Presentation Objectives The main objectives of this presentation are:

1. How Do Adults Living with Symptoms of Depression and Anxiety in Halifax Regional Municipality Get Well? A Pilot Study of Treatment Preferences and Experiences of People with Lived Experience Ingrid Waldron, Ph.D. Associate Professor Faculty of Health Dalhousie University October 11, 2017

2. Presentation Objectives The main objectives of this presentation are: • To examine the experiences and views among adults from culturally, racially and ethnically diverse backgrounds towards prescribed or self-directed treatments of depression or anxiety. • To discuss the demographic factors that shape treatment experiences, attitudes, and preferences. • To identify the barriers and facilitators to accessing preferred care for mental health symptoms. • To describe the multi-pronged knowledge translation strategy the team will be using to disseminate and mobilize data and knowledge from the study.

3. Background • Little is known about the treatment preferences among people living with mental health symptoms in Canada. • Variation of preferences and use of mental health care. • Some Indigenous and Black people experience barriers accessing traditional approaches. • Nova Scotia Mental Health & Addictions Strategy. • Improving mental health care for Indigenous, African Nova Scotian, immigrant, and other diverse communities a priority. • The province’s mental health strategy has acknowledged that culture and other social determinants must be taken into consideration. • Approximately 20% of Canadians suffer from mental illness in their lifetime, with 12% experiencing major depressive disorder (Canadian Mental Health Association 2015; Patten, Wang, Williams, 2006).

4. Background • In 2012, about 2.8 million Canadians reported symptoms related to depression and anxiety(Pearson, Janz & Ali, 2015). • Although depressive symptoms can affect people from across cultures, rates and predictors of mental illness can vary between groups (Bombay, 2015; Bombay, Matheson, Yurkiewich, Thake & Anisman, 2012). • More people around the world are using complementary therapies (CTs), especially for mental health symptoms(Freeman, 2009).

5. Euro-Western Mental Health Knowledge: A Critique • How Euro-Western ideology shapes conceptualisations of mental illness, assessments and treatment. • Belief systems, knowledge, traditions and cultural norms that emanate from the European frame of reference. • Dominance and centrality of Euro-Western knowledge. • Unconscious, standard, universal, and common-sense. • Ideologies, beliefs and traditions that constitute the moral fabric of a society. • Cultural normativity of Euro-Western ideology. • Assessments, diagnoses and treatment shaped by Euro-Western health belief systems. • Denunciation, devaluation and marginalisation of other health belief systems.

6. Euro-Western Mental Health Knowledge: A Critique • Racially and culturally diverse groups often less satisfied with the quality of care and hesitant to access mental health services. • Interrogating the hegemonic and dominant character of Euro-Western thought within psychiatry and mental health knowledge.

7. Indigenous Health Knowledge • Indigenous knowledge premised on the several principles. • Initiatives to forge authentic alliances between Western medicine and Indigenous health practices fraught with challenges. • Opportunities for syncretism between both health systems. • Two-Eyed Seeing Model (Etuaptmumk).

8. African Health Knowledge • African health systems across the globe are considerably pluralistic. • Within African health systems, identification, assessment and classification of diseases and treatments are all shaped by a number of factors.

9. Methodology • PHASE ONE • Engagement of People with Lived Experience • Data Collection • Recruitment • Data Analysis • PHASE TWO • Focus Groups • People using complementary therapies (practitioner guided or self-directed); • Indigenous people; and • Black Canadians. • Data Analysis • Audio-recorded and transcribed • Thematic analysis

10. Methodology • PHASE TWO • Knowledge Translation • Health care providers • Complementary therapy practitioners • People with lived experience/General public • Provincial government

11. Future Research • This study will open the door for future research that will examine in greater detail how diverse communities in the HRM use complementary therapies and Indigenous/traditional methods to cope with and address depression and anxiety. • This study will inform the development of a long-term research program, including larger studies for which grants from CIHR and Nova Scotia Health Research Foundation will be sought. • Future efforts will be focused on practical knowledge translation efforts, which will be facilitated by our research team.

13. References Bojuwoye, O. (2005) Traditional healing practices in Southern Africa: Ancestral spirits, ritual ceremonies, and holistic healing. In Moodley, R. and West, W. (eds.). Integrating Traditional Healing Practices into Counselling & Psychotherapy. (pp. 61-72). Thousand Oaks, CA: Sage Publications. Bombay, A. (2015). A call towards eliminating mental health disparities faced by Indigenous Peoples. The Lancet Psychiatry, 2, 861-862. Bombay, A., Matheson, K., Yurkiewich, A., Thake, J., & Anisman, H., (2012). Adult personal wellness and safety. In First Nations Information Governance Centre (Eds.), First Nations Regional Health Survey (RHS) Phase 2 (2008/10) - National Report on Adults, Youth, and Children Living in First Nations Communities (pp. 212-228). Ottawa, ON: First Nations Information Governance Centre. Canadian Mental Health Association. Fast Facts about mental illness. http://www.cmha.ca/media/fast-facts-about-mental-illness/. Accessed January, 2015. Freeman, M. (2009). Complementary and Alternative Medicine (CAM): Considerations for the treatment of major depressive disorder. J.Clin.Psychiatry, 70 (Suppl 5), S4–S6. Marshall, R. (2005) Caribbean healers and healing: Awakening spiritual and cultural healing powers. In Moodley, R. And West, W. (eds.). Integrating Traditional Healing Practices into Counselling & Psychotherapy. (pp. 73-84). Thousand Oaks, CA: Sage Publications. Patten SB, Wang JL, Williams JVA, et al. Descriptive epidemiology of major depression in Cana- da. Can J Psychiatry. 2006;51(2):84-90. Pearson C, Janz T, Ali J. Mental and substance use disorders in Canada. Health at a Glance, Health Statistics Division. Statistic Canada. Sept, 2013. Catalogue no.82-624-X. Ministry of Industry: Ottawa. http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11855-eng.pdf. Accessed January, 2015. Solomon, D. & Adams, J. (2015). The use The use of complementary and alternative medicine in adults with depressive disorders. A critical integrative review. Journal of Affective Disordes4, 179, 101-113. Waldron, I. (2010) The marginalization of African indigenous healing traditions within Western medicine: reconciling ideological tensions and contradictions along the epistemological terrain. Women’s Health and Urban Life, 9, 50–71. Waldron, I. (2002). “African Canadian women storming the barricades! Challenging psychiatric imperialism through indigeneous conceptualizations of “mental illness” and self-healing”. A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy, Department of Sociology and Equity Studies in Education, University of Toronto.