The public-health community must be prepared to deal with the "emotional burdens" of a national inquiry into missing and murdered indigenous women, which will likely increase mental-health issues such as depression, suicide and addiction among those who participate in the process, says a new editorial in the Canadian Journal of Public Health.
And that help should go beyond "fly-in" teams mobilized when communities are deemed to be in crisis, the editorial says.
"We can improve upon the commonly one-time situational supports that have been offered to residential school survivors and their families by Health Canada during Truth and Reconciliation Commission events and processes," says the editorial, which was published in the December, 2016, issue. "Engagement over time with a skilled and trusted counsellor is preferred by clients addressing mental health and addictions issues, and improves outcomes," the editorial says.
"Such a relationship can provide the opportunity for clients with a history of disrupted and abusive relationships to learn how to be in more balanced relationships that are sustained over time."
The editorial was written by Dr. Janet Smylie, a Métis physician and researcher at St. Michael's Hospital in Toronto, and by Magen Cywink, an Anishnabe woman who has become an advocate for missing and murdered indigenous women since her sister, Sonia Cywink, was murdered in 1994. In the editorial, the authors say the "emotional burdens and triggers" of the inquiry are likely to result in an increase in mental-health issues and that there is a "pressing need" for mental-health counselling and support across the country to deal with those concerns. "It's predictable that there is going to be re-traumatization but there is an opportunity to provide these services, to build them in," Dr. Smylie said Tuesday.
Without that, she added, "It's like we are having a whole bunch of people who are about to have heart attacks, and we're asking them to run a marathon – and there's no paramedics or cardiac specialists to help them."
The authors recommend "community-led social safety nets" that could include, for example, lists of indigenous people who have been pre-screened and are willing to offer peer support.
"The impact of what the missing and murdered [indigenous women] issue has been for the last 30 years has never really, in my personal opinion, been effectively dealt with – in terms of how families have not been able to deal with this," Ms. Cywink said.
"There's no attention being brought to how families are not dealing with this … if you never deal with the underlying issues of that grief and that loss, it just seems to have a life of its own," she added.
As families wait for the inquiry to get under way, anxiety is building, Ms. Cywink said. For some people in small or remote communities, that anxiety could include worries over whether suspected perpetrators might attend inquiry sessions, she added.
The federal Liberal government announced in December, 2015, the launch of a national inquiry to look at the disproportionate rate of violence against indigenous women.
Over the following months, a pre-inquiry process was held to seek input on the design and scope of the inquiry.
The final report from that process, released in May, 2016, included a recommendation that "health supports that are culturally sensitive and appropriate must be available at all stages of participation, including aftercare. Trained professionals and elders, along with existing support workers, should be available to participants."
And a note on the inquiry's current website says, "The emotional well-being of the families who have lost a loved one is at the heart of this National Inquiry. … We are ensuring that the National Inquiry is done in a way that is trauma-informed and culturally appropriate."
Five commissioners and the terms of reference were announced in August, 2016.
The commissioners are expected to submit a final report by the end of 2018.