“What will improve practice in mental health and addiction services for all Canadians?” is the central question in this project. To find answers to this question, focus groups were conducted in Western Canada with practitioners and recipients of services, approximately two thirds of them aboriginal, one third non-aboriginal, the majority working in aboriginal-led organizations serving indigenous people. The focus on mainly aboriginal agencies, their staff and clients, was intentional. Historically, health care in Canada has been dominated by the illness and health belief systems of the dominant culture and has disregarded those of Indigenous people for whom health outcomes have been poor. Constructive ways to address these health inequities are a timely priority.

Methodology

The Western focus groups were held in Saskatoon, Winnipeg, Iqaluit, Yellowknife, and Whitehorse in late 2009. A total of 147 people participated. 95 identified themselves as indigenous (22 Inuit and 75 First Nations or Métis), and 50 non-indigenous. Those in provider roles equalled 108 and those with lived experience 39. One in six people reported having gone through their own healing journey, with or without formal assistance, to evolve into care providers themselves.

Discussions were grounded in an overview of the project context. Facilitators explained that the initiative is intended to contribute to the joint efforts of the FNIM AC within the MHCC, the NMHAC, and the MDSC to further the understanding of culturally safe practice in mental health and addictions.

Through a process of circle dialogue and storytelling, participants reflected on their experiences with mental health and addictions services, what was working, what was not working, and what could be improved. Participant concerns led the emergent discussion and spoke to the unique characteristics of group members with respect to their geographical location, the types of services and systems they dealt with, to their challenges, and ways of addressing these. Sessions were audio recorded and transcribed, and resulted in 583 pages of rich material.

Five members of the FNIM AC cultural safety working-group (including the two facilitators) studied the transcripts and shared the process of “making meaning” of the transcribed information, identifying emerging themes and potential framing metaphors.

The first meeting of the working group resulted in a shared vision of the intent and design of this report. Given the complexities of current mental health and addictions challenges, and the multiplicities within society, the group saw the value of the report to inhere in its ability to open a dialogic space between as many people as possible and to invite them to engage, reflect and work together to arrive at new understandings from which fresh solutions can emerge. To achieve this, the approach taken in analyzing the transcripts was an emergent, collaborative one, in which meanings were negotiated in group discussion, patterns sought, and complexities maintained. The group continued to meet, either in person or through teleconference, to deepen their understanding and analysis.

Findings

Six overlapping categories were developed to capture the emerging themes and organize research findings: direct care; interpersonal relations; professional development; ways of knowing; organizational context; and policy:

1. Direct care refers to the qualities of the care provider/care recipient relationship. As viewed by participants, the relationship needs to be accessible, inclusive of the disabled, respectful and responsive to the uniqueness of each individual, strengths focused, flexible, trauma informed, acknowledging of grief, and making use of human connection in healing.
2. Interpersonal relations refers to the range of relational networks and formal and informal supports in which both the care provider and recipient are embedded, including relationships with families, community members, colleagues, peers, mentors, supervisors, other service providers and agencies. Participants emphasized the importance of reciprocity and dialogue, support for self-care, self-awareness and conscious growth, and the necessity for circles of support for both care provider and care recipient.
3. Professional development refers to the informal, non-formal, and formal knowledge and skill development received by professionals in the course of their training to become a mental health practitioner, as well as the multiple life experiences and cultural practices that care providers draw upon in their work. On this topic, participants shared insights about informal, non-formal and formal education/training, mentoring, lived experience, balance and harmony, and wisdom teachings.
4. Ways of knowing refers to the approaches taken to understand, document and make sense of the social world. Themes related to ways of knowing that emerged in the focus groups are best captured by “all my relations”, cultural continuity, the power of story, and tensions between Western and Indigenous ways.
5. Organizational context refers to workplace norms, policies, resources, agency mandates and professional routines. Participants spoke about organizational norms, centralization vs. decentralization, integration of services, family and community context, and healthy effective organizations.
6. Policy challenges refer to government legislation, policies, and funding. Significant challenges identified in the focus groups include the tension between individual and collective rights, between biomedical and complementary approaches, and concerns about the capacity for response to ethical dilemmas.

The Western Canada focus group team identified some examples of what seems to work, to make a positive difference in the lives of community members with mental health and/or addiction challenges.

1. Wellness Centre (Winnipeg). This is a multi-purpose Aboriginal community centre in an urban area that offers among other services, healing, educational, and work preparation activities that foster ongoing involvement. Everywhere you look, you see things that are familiar to the populations being served. Most people in the centre are indigenous and therefore “like me”, signs and names on the directory and offices are familiar, and pictures and sounds in the spaces resonate warmth. Core values of the people are honoured.
2. Inuit Friendship Centre (Iqaluit). This is a home away from home for “homeless” Inuit, and others. Food from the land is brought in each day by designated hunters, and is always available for those desiring something to eat. Two senior Inuit people serve as hosts/support/ counsellors and visitors are welcome to make themselves comfortable. The centre has no intake process and no one is there to “dig” for personal information. The centre is warm, relaxing and comfortably furnished. During our visit people were watching TV, reading, talking quietly, and playing checkers and/or cards. Financial support from the Aboriginal Healing Foundation makes this resource available and accessible.
3. Women’s Retreat Centre (Yellowknife). This centre offers a variety of programs tailored to meet needs of the residents (mostly Inuit). Core staff members are “grads” of the centre’s healing program, not people with graduate degrees or conventional equivalents. They share an unfailing belief in the ability of the women to modify themselves. This valued resource is not government funded. The team conducted a focus group with 15 women of this centre. The team discovered that life as a homeless person resembles traditional ways of surviving: through mutual support.
4. White Buffalo Youth Centre (Saskatoon). This is a truly unique resource dedicated to serving Aboriginal and other youth. The centre’s staff members facilitate engagement of newcomers into a wide range of sports and other activities. Only information necessary to satisfy safety essentials is collected; no personal profiles or inventories are done. Youth are welcomed into an accepting, supportive community that includes legal, dental, medical, educational and personal support services. While this youth centre receives no direct government funding, it does receive indirect government funding through the local school board, the university law school, the health authority etcetera, each of which make services available on site, with the centre providing the work space. The Director spends most of her time writing for grants and searching for donations.
5. In-House Correctional Program (Yellowknife). The worker responsible for this program employs what he learned and what worked for him to assist “inmates” to become increasingly self-caring and self-determining. His father and grandfather transmitted to him key aspects of his education and training before he entered the residential school. This proud Aboriginal correctional worker has a strong positive presence and enjoys considerable satisfaction from his work. People with lived life experience that enjoy health and wellness possess knowledge and skills to assist others like themselves, and have a commitment to them that makes a positive difference.
6. Dene “Return to the Land” Program (Yellowknife). This community has invested in “return to the land” programs because they do a great deal to bring the community together. People learn together, work together, develop trusting interdependent relationships and community-building skills while finding ways and means to satisfy shelter needs, supply and prepare food, and so on. When included in the program, people from the “homeless” sector in the town, often provide leadership that is highly valued.

A full copy of the Western Canada focus groups is enclosed as Schedule “C”.