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In 2009, there were 3,890 people who died by suicide in Canada making it the 9th leading cause of death. This rate represents an age standardized mortality rate (ASMR) of 10.7 per 100,000 or approximately 10 suicides a dayFootnote 1. It is the 2nd leading cause of death for young people aged 15 to 34, preceded only by accidentsFootnote 2.
Rates of suicide for Aboriginal youth are even higher, and are considered to be among the highest in the worldFootnote 3. In fact, it is thought that as many as 25% of the accidental deaths among Aboriginal youth may actually be unreported suicidesFootnote 4.
Statistics Canada has generated updated statistics that provide new rates for First Nations and Inuit youth suicide. Using a geozones method that takes into account postal code and census dissemination areas, mortality rates by cause can be deciphered in areas of Canada where there are a high proportion of First Nations and Inuit residents.
Using the geozones method, Statistics Canada identified that for the 2005-2007 time periodFootnote 5, the suicide rates for male and female youth 1-19 years old living in areas with a high concentration of First Nations, were:
Using the same geozones methodology, similar rates were calculated for males and females 1-19 years old living in Inuit Nunangat for the 1994-2008 time periodFootnote 6:
It is important to note that the above rates cannot be compared to the rates historically used by FNIHB due to significant differences in methodology.
New knowledge in First Nations and Inuit youth suicide prevention demonstrates that suicide can be prevented through coordinated initiatives carried out at various social levelsFootnote 7. There is solid evidence that suicide rates can be significantly reduced over the long term by using prevention programs. For example, research indicates that the most effective interventions include large-scale (primary) prevention programs as well as targeted treatments (e.g. prescription drug abuse) or secondary prevention programs for young people who have attempted suicideFootnote 8.
Nonetheless, it is important to note that rates of suicide vary widely across First Nations and Inuit communities and that every community is different. Policy makers and researchers recognize that First Nations and Inuit communities know what is best for their youth and have identified the importance of community-based approaches to suicide prevention programs and other mental wellness activities.
A First Nations example is the research that Dr. Michael Chandler from the University of British Columbia and Dr. Chris Lalonde from the University of Victoria have conducted. Their work indicates that in British Columbia, more than 90% of youth suicides occur in only 10-15% of the First Nations Bands. While some communities suffer rates as much as 800 times the national average, more than half of the province's 200 First Nations Bands have not experienced a single youth suicide in almost 15 yearsFootnote 9.
In September 2004, Aboriginal leaders, the Prime Minister, and First Ministers met to discuss joint actions to improve Aboriginal health outcomes, and to adopt measures to address the health disparities facing Aboriginal peoples in Canada. The meeting led to a federal announcement of $700 million in funding for a series of new federal programs. Of this commitment, $65 million over five years (2005-2010) went towards establishing a National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) for First Nations living on reserve and Inuit living in Inuit communities.
NAYSPS was developed based on a review of evidence-based suicide prevention approaches and existing prevention strategies, both nationally and internationally. It was also informed by the Advisory Group on Suicide Prevention's final report, Acting on What We Know: Preventing Youth Suicide in First Nations. The Strategy incorporates the best available evidence with respect to youth suicide prevention and is focused on finding ways to reduce risk factors and promote protective factors for Aboriginal youth suicide. Inuit-specific NAYSPS activities are guided by a NAYSPS Implementation Guide that was designed by Inuit Tapiriit Kanatami's (ITK), Health Canada Regional offices, and ITK's National Inuit Youth Council. First Nations-specific NAYSPS activities are guided by a First Nations-specific Implementation Guide that was designed through collaboration between Health Canada Regions, the Assembly of First Nations (AFN) and their First Nations youth council.
The target populations for this Strategy are between the ages of 10 and 30 and include:
Funding is therefore limited to:
In Phase I of NAYSPS (2005-2010), funding under the Strategy flowed from Health Canada to the Health Canada Regional Offices, and then from the Regional Offices to communities or Tribal Councils based on workplans or proposals. In the Territories, funding flowed to the Government of the Northwest Territories and Nunavut, and for a brief period, the Embrace Life Council to deliver NAYSPS programming on behalf of the Government of Nunavut. Yukon's 11 Self-Governing communities received NAYSPS funding via contribution agreements as part of the Programs and Services Transfer Agreement with Aboriginal Affairs and Northern Development Canada.
Phase I resulted in annual funding for approximately 200 First Nations and Inuit suicide prevention projects that ranged from traditional on-the-land activities to the development of local plans and protocols in the event of a suicide crisis. All projects were diverse and specific to the needs of the communities they served.
Suicide prevention is a long term process. However, results collected from a NAYSPS Special Study and several NAYSPS Case Studies indicate that the Strategy has already led to some measurable success for First Nations and Inuit, such as a decrease in youth delinquency and substance abuse, an increase in youth participation in school and community, community wide commitments to training in suicide awareness and intervention and general improvements in youth leadership skills.
Furthermore, results from the First Nations Regional Health Survey (RHS) for 2008/10 indicate that a large majority of First Nations youth 12-17 years old have not considered suicide (83.5%) or attempted suicide in their lifetime (94.1%). Nonetheless, First Nations and Inuit youth still suffer from suicide rates much higher than the Canadian population and it is important that investments in youth suicide prevention programs continueFootnote 10.
Budget 2010 resulted in an additional $75 million over 5 years to renew the Strategy, allowing First Nations and Inuit communities to continue to address Aboriginal youth suicide.
Phase II continues to support First Nations and Inuit communities to design and deliver culturally relevant suicide prevention projects and activities. The renewed Strategy is focused on reaching at-risk communities and youth, and on strengthening the partnerships between Health Canada and relevant stakeholder groups. Working in collaboration with other organizations, associations and/or committees in the area of suicide prevention is critical to developing regional decision making criteria for NAYSPS at the community level.
In addition, all activities funded under this strategy should:
Lastly, the renewed Strategy will ensure that Land Claims Organizations are fully involved in the design, development and delivery of all program funding and activities.
It will take many years to effectively address the rates of Aboriginal youth suicide. This is because Aboriginal youth suicide is a complex and multi-faceted issue. The experience of many youth is steeped in cultural disintegration, the breakdown of family structures, dislocation from the land, and economic and educational disadvantages due to the intergenerational impacts of colonization, Indian Residential Schools, and assimilative policies. It is important to consider the resulting effect that increasing awareness about suicide will have on overall rates of suicide. For example, as the stigma around mental health lessens and as community members learn more about the signs and symptoms of suicide, it is not unrealistic to expect an increase in the number of youth who come forward with suicidal thoughts, and to expect an increase in referrals to mental health professionals.
Providing people, families, and communities with these types of activities will improve the services and supports available to Aboriginal people. It will allow for the following:
It is expected that NAYSPS will meaningfully contribute to the improved health status of Aboriginal youth, families, and communities; which in the long term, will lead to a reduction in the rates of suicide.
Research shows that Aboriginal youth face unique risk factors, more risk factors at once, and risk factors that are more severe than that of the non-Aboriginal population. However, despite this, many Aboriginal youth are living healthy lifestyles, and demonstrating resilience and powerful leadership qualities. In an effort to improve Aboriginal health outcomes, NAYSPS aims to:
For many Aboriginal youth, suicide becomes a way to communicate distress and escape when there seem to be few other options. Some of the risk factors for Aboriginal youth suicide include:
Protective factors help to protect people from becoming suicidal. These factors can be personal, social, cultural, or environmental. Evidence shows that multiple protective factors can increase resilience and significantly decrease the risk of suicide. Some well documented protective factors are:
Intervention programs that place the origins of problems in the individual or their culture are referred to as deficit-based models. More recent approaches to adolescent health build on assets or strengths-based models of positive health aiming to develop youth potentialFootnote 15. NAYSPS uses a strengths based approach to addressing Aboriginal youth suicide. Guiding principles include:
These principles also serve to destigmatize talking about mental health, and often involve internal/external partnerships across sectors.
The Strategy is based on four elements of prevention (primary, secondary and tertiary prevention, and knowledge development) to help ensure individual, family, and community mental health.
Helps to increase awareness and understanding of suicide prevention through mental health promotion, strengthening protective factors (found below), and reducing risk factors (found below). Mental health promotion activities are intended to enhance positive mental health (defined as a state of well-being) throughout the lifespan and in a range of settings, including the home, school, workplace and community.
Mental health and wellness promoting strategies are oriented towards empowerment and participation, and help to create awareness around suicide prevention and intervention.
Educational activities under NAYSPS should target:
By taking a population health approach, it is recognized that the community as a whole plays a critical role in addressing suicide. Examples of Primary Prevention activities include:
In attempting to prevent suicide, it is important to take a comprehensive approach. Therefore, the Strategy encourages First Nations communities and Inuit regions to develop partnerships and linkages with other relevant departments, organizations, associations and/or agencies in order to have a greater impact on community-related determinants of health and mental wellness. Some examples include:
Health Canada Headquarters and Land Claims Organizations can support Health Canada regions and First Nations and Inuit communities to develop federal linkages through:
The Strategy also encourages communities to set up links with a variety of local resources and committees, such as:
Using and building on national, provincial, territorial, regional, and local efforts to improve mental wellness ensures that activities funded under this Strategy complement and give added value to programs and services where they exist.
Secondary prevention or early intervention aims to help with potentially suicidal individuals either before they injure themselves or during a suicidal crisis. Through NAYSPS, Health Canada is committed to supporting First Nations and Inuit communities to develop community-specific suicide prevention projects and activities that address community-identified priorities. Some examples of these types of projects include:
Should a Region choose to support communities in their area to establish crisis response protocols in the event of a crisis, these protocols should serve to:
Tertiary activities aim to improve and increase crisis response efforts to intervene more effectively in preventing suicide and suicide clusters following a crisis. NAYSPS funding supports communities to develop crisis response plans and protocols with partners, including provinces and territories, Land Claims Organizations, etc.
Examples of tertiary prevention activities include:
Efforts should be made to improve the capacity of a community to respond to and stabilize a crisis. Communities can access training to develop skills for frontline workers and natural caregivers in the community. Communities can build on lessons learned and existing resources and best practices. Training tools and resources should be developed and shared to support communities to:
While community capacity is being improved, the Strategy will support increased emergency response capacity in FNIHB-regional offices to coordinate and bring in additional experts, and natural care-givers from neighbouring communities. In First Nations and Inuit communities in the territories, this will include support for natural caregivers and accepting support from neighboring communities, as the territorial governments are responsible for funding health services and professionals in Nunavut and the Northwest Territories.
Evaluation and monitoring is a critical part of all activities funded under the Strategy. Efforts to evaluate and measure NAYSPS projects and activities are focused on demonstrating results (e.g. an increase in community surveillance, protective factors, positive community changes, and decreases in risk factors, etc.). This serves to assess the Strategy's effectiveness, identify trends, and will help to collect data around progress and outcomes.
Policy makers and community-based project coordinators should use evaluation data to make improvements to the activities funded under this Strategy. It will also add to the growing body of knowledge around what activities are successful in preventing suicide.
Research and evaluation activities that enhance what we know about what works in preventing Aboriginal youth suicide.
There is a clear foundation of knowledge available around suicide. However, there is a need to support First Nations and Inuit driven research and knowledge on youth suicide prevention. In developing the evidence base around this issue, NAYSPS Headquarters (HQ) supports:
Research initiatives will aim to contribute to promising strategies in Aboriginal youth suicide.
Research may include efforts to validate existing community-based approaches and knowledge, and improve our understanding of risk and protective factors that exist both within and outside the health arena. NAYSPS HQ commits to disseminating updates, publications, presentations, and final research reports to all Regions and stakeholders for information.
Increase the number of youth, community members and frontline workers who are familiar with youth suicide prevention.
Increase recognition of:
Develop educational activities and provide tools and resources to:
Each year NAYSPS funding will be transferred from HQ to the Regions and then distributed by the Regions to communities or Tribal Councils via contribution agreements to carry out and deliver suicide prevention activities to the target population. Each recipient is accountable to receive and manage the funds as outlined in the contribution agreement.
The allocation of NAYSPS funding at the Regional level is the responsibility of each Region and should target those communities which are at the highest riskFootnote 17. Regions are expected to develop partnerships with representative First Nations and Inuit groups, mental health organizations, youth associations and/or other expert committees in their area to help define NAYSPS Regional funding criterion. Regionally established criteria should align with the national criteria outlined in this framework and consider demonstrated:
Regions are encouraged to consider and respond to the diversity of First Nations and Inuit within their respective area. Quebec, Atlantic, and the Northern Regions should also include Inuit-specific activities that are based on engaging appropriate Inuit partners.
FNIHB regions will be responsible for preparing a NAYSPS regional workplan in collaboration with First Nations and Inuit regional partners. FNIHB is divided into the following eight (8) regions:
Each FNIHB region will determine, in collaboration with First Nations and Inuit stakeholders, the exact procedure to access and/or allocate regional NAYSPS funding; with the exception being self-government transfer agreements.
Depending on the Regional NAYSPS procedure established in each Region, First Nations or Inuit communities/organizations seeking to develop and carry out a NAYSPS program or activity may be requested to submit a proposal or workplan to the NAYSPS Regional office in their area. The proposal or workplan should:
With the exception of Northern Region, FNIHB regions are responsible for reviewing and approving community workplans. Regions are responsible for documenting and being transparent about:
FNIHB-NAYSPS HQ will review and approve the regional workplans, except for those submitted by self-governing bodiesFootnote 18. There are separate NAYSPS Implementation Guides for First Nations and Inuit that:
There are resources available to guide the implementation of the Strategy (NAYSPS Implementation Guides for First Nations and Inuit). The implementation guides are essential tools for carrying out the activities and tailoring it to the unique needs of communities. The framework and guides are interrelated and should be used together during the planning process, delivery, and evaluation. The documents were developed in partnership with the AFN and ITK's National Inuit Youth Council.
The Strategy should be carried out in a meaningful and consistent way that focuses on achieving results for communities. It is important that the Strategy address the issue of capacity at both the regional and community level. The implementation plan for the Strategy will ensure the greatest possible impact in terms of preventing suicide among Aboriginal youth.
Through NAYSPS, there is an opportunity to build on and develop partnerships. For instance, since 2005/06, partnerships have been established at the national level with the AFN, ITK and their respective youth councils to provide guidance on the NAYSPS projects and activities being delivered on-reserve and in Inuit communities. It is important to build on these partnerships and ensure that appropriate links and collaborations are made.
For example, important national linkages have also been made with organizations such as:
Each region should continue working with its First Nations and/or Inuit partners to determine the most appropriate approach for the Strategy in that area. This could include (are not limited to):
Communities should continue to:
In all cases, activities must be:
The Strategy recognizes and addresses the unique health and social needs of Aboriginal peoples. It considers traditional practices and methods whenever possible. Further links with key stakeholders will be maintained through committees and structures already in place. Strong links will be secured at the national level with other government departments through the Interdepartmental Working Group on Aboriginal Youth Suicide Prevention set up in 2010. The working group has representatives from:
The working group continues to:
As per the Terms and Conditions for Primary Health Care Authority FNIHB Program, a list of eligible expenses that fall under the Health Promotion and Disease Prevention sub-activity for Mental Wellness includes:
Other expenditures may be considered eligible based on a workplan. Expenditures and workplan items will be reviewed and approved by FNIHB- NAYSPS HQ. The program schedule within each contribution agreement provides a list of eligible activities and includes a clause that states "all expenditures must be for the purpose of delivering specific activities as defined in the contribution agreement".
Minor capital expenditures for operational requirements are permitted only if the estimate is in the workplan and has been approved by FNIHB-NAYSPS HQ. These include things such as:
Major capital expenditures are not allowed as identified in the Treasury Board policy on capital. These include:
In addition, NAYSPS will not fund activities or services that:
All NAYSPS activities, if requested by the Minister, must participate in an audit or evaluation as outlined in the Terms and Conditions of Set and Community-Based Contribution Agreements, and in the NAYSPS Evaluation Framework(s)Footnote 19.
FNIHB-NAYSPS HQ will continue to work with the AFN and ITK to plan, carry out, and maintain the integrity of the Strategy. FNIHB regions should continue to work collaboratively with:
Regions and communities are encouraged to form informal/formal partnerships with other services and programs in the community. For example, this could include:
Regional Health Canada offices have information about the Strategy and Implementation Guides and can disseminate accordingly. When sharing information about the Strategy externally, communications about NAYSPS activities, successes, key partnerships, and other opportunities should respect community needs and language policies of the Government of Canada.
Kirmayer, L. et. al. 1994. Aboriginal Suicidal Behaviour Research: From Risk Factors to Culturally Sensitive Interventions. Journal of Canadian Academic Child Adolescent Psychiatry, 15(4): 159-167.
RCAP 1995, also cited in Special Report: Sayt K'uulm Goot - of one Heart, Preventing Aboriginal Youth Suicide through Youth and Community Engagement, Child and Youth Officer for British Columbia, 2005.
Peters, P.A., Oliver, L., & Kohen, D. E. 2013. Mortality among children and youth in high percentage First Nations identity areas, 2000-2002 and 2005-2007. Statistics Canada.
Oliver, L., Peters, P.A., & Kohen, D.E. 1994-2008. Mortality Rates among Children and Teenagers Living in Inuit Nunangat. Statistics Canada.
Schwartz, C., Waddell, C., Barican, J., Garland, O., Nightingale, L., & Gray-Grant, D. (2009). Preventing suicide in children and youth. Children's Mental Health Research Quarterly, 3(4), 1-24. Vancouver, BC: Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University.
Kirmayer, L. 2009. Current Approaches to Aboriginal Youth Suicide Prevention.
Chandler, M. J., & Lalonde, C. E. (2004). Transferring whose knowledge? Exchanging whose best practices? On knowing about Indigenous knowledge and Aboriginal suicide. In J. White, P. Maxim & P. Beavon (Eds.), Aboriginal policy research: Setting the agenda for change: Vol. 2 (pp. 111-123). Toronto, ON: Thompson Educational Publishing.
First Nations Regional Health Survey Phase 2 (2008/10) National Report on the Adult, Youth and Children Living in First Nations Communities.
Charney, 2004; Larocci, Root, and Burack, in press; Fergusson, Beautrais, and Horwood, 2003; Gould, 2003; Luthar, Cicchetti, and Becker, 2000; Vaillant, 2003.
Suicide among Aboriginal People in Canada, Aboriginal Healing Foundation Research Series, 2007.
Katz, L., 2006. Aboriginal Suicidal Behaviour Research: From Risk Factors to Culturally-Sensitive Interventions.
Restoule, B., 2004. A Holistic Response to First Nations Suicide.
N.d. Acting on what we know: Preventing Youth Suicide in First Nations, the Report of the Advisory Group on Suicide Prevention.
Note that health treatment services were transferred to the territorial governments in 1986.
It should be acknowledged that: i) not all Regions are equipped with surveillance systems; and ii) that First Nations and Inuit communities can be at different stages of readiness. Some communities who are in-crisis may not have the capacity or infrastructure needed to deliver suicide prevention programs and activities.
This is mainly to ensure communication between Regions and Headquarters so that there is no duplication or overlap.