Aboriginal Aboriginal Peoples’ Peoples’

Experiences of Experiences of Mental Health and Mental Health and Addictions Care to Addictions Care to Inform Culturally Inform Culturally Safe Health Policy Safe Health Policy and Practice and and Practice and Improved Health Improved Health

StatusStatus

Nominated PI: Victoria (Vicki) Smye Nominated PI: Victoria (Vicki) Smye RN, PhDRN, PhD

Co-Is: Annette Browne RN, PhDCo-Is: Annette Browne RN, PhDand Paddy Rodney RN, PhDand Paddy Rodney RN, PhD

UBC School of NursingUBC School of Nursing

Funded by the Canadian Institutes of Funded by the Canadian Institutes of Health Research (CIHR)Health Research (CIHR)

The PartnershipThe PartnershipResearch CoordinatorResearch Coordinator• Tanu Gamble, Tanu Gamble, UBC School of Nursing (SON)UBC School of Nursing (SON)• Nancy Clark,Nancy Clark, UBC School of Nursing (SON) UBC School of Nursing (SON)StudentStudent• Tej Sandhu, Tej Sandhu, UBC Faculty of MedicineUBC Faculty of MedicinePrincipal InvestigatorPrincipal Investigator• Victoria (Vicki) Smye, Victoria (Vicki) Smye, UBC SONUBC SONCo-InvestigatorsCo-Investigators• Annette Browne & Paddy RodneyAnnette Browne & Paddy Rodney, UBC SON, UBC SON• Evan Adams, Evan Adams, UBC Family Practice, Division of Aboriginal UBC Family Practice, Division of Aboriginal

Peoples’ Health, & Aboriginal Health, B.C. Ministry of HealthPeoples’ Health, & Aboriginal Health, B.C. Ministry of Health• Betty Calam,Betty Calam, UBC Family Practice (St. Paul’s Hospital) UBC Family Practice (St. Paul’s Hospital)• Nadine Caplette,Nadine Caplette, Aboriginal Health, Vancouver Coastal Health Aboriginal Health, Vancouver Coastal Health

(VCH)(VCH)• Elliot Goldner ,Elliot Goldner , SFU, Faculty of Health Sciences SFU, Faculty of Health Sciences• Peter Granger,Peter Granger, UBC Family Practice (Three Bridges) UBC Family Practice (Three Bridges)• Barb Keith,Barb Keith, Aboriginal Wellness Program, VCH Aboriginal Wellness Program, VCH • Bill Mussell,Bill Mussell, Native Mental Health Association of Canada Native Mental Health Association of Canada• Perry Omeasoo,Perry Omeasoo, Strathcona Mental Health & Vancouver Native Strathcona Mental Health & Vancouver Native

HealthHealth• Collin van Uchelen,Collin van Uchelen, UBC Psychiatry UBC Psychiatry• Barnabas Walther,Barnabas Walther, B.C. Ministry of HealthB.C. Ministry of Health (formerly VCH)(formerly VCH)

The PartnershipThe Partnership

CollaboratorsCollaborators• Lorna Howes, Lorna Howes, Mental Health, VCHMental Health, VCH• Doreen Littlejohn, Doreen Littlejohn, Vancouver Native Health Vancouver Native Health

Services Services (VNHS)(VNHS)

• Ron Peters, Ron Peters, Research and Policy, VCHResearch and Policy, VCH• Deborah Senger, Deborah Senger, Contract Services, Provincial Contract Services, Provincial

Health Services Authority (PHSA)Health Services Authority (PHSA) • Isaac Sobol, Isaac Sobol, Chief Medical Officer of Health, Chief Medical Officer of Health,

NunavutNunavut & UBC Family Practice& UBC Family Practice• Leah May Walker, Leah May Walker, UBC Family Practice, UBC Family Practice,

Division of Aboriginal Peoples’ HealthDivision of Aboriginal Peoples’ Health• Diane Woodhouse, Diane Woodhouse, Vancouver General HospitalVancouver General Hospital

** ** Community Aboriginal Advisory TeamCommunity Aboriginal Advisory Team

Purpose of the Purpose of the StudyStudy

• To explore Aboriginal peoples’ To explore Aboriginal peoples’ experiences of mental health and experiences of mental health and addictions services in an urban context addictions services in an urban context to to improve access to appropriate, improve access to appropriate, effective mental health and addictions effective mental health and addictions services for Aboriginal peoples. services for Aboriginal peoples.

Methodology: Critical Methodology: Critical EthnographyEthnography

Data collected at urban health Data collected at urban health and mental health care agencies: and mental health care agencies:

•In-depth interviews and focus In-depth interviews and focus group discussions with clients group discussions with clients (n (n = 42) = 42)

•In-depth interviews with In-depth interviews with healthcare workers healthcare workers (n=23) (n=23)

•Observations in health care Observations in health care settingssettings

•Analysis of organizational policiesAnalysis of organizational policies

Presenting IssuesPresenting Issues

• Schizoaffective disorderSchizoaffective disorder• Mood disorders Mood disorders • DepressionDepression• AnxietyAnxiety• Suicidal ideationSuicidal ideation• Alcohol and drug useAlcohol and drug use• HIV, Hepatitis CHIV, Hepatitis C• Residential School HistoryResidential School History• All clients had a history of All clients had a history of complex traumacomplex trauma

Findings: Findings: The Significance of Relational The Significance of Relational

Practices…Practices…

Client: “She lets me know that [if Client: “She lets me know that [if she cares] by asking about me she cares] by asking about me when I’m not around, stuff like when I’m not around, stuff like that, she asks my outreach that, she asks my outreach worker”….. worker”…..

““I like when she asks me about my I like when she asks me about my traditional practicestraditional practices – they are – they are very important to me” very important to me”

Everyday Encounters Everyday Encounters ……

““Within the system there is Within the system there is some prejudice people in some prejudice people in there and I try not to get too there and I try not to get too mad with them when I find mad with them when I find out that they’re prejudice, out that they’re prejudice, they don’t like Natives and they don’t like Natives and they don’t like drug addicts” they don’t like drug addicts” (C)(C)

Powerful intersecting oppressive Powerful intersecting oppressive forces: race x gender x class x forces: race x gender x class x ability …ability …

Points to the need for: Points to the need for: Decolonizing PracticesDecolonizing Practices

Ideologies and StigmaIdeologies and Stigma

Interviewer: “Why didn’t you get checked out?”

Client: I’ve already got HIV, now Client: I’ve already got HIV, now I’m crazy too?” I’m crazy too?”

Internalized StigmaInternalized Stigma

Mediating Influences: The Mediating Influences: The Impact of Social Conditions Impact of Social Conditions

Client: “There must be Client: “There must be something wrong with something wrong with me, I won’t go shower, I me, I won’t go shower, I take sponge baths in my take sponge baths in my room… the hotel is so room… the hotel is so skungy…we share a skungy…we share a bathroom…like if its bathroom…like if its catchable…” catchable…”

““When I get sick, When I get sick, nobody comes to see me, nobody comes to see me, I literally sit there and I literally sit there and starve for a couple of starve for a couple of days.” days.”

…….Mediating Influences.Mediating InfluencesHealthcare provider: …He always Healthcare provider: …He always writes on the walls and so [name of writes on the walls and so [name of housing official] said, okay, well, housing official] said, okay, well, maybe if you just use pencil instead maybe if you just use pencil instead of felt pen what do you think of of felt pen what do you think of that... that...

So its always options… And he So its always options… And he wrote one word on the wall [when wrote one word on the wall [when he first arrived in his new place] he first arrived in his new place] and it was ‘comfort’…Out of his and it was ‘comfort’…Out of his brain that’s not working very well, brain that’s not working very well, and he uses far less drugs and he and he uses far less drugs and he eats regularly now.eats regularly now.

What is needed: What is needed: Shifts in Practices and PoliciesShifts in Practices and Policies

• Shifting the focus of analysis away Shifting the focus of analysis away from cultural characteristics or from cultural characteristics or cultural differences onto the cultural differences onto the culture culture of health careof health care, , and how practice, and how practice, research and policies can themselves research and policies can themselves create marginalizing conditions and create marginalizing conditions and inequities.inequities.