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Archived Content Contenu Archivé ARCHIVED - Archiving Content ARCHIVÉE - Contenu archivé Archived Content Contenu archivé Information identified as archived is provided for L’information dont il est indiqué qu’elle est archivée reference, research or recordkeeping purposes. It est fournie à des fins de référence, de recherche is not subject to the Government of Canada Web ou de tenue de documents. Elle n’est pas Standards and has not been altered or updated assujettie aux normes Web du gouvernement du since it was archived. Please contact us to request Canada et elle n’a pas été modifiée ou mise à jour a format other than those available. depuis son archivage. Pour obtenir cette information dans un autre format, veuillez communiquer avec nous. This document is archival in nature and is intended Le présent document a une valeur archivistique et for those who wish to consult archival documents fait partie des documents d’archives rendus made available from the collection of Public Safety disponibles par Sécurité publique Canada à ceux Canada. qui souhaitent consulter ces documents issus de sa collection. Some of these documents are available in only one official language. Translation, to be provided Certains de ces documents ne sont disponibles by Public Safety Canada, is available upon que dans une langue officielle. Sécurité publique request. Canada fournira une traduction sur demande. PARTIE V Leadership fédéral CHAPITRE 13: LE RÔLE DIRECT DU FÉDÉRAL […] lancer[…] et coordonner[…] des activités dans l’ensemble des ministères fédéraux pour s’acquitter des responsabilités fédérales à l’égard de populations précises relevant de sa compétence immédiate. — Le Dr Albert Schumacher, président, Association médicale canadienne1 Le gouvernement fédéral est responsable des programmes et services de santé mentale offerts à sept groupes de clients. Pour chacun de ces groupes, le présent chapitre donne une description détaillée des pouvoirs du fédéral et de l’éventail de programmes et services fédéraux en place dans les secteurs de la santé mentale, de la maladie mentale et de la toxicomanie. On trouvera également dans ce chapitre une évaluation des besoins de chaque groupe, et un commentaire sur la situation de chacun. À la connaissance du Comité, c’est la première fois qu’est entreprise une telle évaluation des besoins de santé mentale des groupes de clients qui relèvent de la compétence fédérale. Par conséquent, après avoir examiné la situation de chaque groupe, le Comité examinera le fait même que le gouvernement fédéral soit responsable des besoins de santé mentale du plus d’un million de Canadiens qui relèvent de sa compétence. En conclusion de ce chapitre, le Comité propose quelques éléments d’une approche intégrée visant à améliorer les résultats des interventions de santé mentale menées auprès des divers groupes qui forment la clientèle fédérale. Pour faciliter la lecture de ce long chapitre, le tableau suivant donne un bref aperçu du contenu de chaque section, chacune portant sur un groupe de clients. Chaque groupe y est identifié, de même que le ministère fédéral dont il relève, ainsi que les activités de santé qui lui sont offertes. Tableau 1 : Aperçu des groupes de clients qui relèvent du fédéral Groupe de Ministère fédéral Activités de santé mentale clients Premières Santé Canada Soins de santé communautaires aux Premières nations qui nations et vivent dans des réserves; Inuits Médicaments non assurés et interventions d’urgence en (13.1) situation de crise aux membres inscrits des Premières nations et aux Inuits reconnus; Centres de traitement de la toxicomanie. Affaires indiennes Services de base aux Premières nations des réserves et aux et du Nord Canada communautés inuites : éducation, soutien du revenu, logement, prévention de la violence familiale. 1 20 avril 2005, http://www.parl.gc.ca/38/1/parlbus/commbus/senate/Com-f/soci-f/13eva-f.htm? Language=F&Parl=38&Ses=1&comm_id=47. 315 De l’ombre à la lumière Groupe de Ministère Activités de santé mentale clients fédéral Délinquants sous Service Services de base : évaluation infirmière à l’accueil; admission responsabilité correctionnel au centre de traitement si nécessaire et si possible; services fédérale Canada généraux en établissement hospitalier; Services essentiels (13.2) lorsqu’en centre correctionnel communautaire; services de santé non assurés si approuvés. Forces armées Défense Services de santé mentale non urgents en clinique externe à la canadiennes nationale clinique de la base, au centre de santé ou en groupes de (13.3) soutien; Soins spécialisés payés à la province; aiguillage vers centres de soutien en cas de stress post- traumatique. Anciens Anciens Services de soins de santé communautaires au-delà des limites combattants Combattants des régimes provinciaux ou territoriaux; (13.4) Canada Soins institutionnels à Sainte-Anne-de- Bellevue (Québec) et autres hôpitaux liés par contrat dans les provinces; Services conjoints avec MDN en cas de stress post- traumatique. GRC GRC Services généraux offerts au sein de la division régionale pour (13.5) garantir la capacité physique et mentale nécessaire à l’exercice des fonctions; Recours aux services provinciaux sur autorisation. Immigrants et Citoyenneté et Services de santé mentale essentiels et d’urgence (médecin, réfugiés (13.6) Immigration hôpital, médicaments) pour ceux qui ne peuvent payer. Canada Employés de la Conseil du Services et autres avantages non couverts par les régimes fonction Trésor provinciaux/territoriaux; publique (13.7) Services de consultation et soutien des employés. D’entrée de jeu, le Comité affirme qu’il s’attend du gouvernement fédéral de même que des gouvernements provinciaux et territoriaux qu’ils garantissent aux clients qui relèvent d’eux l’accès aux transformations du système déjà indiquées au chapitre 5. Autrement dit, le Comité compte bien que les Premières nations et les Inuits, les délinquants sous responsabilité fédérale, les membres des Forces canadiennes, les anciens combattants, les membres de la GRC, les immigrants et réfugiés et les employés de la fonction publique soient inscrits d’emblée dans un système de santé mentale axé sur la guérison, centré sur la personne, implanté en milieu communautaire, et pleinement intégré tant du point de vue de l’éventail de soins que des groupes d’âge. Le Comité se réjouit de constater que plusieurs ministères et organismes fédéraux sont déjà orientés en ce sens. Certains ministères offrent des services de prise en charge et font appel à un plus grand éventail de fournisseurs de services provinciaux de santé mentale. D’autres misent sur l’amélioration des facteurs déterminants de la santé mentale comme le logement, l’emploi et l’ensemble des besoins sociaux. Quelques ministères et organismes travaillent en collaboration les uns avec les autres, et avec leurs homologues des provinces et territoires, dans le cadre d’initiatives de santé mentale. De l’ombre à la lumière 316 13.1 LES PREMIÈRES NATIONS ET LES INUITS Les Inuits sont heureux de l’engagement pris par le fédéral envers un renouvellement de la relation. Nous estimons important un engagement plus marqué en faveur d’une stratégie de défense de la santé mentale propre aux Inuits. —Larry Gordon, président, Comité national sur la santé des Inuits, Direction de la santé, Inuit Tapiriit Kanatami2 Un plan d’action conjoint et une stratégie du bien-être entre le gouvernement fédéral et les Premières nations résoudraient immédiatement la crise de la santé mentale d’une façon collaborative, globale et pertinente sur le plan culturel. —Valerie Gideon, directrice du Secrétariat à la santé et au développement social, Assemblée des Premières nations3 13.1.1 La compétence fédérale Dans l’Acte de l’Amérique du Nord britannique, 1867, le paragraphe 91(24) confie la responsabilité C’est à Santé Canada qu’incombe la responsabilité principale des services législative « des Indiens et des terres réservées aux de santé, y compris les services de Indiens » à la compétence exclusive du Parlement santé mentale, offerts aux Premières fédéral. Le Parlement, à son tour, a promulgué la nations et aux Inuits qui vivent dans Loi sur les Indiens qui établit les critères qui des réserves et dans de nombreuses définissent un « Indien inscrit » ainsi que le cadre communautés éloignées; ces services sont offerts par le biais de dispensaires juridique des responsabilités fédérales. Une et de centres de santé. décision de la Cour suprême, rendue en 1939, a déterminé que les Inuits (qu’on appelait alors Eskimos) étaient des Indiens aux fins du paragraphe 91(24)4. Il importe de signaler que nous nous intéressons dans ces pages uniquement aux Premières nations et aux Inuits qui relèvent directement du fédéral. Le gouvernement fédéral n’est pas responsable de tous les peuples autochtones; on estime qu’un tiers environ de la population autochtone n’a pas accès aux programmes et services fédéraux. À l’heure actuelle, le gouvernement fédéral offre aux Indiens inscrits (aussi appelés Premières nations) des programmes et services qui ne sont pas accessibles aux Indiens non inscrits ni aux Métis. Par ailleurs, une partie, mais non la totalité, des programmes et services fédéraux sont offerts aux Inuits. 2 21 avril 2005, http://www.parl.gc.ca/38/1/parlbus/commbus/senate/Com-f/soci-f/13evb-f.htm? Language=F&Parl=38&Ses=1&comm_id=47. 3 20 septembre 2005, http://www.parl.gc.ca/38/1/parlbus/commbus/senate/Com-f/soci-f/27eva- f.htm?Language=F&Parl=38&Ses=1&comm_id=47. 4 Loi sur les Indiens, L.R.C. 1985, ch. I-5, http://lois.justice.gc.ca/fr/I-5/, Tonina Simeone, Sphères de compétence fédérale et provinciale et peuples autochtones, TIPS-88F, Bibliothèque du Parlement, 2001. Mary Hurley, La Loi sur les Indiens, TIPS-17, Bibliothèque du Parlement, 2004, http://lpintrabp.parl.gc.ca/apps/tips/printable/tip17-f.pdf. 317 De l’ombre à la lumière Ce chapitre ne porte que sur les Premières nations et les Inuits considérés admissibles aux programmes et services fédéraux de santé mentale, dont la plus grande partie relève des ministères de Santé Canada et d’Affaires indiennes et du Nord.
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