canadians, the Mi’kmaw Health and Wellness Authority, the Mi’kmaq Native Friendship Centre, many Muslim community leaders.

 

There was a situation also where CNS staff were part of the COVID-19 working group, which was led by the Association of Black Social Workers and the Health Association of African Canadians. This group had significant input on COVID-19 communication products using Afrocentric designs, just to give you an example. I think the effectiveness of these products was actually recognised by other jurisdictions across the country. I think Ontario did request to use similar designs in their communications as well.

 

Something else I think is noteworthy is Public Health guidelines were translated into multiple languages, including Mi’kmaq, Arabic, simplified Chinese, Oromo, Somali, as well as French, significantly increasing our reach to make sure that Nova Scotians are getting accurate and up-to-date information.

 

LISA LACHANCE: That’s very helpful to have specific examples. The question is: Is that type of work codified anywhere? How did the pandemic communications team know to do that kind of work? How can CNS know how to build on that success going forward?

 

BRIAN COMER: I think the conversations have to be frequent. They have to be respectful and collaborative. I think over the course of the last couple of years, that has been the case. Something I mentioned to the department is making sure that there’s frequent, productive consultation with many of the communities, and also some more that I didn’t think to mention. These will be ongoing discussions to make sure we have really collaborative processes in the department.

 

LISA LACHANCE: There were some recent CNS layoffs announced. I’m wondering if the minister can talk about how the decision was made to eliminate those positions and what the plan is going forward with the CNS team to fill those gaps.

 

BRIAN COMER: I think it was a very difficult decision, being minister responsible for the department. One of the difficult situations when you’re in a leadership position is trying to streamline the effectiveness for your mandate. There is significant focus being placed on health care with the current government, but there is also some opportunity to streamline services.

 

Like I said, there will be continuous evaluation. If there needs to be an increase, that could be the case. If there needs to be a decrease, we’ll keep those continuous conversations going. I think there were 16 positions that were eliminated. Very difficult decision, like I said. I think these are just part of being responsible.

 

LISA LACHANCE: Had the minister been asked to reduce the CNS budget by a certain amount, and that’s where the 16 came from? How did 16 as opposed to any other number of layoffs come to be?

 

BRIAN COMER: I think any minister of a department, you really are responsible for looking at increasing the efficiency to the highest level while you’re there. I did start looking at senior management first, and worked my way down. There was also an expectation that - knock on wood - there should be a decrease in workload, given the state that we’re in in the pandemic. There was also an opportunity to streamline some services through amalgamation of roles. I think that’s a higher-level explanation.

 

LISA LACHANCE: Can the minister confirm what the total cost savings were from the 16 layoffs?

 

BRIAN COMER: Thank you, Mr. Chair - $1.4 million.

 

LISA LACHANCE: Where were these savings allocated? Were they all allocated within CNS?

 

BRIAN COMER: Just to clarify, is the member asking if the $1.4 million went back to general revenue? I’m not too sure of the question. It would just be a budget reduction for the department.

 

LISA LACHANCE: Basically, I’m wondering what happened to the $1.4 million. Was that retained within the CNS budget? Did it go back to the general revenue fund, or some combination of the two?

 

BRIAN COMER: The budget reduction will just be within the operating cost within the department and actually wouldn’t go back to general revenue. It would just be a budget reduction.

 

LISA LACHANCE: I’m wondering if the minister can comment on any new external contracts that were undertaken to fill the roles and responsibilities of the 16 people who were laid off.

 

BRIAN COMER: The answer is none.

 

LISA LACHANCE: At this point, I’d like to switch back to questions on addictions and mental health, but continuing on the theme. I’m wondering if the minister can provide what amount of the Office of Addictions and Mental Health budget represents contracts with third-party providers - Togetherall, for example.

 

[4:15 p.m.]

 

BRIAN COMER: The majority of these financial allocations to those third parties mentioned would be in grants, but I will get the department to get specifics for the member opposite. We’re just actively looking for it here now, so if we could revisit it shortly - or I could follow up with the member - that would be great.

 

LISA LACHANCE: Still on the question of budget allocation, I know that the minister is aware of the World Health Organization’s recommendation that mental health constitute 10 per cent of a health budget. We haven’t met that budget here in Nova Scotia. Will the amount or percentage that the government of Nova Scotia spends on mental health and addictions increase further during this fiscal year or next fiscal year?

 

BRIAN COMER: I think it was an 8.3 per cent increase this year. I think as we work towards very ambitious, challenging mandate items, there would be an expectation that spending will increase. I’m a little bit hesitant to give a specific figure today, due to the stage we’re at, but I’m definitely well aware of the 10 per cent from the WHO. I know some other groups that actually have a higher figure, but I think there will be some significant investments. In regard to specifics, we’ll see where we go in the near future.

 

LISA LACHANCE: I understand from the Minister of Health and Wellness that in terms of breakdown of responsibilities, safe supply is under the purview of the Minister of Addictions and Mental Health. I’m wondering if the minister can talk about work currently being done and currently planned for the safe supply of drugs in Nova Scotia, and what funding is in the budget to support that work.

 

BRIAN COMER: For the preventive piece, typically Public Health would lead with that file. That being said, there is a deep correlation between the preventative and the treatment when you have active addiction issues. We have frequent conversations with Minister Thompson and Public Health. There has been an increase in harm reduction services for the 2022-23 budget. That actually increased by 26 per cent, so it’s $2.22 million for this upcoming fiscal.

 

Just an example of some evidence-based harm reduction services that are hopefully changing the landscape of the province for the better, we look at some of the several different types of harm reduction programs, including managed alcohol programs. That looks at preventing severe alcohol dependence. Typically, it’s people experiencing issues with housing or housing instability.

 

There was an increase by $464,000 for needle exchange programs, which offer a variety of very important services to people across the province to safe, clean supplies, whether that’s needles or cookers, and helping people who use drugs with navigation. There is annual funding as well that goes to Public Health to fund some more community-guided harm reduction. Overdose prevention sites are very important to provide equipment and safe, caring space for people to use drugs.

 

Another significant piece of that program is the naloxone program, which provides free naloxone kits via pharmacies across Nova Scotia to anyone at risk who requests one, who would be at high risk for opioid overdose. It’s a very important program, especially in the event of an overdose, which is also important for our first responders. I know I’ve talked to a number of first responders who use these kits to actually reverse the impacts of opioids. That’s an overview of some of the programs.

 

LISA LACHANCE: Thank you to the minister for that update. I am definitely a huge fan and proponent of the naloxone program. Perhaps the minister will remember that I made a member’s statement regarding that program. I have a kit in my desk in the Legislature, if we ever need it. My kids carry them to the skate parks, and to school. I think they’re a really important piece.

 

Just getting back to the issue around safe supply. The managed alcohol program is one thing but wondering about other work toward safe supply. Just to further the question a little bit, I’m also wondering if the office is working with the Department of Justice to look at the decriminalization of drugs. The government of British Columbia for sure has applied to the federal government for exemptions to the Criminal Code related to drug possession in order to better enable their overdose prevention work and their safe supply work. I’m wondering if those conversations are happening in Nova Scotia as well.

 

BRIAN COMER: I’ve been closely following the B.C. proposal since it’s been submitted. I would say it’s something that we’re definitely keeping a close eye on. I’ve had a number of very productive conversations with Minister Bennett from the federal government as well, but I think from a general standpoint, evidence-based harm reduction and safe supply is something I’d be supportive of. The broader question for decriminalization, I will have to probably get some more information, see how that unfolds through the federal government at this point.

 

LISA LACHANCE: I’m switching gears again in my few remaining minutes. The day treatment program that used to be located at the Abbie J. Lane Memorial Building, I don’t know if it was directly moved to make space for the day hospital or what have you, but it’s been moved to Dartmouth. Although, I don’t think it’s fully re-standing again. I’m just wondering if you can talk a bit about where that program is at. Has there been a change in FTEs for that program from the move from Abbie J. Lane to Dartmouth? Has there been a change in the number of clients being served in that move? Based on more limited program offerings, have the expectations for what that program can achieve changed?

 

BRIAN COMER: The mental health day treatment program was changed to a new location after the acute day hospital opened. I believe there was some correspondence that went out last week. It moved from the Abbie J. Lane Memorial Building at the QEII to the Dr. Clyde S. Marshall Building at The Nova Scotia Hospital site. My understanding, based on conversations with staff, is from an operational standpoint - the case load or the patient volume has been the same.

 

I think there was also a change in the actual name of the program. I think the name was changed to DaRT, which stands for Dynamic (attachment-focused) Relational Therapy Program. It’s more reflective of the new physical location in Dartmouth. This program would support adults with complex emotional trauma and behaviours. It also has a lot of very valuable programming as well. They can also access the program through their community mental health teams as well.

 

THE CHAIR: The honourable member for Halifax Citadel-Sable Island with five minutes left.

 

LISA LACHANCE: I just want to query a little bit in terms of serving the same amount of clients. I understand that currently it’s being offered by Zoom, and then the intent is to reconvene some in-person services later this year. I’m wondering, just to really clarify, that same number of folks are being served by Zoom at this point - or how is that working? Also, just going back to the question around FTEs. Has the total number of FTEs with the program changed?

 

BRIAN COMER: I think it is via Zoom right now. I think the general layout of the program is an intensive six-week group therapy kind of dynamic. That being said, if there’s ever a change in acuity or people request an increased intensity of services, that will always be an option, and they would have an opportunity for an intake there as well.

 

[4:30 p.m.]

 

There is, I know, in the upcoming future they’ll be resuming in-person as well. In regard to the number of FTEs, they are the same, so there’s been no reduction in FTEs for that specific service.

 

LISA LACHANCE: There’s $433,000 allocated to a gambling strategy. I’m just wondering what the strategy will consider and what the timelines are for its completion.

 

BRIAN COMER: It’s a very important issue in the province for sure. The office works with the Nova Scotia Health Authority, the IWK Health Centre, and also the Department of Health and Wellness, Public Health, for prevention and treatment of gambling harm. We also oversee the provision of mental health and addictions supports, which are provided through the Nova Scotia Health Authority and the IWK Health Centre. These would be services that are intended to reduce the harms that can result from gambling.

 

We also fund the Gambling Support Network, which is a service provided by Emergency Medical Care Inc., the province’s telecare . . .

 

THE CHAIR: Order. The time has elapsed for the questions for the NDP caucus. We will now move on to the Liberal caucus, the Official Opposition. The honourable member for Bedford South.

 

BRAEDON CLARK: Thank you, minister, for being here and putting up with us for so long. I got a laugh - good start. I did want to begin my questioning. I think all of my questions probably will be around communications actually. Maybe that’s just my bias showing through, my background, what I’m interested in, but I do have a few questions on that.

 

I’d like to start by asking the minister and the staff: Are the social media accounts of politicians - the Premier and ministers, for example, Twitter, Facebook, Instagram - considered partisan channels of communication or not?

 

BRIAN COMER: I think the member is referring specifically to personal Facebook and Twitter sorts of accounts. That wouldn’t be anything that’s under the purview of the department. I believe they would be looked at as personal accounts. That is my understanding.

 

BRAEDON CLARK: In that vein, I would ask the minister: Is there a policy at Communications Nova Scotia for how graphics or logos or any kind of design or communication product are used by politicians? For example, if CNS were to produce a graphic highlighting some element of the budget, and that graphic or logo was used by the Premier’s social media accounts, is that deemed to be a conflict - crossing over into partisan territory or not?

 

BRIAN COMER: Anything produced by Communications Nova Scotia has to be non-partisan, for certain. That’s something we keep a very close eye on within the department. I’m not really sure of the nature of the question in regard to individuals’ personal social media. If the member could elaborate, I’ll try my best to answer.

 

BRAEDON CLARK: I think it’s actually an interesting development, because as the minister knows, as we all know, communications for politicians have changed dramatically in the last 10 or 15 years. We’re not writing letters as much anymore, and we’re not sending things in the mail. It’s all instantaneous, so these lines can be blurred at times, so that’s what I’m referring to here.

 

To be as clear as possible, do CNS staff produce any of the graphics that would be used in the Premier’s social media posts? He’s got this signature and flag and all of these kinds of things. Do CNS staff produce, or are they involved in any way in the production of those materials?

 

BRIAN COMER: The short of it is no. Just to elaborate a little bit, the practice is the Premier’s social media accounts are not operated by government staff. The elements used in the Premier’s accounts are in the public domain, such as the flag, the shield and the signature, and the things that the member would have referenced.

 

BRAEDON CLARK: I’d like to ask the minister if Communications Nova Scotia has a brand or corporate identity policy. In a past life working in public relations, companies have brand identities, brand guidelines. These things can be incredibly detailed in terms of colour palettes, schemes and all of these different things. Does CNS have such a document or guidelines that lay out how the government’s identity should look and be presented?

 

BRIAN COMER: There are brand guidelines. They would be online, I would think, on the Communications Nova Scotia website, if you wanted to take a look. They really do, as the member mentioned get into specifics such as colours, fonts, logos, really kind of the finer points.

 

BRAEDON CLARK: Can the minister tell me when the last time that document was updated?

 

BRIAN COMER: The last update of the branding guidelines would have been done on February 1, 2017. My understanding is that they’re typically done periodically, based on the historical context of the department. There doesn’t appear to be a fixed date. The last one would have been in 2017.

 

BRAEDON CLARK: I would ask the minister - the budget documents were released recently. Is the 2022-23 budget and its overall branding in line with the government’s corporate identity policy that we’ve been talking about?

 

BRIAN COMER: All the brand guidelines would have been adhered to in the budget. I’m not sure if there’s a specific question that the member has.

 

BRAEDON CLARK: I know the minister’s not in the room, so he wouldn’t be able to - well, maybe he can see this. I’m not sure of what he can or can’t see. I’ve got a stack of documents here next to me that are past budgets - this year’s and then the previous three years: 2019-20, 2020-21, and 2021-22. The first three are rather bland in terms of covers. You’ve got kind of generic pictures of downtown Halifax, looks like vineyards, and then some graphic design elements, which are just basically colours. Then this year’s budget is a bit different. It’s an outlier, I would say. It’s glossy, there are photos - three photos - on the cover here, and the colour scheme is interesting, I think. I’ve seen it before. It’s light blue, dark blue, and yellow, which are the colours, I would say, of the Progressive Conservative Party of Nova Scotia. I would just ask the minister: Is that a coincidence, or how were those colours chosen for the budget documents?

 

BRIAN COMER: The colours are also in the flag. That’s significant to note. Like I said before, my understanding is all the branding guidelines were adhered to.

 

BRAEDON CLARK: I appreciate the response from the minister there. Yes, blue - great colour. I wouldn’t dispute that, but I do find the sequence interesting. I would say that. I held up the party platform and the budget document and it was a striking comparison, I think. I just wanted to note that because I think there can be at times - and, again, I don’t want to impugn motive. I know we can’t do that, and I have a lot of respect for CNS staff. I know how hard they work and the great job they do, but I just think it’s important that we don’t let partisan influences seep into any of these documents.

 

[4:45 p.m.]

 

As far as the minister is aware, on this vein, has the photo of the sitting Premier been on a budget document before?

 

BRIAN COMER: I think there are a number of people on the document that the member is referring to, from a historical context. I can probably get the department to check over the many budgets over the many years in the province to see what kind of pictures were on the cover. I will try to follow up with the member.

 

BRAEDON CLARK: That would appeal to the historian in me. I know the Legislative Library has quite a few copies of past years’ budgets. That’s where I started. I only asked for the last three years, otherwise I would have had trouble carrying it all over here. It’s an interesting question and not something that I have seen - not that I’ve seen every budget document, God knows that, but I just think it’s an interesting point.

 

On the overall budget here for Communications Nova Scotia, it’s about $6.8 million, give or take. Could the minister tell us what percentage or dollar value, whatever is easier, of that budget is going to outside consultants - outside consulting communications firms, for example, that might do work for CNS?

 

BRIAN COMER: In regard to vendors and third-party consulting, we would choose the vendor through a standardized process. The department that needed the service would actually pay for it out of their budget. We do have a very small budget within CNS itself for other projects, but typically the actual department responsible would pay for that out of their own budget.

 

BRAEDON CLARK: Just to clarify that point then. My understanding is that each department - for example if the Department of Public Works needed a communications firm to do something for them, they would pay for that out of their own budget. If I were looking for a list of firms that have gotten those contracts, are those available through CNS or some other mechanism?

 

BRIAN COMER: That information would be available through public accounts, which is released in June or July every year. It would actually list all the vendors.

 

BRAEDON CLARK: I look forward to public accounts in June or July as always.

 

Just following up on a point the minister made in reference to a question from the member for Halifax Citadel-Sable Island around cost savings associated with staff layoffs or reductions. I think $1.4 million was the figure the minister cited there. Does that include severance or any other payouts? Is that a net savings, or just a gross based on salary?

 

BRIAN COMER: The $1.4 million that the member mentioned - that I mentioned previously - would be accurate. This figure does not include severance.

 

BRAEDON CLARK: The number would be some degree less than that, probably somewhat significant, I would think.

 

I believe the Department of Public Works is over there in the main Chamber. I’m also the critic for them, so I’m going to head on over there and ask about roads, highways, bridges, and all that fun stuff. Before I leave, I want to thank the minister for his time - and his staff as well - both on the Mental Health and Addictions side and on the Communications Nova Scotia side. I know it’s a lot of work for them as well to sit there, especially the CNS staff who probably sat there for several hours and didn’t get questions, so I’m glad that they got to enter the ring, as it were.

 

I will give my time over now to the member for Cumberland North. I don’t want to speak for her, but I believe she’s going to move over a bit to the mental health side.

 

THE CHAIR: The honourable member for Cumberland North.

 

ELIZABETH SMITH-MCCROSSIN: Thank you to the minister and your department. We’ll focus on mental health and addictions. I’ll start with addictions. I wonder if the minister could share with me, what the plans are for addiction detox units throughout Nova Scotia, and in particular the Northern Zone. Thankfully, I think Pictou reopened. We were seeing quite a lot of pressures on the one in Cumberland County, which is located in the constituency of my colleague for Cumberland South; it’s located in Springhill. We were seeing significant delays for persons who were in need of detox, such as from alcoholism and/or other addictive drug substances.

 

The concern for local health care professionals and myself is that when somebody is finally ready to go to detox, sometimes if it’s not available, we lose that window of opportunity. The fact that a lot of people have to wait up to seven days before they can get admitted and are suffering at home, and oftentimes with suicidal ideation - it’s high risk. I’m wondering if the minister could share what the future plans are for detox centres around the province, and specifically Northern Zone.

 

BRIAN COMER: We’ll start with the withdrawal management services, which I believe was the core of the question. We’ve had some pretty positive announcements in the last few months. (Inaudible) recovery support centres in Dartmouth and at the Aberdeen Hospital. From a little bit of context perspective, there was a significant examination in 2019 really looking at best evidence, especially in regard to withdrawal management services. I know when I used to work at an in-patient withdrawal management unit, I think even the name in itself was probably quite stigmatizing for people seeking out that care. So now we’re kind of really looking at things from a recovery support perspective - very much on that continuum of care across the lifespan. I think people, especially with addictions, you can need services ranging from ICU to emergency to just some group therapy, and lots of things in between on that spectrum.

 

In regard to future plans, I think the recovery support centres would probably be the most significant aspect to mention. These will be providing around-the-clock in-patient care for people who recover from addictions while remaining at home and in their communities. They’re also going to be different than the traditional service modality in the sense that they’re also going to have the opportunity for not only your in-person types of assessments for your withdrawal management needs, but also including opportunities to access opioid-use treatment, community programs, and other supports.

 

In regard to the Northern Zone specifically, there is one plan for later this year in Truro. There will also be some expansions across the province in the next number of months. That being said, I think there are continuous evaluations ongoing, and especially, you know, we can (Inaudible) the province and get out and about a bit more as things kind of open up. I think there’s a significant need. I think oftentimes, effective day programs or recovery support centres can be very effective deterrents of things that can escalate to the point where you need an in-patient admission.

 

It is also notable that the budget did increase by 55 per cent since last fiscal for these specific services. Between this and what’s going on in the opioid use treatment realm, there’s been a real push to take care of this. That being said, we know that there’s much more work to do.

 

ELIZABETH SMITH-MCCROSSIN: It’s very exciting to see some of the announcements that the minister and the department have made, so congratulations for those. One of the concerns, being from rural Nova Scotia, is that my understanding is they’re not 24/7. If someone in, let’s say, Pugwash or Wallace was in need of services, they wouldn’t be able to travel back and forth, so they would have to either be an in-patient, or stay in a hotel, or find accommodations to be nearby. Can the minister clarify if that’s the case because my understanding is right now there’s one in Halifax, but I think that’s the closest one to Cumberland County.

 

BRIAN COMER: It’s a fair point, I think, the issues especially facing many parts of rural Nova Scotia with access to not just addictions but to psychiatric care. I think the intention of the recovery support centres would be to have the outpatient services modality, obviously for the connectivity to have an admission to an in-patient unit if the condition warrants that.

 

I think the transportation aspect is probably a fair point as well. It’s a real, significant issue, especially for a lot of the individuals who utilize these services. I think what’s going to be positive over the next couple of years and coming months, for sure, is there’s going to be an increase in accessibility points in zones right across the province. If you look at standardization of service and the comprehensive services, and the opportunity for referral to appropriate resources, I think the impacts on rural Nova Scotia are significant.

 

[5:00 p.m.]

 

I also think there’s a pretty significant benefit in some of the community-based organizations that can really provide very valuable services within the communities. The community-based group piece is something I think has a lot of value, so it’s something I’ll be focusing on specifically.

 

We can also work with them to potentially develop relationships that could make services available to the community that would be more accessible, which I think is something I would be open to. In regard to intensive, acute admission for withdrawal, there should never be a situation where someone who needs it shouldn’t get admission. That being said, I do see the challenges with the out-patient and transportation piece for sure.

 

ELIZABETH SMITH-MCCROSSIN: I’m sure Cumberland isn’t alone with those challenges of transportation and accommodations, given the demographics and geography of Nova Scotia.

 

Specifically, Cumberland County’s detox unit in Springhill, I’m wondering - and my colleague from Cumberland South may have already had conversations around this. Right now, I’ve had both patients and clinical staff share with me that there’s been a shift away from the patient receiving a lot of actual counselling or therapy - that when they are admitted to detox, it tends to be more medical observation, and that when they are discharged they’re feeling that they aren’t necessarily being discharged with the tools of how to cope and next steps for dealing with the addiction at home.

 

I’m not sure if that’s due to a lack of staffing for therapy and counselling services, or if there’s been a shift in the model of care and who’s involved in the care team. I’ve been hearing that for about two to three years. It was pre-pandemic, and confidentially I had some of the nursing staff come to me with concerns, as well as I had three different patients come to me with that concern.

 

In a more recent situation, I had someone wait seven days to be admitted, and friends had to be with this person 24/7 due to the risk of suicide. It’s pretty stressful for non-medical people to be in those situations. They feel so helpless and there’s a lot of fear around what if they can’t provide the support that is medically or clinically needed to somebody who is in that detox/suicidal state.

 

I know I’m asking a lot of questions here at once, but in addition to asking about the core care team and what it consists of and the lack of actual counselling and therapy when someone is admitted, can the minister also maybe address the wait time in those critical, life-threatening situations?

 

Finally, would there be the ability to increase capacity at All Saints Springhill Hospital, maybe increase the size and capacity of the detox unit? I think certainly the hospital itself would have the physical space available. It would probably also send a good message to the community of the value of the detox team there and the focus on addictions. There’s an overwhelming need in Cumberland County for more addiction services. That’s a lot all at once, but I’ll leave that to the minister.

 

BRIAN COMER: Just to sort of unpack that a little bit, the primary role for in-patient addictions treatment - inpatient withdrawal management - is really medically safe, supervised detox. Oftentimes, there are a host of other issues that are happening concurrently, so that is the primary focus. You should be doing much more than just observation if you’re working on these units, having worked on them. That wouldn’t be something that comes from the top, I guess you could say, for sure. A lot of these people often live with concurrent disorders, addictions, all simultaneously.

 

I think the in-patient occupancy rate for withdrawal management in the Northern Zone is somewhere around 59 per cent. That’s interesting in a sense, but that being said, there needs to be much more done for people in the non-urgent or high-risk roles. I have heard about the specific issues at All Saints Springhill Hospital, specifically, so I did commit to coming to the area to speak with clinicians once the sitting concludes. I do plan on following through with that. I think I just want to hear what’s going on from on the ground, and maybe just take that back and try to re-evaluate.

 

ELIZABETH SMITH-MCCROSSIN: Certainly, the member for Cumberland South and I can identify who would be the best people in the community for you to speak with when the minister is able to come to the area. We’ve got great people and a great team, but they often can’t help in the ways they want to because - either due to lack of staffing or other deficits. So that would be great.

 

The next question I have is a little more specific. We have several patients in Cumberland who have either historically or are in need of ECT treatment - electroconvulsive therapy. It’s quite interesting. Probably about two years ago, we had somebody on a wait-list - and I didn’t realize how effective it is for treating some forms of mental illness, specifically depression. Unfortunately, there’s a fairly significant wait-list and has been for quite a while. I’m wondering if the minister can speak about ECT treatment. Is there work being done to increase capacity and decrease the wait-list for people who are waiting for ECT treatment?

 

BRIAN COMER: ECT is very important. It’s quite interesting from a research perspective. There still isn’t really a thorough understanding of why it works. They just know that it does in psychiatry, especially for major depressive disorder. It’s typically a last resort, I guess you’d say, for treatment options after trying an extensive list of medications or depots and those sorts of things.

 

We did actually just recently invest $500,000 in repetitive transcranial magnetic stimulation. Actually, one of those is in the Northern Zone, and the other would be in the Eastern Zone. This would be a more efficient and less clinically invasive procedure. Typically, when you’d get ECT in the past, you’d have to get anesthetic and you’d be in recovery, and there can be at times short-term memory loss post-ECT, which is fairly common. This will be a much-improved process as well.

 

I think the wait-list mentioned for ECTs specifically probably pretty significantly correlated with the number of psychiatrists in the zones, because they’re the ones who are essentially performing these procedures. I think if we were to get our FTEs up, which we’re actively trying to do at the Office of Healthcare Professionals Recruitment, part of the call schedule for psychiatrists in the province who work at our facilities is actually part of being on the ECT call schedule as well.

 

I think with those things factored in, hopefully there is a notable increase. I think the actual wait-list itself will be significantly impacted by effective health human resources strategic movement.

 

ELIZABETH SMITH-MCCROSSIN: It’s very interesting and definitely seems to be a demand for it. Even though it’s not understood why it works, if we’re seeing positive effects, it sounds like a good area to invest in.

 

I’m going to speak to the minister now about something a little more specific. I won’t go into a lot of detail or spend a lot of time on this because I did speak to the minister about this when we spoke last week. I want to just go back to the specific situations that we’re experiencing at Cumberland Regional Health Care Centre and that a lot of people with mental illness are experiencing, as far as not receiving acute medical care for mental illness.

 

Most of us in health care locally attribute it to the fact that historically, over the last decade especially, our emergency room physicians haven’t been able to access acute mental health care in Truro easily. Because of the intense pressures in our emergency department, a lot of times, some would argue that maybe adequate medical assessments are not being done, and patients are being discharged and released without adequate medical care.

 

I’m wondering if the minister would consider having someone from the department work specifically with Cumberland Regional Health Care Centre to start evaluating how often people are coming in, whether by ambulance, whether by law enforcement or family member, asking for a psych assessment, and it’s not done. I’m wondering if there would be a way of us doing an evaluation to get a clearer picture so that then steps could be taken to improve through planning.

 

I know that the Northern Zone administration through the Nova Scotia Health Authority and through the department are aware of the problems. I think that is one of the reasons that there was a decision made to renovate our emergency department at Cumberland Regional Health Care Centre. There are many deficiencies, but one of the real glaring ones is there’s no physical space for somebody in mental health distress. The department has a really hard time handling someone when they are having psychosis or a severe mental illness. I think the department, I think the Nova Scotia Health Authority is aware of the problems and that we do have plans for renovation of our emergency department, but that is probably going to be three or four years out before it’s finished.

 

[5:15 p.m.]

 

I’m just wondering if the minister would be able to commit or at least discuss with his department to evaluating the lack of access that the residents in the area and families have to acute mental health care in Cumberland.

 

BRIAN COMER: I think the acute mental health presentations to the emergency rooms across the province is a real significant issue. From working in one myself, I think there’s very clear and accurate data for people who get triaged through the medical clearance and get seen by crisis, and then oftentimes either get seen or not get seen by psychiatry before determining level of appropriateness for admission.

 

I think one of the gaps that I’ve kind of identified a number of months back is that for the people who don’t see the ER physician and leave - who have originally presented with psychiatric concerns - I do find that concerning. It’s something the department is actively looking into. I think it’s a good example of a connection point between the acute care primary health care system and the mental health care system, I guess you’d say from a provincial standpoint. It’s something we are discussing.

 

As far as the capital project in Cumberland, I’m not too sure of the specifics to the ER and those sorts of things. From a departmental standpoint, I think it’s something that we’ll continue to look at, for sure. I think the ER mental health is kind of a challenging issue that needs to be looked at, for sure.

 

ELIZABETH SMITH-MCCROSSIN: It might actually be a good idea to make sure - I’m sure there is someone from the mental health team working with the infrastructure on the capital plan. I know that Brian - is it Benoit or David - David Benoit? Anyway, there is a plan being made for the renovation of the emergency department. It’s to make it bigger, but it’s also to ensure there’s adequate space for things like acute mentally ill patients where right now there’s not. I’m sure they’re getting input from the mental health team, but it might be a good idea just to make sure about that.

 

In response to one of the comments by the minister about the crisis team, if the minister will recall, last week one of my questions or comments was around the fact that Cumberland Regional Health Care Centre doesn’t have a 24/7 mental health crisis team. Right now, it’s only eight hours a day, Monday through Friday, and of course that means if there’s a holiday then it’s less.

 

When the emergency department does have someone they want the crisis team to see, there are a lot of times where there’s nobody available. Including if it’s 3:30 p.m. or 4:00 p.m. on a Tuesday, the response that they will get is they’re done at 4:30 p.m. and there’s not enough time to do a full, proper assessment, so they’re not able to go to the emergency department to see the patient. That is a huge factor, and it is the number one request of our mental health team in Cumberland - to have 24/7 availability of a mental health crisis team.

 

I want to ask the minister if there has been any work with our neighbouring provinces in P.E.I. and/or New Brunswick - just collaboration of clinical health services. Of course, that’s a big issue in our border community. Probably 15 to 20 per cent of our patients in Cumberland are from New Brunswick. The same would be going into New Brunswick for services - anywhere from primary health care, emergency department, surgery. It kind of covers the gamut.

 

I would like to make the minister aware of the very significant discrepancy and experiences of patients who do go to the Moncton Hospital for an acute mental illness versus Nova Scotia’s system. I’ve had a few patients who have gone north instead of south. Of course, they’ve accessed the mental health services in New Brunswick through an emergency department in New Brunswick. So if they’ve gone to Sackville Memorial Hospital or the Moncton Hospital emergency department, they get admitted there to the mental health team.

 

In each situation that they’re reporting to me, they are admitted, and they see a psychiatrist each day. They are discharged once the family, the patient and health care professionals deem them to be safe to go home - and they go home with a plan of care. That is almost never the experience of people in our area who get admitted. I don’t know if it’s because we’re in Cumberland or if that’s the experience of everyone in Nova Scotia, but certainly patients of ours who maybe have chronic mental illness who have acute episodes have a very different experience in New Brunswick than Nova Scotia, and definitely would deem the New Brunswick system to be much higher quality of care.

 

I just wanted to make the minister aware of that. I’m always advocating for collaboration between our Maritime provinces, because sometimes we can learn from one another and help each other by working together. We’re a small region. I just wanted to make that as a comment to the minister.

 

One question that I had was around something that I believe was in the platform during the campaign, but I could be mistaken. My understanding is there is going to be a shift to universal coverage for therapy for patients looking for counselling. If that is still the plan, I’m wondering if the minister could share what the plan is to create that model. Is there a timeline for it to be put in place for patients?

 

BRIAN COMER: There’s money allocated in the budget for an extensive, quantitative, needs-based planning for the universal addictions and mental health care piece specifically. Since coming into this role, I’ve had multiple conversations with various mental health care clinicians across the province. That continues; I met with a group this morning. We’re consulting with a range of professionals who will provide mental health services. We really need to make sure that people are maximizing the scope of practice in order to make the most effective use of our resources. Right now, we’re really in the needs-based, quantitative planning stage. In the coming months there should be some significant progress made in regard to implementation.

 

ELIZABETH SMITH-MCCROSSIN: I look forward to seeing that. If I could just add, there may be some sort of low-hanging fruit that the department could possibly look at, and that is what local therapists have shared with me - some who are working within the publicly funded system, and some who used to but are now fully privatized.

 

In my former world of being a businesswoman, I’ve always rented space to private therapists. One of the tidbits that they would share with me is that they had a 30 per cent no-show rate - at least in Cumberland mental health and addiction services. I was really surprised by that as a businesswoman because in business, you would never survive if you had a 30 per cent no-show rate. As a business, you would take steps to lower the no-show rate. That wasn’t something that was taken on or identified as part of a strategy that could help reduce the wait-list. In a lot of businesses that have booked appointments, there are call reminders the day before and/or email reminders to make sure that patients don’t forget their appointments.

 

I just wanted to share that with the minister because if you even decreased your no-show rate from 30 per cent to half of that, 15 per cent, that would allow a lot more patients to be seen. The practice in Cumberland was that they would book four patients a day in an eight-hour day, and then those other three or four hours were for documentation of the therapy lessons. One thing I had shared as an idea was, why don’t you just book five people a day knowing that if you have a 30 per cent no-show rate, some days you’re going to have all five show up, but other days you’re only going to have two or three show up. It would all even out, and it would help to decrease the wait-list. Anyway, just an idea.

 

I think this might be my last question. This is a topic that I think will probably hit home with a lot of people, and that is the effects of the pandemic on mental illness. I’m wondering if the department is looking outside of Nova Scotia at what other jurisdictions are doing, if anything, either throughout Canada or throughout the world that may be innovative to help combat some of the mild or severe mental illness that maybe has come about because of the isolation because of this pandemic.

 

There was a lot of fear, a lot of anxiety. I know when I was going door to door in August, I was really saddened and surprised by the number of people who came to their door at 3:00 p.m. who live alone. They were still in their pajamas, and it wasn’t a Sunday. I could tell that they weren’t coming out much. I just worry a lot about people. It’s not just older people and seniors - it’s also our university students, our young adults. I just had a conversation about that yesterday with someone in their 20s, and they don’t know what to do. They know that they’re down and they’ve lost motivation, gained some weight.

 

[5:30 p.m.]

 

I feel like if maybe there was a plan put in place to try to help address this on a large scale, that maybe it would help some people sort of reset in their life - like almost a reset of creating goals and plans - something to motivate them, get them out of the house, and get them moving. I’m just wondering if the minister would want to comment on that - kind of almost like a post-pandemic mental health plan.

 

BRIAN COMER: I guess there are a couple of comments here. From a health services delivery model standpoint, there’s always significant research, looking at different provinces and countries, current evidence-based best practices. In regard to that, I think there’s a significant value to community-based organizations as we come out of the pandemic. We’ve had some pretty significant investments so far in a number of community-based groups across the province who do great work.

 

We know that the pandemic has had significant impacts on our children with the impacts of social isolation and not being at school, and the depression, anxiety and eating disorders that kind of go with that, right up to our long-term care facilities with very similar issues, just a different population. I think there are a lot of worries in society in general. I think there’s also a real importance to being active, using our outdoor activities, keeping active with our families, eating healthy food, trying to sleep, and trying to cut back on the alcoholic beverages - just small things in everyday life that really make a big impact over the long term. There’s definitely significant work that needs to be done for sure.

 

THE CHAIR: The honourable member for Cumberland North with less than a minute to go.

 

ELIZABETH SMITH-MCCROSSIN: I will just leave that with the minister. It doesn’t sound like there’s maybe any sort of coordinated approach, pandemic related. It would be great to do something, even with focusing on health promotion, and just helping people to get out of this pandemic, and deal with some of the mental illness that’s come about. I’ll leave that. Thank you to the minister.

 

THE CHAIR: Order.

 

Before concluding the consideration of Estimates for this evening, I invite the minister to offer closing remarks, and then to read the department’s estimates for the resolution.

 

BRIAN COMER: Thank you, Mr. Chair, and thanks to the members for their thoughtful questions. We all know the need to work together to fix the problems within our mental health and addictions system. We also know the pressing need. We have to manage a growing demand for services and supports for Nova Scotians who have been hit hard by the pandemic and other difficult events over the last two years. This requires collaboration with health care workers, dedicated staff across the health care system, experienced communicators, as well as the insights of people with lived experiences, and of course, with one another.

 

It also takes funding. That is why I was happy to be part of this panel to answer questions that many of my colleagues wanted to see. An important first step in any democratic budget process is to give people the opportunity to ask thoughtful questions and, of course, answer them as fully and as honestly as possible. Over the last hours, this is exactly what we did, so thank you for participating in this process.

 

The other important part of the budget process, in my opinion, is to thank all of the people involved in this work. First, I would like to thank everyone outside this room who helped, all the staff at the Office of Addictions and Mental Health, and all the staff at Communications Nova Scotia for their hard work and willingness to deliver on the demands placed on them through Estimates and throughout this House session.

 

Thank you to my deputy ministers, associate deputy ministers, and senior management teams for their preparation, of the office and agency’s budget submissions, and for their tremendous work throughout this challenging year. Nova Scotia is grateful for your hard work and commitment to public service. To all the members of this committee over the last several hours who discussed a range of topics as they pertained to my mandate.

 

For mental health and addictions, we talked about our role in ensuring Nova Scotians understand how to access the care they need, that access to multiple services is streamlined, making the system easier to navigate, that those in need have access to services in the same manner, and that there is consistency and integration of practices across the health zones. All this could not be possible without the strong and reliable partnerships we have across provincial and federal government departments, with the Nova Scotia Health Authority, the IWK Health Centre, Tajikeimɨk, and all of our community partners. I especially want to take a moment to acknowledge the unwavering dedication of so many on the front lines who continue to be there and care for Nova Scotians in a time of need.

 

As it pertains to Communications Nova Scotia, my mandate is to work with departments to ensure that priorities and initiatives of government are shared with Nova Scotians in a timely and accessible way. Mr. Chair and members of the committee, no other time has been more critical for sharing information with Nova Scotians than during the last two years. I am grateful and hopeful that the lessons we learned through all this will help us become better communicators, and I appreciate and value the role of communications within our government.

 

Last but not least, thank you, Mr. Chair, for leading this committee, and to all committee members for their pointed and important questions during this year’s estimates. I continue to invite an ongoing dialogue and input from the members here, along with all MLAs across the province. I’ll read my resolutions.

 

THE CHAIR: Shall Resolution E27 stand?

 

The resolution stands.

 

E16 - Resolved, that a sum not exceeding $6,780,000 be granted to the Lieutenant Governor to defray expenses in respect of Communications Nova Scotia, pursuant to the Estimate.

 

THE CHAIR: Shall Resolution E16 carry?

 

The resolution is carried.

 

It is now 5:37 p.m., and the House is set to adjourn at 6:00 p.m. That concludes the subcommittee’s consideration of Estimates for today. The subcommittee will resume consideration when the House again resolves into a Committee of the Whole on Supply.

 

I ask you to please return to your seats in the Legislative Chamber. The Committee of the Whole House must rise and report before the House concludes its business for the day.

 

I adjourn today’s Subcommittee on Supply.

 

[The committee adjourned at 5:38 p.m.]