Reprinted from "Aboriginal People" issue of Visions Journal, 2008, 5 (1), p. 9-10
Aboriginal peoples in British Columbia and other areas of Canada face unique difficulties accessing mental health and addictions services. This is having negative effects on the mental health of Aboriginal people, their families and their communities. In addition, the overall mental health status of Aboriginal people in Canada is poorer than that of non-Aboriginal people by almost every measure.1
Providing responsive mental health and addictions services that fit for Aboriginal peoples is of major concern to community-based leaders in Aboriginal health. This is also a concern for Vancouver Coastal Health (VCH), researchers and members of the primary health care sector. Because of this concern, these groups came together to conduct a three year study (2006-2009), now in its final year.
Seeking to improve Aboriginal people’s access to care
The goal of the study is to understand how to improve mental health and addiction services so they are more responsive to the needs of Aboriginal people. The objectives of the study are:
to explore Aboriginal clients’ experiences of existing mental health and addictions care
to explore, from the point of view of Aboriginal clients, how experiences with mental health and addictions services shape the way they use those services
to explore, from the point of view of mental health and/or addictions service providers, the factors that shape how they provide care
to analyze the experiences of both the providers and the clients, while considering the social, cultural, political, economic and historical factors that shape the way mental health and addictions services are provided
to use the findings of the study to come up with recommendations about how to provide mental health and addictions care to Aboriginal people that is experienced as culturally safe and effective
To meet these objectives, we conducted in-depth individual and focus group interviews. Aboriginal clients who use mainstream and other mental health and addictions services were interviewed, as well as health care providers working in those settings. We also examined guidelines and policies of the organizations where we conducted the research.
Historical, political and social awareness is crucial
The findings of this three-year study point to the importance of recognizing and addressing the social, economic, political and historical factors that shape health and health care—to support Aboriginal well-being.
Most of the people interviewed in this study have profound histories of abuse. For many people, the abuse started in early childhood and continued into adulthood. Abuse and violence is most often the result of colonizing policies and practices (e.g., residential schooling).
Many people noted how their lives have been profoundly affected by the trauma enacted on Aboriginal peoples when children were forcibly removed from their homes to attend residential schools over a 150-year period. Although some people did not actually attend residential schools themselves, they were affected by the trauma experienced by their parents and grandparents (intergenerational trauma).
Not surprisingly, many of the people we’ve interviewed expressed a lack of trust, respect and safety connected to lifelong trauma. Unfortunately, these feelings are sometimes re-created, often unwittingly, by policies, services and practices within our health care system. This is what Paul Farmer describes as “structural violence.”2
As one female participant in the study noted, “I shared a room with a guy [in the hospital] . . . then on the other side of the corridor, a friend of mine . . . is in the hospital too and she’s sharing that room with a guy. Like why didn’t they put us together?” This woman, who had experienced abuse and ongoing violence in her life, was retraumatized when she had to “share a room with a guy” in the hospital setting—now a common practice in hospitals in BC.
This example caused us to ask, Who shares a room with a guy and what impact does that have for those people with abuse histories (female or male) or for those people whose beliefs conflict with such a practice? This particular woman didn’t feel she had the power to refuse to share a room—she was near homeless (impoverished), drug addicted, living with a mental illness and extremely ill. Policy makers need to reflect on the impact of policies such as ‘co-ed rooms’ in hospitals.
In another example, a male participant in the study describes his experience as follows: “Within the system there is some prejudiced people in there and I try not to get too mad with them when I find out that they’re prejudiced. They don’t like Natives and they don’t like drug addicts.” Several participants in the study described experiences such as this, where they weren’t sure why they were being treated badly. Was it their drug addiction, being Native, being HIV+, being homeless or the fact that they had a mental illness that created the tension?
Race, class, gender, ability and so on can intersect to create a powerful oppressive force within systems of care. Health care providers need to reflect on the ways that their own attitudes and beliefs may impact the way they treat clients in these settings.
In a third example, a woman describes her living conditions: “There must be something wrong with me. I won’t go shower, I take sponge baths in my room . . . the hotel is so skungy . . .” This woman, like many others in the study, is living with a mental illness, drug addiction and HIV illness. She’s afraid to use the bathroom she shares at the hotel where she lives because it’s so dirty—she’s afraid of catching something.
Most participants in this study are homeless or near homeless. The lack of safe housing in BC poses a serious threat to the safety and well-being of this client group. Housing is not adequately addressed within mental health and addictions systems of care.3
Many factors influence safe and effective care
These examples are not intended to suggest that Aboriginal people don’t have positive experiences with health care and good outcomes. Rather, they are intended to point out the risk of not taking into account all the issues that influence health and health care—peoples’ histories, poverty, racism, discrimination, stigma and so on. Social and political awareness needs to inform how health care is thought about and delivered, to ensure policies and practices are safe and effective for all people.
About the authorVictoria is an Assistant Professor in the School of Nursing at the University of British Columbia. She holds a New Investigator Award from the Canadian Institutes of Health Research
Acknowledgements:This study was funded by the Canadian Institutes of Health Research (CIHR). Our research team members in alphabetical order include Evan Adams, Annette Browne, Betty Calam, Nadine Caplette, Nancy Clark, Tanu Gamble, Elliot Goldner, Peter Granger, Lorna Howes, Barb Keith, Doreen Littlejohn, Bill Mussell, Perry Omeasoo, Sri Pendakur, Ron Peters, Patricia Rodney, Tej Sandhu, Colin vanUchelen, Leah Walker, and Diane Woodhouse.
Smye, V. (2004). The nature of the tensions and disjunctures between Aboriginal understandings of and responses to mental health and illness and the current mental health system. Doctoral dissertation, University of British Columbia.
Farmer, P., Nizeye, B., Stulac, S. et al. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), 1686-1691. http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030449.
Patterson, M., Somers, J., McIntosh, K. et al. (2008). Housing and support for adults with severe addictions and/or mental illness in British Columbia. Burnaby: Centre for Applied Research in Mental Health and Addictions, Simon Fraser University. www.carmha.ca/publications/resources/pub_hsami/Housing_SAMI_BC_FINAL_(pre-desk).pdf.