Indigenous Advocacy and Campaigns

Our Indigenous Advocacy Focus 

The CCPA is dedicated to several key areas of advocacy to ensure the mental health and well-being of Indigenous peoples are prioritized: 

• Mental Health Equity: Advocating for equal access to culturally appropriate mental health services for Indigenous peoples.

• Cultural Competency: Promoting the importance of cultural competency training for all counselling professionals to better serve Indigenous clients.

• Policy Change: Working alongside Indigenous leaders to influence policy changes that respect Indigenous rights and improve mental health outcomes. 

CCCs4NIHB Campaign 

The Non-Insured Health Benefits (NIHB) program is funded by the Government of Canada and provides eligible First Nations and Inuit peoples with coverage for health benefits that are not covered in other social programs, private insurance plans, or provincial or territorial health insurance.

The Canadian Certified Counsellor (CCC) certification is a national service provided by the Canadian Counselling and Psychotherapy Association (CCPA), which recognizes those who are qualified to provide counselling services through a graduate degree in counselling (or equivalent), other continuing education, and a formal code of ethics.

In May 2015, CCCs were removed from the NIHB list of approved mental health providers. This has significantly reduced appropriate access to mental health counselling services for Indigenous peoples across the country. It places those requiring care in unregulated provinces and territories at a distinct disadvantage and prevents CCCs who are Indigenous themselves from providing care in their own communities.

In September 2015, the Assembly of First Nations’ (AFN) First Nations Inuit Health Branch (FNIHB) NIHB Joint Review Steering Committee recommended immediately reinstating CCCs as eligible providers in provinces and territories that have not regulated the profession.

In December 2022, the House of Commons Standing Committee on Indigenous and Northern Affairs (INAN) released a report which included the recommendation “that the Government of Canada immediately reinstate Canadian certified counsellors in unregulated provinces under the Non-Insured Health Benefits program.” View the report here: Committee Report No. 6 – INAN (44-1) – House of Commons of Canada (ourcommons.ca)

Watch Angela Grier, CCPA’s Indigenous Director, speak to the issue before the Committee on Indigenous and Northern Affairs in 2022.

In April 2023, the government’s response to INAN’s recommendation highlighted concerns about allowing unregulated mental health counsellors to participate in the NIHB Program, noting that regulation and licensing of health professionals are managed by provincial and territorial authorities. They also added that in regions where it is recognized that there are gaps or concerns in the availability of mental health counselling services, the Program might, under special circumstances, approve and register providers associated with non-legislated organizations that operate as self-regulatory bodies (like the Canadian Certified Counsellors from the Canadian Counselling and Psychotherapy Association). Outside of these special cases, practitioners of psychotherapy or counselling not regulated are not qualified to enroll in the NIHB. View the response here: DepartmentOfCrown-IndigenousRelationsAndNorthernAffairs-e.pdf (ourcommons.ca)

Why is this problematic?

• Limited Geographic Coverage: The NIHB program’s current policy limits direct billing privileges primarily to providers in provinces that have regulated the professions of psychotherapy and counselling therapy. This includes only Ontario, Quebec, Nova Scotia, New Brunswick, and Prince Edward Island. Residents of other provinces and territories, where these professions are not regulated or are in the process of being regulated, are generally excluded, unless under special circumstances. This creates a disparity in access to services based on geographic location.
• Exclusion of Qualified Practitioners: Despite the Canadian Certified Counsellors (CCC) meeting qualifications and certification criteria comparable to those required in regulated provinces (such as adherence to a code of ethics, standard of practice, disciplinary procedures, and ongoing education), they are generally not eligible to enroll in the NIHB outside of special exceptions. This exclusion occurs even though CCCs demonstrate professional standards similar to those of regulated providers.
• Impact on First Nations and Inuit Clients: The exclusion of CCCs and other qualified, unregulated practitioners from the NIHB program limits the availability of culturally competent and accessible mental health services for First Nations and Inuit clients, particularly in unregulated provinces and territories. This is especially significant given the unique mental health challenges and needs within these communities.
• Alternative Models in Other Jurisdictions: The First Nations Health Authority in British Columbia includes CCCs under their program, which suggests a model that could be expanded to other regions. This inclusion underlines the feasibility of recognizing CCCs within federal health programs and points to an inconsistency in approach between different jurisdictions.
• Barrier to Mental Health Equity: The current policy may inadvertently contribute to inequities in mental health service access. Clients in unregulated areas may face fewer choices and potentially longer wait times for services, impacting their overall mental health outcomes.

Also important to note:

• Growing Demand for Services: There was an increase in NIHB benefits usage from over 25,000 clients in the fiscal year 2021–22 to more than 27,000 in 2022–23. This indicates a rising demand for mental health services among the eligible populations.
• Insufficient Provider Enrollment: Despite the increasing demand, there were only 4,500 mental health counselling providers enrolled with the NIHB Program as of December 2022. This gap between the demand for services and the availability of providers underscores the urgent need for expanding provider eligibility.
• Potential Relief by Including CCCs: Reinstating CCCs as eligible providers under the NIHB could significantly alleviate the pressure on existing mental health services and emergency resources. CCCs are well-qualified and meet many of the same professional standards as those required in regulated provinces.
• Impact on Indigenous Practitioners and Communities: The current policy restricts Indigenous practitioners, particularly those who are CCCs, from practicing and billing within their own communities and traditional territories. This limitation not only reduces access to culturally informed care but also neglects the valuable cultural expertise and lived experience that Indigenous practitioners bring to mental health services.
• Mental Health as a Growing Priority: Mental health is the fastest-growing benefit area within the NIHB program, highlighting the critical need for access to practitioners who are culturally competent and understand the unique socio-political influences affecting the daily lives and mental health of Indigenous peoples.
• Need for Policy Change: Changing NIHB policy to include CCCs could improve mental health outcomes by ensuring a more responsive and culturally sensitive healthcare system, thereby addressing both the growing demand and the unique needs of Indigenous communities.

To learn more about this critical advocacy effort and find out how you can contribute, leave your email address on the Indigenous Initiatives homepage by filling out the form at the bottom.  Join us in this vital call for the reinstatement of over 1500 CCCs to the NIHB mental health program, ensuring equitable access to counselling and psychotherapy services for Indigenous peoples across Canada.