A/HRC/41/34/Add.2 field of mental health, Canada should direct its international support to projects that predominantly include community-based psychosocial and alternative interventions other than medication. This way, individuals will be effectively safeguarded from discriminatory, arbitrary, excessive, inappropriate and/or ineffective clinical care, users will be empowered and their autonomy respected. The involvement of users should be ensured in the design, implementation, delivery and evaluation of mental health services, and no international support should be given to support institutional care. IV. Right to health of indigenous peoples 69. The Special Rapporteur held many meetings with grass-roots organizations and authorities of indigenous peoples – First Nations, Inuit and Métis – including the unique First Nations Health Authority in British Columbia, which, in coordination with provincial and federal authorities, is now administering and delivering health services on reserves, including those in remote First Nations communities across the province. 70. In Canada, it is broadly recognized that colonial processes have had negative impacts on indigenous peoples’ health and well-being. In 2015, the Truth and Reconciliation Commission described past assimilationist policies, particularly residential schools, as a cultural genocide. 27 Through residential schools, indigenous children were separated from their parents, not for educational purposes, but primarily to break their link to their culture and identity; child neglect was institutionalized; and the lack of supervision paved the way to sexual and physical abuse. The Special Rapporteur was debriefed on those ruptures and abuses, including from the victims themselves. 71. In June 2008, the then-Prime Minister, Stephen Harper, followed by all provinces and territories apologized to former students of residential schools. In 2015, in its election platform, the Liberal Party pledged to change the relationship with indigenous peoples through a new nation-to-nation relationship, the enactment of the 94 recommendations of the Truth and Reconciliation Commission and a federal inquiry into missing and murdered indigenous women and girls, among others. 72. In 2016, Canada removed its objector status for the United Nations Declaration on the Rights of Indigenous Peoples and, in February 2018, the Prime Minister, Justin Trudeau, committed to replacing the Comprehensive Land Claims Policy and the Inherent Right Policy. Among other things, changes to existing legislation and policies and the creation of new ones have been identified as necessary to recognize and affirm indigenous peoples’ rights and self-determination, ensure federal accountability and achieve socioeconomic equity and the overall well-being of indigenous peoples.28 73. The strong commitment of the Federal Government towards a meaningful reconciliation is commendable. Steps taken thus far are important and necessary but remain the first in a long list of efforts necessary to address effectively the historic and structural determinants of health and the well-being of indigenous peoples. Overall, there remains a serious systemic lack of trust that reflects the existence of remaining de facto discriminatory attitudes in health-care settings. Despite efforts to improve indigenous physical and mental health, the situation is still one of the most pressing issues in-country. Official data29 reveal that indigenous peoples’ life expectancy is up to 15 years shorter; rates of infant mortality are 2 to 3 times higher; diabetes rates are almost four times higher for First Nations on reserves; and tuberculosis rates are 270 times higher for Inuit people. 74. Indigenous peoples’ health situation is aggravated by high poverty rates, the geographic remoteness of many communities, overcrowded housing, high population growth rates and other issues, including family violence. Indigenous peoples are overrepresented among those who use drugs and die from opioid overdose. Official data indicate that opioid-related deaths are up to three times higher for First Nations peoples in 27 28 29 14 See http://s3.documentcloud.org/documents/2091415/trc-executive-summary-2015-05-31.pdf. See www.afn.ca/wp-content/uploads/2018/08/Issues-Summary-ENG.pdf. See www.canada.ca/en/indigenous-services-canada/news/2018/01/improving_healthoutcomes.html.