Report on Systemic Disparities in Mental Healthcare and the Role of Indigenous Practices in Achieving Sustainable Development Goals

Introduction: Addressing Inequalities in Mental Health for Sustainable Development

Analysis of mental healthcare systems reveals significant disparities that impede progress toward key Sustainable Development Goals (SDGs). Conventional psychiatric services have demonstrated limited success and, in many cases, systemic failure, particularly for Indigenous, Black, and other racialized communities. This report examines these shortcomings and proposes the integration of Indigenous helping practices as a critical strategy for advancing SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). The current model often results in cyclical hospitalizations and institutionalization, failing to provide transformative outcomes and perpetuating cycles of poverty and social exclusion, which directly contravenes the core principles of the SDGs.

Analysis of Indigenous Helping Practices and Their Contribution to Community Wellness

In contrast to institutionalized mental healthcare, Indigenous communities have long-standing traditions of “helping work” that offer a holistic and effective model for wellness. These practices are integral to building resilient communities and achieving health equity.

Core Principles of Indigenous Helping Work

Doctoral research into Indigenous helpers identifies several core principles that align with sustainable and community-centric wellness models:

1. Knowledge Rooted in Lived Experience: Helpers are identified by their communities based on trust, kinship, and lived experience, not institutional accreditation. This approach fosters community ownership of health solutions, supporting SDG 11 (Sustainable Cities and Communities).
2. Holistic and Relational Support: Helping is a reciprocal, long-term process that integrates physical, emotional, spiritual, and cognitive dimensions. This holistic view of health is fundamental to achieving the comprehensive targets of SDG 3.
3. Language as a Tool for Healing: Indigenous languages contain the frameworks for wellness, relationship, and responsibility. The revitalization of these languages is a crucial component of culturally competent care and the preservation of cultural heritage, linking directly to SDG 4 (Quality Education).

The Role of Language in Fostering Well-being and Justice

The structure of Indigenous languages embeds concepts of wellness that are lost in English translation. This linguistic disconnect contributes to intergenerational trauma and undermines efforts to create just and effective institutions.

• Example from Nêhîyawêwin (Plains Cree): The word kisêyiniw (Elder) translates poorly as “old man.” Its roots describe a protector who sacrifices for future generations, embodying relational responsibility.
• Impact of Language Loss: The forced suppression of Indigenous languages, as seen in the residential school system, severed connections to these embedded values, directly impacting community health and contravening the principles of SDG 16 (Peace, Justice and Strong Institutions).

Policy Recommendations for an Inclusive and Sustainable Mental Health System

To align mental healthcare with the Sustainable Development Goals, a fundamental shift in policy and practice is required. This involves moving away from colonial models and empowering Indigenous-led solutions.

Strategic Actions for Institutional Reform

• Recognize and Fund Indigenous Helpers: Governments and funding bodies must formally integrate Indigenous helpers—including Elders, Knowledge Keepers, and ceremonial leaders—as core mental health providers, ensuring they are compensated and respected. This action directly supports SDG 10 by reducing systemic inequalities.
• Remove Systemic Barriers: Regulatory bodies and universities must dismantle barriers that prevent Indigenous helpers from full participation in the healthcare system, creating pathways that respect and validate Indigenous knowledge systems, in line with SDG 16.
• Prioritize Language Revitalization: Culturally responsive care must treat language revitalization as a central pillar of mental health and wellness strategies, acknowledging its role in healing and identity, which contributes to SDG 3 and SDG 4.
• Shift Resources to Community-Based Models: Power and resources must be redirected to support intergenerational, kinship-based healing through land-based practices, ceremony, and daily caregiving, fostering sustainable and resilient communities as envisioned in SDG 11.

Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s central theme is mental health care. It describes the author’s work in a psychiatric hospital with “people living with severe mental health challenges” and highlights the failures of the current system, where patients often “cycled through repeated hospitalizations” and some “lost their lives before they got any better.” This directly relates to the goal of ensuring healthy lives and promoting well-being for all.

SDG 10: Reduced Inequalities

• The article explicitly addresses inequality in healthcare, noting a “unique disservice done to the Black, brown and Indigenous patients.” It argues that the system is “designed to fail them” and calls for empowering Indigenous communities by recognizing their unique healing practices. This connects to the goal of reducing inequality within and among countries, particularly for marginalized groups.

SDG 16: Peace, Justice and Strong Institutions

• The article critiques the existing mental health system as an institution, describing it as placing people in “institutional or custodial settings.” It calls for systemic reform, urging “funders, policymakers, researchers and clinicians” and “governments, universities and regulatory bodies” to change their practices. This aligns with the goal of building effective, accountable, and inclusive institutions at all levels.

What specific targets under those SDGs can be identified based on the article’s content?

Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

• The article directly addresses this target by focusing on the need to improve mental health outcomes. The mention of patients who “lost their lives” points to premature mortality, and the entire discussion on Indigenous helpers and culturally responsive care is about finding more effective ways to “promote mental health and well-being.”

Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, colour, ethnicity, origin, religion or economic or other status.

• The call to “recognize, fund and integrate Indigenous helpers” and to shift “power back to Indigenous helpers, languages and communities” is a direct appeal for the social inclusion and empowerment of Indigenous peoples within the mental health system, from which they are currently marginalized.

Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.

• The article identifies the current mental health system’s methodology and values as discriminatory towards Indigenous patients, leading to unequal outcomes. The recommendation to “remove barriers preventing Indigenous helpers from full participation in mental health professions” is a specific action aimed at reducing this inequality of outcome and opportunity.

Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels.

• The article advocates for a fundamental shift in how mental health institutions operate, demanding that they become more responsive and inclusive. The call for policymakers and regulatory bodies to integrate Indigenous helpers and avoid “forcing Indigenous helping practices into western psychotherapy models” is a call for participatory and representative decision-making that includes Indigenous worldviews.

Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for Target 3.4

• Rate of repeated hospitalizations: The article mentions that individuals “cycled through repeated hospitalizations,” implying that a reduction in this rate would be a key indicator of improved mental health care.
• Mortality rate among individuals with severe mental health challenges: The statement that “Some lost their lives before they got any better” suggests that tracking and reducing this mortality rate is a crucial measure of progress.
• Rate of positive long-term outcomes: The author notes that “transformative outcomes were typically the exception.” An increase in the proportion of patients who achieve stable, meaningful lives would serve as an indicator of success.

Indicators for Targets 10.2 and 10.3

• Number of Indigenous helpers formally integrated into the mental health system: Progress can be measured by tracking the number of “Elders, ceremonial leaders, traditional knowledge keepers and natural helpers” who are officially recognized, funded, and employed as “core mental health providers.”
• Level of funding for language revitalization within mental health services: The article states that care “must prioritize language revitalization.” Therefore, the allocation of funds to these programs is a measurable indicator.
• Disparities in mental health outcomes: The “unique disservice” done to Indigenous patients implies a measurable gap in outcomes (e.g., recovery rates, satisfaction with care) compared to non-Indigenous patients. Reducing this gap would indicate progress.

Indicators for Target 16.7

• Number of institutional policies revised to support Indigenous practices: Progress could be measured by the number of “regulatory bodies” and institutions that have removed “barriers preventing Indigenous helpers from full participation.”
• Amount of resources and funding reallocated to Indigenous communities: The call for “shifting resources and power back to Indigenous helpers, languages and communities” suggests that a key indicator is the proportion of mental health funding directed towards community-led, culturally specific initiatives.

SDGs, Targets, and Indicators Analysis

Source: theconversation.com