National Summit on Indigenous Mental Wellness highlights report

Presentations and participants

67 presentations were presented by 140 representatives of 65 organizations. These presentations reflected a wide range of initiatives from across Canada. These presentations reflected Indigenous-led approaches to wellness that are innovative and effective with almost 85% highlighting initiatives related to frontline services and community.

Over 600 participants attended this event in-person and virtually, representing a wide range of stakeholders. 61% of participants were representatives from Indigenous organizations (for example, national or regional Indigenous organizations, tribal councils and regional service delivery organizations) or communities, while 27% were representatives from federal, provincial and territorial governments. 12% were from of other organizations or sectors, such as academia.

Themes

The top 5 themes that resonated most with participants are:

• community-based approaches
• Indigenous-led health and wellness models
• distinctions-based mental wellness strategies
• supporting the mental wellness workforce
• on-the-land and culture camps

Other themes that connected with participants include:

• life promotion and suicide prevention
• substance use prevention and treatment
• harm reduction
• Indigenous youth perspectives on mental wellness
• counselling for Indigenous populations

Key takeaways

Several survey respondents highlighted the importance of culturally-safe and strengths-based approaches, as well as listening, sharing information, storytelling, connection, working together, co-creating change and networking.

Many respondents mentioned communities. Several highlighted that many of the challenges communities are facing are the same, yet communities are unique and needs solutions flexible to their needs. Respondents also noted a need for a platform to share ideas and best practices more consistently and to make mental wellness part of a more regular conversation.

Based on respondents, key takeaways from the summit presentations and discussions outlined below are examples of strengths and challenges within the current landscape of Indigenous mental wellness.

Strengths

• Indigenous peoples have the capacity to deliver culturally-based and relevant mental health and substance use programs. There is strength in current programming and communities know what is needed to support their people. Indigenous leadership plays a key role in advocating for community needs.
• Effective approaches are:
  • led by Indigenous people, for Indigenous people
  • holistic and based in equity, inclusiveness and respect
  • those that recognize Indigenous history and trauma
  • based on culture and community in healing
  • distinctions-based and community-led
  • centred in collaboration and cooperation
• Indigenous youth can lead in finding solutions. Community and connection are at the heart of youth well-being.
• Virtual services are creating service innovation and are important for meeting peoples’ needs.

Challenges

• Indigenous leadership and communities should be driving priorities and investments, not the federal government. Provinces and territories need to be brought to the table.
• Current supports and services address a fraction of the need, especially around healing from trauma. More programs and resources (both financial and human) are needed and should include establishing an Indigenous mental wellness association, supporting the mental wellness workforce and focusing on community capacity.
• This are limitations to current investments and a need to move toward Indigenous-led systems that are based on long-term, meaningful cycles of investment.
• There is a need for:
  • equity in mental wellness and determinants of health
  • multi-year, long-term, sustainable and flexible funding and improved access to services
  • improved access to support for basic needs
• There are challenges around mental wellness navigation and a need for clear pathways to treatment.
• A focus on mental wellness during emergencies and crises, including the COVID-19 pandemic, is needed.

Culture

All presentations and discussions at the summit highlighted the importance of culture for health and wellness at the population, community, family and individual levels.^{Footnote 1 Footnote 66} Across services and supports, strengthening a connection to culture, language and land is essential for improving mental wellness and healing. Culture is also identified as a protective factor and linked to resilience.

Several presenters noted concern around the lack of culturally-appropriate and culturally-safe mental wellness services for Indigenous populations. Solutions to this issue include improving access and availability of Indigenous-led services that are grounded in culture; integrating Indigenous culture, language and history with Western services; and supporting training to create culturally-safe health and social services.

Key terms mentioned were:

• Culture as foundation
  • 1 of 4 overarching themes in the First Nations Mental Wellness Continuum Framework (FNMWCF), seen as a social determinant of health and a core focus for mental wellness^{Footnote 3}
• Cultural continuity
  • 1 of 6 key priority areas for action in the National Inuit Suicide Prevention Strategy (NISPS) that emphasizes the importance of culture, land and language to healing^{Footnote 13}
• Cultural safety
  • in relation to education and training for the mental wellness workforce that supports communities and in creating safe spaces for clients that respect culture and are free of racism and discrimination.^{Footnote 1-Footnote 3 Footnote 5 Footnote 8-Footnote 10 Footnote 12 Footnote 15 Footnote 17 Footnote 19 Footnote 27 Footnote 31 Footnote 34 Footnote 38 Footnote 39 Footnote 51 Footnote 54 Footnote 59}
• Culturally-appropriate services, supports and initiatives
  • reflect inclusive services, supports and initiatives that respect culture in their development and delivery^{Footnote 1 Footnote 66}

Community

Community was a key theme across all presentations and discussions, including how it relates to collective experiences, such as intergenerational trauma, healing and, in general, community well-being. Like the well-being of the individual, community well-being was linked to culture, land, language, connection and belonging.^{Footnote 2 Footnote 10 Footnote 12 Footnote 14 Footnote 15 Footnote 18 Footnote 21 Footnote 23 Footnote 24 Footnote 41 Footnote 43 Footnote 45 Footnote 47 Footnote 49 Footnote 52 Footnote 53 Footnote 55 Footnote 57 Footnote 59 Footnote 60 Footnote 62 Footnote 66}

Communities are unique yet face similar challenges and have similar strengths. Outlined below are key concepts highlighted by presentations and in discussions, linking community to service delivery and improvement.

First Nations mental wellness

The First Nations Mental Wellness Continuum Framework^{Footnote 3} is a national framework that aims to improve mental wellness among First Nations in Canada. Its overarching goal is to improve mental wellness outcomes for First Nations and establish a continuum of care that forms the basis for a comprehensive mental wellness system. It also provides guidance to communities to adapt, optimize and realign programs and services to their priorities.

The framework was developed by First Nations across Canada and has a shared vision with practical steps toward achieving that vision. It also identifies ways to enhance service coordination and supports culturally-safe delivery of services, including within and across the health and social sectors. The framework focuses on First Nations worldviews and ways of being in practice, strength-based approaches, the importance of culture and community needs.

The framework can guide the design, delivery and implementation of mental wellness services and initiatives at the national, regional and community level, as well as across sectors. Examples presented at the summit include:

• Feather Carriers: Leadership for Life Promotion^{Footnote 4}
  • a community mobilization and collaborative approach to develop community leaders for life promotion and suicide prevention
  • as part of its training, this initiative explores Indigenous wellness through the lens of the FNMWCF
• Indigenous Youth Perspectives on Mental Wellness^{Footnote 22}
  • gathered through a Canadian Roots Exchange Policy Hackathon that took place in July 2022, this event focused on youth perspectives on the design and implementation of the FNMWCF and how it can meet youth mental wellness needs
• The Southern Chiefs Organization Mobile Crisis Response Team^{Footnote 34} and the Wolastoqey Mental Wellness Team^{Footnote 59}
  • both used the FNMWCF as a guide to shape the delivery of mental wellness services and supports

Community-based strategies for mental wellness are important for ensuring that a First Nations community’s unique needs can be met through services and supports that are effective and sustainable for its citizens. Needs can be influenced by a variety of interlinked factors, such as population demographics, location (for example, urban, rural, remote and isolated) and access to health and social services.

Examples of models presented at the summit that were developed to support First Nations community-specific needs related to mental wellness include:

• The Fish Net Model of Care – An Indigenous-led Approach to Mental Wellness^{Footnote 49}
  • Developed in 2009, the Fish Net Model approach was a response to suicide and problematic substance use in Eskasoni First Nation. It is an Indigenous-led, 2-eyed seeing approach to mental wellness that includes integrated mental wellness services under the Eskasoni Crisis and Referral Centre. In 2016, integrated youth mental wellness services were added through the ACCESS Open Minds project.
• The First Nations Wellness Initiative: Strengthening, Expanding and Sharing Community-Driven Approaches^{Footnote 7} and Nurturing Wellness Through Indigenous Community Leadership – Responding in Meaningful Ways^{Footnote 8}
  • Led by the Centre for Addiction and Mental Health, this approach outlines a collaboration model to support First Nations communities in developing community-driven and community-based mental wellness strategies that are evidence informed. It involves working closely with community members through a research-to-action process. Partners include the Wiikwemkoong Unceded Territory, Walpole Island First Nation and Saugeen First Nation.

Inuit mental wellness

The National Inuit Suicide Prevention Strategy^{Footnote 13} is an Inuit-specific strategy that was launched in 2016 to reduce suicide rates in Inuit Nunangat. It serves as a tool for collaboration and implementation of evidence-based measures at a national, regional and community level. This includes working towards Inuit-specific and evidence-based service delivery and Inuit self-determination.

The strategy aims to:

1. Promote a shared understanding of risk and protective factors.
2. Guide initiatives and policy by synthesizing knowledge, supporting research and identifying key priorities and actions.
3. Strengthen national, regional and community advocacy efforts.
4. Identify stakeholders and their roles.

One key deliverable from NISPS is supporting the development and implementation of regional suicide prevention strategies.

Examples presented at the summit include:

Aulaqatigiikta, Ilumun Ikayuqatigiikluta (Moving Forward, Healing Together)^{Footnote 14}
Released on September 10, 2022, this regional suicide prevention strategy was created for the Inuvialuit Settlement Region. Guided by NISPS, it was developed by engaging communities, frontline service providers and those with lived experience and by recognizing the importance of traditional knowledge, as well as cultural perspectives and practices. Outlined below are elements highlighted in this strategy under themes of strategic direction, barriers and challenges.

Inuuguminaq/Will to Live, Suicide Prevention Strategy for Nunavik^{Footnote 15}
Released in 2019, this strategy was informed by 20 organizations representing Inuit and frontline services, coordinated by the Nunavik Regional Board of Health and Social Services. Its 5 priorities are:

1. Healthy development for children and youth.
2. Comprehensive mental health support.
3. Healing from grief and historical trauma.
4. Inuit knowledge mobilization.
5. Inuit self-determination and collaboration across the region.

NISPS also supports a variety of regional suicide prevention initiatives and programs. Examples include:

• Project Jewel, a land-based health and wellness program in Inuvialuit Settlement Region
• Ilisaqsivik - Our Life's Journey, an Inuit Counsellors’ Training and Mentorship Program in Nunavut. The program teaches counselling and healing skills based in Inuit culture
• Arctic Children and Youth Foundation and the Umingmak Child Advocacy Centre in Nunavut
• The Arctic Rose Foundation, an afterschool art therapy program in Rankin Inlet, Nunavut
• The Sexual Abuse Flying Team in Nunavik
• The Nunami, a land-based healing program in Nunavik
• a youth centre and sexual violence prevention and outreach coordinator in Nunatsiavut
• an overnight youth drop-in centre in 1 community in Nunatsiavut
• a sexual violence prevention and outreach counsellor, traveling throughout Nunatsiavut and providing services by phone where needed to ensure regional coverage

Métis mental wellness

Mental wellness is a priority for Métis populations. Currently, there is no overarching Métis-specific mental wellness strategy or framework; however, there is significant work underway to improve mental wellness for Métis populations. Across this work, a key theme is the importance of recognizing the positive impact of Métis culture on mental wellness.

Several presentations at the summit outlined initiatives specific to Métis populations. Themes across these presentations include:

• the need for more Métis-specific services and support for mental wellness, particularly grounded in culture and connection to community^{Footnote 36 Footnote 38 Footnote 39 Footnote 41 Footnote 45}
• engaging and supporting Métis voices as key step for improving mental wellness^{Footnote 35 Footnote 38 Footnote 39 Footnote 45}
• connection to culture as a protective factor^{Footnote 35 Footnote 36 Footnote 38 Footnote 39 Footnote 41 Footnote 42 Footnote 45}
• client navigation to help address barriers to care^{Footnote 38 Footnote 39 Footnote 41}

Four presentations outlined client navigation initiatives that were developed as a response to needs raised through engagement with Métis populations. This engagement identified the following barriers for accessing mental wellness services:

• limited services being available
• difficulty in accessing services, including a need to travel to services and long wait times
• high costs for specialized services delivered by professionals with relevant expertise and training
• a lack of Métis specific programming and supports
• a lack of knowledge of existing programs and supports
• a lack of trust in the mainstream system

To address these barriers, initiatives were developed to connect Métis with services to address their specific needs and to navigate the care system. A snapshot of these initiatives includes:

• Métis Counselling Connection Program (Métis Nation British Columbia)^{Footnote 55}
  • In 2021, Métis Nation British Columbia launched the Métis Counselling Connection program (MCC) to reduce barriers to accessing quality mental health counselling supports. This program provides Métis Citizens with up to 10 sixty-minute counselling sessions held with counsellors, psychologists, psychiatrist, or social workers registered through the BC Psychological Association, College of Psychologists of BC, BC Association of Clinical Counsellors, Canadian Counselling and Psychotherapy Association or BC Association for Marriage and Family Therapy.
• Community Wellness Advocate: Supporting Métis Albertans’ Mental Health and Wellness (Métis Nation of Alberta)^{Footnote 38}
  • In January 2022, the Métis Nation of Alberta launched the Community Wellness Advocate (CWA) program to provide Métis Albertans with information and referrals, ongoing support for enrolled individuals and financial support to access mental health professionals. It also provides cultural safety education and has developed partnerships with key organizations in Alberta.
• Culturally Specific Mental Health and Addiction Support Program (Métis Nation Saskatchewan)^{Footnote 39}
  • This program is a referral program to connect Métis in Saskatchewan with culturally-specific mental wellness supports through a toll-free line. Supports include case coordination, mental health and addictions assessment, individual counselling for crisis, trauma, stress, anxiety, depression, addictions and anger, family therapy, digital dependency, gaming and gambling, legal consultation and financial counselling. There is also a 24-hour crisis line.
• Distinctions Based Mental Health and Addiction Support Program (Métis Nation of Ontario)^{Footnote 41}
  • This program connects Métis in Ontario with comprehensive mental wellness assessment, treatment, follow up care and system navigation provided by mental health and addictions professionals to meet a client’s needs in their community.

Trauma-informed approaches

Healing from trauma and grief rooted in colonization, racism and discrimination is a priority for First Nations, Inuit and Métis. Several presentations mentioned healing as a key outcome of culturally-safe approaches to mental wellness, harm reduction and substance use. Without effective services and supports, the impacts of trauma on health and well-being can be long-lasting and intergenerational.

Trauma-informed themes highlighted during the summit include:^{Footnote 4 Footnote 14 Footnote 15 Footnote 17 Footnote 21 Footnote 28 Footnote 31 Footnote 34 Footnote 39 Footnote 40 Footnote 42 Footnote 47 Footnote 48 Footnote 51 Footnote 53 Footnote 55 Footnote 57 Footnote 59 Footnote 61}

• Mainstream approaches to mental wellness tend not to consider how intergenerational trauma, vicarious trauma and trauma are experienced as a result of colonization, or how present day events, racism and discrimination impact the health and well-being of Indigenous people, families and communities.
• Effective mental wellness services for Indigenous populations, which recognize the importance of Indigenous-led mental wellness and the need to address the impacts of trauma on mental wellness. Several presentations noted that connection to culture, language and community are key aspects that define trauma-informed approaches.
• Programs and initiatives that address problematic substance use also recognize the importance of incorporating trauma-informed approaches.
• Community-based approaches, such as mental wellness teams and community-based counsellors, are essential in addressing how unresolved trauma and grief intersect with present day crises such as the COVID-19 pandemic, violence, opioid crisis and suicide clusters, to create complex mental wellness needs.
• Several presentations spoke about initiatives developed for and by Indigenous communities that are grounded in the importance of recognizing the role of trauma and the need for healing as key factors for life promotion and suicide prevention. Similar approaches are being used in violence prevention and family programs.
• More than one presentation referenced the impact of trauma, through both direct and vicarious experiences, and the need for trauma-informed approaches to support the mental wellness workforce serving communities.

Integrated services

Several presentations described examples of integrated services and supports that are effective in improving mental wellness for Indigenous people, families and communities. These examples included integration across the continuum of care, sectors, systems and levels of government, as well as integration of Indigenous culture, language, knowledge and teachings with Western evidence and best practices. Examples of key aspects of integrated services include:

• programming informed by community
• multi-disciplinary teams
• co-location of services
• assessments to connect people with services that meet their needs
• client navigation
• peer support
• collaboration and support for staff delivering services^{Footnote 3 Footnote 10 Footnote 11 Footnote 28 Footnote 41 Footnote 42 Footnote 49 Footnote 51 Footnote 60}

Below are examples of summit presentations focusing on integrated services:

The Fish Net Model of Care – An Indigenous-led Approach to Mental Wellness (Eskasoni First Nation, Eskasoni Mental Health Services)^{Footnote 49}

Developed in response to community crisis in 2009, the Fish Net Model is an integrative, Indigenous-led, 2-eyed seeing approach to mental wellness bringing services together under the Eskasoni Crisis and Referral Centre. The centre is available 24/7 and 365 days a year, and has become a central hub in the community providing services to improve well-being. In 2016, the first integrated, youth mental wellness model in Nova Scotia was established at the same site through the ACCESS Open Minds project. The initiative is community- and youth-led, based on the principles of early identification, rapid access to appropriate care, youth and family engagement, and seamless care beyond the age of 18. A dedicated youth space was established and traditional, cultural and western approaches to mental wellness were developed.

Breaking Down System Barriers (Mistawasis, Saskatoon Tribal Council, Saskatchewan Health Authority)^{Footnote 51}

In response to crises and service gaps worsened by the COVID-19 pandemic, Mistawasis Nehiyawak worked with partners to deliver an integrated model of collaborative mental wellness and substance use support. This approach involved a multi-disciplinary approach with cultural and community supports to address complex trauma and mental wellness needs. Outcomes included increased treatment options, more follow up and support for those with complex needs and improved support for staff.

Distinctions-based Mental Health and Addictions Support Program (Métis Nation of Ontario)^{Footnote 41}

Collaborating with mental health providers, the Métis Nation of Ontario provides a wide range of mental health and substance use services and supports grounded in Métis ways of knowing and being. This program connects people to seamless and timely services and supports through system navigation, comprehensive assessment, treatment and follow up. An example of a key partner is the Weaving Wellness Centre, which is a private clinical and consulting practice that supports Indigenous individuals, families and communities.

Ka Ni Kanichihk’s Indigenous Led Youth Huddle (Ka Ni Kanichihk, Manitoba Harm Reduction Network, Ka Ni Kanichihk Youth Huddle)^{Footnote 10}

Ka Ni Kanichihk’s Indigenous-led Youth Huddle provides integrated, culturally-based health and wellness services, such as primary healthcare; access to Knowledge Keepers and counselling; employment services; substance use and harm reduction support; and education, systems advocacy, mentorship, recreation and ceremony. This initiative is delivered through culturally-safe, in person, online and telephone services, with programming and resources that include land-based activities and ceremonies.

Manitoba First Nations School System and Clinical Services Approaches (Manitoba First Nations Education Resource Centre, Manitoba First Nations School System)^{Footnote 11}

The Manitoba First Nations Education Resource Centre delivers a full complement of school-based clinical services in 45 First Nations schools and administering an 11-member school system under First Nations jurisdiction. This includes clinical teams, an intervention support facilitator to support school staff in implementing programs, inclusive education services, student support facilitators with social work and school counselling training, and training initiatives for cohorts of First Nations clinicians in occupational therapy, physiotherapy, school psychology and speech-language.

Virtual services

Virtual approaches to mental wellness services and supports are evolving and innovating. The COVID-19 pandemic was a catalyst for their growth and demand. Several presentations discussed the pivot to telehealth and virtual services and supports during the pandemic.^{Footnote 18 Footnote 22 Footnote 39}

Virtual approaches to mental wellness are seen as a key component to improving mental wellness for Indigenous populations. They serve as a complement to in-person services and supports, rather than a replacement. Virtual options can be successful in reaching individuals who face barriers in accessing services and supports, including people living in remote and isolated communities. Challenges with virtual approaches include lack of or unstable connectivity and limited Indigenous-led virtual services, programs and resources. There were several examples of:^{Footnote 10 Footnote 11 Footnote 12 Footnote 18 Footnote 20 Footnote 21 Footnote 23 Footnote 25 Footnote 27 Footnote 36 Footnote 37 Footnote 39 Footnote 40 Footnote 53 Footnote 55 Footnote 59 Footnote 64 Footnote 66}

• hybrid approaches to service delivery
• virtual or hybrid engagement to support program or service development, implementation and improvement
• cultural activities and ceremonies in a virtual space

Summit presentations that included examples of virtual services or programs include:

Wolastoqey Mental Wellness Team^{Footnote 59}
The Wolastoqey Nation Mental Wellness Team (WNMWT) aims to build capacity in the Wolastoqey communities to address community needs around mental wellness and substance use. A virtual tele-psychiatry practice for First Nations youth in New Brunswick has been established that is also linked to in-person supports and services.

Big River First Nation TetherAll (Big River First Nation)^{Footnote 40}
TetherAll connects community members with health professionals through a tethered app for substance use disorders and addictions, mental health, eating disorders, suicide and self-harm prevention, grief and loss. This program aligns with and complements frontline services.

Substance Use Prevention and Treatment – Meeting the Needs of Individuals within their Community/Home (Wanaki Wellness Centre)^{Footnote 18}
To address the impact of the pandemic and temporary closure of its residential program on service delivery, the Wanaki Wellness Centre launched a virtual program in June 2021. The program is holistic, strength-based and trauma-informed. The virtual program meets an important community need for services, particularly around flexibility and options for care. Virtual services reach a broad client base, including those who would or could not attend a residential program, providing an important complement to in-person programming.

Talking Stick: Strengthening Community Health and Healing, One Conversation at a Time (Federation of Sovereign Indigenous Nations, TryCycle Data Systems)^{Footnote 25}
To address barriers to accessing care and limited services, especially in remote areas, Talking Stick was developed as a "by First Nations for First Nations" resource. It is an anonymous chat platform supported by a trained, community-based First Nations peer network. It is free and currently available in Saskatchewan in English or Cree. Plans include expanding to other provinces and First Nation languages. Its versatility has been well received by community leaders, tribal councils, health directors and members across the province.

Sekwe’ha: A Community-Based Research Approach to Exploring the Use of Virtual Reality Technology to Support the Mental Health of Indigenous Youth (Dene High School, Centre for Health Research, Innovation and Scholarship, Saskatchewan Polytechnic)^{Footnote 26}
Working with students and staff at Dene High School in La Loche, Saskatchewan, as well as local youth, Elders, clinicians and community members, Saskatchewan Polytechnic has been exploring virtual reality to improve access to quality, timely mental wellness services without youth having to leave their community. This initiative is community-directed and prioritizes traditional ways of healing and knowledge.

Youth

An initiative coordinated by the Canadian Roots Exchange engaged Indigenous youth to highlight youth perspectives and priorities in mental wellness, particularly as they relate to the First Nations Mental Wellness Continuum Framework. Key themes include:

• access to services and service availability
• Indigenous youth awareness of existing services
• quality, safety and inclusiveness of services

Examples of issues raised under these themes included a need for:

• an Indigenous youth council that centers Indigenous youth mental wellness priorities inclusive of First Nations, Inuit and Métis youth needs
• services that support youth moving from communities to urban centres, including culturally-relevant supports and navigation services
• a directory of Indigenous youth mental wellness services that is user friendly
• culturally-relevant services specific to 2SLGBTQQIA+ youth, especially in rural areas
• collaboration across existing, trusted partners supporting Indigenous youth mental wellness
• improved communication across mental wellness services for an improved continuum of care
• culturally-specific mental wellness first aid training specific to Indigenous youth for providers, community members and youth themselves

Many presentations noted the need to develop services, supports and resources that meet the specific needs of Indigenous youth, including addressing complex needs and barriers to care, as well as supporting innovation.^{Footnote 26 Footnote 44 Footnote 52} Several examples of effective approaches were presented at the summit include:

• youth services that integrate health, social, education and mental wellness systems, as well as improve access to culture, language, arts and recreation programs^{Footnote 10 Footnote 11 Footnote 49}
• youth specific resources focused on suicide prevention and life promotion^{Footnote 6 Footnote 36 Footnote 43}
• training to support the mental wellness workforce working with Indigenous youth around suicide prevention^{Footnote 6}

There were several presentations on Inuit youth mental wellness, which strongly aligns with priority areas for action in the National Inuit Suicide Prevention Strategy, The Moving Forward, Healing Together: Regional Suicide Prevention Strategy (Inuvialuit) and Inuuguminaq/Will to Live, Suicide Prevention Strategy for Nunavik.^{Footnote 13 Footnote 15}

Families

The importance of family mental wellness was a key theme at the summit. Presentations highlighting mental wellness services frequently mentioned engaging family in recovery and treatment, strengthening family relationships and families supporting children and youth mental wellness.^{Footnote 1 Footnote 17 Footnote 45 Footnote 47 Footnote 58 Footnote 62 Footnote 65}

Presentations focusing specifically on family mental wellness include:

Inunnguiniq: Inuit Focused Family Support Practices (Nunavut Tunngavik Inc.)^{Footnote 47}
The Inunnguiniq Parenting Program, based on Inuit childrearing philosophy, was developed and piloted over 5 years by the Qaujigiartiit Health Research Centre. Its Inuit Qaujimajatuqangit principles help shift the way systems respond in supporting individuals, families and communities. The program has been offered and well received in many communities in Nunavut, supporting parents, grandparents, caregivers, daycare staff, teachers, foster parents and social workers.

Sakələməlsowakən – Encouraging Urban Indigenous Families to Feel Strong in Themselves (Under One Sky Friendship Centre, University of New Brunswick, St. Thomas University, Horizon Health Network)^{Footnote 58}
The Sakələməlsowakən Family Success Program was created in 2020 as a response to the COVID-19 pandemic. Family support, care planning, healing spaces, nurse practitioner services and health promotion activities are delivered across different modalities. Health promotion activities include cooking workshops, cultural crafting and teaching sessions, educational workshops and social media campaigns. A transitional housing unit is available to families in need of short-term housing.

Rankin Inlet Spousal Abuse Counselling Program (Pulaarvik Kablu Friendship Centre)^{Footnote 62}
The Rankin Inlet Spousal Abuse Counselling Program focuses on physical and mental wellness supports for families who are experiencing domestic violence. This includes counselling for people who are in the initial stages of developing an abusive lifestyle and who wish to change. There is also a parallel program for victims, as well as cultural programming. This program is led by Inuit, for Inuit. Counselling is provided in both Inuktitut and English. Inuit Qaujimajatuqangit values are taught to clients, as well as an Inuit history lesson.

Ais’ poo moo’ a nist tooh ko wa ya (Providing Helpful Advice) - Day Treatment Program, Wellness Program (Blood Tribe Department of Health, Inc.)^{Footnote 17}
Launched in 2020, the Day Treatment Program was developed to address increasing wait times to access services at substance use treatment centres. The program supports individuals who want to stop using opioids, alcohol or other substances, as well as parents, grandparents, siblings and other family members who want to support family members in treatment and create changes within family systems.

Connecting Through Culture: Supporting Mental Wellbeing Among Métis Families in Alberta (Métis Nation of Alberta)^{Footnote 45}
The Metis Nation of Alberta (MNA) engaged extensively with the community to develop a series of seasonal family culture camps using a life promotion approach. These camps provide a connection to community through land-based cultural activities and teachings that are based on Métis cultural traditions and knowledge. Each family camp revolves around seasonal activities and other culturally-based activities. Traditional Knowledge Holders and Elders participate in every camp.

Camp Hope (Montreal Lake Cree Nation)^{Footnote 46}
Camp Hope Land-Based Therapeutic Treatment Program is a family therapeutic centre that supports families in Montreal Lake Cree Nation experiencing problematic substance use that is affecting their ability to care for their children. The program provides support for families and children through approaches that are land-based. The program addresses:

• wellness and healing
• grief and loss
• cultural revitalization
• coping mechanisms for crystal meth and other addictions
• anxiety and stress, addictions recovery
• anger management
• parenting
• medicine wheel teachings
• ceremonies
• healthier parent-child relationships

Inuvialuit Regional Corporation: A Cultural Response to the COVID-19 Pandemic (Inuvialuit Regional Corporation)^{Footnote 65}
In response to the COVID-19 pandemic, the Inuvialuit Regional Corporation supported families to go on-the-land (OTL). Support for families to get OTL increased connection to culture and improved mental wellness. Families were able to get back to traditions and culture and spend time at their cabin. Family connectedness was increased, screen time was reduced and cultural identities were strengthened.

Gender-based initiatives

Several presentations provided examples of initiatives supporting Indigenous women, girls, men, boys and people who identify as 2SLGBTQQIA+ people. Generally, there are limited services and supports that consider the specific needs of different genders and gender diverse populations. Services, supports and initiatives that do exist are under-resourced. Key themes from these presentations include:

• creating safe spaces for women and people who identify as 2SLGBTQQIA+ to access services and cultural supports^{Footnote 8 Footnote 20 Footnote 21 Footnote 37 Footnote 63 Footnote 64}
• importance of trauma-informed and culturally-grounded services and supports to address gender-based violence that recognize the role of historical and intergenerational trauma^{Footnote 8 Footnote 15 Footnote 21 Footnote 32 Footnote 37 Footnote 63}
• a need for more resources and services developed by people with lived experience that are easier to navigate, more accessible, more inclusive and culturally-based^{Footnote 21 Footnote 37}
• taking a strengths-based approach, focusing on culture and incorporating both traditional and mainstream methods to develop inclusive supports and services^{Footnote 21 Footnote 32}
• shifting societal norms and structures around gender in addressing gender-based violence, gender stereotypes and inequality^{Footnote 31 Footnote 32}

People living with pain

A panel presentation on the work of the Canadian Pain Task Force^{Footnote 12} outlined key priorities around supporting Indigenous Peoples living with pain. The task force’s mandate included assessing current approaches to chronic pain, national consultations, identifying best and leading practices to support an improved approach to chronic pain prevention and management in Canada, and providing recommendations on priority actions.

During consultations, Indigenous Peoples living with pain raised issues such as:

• living with a range of complex overlapping health challenges, including mental illness, trauma, violence and substance use
• stigma and racism being barriers to seeking and receiving health care, resulting in fear when accessing services
• strong links between all aspects of living with pain on the mental wellness of the individual, their family and community
• importance of cultural safety education and training, enabling family and community to provide supports and integrating conventional and traditional approaches to supporting mental, emotional, spiritual and physical health and well-being
• conventional supports as the most prominent approaches to health and wellness, and how benefits and risks to pharmacological pain management options can complicate care

Perspectives on substance use

2 presentations highlighted results from engagement on substance use, specifically around the mental wellness workforce and community-based approaches.^{Footnote 19 Footnote 28}

Thunderbird Workforce Wellness Strategy (Thunderbird Partnership Foundation)^{Footnote 19}
Thunderbird Partnership Foundation has been working to improve access to culturally-relevant substance user services closer to communities. This includes supporting and building capacity through equitable funding and wages to retain a highly skilled and qualified workforce. There are 5 critical areas for creating systemic change:

1. A system that reflects current community needs and addresses the complexities linked to intergenerational trauma and First Nations social determinants of health.
2. Compensation commensurate of experience.
3. Strengthening relationships between governments to reflect the new era of reconciliation. This includes federal, provincial and territorial governments respecting First Nations inherent rights, Aboriginal and Treaty rights that are protected under section 35 of the Constitution Act, 1982, and the United Nations Declaration on the Rights of Indigenous Peoples.
4. Increased accountability to First Nations peoples and communities through system flexibility in order to support the workforce and First Nations communities taking advantage of existing opportunities.
5. Measurable conditions attached to transfers can be controversial, but they can be effective in guaranteeing measurable results and ensure that provinces and territories support equitable services in rural and remote First Nation communities.

Community Suboxone Treatment: Insights from a Mental Health and Addictions Review (Sioux Lookout First Nation Health Authority)^{Footnote 28}
Starting in 2021, the Sioux Lookout First Nations Health Authority began a review of mental health and addictions services to inform regional planning and improve services coordination. This is a first step to address fragmented services in northern and remote First Nations communities. The review noted that for healing and restoration of relationships to occur, short-term funding and time-limited services must be replaced by long-term, trauma-informed, land-based healing and recovery approaches. More specific findings included that community-based Suboxone taper-to-low-dose-maintenance is feasible for some community members, but abstinence is difficult and longer-term maintenance and support services are urgently required. Suggested ways to improve community Opioid Agonist Therapy (OAT) include:

• integrating community coordinators of Suboxone programs into the circle of care
• creating a referral system to skilled mental health and addictions workers and therapists
• making available a land-based healing component
• ensuring adequate funding, infrastructure and clinical counselling space
• supporting community-level healing strategies, including around harm reduction awareness, to destigmatize addictions in the community

Harm reduction

Three presentations highlighted harm reduction efforts. Here are the key highlights from each:

Supporting the Healing Journey of First Nations in British Columbia (First Nations Health Authority)^{Footnote 2}
A key priority for the First Nations Health Authority (FNHA) is responding to the toxic drug supply crisis in British Columbia. This response includes harm reduction and continuing a long-term response to addictions and trauma. FNHA is also developing a unique public health emergency response to the toxic drug supply crisis focused on preventing people who overdose from dying. For example, the FNHA nursing team supports community access to opioid agonist treatment and safer supply while building community capacity around harm reduction. Work is also underway to establish more Indigenous-focused overdose prevention sites in British Columbia.

FIRE with FIRE (Fully Informed Risk Education with a Foundation of Individual Recovery Experiences) Ishkotay Aputchitoon Chi Meekatamun Ishkotay FIRE with FIRE (Fully Informed Risk Education with a Foundation of Individual Recovery Experiences)^{Footnote 29} Ishkotay Aputchitoon Chi Meekatamun Ishkotay
Launched in 2022, the Southeast Resource Development Council’s (SERDC) Fully Informed Risk Education with a Foundation of Individual Recovery (FIRE with FIRE) project is a peer-led, developed, implemented and evaluated project, focusing on:

• removing stigma through language (Language Matters Campaign)
• widespread naloxone training and take-home kits (train the trainer and community outreach)
• implementing a community-based quick response team led by the same lived or living experience peers

Peer engagement promotes communication, builds trust, increases knowledge and reduces stigma and discrimination to remove barriers and increase use of harm reduction services.

Indigenous Harm Reduction: Pushing the Envelope (Chippewas of the Thames First Nation)^{Footnote 30}
The Cultural Harm Reduction Outreach program provides support for the intravenous drug use population in 3 local communities: Chippewas, Munsee-Delaware and Oneida. A wide variety of services are offered, including:

• safer use supplies
• syringe exchange
• traditional medicines
• cultural support for mental wellness
• attending death in community
• supporting other departments and agencies

The program evolves as a direct response to community survey results and is supported by a community wellness plan.

Innovation

Three presentations highlighted innovation in substance use programming. Here are the key highlights from each:

Walking Buffalo Detox (Cote First Nation)^{Footnote 16}
In response to an increase in overdose deaths, Cote First Nation established the White Buffalo Detox in a remote part of the First Nation to provide safety and anonymity. The program uses a Walk Alongside Approach and provides programming on:

• the effects of substance and solvent abuse
• grief and loss
• abandonment from a First Nation perspective
• relationship building and coping with anger
• treaty and First nationhood

Clients can attend community Alcoholics Anonymous and Narcotics Anonymous meetings and participate in day excursions. They are offered daily support, healthy meals, clean and private rooms, transportation, assistance for securing employment or housing, liaising on legal matters, child-family agencies and all other First Nation services. Cote First Nation also provided an in-kind contribution of a 10-bed facility and resources to operate a detox program to improve access to safe and effective services. The White Buffalo Detox provides detox services for 10 days and has a land-based detoxification program for extended treatment. Examples of program activities include water safety, white water training, fishing, hunting and cultural teachings.

Ais’ poo moo’ a nist tooh ko wa ya (Providing Helpful Advice) – Day Treatment Program, Wellness Program (Blood Tribe Department of Health Inc)^{Footnote 17}
In response to a state of emergency related to substance use declared by chief and council in 2015, the Day Treatment Program was developed to address increasing wait times to access services at substance use treatment centres. This program supports individuals and their families around abstinence. Facilitators present lecture-type sessions, in addition to free-moving sessions such as art therapy or dance. Elders and Knowledge Keepers use story-telling as their mode of delivery.
The program provides specific education, awareness and support to those who are suffering with substance use and alcohol use disorders, while supporting clients in learning adequate skills to cope with drug and alcohol related urges and thoughts. This program also helps clients looking for alternative options for addiction treatment. The Day Treatment Program started January 2020 and is under the jurisdiction of the Blood Tribe Department of Health, situated on the Blood Reserve, Southern Alberta.

Substance Use Prevention and Treatment – Meeting the Needs of Individuals within their Community/Home (Wanaki Wellness Centre)^{Footnote 18}
To address the impact of the pandemic and temporary closure of its residential program, the Wanaki Wellness Centre launched a virtual program in June 2021. The program is holistic, strength-based and trauma-informed. The virtual program meets an important community need for flexible services that provide options for care. Virtual services reach a broad client base, including those who would or could not attend a residential program, providing an important complement to in-person programming.

Global issues and mental wellness: The COVID-19 pandemic and climate change

How global issues, such as the COVID-19 pandemic and climate change, are affecting Indigenous mental wellness was also discussed at the summit.

The COVID-19 Pandemic
Several presentations referenced the impact of the pandemic on Indigenous mental wellness, including worsening mental wellness outcomes and the need to innovate and adapt services and supports. Key themes include:^{Footnote 1 Footnote 11 Footnote 17 Footnote 18 Footnote 19 Footnote 20 Footnote 27 Footnote 30 Footnote 39 Footnote 50 Footnote 52 Footnote 56 Footnote 58 Footnote 65 Footnote 66}

• how the pandemic highlighted complexities around trauma, long-standing gaps in mental wellness services and supports, and the importance of culture and community
• public health measures create challenges in delivering mental wellness services and supports while also being a catalyst for innovation
• growing demand for services further increased during the pandemic, leading to increased stress, fatigue and burnout in the mental wellness workforce, as well as challenges around recruitment and retention

Climate change
One presentation highlighted work on engaging Indigenous youth around climate change and mental wellness. Research questions included: "What do Indigenous youth think about the mental health impact of the climate crisis?" and "How are Indigenous youth's mental health, wellness, and the climate crisis connected?"