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  • 1. The Healing Circle

2. Presented by the Supha Phonchiangkwang Substance Tracey Neal Triggers Amardeep Saini Intolerance Lara Blanks Generational Lois Hyatt Metis Aboriginals COALITION Group Project - PSYN 205-3 Substance Use/Misuse Psychiatric Nursing Practice - Theory. 3. The Healing Circle highlights substance abuse issues and culturally sensitive holistic treatment for North American Aboriginals. Substance abuse in some aboriginal communities is a complex problem requiring culturally appropriate, multidimensional approaches. The use of alcohol, illicit drugs and solvents is a serious problem among First Nations, Inuit and Mtis. This project explores the distinct aspects of Aboriginal generational issues, women and youth, impact & resources for families as well as contemporary and traditional healing methods to facilitate patient, family and community substance abuse education. Psychiatric Nursing values all aspects of health. The profession recognizes the complex relationships between emotional, developmental, physical, and mental health; the influence of social factors on physical and mental health and on illness; and the role of culture and spirituality in health promotion, illness prevention, and recovery. Psychiatric Nursing values equality and believes that persons with mental health and developmental challenges deserve access to high quality health services (Registered Psychiatric Nurses of Canada, 2010). 4. Background Knowledge of the European imposition of colonization is imperative to fully comprehend the resultant social dysfunction and destructive behaviours that plague many Indigenous communities in Canada. Along with European contact came the introduction of alcohol. It is notable that alcohol was one of the most important commodities in the fur trade and was also utilized as a negotiation tool which contributed to the downfall of the Native nation. Through the creation of the Dominion of Canada in 1867, Section 91(24) of the British North America Act established that the federal government of Canada was responsible for Indians and Lands reserved for Indians (Government of Canada, 2013). The Indian Act of 1876 introduced policy decisions across the board such as determining who was an Indian, managing Indian lands, resources and moneys, controlling the access to intoxicants and promoting "civilization." Amendments to the Indian Act became increasingly restrictive and imposed ever greater controls upon the lives of First Nations peoples including taking full responsibility for educating their children. 5. and disconnection roles among the residential school survivors i.e. lack of skills, knowledge, or emotional strength to parent their children Subsequent generation raised in families with chaos, substance abuse, and violence in children (they turn to alcohol, drugs or acting out as this is how they see their parent cope) 6. with higher levels of hopelessness and more prone to depressive symptoms which in turn predispose them to drinking to cope and ultimately makes them to excessive drinking (First Nations Alcohol Policies, 2012, p. 11) 7. This emotional vulnerability is termed as It is essentially different from drinking for a social motive such as conformity and enhancement. It reveals a pattern of drinking with stress, anger, frustration and depression; implying that alcohol abuse is used as an escape from reality (Mushquash, Stewart, Comeau, & McGrath, 2008, p. 46) 8. When one is emotionally competent, one is demonstrating ones self-efficacy in emotionally- eliciting transactions, which are invariably social in nature. And emotional literacy is in turn related with moral competency. 9. This program derives from traditional Aboriginal values The male population within our communities is asking for change and tools to make the change. It is the warrior that is standing up and declaring that he wants to contribute towards the solution 10. Prior to contact with European culture, First Nations people had tribal customary practices for providing mentor-like guidance for children and youth. The whole community contributed to raising children; everyone had a role to play in teaching the young. Children were regarded as a gift from the Creator and members of the community shared responsibility for their upbringing (Klinck, Cardinal, Edwards, Gibson, Bisanz & da Costa, n.d.). 11. Far too many Aboriginal youth experience a sense of hopelessness for the future because of the barriers and discrimination they face including cultural and social alienation, often existing in a world characterized by violence and racism. The rate of morbidity resulting from the use of illicit drugs is three times higher for Aboriginals than for the general population. For many the belief is that using drugs will alleviate the pain they experience in areas of their life that seem unbearable, which may ultimately make them more vulnerable to becoming high risk for suicide. Suicide rates are five to seven times higher for First Nations youth than for non-Aboriginal youth. Suicide rates among Inuit youth are among the highest in the world, at 11 times the national average (Health Canada, 2013). Suicide prevention generally involves finding ways to reduce risk factors, such as eliminating substance abuse, in promoting protective and preventive factors against suicide. 12. High levels of substance abuse in Aboriginal communities are most often generational. As a direct result children of parents who have a drug and alcohol addiction are almost three times more likely to be physically or sexually assaulted, and more than four times more likely to be neglected than children of parents who are not substance abusers. Children of substance-abusing parents suffer low self-esteem, depression, self-mutilation, suicide, panic attacks, truancy, and sexual promiscuity, and will replicate later in life the drug and alcohol abuse problems they witnessed in their parents (National Centre on Addiction and Substance Abuse, 1999). 13. Aboriginal youth are at a significant risk of becoming involved in substance abuse. Studies have shown that youth of First Nations, Mtis and Inuit descent are of the highest abusers of illicit drug use in Canada. This population is also over represented in courts concerning charges relating to drug possession and drug trafficking. In Canada there were approximately 7,500 Aboriginal youth admitted to either custody or probation in 2005/2006 (Tangient LLC., 2014). High crime rates in youth are frequently linked to substance abuse and a marginalized position in society. Other factors that may play a role in affecting a youths choice to abuse drugs are low levels of education, poor school attendance, family breakdown, lack of parental involvement and support in their daily lives. 14. The most important thing to me is to teach the children, so that our culture never dies Blackhawk SanCarlos, Mohawk and Apache Having identified some of the major issues affecting youth, the question is how to foster a more constructive dynamic for Aboriginal youth? Preventing substance abuse is a constant battle and without strong efforts from local communities and organizations that focus on substance abuse prevention nothing will change. As a community, everyone must work together to make changes by providing strong cultural and family supports. The main goal is to reconnect youth with cultural identity and regain a sense of belonging. In this environment the issue of substance abuse prevention can be more readily addressed. 15. As a substance abuse preventative measure, graphic recording is a holistic method that increases youth engagement and may be implemented by trained mentors, possibly with the inclusion of participants if so desired. During an event drawings are produced that parallel the discussion so as to allow visualization of the factors that make up a health promotion framework. It keeps participants focused, gives them a chance to reflect on whats happened, and helps them to remember and care about the ideas discussed. Delivered by mentors as a youth teaching strategy it is productive as well as an effective therapy disguised as fun. 16. During an event participants; See connections Highlight keynote speakers Focus participants Engage visual learners Gain a deeper understanding of the issues Give young people a space to congregate, engage with the visuals and each other (Bradd, 2014). 17. *According to Canadian Womens Health Network (2005), injection drug use is the main path of HIV transmission for Aboriginal women and that 65% reported AIDS cases caused by exposure to injection drug use (Prentice, 2005). * The rate of new HIV infection among Aboriginal women in Canada has been increased over the last two decades. * Aboriginal women account for 50% of all new HIV positive when compare with their non-Aboriginal people which is only 16%. The HIV infection occurs in Aboriginal women between age 15-29 years old (Prentice, 2005). 18. Aboriginal women are vulnerable gender and are twice as likely to be poorer than non-aboriginal women. They live to an environment where substance use and domestic violence are widespread. They are most likely to be using substances which place them at the highest risk for contracting HIV/ AIDS and hepatitis C (Prentice, 2005). Due to poor living environment and their vulnerability, Aboriginal women are more like to migrate from rural area to urban area, become homelessness, work in sex trade, and abuse alcohol and substances (Prentice, 2005). Aboriginal women who have been sexually and physically abused have low-self-esteem, have little access to education, are poor due to lack employment and they often abuse alcohol and illicit drugs as coping strategies and pain after the traumatic incidence(Prentice, 2005). 19. . 20. Substance abuse in some aboriginal communities is a complex problem requiring culturally appropriate, multidimensional approaches. Violence, abuse and harm to children are among the effects of abuse, the cost of which is paid by the community as a whole year after year (Jiwa, Kelly & Pierre-Hansen, 2008). The effects of colonization, residential schools, First Nations and Mtis land appropriation, Indian hospitals and child welfare intrusion continue to ripple through generations. 21. These effects include learned violence, loss of language, loss of emotional security and family connections, and a loss of respect for First Nations and Aboriginal culture. Many children of parents who attended residential school did not experience healthy role modeling and as a result, parenting capacity was often diminished over generations. Beyond the colonial experience, there are other more general risk factors for mental wellness among First Nations and Aboriginal people, such as family problems, unstable housing, school stress, or workplace pressures and substance abuse (NAHO, 2011). Efforts to decrease drug dependencies begin at the community level. 22. Community-based care: Community-based treatment emphasizes prevention, treatment, and after-care taking place in ones home community. The immediate benefit of community-based programs is that they might overcome many of the barriers to off-reserve residential programs. These barriers include fears of unknown larger centres and being away from work or family. A community-based approach to prevention, treatment, and aftercare programs attempts to address these factors by extending healing to the community level. 23. Honoring cultural relevance in community-based addictions treatment can allow individuals to be treated in familiar environments where they are surrounded by family and friends, thus promoting understanding of their illnesses within the communities they will rely on for post treatment support. These programs ideally cover prevention, harm reduction, treatment, and aftercare. 24. Community Mobile Treatment The community mobile treatment (CMT) model, developed in 1984, views substance abuse as a local problem that requires community-based solutions. The goal of CMT is to mobilize the community in order to heal the group as a whole. Changes in values and social structures require a cohesive understanding of what is deemed acceptable behaviour in the belief system of the community. 25. The program requires that a community first identify a need for intervention as well as a belief that change is possible. This approach often eliminates the need for people to leave their remote communities. They become focuses of community development, as the communities become the treatment facilities. Success requires solutions developed within communities, strong community interest and engagement, leadership, and sustainable funding 26. Prevention Education and Harm Reduction Cultural relevance is important in educational and harm reduction programs. Early approaches to prevention often included the belief that people informed of the risks of their behaviour would choose not to participate in activities with known harm. Strategies suggested include the following: sobering-up shelters, which provide a dignified alternative to placing intoxicated people in police custody, and night patrols and personal injury prevention initiatives. These types of policies in the county led to a reduction in motor vehicle collisions and a reduction in mortalities from both suicide and homicide (Homestead Schools, n.d.). 27. Family Therapy Substance use affects all family members. Family counselling can provide tools which assist the family to give up the enabling behavior patterns that abetted the client's substance dependence. Acknowledging the pain of family members can be empowering through addressing family interaction patterns that revolve around denying the problem, avoiding conflict, rationalizing abuse, and protecting the abuser. Relearning effective ways to communicate, express feelings, problem solve, and set limits is essential in order to create safe boundaries which address the issues that could escalate into a crisis. Family therapy will also address the needs of all family members, especially children who struggle with guilt, low self-esteem; fear, distorted perceptions, double messages, identity confusion, all-or-none thinking, and rules of don't think and don't feel. Overall culturally sensitive family therapy can empower the family to reformulate roles and responsibilities (Jiwa, Kelly & Pierre-Hansen, 2008). 28. Government programs: The Government of Canadas Aboriginal Portal has resources dealing with addictions. The Partnership for a Drug Free Canada is also running a nationwide drug prevention campaign. Additionally, Health Canada provides helpful information on drug prevention strategies for all Canadians. Focusing on prevention to address the sixty percent of illicit drug users who are 15 to 24 years old, the Canadian Centre on Substance abused has developed a five-year, $10-million national drug prevention initiative, A Drug Prevention Strategy for Canadas Youth. This Strategywhich is part of the federal governments National Anti-Drug Strategyaims to reduce illicit drug use by Canadian youth between the ages of 10 to 24 (Health Canada, 2012). 29. Aftercare Connectedness to ones cultural group helps in health and recovery. Post treatment success is highly dependent on the individuals environment after addictions treatment. The purpose of aftercare is to help people and their families or other loved ones along their healing journey and to return to positive community life. Successful aftercare in communities requires a long-term focus. 30. In order to design a sustainable program, capacity building and community ownership are crucial (NAHO, 2011). Support from family, peer networks, and friends, as well as access to housing, education, work, and opportunities to celebrate cultural identity, help support a person to be productive and connected to their community. Effective aftercare strategies include follow up by treatment providers; additional supports for people with co-existing mental health conditions; safe living conditions to support recovery; and support for people moving to urban centres or other communities (FNAAP, 2011). 31. Aboriginals believe that mind, body, emotions and spirit need to be in balance in order to have a healthy life (McCabe, 2008). Community contexts changed with colonization and omitted many of their healing traditions (Kirmayer, Simpson & Cargo, 2003). One example of changes in community context is residential schools (Kondro, 1998). Prisons is also another imposed idea that could be looked at as isolation from the community which may only increase negative self-talk and anxiety. Western culture has neglected the need for spiritual and emotional balance and practices to the point of some have disappeared altogether (McCabe, 2008). Traditional healing practices have been shown to rapidly reverse the effects of historical trauma (Schiff & Moore, 2006). Some practices aboriginals use in order to heal the mind, body, emotion and spirit are: medicine wheel, sweat lodges and story-telling (McCabe, 2008). 32. Healing Wheel The healing wheel consists of four directions of North, South, East and West in which each is connected to an aspect of the person and their condition: North is the mind/ receiving, South is the body/holding, East is the spirit / determining West is emotions/ giving. Each aspect of the wheel are the essential ingredients for activating the healing process (McCabe, 2008). McCabe (2008) gives an example in which we are not just people moving around through life reacting to impulses and hormonal signals, watching this presentation but also a more profound interaction with all mind, body and the dialogue of our spirit and emotions are also taking place. The Medicine Wheel can address the issues Aboriginal faces such as damage of their self-concept by colonization and oppression (McCabe, 2008). 33. Sweat Lodge The sweat Lodge is made in a dome shape to block out light and keep in heat. The sweat lodge is for physical and spiritual cleansing while some may also experience deep emotion, visions and may bring clarity (McCabe, 2008). Water and heat are universally known for their cleansing properties (Schiff & Moore, 2006). The sweat lodge is an experience that allows inner dialogue also a connection with the spirit/emotional dialogue. The sweat lodge encourages letting go of negative self-talk and feelings of anxiety (McCabe, 2008). Spiritual and emotional well-being of participants was directly attributable to the ceremony.(Schiff & Moore, 2006). 34. Story Telling Telling of stories became an expression of the healing itself. The healing was the story and the story became part of the healing (McCabe, 2008). Story telling can help make sense of our inner dialogue that helps remove blockages and integrate emotions with thoughts, especially the ones that about self. When someone tells a story, they are living it, or reliving it as a whole and not just partially. The expression of the event allows not only for releasing of negative thoughts but also allows listeners to be sympathetic or even empathetic to their experience (McCabe, 2008). 35. References Bradd, S. (2014). Writing about Visuals. Gathering Wisdom Visuals for a Healthy Future. Retrieved from: http://www.sambradd.com/gathering-wisdom-visuals-for-a-healthy-future/ Brown, L (2011). Creating Emotional Health and Well-being- Provincial Learning Circle Presentation. University of British Columbia. Retrieved from: http://learningcircle.ubc.ca/files/2011/03/Emotional-Health-Wellbeing-Dr.-Lee-Brown.pdf Chansonneuve, D. (2007). Addictive Behaviours among Aboriginal People in Canada. Aboriginal Healing Foundation. Retrieved from: http://www.ahf.ca/downloads/addictive-behaviours.pdf First Nations Alcohol Policies. (2012). Retrieved from http://nnapf.com/?wpfb_dl=9 First Nations Addictions Advisory Panel (FNAAP). Government of Canada, Minister of Health. (2011). Honouring o ur strengths : A renewed framework to address substance use issues among first nations people in canada. Retrieved from website: http://nnadaprenewal.ca/wp-content/uploads/2012/01/Honouring-Our-Strengths- 2011_Eng1.pdf First Nations Health Authority. First Nations Health Authority, British Columbia Ministry of Health and Health Canada. (2012). A path forward. Retrieved from website: http://www.fnhc.ca/pdf/FNHA_MWSU.pdf Health Canada. (2013). First Nations & Inuit Health. Suicide Prevention. Retrieved from: http://www.hc-sc.gc.ca/fniah-spnia/promotion/suicide/index-eng.php Homestead Schools (n.d.). Substance-related disorders. Retrieved from http://www.homesteadschools.com/Nursing/courses/Psych&Mental/Chapter05.html 36. Jiwa, A., Kelly, L., & Pierre-Hansen, N. (2008). Healing the community to heal the individual literature review of aboriginal community-based alcohol and substance abuse programs. Canadian Family Physician , 54(7), 1000. Retrieved from http://www.cfp.ca/content/54/7/1000.full Kirmayer, L., Simpson, C. & Cargo, M. (2003). Indigenous Populations Healing traditions: culture, community and mental health promotion with Canadian Aboriginal peoples. Australasian Psychiatry, 11S15. Klinck J, Cardinal, C, Edwards, Gibson, N, Bisanz, J. da Costa, J. (n.d.). Mentoring Programs for Aboriginal Youth. 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