1. Dr. Margo Greenwood, NCCAH
Indigenous Perspectives in Mental Wellness Promotion: Opportunities for Public Health Action
Dr. Margo Greenwood, NCCAH
PMHP Forum – Feb 28-March 1, 2018

2. Declaration of real or potential conflicts of interest
Presenter: Margo Greenwood I have no real or potential conflict of interest related to the material that is being presented today.
Malcolm’s Lancet article (2009) good health is defined as “A balance of the mental, physical, spiritual, and emotional dimensions of self and the ability to live in harmony with family, community, nature, and the environment”
AFN /Health Canada definition of mental wellness continuum is long “this balance is “enriched as individuals have a sense of purpose in their daily lives whether it is through education, employment, care giving activities, or cultural ways of being and doing; hope for the future and those of their families that is grounded in a sense of identity, unique Indigenous values, and having a belief in spirit; a sense of belonging and connectedness within their family and community and to culture; and finally a sense of meaning and an understanding of how their lives and those of their families and communities are part of creation and a rich history”
ITK defines mental wellness as: “Self esteem and personal dignity flowing from harmonious physical, emotional, mental and spiritual wellness and cultural identity” (ITK, 2014)

3. Indigenous Concepts of Health and Wellness
“ A balance of the mental, physical, spiritual, and emotional dimensions of self and the ability to live in harmony with family, community, nature, and the environment” (King, Smith, Gracey, Lancet, 2009)
“Self esteem and personal dignity flowing from harmonious physical, emotional, mental and spiritual wellness and cultural identity” (ITK, 2014)
Malcolm’s Lancet article (2009) good health is defined as “A balance of the mental, physical, spiritual, and emotional dimensions of self and the ability to live in harmony with family, community, nature, and the environment”
AFN /Health Canada definition of mental wellness continuum is long “this balance is “enriched as individuals have a sense of purpose in their daily lives whether it is through education, employment, care giving activities, or cultural ways of being and doing; hope for the future and those of their families that is grounded in a sense of identity, unique Indigenous values, and having a belief in spirit; a sense of belonging and connectedness within their family and community and to culture; and finally a sense of meaning and an understanding of how their lives and those of their families and communities are part of creation and a rich history”
ITK defines mental wellness as: “Self esteem and personal dignity flowing from harmonious physical, emotional, mental and spiritual wellness and cultural identity” (ITK, 2014)

4. Indigenous Children and Youth
Disproportionate burden of ill-health
Data limitations
Culturally relevant indicators
Jurisdictional barriers - surveillance
Geographic and demographic representation
Emphasis on disease and illness, not wellness and prevention
BURDEN: Indigenous children and youth experience significant health and social disparities, with higher rates of injury, infant mortality, suicide, and chronic and infectious diseases
STATS: Indigenous children aged 14 and under account for 28% of the total Indigenous population (compared to 16.5% of the non-Indigenous population), while Indigenous youth aged 15 to 24 represent 18.2% of the total Indigenous population (compared to 12.9% of the total non-Indigenous population). Inuit are the most youthful of the three Indigenous groups with a median age of 23, followed by 26 for First Nations, and 31 for Métis (Statistics Canada, 2013).
DATA LIMITATIONS - limited by the quality and coverage of data, a lack of culturally relevant health indicators, and jurisdictional barriers associated with Indigenous status and geography; emphasis on Indigenous children’s disease and illness outcomes, rather than preventative and wellness measures; discrepancies in both geographic and demographic representation, with a dearth of research on youth in the Prairie and Atlantic provinces and the Northern Territories, as well as a significant under-representation of Métis and urban Indigenous youth health research

5. Mental Health Challenges and Strengths
Vary immensely among communities and individuals
Reflects distinctiveness of First Nations, Inuit and Metis worldviews and experiences
Determinants of health intersect and manifest differently across lifespan and generations
Knowledge
Gaps
Gender differences and transitions to adulthood
LGBTQ2S populations
Transgenerational impacts of residential schools
Ongoing adversity

6. Beyond the Social
Indigenous knowledges and ways of being as the primary frame of reference for understanding Indigenous health realities
Colonialism as an “active and ongoing” force in lives of Indigenous peoples

7. Protective Factors
Attributes or conditions at the individual, family, community of societal level than promote resilience and decrease risk factors
Community
Cultural continuity
Self-government
Band control of services
Culture and language
Identity
Individual
Self-reliance
Self-confidence
Community involvement
Mentorship
Kim and community relationships

8. Characteristics of Successful Mental Health Promotion
Indigenous Concepts
Holistic
Incorporate Indigenous values, knowledges, cultural practices
Indigenous Contexts
Address underlying determinants
Emphasize strengths and resilience
Focus on protective factors
Indigenous Processes
Community-driven and owned
Build capacity and leadership
Meaningfully engage children, youth, families and communities

9. Public Health Roles
Talk to Indigenous peoples and organizations to learn about their diverse perspectives on mental wellness (Boska et al, 2015)
Learn about the social and cultural contexts of Indigenous communities (Boska et al, 2015)
Commit to providing culturally-safe care
Support Indigenous mental wellness workers
Advocate for Indigenous heath equity
Understand programs must be guided by local Indigenous knowledges
Share knowledge on promising practices in Indigenous communites

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