Review Article

A scoping review of evaluated Indigenous community-based mental wellness initiatives

AUTHORS

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Jeyasakthi Venugopal1
MPH, Graduate Research Trainee

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Melody E Morton Ninomiya2
PhD, Assistant Professor and Affiliate Scientist *

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Nadia TG Green3
MN, RN, Knowledge Exchange Coordinator

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Laura Peach4
MA, Project Coordinator

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Renee Linklater5
PhD, Director

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Priscilla (Ningwakwe) George6
Project Coordinator

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Samantha Wells7
PhD, Senior Director, Associate Professor

AFFILIATIONS

1 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada

2 Health Sciences Department, Faculty of Science, Wilfrid Laurier University, Waterloo, Ontario, Canada; and Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada

3 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; and Shkaabe Makwa, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada

4 School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada; and Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada

5 Shkaabe Makwa, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada

6 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; and Saugeen District Senior School, Southampton, Ontario, Canada

7 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; and School of Psychology, Deakin University, Victoria, Australia

ACCEPTED: 12 January 2021

A scoping review of evaluated Indigenous community-based mental wellness initiatives


early abstract:

Background: Many Indigenous Peoples around the world are disproportionately affected by mental health challenges, due to intergenerational and collective trauma stemming from historical losses and ongoing colonialism. A growing body of literature suggests that mental wellness initiatives are more culturally safe and result in more successful and sustainable outcomes when they are developed for and with Indigenous communities using community-driven approaches that prioritize and privilege Indigenous leadership, knowledge systems, beliefs and practices. However, knowledge has not been synthesized on mental wellness initiatives and the extent of community engagement during the development, implementation, and evaluation stages of these initiatives.
Methods: We conducted a scoping review of studies on Indigenous community-based mental wellness initiatives to (1) identify the characteristics of these initiatives; (2) identify the types of evaluation approaches (specific measures and assessment tools); (3) level of community engagement from inception to the evaluation stage of the initiative; and (4) lessons learned as identified by the authors. Published and grey literature were searched across multiple electronic databases. Inclusion criteria required that the study was published between January 2008 and June 2018; focused on Indigenous Peoples and their communities in Canada, US, Australia, and/or New Zealand; focused on a community-based mental wellness initiative; was meaningfully co-led or co-designed by the community; described the initiative and how it was evaluated; and was printed in English.
Results: The search yielded 1,491 unique articles and 22 of these articles met all of the inclusion criteria. All included studies took place in Canada, the US, or Australia. Most mental wellness initiatives addressed general mental wellness, substance use, suicide prevention, and/or co-occurring conditions and many were tailored for Indigenous youth. Culture-based initiatives were emphasized in most studies, with cultural adaptation and relevance prioritized in all initiatives. Approaches to evaluation ranged from process evaluations to outcome evaluations. Most studies used a mixed methods approach and a wide range of assessment tools, including questionnaires and indicators of community capacity building. Many evaluations used a shared leadership model between community leaders and researchers and had combinations of community members, families, Elders, knowledge keepers, and leaders involved in the development, implementation, and evaluation of the mental wellness initiative. Common challenges in conducting evaluation research included limitations of funding structures and the burden on community staff and leaders during the project.
Conclusions: Overall, across all studies, culture stood out as a major theme for community-based mental wellness initiatives among rural and remote Indigenous communities, with cultural teachings, cultural activities, appropriate use of culture, land-based programming and knowledge sharing integrated into community programming. However, culture and Indigenous leadership throughout was lacking in many of the research studies. Thus, as more Indigenous communities and leaders govern and guide the development of evidence-based mental wellness programming, culture as a form of healing needs to be incorporated into the development of the program and culture should be a core competency in any evaluation research.