'We need to not be footnotes anymore': understanding Métis people's experiences with mental health and wellness in British Columbia, Canada.

OBJECTIVES: This article aims to contribute to an increased understanding of Métis people's experiences with respect to mental health and wellness through sharing the perspectives, journeys and needs of Métis people in British Columbia (BC), Canada. STUDY DESIGN: This research utilized qualitative methods, within an Indigenous research paradigm, as a formative approach to understanding Métis people's experiences with mental health. METHODS: Participants were recruited in partnership with Métis communities and urban Indigenous organizations, through the distribution of online and hard copy posters. Semistructured, conversational interviews were conducted with 33 Métis participants, including 23 women and 10 men, aged 19-84 years (average = 46 years). Data were thematically analyzed using constant comparison analysis. RESULTS: Mental health was recognized as a priority for Métis people in BC, as participants emphasized the importance of addressing mental health disparities for Métis people, and the inequities in which they are rooted. They also spoke about a need for increased access to culturally responsive health care-spanning both Western and traditional systems. CONCLUSIONS: Increased research is needed to highlight and understand the experiences of Métis people, both within BC and across Canada, to help to reshape the health-care system to become more inclusive of and responsive to Métis needs.

A Feasibility Trial of Mental Health First Aid First Nations: Acceptability, Cultural Adaptation, and Preliminary Outcomes.

The Mental Health First Aid First Nations course was adapted from Mental Health First Aid Basic to create a community-based, culturally safe and relevant approach to promoting mental health literacy in First Nations contexts. Over 2.5 days, the course aims to build community capacity by teaching individuals to recognize and respond to mental health crises. This feasibility trial utilized mixed methods to evaluate the acceptability, cultural adaptation, and preliminary effectiveness of MHFAFN. Our approach was grounded in community-based participatory research principles, emphasizing relationship-driven procedures to collecting data and choice for how participants shared their voices. Data included participant interviews (n = 89), and surveys (n = 91) from 10 groups in four provinces. Surveys contained open-ended questions, retrospective pre-post ratings, and a scenario. We utilized data from nine facilitator interviews and 24 facilitator implementation surveys. The different lines of evidence converged to highlight strong acceptability, mixed reactions to the cultural adaptation, and gains in participants' knowledge, mental health first aid skill application, awareness, and self-efficacy, and reductions in stigma beliefs. Beyond promoting individual gains, the course served as a community-wide prevention approach by situating mental health in a colonial context and highlighting local resources and cultural strengths for promoting mental well-being.

"I'm still not over feeling so isolated": Métis women, Two-Spirit, and gender-diverse people's experiences of the COVID-19 pandemic.

OBJECTIVES: The aim of this study was to explore and learn from the experiences of Métis women, Two-Spirit, and gender-diverse people accessing health and social services in Victoria, British Columbia, during the COVID-19 pandemic. METHODS: This paper comes from a larger study exploring Métis women, Two-Spirit, and gender-diverse people's experiences accessing health and social services in Victoria. Using a by-and-for Métis approach that employed a conversational interview method, we conducted interviews with Métis women, Two-Spirit, and gender-diverse people who lived in and/or accessed services in Victoria in December 2020 and January 2021. This paper focuses specifically on data addressing how COVID-19 impacted these participants. RESULTS: A total of 24 Métis women, Two-Spirit, and gender-diverse people participated in the study. Overall, three themes specific to COVID-19 were identified. First, participants described the detrimental impacts of COVID-19 on their ability to connect with their Métis community and practice their culture, as well as their overall feelings of isolation. Second, participants highlighted some of the ways that COVID-19 has exacerbated existing barriers to culturally safe healthcare. Last, participants spoke about the mixed economic impacts that COVID-19 has had for them, sharing insight into the ways in which gender, in particular, has shaped their financial instability. CONCLUSION: Improving access to culturally safe health and social services by incorporating the experiences and expertise of Métis women, Two-Spirit, and gender-diverse people is crucial to mitigating the disproportional negative impacts of the pandemic and improving overall health outcomes within Métis communities across Canada.

RéSUMé: OBJECTIFS: Explorer les expériences de femmes métisses et de personnes métisses bispirituelles et de diverses identités de genre ayant accédé aux services sociaux et de santé à Victoria (Colombie-Britannique) pendant la pandémie de COVID-19, et en tirer des leçons. MéTHODE: Cet article vient d'une vaste étude sur les expériences de femmes métisses et de personnes métisses bispirituelles et de diverses identités de genre ayant accédé aux services sociaux et de santé à Victoria. À l'aide d'une démarche par et pour les personnes métisses qui a fait appel à une méthode d'entrevue directe, nous avons mené des entrevues avec des femmes métisses et des personnes bispirituelles et de diverses identités de genre ayant vécu à Victoria en décembre 2020 et janvier 2021 et/ou accédé à des services dans cette ville durant cette période. Le présent article porte spécifiquement sur les données liées aux incidences de la COVID-19 chez ces personnes. RéSULTATS: En tout, 24 femmes et personnes métisses bispirituelles et de diverses identités de genre ont participé à l'étude. Dans l'ensemble, trois aspects relatifs à la COVID-19 sont ressortis des données. Premièrement, les personnes participantes ont décrit les effets préjudiciables de la COVID-19 sur leur capacité de rester en lien avec leur communauté métisse et de pratiquer leur culture, ainsi que leurs sentiments d'isolement en général. Deuxièmement, elles ont souligné certaines des façons dont la COVID-19 a exacerbé les barrières existantes à l'accès aux soins de santé culturellement sûrs. Enfin, les personnes participantes ont parlé des retombées économiques mitigées de la COVID-19 dans leur cas, et elles ont partagé leurs idées sur le rôle du genre, en particulier, dans leur instabilité financière. CONCLUSION: Pour atténuer les effets préjudiciables disproportionnés de la pandémie et améliorer les résultats cliniques globaux au sein des communautés métisses du Canada, il est essentiel d'améliorer l'accès aux services sociaux et de santé culturellement sûrs en y intégrant les expériences et le savoir-faire de femmes métisses et de personnes métisses bispirituelles et de diverses identités de genre.

'By identifying myself as Métis, I didn't feel safe ': Experiences of navigating racism and discrimination among Métis women, Two-Spirit and gender diverse community members in Victoria, Canada.

OBJECTIVE: Racism acts as a major barrier to accessing health services for Indigenous communities in Canada, often leading to delayed, avoided or lack of treatment altogether. The Métis population is uniquely positioned in urban settings, as they experience discrimination from both Indigenous and mainstream health and social services due to Canada's long colonial history that is ongoing. Yet, Métis are often left out of discussions regarding racism and health service access. This study explores the experiences of racism and health service access among Métis peoples in Victoria, British Columbia. METHODS: We allied a conversational interview method to explore and understand experiences of self-identifying Métis women, Two-Spirit and gender diverse people (n = 24) who access health and social services in Victoria. Data analysis followed Flicker and Nixon's six-stage DEPICT model. RESULTS: In this paper, we share the experiences of racism and discrimination of those who accessed health and social services in Victoria, British Columbia Such experiences include passing as White, experiencing racism following Métis identity disclosure and witnessing racism. Passing as White was viewed as a protective factor against discrimination as well as harming participants' sense of identity. Experiences of racism took the form of discriminatory comments, harassment and mistreatment, which influenced the willingness of disclosing Métis identity. Witnessing racism occurred in participants, personal and professional lives, negatively impacting them in indirect ways. Each experience of racism had a negative influence on participants' wellbeing and shaped their experience of accessing health and social services. CONCLUSIONS: Métis people confront racism and discrimination when attempting to access health and social services through first-hand experiences, witnessing and/or avoidance. While this study contributes to the all too often unacknowledged voices of Métis in Canada, there is a continued need for Métis-specific research to accurately inform policy and practice.

The essential role of cultural safety in developing culturally-relevant prevention programming in First Nations communities: Lessons learned from a national evaluation of Mental Health First Aid First Nations.

Mental Health First Aid is a population health approach that educates people to recognize and respond to mental health challenges. Since 2012, the Mental Health Commission of Canada has worked with six First Nations communities to develop a culturally-relevant version of the program called Mental Health First Aid First Nations (MHFAFN). This paper presents mixed methods, multi-informant data from a national evaluation to assess the extent to which the course was experienced as culturally safe by Indigenous participants, factors that contributed to these experiences, and ways in which cultural relevancy of MHFAFN can be improved. Our evaluation team conducted participant interviews and surveys, as well as facilitator interviews. Nearly all Indigenous participants (94.6%) experienced the course as safe. Participants and facilitators identified a range of factors that promoted cultural safety, including the knowledge and skills of the facilitators and the cultural components of the course. Participants that did not experience safety identified trauma-related factors and facilitation style. The findings suggest that MHFAFN may be situated in a way where shared cultural backgrounds are imperative to the success of the course. Further evaluation of the MHFAFN curriculum, with the goal of continual improvement, may help to further enhance participants' experiences in taking the course.

Moving toward holistic wellness, empowerment and self-determination for Indigenous peoples in Canada: Can traditional Indigenous health care practices increase ownership over health and health care decisions?

OBJECTIVES: This study aimed to understand the role that traditional Indigenous health care practices can play in increasing individual-level self-determination over health care and improving health outcomes for urban Indigenous peoples in Canada. METHODS: This project took place in Vancouver, British Columbia and included the creation and delivery of holistic workshops to engage community members (n = 35) in learning about aspects of traditional health care practices. Short-term and intermediate outcomes were discussed through two gatherings involving focus groups and surveys. Data were transcribed, reviewed, thematically analyzed, and presented to the working group for validation. RESULTS: When participants compared their experiences with traditional health care to western health care, they described barriers to care that they had experienced in accessing medical doctors (e.g., racism, mistrust), as well as the benefits of traditional healing (e.g., based on relationships, holistic approach). All participants also noted that they had increased ownership over their choices around, and access to, health care, inclusive of both western and traditional options. They stressed that increased access to traditional health care is crucial within urban settings. CONCLUSIONS: Self-determination within Indigenous urban communities, and on a smaller scale, ownership for individuals, is a key determinant of health for Indigenous individuals and communities; this was made clear through the analysis of the research findings and is also supported within the literature. This research also demonstrates that access to traditional healing can enhance ownership for community members. These findings emphasize that there is a continued and growing need for support to aid urban Indigenous peoples in accessing traditional health care supports.