WEB OF CULTURE:
CRITICALLY ASSESSING AND BUILDING CULTURALLY RELEVANT ONLINE
MENTAL HEALTH RESOURCES FOR ABORIGINAL YOUTH IN NORTHERN BC
by

Valerie Ward
B.Sc., University of Guelph, 2014

THESIS SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE
IN
COMMUNITY HEALTH SCIENCE

UNIVERSITY OF NORTHERN BRITISH COLUMBIA
April 2016

© Valerie Ward, 2016

Abstract
Traditional sources of health information are no longer meeting the needs of younger
generations, including Aboriginal youth, who are increasingly turning to the Internet with
their health-related questions. Research has shown that culturally tailored health education
and information resources are those best received by Aboriginal people. This project will
look at whether existing online mental health resources are age and culturally appropriate for
Aboriginal youth (ages 19-25) living in Northern BC. Using a social determinants of health
framework, this research employed decolonizing and (participatory) action-based research
methodologies, as well as arts-based methods (digital storytelling). Five key findings resulted
from this study. The most important finding was that existing online mental health resources
do not adequately address needs of Aboriginal youth living in Northern BC. Digital
storytelling, as an arts-based method, however, was an effective and engaging research tool
to work with youth populations.

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TABLE OF CONTENTS
Abstract .................................................................................................................................... ii
List of Tables ........................................................................................................................... v
List of Figures ......................................................................................................................... vi
Acknowledgments ................................................................................................................. vii
Chapter 1 - Introduction ........................................................................................................ 1
1.1 Rationale, Study Objectives and Research Questions ................................................ 1
1.2 Motivation for pursuing this research ................................... .... ... ............................... 3
1.3 Outline of Chapters ..................................................................................................... 5
Chapter 2 -Background and Literature Review ................................................................. 7
Part I - Aboriginal Health and Colonialism ..................................................................... 7
2.1 Understanding Aboriginal People's Health Disparities ........... ................ ... ................ 7
2.2 Colonialism in Canada ..... ...................................... .................. ...... ... .... ... .. ................. 9
Part II - Colonialism and Mental Health ........................................................................ 12
Part III - Research and Aboriginal Youth in Northern BC ......................................... 15
2.3 Defining Northern BC ........... .... .......... ... ... ....... ... ........ ......... ................. ........ ............ 15
2.4 Demographics of Northern BC ......... ........................................ ... ............................. 16
2.5 Socio-cultural context of Northern BC .... ..... ... ....... ............ ..... .. .. ............................. 17
2.6 Aboriginal youth in Northern BC .................... ............. .......... ................................ .. 18
2. 7 Health Promotion for Indigenous Peoples ................... .... ..................... ................... . 22
2.8 Online Mental Health Resources for Indigenous Peoples ........... .... .. .............. ......... 26
2.9 Digital Storytelling for Indigenous Health and Wellness ............ ............................. 29
Conclusion ......................................................................................................................... 32
Chapter 3 - Theoretical Frameworks and Methodologies ................................................ 33
3.1 Location in Research .. ..... ... .... ........................ ....... .................. ....... ......... ...... ....... ... .. 33
3.2 Decolonizing the Research Process ........ ... ...... ......... ..... .. .......... .. ............................. 34
3.3 Action Research ........... ...................... .... .......................... ................... ..... .. .. ...... ....... 36
3.4 Social Determinants of Health Framework ............. ........ ........ ......... ................... .... .. 38
3.5 Strengths Based Approach ...................... ............................................ .......... ............ 40
3.6 Arts-Based Research ............... ................................................... ......... ... ..... ... ......... .. 40
Chapter 4 - Methods ............................................................................................................ 42
4.1 The Research Environment ....................................................................................... 42
4.2 Research Steps ............................................................................................................. 42
Stage One: Community Consultation and Collection of Online Resources ................... 43
Stage Two: Critical Discourse Analysis ......... ............. ......... .... ................................ ...... 45
Stage Three: Recruitment of Participants ..... ........................... ..... .. .... ................ .... ........ 48
Stage Four: Digital Storytelling Workshop ......... .. .................... ...... .. ..... ......... ... .. .......... 50
Stage Five: Knowledge Translation .. ..... ................ ........ ................................................. 55
Conclusion ......................................................................................................................... 55
Chapter 5: Thematic Findings Based on Close Readings and Participant Feedback .... 56
5.1 Defining Mental Health ........... ............... .... .... .......... ........... .. ................ ... .. ........ .. .... 58
5.2 Hope of recovery .......... ...... .. .. ........... .. .............................. .... ... ............. .......... .. ........ 62

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5.3 Diversity of Voices ...... .. ......... ......................................... ... .. ............ .................... .... 67
5.4 Blaming the Individual ............................................................................................. 77
5.5 Technology for Youth ............. .......... ..... .... ........ .................. ..... ................................ 82
Conclusion ......................................................................................................................... 85

Chapter 6 - Discussion .......................................................................................................... 87
6.1 What is mental health? ....... .. ......... ... ....................................................................... .. 87
6.2 Hope of recovery ........................................................................... .................... ....... . 90
6.3 Still silenced: perpetuation of colonialism in online mental health resources .......... 93
6.4 Impact of the environment on mental health .... .. ..... ...... .. .. ................. ...... ..... ........... 96
6.5 Youth and technology: the case fore-health ............................................................. 99
6.6 Considerations ........... .................... .................. ..... .... .......... .... ... ........... ....... ............ 101
6.7 Limitations ...... ..... ................ ... ..... ...... ..... ..... .................. ... ................. ........ ..... ........ 102
Conclusion ....................................................................................................................... 103
Appendix I. Northern Health Authority Service Region ................................................ 105
Appendix II. Criteria checklist for categorizing health websites ................................... 106
References ............................................................................................................................ 107

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List of Tables

Table 1. List of online mental health resources collected

44

Table 2. Online mental health resource and its assigned number

58

Table 3. Aboriginal, geographic and youth relevance of online resources

85

V

List of Figures
Figure 1. The Terrace Women's Resource Centre (TWRC)

51

Figure 2. Line drawing created by youth participant.

52

Figure 3. Screenshot of KW's digital story.

53

Figure 4. Screenshot of digital story made by D

54

Figure 5. Screenshot of KM's digital story about wellness

62

Figure 6. Screen shot of E's digital story about mental health

64

Figure 7. Screenshot of the Kelty Mental Health Resource Centre website

65

Figure 8 . Screenshot of CMHA Prince George's website

66

Figure 9. Screenshot of "Why am I so stressed out?" video on mindcheck.ca

70

Figure 10. Screenshot from TW's digital story

70

Figure 11. Screen shot from TW's digital story

71

Figure 12. Funding for collected online mental health resources

72

Figure 13. Screen shot of mindcheck's home page

78

Figure 14. Screenshot of BCMHSUS' homepage banner

79

Figure 15. Screen shot of Kelty Mental Health Resource Centre banner

80

Figure 16. Screenshot of RF's digital story

82

Figure 17. Screenshot of D's digital story

84

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Acknowledgments
To the organizations that I had the privilege to work with - for welcoming me to your spaces
To the youth involved in this project - for trusting me with your stories and teaching me
To my supervisor, Dr. Sarah de Leeuw, and my committee members - for your continuous
support and guidance
To my family and friends - for your love and encouragement

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Chapter 1 - Introduction
1.1 Rationale, Study Objectives and Research Questions

A growing body of evidence indicates that over the last decade an increasing number
of youth are accessing the Internet, including Indigenous youth (Rushing & Stephens, 2011 ).
Research also suggests that Indigenous youth, like their non-Indigenous counterparts, are
accessing and searching for health information online from a diversity of sources - such as
Wikipedia or WebMD (Geana, Makosky Daley, et al., 2012). What remains unknown is how
Internet resources - especially those catering to a BC audience, might be further strengthened
or culturally tailored to more fully meet the needs of Aboriginal youth living in northern BC.
The objectives of this project were to:
•

Document the strategies that Aboriginal youth in Northern British Columbia use to
find online mental health resources;

• Explore youth opinions of online mental health resources that cater to a BC audience
and those produced elsewhere for Aboriginal youth specifically;

• Critically assess if existing online mental health resources that cater to a BC
audience are age and culturally relevant;

•

Document and assess the efficacy and potential of arts-based tools (digital
storytelling, discursive analysis of hypertexts) to undertake health and wellness
research, particularly when working with Aboriginal peoples.

It was my hope that this work could contribute to a better understanding about how to

produce more accessible and appropriate online mental health resources for Aboriginal youth
in Northern BC that, in tum, may help to promote better health and wellbeing within this
population.

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The very concept of Indigenousness and naming associated with Indigenous people is
a complex, shifting, historically contextualized, etymology. The term Indigenous can
sometimes be used as an umbrella term to represent groups that have a "historical continuity
with pre-invasion and pre-colonial societies that developed on their territories, consider
themselves distinct from other sectors of the societies now prevailing on those territories, or
parts of them" (United Nations Department of Economic and Social Affairs, 2004, p. 2).
However, the use of this term is not meant to pan-Indigenize or erase or disregard the great
diversity between Indigenous groups. In order to preserve the integrity of citations I will
maintain the terminology that is used therein; e.g. Aboriginal, First Nations, Native or
Indigenous. Throughout this paper, the term 'Aboriginal' is commonly used in Canada to
refer to persons reporting to identify with at least one Aboriginal group, i.e. First Nations,
Metis or Inuit and/or who reported as a treaty or Registered Indian as defined by the Indian
Act of Canada and/or who reported they were members of an Indian band or First Nation.
This thesis documents a digital storytelling workshop, embedded within a qualitative
study about online mental health resources available to Aboriginal, mostly First Nations,
youth (ages 19-25) living in Northern British Columbia. The term 'youth' refers to a person
"between the age where he/she may leave compulsory education, and the age at which he/she
finds his/her first employment" (United Nations Educational, Scientific, and Cultural
Organization, 2015, p. 2). 'Youth' includes people between the ages of 15 and 24 and in
some cases, youth can include persons up until the age of 35 (United Nations Educational,
Scientific, and Cultural Organization, 2015). For this research, northern BC refers to the
Northern Health Authority Service region and includes territories and places north of the
community of Quesnel to the Yukon border (see Appendix I). The research process was

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informed by decolonizing and (participatory) action research methodologies, and a social
determinants of health framework, which guided the use of digital storytelling and focus
group methods. Together, this led me to ask the following broad question: Are existing
online mental health resources, especially those catering to a BC audience, age and culturally
appropriate for Aboriginal youth (ages 19-25) living in Northern BC? More specifically, I
addressed the following four questions with my research:
1. Where do Aboriginal youth in Northern British Columbia access online mental
health information?
2. What online mental health promotion resources exist for Aboriginal youth (ages 1925) in Northern British Columbia, especially those catering to a BC audience?
3. Are these existing resources culturally and age appropriate?
4. If not, how could they be modified to be more age and culturally appropriate?
With these questions in mind, the remainder of this chapter provides a discussion about my
motivation for pursuing this project followed by an overview of the chapters that make up
this thesis.

1.2 Motivation for pursuing this research
The motivation for this research was the culmination of several recent experiences.
Spending a summer in the Yukon, I witnessed the number of youth accessing technology
through their mobile devices, library computers, and the recent arrival of wireless Internet to
the community. These young people were celebrating and re-creating themselves, in a
manner of speaking, with the help of this technology. More importantly, during this time, I
observed the way in which First Nation youth were using technologies and social media to

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identify with and share their culture with Aboriginal and non-Aboriginal youth beyond their
community.
Upon arriving at UNBC in September, I quickly became involved in promoting
mental health on campus. Although I have had, and still have, several friends who have
experienced mental illness or challenges to their mental health, this was not an area that I
knew much about. However, due to these personal connections, it was a subject that was of
great interest to me. As part of this new role, I spent a lot of time searching for mental health
information online, learning more about mental health (or more often mental illness), and
exploring strategies for promoting mental health. Considering the stigma associated with
such disorders, and the increased use of technology and the Internet, online resources seemed
like good ways for individuals to learn more and seek resources. However, I began to wonder
about whether online health resources were reflective of health understandings beyond those
of the dominant colonial population. More importantly, I wondered whether online mental
health resources were reflective of holistic understandings of health, which are fundamental
to Aboriginal people's understandings of health. Holistic understandings of health take into
account the mental, physical, spiritual and emotional health of the individual and
communities, often seeing each of these areas as interconnected and inseparable. This got me
to thinking: What if our definitions of mental health and illness are not aligned with what
Aboriginal people need or want? What if current mental health systems are inadequate?
Finally, my interest in qualitative research emerged after completing an
undergraduate degree in Biomedical Science at the University of Guelph. I became interested
in learning more about the bigger picture - while the cell was interesting and could have a
considerable effect on the human as a whole, the same could be said about the human' s

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environment. The arts piece came in when I traveled to Thailand and realized what incredible
things can be communicated, even without verbal language, through art and sport. I was also
aware of my own visceral response when participating in art or creative processes. With all
of this in mind, I began research work, the results of which are in this thesis.
1.3 Outline of Chapters

Following from this first chapter, Chapter Two provides an overview of the literature,
upon which this thesis draws, including a discussion about health disparities experienced by
Aboriginal people, the roots of these disparities and health promotion techniques for
Indigenous people, especially online mental health resources. The literature overwhelmingly
demonstrates that Indigenous people prefer health promotion and education resources that
incorporate cultural elements; this requires input from, and collaboration with, the very
people the resources are targeted to.
Chapter Three, the methodology section, begins by locating myself in my research
and then explores the theoretical foundations that guide my research including: decolonizing
methodologies, social determinants of health frameworks and (participatory) action based
research. The second part of Chapter Three provides a discussion of approaches I employed
for my research project - strengths-based and arts-based research. These, as I discuss, flowed
from the theoretical foundations.
Chapter Four, the methods section, begins with an introduction of the research
environment. The research stages undertaken for this project are then outlined along with a
discussion about the rationale behind and the type of data collected in each stage. The goals
of this project (to explore the age and cultural relevance of online mental health resources by
Aboriginal youth) were achieved by conducting an action-based research project that was

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organized in a 5 stage process, including: 1) community consultation and collection of online
mental health resources, 2) a critical discourse analysis of online mental health resources
collected in stage one, 3) recruitment of participants, 4) a digital storytelling workshop, and
5) knowledge translation through the creation of a website containing youth digital stories.
Chapter Five includes a presentation of the findings that emerged from the data.
Specifically, the identified themes were: defining mental health; hope ofrecovery; blame the
individual; diversity of voices; and youth support technology.
Chapter Six includes a discussion of the five identified themes, drawing on existing
research to explain my findings. This section will conclude with the limitations of this study
as well as some conclusions.

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Chapter 2 - Background and Literature Review
Broadly speaking, vast health inequities exist between Aboriginal and non-Aboriginal
peoples in Canada (Adelson, 2005; Evans, White, & Berg, 2014; Muirhead & de Leeuw,
2012). According to national statistics, Aboriginal peoples have significantly higher rates of
stroke and heart disease, diabetes, tuberculosis, liver disease, suicide, and obesity (Health
Canada, 2011). Additionally, national and provincial statistics consistently report that life
expectancy for Aboriginal Canadians is close to seven years below that of other Canadians
(Treasury Board of Canada Secretariat, 2005). Health statistics paint a grim picture and
highlight the relative disproportionate burden of disease faced by Aboriginal populations
(Adelson, 2005). This chapter will unfold in three parts, beginning with a background on
health disparities experienced by Aboriginal people followed by a discussion about mental
health and colonialism and ending with a thorough review of the literature.
Part I - Aboriginal Health and Colonialism
2.1 Understanding Aboriginal People's Health Disparities
"Statistics are human beings with the tears wiped off" - Paul Brodeur
Aboriginal health statistics often fail to account for the underlying social, economic,
cultural, and political inequities, and landscapes that are increasingly being associated
(directly or indirectly) with worse health outcomes (Adelson, 2005) and that are unique to
each community (Chandler & Lalonde, 1998). For example, youth suicide rates among First
Nations are reported as being between 5-11 times greater than the national average (United
Nations Children's Fund Canada, 2009). However, this is not true of all Aboriginal
communities. A report by Chandler and Lalonde (1998) showed that among 200 Aboriginal
communities across BC, some communities report suicide rates of up to 800 times the

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national average while in others, suicide is essentially unknown. Moreover, this report
identified the role of cultural continuity "as a hedge against suicide in Canada's First
Nations" (Chandler & Lalonde, 1998, p.1 ). Markers of cultural continuity include selfgovernment, land claims, education services, police and fire services, health services, and
cultural facilities. Communities in which more of these markers were controlled by the
individual band were associated with lower rates of youth suicide (Chandler & Lalonde,
1998). This research served two purposes in informing my project. First, it highlighted the
need to approach pan-Indigenous statements cautiously- the statements themselves may
hold some truth, however to assume that the statement is true of all Aboriginals equally
would be incorrect. Secondly, it informed the use of a social determinants of health (SDoH)
framework that views health holistically and understands health disparities as more than a
flawed Aboriginal trait (Adelson, 2005). This approach acknowledges the link between
health and the social context in which one lives (see Marmot, Friel, Bell, Houweling, &
Taylor, 2008) and is important when considering the health of Aboriginal people (Australian
Medical Association, 2007; Greenwood & de Leeuw, 2012; Loppie Reading & Wien, 2009;
Marmot et al., 2008).
While viewing health from a social determinants of health perspective can offer a
more comprehensive understanding, Greenwood and de Leeuw (2012), argue that a
framework specific to Aboriginal peoples is also and always necessary; this Aboriginalspecific framework includes colonialism as a distal determinant of health. Colonialism, in
this context, is understood as the "guiding force that manipulated the historic, political,
social, and economic contexts shaping Indigenous/state/non-Indigenous relations and

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accounts for the public erasure of political and economic marginalization, and racism today"
(Czyzewski, 2011 , p.4) while shaping the health of Aboriginal people in Canada.
2.2 Colonialism in Canada
Colonialism, as a distal determinant of Aboriginal peoples ' health, is complex and far
from over. Less than 200 years ago, colonial legislation (based on the idea of terra nullius)
legitimated the processes of colonization, including European settler expansion into lands
occupied by Aboriginal peoples and the dislocation and confinement of Aboriginal peoples
onto reserves (Gracey & King, 2009). Terra nullius means land belonging to no one; it is a
legal fiction (something which may not be true, but is assumed to be so in order to facilitate
particular legal findings). Based on this concept, Euro-colonial groups 'discovering' Canada
could assume rights over all territories within its boundaries because the lands were 'empty'
upon 'discovery', rather than belonging to the Indigenous nations actually living there
(Gracey & King, 2009). Colonial legislation and policies continue to influence the health of
Aboriginal peoples, explicit, for example, in Indian Reserve systems that continue to
dislocate people from traditional lands, fishing and hunting sites, and water rights (Fisher,
1992). Furthermore, the rural nature of reserves means a lack of infrastructure and staff as
well as jurisdictional ambiguities. Language or cultural barriers can also limit access to
essential services (Fisher, 1992).
While the mechanisms and impact of colonial systems and colonization are similar
among all three Aboriginal groups (First Nations, Inuit and Metis), particular policies and
systems have been especially deleterious to a distinct group. For example, the Indian Act has,
and continues to have, a significant impact on the lives and health of 'status' First Nations
(Loppie Reading & Wien, 2009). The Indian Act continues to define who has or does not

9

have 'status' as an Indian person, and it demarcates services provided by the federal
government (Ministry of Indian and Northern Affairs Canada, 1876). The Indian Act also
governed the Indian Residential Schools, institutions explicitly designed to 'kill the Indian in
the child' (Assembly of First Nations, 2002) to assimilate Indian people into CanadianEuropean society. In addition to the Indian Act, over 160 years ofresidential schools left
deep scars within communities, as family and community structures were disrupted, cultures
and traditions devalued or lost, and trauma from the physical and sexual abuse experienced
in these institutions was carried over into future generations (see Truth and Reconciliation
Commission of Canada, 2015). Still today, child welfare systems continue to intervene in the
lives of Aboriginal families in Canada at a rate greater than any other population in the
country (Sinha, Trocme, Fallon, & MacLaurin, 2013), and currently more Aboriginal
children live as governmental wards than were ever in residential schools (Beaucage, 2011;
Blackstock, 2007; Greenwood & de Leeuw, 2012). Those that remain with their families face
a colonial legacy of poverty, inadequate educational opportunities, unemployment, poor
living conditions, alcohol abuse, and domestic violence (Correctional Service Canada, 2013).
The interplay of these proximal and intermediate determinants affect individuals starting at
birth and continuing to play out over their life-course, manifesting as different health issues
in each life stage (Loppie Reading & Wien, 2009). Proximal determinants of health are
considered to be the conditions of health that have a direct impact on physical, emotional,
mental or spiritual health (Loppie Reading & Wien, 2009). Intermediate determinants are the
origins of the proximal determinants; for example, the health care or education systems.
Discrimination, in the form of racism, remains deeply entrenched in society, affecting
diagnosis and treatment and therefore health outcomes (Allan & Smylie, 2015; Australian

10

Medical Association, 2007). Subtler forms of racism (called micro-aggressions) (Frideres,
Krosenbrink-Gelissen, & Frideres, 1998) include conforming to a narrow view of identity to
be validated, or being labeled by negative stereotypes perpetuated in the media (Greenwood
& de Leeuw, 2012), and can affect the health of the individual in negative ways (Evans-

Campbell, 2008; Sue, 2010). For instance, and tragically, according to one Elder, in order for
an Aboriginal person to make the news they must be one of the 4D ' s: drumming, dancing,
drunk or dead (McCue, 2014). Stereotyping has long been a feature of media coverage of
Aboriginal people in Canada (Harding, 2005) including the "Aboriginal-as-pathetic victim"
(p.322) or "Aboriginal-as-Angry-Warrior" (p.322). Consequently, "a combination of
inaccurate research, inadequate education, slanted media coverage and dehumanizing
stereotypes make even the most ' educated' professional grossly uninformed about American
Indian life and culture" (Poupart, Martinez, Red Horse, & Scharnberg, 2000, p.15). Research
on Indigenous peoples has historically been deficit-based, has applied a 'pathologizing lens,'
and has consisted of non-Native perceptions of Native people and culture (Peacock, 1996),
all of which has contributed to the perpetuation of these stereotypes (Ermine, Sinclair, &
Jeffery, 2004).
Informed by this harmful and deficit-based history of research with Indigenous
peoples, as well as the on-going effects of colonialism in Canada, this project employed a
decolonizing methodology that explicitly engaged participants and ensured that this project
may be valuable, accountable, and empowering to Aboriginal people (L. T. Smith, 1999).
This, in tum, called for a participatory action research (PAR) which is a "culturally relevant
and empowering [research approach] for Indigenous people in Canada as it critiques the
ongoing impact of colonization, neocolonialism and the force of marginalization" (Ermine et

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al., 2004, p. 13). Elements of PAR and a strengths-based focus (Brough, Bond, & Hunt,
2004) were incorporated in this research which, together, aligned well with a decolonizing
approach. A more complete discussion of methodologies will take place in Chapter 3.
Part II - Colonialism and Mental Health
Scholars are increasingly critical of statistical representations oflndigenous peoples'
mental health; these statistics run the risk of essentializing Indigenous peoples as 'victims' or
inherently 'sick' (Nelson, 2012). Although there is a considerable variability of mental health
factors from any community to the next, the high suicide (Trumper, 2004) and depression
rates (Kirmayer, Simpson, & Cargo, 2003) among First Nations people should not be
ignored. Instead, Czyzewski (2011) argues that the collective mental disease experienced by
Indigenous people is socially produced by both colonial policies and mentalities that produce
and reproduce "detrimental discursive environments" (p.4). Nelson (2012), too, suggests:
"colonial conceptions of mental illness have always been closely interrelated with the goals
of colonialism itself' (p.4). For example, mental health and mental illness are based in
'Western' ways of knowing and thought, which "involves inequitable assumptions about
colonized peoples, inherently disadvantaging Aboriginal peoples who access mental health
care" (p. 4). This raised the question, then, as to whether "the production of these mental
health disparities [can] be attributable to how mental health is conceptualized?" (p.4). Mental
health, from a biomedical approach, can be understood as "a state of well-being in which
every individual realizes his or her own potential, can cope with the normal stresses of life,
can work productively and fruitfully, and is able to make a contribution to her or his
community" (World Health Organization, 2014, p. 1), or a state of "psychological well-being
and satisfactory adjustment to society and to the ordinary demands of life" (Dictionary.com,

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2012, p. 1). Alternatively, mental illness is defined as "health conditions that are
characterized by alterations in thinking, mood, or behavior (or some combination thereof)
associated with distress and/or impaired functioning" (U.S . Department of Health and
Human Services, 1999, p. 1). These varying definitions of mental health influence how
recovery from mental illness is understood (Deegan, 1996; Farkas, 2007; Farkas, Gagne,
Anthony, & Chamberlin, 2005). For example, recovery from mental illness can be framed as
returning to normal, or completing a specific treatment plan. Alternatively, an individual can
have a mental illness and can still be mentally healthy (Kirby, Keon, & Senate standing
committee on social affairs, science and technology, 2006). These Western
conceptualizations, along with the Diagnostic and Statistical Manual (DSM) of mental
disorders are used to measure and report broad Canadian mental health statistics, including
those oflndigenous peoples. However, the DSM has been criticized for containing several
problematic assumptions about culture and mental health (Nelson, 2012). Particularly, it has
been pointed out that the DSM was developed in a very specific cultural environment, and
therefore may not be applicable to people who live in other contexts (see Phillips, 2010).
Another challenge of clearly defining how Aboriginal people understand mental
health and illness is the wide range of definitions that exists between groups of Indigenous
peoples. For example, some American Indians attribute depression to serotonin levels
(Cohen, 2008), whereas the Inuit tend to label emotional states rather than people, allowing
for the possibility that someone whose behavior is different today may be ordinary tomorrow
(Nuttall, 1998). Mental health, for the Anishinaabe, is a component of the medicine wheel
(Pitawanakwat, 2006). Individuals seek to maintain a balance between the four realms of the
medicine wheel: the mental, the spiritual, the emotional, and the physical. Joseph Gone

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speaks of his community of the Gros Ventre tribe in Montana as one that configures
"wellness much differently than the 'mental health' of professional psychology, emphasizing
respectful relationships instead of egoistic individualism and the ritual circulation of sacred
power instead of the liberating enlightenment of secular humanism" (Gone, 2009 p. 427).
Regardless of how each group conceptualizes mental health, there is a strong link between
traditional culture and positive mental health. According to McCormick (2009) a well
known Aboriginal psychologist: "Traditional cultural values provide Aboriginal people with
teachings on how to attain and maintain connection with creation and many of the mental
health problems experienced by Aboriginal people can be attributed to a disconnection from
their culture" (p. 348). This close association between mental health and culture was
explored in this research, by assessing the cultural relevance of online mental health
resources.
While it is important to understand Indigenous conceptions of mental health,
differentiating between Aboriginal and Western understandings of mental health can be
problematic and result in the process of' othering.' Othering can marginalize Aboriginal
peoples or generalize Aboriginal culture without acknowledging individual and community
differences or appreciating the dynamic nature of cultural worldviews, values, beliefs, and
understandings (Vukic, Gregory, Martin-Misener, & Etowa, 2011). It can also render
Aboriginal knowledge as a commodity to exploit, appropriate, or potentially misinterpret.
However, to ignore Aboriginal worldviews about mental health and illness would be
"unethical and immoral as Aboriginal people fight the legacy of colonialism to regain a sense
of balance and harmony within their collective historical identity" (Vukic et al., 2011, p. 66).

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For the purposes of this project, I acknowledged that multiple definitions and
understandings of mental health exist. I used a critical discourse analysis to critically analyze
conceptions of mental health that are promoted in existing online mental health resources
catering to a BC audience. Aboriginal youth living in Northern BC also shared their opinions
about whether they felt that their understandings of mental health or wellness were reflected
in these online mental health resources. Together, this knowledge may be used to develop
online mental health resources that provide definitions of mental health/illness and
information, which are relevant to Aboriginal youth living in Northern BC. This, in tum, may
translate into better wellness within this population.
Part III - Research and Aboriginal Youth in Northern BC
2.3 Defining Northern BC

Defining the area that constitutes Northern BC can be challenging. Each sector seems
to define it differently. Forestry, for example, divides the northern portion of BC into a
Northeast region (Fort Nelson and Peace Districts), Omineca region (Fort St. James,
Mackenzie, Prince George and Vanderhoof Districts), Skeena region (Kalum, Nadina and
Skeena Stikine Districts) and Cariboo region (100 Mile House, Cariboo-Chilcotin and
Quesnel Districts) (Ministry of Forests, Lands and Natural Resource Operations, 2015).
Northern BC can also be defined based on river basins (BC-ALCAN Northern Development
Fund Act, 1998) or regional districts (BC Statistics, 2015).
Because this research is health related, I used the Northern Health Authority's
definition of Northern BC (see Appendix I), whose eastern and western borders are the BCAlaska and the BC-Alberta borders respectively. The northern border is the BC-Yukon
border and the southern border begins just south of Quesnel and Valemount (Northern

15

Health, n.d.). The territorial land base in the Northern Region covers a 600,000 square
kilometer area, approximately 64% of BC's land base (First Nations Health Authority, 2015).
Given the vast landscape and relatively small population (approx. 300,000 people or 6.5% of
BC's population), this larger region is divided into three Health Service Delivery Areas
(HSDA's): the Northwest Region, the Northern Interior region and the Northeast Region.
These sub-regions allow for more local health needs to be attended to (Northern Health,
n.d.). Despite efforts to mitigate it, it is not uncommon for people requiring specialized
health services or diagnostic testing to travel 200 kilometers or more to the nearest regional
hospital (Browne, n.d.).
The First Nations Health Authority (FNHA) defines Northern BC as the Northern
Health Authority does (as defined on p.15), but includes First Nations communities that may
lie outside these geographic boundaries. BC is unique from other provinces in Canada as it
has the First Nations Health Authority who plan, design, manage, and fund the delivery of
First Nations health programs and services in BC. The FNHA emerged through a tripartite
agreement in 2005 with the BC First Nations, the Province of BC, and the Government of
Canada (Federal Health Minister, Provincial Health Minister, & First Nations Health Society,
2011). The FNHA do not replace the role or services of the Ministry of Health and Regional
Health Authorities, rather they collaborate with the BC Ministry of Health and BC Health
Authorities to coordinate and integrate their respective health programs and services to
achieve better health outcomes for First Nations in BC (Federal Health Minister et al., 2011).
2.4 Demographics of Northern BC
Generally speaking, the population of Northern BC accounts for 6% of the BC
population, and has a younger demographic than the province as a whole, with 60% aged 44

16

years or younger compared to the province average (54%) (University of Victoria, 2011).
Prince George, which lies in the Northern Interior region, is the largest population center in
the North, with a population of roughly 80,000 people (University of Victoria, 2011).
According to the 2011 Aboriginal Affairs and Northern Development Census (AANDC),
5.4% of BC's total population identify as Aboriginal, with over 200 urban, rural, remote, and
isolated Aboriginal communities throughout the province. Northern BC is home to roughly
35.6% ofBC's First Nations Population (First Nations Health Authority, 2015) which means
an overall 15.7% of Northern BC's population is Aboriginal. As a result, Northern BC has
the highest proportion of Aboriginal people in the province (Northern Health, n.d.). Within
this region, it is estimated that 34% of First Nations live on reserve, and 54% live off-reserve
(First Nations Health Authority, 2015). Metis and Inuit data within this specific region was
not provided. In Canada, 37% of Aboriginal people are aged 19 or younger, and 18.2% are
between the ages of 15 and 24, compared to 22% and 12.9% within the non-Aboriginal
population respectively (Statistics Canada, 2011; University of Victoria, 2011 ).
2.5 Socio-cultural context of Northern BC
Broadly speaking, Northern BC is unlike any other region in the province. Home to
only a small percentage (6%) of BC's population, the region accounts for approximately 70%
of the province's land mass (University of Victoria, 2011). BC's economy was traditionally
built on the area's abundant natural resources, including forestry, mining, and fishing (see
Initiatives Prince George Development Corporation and Northern Development Initiative
Trust, 2008). Northern BC's economy still relies heavily on natural resources and industry,
especially on the growing oil and gas industry in the Northeast region. The expansions of the
oil and gas industry have been met with much resistance, especially from Aboriginals living

17

within the region. Aboriginal youth feel that "their health and identity are inextricably bound
up in their ability to follow in the footsteps of their forebears - fishing and paddling in the
same waters, collecting kelp in the same tidal zones in the outer coastal islands, hunting in
the same forests, and collecting medicines in the same meadows" (Klein, 2014 p.341). Thus,
the Northern Gateway Project, and other similar projects are seen as "another wave of
colonial violence" (Klein, 2014 p.341) all of which form a context for Aboriginal health.
Climate change is expected to impact Northern BC differently than the rest of the
province; more warming is predicted in the northern region as compared to the southern
region, and warming will be greater in the winter than in the summer (Hamilton, 2009).
Change in temperature threatens natural resource-based economies, especially forestry. The
close reliance on the land puts many First Nations communities under considerable stress as
traditional territory risks being developed for industry or is impacted by climate change
(Parkes, de Leeuw, & Greenwood, 2010). The stress caused by a loss of traditional territory
is compounded by a loss of culture, which is also closely linked to the land. Together this
contributes to a decreased wellness among Aboriginal people (Parkes et al., 2010). This all
called for a need to understand whether online mental health resources are reflective of the
realities of Northern BC's Aboriginal youth, especially environmental risk factors.
2.6 Aboriginal youth in Northern BC

"It is no measure of health to be well-adjusted to a profoundly sick society" Krishnamurti
Statistics show that over one-quarter of the Aboriginal population in Canada is below
the age of 19 (Statistics Canada, 2011 ). Despite the existing size and expected growth in this
population, there is a considerable lack of health data (Gionet & Roshanafshar, 2013) and
other information about young Aboriginal Canadians. Furthermore, there is also a dearth of

18

research on Aboriginal youth in British Columbia, let alone Northern BC. Thus the need for
my project. While much of the existing research presented in this section is not specific to
the Northern BC region, one may assume that Aboriginal youth in Northern BC share similar
wishes and experiences as those living elsewhere in Canada.
Traditionally, Indigenous children and youth learned about community activities by
observing and participating in the affairs of the family and community. Each stage of life was
associated with specific roles that provided children and young people with a sense of
belonging to their community (Blanchet-Cohen & Fernandez, 2003). In Canada, however, a
legacy of colonialism has severely disrupted these community structures; as a result, many
youth and children have found themselves without a role and place in society (BlanchetCohen, McMillan, & Greenwood, 2011). This sense of purposelessness can lead to poor
mental health outcomes such as depression, self-absorption, addictions, destructive behavior,
and difficulties with interpersonal relations (Damon, Menon, & Cotton Bronk, 2003). For
instance, when Alaska Native youth were asked the question, "Why do you think people
attempt or commit suicide?" (Wexler, 2009, p.15), one youth responded "They're bored and
think there's nothing better to do with their life" (p. 15).
Despite cultural discontinuity and disrupted community structures, young Aboriginal
people, like other young Canadians, remain optimistic; they have high hopes when it comes
to education, careers, owning their own homes, having children, being involved in their
communities, and having good and lasting relationships (Bibby, Russell, & Rolheiser, 2009).
All this is true whether they expect to eventually live on or off reserves. To date,
understanding the factors that influence how optimistic youth are about their future has not
been well explored (Bibby et al., 2009), however, research overwhelmingly connects cultural

19

affiliation to youth well-being, optimism, and resilience (Brady, 1993; King, Smith, &
Gracey, 2009; Kirmayer et al., 2003; Lalonde, 2006; Wesley-Esquimaux, 2009). For
instance, in the words of one young person, "culture teaches me ways to stay connected to
family and the Creator and [be] true to myself. Sometimes culture is the best way I can
relieve stress" (Blanchet-Cohen et al., 2011 , p. 97). Youth consider a lack of belonging and
cultural discomfort to be central causes of the substandard health conditions of their people,
as well as ongoing systemic challenges (Blanchet-Cohen et al., 2011). A strong sense of
cultural identity is believed to confer feelings of self-worth, self-efficacy, connectedness, and
purpose to Indigenous young people (Minore, Boone, Katt, & Kinch, 1991; Tatz, 2005;
White, 2000). These attributes have also been identified as protective factors for suicide
(Borowsky, Ireland, & Resnick, 2001; Chandler & Lalonde, 1998; Feiner, Dubois, & Adan,
1991). Consequently, language and cultural revitalization are increasingly being seen as
health and wellness promotion strategies for Indigenous youth (King et al., 2009). This will
be discussed more fully in Part II.
Aboriginal youth are increasingly taking matters of wellness and health into their own
hands, seeking to become engaged in their communities, saying "we want to learn from you,
so please extend your hand to us so we hold it" and "youth feel weak; position us to learn to
become strong" (Blanchet-Cohen et al. , 2011). Youth are challenging their communities to
view resources spent on youth as an investment, rather than an expense (Blanchet-Cohen et
al., 2011). In Northern BC, the Nisga'a First Nations have responded by creating youth
councils in all of their four villages as well as youth councils for Nisga'a youth living in
Prince Rupert, Terrace, and Vancouver (Blanchet-Cohen et al. , 2011). Informed by these
community actions, I used (participatory) action-based research methodologies and arts-

20

based research tools, both of which privilege the youth voice and build capacity among youth
(Flicker et al., 2008).
These realities compelled research questions about the broad area of Indigenous
health and online mental health resources. As just discussed, this remains an area of little
inquiry. Broadly speaking, however, some literatures exist that can frame a discussion about
the topic. Five electronic databases were searched, including JSTOR, NEARBC, Native
Health Database, PubMed and Web of Science. The following search terms, tailored for each
database, were used: ' First Nation ' ' Aboriginal' 'Native American' and ' Indigenous,'
'Metis,' 'Inuit,' 'culture,' 'health promotion,' 'digital storytelling,' yielding between a few
hundred and a thousand results depending on the database searched. Refining the search
with the keywords 'youth,' 'mental health' or 'online' generated no more than ten hits in all
searches; further attempts to refine the search for research specific to 'British Columbia' or
even ' Canada' resulted in no more than three results, and in most cases no results. Additional
search methods such as reference list searching within relevant articles or searching the table
of contents of journals were used to pinpoint other articles that may not have been caught by
my initial search.
It is important to note that these database searches, while thorough, only involved

using English search terms. This may, in tum, lead to a cultural bias, excluding papers
written in other languages or those using culturally based search terms. Furthermore, given
that databases identify results based on keywords, misspelling or missing relevant keywords
may cause research to be missed. The combination of several search techniques, however,
arguably ensured a fulsome and thorough review of the literature (Havard, 2007; Webster &
Watson, 2002).

21

2. 7 Health Promotion for Indigenous Peoples
The World Health Organization defines health promotion as "the process of enabling
people to increase control over, and to improve, their health" (World Health Organization,
1986). This definition moves beyond recognizing individual biology as the sole determinant
of health, and shifts the balance towards interventions aimed at social and environmental
factors. Neo-liberal nations, such as Canada and the United States, harbor a laissez faire
attitude towards health and the delivery of health care services, ultimately reducing health
promotion to health education (Coburn, 2004). The current definition of neo-liberalism
eliminates the concept of "the public good" and replaces it with "individual responsibility."
This fundamental idea leads to funding cuts for social services, such as education and health
care, reducing the role of the government and the growth of privatization of services
(Coburn, 2004). Health education, by definition, is "any combination oflearning experiences
designed to help individuals and communities improve their health, by increasing their
knowledge and influencing their attitudes" (World Health Organization, 1986, p.1 ). These
efforts have been described as 'far from stellar' (Raphael, 2008), especially when it comes to
health promotion efforts directed at those living in northern geographies and Aboriginal
peoples, both of whom are frequently found to have higher rates of chronic and infectious
diseases than their southern or non-Indigenous neighbors (Adelson, 2005). Understanding the
context by which health promotion is reduced to health education resources is important to
understanding how Aboriginal people receive these health related messages. This project,
then, evaluated mental health promotion tools in the form of mental health education and
information resources published online, for their cultural and age relevance to Aboriginal
youth living in Northern BC.

22

Until quite recently, a biomedical approach to health has been widely accepted and
promoted in Canada. This approach addresses the individual as an autonomous entity that has
complete control over his/her own health. The approach also understands health as the
'normal state' of being free from disease, pain, or defect (Mobbs, 1991) and disease as being
caused by biological factors. This model is increasingly being critiqued as failing to account
for important class and gender differences, as excluding a majority of the world's cultures,
and as poorly reflecting the indisputable interdependence of people in an era of rapid
globalization (Geertz, 1973; Gilligan, 1982; Kitayama & Markus, 1991; Sampson, 2003,
2003; Schweder & Bourne, 1982). Generally speaking, Indigenous peoples are among those
that view health from a holistic perspective, which differs considerably from the biomedical
approach (Adelson, 2005).
Holistic models take into account the psychological, spiritual, social, and physical
needs of the patients and their families (Leong et al., 2004) and are the balance of all facets
of the person - the body, mind, and spirit (Spector, 2002). Bartlett (2005) stresses
"Aboriginal populations commonly describe life as holistic and use the terms spiritual,
emotional, physical, and mental (intellectual) to describe their perceptions of health and wellbeing," (p.22) however, she cautions that "minimal academic exploration has been done to
document this perception and the meaning of these terms with Aboriginal populations"
(p.22). Additionally, there can be a tendency for particularly non-Indigenous peoples to
generalize characteristics about Indigenous peoples, a practice known as pan-Indigenizing
(Greenwood, de Leeuw, & Ngaroimata Fraser, 2008). For example, the medicine wheel is
often assumed to be an important symbol of health that is central to all Indigenous people
and their understandings of health. While many First Nation Peoples have knowledge of and

23

use the Medicine Wheel, those that do, understand the medicine wheel in many different
ways (Graham & Leeseberg Stamler, 2010). For other Indigenous peoples, like Inuit
communities in Nunavut, the "Inuit Qaujimajatuqangit is the foundation upon which
social/emotional, spiritual cognitive and physical wellbeing is built" (Tagalik, 2009). Thus,
simply creating health education resources that promote a holistic health model is not the
solution. Instead, health promotion resources must reflect understandings of health and
wellness specific to a target audience and explicitly engage participants to share their
understandings of health. This informed my decision to apply (participatory) action research
methodologies that centralize Indigenous ways of knowing and being, instead of imposing
Euro-centric measures and standards (Khanlou & Peter, 2005).
Understanding alternative conceptions of health and wellness, then, is key to
developing effective health education resources for a target group. For example, the Yup ' ik
of the Yukon-Kuskokwim Delta consistently emphasized that traditional values are a source
of wellness and connecting with the community and the wilderness helps to both heal and
sustain a sense of well being. Conversely, cultural change was associated with a greater
degree of stress and poorer health outcomes (Wolsko, Lardon, Hopkins, & Ruppert, 2006).
Thus a generic health promotion strategy may be less effective than one that incorporates and
strengthens traditional values and activities. For the Cree, notions of health, illness, and
healing are central to the discourse of Aboriginal identity in many communities; 'being alive
well' miyupimaatisiiun, serves both to organize social life and create a sense of collective
identity (Adelson, 1998, 2000). By understanding and incorporating the culture of a target
audience into the creation of health education resources, one can improve the overall
relevance and efficacy of the health messages for that target audience. Finally, it is important

24

to note that little research has been carried out about youths' perceptions on health
(Woodgate & Leach, 2010).
Existing literature overwhelmingly demonstrates Indigenous peoples' preference for
culturally tailored health messages, regardless of geography, age, or subject of health
message (Iwasaki, Byrd, & Onda, 2011 ; Petrasek MacDonald, Ford, Cunsolo Willox, &
Ross, 2013 ; Varcoe, Bottorff, Carey, Sullivan, & Williams, 2010). Contemporary Aboriginal
communities are actively seeking health and revitalization, in part through emphasizing
culture and tradition (Baker et al. , 2006; McCabe, 2008). For instance, members of the
Gi~san First Nation were interested in finding ways to protect pregnant women and those
with young children from cigarette smoke. Research on this case drew attention to contextspecific strategies (Bottorff et al. , 2009); for this specific community, the Elders were
frequently identified as an important source of influence (Varcoe et al., 2010). A similar
theme was identified among racially/ethnically mixed urban or geographically remote
Indigenous peoples, calling attention to the positive impact that cultural activities have in
promoting positive mental health (Iwasaki et al. , 2011 ; Petrasek MacDonald et al. , 2013).
Incorporating culture into health promotion and education resources designed for Indigenous
peoples' health requires input from, and collaboration with, the very people the resources are
targeted to.
With this in mind, little research focuses specifically on Aboriginal youth and their
preferences and assessment of mental health education resources. Furthermore, searching for
literature or research specific to Northern British Columbia yielded few results, affirming the
need for such work and, hence, this proj ect. This project, then, explores whether existing
online mental health resources, especially those created for a BC audience, are age and

25

culturally relevant to Aboriginal youth (ages 19-25) living in Northern BC.
2.8 Online Mental Health Resources for Indigenous Peoples

Broadly speaking, Indigenous youth surf the Internet, access social media sites, and
are bombarded, like all youth, by popular culture everywhere (Wemigwans, 2008). In recent
years, however, electronic information and communications technologies are being
recognized as virtual spaces for cultural production and preservation (Kapitzke et al., 2000)
and a space in which youth have the freedom to choose how they represent themselves and
celebrate their Indigenous cultural heritage (Kral, 2011; Steritt, 2014 ). Young Aboriginal
peoples, especially those living on reserves, have identified the Internet and new technology
as having a profound positive impact on their lives (Bibby et al., 2009).
Aboriginal youth are not the only ones interested in this new technology. "Elders are
coming together in gatherings [ ... ] to talk about how to be an Elder in a changing
environment, and how to adapt old forms of sharing knowledge to ensure that the next
generation benefits from the wisdom of our ancestors (Castellano, 2004). Elders and
traditional teachers are increasingly identifying the Internet and new media as a means of
preserving traditions and teachings for future generations (Wemigwans, 2008). Wemigwans
(2008) warns, however, about the need for collaboration between Indigenous communities
and governments around the world to work together to ensure that new information
technologies "become the fuel for re-kindling diverse communal fires - and not merely the
homogenizing bulldozer of western civilizing ideologies, steeped in the icons of colonialism
and agendas of cultural genocide" (p.38). Nevertheless, youth are spending increasing
amounts of time on the Internet or with some form of technology (Hswen, Naslund, &
Bickham, 2014).

26

Traditional sources of health information are no longer satisfying the needs of
younger generations who are increasingly turning to the Internet with their health-related
questions (Borzekowski & Rickert, 2001; Johnson, Ravert, & Everton, 2001). The Internet
has been recognized as an ideal venue for the dissemination of health information as it has
the capacity to provide anonymity (Maczewski, 2002; Skinner, Biscope, Poland, &
Goldberg, 2003), offer accessible e-Health services (Woodruff, Edwards, Conway, & Elliott,
2001), and provide tailored health information (Skinner et al., 2003). Still, given the efficacy
and exponential growth of the World Wide Web, little research has been done that
specifically evaluates the quality and accessibility of online health resources for young
Aboriginal peoples.
Some recent and unprecedented studies by Geana, Greiner, Cully, Talawyma, and
Makosky Daley (2012) and Geana, Makosky Daley, et al. (2012) assess how American
Indians in the Central Plains region of the United States tend to access the Internet as a health
information source. That research is key in informing this study. It again demonstrates that
Indigenous peoples frequently access the Internet, but it also indicates that the Internet is
being used for seeking out health information by Indigenous youth. More importantly, the
research demonstrates an interesting generational gap between Generation X and Generation
Yin terms of what sources were sought out for health information (Geana, Makosky Daley,
et al., 2012). Generation X refers to individuals born between 1966 and 1976. Generation Y
includes individuals born between 1977 and 1994 (Statistics Canada, 2013). Generation Y
was more likely to access health information from a diverse range of sources, where
Generation X was more likely to seek out health information from 'expert sites' such as
WebMD. WebMD is a website that contains credible and timely health information and

27

support; the content on this website is revised and written by knowledgeable professionals. In
a separate study, Rushing and Stephens (2011), provide documentation about the major types
of health information that Indigenous youth search for; diet and exercise (50%), specific
illnesses (47%), drugs and alcohol (42%), sexual health (32%) and mental health (32%).
Additionally, 76% of participants reported using the Internet to search for information on at
least one health-related topic, and 40% reported searching for three or more health-related
topics. This body of research, while small, highlights the need for more research about how
younger generations go about looking for health information online, what they search for,
and how they evaluate online health resources. This also calls for a need to better understand
why youth choose to access health information from online sources, and what their
preferences are. My research addressed this gap, asking youth about how and why they
would go about searching for, and their opinions about, online mental health information.
This work also engaged youth in creating digital stories in which they can share their visions
about ideal online mental health resources.
It is interesting to note that the majority of research on technology-use by young

Indigenous peoples, thus far, has been conducted in the United States. This highlights a
considerable gap in the literature; little is known about Internet and technology use by
Aboriginal youth in Canada and especially in Northern BC. According to the 2004 Report on
Aboriginal Community Connectivity Infrastructure, almost all Aboriginal communities
(98%) in Canada have Internet access in some capacity, and 42% of these communities have
access through a high-speed connection (National Aboriginal Health Organization, 2008).
Meanwhile, in British Columbia, 157 First Nations in BC had access to high-speed Internet
by the end of March 2011 (Government of British Columbia, 2011). As such, Internet is

28

accessible to Aboriginal people in Canada, with high-speed access becoming increasingly
available. Thus, it is reasonable to infer that young Aboriginal people living in Northern BC
use the Internet similarly to their American counterparts, both in terms of quantity and
health-related searches.
There is a significant variety in types of online resources that might be available for
young people searching out health information. Chat rooms have been considered as a source
of health information sought out by Indigenous peoples. A study by (Hoffman-Goetz &
Donelle, 2007) explored the use of a chat-room by Aboriginal women. My difficulty with
this research stems from an ethics ruling about the work that resulted in the researchers not
being allowed to intervene within this chat room setting. The researchers were therefore only
capable of reading the posted chats, which could be considered "lurking" and, consequently,
something about which I am skeptical. This paper informed my decision to not include chat
rooms in my search of online mental health resources.
2.9 Digital Storytelling for Indigenous Health and Wellness
The connection between arts and health is a relatively new concept that is
increasingly being recognized in Canada. It has long been identified and well supported in
England, Australia, and the United States (Archibald, Dewar, Reid, & Stevens, 2012). For
Aboriginal peoples, traditional arts, culture, spirituality, and health were, and are,
interconnected (Archibald et al., 2012). In fact, the creative process is said to touch on the
physical, emotional, mental, and spiritual aspects of the individual, components commonly
associated with more holistic understandings of health. Traditionally, storytelling was used
for a number of purposes - to teach values, beliefs, morals, history, and life skills in
Aboriginal communities (Archibald et al., 2012; MacLean & Wason-Ellam, 2006).

29

Specifically, the healing benefits of storytelling continue to be an important part of most
Aboriginal cultures, despite immense cultural change and the effects of colonialism (see
Bird, Wiles, Okalik, Kilabuk, & Egeland, 2008; Lavallee, 2009; McKeough et al., 2008).
Additionally, art can create open avenues for identification and communication of feelings
(Ferrara, 2004) among the Cree. This section of the chapter will document art as it has been
used in research with Indigenous peoples, as well as the use of digital storytelling as an
emerging method. The section will conclude with an overview of digital storytelling as it has
been used to promote health and wellness with Indigenous peoples.
Using art and arts-based forms of inquiry within research is a relatively new concept,
one that challenges much of the dominant, entrenched academic community (Ferrara, 2004;
Knowles & Cole, 2008). More important, however, is the recognition of arts-based inquiry as
a socially responsible manner of conducting research; it is useful in addressing social
inequities, including the effects of colonialism experienced by Aboriginal people in Canada
(Lavallee, 2009; Stuckey & Nobel, 2010). Arts-based research has also been identified as a
way of bringing together Indigenous ways of knowing and Western ways of conducting
research, specifically qualitative inquiry. Western approaches to knowledge tend to be based
in secular, liberal, and individualist ideologies (Gone, 2009). Arts-based inquiry can explore
multiple, new, and diverse ways of understanding and living in the world, but also has the
ability to expose oppression, target sites of resistance, and outline possibilities for
transformative praxis (Knowles & Cole, 2008). This new and growing body of research
informed my decision to undertake a form of arts-based inquiry, in the form of digital
storytelling, for this research. This arts-based practice fit with a decolonizing methodology
and action-based research, both of which were used in this study.

30

Digital storytelling is an innovative method of storytelling that incorporates new
technologies into traditional storytelling. It has been swiftly adopted for research of all kinds
(Gubrium, 2009b), and is said to be transforming healthcare (Hardy & Sumner, 2015).
Digital stories are short narratives that fuse auditory-, visual-, and text-based storytelling by
stitching together pictures, audio, text, music, and video to create an original piece. Gubrium
(2009) states that digital storytelling "allow[ s] new knowledge to emerge that is mediated by
Indigenous perspectives and returns this knowledge to communities as indigenously
informed" (p. 186) and is thus an invaluable tool for health promotion with Indigenous
people. When used in research, digital stories become the data, from which themes and
findings emerge directly, with minimal interference from the researchers. This allows
participants to decide what information is important, and appropriate for the research topic
(Harper, Edge, & Willox, 2012). This process provides unique and culturally valid data that
is meaningful to participants and representative of lived experience (Harper et al., 2012).
Despite its wide adoption as a tool for health promotion, existing research on digital
storytelling for Indigenous health and wellness is sparse. Digital storytelling has been a
validated tool for health promotion for Indigenous people by Wexler, Gubrium, Griffin, and
DiFulvio (2012). In the Wexler et al. (2012) study, youth living in Northwest Alaska were
asked to identify positive aspects of their lives and then create a digital story to share with
their peers; this project was associated with positive youth health outcomes (see Wexler et
al. , 2012). Similarly, Cueva et al. (2015) gathered input from Alaskan communities about
how to create engaging or appealing digital stories on health-related concepts. They then
created stories and showed them to Alaskan communities. Responses to the stories were
overwhelmingly positive, with participants perceiving digital stories as culturally respectful,

31

informational, inspiring, and motivational. Furthermore, viewers shared that they liked
digital stories because they were short (only 2-3 minutes), nondirective and not preachy,
emotional, told as a personal story and not just facts and figures, and were relevant, using
photos that showed Alaskan places and people. This research thus addresses the potential
that digital stories have in the realm of health promotion and education for Aboriginal
people. The research also underscores the need for context-specific and culturally tailored
health information (see Health Promotion for Indigenous Peoples above).
Based on the reviewed literature, it becomes evident that research incorporating artsbased methods is central to relevant and respectful research with Indigenous peoples. Indeed,
digital storytelling has been identified as a culturally relevant and positive way of sharing
health information. Not enough research, however, adequately explores the use of digital
storytelling as a tool for discussions about health, let alone online mental health resources
with Aboriginal youth. This project used digital storytelling as a tool for participants to share
what they envision to be ideal online mental health resources for themselves and their peers.
Conclusion

Together, this background and literature review was useful in informing this project.
Research increasingly shows the link between traditional culture and the health of Aboriginal
peoples. Additionally, with the growing interest in the Internet as a source of health
information by both Aboriginal and non-Aboriginal youth, it is necessary to better
understand whether or not Aboriginal youth see themselves reflected in online health
education and promotion resources.

32

Chapter 3 - Theoretical Frameworks and Methodologies
This research asks : are existing online mental health resources, especially those
catering to a BC audience, age and culturally appropriate for Aboriginal youth (ages 19-25)
living in Northern BC? My choice of methodologies was informed by the background and
literature review presented in the previous chapter. When I use the term 'methodologies' in
my research, I am referring to the philosophical and theoretical principles that informed my
work. Sandra Harding describes methodology as "a theory and analysis of how research
does and should proceed" (as cited in L. T. Smith, 1999, p. 2-3) while Bourdieu posits that a
good methodology "enable[s] us to see the world through new spectacles" (as cited in
Herrman, 2009, p.5). This chapter presents a discussion of decolonizing and (participatory)
action-based research methodologies, along with social determinants of health perspectives.
3.1 Location in Research

"Its not about knowing the other, its about knowing yourself and your relationship with the
other" - Charlotte Loppie
According to Bishop (2002), an ally is "a member of an oppressor group that works
to end that form of oppression which gives him or her privilege" (p. 12) in the context of
Indigenous-non-Indigenous relations. Similarly, Linda Tuhiwai Smith (1999) recognizes the
role of non-Indigenous peoples as 'allies' in the decolonization process. Based on these two
definitions, I saw myself as an ally in this research process. My project sought to "see
longstanding injustices resolved and a mutual, respectful future realized, whatever the
complexities of getting there" (Davis, 2010, p.10). Additionally, being an ally was about reenvisioning political and personal relationships based on recognition, respect, sharing, and
responsibility without replicating the continuing colonial relations. Finally, I understood this

33

role as an ally as more that just an identity; instead it was a contextual process and a practice
developed through experience and learning (Margaret, 2010).
3.2 Decolonizing the Research Process
Informed by the harmful history of research with Aboriginal peoples in Canada (see
Ermine, Sinclair, & Jeffery, 2004) and the ongoing effects of colonialism, I chose to use
decolonizing methodologies in this research with Aboriginal youth in Northern British
Columbia. Research conducted on Indigenous peoples and communities in exploitative and
insensitive ways (Castellano, 2004) is increasingly being called into question. Decolonizing
methodologies, then, are being seen as a way to address this legacy and continuation of
colonialism in research.
Science as a 'quest for knowledge' developed in the historical context of Europe's
search for new lands and economic resources (Chinn, 2007). Euro-centric thought has come
to mediate the entire world to the point where worldviews that differ from Euro-centric
thought are relegated to the periphery, if they are acknowledged at all (Battiste & Henderson,
2000). Research with Indigenous peoples historically has been deficit-based and analyzed
Indigenous lifestyles, community, and culture through a Euro-centric worldview, which has
contributed to inaccurate representation and negative stereotyping of these people (Peacock,
1996). In fact, "for many Indigenous communities, research itself is taken to mean
"problem"; the word research is believed to mean, quite literally, the continued construction
oflndigenous peoples as the problem" (L. T. Smith, 1999 p.92). An important aspect of
developing alternative research practices is the shift of the researcher's gaze.
Changing the researcher's gaze from what has been typically (unfairly,
individualistically, simplistically, and inaccurately) deemed to be 'the problem', to a broader

34

and more contextualized analysis of the social, political, economic, historical determinants of
social ills and their consequences on the lives of people, may lead to more sustainable and
change-oriented research practices. This informed my decision to approach mental health
disparities using a social determinants of health framework, as the SDoH approach considers
the social, economic, political factors that are at play in the lives of the individual rather than
simply the disease state. Furthermore, colonialism is considered to be a distal determinant of
health for Aboriginal peoples in Canada (Czyzewski, 2011; Greenwood & de Leeuw, 2012).
These two methodologies aligned well, as decolonizing methodologies call for a heightened
awareness of the ongoing effects of colonialism and engaging participants in meaningful and
empowering research (L. T. Smith, 1999).
Decolonizing methodologies are considered transformative; the 'objects' of study
become the 'subjects' of the entire research process. Communities take on a participatory
role when they take ownership of the research process, allowing the perspectives and
interests of the individuals and communities being 'studied' to be privileged and honored (L.
T. Smith, 1999). A decolonized research strategy also calls for the researcher to maintain
accountability to the communities that undertake such work, to have a heightened awareness
of the historical and ongoing effects of colonialism, and be supportive of individual and
community self-determination. As such, reflexivity is fundamental to decolonizing
methodologies as it involves examining both oneself as researcher and the research
relationship (Jootun, McGhee, & Marland, 2009). Thus, throughout this entire project, I kept
detailed field notes and critically reflected on my values, assumptions, worldviews, and
positions, as well as behaviour and presence, and how this can impact interactions with the
research participants (Jootun et al., 2009).

35

Given the increasing popularity and application of decolonizing methodologies, it is
extremely important to maintain a critical and reflexive stance (Martin, 2009) throughout the
entire process. Consequently, the praxis of decolonization is not without contradictions. One
pair ofresearchers, Tuck and Yang (2012), have argued, that "decolonization" should bring
about the repatriation of Indigenous land and life: they criticize those that understand
"decolonization" as a metaphor for other things we want to do to improve our societies and
schools. Tuck and Yang (2012) add that adopting decolonization as a metaphor "re-centers
whiteness, resettles theory, extends innocence to the settler [by reconciling settler guilt] , and
entertains a settler future" (p.3). Similarly, Linda Tuhiwai Smith (1999) argues that
'decolonization' is a "euphemism that only describes the formal handing over of the
instruments of government, when in reality it must be a long-term process involving the
cultural, linguistic and psychological divesting of colonial parameters" (Hammersmith, 2007,
p.65). For my project, I understood decolonization as having a more critical understanding of
the underlying assumptions, motivations, and values that inform research practices (L. T.
Smith, 1999), and with the goal of self-determination of Indigenous peoples. This, in tum,
demanded the use of a social determinants of health framework, (participatory) action-based
research strategies, and arts-based research methodologies for my project.
3.3 Action Research
Informed by the literature on decolonizing methodologies, I understood participant
engagement and a high degree of flexibility to be fundamental to working in a cross-cultural
context. Action research (AR) is therefore the methodology of choice. AR aligns well with
the priorities of a decolonizing approach and enables the researchers to adapt to changing
circumstances as the research process unfolds (East & Robinson, 1994). AR is gaining

36

credibility in healthcare settings (East & Robinson, 1994) because it aims to improve health
and reduce health inequities by involving the people who, in tum, take actions to improve
their own health. Participation, then, is fundamental to action research (Meyer, 2000), often
blurring the line between 'researcher' and 'researched' that is found in other types of
research (Webb, 1989). In order for the collaboration between 'researchers' and 'researched'
to be supportive and productive, the research design must be continually negotiated with
participants (Meyer, 2000). Similarly, a decolonized research strategy shifts the power from
the 'researcher' back to the hands of the 'researched,' involving the participants in
meaningful ways throughout the entire research process and ensuring that the research is
beneficial for those involved (L. T. Smith, 1999). Meyer (2000) notes that the success of
action research should not be judged solely on the size of change achieved or the immediate
implementation of solutions, since change can be a slow process. Instead, success should
instead be measured in terms of what has been learnt from the experience of undertaking the
work. Thus, the emphasis in this research strategy shifts from a results orientation to capacity
building and building meaningful relationships throughout the process. Capacity building
and strong relationships are important in self-determination (Hirch, 2011) and supporting the
self-determination of Aboriginal people is central to the process of decolonizing research (L.
T. Smith, 1999).

This project also incorporated elements of participatory action research (PAR). PAR
can be viewed as a way of "bringing participation into action research" (Elden & Levin,
1991 ). While action research actively engages participants in the research process, PAR is
recognized as a more inclusive form of inquiry and is often practiced in cross-cultural
contexts (Khanlou & Peter, 2005). Developing effective health promotion and education

37

resources for Indigenous youth requires collaboration with the very people that resources are
expected to impact. Thus, involving Aboriginal youth living in Northern BC may be an
effective way of promoting the development of more culturally and age relevant online
mental health resources. Central to a participatory action research strategy is that the topic of
the research comes from the community (Khanlou & Peter, 2005). However, given the high
number of youth living in an urban setting, it is not always possible to identify a clear
community point to start from. Thus, for this project, I came up with a research question, in
consultation with numerous community organizations and contacts throughout Northern BC
(listed fully on p.50). The organizations with whom I worked for my project then invited me
to host my workshop with them, being involved throughout the remainder of the process.
Additionally, I consulted Aboriginal youth not only on the action process but also on how it
will be evaluated. One benefit of this is that it can make the research process and outcomes
more meaningful to individuals (Meyer, 2000).
The intent of this project is consistent with PAR in that the central purpose of
participatory action research is to develop knowledge that is useful, practical, and contributes
to improved well-being of the people and community involved in the research (Reason &
Bradbury 2001 ). PAR provides an opportunity to work across traditional boundaries,
including cultural and professional boundaries, and pays careful attention to power
relationships, which is especially important in research with Indigenous peoples who
continue to live the effects of colonization (Minkler & Wallerstein, 2003).
3.4 Social Determinants of Health Framework
Informed by the deficit-based history of research and pan-Indigenizing health
statistics, I employed a social determinants of health framework to understand health

38

disparities experienced by Aboriginal people. Using an SDoH approach acknowledges the
link between health and the broader social context in which one lives (Marmot et al. , 2008).
Social determinants range from proximal to distal, with distal determinants having the most
profound influence on the health of populations. Distal determinants, using an lndigenized
social determinants of health framework, include colonialism, racism, social exclusion, and
repression of self-determination, which serve to construct both the intermediate and proximal
determinants (see Reading & Wien, 2009). Proximal determinants, then, include conditions
that have a direct impact on physical, emotional, mental, or spiritual health such as physical
environment, employment and income, education, access to food, and other health conditions
(Reading & Wien, 2009). Intermediate determinants are considered the systems that create
and influence the proximal determinants (see Reading & Wien, 2009).
As discussed above, Aboriginal peoples report disproportionately high rates of
suicide, mental illness, and drug and substance use when compared with the general
population (Kirmayer et al. , 2003 ; Trumper, 2004). Understanding mental health of
Aboriginal peoples, however, requires a social determinants of health framework (see
Czyzewski, 2011 ; de Leeuw et al., 2010). For example, Chandler and Lalonde's (1998)
report demonstrated that cultural continuity, an intermediate determinant, acts as a 'hedge
against youth suicide.' Nelson (2012) argues that the DSM is poorly designed to accurately
measure mental illness in non-European populations, and instead imposes Eurocentric
measures of health on Aboriginals, both of which further the cause of colonialism, also a
distal determinant. These examples discussed herein belong to a large body of research that
support this link (e.g. Czyzewski, 2011 ; Iwasaki et al. , 2011 ; Kirmayer et al. , 2003; Petrasek
MacDonald et al., 2013) and informed my choice to use a social determinants of health

39

framework in this project.
3.5 Strengths Based Approach
Research with Indigenous people has been, and continues to a lesser extent to be,
conducted in a deficit-based and 'pathologizing' fashion (Ermine et al., 2004). Thus, a
strengths-based approach was employed, which focused on the potentials, strengths,
interests, abilities, knowledge, and capacities of individuals, rather than their limits (Ermine
et al., 2004). The need to shift from a deficit way of thinking about Indigenous people to an
approach that sees Aboriginal people as strong and resilient is increasingly evidenced in the
literature (Colquhoun & Dockery, 2012; Dockett, Perry, & Kearney, 2010; Ermine et al.,
2004) and aligns with a decolonizing methodology. However, referring to Aboriginal people
as resilient has been criticized by some scholars who argue that using this framework
suggests that resilience is an inherent trait held by some Aboriginal people but not all
(Newhouse, 2006). This then puts the focus on the individual and reduces the notion of
resilience to 'survival of the fittest.' Instead, Wesley-Esquimaux (2009) argues that
Aboriginal resilience must be considered as a reawakening of the social and cultural
resiliencies and capacities that Aboriginal peoples used to sustain them throughout other
challenges. A strengths-based approach calls for a recognition of the importance of people's
environments and the multiple contexts that influence their lives (Saint Jacques, Turcotte, &
Pouliot, 2009). This aligned well with a social determinants of health perspective that also
recognizes the impact of environment and social context on the health of the individual.
3.6 Arts-Based Research
Art does not reproduce what we see; rather, it makes us see. - Paul Klee

40

Employing a decolonizing research strategy calls for alternative approaches to
research and data collection. Broadly speaking, arts-based inquiry "challenge[ s] the
dominant, entrenched academic community and its claims to scientific ways of knowing,"
which, in tum, privileges "multiple, new, and diverse ways of understandings and living in
the world" (Knowles & Cole, 2008, p.71). Knowles and Cole (2008) argue that arts-based
research methodologies can unveil oppression (discovery) and transform praxis (invention)
in discontinuous and discordant social constructions. Thus, arts-based research methods are
useful tools for addressing social inequities, including the effects of colonialism experienced
by Aboriginal people in Canada (Lavallee, 2009; Stuckey & Nobel, 2010). Moreover, art and
the creative process brings together Aboriginal ways of knowing and Western ways of
conducting research (Knowles & Cole, 2008; Lavallee, 2009; Stuckey & Nobel, 2010),
which aligns with a decolonizing methodology that too privileges Indigenous ways of
knowing and being.
This project used digital storytelling as an innovative tool that is increasingly being
used in health-related research (e.g. Cueva et al., 2015; Gubrium, 2009; Hardy & Sumner,
2015; Wexler et al., 2012). Furthermore, and in accordance with a decolonized approach to
research, digital storytelling "allow[ s] new knowledge to emerge that is mediated by
Indigenous perspectives and returns this knowledge to communities as indigenously
informed" (Gubrium, 2009, p.186) with minimal interference by the researcher.

41

Chapter 4 - Methods
4.1 The Research Environment
This research project took place in Terrace, BC, which is located on the traditional
territory of the Tsimshian Nation, specifically that of the Kitselas people, and is situated in
the Northwestern region of Northern BC. Terrace is situated within the Northwest Health
Service Delivery Area (HSDA) (see Appendix I) (University of Victoria, 2011). The
Northwest HSDA has a population of roughly 75,000 people, of which 45% of the
population is concentrated in four municipalities: Prince Rupert (- 17%), Terrace (- 15%),
Kitimat (- 12%) and Houston (- 4%). The remainder of this population is scattered
throughout the region in rural areas (University of Victoria, 2011). As discussed above,
Northern BC has a large Aboriginal population. According to the 2011 census, 22.6% of
Terrace's population identified as Aboriginal (Statistics Canada, 2011).
The digital storytelling workshop detailed in this project was held at the Terrace
Women's Resource Centre and the Terrace Public Library. These two locations are both
left-leaning organizations committed to Aboriginal peoples' health, and combatting racism
towards, and bringing allies to, Aboriginal people. The selection of these two locations for
my digital storytelling workshop aligns with the broader methodologies that were used in this
research, including decolonizing methodologies and a strengths-based approach.
4.2 Research Steps
The basis of this thesis is that, in order to produce online mental health resources that
are age and culturally relevant to Aboriginal youth living in Northern BC, it is necessary to
understand the opinions of Aboriginal youth about existing online mental health resources. In

42

efforts to support my hypothesis, I undertook a community-based research project. The work
was organized into five stages:
Stage One: community consultation and the collection of online mental health
resources
Stage Two: a critical discourse analysis of online mental health resources
collected during stage one.
Stage Three: recruitment of participants
Stage Four: digital storytelling workshop
Stage Five: knowledge translation: creation of a website
Stage One: Community Consultation and Collection of Online Resources
The purpose of stage one was to: 1) develop my research question in collaboration
with local Prince George community organizations and, 2) to identify online mental health
resources catering to a BC audience and recommended by frontline healthcare workers.
After receiving ethics approval from the UNBC Research Ethics Board, I began seeking
informal and anecdotal feedback on my research question from professionals with the
following local community organizations that touch on Aboriginal health: The Prince George
Schizophrenia Society (PGSS); the Canadian Mental Health Association (CMHA) Prince
George Branch; the Prince George Library; the Youth Around Prince Resource Centre
(YAP); the Prince George YMCA; the Prince George Native Friendship Centre (PGNFC);
Intersect Youth and Family Services Society; Instructors at the College of New Caledonia
(CNC); an Aboriginal worker with School District 57; the Prince George Brain Injured
Group (BIG); the UNBC Community Care Centre; the Kelty Dennehy Foundation; a Mental
Health and Addictions worker for Northern Health; the Aboriginal Resource Centre at CNC

43

and the First Nations Health Authority. The feedback and input from these individuals and
organizations was extremely positive and helped to shape my research question. People with
whom I spoke were also instrumental in suggesting online mental health resources to be
included and analyzed for the purposes of this study.
A total of seven health professionals recommended resources (two nurses, one social
worker, one mental health and addictions counselor, two researchers and one physician).
There was overlap in the resources that were recommended by the health professionals; for
example, three health professionals recommended the Kelty Mental Health Resource Centre.
Additional online resources were included if they contained Aboriginal-specific information
or were created in Prince George or Northern BC, even if they were not initially suggested
by the aforementioned professionals. Lastly, a set of principled criteria was recommended to
narrow the scope when using online texts (Mautner, 2005). Usher and Skinner (2011)
propose a criteria checklist (see Appendix II) to categorize online health websites as eprofessional, e-knowledge or e-business based on its purpose, contents and interface.
Table 1

List of Online Mental Health Resources Collected
Type of Resource
Website Name
e-professional
McCreary
e-professional
Network for Aboriginal Mental Health
e-professional
Northern Health
Gitxsan Health Society
Provided links to other websites
Here to Help
e-knowledge
Kelty
e-knowledge
Early Psychosis
e-knowledge - too specific
e-knowledge
CMHA Prince George
Mindcheck
e-knowledge
One resource (e-knowledge)
UNYA
e-knowledge
BC Schizophrenia Society
Carrier Sekani Family Services (CSFS)
e-professional
Website based in Ontario
Check up from the Neck Up
BC Mental Health and Substance Use
e-knowledge
Services

Include (YIN)
N
N
N
N

y

y
y
y
y

y

y

N
N
y

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E-knowledge websites display information that is at an appropriate level of education,
e-health literacy and medical experience in order to educate the general public (Sher, 2000).
E-health literacy is defined as the ability to read, use computers, search for information,
understand health information and put it into context - thee-health literacy and content level
that is needed to promote user engagement through an e-knowledge website is of a low to
moderate level. E-business health websites present and promote a product for profit while eprofessional websites are designed to educate and inform health professionals of the latest
medical advances and information pertaining to specific medical conditions, treatments,
drugs and technology thus requiring a greater degree of health literacy. I only included eknowledge websites as my study is specifically interested in educational resources and my
study population is drawn from the general public. As a final step, Mautner (2005)
recommends considering the geographic origin of the website; all of the resources were
specific to British Columbia, except one, which was excluded (see Table 1). I then applied a
critical discourse analysis on the eight resources that were included in this study and sought
youth opinions on these resources from the youth who participated in my digital storytelling
workshop.
Stage Two: Critical Discourse Analysis

Online mental health resources collected during stage one were analyzed using a
critical discourse analysis in stage two. Critical discourse analysis (CDA) has its beginnings
in discourse analysis and "focuses on the ways discourse structures enact, confirm,
legitimate, reproduce, or challenge relations of power and dominance in society (Van Dijk,
2015, p.353). Once power is gained, it can be built upon through action (discursive practices)
or repetition associated with the formation of roles and responsibilities that sustain power

45

(Foucault, 1988). CDA moves beyond the content of the text alone (Chouliaraki &
Fairclough, 2007), utilizing a separate form of analysis on each of the following three
dimensions: 1) the socio-historical conditions within which the text is created, 2) the
processes by which the text is produced and received by human subjects and 3) the object of
analysis, including verbal and/or visual texts. The corresponding kinds of analysis are: 1)
sociocultural (explanation), 2) discourse level (interpretation) and 3) text analysis
(description). The term text refers to any written or printed text, however it also includes
television programs and web-pages; text then, must encompass language, visual images, and
sound effects (Foucault & Gordon, 1980). Power within a discourse is about powerful
participants controlling and constraining the contributions of non-powerful participants
(Fairclough, 2001). Power is gained through discourse when it is widely accepted within a
society, prompting judgment, control, and self-surveillance among individuals. This lens has
been used in health research for over two decades (Foucault, 1988; J. L. Smith, 2007) to
explore work related to medical practice, health policy, the body, and issues of power within
discourse. CDA has been validated as a tool for analyzing web-based resources (Mautner,
2005) and online mental health resources (Thompson, 2012).
The critical discourse analysis I used looked at how discourse around mental health
constructs a 'truth' which may, in tum, marginalize other ways of knowing and being,
including those of Aboriginal youth living in Northern BC. Western ways of understanding
mental health and illness differ from the ways in which mental health is conceptualized and
understood in an Aboriginal paradigm (Nelson, 2012). Data collected from the focus groups
during the digital storytelling workshop will also be important in better understanding

46

whether Aboriginal youth living in Northern BC feel as if they are represented by existing
online mental health resources.
I began with a sociocultural analysis of the online mental health resources collected
in Stage Two of this research project. A sociocultural analysis can offer insight into
unspoken and unstated assumptions, which may implicitly shape the text as it is created
(Cheek, 2000). This level of analysis explores the macro-level discourse, which is concerned
with intertextual and interdiscursive elements and tries to take into account the broad,
societal currents that are affecting the text being studied. The following questions were asked
of the text, informed by the work of Fairclough (2003): who is speaking and on behalf of
who; who are the key stakeholders and who is silent? Analyzing texts at a sociocultural level
calls for an exploration of the social context under which the text under review is produced.
I proceeded to analyze online mental health resources at a discourse practice level;
this level of analysis addresses the production, distribution, and consumption of the text (J. L.
Smith, 2007), and focuses on micro-level discourses. Micro-level discourses focus on various
aspects of textual/linguistic analysis. In this study, the nature of the discourse practice is
largely dependent on the interaction between the various sociocultural practices present and
in which the discourse is situated. This level of analysis also extends to the history and
practices surrounding the textual medium through which the text under analysis is presented
(J. L. Smith, 2007). The following questions, based on the work of Fairclough (2003), were
asked of the text: who is the subject of the particular discourse; what position is promoted by
the discourse and in whose interest is this position; what are the hidden agendas/biases; what
sorts of decisions have been made; and with what level of authority and influence?

47

Finally, I underwent a textual level analysis, which focuses on how the text is formed
and how a particular vocabulary and style are used to produce meaning (J. L. Smith, 2007).
A deductive approach was used in this study - one in which codes are identified through
content analysis, after which codes will be searched for instances where power and
knowledge are present in the discourse. The following questions, informed by the work of
Fairclough (2003), were asked of the coded text; what power-knowledge relationships exist;
who are the people with the power to make decisions; and how are they using their power?
Screen shots taken of each website between July and October 2015 were
subsequently analyzed as discussed above. Textual sources were revisited and further
analyzed throughout the analysis process (see page 56 for more detail). While analyzing
online mental health resources using a critical discourse analysis, I undertook the recruitment
of participants as well as the planning of a digital storytelling workshop for Aboriginal youth
living in Northern BC, in order to collect opinions from them.
Stage Three: Recruitment of Participants
The purpose of the third stage of the research was to build on my existing
relationships and identify Aboriginal youth interested in participating in a digital storytelling
workshop about their opinions of online mental health resources collected and analyzed in
stage one and two, respectively. I sent information and recruitment posters to contacts around
Prince George and throughout Northern BC. I was contacted by two organizations, one
locally in Prince George and another located in Northwestern BC, both of whom were
interested in learning more and working together to host my digital storytelling workshop;
the organization in Northwestern BC invited me to host a workshop in Terrace BC, as this
would be more accessible to youth living in this region. Although there was considerable

48

interest from the Prince George organization for the workshop, logistical and scheduling
issues resulted in this workshop not being held. Hosting a workshop in Terrace aligns with
the purpose of this research, which is to seek opinions about online mental health resources
from Aboriginal youth living in Northern BC (see Chapter Two), which includes Terrace,
BC. As such, I contacted the Terrace Women's Resource Centre (TWRC), which was
instrumental in offering a place to host the workshop and also put me in contact with local
organizations that worked with youth in and around Terrace. The Terrace Women's
Resource Centre shares a space with three other organizations, the Terrace Family Place,
Skeena Child Care Resource and Referral, and Success by 6 and is located in Terrace, BC. In
order to make this workshop most accessible and welcoming to all participants (men and
women), the workshop was advertised as being held at the Terrace Family Place (instead of
TWRC). The summer student at the TWRC also helped me in the planning and hosting of the
digital storytelling workshop.
During the process of planning the workshop in Terrace, a youth worker from a
nearby community contacted me. She expressed considerable interest in the topic of the
workshop and registered several youth from her community. A few days before the
workshop began, I sent a reminder email to my northern contacts about the workshop, which
was again met with significant interest; eight youth (four males, four females) signed up and
attended the workshop. At least five other youth contacted me expressing interest in the
workshop, although they were unable to attend due to scheduling conflicts or because they
did not have a ride to Terrace and lived outside of town. Additionally, three of the registered
participants expressed an interest in being co-facilitators; in this role, youth helped to guide
the research project, as well as offer continued feedback throughout the data analysis

49

process. Once youth had registered, I began email communication to initiate the building of
relationships with these individuals.
Stage Four: Digital Storytelling Workshop
The purpose of stage four was to gather Aboriginal youth's opinions and ideas about
mental health and online mental health resources collected in stage one in order to juxtapose
them with the findings of the critical discourse analysis (see Stage Two). In order to do this, I
held a digital storytelling workshop for Aboriginal youth (ages 19-25) living in Northern BC.
Digital storytelling was chosen as an arts-based research method that is complimentary to the
broader methodologies that guided this research, including decolonizing methodologies and
(participatory) action-based research. As was discussed in Chapter Three, art and storytelling
are central to many Indigenous cultures (see Archibald et al., 2012); by incorporating
storytelling into the research process allows a bridging of Western and Indigenous ways of
knowing and a respectful and culturally meaningful approach to research (Gubrium, 2009a).
Additionally, digital storytelling has been identified as an effective tool for engaging youth in
creating their own health promotion tools (Wexler et al., 2012). Digital storytelling aligns
well with a decolonizing methodology that was used in this research; with minimal input or
interference from the researcher, participants create digital stories, which then become the
data Gubrium (2009). This medium allows Aboriginal youth to decide what information is
important and relevant to the research topic, which is empowering (Harper, Edge, & Willox,
2012). In this study, youth will create digital stories to express their opinions about online
mental health resources and the role that information technologies could play in addressing
these needs.
The digital storytelling workshop took place August 19-21, 2015 at the Terrace

50

Family Place (see Figure 1). The Family Place was a residential house converted into an
office/work space; as a result, there was a large open space with couches, tables and chairs
that provided a comfortable space. There was also a large kitchen and side rooms where
participants were able to work away from the common space.

Figure 1. The Terrace Women's Resource Centre (TWRC)
Day 1: The first session began at 4:30 pm with a welcome from a member of the

Wolf Clan (Lax Gibuu) on whose land the Terrace Family Place sits. Eight participants (four
males, four females) between the ages of 16 and 35 attended the workshop from throughout
northwestern BC. Following the welcome and prayer, participants signed consent forms;
participants were reminded that they could withdraw at any time and that, if they chose to do
so, all of their information would be removed. Youth then participated in an introductory line
drawing activity in which participants paired up and drew their partner without lifting their

hand from their page or looking down at their paper. This activity was accompanied by many
giggles and everyone was eager to share their image with the group, who subsequently burst
into laughter as well (see Figure 2). As the facilitator, this simple art activity allowed me to
begin to get to know the youth and connect through art. Youth then worked as a group to
create a collective set of rules for our shared space; some examples of collective rules were:
' no drama,' ' be respectful ,' ' no swearing,' ' support each other,' and 'be honest.' After this

51

activity, I talked to youth about my role in the workshop: to listen, to learn, to facilitate the
workshop in partnership with them, and to incorporate their input in the most meaningful
way to ensure that youth felt heard and felt that the workshop was relevant to them.

Figure 2. Line drawing created by youth participant.
Youth began to open up and share more as I gave a short presentation about digital
storytelling, including the seven elements of digital storytelling and some sample digital
stories. The seven elements of digital storytelling include: point of view, a dramatic question,
emotional content, the gift of your voice, the power of the soundtrack, economy, and pacing
(see Lambert 2010). Following this presentation, youth participated in a focus group
discussion about mental health and online mental health resources. Focus groups allow for
the engagement of large numbers of young people in meaningful discussions (Kreuter &
Wray, 2003). In this discussion, youth were asked about how they would go about searching
for online mental health information, as well as how youth understood mental health. Youth
had the option to help lead discussions, but chose not to; however, they eagerly engaged in
conversations with me and the other participants as time and we got to know each other
better. As this discussion came to a close, youth helped to develop the research question
' what does mental health or wellness mean to you?' and ' how can online resources be
created that reflect your understanding?' that was answered using the digital stories. Focus

52

group discussions were recorded and transcribed. I also made personal field notes about my
conversations with individuals during the workshop, however these conversations were not
recorded. Youth spent the last hour after dinner planning and working on their digital stories,
before the session wrapped up at 8:30 pm.
Day 2: The second day consisted of two sessions: the first session was from 10:30 am until

3:30pm at the Terrace Public Library boardroom and the second session was from 4:307:00pm at the Terrace Family Place. The staff at the Terrace Family Place finished their day
at 4:30pm, leaving us free to use the space without disrupting their daily work. The morning
started with a focus group discussion about mental health based on what was said on Day 1.
As a group, youth decided that they preferred the term ' wellness ' instead of ' mental health'.
We then explored why this term was preferred, the results of which are discussed further in
Chapter Five.

Many of the youth reported being tired as they had stayed up late the night before,
excited to be in Terrace. This led to a quieter discussion. This was followed by some work
time (four-five hours) on digital stories. During this time I circulated and spoke with
participants about their digital story, offering help with storyboards and the video software. I
enjoyed sitting with each youth, as this was also a time when the youth were most open and

53

chatty, sharing their lives and lived experiences with me, as we discussed their stories. The
second session was spent working on digital stories. During the last hour of the second
session, youth explored and engaged with online mental health resources (see Table 1); this
was followed by a discussion about what youth preferred about each resource. The session
ended early, after a casserole dinner, as youth were tired.

Figure 4. Screenshot of digital story made by D
Day 3: The third and final day of the workshop began at 11 :30am at the Terrace

Public Library boardroom. Youth worked on their digital stories, until 5:30pm when they
shared their stories with the others. At this time, a third and final focus group discussion was
held, focused on exploring youth ' s opinions of culturally specific online mental health
resources (i.e. BC Schizophrenia Society website). With this, a discussion about creating our
own website as a tool for knowledge translation took place. During dinner, youth shared their
digital stories with each other as well as their final ideas or thoughts about the workshop. All
but three youth finished their digital stories (see Figure 3, 4). One youth chose not to
participate in the workshop altogether, while another youth chose not to create a digital story,
although she participated in focus group discussions. The third youth did not complete due to
technical difficulties and wanted to continue to work on his story. As such, five complete
digital stories were created (three female , two male). Participants received their digital stories

54

on a CD to take home with them. Finally, youth identified a name that they were comfortable
with; these included Raven Farrow, D, Emilio, F, JM, KW, TW; For consistency, I will use
the following: RF, D, E, F, JM, KW, and TW. The third session wrapped up at 6:30 pm.

Stage Five: Knowledge Translation
The purpose of Stage Five was to create a website with digital stories created by
youth participants, and based on feedback from youth participants. The link to the website
was then sent to existing contacts within Prince George and Northern BC, and can be
accessed at: http ://wellnessstory.cloudsingulari ty .xyz/

Conclusion
In total four data sets were collected. These included: digital stories created by
Aboriginal youth participating in the digital storytelling workshop, personal field notes,
online mental health resources analyzed using a CDA, and recordings of focus group
discussions that were transcribed.

55

Chapter 5: Thematic Findings Based on Close Readings and Participant Feedback
A total of four data sets from this project were drawn from for qualitative analyses.
These included: 1) digital stories created by Aboriginal youth during a digital storytelling
workshop, 2) online mental health resources, 3) transcriptions of recorded focus group
discussions, and 4) my field notes. Once all data were collected and transcribed for analysis
(September, 2015), data from all sources were analyzed through critical and close reading
that resulted in themes, which were distilled using an iterative process. To ensure that the
analysis of online mental health resources remained an inductive process and that the
emergent themes did not influence my identification of themes in the other data sets (digital
stories, transcribed focus group responses, personal field notes) I undertook my analysis in
two stages. I first undertook a thorough critical discourse analysis of the screen shots of
existing online mental health resources, identifying words, phrases and exploring the
discursive and socio-cultural context (see Methods). I color-coded each theme and set these
aside; they were not fresh in my mind when I began my second stage of analysis. A few
months later, my workshop took place, in which the other three data sets were collected.
Following the workshop, I began by analyzing the digital stories, focus group transcriptions
and my personal field notes; I then re-analyzed existing online mental health resources and
compared the newly emergent themes with those that had emerged from the digital stories,
focus group transcriptions and my personal field notes as well as those that had emerged a
few months prior in my initial analysis of online mental health resources. This ensured that I
did not guide participant responses during the workshop or look for certain themes in the
findings based on my previous findings.

56

Critical discourse analysis was employed in reference to all data sets but used more
stringently with the textual data sources (e.g. websites). For the purpose of validation, the
findings from the qualitative data were reviewed and agreed upon by the summer student
who assisted in the digital storytelling workshop as well as youth co-facilitators who also
participated in the workshop. Prior to the workshop, only two youth were interested in acting
as co-facilitators, however by the end of the workshop, all of the youth who had made digital
stories were interested in remaining involved in this project and revised and agreed upon the
identified themes.
The purpose of this research was to better understand whether existing online mental
health resources, are age and culturally appropriate for Aboriginal youth (ages 19-25) living
in Northern BC. Using a critical discourse analysis framework, five relevant themes emerged
from my data. These themes are:
1. 'defining mental health'
2. 'diversity of voices'
3. 'blaming the individual'
4. 'hope of recovery'
5. 'youth support technology'
To make transparent how I arrived at each theme, I: 1) present my discursive analysis
findings, 2) I set my discursive analysis findings in dialogue with the words and perspectives
of participants gathered both through conversations and digital story production and, 3) I
assigned a number to each of the online mental health resources that I, with input from youth
participants, collected and analyzed (see Chapter Four), with a number (see Table 2); this
allows me to refer to several resources without having to write the entire name out.

57

Table 2

Online Mental Health Resource and its Assigned Number
Number Name of Resource
Number Name of Resource
1
Heretohelp.ca
5
BC Mental Health and
Substance Use Society
Urban Native Youth
2
The Kelty Mental Health
6
Resource Centre
Association
BC Schizophrenia Society
Canadian Mental Health
7
3
Association Prince George
4
Mindcheck
8
First Nations Health Authority
Resources
5.1 Defining Mental Health
The question 'what is mental health?' was asked of all four data sets, identifying the
broad theme 'defining mental health'. Online mental health resources featured a number of
different terms including 'mental health' although more frequently, terms such as 'mental
illness,' 'mental health challenges,' 'mental health problems,' 'mental disorders' were
present. Other terms such as 'mental wellness' or 'mental well-being' were also present on a
few of the analyzed online resources (2,8). Only one website, the Kelty Mental Health

Resource Centre, defined mental health: "mental health is more than just not having mental
illness - mental health is an important resource for everyday life. It affects how we feel,
think and understand the world. Good mental health and well-being helps us to stay balanced
and resilient, to enjoy life and cope with everyday stress, and to bounce back from bigger
setbacks" (Kelty, 2015) and is "just one component of a person's overall health (Kelty,

2015)." The Kelty Mental Health Resource Centre's website was also the only website of the
collected resources to include a 'healthy living' section providing information about
'nutrition,' 'physical activity,' 'sleep,' 'stress,' and 'mindfulness.' The First Nations Health

Authority website includes a definition for mental wellness, as "far more than the absence of
mental illness and encompasses all aspects of a person's life. Mental wellness is the presence

58

of factors that promote and maintain physical, mental, emotional and spiritual balance"
(FNHA, 2015). On the contrary, most of the collected online mental health resources (1, 2, 3,
4, 5, 7) provided definitions and symptoms of conditions that were labeled as 'mental
illnesses', 'mental health challenges,' and 'mental disorders.' Indeed, although these
websites are designed as 'mental health' resources, they consist mainly of information about
mental illnesses. The critical discourse analysis undertaken in this study demonstrates the
confusion about what mental health means and connects to the identified theme of 'defining
mental health.'
Identifying the difference between mental health and mental illness in focus group
discussions with Aboriginal youth yielded a variety of responses. Youth participants "know
there is a difference" (KW, 2015) between mental health and mental illness. However, when
youth participants were asked what they understood the term 'mental health' to mean, there
was a variety ofresponses; this diversity of understandings supports the broad theme
'defining mental health.' One youth participant said "mental health can mean different things
like taking care of your body, your emotions, physically, emotionally" (TW, 2015) while
another youth participant understood mental health as "chemical imbalances in the brain. It's
a wide area, mental health, and there is also different levels of severity and different names
and different medications that you need - that's how I understand it" (FA, 2015). Prior to this
comment, this youth participant had articulated unfamiliarity with the term 'mental health':
I like the idea that you're mentally healthy. Just getting that word out too is good
because it's not a common word that I hear and I don't know if anybody else has
heard that word before or meaning or definition of it but it is more positive than
[mental illness] and I like that. I like that it is positive. (FA, 2015)
Another comment that came up in this discussion is that "[mental health] is different
than depression and anxiety and how people can deal with it" (TW, 2015). Regardless of the

59

variety in defining mental health, youth agreed that information on both mental health and
mental illness should be included in online mental health resources because "that way you
can actually spot the differences and the pros and cons of the meaning instead of just
throwing [the terms] out there and having people misinterpret what it means" (JM, 2015). In
part due to this confusion, youth articulated a preference for the term wellness; this will be
discussed below.
Since most of the online mental health resources have a focus on 'mental health
challenges,' 'mental illnesses,' 'mental disorders,' and 'mental health problems' these four
terms need to be explored. First and foremost, none of these terms were explicitly defined on
any of the websites. Additionally, what one resource refers to as 'mental illness,' another
resource refers to as 'mental health challenges' or 'mental disorders.' An example of this is
how mental conditions such as bipolar disorder or schizophrenia are referred to as 'mental
health challenges' on the Kelty Mental Health Resource Centre website, but the same
conditions are considered 'mental illnesses' by the BC Schizophrenia Society website. Thus,
it can be assumed that these terms can be, and are, used interchangeably among the
resources. Secondly, all four of these terms seem to imply an abnormality or a deviation from
a 'normal' state. As such, this builds an understanding of mental illness (abnormal) and
mental health (normal) as being binary conditions; both states cannot exist simultaneously.
Third, it is interesting to note the extent to which language around mental illness (or
alternatively challenges, problems, disorders) was negative or fear based. For example, the
words 'cope' 'suffer' 'problem' 'challenge' 'disrupt' 'costs' 'distress' 'abnormality'
'interfering' 'unusual' 'disorder' 'risk' were used in reference to mental illness. This
translates into a stigma around mental illness, in which mental illness is perceived as

60

something bad or undesirable. Due to the interchangeable use of the words mental health and
mental illness, this stigma also becomes associated with the term 'mental health' and adds to
the theme 'defining mental health.'
According to Aboriginal youth participants, not only are conversations about mental
health mainly illness-focused, there is a sense of stigma or fear of labeling around mental
illness, especially within the community. For instance:
I think that in our little community it is more negative focused, and like nobody really
wants to talk about it or nobody wants to discuss if a family member has a mental
illness or to even help that family member or help somebody that you love or care for
with that. (FA, 2015)
The fear-based language seen in the online mental health resources was echoed in the
way that Aboriginal youth spoke of mental illness. "I thought this workshop was about
mental illness, so I was less keen on coming" (E, 2015). This fear and stigma around mental
illness is carried over to the terms mental health as well, to the point that one youth reported:
"I was supposed to take a course on mental health but it was just a bunch of my friends and
they said 'I don't need help with anything like that' and I think it was just the stigma around
[mental illness]" (E, 2015). Fear-based language around mental health contributes to stigma,
which is especially prominent in small communities. This stigma appears to be very real and
influences youth participants' interest to learn more about mental health.
Although youth participants were interested in the term 'mental health' in its true
sense, youth agreed upon the term wellness because it was more positive and reflected their
understanding of 'mental health' within their own lives. Specifically, "wellness is a more
positive way of looking at things instead of jumping to I dunno like mentally ill or
whatever ... [mental illness] comes with a label" (JM, 2015).

61

Figure 5. Screenshot of KM's digital story about wellness

One youth participant created a digital story about what the term wellness means to
her; in it, she describes wellness as "more than being free from illness." Additionally, this
youth participant understands wellness to be a "dynamic process of change and growth" and
"an active state of becoming aware of making choices towards a healthy and fulfilling life
(see Figure 5). KM' s digital story concludes with an image that says: wellness is a proactive
approach to our physical, emotional, social and mental health (2015). Youth participants
pointed out that the term wellness did not have the same degree of stigma associated and
identified a need for "more awareness to the wellness" (KW, 2015) on existing mental health
resources.
5.2 Hope of recovery

The data sets analyzed in this study yielded conflicting results: youth participants
identified a ' hope of recovery ' as important in their understanding of mental health and
wellness, whereas online mental health resources indicated little ' hope of recovery ' from
mental illness. The trend, no ' hope ofrecovery', was identified through the critical discourse
analysis and supported by youth participants' responses following their engagement with the
resources during the digital storytelling workshop. These often opposing results will be
explored in greater detail below.

62

Understanding the recovery process from mental illness was based on how mental
health and illness were conceptualized. Similarly to the previous theme, 'defining mental
health' , youth participants spoke of recovery differently than how recovery was portrayed in
existing online mental health resources. For example, one youth participant commented,
"recovery from mental health can be part of being well" (E, 2015). In other words, youth felt
that they could still be well even though they were recovering from a mental illness. Being
unwell in one dimension of their life does not mean that they, as a whole, are unwell. These
responses indicate that binary understandings of mental health, in which the individual is
either healthy or ill, are not relevant to Aboriginal youth' s understandings of mental health
and wellness. Furthermore, these responses support the theme of 'hope of recovery' as
important to youth participants. Meanwhile, it seems that binary approaches to mental health
are perpetuated in online mental health resources thus indicating no 'hope ofrecovery.'
Aboriginal youth participants had a wellness-based focus and consequently, they
viewed recovery from mental illness as part of wellness. Although youth were familiar with
labels of mental illnesses such as 'depression' or 'anxiety,' it seems that Aboriginal youth in
Northern BC work to incorporate healthy activities into their daily lives to promote wellness
and do not see these strategies as being 'for their mental health,' they just see them as part of
their everyday lives and chest of resources :
I have never actually heard the term mental health ever but that's good to know. I
think as First Nations they try to teach different ways to cope with difficult situations.
Things like walking or doing something like that you can calm yourself down but I
have never actually heard that term. (FA, 2015)
In focus group discussions and within their digital stories, youth participants spoke
about strategies they use when faced with an emotional or stressful challenge. These
strategies included going for a jog, playing music, talking to their partner, writing about it, or

63

watching movies. Youth participants considered recovery from mental illness as part of
wellness. Furthermore, youth participants felt this recovery process was an ongoing process,
perhaps even lifelong, rather than completing a certain treatment plan created by a medical
professional, as was promoted within existing online mental health resources. One youth
participant identified a need to continuously work on mental health:
Something that needs hard work - it' s a commitment to get better. Doing little things
throughout the day, not at only one point in the day - not a one-time fix, but more of
a journey. Sometimes you have got to work out when you don 't want to but the more
that you do it the easier its going to get. Nothing is a one-time fix. Just cause it gets
tougher for some people, gotta keep moving don't stop. Getting started isn't the hard
part its keeping going. (E, 2015)

Figure 6. Screen shot of E's digital story about mental health
In his digital story (see Figure 6), the same youth participant compared exercising to
taking care of his mental health: "exercising is an ongoing process that requires attention
everyday, much like taking care of mental health." However, "oftentimes, the hard part isn' t
getting people to start but keeping them going" (E digital story, 2015).
Existing online mental health resources based on a biomedical approach to mental
health provided little information about the treatment and recovery process; instead, most of
the information discussed risk factors and symptoms of diseases. This contributes to a feeling
of no ' hope ofrecovery.' Additionally, users have to read through all of the risk factors and
symptoms before receiving information about treatment. For example, on the Kelty Mental

64

Health Resource Centre website, under the section on ' mental health challenges and
disorders,' there is an alphabetized list of disorders.

Depression and Depressive
Disorders
,.,

X>NE

R

fRUM

RE

What can be done?
WHAT s ,.,,UNTAl
HEALTM7

M[l'IITAL HEALTH

CH.Al ENC:E5',

DtSOROE:RS

SEJMARM&
CHILDR[-N

Depression can last a lifetime and may happen from time to
time Therapy will help identify the things that may cause
depression. The sooner children and youth receive treatment.
the stronger they will be when depression returns
Treatment includes

-

Pnnt

Web-based mobile app

• talk therapy (also known as psychotherapy)

tracking depression syn

and outcomes

or

such as
NAVtGAT NG THt
M.ENTAl HFALTH

SYSTEM

1t1depressarits

or
• a combination of both

ueore :. n Ou Cle
R

,et

A list of the top website

books, videos, toolkits a
support services

Figure 7. Screenshot of the Kelty Mental Health Resource Centre website
Clicking on ' Depression and Depressive Disorders' brings the user to a screen where
they can learn about ' what is it,' ' how do I know,' ' what can be done,' and ' where to from
here ' (see Figure 7). At the top, are the treatments for depression, which include talk
therapy, medication, or a combination of both. This website states "therapy will help identify
the things that may cause depression. The sooner children and youth receive treatment, the
stronger they will be when depression returns" (Kelty, 2015). This suggests that the
individual is unable to deal with mental illness on their own while implying that the
condition is chronic and therefore that there is no ' hope ofrecovery. ' On the other hand,
prominently located on the Canadian Mental Health Association Prince George Branch
website is the following statement (see Figure 8): "We believe in the idea that people can
recover from mental illness when they play an active and empowered role in their journey"
(CMHA, 2015). This offers a more optimistic and inclusive message to viewers and

65

demonstrates a ' hope ofrecovery.' However, similarly to the other resources in this study,
the understandings of what ' recovery ' means, is unclear.

__
__
........,......

.....

.._

.................
.......

Figure 8. Screenshot of CMHA Prince George's website
The resources that offered no ' hope of recovery ' also used language that
disempowered the individual. For example, "doctors will regulate your levels for treatment
through blood tests" (BC Schizophrenia Society, 2015) or "talk treatment helps people learn
better ways of dealing with their problems" (BC Schizophrenia Society, 2015). Available
treatment options required the individual to leave their health in the hands of a health care
professional, and implied that the individual was weak or needing help. Existing mental
health resources also tend to present mental illnesses as deviations from the normal; recovery
aims to return the individual to ' normal ' so that the individual can "live a happy life". For
example, the BC Schizophrenia Society website says that "a majority of people will recover,
but will most likely experience recurrent episodes in the future" (BC Schizophrenia Society,
2015). This uncertainty leaves the user wondering if they have been diagnosed with a chronic
condition and consequently whether they will ever be ' healthy ' again. Thus the focus
remains on what is wrong, what is broken and needs fixing, rather than on the individual and

66

their strengths. In contrast, youth participants spoke about preferring activities such as
jogging, speaking with friends, reading, cooking, or watching movies, as approaches to
dealing with mental health challenges or stress; each of these activities allow for selfdetermination of the individual, which empowers youth and offers a 'hope ofrecovery.'
On occasion, online mental health resources present self-care as an option for mental
illnesses (BC Schizophrenia Society). Other resources, such as mindcheck offer no
information about treatment options, however they do provide self-care resources, such as
apps, or other interactive activities. One youth participant felt that information present on
these resources was 'depressing' and 'offered no hope' because they discussed risk factors
and symptoms rather than treatment and the recovery process.
Only one resource (a downloadable PDF toolkit for communities to start mental
health programs based on a wellness model) identified wellness (including mental wellness)
as having three parts of equal importance. The resource, titled 'Hope, Help and Healing'
contains a cycle of wellness model consisting of a prevention, intervention and postvention
aspect (see Appendix III) (FNHA, 2015). This model is unique in that other existing online
mental health resources focus mainly on intervention as opposed to a wellness cycle.
Resources that do not contain such nuanced wellness-based models may be reflective of the
current health care system, which seeks to treat disease rather than prevent disease or
promote health (N Adelson, 2005; Martinez, 2005).
5.3 Diversity of Voices
Another theme that emerged from analysis of various data sources and narratives is
the diversity of voices that shape online mental health resources. In this analysis, I
considered both silenced voices and privileged voices in the resources. As the Kelty Mental

67

Health Resource Centre website acknowledges "to different people, [mental health] can
mean a lot of different things" (Kelty Mental Health Resource Centre, n.d. ). However, I
argue that a narrow set of voices (and thus a narrow understanding of mental health) is
currently reflected in the online mental health resources I analyzed. For instance, it appears
that three sets of voices are inadequately heard within the collection of online mental health
resources: voices of youth, voices of Aboriginal youth and voices of Northern youth. These
will be discussed in the following three sections.

Youth Voices. Two of the online mental health resources analyzed explicitly involve
youth voices in the creation of their websites (2, 6). These were the Kelty Mental Health

Resource Centre, whose resources are developed by staff, parents, and youth peer support
workers, and the Urban Native Youth Association, whose resources are co-created with
considerable input from Aboriginal youth. Almost half of UNYA's Board of Director
positions are held by youth. Two other resources (4, 7) were created as collaboration between
the organization's executive team, service providers, and clients (and families) accessing the
organization. However, the degree to which youth are involved in the development of these
resources is unclear.
Youth participants articulated a preference for eye-catching images and colors.
Pictures, videos, and interactive media were recommended by youth. "More pictures make
[websites] more eye-catching for younger audiences" (RF, 2015) and "even having some
little short video clips instead ofreading" (JM, 2015). For example, when asked to explore
and then share their opinions of existing resources, youth commented on how the videos on
the mindcheck website "made it easier to focus" (RF, 2015). As a result, privileging the

68

'youth voice' in the creation or modification of online mental health resources is important
when creating resources for youth and supports the identified theme 'Youth Voices.'
Youth participants also mentioned they preferred easy to understand information.
Defining what is 'easy to understand' may vary depending on youth; however, at least one
youth made clear that, "stories, probably have pictures, visualizations. Having little sentences
at the bottom just explaining what this stuff is ... yeah sometimes my brain gets tired of
reading ifthere is too much information" (TW, 2015). Youth felt that a number of the
resources had too much information. This made them overwhelming to youth, especially to
those youth who may be exploring it for the first time "[Lots of information may be] helpful
for people who are into [mental illness] but harder for people who might be trying to figure
things out for the first time" (E, 2015). Additionally, there was a sense that too much
information was intended for those who had more experience with mental illness rather than
those that were interested in learning more.
And probably if it gave you too much information all at once that's probably a bad
thing. The first one [mindcheck.ca] was divided into categories and if you didn't
know much about it you can click on the subject and learn more about it. The second
one [BCMHSUS website] just gives you all of the information all at once, almost as
if it was developed more for professionals rather than youth. (E, 2015)
Youth participants also identified an interest in learning more about what living with
a mental illness is like and/or the recovery process. However, when including this
information, it is important that too much information is not provided as this may overwhelm
the individual. In addition to having preferences in terms of how, and how much information
is presented on the resources, youth participants articulated a preference for resources, which
offered information about recovery from, or living with, mental illness. Specifically, one
youth participant felt that online mental health resources should "try to show the perspective
of people with mental illness" (RF, 2015).

69

Figure 9. Screenshot of "Why am I so stressed out?" video on mindcheck.ca
However, when engaging with collected online mental health resources, youth
participants felt that these existing resources did not provide this desired information. This
was supported by the findings of my critical discourse analysis of online resources. For
example, Mindcheck contains several videos of youth (see Figure 9) talking about their lived
experiences that have led them to feel this emotion (i.e. stress). However, there was little
information about what living with this emotion/mental illness was like, nor was there
information about the recovery process. As a result, there is a clear need to privilege the
'Youth Voice' when developing online resources and ensure that ' Youth Voices' are
involved in describing their lived experiences with mental health challenges.

Figure 10. Screenshot from TW's digital story
Another youth participant, in his digital story, chose to talk about his own
experiences with anxiety. He began by defining anxiety as he understood it, and then he
70

shared an image of a confused street sign (see Figure 10) while saying "the reason why I
chose this [image] is because I sometimes feel this way when I get anxious and that's ok"
(TW digital story, 2015).
In his digital story, the participant also identifies what causes him to be anxious and
what he feels when he does these things: "When I start to do something challenging for
myself, that' s when I start to get frustrated, depressed and other emotions start coming in"
(see Figure 1 l)(TW, 2015). To conclude his digital story, TW offers suggestions about what
he does to deal with his anxiety, such as talking about it, jogging, going for long walks,
cooking, and reading. This story along with the other stories presented in this section point to
the need to include youth voices as a way to insure relevance and meaning to mental health
resources by including, for example, interactive or visual media (i.e. images, videos).

,,.,

Figure I I . Screen shot from TW's digital story

Northern Voices. Almost all the resources examined in this study aim to be
representative of, and useful to, the population of British Columbia (1 , 2, 4, 5, 6, 7, 8). The
Provincial Health Services Authority is also the main funding source (see Figure 12) for
many of the resources (1 , 2, 4, 5, 6, 7, 8). Although the CMHA PG website (3) identifies
physical resources and events available in Prince George, most of the content is identical to

71

that of other regions across Canada. In other words, there is little in the way of geographic
specificity or sensitivity to these materials, which may mean they have less appeal than they
otherwise could. Some resources also listed community-funding sources (see Figure 12).
The central offices of these organizations (1 , 2, 4, 5, 6, 7, 8) are situated in the Lower
Mainland and such naming of centrality far from the north may also alienate northern users.
Resources rarely acknowledged the role of geography and environment in mental health and
wellness; this is discussed further below.

Government of
Brtbsh Columl>la

rvnd s

fu nds.

funds

~

lu ~

unds

funds

funds

Nbtthem HHllt>
Authority

~

fun s
BC Children's
Ho&pilal Foundation

Canadian Mental Heal h
Associ, tu, BC Br.'lneh
finan(jaly
supporta

RBC Children's Mental
l"lt#lh Prqocl

11,tliniMry of Child &
Family DeYelopmenl

The F O.R.C.E Socie1y f<l"
Kid's Mental Heaith

Figure 12. Funding for collected online mental health resources

72

Youth participants reported that online mental health resources should be developed
more locally in order to best reflect the physical services available to them. If this was the
case, youth participants felt that the physical mental health services on these resources would
be more reflective of the demographics of the north: "I feel like it would be better if it was
more local. I think it would be easier to find the resources and the resources would be
different" (RF, 2015). Additionally, "Vancouver is kind of far- it would be nice to have
some stuff in the area" (TW, 2015).
Youth also mentioned how living in a small community can affect how willing an
individual is to seek care, because "in a small community everybody knows everybody"
(KW, 2015). As a result, "nobody wants to ask questions" (E, 2015) about mental health or
illness. Youth participants often commented on the lack of or inadequate services available to
them and their communities in Northern BC. One youth articulated "there are more resources
in the city, places to go for help than there is in a small community" (KW, 2015).
Additionally one youth participant spoke about how she would search online for
treatment centers for young women that have social anxiety ... but there is really
nothing out there. Like there are treatment centers for women and men but you have
to be an adult. And I contacted a treatment center in Williams Lake but it was for
severe traumatized kids that are into drugs and alcohol like heavy. So if you just have
a child that needs help in other ways, they wouldn't suggest that you send your child
there because it could be more detrimental than anything else ... It probably just gives
you the definition but it doesn't give you the resources to help or where you can find
the proper phone numbers for your area like I think that they just have one general
number that you can call like the nurses line. Otherwise, no I don't think that there is
any. (FA, 2015)
It is evident, then, that there is a lack of actual resources in the northern communities
that youth participants live in. Furthermore, that the resources themselves privilege a
southern, urban placement/geographic orientation, thereby subtly erasing northern presence.

73

The findings of my critical discourse analysis also uncovered a silencing of place, which was
likewise supported by the responses of youth participants.
In one digital story, a youth participant spoke of her friend who "never does anything
except play video games" and "says he is depressed." However, her friend is "worried about
telling anyone because he is worried about getting made fun of." She and her friends tried to
help at first, but "there is only so much that you can do." At the end of her story, D calls for
more resources in the community, which are currently inadequate for helping people like her
friend (D ' s digital story, 2015). This digital story demonstrates the complexity of identifying
and accessing mental health services and the unique realities of a northern community; this
story speaks to the importance of privileging the voice of 'northern youth' in online mental
health resources.
Aboriginal Voices. Aboriginal voices and presences were largely absent from the

collected and analyzed online mental health resources. The First Nations Health Authority
did not directly fund or financially support any of the recommended online mental health
resources (1 , 2, 3, 4, 5, 6, 7) although other regional health authorities are a key funding
source of these online resources (see Figure 12). Two of the recommended resources (6, 8)
were created specifically for First Nations people living in BC, with BCMHSUS receiving
input from the Aboriginal Health Branch of the Provincial Health Services Authority. Six of
the resources (1, 2, 5, 6, 7, 8) point viewers to, or have 'Aboriginal-specific' information,
although it is scarce and hard to find. For example, the Kelty Mental Health Resource Centre
has a link to the First Nations Health Authority website as well as the FNHA's Hope, Help
and Healing document (a toolkit for establishing mental health programing in communities).
Here-to-help.ca also has some Aboriginal-specific information. None of these three

74

'Aboriginal-specific' resources incorporate elements that youth said made resources
appealing, like video or short texts (see 'Youth Voices ' ). This speaks to engaging Aboriginal
youth in the development of online mental health resources.

Th e Kelty Mental Health Resource Centre, along with a few others, states, "Mental
health challenges and disorders can happen to anyone. They affect people of all ages, races
and social classes. No one is immune" (Kelty, 2015). This also suggests that regardless of
age, race or social class, everyone experiences mental illness the same. Two websites offer
resources and information in different languages. The Kelty Mental Health Resource Centre
offers information sheets in French, Farsi, Punjabi, Simplified Chinese, Traditional Chinese
and Korean. However, if an individual speaks a language other than the ones available on the

Kelty Mental Health Resource Centre website, they may feel that the information is not
accessible or relevant to them.
The BC Schizophrenia Society offers recordings of Elders talking about mental
illnesses in three First Nations languages, including Tsilhqot'in, Shuswap, and Carrier.
Youth liked this idea of having Elders speaking in traditional First Nations languages
because it can bridge a generational gap.
I guess its kind of really good. And it also just incorporates your language and it
opens the door to learning more about your own language if you don' t know and
when you talk to Elders and stuff you can use your own language instead of English
they don 't really like. Well you impress them if you speak in your own language
cause us younger generations even though we have it in school its not really high on
the priority list. So it can help bridge that gap between the generations. (JM, 2015)
Additionally, combining traditional language with mental health information was seen to be
positive "because some Elders don't know English. And so it' s good to know stuff in our
language and be able to explain it and talk to them about it" (JM, 2015). Despite the initial
positive reaction, however, youth were still skeptical about these resources as they spoke

75

only of mental illness rather than wellness or mental health. As a result, youth felt that these
resources were not good because they would not be able to talk to their Elders about
wellness, only illness.
Beyond the audio recordings on the BC Schizophrenia Society website, youth
participants expressed an interest in having cultural elements incorporated into online mental
health resources, regardless of how much an Aboriginal youth knows about their culture.
Yeah I think that it would be a positive. Most people that don't know much about
their culture they could use it as a way of learning more about their culture and it
might catch their attention and make it more personal. (E, 2015)
Additionally, youth felt that the analyzed online mental health resources lacked a
spiritual component that was central to their understanding of health. "We have a lot of
spiritual healing in our culture, smudging, sweat lodges stuff like that" (RF, 2015). Including
this information as a way of promoting mental health and wellness " would actually be really
great because just doing a sweat is like so relaxing like right after you come out you just feel
a lot more fresh" (JM, 2015). However, one participant cautioned that he did not think that
information about mental illness was closely connected to spiritual healing techniques: "I
don't really know how that would connect with a sweat lodge" (JM, 2015); rather, it may
"Not necessarily [be about] linking it but just showing that there are different ways to
connect and promote wellness" (JM, 2015). During the final focus group discussion, youth
suggested that places to undertake cultural healing practices should be listed alongside
Western approaches to mental health care. This sentiment was reflected in the digital stories
produced by Aboriginal youth, again supporting an 'Aboriginal Voices' theme that needs to
be privileged in the development of online mental health resources.
In addition to incorporating cultural elements into online mental health resources,
there was a lack of acknowledgement of Aboriginal realities or people on the online mental

76

health resources. Only the Elder recordings on the BC Schizophrenia Society website
attributed the effects of residential school and associated trauma to mental illnesses. The two
websites that did show images of First Nations youth or cultural practices were the First
Nations Health Authority website and the Urban Native Youth Association website, which
are both designed explicitly for First Nations people. While most of the other resources show
images of culturally diverse youth, Aboriginal people are missing. Informed by these
findings, it appears that when 'everyone' is referred to on existing online mental health
resources, Aboriginal youth are excluded. It is interesting too that youth making digital
stories about mental illness (such as RF, E) incorporated no cultural elements, or explicit
references to culture. This may be because it's just hard to find Aboriginal-specific
information, images or resources online, bespeaking a broader silence regarding Indigenous
presence/reality. The reason why this may be the case is that the entire Internet writ-large is
likely not a space of Indigenous representation.
5.4 Blaming the Individual

Another theme that emerged from analyzing the online mental health resources was a
sense of blame towards the individual about their mental illness or poor mental state. This
theme is evident in the critical discourse analysis of the language and images present among
existing online mental health resources. Youth participants, in their responses, also identify
the theme of 'blaming the individual' as differing from their understandings of mental health.
The analysis of language of mental health present on existing online mental health resources
served to blame the individual for their ailments. For example, mental illnesses were referred
to as 'mental health challenges ' on the Kelty Mental Health Resource Centre website, rather
than considering environmental or social conditions as the ' challenges' that may cause stress

77

to the individual. This implies that the ' challenge of mental health' stems from, and is
located at the scale of the individual rather than being within a larger environment.
Additionally, when most of the online mental health resources list the causes of 'mental
illnesses' few make reference to the impact of the environment as driving the emotions or
states that are associated with mental illness (for example). This disregard for environmental
factors supports the theme ' blaming the individual ' identified through critical discourse
analysis of the collected resources. Although not explicit in their definition, the First Nations
Health Authority alludes to the influence that environmental factors may have on wellness.
They note that mental wellness is "far more than the absence of mental illness and
encompasses all aspects of a person' s life. Mental wellness is the presence of factors that
promote and maintain physical, mental , emotional and spiritual balance" (FNHA). This
definition acknowledges the numerous factors (individual, social or environmental) that may
influence the wellness of an individual. Similarly, one youth, in her digital story attributed
mental illness to a "complex interplay of genetic, biological, personality, and environmental
factors" (RF, 2015).

Figure 13. Screen shot of mindcheck's home page

78

This theme, 'blaming the individual' is supported by the images present on many of
the online mental health resources (I , 2, 4 ); many of the images showed youth standing
alone, or set apart from others. Visually, this enforces a feeling of stigma and isolation that
comes from mental illness or negative feelings. For example, the home page of mindcheck. ca
shows seven of the nine youth sitting alone and apart from each other. None of them look
happy (see Figure 13); in fact most look sad or worried and each youth has a thought bubble
that expresses a negative emotion such as 'why do I feel so sad?'
Additionally, language on existing online mental health resources attributed mental
illness to an individual weakness or flaw, adding to the theme 'blaming the individual.' For
example, on the mindcheck website, several self-care resources are listed, including the
words: "here you will find online resources and tools you can use yourself to build skills and
develop ways to manage mood problems. Self-care has been proven to work for many
people" (mindcheck, 2015). This is compounded by other statements which state that "the
sooner children and youth receive treatment, the stronger they will be when depression
returns" (Kelty, 2015). It is worth noting that this language is very dense, seemingly directed
at an adult or parent, rather than at youth. This reflects the theme of 'blaming the individual '
as it disempowers the reader, and implies that they are weak and in need of help by someone

stronger, an adult or parent.

Figure I 4. Screenshot of BCMHSUS' homepage banner

79

Not all images on these resources show youth standing alone or set apart from others;
in fact, several images show a group of people together. For example, an image from the BC
Mental Health and Substance Use Services website shows a family together on what appears

to be a picnic (see Figure 14).
Another image from the Kelty Mental Health Resource Centre website shows a
young girl running ahead of her family in the forest (see Figure 15). Both of these images
have the child as their focus of the image. These images perpetuate an idea that although a
caring and supportive network is needed in the treatment of mental illness, mental illness is
still the domain of the individual. Additionally, these images position the viewer as either
seeing the individual with mental illness as needing extra care, much like a child, or as being
child-like in nature. The viewer is an externalized voyeur, a kind of ' watcher/outsider' to the
subject of mental illness, thereby setting up a kind of 'normal' in the foreground, 'other' in
the background relationship with the illness - a watcher/watched relationship. As a result,
there is a sense of a loss of independence and a greater dependency on others that comes
from these images on the mental health websites. This can add to a theme of ' blaming the
individual. '

Figure 15. Screen shot of Kelty Mental Health Resource Centre banner

80

Almost all of the treatments recommended for mental illness are focused solely on
the individual. It was also clear that Western rehabilitation techniques available to youth in
response even to substance use aims to alienate the individual and move them from their
community. This was noted by participants being asked to comment on the website
resources. One participant spoke about how when she was in a treatment facility, she was not
only sent away from her community, but all modes of communication with her friends were
taken away. The facility took away her cell phone and other access to connections. This was
also evident in another story told by one youth, where she asked if I could help her find her
family member who had recently been taken from her family and placed in a rehab facility.
Her family was not told where he was placed and he had no contact to them. This is
reflective of a non-Indigenous way of knowing and being, in which problems or treatments
are offered at an individual level rather than a collective level.
It is also interesting to note that many of the websites use plural language such as

'we' and 'our' when talking about mental illnesses; as a result there is a sense of a shared
experience and a common illness. The inclusion of statistics on mental illness creates a sense
of these conditions as being 'normal ' or ' common. ' This is a positive thing, as it positions the
reader to be part of a community with others who are experiencing the same condition.
However when discussing the symptoms or changes in behavior experienced by the
individual, the word 'you ' is far more prevalent. For example, mindcheck.ca provides the
viewer an opportunity to 'check their depression ' as well as providing information about
changes in how you think, feel , act, and behave. In other words, there is a kind of
knowledge-space produced wherein there appears to be something inherently wrong with the
individual living with mental illness. There is little acknowledgement of the kinds of

81

situations or environments that may drive these negative emotions, placing the 'blame on the
individual'. When creating their digital stories, youth echoed the preference for the word
"we" as it created a community and emphasized the shared experience instead of being
alone: "I just don' t want to feel like I am talking about my own experience. A lot of people
go through it too" (TW, 2015).
One youth participant, in her digital story attributed mental illness to "a complex
interplay of genetic, biological, personality, and environmental factors" (RF, 2015).
Additionally, she mentions how the fear of stigma or label on the individual, rather than the
environment, is a barrier "not only to diagnosis and treatment but also to acceptance in the
community" (RF, 2015) (see Figure 16). Responses by youth participants make it clear that
they recognize the environment as a stressor and risk factor in mental illness rather than
simply blaming the individual.

what causes it?
A complex interplay of genetic, biological, personality and
environmental factors causes mental illnesses.
Almost one half ( 49o/o) of those who feel they have suffered
from depression or anxiety have never gone to see a doctor
I
abo'i.it this' problem.
,...Afstigma. or discrimination attached to mental illnesses
presents a serious barrier, not only to diagnosis and
treatment but also to acceptance in the community.
Figure I 6. Screenshot of RF's digital story

5.5 Technology for Youth
Youth spoke supportively about using technology for the purposes of reaching youth
populations: "I think [technology] is more for the younger people" (RF, 2015). The appeal of
technology was reflected in the responses of youth interested in participating in this
workshop. Youth expressed an interest in learning computer skills, as well as how to use
82

technology to share information in a meaningful way. There was enough interest in this
workshop that I was invited to hold another workshop in the Nass Valley. This, I think, is a
testament to the use of computers in my project and the idea that computer and technologybased skills are being recognized as appealing to youth. Also that technology appeals to
youth. Needless to say, there was significant interest and support for this workshop in the
areas of northern BC where this research occurred.
Technology offers an avenue for youth to access services or resources with a
confidentiality that does not exist in their communities. For example, one youth spoke of "an
app built mainly for teenagers and that may be good in a small community where you don't
want everyone to know that you are feeling bad" (RF, 2015). Another participant echoed the
appeal about online tools offering confidentiality:
I think that it would be good because I think a lot of people aren't comfortable going
into a building and giving their name and showing that they need help. For me
preferably, I would rather do it myself and find all of the information on my own and
then ifl need to, or my last resort is to go into a center. I would but I would prefer to
find out as much as I could before rather than take that extra step. (FA, 2015)
Youth also felt that "sometimes its easier to talk to someone, like, that that you don't
know" (RF, 2015). These responses from youth participants support the theme 'Technology
for Youth.' When asked about whether they liked the idea of Skype resources as a way to get
in contact with professional mental health workers (i.e. counselors, social workers,
psychiatrists, psychologists), youth thought that "it would be weird but good at the same time
because if you are having problems or whatever and its after hours and you need somebody
to talk to you can talk to them" (TW, 2015). Youth participants also commented about how
social media would be a good venue to raise awareness of mental health because this was
something that was already used by many youth: "Using social media would do it and it
would be awesome because all of us younger generations are already on it and it just pops up

83

first and everything" (JM, 2015). However, there was also awareness that "if somebody
[posted] everyday on my page I would block them" (FA, 2015). This demonstrates the
precarious nature of technology and how using these various technologies require finesse
with youth populations. Additionally, this supports the theme "Technology for Youth.'
Understanding the extent to which youth search for mental health information online
was unclear. Youth mentioned seeking health information from family members, including a
grandma. However others expressed frustration when seeking information from family
members who would get quiet or not answer their questions (see Figure 17). "Trouble is,
when you're trying to talk to somebody about your problems and they start to compare their
problems to yours - its getting nowhere. That usually happens to me that's why I don't really
talk about it" (E, 2015). There was also an interest in not burdening other people by telling
them about how you are feeling "because generally you learn at a young age that everybody
has got their own problems" (E, 2015).

I 1m

d'fFt:l'ted,10dt ~Ff, ~Ch\Citd,
hw.fJ.\t.f, ~~;i,,uJ,jud~~,
. ~i,w,,de,~d in119~~
I

ereke:ti.dtrj~ ;~i

F,ne.

•

Figure 17. Screenshot of D's digital story
A few times, youth participants mentioned searching for health information online "to
try and self-figure out what you have on your own, but we always do it, we Google
everything" (FA, 2015). In terms of specifically searching for mental health information

84

online, youth did feel that online mental health resources might not be ideal for individuals
when they are upset.
I just think that when not just youth but anybody is upset or raging or just not in a
good place they wouldn't in what I have seen is they wouldn't just go directly to a
computer like what are these feelings. They would first try and get into a more sane
state and then afterwards try and figure it out on their own it doesn't seem like that is
something that somebody would do. Like for me, I wouldn't just go to a computer
and be like what does this mean - like maybe after? But I don't think that I would
right when I am feeling upset. (FA, 2015)

Conclusion
Five themes emerged from the close readings and discursive analysis of the four data
sets collected in this study. These themes included: Defining mental health, hope ofrecovery,
blaming the individual, diversity of voices, and youth support technology. At times, the
discourse of mental health promoted by online mental health resources was different than
that of youth participants. However, it seems that three broad characteristics of online mental
health resources made the resources more appealing/accessible to Aboriginal youth living in
Northern BC: appeals to youth; is geographically relevant; and is aboriginal specific. The
following table (see Table 3) outlines which resources contain each of these three
characteristics.
Table 3

Aboriginal, geographic and youth relevance of online resources
t1. Resource
Aboriginal North
specific
specific
1 Heretohelp.ca
2 The Kelty Mental Health Resource Centre
3 Canadian Mental Health Association Prince George
X
4 Mindcheck
5 BC Mental Health and Substance Use Society
6 Urban Native Youth Association
X
7 BC Schizophrenia Society Resource
X
8 First Nations Health Authority Resources
X
*X indicates that the resource is relevant in that specific area

Youth
specific
X
X
X

85

What my findings and this table (see Table 3) demonstrate is that most of the
collected online resources contain only one of the three characteristics identified by
Aboriginal youth as important (youth-friendly, geographically relevant and Aboriginal
specific). Thus, none of the collected online mental health resources are considered
accessible or relevant to Aboriginal youth living in Northern BC.

86

Chapter 6 - Discussion
This research suggests that the development of online mental health resources that are
relevant and accessible to Aboriginal youth living in Northern BC is contingent upon seeking
feedback from the people that the resources are aimed at. Additionally, youth participants
were keen to engage with arts-based methods (digital storytelling), supporting such tools as
having potential for undertaking health and wellness research, particularly with Indigenous
peoples. I will draw on the identified themes as well as existing research in order to explain
my findings. This leads to recommendations as well as some broad conclusions of the
research.

6.1 What is mental health?
Based on the critical discourse analysis undertaken in this study, it became clear that
most online mental health resources presented mental illness as built on an understanding of
health dominated by negative and fear-inducing language. This dominant discourse adopts
and promotes a 'blame the victim' discursive climate wherein individuals 'deviate' from a
narrow range of accepted behavioural norms (Adelson, 2005; Martinez, 2005). This creates a
false binary which reproduces the concept that people are either ill or not ill, and ignoring
grey zones of functionality (Harter, Japp, & Beck, 2005). Youth participants picked up on
this. A biomedical understanding of health is the dominant understanding of health promoted
in Canada (Adelson, 2005), wherein biological/medical models conceptualize mental illness
as a 'pathology' and ignore economic, political, and social causes of a number of widespread
mental health problems. It is interesting to note that some aspects of the Western mental
health care system are increasingly recognizing mental health as a spectrum. For example,
the DSM-5 presents the idea of a dimensional approach to diagnosis (Narrow & Kuhl, 2011).

87

This view is non-binary and places mental disorders on a spectrum of severity and
functionality. However, based on the findings of this research, promoting the current
biomedical approach to mental health remains largely inadequate to Aboriginal youth in
Northern BC.
The findings of this research also suggest that mental illness (and subsequently
mental health due to the discourse present on online mental health resources) discourse is
dominated by negative or fear-inducing language. This is reflective of the powerful
institutions dominated by a hierarchy of experts, administrators, and doctors that regulate and
provide current mental health care services (Martinez, 2005). It has been argued that these
institutions act as powerful mechanisms for the social control of the population; they use
clinics, hospitals, "treatment," and medication to restrain and discipline what they consider to
be "deviant" forms of behaviour and impose regimes of social conformity and passivity on
individuals and communities (Martinez, 2005). Individuals who live with illness
subsequently are conscripted into a role of "the victim, the underdog, and the remedial"
(Seligman & Csikszentmihalyi, 2000, p. 13). This construction and conscription demand that
ill subjects are unable to help themselves, and therefore need help from the powerful
institutions that regulate mental health care services (Jhangiani & Vadeboncoeur, 2010). This
contributes to the fear of labeling and stigma that is often associated with mental illness, and
demonstrates a way in which the very system that is supposed to help may actually be
causing more harm.
Youth participants also spoke about a fear of labeling as a barrier to accessing mental
health care services. Specifically, youth participants were concerned about stigma and how
these labels would affect how other people see them, especially in a small community

88

"where everybody knows each other" (KW, 2015). Prilleltensky and Gonick (1996) argue the
dominant mental health discourse reinforces peoples' problems and, once they are
internalized, these discourses serve to keep individuals trapped in self-subjugating social
narratives through labels of mental illness. Furthermore, stigma associated with mental
illness blankets or mutes individual's traits, which subsequently affects the person's entire
presentation and attitudes (von Peter, 2013). Hinshelwood (2001) deconstructs and criticizes
psychiatric syndromes as being created by psychiatrists based on their psychiatric
perceptions and experiences of their patients, rather than empirical evidence. Diagnoses of
psychiatric syndromes are offered (or constructed) to satisfy patients whose comfortable
narrative of themselves has been disrupted in circumstances of mental illness; these
syndromes offer puzzled patients meaning from an authoritative source. Furthermore,
Hinshelwood (2001) argues that the true purposes of the DSM is to be a source book of
medical ' stories' of symptoms, diagnosis, and cure that can provide a meaningful identity for
insecure and fragmented persons. In some cases, being diagnosed with a mental illness has
been considered a dehumanizing transformation where the person becomes an illness
(Deegan, 1996). Youth participants did not feel as if they were insecure or fragmented, or
even that they had 'problems,' therefore the dominant mental health discourse does not seem
to be relevant to Aboriginal youth.
However, the labels of mental disorders serve to categorize individuals as a means of
applying a generic identity and can also create otherness. "Otherness is often the product of
observations of strangeness and danger in 'them,' in binary opposition to the safety and
familiarity with 'us "' (Warner & Gabe, 2004, p. 388). The notion of otherness is associated
with the anxieties and fears (i.e. stigma) associated with mental illness. At present, current

89

policies and systems of care remain deeply embedded in medical theory and promote
categorical views of mental illness. These categories are used to identify 'appropriate' care
pathways in order to 'manage' the risks of each mental illness accordingly (Warner & Gabe,
2004). Current mental health care systems should be reviewed and restructured so that the
focus shifts away from narrow conceptualisations of 'risk' and moral categories of 'illness'
and 'disorder' towards a focus on the alleviation of mental distress (Warner & Gabe, 2004).
Based on the findings of this research, it seems the biomedical approach to mental
health that is widely promoted by the majority of online mental health resources is culturally
irrelevant and inadequate for Aboriginal youth living in Northern BC. This, in tum, may call
for a wellness-based mental health care system, or one that adopts a 'positive psychology'
approach (Seligman & Csikszentmihalyi, 2000). Positive psychology is a holistic approach
that helps people flourish . However, this approach is not without criticism (see Jhangiani &
Vadeboncoeur, 2010) as failing to adequately account for culture and alternative
understandings of mental health. As a result, self-governance by First Nations on their own
health and mental health care systems seems to be the best and most effective approach and
can result in improved health and wellness within communities (Chandler & Lalonde, 1998).
6.2 Hope of recovery
Recovery from mental illness is conceptualized differently depending on how mental
health and mental illness are defined and understood. One of the themes that emerged from
the data analysis was the tendency to 'blame the individual' for their mental illness, and
ignoring the role of the environment. As demonstrated by the critical discourse analysis
(CDA), current notions of recovery from mental illness tend to be limited or reductionist in
nature, focusing on the individual and ignoring the complex and dynamic relationships in

90

which these individuals live (Rudnick, 2012). Alternatively, Aboriginal concepts of the
person often position the person as being embedded in larger webs of relatedness with the
environment and with the spirit world (Rudnick, 2012). For many Indigenous people, current
reductionist approaches to recovery are inadequate and fail to take into account the historical
and socio-political origins of despair that have made recovery difficult for Aboriginal
peoples, as well as ignoring or minimizing present-day structural barriers that impede
participation and acceptance in the wider community (Rudnick, 2012). There is thus a need
for mental health care systems to be built on Indigenous understandings of mental health, as
this translates into more culturally relevant understandings of treatment and recovery.
Interestingly, when speaking about mental health and recovering from mental illness,
youth participants spoke about spiritual approaches to healing as being important to their
understanding ofrecovery and wellness. Additionally, one youth participant commented that
existing online mental health resources were 'depressing' and 'lacking hope' for the viewer.
Based on the findings of my critical discourse analysis and youth participant opinions of
existing online mental health resources, it appears spirituality remains a 'forgotten'
dimension within the contemporary practice of mental health care (Swinton, 2001). This
observation is mirrored in the literature, where it is argued that there is a need to "step back
from our normal stance of objectivity and distance, to move beyond the limitations of our
current worldview and begin to listen to the actual experience of people with mental health
problems" (Swinton, 2001, p. 9). In doing so, "it becomes clear that spirituality can be
central in the enabling of mental health" (Swinton, 2001, p. 9). Furthermore, Lavallee and
Poole (2010) argue that mental illness among Aboriginal populations is a symptom of the
attack on cultural identity of Aboriginal peoples. As such, it is important to recognize that

91

this assault on cultural identity has played a significant role in the ill health of Aboriginal
people and that the spirit has been wounded; recovery or other healing activities need to
include rebuilding the individual and collective identity of Aboriginal peoples (Lavallee &
Poole, 2010). Proper understanding of recovery and a full life in the community will require
the addressing of these social, structural, political and economic dimensions of suffering that
affect the life course and outcomes of Aboriginal people with mental disorders (Rudnick,
2012). This also demonstrates the importance of applying a social determinants of health
perspective to existing mental health disparities existing among Aboriginal peoples (Reading
& Wien, 2009).

Existing online mental health resources were based on the assumption that the goal of
recovery was returning to 'normal.' Current Euro-American understandings of mental health
care based on returning to normalcy can, in some ways, instill assumptions about 'treatment'
which requires patients to adjust themselves to fit into an addictive, sexist, racist, selfdestructing society (Schaef, 2000). However, Deegan (1996) argues that recovery should not
be about returning to 'normal' but rather to embrace our human vocation of becoming more
deeply, more fully human. In other words, rather than viewing recovery as 'an end product or
result,' Deegan (1996) argues that "recovery often involves a transformation of the self
wherein one both accepts one's limitations and discovers a new world of possibility"
(Deegan, 1996, p. 67). Recovery, understood in this manner is a process, a way of life; youth
participants echoed these sentiments during the digital storytelling workshop. For example,
one youth participant commented, "recovery from mental health can be part of being well"
(E, 2015). It is important to note that physical mental health services are increasingly
recognizing and incorporating the value of a recovery-oriented approach (Anthony,

92

Weisburd, Sargent College of Health and Rehabilitation Sciences, Center for Psychiatric
Rehabilitation, & NAMI California, 1994; Farkas, 2007; Farkas et al., 2005), however based
on the findings of this research, online mental health resources appear to be lagging. Such
recovery-oriented models echo youth participants' responses, understanding recovery from
mental illness as an ongoing process, one that can be part of being well. Similarly, a report
by the Canadian Senate posits that an individual can have a mental illness but experience
good mental health. Alternatively, an individual can have poor mental health even though
they do not have a mental illness (Kirby et al., 2006). These understandings of recovery
challenge the current 'power over' system that continues to dominate mental health care
currently, opting for a 'creating power together' approach.
6.3 Still silenced: perpetuation of colonialism in online mental health resources
A reoccurring theme, implicit in youth participants' responses and supported by the
critical discourse analysis of existing mental health resources, was the ongoing and everpresent effects of colonialism on Aboriginal people. This ongoing legacy was reflected in a
number of ways, including the scarcity of online mental health resources for Aboriginal
youth, the lack of Aboriginal understandings of mental health present within existing mental
health resources and/or guiding the development of these resources, and youth participants'
lived realities.
It was clear that youth participants' realities were, and are, shaped by an ever-present

legacy of colonialism, including disrupted family structures, substance abuse,
unemployment, and violence (Czyzewski, 2011). These realities often led to concerns by
youth participants about talking to family or friends about mental health challenges because
"generally you learn at a young age that everybody has got their problems" (E, 2015).

93

Regardless, it is important to note that despite these realities, youth were very fond of, and
connected to, their families and communities. At present, most Aboriginal men and women
in Canada are generally acknowledged as either survivors of residential schools or as having
suffered secondary trauma as a result of being born to parents who lacked parenting role
models (Ing, 2000). This legacy of residential school has produced a fissure in the
sociocultural transmission of parenting roles across generations, especially father roles (Ball,
2009; Ing, 2000). One aspect of a North American Indigenous theory of mind and mental
health is based on the notion that the mind exists between people and not within individuals;
in other words, each relationship has a mind of its own (see Mehl-Madrona & Pennycook,
2009). Based on this understanding, it is crucial to acknowledge that family and community
structures damaged by colonialism consequently affect mental health (Mehl-Madrona &
Pennycook, 2009). Healing, then, involves relationship and dialogue within these
relationships, including supernatural (through ceremony or ritual), relatives and friends
(Mehl-Madrona & Pennycook, 2009). As a result, Aboriginal approaches to mental health
promotion should focus on community as well as the rebuilding of Aboriginal culture, values
and family structures (Adelson, 2000; Chandler & Lalonde, 1998; Kirmayer et al., 2003).
A critical discourse analysis of online mental health resources and promotion
materials highlighted the ways in which colonialism is perpetuated by existing resources as
well as within the mental health discourse created by these resources. A scarcity of online
mental health resources catering to Aboriginal youth was noted; of the resources collected
and analyzed in this study, only two of the eight collected resources acknowledged a
wellness-based model of health that is reflective of youth participants' understandings of
health and wellbeing. These two resources did not include design or textual elements

94

described by youth participants as appealing and accessible to youth. The remaining six
online mental health resources promote a similar mental health discourse based on
biomedical understandings of health, which subsequently marginalize alternative
understandings to mental health, including Aboriginal perspectives. By creating resources
that are built on a single understanding of health gives power to those creating the resources,
as well as those who accept this discourse within a society, prompting judgment, control and
self-surveillance among individuals (Fairclough, 2001). Furthermore, those who have the
power to control the discourse also have the ability to constrain the contributions of the nonpowerful (those who do not accept the discourse or have another discourse) and marginalize
existing discourses (Fairclough, 2001); Aboriginal-specific resources present on the existing
online mental health resources were often hard to find, offered minimal information and were
not tailored to youth populations. Gaining and maintaining power is the very goal of
colonialism. Existing online mental health resources perpetuate colonialism through the
silencing of Aboriginal understandings of mental health. This, in tum, calls for the
decolonization of existing mental health resources, and emphasizes the need for a
decolonizing methodology when undertaking research with Indigenous peoples (Chinn,
2007; L. T. Smith, 1999).
Additionally, existing online mental health resources do not adequately reflect lived
realities of Aboriginal youth participants or a legacy of colonialism as risk factors for mental
illness. Rather, existing online mental health resources state that "mental health challenges
and disorders can happen to anyone. They affect people of all ages, races and social classes.
No one is immune" (Kelty, 2015). This promotes the idea that everyone has the same
experience of mental illness, regardless of age, race or social class. These findings are similar

95

to a critical discourse analysis of the Canadian Mental Health Association website which
points out that this resource assumes that all Canadians "live within a similar cultural milieu,
adopt and utilize similar cultural tools to mediate their actions, and have interpreted and
internalized common social and discursive practices uniformly" (Jhangiani & Vadeboncoeur,
2010, p. 179). This general lack of appreciation for the economic, sociocultural, and political
histories of minorities leads to inequality, oppression, and the belief that one culture is
superior over another (Jhangiani & Vadeboncoeur, 2010). As a result, these findings
demonstrate that existing online mental health resources perpetuate colonialism and
demonstrates a need for existing online mental health resources to include alternative
understandings of mental health and mental illness. This, in turn, may make the resources
more accessible, however, more research is needed.

6.4 Impact of the environment on mental health
A critical discourse analysis of existing online mental health resources identified a
trend of blaming the individual for their mental illness, often ignoring the role of the
environment as a risk factor or source of stress or strength for the individual. One
explanation, offered by Adelson (2000), is that health issues and approaches remain largely
influenced by medical theory, "which tends to conceptualize health as the absence of
disease" (Adelson, 2000, p. 15). As a result, current health promotion resources aim to effect
changes in individual behaviors and risk factors or target 'at risk' groups (Adelson, 2000).
While engaging with online mental health resources, youth participants mentioned
that they thought that these resources might be useful tools for their communities. However,
it is important to note that youth participants did not see online mental health resources as
replacements for wellness centers, rather as tools to learn more about mental health, identify

96

nearby mental health services and to complement existing services. However, when talking
about searching for the appropriate mental health care services, one youth participant noted,
"there is really nothing out there" (FA, 2015). It seems then, that although the National
Collaborating Centre for Aboriginal Health calls for a multi-level strategy to improve
Aboriginal peoples' access to health services (individual, community and the broader social
and physical environment (Adelson, 2000; see National Collaborating Centre for Aboriginal
Health, n.d.), mental health promotion in Northern BC remains largely focused on the
education of the individual. This needs to change in order to meet the health needs of
Aboriginal peoples in Northern BC, and provide access to culturally appropriate services
(Adelson, 2005; National Collaborating Centre for Aboriginal Health, n.d.).
Youth participants spoke of social and environmental barriers to accessing mental
health care services, such as inadequate services, stigma or the dynamics of living in a small
community, leading them to identify the Internet as an appealing source of mental health
information. The inadequacy and/or lack of appropriate mental health services in rural and
remote regions of Canada are generally attributed to the large distances and low population
density as well as higher service delivery costs per capita that are characteristic to these
regions (Halseth & Ryser, 2006, 2007). Alternatively, Fuller, Edwards, Procter, and Moss
(2000) suggest that those living in rural and remote settings are accustomed to meeting their
own needs, without outside help; this culture of self-reliance affects how mental health
problems are understood and subsequently how services are accessed. This understanding
places the responsibility on the individual to seek out mental health care and continues to
ignore the inadequacy of existing mental health care services and the broader environment,
both of which have been shown to influence mental health (Vukic et al., 2011). Furthermore,

97

although one youth participant pointed out that "stubbornness" (JM, 2015) was a barrier to
accessing mental health care services among his community, this stubbornness stemmed
from individuals not wanting to admit that 'there was something wrong with them' (see
Findings). The discourse around mental illness, which tends to blame the individual is
increasingly being deemed inadequate by research on the social determinants of mental
health, especially for the mental health of Aboriginal people (Vukic et al. , 2011 ). As a result,
more emphasis is being placed on recognizing the role of the environment as a challenge to
mental health.
Youth participants spoke of disrupted family structures, challenges finding
meaningful employment, the effects of substance abuse or violence, difficulties talking to
friends or family, as often being sources of stress in their lives. As such, mental health
challenges arose from the environment in which youth participants live rather than being the
mental illnesses themselves. Similar to the youth participants in this study, rural and remote
respondents in rural Australia spoke of mental health 'challenges', not as disease or illness
states, but as 'challenges' in everyday living (Fuller, 2000). Examples of challenges ranged
from financial threats, alcohol abuse, relationship problems, grief, sexual abuse, and
domestic violence (Adelson, 2000). Following from this is an understanding of mental
wellbeing that is based on the interrelations between people's capacities and the extent of
their environmental supports (Adelson, 2000). Improvements in mental well-being of
populations, then, requires change in social structures as well as individual communities
(Adelson, 2000). It is important, too that online mental health promotion efforts reflect this.

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6.5 Youth and technology: the case for e-health.
Youth participants were supportive of technology as a tool for reaching youth
populations. They recognized the potential of technology as a means of sharing health
information, including mental health information and resources. When searching for online
mental health information during the digital storytelling workshop described in this thesis,
youth participants entered generic search terms, like 'information on anxiety,' into search
engines such as Google (personal notes, 2015). Additionally, youth participants articulated a
preference for websites that were visually appealing (i.e. containing images, videos or other
interactive media) rather than based on the credentials of the publishers of online mental
health information. These findings are similar to those of Geana et al. (2012) and Eysenbach
(2008) who observed that Generation Y tend to use a general search engine and consequently
encounter health information from a variety of websites. However, more research is needed
to better understand how Aboriginal youth living in Northern BC search for, and evaluate,
online mental health information.
Youth participants expressed an interest in seeing more stories from youth, including
those living with mental illness, which were noted as largely absent within the existing
online mental health resources. Consequently, youth participants felt that digital storytelling
was a relevant and engaging tool for youth participants, as it allowed them to share their own
story related to mental health or wellness. Storytelling was pointed out by youth participants
as being a culturally relevant and familiar means of sharing information and lived
experiences with others. Youth participants identified computer and storytelling skills as
useful and of interest to younger generations. Many of the youth or mental health workers
who were unable to attend asked if the digital storytelling workshop would be offered again,

99

and invited the workshop to their communities. This adds to a growing body of research that
supports digital storytelling as a method for undertaking health and wellness research with
Aboriginal youth in culturally respectful and engaging way (Castleden, Garvin, & Nation,
2009; Gubrium, 2009b; Hardy & Sumner, 2015; Wexler et al. , 2012).
Youth participants also spoke about the potential of apps or video-conferencing with
health professionals as resources for accessing mental health information or services.
Specifically, youth felt that online resources and mental health services may offer a venue for
accessing appropriate and confidential services which "may be good in a small community
where you don't want everyone to know you are feeling bad" (RF, 2015). Explicit in their
responses, however, was the preference for culturally tailored and relevant mental health
information, including a focus on holism and wellness. It is important to note that youth were
most interested in mental health information that was relevant to their understanding of
mental health. Thus, generic mental health promotion strategies are likely to be less well
received by Aboriginal youth living in Northern BC. Additionally, one youth participant
commented that culturally relevant online mental health information would likely be wellreceived by Aboriginal youth who were not very familiar with their own culture, as it would
offer an opportunity for them to learn more. These findings add to an extensive body of
research that that shows that Aboriginal youth prefer culturally tailored health promotion
resources (for example Geana, Greiner, et al., 2012; Iwasaki et al., 2011; Kirmayer et al.,
2003; Varcoe et al. , 2010). Furthermore, this is an important finding as cultural growth has
been shown to extend mental wellness in Aboriginal youth (Colquhoun & Dockery, 2012;
Iwasaki et al., 2011; Kirmayer et al., 2003 ; Wexler, 2009).

100

The interest in electronic modes of health care delivery by youth participants (see
Findings) lends itself to an exploration of the viability and potential of e-health and telehealth services in Aboriginal communities. Maar, Seymour, Sanderson, and Boesch, (2010)
posit that e-health and tele-health options in rural and remote health care settings may
facilitate equitable access to health care services and health information in Aboriginal
communities in Canada. E-health has been described as the 'health services and information
delivered or enhanced through the Internet and related technologies' combined with a state of
mind to enhance health care using information and communication technology (ICT) (G
Eysenbach, 2001). However, research demonstrates that even when the appropriate
information and communication technology (ICT) infrastructure has been put in place and
regions become technologically connected, timely access and better care through e-health
applications do not necessarily follow (Maar et al., 2010). As evidenced by the findings of
this research, and existing research, it is necessary to tailor the development of e-health
initiatives to meet the unique health and social needs of the users and their community, to
ensure community uptake and interest (Gagnon, Duplantie, Fortin, & Landry, 2006; Peddle,
2007). Furthermore, it seems that youth are supportive of electronic means of accessing
mental health services or resources however, more research is needed to specifically
understand the opinions of Aboriginal youth living in Northern BC towards e-health services.
6.6 Considerations
Based on the findings of this research, I offer five considerations. First, online mental
health resources and other mental health promotion tools should define terms such as 'mental
health' and 'mental illness' within the materials . This may, in turn, increase general
awareness and knowledge about the differences between the terms and reduce the stigma

101

around mental health. Second, mental health promotion resources should increasingly be
built on holistic and wellness-based models of health that, based on the findings of this
research, are more relevant to Aboriginal youth living in Northern BC. There is also a need
to recognize colonialism and its ongoing effects as a risk factor and distal social determinant,
within both online mental health resources and the broader mental health care system.
However, this needs to be done in consultation and collaboration with the very people that
these services are directed towards. Third, it was clear in this research that online mental
health resources are not replacement for mental health care services (i.e. counselors,
psychologists). Youth spoke about the relational aspect of mental health care especially
during recovery from a mental illness; therefore, there is a need to fund adequate mental
health care services in northern and remote communities. E-health or tele-health may present
a viable option for meeting the mental health needs of rural and remote communities,
however I think that there is a need to build capacity within communities. This can lead to
northern and remote Aboriginal communities providing their own mental health care in ways
that are culturally relevant and beneficial for their people. The fifth consideration from this
research is that spirit and spiritual aspects of the self should be more prominent within online
mental health resources, mental health promotion and mental health care services,
particularly as it relates to healing.

6. 7 Limitations
Given the diversity among and between Aboriginal peoples in Canada, it is important
to recognize that the findings of this study can, and should not be, assumed to be true of all
Aboriginal peoples. What this research highlights is the variability in how mental health is
understood by Aboriginal youth living in Northern BC, and how these understandings often

102

differ from the discourse of mental health promoted by existing online mental health
resources. As a result, my findings demonstrate a clear need for Aboriginal youth voices,
especially those living in northern contexts, to be privileged in the development and
modification of online health promotion resources.
Another limitation of this study was that the youth participants who attended the
digital storytelling workshop did not report using the Internet to search for mental health
information, nor did they report accessing any of the collected online mental health
resources. As a result, youth participants' recommendations for online mental health
resources were based on general preferences when accessing technology for pleasure or
based on their experience of engaging with existing online mental health resources during
this workshop. However, the findings of this research remain useful as they offer an insight
into youth preferences for online resources, as well as information on how to make mental
health resources more appealing and accessible to this population.
Conclusion
The research question that provided the basis of this thesis was: are existing online
mental health resources, especially those catering to a BC audience, age and culturally
relevant to Aboriginal youth (ages 19-25) living in Northern BC. The rationale for this
project was that, currently, traditional sources of health information are no longer satisfying
the needs of younger generations, including Aboriginal youth, who are increasingly turning
to the Internet with their health-related questions (Borzekowski & Rickert, 2001 ).
Furthermore, research has shown that culturally tailored health information resources are
those best received by Aboriginal people (Geana, Greiner, et al., 2012; Iwasaki et al., 2011;
Kirmayer et al., 2003; Varcoe et al., 2010).

103

Using a social determinants of health framework, this research employed
decolonizing and (participatory) action-based research methodologies to explore mental
health disparities experienced by young Aboriginals. These broad methodologies informed
my choice of methods; a combination of digital storytelling (Gubrium, 2009a), focus groups,
and the collection and subsequent analysis of existing online mental health resources. Artsbased research methods (digital storytelling) were explored as potential tools for
documenting young Aboriginal voices in sharing what they envision to be ideal online
mental health resources during a three-day workshop in Terrace, BC.
Four data sets were collected and subsequently analyzed: digital stories created by
Aboriginal youth during the workshop, transcriptions of focus group discussions, personal
field notes and online mental health resources analyzed using a critical discourse analysis.
Analysis of the four data sets collected in this study yielded five key themes: defining mental
health; hope ofrecovery; blaming the individual; diversity of voices; and youth support
technology. The most important finding, discussed in length, was how existing online mental
health resources, especially those made with the purpose of serving populations across the
province, do not adequately address needs of Aboriginal youth living in Northern BC.
Instead, in some cases, they perpetuate a discourse about mental health that is irrelevant to
Aboriginal youth. Digital storytelling, as an arts-based method, however, was an effective
and engaging research tool to work with youth populations. This research contributes to a
better understanding about producing more accessible and appropriate online mental health
resources for Aboriginal youth in Northern BC that may help to promote better health and
wellbeing within this population.

104

Appendix I. Northern Health Authority Service Region

'

,'
\

,-·-j

Map of Northern BC Health Service Distribution Areas (HSDA's). The Northeast HSDA is
situated in the top right comer of the map. The top left region is the northwest HSDA and the
northern interior HSDA is situated in the middle bottom of the map (Northern Health, n.d.).

105

Appendix II. Criteria checklist for categorizing health websites.
Criteria checklist to determine type of health website

I

=low, 2 =moderate, 3 =high

2

3

Level of health literacy required to understand content! (health literacy
level)
- Ease of navigation and user control throughout interface? (Navigation)
" Level of Interactivity throughout interface? (Interactivity)
'Built-in' evaluation tools and mechanisms - providing feedback facilities?
(Evaluation)
Interface is Information based/non,,profit in orientation? (e-knowledge)
Hyperlinks from interfac.e are equivalent in literacy levels and non-profit?
(e-knowledge)
* Multimodalities are designed to be 'user-friendly'/educational?
{e-knowledge)
+Asynchronous functions are designed to assist in searching and
communication? (e-knowledge)
Interface is aimed at generating profit and capital? {e-business)
Hyperlinks from interface are equivalent in literacy levels and profitl
(e-business)
Multimodalities are designed to increase chance of profit? (e-business)
Asynchronous functions are designed to generate profit? Ce-business)
Interface is aimed at educating health professional? (e-professionaf)
Hyperlinks from interface are equivalent in literacy levels/orientationl
(e-professional}
Multimodalities are designed to up skill/educate the health professional?
(e-professional}
Asynchronous functions are designed to assist in educating health
professionalt (e-professionat)
-Ease of navigation and user control. Fonns of usability components are: health literacy, interface engagement,
educational;
"Components of a web page design which demonstrate the types and levels of interaetive technologies throughout a webpage..
Forms of interaaiw components are: multimodality, networi<ability, temporal fl~"bllity and message tailoring capabilities;
• Multimodalities consist of: text. pictures and videos into a single modular unit. These additions are for heightening the
users' engagement through presenting stimuli via auditory or visual mediums;
+Communication such as email, chat rooms and discussion boards which allow Interaction to occur at different times
and locations between two or more leatm!rs.

A Criteria checklist for categorizing health websites that was used in this research (Mautner,

2005).

106

References
Adelson, N. (1998). Health beliefs and the politics of Cree well-being. Health, 2(1), 5-22.
http://doi .org/10.l 177/136345939800200101
Adelson, N . (2000). "Being alive well": Health and the politics of Cree well-being. Toronto:
University of Toronto Press.
Adelson, N . (2005). The embodiment of inequity: Health disparities in Aboriginal Canada.
Canadian Journal of Public Health/Revue Canadienne de Sante 'e Publique, 96(2),
S45-61.
Allan, B ., & Smylie, J. (2015). First Peoples, second class treatment: The role of racism in
the health and well-being of Indigenous peoples in Canada . Toronto, Ontario:
Wellesley Institute.
Anthony, W. A., Weisburd, D. E ., Sargent College of Health and Rehabilitation Sciences,
Center for Psychiatric Rehabilitation, & NAM! California. (1994). On the road to
recovery. Sacramento, CA: NAM! California.
Archibald, L., Dewar, J., Reid, C ., & Stevens, V. (2012). Dancing, singing, painting, and
speaking the healing story: Healing through creative arts. Aboriginal Healing
Foundation. Retrieved from http://www.ahf.ca/downloads/healing-through-creativearts .pdf
Assembly of First Nations. (2002). The urgent need for criteria helping to identify and
denounce different forms offorced integration. Ottawa: Assembly of First Nations.
Retrieved from
www.afn.ca/uploads/files/education2/the_urgent_need_for_criteria,_fnec,_2002.pdf
Australian Medical Association . (2007). Australian Medical Association position statement:
Social determinants of health and the prevention of health inequities (p. 4). Chicago.
Retrieved from http://ama.com.au/node/2723
B.C. Statistics. (2015). Reference Maps. Retrieved from
http://www.bes tats .gov .be .ca/statisticsbysu bject/geography /referencemaps/rds .aspx
Baker, A., Ivers, R., Bowman, J., Butler, T ., Kay-Lambkin, F., Wye, P., ... Wodak, A.
(2006). Where there's smoke, there's fire: high prevalence of smoking among some
sub-populations and recommendations for intervention. Drug and Alcohol Review,
25( 1), 85-96. http://doi.org/ 10 .1080/09595230500459552
Ball, J. (2009) . Fathering in the shadows: Indigenous fathers and Canada's colonial legacies.
The ANNALS of the American Academy of Political and Social Science, 624( 1), 2948 . http://doi.org/10.1177/0002716209334181
Bartlett, J. G. (2005). Health and well-being for Metis women in Manitoba. Canadian
Journal of Public Health/Revue Canadienne De Santi Publique, 96 Suppl I, S22-27.

107

Battiste, M.A., & Henderson , J. Y. (2000). Protecting Indigenous knowledge and heritage:
A global challenge. Saskatoon: Purich Pub.
BC-ALCAN Northern Development Fund Act, 1998 SBC§ Chapter 3 (1998). Retrieved
from http://www.bclaws.ca/civix/document/id/complete/statreg/98003_01 #section 1
Beaucage, J. (2011). Children first: The Aboriginal advisor's report on the status of
Aboriginal child welfare in Ontario, Presented to the Honourable Laurel Broten ,
Minister of Children and Youth Services. Ottawa, ON: Ministry of Children and
Youth Services.
Bibby, R. W., Russell, S., & Rolheiser, R. (2009). The emerging millennials: How Canada's
newest generation is responding to change & choice. Lethbridge, AB: Project Canada
Books .
Bird, S. M., Wiles, J. L., Okalik, L., Kilabuk, J., & Egeland, G. M. (2008). Living with
diabetes on Baffin Island: Inuit storytellers share their experiences. Canadian Journal
of Public Health= Revue Canadienne De Sante Publique , 99(1), 17-21.
Bishop, A. (2002). Becoming an ally: Breaking the cycle of oppression in people (2nd ed) .
London, New York: Zed Books.
Blackstock, C. (2007). Residential schools: Did they really close or just morph into child
welfare? Indigenous Law Journal , 6(1) , 71-78 .
Blanchet-Cohen, N., & Fernandez, A. (2003). Women as generators of children's rights. The
story of promoting Indigenous children's rights in Venezuela. The International
Journal of Children's Rights , 11(1) , 33-49.
Blanchet-Cohen, N., McMillan, Z. , & Greenwood , M . (2011). Indigenous youth engagement
in Canada's health care. Pimatisiwin: A Journal of Aboriginal and Indigenous
Community Health, 9(1), 89-113.
Borowsky, I. W., Ireland, M. , & Resnick, M. D. (2001). Adolescent suicide attempts: Risks
and protectors. P ediatrics, 107(3) , 485-493 .

Borzekowski , D. , & Rickert, V. (2001). Adolescent cybersurfing for health information: A
new resource that crosses barriers. Archive of Pediatric Adolescent Medicine, 155(7),
813-817. http://doi.org/10.1001/archpedi.155 .7 .813
Bottorff, J. L., Carey, J., Mowatt, R., Varcoe, C., Johnson , J. L., Hutchinson , P., ...
Wardman, D. (2009). Bingo halls and smoking: Perspectives of First Nations women.
Health & Place, 15(4) , 1014-1021. http://doi.org/10.1016/j.healthplace.2009.04.005
Brady, M . A . (1993). Health issues for Aboriginal youth: Social and cultural factors
associated with resilience. Journal of Paediatrics and Child Health, 29(sl), S56-S59.
http://doi.org/10.1111/j.l440-1754.l 993 .tb02264 .x

108

Brough, M ., Bond, C., & Hunt, J. (2004). Strong in the City: Towards a strength-based
approach in Indigenous health promotion. Health Promotion Journal of Australia,
15(3), 215-220 .
Browne, A. (n.d.). Issues affecting access to health services in northern, rural and remote
regions of Canada . University of Northern British Columbia. Retrieved from
http://www.unbc.ca/northern-studies/northern-article-series
Bryson , J.M., Cunningham, G. L., & Lokkesmoe , K. J. (2002). What to do when
stakeholders matter: The case of problem formulation for the African American men
project of Hennepin County , Minnesota. Public Administration Review, 62(5), 568584. http://doi.org/10.1111/1540-6210.00238
Castellano , M. (2004) . Ethics of Aboriginal Research. Journal of Aboriginal Health, 1(1),
98-114.
Castleden, H ., Garvin , T., & Nation, H.F . (2009). "Hishuk Tsawak" (Everything Is
One/Connected): A Huu-ay-aht worldview for seeing forestry in British Columbia,
Canada. Society & Natural Resources, 22(9), 789-804.
http://doi.org/10.1080/08941920802098198
Chandler, M., & Lalonde, C. (1998). Cultural continuity as a hedge against suicide in
Canada's First Nations . Transcultural Psychiatry, 35(2), 191-219.
Cheek, J. (2000). Postmodern and poststructural approaches to nursing research. Thousand
Oaks, Calif.: Sage.
Chinn, P. W . U. (2007) . Decolonizing methodologies and Indigenous knowledge: The role of
culture, place and personal experience in professional development. Journal of
Research in Science Teaching, 44(9) , 1247-1268. http ://doi.org/10.1002/tea.20192
Chouliaraki, L., & Fairclough, N. (2007) . Discourse in late modernity: Rethinking critical
discourse analysis (Transferred to digital printing). Edinburgh: Edinburgh Univ.
Press.
Coburn, D. (2004). Beyond the income inequality hypothesis: Class , neo-liberalism , and
health inequalities . Social Science & Medicine , 58(1) , 41-56.
http://doi .org/10 .1016/S0277-9536(03)00159-X
Cohen , K . S. (2008). At the canyon's edge: Depression in American Indian culture. Explore
(New York, N.Y.), 4(2), 127-135. http://doi.org/10.1016/j.explore.2007.12.004
Colquhoun , S., & Dockery, A. (2012). The link between Indigenous culture and wellbeing:
Qualitative evidence for Australian Aboriginal peoples (The Centre for Labor Market
Research Discussion Paper Series). Centre for Labour Market Research: Curtin
Business School.

109

Correctional Service Canada. (2013). Demographic overview of Aboriginal Peoples in
Canada and Aboriginal offenders in Federal Corrections. Ottawa: Government of
Canada. Retrieved from http://www.csc-scc .gc .ca/aboriginal/002003-1008-eng .shtml
Cueva, M., Kuhnley, R ., Revels, L., Schoenberg, N. E., Lanier, A., & Dignan, M. (2015).
Engaging elements of cancer-related digital stories in Alaska. Journal of Cancer
Education: The Official Journal of the American Association for Cancer Education.
http://doi.org/10.1007 /s 13187-015-0826-z
Czyzewski, K. (2011). Colonialism as a broader social determinant of health. The
International Indigenous Policy Journal, 2(1), 1-14.
Damon, W., Menon, J., & Cotton Bronk, K. (2003). The development of purpose during
adolescence. Applied Developmental Science, 7(3), 119-128.
http://doi.org/10 .1207IS 1532480XADS0703_2
Davis, L. (Ed.). (2010). Alliances: Re/envisioning indigenous-non-indigenous relationships.
Toronto, ON: University of Toronto Press.
de Leeuw, S., Greenwood, M., & Cameron, E. (2010). Deviant constructions: How
governments preserve colonial narratives of addictions and poor mental health to
intervene into the lives of Indigenous children and families in Canada. International
Journal of Mental Health and Addiction, 8(2), 282-295.
http://doi.org/10 .1007/s 11469-009-9225-1
Deegan, P. (1996, September). Recovery and the conspiracy of hope. Paper presented at the
"There's a Person In Here": The Sixth Annual Mental Health Services Conference of
Australia and New Zealand, Brisbane, Australia. Retrieved from
https://www .patdeegan.com/pat-deegan/lectures/conspiracy-of-hope
Dictionary.com. (2012). Mental Health . Dictionary.com. Retrieved from
http:/!dictionary .reference .com/browse/mental %20health ?s=t
Dockett, S., Perry, B., & Kearney, E. (2010). School readiness: What does it mean for
Indigenous children,families, schools and communities? (Closing the Gap
Clearinghouse) (pp. 1-35). Australia: Australian Government.
East, L., & Robinson, J. (1994). Change in process: Bringing about change in health care
through action research. Journal of Clinical Nursing, 3(1), 57-61.
http://doi.org/l0.1111/j.1365-2702.1994.tb00359.x
Elden, M., & Levin, M. (1991). Co-generative learning: Bringing participation into action
research. In Participative Action Research (pp. 127-142). Beverly Hills: Sage.
Ermine, W., Sinclair, R., & Jeffery, B. (2004, July). The ethics of research involving
Indigenous peoples: Report of the Indigenous peoples' health research centre to the
interagency advisory panel on research ethics. Indigenous Peoples' Health Research
Centre.

110

Evans-Campbell, T. (2008). Historical trauma in American Indian/Native Alaska
Communities: A multilevel framework for exploring impacts on individuals, families,
and communities. Journal of Interpersonal Violence, 23(3), 316-338.
http://doi.org/10 .1177/0886260507312290
Evans, M., White, K., & Berg, L. (2014). They think you're lying about your need: the
impact of appearance on Aboriginal health and social service access. The Canadian
Journal of Native Studies, 34(1), 55-72.
Eysenbach, G. (2001). What is e-health? Journal of Medical Internet Research, 3(2), e20.
http://doi.org/10 .2196/jmir.3 .2.e20
Eysenbach, G. (2008). Credibility of health information and digital media: New perspectives
and implications for youth. In M. Metzger & A. Flanagin (Eds.), Digital media, youth
and credibility (pp. 123-154). Cambridge, MA: The MIT Press.
Fairclough, N. (2001). Language and power (2nd ed.). New York, NY: Longman.
Fairclough, N. (2003). Analysing discourse: Textual analysis for social research. London;
New York: Routledge.
Farkas, M. (2007). The vision of recovery today: What it is and what it means for services.
World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 6(2),
68-74.
Federal Health Minister, Provincial Health Minister, & First Nations Health Society. British
Columbia Tripartite Framework Agreement on First Nation Health Governance
(2011). Retrieved from http://www.hc-sc.gc.ca/fniahspnia/alt_formats/pdf/pubs/services/tripartite/framework-accord-cadre-eng.pdf
Feiner, R., Dubois, D., & Adan, A. (1991). Community-based intervention and prevention:
Conceptual underpinnings and progress toward a science of community intervention
and evaluation. In E. Walker (Ed.), Clinical psychology: Historical and research
foundations (pp. 459-510). New York: Plenum.
Ferrara, N. (2004). Healing through art: Ritualized space and Cree identity. Montreal:
McGill-Queen's University Press.
First Nations Health Authority. (2015). Northern Region. Retrieved from
http://www.fnha.ca/about/regions/north
Fisher, R. (1992). Contact and conflict: Indian-European relations in British Columbia,
1774-1890 (2nd ed). Vancouver: UBC Press.
Flicker, S., Maley, 0., Ridgley, A., Biscope, S., Lombardo, C., & Skinner, H. A. (2008). ePAR: Using technology and participatory action research to engage youth in health
promotion. Action Research, 6(3), 285-303.
http://doi.org/10.1177/1476750307083711
111

Foucault, M. (1988). Madness and civilization: A history of insanity in the age of reason
(Vintage Books Ed., Nov. 1988). New York: Random House.
Foucault, M., & Gordon, C. (1980). Truth and power. In Power/knowledge: Selected
interviews and other writings, 1972-1977 (1st American ed, pp. 1-270). New York:
Pantheon Books.
Frideres, J., Krosenbrink-Gelissen , L. E., & Frideres, J. (1998). Aboriginal peoples in
Canada: contemporary conflicts (5th ed). Scarborough, Ont: Prentice Hall Allyn and
Bacon Canada.
Fuller, J., Edwards, J., Procter, N. , & Moss, J. (2000). How definition of mental health
problems can influence help seeking in rural and remote communities. The Australian
Journal of Rural Health, 8(3), 148-153 .
Gagnon, M .-P., Duplantie, J., Fortin, J.-P., & Landry, R. (2006). Implementing telehealth to
support medical practice in rural/remote regions: What are the conditions for success?
Implementation Science: IS, 1, 18. http://doi .org/10.l 186/1748-5908-1-18
Geana, M., Greiner, A., Cully, A., Talawyma, M., & Makosky Daley, C. (2012). Improving
health promotion to American Indians in the Midwest United States: Preferred
sources of health information and its use for the medical encounter. Journal of
Community Health, 37(6), 1253-1263 . http://doi.org/10.l007/s10900-012-9564-x
Geana, M., Makosky Daley, C., Nazir, N., Cully, L., Etheridge, J., Bledowski, C., ...
Greiner, A. (2012). Use of online health information resources by American Indians
and Alaska Natives. Journal of Health Communication, 17(7), 820-835.
Geertz, C . (1973). The interpretation of cultures: Selected essays . New York: Basic Books.
Gilligan, C. (1982) . In a different voice: Psychological theory and women's development.
Cambridge, MA: Harvard University Press .
Gionet, L., & Roshanafshar, S. (2013). Select health indicators of First Nations people living
off reserve, Metis and Inuit. Retrieved fromhttp://www.statcan.gc .ca/pub/82-624-

x/2013001/article/11763-eng.htm

Gone, J. (2009). Encountering professional psychology: Re-envisioning mental health
services for Native North America. In L. Kirmayer & G. Valaskakis (Eds.), Healing
traditions: The mental health of Aboriginal Peoples in Canada (pp. 419-439).
Vancouver: University of British Columbia Press .
Government of British Columbia. (2011) . New Relationships with Aboriginal People and
Communities in British Columbia (p. 38). Victoria: Ministry of Aboriginal Relations
and Reconciliation.
Gracey, M., & King, M . (2009) . Indigenous health part 1: Determinants and disease patterns .
The Lancet, 374(9683), 65-75. http://doi.org/10.l016/S0140-6736(09)60914-4

112

Graham, H., & Leeseberg Stamler, L. (2010). Contemporary perceptions of health from an
Indigenous (Plains Cree) perspective. International Journal of Indigenous Health,
6(1), 6-17.
Greenwood, M., & de Leeuw, S. N. (2012) . Social determinants of health and the future
well-being of Aboriginal children in Canada. Journal of the Canadian Paediatric
Society, 17(7), 381-384.
Greenwood, M., de Leeuw, S., & Ngaroimata Fraser, T. (2008). When the politics of
inclusivity become exploitative: A reflective commentary on Indigenous peoples,
indigeneity , and the academy. Canadian Journal of Native Education, 31(1), 198.
Gubrium, A. (2009a). An emergent method for health promotion research and practice.
Health Promotion Practice , 10(2), 186-91 .
http://doi.org/10.1177/1524839909332600
Gubrium, A. (2009b). Digital storytelling: An emergent method for health promotion
research and practice. Health Promotion Practice, 20(2), 186-191.
http://doi.org/10.1 l 77/1524839909332600
Halseth , G., & Ryser, L. (2006) . Trends in service delivery: Examples from rural and small
town Canada, 1998 to 2005. Journal of Rural and Community Development, 1(2) ,
69-90.
Halseth, G., & Ryser, L. M. (2007). The deployment of partnerships by the voluntary sector
to address service needs in rural and small town Canada. VOLUNTAS: International
Journal of Voluntary and Nonprofit Organizations, 18(3) , 241-265.
http://doi.org/10 .1007 Is 11266-007-9042-8
Hamilton, E. (2009). Climate change. Retrieved from
https://www.for.gov .bc.ca/hre/topics/climate.htm
Hammersmith, J. A. (2007 , November). Converging Indigenous and Western knowledge
systems: Implications for tertiary education. University of South Africa, South
Africa. Retrieved from http ://iportal.usask.ca/docs/Hammersmith/Hammersmith.pdf
Harding, R. (2005). The media, Aboriginal people and common sense. The Canadian
Journal of Native Studies, 25(1) , 311-335.
Hardy, P., & Sumner, T. (2015). Cultivating compassion - how digital storytelling is
transforming healthcare. Nursing Management (Harrow, London, England: 1994),
22(1), 15-150. http://doi.org/10.7748/nm.22.1.15 .s 16
Harper, S., Edge, V., & Willox, A. (2012). "Changing climate, changing health, changing
stories" profile: Using an ecohealth approach to explore impacts of climate change on
Inuit health . EcoHealth, 9(1), 89-101. http://doi.org/10.1007/s10393-012-0762-x

113

Havard , L. (2007). How to conduct an effective and valid literature search. Nursing Times ,
103(45), 32-33.
Health Canada.(2011). First Nations, Inuit and Aboriginal health: Program Compendium.
Retrieved from http://www .hc-sc.gc .ca/fniah-spnia/pubs/aborig-autoch/201112_compendium/index-eng .php#share
Herrman , C. S. (2009). Fundamentals of Methodology - Part I: Definitions and first
principles. SSRN Electronic Journal. http://doi.org/10.2139/ssrn.1373976
Hinshelwood, R . D. (2001). Pathology and the postmodern: Mental illness as discourse and
experience. The British Journal of Psychiatry, 178(3), 286-287.
http://doi.org/10 .1192/bjp .178 .3 .286
Hirch, M . (2011) . Self-determination in Indigenous health: A comprehensive perspective.
Fourth World Journal, 10(2), 30.
Hoffman-Goetz, L., & Donelle, L. (2007). Chat room computer-mediated support on health
issues for aboriginal women. Health Care for Women International , 28(4), 397-418.
http://doi.org/10.1080/07399330601180057
Hswen, Y., Naslund , J., & Bickham, D. (2014) . Differences in media access and use between
rural Native American and White children. Rural and Remote Health, 14(2922).
Ing, R. (2000). Dealing with shame and unresolved trauma: Residential school and its
impact on the second and third generation adults (Doctoral Dissertation). University
of British Columbia, Vancouver, BC. Retrieved from
https ://open .library .u be .ca/cIRcle/collections/ubctheses/831 /items/ 1.0055557
Initiatives Prince George Development Corporation, & Northern Development Initiative
Trust. (2008). Northern British Columbia: A vision for prosperity (Outlook 2020:
Shaping BC's economic future) (p. 30). Business Council of British Columbia.
Retrieved from
http://www.un be .ca/assets/reports/outlook_2020_northern_bcs_vision_for_prosperity
2_august_24_09 .pdf

Iwasaki , Y., Byrd, N ., & Onda, T. (2011) . Promoting identities and mental health via
cultural/community activities among racially/ethnically mixed urban American
Indians. Family & Community Health, 34(3), 256- 265.
http://doi.org/10 .1097 /FCH.ObO 13e3182196109
Jhangiani, S. J., & Vadeboncoeur, J. A. (2010). Health care "As Usual": The insertion of
positive psychology in Canadian mental health discourse. Mind, Culture , and
Activity, 17(2), 169-184. http://doi .org/10.1080/10749030903311969
Johnson, K. , Ravert, R., & Everton, A. (2001) . Hopkins Teen Central: Assessment of an
internet-based support system for children with cystic fibrosis. Pediatrics, /07(2),
e24 . http://doi .org/10.1542/peds.107 .2.e24

114

Jootun, D., McGhee, G. , & Marland, G. R. (2009). Reflexivity: Promoting rigour in
qualitative research. Nursing Standard (Royal College of Nursing (Great Britain):
1987) , 23(23) , 4 2-46. http://doi.org/ 10.77 48/ns2009 .02 .23 .23 .42 .c6800
Kapitzke , C., Bogitini, S., Chen, M ., MacNeill, G., Mayer, D. , Muirhead, B., & Renshaw, P.
(2000). Weaving words with the dreamweaver: Literacy, indigeneity, and technology.
Journal of Adolescent and Adult Literacy , 44(4), 336-345.
Kelty Mental Health Resource Centre. (n.d.). Kelty Mental Health Resource Centre.
Retrieved from http://keltymentalhealth.ca/
Khanlou, N., & Peter, E. (2005). Participatory action research: Considerations for ethical
review. Social Science & Medicine, 60(10), 2333-2340.
King, M., Smith, A., & Gracey, M . (2009). Indigenous health part 2: The underlying causes
of the health gap. The Lancet, 374(9683) , 76-85. http://doi.org/10.1016/S01406736(09)60827-8
Kirmayer, L., Simpson, C., & Cargo, M. (2003). Healing traditions: Culture, community and
mental health promotion with Canadian Aboriginal peoples. Australasian Psychiatry ,
1l(sl), 15-23. http://doi.org/10.1046/j.1038-5282.2003.02010.x
Kitayama, S., & Markus, H. (1991). Culture and the self: Implication for cognition, emotion,
and motivation. Psychological Review, 98(2), 224-253.
Klein , N. (2014). This changes everything: Capitalism vs . the climate. Canada: Knopf.
Knowles, J. G., & Cole, A. L. (2008). Handbook of the arts in qualitative research:
Perspectives, methodologies, examples, and issues. Los Angeles: Sage Publications.
Korda, H ., & Itani, Z. (2013). Harnessing social media for health promotion and behavior
change. Health Promotion Practice, 14(1), 15-23 .
http://doi.org/10.1177 /1524839911405850
Kral, I. (2011). Youth media as cultural practice: Remote Indigenous youth speaking out
loud . Australian Aboriginal Studies, 2011(1), 4.
Kreuter, M. W., & Wray, R. J. (2003). Tailored and targeted health communication:
Strategies for enhancing information relevance. American Journal of Health
Behavior, 27 Suppl 3, S227-232.
Lalonde, C. (2006). Identity formation and cultural resilience in Aboriginal communities. In
R. Flynn, P. Dudding , & J. Barber (Eds .), Promoting Resilience in Child Welfare (pp .
52-71). Ottawa: University of Ottawa Press.
Lambert, J. (2010). The Digital Storytelling Cookbook. Digital Diner Press. Retrieved from
http:/!eds-courses .ucsd.edu/eds204/su 12/cookbook.pdf

115

Lavallee, L. (2009). Practical application of an Indigenous research framework and two
qualitative Indigenous research methods: Sharing circles and Anishinaabe SymbolBased Reflection. International Journal of Qualitative Methods, 8(1), 21-40.
Lavallee , L. F., & Poole , J.M . (2010) . Beyond recovery: Colonization, health and healing for
Indigenous people in Canada. International Journal of Mental Health and Addiction,
8(2), 271-281. http://doi.org/10.1007/sl 1469-009-9239-8
Leong, I. Y.-0 ., Lee, A. 0.-K., Ng, T . W ., Lee, L.B., Koh, N. Y., Yap, E., ... Ng, L. M .
(2004). The challenge of providing holistic care in a viral epidemic: Opportunities for
palliative care. Palliative Medicine, 18(1) , 12-18 .
Loppie Reading, C., & Wien, F. (2009). Health inequalities and social determinants of
Aboriginal peoples ' health. National Collaborating Center for Aboriginal Health.
Retrieved from http://www .nccah-ccnsa.ca/docs/social %20determinates/NCCAHloppie-Wien_report.pdf
Maar, M.A ., Seymour, A., Sanderson, B., & Boesch, L. (2010). Reaching agreement for an
Aboriginal e-health research agenda: The Aboriginal telehealth knowledge circle
consensus method. Rural and Remote Health, 10(1), 1299.
MacLean , M., & Wason-Ellam, L. (2006). When Aboriginal and Metis teachers use
storytelling as an instructional practice. Aboriginal Education Research Network.
Maczewski, M. (2002) . Exploring identities through the Internet: Youth experiences online.
Child and Youth Care Forum, 31(2), 111-129.
http://doi.org/10.1023/A: 1015322602597
Margaret, J. (2010) . Working as Allies (Winston Churchill Fellowship Report). New Zealand.
Marmot, M ., Friel, S., Bell, R., Houweling, T. A. , & Taylor, S. (2008). Closing the gap in a
generation: Health equity through action on the social determinants of health. The
Lancet, 372(9650) , 1661-1669. http://doi.org/10.1016/SO 140-6736(08)61690-6
Martin, D. H. (2012). Two-eyed seeing: A framework for understanding Indigenous and nonIndigenous approaches to Indigenous health research. The Canadian Journal of
Nursing Research = Revue Canadienne De Recherche En Sciences Infirmieres,
44(2), 20-42.
Martinez, D. (2005). Mental health care after capitalism. Radical Psychology, 4(2). Retrieved
from http://www.radicalpsychology.org/vol4-2/Martinez4 .html
Mautner, G. (2005). Time to get wired: Using web-based corpora in critical discourse
analysis. Discourse & Society, 16(6), 809-828.
http://doi.org/10.1177/0957926505056661

116

McCabe, G. (2008). Mind, body, emotions and spirit: Reaching to the ancestors for healing .
Counselling Psychology Quarterly, 21(2), 143-152.
http://doi.org/10.1080/09515070802066847
McCormick, R. (2009). Aboriginal approaches to counseling. In L. Kirmayer & G.
Valaskakis (Eds .), Healing traditions: The mental health of Aboriginal peoples in
Canada (pp. 337-354). Vancouver: University of British Columbia Press.
McCue, D. (2014, January 29). What it takes for aboriginal people to make the news. CBC
News Aboriginal (Online). Retrieved from http://www.cbc.ca/news/aboriginal/whatit-takes-for-aboriginal-people-to-make-the-news-1.2514466
McKeough, A., Bird, S., Tourigny, E. , Romaine, A., Graham, S., Ottmann, J., & Jeary, J.
(2008). Storytelling as a foundation to literacy development for Aboriginal children:
Culturally and developmentally appropriate practices. Canadian
Psychology/Psychologie Canadienne, 49(2), 148-154. http://doi .org/10 .1037/07085591.49 .2.148
Mehl-Madrona, L., & Pennycook, G. (2009). Construction of an Aboriginal theory of mind
and mental health. Anthropology of Consciousness, 20(2), 85-100.
http://doi.org/10.1111/j.1556-3537 .2009.01017 .x
Meyer, J. (2000). Qualitative research in health care: Using qualitative methods in health
related action research. BMJ, 320(7228), 178-181.
http://doi.org/10.1136/bmj .320.7228.178
Ministry of Forests, Lands and Natural Resource Operations. (2015). Regions and Districts.
Retrieved from https://www.for.gov .bc.ca/mof/regdis .htm#skr
Ministry oflndian and Northern Affairs Canada. Indian Act (1876). Retrieved from
http ://laws .justice .gc .ca/PDF/Statute/I/I-5 .pdf
Minkler, M., & Wallerstein, N. (2003). Part One: Introduction to community-based
participatory research. San Francisco, CA: Jossey-Bass.
Minore, B., Boone, M., Katt, M., & Kinch, R. (1991) . Looking in, looking out: Coping with
adolescent suicide in the Cree and Ojibway communities of northern Ontario. The
Canadian Journal of Native Studies, JJ(l), 1-24.
Mobbs, R. (1991). In sickness and health: The sociocultural context of Aboriginal wellbeing, illness and healing. Marrickville, NSW: Harcourt Brace Jovanovich Group
[Australia] Pty Ltd.
Muirhead, A., & de Leeuw, S. (2012). Art and wellness: The importance of art for
Aboriginal peoples ' health and healing. Prince George, BC: National Collaborating
Center for Aboriginal Health.

117

Narrow, W. E., & Kuhl, E. A. (2011). Dimensional approaches to psychiatric diagnosis in
DSM-5. The Journal of Mental Health Policy and Economics, 14(4), 197-200.
National Aboriginal Health Organization. (2008). Internet connectivity among Aboriginal
communities in Canada (p . 5) . Ottawa: National Aboriginal Health Organization.
Retrieved from
http://www.naho.ca/documents/naho/english/2008 _Aboriginal_connectivity_rates .pdf
National Collaborating Centre for Aboriginal Health. (n.d.). Access to health services as a
social determinant of First Nations , Inuit and Metis health (pp. 1-6). Prince George,
BC: National Collaborating Centre for Aboriginal Health. Retrieved from
http://www.nccahccnsa.ca/docs/fact%20sheets/social %20determinates/Access%20to%20Health%20Se
rvices_Eng%202010 .pdf
Nelson, M. (2013). Health ownership in American Indigenous communities. Rural and
Remote Health, 13(2), 2302.
Nelson, S. (2012). Challenging hidden assumptions: Colonial norms as determinants of
Aboriginal mental health. Prince George, BC: National Collaborating Center for
Aboriginal Health.
Newhouse, D. (2006) . From woundedness to resilience. Journal of Aboriginal Health, 3(1).
Northern Health. (n.d.). Our services. Retrieved from
https ://northernhealth .ca/OurServices .aspx
Nuttall, M . (1998). States and categories: Indigenous models of personhood in northwest
Greenland . In R. Jenkins (Ed.), Questions of competence: Culture, classification and
intellectual disability (pp. 176-193). Cambridge: Cambridge University Press.
Parkes, M. W., de Leeuw, S., & Greenwood, M. (2010). Warming up to the embodied
context of First Nations child health: A critical intervention into and analysis of
health and climate change research. International Public Health Journal, 2(4), 477485.
Peddle, K. (2007). Telehealth in context: Socio-technical barriers to telehealth use in
Labrador, Canada. Computer Supported Cooperative Work (CSCW), 16(6), 595-614.
http://doi.org/10 .1007/s 10606-006-9030-3
Petrasek MacDonald, J ., Ford, J., Cunsolo Willox , A., & Ross , N. (2013). A review of
protective factors and causal mechanisms that enhance the mental health of
Indigenous. International Journal of Circumpolar Health, 72 .
http://doi.org/l0.3402/ijch .v72i0.21775 .
Phillips, J . (2010, August 15). The cultural dimension in DSM-5: PTSD [Cultural
Psychiatry]. Retrieved fromhttp://www.psychiatrictimes.com/dsm-5-0/culturaldimension-dsm-5-ptsd

118

Pitawanakwat, L. (2006). Ojibwe/Powawatomi (Anishinabe) teaching . Four Directions
Teaching.
Poupart, J., Martinez, C., Red Horse, J., & Scharnberg, D. (2000). To build a bridge: An
introduction to working with American Indian communities. American Indian Policy
Centre.
Prilleltensky, I., & Gonick, L. (1996) . Polities change, oppression remains: On the
psychology and politics of oppression. Political Psychology, 17(1), 127.
http://doi.org/10.2307/3791946
Raphael, D. (2008). Grasping at straws: A recent history of health promotion in Canada.
Critical Public Health, 18(4) , 483-495. http://doi.org/10.1080/09581590802443604
Reading, C. , & Wien, F. (2009). Health inequalities and social determinants of Aboriginal
peoples' health. Prince George, BC: National Collaborating Center for Aboriginal
Health.
Reason, P., & Bradbury, H. (Eds.). (2001). Handbook of action research: Participative
inquiry and practice. Thousand Oaks, Calif: SAGE.
Rudnick, A. (Ed.). (2012). Recovery of people with mental illness: Philosophical and related
perspectives. Oxford, United Kingdom: Oxford University Press.
Rushing, S., & Stephens, D. (2011). Use of media technologies by Native American teens
and young adults in the Pacific Northwest: Exploring their utility for designing
culturally appropriate technology-based health interventions . The Journal of Primary
Prevention, 32(3-4), 135-145. http://doi.org/10.1007/s10935-011-0242-z
Saint Jacques, M., Turcotte, D. , & Pouliot, E . (2009) . Adopting a strengths perspective in
social work practice with families in difficulty: From theory to practice. Families in
Society, 90(4), 454-461.
Sampson, E. (2003). Unconditional kindness to strangers: Human sociality and the
foundation for an ethical psychology. Theory & Psychology, 13(2), 147-175.
http://doi .org/0959-3543(200304)13:2
Schaef, A. W . (2000). Beyond therapy, beyond science: A new mode/for healing the whole
person. Lincoln, NE: Authors Guild.
Schweder, R. A., & Bourne, E. (1982). Does the concept of the person vary cross-culturally?
Cultural Concepts of Mental Health and Therapy, 4(3), 97-137.
http://doi.org/10 .1007/978-94-010-9220-3_4
Seligman, M . E., & Csikszentmihalyi, M. (2000). Positive psychology. An introduction. The
American Psychologist, 55(1), 5-14.

119

Sher, L. (2000). The Internet, suicide, and human mental functions. Canadian Journal of
Psychiatry . Revue Canadienne De Psychiatrie, 45(3) , 297.
Sinha, V., Trocme, N., Fallon, B., & MacLaurin, B. (2013). Understanding the investigationstage overrepresentation of First Nations children in the child welfare system: An
analysis of the First Nations component of the Canadian Incidence Study of Reported
Child Abuse and Neglect 2008 . Child Abuse & Neglect, 37(10), 821-831.
http://doi .org/10 .1016/j .chiabu .2012.11.010
Skinner, H., Biscope, S., Poland, B., & Goldberg, E. (2003). How adolescents use
technology for health information: Implications for health professionals from focus
group studies. Journal of Medical Internet Research, 5(4), e32.
http://doi .org/10 .2196/jmir .5 .4.e32
Smith, J. L. (2007). Critical discourse analysis for nursing research. Nursing Inquiry, 14(1),
60-70. http://doi.org/10.1111/j.1440-1800.2007 .00355 .x
Smith, L. T. (1999) . Decolonizing methodologies: Research and Indigenous peoples (2nd
ed.). New Zealand: Zed Books.
Spector, R. E. (2002). Cultural diversity in health and illness. Journal of Transcultural
Nursing, 13(3), 197-199.
Statistics Canada. (2011). Aboriginal Peoples in Canada: First Nations People, Meris and
Inuit. Retrieved from http://www 12 .statcan .gc .ca/nhs-enrn/2011/as-sa/99-011-x/99011-x2011001-eng .cfm
Statistics Canada. (2013) . Generations in Canada. Retrieved from
https://www12 .statcan.gc.ca/census-recensement/2011/as-sa/98-311-x/98-311x2011003_2-eng.cfm
Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health:
A review of current literature. American Journal of Public Health, 100(2), 254-263 .
http://doi.org/10.2105/AJPH.2008.156497
Sue, D . W. (2010). Microaggressions and marginality manifestation, dynamics, and impact.
Hoboken, N.J.: Wiley. Retrieved from
http:/!public .eblib .com/choice/publicfullrecord .aspx ?p=5 88930
Swinton, J. (2001). Spirituality and mental health care: Rediscovering a ''forgotten"
dimension. London; Philadelphia: J. Kingsley Publishers. Retrieved from
https ://books .google .ca/books ?hl=en&lr=&id=ud2Nxo4Q V n4C&oi=fnd&pg=P A3&d
q=mental+health+discourse&ots=HUCeoiEp4v&sig=Cj5s5BWqYCxGFygLCZF8X
Ybgnxw#v=onepage&q=mental %20health %20discourse&f=false
Tagalik, S. (2009). Inuit Qaujimajatuqangit: The role of Indigenous knowledge in supporting
wellness in Inuit communities in Nunavut. National Collaborating Center for
Aboriginal Health.

120

Tatz, C. M. (2005) . Aboriginal suicide is different: A portrait of life and self-destruction (2nd
ed). Canberra: Aboriginal Studies Press.
Thompson, R. (2012). Looking healthy: Visualizing mental health and illness online. Visual
Communication, 11(4), 395-420 . http://doi.org/10.1177/1470357212453978
Treasury Board of Canada Secretariat. (2005). Aboriginal Peoples (Canada's Performance
Report 2005 - Annex 3 - Indicators and Additional Information). Government of
Canada. Retrieved from http://www.tbs-sct.gc .ca/tbs-sct/cmn/archives-eng .asp# 17
Trumper, R. (2004). Health status and health needs of Aboriginal children and youth:
Literature review. Calgary: Southern Alberta Child and Youth Health Network, and
the Calgary Health Region Aboriginal Health Program. Retrieved from
http://www.calgaryhealthregion .ca/hecomm/aboriginal/
Health_Status_Heal th_Needs_ of_Aboriginal_Children_and_Youth .pdf
Truth and Reconciliation Commission of Canada. (2015) . Honouring the truth, reconciling
for the future. Summary of the Final Report of the Truth and Reconciliation
Commission of Canada (p . 418). Ottawa: Truth and Reconciliation Commission.
Retrieved from www .trc .ca
Tuck, E., & Yang, K. W. (2012). Decolonization is not a metaphor. Decolonization:
Indigeneity, Education & Society, 1(1), 1-40.
U.S. Department of Health and Human Services. (1999) . Mental Health: A Report of the
Surgeon General. MD: U.S. Department of Health and Human Services; Substance
Abuse and Mental Health Services Administration, Center for Mental Health
Services, National Institutes of Health, National Institute of Mental Health.
United Nations Children's Fund Canada. (2009). Aboriginal Children's Health: Leaving no
Child Behind. Toronto: UNICEF Canada.
United Nations Educational, Scientific, and Cultural Organization. (2015). What do we mean
by "youth"? Retrieved from http://www.unesco.org/new/en/social-and-humansciences/themes/youth/youth-definition/
University of Victoria. (2011) . The British Columbia Demographic Context. Retrieved from
http://www.geog .uvic .ca/wellness/wellness2011/Chapter4 .pdf
Usher, W., & Skinner, J. (2011). Categorizing health websites: E-knowledge, e-business and
e-professional. Health Education Journal , 70(3) , 285-295.
http://doi.org/10.1177/0017896910376125
Van Dijk, T. (2015). Critical discourse analysis. In D. Tannen, H. Hamilton, & D. Schiffrin
(Eds.), The handbook of discourse analysis (2nd ed., pp. 466-485). Malden, MA:
John Wiley & Sons.

121

Varcoe, C., Bottorff, J., Carey, J., Sullivan, D., & Williams, W. (2010). Wisdom and
influence of elders: Possibilities for health promotion and decreasing tobacco
exposure in First Nations communities . Canadian Journal of Public Health, 101(2) ,
154-8.
von Peter, S. (2013). "Chronic" identities in mental illness. Anthropology & Medicine , 20(1),
48-58. http://doi.org/10.1080/13648470.2013.772493
Vukic, A., Gregory, D., Martin-Misener, R., & Etowa, J. (2011) . Aboriginal and Western
conceptions of mental health and illness . Pimatisiwin, 9(1), 65-85 .
Warner, J., & Gabe, J. (2004). Risk and liminality in mental health social work. Health , Risk
& Society , 6(4), 387-399. http:!/doi.org/10.1080/13698570412331323261
Webb, C. (1989). Action research: Philosophy, methods and personal experiences. Journal of
Advanced Nursing, 14(5), 403-410. http://doi.org/10.1111/j.13652648 .1989 .tbO 1548 .x
Webster, J., & Watson, R. (2002). Analyzing the past to prepare for the future: Writing a
literature review . Management Information Systems Quarterly, 26(2), 7-23 .
Wemigwans, J. (2008). Indigenous worldviews: Cultural expression on the world wide web.
Canadian Woman Studies/Les Cahiers de La Femme, 26(3), 31-38.
Wesley-Esquimaux, C. (2009). Trauma to resilience: Notes on decolonization. In E.
Guimond, G. Valaskakis , & M. S. Dion Stout (Eds.), Restoring the balance: First
Nations women, community, and culture (1st ed., pp. 13-24). University of Manitoba
Press .
Wexler, L. (2009). The Importance of identity, history, and culture in the wellbeing of
Indigenous youth. The Journal of the History of Childhood and Youth, 2(2), 267-276.
Wexler, L., Gubrium, A., Griffin, M., & DiFulvio, G. (2012) . Promoting positive youth
development and highlighting reasons for living in Northwest Alaska through digital
storytelling. Health Promotion Practice, 14(4) , 616-623.
http:!/doiorg/10.1177/1524839912462390
White, W. L. (2000). The history of recovered people as wounded healers: From Native
America to the rise of the modern alcoholism movement. Alcoholism Treatment
Quarterly, 18( 1) , 1-23. http://doi.org/10 .1300/J020vl 8n01_01
Wolsko, C., Lardon, C., Hopkins, S., & Ruppert, E . (2006). Conceptions of wellness among
the Yup'ik of the Yukon-Kuskokwim Delta: The vitality of social and natural
connection. Ethnicity & Health, 11(4), 345-363 .
Woodgate, R. L., & Leach, J. (2010) . Youth's perspectives on the determinants of health.
Qualitative Health Research, 20(9), 1173-1182.
http://doi .org/10.1177 /1049732310370213

122

Woodruff, S., Edwards, C., Conway, T., & Elliott, S. (2001). Pilot test of an Internet virtual
world chat room for rural teen smokers . Journal of Adolescent Health , 29(4), 239243. http://doi.org/10.1016/S1054-139X(0l)00262-2
World Health Organization. (1986). Ottawa charter for health promotion. Canadian Journal
of Public Health/Revue Canadienne De Sante Publique , 77(6), 425-430.
World Health Organization. (2014). Mental health: A state of well-being. Retrieved from
http://www. who .int/features/factfiles/mental_health/en/

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