PROMISING PRACTICES
A Podcast about Mental Health and Addictions

Episode 1: Yukon

Episode 1: Mental Wellness and Substance Use Hubs (YK)

March 12, 2021 – These hubs are a collaborative program with Yukon First Nations partners, communities and citizens, with the goal of providing care close to home. The goal is that all Yukoners regardless of where they live, have access to timely mental health and substance use support wherever and whatever that they need the most.

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Loretta O’Connor: Welcome to the Promising Practices podcast.  This is the first of a 13-episode series on mental health and addictions. This podcast series is an initiative of Canada’s Premiers. The aim is to highlight innovation and to share promising practices that are underway in each province and territory. In each episode, we’ll introduce you to experts in the field and learn more about innovative practices and programs.  By sharing this information, we hope to improve how governmental and non-governmental organizations address mental health and addiction issues.

My name is Loretta O’Connor.  I am Executive Director of the Council of the Federation Secretariat an organization that supports the work of Canada’s Premiers. Like many Canadians, I know a number of people who struggle with mental health and addiction issues. This is a shared reality that many of us have to address on a daily basis.

I would like to remind everyone listening that if you or someone you know is struggling, help is available. Please reach out for help if you need it.

Today, as we start the podcast series, we are in Yukon, Canada’s western-most northern territory that shares a border with Alaska. Yukon is home to 14 First Nations and about 25 per cent of its population is made up of Indigenous peoples.

As we all know, mental health and addictions are complex issues that impact many of us. According to the Centre for Addiction and Mental Health, in any given year, 1 in 5 Canadians experiences a mental illness or addiction problem. And the steps taken to protect Canadians from COVID-19 have brought even greater focus to these issues.

Yukon residents experience unique challenges in terms of accessing services for mental health and addictions. Outside of the capital city of Whitehorse, most communities are small and relatively isolated. On the one hand, close-knit smaller communities can offer support. But on the other hand, the lack of anonymity and privacy can create hurdles when trying to seek help.

Today, we are going to hear more about Yukon’s experience with Mental Wellness and Substance Use Hubs. First, let’s hear from the Premier of Yukon, Sandy Silver.

Sandy Silver: Hello, I'm Sandy Silver, Yukon Premier. Premier Scott Moe of Saskatchewan and I have been working with Canada's Premiers to launch a new podcast called Promising Practices. Our hope with the series is to help spur innovation, address stigma around mental health and addictions and to address it head on and to share encouraging practices that are already underway in each of the provinces and territories sharing best practices. It gives me great pleasure to kick off this very important conversation with Canadians from the traditional territory of the Kwanlin Dün First Nation and the Ta'an Kwäch'än Council.

So much has changed since Canada's first case of COVID-19 back in January 2020. Many of the public health measures put into place to keep us safe have fundamentally impacted the way that we live our lives. And unlike other emergencies, no one is immune to the impacts of COVID-19. It has and continues to touch us all things we once took for granted like hugging a loved one, celebrating an important milestone, or coming together to grieve a loss. These are often out of reach these days. On top of that the economy has had to innovate, to respond to the pandemic. But many local businesses are still struggling. From coast to coast to coast, Canadians have learned how to deal with the pandemic, often in isolation from family, from friends from support networks, many of us are struggling, feeling isolated, overwhelmed, and unsure of what the future holds, or if things will ever get back to normal.

So now more than ever, we need to talk about our mental health, and how to normalize our struggles. We need to learn from each other. And we need to find ways to cope with the unprecedented situations that we find ourselves. For me, in being Premier and having to do things like canceled the Arctic Winter Games, which is one of the first things we had to do. And these are mental stresses in your in your life that you don't expect. And when you spend your day doing the work of governing, you try your best to be stoic. You try your best to be strong for others. It's, it's when things happen in your personal life in those days that it really hits home, the mental stress.

You know, I was born in Nova Scotia and the massacre really affected me. It was very hard. Those people didn't deserve that. And it's easy enough for me to go to work and to be strong and stoic but when something hits you from your personal life or, you know, you see other people struggling, that's when it really dawned on me that nobody is immune during COVID times to mental struggle and mental health. Now I'm extremely lucky – I have a support network of friends and family. But you know, if ever was there an opportunity for Canadians to unite over something that we all are struggling with. Now's the time. Mental health, especially during a COVID year.

Here in the Yukon, we're proud people. We're very proud of our rich cultures, our natural beauty, the warmth and welcome-ness of our people. We love the rugged and remote nature of our territory, and we cherish our vibrant communities. But sometimes, all this can be very hard. Winters can be long and cold and dark. Living in remote communities can feel isolated, lonely. Yukoners are resilient, but we're not immune. We're not immune to mental health, or substance use challenges. And the services to support Yukoners through these challenging times are more important now than they ever were.

For a long time, Yukoners were faced with very minimal options for mental health services. It was extremely important to me and our team to increase what was available to Yukoners and to make sure that the services available considered the entire person, not just simply some certain aspects of their health.

This is why we're getting extremely proud to profile Yukon’s mental wellness and substance use service hubs in this inaugural Promising Practices episode. These hubs are a collaborative program with Yukon First Nations partners, communities and citizens, with the goal of providing care close to home. Yukon is home to four hubs, with counselors living and working in seven communities. Our goal is that all Yukoners regardless of where they live, have access to timely mental health and substance use support wherever and whatever that they need the most.

This is new, and we're looking for best practices right across Canada to share and to see what works and what doesn't work. This interdisciplinary team consists of counselors, support workers, mental health nurses, who work together to support adults, children, youth, anyone in need – no person or community is the same. And so, they all operate under the principle that one size doesn't fit all. And the teams collaborate with First Nations governments to identify specific community needs to build services that address individual communities and individual people in those community and their concerns.

These teams are doing amazing work and I hope that you enjoy hearing about this, and important and collaborative programming. I'm super proud of the people who work in these communities. And I do hope that the information shared from this podcast is informative and will bring Canadians some comfort during these difficult times. We're all in COVID together, and we're going to get through this together. And we need to become better as communities, better as a nation because of what we've struggled through together. And we can only do that if we share our stories.

We hope that you will subscribe to Promising Practices wherever you get your podcasts or at the Council of the Federation website. Together, let's end the stigma around mental health. Let's talk about it. Let's share your stories. Let's ask for help. And most importantly, remember, you're not doing this alone.

Loretta: That was a great introduction to the promising practices that we are profiling today. Here to tell us more about Yukon’s Mental Wellness and Substance Use Hubs is Rob Furlong who works for Yukon’s Department of Health and Social Services.

Rob Furlong: Thank you. Joining me now is Mary Vanstone, who is Yukon government's Director of Mental Wellness and Substance Use Services. Welcome to the podcast Mary.

Mary Vanstone: Thank you.

Rob: You've been in your current role for just over three years now, what attracted you originally to move to the Yukon?

Mary: I grew up in a small logging community in Vancouver Island and most of my career has been spent in rural remote communities with larger First Nations populations. And I really appreciate working with smaller jurisdictions. There's a lot of grassroots development and meaningful collaborations. That isn’t a change that can happen quickly. Smaller population sizes to serve mean that we're able to capitalize on opportunities and be more flexible with our services. Plus, you can't beat the beauty of the North.

Rob: Indeed. And it's not like turning the Titanic as it is in some other jurisdictions?

Mary: Absolutely not. It's definitely easier to make significant change with less funding.

Rob: And before we get into this further, I thought I would play some comments from Allison Kormendy, who is one of our First Nations partners from the Tr’ondek Hwetch’in First Nation government, which is in Dawson City, which is about five hours north of Whitehorse and she can provide us a little bit of context about the living in a small community and what that means when it comes to mental wellness services and accessing those.

Allison Kormendy: Good day. My name is Allison Kormendy, I was born and raised in Dawson City, Yukon, and I am currently the Director of Wellness for the Tr’ondek Hwetch’in Government. Growing up in the North most definitely has its perks. But it also has its challenges and isn't for the faint of heart, especially when we were talking about mental well-being. Living rurally in small northern communities which have limited or non-existent services for mental wellness has presented numerous heartaches for many, I have not only supported many people dealing with mental wellness, but I have also experienced this myself, and I know the individual challenges of reaching out for support along with once you reach out you may not have much luck in receiving that support. Most barriers that I have seen are not only the limited services in small communities, but also transportation to other communities which be services are provided and then being put on a waitlist because there is a high need. Also, the ability for many to leave their community is not always an option. The Yukon government mental wellness and substance use hub is on the right path for extending these services to rural Yukon communities where people can easily access them as needed. I have seen Yukon government hire local Indigenous clinical counselors that specialize in complex intergenerational trauma and have grown their team in the Dawson hub to better assist our citizens, including support workers and a mental health nurse. Working with Tr’ondek Hwetch’in for many years and the Yukon hospitals, I have seen the need and growth in providing education and cultural awareness and cultural safety as a crucial piece to the service providers in our communities. This not only creates an understanding of our communities, but it provides support to the service providers that are doing this important work. I have seen this model used and it does work when it comes to systemic challenges and changes. I have a background in holistic health and for me that connects directly to our traditional ways of living and life. When we support ourselves and our citizens from a holistic traditional model, we are doing our best to get to the root of the problem that has caused mental wellness challenges. To unite our traditional teachings with Western models is key to optimal health for our citizens and communities at large. Mental Wellness Substance Use and Tr’ondek Hewtch’in have partnered on programs and projects since the hub has been created in Dawson. I look forward with hope as we collaborate and integrate these two worlds to best support our communities with more on the land programs, increased resources and connecting the Western models to our traditional teaching.

Rob: Well, there's a lot to digest there. Absolutely. That was Allison Kormendy from the Tr’ondek Hwetch’in First Nation government in Dawson City. Thank you very much for those comments. Allison. There's quite a bit to digest here, Mary. But I think we could start off with she references the mental wellness hubs, I was hoping you could tell us a little bit more about what they are and what they do.

Mary: Sure. In 2018, the current government decided to integrate three separate services – Mental Health, Alcohol and Drug Services and the Child and Adolescent Treatment Services - under one branch of government: Mental Illness and Substance Use Services. One of the main goals of MWSU, as we call it was to create these four hubs: one in Haines Junction, one in Dawson City, Carmacks and Watson Lake. These four hubs also serve satellite sites in more of the rural remote smaller communities where we have living counselors that provide services in those communities. The other piece of the hub is to provide pre and post care for people community members who may not be able to access services, like withdrawal management services or psychiatric services in their smaller community and need to come to Whitehorse, our Community Councils will provide that pre care and orientation for them as they come into Whitehorse to receive those services. And then when they're completed those services here in Whitehorse, they move back to their communities where they're provided with post care through these hubs.

Rob: So, prior to the creation of these hubs back in 2018, how was service provided in these remote communities?

Mary: Services would have been provided itinerantly, so that would mean a clinician would go into the communities, provide services for a couple days, and then come back to Whitehorse, probably coming back anywhere between two weeks to a month later, to provide service. It lacked consistency, there was a lot of turnover in staff and who would be providing services and certainly not a best practice.

Rob: So, I hear two things. One is that you've integrated three different branches of government into one. So maybe you could tell me a little bit more why that's important, the integration of these services.

Mary: The integration of Mental Health, Alcohol and Drug Services and Child and Adolescent Treatment Services is imperative to good care. Children aged out of services, youth aged out of services, there was a gap that existed, so a lot of people would end up falling through the system and not receiving services until they were in a more acute phase of mental health or addictions. With respect to mental health and addictions, those two tend to go hand in hand. So, if you have to separate doors for people to have to access in order to receive services, again, people get lost or bounced back and forth between services. This way, the integration of the services means we're providing a holistic through the lifespan type of service for people, not only in Whitehorse, but through those rural and remote communities.

Rob: And with the new mental wellness hubs, you're bringing service closer to home, that is one of the key priorities of the hubs?

Mary: That's correct. So, each of the hubs has an interdisciplinary team. There's a mental health nurse there support workers, and there's clinicians for adults and Child and Youth clinicians. These services work at the hub but they also provide services to those satellite communities. So, each community also has a mental health counselor, but when they need specialized services, like a mental health nurse, or a clinical counselor, those services from the hubs come to those smaller communities. We're not expecting community members to come to the hub to receive services. We're going to them so we're providing services where they live.

Rob: Thanks, Mary. Joining me now to talk a little bit more about how these new mental wellness hubs are working on the ground here in Yukon are Todd Pryor and Jayla Rousseau-Thomas. Todd is the manager of community mental wellness and substance use services here at Yukon while Jayla is the Yukon government's cultural counseling coordinator. Welcome to the podcast. Well, Mary is relatively new to the Yukon being here three years, I understand the two of you have a long history here. Let's start with you, Todd, maybe you can tell us a little bit about yourself and what you do.

Todd Pryor: Yeah, thanks for having me. I grew up in the Yukon, my family moved to Faro when I was nine years old. So that's a pretty remote town about four and a half hours from Whitehorse, the population while I was there was around 300 to 400 people. So, I certainly get what it's like to live in rural Yukon. Growing up there, there was a lot of services we didn't have, it was a great place to grow up. But sometimes we didn't have a gas station. So, access to things like mental health and substance use services was, well, something I can't actually remember about the community. So for me, it's a good sort of turn in my life path to be in this role now, where I'm working as the manager of mental illness and substance use services for the community hubs are my job is to not only oversee the programs across the territory in the communities, but also to collaborate directly with our First Nation governments across the territory of the health directors to make sure that the services that we're providing in these communities really fit for the community and to strive further and further toward more culturally relevant to more culturally sensitive programming.

Rob: And that's a great transition to you Jayla, can you tell us a little bit about yourself.

Jayla Rousseau-Thomas: Hello, everyone. My name is Jayla, and I am an Anishinabek woman. I do have the privilege of being the cultural counseling coordinator with mental wellness and substance use services. I was born and raised here in Whitehorse and did my Bachelors of Social Work right here at Yukon College, as well as my Masters of Social Work through the University of Calgary, which is boring as that is has helped me come to a place of being able to support the people that I grew up seeing being challenged by their involvement in the system. So as an Indigenous woman who is a third-generation intergenerational residential school survivor, I've seen the challenges and the mistrust between my family, my friends and the people I grew up around in accessing services. And often there was a bit of a tone that unless you really needed help, you didn't reach out for help, you didn't reach out, you didn't let other people know what was going on, you kept it to yourself. And so being able to work with Todd and Mary and support mental wellness as a whole branch as well as in the hubs, is really important because it brings some comfort for people to be able to access services in a way that makes sense and is relevant to them, where they're at, and like physically, where they're coming from.

Todd: I think something you said really hits home in terms of my role in this position. And the role of metal wellness and substance services throughout the territory is the word comfort or the word trust. Because we need to be able to provide a service in these rural remote communities that people trust us and trust the individuals working on behalf of them and helping them with their mental wellness and substance use needs. I think working with community partners, especially First Nation governments, are really the key to starting to build that trust are building more and more trust.

Rob: And I imagine having mental health workers actually living in the community, being part of everyday life helps build that trust.

Todd: I think so. I was one of the counselors back before the integration of all the different services that traveled back and forth to different communities across the Yukon and you're in, you see your clients, you go away, and you're not part of that community, and you're not involved in at any level of depth in the community. So how do you start to build those relationships?

Jayla: I think it's important that we need to recognize that there can be challenges with that we want people who live, work, and play in the communities and have an investment in the communities they live in. But we also live in a very small place. So, it's not like living in a place like Edmonton, where you can shop somewhere and work somewhere else, those things are all mixed in. So the person that you're seeing at the health center might also then turn around and see you for access to services. Or if you're going to one of the on the land gatherings and have a conversation with someone there that also could increase their comfort and coming to you later for more support services. So, it definitely goes both ways. And it provides an extra challenge for our clinicians, as well as for the people in the community to learn how to dance around that.

Todd: I think it does go both ways. I think that's a really important point. Because there's certainly as a counselor, or support worker, mental health nursing, in a community of anywhere from, let's say, under 100, to under 1,000 people, there's certainly a spotlight on everything you do, because you're that person who people talk to about the concerns they have. But also you have a life outside of that. And you have to become part of the community. So where do you find that balance? I think participation in on the land camps or initiatives are really important. And I was speaking with one of the health directors from across the territory. And they said, that's one of the most important educational experiences that our new staff coming in can have in terms of how to get to know the culture on the ground in the community, they are going to live, work, and play.

Rob: Maybe you could just tell our listeners a little bit about these on the land programs, because these are traditionally put on by First Nation governments and we support them.

Todd: Yeah, we definitely we look to support as much as possible. It's usually at the request of the First Nation government through the relationships that we're trying to build day to day, in our work in the communities. And we're certainly not the experts in traditional ways of healing or traditional ways of being, we want to be able to support with our knowledge from the western perspective from our expertise in mental wellness and substance use services, and go in and learn and learn about the culture and become part of the community to build that trust and build those relationships in a culturally safe and culturally relevant space.

Jayla: One of the things that's really beautiful about the land base camps that happen here in the Yukon is each First Nation can tailor it in the way that makes sense for them. So if they have a different clan system, or they have different practices in other areas, they can make sure that their camps are reflective of that and bring in their traditional teachings. And so again, that importance of having a worker who's predominantly in a single community, they can really get to understand that and build that comfort piece. And with these hubs, mental wellness and substance use services, is stepping up to say, we can be a piece of what's going on for you. And we're not the whole puzzle. So sometimes bringing in that land base camp piece, sometimes people go outside the Yukon for treatment with what makes sense for them, what are their needs? And then how can we support them to either meet those needs or look creatively elsewhere for them.

Rob: And that goes to what Mary referenced earlier, that's not a one size fits all approach. So what I'm hearing is that each of the hubs may be different in the services and the way they the programs they offer.

Todd: Yeah, I think that's key as well. I mean, we could be doing certain outreach activities in any given community. And what I like to tell our frontline staff is there's obviously going to be a key player in the First Nation government no matter what community you're in, who you should sit down and talk to about this new initiative first, and if we talk to four First Nation government health directors across the territory that original idea might be a little bit different, but they're a little bit different because they fit the given community that we're working in. 

Rob: We also heard earlier from Allison Kormendy from Tr’ondek Hwetch’in First Nation in Dawson City who said that transportation is an ongoing challenge in accessing services.

Todd: Yeah, first of all, I really appreciate that Allison was able to contribute to what we're doing today, her perspective is very valuable. The transportation piece, I think what she was referring to has to do with the fact that the mental wellness and substance use hubs are also a conduit for the more in-depth services that are available in the capital, the territory in Whitehorse, for example, intensive treatment, withdrawal management services and a number of other services as well. And sometimes the difficulty is having, it's not difficult to refer the person into, say, the treatment program, but sometimes there might be a lack of means to get them there. So we have to be creative with that. One of the goals of the Hub's is pre and post care for these more in-depth services. So working with a client to fill out all the paperwork that's involved in all the assessments as involved in say, going to the intensive treatment program, doing the pre sessions, working on goals, working on things that will prepare them for their access to the intensive treatment program, and also working with them after so they can take what they've learned from that program back to their home community, work with the staff who's connected with the program and knows about the program, and continue on their healing journey.

Jayla: With the hub models and the workers who are stationed in the communities, one of the benefits, of course, has been that it reduces the amount of travel that people have to do so while it's uncomfortable sometimes to have to drive seven hours to Whitehorse from one of the more remote communities or have to fly in for services, etc. Sometimes it's just not possible. So being able to start out, building the relationship, getting to know someone in your community and access services, and then potentially move into the hub if you need something that they're not on the travel schedule based on your needs to your community, whatever. And then can do that third step up to 10 services in Whitehorse provides that ongoing comfort along the way, as well as connection to more people, we also have the option to sometimes work with other people or other services who can support clients in the communities. So for example, non-insured health benefit is able to provide some support for people who are traveling in to receive withdrawal management support or intensive treatment, so that workers who are in the hubs are aware of some of those services and able to help make those connections or can reach out to other people to get some support to make that happen for the clients. And it connects really beautifully to our indigenous way of being if we think about how, for us, as indigenous people, we look at things in a very holistic way. So we've got the physical, mental, emotional, spiritual side of things, but certainly the connection that we have. And if we even look at the hub model as being connected to the way we look at water, so when you learn to paddle, you do that at home, when you're comfortable in the creeks and the slow-moving waters. And then you slowly get into the eddies that might be representative of those hubs where you can get connection to surface before you jump into the big river, you don't want to just get swept away, there are those people who are ready to just jump right in, and that works for them. But sometimes we need that slower transition. And it just makes a bit more sense when we can slow it down, take a step back and look at what are the slow-moving waters that we can do to support you, and how can we help you get to some of those bigger pieces?

Rob: That's beautiful. I've heard the word trust mentioned a number of times now and it's obviously a very important element. So Todd, just how have the community mental wellness hubs been received?

Todd: I think that's a really, really big question. And I think there's some places, there's some areas where we're received really well. And there's some areas where we're still building on sort of the structures that were put in place when the hubs were first formed. I think a lot of those places where we're still building has to do with some issues that come with working and living in rural remote Yukon. Housing issues. In a lot of communities, there's nowhere for staff to live because there's a lack of housing for community members, let alone government workers. In some places it's really hard to hire, it has been really hard to hire in some parts of the Yukon. So filling those gaps is really important for say the reception to be more realized. I think to that working in rural remote Yukon, in First Nation communities, there's a history that we have to acknowledge of what it means for a government agency for government workers to be in these First Nation communities. And that's the history of residential school, colonization. So we're always having to work on the trust piece, because trust is a process, it's always going to be ongoing. It's never a destination, we will not have achieved it, we will have to keep striving for it.

Jayla: And as the staff and the hubs are working with the community, there's always this piece that's growing of the individuals’ cultural awareness, cultural sensitivity, the cultural humility they bring to their work, which, again is really important as we look at what the fit is in the community. It's important to have people who are invested and want to be able to participate in the community activities and as well are willing to listen. Our elders always say you have two ears and one mouth for a reason. And sometimes, it's really hard to remember that when you're fresh out of school and you got a brand-new degree, and you're super excited to do all of the things, we just need to slow down and listen sometimes and our elders in the communities have been great on taking on different people as they've come through as long as the person is also open and willing to learn. Another benefit that we've had working in the communities and having this relationship established is there's a bit of a feedback loop that can happen. So if someone comes in from a remote community, to Whitehorse to receive support of withdrawal management services, and have a wonderful or a less than ideal experience, and they share that information with their worker in the hub, or their First Nations health director, and that can come back to us, we can then look at how can we improve things so that they make more sense for those rural clients when they come in. Keeping in mind that, for example, withdrawal management is a medical service so we're going to have some of those clashes when we are working within a Western medical system and begging for people who are from an Indigenous kind of worldview or place. But we can always do our best to try and find ways to make it comfortable. How can we shift things in small ways so that people feel like the service is reflective of what they want?

Todd: I think Jayla, you make a really important point. That makes me think of when I first got out of university and had this fancy, shiny degree and I was sent to Watson Lake for a critical incident response. And I remember stopping outside of the community and thinking, what do I know about this community? Nothing. What do I know about the people who live here? Nothing. And what I did, I think I was probably told by a really influential elder in the community to, to sit down and listen and maybe peel some potatoes. And then that's how you'll learn how you can help. And I think the feedback loop for that is, that's a key message that I try and instill in staff across the territory is listen to the community members, don't just go out there and do like you can save the world, because it's a community that is going to help itself on the journey toward wellness.

Jayla: And our communities are a great example of how formal education doesn't actually necessarily mean a lot, or it doesn't mean much to them. So, I can sit down and give down my BSW, MSW credentials. And I'm still going to be asked who's my mama, and who are my two grandmas. And that means more and when you're coming from downtown Toronto, and someone's like, who's your mom? That doesn't necessarily mean much. And people are quick to be like, No, no, but I graduated from this school and this and this. So, I should have credibility. But you build the credibility by sharing a piece of who you are. And maybe if we're lucky, we have a connection. And from there, we can build relationships instead of you coming in with maybe your information and knowledge and seeing how that helps me.

Todd: My small-town Yukon experience has gotten me further in in a lot of ways, then then the degrees that are behind my name.

Jayla: Yeah. And when you come from a small town, or you're used to living and practicing in that way, you get some flexibility in dealing with those things. So I spent some time in one of our very remote communities. I was traveling up there for a non-profit organization I was working for at the time. And we were going to have a big community meeting and a community dinner and host this meeting. And there was a death, and everything shut down. So, the person I was with had more experience working in that community in particular, so she knew what to do. We packed up the food we had, and we walked until we heard the guitars. And what happened was everyone pulled out the Rubbermaid totes that had their hymn books that were all photocopied in there. And they were singing around the fire playing guitar. So, we shared our food. We sat there, we went home two days later, and we didn't talk about what we had been there for. But certainly that experience has been an important one in my career, and the relationships built there just sitting around the fire, talking about this person who I actually never met. But it brought me into understanding their way of being in that community so that I can help them better when I work with them in the future.

Todd: That's really great.

Rob: And obviously, that to bring it right back to the mental wellness hubs, when the counselors and nurses and support workers are living in the community, they have those opportunities, because they're not coming and going.

Todd: Yeah, like I said, before I was one of the counselors that traveled back and forth every couple of weeks. And it didn't allow me the insight to know the gatekeepers in the community, to know the folks who knew how to, to access a certain resource or access certain people.

Jayla: Well, and living in communities provides you those opportunities to understand who might be those informal decision makers, who might have influence in the community with no letters behind their name, they might even have a job, but you show up there and you sit at Susie's house and you drink tea and everybody comes to see her and everybody sees you and you get credit because she knows you. Another important piece of that is understanding how different communities can be when they are a couple 100 kilometers apart. So, in the Yukon with our history of colonization, we had quite a few residential schools here. And the churches came in really early and really got their fingers in our communities. So, we have some communities that do have strong Christian roots and we have some that have gone back to a lot of their traditional ways and some that have kind of a marrying of all of those things together. And so it's important to know how to step in how to walk in those communities, because understanding that one might have whatever is a Christian faith, and then trying to translate into the next one might just not go well at all. And it might close doors in your face.

Todd: I think that's important because a counselor or a service provider who goes in and out of the community, goes in and does their work, gets out goes and does their work gets out doesn't get to gain that knowledge, but living in the community becoming a part of the community and getting to know the gatekeepers and the knowledge holders. That's how you, you know that stuff.

Jayla: Yeah. And so then when we connect that back to how do you support those people with our other services? And how does this improve service delivery, if you live in my community, you're more likely to know that my mom's house burned down, and this person had this happen. And maybe this death happened. Because you live there, you live those events, you know them too. So, then you can share that to the person who works in the hub. And you can share that to the person who might be supporting me when I go to treatment. Whereas if you're just traveling out as a worker, and you've sat with me for an hour a week, and you're asking me these questions for whatever assessment, I might just say, No, I'm okay. Things have been stressed. Yeah, making it work. Oh, yeah. My cousin's living with me now. But you don't know they're living with you, because their Auntie is the one who's died.

Todd: I think, I think to that, even now, even with staff living in the communities, for the first few weeks, for the first few months, it's a slow build up to increasing their caseload to getting to know the folks in the community I can remember when I first started working in one of the smaller communities in the Yukon Territory, and elder came up to me very directly and said, How long are you staying? Why should our community trust you. So, you do have to prove yourself, you do have to become part of that community while maintaining the boundaries that you need to have in your profession, but still being in a trusted member of that whole.

Jayla: And we certainly will have people put, like those community members will put the new workers through those processes. We have some people who work in our communities who are very well adapted to accessing services at our colonial way, I know, I need to talk to Todd to get this referral to get this so I can get my services. And some people will do those motions, but it's not a meaningful connection. But if I run into you at the grocery store, and for better or worse, maybe I've had a moment, but I see you I can remember, I can call you tomorrow, I might try and talk to you next to the cereal. But also, I could talk to you tomorrow if I need to.

Todd: I've had many conversations next to cereal boxes when I was a counselor in the smaller communities. I think that's an important point, right? Because how do we honor the processes that we have to follow within the structure that we're working in? But how do we break barriers down as far as possible, and make things flexible enough that it fits for the community and fits for folks who a lot of these government processes might be a giant barrier because of colonial history, because of residential school? So that's something that's always on my mind. And I try and instill in staff as well.

Jayla: And then what are the supports that we can provide people after they're leaving Whitehorse. So, if they've come into Whitehorse, to see a psychiatrist or to attend the intensive treatment program, for example, when they're returning to the communities, and again, the workers have a good understanding of what it's like for them, they can make sure that they're trying to provide the best aftercare support suited to that person. Instead of knowing that ABC is available. Perhaps we can look at how to create D or E.

Todd: Yeah, to make it fit for them. And I was just thinking, as you were talking, there's some folks who might access services in Whitehorse and say no, I don't want to talk to a counselor, but I talked to Todd, Todd's the counselor, but because Todd's a part of the community, or whoever it is, they know that person on a more personal level. Yeah.

Rob: Thank you both. This was very enlightening. When we come back. We'll talk with Mary Vanstone a little bit more. And any final thoughts from either you, Todd or Jayla?

Todd: I’d just like to say that, this this role, I've been in a role for about seven months. And it's just a really exciting opportunity to work within the Yukon to help support the health and wellness of Yukoners especially in rural remote Yukon Territory. And I think that the most exciting part for me is the building something that really fits for these communities and working with knowledge keepers and First Nation Health Directors and learning from folks like Jayla in her role as Cultural Counseling Coordinator, to continually do better and to continually improve the service and make it a better fit and a better fit and do more and more to strive towards an appropriate service and appropriate fit for each individual community.

Jayla: Yeah, and I also want to express my gratitude for mental wellness and substance use services for making the investment in the hubs and even in my position, as we look at what has come out of the truth and reconciliation, the calls to action, the national inquiry into Missing and Murdered Indigenous Women and Girls, and all of the pieces that we can do in the community. This branch is doing that so instead of making the red Caboose, which is to develop the program, and then you tag on the red box on the end, which is the Indigenous or First Nations component, we are building those relationships with our First Nations partners, so they're helping to steer as we go. Thank you.

Rob: And thank you. We've been talking with Jayla Rousseau-Thomas, Cultural Counseling Coordinator and Todd Pryor, Manager of Mental Wellness and Substance Use Services for the government's Department of Health and Social Services. I'm Rob Furlong. When we come back from the break, we'll be joined again by Mary Vanstone.

Thank you for that overview of Mental Wellness and Substance Use Hubs in Yukon and the services that they offer.

Loretta: Thank you for that overview of Mental Wellness and Substance Use Hubs in Yukon and the services they offer. As a small territory in Canada’s north, Yukon certainly does face some unique challenges. The introduction of the Hub delivery model seems to be making a real difference in rural Yukon communities where people can more easily access services where they need them. Let’s re-join Rob Furlong and Mary Vanstone as they tell us more about the Hubs, some of the obstacles they continue to face, and some valuable lessons learned.

Rob: We're joined again by Mary Vanstone, Director of Mental Wellness and Substance Use Services for the Department of Health and Social Services for the Yukon government. Welcome back, Mary.

Mary: Thank you.

Rob: I noticed you had a little tear in your eye after listening to Todd and Jayla.

Mary: Absolutely. I'm really proud of the work that these teams are doing in the hubs and the way that we're supporting the community members in providing better access to service and more refined and supportive services for their needs.

Rob: Can you talk a little bit more just about some of what you see as some of the lessons learned in setting up these mental wellness hubs? Obviously, they are listening to Todd and Jayla, they are a great idea. And they're having some success. But I'm sure it hasn't been completely smooth path.

Mary: No, there's definitely been a few bumps in the road, so to speak, two things stick out, for sure. One is appropriate hiring and the other is infrastructure. So in some of our smaller communities, we do have difficulty finding adequate space to provide services, and housing. And that's an issue throughout the North, we need to have space in order to practice and we need to have houses in order for our clinicians and staff to reside in those communities that, as you've heard from Jayla and Todd has such a significant impact on the wellness of the community members, hiring is the other big piece to that, we need to make sure that just because a potential employee looks good on paper, doesn't mean they're going to be a right fit. It's really difficult to move from a big bustling city into a small community of less than 500 people, it can be really a quite a shock. And the concern that we have is that someone gets there, they start establishing relationships, and then they decide that the fit isn't right for them, and that they need to move on usually to Whitehorse or a larger center. And it leaves that community one with a void of not having the right service there. But also people who have exposed vulnerable parts of themselves, and now have to wait for somebody else to come and finish some of that work.

Rob: And so, then retell their story to another person.

Mary: Exactly. And so, what we're really trying to do when we're hiring is one involve our First Nations partners, and so they're able to help us in deciding who comes into their community, we have found that when the First Nations partners are involved in our hiring process, that we're more able to engage with our new employee on the orientation of them, adjusting into the community of them being connected with appropriate supports, and people who can help them adjust to living in a smaller community. We also ask those questions of our potential employees, why are you coming to the small community? What do you know about this small community, we want to make sure that they're fully informed about what it is that they're getting into, and some of the restrictions and some of the difficulties that come with living in a really rural and remote community.

Rob: And we talked about there was, again, a lot of talk about collaboration and building trust. And in your experience, you know, how, how important is that? And what is some of the best ways to do it?

Mary: My trust is paramount to the therapeutic relationship. If you don't have trust, if you don't feel comfortable with the person sitting across from you, that you're telling your story to, you're not going to move very far in your in your treatment. With respect to how you gain that listening, as Jayla said, two ears, one mouth, listening, but also being involved in community activities. Your work in a community doesn't end at five o'clock. There's gatherings, there's feasts, there's on the land activities, there's community activities, if you're going to live in a community, you need to be part of the community. That's where you start establishing trust, indeed, and one of the other things we were talking about is how traditional healing and the western approach integrates together.

Rob: And I know, the mental wellness and substance use services unit has a focus on harm reduction. And I think there's some education that goes along there and some collaboration required when if you could just tell us a little bit about that, because I think that's an important lesson learned as well.

Mary: Absolutely. So the harm reduction model doesn't just focus on abstinence, we provide a full continuum of supports, it's meeting people where they're at, and where they're ready to address the harmful aspects of their substance use. We have moved from having a lot of the services centralized in Whitehorse to making sure that all of our clinicians and all of our communities are able to provide harm reduction supplies, Naloxone kits, as well as information and education. And part of that is working in collaboration with our First Nations partners. It would be arrogant for us to assume that every community would want that, as Jayla had indicated before, through colonization. Some communities are very religious, some communities are more spiritual summer a mix of both. The same comes with the value of harm reduction. Some communities are not necessarily ready for us to start handing out crack kits, or needle supplies or even condoms. These are things that we need to have in conversation and collaboration with that first nation through public health education, about the importance of why we provide these supplies to their community members and how it helps them stay healthy and safe, as opposed to the notion that it's encouraging substance use.

Rob: And so Mary, we're talking about lessons learned. Is there any other final thoughts you have for other jurisdictions who might be listening to this podcast that they might take from Yukon?

Mary: we talked about one of the attractions that brought you here was the ability to make change and change is underway. I would say my biggest tip, if you're looking at developing a similar model, is to start with your First Nations to actually sit and talk with the people who will be who you will be providing services to and with to not assume that what worked here in Yukon is going to work in Saskatchewan or any other province or territory. You need to sit with your communities, your rural and remote communities and identify what their needs are, what they think their needs are, what their struggles are and what they identify as their gaps.

Rob: Thank you very much, Mary Vanstone, Director of Mental Wellness and Substance Use Services, Department of Health and Social Services, Government of Yukon. Thank you.

Loretta: That was Mary Vanstone and Rob Furlong talking about Yukon’s Mental Wellness and Substance Use Hubs. Thank you both. And thank you to Allison Kormendy, Todd Pryor, and Jayla Rousseau-Thomas for also joining us today and sharing their strategies and perspectives to improve mental wellness in the North.

Be sure to join us next time where we will learn about internet-based cognitive behavioural therapy programs in Saskatchewan, and how these programs are helping the people of Saskatchewan in rural, remote and northern communities.

 

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