Exploration of Existing Integrated Mental Health and Addictions Care Services for Indigenous Peoples in Canada.

Abstract

Due to the persistent impacts of colonialism, Indigenous peoples of Canada face disproportionate rates of mental health and substance use disorders, which are often insufficiently addressed by Eurocentric 'mainstream' mental health and addiction services. The need to better address Indigenous mental health has led to Indigenous mental health integrated care (hereafter integrated care): programs using both Indigenous and Western practices in their care delivery. This research describes the common lessons, disjunctures, and solutions experienced by existing integrated care programs for Indigenous adults across Canada. It reveals the best practices of integrated care for programs, and contributes to the Truth and Reconciliation Commission of Canada's Calls to Action #20 and #22. This study, co-designed by an Indigenous Knowledge Keeper and Practitioner, explores the programs' relational processes through interviews with key informants. The data was analyzed in consultation with Indigenous collaborators to highlight Indigenous values and interpretations, and knowledge co-production. In highlighting the complexity of integrated care, study results show the lessons of 'Real Commitment to Communities and Community Involvement,' and tensions and disjunctures of 'Culture as Healing,' 'People-focused vs. Practitioner-focused Programs,' 'Community-oriented vs. Individual-oriented Programs,' and 'Colonial Power Dynamics in Integrated Care.' The discussion explores why tensions and disjunctures exist, and suggests how to move forward using integrated care's lessons and the concept of IND-equity. Ultimately, Indigenous-led partnerships are paramount to integrated care because they leverage Indigenous knowledge and approaches to achieve health equity within integrated care.