Tina Fontaine's tragic free fall has been painstakingly detailed so often that many now have the series of missed opportunities that preceded her death seared into memory.

The Indigenous teen's short life was punctuated by trauma — trauma many people who work with at-risk youth say can only be avoided in other cases by bringing Indigenous tradition, teachings and culture into mental health and addictions treatment.

That was one of the recommendations in a recent report into the 2014 death of 15-year-old Tina Fontaine — which helped spur calls for an inquiry into missing and murdered Indigenous women — by Manitoba advocate for children and youth Daphne Penrose.

In detailing the teen's tragically short life — and the systems that failed her — Penrose noted how victim services didn't deliver Tina bereavement counselling after her father was killed when she was 12; how the school and health-care systems did little to intervene when she stopped attending class, showed signs of substance use, self-harm and sexual exploitation; and how child and family services failed to keep her safe before she died.

Penrose suggested the province needs to invest in creating safe, secure, home-like treatment facilities for at-risk youth.

She also recommended Manitoba Health implement recommendations from the Virgo report, released nearly 11 months ago. In its broad review of mental health care and addictions treatment in Manitoba, the report found a pressing need for more treatment for Indigenous youth that is trauma-informed and culturally relevant.

It noted a need to remove geographical and jurisdictional barriers to accessing treatment options in rural and northern First Nations.

A report into the 2014 death of Tina Fontaine found her short life was punctuated by trauma, and that many systems failed to protect her. (Lyza Sale/CBC)

The recommendations touch on the lingering effects of residential schools, the Sixties Scoop and the displacement of Indigenous people from their lands.

The legacy of those colonial institutions is at the root of mental health issues facing Indigenous youth, said elder Dave Courchene.

"The No. 1 issue is their identity," said Courchene, director of Turtle Lodge, a centre for Indigenous education and wellness in Sagkeeng First Nation, at the southern end of Lake Winnipeg.

"There is a real crisis when it comes to a lot of the young people, totally disconnected from their culture, from their way of life," he said.

"That's a result of the experience that our people had to go through. A lot of that knowledge that our ancestors lived by suddenly was not there anymore."

Lodge offers what institutions can't: elder

In 2002, Courchene founded Turtle Lodge in Sagkeeng, Tina Fontaine's home community. The goal was to offer youth and adults alike a chance to reconnect with that lost language and ancestral knowledge.

"We meet a lot of young people and the request that they always make is for us to share as much knowledge as we can in terms of their own identity, their culture, a way of life that identifies the uniqueness of who Aboriginal people are," said Courchene.

After years of frustration and disappointment with the lack of traditional ceremony in Sagkeeng, Courchene — encouraged by elders — went out on the land on a rite of passage, or vision quest, with local knowledge keepers. The resulting insights formed the basis of Turtle Lodge, where youth are taken on similar journeys.

It's not that we don't have the solutions for what we need to do. We know what we need to do. - Elder Dave Courchene

Boys and young men fast over the course of the four-day experience, where they learn to reconnect with the land and all it can provide, said Courchene.

"You're not going to find [that] in any institution," he said. "They're guided to seek a dream spiritually that will give them meaning and purpose to their life."

The Sagkeeng-based Turtle Lodge centre has been offering cultural programming and supports for Indigenous youth and adults since 2002. (Submitted by Turtle Lodge)

Indigenous grandmothers are given positions of influence through the lodge to help girls learn about sacred teachings and water ceremonies that Courchene says help them grow into life-saving women.

"It does something to them. We see it first-hand."

Turtle Lodge was also involved recently in bringing together four First Nation communities to create an Indigenous health and wellness component at Pine Falls Health Complex that provides culturally informed healing and medicine traditions.

'The best chance for young people'

But Courchene says many youth from Sagkeeng and other First Nations still need access to these teachings — and aren't getting it. Some end up in vulnerable positions and, like Tina, fall through the cracks due to gaps in the system, he said.

She went to Pine Falls Health Complex in 2014 with self-inflicted arm injuries, and medical staff failed to come up with a follow-up care plan for her.

Courchene said more needs to be done to restore what was taken away, and governments have a shared responsibility to provide culturally informed support for youth.

"It's not that we don't have the solutions for what we need to do. We know what we need to do," he said.

"We have to again re-establish our right to be responsible for ourselves, and the duties and responsibilities that come with that," said Courchene.

"Going to our way of life is, I feel — and many of the knowledge keepers feel — is the best chance for young people right now to come to terms with their own identity."

Lack of identity for youth: chief

Sagkeeng Chief Derrick Henderson said his community is incredibly fortunate to have one of the few centres in the province like Turtle Lodge.

"But for the other communities, it's too bad because they definitely need to have that direction with respect to their identity as to who they are as Indigenous people," he said.

Henderson believes youth in his community get pulled into substance abuse and mental health struggles because they don't know who they are.

"What I'm finding is that they're trying to fit into society and what society offers them today, right? It's not good."

Courchene says there's only so much Turtle Lodge can do with the small grants it receives, and the centre needs more resources to have a greater impact. (Submitted by Turtle Lodge)

The web of bureaucracy of the provincial health-care system further exacerbates the challenges facing Indigenous youth, he said.

"They [the Manitoba government] want to do it their way and that's the only way they can see it. If we have our own people helping our people, then the results would be different, and that's one of the biggest barriers," he said.

"I can address that issue myself in our community if we're given the direct funding for these programs."

'Not being treated in the right way'

Métis and two-spirit family physician Dr. Melinda Fowler says there has been a failure to help rural and northern communities cope with historic trauma, substance use and mental health.

"[It] is not being treated in the right way," said Fowler, who is director of education for Ongomiizwin, the Indigenous Institute of Health and Healing at the University of Manitoba.

Fowler said healing-centred Indigenous traditions — including smudging, sweat lodges, and access to traditional healers — need to be supported financially and given priority.

"And they have to be supported by the Western or mainstream society," she said.

"We shouldn't be providing health care any longer [where we're] having culture, ceremony, knowledge keepers, elders and healers as a last resort — they should be the first suggestion."

Dr. Melinda Fowler is the director of Ongomiizwin Education at the University of Manitoba's Indigenous Institute of Health and Healing. (Submitted by Krista Anderson)

She said a common problem in northern and remote communities is ultimately an issue of unstable funds from federal and provincial governments. Some First Nations periodically get Indigenous-focused health programming for youth in crisis, only to see the funding and programming disappear in time, she said.

The health-care system has to focus on building on the strengths and teachings of Indigenous culture and think in a preventive way, beyond the conventional primary care and education models, said Fowler.

I have struggled like crazy to get people into programming that is culturally based. - Dr. Melinda Fowler

That should include more land-based programming that teaches Indigenous youth how to hunt, harvest berries and pick medicines, she said.

"We need to teach our people what we used to learn as Indigenous people and that should be the basis of educational programming," she said.

'Step up and change'

That requires thinking beyond individuals when it comes to treatment, Fowler said.

"We need to treat the family as a unit and we need to involve youth with elders and elders with youth, and we need to treat communities," she said.

"This is a very Indigenous-focused world view, because we don't think in silos — we think beyond ourselves."

Fowler has helped patients access culturally based treatment in centres in Peguis First Nation and Norway House Cree Nation, but she says there are still few options.

The things that our province continues to try, it's just not working, and why it's not working is because it's not being led by Indigenous people. - Jackie Anderson, Ma Mawi Wi Chi Itata Centre

"I have struggled like crazy to get people into programming that is culturally based and culturally safe and relevant. There's not enough of these in existence, there's not enough funding, there's not enough beds, especially when it comes to female populations," she said.

"I don't know when the province is going to step up and change things."

Letting Indigenous voices lead

Jackie Anderson said she knows that shortage all too well.

Anderson has spent the past 20 years at the Winnipeg family resource centre Ma Mawi Wi Chi Itata, working with children involved with Child and Family Services who have been exploited.

"It's common knowledge that access to any kind of treatment for young people and for adults — there's none," she said.

"Those [options] that are out there, we're looking at a 200-day wait list for anyone that's an adult."

She helped lead the development of two safe homes in Manitoba, including the six-bed facility Honouring the Spirits of our Little Sisters for sexually exploited girls and transgender youth, and a traditional healing lodge called Hands of Mother Nature.

Ma Mawi Wi Chi Itata's Jackie Anderson said traditional ceremonies offered at this centre, whose location outside of Winnipeg is confidential, help Indigenous youth heal from the trauma they've experienced. (Submitted by Jackie Anderson)

A spokesperson with Indigenous Services Canada said the federal government is working with First Nations to develop culturally minded solutions to addiction and mental health issues.

That work is building off Jordan's Principle — which aims to ensure disputes between provincial and federal governments don't delay care for Indigenous children — and a March 2018 memorandum of understanding between the federal government and Manitoba Keewatinowi Okimakanak committing to a "First Nation-led health care transformation" in remote northern communities.

The federal government currently funds a suicide and substance use prevention online chat and telephone help line, as well as community-based programming such as Building Healthy Communities, Brighter Futures and the National Native Alcohol and Drug Use Program.

At the provincial level, a spokesperson with Shared Health Manitoba said a number of Virgo report recommendations are underway that will remove barriers and make for more integrated, co-ordinated care options across the province.

The Strongest Families Initiative, a partnership between the Manitoba government and communications company Bell's Let's Talk program, launched in January based on Virgo recommendations. It aims to provide mental health services to children and youth in rural and remote settings.

The province has also committed to opening rapid access addictions clinics provincewide and enhancing access to withdrawal and stabilization services, the spokesperson said.

'It's just not working'

But Ma Mawi Wi Chi Itata's Anderson said the reports from Virgo and the children's advocate failed to adequately consult with Indigenous communities on how to accomplish the recommendations they make.

Virgo recommended the province actively engage with Indigenous communities, organizations and elders in the process of refining strategies during its health-care overhaul — something Anderson said it isn't doing well.

There is an untapped strength and resilience in Indigenous tradition, said Anderson, and Indigenous people need to be involved from the ground level if changes to the health-care system are to make a difference.

"The things that our province continues to try, it's just not working — and why it's not working is because it's not being led by Indigenous people," Anderson said.

"They're not clients — they're children, they're little brothers, our little sisters," who need to be given the chance "to start healing and really know what their self-worth [is]," she said.

"They're amazing young people if they're given the opportunity to grow and make mistakes along the way, and not be given up on."