Thank you very much for the invitation. It's a pleasure to be here with you on traditional Algonquin territory.
I think the reason I was invited was that when I was living in Nunavut, I was the government suicide prevention adviser. At that time I had the opportunity to work very closely with Natan Obed, whom I hold in the highest regard, so it's always a pleasure to be presenting with Natan.
I've shown this graph hundreds of times, and every time I look at it, it fills me with sadness and with shame, frankly, as a Canadian. What this shows us is the evolution of the rate of suicide by Inuit living in Nunavut from below the national average in the 1960s and 1970s up to the present day. For the last 15 years the rate has been just under 10 times the national average.
I heard Cathy McLeod ask about trends. The reason I can do this is that in the territories, death certificates are coded by ethnicity. The reason you don't have something similar to this for first nations in the provinces is that in the provinces, no death certificates are coded by ethnicity. This is a rare example of being able to document a pretty serious epidemiological transition from a low-suicide-rate society to a high-suicide-rate community.
The rate is highly structured by age and sex. The most at-risk population is young men. This is not the structure of most of the society. It's also structured by geography, so the red dots are the communities with the highest rates. You'll see they're overwhelmingly in the Qikiqtani region, plus one community in the west. I think this is explainable based on modern social history.
It's an odd thing to talk about mental health outcomes of individual ethnic groups, I realize, but if we look at the United States, where we do have data broken out by ethnicity, we see, for example—however uncomfortable we might feel about the concept of race as used in the United States—that this official government data shows that black people in the United States die by suicide at a much lower rate than white people do. We can talk about that, but it's a fact.
If we put Canada in for comparison, as a whole, because we don't have this kind of data, we come in between the two. Asians and Hispanics are much closer to blacks than to whites.
If we add in the American Indian and Alaska native population—that's the official coding, American Indian and Alaska native—it's very interesting. At the national level, white people and American Indian and Alaska natives have effectively the same rate of suicide across the United States, but it's structured differently, with much higher rates among younger people, among indigenous Americans, and among older white Americans.
If we look at the state level, we see that there's one state, Alaska, that has a rate of over 40 per 100,000, but there's another state, Texas, with 100,000 indigenous people, that has a rate of under four per 100,000. The rate varies massively in the United States at the state level only among American Indians and Alaska natives, not among other ethnicities.
The logic I take from that is that aboriginality per se is not a risk factor. It's the lived conditions of being aboriginal in different parts of the United States.
If we were to take Alaska out from the rest of the indigenous population, we see that actually a lot of the youth suicide is in Alaska and that in the southern states, youth suicide isn't as big a problem as it is in Alaska. If we take it one step further and put in Nunavut, we see the scale of Inuit youth suicide in Nunavut in comparison to Alaska and the rest of the United States. It's pretty shocking.
As we know, suicide behaviour is complex and multi-causal, but the WHO has said for years that it's a largely preventable public health problem. I think we should focus on both parts of that: largely preventable, and public health.
We need to look in terms of cohorts of people who die by suicide. For example, people whose first suicide attempt, whether it's to completion or not, is later in life have one basket of risk factors. People who attempt as teenagers or in their early twenties have a different pattern of risk factors. In our higher-risk indigenous communities, keeping in mind that the rate is very high among our community, it's the basket of risk factors for young people that we need to be thinking about.
We did do a five-year, CIHR-funded follow-back study in Nunavut, supported by everybody. We looked at all 120 deaths in four years, matched with case controls. The reports are online. We did not find risk factors that were unique to Inuit. We found the usual risk factors, operating at a much higher level in some cases.
The conclusion is that mental health matters. There's a need to focus on families and communities as well as individual-level issues.
As I mentioned, I was part of the team, with Natan, that developed the “Nunavut Suicide Prevention Strategy”, which I think we're very proud of. It was very well received when it came out. There is a link to it. Unfortunately, the initial years of implementation have not gone well. However, as you may know, last year the Nunavut government declared a state of suicide crisis and created the world's first minister responsible for suicide prevention position. We're hoping that things will be taken more seriously in the near future.
I want to show you rates for Inuit and Nunavut, and Inuit and Greenland, and point something out. We have data from Greenland for the period 1900 to 1930 from the first chief medical officer of health, which is a rate of 3 per 100,000. I've gone through RCMP files, and I've calculated a rate of 20 for the period of 1925 to 1945.
However, in the Arctic, starting in the late sixties and early seventies, the rate takes off everywhere across Inuit societies. Let me point out that it was not the people who were coerced into settled communities by the government as adults who started dying by suicide: it was the first generation of children to grow up in the settlements in those early days, where there was a lot happening in terms of power and people being bossed around.
There is very interesting data from New Zealand, more detailed data than we have for Canada, showing that Maori have transitioned from a society with lower than national norms use of mental health services and lower than national norms of suicide behaviour to higher rates. However, if you do the analysis—and the data from the Christchurch human development study is linked at the bottom—and you control for socio-economic childhood disadvantage, family adversity, and other socio-economic factors, “Maoriness” disappears.
People aren't not well because they're Maori; they're not well because one section of the Maori community is poor, with low educational outcomes and high rates of substance abuse. There are a lot of Maori who don't fit that profile, but the kids of those Maori who are in trouble in their lives grow up in trouble, just like other people's kids in those conditions grow up in trouble. That's changing. It teaches us that when we talk about mental health outcomes among Maori, we know too much to be able to talk about the Maori as if it's one group of people. There are Maori who are doing well and there are Maori who are not doing well, just like everybody else.
In the new Australian indigenous strategy that accompanies the national strategy, we see the focus on the developmental precursors of suicide and suicide behaviour. Understanding that early childhood adversity can put people on a pathway to trouble in life, the end result of which might be suicide behaviour, invest upstream and take a public health approach so that fewer people need services as teenagers and adults.
I watched the video of the meeting on May 31. I heard several references to Quebec. Canada is a backwards country when it comes to suicide prevention. We're one of the few developed countries to not have a national strategy. However, within Canada, we have one of the greatest success stories in the world. That's why the International Association for Suicide Prevention met in Montreal last year to talk about Quebec. It is fantastic to cut a province's rate of youth suicide in half in a decade, and I hope you look into how they did it. I can suggest people you might want to talk to about that.
I've taken the liberty of coming up with six short references for you, which I can deliver in one minute.
Number one, carefully recommend the landmark 2014 WHO report, “Preventing suicide: A global imperative”. Yes, it took the WHO too long to release this report, but it's great. It's weak on indigenous peoples, but it's a great report generally.
Second, when it comes to elevated rates of suicide behaviour in some indigenous communities—because let's be clear that not all indigenous communities have high rates of suicide in this country, and we know that—take a look at the evidence, pay attention to the realities of social disadvantage, unresolved grief, early childhood adversities, and the need for culturally appropriate mental health care.
There's a lot of prejudice, but there's a lot of nonsense spoken in the media about the root causes of suicide in indigenous behaviours. Some of it is pretty unpleasant in its characterization of indigenous peoples. You have to get down to actual results. There is substantial evidence, clear and compelling evidence the size of the Himalayas, on the relationship between poverty and socio-economic inequality with mental health outcomes and suicide behaviour. The world isn't always as complicated as some people make it out to be.
I would urge the federal government to act on the WHO's recommendations and Quebec's success by developing and implementing a national strategy for suicide prevention. Mr. McLeod asked on May 31, “Where is the strategy?” You can make a strategy happen for everybody, not just indigenous peoples.
I would urge you to allow the national indigenous organizations to determine the character of what suicide prevention should consist of in their regions. Nobody has given more thought to suicide prevention in Inuit communities than Inuit themselves.
I would urge the federal government to support ITK's forthcoming national Inuit suicide prevention strategy with the allocation of resources commensurate with the high social burden of suicide behaviour in Inuit communities. If Inuit youth had been dying at this rate from HIV/AIDS, there would have been a coordinated federal intervention, because it's a communicable disease. How do we explain the lack of action on shocking levels of teen suicide for 25 years? Let's get over it; let's do it.
Finally, on a personal level, I am an ASIST trainer. I teach two-day applied suicide intervention skills training workshops. I think it's great. I wouldn't do it if I didn't think it was great. I encourage you as individuals back in your home communities to take ASIST. You won't regret it, and if you'd like to know how you can do that, drop me a line, and I'll make it happen for you.
Thank you for your attention.