Building Bridges 2 – A Pathway to Cultural Safety, Relational Practice and Social Inclusion
Executive Summary
The Native Mental Health Association of Canada (NMHAC) and the Mood Disorders Society of Canada (MDSC) have a rich history of working collaboratively and sharing their respective expertise in regard to “what works” and “what does not work” in mental health and addictions programs and services. Groundbreaking national initiatives comparing and contrasting similarities and differences between their indigenous and non-indigenous constituents, along with finding common ground and identifying goals for future collaboration, served as the pillars of this unique and effective partnership in Canada.
Aboriginal people and consumers need holistic and relational models of care to develop a sense of belonging and to support their recover y from mental health problems and addictions. These problems do not arise in a vacuum; they emerge within the context of each person’s life history, individual strengths and challenges, current life circumstances and stressors, and they are often inter-related. Healing cannot happen unless people feel safe. People feel safe when service providers view them as whole persons rather than disease entities and treat them with compassion, empathy and respect. Unfortunately, mainstream services do not function in a holistic way and current approaches to training health professionals seem to be lacking in this regard.
For Aboriginal people, the concept of cultural safety is central to developing effective models of holistic care and relational practice. Cultural safety focuses on understanding how structural inequities, systems of health care and dominant health practices affect the health status of minority and Indigenous people, and how a critical examination of these can shift attitudes and result in the development of systems and practices of health care that are more supportive of marginalized groups and their specific needs. These concepts are of great value for transforming service delivery models and restoring good ways of providing mental health and addictions services for (and with) Aboriginal people in Canada. As an example, the Western Canada Focus Group report shows how ideas of cultural safety and relational practice can lead to holistic and effective models of service delivery for Aboriginal people.
Our research and extensive national consultation processes, inform us that these concepts speak to us all—Aboriginal, non-Aboriginal, consumer, family member, service provider or policymaker. We all need to critically reflect on our culture: on what it values and devalues, what it believes and assumes, and what these bring to the table and leave behind for mental health and addictions services. The capacity for critical analysis can be learned, and it has been conceptualized as the highest level of health literacy.
In an effort aimed at modifying the status quo and ensuring that the Canadian mental health and addictions systems respond appropriately to the needs of First Nations, Inuit and Métis and other mental health and addictions consumers and their caregivers, the NMHAC and the MDSC launched Building Bridges 2: A Pathway to Cultural Safety project in April 2009. In keeping with their initial Building Bridges Project (2008/2009), both the NMHAC and the MDSC engaged in dialogue with their respective First Nations, Inuit and Métis communities and provincial Mood Disorders Associations and other provincial and local consumer networks regarding the notion of cultural safety, relational practice, social inclusion and attendant practices that support mental health and well-being.
The two national NGOs have researched and analyzed cultural safety within the context of the Canadian population with specific reference to Aboriginal peoples and mental health consumers. The partners have also collectively developed a comprehensive planning framework on cultural safety and relational practice which will enhance the ability of healthcare providers and others to deal more effectively with major structural and relational issues and barriers facing indigenous and non-indigenous communities.
As part of their Building Bridges 2 initiative, MDSC and the NMHAC collaborated with the First Nations, Inuit and Métis Advisory Committee (FNIMAC) to the Mental Health Commission of Canada (MHCC) in a joint research project to understand best and promising practices that constitute cultural safety and relational practice in the Canadian context. In 2009, they commissioned a total of forty-seven focus groups in Western, Northern and Eastern Canada, a national symposium in Ottawa in 2010, and two research papers, one on social inclusion, the other on cultural safety and relational practice. The focus groups and symposium were designed to capture the voices of those with the most direct experience and knowledge of mental health and addictions services: service providers, service recipients, and family members/caregivers.
The symposium participants emphasized the need to critically analyze the explicit and implicit values and beliefs of the dominant culture, to understand how these underlie decisions about policies and practices that shape health services, and to undertake collective action to “bring others into the circle.” In addition, they agreed that individuals need to reflect on their own assumptions and biases and on how these shape their interactions with others. Participants spoke of the need to “walk the talk”—to lead by example, to effect change from the bottom up, to adopt a critical lens of self-reflection and to open oneself to vulnerability. Participants were aboriginal and non-aboriginal, from government, non-government, and indigenous organizations, as well as community members.
In addition, the partners developed a communications tool in the form of a powerful and compelling professionally produced video entitled ‘Glimpses of Light’, which has already been used extensively in Canada and internationally to stimulate discussion on strategic issues related to cultural safety and relational practice in Canada.
This report also provides an overview of the mental health and well-being of First Nations, Inuit and Métis in Canada in the context of colonial and neo-colonial processes and polices in which mental health and addiction services have been and continue to be provided to First Nations, Inuit and Métis, i.e., why the need for cultural safety. Then we move on to highlight the possibilities, i.e., how cultural safety could be used to create a space for critical reflection and dialogue within the mental health and addictions systems, a dialogue that would lead to action, improved mental well-being for all Aboriginal peoples and Canadian consumers and health equity for all people in Canada. Lastly, we engage with the concept of cultural safety as a means to support social justice and the mental well-being of First Nations, Inuit and Métis in Canada.
Concepts of cultural safety and relational practice are particularly valuable for Aboriginal people, because they encourage health care providers, policymakers, and organizations to reflect critically on issues of racialization, institutionalized discrimination, culturalism, and health and health care inequities, and the root causes and conditions that give rise to mental health and addictions issues among Aboriginal populations; and to recognize that peoples’ experiences, including health and illness experiences, are shaped by the contextual features of their lives – social, historical, political, cultural, and geographic, as well as by other factors such as age, gender, class, ability, biology and so on. (Cultural Safety research paper).
In response to the major emerging themes contained within this report, a total of 17 major recommendations for future action have been advanced covering the following components:
- Building and Exchanging Knowledge
- Generating System Change through Knowledge Development
- Enhancing Education and Training
- Supporting Good Policy Development
- Supporting Effective Program / Service Development