Culturally safe addiction services: An integrated circle of care for homeless Indigenous peoples in Montréal, Canada

Background

As a consequence of historic intergenerational trauma caused by ongoing colonialism, Indigenous peoples in Canada (Inuit, First Nations and Métis) have developed physical and psychological responses such as poor mental health and problematic substance use. To adequately address their specific needs, culturally safe addiction services have been implemented by the University of Montréal Health Centre (CHUM) in partnership with the Indigenous community-based organization Projets Autochtones du Québec (PAQ). The aim of this study was to identify main components of this innovative model of care.

Methods

A mixed-methods approach encompassing descriptive/bivariate analysis of survey data and thematic analysis of qualitative data (focus groups and individual interviews) was adopted. Data was collected from two samples made up of healthcare professionals (MD, nurses and support staff) from CHUM’s Addiction Psychiatry and Addiction Medicine in/out patient units (n=50), and community workers (n=25). 

Results

Provision of culturally safe addiction services must include responses to patients’ basic needs alongside building of trusting relationships through personalised care (i.e. extended consultation times, allowing the presence of patients’ relatives) that combines Western biomedicine and Indigenous spirituality and healing practices (e.g. smudging, beadwork). Despite their scarce knowledge of the hospital functioning, community health workers act as social and cultural mediators, providing insights into the Indigenous-specific social determinants of addiction and mental health. They also support patients and staff in the identification of needs (communication, health literacy) and the referral to external resources thus optimizing adherence to treatment throughout the healthcare trajectory (access, in/outpatient consultation, follow-up) among homeless Indigenous patients. 

Conclusion

Results suggest that a broader knowledge of roles and available internal/external resources among institutional and community actors involved in the integrated circle of care is crucial. Additionally, time constraints and lack of coordinated actions among actors appear as the main organisational barriers to implementing culturally safe addiction services at CHUM.