Contextual study of mental health services in Nunavik
This section summarizes the information gathered from research participants as well as the documentation review.
- Mental health is identified as an intervention priority in the region for the past several years.
- Few statistics are available on the state of mental health of Nunavik Inuit. Most participants however agreed that mental health problems are on the rise.
- Several factors appear to affect or aggravate Inuit mental health problems, including the cultural discontinuity, lack of housing, drug and alcohol use, lack of population knowledge about mental health problems, chronic socio-economic difficulties and unemployment.
- Key targets identified for an eventual mental health program are youth and men. Individuals suffering from serious mental health problems would also benefit from better follow-up aimed at social reintegration. To this date, few initiatives have been undertaken in Nunavik to help individuals who suffer from common mental health problems such as depression or anxiety disorders.
- The different population distribution between Hudson and Ungava partially explains the differences in services organization between the two coasts. In Ungava, services tend to be grouped around Kuujjuaq, while in Hudson, services are spread geographically towards the communities.
- The agreement between Nunavik and the CHUM (Notre-Dame Hospital), the Reintegration Centre of Inukjuak and the Crisis Centre of Puvirnituq constitute the most important mental health developments in Nunavik over the past 15 years.
- Factors leading to hesitation by individuals in calling upon the services offered in the communities include: lack of adequate services to meet needs, mistrust regarding the efficacy of psychosocial interventions and risk of being labeled in these small communities.
- In general, crisis situations require the involvement of health and social services staff. These situations mobilize numerous resources and drain local teams. Implementing mental health prevention activities and better clientele follow-up could contribute to a decrease in the number of such situations. However, reliance for these services on primary health and social services staff remains problematic, since their responsibility is first and foremost to respond to emergencies and ensure the day to day running of the clinic.
- The collaboration between programs should be maximized in order to intervene with individuals who have a combination of dependence problems (drug, gaming, alcohol) and mental health or intellectual impairment and to enable the transition between youth and adult programs.
- Local staff are at times called on to intervene with relatives. Some employees may also be dealing with personal difficult situations. There is little personal support for health and social services staff in Nunavik in this regard.
- Participants agree that interdisciplinary collaboration is an essential attribute to offering quality services in mental health. Collaboration is however compromised by several factors: resource instability, an absence of structured communication channels between health, social services and community resources staff and holders of traditional knowledge, confusion in the exercise of leadership, mutual lack of knowledge of roles and mistrust from all sides.
- The integration of traditional resources is aimed at diversifying the services offering. There is an urgent need to document the knowledge before their holders disappear. Together, the non-Inuit health and social services staff must learn better mastery of the cultural issues and become better informed about community initiatives and resources. That it would be useful to integrate a cultural counsellor into the healthcare teams.
- Group approaches are particularly effective in terms of intervention aimed at improving self-esteem or dealing with collective trauma. These approaches are, however, less suitable to a mental health clientele where an individual approach is more appropriate.
- There is a significant need for training in mental health among local health and social services teams, especially with regards to screening and mental health problems, treatment, traditional and culturally adapted approaches, follow-up, readaptation, and social reintegration of individuals with mental health problems. Specifically, the intermittent presence of psychologists and psychiatrists in the territory appears to diminish the support of local teams.
- Collaboration between Nunavik and the CHUM (Notre-Dame Hospital) for adult psychiatric services is at times compromised by an absence of standardized admission procedures, difficulty in reaching the psychiatrist on call and lack of knowledge of the northern context by some social services staff in Montréal. Furthermore, the fact that the CHUM offers no structure for the transition from Montréal hospital setting to Northern residence increases the risk of relapse. The number of beds in psychiatry (2) available at the CHUM is judged insufficient for the needs of Nunavik.
- Several promising programs of mental health problems prevention and mental health promotion have been abandoned over the years due to lack of financing, turnover of personnel and changes in priorities. Anchoring these programs within the community would encourage Inuit empowerment and correspond more to their collective values.