For Indigenous Peoples who have been discriminated against in health institutions, healing can take place outside of conventional health practices. (Freepic), CC BYFor nearly two decades, I worked as a therapist in a large psychiatric hospital in Toronto, supporting people living with severe mental health challenges. Many of those I encountered were navigating complex intersections of psychiatric diagnoses, chronic physical illness, poverty, and the breakdown of family and social support. Stories of fear, isolation, abuse and abandonment were pervasive.Occasionally, I witnessed transformative outcomes; patients reconnecting with loved ones, reclaiming aspects of their identity and building meaningful lives beyond their diagnoses. Unfortunately, such outcomes were typically the exception. More commonly, individuals cycled through repeated hospitalizations, and were placed in institutional or custodial settings. Some lost their lives before they got any better. While our mental health system certainly fails people of all backgrounds, I observed a unique disservice done to the Black, brown and Indigenous patients I encountered. Read more: Racism impacts your health The system seems designed to fail them not only in its methodology, but also in the basic values it is built upon. Within my own journey of mental health recovery, I found healing alongside helpers across Turtle Island, rather than within the confines of a mental health institution or pages of a manualized treatment protocol. It’s common for First Nations Peoples to refer to “helpers” or “helping work” when describing individuals who provide relationally-based support to others. As a community psychotherapist and later PhD student, I became increasingly interested in these helpers as unsung heroes of community wellness. They didn’t necessarily have a graduate degree in a mental health field, and they were rarely recognized or compensated for their efforts, yet they made great personal sacrifices to support the healing journeys of those around them. Who are Indigenous helpers?My doctoral research investigates who these Indigenous helpers are, the nature of their helping work and the role of language and dialogue in the relationships they form with those they help.Here is what I’ve learned so far:1. Knowledge is defined by lived experienceIndigenous helpers are individuals who emerge naturally from within their families and communities rather than being self-appointed professionals or receiving accreditation from a college or certification board. Their knowledge and skill is defined by their lived experiences, their kinship obligations and the trust placed in them by their community. They seamlessly blend practical support such as caregiving and crisis intervention with relational and spiritual guidance rooted in ancestral values and traditions.2. Helping work is holistic and relationalHelping work is a holistic, relational practice rooted in cultural values and kinship responsibility. It involves a continuous, reciprocal process of healing, where the act of helping heals the helper, their relative and the collective. Helping work is guided by an ethic of relational accountability and powered time spent together and deep, action-based dialogue. It integrates physical, emotional, cognitive and spiritual dimensions through storytelling, presence and joint engagement in work, rest, play and ceremony. It is a long-term process that is highly contextual and nonlinear.3. Language is medicineIndigenous languages hold the blueprint for helping and healing work. Embedded within Indigenous languages are complex relational networks that shape how people understand themselves, their families, their worlds, and their roles within the broader community. While English is an analytic, noun-based language, Nêhîyawêwin (the Cree language) and many other Indigenous languages are polysynthetic, verb-based and highly contextual. This linguistic structure encodes kinship ties, responsibility and ways of being in relation to others (human and non-human). Cree protectors and caretakersOne powerful example of the complexity of Indigenous languages comes from the words used to describe “Elders,” which is often a point of contention, as the English word doesn’t capture what people are trying to say when referring to the helper-leaders in our communities.The Nêhîyawêwin (Plains Cree) word for an Elder is kisêyiniw. This is often translated simply as “old man,” but in reality carries a much deeper meaning. Healing and talking can take place outside of the confines of traditional medical spaces. (Unsplash), CC BY The root kisê- comes from the Cree word ê-kisêt, which describes an animal feigning injury to protect its young. The second root -niw- means “a person,” making kisêyiniw not just an old man, but a protector and a caretaker who sacrifices for future generations. Kisêyiniw describes those who embody relational responsibility: protecting, guiding and enduring suffering for the well-being of others. So rather than just being an aged person, or even an aged person who has wisdom or leadership qualities, the word kisêyiniw describes those who embody relational responsibility — protecting, guiding and enduring suffering for the well-being of others. This contrasting of meaning reveals how the Cree language structures identity, healing and responsibility in ways that the English translation fails to capture. A child forced to cease speaking their native language, and speak only English, would lose all of the values and meaning that exist within the relational networks that comprise the word and its concepts, and be left with a simple arbitrary label. I believe this to be at the core of much of the intergenerational suffering found in the wake of the Indian Residential School system. Culturally specific mental health careThis is one of the reasons Indigenous-led approaches must reclaim language as central to healing, recognizing that Indigenous languages hold entire systems of wellness, governance, relationship and emotional regulation. Truly culturally responsive care must prioritize language revitalization, ceremony and kinship-based care as core practices. Funders, policymakers, researchers and clinicians must recognize, fund and integrate Indigenous helpers — Elders, ceremonial leaders, traditional knowledge keepers and natural helpers identified by their communities — as core mental health providers, not cultural add-ons.Governments, universities and regulatory bodies must remove barriers preventing Indigenous helpers from full participation in mental health professions. Efforts to include Indigenous helpers should avoid forcing Indigenous helping practices into western psychotherapy models with strict, compartmentalized boundaries. Instead, we must restore intergenerational, kinship-based healing through relationships, ceremony, land-based practices and daily caregiving.Genuinely culturally responsive and anti-colonial mental health care requires shifting resources and power back to Indigenous helpers, languages and communities.Louis Busch receives funding from the Social Sciences and Humanities Research Council of Canada (SSHRC), including a Vanier Canada Graduate Scholarship and a SSHRC Impact Award.