Table of Contents
“Killing oneself is, anyway, a misnomer. We don’t kill ourselves. We are simply defeated by the long, hard struggle to stay alive” (Brampton, 2019). The focus of this paper is to explore the problem of suicide among Inuit youth in Canada. This paper will further talk about how the health professional can help the Inuit community in addressing the problem, finding the solution, identifying the appropriate intervention, and finally implementing and evaluating the planned intervention.
Inuit and Suicide
Inuit (meaning people) are the indigenous inhabitants of the North American Arctic, from the Bering Strait to the east of Greenland (Inuulitsivik Health Center, 2011-19). The majority of the population lives in fifty-one communities spread across Inuit Nunangat (Inuit Tapiriit Kanatami, 2018). There are approximately forty thousand Inuit in Canada. The Inuit language is called Inuktut (Inuit Tapiriit Kanatami, 2018).
Suicide is “the act or an instance of taking one’s own life voluntarily and intentionally” (Suicide, 2019). Youth suicide is an alarming issue among the Indigenous community. The suicide rate is five to seven times higher in Indigenous youth as compared to non-Indigenous (Statistic Canada, 2012). Among Inuit youth, suicide is responsible for forty percent of deaths as compared to eight percent in the rest of Canada (Webster, 2016). The sad part is twenty-seven percent of the suicidal deaths by Inuit people between 2005 and 2011 are missing from the figures by the Canadian Government, making the actual Inuit suicide rate eleven times the Canadian average or fifty-five percent higher than the Canadian Government acknowledges (Webster, 2016).
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Suicide in Inuit community is due to multiple risk factors, including social inequality such as poverty, physical and sexual abuse, extensive family and community violence, historic and ongoing loss of cultural identity, lack of access to education, primary health care and social services, psychological distress, substance abuse and low self-esteem (Conference Board of Canada, 2014, & Webster, 2016). The increasing suicide rate among Indigenous youth negatively impacts the individuals, their family, and the whole country (White & Jodoin, 2007). The government era of the 1950s and 1960s has had the most profound and rapid effect on Inuit social change in their history that impacted on intergenerational segregation, hunting, parenting, visiting and feelings of closeness, and affinal and romantic relationships (Kral, 2012). Intergenerational trauma left much youth feeling rejected and disconnected from their family; as a result, they only had a peer group to lean on.
Also, low self-esteem caused by depression, anxiety, and bullying reported a high level of suicidal ideation among the Indigenous youth (Feng, Waldner, Cushon, Davy, & Neudorf, 2016). They are in the constant negative cultural representation of Indigenous people by their non-Indigenous counterparts that results in feeling themselves as an inferior race. Such victims of suicidal ideation are more likely to attempt suicide in their later lives (Eggertson, 2015). The decrease in self-esteem seems to start after the age of twelve-year-old (McGee, & Williams, 2000). Even though the evidence shows the lack of self-esteem as the core cause of suicide among Inuit youth, the implementation of building the self-esteem programs is underrated among the research for the preventive measures of suicidal tendencies; making it a priority issue.
Interventions for suicide prevention in the Inuit population
Most of the study already demonstrated that government based intervention approaches to mental health did not work well and the traditional cultural healing practices often took place outside of the mainstream clinics in such communities (Auger, 2016). Indigenous people do not widely accept westerns programs. This unsuccessful attempt can be seen through the report prepared by Government of Nunavut (2010), in which despite providing suicide-intervention training and evidence-based psychiatric intervention through mental health services, the rate of suicide did not decrease.
The findings say that there was a clash between the scientifically research minded members and the Inuit community-based members (Kral, 2012). Even though it is common sense to understand that the Inuit people would know more about the effective way to prevent the cause of suicide among their people in their community, the members sent by the Canadian government did not bother to acknowledge the elders and Inuit population. Hence, the program failed.
There have also been many successful studies to decrease the rate of suicides among Inuit youth. Especially when the slogan of “for the community, by the community” and “prevention from the inside” had been followed in collaboration with other multi-disciplinary members. One of the community with the highest suicide rate, did not have suicide for almost four years; and what they did was: 1) Local community leaders like Deputy Mayor and other Hamlet Council members brought Inuit people together on a regular basis to talk about suicide and what they should do about it, and local youth committee did the same with youth; also nurses helped in organizing the committee and worked with the community for suicide prevention; and 2) Local housing committee removed closet rods from every house (Kral, 2012). Both, consciousness was raised about suicide prevention (including surveillance of people at risk) and the method of suicide was removed; hence, a decrease in suicidal rate.
Similarly, other community opened a youth center that included peers counselors, films, games, elders speaking, and other activities for youth (Kral, 2012). The suicide rate in this community drastically stopped for almost two years and came back to the surface when the center closed after some financial crisis (Kral, 2012). These two are the perfect examples of what we can assume is a result of collective action of combining both traditional practices and modern intervention.
Also, the recent study showed that the population-based approach with direct community engagement during the planning and implementation of the collaborative research process was found competent to begin addressing the high rates of death by suicide and attempted suicide among Inuit youth; thus, contributing to greater resilience and self-determination in long run (Anang, Elder, Gordon, Gottlieb, & Bronson, 2019). In this study, a group of Inuit youth from the community co-authored the project, lead focus groups and took on a self-directed, self-sustaining initiative that would ultimately belong to the community (Anang et al., 2019).
Roles and Responsibilities of Health Professional
Health professional plays an essential role in conducting any project from the beginning to the end of the project. As a student of health profession (nursing), it is recommended to assess the community by a various approach to identify the strengths, needs, and resources (Stamler, Yiu & Dosani, 2016). The findings of the assessment will guide to implement the culturally grounded innovative program to lessen the risk of suicide by making them empowered, hopeful, and optimistic about their future.
It is also essential to go through various research studies to identify the appropriate interventional tool if ever used in the past or to identify the strengths and limitation of the intervention to further strengthen the ideas, and statistical review that will examine a range of critical factors and data related to Inuit youth suicide. It is also a good idea to be familiarized with the community members and connect with the people. Also, an interactive method of an in-depth ethnographic interview of the youth is vital to capture their perception towards the economic, historical, social, cultural, political risk factors that lead to suicide in their own words. As well as, it will also encourage them to express their feelings of hopelessness, powerless, and pessimism (CBoC, 2014).
The elders of the community and key stakeholders should be interviewed to gain broader knowledge about the youth’s health status. Usually, the stakeholders will be the public health members (addiction managers, health directors, and nurses), the community members and the victims of disparities, and the gatekeepers will be the Inuit councils, community leaders, youth representatives, teachers, and social service providers. Engaging the stakeholders and gatekeepers is vital to acquire their recommendations and inputs based on their experiences.
The meetings should be held in the community, and the programs should be supportive and accessible to the population. The primary responsibility of health personnel is to work in an ethically appropriate way, and the most important ethical considerations being: to respect for persons, concern for welfare and justice (Government of Canada, 2018). It is vital to recognize the actual value of youths and to respect and to treat them fairly. It can be achieved by informed and ongoing consent, which helps the youths to make their judgment with their own. It is important to provide enough information that allows them to assess the risks and benefits related to the project. Active participation throughout the process will help to indicate, clarify, and minimize the negative impact on wellbeing. Lastly, it is essential to maintain a healthy relationship, understand and respect their culture to promote mutual trust with the participants as well as the community members.
Health personnel needs to gather all the risk factors to the problem and identify a priority issue. It is also essential to find the leading cause of the problem (suicide) because it may vary according to the region and the community. So, different approaches might be required to plan the intervention depending upon the cause of the problem, the issue of the community, and the demand of the community people. As the evidence of the successful projects from the various examples discussed earlier, the most important thing to keep in mind is the active collaboration and participation of the community people. So, once the issue is identified, the health professional with the cooperation of the community leaders, elders, and youth, should decide the best possible way to approach the problem.
For example, creating the environment where the youth can openly talk about their issues and situations with other youths; creating a place where the youths can seek advice from the elders; also providing the information on how they can find for medical help if they want to; giving information about the access to the traditional healing methods if they’re going to; creating a helpline if they wish to stay anonymous but still want to share their problems; creating a space where they can divert their feelings towards learning, reading, playing or whatever they are interested in; and lastly, the most essential thing that the health personnel can do is to advocate for the resources and funding for such projects municipal, provincial and federal level. During this time, the essential thing that the health personnel needs to do is be open for anything that comes, understand their culture, and empathize their situation. And not try to force one’s culture, tradition, and understanding over others.
Once the project or intervention is planned and carried out, it is essential to evaluate it as well while also identifying its strength and limitation. This will help the members to validate the intervention and know if it worked as how it was planned. In this case would be, to evaluate if the suicidal rate among the Inuit youth has decreased after the launch of the program, and by how much. If the expected result has achieved, the health professional, as well as other members, should appeal to the higher authorities and make sure that the resources will continue to flow to sustain the project.
However, in the case of the undesired result, it is crucial to identify the problem with the planning and intervention, make a new plan, and try again until the desired outcome is achieved. This kind of project is a long run project that might take a duration from a few years to the decades. However, the motive here is to motivate the community members to run successful projects by themselves in their community for their people.
Due to the wild guess that Inuit people would only prefer to have their traditional ways of dealing with the problems and not wanting to access the western approach, they have been left behind on their own. But with the series of programs implemented in this population, it has been clear that although they prefer their traditional healing ways, they are also open to effective modern technologies. So, why not make it accessible to both the traditional and western methods and let them decide on their own because either of the ways could be accepted in particular situations.
Most of the approaches being more traditional and community-based when working with the Inuit people, it might seem that health professionals have nothing to do with them. But, they play a significant role in advising, planning, implementing, evaluating, and advocating during any program. Also, nurses being the only front liner workers of health care in the north, are one of an integral part of the Indigenous community.
