The importance of sustainable mental health support in First Nations communities

October 31, 2016 - This past April, the northern community of Attawapiskat declared a state of emergency following 28 suicide attempts in March alone. However, these issues have been longstanding, as the reserve has had 100 attempts since last September.

After this incident became publicized, Health Canada said it would provide the reserve with additional mental health workers. The provincial government then announced it would allocate $222 million to First Nations over the next three years to address health issues and an additional $104.5 million on top of that. According to the province’s Minister of Health and Long-Term Care, Eric Hoskins, this includes establishing “expanding supports including trauma response teams, suicide prevention training, positive community programming for youth, and … more mental health workers in schools."

One month later, upon meeting with Attawapiskat Chief Bruce Shisheesh, the federal government declared it would invest an extra $70 million to address these same issues. The subsidies will cover the cost of two permanent mental health workers for Attawapiskat, a 24- hour culturally sensitive crisis response line, four crisis response teams in Ontario, Nunavut and Manitoba, an increase in mental wellness teams, and culturally-tailored training for existing community based workers.

While Attawapiskat has received considerable attention in the media, there is an overwhelming amount of evidence that demonstrates the need for better mental health support systems in First Nations communities overall. 

Attawapiskat has not been the only northern Indigenous community to declare a formal crisis over the issue of mental health. Neskantaga First Nation, also located in the district of Kenora, has been in a state of emergency since April 2013, following two suicides in less than a week and 20 suicide attempts over the previous year.

Overall, statistics show the Indigenous population is particularly vulnerable to mental health issues, which is exacerbated by a lack of resources. For those in their formative years, figures depict a rather unsettling situation. A 2013 report released by the Centre for Suicide Prevention revealed that suicide and self-inflicted injuries are the leading causes of death for First Nations youth and adults up to 44 years of age.  Moreover, according to Health Canada, the suicide rate for First Nations male youth aged 15-24 is 126 per 100,000 compared to the rate of 24 per 100,000 for non-Aboriginal male youth. For First Nations females the rate is 35 per 100,000; whereas non-Aboriginal females sit at a rate of five per 100,000.

Access is also a pressing concern. The Centre of Addiction and Mental Health reported that mental health and addictions represents 15 percent of the disease burden in Canada as a whole, but only receives less than 6 percent of healthcare funding. The situation is even trickier for rural northerners who must travel to receive these services. A Northern Policy Institute briefing note in March 2015 found that unmet mental health needs have been documented in rural Northern Ontario and that there is a need for a community-based rural approach for service supports.

Although northern reserves were deprived of services before the government had made the announcement, there are existing programs which cater to the Indigenous population in northern reserves. For example, Keewanytinook Okimakanak Telemedicine (KOTM) is operated under the Northern Chiefs Tribal Council and has used video conferences for tele-psychiatry since 2002 to provide services to Indigenous peoples in northern First Nations communities. However, KOTM has faced a number of challenges regarding patient and community utilization, jurisdictional issues and resources.

Meanwhile, Health Canada has an additional four programs with strategies advertised to “achieve better mental health” in First Nations and Inuit communities. These government-funded programs were founded from 1990 to the early 2000s. According to a Health Canada spokesperson, the programs are still being accessed by First Nations and Inuit communities and organizations.

Alternatively, the Journal of Aboriginal Health reported on a total of nine Indigenous communities with successful healthcare systems. These communities possessed a number of external measures which had an influence on suicide rates. These factors were related to self-government and band controlled services such as education, crime and safety. A significant element was the presence of a facility designated for cultural practices. The journal found for communities where all measures were present, no suicides occurred in the five year study period. A minimum of three factors were necessary to significantly lower the suicide rate. The rate for communities that possessed none of the measures was 137.5 per 100,000.

Leading by example in successful healthcare systems, Kahnawake First Nation in Quebec has been recognized specifically for its ability to effectively treat mental health issues in its community. Laurel Lemchuk-Favel and Richard Jock describes the reserve as bringing a mature perspective to developing Aboriginal health systems.The community’s health services are overseen by the Kahnawake Health and Social Services Commission. It plans, co-ordinates and reviews all health and social programs. The commission has provided the community with structure in its health system, which embraces a holistic approach, encouraging community members to be responsible for their own well-being. According to Lemchuk-Favel and Jock, this has meant the community has had to establish clear lines of authority over its health professionals to create an environment more compatible to Aboriginal traditions.

Although the government has used the state of emergency in Attawapiskat as partial justification for its plan, the fact is the requirement for mental health resources in Indigenous communities has been there long before suicides on the reserve began to receive mainstream attention. 

Moving forward, First Nation communities in Northern Ontario should look to adopt a similar approach to what has been undertaken in Kahnawake. By defining roles between individuals in the community and outside help, more independence and control for the communities can be achieved, resulting in a more culturally fitting healthcare system that is effective in its purpose.

Lindsay Campbell is a former public relations & marketing intern at Northern Policy Institute.

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