Public Release: 

Including Indigenous elders in primary care positively affects Indigenous patients' mental health

Canadian Medical Association Journal

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 CMAJ (Canadian Medical Association Journal) that partnered Elders with mainstream health care providers in primary care.

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.

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, BC, 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:

  • Healing after prolonged periods of seeking help and desperation
  • Strengthening cultural identity and belonging
  • Developing trust and opening up
  • Coping with losses
  • 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," write the authors.


The study was funded by the Canadian Institutes of Health Research, Pathways to Health Equity for Aboriginal Peoples Grant.

"'All my relations': experiences and perceptions of Indigenous patients connecting with Indigenous Elders in an inner city primary care partnership for mental health and well-being" is published May 22, 2018.

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