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Pathways to healing:
A mental health toolkit for First Nations people
A TOOLKIT FOR CONSUMERS, FAMILIES AND CAREGIVERS
AUTHORS OF THE PATHWAYS TO HEALING TOOLKIT INDIVIDUALS RESPONSIBLE FOR THE DEVELOPMENT OF THIS TOOLKIT Bill Mussell President and Co-chair, Native Mental Health Association of Canada Neasa Martin Mental Health Consultant, Mood Disorders Society of Canada
SUGGESTED CITATION Canadian Collaborative Mental Health Initiative. Pathways to healing: A mental health guide for First Nations people. Mississauga, ON: Canadian Collaborative Mental Health Initiative; February 2006. Available at:www.ccmhi.ca Copyright 2006 Canadian Collaborative Mental Health Initiative ISBN 1-897268-10-6
PROJECT MANAGER Neasa Martin, Neasa Martin and Associates
This document is available in English and French Ce rapport est disponsible en franais et en anglais For additional information please contact: info@ccmhi.ca or Phil Upshall at phil@mooddisorderscanada.ca
Pathways to healing: A mental health guide for First Nations people is funded by the Canadian Collaborative Mental Health Initiative, and was produced under the project management of the Mood Disorders Society of Canada. This toolkit is intended to compliment the CCMHI document Working together towards recovery: Consumer, families, caregivers and providers. 2006.
We would like to thank the panellists who reviewed the document and provided their support and expert guidance in getting it right. They include: Paul Hanki, RSW, Prince George, B.C. Keith Karoniaktatie Leclaire, Director Health Policy & Non-Insured Health Services, at Kahnawake Shakotiiatakehnhas Community Services Brian Muth, Aboriginal Mental Health Liaison Worker, Sto:lo Nation Health Services, Chilliwack, B.C. M. Addie Pryce, Assembly of First Nations, Ottawa Denise Taylor, Manager, Interior Health Authority, Community Mental Health, Kamloops, B.C. on the CCMHI Steering Committee
Canadian Collaborative Mental Health Initiative Secretariat c/o College of Family Physicians of Canada 2630 Skymark Avenue, Mississauga, ON, L4W 5A4 Tel: 905-629-0900 Fax: 905-629-0893 E-mail: info@ccmhi.ca Web site: www.ccmhi.ca
This document was commissioned by the CCMHI Secretariat. The opinions expressed herein do not necessarily reflect the official views of the Steering Committee member organizations or of Health Canada.
Funding for the CCMHI was provided by Health Canadas Primary Health Care Transition Fund
Pathways to healing:
A mental health guide for First Nations people
A Toolkit
February 2006
OUR GOAL
The Canadian Collaborative Mental Health Initiative (CCMHI) aims to improve the mental health and well-being of Canadians by enhancing the relationships and improving collaboration among health care providers, consumers, families and caregivers; and improving consumer access to prevention, health promotion, treatment/intervention and rehabilitation services in a primary health care setting.
Pathways to healing: A mental health guide for First Nations people
Table of contents
Table of contents..............................................................................i Preface .............................................................................................i Introduction ....................................................................................1 Section 1: Pathways to healing.......................................................3 Balance, wholeness and good mental health........................................ 3 Worldview ......................................................................................... 3 Section 2: Challenges to wellness ...................................................5 Residential school trauma................................................................... 5 Cycle of violence and abuse................................................................ 6 Losses and their effects...................................................................... 7 Addictions including alcohol and drug abuse ........................................ 8 Section 3: Making our own history .................................................9 Healing a people................................................................................ 9 Section 4: Pathways to health ......................................................11 Risks and contributing factors........................................................... 12 What is sadness and depression?...................................................... 14 The impact of childhood sexual abuse ............................................... 16 How does sexual abuse affect adults? ............................................... 18 Family violence ................................................................................ 18 Restorative justice ........................................................................... 19 Section 5: What helps protect our mental health? .......................21 Healing and the recovery process ..................................................... 21 Privacy is respected ......................................................................... 22 Who can help?................................................................................. 23 Section 6: Other pathways to healing ...........................................27 Self-help groups .............................................................................. 27 Art as a healer ................................................................................. 27 Parenting programs ......................................................................... 28 The importance of work ................................................................... 28 Section 7: Being part of your recovery..........................................29 Families are the foundation of community ......................................... 30 Tips for families ............................................................................... 31 Section 8: Resources .....................................................................33 Where to find on-line help ................................................................ 33 Suggested reading ........................................................................... 34 On-line meeting places..................................................................... 35 Useful resources for your care provider ............................................. 35 Appendix A ....................................................................................37 Community mental health professionals ............................................ 37 Appendix B ....................................................................................45
Canadian Collaborative Mental Health Initiative
Preface
Welcome to the CCMHI Toolkit Series! TheCanadianCollaborativeMentalHealthInitiative (CCMHI)isledby12nationalorganizationsrepresenting communityservices;consumers,familiesandcaregivers;self helpgroups;dietitians;familyphysicians;nurses; occupationaltherapists;pharmacists;psychiatrists; psychologists;andsocialworkers.FundedthroughHealth CanadasPrimaryHealthCareTransitionFund,thegoalof theCCMHIistoimprovethementalhealthandwellbeingof Canadiansbyincreasingcollaborationamongprimaryhealth careandmentalhealthcareproviders,consumers,families andcaregivers. TheCCMHItoolkitscontainpracticaltoolsto: Helpmentalhealthconsumersandtheirfamilymembers understandmentalillnessandworkwithothermembers ofthecareteam Assistprovidersandplannersintheimplementationof collaborativeinitiatives Informeducatorsofthebenefitsofinterprofessional educationandprovidetoolstoteachaboutcollaborative mentalhealthcare. Eachtoolkitwasdevelopedwithaninterprofessionalexpert panelandguidedbyaworkinggrouprepresentinganumber ofkeystakeholdergroups.Wehopethatreadersofanyof thetoolkitsintheserieswillrecommendthemtoothers(e.g., consumersreferringtoolkitstotheirprovidersandvice versa). Inadditiontothisseriesof12toolkits,theCCMHIhas developedaCharterofprinciplesandcommitmentsthatwill influencethefutureofmentalhealthcareinCanadaanda seriesofreportsthatcapturethecurrentstateofcollaborative mentalhealthcare.Thereportshighlighthealthhuman resourceissues,provideanannotatedbibliography, summarizebestpractices,reviewinitiativesfromacrossthe nationandsummarizeprovincialandterritorialmentalhealth andprimarycarereform.Thesedocumentsguidedthe developmentofthetoolkitsandareavailableatwww.ccmhi.ca.
Consumer, family and caregiver toolkits Consumers,familiesandcaregiversdevelopedbothofthese toolkitsforconsumersandtheirlovedones. Workingtogethertowardsrecovery:Consumers,families,caregivers andprovidersisintendedforallconsumers,familiesand caregiverswishingtoknowmoreaboutmentalhealthand mentalillness,howtoaccessservicesandthetypeof professionalsthatcanassistthemintheirrecovery.This toolkitalsooffersanoutlineofcomplementarytherapiesand selfcareaswellasthecontributionsandneedsofcaregivers. Finally,thistoolkitincludesaguidetogettinginvolved, describinghowgovernmentandboardsofdirectorswork, andwhyconsumersandfamiliesshouldparticipate. Pathwaystohealing:AmentalhealthguideforFirstNationspeople isatoolkitthatoffersabasicoverviewofmentalhealthand mentalillnessalongwithacontextualsectionoutliningthe impactofhistory,social,economicandpoliticalconditionson thementalhealthofthesepeoples.Therearetoolsinthis toolkittofosterholisticcare. Implementation toolkits Collaborationbetweenmentalhealthandprimarycare services.Aplanningandimplementationtoolkitforhealth careprovidersandplannersisaguideforproviderswishing toestablishorenhancethementalhealthservicesthey providethroughcollaboration.Thisgeneraltoolkitoffers readersaguidetoallaspectsofplanning,implementingand evaluatingacollaborativementalhealthcareinitiative, includingassessingneed,settinggoalsandobjectives, developingabudget,buildingateam,maintainingawell functioningteam,managingchangeandmonitoringthe initiative. Eightpopulationspecifictoolkits,entitledEstablishing collaborativeinitiativesbetweenmentalhealthandprimary careservices,aredesignedtobeusedinconjunctionwiththe generaltoolkit.Theyoffertipsonadaptingthegeneral toolkitforAboriginalPeoples,childrenandadolescents, ethnoculturalpopulations,ruralandisolatedpopulations, seniors,individualswithseriousmentalillness,individuals
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withsubstanceusedisordersandurbanmarginalized populations.Thereissomeoverlapinthetoolkits;for example,informationaboutcollaborativementalheathcare andthehomelessmaybefoundinatleastthreetoolkits: individualswithseriousmentalillness,individualswith substanceusedisordersandurbanmarginalizedpopulations. Readersareencouragedtoconsiderallthetoolkitsthatmay berelevanttotheirneeds. Thegeneralandpopulationspecifictoolkitsarenotintended asclinicalpracticeguidesbutofferpracticaladviceon differentaspectsofestablishingsuccessfulcollaborative initiatives. Education toolkit Strengtheningcollaborationthroughinterprofessionaleducation:A resourceforcollaborativementalhealthcareeducatorsservesasan educationalresourcetoassistintheimplementationof educationalinitiativesandprogramsthatpromote collaborativementalhealthcareinprimaryhealthcare settings.Thetoolkitistargetedtoeducationprogram developersinregulatoryagencies,professionalassociations, regionalhealthauthorities,familyhealthteams, governmentaldepartments,andeducatorswithinboth academic(universitiesandcolleges)andcaredelivery settings. Thistoolkithighlightstheimportanceofinterprofessional educationinpromotingcollaborativecare.Itoffersfourcase studiesandseveralactivitiesaccompaniedbyasamplelesson planandotherusefultoolstoaideducatorsinthe implementationofeducationalevents.
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Introduction
About pathways to healing ThepurposeofthistoolkitistoassistFirstNationspeople whoareconsideringtakingactiontohelpthemselvesor otherstoheal: Tomakesenseoftheirhistoryandtheemotionalpain causedbycolonization. Tohelpbuildselfawarenessandunderstandingofhow thepastaffectsusasindividuals,familiesandasa community.Howtraditionalknowledge,waysof knowing,beliefs,values,languageandculturalways supportrenewal,healingandwellness. Tobegintoseehowunspokengriefhurtsourchildren, ouryoungpeople,andourabilitytoformhealthy relationshipsasadultswithourpartners,asparentsand withourelders. Thistoolkitisalsowrittenforfamily,friends,andcaregivers becausethelackofbalanceforoneaffectsusall.Becausewe know,families,caregiversandthecommunitycanplayakey roleinrecovery. Theinformationsharedcomesfromthewisdomofpeople who:havejourneyedthroughtheeffectsofcolonization: understandtheirculturalfoundationandhowtobuildupon itand/orimprovetheirselfawareness:havelearnedtogrieve, andfoundtheredroadtorecovery;haveconductedthebest AboriginalandWesternresearchavailabletoday. Whatwehopetopassonis: Knowingthelinkbetweenourcurrentlifechoices,First Nationshistory,andtherelationthishastoour understandingofbalanceandhealth. Hopeforabetterfuturethroughhealing Thathelpisoftenhardtofindbutisworthseeking, Thatworkingtogetherwithhealthprofessionals,family, Eldersandpeerscanenhancethehealingjourney,
Thatgoodmentalhealthisasharedconcern,and Thatyouarenotalone. ThistoolkitwrittenforFirstNationpeopleregardlessof whereyoulive.Nomatterwhereyoulive,beitinanurban, rural,semiisolated,orisolatedsetting,thistoolkitwillbe useful.Itwillprovidepracticaladviceonhowtobuild supportsandfindcompetentandskilfulhelpwhenthe journeyisdifficult.Itwillguideyoutowhereyoucanfind moreinformation. Itisastartingpointforchange.
Section 1: Pathways to healing

Balance, wholeness and good mental health
Eachofuswantstofeelgoodaboutourselves.Wewant: Tobehealthyandliveinharmonywithourfamilyand ourcommunity. Toknowwhoweareandwherewebelongtobecared forandtocareforothers. TofeelatpeaceandbeatonewiththeCreator.
FirstNations peoplebelievethat: wholenessincludes thehealthand wellnessofour body,mind,heart, andspirit.
Toknowthatwematter,feelaccepted,andtakepridein ourwork. Tobeabletoprovideforourfamilytoknowourhistory andourculture. Tobeabletolearnfrombothoursuccessesandfailures andacceptwillinglythechallengeslifeoffers. Tofeelproudandhaveothersbelieveinourabilities. Toberesponsibleforouractionsandtobeappreciated andtoknowthatthroughouractionswecanshapeour future. Thesethingsgiveusfeelingsofsatisfaction,joy,wholeness, andbalance.Welookforwardtotomorrow.Thisisgood livingandwhatwesternsocietyreferstoasgoodmental health.
Worldview
Inthebeginning,FirstNationspeoplevaluedwholeness, symbolizedbythecircle,family,communityandthedrum. Theybelieved:inthegoodnessofallhumanbeings;that peoplehelpandarehelped;thatthereisalinkbetween people,creatures,andallthingscreatedbytheGreatSpirit; andthatwemustliveinharmonywithnature,takecareof theearthnotcontrolit. FirstNationspeoplebelievethat:wholenessincludesthe healthandwellnessofourbody,mind,heart,andspirit; familiesshareandcareforeachotherwithrespectandsee
Canadian Collaborative Mental Health Initiative 3
eachmemberasimportant;ourcommunitiesarehealthyand empoweringandthateachpersonhasaplace;thelandisour home,itishealing,itwillprovideforus,andteachushowto live;andourlanguage,ourculture,anditsteachingsare importantandthatourpast,present,andfuturearealltied together.Ourfamilies,communities,andcultureteachus howtoliveinbalance,tocareforothersandourselvesandto restorebalancewhenitislost. The big picture1
1 Warrior Caregivers: Understanding the challenges and healing of First Nations men, A guide prepared for the Aboriginal Healing Foundation by W.J. (Bill) Mussell, 2005. 4 Canadian Collaborative Mental Health Initiative
Section 2: Challenges to wellness

Thelossofwellness/wholenessandbalanceofFirstNations peoplespringsfromalonghistoryofcolonization,andthe effectsofbeingcontainedandlimitedinhowwelivedour culture.Cutofffromtraditionalwaysoflivingandbeing oppressed,manyFirstNationspeoplehavebecome dependantonhelpandthedirectionofothers.Thebasic needsoflifearenotmetandmanyFirstNationscommunities haveslippedintoisolationandpoverty.Takingactionto makechangemaybefeared.Facedwithracismand discrimination,generationtogeneration,peoplehavebegun tobelievethattheydeservedtosuffer.Theyblame themselvesforwhattheyhavesuffered.Tosurvivetheyhave learnedtohidetheirtruefeelingsandbeliefstolose confidence,hope,andtoacceptinjustice.
ManyFirst Nationsfamilies weredeeplyhurtby thegovernment policyofsending childrenawayto residentialschools.
Residential school trauma

ManyFirstNationsfamiliesweredeeplyhurtbythe governmentpolicyofsendingchildrenawaytoresidential schools.Children,takenfromtheirfamilies,didnothave theiremotionalneedsmet.Someexperiencedviolenceand sexualabuse.Mostlosttheirlanguageandconnectionto theirculture,families,Elders,andcommunities.They returnedhomehurt,confusedandangry.Therewaslittle spacetogrieveandtheycarriedtheirpaininsilence.They didnotknowhowtomakedecisionsforthemselvesor developthetoolstomaketheirownhistory.Elderswereno longervaluedanddidnotknowhowtohelp.
Victim-Rescuer-Persecutor and Nurturer Model2
Violencehas replacedthetrue strengththatcomes fromknowingwho youareasaperson.
TonumbthepainofhurtandlossmanyFirstNationspeople turnedtoalcohol,drugs,gambling,violence,sexualacting outandselfharmasawaytocope. Havinglivedwithharshrule,theybecamehard,treating themselvesandotherswithdisrespectandviolence.Asoften happens,theoppressedbecametheoppressors. Thesebehavioursgetinthewayofwellnessandgoodmental health.Theycontributetothedevelopmentofthelossof balanceandwholeness.
Cycle of violence and abuse

Astheseresidentialschoolchildrengrewup,mostofthemdid nothavetheskills,knowledge,oremotionalstrengthto parenttheirownchildren.Inmanycommunities,ournext generationofchildrenwereraisedinfamilieswithchaos, substanceabuse,andviolence.Traditionalroleswithinthe familyandcommunityhavebeenlost.Parents,unabletocare forthemselves,leavechildrentocareforeachother.Kids turntoalcohol,drugs,unsafesex,andactingoutasameans ofcopingandnumbingtheirpain.Thisishowtheyseetheir
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Warrior Caregivers: Understanding the challenges and healing of First Nations men, A guide prepared for the Aboriginal Healing Foundation by W.J. (Bill) Mussell, 2005.
parentscope.Sometimeschildrenaretakenaway,andplaced inchildwelfare,leavingaholeinthefamily.Girlslack strong,caringwomentoshowthemhowtolovewiselyand raisehealthyfamilies.Boysdonothavegoodmalemodelsto learnhowtobestrongmen.Violencehasreplacedthetrue strengththatcomesfromknowingwhoyouareasaperson andasapeople:toknowwhereonebelongsintheworld;to findonesplaceandcreateahealthyspace. Whereonceextendedfamiliescaredforeachother,familyties havebeenweakened.Trustisbroken.Insteadofthe traditionalsharingandcaringbetweenextendedfamilies, communitiesandfamilieshavebeguntobeguardedtowards eachother.Manyyoungpeoplehavelefttheircommunities tomaketheirhomeelsewhere.Forsome,thishasledtomore painandlossastheymoveintoahostileandrejectingworld. Withoutpositiverolemodels,hopeforthefuture,and woundedbyviolence,thisgenerationhasrepeatedthe historyoftheirparents.
Losses and their effects

Traumaticlossincludes: Lossofinnocence; Lossofoneslanguage,spiritualandculturalpracticesand identity; Lossofonesland,selfsufficiencyandselfgovernance; Lossofchildrentoresidentialschoolsandchildwelfare systems; Lossofparentingrolesandskills;and Thebreakdownoffamilykinshipsandsocialstructures. Theselosseshaveledto:
Personal failures;
Awillingnesstopassivelyacceptwhathappenandlivein adependantstate; Identityconfusion,rejectionandacceptingdiscrimination andputdowns; Selfdestructivebehaviour; Substanceabuse; Violence; Depression,anxiety;and Suicidalbehaviour.

Theseareallsignsofgreatinnerpain.
Depression Racism Broken Families
Language Loss
Religious Oppression Alcohol Abuse
Cultural Identity Problems
Tragic Losses
Poverty
Destructive Acting Out Behaviour
Themajorhealth problemforFirst Nationspeople,is alcoholaddiction andsubstance misuseincluding prescriptiondrugs andgambling problems.
Thisdrawingshowswhatleadstoculturalidentityproblems forFirstNationspeople3
Addictions including alcohol and drug abuse

ThemajorhealthproblemforFirstNationspeople,whichhas receivedattentionfromgovernments,isalcoholaddictionand substancemisuseincludingprescriptiondrugsandgambling problems.Becauseofthisfocus,societyhasbecomeawareof thelinkbetweensubstanceabuseandhealth.Inspiteof successfuladdictionstreatment,manyFirstNationspeople areleftfeelingasifsomethingisstillmissingfromtheirlife. Dealingwiththeaddictioncreatesastableplacetobeginthe healingjourney.Byonlydealingwiththeaddiction,andnot itsroots,balanceisnotrestored.Itisonlypossibleto understandsomethingifweunderstandhowitisconnected toeverythingelse.Thishasledustoashiftourthinking towardslookingatthementalhealthneedsnotonlyofthe individualbutalsoofthecommunityasawhole.
3 Adopted from A Gathering of Wisdoms: Tribal Mental Health, Swinomish Tribal Mental Health Project, 1991
Section 3: Making our own history

Withthishistory,itisnotsurprisingthattheabsenceof wellnessofsomeFirstNationspeopleisacauseforconcern. However,thathistorydoesnotneedtobeourpresentorour future.Thereishope.Healingandrecoveryispossible.
Healing a people
RecoveryforFirstNationspeoplewilltakemanypaths.One pathalonewillnotbeenough.Eachpathwillstrengthenthe other.Eachpersonwhomovestowardshealthandhealing helpstheirfamiliesandtheircommunitytoheal.Thinkof peoplewhohavebecomeaddictedtoalcoholandwhohave attemptedtohealatatreatmentcentreforaddictions,andare stillburdenedbyinnerpain.Theirpathneedstoincludea focusoninternalwellnessanddealingwithlossesthatwere nevergrieved.
RecoveryforFirst Nationspeoplewill takemanypaths. Theirpathneedsto includeafocuson internalwellness anddealingwith lossesthatwere nevergrieved.
Wewillhealasapeopleby: Healingasindividuals,usuallywiththeassistanceof others,especially,thosewhoshareasimilarcultural foundation,language,traditions,ritualsandceremonies; Buildingfriendshipswithotherswhoenjoyrelativegood healthandwellnessconnectedtonurturingrelationships withothers,natureandtheGreatSpirit; Reconnectingasfamiliesandhealthysocialgroupsthat enjoysharingstories,humourandplay; Understandingwellnessandthequalitiesthatmakeup thelackofbalance(mentalillhealth); Integratingwesternandtraditionalapproachestohealth; Takingactiontobuildhealthy,hopeful,andsuccessful communitiesincludingidentifyingandsupporting healthyleaderswithinourcommunities; Grievingthetraumacausedbyresidentialschoolsand abuse; Healingtogetherasacommunityfromtheeffectsof physicalandsexualassaults;
Restoringjusticebycontinuingtopushforthesettlement ofoutstandingresidentialabuseclaims; Reclaimingcontroloverdecisionmakingandgovernance andeliminatingtheuseofthreatsandabuseofpower withinourcommunities;and,
NotallFirst Nationspeopleare struggling.
Addressinglandclaimsgrievancesandunresolved historicalissuesconcerninglandholdingwithinthe reserve. Thereisapositivelinkbetweenthehealingofeachperson andtheabilityoftheirfamilyandcommunitytomove forwardinhealing.Suchhealingislinkedtoknowledgeof culturalfoundation,culturalways,beliefs,valuesand ceremoniesthatnurtureandaffirmidentity.Itisalsolinked tohealing,whichpromotespersonalandculturalidentity, andbuildscommunitiesofcare.Itisjustastruethatasour communitiesandfamiliesbecomestrongertheyarebetter abletosupportthehealthandwellnessoftheindividual. NotallFirstNationspeoplearestruggling.Manyindividuals andcommunitiesarethriving.Theyhavedrawnontheir culturalfoundation,waysofknowing,language,and traditions.Theyhavedevelopedwaystomanagetheburden oftheeffectsofcolonizationandcanseehopeforthefuture. Theyhaveeliminatedalcoholfromtheirlives.Theyhave refusedtoacceptthenegativeimagethathasbeenplaced uponthem.Theyhavetakencontrolofdecisionmakingand builtopportunitiesfortheiryoung.Theyhavelookedto traditionalhealingpractices,strengthenedkinshipties,and reconnectedwiththeelderswhiledrawingonthebestof Westernwaysthatsupportorfosterthemovementtowards wellness.
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Section 4: Pathways to health

FirstNations peoplehavearich historyofhealing practicesthatcan provideapathway tohealth, wholenessand healing.
FirstNationspeoplehavearichhistoryofhealingpractices thatcanprovideapathwaytohealth,wholenessandhealing. Withinourculture,lackofwellnessisseentohappenwhen thereisalackofbalance.Itisduetomanyfactorsbothinside andoutsideourselves.
TheMedicineWheel4
TheMedicineWheelshowsthe linkbetweenthemind,body, emotions,andspirit.Eachneed mustbemettofeelwhole.The wheelshowsthewaytoknow yourselfandhowtobuildself care. Whenourphysicalneeds(air,water,food,clothing,shelter, exerciseandsex)aresatisfiedwecanseekmeaninginlife. Thepersonhasthetoolstounderstandthewhat,howand whysoflife.Thisispartofintellectualandspiritualgrowth. Emotionalgrowthhappenswhenourphysicalandemotional needsaremetincluding: beinglovedandbelonging, feelingpositivelyincludedandacceptedbyfamily, friendsandcommunity, havingsomeonewholistensandunderstands, havingaprivatespacetolistentoonesheart,body,brain andsoul, tounderstandandacceptoneslimitsandhaveotherswho willhelpyoudothiswhenneeded, tohavehealthyboundariesandrespecttheboundariesof others, tolearnthedisciplineneededtocontrolemotions.
Emotional growthhappens whenourphysical andemotional needsaremet.
4 Medicine Wheel is from 4 Worlds Directory http://www.4worlds.org/4w/directory.html Canadian Collaborative Mental Health Initiative 11
Weareborntolearn Throughplay,trialanderrorlearning,andteachingweare abletogatherthetoolsweneedtomakesenseoflifeand solveproblems.WhereWesterneducationvaluesformal learningfromexpertsandbooks,FirstNationspeople traditionallysharedknowledgeandskillsinformallythrough storytellingandactivitieslikebuildingacanoe,hunting,or play.Whentraditionalskillsarenottaughtorbeing practiceditishardertomakesenseoftheworld. Spiritualgrowth Whenweareraisedinasafe,caring,andrespectful environment,welearntovalueothersandourselves.This includesplants,animalsandothercreationsoftheGreat Spirit.Thisgivesusrichnessandmeaninginlife.Song, danceandceremonyhelpstobuildinnerwholeness. Throughthis,wepayattentiontoourinstincts.Weletthem guideourdailylives.Wefeeltogethernessandpurposeon thisearth.Spiritualgrowthisconnectedtotheland,each other,andthecommunity. FormanyreasonsFirstNationspeoplehavenothadthese needsmet.Bynamingandunderstandingtheseneeds,we cantakestepstowardsreachingbalanceandwholeness.
Whenweareraised inasafe,caring, andrespectful environment,we learntovalue othersand ourselves.
Risks and contributing factors

Noteveryonerespondsthesametowaytolifesproblems. Thisisbecauseweareeachuniqueindividualswithourown historyandnature.Asaresultwemakechoicesthatcan eitherhelpuskeepourbalanceandsenseofwholenessor loseoursenseofbalanceandwholeness.Mentalhealthis linkedtothestrengthandsecuritywegainfromourfamily andcommunity.Whenoursenseofbalanceandwholenessis notpresentinourself,wecallthispoormentalhealth. Whatdoespoormentalhealthlooklike? Althoughchanging,traditionalWesternmedicinehasoften lookedatpoormentalhealth,alsocalledmentalillness,asan individualillnessadiseaseofthemind.Itiscommonly believedthatmostmentalillnessesarepasseddownfrom familymembertofamilymemberandoftenpresentwhen stressishigh.Treatmentfocusesontheindividualpatient
Mentalhealthis linkedtothe strengthand securitywegain fromourfamily andcommunity.
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andattemptstofixtheirbrokenbrain.Thisapproachmay notalwaysbehelpfulforFirstNationspeople. Butsometimesitis. Peoplewhohavebeentraumatizedmayalsosufferfroman illnessthatimpactshowtheythinkandfeel.Theyalsocanbe treated.Althoughthelossofmentalhealthmayberootedin oursocial,economic,andemotionalhistory,theimpactcan changeourmindsandbodiesandthewaytheywork.For example: Childrenwithahistoryoftrauma,violence,andneglect gothroughchangesinhowtheirbrainworksandhow theyexperiencetheworld.Theycanbecomemore sensitivetostressandfeelanxietymoreeasily.Overtime, theyarealsomorelikelytobecomedepressed. Ifamotherdrinkswhenpregnant,thenherunbornbabys brainandbodycanbedamaged.TheeffectiscalledFetal AlcoholSyndrome.Itcanharmachildforlife,makingit difficultforthemtolearnandtomakegoodchoicesthat areacceptedbyothers.Asthesechildrengrowup,they haveahardtimeshowingselfcontrolanddeveloping selfdiscipline.Thatiswhytheyareoftenclosely watched.Theyoftenmakepoorchoicesthatcanleadto crime,andantisocialbehaviour.Thiscanaffectthe familyandthecommunity. ManyFirstNationsyouthsniffglueorgasoutof boredomorasawaytoescapepainfulsituations.Inthe shorttermitcanmakethemfeelhappyastheylaugh, sing,anddance,speakmorefreelyorfight.Itcanalso causedepressionanddamagetothenervoussystem, body,orbraininwaysthatcannotberepaired. Longtermuseofalcoholalsocanalsoharmthebrain. Thebraindoesnotworkasquicklyandcanmakeyoufeel depressed. Overtime,pooreatinghabits,lackofexerciseandnot enoughrestcanalsocauseharmtothebodyandmind.
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What is sadness and depression?

Sadnessisanimportantpartoflife.Ithelpsusunderstand whoweare.Ittellsuswhatweneedandwhenweshould makechanges.Sadnesscomesfromthelossesand frustrationsofdailylife.Sadnesswillgoawaywhenyouget supportandencouragement,eatandsleepenough,lower stressandbecomemorephysicallyactive.
Depressionisdifferent.Itcanbecomesevere,lastalong time,andmakeitveryhardtomanagelife.Itcango frombeingmildtothepointthatpeoplewanttoend theirlife.Majordepressioncanbeaserious,unbearable illnessthatstronglyaffectshowyoufeel,think,and behave.Depressioncanlastforyears.Itisverypainful andisrarelyovercomewithouthelp.Youcannotwill yourselfoutofdepression.Eachpersonfeelsdepression intheirownwayanditcansometimesbedifficulttosee. Althoughnotallofthesechangesmaybepresent,the followingdescribeshowmostpeoplelookandfeelwhen theyaredepressed.
Physical Changes Notwantingtoeatoreatingtoomuch Troublefallingasleep,stayingasleeporsleepingtoo much.Sleepdoesnotgiveenergy Feelworseinthemorningmoodliftsasdaygoeson Feelweakandtired Somepeoplefeelnervousandjumpyandneedtomove Feelmoreheadaches,muscleachesandpains,butnothing iswrongwiththebody Stomachupsetsconstipation Changes in Thinking Thoughtsareslowed,difficultythinking,focussingonor rememberinginformation Decisionmakingisdifficultyandoftenavoided Negativethoughtsrepeatandrepeat Worryingoverandoveraboutfailuresornotbeinggood enough Treatoneselfandothersharshly
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Inextremecases,therecanbealossoftouchwithreality, perhapshearingvoices(hallucination)orhavingstrange fixedideas(delusions) Constantthoughtsofdeath,suicide,orattemptstohurt oneself Changes in Feeling Lossofinterestinactivitiesthatoncegavepleasure Lessinterestinandenjoymentfromsex Havingnosenseofpersonalvalue,feelinghopelessand lotsofguilt Alossoffeelingssothatlifehasnocolor Senseofcrushingorimpendingdoom Lossofselfesteem Feelingsad,blue,downinthedumps Unexplainedcryingwithoutanyclearreason Badtemper,impatience,angerandaggressivefeelings Changes in the way we act Pullingawayfromsocial,workandplayactivitiesnot wantingtobewithothers Avoidingdecisionmakingitsimplyseemstoohard Avoidingeverydayjobssuchashousework,gardening, payingbills Lessphysicalactivityandexercise Reducedselfcaresuchaspersonalgrooming,eating Increaseduseofalcoholordrugs(prescriptionandnon prescription) Mania Somepeoplemovefromdepressiontofeelingoverlypositive, excitedaboutlife,andoddlyoverjoyed.Theymayfeellike theyhavespecialpowersorareveryimportant,takerisks, showpoorjudgementwithmoney,orhaveaveryhighsex drive.Othersmayfindthemoverlytalkative,jumpingfrom topictotopic.Theirmoodmayrapidlychangeandtheymay becomeanxious,irritableandblameothersfortheir problems.Theymaynotsleep,sleepverylittleandforgetto eat.Theymaylosetouchwithwhatisreallikehearing voicesorhavingstrangeanddisturbingideas.Thisiscalled manicdepressionorbipolardisorder.
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Anxiety is common Anotherwaymentalimbalancecanappearisthroughgreat feelingsofanxietyandstress.Thereisoftenastrongphysical feelingofthreatandworrywithshortnessofbreathorrapid heartbeat.Thefearcanbecomesobaditisdifficulttobe withothers,workorcareforoneself.Sometimespeoplewill trytomaintainbalancebyrepeatingsoothingritualsto controltheirfears.Sometimesthisanxietyfollowsa frighteningorlifethreateningeventsuchasanassault,which issuddenandisrelivedagainandagain. Losing touch with what is real Sometimes,whenpeopleareunderalotofpressure,arevery depressedorworried,theymaybegintohearorseethings thatothersdonotinawaythatfeelswrongorcausesthem tofeelanxious.Thisiscalledpsychosis. Manypeopleselfmedicate,byusingalcoholorstreetdrugs, tocopewiththesepainfulfeelingsandthoughts.Whileinthe shortrunthiscanhelppeoplefeelmoreincontrol,itbrings manymoreproblemsthanitsolves. Treatment Depression,mania,anxiety,andpsychosisaretreatedby traditionalWesternmedicinethroughtalktherapyand medications.Medicationscanbehelpfulinliftingthe darknessofdepressionorrelievingthepainofanxietyor psychosis.Itcanprovideyouwithasupportindealingwith difficultissuesintherapy.Butpillsdonotsolvelifes problems.Withoutdealingwiththerootcauses,mentalill healthmaycomebackagainandagain.
The impact of childhood sexual abuse5

Whenachildisusedsexually,byayouthoranadult, theyarebeingabused.Itofteninvolvessexualtouching butcanincludehavingsexualintercourse,teenage prostitutionandsexualmisusethroughpornography.It
5 Child Sexual Abuse: Public Health Agency of Canada http://www.phac-aspc.gc.ca/ncfvcnivf/familyviolence/html/nfntsxagrsex_e.html
hurtsemotionallyandoftenincludesotherformsof harm.Itisadeepbetrayaloftrustandanabuseof poweroverthechild.Wedontknowhowmanykids areabusedbutthelevelofabuseishigherforFirst Nationschildren.Sexualabusemayalsohappenover manygenerationsandbecomeapartofthefamilys unspokenhistory. Althoughsexualabuseisagainstthelawitisoften hidden.Itmaybekeptasecretbychildrenbecausethey fearfurtherharm,dependontheabuserforsupportor becauseofadeepsenseofshame.Childrenwhohave physicalormentaldisabilities,whohavelittlecontact withfriends,brothersandsistersordonthavetrusted adultstheycancounton,areatgreaterriskofbeing sexuallyabused. Mostabusersarewellknowntothechild.Oneinfour peoplewhoabusechildrenareteenagers.Mostoftenthe abuserismale.Studiestellusthatfouroutoftenpeople whowereconvictedofsexualabusewerealsoabused themselvesaschildren.Iftheabuserisafamily member,oratrustedmemberofthecommunity,the childmaynotwanttosharewhatishappeningto protectthemfromcriminalcharges.Becauseitiskept secret,childrenandtheirfamiliesmaynotseekhelpor knowhowtofindthesupporttheyneed. Sexualabuseisalwaysharmfulbutthelongtermaffects areworseif: Force,orthethreatofforcewasused, Theabusewasbyafamilymemberorsomeoneina positionofpowerlikeateacher,ministerorband leader, Theabusehappenedrepeatedlyoveralongperiod oftime, Thechildisnotbelievedorontellingistoldtokeep quiet.
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Thesechildrengrowupnotbeingabletotrustothers andtendtobeloners,preferringtobeontheirown. Manytimestheybegintobelievetheywereresponsible fortheabuseordeservedwhathappened.Theyhave troublewithselfesteem,havedifficultymakingfriends orformingintimaterelationshipswithothers.Asthey growuptheyaremorelikelytobeanxiousand depressedandusedrugsoralcoholtonumbtheirpain. Selfharmthroughselfslashing,prostitution,orsuicide attemptsarecommon.
How does sexual abuse affect adults?

Peoplewhohavebeenabusedmayresisttellingotherswhat hashappenedtothem.Untiltheycan,therealproblemgoes undergroundandbecomesworse.Thistraumacanbecarried fromonegenerationtothenext.Womenwhoweresexually abusedsuffermorefromphysicalandemotionalproblems. Abusivemenmaytargetthesewomenandtheiradult relationshipmayrepeattheexperienceofphysical,sexualand emotionalabuse. Menwhoweresexuallyabusedaschildrenalsosufferfrom depression,anxietyandsuicidalthoughtsorbehaviour, particularlyifthereweremanyactsofabuse.Buildingtrust andhavinghealthysexualrelationswithothersisdifficult. Menwhowereabusedemotionally,physicallyandsexually havehigherlevelsofmentalillhealth.Theyalsotellof havingsexualinterestinchildren(oftenofthesameagesas whentheywereabused).Thiscanleadthemtoabusing others.
Family violence
WedonotknowalotaboutfamilyviolencewithinFirst Nationsfamilies.ItisnotapartoftraditionalAboriginal cultureandisnotseenasacceptable.Whatwedoknowis thatmuchoftheviolenceinFirstNationscommunitiesis youthonyouthassault.Theyarelearningtodealwith confusion,frustration,andpowerlessnessbyusingthreats andforce.Substanceabuse,theeffectsofFetalAlcohol Syndrome,andgrowingupinchaotichomes,whererulesare
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few,andproblemsaresolvedthroughviolenceratherthan talk,hasresultedinmanyyouthcomingintoconflictwiththe law.ThereareveryhighratesofimprisonmentforFirst Nationspeople.
Thereisaneedto looktothe communitytofind solutionsto preventfurther harm.
Restorative justice
ItisonlyrecentlythatFirstNationspeoplehavebegunto discusstheproblemofsexualabuseandviolencewithintheir communities.Theyrecognizethatthejusticesystemis limitedinwhatiscandotosolvethisproblem.Thereisa needtolooktothecommunitytofindsolutionstoprevent furtherharm,stopitquicklywhenithappens,andhelp individuals,familiesandthecommunityhealfromtheharm itcauses.Whenthefamilyandthecommunityplayanactive andsupportiverolewithkidstheycanhelptoprotectthem fromenteringontoapaththatmayresultintheirgoingtojail orcausingselfharm. SomeFirstNationscommunitiesaretakingaveryspecial approachtodealingwiththeirhistoryofviolence,suicide, addictionproblemsandsexualabuse.Forexamplethe OjibwavillageofHollowWater,inNorthernManitoba,is usingtimehonoredAboriginalapproachessuchashealing andsentencingcirclestohelpwrongdoersadmitguiltand takeresponsibilityfortheiractions.Overmanyyearsthey havelearnedthatspeakingthetruthaboutabusepromotes healingandhealingencouragestellingthetruth. Thecommunitycomestogethertoholdtheperson responsiblefortheirbehaviour,whilehelpingthemgainself insightintotheemotional,mental,physicalandspiritual problemsofsexualabuse.Thoseinvolvedinthehealing circlewillalsosharetheirownhistoriesofabusetosweet talkothersoutoftheanger,denial,guilt,fear,selfhatredand hurtthatmustbedealtwith.Thevictim(s)arehelpedtoheal fromtheirpain.Intheend,whenconfrontedbythevictim, theabuserisabletohonestlyfeelthepaintheyhavecaused. Onlythencanrebuildingforthevictimandtheabuser,their familiesandthecommunitytakeplace.Peoplecanlearn aboutthesourceofdisharmonyintheirrelationswithothers andwaystochangetheirbehaviourtobringbalanceand restoreharmonywiththemselvesandtheircommunity.
Thesetraditionalhealingpracticesareseenworldwideas modelsforthequalityofcarewhichteachesfairnessand justice.
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Section 5: What helps protect our mental health?

Somepeoplearebornwithasunnynature.Inspiteof problems,theyremainhopefulthatthingswillgetbetter. Theybelievethattheycanmakeadifferenceintheirworld andbelieveinthemselves.Theyseenewsituationsasa challengeandnotsomethingtobeavoided.Theyfind meaninginthebadthingsthathappenandlearnfromtheir mistakes.Iftheyhaveafamilythatmakesthemfeelloved, seeothersaroundthembehavinginhealthywaysorjust enjoytheapprovalononepersonwhobelievesinthem,itcan beenoughtohelpthemcopeindifficulttimes. Youdonothavetobebornintoahealthyfamilytobe successful. Childrenwhogetinvolvedinschool,joininwiththeir community,playsports,docrafts,makefriends,learntheir cultureandlanguage,andbelieveintheGreatSpiritareable tomanagelifesdifficultiesmoreeasily.Theydothingsthat theyenjoy.Theyarewillingtoreachoutandhelpothers.By tryingnewthings,theycanlearnwhotheyare,whatthey like,andatwhattheyaregood.Theycanlearnhowtoplan andworktowardsagoalwithoutgivingup.
Youdonothaveto bebornintoa healthyfamilytobe successful.
Healing and the recovery process

Therearefourmainthingsimportanttorecovery: 1. Acaringrelationshipwithapersonwhocanhelpyou restoretrustinyourselfandinothers.A relationshipwhereyoucangrowasaperson; 2. Safetyinyourpersonalenvironmentsothatyoucan enterintoapotentiallyacceptingandtrusting relationshipandfacethejourneytodiscoverwhathas beenavoided; 3. Learningstrategiesformanagingyouremotionsand controllingyourbehaviour;and 4. Time. WeknowwhyitisdifficultforFirstNationspeoplestoask forhelp.Ourhistoryofoppressionmakesithardtotrust.It ishardtoimaginethatthingscanbedifferent.Toaskfor
help,wemustbelievethatweareworthyoffriendship,and entitledtogoodhealth.Thatisunfamiliar.Wemustbe willingtofeelourgrief,faceourshameandtoact.Itcanbe muchmorecomfortablestayingwithpain,andwithwhatis familiar,thantotaketheriskofenteringintothisunknown. Evenifgoingforwardmovesyoutowardsabetterlife. Formanypeople,askingforhelpcanfeellikeafailureora weakness.Itisnot.Itisanactofcourageandstrength.Itisa wayofbeingresponsibleandcaringforonesself.Changeis noteasy.However,livingalifeofnotknowingonestrueself ismuchharder. How can therapy help? Goodtherapyprovidesasafeandprivateplacetobeginto tellyourstory.Itgivesyoutimetoseekyourtruthandfind yourvoice.Themoreyoureflect,themoreyoulearnwhat youknow,andwhatyoudonot.Itcanbringinsight,help youunderstandyourfeelingsandlearnnewwaysofsolving lifesproblems.Itisarewardingbutnotaneasyjourney.It takestimeandcommitment. Agoodtherapistdoesnotgivetoomuchadvice.Theyhelp yousortoutwhatyoucanandcannotcontrol.Agood therapistcanhelpyousetandmovetowardsyourowngoals. Theycanteachyouthatallyourfeelingsareacceptablebut notallbehaviorisokay.Theyencourageyoutoexpressyour feelingshonestly.Theymodelhonest,respectfulbehaviour. Andteachyouhowtogetalongwithothers,howtolisten withcareandtalkwithothershonestly.Ittakestimetotell onesstoryandarespectfultherapistwilllistencarefullyto understand.Throughthetellingofyourstoryagood therapistwillhelptouncoverwhatarethevaluesthatare importanttoyou.
Privacy is respected
Manypeopleareembarrassedatneedinghelpandfeelafraid thatotherswillthinklessofthemiftheyfindoutaboutaloss inmentalwellness.Counsellorsaretrained,andexpectedto respectyourprivacyandwillnotshareyourprivate informationwithothers.Respectingyourprivacyis particularlyimportantinsmaller,closeknitcommunities.
Somepeopleprefertofindhelpoutsideoftheircommunity becauseoftheirconcernsforprivacy. Healthy Relationships Securefamilyrelationshipsandsharingwhichsupportsour emotional,intellectual,andspiritualgrowtharecentraltoour healthyprogress.6

Familiar with family/community history belief in optimistic future Enjoys uniqueness Makes meaningdialogue Spiritual connectedness Secure family relationships Manages ups and downs of life Satisfied needs
Self-care and social responsibility
Relatively Secure Personal and Cultural Identify
Accepts recognition and assistance, enjoys natural highs reaches out to assist others
Who can help?

Finding help in remote and isolated communities Therearedifferentpathsyoucantaketoseekinghelp. Findingtherightcounselorcanalsotaketime.Inremote partsofthecountrytheremaybefewformalservices available.Youmayhavetodosomeresearchtofindthehelp youneed.Manypeoplefindthisfrustratinganditcantake yousometimetoorganize. Keeparecordofwhoyoucontactandwhattheysay(see AppendixBforanexample).Iftheycannothelpyou,askfor suggestionsofwhereyoucangoforhelp.Putyournameon waitinglistswhileyoucontinueyoursearch.Bepatientand dontgiveup!
6 Adopted from A Gathering of Wisdoms: Tribal Mental Health, Swinomish Tribal Mental Health Project, 1991
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Herearesomeideasofwheretobegintolookforhelpinyour community: Speaktoahealthworker,especiallyanurseora communityhealthworker. Gotothehealthcentre. Askafamilyphysicianiftheyareavailable,theymay knowwhathelpisavailable. Speakwithapharmacistinyourcommunity. Talkwithsomeoneatthebandofficewhohassome familiarityandaccesstocomputerresourcestohelpyou undertakeasearchofwhatisavailable. Asktrustedothersinyourcommunitysuchasateacher orarespectedelder Thementalhealthworkeriftheyareemployedbythe band. Drugandalcoholcounselorsareavailablethroughthe NationalNativeAlcoholandDrugAbuseProgram.They mayhelpyouwithmentalwellnessneedsinadditionto addictionsissues.Thereisalistingoftreatmentcentres availableontheHealthCanadawebsite(seeresources providedinsection8. Visitatalkingcircleorselfhelpgroup. AskthelocalFriendshipCenterforinformation. Contactthenationalofficesofhealthcareprofessionalsto learnaboutprovincialresources. Finding help in centres closer to towns or cities Thereareoftenexcellenttreatmentandwellnessresource availablebuttheyarepoorlyadvertised,evenamongsthealth careproviders.Becausehealthisaprovincialconcern, servicesvaryacrossthecountry.Youwillneedtodosome researchtofindlocalresourcesclosetohome.Askatrusted friendorfamilymembertohelpyouwiththesearch. Herearesomesuggestedplacestostartyoursearch: FriendshipCentresespeciallyforpeoplelivingoff reserves. Contactyourlocalbandofficeforinformationadvice. Findoutifthereareaboriginalpeoplewhoareinvolved inhealingwithinthecommunity. Walkinclinics.
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Gotothelocalhospitalsomehospitalswillhavean Aboriginalliaisonworkerwhocanhelpyouget connected. ContacttheMinistryofHealthinyourprovince.They canhelpyouconnectwiththehealthauthoritiesthatwill knowaboutresourceareavailableinthecommunity. FirstNationsandInuitHealthBranch. Lookforeducationalopportunitiesthatwillhelpyoufind moreinformationandresources. Findamedicaldoctor. InadditiontolookingtotheFirstNationscommunityfor help,youmayalsowanttousehealthandhealingresources thatareavailableinthelargercommunity.Moreandmore careprovidersarereceivingtrainingtounderstandthe uniqueneedsoftheFirstNationspeopleandgiveyouthe rightkindofcare.TheMoodDisordersSocietyofCanada hasinformationandalistingofwheretofindhelpat http://www.mooddisorderscanada.ca. Manypeopleareverysatisfiedwiththesupporttheyreceive fromtheirfamilydoctor.Somedoctorsarenowworkingin mutualcarepracticeswithotherhealthcareproviders.The doctorcanhelptoconnectyouwithspecialiststodealwith otherhealthneeds.Therearemanykindsofcommunity mentalhealthcareproviderswithspecialtrainingtomeet differentneeds.Wehaveincludedalistofcommunity mentalhealthandregisteredprofessionalsattheendofthis toolkit,withabriefsummaryofwhattheydo. If you are feeling suicidal Peopleoftenreachoutforhelpwhentheyareattheirlowest point.Thiscanmakethechallengeoffindinghelpevenmore difficult.Ifyoufeellikelifeisnotworthliving,callthe HelplineorDistressCentrelistedinthefrontofthetelephone book,orgotothenearesthospitalemergencydepartmentand seeadoctor. Building good relations with help providers Sometimeshelpjustdoesnothelp.Ifthecareprovidersdo notunderstandtheFirstNationscultureandhistory,they maynotgivethekindofhelpyouneed.Ifyoudonotfeel
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youaregettingthekindofhelpyouneed,findsomeoneelse whocanhelpyou.Youhavearighttobetreatedasanequal, inaculturallyappropriateway,andtobearespectedpartner inyourcare. Attimes,morethanonepersonmaybeinvolvedinhelping yougetwell.Remember,youarethemostimportant memberofthecareteam.Howdoyouknowyouarea partnerinyourcare?Lookforthefollowinginmembersof yourcircleofcare: Youaretreatedwithdignity,kindness,andrespect. Careproviderslistenandtakethetimetoknowmore aboutyouandyourpersonalhistory. Theyexplainwhattheydo,andhowtheycanhelpyou. Theyareinformedandskilledintheirareaofcare. Thingsareexplainedtoyouinwaysyoucanunderstand andyouaregiventimetoaskquestions. Youaregivenchoiceinyourcare. Careprovidersknowwhathelpisavailableinthe communityandsharethisinformationwithyou. SometimesthewellmeaningactionsoftraditionalWestern healthcarepracticescancausemoreharmthangood.For example,bydiagnosingandtreatingFirstNationspeople withmentalillnessesbasedonpresentingsymptomswithout takingthetimetounderstandtheirhistory.Theymay mistakehavingaspiritanimalasadelusionora hallucinationratherthanasausefulguidetoyouinlearning thelessonsoflife.Professionals,whotakeontheroleof expertandgivedirectionandadviceratherthan encouragingyourownselfdiscovery,canundermineyour senseofempowerment.Peoplesaythatbeinghospitalized againsttheirwishes,whentheyareindistressandsuicidal, and/orbeingphysicallycontrolledorplacedinisolation,can bringbacktraumaticmemoriesofearlyabuse.Taketimeto learnaboutyourrights,undertheMentalHealthActofyour province,sothatyoucanbeactiveinmakingimportantcare decisions.
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Section 6: Other pathways to healing

Notallhelpcomesfrompaidhelpers.Caringissomething thatwedoforeachother.Itiswhatbuildsstrongfamilies andclosecommunities.Themorewecanbothgiveand receivecarethemoreinbalanceweare.FirstNationspeople havealwaysknownthisandwearerelearninghowtocare foreachother.
Notallhelpcomes frompaidhelpers. Caringis somethingthatwe doforeachother.
Self-help groups
Manypeoplefindthatmeetingothersinselfhelpgroups reallyhelps.Heretheyfeelasiftheyareunderstoodandnot judged.Peoplearegoingthroughthesamethingandcan learntogether.Selfhelpgroupsareavailableforpeoplewith mentalhealthandaddictionschallengesandtheirfamilies.It isaplacetosharestories.Youcanlearnnewwaysofcoping. Youcanhelpothersbysharingyourhardearnedwisdom. Somegroupsoffermanuals,hostchatrooms,andprovide linkstolocalresources.Mostimportantisthemessageof hopeandknowingthatyouarenotalone.Peersupportmay alsoincludeoneononecounsellingbypeoplewhohave beenthere.Peersupportworkersprovidepracticaladvice andhelpwiththetasksofdailyliving.Theycanbehelpful becausetheyknowwhatyouhavebeenthroughandcan shareinformationabouthelpfulservicesandwaysofcoping. Someselfhelpandpeersupportgroupsgetinvolvedin advocacy,reachingouttopoliticiansandgovernmentpolicy workersonissuesthataffecttheirmembersqualityoflife. Theymaydopubliceducationbyspeakingtoschoolsand communitygroupsorholdinformationandresourcefairsto helpeducatethepubliconmentalhealthandmentalill health.Manypeoplesaythatgettinginvolvedinthese activities,andmakingthingsbetterforothers,helpstheir ownrecovery.
Art as a healer
Talktherapyisnottheonlypathtoselfawareness.Many FirstNationspeoplearelearningaboutthemselvesthrough art,dance,music,andtheatre.Thisisapowerfulwaytofind yourvoice,discoveryourtalent,tolearnaboutyourculture
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andconnectwithothers.TalkwiththelocalNative FriendshipCentretofindoutaboutwhatisgoingoninyour community.Manypeoplearefindingthisasuccessful approachtohealingandselfdiscovery.Useyourjudgement infindingaprogramthatmatchesyourneeds.
Parenting programs
ManyFirstNationsparentsdidnothavegoodrolemodelsto teachthemhowtoraisehealthyandhappychildren.They maynotknowabouthealthygrowthandnormal developmentofchildrenandwhattoexpect.Theymaynot knowhowtosetgoodlimitsandencouragekidstolearnself control.Buttheseskillscanbelearned.Thereareprograms availabletoteachhowtobeagoodparentorgrandparent. Bylearninghowtoparentyourchildyoualsohaveachance tolearnhowtoparentyourself.Thiscanbeveryhealing.
The importance of work

Makingalivingisanimportantpartofouridentity.Paidand volunteerworkprovidesstructuretoourday,andpurpose andmeaningtoourlife.Itallowsustosupportourfamilies andourselves,especiallyourneedforrenewal.Meaningful workisimportantforgoodmentalhealth.Apaycheque increasesoursenseofpersonalempowerment.Andbeing abletoassistothersvoluntarilyalsobringssatisfaction. Damagefrominstitutionalizationandresidentialschooling includesbreakdowninknowinghowtobehelpfuland developingrelationshipsthatfostermutualaid.ManyFirst Nationspeopleareshutoutofemploymentopportunities becauseofracism,lackofqualityeducationandtraining,or becausethereislackofeconomicopportunitiesintheirhome territories.Findingsupporttohelpyougainafootholdinthe worldofworkoraccesseducationandtrainingprogramscan improveyouropportunitiestomakealiving.Volunteerwork canbeequallyvaluableinmaintaininggoodmentalhealth andhelpstobuildastrongworkhistoryandinmakingyou morecompetitiveingettingwork.
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Section 7: Being part of your recovery

Professionalsandpaidhelperscanprovidevaluablehelp,just asvolunteersmay.However,youwalkthepathtorecovery. Therearemanywaysthatyoucanhelpyourselftofindpeace andbringbalancetoyourlife.
Therearemany waysthatyoucan helpyourselfto findpeaceand bringbalanceto yourlife.
Askyourself Areyoumakinghealthychoicesforyourself? Doyougetenoughsleepandeatwellwhenyouare hungry? Doesyourdietsupportyourhealthandwellbeing? Areyouphysicallyactive?Doyouexerciseregularly? Areyouinvolvedinsports? Canyoucalmyourselfdownwhenyouareupsetand avoidgettingtooangry? Haveyouasacredspacewhereyoucangoandlistento yourheartandsoul? Doyouspendtimeinnature? Haveyoujoinedaselfhelpgroup? Doyouknowyouhistory,yourculturalfoundation,ways ofknowing,values,beliefsandmeaningofceremonies anddoyouparticipateinmeaningfulculturalactivities? Doyouknowaboutyourcondition(grief,depression, anxiety,posttraumaticstressdisorder,substanceabuse) andhowtomanageit? Doyouhaveatleastoneconfidential,closerelationship Areyouinvolvedwithyourcommunity? Doyouvolunteertohelpothers? Doyouhavegoodrolemodelsforlivingandlearnfrom them? Doyoureachouttootherwhenyouneedhelp?
Canyousetlimitsonothersandsaynowhenyoudonot wanttodosomething? Areyoulearninganewskillinwhichyoucantakepride? Doyousetsmallgoalsforyourselfandworktowards them? Areyouconnectedwithfamilyandfriends?
Helpingfamilies sharetheirhistory, listentoeachother, andlearnwhatis importantisapart ofhealing.
Families are the foundation of community

FamilyandkinshiptiesareveryimportanttoFirstNations people.Thehealthierthefamily,thehealthier,andstronger isthecommunity.Familyandfriendsareveryimportantin helpingpeoplerecognizewhensomethingiswrong.They knowusandcanseewhenthingsarenotgoingwell.They canprovideacceptance,support,reassurance,andpractical help. Goodcareproviderswillincludeyourfamilyincare.You mayneedtotellthemwhoyouconsidertobepartofyour family.Itmayincludepeoplewhoarenotrelatedtoyouby bloodormarriagebutareimportantforyouinbuildinga supportnetworkorplanninglongtermgoals.Careproviders areabletoworkwiththefamilyandfindthosememberswho canprovidebroadersupportandguidancelikeatrusted auntie.Nomatterhowbadlyfamiliesrelatetooneanother, therearealwaysstrengthstobedrawnupon.Careproviders canhelpbyfindingoutwhatisworkingwithinthefamily andbuilduponit.Helpingfamiliessharetheirhistory,listen toeachother,andlearnwhatisimportantisapartofhealing. Not all families are helpful Sometimesfamiliesarenotplacesofsafety.Whenthereis violenceandabuse,orwhenyouarenotacceptedforwho youare,itishardtoheal.Sometimes,takingtimeawayfrom yourfamilymaybeimportant.However,familyisvery importantinhealing.Isthereextendedfamilyyoucanreach outtothatissupportive?Somepeoplecreateanew, acceptingfamilythroughtheirfriendships.Thisnewfamily canmeetourneedsforacceptance,care,andbelonging. Whomeveryoucallfamily,theycanplayanimportantrolein helpingwithrecovery.
Tips for families

Believe unfailingly in the ability of people to change Mostpeople,whohaverecoveredfrommentalillhealth, agreethattheloveandsupportoftheirfamilywasvery important.Reflectinghopeandthepromiseofabetter tomorrowcanhelppeoplemovetowardschange. Be there Sometimesjustbeingthereisenough.Aquiet,caring, presencehelpspeopleknowtheyarelovedandvalued.You donotneedtofixtheproblemormakeitgoawaytobe helpful. Share your concerns - not your advice Tellingpeoplewhattodocanshutdownlisteningand learning.Peopleneedtofindtheirownpathtowellness. Youcanhelpbylisteningrespectfully,sharingwhatyousee andyourconcerns. Accept that people are in charge of their own lives Itisverydifficulttowatchpeopleyoulovemakebad decisionswithouttakingoverorrunningaway.Butmaking mistakesispartoflearning. Provide practical help Sometimespeopleneedhelpwiththeburdensoflifeinorder totakethetimetoheal.Familyandfriendscanhelpwith caringforchildren,helpingwithchores,orlookingafterthe home.Thispracticalsupportcanprovideaneededbreak. Learn as much as you can Ifyourlovedoneisoneisdealingwithdepressionoranxiety trytolearnasmuchasyoucanaboutthissothatyoucan makesenseofwhatishappeningandprovidesupportand encouragementthatthingswillgetbetter. Find out what help may be available Findinghelpcanbeachallenge.Itisevenmorechallenging whenyouarefeelingunwellorhopeless.Theremaybefew, ifany,professionalsupportsavailableinremoteandrural communities.Youcanbeveryhelpfulindoingsomeofthe
researchtofindoutwhereandwhatservicesmaybe available. Heal yourself Ifyouarealsocarryingunhealedgrief,taketimetofindhelp foryourselfaswell.Caregivingcanbealong,frustrating, anddifficultjourney.Donotforgettolookafteryourown physical,emotional,andspiritualneeds. Be patient! Itcantakeawhileforpeopletoacceptthatsomethingis wrong.Ittakesfaithtoknowthatchangeisneededor possibleandtotaketheactiontogethelp.Evenifyourloved onereachesoutforhelp,ittakestimetolearnnewwaysof copingandtomakepositivechange.Mostjourneysof recoveryinvolveslipsandfallingbackonoldhabitsduring timesofstress.Thiscanbeimportantforlearning.Itispart ofchange.
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Section 8: Resources
Where to find on-line help
The Aboriginal Youth NetworkrunsacrossCanada(andbeyond) connectingAboriginalyouth.ThiswebsiteincludesaHealthy Youth Directorylinkingyoungpeopletoservices. http://www.ayn.ca/Resources-HealthyYouthDirectory.aspx
A Directory of Mental Health Programs and Services Native
WomensAssociationofCanada1996.http://www.nwachq.org/DirectoryMentalHealthProgramsServices.pdf
Centre for Suicide Preventionhasalistingofcrisiscentresand
onlinecounsellingservicesacrossCanada.Theyalso provideusefulinformationforfamilyandfriendsfor supportingsomeonewhentheyaresuicidal.

http://www.suicideinfo.ca/
First Nations Child and Family Caring Society of Canada Includesa
listingofChildandFamilyServiceAgenciesacrossCanada.
http://www.fncfcs.com/resources/agencyList.php
Healing Lodges For Aboriginal Federal Offenders Providesalisting
oftreatmentserviceswithinthefederalcorrectionsservice.
http://www.cscscc.gc.ca/text/prgrm/correctional/abissues/challenge/11_e.shtml
National Aboriginal Health Organization,NAHOisanAboriginal
http://www.naho.ca/english/
designedandcontrolledbody,focussedonadvancingthe healthandwellbeingofAboriginalPeoples.
National Native Alcohol and Drug Abuse Program / National Youth Solvent Abuse Program Treatment Centre Directory This
directorywasdevelopedinordertoprovideadocumentthat summarizesbasicinformationonallnativeInpatient treatmentcentresfundedbyNNADAP.http://www.hcsc.gc.ca/fnih-spni/substan/ads/nnadap-pnlaada_dir-rep_e.html National Association of Friendship Centres VisitorstoFriendship
Centrescanoftenfindaccesstoculturalprograms,education,
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andtraining,employmentcounselling,healthprograms, childrenandyouthprograms,recreationprogramsand economicdevelopment. http://www.nafcaboriginal.com/index.html
The National Aboriginal Circle Against Family Violence Includesa
listingofFamilySheltersAcrossCanada.
http://www.nacafv.ca/home.asp
The National Native Addictions Partnership Foundationand NationalYouthSolventAbuseProgramList of treatment centres http://www.nnapf.org/english/treatment_centres.html
Za-geh-do-win Information Clearinghouse isalibraryof
informationaboutAboriginalinitiativesinhealth,healing, andfamilyviolence.http://www.anishinabek.ca Alistingofresourcesonfamilyhealing

http://www.anishinabek.ca/zagehdowin/famheal.htm
Ahealthlisting
http://www.za-geh-do-win.com/resultsheet.asp
Suggested reading
Aboriginal Mental Health: What Works Best ADiscussionPaperPreparedby:VickieSmyeandBill MussellJuly2001
ForMheccu,UBC
http://www.mheccu.ubc.ca/documents/publications/discussionpaper.pdf
WarriorCaregivers:UnderstandingtheChallengesandHealingof FirstNationsMen.AResourceGuide,byW.J.Mussell.
Aboriginal Healing Foundation 2005
ReclaimingConnections:UnderstandingResidentialSchool TraumaAmongAboriginalPeople. AResourceGuide,by DeborahChansonneuve.AboriginalHealingFoundation, 2005
Workingtogethertowardsrecovery:Consumer,families,caregivers andproviders.AToolkit.AvailablethroughCanadian Collaborative Mental Health Initiative website. Thisguide

providesdetailedinformationandlinkstoresourcesrelated tomentalillnessandmentalhealth.http://www.ccmhi.ca/
Here to Help B.C. offersanumberoftoolkitsandfactsheetsfor
http://www.heretohelp.bc.ca/helpmewith/index.shtml
understandingandselfmanagementofanxiety,depression, substancemisuseandsupportingfamiliesthatareavailable online.
Feeding Mind, Body and Spirit: Role Paper of the Dietitians of Canada Aboriginal Nutrition Network. http://www.dietitians.ca
On-line meeting places

Turtle Island Native Network Thissiteissponsoredexclusively
byAboriginalpeoplesandoffersavarietyofhealth information,includinghealingandwellnessformentalhealth andaddictionproblems.Itgivesinstructiontovisitorswho wanttoengageintraditionaltreatmentandexplainsthe manyfacets(basedonthenumberfour)oftheMedicine Wheel.http://www.turtleisland.org
Turning Point TurningPointofferscyberspaceforAboriginal
point.ca/index.php/article/frontpage/1
andnonAboriginalpeopleinCanadatohaveopenanddirect communicationwitheachother.Itincludesawealthof informationonhistory,culture,advocacyarticles,anda discussionboardtoallowpeopletoconnect,share,andlearn. CoalitionfortheAdvancementofAboriginalStudies(CAAS) Forumisforeducators,activists,andotherscommittedtothe taskofimprovingtheteachingandlearningofAboriginal worldviews,cultures,histories,andcontemporaryconcerns inCanadianclassrooms.http://www.turning-
http://www.redwiremag.com/mentalhealth.htm ThisAboriginal
onlinemagazineoffersastoryofhopeusingthemedicine wheelandtraditionalhealingpractices.
Useful resources for your care provider

Acting On What We Know: Preventing Youth Suicide in First Nations
isacomprehensivemanualthatdescribestherootsofthe problem,andoffersamodelforaneffectivesuicide
preventionprogramthatinvolvesyouthinallaspects.
http://www.hc-sc.gc.ca/fnib-spni/pubs/suicide/prev_youtjeunes/index_e.html
A Manual Of Promising Suicide Prevention Strategies. Thissiteis
sponsoredbytheCentreforSuicidePreventionandincludes apracticalresourcedevelopedwiththesupportoftheRCMP AboriginalPolicingServices.

http://www.suicideinfo.ca/csp/go.aspx?tabid=144 The Mental Health and Well-Being of Aboriginal Children and Youth: Guidance for New Approaches And Services http://www.crpnm.mb.ca/library/Mental%20Health%20of%20Abori ginal%20Children.pdf
EmergencyMentalHealthManagement:Atrainingmanual
http://www.mheccu.ubc.ca/documents/publications/emhmanual.pdf Cultural awareness workbook for GPs
Conducting Assessment of First Nations and Inuit Communities: A Training and Reference Guide for Front-Line Workers inMental
HealthandAddictionsServices.
http://www.nnapf.org/english/pdf/publications/NNAPF_Publications _Risk_Assessment_Manual.pdf
36
Appendix A
Community mental health professionals7
AssertiveCommunityTreatmentTeams(ACTTeams):The membersofACTTeamsarepsychiatrists,nursesandsocial workers.Ifyouhaveaseverementalillness,youmaybe referredtoanACTTeamsothatyoucanlivecomfortablyand safelyoutsideofhospitalandasindependentlyaspossible. ACTTeamshelpmonitoryourmedication,referyoutoother servicesandstaycloselyintouchwithyouthroughregular visitsforaslongasyou,theteamandyourfamilyagreethat youneedthem. Casemanagers:Casemanagerswillalsoworkwithyouona longtermbasis.Someprovidecounselling.Otherswillhelp youfindhousingandcommunitysupportservicesand coordinatetheseservicessoeveryoneisworkingasateam. Theywillhelpyoustayoutofhospitalbyworkingwithyou topreventarecurrenceofyourillness.Youwilllikelysee yourcasemanagerweeklyandtheywilloftenbeableto visityouinyourhomeratherthanyouhavingtogototheir office.Casemanagersalsoworkinmentalhealthlawcourts andhelppeoplegettreatmentifthechargesareminorand directlyrelatedtomentalillness. Crisisworkers:Notallcommunitieshavecrisisservicesbut forthosethatdo,crisisworkers(notalwaysbutmostoften) workwithamobileteamthatwillgotoyourhomeinan emergency.Sometimes,thepolicemaybethefirstpeopleto arrivebut,ifthecrisisisrelatedtoyourmentalillness,they willcallacrisisworker(oronewillcomewiththem)whois speciallytrainedtohelp.Somecommunitieshavecrisis programsthatyouoryourfamilycancalldirectly.This approachislessupsettingthanhavingthepoliceinyour home.Thecrisisworkerstayswithyouuntilyoufeelbetter andthenfollowsupinthenextseveraldaysorweekstosee thatyouarereferredtoservicessoyoucanavoidacrisisin thefuture.
7 This list comes from CCMHI Consumer, Family and Caregiver Guide 2005 Canadian Collaborative Mental Health Initiative 37
Housingworkers:Ifyouliveinsupportivehousing,there maybestaffworkingtheretohelpyousettleinandgetto knowyourneighbours.Housingworkersoftenorganize tenantsmeetings,socialeventsorworkpartiestodo commonchores(ifthetenantsarerequiredtohelpout).Some housingsituationshavestaff24hoursaday,7daysaweek. Inothercases,thestaffareavailableoncalloratspecified hours. Peersupportworkers:Peoplewhohavehadamentalillness orwhoareafamilymembermayvolunteertohelpothers,or theymaybepaidparaprofessionals.Theyworkinconsumer orfamilyorganizationsorinprofessionallymanagedmental healthservices.Theymaybecalledbydifferenttitlessuchas PeerAdvocate,PeerCounselororPeerOutreachWorkerbut theyallhaveonethingincommontheyvebeenthere. Vocationalcounsellors:Someprogramshelpyoutofinish youreducationand/ortodeveloptheskillstowork.Then, theysupportyouthroughtheprocessoffindingandkeeping ajob.Vocationalcounsellorsalsoworkwithemployersto findjobsforpeopleandensurethattheyareeducatedabout mentalillness. Someothernamesforprofessionalswhoperformtheseroles, asdescribedabove,areNationalNativeAlcoholandDrug AbusePreventionWorker(NNADAPWorker),mentalhealth therapist,wellnessworker,communityandsocial developmentworker,addictionworkeroralternativeworker themainthingistoaskwhattheydo,notwhattheyare called. Traditionalhealers:Traditionalhealershelptosortoutwhat iscausingthecurrentimbalance.Theirknowledgeandgift forhealingcomesfromtheCreator.Thevaluesofkindness, honesty,sharingandstrengtharethefoundationof traditionalhealing.Thejobofthehealeristosupportand providedirectiononhowtoregainandmaintainbalancein life.Thetraditionalhealerrecommendsoptionstolivelifein agoodway.Becausehealingiswithineachofus,weareall capableofhealingourselves.Sometimesthisisbetterdone withtheassistanceorsupportofotherssuchasElders, Healers,andHelpers.
Other professionals who can help you Artandmusictherapists:Somepeoplefindthattheir recoveryisaidedbycreativeexpression.Arttherapyallows peopletodealwithoverwhelmingemotionsinwaysother thantalkingaboutthem.Theyalsohelppeoplefindtheir creativesideandrelateittotheirpsychologicalandmental wellbeing.Somesponsorartshowswhereworkisexhibited andsold.Musictherapistsknowthattheheartistouchedby music.Creatingorlisteningtomusicishealing. Psychotherapists:Psychotherapistsmayhavemany professionalbackgrounds.Psychotherapyisnotaregistered healthprofession(thereisnoformalregulatorybody)soyou needtobesurethatthepersonyouareseeinghasproper training.Psychotherapistsworkfromawidevarietyof approaches.Notethatonlyfamilyphysiciansorpsychiatrists havetheirfeespaidbyMedicareotherpsychotherapistswill chargefees(unlesstheyworkforahospitalorcommunity agency).Visithttp://www.aboutpsychotherapy.com,aBritishsite thatoffersinformationonthemodelsofpsychotherapyand whattheycandoforyou. For people who are working EmployeeAssistancePrograms(EAPs):Manyworkplaces nowofferemployees,aspartoftheirhealthbenefitspackage, confidentialcounsellingforemotional,marital,mentalhealth andaddictionproblems.Whilesessionsarelimited (approximatelysixperemployee),EAPcounsellorscan providereferralstocommunityservicesandlongerterm counselling.SomeEAPsofferworkplacetrainingonsubjects suchaswellness,recognizingthesignsofmentalillnessand accommodation. Registered health professionals and what they can do for you Registeredmeansthattheseprofessionalsmustbelongtoa collegethatoverseesethics,practicestandards,complaints anddiscipline.Thefollowingareshortdescriptionsofwhat theseprofessionalscandoforyou,butbesuretoask questionsasmanymayofferserviceswhichcanbebroaderin scopethanwhatisdescribedhere.Some,suchasregistered nurses,registeredpsychiatricnurses,socialworkers,and
occupationaltherapistsmayfulfillmanyoftheroleslisted undertheprevioussection. Familyphysicians:Yourfamilydoctorisyourpersonal physicianandyourhealthadvocatefrombirthtooldage. Afterobtainingamedicaldegree,yourfamilydoctorreceived additionaltraininginthediagnosisandtreatmentofawide rangeofhealthproblems,andlearnedtoprovidecarein differentsettings(hospital,clinic,home)withotherhealthcare providers.Thisexpertiseenablesyourfamilydoctortosee youthroughthelittleproblemsaswellasthebiggerhealth problemsthatrelatetobothyourphysicalandemotional health,whichmayafflictyouovertime.Yourfamilydoctor canalsoworkwithyoutominimizeyourriskofbecomingill andadviseyouonthebestwaystostayhealthy.Yourfamily doctorispartofanetworkofhealthcareprofessionalsand canhelpyouaccessthecarethatyouneed.Formore informationseehttp://www.cfpc.ca. Dietitians(RDs):Nutritionplaysakeyroleinmentalhealth, includingrecoveryfromsubstanceabuse,inmoodandeating disordersandincombatingthesideeffectsofcertain psychiatricmedications.Weightmanagement,diabetes,blood levelsaffectingheartdisease,highbloodpressure, heartburn/reflux,foodallergies,swallowingproblemsand accesstogoodfoodarejustafewoftheissuesdietitianscan address.Dietitiansmaybeavailablethroughoutpatient clinics,homecarecentersandthroughmentalhealth programs.Youwillneedtocheckwithyourfamilyphysician orcasemanagertofindaboutthisserviceinyourcommunity. TheDietitiansofCanadahasaconsumerfriendlywebsite http://www.dietitians.ca (bilingual)thathasresourcesfor healthyeatingandinstructionsonhowtofindanutrition professional.TheConsultingDietitiansNetworkstollfree line(18889017776)isalsoavailabletoprovidereferralto dietitiansinprivatepractice.InBritishColumbiathereisa DialADietitianline(18006673438)thatprovidesanswers tonutritionrelatedquestions. Occupationaltherapists:Occupationaltherapistshelpyou identifythedailyactivitiesinyourlifethatareimportantto youbutarecausingyoudifficulty.Theyworkcloselywith
40
youtodevelopwaysofovercomingthesedifficulties.They addressabroadrangeofactivitiessuchasselfcareand communityliving,toeducation,work,parenting,recreation andleisure.Theyevaluatewhyproblemsareoccurringand suggestapproachestocompensateforthesedifficulties.Some problemsyoumighthavearetroublewithconcentrationor memory,difficultiesgettingorganized,ahardtimemaking planstoreturntoworkordifficultynegotiatingworkplace accommodationswithyouremployer.Anotherthingan occupationaltherapistmightdoisdevelop(withyou)an activityschedulethatpromotessuccessintacklingyourday todaychallengesbutwhichalsosupportsyourmentalhealth andwellbeing.Formoreinformation,seehttp://www.caot.ca Pharmacists:Pharmacistsworktoensurethatyouaretaking therightdosefortherightreasonsandarenottakingany unnecessarymedications.Workingindrugstoresand hospitals,pharmacistsdispensemedicationandarethereto answeryourquestions.Somepharmacieshaveprivate counsellingroomswhereyoucanaskquestionsin confidence.Ifthereisnospecialspace,youarestillentitledto yourprivacy.Itisimportantthatyourpharmacistisawareof allyourmedications.Workwithyourpharmacisttogetyour questionsansweredinaconfidentialmannerperhapsover thephone.Formoreinformation,see http://www.pharmacists.ca Psychiatrists:Yourfamilydoctormayreferyoutoa psychiatristtohelpwithdiagnosisandfindingtheright medicationforyou.Yourpsychiatristwillinvolveyour familyorcaregiveratyourrequestandrecommendyour treatmentplan.Psychiatristsalsoprovideconsultationsto familyphysiciansandtocommunitymentalhealthservices. Inthecaseofconsultation,youmaynotactuallyseethe psychiatrist,yourself,buttheywillbeworkingonyourbehalf inthebackground.Formoreinformation,seehttp://www.cpaapc.org Psychologists:Psychologistsassessanddiagnose psychologicalproblems,sometimeswiththeuseof psychologicaltests.Theyarealsoofferpsychotherapywhich canhelpyouunderstandwhyyouthink,feelandbehavethe wayyoudoand,ifyouareindistress,helpyoufigureout
whatyoucandotomakechangesinyourlife.Some psychologistsworkforhospitals,clinics,jailsorschoolboards wheretheirservicesarecoveredbypublichealthinsurance. Othersworkinprivatepracticewheretheychargeafeefor theirservices.Ifyouareemployedandhaveahealthbenefits plan,itmayofferfrom$500to$1000peryearfortheservices ofaregisteredpsychologist.Visit http://www.cpa.ca/Psychologist/psychologist.htm whereyoucan learnmoreaboutwhatpsychologistsdo. Registerednurses(RNs):RNsworkinmanylocations throughouttheentirehealthcaresystem.Theywillhelpyou withallyourhealthneedssomeofwhichwillrelatetoyour mentalillness.Nursescanprovidecounselling,helpyou monitoryourmedication,makereferralsandadvocatefor you,andprovideteachingabouthealthyliving.Somenurses workincommunityrolessuchascasemanagersorcrisis workers.OthershaveadvancetrainingandarecalledNurse Practitioners.Workinginconsultationwithaphysician,these nursesofferabroaderrangeofhealthservicesincluding diagnosisandtheprescriptionofsomemedicationsthings thatonlydoctorsusedtobeabletodo.Formoreinformation, seehttp://www.cna-nurses.ca Registeredpsychiatricnurses:RegisteredPsychiatricNurses providehealthcaretopersonsinavarietyofsettings.Their focusisonthementalanddevelopmentalhealthofpersons withinthecontextoftheiroverallhealthandlifesituation. Theireducationprovidesaspecialfocusonmentalhealthand mentalillnesses.Theirknowledgeandskillsincludeneeds assessment,programplanningandtherapeuticinterventions. Theypracticewherepeoplelive,workandplayaswellasin hospitalsandcommunityclinics/services.Theyareoftenthe onlymentalhealthresourceavailabletoaruralorremote communityandthereforeworkcloselywithothermembers ofthecommunitytomeetthediversementalhealthneedsof itspeople. Thesearenursesspeciallytrainedtohelppeoplewithmental illness.Theyworkinmentalhealthservices,bothinhospitals andinthecommunity.Theycanprovideyou,yourfamilyor caregiverwitheducation,adviceandcounsellingandthey
42
areskilledathelpingyoumonitoryourmedication.Formore information,seehttp://www.psychiatricnurse.ca or
http://www.cfmhn.org
Socialworkers:Socialworkershelpwithpersonalproblems inthecontextofyourrelationships,family,communityand lifecircumstances(poverty,childhoodtrauma,domestic violence,marginalization,culturalheritageandmanyother situationsthatareuniquetoyou).Somesocialworkers providecounsellingorpsychotherapy.Manyworkin positionswheretheirjobistogettoknowtheservicesinyour communityand,withyourinput,referyoutotheonesthat willhelpyouliveindependently.Theirrolesinmentalhealth agenciesorhospitalsincludehealthteaching,treatmentand rehabilitationservicesandtheywillworkwithindividuals, couples,familiesand/orcommunitygroups.Formore information,seehttp://www.casw-acts.ca
43
44
Appendix B
CREATING A CARE PLAN Finding help is not always easy particularly when you are not feeling well. Take time to plan what you can do and whom you can call. Keep a record of contacts made. What do I want from a care provider? __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Who in my community might know what help is available? __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Whom can I call for help? __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Questions I would like answered __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________
45
Whom did I speak to?
Date:
What they said:
What can I do if I am feeling distress? __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Whom can I call on for immediate support? __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________
46
Toolkit Series
This toolkit belongs to a series of twelve toolkits.
Implementation toolkits for providers and planners
1.
Collaboration between mental health and primary care services. A planning and implementation toolkit for health care providers and planners A series of companion documents to the CCMHI planning and implementation toolkit for health care providers and planners. Establishing collaborative initiatives between mental health primary care services for
2. 3. 4. 5. 6. 7. 8. 9.
Aboriginal Peoples Children and adolescents Ethnocultural populations Individuals with serious mental illness Individuals with substance use disorders Rural and isolated populations Seniors Urban and marginalized populations Working together towards recovery: consumers, families, caregivers, and providers Pathways to healing: A mental health guide for First Nations people
Toolkits for consumers, families and caregivers

10.
11.
A toolkit for educators 12. Strengthening collaboration through interprofessional education: A resource for collaborative mental health care and educators
A series of documents examining aspects of collaborative mental health care support these toolkits:
1. 2. 3. 4. 5. 6.
Barriers and strategies A framework Annotated bibliography Better practices Canadian initiatives A policy review
7. 8. 9. 10. 11. 12.
International initiatives [unpublished] Health human resources Mental health prevalence and utilization Interprofessional education Aboriginal mental health [unpublished] The state of collaborative mental health care
Steering Committee
Joan Montgomery Phil Upshall Canadian Alliance on Mental Illness and Mental Health Terry Krupa Darene Toal-Sullivan Canadian Association of Occupational Therapists Elaine Campbell Jake Kuiken Eugenia Repetur Moreno Canadian Association of Social Workers Denise Kayto Canadian Federation of Mental Health Nurses Keith Lowe Penelope Marrett Bonnie Pape Canadian Mental Health Association Janet Davies Canadian Nurses Association David Gardner Barry Power Canadian Pharmacists Association Nick Kates [Chair] Francine Knoops Canadian Psychiatric Association Lorraine Breault Karen Cohen Canadian Psychological Association Marilyn Craven Francine Lemire College of Family Physicians of Canada Linda Dietrich Marsha Sharp Dietitians of Canada Robert Allen Barbara Lowe Annette Osted Registered Psychiatric Nurses of Canada Scott Dudgeon Executive Director
CCMHI Secretariat
Maureen Desmarais, Project Coordinator Scott Dudgeon, Executive Director Marie-Anik Gagn, Project Manager Valerie Gust, Communications Manager Tina MacLean, Research Assistant Jenevive Mannell, Communications Assistant Enette Pauz, Research Coordinator Enric Ribas, Design Assistant Shelley Robinson, Administrative Assistant
Canadian Collaborative Mental Health Initiative 2630 Skymark Avenue, Mississauga, Ontario, L4W 5A4 Tel: (905) 629-0900 Ext 215, Fax: (905) 629-0893 E-mail: info@ccmhi.ca
www.ccmhi.ca

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Pathways to healing:

A mental health toolkit for First Nations people

A TOOLKIT FOR CONSUMERS, FAMILIES AND CAREGIVERS

PROJECT MANAGER Neasa Martin, Neasa Martin and Associates

Pathways to healing: A mental health guide for First Nations people

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Pathways to healing: A mental health guide for First Nations people

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Section 1: Pathways to healing

FirstNations peoplebelievethat: wholenessincludes thehealthand wellnessofour body,mind,heart, andspirit.

Pathways to healing: A mental health guide for First Nations people

Pathways to healing: A mental health guide for First Nations people

Section 2: Challenges to wellness

ManyFirst Nationsfamilies weredeeplyhurtby thegovernment policyofsending childrenawayto residentialschools.

Residential school trauma

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Victim-Rescuer-Persecutor and Nurturer Model2

Violencehas replacedthetrue strengththatcomes fromknowingwho youareasaperson.

Cycle of violence and abuse

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Losses and their effects

Awillingnesstopassivelyacceptwhathappenandlivein adependantstate; Identityconfusion,rejectionandacceptingdiscrimination andputdowns; Selfdestructivebehaviour; Substanceabuse; Violence; Depression,anxiety;and Suicidalbehaviour.

Pathways to healing: A mental health guide for First Nations people

Religious Oppression Alcohol Abuse

Cultural Identity Problems

Themajorhealth problemforFirst Nationspeople,is alcoholaddiction andsubstance misuseincluding prescriptiondrugs andgambling problems.

Addictions including alcohol and drug abuse

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Section 3: Making our own history

RecoveryforFirst Nationspeoplewill takemanypaths. Theirpathneedsto includeafocuson internalwellness anddealingwith lossesthatwere nevergrieved.

Pathways to healing: A mental health guide for First Nations people

Restoringjusticebycontinuingtopushforthesettlement ofoutstandingresidentialabuseclaims; Reclaimingcontroloverdecisionmakingandgovernance andeliminatingtheuseofthreatsandabuseofpower withinourcommunities;and,

NotallFirst Nationspeopleare struggling.

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Section 4: Pathways to health

Emotional growthhappens whenourphysical andemotional needsaremet.

Pathways to healing: A mental health guide for First Nations people

Whenweareraised inasafe,caring, andrespectful environment,we learntovalue othersand ourselves.

Risks and contributing factors

Mentalhealthis linkedtothe strengthand securitywegain fromourfamily andcommunity.

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

Canadian Collaborative Mental Health Initiative

Pathways to healing: A mental health guide for First Nations people

What is sadness and depression?

Pathways to healing: A mental health guide for First Nations people