Good afternoon.
I want to acknowledge my colleague, Dr. Lalonde.
[Witness speaks in Cree]
My name is Janet Smylie. I'm a family doctor and public health researcher living here in Toronto, the land of the Mississauga people.
I want to touch on four content areas.
The first one is the burden of mental health challenges and the inequities that face indigenous people in Canada compared to non-indigenous people. I'm glad to follow Dr. Lalonde, because he has talked about suicide and put it in a good context for us. I think most Canadians are aware of the disparate rates of suicide experienced by indigenous people and indigenous youth.
I want to discuss some emerging evidence that we have been able to develop in partnership with provincial and local aboriginal health service providers here in Ontario. With the majority of aboriginal people now living in urban areas, we were able to use respondent-driven sampling over the past couple of years, in partnership with an urban aboriginal health access centre called the “De dwa da dehs nye>s Aboriginal Health Centre”, to develop population-based estimates in looking at the determinants of urban indigenous health as well as health status and mental health status indicators.
Respondent-driven sampling has emerged in urban health as a major source of population-based data for hard-to-find groups of people. Unfortunately, in urban areas, our federal statistics are very poor at getting actual counts of aboriginal people, and that's gotten worse with the switch of the indigenous identity question from the long form census to the national household survey. I recently published on this topic in an international journal of statistics.
With respect to this study, which is under final review for the Canadian Journal of Public Health, we found out that 42% of the self-identified first nations adults in Hamilton had been told by a health care provider that they had a psychological and/or mental health disorder. I should mention that the dataset is owned by the aboriginal community, and they gave permission to share the data.
Using the recognized tool, the Kessler, we found high rates of depression and anxiety. Shockingly, though, using a PTSD screener, we also found that 33% of the adult population, or one in three self-identified first nations people in this urban centre, met the criteria for post-traumatic stress disorder. Also, 41% had suicidal ideation and over half had attempted suicide. Then, and not surprisingly, I guess, given this high burden of mental health challenges, half the sample reported marijuana use in the last 12 months, one out of five reported the use of cocaine, and one out of five reported the use of opiates.
One remarkable thing, given this and other burdens—including, for example, that 16% of adults in a non-age-adjusted sample had diabetes, and that over half of respondents reported making suicide attempts and one in three had symptoms of active PTSD—we found, using the tool that was developed for veterans, that 25% reported excellent or very good health and 33% reported overall good health. When we asked specifically about mental health, 21% reported excellent or very good mental health and 43% reported good mental health. Three-quarters of the people, if you ask them in a self-reporting way, would say they're doing fine or good.
There are things I wanted to mention. I'm going to drill down a bit on the issues about post-traumatic stress disorder just because I think this is something that we really need to be thinking about if we're going to think about adequate responses to these inequities in indigenous and non-indigenous mental health.
Basically, it's an inadequate measure because what we're really looking at is complex trauma. On this, we have some distinguished scholars, including Dr. Renee Linklater here in Toronto, who's published a book about the nature of the trauma experienced by indigenous people. It's linked to the impacts of multi-generational trauma and trauma in family of origin, as well as ongoing trauma and insults. The PTSD screener was developed for veterans of war who, of course, would have experienced a very severe trauma, but it would have been for a limited period of time.
The other thing I wanted to say about this PTSD screener is that one out of three adults in this population is experiencing three or more of the following four symptoms on a regular basis: nightmares of traumatic experiences; actively needing to suppress memories of trauma or avoid situations that remind them of trauma; feeling constantly on guard, watchful, or easily startled; and feeling detached from others or surroundings.
To me this is really a huge and mostly hidden burden. Substance use has been a way of self-managing this huge burden of complex trauma, grief, depression, and anxiety for generations.
Of course it's important to note, as I've mentioned, that there are physical co-morbidities that make it even more complex. What we found in addition to the high rates of diabetes were rates of hepatitis C that were over ten times the rate of those in the general population. Actually 52% of adults and three-quarters of those over the age of 50 report activity limitations.
Given all this burden, there is also an incredible degree of resilience in the self-reported measures, but I would raise concern then, and I have been for years, around the use of these self-reported measures. So here we have one-third of the population experiencing active symptoms that you could compare to those of acute war vets and over half of them having activity limitations, but there's this huge under-reporting when you ask people how they're doing. We see that kind of reporting used still in the reports that are being generated by the federal government, based on studies like the “Aboriginal Children's Survey” and the “Aboriginal Peoples Survey”.
Turning to the root causes, another resource that I would like to bring to your attention is a report that we released in February of this year, commissioned by the Wellesley Institute, a non-partisan institute in Toronto, and called “First Peoples, Second Class Treatment: The role of racism in the health and well-being in Indigenous peoples in Canada”. In this report, with my co-author Dr. Billie Allan, who's another indigenous scholar with a doctorate in social work, we were able to draw on the extensive work of my scholarly colleagues and community members and a council of grandparents.
We detailed the impacts of specific historic and ongoing colonial policies, including the Indian Act, land dispossession and political persecution of Métis, the forced relocations of the Inuit, as well as the traumas of residential schools, the sixties scoop, and the ongoing and contemporary overrepresentation of indigenous children in the child welfare system. As many of you may be aware, there are now more children in care than at the height of residential schools. In the province of Saskatchewan, for example, aboriginal children represent 80% of the children in care.
In this report we were able to detail the pervasive nature of ongoing systemic attitudinal and epistemic racism and its adverse mental health impacts, including trauma and re-traumatization when someone tries to access services.
The adverse impacts of racism on health and mental health have been well documented in the literature internationally for other racialized populations. In fact, we had an international gathering associated with the release of the report so we were able to invite Dr. David Williams, a pre-eminent scholar who developed the measures of racism in the U.S. at Harvard University, as well as our international indigenous colleagues. For example, our indigenous public health colleagues, including Ricci Harris, have been able to demonstrate—because the New Zealand health survey asks about racism—that if you control for class and racism, health inequities actually disappear. Their research has been published in The Lancet.
We have less data in Canada, and in the report we discuss the strong stigma that interferes with acknowledgement of racism. However, there is evidence that has been generated, for example, about “racial battle fatigue” among aboriginal students in Edmonton, and a level of perceived racism, described by my colleague Dr. Annette Browne in her study of an inner-city emergency room, that was so severe that clients actually regularly strategized on how to manage racism in their encounters with emergency room staff in advance of their visits. In the Hamilton study that I previously cited, the respondent urban sampling study, we found that half of the self-identified adults had recorded experiencing unfair treatment as a result of racism.
In terms of other routes, of course, one also needs to be thinking about the gendered impacts of colonial policies and how this intersects with—