Exploration of Existing Integrated Mental Health and Addictions Care Services for Indigenous Peoples in Canada
2.1. Recruitment and Sample
2.2. Design and Procedure
3.1. Qualitative Data
3.2. Lessons from Existing Integrated Care Programs
Real Commitment to Communities and Community Involvement
“[Our treatment centre] began in 1976—four First Nations people from X and Y communities met to discuss alcohol problems of our people. They felt that the single biggest problem was the lack of alcohol and drug treatment centres. They organized, developed a proposal and lobbied for funding.”(A4).
“I think one thing that a lot of treatment centres work towards is aftercare. […] Before we’d hear [from clients in therapy], “I don’t want to go back home, I’m not comfortable at home. I’m not comfortable to go back into that environment. […] But it would be nice to have more programs that would take clients coming right from treatment. And maybe they’ll see them for two months and maybe, you know, help them get back onto the job, and help them establish healthy [habits] or move back to school.”(A8).
“We have a Board of Directors, sometimes I would say—and everyone who’s on our board is in sobriety; some of them have been on a long time, a lot of them are what you would consider Elders.”(A5).
“I am the Treatment Director […] I’m a former client of the [counselling centre]. Back in 2009, they were a reconciliation program because of the Indian Day Schools, the Residential Schools. So I went through the program […] I do like using my story because clients will ask me ‘how did you do it?”(A7).
“We’ve gotten feedback from clients, staff, and referral agents, from court, personal liaisons […] So we’ve really gathered a lot of feedback over the last few years to see if what we’re doing is working and where our needs are. As time has moved on, so have the needs of the individual.”(A1).
3.3. Tensions and Disjunctures within Integrated Care
3.3.1. Culture as Healing
“We are a First Nations treatment Centre serving mostly First Nations people and are grounded in the First Nation’s cultural values of respect and honour for all living things.”(A4).
“But we quickly found out that there was something under all of this [alcoholism and addictions], which is from unresolved trauma and colonization, and not feeling good enough and not feeling like they belong because of the disconnection that happened due to the residential schools and scooping our children and taking away our ceremony and banning our languages and keeping us little tiny plots of land, and not letting us live with the land and function in a way that we normally do.”(A5).
“We find that with the [cultural programming], people can adapt to it more—they understand it better. Because they’re able to connect with it, especially if it’s an Elder talking about parenting and stuff like that. They’re going to adapt to it more if an Elder is speaking rather than someone coming and giving a workshop. That kind of thing. [With the Elders], there’s a lot more respect as well.”(A8).
“Some communities have even banned some of the cultural ceremonies and practices which were traditionally part of their territory. When individuals from those communities that have banned or outlawed these types of ceremony come to the centre, I notice that they’re really hesitant.”(A1).
“So we try to incorporate our language into some of the programs; it’s really hard because some of [the clients] have a ‘mental block’ into trying to speak our language again. I think in some ways, it has to do with colonization and in some ways, some of the people have almost lost our native tongue, and it’s hard to pronounce the sounds properly.”(A6).
“One of the programs that we’ve recently introduced in these past few years is the Circle of Security Parenting Program, but we’ve adapted it to [the community’s] values…”(A2).
“And we’d also have cultural aspects of First Nations: sharing circles, healing circles.”(A9).
“So part of the program we have is that we integrate an “on the land” component by arranging for a retreat outside of [the city]. We use an [equestrian retreat] and we integrate equestrian therapy as well as camping, fire, hikes, those sorts of things to try and mimic what our connection to the land or ‘on the land’ learning would look like in an urban context.”(A3).
3.3.2. People-Focused vs. Practitioner-Focused Programs
“[Clients] have the choice to choose the change.” And if they don’t want to change, then they’re stuck. If they make that change, they’ll give themselves wings and look at themselves as birds on a wire.”(A7).
“One of the things people always ask me is ‘how successful is your program?’ and I say ‘tell me what you call success? How are you measuring success?’ I think if someone’s life has improved from walking through our doors, whether they stay an hour, a day, a week or complete our program, if something has improved in their life, then I think for them its successful.”(A5).
3.3.3. Community-Oriented vs. Individual-Oriented Programs
“We developed this whole program based on treating the whole family; it was never just like take the one person that’s drinking, it was like the whole family was looked at in needing support and help.”(A2).
“We also provide a Colleagues Program for individuals who work with First Nations […] Its focus is addressing the effects of intergenerational trauma and the impact of unresolved trauma and shame on our people.”(A4).
3.3.4. Colonial Power Dynamics in Integrated Care
“The person going through treatment maybe got a low educational level, and the language […] It’s like that can be a barrier where… How do you sort of address that if the understanding is not there?”(A9).
“How do you make [topics like neuroscience] understandable and translate it to people who are just making it day-to-day, people who have been using substances… How do you make them really get it?”(A2).
“A lot of the psychologists and psychiatrists and social workers for that matter don’t understand what happened to us! […] And so then they try to impose their views like there’s something flawed about us.”(A2).
“Right now, something that I’m actively working on is creating a guidance system for our staff, our clients, our partners on Inuit Qaujimajatuqangit (Inuit Knowledge). […] And I think it’s especially important if you’re in an organization where 100% of staff are not Indigenous.”(A3).
“You know what, I’m always teaching. Especially in circles where there’s settlers. The reason I do that is because sometimes it’s just ignorance and they don’t have a clue […] I truly believe that our people know how to heal.”(A5).
“Always working from a budgetary approach—the way the government does—really does limit us. There’s always more things that we want to do moving forward, there are a lot of great ideas that we have as a team, but we are always limited in terms of dollars.”(A1).
“[The healing centre] operated for a few years, and then we lost funding […] the program completely had to shut down, and it was very very difficult for the community to go through that. It was traumatic to both staff that were working at the healing centre and clients.”(A3).
4.1. Placing Our Study Findings in Theory and History: Why Do These Tensions and Disjunctures Exist?
4.2. What Is Next? Drawing on Integrated Care’s Lessons to Move towards IND-Equity
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Wu, J.; Smye, V.; Hill, B.; Antone, J.; MacDougall, A. Exploration of Existing Integrated Mental Health and Addictions Care Services for Indigenous Peoples in Canada. Int. J. Environ. Res. Public Health 2023, 20, 5946. https://doi.org/10.3390/ijerph20115946
Wu J, Smye V, Hill B, Antone J, MacDougall A. Exploration of Existing Integrated Mental Health and Addictions Care Services for Indigenous Peoples in Canada. International Journal of Environmental Research and Public Health. 2023; 20(11):5946. https://doi.org/10.3390/ijerph20115946Chicago/Turabian Style
Wu, Jasmine, Victoria Smye, Bill Hill, Joseph Antone, and Arlene MacDougall. 2023. "Exploration of Existing Integrated Mental Health and Addictions Care Services for Indigenous Peoples in Canada" International Journal of Environmental Research and Public Health 20, no. 11: 5946. https://doi.org/10.3390/ijerph20115946