The National Inuit Suicide Prevention Strategy: An Inuit-led approach to suicide prevention

The elevated rate of suicide among Inuit is a symptom of wider social challenges that have emerged only in the last several decades. Suicide among Inuit is a public health crisis whose roots we understand and have the responsibility to change. Inuit Tapiriit Kanatami (ITK) released the National Inuit Suicide Prevention Strategy (NISPS) in Kuujjuaq, Nunavik, in July 2016 to provide a coordinated, evidence-based, national response to what remains the most urgent challenge facing our people. The document is a tool for assisting community service providers, policymakers, and governments that are working to reduce the rate of suicide among Inuit in Inuit Nunangat to a level that is equal to or below the rate for Canada as a whole. The NISPS transforms our collective knowledge, experience, and research on suicide into action by setting out a series of interventions to address suicide risk factors among Inuit. It promotes a shared understanding of the context and underlying risk factors for suicide, and directs policy and investments at the regional and national levels in response to need.

Natan Obed. Image courtesy of Inuit Tapiriit Kanatami

Natan Obed. Image courtesy of Inuit Tapiriit Kanatami

Background
ITK developed the NISPS in collaboration with the National Inuit Committee on Health, the Alianait Inuit Mental Wellness Advisory Committee, and the National Inuit Youth Council. Through our discussions, we identified the need for a shared, evidence-based approach to suicide prevention among Inuit that reflects an understanding of how persistent inequities such as poverty, violence, and lack of access to services and supports contribute to suicide risk and suicidal behaviour. We were motivated by the knowledge that strategies are important prevention tools that can facilitate concerted suicide prevention efforts. For example, Scotland and the Province of Quebec (not including Nunavik) have reduced suicide rates among their respective populations through actions that were made possible by the creation and implementation of a jurisdictional strategy. Quebec’s success is particularly striking: the province cut its suicide rate almost in half 10 years after launching its comprehensive suicide prevention strategy in 1999.

Elevated rates of suicide among Inuit have persisted since the 1970s despite the best efforts of individuals and organizations working with limited resources in our communities to address specific aspects of suicide risk. Efforts have mainly focused on culture-affirming interventions, anti-suicide campaigns, and training programs that teach suicide intervention. Each of these approaches has an important role to play in suicide prevention but cannot, in isolation, systematically reduce suicide in Inuit Nunangat.

Inuit society historically had a very low rate of death by suicide. Suicide occurred as it does in all societies but it happened infrequently and rarely among young people. The difference today is that too many Inuit face preventable risk factors for suicide that include high rates of unemployment, poor access to mental health services, low educational attainment, and intergenerational trauma.

The rate of death by suicide among Inuit in Canada rose above the national rate in the 1970s among the first generation of young people to grow up in settlements. The rise in deaths during this time coincides with social and economic upheavals in our society that were largely engineered by the federal government after World War II. These changes included families being relocated by the federal government off the land into permanent settlements, where they faced crowded and inadequate housing. Traumatic experiences followed that are associated with residential schooling, the loss of loved ones to epidemic diseases, and the rapid social transitions that accompanied these events.

Social and economic upheaval among Inuit created the conditions under which suicide risk factors multiplied and, within some families, were passed from one generation to the next. Substance abuse, family violence, and poor mental health became more prevalent in Inuit society as a result of these changes within a country that, based on past social inequities still evident today, sees Inuit as unworthy of the basic services, supports, and infrastructure taken for granted in most other parts of Canada.

Few concrete steps have been taken by governments in Canada to reconcile the human rights violations committed against Inuit and other Indigenous peoples. Consider, for example, that there is only one in-patient addictions treatment centre in all of Inuit Nunangat, despite the known link between addictions and suicide risk, as well as the fact that our people have perhaps the highest burden of historical and intergenerational trauma in the country. The reality today is that many Inuit are struggling to meet their basic needs in areas such as food security, housing, and safety.

Graphic illustrating how the National Inuit Suicide Prevention Strategy (NISPS) can create change.

Graphic illustrating how the National Inuit Suicide Prevention Strategy (NISPS) can create change.

 

An evidence-based approach to suicide prevention
Preventing suicide among Inuit is entirely possible, but our success depends on our willingness to confront the social inequities that have placed enormous stress on Inuit since we began living in settlements, and which create a foundation of risk for suicide. The NISPS puts forward an holistic approach to suicide prevention that focuses on intervening and providing support much earlier in life so that individuals are less likely to reach the point of contemplating suicide. It is informed by evidence about the experiences, events or conditions that research has linked to suicidal behaviour.

Those of us who live in Inuit communities are exposed to society-wide risk factors for suicide as well as individual risk factors. Society-wide risk factors include being exposed to suicide, historical and intergenerational trauma, and lack of access to essential services. Individual risk factors for suicide include physical or sexual abuse during childhood, poverty, undiagnosed mental health disorders and substance abuse. Protective factors can help shield individuals from the negative effects of risk factors. Protective factors include access to Inuit-specific mental health services and supports, close connections to family and community, and economic stability.

The initial trauma and hardship Inuit faced as a result of colonial policies set in motion the array of risk factors for suicide that too many Inuit face today. Studying the lives of those who have attempted or died by suicide reveals patterns of experience and behaviour that tell us where interventions can be effective. For instance, we know from studies of Inuit and non-Inuit populations that adverse experiences in childhood are strongly linked to suicide attempts during adolescence and adulthood, with the highest levels of adversity increasing risk of suicide attempts in youth and adults. We also know, for example, that mental health disorders and suicide are linked, with those who have died by suicide being more likely than their living peers to have suffered from mental health disorders such as substance abuse disorder, schizophrenia, and personality disorders.

The NISPS is structured to address these and other risk factors for suicide that are prevalent in our society. It sets out objectives and actions for guiding regional and community suicide prevention efforts in the following six priority areas: create social equity; create cultural continuity; nurture healthy Inuit children; ensure access to a continuum of mental wellness services for Inuit; heal unresolved trauma and grief; and mobilize Inuit knowledge for resilience and suicide prevention.

Implementing the NISPS
Implementation of the NISPS is being coordinated through ITK’s National Inuit Committee on Health (NICoH). Health Canada provided ITK with nine million dollars over three years to begin implementation. We are using these resources during this initial phase of implementation to ensure that local, regional, and national systems and practices reflect an evidence-based approach to suicide prevention for Inuit. ITK and NICoH are supporting initiatives in Inuit communities that strengthen understanding of suicide and suicide prevention, thereby enhancing the resourcing and capabilities of Inuit organizations that are delivering programs aligned with the NISPS, and leveraging resources for initiatives related to the NISPS priority areas.

One of the primary outcomes of the past year has been to provide support to Inuvialuit Regional Corporation, Nunavut Tunngavik Incorporated, Makivik Corporation and the Nunatsiavut Government to provide enhanced mental health services in their regions that align with the evidence-based objectives set out in the NISPS. Projects include support for youth programs and infrastructure repairs; student and family support workshops; support for an Inuit men’s and Inuit counsellor’s program; sexual violence programming; and land-based healing programming. In addition, ITK is coordinating culturally relevant suicide intervention training across Inuit Nunangat through two programs: an expanded version of Applied Suicide Intervention Skills Training (ASIST) and Mental Health First Aid-Inuit (MHFA-I), a new Inuit-specific training program jointly developed by the Mental Health Commission of Canada and ITK.

ITK is working with Inuit regions during the second and third years of implementation to enhance resources for mental health services in Inuit regions as well as ITK-led coordination, outreach and education about evidence-based approaches to suicide prevention. Focusing on the early years and ensuring that children grow up in safe, nurturing, and predictable environments, in which they can achieve optimal development, is the most impactful, long-term approach to preventing suicide among Inuit. We are therefore developing resources that early learning and child care centres can utilize to build resilience in children. In addition, we will continue to support community interventions that are aligned with the actions identified by the NISPS.

Implementing the NISPS will take time and resources. ITK will use the NISPS to continue fighting for social equity in the form of increased investments in a continuum of mental wellness services for Inuit, early childhood education, access to housing and family violence shelters, poverty reduction, research, and support for language and cultural promotion and revitalization. At the individual and family levels, we will work to ensure that people at risk for suicide have access to Inuit-specific services, guide and support initiatives that teach resilience in the face of adversity, support trainings that teach people how to intervene when someone they know is suicidal, and advocate for a greater network of services for those who need help.

ITK will evaluate progress in achieving the objectives of the NISPS in two-year increments. The NISPS envisions evaluation as a way of continuing to add to Inuit knowledge in suicide prevention, advancing promising practices, and enabling communities and regions to learn from each other.

Conclusion
We owe it to our society, and especially our children, to address all risk factors that we know contribute to the elevated suicide rates facing our people. To be effective, we must transform the way we talk about, understand, and work together to prevent suicide among Inuit. Evidence linking overarching life experiences and risk for suicide must guide the investments and interventions necessary to reduce suicide. The holistic approach to suicide prevention put forward by the NISPS guides us to a low suicide reality that is only possible if governments rise to the challenge of creating equity in our society.

Implementing the NISPS requires significant resources, and it will be years before we begin to see corresponding reductions in rates of suicide across Inuit Nunangat. Inuit regions have never been equipped with the basic resources and supports needed to address challenges such as childhood adversity, addictions, and poverty, that we know are risk factors for suicide. The NISPS is a critical tool that can lead us all to a better society, and we will be diligent in its implementation out of respect for all who are affected by suicide. ◉

Natan Obed is the president of Inuit Tapiriit Kanatami (ITK), the national representational organization for Inuit in Canada. ITK represents the four regions of Inuit Nunangat, which is the Inuit homeland encompassing the Inuvialuit Settlement Region in the Northwest Territories, Nunavut, Nunavik in Northern Quebec, and Nunatsiavut in Northern Labrador. Approximately 60,000 Inuit live in Canada.


Download Article