March 23, 2007

The Great Disconnect

While this week’s Canadian Federal Budget left many salivating at the tax cuts (for some) and rebates on fuel efficient cars, the lack of attention to the economic and social conditions of Aboriginal peoples has yet to be reconciled by Steven Harper’s government, if not the rest of Canada.

There is an inherent contradiction, a disconnect within what the budget and government of the day proposes. To begin with, it is important to understand what Kelowna means in the historical record of Canada. In a country as diverse as Canada, (even among Aboriginal communities) it represented an agreement between the government and the major political representatives of Aboriginal people across Canada. You rarely get that type of agreement even in Federal/Provincial/Territorial discussions. An agreement that everyone could work towards, heading in the same direction, endorsed by all. This was no small feat.

As Phil Fontaine discussed in the Toronto Star (Budget a blow to First Nation’s hopes, March 23, 2007), even the party in opposition at that time through Jim Prentice (now Minister of Indian Affairs) spoke of the need for vision and courage to act in the interests of First Nation young people as he promised to "put the wheels on Kelowna". It was at that time, and still is the best chance to level some part of the playing field. Among many things, what Kelowna finally meant was that someone was listening and willing to put their money where the words were. Given the history of broken programs and promises towards Aboriginal people, it was a refreshing change and could be recognized as such. It was an outcome of a mutually decided process between Aboriginal leadership and the government, not another example of a "top down you will do it this way" approach.

So where is this disconnect? It consists of what the government is willing to do. It is willing to fund a national mental health commission headed by Senator Kirby, towards the development of a national mental health strategy. I am not against this, it is a worthwhile endeavor, and needs to be supported. Canada has continued to lag behind the rest of the G8 in not having a national mental health strategy and behind most in not having a national suicide prevention strategy. The commission and development of a strategy is based on the Kirby commission report which includes the recognition of the disproportionate attention towards mental health and mental illness among Aboriginal people. However, this disconnect comes in not recognizing the connections between economic, social, physical and mental health.

You cannot address mental illness and mental health without addressing equally the gap with economic and social conditions. If I live in a community with third world conditions, substandard housing, poor drinking water, why wouldn’t I feel depressed and anxious. If the despair in such communities is driving many towards substance abuse and suicide why wouldn’t my mental health suffer as I watch my children, or those of my neighbors die in disproportionate numbers to the rest of Canada.

This disconnect is by no means new. It has existed in all circles and has a lot to do with a highly fragmented approach to many of life’s challenges. Years ago under the Liberal government a community in northern Ontario made national and international news due to the rapidly increased rate of suicides. In a community of 1800, 8 youth had died by suicide. When asked about the crisis, the third world conditions, overcrowding and lack of housing the minister for Indian Affairs commented that the community required more counselors; housing wasn’t going to solve the crisis.

This disconnect came in failing to recognize that poverty, overcrowding and housing was connected to the rate of suicide. While the situation regarding stigma has improved, it still exists in connection with mental illness and suicide. If someone kills him or herself in an overcrowded house in a community with a fundamental shortage of housing, the stigma and fear makes the house uninhabitable. Lack of housing represents one of the overwhelming stresses within the community that increases the vulnerability of those who were doing okay, and further increases the vulnerability of those who were vulnerable already.

To act as if mental illness is disconnected form the realities of the community is to operate in a vacuum. Too many times the genetic biological pathways to mental illness are emphasized without connecting to the larger environmental factors (overwhelming stressors) that increase the frequency and severity of mental illnesses. While a mental illness can be considered an illness like any other illness, the entire story doesn’t lay within the individual. The question can always be asked, if the economic and social stressors within a community are reduced, how many fewer cases of mental illness will be realized.

For awhile I was involved in the Canadian Alliance for Mental Illness Mental Health (CAMIMH) which developed strong connections with the Kirby commission. It was often remarked that there was no health without mental health. But there is no mental health if the health (economic, social, physical etc.) of the community isn’t adequate. Continuing to separate mental health and mental illness from the greater health of the community whether Aboriginal or otherwise will only result in marginal improvement if that. The danger is that it amounts to a feel-good exercise. We believe we are doings something about mental illness, but in fact are doing and accomplishing very little. These connections have long been recognized within Aboriginal and Inuit people.

If progress for Aboriginal and Inuit people, real progress on all fronts is to be made, Canada can no longer afford to operate under the great disconnect. You do not have to be on the left or right of the political spectrum to recognize that what didn’t happen in this week’s federal budget was wrong. For the sake of health and mental health of Aboriginal People, and one could argue the larger society, it is time to make these connections. . Make the Kelowna accord a national priority.