Scaling up the Knowledge to Achieve Aboriginal Wellness

Mental health is, in some ways, the most important health issue for Aboriginal Peoples in Canada, partly because it contributes both directly and indirectly to so much of the gap in health status, and perhaps even more importantly, because mental health issues are so neglected in our society, especially so for Aboriginal Peoples, where the gap in mental health research and services is particularly accentuated.' Recognizing and understanding the social determinants of health is key to understanding the problems, and in my view, key to achieving success in addressing and correcting those problems. It is important to realize that there are unique social determinants for Aboriginal Peoples associated with their cultures, histories, and colonization, and the current social, economic, political, and geographic context.2 In the first In Review article, Dr Colleen Anne Dell and colleagues3 describe their experiences with helping addicted First Nations youth at an Ontario native-run solvent-abuse treatment centre. Their experience and their study is an exercise in knowledge translation. They draw on a residential school treatment modality that is grounded in a culture-based model of resiliency. The youth they are trying to help are too young to have experienced residential schools, and, although they may be suffering from intergenerational trauma, the means of helping them lies in appealing to and reviving their cultural roots and evoking their resilience through that culture. Youth who come to the treatment centre for solvent abuse are introduced to the spirituality that is the lost part of their culture and their identity. Their identity as First Nations youth, and their inner spirit, has lain dormant, and needs to be revitalized. The whole family can benefit from this program, which is particularly important where the parents and even the grandparents have lost those connections and that identity. A consultation with an Elder and a sweat lodge ceremony are integral parts of the treatment program. The offering of blueberries as a traditional medicine, as an example, helps to make that connection with their cultural roots. Through the examples brought forward, these addicted youth have benefited from this culture-based approach to healing. So how do we translate the knowledge? How do we apply it to a different community, a different pathology, a different sociocultural context within our diverse community? How do we scale up the knowledge about what works? This is the critical point. If we improve the health of a small community, that is important, but, for every group such as the clients of the Nimkee Healing Centre, there are hundreds or even thousands more like them, but different. Blueberries are a particular thing, common in our country, but certainly not universal. Are strawberries the same as blueberries? The concept of blueberries, as a form of therapy - an adjunct or an amplifier - may be much closer to universal if we can just find the translation key. What is it about the blueberry treatment that worked? Knowledge translation is a vital part of our scientific arsenal that still needs refinement. In the second In Review article, Dr Laurence J Kirmayer and colleagues4 present 4 case studies in 4 different Aboriginal communities in Canada: 1 Inuit, 1 Metis, and 2 First Nations (Mi'kmaq and Mohawk). Their choices reflect only a small part of the diversity of Aboriginal Peoples in Canada. Again, there is no universal story, no universal solution, no magic pill that works for everyone. And yet there is a commonality in these 4 compelling stories. The commonality is in the incorporation of indigenous constructs in achieving wellness through resilience. …

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