Yes.
[Witness speaks in Ojibway]
Good afternoon and thank you. I'd like to begin by thanking you for the opportunity to speak with the committee. Thank you for the invitation.
I'd like to discuss with you mental wellness from a first nations' perspective. I've introduced myself to you in terms of my cultural identity. I am from the Delaware first nation. It's a small community in southwestern Ontario, and I was acknowledging the Anishinaabe people on whose land we are meeting.
I'm excited to share with you a research project that we just finished this past year. It was a CIHR-funded research project that explored the role of culture in addressing substance use issues. The mandate for this research came from “Honouring Our Strengths: A Renewed Framework to Address Substance Use Issues Among First Nations People in Canada”, which said that the approach to research needs to reflect indigenous culture and values.
We constructed a methodology to do just that, and the outline of the priorities for that research is articulated in the Honouring Our Strengths renewal framework. We applied that mandate and conducted research with the national native alcohol and drug abuse programs and the national youth solvent abuse programs across Canada. There were 15 different language and cultural groups participating in our research, from the east coast to the west coast, from the Mi'kmaq, Malaseet, Cree, and Ojibway first nations all across the country to the west coast first nations of Coast Salish, Nuu-chah-nulth, Kwakiutl, Carrier Sekani, and Chilcotin.
Participating in the research were elders, cultural practitioners, and indigenous knowledge keepers. A priority for the research was indigenous knowledge and demonstrating how knowledge development and evidence do exist within culture. We can find the evidence outside of peer-reviewed journals and such, but we did go to the literature as well, and we conducted a scoping study. We found that about 4,500 articles, which talked about culture and its role in addressing substance-use issues, existed in the world.
From that search, we extracted only 19 studies and applied them in our research. In the research we looked at, none of the measures to demonstrate the impact of culture measured wellness from a whole-person perspective. Nine of the 19 studies measured the impact of culture, and most of those focused on physical wellness and behavioural changes. Most of the literature examined changes based on deficits. It didn't talk about wellness; it talked about changes in deficits: How much of a substance are you using today? How much will you be using tomorrow?
We were excited by what the research produced, which was a native wellness assessment instrument. We've also developed a number of other tools, one being an indigenous wellness framework based on indigenous knowledge. We tested the instrument across 18 treatment centres out of 54 nationally to ensure that the instrument was psychometrically sound. In the pilot test of the instrument, we found that it performed well across age and gender. We saw that those with native language dominance reported higher overall levels of wellness. The instrument also demonstrated that clients had been in treatment at least five times prior to the current episode of treatment. Progression of wellness was equally meaningfully demonstrated between repeats and new clients in treatment, which validates the purpose of repeat admissions in the national native alcohol and drug abuse program and the national youth solvent abuse program.
We saw that the length of treatment made a difference as well in achieving different levels of wellness. Programs that were at least 12 to 16 weeks in length achieved the best results, with programs of seven to 11 weeks showing the least amount of change.
Part of this native wellness assessment instrument is self-rating as well as observer-rating, and the combined measure of change between the two demonstrated at least an 18% increase in wellness between an entry and an exit assessment.
The wellness assessment instrument and the indigenous wellness framework does measure wellness from a whole-person perspective, and we have put forward in this framework culturally based indicators that reliably measure wellness and change over time.
The culturally grounded definition of wellness, as I said, is based on the whole person. So it looks at wellness from a spiritual, emotional, mental, and physical perspective, and the indicators of wellness are hope, belonging, meaning, and purpose. Investments in spiritual wellness through identity, values, and connection to belief produce a level of hope. And investments in emotional wellness—those being connection to culture through family or cultural definitions of family, community, relationships, and having an attitude toward living—produce a level of and a sense of belonging.
Investments in mental wellness, being rational and intuitive and thought-based in culture, when those two are put together, create an understanding, which is an outcome of meaning for and about life. Finally, physical wellness is achieved through a sense of wholeness and understanding a unique way of being and a unique way of living from the culture, which achieves purpose.
When we presented this indigenous wellness framework across the country in many different venues, it resonated well in both the community and treatment centres that did not participate in the research. We also found that there were 22 common ways of talking about culture as an intervention. This is significant in that there is no homogeneous culture but are distinctions across the land based on language and connection to the land. Nonetheless, across those cultures there are 22 common ways of talking about culture.
In our limited data in the national native alcohol and drug abuse program, we know that 90% of people who complete treatment have had access to cultural interventions. What's important about this is that treatment centres have been using culture for a long time, but it hasn't been well defined and it hasn't been documented. Now, this wellness assessment instrument is going to be embedded in a national database we've developed called the addictions management information system. This national information management system was deployed last year across all treatment centres.
A challenge in the full use of the database is that there were no resources nationally to build capacity among treatment providers to use the addictions management information system, so we're relying on things such as webinars to teach people in the treatment centres to use the full capacity of the addictions management information system.
Our hope is that over time we can demonstrate the significance and importance of the AMIS system so that we have service providers fully utilizing the system. Then we'll have an evidence base that we build across the country to demonstrate the importance of culture and the strengths of the NNADAP and the NYSAP programs in addressing substance abuse and mental health issues.
We've also developed a cultural adaptation of the drug-use screening inventory, which is both a screening and an assessment tool that has been adapted to measure trauma from a first nations perspective that considers not only the long-term intergenerational effects of trauma but the community aspects of trauma that layer onto people across generations as well.
As I said, the addictions management information system needs more support in terms of building capacity across this system to be able to use it.
This fall we're also going to pilot test the native wellness assessment instrument in the Indian residential school health supports program and the mental wellness teams.
A good example I wanted to offer around collaboration and partnerships—and also to demonstrate the impact of the conversation around these wellness indicators of hope, belonging, meaning, and purpose—is the development of the national first nations mental wellness continuum framework. When we presented the research, across the regions those indicators resonated with people as well. So they've been embedded in the first nations mental wellness continuum framework. Also, what people have said is that culture has to be the foundation of whatever investments we make in wellness or towards wellness, and the outcome should be measured in terms of hope, belonging, meaning, and purpose.
The other point I wanted to make about the collaboration—