Editor’s note: Canada’s Indian Residential School Survivors and Family Crisis Line is available 24 hours a day at 1-866-925-4419.
Despite efforts made by governments to aid Indigenous mental health services, some community members are still reporting inadequate mental health care.
Intergenerational trauma, colonization and the residential school system all play a role in the mental health of Indigenous peoples. However, these aren’t the only factors. Indigenous mental health is a complex subject matter with many nuanced components. With the discovery of thousands of unmarked graves from former residential schools, these wounds are being reopened or deepened for many First Nations, Métis and Inuit communities across Canada.
Through government programs and grants, the Alberta government is attempting to work towards reconciliation. But inaccessibility, denials of benefits and inadequate services often put a damper on these efforts.
A number of Indigenous peoples and mental health professionals were interviewed for this article. They shared their diverse experiences and offered perspectives on how to better work towards appropriate mental health measures.
One common belief is that Indigenous peoples can build off of their resilience and strength through Indigenous-led mental health services.
Steve Kootenay-Jobin, Mount Royal University’s Indigenous housing and events coordinator and a member of the Iyahe Nakoda Nation in Treaty 7 Territory, said that when his uncle was diagnosed with paranoid schizophrenia, his family struggled for assistance due to a lack of resources and programs for Indigenous mental health.
Thirteen years ago, when Kootenay-Jobin was 19 years old, his grandmother passed away. Since his grandmother was his uncle’s primary caregiver, there was a void of care that needed to be filled.
“No one from my family could really take him on, and there’s a lack of resources and programming on reserve for mental health and mental illnesses,” he said. “So my uncle really didn’t have much of an option of where he was going to go.”
“It was either he had to go to a place with no resources or supports or to possibly be placed in a live-in situation in a program for persons with mental illnesses,” he said.
Growing up close to his uncle, Kootenay-Jobin’s uncle moved in with him in 2008 and he bravely took on the role of his caregiver.
One place where Kootenay-Jobin and his uncle found solace was the Elbow River Healing Lodge, which is Alberta’s first Indigenous primary care clinic in an urban centre.
The healing lodge is located downtown and is funded by Alberta Health Services but requires referral to be placed on the waiting list.
Kootenay-Jobin said that lodge is so effective because it combines Indigenous cultural practices and spirituality with western medical models and methodologies.
“It creates a sense of safety. It creates a sense of support,” he said. “They’re also able to provide their staff with training to be culturally sensitive, because as Indigenous peoples, we’re always battling against different stereotypes and things that we’re trying to overcome.”
The Elbow River Healing Lodge’s structures and supports are something that Kootenay-Jobin said should be modeled across the country.
He said that prior to finding appropriate care his uncle met with several different medical professionals that failed to manage his schizophrenia.
“It was always just assigning different prescriptions and increasing the injections here and there,” he said. “There was never really that time to get to know my uncle or that time to get to understand my uncle.”
The lodge uses the approach of including the entire family in the treatments. Kootenay-Jobin said with him and his family invited into the appointments, his uncle is now able to manage his schizophrenia to a point where they’re seeing significant change and fewer episodes.
“[It’s about] bringing in the whole family and recognizing that wellness for us as Indigenous peoples isn’t just based on a western medical model,” he said. “It’s our families. It’s our communities. It’s our bodies. It’s how we’re feeling emotionally, physically, mentally and spiritually.”
Another method used by the Elbow River Healing Lodge is home visits to administer medication, provide injections and drop off medication refills. He said the nurse then sits with his uncle for around half an hour to converse and ask questions to learn more about his history, background and struggles.
“If they notice anything off, they’ll connect with me or my mother and ask if we’ve noticed anything,” he said. “But they take that extra time to get to know my uncle so they could see him as a person and not just a patient, but in getting to know him as a person, they’re able to better support him as a patient and recognize when things aren’t going well.”
Kootenay-Jobin said that when they were first offered home visits, they also offered to send medications by delivery or provide bus tickets for his uncle to get to the clinic. He said that was the first time he realized how different the lodge is.
“It’s just so insightful when you could sit down with someone and they have similar experiences to you,” he said. “It’s really hard to sit across and share your true thoughts, feelings and experiences with individuals who have never walked a mile in your moccasins.”
Scholars have offered insights into providing culturally appropriate healthcare.
A 2017 critical review of research on the mental health of Indigenous peoples in Canada states that “research from around the world strongly indicates that we should be cautious in drawing conclusions about the prevalence of mental illness without taking colonial processes and structures into account.”
Sarah Nelson, one of the primary researchers of the 2017 study, said there’s a lot of important work being done on bringing Indigenous concepts and Indigenous practices into mental health services.
“Something that we really found in a lot of studies related to mental health services is that when the particular community is involved in designing and planning the services, then those mental health services tend to have better success,” she said.
However, not everyone has found the same success with Alberta’s Indigenous mental healthcare system.
Veronica Headley, a member of the Yellow Quill First Nation, grew up in Alberta. She was separated from her birth mother due to her mother’s struggle with mental health and alcoholism stemming from her time in the residential school system. Headley was then placed into foster care and adopted at six months of age.
As a BIPOC rights activist and co-founder of the United Black and Indigenous Athletes Association, Headley said that the first step is to acknowledge the reasons Indigenous peoples need mental health services and what barriers exist in access.
In searching for mental health support, Headley said she was given a list of approved mental health professionals by Non-Insured Health Benefits that would be subsidized by the government.
Non-Insured Health Benefits is a federal program dedicated to providing health benefits for First Nations, Inuit and Métis clients that are not covered under social programs, private insurance plans or provincial or territorial health insurance.
Headley said that the process of obtaining this list was difficult and made her benefits hard to access. When she did eventually gain access to the list, she said she was disappointed.
“Only one out of maybe 60 or 70 that were given to me was either Indigenous or a visible minority,” she said. “You’re not going to go and talk to a white therapist about intergenerational trauma and about residential schools to someone that has no idea what that even feels like.”
Eventually, Headley sought out a therapist outside of the list she was given who she thought met the criteria for her health benefits but was then told that person did not meet the requirements and she would have to pay out-of-pocket for her treatment.
“Those rules are really not even available on their websites at all. You’d have to phone and ask specifically and it’s really kind of sneaky,” she said. “I’ve actually had to stop seeing someone until I can find someone that’s going to be either approved for reimbursement or maybe the list is going to be updated.”
The Calgary Journal reached out to the federal government for an interview about these claims. In response, a spokesperson for Indigenous Services Canada sent an email statement.
“As of September 2021, there were 3,128 mental health counselling providers registered with the NIHB Program, with a fee-for-service billing agreement. Of these, 430 voluntarily self-identified as Indigenous on their billing agreements. Eligibility to enroll is not limited to Indigenous professionals. Clients can contact their regional office to find out about an enrolled provider in their area, including factors such as Indigenous identity and areas of expertise reported by the provider.”
Research supports the unique needs of Indigenous peoples and the need for culturally appropriate care.
One 2019 study about expanding Indigenous health practices with Alberta Health Services suggests that Indigenous mental health differs from traditional western mental health because “Indigenous people have unique health needs that require culturally appropriate holistic care that addresses physical, mental, emotional and spiritual health.”
Jazmine Drost, the author of the study, suggests five sub-themes of appropriate care: enhancing cultural competency and safety training among leadership and employees, adhering to tradition and protocol, establishing meaningful partnerships, strengthening organizational facets of program delivery and need for additional financial, human and logistical resources.
Experts in the medical field echo these perspectives on the need for Indigenous providers within the public health care system.
Cayla Gilbert, a Métis rural family doctor based out of Ponoka, said the key to good healthcare is to be trauma-informed and culturally competent.
“You need to have those understandings of the historical trauma and the individual trauma and be willing to meet people where they’re at,” she said. “It’s somewhat easier to do when you have that cultural connection as an Indigenous person myself.”
She adds that it is vitally important to have Indigenous-led mental health services available to Indigenous communities despite the medical model catering typically to non-Indigenous methodologies.
“There’s lots of room in traditional medicine for western medicine, but there’s not always a lot of room in western medicine for traditional medicine,” she said. “We do sometimes get boxed in our thinking and it’s really important not to let that happen.”
Gilbert said she intentionally works to incorporate her patients’ experience with traditional healing and practices.
“It is so important for their mental health,” she said. “And I often recommend that they connect with elders and they connect with their culture.”
Other medical experts in different fields share similar sentiments.
Caroline Tait, a Métis medical anthropologist in the department of psychiatry at the University of Saskatchewan, co-founded the Indigenous Peoples’ Health Research Centre in 2004.
Tait said that the model of psychiatric care is to pinpoint a diagnosis as efficiently and effectively as possible. However, she adds that acknowledging pain outside of a physiological imbalance by looking at the whole person and their experiences is a more beneficial method.
Mental health providers “see that they’re treating a patient and not that they’re treating an Indigenous patient,” she said. “There’s trust levels and people feel very uncomfortable talking to people who they feel may judge them or not take them seriously.”
Tait said that many successful government programs aimed towards Indigenous communities are closed or ended when new governments come into power.
“The Aboriginal Healing Foundation made enormous inroads into helping people cope with mental illness, cope with addictions and move into a meaningful life where they had steady employment and were breaking generational cycles of addiction,” she said. “But during the Harper government, the healing foundation’s mandate was completed.”
In 2014, the Aboriginal Healing Foundation closed after 16 years of operation. The move followed cuts from the Conservative government in 2010. The foundation shut down despite having funded more than 1,500 projects and despite the department recommending it continue.
Similarly, the National Aboriginal Health Organization was closed in 2012 after 12 years of operation as part of a federal budget cut.
“This is not uncommon that you see Indigenous peoples addressing these very complex issues such as addictions, mental illness, trauma or intergenerational trauma and just about the time that we have significant momentum, it’s about the time that they cut things,” Tait said.
Despite previous federal government programs coming to an end, one new provincial government program was announced in July 2021.
The Alberta government promised $2.8 million towards Indigenous-led mental health efforts through the new Residential School Mental Health Support Grant Program.
This program allows First Nations, Métis Settlements and the Métis Nation of Alberta to apply for funding for “counselling services and traditional healing practices such as talking circles for individuals, families and communities affected by Canada’s residential schools and the ongoing tragic discoveries of children’s remains,” the Alberta government press release states. Grants were available for up to $50,000.
To better understand the work that is being done by the Alberta government, the Calgary Journal requested an interview with Mike Ellis, associate minister of mental health and addiction, regarding the grants and where they have gone so far.
In response, Eric Engler, the press secretary for the associate minister’s office, said the program has had 23 applications. Three grants have been “fully executed,” two have been rejected and the rest are still being evaluated. Engler said they could not offer further details due to privacy issues, especially given the sensitivities around residential schools and intergenerational trauma.
Despite complex and urgent challenges with the mental health system, Tait said it is important to recognize the strength and resilience of the Indigenous peoples.
“There is a huge amount of hope and people tend to want to focus on how bad things are, but things are really good in many ways,” she said. “That strength and that resilience comes from within the communities themselves, within the families and within the individuals who are fighting every day.”
Adding on to that notion, Steve Kootenay-Jobin, whose uncle is a patient at the Elbow River Healing Lodge, said that moving forward is about unity.
“One-on-one we need to heal as a community. We need to heal as a nation and it’s not only Indigenous peoples that need to heal from this colonial past. It is Canada as a whole.”