Canada’s Truth and Reconciliation Commission was established in 2008 to interview Indigenous peoples who had been in Residential Schools and publicize their stories. At its conclusion in 2015, the commission identified 11 areas in which healthcare disparities remain greatest between Indigenous and non-Indigenous Canadians, including a life expectancy of 14 years less for Indigenous peoples. Mental health outcomes, specifically addiction and suicide, prove important contributors to these reductions in life expectancy. 25 percent of Indigenous peoples in Canada suffer from addiction, compared to 17 percent of the general population, and suicide rates in Indigenous youth are six times higher than in non-Indigenous Canadian populations. Indigenous peoples in Canada face many barriers to healthcare, particularly in accessing mental health services and benefitting from urban outreach programs.
Disparities in mental health between Indigenous peoples and non-Indigenous people in Canada stem from systemic colonial practices. Poor mental health outcomes are linked to the intergenerational effects of Residential Schools, government programs that remove autonomy from Indigenous communities, and policies that create and perpetuate social determinants of mental illness, including poverty, unemployment, housing, and food insecurity. Some of these are outside the scope of the Canada Health Act which outlines the goals and responsibilities of Canadian healthcare, but the Canadian government still has a responsibility to improve healthcare provision to Indigenous peoples in Canada. A newfound two-pronged approach by the Canadian government would prove highly beneficial for better addressing the mental health issues of the Indigenous peoples in Canada: First, the healthcare model should be modified to make it more culturally informed and inclusive. Second, accessibility to healthcare should be made more visible to the urban Indigenous homeless and under-housed through the creation of mobile health clinics staffed, in part, by members of the Indigenous community.
While the Western biomedical model takes a more individualistic perspective that focuses on patients as singular medical cases, the Indigenous model of health places the individual and their health in the context of their community and culture to a much greater degree. The Saskatchewan government worked with First Nations peoples to identify four key components of an approach to healthcare that is respectful of the First Nations experience, in which healthcare is 1) trauma-informed; 2) strengths-based; 3) community-engaged; and 4) spiritually-grounded. In Alaska, the Nuka system has taken this approach over the past 10 years and has seen a 42 percent reduction in emergency department visits, a 36 percent reduction in hospital stays, a 25 percent increase in childhood vaccination rates, and a 94 percent increase in patient and client reports of satisfaction and cultural safety. Thus, improving health outcomes and increasing medical access for Indigenous peoples depends on 1) developing training modules for medical and nursing professionals using Indigenous experiences in collaboration with First Nations leaders, and 2) modifying healthcare delivery to acknowledge and respect Indigenous perspectives, both in remote settings serving primarily Indigenous peoples and in urban hospitals where they receive tertiary care.
Making healthcare more accessible to urban Indigenous populations will require bringing healthcare directly to these communities. In urban settings, homeless and under-housed Indigenous peoples often suffer from mental health issues, such as substance abuse and depression. Many of these individuals are unwilling to go to hospitals for care due to previous negative experiences with the healthcare system, including traumatic separation from families and racist stereotyping from medical staff. To improve healthcare access, mobile clinics affiliated with Indigenous community support centres could provide easily accessible emergency and addiction-related care. A pilot program of this type was started last year in Vancouver, expanding mobile health clinics for Indigenous homeless people by providing “trauma-informed, culturally-sensitive primary care, Indigenous elder-led cultural care, mental health services, and addictions support.” In major cities across Canada, Indigenous peoples constitute a large proportion of the homeless population. Developing a consistent, culturally-sensitive presence among these groups could foster addiction recovery, mental health support, and referrals to traditional healing, dentists, and other healthcare services for those seeking to escape homelessness.
Only when the healthcare provided to Indigenous peoples is equal in quality and accessibility to that of non-Indigenous Canadians will the Canada Health Act’s values truly reflect the reality of the Canadian healthcare system.