Aboriginal Peoples Experiences of Mental Health and Addictions Care to Inform Culturally Safe Health Policy and Practic

1. Aboriginal Peoples’ Experiences of Mental Health and Addictions Care to Inform Culturally Safe Health Policy and Practice and Improved Health Status Nominated PI: Victoria (Vicki) Smye RN, PhD Co-Is: Annette Browne RN, PhD and Paddy Rodney RN, PhD UBC School of Nursing Funded by the Canadian Institutes of Health Research (CIHR)

2. The Partnership Research Coordinator Tanu Gamble, UBC School of Nursing (SON) Nancy Clark, UBC School of Nursing (SON) Student Tej Sandhu, UBC Faculty of Medicine Principal Investigator Victoria (Vicki) Smye, UBC SON Co-Investigators Annette Browne & Paddy Rodney, UBC SON Evan Adams, UBC Family Practice, Division of Aboriginal Peoples’ Health, & Aboriginal Health, B.C. Ministry of Health Betty Calam, UBC Family Practice (St. Paul’s Hospital) Nadine Caplette, Aboriginal Health, Vancouver Coastal Health (VCH) Elliot Goldner , SFU, Faculty of Health Sciences Peter Granger, UBC Family Practice (Three Bridges) Barb Keith, Aboriginal Wellness Program, VCH Bill Mussell, Native Mental Health Association of Canada Perry Omeasoo, Strathcona Mental Health & Vancouver Native Health Collin van Uchelen, UBC Psychiatry Barnabas Walther, B.C. Ministry of Health (formerly VCH)

3. The Partnership Collaborators Lorna Howes, Mental Health, VCH Doreen Littlejohn, Vancouver Native Health Services (VNHS) Ron Peters, Research and Policy, VCH Deborah Senger, Contract Services, Provincial Health Services Authority (PHSA) Isaac Sobol, Chief Medical Officer of Health, Nunavut & UBC Family Practice Leah May Walker, UBC Family Practice, Division of Aboriginal Peoples’ Health Diane Woodhouse, Vancouver General Hospital ** Community Aboriginal Advisory Team

4. Purpose of the Study To explore Aboriginal peoples’ experiences of mental health and addictions services in an urban context to improve access to appropriate, effective mental health and addictions services for Aboriginal peoples.

5. Methodology: Critical Ethnography Data collected at urban health and mental health care agencies: In-depth interviews and focus group discussions with clients (n = 42) In-depth interviews with healthcare workers (n=23) Observations in health care settings Analysis of organizational policies

6. Presenting Issues Schizoaffective disorder Mood disorders Depression Anxiety Suicidal ideation Alcohol and drug use HIV, Hepatitis C Residential School History All clients had a history of complex trauma

7. Findings: The Significance of Relational Practices… Client: “She lets me know that [if she cares] by asking about me when I’m not around, stuff like that, she asks my outreach worker”….. “I like when she asks me about my traditional practices – they are very important to me”

8. Everyday Encounters … “Within the system there is some prejudice people in there and I try not to get too mad with them when I find out that they’re prejudice, they don’t like Natives and they don’t like drug addicts” (C) Powerful intersecting oppressive forces: race x gender x class x ability … Points to the need for: Decolonizing Practices

9. Ideologies and Stigma Interviewer: “Why didn’t you get checked out?” Client: I’ve already got HIV, now I’m crazy too?” Internalized Stigma

10. Mediating Influences: The Impact of Social Conditions Client: “There must be something wrong with me, I won’t go shower, I take sponge baths in my room… the hotel is so skungy…we share a bathroom…like if its catchable…” “When I get sick, nobody comes to see me, I literally sit there and starve for a couple of days.”

11. ….Mediating Influences Healthcare provider: …He always writes on the walls and so [name of housing official] said, okay, well, maybe if you just use pencil instead of felt pen what do you think of that... So its always options… And he wrote one word on the wall [when he first arrived in his new place] and it was ‘comfort’…Out of his brain that’s not working very well, and he uses far less drugs and he eats regularly now.

12. What is needed: Shifts in Practices and Policies Shifting the focus of analysis away from cultural characteristics or cultural differences onto the culture of health care, and how practice, research and policies can themselves create marginalizing conditions and inequities.