The article under review is titled Everything Is Related and It All Leads Up to My Mental Well-Being: A Qualitative Study of the Determinants of Mental Wellness Amongst Urban Indigenous Elders. Eight people are listed as its authors: these are the representatives of University of Calgary’s Cummings School of Medicine, University of British Columbia’s Faculty of Health and Social Development, and Ki-Low-Na Friendship Society. This article states that Indigenous peoples in Canada bear a heavier burden of ill health and well-being as compared to non-Indigenous Canadians: a legacy of racism and colonization is to blame. Indigenous mental health outcomes tend to vary from community to community; however, in general, Indigenous people still feel discriminated against even in urban settings, which are supposed to be increasingly accepting of minority groups. Recognizing the ways in which urban Indigenous Elders are affected by specific mental health determinants and will help health services rectify the situation and contribute to improvement of Indigenous mental wellness.
A review of the influence of boarding school attendance on the health and well-being of Indigenous children in Canada showed that the school-related trauma intensifies over time and is transmitted from generation to generation. This trauma is closely linked to inequities in the social determinants of health (SDoH); however, conventional views of SDoH are not appropriate for the Indigenous perspective. They do not consider the processes and experiences of historical and modern colonization, and to address it, Schill et al. (2019) propose an alternative framework for social factors of Indigenous well-being – three levels of determinants. Proximal determinants refer to the factors directly impacting one’s health – health behaviors, physical and social environment, income, and education. Intermediate determinants are resources and systems effecting proximal determinants – that is, Ingenious access to health-care and educational systems, environmental management, as well as community infrastructure and capacity. Distal determinants include contexts constructing proximal and intermediate factors – racism, social isolation, and self-identification.
Moreover, the authors of the article point to a lack of research on urban populations leading to a lack of representation of urban Indigenous residents in academic contexts. Since urban Indigenous peoples might experience health determinants differently than those in rural communities, these unique needs and experiences need to be taken into account by health services and policies. In addition to that, there is little to no research on mental health of urban Indigenous Elders. Schill et al. (2019) report that in a review of nearly 230 articles on mental health of Indigenous Canadians, one focused on mental well-being of Elders, and two on mental well-being of Indigenous urban residents. No articles combining these two subjects of research were found. The purpose of this study is to share insights gained from a research conducted in partnership with an urban organization servicing Indigenous communities, the Ki-Low-Na Friendship Society (KFS). In particular, it addresses the knowledge gaps related to the ways in which urban Indigenous Elders of Kelowna, BC, are affected by the social determinants of mental well-being.
This study resorted to a qualitative, decolonising methodology that allowed Indigenous Elders living in urban areas to share their knowledge of mental well-being and experiences of supports and services. According to Schill et al. (2019), decolonising methodology is closely linked to postcolonial theory, which emphasizes race as a social construct, and studies how racism and social processes are related to colonial practices negatively affecting health. Moreover, it examines social justice and determines the ways in which the balance of power is created, perpetuated, and changed. People interested in sharing wisdom were invited to participate in the study if they were (i) urban residents, (ii) Indigenous, and (iii) fifty-five years of age and older. Exclusion criteria was the inability to participate in English. Data was collected via sharing circles and individual interviews. At sharing circles, Elders took turns in speaking, telling stories and expressing opinions. Each participant’s definition of mental wellness was required for everyone to recognize what it is exactly they came to discuss.
In evaluating the authors’ approach to exploring mental well-being of a marginalized group, there are a few points to make. First of all, Schill et al. (2019) proposed a specific framework to rely on when assessing Indigenous well-being, which differs from the standard one (that is, SDoH). Groh (2018) notes that it is essential: indigenous contexts are challenging to define, but they certainly cannot be defined using methodologies and techniques applied to the majority groups. Additionally, recruiting Indigenous Elders as study subjects is the way to gain perspective not only on their personal experiences as older people but also on the way of thinking of their communities’ representatives in general. Hadjipavlou et al. (2018) speak about the crucial role that Elders play among their people – they are regarded as leaders and keepers of values and beliefs. Participating Elders, coming from a variety of communities, helped Schill et al. (2019) recognize the diverse effects of inequity and poverty on different Indigenous communities.
The relevancy of the study’s outcomes is confirmed by the conclusions of related research. For one, Schill et al. (2019) found that, for Indigenous people, mental health is closely connected to relationships with their community, land, and culture. This is echoed by Tremblay et al. (2013), according to whose study Indigenous people’s connection to their culture is vital to their development of strong identity, which is central to Indigenous social-emotional health. Moreover, Elders confirmed to Schill et al. (2019) that many of their urban-based community members avoided using health-care services that were deemed by them culturally unsafe – that is, highly discriminatory against Indigenous people and not treating them with respect. These services operate both as cause of ill mental well-being and a barrier to improving it. According to Tu et al. (2019), health services in general are not adapted to serve Indigenous patients – even in urban areas. Additionally, when it comes to older people, Dillon et al. (2021) support Schill et al. (2019) in that, as a rule, they are not accustomed to treating mental health. That results in them being more prone to depression and anxiety disorders.
All of that leads to the conclusion: cultural safety needs to be incorporated into care provision in Canada. In particular, Indigenous Elders of urban areas, apart from struggling with a general lack of desire to care for their mental health, tend to avoid health-care services as a phenomenon. This is due to their discriminatory nature against Indigenous peoples, who suffer greatly from the dismissal of their culture. Studies related to the one conducted by Schill et al. (2019) confirm that measures need to be implemented for discrimination to be stopped – and that will contribute to Indigenous Elders’ mental health improving greatly.
References
Dillon, L., Gandhi, S., Tang, D., Liew, G., Hackett, M., Craig, A.,… & Gopinath, B. (2021). Perspectives of people with late age‐related macular degeneration on mental health and mental wellbeing programmes: a qualitative study. Ophthalmic and Physiological Optics, 41(2), 255-265. Web.
Groh, A. (2018). Research methods in indigenous contexts. Springer International Publishing.
Hadjipavlou, G., Varcoe, C., Tu, D., Dehoney, J., Price, R., & Browne, A. J. (2018). “All my relations”: experiences and perceptions of Indigenous patients connecting with Indigenous Elders in an inner city primary care partnership for mental health and well-being. Canadian Medical Association Journal, 190(20), E608-E615. Web.
Schill, K., Terbasket, E., Thurston, W. E., Kurtz, D., Page, S., McLean, F., Jim, R., & Oelke, N. (2019). Everything is related and it all leads up to my mental well-being: A qualitative study of the determinants of mental wellness amongst urban indigenous elders. British Journal of Social Work, 49(4), 860–879. Web.
Tremblay, M., Gokiert, R., Georgis, R., Edwards, K., & Skrypnek, B. (2013). Aboriginal perspectives on social-emotional competence in early childhood. International Indigenous Policy Journal, 4(4). Web.
Tu, D., Hadjipavlou, G., Dehoney, J., Price, E. R., Dusdal, C., Browne, A. J., & Varcoe, C. (2019). Partnering with Indigenous Elders in primary care improves mental health outcomes of inner-city Indigenous patients: Prospective cohort study. Canadian Family Physician, 65(4), 274-281. Web.