Health

No More Apologies

The latest crisis shows once again that the government must do more to stop suicides in Indigenous communities

by
• 1,270 words

Bob Rae once did something that few politicians ever do: he apologized.

As interim leader of the Liberal party in 2011, Rae had the decency to apologize for the failure of the Chrétien and Martin governments to act on the World Health Organization recommendation that all countries should develop and implement national strategies for suicide prevention. The WHO calls suicidal behaviour a “largely preventable public health problem.” And to his credit, Rae began lobbying the Harper government for such a strategy himself—to no avail.

For the past few weeks, Canadians have been reeling from the news coming out of the Pimicikamak Cree Nation in Cross Lake, Manitoba, located 500 kilometres north of Winnipeg. In a population of about 6,000, there have been six deaths by suicide in two months and 140 suicide attempts in two weeks. The community is grieving, parents are worried sick about their kids, the two resident nurses are “ready to drop” from exhaustion, and the community leadership has declared a state of emergency.

The situation in Pimicikamak shows that there has never been a more urgent need for the Liberal party to show leadership on evidence-informed suicide prevention, especially in Indigenous communities.

As one of the few developed countries not to have a national strategy, Canada is a peculiar place when it comes to suicide prevention. Quebec, which has energetically implemented a multifaceted provincial suicide prevention strategy, cut its teenaged suicide rate in half between 1999 and 2009. Overall, approximately 3,000 lives have been saved over the past ten years—an accomplishment which has brought international attention from suicide prevention practitioners. But English-speaking Canada has yet to take similarly concerted action, and the suicide rate remains unchanged at approximately 11.5 deaths per every 100,000 people.

Effective suicide prevention requires tackling both the immediate and underlying risk factors. Greatly strengthening the continuum of mental health services, better equipping youth to cope with adverse life events and negative emotions, and delivering suicide intervention training on a large scale—these measures can be accomplished and make a positive difference if the will and the resources are there. Quebec’s accomplishment is proof of this.

Around the world, many Indigenous societies with historically low rates of death by suicide have seen a sharp rise in suicidal behaviour in recent decades. One of the best-documented examples is that of Inuit in Nunavut, where coronary records dating back to the 1960s have tracked the mounting losses. No similar historical data exist for Indigenous peoples living in the south, as death certificates in the provinces are not coded by ethnicity.

NU-Inuit-suicide-graph
Calculated from data obtained from the offices of the Chief Coroners of the Northwest Territories and Nunavut, and Statistics Canada.

Not all Indigenous communities in Canada suffer elevated rates of suicide—studies demonstrate a wide gap, and many First Nations communities are well below the national rate. Indigeneity is not, in and of itself, a risk factor for suicide.

But the communities in this country with the highest rates of suicide—particularly youth suicide—are all Indigenous communities. That portion of Indigenous Canada suffers the most from the lack of a national strategy, and the financial and intellectual resources that such a strategy would make available to the parts of the country in greatest need of them.

Addressing the structural risk factors—overcrowded housing, weak and underfunded education and health programs, the transmission of historical trauma from one generation to the next (a recent phenomenon, still not well understood), addictions—underlying elevated rates of suicidal behaviour in many Indigenous communities will take time, respect, partnerships, concerted effort, and resources.

Suicide and other public health emergencies in Indigenous communities such as Pimicikamak have their roots in colonialism—both historic and ongoing—in the form of grossly substandard living conditions and inadequate health services.

After a roadblock at Manitoba Hydro’s Jenpeg power dam, close to the site of a former residential school, Premier Greg Selinger flew to Cross Lake in October 2015 and offered a “sincere apology to aboriginal people affected by hydro development.” Chief Catherine Merrick acknowledged the premier’s contribution to the healing taking place in the community, but noted that “The apology does not fix the past. It does not even fix the present. Our lands, waters and resources are still a mess. Our people still lack a fair share of the opportunity generated by the river.” The result, Pimicikamak’s website asserts, is that the federal government and the Indian Act “preside over third-world conditions of poverty, corruption and human despair.” The community is estimated to have an 80 percent unemployment rate.

The 2015 First Peoples, Second Class Treatment report from the Wellesley Institute found that “indigenous peoples experience the worst health outcomes of any population group in Canada, underscoring the urgency and importance of understanding racism as a determinant of indigenous health.”

Assembly of First Nations (AFN) National Chief Perry Bellegarde told a gathering in Winnipeg last Friday that the federal government has known about the suicide crisis in Indigenous communities for years, but has turned a blind eye to the tragedy. “There’s got to be a huge intervention there,” Bellegarde said, “but also in a lot of communities across Canada. There’s got to be a national strategy on mental health to deal with the youth suicide that is rampant amongst our communities.” The Premier of Manitoba echoed Bellegarde’s call for a national strategy, noting that “under the previous [federal] government, there had been quite a few reductions in the mental health workers in First Nations. There is clearly a need for more prevention resources.”

It’s not clear whether the programs that were shut down when former Health Minister Leona Aglukkaq terminated the Aboriginal Healing Foundation (AHF) funding will be re-established. The Mamisarvik Healing Centre in Ottawa, which specializes in treating addicted and traumatized Inuit, received core funding from the AHF. The staff have been given their termination notices effective the end of this month. Who is going to do their important counselling work?

Internally, the AFN’s work has focused on its First Nations Mental Wellness Continuum Framework, that outlines opportunities to build on community strengths and control of resources in order to improve existing mental wellness programming for First Nations communities.

The Inuit leadership is also taking action. The Government of Nunavut has created a minister responsible for suicide prevention position (the world’s first), named a senior Inuit official to coordinate implementation of the territory’s new suicide prevention strategy, and is committing significant financial resources to fund programs. National Inuit leader Natan Obed, who played a key role in developing Nunavut’s strategy, has announced that taking action to prevent suicide among Inuit is Inuit Tapiriit Kanatami’s number-one priority for the next three years. By July 2016, ITK will have released a National Inuit Suicide Prevention Strategy, and will follow up with a national plan to evaluate and monitor implementation of the strategy in September of this year.

Canada now has progressive doctors as ministers of both health and Indigenous and northern affairs. They likely both know what needs to be done, or have officials who do. The extra help that Ottawa has offered to Pimicikamak for the next eight weeks is just a Band-Aid, albeit a much-needed one. Ministers Jane Philpott and Carolyn Bennett need to be given the direction and the resources to work in partnership with representative Indigenous organizations and both provincial and territorial governments to make serious suicide prevention happen. If not, there will be other Pimicikamaks—and more apologies for action not taken.

Jack Hicks helped develop the Nunavut Suicide Prevention Strategy, and is a suicide prevention researcher and practitioner. He is adjunct professor in the department of community health and epidemiology at the University of Saskatchewan.


  • Dan

    Keep up the good work Mr. Hicks, but please save the “No More Apologies” stuff, and related moral outrage, unless some difficult truths can also be considered.

    To speak plainly, the problems in some (not all) of our Indigenous communities are not going to get better unless there is a big re-think that does not take, as an initial premise, that wholesome, integral communities can be established in far-flung and isolated places where there are no jobs, few people, no prospects. This is the inescapable reality underpinning the numerous other “structural risk factors” that you dispense with in one paragraph.

    I do not understand why it is not more widely considered racist in this country, to support the almost-apartheid of the Indian Act, whereby certain classes of people are abandoned to reservations in barely-hospitable locales, where they are not allowed to own property, and to “traditional lifestyles” which are not allowed to change or at least migrate–instead, it is racist to question whether any productive or moral purpose is being served by the continued existence of these isolated and remote communities, which breed nothing but material hardship, hopelessness and despair.

    Greater infusions of resources will not change the socio-economic realities of remoteness and isolation, as the world launches further into the age of acceleration, connectedness, and urbanization. Unfortunately, this is not the view taken by some members of the Indigenous political class (and their lawyers, like Bob Rae), who have vested interests in the status quo–the “national-strategy class”.

    Has anyone ever asked the youth in these communities what sort of lives they dream of? What they want? They have the internet, they know about the world. Every suicide, in my opinion, is a vote against the Indigenous and Canadian leadership alike.

    It is a disturbing comment on the state of Canadian progressivism, that the same country that can so proudly accept 25,000 Syrian refugees–providing families from distant lands with relocation and set-up assistance in our cities–cannot even begin to discuss similar efforts to help some of our northern brethren, now engaging in a kind of self-genocide at an increasing rate.

  • Michael Black

    So long as the stories are only about how bad things are, nothing will change. People were told they were inferior, that’s really the core of it. That’s what we need to cry about. But there’s no rebalance so long as the stories are only about the bad things.
    Tell the stories about the kids entering science fairs, tell the story about the elementary school kids who recited Martin Luther King’s “I Have A Dream” speech in Salish. Show that they are the same as us, with only a small shift in viewpoint. Or about some teenager getting Bill Gates scholarship.
    Identity is important, because that’s what others wanted to take away. But they are multidimensional, to not see the rest is to not see them as anything but stereotypes.
    Let them tell their own story, not “to give them jobs”, but because they can do it themselves. Let them tell that story, but let them tell other stories too, their somewhat different viewpoint adding to any discussion.
    The viewpoint has to change. There are streets named for the children of some white guy in Winnipeg, but they are also the children of a native woman. Toss out all those Westerns where the indians speak broken English, and realize people went to European schools soon after meeting white people, hardly a sign of “lesser”. The usual consideration is that they wanted the “superior” knowledge of Europe, but why can’t it be that they were curious, the same way I’ll read all kinds of things because it’s right in front of me?
    Everyone knows the story of their erasure, but let’s remember that they keep the language and the culture, despite all that was done. They are better off than someone like me who is them except that white guy in the Red River Colony decided the kids would be raised white, so we stopped being indians with my great, great grandmother Henrietta, who had at least some shame in being half breed. They are us, not someone over there on the reservations.
    Michael