Biigajiiskaan: Indigenous Pathways to Mental Wellness

An Indigenous women holding a feather over the head of a female Indignenous patient

Co-delivered by St. Joseph’s Health Care London (St. Joseph’s) in partnership with Atlohsa Family Healing Services (Atlohsa), Biigajiiskaan (bee-gaw-jees-gawn) is a referral-based mental wellness program that aims to provide accessible, culturally-safe, specialized care for Indigenous people with serious mental illness, addictions and concurrent disorders.

Based at St. Joseph’s Parkwood Institute, Biigajiiskaan offers both Traditional Healing services and Western psychiatric treatment to Indigenous individuals experiencing mental health and addiction issues as well as addressing common barriers and bridging care transitions for inpatients, outpatients and community outreach clients in the London-Middlesex region. 

The name Biigajiiskaan is an Ojibway concept that describes how a broken or rotting tree stump feeds new life. It acknowledges the importance of all living things working together in harmony for the greater good.

A history in need of healing

Indigenous people in Canada experience mental health and addictions at rates that are more than double those among non-Indigenous people. The impact is crippling. Suicide rates among Indigenous youth are more than five times higher than among non-Indigenous youth in Canada.

herbal medicines in shells surrounded by implements used Indigenous healing ceremonies

Yet many Indigenous people are reluctant to come to hospital for treatment, fearful of discrimination and maltreatment after generations of systemic discrimination created by government policies including Canada’s residential school system and Indian hospitals. These experiences have led to the loss of language, culture, a sense of safety and community. 

The program aims to address immediate mental health needs as well as intergenerational trauma and violence experienced by many Indigenous people. Biigajiiskaan recognizes systemic racism as well as institutional trauma caused by residential schools and Indian hospitals and validates the loss of Indigenous identity, knowledge and culture. The program creates a more positive experience for Indigenous people, within the health care system, by reinstating the importance of Traditional Healing.

By providing culturally-safe and accessible mental health care to Indigenous peoples through an Indigenous lens, Biigajiiskaan creates connections with and beyond the Western-notion of mental wellness, and seeks ways to support community through relationships with the self, land and all of creation. It is through this holistic approach that Biigajiiskaan will improve the experience and quality of care that Indigenous patients and families receive. By dismantling the barriers of distrust and bridging Traditional Healing and Western modalities, Atlohsa Family Healing Services and St. Joseph’s Health Care London have the ability to transform the mental wellness design and service delivery model.

Frequently Asked Questions

1. What is Biigajiiskaan?

Biigajiiskaan (Bee-Gaw-Jees-Gawn) is a referral-based mental wellness program that aims to provide accessible, culturally safe, specialized care for Indigenous people with serious mental illness, addictions and concurrent disorders.

Based at St. Joseph’s Health Care London’s Parkwood Institute, and co-led by Atlohsa Family Healing Services (Atlohsa), Biigajiiskaan offers Indigenous-led Traditional Healing services combined with psychiatric treatment. Services are provided in-hospital and in the community to the Indigenous population in the London-Middlesex region.

The program aims to address immediate mental health needs as well as intergenerational trauma and violence experienced by many Indigenous people. Biigajiiskaan recognizes systemic racism as well as institutional trauma caused by Residential Schools and Indian hospitals and validates the loss of Indigenous identity, knowledge and culture. The program creates a more positive experience for Indigenous people, within the health care system, by reinstating the importance of Traditional Healing.

Biigajiiskaan is the only program of its kind in Canada, within a faith-based hospital.

2. What is Traditional Healing?

Traditional Healing practices are skills based in Indigenous knowledge and beliefs, used for holistic health care through the use of sacred medicines, ceremonies and traditional teachings to promote spiritual, mental, physical and emotional well-being.
 

3. Who is Atlohsa and what is its role in the program?


Atlohsa is a non-profit, charitable organization, dedicated to strengthening community through Indigenous-led programs and services that offer holistic healing and wellness. Atlohsa has been serving individuals and families across Southwestern Ontario for more than 33 years, providing low-barrier services to community members with complex needs, including mental wellness, substance use, homelessness, domestic violence, and trauma. Atlohsa specializes in providing strength-based healing and wellness supports, utilizing trauma-informed and harm reduction approaches.

Atlohsa Family Healing Services and St. Joseph’s Health Care London have come together to co-design and co-deliver Biigajiiskaan, in order to transform health care and mental wellness services for Indigenous peoples in both urban and rural areas of the London-Middlesex region.

4. What does the Biigajiiskaan name mean?

Biigajiiskaan (Bee-Gaw-Jees-Gawn) is an Ojibway concept that describes how a broken and rotting tree stump feeds new life. It acknowledges the importance of all living things working together in harmony for the greater good.

5. What makes Biigajiiskaan unique from existing mental health strategies?

This initiative is unique because it incorporates traditional medicine, Indigenous elder-guided care, and ceremony with Western psychiatric treatment and hospital care. Biigajiiskaan is guided by the Thunderbird Partnership’s Foundation’s First Nations Mental Wellness Continuum Framework. The goal is to provide a hostile-free environment, and services that are culturally-safe and Indigenous-led with a focus on meeting the individual, cultural and health care needs of each client. Biigajiiskaan is about creating a new Indigenous wellness model of care that transforms health care and mobilizes knowledge to other interested communities, organizations and institutions.

6. What does the Biigajiiskaan program consist of?
  • An Indigenous-led mobile outreach team working in-hospital and in the community providing consultation, assessment, treatment planning/management, discharge planning and ambulatory services
  • A dedicated Indigenous Healing Space at Parkwood Institute’s Mental Health Care Building (Okwari: Kowa Healing Space, Rm F3-240) for use by inpatients and outpatients of St. Joseph’s Mental Health Care Program
  • Indigenous Elder-guided care and teachings from knowledge keepers
  • Traditional Indigenous practices, such as healing circles, ceremony, smudging and drumming circles
  • Educational and mentoring opportunities for health care professionals and students
7. Who can access these services?


The Biigajiiskaan program is available to Indigenous inpatients, outpatients and community outreach clients of Parkwood Institute’s Mental Health Care Program, which is part of St. Joseph’s Health Care London. Participants at Atlohsa also have access to these services and Biigajiisakaan is growing referrals through other local Indigenous agencies and organizations in the London-Middlesex and St. Thomas-Elgin County regions.

8. How can patients access these services?

To access Biigajiiskaan services, Indigenous people in need of mental health and addictions services will require a referral from a mental health care provider at St. Joseph’s Health Care London or Atlohsa Family Healing Services. At this time, Atlohsa is the only partnering agency that can refer clients. Further pathways with partnering agencies are in development and will be added to our websites as they become confirmed.

9. Can patients and outpatients of St. Joseph’s Southwest Centre for Forensic Mental Health Care access these services?

The program is currently not available at Southwest Centre but the hope is to offer this in future.

10. Is this team and these services available to individuals who are NOT patients/clients of St. Joseph’s Mental Health Care Program?

Yes. Indigenous people can access Biigajiiskaan services through Atlohsa Family Healing Services and in the near future, through other partnering Indigenous agencies.

11. Can non-Indigenous individuals access the program?

Not at present, as the program is still in its early days. A growth opportunity would be to expand to the non-Indigenous community in a future phase if/when possible.

12. How will this program work with existing mental health care services at St. Joseph’s?

Biigajiiskaan is meant to enhance existing care and services that exist within Parkwood Institute’s Mental Health Care Program. The aim of this program is to combine Traditional Healing as part of the clinical services that are offered. Our goal is to validate and honour Indigenous culture and identity, enhance the care currently provided and create a more positive patient experience for the Indigenous population. 
 

13. How will this initiative improve mental health pathways to care?

This program offers Traditional Indigenous Healing services in a hospital setting – making internal hospital referrals more convenient and comfortable for Indigenous community members. Biigajiiskaan staff are also developing and nurturing networks with mental health and addictions workers both in urban and First Nation settings, opening lines of communication for seamless referrals for those in need of support. In addition, the mobile outreach team allows for follow-up to ensure continuous care for outpatients and those who are transitioning from hospital to community. 

14. Who makes up the Biigajiiskaan team?


The Biigajiiskaan team is comprised of eight specialists (both Indigenous and non-Indigenous) including: a project lead (MSW/RPN), clinical documentation coach/team administrator, addictions specialist, clinical lead (MSW), Indigenous Knowledge Keeper, Shkaabewis (Helper), registered practical nurse and a psychiatrist. Together with Atlohsa Family Healing Services, the team reaches out to area Indigenous communities and Indigenous-serving agencies with the goal of making connections and helping to facilitate access to Biigajiiskaan.

Program care is guided by an Indigenous Governance Circle (IGC) comprised of local Elders/Knowledge Keepers from Anishinabek, Haudenosaunee, and Lene-Lenape nations, Indigenous and non-Indigenous agency representatives, and the Biigajiiskaan Team. The IGC utilizes a strengths-based approach to facilitate decision-making and set standards of practice. It also ensures that all processes and outputs are Indigenous-informed.

15. Why do we need a special program for Indigenous people? 

Indigenous people have experienced institutional trauma – through Canada’s residential school system and Indian hospitals, and continue to experience systemic discrimination and stereotyping in institutions to this day. These experiences have led to the loss of language, culture, a sense of safety and community. Today, community members continue to experience systemic discrimination and stereotyping in institutions. As a result, many Indigenous people are reluctant to go to hospital or access help from Canadian health care agencies.
At the same time – and as a result of colonization and government programs such as the residential school system – Indigenous people experience mental health and addictions at rates that are more than double those among non-Indigenous people in Canada. The impact is crippling. Suicide rates among Indigenous youth are more than five times higher than among non-Indigenous youth in Canada.

In acknowledgement of these realities, Canada’s Truth and Reconciliation Commission has called on health care institutions to build culturally-safe care and offer Traditional Healing services for Indigenous patients in an effort to create change and support the journey to reconciliation. The goal is to ensure equity of care for everyone in this country.

16. But doesn’t everyone has access to the same services in Ontario hospitals?

Despite having access to the same services as all Ontarians, Indigenous peoples face barriers to equitable health care as a result of a history of colonization. By ensuring that the mental health care and wellness services of Biigajiiskaan are Indigenous-led, we can begin to break down these inequities and barriers, which will lead to culturally-safe care and hostile-free environments. This is important because there is strong evidence that providing culturally-safe care improves health outcomes.

17. Where does Biigajiiskaan fit within the issue of those who don’t seek help?

The goal is to raise awareness about Biigajiiskaan among care providers in and out of hospital settings so they can facilitate culturally-safe care. Equitable, mental wellness in a hostile-free environment requires removing barriers to care and being accessible to offer people the help they need.

18. How will the success of Biigajiiskaan be measured?

Biigajiiskaan is partnering with Western University and Lawson Health Research Institute on a program evaluation that includes both qualitative (stories, narratives) and quantitative methods (e.g., client satisfaction and engagement) to capture key outcomes as defined by the communities of practice. The process and formative evaluation will draw upon the experiences and perceptions of Indigenous community members, mental health care providers, and leadership, as well as other stakeholders (e.g., Elders and Knowledge Keepers) who work within mental health care settings.

19. Who can I contact to learn more?


Bill Hill (Ro'nikonkatste) Project Leader
519-455-5110 ext. 47554
@email
For inpatient and outpatient referrals, please email biigajiiskaan@sjhc.london.on.ca