Indigenous youth experience disproportionately high rates of mental health, often stemming from a combination of historical trauma, socio-economic disparities, and ongoing systemic discrimination, leading to increased vulnerability to addiction and homelessness. Effective interventions like the Hope for Wellness program should recognize and address the intersecting factors contributing to mental health issues, addiction, and homelessness among Indigenous youth. The purpose of this paper is to analyze a clinical case in the context of the Hope for Wellness program and relate it to Indigenous health inequities and social justice using research and data.
The selected clinical case describes Takoda, a 25-year-old Indigenous male residing on the streets of Winnipeg due to being expelled from his parent’s home as a result of drug addiction. Takoda also suffers from schizophrenia, which is mostly characterized by disruptions in thought processes, perceptions, emotions, and behavior. His homelessness and substance abuse issues likely exacerbate his mental health condition, which can be considered as contributing to a cycle of poverty, marginalization, and inadequate access to healthcare and social support systems. Takoda’s case is significant to this discussion as it illustrates the intersection of social justice and health inequities faced by Indigenous individuals in Canada, including systemic discrimination, historical trauma, lack of culturally appropriate care, and limited access to housing and support services.
Nelson and Wilson’s (2017) research supports the clinical case in regard to the constructs. They state that research on mental health among Indigenous peoples in Canada often focuses excessively on suicide and substance abuse issues. They then explain that it is recommended to adopt a more critical approach that incorporates the concepts of colonialism and historical trauma to understand better and address the mental health challenges faced by Indigenous communities. This study also implies that history is a major contributor to the injustices and health inequities present in indigenous communities.
Takoda’s Indigenous identity is an important construct of this clinical issue. According to Graham et al. (2023), Indigenous peoples in Canada, including First Nations, Métis, and Inuit communities, face unique social, economic, and health challenges rooted in historical and ongoing colonization, systemic discrimination, and intergenerational trauma.
Secondly, his condition-schizophrenia represents the mental health disorders that indigenous peoples often experience. Schizophrenia is complex, and it is influenced by genetic, biological, and environmental factors that contribute to its onset and progression. Disputed evidence shows that disorders like schizophrenia were rare among indigenous peoples, and its increase was a result of contact with Western cultures, and the increase was notable during the Industrial Revolution (Peet, 2003).
Substance abuse is also a significant element of this case because, like other indigenous peoples, Takoda’s substance abuse issues likely stem from a combination of genetic predisposition, environmental stressors, and coping mechanisms. This element contributes to the analysis of the case through the assertion that it often complicates the management and treatment of co-occurring mental health disorders like schizophrenia. The results of the complications are severed social relationships and isolation from the family, leading to homelessness. According to Omerov et al. (2020), homelessness exposes individuals to numerous health risks, from physical health problems, substance abuse, and violence to lack of access to healthcare and social support services.
Significantly, the intersectionality of the constructs shows the social injustices and health inequalities that contribute to the lack of health and support services promised under the Hope for Wellness program. This intersectionality acknowledges the complex interplay of multiple social identities and structural factors in shaping indigenous individuals’ experiences and health outcomes. Moreover, it helps in reflecting how systemic discrimination and lack of access to culturally appropriate healthcare, education, housing, and employment opportunities influence health outcomes in the population Takoda represents.
As the primary individual experiencing the clinical issue, Takoda is a key stakeholder whose well-being, rights, and preferences are central considerations in developing and implementing interventions to address his mental health, substance abuse, and homelessness. Other stakeholders could include his family members, healthcare providers, policymakers, community organizations, and government agencies, whose role can have significant implications on the key stakeholders.
Roughly 370 to 500 million Indigenous people reside globally. Despite constituting merely 5% of the global population, they represent 15% of those living in extreme poverty and experience a life expectancy 20 years lower than their non-Indigenous counterparts (Dawson et al., 2020). Dawson et al. also recognize that the communities encounter challenges in accessing quality healthcare. Even with the presence of telehealth interventions like the Hope for Wellness program, Dawson et al. (2020) report that there is a lack of available evidence regarding the effectiveness of telehealth programs in improving access to chronic disease management for Indigenous communities. This research resonates with the clinical case stakeholder, who has failed to receive the help he needs. Dawson et al.’s (2020) study is an accurate portrayal of the indigenous communities because the results therein have been derived from a rich literature source.
In areas with significant Indigenous populations, such as Canada and Australia, the utilization of digital solutions has been specifically suggested as a means to tackle mental health challenges and bridge gaps in service provision (Hensel et al., 2019). Hensel et al. (2019) also state that the disparities in health outcomes among Indigenous communities stem from a multifaceted interaction involving geographical factors, socio-economic determinants of health, distinct cultural perspectives on well-being, and enduring effects of colonialism, intergenerational trauma, and systemic violence, which contribute to the perpetuation of stigma and a lack of confidence in Western healthcare systems. Hensel et al.’s review is quality and accurate, and like other authors, they recommend culturally informed interventions, as similarly reported in Dawson et al. (2020).
The disproportionate rates of Indigenous homelessness in Canadian urban areas, ranging from 35-60% in Western Canada to 90-95% in the Northwest Territories and 15% in Toronto, serve as clear evidence of the systemic structures that cause displacement and harm to Indigenous Peoples in their quest for housing security (Gabriel, Mirza, and Stewart, 2022). Gabriel, Mirza, and Stewart’s (2022) statement can be linked to the clinical case because of the lack of social support and services like housing solutions for individuals with mental health issues, as expected from the Hope for a Wellness program. At the same time, the lack of housing security is evidence of the inequities facing indigenous populations.
There is a significant need to address structural factors before interventions like telehealth because, without resources, it will be challenging to seek help. Dawson et al.’s (2020) study highlights the significance of culturally tailored programs, regardless of the delivery modality, that all factors are considered before the community is exposed to them. They also recommend telephone-based delivery via a trained health professional because this modality has a high probability of meeting marginalized indigenous populations’ needs.
On the other hand, Gabriel, Mirza, and Stewart (2022) support that mental health problems and other intersecting factors are a result of social and structural inequalities stemming from their history. In their words, Gabriel, Mirza, and Stewart (2022) explain that Indigenous youth experiencing homelessness are not only contending with a history marked by oppression and injustice but also facing multiple obstacles at individual, societal, structural, and systemic levels that contribute to their homelessness.
In conclusion, Takoda’s case is a reminder of the complex interplay between individual struggles and systemic injustices faced by Indigenous individuals in Canada. Research has shown that such experiences necessitate an urgent need for comprehensive approaches that address the underlying social determinants of health, including historical trauma, systemic discrimination, and lack of access to culturally appropriate services. Recognizing and addressing these intersecting factors will enable policymakers, healthcare providers, and communities to work towards creating a more equitable and supportive environment for Indigenous individuals like Takoda, ensuring they receive the care, resources, and opportunities they need to thrive. Significantly, initiatives like the Hope for Wellness program could use recommendations like ensuring professionals are in charge of telehealth and the services are culturally sensitive.
Dawson, A. Z., Walker, R. J., Campbell, J. A., Davidson, T. M., & Egede, L. E. (2020). Telehealth and indigenous populations around the world: a systematic review on current modalities for physical and mental health. Mhealth, 6. https://doi.org/10.21037%2Fmhealth.2019.12.03
Gabriel, M. D., Mirza, S., & Stewart, S. L. (2022). Exploring Mental Health and Holistic Healing through the Life Stories of Indigenous Youth Who Have Experienced Homelessness. International Journal of Environmental Research and Public Health, 19(20), 13402. https://doi.org/10.3390/ijerph192013402
Graham, S., Muir, N. M., Formsma, J. W., & Smylie, J. (2023). First Nations, Inuit and Métis Peoples Living in Urban Areas of Canada and Their Access to Healthcare: A Systematic Review. International Journal of Environmental Research and Public Health, 20(11), 5956. https://doi.org/10.3390/ijerph20115956
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