At this stage of our SC, we were most interested in a review of health policy, and professional and scientific research related to Indigenous Peoples and Mental Health and Substance Use (MHSU) in the context of the COVID-19 pandemic . How social, economic, structural and systemic inequalities affect the mental health of indigenous peoples. In this context, substance use issues and related mental health issues continue to be some of the most visible and dramatic symptoms of these underlying challenges.
In addition, it recognizes that community development and capacity building are central to more self-directed substance use and mental health services and support. Data from the RHS Phase 3 (FNIGC, 2018) indicate several strengths and gaps in mental health and addiction indicators. The RHS Phase 3 survey results indicated that 70.9% of First Nations adults had never accessed any mental health services.
Rates of First Nations children's access to mental health diagnoses and treatments are difficult to interpret. Information regarding the use of indigenous healers and their perceived efficacy for treating mental health and substance use disorders warrants further attention in health survey research.
Previous experiences of contagious disease
The authors found that almost all participants identified good health as being happy, energetic and stable. Additionally, the authors found that participants' family and friends were helpful in helping them search. The authors argue that the Canadian health care system must address the social determinants of health and the colonial legacy that continues to disrupt effective communication between them.
The authors concluded that this was due to poor living conditions (overcrowding, limited access to clean water, wood burning), poverty and due to limited access to health care (as many lived in rural areas). Furthermore, the authors argue that the pneumococcal vaccine should be prioritized within this region and community. The authors found that younger people were disproportionately affected by the virus and that various social determinants of health such as “access to household water, household.
Social Determinants of Health and impacts on mental health
The authors also argue for indigenous food sovereignty (IFS), “specifically with regard to cultural foods” (Cidro et al., 2015, p. 26). Participants in this study were from the inner city “including downtown Winnipeg and the north end” (Cidro et al., 2015, p. 33). In addition, “ten interviews were conducted with participants answering similar questions” – all “interviews transcribed and coded” (Cidro et al., 2015, p. 33).
The study found that not only were "indigenous people in the city [experiencing] food insecurity, but they were also working towards the larger goals of what is called Indigenous Food Sovereignty (IFS)" (Cidro et al., 2015, p. 26). Participants identified three areas “as important to Indigenous food security in Winnipeg” (Cidro et al., 2015, p. 33). The three areas identified include: "(1) growing, harvesting, preparing and eating cultural food as ceremony, (2) cultural food as part of connecting to the land through reciprocity, and (3) relearning IFS practices to address food insecurity" (Cidro et al., 2015, p. 33).
Even if I worked at McDonalds, I would still have exactly the same access to traditional foods” (Cidro et al., 2015, p. 36). Researchers argue that there was a “decrease in the availability and/or use of traditional foods” due to the introduction of European foods after the settlement of Europe (Gendron et al., 2016, p. 809). By re-teaching and re-introducing indigenous or traditional food practices into the community, researchers suggest that “[food practices and networks] could be revived in the future (Gendron et al., 2016, p. 809).
Workshops would include traditional foods and drinks and were open to “12-15 people from Regina and surrounding areas” (Gendron et al., 2016, p. 810). After participating in the workshops, participants completed a survey “to evaluate their knowledge of traditional food” (Gendron et al., 2016, p. 810). An example of a closed question asked was: “the workshop provided me with new tools/knowledge that will be useful in my everyday life” (Gendron et al., 2016, p. 811).
As for the community garden, of the 24 garden beds available “four gardeners grew their produce in five plots” (Gendron et al., 2016, p. 810).
Gendered Experiences of Indigenous Mental Health
Aboriginal women are generally less likely than their non-Aboriginal counterparts to be part of the paid workforce. The proportion of Aboriginal women working in these sectors (60%) was slightly higher than the proportion of non-Aboriginal women (56%). Higher proportions of First Nations women living on reserve and Inuit women reported employment in 'social science, education, government services and religious occupations' compared to non-Aboriginal women.
Unemployment rates for Aboriginal women were twice that of their non-Aboriginal counterparts. As with the overall population, unemployment rates among Aboriginal women were highest among young adults. Previous studies have shown that a higher proportion of Aboriginal women experience intimate partner violence than non-Aboriginal women.
In 2009, approximately 15% of Aboriginal women who had a spouse or common-law partner reported experiencing spousal violence in the past five years. In 2009, 58% of Aboriginal women who had experienced spousal violence reported that they had suffered an injury, compared to 41% of non-Aboriginal women. Almost half (48%) of Aboriginal women who experienced spousal violence reported being sexually assaulted, beaten, strangled or threatened with a gun or knife.
Indigenous women who were victims of spousal violence reported that there were times when they feared for their lives. About 38% of Aboriginal women who were victims of spousal violence reported that the incident came to the attention of the police. Again, this was twice the percentage of non-Aboriginal women who reported being victimized.
ORIGINAL WOMEN'S MENTAL HEALTH NEEDS AND SUPPORTS: THROUGH THEIR OWN EYES, IN THEIR OWN WORDS (57).
Physical Distancing, Quarantine, and Mental Health
People with pre-existing mental disorders or substance abuse may be severely affected by the pandemic due to their high risk of medical comorbidity. The researchers also explained the impact on the mental health of essential service providers due to their high risk of exposure to the virus. They suggest the importance of providing mental health support to these people who may be experiencing stress and trauma.
For people infected with the virus, several factors can lead to mental disorders. From an epidemiological perspective, the mental health consequences of COVID-19 should be examined in terms of various demographic variables such as race, gender, age, and past mental health status. In addition, studies should focus on short- and long-term mental health outcomes due to infection, isolation, and socioeconomic issues related to the pandemic.
These indigenous scholars of Latin America contributed a scoping review of three health databases in their attempt to describe the mental health situation of indigenous people. They found that limited access to quality information and low access to information sharing cause negative feelings and worsen pre-existing mental health problems (Junior et al., 2020). It has been found that COVID-19 prevention measures designed for a Western capitalist society disregard Indigenous peoples' cultural differences, and that these differences are a risk factor for exacerbating poor mental health in the pandemic context (Junior et al., 2020 ).
Reduced access to Indigenous healing practices due to physical distancing measures exacerbates an already severe disparity, where we know that racial/ethnic populations are less likely than Whites to access and receive mental health care (Moon et al., 2018). It is suggested that the suggestion for rapid responses to build resilience in the context of physical distancing sanctions due to COVID-19 is integral to public health. The prevalence of BPD is estimated at 1.6-5.9% in the general population, 6% in primary care, 10% among those seen in outpatient mental health clinics, and 20% among psychiatric patients (American Psychiatric Association , 2013).
The comprehensive nature of this document is intended to help communities create their own PIP responses, which we know are most appropriate based on the literature on mental health service utilization and Indigenous peoples.
Existing MHSU health services and how might they inform COVID-19 health services
The authors reported that the desire for telehealth services in remote clinics is a response to the restrictions and barriers Indigenous people face in accessing mental health services and that PTSD is a significant concern throughout their communities. Jones and others tracked the current status of assistive technology research in the health of Indigenous communities around the world. This article described the successes of pilot projects that have been applied to health services in Northern First Nations communities in Saskatchewan, in collaboration with First Nations leaders and health providers (Khan, Ndubuka, Stewart, McKinney, & Mendez, 2017).
The project has “enabled nurses to have quick access to various resources while using these tablets during the delivery of mobile/outreach care in local communities” (Khan et al., 2017, p. 121). Regardless, technology cannot be a complete substitute for in-person care and there needs to be additional funding and access to quality health care in northern Saskatchewan communities. The e-mental health technology in this study referred to two e-mental health apps for the treatment of mental illness: (1) the AlMhi Stay Strong app and; (2) ibobby suicide prevention app.
The authors argued for the use of e-mental health approaches as safe, therapeutically effective and acceptable mental health. The authors note that “the AIMhi app is a therapist-led intervention, while the ibobbly app is designed as a self-driven tool” (Povey, 2016, p. 4). One participant said that "it [was] great to move with the times" and another said that "the immediate access to help" could provide.
Researchers concluded that the acceptability of technology factors for e-mental health are related to the person, the environment and the app itself. These findings highlight the dimensions that require ongoing consultation with Indigenous communities for the planning and development of culturally safe and appropriate e-mental health apps for intervention, prevention and treatment. This preliminary draft of our Knowledge Synthesis could benefit from several more steps, including a scoping methodology that better addresses the vast gap in the literature when it comes to gendered mental health and substance use experiences in Indigenous communities.
Assessing the use of mental health services by Indigenous populations in Australia, Canada, New Zealand and the United States of America: a rapid review of population surveys. Factors associated with U.S. mental health care utilization compared to white older adults. Cross-national analysis of the associations between mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys.
