1. First Nations Mental Wellness Continuum Framework
National Forum On the Role of Public Health in Population Mental Health and Wellness Promotion.
Presented by:
Carol Hopkins, Executive Director
Thunderbird Partnership Foundation
February 28, 2018

2. Declaration of real or potential conflicts of interest
Presenter: Carol Hopkins I have no real or potential conflict of interest related to the material that is being presented today.
Ce webinaire est accrédité par l'École de santé publique de l'Université de Montréal. De ce fait, je dois déclarer mes conflits d’intérêt.

3. First Nations Mental Wellness Continuum Framework
Key Themes:
Culture as foundation
Community Development and Ownership
Quality Health System and Competent Service Delivery
Collaboration with Partners
Enhanced flexible funding investments
Supporting Elements:
Performance Measurement
Research
Workforce Development
Change Management
Governance
Self-Determination
Legend: (from centre to outer ring)
4 Directions (outcomes)
Community
Populations
Specific Population Needs
Continuum of Essential Services
Supporting Components/Infrastructure
Partners in Implementation
Indigenous Social Determinants of Health
Key Themes for Mental Wellness
Culture as Foundation

4. Paradigm Shift From To An examination of deficits
The discovery of strengths
Use of evidence absent of Indigenous world view, values and culture
Indigenous Knowledge sets foundation for evidence
A focus on inputs for individuals
A focus on outcomes for families and communities
Uncoordinated and fragmented services
Integrated models for funding and delivery of services
What would this look like from academic field within the system: this is the work of the team to explore and to engage partners

5. establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non- Aboriginal communities, and to publish annual progress reports and assess long-term trends.  Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services. (Action #19)
We call upon all levels of government to:
Increase the number of Aboriginal professionals working in the health-care field
Ensure the retention of Aboriginal health care providers in Aboriginal communities
Provide cultural competency training for all health-care professionals.
(Action #23)
TRC Calls to Action

6. Equity in Public Health Policy on Mental Health
Equity is not created by access alone
Equity also requires:
Attention to specific needs of the population. For example, trauma is experience differently among Indigenous populations
Depends on the strategy that is used
We have to also think about equity in outcomes.
In order to understand outcomes that will make the most difference, we also need to be explicit about the causes of the problems along the whole path
colonization, dispossession of lands and resources, racism, oppression, stigma and discrimination
We can also improve equity by engaging partners across the social determinants of health

7. Input or Outcome
Is it necessary for “Harm reduction” to be only about a strategy, a way forward, a program, an input?

8. Harm Reduction as an Outcome
Addressing risks of individuals
Independent & Individual
wholeness
Collective
Harm Reduction as an Outcome
Moves us from thinking of “inputs” for “individuals” to seeing that these very things have a benefit to the whole, i.e., the whole community. Think of the issues of increased violence, theft, and children living without anything in their homes - furniture, toys, and most importantly food because of addictions, and all of this changes with access to buprenorphine and cultural interventions. So through opioid replacement therapy, not only are harms reduced for the person who is addicted, they are also reduced for: children, family, whole community.
See the Kanate article
Harm Reduction from a First Nations Public Health Perspective

9. First Nations Communities who implemented buprenorphine and land based treatment had great success:
Kanate and colleagues (2015), documented remarkable results for a buprenorphine program in North Caribou Lake First Nation.
A year after program initiation, criminal charges and Medevac transfers decreased, the needle distribution program dispensed less than half its previous volume and rates of school attendance increased.
Kanate, D. Folk, D., Cirone, S., Gordon, J., Kirlew, M., Veale, T., Bocking, N., Rea, S., & Kelly, L. (2015). Community-wide measures of wellness in a remote First Nations community experiencing opioid dependence. Evaluating outpatient buprenorphine-naloxone substitution therapy in the context of a First Nations healing program. Can Fam Phys,61(2):
Summer of Hope. Image Credit: Craig Chivers

10. Challenges
few health equity plans or accountability, poor data, barriers to care and quality of care
Culturally competent and culturally safe healthcare systems may have the potential to reduce disparities
First Nations seek help less often than the general Canadian population
Barriers to care: language, discrimination, epistemic racism, fear, shame, service accessibility, patient- provider interaction, circumstantial challenges (cost, transportation, competing priorities)
Violence/Victimization
Intergeneration trauma
Food security
Caregiver burden/Health of a family member

11. Cultural Competency Organizational: cultural safety
Service Design & Delivery: culturally competent interventions
clinical culturally competent interventions: cultural humility

12. Indigenous Knowledge
" For many Aboriginal people, knowledge claims arise from an intimate, long-term, equal-exchange relationship with a Creator who gives Aboriginal peoples everything they need to survive on the land in return for exercising their duty to care for the land (Barnaby, 2005; Castellano, 2000; Turner, Ignace, & Ignace, 2000; RCAP, 1996). Therefore, Indigenous knowledge is a gift from the Creator upon which the survival of Aboriginal peoples depends." (Anderson, 2011)

13. Health Promotion
Health promotion, prevention, and education activities seek to:
increase skills and knowledge in order to: create changes in awareness, attitude, and behaviour;
help people engage in safer and healthier lifestyles;
and create conditions that support such lifestyles,
reduce the occurrence of harmful behaviours,
and support healthy and supportive family relationships.
Cultural knowledge is critical to increasing skills and knowledge for living as a whole and healthy person, family, or community.
focus on restoring linkages to cultural strengths,
enhancing empowerment at the individual and community levels to increase participation in family and community life,
strengthening resilience,
increasing protective factors, and decreasing risk factors.

14. Health Promotion Indigenous knowledge is critical to
Health promotion, prevention, and education activities seek to
increase skills and knowledge in order to: create changes in awareness, attitude, and behaviour;
help people engage in safer and healthier lifestyles;
and create conditions that support such lifestyles,
reduce the occurrence of harmful behaviours,
and support healthy and supportive family relationships.
increasing skills and knowledge for living as a whole and healthy person, family, or community.
focus on restoring linkages to cultural strengths,
enhancing empowerment at the individual and community levels to increase participation in family and community life,
strengthening resilience,
increasing protective factors, and decreasing risk factors.

15. QUESTIONS
1. What is a whole and healthy person?
2. How does Indigenous Culture facilitate wellness?
3. When we rely on culture to promote wellness, what should we expect the outcomes to be?

16. Indigenous Wellness Framework…the foundation of the Native Wellness Assessment
NWATM - Copyright 2015, Thunderbird Partnership Foundation.  All rights reserved.  Austin Line, Bothwell, ON, N0P1C0

17. Hope, Belonging, Meaning, & Purpose Across the 7 Stages of Life
Spirit Journey through 7 stages of life
Elder / Giveaway life
Death & Spirit Journey
Pre-Birth
Good Life
Fast Life
Wandering & Wondering
Truth Life
Planning & Planting Life
Doing Life
Hope, Belonging, Meaning, & Purpose Across the 7 Stages of Life
(Peter Ochiese, Aki winini)

18. ENGAGING ALL GENERATIONS
HEALTH PROMOTION BEGINS DURING PREGNANCY AND FOCUSES on TETHERING THE SPIRIT OF THE DEVELOPING FETUS TO A "GOOD LIFE"
VARIOUS CULTURAL PRACTICES PROMOTE MENTAL WELLNESS AT BIRTH AND BEYOND. THESE CULTURAL PRACTICES CONNECT THE FULL CONTINUUM OF LIFE STAGES TO THE NEW BORN

19. Cultural Understanding
Manido Meness is an Ojibway term used for “beads” but its origin comes from the understanding that our physical and spiritual life is “strung” together by the Creator with “spirit seeds”
The spirit seeds that are strung together, physically and spiritually make up our unique identity, which is: our nation, spirit name, language, and from these comes our personality, characteristics, strengths, gifts and potential… 18
This teaching comes from the Ojibway Creation Story and illustrates a cultural understanding of science.

20. Cultural Understanding
Meness is an Ojibway term used for “beads” and its origin comes from the understanding that our physical and spiritual life is “strung” together by the Creator with “spirit seeds” – manido maness, also known as DNA
The spirit seeds make up our unique identity, which is: our nation, spirit name, language, and free will …together these inform our personality, characteristics, strengths, gifts and potential… 18
This teaching comes from the Ojibway Creation Story and illustrates a cultural understanding of science.

21. Dressing Up Identity 19
The stringing together of the tikinagan or moss bag is a cultural teaching that reminds everyone in the family and extended family that the way the baby is wrapped is reflective of the responsibility of family and community to dress the baby with those things that reflect their identity… the little boy with the 3 large flowers on each side of his moss bag is named “star boy” Anung Gweizehns and the flowers are representative of the stars where he draws his understanding of who is and his place and purpose on the earth. In this way the family facilitates the expression of the DNA… the spiritual and physical string of life.

22. Connection and Nurturing
Touches the earth for the first time

23. Cultural Understanding of Development Needs
Rites of Passage

24. Fasting …igniting the spirit seeds
Some things fasting teaches….
How to manage fear of the unknown
How to manage emotions
Delayed gratification
Connect with spirit family
Vision
Purpose and Meaning
Social responsibility

25. Spirit Journey through 7 stages of life
Elder / Giveaway life: neurological disorders
Death & Spirit Journey
Pre-Birth: Intergenerational Trauma & Addiction
Good Life: Child Welfare & neurological disorders
Fast Life: appearance of trauma, i.e. sexual abuse
Wandering Wondering Life: suicide
Truth Life: lack of education
Planning & Planting Life: addiction & loss of family
Doing Life: chronic health disease
Hope, Belonging, Meaning, & Purpose Across the 7 Stages of Life…without culture

26. Cumulative intergenerational effects of residential schools
Having access to this data – and such a large sample size – also allowed us to assess certain research questions we could not in the data we collected….
For example… We were able to provide evidence of the cumulative effects of residential schools across generations…
Bombay, A., Matheson, K., & Anisman, H. (2014). The intergenerational effects of Indian Residential Schools: Implications for the concept of historical trauma. Transcultural Psychiatry, 51(3),

27. Learning about intergenerational effects & cultural pride and renewal
“I was ashamed growing up but I have since reclaimed my identity… Now that I am on my own, I have more pride and I am learning to love my identity. I gave my son a traditional Ojibwe name and I vow to raise him to be proud of who he is.”
Bombay, A., Matheson, K., & Anisman, H. (2011). The impact of stressors on second generation Indian Residential School Survivors. Transcultural Psychiatry, 48(4), 27

28. Identity
Nunavik project uses Inuit identity to tackle addictions, mental health issues
“It gives them hope and confidence that they can succeed"
SARAH ROGERS, NEWS: Nunavik April 11, :15 pm
Pigiatsiaq hunters and youth pose for a photo in an igloo the group built together outside of Puvirnituq Feb. 3. The life-skills program is largely focused around on the land activities for at-risk youth. (PHOTO BY JAMES ASINAJAQ NAPPARTUK)

30. REQUIRED ACTION:
For First Nations children and youth this means investing in culture as a foundation, in: - culturally based, community based, and land based programs - teaching youth about the history of colonization and oppression so that they can stop internalizing this as their identity - teaching youth the meaning of their language versus a language vocabulary. Their world view is held within the language - First Nations needs are understood within structural and social determinants of health

31. Thank you!
For more information on our work and access to the Native Wellness Assessment, please visit 26