Northern Public Affairs

Hicks: Suicide prevention and the responsibilities of leadership

Our Nunavut political correspondent Jack Hicks on Canada’s “national disgrace”.

Proof that gradual but steady reductions in rates of death by suicide are possible is not hard to come by.
 
The developed country with the highest overall youth suicide rate is New Zealand. Their most recent data show that the country’s youth suicide rate has dropped from 44.1 per 100,000 in 1995 to 29 per 100,000 in 2009 – a decline of one third over 15 years.
 
The New Zealand government is evaluating the effectiveness of its 2008-2012 strategy, and preparing to launch an updated plan. “We want every young person who needs help to receive it in a way that works for them — and that is why the package will be delivered through schools, health professionals, online and at home,” says the Associate Minister of Health. “We also want parents to know where to turn which is why we’ve developed a new fund to provide information to parents, families and friends.”
 
Isn’t it interesting how little we hear about what is arguably Canada’s biggest suicide prevention success story? In Québec the suicide rates for all age groups have declined over the past ten years, and the youth suicide rate in 2008 was half the rate it was in 1998 — the year the provincial suicide prevention strategy was initiated. Isn’t that great news?!

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Have you ever wondered why it is that Canada doesn’t have a national strategy for suicide prevention?

I’ve found that if you ask people in Ottawa, the most common answer is that it’s because Canada is a federal system. The logic is that because health is the responsibility of the provincial/territorial governments, the federal minister of health has to be very careful not to step on their jurisdictional toes.

I don’t buy it.

If a federal minister of health were to stand up in the House of Commons and give a barn-burner of speech noting that the World Health Organization has called suicide a “huge but largely preventable public health problem”, that it’s a national disgrace that Canada is one of the only developed countries without a national strategy for suicide prevention, and that it’s time we got serious about the issue like other countries have — my guess is that the provincial and territorial ministers would be happy to sit down and have a meeting about it.

But no federal minister of health has ever done so.

(I’m no big fan of interim Liberal leader Bob Rae, but he has at least had the decency to publicly apologize for the failure of past Liberal governments to take the steps that the World Health Organization recommends that countries should take to prevent suicide.)

Why? I have a simple explanation: money.

If Health Canada were to acknowledge that it could do something to lower the tragically high rates of death by suicide in the hardest-hit parts of this country, it would be obligated to take action. And that would cost money. Not all aboriginal communities in Canada have high rates of death by suicide – not at all. But all the communities in Canada with very high rates of death by suicide – especially youth suicide – are aboriginal. Health Canada is responsible for the delivery of health services in many of those communities. Improving living conditions, providing mental health services commensurate with needs, and taking specific evidence-based suicide prevention measures…these things cost money.

I don’t think that federal government policy in this regard is racist in intent, but the fact that it’s aboriginal communities who have the most unmet needs means that federal government policy in this regard is racist in effect.

If you’re wondering about Canada`s new mental health strategy, Changing Directions, Changing Lives, I think it’s a good start – and kudos to former Senator Michael Kirby for having gotten the ball rolling back in 2006 with a trail-blazing Senate committee report.

But a national mental health strategy is not the same thing as a national suicide prevention strategy. National suicide prevention strategies look like this, this, this, this, this, and this. (A review of the effect of national suicide prevention programs on suicide rates in 21 OECD nations to date can be found here).

To be fair to the Mental Health Commission of Canada, it never claimed to be developing a national strategy for suicide prevention. As the Past President of the Canadian Association for Suicide Prevention stated in an article in the Canadian Medical Association Journal (‘Canada suicide prevention efforts lagging, experts say’):

In May [2010] the federal Minister of Health told us that suicide is a mental health issue and, because there’s already a national mental health commission, any other national efforts on suicide would be redundant and confusing for Canadians. But if you look at the documents to come out of the commission so far, there’s been only the briefest mention of suicide. They’ve been clear with us from the start that suicide prevention wasn’t going to be embedded in their national mental health strategy.

So now we have to wait and see what happens to the two private members bills in Parliament: Harold Albrecht’s Bill C-300 and Megan Leslie’s stronger Bill C-593. Will the Conservative government walk the walk, or will it just continue to talk the talk that it cares about suicide prevention?

Meanwhile, south of the border, “The next generation of the National Strategy for Suicide Prevention (NSSP 2.0) is now being developed” – see ‘Suicide prevention is a winnable battle’ in the American Journal of Public Health.

The pressure to strengthen suicide prevention measure in the United States is in part driven by the fact that for the first time ever, military suicides outnumber war deaths in America’s foreign wars. In a letter to military commanders last month, Defense Secretary Leon Panetta said that “suicide prevention is a leadership responsibility.”

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Leadership on suicide prevention was demonstrated in Alaska recently. On May 24 the Anchorage Daily News reported:

Gov. Sean Parnell has signed legislation requiring suicide prevention training for certain teachers, administrators, counsellors, and specialists in Alaska public schools.
 
SB137, sponsored by Sen. Bettye Davis, requires at least two hours of training for school personnel who work with students in grades 7 to 12.
 
Davis, in a news release, said most young people considering suicide exhibit warning signs. She said it’s critical that educators know how to recognize the signs of at-risk youth and that they are prepared to step in if they see a problem.
 
Davis, an Anchorage Democrat, said suicide is the leading cause of death for Alaskans under the age of 50. She said kids deserve a better chance at life, and this training is an important step forward in that effort.

In Nunavut, however, the Government of Nunavut (GN)’s Department of Education rejected a motion passed unanimously by the 2010 Annual General Meeting of the Nunavut Coalition of District Education Authorities (DEAs) urging the Department “as a matter of the highest priority to make suicide alertness and intervention training available to ALL staff in Nunavut schools who wish to take it, as soon as possible and on an on-going basis.”

As a result, almost no teachers in Nunavut received suicide intervention training during the 2011/12 school year.

This despite the fact that the GN committed in writing to make a priority of providing suicide intervention training to “[Health and Social Services] and other front-line workers, correction workers, probation officers, school staff (as per request from the Coalition of Nunavut DEAs), community groups which provide counselling services, and Nunavut Arctic College students.” (Nunavut Suicide Prevention Strategy Action Plan, 2011, page 8, Objective 4.1).

Also despite the fact that Nunavut’s youth suicide rate towers over that of the rest of Canada, and that of Alaska:

Rate of death by suicide, all residents aged 15 to 19. Sources: Statistics Canada, US Centers for Disease Control, and the Office of the Chief Coroner of Nunavut

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Leadership on suicide prevention in Nunavut was shown by the Working Group of government, Inuit, police, and NGO staff who developed the Nunavut Suicide Prevention Strategy and its associated Action Plan.

The NSPS makes eight “commitments” to Nunavummiut. The strategy’s partners (the Government of Nunavut, Nunavut Tunngavik Incorporated, Royal Canadian Mounted Police, and Embrace Life) committed to:

• take a more focused and active approach to suicide prevention;
• strengthen the continuum of mental health services, especially in relation to the accessibility and cultural appropriateness of care;
• better equip youth to cope with adverse life events and negative emotions;
• deliver suicide-intervention training on a consistent and comprehensive basis;
• support ongoing research to better understand suicide in Nunavut and the effectiveness of suicide prevention initiatives;
• communicate and share information with Nunavummiut on an ongoing basis;
• invest in the next generation by fostering opportunities for healthy development in early childhood; and,
• provide support for communities to engage in community-development activities.

The Action Plan specifies how these commitments are to be met. When it was released, NTI (Nunavut’s constitutionally-mandated Inuit association) said that the Action Plan “reflects a combination of Inuit input and knowledge and best suicide prevention practices from around the world.” Great – so there’s agreement on what needs to be done.

Leadership on communicating and sharing information with Nunavummiut on an ongoing basis has been demonstrated by both the Embrace Life Council through their TV commercials and NTI through its magazine Naniiliqpita.

But what of the core tasks of strengthening the continuum of mental health services, better equipping youth to cope with adverse life events and negative emotions, and delivering suicide-intervention training on a consistent and comprehensive basis? Only government can do those things, because only government has health and education systems.

It’s time for Nunavut Health and Social Services Minister Keith Peterson to show leadership on suicide prevention.

The department Peterson took responsibility for last November wasn’t even able to deliver the ten two-day suicide intervention workshops that it advertised on its website this past winter. Has the HSS Mental Health and Addictions division explained to its Minister how many of those workshops actually took place, and why? Has the Minister asked how many of those workshops actually took place, and why?

New Zealand and Québec didn’t lower their suicide rates by making suicide intervention commitments that never got implemented.

Minister Peterson should gather his senior managers together and demand a progress report on each and every one of the Objectives contained in the Action Plan.

If he doesn’t, there is little likelihood that Nunavut’s tragically high rate of death by suicide will start declining any time soon.

Rate of death by suicide, Nunavut Inuit and all Canadians, by 5-year time period. (Calculations by the author based on data from the Office of the Chief Coroners of the Northwest Territories and Nunavut, Statistics Canada, and other sources)

As US Defense Secretary Leon Panetta put it, “suicide prevention is a leadership responsibility.” No Ministerial leadership will mean no real action on suicide prevention.

Jack Hicks lives in Iqaluit, Nunavut, where he is completing his Ph.D. disseration on the social determinants of elevated rates of suicidal behaviour by Inuit youth. Jack can be reached at jackhicks@live.ca. Follow Jack on Twitter @jackooloosie.

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