Research Snapshot: Three key intervention components that improve mental health outcomes of First Nations, Inuit, and Métis peoples in Canada

What you need to know

First Nations, Inuit, and Métis (FNIM) people in Canada report higher rates of anxiety, depression, and attempted suicide compared with non-Indigenous people. Mental health disparities exist further within FNIM populations, including those living on reserves compared to urban areas. There is a need to develop and deliver culturally based programs designed specifically for FNIM peoples in Canada. Most program addressing poor mental health have come from Western science and these have provided benefits, however the researchers examined if programs designed by or for Indigenous communities provided additional benefits that could compliment Western approaches. This review identified three components that improve the mental health outcomes of FNIM peoples in Canada. These include:

  1. culturally grounded indoor and outdoor activities
  2. Elder and peer mentorship, and 
  3. participating in collective activities with other Indigenous peers and an Elder, including ceremony, being on land, engaging in traditional food gathering.

 

This Research Snapshot is based on the article, “Mental health interventions for First Nations, Inuit, and Métis peoples in Canada: A systematic review” which was published in The International Indigenous Policy Journal, in 2021. https://doi.org/10.18584/iipj.2021.12.2.10820 

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

What is this research about?

Most mental health interventions are approaches based on Western scientific principles that do not consider intergenerational trauma brought on by settler colonialism. Culturally specific interventions that are holistic, grounded in Indigenous Knowledges and ways of being, trauma informed, and focused on “culture as treatment” have benefits to reduce trauma and improve  overall mental health and wellbeing. 

This review summarizes the research on interventions  designed by or for Indigenous Peoples in Canada that have improved the mental health of FNIM peoples. Three effective components of mental health interventions for Indigenous Peoples are identified. 

What did the researchers do?

Researchers searched MEDLINE, PubMed, PsycINFO, and Web of Science for peer reviewed studies published between January 1, 1970, and August 30, 2019. They focused on interventions addressing anxiety, depression, or suicidal thoughts or attempts among Status First Nations, non-Status First Nations, Inuit, and/or Métis peoples. 

Of 14 studies included, 11 were cross-sectional studies that compared symptoms before and after an intervention. One was a prospective cohort study, four conducted one-on-one interviews, one conducted focus groups, and one used snowball sampling methods (a technique that involves research participants in identifying other participants /their peers). 

Five studies focused on urban geographical locations, five were non-urban, and four included various types of locations. Eight of the studies included First Nations peoples and five included a mix of First Nations, Inuit, and Métis people. Six of the 14 studies involved participants younger than 18 years.

What did the researchers find?

This systematic review supports the concept of ‘culture as treatment’. The three main intervention components identified are described below. Although these are not new concepts for Indigenous Peoples, this study highlights that these interventions can play a role in reducing anxiety, depression, and suicidal thoughts. 

While the authors acknowledge that Western approaches can help to reduce poor mental health outcomes, this review highlights that adding culture to existing treatment programs has added benefits for improving mental health outcomes especially with Indigenous peoples in Canada. 

Culturally grounded indoor and outdoor activities

Activities in this category included retreats, ceremonies, Indigenous language study and cultural camps that include traditional food gathering techniques, language, survival techniques, and clan affiliation. Cultural activities that had a strong Indigenous component seemed to provide some benefits in reducing anxiety, depression, or suicidal thoughts. Qualitative results also support the benefits of an intervention that involves engaging in culturally grounded activities together. 

Qualitative studies were able to ask participants about the culturally grounded activities. These included, Women and young girls who participated in a seven week culturally grounded program began to characterize themselves as “strong, capable caregivers who guide their girls as they made decisions.”  A participant in a culturally based camp said, “After the camp I felt very good, like I learned more about what culture is and who I actually am”. Another participant said, “I used to be ashamed of being Native and now I’m not…so yeah, it made me happy for who I am and where I come from”.

Elder or peer-to-peer mentorship

Some studies paired an Indigenous Elder with a young person. For example, a study by Crooks et al. (2017) compared one group of young people who were mentored by an Indigenous Elder compared to another group of young people who were not. Over a two-year period, the group that was mentored by an Elder had better mental health scores. The mentorship group also increased cultural identity compared to those without a mentor. Indigenous participants who participated in a mentoring program said, “It feels like they understand what I am trying to say”, “When you don’t feel comfortable it’s okay . . . you can tell them”. Men who participated in a culturally based program reported an increase in feelings of trust, trusting others with their health, and connectedness to their culture.

Group activities with other Indigenous people and an Elder

These activities included non-competitive games, sharing a meal, discussion circles, and the Medicine Wheel. Involvement of Indigenous Elders seemed to provide a safe space to talk, be heard, and feel like someone was listening. By having an Elder to connect with, participants seemed to feel less alone and they valued the added cultural connection. This connection with Elders, other Indigenous people, and their shared culture seemed to change the participants’ negative mental health state and made them feel included and wanted. Statements from participants included, “It feels like they understand what I am trying to say”, “When you don’t feel comfortable it’s okay . . . you can tell them [Elders]” and “friends are complimenting me on stuff, and it’s making me feel better about myself.”

How can you use this research?

Groundwork to establish relationships is required

Studies found it challenging to recruit Inuit and Métis participants, so they often recruited First Nations people to reach their sample size targets or at the request of the community. This suggests that groundwork is needed early in the project to engage with Indigenous communities in order to understand the community’s needs and expectations, and to set up an effective recruitment approach with the community’s involvement. Considering the high demand for mental health interventions that respect and honour Indigenous Ways of Knowing, it is also integral that mental health interventions do the groundwork to establish relationships with the communities they hope to work with to deliver an intervention.

Future research and interventions

Future research should focus on examining the needs of subpopulations within Indigenous communities, including urban or off-reserve populations, young people, women and girls, men, and Inuit and Métis communities. 
 
There is also a need to look at the grey literature to obtain a richer understanding of culture-based interventions and initiatives designed and led by Indigenous communities.

Policy implications

Existing mental health policy and practice should incorporate an Indigenous lens and ”culture as treatment” to achieve better mental health outcomes. Further funding and policy is required to support and strengthen the evidence base of interventions to improve the mental health of Indigenous and non-Indigenous people in Canada.

About the researchers

Simon Graham, Office of the Chief Medical Officer, First Nations Health Authority, Vancouver, Canada, and Department of Infectious Diseases, The Peter Doherty Institute, University of Melbourne, Australia 

Krista Stelkia, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada 

Cornelia Wieman, Office of the Chief Medical Officer, First Nations Health Authority,  Vancouver, British Columbia, Canada 

Evan Adams, Chief Medical Officer First Nations Health Authority,  Vancouver, British Columbia, Canada