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The mental health of Indigenous peoples in Canada: A critical review of research
Abstract
Many scholars assert that Indigenous peoples across the globe suffer a disproportionate burden of mental illness. Research indicates that colonialism and its associated processes are important determinants of Indigenous peoples’ health internationally. In Canada, despite an abundance of health research documenting inequalities in morbidity and mortality rates for Indigenous peoples, relatively little research has focused on mental health. This paper provides a critical scoping review of the literature related to Indigenous mental health in Canada. We searched eleven databases and two Indigenous health-focused journals for research related to mental health, Indigenous peoples, and Canada, for the years 2006–2016. Over two hundred papers are included in the review and coded according to research theme, population group, and geography. Results demonstrate that the literature is overwhelmingly concerned with issues related to colonialism in mental health services and the prevalence and causes of mental illness among Indigenous peoples in Canada, but with several significant gaps. Mental health research related to Indigenous peoples in Canada overemphasizes suicide and problematic substance use; a more critical use of the concepts of colonialism and historical trauma is advised; and several population groups are underrepresented in research, including Métis peoples and urban or off-reserve Indigenous peoples. The findings are useful in an international context by providing a starting point for discussions, dialogue, and further study regarding mental health research for Indigenous peoples around the world.
... Indigenous people have suffered from forced assimilation, dispossession of lands, and both cultural and physical violence within the residential school system (Hahmann et al., 2023). They continue to suffer from socioeconomic inequalities, marginalization of cultural identity, ongoing systemic discrimination, and health disparities (Adelson, 2005;Burns and Shor, 2021;Durand-Moreau et al., 2022;Nelson and Wilson, 2017). In the current study, we focus on examining the association between ethnic belonging and the health of Indigenous peoples. ...
... Considering heterogeneity (disparity) in gender, urban-rural divisions, generations, and ethnic groups among Indigenous Canadians is also crucial (Macklem, 2001;Nelson and Wilson, 2017). Indigenous women have specific statuses and responsibilities within traditional social and cultural roles, which may grant them a unique sense of belonging and community connection (Brodribb, 1984). ...
... The typological analysis reveals some unsettling phenomena: 35.0 % of the population are in a suboptimal health condition. This aligns with existing statistics and research (Durand-Moreau et al., 2022;Nelson and Wilson, 2017), highlighting the persistent and complex health challenges faced by the Indigenous population in Canada. Recent studies have shown that Indigenous individuals often endure substantial injustices, often rooted in colonial practices and ongoing discrimination (Kubik et al., 2009;Nelson and Wilson, 2017). ...
... Introduction U.S. Indigenous peoples have experienced dramatic shifts in culture, family, foodways, and political, environmental, and spiritual health because of historical oppression, the insidious, institutional, structural, and intergenerational experiences of cultural disruption, settler colonialism, and associated historical traumas (Burnette & Figley, 2017;McKinley, Ka'apu et al., 2020;Nelson & Wilson, 2017;Sam et al., 2022). Settler colonial structures of historical oppression and persist through aims at erasing and assimilating Indigenous peoples (Arvin et al., 2013;Fast & Collin-Vézina, 2019;Sam et al., 2022;Wolfe, 1999). ...
... The erasure of cultural memory enables settlers to claim Indigenous peoples' lands as their own and restructure society according to heteropatriarchal (dominant heterosexual and patriarchal social arrangements) and heteropaternal (organizing society through nuclear family systems and institutions, e.g., religious, business, educational) dominant norms (Arvin et al., 2013;Wolfe, 1999). Historical oppression in the forms of forced removal, relocations, and the introduction of European food rations has disrupted lifeways and caused a separation from land, place, foodway, culture, and health (Burnette & Figley, 2017;Fast & Collin-Vézina, 2019;Gurney et al., 2015;Nelson & Wilson, 2017). The legacies of past and present structures of settler colonial historical oppression undermine Indigenous peoples' (the scope of this inquiry is limited to Native Americans) wellness and perpetuate experiences of physical, mental, and socio-structural health inequities (Fast & Collin-Vézina, 2019;Gone & Kirmayer, 2020;McKinley, Spencer et al., 2020;Nelson & Wilson, 2017;Sam et al., 2022), which drive heightened mortality and morbidity, with Indigenous peoples in North America dying, on average, almost six years sooner than their non-Indigenous counterparts (Indian Health Service, 2019). ...
... Historical oppression in the forms of forced removal, relocations, and the introduction of European food rations has disrupted lifeways and caused a separation from land, place, foodway, culture, and health (Burnette & Figley, 2017;Fast & Collin-Vézina, 2019;Gurney et al., 2015;Nelson & Wilson, 2017). The legacies of past and present structures of settler colonial historical oppression undermine Indigenous peoples' (the scope of this inquiry is limited to Native Americans) wellness and perpetuate experiences of physical, mental, and socio-structural health inequities (Fast & Collin-Vézina, 2019;Gone & Kirmayer, 2020;McKinley, Spencer et al., 2020;Nelson & Wilson, 2017;Sam et al., 2022), which drive heightened mortality and morbidity, with Indigenous peoples in North America dying, on average, almost six years sooner than their non-Indigenous counterparts (Indian Health Service, 2019). ...
Sociocultural, mental, behavioral, and physical factors are interrelated associates of chronic health conditions—such as diabetes, obesity, and cardiovascular disease—all of which are disproportionally high and drive much of the mortality and morbidity for Indigenous peoples. Indigenous worldviews conceptualize health holistically, with inseparability across social, spiritual, cultural, familial, mental, behavioral, physical, and social dimensions of wellness. Food, family, and culture are fundamental to Indigenous wellness. The purpose of this article is to use the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) conceptualization of relational wellness to honor urban and rural U.S. Indigenous perspectives that highlight the intersections of family, culture, physical health, spiritual, and mental health to promote resilience and wellness. This research focused on interconnections between wellness, culture, health, and family. Thirty-one critical ethnographic interviews used a life-history approach with methodology following an Indigenous toolkit for ethical and culturally sensitive research strategies, such as building upon cultural strengths, engaging in long-term, relational commitments with communities, incorporating storytelling and oral history traditions, centering Indigenous methodologies and preferences, working with cultural insiders, and prioritizing the perspectives of Indigenous peoples. Emergent themes included: (a) roots of Indigenous wellness: cultural values promoting balance and connection; (b) practicing resilience: family transmission of health information; and (c) wholistic mental wellness and resilience, with the subtheme culture and wellness. Interventions can be developed in collaboration with tribes for optimum efficacy and cultural relevancy and can approach wellness holistically in culturally relevant ways that center foodways, culture, family, and spirituality.
... Funding should be directed away from ineffective and punitive drug control and toward health and social programs (Daniels et al., 2021). Culturally safe mental wellness interventions and community-owned services, for example, are needed to address trauma, historical or contemporary, and harmful coping strategies that exacerbate strain among Indigenous peoples who use drugs Hansen & Calihoo, 2014;Nelson & Wilson, 2017;Spillance et al., 2023;Urbanoski, 2017). ...
... Finally, because of the shared experiences of colonialism, we treat all Indigenous peoples in Canada as one group in this study, whereas in reality, there are significant gaps between Indigenous peoples who live on-reserve or off-reserve, and there are significant differences among First Nations, Metis, and Inuit (Spillance et al., 2023). For example, in a critical review of research, Nelson & Wilson (2017) found that mental health research overemphasizes suicide and problematic substance use and that Metis peoples and urban or off-reserve Indigenous peoples are understudied. Future studies, therefore, should break down Indigenous peoples into sub-groups and study them separately. ...
Cashing in on the first-ever opportunity for data release after the legalization of marijuana in 2018, the present research brings criminological theories to explore the correlation of cannabis use among Indigenous peoples in Canada. Logistic regression of a subsample of all Indigenous peoples in General Social Survey data shows that variables broadly derived from general strain model, together with those of the comorbid model and social support model, can explain the variance of cannabis use among Indigenous peoples. Lived experiences of discrimination and cyber victimization, residential mobility, and mental health are significant correlates of marijuana use. Policies that aim to increase equity and equality, as promised in the 1982 Canadian Charter of Rights and Freedoms, would alleviate the dilemma of Indigenous peoples and are thus called for.
... 14,42 Previous research has found that Indigenous people are more likely to have anxiety disorders. [43][44][45] A number of factors behind poor mental health outcomes of Indigenous people have been identified, including historical and intergenerational trauma, socioeconomic disparities, geographical barriers to health care access, and persistent inequities in access to health care services. [44][45][46] In this study, Indigenous males had higher odds of having anxiety disorders than non-Indigenous, non-racialized males. ...
... [43][44][45] A number of factors behind poor mental health outcomes of Indigenous people have been identified, including historical and intergenerational trauma, socioeconomic disparities, geographical barriers to health care access, and persistent inequities in access to health care services. [44][45][46] In this study, Indigenous males had higher odds of having anxiety disorders than non-Indigenous, non-racialized males. However, Indigenous females were more likely than non-Indigenous, non-racialized females to have an anxiety disorder, but this association did not persist in multivariable analysis. ...
Background
Anxiety disorders are among the most common mental health problems. However, few studies have examined the prevalence of, and factors associated with, anxiety disorders among older Canadians (65 years or older), with a particular focus on Indigenous and racialized population groups.
Data and methods
Data from eight cycles of the annual Canadian Community Health Survey (CCHS)—2015 to 2022—were used to examine anxiety disorders among older Canadians. Multivariable logistic regression, stratified by sex, was carried out on a pooled sample of 151,755 respondents aged 65 years or older.
Results
From 2015 to 2022, on average, 6.0% of older Canadians reported a diagnosis of an anxiety disorder, with females (7.5%) more likely than males (4.2%) to have done so. Indigenous males had higher odds of having an anxiety disorder than non-Indigenous, non-racialized males, while Chinese and other racialized females had lower odds of having an anxiety disorder than non-Indigenous, non-racialized females.
Interpretation
Findings of this study highlight the importance of considering Indigenous and racialized population groups disaggregated by sex when examining anxiety disorders among older Canadians to inform screening and intervention programs.
Keywords
anxiety disorder, older Canadians, Indigenous people, racialized populations, sex at birth
... Des recherches antérieures ont révélé que les Autochtones étaient plus susceptibles d'avoir des troubles anxieux [43][44][45] . Un certain nombre de facteurs à l'origine des piètres résultats en matière de santé mentale des Autochtones ont été cernés, notamment les traumatismes historiques et intergénérationnels, les disparités socioéconomiques, les obstacles géographiques à l'accès aux soins de santé et les iniquités persistantes en matière d'accès aux services de soins de santé [44][45][46] . ...
... Des recherches antérieures ont révélé que les Autochtones étaient plus susceptibles d'avoir des troubles anxieux [43][44][45] . Un certain nombre de facteurs à l'origine des piètres résultats en matière de santé mentale des Autochtones ont été cernés, notamment les traumatismes historiques et intergénérationnels, les disparités socioéconomiques, les obstacles géographiques à l'accès aux soins de santé et les iniquités persistantes en matière d'accès aux services de soins de santé [44][45][46] . Dans la présente étude, les hommes autochtones étaient plus susceptibles d'avoir des troubles anxieux que les hommes non autochtones et non racisés. ...
Contexte
Les troubles anxieux figurent parmi les problèmes de santé mentale les plus courants. Cependant, peu d’études ont porté sur la prévalence des troubles anxieux et les facteurs associés à ceux-ci chez les Canadiens âgés (65 ans et plus), en mettant l’accent sur les groupes de population autochtones et racisés.
Données et méthodologie
Les données de huit cycles de l’Enquête annuelle sur la santé dans les collectivités canadiennes (ESCC), soit ceux de 2015 à 2022, ont été utilisées pour examiner les troubles anxieux au sein de la population canadienne âgée. Une régression logistique multivariée et stratifiée selon le sexe a été réalisée sur un échantillon groupé composé de 151 755 répondants de 65 ans et plus.
Résultats
De 2015 à 2022, en moyenne, 6,0 % de la population canadienne âgée a déclaré un diagnostic de trouble anxieux, et les femmes (7,5 %) étaient plus susceptibles que les hommes (4,2 %) d’en avoir déclaré un. Les hommes autochtones étaient plus susceptibles d’avoir des troubles anxieux que les hommes non autochtones et non racisés, tandis que les femmes chinoises et les autres femmes racisées étaient moins susceptibles d’avoir des troubles anxieux que les femmes non autochtones et non racisées.
Interprétation
Les résultats de la présente étude soulignent l’importance de tenir compte des groupes de population autochtones et racisés désagrégés selon le sexe lors de l’examen des troubles anxieux au sein de la population canadienne âgée, afin d’orienter les programmes de dépistage et d’intervention.
Mots-clés
trouble anxieux, population canadienne âgée, Autochtones, populations racisées, sexe à la naissance.
... About 30% of First Nations individuals live on a reserve, tracts of land that are designated for use by First Nations according to treaty rights (Government of Canada, 2017), whereas the other 70% live off-reserve in rural or urban areas throughout Canada. Even though the majority of First Nations individuals live off-reserve, the offreserve population is significantly underrepresented in the Indigenous child development and health literatures (Nelson & Wilson, 2017). ...
... In accordance with the suggestions of many Indigenous researchers and the United Nations (United Nations, 2019), we did not aggregate all Indigenous children who participated in the ACS into a single homogenous group since doing so neglects the rich diversity among Indigenous groups and prevents the identification of community-specific data (Chandler, 2011). Rather, we only include First Nations children as they are the most populous Indigenous group in Canada (Government of Canada, 2017), but remain underrepresented in the Indigenous health literature (Nelson & Wilson, 2017). Out of the 3465 First Nations children eligible to complete the SDQ, 86.3% (n = 2990) had complete outcome data. ...
Few studies have focused on off‐reserve Indigenous children and families. This nationally representative, cross‐sectional study (data collected from 2006 to 2007) examined Indigenous‐ and non‐Indigenous‐specific determinants associated with positive socioemotional and behavioral well‐being among First Nations children living off‐reserve in Canada. The parents or other caregivers of 2990 two‐to‐five‐year‐old children ( M = 3.65; 50.6% male) reported on their children's socioemotional and behavioral well‐being and a range of child, parent, and housing characteristics. Being taught an Indigenous culture, greater community cohesion, caregiver nurturance, good parental/other caregiver health, and fewer household members were associated with better socioemotional and behavioral well‐being. These results highlight the importance of leveraging Indigenous‐specific determinants and acknowledging non‐Indigenous‐specific factors, to promote the well‐being of First Nations children living off‐reserve.
... Recent research has investigated the lived experience of water (in)security, and how it is embodied and manifests 'under the skin' , and in mental health, through feelings of shame, anger, and humiliation (Eichelberger 2017, Rosinger et al 2021, Wutich et al 2022, Martin-Ortega 2023. For many Indigenous Peoples, the complex, collective, cumulative, and intergenerational psychosocial impacts that resulted from the depredations of past colonial subjugation, including water injustices and water colonialism, remain an ongoing challenge (Tuck 2009, Nelson and Wilson 2017, Leonard et al 2023. ...
... A lack of access to safe drinking water has also been shown to increase suicide risk and impact mental health in first nations (Cunsolo Willox et al 2013, Hanrahan et al 2016, Ansloos and Cooper 2023. Mental health and its relationship to water justice, colonialism, historical trauma and their associated processes have been highlighted as areas that need to be critically investigated (Nelson and Wilson 2017). ...
Indigenous water knowledge recognizes water as living, and that the relationship between people and water is one of reciprocity. Yet, Indigenous Peoples continue to struggle for water justice due to centuries long and ongoing colonial legacies that have intergenerational effects on self-determination, culture, and wellbeing. Using a narrative review, this paper explores how published research has used art and arts-based approaches to explore dimensions of water injustice, wellbeing and mental health with Indigenous communities living in the Arctic and Amazon regions. Within the three central themes of the review (wellbeing, water justice, and arts-based research approaches), the most discussed emergent themes were: relationship to place, kinship, the lived experience of water, ongoing changes to water, and storytelling and art as instruments of resistance and to make visible what is not visible. The paper discusses those themes from the literature, and possible areas of future research. The findings underscore the importance of including diverse voices, worldviews and knowledges in water governance, and the potential for arts-based approaches to facilitate intercultural and intergenerational efforts to address water injustice and advance Indigenous Peoples’ rights to self-determination.
... [40][41][42][43] Due to historical and contemporary colonial landscapes, Indigenous Peoples experience higher rates of socioeconomic inequity and their health outcomes are worse than the general population. 13,44 Indigenous Peoples suffer a disproportionate burden of mental illness, 45 poorer cancer outcomes, 46 as well as an overall shorter life expectancy when compared to non-Indigenous People. 44 Indigenous Peoples are overrepresented in the precariously housed population in Canada, the United States of America, Australia, and New Zealand. ...
... There is a disproportionate rate of chronic disease burden and higher mortality rates in Indigenous Peoples when compared to non-Indigenous People. [44][45][46] It is well documented that the historical implications of colonization, residential schools, multigenerational trauma, and systemic anti-Indigenous racism have greatly impacted the health and well-being of Métis, Inuit, and First Nations Peoples in Canada. 19 Indigenous identity further shapes the type of person-centered care needed in Canada for those experiencing socioeconomic inequity. ...
Background
Individuals experiencing socioeconomic inequity have worse health outcomes and face barriers to palliative and end-of-life care. There is a need to develop palliative care programs tailored to this underserved population.
Objectives
To understand the characteristics and symptom profiles of a group of urban patients experiencing socioeconomic inequity and receiving palliative care.
Design
Descriptive exploratory analysis of a patient dataset. The patient dataset was generated through a pilot research study with patients experiencing socioeconomic inequity and life-limiting illness who received a community-based palliative care intervention.
Methods
The intervention took place over 1 year in the Palliative Care Outreach and Advocacy Team, a community-based urban palliative care clinic in Edmonton, Alberta, Canada, serving persons experiencing socioeconomic inequity. Participants had to be at least 18 years of age, be able to communicate in English, require palliative care for a life-limiting illness, and be able to consent to inclusion in the study.
Results
Twenty-five participants were enrolled. Participants predominantly identified as male and Indigenous, experienced poverty and housing instability, and had metastatic cancer. Our participants rated their pain, shortness of breath, and anxiety as more severe than the broader community-based palliative care population in the same city. Most patients died in inpatient hospices (73%).
Conclusion
Our analysis provides an in-depth picture of an understudied, underserved population requiring palliative care. Given the higher symptom severity experienced by participants, our analysis highlights the importance of person-centered palliative care. We suggest that socioeconomic inequity should be considered in patients with life-limiting illnesses. Further research is needed to explore palliative care delivery to those facing socioeconomic inequity.
... Inuit youth mental health has received considerable attention in the literature, compared to First Nations or Métis [1], yet the provision of Inuit youth-centric culturally-safe programming to promote well-being has received far less attention. We use Inuit Tapiriit Kanatami's (ITK) definition for Inuit in Canada, which states "Inuit are an Indigenous people living primarily in Inuit Nunangat … [but] our population is also increasingly urban … Canadian Inuit are young with a median age of just 23" [2] no pagination. ...
... Colonialism has impacted Inuit health, physically, mentally and structurally. Experiences of residential school have been linked to suicide ideation [1]. Sedentarization had profound impacts on physical health; with this shift in lifestyle, and arguably culture, came sustained long-term contacts with relatives and community members, with little opportunity to step back. ...
Inuit youth face challenges in maintaining their wellbeing, stemming from continued impacts of colonisation. Recent work documented that urban centres, such as Winnipeg Canada, have large Inuit populations comprised of a high proportion of youth. However, youth lack culturally appropriate health and wellbeing services. This review aimed to scan peer-reviewed and grey literature on Inuit youth health and wellbeing programming in Canada. This review is to serve as an initial phase in the development of Inuit-centric youth programming for the Qanuinngitsiarutiksait program of research. Findings will support further work of this program of research, including the development of culturally congruent Inuit-youth centric programming in Winnipeg. We conducted an environmental scan and used an assessment criteria to assess the effectiveness of the identified programs. Results showed that identified programs had Inuit involvement in creation framing programming through Inuit knowledge and mostly informed by the culture as treatment approach. Evaluation of programs was diffcult to locate, and it was hard to discren between programming, pilots or explorative studies. Despite the growing urban population, more non-urban programming was found. Overall, research contributes to the development of effective strategies to enhance the health and wellbeing of Inuit youth living in Canada.
... Cases of suicide identified were predominantly Caucasian, which is similar to U.S. data on suicide in older adults from the National Violent Death Reporting System (4). Of note, while Indigenous populations are a group at particularly elevated risk of suicide in Canada (9), no cases in this study were identified as Indigenous. This may be due in part to mental health services' colonial roots, which negatively impact the willingness of Indigenous populations to engage with the system (9). ...
... Of note, while Indigenous populations are a group at particularly elevated risk of suicide in Canada (9), no cases in this study were identified as Indigenous. This may be due in part to mental health services' colonial roots, which negatively impact the willingness of Indigenous populations to engage with the system (9). It is also possible that patients may have been reluctant to identify as Indigenous, due to potential concerns on how this may impact the way they are treated. ...
Introduction
Suicide prevention is an important aspect of psychiatric care, with older men being a population identified at especially high suicide risk and a recent increase in suicides among older women.
Methods
Using data collected by the region’s quality assurance team, we examined all suicide deaths occurring between March 1999 and February 2024 in patients aged 60 years or older who were connected to the region’s Addiction and Mental Health Program at the time of death. Data were analyzed to describe which factors were most commonly identified in suicides in older adults receiving mental healthcare. We also compared male and female cases to determine whether certain factors were more commonly observed in one gender.
Results
We identified 48 cases of suicide occurring in patients aged 60 or over. 60% of suicides occurred in males. Overdose and hanging were the most common suicide methods used, and all suicides occurring on inpatient units occurred via hanging. Depression was the most common diagnosis, and was diagnosed more frequently in suicides of female older adults. A greater proportion of suicides in older women were associated with previous history of suicide attempts.
Discussion
Our findings support many current best practices for suicide prevention in psychiatric care, including minimizing ligatures and anchor points on inpatient settings, assessing for and limiting access to means in individuals at-risk, and assessing suicide risk in hospitalized patients prior to passes and discharge. Recognition and treatment of depression remain important aspects in the treatment of older adults to prevent suicide.
... Being female, socioeconomic factors (including lower education levels, unemployment, lower income, and overall area-level disadvantage in non-remote regions), and cultural factors (including experiences of racism and a history of family removal) were associated with experiencing high/ very high levels of psychological distress [6,8]. Similar associations with socioeconomic factors, education, disconnection from culture or community, and interpersonal violence have been found in First Nations populations of comparable OECD countries [10][11][12][13][14]. Importantly, the literature also presents evidence of the converse pattern. ...
... Similar associations with socioeconomic factors, education, disconnection from culture or community, and interpersonal violence have been found in First Nations populations of comparable OECD countries [10][11][12][13][14]. Importantly, the literature also presents evidence of the converse pattern. Studies have consistently shown that factors such as connection to community, language, and spirituality have predictive value for positive mental health outcomes [11]. In Australia and New Zealand, research has demonstrated that maintaining a strong connection to Indigenous culture and residing in areas with a high ethnic density serve as protective factors against mental disorders by fostering resilience and well-being. ...
Purpose
Limited data exists on the relationship between sociodemographic and cultural variables and the prevalence of specific mental and substance use disorders (MSDs) among Indigenous Australians, using diagnostic prevalence data. This paper utilises data from the Queensland Urban Indigenous Mental Health Survey (QUIMHS), a population-level diagnostic mental health survey, to identify socioeconomic and cultural correlates of psychological distress and specific MSDs in an urban Indigenous Australian sample.
Methods
Using a mixture of household sampling (door-knocking) and snowball sampling (promotion of the survey in the community), 406 participants aged 18 to 89 were recruited across key locations in Southeast Queensland. The study investigated various demographic, socioeconomic, and cultural factors as predictors of psychological distress (measured by the Kessler-5) and MSD diagnoses (utilising the Composite International Diagnostic Interview, CIDI 3.0) using a series of univariate logistic regressions.
Results
Individuals in unstable housing (homeless, sleeping rough) and those reporting financial distress were more likely to experience an MSD in the past 12 months and throughout their lifetime. Individuals reporting lower levels of connection and belonging, limited participation in cultural events, and lower empowerment were more likely to have a lifetime mental disorder.
Conclusion
This data emphasises the importance of addressing systemic and social determinants of health when designing and delivering community mental health services and underscores the need for holistic approaches when working with Indigenous communities.
... Based on the findings herein, as well as existing literature on cultural connectedness and health, it is important for institutions and governments alike to assist in efforts to restore ITEKs at individual, family, and community levels for Indigenous and planetary health. In this case, the return to culture, traditions, spirituality, and language are recognized as foundational elements in the efforts to understand and ameliorate the corresponding effects of settler colonialism, as well as historical loss, while moving toward individual and collective healing and cultural continuity(Gone & Trimble, 2012;Nelson & Wilson, 2017;Walls et al., 2012;Warne & Wescott, 2019;Bethune et al., 2019). ...
Addressing Indigenous determinants of health includes understanding the interconnectedness among Indigenous health and wellbeing, relationship to place and Mother Earth. Though persistent challenges exert a disproportionate burden on Indigenous communities, many experience an intersecting risk profile that includes a history of settler-colonial subjugation and historical loss, while navigating loss and damage due to climate change which further impinges on their mental health. Traditional, spiritual, and cultural activities operate as functional observations of Indigenous Traditional Ecological Knowledges (ITEK) and are increasingly recognized as necessary components of adaptation and mitigation to climate change and sustainability of otherwise delicate ecosystems. In addition, corresponding traditional and cultural activities have been associated with improved mental health. The present investigation utilizes land-based cultural and traditional activities, as well as indicators of language revitalization in a composite variable-Indigenous Eco-Relational Engagement (IERE) to determine the relationship to positive mental health among Anishinaabeg in the United States and Canada. The results suggest that IERE shares a positive relationship with positive mental health among Anishinaabeg adults. Results of the present investigation help us to reconcile the relationship between Indigenous and planetary health, such that both may be supplemented through the active observation of ITEKs vis-à-vis engagement in traditional cultural, spiritual activities and language revitalization efforts.
... Based on the findings herein, as well as existing literature on cultural connectedness and health, it is important for institutions and governments alike to assist in efforts to restore ITEKs at individual, family, and community levels for Indigenous and planetary health. In this case, the return to culture, traditions, spirituality, and language are recognized as foundational elements in the efforts to understand and ameliorate the corresponding effects of settler colonialism, as well as historical loss, while moving toward individual and collective healing and cultural continuity(Gone & Trimble, 2012;Nelson & Wilson, 2017;Walls et al., 2012;Warne & Wescott, 2019;Bethune et al., 2019). ...
Addressing Indigenous determinants of health includes understanding the interconnectedness among Indigenous health and wellbeing, relationship to place and Mother Earth. Though persistent challenges exert a disproportionate burden on Indigenous communities, many experiencing an intersecting risk profile that includes a history of settler-colonial subjugation and historical loss, while navigating loss and damage due to climate change which further impinges on their mental health. Critically, Traditional, spiritual, and cultural activities operate as functional observations of Indigenous Traditional Ecological Knowledges (ITEKs) and are increasingly recognized as necessary components of adaptation and mitigation to climate change and sustainability of otherwise delicate ecosystems. In addition, corresponding traditional and cultural activities have been associated with improved mental health. The present investigation utilizes land-based cultural and traditional activities, as well as indicators of language revitalization in a composite variable – Indigenous Eco-Relational Engagement (IERE) to determine the relationship to positive mental health among Anishinaabeg in the U.S. and Canada. The results suggest that IERE shares a positive relationship with positive mental health among Anishinaabeg adults. Results of the present investigation help us to reconcile the relationship between Indigenous and planetary health, such that both may be supplemented through the active observation of ITEKs vis-à-vis engagement in traditional cultural, spiritual activities and language revitalization efforts.
... Remembering the deaths of family members or loved ones, torture and food deprivation remained fresh in the minds of the mentally ill despite their usual calm state. In Canada, it is justified by colonisation and its associated processes, and in Nigeria, by attacks of spiritual origin [19], [27] Representations of mental illness lead to behaviour within the population that ranges from distancing and segregation to avoidance and exclusion [28], [29], [30]. In the city of Bukavu, the mentally ill are seen by some as people who should be treated (55.5%) and by others as very dangerous people who should be avoided (22.6%), chained up or locked up (21.1%). ...
Backgroung: The perception of mental health by the population conditions the care and social reintegration of the patient. The objective of
this study was to describe the perception of mental illness in the city of Bukavu
Methods: This study was a descriptive cross-sectional study conducted in the urban health zone of Ibanda in the east of the Democratic
Republic of Congo in 3 strata, namely Mama Mwilu, Muhungu Celpa and Irambo from January to July 2018. It involved 381 respondents.
Results: In total, 31% of the interviewees attributed the onset of mental illness to a traumatic event, 21% to drug use and 18% to witchcraft.
Of all the interviewees, 46% recognised the mental illness by its behaviour, 57.7% maintained that mental illness is curable, that the ideal
place for its management was the psychiatric centre (63.8%) or prayer (20.7%). The most educated interviewees perceived mental illness as
a demonic possession three times less than the less educated interviewees.
Conclusion: A large part of the population of Bukavu continues to consider mental illness to be of mystical origin. Work needs to be done to
improve this perception in order to correct the way in which the illness is managed.
... As such, historical trauma and events of racial discrimination, at both individual and systemic levels, should be a central theme in the discussion of ACE among Indigenous populations. The intergenerational transmission of historical trauma, such as the Indian Residential School System and the 60's Scoop, is regularly identified as a significant moderator of the health of many Indigenous children (Nelson & Wilson, 2017). Similarly, experiences and perceptions of discrimination have been previously found to produce poor mental health outcomes, particularly among Indigenous populations (Bombay et al., 2011). ...
Objective: Adverse childhood experiences (ACEs) are associated with health-risk behaviors and chronic disease development. Although valuable, conventional ACE surveys may fail to adequately capture the range of adversities that some communities experience. The primary objective of this study was to investigate whether First Nations and Metis postsecondary students and staff in Ontario identified domains of ACE not captured by conventional ACE surveys. In addition, this study aimed to identify potential coping strategies or factors. Method: Qualitative interview and focus group methodologies were used; notably, we integrated aspects of the nominal group technique with elements of First Nations Sharing Circles. The data were thematically analyzed and organized by their impact as perceived by participants. Results: Sixteen First Nations and Metis participants (ages 21–38) shared five additional domains of ACE: historical trauma, lack of infrastructure and public services, household and community dysfunction, gender-based adversities, and racial discrimination. Four domains of coping strategies and factors were identified: healing from trauma, improving cultural connections, strengthening social networks, and developing skills and knowledge. Conclusions: Findings highlight the need to appreciate the sociological and historical experiences of communities, not just individuals, when surveying ACE among Indigenous youth. Specifically, when surveying ACE in Indigenous populations, measures should be expanded to include historical trauma, lack of infrastructure and public services, gender-based adversities, and racial discrimination.
... It is well documented that iyiniwak are given DSM diagnoses such as substance use and depression at higher rates than the general population (S. E. Nelson & Wilson, 2017). The DSM situates these forms of distress inside the person while ignoring the effects of historical and ongoing colonialism such as land theft, attempted genocide, residential TURNING THE DSM ON ITS HEAD schools, systemic racism, and overincarceration. ...
The conception of this article came to us at the end of a land-based healing program informed by Indigenous approaches to wellness. In this article, we dismantle psychiatric diagnosis, particularly the Diagnostic and Statistical Manual of Mental Disorders (DSM). Drawing on Frantz Fanon's notion of sociodiagnosics, we put DSM diagnostic categories under a sociogenic microscope. We assert that the DSM and psychologizing discourses are cultural products born out of coloniality, which continue to serve as tools for the subjugation of iyiniwak (Indigenous peoples), a phenomenon termed psycholonization. After setting our intentions and describing Fanon's sociodiagnostics, we will examine various disorders and symptomatology from a decolonial lens. By using the very language of the DSM, we make visible and "diagnose" the colonial logics and ideologies inherent in these categories. This includes addiction to, and obsessions with, excessive material wealth and power that has justified the dispossession of iyiniwak land and now is causing a climate crisis that threatens humanity and all our relations. We assert that these colonial logics and ideologies are pathogenic not only for iyiniwak but also for settlers and all people. In the second section, we recenter vastly different worldviews that underpin Indigenous approaches to "assessment" and "diagnosis," including a nonlinear understanding of time, listening to and engaging wisdoms, and the acknowledgment of diversity and divergence as a given that is celebrated and honored. We end this article by addressing the importance of conceptual humility to rectify epistemic violence that is at the core of jagged diagnostic worldviews colliding. Public Significance Statement By drawing on Franz Fanon, we "diagnose" the colonial logic and Eurosettler ideologies inherent in the Diagnostic and Statistical Manual of Mental Disorders, a widely used classification system for mental disorders. We then discuss vastly different worldviews that underpin Indigenous approaches to "assessment" and "diagnosis" that acknowledge the giftedness of all people.
... Unsurprisingly, MDP is highest in, for example, Central African countries, where burden of disease from mental disorders is simultaneously extremely high (UNDP, 2023;GBD 2019Mental Disorders Collaborators, 2022. In high income settings such as Canada, MDP is highest among traditionally excluded populations (such as racialised or indigenous populations (Employment and Social Development Canada, 2021) -groups which also face high levels of burden of mental ill health (Nelson & Wilson, 2017). ...
... Another critique of CTOs indicates that racialized and socioeconomically marginalized people would be more likely to consent to it to access services even though they may not want to receive psychiatric treatments (Mfoafo-M'Carthy, 2010; Mfoafo-M'Carthy & Williams, 2010). Colonization and neoliberal policies have significantly reduced social service provisions for the health and well-being of those who disproportionately experience socioeconomic deprivation and intersecting forms of discrimination (de Leeuw & Greenwood, 2011;Morrow, 2004;Nelson & Wilson, 2017). People who experience intersecting forms of disadvantage are likely to be pushed to a circumstance where consent to a CTO is the only way to receive necessary services that are otherwise not accessible to them (Mfoafo-M'Carthy, 2010, 2014Mfoafo-M'Carthy & Williams, 2010). ...
Employing critical discourse analysis (CDA), this paper examines how medicalized concepts of mental illness and paternalistic views are framed and used in the legal case, Thompson and Empowerment Council v. Ontario (2013). The paper argues that the case utilizes a pathologized notion of mental illness to justify and defend the legality of involuntary treatment, specifically, the community treatment orders (CTOs) under Ontario’s Mental Health Act (MHA). This paper shows how the Thompson case relies on medical reductionism and binary notions of capacity versus incapacity while failing to consider intersecting factors and contextual and social determinants of psychosocial disability. Following this, I suggest that a postmodernist relational theory of disability could change the legal discourses about the MHA. Challenging the medicalized view of mental illness through the relational approach to psychosocial disability could have strengthened the plaintiffs’ case and prompted legal reforms for better safeguards under the MHA. In doing so, this paper offers a basis and future direction for legal reforms that can lead to legal mandates for improved social and healthcare services to enhance the autonomy of individuals subjected to CTOs.
... The mental health of the Canadian Inuit has attracted considerable attention in the literature, even in comparison to other Indigenous peoples [1]. This focus has presumably been in response to the disproportional rates of suicide documented among Canadian Inuit [2][3][4][5][6][7][8]. ...
Despite decades of Inuit accessing services in Manitoba, Inuit-centric services remain scant and have only begun to emerge. This article reports on Inuit utilisation of mental health services in Manitoba. In this study, we focused on two interrelated cohorts: Inuit living in Manitoba and Inuit from the Kivalliq region who come to Winnipeg to access specialised services. We used administrative data routinely collected by Manitoban agencies. The study was conducted in partnership with the Manitoba Inuit Association, and Inuit Elders from Nunavut and Manitoba. Our results show that mental health-related consults represent between 1 in 5 and 1 in 3 of all consults made by Inuit in Manitoba. Rates of hospitalisation for mental health conditions are considerably lower than those of residents from the Manitoba northern health authority. Given that Nunavut has the highest rate of suicide in the world, our results suggest underserved needs rather than lower needs. Kivalliq and Manitoba Inuit utilise mental health services in Manitoba extensively, yet these services for the most part remain western-centric. Epistemological accommodations in the provision of mental health services have yet to be implemented. This is now the focus of our work.
... Indeed, populationlevel differences in health inequities stem from this context. While mental health research on outcomes and suicide rates varies significantly across First Nations, Inuit, and Métis communities (Nelson & Wilson, 2017;Health Canada and the Public Health Agency of Canada, 2016, Auger, 2021, Konefal, 2021Affleck et al. 2020), there are significant inequities at the population level compared to non-Indigenous peoples (Kumar & Tjepkema, 2019). At the same time, we must be cautious with population level assertions as there have been no disaggregated population-level reports on suicide rates among First Nations, Métis, and Inuit since 2019, which was based on the 2011 Canadian Census Health and Environmental Cohort and utilized records integration between the 2011 National Household Survey and the Canadian Vital Statistics Database (Kumar & Tjepkema, 2019). ...
This article examines the critical issue of Indigenous mental health in Canada, focusing on First Nations, Inuit, and Métis. It underscores the urgency in addressing Indigenous mental wellness challenges, particularly the high rates of suicide, amid their rapid population growth. The study centers on the role of frontline responders in managing mental health and suicidal distress in these communities, and their work to promote life and mental wellness. Through a synthesis of psychological, critical, and Indigenous perspectives, the article reviews Canadian literature on Indigenous mental health and suicide prevention. The article then highlights reflexive insights derived from a knowledge-sharing event with 33 Indigenous mental health professionals, focusing on the unique challenges and opportunities in this field and the importance of life-affirming dialogues in suicide prevention. The article aims to integrate these insights into broader discussions on Indigenous mental wellness, health, and life promotion systems, proposing enhanced wellness and suicide prevention strategies and frameworks tailored to the needs and aspirations of Indigenous communities.
... Settler colonialism and systemic oppression of Indigenous peoples must be mentioned when talking about Indigenous mental health inequalities. Intergenerational trauma and racism are often cited as major factors that impact the mental health of Indigenous peoples (Nelson & Wilson, 2017). Lastly, our results did not see social support to be associated to mental health service utilization, despite the literature (Meyer, 2003;Perrin et al., 2020) suggesting otherwise. ...
LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples.
... .future policy development and implementation should aim to support Indigenous Peoples and communities when they decide to learn about, maintain, and build upon the knowledge amassed by their ancestors" [53] p. 3. We have also come to recognize that relationships are central to advancing this movement, wherein "Indigenous-led healing movements reflect concrete steps in the efforts to advance health equity for Indigenous Peoples in Canada" [10] p. 215. However, support for Indigenous TH practices within Western healthcare systems has been lacking, due in part to the history of colonization and differences in worldview, despite various policy recommendations that have been made [6,27,54]. Questions emerging from the data related to these tensions are built on longstanding colonial-settler tensions and include the following. Should there be a unique formula/lens for Indigenous programs/space used in CAMH? ...
Globally and historically, Indigenous healthcare is efficacious, being rooted in Traditional Healing (TH) practices derived from cosmology and place-based knowledge and practiced on the land. Across Turtle Island, processes of environmental dispossession and colonial oppression have replaced TH practices with a colonial, hospital-based system found to cause added harm to Indigenous Peoples. Growing Indigenous health inequities are compounded by a mental health crisis, which begs reform of healthcare institutions. The implementation of Indigenous knowledge systems in hospital environments has been validated as a critical source of healing for Indigenous patients and communities, prompting many hospitals in Canada to create Traditional Healing Spaces (THSs). After ten years, however, there has been no evaluation of the effectiveness of THSs in Canadian hospitals in supporting healing among Indigenous Peoples. In this paper, our team describes THSs within the Center for Addiction and Mental Health (CAMH), Canada’s oldest and largest mental health hospital. Analyses of 22 interviews with hospital staff and physicians describe CAMH’s THSs, including what they look like, how they are used, and by whom. The results emphasize the importance of designating spaces with and for Indigenous patients, and they highlight the wholistic benefits of land-based treatment for both clients and staff alike. Transforming hospital spaces by implementing and valuing Indigenous knowledge sparks curiosity, increases education, affirms the efficacy of traditional healing treatments as a standard of care, and enhances the capacity of leaders to support reconciliation efforts.
... While Indigenous people generally have higher rates of mental health problems than non-Indigenous Canadians (Nelson & Wilson, 2017;Söchting et al., 2007), the few studies about Indigenous women affected by IPV also suggest significant mental health difficulties such as depression (Evans-Campbell et al., 2006;Schultz et al., 2021), posttraumatic stress disorder (PTSD) and psychological distress (Tutty et al., 2020). Several qualitative studies (Burnette & Cannon, 2014;Hoffart & Jones, 2018) describe such mental health problems as PTSD, depression, and suicidal ideation. ...
Canadian Indigenous women often experience severe partner violence and child abuse, but few studies holistically examine risk and protective factors and evidence of resilience that affect their well-being. This mixed-methods secondary analysis explored the experiences of 40 Canadian Indigenous abused women. Risk factors included intimate partner violence (IPV), childhood abuse, poverty, colonization, and disability. Protective factors included formal and informal support, community support, spirituality, and childhood residence. Evidence of resilience is from interview quotes and none of the measures of depression, mental distress, and posttraumatic stress disorder was in the clinical range. Despite significant IPV and childhood abuse, the women's resilience is highlighted. Keywords intimate partner violence, Indigenous women, violence against women, resilience, mental health In Canada, intimate partner violence (IPV) against Indigenous women is a significant issue, with IPV rates three times higher than non-Indigenous women (21% to 7%; Brownridge, 2008; Johnson, 2006). Further, Indigenous women across North
... Indigenous respondents also had more than twice the odds of strongly supporting (versus somewhat support or somewhat oppose) "Support First Nations, Métis, and Inuit control of mental health services" compared to their settler counterparts. This aligns with hypotheses that populations would more strongly support policies directly affecting them and may be further explained by settler governments continued failure to meet the mental health needs of Indigenous Peoples [67]. ...
Background
There is a need to improve mental health policy in Canada to address the growing population burden of mental illness. Understanding support for policy options is critical for advocacy efforts to improve mental health policy. Our purpose was to describe support for population-level healthy public policies to improve mental health among policy influencers and the general public in Alberta and Manitoba; and, identify associations between levels of support and sociodemographic variables and relative to the Nuffield Bioethics Intervention Ladder framework.
Methods
We used data from the 2019 Chronic Disease Prevention Survey, which recruited a representative sample of the general public in Alberta (n = 1792) and Manitoba (n = 1909) and policy influencers in each province (Alberta n = 291, Manitoba n = 129). Level of support was described for 16 policy options using a Likert-style scale for mental health policy options by province, sample type, and sociodemographic variables using ordinal regression modelling. Policy options were coded using the Nuffield Council on Bioethics Intervention Ladder to classify support for policy options by level of intrusiveness.
Results
Policy options were categorized as ‘Provide Information’ and ‘Enable Choice’ according to the Nuffield Intervention Ladder. There was high support for all policy options, and few differences between samples or provinces. Strong support was more common among women and among those who were more politically left (versus center). Immigrants were more likely to strongly support most of the policies. Those who were politically right leaning (versus center) were less likely to support any of the mental health policies. Mental health status, education, and Indigenous identity were also associated with support for some policy options.
Conclusions
There is strong support for mental health policy in Western Canada. Results demonstrate a gap between support and implementation of mental health policy and provide evidence for advocates and policy makers looking to improve the policy landscape in Canada.
... The impacts of industrial relations threaten the identity, resources, language, traditions, spirituality, and indigenous community's way of life (Mazel, 2018). This study proposed that the health impact assessment process in industrial resource development had to explicitly consider risks and potential impacts on mental health and respect the rights of indigenous peoples by making knowledge of mental health risks a key component in government decisions (Tom, 2008) (Nelson & Wilson, 2017 (2019) and Malone et al. (2023), and need the best solution. ...
Objective: This research aims to uncover land conflicts on Rempang Island, Indonesia and provide solutions. People who claim to have had rights to their land since 1720 feel disturbed by plans to build Rempang Eco City, spearheaded by a national company in collaboration with Xinyi Glass Holdings Ltd, China, to manage 17,600 hectares of land. The riots on September 6 and 7, 2023, sparked major conflict when officers tried to break through residents' barricades using water cannons and tear gas. Theoretical framework: Regarding land acquisition for strategic projects, Downing (2002) advised the Government to be careful because every investment plan is generally designed to avoid structural poverty by avoiding new poverty by relocating communities due to mining and providing resettlement. Meanwhile, land owned by the state is very limited. Therefore, the best way for the Government is to buy land belonging to communities whose rights are controlled based on customary law and formal law, not by force. Johnson and Swedlow (2019) explain that land acquisition for National Strategic Projects requires the principle of deliberation between the government and land rights holders. To ensure the successful implementation of government policies, the concept of deliberation is essential and needs to involve many community groups. Williams (2021) states that designing deliberations is a challenge because society is guided by its culture's norms, values and rules. Mitchell et al. (2023) refer to deliberation as policy dialogue, a tool that encourages evidence-based policymaking that addresses high-priority issues a synthesis of the best available evidence. Land acquisition analysis should focus on deliberative dialogue and not on ethical issues in a policy context (Bevan & Rasmussen, 2017). Method: This research method uses a qualitative approach with a phenomenological study. The selection of informants was carried out using purposive sampling technique. We used an interview study supported by information from trusted online newspapers to obtain various information. The triangulation method is used to recheck the correctness of the data by reducing as much as possible bias during data collection and analysis. The research questions are why land conflicts occur, whether no regulations facilitate them, and how land conflicts should be resolved. The research results show weaknesses in communication and outreach, officials do not understand the history of community land ownership, and weak bureaucratic structures result in repressive actions. Results and Conclusions: The land conflict on Rempang Island exploded due to the Government's weakness in communicating and socializing the President's policies, demonstrated
... These findings suggest that ACE exposures and their detrimental health outcomes in Mexican adolescents are similar across population groups, as Nelson and Wilson (2017) and Radford et al. (2021) identified. ...
... The impacts of industrial relations threaten the identity, resources, language, traditions, spirituality, and indigenous community's way of life (Mazel, 2018). This study proposed that the health impact assessment process in industrial resource development had to explicitly consider risks and potential impacts on mental health and respect the rights of indigenous peoples by making knowledge of mental health risks a key component in government decisions (Tom, 2008) (Nelson & Wilson, 2017 (2019) and Malone et al. (2023), and need the best solution. ...
Objective: This research aims to uncover land conflicts on Rempang Island, Indonesia and provide solutions. People who claim to have had rights to their land since 1720 feel disturbed by plans to build Rempang Eco City, spearheaded by a national company in collaboration with Xinyi Glass Holdings Ltd, China, to manage 17,600 hectares of land. The riots on September 6 and 7, 2023, sparked major conflict when officers tried to break through residents' barricades using water cannons and tear gas. Theoretical framework: Regarding land acquisition for strategic projects, Downing (2002) advised the Government to be careful because every investment plan is generally designed to avoid structural poverty by avoiding new poverty by relocating communities due to mining and providing resettlement. Meanwhile, land owned by the state is very limited. Therefore, the best way for the Government is to buy land belonging to communities whose rights are controlled based on customary law and formal law, not by force. Johnson and Swedlow (2019) explain that land acquisition for National Strategic Projects requires the principle of deliberation between the government and land rights holders. To ensure the successful implementation of government policies, the concept of deliberation is essential and needs to involve many community groups. Williams (2021) states that designing deliberations is a challenge because society is guided by its culture's norms, values and rules. Mitchell et al. (2023) refer to deliberation as policy dialogue, a tool that encourages evidence-based policymaking that addresses high-priority issues a synthesis of the best available evidence. Land acquisition analysis should focus on deliberative dialogue and not on ethical issues in a policy context (Bevan & Rasmussen, 2017). Method: This research method uses a qualitative approach with a phenomenological study. The selection of informants was carried out using purposive sampling technique. We used an interview study supported by information from trusted online newspapers to obtain various information. The triangulation method is used to re-check the correctness of the data by reducing as much as possible bias during data collection and analysis. The research questions are why land conflicts occur, whether no regulations facilitate them, and how land conflicts should be resolved. The research results show weaknesses in communication and outreach, officials do not understand the history of community land ownership, and weak bureaucratic structures result in repressive actions. Results and Conclusions: The land conflict on Rempang Island exploded due to the Government's weakness in communicating and socializing the President's policies, demonstrated by regional government officials and other institution, which only carried out socialization in April 2023 but failed because they did not understand the history of community land control. The weak bureaucratic structure causes repressive actions, which are shown in the implementation of wrong government policies. This conflict has caused trauma to children and society, requiring various mental and psychological health efforts. The conclusion shows that conflicts occurred because the regulations for determining land in Rempang as a strategic state project were too hasty without socialization, and the law could not prevent land conflicts. This conflict has caused trauma to the community, especially children. Most informants want the government to be able to solve problems by implementing a dialogue (deliberation) policy as a solution. Research implications: This study presents policy implications that regional, provincial and national governments can utilize to encourage the successful resolution of land conflicts in any region. The consequences of this strategy can help develop more potent methods for enhancing regional cooperation. Originality/value: This research analyses paradigm changes in the land administration system, strengthening bureaucratic structures, collaboration between institutions, and increasing community understanding through socialization and public dialogue. These changes can affect land governance and reduce land conflicts that continued to occur after Indonesia's independence. This paradigm shift study is a new contribution because it can provide a deeper understanding of the evolution of land governance and law in Indonesia.
Canadian medical assistance in dying (MAID) is positioned to expand to allow voluntary euthanasia for individuals with mental disorders as their sole underlying condition(s) (MAID-MD-SUMC) by 2027. As governments consider this type of legislation, thoughtful critique of proposed eligibility criteria is imperative in order to consider potential consequences that may follow expansion of current policies guiding end-of-life care. As MAID-MD-SUMC enters another phase of revision, we propose two critical consideration: (1) the need to define a comprehensive, empirical basis for the “irremediability” of psychiatric disorders and (2) a more comprehensive consideration of the inextricable links between an individual’s surrounding environment, socioeconomic factors, access to healthcare and outcomes resulting from treatment of mental health disorders.
Indigenous post-secondary students face cumbersome barriers to educational attainment. This article explores those barriers and presents findings from a survey of Indigenous students conducted at Algoma University in Sault St. Marie, Ontario, Canada. For First Nations’ students surveyed in 2016 ( n = 36), funding was identified as a major barrier and, considering that nearly half of students had dependents, finding affordable housing and childcare was a significant challenge. The transition to an urban area from living on-reserve is also difficult for many students. The Anishinaabe Initiatives Division at Algoma University hosted culturally affirming events for Indigenous students. We found this to be an effective tool universities can use to bolster student resilience and foster a sense of belonging. We also propose that funding on university campuses must increase to support Indigenous students’ educational attainment goals.
Contemporary American Indian communities experience a disproportionately high rate of specific mental health concerns, including psychiatric disorders as defined by professional psychology. Although integrating mainstream mental health services and Indigenous traditional healing (ITH) has been presented as a promising approach to addressing these inequities, such integration necessitates in-depth exploration and consideration of ITH. To that effect, this article provides a thematic analysis of an interview with an urban American Indian traditional healer who reflected on more than 4 decades of therapeutic experience. Based on this analysis, we identified two major themes. The first theme, Expansive View of ITH, reflects this healer’s conceptualization and understanding of the therapeutic process while the second theme, Guiding Principles of ITH, explicates the foundational commitments that shape and guide this healer’s application and practice of ITH. These insights reinforce previous observations made by scholars of Indigenous health and well-being that challenge dominant Euro-American perspectives and call for transformative change in psychology research and practice, advocating for professional consideration of a broader range of therapeutic rationales, traditions, and practices than what is common within the field.
This paper reflects on suicide research from a critical Indigenous studies perspective, drawing on pluralistic epistemologies of Indigenous peoples in settler-colonial contexts. It argues that suicide prevention research must center on Indigenous knowledge systems to address the complex, interconnected nature of suicide and the broader ecological, cultural, and spiritual harms of neoliberal capitalism and settler colonialism. Indigenous scholars suggest contemporary suicide research is often based on binary-anthropocentric Western epistemologies and insufficiently attentive to holistic, communal, and land-based dimensions of Indigenous life-promoting relations. To unsettle settler-colonial suicidology is to reconceptualize prevention as the process of communal, environmental, social, and cultural healing that emphasizes the importance of harmony in the interconnectedness of all life. This more expansive and contextualized approach recognizes the structural entrenchment of suicide and system factors contributing to suicidal distress. Justice in suicide research involves co-creating meaning and relationally evolving to support all beings’ conditions for life. Indigenous studies of care, life promotion, and healing offer promising frameworks to reorient suicide research from individual responses toward collective healing-justice that is generative and supportive of interdependent communities. Thus, resisting narrow definitions of health and justice operative within the state’s normative desires; re-centering Indigenous communities’ fights to address the structures that thwart life.
Members of the Indigenous mental wellness and trauma-informed specialist workforce - including Mental Wellness Teams (MWTs), Crisis Support Teams (CSTs), the Indian Residential Schools Resolution Health Support Program workforce, and other community-based cultural support workers - are often the primary and urgent care providers for individuals and families in need of culturally safe supports. While fulfilling a critical role, these teams contend with distinct challenges stemming from colonial impacts and health systems that continue to undermine Indigenous mental wellness and cultural traditions of healing. During the COVID-19 pandemic, increasing rates of mental illness and substance use among Indigenous populations strained the already overworked and under-resourced mental wellness workforce. First Peoples Wellness Circle sought out and embraced new approaches for meaningful virtual engagement to sustain and enhance workforce wellness and capacity by facilitating culturally relevant and culturally led connections from coast to coast to coast.
Residential schools are commonly used in India to provide education for Indigenous youth, which requires young people to stay for long periods at distance from their families and communities. Internationally, there is clear evidence for the deleterious effects of residential schools on the mental health and social and community outcomes of Indigenous children, however little is known about the Indian Indigenous experience. This study examined the impact of residential schooling on Indigenous children's wellbeing and that of their communities, using data from an ethnographic research project in Attapadi, Kerala, including interviews, focus group discussions and participant observation with Indigenous communities. Key outcomes from residential schooling reported by the participants include the fear of losing Indigenous identity, shame of being Indigenous, change in the attitude of young people when they returned from schools, and feelings of confusion and stress that young Indigenous participants felt trying to fit into their communities on their return. Findings suggest that these Indigenous youth felt disconnected from several factors that are known to promote resilience for Indigenous communities including a strong cultural identity, connection to the land and ancestors, thereby making them more vulnerable to poor mental health and negative impacts on their overall wellbeing. Addressing these concerns requires a detailed understanding of the specific factors influencing outcomes for Indigenous youth within the Indian residential schooling system, and designing and implementing data-informed conceptual, structural and policy change including the provision of culturally safe mental health services.
The academic literature on personal experiences of climate-induced wellbeing erosion (often conceptualised as ‘non-economic losses and damages’) is still limited. This represents a serious climate policy gap that hinders support for marginalised people across the world including Indigenous People. Lately, we have seen a rapid growth in empirical studies exploring linkages between climate change and mental health among Indigenous Inuit in Canada. However, its association with human (im)mobility remains unexplored. This review article brings together the empirical evidence of Inuit experiences and perceptions of climate-related wellbeing loss and (im)mobility while providing climate policy with guidance for appropriate action. The systematic review investigates how Inuit in Arctic Canada felt that climatic changes impacted their (im)mobility and mental health while putting these feelings into a wider context of colonial violence, forced child removal, the residential schools, and other systematic human rights abuses. Twelve electronic databases (four specific to Arctic research) were searched for English and French, peer reviewed, qualitative studies published between 2000 and 2021. Fifteen selected articles were analysed using NVivo and thematic narrative analysis from a climate-violence-health nexus systems approach. Three overarching climate-related wellbeing loss themes, all strongly intertwined with feelings of immobility, emerged from the literature namely ‘identity and cultural loss’, ‘land connection as a source of healing’, and ‘changing environment triggering emotional distress’. The narratives circled around Inuit land connection and how climate-induced temporary (im)mobility interrupted this relationship. Climatic changes isolated Inuit away from the land and cut off their ability to partake in land activities. This strongly eroded Inuit wellbeing, expressed through distress, anxiety, depression, social tension, suicide ideation and deep feelings of cultural loss. The findings showed how Inuit mental health strongly depend on a sustained connection to the land. Further empirical research among other Indigenous People or nomadic groups on wellbeing loss and climate-induced involuntary immobility is urgently needed. Future research should particularly explore how such mental health impacts tie into past and present (post)colonial traumas and current suicide occurrences. This will help climate policy, research, and adaptation planning better prepare and propose more contextually and culturally appropriate health actions in the future.
The mental health needs and disparities facing First Nations and Inuit in Canada far exceed those of the general population and yet accessing culturally safe care remains a serious challenge. One means for accessing mental health care is through the Non-Insured Health Benefits (NIHB) mental health counselling program run by Indigenous Services Canada. However, evaluations of the efficacy of the NIHB’s mental health counselling program remain entirely absent in the academic literature and this is startling given that this program receives significant federal funding to care for a population that experiences extreme marginalization. The following commentary will present three challenges observed with the present state of the program in the areas of service accessibility, the need for an Indigenous mental health workforce, and culturally safe care. For each challenge presented, we make recommendations on how to improve the program in its current state. The conclusion of this article advocates for a broader evaluation of the NIHB mental health counselling program from the perspective of its service users and its registered mental health professionals. This type of evaluation is commensurate with the Calls to Action outlined by the Truth and Reconciliation Commission of Canada.
Using the 2004–2007 and 2008–2011 panels of the Canadian Survey of Labour and Income Dynamics, we examine earnings and employment disparities between Indigenous and non‐Indigenous adults. While an income gap exists and tends not to significantly change over time, taxes and transfers reduce it by almost 40 percent. Further, the gap is generally largest at the bottom of the income distribution. The explained component of the gap is primarily due to differences in education, particularly for young workers, and although the unexplained portion decreases over time, this is due to increased differences in observed labor market characteristics, implying that labor market discrimination may be on the rise. In addition, the probability of joblessness is higher for Indigenous adults and the male gap has increased. Results are robust to a bounding technique that adjusts for labor force participation differences and tend to be driven by First Nations (as opposed to Métis) adults.
As a case study on collaboration, this paper is a first person account from a psychologist and a social worker and their experiences developing and piloting community-based mental health programs for a rural Albertan Cree community. We provide an overview of two such pilots, the Family Wellness Program and the Community-based Anger Management Workshops. Here we reflect on our attempts to integrate mental, physical, emotional, and spiritual considerations consistent with the community cultural context. Each of these programs have been developed and offered within both interdisciplinary and multidisciplinary contexts involving counsellors, teachers, nurses, and community Elders from within and outside the community. Such dynamic programming has evolved into transdisciplinary community-based mental health initiatives that have enhanced community wellness but also taxed these rural service providers. Together we share our reflexivity, outlining some of the issues, challenges, and inspirations in our separate and collaborative work in our attempts to foster mental health and community wellness for this resilient but marginalized population.
As reported rates of mental illness and suicide among Canadian First Nations youth continue to rise, counsellors are uniquely placed to contribute to mental health literacy. Development of contextually appropriate programs requires knowledge of the myriad of contributing factors including residual issues of colonization, discrimination, marginalization, and socioeconomic struggles that play pivotal roles in wellness and mental health risks. Given the potential contribution of such programs and the dearth of literature in this area, we reflect on what factors would contribute to facilitating or adapting existing mental health literacy programs to target Canadian First Nations youth. We explore ideas for integrating culture and context, youth engagement, and youth empowerment.
résumé
Comme les taux déclarés de la maladie mentale et le suicide chez les jeunes des Premières Nations canadiennes continuent d’augmenter, les conseillers sont particulièrement bien placés pour contribuer à la littératie en santé mentale. L’élaboration de programmes adaptés au contexte nécessite la connaissance d’une multitude de facteurs en jeu, y compris les questions résiduelles de la colonisation, la discrimination, la marginalisation, et les luttes socio-économiques qui jouent un rôle essentiel dans les risques à la santé mentale et le bien-être. Compte tenu de la contribution potentielle de ces programmes et de la pauvreté de la littérature dans ce domaine, nous réfléchissons sur les facteurs qui pourraient contribuer à faciliter ou à adapter des programmes existants d’alphabétisation en santé mentale afin de cibler les jeunes Canadiens des Premières Nations. Des idées sont explorées sur l’intégration culturelle et le contexte, l’engagement des jeunes, et le renforcement de l’autonomie des jeunes.
This article is freely available in electronic or hard copy from the National Collaborating Centre for Indigenous Health, https://www.nccih.ca/en/publicationsview.aspx?sortcode=2.8.10.16&id=70
Introduction:
This paper reports results from a preliminary observational study of ayahuasca-assisted treatment for problematic substance use and stress delivered in a rural First Nations community in British Columbia, Canada.
Methods:
The "Working with Addiction and Stress" retreats combined four days of group counselling with two expert-led ayahuasca ceremonies. This study collected pre-treatment and six months follow-up data from 12 participants on several psychological and behavioral factors related to problematic substance use, and qualitative data assessing the personal experiences of the participants six months after the retreat.
Findings:
Statistically significant (p < 0.05) improvements were demonstrated for scales assessing hopefulness, empowerment, mindfulness, and quality of life meaning and outlook subscales. Self-reported alcohol, tobacco and cocaine use declined, although cannabis and opiate use did not; reported reductions in problematic cocaine use were statistically significant. All study participants reported positive and lasting changes from participating in the retreats.
Conclusions:
This form of ayahuasca-assisted therapy appears to be associated with statistically significant improvements in several factors related to problematic substance use among a rural aboriginal population. These findings suggest participants may have experienced positive psychological and behavioral changes in response to this therapeutic approach, and that more rigorous research of ayahuasca-assisted therapy for problematic substance use is warranted.
ABSTRACT
The overview of literature provides emergent themes on the topic of Aboriginal health, culturally oriented interventions and prevention strategies. Recommendations are also provided on how to apply indigenous knowledge and traditional medicine approaches in the intervention for at risk Aboriginal populations or communities in crisis. Through a literature review of indigenous knowledge, it is proposed by several Indigenous scholars that the wellness of an Aboriginal community can only be adequately measured from within an indigenous knowledge framework which is a holistic and inclusive approach that seeks balance between the spiritual, emotional, physical, and social spheres of life. Their findings indicate that high rates of social problems, demoralization, depression, substance abuse, and suicide are prevalent in many Aboriginal communities and must be contextualized within a decolonization or self-determination model. The evidence of linkages between the poor mental health of Aboriginal peoples and the history of colonialism is key to improving the wellness in communities. Conversely, there is sufficient evidence that strengthening cultural identity, community integration, and political empowerment contributes to improvement of mental health in Aboriginal populations including at risk youth and women. The interconnection of land, language and culture are the foundations of wellness strategies. The overview clearly suggests adopting new strategies for intervention and prevention, and learning from historical wrongs to ensure future policies support of the restoration of traditional practices, language and knowledge as a means of developing strategies for this generation’s healing and wellness.
KEYWORDS
Traditional medicine and healing, Indigenous knowledge, intervention and prevention, historical trauma, holistic and inclusive approaches, partnerships of empowerment in restoration of culture and wellness strategies
Over the past 10 years, Aboriginal women from a northern Ontario urban community have been gathering to hand drum as a way to revive their culture and support one another. As a member of an Aboriginal women’s hand-drumming circle called the Waabishki Mkwaa (White Bear) Singers, I had a vision of exploring the connection between hand-drumming practices and health promotion, and was the primary researcher for the study described in this article. Adhering to Aboriginal protocols as part of an Indigenous research methodology, I offered traditional tobacco to members of the Waabishki Mkwaa Singers, as an invitation for them to be both co-researchers and participants in the study. In accepting the tobacco, the members agreed to help facilitate the research process, as well as to journal their experiences of the process and of their own hand-drumming practices. Using an Aboriginal Women’s Hand Drumming (AWHD) Circle of Life framework—a framework developed by the co-researchers of the study—we explored the physical, mental, spiritual, and emotional benefits of Aboriginal women’s hand-drumming practices, and examined how culture and social support networks are key determinants of Aboriginal women’s health. Results of the qualitative analysis show that the Aboriginal women’s involvement in hand-drumming circles has many health promoting benefits and builds on strengths already existent within their community. Through their experiences with hand drumming, the women reported gaining a voice and a sense of holistic healing, empowerment, renewal, strength and Mino-Bimaadiziwin (“good life”). These findings are consistent with evolving Aboriginal perspectives on health promotion.
At the end of 2008, there were 17 First Nations casinos operating in Canada. Recent statistics con rm that all are money-making enterprises, and that individual First Nations are using the money to improve social programming and augment infrastructure. What has been overlooked to date is local health: specifically, limited funding was set aside in all Province-First Nations gaming agreements to implement problem gambling
treatment programs for on-reserve residents negatively in uenced by the introduction of a casino. This is surprising considering that several studies in Canada and the United States have shown Aboriginal people are more likely to become problem gamblers. This paper argues that by situating a casino in a reserve community, the host community establishes an imperative to treat those negatively affected by ease of access to casino gambling games. To do so is an aspect of self-determination, and a responsibility First Nations assume when selecting casinos as mechanisms of economic development.
Objective:
To assess the prevalence of gambling and problem gambling in urban Aboriginals in the Canadian Prairie provinces and to determine the predictors of problem gambling.
Method:
In total, 1114 Aboriginals living in 15 cities in Alberta, Saskatchewan, and Manitoba were recruited via posters and direct solicitation at Native Friendship Centres, shopping malls, and other locations where Aboriginals congregated. They each completed a self-administered 5- to 10-minute survey.
Results:
Urban Aboriginals in the present sample were found to have a much higher level of gambling participation than the general Canadian public, especially for electronic gambling machines, instant lotteries, and bingo. Their intensity of participation in terms of number of formats, frequency of play, and gambling expenditure was also very high. This, in turn, is an important contributing factor to their very high rate of problem gambling, which was found to be 27.2%. Problem gambling was higher in males, unemployed people, and cities having the highest proportion of their population consisting of urban Aboriginals.
Conclusions:
Urban Aboriginal people appear to have some of the highest known rates of problem gambling of any group in Canada. This is attributable to having many more risk factors for problem gambling, such as a greater level of participation in gambling, greater participation in continuous forms of gambling (e.g., electronic gambling machines), younger average age, higher rates of substance abuse and mental health problems, and a range of disadvantageous social conditions (e.g., poverty, unemployment, poor education, cultural stress) that are conducive to the development of addictive behaviour.
p> Objective: This study responded to a community-identified need to form an evidence base for interventions to promote mental health and wellness among youth in Nunavut. Methods: A literature review was conducted using the terms adolescence and Inuit and intervention or program or camp or land-based . PubMed and Google Scholar databases were used to find peer-reviewed and grey literature on community-based youth programs. The literature review was presented to parents, elders, and youth for discussion over several months in 2009-2010. Results: Key themes included: self-esteem, physical activity, stress and coping, positive peer relationships, Inuit identity, mental health and well-being, and the effects of intergenerational trauma on youth in Nunavut. Themes were incorporated into a model for youth mental health interventions based on Inuit terminology, philosophy, and societal values—the Eight Ujarait /Rocks Model. The model was implemented as a camp program in 6 pilots in 5 communities from 2011 to 2013. Data were collected before and after the camp. Results indicated that the program fostered physical, mental, emotional, and spiritual wellness among youth. Parent observations of participants included an improvement in behaviour and attitude, strong cultural pride, greater confidence in identity, and improved family and community relationships. Conclusion: Evidence-based, community-driven models for youth mental health interventions in the North hold promise. The application of one such model through a camp program had a lasting impact on the individuals involved, beyond their immediate participation. Long-term monitoring of the participants, and ongoing evaluations of camps as they continue to unfold across Nunavut, are needed to contribute to the robust evidence base for this program over time.</p
The “Understanding from Within” (UFW) project was part of the National Health Population Study of Neurological Conditions (NHPSNC), a 4-year study aimed at better understanding the scope of neurological conditions in Canada, and funded by the Public Health Agency of Canada. The goal of the UFW project was to develop a better understanding of how Aboriginal people conceptualize neurological conditions and the impacts on their families and communities, and the resources and supports needed to provide culturally safe and appropriate care. The research was qualitative and used an Indigenous Research Methodologies (IRM) approach to guide the design, collection of data, and analysis. Two methods were used to collect information: in-depth interviews and research circles (focus groups). A total of 80 people participated in the research, 69 women and 11 men. In-depth interviews were undertaken with key informants (22), with Aboriginal people living with a neurological condition (18), and with Aboriginal people caring for someone with a neurological condition (40). This paper examines the physical, mental, emotional, and spiritual impacts of neurological conditions on Aboriginal people, primarily women. It also examines other themes that emerged from the narratives, including recommendations to healthcare providers and cross-cutting themes that are relevant to culturally safe care and how it relates to neurological conditions.
Stressful events may have immediate effects on well-being, and by influencing appraisal processes, coping methods, life styles, parental behaviours, as well as behavioural and neuronal reactivity, may also have long lasting repercussions on physical and psychological health. In addition, through these and similar processes, traumatic experiences may have adverse intergenerational consequences. Given the lengthy and traumatic history of stressors experienced by Aboriginal peoples, it might be expected that such intergenerational effects may be particularly notable. In the present review we outline some of the behavioural disturbances associated with stressful/traumatic experiences (e.g., depression, anxiety, posttraumatic stress disorder, and substance abuse disorder), and describe the influence of several variables (age, sex, early life or other experiences, appraisals, coping strategies, as well as stressor chronicity, controllability, predictability and ambiguity) on vulnerability to pathology. Moreover, we suggest that trauma may dispose individuals to further stressors, and increase the response to these stressors. It is further argued that the shared collective experiences of trauma experienced by First Nations peoples, coupled with related collective memories, and persistent sociocultural disadvantages, have acted to increase vulnerability to the transmission and expression of intergenerational trauma effects.
Background
There is a higher prevalence of alcohol use and severe alcohol dependence among homeless populations. The combination of alcohol use and lack of housing contributes to increased vulnerability to the harms of substance use including stigma, injury, illness, and death. Managed alcohol programs (MAPs) administer prescribed doses of alcohol at regular intervals to people with severe and chronic alcohol dependence and homelessness. As a pilot for a larger national study of MAPs, we conducted an in-depth evaluation of one program in Ontario, Canada. In this paper, we report on housing and quality of life outcomes and experiences of the MAP participants and staff.
Methods
We conducted a pilot study using mixed methods. The sample consisted of 38 people enrolled in or eligible for entry into a MAP who completed a structured quantitative survey that included measures related to their housing and quality of life. All of the participants self-identified as Indigenous. In addition, we conducted 11 in-depth qualitative interviews with seven MAP residents and four program staff and analyzed the interviews using constant comparative analysis. The qualitative analysis was informed by Rhodes’ risk environment framework.
Results
When compared to controls, MAP participants were more likely to retain their housing and experienced increased safety and improved quality of life compared to life on the streets, in jails, shelters, or hospitals. They described the MAP as a safe place characterized by caring, respect, trust and a nonjudgmental approach with a sense of family and home as well as opportunities to reconnect with family members.
Conclusions
The MAP was, as described by participants, a safer environment and a home with feelings of family and a sense of community that countered stigma, loss, and dislocation with potential for healing and recovery. The MAP environment characterized by caring, respect, trust, a sense of home, “feeling like family”, and the opportunities for family and cultural reconnections is consistent with First Nations principles for healing and recovery and principles of harm reduction.
Using media coverage of the withdrawal of OxyContin in Canada in 2011 and 2012 as an example, this article describes a systematic analysis of how news media depict First Nations peoples in Canada. Stark differences can be seen in how First Nations and non-First Nations individuals and communities are represented. In First Nations communities, problematic substance use is discussed without considering the context of pain management, broad generalizations are made, and language of hopelessness and victimization is employed. An analysis of the differences in language, tone, sources of information, and what is left unsaid, makes visible the ways in which misinformation about First Nations peoples and communities is constructed and perpetuated in media discourses.
This youth suicide prevention research project is an example of a partnership between Carrier Sekani Family Services (CSFS) and the University of Northern British Columbia (UNBC), funded by the Canadian Institutes of Health Research (CIHR), Institute of Aboriginal Peoples’ Health, that directly responds to goals of ethical research conducted in First Nations’ communities. Through the use of mixed methods, the project investigated the effectiveness of community-based interventions in preventing suicide and tracked youth self-esteem, depression, and other indicators over the course of the project. The knowledge gained from this research project will help guide CSFS and its member communities in offering programs and services that will assist in reducing incidence of suicide.
Intergenerational trauma (IGT) explains why populations subjected to long-term, mass trauma show a higher prevalence of disease even several generations after the original events. Residential schools and other legacies of colonization continue to impact Aboriginal populations, who have higher rates of mental health concerns. Poor maternal mental health during pregnancy can have serious health consequences for the mother, the baby, and the whole family; these include impacting the cognitive, emotional and behavioural development of children and youth. This paper has the following objectives: 1) To define intergenerational trauma and contextualize it in understanding the mental health of pregnant and parenting Aboriginal women; 2) To summarize individual-level and population-level approaches to promoting mental health, and examine their congruence with the needs of Aboriginal populations; 3) To discuss the importance of targeting IGT in both individual-level and population-level interventions for pregnant Aboriginal women . Various scholars have suggested that healing from IGT is best achieved through a combination of mainstream psychotherapies and culturally-entrenched healing practices, conducted in culturally safe settings. Pregnancy has been argued to be a particularly meaningful intervention point to break the cycle of IGT transmission. Given the importance of pregnant women’s mental health to both maternal and child health outcomes, including mental health trajectories for children and youth, it is clear that interventions, programs and services for pregnant Aboriginal women need to be designed to explicitly facilitate healing from IGT. In this regard, further empirical research on IGT and on healing are warranted, to permit an evidence-based approach.
Traditional medicine has been practiced by Aboriginal people for thousands of years at the community level. It is still practiced today outside of the mainstream health system by many Aboriginal people. However, providing this type of care in a clinical, health centre setting and in co-operation with western treatment methods is new, and requires a merging of traditional Aboriginal and western medical world views in order to develop protocols for service delivery that ensure the integrity of both systems. The groundwork required to ensure the safety of clients, providers, and organizations within the new integrated system is still largely undocumented. To address this gap, we studied factors that support the successful integration of traditional Aboriginal healing and western mental health care approaches, and document the experiences of clients and providers. To accomplish this we contextualize 10 years of experience of traditional healing services development with in-depth interviews and focus groups with 17 community service providers and 23 clients. We found that the development of traditional healing protocols, inter-professional education for providers and community members and a focus on client access to traditional Anishinabe health services provide the basis for the integration of western and traditional healing practices in the model under study. Our findings show integrated care resulted in positive experiences for clients and providers. We conclude that traditional healing approaches can be successfully integrated with clinical mental health services. Further research is necessary to improve our understanding of client experiences with this integrated approach and the impact on wholistic health and well-being.
Adolescence is a period of development characterized by risk-taking, sensation-seeking, emotionally-influenced and independence-seeking behaviours. There is a move away from family and towards the social influences of peer groups. Emotionally-driven behaviours may override adolescents’ higher cognitive functioning during this time. Especially vulnerable are youth who have been the victim of high-impact trauma or chronic abuse and neglect. Specifically, the posttraumatic stress symptomatology that is often associated with experiences of abuse and neglect may impair the ability of youth to cope during this developmental period. This is where intervention by community workers may be used to support teens with a history of maltreatment, as they develop from children to adolescents and, finally, to adults. Part of such intervention includes violence prevention in families and in teen dating relationships, as well as directly addressing posttraumatic stress disorder symptomatology. This critical developmental period of adolescence presents community workers with an opportunity to intervene and guide the development of these youth, building upon resiliency factors, such as areas of individual mastery and empowerment and participation within the community. Aboriginal youth with a history of maltreatment present a special case for community workers. These youth have been subjected to intense acculturation pressures that do not exist for other adolescent populations, which create unique problems during their transition to adulthood. In order to intervene in the most effective manner, it is necessary to understand the psychological and physiological developmental processes that are unfolding in the adolescent brain. We discuss adolescent development in general and among Aboriginal adolescents, in particular. We present ways to support both groups through these challenging periods that are empirically-based and supported by research.
This article addresses topics related to Indigenous holistic well-being including, 1) Indigenous perspectives on Aboriginal child and youth holistic mental health; 2) Factors undermining Indigenous well-being; 3) Process and curriculum for training to support mental health practitioners working with Indigenous children, youth and communities; 4) concrete applications and participant feedback. To begin, it is important to explore the following question: What is holistic mental health for First Nations, Métis and Inuit children and youth? In outlining this training curriculum we hope to contribute to a broader conversation about supporting and enhancing the well-being of Indigenous children and youth in Canada.
Mainstream child and family well-being indicators frequently are based on measuring health, economic, and social deficits, and do not reflect Indigenous holistic and strength-based definitions of health and well-being. The present article is a review of literature that features Indigenous communities' self-identified strength-based indicators of child and family well-being. The literature search included Indigenous communities from across the world, incorporating findings from American Indians and Alaska Natives, First Nations, Native Hawaiians, Māori, Aboriginal Australians, and Sámi communities. Sorting the identified indicators into the quadrants of the Relational Worldview, an Indigenous framework for well-being based on medicine wheel teachings that views health and well-being as a balance among physical, mental, contextual, and spiritual factors, the authors discuss the findings.
We conducted a mixed methods study to explore links between substance use and sexual risk among Aboriginal young people in British Columbia, Canada. Individual in-depth interviews were conducted in 2004–2005 with 30 young people ages 15–19; we present a descriptive thematic analysis. Data from a 2003 provincially representative survey that included 2,467 Aboriginal young people attending secondary school were used to model relationships between substance use and sexual behaviour outcomes. Young people perceived that substance use affected community and extended family relationships and could shape behaviour during sexual encounters. Survey data show different age trajectories of risk. For young men, there was a strong and consistent linear relationship between substance use and potentially risky sexual behaviour across all age groups. For women, using more substances at younger but not older ages was a strong marker of sexual initiation. Using more substances in older but not younger age groups was a strong indicator for having more sexual partners. For both young women and young men, lifetime substance use and substance use at last sexual encounter did not predict condom use. Interventions must consider the effects of substance use on community structures and family relationships in addition to individual risk.
p>Objective: Non-medical prescription opioid use (NMPOU) is a major health problem in North America and increasingly prevalent among First Nations people. More than 50% of many Nishnawbe Aski Nation communities in northern Ontario report NMPOU, resulting in extensive health and social problems. Opioid substitution therapy (OST) is the most effective treatment for opioid dependence yet is unavailable in remote First Nations communities. Suboxone (buprenorphine and naloxone) specifically has reasonably good treatment outcomes for prescription opioid (PO) dependence. A pilot study examining the feasibility and outcomes of a community-based Suboxone taper-to-low-dose-maintenance program for PO-dependent adults was conducted in a small NAN community as a treatment option for this particular setting.
Design: Participants (N = 22, ages 16–48 years) were gradually stabilized on and tapered off Suboxone (provided on an outpatient and directly-observed basis) over a 30-day period. Low dose maintenance was offered post-taper to patients with continued craving and relapse risk; community-based aftercare was provided to all participants. Results: Of 22 participants, 21 (95%) completed the taper phase of the program. Fifteen (88%) of 17 participants tested by urine toxicology screening had no evidence of PO use on day 30. No adverse side effects were observed. All but one of the taper completers were continued on low-dose maintenance. Conclusion: Community-based Suboxone taper-to-low-dose-maintenance is feasible and effective as an initial treatment for PO-dependence in remote First Nations populations, although abstinence is difficult to achieve and longer term maintenance may be required. More research on OST for First Nations people is needed; existing OST options, however, should be made available to First Nations communities given the acute need for treatment.</p
Intergenerational trauma explains why populations subjected to long-term and mass trauma show a higher prevalence of disease, even several generations after the original events. Residential schools and other legacies of colonization continue to impact Aboriginal populations, who have higher rates of mental health concerns. Poor maternal mental health during pregnancy can have serious health consequences for the mother, the baby, and the whole family; these include impacting the cognitive, emotional, and behavioural development of children and youth. This paper has the following objectives: to define intergenerational trauma and contextualize it in understanding the mental health of pregnant and parenting Aboriginal women; to summarize individual-level and population-level approaches to promoting mental health and examine their congruence with the needs of Aboriginal populations; and to discuss the importance of targeting intergenerational trauma in both individual-level and population-level interventions for pregnant Aboriginal women. Various scholars have suggested that healing from intergenerational trauma is best achieved through a combination of mainstream psychotherapies and culturally-entrenched healing practices, conducted in culturally safe settings. Pregnancy has been argued to be a particularly meaningful intervention point to break the cycle of intergenerational trauma transmission. Given the importance of pregnant women’s mental health to both maternal and child health outcomes, including mental health trajectories for children and youth, it is clear that interventions, programs, and services for pregnant Aboriginal women need to be designed to explicitly facilitate healing from intergenerational trauma. In this regard, further empirical research on intergenerational trauma and on healing are warranted, to permit an evidence-based approach.
Objective:
The aim of this study was to systematically review the evidence-base for the effectiveness of culturally unadapted, culturally adapted and culture-based interventions for Indigenous adults with mental or substance use disorders.
Methods:
We conducted a systematic search of scientific databases, government websites and web-based Indigenous research repositories. We sought studies using designs comparing an intervention group to a control/comparator group or pre- and post-test designs, published between 2000 and 2015 examining interventions to improve individual-level outcomes (e.g. remission, symptoms, quality of life, functioning) or service-level outcomes (e.g. number of interventions delivered) for Indigenous adults with mental or substance use disorders in Australia, Canada, New Zealand or the United States.
Results:
A total of 16 studies met inclusion criteria. Virtually all North American studies (6 US and 1 Canadian) evaluated culturally unadapted interventions, all of which were interventions for substance use. Two-thirds of Australian and New Zealand studies evaluated culturally adapted interventions and included samples with mental disorders. Of eight culturally unadapted psychological/psychosocial, pharmacological and educational intervention studies, seven reported significant improvements on at least one measure of psychological well-being, mental health problem severity, or significantly reduced alcohol or illicit drug use. Of seven culturally adapted psychological/psychosocial intervention studies, all reported significant improvement on at least one measure of symptoms of mental illness, functioning, and alcohol use. One culture-based psychological/psychosocial intervention study significantly reduced problem severity in medical and psychiatric domains.
Conclusion:
There remains inconclusive evidence regarding interventions due to a small and methodologically weak evidence-base. The literature would be enhanced by intervention replication and outcome standardisation, validating the outcome instruments used in Indigenous populations, including sample size calculations and using stronger research designs (e.g. interrupted time-series designs). Robust implementation and outcomes research is needed to further progress evidence-based practice in Indigenous mental health.
Background:
We assessed associations between key demographic risk factors and the outcome of depressed mood in Saskatoon, Saskatchewan, to inform the planning and implementation of mental health promotion programming in schools.
Methods:
In the 2008/2009 school year, 3958 students from grades 5 through 8 from 76 elementary schools completed questions regarding depressed mood on the Student Health Survey administered by the Saskatoon Health Region. The demographic risk factors for depressed mood considered in this study included age, sex, cultural status, and neighborhood income, as well as the role of school and age cohorts or grades within schools.
Results:
We found Aboriginal students were significantly more likely to report moderate/severe depressed mood than other students. We also found older female adolescents were significantly more likely to report moderate/severe depressed mood. Neighborhood income explained the largest proportion (40%) of depressed mood differences between schools.
Conclusions:
These results can inform the planning and implementation of mental health promotion programming by the health sector in Saskatoon's elementary schools, including an appropriate balance between targeted and population-based interventions that address both the distal and proximal determinants of depressed mood in adolescents.
Rationale:
Rehabilitation-oriented criminal court mental health initiatives to reduce the number of people with mental illness caught in the criminal justice system exist in many North American cities and elsewhere but not in the mainly Inuit Canadian Arctic territory of Nunavut.
Objective:
This study explores whether the therapeutic aims of these resource-intensive, mainly urban initiatives can be achieved in criminal courts in Nunavut's resource constrained, culturally distinct and geographically remote communities.
Method:
A qualitative multiple-case study in the communities of Iqaluit, Arviat and Qikiqtarjuaq involved 55 semi-structured interviews and three focus groups with participants representing four sectors essential to these initiatives: justice, health, community organizations and community members. These interviews explored whether the therapeutic jurisprudence (TJ) principles that guide criminal court mental health initiatives and the component objectives of these principles could be used to improve the criminal court response to people with mental illness in Nunavut.
Results:
Interviews revealed 13 themes reflecting perceptions of Inuit culture's influence on the identification of people with mental illness, treatment, and collaboration between the court and others. These themes include cultural differences in defining mental illness, differences in traditional and contemporary treatment models, and the importance of mutual cultural respect.
Conclusion:
The findings suggest Inuit culture, including its recent history of cultural disruption and change, affects the vulnerability of Nunavut communities to the potential moral and legal pitfalls associated with TJ and criminal court mental health initiatives. These pitfalls include the dominance of biomedical approaches when identifying a target population, the medicalization of behaviour and culture, the risk of "paternalism" in therapeutic interventions, and shortcomings in interdisciplinary collaboration that limit considerations of Inuit culture. The pitfalls are not fatal to efforts to bring the rehabilitative benefits of these initiatives to Nunavut, but they require careful vigilance when employing TJ principles in an Indigenous circumpolar context.
Problem addressed In Canada, there are few health promotion programs for men, particularly programs focused on indigenous and other men marginalized by social and structural inequities. Objective of program To build solidarity and brotherhood among vulnerable men; to promote health through education, dialogue, and health screening clinics; and to help men regain a sense of pride and fulfilment in their lives. Program description The DUDES Club was established in 2010 as a community-based health promotion program for indigenous men in the Downtown Eastside neighbourhood of Vancouver, BC. Between August 2014 and May 2015, 150 men completed an evaluation survey developed using a logic model approach. Responses were analyzed based on the 4 dimensions of the indigenous medicine wheel (mental, physical, emotional, and spiritual). Evaluation results demonstrated high participant satisfaction and positive outcomes across all 4 dimensions of health and wellbeing: 90.6% of respondents indicated that the DUDES Club program improved their quality of life. Participants who attended meetings more often experienced greater physical, mental, and social benefits (P < .05). Conclusion Findings indicate that this innovative model is effective in promoting the well-being of mainly indigenous men through culturally safe services in an urban community.
Mainstream child and family well-being indicators frequently are based on measuring health, economic, and social deficits, and do not reflect Indigenous holistic and strength-based definitions of health and well-being. The present article is a review of literature that features Indigenous communities' self-identified strength-based indicators of child and family well-being. The literature search included Indigenous communities from across the world, incorporating findings from American Indians and Alaska Natives, First Nations, Native Hawaiians, Māori, Aboriginal Australians, and Sámi communities. Sorting the identified indicators into the quadrants of the Relational Worldview, an Indigenous framework for well-being based on medicine wheel teachings that views health and well-being as a balance among physical, mental, contextual, and spiritual factors, the authors discuss the findings.
Objectives:
To examine whether bullying victimization, psychological status, parental and peer relationships and other risk factors are associated with suicidal ideation and to identify high-risk neighbourhoods for suicidal ideation among the elementary school children in Saskatoon Health Region.
Methods:
A sample of school students (n = 5340, grades 5-8; ages 9-14 years) from 109 elementary schools in Saskatoon Health Region, Saskatchewan completed the Student Health Survey in 2010-2011. A multilevel logistic regression model was used to investigate the hierarchical data structure at student, grade and school levels. Bayesian spatial analysis was conducted to examine the spatial disparity in the risk of suicidal ideation among residential neighbourhoods.
Results:
Of 5,340 children, 340 (6.4%) indicated they had considered suicide at least once in the previous 12 months. Our findings indicated that school children who were frequently verbally or electronically bullied were more likely to report suicidal thoughts than those who were not bullied. Students who were more depressed or anxious, and those with lower self-esteem and poorer relationships with their parents were also more likely to report suicidal ideation. The Aboriginal elementary school students and those from the west side of the city were at a higher risk of having suicidal ideation.
Conclusion:
Our findings suggest the need for targeted intervention strategies on suicidal ideation among the elementary school children in Saskatoon Health Region, before they reach high school.
The health disparities affecting Indigenous peoples in Canada might well be understood as a national epidemic. Although progress has been made in the last decade towards both understanding and ameliorating Indigenous health inequalities, very little research or writing has expanded a social determinants of health framework to account for the unique histories and present realities of Indigenous peoples in this country. This timely edited collection addresses this significant knowledge gap, exploring the ways that multiple health determinants beyond the social―from colonialism to geography, from economy to biology―converge to impact the health status of Indigenous peoples in Canada.
This unique collection, comprised largely of contributions by Indigenous authors, offers the voices and expertise of First Nations, Inuit, and Metis writers from across Canada. The multitude of health determinants of Indigenous peoples are considered in a selection of chapters that range from scholarly papers by research experts in the field, to reflective essays by Indigenous leaders. Appropriate throughout a range of disciplines, including Health Studies, Indigenous Studies, Public and Population Health, Community Health Sciences, Medicine, Nursing, and Social Work, this engaging text broadens the social determinants of health framework to better understand health inequality. Most importantly, it does so by placing front and center the voices and experiences of Indigenous peoples.
Questions of national identity, indigenous rights, citizenship, and migration have acquired unprecedented relevance in this age of globalization. In Exalted Subjects, noted feministscholar Sunera Thobani examines the meanings and complexities of these questions in a Canadian context. Based in the theoretical traditions of political economy and cultural / post-colonial studies, this book examines how the national subject has been conceptualized in Canada at particular historical junctures, and how state policies and popular practices have exalted certain subjects over others.Foregrounding the concept of ‘race’ as a critical relation of power, Thobani examines how processes of racialization contribute to sustaining and replenishing the politics of nation formation and national subjectivity. She challenges the popular notion that the significance of racialized practices in Canada has declined in the post Second World War period, and traces key continuities and discontinuities in these practices from Confederation into the present. Drawing on historical sociology and discursive analyses, Thobani examines how the stateseeks to ‘fix’ and ‘stabilize’ its subjects in relation to the nation's ‘others.’ A controversial, ground-breaking study, Exalted Subjects makes a major contribution to our understanding of the racialized and gendered underpinnings of both nation and subject formation. © University of Toronto Press Incorporated 2007 All rights reserved.
The recent debate about cultural safety highlights the distance between those who seek to retain the practices and values of a colonial past, and those who want to proceed to a post-colonial future. In the present case, the latter group have attempted to alter the education of some health professionals, nurses, by offering a critical understanding of colonial structures and their effects, and by providing an alternative that centres on ethnic sensitivity. In most respects, it has been a modest innovation in nursing education in terms of meeting the goal of tino rangatiratanga in health delivery services for iwi. But the opposition that began in 1992 in Metro Magazine and which reached something of a crescendo from mid-1993 illustrates the reluctance of important sectors of the community to even consider such modest changes an improvement. Indeed, the reverse is the case. Cultural safety has become defined as a politically inspired campaign of subversion which represents the agenda of extremism....
Objective:
Racial discrimination is a social determinant of health for First Nations people. Cultural resilience has been regarded as a potentially positive resource for social outcomes. Using a compensatory model of resilience, this study sought to determine if cultural resilience (compensatory factor) neutralized or offset the detrimental effect of racial discrimination (social risk factor) on stress (outcome).
Methods:
Data were collected from October 2012 to February 2013 (N = 340) from adult members of the Kettle and Stony Point First Nation community in Ontario, Canada. The outcome was perceived stress; risk factor, racial discrimination; and compensatory factor, cultural resilience. Control variables included individual (education, sociability) and family (marital status, socioeconomic status) resilience resources and demographics (age and gender). The model was tested using sequential regression.
Results:
The risk factor, racial discrimination, increased stress across steps of the sequential model, while cultural resilience had an opposite modest effect on stress levels. In the final model with all variables, age and gender were significant, with the former having a negative effect on stress and women reporting higher levels of stress than males. Education, marital status, and socioeconomic status (household income) were not significant in the model. The model had R(2) = 0.21 and adjusted R(2) = 0.18 and semipartial correlation (squared) of 0.04 and 0.01 for racial discrimination and cultural resilience, respectively.
Conclusions:
In this study, cultural resilience compensated for the detrimental effect of racial discrimination on stress in a modest manner. These findings may support the development of programs and services fostering First Nations culture, pending further study.
A key priority of the mental health strategy for Canada is to establish a coordinated continuum of mental wellness (mental health and substance use) services for and by First Nations, which include traditional, cultural, and mainstream approaches. This paper describes developments critical to informing the strategy and helping to create foundations for systems change at all levels with positive impacts being created in First Nations communities across Canada. Key lessons include the need to create mutually cooperative and respectful working relationships that will foster collaborative partnerships with First Nations in order to effect change in communities, and the use of culture as a foundation to create lasting and meaningful change.
The concept of therapeutic landscape is concerned with a holistic, socio-ecological model of health, but most studies have attempted to explore land-health links from a Western perspective. On an Indigenous reserve in Northern Ontario, part of the Canadian subarctic, we explore the importance of spaces and places in creating postcolonial therapeutic landscapes to treat the wounds inflicted by colonialism. The aim of this research is to gain insight from views and experiences of First Nations residents living on reservations that are undergoing a process of regaining traditional spiritual beliefs and teachings to construct therapeutic spaces to face mental health problems caused by legal opioid analgesic abuse. This qualitative study used semi-structured interviews with Cree and Ojibwe participants to understand how they are reconnecting with earth, spirituality and traditional animist beliefs on their way to recovery. We find that practices such as taking part in ceremonies and ritual spaces, and seeking knowledge and advice from Elders assist with personal healing and enable Indigenous people to be physically and mentally healthy. Our research findings provide important insights into the relationship between space, healing and culture as determinants of health and well-being and document some key factors that contribute to substance abuse recovery.
Background:
The 10-item Kessler Psychological Distress Scale (K10) is a short measure of non-specific psychological distress, which has been shown to be a sensitive screen for the Diagnostic and Statistical Manual of Mental Disorders criteria for anxiety and mood disorders. The scale has yet to be validated as a measure of psychological distress for Aboriginal peoples in Canada.
Data and methods:
Using the 2012 Aboriginal Peoples Survey (APS), this study examined the psychometric properties of the K10 for First Nations people living off reserve, Métis, and Inuit aged 15 or older. The factor structure and internal consistency of the K10 were examined via confirmatory factor analysis and Cronbach's alpha, respectively. Descriptive statistics by sex, education, household income, and age group were provided for the scale. K10 construct validity was further assessed by examining associations with mental health variables in the 2012 APS: self-rated mental health, self-reported diagnosed mood and anxiety disorders, and self-reported suicidal ideation in the past 12 months.
Results:
A unidimensional "Distress" model with correlated errors was a good fit to the data. Cronbach's alpha values were satisfactory. K10 mean scores were positively skewed, with most respondents reporting few or no distress symptoms. Females and respondents with lower education and household income levels had significantly higher distress. Respondents aged 55 or older had significantly lower distress than their younger counterparts. K10 mean scores were significantly higher for respondents who reported poor mental health, a diagnosed mood disorder, a diagnosed anxiety disorder, or suicidal ideation in the past 12 months. Results were consistent across all three Aboriginal groups.
Interpretation:
Based on the 2012 APS, the total score of the K10 appears to be psychometrically sound for use as a broad measure of non-specific psychological distress for First Nations people living off reserve, Métis, and Inuit.
https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2016001/article/14307-eng.pdf?st=kdfItU9J
Objectives:
Mental health and substance use have been identified as health priorities currently facing Indigenous peoples in Canada; however, accessible and culturally relevant population health data for this group are almost non-existent. The aim of the Our Health Counts study was to generate First Nations adult population health data in partnership with the De dwa da dehs ney>s Aboriginal Health Access Centre in Hamilton, Ontario.
Methods:
Analysis involved data gathered through respondent-driven sampling. Prevalence estimates and 95% confidence intervals were generated for diagnosis and treatment of a psychological disorder or mental illness, depression, anxiety, post-traumatic stress disorder (PTSD) and suicide, alcohol and substance use, and access to emotional support.
Results:
Of the 554 First Nations adults who participated in the Our Health Counts study in Hamilton, 42% had been told by a health care worker that they had a psychological and/or mental health disorder. High rates of depression (39%) and PTSD (34%), as well as suicide ideation (41%) and attempts (51%) were reported. Half of the sample reported marijuana use in the previous 12 months, and 19% reported the use of cocaine and opiates.
Conclusion:
First Nations adults living in Hamilton experience a disproportionate burden of mental health and addictions. By working in partnership with urban Aboriginal organizations, it is possible to produce policy- and service-relevant data and address the current deficiency in appropriate mental health and substance use services for urban Aboriginal people.
