Indigenous and Northern Affairs Committee on Oct. 24th, 2016

[The Clerk of the Committee, Ms. Michelle Legault]

Yes.

[The Chair, Liberal, Andy Fillmore]

Thanks for the clarification.

All in favour of moving to another order of business?

(Motion agreed to: yeas 5; nays 4)

With that, we'll return to Dr. Kirmayer's testimony.

You have a minute left on your time for a question to Dr. Kirmayer if you would like, David.

[David Yurdiga, Conservative, Fort McMurray—Cold Lake, AB]

Thank you very much.

We do hear a lot of issues about isolation. How is technology changing that? Is there a movement forward that's making it better, such that psychiatrists and psychologists can actually have face time with either their counterparts or individuals seeking counselling?

[Dr. Laurence Kirmayer]

Thank you, Mr. Chair.

Thank you, honourable member.

I think there is good evidence that the Internet and telecommunications can be used to have meaningful engagement with people to offer them support, to do psychotherapy and a variety of things. It's particularly the case for young people, who are already often heavily engaged in various forms of social media, and telecommunications, and are perhaps more comfortable with it. That said, there's no substitute for a physical presence, both on the part of somebody who wants to know the realities of the community and in terms of the physicality, the presence of someone who is there for you. Again, the ideal scenario involves some combination. It's much easier, for example, to provide support to someone over the Internet when you've met them at least once in person and you're reinstating or building on that existing relationship.

There is good evidence now that a whole variety of mental health interventions can be provided at a long distance and that they're more acceptable than some people would have thought, reflecting the comfort that many people are developing with these kinds of communications.

[The Chair, Liberal, Andy Fillmore]

Thank you, Doctor.

The next question is from Charlie Angus.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Thank you, Mr. Chair.

Thank you, Doctor, for this discussion.

I was fascinated by your talk on the disruption of parenting. It's something that I don't know if we've looked at all that much in this. We see the broken child welfare system. We see the huge effects that have been raised through Cindy Blackstock's work. If you look at statistics, we also see that it appears consistently that rather than support being provided to a family at home, when it comes to an indigenous family, the child will be taken out. If it's a non-native family, the supports will be put in place to support the family. We have this perpetuation of broken families from the sixties scoop right up through today.

What do you think that effect is, in terms of destabilizing young people and its effect in terms of suicide?

[Dr. Laurence Kirmayer]

I think you're pointing to a very important issue that occurs at multiple levels. There's no doubt that, because generations of people experienced institutional environments in the residential schools, they had very poor models for parenting in many of those environments. Parenting is something that, at least in part, needs to be learned; it's not innate. You need to acquire positive models. If your model is from a rigid and at times violent environment, then that will be the model—to some degree—that you're taking on board. That has affected whole cohorts of people, so the effect goes beyond individual families to affect whole communities.

Indeed, in our mental health promotion intervention in some first nations communities in the last few years, parents have been very keen to have parenting groups to talk together and to share experience, ideas, and approaches to the dilemmas they are experiencing with their kids.

There's an added wrinkle to this, which is that the nature of many communities is fundamentally different from what it would have been 100 years ago. In the sense of the scale of the community, for example, many northern peoples lived in small, nomadic groups, and the kind of parenting that works very well in that environment does not fit perfectly in an environment of 500, 600, or 1,000 people in a community. Different approaches are needed. People are in the midst of recalibrating their parenting processes. Taking children out of the communities and not reinforcing and helping people to build appropriate parenting in context contributes to a sense of destabilization and vulnerability in the communities.

It's a missed opportunity to help people reconnect with both traditional notions of parenting and those aspects that need to be adjusted creatively in order to deal with the modern environment, the Internet, and the other possibilities that our youth are facing in the larger communities.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Thank you.

I want to add another element to this. I was in one of the communities just before a huge suicide wave hit. They were trying to stabilize a youngster, but there were no mental health services available, and they couldn't get her flown out. It was told to me by people on the ground that when a young person is identified as being at risk of self-harm, there's the duty to report. Then, if the only tool you have is a hammer, the hammer is applied. The hammer is child welfare, so the child is taken and put into protective care, which makes all the young people go to ground, so tracking youth at risk becomes very, very difficult. If the only tool we have in the community is the child welfare system, it has an obvious negative effect.

I'd like your thoughts on whether we could put other proactive and preventive strategies in place so that the youth don't go to ground. What effect would that have in terms of breaking up these clusters of suicide before they form?

[Dr. Laurence Kirmayer]

You're absolutely right. I had an experience many years ago, in Inukjuak, in northern Quebec. It was during a period when the community had set up a kind of safe house or crisis centre for young people who were suicidal, where they could go, and where they could have a local elder or older person in the community who was solid and reliable be with them 24-7. It was possible not only to give them some support there but to bring in the family and talk to the family and try to defuse the crisis in some way. Therefore, there is potential to do much more good and, moreover, to have a positive intervention that would have a spillover or ripple-outward effect in the community, as opposed to simply taking the child out of the community.

You're right that our existing child welfare mechanisms are relatively crude. They're based on trying to intervene in what's viewed as a life-threatening situation, but they don't allow those gradations of intervention that could be more constructive. I think there's a very important opportunity to think that through more effectively.

[Charlie Angus, NDP, Timmins—James Bay, ON]

There is, I guess, a perception in the non-indigenous community that the children are being taken out because they're at risk of violence or abuse. However, we were dealing with a case of a young woman who was in treatment for potential suicide. Her children had been taken away from her because she had no place to live, and unless she could find a place to live, they would not give her children back. These children were in a non-native community 1,000 kilometres away. She had no way to get her children back because we had no housing. In this situation, she is on the suicide watch, but these factors mean it is well beyond her ability or her family's ability to actually keep their family together. Again, we have really crude tools here, but they're actually incredibly effective at destroying lives.

[Dr. Laurence Kirmayer]

You have given an extraordinarily important example, not only because of how painful and how urgent the situation is, but also because it points to two blind spots in our way of thinking about these problems.

One is that a social structural problem, like a lack of housing, can have a profound effect on how people cope with situations. When the mental health system encounters that, it still tends to interpret it in terms of individual vulnerability and individual characteristics because those are the tools we have. There's a shift away from keeping the focus on the thing that needs to be changed structurally.

Equally, this becomes a problem in terms of social interventions. I think you're right when you say that the larger Canadian society—not only professionals but society as a whole—doesn't often have a very good picture of the real constraints and the tradeoffs in a small or remote community. These stories need to be brought forward so that people understand the kind of catch-22 that's built into the system and that demands a more flexible and appropriate response.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Thank you very much.

[The Chair, Liberal, Andy Fillmore]

I'm afraid we're now out of time for the panel discussion.

I want to thank you, Dr. Kirmayer, on behalf of all the committee members, for your well-considered and thoughtful testimony. It will be a wonderful help to us as we carry on.

[Dr. Laurence Kirmayer]

Thank you. It was a privilege to take part.

[The Chair, Liberal, Andy Fillmore]

We're not going to suspend. I think we'll move right into committee business. We'll go in camera at this point.

[Proceedings continue in camera]