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March 19, 2019
What the Manitoba Advocate Means When She Talks about
Safe and Secure Treatment for Youth at Imminent Risk of Harm and Death
Last week, when I released my investigation into the death of Tina Fontaine, I made five formal
recommendations to the Manitoba government. This included the need to examine models for safe and
secure treatment which are running in other provinces, like Alberta, because some Manitoba youth are
at imminent risk of dying from their addictions. Manitoba families who urgently require secure
treatment for their children need to be given those same options here in our province.
Secure care, which may be involuntary for the youth, is not an option that should be available to all
families. It is for a small number of youth who urgently need life-saving intervention. My team and I
knew that making this recommendation was going to raise concerns from some in the community,
because not all people believe that involuntary care is needed. We agree that involuntary care is not
always or often needed. In many cases, there are other existing interventions that need to be attempted
first before a parent, caregiver, or guardian should consider accessing involuntary treatment for their
child. However, for parents who are facing the desperate possibility of losing their child to the disease of
an untreated addiction, and when all other options have failed, we need to ensure that here in
Manitoba we are responding in ways that prioritize a child’s right to life.
In the time before we released In Need of Protection: Angel’s Story (2018), and A Place that Feels Like
Home: The Story of Tina Fontaine (2019), we spoke with community members, Elders, parents, youth,
Indigenous-led and non-Indigenous organizations, survivors of sexual exploitation, policy makers,
frontline advocates, and other experts, and we came to several important conclusions. Among them,
and in an ideal world, Manitoba families should have access to the early, health-focused interventions
that would prevent severe addictions from taking root in the lives of their children. In an ideal world,
Manitoba would be a leader in rapid, child-centred responses to trauma. These responses would
prioritize the individual needs of the child and their family, and would promote healing and healthy
relationships. All youth would have a protective circle of care that surrounds them and keeps them
sheltered from harm. We have not yet created that protective circle here in Manitoba. We have more
work to do.
That reality becomes even starker as my team and I read each of the 160+ child death notifications that
are sent to my office each year. These child deaths include the numerous stories of accidental overdose,
suicide, and homicide deaths where mental illness and addictions were contributing factors. In

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examining the evidence and the data we collect, I can say with certainty that Manitoba is not yet living
in that ideal world. In the meantime, Manitoba children are at imminent risk from their addictions.
My team is currently working on an aggregate investigation of 19 suicide deaths of girls who died
without receiving the meaningful mental health and addictions interventions that might have saved
them. Nineteen families, extended families, and communities are grieving while Manitoba does not
have a full continuum of options to offer young people who need adults to intervene to get them help.
The public discussion about safe and secure treatment is important. It is important that we listen to the
full range of voices and values when we consider how best to care for children. What is vital, however, is
to acknowledge that the existing programs here in Manitoba are not meeting the needs of a small
population of youth. The youth I spoke publicly about last week who are at imminent risk from their
addictions are beyond the scope of all existing programs here in Manitoba. What currently exists has not
worked for them because their addictions are so severe they are unable or unwilling to engage in
voluntary treatment. Those youth deserve to have people who care about them ensure they are
supported by clinicians, Elders, cultural workers, and medical professionals, so those youth can be saved
from further harm or death.
When I say safe and secure treatment, as I described in last week’s Tina Fontaine report, what is needed
are safe and secure, home-like settings, which include clinicians and cultural workers who can attend to
the physical, emotional, and spiritual selves of the youth who are quite literally dying from their traumainduced addictions. As Tina herself described to her worker in the days before her death, she envisioned
“a place where it feels like home.”
What is unique about the vantage point at the

… what is needed are safe and secure, homelike settings, which include clinicians and

Manitoba Advocate for Children and Youth is
that through the powerful legislation that came

cultural workers who can attend to the

into effect last year, my team and I are able to

physical, emotional, and spiritual selves of

view the complete set of public services that are

the youth who are quite literally dying from

active, or which ought to be active in the lives of

their trauma-induced addictions.

children. In some cases, while children
themselves are pleading for help and secure treatment, and are self-admitting to short-term local
resources, we have no long-term options for youth as they battle a 60- or 90-day detox period. Youth
tell us short-term stays can give them a moment of reprieve, but they exit those resources back into the
throes of addiction and of being sexually exploited. They want to stop and they cry for help, but they
cannot stop on their own.

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To suggest that love and relationships is all that it takes to address
the staggering health needs of a crippling addiction does not properly acknowledge the
experiences of those parents who have lost their child to an addiction-related death.
Secure treatment is not for all children. It is not even for most children. But for the children who are
asking for it, and those who require it, we need to consider how to meet their needs. We need to
understand that meth has moved the markers of what services we need and what we have now is not
working for some youth. For the youth who is profoundly addicted, non-compliant with prescribed lifesaving medications, is missing for long periods and at the mercy of predatory sexual exploiters, we need
to put all options on the table. We need to accept that some of these options are things we might not
have considered five or ten years ago, but that the world has evolved and our treatment options must
evolve as well.
Last week, I spoke publicly about the 17 youth my office is currently working with who are at imminent
risk. Each of those youth are in care of child and family services, is known to the Department of Families,
and nearly all of them have CFS workers who are working around the clock alongside staff in my
advocacy team and others to keep these youth alive. When I spoke about the very real dangers faced by
these youth, this was not an exaggeration. I am fearful that in the near future I will see some of their
names appear on the child death notifications I read at my office. I want citizens in Manitoba to have an
understanding of how desperate some of these youth are and why some of them are begging for safe
and secure, home-like treatment settings, like the ones described in last week’s report, A Place Where it
Feels Like Home.
Consider a few examples:
A 16 year old child in care who has been sexually exploited since age 11 and is currently
missing. This youth has been diagnosed with chronic PTSD from trauma they
experienced in their early years. The youth is a heavy user of methamphetamine, crack
cocaine, and alcohol and has been hospitalized numerous times for overdoses. The
youth has experienced more than 90 placement breakdowns in the past 6 years. They
were recently assaulted by an adult sexual predator. The youth is asking for treatment
and their workers are desperately seeking options outside of Manitoba as the resources
they need do not exist here in our province.

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A 16 year old child in care who is injecting alarming amounts of methamphetamine and
cocaine and who struggles with suicide ideation and self-harming. This youth is
frequently missing and is being sexually exploited by adults on a daily basis. They are
experiencing meth-induced psychosis and paranoia in the community and is refusing
treatment. The youth has a diagnosed cognitive disability, which makes them even more
vulnerable to adult predators. The youth also has a life-threatening medical illness and is
non-compliant with needed medications; they weigh well under 100 pounds.

A 13 year old child in care who is addicted to crack cocaine, alcohol, and cannabis, and
who has suspected mental illnesses and a cognitive disability. This child has had more
than 30 placement breakdowns in the past 7 years, periods of incarceration, multiple
admissions to crisis stabilization units, and short-term detox. The youth is frequently
missing and has been sexually exploited by adults since they were 11 years old. Due to
long periods when the youth is missing, little progress has been made on interventions.
On September 20, 2018, I issued a statement of concern about the urgent need for a mental health and
addictions system that meets the needs of children and youth in Manitoba who are falling through the
cracks. I said that it was time to set aside our comfort levels as adults and service providers, and listen to
the voices of young people who do not want to be further harmed from their addictions.
On December 13, 2018, I released a special report, In Need of Protection: Angel’s Story. In it, I formally
recommended that Manitoba Families and Manitoba Health, Seniors and Active Living:
1) Review and reform the province’s treatment programs for children and youth, and
2) Create safe and secure facilities for youth in Manitoba who are sexually exploited and harmfully
involved in substance misuse.
My office’s investigation revealed that Angel’s death by accidental overdose could have been prevented
had she received treatment to help her with her compounded trauma and addictions. In Angel’s report, I
noted that hundreds of sexually exploited youth in the province were at risk of similar preventable
deaths and that action was needed immediately. I profiled seven youth, including one deceased and six
at risk of significant harm and death. My office’s findings made it clear that an addictions treatment
strategy is a crucial, urgently needed part of the continuum of care of services for children and youth.
Last week, in A Place Where it Feels Like Home: The Story of Tina Fontaine, I recommended the creation
of safe, secure, culturally-informed home-like settings for treatment and programming for youth like
Tina who are currently at imminent risk of harm and death. I emphasized that lives were hanging in the
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balance. I shared with Manitobans that my office is actively advocating for and working with 17
Manitoba youth in the care of child and family services who desperately require safe and secure detox
treatment before it is too late.
These youth are not ‘out partying’, choosing to be sexually exploited, or to be profoundly addicted.
These are common myths that lead to victim blaming and allow predators to continue exploiting
children. What these youth tell us is that they are hungry, have not slept for days, often require urgent
medical treatment when they resurface, and are being sexually exploited in exchange for drugs and
shelter in order to survive. The adults and gangs who are exploiting and trafficking these youth are
fuelling their addictions in order to further abuse them. Some of these youth have told us they cannot
make safe choices and are crying out for help to get desperately needed treatment, to no avail. Others
are self-harming to cope with their trauma. Some have died by suicide, homicide, and accidental
overdose.
Parents who have lost a child to the harms associated with drug addiction, when that addiction is cooccurring with mental illness, cognitive disabilities, sexual exploitation, and other dangers have given us
a clear message. They would trade anything to have one more chance to save their child. Parents and
care providers who struggle to support a child through spiralling addiction know that all of the love and
good intentions in the world are sometimes not enough to keep their child safe and alive.
When youth are unable to make safe choices for themselves, parents, care providers, and guardians
need options that will allow them to step in and place their child into a resource that can provide
appropriate supports and give them the chance to save their child’s life.

If love were all that it takes, then those children would still be here.
If you are a parent, guardian, caregiver, professional, or organization who is seeking addiction-related
treatment for a child, I invite you to reach out to our office to ask questions, find support, and tell your
story. Together, we can work to change the outcomes for children who need support and intervention.
Daphne Penrose, MSW, RSW
Manitoba Advocate for Children and Youth

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