Reconnecting with roots has proven to be transformative for Indigenous youth struggling with mental health — so what would land-based mental-health and addictions treatment entail?
To get a better idea, TVO Today speaks with a graduate from and also the director of operations for Gwekwaadziwin Miikan, on Manitoulin Island, a publicly funded land-based mental-health and addiction program for young adults between the ages of 19 and 29. The show gets into the Indigenous concepts of wellness that underpin its programming and what Indigenous teachings tell us about mental health more broadly.
Read the full transcript below.
Matthew O’Mara (producer): This episode is about addiction, depression, and anxiety and harms from the medical system. Please listen with care if you feel like you need support. We’ve got resources listed in our show notes.
Jason Simpson: I know for myself, boredom is one of my biggest triggers. If I allow myself to sit around and get bored enough to get trapped in my head and start struggling with the way I’m feeling, and I have a way or means to pick up and use, I‘m going to do it.
Tiffany Lam (host): This is In Our Heads, a TVO Today podcast about Generation Distress. I’m Tiffany Lam.
Simpson: My name is Jason. Jason Simpson. I’m a 29-year-old male, originally from Bracebridge, Muskoka. Spent a fair amount of my time, certainly in my adult life, in northeastern Ontario, North Bay, Sudbury area. I come from a middle-class family, and, for most of my life, I struggled at times with mental health, and that kind of evolved into pretty serious addiction issues. Right now, I’m a little over two years clean and sober and essentially starting my life over in many ways.
Lam: Jason and I connected over a Zoom call after he got off work. He lives up at Manitoulin Island right now, about a six-hour drive northwest from the office in midtown Toronto. He works at a body shop at the largest full-service marina on the North Channel. He fixes boats, among other things.
Simpson: I’m six months into an informal apprenticeship in marine restoration and fibreglassing.
Lam: I had to Google this. Fibreglass helps weigh down a boat so it’s not as easily buffeted by the wind. Fibreglass vessels tend to drift more slowly and predictably. It hasn’t always been like this for Jason. To my co-producer Matthew, Jason described growing up in his family as fairly dysfunctional and separated and with a lot of abuse and alcoholism.
Simpson: I started displaying symptoms or signs of depression and anxiety when I was fairly young, maybe 11, 12 years of age. Shortly after that, I began self-medicating, and I was introduced to alcohol and substances. And that kind of became my way and my means of coping. For the following 13 years of my life, I was pretty much a daily user and/or drinker.
Lam: One day, it became clear to him that he really needed to make a change.
Simpson: I realized that I was dysfunctional when I was under the influence, and I was dysfunctional when I was not under the influence. There were many times I couldn’t hold down a job — I couldn’t achieve a consistent kind of functionality in day-to-day life. And I just kept going further and further downhill and faster as time went on. I just remember waking up at about 7:30 in the morning on Wednesday, May 26, 2021, and I looked out the window, and I just thought to myself, “It’s now or never, and it’s either this or nothing.” I couldn’t think of any other options. I was all out of answers — not that I had any good answers to begin with. I kept repeating the same mistakes, but I just remember thinking, ”Yeah, I’m going to go do this, and I’m going to stick it out this time.”
Lam: Jason’s mom is Indigenous, so Jason thought to reach out to an Indigenous Elder for help.
Simpson: And I just reached out to her over the phone, just hoping to get some guidance and direction.
Lam: When Jason told her he wanted to try something different, something grounded in learning more about the land and nature, the Elder suggested that Jason should check out a treatment centre called Gwekwaadziwin Miikin. Their website shortens it to Gwek - g-w-e-k.ca.
Lam: This is a podcast, so I’m curious: When you sit in silence at Gwec, what do you think you remember hearing?
Simpson: The birds. And often the wind. Even when it didn’t feel windy, you could still hear the wind. Out on the big water, you might not be able to feel it where you are, but you can hear it on the top of the trees. And, of course, the waves, the sound of water, which is probably the most nurturing sound that I think I’ve ever heard — just that constant flow of gentle waves brushing against the shore.
Matt Maracle: Gwekwaadziwin Miikan is a mental-health and addictions program on Manitoulin Island, operating across the Robinson Huron Treaty area. It really focuses on a continuum of care from land-based and wilderness treatment all the way through community aftercare.
Lam: Gwekwaadziwin Miikan separates the program into three phases: land-based treatment, live-in aftercare, and community aftercare. We‘ve heard the term “continuum of care” in the show before — that notion of stepped care, where mental-health treatment is proportionate to the complexity of your needs. There’s a space to choose which step you’re ready for, and the steps should be navigated with ease. Gwek’s land-based treatment appears to be on the further end of the spectrum: specialized, continuous chronic care.
Maracle: My name is Matt Miracle, and I’m currently the director of operations at Gwekwaadziwin Miikan. I’m a band member of Mohawks of the Bay of Quinte, but I also have matrilineal association with M’Chigeeng First Nation up here on Manitoulin Island, which is what brought us up here.
Lam: Matt’s a dad to three girls who are eight, seven, and three years old.
Maracle: The name of the program is Gwekwaadziwin, which means honesty. So it’s very honest conversation.
Lam: The theme of honesty seems to run through the program in different ways. It seems to encourage honesty within individual participants of their land-based 90-day treatment. The honest acknowledgement of what brought them to this treatment program is encouraged right in the application form. Applicants must check off what their mental-health struggles are in a long laundry list: depression, anxiety, obsessive-compulsive disorder, oppositional defiant disorder, self-harm, addiction, among others. They say whether they’ve been diagnosed formally, they tick off which drugs they use. They declare whether they’ve ever been part of a gang, ever been part of human trafficking, been in an abusive relationship recently, or ever had a restraining order placed against them — again, just to name a few.
If people declare criminal background or anything like that, it doesn’t disqualify them necessarily, right?
Maracle: No, absolutely not.
Making fire with Gwekwaadziwin Miikan land-based counsellors
Lam: Matt says that those declarations just help him and his staff get a better sense of how to keep the program as safe as possible.
Maracle: The only thing where we would have to sort of draw our line is we can’t be named on a court order to attend treatment, because we are a voluntary program.
Lam: This single disqualification criterion strikes me as very meaningful given that we’ve learned throughout our series that Black and Indigenous folks’ entry into mental-health care is disproportionately involuntary, and involuntary entry can be highly traumatic.
Maracle: No one can be ordered to attend Gwekwaadziwin, because we do believe in that freedom of choice and that right to attend and participate and to seek their own sort of recovery and wellness journey.
Lam: Gwekwaadziwin Miikan’s hope is to have applicants intentionally make the choice to make change.
Maracle: It’s about removing oneself from a lot of the hardships, the barriers and the challenges of whatever community they may be coming from and really providing an opportunity for someone to have 90 days to truly focus on their self. It’s about being able to really look at the root cause of what got us to where we are now and how do we create meaningful change moving forward.
Lam: Upon arrival, participants are effectively removed from everything they’d once known and are exposed to the land that they’ll be living on for the next 90 days.
Maracle: We’re absolutely blessed with the natural surrounding that we have.
Lam: But as idyllic as the surroundings are, the program is no breeze.
Maracle: One of the absolute first things that we do after intake is we get in canoes, and we paddle across. It’s about a four-kilometre paddle from our launch point to our actual site. And the reason we do that is we want to build success right off the hop.
Lam: I can see where Matt’s coming from there: overcoming something difficult can help build self-confidence. But a four-kilometre paddle sounds like no joke. Notably, people also have to declare how physically active they’ve been in the application form. “Not at all” is an option. I asked if that would mean applicants aren’t a good fit for their programming.
Maracle: [laughs] No, not necessarily, because we get into some of those ruts when we’re in active usage and addiction. What we see oftentimes is, while they may not be active, there is a willingness to try to participate and to be out there. A lot of the things that we hear are individuals come out and they go fishing, for example, and they’re like, “Oh, I haven’t done this since I was a kid. It feels so good to get back to this.”
Lam: The honest conversation at Gwekwaadziwin Miikan goes both ways, though.
Maracle: Obviously, we hear things that people aren’t thrilled about. Maybe it’s the expedition or the canoe trek was too long, so we adjust. It’s always been an evolving program. I strive to meet the needs of participants as they come in.
Lam: The criteria for being admitted to Gwek’s land-based treatment program are simple. They have to be at least 19 years old and be open to Anishinaabeg values and traditions.
Maracle: Within the land-based treatment model, it’s really about creating stabilization, emotional growth, and resilience and looking at creating success out in the wilderness setting.
Lam: There isn’t a single therapy game plan like attending cognitive-behavioural-therapy sessions on a set schedule.
Maracle: It’s not one typical tool, but it’s about finding those teachable moments in the everyday relationship and everyday operation that’s happening.
Lam: The website says the goal for this portion of their treatment is to help achieve stabilization, emotional growth, self-management skills, and social skills.
Maracle: We operate rain or shine. Our executive director famously says it’s an outdoors program, not a sunshine program. Within that setting, individuals, depending on what season they’re in, they really focus on different seasonal activities. Really, it’s about creating that connection to land; that dedicated 90 days is an opportunity to literally face the hazards of the natural environment and weather the storm and to come out with brighter eyes and a fuller body on the other side of things.
Lam: I’ve learned that being connected with the land has deeply spiritual implications in Indigenous teachings. In Episode 1 of the series, we spoke with Hiawatha First Nation Chief Laurie Carr; she said the good life was called Mino Bimaadiziwin in her language, Anishinaabemowin.
Chief Laurie Carr: Our goal is to live in Mino Bimaadiziwin, and that’s the good life, the life Creator intended for all of us. And so we need to get there. My English name is Laurie. My Indigenous name is Eagle Woman, and I am chief of our community of Hiawatha First Nation.
Lam: For reference, Hiawatha First Nation is around Peterborough. Chief Carr told me that Mino Bimaadiziwin can only be achieved in a holistic way, so not just by treating the intellectual or the mental capacities.
Carr: There’s also the physical and the emotional and the spiritual, and they all have to be in balance. You can’t look at just the one aspect or the one piece of it. You have to look at all of it.
Lam: Back when she was just Laurie and not yet chief, she helped with community mental-health initiatives for Hiawatha shortly after she got her own formal anxiety diagnosis. She saw how generations before her didn’t talk about depression and anxiety.
Carr: It stays unresolved. And how horrible is it to feel that internally and not know what it is and not know that you can do something about it or that taking care of yourself is okay? These are the messages that have come out more and more: only you can take care of yourself, and we’re here to support you.
Lam: This person-centred approach is one that Matt and his team at Gwekwaadziwin Miikin champion, according to their website. The program’s goal is to remove barriers to treatment for Indigenous youth and young adults in northeastern Ontario. But anyone with an OHIP card is eligible and welcome to apply, since the program is in part publicly funded. Matt and the team believe that fostering participants’ connection with the land lends itself to a holistic approach to achieving good mental health.
Maracle: It’s interesting, too, because we ask that question with interviews for new staff: Can you please describe a holistic model of care for participants? And it’s amazing because you never really get the same answer twice. Kind of the foundation of it is really looking at the person first. And, really, that comes down to a basic teaching of the medicine wheel.
Lam: A medicine wheel is an Indigenous symbol and guide to healing. Online, I see many iterations of these wheels from different Indigenous cultures. One constant appears to be the way it represents healing and medicine as the process of balancing physical, emotional, intellectual, and spiritual well-being in the context of the land that holds us — four equal quadrants that make up a circle being the visual representation.
Maracle: It’s about trying to regain that balance. It’s about trying to have that humility and that teaching and the understanding of where we fit in all of creation by having that connection with land and then building the pieces around it, too. So it starts with the holistic, wraparound approach for the individual.
Lam: The wraparound approach to services is a concept often found in youth mental-health care that acknowledges that youth having a tough time can require different types of help from different services. The approach looks to help coordinate peer and family support, as well as various workers or community representatives from different organizations. It’s kind of like the hub model that we talked about in Episode 3, but here’s how land-based treatment is a bit different.
Maracle: We have individuals that are with our counsellors for 90 days, 24 hours. When you’re out on the land, you’re waking up, and you’re doing morning circle together, and you’re in the kitchen, tent, or cabin together, and you’re cooking, and then you’re going on treks and doing closing circles and running our group model and doing those one-on-ones. You’re really looking at up to 118 hours of face time with our land-based counsellors over a one-week period. So within that first eight days on the land, the first eight days of their program, they’ve essentially doubled — they’ve expedited that therapeutic allyship because there’s that much time together.
Lam: Matt has seen how this added face time helps build rapport between participants and counsellors. He says that Gwek is often the first time that participants in the program have built a trusted relationship with someone who works in mental-health care.
Maracle: One of the things that I think is often overlooked is the importance of role modelling. If we get out there on the land and something doesn’t work and we throw our hands up in the air and say, “Oh, this sucks, and we can’t do this” or “what are we going to do now?” we’re not really demonstrating anything, and we’re sort of fuelling a fire that is already there in terms of negativity and deficit-based thinking. But if we look at something and say, “Hey, you know what? This isn’t what we planned, but now we have to figure out how we’re going to resolve this and how we’re going to create resilience and how we’re going to create success out of this situation.” Then, after 90 days, that becomes the mentality of the camp.
Lam: And that mentality seems to help create bonds between the counsellors and participants of each cohort. Here’s Jason on what it was like when he first got to Gwekwaadziwin Miikin.
Simpson: I can remember the first week of treatment out on the land with all these complete strangers. None of us really wanted to get to know each other. And before halfway through, we were like the most tightly knitted little fabric of family that I think I’ve ever known. I have a family of my own; I’ve had multiple friends circles. But being isolated out in nature, completely detached from the outer world — it was different. It was almost like it was the closest thing I ever felt to being part of a tribe. If we weren’t out cutting deadfall trees and splitting firewood, we were out fishing in order to harvest or cultivate as much fresh fish as possible to add with our regular meals. In some cases, we were out picking and then coming back to camp and preparing medicines, usually going on pretty lengthy canoe excursions, trips that would last up to maybe three or four days, in our case.
Lam: Throughout the day-to-day at the program, Jason learned more about the things he was good at.
Simpson: I found myself cooking quite a bit. I grew up cooking and in restaurants, and I guess people tended to like what I made. I would often sub in for someone if they didn’t feel like they were up to cooking for the day.
Lam: The program also seemed to empower participants by introducing them to new things. Jason remembers doing something he had never done before.
Simpson: Our group constructed a 12-paddler Voyager canoe. It looks like a really long and fairly wide canoe, almost like a small Viking ship, but without the sail. It was a cedar-strip canoe that we ended up fibreglassing. I believe we donated it to one of the local Indigenous health centres — that was prior to or actually during the climax of the Every Child Matters movement. So we ended up painting most of it orange and donating it to this organization. To my knowledge, they were going to use it for kids in the community on that reservation to go on summer trips out on the water. I felt happy when I was making it, knowing that there was a fairly significant purpose for it all. That definitely felt good.
Lam: Despite his success getting sober, all the outdoor programming and the skills he picked up at Gwek, Jason also wanted to be honest about something.
Simpson: I had a lot of time to sit and do nothing, and I didn’t want to say that because maybe that would be kind of discouraging. But, in truth, that’s a big component of their program. Being out in nature constantly had this effect of just insulating me from all the difficulties. It allowed me to really focus on some things that were going on within me and that I had neglected for a long time. I learned that if I’m compassionate with myself and I’m patient and I’m tolerant, I can endure. I can sustain. I also learned how to make myself busy. In my case, boredom is often a choice. If we’re going to talk about just the trigger of boredom, boredom for me is very much a decision. There are so many things to do even when out in the bush, whether you’re with others or completely alone. I learned how to kind of rely on my inner child to find ways to be playful.
GWEK health practitioner
Lam: That said, the land can be a cause for quitting the program, too. Here’s Matt Maracle again — Gwekwaadziwin Miikan’s director of operations.
Maracle: With individuals who have left the program and said, just the fall programming isn’t for me: the bugs are too bad or I don’t want to be on the trap line or whatever it is. And then they’ll reapply for winter or summer and things like that as well. So it’s just, again, recognizing the individuals where they’re at, what best fits their needs, because it’s really reciprocal in that it’s not just are they a good fit for the program, but is the program a good fit for them?
Lam: I asked what the dropout rates were like. Fidelity to the program is a metric of success for mental-health treatment for the government of Ontario.
Maracle: At the sort of height of our success, we’ve seen up to an 87 per cent graduation rate with the 90-day program. And then we’ve sort of ebbed and flowed between the national average, which is tough to get an actual number for for whatever reason, but we’ve ascertained it’s between 35 per cent and 50 per cent; we’ve gone anywhere between 50 and 75, on average, to highs of 87-plus with those graduation rates.
Lam: But Matt was cautious about defining success by people sticking with the program. He framed success as relative.
Maracle: What is success? To us, it isn’t a graduation rate. Individuals who come, they may make it to 31 days, but they’ve only done 28-day programs in their past. Your typical program, looking at 28 days, even if someone just did 66 per cent of our program, that’s still 60 days and more than double what they would attend elsewhere.
Lam: Outcomes from the therapy is another metric the government has used. Of course, relative outcomes would be trickier to quantify, but the expected outcomes listed on Gwek’s website are linked to the medicine wheel, such as increase in physical health, decreased problematic substance use, increased perception of quality of life, and increased life skills, including employment readiness and increased knowledge and experience with Indigenous culture, resulting in stronger identity and resilience. But for what it’s worth, Matt was keen to point out that employment readiness and educational engagement were things that Gwekwaadziwin Miikan was able to help facilitate with success in the second phase of Gwek’s continuum of care, the live-in aftercare or LIAC. Once people graduate from land-based treatment, they’re eligible to apply for one of the 11 LIAC beds to transition back to mainstream society.
Maracle: So we have 11 beds that are in a living facility where individuals are able to focus on stable living environment, life-skills development. There is an expectation that anyone within the program is working toward higher education or vocational success or anything like that. At this point, we’re really proud to say that we have a 100 per cent success rate of connecting our participants with an educational institution or with employment. So that’s been really beneficial.
Lam: When the Investigative Journalism Bureau first did their reporting on mental-health care back in 2020, experts like Angela Ashford-Pringle told the IJB that bringing youth back to the land, where they can reconnect with their culture and language, holds the greatest promise for healing. But Gwekwaadziwin Miikan’s existence is more an exception than a rule when it comes to mental-health care. One expert said that it is “often impossible” to find help that incorporates a traditional First Nations approach. Here’s Matt Maracle on the demand Gwek faces up in Manitoulin Island.
Maracle: Our wait-list, just for our program alone, for our 20 beds, is anywhere between 140 and 180 people for any cohort. And those are the ones that are eligible for the program. Then you have those who are looking for programs for under 19. So there certainly is a lack of culturally appropriate services to meet the actual needs of the population.
Lam: Gwek is currently working on getting their 13- to 19-year-old Youth Mental Health and Addictions program up and running. The demand isn’t showing signs of slowing down when we look at recent numbers from our Western mainstream medical institutions. In Ontario between 2019 and 2021, there was a small increase in the number of hospitalizations for youth and children for substance-related disorders. That’s according to numbers from the Canadian Institute of Health Information. And while there was a small decrease in emergency visits and hospital stays for children and youth with mental disorders generally in 2020, the proportion for visits to the emergency room and hospitalizations for mental disorders increased. And it’s worth noting that, every year since 2019, Manitoulin Island’s public-health unit, Sudbury and Districts, has reported the highest rates of opioid-related emergency-department visits.
Maracle: If you’re familiar with Manitoulin, there is basically a greater rate per capita of substance use. We just had a coroner’s report that went through some of the numbers that we’re seeing of deaths over the last four years. And when you actually weigh it by a per capita basis, the numbers are absolutely remarkable and a little daunting and overwhelming, when you see what’s happening on our island, because it is a small location.
Lam: Geography is not the only thing that can influence health outcomes. The data that the Investigative Journalism Bureau gathered between March and October 2019 to 2020 found that 20 per cent of 161 First Nations post-secondary students struggled with PTSD and substance abuse. Less than 10 per cent of all ethnicities surveyed in Canada said the same. And while 30 per cent of the Indigenous post-secondary students said that counselling they received was helpful, they were overall more likely to report feeling unsupported in their counselling compared to other ethnicities. You may remember Jaclyn Carr. Jaclyn is Chief Carr’s child. We heard from Chief Carr earlier in the episode on the importance of how to achieve the good life. We spoke with Jaclyn in Episode 1 as well. They have faced a fair share of mental-health struggles, but they’re now a knowledge keeper in their community.
Jaclyn Carr: And I was so grateful to be recognized from my community.
Lam: Jaclyn approaches care in the Western system with caution. She felt she couldn’t be completely honest with people in the medical system.
Carr: I never really say a lot in therapy. Counsellors, psychologists, psychiatrists who are not Indigenous or do not have an in-depth understanding of our culture. I do not want to open up as much as I probably should, because I feel like, if I get a misdiagnosis on something, then I’m going to be like mistreated in a way that my mind and my body may not be able to come back from. I just kind of get that feeling like going back to being zombified again, like losing that kind of thing that makes you you — that fire inside you or that that zest [laughs]. That spice you got.
Lam: Jaclyn’s been off psychiatric medication since 2022. She tells me that she has tried different kinds of psychiatric meds since 2011. When we met at Hiawatha First Nation, Jaclyn was coming off a medication.
Carr: I was on a mood stabilizer. I felt like I was just kind of zombified, really. Though it did take away my extremes, I kind of felt I was just going through the motions.
Lam: And it didn’t feel like it was for you then at that point?
Carr: No. And then I thought I was having thyroid issues, because I was gaining weight like crazy. And I would come to work, and I’d be just drenched in sweat.
Lam: And while CAMH has said that antidepressants can be useful for up to 70 per cent of those who try them, I think it’s interesting that Jacqueline names this concern with the medical system: being diagnosed with something that she does not think is representative of her experience. In fact, there’s a growing movement of people who are voicing their skepticism on the utility of medical diagnoses and are speaking out about the harm they have experienced in the medical system when it comes to mental-health treatment.
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Jenna Reid: I think that the “mad movement” or the psychiatric-survivor movement is still a movement that is often very overlooked. My name is Jenna Reed. My pronouns are she and her. I’m a woman who wears many hats. I’m an artist and artistic director. I am an activist, and I am a fairly reluctant academic.
Lam: Jenna is also a white queer person. She tells me she experienced sexual abuse growing up, and when she got to university, she was not doing so well.
Reid: I think I’ve written about it publicly by saying I went batsh*t crazy. I was always being threatened to be institutionalized. It was always prioritizing making sure that I was on medications regardless of what those medications were doing to my body. And it was doing pretty horrific things. So I was in a constant state of crisis.
Lam: It felt like, when she was seeking support, she was being told that something was wrong with her instead.
Reid: There was such a heavy focus on fixing me, and I don’t actually think that was a helpful approach. I don’t believe that what I needed was to be fixed in the way that they saw it. There’s this heavy emphasis on “it just needs to be the right meds; it just needs to be the right diagnosis.” I have to say, it’s like people will often be very curious to know what my diagnosis is, and I generally refuse to share specifically, because, for me, that was never an illuminating or helpful resource in coming to a diagnosis. I actually got dozens and dozens and dozens of diagnoses in my charts.
Lam: Of course, there are people in this movement who also acknowledge that diagnoses can help people better understand who they are and better manage their mental health.
Reid: But madness is also deeply connected to structural and systemic issues, and there is a lot within that that people don’t have a knowledge of. So when you start to learn about the relationships, for instance, between the history of psychiatry and the enforcement historically and ongoing of colonial violence, you can see that unpacking madness is a justice issue. That has us thinking, “How are we addressing contemporary issues of colonial violence, and how do those relate and overlap in movement spaces?’
Lam: The unfortunate part is that we don’t even need to go that far in history to see how the medical system has harmed Indigenous people here. The one story that rings loudest for me is Joyce Echaquan’s death in 2020 in Quebec. Even though her death was ruled accidental, the coroner’s investigation in 2021 declared that racism and prejudice played a role in the outcome. Joyce had caught racist insults from medical staff on camera, but the coroner also found that the medical staff’s course of treatment assumed that Joyce was in withdrawal. The assumption that she was addicted to drugs was unfounded. When she became agitated at the hospital, she was given sedatives without further tests. And the fact that she was restrained and left lying down also may have led to her lungs filling up with excess liquid, leading to her death. As recently as 2022, health officials acknowledged that there was anti-Indigenous racism in northern Manitoba in their health care and that this was reflected in their health-care outcomes. A declaration was signed to promise its elimination.
Despite the risk of misunderstanding and, frankly, a history of harm, Matt Miracle also wants to be honest about something else, too.
Maracle: Our strength is in the cultural approach, but we also understand we need to have those partnerships with some of those Western programs as well, especially when you’re starting to look at things like the introduction of methadone and Suboxone within the program.
Lam: Methadone and Suboxone is a type of opioid-agonist-therapy medicine that offers a slower extended release of opioids to help with withdrawal management and curb problematic substance use.
Maracle: That’s not necessarily a cultural approach, but it’s a reality that if we were not to permit individuals who are utilizing some of those opioid-agonist therapies, we would lose a lot of people because we would be shutting down something that’s very much embedded in their day-to-day.
Lam: For Matt, it’s not about doing away completely with Western approaches or being anti-medication.
Maracle: Sometimes you need things like that Western medicine in order to help support individuals through whatever it is that they’re going through, whether it’s anxiety meds or something that will help with depression — whatever it is. There is a benefit to appropriate medication regimen.
Lam: In an email, Matt said that, initially, Gwek did not allow opioid-agonist therapy in their program for a number of reasons, but through a pilot project, they were able to take a look at how they could implement the use of OATs at Gwek. They developed appropriate policies and procedures, trained their staff and land-based counsellors to support the administration of OAT, and occasionally would have a registered nurse once a month to help with its administration. Sometimes health teams will go to Gwek, and other times, Gwek participants and staff will access provincial facilities. Matt said it really depends on circumstance because of their person-centred approach.
Maracle: Being on Manitoulin, we’re certainly a much smaller population. Even things like withdrawal management and detox — the closest ones are 90 minutes to 120 minutes away. A lot of things can happen from the point of leaving Manitoulin to being dropped off in, let’s say, Sudbury and then hoping that everything’s going to be okay after the detox period. So the service gaps are very obvious in what we do, and we’re really working to fill those service gaps. And a lot of that is just bridging with our community partners and trying to support each other as we have new endeavours that work toward filling some of those service gaps.
Lam: Gwek does their best to have their individual programs ready through pre-treatment check-ins and referrals, knowing that many variables within the nature of addictions and recovery can come up. Their health-care partners are aware of Gwek’s intake days and are either on site or on standby.
Maracle: The ultimate goal is to have a therapeutic community that is able to support itself. But, again, just where we are and with the HR supply and demand of being in a remote area, there can certainly be limitations just because of our population. Really, it does take a community. And that’s something that we’ve wholeheartedly embraced and actively work toward.
Lam: To reach that ultimate goal, Matt says that withdrawal management — one of the main moments for a blended approach — is one of the challenges they’ll need to keep a good handle on.
Maracle: There’s only so much we can do. It really needs to look at sort of systems overhaul and how do we do things differently. And it doesn’t necessarily need to be a novel approach, because we’re not doing anything that the blueprint hasn’t already laid out for us. We’re just getting back to some of those original teachings and original understanding of nurturing Spirit and the original understanding of bringing people together to heal together.
Lam: Today, while Jason has a better handle on his addiction, he is still learning how to live with what could have been the root causes of it.
Simpson: I’ve struggled more with mental health and lack of emotional health in the last two years than I ever have, even prior to my addictions.
Lam: How so?
Simpson: Not knowing how to regulate my emotions. You know how to cope with certain thinking patterns. Being a person with OCD, I can become pretty obsessive in the mind. And the last time I met with a psychiatrist, he told me that people with OCD tend to generate slightly more intens — if not much more intense — emotions than the average person, just because we have a tendency to ruminate and obsess so deeply. I’ve had a lot of days and moments where I was really confused and I couldn’t understand why my mind was thinking in the ways it was. And I struggled and tried desperately to control my thoughts and avoid negative thinking patterns that would really get me into a whole load of trouble physically.
I remember for the first six months of my recovery, I think I made at least seven or eight visits to the local emergency department at the nearest hospital because I was just so intolerant of the way I was feeling and the things I was thinking. The first time I ever experienced a panic attack was in my recovery. The first time I’ve experienced suicidal ideation has been in my recovery. Many good things have happened since I’ve been sober, but there are also a lot of difficulties along the way.
Lam: Research shows that addiction and mental illness can happen at the same time. It’s also true that substances can mask what had previously been there or even make it worse due to how the brain gets rewired from continued substance use. Finding treatment for two diagnoses can be important for folks sobering up. As far as good things go, though, Jason finds he still applies what he learned at Gwek at the body shop he works at.
Simpson: I definitely do refer to some of the tricks of the trade that I learned when I was building that canoe and apply them to repairs that I have to do on different kinds of boats at the marina. The first time I experienced what it’s like working with fibreglass and resin was out on the land. I think it’s kind of funny that the first constructive project of any kind that I took part in in my current sobriety was building a boat of some kind.
Lam: More broadly, there are softer skills he takes with him, too.
Simpson: The trade that I’m learning right now is one that definitely demands a certain level of tenacity and patience. And those are two things I didn’t have. I couldn’t see through something that was tedious and time-consuming, and learning how to be patient and tolerant and relaxed out in the wild has helped me to learn how to be that same way when I’m at work today.
Lam: Matthew and I, we’re here in Toronto, and I would say that there’s a lot of stigma about folks who are not sober on the street. What message do you have for people here to help them feel more compassion toward folks who are struggling?
Simpson: I do my best to not be too judgmental or critical or discriminate today, but there was a time when I was very judgmental and very critical. All I can say is that what I’ve learned is that, when I’m approaching a person, place, thing, or situation from a place of judgment, I can’t really be of much help. I understand that the person I once was can be seen as a great burden and a great weight for society to carry and a great problem that communities face on a daily basis. Like I said, if approaching from a place of judgment and criticism or ill feelings, we can’t really be of assistance or of much service to those people — or really any people, in my opinion.
Lam: I’m curious: What do you do now these days for your mental health?
Simpson: Aside from continuing to utilize the medicines like I was when I was out on the land — such as smudging or picking up my eagle feather and preparing cedar tea or praying and meditating, getting in touch with the land — something I think I’ve turned to more than anything else is exercise. But, on the other hand, I can also drink six cups of coffee and smoke a pack of cigarettes in a day. So.
National Addictions Awareness Week
Lam: Thanks for listening. I hope to leave it there — with Jason discussing the way he copes — to affirm that it’s complicated to maintain good mental health. Throughout the show, mental-health professionals have told us there is no one way to heal. There isn’t a way to do it perfectly, and it is definitely not linear. Reporting out this episode on land-based healing, a common thread of the show really sank in. Whether it was from a medicine wheel, teachers saying that learning to cope is like a muscle, doctors highlighting the importance of the social determinants of health, a neuroscientist lauding how cutting-edge individualized medicine might be in the near future, or a psychologist exploring promising new digital options, the message was consistent: the toolbox is varied. There’s no one answer, because of the diversity of experiences that bring people to the headspace they’re in. And a main barrier to good mental health is when we act like one answer is a panacea. Another barrier could be rigid adherence to criteria for what is considered successful treatment or maybe the lack of clear criteria altogether.
Making the show has been a real journey. And, honestly, there was so much more I wish we could have discussed, but maybe another time. I hope the show was a helpful start that helped shed light on a fraught topic and spur some imagination about how we think of mental health and approaches to care.
I would love to hear what you thought of In Our Heads. You can write me at tlam@tvo.org or find me on Twitter. If Twitter is not your thing, I’m also on Instagram. This episode tried to focus on a solution and a success story, albeit one couched in the challenges that come with success. If you’re feeling like you need help, you can always call Wellness Together Canada at 1-866-585-0445 or text “wellness” to 686868 for youth and 741741 for adults.
In Our Heads is hosted and written by me, Tiff Lam, and co-produced with Matthew O’Mara. This episode featured additional reporting from TVO Today’s Ontario Hubs journalist Charnel Anderson. Matthew and I also reported and edited the show. The show also relies on reporting from Generation Distress, an Investigative Journalism Bureau series published in the Toronto Star. The team was led by Robert Cribb, Declan Keogh, Julia Finney, and Charlie Buckley. This episode had production support from Erica Giancola, Carla Lucchetta, Nikki Ashworth, and Jonathan Halliwell. Shaghayegh Tajvidi is managing editor for podcasts and digital video. Laurie Few is executive producer digital, and John Ferri is VP of programming and content here at TVO. Thanks again for listening to In Our Heads.