THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
EVIDENCE
OTTAWA, Thursday, October 20, 2022
The Standing Senate Committee on Social Affairs, Science and Technology met with videoconference this day at 11:11 a.m. [ET] to study the Federal Framework for Suicide Prevention; and, in camera, in consideration of a draft agenda (future business).
Senator Ratna Omidvar (Chair) in the chair.
[English]
The Chair: Good morning. My name is Ratna Omidvar, I am a senator from Ontario and chair of this committee.
Before we welcome our witnesses, I would like to provide a context warning for our meeting today. Our committee continues its study of the Federal Framework for Suicide Prevention. We will be discussing topics related to suicide and mental health. This could be a trigger to both people in the room with us as well as those watching and listening at home. Phone numbers for crisis lines will be broadcast during this meeting. Senators and parliamentary employees are also reminded that the Senate’s Employee and Family Assistance Program is available to them and offers short-term counselling for both professional and work-related concerns as well as crisis counselling.
For our first panel, we are joined today by the Honourable Senator Patrick Brazeau from Quebec. Senator Brazeau, thank you so much for joining us today.
Colleagues and Senator Brazeau, the steering committee agreed to not follow our usual practice and timing for opening remarks of five minutes for this panel. However, we hope there still will be time for questions after Senator Brazeau gives his remarks. Senator Brazeau, the floor is yours.
Hon. Patrick Brazeau: Thank you very much and good morning to everyone. My name is Patrick Brazeau. I’m an Algonquin registered band member of the Kitigan Zibi Anishinabeg reserve near Maniwaki, Quebec. I’m also the son of a French-Canadian mother and the father of six beautiful children. I’m speaking today as a survivor of two suicide attempts. I’ve spoken to you about this many times and will not be going into details again today. Suffice it to say that, to break down barriers and reduce the stigma, we must be able to speak openly and give hope to others who may be struggling.
Today, I’m here as your colleague to address the question sponsored by Senator Kutcher. Senator, I thank you for bringing this study to this committee.
[Translation]
I would like to thank Senator Omidvar for her work as chair. She takes her role very seriously. I would like to thank her and the steering committee for making it easy for me to have enough time here today. I really appreciate their welcoming spirit and flexibility.
To the committee members, thank you for your interest and dedication. I want to thank all of you for bravely taking on this topic. It is not easy to confront and critique the work of experts, but you have stepped up.
To the parliamentary researchers, committee clerks and staff, I also thank you for your efforts. Moreover, I want to thank all the staff members, who had no choice but to follow our lead in doing this study. It can be very difficult, especially if you have lost someone in this way. I don’t know all the staff personally, but we are all in this together.
Some have contacted me privately to tell me how much this work means to them. I’ll just say that your moral support and kindness have given me strength and I thank you for that.
To the experts and expert witnesses who took the time to testify and answer our questions, I was especially interested in hearing from the Indigenous witnesses yesterday. Thank you for dedicating your professional life to helping others. I can imagine that it is not an easy journey, day in and day out, to try to understand and do something.
While those of us who sit at this table are given the title “honourable,” dedicating one’s professional life to suicide reduction and prevention is truly an honourable path.
Finally, I want to give some very special thanks. In particular, I want to thank Senator Frances Lankin for offering me her seat on this committee for the duration of this study. While any senator is free to attend any meeting of the committee, being a full member has been essential, and I am grateful to Senator Lankin for living her values in such a personal way. Senator Lankin walks the talk, and I admire her for that.
[English]
Senators, I will now make a few general observations and then take your questions.
It is impossible to speak about the Suicide Prevention Framework without speaking about suicide and suicide prevention. Respectfully, the committee is aware of this. That’s why they wisely have included helpline information in case anyone feels distressed. It is not discussions of government frameworks or anonymous data points that cause distress. It is the topic of suicide itself that causes distress. In fact, the topic causes so much distress that we will often go to great lengths to avoid discussing it openly, even in a Senate committee that studies the topic. I hope everyone understands that I offer that insight for your consideration with the greatest of humility and respect. Having said that, let’s talk about the framework.
As many witnesses have stated, the framework is due for a rethink. It has no built-in evaluation section, and that’s a glaring weakness. Its strengths are that it offers guiding principles, which we can all support, such as building hope and resilience, leveraging complementary initiatives and partnerships, being evidence-based and using a public health approach.
The framework suffers from the same malady that this committee study suffers from, namely, the problem of focus and proportionality. If we want to reduce the greatest number of suicides in Canada, we need to focus research, programs and evaluations on those populations that commit suicide most. Ladies and gentlemen, all researchers agree that those people are Indigenous people and men. If suicides in those two groups alone were halved, the entire picture in Canada would change. Senators, this is not about comparing the suffering of one group to another. It’s not a competition. Let’s never get stuck on comparing pain. It’s about focusing on those areas first. Yes, the problems in those propositions are complex and long-standing, but they are the populations in need of the most help.
I was glad to see an Indigenous panel. That’s good. But respectfully, given the proportion of suicides among Indigenous peoples in Canada, it should have been first. That is not just a matter of being first in line, first to speak; it’s about starting with and centring the greatest challenges first. Anyone who claims to have any sort of expertise about suicide in Canada must absolutely be, first and foremost, highly informed on Indigenous mental health and men’s mental health.
I’m a little bit disheartened not to see a men’s mental health panel in this study, again, for the same reason: Men account for 75% of suicides. Three out of four suicides are committed by men. This committee is very aware of applying a gender-based lens to policy issues, but today I’m asking you to recognize men and boys as a gender and to mobilize resources aimed at steering them away from making that final fatal choice. Gender-based analysis is about assessing systemic inequalities. History has shown us that pointing out systemic inequalities can cause resistance and sometimes hostility. It takes a certain humility when looking at the data to acknowledge that we have not proportioned resources well when it comes to male suicide.
If you are looking for data, I invite you to read the report produced by my office that specifically focuses on suicide prevention and the mental health needs of Indigenous peoples and of men and boys in Canada. I believe the chair has shared it with all members. The public can find the report on the committee’s webpage under the headings “Briefs and Other Documents.” It’s available in both official languages. Getting parliamentary attention to this report has been challenging, to say the least, but here it is again. I have submitted it in this committee for the present study. I am asking all senators, witnesses, researchers and Canadians to read it and to turn their minds to solutions impacting their key populations.
When I noted the lack of a panel on men’s mental health for this study, I wondered if perhaps Canada lacks expertise. I quickly found out that is not the case. As a matter of fact, Dr. Rob Whitley, Associate Professor in the Department of Psychiatry at McGill and Research Scientist at the Douglas Research Centre, for example, has written extensively on men’s mental health and suicide prevention. He has published Men’s Issues and Men’s Mental Health: An Introductory Primer, which is both rigorously researched and easy enough to read for a non-expert. This book right here, colleagues, has several decades of experience of men’s mental health.
In his chapter on the social determinants of male suicide, he notes that there are six groups of men at the highest risk. They are, in no particular order, middle-aged men, Indigenous men, military veterans, men in rural and remote regions, White men and men involved in the criminal justice system. Dr. Whitley describes a combination of interacting factors that seem to contribute to the problem. They are employment issues, marital status, divorce and family issues, mental health disorders and substance abuse issues.
Ideally, he would have been here present today to share his research and answer the questions that must surely be on your mind, having heard what I just said, but with such a short time frame for this study, it was not possible to have him here today. He has submitted an informative brief to this committee, which I invite everyone to study very carefully.
There are some basic facts about male suicide and prevention principles that all of us need to know. As I alluded to earlier, not only are we not experts if we do not understand fundamental information in this area, but we should not even consider ourselves informed. If we are not informed about who is committing suicide, in what numbers and why, we are in no position to address suicide prevention, and if we are in no position to address suicide prevention, we are certainly not qualified to evaluate a national framework.
Senators, what you are undertaking is admirable. I appreciate it professionally and, obviously, you know I appreciate it very personally. I ask you, before you table your report, to think deeply and critically about the place of Indigenous people and men in this study. Are they given their due, considering their numbers?
Before I take your questions, I would like to speak directly to those, Indigenous or not, men or not, who are struggling right at this very moment if they are watching this program. You are not alone. You are valuable. We need you because you belong. We love you. Please reach out now and accept the helping hand being offered to you. Please call the number on the screen, and if you don’t see the number on the screen for any reason, the number is 833-456-4566 or text to 45645. Those Indigenous brothers and sisters who may feel more comfortable with a culturally appropriate hotline, please call Hope For Wellness at 855-242-3310.
Thank you for your time and listening to me, and I’m happy to take your questions. Meegwetch.
The Chair: Senator Brazeau, thank you very much for those comments. Thank you also for submitting your study to us. I’m sure we have looked at it. I believe your statements here will have far-reaching impacts, and they are very timely because we are considering draft considerations at this point.
Senator Brazeau, perhaps I can kick off a first question. You have mentioned earlier in this committee and now again that we need to look at Indigenous suicide prevention through the lens of gender, and more specifically through the lens of the male gender because they are over-represented in the suicide data of this country. I think I know the answer to this, but I’d like to hear you say it: Did the framework address the male Indigenous population, and if so, how? If it did not, what would you have inserted?
Senator Brazeau: First of all, thank you for the question.
If you look at the framework, it is more of an aspirational document than anything else. Having said that, there’s very little in there presently. If we look at the last 10 years, if there had been anything in there specifically for Indigenous peoples, boys and men, we probably wouldn’t be here having these discussions this morning.
I’m not an expert. I am not a psychiatrist, psychologist or researcher. However, I have lived experience, and I know how to count. When we see that three out of four suicides are committed by men, maybe we’re just doing what historically we’ve always done in thinking that men are strong, men are supposed to be tough and men don’t have to get help, and they’ll sort it out on their own. I’m living proof that that’s not the case. That’s simply not the case.
As I said, I’m not an expert, but there has to be some strong language with teeth. For the next decade that the Federal Government deals with and comes up with programs, especially for Indigenous peoples, there has to be strong language that we target those two populations. If not, I’m sad to say it, but I’ll make a bold prediction that if we don’t deal with these two target populations, we’ll be back here in 10 years. Hopefully, if my health is good, I’ll be back here in 10 years and I’ll be saying, “I told you so.” I hope that’s not the case.
I’m aware that many studies such as these often happen in the Senate and in the House of Commons when they get backing from the current government. We have to go deeper. We have to target where the numbers are. If we don’t, we’ll be here again. It’s up to us, collectively, to decide exactly what we want to do and what we want to recommend. I would just say that we have to have the moral courage to say what needs to be said sometimes. This is the chamber of sober second thought. I don’t know. I feel a lot of frustration and a little bit of anger in terms of it doesn’t seem as if anybody is moving on these things, so let’s collectively do it, colleagues. Thank you.
The Chair: Your observation or your recommendation is that we specifically name the populations that you have just described as opposed to keeping it general?
Senator Brazeau: Absolutely. I do not see how we cannot. I do not see how we can go through this exercise and just turn a blind eye to the over-representation of Indigenous peoples, and we all know why. We’re not going to discuss the reasons why. We’re all intelligent enough to know why. There are also boys and men. Healthy men may make the violence end. We don’t want iron men. We don’t want super men. We want healthy men.
The Chair: Thank you, Senator Brazeau.
The next question will go to Senator Pat Bovey, deputy chair of the committee.
Senator Bovey: Senator Brazeau, I applaud you. I applaud the dedication, honesty, openness and the sincerity with which you’ve not only continuously shone light on this issue nationally with our Indigenous peoples, but your own story, and that takes courage. So bon courage, mon ami.
In the report you did — I applaud you for that report — your recommendations sing loud to me. One of your recommendations is adapting health care to Indigenous cultural practices. You know how I value the role of culture in every aspect of our society. You also recommend that social workers involved with Indigenous communities be better trained and educated on Indigenous realities and cultures.
How can we bring this to the fore in this framework but also in wider society? I agree with you with those recommendations. I know the families of some of these, I’m going to say boys, in the North who have committed suicide in the last few years. When I hear from communities, it’s been four people in the last two weeks, or four people in the last month. It’s horrific.
Senator Brazeau: Thank you, Senator Bovey, for your question. Thank you for your kind words. I certainly appreciate it.
When we’re dealing with Indigenous peoples in this country, it always comes to a boiling point or a lack of political will. It’s always a lack of political will. If the 75% suicide rates were women, or any other group, I think we’d act pretty quickly. But perhaps because it’s men and we have these traditional notions of how men should look, we’re doing a disservice to a lot of people and to a lot of families by not targeting this.
It takes political will. It takes resources. It takes money. It’s funny, and it’s ironic, but when it comes to Indigenous issues, there’s never enough money. There’s only money when something is really significant and some kind of an emergency, then there’s funding. But when we’re dealing with suicide in particular, and the over-representation of Indigenous peoples in suicide, where are the programs that will work for them? We have very little. There are some that exist, but there are very few. Instead, we have non-Indigenous peoples and health care workers who are not necessarily sensitized to Aboriginal realities and cultures. That poses problems. To answer your question specifically, it’s political will and resources. That’s what it is.
Senator Bovey: Coming back to resources, if I may, at last night’s Finance Committee meeting, we were hearing from people in Indigenous Services, among other departments. I asked the same question about health, mental health and where’s the funding of Indigenous Services. I will keep asking that question because I don’t think we got an answer.
The Chair: Senator Bovey, was that a question or an observation?
Senator Bovey: Senator Brazeau is going to know far more about this topic.
The Chair: Senator Brazeau, you have a minute left to answer this question.
Senator Brazeau: I will just say that, as a former national chief of a national organization, I certainly know the pitfalls and the struggles with trying to access resources, because all the departments work in silos. There are different pockets of funding everywhere. The Government of Canada knows very well that they allow and have created a system for First Nations people and organizations to fight over the breadcrumbs that are left for them.
The Chair: Thank you, senator.
Senator Patterson: Thank you very much for all you’ve said today, Senator Brazeau, and otherwise. I’m really glad that you’re participating in this study and will be helping us draft the report and recommendations to the government, which we’re going to do next week.
I think you’ve made a clear recommendation that the framework, which seems to have not produced results, has missed the real targets. You’ve mentioned men. The Indigenous population is three times higher than non-Indigenous. When you add the three quarters of suicide victims who are men and the three times higher Indigenous rate compared to the non-Indigenous suicides, we have a really compelling case to argue for focused attention on those two areas. I thank you for your study and canvassing the provinces and territories.
In your report, you recommend that this terrible problem that, sadly, I’m familiar with personally in my own family, is a crisis that is not being acknowledged as a crisis. Would you say that this should be another aspect of our recommendation so that the country and the government can finally wake up to the fact that this burning issue has been too long ignored and that there should be a declaration of a crisis in our recommendation?
Senator Brazeau: Thank you, Senator Patterson, for all of that.
Absolutely, we need to have strong language there. As I said, this was significant, and it was a national disgrace 10 years ago. Now, 10 years later, we are still suggesting that it is a national disgrace. But is it really a national disgrace? We are dealing with Indigenous people, and very little is being done. If it were White people, I can guarantee you that something would be done very quickly. You know this as well. We need to be honest about this and we need to say it. If we hide behind it, nothing will get done.
This is a tough subject. I have been through it. I have been through different stints in rehab where I was with a lot of men. In those rehab sessions, you had a collection of people coming out of jail, for example, people with substance abuse and other issues like gambling and sex addiction. Everybody was all lumped into one. I took the time to listen to a lot of those people. Once you get into those rehab facilities, it’s a business. The owners tell you the success rate is 2%. I repeat: 2%. Why in the heck would the justice system send people to these places when it is really just a number in, a number out. People go back in and they go back out, but nothing is being done. I say 2%, but I’m one of the lucky ones that made it. I count my blessings every day.
You are darned right that we need some strong language for the federal government to act. This is a complicated issue, as I said, but with the numbers, the data and the research that exists, we can significantly make the recommendations necessary for the government to act. If they don’t act, then they will have to answer. We should be as strong as possible so that, over the next 10 years, hopefully we will see those numbers drop significantly drop.
Senator Kutcher: Senator Brazeau, thank you from the bottom of my heart for being here and for continuing your incredible and important work on this topic and on other topics.
I have three questions. Hopefully, I’ll have time to ask them and you can answer them. The first one is on race-based intervention, the second one on knowledge and the third one on alcohol.
You made the point that a number of previous witnesses made, namely, that we should focus our prevention activities not into the general population, where rates are very low, but into populations where rates are the highest. The framework doesn’t do that. Do you think that one of our recommendations should be that the framework should focus on where rates are highest?
Senator Brazeau: We have to, because the Government of Canada has had a decade to do that and they chose not to do so. We still have similar numbers and there’s still an over-representation of Indigenous people. I firmly believe we have to place our focus there.
Senator Kutcher: Right. That goes along with what all the experts say. They would echo what you said. When you look at population numbers, that already includes the highest populations. If we want to make an impact on the general numbers, we have to deal with the higher numbers first.
Senator Brazeau: In response to that, we had an expert last week who basically gave us a graph that indicated suicide rates have not changed much in the last 10 years. I was frustrated in hearing that. I thought, “Hold on, madam expert. There’s an over-representation of Indigenous peoples.” I didn’t hear alarm bells or red flags from those experts, so I’m trying to raise those red flags. If we only look at the Indigenous suicide rates, there is nothing we should be proud about. So, absolutely.
Senator Kutcher: My second question is about best practices. The framework talks about best practices. In much of my pre-Senate work, we defined best practices as, “We like the idea and we hope it works.” Global health has gone beyond that and has created structures where people submit interventions they have tried and researched. There is a group of experts that does a critical analytical review of that and evaluates the quality of it, whether it is culturally appropriate and whether it is ready for scale up. However, we don’t have anything like that in Canada. If we had that kind of service, do you think that might be helpful so communities can learn what works instead of what we think might work?
Senator Brazeau: When we talk about interventions that work, obviously it is important to use interventions that we know work and that people are satisfied with. Having said that, again, it is a question of resources. I can safely say that many Indigenous interventions are happening across the country, but knowledge about it is not widely known by experts specifically in this field. If there were resources for those Indigenous peoples and communities who have intervention processes, that would help the health practitioners collectively to deal with this issue.
Senator Kutcher: Thank you for that. I also thank you for nuancing what I had asked you by stating that such an independent and properly funded service should ensure it has all the Indigenous components in it.
Senator Brazeau: Yes, for others to follow.
Senator Kutcher: Absolutely.
You and Dr. Niaz made some impressive comments yesterday drawing our attention to the relationship between suicide and alcoholism or intoxication. I can share my professional experience. My work in youth cluster suicides has pretty well always been associated with intoxication, mostly gasoline and glue. However, none of this is explicitly addressed in the framework. Do you think it should be? Should we make recommendations about that?
Senator Brazeau: Thank you for that. That is probably a question that we could answer for a couple of days.
As I said from the start, we have to be honest and frank. We know that 90% of suicides are committed while using a substance. That’s fairly high as well. You talked about cluster situations. There was one in the Algonquin community of Rapid Lake last year. There were 12 attempted suicides within a couple of weeks. Unfortunately, two kids took their lives. But we don’t see that in the paper. We don’t read about it. But Indigenous people do. It’s hurtful.
I don’t need to pain a picture here. We all know there are many people, Indigenous or not, who turn to alcohol and other substances when they are having problems, myself included. Having said that, I’m proud to say I’m just over two and a half years sober. Those are changes I needed to make personally to be here today with you. It is not always easy. It is an everyday struggle, but I like that fight.
Again, the bottom line is we just have to have strong language, with nothing left for interpretation. It has to be direct. It has to be strong.
Coming back to alcohol, alcohol needs to be dealt with in Indigenous communities. We know the effects of residential schools and intergenerational trauma. We know what that is, and that is not going to be fixed overnight either. We need to have some programs to sensitize Indigenous peoples. I’m trying to do my part. Very soon, I will be introducing legislation in the Senate around the idea that every industry that provides alcohol will have to have warning labels that follow the science, and the science says that alcohol causes at least seven types of cancer. I’ll be introducing that piece of legislation, not to tell people what they should or should not do but at least for them to make informed decisions and to be in a position to make informed decisions. If that would occur down the road, that would be a significant help to future generations with respect to their relationship with alcohol. We are not there yet. I know that the alcohol industry is very powerful. Again, I don’t mind these fights. I have fought all my life. I have won a few and lost others. I have lost others that were televised. This is a fight I’m very comfortable with, probably because everything I have gone through in my life has perhaps set the stage for me to be here today and to do what I’m about to do. It’s all about trying to give back. That’s all I want to do with the experience and knowledge I have.
Senator McPhedran: Thank you, Senator Brazeau. It is an honour to sit close to you in the Senate and to work with you and your team.
I think your willingness to be here today is a tremendous learning opportunity for us to really understand much better what we actually mean when we talk about gender-based analysis, because so often that translates, certainly in my mind, as being “women and girls.” It has been a really important wake-up call that you have brought to us, certainly to me.
You have addressed a number of ways in which the framework is lacking. We heard yesterday, and we are hearing again from you today, that one-size-fits-all is completely ineffective and inappropriate. We all deeply appreciate the extent to which you have been prepared to be personally sharing with us. Given your personal experiences and your own deep cultural identity, could you share with us more about particular interventions and the way in which the framework could respond better, based on your experiences as an Indigenous male?
Senator Brazeau: Thank you for the question, Senator McPhedran.
Like you said, there is no one-size-fits-all in terms of intervention. I’m speaking from my own experience, but when I was having issues or problems, first of all, I was ashamed to ask for help. I was raised to be tough and suck it up or walk it off, but at one point, it was no longer possible. I took the time then, between 2014 and 2016, to look for appropriate programs or places I could go. I spoke with several elders to see what could be done.
There are some programs out there. I hate to do this. Provincial governments and territorial governments, those who responded, showed us what they have in terms of programs. We also Googled every single program that was forwarded to us. It is safe to say that there is a huge gap or disparity between what is available for women and what’s available for men. Like I said, it is not a competition, but in this particular case, given the data, I firmly believe we have to put a lens on this in terms of suicide prevention. I don’t want to talk about that in any other lens or context, but as I said before, there is Professor Whitley’s book. Ironically enough, he was working on women’s mental health until, one day, a woman asked him about the needs of men’s mental health. He sat on that for a while and, lo and behold, we have the expertise.
Specifically on suicide prevention, we have no choice but to put a gender-based analysis lens on this if we want to reduce those numbers. If we just want to maintain the status quo, then maintain the status quo. But if we want to reduce those numbers, let’s do what you have been doing all your life for women, Senator McPhedran, for the sake of young men and boys dealing in terms of dealing with problems with suicide.
[Translation]
Senator Petitclerc: Thank you very much, Senator Brazeau, for the content you are bringing, and for the manner and thoroughness with which you are bringing it. This is very, very important testimony.
In this context, there are these numbers that we know about, but that we haven’t really taken into account. It’s true, you mentioned during this study the 75% male rate.
This federal framework exists, but what strikes me today is that there are men like you, who are survivors, who have this courage and strength to be here, to break the silence and articulate the existence of social and cultural stigma and barriers. We are talking about men, about suicide, and also about mental health.
It amazes me, and I think it’s a great responsibility that you’ve given yourself — a burden too, I guess, in a way. I thank you for that.
However, is it really up to you and other survivors who are in the same situation as you to carry that responsibility and that burden? Is this Federal Framework for Suicide Prevention part of the solution to break down these barriers, taboos and stigmas? Should it do more? How should it be structured?
Senator Brazeau: Thank you very much for your questions.
First of all, I don’t speak for all suicide attempt survivors, obviously. I am only speaking for myself. However, personally, even if it is difficult, and even if, at times, tears start to flow, it helps me in my personal journey. However, I have been hearing for a very long time that we need to break down barriers and reduce stigma. Unfortunately, I often see this as just talk. On world mental health days, we hear lofty rhetoric for one day, but after that it’s over.
So this is my personal position, but I believe that, by being open and transparent, and even graphic at times about what happened to me, I will help people who listen or read. They will see that anything is possible. I hit rock bottom and I was lucky to get out. I am using the opportunity to talk about it, whenever I can, because I think it can help people.
I am not an expert like our colleague Senator Kutcher, but I do what I can. It gives me strength, and I know it gives strength to people who have problems.
I would like to add something. Yesterday, I asked a witness if the federal government cared or was concerned about this — and maybe I shouldn’t have asked the witness because these witnesses deal with the federal government to obtain funding. Maybe it wasn’t the best question to ask, but if I had to ask myself, I would say the answer is no, not yet. Until the over-representation of Indigenous people in suicide rates is better addressed, I will stand by my position that the government is not concerned about Indigenous suicide prevention.
[English]
Senator Cordy: Thank you, Senator Brazeau, for being here today.
I was stuck by your opening comments when you said that we have to talk openly about suicide. First, you also said we can’t talk about a framework without actually talking about suicide, so it gives us an opportunity to speak here today. You practise what you preach, because I heard you speaking to the witnesses yesterday, saying that you would speak to “any group, to anybody and any person, just let me know.” So you certainly are walking the talk. Many people have been told that you shouldn’t talk about suicide and that it is a family issue or whatever. We are getting better, but for my generation, it was, “No, you can’t talk about it because it will just increase the numbers.” Are we getting better about talking openly? Because I agree, we have to talk about it.
Senator Brazeau: Thank you, Senator Cordy, for that question. That is a very important question, because 10 years ago, I wasn’t as interested in this issue as I am today.
We are slowly getting better in terms of destigmatizing it. We are not where we should be yet, because, let’s face it, it is an uncomfortable discussion. I’ll admit: It has even been an uncomfortable discussion within my own family, with my father, brothers and the rest of the family, because it has severely impacted not just my life but the lives of others. I have had to do a great deal of work to try to rebuild a lot of relationships.
Having said that we are getting better, there are some people who will never be comfortable talking about it. Some people have lost cherished ones to this and just can’t handle it, but for those who can handle it, it is very important that they share their voices and stories. We need them; we simply need them to tell others who are having problems. There are many people having problems in Canada today. There is hope, but it takes work. There is hope and there is help. Help is everywhere. I have said it many times. Anybody who is having problems can ask for help, not only from a friend or family member but from a complete stranger on the street. Sooner or later, they are going to get help.
Senator Cordy: Thank you for that.
One of your recommendations was to consult the communities that have successful solutions. Sometimes we tend to look at the numbers of men and Indigenous peoples but — and you touched on this earlier — not all Indigenous peoples are the same, and not all men are the same. I’ll speak specifically about Indigenous peoples. It depends where you live. We have the high North. We have the East Coast and smaller communities. We have the West Coast. We have very isolated areas. We have Indigenous people who have moved to urban areas and may not have support. You know all of that. I’m just trying to say there is a lot of diversity within the communities, but are there communities that have successful solutions that are working within the communities? Because in communities, each individual is different.
Senator Brazeau: That is another very relevant and important question.
To be quite honest, I wasn’t very much aware of some of the practices that were being conducted by Indigenous peoples for Indigenous peoples. Like I have said repeatedly, I’m not an expert in the modes of interventions, but having said that, ever since I started speaking more openly about my own personal story and promoting issues of suicide prevention and mental health, Indigenous peoples have come to me and said that maybe I should see what they are doing because it is kind of new but there is a success rate. Like I said, I’m not an expert but I know how to count. One plus one equals two. There are some — not many — but I’m going to be taking the time over the next few weeks and months to visit those facilities to get a first-hand look at how the clientele are viewing what the processes are in terms of intervention. We’ll have more information in the future in terms of sharing best practices regarding Indigenous interventions. I’m sure there are more than what I am currently aware of.
Senator Cordy: Thank you.
The Chair: If I may, I have a final question, Senator Brazeau. I am looking at your report. Thank you very much for providing it to us. It goes into the testimony of the Senate so we can draw upon it for any conclusions. I noted with some interest that, since 2020, the suicide rate in Quebec seems to be dropping. It dropped and then remained stable after the drop, especially among teenage boys. Do you have any reflection as to what accomplished that drop in suicide rates in Quebec?
Senator Brazeau: If I recall, I think the government of Quebec had introduced several programs aimed at youth in the 1990s or 2000s. Don’t quote me on the year, but it was several years ago. They are reporting that there has been a steady decline, but they are just looking at the big picture and not necessarily focusing on the Indigenous populations of Quebec, so we can never forget that, colleagues.
The Chair: But your report does say that Quebec is a model to follow. With all its failings, it is doing things better than the rest of the country. Would you agree with that?
Senator Brazeau: It is a model to follow, perhaps, for other provinces and territories, given what they have noted as success and reductions with respect to that. But again, they are talking about the population as a whole. If the Quebec government is saying that they have a reduction in suicides there but fail to mention that there is still an over-representation of Indigenous suicides and they are doing nothing or very little about it, we are still going to have the same numbers two, three or ten years from now. We could perhaps look more in depth into the Quebec model and try to apply it. Let’s not make the mistake of looking at the countrywide statistics, regardless of which province or territory, and always keep in the back of our mind what the rate of Indigenous suicide is.
The Chair: Thank you, Senator Brazeau. That brings us to the end of our time with you. I want to thank you very much, as an individual senator — and I know my colleagues subscribe to that — for sharing your personal story. It takes a lot of courage and fearlessness. I think you have both of those qualities in spades. Rest assured that your testimony will inform us as we start reflecting on our deliberations and discuss the recommendations in the report.
For our second panel, we welcome, by video conference, Nitika (Rewari) Chunilall, Director, Prevention and Promotion Initiatives at the Mental Health Commission of Canada; and Kimberly Fairman, Executive Director with the Institute for Circumpolar Health Research. Thank you very much for being with us today. I now invite each of you to provide opening remarks. I remind you that you have five minutes allocated to your statements, followed by five minutes from senators to you. Ms. Chunilall, the floor is yours.
Nitika (Rewari) Chunilall, Director, Prevention and Promotion Initiatives, Mental Health Commission of Canada: Thank you so much. It is an honour for me to appear in front of you to discuss this important topic.
Today, I would argue that the Framework for Suicide Prevention has not shown its true effectiveness to date. Since its release, deaths by suicide have been consistent or increasing, disproportionately so, for certain populations, like men, First Nation, Inuit and Métis people, young people and the 2SLGBTQIA+ community.
While communal trauma related to the COVID-19 pandemic may have caused a decrease in suicide rates in 2020, possibly reflecting the effects of social cohesion and shared suffering, suicidal ideation has been on the rise since the pandemic. This is deeply concerning. Approximately 8% of those recently surveyed reported seriously contemplating suicide, and about one in three people with a history of substance use disorders reported suicidal ideation during the pandemic. Despite this, access to services remained low. There is a lack of understanding of the distinct experiences of suicidal behaviour among ethno-racialized groups and other equity-seeking groups. As is often the case, programs and services are not tailored enough to meet their needs.
However, some strides have been made in the right direction: the significant appointment of Canada’s first-ever mental health and addictions minister; launch of the wellness portal that not only shares information but also access to counsellors; the recent announcement to launch the 998 mental health crisis and suicide prevention hotline; ongoing development of national standards for mental health and substance use services in Canada; and convening meaningful dialogue among coroners and medical examiners to explore standardization of practices and collection of data. But Canada needs more, and I would like to highlight four areas to improve the ongoing work related to the framework.
My first point is to ensure that the action plan has sufficient flexibility and investment allotted for communities to adapt implementation within their own unique contexts. A true framework must be implemented in partnership with those who are impacted by suicide or those who demonstrate a greater risk of suicidal ideation. Since 2018, the commission has been working with several communities across Canada to implement a made-in-Canada, community-led approach to suicide prevention and life promotion, a model called Roots of Hope. Based on 13 guiding principles and 5 pillars of action, Roots of Hope is reducing stigma and raising public awareness, connecting communities to information and resources and accelerating the use of research and innovation in suicide prevention. Today, Roots of Hope is being implemented in the entire provinces of Saskatchewan, New Brunswick, Newfoundland and Labrador and Yukon Territory, as well as in several other communities in Canada.
My second point is about building a bigger kitchen table. As someone who belongs to the South Asian community, most of the supportive conversations in my culture take place at the kitchen table. Suicide prevention happens at homes, family doctors’ offices, workplaces, grocery stores, theatres, liquor stores and hockey rinks. This is where training programs, workplace interventions and benefits, public campaigns and forming unique private-public partnerships can be effective.
My third point is about means safety. One of the most effective ways to prevent suicide is through means safety and means restriction. Through Roots of Hope, communities are paying special attention to the means being used and ensuring safe access to those. Examples include medication lock boxes and barriers to bridges, to name a few. Canada does not have national guidelines related to means safety. Better coordination across all government departments, provinces and territories is needed to have a collective dialogue on this topic.
My final point is around data. Investing in timely access to informative data on suicide and suicidal behaviour will be a game changer for communities across Canada. Data plays a crucial role in identifying who is at risk, why, under what circumstances, how often, means used and where the opportunities for interventions and preventions lie. This must be a top priority, as lack of timely data connected across systems often means missed opportunities and lives lost.
Thank you for your time today.
Kimberly Fairman, Executive Director, Institute for Circumpolar Health Research: Good morning, senators. Thank you for the opportunity to speak with you this morning.
I’m Nunavummiut. I live and work in Yellowknife in the Northwest Territories, the traditional territory of the Yellowknife Dene First Nation, the North Slave Métis and the Tlicho people. I was trained as a nurse many years ago and nursed in the community as well as in the regional hospital here. I did many years of work with the federal and territorial governments, mostly in the area of community development. More recently, my work has been with the Institute for Circumpolar Health Research here in Yellowknife, focused on issues of community capacity building and community-based and community-led research in the area of health policy. I also do some work with the Canadian Society for Circumpolar Health. I’m a member of the CCA panel on the future of Arctic and northern research in Canada. There will be a report coming out next year.
I’m happy to be here this morning talking to you about the Federal Framework for Suicide Prevention. As we know, suicide is a multifaceted public health issue. There’s a lot of recognition that we need a comprehensive approach to prevention. I’m not going to touch too much on or repeat a number of things you’ve heard already in terms of the issue, but I want to highlight the fact that Indigenous communities continue to be disproportionately impacted by suicide.
Briefly, I will talk about maybe four of the areas where I think the framework has some gaps or areas to think about moving forward.
Potential problem areas are around the fact that decision makers lack guidance. You know that policy-makers, managers and clinicians really need strategic and practical guidance that’s applicable to their needs. Thinking about increasing Indigenous health and human resources, providing funding and grant opportunities to support leadership development in Indigenous communities and really educating about the issue will lead to clearer policies and a clearer sense of direction they need to take at that level in order to address the problem.
Another thing I’ve heard from other witnesses but which is also something that I feel is very important to consider is that the priority-setting on this issue is a problem of justice. There’s little or no consensus on how to appropriately distribute resources in a just fashion. Thinking about how to provide ongoing and equitable funding for community-designed and local interventions is key. In the North, in particular, which is where I have most of my lived and working experience, it is a focus on land-based practices for a number of reasons. One of the most important is the idea of cultural continuity and the link between individual identity and culture.
Another problem or issue is one around the state of knowledge. It’s really hard to do complete analysis of the issue when there’s insufficient data and information about the actual incidence and some of the preventive measures that may have been employed. Thinking about a pan-Northern suicide surveillance and monitoring system and really trying to get a clear understanding of the issue and the current state of what policy approaches are currently being used is important, through dialogue and trying to understand where there are clashes in values and how to really open up that conversation a little bit in terms of how it influences our priority setting. Another piece on that is the amount of funding available for research on the issue.
The last point I would make in terms of potential problems that exist is that there are no explicit policies for consistency, transparency and accountability and being able to have those policies, as other witnesses have said, address cultural, linguistic and geographic context, and improved communication between care providers in the North, because people are often medevaced and the information for care is not available, so specific policies around privacy legislation and those sorts of things need to be a component of the possible solutions.
I’ll stop there. I really appreciate having the opportunity to address the committee this morning.
The Chair: Thank you very much to both our witnesses. We will start our questions with Senator Bovey, the deputy chair of our committee.
Senator Bovey: I’d like to thank both our witnesses. I very much appreciate your perspectives.
Ms. Fairman, you talked about the link between identity and culture and the importance of culture and roots, which links me to Ms. Chunilall’s comments about Roots of Hope. She also mentioned a community-led approach, and there’s not enough of that in the framework. My one question to both of you is this: When we talk about research, which you both have, and when we talk about hope, which you both have, and that link of community and culture, how would you put that into the framework so that it’s succinct, meaningful and has the force you believe it should have?
Ms. Chunilall: Thank you so much for your question.
In order to put that language strongly within the framework, we have to acknowledge that communities have a lot of strengths that they bring to the table already. One of the experiences we’ve had with Roots of Hope is that the process to implement that model into a community first begins by the community stakeholders and community partners coming to the table, the ones who we have long-standing relationships with but also new partners. It is really to identify where the strengths lie within that community and then to assess where the community is currently perhaps not doing well. From there, those strengths-based approaches and gaps can be filled. The emphasis needs to be on learning from what’s working well and building partnerships that are unique and new to create a community-led approach as part of the prevention.
Ms. Fairman: Just to build on that, to put it succinctly into a framework, it’s really around, in the first case, social equity, which is having the ability to address these social and health disparities that exist and create social inequity. It is linking interventions to the social determinants of health. In the North in particular, those are issues that will not be unfamiliar to people, such as housing, employment, education and mental wellness.
I think a key component — maybe just building on previous witnesses’ comments — is to provide sustainable funding for established community-designed interventions. It could be something like healthy child and family development, youth resilience programs, mental wellness programs — anything that has the potential to be scaled up at the community and then even regional levels. It’s important that those types of programs have sustainable funding in order for us to see the benefit over the long term.
I also want to emphasize the importance of culture, language and way of life for Indigenous people as something that has been disrupted by colonial systems and need to be reestablished as elements of identity that need to be supported.
Senator Bovey: Thank you.
Senator Patterson: Thank you to both witnesses. It’s great to see you, Ms. Fairman.
I’d like to direct my question to the Mental Health Commission of Canada, which was actually created as a result of work of a Senate committee and its recommendations. We’ve heard in our study of the suicide framework that many of our rehabilitation programs are not effective. They have very poor success rates. We’ve heard from witnesses working in Indigenous communities that what is needed is Indigenous-led, trauma-informed, culturally appropriate services for Indigenous people to have more effective treatment and rehabilitation programs. I note that Budget 2022 has assigned, if I understand correctly, $228 million through the Mental Health Commission of Canada towards doing exactly that, creating trauma-informed, culturally appropriate, Indigenous-led services. Ms. Chunilall, could you please tell us what the plans are for this money and how it’s going to be deployed towards that worthwhile goal? Thank you.
Ms. Chunilall: Thank you, senator, for your question.
Roots of Hope is embedded in communities, and many of the communities that we have been working with represent Indigenous populations. We have been working with Edmonton, which houses the largest urban Indigenous population in Canada, the Yukon Territory, as I mentioned, many communities out in Saskatchewan and in Nunavut and Iqaluit, where we have been working with communities as well. Really, where suicide prevention is working in those communities with respect to Roots of Hope is that it gives them adaptability and flexibility to put culturally appropriate interventions in place in those communities, as well as make sure that they are monitoring the programming that’s working in that context and what that looks like. We have done a lot of work where we’ve co-created products that are awareness pieces and training approaches within those communities and in those specific languages. For example, we have created products in Cree and Inuktitut, and they have been very well received to address the needs of the communities in that moment.
When it comes to the Mental Health Commission of Canada, as you know, we are funded primarily by Health Canada, where we have programming across all aspects of mental health for Canadians. Our programming touches upon Indigenous people and collaborates with Indigenous people in a very meaningful way with regard to the Suicide Prevention Framework, but at the same time, around e-mental health, around workplace mental health and around cannabis and mental health. There’s a lot of work currently being done in many aspects of the Mental Health Commission of Canada to meet the needs of Indigenous populations and to really work with them to learn from them and to help us understand what they need and where the interventions work best in their communities and contexts.
Senator Patterson: If I may, do you evaluate the effectiveness of those programs? Can you give us a list of those programs?
Ms. Chunilall: We can absolutely send that after the meeting today.
The Chair: Thank you very much, Ms. Chunilall.
Senator Kutcher: Thank you to the witnesses for being here. I have two questions which shouldn’t take long to answer and then one request for the Mental Health Commission.
First question: Minister Bennett has challenged this committee to recommend an independent critical review of the effectiveness of suicide prevention programs currently sold across Canada in terms of how they decrease suicide rates and decrease emergency room and hospital visits. Would you agree with the minister that it is important to conduct such a review? If not, what reasons do you think there would be for us not to recommend that?
Ms. Chunilall: Senator Kutcher, was that question directed for me?
Senator Kutcher: Yes.
Ms. Chunilall: I do think there are a number of programs being offered across the country that are aimed at suicide prevention and life promotion. I do think that there’s a strong requirement to have research and empirical evidence to support their effectiveness. There needs to be criteria in place to ensure that the effectiveness they’re able to showcase really meets the research standards, so I do agree with that recommendation.
Senator Kutcher: Roger that.
The second question is again about the framework. The Mental Health Commission played a very important leadership role in the creation of the framework. We’ve heard numerous witnesses say that the framework does not really focus on what’s effective in suicide prevention. Would the commission agree with the witnesses that the framework should address what is effective in suicide prevention as part of its major mandate?
Ms. Chunilall: Yes, 100%. I think we are learning more and more with every passing year in terms of what is effective. With COVID as well, we have been able to explore opportunities that didn’t exist earlier in terms of virtual access to care. These have to be evidence-informed and placed highly within the framework and the action plan for suicide prevention.
Senator Kutcher: Thank you so much.
My last request is similar to Senator Patterson’s. The Mental Health Commission, as you noted, has created and distributed the program called Roots of Hope, which is very similar to many parts of the framework. Could you please provide the committee with a written report on two things: What revenue has been received by the commission from all sources to support the Roots of Hope program, whether provincial, federal or private sources? And then, very importantly, what evidence does the commission have that indicates the implementation of this suicide prevention intervention has significantly, substantively and sustainably decreased rates of suicide?
Ms. Chunilall: Thank you for that question. I will maybe answer parts of that and then follow up with some documentation afterwards.
In order to do Roots of Hope from the commission’s standpoint, we began with a research demonstration project, which started with eight communities in Canada. Our funding to be part of that demonstration project came entirely from Health Canada in respect to we were funding the principal investigator and their team to carry out the research, as well as coordinating a community of practice amongst all the communities that participated in this project. This project began in 2018.
In terms of the eight communities that participated, we did not receive any funding from those communities, but they brought their own funding through their ministries of health or other bottom-up sources, which allowed them to participate in this project. In addition to programs and interventions that they were implementing, that funding also went towards hiring a community coordinator within each community to be a project manager to get all the pieces of implementation covered, as well as hiring a local researcher in that community to work with the principal investigator that we funded to make sure data is being collected, monitored and analyzed.
COVID did pose some challenges in terms of the plans and what would be implemented. However, we are in the process of analyzing the data from the research demonstration project, and that will be a report that is available in the coming months that we will be able to share with you in more detail.
Senator Kutcher: We don’t have a couple of months.
The Chair: We don’t have a couple of months, Ms. Chunilall.
Senator Kutcher: We need that information now, and specifically the effectiveness on those parameters.
The Chair: I think that is an excellent request, Senator Kutcher, and hopefully we get that information in.
Senator Cordy: Thank you, Senator Patterson, for raising the issue of the mental health commission, which was actually a recommendation of the Social Affairs Committee quite a while ago. It was a great recommendation and good that the government followed through on it.
My question is about the challenges for people who are seeking help in smaller communities. Ms. Fairman, you spoke about the need for privacy legislation. Is that because of working in the North and the need for people to feel freer to come forward? Is that why you suggested that, or what is the reason for the privacy legislation? And for both of you, what are the challenges of people seeking help in smaller communities where they may or may not be a little nervous that their neighbours and so on find out about it? Because that is a concern for people who are seeking help.
Ms. Fairman: The reference to the privacy legislation is one where often very basic services are available in the community, but for specialized mental health services and services specific to an immediate threat with suicide attempt, individuals have to seek care across jurisdictions, and sometimes there are limitations on information. There are already challenges in terms of communication between health care providers and institutions, and sometimes there are added difficulties in sharing personal health information across jurisdictions. That could be attributed to legislation related to health information.
Senator Cordy: So that would be if they were moving from a small community in the North to a larger community to seek help, then it is very challenging to transfer the information that would be beneficial to the receiving hospital or medical profession; is that what you mean?
Ms. Fairman: Yes. There are challenges, in some cases, transferring the information, and it impacts on the outcomes for the individuals and their care.
Senator Cordy: Definitely. Because time is of the essence in health situations.
What about the challenges of people seeking help in smaller communities? I think you have just talked about one now in that sometimes the resources are not in the smaller communities and they have to be transferred. Would that be the only challenge?
Ms. Fairman: I think one of the things that you have referenced is the stigma related to suicide and mental health issues. I think that’s a really interesting issue to try to explore. I’m not entirely sure about whether or not people are worried about seeking care because of worries of community members or others, but I think there are issues of trust with care providers and individuals. I think there is the sense that even if you do come forward, there are very limited resources that are available immediately. There are very limited culturally appropriate resources available. Sometimes racism in the health care system is a huge issue in communities. It is something that should not be underestimated in terms of individuals seeking care for any type of problem or issue. There are issues of people feeling that they may be judged or that there is personal stigma associated, but I really feel these other issues are ones that create more hesitancy in terms of seeking care.
Senator Cordy: Thank you very much for that.
[Translation]
Senator Petitclerc: My question is for both witnesses. Thank you for being here.
My impression, after hearing a number of witnesses talk, is that we have a federal framework, as well as the people, communities, and organizations that are on the ground, but there is some disconnect between the two.
I am asking my question from the perspective of this national action plan that is being developed and is expected to be released in the fall of 2023, we are told. From that perspective, how important is it to make sure that the experience, successes, and challenges of the communities on the ground, with the people on the ground, are incorporated into this future national action plan?
Are we doing enough? Are we doing it right? Should this be a priority?
[English]
Ms. Chunilall: Thank you so much, senator, for your question.
I couldn’t agree more. I think the development of the national action plan needs to take into account two very distinct population groups. When I say “population groups,” I mean it in a different way than we have usually been talking about. I think that we need to take into account the experience of communities so far, and we also need to take into account the experience of people with lived experience expertise to inform what our true action plan and its tenets would mean.
One of the things I would argue that you will often hear about is investment and placing sufficient investment at a community level to ensure that they have the flexibility to utilize and take advantage of evidence-informed practices but in their context, but at the same time, to be able to connect from coast to coast to coast so that we are not utilizing resources inefficiently. One of the experiences we have had in the Roots of Hope project is that communities are telling us, because the commission was able to set the table of a community of practice model where these communities from different geographies came together on a very regular basis to troubleshoot together and talk about what is working in one part of the country versus another, we were able to take advantage of learning from one another and being able to try to test what works in their context, without maybe going through several iterations of interventions that maybe didn’t work in their communities.
I do agree with you that communities have to be consulted but as well as people with lived experience.
Ms. Fairman: I am very supportive of the comments about community involvement in the design and this idea of creating a network where best practice can be shared as well as trying to sustain a critical mass of expertise across the board in dealing with the issue of suicide prevention.
I think it’s also important to consider as a component of that that the evaluation of the action plan needs to include community-level indicators. When we think about health systems and health systems performance, sometimes the indicators don’t include what community members would think are important or effective interventions, and those are key for us to be able to build on community-level success in this area.
The Chair: Thank you very much.
I have just a little time to ask a final and short question to Ms. Chunilall. You spoke about stigma. Has stigma within certain communities been addressed through the national framework or should it be addressed in the action plan? I’m talking about the South Asian community where stigma is huge. It does not get talked about. It may therefore not appear in the data. I’m not quite sure about that, but I do know it is an issue. What recommendations would you like to see in our report that would help these communities deal with reducing stigma and, therefore, eventually reduce suicide?
Ms. Chunilall: Thank you for that very important question.
I would argue that there needs to be a shift in conversation. Speaking specifically to the South Asian community, I’m not 100% sure that we go home and talk about mental health naming it mental health, or mental illness, or naming it in a very diagnostic way or diagnostic language, so meeting the community where they are at in terms of what are the words that they use to describe mental health, mental wellness, mental illness in their community; what are the words that they use when something is not going right and support is needed is valuable. I do think there is value in really understanding the different cultures and in giving some flexibility for folks within that culture to provide guidance into how mental health, mental illness and suicide prevention can be better discussed at those tables.
I do think in the South Asian community there is a demarcation in Canada between second or third generation and then the immigrant population. For folks just coming into Canada fully prepared to work hard to make it in this country, their mental health is the last piece that they think about. Self-care is not something top of their mind. They don’t even know the resources that exist in their community. There are great examples of organizations working in grassroots, like SOCH Mental Health, that are trying to raise public awareness within the South Asian community. I think we need to talk to more of those people.
The Chair: Thank you very much, Ms. Fairman and Ms. Chunilall. You have helped us a great deal as we try to gather wisdom for our study.
Colleagues, we have some matters to deal with in camera.
(The committee continued in camera.)