Portal de Periódicos da CAPES

Analysing ‘cultural safety’ in mental health policy reform: lessons from British Columbia, Canada

2011; Taylor & Francis; Volume: 22; Issue: 2 Linguagem: Inglês

10.1080/09581596.2011.616878

1469-3682

Viviane Josewski,

Indigenous Studies and Ecology

Abstract In response to the mental health disparities experienced by Aboriginal peoples, and related inequities regarding the accessibility to appropriate mental health care, there has been a shift in health policy to endorse 'By Indigenous for Indigenous' health care delivery models. In Canada, this has resulted in the creation of new mechanisms for Aboriginal participation in health care planning by health authorities with the goal of fostering culturally safe mental health and addictions care. Yet, there is a growing concern about the effects of neo-liberal cost concerns in health policy on the effective implementation of such progressive reform ideas. Drawing on a critical policy review and ethnographic interviews with four community-based Aboriginal organisations and one health authority, this article uses 'cultural safety' as a critical lens to discuss emerging tensions within the context of regional Aboriginal mental health care reform in British Columbia. The findings of this study draw attention to the intersecting ways that dominant socio-historical and political ideologies undermine cultural safety in decision-making and funding practices, thereby creating situations of cultural risk for both Aboriginal people working within the area of Aboriginal mental health and by extension for Aboriginal people who are seeking mental health and addictions care. The insights gained from this research contribute to the ongoing dialogue regarding how to foster culturally safe mental health policy and practice, and for action in the political realm. Keywords: health policyindigenous peoplesmental health Acknowledgements The author thanks Dr Marina Morrow, Associate Professor at Simon Fraser University, Dr Victoria Smye, Assistant Professor at the University of British Columbia and Dr John O'Neil, Dean of the Faculty of Health Sciences at Simon Fraser University for their most valuable and insightful comments on the previous drafts of this article. The author also thanks the research participants and the Social Sciences and Humanities Research Council of Canada (SSHRC) for its financial support through the award of a master's scholarship. Notes Notes 1. In this article, I use the term Aboriginal peoples consistent with the terminology used by the RCAP (1996a). The Commission stresses that the term Aboriginal peoples 'refers to organic political and cultural entities that stem historically from the original peoples of North America, rather than collections of individuals united by so called "racial" characteristics. The term includes the Indian [First Nations], Inuit and Métis peoples of Canada (see section 35(2) of the Constitution Act, 1982)' (p. xii). Specifically, the term 'First Nation' replaces the term 'Indian'. 2. Under the terms of the Indian Act, federal stewardship for Aboriginal health and social services is constrained to people who have been registered by the Department of Indian and Northern Affairs Canada under the Indian Registry. Individuals of First Nations ancestry not eligible for registration under the Indian Act are generally called 'non-status' or 'non-registered Indians'. For these individuals, funding for health and social programmes are presumed to fall under provincial jurisdiction. 3. To protect the confidentiality of participants, the name of the health authority has been purposively omitted from the references. 4. Due to the relatively small number of employees in the Aboriginal Health Division of the health authority (seven at the time) and the tight community of Aboriginal mental health service providers on- and off-reserve in these communities, additional participant descriptors have been purposively excluded from this article to protect anonymity and confidentiality.