Social Suffering: Indigenous Peoples’ Experiences of Accessing Mental Health and Substance Use Services

Abstract

In this paper, we present findings from a qualitative study that explored Indigenous people’s experiences of mental health and addictions care in the context of an inner-city area in Western Canada. Using an ethnographic design, a total of 39 clients accessing 5 community-based mental health care agencies were interviewed, including 18 in-depth individual interviews and 4 focus groups. Health care providers also were interviewed (n = 24). Data analysis identified four intersecting themes: normalization of social suffering; re-creation of trauma; the challenge of reconciling constrained lives with harm reduction; and mitigating suffering through relational practice. The results highlight the complexities of experiences of accessing systems of care for Indigenous people marginalized by poverty and other forms of social inequity, and the potential harms that arise from inattention to the intersecting social context(s) of peoples’ lives. Service delivery that aims to address the mental health concerns of Indigenous people must be designed with awareness of, and responsiveness to, the impact of structural violence and social suffering on peoples’ lived realities. A relational policy and policy lens is key to alleviate patterns of social suffering and counter the harms that are unwittingly created when social suffering is normalized.

Youth not engaged in education, employment, or training: a discrete choice experiment of service preferences in Canada

“…Previous literature has showed that Indigenous , Black, and racialized youth have experience longer wait times and poorer quality of mental health care compared to their White counterparts [ 71 – 73 ]. Prior literature has described how MHSU systems often do not consider or address the discrimination, systemic racism, economic marginalization, and intergenerational traumas that Indigenous, Black, and racialized populations experience within and outside of the service system [ 74 , 75 ]. These negative experiences adversely affect their access to and quality of MHSU care, leading to inequities in MHSU outcomes.…”

Racial and Ethnic Disparities and Prevalence in Prescription Drug Misuse, Illicit Drug Use, and Combination of Both Behaviors in the United States

“…Other issues, like historical trauma these people may have encountered across generations (e.g., oppression and colonialization), may become factors with higher incidence of drug use and substance use treatment (RHIH, 2020 ). We should point out that many indigenous populations across the world face similar challenges like lack of healthcare services in different parts of the world (Lee et al, 2019 ; Smye et al, 2023 ; Spillane et al, 2022 ), substance use interventions and treatments may specifically focus on providing culturally based treatments and services within the local communities for supporting substance use cessation (Burlew et al, 2021 ; Maina et al, 2020 ; Urbanoski, 2017 ). However, we should state that illicit drug use was the only statistically significant association observed.…”

“I needed the help. They weren’t giving it”: Experiences of young people in tertiary education on waitlists for mental health services in Aotearoa

“…If people dependent on publicly funded services come to expect and normalise long waits and poor care as a result of a social context that renders them powerless, other marginalised groups may be likely to do the same. Smye et al (2023) conducted individual interviews and focus groups with 39 Indigenous peoples in Canada about their experiences accessing mental health and addiction services. The experience of waiting permeated participants' accounts, and the authors noted how even in contexts where participants were unwell and needed care sooner, they normalised and accepted the waits they encountered.…”

“…The experience of waiting permeated participants' accounts, and the authors noted how even in contexts where participants were unwell and needed care sooner, they normalised and accepted the waits they encountered. Smye et al (2023) argued that this response was a reflection of the historic and ongoing systematic oppression of Indigenous peoples who exist in a social context that normalises their suffering. When social suffering is normalised, it can be made invisible (Smye et al, 2023), making it harder to be identified, defined, or challenged.…”

“…Smye et al (2023) argued that this response was a reflection of the historic and ongoing systematic oppression of Indigenous peoples who exist in a social context that normalises their suffering. When social suffering is normalised, it can be made invisible (Smye et al, 2023), making it harder to be identified, defined, or challenged. As discussed earlier, this was evident for some participants in Dowell et al's (2021) study, who accepted longer waits with little criticism as they were reliant on the service being free.…”