Tait Caroline L
Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada.
Int J Circumpolar Health. 2013 Aug 5;72. doi: 10.3402/ijch.v72i0.21207. eCollection 2013.
Over generations, government policies have impacted upon the lives of Indigenous peoples of Canada in unique and often devastating ways. In this context, Indigenous women who struggle with poverty, mental illness, trauma and substance abuse are among the most vulnerable, as are Indigenous children involved in child welfare systems.
By examining the life history of Wanda, a First Nations woman, this article examines the intergenerational role that government policies play in the lives of impoverished Indigenous women and their families. Questions of moral governance and responsibility and the need for ethical policies are raised.
The life narrative presented in this article is part of a larger qualitative research programme that has collected over 100 life histories of Indigenous women with addictions and who have involvement with the child welfare system, as children or adults. Wanda's life story exemplifies the impact of government policies that is characteristic of vulnerable Indigenous women and draws attention to the lack of ethical standards in government policymaking in child welfare, public health and mental health/addictions.
The path to recovery for Canadian Indigenous women in need of treatment for co-occurring mental disorders and substance addiction is too frequently characterized by an inadequate and ever shifting continuum of care. For those who feel intimidated, suspicious or have simply given up on seeking supports, a profound invisibility or forgetting of their struggle exists in areas of government policy and programming provision. Living outside the scope of mental health and addiction priorities, they become visible to the human service sector only if they become pregnant, their parenting draws the attention of child and family services (CFS), they need emergency health care, or are in trouble with the law. The intergenerational cycle of substance abuse, mental illness and poverty is commonly associated with child welfare involvement, specifically practices that place the health and well-being of Indigenous children at risk. In order to break this cycle, close attention to implementation of ethically based policies and best practice interventions is required.
From an ethical policy perspective, the focus of government policies and the practices they generate must be first and foremost to ensure that individuals, families and groups are not left worse off than prior to a government policy impacting upon their life. Furthermore, the impact of living a life determined by multiple government policies should not be a story of individual and family devastation, and government policies should not be the most significant determinant of health for any group of people.
几代以来,政府政策以独特且往往具有毁灭性的方式影响着加拿大原住民的生活。在这种背景下,与贫困、精神疾病、创伤和药物滥用作斗争的原住民妇女是最脆弱的群体之一,参与儿童福利系统的原住民儿童也是如此。
通过审视一位第一民族妇女旺达的生活史,本文探讨政府政策在贫困原住民妇女及其家庭生活中所起的代际作用。文中提出了道德治理与责任问题以及制定符合伦理道德政策的必要性。
本文所呈现的生活叙事是一个更大的定性研究项目的一部分,该项目收集了100多位有药物成瘾问题且曾作为儿童或成年人参与儿童福利系统的原住民妇女的生活史。旺达的生活故事体现了政府政策对弱势原住民妇女的典型影响,并凸显了儿童福利、公共卫生以及精神健康/药物成瘾领域政府政策制定中缺乏道德标准的问题。
对于需要同时治疗精神障碍和药物成瘾的加拿大原住民妇女而言,她们的康复之路往往因护理的连续性不足且不断变化而受到影响。对于那些感到害怕、怀疑或干脆放弃寻求支持的人来说,在政府政策和项目提供方面,她们的挣扎被严重忽视或遗忘。由于生活在精神健康和药物成瘾优先事项范围之外,只有当她们怀孕、育儿引起儿童和家庭服务机构(CFS)的关注、需要紧急医疗护理或触犯法律时,才会进入人类服务部门的视野。药物滥用、精神疾病和贫困的代际循环通常与儿童福利参与相关,特别是那些将原住民儿童的健康和福祉置于风险之中的做法。为了打破这种循环,需要密切关注基于伦理道德的政策实施和最佳实践干预措施。
从伦理政策的角度来看,政府政策及其产生的实践的重点必须首先确保个人、家庭和群体在政府政策影响其生活之后不会比之前状况更糟。此外,由多项政府政策决定的生活不应是个人和家庭遭受破坏的故事,而且政府政策不应成为任何人群健康的最重要决定因素。