Promoting mental health and preventing suicide in Inuit youth: the importance of building partnerships in an empowerment perspective

Transcription

1 Promoting mental health and preventing suicide in Inuit youth: the importance of building partnerships in an empowerment perspective Georgia Vrakas, Center for Research and Intervention on Suicide and Euthanasia Louise Fournier, CRCHUM, INSPQ, University of Montreal Sore Moller & Robert Levy Powell, Kativik School Board, Nunavik Jessie Mesher, Saputiit Youth Association, Nunavik Jessica Tooma, Kuujjuaq Youth Committee, Nunavik

2 PRESENTATION OUTLINE Presentation of Nunavik Research objectives Mental health and suicide in Nunavik Proposed methods Proposed results presentation and discussion Building Partnerships Questions? XXV IASP Congress

3 PRESENTATION OF NUNAVIK Nunavik, «the place to live» in Inuktitut Nunavimmiut Description of the population residents 90 % are Inuit Predominance of youth 42 % < 18 years old versus 21 % for Quebec In the past: nomadic people Colonization and its impacts Sedentary living for approximately the past 60 years, causing a rupture of the traditional way of life; important socio cultural, economic and environmental effects Traditions and lifestyles radical changes Identity discontinuity in the roles of the youth XXV IASP Congress

4 PRESENTATION OF NUNAVIK XXV IASP Congress

5 NUNAVIMMIUT CONCEPTS OF MENTAL HEALTH What is mental health for the Nunavimmiut? No Inuktitut term for mental health (nor for mental illness); «not being well» in terms of one s thoughts, a state a person is in characteristic attached to one s identity Kirmayer et al., 1997 Definition of mental wellness : «self esteem and personal dignity flowing from harmonious physical, emotional, mental and spiritual wellness and cultural identity» (Inuit Tapirisit of Canada, 2001: 7) Young & Robitaille, 2009 XXV IASP Congress

6 RESEARCH OBJECTIVES 1. Understand Nunavimmiut youth s concepts of mental wellness and their mental wellness needs 2. Analyse youth mental health promotion and prevention strategies currently offered to them in Nunavik in relation to their mental wellness needs 3. Collectively propose recommendations to improve these mental health promotion and prevention strategies based on Nunavimmiut youth s concepts of mental wellness and their mental wellness needs XXV IASP Congress

7 MENTAL HEALTH AND SUICIDE Mental health and wellness problems (Kirmayer, 2008) Psychological distress: 13 % of people aged 15 years and over : high levels of distress possibly indicating the presence of depression or other problems; highest levels of distress in 15 to 29 year olds Psychological distress associated with: alcohol and drug consumption, a history of sexual abuse and being exposed to domestic violence Psychosocial problems: gambling, physical and sexual violence Origins of high rates of mental health problems: cultural oppression of Indigenous peoples via forced assimilation policies (Kirmayer, 2003) XXV IASP Congress

8 MENTAL HEALTH AND SUICIDE Suicide rates per residents ( /2006) ans Total Nunavik Québec If the population of mainland Canada [ ] had suicide rates comparable to [that of its ] Inuit population, national emergencies would be declared. (Upaluk Poppel 2005 in Hicks 2007) XXV IASP Congress

9 MENTAL HEALTH PROMOTION AND PREVENTION Mental health promotion acts on the determinants of health and aims at improving individuals and communities wellness by developing protective factors (Blanchet et al., 1992); conceptualizes mental health in positive terms; involves implementing effective programs aimed at reducing health inequalities by using collaborative and participatory methods which increase empowerment of people and communities (Jané Llopis et al., 2005) Mental health prevention acts on risk factors in order to decrease the incidence of mental health problems (Blanchet et al., 1992) XXV IASP Congress

10 EMPOWERMENT AND HEALTH PROMOTION Empowerment is : An ideology change in the «illness» model towards model based on health, well being and strengths where people are active participants in maintaining their health A process permitting individuals, organisations and communities to increase control over their lives and situations An outcome subjective lived experience (e.g., a feeling of perceived control in a person) and objective realties (e.g., better access to community resources) Community member s engagement: positive impact on health promotion (Keleher, et al., 2007) & improves programs capacities to better understand and meet the needs of the community (Jané Llopis and Barry, 2005). XXV IASP Congress

11 PROPOSED METHODS Community based participatory research (Minkler et Wallerstein, 2003) o o o is in itself an empowerment process, permitting individuals, organisations and communities to increase control over their lives and situations and building capacity to address present and future health issues researchers and community partners collaborate and work together throughout the entire research process and contribute equitably in the various stages of the project (e.g., meetings to collectively write the Research Agreement) increases community participation and engagement (Macaulay et al., 1999) XXV IASP Congress

12 PROPOSED METHODS Research partners: Kativik School Board, Saputiit Youth Association, Kuujjuaq Youth Committee Collaborators: Kuujjuaq Youth Center, Health and Social Services Center, Health Center s Mental Health Development Team, community mental wellness worker OCAP: Ownership, Control, Access and Possession principles regarding the collected data. The OCAP principles are a way to ensure that First Nations, Inuit and Métis decide the type of research involving them that can be conducted, for what purpose the collected data will be used, where this data will be stored and who will have access to it. First Nations Centre of the National Aboriginal Health (April 2007). XXV IASP Congress

13 PROPOSED METHODS Participatory rural appraisal (PRA): a group of methods influenced by Freire s work consistent with empowerment education, enabling people to identify their community s problems, analyze their situations and propose actions in order to implement changes Photovoice: is a research strategy that uses photography as a tool for social change. It is a process that gives people the opportunity to record, reflect and critique personal and community issues in a creative way. Photovoice Hamilton (2007) XXV IASP Congress

14 PROPOSED METHODS Photovoice youth participants 10 sessions 1. Youth in high school: different grade levels in 4 schools (2 in Hudson Bay; 2 in Ungava Bay); support from KSB and the schools. 2. Youth not in school: ages may vary between 12 to 25 years; one group of youth who are not in school will be recruited in Kuujjuaq. What is mental wellness for you? : group discussions & individual interviews Photovoice training will be provided for Photovoice facilitators (e.g., student counsellors, youth workers, teachers, etc.) Research assistant (RA) hired and trained from the community XXV IASP Congress

15 PROPOSED METHODS Analysing existing youth mental health promotion and prevention strategies: o o Documentary analysis of the youth mental health promotion and prevention programs, including suicide prevention, currently offered to youth in Nunavik will be carried out Individual interviews with key decision makers who have developed/implemented such programs, in the villages were the Photovoice projects will take place, will be conducted. XXV IASP Congress

16 PROPOSED RESULTS PRESENTATION & DISCUSSION Workshop with partners and collaborators to present and discuss results with the help of one or two youth, specifically: the youth s concepts of mental wellness and their mental wellness needs; the analysis of existing mental health promotion and prevention strategies in Nunavik; recommendations formulated by the youth in order to improve their mental wellness, including suicide prevention, strategies Youth Conference in Kuujjuaq: goals will be to discuss and reflect upon the issues and the solutions which emerged from the research with youth, adults, elders, practionners, community workers and decision makers. XXV IASP Congress

17 BUILDING PARTNERSHIPS Certain challenges Work in progress Time Distance Building trust Fear of project being abandoned Negative past experiences with researchers Cultural differences Communication between organisations XXV IASP Congress

18 BUILDING PARTNERSHIPS Importance of partnerships and their benefits Community based participatory research Building trust Capacity building and empowerment Shared power between partners Researcher as facilitator Continuation after end of research XXV IASP Congress

19 Questions? Thanks! Information: Georgia Vrakas XXV IASP Congress