Interior Region Chiefs and Health Leads engage in constructive dialogue on community Mental Health & Wellness and Nation-based Governance



Colleen Lessman, Sheila Dick and Joyce Johnson of Secwepemc Nation; Chief Mike Archie and Kukpi7 Wayne Christian of Secwepemc Nation

Day 1: Health Services

The Interior Caucus session began on March 13-15, 2018 with ceremony, brushing off, and a prayer from Syilx Nation's Mary Louie and Wilfred Barnes; Chief Roxanne Lindley of Westbank First Nation provided the territory welcome. 42 Political Leads and 53 Health Leads participated in the three-day event.

Interior Update

Caucus Chair Allan Louis, Syilx Nation opened the caucus with an update on Interior Region priorities. He noted that there are some challenges with the Pharmacare transition; Interior Region Nations are requesting deeper engagement before the next round of changes to Health Benefits; and wildfire/flooding, opioid response, and mental wellness are top priorities for the Interior.

FNHA Key Priorities: 'Nothing about Us without Us'

FNHA COO Richard Jock discussed key priorities for FNHA which included: urban away-from-home health strategies; innovative, regionally-based service delivery; cultural safety; continued transformation of Health Benefits; and emergency response policies and plans.

Text polling showed that Chiefs and Health Leads ranked health priorities as follows:

• 86 percent ranked Addictions Workers as their 1st priority

• 78 percent ranked Addictions Workers as their 2nd priority

• 78 percent ranked Nursing increases as their 3rd priority

Blanketing Ceremony honours Interior Health’s CEO

CEO Chris Mazurkewich is blanketed by Kukpi7 Wayne Christian of Secwepemc Nation (left) and Ko'waintco Michel of Nlakapamux Nation 

CEO Chris Mazurkewich who is retiring as CEO of Interior Health (IH) in the fall of 2018 was recognized for his leadership in deepening IH's partnership with First Nations communities in the Interior and for successfully advocating health funding flow directly to the Nations – so that services can be provided closer to home.

Kukpi7 Charlene Belleau of Esketemc First Nation outlined recent successes of the Partnership Accord Leadership Table. A key highlight was the implementation of cross-organizational accountability at IH for critical First Nations health priorities. Kukpi7 Belleau thanked Chris for his leadership in opening an additional 14 IH treatment beds for the Aboriginal population last year, addressing racism in IH hospitals, and aiming for a 10 percent Aboriginal IH workforce. 

After lunch, Theo Fleury, NHL Stanley Cup Champion and relational trauma expert, spoke about trauma, mental health and wellness, and addiction. He signed books and posed for photos after his presentation.

Health Benefits 'Plan W' and the next Phase of Transformation

John Mah, FNHA VP Health Benefits, committed to continuous improvement for Plan W and outlined how and why Pharmacare will give FNHA the flexibility to transform Health Benefits to better suit First Nation needs in the future. Cindy Preston, FNHA Pharmacist, discussed how FNHA is working with health partners to improve the delivery of Pharmacare and is also working on educating prescribers and pharmacists about Plan W. Darren McKnight, Director Health Benefits, outlined his plan to improve engagement with community members on Phase 2 of Transformation with the support of a new community relations team.

Lively Q & A Session

First Nations Chiefs and Health Leads asked questions, voiced concerns, and engaged in dialogue with FNHA representatives. Key questions and comments included hardship and confusion for clients, pharmacists and prescribers over the transition to Pharmacare; cultural safety at the pharmacy counter; the complexity of using a Third Party Provider for the next phase of Health Benefits transformation; challenges with generic drugs and Special Authorities; poor diabetic medication coverage; and treatment beds.


Franny Alec Xaxlip Health Director, Chief Chad Eneas, Penticton Indian Band, and Eliza Terbasket Lower Similkameen Band Health Director

Opioid Strategy Update
A panel comprised of FNHA and IH staff provided an overview of what is being done to combat the crisis of accidental overdoses. Dr. Shannon McDonald, FNHA Acting Chief Medical Officer stressed that FNHA would like to hear from community to know if FNHA’s efforts are truly helpful at the community level. “This is a very challenging issue and we can’t resolve it alone. At FNHA, we want to make sure that you have the resources you need to tackle this complex problem,” she said.

Day 2: Mental Health & Wellness (MH&W) and Health Governance

Discussion on Day 2 focused on preparing for the opportunity to secure long-term funding commitments from the governments of BC and Canada to support community-based mental health and wellness services.

MH&W Priorities

Lisa Montgomery-Reid, FNHA Regional Director, Interior, outlined Nation priorities for mental health and wellness. She spoke passionately about weaving traditional wellness into all programs and developing a 'close-to-home' approach. "Let's get resources to flow directly to the Nations so that everything we do is a wrap-around approach to the Nation." Montgomery-Reid also spoke to the need for incorporating family in the treatment process and focusing on treating trauma not addiction.

Wildfire and Flooding: The healing is ongoing

[L to R] Chief Darrell Bob, Xaxlip First Nation, Kukpi7 Mike Archie Canim Lake Band, Kowaintco Michel IRNE Nlakapamux Nation, Kukpi7 Wayne Christian Splatsin First Nation, and Jennifer Lewis Syilx Nation

Drumming, singing, and brushing acknowledged the ongoing emotional impact of the 2017 wildfires on the people, lands and animals of the Interior Region. "What hurts most is the human losses we've had due to the wildfires," relayed a tearful Kukpi7 Charlene Belleau.

Lisa Montgomery Reid noted that the people of the Interior Region have experienced an incredible amount of crises in recent years – fires, floods, the opioid crisis and the Mt. Polley Mine disaster. During emergencies, mental health services are critical yet the access to mental health workers during the 2017 wildfire emergency was very challenging. “There is a lot of anxiety about the upcoming fire season,” Lisa added.

Proposing a First Nations Approach to MH&W

Gwen Phillips, FNHC representative from Ktunaxa First Nation, urged delegates to remain resolute in honouring First Nations approaches to mental health and wellness. "For us, mental health and wellness is about the whole human being … how we relate to ourselves, our families, our communities, the Creator. It's about our ceremonies, our language, our culture."

Gwen promoted changing the focus from 'closing gaps' in MH&W services to working towards the outcomes First Nations want – with a focus on the social determinants of health.

"Mental health and wellness is a journey," she said and then asked: How do we develop our communities so they are conducive to wellness? By working together and sharing ideas among Nations to develop community MH&W plans, which feed into Nation-level plans, and ultimately culminate in a regional MH&W strategy.

"We also need to help bring all the outside partners into a circle to collaborate with us on our approach … the people at the ministries of education, children and family development, health …

we need to teach them so they can help us better," Gwen added.

First Nations Health Council proposes knocking down Silos

Grand Chief Doug Kelly, FNHC Chair

Grand Chief Doug Kelly, Chair of the FNHC, told Chiefs and Health Leads that "when it comes to mental health and wellness, the FNHC wants to support you in planning your community strategy. We want you to have the funds you need – no strings attached. No proposals to write. That's our goal."

The FNHC is working towards dramatically changing the way communities receive funding for MH&W – towards a government-wide response. The FNHC aims to move planning to the community level. For this to happen, First Nations, FNHC, and all health partners will need to knock down silos in order to work together in a way that they never have before.

Kelly appealed to Interior Region leadership to lead the way in working with partners in a brand new way – as they have done before with other ground-breaking endeavors such as re-identifying and reorganizing themselves as seven Nations.

Health Directors’ Perspective on the Social Determinants of Health
First Nations Health Directors Association (FNHDA) Interior representatives Jacki McPherson, Shelley Lampreau, and Franny Alec also weighed in on the importance of the social determinants of health. 

“A social determinants approach is more effective because it focuses on treating the causes - not the symptoms,” -Franny Alec 

All agreed that a social determinants approach improves health outcomes more than health services do. “A social determinants approach is more effective because it focuses on treating the causes - not the symptoms,” explained Franny Alec.

Concerns and Opportunities

Chiefs and Health Leads broke into groups to discuss the proposed new 'social determinants approach' to MH&W planning. Leadership's main concerns centred on minimizing administrative burden and proposal writing as well as being cautious about replicating a Western-style wellness program. They saw opportunities to include youth and Elders in the planning process, recognize non-professional healers such as aunties and Elders, and leverage existing partnerships while also building new ones.

Day 3: Health Governance and a Nation-based Approach

Speakers, Chiefs and Health Leads discussed strategies, experiences, and successes of health and wellness in supporting Nation-based governance.

Moving the Conversation Forward

Gwen Phillips of the Ktunaxa Nation kicked off the discussion on governance by reminding attendees that “our strength is the collectivity of our families and our communities … Interior Nations have been driving the conversation forward and have been quite assertive since the beginning.” 

Gwen continued by saying that the main themes of health governance are a Nation-based approach, collaboration, accountability, cultural safety, and the role of culture in healing.

FNHC Representative Gwen Phillips of the Ktunaxa Nation

"Our job is not just to look at health and health services. Don't think narrowly. Think about all partners out there and resources to bring to our community plans. Governance is about long term plans and the big picture."

Gwen spoke about how governance work is about changing policy. The first entity to be funded should be the Nations, as they are in the best position to decide how to fund programs and provide services.

Gwen pointed out that federal and provincial government officials don't really know what 'Nation to Nation' means. "We need to tell them what Nation-based governance is. It's up to us."

Building a Nation-based Governance Model

The seven Nations broke out into groups to discuss cultivating a governance model within their Nations. Participants clearly voiced the need for more governance capacity at the community level, sharing information between Nations, mentorship support for leadership and for the community as a whole, direct engagement with citizens, and for incorporating ceremony and traditional gatherings into the process. 

Interior Region closed out its caucus session by singing and drumming in a huge circle. Much discussion and sharing of knowledge happened over the three days.