Nunavut’s youth suicide epidemic — ‘Who is next? How do we stop this?’

Api Akumalik was 24 when he took his life in 2013 — one of a record number of suicides in Nunavut that year. His father says the signs of his distress were unremarkable. “He stayed in his room a lot. He could not be with us as a family.” Toronto Star.

Questions are being raised about Nunavut’s suicide prevention strategy as the rate of deaths — particularly among young men — remains alarmingly high.

By Sandro Contenta, Toronto Star, April 4, 2015

When Joanasie Akumalik thinks back, the signs of impending doom were real but unremarkable. They amounted to a quiet withdrawal.

“He stayed in his room a lot,” Akumalik says of his son, Api. “He could not be with us as a family.”

Akumalik is a municipal councillor in the Arctic city of Iqaluit, the capital of Nunavut. On a cold October morning in 2013, he woke at dawn. “I could sense something was wrong,” he says. “All morning it’s like very eerie quiet in the house.”

He and his wife left to visit their daughter at about 9 a.m. Akumalik couldn’t shake a bad feeling. He returned home an hour later and went straight to Api’s room.

“When I found him, he was hanging. He was only wearing shorts, and when I put my arms around his body, it was already cold. At that point, I thought to myself, I can’t do anything.”

Api Akumalik was 24 years old. His death became part of a shocking statistic — 45 suicides in Nunavut in 2013, a record number for one year. They included an 11-year-old boy, the youngest suicide case recorded in Nunavut, who took his life in Repulse Bay. Painful levels of trauma and soul-searching were felt across the territory.

In 2014, the number of suicides dropped to 27. But no one in the territory of 36,000 people is relieved.

Inuit suicide rates have been well above the Canadian national average since the mid-1970s. For the past two decades, they have been about 10 times as high — 110 suicides per 100,000 people. (The rate for First Nations communities is twice as high as the national average.)

Among young males, the difference is more astounding. Inuit males under 25 account for 56 per cent of all suicides in Nunavut; across Canada, males that age make up 7 per cent of suicides. Researchers say women attempt suicide at least as often as men, but more often survive because they use less lethal means.

Nunavut and Greenland — both with populations that are at least 85-per-cent indigenous — have the highest youth suicide rates in the world, according to a study released in March by health researchers from Canada, Russia and Finland.

The body count is only part of the dire picture. An extensive Inuit Health Survey in 2008 discovered that 48 per cent of Inuit adults had considered suicide at some point in their lives. And a study by the Qikiqtani General Hospital in Iqaluit found that almost half of hospitalizations for people in their 20s were due to suicide attempts.

“I don’t meet anybody who doesn’t carry some pain and awareness of the magnitude of the problem,” says Dr. Allison Crawford, a Toronto psychiatrist and former Iqaluit resident who works on suicide prevention in Nunavut. “And their frequent worry is ‘Who is next? How do we stop this?’”

The 2013 spike resulted in Nunavut’s chief coroner, Padma Suramala, announcing an inquest into what she called the “growing epidemic rate of suicide in the territory.” But it has been repeatedly delayed, much to the frustration of Akumalik, who agreed that his son would be one of five suicides the inquest would examine.

Questions are also being raised about Nunavut’s suicide prevention strategy, drafted in October 2010 by the territorial government and other agencies. It includes a greater government focus on suicide prevention, more mental health services, evidence-based programs to reduce the suicide rate, and early childhood development with quality daycare, proper nutrition and protection from abuse.

The strategy’s effectiveness is being officially evaluated amid criticisms of poor implementation and funding.

Dramatic levels of suicide in Nunavut — a self-ruled territory since 1999 — came in the wake of dramatic intervention of authorities from the south.

Whalers, fur traders, explorers and missionaries arrived in the Arctic beginning in the mid-1700s. Canada declared its sovereignty over the region in 1880 and the North-West Mounted Police set up posts. But the general policy, until the 1950s, was to leave the Inuit to their traditional, seasonally nomadic way of life.

From 1920 to 1945, the RCMP investigated 27 suicides by Inuit throughout the Northwest Territories, which at the time included the eastern area now called Nunavut. Only one case involved a young person, a 17-year-old male. These statistics were uncovered by Jack Hicks, former suicide prevention adviser to the Nunavut government, by searching RCMP archives for a PhD thesis on suicides in the region.

That suicide rate was slightly above today’s national average. Given the harsh living conditions and complete lack of mental health care at the time, Hicks says, the difference isn’t noteworthy.

Upheaval came in the 1950s. The federal government relocated some Inuit families to remote spots in the Arctic, using them at times as human flagpoles in the exercise of sovereignty. The use of residential schools — where many young Inuit were sexually and physically abused — also grew rapidly.

Landscape just outside Pangnirtung, Nunavut.

The DEW Line — a string of military radar stations across the Arctic to defend against Soviet bombers — was completed in 1957. Inuit were attracted to the massive construction project by jobs and by mounds of discarded building materials, which many scavenged to build shacks near the stations.

Epidemics of tuberculosis and chickenpox ravaged the nascent shanty towns. In 1959 the federal government introduced the first Inuit housing program.

In the blink of an eye, a hunting-and-gathering culture became tied to a wage economy and sedentary lifestyle. Not surprisingly, studies often speak of people caught between two cultures.

Family bonds frayed, traditional coping mechanisms were lost and social scars bore deep. The descendants of the men and women who suffered the traumatic transformation have been paying the price ever since.

“There’s no reason at all to think that the Inuit have any genetic predisposition to mental illness or addiction or suicide,” says Lynn Ryan MacKenzie, Nunavut’s director for mental health and addictions, insisting social factors and historical trauma are largely to blame.

The territory’s suicide rate began climbing in the 1970s with the first generation to grow up in settlements. In 2010, a report that launched Nunavut’s suicide prevention strategy, based on research by health-care specialists, argued that a “continuous cycle of trauma … has been passed from generation to generation.”

A year later, the auditor general of Canada noted that sexual violence against children in Nunavut is 10 times as high as the national average. Also significantly higher are infant mortality, unemployment, overcrowded households, substance abuse and crime. A Statistics Canada report in March found 36 per cent of Nunavut residents can’t afford to buy the food they need, more than any other province or territory.

Iqaluit, Nunavut.

The correlation among social factors, mental health and suicide became clear in a five-year study by McGill University researchers released in 2013. It examined the lives of 120 people who committed suicide in Nunavut between 2003 and 2006. The average age was 24. They were compared with 120 living individuals who reflected the age, gender and home communities of those who killed themselves.

Those who took their lives, the study found, were four times as likely to have less than seven years of education. They also suffered physical or sexual abuse as children at significantly higher rates, and had higher levels of unemployment, depression, substance abuse and psychiatric disorders.

RCMP Sgt. Yvonne Niego, president of Embrace Life Council, one of the agencies behind the suicide prevention strategy, adds isolation and boredom to the list of challenges.

“Everything is usually within a two-mile radius,” says Niego, noting roads rarely extend further from a community. “The scenery doesn’t change. There are no trees. The pace of life is slow.

“Everything you see in a day will be the same the whole year round except for snow cover,” continues Niego, speaking on the phone from Iqaluit. “So it’s very hard to forget some trauma when you’re dealing with such a confined space where things visually don’t change.”

Trauma doesn’t need roads to connect communities.

“There are a lot of people in Nunavut, including little kids, who have found bodies,” says Hicks. “We have to realize that 20 or 30 years of this rate of suicide behaviour has put Nunavut socially in a space where virtually nowhere else on the planet is.”

Nunavut residents, the prevention report says, “have been exposed so directly and repeatedly to suicide that they have come to accept the situation as normal.”

Coroner Padma Suramala hoped her inquest would explore underlying issues when she announced it in January 2014. She would not comment on why it has been repeatedly postponed. Niego suggests grieving families who lost loved ones are not ready to have their cases examined in public.

Igloolik community members study aerial images, API Foxe Basin field trip. Photo: API.

Stigma makes confronting suicide difficult for any society. Inuit silence also stems from a fear that discussing it publicly would encourage others to take their lives, MacKenzie says.

A lack of services in Inuktitut — one of Nunavut’s official languages — hasn’t helped. Inuit also widely complain of programs that fail to tap into local customs and traditional knowledge.

The 2010 suicide prevention strategy was a widely applauded attempt to tackle the challenges. But it has no separate budget, and the Nunavut government has been unable to say how much of its overall budget has been spent on implementing the plan. In the 2014-15 fiscal year, Nunavut had an $11-million budget for mental health and addiction services.

MacKenzie says a “quality of life committee,” made up of assistant deputy ministers, meets regularly to co-ordinate measures in the plan with initiatives from health, education, housing and others departments.

“We’ve made progress in many areas and there’s still quite a bit more work to be done,” she says.

Concrete action includes the opening of a 12-bed mental health centre in Cambridge Bay, with a full-time staff of 22 people, and expansion of a mental health facility in Iqaluit. Five new community mental health staff were also hired, and MacKenzie says every Nunavut community now has access to a mental health worker.

More than 800 people, including teachers and ordinary residents, have taken an Applied Suicide Intervention Skill Training course that helps them detect and deal with worrying signs. Awareness activities have been held in most communities, including contests in which children submitted drawings or essays about suicide.

“There is more openness over the last number of years (and) I think there is more anger that more is not being done,” says Crawford, program director of northern psychiatric outreach at Toronto’s Centre for Addiction and Mental Health.

“The other way they respond is being sick and tired of people from the south saying, ‘Oh, this is such a tragedy, such an epidemic,’ because it makes it seem like everyone is walking around just about to kill themselves,” she adds.

In a written response tabled in the Nunavut legislature last fall, the government was unable to say whether some programs required under the prevention strategy have been set up. They include increased support for high school youths at risk, initiatives to prevent physical and sexual violence against children and programs focused on early childhood development.

The agencies that drafted the plan are expected to complete a report on how much of it was implemented by the end of March. Hicks describes implementation as mediocre, at best, and blames “extremely weak political and bureaucratic leadership on this issue.”

Akumalik, the city councillor who lost his son, says he has seen little change. He is involved in setting up a support group for families who have lost loved ones to suicide — a pilot project in the prevention strategy — but doesn’t know when it will get off the ground.

“There has just been a lot of talk,” he says.

The last time the Star spoke to Akumalik by phone, he had just returned from visiting his son’s grave. He says Api was “a typical Inuit young man.” He watched hockey, played soccer and computer games, listened to gospel and hip hop music, had a girlfriend and lots of friends, and was close to his family, especially his twin brother, Clayton.

He drank and smoked dope, but his father says never in ways that suggested abuse or addiction. He knew how to hunt but rarely went out on the land.

Api’s early years were spent in Arctic Bay, a hamlet of about 800 people at the northern tip of Baffin Island. His grandfather was a full-time hunter who passed on his skills to Akumalik, his adopted son. Akumalik, now 54, recalls a childhood of relative affluence.

Api’s first years of school, from kindergarten to Grade 3, were largely in Inuktitut. The switch to English in Grade 4 proved difficult. Api was 12 when he dropped out. He would end up landing odd jobs, but nothing full-time. He collected welfare and couldn’t afford to live on his own.

“I think he was getting tired of his life not going anywhere and not having any promising future,” says Akumalik, who has five other children.

“But I cannot answer why he did it. That’s always the question as a father — why did he commit suicide?”

http://www.thestar.com/news/insight/2015/04/04/nunavuts-youth-suicide-epidemic-who-is-next-how-do-we-stop-this.html