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By: Earvin S. Tio

Louis Busch is a Community Support Specialist with Shkaabe Makwa, a centre within the Centre

for Addiction and Mental Health (CAMH) designed to drive culturally-responsive systems initiatives to achieve health justice and wellness for First Nations, Inuit, and Métis communities. Louis is a Bear Clan member of the Nisichawayasihk Cree Nation, a community in Northern Manitoba. He has been a mental health clinician CAMH for 15 years and with Shkaabe Makwa for the past four. Louis is a board-certified behaviour analyst and a registered psychotherapist, is currently pursuing his doctorate in Adult Education and Community Development at the Ontario Institute for Studies in Education of the University of Toronto and is currently completing a visiting fellowship at Harvard University.


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Louis Busch, a Community Support Specialist for Shkaabe Makwa

The Shkaabe Makwa Centre for First Nations, Inuit, and Métis, the first hospital-based centre of its kind in Canada, gets its name from the Anishinaabemowin words for help- er (Shkaabewis) and bear (Makwa). A helper can often refer to a ceremonial helper - one that provides support to Elders and knowledge keepers in ceremony but can also refer to spirit helpers. The bear is an important figure for many First Nations and is often traditionally seen as a healer, medicine keeper, and protector. Together, Shkaabe Makwa translates to Spirit Bear Helper.

Shkaabe Makwa focuses on patient care, evaluation, workforce development, provincial systems initia- tives, research, and reconciliation, to name a few. As a Community Support Specialist, Louis supports the workforce development team by providing tailored training for First Nations, Inuit, and Métis helpers. These can include materials on trauma-informed care and essential counselling skills for helpers such as case managers, crisis workers, addictions workers, and educational assistants. Shkaabe Makwa is dedicated to providing culturally relevant and safe services for First Nation, Inuit, and Métis and to supporting helpers who walk with others on their healing journeys.

On Hope and Resilience

In an interview between Louis and knowledge keeper and helper Ron Linklater at the Linklater family camp in Saskatchewan, the topic of mental illness and its etymology in Anishinaabemowin or Nêhiyawêwin was discussed. Louis shares Ron Linklater’s words: “‘There really isn't a clear word for mental illness, but the word I can think of is bagosendan,’ which translates to hope.” Louis continues, explaining that one word carries so much com- plexity and meaning and has much to do with the heart. Indigenous languages, teachings, and cultures focus on the strengths and gifts one brings as opposed to deficits and pathology that often define Western Eurocentric medicine, especially in psychiatry. This is evidenced by Ron Linklater’s words and his re- defining of illness in terms of hope. Louis expands on this pathology-based model which he is tradi- tionally trained in, stating that it can at times find itself in conflict with Indigenous wellness frame- works. This discord complicates the engagement of First Nations, Inuit, and Métis with Eurocentric health systems, as these systems can con- flict with core Indigenous values. This often results in First Nations, Inuit, and Métis avoiding health- care systems entirely. This mistrust is unfortunately well-earned; med- ical, educational, and social service systems and academia have and continue to play a significant role in colonial harm. Examples include unethical experimentation on In- digenous peoples, and the residen- tial school system has left a legacy of distrust in many communities. Louis comments that even younger generations who may not directly identify the source of their discom- fort and mistrust are averse to engaging with these health systems as a result of this persisting generational conflict and trauma. He shares, “Hope is at the centre of an Indigenous wellness framework.” First Nations, Inuit, and Métis com- munities are not one conglomerate; with approximately 80 different languages and 800 distinct nations across North America, each with its own governance systems, histories, and spirituality, one cannot claim or prescribe a singular Indigenous perspective. However, Louis believes that commonalities exist across

these diverse Nations, especially concerning wellness. These include a wholistic view of what it means to be human and to be well, a focus on interconnectivity and a reality rooted in the physical world, and a coherence across emotional, spiritual, physical, and mental parts of the self. It is in the compartmentalization and imbalance of these components that challenges can arise; thus, returning one to balance is integral to Indigenous wellness per- spectives and corresponding inte- grated health approaches practised by communities, Elders, traditional healers, and knowledge keepers. With these guiding principles, Shkaabe Makwa integrates a focus on resilience, resistance, and resur- gence in a psychiatric hospital like CAMH as opposed to a deficit-focused view. Traditional medicines and helping practices are brought to the forefront of patient care with a level of self-determination for First Nations, Inuit, and Métis in how culturally-informed services are accessed, delivered, and evaluated.

On Reconciliation

Traditionally, land acknowledgements serve as a way to acknowledge the space and place one is in and are particularly important when one is a visitor. Unfortunately, they have recently taken on a performative role in mainstream perceptions around reconciliation. Shkaabe Makwa’s guiding principles on Honouring the Land and Ancestors through Land Acknowledgements encourage visitors to transform the experience into something deeply personal, focusing on personal and familial experience on the land, exploring views of ancestry, and the benefits and struggles that one experiences as a settler - especially as their experiences relate to colonisation. CAMH has set a leading example in bringing First Nations, Inuit, and Métis mental health to the forefront. This was made possible by strong support from leadership, who to- gether with Indigenous commu- nities, have integrated Indigenous healing practices and philosophies into clinical settings. However, hav- ing traditional healers, known as Cultural Care Practitioners, as staff in a medical model did not come without challenges. As Louis puts it, “To bring a sweat lodge onto the grounds of a of one of Can- ada’s oldest psychiatric hos- pitals is a pretty big deal.” He also points out that work around reconciliation must be congruent with action. Reconciliation can- not solely be approached passively; personal reflection, cultural humil- ity, and acknowledging the land are important concepts to engage with. Nonetheless, if the social determi- nants of health and the disparities in healthcare quality and accessi- bility continue to harm Indigenous peoples across the country, then reconciliation is nothing but a per- formative band-aid solution. Louis describes a resurgence and resis- tance that accompanies reconcilia- tion and resilience. He believes that “there's a really great opportunity for First Nations, Inuit, and Mé- tis and non-Indigenous allies to work together in a way that really respects and understands that we are dealing with two very different world views that can come togeth- er in a respectful way for the ben- efit of people who need healing.”

On First Nations, Inuit, and Métis Mental Health

Reflecting on another teaching from Ron Linklater on “the capacity of binding together,” Louis shares that treaties between two Nations are sacred agreements and that treaties are meant to facilitate two-way ex- changes that bind the best of both parties together for the benefit of all. Historically, this philosophy had not been upheld by the Canada’s government. Moving forward, Western healthcare systems can take the opportunity to learn from Indigenous approaches to wellness by considering the individual body and mind in a broader context including land, policy, and government. Louis shares, “At the core of Indigenous suffering is the impact of colonisation and the larger sys- temic factors. If you focus on individual-level health, you ignore and let the systems that perpetuate that suffering off the hook.”

“At the core of indigenous suffering is the impact of colonisation - the larger systemic factors.
If you focus on individual-level health, you ignore and let off the hook the systems that have perpetuated that.”

These systems can offer hope and resilience to First Nations, Inuit, and Métis considering each individual in the context of their family, community, land and place they occupy as “inseparable parts of their wellness.”

Edited by Paul Jerome Gamueda