Indigenous Mental Health in British Columbia with Comparison to Ontario
- Jessica Hart
- Jul 17, 2021
- 7 min read
The government of Canada has committed to improving and achieving high levels of physical and mental health for the Indigenous people of Canada as evident by there agreement to partake in the United Nations Declaration of the Rights of Indigenous Peoples (UNDRIP) in 2016. However only as of June 22, 2021, did the UNDRIP become law (Department of Justice, 2021). The policies created both nationally and provincially are important, now more than ever, to be implemented effectively. The following will focus on mental health accessibility for the Indigenous population in British Columbia (BC) while briefly comparing similarities in Ontario (ONT).
Indigenous people in Canada experience a high level of suicide and suicide ideation (MacIntosh, 2017; Kumar & Tjepkema, 2019). It has been reported that poor access to care, jurisdictional boundaries, and status versus non-status identification are barriers that prevent Indigenous people from receiving appropriate mental health care (MacIntosh, 2017). In fact, very few families and communities have been unaffected by suicide, addiction, and other mental health issues (MacIntosh, 2017). In Canada, between 2011 and 2016, there were 24.3 First Nations deaths from suicide per 100,000 people compared to 8 non-Indigenous deaths from suicide per 100,000 people (Kumar & Tjepkema, 2019). If the rate of suicide reflects the well-being and mental health of a community, it can be viewed that Indigenous people require more supports including appropriate policy implementation.
The First Nations Health Authority (FNHA) is one of seven health authorities in BC. The role of this health authority is aimed at improving the health of First Nations people in the province. The FNHA created a policy statement for the mental health of first Nations people in British Columbia. The statement is as follows:
The FNHA, through our relationships and partnerships, will ensure that all First Nations people have access to a culturally safe, comprehensive, and coordinated continuum of mental health and wellness approaches that afforms, facilitates and restores the mental health and wellness of our people, and which contributes to Reconciliation and Nation rebuilding (FNHA, 2019, page 2)
This policy was created to be used a tool in response to four documents that aimed at improving the lives on Indigenous people. The preceding documents included the Transformative Change Accord (Appendix A), the Transformative Change Accord: First Nations Health Plan (Appendix B), the Tripartite First Nations Health Plan (Appendix C), and the Health Partnership Accord (Appendix D). This policy has 5 objectives:
Prioritize wellness to be viewed across a continuum while focusing on enhancing environments to foster mental health and wellness as well analyzing underlying causes.
Utilize culture and traditional healing as founding principles for interventions.
Improve the quality and access that First Nations people have to health care.
Create and integrative health system that addresses that causes of mental health issues and substance abuse with attempts to remediate those causes.
Empower First Nations by partnering with communities to engage in and improve health and wellness initiatives (FNHA, 2019).
The FNHA offers four support services to support Indigenous people 24 hours a day. The FNHA lists the following 24-hour support services: The Hope for Wellness Help Line, the Indian Residential School Crisis Line, the Kuu-Us Crisis Line Society, and the Métis Crisis Line. The Hope for Wellness Help Line is available for immediate counselling or intervention either by phone or online chat. Conversation is offered in English, French, Cree, Ojibway, and Inuktitut. The Indian Residential School Crisis Line is available nationally for those who experienced trauma from the Residential school system. The Kuu-Us Crisis Line Society offers supports via a phone call for adults, children, and Métis Indigenous people across British Columbia. The fourth crisis line, the Métis crisis line, is service offered through the Métis Nation of British Columbia to members.
Other supports listed by the FNHA include the Virtual Substance Use & Psychiatric Service. This service does require a referral from a health care provider, but once referred, it offers support for individuals along their journey. Another program, The Indian Residential School Resolution Health Support Program, is available to all former Residential School students and their families for culturally safe, mental health counselling. In addition, mental health and wellness counselling is available in British Columbia through Indigenous Services Canada, but unfortunately coverage may be challenging for those who do not have their status identification. Furthermore, the access to counselling is challenged by exclusions that include (but are not limited to) psychiatric emergencies, services that can be provided through other British Columbia agencies, and for legal purposes.
Additionally, the plan A Path Froward: BC First Nations and Aboriginals People’s Mental Wellness and Substance Use – 10 Year Plan, was created in 2013 by the Tripartite First Nations Health Plan to improve mental health and decrease substance use in the First Nation and Aboriginal population. The plan was created to address the Truth and Reconciliation Commission of Canada calls to actions while recognizing the racism and health disparities that exist in First Nations and Aboriginal communities alike (Tripartite First Nations Health Plan, 2013). It also draws from The Consensus Paper (Appendix E) which was created in 2011 to help improve the lives of First Nations people in British Columbia. The foundation of the plan includes the concept that is known as the Seven Sacred Teachings which includes love, respect, courage, honesty, wisdom, humility, and truth (Tripartite First Nations Health Plan, 2013). The goals of the plan are as follows:
To improve services, supports, and health outcomes for all First Nations and Aboriginal People in BC.
To keep First Nations and Aboriginal people’s well-being at the centre of our initiatives, while maintaining a high operational standard, and cross-sectoral integration.
To ensure that mental wellness and substance use strategies and actions for First Nations and Aboriginal people reflect individual and family needs and are Community-driven and Nation-based.
To engage First Nations and Aboriginal people in the journey towards improving health outcomes (Tripartite First Nations Health Plan, 2013, p. 14).
Furthermore, the plan draws from the Circle of Wellness for BC First Nations and Aboriginal People which proves to be a culturally significant tool (Figure 1).
Figure 1. The Circle of Wellness for BC First Nations and Aboriginal People
Note. From “A Path Forward: BC First Nations and Aboriginal People’s Mental Wellness and Substance Use—A 10 Year Plan.” By Tripartite First Nations Health Plan, 2013, p. 15, (https://www.fnha.ca/Documents/FNHA_MWSU.pdf). Copyright 2013 jointly by the First Nations Health Authority, the British Columbia Ministry of Health, and Health Canada.
The plan continues by outlining in detail specific areas that should be addressed, strategies, and actions required to meet the needs. Because the plan is still active until 2023 it will be several years until it will be reviewed, and only at that time will success be determined.
When comparing to Ontario, the province does not have a separate health authority advocating for the health of Indigenous people. The Health Equity Guideline (2018) does however mention the importance of collaboration with Frist Nations communities to establish health equity (Ministry of Health and Long-Term Care, 2018). The government of Ontario has also created a guiding document, Relationship with Indigenous Communities Guideline (2018), to assist health agencies in creating partnerships improve the health equities of Indigenous people (Ministry of Health and Long-Term Care, 2018).
More specific to Indigenous mental health in ONT, is the Aboriginal Health Access Centres (AHAC) and the Aboriginal Community Health Centres (ACHC). Both AHAC and ACHC provide mental health and addictions support (along with other services) to Indigenous people through a culturally sound approach (Government of Ontario, 2014). There are currently ten AHAC in Ontario that serve communities on and off reserve as well as people in urban, rural, and remote locations (Alliance for Healthier Communities, n.d.). There are currently three ACHC in Ontario located in Toronto, Timmins, and Midland (Alliance for Healthier Communities, n.d.). Similar to The Circle of Wellness for BC’s First Nations and Aboriginal People, the Aboriginal Health Access Centre is represented through a circle as well: the Wholistic Health and Wellbeing (Figure 2). Additionally, the Indigenous Friendship Centres offers services focusing on children with mental health issues and those who have experienced abuse.
Figure 2. AHAC Model of Wholistic Health and Wellbing
Note: Adapted from “AHAC Model of Wholistic Health and Wellbeing.” By Ontario’s Aboriginal Health Access Centres, (https://www.allianceon.org/sites/default/files/documents/Model%20of%20Wholistic%20Health%20and%20Wellbeing.pdf). Copyright 2015 Ontario’s Aboriginal Health Access Centres.
While comparing the two provinces, it is apparent that both BC and ONT have supports and services available to improve mental health and wellbeing of Indigenous people. In BC services are primarily delivered via the FNHA, whereas in ONT services are delivered via health care organizations. Similarities in approach to care are noted in the Circle of Wellness for BC Aboriginal and First Nations People and Ontario’s AHAC Model of Wholistic Health and Wellbeing. A significant difference between the two provinces of BC and ONT is that BC has created a formal guide for mental health that identifies strategies required, where as ONT appears to lack such documentation. Regardless of the formal documentation, it is vital that governments are held accountable to implement policies and practices that will adhere to improving the lives of Canada’s Indigenous population. This is especially important considering that UNDRIP is newly adopted to Canadian law.
References
Alliance for Healthier Communities. (n.d). Aboriginal health access centres. https://www.allianceon.org/aboriginal-health-access-centres
Kumar, M. B., & Tjepkema, M. (2019). Suicide among First Nations people, Me’ties and Inuit (2011-2016): Finding from the 2011 Canadian census health and environment cohort (CanCHEC). Statistics Canada. https://www150.statcan.gc.ca/n1/pub/99-011-x/99-011-x2019001-eng.htm
MacIntosh, C. (2017). Indigenous mental health: Imagining a future where action follows obligations and promises. Alberta Law Review, 54(3), 589-610. https://0-heinonline-org.aupac.lib.athabascau.ca/HOL/Page?handle=hein.journals/alblr54&div=23&collection=journals
First Nations Health Authority [FNHA]. (2019, February 15). FNHA’s policy on mental health and wellness. https://www.fnha.ca/WellnessSite/WellnessDocuments/FNHA-Policy-on-Mental-Health-and-Wellness.pdf
Frist Nations Health Authority. (n.d.). Mental health benefits. https://www.fnha.ca/benefits/mental-health
First Nations Health Authority. (n.d.). Mental health and wellness supports. https://www.fnha.ca/what-we-do/mental-wellness-and-substance-use
Department of Justice Canada. (2021, June 22). Legislation to implement the United Nations Declaration on the Rights of Indigenous Peoples Becomes Law. Government of Canada. https://www.canada.ca/en/department-justice/news/2021/06/legislation-to-implement-the-united-nations-declaration-on-the-rights-of-indigenous-peoples-becomes-law.html
Government of Ontario. (2014, September 4). Aboriginal health access centres. https://www.ontario.ca/page/aboriginal-health-access-centres
Ministry of Health and Long-Term Care. (2018). Health equity guideline, 2018. Queen’s Printer of Ontario. https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Health_Equity_Guideline_2018_en.pdf
Ministry of Health and Long-Term Care. (2018). Relationship with Indigenous communities guideline, 2018. Queen’s Printer of Ontario. https://health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Relationship_with_Indigenous_Communities_Guideline_en.pdf
Tripartite First Nations Health Plan. (2013). A Path Forward: BC First Nations and Aboriginal People’s Mental Wellness and Substance Use—A 10 Year Plan. First Nations Health Authority. https://www.fnha.ca/Documents/FNHA_MWSU.pdf
Appendix A
Appendix B
Appendix C
Appendix D
Appendix E
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