Indigenous Mental Health - streamlining platforms for knowledge

I am a psychiatry resident at McGill University and a Diversity Leadership Fellow at American Psychiatric Association. Given my background as a family physician and an immigrant in North America, I have a special interest in mental health and wellbeing of vulnerable populations, most notably, the indigenous people (my current area of focus this summer at the Centre for Global Mental Health at the London School of Hygiene & Tropical Medicine). For this year’s International Day of the World's Indigenous People, taking place every year on 9 August, I would like to write about how knowledge exchange can be a simple way of promoting the often overlooked mental health of indigenous people.

Mental health conditions are among the main causes of disability worldwide. Comparing their prevalence and burden with the existing state of care by health services reveals a huge treatment gap at approximately 50% in high-income countries, and up to 90% in low-income countries. Indigenous communities worldwide experience risk factors for mental health conditions more frequently than non-indigenous people in the same region. These risk factors include discrimination, conflict, trauma, the stresses of acculturation and dislocation, and other barriers for accessing health care. In addition, there are poorly adapted and fewer available services that address the ethnic, social and cultural specificities in their communities. These factors, unsurprisingly, make the treatment gap even larger in indigenous communities.

In recent years, multiple national and international organizations have developed and carried out projects and initiatives to address indigenous mental health (IMH). One way for helping to reduce the treatment gap is to facilitate access to this available information via packaging on knowledge exchange platforms. Such platforms will help clinicians, policymakers, service users, researchers, donors and other mental health stakeholders to access the methods, challenges, implementation protocols, and outcomes of the research projects, innovations and initiatives aimed at the promotion, prevention and treatment of mental health conditions in indigenous communities. A dedicated online space for IMH will efficiently serve the purpose of an open exchange of information and recommendations for IMH. One good example of such collaboration for knowledge exchange is the toolkit RISING SUN that is the result of collaborations between National Institute of Mental Health (NIMH) and Mental Health Innovation Network (MHIN). This great toolkit offers a wide range of information on the determinants of suicide across the Arctic, as well as best practices in suicide prevention in circumpolar Indigenous communities.

As part of my work at the Centre for Global Mental Health, I have also conducted a basic literature review and situational analysis contacting stakeholders in the field of global mental health (GMH) and IMH in order to have a better understanding of the context, public health priorities, current projects and knowledge exchange platforms for IMH. Very few local knowledge exchange platforms are currently dedicated to the exchange of indigenous wellbeing practices. These platforms are excellent resources in that they are local, targeted towards specific users and focused on overall health rather than specifically mental health. However, a larger group of international service advocates, implementers, researchers, practitioners, health policy makers and funders may sometimes miss them. Below I have compiled a list of some of the existing platforms and initiatives to highlight the ones that could make a local or global impact on indigenous wellbeing:

Some of the existing knowledge exchange platforms dedicated to IMH:

  1. Wise Practices: Highlighting indigenous wise practices to honor what is already happening for promoting life and wellbeing by drawing links and connections.
  2. Indigenous Innovations Initiatives: a platform to empower Indigenous innovators and communities to identify and solve their own challenges and driving inclusive growth and health through social innovations.
  3. Thunderbird Partnership Foundation: This Canada national organization brings together the efforts to develop and support holistic healing approaches of the Indigenous people.

Some of the existing initiatives, innovations and research/implementation projects for IMH:

  1. RISING SUN: Reducing the Incidence of Suicide in Indigenous Groups - Strengths United through Networks (RISING SUN) is an initiative to produce an online toolkit on effectiveness of suicide prevention.
  2. CREATeS: Circumpolar Resilience, Engagement & Action through Story (CREATeS) aims to support community engagement towards to reduce suicide and fosters mental wellness among Arctic Indigenous.
  3. Makimautiksat Youth Wellness and Empowerment Camp: a culturally relevant summer camp for Inuit youth focused on fostering wellness, positive Inuit identity, community building and skills building.
  4. Aullak Sangillivalianginnatuk (Going Off, Growing Strong): A community-led program created with youth at-risk for suicide based on intergenerational healing through the transmission of Inuit skills.
  5. IIMHL: (IIMHL) is a unique international collaborative that focuses on improving mental health and addictions services in the countries and includes minority communities like indigenous people.
  6. Giving LIFE a Chance: To reduce the prevalence of suicide in an indigenous community in Colombia

As we can see, there is already incredible research and implementation projects focusing on IMH. Given this growing body of evidence (particularly in promotion and prevention, strengthening of youth resiliency, recovery initiatives, and innovative approaches in indigenous community engagement), more effort is required to meaningfully highlight them and make them more widely available to researchers, implementers, policy makers and indigenous communities via a dedicated online platform. This approach should embody a positive attitude toward bi-directional learning that prioritizes respect and openness to evidence-informed local indigenous approaches and methods for promoting mental health and wellbeing.

A collaborative and unified platform for knowledge exchange within the field of Indigenous Mental Health may help to amplify the voices of Indigenous people, researchers and professionals working to promote more innovative and resilience approaches to mental health worldwide. I envision that a dedicated IMH platform, which collectively aggregates and simplifies access to this information, has the potential to enhance their visibility, facilitate the exchange of common implementation barriers and enablers, and encourage interaction and partnership between different institutions interested in exploring and evaluating the impact of their research in different settings and populations. Given the evidence for such a platform, I believe it can also provide significant merit in providing a community-owned and administered space to facilitate the development of partnerships with interested users, and to liaise with existing services, projects and innovations in their area and work together to promote the uptake of burgeoning evidence within the field of indigenous mental health.

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