Running head: MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY 1

Mental Health and the Canadian Aboriginal Community Dermot Connolly Stenberg College 0312 FNTS 201-3 First Nations Health April 2013

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY Mental Health and the Canadian Aboriginal Community Statistics indicate that one of five people in British Columbia will suffer from a mental illness during their lifetime (First Nations Health Council 2011), yet when compared to the Canadian aboriginal community, this number is almost doubled (Kirmayer, Brass & Tait 2000).

While the aboriginal population must content with many health concerns, mental illness ranks as one of their most prevalent. At 16% for example, depression rates among aboriginals are twice the Canadian average. (Here to help 2009). In terms of alcohol consumption, figures have shown that while aboriginal Canadians are less likely to consume alcohol compared to the rest of the Canadian population, those that do consume alcohol are more likely to abuse it.(Here to help 2009). While depression and alcohol abuse represent two of the more serious mental illnesses facing the aboriginal population, suicide still ranks as their leading cause of death for those under the age of 44. (Here to help 2009). Why then are the rates of mental illness among aboriginal communities so high, and what are the factors that impact these rates? The purpose of this paper is to explore these questions in greater detail looking specifically at some of the social origins to aboriginal mental illness and the impact these origins have had on aboriginal alcohol consumption, depression and suicide rates. Preventative outreach programs and methodologies are also explored. When discussing alcohol consumption among aboriginal communities, it is important to make the distinction between alcohol abuse and alcoholism. (Belanger 2010). Alcoholism is a disease associated with the dependence on alcohol, whereas alcohol abuse relates to the binge pattern of alcohol consumption more commonly associated with aboriginal communities. (Korhonen 2004).

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY

Most alcohol related problems identified among the aboriginal communities are attributed to the effects of binge drinking as opposed to the regular overconsumption of alcohol indicating dependence. (Korhonen 2004). In a literary review of substance abuse carried out in 1979, four environmental risk factors were identified to increased rates of alcohol abuse among aboriginals. These were; parental drug use, influence of peers, low social assets and acculturative stress (Waldram, Herring &Young 2007). The excessive consumption of alcohol through binge drinking not only contributes to social issues such as violence, injury and domestic abuse, but it can also be attributed to problems associated with mental illness such as depression and suicide. (Korhonen 2004). The cause and effect link between depression and alcohol abuse has long being established, where depression has being shown to cause an increase in alcohol consumption and subsequent abuse. On the other hand, depression has also being attributed to the misuse of alcohol. (Korhonen 2004). Studies have also shown that excessive consumption of alcohol combined with poor nutrition, can lead to abnormalities of the liver and pancreas, both of which are essential for processing vitamins, minerals and other nutrients. (Korhonen 2004 p7). A body depleted in essential nutrients has being known to cause depression and anxiety among intoxicated patients. (Korhonen 2004). In fact, individual episodes of binge drinking can result in depression brought amount by changes in the aboriginal brain chemistry. (Korhonen 2004). On the other hand, it has long being established that aboriginal people who demonstrate certain mental disorders such as depression are at greater risk to developing an alcohol problem. (Korhonen 2004). One cannot talk about mental health among the aboriginal communities without discussing suicide. Recent history suggests that the suicide rates among aboriginal communities

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY have being much higher than the rates observed among the rest of the Canadian population. While the overall suicide rate for Canada continues to decline, the same trend has not being experienced among aboriginal populations. (Kirmayer et al, 2007). Some have described the suicide rates among aboriginals as epidemic (Brown n.d.). In 2000 for example, suicide accounted for 22% of all deaths among aboriginal youth and 16% of all deaths among young adults. Canadian Mental Health Association Ontario (n.d.). Of further concern is the belief that 25% of all accidental deaths are in fact suicides, indicating that this alarmingly high rate of suicide may actually be underreported. (Brown n.d.). This paper will discuss some of the causes of aboriginal suicide later, but it is important to remember that there is never a single cause for suicide; instead it can be traced back to many social and personal circumstances. (Kirmayer et al, 2007). While the impact of suicide is the same across all communities, the small community dynamics of aboriginal populations where many people are related and have experienced similar circumstances can be particularly damaging. (Kirmayer et al, 2007). The risk factors associated with aboriginal suicide is similar to those experienced by the rest of the Canadian population and include low self esteem, hopelessness, low self concept and a family history of suicide and / or violence. It is also interesting to note that other risk factors include other mental disorders such as depression and alcohol abuse. (Kirmayer et al, 2007). In fact, the role of mental illness as a contributing factor to suicide is so compelling that all risk

factors associated with suicide, can be categorized into; 1) severe depression, 2) a life crises such as substance abuse. (Kirmayer et al, 2007).

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY Depression is long being recognized as being a significant mental health problem among aboriginals. In fact in a survey carried on 57 reserves in Manitoba, 47% of respondents

considered depression to be a problem on their reserves. (Brown n.d.). Depression is also an area of concern for aboriginals living off the reserve. In a survey carried out in 2001 for example, approximately 13% of aboriginals living off the reserve stated they experienced a major depressive episode in the previous 12 months, which is almost 2 times higher than the Canadian average. (Canadian Mental Health Association Ontario n.d.). Looking at these numbers and indeed all the statistical data for mental health in aboriginal communities, one could be forgiven for thinking that being aboriginal is a risk fact for mental illness. The University of Saskatchewan and the Saskatoon health region however challenged this assumption in a study it carried out in 2008 in which it made the determination that other measures such as poverty and parental education influenced depression rates among aboriginal children and not their race. (French 2008). These findings have important implications when attempting to attribute mental illness as unavoidable circumstances among aboriginals. Policy makers will often attribute aboriginal mental health to culture or genetics, allowing them to dismiss the problem instead of treating it. (French 2008). Looking at childhood depression alone, the findings from the University of Saskatchewan and the Saskatoon health region concluded that levels of depression were highest among children from low income families whose parents had achieved at best, a high school education. In fact there was no statistical correlation at all between the aboriginal culture and depression. (French 2008). As we have seen, other external factors outside of race have shown to contribute to the diagnoses of depression. (French 2008). Is it not plausible therefore to consider that similar

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY contributing factors may also play a role in other mental illnesses within the aboriginal community? Perhaps these factors can help explain the clear disparancy that exists between the mental health statistics of Aboriginal people compared to the rest of the Canadian population? Kirmayer, Brass & Tait suggest that the Canadian aboriginal population suffered profound disruption to their culture and way of life as a result of European contact. (Kirmayer, Brass & Tait 2000). Such disruption, while complex in nature, included the introduction of infectious disease, religious conversion, family separation, population segregation and poverty.

(Kirmayer, Brass & Tait 2000). Over time, this disruption has had a marked impact on the social structure and cultural identity of aboriginal communities, which is reflected in the endemic mental health issues of the aboriginal community. (Kirmayer, Brass & Tait 2000). As we have shown, epidemiological studies have revealed high rates of mental illness among the aboriginal community, with alcohol consumption, depression and suicide among the most prevalent. (Kirmayer, Brass & Tait 2000). Systematic attempts at cultural assimilation through the introduction of residential schools have also played their part. Studies have shown that almost one third of the 1 million aboriginal people living in Canada have being affected either directly or indirectly by the residential schools program of the 1920s. (Canadian Mental Health Association Ontario n.d.). The program resulted in the forced removal of over 100,000 children from their homes where they were subjected to institutional regimes designed to suppress and disassociate then from their heritage. (Kirmayer, Brass & Tait 2000). Outside of the physical, sexual and emotional abuse that is now known to have taken place within these schools, this program also denied the aboriginal community their basic right to practice their traditions and maintain a sense of cultural identity. This cultural abuse is now known to have had a profoundly negative effect on the social,

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY economical and mental well being of the aboriginal community for generations to follow. (Kirmayer, Brass & Tait 2000). So if external factors have largely contributed to the current status of mental health

among aboriginal communities, do we not then have a social responsibility to work alongside the aboriginal population and help treat those affected? In addressing these concerns, it is important to be cognizant of the cultural differences between western and aboriginal approaches in the treatment of mental illness. (Here to help 2009). For support to be effective, psychiatric practice must be adapted to incorporate cultural concepts in order to fully engage with aboriginals (Kirmayer, Brass & Tait 2000). For any outreach program to be successful, it should first screen for the biggest problems affecting the aboriginal community such as mental illness. (Here to help 2009). The most vulnerable within the community should also be targeted such as children and young women. (Here to help 2009). The rebuilding of the family unit and the establishment of a sense of community is also important as it can help eliminate issues within the family caused by many mental illnesses such as substance abuse and depression. (Here to help 2009). In a study carried on the Ojibwa community in Manitoba for example, it was determined that children who came from a good family structure, were less likely to abuse alcohol. (Waldram, Herring &Young TK 2007). Such outreach programs can also have a positive effect on suicide rates where the establishment of a stable social environment acts as a protective factor against suicide risk. (Kirmayer et al, 2007). For many, suicide is an escape from grief, frustration and psychiatric illness. Preventative outreach programs should therefore also be cognizant of tackling individual

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY issues through the renewal of the individuals sense of self worth and self esteem. (Kirmayer et al, 2007). This two pronged approach of rebuilding a sense of community and identifying the needs of the individual are important first steps in the reestablishment of cultural relationships and the tackling of mental illness. The aboriginal population of Canada has long being discriminated against since the time of first contact with European settlers. This discrimination began with the introduction of infectious diseases and progressed to include the disruption of their cultural identity through religious conversion and family segregation. (Kirmayer, Brass & Tait 2000).

The introduction of the residential school system of the 1920s also played its part, where the systematic and purposeful destruction of culture, language and identity, resulting in a high percentage of residential schools survivors suffering from mental health and behavioral problems. Here to help (2009). While the last of these schools closed in the 1980s and the European culture is embedded into Canadians way of life, the trauma inflicted on the aboriginal communities is still evident today. Here to help (2009). As a result, rates of mental health such as alcohol abuse, depression and suicide are significantly higher in aboriginal communities when compared to the rest of the Canadian population. Many will try to ignore these facts by attributing being aboriginal as a risk factor for mental illness, which is not the case. (French 2008). Instead of hiding from these mental health statistics, we need to embrace them by acknowledging our social responsibility in addressing historical wrongdoings.

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY The process begins through engagement with the aboriginal community and the

establishment and running of outreach programs designed to tackle the fundamental problems of mental illness such as the establishment of a functioning community and family unit. (Kirmayer et al, 2007). Once established, the knock on effects on the rates of alcohol abuse, depression and suicide are profound.

References: Belanger, Y. D. (2010). Ways of Knowing: an introduction to native studies in Canada. Toronto, Canada: Nelson Education

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY Brown, I. (n.d.). Main problem areas in Aboriginal mental health. Retrieved from: http://www.niichro.com/mental%20health/men_2.html

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Canadian Mental Health Association Ontario (n.d.). Facts and figures on aboriginal communities and mental health. Retrieved from: http://www.ontario.cmha.ca/about_mental_health.asp?cID=23053 First Nations Health Council (2011). Provincial conference targets mental health. Retrieved from:http://www.fnhc.ca/index.php/news/article/provincial_conference_targets_mental_h ealth1/ French, J. (2008). Depression in Aboriginals linked to poverty. The Star Phoenix. Retrieved from:http://www.numberswatchdog.com/numbers%20docs/Depression%20in %20aboriginals%20linked%20to%20poverty.pdf Here to help (2009). Aboriginal mental health and substance use. Retrieved from: http://www.heretohelp.bc.ca/factsheet/aboriginal-mental-health-and-substance-use Kirmayer, L., J., Brass, G., M., Holton, T., Paul, K., Simpson, C. & Tait, C. (2007). Suicide among aboriginal people in Canada. Aboriginal healing foundation. Retrieved from: http://www.ahf.ca/downloads/suicide.pdf

Kirmayer, L., J., Brass, G., M. & Tait, C., L. (2000). The mental health of Aboriginal peoples: Transformations of identity and community. The Canadian Journal of Psychiatry. 45,7. 607-616.

MENTAL HEALTH AND THE CANADIAN ABORIGINAL COMMUNITY Korhonen, M., (2004). Alcohol problems and approaches: Theories, evidence and northern practice. National Aboriginal health Organization. Retrieved from: http://www.naho.ca/documents/naho/english/pdf/alcohol_problems_approaches.pdf Waldram, JB; Herring, DA &Young TK (2007). Aboriginal Health in Canada: Historical, Cultural and Epidemiological Perspectives, Second Edition Toronto University Press, Toronto.

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