The Mental Health of First Nations Children in Manitoba: A Population-Based Retrospective Cohort Study Using Linked Administrative Data

BY Dr. Mariette Chartier

Indigenous children worldwide are at risk of experiencing mental health problems due to historical, intergenerational and societal reasons, yet we know relatively little about their mental health. The Truth and Reconciliation Commission of Canada (https://www.rcaanc-cirnac.gc.ca/eng/1450124405592/1529106060525) called for frequent reporting of First Nation’s people health in order to keep the Canadian government and broader Canadian society accountable. Of note, the term First Nations people in Canada refers to Indigenous peoples who are registered members of a band. Given this gap in knowledge, First Nations people and their allies from the University of Manitoba created a research team to examine the mental health of both First Nations children and other children living in the Canadian province of Manitoba.

The partnership approach that we used merits highlighting. Researchers from academia and co-principal investigators from First Nations organizations collaborated in all aspects of the study. This facilitated the linking of the First Nations registry of children, 6-19 years old, held by the Canadian government and health and social data sources housed by the Manitoba Centre for Health Policy (https://umanitoba.ca/manitoba-centre-for-health-policy/) These data were linked together using 9-digit numbers that none of the research team could unscramble to identify any single child. In addition, the research team worked closely with Indigenous Knowledge Keepers from the five main cultural groups in Manitoba. Knowledge Keepers are respected Elders with knowledge about Indigenous values and traditions. These Elders provided guidance and ensured that the findings were understood appropriately.

Although not completely surprised with the results, the research team was disheartened by the large disparities between First Nations children and all other Manitoba children. Compared to other children, First Nations children had rates of schizophrenia that were 4 times higher, substance use disorder was 5 times higher, attention-deficit hyperactivity disorder was 1.2 times higher, hospitalization for suicide attempts were 7 times higher and deaths by suicide were 10 times higher. We wondered if the gaps were because of economic reasons, so we compared the rates of mental disorders of First Nations children to only those comparison children living in low-income areas. The gap narrowed between the two groups, however remained unacceptably large. Finding this remaining gap - despite accounting for income - told us that other factors must be responsible. Some of these factors likely include discrimination, racism, the legacy of residential schools and too many children taken into care by the child welfare system.

The Knowledge Keepers shared with us that the study results were consistent with their observations and were explained by intergenerational impacts of destructive policies. According to the Knowledge Keepers, even today the children are continuing to contend with unsafe homes, unsafe drinking water, lack of health care, unresolved trauma and the impacts of colonial policies intended to destruct rather than to build and empower. To address these disparities, the Knowledge Keepers called for improvements of the health care system so that children have equitable access to health services free of racism and discrimination; equitable funding to the education system including support for land-based models, culturally appropriate models and assessments and full language immersion programs; and child welfare supports and services planned by and put in place by First Nations people and discontinuation of colonial practice of child removal. Fortunately, effective programs and services are currently being carried out by First Nations people and their allies to improve the health of their children. A few examples of these initiatives include: home visiting programs (https://bettercarenetwork.org/sites/default/files/2020-02/1-s2.0-S0190740919309788-main.pdf), school-based mental health programs (https://europepmc.org/article/med/31558456), primary care models located in First Nations communities. (https://ojs.lib.uwo.ca/index.php/iipj/article/view/8334). The First Nations Health and Social Secretariat of Manitoba (https://www.fnhssm.com/copy-10-of-new-page) is involved in a myriad of initiatives.

This study found higher rates of mental disorders and higher suicide rates among First Nations children compared to other Manitoba children. These study findings along with the Knowledge Keepers’ calls to action demonstrate that equitable access to culturally safe services is urgently needed to improve the well-being of First Nations children.