In May of 2018 at Gathering Wisdom for a Shared Journey IX, the First Nations Health Council (FNHC), Government of Canada and Province of British Columbia announced a commitment to improve mental health and wellness services that support First Nations children, families and communities in BC. Building on this announcement, Canada, BC and the FNHC signed a tripartite agreement on July 26, 2018 that confirms the commitment of all partners to take action on mental health and wellness.
Since 2015, the FNHC has talked to BC First Nations about the social determinants of health. Through these discussions, issues related to mental health and wellness emerged as the top priority across all regions. This reinforces the direction provided by First Nations through Regional Health and Wellness Plans that identify mental health and wellness and substance use as the most important priority for us to make progress on.
For many, issues related to mental health and wellness, substance use challenges, and untreated trauma can be the roots and risk factors that contribute to other concerns like the opioid/overdose public health emergency, overrepresentation of First Nations in child welfare and criminal justice systems, family violence, and other determinants of health.
The FNHC has heard from many communities that immediate and flexible investments in mental health and wellness will result in better outcomes by supporting community-led solutions that address these root causes. The FNHC has heard that First Nations need to be able to design and implement their own services that address the unique needs of their children, families and communities. When we make progress on mental health and wellness, we will make progress on the social determinants of health.
New Funds for Mental Wellness Services and Treatment Centres
The purpose of this MOU is to support a Community-Driven, Nation-Based approach to the design, planning and delivery of mental health and wellness services. This MOU sets out commitments that the partners will work towards over the next two years. The MOU comes with a commitment of $30 million – $10 million each from the FNHA, Canada and BC – over two years to fund health and wellness planning and a series of “demonstration” or “test” site projects that can support enhanced service delivery models determined by communities.
These investments will be administered through the First Nations Health Authority as the health service delivery partner of the First Nations health governance structure in BC. This division of responsibility ensures the separation of services and politics in the administration of this funding. The actual investment approach will be determined through the creation of a public implementation plan in Fall of 2018. It is expected that the first phase of this funding will be available to BC First Nations in the fall of this year.
In addition to the $30 million commitment, this MOU confirms the commitment of the partners to build, renovate, replace and expand a number of First Nations treatment centers in BC. We have heard how challenging it can be to access timely, culturally safe treatment services. This is a significant investment by all partners and an important part of improving the accessibility of substance use services across BC. This commitment is a separate funding commitment from the $30 million to be determined by the partners through a plan also to be created by the Fall of 2018.
Through engagement on the social determinants of health, the FNHC has heard that funding provided by Canada and BC for community services is inequitable, unpredictable and not based on actual need of communities. These programs are often developed in silos and do not provide the flexibility to work wholistically. We have heard that proposal-based processes creates competition and reporting requirements are burdensome and based on external priorities. Finally, we know that funding is needed to address capacity challenges, including resources for training, infrastructure, recruitment and retention, pay equity, and governance development.
Recommendations from First Nations have informed this new funding approach. Through this agreement, flexible funding is available directly to Nations and communities to plan, design, and implement mental health and wellness plans, without burdensome application and reporting requirements. We are testing a new funding approach, where federal and provincial funds are pooled, providing Nations with the flexibility to align resources with their health and wellness plans and priorities. This means less money is spent on the administration of funds and more money is available to communities to do the work they know is needed.
Based on recommendations from the Regional Caucuses, there will be no ‘call for proposals’ as part of this new funding approach. A key part of this process is to explore approaches that it make it easier for communities to access funding for mental health and wellness services.
Long-Term Investments in Mental Health and Wellness
As part of this agreement, the parties are committed to work together and with BC First Nations to secure long term funding to transform mental health and wellness in BC. The timeframe for the current MOU is set for two years, in order to test the new funding approach. Over the next two years, the FNHC will be engaging First Nations to gather feedback in order to inform future mental and wellness funding agreements.
There is an understanding between BC, Canada and the FNHA that the $30 million is an initial investment. The FNHC is aware that communities need more resources to improve health outcomes. Over the next two years, we have the opportunity to plan as communities and as Nations. Together, we will learn what resources are required in the long-term to ensure we create a sustainable, comprehensive system of mental health and wellness care for our people.
As set out in the MOU, the next step in the process is to develop an implementation plan by October 2018 that sets out an approach for allocating the funding over the two-year period. In order to ensure this new funding approach works for First Nations, we look forward to immediate engagement at Regional Caucuses in the fall.
Over the next two years, we will be actively engaging First Nations to determine what does and does not works and what needs to change, in order to inform long term investments that meet the needs of our communities. In the below links you will find a copy of the MOU, some Frequently Asked Questions and a link to this letter as a PDF.
We look forward to discussing this work further directly with Chiefs, Leaders and Caregivers in the months ahead and hope you have a safe and healthy summer.
The First Nations Health Council
Visual: Mental Health and Wellness Memorandum of Understanding between the Government of Canada, Province of BC and First Nations Health Council – Breakdown of New Funding Commitments