we belong: life promotion to address indigenous suicide ... · we belong: life promotion to address...

WeBelong:LifePromotiontoAddressIndigenousSuicideDiscussionPaper

JenniferWhite,SchoolofChildandYouthCare,UniversityofVictoriaChristopherMushquash,DepartmentofPsychology,LakeheadUniversity

December 18, 2016

Acknowledgements

WewishtothankCarolHopkins,ExecutiveDirectoroftheThunderbirdPartnershipFoundation,aswellastheboardoftheThunderbirdPartnershipFoundationfortheirsupportofthispaper.WealsowanttoacknowledgetheworkoftheAssemblyofFirstNationsinaddressingsuicideinFirstNationcommunitiesacrossCanada.WearegratefultoMeghanMcKenna,ImprovementLead,CanadianFoundationforHealthcareImprovement,andtheWeBelongInternationalForumonLifePromotiontoAddressIndigenousSuicideplanningadvisorycommitteefortheirreviewandcommentsonearlydraftsofthispaper.

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Foreword

ThisdiscussionpaperismeanttoserveasaspringboardfordialogueandjointlearningonLifePromotiontoAddressIndigenousSuicide.Thepaperhasbeenorganizedtoachievethefollowingaims:(a)situatetheissueofsuicideamongIndigenouspeopleswithinabroadsociopoliticalandhistoricalcontextthatcallsattentiontothelegacyofcolonialattemptsatassimilationandongoingnegativeeffectsofsocialinequities;(b)summarizethecurrentknowledgebaseandhighlightpromisingpracticesforpreventingsuicideandpromotinglifeamongIndigenouspeoples(i.e.creatingtheconditionsforIndigenouschildren,youth,families,andcommunitiestoflourish);(c)recognizethatIndigenousandnon-Indigenouspeoples,aswellasprovincial,federal,territorial,andIndigenousorganizations,mustallbeactivelyengagedaspartofthesolution;(d)emphasizetheimportanceoflong-term,comprehensive,strengths-basedandlifepromotingapproachesthatrecognizethesignificanceoflandandceremony,andhonorIndigenousknowledge,values,spirituality,andcultures;and(e)articulateaseriesofguidingprinciplesthatcouldstimulatefurtherdialogueandprovidedirectionforfuturesuicidepreventionandlifepromotioninitiatives.

Thereisagreatdealofvaluableandimportantworkinthisareathatiseitherunderway,oralreadycompleted.Theintentionofthispaperistobuildonthisstrongfoundation.1234WhilemuchoftheliteraturehighlightedhereisfromaCanadiancontext,withanemphasisonFirstNationscommunities,thematerialisexpectedtoberelevantforIndigenouspopulationselsewhere,giventhepervasivelegacyofcolonialattemptsatassimilationthathasnegativelyaffectedthelivesofIndigenouspeoplesaroundtheworldthroughdisruptionofindividuals,families,communities,andnations.56Thatis,thoseconditionsthatcontributetoincreasedratesofsuicideinsomeIndigenouscommunitiesaretypicallythesamefactorsthatcontributetoincreasedratesofsuicideinneighboringcommunities.ThepaperfocusesonsuicidepreventionandlifepromotionstrategiesthatareaimedatreducingcollectivesufferingandinjusticeandstrengtheningtheconditionsthatfacilitatethewellbeingofIndigenouspeoplesandcommunities.Inkeepingwithrecentrecommendationstogo“beyondthesocial”whenconsideringdeterminantsofIndigenouspeoples’health,particularemphasisisplacedoncomprehensive,multi-levelstrategiesthatengagewithIndigenouswaysofknowing,drawonculturalvalues,recognizeconnectionstolandandceremony,andadvancethegoalsofsocialequityandcommunityself-determination.7Individualandbiomedicaltreatmentstrategieswillnotbepresentedhere,butmaybepartofacommunity-directedapproach,whendeemedappropriatebythatcommunity8.

RatesofsuicideamongIndigenouspeoplesinCanada(FirstNations,Inuit,andMétis),theUnitedStates,Australia,andNewZealandarehigherthanthegeneralpopulation.910Whilethereisahighlevelofvariationinsuicideratesacrossagegroups,communities,andregions,1112andthereistremendousculturaldiversityacross

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Indigenouscommunities,ithasbeenwelldocumentedthatIndigenouspeoplesasawhole,donotenjoythesamelevelsofhealth,education,income,employment,securehousing,socialopportunities,orrightstocommunityself-determinationasnon-Indigenouspeoples.13Itisindisputablethatracism,colonization,assimilationistpolicies,structuraldiscrimination,landtheftandtheresidentialschoolsystemhavecontributedtohighlevelsofculturaldisruption,trauma,healthinequities,addictions,suiciderisk,andsuicideinmanyIndigenouscommunities.141516Whileneverlosingsightofthelegacyofcolonizationanddeep“culturalwounds”17thatpersistinmanyformstoday,thestrength,solidarity,andresilienceofIndigenouspeoplescannotbeunderestimatedandisanimportantcounterpointtothesingularandone-dimensional“damage-centric”anddeficits-basednarrativethatoftentakesholdinthepublicimagination.18ThispaperfindsstrongresonancewithagrowingbodyofIndigenousandcriticalscholarship1920that,“…accountsforthelossanddespair,butalsothehope,thevisions,thewisdomoflivedlivesandcommunities.”21

Inthesectionthatfollows,wecallattentiontoanumberofinfluentialCanadianreportsthataddresssuicidepreventionandlifepromotionfromanIndigenousperspectiveasawaytoshowthatIndigenouspeopleshavelongknownwhatneedstobedoneandthereisasolidfoundationofknowledgeandlocalcommunityactiononwhichtobuild.Wethengoontosummarizekeyfindingsfromthepublishedacademicliterature(includingexistinggapsandlimitations)asawaytohighlightadditionalopportunitiesforaction,extendtheknowledgebase,andraisenewquestions.

WhatDoWeKnow?

IndigenousResponsestoSuicideandLifePromotionInresponsetotheelevatedratesofsuicideobservedamongmanyIndigenouscommunitiesinCanada,anumberofkeypolicydocuments,practiceframeworks,andcallstoactionhavebeenproducedoverthepast30years(seeAppendixA).StartingwiththeRoyalCommissiononAboriginalPeoples’Reporton“ChoosingLife”in1995,andreflectedineachsubsequentdocumentthereafter,thereisagrowingclarityaroundthefactthatsuicideamongIndigenouspeoplescanbeunderstoodasadirectconsequenceofthehistoryofcolonization.2223Aseachofthereportswrittenoverthepasttwodecadesmakesclear,anyproposedsolutionstoaddressingtheproblemofsuicideamongIndigenouspeoplesmustdirectlyaddressthelegacyofcolonization.Thisincludesdismantlingstructuralformsofracism,settlinglandclaims,promotingcommunityself-determination,healingfromintergenerationaltrauma,andreducingsocialinequitiesthatcontributetohighlevelsofhopelessnessanddistressamongmanyIndigenouscommunities.

Anumberofcomprehensive,culturally-andcontextually-informedapproachestosuicideandlifepromotionamongIndigenouspeopleshaverecentlybeendevelopedinCanada.First,theNationalInuitSuicidePreventionStrategyprovidesanexcellentexampleofaholistic,evidence-basedapproachtosuicidepreventionthatseekstoreducesuiciderisk

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factorsandbolsterprotectivefactorswithinInuitcommunities.24Second,theAssemblyofFirstNationsNationalYouthCouncil“CallstoActionforLifePromotion”Reportrecognizesthathonoringculturalpractices,recoveringIndigenouslanguages,creatingopportunitiesforinter-generationallearning,andrecognizingIndigenouspeoples’sacredconnectionstolandandstoriesarevitalcomponentsinanysuicidepreventionstrategy.25Third,MétisyouthcouncilshavebeenestablishedacrosstheMétisNation(Ontario,ManitobaandBritishColumbia).TheseCouncilsmeetanddiscussissuesthatdirectlyrelatetoMétisyouth,includinglifepromotionandsuicideprevention.Finally,therecentlypublished“FirstNationsMentalWellnessContinuumFramework”26providesaclearoutlineofwhataculturallyresponsive,holistic,strengths-based,comprehensiveapproachtopromotingwellnesslookslikefromaFirstNationperspective.Thatis,fosteringpurpose,hope,belonging,andmeaningareessentialinpromotingwellness.

Insummary,Indigenousleadersandnon-IndigenousallieshaveknownforalongtimethatpreventingsuicideamongIndigenouspeoplescannotbeachievedthroughanexclusivefocusonindividualrisksortheprovisionofindividually-focusedmentalhealthservices(despitetheneedforsuchservices),norcantheonusforchangebeplacedsolelyontheshouldersofIndigenouscommunitiesororganizations.AstheCallstoActionfromtheTruthandReconciliationCommissionofCanadamakeclear,allCanadianshavearoletoplayinredressingtheharmscausedbyresidentialschools,assimilationistpolicies,and“culturalgenocide.”Meaningfulchangewillrequireaconcertedandsustainedcommitmentfromindividuals,communitiesandgovernments.27Inshort,itisunacceptableforCanadianstopayattentiontoIndigenousyouthonlywhentheyareinacutedistressorattemptsuicide.2829Instead,andconsistentwithIndigenousvalues,ongoingattentionmustbeplacedoncreatingtheconditionsforallIndigenouschildren,youth,andfamiliestoflourishsothattheycanresilientlypursuelivesofdignity,withpurpose,hope,belonging,andmeaning;andbeenabledtorealizetheirfullpotential.

ContributionsfromthePublishedScholarlyLiterature

Keepingtheirextraordinarydiversityinmind,ratesofsuicideamongIndigenouspeoplesinCanada,Australia,NewZealandandtheUnitedStatesaredisproportionatelyhigh,relativetothenon-Indigenouspopulation.30YoungIndigenouspeopleareatgreaterrisktodiebysuicidecomparedwitholderagegroups.InCanada,suicideratesamongIndigenouspeopleaged10-29areestimatedtobe5to6timeshigherthanyouthinthegeneralpopulation,withoverathirdofalldeathsamongAboriginalyouthattributabletosuicide.31RecentstatisticssuggestthatratesofsuicideamongInuitpeoplesinNunavikandNunavutaretentimesthenationalrate.32

Wealsoknowthatthereisagreatdealofvariationinyouthsuicideratesacrosscommunities.Forexample,inaCanadianstudyofyouthsuicideamongFirstNationsinBritishColumbia,thosecommunitiesthathadhigherlevelsof“culturalcontinuityfactors”(i.e.self-government,activeeffortstorestorelandclaims,controlovereducation,healthcare,culturalfacilities,andpoliceandfireservices),hadlowerorzeroratesofyouth

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suicidecomparedwiththosecommunitieswithfewerofthesefactors.33Afollow-upstudyreportedthatIndigenouslanguageusewasarobustindicatorofcommunitywellbeingandwasassociatedwithloweredsuiciderates.34

Socialscientistshavelongbeeninterestedinidentifyingkeyriskfactorsforsuicide,asthefirststepinanylarge-scalepreventioneffort.Afterseveraldecadesofresearch,acommonsetofriskfactorsforsuicidehasbeenidentified,including:previoussuicidalbehaviours,depression,problematicsubstanceuse,childhoodmaltreatment,stressfullifeevents,poorphysicalhealth,exposuretoapeer’ssuicide,andafamilyhistoryofsuicide.35363738Theproblemwithconventionalsuicideriskfactorresearchisthatitilluminatesindividualtraitsandvariablesassociatedwithsuicide,buttypicallyobscuresfromviewthosesocial,historical,andstructuralarrangementscontributingtoexperiencesofdistressandsufferingamongIndigenouspeoplesandcommunities.39404142Further,inarecentmeta-analysisofriskfactorsforsuicidalthoughtsandbehaviours,whichexamined50yearsofresearchonsuicideinthepublishedliterature,predictionofsuicidalthoughtsandbehaviourswasonlyslightlybetterthanchance,andpredictiveabilityhadnotimprovedacross50yearsofresearch.43Theseauthorsnotedthatstudiesonsuicideriskfactorsandpredictionrarelyexaminedthecombinedeffectofmultipleriskfactors.ForIndigenouspeoples,additionalsocio-politicalandhistoricalfactorsinclude:racism,culturaldislocation,legacyofresidentialschools,landtheft,lossoflanguage,overcrowding,poverty,unsafehousing,andmulti-generationaltrauma.44 45 46 47 48

Protectivefactorsrefertothosefactorsandexperiencesthatappeartoreducethelikelihoodofsuicidedespiteexposuretorisk. Theyinclude:copingandproblemsolvingskills;experiencewithsuccess;feelingsofeffectiveness;senseofbelongingandconnection;socialsupport;interpersonalcompetence;familywarmth,supportandacceptance;successatschool;supportiveschoolclimate;andschool-basedanti-harassmentpoliciesandpractices.4950 51 52 TheundeniableresilienceofIndigenouspeoples,whohavemaintainedhealthandwellnessdespitefacinganumberofculturalassaultsandhistoricaladversities,cannotbeoverlooked.ScholarshavebeguntoidentifykeyculturalandinstitutionalpracticesthatcanstrengthensocialrelationsandpromoteresilientoutcomesforIndigenouscommunities,including:53 54 55

• revitalizinglanguageandtraditionalhealing• enhancingculturalidentityandspirituality• supportingfamiliesandparentstoensurehealthychilddevelopment• enhancinglocalcontrolandcommunityself-determination• strengtheningsocialcapital,networksandsupport• buildinginfrastructure(material,humanandinformation)• respectinghumandiversity

Ingeneral,theevidencebaseforsuicidepreventionisquitelimited,makingitextremelydifficulttomakeunequivocalclaimsabouttheeffectivenessofanyonespecificsuicidepreventionstrategy.Asmallnumberofsuicidepreventionstrategiesforthegeneralpopulationhavebeenidentifiedaspromising,including:someschool-basedsuicide

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preventionprograms,gatekeepertraining,physicianeducationandtraining,meansrestriction,andbriefEmergencyDepartment(ED)interventions.565758Importantly,arecentevidencebasedreviewfromCanadasuggestedthatFirstNations,Inuit,andMétisleaders,non-Indigenousclinicalandresearchcollaborators,andcommunity-basedserviceprovidersreviewtheirrecommendations,andthenconsidertheirownuniqueculturalandcontextualfactorswhenformulatingconclusionsregardingrelevancetotheneedsoftheyouthintheircommunities.59Further,theyalsoacknowledgedandsupportedtheneedforcommunity-ledandcommunity-basedsuicidepreventioninitiatives,includingevaluationresources,suchthatuniquecontextualandculturalneedsofIndigenouscommunitiesarerespectedandincorporatedintoshorter-andlonger-termplanning.Interventionshaveintendedconsequencesbutcanalsohaveunintendedconsequences.Itisthroughrobustresearchandevaluationthatthefullunderstandingoflifepromotion,andsuicidepreventionandinterventionapproachesinIndigenouscommunitiescanbeachieved.VeryfewevaluationsofprogramsspecificallytargetingIndigenouscommunitieshavebeenpublished,606162althoughtherearesomenoteworthyexceptions.Specifically,arecent Canadianstudyshowedthatparticipatinginculturecampsdesignedtopromoteyoungpeoples’involvementinculturalactivitiesandstrengtheningtheirbondswithlocalElders,hadapositiveimpactonyouthwellbeing.Theseculturalandcommunity-buildingactivitiescanbeanimportantpartofanoverallyouthsuicidepreventionstrategy.63ThereisalsosomeevidencetosuggestthattheZuniLifeSkillsProgram,whichisaculturallytailored,school-andcommunity-basedsuicidepreventionprogram,designedtoimprovesuicidepreventionskillsanddecreasehopelessnessamongIndigenousyouthcanmakeapositivedifference.64Long-termresearchonthisprogramsuggeststhatwhensuicidepreventionstrategiesareembeddedwithinexistingculturalprotocols,localvaluesandIndigenoushealingprocesses,thelikelihoodofbroadcommunityownershipandinvestmentincreases.Otherevidencepointstotheeffectivenessofcomprehensive,flexible,publichealthapproachesforpreventingrisksforsuicideinIndigenouscommunities.Forexample,onestudyundertakenwithanAmericanIndianTribalNationfoundthatmultiplestrategies,whichaddressedrootconditionsaswellassocial,psychologicalanddevelopmentalissues,contributedtoreducedsuicidalbehaviours.65Strategiesincluded:identifyingspecificindividualsandfamiliesathighriskforsuicide,violence,andmentalhealthproblems;implementingpreventionactivitiestoreachhigh-riskindividuals,familiesandgroups;providingmentalhealthservicestohighriskgroups;andmobilizingacommunity-wide,systemsapproachtoincreasecommunityknowledgeandawareness.Creatingopportunitiesforongoingcommunityinputwasvitaltoprogramsuccess.Finally,theWhiteMountainApacheTribedevelopedasystemofsurveillanceandpreventionofsuicide(namedCelebrating Life)in2006,whichincludeduniversal,selected,andindicatedtiersofintervention.Comparingthetimeperiods2001-2006(pre-implementation)to2007-2012(post-implementation),therewasa38.3%overalldecreaseinsuicidedeathsanda23.0%decreaseamongthoseaged15-24years.66TheWhiteMountainApacheTribefoundthattheCelebratingLifesurveillancesystemplayedacentralroleinsettingthefoundationonwhichthecommunitycouldprovidepreventionprogramming,whileimportantlyprovidingthedataneededtodemonstratesuccess.

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Therearemanygapsinourknowledgeaboutsuicideingeneral,andsuicideamongIndigenouspeoplesinparticular.Someaspectsofsuicideanditspreventionarenoteasilycapturedbytraditionalresearchmethodsandsoourknowledgeabout“whatworksbest”isalwaysimperfect,evolvingandsubjecttochange.Standardsuicidepreventionpracticeswhichmakeassumptionsaboutsourcesofdistressandarepredicatedonmodelsofexpertinterventionsandindividualizedtreatmentscansometimesbeoutofstepwithnon-western,non-Europeanculturalconceptualizationsofmentalhealthandwell-being.67Beingculturallyresponsivemeansbeingattunedtolocal,historical,andsociopoliticalinfluencesonmentalhealthandwellbeing,anddevelopingsolutionsthatbuildonlocalstrengthsandaddresshistoricalandcontextualrealities. Contributionsfrompublishedqualitativeresearchrespondtosomeofthesegapsbyfocusingonlocalmeanings,relationshipsandcontexts.68Forexample,ethnographicfieldworkhasbeenusedtobetterunderstandthedisproportionatelyhighratesofsuicideandsuicidalbehavioursamongInuitmaleyouthinCanada.Findingsrevealedthatsuicidalbehaviourswereveryoftenlinkedtodisruptionsinromanticandfamilyrelationshipsandintergenerationalsegregation.69Meanwhile,participatoryactionresearch(PAR)methodologiescanengagecommunitymembersinongoingandtransformativeconversationsaboutyouthsuicide.70Bytryingtobetterunderstandhowcommunitymembersmakesenseofyouthsuicideandbyelicitingdominantculturalnarrativesoftheproblem,thestagecanbesetforcollectivecritiqueandsocialaction.Inanotherparticipatoryresearchdesign,youngpeopleweretaughthowtocreatedigitalstoriesaspartofalargeryouthsuicidepreventioninitiativeinNorthwestAlaska.71Drawingonapositiveyouthdevelopmentframework,theprojectwasdesignedtobestrengths-based,empowering,andtransformative.Otherresearchershaveutilizedfocusgroupsandinterviewstobetterunderstandparents’andElders’perspectivesoncolonizationandtheimplicationsforyouthsuicidepreventioninaPacificNorthwestAmericanIndiancommunity.72

GivenWhatWeKnow,WhatCanBeDone?

WeknowsuicideamongIndigenouspeoplesiscomplexandweknowitwilltakethesustainedandconcertedeffortsofgovernments,communities,families,andindividualstoaddressthisproblem.Theprevioussectiondocumentedthatthereisadecentfoundationofempiricalandculturalknowledgeonwhichtobuild,eventhoughmanyquestionsremainregardingtheeffectivenessofIndigenous-specificsuicidepreventionstrategies.Atthesametime,itisbecomingincreasinglyclearthatmanyapproachestoaddressingthisproblemarelessaboutimplementingdiscretesuicidepreventionprograms,andmoreaboutcreatingtheconditionsforIndigenouschildren,youth,familiesandcommunitiestoflourish,preservetheirlanguages,reclaimtheirland,recovertheirculturalandspiritualpractices,andexercisetheirsovereignrightstobeselfdetermining,Thesearecompellinglifepromotingpracticesthatholdtheseedsforsocialtransformationanddeserveseriousconsideration.73Theseapproachesarediverseinscopebutcanbebroadlycharacterizedbyafocusonreducingsocialinequities,buildingoncommunitystrengths,andcreatingpracticesandpoliciesthatsupportthebroadgoalsofreconciliation:

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Reconciliationrequiresthatanewvision,basedonacommitmenttomutualrespect,bedeveloped.Italsorequiresanunderstandingthatthemostharmfulimpactsofresidentialschoolshavebeenthelossofprideandself-respectofAboriginalpeople,andthelackofrespectthatnon-AboriginalpeoplehavebeenraisedtohavefortheirAboriginalneighbours.ReconciliationisnotanAboriginalproblem;itisaCanadianone.VirtuallyallaspectsofCanadiansocietymayneedtobereconsidered.74

Comprehensive,flexible,multi-strategy,ecologicalapproaches,whichareimplementedacrossanarrayofsettingsandcontextsanddevelopedby/withlocalcommunities,arerecommended.757677Thesecommunitystrategiesandpracticesshouldbeinformedbymultipleanddiverseformsofknowledge.Thisincludes:theculturalknowledgeofEldersandotherknowledgekeepersinthecommunity;youngpeople’sknowledgeandwisdom;professionalknowledgeofpractitioners;knowledgegeneratedthroughresearchandscholarship;andtheknowledgeofthosewithlivedexperienceofsuicideandsuicideattempts.EachIndigenouscommunityisuniqueandcloseattentionmustbepaidtotheparticularsocial,cultural,political,andhistoricalcontextwhendesigningandimplementinganylifepromotionorsuicidepreventionstrategy.Comprehensiveapproaches,whichreflectholisticviewsofchildren,youth,familiesandcommunities,recognizethesignificanceoflandandplace;anddrawonthedistinctstrengthsandculturalpracticesofIndigenouscommunitiesholdthemostpromise.Awell-resourced,highfunctioningcontinuumofservices,includingprevention,earlyintervention,assessment,crisisintervention,treatment,bereavementandpostventionprograms,staffedbypractitionerswhoareclinicallycompetenttoprovideculturally-andcontextually-appropriatecaretoIndigenouspeoplesinaculturally-safemannerisalsokeytoacomprehensiveapproach.Strengths-based,lifegeneratingstrategieswhichhonourIndigenouswaysofknowingandreflectrelational,familial,social,andspiritualdimensionsofselfhoodaremorelikelytobeeffectivethanthosewhicharepredicatedonde-contextualized,expert-driven,individualistic,biomedicalunderstandingsofdistress.78Buildingonlocalresources,respectingculturalprotocolsandsacredceremonies,recognizingtheimportanceoftheland,valuingthespiritualdimension,andstrengtheningfamilyandcommunityrelationshipsarecriticalcomponentswhenworkingwithIndigenouspeoplesandcommunities.Byfocusingonwhatisalreadyhelpful,hopeful,andlife-giving(withoutdenyingthepainfulrealityofsuicideoravoidingtalkingaboutit),aspiritofpossibilityandsolidaritycanprevail.Focusingonlifepromotionanddrawingontheexistingstrengthsofpeopleandcommunitiescanprovidetherightconditionsfor‘knowinganddoing’inwaysthatmobilizehope,collectivelearning,andsocialaction.

De-colonizingpracticesbringattentiontotheracistsystemsandcolonialstructuresthatperpetuateoppressionandinequityamongIndigenouspeoplesandcommunities.Theycontextualizeexperiencesofdistressandsuffering(ratherthanlocatingriskwithinindividuals).Acommitmenttodecolonizationunderscorestheimportanceofcommunity

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self-determinationandreconciliationaskeysuicidepreventionstrategies.79Effortstopromotewell-beingandreducerisksforsuicideshouldbeinformedbytheconceptsofculturalsafetyandreconciliationwhicharepredicatedonmultipleformsofengagementandrelationalvaluesofrespect,trust,justice,relationalaccountability,andsafety.80

KeyPrinciples

Givenwhatwealreadyknowabouttheproblemofsuicideandtheprocesseswemightengageinasawaytoreducerisksforsuicideandpromotelife,weproposefiveguidingprinciplestogroundfutureeffortsinthisarea.

IndigenousWaysofKnowing

IndigenouspeoplesinCanadaarediversewithrichhistoriesandcultures.InordertodefineIndigenouswaysofknowingitishelpfultounderstandwhathasbeentermedWesternwaysofknowing.Westernwaysofknowing,whicharegenerallyassociatedwiththeEnlightenmentperiod,aretypicallypredicatedonthefollowing:rationality,boundedindividualism,aseparationbetween‘nature’and‘culture,’andaprofoundfaithinscientificprogress.Knowledgeisunderstoodassomethingthatisgeneratedthroughthescientificmethod,whichassumesthatthereisanobjective,andknowableworldindependentofhumanexperience,language,tools,anddescriptions.Thisempiricalapproach(oftenknownaspositivism)hasbeenfavoredinscienceandmedicine.Eventhoughhelpfuldiscoverieshaveoccurredthroughwesternknowledgeparadigms,thiswayofknowingisoftenatoddswithmorecontextualized,culturallygroundedapproaches.8182Accordingtosomecriticalscholars,thedominanceofWesternknowledge–withitsemphasisonuniversalreason,linearnotionsoftimeandhistory,andtheseparationofmind/body–systematicallyconcealstheywaythatsuchassumptionsabout‘truth’and‘reality’imposeaformofsystematic(colonial)discriminationonothers.83

Allsystemsofknowledgearedependentuponplace,languages,uniquevalues,beliefs,attitudes,artifacts,worldviews,andassumptions.Observation,imitation,metaphor,storytelling,relationshipstothelandandAncestors,experientialapproaches,andcollaborationareamongthemethodsinwhichIndigenouspeoplesusetoconveyandshareknowledgethroughteachings.Inthisway,culture-basedpractices,stories,andceremoniesarethewaysinwhichIndigenouspeoplesarekeepersofknowledgeratherthanknowledgecreators.Knowledgeisrelationalandsharedbetweenonewhoholdsknowledgeandonewhoseekstolearn.Therearevariouswaysinwhichknowledgecanbesoughtandavarietyofculturaltraditionsandceremoniesthatsignaltransmissionofknowledge.Astrongethicofrelationalaccountabilitytotheland,peoples,Ancestors,andfuturerelationspermeatesIndigenousknowledgesystems.8485Thecommunal,relational,timeless,andcontextualnatureofthiswayofknowingcanbethoughtofastheknowledgethatacommunityaccumulatesovergenerationsoflivinginaparticularenvironment.Thisencompassesallformsofknowledge–technologies,know-howskills,practices,andbeliefs–thatenablethecommunitytoachievestabilityintheirenvironment.Italsohighlightsthedynamicandfluidnatureoftraditionalknowledge,itsconnectionstothephysicalandsocial

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environmentsofspecificcommunities,andthesocial,political,andkinshipstructuresthatreinforceindividualandcollectivewellbeing.

Land,Language,andStories

WellnessfromanIndigenousperspectiveisunderstoodtobethepresenceofbalanceinspirit,emotion,body,andmindthroughconnectiontolanguage,land,beingsofcreation,andancestry.Spiritualwellnesscreateshope,emotionalwellnesscreatesbelonging,physicalwellnesscreatespurpose,andmentalwellnesscreatesmeaning.86Thesearetheaspectsofwellnessthatmakeanindividualfeelasthoughlifeholdsvalueforthem.Explicitinthisdefinitionofwellnessisconnectiontoland,language,andstories.Infact,healingforIndigenouspeopleswillnecessarilyincludeland,language,andstoriesifweacceptthatthepresenceofbalanceinspirit,emotion,body,andmindisourdesiredoutcome.Whilethereisagreatdealofdiversityacrosscommunities,mostIndigenouswaysofknowingreflectholisticunderstandings,inter-connectedness,andbalance.Thecommunityisbothacontextandresourceforhealingandspiritualityisintimatelytiedtotheland.Understandingtheroleofhistory,tradition,culturalprotocols,andlocalcommunitynormsareimportantaspectsofbuildingrelationshipswithmanyIndigenouscommunities.Meanwhile,storytellingisakeymechanismforteachingandmobilizingculturallyinformedvaluesandpractices.Livinginharmonyandmaintainingrespectfulco-existencewithalllivingthingsareimportantculturalteachingsthatcanbeconveyedthroughbothtraditionalandcontemporarystories.Suchstorieslinkindividuals,families,andcommunities,throughthepast,presentandfuture,andcanprovideanimportantresourceforresilience.87FocusonStrengths

Strengths-basedapproachesemphasizetheuniqueresources,capacitiesandwisdomofindividuals,families,andcommunities.Strengths-basedstrategiesareindirectcontrasttodiseasemodelsandproblem-basedapproachestoassessmentandtreatment.Workinginastrengths-basedwaymeansknowingwhenandhowtoengagetheexistingresourcesofthelocalcommunity(e.g.Elders,spiritualleaders,culturalmentors,extendedkin,etc.).Theexistingstrengthsandresourcesofthecommunitycanbemobilizedinrespectfulandculturally-appropriatewaysthroughongoingrelationshipbuildingwithcommunityleadersandbyhonoringculturalprotocols.Onewaytohelppeoplewhentheyexperiencedifficultiesisthroughdeterminingtheirintrinsicstrengthsaswellasthestrengthsoftheirfamilies,andcommunitiesandusingthesestrengthsandexistingcapacitiestopromotehealing.Simplyput,ratherthanasking:Whatiswrong?wecaninsteadask:Whatisright?Whatisworking?Whatishopeful?Doingsooffersanumberofbenefits.Thisisparticularlyimportantinthecaseofsuicidewhereanindividualmayfeelparticularlyhopeless,oflittlevalueorworth,andmayhavelostsightoftheiruniqueresources,gifts,andskills.Further,itallowsindividualsandcommunitiestoaccesstoolsandstrategiesthatarealreadyavailabletothem,ratherthanbeinginaccessibleorspecialized.

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DecolonizationandCommunitySelf-Determination

Decolonizationisalong-termprocess.Itrequireschallenging,resistinganddismantlingcolonialstructuresthatimpedecommunities’self-determination.Indigenousandnon-IndigenouspeoplesmustworktogethertosupportIndigenouscommunitiestoreclaimtheirland,theirlanguages,andreestablishconnectionstocultureandtradition.Throughadvocacy,scholarship,policychanges,andcommunityaction,Indigenouscommunitiescanworktowardsself-determination.Aspreviouslydiscussed,researchclearlydemonstratesthatcommunityself-determinationisakeyfactorassociatedwithreducingratesofsuicideinIndigenouscommunities.Specifically,FirstNationscommunitiesinBritishColumbiathathavetakenstepstosecuretitletotheirtraditionallands,takenbackfromgovernmentrightsofself-government,securedsomedegreeofcommunitycontrolovereducationalservices,police,fireprotectionservices,andhealthdeliveryservices,andestablished“culturalfacilities”tohelppreserveandenrichtheirculturallivesshowedloweredratesofsuicidewhencomparedtocommunitieswhohadnotyetestablishedthislevelofself-determination.88Hence,decolonizationandcommunityself-determinationgohandinhandinstrengtheningacommunity’sabilitytoadapttochangingcontextsandrespondtoemergingcrisesinatimelyandflexiblemannerthatrespectsthecommunity’sabilitytosupporttheirpeople.

CollectiveResponsibilityandReconciliation

InIndigenouscommunities,itisunderstoodthattrauma,distressandsuicideemergefromacomplexsetofdeterminantsbothindividualandcollective.Thatis,anindividualcanexperiencetrauma,whichoverwhelmstheirabilitytocopeandleavesthemfeelinghopeless.However,thisprocesscanalsoexistwithinthecollectiveinIndigenouscommunities.Historicandongoingcolonialprocessescanoverwhelmacommunities’abilitytocopeandleavethecollectivefeelinghopeless.InthecontextofTruthandReconciliation,89thesystemsandpoliciesimposeduponIndigenouspeoplesinCanadaandthesubsequentharmsassociatedwiththeseinterventionsarebeingdiscussedatcommunity,regional,provincial,andfederallevelsaswellasatmanykitchentables.Insuicidepreventionandlifepromotion,wehaveacollectiveresponsibilitytoensurethatwehelpouryoungpeoplebycreatingsupportivecommunitieswheretheycanfindalifeforthemselves.Reconciliationoffersapathwayforencouragingcollectiveresponsibility.ReconciliationalsooffersamechanismbywhichIndigenousandnon-IndigenousCanadianscanholdgovernmentsaccountablewhilecontinuingtoadvocateforresponsestotheCallstoActionandothercommunity-specificpriorities.

NextSteps

1. FocusontheSocialConditionsandPracticesThatReduceRisksforSuicideandPromoteLifeinIndigenousCommunities.

Whenasuicidecrisisoccursinourcommunities,theresultsaredevastating.Youngpeoplelost,familiesbroken,communitiesdevastated,anddisparitieshighlighted.Withoutsubstantiveandsustainedinvestmentinourcommunities,itisastorythatkeepsbeingtoldthroughthemedia.WhetherinPikangikum,Neskantaga,Attawapiskat,StanleyMission,La

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Ronge,Iqaluit,orelsewhere,tragedy,sadly,continues.Governmentandsystems-levelresponseshavebeentotransportcounselorsintocommunitiestobeavailabletosupportpeoplewhohavebeenaffected.Whilesuchinterventionsmayhavesomelimitedshort-termvalue,suicideinIndigenouscommunitiesisnotsimplyanindividual-levelproblemthatcanbesolvedbymentalhealthservicesalone.Instead,asmanyIndigenousorganizationsandleadershavebeenadvocatingforalongtime,thefocusmustshifttowardimprovingsocialconditionsandstrengtheningcommunitiestosupportlifeinallitsforms.Indigenousyouthandothercommunitymembersalreadyknowthis.Forexample,inApril2016inthemidstofongoingsuicidecrisesinAttawapiskatandNeskantaga,CBCNewsinterviewedanumberofcommunitymembers.Oneyoungpersoncommentedwithgreatwisdomandcourage:

"Thesuicides,thewater,thehousing—everythingisconnected."

–CharlaMoonias,age18,NeskantagaFirstNation90

Wemustcommunicatethisstoryabouttheinterconnectednessofalllivingthings.Thismeanspushingforabroaderconceptualizationofsuicidethatgoesbeyondthinkingofitinindividualterms.Itmeansensuringthatcommunitiesareappropriatelyandfairlyresourcedtosupportyouthandcommunitywellbeingatalltimes,notjustduringcrises.PromotinglifeandreducingrisksforsuicideinIndigenouscommunitieswillrequireashiftawayfromanarrowandlimitingnarrativeofsuicideasanindividualmentaldisordertowardsamoreexpansive,lifeaffirmingapproachthatseekstoliftupallchildren,youth,familiesandcommunitiesthroughspiritual,cultural,social,andpoliticalformsofrevitalizationandengagement.

2. GenerateCulturallyRelevantKnowledgeinSupportofPracticalActionandPositiveSocialChange.

GiventhelimitedknowledgebaseinsupportofspecificsuicidepreventionstrategiesforreducingsuicideamongIndigenouspeoples,callsformorefruitfulcollaborationsbetweenIndigenouscommunities,governmentagencies,healthcareprovidersandresearchershaverecentlybeenissued.9192ByprivilegingIndigenousknowledgesystemsandworldviews,involvingmoreEldersandknowledgekeepersinthegenerationofnewapproaches,andrecognizingtheneedforflexibility,suicidepreventionandlifepromotionstrategieswillbetterreflectthespecificneedsandinterestsoflocalcommunities.BydrawingonIndigenousandde-colonizingmethodologiesandframeworks,theknowledgethatisgeneratedwillbegroundedinIndigenousworldviews,values,andastrongethicofrelationalaccountability.9394Researchthatinvolvescommunitiesateverystepoftheway95andrespectstheprinciplesofOCAP(Ownership,Control,AccessandPossession)isrecommended.Thisisbecause“OCAPoffersaFirstNationsapproachtoresearch,dataandinformationmanagement.Itisawaytosay“yes”tobeneficialresearchand“no”toresearchthatmayresultinharm.Itisawaytoimproveresearchrelevance.”96Researchandevaluationisessential.Anyinterventionhasintendedandunintendedconsequences.Atbest,improvementoccursasexpected.Atworst,theinterventioncausesharm.Sometimes,theinterventionresultsinnochange.Unlesswecarefullyexaminetheeffectsofourinterventions,anddrawonmeasuresandevaluationframeworksthatareculturallyresponsiveandcontextuallyappropriate,weriskdoingharm.

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Conclusion

Toconclude,thispapersummarizedthecurrentissueofsuicideinIndigenouscommunities,providedanoverviewofwhatisknowntobehelpfulfromtheperspectiveofIndigenousorganizationsandthepublishedliterature,andprovidedanumberofrecommendationsforconsiderationthataregroundedinIndigenousvaluesandwaysofknowing.ItisourhopethatthispaperassistsinthedialogueandsupportstheimportantworkbyIndigenouscommunities,ourleaders,andthosewillingtohelp,sothattogetherwecancreatetheconditionsforchildren,youth,families,andcommunitiestochooselifeandembraceafuturefullofpurpose,hope,belonging,andmeaning.

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AppendixA–KeyMilestonesandReportsRelevantforPromotingLifeandPreventingSuicideAmongIndigenousPeoplesinCanadaCanadianTaskForceReportonSuicide(1987)

ChoosingLife:SpecialReportonSuicideAmongAboriginalPeoples(RoyalCommissiononAboriginalPeoples,1995)

CanadianAssociationforSuicidePrevention(CASP)BlueprintforaCanadianNationalSuicidePreventionStrategy(2004)

AboriginalYouth:AManualofPromisingYouthSuicidePreventionStrategies(2007)

SuicideAmongAboriginalPeopleinCanada(2007)

OCAP:Ownership,Control,AccessandPossession(2007)UnitedNationsDeclarationontheRightsofIndigenousPeoples(2008)

HealingTraditions:TheMentalHealthofAboriginalPeoplesinCanada(2009)

ActingonWhatWeKnow:PreventingYouthSuicideinFirstNations(2013)

FirstNationsWellnessContinuumFramework(2014)

TruthandReconciliationCommissionofCanada:CallstoAction(2015)

NationalInuitSuicidePreventionStrategy(2016)

AssemblyofFirstNationsYouthCouncilCallstoActiononLifePromotioninFirstNationsCommunities(2016)

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