Nunavut suicide inquest: territorial government defends work on prevention

A Government of Nunavut bureaucrat defended the territory's progress on suicide prevention work Thursday at a coroner's inquest in Iqaluit into the high rate of suicides. 

Lynn Ryan MacKenzie, the health department's territorial director of mental health and addictions, was speaking in response to criticisms lobbed by Nunavut Tunngavik, Inc. and prominent suicide researcher Jack Hicks earlier this week. 

"I think one of the challenges of the partnership has been expectations of what that partnership means," MacKenzie testified. 

"I can't make commitments on behalf of the government, which seems to be the expectation." 

Both Hicks and Natan Obed, who spoke on behalf of NTI, blamed the government's high turnover rate and complex decision-making matrix for slowing progress on the strategy — a finding echoed in a recent independent review. 

Since he began work on the strategy in 2007, Obed says as many as 30 people have represented the Government of Nunavut at the table. 

Having stepped into her current position about two years ago, MacKenzie says she was "possibly number 30," but argues that the solution suggested by earlier witnesses — putting a high-level government employee who can make decisions on behalf of multiple departments at the table — is untenable.

"I think it's unrealistic to think one person could be given that responsibility," MacKenzie said.

"That's not how the government is structured."

Strategy 'problematic' from the start

MacKenzie, who was not at the table when the action plan was drafted, testified that it is both "problematic" and "unrealistic." 

The objectives are not clear and that has made it impossible to fulfil goals, she said.

"It is a credit to the partnership that it has endured a structure of implementation that was problematic," she said, saying their continued work speaks to the "dedication" and "commitment" of all involved.

MacKenzie proposed a re-imagined partnership, based on a successful model used by the Manitoba government, where the groups are less integrated in their work and instead work toward their goals in parallel. 

"Each party could have its own plan and work in collaboration." 

Things 'are happening'

In her cross-examination, Kathryn Kellough, the lawyer representing the Akumalik family, who lost 25-year-old Clyde to suicide in 2013, pressed MacKenzie for reasons why goals for improved training and grief counselling services have not been advanced further.

"Is it just too unwieldy?" she asked. "Is it never going to happen?"

"There are things that are happening," MacKenzie answered. "We have built capacity. We are building capacity."

The Department of Health representative maintained that the last few years have seen progress in several areas.

"I think one of the problems with this action plan is that somehow it's conceptualized that these are the only things the government is doing."

To bolster that point, the Government of Nunavut entered into evidence a list of 25 active projects related to improving mental health programming, ranging from a mentorship program involving high school students, to support for the Kamatsiaqtut Helpline, to a tele-psychiatry program in partnership with Toronto's Hospital For Sick Children. 

88 workers across Nunavut

Both MacKenzie and Victoria Madsen, the director of mental health for Iqaluit, also testified about capacity issues in the mental health system and the challenge of recruiting and retaining staff. 

"We need more qualified and experienced counsellors," said Madsen. "That is a challenge."

She identified two other challenges her department is facing: hiring counsellors who specialize in youth and substance abuse issues and finding Inuktitut-speaking staff.

Madsen estimates that 75 per cent of Iqaluit positions are filled, but says the services her team provides at the Akausisarvik Mental Health Centre and ambulatory clinic are not compromised. 

"Sometimes there will be a wait list [at Akausisarvik], but not very long. Never more than two weeks."

MacKenzie testified that as of Sept. 2, 2015, there were 88 frontline staff working in the territory, including 16 in Iqaluit.

"Across the board we need more capacity, but there were staff in every community with the exception of Repulse Bay."

Despite the capacity challenges, Madsen said it's important to continue searching for the most qualified staff, adding that the government has "turned a corner" in its ability to retain staff. 

"We owe it to the community that we keep our standards high." 

From Jan. 1 to June 30, 2015, Madsen estimates that about 500 people were referred to Iqaluit's mental health system, and about 90 per cent of those people became clients.