Good morning. I'm James Irvine. I'm the medical health officer for three northern health authorities in Saskatchewan, roughly the northern half of the province. David Watts and Denise Legebokoff work with Mamawetan Churchill River Health Region. We're on Treaty 6 territory here in northern Saskatchewan. Thank you very much for the opportunity to present to you.
The northern half of Saskatchewan has roughly 40,000 people. It has some of the highest proportions of indigenous people in Canada, with about 87% being self-identified as indigenous and about 49% of those living on reserve. We have 12 first nations living in multiple communities, all of which have had health transfers, and we work in partnership with them.
Northern Saskatchewan faces, like many other northern or mid-northern areas, challenges related to social determinants. We've provided information on some of those determinants, such as the income levels and poverty.
Fifty per cent of the individuals in northern Saskatchewan live on 20% of the average income of the average Canadian. Crowding in northern Saskatchewan on average is more than six times that of crowding within other Canadian homes. All of those things are indicators that show the challenges related to some of the social determinants of health.
With regard to the longer-term incidence of suicides in northern Saskatchewan, since about the mid-1970s we've had rates two to three times the crude rates in Saskatchewan. On average across the north, with about 40,000 people, we have about 12 suicide deaths a year. Youth account for most of these deaths. This slid shows that across Canada, the highest group at risk of suicide are the middle-aged or elders, whereas in northern communities and many indigenous communities the rates are highest within youth. For data up until 2014, for males and females combined, in northern Saskatchewan the suicide rate for youths age 15 to 24 is almost seven times greater than the Canadian average.
Hospitalizations for self-harm tend to be greater among females. In the last 10 years, suicide deaths have been higher in males, while in the French version, you see that females have a higher rate of hospitalization for self-harm.
We've just experienced a cluster of suicides in the north that was somewhat different from what we had in the past. These suicides were predominantly young girls under the age of 15. There was a cluster. We've experienced clusters in the past, with one community experiencing this and then several years later there was another community. That tends to be the pattern. We've noticed over the last few years that those clusters have spread geographically, and it's thought that part of this may be because of social media.
Six deaths occurring within about a two-week period has had a tremendous impact, and that impact was sustained in the following several months, with fairly serious attempts and serious ideations. We've provided a graph showing the significant effect on emergency departments and other mental health teams.
We've also provided a breakdown of this last cluster of attempts and ideation following these deaths. It's hard to comprehend that girls between the ages of 12 and 14 would find themselves in this situation. I would be happy to respond to questions about this later.
Generally across the north, we've had the issue of suicides for decades, and this will continue unless really long-term supports and strategies are enhanced and sustained.
These events have been occurring on and off reserve, in Métis communities, and in first nation communities. In general, communities work closely together, and we do well at times of crisis, pulling together and responding and getting support from provincial and federal governments. It's really the longer, sustained, culturally based preventive strategies that need to be strengthened and resourced.
We also talk about the many faces of the issue. Suicide is one. Others are self-harm, assaults, injury, unresolved grief, previous trauma, bullying, substance abuse, and addictions. Social issues of poverty, intergenerational trauma, and cultural ties and loss are also important.
We also looked at risk factors. As you're very well aware, there are the individual factors and social factors, as well as community culture and continuity. In our circumstances, we find that it tends to be much more involved with the social and community and cultural perspectives and that it's often not an individual issue. It ends up being much more of a community issue, and it's often in clusters.
It's the same with the sense of protective factors. There's the sense of community cohesion, family cohesion, family communication, social supports, engagement in things like schools and sports, but there's also a lot of evidence in British Columbia and Alaska, and anecdotally around the country, that it's the community engagement in maintaining cultural continuity that's so important for that self-identity.
In general, we've put together a couple of recommendations that you see before you, but really, one of the areas is that big area of prevention and looking at those social determinants: poverty reduction, housing, early childhood intervention, indigenous language and cultural identity, and intergenerational knowledge sharing, and really learning what's working in other indigenous communities through rigorous evaluation, along with culturally based early childhood development, supporting parents, enhancing coping skills, and strengthening and supporting communities to strengthen the family and cultural identity.
In the area of more clinical connections, there is working together between the biomedical and indigenous systems, enhancing training of mental health workers and mental health professionals, increasing the availability of team approaches and multidisciplinary teams, and coordinating across jurisdictions. We have several first nation health authorities and several regional health authorities provincially, and it's so important to be working together there, as well as with social services, the RCMP, and education.
Then there's working closely and supporting indigenous approaches to wellness.
There are a couple of things as well that we've learned recently. One is the importance of having suicide cluster response plans, and having the surge capacity to deal with that. Learning to use some common assessment tools and training across jurisdictions have been found to be valuable as well. We also support the development of quality data systems for surveillance, very much led or incorporated with first nation and Métis collaboration.
Thank you very much, and we'll be happy to respond to questions.