Post on 03-Jan-2021
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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