Pharmacy Connection
At the September 2019 meeting, College Council approved the adoption of three opportunities to cultivate Indigenous cultural competency amongst Council, College staff and registrants:
- Develop a commitment to act. The College will identify ways to address cultural inequities to improve patient outcomes (reflecting the calls to action identified in the Truth and Reconciliation Commission of Canada’s Calls to Action) and strive to build relationships with Indigenous communities and others focused on Indigenous health.
- Create a page on the College’s website that would include resources and a training module on the inclusionary services that the College expects of registrants.
- Council meetings begin with a land acknowledgement, starting with the December 2019 meeting, which will help remind Council members, College staff and registrants that we all have a role in the reconciliation process and to consider this role within our work.
The College’s Indigenous cultural competency and safety initiative has emerged from our growing awareness of the disparities in healthcare and health outcomes for Indigenous people. Our approach to all three of these opportunities will reflect the importance of working in collaboration with Indigenous communities to improve pharmacy care and patient outcomes.
Work this year at the College will focus on establishing relationships with members of the Indigenous communities in Ontario, and identifying and implementing ways to heighten cultural competency within the organization. It will also focus on making helpful resources available to all registrants as an important first step towards more formal opportunities in future years.
In this issue of Pharmacy Connection, we are pleased to reprint a recent story from Pharmacy Practice + Business magazine that provides pharmacy professionals with some tips on how to support the health and well-being of Indigenous youth.
5 TIPS ON SUPPORTING
the Mental Health and Wellness of Indigenous Youth
By: Jaris Swidrovich
Story reprinted with permission from Canadian Healthcare Network.
Approximately 5% of people in Canada are self-identified as Indigenous.1 In the Canadian context, the term Indigenous is used interchangeably with the term Aboriginal, which is defined in the Constitution Act of 1872 as Indian (now more appropriately referred to as First Nations), Métis or Inuit persons.2 Despite comprising only about 5% of the Canadian population, Indigenous peoples are drastically overrepresented in terms of accessing the healthcare system, with mental health and wellness being of particular concern.1
Indigenous youth aged 15-24 in Canada experience a rate of suicide that is five to six times higher than the rate witnessed in non-Indigenous youth.3,4 The overall number of completed suicides by males, and specifically young Indigenous males, is larger than the number of completed suicides by females; however, the difference in rate of death by suicide among First Nations females is much greater than that seen in non-First Nations females. First Nations males aged 10-19 in Saskatchewan, for example, experience a rate of suicide that is six times higher than the suicide rate for non-First Nations males of the same age group, while First Nations females of this age group experience a rate of suicide that is 26 times higher than the suicide rate among their non-First Nations counterparts.5 In Nunavut, the suicide rate for young Inuit males aged 15-24 is 40 times the national rate of suicide.3,4
Indigenous youth have cited a number of contributing factors to the high suicide rate, including the impact of bullying and cyberbullying, lack of emotional support, lack of physical safety, lack of activities and its impact on emotional and mental wellness, and the impact of substance use.6 Other known contributing factors to the disproportionally high rates of suicide experienced by Indigenous youth in Canada versus non-Indigenous youth include all forms of racism, intergenerational trauma, access to healthcare services, the historical and ongoing child welfare crisis for Indigenous children, a history (and ongoing experience of) colonialism and other social determinants of health.2
While pharmacists can support the mental health and wellness of Indigenous youth in Canada in many ways, the following five suggestions are offered as a starting point.
1. Dedicate both personal and professional time to learning about Canada’s historical and ongoing “truths.”
In our age of Truth and Reconciliation, it is critical for pharmacists (and all Canadians) to learn the historical and ongoing truths of our nation and of the people living in it. Thankfully, taking the time to learn does not have to come at any personal financial cost. Consider consulting your local public library for a list of suggested readings and other sources of learning, including online and loanable videos and podcasts, as well as websites and in-person programming. Contact KAIROS Canada to arrange a Blanket Exercise for your pharmacy staff, which will build understanding about our shared history as Indigenous and non-Indigenous peoples in Canada. Read the Truth and Reconciliation Commission of Canada’s report and all 94 Calls to Action.7 Participating in reconciliation and other programs, interventions and initiatives without first dedicating time to “truth” has the potential to be harmful and insincere if coming from an uninformed, or not fully informed, position.
2. Establish, build and reaffirm relationships with Indigenous peoples, communities and organizations in or near your own community.
A foundational element of Indigenous world view is relationality and the interconnectedness of all things. Supporting the mental health and wellness of Indigenous youth also means supporting the health and wellness of the people and communities surrounding and supporting the youth. Indigenous youth have cited intergenerational trauma as one of the many contributing factors to their emotional health and wellness, which means we must include all generations in our efforts to support the mental health and wellness of Indigenous youth versus just the youth themselves. Some starting points might include your local Indigenous (First Nations / Métis / Inuit) Friendship Centre, local reserves and/or tribal council(s), and the urban offices for First Nations, Métis and Inuit communities. Success will be enabled through positive and lasting relationships.
3. Partner with Indigenous youth.
A common saying and a philosophical approach to truth and reconciliation is “nothing about us without us.” In order to have the most authentic and genuine participation in contributing to the mental health and wellness of Indigenous youth, you must work directly with Indigenous youth. For assistance in locating Indigenous youth in your own area, a starting point might be to connect with the Assembly of First Nations (AFN) National Youth Council.
4. Familiarize yourself with support services and programs in your community and remotely accessible supports.
While 50% of First Nations people in Canada live off-reserve, the other 50% live on reserves where access to services may be dramatically lower than what is available in urban settings.8 Although many reserve communities do have access to the internet through cellular data and/or WiFi, some reserve (and Northern, rural and remote) communities do not. As such, resources that support the mental health and wellness of Indigenous youth may need to be accessible without access to in-person or internet-based services, and resources should be inclusive of the physical, mental, emotional and spiritual dimensions of health and well-being. Expanding and promoting the services of your pharmacy is important; however, recognizing that mental health and wellness extends far beyond pharmacists and pharmacies, pharmacists must have the ability to connect Indigenous youth with other supports and services that are accessible to them—wherever they are.
5. Practise anti-racism and be an anti-racist leader.
Considering the identified impacts of racism on the mental health and wellness of Indigenous youth, it is not enough to “not be racist”—we must be anti-racist. While engaging with your local library, consider also adding anti-racist materials to your inquiry. Be an anti-racist leader and mentor to the other staff, students and professionals you interact with. Focus on the social determinants of health that have impacted, and continue to impact, the mental health and wellness of Indigenous youth; practise from this perspective instead of from a perspective that assumes each individual Indigenous youth is in complete control of their own mental health and wellness.
Jaris Swidrovich (jaris.swidrovich@usask.ca) is an assistant professor in the College of Pharmacy and Nutrition at the University of Saskatchewan on Treaty 6 territory and the traditional homelands of the M?tis in Saskatoon, SK. He is a member of Yellow Quill First Nation and is the first self-identified First Nations Doctor of Pharmacy and faculty member in pharmacy in Canada.
REFERENCES
1. Statistics Canada. Aboriginal peoples in Canada: key results from the 2016 census. October 25, 2017. https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025a-eng.htm (accessed June 10, 2019).
2. Allan B, Smylie J. First Peoples, second class treatment: the role of racism in the health and well-being of Indigenous peoples in Canada. Toronto, ON: Wellesley Institute; 2015.
3. Health Canada. A report on mental illnesses in Canada. Ottawa, ON; 2002. www.phac-aspc.gc.ca/publicat/miic-mmac/pdf/men_ill_e.pdf (accessed June 10, 2019).
4. Health Canada. Acting on what we know: preventing youth suicide in First Nations. Ottawa, ON; 2003. www.hc-sc.gc.ca/fniah-spnia/alt_formats/fnihb-dgspni/pdf/pubs/suicide/prev_youth-jeunes-eng.pdf (accessed June 10, 2019).
5. Federation of Sovereign Indigenous Nations. Discussion paper regarding a Saskatchewan First Nations suicide prevention strategy. September 22, 2017. http://caid.ca/SasFNSuiDisPap2017.pdf (accessed June 10, 2019).
6. Giles D. Sask. children’s advocate raises alarm bells over Indigenous youth suicide rate. December 5, 2017. https://globalnews.ca/news/3898080/saskatchewan-childrens-advocate-corey-osoup-indigenous-youth-suicide/ (accessed June 10, 2019).
7. Truth and Reconciliation Canada. Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commission of Canada. Winnipeg, MB: Truth and Reconciliation Commission of Canada; 2015.
8. Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. Ottawa (ON): Statistics Canada; 2018. https://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.cfm (accessed June 10, 2019).
