Changes cut wait times for mental health counselling by 79 per cent in N.W.T.

The Northwest Territories government is laudingchanges to its health-care system that it says reduced wait timesfor mental health counselling by 79 per cent.

The territory released a report Tuesday on its implementation ofStepped Care 2.0 in partnership with the Mental Health Commission ofCanada and Stepped Care Solutions. The model for delivering mentalhealth and addictions recovery services is designed to meet people'sneeds with the least intensive and most effective options.

In the N.W.T. that included simplifying or eliminating intakeprocesses, getting rid of wait-lists, introducing drop-incounselling sessions and e-mental health services and launching amental wellness and addictions recovery advisory group.

The report said 47,563 counselling sessions were held in theterritory between 2020 and 2022, 27 per cent of which wereunscheduled or drop-in. It found median wait times between initialreferral and the first agreed-upon time for a session dropped from19 days to four during that period.

"I'm thrilled with the results," Health and Social ServicesMinister Julie Green said. "This seems to have been the change weneeded to make our (community counselling) program more culturallysafe, but also more accessible."

More work needed

"I was so impressed with the Northwest Territories," saidAnnMarie Churchill, president and lead executive officer with thenon-profit Stepped Care Solutions.

"The Stepped Care 2.0 model is really about open access, gettingthe right care for people when they need it ... they really focusedon that from the beginning."

The report said 72 per cent of those surveyed were satisfied withwait times and hours of counselling, 78 per cent were satisfied withtheir involvement in care decisions and 73 per cent were satisfiedwith their overall counselling experience.

The report also found, however, that more work is needed toenhance culturally safe programming and support Indigenousapproaches, as well as community-based and long-term treatmentoptions.

Among Indigenous service-users, 81 per cent said they weresatisfied with the safety of the counselling environment compared to93 per cent of non-Indigenous service users. Meanwhile, 72 per centof Indigenous and 82 per cent of non-Indigenous people surveyed saidthey were satisfied with the respect for individual needs, preferences and values based on racial identity.

'A huge system change'

Service providers reported lower rates of satisfaction.

Thirty-six per cent of those surveyed agreed they had seen positiveimpacts from the Stepped Care program, 38 per cent said it helpedthem work with clients to find care and practices to fit their needsand 42 per cent said it helped them provide recovery-oriented care.

"This was a huge system change. It really shifted the entire waythat we've offered care," said Carly Straker, who is manager of theterritory's mental wellness and addictions recovery quality andintegration unit. "So it just takes time."

She added that across Canada, there has long been a perceptionthat ongoing individual therapy at pre-scheduled sessions is thebest approach. The Stepped Care model, however, is based on theconcept that the best intervention is whatever meets a person'sneeds at any time.

"We're really recognizing that support can look a lot ofdifferent ways for a lot of different people," Straker said.

Other reports have raised concerns about mental health andaddictions recovery services in the territory, which has some of thehighest rates of mental health hospitalizations and addictions andsubstance use in Canada.

A 2022 auditor general's report found shortcomings in theaccessibility, co-ordination and cultural safety of addictionsservices, including aftercare support.

In October, the N.W.T.'s chief coroner, Garth Eggenberger,released numbers on deaths by suicide in 2021 and 2022 earlier thanplanned because they were unusually high. He said by the end of thethird quarter of 2022, there were 18 confirmed suicides, compared toa yearly average of 10 since 2011.

Then in January, Eggenberger reported an increase inopioid-related deaths in 2022, with six such deaths in the town ofHay River. There were five opioid toxicitydeaths across the territory in 2016, one in 2017, two in 2018, onein 2019 and three in both 2020 and 2021.

"We are trying to reach people in a variety of waysso thatwhen they decide that they need an intervention, that we're ready toprovide that intervention," Green said. "The key, though, is thatpeople need to want it, and that's not always the case."

Danielle Impey with the Mental Health Commission of Canada saidcontinuous quality improvement and collaborative partnerships arecore parts of the Stepped Care model.

The report said there is a need for ongoing communication andengagement so people know what care options are available. Greenadded that the territory is working to address its high vacancy ratefor counselling positions.

The Stepped Care model was developed in the United Kingdom.Stepped Care 2.0 was developed in Canada by Dr. Peter Cornish andfirst implemented at Memorial University in 2015 then provinciallyin Newfoundland and Labrador in 2017.

It has since been implemented in P.E.I., New Brunswick and NovaScotia and is used by Wellness Together Canada, a national virtualmental health service.

This story was produced with the financial assistance of the Metaand Canadian Press News Fellowship, which is not involved in the editorial process.