BY ALEC HUGHES
World Mental Health Day took place on October 10th, and offered us a chance to reflect on the mental health status of Canadians and our awareness of mental health issues. On September 22nd, Bell renewed its commitment to the well-known “Bell Let’s Talk” program for another five years with at least $100 million in total funding1. A week later, the Centre for Addiction and Mental Health (CAMH) announced the creation of the Cundill Centre for Child and Youth Depression to reduce the burden of depression in the first twenty years of life. As a general trend, it would appear that mental health stigma is slowly eroding. Canadians are viewing poor mental health as a very serious problem facing all sectors of the population.
Despite all the progress that has been made, not all Canadians enjoy equal access to mental health services: far away from these new mental health initiatives there is an epidemic of suicides among the Canadian Inuit. The Inuit have the highest suicide rates in Canada and one of the highest in the world. Suicide rates in Inuit regions of Canada (including Nunavut, Inuvialuit, Nunavik, and Nunatsiavut), stretching across Canada from Labrador to the Yukon Territory, consistently hover around ten times the national average. In Particular, the suicide rates of both Nunavut and Nunavik, from the 1970s to the early 2000s, have steadily increased2. In stark contrast to the recent announcements on new mental health initiatives in the Canadian south, reports from June 2015 suggest that the Nunavut Suicide Prevention Strategy (NSPS) is failing to meet its goals. In fact, since the initiative began in 2011, there has been no evidence that suicide rates are decreasing at all.
It is important to note, as emphasized in The Aboriginal Healing Foundation report on Suicide Among Aboriginal People in Canada, that suicide and poor mental health are not always completely related. In fact, psychiatrist Robert Krauss highlighted that Inuit elder suicide, which was undertaken after sober reflection and consultation with the family, and was generally positively sanctioned by the Inuit culture3, transitioned to an epidemic of youth suicide in North Alaska in the late 1960s, Greenland in the 1970s, and the Canadian Eastern Arctic in the 1980s2. This demonstrates that although poor mental health in a population is often related to the suicide rate, it is possible that the suicide rate does not entirely reflect the well-being of society, and any suicide prevention plan or mental health initiative must consider that these two problems are both distinct, yet related.
In spite of the seemingly bleak overall situation, there are some signs of positive change. A year ago, ‘Connected North’ was released to bring psychiatric and youth mental health services to some Nunavut health centres, in partnership with the Tele-Link Mental Health Program developed by the Hospital for Sick Children. This was in response to the critical shortage of psychiatrists and psychiatric nurses in Nunavut, and it allows 10 Sick Kids Hospital psychiatrists to work with young people remotely. This launch came after the success of the program in northern Ontario communities. It will be interesting to assess the effectiveness of this new system over the coming years. If successful, it could lead to more widespread use of technology to reach out to remote regions of Canada by expanding the reach of psychiatrists far beyond large hospitals in major cities.
The fact that Inuit communities in Greenland and Alaska are similarly affected by a suicide epidemic indicates that the problem is potentially a trans-national one, and any potential solution would ideally be collaborative. A deeper understanding of the underlying socio-economic and environmental conditions leading to the rising suicide rates must be coupled with improved mental health treatment outcomes for Inuit youth contemplating suicide. The NSPS’s failure so far has highlighted the difficulties the Nunavut territorial government faces to administer a clear and effective action plan.
Looking forward, it would seem likely that improved mental health outcomes among the Inuit will likely result from a hybrid solution to the socio-economic, environmental, and mental health-specific problems. A recent, large epidemiological study could potentially indicate the best areas to develop strategies for suicide prevention4. The difficulty, of course, is to contend with limited resources to obtain positive suicide prevention outcomes while considering the unique challenges of providing mental health care to a remote and distinct Canadian population.
Alec Hughes is a PhD student in the Department of Medical Biophysics at the University of Toronto.
Image: “Inukshuk Sunset in English Bay” by Kyle Pearce, taken on April 4, 2008. CC 2.0.
- Bell (2015). Bell Let’s Talk: The first 5 years (2010-2015).
- Hicks, J. (2007). The social determinants of elevated rates of suicide by Inuit youth. The University of Greenland.
- Krauss, R. F. (1971). Changing patterns of suicidal behaviour in North Alaska Eskimo. Psychiatric Research Review, 9(1), 69–71.
- Chachamovich, E., Kirmayer, L. J., Haggarty, J. M., Cargo, M., McCormick, R., & Turecki, G. (2015). Suicide among Inuit: results from a large, epidemiologically representative follow-back study in Nunavut. Canadian Journal of Psychiatry, 60(6), 268–275. Retrieved from http://dx.doi.org/