Source: iStock
WRITTEN BY THE NATIONAL COLLABORATING
CENTRE FOR ABORIGINAL HEALTH
Considerations for Indigenous child and youth
population mental health promotion in Canada
This document is part of a collection produced by the six National Collaborating Centres for Public
Health to encourage mental health promotion for children and youth within a strong, integrated
public health practice. The collection provides numerous entry points for the public health sector
to collaborate with other stakeholders to support evidence-informed action that addresses the
determinants of mental well-being for all children and youth in Canada.
This paper aims to improve understandings of Indigenous mental health in Canada, and
demonstrate how particular determinants either contribute to increased risk for mental illness
or act as protective factors for positive mental health. Details on search methods and terms used
for this paper can be found in the introduction document: Population mental health promotion
for children and youth - a collection for public health in Canada.
INDIGENOUS CONCEPTS OF
MENTAL HEALTH
Mental health is increasingly recognized as more than the
absence of mental health problems or illnesses. Rather, it
is a “state of well-being in which the individual can realize
his or her own potential, can cope with the normal stresses
of life, can work productively and fruitfully, and is able to
make a contribution to his or her community” (World Health
Organization [WHO], 2016, para. 1). Indigenousi concepts of
mental health and wellness extend beyond this definition to
include holistic and relational ways of knowing and being in
the world. Good health is generally understood as a balance
of the mental, physical, spiritual and emotional dimensions of
self and the ability to live in harmony with family, community,
nature and the environment (King, Smith, & Gracey, 2009;
i
The terms ‘Indigenous’ and ‘Aboriginal’ are used throughout
this paper to refer to the original inhabitants of Canada and
their descendants, including First Nations (referred to as
Indians in Canadian Constitution), Inuit, and Métis peoples as
defined by Section 35 of the Canadian Constitution of 1982.
Wherever possible, specific Indigenous groups are cited. To
learn more about how Indigenous peoples are defined within
Canada, please refer to https://journals.uvic.ca/journalinfo/ijih/
IJIHDefiningIndigenousPeoplesWithinCanada.pdf
Visit NCCPH.CA to download the complete collection
CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH
POPULATION MENTAL HEALTH PROMOTION IN CANADA
1
Vukic, Gregory, Martin-Misener, & Etowa, 2011). For Inuit,
mental wellness is defined as self-esteem and personal
dignity flowing from harmonious physical, emotional, mental
and spiritual wellness, and cultural identity (Inuit Tapiriit
Kanatami [ITK], 2014). The First Nations Mental Wellness
Continuum Framework suggests that this balance is “enriched
as individuals have a sense of purpose in their daily lives
whether it is through education, employment, care giving
activities, or cultural ways of being and doing; hope for the
future and those of their families that is grounded in a sense of
identity, unique Indigenous values, and having a belief in spirit;
a sense of belonging and connectedness within their family and
community and to culture; and finally a sense of meaning and
an understanding of how their lives and those of their families
and communities are part of creation and a rich history”
(Health Canada & Assembly of First Nations, 2015, n.p.).
Source: aboriginalimages.ca
Mental health promotion “involves actions to create living
conditions and environments that support mental wellness
across the lifespan and allow people to adopt and maintain
healthy lifestyles” (WHO, 2016, para. 7; see also Mental Health
Commission of Canada [MHCC], 2012). At a population level,
it involves intersectoral action in various settings, including
home, school, the workplace and the community, through
programs, policies and other interventions that promote health
for all, as well as for those at greater risk, such as children and
youth. Healthy emotional and social development in early
childhood and adolescence not only sets the stage for good
mental health in adulthood, it has been shown to reduce the
demand for mental health services and for services outside the
health sector (Chief Public Health Officer, 2009; MHCC, 2012;
National Collaborating Centres for Public Health [NCCPH],
2017). For Indigenous children and youth in Canada, who
experience a disproportionate burden of ill-health compared
to their non-Indigenous counterparts, access to culturally
safe, strengths-based, family and community-oriented mental
health promotion programs and services is critical to mental
wellness and resilience in later life.
2
POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH A COLLECTION FOR PUBLIC HEALTH IN CANADA
FRAMING THE LINKS BETWEEN
MENTAL HEALTH PROMOTION
AND INDIGENOUS CHILDREN
AND YOUTH
Demographics
Indigenous peoples are the youngest and fastest growing segment
of Canada’s population. In 2011, the Indigenous population
reached 1.4 million people (4.3% of the total Canadian
population), representing an increase of 20.1% from the 2006
Census (Statistics Canada, 2013). Indigenous children aged 14
and under account for 28% of the total Indigenous population
(compared to 16.5% of the non-Indigenous population), while
Indigenous youth aged 15 to 24 represent 18.2% of the total
Indigenous population (compared to 12.9% of the total nonIndigenous population). Inuit are the most youthful of the
three Indigenous groups with a median age of 23, followed by
26 for First Nations, and 31 for Métis (Statistics Canada, 2013).
Limitations of data
Useful and reliable data on Indigenous child and youth health
in Canada is limited by the quality and coverage of data, a
lack of culturally relevant health indicators, and jurisdictional
barriers associated with Indigenous status and geography
(National Collaborating Centre for Aboriginal Health [NCCAH],
2009; Smylie, 2009a). McShane, Smylie, and Adomako (2009)
note significant gaps in the health information available for
Indigenous children in Canada, including vital registration
and health care access data, prevalence rates for obesity,
diabetes, cancer and mental health, and data specific to Métis
and First Nations children living off-reserve. An emphasis
on Indigenous children’s disease and illness outcomes, rather
than preventative and wellness measures, was also noted. In a
recent review of Indigenous youth health research in Canada,
Ning and Wilson (2012) found similar discrepancies in both
geographic and demographic representation, with a dearth
of research on youth in the Prairie and Atlantic provinces
and the Northern Territories, as well as a significant underrepresentation of Métis and urban Indigenous youth health
research. Despite these challenges, it is clear that Indigenous
children and youth experience significant health and social
disparities, with higher rates of injury, infant mortality, suicide,
and chronic and infectious diseases (Greenwood & de Leeuw,
2012; McShane et al., 2009; UNICEF Canada, 2009).
Mental health status
Children
Data specific to Indigenous children’s mental health in Canada
is very limited (Kirmayer, Brass, & Tait, 2009). The 2008-10
First Nations Regional Health Survey (RHS) found that
14.1% of primary caregivers of First Nations children living
on-reserve aged 3 to 11 reported their child experienced more
emotional or behavioral problems during the previous six
months than other boys and girls of the same age (First Nations
Information Governance Centre [FNIGC], 2012). The survey also
found that a higher proportion of First Nations boys had been
diagnosed with anxiety/ depression than girls (0.9% vs. 0.4%),
and that the prevalence was also higher among older First
Nations children compared to younger First Nations children
(FNIGC, 2012). Analogous mental health data is not available
for Inuit, Métis and off-reserve First Nations children.
Youth
In terms of First Nations youth, the 2012 Aboriginal
Peoples Survey found that 61% of youth living off-reserve
15 to 24 years of age reported excellent or very good mental
health (Statistics Canada, 2016a). Similarly, results from
the 2008-10 First Nations Regional Health Survey found
that approximately 64.8% of First Nations youth living
on-reserve felt their mental health status was very good
or excellent, with only 0.8% reporting it was poor, with
no difference observed between genders (FNIGC, 2012).
However, approximately 33.8% of female and 17.2% of male
First Nations youth living on-reserve reported there was a
time when they felt sad, blue or depressed for two weeks or
more in a row in the previous 12 months (FNIGC, 2012). A
higher proportion of First Nations youth with at least one
health condition also reported feeling sad, blue or depressed
(31.6%), had thoughts about suicide (23%) or had attempted
suicide (8.1%) compared to youth without a health condition
(FNIGC, 2012).
Suicide rates
Suicide rates vary substantially among Indigenous
communities in Canada, ranging from no suicides at all and/
or rates that are low or comparable to the general population,
to elevated rates that are well above the national average
(Kirmayer et al., 2007, 2009; Chandler & Lalonde, 1998, 2008).
Rates of suicide are reported to be 5 to 7 times higher for
First Nations youth living on reserve (Kielland & Simeone,
2014; Public Health Agency of Canada [PHAC], 2006) and 5 to
25 times higher for Inuit youth respectively than the national
CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH
POPULATION MENTAL HEALTH PROMOTION IN CANADA
3
average (ITK, 2016). Comparable national data does not exist
for Métis youth. Although suicide rates among Indigenous
males aged 14 to 24 have historically been higher, a recent
increase among Indigenous females has been observed (Fraser,
Geoffroy, Chachamovich, & Kirmayer, 2015; Kirmayer, 2012).
Knowledge gaps
With respect to knowledge gaps, it is clear that more research
is needed specific to Inuit, Métis and First Nations off-reserve
children and youth to develop more relevant and responsive
policies, programs and interventions. A better understanding
of gender differences in the mental health of First Nations,
Inuit, and Métis boys and girls is also needed, particularly as
they transition to adulthood where differences in self-reported
mental health status have been shown to vary considerably
between groups.ii Significant knowledge gaps exist related
to the mental health of lesbian, gay, bisexual, trans, queer
In 2012 approximately 56% of First Nations women aged 18
and over living off-reserve reported excellent or good mental
health, compared to 64% for off-reserve First Nations men.
Differences in self-reported mental wellness of Métis women was
slightly less than for Métis men (61% vs. 68%), while there was no
significant difference between Inuit women (51%) and their male
counterparts (Statistics Canada, 2016b).
Despite the inadequacies of the existing data, mental health
challenges and strengths vary immensely among Indigenous
communities and across individuals (Boksa, Joober, & Kirmayer,
2015). This variation reflects the distinctiveness of First
Nations, Inuit, and Métis peoples’ histories, languages,
cultures, environments, beliefs and worldviews in relation to
health experiences and outcomes. It also speaks to the different
ways in which health determinants intersect and manifest
across the lifespan and across multiple generations to influence
both risk and protective factors (Statistics Canada, 2016a;
Loppie & Wien, 2009).
Source: cattroll.com
ii
and Two-Spirit (LGBTQ2S) Indigenous children and
youth, even though they are more likely to experience mental
health issues such as depression and anxiety, and often face
additional barriers to accessing programs and services (Hunt,
2016). Finally, although there is growing evidence for the
transgenerational impact of residential schools and other
colonial policies on Indigenous mental health outcomes, more
research is needed to understand cumulative negative effects
and ongoing adversity (Bombay, Matheson, & Anisman, 2009;
Kirmayer, Sheiner, & Geoffroy, 2016).
4
POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH A COLLECTION FOR PUBLIC HEALTH IN CANADA
Mental health and wellness are shaped to a great extent by
the underlying social determinants of health (SDoH) that
create inequalities along a social gradient where the poor and
the disadvantaged suffer disproportionately (Allen, Balfour,
Bell, & Marmot, 2014). The relationship between Indigenous
health inequalities and social determinants such as poverty,
overcrowded and sub-standard housing, food insecurity,
social and economic exclusion, and inadequate health services
is well-documented (ITK, 2014; King et al., 2009; Loppie &
Wien, 2009; Smylie, 2009b). However, to fully understand
the enduring health inequities experienced by Indigenous
peoples in Canada and globally, it is necessary to look beyond
mainstream SDoH frameworks to determinants that are not
strictly ‘social’ in nature such as language, culture, spirituality,
geography, relationships to the land, self-determination and
knowledge systems (Greenwood, de Leeuw, Lindsay, & Reading,
2015). By moving beyond the social, Indigenous knowledges
and ways of being in the world rightfully become the “primary
frame of reference for understanding current health realities
in Indigenous communities” (Greenwood et al., 2015, pg.
xii). From this perspective, colonialism is understood as the
broadest and most fundamental determinant of health and
one that remains an “active and ongoing force” in the lives of
Indigenous peoples (Greenwood et al., 2015).
Protective factors
Protective factors are attributes or conditions at the
individual, family, community or societal levels that can
promote resiliency and decrease risk factors associated with
poor mental health outcomes (MHCC, 2012; NCCPH, 2017).
A recent review of protective factors and causal mechanisms
that enhance resilience among Indigenous circumpolar
youth identified over 40 protective factors, many of which
Source: cattroll.com
DETERMINANTS AND PROTECTIVE
FACTORS OF INDIGENOUS
MENTAL HEALTH AND WELLNESS
CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH
POPULATION MENTAL HEALTH PROMOTION IN CANADA
5
overlapped at the community, family and individual levels
and were directly associated with other protective factors
(Petrasek MacDonald, Ford, Cunsolo Willox, & Ross, 2013).
For example, hunting and spending time out on the land
can promote individual protective factors like self-reliance
and self-confidence, but can also provide opportunities to be
involved in the community, receive mentorship from older
generations, and build kin and community relationships
(Petrasek MacDonald et al., 2013). At the community level,
cultural continuity has been identified as a protective
factor. In a seminal study examining variations in youth
suicide rates across First Nations communities in British
Columbia, Chandler and Lalonde (1998, 2008) found a
strong correlation between cultural continuity factors –
self-government, involvement in land claims, band control
over education, health services, fire and police services, the
presence of cultural facilities – and lower rates of youth
suicide. Other important cultural continuity factors included
the involvement of women in band councils, band control over
child welfare services and knowledge of Indigenous languages
(Chandler & Lalonde, 2008; Kielland & Simeone, 2014).
EXAMPLES OF INTERVENTIONS
Promising practices in health promotion interventions among
Indigenous peoples in Canada share many commonalities,
including their incorporation of:
R5 Indigenous concepts such as holism, reciprocity and
plurality;
R5 Indigenous contexts including acknowledgement of
inequalities and colonial oppression; and
R5 Indigenous processes like community control,
community engagement, cultural responsiveness and
capacity building (Reading & Reading, 2012).
The new First Nations Mental Wellness Continuum Framework,
jointly developed by the Assembly of First Nations (AFN)
and Health Canada, and the Inuit Tapiriit Kanatami (ITK)
National Inuit Suicide Prevention Strategy both provide
6
evidence-based, holistic and relational approaches to mental
wellness that are rooted in these concepts, contexts, and
processes. Culture is at the heart of each strategy, including
the important role that Indigenous languages, identity and
knowledges play in achieving wellness across the lifespan.
Similar to the Mental Health Commission of Canada’s
Changing directions, changing lives: The mental health strategy
for Canada (2012) recommendations for action (Strategic
Direction 5.1 to 5.4), the AFN and ITK strategies call for a
coordinated continuum of culturally competent and safe mental
health supports and services, by and for Indigenous peoples, to
address jurisdictional, geographical and funding issues.
Key characteristics of successful mental health promotion
initiatives for Indigenous children and youth identified
in the literature include interventions that are: holistic,
community-driven and owned; build capacity and leadership;
emphasize strengths and resilience; address underlying health
determinants; focus on protective factors and resilience;
incorporate Indigenous values, knowledges and cultural
practices; and meaningfully engage children, youth, families
and the community (Gray, Richer, & Harper, 2016; Kirmayer et
al., 2016; Smye & Mussell, 2001; Systems Improvement through
Service Collaboratives, 2012; Vukic et al., 2011; Wortzman,
2009). There are a myriad of innovative, culturally responsive
mental health promotion interventions for Indigenous
children and youth being implemented in rural, remote and
urban settings across Canada.
Examples of interventions in family, school, community
and land-based settings:
R5 Makimautiksat Wellness and Empowerment Camp is a
10-day land and community-based camp program based
on the Eight Ujarit/Rocks Model that provides Inuit youth
with the skills and knowledge they need to build their
lives. The evidence-based modules focus on strengthening
coping skills; Inuuqatigiitiarniq (being respectful of others)
to build healthy and harmonious relationships; Timiga
(my body) to nurture awareness of the body, movement
and nutrition; Sananiq, to craft and explore creativity;
Nunalivut (our community) to foster personal and
POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH A COLLECTION FOR PUBLIC HEALTH IN CANADA
R5 Promoting Life-Skills in Aboriginal Youth (PLAY)
Program is a partnership with 88 First Nations
communities and urban Indigenous organizations
across Canada to deliver safe, fun and educational
programming for Indigenous children and youth (Right
to Play, 2016). The program, implemented in 2010, aims
to enhance educational outcomes, improve peer-to-peer
relationships, increase employability and improve physical
and mental health of Indigenous children and youth
through regularly offered weekly activities. Activities vary
across communities but may include after-school, youth
leadership, diabetes prevention, sport for development
programs, summer camps and baseball leagues, female
empowerment workshops, and sport-based clinics (hockey,
lacrosse, soccer, basketball).
R5 Listening to One Another is a culturally-based, familycentred, mental health promotion program for Indigenous
youth aged 10 to 14 and their parents. Funded by the Public
Health Agency of Canada, the program is a collaboration
between First Nations communities in British Columbia,
Manitoba, Ontario and Quebec and researchers at McGill
University, the University of Lincoln, Nebraska and the
University of Manitoba. The program is delivered over 14
weeks in 2.5 hour sessions and takes participants through a
series of activities related to community history and cultural
pride, family and peer communication, skills for problemsolving, critical thinking and emotion regulation, bullying,
dealing with discrimination, problematic substance abuse,
and other themes. Communities are involved in every
stage of the program, from the adaptation of resources and
recruitment of participants to delivery and evaluation. It is
currently delivered with the help of Indigenous staff
at regional health organizations (Kirmayer et al., 2016).
Source: iStock
community wellness; Saqqatujuq (distant horizon) for selfdiscovery and future planning; understanding informed
choices and peer pressure; and Avatittinik Kamatsiarniq
(stewards of the land) to connect knowledge and skills on
the land (Healey, Noah, & Mearns, 2016, p. 7). With the
support of local wellness youth centres, the model was
piloted from 2011 to 2013 as a two-week camp program in
five communities: Cambridge Bay, Arviat, Coral Harbour,
Iqaluit and Panniqtuuq.
CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH
POPULATION MENTAL HEALTH PROMOTION IN CANADA
7
PUBLIC HEALTH ROLES
Public health practitioners and policymakers can support
and promote Indigenous mental wellness, address underlying
health determinants, and contribute to the broader process of
reconciliation in Canada, in a number of ways including:
Source: iStock
R5 Talk to Indigenous peoples to learn about their diverse
perspectives on mental wellness (Boksa, et al., 2015)
and recognize that Indigenous cultures and holistic
understandings of the world have much to contribute to
the transformation of the mental health system in Canada
(MHCC, 2012).
R5 Learn about and understand the unique social and cultural
context of Indigenous communities, their historical legacy,
and the current challenges that impact mental health in
some Indigenous communities (Boksa, et al., 2015)
R5 Commit to providing culturally safe care to address power
imbalances, build trust and form lasting relationships
with Indigenous patients and communities. Taking a
cultural safety training course is a good starting point for
this lifelong learning endeavor (Indigenous Health Working
Group, 2016).
R5 “Bear witness to the facts of history and acknowledge
that effects are still deeply felt today” (Boksa et al., 2015).
For example, you can bear witness by reading the report,
Honouring the Truth, Reconciling for the Future: Summary of
the Final report of the Truth and Reconciliation Commission
of Canada, and by showing solidarity through the
“It Matters to Me” campaign (Smylie, 2015).
R5 “Provide mental health services in culturally responsive
ways and work respectfully with Indigenous frameworks
of mental wellness” (Boksa et al., 2015, p. 365), for
example, by learning about national Indigenous mental
wellness frameworks (Health Canada & Assembly of
First Nations, 2015; ITK, 2016), as well as Indigenous
frameworks developed at the provincial and territorial
levels.
R5 Disseminate and share knowledge about promising
traditional, cultural and mainstream approaches to mental
wellness such as mental wellness teams and recognizing
the role of Elders (MHCC, 2012).
R5 Acknowledge that for mental health programs to be
effective in Indigenous communities, they must be guided
by local Indigenous knowledge (Boksa, et al., 2015;
Kirmayer et al., 2016).
8
POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH A COLLECTION FOR PUBLIC HEALTH IN CANADA
R5 Collaborate with traditional healers and knowledge
holders in the development of mental health promotion
initiatives in a respectful manner (Boksa et al., 2015).
R5 Consider ways you can assist Indigenous communities
in providing better access to health services, preferably
within the community itself (Boksa et al., 2015).
R5 Support Indigenous mental wellness workers in their
efforts to navigate and collaborate with mental health
services, and actively promote and support the training of
young Indigenous health professionals (Boksa et al., 2015).
R5 Advocate for Indigenous health equity by partnering
and collaborating with Indigenous organizations across
Canada (Indigenous Health Working Group, 2016).
Public health practitioners and policymakers can also refer
to the 94 calls to action to “redress the legacy of residential
schools and advance the process of Canadian reconciliation”
released in 2015 by the Truth and Reconciliation
Commission of Canada (TRC, 2015, p. 5). Several spoke
directly to the health and well-being of Indigenous peoples,
and included calls for federal, provincial, territorial and
Indigenous governments, medical and nursing schools, and
the health care system to:
R5 establish measurable goals to identify and close the gaps in
health outcomes and publish annual progress reports and
assess long terms trends on indicators such as suicide and
mental health (#19)
R5 recognize the value of Indigenous healing practices and
use them in the treatment of Indigenous patients in
collaboration with healers and Elders if requested (#22)
R5 increase the number of Indigenous health care
professionals (#23i)
R5 ensure the retention of Indigenous health care providers in
Indigenous communities (#23ii)
R5 provide cultural competency training for all health-care
professionals (#23iii)
R5 implement a mandatory Indigenous health course at
medical and nursing schools (#24) (TRC, 2015).
POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH
Visit NCCPH.CA to download the complete collection
General resources
Topical papers
t Population mental health promotion for children
t Environmental influences on population mental
health promotion for children and youth
and youth – a collection for public health in Canada
t Chronic diseases and population mental health
t Foundations: definitions and concepts to frame
promotion for children and youth
population mental health promotion for children
t Infectious diseases and population mental health
and youth
promotion for children and youth
t Scan Report: resources for population mental
health promotion for children and youth in Canada
t Healthy public policies and population mental
health promotion for children and youth
t Database of resources for population mental
health promotion for children and youth in Canada
t Considerations for Indigenous child and youth
population mental health promotion in Canada
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9
Click the links below to access each
resource. Broken link? Let us know
at [email protected]
RESOURCES
Training Resources
Framework/strategies
Indigenous Cultural Competence Course, Canadian Foundation
for Healthcare Improvement
R5 Retrieved from: Canadian Foundation for Healthcare
Improvement
First Nations Mental Wellness Continuum Framework
Summary Report, Health Canada and Assembly of First
Nations (2015).
R5 Retrieved from: First Nations and Inuit Health,
Health Canada
Mental Health First Aid First Nations & Northern Peoples,
Mental Health Commission of Canada
R5 Retrieved from: Mental Health Commission of Canada
San’yas Indigenous Cultural Safety Training – Core ICS Mental
Health Training
R5 Retrieved from: San’yas Indigenous Cultural Safety
Training
Tools
Native Wellness Assessment
R5 Retrieved from: Thunderbird Partnership Foundation
Mental Health Programs for Aboriginal Peoples in Canada
Database
R5 Retrieved from: Network for Aboriginal Mental Health
Research
Guidelines/best practice
A Guide for Health Professionals working with Aboriginal
Peoples: Aboriginal Health Resources, Smylie, J. (2000).
Health and Health Care Implications of Systemic Racism on
Indigenous Peoples, The College of Family Physicians of
Canada (2016).
R5 Retrieved from: College of Family Physicians of Canada
National Inuit Suicide Prevention Strategy. Inuit Tapiriit
Kanatami (2016).
Webinars/podcasts
Anti-Aboriginal Racism in Canada
R5 Retrieved from: National Collaborating Centre for
Aboriginal Health
Cultural Safety for Indigenous Peoples: A Determinant of Health
R5 Retrieved from: National Collaborating Centre for
Aboriginal Health
Other
Honouring the Truth: Reconciling for the Future. Summary of
the Final Report of the Truth and Reconciliation Commission of
Canada, Truth and Reconciliation Commission of Canada (2015).
R5 Retrieved from: National Centre for Truth and
Reconciliation
Just a Story – Mental Health Stigma. Healthy Aboriginal
Network
R5 Retrieved from: Healthy Aboriginal Network
Empathy, Dignity and Respect: Creating Cultural Safety for
Aboriginal People in Urban Health Care, Health Council of
Canada (2012).
10
POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH A COLLECTION FOR PUBLIC HEALTH IN CANADA
REFERENCES
Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social
determinants of mental health. International Review of Psychiatry,
26(4), 392-407.
Hunt, S. (2016). An introduction to the health of two-spirit people:
Historical, contemporary, and emergent issues. Prince George, BC:
National Collaborating Centre for Aboriginal Health.
Boksa, P., Joober, R., & Kirmayer, L. (2015). Mental wellness in
Canada’s Aboriginal communities: Striving toward reconciliation.
Journal of Psychiatry and Neuroscience, 40(6), 363-365.
Indigenous Health Working Group. (2016). Health and health care
implications of systemic racism on Indigenous Peoples in Canada.
College of Family Physicians of Canada & Indigenous Physicians
Association of Canada. Retrieved December 13, 2016 from
http://www.cfpc.ca/uploadedFiles/Resources/_PDFs/
SystemicRacism_ENG.pdf
Bombay, A., Matheson, K., & Anisman, H. (2009). Intergenerational
trauma: Convergence of multiple processes among First Nations
peoples in Canada. Journal of Aboriginal Peoples’ Health, 5(3), 6-47.
Chandler, M.J., & Lalonde, C. (1998). Cultural continuity as a hedge
against youth suicide in Canada’s First Nations. Transcultural
Psychiatry, 35(2), 191-219.
Chandler, M.J., & Lalonde, C. (2008). Cultural continuity as a
protective factor against suicide in First Nations youth. Horizons
– A Special Issue on Aboriginal youth, hope or heartbreak: Aboriginal
youth and Canada’s future, 10(1), 68-72.
Chief Public Health Officer. (2009). Report on the state of public health
in Canada. Growing up well: Priorities for a healthy future. Ottawa,
ON: Government of Canada. Retrieved September 15, 2016 from
http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2009/fr-rc/pdf/
cphorsphc-respcacsp-eng.pdf
First Nations Information Governance Centre (FNIGC). (2012). First
Nations Regional Health Survey (RHS) 2008/10: National report
on adults, youth and children living in First Nations communities.
Ottawa, ON: Author.
Fraser, S.L., Geoffroy, D., Chachamovich, E., & Kirmayer, L.J. (2015).
Changing rates of suicide ideation and attempts among Inuit
youth: A gender-based analysis of risk and protective factors.
Suicide and Life-Threatening Behavior, 45(2): 141-156. DOI:
10.1111/sltb.12122
Gray, A., Richer, F., & Harper, S. (2016). Individual and communitylevel determinants of Inuit youth mental wellness. Canadian
Journal of Public Health, 107(3), 251-257.
Greenwood, M., & de Leeuw, S. (2012). Social determinants of health
and the future well-being of Aboriginal children in Canada.
Paediatrics and Child Health, 17(7), 381-384.
Greenwood, M., de Leeuw, S., Lindsay, N.M., & Reading, C. (Eds.)
(2015). Determinants of Indigenous Peoples’ health in Canada: Beyond
the social. Toronto, ON: Canadian Scholars’ Press.
Healey, G., Noah, J., & Mearns, C. (2016). The eight ujarait (rocks)
model: Supporting Inuit adolescent mental health with an
intervention model based on Inuit knowledge and ways of
knowing. International Journal of Indigenous Health, 11(1), 92-110.
Health Canada & Assembly of First Nations. (2015). First Nations
mental wellness continuum framework summary report. Ottawa, ON:
Author.
Inuit Tapiriit Kanatami (ITK). (2014). Social determinants of Inuit
health in Canada. Ottawa, ON: Author
Inuit Tapiriit Kanatami (ITK). (2016). National Inuit suicide prevention
strategy. Ottawa, ON: Author.
Kielland, N., & Simeone, T. (2014). Current issues in mental health in
Canada: The mental health of First Nations and Inuit communities.
Ottawa, ON: Library of Parliament.
King, M., Smith, A., & Gracey, M. (2009). Indigenous health Part 2:
The underlying causes of the health gap. Lancet, 374, 76-85.
Kirmayer, L.M. (2012). Changing patterns in suicide among young
people. Canadian Medical Association Journal, 184(9), 1015-16.
Kirmayer, L., Brass, G., Holton, T., Paul, K., Simpson, C., & Tait, C
(2007). Suicide among Aboriginal peoples in Canada. Ottawa, ON:
Aboriginal Health Foundation.
Kirmayer, L., Brass, G., & Tait, C. (2009). The mental health of
Aboriginal Peoples: Transformations of identity and community.
The Canadian Journal of Psychiatry, 45(7), 607-616.
Kirmayer, L., Sheiner, E., & Geoffroy, D. (2016). Mental health
promotion for Indigenous youth. In M. Hodes & S. Gau (eds.),
Positive mental health for children and adolescents: Fighting stigma and
promoting resiliency (pp. 111-140). London: Academic Press.
Loppie, C., & Wien, F. (2009). Health inequalities and the social
determinants of Aboriginal Peoples’ health. Prince George, BC:
National Collaborating Centre for Aboriginal Health.
McShane, K., Smylie, J., & Adomako, P. (2009). Health of First
Nations, Inuit, and Métis children in Canada. In J. Smylie & P.
Adomako (eds.), Indigenous children’s health report: Health assessment
in action (pp. 11-66). Toronto, ON: Centre for Research on Inner
City Health. Retrieved September 15, 2016 from http://caid.ca/
IndChiHeaRep2009.pdf
Mental Health Commission of Canada (MHCC). (2012). Changing
directions, changing lives: The Mental Health Strategy for Canada.
Calgary, AB: Author.
National Collaborating Centre for Aboriginal Health (NCCAH).
(2009). The importance of disaggregated data. Prince George, BC:
Author.
CONSIDERATIONS FOR INDIGENOUS CHILD AND YOUTH
POPULATION MENTAL HEALTH PROMOTION IN CANADA
11
REFERENCES
CONTINUED
National Collaborating Centres for Public Health. (2017). Population
mental health promotion for children and youth: A public health primer.
Ottawa, ON: Author.
Ning, A., & Wilson, K. (2012). A research review: Exploring the health
of Canada’s Aboriginal youth. International Journal of Circumpolar
Health, 71, 18497.
Petrasek MacDonald, J., Ford, J.D., Cunsolo Willox, A., & Ross, N.A.
(2013). A review of protective factors and causal mechanisms
that enhance the mental health of Indigenous circumpolar youth.
International Journal of Circumpolar Health, 72, 21775. DOI: http://
dx.doi.org/10.3402/ijch.v72i0.21775
Public Health Agency of Canada (PHAC). (2006). Aboriginal mental
health and well-being. In Government of Canada, The human face
of mental health and well-being of Aboriginal Peoples in Canada (pp.
159-180). Ottawa, ON: Author. Retrieved December 5, 2016
from http://www.phac-aspc.gc.ca/publicat/human-humain06/pdf/
human_face_e.pdf
Reading, C., & Reading, J. (2012). Promising practices in Aboriginal
community health promotion interventions. In I. Rootman, S.
Dupéré, A. Pederson, & M. O’Neill (eds.), Health promotion in
Canada: Critical perspectives on practice, 3rd Edition (Ch. 10).
Toronto, ON: Canadian Scholars’ Press.
Right to Play. (2016). Promoting life-skills in Aboriginal youth
(PLAY) program. http://www.righttoplay.ca/Learn/ourstory/
Pages/PLAY-Program.aspx
Smye, V., & B. Mussell (2001). Aboriginal mental health: ‘What works
best’ - A discussion paper. Vancouver, BC: Mental Health Evaluation
& Community Consultation Unit, University of British Columbia
Smylie, J.M. (2009a). Achieving strength through numbers: First Nations,
Inuit and Métis health information. Prince George, BC: National
Collaborating Centre for Aboriginal Health.
Smylie, J. (2009b). The health of Aboriginal Peoples. In D. Raphael
(ed.), Social determinants of health, 2nd Ed. (pp. 280-304). Toronto,
ON: Canadian Scholars’ Press.
Smylie, J. (2015). Approaching reconciliation: Tips from the field.
Canadian Journal of Public Health July/August, 106, 5, e261.
Statistics Canada. (2013). Aboriginal Peoples in Canada: First Nations
People, Métis and Inuit – National Household Survey, 2011. Ottawa,
ON: Ministry of Industry. Retrieved June 30, 2016 from https://
www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011x2011001-eng.cfm
Statistics Canada. (2016a). Social determinants of health for the off-reserve
First Nations population, 15 years of age and older, 2012. Ottawa,
ON: Ministry of Industry.
Statistics Canada. (2016b). First Nations, Métis and Inuit women.
Ottawa, ON: Ministry of Industry. Retrieved October 13,
2016 from http://www.statcan.gc.ca/pub/89-503-x/2015001/
article/14313-eng.htm
Systems Improvement through Service Collaboratives (SISC). (2012).
SISC Evidence brief #4: Effective mental health services for Aboriginal
children and youth. Toronto, ON: Centre for Addiction and Mental
Health. Retrieved September 15, 2016 from http://eenet.ca/wpcontent/uploads/2012/11/Aboriginal-Evidence-Brief.pdf
Truth and Reconciliation Commission of Canada (TRC). (2015).
Truth and Reconciliation Commission of Canada: Calls to action.
Winnipeg, MB. Author.
UNICEF Canada. (2009). Aboriginal children’s health: Leaving no child
behind. Canadian supplement to the State of the World’s Children 2009.
Toronto, ON: Author.
Vukic, A., Gregory, D., Martin-Misener, R., & Etowa, J. (2011).
Aboriginal and western conceptions of mental health and illness.
Pimatisiwin: A Journal of Aboriginal and Indigenous Community
Health, 9(1), 65-86.
World Health Organization. (WHO) (2016). Mental health:
Strengthening our response. Geneva: Author. Retrieved August 26,
2016 from http://www.who.int/mediacentre/factsheets/fs220/en/
Wortzman, R.L. (2009). Mental health promotion as a prevention and
healing tool for issues of youth suicide in Canadian Aboriginal
communities. The First Peoples Child & Family Review, 4(1), 20-27.
Population mental health promotion for children and youth is a collaborative project of the six National Collaborating Centres
(NCCs) for Public Health. The NCCs work together to promote and improve the use of scientific research and other knowledge to
strengthen public health practices, programs, and policies in Canada. A unique knowledge hub, the NCCs for Public Health identify
knowledge gaps, foster networks and provide the public health system with an array of evidence based resources, multi-media
products, and knowledge translation services.
This document was written and developed by the NCC for Aboriginal Health. Special thanks to our reviewers for their assistance.
Download this document, and others in this collection, at www.nccph.ca.
Please cite this document as: Atkinson, D. (2017). Considerations for Indigenous child and youth population mental health
promotion in Canada. Canada: National Collaborating Centres for Public Health.
This publication was funded by the National Collaborating Centres for Public Health and made possible through a financial
contribution from the Public Health Agency of Canada.
The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
ISBN 978-1-988833-09-5
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POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH A COLLECTION FOR PUBLIC HEALTH IN CANADA