1. Six Nations of the Grand River Territory
Six Nations Mental Health Team Manager
Crystal Burning BA, MPA
HOS 2014

2. Six Nations Mental Health received funding from the Ministry of
Health and Long-Term Care for the “Supportive Housing for
People with Problematic Substance Abuse Program” and we
thought this name would be stigmatizing an already
vulnerable population
The SǪGYǪ̨́HǪGYE⁷ (I’m Coming Home) Supportive Housing for
Addiction Recovery Program was created. SǪGYǪ̨́HǪGYE⁷
has been able to provide secure, safe housing for one year to
eight adult clients who are Six Nations Band Members and are
at risk of homelessness or are homeless, have a complex
addiction issue or concurrent disorder.
The overall goal of the program is to enhance the client’s quality
of life and help them to transition into a healthy lifestyle.
Background Development
Sǫgyǫ̨́hǫgye⁷ (I’m Coming Home)

3. Sǫgyǫ̨́hǫgye⁷ (I’m Coming Home)
Processes
InitialVisit/Referral/Telephone Call
Intake
Police Check/Recovery Plan
Addiction Recovery Advisory Committee
Decision is made on eligibility/ineligibility

4. Tenants are expected to abide by established rules and
regulations and if not followed, an eviction process is in
place.
If the Resident does not abide by the terms in the lease then
the Eviction Level System will be carried out as necessary,
each situation is reviewed on the level of severity and on a
case-by-case basis:
LEVEL ONE: Written Warning from Case Manager and/or
Landlord
LEVEL TWO: Meeting with Case Manager and/or Landlord.
LEVEL THREE: Eviction.
Sǫgyǫ̨́hǫgye⁷ (I’m Coming Home)
Recovery Focused

5. Check all
that
apply
Victim Witness Age of
Incident
Physical
Abuse
Sexual
Abuse
Neglect
Domestic
Violence
Trauma
Bullying
Drug/
Alcohol
Used
(Opioid,
alcohol,
crack
etc.)
Use in
the past
12
months
(Daily,
weekly,
amount)
How
long
since
last
drug/
alcohol
use?
(Date)
Age of
First Use
Sǫgyǫ̨́hǫgye⁷ (I’m Coming Home)
Intake Questions
We combined these questions with
information on applicant’s medication,
dosage and reason for taking med to
see an clear trend developing…..

6. • The SǪGYǪ́HǪGYE program began to see one of two things:
• Some form of trauma happened ~ drug/alcohol use began
• Medications were prescribed for chronic pain
~drug/alcohol/prescription drug misuse either began or
increased
• The trend of substance use being heavily impacted by chronic
pain and trauma demonstrated the bigger picture.
• At Six Nations, we know that a large percentage of our
population has chronic physical and emotional pain due to
sports injuries, car accidents, work-related accidents, multi-
generational trauma and chronic disease.
• We have high rates of prescription drug use as accessed
through medical professionals. The rate increases if we take
into consideration illegal prescription drug use.
Need for the Connections Project

8. • Investigate the number of physicians who are prescribing
suboxone in our community (1)
• Provide community education workshops on methadone,
chronic pain and prescription drug abuse
• Conduct a needs analysis of connections between chronic
physical & emotional pain and addictions
• Develop a community plan
CONNECTIONS PROJECT
PURPOSE

9. •We recognized that we did not have a very good
understanding of individuals who WERE NOT accessing
our mental health and addictions services
•We knew we had a high population that was accessing
independent methadone clinics in surrounding urban
centres
• So we targeted:
•Six Nations Band Members who access surrounding
methadone clinics, pain management clinics and have
experienced addiction issues.
CONNECTIONS PROJECT
TARGET POPULATION

10. •Develop recommendations on how Six Nations
Health, Social and Justice programs need to work in
order to better address prescription drug abuse,
addictions, chronic pain and associated mental health
issues
•Utilize information garnered directly from our band
members in order to support the community
development that will happen within Six Nations.
EXPECTED OUTCOMES

11. •Pain Management – Dr. Ramesh Zacharias
•Service Providers – 39
•Community Members – 26
•MethadoneTreatment – Dr. Dennis Di Valentino
•Service Providers – 40
•Community Members - 27
Community Information Sessions

12. •Dr. Ramesh Zacharias - Medical Director
•2 Six Nations clients went through the Pain Clinic in
February 2014.
•Shadowed by our Physiotherapist & Occupational
Therapist
•2 Six Nations clients went through the Pain Clinic in
March 2014
• Shadowed by our Addictions Counsellor & Dietitian
•Goals for the Future ~ Develop Six Nations Pain
Management Program
Chronic Pain Management Unit
Hamilton Health Sciences

13. • Intensive 4 week day program for adults with chronic pain
• Group discussions
• Functional and recreational activity
• Daily relaxation
• Hydrotherapy and yoga
• Discussions about return to work
• Education groups to provide more info on techniques to cope with pain
Supported by MultidisciplinaryTeam:
Dietetic Assistants, OccupationalTherapists, Pain Specialists,
Pharmacists, Physiotherapists, Psychologists, and Social Workers
Chronic Pain Management
Program

14. • Intake interview
• Medical exam and lab tests, where appropriate
• Supervised urine testing
• Signed treatment contract & treatment plan
• Addiction counselling
• Regular medical follow up
• Daily methadone dose
• Post-methadone treatment (i.e., relapse prevention, and medication
where appropriate)
Supported by a multidisciplinary team:
Addictions Physicians, Registered Nurses, Registered Practical Nurses,
Addiction Counsellors, Pharmacists & Other Allied Health Professionals
Methadone Maintenance
Best Practices

15. • Questions were developed by the Connections Project
Steering Committee:
• Ruby Miller, Director of Health Services
• Penny Hill, Programs & Services Supervisor, New Directions
Group
• Crystal Burning, Six Nations Mental Health Program
Manager
• Jerica Kennedy, SNMH Supportive Housing Case Manager
• Sher Miller, SNMH Connections Coordinator
Six Nations
Addiction Needs Analysis

16. • Six Nations Band Members
• Currently using substances
• or
• Involved in Opioid MaintenanceTherapy
(Methadone/Suboxone)
Criteria

17. Results

18. 40 (38%) 64 (62%)
104

19. Age 21-30 is the largest group with 51 people (49% )
7 51 22 11 13
104

20. 81 (78%)
23 (22%)
104

21. 62 (60%)
42(40%)
104

22. 38% Some High school
28% High School Diploma/GED
14% Some College/University 104

23. 70% No employment of any kind
13% Working full time, 11% Working part time
104

24. 62 15 9 14 18 25 13 82 9 7 18
104
79% Addictions Services
60% Ontario Works, 24% Mental Health Supports

25. 68% Family Members have attended Residential School
71 11 22
104

26. 81 (78%)
23(22%)
104

27. The largest incidence of chronic pain is due to
Physical/sexual/emotional abuse 43% 104

28. 24(23%)
80(77%)
104

29. 88% of respondents had experienced some form of
abuse or exposure to a traumatic experience 104

30. 10476% My friends or family use

31. 48

32. 8
8
4
2
3
3
2
5
6
12
5
7
4
3
4
10
I do not wish to stop. I am happy with my lifestyle
I would like to still use drugs sometimes
Lack of information/don't know enough about the treatments
Don't like what I hear about treatment programs
I can't find access in my area
There's a waiting list to get treatment in my area
I don't know who to talk to, to obtain a place in the program
Costs
No Transportation
I have pain and can't give up substances I use to manage it
I don't want people to know that I have an addiction
I am concerned I wouldn't be able to make it through therapy
I am concerned I wouldn't be able to follow the rules
I am concerned my family/friends, employer will find out
The system is too complicated
Other
What are your reasons for not seeking treatment?
22

33. 12 11 9 11 13 8 9 8
22

34. 22

35. 23 (28%) 18 21 20
82

36. 38(46%) 44(54%)
82

37. 18% 17% 49% 16%
82

38. 82
15% 68% 17%

39. 26 (32%) 56
(68%)
82

40. 82

41. 82

42. Final Comments from
Respondents

43. • “More people would quit if treatment was
easier to access.”
• Several people moved to be closer to the
methadone clinics.
• Medical transportation does not provide rides
long enough.
• Family & friends get tired of giving rides.
Transportation is a major issue

44. • Abuse is hidden
• “There is so much pain in our community.”
• “I believe there is pain in everyone’s past.”
• “I think physicians need to be more responsible about
what they are prescribing to people.”
• “I told my doctor that I had been to detox and he still
gave me a prescription for opiates…I became addicted
to them quickly.”
• “My doctor wanted me to start on suboxone but I don’t
want to because then I would have difficulty getting
pain medication in the future.”
Pain

45. FOR
• “I wish they would bring a clinic to the Reserve. Everyone here is
using the methadone clinic anyway why should we send them off
Reserve. More people would quit if treatment was easier to access.”
• “Methadone saved my life…It’s better than me coming in and kicking
your door in to get money to get high.”
• “I don’t like going to another community for support.”
• Counselling should be a requirement of Methadone Treatment.
AGAINST
• “People will abuse the system and sell their carries and people will
buy it.”
• “The doctors seem like they don’t want you to stop methadone
treatment.”
• “I feel like I traded drugs and if I knew how difficult it would be to
stop taking methadone I may have tried something else.”
Six Nations Methadone Clinic

46. •“I think they should have more people to talk to
who have been through it. Someone who is not
going to judge you…People think that it is just a
choice and it is not.”
Understanding
Readiness
• “I think you have to want to quit and no one can
make you, not any program can make you change.”
• “The person has to be ready. My family pushed me
into treatment and I stayed for the minimum
amount of time just to please them.”
• “I think there is a lot of help at Six Nations, people
just don’t want to access the help. People just
don’t care.”

47. •More education for our youth.
•“If I had known that it was going to be this hard I would
not have tried it.”
•“We need to be more vocal about the options for
treatment.”
•“I didn’t know about services for a long time…I know a
lot of people still using and don’t know the options to
make treatment possible for them. People will not ask
for help.”
•“Substance abuse & treatment need to be more of an
open subject.”
•“Awareness is prevention.”
More Education & Awareness

48. • Confidentiality is an issue
• Methadone Clinic
• Pharmacy
• Narcotics Anonymous
• Needle Exchange
• Detox Centre
• Pain Clinic
• Services in one location
• More privacy
• More addictions counselling
• Waiting lists discourage people from seeking treatment
• “The pharmacy here doesn’t want to be bothered with it.”
• “It’s hard to navigate the services and to know where to start.”
• “I see more and more native people coming to this clinic and we need to find a better
solution for our people.”
Improving Services

49. • Data results from the Needs Analysis has been compiled
• Evaluation report from Six Nations Physiotherapist, Katie
Gasparelli and OccupationalTherapist, Roxanne Miller has been
completed
• Information is being disseminated among Six Nations Providers
• Traditional medicine people, language speakers and advisors are
broadly being consulted to look at Haudenosaunee alternatives to
prescription drugs for pain management
NEXT STEPS

50. • A model of care is being developed by Six Nations
providers that:
• Will address chronic physical pain, chronic emotional pain
and addictions
• Be delivered in a multi-disciplinary approach
• Six Nations health professionals will work collaboratively
with traditional resource people
• Programming that regenerates traditional skill building and
focuses on theoretical concepts of Belonging, Mastery,
Independence and Generosity will be expanded/developed
END PRODUCT

51. QUESTIONS?
Nya:weh!