Grounding Wellness: Coloniality, Placeism, Land, and a Critique of "Social" Determinants of Indigenous Mental Health in the Canadian Context.

Authored by a small team of settler and Indigenous researchers, all of whom are deeply involved in scholarship and activism interrogating ongoing processes of coloniality in lands now known to many as Canada, this paper critically examines "social" and grounded determinants of Indigenous mental health and wellness. After placing ourselves on the grounds from which we write, we begin by providing an overview of the social determinants of health (SDOH), a conceptual framework with deep roots in colonial Canada. Though important in pushing against biomedical framings of Indigenous health and wellness, we argue that the SDOH framework nevertheless risks re-entrenching deeply colonial ways of thinking about and providing health services for Indigenous people: SDOH, we suggest, do not ultimately reckon with ecological, environmental, place-based, or geographic determinants of health in colonial states that continue to occupy stolen land. These theoretical interrogations of SDOH provide an entry point to, first, an overview of Indigenous ways of understanding mental wellness as tethered to ecology and physical geography, and second, a collection of narrative articulations from across British Columbia: these sets of knowledge offer clear and unequivocal evidence, in the form of Indigenous voices and perspectives, about the direct link between land, place, and mental wellness (or a lack thereof). We conclude with suggestions for future research, policy, and health practice actions that move beyond the current SDOH model of Indigenous health to account for and address the grounded, land-based, and ecologically self-determining nature of Indigenous mental health and wellness.

Mining sick: Creatively unsettling normative narratives about industry, environment, extraction, and the health geographies of rural, remote, northern, and Indigenous communities in British Columbia.

Rural, remote, northern, and Indigenous communities on Turtle Island are routinely-as Cree Elder Willie Ermine says-pathologized. Social science and health scholarship, including scholarship by geographers, often constructs Indigenous human and physical geographies as unhealthy, diseased, vulnerable, and undergoing extraction. These constructions are not inaccurate: peoples and places beyond urban metropoles on Turtle Island live with higher burdens of poor health; Indigenous peoples face systemic violence and racism in colonial landscapes; rural, remote, northern, and Indigenous geographies are sites of industrial incursions; and many rural and remote geographies remain challenging for diverse Indigenous peoples. What, however, are the consequences of imagining and constructing people and places as "sick"? Constructions of "sick" geographies fulfill and extend settler (often European white) colonial narratives about othered geographies. Rural, remote, northern, and Indigenous geographies are discursively "mined" for narratives of sickness. This mining upholds a sense of health and wellness in southern, urban, Euro-white-settler imaginations. Drawing from multi-year, relationship-based, cross-disciplinary qualitative community-informed experiences, and anchored in feminist, anti-colonial, and anti-racist methodologies that guided creative and humanities-informed stories, this paper concludes with different stories. It unsettles settler-colonial powers reliant on constructing narratives about sickness in others and consequently reframes conversations about Indigenous well-being and the environment.

Les communautés autochtones, nordiques et rurales de Turtle Island sont, comme le dit l'aîné cri Willie Ermine, couramment considérées comme pathogènes. Le discours professoral en sciences sociales et en santé, y compris chez les géographes, conçoit souvent les géographies autochtones, tant humaines que physiques, comme étant malsaines, malades, vulnérables et soumises à l'extraction. Ces conceptions ne sont pas erronées: les gens et les endroits en dehors des agglomérations urbaines sur Turtle Island sont davantage exposés à un état de santé précaire, les Autochtones font face à une violence et un racisme systémique dans les milieux coloniaux, les géographies autochtones, nordiques et rurales sont le siège d'incursions industrielles et de nombreux contextes territoriaux ruraux et éloignés continuent de présenter un défi pour diverses populations autochtones. Toutefois, quelles sont les conséquences d'imaginer et de concevoir les gens et les endroits comme étant « malades ¼? Le concept de territoires « malades ¼ favorise et consolide les récits coloniaux (souvent le blanc européen) sur l'état d'autres territoires, lesquels seraient dans une situation plus favorable. Les géographies autochtones, nordiques et rurales sont alors « minées ¼ de manière discursive par les récits sur leur caractère pathogène. Ce minage soutient une impression de santé et de bien­être dans l'imaginaire colonial, blanc européen et urbain des populations du sud. S'inspirant d'expériences communautaires qualitatives éclairées interdisciplinaires pluriannuelles axées sur les relations et ancrées dans les méthodologies féministes, anticoloniales et antiracistes qui ont guidé les discours créatifs inspirés par les sciences humaines, le présent texte se termine avec des récits différents. Ceux­ci déstabilisent les pouvoirs coloniaux qui se fondent sur le concept de territoire pathogène et, par conséquent, ré­interprètent les perceptions et les affirmations sur l'environnement et le bien­être des Autochtones.

Development and Evaluation of Innovative Peer-Led Physical Activity Programs for Mental Health Service Users.

Mental health service users (MHSUs) have elevated rates of cardiometabolic disturbance. Improvements occur with physical activity (PA) programs. We report the development and evaluation of three innovative peer-developed and peer-led PA programs: 1) walking; 2) fitness; and 3) yoga. Qualitative evaluation with 33 MHSUs in British Columbia, Canada, occurred. These programs yielded improvements for participants, highlighted by powerful narratives of health improvement, and improved social connections. The feasibility and acceptability of innovative peer-developed and peer-led programs were shown. Analyses revealed concepts related to engagement and change. Relating core categories, we theorize effective engagement of MHSUs requires accessibility on three levels (geographic, cost, and program flexibility) and health behavior change occurs within co-constituent relationships (to self, to peers, and to the wider community). This study highlights the benefits of peer involvement in developing and implementing PA programs and provides a theoretical framework of understanding engagement and behavior change in health programs for MHSUs.