This research initiative, entitled Negotiating Change: Community-Based Mental Health and Addiction Practice in the Northwest Territories of Canada set out to explore how community mental health and addictions practitioners in the Northwest Territories (NWT) experience and respond to rapid socio-economic change in their professional practice. Qualitative in nature, the research consisted of personal interviews with 15 community-based mental health and addictions practitioners (counselors and a paraprofessional role called the community wellness worker) throughout the territory. As the front-line service providers who work in the NWT-wide Community Counselling Program (CCP), these practitioners were considered to have special access and insight into community life and trends in health and wellness.
Findings drawn from the thematic analysis of these interviews were categorized into three groups: (1) practitioner expressions of external changes related to the communities they serve, (2) internal changes related to the structure and function of mental health and addiction services in the NWT, and (3) practitioner views on what is needed for the future related to mental health and addictions services in light of all of these changes. Within these three categories, several key findings were identified as significant.
In brief, external community-related findings included practitioner reflections on changes in substance use patterns in northern communities, changes in community attitudes towards abuse disclosure, and the impacts of economic booms on people with mental health and substance use issues. Findings of an internal organizational nature included practitioner reflections on how recent changes to the way mental health and addiction services are structured and delivered to communities has impacted their work. Findings related to practitioner-identified needs for the future include the need for choice and flexibility in how services are delivered and the need for trauma-specific training and referral options.
In the discussion of the research findings, three key lessons were considered. These lessons focus on how social and economic changes affect NWT mental health and addictions practitioners and how to best move forward in light of these changes. A brief synopsis of this discussion is presented here:
Lesson #1: Social and Economic Change Affects Mental Health and Addictions in Northern Communities
An important lesson drawn from the research is that social and economic change is not always negative and that community experiences of change do not necessarily affect people in the same way. Practitioners’ observations of community changes with respect to substance use patterns, social norms around abuse disclosure and the effects of economic booms were a combination of positive and negative insights on changes taking place in community that affects their practice. Practitioners indicated that the issues are much more nuanced and may occur at the individual rather than community level. These are the most tangible expressions of rapid social and economic change on community mental health and addictions.
As well as these specific examples of change at the community level, almost all of the practitioners interviewed emphasized that unresolved pain or trauma is a root cause of problematic substance use or addictions. Practitioners did not explicitly make the connection between rapid social and economic change and their observations of trauma. However, other researchers have made this theoretical link, suggesting that trauma in the Canadian Indigenous context stems from the rapid culture change, cultural oppression, and social marginalization. Practitioners’ observations of trauma can be more clearly understood when related to the phenomenon of rapid change and its impact on mental health and addictions practice in this way.
Lesson #2: Internal Organizational Changes are an Expression of Socio-Economic Change and Affect Practitioner Interactions with Community
Overshadowing the discussion of socio-economic change, at times, was the emphasis many practitioners placed on internal organizational change. This discussion was related to the structure and function of mental health and addiction services and the effect these organizational changes have had on their practice. The focus on internal organizational issues demonstrates the significant impact that policy has on practice. It also suggests practitioners’ experience on the job is more a product of the workplace environment than the community environment. While outside forces of change may greatly impact their clients, it is practitioners’ interactions with internal organizational change that really shapes their experiences as helping professionals. This is perhaps because internal organizational changes, such as restructuring of programs and services, are so much closer to them and their “real lives” than some of the larger system changes brought about by shifts in the social and economic landscape. Practitioners are directly affected by these sorts of changes, so they are the ones that first come to mind as influencing practice when asked about change.
Practitioner discussions of organizational change reveal how standardizing mental health and addiction services changes the role of the practitioner vis-à-vis the community. Prior to the implementation of the Community Counseling Program across the NWT, practitioners carried out their counseling and wellness work as part of NGOs and community councils. Under the community-run system, some communities were very well served while others did not have adequate services in place. In recent years, the GNWT has achieved their goal of creating a standardized mental health and addiction program across the territory by assuming the role of service provider in place of the community-run services. By standardizing this front-line occupation the GNWT has placed boundaries on this role, which practitioners conceived in both positive and negative ways. Internal organizational change, it seems, is having just as much of a mixed effect on practitioners as external community changes are having on northern residents.
These days, practitioners must navigate two worlds. They must be bureaucrats, meeting set standards and regulations. Yet, to be effective, they must also gain the trust of clients by engaging in the community life. Performing the role of bureaucrat too well may prove a handicap in meeting community needs. Practitioners also emphasized the critical importance of earning the community’s trust and respect. They saw this as the foundation of effective counseling in the north. This view is consistent with research conducted on health care provision in other northern Canadian Aboriginal communities. It follows then that practitioners take every opportunity to establish themselves, giving people a chance to get to know them. In the northern Aboriginal community context, this means being visible at community events and in some cases, making unsolicited house calls. Given the importance of trust and cultural competency in the effective delivery of health and social services to northern communities, should we not be doing everything we can to get our mental health and addiction professionals integrated into community life? Mental health and addiction services can be professionally and accountably delivered, but also responsive and sensitive to the unique traditions and context of life in small communities in the north.
Lesson #3: There are Ways to Move Forward Together
The community counseling program may be a government invention, but there are ways for NWT communities to make it their own. Practitioners spoke of the need for more local involvement in community-based service delivery; several mentioning how they would like to see more local people trained as counselors. They also see room for greater community direction in terms of how services are structured and delivered, such as the inclusion of more on-the-land type of activities. Together, these findings create a picture of a system that is looking for more community engagement.
Comments made by practitioners indicate that in addition to helping professionals who are local to the community they serve, those from elsewhere also have important roles to play. A diversity of practitioners is valuable in terms of providing residents with options as to who they can interact with. It is also necessary given the current paucity of skilled helping professionals from the smaller communities. This mixed workforce needs to be supported to (1) increase the cultural competency of those who are not indigenous to the communities they serve, and (2) continue their professional development so that eventually, those working in a paraprofessional community wellness worker role might be equipped to take on more counselling responsibilities. The goal of greater Aboriginal leadership in these areas of healing was a goal expressed several times by participants in this research as the only long-term solution to the constant issue of staff-turnover.
To be relevant and effective, the community counseling program also needs to take into consideration local culture and context. This sentiment was expressed repeatedly by practitioners interviewed for this thesis. Improvements will be seen in a practitioners’ familiarity with emerging issues in their communities and their ability to outreach to a variety of residents if they are encouraged to have a flexible work environment. This includes being able to meet people on their own terms, at a variety of different locations, at a variety of times throughout the day. This also could mean providing more cultural competency training for those individuals working in northern communities who are not Indigenous to the region so that they can better understand the social and historical context of they are working in.
This is a brief summary of findings and discussions emerging from the IPY GAPS Negotiating Change study. For more information on this research initiative, or to request a complete copy of the Masters thesis from which this research synopsis was extracted, please contact Alana Kronstal at firstname.lastname@example.org
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