Safe-injections sites became an even bigger controversy for the Pallister government after Manitoba Health mistakenly released a version of the provincial mental health and addictions strategy Monday that recommended the province set up a safe-injection site in Winnipeg.
The long-awaited report from Virgo Planning and Evaluation Consulting Inc. puts forward more than 130 recommendations for the government. Among the recommendations released to reporters is that they make increases to harm reduction services, "including a safe-injection site in Winnipeg."
But that recommendation didn’t make it into the final version of the report — an error that reporters first noticed when the report’s lead author, Dr. Brian Rush, denied making such a recommendation during its public release.
Brian Pallister’s government seemed to realize the mistake hours later when NDP Leader Wab Kinew and health critic Andrew Swan repeatedly called on them to commit to the recommendation during question period.
Tory MLAs heckled the report didn’t recommend one.
"It is not in the report," boomed Radisson MLA James Teitsma.
Health Minister Kelvin Goertzen said he did not ask Rush to take the recommendation out and that the only time he’s spoken with the report’s author about safe-injection sites was Monday morning ahead of its release.
Rush said he hasn’t spoken with the government about safe injection sites at all.
"The recommendations that I received, as minister and as a government, are contained in his final report," Goertzen told reporters. "I have not asked Dr. Rush to do anything to the draft report."
Rush is personally supportive of safe-injection sites but told reporters he took the recommendation out as recently as two weeks ago because "I didn’t have the data."
"I sat in my office and I looked at that and I said I didn’t have enough to defend it one way or another besides my personal conviction that those resources are really helpful," he said.
Rush said nobody in government asked him to remove the recommendation and he had no discussions with government about it.
The fact that an early draft of the report, which is the result of extensive review and public consultation, was what went out to reporters is "really unfortunate," Rush said, who had earlier in the day applauded the government for releasing the report in its unvarnished entirety.
"At the end of the day," he said, "this little stain drops onto a report that is actually a good report and helpful in this province."
Goertzen wouldn’t say how the error came about.
"I’m not going to throw anybody under the bus," he said. "I’m the minister, I’ll take accountability."
Goertzen also wouldn’t commit to implementing all the recommendations in the final report, despite standing in front of signs proudly proclaiming the province’s "new direction" and "better results."
He did announce $1.2 million in funding for five Rapid Access to Addictions Medicine clinics in keeping with the report last week. The clinics are modeled after existing facilities in Ontario, which seek to connect people struggling with addictions more quickly with the care best suited to them. Those five clinics are expected to open sometime this summer.
However, Goertzen was mum as to the rest.
"We’ve received the final recommendations today, so the department will put forward… an implementation plan," he said.
Goertzen also would not make specific comments as to the recommended funding changes.
Per the Virgo report estimates, the province spends more than $506 million a year on substance use, addiction and mental health issues, of which $330.7 million comes from the health care budget. Still, that funding amounts to just 5.1 per cent of the total health budget, a figure below the national benchmark of 7.2 per cent.
Rush and his colleagues would like to see the province increase targeted mental health and substance use and addiction funding to between seven and nine per cent over the next three years in order to reach the national benchmark and to make up for the historic funding gap.
"I can’t commit that that will change overnight," said Goertzen, "but obviously we need to start moving to narrow that gap."
Ultimately, Manitoba is going to have to make lots of changes to how it handles mental health and addiction services if it’s going to meet the increasingly high need of its residents, the Virgo report warns, and it’s not just about funding. The report paints a portrait of a province not keeping up. As expected, it recommends bridging the gap between mental health and addictions — currently treated as two distinct issues with their own services — to improve access and to create better and more continuous care.
"There is a significant cost of doing nothing," Rush said. "The status quo, quite frankly, should not be acceptable."
The report says the province needs to eliminate long waits to access services, increase the availability of services in rural and northern communities, and take steps to fill gaps between acute-care services and community-based ones.
Among the swath of recommendations are centralized intake for addictions and mental-health services, a formal systems audit of barriers to access, a Telehealth expansion, more community-based treatment options with extended hours, and increased capacity for mental health housing supports. The report also recommends support to personal care homes so they can take in people with mental-health and addictions issues so they don’t have to stay unnecessarily in inpatient facilities.
Virgo also recommends the province expand and diversify its workforce, adding more peer support workers, recovery coaches, psychiatrists, psychologists and nurse practitioners, among other roles.
"This is a report calling for a bold government response," Rush said. "Justice, families, education, virtually every part of government can own a piece of this report."
Its unfortunate, then, that the government’s clerical error has cast doubt on the final report, opposition leaders said.
Kinew said the "secret" report calls into question a strategy that was meant to be about "the best interests and the well-being of Manitobans."
"Somebody made the decision to conceal a very important recommendation that is going to impact people in the city of Winnipeg," he said, noting his concern is not with Rush’s work but with the "political interference."
The report has lost its credibility, said Liberal leader Dougald Lamont.
"I feel very badly for the experts who prepared this," he said, "but there are at least two different versions of this report and one of them had some very big changes made to it."
Neither Goertzen nor Rush could say exactly how much was changed given how extensive the list of recommendations is in both reports, a closer read is needed to catalogue a full list of revisions.
While Rush said he didn’t feel like he had enough evidence in the end to recommend a safe injection site, he does recommend the government do the leg work to see if one might beneficial. Such a study would involve researching the number of drug users on the streets, what drugs they are using — heroin? Crystal meth? Cocaine? — and what the demand for such a site is among those who are using, he said, a deeper dive than Virgo was tasked with. Rush did note that if he had known that Main Street Project had a proposal for a safe consumption site he would have asked to see it as part of his work.
"This is not a negative statement on safe injection sites. I simply did not have enough information," Rush said. "I couldn’t have stood here and defended that as I can the rest of the report."
— with files from Nick Martin
Updated on Tuesday, May 15, 2018 at 10:04 AM CDT: Updates with writethrough