A SUICIDE PREVENTION TOOLKIT Indigenous people, trauma and suicide prevention IN THIS TOOLKIT

Introduction

What to expect

Statistics

Intergenerational trauma

Why is suicide an issue in Indigenous people?

Life promotion in Indigenous communities

Promoting life through hope, belonging, meaning and purpose

Resilience in Indigenous communities

Indigenous people in urban centres

Healing from trauma and preventing suicide

Healing through culture

Restorative justice and historical trauma

References

LAST UPDATED JUNE 2021 Expert reviewer: Ed Connors Ph.D., C.Psych. Dr. Connors is of Mohawk ancestry from Kahnawake Mohawk Territory. First Nations, Inuit and Métis are collectively referred to as Indigenous people in Canada.

Indigenous people in Canada have some of the highest suicide rates in the world, but there are also many communities that have very low rates of suicide.

Historically, suicide was a very rare occurrence among First Nations and Inuit (Kirmayer, 2007). It was only after contact with Europeans and the subsequent effects of colonialism that suicide became prevalent.

Intergenerational trauma is one of the primary colonial effects contributing to the elevated rate of suicide among Indigenous people. What to expect

The purpose of this toolkit is to provide a brief introduction to people in the general population about trauma and suicide in Indigenous people.

You’ll learn about statistics, intergenerational trauma, why some Indigenous people may be more at risk for suicide than the general population, how these suicides can be prevented, and how life can be promoted. • If you or someone you know is actively thinking about suicide, call 1-833-456-4566. Your call will be answered by the Canadian Suicide Prevention Service who will then connect you to a crisis centre in your area. In an emergency, call 911.

• Indigenous people in Canada can also call Hope for Wellness at 1-855-242-3310, or connect online via chat with a counsellor at hopeforwellness.ca. Both crisis lines are toll free and available 24/7. Statistics

SUICIDE AND SELF-INFLICTED INJURIES ARE THE LEADING CAUSES OF DEATH FOR INDIGENOUS PEOPLE FIRST NATIONS YOUTH AND MAKE UP ADULTS UP TO 44 YEARS OF AGE (Public Health Agency of % Canada, 2016).

OF THE4.9 POPULATION IN CANADA: OVER 1.6 MILLION (Statistics Canada, 2018).

FOR FIRST NATIONS, THE SUICIDE RATE IS

INDIGENOUS PEOPLE HAVE NEARLY

THE NATIONAL3 AVERAGE× 4 FOR MÉTIS THE RISK OF EXPERIENCING× SEVERE TRAUMA THAN THE NON-INDIGENOUS THE NATIONAL AVERAGE POPULATION (Haskell & 2× Randall, 2009). & FOR INUIT

THE NATIONAL 9× AVERAGE (Kumar & Tjepkema, 2019). Intergenerational trauma

BACKGROUND DID YOU KNOW? Indigenous people have experienced, and may continue to experience, The current child welfare system collective trauma stemming from continues to be especially colonization, the effects of which are traumatic for Indigenous youth. passed on from one generation to the IN CANADA, 52% OF next; this is referred to as CHILDREN IN FOSTER CARE intergenerational trauma. ARE INDIGENOUS, WHILE Colonization led to the forced ONLY 7% OF CHILDREN IN settlement of nomadic tribes, CANADA ARE INDIGENOUS relocation from traditional (INDIGENOUS SERVICES settlements, forced removal of CANADA, 2020). children from their homes into The Truth and Reconciliation residential schools or non-Indigenous Commission of Canada (2015) homes or orphanages (“Sixties Scoop”) recommends reducing the (Linklater, 2014; Haskell & Randall, 2009). “over-representation of Colonization led to losses of culture, Indigenous children in the care of child welfare.” traditional values, and family stability, An Act respecting Indigenous as it was made impossible, in many children, youth and families was cases, for parents and Elders to pass enacted in January 2020 and along vital cultural knowledge and allows Indigenous communities resilience to children who were taken more jurisdiction and autonomy away. In addition, relocation and over child and family services. Read the act: settlement took many Indigenous https://bit.ly/34rGMLn people away from their traditional ways of living and thriving (Elias, 2012). Why is suicide an issue in Indigenous people?

A RISK OF SUICIDE COPING WITH TRAUMA Anyone who has experienced trauma is People who have experienced trauma at greater risk for suicide. Most people will cope with it in some way, whether receiving treatment for mental health they are aware of it or not, and some issues have had some form of trauma ways of coping may contribute to (Rosenberg, 2011), and trauma places suicide risk. people at higher risk for additional Some ways in which people may cope mental health issues such as with trauma that can lead to increased depression and addiction. suicide risk include: When people have healthy coping • Drinking alcohol or taking drugs to mechanisms and strong support excess (may lead to addiction) systems, they are better equipped • Isolation from support systems to heal from trauma. Not only did • Self-harm acts of colonialism cause trauma in Indigenous people, but it also These coping mechanisms can affected their means of coping with increase a person’s risk of suicide. and healing from trauma. This is how They, and the experience of trauma intergenerational trauma continues generally, may lead to: to negatively affect generation after • Depression and mental illness, generation of Indigenous people today sometimes leading to suicide (Linklater, 2014; Haskell & Randell, 2009). • Feelings of hopelessness Life promotion in Indigenous communities

Suicide prevention and life promotion are interconnected: everything that promotes life can also prevent suicide. Historically suicide prevention focused more specifically on To learn more about life preventing suicide, for example, by promotion practices, check intervening with someone who is in out the Wise Practices crisis. Life promotion and suicide website: https://bit.ly/3ust717 prevention are broad terms that can include things like healthy living To learn about community- activities. led suicide prevention plans, Life promotion practices are most check out our guide, co- effective when they are developed developed with Knowledge and implemented by Indigenous Keepers from across Alberta: communities themselves (Wise https://bit.ly/2TcNSkr Practices, 2021). Strategies must be formulated in response to local cultural meanings and practices (Wexler, 2012). Promoting life through hope, belonging, meaning and purpose

The First Nations Mental and understand life from an Indigenous perspective and promotes Wellness Continuum a sense of meaning; and an Framework proposes four understanding of the unique First key elements that are Nations way of being and doing in the integral to mental world promotes purpose” (Thunderbird Partnership Foundation wellness: hope, belonging, & Health Canada, 2015, p.13). meaning and purpose. The continuum is a strengths-based These four aspects work framework illustrated as a medicine wheel. It can be used to develop mental together and, when wellness policies and programs and can aligned, contribute to the inform how individuals work towards mental wellness of mental wellness. individuals and Read more: https://bit.ly/3frjuM3 communities. “From coast to coast, First Nations people have said that: a connection to spirit (identity, values, and belief) promotes hope; a connection to family, community, land, and ancestry promotes a strong sense of belonging; knowing who one is and where one comes from allows one to think and feel Resilience in Indigenous communities

Indigenous communities Autonomy has also been found to be a factor contributing to resilience build resilience through in Indigenous communities. their culture Communities with control over their (Doria et al., 2020). services have been found to have lower rates of suicide, including control over: Resilience goes hand-in-hand with life government, land, education, police, promotion: anything that builds fire, and health services (Chandler & resilience also promotes life. Many Lalonde, 1998; Chandler & Lalonde, aspects of Indigenous culture have 2008; Kral, 2016). been found to contribute to resilience Communities with strong cultural against suicide, including: practices and control over services • a strong connection between often have lower rates of suicide (in Indigenous Elders and youth some cases, zero suicide) (Chandler & • speaking the Indigenous language Lalonde, 2008; Kral , 2016). practicing spirituality (Doria et al., 2020; Chandler & Lalonde, 2008)

The Truth and Reconciliation Commission of Canada (2015) % recommends that the federal government “establish multiyear 27 funding for community-based youth OF THE INDIGENOUS POPULATION IS organizations to deliver programs on UNDER 14 YEARS OLD, COMPARED TO reconciliation, and establish a national 16% OF THE GENERAL POPULATION (Statistics Canada, 2017). network to share information and best practices” (p. 8). Indigenous people in urban centres

In addition to intergenerational trauma, Indigenous people living in % urban centres may face the following challenges, or face them more 54 frequently, than those living in of First Nations (both community: status and non-status), • discrimination and racism Inuit and Metis now live in • challenges to their cultural identity cities and towns • feelings of isolation (Place, 2012). • loss of connection with land, Elders, and spiritual ceremony

• difficulty finding culturally appropriate services

RESILIENCE IN AN URBAN SETTING Indigenous people living in urban centres can build resilience by retaining a connection with their culture and traditional knowledge, for example, through communication with Elders and/or by participating in ceremony. They can also find meaning and hope in nature and the land even in an urban context (Hatala et al., 2020). Suicide is not the only negative outcome where Indigenous people are over-represented. We see similar trends in homelessness and incarceration.

While only 3% of people in Canada are Indigenous, they make up 22% of people in the correctional system (Environics, 2010).

Systemic racism in Canadian police higher than for those in the general forces and in the legal system are at population (Belanger et al., 2013). the heart of these numbers. The This inequality, caused by racism in Royal Canadian Mounted Police our systems, has meant that many force was set up in the 19th century Indigenous people do not have the to guard against American attacks same opportunities as white people but also to facilitate the and others in the general population. colonization of Indigenous lands in The result is that many Indigenous western Canada: they were founded people have limited access to on the idea that the Indigenous education and employment, and population must be contained. The therefore a higher instance of RCMP aided settler passage and poverty, which may lead to the ultimate colonization of homelessness and ‘unlawful’ Indigenous lands so that settlers behaviour (E.Connors, personal could live on them and exploit their communication, February 18, 2021). resources. As for the Canadian The rate of homelessness also legal system, many Indigenous speaks to the many failures of the people were, and continue to be, reserve-system and how so many brutally and unfairly treated, Indigenous people fall through the resulting in highly disproportionate cracks, unsupported by the system, numbers of incarceration. The in an urban setting. Far too many system has not been fixed and do not qualify as having “Indian systemic racism persists in that Status” and fail to receive adequate system, as well as in the police supports. The result is a highly force, today (Chartrand, 2020). disproportionate rate of Indigenous Racism is also at the root of the people experiencing homelessness high rate of homelessness for and exposure to incarceration, Indigenous people, which is 8 times violence and death. Healing from trauma and preventing suicide

Another way that suicide can be • understand that a traumatized prevented among Indigenous people is person’s behaviour is a normal through the treatment of trauma. This response to trauma can happen through Indigenous • embrace a strengths-based approach service providers, traditional healers, (as opposed to a deficiency-based or in mainstream healthcare settings. approach which focuses on the flaws EFFECTIVE TRAUMA-TREATMENT FOR in the “character” of the trauma INDIGENOUS PEOPLE SHOULD: survivor) • be informed by Indigenous peoples • respect the individual and their themselves culture and treat them with dignity • be culturally relevant • acknowledge the physical, mental, • strengthen bonds with Indigenous emotional and spiritual aspects of traditions and heritage one’s overall health

• foster resilience, which helps those • be non-linear and adapted for the exposed to trauma survive, resist needs of each individual and cope with its destructive effects (Haskell & Randell, 2009; Linklater, 2014) Providing culturally Collaborative Practices: appropriate services “Two-eyed seeing”

Cultural safety and competence are key The best health outcomes of components in providing services to Indigenous peoples are achieved when Indigenous people. Without them they provide leadership in addressing there are greater chances of inaccurate their own trauma and mental health. or inappropriate assessments, However, collaboration between inadequate treatment, and risk of mental health providers, who offer re-traumatization more mainstream approaches, and (Twigg & Hengen, 2009). affected communities can also be In order to effectively treat effective, when communities decide traumatized people who are to include them. Indigenous, those working with them: “Learning to see from one eye • need to be trained to deliver a with the strengths of Indigenous trauma-informed approach in an knowledges and ways of knowing, Indigenous context and from the other eye with the

• must be aware of the interplay of strengths of Western knowledges and traumatic historical events and ways of knowing… and using both social conditions that impact both these eyes together, for the benefit of the community and the individual all” Eskasoni Mi’kmaq Elder Albert Marshall (Hogue & Bartlett, 2014, pp. (Haskell & Randell, 2009; Linklater, 2014) 30-31). WHAT IS WRONG WITH YOU?” HAS SHIFTED TO “WHAT HAS HAPPENED TO YOU?” (ROSENBERG, 2011).

Trauma-Informed Care (TIC) is a health of an individual, while TIC determined effort to implement a stresses the well-being of the better approach to treating people individual. Despite this difference, that takes into account the impact both traditional Indigenous healing that previous traumatic practices and TIC share common experiences have had on an elements. individual’s overall mental health. Read more about treating trauma in iE13: Trauma-Informed Care: Trauma, Most Indigenous communities base substance abuse and suicide prevention their healing practices on the belief or in our resource toolkit on the topic: that connection with nature and https://bit.ly/3pZ8Lw3 community is vital to the overall Healing through culture

“‘Culture as healing’ is an Indigenous approach to life promotion that addresses the whole HEALING THROUGH CULTURE unique person, in the context of (their) family, According to Wise Practices, community, land, history, healing through culture includes: and spiritual world. • Building and nurturing Culture as healing aims to deepen relationships with family, connections with self, others, and land community, and land as a path towards wholeness and • Revitalizing language and wellbeing, in keeping with Indigenous teachings values of holism and interdependency. • Avoiding one-size-fits-all It recognizes healing as simultaneously approaches, which would look a deeply intimate and personal different depending on who experience and a relational and you are, where you are, and collective process. When we support with whom you’re working the healing of others we are also doing (Wise Practices, 2021) the work of healing the community now and into the future.” (An excerpt from Wise Practices) Restorative justice and historical trauma

Restorative justice Restorative justice owes much to the insights of Indigenous conceptions of attempts to repair the justice. It is a restoration of balance harms done to people and and harmony like that represented relationships through by the medicine wheel (Llewellyn, wrongdoing. It tries to 2008). The Truth and Reconciliation Commission in Canada is one such restore those damaged example of an organization dedicated relationships and ensure to restorative justice. that everyone involved is treated with equal concern, respect, and dignity. It is not a return to the past but the creation of a better future (Llewelyn, 2008). People are interconnected and when wrongs are perpetuated it affects not only the victim and offender but the fabric of society. REFERENCES

An Act respecting First Nations, Inuit, Environics Institute. (2010). Urban and Metis children, youth and families, Indigenous peoples study: Main report. SC 2019, c.24. Retrieved from https:// Toronto, ON.: Environics Institue. http:// laws-lois.justice.gc.ca/PDF/2019_24.pdf uaps.ca/wp-content/uploads/2010/03/ UAPS-Main-Report_Dec.pdf Belanger, Y., Awosoga, O. & Weasel Head, G. (2013). Homelessness, urban Aboriginal Haskell, L. & Randall, M. (2009). people, and the need for a national Disrupted attachments: A social context enumeration. Aboriginal Policy Studies, complex trauma framework and the lives 2(2). of Aboriginal peoples in Canada. Journal of Aboriginal Health, 5(3), 48-99. Chandler, M. & Lalonde. (1998). Cultural continuity as a hedge against suicide in Hatala, A., Njeze, C., Morton, Pearl, T. & Canada’s First Nations. Transcultural Bird-Naytowhow. (2020). Land and nature Psychiatry, 35(2), 191-219. as sources of health and resilience among Indigenous youth in an urban Canadian Chandler, M. & Lalonde, C. (2008). context: A photovoice exploration. BMC Cultural continuity as a protective factor Public Health. https://doi.org/10.1186/ against suicide in First Nations youth. s12889-020-08647-z Horizons, 10(1), 68-72. Hogue, M. & Bartlett, C. (2014). Two-eyed Chartrand, V. (2020). Unsettled times: seeing: Creating a new liminal space in Indigenous incarceration and the links education. Canada Education, 56(3), 30-31. between colonialism and ther penitentiary in Canada. Canadian Journal of Indigenous Services Canada. (2020). Criminology and Criminal Justice. Reducing the number of Indigenous https://doi.org/10.3138/cjccj.2018-0029 children in care. https://www.sac-isc.gc. ca/eng/1541187352297/1541187392851 Doria, C., Momper, S. & Burrage, R.(2020). “Togetherness”: The role of Kirmayer, L., et al. (2007). Suicide among intergenerational and cultural Aboriginal people in Canada. Ottawa, ON.: engagement in urban American Indian Aboriginal Healing Foundation. and Alaskan native youth suicide Kral, M. (2016). Suicide and suicide prevention. Journal of Ethnic & Cultural prevention among Inuit in Canada. Diversity in Social Work. https://doi.org/ Canadian Journal of Psychiatry, 61(11), 10.1080/15313204.2020.1770648 688-695. Elias, B., et al. (2012).Trauma and suicide Kumar, M. & Tjepkema. (2019). Suicide behaviour histories among a Canadian among First Nations people, Métis and indigenous population: An empirical Inuit (2011-2016): Findings from the 2011 exploration of the potential role of Canadian Census Health and Canada’s residential school system. Social Environment Cohort (CanCHEC). https:// Science & Medicine, 74(10), 1560-1569. www.nunivaat.org/doc/ document/2019-10-09-01.pdf Linklater, R. (2014). Decolonising trauma Thunderbird Partnership Foundation & work: Indigenous practitioners share Health Canada. (2015). First Nations stories and strategies. Toronto, ON.: Mental Wellness Continuum Framework. Fernwood Books Ltd. https://thunderbirdpf.org/first-nations- mental-wellness-continuum-framework/ Llewellyn, J. (2008). Bridging the gap between truth and reconciliation: Truth and Reconciliation Commission of Restorative justice and the Indian Canada. (2015). Calls to action. Winnipeg: residential school Truth and Truth and Reconciliation Commission of Reconciliation Commission. In Castellano, Canada. http://trc.ca/assets/pdf/Calls_to_ B., Archibald, L., & DeGagne, M. (Eds.), Action_English2.pdf From truth to reconciliation: Twigg, R. & Hengen, T. (2009). Going back Transforming the legacy of residential to the roots: Using the medicine wheel in schools (pp. 183-201). Ottawa, ON.: the healing process. First Peoples Child & Aboriginal Healing Foundation. Family Review, 4(1), 10-19. Place, Jessica. (2012). The health of Wexler, L. and Gone, J. (2012).Culturally Indigenous people living in urban areas. responsive suicide prevention in Prince George, B.C.: National indigenous communities: Unexamined Collaborating Centre for Indigenous assumptions and new possibilities. Health. https://www.ccnsa-nccah.ca/docs/ American Journal of Public Health. emerging/RPT-HealthUrbanAboriginal- 102(5), 800-806. Place-EN.pdf Wise Practices. (2021). Action guide for Public Health Agency of Canada. (2016). communities: Bringing Wise Practices Suicide prevention framework. https:// to life. https://wisepractices.ca/ www.canada.ca/en/public-health/ action-guide-for-communities/ services/publications/healthy-living/ suicide-prevention-framework.html

Rosenberg, L. (2011). Addressing trauma in mental health and substance use treatment. The Journal of Behavioral Health Services & Research, 38(4), 428-431.

Statistics Canada. (2018). First Nations People, Métis and Inuit in Canada: Diverse and growing populations. https://www150.statcan.gc.ca/n1/ pub/89-659-x/89-659-x2018001-eng.htm We are the Centre for Suicide Prevention, a branch of the Canadian Mental Health Association. For 40+ years we have been equipping Canadians with knowledge and skills to respond to people at risk of suicide.

We educate for life.

Centre for Suicide Prevention suicideinfo.ca

T 403 245 3900 @cspyyc [email protected]