1CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH POPULATION MENTAL HEALTH PROMOTION IN CANADA

This document is part of a collection produced by the six National Collaborating Centres for Public

Health to encourage mental health promotion for children and youth within a strong, integrated

public health practice. The collection provides numerous entry points for the public health sector

to collaborate with other stakeholders to support evidence-informed action that addresses the

determinants of mental well-being for all children and youth in Canada.

This paper aims to improve understandings of Indigenous mental health in Canada, and

demonstrate how particular determinants either contribute to increased risk for mental illness

or act as protective factors for positive mental health. Details on search methods and terms used

for this paper can be found in the introduction document: Population mental health promotion

for children and youth - a collection for public health in Canada.

Visit NCCPH.CA to download the complete collection

INDIGENOUS CONCEPTS OF MENTAL HEALTH

Mental health is increasingly recognized as more than the absence of mental health problems or illnesses. Rather, it is a “state of well-being in which the individual can realize his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (World Health Organization [WHO], 2016, para. 1). Indigenousi concepts of mental health and wellness extend beyond this definition to include holistic and relational ways of knowing and being in

the world. Good health is generally understood as a balance of the mental, physical, spiritual and emotional dimensions of self and the ability to live in harmony with family, community, nature and the environment (King, Smith, & Gracey, 2009;

i The terms ‘Indigenous’ and ‘Aboriginal’ are used throughout

this paper to refer to the original inhabitants of Canada and

their descendants, including First Nations (referred to as

Indians in Canadian Constitution), Inuit, and Métis peoples as

defined by Section 35 of the Canadian Constitution of 1982.

Wherever possible, specific Indigenous groups are cited. To

learn more about how Indigenous peoples are defined within

Canada, please refer to https://journals.uvic.ca/journalinfo/ijih/

IJIHDefiningIndigenousPeoplesWithinCanada.pdf

Considerations for Indigenous child and youth population mental health promotion in Canada

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2 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH - A COLLECTION FOR PUBLIC HEALTH IN CANADA

Vukic, Gregory, Martin-Misener, & Etowa, 2011). For Inuit, mental wellness is defined as self-esteem and personal dignity flowing from harmonious physical, emotional, mental and spiritual wellness, and cultural identity (Inuit Tapiriit Kanatami [ITK], 2014). The First Nations Mental Wellness Continuum Framework suggests that this balance is “enriched as individuals have a sense of purpose in their daily lives whether it is through education, employment, care giving activities, or cultural ways of being and doing; hope for the future and those of their families that is grounded in a sense of identity, unique Indigenous values, and having a belief in spirit; a sense of belonging and connectedness within their family and community and to culture; and finally a sense of meaning and an understanding of how their lives and those of their families and communities are part of creation and a rich history” (Health Canada & Assembly of First Nations, 2015, n.p.).

Mental health promotion “involves actions to create living conditions and environments that support mental wellness

across the lifespan and allow people to adopt and maintain healthy lifestyles” (WHO, 2016, para. 7; see also Mental Health Commission of Canada [MHCC], 2012). At a population level, it involves intersectoral action in various settings, including home, school, the workplace and the community, through programs, policies and other interventions that promote health for all, as well as for those at greater risk, such as children and youth. Healthy emotional and social development in early childhood and adolescence not only sets the stage for good mental health in adulthood, it has been shown to reduce the demand for mental health services and for services outside the health sector (Chief Public Health Officer, 2009; MHCC, 2012; National Collaborating Centres for Public Health [NCCPH], 2017). For Indigenous children and youth in Canada, who experience a disproportionate burden of ill-health compared to their non-Indigenous counterparts, access to culturally safe, strengths-based, family and community-oriented mental health promotion programs and services is critical to mental wellness and resilience in later life.

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3CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH POPULATION MENTAL HEALTH PROMOTION IN CANADA

FRAMING THE LINKS BETWEEN MENTAL HEALTH PROMOTION AND INDIGENOUS CHILDREN AND YOUTH

Demographics

Indigenous peoples are the youngest and fastest growing segment of Canada’s population. In 2011, the Indigenous population reached 1.4 million people (4.3% of the total Canadian population), representing an increase of 20.1% from the 2006 Census (Statistics Canada, 2013). Indigenous children aged 14 and under account for 28% of the total Indigenous population (compared to 16.5% of the non-Indigenous population), while Indigenous youth aged 15 to 24 represent 18.2% of the total Indigenous population (compared to 12.9% of the total non-Indigenous population). Inuit are the most youthful of the three Indigenous groups with a median age of 23, followed by 26 for First Nations, and 31 for Métis (Statistics Canada, 2013).

Limitations of data

Useful and reliable data on Indigenous child and youth health in Canada is limited by the quality and coverage of data, a lack of culturally relevant health indicators, and jurisdictional barriers associated with Indigenous status and geography (National Collaborating Centre for Aboriginal Health [NCCAH], 2009; Smylie, 2009a). McShane, Smylie, and Adomako (2009) note significant gaps in the health information available for Indigenous children in Canada, including vital registration and health care access data, prevalence rates for obesity, diabetes, cancer and mental health, and data specific to Métis and First Nations children living off-reserve. An emphasis on Indigenous children’s disease and illness outcomes, rather than preventative and wellness measures, was also noted. In a recent review of Indigenous youth health research in Canada, Ning and Wilson (2012) found similar discrepancies in both geographic and demographic representation, with a dearth of research on youth in the Prairie and Atlantic provinces and the Northern Territories, as well as a significant under-representation of Métis and urban Indigenous youth health research. Despite these challenges, it is clear that Indigenous children and youth experience significant health and social disparities, with higher rates of injury, infant mortality, suicide, and chronic and infectious diseases (Greenwood & de Leeuw, 2012; McShane et al., 2009; UNICEF Canada, 2009).

Mental health status

ChildrenData specific to Indigenous children’s mental health in Canada is very limited (Kirmayer, Brass, & Tait, 2009). The 2008-10 First Nations Regional Health Survey (RHS) found that 14.1% of primary caregivers of First Nations children living on-reserve aged 3 to 11 reported their child experienced more emotional or behavioral problems during the previous six months than other boys and girls of the same age (First Nations Information Governance Centre [FNIGC], 2012). The survey also found that a higher proportion of First Nations boys had been diagnosed with anxiety/ depression than girls (0.9% vs. 0.4%), and that the prevalence was also higher among older First Nations children compared to younger First Nations children (FNIGC, 2012). Analogous mental health data is not available for Inuit, Métis and off-reserve First Nations children.

YouthIn terms of First Nations youth, the 2012 Aboriginal Peoples Survey found that 61% of youth living off-reserve 15 to 24 years of age reported excellent or very good mental health (Statistics Canada, 2016a). Similarly, results from the 2008-10 First Nations Regional Health Survey found that approximately 64.8% of First Nations youth living on-reserve felt their mental health status was very good or excellent, with only 0.8% reporting it was poor, with no difference observed between genders (FNIGC, 2012). However, approximately 33.8% of female and 17.2% of male First Nations youth living on-reserve reported there was a time when they felt sad, blue or depressed for two weeks or more in a row in the previous 12 months (FNIGC, 2012). A higher proportion of First Nations youth with at least one health condition also reported feeling sad, blue or depressed (31.6%), had thoughts about suicide (23%) or had attempted suicide (8.1%) compared to youth without a health condition (FNIGC, 2012).

Suicide ratesSuicide rates vary substantially among Indigenous communities in Canada, ranging from no suicides at all and/or rates that are low or comparable to the general population, to elevated rates that are well above the national average (Kirmayer et al., 2007, 2009; Chandler & Lalonde, 1998, 2008). Rates of suicide are reported to be 5 to 7 times higher for First Nations youth living on reserve (Kielland & Simeone, 2014; Public Health Agency of Canada [PHAC], 2006) and 5 to 25 times higher for Inuit youth respectively than the national

4 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH - A COLLECTION FOR PUBLIC HEALTH IN CANADA

average (ITK, 2016). Comparable national data does not exist for Métis youth. Although suicide rates among Indigenous males aged 14 to 24 have historically been higher, a recent increase among Indigenous females has been observed (Fraser, Geoffroy, Chachamovich, & Kirmayer, 2015; Kirmayer, 2012).

Knowledge gaps

With respect to knowledge gaps, it is clear that more research is needed specific to Inuit, Métis and First Nations off-reserve children and youth to develop more relevant and responsive policies, programs and interventions. A better understanding of gender differences in the mental health of First Nations, Inuit, and Métis boys and girls is also needed, particularly as they transition to adulthood where differences in self-reported mental health status have been shown to vary considerably between groups.ii Significant knowledge gaps exist related to the mental health of lesbian, gay, bisexual, trans, queer

and Two-Spirit (LGBTQ2S) Indigenous children and youth, even though they are more likely to experience mental health issues such as depression and anxiety, and often face additional barriers to accessing programs and services (Hunt, 2016). Finally, although there is growing evidence for the transgenerational impact of residential schools and other colonial policies on Indigenous mental health outcomes, more research is needed to understand cumulative negative effects and ongoing adversity (Bombay, Matheson, & Anisman, 2009; Kirmayer, Sheiner, & Geoffroy, 2016).

Despite the inadequacies of the existing data, mental health challenges and strengths vary immensely among Indigenous communities and across individuals (Boksa, Joober, & Kirmayer, 2015). This variation reflects the distinctiveness of First Nations, Inuit, and Métis peoples’ histories, languages, cultures, environments, beliefs and worldviews in relation to health experiences and outcomes. It also speaks to the different ways in which health determinants intersect and manifest across the lifespan and across multiple generations to influence both risk and protective factors (Statistics Canada, 2016a; Loppie & Wien, 2009). ii In 2012 approximately 56% of First Nations women aged 18

and over living off-reserve reported excellent or good mental

health, compared to 64% for off-reserve First Nations men.

Differences in self-reported mental wellness of Métis women was

slightly less than for Métis men (61% vs. 68%), while there was no

significant difference between Inuit women (51%) and their male

counterparts (Statistics Canada, 2016b).

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5CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH POPULATION MENTAL HEALTH PROMOTION IN CANADA

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DETERMINANTS AND PROTECTIVE FACTORS OF INDIGENOUS MENTAL HEALTH AND WELLNESS

Mental health and wellness are shaped to a great extent by the underlying social determinants of health (SDoH) that create inequalities along a social gradient where the poor and the disadvantaged suffer disproportionately (Allen, Balfour, Bell, & Marmot, 2014). The relationship between Indigenous health inequalities and social determinants such as poverty, overcrowded and sub-standard housing, food insecurity, social and economic exclusion, and inadequate health services is well-documented (ITK, 2014; King et al., 2009; Loppie & Wien, 2009; Smylie, 2009b). However, to fully understand the enduring health inequities experienced by Indigenous peoples in Canada and globally, it is necessary to look beyond mainstream SDoH frameworks to determinants that are not strictly ‘social’ in nature such as language, culture, spirituality, geography, relationships to the land, self-determination and

knowledge systems (Greenwood, de Leeuw, Lindsay, & Reading, 2015). By moving beyond the social, Indigenous knowledges and ways of being in the world rightfully become the “primary frame of reference for understanding current health realities in Indigenous communities” (Greenwood et al., 2015, pg. xii). From this perspective, colonialism is understood as the broadest and most fundamental determinant of health and one that remains an “active and ongoing force” in the lives of Indigenous peoples (Greenwood et al., 2015).

Protective factors

Protective factors are attributes or conditions at the individual, family, community or societal levels that can promote resiliency and decrease risk factors associated with poor mental health outcomes (MHCC, 2012; NCCPH, 2017). A recent review of protective factors and causal mechanisms that enhance resilience among Indigenous circumpolar youth identified over 40 protective factors, many of which

6 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH - A COLLECTION FOR PUBLIC HEALTH IN CANADA

overlapped at the community, family and individual levels and were directly associated with other protective factors (Petrasek MacDonald, Ford, Cunsolo Willox, & Ross, 2013). For example, hunting and spending time out on the land can promote individual protective factors like self-reliance and self-confidence, but can also provide opportunities to be involved in the community, receive mentorship from older generations, and build kin and community relationships (Petrasek MacDonald et al., 2013). At the community level, cultural continuity has been identified as a protective factor. In a seminal study examining variations in youth suicide rates across First Nations communities in British Columbia, Chandler and Lalonde (1998, 2008) found a strong correlation between cultural continuity factors – self-government, involvement in land claims, band control over education, health services, fire and police services, the presence of cultural facilities – and lower rates of youth suicide. Other important cultural continuity factors included the involvement of women in band councils, band control over child welfare services and knowledge of Indigenous languages (Chandler & Lalonde, 2008; Kielland & Simeone, 2014).

EXAMPLES OF INTERVENTIONS

Promising practices in health promotion interventions among Indigenous peoples in Canada share many commonalities, including their incorporation of:

Indigenous concepts such as holism, reciprocity and plurality;Indigenous contexts including acknowledgement of inequalities and colonial oppression; andIndigenous processes like community control, community engagement, cultural responsiveness and capacity building (Reading & Reading, 2012).

The new First Nations Mental Wellness Continuum Framework, jointly developed by the Assembly of First Nations (AFN) and Health Canada, and the Inuit Tapiriit Kanatami (ITK) National Inuit Suicide Prevention Strategy both provide

evidence-based, holistic and relational approaches to mental wellness that are rooted in these concepts, contexts, and processes. Culture is at the heart of each strategy, including the important role that Indigenous languages, identity and knowledges play in achieving wellness across the lifespan. Similar to the Mental Health Commission of Canada’s Changing directions, changing lives: The mental health strategy for Canada (2012) recommendations for action (Strategic Direction 5.1 to 5.4), the AFN and ITK strategies call for a coordinated continuum of culturally competent and safe mental health supports and services, by and for Indigenous peoples, to address jurisdictional, geographical and funding issues.

Key characteristics of successful mental health promotion initiatives for Indigenous children and youth identified in the literature include interventions that are: holistic, community-driven and owned; build capacity and leadership; emphasize strengths and resilience; address underlying health determinants; focus on protective factors and resilience; incorporate Indigenous values, knowledges and cultural practices; and meaningfully engage children, youth, families and the community (Gray, Richer, & Harper, 2016; Kirmayer et al., 2016; Smye & Mussell, 2001; Systems Improvement through Service Collaboratives, 2012; Vukic et al., 2011; Wortzman, 2009). There are a myriad of innovative, culturally responsive mental health promotion interventions for Indigenous children and youth being implemented in rural, remote and urban settings across Canada. Examples of interventions in family, school, community and land-based settings:

Makimautiksat Wellness and Empowerment Camp is a 10-day land and community-based camp program based on the Eight Ujarit/Rocks Model that provides Inuit youth with the skills and knowledge they need to build their lives. The evidence-based modules focus on strengthening coping skills; Inuuqatigiitiarniq (being respectful of others) to build healthy and harmonious relationships; Timiga (my body) to nurture awareness of the body, movement and nutrition; Sananiq, to craft and explore creativity; Nunalivut (our community) to foster personal and

7CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH POPULATION MENTAL HEALTH PROMOTION IN CANADA

community wellness; Saqqatujuq (distant horizon) for self-discovery and future planning; understanding informed choices and peer pressure; and Avatittinik Kamatsiarniq (stewards of the land) to connect knowledge and skills on the land (Healey, Noah, & Mearns, 2016, p. 7). With the support of local wellness youth centres, the model was piloted from 2011 to 2013 as a two-week camp program in five communities: Cambridge Bay, Arviat, Coral Harbour, Iqaluit and Panniqtuuq.

Promoting Life-Skills in Aboriginal Youth (PLAY) Program is a partnership with 88 First Nations communities and urban Indigenous organizations across Canada to deliver safe, fun and educational programming for Indigenous children and youth (Right to Play, 2016). The program, implemented in 2010, aims to enhance educational outcomes, improve peer-to-peer relationships, increase employability and improve physical and mental health of Indigenous children and youth through regularly offered weekly activities. Activities vary across communities but may include after-school, youth leadership, diabetes prevention, sport for development

programs, summer camps and baseball leagues, female empowerment workshops, and sport-based clinics (hockey, lacrosse, soccer, basketball).

Listening to One Another is a culturally-based, family-centred, mental health promotion program for Indigenous youth aged 10 to 14 and their parents. Funded by the Public Health Agency of Canada, the program is a collaboration between First Nations communities in British Columbia, Manitoba, Ontario and Quebec and researchers at McGill University, the University of Lincoln, Nebraska and the University of Manitoba. The program is delivered over 14 weeks in 2.5 hour sessions and takes participants through a series of activities related to community history and cultural pride, family and peer communication, skills for problem-solving, critical thinking and emotion regulation, bullying, dealing with discrimination, problematic substance abuse, and other themes. Communities are involved in every stage of the program, from the adaptation of resources and recruitment of participants to delivery and evaluation. It is currently delivered with the help of Indigenous staff at regional health organizations (Kirmayer et al., 2016).

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PUBLIC HEALTH ROLES

Public health practitioners and policymakers can support and promote Indigenous mental wellness, address underlying health determinants, and contribute to the broader process of reconciliation in Canada, in a number of ways including:

Talk to Indigenous peoples to learn about their diverse perspectives on mental wellness (Boksa, et al., 2015) and recognize that Indigenous cultures and holistic understandings of the world have much to contribute to the transformation of the mental health system in Canada (MHCC, 2012).Learn about and understand the unique social and cultural context of Indigenous communities, their historical legacy, and the current challenges that impact mental health in some Indigenous communities (Boksa, et al., 2015) Commit to providing culturally safe care to address power imbalances, build trust and form lasting relationships with Indigenous patients and communities. Taking a cultural safety training course is a good starting point for this lifelong learning endeavor (Indigenous Health Working Group, 2016).

“Bear witness to the facts of history and acknowledge that effects are still deeply felt today” (Boksa et al., 2015). For example, you can bear witness by reading the report, Honouring the Truth, Reconciling for the Future: Summary of the Final report of the Truth and Reconciliation Commission of Canada, and by showing solidarity through the “It Matters to Me” campaign (Smylie, 2015).“Provide mental health services in culturally responsive ways and work respectfully with Indigenous frameworks of mental wellness” (Boksa et al., 2015, p. 365), for example, by learning about national Indigenous mental wellness frameworks (Health Canada & Assembly of First Nations, 2015; ITK, 2016), as well as Indigenous frameworks developed at the provincial and territorial levels.Disseminate and share knowledge about promising traditional, cultural and mainstream approaches to mental wellness such as mental wellness teams and recognizing the role of Elders (MHCC, 2012).Acknowledge that for mental health programs to be effective in Indigenous communities, they must be guided by local Indigenous knowledge (Boksa, et al., 2015; Kirmayer et al., 2016).

9CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH POPULATION MENTAL HEALTH PROMOTION IN CANADA

Collaborate with traditional healers and knowledge holders in the development of mental health promotion initiatives in a respectful manner (Boksa et al., 2015).Consider ways you can assist Indigenous communities in providing better access to health services, preferably within the community itself (Boksa et al., 2015).Support Indigenous mental wellness workers in their efforts to navigate and collaborate with mental health services, and actively promote and support the training of young Indigenous health professionals (Boksa et al., 2015).Advocate for Indigenous health equity by partnering and collaborating with Indigenous organizations across Canada (Indigenous Health Working Group, 2016).

Public health practitioners and policymakers can also refer to the 94 calls to action to “redress the legacy of residential schools and advance the process of Canadian reconciliation” released in 2015 by the Truth and Reconciliation Commission of Canada (TRC, 2015, p. 5). Several spoke

directly to the health and well-being of Indigenous peoples, and included calls for federal, provincial, territorial and Indigenous governments, medical and nursing schools, and the health care system to:

establish measurable goals to identify and close the gaps in health outcomes and publish annual progress reports and assess long terms trends on indicators such as suicide and mental health (#19)recognize the value of Indigenous healing practices and use them in the treatment of Indigenous patients in collaboration with healers and Elders if requested (#22)increase the number of Indigenous health care professionals (#23i) ensure the retention of Indigenous health care providers in Indigenous communities (#23ii) provide cultural competency training for all health-care professionals (#23iii)implement a mandatory Indigenous health course at medical and nursing schools (#24) (TRC, 2015).

POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTHVisit NCCPH.CA to download the complete collection

General resources

Population mental health promotion for children

and youth – a collection for public health in Canada

Foundations: definitions and concepts to frame

population mental health promotion for children

and youth

Scan Report: resources for population mental

health promotion for children and youth in Canada

Database of resources for population mental

health promotion for children and youth in Canada

Topical papers

Environmental influences on population mental

health promotion for children and youth

Chronic diseases and population mental health

promotion for children and youth

Infectious diseases and population mental health

promotion for children and youth

Healthy public policies and population mental

health promotion for children and youth

Considerations for Indigenous child and youth

population mental health promotion in Canada

This document is part of a collection produced by the six National Collaborating Centres for Public

Health to encourage mental health promotion for children and youth within a strong, integrated

public health practice. The collection provides numerous entry points for the public health sector

to collaborate with other stakeholders to support evidence-informed action that addresses the

determinants of mental well-being for all children and youth in Canada.This paper aims to improve understandings of Indigenous mental health in Canada, and

demonstrate how particular determinants either contribute to increased risk for mental illness

or act as protective factors for positive mental health. Details on search methods and terms used

for this paper can be found in the introduction document: Population mental health promotion

for children and youth - a collection for public health in Canada.INDIGENOUS CONCEPTS OF MENTAL HEALTH

Considerations for Indigenous child and youth population mental health promotion in Canada

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WRITTEN BY THE NATIONAL COLLABORATING CENTRE FOR ABORIGINAL HEALTH

This document is part of a collection produced by the six National Collaborating Centres for Public Health to encourage mental health promotion for children and youth within a strong, integrated public health practice. The collection provides numerous entry points for the public health sector to collaborate with other stakeholders to support evidence-informed action that addresses the determinants of mental well-being for all children and youth in Canada.This paper clarifies the relationships between healthy public policies (HPPs), mental health promotion and reducing inequalities in the mental health of children and youth. It provides information and key resources to support public health practitioners who want to create and influence public policies that support mental health. Details on search methods and terms used for this paper can be found in the introduction document: Population mental health promotion for children and youth - a collection for public health in Canada.

The development of mental healthi begins before birth and continues throughout infancy and childhood. Mental health is essential for functioning through the lifespan. In children and youth as well as in adults, mental health can be understood as

promoting mental health is conceptually a separate activity from preventing mental illness, although, in practice they often intersect, and the former contributes to the latter. In

Healthy public policies and population mental health promotion for children and youth

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WRITTEN BY THE NATIONAL COLLABORATING CENTRE FOR HEALTHY PUBLIC POLICY

This document is part of a collection produced by the six National Collaborating Centres for Public

Health to encourage mental health promotion for children and youth within a strong, integrated

public health practice. The collection provides numerous entry points for the public health sector

to collaborate with other stakeholders to support evidence-informed action that addresses the

determinants of mental well-being for all children and youth in Canada.

This discussion paper describes how infectious diseases can be both risk factors for, and result

from, neurocognitive conditions and mental illnesses and explores how mental health can be a

protective factor against some infectious diseases. Details on search methods and terms used for

this paper can be found in the introduction document: Population mental health promotion for

children and youth - a collection for public health in Canada.

FRAMING THE LINKS BETWEEN

INFECTIOUS DISEASES AND

MENTAL HEALTH PROMOTION

IN CHILDREN AND YOUTH

When it comes to promoting the mental health of children

and youth, public health practitioners and policy makers may

First, a growing body of research suggests that infection and

infectious diseases may play a role in the development of neuropsychiatric conditions and mood disorders in female and male infants, children and youth, including attention deficit hyperactive disorder (ADHD), schizophrenia, obsessive-compulsive disorder, tic disorders, autism spectrum

disorders, anxiety and depression (Benros, Mortensen, &

i For more information, please see Environmental influences on

Infectious diseases and population mental

health promotion for children and youth

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CENTRE FOR INFECTIOUS DISEASES

g social stratification) and

This document is part of a collection produced by the six National Collaborating Centres for Public

Health to encourage mental health promotion for children and youth within a strong, integrated

public health practice. The collection provides numerous entry points for the public health sector

to collaborate with other stakeholders to support evidence-informed action that addresses the

determinants of mental well-being for all children and youth in Canada.

This paper explores how the structural and intermediary determinantsi of mental wellbeing

intersect with physical and social environments to both influence risk for poor mental health

and protect positive mental health in children and youth. Details on search methods and terms

used for this paper can be found in the introduction document: Population mental health

promotion for children and youth - a collection for public health in Canada.

WHAT ENVIRONMENT MEANS

The term “environment” encompasses three major areas

(Barnett & Casper, 2001; Schulz & Northridge, 2004):

1. The built environment refers to buildings, spaces and

products created or modified by people. This includes

houses, roads, traffic noise, transport systems, buildings,

3. The social environment refers to the physical

surroundings, social relationships and cultural settings

within which people function. It includes social and

economic processes, beliefs about place and community,

and influences such as income, race, social supports,

cultural practices (including religion), community

connectedness, stress, social inequities, networks, family

influences and power relations (Barnett & Casper, 2001).

Environmental influences on population

mental health promotion for children and youth

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WRITTEN BY THE NCCS FOR ENVIRONMENTAL

HEALTH AND DETERMINANTS OF HEALTH

This document is part of a collection produced by the six National Collaborating Centres for Public

Health to encourage mental health promotion for children and youth within a strong, integrated

public health practice. The collection provides numerous entry points for the public health sector

to collaborate with other stakeholders to support evidence-informed action that addresses the

determinants of mental well-being for all children and youth in Canada.

This foundational paper provides definitions and background on key concepts, including the

determinants of positive mental health for children and youth. A population approach to mental

health promotion, as well as a description of settings and public health roles are also included as

foundational concepts to support the other papers in this collection. Details on search methods

and terms used for this paper can be found in the introduction document: Population mental

health promotion for children and youth - a collection for public health in Canada.

OVERVIEW OF KEY CONCEPTS

tion mental

University, 2010) and is a strategy to protect against mental

illness. 70% of mental health problems in Canadian adults

have their onset in childhood and adolescence. 15-21% of

children and youth report experiencing at least one mental

health challenge. Anxiety disorder, attention-deficit/

hyperactivity disorder (ADHD), depression and substance

tal illnesses among

Foundations: definitions and concepts to frame population

mental health promotion for children and youth

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WRITTEN BY THE NATIONAL COLLABORATING

CENTRE FOR DETERMINANTS OF HEALTH

10 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH - A COLLECTION FOR PUBLIC HEALTH IN CANADA

RESOURCES

Training Resources

Indigenous Cultural Competence Course, Canadian Foundation for Healthcare Improvement

Retrieved from: Canadian Foundation for Healthcare Improvement

Mental Health First Aid First Nations & Northern Peoples, Mental Health Commission of Canada

Retrieved from: Mental Health Commission of CanadaSan’yas Indigenous Cultural Safety Training – Core ICS Mental Health Training

Retrieved from: San’yas Indigenous Cultural Safety Training

Tools Native Wellness Assessment

Retrieved from: Thunderbird Partnership FoundationMental Health Programs for Aboriginal Peoples in Canada Database

Retrieved from: Network for Aboriginal Mental Health Research

Guidelines/best practice

A Guide for Health Professionals working with Aboriginal Peoples: Aboriginal Health Resources, Smylie, J. (2000).Health and Health Care Implications of Systemic Racism on Indigenous Peoples, The College of Family Physicians of Canada (2016).

Retrieved from: College of Family Physicians of CanadaEmpathy, Dignity and Respect: Creating Cultural Safety for Aboriginal People in Urban Health Care, Health Council of Canada (2012).

Framework/strategies

First Nations Mental Wellness Continuum Framework Summary Report, Health Canada and Assembly of First Nations (2015).

Retrieved from: First Nations and Inuit Health, Health Canada

National Inuit Suicide Prevention Strategy. Inuit Tapiriit Kanatami (2016).

Webinars/podcasts

Anti-Aboriginal Racism in CanadaRetrieved from: National Collaborating Centre for Aboriginal Health

Cultural Safety for Indigenous Peoples: A Determinant of HealthRetrieved from: National Collaborating Centre for Aboriginal Health

Other

Honouring the Truth: Reconciling for the Future. Summary of the Final Report of the Truth and Reconciliation Commission of Canada, Truth and Reconciliation Commission of Canada (2015).

Retrieved from: National Centre for Truth and Reconciliation

Just a Story – Mental Health Stigma. Healthy Aboriginal Network

Retrieved from: Healthy Aboriginal Network

Click the links below to access each resource. Broken link? Let us know at communications@nccph-ccnsp.ca

11CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH POPULATION MENTAL HEALTH PROMOTION IN CANADA

REFERENCES

Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental health. International Review of Psychiatry, 26(4), 392-407.

Boksa, P., Joober, R., & Kirmayer, L. (2015). Mental wellness in Canada’s Aboriginal communities: Striving toward reconciliation. Journal of Psychiatry and Neuroscience, 40(6), 363-365.

Bombay, A., Matheson, K., & Anisman, H. (2009). Intergenerational trauma: Convergence of multiple processes among First Nations peoples in Canada. Journal of Aboriginal Peoples’ Health, 5(3), 6-47.

Chandler, M.J., & Lalonde, C. (1998). Cultural continuity as a hedge against youth suicide in Canada’s First Nations. Transcultural Psychiatry, 35(2), 191-219.

Chandler, M.J., & Lalonde, C. (2008). Cultural continuity as a protective factor against suicide in First Nations youth. Horizons – A Special Issue on Aboriginal youth, hope or heartbreak: Aboriginal youth and Canada’s future, 10(1), 68-72.

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REFERENCES CONTINUED

Population mental health promotion for children and youth is a collaborative project of the six National Collaborating Centres (NCCs) for Public Health. The NCCs work together to promote and improve the use of scientific research and other knowledge to strengthen public health practices, programs, and policies in Canada. A unique knowledge hub, the NCCs for Public Health identify knowledge gaps, foster networks and provide the public health system with an array of evidence based resources, multi-media products, and knowledge translation services.

This document was written and developed by the NCC for Aboriginal Health. Special thanks to our reviewers for their assistance.

Download this document, and others in this collection, at www.nccph.ca.

Please cite this document as: Atkinson, D. (2017). Considerations for Indigenous child and youth population mental health promotion in Canada. Canada: National Collaborating Centres for Public Health.

This publication was funded by the National Collaborating Centres for Public Health and made possible through a financial contribution from the Public Health Agency of Canada.

The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

ISBN 978-1-988833-09-5