A Community Partnership to Explore Mental Health Services in First Nations Communities in Nova Scotia

Abstract

Nationally, mental health has been identified as the top health priority by the Assembly of First Nations. 1,2 Regionally, the Mi'Kmaq Health Research Group has identified areas for improvement, a major one being mental health services. 3 In Nova Scotia, 73% of Mi'kmaq people live in First Nations communities, and analgesics, sedatives and antidepressants are the highest category of drug claims in this population. 4 While several studies have investigated Aboriginal mental health and services related to suicide and substance abuse, 5-7 minimal research has been done specifically about mental illness. 8 Current best practices recognize that psychiatric rehabilitation models framed under assumptions based on metropolitan urban areas are problematic. 9 Further, the literature stresses the need to integrate and coordinate an interdisciplinary team approach 10 and to address the cultural appropriateness and relevance of services. [11][12][13] Most significantly, Aboriginal perspectives and knowledge remain largely absent from the dominant discourse around mental health care. This arises from the socio-political marginalization of Aboriginal people and the design of services for individuals with severe mental illness (3% of the Canadian population), which fail to address the unique and complex concerns of Aboriginal communities. 14 METHODSCommunity-based participatory research 15,16 was the approach for this qualitative descriptive study aimed at increasing understanding of the gaps, barriers and successes/solutions in mental health services in Mi'kmaq communities. Health directors of the 13 Mi'kmaq communities invited university researchers to conduct the study. The health directors and researchers carefully adhered to Ownership, Control, Access and Possession principles for research with Aborigi-nal communities. 17,18 Health directors collaborated with the university researchers on decisions about the research question, interview guide, design, data collection, write-up and dissemination. The academic researchers conducted the structured, open-ended interviews and analyzed the data in consultation. The study was approved by ethics review boards at Dalhousie University and the Mi'kmaq Ethics Watch. Approval was also obtained from the 13 chiefs. Teleconferences with the health directors from the 13 Mi'kmaq communities were conducted by two of the researchers during proposal writing and after analysis and then completion of the study. Data collectionHealth directors wanted consumers, family members and health care providers interviewed to provide a broad range of understanding. The interview guide for all three groups focused on questions about participants' experience with mental illness, identifying

Black and minority ethnic group involvement in health and social care research: A systematic review

“…Eleven study populations focused on African Americans, five studies on Aboriginal groups, four on Chinese, three on South Asians, two on Native Hawaiian, five on Latinos, two on Korean Americans, one each on Zuni Indians, Somalis, Afghan, Native Americans, Alaska Natives, Inuit, indigenous groups, First Nations, Hispanics, Vietnamese Americans, various groups (Somalian, Eritrean, Pakistani, Iranian, Iraqi, Chinese and Sri Lankan), Burmese and African Americans and Hispanics . Thirty‐three studies were undertaken in the USA, seven in Canada, two each in UK and Australia and one in New Zealand …”

“…Six studies employed a mixed‐methods design with both quantitative and qualitative elements, and twelve studies included a quantitative design with five randomized controlled trials, one pilot survey, repeated measures, cross‐sectional, quasi‐experimental, population‐based survey, intervention design and retrospective design . Fourteen studies utilized qualitative methods of data collection, one was an ethnography and two utilized a case study design . Furthermore, two studies described interventions, one on grant writing, four on evaluation and two on curriculum development …”

“…A range of health conditions were identified: one study on alcohol abuse and sobriety, brain injury, chronic disease prevention, cardiovascular disease, cardiovascular disease and diabetes, depression, diet, obesity and psychological factors related to nutrition for cancer, obesity (weight loss), elder mistreatment, general health, eating, physical activity and sleep, general health, pregnancy and infant care, pre‐term birth, oral health, reducing health disparities, reproductive health, smoking cessation, tuberculosis, hepatitis B and cancer . The remaining included diabetes, health promotion, HIV, mental health and hypertension …”

“…Forty‐three studies claimed that the projects were undertaken through partnering with different communities during the course of the research process; from Table (columns 4‐11), it is clear that it did not necessarily translate in practice and the remaining two studies utilized consultative forms of involvement. The notion of collaborative involvement where PPI contributors are active partners in the research process does not fully reflect in practice, as involvement activities took place at selective stages of the research process and never reportedly happened throughout the research process.…”

“…For example, involvement most commonly took place during the design stage (35 of 45) (column 6), 29 studies on the development of various study materials (column 7) and 22 studies to enable recruitment of study participants (column 8), data collection (18) (column 9) and data analysis and interpretation (11) (column 10). Involvement of PPI contributors was seldom during the preliminary stages of the research that is development of proposal/funding (13) (column 5), and only one study involved PPI contributors in identifying the research agenda (column 4). Only ten studies reported involving PPI contributors at the dissemination stage (column 11).…”