Mental Health Disparities of Indigenous Communities During COVID-19

By: Nardeen Oweis

Pre-pandemic, post-traumatic stress disorder (PTSD), major depressive disorder, and substance use disorder were amongst the most prevalent mental disorders faced by the indigenous people of Canada.These issues have not only persisted but have been exacerbated by the outbreak of COVID-19. Although there has been a nationwide decrease in the mental health of non-indigenous Canadians due to the pandemic, this trend is exaggerated when it comes to our Indigenous peoples.

Health is not as simple as having an adequate health care system in a country, but rather a compilation of social factors affect the level of health in a population. In order to combat a pandemic such as COVID-19, a population requires the following social determinants of health: secure housing, employment, health insurance, functional literacy, food security, access to running water, and access to health care. It is apparent that many Indigenous people living on reserves around Canada were lacking in all of these, contributing to their struggling efforts to withstand the ramifications of COVID-19. Most Aboriginals live in multigenerational homes, leaving many struggling to adhere to the isolation rules during lockdown. Without access to running water, they were unable to follow hand-washing recommendations. The issue of food security was always an issue prior to the pandemic, with 1 out of 3 adult Aboriginals living remotely claiming to run out of food and being unable to afford any more. With COVID-19, transportation and delivery disturbances to the already low supply of food, drove prices even higher. The Indigenous people who often travelled outside their reserves to nearby towns to get their groceries or to hunt were unable due to the lockdown measures.

Another problem that Indigenous people faced was that they live geographically isolated, making healthcare access difficult and sometimes close to impossible. It appears that Canada’s Universal Healthcare may not be as ‘universal’ as it claims as only 70% of Inuit in Canada have seen a healthcare professional at least once in their lives, and of those, only 23% have a regular medical doctor. Pre-pandemic, many isolated, northern reserves would have a medical professional fly or travel to their community for a short period of time to diagnose and treat the people. With lockdown and travel restrictions, this was made abundantly more difficult. Furthermore, many Indigenous people on reserves who are able to visit a hospital have longer wait times than non-Indigenous people. In many cases, a prolonged diagnosis of a medical disorder can lead to a more difficult, and less successful, treatment; reducing the overall quality of the healthcare being received.

What was not considered in the COVID recommendations and restrictions was that not all communities in Canada operate as a Western Capitalistic society, especially Indigenous people. Since the invasion and colonization by Europeans, they have repeatedly endured segregation and assimilation. Although some aspects of their culture were preserved, COVID-19 would soon change that. With lockdown restrictions and social distancing, Indigenous people had to forgo many traditional practices done as a community. In particular, many Indigenous communities had to change their mourning and grief ceremonies following the death of a loved one. These ceremonies are very sacred and were especially needed during the pandemic to cope with the unexpected COVID-19 deaths. Moreover, even the basic rule of isolation was a great stressor for many older indigenous people as it triggered episodes of segregation by the French and British. Indigenous people have a history of being segregated and forced to live in reserves isolated from the rest. Having to conform to these pandemic regulations was a cruel reminder of their oppressed history.

A combination of social and health inequities are in effect; working together against the mental health of Indigenous people. Six in ten indigenous people reveal that their mental health has worsened since the start of the pandemic . This has dramatically increased since 2017 where a report revealed only 16% of Indigenous people describe their mental health as fair or poor and 53% report excellent mental health. Additionally, women and children seem to be experiencing higher stress and anxiety compared to their male counterparts. There are also disparities in the mental health of indigenous people and the non-indigenous in Canada. 38% of Indigenous people report having fair/poor mental health compared to the 23% of their non-indigenous counterparts). As mentioned previously, 60% of Indigenous people in a study report that the pandemic has worsened their mental health. This is compared to 52% of non-indigenous Canadians. Indigenous people also report having a greater level of stress and anxiety compared to non-indigenous people.

Because of a global shortage of mental health experts and limited access to mental health care, Indigenous people's mental health has been an issue throughout the pandemic. Mental health professionals are not immune to the outbreak of COVID-19 and as the general population, many were infected and some unfortunately passed away. In Spain, 14% of infection rates were medical professionals. Moreover, since the beginning of the pandemic, COVID-19 has infected approximately 90,000 health-care workers in Canada. Even if it were possible to increase the number of mental health professionals, Indigenous people often have lack of access to mental health care services. Assuming some have access, they are reluctant to go. In fact, ethnic minorities are less likely to seek mental health treatment than white people regardless of having any difficulties that are incapacitating. Costs, stigma, mistrust of the system, and, in many cases, the clinician's lack of understanding of Indigenous people's culture and language have all been offered as causes for this. It is still important to mention that it is often as simple as a lack of geographical availability to mental health care that discourages the use of these services.

The mental health crisis for the Indigenous people in Canada is undoubted but little to nothing is being done. The first step to tackling any issue is awareness and studies show that Canada is growing in knowledge about the long-term effects of colonialism of Indigenous people. What is not being revealed is the statistics of COVID-19 and its effects on Indigenous communities. Indigenous people have a greater vulnerability to infection and suffer greater pandemic severity. Despite this, the rates of COVID-19 in these populations are particularly unknown. Not only is testing for COVID-19 largely unavailable in reserves, but when testing does occur, data is rarely categorized by ethnicity. This makes recognizing COVID-19's actual impact on Indigenous people extremely challenging. It would also help determine what exactly they are lacking that is needed to combat this pandemic. Although this is not an excuse as without this data, there are essentials that are needed regardless, such as running water and food security.

To date, $380 million dollars have been allocated to the Indigenous Community Support Fund by the Canadian Government, bringing the total investments to $685 million. This money was devoted for food security, mental health services, emergency services, educational support, and anything else the Indigenous community may need during the pandemic. While monetary aid is very helpful, it should just be the start. The most prominent barriers that Indigenous people may face when seeking urban mental health services are stigma and discrimination; often by the clinicians themselves. Mental health professionals need to be trained on how to treat minorities in ways that align with their culture. In order for trust to be built between a clinician and patient, there can be no discrimination or bias of any kind. Instead, clinicians should focus on respect and compassion as cornerstones for their treatment plan. This is something that is expected to already be instilled in the minds of mental healthcare professionals. Unconscious bias may also add to the problem which requires the problem to be brought to the attention of clinicians. The Truth and Reconciliation Commission urged all government levels in Canada to provide cultural competency training to all health-care providers in 2015. Seeing as this is still an issue in 2021, it appears that the training is not yet in session or not properly administered. By tackling this obstacle, it would encourage more Indigenous people to seek the help of mental healthcare professionals. Although many would think that opening up more mental health services may rectify the issue, it would not deal with the fundamental root of the problem; mistrust of the system.

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