From September 2000 through May 2001, a team of two psychologists and two psychology graduate students (myself included) from the University of Saskatchewan delivered a variety of psychological services to a remote reserve community in northern Saskatchewan via telehealth from the Royal University Hospital in Saskatoon. Using telehealth, we provided psychoeducational information, therapy, assessments, case consultations and support services to Aboriginal health workers in this community. The present study is an evaluation of the use of telehealth in the delivery of psychological services to remote reserve communities. A semi-structured interview was employed to gain knowledge about the experiences of people involved in this telehealth project as well as the insights, thoughts and beliefs of Aboriginal and non-Aboriginal mental health workers regarding the use of telehealth with remote communities. In total, eight interviews were conducted for this study. Results indicate that although telehealth technology was seen as positive, psychology is often perceived in a negative manner by Aboriginal people. Due to this disconnection between Aboriginal people and Western psychology, psychological service provision with telehealth needs to be considered in conjunction with building relationships and trust in the community. Despite the difficulties, the results indicate that there is much that can be gained by providing psychological services to remote Aboriginal communities via telehealth.

From September 2000 through May 2001, a team of two psychologists and two psychology graduate students (myself included) from the University of Saskatchewan delivered a variety of psychological services to a remote reserve community in northern Saskatchewan via telehealth from the Royal University Hospital in Saskatoon. Using telehealth, we provided psychoeducational information, therapy, assessments, case consultations and support services to Aboriginal health workers in this community. The present study is an evaluation of the use of telehealth in the delivery of psychological services to remote reserve communities. A semi-structured interview was employed to gain knowledge about the experiences of people involved in this telehealth project as well as the insights, thoughts and beliefs of Aboriginal and non-Aboriginal mental health workers regarding the use of telehealth with remote communities. In total, eight interviews were conducted for this study. Results indicate that although telehealth technology was seen as positive, psychology is often perceived in a negative manner by Aboriginal people. Due to this disconnection between Aboriginal people and Western psychology, psychological service provision with telehealth needs to be considered in conjunction with building relationships and trust in the community. Despite the difficulties, the results indicate that there is much that can be gained by providing psychological services to remote Aboriginal communities via telehealth.

There are unequivocal health disparities, both physical and mental, between the Indigenous and non-Indigenous peoples of Canada. Utilizing narrative inquiry, a qualitative methodology, 15 néhiyawak (Plains Cree people) between 18 and 71 years of age from Thunderchild First Nation were interviewed to explore what improved their mental health and well-being and what they needed to attain optimal mental health and well-being. The néhiyawak interviewed for this study responded with descriptions of strength and resilience. By posing questions that focused on the positive, the strengths, and resilience of the néhiyawak in this study came to the forefront. Narrative thematic analysis of the interviews conducted with the néhiyawak from Thunderchild First Nation consistently revealed four overarching themes that highlighted what positively impacted their mental health and well-being and their perceived needs to attain optimal mental health and well-being: relationships; spiritual beliefs and cultural practices; tānisīsi wāpahtaman pimātisiwin (worldview); and ēkwa ōhi kikwaya piko ka-ispayiki kīspin ka-nohtē-miyo-mahcihoyān (these are the things that need to happen if I want to be healthy). The néhiyawak in this study described holistic health determinants that could best be associated with the medicine wheel and the determinants of health as making a positive difference to their mental health and as necessary for them to obtain optimal mental health and well-being. These results suggest that mental health programming and intervention should be harmonious with Indigenous culture; utilize a holistic approach that takes physical, emotional, mental, and spiritual well-being into consideration; and address the existing mental health disparities using the determinants of health as a framework, with an increased focus on the current socio-economic status of Indigenous peoples in Canada.

There are unequivocal health disparities, both physical and mental, between the Indigenous and non-Indigenous peoples of Canada. Utilizing narrative inquiry, a qualitative methodology, 15 néhiyawak (Plains Cree people) between 18 and 71 years of age from Thunderchild First Nation were interviewed to explore what improved their mental health and well-being and what they needed to attain optimal mental health and well-being. The néhiyawak interviewed for this study responded with descriptions of strength and resilience. By posing questions that focused on the positive, the strengths, and resilience of the néhiyawak in this study came to the forefront. Narrative thematic analysis of the interviews conducted with the néhiyawak from Thunderchild First Nation consistently revealed four overarching themes that highlighted what positively impacted their mental health and well-being and their perceived needs to attain optimal mental health and well-being: relationships; spiritual beliefs and cultural practices; tānisīsi wāpahtaman pimātisiwin (worldview); and ēkwa ōhi kikwaya piko ka-ispayiki kīspin ka-nohtē-miyo-mahcihoyān (these are the things that need to happen if I want to be healthy). The néhiyawak in this study described holistic health determinants that could best be associated with the medicine wheel and the determinants of health as making a positive difference to their mental health and as necessary for them to obtain optimal mental health and well-being. These results suggest that mental health programming and intervention should be harmonious with Indigenous culture; utilize a holistic approach that takes physical, emotional, mental, and spiritual well-being into consideration; and address the existing mental health disparities using the determinants of health as a framework, with an increased focus on the current socio-economic status of Indigenous peoples in Canada.

This research project is located in the context of Aboriginal health and education, and in particular, emotional and social wellbeing, recognising the critical need for effective mental health services and resilient, well-trained workers in the field of mental health.Mental health is understood to include a broad spectrum of conditions with extreme and chronic mental illness at one end and resilience or wellbeing at the other – the socalled ‘soft end’ of the social health spectrum. While recognising that the lines of demarcation between one category and another are grey, my thesis addresses the problems at the latter end of the spectrum: problems of excessive pain; the grief and despair caused by dispossession, loss of place, family and identity; and the deep frustration, humiliation and anger that results in family violence and child sexual abuse, intergenerational substance abuse, neglect and poor physical health. It is my position that very many Aboriginal people who need to make changes in their lives in order to feel well and functional in the world are not suffering from a Western disease but from the transgenerational consequences of colonisation. In recognition of the notion that Aboriginal wellbeing is everybody’s business, this PhD research project represents my response to these consequences.While popular assumptions are made about the relevance of art to Aboriginal health and many Aboriginal people testify to the fact that their engagement with art (writing, drama, dance, music and visual art etc.) has brought about significant change in their lives, there is no available research in Australia that supports the development of an arts-based approach to learning/therapy/wellbeing that has, for reasons that are well understood, the potential to suit the needs of Aboriginal people.Addressing this gap in the research, I inquire into an experiential, arts-based, emotionfocused, narrative-orientated, constructivist approach to healing in the tradition of humanistic psychology, which emphasises the importance of an emancipatory, clientcentred processes that facilitates the development of awareness, creativity, clarity of expression and critical reflection. The position I take breaks with the traditions of the biomedical model and conforms to the now widely held view that psychology and counselling treatment programs for Aboriginal people must address the whole person, emotionally/spiritually, mentally and physically, responding to the individual in his/her sociopolitical and historical context. Expressive arts therapy, the multi-modal approach to healing explored in this thesis, lays claim to these intentions.In this project, I locate myself as the researcher/practitioner whose life-stance is expressive of the phenomenological principles of experiential learning and reflexivity. Accordingly, I have drawn on a number of closely related research methodologies all of which, I argue, are consistent with phenomenology and Indigenous, participatory research practices: critical action research, art-based research and phenomenological research methodology. These modes of inquiry are linked through principles that value subjective experience and allow for a diversity of ways of knowing. Embracing an expanded field of ways of knowing respectful of Indigenous epistemologies is at the core of the arts-based therapy program under investigation.Expressive arts therapy, in this research project, was delivered in two modes: one was a series of nine full-day group workshops conducted over an academic semester; the other was a series of ten intensive individual therapy sessions with three participants conducted over the period of a year. The participants or ‘co-researchers’ were drawn from the College of Indigenous Australian Peoples and the Education and Art departments at Southern Cross University. Three mature-age Aboriginal students who had engaged in the Masters of Indigenous Studies program emerged as the core participants who, having contributed to the development stage of the project, followed the program through the group workshops to the final interviews at the end of the series of individual sessions.This thesis is, in part, an illustrated narrative of the in-depth work the core participants did with me in both the context of the group and individually. It invites the active participation of the reader. Insights into the nature and impact of expressive arts therapy are offered through a focus on the lived experience of the three core participants, their reflections on the program and their observations of the changes they made in their lives. An important parameter that I set, determined that the ultimate voices of authority were to be those of the participants. I was not at liberty to look for meanings that went beyond their experience and understanding.I argue that the experiences of expressive arts therapy re-presented in this thesis demonstrate that expressive arts therapy is in principle consistent with current approaches to Aboriginal psychology and counselling currently recommended by Aboriginal professionals and spokespeople in the field of Aboriginal health. Furthermore this body of work demonstrates that expressive arts therapy is a culturally appropriate intervention grounded in a creative process that has the potential to facilitate healing and change in the lives of people suffering from the long-term consequences of damaging childhoods.It is my hope that this approach to healing will be further researched and developed and, with culturally appropriate terms of reference, adapted to a wide variety of existing community services – rightfully, Aboriginal and Torres Strait Islander practitioners working for the wellbeing of their own people.

This research project is located in the context of Aboriginal health and education, and in particular, emotional and social wellbeing, recognising the critical need for effective mental health services and resilient, well-trained workers in the field of mental health.Mental health is understood to include a broad spectrum of conditions with extreme and chronic mental illness at one end and resilience or wellbeing at the other – the socalled ‘soft end’ of the social health spectrum. While recognising that the lines of demarcation between one category and another are grey, my thesis addresses the problems at the latter end of the spectrum: problems of excessive pain; the grief and despair caused by dispossession, loss of place, family and identity; and the deep frustration, humiliation and anger that results in family violence and child sexual abuse, intergenerational substance abuse, neglect and poor physical health. It is my position that very many Aboriginal people who need to make changes in their lives in order to feel well and functional in the world are not suffering from a Western disease but from the transgenerational consequences of colonisation. In recognition of the notion that Aboriginal wellbeing is everybody’s business, this PhD research project represents my response to these consequences.While popular assumptions are made about the relevance of art to Aboriginal health and many Aboriginal people testify to the fact that their engagement with art (writing, drama, dance, music and visual art etc.) has brought about significant change in their lives, there is no available research in Australia that supports the development of an arts-based approach to learning/therapy/wellbeing that has, for reasons that are well understood, the potential to suit the needs of Aboriginal people.Addressing this gap in the research, I inquire into an experiential, arts-based, emotionfocused, narrative-orientated, constructivist approach to healing in the tradition of humanistic psychology, which emphasises the importance of an emancipatory, clientcentred processes that facilitates the development of awareness, creativity, clarity of expression and critical reflection. The position I take breaks with the traditions of the biomedical model and conforms to the now widely held view that psychology and counselling treatment programs for Aboriginal people must address the whole person, emotionally/spiritually, mentally and physically, responding to the individual in his/her sociopolitical and historical context. Expressive arts therapy, the multi-modal approach to healing explored in this thesis, lays claim to these intentions.In this project, I locate myself as the researcher/practitioner whose life-stance is expressive of the phenomenological principles of experiential learning and reflexivity. Accordingly, I have drawn on a number of closely related research methodologies all of which, I argue, are consistent with phenomenology and Indigenous, participatory research practices: critical action research, art-based research and phenomenological research methodology. These modes of inquiry are linked through principles that value subjective experience and allow for a diversity of ways of knowing. Embracing an expanded field of ways of knowing respectful of Indigenous epistemologies is at the core of the arts-based therapy program under investigation.Expressive arts therapy, in this research project, was delivered in two modes: one was a series of nine full-day group workshops conducted over an academic semester; the other was a series of ten intensive individual therapy sessions with three participants conducted over the period of a year. The participants or ‘co-researchers’ were drawn from the College of Indigenous Australian Peoples and the Education and Art departments at Southern Cross University. Three mature-age Aboriginal students who had engaged in the Masters of Indigenous Studies program emerged as the core participants who, having contributed to the development stage of the project, followed the program through the group workshops to the final interviews at the end of the series of individual sessions.This thesis is, in part, an illustrated narrative of the in-depth work the core participants did with me in both the context of the group and individually. It invites the active participation of the reader. Insights into the nature and impact of expressive arts therapy are offered through a focus on the lived experience of the three core participants, their reflections on the program and their observations of the changes they made in their lives. An important parameter that I set, determined that the ultimate voices of authority were to be those of the participants. I was not at liberty to look for meanings that went beyond their experience and understanding.I argue that the experiences of expressive arts therapy re-presented in this thesis demonstrate that expressive arts therapy is in principle consistent with current approaches to Aboriginal psychology and counselling currently recommended by Aboriginal professionals and spokespeople in the field of Aboriginal health. Furthermore this body of work demonstrates that expressive arts therapy is a culturally appropriate intervention grounded in a creative process that has the potential to facilitate healing and change in the lives of people suffering from the long-term consequences of damaging childhoods.It is my hope that this approach to healing will be further researched and developed and, with culturally appropriate terms of reference, adapted to a wide variety of existing community services – rightfully, Aboriginal and Torres Strait Islander practitioners working for the wellbeing of their own people.

Ce mémoire est catégorisé dans la sous-discipline de l'anthropologie culturelle, car la culture - comme phénomène - occupe un rôle important dans l'analyse. Il aborde néanmoins des questions de santé et de santé mentale. On pourrait donc le catégoriser également dans une sous-sous-discipline de l'anthropologie de la santé mentale. / L’étiologie et l’épistémologie biomédicale sont importées par les psychiatres, les thérapeutes et les intervenants-es qui pratiquent en milieux autochtones. Elles entrent parfois en conflit avec des conceptions locales des troubles (Laplantine 1998 ; Summerfield et al. 2016). C'est en réaction à ce problème que des champs d'études interdisciplinaires relativement récents tels que la psychiatrie transculturelle et l’ethnopsychiatrie se sont développés. Ces disciplines proposent une épidémiologie socioculturelle et contextuelle de la santé mentale ainsi que des traitements alternatifs originaux (Lecompte et col. 2006). La différence culturelle ferait partie des obstacles au succès du travail de prévention, au traitement et particulièrement au développement d’une alliance thérapeutique (Chandler et Lalonde 1998 ; Kirmayer 2003 et 2009 ; Sterlin et Dutheuil 2000). Dans le Nord du Québec, l’enjeu de la différence sociale et culturelle s’ajoute au fait que certains services de santé sont parfois difficiles à offrir dans les communautés nordiques et donc éloignées des centres urbains et hospitaliers. De plus, le roulement des employés y serait plus grand (Paré 2004). Cette recherche étudie spécifiquement la rencontre clinique dans un contexte interculturel précis et l‘adaptation des services et des cadres psychothérapeutiques qui en suit. Le travail des intervenantes et leur vécu est documentés et analysés en profondeur. Cette recherche accorde une attention particulière à l’analyser de la dynamique originale du soin de type « fly-in, fly-out » (FIFO) et à ses effets sur l’issue des rencontres cliniques. Les données de l’étude témoignent de plusieurs modifications apportées à la pratique des soignantes suite à ce que j’appelle leur psytinéraire interculturel en contexte colonial. Mon étude est fondée sur une approche inductive et qualitative. L’analyse conjugue des données provenant d'une quinzaine d’entrevues semi-dirigées avec des informateurs-trices psy- de même que du matériel de prévention et de formation que ces informatrices ont développé. En bref, je m’intéresse à la manière dont s’articulent la prévention et les soins de santé mentale et aux défis rencontrés par les intervenantes psy. Les variables mises en cause sont : les effets de l’éloignement et de l’isolement (« fly in fly out » - FIFO), la différence sociale et culturelle et d’autres particularités liées au contexte colonial qui entrent en jeux lors des rencontres thérapeutiques (violences coloniales, traumatismes, pauvreté, etc.). Finalement, je me questionne sur les éléments des modèles d’interventions transculturelle et ethnopsychiatrique qui pourraient être importés dans ce contexte afin que le travail clinique ait davantage de succès. En trame de fond, j’interroge quelle place prend la culture portée par les différents acteurs de la rencontre dans les traitements. Une perspective systémique complémentariste inspirée des travaux de George Devereux et de Grégory Bateson s’est avérée très utile. / This exploratory study focuses on the mental health care services provided within aboriginal communities in Northern Québec, through a systemic and ethnopsychiatric perspective. Based on an approach both inductive and qualitative, this analysis relies on data from some fifteen semi-structured interviews with informants from the psychological and psychiatric fields, combined with educational and prevention materials developed by those actors. This study first wishes to document and examine the peculiar dynamics of mental health care within northern communities and how the medical staff adapts its methods, yet it also wishes to question the very own nature of the provided mental health care system, focusing especially on the impact of the alternating care providing system (the "fly-in, fly-out") on the outcomes of clinical meetings. While presenting some advantages, this structure of care still raises numerous issues, from the constraints emerging from cultural differences, to the geographical and demographical situations of those communities, even raising issues linked to the colonial history of Quebec. In this context, all the boundaries of medical intervention are increased, as well as risks associated with errors, re-traumatization, even neo-colonisation. Consequently, therapists seem to see their practice transcultured once immersed in a new environment. I therefore examine potential elements for a new model of transcultural and ethnopsychiatric intervention, that once developed, might help clinical works be more successful. Moreover, the idea is to think more generally about what should be the place given to the culture of the care providers, in order to start creating an environment more in line with the issues brought by the testimonies I collected. Finally, this Master Thesis wishes to link theories of ethnopsychiatry and transcultural psychiatry to field work in the Northern territories, in order to offer a reflection on the decolonization of mental health care, through the use of a complementarist systemic perspective and a community-based, partnership-based approach.