First Nations Mental Wellness Continuum Framework

Transcription

1 First Nations Mental Wellness Continuum Framework HOSW 2015 Hamilton, New Zealand Carol Hopkins Thunderbird Partnership Foundation Dr Brenda M Restoule- First Peoples Wellness Circle

2 Indigenous Inclusion in Canada Prior to 2000 programs and services for Indigenous people in Canada were developed, designed and implemented with limited to no Indigenous inclusion These programs and services were based on addressing problems and deficits Often reactive based Sometimes following a crisis that required a response Solutions based on illness and medical model Outcomes demonstrated limited improvements and shifts in addressing Indigenous needs This strategy erroneously supports myths of Indigenous people in Canada being a drain on they systems

3 Shifting the Dialogue Indigenous leaders and Indigenous mental wellness experts in Canada have consistently stated that we hold knowledge that can reduce gaps and improve outcomes in mental wellness Demanding inclusion and involvement in designing and implementing Indigenous programs and services in First Nation communities The aim is to create collaboration and partnerships with various government organizations to shift the dialogue

4 Current Status of MW Programming 4 First Nation and Inuit Health Branch of Health Canada who holds funding arrangements for First Nation health services largely focusses on specific mental health and addictions issues. Provincial/territorial funding to FN services largely doesn t exist P/T services are being accessed by FN in order to access a broad range of services not available in FN communities Siloed approach to care versus a comprehensive continuum currently exists in FN communities Gaps include: clinical services; culturally safe services; coordination of care; collaboration and knowledge exchange; supports for those with serious mental health issues. First Nations partners have consistently indicated that mental wellness is their top concern and priority.

5 5 Mental Wellness Realities in FN Communities Mental health & addiction services are federally funded Population based funding regardless of the need or challenges (i.e., geography) Programs and services are usually targeted toward prevention & promotion Specialized programs and services (i.e., NAYSPS) are proposal driven and/or time limited Few if any clinical services in FN communities Does not service SMI Provincial funding to FN communities are minimal There may be a discrepancy in expectations for Indigenous specific programs compared to other provincial programs Provincial services are usually accessed outside of a FN community Provincial and federal services are often not coordinated Federal departments with a mandate on wellness are often siloed and uncoordinated Little to no recognition of the importance of culture and language

6 6 What is needed? A way to: Strengthen Federal Mental Wellness Programming for First Nations Support integration between federal and provincial/territorial programs Facilitate a move away from siloed programs toward more coordinated and effective approaches Provide guidance to communities to adapt, optimize and realign their mental wellness programs and services based on their own priorities

7 Engagement 7 Process led by Indigenous mental health leaders as cochairs with FNIHB. Indigenous leaders across social determinants of health and/or within their region led the process for defining and developing the Framework Broad engagement with First Nations workers and health leaders across the country Over 600 participants involved in focussed regional discussion sessions Ongoing reviews, opportunities to define the concepts and themes, ensure First Nation experiences reflected in the document Strategy sessions with First Nation leaders Opportunities for reviews and final endorsement received in July 2014 Engaged Federal departments as well as provincial/territorial ministries at points in the process

8 9 Key Drivers for Change High level of need in First Nations communities for access to a full continuum of mental wellness services First Nations and Inuit Mental Wellness Advisory Committee (MWAC) Mental Health Commission of Canada Mental Health Strategy Health Canada-Assembly of First Nations-Public Health Agency of Canada Task Group on First Nations Health Honouring our Strengths NNADAP Renewal Framework Sunsetting of Indian Residential Schools Resolution Health Support Program

9 10 The Framework The First Nations Mental Wellness Continuum (FNMWC) Framework has emerged as a guide, whose principles and commitments will assist us in adapting, optimizing and realigning programs and services. The FNMWC promotes: The development of a coordinated, comprehensive approach to MW programming, in partnership with First Nations, that takes into account the important role of their culture, traditions, and language The flexibility to tailor programs to the community s unique circumstances, culture and history; and building on community priorities. Capacity development and support for improved planning (including enhanced funding flexibility and reduced reporting burden) Stable horizontal structures and processes to support access and service continuity (i.e. collaboration, relationship building, and partnership at the system level)

10 First Nations Mental Wellness Continuum Model 11

11 12 Four Directions (outcomes) Hope, Belonging, Meaning, and Purpose. Community Kinship, Clan, Elders, and Community. Populations Infants and Children, Youth, Adults, Gender-Men, Fathers and Grandfathers, Gender-Women, Mothers and Grandmothers, Health Care Providers, Community Workers, Seniors, Two-Spirit People and LGBTQ, Families and Communities, Remote and Isolated Communities, Northern Communities, and Individuals in Transition and Away from Reserve. Specific Population Needs Intergenerational Impacts of Colonization and Assimilation, People Involved with Care Systems and Institutional Systems, Individuals with Process Addictions, Individuals with Communicable and Chronic Diseases, Individuals with Co-occurring Mental Health and Addictions Issues, Individuals with Acute Mental Health Concerns, Crisis, and People with Unique Needs. Continuum of Essential Services Health Promotion, Prevention, Community Development and Education; Early Identification and Intervention; Crisis Response; Coordination of Care and Care Planning; Detox; Traumainformed Treatment; and Support and Aftercare. Supporting Elements Performance Measurement, Governance, Research, Education, Workforce Development, Change Management and Risk Management, and Self-determination. Partners in Implementation Non-governmental Organizations, Provincial and Territorial Governments, Federal Government, Regional Entities, Nations, Communities, and Private Industry. Indigenous Social Determinants of Health Environmental Stewardship; Social Services; Justice, Education and Lifelong Learning; Language Heritage and Culture; Urban and Rural; Land and Resources; Economic Development; Employment; Health Care; and Housing. Key Themes for Mental Wellness Community Development, Ownership and Capacity Building, Quality Care System and Competent Service Delivery, Collaboration with Partners, and Enhanced Flexible Funding. Culture as Foundation Elders, Cultural Practitioners and Kinship Relationships, Language, Practices, Ceremonies, Knowledge, and Land and Values.

12 13 Key Themes & Supporting Elements Key Themes: 1. Culture as foundation 2. Community Development and Ownership 3. Quality Health System and Competent Service Delivery 4. Collaboration with Partners 5. Enhanced flexible funding investments Supporting Elements: Performance Measurement Research Workforce Development Change Management Governance Self-Determination

13 14 What have we heard? From An examination of deficits To The discovery of strengths Use of evidence absent of Indigenous world view, values and culture A focus on inputs for individuals Indigenous Knowledge sets foundation for evidence A focus on outcomes for families and communities Uncoordinated and fragmented services Integrated models for funding and delivery of services

14 15 Shifting the Evidence FN communities and organizations have begun to demand inclusion of culture and language as a central component to their work During the TRC there was a consistent request by survivors and their families to use culture based practitioners in working through their trauma and addressing IRS, including during statement taking, public sharing and personal claims There has been an increase in use of land based programming that focuses on cultural values and teachings Early evidence of Mental Wellness Teams, Community Development Wellness Teams and Community development plans are all promising Indigenous scholars are talking about practice based evidence which is more in keeping with Indigenous culture Culture as Intervention research highlights Indigenous knowledge, culture as critical and development of a wellness indicators

15 16 FNMWC Implementation The FNMWCF partners have developed an Implementation Action Plan. Examples of the FNMWCF in practice include: Community wellness plans help communities reorient existing resources around a continuum of services to reduce gaps, barriers, and silos. The quality of community based services is improved through case management and by supporting a more stable, integrated mental wellness workforce. Service level agreements (between First Nations and P/T regional health authorities) are in place to support access to the basket of mental wellness services and service continuity Services might be available at the community, Tribal Council, Zone, or Regional level Models of FN aggregation are explored where applicable/possible Communities have access to MW services in crisis situations Crisis response planning, crisis response services, and aftercare services Communities with the greatest needs have focused mental health services within the community Coordinated efforts to lever the resources necessary for communities to take action in these areas through ongoing flexible funding approaches.

16 17 Links to the Framework Summary Document EN03_low.pdf Full Document EN05_low.pdf