THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
EVIDENCE
OTTAWA, Wednesday, October 19, 2022
The Standing Senate Committee on Social Affairs, Science and Technology met with videoconference this day at 4 p.m. [ET] to study the Federal Framework for Suicide Prevention.
Senator Ratna Omidvar (Chair) in the chair.
[English]
The Chair: Honourable senators, my name is Ratna Omidvar, senator from Ontario and chair of this committee.
Before we welcome our witnesses, I would like to provide a content warning for our meeting today, as our committee continues its study of the Federal Framework for Suicide Prevention. We will be discussing topics related to suicide and mental health. This may be a trigger to both people in the room with us and those watching and listening at home. Phone numbers for crisis lines will be broadcast during this meeting. Senators and parliamentary employees are reminded that the Senate’s Employee and Family Assistance Program is available to them, offering short-term counselling for both personal and work-related concerns as well as crisis counselling.
For our first panel, joining us in person is Wendy Stewart, Director, Community Wellbeing Branch, Métis Nation of Ontario, representing the Métis National Council. Welcome, Ms. Stewart.
Also joining us, by video conference, is Jocelyn W. Formsma, Executive Director, National Association of Friendship Centres. Welcome, Ms. Formsma. Thank you both for joining us today.
Before we get started, I wish to remind everyone that the focus of the study is the Federal Framework for Suicide Prevention, which was published in 2012. I ask you to please keep your comments on the framework as much as possible. This is true both for our witnesses and for our committee members.
I invite Ms. Stewart and Ms. Formsma to both provide opening remarks. As usual, you each have five minutes allocated, and following that, we will take questions from the senators, also five minutes per round.
Ms. Stewart, the floor is yours.
Wendy Stewart, Director, Community Wellbeing Branch, Métis Nation of Ontario, Métis National Council: Tawnshi. Good afternoon, chair and committee members. Marsee and thank you for the opportunity to participate in your hearing today. I’m here as a member of the Métis National Council’s technical health table to speak to you about governing members’ perspectives regarding the study on the Federal Framework for Suicide Prevention.
Métis are a distinct Aboriginal people defined in section 35 of the Constitution. Métis governing members — Métis Nation British Columbia, Métis Nation of Alberta, Métis Nation-Saskatchewan and Métis Nation of Ontario — form the Métis National Council. The Métis Nation, with its own collective identity, language and way of life, continues to advance its rights to self-determination, including self-governing in Canada through democratically elected governance structures and registries. Each governing member is mandated to represent its own citizens.
As a constitutionally recognized Indigenous people, Métis citizens must have the same inherent right as First Nations and Inuit to contribute to the achievement of the overall health status comparable to the Canadian population and shift the focus of health service delivery from an illness model to prevention, wellness and health-promotion model.
As such, we appreciate this invitation to speak to the Federal Framework for Suicide Prevention. Let me tell you the story of Alex, a Métis teenager who was sent to 17 different care homes and seen by 23 different social workers over a span of 11 years. Throughout his time in care, Alex was subjected to abuse and neglect. He was also denied access to mental wellness supports or any meaningful connection to his family or Métis culture. At the end of his life, Alex was placed alone, unsupported in an Abbotsford, B.C., hotel room for 49 days. He ended his life by jumping out the window from that very room. Beyond statistics, we’re talking about a community tragedy.
In 2016, the Federal Framework for Suicide Prevention highlighted no evidence of suicide rates or action plans. In 2018, a progress report showed some improvement, including prevalence rate, yet no action plans to appropriately address the needs for Métis people.
Two years later, we find ourselves in a similar situation — some Métis health data on prevalence rates but no Métis-specific mental wellness or suicide prevention strategies. Furthermore, if we put the three reports side by side for the purpose of evaluation, Métis people are once again invisible. You cannot evaluate progress when you’re not meaningfully included.
The trajectory leads us to believe that the upcoming 2022 report will reflect the same situation. Only in the last two years has the Métis Nation received federal funding to support Métis wellness and life-promotion initiatives. Even so, this investment is currently temporary, leaving governing members struggling to provide a continuum of care for those in their respective communities.
From this Métis worldview, suicide and life promotion are interconnected. Everything that promotes life can also prevent suicide. Although helpful, a suicide prevention model without a life-promotion focus neglects the unique circumstances of Métis people, our histories and the continued impact of colonization on our well-being. It also focuses on a deficit-based approach rather than leveraging the incredible strengths of our communities.
From a broader perspective, what health data is available suggests that most available statistics underestimate the health disparities and outcomes for Métis. As stated at various tables, it is essential for Métis communities to have access to appropriate health data to fully understand and inform any initiatives moving forward in this regard.
This means meaningful inclusivity of Métis health data to apply the best available evidence, knowledge and practices. This would also facilitate Métis communities to be mobilized to address current life-promotional and suicide-intervention needs and support funding proposals and enhance life-promotion initiatives.
The Métis Nation is also committed to ensuring that at-risk populations within our communities are receiving the care that they need. This includes but is not limited to a focus on gender-diverse populations, women, girls, youth, elders and those facing geographical barriers. When we are viewing this framework, it is clear that there is a capacity for the Métis Nation to support this work. Your framework speaks to leveraging partnerships, building on decades of community-based research and conversations, pan- and Métis-specific advisory committees and formal government tables. The Métis governments have worked to provide culturally appropriate, self-determined health and well-being opportunities that address the unique health profile of Métis in our communities.
In closing, we do not want to grieve another Alex. We need to be included in the next framework report. We have hope that by being here today, that meaningful inclusion will allow us to advance suicide and life-promotion initiatives for Métis, preventing the unnecessary deaths of any Alexes.
Thank you again for this opportunity to articulate the importance of having meaningful engagement and participation of the Métis Nation and to express the voice of Métis citizens. We welcome any questions that you may have. Marsee. Thank you.
The Chair: Thank you, Ms. Stewart.
Ms. Formsma, the floor is yours.
Jocelyn W. Formsma, Executive Director, National Association of Friendship Centres: Good afternoon, everyone, [Indigenous language spoken].
I’m joining you today from the city of Whitehorse on the traditional territories of the Taa’an Kwächän and the Kwanlin Dün First Nations.
I really appreciate the opportunity to speak today on this issue. I was not able to prepare notes ahead of time, but there are a few areas that I wanted to touch on in my opening remarks. First, I have the pleasure and privilege of being the executive director of the National Association of Friendship Centres. My community is Moose Cree First Nation, and I’m originally from Treaty 9 territory in northern Ontario, Nishnawbe Aski Nation and Mushkegowuk territory along the James Bay coast, which will come into play a little bit later.
As I understand it, the Senate committee is examining and reporting on the Federal Framework for Suicide Prevention and, in particular, looking at some of the effectiveness after the period of time that this framework has been in play.
Just to give you a sense of my background, I’m a long-time Indigenous children’s rights advocate and youth engagement advocate. I have been involved with at least two rounds of engagement with the Committee review of the UN Convention on the Rights of the Child.
I have worked across borders with both Canada and the United States on the issues of children’s rights and, in particular, child welfare. I have also done some writing with respect to upholding the rights of Indigenous children with respect to their rights articulated under both the Convention on the Rights of the Child and the United Nations Declaration on the Rights of Indigenous Peoples.
As a young person, I was the president of the youth council for the National Association of Friendship Centres and a representative on the NAN Decade for Youth Council, which is now the Oshkaatisak, still operating within Nishnawbe Aski Nation, or NAN territory. For many years, we worked with the NAN Decade for Youth Council specifically on suicide prevention with our NAN Decade for Youth Development, which saw great success, and now we are looking at its successor, the Choose Life program, which operates across northern Ontario under the Jordan’s Principle program, as I understand it.
The current federal funding for Indigenous youth is quite sparse. As the National Association of Friendship Centres, or NAFC, we operate with the Urban Programming for Indigenous Peoples, of course. Youth coordinators and youth programming are eligible under those funding boxes, but the amount of funding is nowhere near the amounts that are needed to provide the broad range of services that friendship centres provide, inclusive of youth programming.
For many years, we operated the Urban Multipurpose Aboriginal Youth Centres Initiative, or UMAYC, which I think was an amazing program. It provided so many supports to Indigenous young people across the country. I personally benefited from that program and attribute to it some of the success that I have seen and some of the early supports that I received as a young person.
Its predecessor, the Cultural Connections for Aboriginal Youth, was short-lived. The entire youth programming was cut in 2018, and nothing has really replaced it. I already mentioned the Choose Life program. Other current federal programs are more related to youth exchanges, labour market, employment, volunteerism and reconciliation. But there is nothing for us, by us as Indigenous peoples.
Just to close, looking back on the framework, I cannot say how effective it has been for urban Indigenous children and youth, but I can say that what we need to do to save more lives is to offer connection, culture and community to Indigenous children and young people across this country. We need to address jurisdictional wrangling so that it does not become a barrier to providing the supports needed for all Indigenous youth, regardless of residency. And we need to increase Indigenous children’s and youth programming, including things like Aboriginal Head Start, and reinstate national Indigenous children and youth programming.
Thank you very much for your time today.
The Chair: Thank you very much, Ms. Formsma. As is our current practice, we will now go to questions from senators.
I do not need to remind you that each senator has five minutes for your question and your answer. I would appreciate it if senators indicated which witness they would like the question addressed to.
The first question will go to Senator Pat Bovey from Manitoba, who is the deputy chair of the committee, followed by Senator Patterson from Nunavut, followed by Senator Kutcher, who is the sponsor of the study.
Senator Bovey: I would like to thank both witnesses. I very much appreciate your viewpoints. I like the fact, Ms. Stewart, that you talked about life promotion and the life-protection focus and that, Ms. Formsma, you talked about connection, culture and community. You are both forward-looking, which I certainly appreciate.
As we look at this framework, I would be interested in both your thoughts about what you feel is missing from the framework.
Ms. Stewart, I know you said that the Métis experience and realities are not there. I am interested to know how you feel they should be voiced in the framework. What are the gaps in data that would help underline the importance of the Métis and the friendship centres being in the framework?
For my last question, I would like you to reflect a bit on what you feel the role of research is to inform the framework for viable action plans. Pick what you can from that. I am sure others will pick up what you can’t.
Ms. Stewart, if you can go first.
Ms. Stewart: Certainly. Thank you for those questions.
Ironically, this week we are meeting in Gatineau for the Métis National Council’s health forum. We are actually talking about Métis-specific approaches to data — data stewardship, access to data, taking our data to the nation and actually having that dialogue about what the data means.
Although we see numbers, it is the first time we have seen them. The data was presented without consultation. In some of the co-analysis that is happening right now, Métis are often an afterthought.
All we’re asking for is to have that meaningful engagement — you know, dialogue about data up front. We’re also asking for meaningful consultation in terms of asking the communities what something might mean instead of having it interpreted and presented to us afterwards.
As it relates to meaningful life-promotional activities, we look at the Métis-specific social determinants of health. We actually do have a report on social determinants of health available for the Senate that we can provide.
We are looking at things that are related to kinship — related specifically to the Métis community. The pan-Indigenous approach often places Métis in a situation where they are deemed invisible. Again, we are just asking for more meaningful engagement. The community is an official Aboriginal population. At some point, that same, equitable engagement would be appreciated. Thank you.
Senator Bovey: For Ms. Formsma, I wonder if you can give us some reflections from your perspective on the research you feel is necessary to inform the framework so that there are the programs that you feel are necessary.
Ms. Formsma: Absolutely.
What is missing? I do not think anything is really missing from the framework. What is lacking is the on-the-ground implementation. Something I always talk about with my team at NAFC is that whatever we are doing, we have to map it to the ground — tell me how this matters to someone who walks through the doors of a friendship centre. How does it matter to a young person who does not have the resources to be able to address some of the thoughts they are having that may be suicidal, who is affected by depression or who is feeling disconnected? Anything we’re doing has to matter to them. It has to matter at the level of the child or that young person.
That implementation piece is what is missing.
The gaps in data — it is known that a lot of Indigenous organizations, communities and governments are missing the capacity to do their own data collection and analysis. We are certainly facing that now. We have gone ahead anyway and built our own database. Now we are finding that we have to backfill the capacity for people to input the data into the database and for the analysis piece. We have decades’ worth of data on youth programming that I have not been able to do anything with because I do not have the people to go in, clean the data and tell us what it said over that period of time.
Certainly, there is research that can be very helpful. We take the approach of community-driven research. It is not just research done by academics in institutions. We have actually developed a framework and system where friendship centres and community-driven organizations are the ones who are leading the research so that the outcomes of their research actually matter to them at the end of the day.
Our senior research coordinator’s own research project for her PhD is with respect to the impacts that those two programs I mentioned — Urban Multipurpose Aboriginal Youth Centres Initiative and Cultural Connections for Aboriginal Youth — have actually had on the lives of Indigenous young people. When that research comes out — and hopefully she will make it public whenever it is ready — it can tell us a lot about what actually matters to young people and how we keep them safer.
Senator Bovey: Thank you.
Senator Patterson: Thank you to both witnesses.
I would like to ask Ms. Stewart first. You talked about, as I understood it, Métis being recognized in the Constitution, having the same inherent rights as the other Indigenous groups in Canada. I am quite familiar with the Inuit-Crown partnership table, which has done quite a bit of work on suicide. We will hear more about that later in this committee.
Has the Canada-Métis Nation Accord been a vehicle to address the issues that you mentioned about feeling overlooked or left out?
Ms. Stewart: It is a start. It is a start to a meaningful dialogue: (a) being recognized and (b) being able to exercise that accord on many levels beyond just mental health and wellness initiatives. So yes, I would say it has been extremely helpful.
Do we have a way to go? Clearly, this report would indicate that we do. We are certainly open and welcoming it.
Senator Patterson: Thank you. I would like to ask both witnesses. We have fortunately heard from the Minister of Mental Health and the Chief Medical Officer of Public Health of Indigenous Services Canada, or ISC, and both of them said that they were going to be consulting Indigenous organizations: Minister Bennett on the action plan that is aiming for the fall of 2023 and engaging with Indigenous communities, and the Chief Medical Health Officer of Public Health for ISC will be engaging with Métis and other Indigenous organizations to support Inuit-led evaluation of outcomes.
I would like to ask you both if you have been involved in those consultations yet. Could each of you give us a short answer on that?
Ms. Stewart: Jocelyn, would you like to go first?
Ms. Formsma: Sure, thank you. We have been engaged. There was a dialogue in Toronto just a few weeks ago. We sit in a really weird position, though. We completely understand and support the nation-to-nation relationships that the government has and has been advancing with Métis, First Nations and Inuit governments. We operate in the civil society space where we are a volunteer-driven network. We provide a wide range of programs and services. We are a community hub. We do not represent anybody. When it comes time to do a lot of the dialogue and conversations and action planning and strategic planning around anything Indigenous, there is no federal forum for us to engage that is not through a representative means. That is something I think I would highlight.
When I mentioned jurisdictional wrangling, that is where a lot of urban Indigenous folks get caught up in. A lot of Indigenous people — the vast majority of Indigenous peoples now are urban-based. We have various relationships with our respective First Nations, Métis and Inuit governments, and as a network of civil society organizations, we have been trying to call for and ask for a voice that is outside of that nation-to-nation relationship where we can provide our perspective, our realities and our experiences from the hundreds of thousands of people we serve every day and the millions of people we serve every year. But we have not quite gotten there yet. I will just make that comment. Hopefully, that answers your question.
Senator Patterson: Thank you.
Ms. Stewart: As it relates to the experience of the Métis National Council, yes, we would all say from the health technical table that we have started to have meaningful dialogue from Crown-Indigenous Relations and Northern Affairs Canada, or CIRNAC, and ISC. Again, the dialogue happens at the technical table with all of the governing members, but it also happens at a jurisdictional level as well with each governing member. So for that we certainly appreciate that meaningful dialogue.
Senator Patterson: Ms. Formsma, you were telling us about the importance of the national Indigenous children and youth programming. Could you give the committee, either now briefly or later, some idea of how this program worked and why it was so effective? I have high regard for the work of the friendship centres, so I think we should be very interested in learning of your experience with that now-defunct program.
The Chair: Senator Patterson, could we get that information in the second round? Because your time is up and I am conscious —
Senator Patterson: Please just note my question, Madam Chair.
The Chair: Note your question and perhaps Ms. Formsma can get back to us.
Senator Patterson: Thank you.
Senator Kutcher: Thank you to the witnesses for your input. Previous witnesses have noted that the framework does not promote interventions that are already known to prevent suicide. It often talks about actions which we do not know if they are effective. General interventions that improve social determinants of health, strengthening communities are absolutely essential and are lacking. We know that. But even then, they may not fully deal with all the suicides in the community.
My question is about what kind of additional, on top of that, specific interventions need to be considered. The question that I have is to ask you both what actions are needed to help us identify which kinds of additional interventions, beyond strengthening communities, are needed or have been demonstrated — or do we have to research them to find them — that specifically will decrease rates of suicide in Indigenous populations.
Ms. Formsma: Thank you. Yes, so as I mentioned in my opening, Indigenous people, Indigenous children and youth are the fastest-growing segment of the Canadian population. We are some of the only populations that actually are growing, and I think that is something that Canada is grappling with.
With that, you look at the landscape of federal funding and the federal landscape, and the investment specifically in Indigenous children and youth well-being is very sparse and it is not coordinated.
We are involved with some action planning around a national children’s framework. We have been very vocal with multiple departments about what they need to be doing with respect to existing youth programming and what new youth programming needs to be there.
Basically, it comes down to the fact that you can’t really put a barrier in front of Indigenous youth engagement and expect them to engage with that. It is like asking them for more, and with respect to some of the stuff coming out of the Canada Service Corps — I’m trying to be quick. Basically, there are examples that have worked. I gave two of the UMAYC program.
Maybe I could touch briefly on the senator’s previous question. What made it work was that it was by youth, for youth. It was multi-purpose. It really met the needs of the communities regardless of which community they were in. If you were in downtown Vancouver, that program looked different than when you were in northern Manitoba and different from when you were in Whitehorse or in downtown Toronto.
That was the beauty of that program. It was flexible enough to meet the needs of the youth of that community, and it was driven by the youth. I think that program should not only be brought back but expanded to include all Indigenous communities, not just urban but First Nations, Métis and Inuit. I cannot speak highly enough about how great that program was.
Ms. Stewart: Just building on these comments: not without youth, and I would say specifically not without Métis youth.
I would also say in addition to that, looking at early interventions for children, if you are asking how you would measure that long-term impact, I think that we need to actually start putting some investments for early childhood interventions.
For example, in some of the programming that our governing members run, we know that early intervention for a diagnosis, looking at problems at home and in the school — how can we change those trajectories so that it actually has an impact on that individual’s overall well-being, their ability to manage well in school and end up in an appropriate vocational setting for them?
At this point, we do not know. We do not have all of that information. In terms of our ability to have access to that data, to actually look at what was and what is, this is where having meaningful nation-to-nation dialogue about access to data would be really helpful.
We can come back to the table with further information in that regard, if you wish, in terms of what it looks like from a Métis lens and what we would recommend as possible outcomes. We can do that.
Senator Kutcher: That would be wonderful. The other thing is the program that Jocelyn Formsma talked about and its impact on suicide prevention. Does it have data that shows that when you put that program into place, you actually decrease suicide? We would love to get that.
The Chair: Yes, we would, for our study.
[Translation]
Senator Mégie: My question is for Ms. Formsma. You spoke earlier about the friendship clinics. Before, this afternoon, I was in another group and I heard a lot of good things about what the health centres are able to do.
When you get the opportunity to be called and consulted for the national action plan, are you going to ask for all the things you said earlier, like expansion and increased funding? From what I just heard, it would be a good thing to include it in the action plan.
You who are on the ground, how do you see this implementation?
[English]
Ms. Formsma: Thank you. We’ve done a lot and I think we continue to do more around anti-racism in health care, around education, access to justice, children and youth. What we keep finding is that we have better outcomes when we do it for ourselves, and we’ve recently submitted our pre-budget submission, which we’re trying to push on all fronts. Give us the core programming but allow us to do a lot of expanding up and out of this programming. We find Aboriginal Head Start is another example of a program that works so well, and it needs to be in every community. That’s an easy one; it’s existing, and there is a lot of data on that.
The work we did in Nishnawbe Aski Nation with the Decade for Youth work, I think there is a lot of data and information there as an example of what actually works. On the idea of how we measure decreasing suicide, we struggled with that when we were on that Decade for Youth Council. How do we measure the ones who don’t commit suicide, right? Instead, we tried to flip it around to say we can measure engagement and we’ll measure our success by how engaged the young people are within our territory. That’s 49 First Nations communities that are largely fly-in.
When we look at trying to bring some of those aspects, the best practices within the friendship centre network, it’s the same thing: How do we measure engagement? We have a lot of success when we are able to do it ourselves and actually have the capacity.
[Translation]
Senator Mégie: Thank you. You say that some people can go by plane. Could the action plan and the expansion create several service points that could be accessible to more people?
The other thing you said before was that the friendship centres didn’t make too much sense to people. Do you have a communication plan so that people know what a friendship centre is for, so they can come to you?
[English]
Ms. Formsma: That’s part of our work over the next couple of months. We know budget conversations are very active right now. We’re trying to make sure people have the right information to do that. We always want to be in lockstep with First Nations, Inuit and Métis governments. We recognize the value and support that the governments try to provide for their citizens.
This idea of overlap or competition I think is a bit of a red herring. God forbid we have enough resources to meet the diverse needs of our community members across the country! But the idea they would have multiple ways to have their basic human rights met and to make sure they have multiple areas for connection, I think that’s a best-case scenario we should be striving for. Having the bare minimum should not be our goal. We should be trying to strive for the best-case scenario, which is an Indigenous young person, whether First Nations, Inuit or Métis, who, wherever they are in the country, has an equitable level of basic human rights support where they have the connection, the culture, their community, housing, food in their bellies, and they feel proud of who they are. That should be what we’re striving for. We shouldn’t be trying to strive for the floor.
And yes, we are working on some of those communication points to make sure people know the roles that the centres play within their lives, especially within the urban settings. We become a first and continuous point of contact for many Indigenous people living in urban centres, and we include rural, remote and northern communities in that. We just mean off reserve, outside of Métis settlements and territories and outside of Inuit Nunangat.
[Translation]
Senator Petitclerc: Thank you to our witnesses for being with us today. My question will also be asked in French.
My question is about what is happening on the ground. We hear that when it comes to the consultations that are done, they are often not adequate, sufficient or optimal enough. On the ground, at the programs and services stage, can you tell me if the members of the First Nations, Inuit and Métis communities are at the centre of the decisions and the implementation of these programs and services? If not, should they be?
My question is for both witnesses. Perhaps Ms. Stewart can answer first.
[English]
Ms. Stewart: Just quickly, I wanted to comment that, for the first time, I would say that there is starting to be meaningful engagement. There hasn’t been in the past, and clearly by the evidence of these reports, we’re still waiting for that. So the fact that you have invited Métis National Council to be present today to speak to this very issue is a testament to the fact that engagement is starting to happen, so we appreciate that. Our relationship with ISC and CIRNAC — the monies we’ve received most recently in response to COVID we’ve been able to apply to address our mental health and wellness needs. That has been super meaningful for all of us. Looking at what the data is going to tell us, hearing from our communities about how you facilitated Métis communities across the whole land to be responsive to their communities in a culturally safe, culturally relevant manner — that is testament to the commitment we’re starting to see, and we appreciate that. So we are seeing a change.
Ms. Formsma: Same thing, we are starting to see a bit more engagement. I think we need to face a reality of our populations. Making programs and policy decisions from the federal government level that doesn’t include the reality that most Indigenous peoples are living in urban spaces is a challenge we continually face. I mentioned that around jurisdictional wrangling. Sometimes we come up against this barrier where we’re trying to advocate, saying we need programming within urban spaces, and the pushback we get from the federal government is, “Where are the provinces and territories on this? They should be stepping up into this space.” We try to push back and say we are part of a federated model where we have our regional associations that are advocating quite constantly with the provincial governments and so when we’re coming to the table asking for resources, we’re only asking for the federal component of the full ask.
I kind of go two ways on consultations. On the one hand, I would rather drive the resources to the ground and have them put to work immediately, and then the consultation and engagement would be telling you what we did with it and where the gaps are. I feel like that’s a better way than having perfect consultations and coming up with a perfect model and then the funding going out. We could spend so much time and energy and money — and we have — on consultations but, really, when you go to the community level — as I’ve said, I’m sitting here in the Skookum Jim Friendship Centre in Whitehorse — they know what they need for their communities. I’m here working with them on figuring out how I can get the resources in their hands to actually meet the needs of this community. We do the same thing for every community across Canada where there’s a friendship centre.
For the resources, I always look at who’s getting paid and who’s making the decisions. If the people who are getting paid are consultants and contractors and folks, and if it’s not the people who are doing the work on the ground, we need to look at that.
We have a lot of experience in trying to flip that script to make sure that the resources go to the ground first. What we’re feeding back in terms of engagement and consultation is just what’s happening right now in as much real time as we can provide.
Senator McPhedran: Thank you very much to the witnesses, Ms. Stewart and Ms. Formsma, for being with us today. I want to try to get a better understanding — and this may just be on my part — about the cooperation, sharing of resources and the requirements on your organizations and your leaders to interact with multiple federal agencies, multiple federal ministers and multiple officials connected to those federal ministers.
Pretty much everyone in this room and with us online has the experience of what happens when a fairly modestly resourced organization tries to access all of those levels within the federal government and, when you have multiple departments and multiple ministers, how truly challenging that can be. I’m not presuming your answer on this. I’m really going from my own years of advocacy. Can you talk to us about the ideal scenario for you, given your resources, given where you want to see suicide prevention go? I’m asking this because we have the potential here to make recommendations and observations. To the extent that you are comfortable telling us the truth about your experience, we certainly welcome hearing it.
Ms. Stewart: I really appreciate the fact, on behalf of the council, that you just asked that question because — let’s be honest — all of us in the Indigenous world can say that engagement is exhausting. Our communities are exhausted. They don’t want to engage any more. Number one, they want to see action. Number two, for those of us who have to engage with the government, it is exhausting. There are multiple and multi-faceted agencies we have to dialogue with. In addition, we are also dialoguing with provincial governments and obviously their own jurisdictions. We’re talking about a federal, national suicide strategy, and yet we’re often dialoguing about data that sits on a provincial level, accessing that data within regional levels, then dialoguing with different ministers, different portfolios — let alone talking about those in conflict or at risk of being in conflict with the law. And we know that our criminal justice system has become the default mental health facility.
Among other things that are not talked about here at the moment are harm-reduction strategies. Métis have zero access to culturally appropriate substance-use services and supports. We are only starting to have access to it within our own jurisdictions at this time, but in terms of having access to land, having access to residential treatment facilities to help address some of those things — again, it’s another ministry, and we’re talking about infrastructure, and no one wants to talk about that.
Yes, I could talk for a while but I will leave it at that. I think you can sense. Thank you.
Ms. Formsma: Yes, I think we have very similar experiences. The capacity that we have does not match the need. We’re working with multiple departments, and it is a challenge. Every day, we try to work out what we can. We are building more capacity, and we appreciate that, but we’re not there yet. For example, even to come to this committee and for our invitation to another committee, and even though I have policy analysts, it’s basically me who is putting together the information and drawing on my personal experience to speak to some of these issues. Ideally, I would have the ability for folks to respond to every single request for information and engagement that we get.
They’re reaching out, absolutely. I have seen more engagement, but we don’t have the capacity to really respond. Then it becomes a need to balance where we put our resources again. I don’t ever want to have us build up to be a massive organization that takes up all of the resources when, really, it’s better that those resources go to the ground. We’re constantly having to ask how much is enough and how much we can do with what we have. And does that mean we’re taking away from our communities to continue doing this work? There’s a balance.
Senator Brazeau: Thank you to both of you for being with us this afternoon. Obviously, it’s an issue that is important to this committee — as you can see, there are many members around this committee table — and me, personally, as well. I have two questions. First, seeing that we’re talking about suicide prevention and Indigenous peoples, we know there is an overrepresentation of Indigenous people in suicide rates. My question is pretty simple. In your dealings with the federal government, do they care about suicide prevention for Indigenous people?
Ms. Stewart: I think the answer is yes, they do care. We’re in dialogue. We’re having this discussion right here, right now. Again, moving forward, we are also urging meaningful engagement. It’s one thing to care. It’s another thing to actually do something in a meaningful way that is culturally appropriate and specific to a community. Thank you.
Ms. Formsma: I measure things by effectiveness. If someone cares or not, I appreciate that. I thank them for caring. But are they actually effective in what they’re trying to achieve? That’s the question I have. The structures, the money, the announcements that have been set up, have they been mapped to the ground, as I mentioned? Has the effectiveness really played out the way that it’s intended? If it hasn’t, then that’s what we need to work and focus on.
An announcement is not going to help somebody when they wake up in the morning and maybe are thinking about not being there by the end of the day. The effectiveness is whether or not the resources are there when they reach out for help and if, when they call someone, there is someone there to answer. Are there supports in the community, whether you’re in an urban community or First Nations or Inuit or Métis community? That’s what I measure: effectiveness. It’s not really about whether someone cares or not.
Senator Brazeau: Section 91(24) of the Constitution states that the federal government has jurisdiction over “Indians, and lands reserved for the Indians.” As a former leader of a national organization, it’s always been the position of the federal government to limit its responsibility toward Indigenous peoples. However, in 2016, there was a Supreme Court decision. One of my predecessors, the late Harry Daniels, who fought and fought and went to the Supreme Court and said, “Enough of these labels of on- and off-reserve, status, non-status, urban, remote. Indigenous peoples are Indigenous peoples.”
Because of government policies, we have these different labels. This is primarily a health issue, so more of a provincial jurisdiction, but the federal government has jurisdiction for all Indigenous peoples. They don’t practise that, but they should have jurisdiction for all Indigenous peoples. Do you believe that they’re diluting or sort of getting away from their responsibility by saying that this issue is more of a provincial nature? And perhaps this is why, in terms of organizations, you don’t receive the funding that you need to have good suicide prevention programs that work and that are culturally sensitive and available for Indigenous people?
Ms. Stewart: On behalf of the Métis National Council, I would say we are all looking forward to continued dialogue to really talk about those commitments. They have yet to take full actualization. Here we are at this table, having this dialogue. Again, we are constantly urging the government. We’re still waiting for health benefits, let alone suicide interventions. So, again, we welcome this. We also have a report that we can make available in terms of our requests and our priorities.
Ms. Formsma: Jurisdictional wrangling is a problem that we have not even begun to start talking about. There is no forum for addressing the challenges that federalism has caused under those sections that you mentioned, the division between provincial and federal jurisdictions. They look at urban Indigenous or Indigenous peoples. Wherever we are, as jurisdictions, we need to look at it as people and how we help people, regardless of jurisdiction. So, yes, it’s a problem. We need to solve that because it’s welfare, health, education — all of those issues.
Senator McCallum: Thank you both for coming to present and especially for the work that you do. It is overwhelming. I had experience with child suicide while I was working up in the North as a health professional. To be able to look at all the issues that you have to consider, with very little power, very little funding, is amazing.
This is a community issue with historical, colonial damage that we still carry within us and that results in individual tragic deaths. What do you do with that individual in a community which is overwhelmed with trauma in all sections, whether it’s health, education, child care, all those realms? The jurisdictional wrangling with that lack of portable rights is such a big issue.
Social determinants of health are very important. If social determinants of health are not addressed, do you think that individual engagement — and I’m thinking about the mental health professionals who would travel, the therapists. They will work and, at the end, if those health professionals are removed, you have nothing. You’re back to square one. Right? How do you deal with that? What are your recommendations that would help you?
Ms. Stewart: With respect to the Métis National Council and all the governing members at our health tables, our jurisdictional governments are well poised to provide appropriate distinctions-based services and supports to Métis communities. Particularly, as it relates to the last three years, we have been very grateful to receive funding, for the first time, from the federal government to support mental health and wellness initiatives. Our concern is solely predicated on that very issue: What do we do after this funding dries up? These communities have come to rely on us as a culturally safe and professional institution for their services and supports. They’re linked to kinship; they’re linked to culture. And we’re in that situation at this very moment. Again, beyond the framework, we’re looking forward to having that dialogue: What does continuity of culturally appropriate care and services look like for Métis in Canada? Thank you.
Ms. Formsma: I don’t think there’s enough to time to go into everything we need and the recommendations that we have. But I can tell you that what we’ve done and what we continue to do is listen to communities. We’ve committed to being a good national partner, to communicating what we’re hearing on the ground and to providing practical and pragmatic options for moving forward. There is no easy solution but, right now, we don’t have a mechanism to even begin to talk about those jurisdictional issues.
I would agree with my colleague on the idea of the continuity of services. I hate this idea that we are pitted against each other because of our residency: urban versus on-reserve versus in the North. The way that we’ve established our network is, even though we have a national voice and a national office that works federally on national issues, we get our direction from those over 100 communities across Canada where there are friendship centres. Those are run by the communities and cultures of those local urban places. It’s First Nations; it’s Métis; it’s Inuit, depending upon which community you’re going into. The solutions need to be based in reality, not, as I sometimes say, on thoughts and feelings. They need to be based on good information. We need proper mechanisms to get the full picture to make the best decisions on program policies and ways forward.
The Chair: Thank you, Ms. Formsma.
Senator Cordy: Thank you both very much and to your organizations for the work that you do with the challenges that there are. I know Senator McPhedran spoke about the funding, trying to find funding, and I heard that many years ago on the Social Affairs Committee with Senator Kirby as chair when we were studying mental health and mental illness. Organizations then said they had an almost-full-time staff person just looking for ways to find out where to apply for the money. That frustration is still there, unfortunately, 20 years later.
Ms. Formsma, you spoke about starting to see more engagement with the government in terms of developing a framework. Frameworks are a great tool to get things done, and it’s great to have it as a guideline, but you also then spoke, on the other hand, about the funding for youth — that it is sparse, that there is nowhere near the amount of money that you need for programming. My question is, no matter how great a framework might be, whether there are challenges surrounding funding — for youth programs particularly because we certainly have to focus when we look at the suicide rates among young Indigenous people. We know that’s where it all starts. You also spoke about the Head Start program being very much a success story. Is there enough money for the Head Start program to continue? How will this affect the programming that you do?
Ms. Formsma: The Head Start that’s operating in urban settings, I would love to have one of those in every single friendship centre. That’s not the case right now. The way I look at it, whether it’s suicide prevention or mental health, in my opinion, the governments are likely spending the money anyway. It’s about where they are putting the priority.
You are going to be spending the money in the child welfare system, in the justice system, prisons and jails — we know the numbers of our Indigenous folks who are incarcerated and within the child welfare system, as examples. So you are paying for that anyway.
What we are saying is if we provide upfront investments in prevention, in connection and what builds strength, then we will see the decrease down the line. It might take a little bit of time, but I am fully confident that we would see the decreases in spending on the back end on providing the remedies afterwards. We want to see the upfront investment. We will see more people wanting to continue their lives and to continue contributing to their communities if we are able to do those upstream and upfront investments.
That would be where I would say, “Where is the priority?” It is so important that we put those up front.
If you wanted to make the economic argument, which we hear now, too, about the economy and, “We cannot be spending all of this money.” Well, again, the fastest-growing segment of the Canadian population and we have zero investments in their development, in children and young people? That makes no sense from an economic standpoint. You will be counting on Indigenous children and young people to be a part of the labour market or to be the bodies to fill these labour needs. You need to make sure that people have good lives to be able to contribute in multiple ways to their local economies whether they are Indigenous economies or the Canadian society as a whole. I hate making that economic argument, but obviously it is something that resonates with decision makers right now, so we need to put that in there as a factor.
We do not look at Indigenous young people as just bodies to fill this labour need, but if we actually look at them as the future drivers of our future economies, then we need to be thinking about what types of investments do we instill in them as soon as possible, as early as possible, so that we can benefit from their great and wonderful ideas and their efforts down the line.
The Chair: Thank you very much, witnesses.
This brings us to the end of this panel. I would like to thank Ms. Stewart and Ms. Formsma very much for your participation in our study. Your wisdom and your on-the-ground knowledge coupled with some powerful language that you have used will certainly find reflection in our study. I want to thank you.
For our second panel we welcome in person Natan Obed, President, and Daniel Afram, Senior Policy Advisor, with Inuit Tapiriit Kanatami; and by video conference Dr. Polina Anang, Assistant Professor of Psychiatry, Max Rady College of Medicine, University of Manitoba.
I would like to invite our witnesses to provide opening remarks. As always, you will have five minutes for your opening statements, followed by questions from our senator colleagues. Mr. Obed, the floor is yours.
Natan Obed, President, Inuit Tapiriit Kanatami: Nakurmiik. Thank you very much, everyone. It is so good to be with you all in person. Thank you, chair and deputy chair, for the opportunity to witness here today.
Inuit Tapiriit Kanatami, or ITK, is the national representational voice for Canada’s 65,000 Inuit. We occupy about 51 communities across over 40% of Canada’s land mass and 72% of Canada’s coastline. Our governance model is structured by our land claim organizations. Nunavut Tunngavik Incorporated, Makivik Corporation, Nunatsiavut Government and the Inuvialuit Regional Corporation make up ITK’s board of directors and elect our president. So I am here as a representative of the Canadian Inuit through that governance model.
We also have made great strides with the Government of Canada working on policy issues such as mental wellness and suicide prevention through the Inuit-Crown Partnership Committee, along with ongoing and existing relationships with Health Canada, the Public Health Agency of Canada, Crown-Indigenous Relations and Indigenous Services Canada being the leads within this particular space of mental wellness, mental health and suicide prevention.
In 2016, Inuit Tapiriit Kanatami released the National Inuit Suicide Prevention Strategy. It was actually the first strategy that was met on day one with federal funding. We had initial funding for $9 million over three years.
In 2019, through a pre-budget submission, ITK was allocated $50 million over 10 years to further the implementation of our National Inuit Suicide Prevention Strategy. And only recently, in Budget 2022, we received an additional $11 million for suicide prevention activities to implement our strategy for this fiscal year and next fiscal year.
We focus our strategy on being globally informed, evidence-based and Inuit-specific. Our key priority areas within the strategy are creating social equity, creating cultural continuity, nurturing healthy Inuit children, ensuring access to a continuum of mental wellness services for Inuit, healing unresolved trauma and grief and mobilizing Inuit knowledge for resilience and suicide prevention.
Inuit experience suicide at roughly 6 to 25 times the national rates, depending upon region and also demographic.
This has been an issue since the mid-1970s. Even if, historically, Inuit have had lower rates of suicide, we recognize that we as a people, just by the very nature of being Inuit, are not at a higher risk of suicidality. There are a multitude of factors that have placed us in this scenario, and that is why we believe that through the implementation of our strategy and working with the federal government, we can do all that we can to reduce suicide levels throughout Inuit Nunangat. We have been able to do a multitude of different initiatives, and I look forward to talking with you more over the course of this hour about what those initiatives are and how they relate to the federal framework that you are discussing. Nakurmiik.
The Chair: Thank you, Mr. Obed. Dr. Anang, your five minutes, please.
Dr. Polina Anang, Assistant Professor of Psychiatry, Max Rady College of Medicine, University of Manitoba, as an individual: I am very sorry that I am not in person with you. Honourable senators and members of the committee, my name is Polina Anang. I was born in Ukraine to Ashkenazi Jewish parents. I grew up in the Soviet Union and moved to West Germany as a refugee in 1989. Winnipeg has been home to my family since 2008. I am a certified child and adolescent psychiatrist with a special interest in community-based participatory research.
My opening statement is co-authored by the Building on Strengths in Naujaat youth group: James Junior Kopak, Veronica Uttak, Lydia Haqpi, Shelly Iguptak, Diana and Deana Kringayark, Brenden Angotingoar, Suzanne Putulik, Jonathan Ijjangiaq, Cathy Katokra, Amber Kringayark, Lou and Nathaniel Kopak, Diane and Eva Uttak and Julieanne Kringuk. The youth group was established as a partnership between youth in Naujaat and the University of Manitoba team to enhance youth resilience and create a sense of ownership, agency and purpose. For me, it was the realization that clinical work alone would not be an adequate response to the mental health crisis in the community. Even if we had enough psychiatrists, psychologists and social workers to meet the demands of the population of Nunavut — which, as you know, is not feasible given the scarce resources — it would not curb the tide of the downward mental-health spiral. Formally trained southerners are not well versed in Inuit culture and have very little understanding of the realities on the ground, especially when services are delivered exclusively via telehealth.
Engaging Inuit youth taught me about resilience, resourcefulness, generosity and kindness. I believe that it is important to address why and how people lose hope instead of focusing on treating them afterwards. Inuit youth emphasized the same upstream factors or social determinants of health that public health researchers have identified: overcrowded housing, poor quality of housing, lack of post-secondary educational opportunities, lack of economic opportunities and lack of recreational activities.
I think it is crucially important for the Federal Framework for Suicide Prevention to embrace a multi-pronged approach with sufficient resources allocated to creating conditions that will allow people to live healthy lives. Despite the importance of contextual factors, given my own expertise, I will focus my arguments on one specific aspect of suicide prevention: training local mental health providers.
Therapeutic alliance has been shown to be the most beneficial aspect of talking therapy. Most Inuit patients prefer talking therapy to psychopharmacological options. Unfortunately, most clinicians who work in Nunavut do not stay long enough to build a therapeutic alliance with their patients. As an alternative, it will be important to build local capacity, which will allow for continuity of care and cultural literacy and will eliminate the language barrier. It will, furthermore, improve the systemic understanding of post-colonial legacy and intergenerational trauma. Several challenges need to be addressed. Candidates must be carefully chosen. Internal struggles with trauma and current addictions will compromise their capacity to be there for others. Some community members will still prefer to open up to someone from outside. Small communities make this work very complex.
Another challenge is the quality of the training provided. I cannot emphasize enough the importance of high academic standards for such training. Unfortunately, when there is a high demand and an even higher degree of helplessness, private-sector entities may attempt to fill the gaps with offers that deliver all the buzzwords but very little evidence-based expertise. Without rigorous academic standards and proper accreditation, this training will not prepare Inuit mental health workers for the nuances and complexities of the therapeutic interventions that are required. Both high teaching standards and ongoing supervision should be considered essential parts of this training.
While foreseeing many challenges, I also anticipate a significant positive impact. Inuit mental health workers will revitalize the talking therapy and create a new cultural acceptance of mental health as inherently beneficial for community members. They will dismantle mental health stigma by role modelling openness to both traditional Inuit values — Inuit Qaujimajatuqangit — and the psychological validation of accepting emotions and seeing courage in sharing feelings with others. Inuit mental health providers will enhance the resilience of their communities by shifting ownership of well-being. Finally, it will create fulfilling professional opportunities for Inuit within their own communities.
Thank you for the opportunity to address the Senate committee on this most important issue. Qujannamiik.
The Chair: Thank you, Dr. Anang. We will go to senators for questions. We will start with the deputy chair of this committee, Senator Pat Bovey from Manitoba, followed by Senator Patterson from Nunavut, followed by Senator Kutcher from Nova Scotia. Senator Kutcher is the sponsor of the study.
Senator Bovey: I would like to thank Mr. Obed and Dr. Anang. I found that you were both very compelling.
I was interested that you both underlined the importance of evidence-based approaches. The cultural continuity, obviously, came out in both of your presentations. Mr. Obed, you certainly know my interest in the North and the number of times I have been there and been concerned about these issues.
I’m intrigued and really pleased to hear about your National Inuit Suicide Prevention Strategy. You said you would be willing to talk about its relationship with the federal framework, so that is my question to you. If I have time, I have a question for Dr. Anang as well.
Mr. Obed: Thank you, Senator Bovey. The framework references Indigenous peoples. It also references the National Inuit Suicide Prevention Strategy. There is also a little bit of text around context for Indigenous peoples. It is largely quite good and is in keeping with the rest of the framework.
There is one quote on page 20 of the framework that states of suicide rates that “in fact sometimes” there are “none at all” if there is cultural continuity in Indigenous peoples’ communities. I would like to question the merits of that particular finding and say that during COVID we all recognized the importance of evidence-based public health. Hearing from officials and chief public health officers was quite important. In the area of Indigenous people’s suicide prevention research, there are some findings that certainly wouldn’t pass the evidence-based test.
I would say that I do not know of a society on earth that has not been touched by suicide. So in the federal framework, it is unfortunate that there is a reference that if somehow we had culture, there wouldn’t be suicide in our communities.
Senator Bovey: And rich cultural communities.
Mr. Obed: Yes, absolutely. That is not to say that culture is not important. Culture is extremely important, especially as a protective factor. But in the consideration of suicide, risk factors and protective factors, they do not balance out. One particular protective factor does not mean that a person is free from suicide risk.
Getting back to the situation of the framework, and especially with Inuit Tapiriit Kanatami, we would be pleased if there were an even closer connection between the funds that we have received and the connection to the framework, especially since the framework is legislated, and our funds are through federal budgets or through associated federal envelopes for mental health.
We would like to have closer alliances between our strategy and the larger work that happens in suicide prevention because I believe we need to work together — between Indigenous and non-Indigenous work in this area — to ensure that we have the best possible opportunity for success.
Senator Bovey: Thank you.
Dr. Anang, I know that my time is probably running out. Very quickly, I’m very interested in the work that you did with the Inuit youth. If my time runs out, Dr. Anang, could you send us that report or a summary of that work? It is really important in light of your presentation and the framework that we’re working on.
Dr. Anang: Thank you, senator. It is ongoing work. We started in 2017, and the youth group is meeting on a weekly basis, so it is ongoing. I will be happy to provide the two articles we have published so far.
I am very much looking forward to continuing this work.
Senator Bovey: We would be very pleased with the two articles. Thank you.
Senator Patterson: Welcome, witnesses. Good to see you again, Mr. Obed. I would like to drill down a little further in what Senator Bovey was asking about: the relationship between your very well-conceived National Inuit Suicide Prevention Strategy since 2016 and the federal framework.
We will be making recommendations to the federal government about the framework and its effectiveness and improving it, including the question of funding, as you say. Could you just elaborate further? Where does your strategy fit in alongside the framework? Should it be incorporated into the framework given that Inuit are facing grievous, agonizing and elevated public health crises? Should it be an appendix to the framework? Should it be integrated or acknowledged in the framework? How do you see that?
What would you recommend that we recommend?
Mr. Obed: In some cases, our work could be too closely aligned with the federal government, especially in scenarios where there is a change of government or change of attitudes toward particular frameworks or strategies that the federal government produces — or even the implementation of legislation. In this particular case, though, it is a Canadian challenge and one where the Inuit specificity is paramount in the way in which the federal government responds to this crisis we have.
We have done the work to create a strategy that we feel is in keeping with other suicide prevention strategies, globally. We would be pleased to be able to more formally connect our strategy with the framework at hand.
There are three Indigenous peoples in this country, and this would not preclude First Nations or Métis from also having associated strategies or scopes of work that they would put forward as adjacent to the framework.
This works best in concert with the Inuit Nunangat Policy, which has been recently adopted by the federal government. All programs, services and all legislation that the federal government considers is affected by the Inuit Nunangat Policy in a way in which the federal government creates its response.
Previous to the adoption of the Inuit Nunangat Policy, there had been a scattershot approach to the way Inuit are considered in areas that affect Indigenous peoples. This Inuit Nunangat Policy, when applied to the framework, the implementation of the framework and associated funds, would also be an essential help to the implementation.
Even referencing the Inuit Nunangat Policy in the implementation of this suicide prevention framework would be extremely helpful to us.
Senator Patterson: Thank you.
Dr. Anang, yes, I’m familiar with your work in Naujaat. I would like to ask you some very specific questions. You talked about the importance of developing Inuit-trained counsellors who would stay in the community and not transit in and out. Right now, Nunavut seems to require an MSW, and very few Inuit have that. But you said academic qualifications are important, so how do we design a training program that would be accessible to Inuit?
You spoke about private-sector fixes that are sometimes jumping in and not effective. Can you just elaborate a little bit more on that? We want to know where monies are being misspent as well as how they can be well spent.
The Chair: I will have to ask you, Dr. Anang, to be very brief — 20 seconds. If we have time, we will get back to you on that.
Dr. Anang: Thank you. I work very closely in Naujaat with community mental health outreach workers. This is the target — mental health worker — I would invest the training in.
I don’t think it is possible to stay in the community and get a Master of Social Work or a degree in psychology, but I do think it is possible to create a curriculum. When I say “academic,” it means that there needs to be some university input into creating that curriculum.
But I do think that it can be delivered virtually and in-person at the same time, targeted to people who are on the ground who are already, in some capacity, working in the health centres or in community halls. That is my thinking.
I need more than 20 seconds to talk just peripherally about the training that the community mental health nurses are getting or the outreach workers are getting. I look into the private companies that are delivering that training and —
The Chair: Thank you, Dr. Anang. Unfortunately, I have to cut you off. Perhaps Senator Kutcher could cede some of his time on that.
Senator Kutcher: Thank you to both of you for being here. I will quickly put Dr. Anang’s comments into some context and I will ask Dr. Anang to give us specific written recommendations as to how you would improve the mental health workforce. The WHO has done this for a long time with the mhGAP program that provides a substantive component. Vikram Patel developed all sorts of programs in India, and my group did them in sub-Saharan Africa. They are all there, and they do work. Thank you for taking that on.
Mr. Obed, nice to see you again. I remember the last time we were together, you had to leave to deal with a suicide that happened in your community. I am sorry about that. Thank you for persisting.
You mentioned that Indigenous suicide prevention interventions often do not pass the evidence-based test. How can the framework ensure that the suicide prevention interventions it identifies are evidence-based?
Mr. Obed: Yes. There are so many areas of focus within suicide prevention that it is sometimes easy to take one particular area and imagine that it alone is the path toward less suicide in our communities, especially when we know that we want to do more to infuse our children and our communities with culture, language and opportunities to be on the land.
Those are all very positive. Sometimes I’ve wished for more opportunities for there to be just positive community-based programming that is celebrated for just that.
Yes, absolutely, they are building protective factors which you could put into a suicide prevention lens, but so much of the work we are focusing on has to do with things like undiagnosed mental health disorders, overcoming the effects of child sexual abuse, early teen cannabis use and the effect neurologically on developing brains. These are the areas that the research tells us that we need to focus on to make a positive difference in our communities.
Part of it is just the reorganization or at least the ability to articulate what we are trying to achieve and label it accordingly so, while taking an evidence-based approach but also, in some cases, a very positive community-based approach as well.
Senator Kutcher: Thank you for that. I completely agree with what you just said. You were one of the people that worked on the 2017 House of Commons report which all these things are in, and thank you for the work you did there.
If I could get you thinking on three different areas to focus on: investing and building Indigenous-led culturally safe and economically viable healthy communities — that’s a whole whack of work in there — ensuring availability of Indigenous experts in culturally safe health and mental health care — there’s a whole whack of work in there — and then developing and delivering effective Indigenous-specific evidence-based unique suicide prevention interventions. We have three whacks of work that have to be done. Would that be a reasonable way to think about this?
Mr. Obed: Those groups that you have outlined absolutely align with the implementation work we are doing in part. If I were to talk about this in our communities, I would say first and foremost that we need our children to be loved. We need them to grow up in safe, healthy environments, with enough food to eat, with education, but first and foremost to be safe. If I were to do one thing, I would try to do that first.
Then we talk about what we can do for the people who are caring for those children, and that’s when investing in communities and mental health supports comes in. Building healthy, strong communities does take investments in those families, parents and caregivers. From the evidence-based research and an ongoing understanding of how we are doing, it would be to tie those efforts that we do to then not just deaths by suicide but also other indicators that indicate success over time with achieving that first goal: Are our children loved? Do they grow up in safe environments? Do they have what they need to thrive in this world?
Senator Brazeau: Thank you to both of you for being with us and thank you for the work you’re doing on suicide prevention.
I’m going to repeat myself. We’re here to study the Federal Framework for Suicide Prevention, but we’re being asked to not talk about suicide prevention.
I will ask anyway. Because we don’t have too much to be proud of. I mean, Inuit communities are home to some of the biggest suicide rates in the world, colleagues. Here we are sitting around a table and trying to come up with solutions as to how to prevent suicide, but we’re not supposed to talk about suicide. I will ask you a very direct question: Have you seen a documentary that was shown on Radio-Canada in 2020 — and I apologize if I don’t pronounce this well — but it’s called “Imialuk : la méchante boisson,” which translates in English to “the bad drink”? Have you seen that documentary? It’s not the only factor, obviously, but how prevalent in Inuit communities are substances and alcohol in particular? Because this documentary was based on the fact that there is a lot of bootlegging being done in Inuit communities. There are a lot of people making a lot of money on the backs of Inuit children and other Inuit men and girls.
In the documentary, it shows that Canada Post, airline companies, the SAQ in Quebec are all aware of the bootlegging taking place. I would like to hear from you specifically how dominant the issue is, how important that issue is and how we start attacking that to reduce the numbers. Because that’s the ultimate goal. We’re not going to prevent every suicide but we can certainly do things to reduce them, and that’s why we’re here.
Mr. Obed: Substance and alcohol abuse are a challenge within Inuit communities, and many Inuit communities have tried to introduce and maintain policies that those communities believe will keep their communities safe. Some of our communities are dry communities, in some you have to fill out permits, and some have open access to certain types of alcohol but not others. This scenario does lead to bootlegging being very profitable. But from a societal perspective, it also leads to certain ways in which you interact with substances, especially alcohol.
Would you fly in three cases of beer or two bottles? If you know you are not allowed to have them, how do you drink versus how you might drink otherwise if it was just to have a beer on a Friday night, watching a hockey game? This is a part of the complex relationship, I suppose, that we have with drinking. It then shifts into scenarios where people are most at risk. If people have access to certain types of alcohol at certain times and then have a higher risk or are in a phase of suicidal ideation, then their choices are greatly impacted by the way in which their attitudes are toward alcohol or substance abuse.
We need to do a better job of having a more sustainable, normalized relationship with these substances and do a better job of understanding the links between the policies and attitudes toward substances and suicide ideation and risk. This is a really difficult topic and one that we don’t have the answer to, but we certainly see how difficult it is and how real the effects are in our outcomes.
Senator Brazeau: Thank you. I want you to know, like I said, I’m not proud of that statistic that so many of our Inuit brothers and sisters are committing suicide among other people as well. I’ve had personal issues and experiences with that, but anything I can do to assist you and Inuit communities in any way, shape or form, you just let me know and I will do whatever I can because it’s close to my heart.
[Translation]
Senator Petitclerc: My question is for you, Dr. Anang. If we have time, I would appreciate an answer from both witnesses. Thank you for being here with us today.
We’re talking about the Federal Framework for Suicide Prevention, and I’ve heard from several of our witnesses about the importance of what is being done on the ground in communities and by those communities who know the people and the needs and who are experts in finding solutions. I want to hear from you and hear your views on the importance of ensuring that the solutions are brought by the people in the community and on the ground.
Of course, we have a scientific and academic eye, and we have a federal framework. Should we give priority to those who are in the communities and on the ground?
[English]
Dr. Anang: Thank you so much for this wonderful question.
I will answer while also addressing the previous senator. When I asked the youth group, we mostly talk about what they want to see change in their community, what they are proud of and what they want to improve for their children. But when I asked the youth, “What is the one thing you don’t want to see?” the answer was unanimous, and it was alcohol. So I do think that listening to the voices of the community is the answer. And it is challenging. This qualitative community-based research needs time — and funding is usually very short-lived — it needs time to build relationships, to build trust, to bridge that divide between our academic expectations and kids who just finished high school or dropped out of high school and they do — they have very important things to say and they have a really good understanding of what is going on on the ground for them.
But in order to start a dialogue, it takes time, and our funding does not “understand” how much time goes into the foundation of relationship building. I think that the future lies in giving community members a voice and an opportunity to determine how to make a future livable for their children.
The Chair: Senator Petitclerc, you have a minute left, if you’d like to ask our other witness.
Senator Petitclerc: Can you have an answer for that? My question was how important it is to make sure that the focus is on people on the ground, knowing the community and making the decision on what’s good for them.
Mr. Obed: Absolutely, and it’s good to also recognize so many people who keep other people safe in our communities. That could be coaches, it could be teachers, it could be extended family members. There are so many people who care about those who are at risk and are there for them in their times of need. That’s why we, at ITK, have worked on providing specific suicide intervention programming and have created an Inuit-specific Mental Health First Aid that we have done in partnership with other mental health organizations in this country.
The community focus of our national strategy is at the heart of what we do. We recognize we do need resources to do things at the national level, especially when it comes to policy development or research.
But certainly we want to change the lives of people in the community and we want to give people more resources and we want the people who are at risk of suicide, we want them to have resources and feel as though, in their time of need, that they have hope.
Senator McCallum: Thank you both for coming here and also for all the work that you do.
Dr. Anang, you said it was important to understand why people lose hope. Is it hope or is it much more than that? I will tell you that I had a bout of anxiety that was so bad that I understood why people commit suicide. Just that energy within you, which is so erratic that you cannot be in one place, you know? I really had to force myself for eight hours to walk slowly around and around in the cold and to block my ears.
When I realized, I spoke to a medical doctor, and he said it is anxiety, and then I thought, “Oh, I can deal with that.” But a lot of people don’t know what that is, right, so they are living with it.
How do you teach people at the community level, where colonialism, for example, learned helplessness, because that is what we were taught in residential school? We do self-fulfilling prophecies where we were taught that we were nothing. And even though I’m 70, I still fall just like that into victimhood, even with all the work that I have done. How do you work with people when they have so much inside? Sometimes they don’t even know what they carry, and, you know, to be able to take them to a place of safety, to take them to a place where they know they matter.
I think the one topic we have not spoken about is sexual violence. It exists all over, but our communities don’t deal with that. They don’t have any programs. They will do harm reduction with alcohol, and I have seen it working successfully in one community. But that topic of sexual violence doesn’t seem to ever be addressed.
Does this framework deal in any way with sexual violence, or do you think sexual violence plays a big part in what’s happening?
Dr. Anang: Thank you, Senator McCallum. This is a really important question. Sexual trauma plays a huge role in my clinical opinion, as does anxiety, as does witnessing intimate partner violence.
I would go back to what Mr. Obed was saying: Giving positive experiences, taking youth out on the land, building memories of we’re in this together, we’re having a good time, we’re having fun, we’re doing something that makes us all feel better and we’re all together in it — that is really important.
I also agree with Mr. Obed saying that family members, friends and cousins are part of what will keep our youth safe. I’ve been going to Naujaat since 2012 and, as I get to know the families, I can ask, “Who do you go to? Whose house is a safe house?” Being able to talk about what a panic attack is, how anxiety comes and goes and how that desperate feeling can come and go. And how important it is to have a friend, an auntie, a grandmother who will give you some soup or a cup of tea and give you some time to breathe. How important that is.
Senator Patterson: I have a brief question for Dr. Anang. You talked about the importance of ongoing funding, and I think you’re doing really important work that we can learn from in Naujaat. Could you tell us how you got funded and if you have any comments about how the federal framework should improve the effectiveness of its federally funded programs?
Dr. Anang: The first funding we got was from the Government of Nunavut in 2017. Since then, we have not had any support from the GN, but we did get small private funds. The Canadian Medical Association funded trips out on the land for youth. Last year, it was the True North charitable fund that funded our land trips. My research time is supported by the University of Manitoba, and all the money we can find goes directly into finding guides and going out on the land.
[Translation]
Senator Mégie: My question is for Dr. Anang.
As you know, the training of professionals, whether in mental health or otherwise, is the responsibility of the provinces and universities. You said that the universities could be asked to train these professionals.
While Minister Bennett is developing her action plan, do you think this would be a good time in your consultation meetings to ask her if there is something that could be tailored to you, to the community? Mr. Obed was talking about embedded therapies in the community, about including families. What advice or recommendations could you give to Ms. Bennett? Maybe we could start with that recommendation through our committee.
[English]
Dr. Anang: Thank you, senator. I would recommend to make it part of the mandate of every professional who goes to Nunavut or who in some way is serving Nunavut, to have part of their mandate to be delivering training.
I do think that the colonial way of flying in, providing services and then going back home is not a good long-term strategy. I think that if I am spending time in Naujaat, one of the best things I can do is actually spend time with the community mental health nurse and the Inuit outreach workers to help them because they will be there when I am gone. The best time I can spend is to help them learn how to be therapeutic. I do think it is a good investment to say that the people who are delivering services should be providing something that is sustainable and should be part of training that can accumulate over time to give the local providers the capacity to do this work on their own with support in the future.
[Translation]
Senator Mégie: Thank you.
[English]
Senator McPhedran: First, I want to acknowledge, President Obed, that I think back in 2010 the suicide prevention strategy that you were working with emphasized the social determinants of health, and we’re still hearing that today. This is a question around the architecture of the kind of ongoing research and it’s open to both of our witnesses, please.
I’m going to anchor my question by noting, as I’m sure you’re aware, that the Australian government funds the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention. In that context, it is the leading authority on Indigenous suicide and has developed a number of different strategies that I think we can say are trauma-informed, and my understanding of the findings coming out of that centre is that they are highly consistent with what we have heard from the witnesses today.
My question to both of you is this: Do we need to change the architecture of the research facilities — they can be online — that we currently have, or are we looking at making what we have better?
Mr. Obed: First, it’s the conversation itself when it comes to Indigenous suicide prevention. I was a witness in the House of Commons when they had the emergency session, which was perhaps four or five years ago, and I was astounded at how anecdotal and uninformed a lot of the interventions were, however well-meaning. An individual’s experience in relation to what they know about Indigenous suicide is an entirely different thing than evidence-based outcomes. That’s where we need to be. We need to have an intelligent conversation in this country about suicide prevention, about Inuit suicide prevention, and also the interventions and the research programs that are necessary.
I would say we also need to work with the RCMP and with jurisdictions to get the best possible data that we can then use to understand the situation as it presents itself. Because we are still in a place where we don’t, as Inuit, have access to the Inuit-specific data that we need to understand suicide completions and suicidal ideations in our communities.
Senator McPhedran: And the architecture?
Mr. Obed: If we could have a central place where we could collaborate and partner, in this specific area, it would be incredibly important. It would also elevate the way in which Canada responds to suicide prevention globally, but it would certainly help us not be an island within a larger conversation that sometimes does not go anywhere when it comes to effectiveness.
Dr. Anang: I think that the structure that was built in New Zealand and Australia is working really well. We do have something to learn from how well that parallel stream of Indigenous wellness has been established.
The Chair: Thank you, colleagues. I apologize for rushing you, but I have my limitations in terms of time as well.
Colleagues, we will continue our study tomorrow on suicide prevention. The last 15 minutes of the meeting will be devoted to drafting instructions. If you have particular themes, recommendations or quotations, please be ready with them. The analyst has indicated that she would be happy to receive additional comments from you by Wednesday, October 26, 2022.
(The committee adjourned.)