Mental health services in the Northwest Territories: a scoping review

Figures & data

Figure 1. Map of regional HSSA and communities prior to 2016 transformation [12]

Figure 2. Transformation of governance structure for NWT HSS system [12]

Figure 3. First nations mental wellness continuum model with legend [5]

Table 1. Grey literature search strategy

Method	Tools	Used to find …
Grey literature repositories	Government websites	Government programs, reports, resources and services
	- Federal
	- Territorial
	- Indigenous and Regional
Contacting experts	E-mail and phone conferences with mental health workers in 5 regions	All grey literature types specific to region, information on services not available elsewhere
Targeted and general web searches	- Centre for Addiction and Mental Health, Canadian Mental Health Association, Mental Health Commission of Canada websites	Health promotion, campaigns, social networking, NGO and other agency programs
	- Google search engine

Figure 4. Source identification and mental health service selection for inclusion in scoping review

Table 2. Continuum of essential services and collected data

Continuum of Essential Services from FNMWC Model	Services targeting Continuum of Essential Services category
	Number of services	% of services (n = 68)
Health Promotion, Prevention, Community Development and Education	41	60%
Early Identification and Intervention	14	21%
Crisis Response	14	21%
Coordination of Care and Care Planning	12	18%
Detox	0	0%
Trauma-Informed Treatment	13	19%
Support and Aftercare	28	41%

Table

source	jurisdiction	Partners	title of intervention	Date started, Duration	CES	Service Site
(GNWT, 2012)	community	CCP, NGO	Tl’oondih Healing Society		HPPCDE, TIT, SA	Fort McPherson
(Tlicho Government)	community	Community Action Research Team (CART)		2009	HPPCDE	Rae
Expert Consults with Representative from the Inuvialuit Regional Corporation. (2016).	community	DEA (district education authority)	Student and family support workers	2014, during school year	HPPCDE	IRC except Sachs Harbour (Aklavik, Inuvik, Paulatuk, Tuktoyaktuk, Ulukhaktok)
(Amos et al., 2013)	community	GNWT and National Crime Prevention Centre	Leadership and Resiliency Program (LRP)- Crime Prevention in Action	2009	HPPCDE	schools in Hay River, Fort McPherson, Aklavik, N’dilo, YK
(Expert Consults with Representatives from HSSA of the NWT, 2016)	community	GNWT, NGO	Salvation Army Withdrawal Management Program		CCCP	YK
(Public Health Agency of Canada, 2015)	community	Health Canada	Open Door Society		EII	Fort Simpson
(Public Health Agency of Canada, 2015)	community	Health Canada	Gameti Early Intervention		EII	Rae-Edzo
(Public Health Agency of Canada, 2015)	community	Health Canada	Treehouse Drop In Centre for Parents and Children		SA	Hay River
(Public Health Agency of Canada, 2015)	community	Health Canada	Yellowknife Family Centre		SA	YK
(Environment and Natural Resources)	community	HSSA, Environment and Natural Resources	Take a Kid trapping	2007 start	HPPCDE	Nahanni Butte, Aklavik, Dehcho, Inuvik, Trout Lake, Wrigley, Fort McPherson, Tuktoyaktuk, Yellowknife, Tlicho, Lutselk’e, Tulita, Deline, Colville Lake, Fort Good Hope, Fort Providence, Fort Smith, Fort Resolution, Hay River, Fort Simpson
(GNWT, 2012)	community	NGO	Lutsel K’e Mental Health and Addictions		EII, CCCP, TIT	Lutsel K’e
(GNWT, 2012)	community	NGO	Deninu Kue First Nation		EII, CCCP, TIT, SA	Fort Resolution
(Amos et al., 2013)	community	RCMP	D.A.R.E (Drug Abuse Resistance Education)		HPPCDE	Schools: Weledeh Catholic School (YK), Inuvik, Hay River
(Expert Consults with Representatives from HSSA of the NWT, 2016)	community	Salvation Army, southern facilities	Adult services		EII, SA	YK
(Tlicho Government, 2016a)	community	Tlicho government, Tlicho friendship center	On the Land Grief & Loss Workshop	2016, 5 days	TIT, SA	Behcheko
(Tulita Community Wellness Plan, 2013)	community	Tulita Wellness Agency	Youth Wellness programs		HPPCDE	Tulita
(GNWT, 2014)	community		Native Women’s Association		HPPCDE, SA	YK
(Deline First Nation, 2013)	community		Mental health and Addictions Program		HPPCDE, SA	Deline
(GNWT, 2014)	community		Sutherland House Women and Children’s Shelter		HPPCDE, CR, SA	Fort Smith
(GNWT, 2014)	community		Friendship centers/tree of peace		HPPCDE	Fort Smith, Hay River, YK, Fort Providence,Fort Resolution, Fort Simpson, Inuvik
(GNWT, 2014)	community		Family Support Centre/Safe Home Network		CR	Hay River
(GNWT, 2014)	community		Drop-in Centre		CR, SA	Fort Good Hope
(GNWT, 2014)	community		Mental Health and Addictions Program		EII, CCCP	Fort Liard
(GNWT, 2014)	community		Deline Wellness Centre		EII, CCCP, SA	Deline
(Expert Consults with Representatives from HSSA of the NWT, 2016)	community		Central intake		EII, CR, CCCP, SA	YK
(GNWT, 2014)	community		Side Door Youth Drop in	almost daily	HPPCDE	YK
(Amos et al., 2013)	community		Purple Door		HPPCDE	Hay River
(Expert Consults with Representatives from HSSA of the NWT, 2016)	community		Wellness Café- Dialectical Behavioural Therapy (DBT) at YK Primary Care clinic	Oct 2015, 1x/week	HPPCDE, SA	YK
(GNWT, 2014)	community		Alcoholics Anonymous		SA	YK
(Tetlit Gwich’in Council, 2013)	community		Grieving workshop	2013	SA	Fort McPherson
(GNWT, 2004)	community, NGO	funding from YKHSSA	Women and Children’s Healing and Recovery Program		TIT, SA	YK
(GNWT, 2004)	community, NGO		Centre for Northern Families (formerly the Yellowknife Women’s Centre)		CR, SA	YK
(GNWT, 2014)	national		Native Mental Health Association of Canada	annual	HPPCDE	national
(Canadian Mental Health Association, 2016)	national		Annual Mental Health Week	annually, 1 week	HPPCDE	national
(GNWT, 2012)	national		Kids Help Phone	Aug-10	HPPCDE, CR	national
(Health Canada, 2014)	national, federal government	GNWT	Health Canada’s Non-Insured Health Benefits (NIHB program)- short term crisis intervention mental health counselling benefits		CR	National
(Health Canada, 2015)	national, federal government	Aboriginal Affairs, Northern Development Canada	Indian Residential School Resolution Health Support Program		CR, TIT, SA	National
(Expert Consults with Representatives from HSSA of the NWT, 2016)	regional	community recourse and people, Elders etc.	Community education support and critical incident debriefing	upon request, typically 3 months post suicide	TIT, SA	Fort Resolution, also in Sahtu
(Expert Consults with Representatives from HSSA of the NWT, 2016)	Regional	Diabetes team	Craving Change	1x/wk., 4wk program	HPPCDE	Hay River HSSA
(Inuvialuit Regional Corporation, 2015)	regional	elders, partners in Alberta, GNWT	Project Jewel: Helping Aboriginal People Re-Discover Their Value	2012, one week	HPPCDE, EII, TIT, CCCP, SA	Beaufort-Delta Region
(Tlicho Government, 2016b)	regional	GNWT, Tlicho Community Services Agency	Youth on the land healing program	2013	HPPCDE	Tlicho
(Expert Consults with Representatives from HSSA of the NWT, 2016)	regional	Stanton Hospital, Salvation Army, southern detox facilties	Psychiatric services		EII, CR, CCCP, TIT	YK, Hay River, Fort Smith HSSA, Fort Simpson
(Tlicho Government, 2014)	regional	Tlicho Community Services Agency	International Suicide Prevention Day	2014	HPPCDE	Behchoko
(GNWT, 2015)	regional		“Talking About Mental Illness” (TAMI)		HPPCDE	YK, Beaufort-Delta regions
(Expert Consults with Representatives from HSSA of the NWT, 2016)	Regional		Empathetic Parenting	2016, 2 days	HPPCDE	Hay River HSSA
(GNWT, 2012b)	regional		The Health Café		HPPCDE, SA	Fort Smith
(Expert Consults with Representatives from HSSA of the NWT, 2016)	Regional		Domestic Violence treatment options	no longer related to HSSA	HPPCDE, EII	Hay River HSSA
(GNWT, 2014)	regional		Yellowknife Victim Service Program		SA	YK and region
(GNWT, 2014)	regional		Mental Health Clinic		EII, CCCP	YK, Mackenzie, Sahtu, Kitikmeot
(Expert Consults with Representatives from HSSA of the NWT, 2016)	Regional		CBD Depression Groups	3 hrs./week, 9 weeks, 3x/yr., since 2014	HPPCDE	Hay River HSSA
(Fort Smith Metis Council and Salt River First Nation, 2013)	regional		AA/Alanon		HPPCDE	Fort Smith
(Expert Consults with Representatives from HSSA of the NWT, 2016)	regional		National Addictions Awareness Week	annually, 1 week	HPPCDE	Beaufort-Delta
(Expert Consults with Representatives from HSSA of the NWT, 2016)	Regional		Group for caregivers	2015, 1x/week for 8 weeks	HPPCDE	Hay River HSSA
(Inuvialuit Regional Corporation, 2015)	regional		Red Cross RespectED	2015	HPPCDE	Beaufort-Delta Region
(GNWT, 2012b)	regional		Mental Health First Aid for Northern People training	2013, 3x/yr.	HPPCDE, EII, CR	Fort Smith, Tlicho
(Inuvialuit Regional Corporation, 2015)	regional		Resiliency Workshop	2015	HPPCDE, TIT	Beaufort-Delta Region
(Expert Consults with Representatives from HSSA of the NWT, 2016)	Regional		Trauma Workshop	2 days, needed before allowed to start processing group, 2x/yr.	HPPCDE, TIT, SA	Hay River HSSA
(Expert Consults with Representatives from HSSA of the NWT, 2016)	Regional		Trauma Processing Group	2013, 12 weeks long (1 day/week), 1x/yr.	TIT, SA	Hay River HSSA
(Expert Consults with Representatives from HSSA of the NWT, 2016; GNWT, 2014)	territorial	Aboriginal band funding uses federal wellness funding, GNWT	Brighter Futures Program	2013	HPPCDE	YK, territorial (Aklavik, Fort Providence, Inuvik Native Band), Hay River
(GNWT, 2011; GNWT, 2012b)	territorial		My Choice, My Voice campaign	2011	HPPCDE	Tulita, Fort Good Hope, Tuktoyaktuk, Aklavik, Deline
(GNWT, 2014)	territorial		Healing Drum Society		SA	territorial, in YK
(GNWT, 2014)	territorial		Bosco Homes		HPPCDE, CR, CCCP	territorial treatment center in YK
(GNWT, 2014)	territorial		Alison McAteer House- family violence program		HPPCDE, SA	territorial, in YK
(GNWT, 2012)	territorial government	HSSA	Health and Social Services Addictions Treatment Program; Matrix Project	3 aft/week ongoing, 2.5 hours	HPPCDE	territorial- all regional health authorities
(GNWT, 2004)	territorial government	Regional HSSA	Community Counselling Program (CCP)	2002	HPPCDE, EII, CCCP, TIT, SA	offered by each regional health authority to all communities
(GNWT, 2015)	territorial government		ASIST (Applied Suicide Intervention Skills Training)	3x/yr. in YK or upon request	HPPCDE, CR	Fort Smith, YK, Hay River, Sahtu, Norman Wells
(GNWT, 2014)	territorial government		Trailcross Treatment Centre		HPPCDE, CR, CCCP	Fort Smith
(GNWT, 2012)	territorial government		NWT Help Line		CR, SA	territorial
care provider	target population	mental health target	Culture as a foundation	community based	Indigenous Social Determinants of Health	notes/recommendations/descriptive summary
		mental health and addictions		community		“Project activities will include counselling, support groups and support visits. The project will provide workshops that, in conjunction with the counselling, will provide participants with the tools to address the Legacy of Physical and Sexual Abuse in Residential Schools.”
Healing Winds Advisory Committee			cultural practice			Community Action Research Team (CART), a research group that combines modern and traditional practices for community well-being
Community support worker	elementary and high school (youth)	addressing issues that resulted in low school attendance		community	education and lifelong learning	goal is to Increased attendance at school, academic leading into professional success, promote wellness, need for increased attendance and motivation in communities to go to school
	students 14–19 yrs. (youth)	enhances youth’s internal strengths, resiliency, preventing substance use	values	school and community based		weekly groups, monthly community volunteering, monthly alternative/adventure activities
	adults	addictions treatment
	preschool program
	parents and children
			land based		land and resources
		addictions	cultural focus	community based
		addictions	cultural focus	community wellness
	grade 6 (youth)	drug awareness program
psychiatric nurse for caseload management	Adults, mostly males	acute, chronic and persistent mental illness, learning disabilities			economic development, social services, housing	Supported living arrangements, help with living/financial forms, navigating social system, basic needs
	residential school survivors and families		land-based		land and resources
	youth				health care, education and lifelong learnng	promote youth to participate in healthy activities, education on drugs and alcohol
					employment, economic development, social services	“Work activity program – upgrading, life skills, healing, computer skills, work placement, counselling support. Victim Services Program – assistance to victims of crime in Yellowknife areas.”
			land based		environmental stewardship, social services	recreation weekly sports, nature and Nordic walks, healthy eating education, counselling and advocacy services, relapse support and counselling
	abused women and children				hosuing
community justice facilitator	adult	addictions		community wellness program	justice	Community justice facilitator, choices and alternatives, youth programming and resource room.
					social services	“24-Hour Crisis Line: 867–874-6626. Provides a safe place for women and children living in abusive situations, crisis support, family violence issues, child/youth programs and community outreach.”
				community		“men’s support group, adults and children of Alcoholism, EGH support group, AA meetings, parenting, youth and women’s support group, counselling, home visits, victim services, family violence and mental health issues”
		alcohol and drug
community counsellors		alcohol, drug and substance abuse
1 intake counsellor, 1 intake psychiatry mental health nurse	all	mild to moderate mental health conditions
	ages 13–19, 6–13, ladies					“a safe place for teens to come without negative pressures”
public health workers	high school (youth)					“Programs that allow public health workers in high schools, text/cell phone based “
counsellors and social groups	self-referral, anyone	suicidal thoughts, severe depression		community		skills-based group, teaching participants to develop awareness of how to deal with strong emotions and negative thinking, learning self-acceptance, DBT developed to treat chronically suicidal thoughts with BPD (borderline personality disorder)
	adults	alcohol addiction		community based
facilitator		focus on grieving and loss
	women and children, in and outside of YK	trauma- sexual abuse/domestic violence, addiction related issues			social services
	women and families				housing, social services	emergency housing, advocacy, pre and post natal care, family support, clothing, lunch, supportive programming
education and training conference	mental health practitioners	mental health	cultural knowledge		heritage and culture	“increase aboriginal awareness, understanding of native culture and improve mental health care for native people”
Canadian Mental Health Association	Canadians
professional counsellors	children and teenagers (youth)	depression, wide variety of problems, issues and concerns				“The Kids Help Phone is a national 24/7 phone counselling service that is free, anonymous and confidential for ages 20 and under. This bilingual service may be reached toll-free at 1–800-668–6868. Web counselling is also available at: KidsHelpPhone.ca”
Therapists registered with Health Canada	First Nations, Inuit					“When there is a crisis or at-risk situation and there is no other source of immediate funds for services. An initial assessment by a professional mental health therapist in order to develop a treatment plan (maximum two hours). Mental health short-term crisis treatment and referral services by a NIHB recognized mental health professional.”
Aboriginal organizations, Resolution Health Support Worker, professional counselling	Indian residential school survivors and family	PTSD, issues related to residential school experiences				“Provides mental health and emotional support services to eligible former Indian Residential School students and their families throughout all phases of the Indian Residential School Settlement Agreement”
			cultural focus	Yes	education and lifelong learning	grief and loss workshops in communities
	no specifications	addictive habits, eating, mental health and diabetes			health care	changing addictive eating behaviours, what cravings mean, geared to eating but also understanding emotions
Counsellors, financial advisors, dietitian	all ages	any issues	Elders, practice, values, land		heritage and culture	Elders always present. Engage in and contribute to holistic workshop in culturally relevant, therapeutic environment, wellness programming- inclusive mental health
Teachers, Instructors, Facilitators, Elders, Workers	Behcheko youth, 13–18 yrs.	wellness, healing spiritual language, culture	cultural knowledge, language, values	yes	land and resources, language, heritage and culture
adult and child psychiatrists, locum – rotational and travel to communities region	adult and child
	grade 8 students (youth)	increase mental health literacy to decrease stigma			education and lifeling learning	“Talking About Mental Illness” (TAMI) was delivered to grade 8 students in Yellowknife. This program works to increase mental health literacy to decrease stigma. The program draws on the lived experience of speakers living with mental illness who tell their stories to help reduce stigma. NWT speakers have been identified and trained and school boards outside of Yellowknife have been invited to express interest in offering the program. In the 2015–16 school year, the program will expand to the Beaufort Delta.’
mental health counsellor and wellness worker	any parents				education and lifelong learning	learning skills such as empathetic listening and help children problem solve through feelings etc.
Public Health, Mental Health and Addictions workers, nurse practitioners	young people	mental health and addictions			health care, education and lifelong learning	“The health Café, developed in Fort Smith, encourages young people to play an active role in health discussions, seeking support and receiving treatment if they require it. Topics include sexually transmitted infections, mental health and addictions, and pregnancy, among others. These services are provided by Public Health, Mental Health and Addictions workers and Nurse Practitioners. Information is also provided via phone or text.”
probation officer and mental health and addictions counsellor	1st time offenders, spouse violence	violence			jusice	used to be option for people to do treatment or go through justice system upon 1st time offence, no more money for HSSA to be part of it, stopped and now just justice runs it
		victims of crime or tragedy			justice	The program provides immediate and follow-up support to victims in the form of emotional support, referrals to community agencies, assistance with Victim Impact Statements, information about the legal system, and liaison with the police, hospital, court and other community services. Victim Services staff and volunteers provide 24 hour crisis support to victims to lessen the immediate effects of crime.
						“assessment and treatment to persons referred by general practitioners or settlement nurses from the Mackenzie, Sahtu or Kitikmeot regions of the NWT”
2 mental health and addictions counsellors, 1 wellness worker	adults	depression and anxiety	vaues
		alcoholism		community-based
2 mental health counsellors	caregivers of youth who self harm					work through feelings, money and time are limiting factor
						anti-violence program for suicide prevention
		mental health problems, suicidal people				“ … training course was developed to help people provide initial support for someone who may be developing a mental health problem or is experiencing a mental health crisis. … The program teaches people how to recognize the signs and symptoms of mental health problems and guides a person towards appropriate professional help”
mental health counsellors						help understand trauma, if participate in this can do processing group, review symptomology and physiology of what happens to brain during trauma, can understand if have triggers etc.
2 mental health and addictions counsellors	mostly women, Indigenous, adults over 18	any kind of trauma and trauma related illnesses		community based		daytime counselling is stopped when these workshops are happening
	Aboriginal youth	community mental health, child development, solvent abuse, life skills, youth	land, knowledge, practice	community based	health care, education and lifelong learning, heritage and culture, land and resources	“Brighter Futures supports community projects designed to improve the physical, mental and social well-being of Aboriginal children, their families and communities. Projects must have community support and re etc. one or more of the following elements: community mental health, child development, solvent abuse, injury prevention, healthy babies or parenting skills”
	young people, 13–18	addictions, drug and alcohol	cultural focus	community wellness	education and lifelong learning	“ … helping youth and other NWT residents to get the message out about how addiction and binge drinking hurts families and communities. … A toolkit for teachers and other mentors is being developed that will help to guide meaningful discussion.”
	residential school survivors	addictions or other problems	cultural focus		heritage and culture
psychologist and psychiatrist	children ages 8–12 (youth)	social, emotional and behavioural issues	culturally relevant approach	community based
	12-bed shelter for women and children	family violence victims			housing, social services	“Services include shelter, food, counselling, group support, referrals to other agencies and services. Advocates to challenge systematic barriers to women’s safety and empowerment. Support groups and counselling for women and children who have witnessed violence.”
CWW		addictions				“12-week outpatient addictions treatment program which is run three times a year. The program includes education, relapse prevention, and is based on cognitive behavioral skills, motivational skills and harm reduction.”
CWW, mental health and addictions counsellors, clinical supervisors, social workers	across whole territory	variety: mental health, addictions, family violence,		community-based programming		“1st territory-wide program to bring mental health and addictions closer to home. HSSA deliver mental health”
training frontline workers, trained by 2 mental health and addictions counselors	primary care workers in screening	suicidal			education and lifelong learning	“Applied Suicide Intervention Skills Training (ASIST) teaches effective intervention skills while helping to create suicide prevention and support networks in the community. The program gives community members the skills to help those who may be dealing with mental health issues. In 2014/15, 130 residents attended the two day ASIST program offered through the Authorities.”
workers, peer culture influence, group centered therapy, one to one therapy	children/adolescent ages 13–15 (youth)	social, emotional and behavioural issues	cultural focus	family and community based	social services, education and lifelong leanring, heritage and culture	“This involves living, working, therapy and skill building groups a one- to-one psychotherapeutic relationship, educational remediation, familial interventions, and community integration. The program features a culturally relevant approach in addressing the physical, emotional, intellectual, and spiritual needs of individuals and their families”
						“The NWT Help Line, which is available 7 PM to 11 PM, 7 nights a week. Call 1–800-661–0844 or in Yellowknife at 920–2121, Call this number if you are having any sort of personal problem and want to talk to someone. This line provides information, support and referral services. Your call will be completely con denial, which means no one will know that you have called and talked about your personal problem”

Government of the Northwest Territories. Northwest Territories Health and Social Services Authority 2016–2017 Annual Report. Yellowknife, NT; 2017.

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Health Canada. First Nations Mental Wellness Continuum Framework. Ottawa, ON; 2015.

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