Resilience, empowerment, and interaction: the need to provide culturally appropriate tools to respond to mental health issues for Quebec's Indigenous populations

Mental health interventions in First Nations and Inuit communities frequently rely on the use of psychometric questionnaires that are often not well received by Indigenous patients. They have reported preferring tools that promote resilience and empowerment and allow for a real dialogue between the stakeholder and themselves. Therefore, it is important to develop culturally adapted instruments that correspond to the values, language, and reality of each population.

A Douglas Research Centre team, led by Dr. Outi Linnaranta and Dr. Liliana Gomez Cardona, worked with members of the Mohawk and Inuit communities living in Montreal. For this project, the research team actively collaborated with partners from the Kahnawake Shakotiia’takenhas Community Services, the Kahnawake Schools Diabetes Prevention Project, the Mohawk Council of Kahnawake, Ullivik Centre and LaLouve Consulting. Ethical approval to conduct this project was obtained from the Onkwata’karitáhtshera Health and Social Services Research Council of Kahnawà:ke and the Research Ethics Board of the Douglas Mental Health University Institute.

 The primary objective of the study was to develop culturally adapted versions of psychometric tools commonly used in psychiatry.  Assessment tools that focus on patients' symptoms with numerical scales to quantify the severity of symptoms do not correspond to traditional perspectives on health within these populations. Such numerical questionnaires that focus on symptoms are not considered safe and secure, and therefore do not help the therapeutic process in these communities.

Dr. Linnaranta and her collaborators conducted a study to better understand the shortcomings of standard psychometric tools and to explore the characteristics of tools that are culturally adapted to Indigenous patients. Through focus groups, various stakeholders, including healthcare providers and representatives of the Mohawk and Inuit communities, provided feedback on a number of standard and newly-developed psychometric tools. 

These consultations revealed that tools that focus on individuals' resilience, rather than negative symptoms, were considered adequate and necessary. In particular, the Growth and Empowerment Measure was singled out among the many tools offered. It contains elements that capture the attention of participants (e.g., culturally significant symbols), contribute to introspection, and encourage self-confidence and empowerment. It also includes issues that are not only centred on the individual but that also consider family and community aspects. This instrument is particularly promising because it could be easily adapted to local cultures and could facilitate communication between the healthcare providers and the individuals.

“One thing that stood out to me is this GEM one because I really like the balance; it includes the resilience and a lot of the good stuff too. A lot of time when we look at our measures, I don't think there’s too much in there that talks about what is it that you have as a resource for yourself to be able to assess those kinds of things about what’s good and what kind of things that are positive in their life”.

This study found that psychiatric assessment and mental health tools need to be adapted to the specific cultural needs of Indigenous populations. This requires developing tools that are not only focused on measuring symptoms, but that allow patients to progress and to communicate with the healthcare provider. These results pave the way for the development of new culturally appropriate tools and evaluation practices.

This project would not have been possible without the participation of community partners. The work was funded by the Fonds de recherche en santé du Québec (FRSQ), Réseau universitaire intégré de santé et services sociaux (RUISSS) McGill,  the Canadian Institutes of Health Research (CIHR) and the Réseau Québécois sur le suicide, les troubles de l’humeur et les troubles associés (RQSHA).