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Indigenous mental health:

Exploring issues of culture,

assessment, and oppression

Dr. Suzanne L Stewart, C.Psych

University of Toronto

Territorial Acknowledgement

Chi Miigwetch /mahsi cho to the Ojibwe

Peoples:

Mississauga of the New Credit

First Nations

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Overview

This presentation will review psychological practices

related to assessment and treatment, parenting practices in

Aboriginal families, as well as the particular challenges

faced by Aboriginal youth:

the legacy of colonization: social determinants of health

Indigenous models of healings: hybrid-ism (Indigenous spiritual and western approaches blended or integrated)

Current issues in assessment and treatment in cross-cultural practice

Two reasons why mental health worker

should incorporate Indigenous mental

health into their practice:

1) There is a lack of knowledge and understanding

related to an Indigenous paradigm of health and

healing (and how it differs from Western health

and worldviews) by mental health care

professionals in the provincial health care

systems.

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2) Currently there is a health crisis in some

Native communities, yet there is an under-

use of health services by Indigenous

peoples. Also, Aboriginal parenting is often

evaluated from non-Aboriginal

perspectives which leads to

misunderstanding (minimally) or

persecution (at worst) in cross-cultural

contexts.

1) Lack of knowledge by

medical professionals

• Mental health care practitioners in Canada

have been faced with a dearth of

information relating to culturally

appropriate methods of assessment and

treatment with Indigenous populations.

– Psychological assessments

– Parenting assessments

– Cognitive assessments

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In the mental health care professions there is a need for more systemic exploration of health approaches and practices that are seen to be successful in today’s Indigenous communities, because most currently existing research and forms of treatment and assessment focus only on the health problems and not the health and healing solutions (see Alderete,

2002; Bohn, 2003; Royal Commission on Aboriginal Peoples, 1994; 1995; Waldram, Herring & Young, 1995; Young, 1998).

Differences in worldviews

Indigenous paradigm

• Collectivist orientation

• Non linear perspective

• Time orientation (general)

• Oneness with nature

• Holistic: spiritual, physical, emotional, intellectual

• Health/wellness focus

Western paradigm

• Individualist orientation

• Linear perspective

• Time orientation (specific)

• Humans against nature; hierarchical

• Dualism: Cartesian split

• Illness/disease focus

(Duran, 2006)

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2) Health Crisis & Under Use of

Services

The impact of colonization practices on

Indigenous health across Canada has been

summed up by as the destruction and

discontinuity of the structure of community,

and the transmission of traditional knowledge

and values, such as an Indigenous paradigm

of health and wellness (Kirmayer et al. (2000).

The legacy of colonization: social

determinants of health

As a result of colonial history, Aboriginal

people experience a broad range of health

issues, many of which lead Aboriginal

people to suffer from among the poorest

health levels in the country

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For example:

• Indigenous people in Canada have 1.5 times the national mortality rate and 6.5 times the national rate of death by injuries and poisonings.

• The suicide rate for Natives in Canada as a whole is 3 times the suicide rate of the non-Native population (Royal Commission on Aboriginal People,

1995).

• A deeper look reveals that, according to Health Canada (2003), in 1999, suicide and self-injury were the leading cause of death for Indigenous Canadians, accounting for 38% of deaths among youth and 23% of deaths for young adults.

• Indigenous groups in North America, like other international Indigenous peoples, have experienced profound disruption and destruction of their traditional ways of life through cultural contact and colonization practices of dominant western forces, i.e., Settler governments (Duran, 2006).

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• In Canada, this has involved various processes (from 1492 to present) including cultural assimilation tactics to destroy Native cultural identity & community by enforced Federal and Provincial government legislation through:

– relocation from traditional lands and confinement to reserves

– Parents and children (through many generations) suffering prolonged separation from family, culture, and traditional lands by forced placement in residential schools

– loss of control of self and community governance, including language, religion, land use, food sources, clan structure, etc. i.e., colonial rule

– gradual involvement in national and global economics

– historic and continued political and social marginalization

– more efforts too numerous to itemize

(Kirmayer et al., 2000).

• The health implications of this colonial history for communities and individuals include high rates (compared to non-Indigenous pops.) of:

– Grief and loss

– Depression

– Suicide

– Trauma

– Family violence

– Substance abuse

– Sexual abuse

– And more

(Duran, 2006; Health Canada, First Nations and Inuit Health Branch, 2003 Kirmayer, et al.,

2000; Waldram, 2004).

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HEALTH IS A POLITICAL CONSTRUCT, NOT A

BIOLOGICAL OR TECHNICAL PROCESS

(Shah & Stewart, 2011)

THE MAJOR DETERMINANTS OF HEALTH IN ABORIGINAL

COMMUNITIES POVERTY

RESIDENTIAL SCHOOL

LOW EDUCATIONAL ACHIEVEMENT

SUBSTANCE ABUSE

UNEMPLOYMENT

DEPENDENCE ON SOCIAL ASSISTANCE

EXPOSURE TO ENVIRONMENTAL CONTAMINANTS

DISCRIMINATION WITHIN JUSTICE SYSTEM

INADEQUATE WATER SUPPLIES AND WASTE DISPOSAL

POOR HOUSING QUALITY AND SUBSTANDARD INFRASTRUCTURE AND MAINTENANCE

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Aboriginal poverty

• 52.1% of all Aboriginal children are poor.

• 12% of all families are headed by parents under 25 years of age vs. 3% in the general population

• 27% of Aboriginal families are headed by single mothers vs. 12% in the general population

• Over 40% of Aboriginal families in urban areas are headed by single mothers

• 47.2% of the Aboriginal community

lives on less than $12,000 per year

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Indigenous models of health in

psychology: Hybridism

• What is Hybridism?

– Hybridism, in psychological service, is

bringing together the best of multiple differing

worldviews or practices to best meet the

client’s needs (Duran, 2007)

– Western psychology models + Indigenous

traditional practices

Indigenous mental health:

balance and harmony between and

within the four aspects of a person’s

nature, which are mental, physical,

spiritual, and emotional (Blue & Darou, 2005, Mussell,

Nichols, & Adler, 1993).

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Western Mental Health:

A state marked by the absence of

disease (DSM-IV)

(as defined by the health care system)

A holistic conception of health and healing should be used by mental health practitioners who are part of the health promotion movement.

-- Such a conception will serve to improve the disparity between the needs of Indigenous peoples and the largely Eurocentric systems of health care. The adoption and use of such a conception would also be an important step in the construction of a health literacy that includes an Indigenous perspective and worldview (see Stewart

et al, 2008).

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Holistic Approach?

• What this really means is paying attention

to SPIRITUALITY in counselling.

• Spirituality is the missing piece in a holistic

approach to psychological assessment

and interventions.

The Dze L. K’ant

Friendship Centre’s

model embeds practices

of “mental health

support” and “being in

sound mind” through the

acknowledgement of the

four aspects of each

person’s personal “will”

as depicted by the

medicine wheel (Dze L. K’ant

Friendship Centre Society, 2006).

Being of Sound Mind

Mental Health Support (Dze L. K’ant Friendship Centre Society, 2006)

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• Indigenous models and practices of spirituality in health and healing are based on and incorporate:

– Storytelling

– Advice from Elders

– Interconnectedness with family and community

– Healing circles (round robin, usually started by an Elder)

– Ceremony (sweet grass use, vision, quest, sweat lodge, drumming, sundance, and more) (Stewart, 2007)

– Use of traditional healers and medicines

These practices usually include involvement with local community, including Elders, traditional helpers, and those who wish to share traditional forms of helping and with medical professionals who make the invitation to incorporate Native methods

(See Blue & Darou, 2005; Duran, 2006; McCormick, 1996).

Implications for Psychological

Assessments Traditional parenting for Canadian

Indigenous peoples of North America shares

some common elements (vis a vis within

group differences): (West Kootenay & Boundary Aboriginal Resources, 2012)

• Children are a gift from Creator and hold

central importance in the community, total

respect is shown for the body/mind/soul of

the child

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• Belief in innate goodness and good

intentions

• Trust in the child's instincts without

burdening them with responsibility

• Respect for the child's personhood and full

inclusion and membership in the

community

• Simple acceptance of a child's feelings

and emotions

• Close physical contact by way of baby

carrying/family bed/massage

• Positive regard/listening/eye contact

• Teaching by example and gentle

encouragement

• Patience in the belief that no matter how

long it takes, a person will ultimately heal

or learn/faith in the process of growth

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• Mutual meaning (life is meaningful for the

same reasons ie: each other, the group,

family, spiritual practice, culture, mutual

work and play)

• Community participation and responsibility

in parenting

• Ceremony to mark the end of

infancy/young childhood

• Initiation/welcoming the adult

These common elements create a

relationship between parents, individual

differences in growth, child, and the

community that is mutually supportive. (West Kootenay & Boundary Aboriginal Resources, 2012)

In this environment a child is raised to be

compassionate, sharing, patient, reliable

and loving: This has been observed in

Indigenous communities worldwide. (West Kootenay & Boundary Aboriginal Resources, 2012)

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Community parenting (West Kootenay & Boundary Aboriginal Resources, 2012)

• The concept of community parenting is an

important implication to understanding

traditional parenting.

• Communities work together to raise

children.

Aboriginal cultures also contained traditions

that emphasized the sacredness of the

community and human relationship to the

whole.

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There are many traditions from hundreds of

cultures, such as The Sweatlodge, the

Sundance, the Potlatch or Giveaway, the

Pipe Ceremony and all the drumming,

singing, prayer and ceremony that

accompany them.

These are all tools that served to maintain

harmony, balance and connection. They

satisfy the human need to express big

feelings and to feel purpose. These are not

only important to the lives of children and

families, but necessary to maintain mental

health and wellness according to the

Indigenous paradigm of health.

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Western health as continued

oppression

• Some researchers and clinicians have

suggested that employing a Western

paradigm of practice with Indigenous

peoples is a form of continued colonial

oppression (see Gone, 2004, Battiste, 2002, Stewart 2008).

• What this means is that Native clients may

view Western mental health practitioners,

assessments, and treatments with mistrust

due to past or ongoing experiences of

colonial trauma or oppression.

Discussion Question:

How can we address this issue in our work

with clients?

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ALL Mental Health Workers and professionals involved in mental health information should be educated about an Indigenous paradigm of mental health and healing:

–training programmes & client services could contain a component on Indigenous models of mental health and healing that serves to identify the Indigenous paradigm (Duran, 2006).

This hybrid model of psychology supports the development of culturally-based and holistic models of health and healing as a positive alternative to the deficit models of health.

Lavallee and Clearsky (2006) note that current systems of health “define a deficit model of health approach whereby we, as Aboriginal peoples, are seen to be solely responsible for our health and healing” (p. 4).

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To be effective, mental health professionals should use or incorporate Aboriginal approaches with Aboriginal clients, including in assessments and treatment planning:

– A healing approach that includes a culturally based conception of health can contribute to new forms of mental health services that respond effectively to client needs created by the colonial history and social context of Canada’s Indigenous peoples (Blue & Darou, 2005).

Popularizing Indigenous models of health and healing could benefit everyone:

– Traditional knowledge, values, wisdom, and healing practices of Native peoples can be used not only to appropriately address and deal with community health dysfunction and healing, but as a model to serve non-Native populations, whose cultural assumptions and arrogance have historically overlooked and denied the strengths of an Indigenous mental health and healing psychology model (Kirmayer et al.,

2000).

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Moving forward: Children &

Youth

• For many Indigenous peoples there is

pain, loss, anger, shame and trauma

about the loss of culture and tradition.

• Residential school, the removal of children

into non-aboriginal homes, and the

outlawing of religious and cultural

expression added to the loss of the

ancestral land upon which those traditions

were supported has caused generational

disruption to the continuum of traditional

parenting.

• Indigenous parenting styles worked

successfully for tens of thousands of years

prior to contact and the colonial

destruction that followed.

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Healing from intergeneration

traumas is a focus for children,

youth, and families.

According to my research

(see Stewart 2009, 2010, 2011, 2012)

• Youth experience low levels of educational

attainment and achievement, high rates of

unemployment, high risks for incarceration

or homelessness, and high risks for

poverty.

• Most youth express a strong desire to

attend post secondary education.

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Strengths of youth:

• Strong connections to culture, family, ad

community

• Desire to work toward goals of individual

and community healing

• Have access to strong models and

mentors in their communities

Challenges for youth:

• High levels of racism and systemic

oppression in all contexts

• Migration to urban areas with not enough

services and resources

• Lack of cross cultural competency by

those servicing youth (teachers,

counsellors, mental health services, etc)

• Mental health and addictions

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Conclusions:

• Psychological assessments and

interventions must be culturally responsive

and competent in order to have validity.

• This means that without attention to

Indigenous culture at multiple levels of the

process (assessment tools, clinician

cultural competency, contextual results

interpretation, consultation with Aboriginal

community and knowledge keepers, etc.),

the outcomes and recommendations will

be ineffective and possibly detrimental.

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Discussion and Closure

• What did you find useful in today’s

presentation?

• What have you learned that will change

how you view and practice of working with

Indigenous peoples?

Chi Miigwetch

Mahsi Cho

suzanne.stewart@utoronto.ca

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References

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Assembly of First Nations. (2002). Top Misconceptions About Aboriginal Peoples. Retrieved December, 15, 2005, from http://www.afn.ca.

Blue, A. W. (1977). A study of native elders and student needs. US Bureau of Indian Affairs Education and Research Bulletin, 5, 15-24.

Blue, A. W. & Darou, W. (2005). Counseling First Nations peoples. In N. Arthur and S. Collins Eds., Culture-Infused Counselling: Celebrating the Canadian Mosiac, pp 303-330. Calgary, AB: Counseling Concepts.

Duran, E. (2006). Healing the Soul Wound. New York: Teachers College, Columbia University.

Duran, E. & Duran, B. (l995). Native American postcolonial psychology. Albany, NY: State University of New York Press.

Dze L K’ant Friendship Centre and Society (2006). Medicine Wheel Model for Mental Health. Retrieved September 10, 2006 from http://www.bcaafc.com/centres/smithers/Mental.html

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994).Washington D.C.: American Psychiatric Association.

Government of Canada. (1991). Agenda for First Nations and Inuit Mental Health. Retrieved May 01, 2005, from http://www.hc-sc.gc.ca/fnih-spni/pubs/ads/literary_examen_review/rev_rech_6_e.html

Health Canada, First Nations and Inuit Health Branch. (2003). A Statistical Profile on the Health of First Nations in Canada. Retrieved May 15, 2005 from www.library.ubc.ca/xwi7xwa/stats.htm

Health Canada, Health Promotion (2006). Mental Health Promotion For People With Mental Illness. Retrieved 01 November , 2006 from http://www.phac-aspc.gc.ca/publicat/mh-sm/mhp02-psm02/1_e.html

Johannes, C. K. & Erwin, P.G. (2004). Developing multicultural competence: Perspectives on theory and practice. Counselling Psychology Quarterly, 17, 3, 329-338.

Kirmayer, L. J., Brass, G. M., & Tait, C. L. (2000). The mental health of Aboriginal peoples: Transformations of identity and community. Canadian Journal of Psychiatry, 45, 7, 607-617

King, J. (1999). Denver American Indian mental health needs survey. American Indian ,Alaska Native Mental Health Research, 8, 3, 1-12.

Lamarche, P. A. (1995); Our Health Paradigm in Peril. Public Health Reports, Vol. 110. Retrieved September 10, 2006 from http://www.questia.com/PM.qst?a=o&se=gglsc&d=5002244683&er=deny

McCormick, R. D. (1996). Culturally appropriate means and ends of counselling as described by the First Nations of British Columbia. International Journal fore the Advancement of Counseling, 18, 163-172.

Mussell, W. J., Nichols, W. M., & Adler, M. T. (1993). Meaning Making of Mental Health Challenges in First Nations: A Freirean Perspective, 2nd Ed. Chilliwack, BC: Saltshan Institute Society.

Stewart, S. (2007). Indigenous Helping and Healing in Counsellor Training. Centre for Native Policy and Research Monitor, 2, 1, 53-62.

Stewart, S. (2008) Promoting Indigenous mental health: Cultural perspectives on healing from Native counsellors in Canada. International Journal of Health Promotion and Education, 46, 2, 49-56.

Stewart, S., Riecken, T., Scott, T., Tanaka, M., & Riecken, J. (2008). Expanding health

literacy: Indigenous youth creating videos. Journal of Health Psychology, 13, 2, 180-189.

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Waldram, J. B. (2004). Revenge of the Windigo: The Construction of the Mind and Mental Health of North American Aboriginal Peoples. Toronto: University of Toronto Press.

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West Kootenay & Boundary Aboriginal Resources. (2012). Talking Little Feet. Retrieved October 15, 2012 from

http://www.talkinglittlefeet.com/parenting.html#foundation

Children’s Voices have Power

Cindy Blackstock, PhD

First Nations Child and Family Caring Society

Associate Professor, U Alberta

Advocate’s Society : November 22, 2012

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I am profoundly disappointed to note

in Chapter 4 of this Status Report that

despite federal action in response to

our recommendations over the years,

a disproportionate number of First

Nations people still lack the most

basic services that other Canadians

take for granted.

Sheila Fraser,

Auditor General of Canada

(June 2011)

“

“

Comparing Services for children off and on reserve

Off Reserve On Reserve

64 Percent of Canadians believe First Nations receive TOO

much support from the Federal Government (Ipsos-Reid, 2012)

Negligible

non profit

Indian Act

restricts

economic

development

Fed and

Band only Fed, Prov,

Municipal

2400 per Canadian

in public funding

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6722 Supporters

www.jordansprinciple.ca

A child first principle for

First Nations children to

resolving payment

disputes between the

federal and provincial

governments about how to

pay for services every

other child gets

Jordan’s

Principle Jordan River

Anderson Founder of Jordan’s Principle

1999-2005

“Although we have not

found …situations

where the federal

government has been

found liable because of

child fatalities or critical

incidents relating to

failure to provide

necessary medical

services, we believe that

they exist and that,

unless solutions are

found, they will continue

to occur” INAC document on Jordan’s Principle

obtained through Access to Information

(002474) Likely dated 2006/2007

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Maurina Beadle and Pictou Landing FN v Attorney General of Canada

• Maurina Beadle and Pictou Landing taking Canada to court to enforce Jordan’s Principle for Jeremy and all FN children across Canada

• Federal Court hearing in Halifax: June 11, 2012

• Court docs on jordansprinciple.ca

First Nations in State Care in Canada

*estimates. FN children 6-8 more times likely to be in foster care (Auditor General of Canada, 2008)

Res. School 1870-1996

Child Welfare 1955- Present

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“circumstances are dire….as a consequence of providing inadequate prevention resources, it is foreseeable that civil proceedings could be initiated against the Government of Canada as a result of neglect or

abuse of children in care” Government of Canada document obtained under Access to Information

The I am a witness Campaign

• Human Rights case alleges Canada racially discriminating against First Nations children by providing inequitable child welfare services.

• The most formally watched legal case in Canadian history

11,152 Supporters

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Discrimination and Service

Canada not successful in getting case dismissed on service matter in Tribunal

ruling 2011

Hearing on discrimination and service set to begin at Tribunal on Sept. 25,

26, 2012

Comparator

Tribunal dismissed case on comparator March

2011

Federal Court overturns decision April 2012

Canada appeals to Federal Court of Appeal

Broadcasting

Tribunal refused broadcasting at Canada’s

request

Federal Court overturns decision in 2011

Tribunal allows broadcasting

Issues and levels of decision making

Human Rights Tribunal Process

Complaint filed

Canadian Human Rights Commission refers complaint to

tribunal

Hearing begins and then derailed by new

tribunal chair and INAC motion to

dismiss

APTN motion to broadcast- Canada

opposes

Canada’s Motion to dismiss on funding not a service issue

Mandamus application filed Tribunal dismisses case on

comparator

Federal Court overturns Tribunal decision (April

2012)

Feds appeal to Fed Court of Appeal but Tribunal proceeds

February 2007

March 29,

2010 Hearings begin: Feb 15, 2013

September 30,

2008

September 14,

2009; Dates

vacated Nov 6,

2010

March 2011

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Parties to the Child Welfare Case Complainants and interested Parties in support of full hearing on discrimination

• Assembly of First Nations

• First Nations Child and Family Caring Society

• Canadian Human Rights Commisssion

Interested Parties:

Amnesty International

Chiefs of Ontario

Respondent

• Attorney General of Canada representing the Government of Canada

• No interested parties have supported the government’s position s

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Jordan’s Principle

Take Action: Reconciliation does

not happen without you!

www.fncaringsociety.com

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Direct - Indirect

Expressive - Restrained

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Concrete - Abstract

Linear - Circular