Partnership with Douglas Hospital is mending minds and fences

November 17, 2011 by admin

Once every month Dr. Janique Harvey boards an Air Creebec plane for a flight into another world. She’s off to the Cree territory on the eastern shore of James Bay, where she spends a week ministering to clients with mental health problems.

This article was originally published in Share & Care, the newsletter of AMI-Quebec - Action on Mental Health.

The connection has its roots in a Quebec government program called Réseau Universitaire Intégré de Santé (RUIS). Begun in 2003, it divided the province into four sectors and gave each of the province’s medical schools responsibility for one of them. McGill’s sector, which includes the Cree and Inuit territories, is the largest of the four. An agreement between the Cree and the Douglas spells out the services the hospital will provide, both up north and in Montreal. Harvey is a trans-cultural psychiatrist who trained at McGill and in Africa.

She was hired in 2008 to run what the Douglas calls its supra-regional team, meaning services are provided outside the hospital itself. “The area is called region 18,” she says, “and I’m responsible for nine communities there.” The largest has a population of 4,000, the smallest, 400. Roads built in the ’70s opened up eight of the nine. Only Whapmagoostui, the northernmost, remains isolated. Harvey needs a plane for that trip. She only has time to visit two or three communities in a week, which means a client sees her once every four months. Locally based professionals fill in between visits. A psychologist makes the rounds regularly and social workers hold workshops. It may not be ideal, but it’s better than it once was. Harvey’s heavy schedule continues back in Montreal with external follow-ups and an outpatient clinic. All day every day there are calls to and from healthcare workers in the territory.

The Cree Board of Health and Social Services of James Bay manages medical and social services in region 18. These jobs are held by residents living there permanently. Today a program is in place to encourage and train natives as healthcare professionals. There’s a Cree doctor now and more than 10 Cree nurses. Nurse Mary-Louise Snowboy has worked with Harvey from the beginning, introducing her, acting as her interpreter and giving her a crash course in Cree life.

A toxic legacy

The predominant mental health problem Harvey sees is post-traumatic stress disorder, a direct result of the era of residential schools, which Cree students were forced to attend. They were forbidden to speak their language or celebrate their culture and often became the victims of physical, mental and sexual abuse.

So deep were their wounds that a trans-generational trauma has developed. “The original trauma was never treated,” says Snowboy. “Students became mentally fragile and unable to cope with problems as they grew older. The tragedy of our elders has passed down from generation to generation.” Much of the domestic violence, depression, suicidal thoughts and alcohol and drug abuse that exist today can be traced to the same source.

Before the agreement with the Douglas, a psychiatrist only turned up sporadically and not in every community. Anyone with a full-blown psychosis would be sent to Montreal for an indeterminate hospital stay. Once back home, there was little if any followup and patients would slip through the cracks. People were wary of Harvey when she first arrived, afraid that if they agreed to meet with her they would be automatically sent away.

Harvey and Snowboy have worked to break down social barriers and increase the awareness and understanding of mental illness. They’ve screened movies and discussed them after. They want to add mental health information to community websites. They’re also exploring ways to be able to treat more people up north.

Family benefits

Close families are a Cree tradition, and while that’s no longer always the case, the family unit generally remains strong. This benefits a relative who develops a serious mental illness. “Families willingly care for their ill relative as long as they understand the diagnosis,” says Snowboy. “I explain that illnesses that cause psychosis can be controlled with medication. Once that idea gets through, they’re supportive. Their relative still plays a role and remains very much a part of the family.”

The Cree approach to illness is complex, as Harvey learned. “It’s not unusual that a belief can be cultural, religious and scientific all at the same time,” she says. “Someone can understand psychosis as a biological problem, see it in spiritual terms and also describe it as a gift, a special talent. We have to reach those three visions and respect them if we want to help the client.”

The agreement with the Cree runs for three years before it’s up for renewal. Despite the growing pains, there have been successes. “The James Bay area is huge, but our clients don’t get lost in the system. Whether they see a doctor in the territory or in Montreal, we’re in control,” notes Snowboy. She’s based in Chisasibi, where the regional mental health office is located. She hopes that before too long there’ll be a mental health worker in every community.

“I think ours is the only native program tied in with a specific hospital and with one psychiatrist in charge,” Harvey says. “I’m now following at least 200 clients. That’s a positive sign.” She dreams big, imagines the Douglas with a dedicated program to help all the native groups of northern Quebec. With their respectful approach to healthcare, the Douglas is not only treating mental illness, it’s encouraging the Cree back from a very dark place.

The new Cree confidence

Her mother and aunt were hospital workers. Now Marie-Louise Snowboy has gone a step further. A  graduate of John Abbott College in 1993, Snowboy is the clinical nurse for mental health for nine Cree communities. She’s part of the Cree wish to participate in today’s world — and still remain Cree. They’re reviving traditional values and ceremonies. Children are being taught to speak and write the language. As a role model for youth in the territory, Snowboy is the face of a better future in the north.