Indigenous Mental Health & Cultural Factors

• Indigenous mental health considers the influence of environmental, family, wisdom, physical responsibility, community, and cultural factors.
• It further considers the influence of emotional, social, land, respect, mental and spiritual connections, along with relationships to nations and the economy, on human beings.

Thanksgiving Address

• Across most Indigenous nations, gatherings and ceremonies often begin with a Thanksgiving address led by an Elder or nation member.
• These addresses are usually in traditional language and take the form of prayers or general recognition of all relations.
• Relations include all living things.

Ways of Introducing Oneself

• Many North American Indigenous cultures introduce themselves by stating their name, clans, community, nation, heritage, ancestors, place, land, language, and treaty.
• They focus on relationships instead of status, position, or power.
• These relationships extend to community, nation, international community, land, and other living things.
• Individuals with a spirit name proclaim it so that all their relations can know who they are and hear the truths they want to convey.

Indigenous Mental Health in Canada

• Indigenous peoples in Canada have historically and continuously experienced complex and layered intergenerational trauma.
• As a result, many communities face mental health and suicide crises.
• These collective experiences are referred to as "colonial trauma", which is considered a key political determinant of health.
• Colonial trauma serves as an explanatory factor for the health inequities borne by Indigenous peoples.
• Colonialism's shape-shifting nature adds another layer to this framework.
• Recognizing the ongoing nature of colonialism helps to understand trauma in more nuanced ways.
• Indigenous people in Canada face significant challenges regarding mental illness and inadequate health care services due to racism, stereotypes, ignorance, and historical government interventions.

Human Costs

• Internalization of racism and harm results from being told repeatedly that one is not good or smart enough, or viewed as a "problem" that needs to be addressed.
• Indigenous people are twice as likely as non-Indigenous people to experience major depression and other mental illnesses.
• 16% of First Nation adults living on reserve experience major depression, compared to 8% of the Canadian population.
• First Nations youth are nine times more likely to experience mental health problems than their Canadian peers.

Mental Health Diagnoses

• Higher proportions of Indigenous participants report fair/poor mental health compared to non-Indigenous participants (38% compared to 23%).
• Common mental health diagnoses in Indigenous populations include PTSD, substance use disorder, major depression, and suicide.
• Suicide in Indigenous communities is the leading cause of death for young people aged 10-29.
• Rates of suicide are three times the national average, with Inuit, youth, and young adults being particularly impacted.
• The British Columbia Aboriginal Survivors Study found only two of 127 residential school survivors to be free of mental illness, 30.4% experienced a major depressive episode, 26.1% had chronic depression and 64.2% had post-traumatic stress disorder (PTSD).
• Statistics Canada reports that suicide rates among First Nations youth are five to seven times that of non-Indigenous youth, and Inuit youth are at a rate of eleven times greater.
• First Nations men die by suicide 2.4 times the national average, and women five times.

Existing Mental Health Support

• Current mental health "support" has inadequate resources.
• Support is needed from professionals with specific training.
• Responding to crises when Indigenous peoples are suicidal requires filling out multiple forms, creating a prohibitive process.
• There is a limited number of service providers, especially in rural and remote Indigenous communities.

Existing Mental Health Supports

• Mental health services are supported by Indigenous Services Canada (ISC).

• These services include:

  • The National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) Program Framework
  • Mental health counselling through the Non-Insured Health Benefits (NIHB) Program
  • Jordan's Principle
  • The Inuit Child First Initiative
  • The Indian Residential Schools Resolution Health Support Program
  • Health support services for the issue of missing and murdered Indigenous women and girls
  • Phone and chat lines such as "hope for wellness"

• More long-term intensive and non-crisis response support is needed.

Non-Insured Health Benefits (NIHB) Program

• The "guide to mental health benefits" instructs both clients and mental health service providers to attempt other avenues first.
• Contacting an NIHB regional office to get a list of service providers is then required.
• If a client finds a service provider in their area, they are eligible for up to "22 hours of counselling" annually, which must be pre-approved.
• The administration, availability, and type of programming differs between provinces.

Barriers to Supports

• Accessing existing supports, if one is deemed eligible, is often a cumbersome process.
• Accessing NIHB is an example.
• Access often involves literacy and access to technology.
• LGBTQ2S individuals in the Indigenous community are more likely to experience mental health concerns like depression and anxiety.
• Approximately 33.8% of female and 17.2% of male Indigenous youth living on reserve reported feeling sad, blue, or depressed for two weeks or more in the previous twelve months.
• This is worsened by the increasing reliance on virtual and telehealth services, because many remote communities struggle with limited connectivity.

Social determinants of Health

• Social determinants include access to health services, personal health and coping skills, early childhood development, social support networks and genetics.
• It also includes culture and language, social inclusion, education, income and social status, employment and working conditions, and the physical environment.

Truth and Reconciliation Commission

• The Truth and Reconciliation Commission [TRC] (2015) Calls to Action 18-24 include health actions to improve the mental well-being of Indigenous peoples and prevent suicide.
• The Calls to Action include acknowledgment of harm and provision of funding towards healing centers and programming.
• Canada has not completed a single Health Call to Action for the second year in a row.

Health Calls to Action 18-24

• Actions to take include recognizing the current state of health of indigenous peoples.
• Actions to take include identifying and closing gaps in health outcomes.
• Actions to take include recognizing the distinct health needs of on and off reserve indigenous peoples, urban indigenous, Métis and Inuit.
• Actions to take include funding healing centres.
• Actions to take include recognizing the value of indigenous healing practices
• Increase and ensure the retention of Indigenous Professionals and
• Ensure cultural competency training happens for health care professionals

What is Needed?

• Mental health care for Indigenous peoples should be accessible, free (and funded), and colonial trauma-informed, with trained practitioners available.
• Barriers to accessing mental health support need to be removed to ensure Indigenous persons who find the strength to seek support can do so.
• Direct financial support is vital for those unraveling complex trauma.

Indigenous Support

• Indigenous peoples who seek help must have access to financial support and comprehensive trauma care.
• A program utilizing trained psychologists, psychiatrists, and trauma counselors that allows for collaboration with Indigenous Nations and peoples and respects and upholds their self-determination is needed.
• Interventions should be under the directive and guidance of varied cultural knowledge holders.
• Education on the roots of oppression, genocidal and colonial acts inflicted by the state, and the reality of intergenerational trauma is necessitated for Indigenous communities to implement intervention strategies.

Traditional Healing

• Holistic Indigenous healing interconnects family, community, spirituality, and nature.
• Wellness involves striking a balance and achieving harmony.
• A focus should be placed on strengths and a sense of control over one's own health.
• Indigenous treatments may include spiritual practices like ceremonial prayers and songs.
• Sacred remedies are utilized like tobacco, sweet grass, or sage, healing circles, sweat lodges, and elders or healers.
• Toronto's Centre for Addiction and Mental Health (CAMH) launched Shkaabe Makwa (Spirit Bear Helper), which is an Indigenous-led hospital center incorporating traditional healing practices to improve healthcare for First Nation, Inuit and Métis members.

Incentives

• Incentives should be offered to recruit and retain mental health practitioners, especially Indigenous practitioners, as many Indigenous communities need to travel to access healthcare services.
• Funding should be prioritized for housing, recreation, gymnasiums, fitness programs and centers, healthy foods initiatives, cultural programming, and relevant community infrastructure.

Two Row Wampum Treaty-Healing

• The Haudenosaunee see the Two Row Wampum as a living treaty that promotes peaceful coexistence and respect between nations.
• The Two Row Wampum belt is a symbolic record of the first agreement between Europeans and American Indians on Turtle Island (North America).
• The agreement outlined a commitment to friendship and peace between peoples living perpetually in parallel, with each party recognizing the other as an equal partner.

Two-Eyed Seeing

• Two Eyed Seeing or Etuaptmumk is a process of "bringing our knowleges together" to benefit from multiple distinct perspectives.
• It challenges people to appreciate Indigenous traditional knowledge alongside scientific perspectives.
• Prioritizing diverse perspectives of knowing improves learning outcomes.
• This approach has been recognized as promising for research into Indigenous health.

Knowledge Gardening

• Teaching and learning is intended to sow the seeds of knowledge which are planted in individual minds but may take many years to bloom and be fully appreciated.
• Knowledge and teaching is a spiritual experience nurtured by relationships.

The Seven Generations

• The Seven Generations considers inherited wisdom and knowledge.
• Future actions seek to protect and provide for the next Seven Generations.
• One generation is 120 years.
• A full family memory of lineage occurs.
• Consideration of actions considers impacts 840 years later.

Grandfather Teachings

• The seven grandfather teachings are love, respect, bravery, truth, honesty, humility and wisdom.
• Love is a compassionate recognition of oneself, the Creator and the world. Demonstrated through clear communication, effective listening and non-judgement
• Bravery means having the courage to be yourself and defend what you believe in.
• Truth means understanding, speaking and feeling the truth.
• Honesty involves being truthful and accepting responsibility
• Humility involves living a selfless life, and respecting your place in the world.
• Wisdom recognizes the value of experience.

The Medicine Wheel for Indigenous Wellness

• The medicine wheel considers the physical, emotional, spiritual and mental.
• Elements of the wheel include history lessons, spirituality, connection to land, language, stability, identity, belonging, etc.
• Mental health is impacted when pieces are not correctly connected.

Additional Factors Impacting Indigenous Mental Health

• Traumatic experiences can damage the parent-child relationship, leading to insecure attachment styles.
• Emotional regulation and interpersonal relationships thereby impact mental health.
• Traumatic events can shape an individual's behaviour and beliefs.
• Substance abuse can contribute to generational mental health issues
• The risk of more mental health is increased whenever there is war, abuse, or oppression.