By: Vanessa Greer
University of Victoria – School of Social Work
SOCW 435: Decolonial and Anti-Oppressive Views on Mental Health
November 26, 2025
1. Introduction
The practice of social work with Indigenous youth in Canada does not exist in a vacuum but operates within the ongoing and often harmful legacy of colonialism. Historically, the Western systems of care have continued to utilise deficits-based and reductive words such as “diagnosis”, “problem”, and “disability” as tools to justify the harms against indigenous youth, children, and families. In the past, social workers have used this language as a justification for surveillance and removal of indigenous children and youth from their families and their community. While many current social work practices often pathologise Indigenous youth through the Western medical model that views differences as a deficit, a decolonial approach requires a shift toward a decolonised framework which Ansloos et al. references as “Radical Care” (2021). This model, which is grounded in intergenerational reciprocity and land-based relationality, reframes unique identities such as neurodiversity, not as disorders to be treated, but as sacred gifts that are essential to the community as a whole. This literature review attempts to show the flaws in the current colonial and Eurocentric medical model, and how the decolonised Radical Care model is better equipped to meet the needs of Indigenous neurodivergent youth.
The dominance of the medical model continues to create a critical gap in the care of Indigenous youth. By viewing neurodiversity as a deficit or problem to be cured, we continue to pathologise behaviours and view Indigenous youth as “problematic” or “troubled”. These are terms I have often heard associated with youth in general, but often disproportionately for Indigenous youth who do not behave the way Western colonisers want them to. These approaches also ignore Indigenous world views that have historically held space for diverse ways of being. As a result, Indigenous youth often face what Ineese-Nash (2020) calls a “double burden” from the systemic barriers created by ableism as well as the ongoing structural violence of colonialism.
Drawing from literature based around Indigenous youth, land-based healing practices, two-spirit wellness, and radical care, this paper argues that effective mental health support requires reframing our views of mental health and neurodiversity from a deficits-based and pathologised approach, to a decolonised lens of radical care and sacred community roles. This paper is organised into four sections, starting with my rationale and social location, then providing a critical review of the existing medical model, and finally, proposing a new practice framework grounded in reciprocal community relationships and land-based healing.
2. Rationale and Social Location
As a white transgender woman navigating the world with hearing loss, disabilities, neurodiversity, and mental health challenges, I approach this topic from both an academic perspective as well as from lived experience. Due to being raised with naturopathic and homeopathic medicine and holistic approaches to care, I often struggle to navigate the complexities of accessibility and identity within colonial medical systems. My non-traditional background of being raised in a holistic farming community which was based around caring for those with various disabilities, also allows me a complex and unique perspective on diversity that promotes a strengths-based approach to my social work practice. I also acknowledge that my social location has fundamentally shaped my perspective. It has sensitised me to the ways in which Western institutions often pathologise differences and view neurodiversity as something to be fixed or corrected instead of as a “superpower” or distinct cognitive strength which allows my brain to work differently than others. Indeed, I have seen that many people with ADHD, including myself, have increased creativity, attention to detail, hyperfocus, and many other skills.
Through this lens, I have observed how the medical model inherently frames differences as lacking in one or more areas. For example, the title of Attention Deficit Hyperactivity Disorder (ADHD) is clearly viewed as a deficit of attention. This, as many people with ADHD will attest to, is fundamentally incorrect. People with ADHD do not have a deficit of attention, but rather a difficulty with where that attention is directed, especially if there is little interest in the subject matter (Pritchard, 2024). As a friend of mine previously stated, “It is like watching TV, but I don't have the remote and someone else is changing the channel at random” (K. Hansen, personal communication, 2021). Similarly, terms like “hearing loss” or “hearing impaired” frame the experience as a shortcoming or absence. However, many people in the deaf community would not see it as a loss, but as a different way of being. Indeed, deaf people have a rich culture with their own languages and history. From personal experience, I have seen that often when one of our main senses is missing, other senses heighten to create balance and new ways of being.
These examples illustrate how the medical deficit-based approach is an ineffective and often harmful way to view differences. It focuses entirely on what is missing rather than what is present. Consequently, this paper advocates for a shift toward radical care because it aligns with a vision of social work that refuses to pathologise those who are in our care. When working with Indigenous youth, as an example, we can move beyond the rigid categories of the medical model and appreciate neurodiversity and disabilities not as individual failures, but as essential parts of a diverse and thriving community ecosystem.
3. Literature Review on Existing Policy
The current social work and mental health practices with Indigenous youth are still overwhelmingly dominated by the Western medical model. This colonial-style framework continues to operate through a lens of pathology, which often views disability as individual deficits which are to be diagnosed, managed, and cured. As Ineese-Nash (2020) argues, this model is not neutral. Additionally, the label of “disability” acts as a construct that imposes colonial norms of ability and behaviour onto Indigenous people (Ineese-Nash, 2020). By narrowly focusing on individual impairments and deficits, this approach systematically ignores the structural determinants of health such as poverty, intergenerational trauma, and systemic racism that shape the lives of Indigenous youth (Ineese-Nash, 2020). Instead of addressing these root causes of harm, the medical model instead attempts to “fix” the child, which often leads to interventions that prioritise compliance with Western norms of behaviour over the well-being of the person (Ineese-Nash, 2020).
The over-reliance on this biomedical model creates significant barriers to access and effective support. Antony et al. (2022) explain in their article that diagnostic services for autism are often geographically inaccessible and rigid in their application. The evidence shows that this “one-size-fits-all” approach frequently causes barriers in diagnosis since the standard assessments fail to account for cultural differences in communication and child-rearing (Antony et al., 2022; Ineese-Nash, 2020). Also, the medical “expert” model often alienates families, who may view the pathologising language of the healthcare system as a continuation of colonial oppression rather than a source of support (Ineese-Nash, 2020). Thus, many Indigenous families are reluctant to engage with services that do not respect their worldviews or acknowledge their strengths (Antony et al., 2022).
The failure of the medical model is further compounded by the intersection of ableism and colonialism (Ineese-Nash, 2020). Indigenous youth with disabilities face a “double burden” where they must navigate the systemic barriers of a society designed for neurotypical individuals while simultaneously contending with the ongoing structural violence of colonisation (Ineese-Nash, 2020). This intersectional reality means that what are termed as standard “special needs supports” are quite often insufficient because they do not address the specific cultural and historical context of Indigenous youth. For example, some behavioural interventions that solely focus on social skills or compliance may actively cause harm to Indigenous youth by enforcing norms that are assimilationist in nature while discouraging the very cultural connections that foster resilience in those youth (Preston & Claypool, 2021).
Additionally, as Hardy et al. (2020) explains, the metrics that are used by Western colonial systems to define health often fail to capture the realities of Indigenous youth. In their research, Hardy et al. (2020) argue that public health interventions frequently rely on reductionist and deficit-based metrics such as disease rates or risk behaviours, while ignoring the holistic relationality that defines Indigenous well-being. The authors explain that this disconnect is exacerbated by paternalistic policies where experts define the needs of youth without their input (Hardy et al., 2020). Therefore, services are often designed for Indigenous youth rather than with them. This results in programming that can feel alienating or irrelevant because it fails to account for the specific lived experiences of 2SLGBTQIA+ and gender non-conforming youth (Hardy et al., 2020).
In their paper, Ward and Leeuw (2018) show how this disconnect is further evident in the digital landscape by critiquing existing online mental health resources for Indigenous youth. The authors note that many platforms fail to reflect Indigenous cultures or realities and instead offer generic, Eurocentric advice which alienates the user (Ward & Leeuw, 2018). By analysing these resources through a critical lens, they found that most digital interventions lack the relational and land-based context necessary for Indigenous well-being (Ward & Leeuw, 2018). This digital erasure mirrors the physical erasure found in clinical settings, which reinforces the narrative that Indigenous youth must conform to Western modes of healing even in virtual spaces (Ward & Leeuw, 2018).
This pattern of pathologising extends into schools and the educational system, where many differences are labelled as disabilities for the first time. Preston and Claypool (2021) argue that standardised assessments are inherently Eurocentric. These assessments often label Indigenous students as “disabled” simply because their learning styles or cultural knowledge differ from the Western norm (Preston & Claypool, 2021). This inherent bias in assessment not only leads to the inappropriate labelling of children and youth but also obscures the unique gifts and capabilities of Indigenous learners. By measuring Indigenous youth against a yardstick of Western normativity, the current system fails to recognise or nurture their true potential and instead funnels them into streams of remediation and control.
4. New Approach to Practice and Rationale
In contrast to the Western medical model, a decolonial approach to social work practice with Indigenous youth emphasises holistic wellness and spiritual significance which then results in the restoration of community roles (Ansloos et al., 2021). According to the Native Youth Sexual Health Network, this approach requires a fundamental shift from viewing differences as deficits to viewing them as gifts (Native Youth Sexual Health Network, 2021). A central tenet of this new approach is the recognition that differences have historically been viewed by many Indigenous cultures as a form of specialised power or wisdom (Ansloos et al., 2021). Unlike the colonial imposition of deficit frameworks, traditional Indigenous views often regarded people with mental health challenges or unique identities not as problems to be fixed, but as "people with gifts" (Native Youth Sexual Health Network, 2021).
This crucial reframing is important for neurodivergent youth. As Bruno et al. (2023) articulate in their work with First Nations families, many Indigenous communities view autism not as a disorder but as a unique way of being that requires acceptance and relationship rather than remediation. This aligns with concepts found in various Indigenous traditions where neurodivergent youth are seen as possessing specific spiritual roles or unique insights essential to the community. By affirming these identities as sacred, social work practices can move from attempting to “cure” the child or youth, to honouring their inherent value in the community. Social workers can do this by celebrating the unique qualities in each child or youth.
In order to implement this shift, social work practice must be grounded in what Ansloos et al. (2021) define as “Radical Care.” This framework moves beyond the clinical hierarchy of the “expert” and “patient” to embrace a model of mutual aid and community belonging. As Ansloos et al. (2021) explain, Radical Care is not merely about providing services, but also about activating the uplifting concept of “decolonial joy” and ensuring that youth feel held by their communities. Central to this concept is the shift from hierarchical intervention to reciprocal community relationships. While the medical model positions the professional as the so-called “expert” and the youth as the “deficient patient,” a reciprocal framework recognises that all community members, including those with neurodivergence, possess unique gifts that are essential for the collective good (Ansloos et al., 2021).
This shift toward Radical Care aligns with what Munford and Sanders (2020) describe as “transformative practice.” In their research with vulnerable youth, they found that effective social work moves beyond simple case management to foster a sense of agency and control. For neurodivergent Indigenous youth, whose agency has often been stripped away by medical labelling and colonial interventions, this restoration of control is vital. Munford and Sanders (2020) argue that practitioners must pay close attention to the “everyday events” in a young person's life, like the small daily interactions where trust is either built or broken. By shifting the focus from “managing behaviours” to “building agency,” social workers can help youth navigate their environments with confidence rather than compliance (Munford & Sanders, 2020).
Furthermore, Munford and Sanders (2020) emphasise that transformative practice requires understanding the youth's behaviour within their broader context, rather than viewing it as an individual deficit. This directly supports the decolonial framework of reframing neurodiversity. Instead of asking, “Why is this youth acting out?”, a transformative practitioner asks, “How does this environment support or hinder this youth's unique way of being?” By adopting this contextual lens, social workers can move away from the pathologising gaze of the medical model and towards a practice that validates the youth’s reality (Munford & Sanders, 2020). When combined with Indigenous concepts of relationality, this approach ensures that interventions are not just clinical but deeply connected to the youth's sense of belonging and identity (Munford & Sanders, 2020; Ansloos et al., 2021).
This approach is best realised through intergenerational and land-based learning practices. Gabel et al. (2016) demonstrate that well-being is maximised not when youth are isolated in clinical settings, but when they are actively engaged in sharing skills and knowledge with Elders on the land. In their study, the transmission of traditional skills facilitated a reciprocal exchange where youth taught Elders about technology while Elders taught youth about the land (Gabel et al., 2016). For neurodivergent youth, land-based practices can offer a powerful alternative to the classroom or clinic, as the land does not demand compliance with neurotypical social norms but instead allows for diverse ways of learning and moving (Ansloos et al., 2021; Bruno et al., 2023). The practice of land-based healing is especially important for neurodivergent people like me, due to the value I gained from being raised on farms and feeling connected to nature. Gabel et al. (2016) explain that land-based healing is not just about being outside, but about activities such as picking berries or making snowshoes which connect youth to their elders and to their history. By reintegrating youth into this circle of intergenerational care, the “disability” is not fixed. However, the barrier of colonial isolation is removed, allowing the youth to thrive in their authentic role (Native Youth Sexual Health Network, 2021).
A practical application of the decolonial approach of radical care is what Hardy et al. (2020) call the principle of “meeting Indigenous youth where they are at,” which prioritises the self-determination of youth over clinical compliance. The authors of this paper highlight the “Sexy Health Carnival” developed in partnership with the Native Youth Sexual Health Network as a prime example of this praxis (Hardy et al., 2020, p. 9). This study specifically emphasises the importance of centering Indigenous youth in public health research and mentions how chronically underrepresented they are in public health implementation research (Hardy et al., 2020, p. 2). Unlike many clinical models that may induce anxiety or apprehension, this peer-led intervention used methods of having fun in culturally safe spaces to engage Indigenous youth on their own terms. By merging “knowing” with “doing”, such initiatives demonstrate that health promotion is most effective when it is disentangled from the rigid authority of the medical system and instead embedded in the joy and autonomy of the youth community (Hardy et al., 2020).
This shift towards reciprocal care resonates deeply with my own social location. As a neurodivergent transgender woman, I have often experienced clinical settings as spaces of judgment instead of spaces of safety. The model of radical care, which encompasses the validation of peer support, offers a framework where my own ways of being are not just tolerated but also valued. By centering lived experience and community wisdom, this approach creates space for a practice that is genuinely restorative, instead of merely corrective.
Finally, an anti-oppressive decolonial practice must prioritise the self-determination of youth through affirming language as well as peer support (Native Youth Sexual Health Network, 2021). The booklet entitled “You Are Made of Medicine” from the Native Youth Sexual Health Network (2021) argues that changing how we speak about mental health is important. Simple acts such as rejecting labels like “crazy” in favour of more inclusive language which reflects the youth's own experience is an important act of harm reduction (Native Youth Sexual Health Network, 2021). By fostering peer support networks where “Indigiqueer” and neurodivergent youth can share their lived experiences without judgment, social workers can facilitate a sense of safety that the medical model rarely achieves (Ansloos et al., 2021). As described by youth activists in Ansloos et al. (2021), this practice of “coming home” to oneself and one's community is the essence of decolonial healing.
5. Conclusion
This literature review paper has attempted to show that the current medical model of social work practice is fundamentally inadequate and ill-equipped to meet the needs of neurodivergent Indigenous youth. By stubbornly hanging on to a framework of pathology, the current system fails to address the structural violence of colonialism and often replicates it through culturally unsafe diagnostic processes (Antony et al., 2022). As Ineese-Nash (2020) demonstrates, this approach creates a “double burden” for Indigenous youth. Furthermore, the educational system’s reliance on Eurocentric assessment tools frequently obscures Indigenous forms of intelligence and misidentifying cultural difference as a disability (Preston & Claypool, 2021).
In response to these failures, this paper advocates for a shift toward the decolonial framework of “Radical Care” (Ansloos et al., 2021) as well as “Transformative Practice” (Munford & Sanders, 2020). As articulated by Ansloos et al. (2021) and Munford and Sanders (2020), this approach moves beyond the hierarchy of the “expert” to embrace a model of mutual aid, and community-based support that fosters “decolonial love, self-determinism, responsibility, and joy”. By reframing neurodiversity not as a disorder to be fixed but as a sacred gift or role, social work practice aligns with Indigenous self-determination (Native Youth Sexual Health Network, 2021). The evidence from Gabel et al. (2016) confirms that intergenerational and land-based practices are essential modalities for restoring well-being, as they allow for reciprocal teaching between youth and Elders that restores community belonging.
Ultimately, as Hardy et al. (2020) state, the process of decolonising social work requires a transformation of the practice itself. They base their research on prioritising youth-focused interventions that utilise fun, games, and cultural safety over clinical compliance (Hardy et al., 2020). For us as social workers, this means stepping back from the role of gatekeeper and stepping into a facilitator role to validate their lived realities within their specific contexts (Munford & Sanders, 2020). By embracing this shift from pathology to reciprocity, the profession of social work can move towards a practice that not only supports survival but actively cultivates Indigenous flourishing (Ansloos et al., 2021).
References
Ansloos, J., Zantingh, D., Ward, K., McCormick, S., & Siriwattakanon, C. B. (2021). Radical Care and Decolonial Futures: conversations on identity, health, and spirituality with Indigenous queer, trans, and two-spirit youth. International Journal of Child Youth and Family Studies, 12(3–4), 74–103. https://doi.org/10.18357/ijcyfs123-4202120340
Antony, C., Campbell, M., Côté, S., Bruno, G., Tinglin, C., & Lai, J. (2022). Informing care pathways and policies for children and youth with indigenous perspectives to advance Canada’s National Autism Strategy. Frontiers in Psychiatry, 13, 916256. https://doi.org/10.3389/fpsyt.2022.916256
Bruno, G., Chan, T. A., Zwaigenbaum, L., Coombs, E., & Nicholas, D. (2023). Indigenous autism in Canada: A scoping review. Journal of Autism and Developmental Disorders, 54(9), 3478–3491. https://doi.org/10.1007/s10803-023-06045-z
Gabel, C., Pace, J., & Ryan, C. (2016). Using Photovoice to understand Intergenerational Influences on Health and Well-Being in a Southern Labrador Inuit community. International Journal of Indigenous Health, 11(1), 75–91. https://doi.org/10.18357/ijih111201616014
Hardy, B., Lesperance, A., Foote, I., Firestone, M., & Smylie, J. (2020). Meeting Indigenous youth where they are at: knowing and doing with 2SLGBTTQQIA and gender non-conforming Indigenous youth: a qualitative case study. BMC Public Health, 20(1), 1871. https://doi.org/10.1186/s12889-020-09863-3
Ineese-Nash, N. (2020). Disability as a colonial construct: The missing discourse of culture in conceptualizations of disabled Indigenous children. Canadian Journal of Disability Studies, 9(3), 28–51. https://doi.org/10.15353/cjds.v9i3.645
Munford, R., & Sanders, J. (2020). Transformative practice: social work practice with vulnerable young people. European Journal of Social Work, 24(4), 720–731. https://doi.org/10.1080/13691457.2020.1819205
Native Youth Sexual Health Network. (2021). You are made of medicine: a mental health peer support manual. https://static1.squarespace.com/static/5f3550c11c1f590e92ad30eb/t/6109b2f9d66ea10365dd929f/1628025613807/You+Are+Made+of+Medicine_FINAL.pdf
Preston, J. P., & Claypool, T. R. (2021). Analyzing assessment practices for Indigenous students. Frontiers in Education, 6. https://doi.org/10.3389/feduc.2021.679972
Pritchard, A. (2024, October 31). The attention “Deficit” myth. ADHD Newsstand: Attention Magazine. Retrieved November 23, 2025, from https://chadd.org/adhd-news/adhd-news-caregivers/the-attention-deficit-myth/
Ward, V., & Leeuw, S. (2018). Web of Culture: Critically assessing online mental health resources for Indigenous youth in Northern British Columbia using digital storytelling. In UBCMJ (pp. 20–22). Retrieved November 20, 2025, from https://med-fom-ubcmj.sites.olt.ubc.ca/files/2018/02/Ward-PROOF.pdf