Three years after Steel Town Down: Why we still don't have a Level III withdrawal management facility

It was three years ago last week that CTV and Vice Canada aired Steel Town Down: Overdose Crisis in the Soo.

If Saultites didn't know it before then, we definitely learned from that Feb. 10, 2018 broadcast that we have a problem.

Steel Town Down was a one-hour documentary depicting how powerful and potentially lethal synthetic opioids like fentanyl were finding their way into our street drugs.

There was no reporter telling the story – narration was entirely by local drug users, their families and case workers, all pleading for help. 

"I think it's not talked about," said one of the users interviewed.

"Obviously you hear about the overdoses. That's it. You get a post on SooToday and then it's overlooked. It's like another one bites the dust, almost. That's the mentality in this town."

Around that time, Saultites were told what we needed was a Level III withdrawal management facility – essentially a residential rehab with symptoms monitored by medically trained staff.

And the wheels were supposed to be in motion to make that happen.

'There most definitely has been a hold-up'

Months before the Vice/W5 documentary aired, Sault Area Hospital had already sent a Level III proposal to the North East Local Health Integration Network (NE-LHIN).

Today, three years later, we still don't have a Level III withdrawal management facility, or even an agreement from the province to establish one here.

And last week, Sault Ste. Marie City Council was told it was only during the past few weeks that the final draft of the Sault's critically important application finally found its way to the desks of senior officials at Queen's Park.

"There most definitely has been a hold-up," Dr. Paul Hergott told councillors.

Hung up at the LHIN

Dr. Hergott was speaking on behalf of Citizens Helping Addicts & Alcoholics get Treatment (CHAAT), a grassroots advocacy group pushing for a comprehensive local addictions strategy and a full-scale treatment facility.

"It was hung up at the LHIN for quite some time." Hergott said.

"My understanding is it really just got to the higher levels of the ministry in perhaps the last couple weeks."

"I'm not sure it's up to me to explain what the hold-up has been. That may be something that Mr. Romano can explain."

Ross Romano, MPP

Approached by SooToday to help us understand that, Sault MPP Ross Romano was unable to say exactly when the Sault's critically important application finally reached Queen's Park.

"I don't have any information specifically when it arrived," Romano said.

"I certainly can't comment on the day that the specific application that is presently before the Ministry of Health arrived."

"Those applications get prepared by the hospital. They're submitted to the North East LHIN, which acts as a conduit which sends those applications off to the Ministry of Health."

What's a LHIN, anyway?

A LHIN is a provincial crown corporation.

The North East LHIN maintains offices in 20 communities and plans and funds health care services for more than 565,000 people over 400,000 square kilometres of the province.

Ontario's 14 LHINs and six other health agencies are being merged into a super agency called Ontario Health and LHINs will eventually be a thing of the past.

Since 2019, LHINs have no longer been required to open their meetings to members of the public and news media.

Six per cent of the North East LHIN's $1.5 billion annual budget goes to 44 community mental health and addiction providers.

How long was the Sault's application parked at the LHIN?

"I personally can't comment on that," Romano told us.

"I'm not aware of how long it was at the LHIN. I can't comment on any of the specifics as it when it reached the LHIN."

Cream rising on buttermilk

Ward 5 Coun. Corey Gardi and his Ward 4 counterpart Rick Niro both expressed concern last week about the slower-than-cream-rising-on-buttermilk pace of provincial approval.

"I am at a loss...why we have not had any response from the province on this so far?" demanded Niro.

"For whatever reason, it hasn't come through in as timely as fashion as we want," added Gardi. "The excuse from the province cannot be the pandemic. Hopefully they don't use that. This is an epidemic that has been in existence far prior to what we're experiencing with COVID-19."

Mayor's greatest frustration

Mayor Christian Provenzano was using stronger language.

"It's been the greatest frustration of all of the years of my mayoralty that we have not made more progress in this respect," the mayor said.

"Notwithstanding that I might have tried, I have not been successful and there are people in the community that are having a hard time. I want them to know that their mayor and their council recognize that and I want them to know that we're trying and I want them to know that we believe they deserve health care. I'm hoping we will see some progress soon to make that come to pass."

In our attempt to track Sault Ste. Marie's rehab application, we also contacted the NE-LHIN.

Here's the timeline they provided:

• a business case for a Level III Enhanced Withdrawal Management Services Facility was received by the North East LHIN on Nov. 3, 2017
• Sault Area Hospital (SAH) then presented at the Jan. 10, 2018, North East LHIN board meeting
• following further community engagement/consultation, the North East LHIN board then approved support for this proposal at its March 7, 2018 meeting
• it was then sent shortly afterwards to the Ministry of Health and Long-Term Care's capital branch.
• the capital branch noted the hospital did not have the operating dollars to support the new facility and that it required the operating dollars before it could undertake a build. The North East LHIN does not fund builds but rather programs/services
• since then, the North East LHIN has funded various parts of the initial proposal’s programs/services as well as others related to mental health and addictions in the community. Some examples of new services that align with the proposal include: the Rapid Access Addiction Medicine Clinic (SAH) in 2019; Addiction Medicine Consult Team (SAH), Registered Nurse to Support Withdrawal Management (SAH), four new Safe Beds (SAH) in 2019-20; and Nurse Practitioner to support residential withdrawal management and a Registered Nurse to support home/mobile withdrawal management (SAH) in 2021
• additional NE LHIN 2019-20 mental health and addiction investments in Algoma include: Mobile Crisis Rapid Response Team (SAH); Peer Support in the Emergency Department (CMHA); and Mental Health Justice Supportive Housing (CMHA). Since the initial proposal was received, Mental Health and Addiction partners including the hospital have also been working together to look at other ways to support clients and families
• Sault Area Hospital has since modified its original proposal, which it recently presented to City Council (November 2020).

MPP Ross Romano says while he might not know the exact time Sault Area Hospital's application arrived at Queen's Park, he's fully aware of the details of that application.

"Part of the working group that we just recently announced this past Friday  was aimed at trying to get some of the clarity surrounding what the nature of the ask is,"

"I've been talking to Health Minister [Christine] Elliott about it very extensively. It's been years, but especially now in the last several weeks, we've had numerous conversations around the present application."

Local site identified

"Sault Area Hospital is asking the Ministry of Health for a financial commitment for leasehold costs associated with rental of a space in our city which would act as the site for a residential withdrawal management services building in Sault Ste. Marie," Romano says.

"It would be a 20-bed facility and it would provide all of the services that we've been speaking of for years, in terms of what we had traditionally come to know as a detox site."

The hospital is also asking for some capital improvements allowing an existing site to be retrofitted to be used as a residential rehab.

"A series of facilities have been reviewed through the hospital as well as the ministry. The ministry has identified a site that does meet their specifications," the MPP says.

"I know there's been so much confusion and there's been changes in the titles and terminology and the continuum of care and the circumstances have changed since approximately 2017 when it first entered the scene."

"I could certainly see where there's been a great deal of confusion in the nature of what is being sought."

Interestingly, Romano says some of the confusion involves the terminology used by the city and others demanding a residential rehab here.

We have, it turns out, been asking for something that doesn't exist.

"There is no such thing as a Level III treatment facility any longer. That terminology since 2017 has ceased to exist. I can appreciate where the confusion arises in terms of what the terminology means. But the services that we are after would be housed within this residential withdrawal management services site."

Romano, who is the province's minister of training, colleges and universities, says he talks with Health Minister Elliott at least once a week about the Sault's application.

"We have a routine call every single Friday that has happened now for four consecutive weeks, where we have been speaking specifically about this application and what will be required to bring it to a point of receiving approval." 

Dr. Hergott, meanwhile, points out that Sault Ste. Marie has Ontario's highest opioid death rate.

"Most communities in the north have a residential treatment centre. We are the only community without a proper residential withdrawal management facility or a 28-day treatment centre."

"We don't need another committee to look into things. We know what the problems are," Hergott says.