Ne Lhin Aboriginal/First Nation and Métis Mental Health and Addictions Framework
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NE LHIN ABORIGINAL/FIRST NATION AND MÉTIS MENTAL HEALTH AND ADDICTIONS FRAMEWORK January 2011 NE LHIN Aboriginal First Nations Métis Mental Health and Addictions Framework NE LHIN ABORIGINAL/FIRST NATION AND MÉTIS MENTAL HEALTH AND ADDICTIONS FRAMEWORK Table of Contents Executive Summary ............................................................................................ 4 Introduction to the Framework ........................................................................ 11 About the NE LHIN .......................................................................................... 11 Development of this Framework ...................................................................... 12 Towards an Understanding of Mental Health and Addictions in Aboriginal Communities ..................................................................................................... 14 A Note on Terminology .................................................................................... 14 Statistical Overview of the Aboriginal Population in the NE LHIN ................... 14 Access to Aboriginal Mental Health and Addictions Data ................................ 15 Aboriginal Mental Health and Addictions in Canada ........................................ 16 Statistical Data on Aboriginal Mental Health and Addictions in the NE LHIN .. 17 Aboriginal Stakeholder Perceptions of Mental Health and Addictions in Communities in the NE LHIN Region .............................................................. 20 Statistical Data on the Determinants of Health in the NE LHIN ....................... 21 Aboriginal Stakeholder Perceptions of the Determinants of Health in the NE LHIN ................................................................................................................ 22 Mental Health and Addictions Policy Directions and Aboriginal, First Nations and Métis People ................................................................................ 23 Aboriginal Mental Health and Addictions Health Policies in Canada ............... 23 Aboriginal Mental Health and Addictions Policies in Canada .......................... 24 Ontario Policy Directions on Aboriginal Health and Mental Health .................. 25 Ontario Policy Directions on Mental Health and Addictions ............................. 27 International Policy Approaches to Improving Indigenous Mental Health ........ 29 Insights from Communities and the Literature: Approaches to Mental Health and Addictions and Related Services ................................................. 31 Community Development ............................................................................ 31 Integration of Traditional Wellness Approaches........................................... 32 Integration of Federal, Provincial, Municipal and First Nations Primary Care and Health Services ..................................................................................... 34 NE LHIN Aboriginal First Nations Métis Mental Health and Addictions Framework Case Study in NE Ontario: The Weeneebayko Area Health Integration Framework ................................................................................................... 35 Promoting Aboriginal Youth Mental Health: Strengthening Resilience ........ 36 Access to Aboriginal Mental Health Information .......................................... 37 Family Based Approaches ........................................................................... 38 Trauma Informed Approaches ..................................................................... 39 An Inventory of Aboriginal, First Nations and Métis Mental Health and Addictions Services in the NE LHIN ................................................................ 41 Gaps in the Aboriginal Mental Health and Addictions Service System ....... 46 Lack of a Comprehensive Mental Health and Addictions Infrastructure .......... 46 Transportation ................................................................................................. 47 Northern Realities ............................................................................................ 47 Interjurisdictional Barriers ................................................................................ 47 Lack of a Comprehensive, Evidence Base and Data Sets to Inform Service Planning .......................................................................................................... 48 Health Human Resource Gaps ........................................................................ 49 Cultural Safety in Mental Health and Addictions Services for Aboriginal People ........................................................................................................................ 49 Access and Linkages with Primary Care ......................................................... 50 Service Gaps in the Continuum of Care .......................................................... 50 Psychiatry Services ......................................................................................... 51 Need for respite care ....................................................................................... 51 Relapse Prevention Support ........................................................................... 51 Supportive and Transitional Housing ............................................................... 53 Prescription Drug Abuse, Concurrent Disorders and Dual Diagnosis .............. 53 Withdrawal Management ................................................................................. 53 Methadone Treatment, Linkages, Supports and Aftercare .............................. 54 Alternatives to Pain Management .................................................................... 54 Crisis Response Services ............................................................................... 54 Children‘s and Youth Mental Health and Addictions Treatment and Services . 55 Formal Coordination, Case Management and Linkages to Other Services and Sectors ............................................................................................................ 56 Traditional Aboriginal Healing Services ........................................................... 56 Culturally Safe Mental Health and Addictions Assessment Tools and Processes ....................................................................................................... 57 Context to the Recommendations ................................................................... 58 How Can Approaches to Aboriginal Mental Health and Addictions be Enhanced or Strengthened? ........................................................................... 58 Framework Principles ...................................................................................... 60 Recommendations for an Aboriginal Mental Health and Addictions Framework ......................................................................................................... 61 1.0 Recommendations Related to Improved Integration of Services ............... 61 2.0 Recommendations Related to the Strengthening of the Regional, Community and Systems Foundations for Effective Services ......................... 74 References ........................................................................................................ 84 NE LHIN Aboriginal First Nations Métis Mental Health and Addictions Framework Appendix A: An Inventory of Aboriginal Mental Health & Addictions Programs & Services in the NE LHIN .............................................................. 88 Appendix B: The OFIFC “Good Mind” Strategy & “Leaders for Change” 143 NE LHIN Aboriginal First Nations Métis Mental Health and Addictions Framework Executive Summary In 2009, the NE LHIN published its 2010-2013 Integrated Health Services Plan IHSP). Major priorities identified in the IHSP included Aboriginal First Nations and Métis Health Services as well as Mental Health and Addictions Services. Subsequently in 2010 the NE LHIN initiated the development of an Aboriginal, First Nations and Métis Mental Health and Addiction Framework Strategy to provide direction for improving the access to and the quality of mental health and addiction services for Aboriginal, First Nation and Métis people across the lifespan. Although there are considerable deficits in Aboriginal mental health and addictions data, there are significant health inequities making the need for this framework compelling: Mental health issues are more common in northern Ontario but fewer people have access to mental health services. Ontario‘s recent 10 Year Mental Health and Addictions Strategy and the Select Committee on Mental Health and Addictions have identified significant gaps in the mental health and addictions services sector and called for a core basket of services among many other improvements. But Aboriginal people face additional challenges. The Aboriginal population in the NE LHIN is estimated to be 55,172 people, approximately 10% of the total population. Compared with the general population, Aboriginal people rate their health less frequently as excellent or very good (66.1 % versus 75.1 %); report higher rates of excessive alcohol use (23.3 % versus16.3 %); higher rates of prescription and illicit drug use; and the negative multi generational mental health effects of residential school attendance touch the lives of many. Furthermore, there are significant inequalities in the social determinants of health: The unemployment rate for First Nations people in the NE LHIN is double