Indigenous and Northern Affairs Committee on May 31st, 2016

[The Chair, Liberal, Andy Fillmore]

We'll come to order, please.

Welcome, everyone. We're very grateful today as always to be meeting on unceded Algonquin territory.

I just want to take one minute for some housekeeping, and then we'll get right into the session with our guests.

First, I want to say welcome back to David Yurdiga who's been doing yeoman service in Fort McMurray for the past several weeks, helping his community there. David, well done. It's nice to have you here.

I'd like to introduce the committee to Grant McLaughlin, who is joining us right now as a clerk for a while. You'll be seeing his face around, and we welcome Grant as well.

With regard to the suicide study, if you still have witness names you'd like to add to that list, I'm reminding you of the June 15 deadline for additional witnesses so that the analysts can plan the logistics of that trip and that study.

Then finally, you may recall at our last meeting we talked about having each member indicate which of the communities we're visiting are mandatory for them and which would be nice to have.

Michelle Legault, as our clerk, has kindly prepared a little form. It's easy to fill in. You check boxes. I'm going to ask Michelle to pass that around. Perhaps you or the staff members that are with you might get that done while we are here today. That would be great, but if not, certainly if we could have that completed form back for Thursday's meeting this week, that would allow us to build a budget and proceed with the study.

Thank you very much for that. Let's go right in.

We're very happy to have some guests from Indigenous and Northern Affairs Canada. We welcome Paula Isaak, the assistant deputy minister, education and social development programs and partnerships; and Daniel Leclair, director general of the community infrastructure branch, regional operations. From Health Canada, Keith Conn is with us. He is the assistant deputy minister of regional operations. Dr. Tom Wong is here again, executive director, office of population and public health. From the Canadian Institutes of Health Research, we have Dr. Alain Beaudet, the president.

Welcome to you all.

Since we have this group for the full two hours, I wonder if we might give our speakers 15 minutes rather than the usual 10. Is there consent among the committee members for that?

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

There are bells at 5:15.

[The Chair, Liberal, Andy Fillmore]

Cathy McLeod reminds me there will be some bells at 5:15 for a vote at 5:30; perhaps we should stick with the 10 minutes, if you're able to stay.

Thanks and let's get right to it.

Who would like to start?

[Dr. Tom Wong, Executive Director, Office of Population and Public Health, Department of Health]

To begin, I would like to acknowledge that we are on the traditional territory of the Algonquin people. Thank you for gathering us here today and inviting us to speak on this very important issue of suicide in indigenous communities in Canada.

As a physician and as a father, I know the death of a child is heartbreaking. A death of a 10-year-old child by suicide compounds that heartbreak as the profound impacts spread across families and communities. The circumstances are tragic and difficult to comprehend. When we ask ourselves why, we must acknowledge the impacts of colonization, which continue to affect indigenous peoples today. The Truth and Reconciliation Commission has offered Canada the knowledge and recognition that policies of forced assimilation have assaulted and suppressed indigenous culture for as long as Canada has existed as a nation.

As a nation, we now have an opportunity to recognize that the introduction of the reserve era in the 19th century, the residential school experience in the 20th century, and the forced adoption policies of the sixties and the seventies are just examples of policy that led to eradication of culture, loss of language, erosion of traditional values, and the disintegration of traditional family structures. These impacts have been passed down through the generations and these effects are often referred to as intergenerational trauma and have led to the tragedies that we collectively face today.

Health Canada, through the first nations and Inuit health branch, recognizes the need to reset its relationship with indigenous partners, and through these relationships, support community-led, comprehensive, culturally founded, and culturally safe services that are integrated into a broader continuum of wellness programming.

My role and the work of the branch is guided by inclusive and participatory policy engagement approaches with first nations and Inuit organizations, as seen through several key frameworks developed in partnership with indigenous organizations.

In fulfilling the mandate to promote the health of indigenous peoples, I advocate for equitable programming to address social determinants of health, and to strengthen prevention, diagnosis, treatment, support, surveillance, and data for public health actions.

In Canada, the rates of indigenous suicide are much higher than the general population. The overall Canadian rate has declined, while in some aboriginal communities rates have continued to rise. In general, risk factors for suicide include depression, hopelessness, low self-esteem, substance use, suicide of a family member or friend, a history of physical or sexual abuse, family violence, intergenerational trauma, poor peer relationships, social isolation, poor performance in school, and unemployment, to name just a few.

Protective factors that contribute to resilience include family cohesion, good communication, feeling understood by one's family, involvement in family and community activities, indigenous language, cultural knowledge, activities with elders and traditional healers, community self-determination, good peer relations, and school successes.

Suicide is just one indicator of distress in communities. For every suicide there may be many more people suffering from depression, anxiety, and despair.

There are five key elements funded by Health Canada to support first nations and Inuit health: health promotion, health protection, primary care services, supplemental health benefits, and health infrastructure support. Health Canada spends $300 million a year in community-based programming and services guided by mental wellness frameworks. Through a variety of targeted programs, organizations and communities deliver mental health promotion, addictions and suicide prevention, crisis response services, treatment and aftercare, including prescription drug abuse and supports for eligible former students of Indian residential schools and their families.

Mental wellness teams are community-led teams that provide a comprehensive suite of culturally appropriate services, which include but are not limited to capacity-building, trauma-informed care, land-based activities, early intervention and screening, aftercare, and care coordination with provincial and territorial services. Each mental wellness team serves between two and 10 communities, depending on community size, location, and need. Health Canada has allocated funding to regions for 10 mental wellness teams. The B.C. First Nations Health Authority also funds a team in B.C. However, flexible funding allows regions to maximize the number and reach of teams to address regional needs.

The brighter futures, building healthy communities program, available to all first nations and Inuit communities, supports improved mental health, child development, parenting skills, healthy babies, injury prevention, and response to mental health crisis, depending on community needs.

The IRS resolution health support program provides cultural, paraprofessional, and professional supports to eligible former students, their families, and communities.

The national native alcohol and drug abuse program and the national youth solvent abuse program include funding for 43 first nations addiction treatment centres and community-based prevention programs that respond to substance abuse.

The national aboriginal youth suicide prevention strategy supports over 130 community-based suicide prevention projects in first nations and Inuit communities across Canada. Strategy funding was used to train over 800 community-based front-line workers to provide culturally appropriate information about suicide prevention. We have seen positive results.

For example, the Taiga Adventure Camp is a camp for girls aged 11 to 17 and is open to all 33 Northwest Territories communities. The goal of the camp is to increase self-esteem and promote healthy living, relationships, and mental wellness to protect against youth suicide. The camp uses outdoor skills development to provide leadership opportunities and develop confidence and respect for others. Outcomes have shown improvements in confidence, initiative, leadership, and optimism, an increased ability to address conflict, and improved knowledge of protective factors.

The department is also supporting the development of a web-based first nations “wise practices” resource that will allow communities to access and implement proven and promising youth suicide prevention strategies.

The Mental Health Commission of Canada has been provided with $1.2 million from FNIHB to support first nations and Inuit adaptation of its mental health first aid training.

Health Canada, the Assembly of First Nations, and community mental health leaders jointly developed a first nations mental wellness continuum framework, grounded in culture as its foundation.

Application of the framework is supported by an implementation team with members across regions and communities, as well as the department.

FNIHB is also supporting ITK in their work to develop Inuit mental wellness teamwork and an Inuit suicide prevention strategy. Both the strategy and the framework are anticipated to be finalized later on in 2016.

[The Chair, Liberal, Andy Fillmore]

You have one minute remaining, Dr. Wong.

[Dr. Tom Wong]

Other federal programs and departments, including but not limited to INAC, Public Health Agency of Canada, CIHR, Public Safety, and Justice provide programs and services to first nations that address indigenous social determinants of health, and they are important partners in this effort.

Health Canada is working with partners on their approach based on mental wellness frameworks that amalgamate mental wellness programming and seek additional resources to address gaps. Additional resources are required to expand core services and services that help indigenous people, and any new federal funding will support the long-term goal of transfer to communities, alignment, and integration with provincial services. Promising practices of community healing relate to culture and identity, and are community-based, community-paced, and community-led initiatives with strength-based and holistic approaches that blend western and indigenous therapeutic approaches with strong community relationships.

While important progress has been made, it is clear that more needs to be done. The levels of health inequity between indigenous Canadians and the rest of Canada are unacceptable. Health Canada will continue to work with first nations and Inuit to advance areas of mutual priority. Efforts to support first nations and Inuit in their aim to influence, manage, and control health programs and services that affect them continue to be fundamental for improving health outcomes and access to needed health services and programming.

In addition, Health Canada will participate in a whole-of-government approach to address the recommendations of the Truth and Reconciliation Commission, but this is not something we do alone. Reconciliation is the work of Canada as a whole. I ask you to join us in the efforts of reconciliation and ensure that all children in Canada have access to nutritious food, safe housing, quality education, clean water, and finally, access to a robust and responsive health system.

Mr. Chair, I'm glad we had the opportunity to present here today on this very important issue. My colleagues and I would be pleased to respond to the committee's questions at the end of all the opening remarks. Thank you.

[The Chair, Liberal, Andy Fillmore]

Thank you very much for those remarks.

Let's move right along to the next speaker, Dr. Beaudet.

[Dr. Alain Beaudet, President, Canadian Institutes of Health Research]

Thank you, Mr. Chair.

First I would like to thank the committee as well for inviting me to discuss this critical issue of suicide prevention in first nations, Inuit, and Métis communities. As president of the Canadian Institutes of Health Research, or CIHR, I appreciate the opportunity to share with your committee the vital role that research is playing to address this tragedy.

As you may be aware, CIHR is the Government of Canada's granting agency responsible for supporting health research in universities, hospitals, research centres, and communities across Canada. CIHR's commitment to address the disproportionate health burden faced by indigenous people in Canada is steadfast. This is why we have made the health and wellness of indigenous communities and families one of four research priorities in our most recent five-year strategic plan.

When it comes to suicide, science has a critical role to play in helping us understand the root causes of this most complex and sensitive issue, and in developing evidence-based solutions for preventing it. The causes behind the unacceptably high incidence of suicide among indigenous people and how to design and evaluate interventions aimed at promoting mental wellness are at the heart of our research efforts.

It is important to understand that the research funded by CIHR on the topic of suicide and mental health covers a vast range of the health sciences, from basic to applied. It ranges from studies on the biological basis of depression to investigations of the cultural, social, and environmental risk factors linked to suicide ideation.

It includes, for example, research on the effects of the environment on genetic disposition to mental health disorders, research on intergenerational health impacts of residential schools, studies linking suicide to variance in exposure to daylight in the north, and the psychosocial impacts of housing conditions.

The research is happening at all levels, for it is critical to understand the etiology and the risk factors underpinning these high suicide rates if we want to be in a position to meaningfully address and prevent them. Indeed, research on suicide is not only meant to improve our understanding of the problem, but it is also meant to help develop evidence-informed interventions and programs, in other words, to translate knowledge into practice.

Appropriate interventions can be successful, as demonstrated by Quebec's preventative efforts, which led to a more than 50% reduction in suicide rates among its youth; this reduction was even more pronounced among young men.

It is imperative that research be leveraged in a similar way to help address suicide in first nations, Inuit, and Métis communities. We are talking about two very different sets of research questions and approaches here. The first, referred to as intervention or comparative effectiveness research, is about developing and testing the efficiency of interventions under tightly controlled conditions. The second, referred to as implementation research and delivery science, or IRDS, is about implementing and scaling up successful interventions in the real world. What works, for whom, and in which circumstances? How can successful prevention strategies be adapted and scaled up for different communities and settings?

Implementation science needs that research to be embedded into care and adapted to socioeconomic and cultural contexts to maximize efficiency and impact.

Implementation science and delivery research is a relatively new area of health research that we have embraced at CIHR to address a number of global health issues, including indigenous people's health. Thus, through a major strategic research initiative called “Pathways to Health Equity for Aboriginal Peoples”, we have supported a series of implementation science projects aimed at improving mental wellness and reducing the incidence of suicide in indigenous communities.

For instance, a project led by Dr. Claire Crooks from the Centre for Addiction and Mental Health in Toronto, took the mental health first aid program and adapted it to first nations communities across Canada. This original program had been demonstrated to increase individual skills and knowledge about how to respond in a mental health crisis.

It is currently used across Canada; however, previous evaluation studies found a critical need to culturally adapt the program to first nations communities. Using a combination of interviews, focus groups, implementation tracking, and surveys, the research studied the implementation of the adapted program in several first nations communities and confirmed its effectiveness.

Another example of the CIHR-funded research aimed at implementing research into practice is ACCESS open minds, a groundbreaking, national research network focused on youth mental health. Through this network, supported in partnership with the Graham Boeckh Foundation, researchers are taking existing mental health practices and treatments and making them age-appropriate for diverse youth populations. Through testing and evaluation of these tailored youth interventions at 12 sites across the country, including five that are working with indigenous communities, this network will help identify effective approaches for assessing and treating Canadian youth with mental illnesses.

A common feature of these two research initiatives is that they both involve multiple research sites and allow for learning across communities and between jurisdictions. Crossing jurisdictional boundaries also means developing international collaborations to address suicide prevention. The issue of indigenous suicide is not unique to Canada. Indigenous populations in other countries such as the U.S., Denmark, Sweden, and Australia are facing similar challenges.

While some of the causes and manifestations of suicide differ across countries, as they do across Canada's first nations, Inuit, and Métis communities, there are also important points of commonality and overlap. This shared problem presents an opportunity for joint research efforts and the sharing of best practices across borders. This is why since 2013 we've been involved in international research efforts to address suicide prevention in northern indigenous communities through the Arctic Council. Under the Canadian chairmanship of this international forum during 2013-15, CIHR spearheaded a research initiative involving researchers and community members from across four Arctic countries to identify promising practices in suicide prevention. These efforts culminated in an Arctic symposium in Iqaluit, held in March 2015, where researchers shared best practices in suicide prevention. The symposium was hosted jointly by the CIHR, the Government of Nunavut, and international partners.

As a second phase of this work, we are now partnering with a U.S. organization, the National Institutes of Health, in a follow-up project to further address suicide in Arctic regions. Through this follow-up initiative, called the RISING SUN, partners from across the Arctic states are coming together to identify common metrics to track suicidal behaviours, as well as key correlates and outcomes, so as to facilitate data sharing, evaluation, and interpretation of interventions for suicide prevention.

CIHR will soon be launching another major international research program on global mental health through the Global Alliance for Chronic Diseases or GACD, an international consortium of health research funders that Canada currently chairs. This program, with a combined international investment of over $60 million, will fund research into the prevention and management of mental disorders, with a focus on interventions in low- and middle-income countries, as well as vulnerable populations in high-income countries, including Canada's indigenous populations. Once again, through this opportunity, the CIHR will be able to leverage knowledge from international contexts that are relevant for Canada and will provide tools to tackle the issue of suicide in our communities.

These are just a few national and international examples of how CIHR is supporting research to address wellness and suicide prevention in indigenous communities. Through the science and applied research initiatives I described, CIHR is committed to continue supporting research to identify ways to promote resilience and positive mental health among indigenous peoples and to ensuring that research evidence is brought to bear on policy-making through knowledge translation.

In this regard, CIHR will look forward to continue working with Health Canada and other federal, provincial, and territorial partners to help inform policies and programs related to indigenous health.

Before closing, I would like to take a moment to underscore that all of the CIHR research projects in this area are designed and carried out in close collaboration with indigenous communities. Our ultimate objective over the long term is to develop and support a cadre of indigenous researchers as they are best positioned to understand from the inside the cultural determinants of mental wellness.

This is why strengthening research capacity within our indigenous population is at the heart of the CIHR agenda.

Finally, please allow me to acknowledge that research is only part of the solution to this very complex and challenging issue, but it is an important one for identifying the most effective path to achieving wellness.

Mr. Chair, thank you again for this opportunity to share our work with you in this critical area. I look forward to your questions.

Thank you.

[The Chair, Liberal, Andy Fillmore]

Thanks very much, Dr. Beaudet.

The next speaker is Paula Isaak.

Thank you.

[Paula Isaak, Assistant Deputy Minister, Education and Social Development Programs and Partnerships, Department of Indian Affairs and Northern Development]

Good afternoon, Mr. Chairman and members of the committee.

I'd like to thank the committee for this invitation and would also like to acknowledge that we are gathered on traditional Algonquin territory. This is an important study, and I want to offer INAC's full support as it evolves.

As my colleagues have noted, suicide is often the tragic consequence of a complex array of factors.

That includes mental health issues such as depression, substance abuse, social and family factors, poor performance in school, and bullying or relationship issues.

One of the contributing factors to high suicide rates among first nations and Inuit, including youth, is inadequate basic supports. These can include a lack of income supports, education opportunities, adequate housing, or health and social services. These factors of instability have direct repercussions on the decline of mental health in indigenous communities, and each element is part of a continuum that is vital to providing a sense of hope, to wanting to go on in life, and to seeing oneself contributing in society.

I understand that, among other aspects, the committee will be studying these risk factors broadly, as well as protective factors that promote well-being and help reduce vulnerability.

This broad approach is helpful because so many players are involved in ensuring that those basic needs for indigenous communities are met.

For my part, I'll frame my remarks around those elements today, in order to best provide context on INAC's roles and programs. INAC, as you know, is a focal point at the federal level for indigenous issues. We are one of 34 federal departments responsible for meeting the Government of Canada's obligations and commitments to first nations, Inuit, and Métis.

INAC provides financial support to first nations communities to deliver services on reserve. This includes education, housing, and social support to indigenous peoples.

Our social programs aim to assist first nation individuals and communities to become more self-sufficient, and promote strategies to reduce the risk factors that negatively affect the health and well-being of communities.

Embedded in many of these programs is funding for prevention. It supports indigenous families and communities in taking steps to avoid situations of crisis, and in achieving improved outcomes whether they be in the care of children or generally in the support for greater participation in the labour market.

The department flows funds to first nation bands, organizations, and, in some cases, provincial service providers who provide on-reserve residents with individual and family social services that aim to offer culturally appropriate programming to meet the needs of those individuals and families.

INAC also provides funding for a suite of elementary and secondary programming through core funding and complementary targeted request- and proposal-based education programs that seek to focus on specific aspects of education support and success.

INAC's elementary and secondary education program funding is part of a broader strategy of investment in first nations children and youth. In addition to supporting elementary and secondary education, INAC also provides support to first nation and Inuit students to attend post-secondary institutions. Health Canada and the Public Health Agency of Canada provide early childhood programs such as the aboriginal head start program, which helps promote school readiness among aboriginal children. Employment and Social Development Canada has labour market programs tailored specifically to aboriginal Canadians, including the first nations job fund and the aboriginal skills and employment training strategy. Departments are increasingly looking for ways to enhance co-operation.

In all cases, the programs are intended to be community-driven.

These types of programs go a long way toward promoting stronger, healthier communities, and toward reducing vulnerability and improving mental well-being.

The fundamental challenge that's before all of us is improving the foundations upon which indigenous communities can thrive. When those basic needs are not met, it is a tragic reality that crises and emergencies can occur. In those cases, as the committee knows, both our minister and departmental officials engage quickly with local leaders to discuss how best to give immediate and long-term help.

Certainly this outreach informs our ongoing efforts on how to proceed to meet the Government of Canada's commitment to working on a nation-to-nation basis and improving health and social outcomes in first nation communities, identifying program supports for required services, and strengthening the resilience among children and families on reserve.

In all cases, collaboration between all partners is key in working toward ensuring the continuum is working—that basic needs are in place to not only address crises when they occur, but more importantly prevent them from happening in the first place.

As part of historic budget 2016's $8.4 billion in investments, the department is on track to providing first nation recipients with the first round of investments. Much of this early budget funding is earmarked for addressing basic needs. As that moves forward, INAC remains committed to delivering on the government's promise of a new fiscal relationship with first nations to provide sufficient, predictable, and sustained funding for first nations communities.

I can also report that the Minister of Indigenous and Northern Affairs Canada continues to work with cabinet colleagues on several early key initiatives, as outlined in their respective mandate letters.

This includes elementary and secondary education, the first nation and Inuit youth employment strategy, and post-secondary education.

Our department's work also contributes to meeting the Government of Canada's commitment in addressing the Canadian Human Rights Tribunal's order to reform the first nations child and family services program. We are also moving with all partners toward meaningful engagement with regard to informing options for program reform.

Recently departmental officials also joined the minister in announcing full support for the United Nations Declaration on the Rights of Indigenous Peoples. One of the principles of that declaration reads, “Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health.”

The department is committed to working in collaboration with partners to ensure those gaps between indigenous and non-indigenous people are closed, and to help first nations, Inuit, and Métis people improve wellness.

On one front, the department and minister spent the months from December to February engaging with survivors, families, and loved ones, indigenous organizations and governments, and provinces, territories, and experts on the design of an inquiry into missing and murdered indigenous women and girls. We expect that this inquiry will also shed more light on many of the conditions that lead, tragically, to suicide in some communities.

I will also highlight that the minister is working with the Minister of Families, Children and Social Development to launch consultations with provinces and territories and indigenous peoples on a national early learning child care framework. This is a first step towards delivering affordable, suitable, high-quality, flexible, and fully inclusive child care.

A key component of combatting this ongoing tragedy is working in partnership with indigenous communities to promote and ensure that indigenous peoples have a secure personal cultural identity. This is a key issue for the minister and department. I am sure my colleagues at Health Canada will attest to the evidence that shows that a stronger sense of identity and self-sufficiency can in fact lead to reduced rates of suicide in indigenous communities.

As I and my colleagues have noted, to truly improve the situation for indigenous peoples, we must focus squarely on improving the socioeconomic conditions they face.

We will continue to reach out to provinces, territories, indigenous leadership, and others to find concrete solutions and look at long-term needs in mental health, child welfare, education, infrastructure, and employment in indigenous communities. I look forward to the advice, support, and dedication of this committee as we move the yardstick forward together on these issues.

I will be happy to answer any questions at the end.

Thank you very much.

[The Chair, Liberal, Andy Fillmore]

Thank you very much, Ms. Isaak.

To all the speakers, I think you've been through this before, so you will know that we now go to a round of seven-minute questions. I'll continue to use the yellow and red cards, sometimes for the responder and sometimes for the questioner.

I would just invite all the members to try to come to their questions with as little preamble as possible.

Jumping right in, we'll begin with Don Rusnak, please.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

I'll be as brief as possible.

We know this is an absolutely complex issue, and there are many layers and ideas for solutions. I look at this as a short-term problem where we're reacting to the immediate crises that are absolutely horrible in these communities. That will form one of my questions.

Ultimately we're going to have to look at long-term solutions to make sure the first nations communities and the indigenous populations aren't facing these horrible issues. I'm familiar with them because of my work. For the benefit of committee members who've heard me talk many times, I've worked with first nations organizations. Over the years I've worked in first nations communities in different capacities and with different governments.

I have one question for INAC and one for Health Canada. What have you come up with in terms of immediate solutions and immediate programs to deal with the immediate crises? Are you working ad hoc, or are there crisis teams on standby? We know the problems are entrenched in the communities. We need that immediate response to the crises to make sure the communities get the support they need right away. Is there a plan in place?

The first question will go to Health Canada.

[Dr. Tom Wong]

Thank you very much for the question.

Yes, crisis needs to be dealt with in the context of needing to deal with the long-term issues. Regarding the immediate crisis, there are a number of things already in place. I spoke about the small number of mental wellness teams across Canada that have been mobilized and can be mobilized to help deal with emergencies. Within that context it has to be working together at the invitation of the first nations communities and also in collaboration with the involved province. Most recently, with Attawapiskat, there was an invitation by the province and the invitation from the community to assist. It's a collaborative effort.

The reason why I mentioned the number is small is so you can do the math. Canada is a big country. Ten mental wellness teams are a good start, but we need more to do a better job.

As far as what to do in emergencies, before dealing with emergencies one should think about whether there is a way to prevent emergencies. Some of those elements are social determinants of health, reconciliation around Indian residential schools, and the TRC recommendations. All those things need to be in place.

I will turn to my colleague, Paula, regarding some of the social determinants of health work her department has been actively working on with the communities.

[Paula Isaak]

As Dr. Wong was talking about, the long-term solution is around ensuring those basic underpinnings are solid. That means ensuring education supports, labour market supports, and income supports are there to prevent these from happening in the future. Those are long-term solutions that need to be done with the communities, jointly and collectively. There is not one strategy for all communities writ large, but there are strategies that need to be developed with those communities.

That's the commitment our department has with our Health Canada partners. Health Canada is there at the front lines when some of these crises happen, but we're right there with our Health Canada partners working with the communities to see what key underpinnings need to be strengthened.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

Immediately, is INAC working with these crisis teams through their contacts within the communities to make sure they're localized? This is probably a two-part question. What are the outcomes or successes of these crisis teams going in? What has been the reception in the community, and what's been the result?

[Dr. Tom Wong]

INAC and Health Canada work hand in glove with some of the activities in response to a crisis. For example, with a crisis we know there are some long-term issues that need to be addressed, but there are some short-term approaches that can be quickly instituted. For example, when we hear from youth that there's a need for more books, better schools, a place to play sports, and programs to actually link up with elders, some of those activities and some of the linkages do not need to wait two, three, or four years. Those are some of the things, like building a centre, that can be done very quickly.

Those are some of the practical linkages and activities that we at Health Canada have been working with communities to try to facilitate. To me nothing is as important as linking a youth who sees no hope, no meaning in life, and is disconnected from their culture to a connection with the elders and with their culture.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

I'm going to cut you off there because I want to ask a question of my friend Dr. Alain Beaudet from the CIHR. I see I have one minute left.

Targeted research funding and suicide prevention to build research capacity at the community level, build partnerships with communities.... How many community-based research projects and suicide prevention research projects were funded, and what are the outcomes of those funded projects?

[Dr. Alain Beaudet]

We've been funding a number of communities. I can't pull open the exact number, because different projects will fund different numbers of communities. We've been funding particularly through major strategic initiatives and implementation science, as I said, which actually aims at integrating research and care.

We not only implement an intervention but ensure that the intervention as it is being implemented has a research protocol built into it so that you can actually analyze the results and determine if the intervention is effective, and if it's not, how you can correct the course to improve it.

We've done that with multiple communities and particularly in the ACCESS open minds project, and the advantage of it is that we then bring the researchers and the network together so that we can compare notes on the effects of the interventions on the various communities.

I think what I could best do to illustrate the impact is perhaps to read you an email that I received from the chief of the Eskasoni First Nation. He writes, “As Chief of Eskasoni First Nation, I have been on board with being involved with the jointly funded CIHR/Graham Boeckh Foundation ACCESS Open Minds initiative since day one! With more than half of Eskasoni’s population being under the age of 25, I, and my fellow council members, are excited that ACCESS Open Minds will build upon our current model of mental health/addictions care and make our services even better. We believe that this enhanced model—which includes and blends case management/care facilitation, 24/7 online, in person, and toll free crisis intervention, peer support/lived experience, sports, recreation, and Aboriginal cultural and traditional teachings with Western therapeutic interventions, therapies, and practices—can be implemented successfully by others throughout Canada.”

[The Chair, Liberal, Andy Fillmore]

Thank you, Dr. Beaudet.

Now, Mr. Rusnak.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

My friend, Jaime Batiste, who's from Eskasoni, will actually be here this week meeting with me and Phil Fontaine.

[The Chair, Liberal, Andy Fillmore]

Thank you.

Next is Cathy McLeod, please.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

Thank you to the witnesses.

This is a quick question. We know that the rate is horrific; it's unacceptable. In the period between 1980 to 2016 has the suicide rate decreased at all in indigenous communities?

[Dr. Tom Wong]

The question is a complex one. The reason is that surveillance or information gathering is very specific to each community. Therefore, the statistics for Canada as a country and specifically for first nations on reserve nationally do not come on a day-to-day basis. They only come when periodic surveys are done.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I thought that could be a quick sort of.... Is your sense, then, that we are making any headway on this issue, or are the rates as horrific as always? Just a quick answer....

[Dr. Tom Wong]

Unfortunately, there are some communities where we are actually seeing increases in suicide. However, there are some communities that are not experiencing any suicide or are experiencing a decrease in suicide.