Manitoba government on hot seat after safe injection site recommendation cut from report

Poorly co-ordinated, underfunded mental health and addictions services in Manitoba lag behind the rest of the country — and will take a long time to repair, an extensive report suggests.

Health minister says wrong report on mental health and addictions was released to media

NDP Opposition Leader Wab Kinew says the Progressive Conservative government decided to conceal a recommendation for safe injection sites before releasing the report. (Rafferty Baker/CBC)

The Manitoba government is facing accusations of political interference after it released a report recommending a safe injection site in Winnipeg only to retract it hours later, saying it was a draft report not meant for the public.

The long-awaited review of Manitoba's mental health and addictions services, the Manitoba Mental Health and Addictions Strategy, Improving Access and Co-ordination of Mental Health and Addiction Services, was released to media on Monday morning.

It included a specific recommendation for a safe consumption site for the city — something Health Minister Kelvin Goertzen has publicly spoken against, citing a lack of supporting evidence to justify such a facility in Winnipeg.

The report released to media Monday morning, recommending a safe injection site.

When the government put the report online later in the afternoon, all recommendations for the safe injection site were removed, drawing criticism by the Opposition NDP that government tried to conceal recommendations it didn't like.

"So the government comes out here and says, 'Hey we gave you the secret report we weren't supposed to give you,'" said NDP Leader Wab Kinew.

"Somebody made a decision to conceal a very important recommendation that is going to impact in the city of Winnipeg.… The concern is with the political interference that has gone on after the government received this report."

The wording in the final draft of the report.

Government officials said they accidentally released a draft version and all decisions to remove content were made by Dr. Brian Rush, the report's author. Rush was forced to defend answers he gave to reporters in the morning, when he said no recommendations for a safe consumption site were made.

"Someone sent you the wrong report, that simple," Rush said. "You guys got an early draft."

Rush said he made the changes himself after realizing there was not enough data available for him to support a safe injection site in Winnipeg — despite his personal support for them.

"At the end of the day, I took it out," he said, adding that no one asked him to make the change.

The news of the edits to the report surprised Rick Lees, executive director of the Main Street Project, who saw the draft in December when the recommendation for a safe injection site remained. Lees is in the midst of trying to open Winnipeg's first injection site.

"It is concerning when you come out with a finding and the finding can be changed," he said. "My question would be for the author is to why did you do that."

'Perfect storm'

The report details how poorly co-ordinated, underfunded mental health and addictions services in Manitoba lag behind the rest of the country and will take a long time to repair.

"It's a trajectory propelled by multiple 'drivers,' many with deep historical roots," co-authors Rush and Adair Roberts wrote in the 287-page report.

"All of this is being managed with much the same resource base as was set decades ago during de-institutionalization — a perfect storm, if you will."

The province scrambled Monday after an early draft of a mental health and addictions report was released by mistake. 2:40

The report recommends boosting funds for mental health and addictions services, and says there's a need for greater crisis supports and collaboration between primary and community-based treatment services to create a "seamless continuum of services."

Right now, it's an "overly siloed system," with separate areas of care that are "significantly more integrated in all other Canadian jurisdictions."

Indigenous communities, women and youth are among those most affected by gaps in the addictions treatment system, the report says.

Colonization and residential schools, deinstitutionalization, the high number of children in care, increasing availability of drugs and alcohol and the increasing social complexity of people's lives are among the drivers of the problems, the report says.

Unable to meet demand

The province tapped Virgo last year to review Manitoba addiction and mental health services and suggest ways to better help Manitobans and families struggling with substance abuse issues.

Rush and Roberts carried out 80 consultations and interviewed 600 people (including addicts, Indigenous leaders and stakeholders involved in service delivery) from June to September 2017. They also reviewed population and health service data and pored over more than 275 documents from Manitoba health-care providers.

The authors say many people they spoke with shared serious concerns about wait times, limited hours of access to services, not knowing how to access treatment and not being able to find support close to home. Supports for family of those struggling with substance-abuse issues is also lacking, the report says.

"Overwhelmingly, service providers and the general public alike expressed significant concerns that the available services and supports are not able to meet current demand," the report says. "People are experiencing a system of services and supports that is essentially stretched too thin."

The report makes six "strategic priorities" recommendations, including urging a shift to a "whole-of-society" model.

The whole-of-society approach emphasizes the need for a model that helps address the range of needs of all community members.

The report recommends more funding for transition supports and community housing initiatives, investments in programming for youth, targeted and culturally appropriate mental health treatments for Indigenous communities, and prioritizing supporting the mental health-addiction workforce throughout the system-wide changes.

Ongoing meth crisis

The report comes amid meth and opioid crises in the province that have many calling for better access to detox centres, the creation of supervised consumption sites and more treatments options along the path to recovery.

In the past five years, Winnipeg alone had an enormous increase in the number of people whose methamphetamine use was noted by emergency room health-care workers, going from about 10 per month in 2013 to 190 per month in 2017, the authors say.

"Notwithstanding the many excellent examples of collaboration and partnership that we identified, from the perspective of individuals looking for help for themselves or a loved one, the rules of engagement seemed stacked against them, seemingly designed primarily to 'keep you out' rather than 'welcome you in,'" the authors wrote.

Though meth and opioids continue to plague various Manitoba communities, alcohol is still taking a "heavy toll" across demographics. Women in particular have challenges with quickly accessing treatment for alcohol addiction, the report says.

"While alcohol addiction is often overlooked during public discussion of addictions, it continues to represent roughly 80 per cent of all addictions problems in Manitoba and has by far the greatest impact on health and social well-being," Manitoba Health Minister Kelvin Goertzen said in a statement.  

'Solid foundation'

Although the report reinforces past observations of a fractured system, the authors note there also exists a "solid foundation" in the current system "on which a more accessible and co-ordinated system can be built."

The report recommends implementing a health model that tailors care based on the needs of individuals.

Such a system would span the gamut, with more intensive, highly specialized around-the-clock psychiatric and long-term recovery supports for those with the greatest needs (about 15,000 of the resident population), to better primary prevention and health education campaigns aimed at the general population (about 380,000 Manitobans).

Goertzen said the new strategy "offers a fresh start" and will help address "silos and gaps" in how mental health and addictions services are delivered in the province.

Increasing funding for mental health and addictions services alone won't fix the problem, the report says, though the authors recommend boosting funding over three years to get Manitoba in line with the national guideline of 7.2 per cent of provincial health funding for joint mental health and addictions services. Manitoba invested $506.3 million — or just 5.1 per cent of its health budget — to that area in 2016-17. 

The government should tack on an additional two per cent of funding annually to make up for historic funding gaps, the report says, and earmark eight per cent of all addictions and mental health budget funds for prevention.

The report suggests developing more culturally and language appropriate care options for Indigenous communities, and investing in more nimble community-level "one-stop-shop" hubs where those in the grips of addiction can access psychiatric care from cross-trained mental health and addictions professionals earlier in the intake process.

The province is expecting to roll out its implementation plan in the fall.

With files from Bryce Hoye, Kristin Annable, Cameron MacLean, Sean Kavanagh