During the process of researching topics for this blog I have tried to think of stories and experiences from my field placement in mental health that I would be able to incorporate into my entries. As I poured over the different experiences and situations that I have encountered in my placement I realized that I have yet to work with or even see any older Aboriginal patients. The more I thought about this, the more I began to question why this is. Based on my previous knowledge of issues affecting Aboriginal people I definitely know that this has nothing to do with the fact that Aboriginals don’t experience mental illness or mental health issues, in fact I know this is to the contrary. According to Stewart (2008) the Aboriginal community experiences a disporportianetly high number of mental health issues compared to the rest of Canada, but at the same time mental health services are under utilized by Aboriginal people. So why is this? Although there are a number of complex issues that are beyond the scope of a single blog entry, there are a number of key issues that are present and have a direct relationship to our roles as social workers.
One of the first possible explanations that could explain the under utilization of mental health services by Aboriginal people is the underlying worldviews that are held by Aboriginal people, namely that one’s health is holistic and that health also refers to a person entire being. This notion means that health is looked at as being a balance on one’s physical, mental, emotional and spiritual being. (Smye, Mussell, 2001) The views held by Aboriginal are in conflict to the traditional biomedical approach to illness that is very Eurocentric in nature. (Kafele, 2004) The divergence in these two ways of thinking becomes very apparent when we look at a counselling approach to mental illness. Stewart (2008) states that counselling in mental health has not been successful for many indigenous people because mental health counsellors often lack an understanding of Indigenous people’s concepts, including their ideas of health and their worldviews. In fact a 1977 study cited by Stewart (2008) found that native clients do not value or utilize counselling services that are not adapted to a first nations helping model. If we look at Aboriginal elders in particular, it seems more likely that they would not readily seek out counselling for mental health issues because often times, they themselves would be the people in the community that others would go to for advice because they may be seen as being wise or knowledgeable about traditional healing ways and mental illness.
As Stewart (2008) explored the issue of what Aboriginals people consider to be important in the process of mental health and healing she discovered four main themes that were expressed by Aboriginal people as being important to them.
Community
Aboriginal people identified community as being a central component of mental health and healing. Community in this sense was identified as a collective or social grouping with others to which some link to indigenous culture exists. (Stewart, 2008)
Cultural Identity
Cultural identity was also shown to be an important component to maintaining mental health. Incorporating traditional ceremonies and spiritual acts such as dance and different traditional ceremonies was shown to be something that Aboriginal people would like to see more of in mental health counselling. (Stewart, 2008)
Interdependence
The concept of interdependence was also identified as being extremely important to Aboriginal people within the therapeutic relationship. This was identified as being important because in day to day life Aboriginal people typically rely on one another in all of their daily relationships. Therefore this was seen as being integral to the therapeutic relationship between an Aboriginal client and their counsellor to promote mental health and healing. (Stewart, 2008)
Holistic Approach
In Stewart’s study she found that Aboriginal people considered a holistic approach to healing to be of the utmost importance. Stewart (2008) identified that Aboriginal people want a holistic approach to be regarded as a mainstream way of looking at mental health services, rather than just being an alternative. Some examples of what a holistic approach to counselling could include taking clients into nature or back into their community or integrating prayer or ceremonies such as smudging.
These themes were the four main points that were raised by Aboriginal people as being important to them to improve current mental health services. Unfortunately we still have a long way to go to incorporate these approaches into the mental health system, which is still very illness based and Eurocentric. The lack of culturally appropriate services has meant that a very few Aboriginal people seek out mental health services and when they do they often lack confidence in the system. One of the main things that I believe that we can do as future social workers is become an ally to the Aboriginal community and advocate that these approaches to mental health become more actively utilized when we work with Aboriginal clients. Although I know that I won’t be able to claim any expertise in this area I believe that it will be important to continue to educate myself in different Aboriginal approaches to healing and try to work with Aboriginal people to incorporate these approaches into my practice whenever possible.
Kendall
References-
Kafele, K. (2004) Racial Discrimination and Mental Health: Racialized and Aboriginal Communities. Race Policy Dialogue Conference Paper. Ontario Human Rights Commission.
Smye, V., Mussell, B. (2001) Aboriginal Mental Health: What works best: A Discussion Paper. Mental Health Evaluation & Community Consultation Unit 1-40
Stewart, S. (2008) Promoting Indigenous mental health: Cultural perspectives on healing from Native Counsellors in Canada. International Journal of Health Promotion & Education 46(2) 12-19
Kendall,
ReplyDeleteGreat analysis on such a tragic situation. I am pleased to see more recent research being done with relation to the needs of Aboriginal people. As we are already aware there is not much reliable research out there in the academic world (as this has been mentioned in class on several occasions). I hope that Silvia Straka's current project with Michael Hart will bring more awareness and end up with "Epidemiological data" that will hopefully benefit all Aboriginal peoples and change the perception society has of blaming them.
People in society must realize and acknowledge that we must begin removing the harmful impacts of colonization on Aboriginal people.
I agree with you Kendall that as social workers we will be strong, devoted allies to all Aboriginal communities.
Melissa
Kendall,
ReplyDeletethank you for you post, mental health is an area of health that remain somewhat mysterious to me. I appreciate you perspective on this topic. I want to speak to the word "expert". One of the best parts of social work is that we try to position ourselves as not being the "experts". This sets us apart from other professions such as nursing, medicine, psychiatry etc. These individuals are seen as the "experts" on health issues. Especially i have found with psychiatry and mental health that these disciplines are very based in a medical model. A social work voice is important in mental health because we remind other disciplines that patients are actually the experts on their lives and we are simply there to bring our knowledge to help them.
I have never been more aware of the reality of power dynamics, oppression and privilege as i have been learning since working in a medical model placement. It is not just a concept but a reality. This is also true for the colonial process. Colonization and its effects are still occurring and many of us are blind to it. This ignorance furthers colonization as it can be allowed to continue if we ignore it. The dominant perspective is seen as "the only way". This means that the dominant healthcare processes and outcomes are what are practiced and desired. It is difficult to expand our understanding of health to incorporate the views of others. This however must happen if we hope to provide culturally safe and effective helping to those who are in need.
thanks
-Meagan
Hi Kendall,
ReplyDeleteYour comments on Aboriginal perspectives in mental health reminded me of an experience I had last year working at a high school.
I was asked to work with an Aboriginal student who was a 'voluntary mute', meaning she chose not to speak, though she was physiologically able to do so. Besides her choice to never speak (ever), staff had many concerns about this student, including her complete lack of participation in class, and a website she had posted with pictures of her classmates, and comments about them.
There were some obvious issues that needed to be addressed with this student, but before this could be accessed, her parents had to agree to a cognitive assessment. The school pyschologist asked their permission twice, twice the parents refused.
A family meeting was called involving the parents, and our Oji-Cree vice-principal who spoke the parent's language. During the meeting, the vice-principal explained their cultural traditional belief that those who needed mental help were 'crazy people' (she used an Oji-Cree term). She reassurred the parents that were not trying to prove that their daughter was a 'crazy one', just to help her access the supports she needed. The parents agreed.
Among many things, this experience taught me the necessity of understanding the cultural backgrounds that inform individual decisions. Without the insight of our vice-principal, we may never have been able to explain the situation properly to the parents, and this student would not have been able to access the supports she needed.
-Nikki
Kendall,
ReplyDeleteThis entry is very thorough and insightful. I agree with you, there is a need for culturally appropriate mental health care practice for Aboriginal people and communities. However, although this may sound too radical, I believe that Aboriginal people's views of mental health and their ways of healing should be seen as equally efficient, scientific, and valid as Amer-Eurocentric bio-medical based theories and interventions. I would love to see modern-day science fully acknowledge Aboriginal ways of helping not just as an alternative form of healing but one that is as effective and competent as the highly regarded Diagnostic and Statistical Manual of Mental Disorders (DSM) and mainstream interventions such as Cognitive Behavioural Therapy (CBT). Rather than trying to blend the Western ways to helping with Aboriginal perspectives to make it “culturally appropriate”, an acknowledgement of Aboriginal peoples' ways as equally superior sounds more just and fair. Honestly, I know this might not happen in our lifetimes but I guess we can start planting seeds right now so the hope for a fairer future will start to become promising. I'm sure our efforts to fight oppression will not go to waste. Thanks for sharing.
-Darnel