Improving the mental health status of Canada's Aboriginal youth.

It has been ten years since the Royal Commission on Aboriginal Peoples (RCAP) released its Final Report. Numerous recommendations grouped into major themes had the common goal of improving the relationship between Canada and its Aboriginal Peoples. There were specific recommendations to address the disparities in health status between the general Canadian population and Aboriginal Peoples. As such, the report was released with great optimism and hope by its authors and in turn, was met with considerable expectations on the part of Aboriginal people for positive change. The creation of the Institute of Aboriginal Peoples Health (IAPH) in 2000, one of thirteen institutes comprising the Canadian Institutes of Health Research (CIHR), the government of Canada’s health research funding agency, is regarded as playing a major role in advancing the Aboriginal health research agenda. Specific initiatives funded by IAPH, including the National Network for Aboriginal Mental Health Research (NNAMHR) have brought together collectives of researchers who may previously have been working in isolation. These researchers have been able to access funding through CIHR and other agencies to work collaboratively with Aboriginal communities in addressing research questions that are both pressing and relevant. This special theme issue of the Journal is an opportunity to share a small sample of some of the innovative work and thinking that is taking place across the country regarding different aspects of the mental health and well-being of Aboriginal youth. There are always two major issues that arise in the discourse around Aboriginal Peoples and research. One is the contention, mainly arising from Aboriginal communities that they have been “researched to death”. While it may be true that relationships between researchers and Aboriginal communities in the past were problematic, it is also true that current and future health policies and programming need to be evidence-based. It is also important to note that contemporary evidence-based research can be inclusive and respectful of traditional and indigenous knowledge. The article by Katz and colleagues that outlines an intended comprehensive research program to examine Aboriginal youth suicidal behavior is an example of collaborative community-based research. Aboriginal youth in Canada, unfortunately, continue to experience some of the highest suicide rates in the country and there is a critical need to move beyond describing the extent of the problem and begin to develop a more complex understanding of the risk factors and pathways that youth take toward self-harm. It is only then that more optimal, culturally-sensitive suicide prevention programs and interventions can be created and delivered. The second issue arising involves the framing of problems or difficulties, in this case, of Aboriginal youth. While one does not want to continue to perpetuate negative stereotypes or misunderstandings that Aboriginal youth as a whole population are in distress and participating in self-destructive behaviors, the reality is that a significant number of Aboriginal youth do struggle with health-related issues that warrant the attention of researchers and health care providers. For example, the birth rate for First Nations females in the 15–19 year age group is at least five times higher than the national rate. The highest rates of sexually transmitted diseases such as chlamydia are also experienced by First Nations females in the same age range. In the article by Banister and Begoray, they describe an approach to sexual health education for young Aboriginal females that is also inclusive of traditional ways of knowing including the use of elders and mentoring, sharing circles and storytelling. The authors demonstrated that sexual (physical) health emerged as being inextricably linked to other aspects of health: the mental, emotional and even spiritual, for the young Aboriginal females in the study. Sexual health education for Aboriginal youth to date has not received much attention within the mental health spectrum and so the contribution of Banister and Begoray is both timely and valuable. The article by Kassam poses several important questions in utilizing western medical model approaches to address the emotional distress experienced by Inuit youth in Canada’s North. Specifically, the author examines whether or not psychiatric consultation is the most appropriate method to assist Inuit youth in crisis. The article by Kassam expands on the model of cultural consultation put forward by Kirmayer and colleagues in terms of contextualizing it for Inuit youth. However, increasing cultural competence in working with Aboriginal people is relevant for all clinicians who work with communities across the country, being mindful that Aboriginal people now live in a variety of settings: remote, rural, and urban. One of the purposes of a special theme issue that focuses on aspects of the mental health of Aboriginal youth is to draw attention for the need to close the gap in health and mental health status between Aboriginal youth and their Canadian peers. Community-based research with robust findings will translate into better mental health policies and programs for Aboriginal youth in Canada. And as stated in the RCAP Final Report, Aboriginal youth want very much to be involved in working collaboratively toward optimal change.1 In Volume 4 - Perspectives and Realities, Chapter 4 – The Search for Belonging: Perspectives of Youth, the final paragraph concludes: “Aboriginal youth want to be the solution, not the problem. Healing youth today will lead to their empowerment tomorrow. With empowerment, they will have the mental, physical, emotional, and spiritual energy to help those around them: their peers, their parents, and their communities. The circle of wellness will grow.” Let us not wait another ten years to see positive advancements. The time to capitalize on the growing momentum in Aboriginal mental health research is now. As is often said, “Aboriginal youth are our future” – they are, but they are also our present.

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