Members of the Indigenous mental wellness and trauma-informed specialist workforce – including Mental Wellness Teams (MWTs), Crisis Support Teams (CSTs), the Indian Residential Schools Resolution Health Support Program workforce, and other community-based cultural support workers – are often the primary and urgent care providers for individuals and families in need of culturally safe supports. While fulfilling a critical role, these teams contend with distinct challenges stemming from colonial impacts and health systems that continue to undermine Indigenous mental wellness and cultural traditions of healing. During the COVID-19 pandemic, increasing rates of mental illness and substance use among Indigenous populations strained the already overworked and under-resourced mental wellness workforce. First Peoples Wellness Circle sought out and embraced new approaches for meaningful virtual engagement to sustain and enhance workforce wellness and capacity by facilitating culturally relevant and culturally led connections from coast to coast to coast.

Introduction

It is well-documented that Indigenous communities and individuals experience disproportionately high rates of mental wellness challenges compared to their non-Indigenous counterparts (Kirmayer et al. 2000) and have inequitable access to culturally safe healthcare and related services (McIntyre et al. 2017). These inequities stem from colonial policies that have displaced Indigenous ways of being and doing (Nelson and Wilson 2017). They persist as Western colonial healthcare systems continue to underservice Indigenous communities and undermine Indigenous knowledge and cultural approaches to healing. In this context, recent and ongoing efforts within mainstream healthcare systems and institutions to improve quality of care through patient, family and community engagement often exclude Indigenous experiences and perpetuate culturally unsafe care environments. This article provides insights into strategies for meaningful engagement that empower Indigenous leaders, practitioners and communities to reclaim systems and practices of care that are relevant, responsive and informed by Indigenous knowledge and culture.

There is increasing recognition of the success and need for strength-based, holistic, community-led approaches to care, healing and recovery that are firmly rooted in Indigenous culture, communities and knowledge. The Indigenous mental wellness and trauma-informed specialist workforce – including Mental Wellness Teams (MWTs), Crisis Support Teams (CSTs), members of the Indian Residential Schools Resolution Health Support Program (IRS RHSP) workforce and other community-based cultural support workers – are a key resource in providing critical services to address crises and promote intergenerational healing. Unlike mainstream approaches to addressing mental health, these teams incorporate both Western and Indigenous methods informed by knowledge, language and culture. Often occupying a dual role of community member and care provider, this workforce is well-positioned to navigate and provide culturally safe and trauma-informed care. However, teams frequently contend with high rates of burnout, compassion fatigue, stress and staff turnover, and are at higher risk of experiencing lateral violence and secondary trauma (FPWC 2019). Despite ongoing and significant need for their care, the workforce struggles against issues of wage parity and inequitable government funding, which results in inadequate workplace conditions, a lack of capacity to support workforce wellness and challenges with recruitment and retention of a qualified workforce (Sutherland et al. 2019).

Many of these issues were compounded and exacerbated with the onset of the COVID-19 pandemic, which disproportionately impacted Indigenous Peoples and put unprecedented pressure on the workforce. In 2020, Indigenous Peoples reported poorer mental health than their non-Indigenous counterparts, with 60% indicating that their mental health had worsened since physical distancing came into effect (Arriagada et al. 2020). A recent survey found that 10% of First Nations adults and 6% of First Nations youth started using substances during the pandemic (TPF and ISC 2023). In the context of the ongoing drug crisis, frequency and severity of substance use among Indigenous communities also increased, contributing to high rates of drug poisonings and related hospitalizations and deaths (Task Group on Mental Wellness 2021). At the same time, many social determinants of health (i.e., poverty, food insecurity, housing) became increasingly unstable, contributing to negative mental health outcomes.

First Peoples Wellness Circle and the Indigenous Mental Wellness Workforce

First Peoples Wellness Circle (FPWC) is an Indigenous-led national not-for-profit dedicated to enhancing the lives of First Peoples from coast to coast to coast by supporting and promoting strong, holistic mental wellness of Indigenous Peoples, families and communities. We target our services to supporting the mental wellness and trauma-informed specialist workforce to ensure coordinated, competent and culturally safe programs and services that are, above all, responsive to community needs and firmly rooted in culture. Our work is guided by the implementation of the First Nations Mental Wellness Continuum Framework (AFN and Health Canada 2015). At the system level, FPWC advocates for collaborative and transformative policy and system change that fully embraces the strengths of culturally based approaches to healing embedded in Indigenous cultural lenses and knowledges. At the community level, we strive to elevate and address the identified needs of the workforce by developing and delivering culturally safe, respectful and relevant resources and trainings that build capacity, promote workforce wellness and advance pay and funding equity.

During the pandemic, this became even more important as the workforce continued to support communities despite the challenges they faced. The COVID-19 pandemic resulted in higher levels of stress, burnout and fatigue, compounded with an increasing workload and lack of supports (FPWC 2019; Task Group on Mental Wellness 2022). We heard from the workforce the need to develop skills and strategies built on Indigenous knowledge and cultural practices to foster worker wellness and well-being in communities (FPWC 2022). In response to these needs, FPWC created and introduced initiatives to support the existing work of the workforce as they navigated their way through the pandemic (FPWC 2021, 2022).

FPWC engagement during COVID-19

From the onset of the COVID-19 pandemic, FPWC engaged members of the workforce, Elders, community leaders and knowledge holders to identify and discuss how to address areas of support. Together, we developed and implemented virtual methods to connect members of the workforce with resources, each other and cultural supports. For example, early in the pandemic, FPWC made culturally relevant information sheets available online for Elders, parents, health providers and communities to assist in coping and managing the challenges they were experiencing. As community needs increased, FPWC introduced national, virtual support calls with participants working in and for communities across the country to sustain and enhance workforce wellness. FPWC hosted 23 weekly/biweekly sessions with nearly 600 participants in 2020–21 to facilitate sharing of wise practices; identify tools, resources and training needed to adequately respond during the pandemic; and highlight promising approaches to supporting wellness. Over time, these calls expanded to learning series consisting of workshops and virtual gatherings designed to specifically address the needs identified by the workforce in the support calls. From 2020 to 2022, FPWC held five learning series that focused on skills to promote worker wellness, Indigenous methodologies to support well-being, decolonizing healthcare, as well as (re)connecting with traditional knowledge.

To further support capacity building within the workforce, FPWC shifted to virtual delivery of our training services and offered new, relevant training opportunities, toolkits and learning resources to enhance the efficacy of teams. In 2021, we held a virtual National Gathering, titled, Caring for Our Bundles: Healing and Resilience During and After the Pandemic. The gathering included 10 expert guest speakers and was attended by over 200 participants who shared stories and experiences of strength and resiliency. In addition to highlighting holistic wellness in prevention, healing and self-care within the workforce, this gathering was also a meaningful opportunity for participants from the workforce, knowledge keepers, community helpers and partners and allies to connect with one another and support their well-being.

Successes and enablers of engagement

Workforce-Centred Relationship Building and Partnership

FPWC is founded on values and beliefs in community-driven, Indigenous-led, culturally based holistic mental wellness care and services. At the core of this work is a commitment to meaningful engagement that centres the knowledge and experience of the workforce in discussions, planning and policies related to supporting Indigenous mental wellness. The FPWC executive leadership, as well as the chief executive officer and staff members, have lived and/or worked in communities, with experience in front-line and Indigenous mental wellness healing. FPWC has teams of staff dedicated to addressing the needs and supporting MWTs and the IRS RHSP workforce, with direct engagement to identify challenges and opportunities for support. During the COVID-19 pandemic, the workforce maintained a strong willingness and desire for FPWC to continue to deliver specialized and tailored programs and resources. As such, FPWC and the workforce worked alongside each other, sharing knowledge, insight and feedback throughout the development and delivery of pandemic resources, training and online gatherings. FPWC's strong commitment to engage with and centre the needs of the workforce during the design and development of programs and policies by building upon existing organizational structures and relationships ensured the delivery of relevant activities and initiatives during the pandemic.

New Approaches for Accessible Engagement

The primary way in which FPWC was able to reach and engage with the workforce during the pandemic was by quickly transitioning and embracing technology as a means for connecting. While technical difficulties are inevitable, FPWC remained flexible, willing and open to learn and made changes when suggested by the workforce. Importantly, members of the workforce, keynote speakers, workshop leaders, Elders, knowledge keepers and partners who participated in the online sessions and gatherings also demonstrated patience and flexibility to adapt and learn new tools.

We learned that shifting to delivering activities and programs virtually can better accommodate the needs of an overworked, under-resourced workforce and improve the accessibility of resources. By providing workshops and training remotely, participants were not required to expend travel time to attend events in person, and the same could be offered to a larger audience. However, while more accessible to some, shifting to virtual connections also highlighted the need for equitable access to stable and reliable Internet and hardware in remote and northern communities.

Creating and Supporting Ethical Spaces for the Mental Wellness Workforce to Lead, Build and Sustain Relationships

The online training, resources and gatherings that FPWC hosted responded to the needs and priorities expressed by the workforce. Their lived experiences led the direction and development of activities. For example, areas of support identified during the biweekly support calls held in 2021 informed the topic areas and discussion for the subsequent learning series to directly address and share strategies to cope with the challenges of the pandemic. Creating spaces and opportunities to come together with the intention to listen and learn from the workforce promotes a strengths-based approach for nurturing and maintaining meaningful and respectful engagement grounded in reciprocity.

In addition to tangible professional outcomes of online sessions (i.e., coping skills, tools, resources), workshops, trainings and gatherings created a space and enhanced opportunities for members of the workforce to connect and build relationships with each other across and within regions. Rather than being limited to one community, workshops included participants from various communities across a region, who could share, validate and learn from their own and others' experiences of navigating the pandemic. While physical distancing and travel restrictions were in effect, virtual offerings reduced the sense of isolation many felt by connecting them with a network of like-minded people who were all working toward supporting their communities, thereby promoting wellness and capacity building from within.

Culture as Foundation

The success of many of the learning series and gatherings that FPWC hosted during the pandemic was facilitated by a focus on strengths-based approaches that are firmly rooted in culture – the foundation of promoting and supporting Indigenous mental wellness. During the pandemic, many members of the workforce were disconnected and displaced from the communities they worked with, and physical distancing and isolation made it difficult to carry out traditional and cultural practices. For instance, ceremonies and rituals that connect people with family, community and culture, such as those during funerals and burials, could not be held. While recognizing that virtual spaces cannot replace in-person gatherings, they offered an alternative way to share traditional knowledge and cultural practices, and to connect with Elders, cultural practitioners and cultural supports.

In 2021, FPWC held a three-day learning series, titled, Connecting to Our Traditional Knowledge to Support Wellness. This event included a panel discussion about the role of language revitalization in upholding Indigenous wellness, land-based teachings and workshops with Elders and other leaders. The National Gathering in 2021 celebrated how land-based programs and connecting with Indigenous culture, language and knowledge contribute to wellness, and also highlighted the strengths of the workforce to lead this work, especially given the challenges of the pandemic. The significant message that resonated throughout this event emphasized that Indigenous ways of being and doing are practices that had immeasurable benefits to support wellness within communities and the workforce during the pandemic. Members of our team shared that these and other events that brought culture to the foreground were some of the most powerful and meaningful moments of connection.

Conclusion

During the pandemic, FPWC saw our organizational reach and engagement extend and increase as participants in online training, learning series and gatherings invited colleagues and members of their networks to attend, and barriers to access were reduced. Rather than witnessing diminished connection, a new form of connection was fostered among teams within and across regions. Although challenges persist, many barriers in accessing personal and professional resources and supports were reduced. Despite high stress, workload and burden, members of the Indigenous mental wellness and trauma-informed specialist workforce reported many positive outcomes from participating in FPWC activities during the COVID-19 pandemic, including feeling validated and supported, building relationships with others and cultural connection.

The pandemic also highlighted some challenges and considerations while operating in a new virtual reality. Inequitable and unreliable Internet access, especially among northern and remote communities, must be addressed to share resources to build capacity and resilience and promote wellness. Questions also arose about the blending of technology and teachings, uncovering the need to identify wise practices related to sharing ceremonial, ritual and cultural practices virtually in ways that honour and respect their intentions and sacredness.

FPWC's commitment to building relationships facilitated the design and development of resources and initiatives that directly respond to workforce-identified areas of support. During the pandemic, relationships within and across regions among members of the workforce could be strengthened and sustained virtually, cultivating a network of support for navigating the pandemic. Meaningful engagement emerged from a foundation of culture that supports workforce wellness by building on cultural knowledge, teachings, ceremonies and practices. Given the multiple benefits to the workforce of offering online and virtual tools, resources and training, FPWC continues to maximize this approach to engagement, which better accommodates the needs of the workforce while building on Indigenous knowledge and cultural practices.

For FPWC, meaningful community engagement encompasses the Indigenous mental wellness and trauma-informed specialist workforce that often occupies the entangled role of community member and care provider. Importantly, engagement-capable environments, be it with patients, communities or community workers, are always situated within western worldviews and colonial ways of knowing and doing that are upheld by health education, systems and institutions. The Indigenous mental wellness and trauma-informed specialist workforce faces double exclusion from these systems that do not prioritize the health and wellness of Indigenous communities and individuals and undermine non-western approaches to care, including cultural models of care and healing. In order to respectfully and effectively address Indigenous wellness needs and priorities, healthcare systems and services must fundamentally shift their orientation of care to centre engagement with and for Indigenous communities, which involves empowering the wise practices and knowledge held by communities and the workforce. Such a shift rests on a commitment to reciprocal relationship-building and exchange at all levels of engagement and across the health system more broadly to recognize and enhance the strengths of cultural and traditional knowledge and healing practices. During the pandemic and beyond, FPWC has striven to model this approach and motivate structural and policy shifts by amplifying the voice of the workforce and promoting their needs through meaningful and respectful engagement grounded in reciprocity, in the hopes of creating a more balanced and equitable decision-making system that fosters resilience to withstand future shocks, wherein a well-supported workforce, families and communities can thrive.

Collaboration du First Peoples Wellness Circle et du personnel spécialisé en bien-être mental des Autochtones et en prise en compte des traumatismes pendant la pandémie de COVID-19

Résumé

Les membres du personnel spécialisé en bien-être mental des Autochtones et en prise en compte des traumatismes, dont les équipes de mieux-être mental (EMEM), les équipes de soutien en cas de crise, le personnel du Programme de soutien en santé – résolution des questions des pensionnats indiens (PSS-RQPI) et d'autres intervenants de soutien culturel, assurent souvent les soins primaires et d'urgence des personnes et des familles qui ont besoin de soutiens respectueux de la culture. Si leur rôle est fondamental, ces équipes rencontrent des défis particuliers découlant des séquelles du colonialisme et des systèmes de santé qui nuisent encore au bien-être mental et aux traditions culturelles de guérison des Autochtones. Pendant la pandémie de COVID-19, les taux accrus de maladie mentale et d'usage de substances psychoactives chez les populations autochtones ont essoufflé le personnel de bien-être mental, qui était déjà débordé et sous-financé. Le First Peoples Wellness Circle (FPWC) a recherché et adopté de nouvelles approches concrètes de mobilisation virtuelle afin d'améliorer et de préserver le bien-être et les capacités du personnel en encourageant des liens culturellement adaptés et fondés sur la culture dans tout le pays.

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