Critical Analysis Paper

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Critical Analysis Paper Equity & Inclusion in Addictions and Mental Health ADMH 2000 – 0LB Samantha Ledamun N00672314 Shivon Raghunandan November 9 th , 2023

Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun Introduction Many factors can influence an individual or population’s health status. Environmental factors, including social, economic, and physical ones, have a significant influence on mental health and many mental health illnesses. Our access to proper healthcare services, income status, affordable housing, employment status, disability status, education status and gender are all social determinants of health (SdoH). All these factors can affect an individual's mental health status and one’s ability to access mental health services. When considering mental health as a SdoH, it is important to consider the Biopsychosocial model of Mental Health when working with individuals, especially those who are marginalized or groups who have been systemically discriminated against – such as Indigenous communities. For this critical analysis paper, I am choosing to focus on the opioid crisis in Canada, more specifically, in relation to Indigenous communities. Indigenous communities have been systemically discriminated against for generations since the start of the Indian Act 1876. Not to mention, being Indigenous is also a SdoH itself. The SdoH I will be focusing on for this paper is Race/Racism, as Indigenous Peoples in Canada are disproportionately affected by the drug overdose issue due to historical colonialism, racism, and intergenerational trauma. “ Structural racism keeps Aboriginal people in poverty; this must be addressed to improve health outcomes for these communities” (Canadian Medical Association, 2013, p.1). Lavalley et al. (2018) stated that in 2017, Canada had 4000 opioid- related deaths, and Indigenous peoples accounted for 10% of those overdose deaths. This is now seen in some Indigenous communities in Canada, as a state of emergency. 2

Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun Key Issues The article I found on Global News speaks about Treaty 6 First Nations in Alberta declaring a state of emergency over the rising opioid deaths. While this is quickly becoming a national crisis, Indigenous communities in western Canada are seen to have higher mortality rates for substance users using opioids, 5 times higher than for other drug users (The Canadian Press, 2023). Treaty 6 territory covers central Alberta and Saskatchewan spanning over 300,000 km. The article focuses on the opioid crisis that is affecting Treaty 6 First Nations and the lack of harm reduction services & funding available, which is supposed to be provided by the government. Treaty 6 is supposed to guarantee health care for Indigenous communities, and states that federal government must provide ongoing health care (Mertz & Meilleur, 2023). Indigenous life expectancy is decreasing due to the opioid crisis and the lack of harm reduction services. Alberta Health Services collected data that disclosed the life expectancy of Indigenous Albertans went from 71 years in 2017, to 63 years in 2021 (Mertz & Meilleur, 2023). This relates to race/racism as a social determinant of health (SdoH) as the federal and provincial governments are not seeing eye to eye with what the Grand Chief Leonard Standingontheroad is suggesting on how to handle this crisis. While certain levels of government do not believe in a harm reduction approach, Indigenous communities are requesting for Indigenous voices to be represented and be present at the table when making these decisions and plans. The community knows what is best for them when it comes to mental health and addiction support. According to the Confederacy of Treaty 6 First Nations, death rates have increased after 3

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Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun supervised consumption sites were shuttered, and 71 First Nations have declared an opioid crisis, but only 22 to 24 have received money. (Mertz & Meilleur, 2023). Location of Self While I don’t identify as Indigenous, I am a white settler here in Tkaoronto and I am an ally to these communities, using my ethnicity to be a voice for those Indigenous communities who deserve justice, honesty, and to have the right to access proper healthcare as I do. I identify as a white, non-binary, bi-sexual, English-speaking individual – with mental health challenges, and previously a substance user living in Etobicoke, previously the GTA. I have had the privilege of always having access to healthcare as my parents always had good health benefits, I live near a hospital, I have access to a primary physician, I can access mental health supports, and have an abundance of harm reduction services/safe consumption sites around me. On the outside I have privilege but the more you peel back the layers, I am also facing discrimination in other parts of my social location. The reason I decided to focus on the opioid crisis within Indigenous community’s vs within Canada as a whole, is because I have always had this spiritual tie to Indigenous culture and practices without knowing, it’s almost intuition. While I am not tied to this community or culture by genetic blood, spiritually or from a past life, I feel a strong connection to protect these people and communities. I may not be affected directly with what is happening within these communities, but as a social service worker and as a human being, it is very upsetting to me that they are not receiving basic health care services, clean drinking water, and their harm reduction services are being taken away. While also using my intercultural competency skills I’ve been learning over the past year or so, I will continue to adapt and learn 4

Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun about Indigenous cultures & practices to incorporate them into my social work lens. By building continuously working on building intercultural competency, I will continue developing my self- awareness and biases, but wanting to learn from Indigenous lived experiences on how I am able to be an advocate for the changes that need to happen within this community. Systemic Analysis The main structural/socioeconomical factors that are influencing this situation vary. This can be factors such as social support, employment, income, access to basic healthcare and substance us intervention and prevention supports. From what I have collected, the opioid crisis in Treaty 6 First Nations has been affecting the community in many ways as stated in the factors above, but the main factors are not being able to access harm reduction supports and safe supply. I was reading a quote from Mertz and Meilleur (2023) stated by the grand chief Standingontheroad of Treaty 6 First Nations, “If harm reduction isn’t available, our people will die”. This is a community who already is under-served and marginalized and when we are taking away their access to harm reduction supports for using substances, let alone proper healthcare – we as a government are leaving this group with unmet needs. This is an equity issue because we are making these harm reduction and consumption sites available in other provinces, in communities where they are available to different groups, why not make it available to a vulnerable population who is losing community members each day? I found another article related to the same topic of the opioid crisis in Indigenous communities, except this is specified to the region of Thunder Bay, Ontario, which is known as Indigenous land, or more negatively as the “murder capitol, the drug capitol”. The past five years Thunder Bay paramedic and emergency services have witnessed a sharp increase in opioid-related calls over the last five 5

Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun years, going from about 20 per month to almost 100 in certain months (Paas-Lang, 2023). This is due to not having enough resources and enough detox beds for people. There is also the structural factor of politics as well, as from a macro level – the government is responsible for not being able to support with these harm reduction supplies. As stated previously above, Treaty 6 is supposed to guarantee health care for Indigenous communities and provide rapid and on-going access to healthcare. The general political structure of a country shapes opportunities for political involvement and mobilization, as well as the enforcement of rights, notably those of disadvantaged communities. Finally, there are ethical and human rights imperatives for increasing the involvement of drug users. As an ethical concept, everyone should have the right to participate in decisions that affect their lives. Just like the community members from Treaty 6 First Nations & the grand chief is requesting, the Canadian HIV/Aids Legal Network, 2006 states: “the United Nations International Guidelines on HIV/AIDS and Human Rights, which urge states to involve representatives of vulnerable groups, such as people who use drugs, in consultations and in the planning and delivery of services.” Treaty 6 First Nations should have the right to represent their community on the decision to have or not have harm reduction services available to their people. Implications for Mental Health Practice The issues intersect with mental health because not only is it damaging the individuals’ using substances, their loved ones, but it is stemming back to the SdoH I am speaking about with regarding race and racism. The approach the government is taking is deeply rooted in 6

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Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun colonialism by continuing to create harm within these communities and taking away their access to rapid addiction medicines, supervised consumption sites, and access to healthcare services. Historically, Indigenous peoples were not used to consuming the various intoxicants given by white settlers to this region, and they quickly became reliant on them. This started with liquor which was used with illegal transactions involving the government & Indigenous peoples got to use to using this substance – they started losing their values, teachings, and traditions (Csiernik, R., & Rowe, W. S. (Eds.) (2017). For centuries we have been neglecting the mental health needs of Indigenous communities and this is only creating more mental health challenges for them in 2023. Why do you think there is an opioid crisis in Treaty 6 First Nations? They did not wake up one day and decide to use opioids, racism and colonialization has been the never-ending factor for them to start using substances. If these communities do not get access to harm reduction supports, the death rates will continue, lives will be lost, more intergenerational trauma will occur, and the issue at hand will never see a solution. If I were working with a client who was experiencing this exact SdoH, I would want to honour the Indigenous lens and the harm reduction approach that the client deserves the right to have. I would integrate a holistic model, which blends traditional healing with contemporary practices in substance use treatment which I found from Rowan et al. (2014). In contrast to Western biological techniques that emphasize on the absence of disease and imply mind-body separation in treating illnesses such as addictions, cultural therapies target wellness holistically. Various research has been conducted to differentiate western medicines vs Indigenous medicines, and majority of the Indigenous peoples who were given the option to use their own holistic and spiritual model found this more beneficial towards their healing & being able to re-establish their 7

Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun stolen identities and culture in the process. I would incorporate my anti-oppressive and trauma- informed lens to approach things from a client-centered, recovery-oriented and harm reduction approach while being mindful of adapting some Indigenous pieces into my practice. I would offer my client a variety of methods some could include creation stories, 7 grandfather teachings and the medicine wheel to reflect, encouraging smudging ceremonies, teachings from elders and healing ceremonies from medicine men/women and knowledge keepers, peer support, as well as, asking the client what best would work for them. Leaning towards my resources of services available that offer harm reduction and Indigenous lens agencies such as: Parkdale - Queen West Community Centre (PARC), 2 Spirit of The First Nation, Anishnawbe Health Toronto, Toronto Indigenous Harm Reduction, etc. I would want to let my client honour their strengths by using cultural interventions. Conclusion In conclusion, there are multiple barriers when it comes to social determinants of health when referencing Indigenous communities and substance use – more specifically when it comes to race and systemic racism that only continues with the effects of colonialism. What I have learned from doing this critical analysis is Indigenous folks needs more support with accessing harm reduction services, especially if there are in rural areas of Canada. This is something I was already aware of, as most of my research papers this semester has been focused on Indigenous communities and substance use. How I can continue informing my practice is to keep being an advocate for these communities & learn from their culture to understand how better to support them & listening to their cultural needs when healing from substance use. 8

Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun References Arya, A. N., & Piggott, T. (Eds.). (2018). Under-served: Health Determinants of Indigenous, Inner-city, and Migrant populations in Canada. P. 14. Canadian Scholars. Brownbill, K. & Etienne, M. (2017). Chapter 20: Understanding the Ultimate Oppression: Alcohol and Drug Addiction in Native Land, pp. 295-315. In R. Csiernik & W. S. Rowe (Eds.), Responding to the Oppression of Addiction, 3rd ed. Canadian HIV/AIDS Legal Network (2006). “Nothing About Us Without Us”: “Nothing About Us Without Us”. A manifesto by people who use illegal drugs, pp. 21-24. Canadian Medical Association. (2013). Health care in Canada: What Makes Us Sick? National Collaborating Centre for Determinants of Health . Lavalley, J., Kastor, S., Valleriani, J., & McNeil, R. (2018). Reconciliation and Canada’s overdose crisis: responding to the needs of Indigenous Peoples. Canadian Medical Association Journal , 190 (50), E1466–E1467. https://doi.org/10.1503/cmaj.181093 Mertz, E., & Meilleur, D. (2023, July 11). ‘Our people will die’: Opioid crisis prompts state of emergency in Treaty 6 First Nations. Global News . https://globalnews.ca/news/9821613/opioid-crisis-state-of-emergency-treaty-6/ 9

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Critical Analysis Paper ADMH 2000 – 0LB Samantha Ledamun Paas-Lang, C. (2023, October 7). Toxic drugs, gangs and hope: Meet the people fighting Canada’s opioid crisis. CBC . https://www.cbc.ca/news/politics/national-opioid-crisis- thunder-bay-response-1.6988260 Rowan, M., Poole, N., Shea, B., Gone, J. P., Mykota, D., Farag, M., Hopkins, C. A., Hall, L. J., Mushquash, C., & Dell, C. A. (2014). Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. Substance Abuse Treatment, Prevention, and Policy , 9 (1). https://doi.org/10.1186/1747-597x-9-34 10

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