This paper reviews some recent research on the mental health of the First Nations, Inuit, and Métis of Canada. We summarize evidence for the social origins of mental health problems and illustrate the ongoing responses of individuals and communities to the legacy of colonization. Cultural discontinuity and oppression have been linked to high rates of depression, alcoholism, suicide, and violence in many communities, with the greatest impact on youth. Despite these challenges, many communities have done well, and research is needed to identify the factors that promote wellness. Cultural psychiatry can contribute to rethinking mental health services and health promotion for indigenous populations and communities.

(Can J Psychiatry 2000;45:607-616)

Key Words: Aboriginal mental health, First Nations, Inuit, Métis, Cree, psychiatric services, suicide, colonialism, culture, epidemiology, ethnography

Around the world, indigenous peoples have experienced rapid culture change, marginalization, and absorption into a global economy that has little regard for their autonomy. Cultural discontinuity has been linked to high rates of depression, alcoholism, suicide, and violence in many communities, with the most profound impact on youth. Despite these challenges, many communities have done well. This paper will explore mental health issues of the First Nations, Inuit, and Métis peoples of Canada. We first summarize the social origins of distress among the original inhabitants of North America. We then discuss the range and magnitude of the individual and collective problems caused by a history of systematic suppression and dislocation. We also consider some ongoing transformations of individual and collective identity and forms of community that hold the seeds of revitalization and renewal for Aboriginal peoples. Finally, we outline some of the implications for mental health services and health promotion of an emphasis on identity and community.

Manuscript received August 2000.
¹Professor and Director, Division of Social and Transcultural Psychiatry, McGill University; Director, Culture and Mental Health Research Unit, Sir Mortimer B Davis–Jewish General Hospital, Montreal, Quebec.
²Formerly, Coordinator, Aboriginal Mental Health Research Team, Culture and Mental Health Research Unit, Sir Mortimer B Davis–Jewish General Hospital, Montreal, Quebec; now, Coordinator/Facilitator, United Native Nations Study on Urban Aboriginal Homelessness in British Columbia, Vancouver, British Columbia.
³Coordinator, Aboriginal Mental Health Research Team, Culture and Mental Health Research Unit, Sir Mortimer B Davis–Jewish General Hospital, Montreal, Quebec.
Address for correspondence: Dr LJ Kirmayer, Institute of Community and Family Psychiatry, 4333 Côte Ste Catherine Rd, Montreal, QC  H3T 1E4
e-mail: cylk@musica.mcgill.ca

First Nations, Inuit, and Métis constitute about 1 million people, or 4% of the Canadian population. There are 11 major language groups with more than 58 dialects distributed among some 596 bands residing on 2284 reserves, or in cities and rural communities (1,2). The cultural and linguistic differences among many groups are greater than the differences that divide European nations. In addition to inter-group social, cultural, and environmental differences, there is an enormous diversity of values, lifestyles, and perspectives within any community or urban Aboriginal population. While this diversity makes lumping people together under generic terms like “Aboriginal” or “indigenous” profoundly misleading, most groups nevertheless share a common social, economic, and political predicament that is the legacy of colonization. This shared predicament has motivated efforts to forge a common political front and, to some degree, a collective identity among diverse groups. Indeed, striking parallels in the mental health problems of indigenous peoples around the world suggest that, while biological, social, cultural, and political factors vary, there are common processes at work (3–5).

Social Origins of Distress

Despite myths of a timeless past and cultural continuity, traditional Aboriginal societies were not static, nor were they entirely free of disease or social problems (6,7). In the 16th century, however, the process of cultural change accelerated