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Background: Under- and over nutrition as well as nutrition risk factors such as communicable and non-communicable diseases are a common and major cause of morbidity and mortality in correctional facilities. Consequently, medical nutrition therapy (MNT), a spectrum of nutrition services aimed at optimizing individual well-being, is being recognized as integral to the health of people who experience incarceration. However, there is a paucity of research that explores the delivery of MNT in correctional facilities. Methods: A scoping review combined with secondary analysis of qualitative data (field notes, in-depth stakeholder interviews) from a 2-year ethnographic study about food insecurity and incarceration was undertaken to gain insights about the delivery of corrections-based MNT in Canada. Thematic analysis of all documents was done using an interpretive framework. Results: An understanding about MNT was developed within three themes: 1) specialized service provision in a unique environment; 2) challenges with the provision of MNT; and 3) consideration of corrections-based MNT alternatives. An incarcerated individual's nutritional health was conceptualized as culminating from various factors that included dietary intake and health status, enabling environments, access to quality health services, and clinical nutrition services. Nutrition care practices, which range from health promotion to rehabilitation, are challenged by issues of access, visibility, adequacy, and environmental barriers. Their success is dependent on demand (e.g., ability of recipient to act) and factors that enable quality health and food services. Advancing corrections-based MNT will require policies that provide supportive food and health environments and creating sustainable services by integrating alternatives such as peer approaches and telehealth. Conclusions: Professional associations, government, researchers and other stakeholders can help to strengthen corrections-based MNT by fostering shifts in thinking about the role of health practitioners in these contexts, preparing future health professionals with the specialized skills needed to work in these environments, generating evidence that can best inform practice, and cultivating collaborations aimed at crime prevention, successful societal reintegration, and the reduction of recidivism. ; Applied Science, Faculty of ; Non UBC ; Nursing, School of ; Reviewed ; Faculty

Abstract Background Under- and over nutrition as well as nutrition risk factors such as communicable and non-communicable diseases are a common and major cause of morbidity and mortality in correctional facilities. Consequently, medical nutrition therapy (MNT), a spectrum of nutrition services aimed at optimizing individual well-being, is being recognized as integral to the health of people who experience incarceration. However, there is a paucity of research that explores the delivery of MNT in correctional facilities. Methods A scoping review combined with secondary analysis of qualitative data (field notes, in-depth stakeholder interviews) from a 2-year ethnographic study about food insecurity and incarceration was undertaken to gain insights about the delivery of corrections-based MNT in Canada. Thematic analysis of all documents was done using an interpretive framework. Results An understanding about MNT was developed within three themes: 1) specialized service provision in a unique environment; 2) challenges with the provision of MNT; and 3) consideration of corrections-based MNT alternatives. An incarcerated individual's nutritional health was conceptualized as culminating from various factors that included dietary intake and health status, enabling environments, access to quality health services, and clinical nutrition services. Nutrition care practices, which range from health promotion to rehabilitation, are challenged by issues of access, visibility, adequacy, and environmental barriers. Their success is dependent on demand (e.g., ability of recipient to act) and factors that enable quality health and food services. Advancing corrections-based MNT will require policies that provide supportive food and health environments and creating sustainable services by integrating alternatives such as peer approaches and telehealth. Conclusions Professional associations, government, researchers and other stakeholders can help to strengthen corrections-based MNT by fostering shifts in thinking about the role of health practitioners in these contexts, preparing future health professionals with the specialized skills needed to work in these environments, generating evidence that can best inform practice, and cultivating collaborations aimed at crime prevention, successful societal reintegration, and the reduction of recidivism.

Background: Using our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, particularly how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned. Using the lens of intersectionality, we refine the notion of Harm Reduction by specifying the conditions in which both harm and benefit arise and how experiences of harm are continuous with wider experiences of domination and oppression; Methods: A qualitative design that uses ethnographic methods of in-depth individual and focus group interviews and naturalistic observation was conducted in a large city in Canada. Participants included Aboriginal clients accessing mainstream mental health and addictions care and primary health care settings and healthcare providers; Results: All client-participants had profound histories of abuse and violence, most often connected to the legacy of colonialism (e.g., residential schooling) and ongoing colonial practices (e.g., stigma & everyday racism). Participants lived with co-occurring illness (e.g., HIV/AIDS, Hepatitis C, PTSD, depression, diabetes and substance use) and most lived in poverty. Many participants expressed mistrust with the healthcare system due to everyday experiences both within and outside the system that further marginalize them. In this paper, we focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples' agency, and homelessness; Conclusions: Harm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An intersectional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing the historical, socio-cultural and political forces that shape responses to mental illness/health, addictions, including harm reduction and methadone maintenance treatment. ; Applied Science, Faculty of ; Nursing, School of ; Reviewed ; Faculty

This article reports on the findings of a larger study that explored urban Indigenous providers' experiences with contracting in mental health and addictions care. The study was undertaken with seven Indigenous and one non-Indigenous non-profit organizations based in diverse large and mid-size cities (off reserve) in British Columbia, Canada. Indigenous and critical theoretical perspectives provided the lens for this ethnographic inquiry. In-depth interviews were the primary data source. Participants' narratives provide an account of the ideological embeddedness of contracting and how a New Public Management operates to perpetuate colonial power imbalances and structural barriers to culturally safe and equity-oriented care within urban Indigenous communities. Policy and practice implications for government funders are discussed.

The DUDES Club is a novel men's health and wellness organization founded in 2010 in Vancouver, BC. Since 2017, the DUDES Club has rapidly expanded in Northern BC and, with the help of a partnership with the First Nations Health Authority, has grown to include 40 sites in British Columbia and 2 sites nationally. In this study, we analyze interviews (n = 5) and 15 focus groups (n = 101) conducted as part of a program evaluation with DUDES Club members, Elders, providers, and health care professionals. We focus on men's experiences with the DUDES Club to identify four main themes in the data: brotherhood and community, accessible health care information, disrupting colonial constructions of masculinity, and systemic and structural challenges. We conclude with policy recommendations.

An exceptional showcase of interdisciplinary research, Critical Inquiries for Social Justice in Mental Health presents various critical theories, methodologies, and methods for transforming mental health research and fostering socially-just mental health practices. Marina Morrow and Lorraine Halinka Malcoe have assembled an array of international scholars, activists, and practitioners whose work exposes and disrupts the dominant neoliberal and individualist practices found in contemporary mental research, policy, and practice. The contributors employ a variety of methodologies including intersectional, decolonizing, indigenous, feminist, post-structural, transgender, queer, and critical realist approaches in order to interrogate the manifestation of power relations in mental health systems and its impact on people with mental distress. Additionally, the contributors enable the reader to reimagine systems and supports designed from the bottom up, in which the people most affected have decision-making authority over their formations. Critical Inquiries for Social Justice in Mental Health demonstrates why and how theory matters for knowledge production, policy, and practice in mental health, and it creates new imaginings of decolonized and democratized mental health systems, of abundant community-centred supports, and of a world where human differences are affirmed