Guest Blogger: Syeda Shanza Hashimi (University of Ottawa, Faculty of Medicine)
Tracing back a number of years, medical students have chosen a plethora of topics to dedicate advocacy and research efforts. Whether it be in targeting clinical issues affecting society, social climates needing exposure and reform, or healthcare in Canada generally, these topics seep into all aspects of the determinants of health.
The Canadian Federation of Medical students (CFMS) is a body that represents over 6000 medical students in Canada. Annually, CFMS holds their Day of Action (formally known as Lobby Day), where medical students travel to Ottawa to participate in advocacy training and meetings with Parliamentarians for a nationally chosen topic . This year, the topic was Indigenous Mental Wellness, inspired by the position paper released in 2017, “Mental Health & Suicide in Indigenous Communities.” This paper, created by medical students across the country, highlighted a number of issues that are still prevalent, namely the significantly higher mental illness and suicide rates .
In order to guide the federal response to the Indigenous suicide crisis, and direct Health Canada and Indigenous Services to increase funding for preventative and land-based wellness programs , students across Canada were selected as delegates. Acting as CFMS representatives, these delegates worked extensively with Indigenous community leaders to make preparations, research, and hold consultations with the aim of advancing these policies.
Speaking as a second-year medical student and current National Officer of Health Policy, I can say that there has not been much educational exposure to this issue. It appears as an elephant in the room, one that many seem to acknowledge briefly, but then forego.
Nevertheless, for more than 70 passionate delegates from across the country, a decision was made to actively advocate for the rights of aboriginal peoples, and to urge specific changes to the funding currently supporting Indigenous programs. In order to enter into these difficult conversations and discussions, these students had to dive into the troubling history of aboriginal peoples (First Nations, Inuit, and Métis), for only then were we able to begin to translate our knowledge into action.
Following 25 years of negotiations, the UN General Assembly on September 13th, 2007, 143 countries voted to adopt the United Nations Declaration on the Rights of Indigenous Peoples. In Canada, the Federal government formally endorsed the UN Declaration on November 12th 2010, through its commitments to the Truth and Reconciliation Commission (TRC). Accordingly, this commission published a “Call to Action” report, consisting of 94 recommendations the government took on as their mission . Much of the content in the Declaration involves commitments to Indigenous rights, by securing strength in self-government, maintaining distinct political or cultural institutions, ensuring informed consent, approval, and fair compensation for any approval of projects for traditionally owned lands/resources -as well as land that has already been taken or damaged prior to such right-, determining identity, recognizing treaties, and relinquishing populations from discrimination . To achieve these goals, the Canadian government has allocated resources to interpret and act on the report’s recommendations.
Despite this commitment, there remains a significant amount of mental health issues in Indigenous populations. This stems from trauma and cultural losses as a consequence of colonization, creating a ripple effect that has seeped into younger generations. For example, memories of Residential Schools, operating from late 1800s to the 1960s, whereby children were separated from families and their roots, created rifts in cultural identity, resulting from an inability to in participate in traditional activities. Many children within these schools also experienced emotional, sexual and physical abuse, and often internalized these traumas upon returning to their homes . This history is now an ingrained part of the story of Indigenous people in Canada, it looms over and colours the ancestral lands they continue to call home, and years of bearing its weight tells a story of great resiliency and courage. Today, members of these communities continue to fight for their land, their identity, and their future.
However, even with the abolishment of Residential Schools and Canada’s commitment to the TRC’s recommendations , a lack of access to adequate resources, professional and educational opportunities, and political autonomy has acted as a catalyst contributing to the ongoing deterioration and disconnection of Indigenous communities. Despite federal reconciliation efforts, there remain significant issues mental health concerns in First Nations and Inuit communities . The community of Neskantaga in Northern Ontario declared a state of emergency on April 17th, 2013 “…following two suicides in less than a week and 20 suicide attempts over the previous year” ; Inuit communities experience suicide rates estimated to be 11 times higher than the general Canadian population ; and the national rate of suicide among First Nations communities is approximately double that of the general public .
With the passing of Bill C-262 (April 2016)  and public endorsement of the United Declaration on the Rights of Indigenous Act, there is now a nation-wide call in Canada for alignment of Canadian laws with that of the UN Declaration on the Rights of Indigenous Peoples. With this, as well as other federal initiatives aimed at forming a legislative framework in keeping with such provisions, medical students looked at adopting the First Nations Mental Wellness Continuum Framework and the National Inuit Suicide Prevention Strategy to address these two populations’ mental health and suicide rates. Students were also to undertake a comprehensive review of current distribution of funding through the National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) .
In addition to learning about the nature of funding for these programming initiatives, as well as logistical and legal considerations, students engaged in extensive consultation with community leaders for an appropriate account of personal experience. A proportion of delegates were also Indigenous students, who contributed their own personal and professional efforts toward the Day of Action. Students met with Parliamentarians and posed questions, received feedback, and established a follow-up process to ensure something was being done. Students were also assigned to meet in pairs or alone, and were provided a day of training beforehand to review all relevant documentation and participate in group discussions.
The social media outreach of Day of Action was tremendous. Along with the “Thunderclap” campaign and incredible Twitter coverage, 91, 455 people were reached. Delegates were encouraged to spread the word the word and encourage discussion.
In the collected reflections of delegates, many comments described the opportunity to meet with MPs, professionals and students across the country as inspiring. Similar interests and a drive for activism motivated students to unite on a single day, where all their work and preparation served them well in advocating for Indigenous mental well-being. Time and energy was spent to ensure that students were well-prepared and equipped to support their claims and pose their difficult questions, and to propose alternative strategies to address this nationwide issue.
Students established professional relationships to ensure there was a follow-up process after the meetings. While some students were exposed to difficult realities in having these discussions, for the most part, students received a positive response from their questions, and perceived an overarching desire to support ongoing efforts for Indigenous mental wellness. Some students hit hard obstacles, where they found their points were not being considered, or were confronted with a lack of knowledge from the specific Parliamentarians , making higher level advocacy a harder target to achieve. In such cases, these students left the room with a belief that they tried their best. “And I think we planted a seed” (Day of Action Delegate), a good analogy in the efforts that took place Monday, February 12th on Parliament Hill. By voicing pertinent issues, strategizing action plans for improvement, posing difficult questions and conversing through months of research and consultation, students started something they will continue to push forward. As a united nation, we stand forward for what is right and true.
 CFMS (2018) CFMS Day of Action on Indigenous Mental Wellness. Retrieved February 16, 2018 from: https://www.cfms.org/news/2018/02/03/the-cfms-national-medical-student-day-of-action-on-inidigenous-mental-wellness.html
 (2017) Mental Health & Suicide in Indigenous Communities. Retrieved February 16, 2018 from: https://www.cfms.org/files/position-papers/sgm_2017_indigenous_mental_health.pdf
 (May 2016). The United Nations Declaration on the Rights of Indigenous Peoples- Moving Forward. Retrieved February 16, 2018 from: https://hillnotes.ca/2016/05/25/the-united-nations-declaration-on-the-rights-of-indigenous-peoples-moving-forward/
 Truth and Reconciliation Commission of Canada (2012). Calls to Action. Retrieved February 16, 2018 from: http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Calls_to_Action_English2.pdf
 Bill C-262. House of Commons of Canada. Retrieved February 16, 2018 from: http://www.parl.ca/DocumentViewer/en/42-1/bill/C-262/first-reading
 Kielland, N and Simeone, T. (2014). Current Issues in Mental Health in Canada: The Mental Health of First Nations and Inuit Communities. Retrieved February 16, 2018 from: https://lop.parl.ca/Content/LOP/ResearchPublications/2014-02-e.pdf
 Oliver, L., Peters, P., and Kohen, D. (2012) Mortality rates among children and teenagers living in Inuit Nunangat, 1994 to 2008. Retrieved February 16, 2018 from:http://www.statcan.gc.ca/pub/82-003-x/2012003/article/11695-eng.pdf
 Public Health Agency of Canada. The Mental Health and Well-Being of Aboriginal Peoples in Canada. Retrieved February 16, 2018 from: https://www.canada.ca/en/public-health/services/reports-publications/human-face-mental-health-mental-illness-canada-2006/mental-health-2006.html