Where do we go from here?

That's the question.The Rant and Rave posts (a Kenora, Ontario internet space ) are becoming increasingly racist. Prophecies tell us this is the time for One Heart, One Mind and One Drum. In his book One Story, One song (2011), Ojibway author Richard Wagamase wrote of the Loons Necklace. He tells us that a loons' call reminds us to look outside ourselves, at the air, the land, the water and brings us back to the natural order of things. "There is no need to see the teacher. We only need to feel the teaching. And then, he becomes the teacher (pg.114)". In Embers, One Ojibways Meditations, Wagamase writes, "It is love itself that brings us all together, This human family we are a part of, this singular voice that is the accumulation of all voices raised together in praise of all Creation. This one heart beat, this one drum, this one immaculate drum that puts us all together so that we can learn its primary teachings-that love is the energy of Creation, that it takes love to create love" (pg 46).

Wagamase's home community in Northwestern Ontario, the Wabaseemoong First Nation, and its neighboring community, Auubpeeschoseewagong (Grassy Narrows First Nation) have been ravaged by mercury contamination. This tragedy is discussed in Children of the Poisoned River-half a century after mercury contamination near Grassy Narrows. The poisoning continues to have deadly consequences-especially for youth. Jody Porter (2019), details the impact on three generations of Ojiway individuals of 9000 kilograms of mercury being dumped into the English -Wabigoon river by the chemical plant of the Reed Paper mill in Dryden Ontario.The negative mental health implications of mercury poisoning haven not been well studied.A resident of Grassy Narrows is quoted in the disturbing story of the destruction by alcohol of Grassy Narrows. A Poison Stronger than Love The Destruction of an Ojibway Community. Anatasia Shkilnylk (1995), quotes a community member, "I cannot explain it to you, because I cannot explain it to myself. The only thing I know about alcohol is that alcohol is a stronger power than the love of children. It's a poison and we are a broken people.We suffer enough inside and therefore we understand each other" .

1. Wagamase was very familiar with suffering. In his memoir, One Native life (2008), he wrote, "I'd suffered abuse and neglect as a toddler. My terror was magnified in foster homes and in an adopted home where I lived for seven years. For a long time, afterwards, I tried running away, hiding or drinking excessively to shut out the pain. It was the trauma that had caused me to choose hurt over joy, that made me believe my life would always be a bottomless hole of blackness and misery". He did not live to read Death as Expected: Inside a child welfare system where 102 Indigenous children died over four years (Kenneth Jackson, 2019). This report details the correlation between these deaths and the gross under funding of Child welfare agencies supporting Indigenous children. I, in my role as a consultant psychiatrist to a number of community living agencies and private providers of group home facilities for children in care, think of the displaced children I have met. A distraught Indigenous fourteen year old young lady born, in a fly in community in Northwestern Ontario, with a Fetal Alcohol Spectrum Disorder (FASD), convicted of murdering a two month old baby. After being evicted from her foster home at midnight and being relocated to another home at 2 am, she is overwhelmed and does the unspeakable. A young man who has lived in 40 foster homes in five provinces and three states because he is extremely aggressive and addicted to multiple substances. I suggested to him that it might be true that he had trouble trusting others. "No shit," he answered. I worry that the crimes committed by Indigenous children and young adults are becoming increasingly violent. A 14 year old convicted of second degree murder. Will he re offend as he leaves the provincial youth correctional service? He greets us in the basement of his current home, the Kenora jail. A home destroyed by arson near the Kenora city core. The Toronto Star (Feb. 2, 2020) reports that 30% of the inmates in Canadian prisons are Indigenous, a horrifically disproportionate number given that Indigenous individuals only constitute 3 % of our population (Penny Collenetatte, What is wrong with our prisons ? New report reveals shocking numbers). Indigenous women constitute 40 % of the Canadian female prison population. Independent senator, Kim Pate, an expert on prison reform, will introduce a Judicial Discretion Bill next week. Which argues that mandatory minimum sentences increases criminalization amongst the poorest, racialized, and those dealing with mental Heath issues. After touring the Kenora Jail in 2017, Renu Mandhane, an Ontario Human Rights Commissioner, concluded that every Indigenous inmate incarcerated in the Kenora jail, constituting 90% of the prisons census, have mental illnesses and or addictions. These men, who may also struggle with impulsivity, poor judgment, and social vulnerability secondary to FASD, often leave jail with no money, no support system and no where to sleep. Some have been told to re offend and return with drugs, at the risk of grave physical harm or death, should they not comply.

Senator Murray Sinclair, chairman of the Indian Residential schools Truth and Reconciliation Committee, has said that there are four questions all Indigenous individuals need to ask to understand who they are: Where did I come from? Where am I going? What is my purpose? Who am I? (All our Relations, Talag, T., 2018). For many Indigenous individuals, there is a disconnect when these questions are asked. The Residential school system in place in Canada between the 1880s and 1996 exposed 150,000 Indigenous individuals to a government and church sanctioned attempt to isolate them from their homes, language, culture and tradition. Subjected to harsh conditions and abuse, children surviving the Residential school experience often developed Post Traumatic Stress Disorders. Many self-medicated with alcohol and non-prescribed substances to address symptoms of Post Traumatic Stress Disorders. Inter generational trauma then followed. Wagamase, in One Native Life ( 2008) describes leaving a home of chaos at age 16 with a grade 9 education, not knowing who he was, filled with anger, resentment and fear. His words describe the life he choose, "drugs and alcohol eased the hurt". He slept in abandoned buildings, cars, parks, and doorways. Often cold and hungry, he explains that "you become invisible when you are homeless". You understand what it is to exist as a shadow, as a phantom, as irrelevant as the discarded papers swirling at your feet (pg79). There is a craving amongst the homeless to belong.

The Kenora Association for Community Living (KACL) has embraced the need to be trauma-informed in supporting transitional-aged Indigenous youth.The Dual Diagnosis program at KACL provides support locally and regionally in Northwestern Ontario to individuals with Intellectual Disabilities (ID), Fetal Alcohol Spectrum Disorder (FASD), Autism Spectrum disorders, and co-existing mental health concerned and or addictions.The demographic of those supported has shifted from repatriated individuals formerly living in institutions with severe to profound degrees of ID to individuals with mild or borderline degrees of ID and often FASD; either homeless or living in precarious housing situations. Addicted to crystal methamphetamine (Meth) and narcotics, the men are not infrequently incarcerated, the women forced into the sex trade; individuals unable to answer the questions posed by Senator Sinclair.

Gaining trust is a cornerstone to a lasting therapeutic relationship. Insisting on twelve step programs based on abstinence rarely goes over well here. Instead, the principles of harm reduction make so much sense.These include: the belief that the opposite of addiction is connection, avoiding stigmatization, meeting people where they are in the cycle of change regarding their addiction, reducing physical illness with accessible primary health care, needle exchange programs, reducing death by overdose through education, Naloxone kits, and safe consumption sites.

We have been taught that Meth can precipitate psychosis. We have observed that repeated episodes of Meth-induced psychosis become harder to treat with anti-psychotic medications. Prescribing Cesamet (THC in pill form ) or medical marijuana has reduced cravings for Meth and lessened the intensity of narcotic withdrawal. Individuals prescribed marijuana are willing and able to record their subjective reactions to marijuana. They are receptive to treating it as a medicine. There is a role for PRN or as needed marijuana in some individuals lives. The safe and efficacious use of medical marijuana in this instance is guided by a PRN Protocol, a written summary based on a bio-psycho-social-spiritual framework for support strategies, offered by community support workers when clients are in crisis. The potential value of using stimulants off label to reduce Meth consumption appears to be a next step. Partnerships are so important. We pursue these with community and hospital based counselling programs, the Detox center, the schedule one psychiatric unit at the local hospital, police, the public health unit, Indigenous health and addiction groups.We honour traditional Ojibway healing practice and the need to care for ourselves to avoid vicarious traumatization.

Richard Wagamese concludes with "we heal each other by sharing the stories of our time here. We heal each other through love. In the Indian way, that means you lead me back to who I am. There's no greater gift, and all it takes is listening and hearing, Ahow (One Native life, 2008, pg.181).

Wise words. That's where I am going to go next.

Peace