Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 27 - Evidence - Afternoon meeting
OTTAWA, Tuesday, September 20, 2005
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 1 p.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: I thank all our guests for travelling, great distances for some, to appear before the committee to provide their views on these important issues. As you know, the purpose of this hearing is to help us to produce the final committee report due in mid-January.
Mr. Devlin, please proceed with your opening comments, focusing on the basic question: What key elements do we need to begin making progress on a problem that will take a long time to resolve?
Arnold Devlin, Dilico Ojibway Child and Family Services: Dilico Ojibway Child and Family Services is a First Nations organization that has been around for 20 years. It encompasses child welfare, health, and mental health and addiction services. We take a holistic approach to providing health and mental health services. We serve the 13 First Nations of the Robinson-Superior Treaty area, where there are 15,000 Anishinabek peoples. Previously, I was a clinical supervisor for Nodin Counselling Service in Sioux Lookout.
Today, I will speak about suicide and how it greatly influences the mental health of the First Nations and Inuit peoples.
Mr. Jim Morris will speak to the serious problem in Sioux Lookout where 350 youth have committed suicide in the past two decades.
Aboriginal suicide is contagious and ``clustering'' creates a momentum where some of these very small communities have a significant series of completed suicides, suicide attempts and other suicidal behaviour.
One solution to this problem is a strategic approach that engages both the community and the youth. That is a key to the solution.
As a non-native and outsider who has worked in these communities for 15-20 years, I can tell you that our Euro- Canadian solutions do not work for the First Nations communities. We need to be creative and rethink our approach to the serious issue of suicide.
We hope to receive support for a national Aboriginal youth suicide prevention strategy, which Health Canada has discussed. This step is long overdue and is a step in the right direction. The strategy must be linked with an integrated mental health and addiction system. That is what we are missing both in Canada as a whole and in First Nations communities in particular. If you look at the development of Aboriginal resources, you will see that it has been piecemeal and not linked into a cohesive system. The system is lacking in financial support and other resources to address the problem.
The linkages and the networks need to focus on both the non-native health care system and the traditional health care system within Aboriginal communities, including the use of traditional healers and other community-based helpers.
Dilico developed an agency-wide protocol with guidelines and training for its 300 staff members. It developed a culturally specific suicide risk assessment and screening tool for front line employees. I believe that anyone who works in the health care system as well as in education, policing, et cetera, should have suicide prevention training because these folks meet people who are suicidal.
The national Aboriginal suicide prevention strategy is a five-year plan with funding for a five-year period. One of our greatest concerns is the sustainability of the program; it needs to be linked with some long-term planning and this will be the key to success. If we just think this will be our solution, it will not be effective.
I would also like to speak to the fact that the research that has become available through the Canadian Institute of Health Research, specifically on Aboriginal suicide, is an excellent step in the right direction. It will confirm that Aboriginal communities have the solutions to their own success.
Sheila Levy, President, Nunavut Kamatsiaqtut Help Line: Much of what I handed out I will comment on. I know I only have six minutes to speak but there is much more to say.
The Chairman: I will not cut you off.
Ms. Levy: I have been involved in community health and education in Nunavut for 27 years. I have been involved with suicide prevention and help lines and training, and I have been a psychologist/counsellor as well.
All levels of government would like Nunavut to become more economically viable; and there is an interesting parallel to the experiences in Africa and other Third World countries.
For the longest time, it has been maintained that a stable economy serves as a platform for good physical and mental health, however, there is a growing consensus that this really is not the case and that good health may be necessary for the economic health of any community, territory or country. I believe this is true for Nunavut.
You are aware of most of the issues, but in my experience the significant issue for the Inuit is a lack of coping skills, which has resulted in high suicide rates, addiction, substance abuse, violence and high crime rates.
Survival no longer means just surviving in a harsh environment; it means survival of life and coping with the difficulties of life and all the changes that have occurred in a short period of time. The whole concept of survival is different now and the Inuit must develop new coping skills to deal with the change.
There is a need for increased awareness of the importance of healthy relationships. The importance of healthy relationships was important to the Inuit family but many of these facets are not used today in raising children and grandchildren.
Mr. Devlin mentioned suicide, and we have a very high suicide rate. The breakup of a relationship often leads to suicide and it is important to focus on mental health and the ups and downs of relationships.
Poverty, crime, violence, addictions, all categories of abuse, overcrowded housing, alienation, abandonment and suicide are all connected to mental and physical well-being. That interconnectivity of mental health issues is often forgotten. We need to consider this when drawing up any kind of a strategy.
The person who runs one of our young offenders' institutions has young people who really do not belong there; they should be receiving mental health care because mental health issues are behind their problems. In that situation, the workers are unable to deal with the mental health problem and so the problem persists. We need other facilities and more people trained to deal with these issues within communities and institutions.
There is an extremely high rate of suicide, especially among the youth in Nunavut. As I pointed out, the rate is so high that if it were SARS or AIDS, no resource would go untapped to solve the problem. I realize it is not as easy to find solutions for suicide as it is for some physical ailment. I have to be aware of that every time I think about it; however, we need to look at that issue.
Then there is the veil of apathy. I say ``veil'' because there is frustration around the fact that the same small core of people in any community are the only people who organize all the positive activities. There is a belief that to some degree the communities are apathetic. It is more likely the communities are overwhelmed and see little hope for the future. In times of great stress and distress, they often overlook stories of success. We need to look at stories of success.
I have some general suggestions for solutions and some of them reflect Mr. Devlin's remarks. Any mental health activity needs to reflect engagement at the community level. Integral to this is the strengths-based approach. I believe in looking for what is good and what works as opposed to what has not worked. We all know what has not worked, but there are things keeping people alive and we need to find out what they are and build on them.
Any mental health model needs to reflect cultural and social realities. Looking backward in rose-coloured glasses has not helped. Inuit want the best of both worlds in which they live. Many Inuit with whom I work and whom I know well have pointed this out to me. They want evidence-based methods and approaches integrated with Inuit beliefs, ways and cultural knowledge.
Assumptions of cultural appropriateness must be exchanged for realistic and evidence-based best cultural practices, understanding that this is very difficult as individuals differ greatly on these definitions.
People involved in overseeing the development, implementation, and monitoring of a strategy should be local people working in the area, who have some knowledge as to what will and will not work. These people should not be political; I think you know what I mean. This happens too much everywhere and certainly in Nunavut.
Many programs targeting mental health are fragmented and this approach has had little success.
There is a tendency to view suicide, violence, addictions, abuse and mental health as separate issues. These problems receive separate funding while we should address the underlying commonalities in these issues.
Any strategy must include capacity-building activities for people already in the field or people who want to go into it, and for southerners who are living up north or who have lived there for many years. My three children were born and brought up there and work there now, having finished college and university down here.
Everyone, especially southerners, who come out need Inuit-specific awareness of values and beliefs and northern orientation. There has to be capacity-building for Inuit who have lived there all their lives and other people who have lived and have dedicated their lives to working in the North. Capacity-building is important everywhere, especially within the small communities.
I realize we are all on the same page in some respects. We need to develop protocols at all levels of government to identify high-risk individuals, to monitor them and be prepared to do outreach and prevention work. Protocols enable our communities and caregivers to act, mobilize, prevent, intervene or perform follow up services concerning trauma and death. It also allows us to identify, consult, and utilize second-tier natural and lay caregivers.
There is a need for health and social services to work together, raise their own awareness, stay current and spread information on how to deduce, monitor, intervene and follow up as a part of a strategy complete with the above protocols.
Tell me when you want me to stop, because I could go on forever.
I have suggestions for all the different areas that you have suggested, such as the federal government and provincial government. Do you want other people to take over?
The Chairman: Yes, please. I have some questions.
Ms. Levy: I want to mention a marketing campaign to promote culturally-approached messages of wellness, stressing early help-seeking behaviours, reaching out prevention, stigma lessons, et cetera. These are general points and you have a copy of the specific points.
James Morris, Executive Director, Nodin Counselling Services: Honourable senators, thank you for inviting me here today.
My comments will be brief, but I want to table these documents with the committee because they come from 20 years of experience dealing with social problems in our area.
I am the executive director of the Sioux Lookout First Nations Health Authority. I would like to note that our chair is here as an observer.
There are 32 First Nations communities located in the area of the map that I have included in my presentation. The area circled is northwestern Ontario. Most of the First Nations communities are isolated.
The Sioux Lookout First Nations Health Authority delivers a number of health programs to that region, and one of them is the Nodin Child and Family Intervention Services, which is the program that delivers mental health services to First Nations.
Please turn to the chart of suicide statistics. You will notice that from 1986 to today — almost 20 years — we have had 292 suicides that have affected about 28 communities. What this particular chart does not say is that about 90 per cent of those victims are young men between the ages of 15 and 25. We will touch on that later.
On the next page, you will see the chart that shows you where the numbers have gone. The statistics from the 1920s and 1930s indicate that there were suicides but suicides that did not follow a pattern. Starting in about 1986, a pattern emerged where an identifiable group of people, namely, young Aboriginal men living in isolated reserves, started committing suicide in large numbers, in clusters.
We are still there today. The worst year was 2000 when we had 26 suicides in one year. In one community of 2,000 people, there were four suicides in one weekend. That same community just had two suicides on the same day last week. They are still struggling with that tragedy.
The national rate for suicide for young people in Canada is 0 to 14.9 per 100,000. In some of our communities, the rate is 42.5 per 100,000. The suicide rate is 398 per 100,000 in the age group 15 years to 19 years. The national average is 12.9 per 100,000.
I will not go through the figures with you. The most disturbing figure is the 15 to 19 age group where the figure is 31 times the national rate. Again, that figure is way off the chart. That gives you an idea of our problem with suicide rates.
The next chart shows that under age-specific suicide rates our area is 47 times the national rate.
The next chart shows the suicide rate for all ages by years. From 1986-05, it jumps up to 106 per 100,000, whereas the national average remains the same at 15 per 100,000. I was not able to get all the figures for all Ontario and all First Nations, but the highest rate is in our area at 465 per 100,000. Our area has been struggling with high rates of suicide for the last 20 years.
The next chart shows one particular community. These are the national rates compared to all age groups over the five-year periods. You will see the Sioux Lookout First Nation national column, yet you cannot even see the Ontario column. The large blocks represent the national Aboriginal rate. The column on the extreme right represents one of our communities. It has the highest suicide rate anywhere because it is way past the 450 mark.
That particular community had the highest suicide rate until 1999 until it started a series of suicide prevention programs with the help of an intergovernmental committee started in Thunder Bay. The committee agreed to do business in a new way, which allowed that community to do what it felt needed to do to stop the suicides.
It is very expensive. I think I already poured about $300,000 a year into that one community. I am not completely sure of everything they have done, but the point is — I knock on wood every time I say this — they have not had one suicide since 1999. They have had attempts, but no completed suicides.
I am very familiar with that community and so is Mr. Devlin, but I still do not fully understand everything they have done. Maybe they have not told us everything, but that is a hopeful sign and it is probably one of the most successful communities in that area for suicide prevention.
I do not need to talk about the environment in which these people live; they live in debilitating poverty in remote communities. It is the same story in any remote area where people are poor. The environment is the same in all First Nations communities. I never think of a reserve as the normal environment for First Nations people. The normal environment — the one I grew up in — was to wander all over the land with total access to all the land and resources.
My father was a professional hunter and trapper. My mother was a professional in her way as she was able to run a camp, make moosehide, clothes, nets and so forth. You name it; she could make it. We were totally self-sufficient on the land. My parents raised seven of us in that way.
My life has changed, I can hunt a little bit, but I cannot trap. I cannot survive like that. With respect to the values, some people call them the ``seven sacred teachings.'' My mom and dad did not call them that; they called them truth, honesty, love, caring, sharing, respect for people and for the land. That is what sustained me.
My grandchildren and the children coming after that have even less, so that the cumulative effect of change and colonization, or whatever you want to call it, becomes more extreme with each generation that follows.
The children we are talking about now have nothing to sustain them, not an ideal, a value or a belief. They live in grinding, debilitating poverty day after day after day. I am not surprised they kill themselves when they are 14. I had something to sustain me, but they do not.
If they have a mental health problem, suffer from sexual abuse, or see visions — psychiatrists call them ``hallucinations'' — they are told they are crazy.
At my age, if I saw a hooded figure, which is what they all talk about, and I went to Mr. Devlin and he told me I was crazy that would finish me. You can imagine these eight and nine-year-old kids having these visions. I do not know the real answer to those hallucinations. It is all in the mind, I guess, but to these kids it is very real.
What I do not have and what I need is a good mental health service that can reach these kids early on, or at least know that, if their mother, father, or grandmother tells them not to talk crazy, they can come to us and we can help. That is what we need. That is what we are trying to build with the service.
It is hard for people who are not touched by these types of things to fully understand what they mean. However, like that one community that I talked about, the number of suicides it had would be the equivalent of 100,000 people committing suicide in Toronto every year. I do not know if they do or not, I hope not. I am sure that would be noticeable. I am sure that the people in Toronto would do something about that type of crisis. In Ottawa, it would be 35,000 people a year committing suicide. I think people would notice it and do something about it.
The documents that I have attached are recommendations from the youth forum, a commission of young people in the communities who tried to find out why young people are committing suicide. They talk about hope and dealing with poverty, sexual abuse, family violence, community infrastructure and meaningful employment.
I have included a coroner's inquest from 1997 on a young girl who committed suicide after being in the system for several years. I think that inquiry not only reaffirms the youth forum recommendations, but it also challenges us to find different ways of doing business to help these young people.
The intergovernmental committee that I mentioned earlier was a response to that inquest because we wanted to start working and finding out how we could better work with our young people.
We also did an inventory of services for children in our area. During that process, we tracked one kid living on a reserve. We followed where he would go to get help, and he kept falling through the cracks.
The classic example is in terms of provincial services. Ontario had a program called Integrated Services for Northern Children, and that is where our kids go to get service for things like speech pathology et cetera. They get help, however they had a clause that said ``except for status Indians living on reserve.'' When the kid got to that point, he fell through the cracks. The result is that in all in this talking about jurisdiction the kid did not get the help he needed.
We are trying to build a service that will focus on the kids and it is very hard to do. If you read that inventory of services, you realize what is available and what we can do to help these kids and young people.
We are in the third year of our five-year plan. Odin has been in existence since 1991 as a constant service for adults. Mr. Devlin worked there for five or so years.
In 2002-03, the intergovernmental committee asked us to merge Nodin with the provincial CFI service to create one comprehensive, mental health service for adults and children in our area. We are in the early stages of that process. Frankly, that area did not have service until 2002 and anyone in need of services would have to travel away from home to get the service.
I wish there was some way that we could accelerate our five-year plan. I learn about children with problems every day and I just do not know what to offer them. They have nothing. The only thing you can do is send them somewhere, to Winnipeg, Thunder Bay or Ottawa, but that means uprooting the kids and their families and creating other problems.
We need to develop a service quickly so that these kids can get service when they need it. I am focusing on kids. We have been dealing with adults for the last 30 years, and we will continue to help them as best as we can, but my focus is to work on the kids. If we can help the kids, I believe the trends will be better when those kids grow up.
Bill Mussell, Chair, Native Mental Health Association: The Native Mental Health Association of Canada is a volunteer organization that focuses on capacity building which consists of an annual training conference that attracts both Aboriginal and non-Aboriginal people.
We are at the stage in our development where we have been able to get some funding to do some organizational and reorganization development work. It looks like we will expand the scope of our roles and responsibilities and begin to undertake some of the research that is necessary concerning mental health challenges within our communities.
I was able to join this morning's committee and the discussion about education, in particular the notions of cultural continuity and connectivity that Chief Shawn Atleo and Dr. Valaskakis mentioned, inspired me.
Cultural continuity and connectivity are extremely important in terms of the information that we require as infants and young children if we are going to grow up with a relatively secure personal and cultural identity. My concern is that since the beginning of our modern history formal education has displaced non-formal, informal and incidental education.
The discussion this morning focused on formal education, and I think we tend to forget the tremendous importance of non-formal teaching and learning activities that take place within families, other social groups and within communities.
In the late 1960s, when I began my community education work with home school coordinators they were saying that parents were not assuming or taking any responsibility for the education of their children. The parents would say to the worker, ``It is your job; you are being paid; you look after my child who is having difficulty in the school system.''
That in many ways reflects some of the reality we live with today and the tremendous dependence on the paid worker to assume responsibilities that otherwise would have been responsibilities of parents. The creation of reserves and the establishment of residential schools that housed five or six consecutive generations of our people lead to a tremendous discontinuity in our culture.
In the study of healing and language, professionals in that field make the point that schools are there in terms of learning traditional or other languages to supplement and complement the teachings within the family system. They are not there to provide the lead and to find some way of engaging parents in the education of the children who are expected to learn that language. There is an important message there.
In most of the cases regarding the preservation or the protection of our traditional languages, we expect the schools to do the job that only parents, and other people in our family systems familiar with the language can do. Schools cannot do the job, but they can help us do it as parents, grandparents and so on. That, to me, emphasizes the tremendous importance of non-formal education.
I think of what I learned on the fishing grounds. I learned about fixing nets, catching salmon, cutting it up and hanging it to dry. I received that education in a non-formal way. The same thing applies to trapping, hunting, and many of the traditional features of our original lifestyle. Today, that seldom if ever takes place except in families where there is a strong continuity of cultural teachings. It is important to keep this teaching alive because the lack of it very much applies to the incidents of depression and suicide in our communities.
As for the concept of connectivity, we are looking at some of the culturally good ways of life that are practised by the families that live in a more traditional way in terms of being extended, social systems that are mutually supportive. It is important to recognize the tremendous relationship to Mother Earth, the connection with the land, its resources and the sacred places of that territory.
I remember when I was growing up, my dad — there are five boys and a girl in our family, all born very close together — introduced us to our boundaries and territories. He taught us about the conflicts with non-Aboriginal people concerning the reserve boundaries where the vegetables grew traditionally and naturally. He told us how that land became part of the land that was available for sale. We still have issues concerning fishing sites and the harvesting of resources.
I think that the relationship to our land is important. I wonder how many parents and grandparents bring their children to the boundaries and teach them about our past. I wonder how many children know about our sacred places.
Our cultural institutions are equally important to us. One of the most important cultural institutions is the family that represents our culture.
There are so many children in care. There are so many difficulties that many children never experience a relatively healthy, dynamic, cultural family that represents the group into which they were born.
In some communities, there are three or four groups, and people of each group do not necessarily let their children play together. Often the children who are most deprived are those who have the least opportunity to get a chance to become familiar with the fact that other families live differently. Children that acquire this knowledge are able to live in greater safety with greater resources and greater support. The lack of this knowledge has a great deal to do with the phenomenon of self-destruction and, in particular, suicide.
Another important aspect of life has to do with storytelling. I do not see much storytelling in most families that have difficulties. I am trained as a high school teacher. I have taught at university. I am a trained social worker. There is not much time taken to tell stories and for children to have a chance to get in touch with their experiences. As an educator working with adults, I have discovered that many adults do not really know what they know because they are not in touch with their life experiences. They have not had an opportunity to begin to paint pictures with words, and, through painting pictures with words, get in touch with their past.
When you think about grieving, healing, and the effects of trauma, there is a process of helping people to get in touch with what happened so they can continue to grow and develop. They must get in touch with their experiences. This process can be successful when performed with people who care about them that can provide them with the safety that is necessary to begin to get in touch with the dynamics of their life.
These people have not had a chance to understand their past and because they have not had a chance to understand it, they have not been able to replace aspects of their life with healthier strategies and healthier ways and means of coping.
Indigenous knowledge is important. If we do no have the informal education and the incidental learning that the people in the community have, our children will never have a chance to get in touch with that indigenous knowledge, which provides the foundation for a secure personal and cultural identity.
The Swinomish people in Washington State, just south of British Columbia, conducted a study on the mental health of their community. The object of the study was to find the primary problem in the community, which turned out to be identity problems. The opposite of identity problems is having a relatively secure cultural and personal identity.
The notions of connectivity are all very much related to helping a person begin to know who they are, what they are, who they belong to, that they are wanted, needed and loved and that they really have a purpose because they belong to a family. It is a family with a purpose and a family that is living life in a healthy, constructive way.
The Maori and, in particular, their nursing profession has developed a strategy that, if it were used in Canada, would enrich the opportunities of our children in the public schools 1,000 per cent. The strategy relies on the underlying principles of cultural safety. The notion of cultural competency connects with that strategy.
As for points, some of them were mentioned this morning, but I will quickly review them. There definitely must be a resolution of the jurisdictional issues. Too many people are told that service cannot be provided because it is outside of the jurisdiction of the people responsible for the agency that they have approached. That is absolutely critical. I think you have already attended to it based on what I have read.
We do need a national program and service that makes human and material resources available to all Aboriginal groups in Canada.
The education and training of Aboriginal practitioners is extremely important, but we must remember this: We have hundreds of very small communities of people that will never be able to afford to employ their own practitioners. That means, then, that other Canadians working as psychiatrists, psychologists, and clinical social workers, who happen to be of a different culture, have the background to be seen as culturally competent practitioners. That is extremely important.
It is critical that the government make the mental health of Aboriginal peoples a priority. It has never been a priority. That is a huge problem.
I am optimistic that this committee, the collaborative care initiative, and the public health round tables realize the importance of mental wellness of Aboriginal peoples. It is important that the changes happen quickly.
Stigma is a huge problem. It is not well understood. It is a problem in all health and educational systems, when it comes to Aboriginal people. I have been concerned that there has been very little research done in Canada to address that issue. I am not really sure how that might be done, but it is something that needs careful attention.
Treatment and healing of trauma came up this morning. The Aboriginal Healing Foundation has done some good work, but has only begun to touch the surface. We need to do so much more because we have a long history of oppression that has created serious consequences that many people do not understand.
The notion of integrated services is critical in our communities. Holism is an important value. We are talking about interpersonal relationships, kinship and togetherness as core values. Integrated service would honour those traditional values. If we could begin to do that, I think a tremendous difference would take place over time in terms of producing the desirable kinds of outcomes. In order to do that, we must do something about rebuilding relationships and rebuilding families. The destruction of our history and the historical depression that we suffered are far more serious than most people believe and many people do not want to believe. That is a challenge facing us as a group.
Regarding research, I am pleased that some has been done. More needs to be done. Most of the research is not efficiency oriented. We talk about our weaknesses, problems and issues, but seldom do we ever talk about our resources and what our strengths are and the good ways of our life. What are the promising practices that we live with? I tend to hesitate to use ``best practices'' because I think there is so much that we do not know. If we were to buy into the notion of best practices, I think we would be cutting ourselves off before we had a chance to truly identify, explore and discover what truly works.
Finally, it is important that collaboration becomes a way of life for all of us in leadership roles, whether we are with government, non-government organizations or the public. I think it is tremendously important that we make time to share, to collaborate, to talk, to help each other get to know what it is that we know. When we can do that, we are working with the tools that are necessary to be able to find the strategies to be able to develop the strategies that are necessary and to help us find answer to other kinds of problems that we have not yet begun to identify but we could if we would make the time to truly dialogue.
With that, I would like to thank you for this opportunity.
Dr. Arthur W. Blue, Psychologist, Native Psychologists of Canada: It is an honour to be with the great people that I am amongst and to have them listen to a few words from me.
The Native Psychologists of Canada is a small organization. We have less than 20 members. Our need is drastic. We need to have your support in developing an institution that supports and develops native psychologists. We do not have such support.
Let me go back and become a bit of a storyteller. Senator Cook, I apologize initially. In 1971, I was invited to Newfoundland, to discuss the fate of the Fogo Island fishermen. One of the speakers impressed me twice — first, because he was a British Lord and I had never met a British Lord before.
His statement was that while working in Africa he had come up with the decision that if indigenous people are to survive and develop, they need three things: Control of their own food supply, control of their own clothing, and control of their own shelter. If they had control of these things, they may in fact tell the governmental organizations to go to hell because they could stay back and do what was necessary.
My own people in the Northwest Territories do not have this control. They are dependent and that dependency, as both Mr. Mussell and Mr. Morris have pointed out, is built into the system. They have come to us and told us to move over, we will take care of you and we will furnish you with food and education. Now you decide you are not doing it and you withdraw. We are then subservient and mental health is dependent upon independence. If we are to become mentally healthy, it is essential that we have control of ourselves.
I am reminded of a friend of mine, Dr. Joe Hill, who was superintendent of the Six Nations. He did a fabulous job in the development of education at the Six Nations. His simple statement was, ``Help an Indian to know who he is and he will decide for himself where he is going.'' I think that is a secret that, perhaps, we do not fully understand. Mr. Morris, Mr. Mussell and Mr. Devlin also referred to it.
We face the problem of a very high rate of unemployment. We also face isolation. Many reserves are at least 20 miles from the nearest city. We have status quo housing. How do you like that term? My wife thought it was good. Status quo means no running water, no washrooms, no proper kitchens, inadequate electrical systems and, very often, far too many people per room.
When I worked with the World Health Organization, Mr. Durkheim laid out a very interesting chart. He said that if we want to know what creates asocial problems, such as crimes, and mental health problems, one of the things we can do is build a small two by two chart. On that chart, all we have to do is place ``modern area'' at the top, and put ``modern and traditional'' and on the side put ``people, modern and traditional.'' You will find the greatest crime and the greatest suicide where native people live in that modern area. If in fact you look at those living in traditional areas, you will find very low crime and very low suicide rates. That says something.
I found the same thing with the people in Chiapas who live in the rain forest. When forced to live on the outskirts of the cities, in the modern area, and forced to continue to interface with the city in a modern way, the crime and prostitution rates went up, language deteriorated and mental health problems increased. What Mr. Mussell has been saying and what Mr. Morris has been saying is that there are ways of understanding what is going on. Now we need ways of treating it.
I suggest that one of the ways that we can begin to look at treating this problem is to create an institution responsible for training native clinical psychologists. There is not one, yet we need one. We need a program similar to the native access program that moved from 51 native physicians 20 years ago to 250 today.
My daughter-in-law, a Cree, who is a psychologist, fought every step of the way, was abused and ignored within the universities as she attempted to get a masters degree.
The psychologist's role in the native community has to evolve into an integral part of the community. It is not only treatment but it is also prevention. Not only do they do psychometrics, psychotherapy, group psychotherapy, abuse treatment, both physical and substance, they are the best educated mental health professionals available in Canada, and should be working hand in glove with mental health workers, social workers, physicians and the band council.
We have had some suicide, and I think you have to call them epidemics, as Mr. Morris mentioned. When I was treating people at the reserve level, I discovered that the best treatment was to teach the young people and their peers how to recognize and come to grips with those who were suicidal.
There is a serious difference between mental health problems and mental health illness. A psychologist's role is not to deal with every mental health problem, but to help others who are there to deal with mental health problems. Our long-term work is to work with those who are sick. There will never be enough native psychologists to deal with all the mental health problems.
How do I go on? I have found, when I was working in the Interlake, that one of the best ways to deal with mental health problems was to have a weekly meeting with health centre physicians, nurses, public health workers, school officials, counsellors, teachers, home care nurses and workers, substance abuse workers, AA, DA, band officials and church officials. At the weekly meetings, we discussed what sorts of things were coming up, how we were dealing with them and tried to find solutions. This method worked well. We went from a community that was having major difficulties to a community that was working together. There are solutions.
Lorraine Boucher, Director of Health Programs, North Peace Tribal Council: Thank you for having me here today. My colleagues, especially Mr. Mussell, have said everything I came here to say and I will not add further because he spoke so eloquently about the problems of First Nations people.
I was not quite sure what words of wisdom from Northern Alberta I could share with you except to say that cooperation is key to solving the jurisdictional problems that we deal with. Working together in partnership with the regional health authorities, with the provinces and with the federal government is key to developing innovative and integrated ways to develop a mental health care system that is built around First Nations issues and concerns. I prepared some speaking notes but I will not go into their detail because other witnesses have covered much of what I had to say.
I will add that the need to focus on traditional knowledge and its processes and to have guidance from the elders is essential to a mental health care system that will address the cultural identity that we have lost through various means, such as the residential schools. In our tribal council in the North, we worked on developing a mental health framework; and I have a copy of it with me today. We found that, in developing this framework, our northern communities have their own vision and ideas of how to start building capacity within the communities to train our local mental health workers to work with our community health representatives. We worked with our traditional elders to help us develop a program that will focus on rebuilding what we have lost as First Nations people. The variety of approaches needed to respond to the problems requires a combination of mainstream and cultural complementary options.
Capacity needs to be built at all levels of the system: the individual; family communication and problem solving; peer-to-peer helping; support group models that reflect the reality of community networks and existing relationships; peer and other professionals to help staff at the community level who offer services based in the range of mainstream cultural and complementary approaches of healing and helping; regional resources, including highly skilled professionals such as psychologists willing to bring their skills to engage in a creative and collaborative process to develop new programs and services; and provincial services that provide a high level of specialized services to support the capacity-building needed in the communities. The foundation of the approach is to build community capacity that is reliable, safe and helpful within the context of regional and provincial support.
All I needed to say with regard to my First Nations people has been said. I am honoured to be invited by Senator Kirby to be here because this work gives me hope that we are starting to collaborate and to work together to create quality services for First Nations people; and the only way we can do that is by working together.
Debbie Dedam-Montour, Executive Director, National Indian and Inuit Community Health Representatives Organization: Like my colleague, I had written all kinds of notes. This is the first time I have appeared before a senate committee. I am truly honoured to have this opportunity to bring forward some of the work that we do at NIICHRO on behalf of community health representatives. For those not familiar with community health representatives, CHRs, they are front-line workers in Aboriginal communities promoting health, education and disease prevention. They have a broad range of responsibilities. As an organization that represents or works for their interests, we are always looking at ways to provide them with the tools needed to service the community.
In 1996, NIICHRO had a national training session that covered mental health. Each year we have a national training session, similar to the one at Mr. Mussell's organization. We have covered tobacco use, injury prevention and mental health. As well, we have worked with the frail and elderly. We work in a variety of areas to assist community health representatives in their services to the communities. The CHRs play a vital role in community health. They know and monitor the pulse of the community's well-being. As front-line health workers, even in isolated communities, they are the first line of defence in identifying a problem and trying to find ways to facilitate interventions and collaboration with the other members of their health team.
Mr. Mussell mentioned that for Aboriginal people the health continuum is about wellness and not illness. Aboriginal mental health is relational because strength and the security are derived from family and community. Apart from sharing healing traditions, Aboriginal communities are bound by a concept of wellness wherein the mind, body, spirit and soul are interconnected. This has been mentioned by a number of witnesses here. The residential school has had a profound impact on communities and family functioning. It has created a multi-generational loss of inter- connectivity in the home and family unit. Through the work of the community health representatives, we try to rebuild the family and the community, and bring forward values that are related to a holistic wellness.
I will not use this time to bring forward statistics because Mr. Morris has brought forward some amazing information. It is important to realize that those statistics do not cover the complete reality because many things have gone unreported. For example, the statistics do not account for suicides that, perhaps, were wrongly reported as accidental deaths. As well, there are incomplete suicides, which no one here today has mentioned in the statistics. That is important and must be recognized.
There is the broad term of ``family violence,'' which is sexual, physical, emotional and psychological abuse, and neglect. This violence has had a domino effect because it leads sufferers to self-medicate with alcohol or any other harmful substances and to involvement with correctional institutions. There is an extremely high proportion of Aboriginal people in these correctional institutions. I attended a meeting yesterday held by the Canadian Public Health Association. One presentation was on correctional services and its needs, whether counselling, medical use, needle exchanges, et cetera. The mental health aspect is ever present.
Furthermore, many people do not report their mental health problems because of the unfortunate stigma attached to this type of affliction.
We have to look at identifying problems as well as their causes in proposing solutions to improve mental health of Aboriginal people; that is one-step in the right direction. The next step is to allocate sufficient resources. Mr. Morris mentioned the cost of one report; that may seem like a lot of money, but what we are putting into the system to solve and identify some issues will pay off in the end.
A comprehensive strategy must include changes to the education system and ways to create economic development opportunities; is not just a look at mental health and family violence and suicide. They are all interrelated — there is interconnectedness, as we keep mentioning around the table.
Like all the other front-line health workers, CHRs from all the regions of Canada jointly with their communities must be consulted as to where their mental health problems and solutions truly lie. We must engage not only those that are affected, but those that can effect change.
When we do that, we must ensure that we incorporate the principles of cultural relevancy and sensitivity into any strategy we consider. Support to these initiatives needs to be wide ranging as the scope of mental health problems is so all encompassing. The task at hand is formidable, but the cost of doing nothing beyond the status quo is immeasurably greater, both for the Aboriginal people and for Canada as a whole.
We are in the process of looking at core competency of the health workers; specifically, we look at community health representatives. However, when we are talking about collaboration, the Public Health Agency of Canada and many of those groups — the epidemiologists, all the other medical practitioners, doctors and nurses — are looking at it also and a lot of different words and phrases are coming up, ``core competency,'' among others. We have been looking at this issue for over 20 years. We called it ``standards of practice and accreditation.'' We have had to change our titles to fit the times; basically, it is health human resource development.
I believe there is a need for this core competency training. The CHRs and the mental health workers are identifying problems and working with their health team developing strategies, but how do you go about making this movement for change?
In the last year and a half, there has been this momentum for health unit resource development. It is under the pan- Canadian strategy. To get that number of people at the table with a common goal takes commitment. The Government of Canada needs to make the same commitment. I believe that the Aboriginal community and those who can help the Aboriginal community are ready to make that change.
The proverbial ounce of prevention in addressing this matter is well worth the alternative pound of cure.
On behalf of NIICHRO and the CHRs across Canada, I can only ask that we work together to find solutions that will ultimately benefit us all. A collaborative approach will offer the greatest opportunity for positive change.
The Chairman: Thank you all for your very good presentations.
For clarification, what is the training of a community health representative? Is that what I would think of as a public health nurse?
Ms. Dedam-Montour: No. The public health nurse holds a position that is part of the Canadian Public Health Act. The government mandates that person to that position. The CHR program was initiated because health programs were not reaching First Nations communities. In 1962, the medical services branch, which is now another name — I think it is Health Canada — initiated a program called the community health representatives' program. It reflects very much what we are talking about today, getting somebody from the community who understands the issues being able to link up with the health care centres.
The Chairman: So, there is no formal training?
Ms. Dedam-Montour: No. There was training, a formal type of system, when the CHR program was under FNIB. However with the health policy transfers, the communities got more power. That mandated training to come under the band jurisdiction. Some colleges have CHR programs, such as the course at Portage College. Alberta and Manitoba offer courses but they are fragmented.
We are looking at trying to bring it forward and get core competency training programs in each of the provinces. We are looking at these multi-jurisdictional issues.
The Chairman: Will they be targeted at Aboriginal communities and not at the population as a whole?
Ms. Dedam-Montour: The CHR program is unique to the First Nation communities. However, talking at the public health meeting yesterday, I think there needs to be more of a link between the nurses and those community people and that is what the CHR is. It could be something that could be transferable as a best practice.
The Chairman: I have a question that has been bothering me all day, particularly given the frequency with which the suicide issue has come up. It is not meant to be a pejorative question but meant to get a handle on the issue.
Is suicide prevention where you begin or is a suicide the outcome and, therefore, do you have to start farther up the line? In other words, if suicide is the end product of someone who is mentally ill, does focusing on preventing suicide, in and of itself, the thing to do or should the resources be devoted at an earlier stage toward stopping or easing the problem of the mental illness that leads to suicide?
Both this morning and this afternoon, a large number of you have talked about family violence as one of the sources of the problem. I totally understand that.
If one had a limited amount of money and the objective is to reduce the suicide rate, where do you put the money? Do you put it into reducing family violence? Do you put it into dealing with a child who is mentally ill? Do you put it into what a suicide prevention strategy?
I understand we talk about suicide as the thing we want to stop.
How far before that do you actually intervene if you only have a limited amount of money?
Mr. Morris: I have been asked the same question in the communities. The best thing I can do is reply using the ice- break theory.
All these social problems, suicide, sexual abuse, family violence, alcohol and drug abuse, are manifestations of deeper problems.
What are the root causes of suicide?
Some of the causes are oppression and colonization, going back 100 years. The problem cannot be understood by anybody who has not been colonized or oppressed. We understand because we have experienced it.
Part of the problem is the residential school system. Once again, if you have never been a residential school victim, you do not know how it is because you do not know how it feels. It is the same with racism. Racism is everywhere. Once again, if you have never been a victim of racism, you do not know what it is. If you are not affected by it, if you are not hurt by it, you do not respond to it. When you see somebody victimized by racism, you do not do anything because it does not bother you. We experience racism every day, everywhere. It is a fact of life.
The other issue is poverty. I focus on child poverty because I figure it is the place to start. I experienced poverty as a child. One of the things that I am proud of is that my mother always came through for me.
We have kids now, supposedly in a more enlightened age, in a richer country, and I think they are hungrier today than I was as a kid. I do not know why that is. Maybe the resources of the country are not being channelled in such a way so that kids can eat well.
I know kids who are hungry. I know kids who are not well clothed. I know kids who have no place to sleep. I went to a place in one community, which consisted of just a little trailer. There were 18 people living in there, with three beds. Everybody had to take turns sleeping. If it was not the kid's turn to sleep that night, he did not go to school the next day. He had to go to bed when everybody else got up. Poverty is a big problem in reserves and I believe it affects kids.
I often talked about the little kid growing up hungry. They know all these things. They know what it means to be a First Nation person, the people you call ``Indians,'' living on a poor reserve. I believe that many of them make the decision by the time they are 15 that they do not want that any more, so they check out. I understand that totally.
There is a whole list of problems that are the root causes. There are the social problems like sexual abuse and incest. There are cultural and religious differences.
One of the big problems that we have in revitalizing our culture is to get over the religious differences because the fundamentalist Christians do not agree with our culture. The churches undermined our faith and now have come back to say that we can have our culture back, but it is our own people who oppose it. We had to deal with that first. You cannot rebuild your culture if half of the people in the community do not agree with it. You cannot march into a community and say, ``You do this; you do that.'' We have to help communities deal with those issues on their own. They have to do it themselves. It takes a lot of trust on your part to give them vast resources and say, ``Now do it.''
Mr. Devlin: If you look at suicide in First Nation communities, I am not sure that you can use the mental illness model. I think that depression and substance abuse contribute, but there are other factors that are integral to that desperation, that despair, and that loss of hope that actively contribute to suicide.
The 10 year-old or 14 year-old who commits suicide is not suffering from a mental illness. They have given up. If we look at it from a mental illness model, we miss that sense of historical dynamics.
The Chairman: That is an extremely important comment. If you are looking at non-Aboriginal population, we would be more inclined to look at it that way.
Mr. Devlin: That is right. I do think depression is a factor.
The Chairman: However, depression is not the principal factor.
Mr. Devlin: Untreated depression is a factor. I do think that substance abuse actively contributes in the trauma. I do think that trauma and unresolved trauma are background issues, but I do not think it is a mental illness model as we understand it.
Ms. Levy: What you asked is something I have thought about often. I deal with suicide, and suicide intervention and prevention in my job as a counsellor and psychologist with the board of education, as well as in my community work as a volunteer with the Nunavut Kamatsiaqtut Help Line and other services.
Where the money should go is a hard question to answer. I agree with everything that has been said. I do not want to repeat, but some money must go into intervention. You can intervene successfully and stop somebody from committing suicide. I know that for a fact myself. Many people that I deal with and have trained have done that successfully. When you do that you become a resource in the life of that person. The more resources anyone has, the less likely they are to commit suicide.
I believe in putting some money towards training people to become really good at intervention. Anybody can do it. There is not one person in this room who could not intervene in a suicide and have positive results.
I agree that the majority of the money cannot really go into suicide prevention as a little silo. It is more complicated than that. That is clear.
You mentioned the blueprint for a Canadian national suicide prevention study. I am the past president of the Canadian Association for Suicide Prevention and I have a copy of the study with me today. It is actually from the Canadian Association for Suicide Prevention and not from the Canadian Psychiatric Association. We cannot look at suicide prevention without looking at the cultural problems of poverty, abuse violence and all of the other issues that we have been talking about today. That is where the majority of the money should go.
With regard to suicide intervention, there are skills that can be taught and used. We have to put some money into that area as well.
Mr. Blue: The one thing that has not been mentioned directly and I think perhaps needs to be is the function of trans-generational trauma. When we speak of that, I mean to speak not only of a people that has been dispossessed of their land, their way of government and their heroes, but also of the tremendous loss that took place when over two- thirds of the people died of measles, followed a few years later by death from smallpox. That has been passed on generation-to-generation and still affects people of this generation.
If you look at the second and third generation from the Holocaust, which is a good example for us to look at, you will find that they have very high suicide rates. They have exactly the same sorts of problems with increased alcohol abuse. It is another look at exactly what has happened to the First Nations people in Canada.
The Chairman: Thank you. That is a perspective I had not heard.
Mr. Mussell: I like the notion of ``community of care.'' Our young people feel that they are homeless people even though they have a house with a roof, walls and so on. They have a house but not a home. Their caregivers are not there, their loved ones are not there, and the people they would like to have care about them are absent.
The better question is this one: What do we need to do with limited resources to contribute to the creation of that community of care?
I do not think you can buy it, but I certainly think you can do things to contribute to its development.
In the work I have been doing, and I have done a lot of work with suicide, I find that when young people have people who truly care about them and they know they care, they are less likely to commit suicide. That seems simple, but in a sense, it is very complex when you look at four-and-five generations that have suffered serious oppression. Many of these children live without that community of care, but they have survived and are dealing with the issues connected with that as well.
Senator Keon: What Mr. Mussell has raised is so tremendously important that it should be expanded upon. We should not leave it alone.
I know you do not want analogies to the non-Aboriginal population, but in the non-Aboriginal population of Canada, there is good scientific evidence that if you have a troubled person, the trouble in that person's life started before he or she was two years old. It started because of what Mr. Mussell is talking about; the child did not have appropriate family, parenting or security and all of these things.
As a heart surgeon, I operated on people that had only eight or 10 hours of life left if they did not have an operation. That was fine. It was dramatic and all of that. However, the most important thing I ever did in my life was establish a prevention unit in the Heart Institute that allowed them to live to be age 80 without heart disease.
If we are to have an impact on this horrific problem, Mr. Mussell has just put his finger on the pulse. I leave this matter with the experts, but that is where we have to start looking.
Mr. Mussell: I want to mention one additional thing. There is information from the United States that indicates that as communities depend more and more upon professionals and paid help, the people being served do less and less for themselves. That really describes the reality in most of our communities, and, in particular, the communities that have a history of suicide, violence and other types of abuse.
Ms. Dedam-Montour: A story came to my mind while we were talking about the allocation of funds and to which initiative we should give priority. We must have a multi-pronged, multi-dimensional attack on these issues.
When I was coming here on the train, I met a community health nurse who works at Health Canada. She arrived in the community and said, ``Okay, tobacco is on the agenda, so here is my tobacco strategy.'' She went into the school and had a little program all set up to educate grades 5 to 8 on tobacco. After her presentation she asked, ``How many of you smoke?'' We are talking about 11 to 14 year year-olds. ``I have been smoking since I was 8.''
She left that session realizing that she came in with a pre-conceived idea of where she should be attacking the issue, thinking it starts in grade 5. She had to restructure her education program on tobacco and went to the kindergarten and grade 1 class to show them the reality of tobacco, second-hand smoke and its harm and all that. She tried to make a pact with these kids not to smoke.
That is a similar story with the Inuit. They were teaching the Inuit kids up north not to smoke. The kids were going home to their parents saying, ``It is my right to have a clean environment. Do not smoke.'' The kids are forcing their parents to go outside if they want to smoke.
The reality is we perceive a problem and we perceive it as adults; however, we have to start putting in place intervention/prevention measures so that kids who are four, five and six years old will have some ideas on how to protect themselves. We have to give them some of those tools because we are maybe going too high at the end of the ladder.
[Translation]
Senator Gill: I want to thank everyone who made a presentation. These have contributed substantially to what we heard thus far from various aboriginal representatives across the country and well as here this morning. The committee's task is not an easy one.
I would also like to thank my Senate colleagues, in particular the Chairman, for the time devoted to studying the issue of mental illness, mental health and drugs. Considerable time has been spent studying these matters.
I hope that we will see some results. I have often been told that one of the Senate's roles is to work for minority rights in the regions. The focus of our recent discussions is in keeping with the aims pursued by senators.
We discussed at great length stigmatization and identity. History has not been kind to us. In life, one needs reference points. Without reference points, where we do get our identity? A number of years ago, I was involved extensively in education. The solution at the time to the education problem was to remove young people from remote communities and relocate them to residential, non-aboriginal schools closer to urban centres. Personally, I believe the experiment was a failure because the students were never able to integrate. They were uprooted and alienated from the community.
What is happening today? Today, suicide rates have risen sharply, problems are rampant and families have been shattered. We need to find a solution.
We are calling upon the government to help us find solutions.
Of course a report will be drafted and recommendations put forward, I would imagine, along the lines of what we have often heard. I am tempted to put the following question to you: what exactly do you expect from this committee's report? What expectations do you have? Quite often, you have been a party to discussions like these, to round tables, and you have subsequently asked yourself what results have been achieved.
Perhaps I am asking too much of you, but I would like to know what your expectations are, in so far as our aboriginal communities are concerned.
[English]
Mr. Morris: I believe that the best way to deal with social problems in the communities, including suicide, is to let the community deal with the problems. We do not know what approach they will use. As I said about Angling Lake, I do not know what they did, but whatever they did, it worked.
The intergovernmental committee that I talked about earlier built on the notion that it has to be comprehensive. Federal and provincial health, INAC, education, housing, every aspect of life that the child needs to consider is involved in it, and they try to deal with it in a comprehensive way.
When the community begins to deal with its problems, it does not just deal with the issue of suicide. For example, if you read the youth forum report, you will see that although they began with the issue of suicide, the report covered life in all of its aspects including education, housing, everything that they need to survive.
I am looking for youth to say that if a community wants to come up with a strategy to deal with social problems, they need support because they need to succeed.
Senator Cordy: As a former teacher, I remember words that stuck with me throughout my entire teaching career, ``A good teacher should be a guide on the side and not a sage on the stage.'' Perhaps that is the advice that government should take in this matter.
The Chairman: That is a good line. We may plagiarize that line.
Mr. Mussell: If we look at the challenges connected with successful collaboration, I think we can identify some of the expectations of the work of this committee. One would be to fill the void of knowledge or understanding by health care providers in particular about Aboriginal worldview, beliefs and values. That is not well understood at all. In fact, it is not really a priority in many health care providers' agenda.
Regarding the historical treatment and colonization process applied to First Nations, Inuit and Metis people, although there is better research now, it is not public enough as basic information.
There is also the importance of involving family and community in all aspects of their lives, particularly as it applies to restoration, rehabilitation and treatment.
It is also important that mental health professionals have every opportunity to become culturally competent in Canada. Canada is very distinctive and unique because of its Aboriginal people in particular.
It is also important that we have more Aboriginal trained practitioners, well-versed in their own cultural foundation as well as Western ways, and to be able to use that as a resource to build upon in regard to creating new ways and means of helping people to become effective human beings.
It is important that resources that support good work in the communities is available and provides an unfailing belief in the ability of that community to do the job. That is important.
Your report must also address the other issues that very much affect how we live our lives and how the public treats us.
Ms. Boucher: My expectation from today's round table is that I expect the committee members to take my mental health framework to the Prime Minister and tell him that you have the solution. I am just teasing.
Mr. Mussell indicated the need to focus on the community. It has to be community-based in regards to developing a new and more culturally relevant mental health process.
In regard to today's discussions, I will be honest that I came here today with the realization that, yes, I have been invited to round table discussions, and yes, I have attended many round table discussions in regard to how we can help our First Nation communities and how to start healing and how to start working with us. The reality is that it does not go very far. The reality is that our comments and our suggestions are documented, but it has yet to be proven that they have been implemented.
Today, I would like to know that what I have said will be noted and that it will be used to the advantage of creating mental health programs, which in my tribal council we have come to call ``emotional wellness and healing'' because mental health has such a stigma in First Nation communities.
I would like to know that I have the support of honourable senators today to move forward. I have come here from northern Alberta, from mostly isolated, semi-isolated communities. We have huge challenges in providing quality health care, one being mental health. We need to be heard. We need to have support. We need to know that today's discussion will help us move forward.
The Chairman: It will certainly help us in drafting our recommendations; there is no question about that.
Ms. Dedam-Montour: I am new to the health field. I am not a mental health worker. I work for the interests of the community health representatives, and I try to be as informed as they are about the various issues.
When I had the opportunity to speak on mental health, I quickly went to our own resource material and tried to gather some information. My understanding is that I was going to come here and give my little perspective of my organization. I was glad to hear from the other presenters.
I am not sure of your position on the mental health issue. Somebody mentioned a document, and I do not know if there is a document, but I have not had the position from your side of the table. We are presenting you with ours.
I believe you do have an interest in addressing this issue, and my expectation is that after listening to us, you will realize that the need is greater than you thought. I believe that after convincing all of you around the table of the need, you will go to that higher level and ask for more money. I believe there is a commitment somewhere along the table to address the issue.
Mr. Blue: One thing I hoped was to be able to look at mental health as a broader issue than I have seen.
I look at the reserves. I see tremendous problems with diabetes, for example. That is a mental health problem. I see tremendous problems with other physical as well as social problems. These are problems that mental health underlies. If we are to deal with those problems, we must begin to look at them in a much broader perspective to include the community health workers. We must begin to bring together those people who are servicing at the reserve level to formulate programs to deal with them.
I am overwhelmed with the number of problems at the health centre when I have gone to the reserve. I look at, as James Morris barely mentioned, reserves split right down the centre between traditional religion and fundamentalism. The ability to bring together so that people work together is a solution that seems not to have been undertaken in seriousness in many places.
Any support you can give us for the development of an access program for psychologists would be much appreciated.
Ms. Levy: I was really delighted and optimistic when I read that you were not just looking for us to name all the problems and the issues. I assumed that you are well versed in regard to them. You seem to have that awareness and you were looking for suggestions and opportunities for action, which is very good.
We ask, what will happen? What will be implemented because of this discussion? I am very interested in that. In the end result, there must be money allocated for different programs and different strategies, et cetera. However, funding for these programs cannot be given in Aboriginal communities on a per capita basis. It just does not work, and many communities that are very small would not be funded as a result. Some of those communities are where the needs are highest. Also, funding must be given to programs which are researched and planned before implementation, based on expectations and goals that can be realistically met but they must be culturally appropriate and community driven. Community members are their own best experts. Other people cannot come in and tell them what to do. We must know that and trust that.
Senator Pearson: Thank you very much. I would like to start my commentary with some ideas and questions, first, with thanks to Senator Kirby. I am not a regular member of this committee, but I would like to commend him and his regular committee for undertaking this enormously important issue. It has been much ignored in the past and not adequately addressed. The report that will come out from this committee will be important. I hope it will be hard hitting and will receive lots of controversy which is the way you start to make things happen.
I would like to take the opportunity to express my great appreciation to James Morris, and others, for having asked me to come along with Judy Findlay, the Child Advocate for the Province of Ontario, twice now, to visit the reserves with which he is preoccupied. In both cases, it was an enormously impressive experience, both from an asset point of view and from an opportunity to see the most pressing issues in greater depth.
Looking at myself, I understand how difficult it is for so many Canadians to understand some of the things that you have all been talking about in terms of colonization and the long-term effects of the residential school syndrome, et cetera. To be there is to see it in a clearer way.
I would like a couple of suggestions and would be interested in peoples' comments. On my return from my last visit, there was a suicide on one of the reserves.
Mr. Morris: Senator, there were two suicides.
Senator Pearson: Were both in Sandy Lake?
Mr. Morris: No, in another area.
Senator Pearson: This involved a 13-year-old girl.
Mr. Morris: We postponed our trip because of it.
Senator Pearson: It brings the issue home to me in a way that is very strong, partly because I felt there was a lot of hope and positive things going on. It sort of hits you that we have a big challenge in front of us.
Since then, I have been talking about a number of people, including, Cindy Blackstock from the First Nations Child and Family Caring Society. I want to make a suggestion called Jordan's principle. Mr. Blue, you are from Winnipeg so you may know about this case. It involved a child who was severely disabled and who was in the hospital — I do not know in if he was born in the hospital or taken there. However, once he was taken to the hospital, the family wanted to have the child come back with them even though they knew the child would not live all that long. Nobody could agree on who would pay the costs for the care. The child lived for two years in the hospital and died there and never had the experience of living in a family. Jordan's principle, which has been put forward by this group, is that wherever a child ends up, so to speak, or comes to the attention of an authority, that authority assumes immediately the responsibility and they argue it out afterward. The fact that a child should spend two years in a hospital with huge expenses — because nobody would agree on who would be responsible for funding the family, with their extra costs to look after this child — is unacceptable. That is one principle: Go with the child and then sort the stuff out afterward but never let the child be the victim of conflict.
The second thing that I feel strongly about — and, again, this is through some of the people that I met through James Morris — is the use of art therapy generally for children and, in particular, for Aboriginal children and children who are used to visual symbols as a way of working things out and who have had less opportunity. Goodness knows our kids do not have much opportunity either to work out the understanding of their situation. These are recommendations for funders and for the people who hold the bags.
The other thing that Cindy has discovered is that, in a study of the 20 cases involving First Nations Child and Family Services, among those 20 cases there were 385 cases of jurisdictional conflicts, each one involving an average of 54 person hours. The biggest conflicts were between two federal departments; the next largest area of conflict was between two provincial departments and the lowest group was what we all think of as federal-provincial conflicts. We have some strong messages to give to our federal departments, namely, INAC and Health Canada.
The final comment I want to make is this. I agree with everybody's sense of the importance of community base for solutions to some of the issues. In those communities, as James Morris has explained, and others have reinforced, there are splits within the community. Who is the community you are working with? I would like to think that, in many cases, it is the women who are involved. My sense is that the young people are not as involved as much as they should be in community solutions. Since many of the issues relate to them, I hope the committee will make some strong recommendations about youth engagement and the engagement with young people to deal with one of the predominant issues, which is the issue of sexuality.
Many of the young high-risk women leave their homes to have their babies instead of having their babies in the community. They are at high risk; they have dysplasia and various other problems. These young women need help.
The young people themselves, as the young people I know who have been involved in the sex trade, et cetera, will suggest that we listen to them because they may give us some good ideas that would not otherwise have been considered.
[Translation]
Senator Pépin: I would like to comment on children, one subject that was broached by the committee this morning.
We heard today that a link has been established between suicide and social relations and that balance also comes into play. According to the testimony presented this morning, children achieve a balance in their lives through tradition, history and the family. Mention was also made of the importance of keeping people in the community.
A high suicide rate among young people has been observed. If we could somehow invest in youth and children, to keep them in school and to give them the services they need, I believe it would make it easier later on to keep them in the community where they could take their place as future leaders.
It is important for you to have psychologists and nurses who are also members of your community. You need specialists to deal with mental illness. However, the first step in the process is to consider the impact of our actions on young children.
[English]
Mr. Mussell: A very desirable goal in terms of growth and development is that young children learn early how to find a place and make a space for themselves in whatever activities are going on within their family system. That was very common when I was a young person. I do not see it much today because families do not have those kinds of gatherings, such as work activities, work bees, picnics, things where there are systematic order to what it is they are doing. Young children who are able to do that at three, four and five have no trouble adapting in the school system. They are able to find a place and make a space, even in a public school system where they are a minority. The same applies to youth and young adults.
I had the pleasure of being part of a discussion in Winnipeg about 20 years ago and during that discussion, we talked about the significance of the reserve boundary. We asked whether the boundary was protecting us and keeping us in or whether it was unimportant unless we needed to return home and had to enter it from outside.
There is also the whole question of the ability to find a place and make a space wherever we choose to live in the world became very conscious in my mind. I thought that was a nice goal to work toward; to create opportunities for young people who as young adults are able to find a place and make a space wherever they choose to go; whether it is university, or move to Paris or London, England or South America. That is a model, a goal, and an ideal that should represent the nature of the education that is best for us. It begins by knowing our history, our culture and our traditional knowledge, our language and that kind of thing. I believe that is critical. If that could be a goal that is shared by all nations of the world it would be a much happier world in which to live.
Senator Gill: Your point about education is very important. I read recently that we have been failing our Aboriginal schools. For some years we have been able to change the programs a bit to adapt the services and things like that in the First Nations schools. However, now we have a report that says that the system in not very good.
I believe that the system seems to be bad because it is evaluated according to outside standards. We have to do something about the evaluation. Outsiders have evaluated it. If you go by outside values, it is almost a zero. There are no results. This justifies people to come back to the old system and control more and more, saying it is because the Aboriginal people are not able to do anything and that they are incompetent.
The Chairman: Evaluating someone against the incorrect frame of reference is a problem.
Mr. Blue: When I was a young child of seven, I had the opportunity to go north again and spend the summer with my grandfather, who was a fisherman. He was a trapper in the winter but in the summertime he fished for the dogs that take you out in the winter. I got into the canoe with him and go down the river to get to the MacKenzie and then down the Mackenzie to the fish camp where we set up. We had not gone probably an hour and I told him, my knees hurt, can we stop? He said ``no.'' We went on a ways further and I asked him again. This process went on for the next couple of hours. I am sure because of my complaining he finally pulled in, but in the process each time I would ask him, he would say to me, ``The trees don't say that.'' When we finally did stop I told him that I did not hear the trees say anything. He seriously and honestly heard the trees in the environment talking to him. This is something I have lost.
There is a tremendous amount to learn from the elders. They have their own unique way of looking at the world. It is tremendously important that we once again tap into that understanding, that knowledge. I think the bush talked to him, and what a loss.
Senator Cook: Dr. Blue, I should tell you that the Fogo Island Cooperative is very much a booming enterprise so you did do something well that day. There has been no out-migration on Fogo Island. The biggest challenge that they have is the way the fishery is managed, but that will be left for another table.
The President of Ireland recently came and celebrated 500 years of Irish people settling in Tilting. That is one of our good news stories.
I want to come back to recognizing the challenge that we have before us. We must understand the diversity that we have in this country and realize that we can live together in a global village.
You talked about communities in respect of capacity building and health. We are struggling with the challenge of mental health and mental illness. The focus has been on building a healthy community followed by the development of mental wellness as a result.
If I were to put up my determinants of jurisdiction, integration and the delivery of services, I believe that I could put up all the elements that I have heard around this table today.
You know better than I know about the framework within which we are working vis-à-vis governments, people and the integration of the jurisdictions for the delivery of services to individuals.
We are here today because it is all about helping people and their communities. Anyone may speak to those three areas, given the reality of the parameters with which we are working. Yes, you came and you can change things because I believe that you can. That is where I need help to understand.
I heard the issues of jurisdiction and the issues of integration into that jurisdiction in order to have a healthy community where there is mental wellness. I understand that there some elements cause a person to become mentally ill.
Mr. Mussell: That is where the notion of community of care comes into play in every way. Every community has a few families who enjoy that quality of life. They are an unexplored resource. They are not being encouraged to provide the kind of leadership that they could provide. Sometimes those families are the most marginalized families in the community because they are a minority and are different from the majority. That is tragic because, in my view, in most instances they are the more traditional families in that they are self-caring, co-reliant and they take responsibility for their children. Often, they are not encouraged to run for chief or to be on the council. They are not encouraged to apply for jobs at the band level and if they do run or apply for the job, often they are not hired. That is a huge community development challenge from the point of view of reframing values to see the world in a different way in order to begin to recognize the tremendous resources those people can bring to the community. That does not cost much money but over time the payoff would be tremendous. It is important to recognize that the core families of our communities have been core families for hundreds of years.
The Chairman: One of the interesting things in your comment, Mr. Mussell, is that all of us who are non-Aboriginal would have been inclined to think of the Aboriginal community on reserve X as homogeneous. The point you are making is the opposite, and there is no reason why any group of several hundred people ought to be homogenous.
The reality is that I do not know that I do it as a conscious thing but there is a subconscious assumption that there is an Aboriginal policy because they are kind of all the same. Therefore, in that sense your comment is that there can be the same kind of discrimination among people on the reserve as there is toward the people on the reserve.
Mr. Mussell: Some of the strongest leadership in our communities has been provided by women who married into our communities from another community. It is the women who relocate more often than the men. Honestly, some of the first chiefs we had in British Columbia, back to the late 1950s and early 1960s, were outsiders; and my mom was one of them. They married into the community. Often in those circumstances they are not fettered with the positives and negatives of the family history because they are brand new.
Mr. Devlin: It is important to differentiate between mental problems and mental illness. There is no reason to expect, and I see no evidence that mental illness is any greater within the native community than it is in the general population. The fact that we have more mental problems is true. That is what we are referring to and looking at. There is a highly significant difference between the two.
The Chairman: Explain to the committee the difference between mental illness and mental problems.
Mr. Blue: Mental illness interferes with the three functions of life: you cannot maintain a job; you cannot care for your family; and you cannot pursue a given place within your family or community. Things that interfere at this point become mental illness — psychosis or very severe neurosis, as defined by Management Sciences for Health, MSH, and the Diagnostic and Statistical Manual of Mental Disorders — Fourth Edition, DSM-IV.
The Chairman: You would call an episodic period of depression a mental problem and not a mental illness.
Mr. Blue: Yes. We can deal with such a problem at the community level provided we have the professionals available.
Mr. Devlin: To build on Dr. Blue's comment, I have always seen it as mental distress versus mental illness. The level of mental distress can be a specific episode that lasts a certain length of time but I would not classify it as a mental illness.
At one time psychiatrists in the Nishnawbe-Aski area were educated in Scotland and England. They would arrive from the University of Toronto to work in the area. They classified people with many strange multiple personality disorders and exotic mental illnesses. One time I spoke to a lady after she had seen the psychiatrist and asked what she had said to him. She said that she had simply told him about her life and he gave her medications to take. That is the reality and, often, the worldview and the sense of values and beliefs is very different so the psychiatrist's paradigm missed it all together and did not click on what was happening to that person.
The Chairman: The psychiatrist would have thought that Arthur's father was very ill; just to get it right.
Mr. Devlin: Yes, because he was listening to the trees.
Senator Cook: I want to make an observation about caring communities. In the 1990s, Newfoundland was hit by the cod moratorium, which displaced 30,000 Newfoundlanders to other parts of this nation. Into those communities went a community development officer to help stabilize the community and to deal with what was happening. Do you see that as a component of a caring community?
Mr. Mussell: That is effective community development and is well worth the investment. I am aware of the history of secondary adult education in the eastern part of the country and its effectiveness.
On the point of language, I know fluent speakers of some of our coastal languages. One of the teachers told me the story that would explain Mr. Blue's little story. Her father taught her and said this: If you learn the traditional language on the laps of your caregivers — all of the movements, actions and expressions and so on, both verbal and non-verbal — you will be in touch with everything in your world, including that which happens with nature, with the trees and the animals and the birds. Wherever you go, you are connected.
However, if you have learned a second language and it is an institutional language like the foreign languages that are often taught in the Canadian public school system, you do not have that same ability; you do not have the same command. You do not see in the language; you do not dream in the language; you do not think in the language. When that happens, you do not have the tools to be in touch with all things natural, all of nature. The traditional speakers really believed that we can communicate with the trees and we can hear messages and feel connections.
Mr. Morris: I just wanted to tell Senator Cook that I do not think that her questions about jurisdiction, integration and — what was the third point?
Senator Cook: The delivery of service.
Mr. Morris: I do not think we are answering your questions very well.
Senator Cook: You are being helpful but you are not there yet.
Mr. Morris: I was wondering if after we give it some more thought, could we convey our thoughts to you later?
The jurisdictional issue is a very difficult issue. I do not know if the intergovernmental committee recognizes that issue. Rather than dealing with government policy, they have just said that those of us sitting around the table were going to do business in a different way. When the time comes to deal with an issue, we will not worry about policy right now, we will just see who can do this and we will worry about policy and money later. That is similar to your approach.
I am not sure I understand everything that Mr. Mussell is talking about with the community of care — I would like to learn more about it — but I agree with it. Where it begins is with each individual like myself. This is why with organizations like mine, I need money to literally train people how to be parents. We have to do that. I learned that from my experience as a residential victim.
I had two families. I had an earlier family and I literally destroyed a marriage with drinking and anger that I got from being who I am. In my second marriage, I changed a little bit. I stayed with a Mohawk from Six Nations who took me through my journey to learn why I was so angry and all that.
Today, I have a son who is 12 years old. My goal today is to make sure that he does not inherit what I had — the anger, the residential school and the feelings of anger that I have about being a native person. I do not want him to have that baggage when he grows up. I want him to learn to be who he is and he is doing that.
It is hard. It is almost like the AA model that you take it day by day. I have to watch myself every day when he does something stupid, like screwing up my computer. He is really good on the laptop but sometimes he does things that I cannot figure out. I have to make sure that I do not get mad. I have to check myself and respond like his father.
If my goal is to make him realize that he has to grow up to be a caring and loving individual, I have to show him that example. That is what all of the community has to learn and that is a big job.
Senator Keon: I did not want to leave this subject because it fascinates me. There is a conflict here between person- centred programs or patient-centred programs and jurisdiction. Perhaps we should come back to Lorraine and put her behind the eight-ball.
I find it very interesting when I am in Edmonton and Winnipeg to observe the native people on the street. It is true there is a net for them in the social structure of the provincial health system; however, the reality is that they are lost souls.
One of the big failures of the Aboriginal health system is they have a total inability to follow that patient when he or she gets outside the jurisdiction that your organization oversees.
It seems to me that you have to get tough about this, raise your horizons, and say this native person has certain rights and we will follow that person and see to his or her care. We do not care where they are.
I want to hear your comment on that. As a matter of fact, join in the dance around the table.
Ms. Boucher: Thank you, Senator Keon, for putting me on the spot. I would just like to say that the jurisdictional issues that we contend with in Alberta — and I am sure in other provinces — in regard to the federal and provincial care that we are under as First Nations people is always a challenge.
In my community if a community member needs mental health counselling, it used to be up until about five years ago that they were able to access psychologists in Edmonton, for example, within the provincial system.
That has changed. What we are now able to cover in regard to the cost of travel and accommodation for our community members is that they have to go to the nearest counselling services. Sometimes, they are not able to continue seeing a psychologist that they have been seeing in Peace River or in Edmonton. That type of change can hurt their recovery.
I find that as First Nations people are always being thrown back and forth like a political football concerning accessing services. When we are on reserve, we are under the federal government; when we are off reserve, we are under the provincial government.
The level of mental health services is really quite sad as far as providing any real counselling for our communities, and not only the mental health services. However, we have certainly tried to address the diabetes epidemic in our communities.
For the past four years, I have been working on a project called Many Jurisdictions, One System: A Diabetes Integration Partnership. The project brings together federal and provincial representatives, regional health authorities, and my health directors. We collaborate on how to improve the communication and relationships from the community to primary care and to tertiary care, which is in Edmonton for most of my communities.
I would need more time to go into detail, but most of my community members have to travel by Greyhound bus, which is a 12-hour ride from our northern community to Edmonton for any sort of tertiary care or specialty diagnostics.
We have enormous challenges. My project focuses on diabetes and diabetes and foot care, and includes mental health in the model. We were able to hire a psychologist within the tribal council to work with our twelve communities.
Unfortunately, the level of funding is always a challenge. I am constantly in deficit in regard to my programs. I believe that there is a way to bridge both governments. I believe that there is a way to work with both governments and also with us as First Nations people at the table in regard to addressing the jurisdictional issues that are detrimental to our health.
I have also started to develop a knowledge-broker project where we are bringing in our traditional elders to work with the Western health care providers, and this is in respect and honouring our First Nation communities. We are searching for solutions to our jurisdictional problems.
I am not sure that I have answered your question. I am hoping that in a roundabout way that I have touched on some of what you have said.
Senator Keon: You have done very well. It was a rather brutal question at the end of the day. Just to get really cruel, let me ask you now about the patient who is making progress with counselling. He has two appointments and then gets lost in Edmonton. Who finds him and gets him back in?
Ms. Boucher: I will be as honest and say that there is no one. There is no one that goes and finds him. There is no one that follows up. There is no one there that will provide the guidance to get him back home.
Some of our members have had to stop counselling sessions because of government cutbacks, such as medical transportation cutbacks, and those people are lost in the system. The cost to travel to Edmonton or Peace River is too heavy a burden for them to carry without assistance. They are lost in the community. They are not able to continue their healing process.
Senator Gill: I believe that it is a fact that people refuse to give services to members of First Nations because everybody would like to see the other government giving this service. We are facing the old policies of assimilation. People just try not to give the services if it is possible not to give the services.
I have a perfect example of that situation. Bill C-31, concerning the native women returning to the bands, created many arguments on the reserves.
On my reserve, for example, we had to have 1,000 people, on limited land and limited money because we did not have any more money for that purpose. We had to face our chief an there were many fights among our members. It was a tough time to face those difficulties without too much funding. There were many arguments over who would pay for the services.
Mr. Blue: In Manitoba, I have been retired for a number of years, so I only speak then. I flew to work in an airplane most mornings. I have also seen patients in Winnipeg. In the process, I found the community health worker to be an excellent resource. I also found the workers within the City of Winnipeg to be excellent, and I tried to furnish them with a list of people that I expected to see. They went and got them many times, sometimes off the street or in the areas in northern Winnipeg.
As well, on the reserve, the community health centre worked well with me. Again, I suggest to you that the big thing that worked so well and made the reserve community work well were those weekly meetings, which brought everybody together. We sat there and said, ``Look, these are the people I am seeing, and these are the kind of problems we have. What can we as a group do to help sometimes the family, sometimes the individual?''
That community meeting really was very important. The community health workers were absolutely essential in the process of seeing all this done.
I sat back and I said, ``I want this,'' and they did it.
The Chairman: Your example is a perfect one, at least in my mind, of Ms. Boucher's concept of one system, many jurisdictions.
Senator Callbeck: Debbie, you said that it is your hope that after we heard the presentations today, we would realize the need is greater than we ever thought. As far as I am concerned, that is the way I feel.
Mr. Morris according to this chart, it covers a 24-year period, but in 1982, 1983 and 1984, there are no suicides. Then in 1986, it starts to skyrocket. It goes down a bit in 1998. Why has it escalated so much from 1986?
Mr. Morris: I did not have a chance to get to that part. There are several reasons for the escalation. Mr. Devlin can help me on this if he wishes.
One of the reasons is that we have had a lot of sexual predators in our area. In particular, there was an Anglican priest who lived in our area for 17 years. I got married in 1969, and he participated in my first wedding. He had authority in the community. He was a pilot. He was in Boy Scouts, and he had access to 17 communities in northwestern Ontario as well as northern Manitoba.
All during the time he was there, he abused boys. I believe that many of these boys started to mature to an age where they started committing suicide. When I became a deputy grand chief for the band in 1988, I met with some elders and they told me to keep an eye on two particular communities. They said pay particular attention to those two communities. That is where the suicides started.
That is just one reason, but coupled with the environment that I described earlier that type of personal trauma is normally enough to push the child over the edge to suicide.
I believe that is one reason why the suicides started.
The mental health experts in Toronto also told me — and I do not know who will check this out — that a pedophile has on average 500 victims before he is caught. I do not know where they came up with that figure. This guy was up there for 17 years. He has been to court three times already. He is going to court again. They have identified fewer than, let us say, 50 victims. As far as I am concerned, there are still hundreds walking around out there.
In the intergovernmental committee that I talked about, I wanted to try a new form of peer counselling. In peer counselling you teach kids how to listen to their fears and learn how they can be helped. I wanted to try a method of bringing in the victims who have identified themselves. They know each other. I wanted to say, ``Who are the other people?'' I wanted to bring them in for help. The intergovernmental committee did not agree with me because they said I did not have a safety net.
That is what I am doing right now, building up these mental health services, trying to treat these victims.
We do not know who they are. My nephew killed himself suddenly two years ago. I did not know until afterwards that he had been a victim, when he was about nine years old. How do you stop something like that? That is just one element. I know they are out there, but I do not know where they are. What do you do?
Mr. Blue: I think you have hit it exactly right. The peer counselling is exactly the stop-gap in both the identification and the treatment. You are right on.
Senator Keon: I cannot compete with the wisdom that I have experienced today. I think we have heard sufficient to roll up our sleeves and get busy with our report.
It is obvious everywhere we go that those of us who have been in the health field in our careers have had one miserable failure: We have failed to put adequate resources in the communities.
We have built our monuments and so forth, and there is no question most of them were needed. However, we simply forgot about the community resources that are necessary to deal with mental illness at every level but, in particular, at the Aboriginal level.
We are obliged to settle for nothing less than a structural framework that allows the people who know how to do the job to get the job done. These people need an appropriate network to identify the resources that they have and utilize them to the maximum.
It is a great privilege to have listened to all of you this afternoon and this morning. It was outstanding.
I repeat what I said this morning: For those of us who are non-Aboriginals, the Aboriginal situation is an embarrassment that we cannot afford to live with simply because we are embarrassed, we have a moral obligation to do something about it.
The committee adjourned.