The Council of Yukon First Nations has sent 197 people to Outside residential treatment centres for substance use disorders since October 2020.
Shadelle Chambers, executive director of CYFN, described how the initiative originated during the pandemic, when access to services was shuttered and travel restrictions were put in place. For a period of time, most of British Columbia’s Indigenous treatment centres stopped accepting out-of-province clients, or would only accept people if they had not flown in an aircraft to get there.
“People were then forced to have a whole bunch more barriers,” Chambers said.
These came in addition to pre-existing barriers to residential treatment put in place by the federal government’s non-insured health benefits program. Other requirements that served as barriers included things like needing to have a doctor, or to having a period of abstinence, and being officially registered under the Indian Act.
“It was like, barrier after barrier,” Chambers said.
The barriers to care were coupled with a soaring need for residential treatment because of the opioid, housing and pandemic crises, she said.
CYFN approached the federal government with the problem of lack of access just as the Yukon’s opioid crisis was beginning in 2019. Canada agreed to fund them to identify options to get Yukon First Nations people to treatment.
“We reached out to a number of private treatment centres in B.C., and one in Alberta, to see if they would enter into a private contract with us so we can just send people to them. And we would pay for the cost of those places,” she said.
The whole concept was developed with the involvement of the Yukon First Nations Health Commission, which consists of health directors from all of the 14 Yukon First Nations.
Residential treatment options
Alcohol and substance use treatment in Canada is a tiered system.
In the Yukon, everyone has access to the programs run out of the Sarah Steele building, either a fixed intake 35-day program, or a 10-day flexible intake program. In 2021, a total of 150 Yukoners accessed either the 10- or 35-day programs, according to the acting program director at Health and Social Services, Cameron Grandy.
Yukon First Nations, who are also status Indians, are able to go through their First Nation and the federal non-insured health benefits program to attend one of about 10 residential treatment centres in B.C. and Alberta. Two of these centres are family-based and the waiting list for those is six to eight months.
Other people, who work for a major employer with supplementary insurance programs, are eligible to have their residential treatment paid by their insurance. According to a Public Service Commission spokesperson, the Yukon government used to pay private centres directly for an employee’s treatment, but now arrangements and payment is made through the employee’s insurance benefits.
Any other Yukoners, including people who are “non-status Indians” according to the federal government, have to pay their own way for a residential program outside the territory. Prices start at $250 per day.
Aftercare for long-term recovery
The Outside programs utilized by CYFN are six to eight weeks long. Some have stabilization beds available prior to treatment and some have longer term aftercare programs attached for relapse prevention.
CYFN is also working to build secondary steps of treatment to follow the initial multi-week programs.
“Right now, we recognize that there’s a huge gap in second stage, so people can go to their intense six- to eight-week treatment. But they come back here and there’s no formalized recovery. There’s no second stage, there’s no housing.”
Recognizing the challenge of discharge planning and need for long-term support, Chambers says they have sent 30 people to second stage recovery programs. “But they’re living in B.C., they’re not living here.”
B.C. operates a system of long-term recovery homes, while the Yukon has none.
“They’re not coming back to their home and their culture and their community and their families,” Chambers said. “However, that’s all we have.”
John Kelly, a professor of addiction medicine at Harvard University, has lauded the importance of multi-stage treatment. He outlined this at a national summit on addiction in Edmonton last April.
“The clinical course of addiction is often a chronic one characterized by several episodes of treatment and shorter periods of remission and relapse, before full sustained remission is achieved,” he said.
He writes that the majority of individuals with substance use disorder achieve full sustained remission, but that it may take several years following the achievement of sustained remission before the risk of substance use disorder is no higher than the general population. This means that “ongoing recovery monitoring and management over the long-term may be required to facilitate long-term recovery.”
Chambers considers this initiative as a pilot program. It has been useful to understand the needs, the requirements of referral processes and how wraparound supports and services can be delivered, she said.
“Truly, what we need is a Yukon First Nations-based treatment centre.”
Chambers has been talking with federal ministers and defining the request for a formal Yukon First Nations treatment centre. Chambers says the number of people sent out speaks to the needs of the community of Yukon First Nations.
“What we’ve learned is we need a variety of options for people who have a variety of needs. We know that youth treatment remains a significant gap, we know that family treatment remains a significant gap.”
Chambers is advocating for a balance of both approaches and worldviews. “We have got to meet people where they’re at, when they’re ready.” She adds that the opioid crisis is getting a lot of attention, but that alcohol remains one of the bigger issues.
She recognizes that preventative supports are lacking in the territory and detox beds are limited. She says that the government’s withdrawal services are far too institutionalized and do not provide a culturally safe space.
CYFN currently has six counsellors available for Yukon First Nations in their new building at 206 Alexander Street, adjacent to their main building on 2nd Ave.
“We’re building our own capacity, and then working with the First Nations to help support them go to their land-based healing camps, as a second stage, or maybe as a preventative stage” she said.
“This initiative has let us dip our toes into this area a bit to understand all the variables, the needs, the money, the money behind it — treatment is costly. But also, so is the cost of addictions and trauma in our healthcare system, and our education system.”
Contact Lawrie Crawford at firstname.lastname@example.org