Stereotyped, misunderstood, and impacted by government intervention, the First Nations People continue to deal with health care challenges regarding mental illness and substance abuse.
Mental health and substance abuse are serious issues faced by most indigenous communities. While virtually all communities are affected by substance use and mental illness, aspects of aboriginal culture create distinctive barriers to managing these issues. The struggle to hold onto their traditions in the face of the imposition of Western thinking has contributed significantly to the health and social problems experienced by indigenous peoples.
Suicide is at a crisis level worldwide, and the number of deaths annually continues to climb. This, tragically, is even truer for the indigenous population. According to a late 2019 report in Canada’s National Observer, the suicide rate among indigenous Canadians is three times that of non-indigenous Canadians. Within this group, suicide is more prevalent among males and youth aged 15-24.
However, First Nations women die by suicide at five times the rate of other Canadian women. For First Nations men, the suicide rate is 2.4 times that of other Canadian men. Indigenous Canadians who live on a reserve are twice as likely to die by suicide as those who live off-reserve.
Because the Canadian government does not specifically track suicide by indigenous populations, we need more research in order to detect and alleviate the factors that put these communities at risk. Notably, for example, some First Nations communities have a zero percent suicide rate. In contrast, others have a rate of hundreds of times the national average, according to the Canada Library of Parliament.
Image via Flickr by Sander van der Wel
Mental health conditions, particularly depression, are very common globally. Again, indigenous people experience these at high rates compared to the general population. They are twice as likely to experience major depression and other mental illnesses. Depression is even more prevalent among First Nations youth, who are nine times more likely to experience mental health problems than other Canadians in the same age group, according to the Library of Parliament.
In aboriginal communities, wellness is about balance, harmony, and connection to family. The focus is on strengths rather than weaknesses, so individuals may avoid mental health and addiction treatment for fear of being stigmatized. Years of victimization through colonization, residential schools, child welfare programs, and intergenerational trauma have led to challenges with mental health, higher rates of suicide, and substance abuse.
Substance Use Disorder
Drug abuse and alcoholism in indigenous communities is a cause for great concern. Research findings indicate that 75% of aboriginals feel that alcohol and drug use is present in their community, 33% see it is an issue in their own family or household, and 25% report a personal problem with substance abuse.
In Alberta and British Columbia, hospital records show that First Nations people, particularly men, are admitted for problems with alcohol abuse and addiction more frequently than other residents in those provinces. Approximately 27% of aboriginal adults, and 32% of youth, use cannabis.
Substance abuse increases the likelihood of developing an addiction. The earlier people drink or use drugs, the greater the risk of developing problems with binge drinking or substance use disorder. Drug and alcohol consumption also has a significant impact on physical and cognitive development, and it can eventually cause issues at school and, later, with obtaining and maintaining employment.
Issues with violence, even among family members, is another challenge indigenous communities face, and this is directly related to substance use problems and alcoholism in indigenous communities. Suicide, substance use disorder, and mental illness are all closely interconnected, and each condition exacerbates the others. They must be treated together with an integrated approach.
Treatment for Indigenous Peoples
The health care system has evolved in its understanding of the needs of indigenous communities. As with any group, medical services and prevention programs are crucial in treating mental health conditions and substance abuse. Prompted by research projects that have revealed gaps and changes needed in treatment for aboriginals, the federal government has been working with First Nations organizations to address disparities in mental health care and expand access to public health.
Residential school survivors and their family members receive community-based mental health care services and substance abuse programs provided by Health Canada. The First Nations Inuit and Mental Wellness Advisory Committee has been working collaboratively with elders to develop strategies to address mental illness and addiction.
First Nations communities can also receive specific health care programs through the federal government. However, these services focus on primary care, so it can still be quite difficult for indigenous individuals to access mental health services and substance use treatment.
Parliament also reports the importance of cultural continuity in reducing psychological issues and suicide rates among indigenous groups. Factors that support cultural continuity include land claims, cultural facilities, self-government, and access to police, fire, education, and health services.
Researchers have found that a protective effect results from the sense of culture and heritage that certain factors create. These factors include when the community itself controls child welfare services, when women are involved in local government, and when the population can communicate using their native language. Youth in communities with a high level of cultural continuity are less likely to die by suicide or develop substance use disorder.
Aboriginal healing follows a holistic approach that involves interconnectedness between family, community, spirituality, and nature. This may include traditional teaching, spiritual practices like ceremonial prayers and songs, sacred remedies such as tobacco, sweet grass, or sage, healing circles, sweat lodges, and interactions with elders or healers.
The Aboriginal Child and Family Services agencies are located in both rural and urban communities, on and off-reserve. They provide a wide variety of mental health programs, particularly for children and young people.
Aboriginal Health Access Centres (AHAC) are another resource offering health and social support services to Inuit and First Nations communities. These are found throughout Ontario in cities and rural areas, both on the reserve and off. Services include mental health counselling, addiction programs, traditional healing, and cultural activities.
Indigenous Friendship Centres are found across Ontario. They provide a combination of health and social supports, including the Children’s Mental Health Project for First Nations children and youth aged 7-15. Another service for children ages 7-14, Children Who Witness Violence, works to address the traumatic stress associated with events that many indigenous families experience.
The Métis Nation of Ontario provides mental health care services as well, including assessment, intake, early intervention, referrals, and aftercare support, using a combination of traditional and contemporary approaches. A variety of programs that honour the needs of indigenous women and children are available through the Ontario Native Women’s Association.
Mental health services can be accessed at mainstream centres, clinics, agencies, and hospitals for anyone with mental illness or substance use disorder. A health care provider, an expert in addiction, works with the person who is struggling and his or her family members to develop an individualized treatment plan.
Honouring a Promise
The Truth and Reconciliation Commission of Canada was originally formed in 2008 as a result of the Indian Residential Schools Settlement Agreement (IRSSA). The largest settlement in Canadian history, it was intended to compensate for the impact of residential schools on the survivors and their families, as well as to begin to address the inequities and injustice faced by indigenous people.
With the hope of creating a more just and equitable future, health care services continue to look to honour traditional treatment interventions. Family, community, and spirituality are all key components of indigenous well-being, along with a sense of control over their own health.
Indigenous People and Substance Abuse World Health Organization (WHO), Copyright 2019
Mental Health Addictions and Indigenous Health Report Prepared for Health Canada, Date Modified: May 17, 2019
Indigenous and Non-Indigenous People Experiencing Homelessness and Mental Illness in Two Canadian Cities Brittany Bingham, et al., US National Library of Medicine, April 8, 2019
Truth and Reconciliation Commission of Canada Government of Canada: Indigenous Relations and Northern Affairs Date modified: February 19, 2019
Mental Wellness in Canada’s Aboriginal Communities: Striving Toward Reconciliation Patricia Boksa, et al., Journal of Psychiatry and Neuroscience, November 2018
Mental Health and Suicide in Indigenous Communities Ryan Sioux, et al., National Institutes of Health, November 2017