Canada-Yukon Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26)

Table of contents

• Funding agreement
• Annex 1 – Common statement of principles on shared health priorities
• Annex 2 – Shared pan-Canadian interoperability roadmap
• Annex 3 – Headline common indicators
• Annex 4 – Action plan

Funding agreement

(the "Agreement")

BETWEEN:

REFERRED to collectively as the "Parties", and individually as a "Party"

PREAMBLE

WHEREAS, on July 6, 2023 Canada and Yukon announced an overarching agreement in principle on Working Together to Improve Health Care for Canadians, supported by almost $200 billion over ten years in federal funding, including $46.2 billion in new funding to provinces and territories;

WHEREAS, Canada has also announced a 5 per cent Canada Health Transfer (CHT) guarantee for the next five years, starting in 2023-24, which will be provided through annual top-up payments as required. This is projected to provide approximately an additional $17 billion over 10 years in new support. The last top-up payment will be rolled into the CHT base at the end of the five years to ensure a permanent funding increase, providing certainty and sustainability to provinces and territories;

WHEREAS, Working Together to Improve Health Care for Canadians includes a federal commitment of $25 billion in bilateral funding to provinces and territories over ten years focused on four shared health priorities:

• expanding access to family health services, including in rural and remote areas;
• supporting our health workers and reducing backlogs;
• improving access to quality mental health, substance use, and addictions services; and
• modernizing health systems with health data and digital tools.

WHEREAS, in the area of mental health, substance use, and addictions services, Working Together to Improve Health Care for Canadians also includes a commitment by Canada and Yukon to continue to work to support collaboration on the Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the "Common Statement", attached hereto as Annex 1), supported by the federal Budget 2017 investment of $5 billion over ten years;

WHEREAS, Yukon has the primary responsibility for delivering health care services to its residents and supports diversity, equity, and the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+;

WHEREAS, Canada authorized the federal Ministers to enter into agreements with the provinces and territories, for the purpose of identifying activities that provinces and territories will undertake in respect of the four shared health priorities, and for funding in this Agreement associated with the federal investment for mental health, substance use, and addictions services consistent with the Common Statement (and menu of actions outlined in Annex 1);

WHEREAS, the Government Organization Act authorized the territorial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Yukon associated with the federal investment for four shared health priorities, and mental health, substance use and addictions services consistent with the Common Statement; and

NOW THEREFORE, this Agreement sets out the terms between Canada and Yukon as follows:

1.0 Key Principles and Collaboration

The key principles and commitment to collaboration agreed to in Working Together to Improve Health Care for Canadians are outlined below.

1.1 Canada and Yukon acknowledge that this Agreement will mutually respect each government's jurisdiction, and be underpinned by key principles, including:

• A shared responsibility to uphold the Canada Health Act that strengthens our public health care system;
• Principles agreed to in the Common Statement (outlined in Annex 1);
• Reconciliation with Indigenous Peoples, recognizing their right to fair and equal access to quality and culturally safe health services free from racism and discrimination anywhere in Canada, including through seamless service delivery across jurisdictions and meaningful engagement and work with Indigenous organizations and governments; and
• Equity of access for under-served groups and individuals, including those in official language minority communities.

1.2 Canada and Yukon acknowledge the importance of supporting health data infrastructure, data collection and public reporting, and will work together to improve the collection, sharing and use of de-identified health information, respecting federal/provincial/territorial privacy legislation, to improve transparency on results and to help manage public health emergencies, and to ensure Canadians can access their own health information and benefit from it being shared between health workers across health settings. This includes:

• collecting and securely sharing high-quality, comparable information needed to improve services to Canadians, including disaggregated data on key common health indicators with the Canadian Institute for Health Information (CIHI);
• adopting common interoperability standards (both technical exchange and content of data), including the Shared pan-Canadian Interoperability Roadmap (outlined in Annex 2), to improve Canadians' access to their health information in a usable digital format and support the exchange and analysis of health data within and across Canada's health systems in a way that protects Canadians' privacy and ensures the ethical use of data to improve the health and lives of people;
• work to align provincial and territorial policies and legislative frameworks where necessary and appropriate to support secure patient access to health information, and stewardship of health information to support the public good, including improving care quality, patient safety, privacy protection, system governance and oversight, planning and research;
• promoting health information as a public good by working with federal-provincial-territorial Ministers of Health to review and confirm overarching principles, which would affirm Canadians' ability to access their health information and have it follow them across all points of care. The existing draft Health Data Charter, as outlined in the Pan-Canadian Health Data Strategy would serve as the starting point for the discussion of these principles; and
• collecting and sharing available public health data (e.g., vaccination data, testing data) with the Public Health Agency of Canada to support Canada's preparedness and response to public health events, building on commitments made as part of the Safe Restart Agreements.

1.3 Canada and Yukon acknowledge they will work with other provinces and territories to streamline foreign credential recognition for internationally-educated health professionals, and to advance labour mobility, starting with multi-jurisdictional recognition of health professional licences.

1.4 Canada and Yukon acknowledge a mutual intent to engage in a two-phased formal review process:

1. Phase 1: This review will be done in 2026 by a joint committee of Federal, Provincial, and Territorial health and finance officials to assess results and determine next steps for bilateral agreements related to improvements to home and community care, mental health, substance use, and addiction services associated with the Common Statement and long-term care; and
2. Phase 2: A formal five-year review of the healthcare plan outlined on February 7, 2023, recognizing the importance of long-term sustainability for provincial-territorial health systems. This review would consist of an assessment of both the bilateral agreements (herein) and the CHT investments (not included as part of this bilateral agreement). The review will be done by a joint committee of Federal, Provincial, and Territorial health and finance officials, commencing by March 31, 2027, and concluded by December 31, 2027, to consider results achieved thus far in the four shared health priority areas and will include:
   1. an assessment of progress-to-date on public reporting to Canadians using the common indicators;
   2. sharing of de-identified health information, and other health data commitments; and
   3. current and forward-looking Federal, Provincial, and Territorial investments to support this plan.

2.0 Objectives

2.1 Canada and Yukon agree that, with financial support from Canada, Yukon will continue to build and enhance health care systems towards achieving some or all of the objectives of:

• timely access to high-quality family health services, including in rural and remote areas;
• a sustainable, efficient and resilient health workforce that provides Canadians timely access to high-quality, effective, and safe health services;
• access to timely, equitable, and quality mental health, substance use, and addictions services to support Canadians' well-being; and
• access to a patient's own electronic health information that is shared between the health professionals they consult to improve safety and quality of care, and which informs Canadians on how the system is working.

2.2 Canada and Yukon agree that, with Budget 2017 financial support from Canada outlined in 5.2.2, Yukon will continue to work to improve access to mental health, substance use, and addictions services consistent with the Common Statement (and menu of actions outlined in Annex 1).

3.0 Action Plan

3.1 Yukon set out in their Action Plan (attached as Annex 4) how the federal investment under this Agreement will be used, as well as details on targets and timeframes based on common headline indicators in priority areas where federal funds will be invested, as well as jurisdiction-specific indicators, for each of the initiatives.

3.2 Yukon will invest federal funding as part of the 2017 commitment for mental health, substance use, and addictions services provided through this Agreement in alignment with the menu of actions listed in the Common Statement.

3.3 Yukon will invest federal funding in some or all of the four shared health priority areas, without displacing existing planned spending in those areas.

3.4 In developing initiatives under this Agreement, Yukon agrees to implement measures that also respond to the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+.

3.5 Yukon's approach to achieving objectives is set out in their three-year Action Plan (2023-24 to 2025-26), as set out in Annex 4.

4.0 Term of Agreement

4.1 This Agreement comes into effect upon the date of the last signature of the Parties and will remain in effect until March 31, 2026 ("the Term"), unless terminated in accordance with section 11 of this Agreement. Funding provided under this Agreement will cover the period April 1, 2023 to March 31, 2026.

4.2 Renewal of Bilateral Agreements

4.2.1 Upon signing renewed bilateral agreements, Yukon will have access to the remainder of its share of the federal funding, subject to appropriation by Parliament, for:

• 2026-27, the allocation based on the federal commitment in Budget 2017 of $5 billion over ten years for mental health, substance use and addiction services; and
• 2026-27 to 2032-33, the allocation based on the federal commitment in Budget 2023 of $25 billion over ten years to support the Working Together to Improve Health Care for Canadians plan.

5.0 Financial Provisions

5.1 The funding provided under this Agreement is in addition to and not in lieu of those that Canada currently provides under the CHT to support delivering health care services within the territory.

5.2 Allocation to Yukon

5.2.1 In this Agreement, "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

5.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative based on the allocation method outlined in subsection 5.2.3 for the Term of this Agreement.

Working Together to Improve Health Care for Canadians

1. $2.5 billion for the Fiscal Year beginning on April 1, 2023
2. $2.5 billion for the Fiscal Year beginning on April 1, 2024
3. $2.5 billion for the Fiscal Year beginning on April 1, 2025

Budget 2017 Mental Health, Substance Use, and Addictions Services

1. $600 million for the Fiscal Year beginning on April 1, 2023
2. $600 million for the Fiscal Year beginning on April 1, 2024
3. $600 million for the Fiscal Year beginning on April 1, 2025

5.2.3 Allocation Method

1. For the funding associated with Working Together to Improve Health Care for Canadians, annual funding will be allocated to provinces and territories on base ($5,000,000 if population is less than 100,000; $20,000,000 if population is between 100,000 and 500,000; and $50,000,000 if population is greater than 500,000) plus per capita basis. The final total amount to be paid to each jurisdiction will be calculated using the following formula: B + (F - ((N * 5,000,000) + (O * 20,000,000) + (S * 50,000,000)) x (K / L), where:

   B is the base amount allocated to each province or territory based on population ($5,000,000 if population is less than 100,000; $20,000,000 if population is between 100,000 and 500,000; and $50,000,000 if population is greater than 500,000), as determined using annual population estimates on July 1^st from Statistics Canada;

   F is the total annual funding amount available outlined under this program;

   N is the number of provinces and territories with a population less than 100,000, as determined using annual population estimates on July 1^st from Statistics Canada;

   O is the number of provinces and territories with a population between 100,000 and 500,000, as determined using annual population estimates on July 1^st from Statistics Canada;

   S is the number of provinces and territories with a population greater than 500,000, as determined using annual population estimates on July 1^st from Statistics Canada;

   K is the total population of Yukon, as determined using annual population estimates on July 1^st from Statistics Canada; and

   L is the total population of Canada, as determined using annual population estimates on July 1^st from Statistics Canada.

2. For funds associated with Budget 2017 Mental Health, Substance Use, and Addictions Services, annual funding will be allocated to provinces and territories on a per capita basis. The per capita funding for each Fiscal Year, is calculated using the following formula: F x K/L, where:

   F is the annual total funding amount available under this program;

   K is the total population of Yukon, as determined using the annual population estimates on July 1^st from Statistics Canada; and

   L is the total population of Canada, as determined using the annual population estimates on July 1^st from Statistics Canada.

5.2.4 Subject to annual adjustment based on the formulas described in section 5.2.3, Yukon estimated share of the amounts will be:

5.3 Payment

5.3.1 Funding provided by Canada will be paid in semi-annual installments as follows:

1. In 2023-2024, the first installment will be paid within approximately 30 business days of execution of this Agreement by the Parties. The second installment will be paid on or about November 15.
2. Starting in 2024-2025, the first installment will be paid on or about April 15 of each Fiscal Year and the second installment will be paid on or about November 15 of each Fiscal Year.
3. The first installment will be equal to 50% of the notional amount set out in section 5.2.4 as adjusted by section 5.2.3.
4. The second installment will be equal to the balance of funding provided by Canada for the Fiscal Year as determined under sections 5.2.3 and 5.2.4.
5. Canada will notify Yukon prior to the first payment of each Fiscal Year, of their notional amount. The notional amount will be based on the Statistics Canada quarterly preliminary population estimates on July 1 of the preceding Fiscal Year. Prior to the second payment, Canada will notify Yukon of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
6. Canada shall withhold payments if Yukon has failed to provide reporting in accordance with 7.1.
7. Canada shall withhold the second payment in 2023-24 if Yukon has failed to satisfy all reporting requirements associated with the preceding Canada – Yukon Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23, specifically to:
   1. continue to participate in a Federal-Provincial-Territorial process to improve reporting on and provide data to CIHI for the 6 common indicators to measure pan-Canadian progress on improving access to mental health, substance use, and addictions services; and
   2. submit an annual financial statement, with attestation from the Government of Yukon's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada for mental health and addiction services under the Canada – Yukon Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23 compared against the Expenditure Plan, and noting any variances, between actual expenditures and the Expenditure Plan.
8. The sum of both installments constitutes a final payment and is not subject to any further payment once the second installment has been paid.
9. Payment of Canada's funding for this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.

5.4 Retaining Funds

5.4.1 For Fiscal Years 2023-24 through 2024-25, upon request, Yukon may retain and carry forward to the next Fiscal Year up to 10 percent of funding that is in excess of the amount of the eligible costs actually incurred in a Fiscal Year and use the amount carried forward for expenditures on eligible areas of investment. Any request to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by their designated officials, at the Assistant Deputy Minister level (herein referred to as "Designated Officials"), and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.

5.4.2 Any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to Yukon under subsection 5.2.4 of this Agreement in the next Fiscal Year.

5.4.3 Upon request, Yukon may retain and carry forward up to 10 percent of funding provided in the last Fiscal Year of this Agreement for eligible areas of investment, to be noted in the new agreement and subject to the terms and conditions of that new agreement. The new Action Plan will provide details on how any retained funds carried forward will be expended. Any request by Yukon to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by their Designated Officials, and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.

5.5 Repayment of overpayment

5.5.1. In the event payments made exceed the amount to which Yukon is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Yukon shall repay the amount within sixty (60) calendar days of written notice from Canada.

5.6 Use of Funds

5.6.1. The Parties agree that funds provided under this Agreement will only be used by Yukon in accordance with the initiatives outlined in Annex 4.

5.7 Eligible Expenditures

5.7.1. Eligible expenditures under this Agreement are the following:

• data development and collection to support reporting;
• information technology and health information infrastructure;
• capital and operating funding;
• salaries and benefits;
• training, professional development; and
• information and communications material related to programs.

6.0 Performance Measurement

6.1 Yukon agrees to designate an official or official(s), for the duration of this Agreement to participate in a CIHI led Federal-Provincial-Territorial indicator process to:

1. Refine the eight common headline indicators (outlined in Annex 3);
2. Work to identify additional common indicators that are mutually agreed upon, including indicators focused on the health of Indigenous populations with acknowledgement of the role for Indigenous partners in this work;
3. Improve reporting on common indicators to measure pan-Canadian progress on improving access to mental health, substance use, and addictions services, associated with the commitment in the Common Statement; and
4. Share available disaggregated data with CIHI and work with CIHI to improve availability of disaggregated data for existing and new common indicators to enable reporting on progress for underserved and/or disadvantaged populations including, but not limited to, Indigenous peoples, First Nations, Inuit, Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+.

7.0 Reporting to Canadians

7.1 Funding conditions and reporting

7.1.1 By no later than October 1, in each fiscal year, with respect of the previous Fiscal Year, Yukon agrees to:

1. Provide data and information annually to CIHI related to the new headline indicators, additional common indicators, and the mental health, substance use, and addictions services indicators identified as part of commitment made in the Common Statement.
2. Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to residents of Yukon on progress made on targets outlined in Annex 4 (Action Plan) for headline indicators in the priority area(s) where federal funds are to be invested, and on jurisdiction-specific indicators for each of the initiatives tailored to their jurisdiction's needs and circumstances.
3. Beginning in Fiscal Year 2024-25, provide to Canada an annual financial statement, with attestation from the Government of Yukon's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada under this Agreement or the Previous Agreement compared against the Action Plan, and noting any variances, between actual expenditures and the Action Plan:
   1. The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
   2. The total amount of funding used for each of the shared health priority areas that are supported by the federal funds;
   3. If applicable, the amount of any funding carried forward under section 5.4; and
   4. If applicable, the amount of overpayment that is to be repaid to Canada under section 5.5.

7.1.2 Yukon will provide quarterly reporting to Canada on the management and spending of the funds retained to the next Fiscal Year.

7.2 Audit

7.2.1 Yukon will ensure that expenditure information presented in the annual financial statement is, in accordance with Yukon's standard accounting practices, complete and accurate.

7.3 Evaluation

7.3.1 Responsibility for evaluation of programs rests with Yukon in accordance with its own evaluation policies and practices.

8.0 Communications

8.1 The Parties agree on the importance of communicating with citizens about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.

8.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.

8.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

8.4 Yukon will make publicly available, clearly identified on a Government of Yukon website, this Agreement, including any amendments.

8.5 Canada, with prior notice to Yukon, may incorporate all or any part of the data and information in 7.1, or any part of evaluation and audit reports made public by Yukon into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

8.6 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Canada agrees to give Yukon 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

8.7 Yukon reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Yukon agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

8.8 Canada and Yukon agree to participate in a joint announcement upon signing of this Agreement.

8.9 Canada and Yukon agree to work together to identify mutually agreeable opportunities for joint announcements relating to programs funded under this Agreement.

9.0 Dispute Resolution

9.1 The Parties are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

9.2 If at any time a Party is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, that Party may notify the other Party in writing of the failure or breach. Upon such notice, the Parties will endeavour to resolve the issue in dispute bilaterally through their Designated Officials.

9.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and Yukon responsible for health, and if it cannot be resolved by them, then the federal Minister(s) and the territorial Minister(s) shall endeavour to resolve the dispute.

10.0 Amendments to the Agreement

10.1 The main text of this Agreement may be amended at any time by mutual consent of the Parties. Any amendments shall be in writing and signed, in the case of Canada, by the federal Minister(s), and in the case of Yukon, by the territorial Minister(s).

10.2 Annex 4 may be amended at any time by mutual consent of the Parties. Any amendments to Annex 4 shall be in writing and signed by each Party's Designated Official.

11.0 Termination

11.1 Either Party may terminate this Agreement at any time if the terms are not respected by giving at least 6 months written notice of intention to terminate.

11.2 As of the effective date of termination of this Agreement, Canada shall have no obligation to make any further payments.

11.3 Sections 1.0, and 8.0 of this Agreement survive for the period of the 10-year Working Together to Improve Health Care for Canadians plan.

11.4 Sections 5.4 and 7.0 of this Agreement survive the termination or expiration of this Agreement until reporting obligations are completed.

12.0 Notice

12.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter, email, postage or other charges prepaid. Any communication that is delivered will be deemed to have been received in delivery; and, except in periods of postal disruption, any communication mailed by post will be deemed to have been received eight calendar days after being mailed.

The address of the Designated Official for Canada shall be:

Assistant Deputy Minister, Strategic Policy Branch
Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9
Email: jocelyne.voisin@hc-sc.gc.ca

The address of the Designated Official for Yukon shall be:

Assistant Deputy Minister, Corporate Services
Health and Social Services
Government of the Yukon, H-1
P.O. Box 2703
201-#1 Hospital Road
Whitehorse, Yukon
Y1A 3H7
Email: Paul.Payne@yukon.ca

13.0 General

13.1 This Agreement, including Annexes, comprises the entire Agreement entered into by the Parties.

13.2 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Yukon.

13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Yukon shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

13.4 If for any reason a provision of this Agreement, that is not a fundamental term, is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be severed and deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

13.5 This Agreement may be executed in counterparts, in which case (i) the Parties have caused this Agreement to be duly signed by the undersigned authorized representatives in separate signature pages in accordance with the following signature process, which together shall constitute one agreement, and (ii) the Parties agree that facsimile signature(s) and signature(s) transmitted by PDF shall be treated as original signature(s). Electronic signature(s) may be accepted as originals so long as the source of the transmission can be reasonably connected to the signatory.

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Canada by the Minister of Health

The Honourable Mark Holland, Minister of Health

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Canada by the Minister of Mental Health and Addictions and Associate Minister of Health

The Honourable Ya'ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Yukon by the Minister of Health and Social Services

The Honourable Tracy-Anne McPhee, Minister of Health and Social Services

Annex 1 – Common Statement of Principles on Shared Health Priorities

Common Statement of Principles on Shared Health Priorities

Annex 2 – Shared pan-Canadian interoperability roadmap

Annex 3 – Headline common indicators

Annex 4 – Action plan

Overview/ Background

The Government of Yukon remains committed to delivering responsive health and social services that place patients, families, caregivers and the dedicated health and social services workforce at the centre of this work. Guided by the 2020 Putting People First report, the Government of Yukon is working to create a healthcare system that is high-performing, integrated, collaborative, culturally safe, anti-racist and puts Yukoners at the center.

Working Together to Improve Health Care for Canadians includes a federal commitment of $25 billion in bilateral funding to provinces and territories over ten years focused on four shared health priorities:

• expanding access to family health services, including in rural and remote areas;
• supporting our health workers and reducing backlogs;
• improving access to quality mental health, substance use, and addictions services; and
• modernizing health systems with health data and digital tools.

The annual $7.27M allocation of federal funding available through the "Agreement to Work Together to Improve Health Care for Canadians" [hereinafter agreement] represents an increase of approximately 1.5% to the Department of Health and Social Services current annual operating budget. The Yukon will focus on the following two priorities:

• improving access to quality mental health, substance use, and addictions services via our response to our Substance Use Health Emergency; and
• to expanding access to family health services through the opening of a walk-in medical clinic.

Activities related to the other two agreed upon priorities are being actioned as part of the Yukon's Putting People First recommendations. These activities are not included within this agreement. Descriptions and progress updates on these priorities can be found in the Putting People First 2023 Annual Report here.

This action plan may require updating in the future to shift activities across other identified shared priorities to meet evolving and other pressures and priorities important to the Yukon. It is imperative that the agreement meets the needs as well as the priorities of Yukoners; by supporting the principles of flexibility and low administrative burden.

Transforming primary care

The Government of Yukon continues to work towards the goal of ensuring that all Yukoners have access to the health care and supportive services they need, when they need them. A new walk-in clinic in Whitehorse seeks to support this goal by providing accessible, comprehensive primary care services. This clinic is a tangible measure to improve health care access and alleviate some pressures on Whitehorse General Hospital's emergency department. In alignment with our efforts to address the Substance Use Health Emergency, the clinic will also have the capacity to support individuals with substance use or mental health issues and will facilitate referrals to appropriate mental wellness and substance use programs and services.

In recognition of the perspectives and experiences of specific populations, including First Nations citizens and others who have historically faced barriers to health care access, the clinic's services will reflect the Yukon government's commitment to inclusivity, respect, and person-centered, trauma-informed care, while also making tangible improvements in Yukoners' health and wellbeing.

Substance Use Health Emergency

On January 20, 2022, the Government of Yukon (YG) declared a Substance Use Health Emergency in response to the dramatic increase in overdose-related deaths and substance use-related harms in the territory. This declaration was a commitment to respond and a call to action to all governments, communities, organizations, partners and Yukoners to do their part to address this emergency.

Since the declaration of the Substance Use Health Emergency, our government has worked closely with community partners, First Nations and governments to coordinate our ongoing response to many substance use issues in the territory, including those related to alcohol and to advance a range of treatment, harm reduction, prevention, community safety and awareness initiatives.

Despite diligent efforts by government and community partners to expand and improve mental wellness and substance use -related services in the territory and ultimately reduce demand, toxic drugs continue to circulate in our communities, and many Yukoners still struggle with substance use.

The Yukon is experiencing the effects of the toxic drug crisis at an alarming rate. 25 deaths in 2022 were attributed to toxic substances, 20 of which involved opioids in our territory of about 43,000 people. On a per capita basis, this rate is worse than in B.C., which had the country's highest death toll last year with 2,272 suspected illicit drug toxicity deaths.

On May 5, 2023, Yukon's Chief Coroner confirmed that eight people died between April 7 and 27, all related to substance use, in Whitehorse and in two separate Yukon communities. This brought the total number of toxic drug poisoning deaths to-date in 2023 to 11.

The government launched a new Yukon Substance Use Health Emergency Strategy in August 2023, based on four pillars of growth: Prevention, Harm Reduction, Treatment and Recovery Support, and Community Safety and Wellbeing.

Substantial new funding is required to implement initiatives proposed within this strategy.

The development of the Yukon Substance Use Health Emergency Strategy was informed by a detailed research and engagement process that included:

• Mental Wellness Summits
• Opioid Treatment Services needs assessment
• Journey maps with Mental Wellness and Substance Use Service clients.
• Extensive consultation with frontline providers
• One Death is Too Many: Grappling with the Overdose Epidemic in the Yukon report
• Substance Use Health Emergency Strategy Project Executive Committee

Targeted engagement with multiple stakeholders including Yukon First Nations governments, multiple Yukon government departments and program areas, Blood Ties Four Directions Yukon, the RCMP, Yukon Anti-Poverty Coalition, Whitehorse Chamber of Commerce, Klondyke Pediatrics, Yukon First Nation Education Directorate, City of Whitehorse and the Association of Yukon Communities. Substance use-related harms can be prevented – not just in the immediate term, but over the long haul through the application of evidence-based preventive initiatives. The strategy's recommendations strive to transform the wellness landscape in the Yukon for future generations, aiming to avoid future substance use related deaths.

In addition to harm reduction, treatment and aftercare, prevention is one of the strategy's key priorities.

The Yukon is committed to addressing the Substance Use Health Emergency by prioritizing prevention initiatives with a long-term approach. The strategy's mission is that partners will work together to implement innovative, bold, and evidence-based actions so that substance use related harms are reduced and the health and wellbeing of Yukoners improves.

The Substance Use Health Emergency Strategy includes 43 actions across the four areas for growth to guide the ongoing response to many substance use issues in the territory, including those related to alcohol. This agreement will fund some of these initiatives including increasing Yukoners access to opioid treatments; a significant increase in the number and availability of culturally appropriate land-based treatment programs; the development of community-specific wellness programs, Yukon's first managed alcohol program and more.

While the strategy provides a framework and sets out the overall direction, it is not a rigid action plan. This flexibility enables adaptability in implementation, allowing for adjustments based on real-time feedback, emerging evidence, and evolving priorities. Building on collaboration, we are dedicated to continuous dialogue with partners and communities, shaping our actions to be flexible and responsive to changing needs and realities. Continuous engagement with stakeholders on the published strategy will help the Yukon government to refine the prioritization, scope and implementation of the actions in the strategy.

The Substance Use Health Emergency Strategy is a living document, which means it will undergo regular updates and adaptations to stay relevant and responsive to changing circumstances and emerging needs.

Statement on reconciliation

Yukon First Nations are an important partner in the governance of the territory. First Nations' traditional territories cover almost all the land in Yukon. Of the 14 First Nations in the Yukon, 11 signed modern treaties between 1993 and 2005. These First Nations make laws and decisions on their Settlement Land and for their Citizens. The Government of Yukon works with all Yukon First Nations to deliver programs and services to Yukoners.

The development and implementation of the actions in the Substance Use Health Emergency Strategy took place, and will continue to unfold, on the traditional territories of the Indigenous people, represented today by the Carcross/Tagish First Nation, Champagne and Aishihik First Nations, First Nation of Na-Cho Nyäk Dun, Kluane First Nation, Kwanlin Dün First Nation, Liard First Nation, Little Salmon/Carmacks First Nation, Ross River Dena Council, Selkirk First Nation, Ta'an Kwäch'än Council, Teslin Tlingit Council, Trondek Hwech'in Government, Vuntut Gwitchin First Nation, White River First Nation, as well as the traditional territories overseen by the Acho Dene Koe First Nation, Dease River First Nation, Gwich'in Tribal Council, Inuvialuit Regional Corporation, Kwadacha Nation, Tahltan Central Government, Taku River Tlingit First Nation, and the Tetlit Gwich'in Council.

In executing the actions detailed in the Yukon Substance Use Health Emergency Strategy on these traditional territories, the Government of Yukon acknowledges the profound connection between the land and the health and wellbeing of Indigenous peoples. We recognize that the land extends beyond just the earth. It encompasses the water, air, food, medicines, and all aspects of nature.

The partners involved in this endeavour recognize and value the significance of Indigenous voices in all responses to the Substance Use Health Emergency. We acknowledge the necessity to consider the path to reconciliation, recognizing the ongoing impact of colonization on these lands and their people.

Reconciliation is a continuous journey of learning from the past to understand our present better, which enables us to envision and work towards a healthy future for all Yukoners.

The legacy of residential schools and the persistent effects of intergenerational trauma and colonization have led to significant health disparities between Indigenous and non-Indigenous people in the Yukon. These disparities, resulting in unjust, avoidable gaps in health outcomes, often stem from systemic injustice. All partners involved in the Substance Use Health Emergency Strategy committed to leveraging our work and influence to help reduce these gaps.

We recognize and honour the extraordinary resilience of Indigenous people in the Yukon, who have persisted in the face of these disparities and systemic barriers. These strengths form the foundation of improved health for all Yukoners.

The processes of health improvement and reconciliation can reinforce each other. The growth of reconciliation helps to create environments where disparities are reduced, and health and justice can thrive.

1. Initiatives supported by Working Together federal funds – expanding access to family health services, including in rural and remote areas;

1.1 Transforming primary care

Many Yukoners are having difficulty accessing primary care from a physician or nurse practitioner. As reported by the Canadian Institute for Health Information, in 2019-2020, about 17% of Yukoners did not have access to a primary health care provider, which was higher than the national average of 14.4%. As of December 18, 2023, a new walk-in clinic has opened in Whitehorse to increase access to primary care.

Yukoners in Whitehorse who do not have access to primary health care often must seek care through the emergency department at Whitehorse General Hospital. This is costly, reduces continuity of care and diverts resources from urgent and emergent care. Alternatively, some people simply choose to forgo seeking medical care entirely, which can result in increased adverse health outcomes and higher long term care costs.

The Yukon government has established a new walk-in primary care clinic in Whitehorse, which is expected to serve about 1500 patients per year once it is fully operational. The clinic will enable patients to book same-day appointments and will provide primary care services for non-urgent conditions for individuals without a dedicated primary care provider or for those unable to access a timely appointment with their provider.

The clinic will be staffed by family physicians, nurse practitioners, registered nurses, licensed practical nurses, and social workers who will be able to connect patients to other resources in the community. For example, Francophone patients could be referred to the bilingual health centre, and vulnerable adults with complex mental health challenges or substance use disorders could be referred to the referred care clinic. Services will be person-centered and trauma informed and will use a team-based approach.

2. Initiatives supported by Working Together federal funds – Canadians have access to timely, equitable and quality mental health, substance use and addictions services to support their wellbeing

2.1 Implement Icelandic Prevention Model (IPM) in Yukon communities

Description of activities

The IPM is a community based, data-driven approach to substance use prevention for youth. Instead of discussing the facts and faults of substance use with adolescents, the IPM aims to change the environments for youth to prevent substance use from occurring. The focus is on primary prevention; preventing the development of substance use.

The IPM has been successfully implemented in many countries around the world including Ireland, Spain, Lithuania, Scotland, Belgium, Chile, Mexico, and New Zealand. It has already been successfully implemented by several municipalities in Canada too.

At the heart of the IPM is the identification of community specific risk and protective factors for substance use among young people, interventions are community specific and designed with the subsequent goal of mitigating the risk factors and strengthening the protective factors via community-driven interventions that are tailored to the unique characteristics of each community. Community interventions are identified and implemented by the community and have been known to include, but not limited to, afterschool clubs (sports, cultural, arts), leadership workshops, family centric activities and events.

The Yukon plans to begin implementing the IPM in a phased approach, beginning with two communities or two 'local units' (a combination of communities grouped together as one local unit). An equitable process will determine which two communities have a combination of desire, need and capacity to implement the IPM model.

The intention is to start small, with two programs. If the approach proves to be successful, a phased approach will be implemented to roll out the IPM to all interested Yukon communities.

The IPM has decades of evidence showing that through cooperation of many stakeholders, including front-line providers, policy makers, family members, and teachers, prevention initiatives can almost completely reverse entrenched substance use in a society.

Many communities have found that increasing the role a family plays in young people's lives and increasing the opportunities for young people to engage in positive activities in their free time leads to healthier choices. Possible examples include family centric activities as well as organized and supervised leisure time activities which could be sport or organized recreation or clubs for youth. But the design and decisions on specific types of activities will be led by the community based on their own needs, interests and data.

The Planet Youth organization, that supports the implementation of the IPM, requires a five-year commitment. This is consistent with one of the main cornerstones of the approach: to consider long-term solutions to long-term challenges. It's important to note that implementing the IPM is a long-term commitment, and results may not be immediate. However, over time, it has the potential to create a healthier, more resilient community and improve the overall quality of public health services and care within the Yukon.

Rationale

The IPM is focused on substance use prevention, but because there is so much overlap between risk and protective factors, positive changes in other key behaviours such as bullying, sexual abuse, unwanted pregnancies, crime, violence, and school attendance have been observed in other countries' Planet Youth programs. In Iceland, for example, it was also determined that due to Planet Youth interventions the need for addiction treatment among 20-year-olds was reduced by more than half, resulting in significant downstream healthcare savings.

Implementing the IPM can potentially improve the public health care system, including access to and the delivery of quality services and care within the Yukon in the following ways:

Relation to broader initiatives

The implementation of the IPM is one of the recommended actions in the Government of Yukon's Substance Use Health Emergency Strategy, that was released in August 2023.

Implementing the IPM with Planet Youth is also closely linked to Minister McPhee's 2023 mandate letter:

• Respond to the Substance Use Health Emergency by taking innovative and bold actions, including prevention and harm reduction efforts and the implementation of collaborative programming with partner governments and organizations.

Addressing the needs of Indigenous peoples and other underserved and disadvantaged populations

The IPM emphasizes the importance of local coalitions: strong local teams that will help support the Planet Youth project throughout the entire implementation process to build healthier environments for young people. This can be beneficial for addressing the needs of Yukon First Nations.

In the selected communities, community leaders and elders will be central to the planning and decision-making for local initiatives and process to ensure that they are culturally appropriate and align with the community's priorities.

2.2 Provide support for Yukon communities to create and implement community wellness plans

Description of activities

The Government of Yukon will provide support for Yukon communities to create and implement community wellness plans. This is a strategic initiative which will have a dual purpose of engaging communities to take an active role in determining what wellness means to their community and how they can contribute to it while also providing a means to collect data and provide an accountability framework and strategic direction for rural health and wellbeing provision in the Yukon.

Community wellness is a shared vision for healthier communities and results in a healthier population.

The wellness plans will include sections for the current state and relevant issues, the community wellness vision, the goals, objectives and initiatives, both on behalf of the Yukon Government as well as the other partners involved, an evaluation plan which shall include a way for the community to understand progress towards outcomes and provide feedback.

Every Yukon community has unique characteristics, needs, resources, and challenges that must be considered to effectively address the health and wellness concerns of each community. A community wellness plan is a strategic framework that outlines the goals, objectives, and actions to promote the overall well-being and health of a community. It is a comprehensive, community-led approach that involves collaboration among community members, First Nations governments, healthcare providers, local government, and other organizations.

A community wellness plan typically addresses multiple dimensions of health, including physical, mental, social, and environmental wellbeing. Once implemented, its aim is to improve the health outcomes of community members, prevent illness, and promote healthy behaviors and lifestyles.

The Government of Yukon is dedicated to providing financial support so that all Yukon communities can develop their own community wellness plans. The intention is for each community's plan to have linkages and be in alignment with their community safety plan.

Rationale

Implementing community wellness plans in all Yukon communities can have several positive impacts on the Yukon's health care system, including improving access to and the delivery of quality services and care. These plans are designed to address health and well-being holistically, focusing on prevention, community engagement, and tailored solutions.

It is anticipated that the community wellness plans will prioritize prevention and health promotion, aiming to reduce the incidence of preventable health issues. This focus on prevention can reduce the burden on the healthcare system by decreasing the prevalence of chronic diseases and acute health problems.

Each community will have at least one, and in some cases, several, identified partners who will contribute to the plans and help ensure the solutions and outcomes are meaningful to the communities. Engaged communities are more likely to take ownership of their health and participate in initiatives that can improve overall well-being. The community wellness plans will be customized to address the unique needs and challenges of each community. This tailoring ensures that interventions are culturally and contextually relevant, making them more effective in improving health outcomes.

These plans typically involve collaboration between various sectors and governments, as appropriate, including First Nations, municipalities, and the areas of healthcare, education, social services, and local organizations. This cross-sectoral approach can lead to more comprehensive solutions that address the social determinants of health while also finding efficiencies and areas of shared priority.

Relation to broader initiatives

Creating and implementing community wellness plans in Yukon communities is one of the recommended actions in the Government of Yukon's Substance Use Health Emergency Strategy, that was released in August 2023.

The development of community wellness plans is also closely linked to Minister McPhee's 2023 mandate letter:

• Respond to the Substance Use Health Emergency by taking innovative and bold actions, including prevention and harm reduction efforts and the implementation of collaborative programming with partner governments and organizations.

Addressing the needs of Indigenous peoples and other underserved and disadvantaged populations

The Indigenous population in the Yukon, particularly in the Yukon's rural and remote communities, comprises a significant portion of the territory's total population. The development and implementation will prioritize cultural sensitivity by recognizing and respecting First Nations traditions, values, aspirations, languages, and ways of life. This includes acknowledging the importance of cultural practices and ceremonies in promoting wellness.

The community wellness plans will respect self-determination, promote cultural resilience, and ultimately improve health outcomes while respecting the unique cultural diversity of First Nations throughout the Yukon.

2.3 Plan, develop and implement a communications strategy and education campaigns that align with the Substance Use Health Emergency Strategy

Description of activities

The Government of Yukon will plan, develop and implement a multi-faceted communications strategy that aims to address the unique needs of different groups affected by the Substance Use Health Emergency.

The communications strategy and subsequent campaigns will consider:

Personal wellness: Offering support and resources to individuals directly affected by substance use, including people who use substances, their family and friends. This involves making resources easily accessible and promoting the availability of help.

Youth prevention: Addressing the unique needs of youth including at-risk youth, providing them with substance use prevention tools and resources. This involves the development of educational and cultural projects that can benefit the youth and the community at large.

Community safety: Addressing the unique public safety needs of each Yukon community by collaborating with, and supporting, communities through approaches that are responsive to individual circumstances, concerns, and priorities. It will support increased awareness of the available programs and supports to assist communities in improving community safety.

Internal communications: Keeping the health and social workforce informed and involved. This sub-strategy will emphasize providing culturally appropriate care and non-stigmatizing services.

Involving key partners: integrating insight from community partners and stakeholders, First Nations governments, people with lived and living experience, NGOs, communities, businesses, and other organizations in the development of communications.

Media Relations: fostering a productive relationship with the local media community, providing timely and accurate information.

Rationale

Effective communications can help:

• reduce the stigma surrounding mental health issues and substance use.
• provide information about available mental health and substance use services and increase awareness of and access to supports and services.
• improve the health literacy of the population, helping individuals better understand mental health and substance use issues. This can lead to more informed decisions and greater engagement in self-care. Education campaigns can also teach harm reduction strategies, such as safer substance use practices, which can minimize the health risks associated with substance use and potentially reduce the need for acute medical interventions.
• promote community support networks and resources for individuals and families affected by mental health and substance use challenges. Stronger community support systems can complement formal healthcare services.

Relation to broader initiatives

Developing and launching new and continuing communication and education campaigns addressing mental wellness and substance use issues is one of the recommended actions in the Government of Yukon's Substance Use Health Emergency Strategy, that was released in August 2023.

Communications and education campaigns relating to substance use and mental wellness issues is also closely linked to Minister McPhee's 2023 mandate letter:

• Respond to the Substance Use Health Emergency by taking innovative and bold actions, including prevention and harm reduction efforts and the implementation of collaborative programming with partner governments and organizations.

Addressing the needs of Indigenous peoples and other underserved and disadvantaged populations

To maximize the impact of such campaigns, they will be evidence-based, culturally sensitive, and targeted to the specific needs and demographics of different audiences within the Yukon population.

2.4 Expand access to Opioid Treatment Services, including safer supply

Description of activities

The Government of Yukon will expand access to Opioid Treatment Services, including safer supply, by purchasing and operating a Mobile Opioid Treatment Services Clinic. This is a clinic on wheels that will increase access to mental health and substance use treatment and care. The mobile clinic will be staffed by existing staff from Opioid Treatment Services.

The mobile clinic will provide a range of services, including medical assessments, treatment options such as Opioid Agonist Therapy and basic medical care, with a greater ability to find individuals requiring follow-up care. The clinic will play a critical role in harm reduction efforts by providing prescriber services throughout Whitehorse by meeting clients "where they are at" and provide same day appointments, medical testing and initiate front-line medical treatments for all substance use disorders. The mobile clinic will also help facilitate access to broader health and social resources by providing clients with education on services and supports that are available in the territory.

Designed and built by a Canadian firm and measuring eight square meters, these compact clinics are having a positive impact in the communities they serve, and they are facilitating the health care initiatives of a rapidly growing list of health organizations across Canada, including TELUS Health, Ottawa Inner City Health, Fraser Health, Alberta Health Services, the Canadian Mental Health Association and Pathways to Recovery in Ottawa, to name a few.

The mobile clinic includes the following features:

• clinical space for assessment and examination /treatment
• integrated seating and folding worktable
• electrical generation and battery system for powering devices, ventilation, air conditioning and heating
• storage areas for medical supplies and equipment
• sink with warm and cool running water
• integrated whiteboard, mirror, and public information display unit
• compartments for waste and biohazardous waste disposal
• safety features including grab bars, fire extinguisher, smoke and carbon monoxide detectors and exterior slip-resistant steps
• video security system with options for exterior lighting
• options for an exterior canopy.

Rationale

The mobile opioid treatment services clinic will improve access to Opioid Treatment Services within the Whitehorse area, such as Opioid Agonist Therapy and safer supply through the following mechanisms:

• Helping to ensure individuals receive the care and support they need when and where they need it
• Reducing the need for people who use substances to travel to access healthcare services
• Providing care in a culturally competent and safe manner
• Offering a variety of services together under one roof, close to home

The mobile clinic is a cost-effective interim solution to expanding the Referred Care Clinic/Opioid Treatment Services fixed site. The physical space at the current clinic is well over capacity and there are not enough clinical rooms to see patients. A mobile clinic requires fewer infrastructure investments and can reach a larger population within a designated area, maximizing the impact of resources.

Relation to broader initiatives

Expanding access to Opioid Treatment Services is one of the recommended actions in the Government of Yukon's Substance Use Health Emergency Strategy, that was released in August 2023.

Addressing the needs of Indigenous peoples and other underserved and disadvantaged populations

A mobile clinic can reach individuals in underserved areas away from the downtown core where access to healthcare services, including substance use treatment, is limited. The mobile clinic would enable more outreach to meet people where they are at. In addition, a mobile clinic can be easily deployed to different locations, allowing for flexibility in responding to changing patterns of where people who use substances gather and targeting areas with the greatest need.

Many people who use substances face various barriers to seeking treatment, such as lack of transportation, stigma, or work and family obligations. A mobile clinic can help overcome these obstacles by delivering services directly to the individual, reducing the need for travel, making treatment more convenient and discreet and could address healthcare needs that have not been met by more conventional models of care.

The mobile clinic will offer personalized care by bringing treatment directly to the individuals in need. This approach allows for stronger engagement and rapport between healthcare providers and patients, leading to better treatment outcomes.

2.5 Increase support for Yukon First Nations to develop and implement land-based mental health and substance use treatment options

Description of activities

Land-based healing is an important part of mental wellness in the Yukon. The Government of Yukon supports healing initiatives and is working with Yukon First Nations to explore future land-based healing initiatives. Mental Wellness and Substance Use Services staff in communities routinely support land-based programing in coordination with local First Nations governments upon invitation and routinely incorporates land-based healing components into its youth programming and Intensive Treatment programs.

In collaboration with the Council of Yukon First Nations (CYFN), the Government of Yukon is developing a land-based healing funding initiative that will provide time-limited funding for First Nation-designed, led and implemented land-based healing projects and activities as an incremental capacity-building initiative to pilot First Nations-led land-based healing programs consistent with their Administration of Justice Agreement aspirations and negotiations and other future self-government arrangements.

Funding will be delivered to the Council of Yukon First Nations via a transfer payment agreement. Yukon First Nations or Yukon First Nations-led organizations will be able to apply for funding through CYFN, who will review applications and allocate funding accordingly. Applications will be assessed on whether they fit the scope of the funding initiative and whether the proposed project costs are eligible for funding. If an initial application does not meet eligibility criteria, CYFN will seek to work with the applicant to refine the project application with a goal of helping all First Nations governments to leverage available funding to support land-based healing projects and activities in their communities.

Yukon First Nations governments or Yukon First Nations-led organizations will be eligible to receive funding for land-based mental health and substance use treatment projects with a total funding pot of $9M over three years. The funding program aims to be flexible and responsive to the unique needs of each First Nations community, and will also be linked to multiple Government of Yukon priorities, interests, and goals.

Rationale

The goals of a land-based healing funding initiative are as follows:

• Empower Yukon First Nations to identify their land-based healing and programming needs and develop solutions appropriate to their own community contexts,
• Support projects that focus on preserving, reviving, and promoting traditional Indigenous knowledge, languages, customs, and practices related to healing specific to Yukon First Nations. This may include land-based activities such as traditional hunting, fishing, gathering, and land stewardship.
• Promote healing, resilience, and well-being among individuals and communities affected by intergenerational trauma, colonization, and other historical injustices. This may involve incorporating traditional healing practices, ceremonies, and teachings.
• Support Yukon First Nations communities and organizations to deliver land-based healing programs and initiatives,
• Encourage collaboration and partnerships among various stakeholders to ensure a holistic and community-driven approach to land-based healing.
• Provide transparency about program eligibility and assessment criteria so that all First Nations governments applying for funding through the program will be treated fairly and have their applications evaluated based on clear and consistent criteria.
• Gather adequate performance information to enable learning and continuous improvement in program design and delivery.
• Reduce barriers to First Nations governments accessing the available funding, including minimizing administrative and reporting requirements.

Relation to broader initiatives

Increasing support for Yukon First Nations to develop and implement land-based mental health and substance use treatment options is one of the recommended actions in the Government of Yukon's Substance Use Health Emergency Strategy, that was released in August 2023.

This action is also closely linked to Minister McPhee's 2023 mandate letter:

• Respond to the Substance Use Health Emergency by taking innovative and bold actions, including prevention and harm reduction efforts and the implementation of collaborative programming with partner governments and organizations, and
• Continue to support First Nation partners with funding to develop and implement rural, on-the-land mental health and substance use treatment options for Yukoners.

Land-based infrastructure and programming has been identified as a priority in the Putting People First final report, in Changing the Story to Upholding Dignity and Justice: Yukon's Missing and Murdered Indigenous Women, Girls and Two-spirit+ People Strategy, and in the 2023 Confidence and Supply Agreement between the Yukon Liberal Caucus and the Yukon NDP Caucus.

In addition to meeting other priorities, this initiative is also consistent with the Yukon government's recent mandate for Administration of Justice Agreement and justice-related negotiations and arrangements with all Yukon First Nations.

Addressing the needs of Indigenous peoples and other underserved and disadvantaged populations

Land-based healing is a culturally relevant and holistic approach to addressing the needs of Indigenous people that centers on the land, culture, and traditional knowledge. It recognizes the deep connection between Indigenous communities and their ancestral lands and acknowledges the healing power of nature, culture, and spirituality. The goal is to build capacity for Yukon First Nations to implement their own land-based healing initiatives.

2.6 Create the territory's first residential Managed Alcohol Program for people 19 years of age and older who are severely alcohol dependent and who require medical management of substance use disorder focused on harm reduction and stabilization.

Description of activities

The Government of Yukon will establish and operate a residential managed alcohol program in Whitehorse, beginning in 2024 – 2025 with five beds and expanding to 10 beds by 2025 - 2026.

Managed alcohol programs are a harm reduction intervention that serve as an option within the continuum of care for individuals with severe alcohol use disorder for whom abstinence-based treatment is not a realistic or desirable option, particularly those who face additional barriers to basic care and psychosocial supports due to poverty and homelessness. This harm reduction intervention will incorporate managed provision of alcohol as a key component of an integrated program that will also include a range of healthcare and psychosocial services, such as housing, nutritional and financial support, access to medical care, and social and cultural supports.

Rationale

The residential managed alcohol program will aim to reduce harms related to alcohol dependency. Managed alcohol program participants are people who experience severe alcohol dependency. There are three categories of harm associated with alcohol dependency that managed alcohol programs aim to reduce:

1. "acute" comprising injuries, poisonings, or acute illnesses caused in part by heavy alcohol consumption;
2. "chronic" comprising a range of serious illnesses including liver disease, cancers, strokes, and gastrointestinal diseases which are caused by the overall volume of alcohol consumed over time; and
3. "social" comprising problems relating to housing, relationships, employment, finances, and crime.

Relation to broader initiatives

Implementing a managed alcohol program is one of the recommended actions in the Government of Yukon's Substance Use Health Emergency Strategy, that was released in August 2023.

This action is closely linked to Minister McPhee's 2023 mandate letter:

• Respond to the Substance Use Health Emergency by taking innovative and bold actions, including prevention and harm reduction efforts and the implementation of collaborative programming with partner governments and organizations.

The establishment of a managed alcohol program is also an element of the 2023 Confidence and Supply Agreement between the Yukon Liberal Caucus and the Yukon NDP Caucus.

Addressing the needs of Indigenous peoples and other underserved and disadvantaged populations

Many harm reduction models neglect the broader social and system-wide issues that contribute to and intersect with substance use for Indigenous people. For Indigenous communities, harm reduction also needs to include reducing the harms of colonization. The Department of Health and Social Services will work with Yukon First Nations when designing and implementing the residential managed alcohol program.

2.7 Supervised Consumption Site - extended hours

Description of activities

Whitehorse's Supervised Consumption Site, a partnership between Health and Social Services and Blood Ties Four Directions, opened in September 2021. The Supervised Consumption Site is a safe and confidential space for people to consume drugs. Non-judgmental staff are onsite to assist in the event of an overdose or other health emergency. Staff also provide health care services, referrals, supportive listening, drug checking, and other support as needed.

Renovations in May 2022 to enable inhalation as a method of consumption have resulted in a significant increase in visits to the Supervised Consumption Site, from 44 visits in May 2022 to a high of 677 visits in May 2023.

The increased funding will provide for additional staff, including dedicated Mental Wellness and Substance Use services and a drug checking specialist, to enable the Supervised Consumption Site to be open 365 days per year.

Rationale

Since the Supervised Consumption Site opened, approximately 40 lives have been saved onsite. This number includes only the number of overdoses reversed and not other medical emergencies responded to onsite. Despite this, the Yukon continues to lead the country in per capita apparent opioid toxicity deaths.

Relation to broader initiatives

Increasing services at the Supervised Consumption Site is one of the recommended actions in the Government of Yukon's Substance Use Health Emergency Strategy, that was released in August 2023.

This action is closely linked to Minister McPhee's 2023 mandate letter:

• Respond to the Substance Use Health Emergency by taking innovative and bold actions, including prevention and harm reduction efforts and the implementation of collaborative programming with partner governments and organizations.

Measuring and reporting on results

By no later than October 1, in each fiscal year, with respect of the previous Fiscal Year, the Yukon agrees to:

1. Provide data and information annually to CIHI related to the new headline indicators, additional common indicators, and the mental health, substance use, and addictions services indicators identified as part of commitment made in the Common Statement.
2. Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to Yukon residents on progress made on targets outlined in this Action Plan for headline indicators in the priority area(s) where federal funds are to be invested, and on Yukon-specific indicators for each of the Working Together funded initiatives.

3. 2017 Common Statement of Principles on Shared Health Priorities funding

In the area of mental health, substance use, and addictions services, Working Together to Improve Health Care for Canadians also includes a commitment by Canada and the Yukon to continue to work to support collaboration on the Common Statement of Principles on Shared Health Priorities (CSOP), supported by the federal Budget 2017 investment of $5 billion over ten years. The Yukon's annual per capita allocation of these CSOP funds related to mental health is approximately $670,000 per year.

Through the previous Canada-Yukon Mental Health and Addiction Services Funding Agreement, the Yukon utilized funding to support and improve access to mental health and addiction programs and services. Specifically, funding provided is being used in two primary areas:

3.1 Improving access to community-based mental wellness and substance use services

Through partnerships with service providers, government departments and First Nations, the number of access points have been increased with a focus on early intervention and prevention activities in the community and schools, while allowing for innovative approaches. Examples of how federal funds are being used include:

• Adding clinical counseling positions to support child, youth and family counselling and treatment capacity in communities;
• Rolling out community wellness plans to improve capacity in rural communities with the addition of new positions working within a collaborative care team or Hub model; and
• Implementing child and youth programming in schools, youth programs, youth drop-ins and other locations youth access in communities outside of Whitehorse.

3.2 Culturally appropriate and Integrated interventions

Yukon is working with First Nation partners to improve the delivery of mental wellness and substance use programming through data system improvements for better case management and service coordination, tele-psychiatry supports, better-matched services through primary care health system collaboration for individuals with complex needs, and appropriate and timely services and supports (regardless of location). Examples of this work include:

• Implementing a cultural counselling program;
• Implementing an electronic client information data system to ensure effective case management (e.g., database upgrade, software and culturally appropriate digital health records); and
• Employing innovative approaches to use technology (e.g. video connections, hand-held devices with apps, interactive games, smart phones, etc.) in classrooms to deliver mental health and substance use information.

With remaining funding for mental health and substance use services carried over from the 2017 Agreement, the Yukon remains committed to investing federal funds to support the initiatives above, which are in alignment with the Common Statement of Principles on Shared Health Priorities.

Funding Allocation