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Mental health and transitions: Possible Selves for youth and emerging adults

Mental health and transitions: Possible Selves for youth and emerging adults. E. Anne Marshall, PhD, RPsych Director, Centre for Youth & Society University of Victoria, British Columbia, CANADA. Youth Funders Affinity Network & Society for Youth Health Professionals Aoteoroa New Zealand

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Mental health and transitions: Possible Selves for youth and emerging adults

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  1. Mental health and transitions:Possible Selves for youth and emerging adults E. Anne Marshall, PhD, RPsych Director, Centre for Youth & Society University of Victoria, British Columbia, CANADA Youth Funders Affinity Network & Society for Youth Health Professionals Aoteoroa New Zealand November 25, 2011 Auckland, New Zealand

  2. Canada: population of 31,612,897 (1,172,785 Aboriginal) Victoria

  3. British Columbia • 2006 census: 4,113,487 BC residents • 196,075 residents in the Aboriginal identity population Victoria

  4. Canadian Youth • Aboriginal youth in Canada under 24: 562,936 • All Canadian youth under 24: 10,243,518

  5. BC Youth • All BC Youth: 1,294,693 • Aboriginal youth in BC: 111,875 • (from a 2010 BC population estimate)

  6. Victoria • Victoria Inner Harbour • 325,060 Victoria residents • 10,905 in the Aboriginal identity population Parliament Buildings

  7. University of Victoria 2011 Enrollment rates • 12,267 full-time undergraduate students • 4,703 part-time undergraduates • 2,959 full-time graduate students (227 part-time) • 861 Indigenous students

  8. Centre for Youth & Society Anne Marshall, PhD, RPsych

  9. What We Do Our mission is to promote the well-being of youth.

  10. Who We Are • Founded in 1997, established as a Research Centre in 2001 • 34 faculty Research Fellows • 33 Graduate Student members • Numerous and significant Community Partners • Guided by a volunteer Advisory Board with administration, academic, student, and community representation

  11. 34 Research Fellows from 3 faculties

  12. Staff

  13. Overview of presentation • Context: Issues in health and mental health • Focus on youth • The particular challenges faced by Indigenous peoples in Canada • Solution Focus: Successes and challenges • Our work with youth: Transitions and Possible Selves • Processes and examples

  14. Mental health needs • Globalization and the digital age have had a major impact on the lives of adolescents and young adults in the first decade of the 21st century. • Social and economic changes have been linked to reduced family incomes, escalating unemployment, cutbacks in services, and increasing dependence on social assistance – particularly for marginalized and Indigenous populations. • Concomitant health problems include stress-related illness, substance abuse, family violence, and depression.

  15. The challenge • Health professionals, mental health workers, and counsellors are increasingly challenged to provide support for young people, especially in rural areas. • Mental health difficulties affect about one in five youth and young adults (20%); the rate is higher for at-risk and Indigenous populations (30 - 60%) • My research and practice has focused on youth and emerging adults in urban and rural communities in British Columbia and Ontario, Canada.

  16. Youth health • Ages 12 to 29 are times of change and decisions • Transitional pathways for youth are diverse and more difficult for those who are marginalized by race, ability, restructuring, poverty, and sometimes location • Increasing technology demands post-sec training • Nutrition and sleep are increasingly declining • Depression, anxiety, and other mental health problems • Youth mental health is becoming a high priority

  17. Youth mental health • 74.6% of Canadians 12 years+ perceive their own mental health status as excellent or very good (StatsCan 2008) • 2008 McCreary Adolescent Health Survey: most BC youth in good health, feel connected to family, school & community, and engage in health promoting behaviours that will assist their transition into a healthy adulthood. • However, 22.2% of Canadian 15 or older experience most days as quite a bit or extremely stressful (StatsCan 2008). • Some youth are exposed to violence, poverty and other stressors. These youth are more likely to engage in risky behaviours affecting them now and in the future (eg.drugs)

  18. Youth mental illness & addiction • Onset of most mental illness occurs during adolescence and young adulthood (Health Canada, 2002) • High rates (41%) of hospitalization among young adults aged 15 to 24 years attest to the impact of mental illnesses on young people (Health Canada, 2002) • 47.0% for males and 29.3% for females ages 18 to 24 engage in heavy drinking (Statistics Canada, 2008) • According to the Crisis Intervention and Suicide Centre of British Columbia, suicide is the second leading cause of death in 15 to 24 year olds in BC, Canada and world. •  High suicide rates are found in many Aboriginal communities (Chandler & Lalonde, 1994)

  19. Help Seeking •  “While young people have the greatest need for mental health interventions, they are the least likely to seek help” (Rickwood et al., 2007, p. 35). • One in five youth report moderate to serious mental health difficulties (Canadian Mental Health Ass’n, 2009) • 14% of youth report that the stress in their lives is “almost more than they could take” (McCreary, 2008). • However, youth (esp males) are under-users of mental health and counselling support services. About 80-90% of adolescents report going first to their friends for assistance with health questions and concerns.

  20. Appropriate support is needed • Thus, we need upstream and preventive mental health initiatives actively engage youth in positive mental health promotion strategies and programs. • Education and early interventions have been shown to prevent later and more serious mental health problems • Lack of youth-friendly services and stigma have long been barriers to help-seeking and treatment for youth (Samargia, 2006; Sears, et al., 2009). • However, relationships with caring adults are empowering for youth and are considered to be a protective factor (Ungar, 2004). • Youth and caring adults need to work together   

  21. Indigenous population • Aboriginal people represent approximately 3.9% of Canada’s total population or about a total of 1 million people. • The Aboriginal population is very young -- over 50% are under the age of 24; 40 % are under the age of 16 • The population is growing faster than the non-Aboriginal – 2 to 3 times higher birth rates

  22. Population reporting Aboriginal Ancestry (Origin), Canada, 1901- 2001

  23. Number % Canada 976,310 100.0 Newfoundland and Labrador 18,780 1.9 Prince Edward Island 1,345 0.1 Nova Scotia 17,015 1.7 New Brunswick 16,990 1.7 Quebec 79,400 8.1 Ontario 188,315 19.3 Manitoba 150,040 15.4 Saskatchewan 130,190 13.3 Alberta 156,220 16.0 British Columbia 170,025 17.4 Yukon Territory 6,540 0.7 Northwest Territories 18,725 1.9 Nunavut 22,720 2.3 Population Reporting Aboriginal Identity, Canada, Provinces and Territories, 2001

  24. The legacy of colonization: social determinants of health As a result of colonial history, Aboriginal people experience a broad range of health issues, many of which lead Aboriginal people to suffer from among the poorest health levels in the country The impact of colonization practices on Indigenous health across Canada has been summed up by as the destruction and discontinuity of the structure of community, and the transmission of traditional knowledge and values, such as an Indigenous paradigm of health and wellness (Kirmayer et al. (2000).

  25. In Canada, this has involved various processes (from 1492 to present) including cultural assimilation tactics to destroy Native cultural identity & community by enforced Federal and Provincial government legislation through: relocation from traditional lands and confinement to reserves Parents and children (through many generations) suffering prolonged separation from family, culture, and traditional lands by forced placement in residential schools loss of control of self and community governance, including language, religion, land use, food sources, clan structure, etc. i.e., colonial rule gradual involvement in national and global economics historic and continued political and social marginalization more efforts too numerous to itemize (Kirmayer et al., 2000).

  26. The health implications of this colonial history for communities and individuals include high rates (compared to non-Indigenous pops.) of: Grief and loss Depression Suicide Trauma Family violence Substance abuse Sexual abuse And more (Duran, 2006; Health Canada, First Nations and Inuit Health Branch, 2003 Kirmayer, et al., 2000; Waldram, 2004).

  27. For example: Indigenous people in Canada have 1.5 times the national mortality rate and 6.5 times the national rate of death by injuries and poisonings. The suicide rate for Natives in Canada as a whole is 3 times the suicide rate of the non-Native population (Royal Commission on Aboriginal People, 1995). A deeper look reveals that, according to Health Canada (2003), in 1999, suicide and self-injury were the leading cause of death for Indigenous Canadians, accounting for 38% of deaths among youth and 23% of deaths for young adults.

  28. Gap in Life Expectancy at Birth by Gender for Registered Indian Population Source: Basic Departmental Data, 1999. Indian Affairs and Northern Development, Feb. 2000

  29. First Nations/Inuit to Canadian Rate Ratio for Age-adjusted Chronic Disease Prevalence • Chronic diseases range from 1.5 to 5.3 times higher, compared to the Canadian population. • Diabetes is the leading chronic condition, followed by cardiovascular problems. • Diabetes is more prevalent among women. • Chronic diseases tend to cluster in the same individuals. Source: Young et al. and the FNIRHS Steering Committee

  30. Aboriginal people experience a higher prevalence of HIV / AIDS than the broader Canadian population The fastest growing HIV/AIDS population is 15-29 year old Aboriginal women (35–40% of new cases reported in 2001) Highest Smoking rates: - 57% of Aboriginal adults and 54% of Aboriginal teens smoke (some start as young as 8) Poverty 52.1% of all Aboriginal children are poor. 12% of all families are headed by parents under 25 years of age vs. 3% in the general population 27% of Aboriginal families are headed by single mothers vs. 12% in the general population

  31. Future Generations: Children’s Health • Greater than 80% reported their children’s health to be very good or excellent. • Ear problems, injuries, respiratory and weight problems are common. Source: MacMillan et al and the FNIRHS Steering Committee

  32. Treatment: Western health models as continued oppression? • Some researchers have suggested that employing a Western paradigm with Indigenous peoples is a form of continued colonial oppression (see Gone, 2004, Battiste, 2002, Stewart 2008). • What this means is that Native patients may view Western medical health practitioners and treatments with mistrust due to past or ongoing experiences of colonial trauma or oppression.

  33. Implications for mental health practitioners There is a lack of knowledge and understanding related to an Indigenous paradigm of health and healing (and how it differs from Western health and worldviews) by mental health care professionals in the provincial health care systems. 2) Currently there is a health crisis in some Native communities, yet there is an under-use of health services by Indigenous peoples.

  34. Indigenous concept of health Balance and harmony between and within the four aspects of a person’s nature, which are mental, physical, spiritual, and emotional. A holistic conception of health and healing should be used by mental health practitioners and educators who are part of the health promotion movement Such a conception will serve to improve the disparity between the needs of Indigenous peoples and the largely Eurocentric systems of health care. The adoption and use of such a conception would also be an important step in the construction of a health literacy that includes an Indigenous perspective and worldview (see Stewart et al, 2008).

  35. Successes and challenges associated with bringing together Indigenous and western forms of healing….

  36. Successes • INDIGENOUS MODELS OF HEALING • ABORIGINAL MENTAL HEALTH CAREERS PROGRAMS • CONTINUED REVIVAL OF TRADITIONAL PRACTICES • ABORIGINAL COMMUNITY MENTAL HEALTH CENTRES IN URBAN AREAS

  37. Indigenous models of healing Popularizing Indigenous models of health and healing that includes spirituality could benefit everyone: • Traditional knowledge, values, wisdom, and healing practices of Native peoples can be used not only to appropriately address and deal with community health dysfunction and healing, but as a model to serve non-Native populations, whose cultural assumptions and arrogance have historically overlooked and denied the strengths of an Indigenous mental health and healing counselling model (Kirmayer et al., 2000).

  38. The Dze L. K’ant Friendship Centre’s model embeds practices of “mental health support” and “being in sound mind” through the acknowledgement of the four aspects of each person’s personal “will” as depicted by the medicine wheel Being of Sound Mind Mental Health Support (Dze L. K’ant Friendship Centre Society, 2006)

  39. Suzanne Stewart’s research • One model of Indigenous mental health a and healing in counselling has been articulated by Indigenous counsellors in British Columbia as based on 4 major themes: -- Community • Cultural identity • Holistic approach • Interdependence (Stewart, 2008)

  40. Community Inter- dependence Cultural Identity Holistic Approach Model of Indigenous Counselling & Healing(Stewart, 2007) Healing Tools: Being in Nature Ceremony, Elders Family & friends, Prayer Sharing food Therapeutic alliance

  41. Potential challenges • Fostering community development, including community-based health initiatives • An openness and respect for traditional medicine and traditional healing practices • An increase in the number of aboriginal health care providers

  42. Improved cross-cultural awareness in mental health workers in general • Use of inter-professional collaboration or multi-disciplinary team approach • Increased representation of Indigenous peoples on health facility boards where there is a significant Indigenous population

  43. Mental Health Workers should be educated about an Indigenous paradigm of mental health and healing Training programmes should contain a component on Indigenous models of mental health and healing that serves to legitimize the Indigenous paradigm (Duran, 2006). Training should include traditional healing practices and spirituality

  44. Continued and future challenges • HEALTHY PUBLIC POLICY: • Housing • Employment • Food subsidy • Land claim settlement • Self government • Community development • Sensitization of dominant society

  45. Positive futures for youth

  46. Transitions & Possible Selves • Our projects are informed by social constructivist and social constructionist theoretical frameworks • Emphasis on the central importance of people’s physical, social, and cultural milieu, and how these affect life planning and decision-making. • People form identities and make choices according to how they construe experiences and derive meaning from them. • Personal variables, environmental factors, and overt behavior interact and affect one another through complex, reciprocal linkages.

  47. Influences and Allies • Our work is also guided by developmental perspectives, and • The cognitive and motivational concept of possible selves (Markus & Nurius, 1986) • Community partners • Nationally funded research projects – SSHRC, NSERC, and CIHR grants, plus United Way, Truth and Reconciliation Commission of Canada, and others

  48. Theoretical Orientation Constructivism (Young & Collin, 2003; Mahoney, 2002) • “Individual constructions take place within a systematic relationship to the external world” (Young & Collin, p.4). • People are active agents in cognitively constructing their experience. Social Constructivism (Young & Collin, 2003; Gasper,1995) • Social relationships have an influence on an individual’s construction of knowledge and experience. • Knowledge is the product of our social interactions and processes.

  49. Constructivism and Planning • Constructivist and social constructionist approaches to development foster conversations and reflections that engage students in meaningful goal-driven projects (Valach and Young, 2002). • Self-concept plays a key factor in development and decision-making (Bandura, 1993; Savickas, 1995). • Self-efficacy and identity in a particular domain influence planning and decision-making activities (Turner & Lapan, 2002;Wallace-Broscious, Serafica, & Osipow, 1994).

  50. Cultural Sensitivity • Related to cultural safety • Constructivist strategies and resources are grounded in social values and life contexts • Adaptable for students of varying educational levels, abilities, and cultural backgrounds • Utilize creative adaptations & individualizing • Task-based tools engage learners • Kate Fisher’s FN Math Mapping • Indigenous PSMP in progress

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