Ka Malu a Wa'ahila: Cultivating cultural safety for Native Hawaiian students in university behavioral health.

Ka Malu a Wa'ahila, an Indigenous-centered and student-informed program, was established in 2022 to meet the growing behavioral health needs of Native Hawaiian college students at the University of Hawai'i at Manoa. Utilizing a cultural safety foundation and relying on the wisdom of community voices articulated by the Pilinaha framework, clinicians provide prevention, direct intervention, and outreach services. As the program continues to evolve, future plans include expanding to other Pacific Islanders and developing an additional layer of systemic change through building an Indigenous behavioral health training pathway and training curriculum for clinicians serving Native Hawaiian and Pacific Islander (NHPI) communities.

Inuit youth health and wellbeing programming in Canada.

Inuit youth face challenges in maintaining their wellbeing, stemming from continued impacts of colonisation. Recent work documented that urban centres, such as Winnipeg Canada, have large Inuit populations comprised of a high proportion of youth. However, youth lack culturally appropriate health and wellbeing services. This review aimed to scan peer-reviewed and grey literature on Inuit youth health and wellbeing programming in Canada. This review is to serve as an initial phase in the development of Inuit-centric youth programming for the Qanuinngitsiarutiksait program of research. Findings will support further work of this program of research, including the development of culturally congruent Inuit-youth centric programming in Winnipeg. We conducted an environmental scan and used an assessment criteria to assess the effectiveness of the identified programs. Results showed that identified programs had Inuit involvement in creation framing programming through Inuit knowledge and mostly informed by the culture as treatment approach. Evaluation of programs was diffcult to locate, and it was hard to discren between programming, pilots or explorative studies. Despite the growing urban population, more non-urban programming was found. Overall, research contributes to the development of effective strategies to enhance the health and wellbeing of Inuit youth living in Canada.

Climate change and Indigenous mental health in Australia: In the aftermath of the defeat of the Voice referendum.

INTRODUCTION: This manuscript delves into the intricate connection between climate change and Indigenous mental health in Australia, with a focus on the aftermath of the defeat of the 'Voice' referendum. Climate change, recognized for its broad impact on mental health determinants, poses heightened risks to vulnerable communities, including Indigenous populations. The defeat of 'The Voice' referendum adds complexity, highlighting concerns about the lack of meaningful rights for the First Peoples of Australia. The bushfires further underscore ecological consequences, affecting Indigenous ecosystems and intensifying existing environmental challenges. Climate change exacerbates existing health challenges for Indigenous peoples, introducing new issues like ecological sorrow and anxiety. METHODOLOGY: The manuscript advocates for prioritized research in Indigenous communities to explore the link between climate change and mental health. It emphasizes interdisciplinary and collaborative research, giving voice to those directly affected by climate change. The lack of trust between Indigenous populations and authorities, along with the implications on self-determination, is crucial research focus. RESULTS: Renewable energy emerges as a potential solution deeply ingrained in Indigenous practices. The manuscript discusses challenges in achieving eco-friendly resettlement, emphasizing collaboration difficulties between the government and remote communities. The indigenous worldview, with its interconnectedness, is crucial for sustainable strategies. DISCUSSION AND FUTURE DIRECTIONS: Indigenous perspectives on planetary health are crucial, emphasizing the importance of Indigenous knowledge in shaping effective climate policies. The manuscript stresses dialogues between policymakers and Indigenous elders for formulating respectful land laws. It calls for global attention to the role of Indigenous peoples as biodiversity caretakers and urges recognition of their knowledge in climate change. Future directions include data collection for ecosystem protection, improving mental health outcomes post-climate events, and supporting impacted communities. Mental health care approaches in remote communities and practitioner training for climate-related issues are emphasized. The manuscript calls for increased funding for interdisciplinary research to understand the long-term impact of climate change on mental health, especially among vulnerable populations.

Therapeutic Effects of Ceremonial Ayahuasca Use for Methamphetamine Use Disorders and Other Mental Health Challenges: Case Studies in an Indigenous Community in Sonora, Mexico.

This paper describes three case studies from an outpatient intercultural therapeutic program founded and run by Yaqui health professionals and traditional healers to serve members of the Yaqui tribe residing in Sonora, Mexico. This pilot therapeutic program has been designed specifically for Indigenous individuals, incorporating the ceremonial use of naturally derived psychedelics in addressing substance use disorders and other mental health issues. The program employs a community-based approach, integrating various traditional Indigenous healing practices like the sweatlodge (temazcal), medicinal plant preparations, and the ritualistic use of selected psychedelics from natural sources (such as ayahuasca, peyote, and secretions from Incilius alvarius). These approaches are complemented by culturally attuned group and individual psychotherapy sessions, as well as group sports, community meals, collaborative construction efforts for a permanent clinical infrastructure, and cultural engagements such as art, crafts, and collective music. To evaluate the program's efficacy, safety, and cultural implications, an ongoing observational study is being conducted by an international team of researchers. The preliminary results demonstrate therapeutic progress and improved psychometric outcomes observed in the three case studies presented, indicating promise for this intercultural therapeutic intervention.

A model of care for attention deficit and hyperactivity disorder among adults in the community.

OBJECTIVE: To describe the process of collaborative, contextualised development and implementation of a model of care for adults with symptoms suggestive of attention deficit and hyperactivity disorder in an Aboriginal community-controlled health service. CONCLUSION: The current article describes an attempt to reduce unmet mental health needs through a systemic approach within a well-established Indigenous community-controlled organisation.

Grounding Wellness: Coloniality, Placeism, Land, and a Critique of "Social" Determinants of Indigenous Mental Health in the Canadian Context.

Authored by a small team of settler and Indigenous researchers, all of whom are deeply involved in scholarship and activism interrogating ongoing processes of coloniality in lands now known to many as Canada, this paper critically examines "social" and grounded determinants of Indigenous mental health and wellness. After placing ourselves on the grounds from which we write, we begin by providing an overview of the social determinants of health (SDOH), a conceptual framework with deep roots in colonial Canada. Though important in pushing against biomedical framings of Indigenous health and wellness, we argue that the SDOH framework nevertheless risks re-entrenching deeply colonial ways of thinking about and providing health services for Indigenous people: SDOH, we suggest, do not ultimately reckon with ecological, environmental, place-based, or geographic determinants of health in colonial states that continue to occupy stolen land. These theoretical interrogations of SDOH provide an entry point to, first, an overview of Indigenous ways of understanding mental wellness as tethered to ecology and physical geography, and second, a collection of narrative articulations from across British Columbia: these sets of knowledge offer clear and unequivocal evidence, in the form of Indigenous voices and perspectives, about the direct link between land, place, and mental wellness (or a lack thereof). We conclude with suggestions for future research, policy, and health practice actions that move beyond the current SDOH model of Indigenous health to account for and address the grounded, land-based, and ecologically self-determining nature of Indigenous mental health and wellness.

Victimization and Distress in Indigenous Maya Women: A Qualitative Investigation of Gender-Based Violence and Mental Health Outcomes in Rural Guatemala.

Purpose: There is currently scant research exploring Indigenous Guatemalan women's experiences of gender-based violence and mental health outcomes, but existing research suggests further exploration in this area is necessary. The current study aimed to address this gap by analyzing the experiences with violence and subsequent well-being of Indigenous Maya women in rural Guatemala. Methods: Data were collected in an ethnographic project on mental health in Panajachel, Guatemala, consisting of a cross-sectional survey on violence exposure and mental health history, followed by semi-structured interviews to elaborate on the experiences. Interviews with seven Kaqchikel Maya women who had been exposed to violence provided the qualitative basis for this study, supplemented by the survey results. Descriptive statistics of survey results and thematic analysis of interviews are presented. Results: The survey results pointed to a deep relationship between violence victimization and mental health issues. Recurring themes in the interviews included symptoms of post-violence emotional distress including fear, sadness, physical ailments, and suicidal ideation; the role of the women as mothers; lack of legal and mental health support; and the importance of spirituality and religion. Conclusions: These results highlight the importance of examining emotional distress as separate from diagnostic psychiatric disorders in addressing women's mental health post-violence. This exploratory study provides examples of violence exposure, mental health, and resource availability among Guatemalan Maya women and suggests possibilities for future investigation.

Cultural adaptation considerations of a comprehensive housing outreach program for indigenous youth exiting homelessness.

Generalist health interventions that aim to reduce chronic health disparities between Indigenous and non-Indigenous populations can be culturally adapted to better meet the needs of Indigenous people in Canada; however, little is known regarding best practices in implementing these adaptations. The present study first provides a review of the research process used to adapt a previous evidence-based housing initiative for Indigenous youth in Northwestern Ontario. Second, it includes an overview of the adaptations that were made and the associated rationale for such adaptations. Third, it examines the experiences of participants and staff involved in the cultural adaptation of the Housing Outreach Program Collaborative (HOP-C), a health intervention re-designed to improve physical and mental health outcomes, wellbeing, and social support for formerly homeless Indigenous youth as they secure housing. Qualitative feedback from interviews with 15 participants and eight program staff, in addition to one focus group with an additional six frontline workers, described perceived outcomes of the program's cultural adaptations. Modifications to the overall program structure, specific roles within the program (including counseling services, peer mentorship, cultural services, and case management), and adaptations to general implementation within the health organization providing the intervention were described by participants and staff as effective and helpful adaptations. The focus of Indigenous values at an organizational level led to consistent adaptations in counseling and case management to best meet the unique needs of the youth involved. Based upon participant interviews, recommendations to future adaptations are provided.

Exploring Mental Health and Holistic Healing through the Life Stories of Indigenous Youth Who Have Experienced Homelessness.

Indigenous youth are the fastest growing population in Canada, yet are marked by profound and disproportionate personal, societal, political, and colonial barriers that predispose them to mental health challenges, employment and educational barriers, and experiences of housing insecurity and homelessness. It is only from the perspectives and experiences of Indigenous community members themselves that we can gain appropriate insights into effective supports, meaningful interventions, and accessible pathways to security. This paper will explore the mental health of Indigenous youth who are at risk of, or who have experienced, homelessness, as well as the lifelong perspectives, teachings, and guidance from Indigenous Elders and traditional knowledge keepers; their perspectives are weaved throughout, in order to provide a more effective means to addressing holistic healing and the mental health needs of Indigenous homeless youth. As educators, researchers and clinicians who have sought to understand this issue in more depth, our analysis aims to raise awareness about the complexities of Indigenous youth homelessness and push back against systemic barriers that contribute to homelessness, fail young people, and subject them to oppression. We also offer recommendations from a clinical perspective in order for clinicians, researchers and those working within communities to serve our Indigenous youth with a diverse set of methods that are tailored and ethical in their approach.

The Health Effects of a Cherokee Grounded Culture and Leadership Program.

INTRODUCTION: Indigenous youth and young adults endure some of the highest rates of physical and mental health problems in the United States compared to their non-Indigenous counterparts. Colonization, oppression, and discrimination play a substantial role in these inequitable disease rates. However, culture (e.g., identity, participation, and connection) relates to the prevention of and recovery from illness in Indigenous populations. The Remember the Removal program aims to teach Indigenous youth and young adults tribally specific culture, history, and language to put them on a trajectory to become informed and culturally connected community leaders. We examined the program's effects on health. METHOD: Thirty Remember the Removal program participants, mainly young adults, completed surveys four times: before the program's start, at the end of the training period, at the program's end, and at a six-month follow-up. Various indicators of physical, mental, spiritual, and cultural health and well-being were measured at each time period. Paired t-tests were completed to compare baseline scores to each subsequent time interval. RESULTS: At program completion, and as indicated with an asterisk at the six month follow-up, participants had statistically significantly improved diet and exercise measures (e.g., reduced sugary, salty, and fatty foods, reduced soda consumption, increased fruit consumption, and improved self-efficacy for exercise), improved mental health indicators (e.g., reduced stress, anxiety, depression*, anger*, post-traumatic stress disorder, and microaggressions*, and improved positive mental health) and improved social and cultural connection (e.g., social support, Cherokee identity*, Cherokee values). DISCUSSION: This is one of the first quantitative studies to demonstrate the profound effects that cultural learning and connection have on the health and well-being of Indigenous people and practices. It also demonstrates the specificity and effectiveness of a program created by and for tribal citizens. Future programs with Indigenous populations should work to center cultural connection and ensure that programs are created and directed by tribal community members.

Predictors of Land-Based Activity Participation in a National Representative Sample of Indigenous Individuals Living Off-Reserve.

This study examined data from the 2017 Aboriginal Peoples Survey to consider predictors of land-based activity engagement. We hypothesized that higher self-reported mental and physical health scores, an increased sense of cultural belonging, living in a rural community, and no prior individual or family history of residential school attendance would predict a higher frequency of land-based activity engagement among First Nations individuals living off-reserve. Results from linear regression analyses suggested that an increased sense of cultural belonging, being male, and living in a rural community with a population of less than 1000 people were significant predictors of the frequency of land-based activity engagement. With these preliminary findings, further research can explore how physical and mental health outcomes influence the frequency of land-based activity engagement, in addition to how community-specific indicators may promote higher frequency of these activities, particularly among First Nations individuals living off-reserve.

Reclaiming Land, Identity and Mental Wellness in Biigtigong Nishnaabeg Territory.

Indigenous peoples globally are pursuing diverse strategies to foster mental, emotional, and spiritual wellness by reclaiming and restoring their relationships to land. For Anishinaabe communities, the land is the source of local knowledge systems that sustain identities and foster mino-bimaadiziwin, that is, living in a good and healthy way. In July 2019, the community of Biigtigong Nishnaabeg in Ontario, Canada hosted a week-long land camp to reclaim Mountain Lake and reconnect Elders, youth and band staff to the land, history, and relationships of this place. Framed theoretically by environmental repossession, we explore the perceptions of 15 participating community members and examine local and intergenerational meanings of the camp for mental wellness. The findings show that the Mountain Lake camp strengthened social relationships, supported the sharing and practice of Anishinaabe knowledge, and fostered community pride in ways that reinforced the community's Anishinaabe identity. By exploring the links between land reclamation, identity, and community empowerment, we suggest environmental repossession as a useful concept for understanding how land reconnection and self-determination can support Indigenous mental wellness.

Identifying priorities, directions and a vision for Indigenous mental health using a collaborative and consensus-based facilitation approach.

BACKGROUND: Mental health disparities between Indigenous and non-Indigenous people in Canada are related to underlying economic, social, and political inequities that are legacies of colonization and the oppression of Indigenous cultures. It also widely acknowledged that mental health services currently available may not be culturally appropriate in supporting the health needs of Indigenous Canadians. A two-day Indigenous mental health forum examined mental health needs and gaps among Indigenous communities across the Regional Municipality of Wood Buffalo (RMWB) on Treaty 8 territory, in northern Alberta, Canada. This paper outlines the insights generated by stakeholder engagement at the forum to identify and prioritize directions for Indigenous mental health and build a vision and strategy for improving mental health services and programs for the region's diverse Indigenous population. METHODS: We applied a modified nominal group technique (NGT) consensus method embedded within Indigenous knowledge to determine key priorities and directions for Indigenous-focused mental health and synthesize information from discussions that occurred at the forum. Following the NGT, a participatory community visioning exercise was conducted with participants to develop a vision, guiding principles, and components of an action plan for an Indigenous mental health strategy for the RMWB. RESULTS: Four key themes for setting priorities and directions for Indigenous mental health emerged from roundtable group discussions: 1) understand the realities of mental health experiences for Indigenous peoples, 2) design a holistic and culturally rooted mental health system, 3) foster cross-sectoral engagement and collaboration on mental health service delivery, and 4) focus on children and youth. The community visioning exercise helped stakeholders to visualize a direction or path forward for addressing existing gaps in the mental health system and opportunities for strengthening Indigenous mental health in the region. CONCLUSIONS: Forum participants described mental health and well-being around holistic concepts of social and emotional well-being. Addressing Indigenous mental health and wellness involves multi-sectoral action in various settings including community and school through programs, policies, and other interventions that promote mental health for all Indigenous peoples, as well as for those at greater risk such as children and youth.

How did Nunavummiut youth cope during the COVID-19 pandemic? A qualitative exploration of the resilience of Inuit youth leaders involved in the I-SPARX project.

This study investigated how COVID-19 has affected the wellness of a group of Inuit youth leaders in Nunavut in the context of their involvement with an ongoing mental health research initiative, the Making I-SPARX Fly in Nunavut [I-SPARX] project. The study had three goals: (1) to understand how the pandemic has affected I-SPARX leaders' perceived involvement in the I-SPARX Project; (2) to build knowledge around how the pandemic has impacted the daily life and wellbeing of youth in Nunavummiut communities; and (3) to acquire a culturally specific understanding of their coping mechanisms and resilience strategies through the lens of Inuit Qaujimajatuqangit (IQ). Nine Inuit youth were interviewed virtually about their participation in I-SPARX, their life during the pandemic, and their coping strategies. Their comments were analysed using inductive thematic analysis. Pandemic challenges, the utility of I-SPARX teachings and participation, and culturally and community-embedded pathways to resilience were discussed.The implications of COVID-19 on Inuit youth in remote communities are not fully understood. The current study illuminates their experiences of the pandemic to inform future research on ways in which Inuit youth might be supported in situations, such as a global pandemic, that restrict their traditional resilience-enhancing activities and create social isolation.

Suicidal ideation in an ethnically mixed, highland Guatemalan community.

Reported suicide rates in Latin America remain low, but there is evidence to suggest they may be increasing, particularly among indigenous populations. To better understand who may be at risk for suicide, we examined the prevalence of suicidal ideation and explored factors contributing to suicidal thoughts in an ethnically mixed, highland Guatemalan community. The data presented in this article are from a mixed methods ethnographic field project conducted over 15 months from 2010 to 2011 in Panajachel, Guatemala. We surveyed a random sample of 350 community members. Survey questions included standardized modules from the Mini-International Neuropsychiatric Interview, as well as questions on experiences of violence and mental health care. We also conducted semi-structured interviews with 13 self-selected survey participants with current suicidal ideation. These interviews included questions regarding survey responses, experiences of mental illness, and access to mental health care. A total of 55 survey participants (N = 350; 15.7%) scored positive for suicidality. Ethnic identity, gender, psychiatric illness, and experiences of violence were all correlated to suicidal ideation. Qualitative interview data highlight distinctions between genders within prominent themes of religion, family, experiences of violence, and seeking resources. Three key findings emerged from our research that are relevant to the literature: 1) ethnic identity may be both a critical risk and a protective factor for suicide in some indigenous people; 2) intersections between violence and gender highlight different patterns in suicidal ideation; and 3) high rates of suicidal ideation and other psychiatric comorbidities underscore the need for greater access to mental health services.

Recounting coup as the recirculation of Indigenous vitality: A narrative alternative to historical trauma.

Contemporary American Indians suffer from disproportionately high degrees of psychiatric distress. Mental health researchers and professionals, as well as American Indian community members, have consistently associated these disproportionate rates of distress with Indigenous historical experiences of European and Euro-American colonization. This emphasis on the impact of colonization and associated historical consciousness within tribal communities has occasioned increasingly widespread professional consideration of historical trauma among Indigenous peoples. In contrast to personal experiences of a traumatic nature, the discourse of Indigenous historical trauma (IHT) weds the concepts of "historical oppression" and "psychological trauma" to explain community-wide risk for adverse mental health outcomes originating from the depredations of past colonial subjugation through intergenerational transmission of vulnerability and risk. Long before the emergence of accounts of IHT, however, many American Indian communities prized a markedly different form of narrative: the coup tale. By way of illustration, I explore various historical functions of this speech genre by focusing on Aaniiih-Gros Ventre war narratives, including their role in conveying vitality or life. By virtue of their recognition and celebration of agency, mastery, and vitality, Aaniiih war stories functioned as the discursive antithesis of IHT. Through comparative consideration of the coup tale and the trauma narrative, I propose an alternative framework for cultivating Indigenous community "survivance" rather than vulnerability based on these divergent discursive practices.

A community-led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders.

OBJECTIVE: To generate outcomes for the development of a culturally appropriate mental health treatment model for Indigenous Australians with depression. METHODS: Three focus group sessions and two semi-structured interviews were undertaken over six months across regional and rural locations in South West Queensland. Data were transcribed verbatim and coded using manual thematic analyses. Transcripts were thematically analysed and substantiated. Findings were presented back to participants for authenticity and verification. RESULTS: Three focus group discussions (n=24), and two interviews with Elders (n=2) were conducted, from which six themes were generated. The most common themes from the focus groups included Indigenous autonomy, wellbeing and identity. The three most common themes from the Elder interviews included culture retention and connection to Country, cultural spiritual beliefs embedded in the mental health system, and autonomy over funding decisions. CONCLUSIONS: A treatment model for depression must include concepts of Indigenous autonomy, identity and wellbeing. Further, treatment approaches need to incorporate Indigenous social and emotional wellbeing concepts alongside clinical treatment approaches. Implications for public health: Any systematic approach to address the social and cultural wellbeing of Indigenous peoples must have a community-led design and delivery.

RISING SUN: Prioritized Outcomes for Suicide Prevention in the Arctic.

The Arctic Council, a collaborative forum among governments and Arctic communities, has highlighted the problem of suicide and potential solutions. The mental health initiative during the United States chairmanship, Reducing the Incidence of Suicide in Indigenous Groups: Strengths United Through Networks (RISING SUN), used a Delphi methodology complemented by face-to-face stakeholder discussions to identify outcomes to evaluate suicide prevention interventions. RISING SUN underscored that multilevel suicide prevention initiatives require mobilizing resources and enacting policies that promote the capacity for wellness, for example, by reducing adverse childhood experiences, increasing social equity, and mitigating the effects of colonization and poverty.

Decoloniality as a Framework for Indigenous Youth Suicide Prevention Pedagogy: Promoting Community Conversations About Research to End Suicide.

Indigenous youth suicide remains a substantial health disparity in circumpolar communities, despite prevention efforts through primary health care, public health campaigns, school systems, and social services. Innovations in prevention practice move away from expert-driven approaches to emphasize local control through processes that utilize research evidence, but privilege self- determined action based on local and personal contexts, meanings, and frameworks for action. "Promoting Community Conversations About Research to End Suicide" is a community health intervention that draws on networks of Indigenous health educators in rural Alaska, who host learning circles in which research evidence is used to spark conversations and empower community members to consider individual and collective action to support vulnerable people and create health-promoting conditions that reduce suicide risk. The first of nine learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. We describe the theoretical framework and feasibility and acceptability outcomes for this learning circle, and elucidate how the educational model engages community members in decolonial approaches to suicide prevention education and practice, thus serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing.

"You didn't just consult community, you involved us": transformation of a 'top-down' Aboriginal mental health project into a 'bottom-up' community-driven process.

OBJECTIVE: Recently, there has been a consistent call for Indigenous health research to be community-driven. However, for a variety of reasons, many projects, such as the one featured here, start as 'top-down'. Using ten accepted principles for Aboriginal health research, the present article illustrates how a top-down project can be transformed into a 'bottom-up' community-driven project. METHOD: A table of examples is provided to show how the ten principles were translated into practice to create a bottom-up process. RESULTS: We suggest that key elements for creating a bottom-up process are iterative conversations and community involvement that goes beyond notional engagement. A feature of community involvement is generating and sustaining ongoing conversations with multiple levels of community (organisations, health professionals, Elders, community members, project-specific groups) in a variety of different forums across the entire duration of a project. Local research teams, a commitment to building capacity in the local Indigenous workforce, and adequate timelines and funding are other factors that we hypothesise may contribute to successful outcomes. CONCLUSION: The article contributes to a much-needed evidence base demonstrating how appropriate structures and strategies may create bottom-up processes leading to successful outcomes.