The Northwest Territories government is lauding changes to its health-care system that it says reduced wait times for mental health counselling by 79 per cent.
The territory released a report Tuesday on its implementation of Stepped Care 2.0 in partnership with the Mental Health Commission of Canada and Stepped Care Solutions. The model for delivering mental health and addictions recovery services is designed to meet people’s needs with the least intensive and most effective options.
In the N.W.T. that included simplifying or eliminating intake processes, getting rid of wait-lists, introducing drop-in counselling sessions and e-mental health services and launching a mental wellness and addictions recovery advisory group.
The report said 47,563 counselling sessions were held in the territory between 2020 and 2022, 27 per cent of which were unscheduled or drop-in. It found median wait times between initial referral and the first agreed-upon time for a session dropped from 19 days to four during that period.
“I’m thrilled with the results,” Health and Social Services Minister Julie Green said. “This seems to have been the change we needed to make our (community counselling) program more culturally safe, but also more accessible.”
“I was so impressed with the Northwest Territories,” said AnnMarie Churchill, president and lead executive officer with the non-profit Stepped Care Solutions.
“The Stepped Care 2.0 model is really about open access, getting the right care for people when they need it … they really focused on that from the beginning.”
The report said 72 per cent of those surveyed were satisfied with wait times and hours of counselling, 78 per cent were satisfied with their involvement in care decisions and 73 per cent were satisfied with their overall counselling experience.
The report also found, however, that more work is needed to enhance culturally safe programming and support Indigenous approaches, as well as community-based and long-term treatment options.
Among Indigenous service-users, 81 per cent said they were satisfied with the safety of the counselling environment compared to 93 per cent of non-Indigenous service users. Meanwhile, 72 per cent of Indigenous and 82 per cent of non-Indigenous people surveyed said they were satisfied with the respect for individual needs, preferences and values based on racial identity.
Service providers reported lower rates of satisfaction. Thirty-six per cent of those surveyed agreed they had seen positive impacts from the Stepped Care program, 38 per cent said it helped them work with clients to find care and practices to fit their needs and 42 per cent said it helped them provide recovery-oriented care.
“This was a huge system change. It really shifted the entire way that we’ve offered care,” said Carly Straker, who is manager of the territory’s mental wellness and addictions recovery quality and integration unit. “So it just takes time.”
She added that across Canada, there has long been a perception that ongoing individual therapy at pre-scheduled sessions is the best approach. The Stepped Care model, however, is based on the concept that the best intervention is whatever meets a person’s needs at any time.
“We’re really recognizing that support can look a lot of different ways for a lot of different people,” Straker said.
Other reports have raised concerns about mental health and addictions recovery services in the territory, which has some of the highest rates of mental health hospitalizations and addictions and substance use in Canada.
A 2022 auditor general’s report found shortcomings in the accessibility, co-ordination and cultural safety of addictions services, 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 than planned because they were unusually high. He said by the end of the third quarter of 2022, there were 18 confirmed suicides, compared to a yearly average of 10 since 2011.
Then in January, Eggenberger reported an increase in opioid-related deaths in 2022, with six such deaths in the town of Hay River near the Alberta boundary. There were five opioid toxicity deaths across the territory in 2016, one in 2017, two in 2018, one in 2019 and three in both 2020 and 2021.
“We are trying to reach people in a variety of ways so that when they decide that they need an intervention, that we’re ready to provide that intervention,” Green said. “The key, though, is that people need to want it, and that’s not always the case.”
Danielle Impey with the Mental Health Commission of Canada said continuous quality improvement and collaborative partnerships are core parts of the Stepped Care model.
The report said there is a need for ongoing communication and engagement so people know what care options are available. Green added that the territory is working to address its high vacancy rate for counselling positions.
The Stepped Care model was developed in the United Kingdom. Stepped Care 2.0 was developed in Canada by Dr. Peter Cornish and first implemented at Memorial University in 2015 then provincially in Newfoundland and Labrador in 2017.
It has since been implemented in P.E.I., New Brunswick and Nova Scotia and is used by Wellness Together Canada, a national virtual mental health service.