Mental health can be influenced by traumatic early life exposures, leading to greater risk of long-term stress and mental illness in some individuals (1, 2). Although disproportionate burden of mental illness among Indigenous people has been attributed to the intergenerational impact of colonization, others have acknowledged that services currently available may not be culturally appropriate in supporting the health needs of Indigenous peoples (1).
For many Indigenous residents and communities in the Regional Municipality of Wood Buffalo (RMWB) in northern Alberta, Canada, the collective intergenerational trauma of colonization and persistent racism, together with a natural disaster and the recent COVID-19 global pandemic, has produced combined effects on mental health. The 2016 Horse River wildfire in the RMWB resulted in community destruction and displacement, loss of homes, jobs, finances, lives as well as injuries and separation from loved ones. Nearly five years post-wildfire, many individuals continue to be impacted by the social, emotional, and psychological difficulties as a result of the aftermath of the wildfire. In addition, stress and isolation from the COVID-19 pandemic in the region have also contributed to increased mental distress (3). There have been reported increases in suicide, depression, drug and alcohol use across the region, resulting from community lockdowns and the temporary unavailability of needed mental health and addictions services and supports (4). Furthermore, the COVID-19 pandemic and the actions to eliminate or mitigate it, have far-reaching social and economic consequences that are likely to disproportionately impact Indigenous communities and exacerbate mental health inequities.
The RMWB is located in a northern region of the province of Alberta and on Treaty 8 Territory, which encompasses a landmass of approximately 840,000 kilometres and home to 39 First Nations communities across the provinces of Alberta, Saskatchewan, British Columbia, and the Northwestern Territories. The RMWB is home to five First Nation communities (Mikisew Cree First Nation, Athabasca Chipewyan First Nation, Fort McKay First Nation, Fort McMurray First Nation, Chipewyan Prairie Dene First Nation), and lies within the Métis Nation of Alberta (MNA) Regions 1 and 51, and includes five Métis Locals located in Fort McMurray, Anzac, Fort Chipewyan, Fort McKay and Conklin.
In the summer of 2019, a two-day Indigenous mental health forum was hosted in June by University researchers and local Indigenous organizations from the RMWB. The purpose of the forum was to examine mental health needs and gaps among Indigenous residents and communities in the region, identify community-derived strategies for promoting mental health, and co-create a vision for improving mental health services for the Indigenous population. Using collaborative and consensus-based facilitation approaches, participants were invited to generate priorities and directions for Indigenous mental health for the RMWB. Specifically, the forum’s aims were to: 1) discuss the challenges and opportunities in addressing mental health among Indigenous youth, adults, and families; 2) network key stakeholders from Wood Buffalo to explore where sectors could overlap and collaborate on improving mental health services for Indigenous populations; and 3) create innovative recommendations to support mental health wellness for Indigenous populations across the life course. This paper outlines the process and insights generated by stakeholder engagement at the forum to identify and prioritize directions for Indigenous mental health and build a vision and strategy for improving mental health services and programs for the region’s diverse Indigenous population.
Indigenous Peoples’ Historical and Contemporary Experiences with Access to Mental Healthcare
Mental health disparities between Indigenous and non-Indigenous people in Canada are related to underlying economic, social and political inequities that are legacies of colonization and the oppression of Indigenous cultures — now recognized as “cultural genocide” by the Truth and Reconciliation Commission (TRC) of Canada (5). The mental health status of Indigenous peoples in Canada must therefore be understood within the context of current and historical colonial experiences, from the loss of land and autonomy, to the creation of the reserves systems, the historical removal of Indigenous children into residential schools, the current removal of Indigenous children by the child welfare system, and systemic and epistemic racism in healthcare settings (1, 2).
Inequitable access to healthcare is influenced by the complexity of multiple governing bodies overseeing health care delivery, with lack of jurisdictional coordination leading to gaps in care and disparities in funding and data collection within Indigenous populations (6, 7). Remote communities face a lack of service providers, lack of health infrastructure and services, and high costs (7). While lack of sufficient number of mental health professionals is a concern across Canada (8), accessibility and availability of mental health care is particularly lacking for Indigenous populations, especially those in rural, remote and northern settings. Scholars have pointed to the absence of a national Indigenous mental health strategy and subsequent lack of funding as barriers to recruiting mental health professionals in rural and remote Indigenous communities and to providing culturally-competent mental services (9). Additionally, different Indigenous groups in Canada, such as Métis (6, 10) and urban or off-reserve First Nation communities, can have unique experiences that are often excluded in research and data, and which may require different culturally-based responses. Indigenous people also face many structural barriers due to the legacy of colonialism in a healthcare system where western knowledge is valued over Indigenous knowledge, trauma-informed care is not consistently practiced, and negative bias from care providers persists due to lack of cultural competency (6, 11–13).
Given the context of historical trauma and ongoing discrimination faced by Indigenous people, culturally-appropriate mental health services are imperative (7, 14). Self-determination is a key determinant of health for Indigenous individuals and communities. (8, 15). Self-determination is understood as the individual and collective right to have control over health, education, and economic systems (16). In this sense, self-determination shapes health care experiences for Indigenous peoples.
Many Indigenous communities’ perspectives on health are wholistic and centered on a connection to culture (17, 18). Research has supported the importance of mental health clinicians practicing multicultural competence when working with Indigenous peoples, which includes acknowledging and understanding the social and cultural realities of Indigenous peoples and addressing the cultural and historical impacts of colonization (19). The strengthening of cultural and community connectedness has been recommended for improving mental health services provided to Indigenous peoples (19). Consultation with Elders by Drost (20) provided perspectives on how Alberta Health Services (AHS)—a provincial health authority— can expand their traditional Indigenous healing practices, which included enhancing cultural competency training for staff, and creating and maintaining partnerships with Indigenous communities.
The use of collaboration and teamwork has also been proposed to improve mental health services for Indigenous peoples. While the inclusion of Indigenous Elders within mental health services was suggested in the TRC, few health systems have attempted to integrate this, though some research projects have noted preliminary success (21, 22). Restoule, Hopkins (23) emphasized the need to build partnerships between governments and Indigenous communities in order to continue building mental wellness, and supported the creation of multidisciplinary Mental Wellness Teams that included Elders as part of a team with community workers, social workers, psychiatrists, and other health professionals. However, more research is needed to understand opportunities and barriers for Indigenous health practitioners (11), and to fill the gap in knowledge regarding integration of Indigenous mental health workers and Indigenous Elders to provide mental health care. In order to truly have culturally-appropriate mental health programs and policies (10, 24), Indigenous communities need to be involved in research and consulted throughout policy-making, and receive adequate funding for mental health services. Moreover, needed transformations identified in the TRC Calls to Action for mental health include: 1) eliminating health care resource disparities; 2) ensuring culturally safe services free of racism; 3) building provider capacity to effectively support healing by addressing impacts from multigenerational adverse life experiences; and 4) engaging Indigenous people within systems so that inclusion of diverse Indigenous cultures and wellness practices may promote optimal outcomes (25).