Evidence of meeting #30 for Indigenous and Northern Affairs in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was suicide.
A recording is available from Parliament.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Thank you, both, for some great presentations here today.
One area we haven't had a conversation about is pharmaceuticals, appropriate use, and appropriate access. We have a different issue with collective trauma, and I think it was Dr. Haggarty who talked a bit about the incidence and about being less connected with normal psychiatric issues.
Do you have anything to say about that, and is there access to appropriate best practice for...?
Professor / Chief of Psychiatry, Northern Ontario School Medicine / St. Joseph's Care group, As an Individual
I'm not sure if I'll answer that question correctly, or if I understand it right. There can be a tendency for distress to mean depression and that means using an anti-depressant. We sometimes placate these issues by thinking that if we can get the newest anti-depressant, even though it's more costly....
My recent travels to Haiti reminded me that you don't need the sophisticated best stuff. What you need is a good understanding of the circumstances of the situation.
I can't comment on the rates of prescribing in these communities. What I can say is that this is where primary care.... A psychiatrist on a distant line will have a different experience seeing someone in Sioux Lookout or Thunder Bay than will a nurse practitioner in the community who understands the context. I think it's important to not confuse clinical phenomena with complex social issues that are not prescribed away.
If someone's life circumstances aren't changing, why would I expect an anti-depressant to be helpful, let alone treatments. When there are such powerful challenges to someone living a healthy life, such as poverty, homelessness, and a lack of housing, it's not uncommon for me to tell a clinician that these things have to change in order for any medication to fix this.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
So you have no sense of either over or under in terms of what would be best practice.
Professor / Chief of Psychiatry, Northern Ontario School Medicine / St. Joseph's Care group, As an Individual
I can say that until we get a grasp of the roots of what's going on, the tendency would be for there to be higher rates of distress. Amy spoke to Dr. Kirmayer, as I did in my studies, which I didn't comment on. There will be a tendency to prescribe more readily, but there is no solution through prescribing in this situation.
Conservative
Assistant Professor, Department of Psychiatry, As an Individual
I've been working with the friendship centre in Halifax, and it has approached me with this exact problem. The number one issue for the people they're working with is mental health, and typically they are prescribed something, which is funded through NIHB, whereas psychologist visits are typically not funded. They are now, actually, through NIHB, but no one seems to know about that. In Halifax I looked into it, and there are two psychologists on the NIHB list who indigenous people can go to, but no one seems to know about them or is being connected to them appropriately. I think that's because a lot of mainstream providers don't even know that exists.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
I understand from the psychologists association that Health Canada has decertified a lot of capable providers, indigenous and non-indigenous master's-trained counsellors. So you are aware of that issue.
Assistant Professor, Department of Psychiatry, As an Individual
Yes, that's what we've been hearing anecdotally from people. I haven't talked directly with NIHB about it yet.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
That's a really big issue when you have a problem with health care providers, and the move by Health Canada to decertify has all of a sudden created a much bigger problem of, as I say, capable people who could be doing the job.
You talked about a strong primary care system. In your experience, do most of the communities have the appropriate level of broadband to actually deliver that connectivity? Also, in our rural northern remote communities, I'm not thinking that we're actually starting from a strong, stable primary health care base.
Do you have a few comments?
Professor / Chief of Psychiatry, Northern Ontario School Medicine / St. Joseph's Care group, As an Individual
Both of those things are true. Do all communities have great broadband? No. Is it getting better as each year passes? I think it is improving and I think that'll be a challenge. Again, the farther north you go, the more those challenges exist. There are places in which it can be successfully done, but it's not disseminated through all of the north. I do know that the OTN in Ontario has really made an attempt to improve that. I don't think it's there yet in every community to the depth that you would get down the street from here. I think there is some work to be done. It's not disseminated broadly.
Your second question...
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
I was talking about starting from a primary care base that will.... It's all packaged.
Professor / Chief of Psychiatry, Northern Ontario School Medicine / St. Joseph's Care group, As an Individual
Yes, is it stable. I think was your question.
As we often hear in the media, there are sometimes waves of exodus of stable clinicians, nurses with experience who may exit the pressure and the scope of practice for RNs, as it's changed with nurse practitioners. I think it's made us hopeful to know that the NPs have more autonomy, but getting NPs to be stable in communities is often a struggle, as you go farther north. I certainly notice where I work in Thunder Bay that having NP-led clinics with really no physician on site—except when I'm there doing my clinics with my nurses—really creates more accessibility for those who are often the most underserved in our communities and that the NP-led clinic offers some hope. The greater autonomy for those clinicians, I think, offers a really positive stability.
Liberal
Charlie Angus NDP Timmins—James Bay, ON
I want to thank you both for these incredible reports that you brought forward.
Professor Bombay, when I look at the factors that you've identified—the residential schools, the intergenerational effects, the sixties scoop, the issues of early intervention—I see you've drawn a map of my riding. Would you be able to say that it would be possible, from this kind of evidence and research, to map out where the high-risk areas and high-risk communities could be found? Is that something that would be a fairly straightforward thing for a researcher to do?
Assistant Professor, Department of Psychiatry, As an Individual
Yes. I think right now not a lot of reliable data exists across Canada. The data I was showing was from the First Nations Regional Health Survey, so it's just a sample of first nations communities. It could definitely give you an indication of what regions are maybe more at risk. At the same time, for example, in Chandler and Lalonde's work, when they look at individual communities in the same province, those rates vary wildly. For example, I can't report on individual community-level data on that because of the rules around OCAP.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Yes, but I mean generally, if you're looking at risk factors, there are predictive elements you can see.
Assistant Professor, Department of Psychiatry, As an Individual
That's right, for sure. If you had more funding for research, and funding for communities to measure the things they want to measure, I think that would be very helpful.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Dr. Haggarty, I find it fascinating when we talk about the biological or genetic effects of passing on trauma. These are things we hear in our communities all the time. Having scientific support is really fascinating.
I always felt, when we dealt with suicides in our region that there was this notion of it being a contagion. I see that the World Health Organization talks about suicide as a contagion, and if it's not addressed, especially in young people, clusters form.
From your work in Thunder Bay, would you say that in the northern communities the cluster effects from the shockwave of a suicide create the contagion? Is the outcome predictable if there is no intervention?
Professor / Chief of Psychiatry, Northern Ontario School Medicine / St. Joseph's Care group, As an Individual
Clusters are a phenomenon. Clusters are unique. They link with what Amy has touched on and others have commented on, which has to do with a sense of self. If my sense of self is built around pride and a connection with my grandparents, and if I know who I am, then as a 14-year-old or 16-year-old, I'm going to be influenced by my peers but I'm not going to be life-dependent on them.
I would say that individuals who may not have that stability and may be disconnected from the language of grandparents make themselves more vulnerable. At least that's some of the rationale.
Why are there clusters? Why would a 14-year-old lead to three other 14-year-olds ending up in hospital or actually dying? In a sense, that vulnerable sense of self has occurred with this loss of cultural continuity.
Without getting into more details—clusters are a whole talk in themselves—I certainly think it's a factor. As you address some of the issues Amy has touched on, which Laurence Kirmayer will comment on, you'll see that building cultural stability is going to be important to reverse the likelihood of the impact.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Here's the thing. We had a horrific suicide crisis in Attawapiskat in March or April. At the same time there were six states of emergency declared across Canada in communities that were completely overwhelmed and could not deal with the self-destructive behaviour of their youth. Yet every time it happens, it seems to me that at the government level there's shock; there's surprise. They tweet out that it's a tragedy.
To me, a tragedy is someone getting hit by a car while they're walking home. Something that's predictable, something that's preventable is not a tragedy to me. That's something else; it's a form of negligence.
I mention that because I was in Saskatchewan talking to people about the latest suicide crisis, and we were getting the same level of response—the shock, the surprise. Now we're going to send in an emergency team and we might have them for 30 days.
I was talking to front-line workers who had been doing the programming of suicide prevention. They are not working up in La Ronge because their funding is gone. They get hired on these short-term projects.
I look at the projects funded by the Aboriginal Healing Foundation, and I see the dramatic drop-off from 2009 down to 2012. From that point on, in my region we had 700-plus suicide attempts, and nothing was done.
I'd like to ask you about this idea of sending in an emergency team. The minister, God love her, sent out a tweet the other night, saying, “Hey kids, there's a 24-hour hotline,” as opposed to supporting the people who could actually do the preventative work.
Do you see that there's a connection between these suicide clusters and suicide effects, and the fact that there is no proactive programming in many of the high-risk regions where we could have predicted this would happen?
Assistant Professor, Department of Psychiatry, As an Individual
Yes, absolutely. We just looked at the data. We showed psychological stress over time, but it's the same with ideation and attempts. They haven't changed. You have to wonder whether, if the Aboriginal Healing Foundation had continued, that would have changed at all.
We also know, based on the Aboriginal Healing Foundation reports, that even at their peak—I think they had the most community projects going in 2003—the service providers who were interviewed said they still weren't getting to the people who needed the most healing. There was still so much healing left to do in these communities. The fact that a model that was really working closed down really didn't make much sense.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Thank you.
I want to go back to the issue of the Healing Foundation. St. Anne's Indian Residential School was in our region, and the intergenerational effects are still horrific. The grandparents still need counselling as it winds down. We have unfinished business still affecting the families.
Edmund Metatawabin, a St. Anne's survivor, said that there was a direct highway from what happened at St. Anne's to the suicides we're currently seeing all across Mushkegowuk territory. What do you say about the issues of this intergenerational trauma? If we're still not healing the grandparents and the parents, what about the effect on the children?
Liberal
Assistant Professor, Department of Psychiatry, As an Individual
I think that it's really clear. I have a graph in there showing the proportion of youth affected. So many youth reporting don't even know if their families.... Some families haven't even spoken about it. Still some communities aren't speaking about it. So many communities are not even close to being finished healing.
Liberal
