Canadas Inuit Launch National Suicide Prevention Strategy

Canada’s national Inuit organization unveiled its highly anticipated suicide prevention strategy last week during an emotional ceremony in Kuujjuaq, northern Quebec.

“All Canadian Inuit are affected by suicide,” said Natan Obed, president of Inuit Tapiriit Kanatami (ITK), in an interview following the strategy’s release. “Every single day we have that level of internalized grief.”

Speaking at the event, Obed visibly held back tears as he spoke of how suicide has affected his family. The community of Kuujjuaq, where the launch was held, is still reeling from a spate of suicides earlier this year.

Addressing suicide has long been Obed’s personal goal. Though the strategy has been under development over the past two years, much of it came together since Obed assumed office last fall and placed suicide prevention at the top of the organization’s priorities.

Inuit struggle with the highest suicide rates in Canada, ranging from five to 25 times the national average, with particularly alarming rates among young men between the ages of 15 and 29.

The statistics are not unique among indigenous people in the circumpolar region. In 2010, Greenland, whose population is predominantly Inuit, recorded 82.8 suicides per population of 100,000 —more than seven times Canada’s national average.

But unlike Greenland, Canada does not have a national suicide prevention strategy. The plan unveiled by ITK is the first to cover the country’s four Inuit regions, collectively referred to as Inuit Nunangat, promoting a collaborative approach between the territory of Nunavut, Nunatsiavut in Labrador, Nunavik in northern Quebec and the Inuvialuit Settlement Region (ISR) in the Northwest Territories.

 “What Our Parents Went Through”

The first half of the National Inuit Suicide Prevention Strategy (NISPS) reads like a history lesson. It covers the federal government’s decision in the 1950s to forcibly relocate Inuit families into communities. It describes the way the Royal Canadian Mounted Police culled sled dogs, preventing hunters from providing for their families and living off the land. It chronicles the damaging effect the federal government’s residential schools had on families and children, the far-reaching consequences of tuberculosis and the substandard government-provided housing that led to overcrowding.

The strategy’s historical context sends a pointed message to those who mistakenly assume suicide is inherent in the culture, rather than the result of decades of trauma , says Allison Crawford, director of the Northern Psychiatric Outreach Program at Toronto’s Centre for Addiction and Mental Health. Crawford has done extensive work as a consultant psychiatrist in Nunavut, and was part of the team of researchers and policymakers who developed the strategy.

“We act like this crisis is out of our hands,” says Crawford. “Suicide is a solvable problem.”

To George Hickes, Nunavut’s minister responsible for suicide prevention, the historical narrative is key to helping Inuit heal.

“Some people don’t talk about the trauma they went through personally with their family,” he said in an interview following the strategy’s launch. “This gives us an opportunity to know what our parents and our grandparents went through … so we could have the privilege of having our lives today.”

The strategy’s document also points to continuing concerns: Only 29 percent of Inuit between the ages of 25 and 64 have completed high school, for instance, versus 85 percent of Canadians in the same age bracket. Despite the high costs of living in the Arctic, Inuit earn around C$12,000 ($9,200) less than the average Canadian salary, and C$60,000 less than non-Inuit living in Inuit territory. In the Inuit Health Survey of 2007–2008, 41 percent of respondents reported having experienced some form of sexual abuse during their childhood.

According to ITK’s strategy, all of those factors, both historical and modern, are related.

“When someone ends their life by suicide,” the document states, “we know that an accumulation of life circumstances and events has shaped that decision.”

A C$9-million beginning

During the launch, Health Canada pledged C$9 million ($6.9 million) over three years in support of Inuit-specific mental health services, early childhood development programs and Inuit-led suicide prevention programs. ITK worked with the federal government in determining how the funding would be allocated.

“It is the first time that ITK has released a strategy that has received funding on day one from the federal government, so it is a landmark change in a way that we interact with the federal government,” said Obed.

As an advocacy group, ITK does not itself deliver programs and services. Instead, said Obed, the organization will consult with various levels of government as well as regional and national organizations in creating and improving programs.

Some of the funding, said Obed, could be used to expand capacity-building programs such as Applied Suicide Intervention Skills Training (ASIST), a two-day course in identifying and supporting those at risk of suicide that has already seen some success in Inuit communities. With more funding, the program could be offered in more communities, said Obed, and trainers would also have a more structured way of maintaining their accreditation.

While the funding announcement is welcome, said Obed, its remit is relatively narrow: “It is very specific to a few key areas of the strategy’s implementation.” What makes ITK’s strategy unique among other population-specific suicide prevention strategies around the world, he said, is its holistic approach – and implementing it will take far more funding in the long term.

“The environment in which people grow up­ creates the risk factors that ultimately are very meaningful in a person’s risk for suicide. It starts when they are in the womb,” said Obed. “We need to acknowledge that and work on that.”

The second half of the strategy aims to do exactly that. It outlines six priority areas in combatting suicide:

• achieving social equity for Inuit through improved housing, culturally relevant education, income distribution, healthcare and mental health support services
• developing programs to foster stronger connections with Inuit culture, language and the land
• supporting families to allow for improved childhood development
• developing Inuit-specific mental health and wellness support services
• healing unresolved trauma
• ensuring that these efforts are led and evaluated by Inuit.

The last point, said Crawford, is crucial. “ITK really wants this to be grounded in what’s known and the [scientific] evidence that is available,” she says, “but recognizes that it’s equally important to draw on Inuit knowledge, values and strength.” Crawford emphasizes the importance of involving Inuit in decisions around delivering, evaluating and refining suicide prevention practices: “Hopefully we will reach a point where [the evidence base will be built] on Inuit knowledge of suicide prevention, and that base will continue to grow.”

Suicide prevention resources and contacts in Canada:

• Nunavut Kamatsiaqtut Help Line provides anonymous and confidential telephone counselling in Inuktitut and English for Northerners in crisis: 1-800-265-3333 (toll free) or 867-979-3333

• The Canadian Association for Suicide Prevention provides information and resources about reducing suicide, but it is not a crisis center.