Thank you very much, Mr. Chair.
It's a privilege for me to be able to speak with you. I regret I can't be there in person, and I thank you for your patience with telecommunications. I had the opportunity to listen to the last 20 or 25 minutes or so of my colleagues' presentation, so I'll try to build a little on that in my own remarks.
With regard to my own background and the perspective that I bring to this, the program I direct at McGill is focused on issues of culture and mental health. It's primarily concerned with putting the social and cultural dimensions into our thinking about mental health problems. I also direct the national Network for Aboriginal Mental Health Research, which was funded by CIHR to build capacity across Canada to do research in ways that respond to the needs of communities, in terms of both the protocols and the actual topics of concern.
My own research was driven by my experience as a clinician working in northern Quebec and Nunavut, going back to the late eighties, during which time I encountered many young people making suicide attempts. Despite efforts on the part of myself and many people in the communities, over time the problem has continued in many places, and indeed has been exacerbated by a variety of factors.
My own research over 25 years or so now, with many colleagues, has been aimed at trying to understand what is distinctive about indigenous mental health issues, and suicide in particular, with a view to developing meaningful interventions.
I'll say a few words about what's distinctive. I apologize, again. I know this presentation is coming at the end of a long string of experts you have heard, who have given you, I hope, a very vivid picture. Most of what I'm going to say, I'm sure is already very familiar to you. Hopefully, I can address specific issues with you in the questions afterward.
What's distinctive about the situation of indigenous people in Canada is, first of all, the shared history of colonization and of the state apparatus that specifically targeted people's cultures and ways of life, and, in so doing, unravelled some of the fabric of community for people in ways that are still echoing down the generations.
What's also a common dilemma across these communities is their very geographic locations, their cultures and contexts, which pose challenges for the delivery of conventional mental health services. Finally, what's distinctive, looking more specifically at mental health, is the fact that suicide in these communities occurs primarily among young people, starting from early teens into young adulthood, and it often occurs in clusters. I think all of these are reflections of a particular social dynamic, a particular social context.
In addition to the conventional psychiatric or psychological or mental health approach, which tends to focus on individual characteristics and individual vulnerability, all of that kind of knowledge is certainly pertinent to understanding why one person rather than another in any particular community is vulnerable. However, given the high levels across whole communities and whole cohorts of young people, we have to look at the broader factors. Those are primarily social and structural factors. They include what I've already mentioned and what the work of many speakers, including Amy Bombay, speaks to, which is this history of suppression of culture and of forced assimilation and the disruption to parenting that resulted, in terms of the kinds of early parenting experiences that young people have in the community.
Then, in addition to those transgenerational forces, there are ongoing structural problems related to poverty, to relative poverty, not just to the absolute constraints of infrastructure, but to young people's sense of their own possibilities or disadvantage. There are also the problems of housing and crowding, infrastructure, and limited educational and vocational opportunities. Added to that mix is exposure to high rates of interpersonal violence, childhood abuse, and domestic abuse, resulting from trauma-related problems.
Finally, in the larger society, there is a dilemma of what we could call the “misrecognition” of indigenous people in terms of their histories, their autonomy, and their identities, and, along with that in many places, elements of racism and discrimination that really hit people very hard.
All of these issues need to be looked at to try to explain why certain communities, many indigenous communities, and young people in particular are affected. Also, in a sense, we have to put together the conventional body of knowledge in mental health around individual vulnerability, which most of our interventions are oriented toward, with a broader social perspective that understands these historical and contemporary forces that are really raising the vulnerability of a whole population.
We've also been involved in research, working with different first nations and Inuit communities around questions of resilience, because although rates of suicide are high in many communities, of course there are many communities and many families and individuals who are doing well, despite common adversities. There again, we assume that much of what's been learned about resilience in the general psychological literature is pertinent, but in our research, we try to look at what might be specific to indigenous communities in terms of aspects of resilience.
Very roughly, four broad themes came out of that work.
One was the notion of identity as being tied to place, tied to the land, and tied to the environment, and the sense in which one can have a self that is deeply related to the environment. That applies in particular for communities in remote and rural areas, where people are still very much surrounded by a living environment that they feel emotionally connected to.
The second distinctive source of resilience—I mention these because if we are looking at vulnerability factors, we also have to look at where the solutions might lie—has to with the recuperation of tradition, language, and spirituality, all of those sources of positive identity that we each draw from to have a sense of who we are and where we come from and a sense of pride in our background. Since that was an explicit target of the state policies that I've mentioned, such as residential schools and other policies, the strengthening and reinvigoration of indigenous traditions is recognized as important in many communities.
The third has to do with the oral transmission of knowledge, the idea that one trusted source of knowledge—the most basic, perhaps—comes from other people, and it comes in the form of stories that are rooted in tradition and convey a sense of collective knowledge that can then be a source of personal strength and problem-solving ability.
Finally, the thing that was raised by a number of communities we worked with was the notion of political activism. Given the history of disempowerment and the conflicts people have faced, the ability to engage actively in some way in taking control of local institutions—as was shown in the work of Michael Chandler and Chris Lalonde—and being able to feel a sense of empowerment and a collective voice is a very important issue, and for young people as well.
We've been interested in how these kinds of observations, which come from communities themselves, can be translated into effective intervention. Part of the challenge is that suicide itself, although it's an urgent problem and demands its own focus, is in a sense part of a larger array of interwoven issues related to mental health and well-being, so it probably requires a multipronged approach, in which some responses are targeted to the acute vulnerability to suicide, and others have to do with following up on people who are recognized as being at risk and providing them with appropriate resources that can prevent the escalation of their problem. Ultimately, they would have to do with long-term prevention, beginning with very young children and with parents before they have children, working through infancy and early childhood, and helping to strengthen resilience.
