Nunavut suicide inquest: Inuit-specific programs needed, say witnesses

An expert with a decade of experience working in the Nunavut mental health system and an elder tasked with safeguarding traditional knowledge are both calling for culturally-appropriate suicide prevention programs.

"It should feel safe to come for health care," said Dr. Allison Crawford, a psychiatrist who has worked in several Nunavut communities.

She testified Wednesday at a coroner's inquest into the territory's high rate of suicides being held in Iqaluit at the Nunavut Court of Justice. 

She says many Inuit don't like to seek treatment as part of the formal health care system because of historical trauma.

"It's a real limitation that I think everyone recognizes."

But, over the past decade, Crawford says mental health programs in Nunavut have improved.

Jack Hicks has testified that Nunavut did not hire its first Director of Mental Health and Addictions until after work on the suicide prevention strategy began in 2008. 

Now, Crawford says the government has made a commitment to have a mental health nurse in every Nunavut community and people who work in different communities are meeting regularly to share their knowledge.

Childhood abuse 'still present and prevalent'

"I don't think suicide was talked about as much or as openly [10 years ago]," testified Crawford. "That's really improved." 

But Crawford says the same cannot be said for another pressing issue.

"The degree of childhood abuse is something that I think is even talked about less than suicide," she said.

"It's still present and prevalent in communities."

Reducing the stigma surrounding talking about abuse — and particularly sexual abuse — would help people encourage Inuit to seek counselling and prevent suicide, she said. 

"We need to start doing some long-term thinking and prevention around children," Crawford said. 

While the expert witness said she was hesitant to "place more responsibility on teachers," she said that children should be taught basic social coping skills when they are young.

"We have to support healthy families."

Families 'waiting to talk'

Crawford also noted the importance of 'postvention' activities, where mental health workers provide counselling and mental health support to family members who have lost loved ones to suicide. 

"I'm not aware of any formal mechanism to provide ongoing support."

Since the beginning of the inquest, this has been a recurring suggestion. 

Joanasie Akumalik, whose son Clyde died by suicide in 2013, testified that he and his family — including Clyde's twin brother — received no formal counselling as part of the territory's mental health system. 

Jack Hicks, the inquest's first expert witness, testified that he had interviewed loved ones of 120 Inuit who died by suicide as part of a major research project. 

"Most families were more than happy to talk," Hicks said Tuesday. "Some families were waiting to talk." 

On Wednesday, Crawford said that postvention can be challenging since the decision to come for counselling needs to come from the person who is struggling and, in most cases, cannot be forced on them by the health system. 

However, when it's felt that someone is at a serious risk to harm themselves, they can be "certified" — detained by medical staff involuntarily under the Mental Health Act.

Once, Crawford testified that she "had no choice" but to certify a 12-year-old because she feared for his life. 

Due to a lack of "secure physical spaces" at the community's health centre, the boy had to be held overnight in an RCMP cell. 

"It's in the interest of their safety," she said, "but it has other consequences."

'I was shocked'

Shuvinai Mike, director of Inuit Qaujimajatuqangit (traditional knowledge) with Nunavut's Department of Culture and Heritage, shed light on the need to understand Inuit culture in her testimony Wednesday afternoon.

"Whoever is leading the strategy, I think we need to work together," she testified. "We need for them to utilize our elders."

Mike's testimony became emotional as she discussed losing her daughter.

"When I asked for a copy of my late daughter's coroner's report, I was shocked to learn that my daughter had gone to the hospital many times," she said.

"If I had been informed of this, I definitely would have intervened and sought help with her.

"[If I had], she may still be alive and be here with her kids."

If you are feeling suicidal you can call the Kamatsiaqtut Help Line. It is anonymous and confidential: (867) 979-3333 or (800) 265-3333. You can also call the Kids Help Phone to speak to a counsellor: 1-800-668-6868.