Introduction
Literature review: Indigenous peoples’ historical and contemporary experiences with access to mental healthcare in Canada
Setting
Methods and approach
Modified NGT consensus
Participant recruitment
Provincial and local organizations with mandates for Indigenous Health and Wellness | Alberta Health Services (Wellness and Recovery Services) |
Alberta Health Services (Community Wellness Travelling Team) | |
McMurray Métis Local 1935 | |
Nistawoyou Friendship Centre | |
Conklin Community Association | |
Nunee Health Board | |
Chipewyan Prairie Dene Health Services | |
Janvier Dene Wood Buffalo Community Association | |
Critical Incident Stress Management | |
Waypoints | |
YMCA of Wood Buffalo | |
Fort McMurray Public School District | |
Fort McMurray Catholic Board of Education | |
Dr. Clark School | |
Borealis Counselling Services | |
Regional Municipality of Wood Buffalo (Indigenous & Rural Relations) | |
Canadian Red Cross | |
Non-Indigenous health care organizations | Alberta Health |
Alberta Health Services (Mental Health Promotion & Illness Prevention Team) | |
Academic and research organizations | The University of Alberta |
Roundtable group discussions
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1. What matters most to you in promoting mental wellness for Indigenous youth, families, or communities?
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2. What mental health resources are critical to advocate for in your community or within your organization?
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3. How do current mental health services or programs address the root social causes (e.g., poverty, racism, housing, geography, etc.) of poor mental health? How might services or programs be strengthened for Indigenous clients?
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4. How can the different sectors (e.g., health, education, justice) collaborate to support integrated and coordinated mental health and wellness among Indigenous peoples?
Community visioning
Community advisory committee
Data analysis
Realities of Mental Health Experience | |||
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Gaps | Education | Destigmatizing Mental Health | Indigenous Voice |
• Lack of consistency and availability of mental health services. Increase frequency of services and supports for mental health (i.e., services and supports should be available more than once a week) • Lack of reliable transportation between rural and to urban communities. Include transportation for residents living in rural and remote communities to access mental health services in urban centres • Services and support programs need to be offered in the Indigenous languages (i.e., Cree, Dene, Michif) • Service providers such as mental health therapists who travel from urban centres to rural communities have limited time to spend with clients. Additional funding is needed to hire mental health professionals that provide care in rural and remote communities | • Mental health providers need to understand the history of Indigenous peoples and the impacts from colonialism on intergenerational trauma • Effective mental health care for Indigenous patients is shaped by a deep understanding of the causal relationships between social factors specific to Indigenous people and health • Land-based learning and exploring the lived experience of Indigenous peoples are ways to help providers to understand, acknowledge, and identify multigenerational adverse life experiences •Mental health professionals need to build relationships and trust with their Indigenous clients. Spending more time with their clients can allow providers to explore and understand the root social causes of inequities in health | • Empower individuals to understand mental health and wellness without having the stigma associated with mental illness • Change the way we talk about and view mental illness and health | • Community needs to be engaged in the design of mental health programs and services • Create opportunities for Indigenous communities to influence the mental health service delivery model • Community drives the focus of mental wellness, not government-initiated programs and services • Engage the communities to understand what healing and mental wellness means to them. “Nothing about us without us” |
Participant Quotes | |||
“Consistency is having the same person come in and not different service organizations …because you open up once, you want to keep talking to that same person. You don’t want to have to keep telling your story over and over again…” | “The workers need to build up the trust and rapport if they’re going to work in the community. Because they [referring to Indigenous residents] are not going to come to you. The workers are the ones that got to build that relationship.” | “Maybe we need to start talking about mental health differently and talking about brain health, so that we start to change the image of it as something that is broken and needs treatment.” | “We really need a holistic, coordinated approach that’s coming from our community members, not from me as a service provider, or a community leader, but truly at the heart of the grassroots level from our members.” |
Holistic and Culturally Rooted Mental Health System | |||
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Hiring and Training Indigenous Mental Health Workers | Engage Elders | Cultural Appropriateness | Trauma-Informed Care |
• Support capacity building opportunities within the community. Allocate funding to train and hire Indigenous mental health workers or Indigenous mental health navigators from the communities who can provide cultural supports and traditional healing to Indigenous residents • Employing people in the community builds local capacity | • Engage Elders and Knowledge Holders from the communities as ‘cultural mentors’ to be involved in the training and education of mental health professionals • Engage Elders in the Schools to teach youth about cultural and traditional practices • Hire Elders to work alongside health professionals by participating in home visits | • Move away from the medical model of wellness/sickness to include Indigenous ways of knowledge on health and healing (i.e., use the Medicine Wheel) • Reclaim traditional healing practices such as native counselling and offering traditional foods (not market-based/western foods) in the communities • Focus on the ‘whole person’ (individual, family, and community needs) to promote healing • Promote cultural sensitivity across the spectrum of care, from prevention to promotion of mental health | • Embed Indigenous culture and values into healing and treatments for mental distress • Addiction and counselling services should be offered across the individual’s life span • Acknowledging and implementing the TRC recommendations across organizations |
Participant Quotes | |||
“Staff or provider turn-over is a big challenge. Providers outside of the community are going to invest very differently in a community when they don’t expect to stay, because they don’t put down their roots [in the community].” “Community-led, community-run facilities are needed to address mental health. We are always going to encounter turn-over and lack of trust from community members [of providers] if we don’t have these services and programs embedded in our communities.” “And we are building the capacity of our members and our residents who are there because they do have the knowledge, they have the connections and their relationships, and they do have their hearts in the community.” | “…and that means moving away from mainstream education simply in your classroom…and going back to our Elders, and whether that’s involving Elders in a sort of formal education system or if that’s Elders educating professionals, I don’t know. We need to do that, but I think we need to look to our Elders who have that knowledge.” | “In order for the health system to better meet the needs of Indigenous people, first of all it has to respect and value the people, the language, the culture, and then it has to be equipped to be responsive to whatever needs that exist.” | “I think we need trauma-informed services and support, which means we are grounding our supports in a non-judgmental, non-oppressive, non-violent approach, [encouraging] empowerment, choice and safety.” “Trauma-informed care asks what happened to you rather than what’s wrong with you.” |
Cross-Sectoral Engagement and Collaboration | |||
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Wrap-around Care | Social Determinants of Health | Collaboration | Education |
• Current services often operate in silos and do not address the holistic nature of health and wellness. More wrap-around services that are family- or individual-oriented and comprehensive are needed across sectors; and services in which a number of organizations work together to provide a holistic program of supports and services for Indigenous clients | • Advocate for ‘whole health’ – food security, shelter, safety, community and social support, and access to health services. This requires all the sectors to work together • Meeting the basic needs of Indigenous peoples first, such as housing and access to affordable foods | • Interagency collaboration can support delivery of wrap around services and programs • Consistent and ongoing collaboration required across the sectors (health, education, justice) • Break down the silos between the sectors by creating a safe space for decision-makers and providers across the sectors to come together to coordinate services and delivery | • Decolonize the sectors by promoting understanding and awareness of past historical trauma • A restorative justice remedy is one that places the emphasis on healing the harm done by the offence and rehabilitating the offender to avoid future harms. Such processes are in line with traditional Indigenous views of justice and healing |
Participant Quotes | |||
“…it’s about sectors working together, it’s about collaboration and more wraparound services between sectors. So, justice, health, education, community supports coming together.” “Like collaboration is necessary for wraparound services to happen. But it’s more than collaboration, like, you know, is it a formal team approach. Is it where we have a judge let’s say, who is hearing a case, can consult with a mental health professional to say, this is the case that I'm dealing with, you know, to understand the realities the individual is faced with.” “So it’s about systems thinking, expanded thinking, to see the full picture and how all the systems such as education, health, justice, etc. function…and working with allies across the systems to provide more wraparound service.” | “So what are the adversities the family is experiencing? Is it historical? Is it intergenerational trauma? Is it residential school? What might contribute to that? And then how can we support it? […] knowing what these individual needs are, and then [in] the community? […] Where are the gaps? And then how do we bring them all together? So not just looking at health, education, or justice, but the whole facet of it.” | “I think an important first step is the openness to explore within each sector, own biases, belief systems, and prejudices that underlie how we provide services.” “Between the different sectors we can create a board to facilitate or co-facilitate the supports for our clients. Because a lot of times we serve the same clients.” “We need to start to think outside the box and figure out ways to navigate these systems that are kind of making us feel a little bit inside a box…we need to be open to offering services in different ways.” “It’s being able to trust the other agencies and work together collaboratively to communicate, so that in times of need or when you need that information, you can reach out to other services, like Child Services and say hey, this is what I need. But in order for that to happen, there has to be a trust in the relationship.” | “I think it’s really important to bring back what was lost. But it’s also difficult for Elders and Indigenous health workers to enter into institutions or organizations that have been, were colonial” “Sectors have a responsibility to spend more time actually learning and understanding the history [of Indigenous peoples].” |
Children and Youth | |||
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Early Investments (Preconception to early childhood) | Engaging Parents and Families in the Schools | Culturally Appropriate Counselling for Youth | Mentorship |
• Foster healthy childhood development which begins during pregnancy and infancy | • Engage the parents in the school and in their child’s learning • Involve Elders as mentors in the schools to support Indigenous school-aged children | • Focus on specialized counselling services for children and youth in the schools and in communities | • Train youth to be peer-mentors in the schools or in their communities |
Participant Quotes | |||
“We talk about supporting early childhood development…[but] we forget that their brains are changing [like] rapid fire in their teen years…It’s really important that we sustain their development throughout the years and bring in the knowledge and expertise of Elders in the school to support them [youth]…we need to provide supports throughout the lifespan.” “So when you experience relationship violence or gender-based violence…and we know that if youth are experiencing violence then they are likely going to continue that violent behavior when they’re older. So we need to do a better job at intervening and creating supports and interventions so that youth who experience violence or trauma within personal relationships are not going to go on and continue those cycles of violence later in life.” “Education must start at home. Families, teach their children the culture, how to live, how to respect, how to treat others.” | “It’s going back to that holistic model of health…we need to start with the families and the parents, that where you can do the best prevention and to create healthy children. It has to start in our communities and our homes, because that’s where the wisdom and the knowledge is.” | “We don’t have enough pediatric and youth mental health services, we simply don’t…it’s a greater challenge to get them to come to the rural areas, especially those specialized services” |