Building Bridges 2 – A Pathway to Cultural Safety, Relational Practice and Social Inclusion

Eastern Canada Focus Groups

This report summarizes the findings from 14 focus groups held in Eastern Canada between November 2009 and January 2010. Focus groups were conducted in Halifax, Moncton, St. John’s, Montreal, North Bay and Sudbury. Participants included Aboriginal and non-Aboriginal consumers, family members/caregivers and service providers. The purpose of the discussions was to further knowledge and understanding of what happens when people attempt to access mental health and/or addictions services, what happens when they succeed in accessing services, what makes them feel safe and comfortable or not with the services, and what actions they take to protect and promote their own mental health. A full copy of the Eastern Canada focus groups is enclosed as Schedule “D”.

What brings people to mental health and/or addictions services?

There are many reasons why people seek mental health or addiction services. Frequently, help-seeking is precipitated by some sort of crisis. The most frequently mentioned issues were serious depression and substance abuse or substance abuse combined with a mental health problem. Close to one-third of consumers reported a history of physical and/or sexual abuse. A majority of the Aboriginal consumers have been abused and in many cases this abuse was systemic, severe, and institutional in nature, i.e. it occurred over long periods of time in foster care, group homes and residential schools.

What happens when people attempt to access services?

The easiest place to access services so far for me has been jail.
– Aboriginal Consumer, Halifax, Nova Scotia

Very few consumers found it easy to access services. Oftentimes, people simply do not know how to access mental health or addictions services. Many find the multitude of services and the differing mandates of organizations very confusing. Because they are unaware of the options, family members often end up taking their loved ones to hospital emergency departments.

When people do get access to services, the services they need are often unavailable, limited in availability or difficult to access for other reasons. In some areas there is a serious shortage of family physicians/general practitioners. Psychiatric services are limited almost everywhere, however, especially with respect to community-based psychiatrists (outside the hospital system) and more so in rural/remote areas and small communities. This means that people needing help are often forced to rely on hospital-based emergency services.

Services for people with concurrent disorders (mental health and addictions) are extremely difficult to access. Non-medical services such as psychotherapy are also difficult to access unless people can get them through work or can afford to pay for them out-of-pocket. Services for trauma-based issues are sparse; this includes services to treat Post-traumatic Stress Disorder (PTSD) and the inter-generational trauma of Aboriginal people.

…the medical system doesn’t do well with trauma: childhood sexual abuse or PTSD for any reasons, like vets coming back from Afghanistan… In my opinion, it’s because nobody is trained in the system to deal with these types of issues.
– Service Provider, Halifax, Nova Scotia

I was told that residential school trauma has nothing to do with the problems of today – they [mainstream service providers] don’t understand the intergenerational trauma.
– First Nation Services Provider, New Brunswick

Culturally sensitive and safe services are in short supply for newcomers and for Aboriginal people. For those who speak a language other than English or French, supports such as translators and written information in their language are hard to access.

When mental health and/or addictions services are available, consumers and family members often encounter long wait times. The need for more timely access is most acute in rural/remote areas but it still exists in larger cities. Even when people are in crisis, they often experience long waits for service.

The only way to get in [to mental health services] is if you threaten to kill yourself. And even then you will have to wait.
– Consumers, North Bay, Ontario

What happens once people succeed in accessing services?

Unfortunately, it is not uncommon for people to have negative experiences when entering the system of services. Entry points where people most frequently report experiencing poor treatment include crisis services and hospital emergency rooms. Issues identified with entering the system of services include:

  • Over-use of police and security guards due to perceptions that people with mental health issues are potentially dangerous.
  • Lack of adequate training for police to provide effective support for people in crisis.
  • Long wait times in environments that do not feel safe or comfortable.
  • Being turned away when there is a clear need for admission.
  • Being treated disrespectfully by staff.

A friend of mine went to Emergency – she knew her own symptoms – and they sent her home. Finally she called someone in her building for help and this person called Mobile Crisis Intervention. They put her in cuffs and brought her to hospital, which put her in an isolation room. She lost everything including her apartment and it took her six months to recover.
– Consumer, Halifax, Nova Scotia

Once inside the formal mental health or addictions service systems, many consumers have had negative experiences with the system including:

  • Being misdiagnosed or having to wait years for an accurate diagnosis.
  • Being diagnosed with no consideration of the individual’s lived experience and current life context, including his or her culture.
  • Being treated like a label rather than a whole person.
  • Feeling judged and “looked down on”.
  • Having their complaints ignored or dismissed.

Because we have no focus on the Aboriginal population as a unique and different culture, when they come into the hospital psychiatrists are diagnosing, not in the context of culture, history, family dynamics. People are diagnosed with very serious mental illness and put on heavy medication which may or may not be appropriate.
– Aboriginal Service Provider, Sudbury, Ontario

They process people like numbers. If you have cancer they will hold your hand; if you lose your foot they will be there to help you learn to walk again. If you have mental health issues, they just send you out on the street – you get no support.
– Aboriginal Consumer, Halifax, Nova Scotia

People who have addictions, are poor or are Aboriginal are especially likely to feel judged and stigmatized and to experience discrimination from mental health service providers.

I’m lucky that I’m not on pills or alcohol but when we First Nations people go for services, they assume we are all alcoholics. One doctor asked me if I ever drink, which I did, occasionally and moderately, and he put in my chart that I was an alcoholic.
– Aboriginal Consumer, First Nation, New Brunswick

Participants from every focus group spoke about significant problems with the formal system of services for mental health and addictions. First, models of service provision are too narrowly biomedical in nature and place too much emphasis on psychiatric medications. This is particularly problematic for Aboriginal people, many of whom are still struggling with racism and the lingering effects of colonization including the loss of culture, the residential school experience and intergenerational trauma, all of which they see as the root causes of their mental health and addictions problems.

Everything can’t be fixed with a pill.
– Consumer, North Bay, Ontario

The lack of connection is the problem with mainstream service providers: they bring a linear perspective to everything they are doing instead of seeing how things are connected. Things are circular – when you’re having a problem, there are all sorts of causes for it. The lack of humility of service providers is staggering. There are ways of dealing with problems that are better. There are a lot of problems with the psychiatric drugs. They have bad side effects and are hard to get off. People need support structures, the medicine wheel. These can affect the mind and body just as much if not more than psychiatric drugs. There’s no orthodox description of how these things are curative, but they are.
– Aboriginal Consumer/Service Provider, Halifax, Nova Scotia

Second, services are not holistic or recovery oriented, do not recognize the multiple underlying factors that cause illness, and are often experienced as cold and inhumane. This is particularly evident in psychiatric in-patient facilities.

When I was admitted to hospital for anxiety and panic, I was diagnosed with psychosis. All they wanted to do was pump me full of drugs and stick me in a room…I had no sense of being helped there. There was no communication and no one to talk to.
– Aboriginal Consumer, Sudbury, Ontario

Third, services are fragmented and uncoordinated. Consumers with multiple needs are often bounced around from one service to another, they have to tell their stories again and again to each new service provider, and there is no continuity of care.

Finally, there is a significant gap between the formal health system and community organizations, such as those that offer self-help and peer support programs. People often stumble across these supports on their own, having failed to receive any information about them from health care providers.

What makes people feel safe?

I just want to be treated with respect.
– Consumer, North Bay, Ontario

Many of the focus group participants spoke of feeling safe when they accessed a service provider who was kind, compassionate, accepting and respectful. This creates a sense of trust and helps to make consumers feel cared for and cared about. Consumers also feel safe if they receive information from service providers that can assist them in making their own decisions.

I need someone who… sees me as a person, who explains to me why she is prescribing what she is prescribing, tells me why she is giving me this one rather than that one, talks to me about the side effects.
– Consumer, Montreal, Quebec

Coordinated services and continuity of care help to make consumers and family members feel safe. They want service providers to work with them, using a team approach. Participants suggested that mental health and addictions services should be coordinated and that they should also be coordinated with other needed services and supports such as community support programs, housing and income security programs.

For many consumers, support from people who understand their experiences is critical in helping them to feel safe and to begin to recover. A few have received this kind of support within the formal system of services. Most, however, are more apt to get this kind of support from community organizations, especially from those that offer peer support and self-help.