Indigenous Elders can have a broad range of positive effects on the mental and physical health of urban Indigenous people who often experience marginalization and barriers accessing health care, according to a study in Canadian Medical Association Journal.

In urban settings, such as Vancouver's Downtown Eastside, where the study was conducted, Indigenous people often feel excluded from mainstream health care services because of experiences with racism, lack of cultural understanding and other marginalizing factors.

In particular, mental health services which have not been adapted to serve the needs of Indigenous people, may not be welcoming. Mental health services in urban settings generally have not been adapted to serve the needs of Indigenous patients.

The researchers explored how patients’ encounters with Indigenous Elders affected their overall mental health and well-being to identify therapeutic mechanisms underlying improvement.

Elders, respected for their leadership, wisdom, compassion, dedication to healing and other positive qualities, play important roles in providing mental health support to Indigenous Peoples.

"Access to Elders as part of routine primary care offers one important avenue for meaningful participation in cultural practices that can improve Indigenous patients' care and help reduce inequities," writes Dr. George Hadjipavlou, Department of Psychiatry, University of British Columbia, Vancouver, with coauthors.

The qualitative study, which explored patients' experiences and perspectives as part of a larger project, included 37 participants from 20 different First Nations who were interviewed about the impact of Elders on their mental health.

Five broad themes were identified:

1. Healing after prolonged periods of seeking help and desperation

2. Strengthening cultural identity and belonging

3. Developing trust and opening up

4. Coping with losses

5. Engaging in ceremony and spiritual dimensions of care as a resource for hope.

The study adds to the body of (non-Indigenous) knowledge describing the positive effect of Elders on mental health. Its findings support the Truth and Reconciliation Commission of Canada's recommendations to include Elders in health care to improve the health and care of Indigenous patients.

"Our findings are consistent with research showing that the inclusion of Elders in health care initiatives led to a reduction in teen suicides, decreased rates of domestic violence, improved quality of life, reduced depressive and trauma symptoms, and improved understanding and trust between Indigenous and non-Indigenous staff and patients," noted the authors.

None of the participants described being negatively affected by their work with Elders. All but 1 participant endorsed some form of benefit from seeing the Elders, this participant expressed feeling optimistic about the potential for benefit but thought that it was too early to tell.  

Although some participants discussed positive changes that emanated from listening to and directly incorporating the Elders’ teachings into their lives, most identified the process of being with Elders how they related to them or felt in their presence, or what the Elders represented as the primary source of benefit.