GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES

Professor Pat Dudgeon, Dr Ian Ring, Georgia Leyendekkers, Dr Kahu McClintock, Dr Keri Lawson-Te Aho, Dr Malcolm King, Dr Alexandra King, Dr Gayle Skawen:nio Morse, Michele Connolly and Jon Petter A Stoor

The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 1 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION The Centre of Best Practice in Aboriginal and Torres Strait Poche Centre for Islander Suicide Prevention Indigenous Health

Cover Artwork Shifting Sands by Roma Winmar

Authors Professor Pat Dudgeon Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, Poche Centre for Indigenous Health, University of Western Australia. Dr Ian Ring Adjunct Professor, University of Wollongong, Australia. Georgia Leyendekkers Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, Poche Centre for Indigenous Health, University of Western Australia. Dr Kahu McClintock Te Kìwai Rangahau, Te Rau Matatini (National Centre for Māori Health, Māori Workforce Development and Excellence). Aotearoa/New Zealand. Dr Keri Lawson-Te Aho Department of Public Health, University of Otago, Aotearoa/New Zealand. Dr Malcolm King Professor, Department of Community Health and Epidemiology, University of Saskatchewan, Canada. Dr Alexandra King Inaugural Cameco Chair in Indigenous Health and Wellness, University of Saskatchewan, Canada. Dr Gayle Skawen:nio Morse School of Health Sciences, The Sage Colleges, United States of America. Michele Connolly International Group on Indigenous Health Measurement, United States of America. Jon Petter A Stoor Sámi Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS), Finnmark County Hospital Trust, Norway.

The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention is funded by the Australian Government through the Department of Health’s National Suicide Prevention Leadership and Support Program.

This material is copyright © University of Western Australia, except where otherwise indicated. You may download, store in cache, display, print and reproduce the material in an unaltered form only (retaining this notice, or links to it where they appear) for your personal, non-commercial use or use within your organisation. You may not deal with the material in a manner that might mislead or deceive any person.

Poche Centre for Indigenous Health School of Indigenous Studies University of Western Australia 08 6488 3428 35 Stirling Highway, Crawley, Western Australia 6009

Published: November 2018

Publications (online) ISBN: 978-1-74052-408-7

Reference: Dudgeon et al. (2018). Global Overview: Indigenous Suicide Rates. Perth, WA: University of Western Australia.

The opinions, comments and analyses expressed in the document are those of the author/s and individual participants and do not necessarily represent the views of the Government and cannot be taken in any way as expressions of Government Policy.

2 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION TABLE OF CONTENTS

GLOSSARY...... 4

INTRODUCTION...... 5

DEFINITIONS OF INDIGENOUS PEOPLES...... 6

COLONISATION AND SUICIDE...... 6 Notes...... 6 CAPTURING WORLD INDIGENOUS SUICIDE RATES...... 7

OVERVIEW BY COUNTRY...... 8 Australia ...... 8 Aotearoa: New Zealand ...... 10 TURTLE ISLAND: NORTH AMERICAN CONTINENT...... 12 Canada ...... 12 United States of America ...... 16 CIRCUMPOLAR REGIONS...... 19 Sápmi: Scandinavia...... 19 Kalaallit Nunaat: Greenland...... 21 APPENDICES...... 22 Appendix 1: Table: Suicide Data for Overall Populations at Latest Available Year...... 22 REFERENCES...... 23

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 3 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION GLOSSARY

Mainstream: Usually the non-Indigenous population of the country, alternatively- the dominant population.

Dominant society: Usually the White dominant population and systems of government of a Western country. This population usually has a higher population than the Indigenous population.

Overall: Overall data includes total population of the country- including Indigenous and non-Indigenous peoples.

Indigenous peoples1: The working definition used throughout this paper is as below. For a more detailed understanding of Indigenous peoples, see A working definition, by José Martinez Cobo (IWGIA, 2011).

Colonisation: The process of settling and establishing control over the Indigenous peoples of an area2.

Age-standardised: The age-standardised mortality rate is a weighted average of the age-specific mortality rates per 100,000 persons, where the weights are the proportions of persons in the corresponding age groups of the corresponding countries standard population.

1 The terms used for First Nations or Indigenous peoples, like 'Australian Aboriginal peoples', 'Inuit’ and 'Indigenous' are used interchangeably. It is acknowledged that there are many cultural differences amongst and within the world’s First Nations and Indigenous communities and the use of differing terms does not intend to disregard such differences. For the purpose of this report, the term ‘Indigenous’ is used, unless specific groups of Indigenous people need to be recognised. 2 This definition is commonly used; however, some Indigenous peoples use the term ‘invasion’ to describe the process of colonisation.

4 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION INTRODUCTION

This background paper presents an overview of suicide in Indigenous peoples in countries where there is a dominant White society. The countries identified for this background paper share similar colonial histories and all but Greenland have populations where the Indigenous population is significantly smaller in comparison to the non-Indigenous/mainstream population.

The countries reviewed for suicide rates were Australia, Aotearoa/New Zealand, Canada, the United States of America, Greenland, and Scandinavian countries of Finland, Norway, Sweden, and Russia3. These are all countries where the Indigenous peoples have elevated suicide rates compared to the non-Indigenous/mainstream population (Pollock, Naicker, Loro, Mulay & Colman, 2018).

Whilst definite figures for Greenland are unavailable, a rate of 82.8 suicide deaths per 100 000 in 2015 was identified in an analysis of suicides (Hersher, 2016). Greenland Inuit people make up 90% of the population of Greenland, and it shares a colonial history. A global comparison of Indigenous suicide rates to non-Indigenous rates at particular time periods in these colonised countries has been collected in the following table.

Global Comparisons: Indigenous and Non-Indigenous Population Suicide Rates at Various Years

80 76.9

70

60

50

40 31.8 30 25.5 21.4 18.4 20 12.6 13.5 11.1 10.8 11.2 10 Number of Suicide deaths per 100 000 People 0 Australia Aotearoa/NZ Canada Canada USA (2016) (2016) (2013) (First Nations, (Inuit Region 1993-2009) v Overall Pop, 2004-2008)

Overall Population Indigenous Population

Table 1: Global Comparisons: Indigenous and Non-Indigenous Population Suicide Rates at Various Years. Australia (Australian Bureau of Statistics, 2018), Aotearoa/NZ (Ministry of Health - Manatū Hauora, 2017) Canada (Statistics Canada, 2018a; Pollock, Mulay, Valcour & Jong, 2016), USA (American Foundation of Suicide Prevention, 2016; Jiaquan et al., 2018).

For comparisons of overall population data4 on suicide deaths in these countries, the figures on suicide deaths, age- standardised at the latest available year are available in Appendix 1.

3 These are the four countries in which the Indigenous Sámi peoples live, with the Sámi lands referred to as Sápmi. 4 Overall data includes total population of the country- including Indigenous and non-Indigenous peoples.

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 5 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION DEFINITIONS OF INDIGENOUS PEOPLES

This paper uses the widely accepted working definition developed by the United Nations;

Indigenous communities, peoples and nations are those which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing in those territories, or parts of them. They form at present non-dominant sectors of society and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social institutions and legal systems. (IWGIA, 2018)

COLONISATION AND SUICIDE

Countries in which Indigenous people remain a dispossessed minority face considerable adversity, part of which includes the impacts of the history of colonisation. As Indigenous populations engage in processes of recovery and cultural reclamation, the processes of colonisation have left a legacy showing up as disadvantage, particularly in comparison to mainstream populations. These issues are shared by Indigenous populations across the globe. In particular, high rates of suicide are a shared issue. As colonisation is a social determinant of suicide (Redvers et al., 2015), Indigenous peoples in nations with shared colonial histories are highlighted in this paper.

Suicide is complex and should be treated as such, including the ways in which the complex traumas of colonisation can contribute to suicide deaths in Indigenous communities living in colonised countries. By culturally contextualising suicide deaths for Indigenous people, this paper aims to collaborate information in these countries to better inform and strengthen suicide prevention.

It also needs to be noted that behind each number is a person, a family, and a community grieving the impacts of suicide.

Notes There is a lack of global comparative data for Indigenous and non-Indigenous populations across different countries. The in-country data used in this paper may not use methodologies consistent to the comparable countries. However, data sources are referenced throughout this paper and need to be considered when interpreting the findings. Not all in-country demographic data, including systematic health data collection systems for specific groups, is readily available.

Where age-standardised and gender-standardised data is available, it is made clear throughout the paper. However, variations in Indigenous grouping (eg. distinctions made between Métis peoples and Inuit peoples in Canada), and regional variations (eg. Remote circumpolar and urban regions) were not always distinct.

6 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION CAPTURING WORLD INDIGENOUS SUICIDE RATES

Smi: Canada: Sámi peoples suicide First Nations peoples rates are elevated in have suicide rates comparison to majority nearly three times the populations in Norway, national average Sweden and Finland.

GREENLAND

CANADA Circumolar Regions: UNITED STATES Inuit communities in Aotearoaew OF AMERICA Canada and Greenland ealand: experience some of the Māori suicide rates are highest suicide rates over one and a half in the world. times the general population

SA: American Indian and

Alaska Native suicide AUSTRALIA rates are over one and a half times the national average. Australia: Aboriginal and Torres Strait Islander people suicide rates are twice the general population.

Map 1: Indigenous Suicide Rates, Global Context.

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 7 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION OVERVIEW BY COUNTRY

BRIEF TIMELINE AUSTRALIA Approximately 500-700 groups, languages, and/or tribes and 750 000 at time of colonisation Overview Australia’s population is currently estimated to be just over 25 million people, Aboriginal and Torres Strait with an estimated almost 800 000 people identifying as Aboriginal, Torres Islander peoples living in Australia Strait Islander, or both Aboriginal and Torres Strait Islander (Australian Bureau between 40-60,000 years ago. Statistics, 2018c). 1788: Beginning of colonisation A brief timeline of Australia’s history shows that in the years since European as European settlers/invaders settlers arrived, colonisation has had a profound impact on Aboriginal and arrived. Torres Strait Islander peoples, health, land, and cultures. In 2018, Aboriginal Frontiers wars, land and resource and Torres Strait Islander communities face some of the highest suicide rates in disputes, slave labour, and the world, and it is the fifth leading cause of death compared to 13th for non- violence followed. Indigenous Australians (ABS, 2018b).

1900s: Laws of assimilation and According to the latest figures provided by the Australian Bureau of Statistics denial made and implemented (ABS), Indigenous Australian suicide rates were double the overall Australian about Aboriginal cultures, rate in 2017 (ABS, 2018a; ABS, 2018b). languages and history. The forced Suicide accounts for a greater proportion of overall deaths amongst Aboriginal removal of Indigenous children. and Torres Strait Islander peoples than non-Indigenous Australians, at 5.5% Health issues and mental health compared to 2.0% in 2017 (ABS, 2018c). issues pertinent in Aboriginal and Australia: 2017 Suicide Rates Torres Strait Islander communities as a result of colonisation. 45 39.6 High rates of suicide and 40 other health issues. Still no 35 treaty between the Australian 30 governments and the traditional 25.5 custodians of the land. 25 19.7 19.1 Contemporary: Aboriginal and 20 Torres Strait Islander population 15 11.9 12.7 21.6 around 3% of 25 million 10 Australians 120 Indigenous 6.0 6.2 language groups remain in 5

2018 with many at high risk, but Number of Suicide deaths per 100 000 People language and cultural reclamation 0 Indigenous Non-Indigenous Overall is strong.

(Mooney, 2018; Australia Institute of Total Aboriginal and Torres Strait Islander Studies, Males Females 2018)

Table 2: Australia: 2017 Suicide Rates. Data retrieved from the Australian Bureau of Statistics (ABS, 2018a; ABS, 2018b). There is no disaggregated data between Aboriginal and Torres Strait Islander groups.

8 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION Aboriginal and Torres Strait Islander Youth In 2017, suicide remained the leading cause of death for both Aboriginal and Torres Strait Islander and non-Indigenous children and young people between 5-17 years of age. Suicide accounted for 40% of all Indigenous deaths in this age bracket.

For 2013 – 2017, Aboriginal and Torres Strait Islander youth (aged 5-17 years of age) accounted for 26.7% of Indigenous deaths by suicide, with suicide rates for Aboriginal and Torres Strait Islander children and young people at 10.1 suicide deaths per 100 000 persons, compared to the same age group of non-Indigenous people at 2 suicide deaths per 100 000 peoples (ABS, 2018c).

Young Indigenous men are at the highest risk of suicide (The Department of Health, 2013). In the 2013 National Aboriginal and Torres Strait Islander Suicide Prevention Strategy, it was indicated that the highest age-specific rate of Aboriginal and Torres Strait Islander suicide was among males between 25 and 29 years of age at 90.8 suicide deaths per 100,000 persons, four times the rate for non-Indigenous males (2013).

Regional Disparity Suicide rates vary geographically and within groups such as youth. In the Kimberley region of Western Australia in TIMOR SEA PACIFIC OCEAN the 10 year period between 2005-2014 KIMBERLEY REGION there was an age-adjusted rate of 74 NORTHERN suicide deaths per 100 000 peoples TERRITORY (McHugh, Campbell, Chapman &

Balaratnasingam, 2016). QUEENSLAND WESTERN Risk Factors AUSTRALIA The high Indigenous suicide rate in SOUTH Australia is attributed to a range of AUSTRALIA complex and interrelated factors that heighten the risk for suicidal behaviours. NEW SOUTH These include trauma, grief and loss WALES associated with the ongoing impacts Canberra INDIAN OCEAN of colonisation and dislocation. Such VICTORIA impacts include the effects of forced removal of children, mistreatment and Map 2: Map of Australia, Kimberley Region. pervasive racism and discrimination at the individual, institutional and system TASMANIA levels, and the cumulative impacts of ongoing exposure to socio-economic disadvantage and various other psychological stressors (Dudgeon et al., 2016). Loss of language, culture, and land struggles have been attributed to elevated suicide rates.

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 9 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION BRIEF TIMELINE AOTEAROA: NEW ZEALAND

The Māori population around 1800 was approximately Overview 100-120 000 people New Zealand, or known in the Māori language as Aotearoa, has an estimated population of 4.5 million with Māori people representing 15% (IWGIA, 2018). Māori are the Indigenous peoples The Indigenous Polynesian Māori peoples had occupied Aotearoa for more of New Zealand, or known to the than 700 years before European arrival between 1769-79. Māori as Aotearoa.

Late 1700s: Colonisation began Aotearoa/New Zealand: 2015 Suicide Rates and land wars followed between 30 Māori people and the new settler 25.3 population. 25 Treaty of Waitangi signed in 1840 but not implemented. 20 18.4 16.4 Due to the hostile takeover of 14.7 lands and the introduction of 15 11.5 11.1 diseases by Europeans, the Māori 9.7 population had declined by the 10 6.1 end of the 1800s. 4.7 5 The Māori population face

adversity across all social and Number of Suicide deaths per 100 000 People 0 health indicators, including higher Māori Non-Māori Overall suicide rates at nearly twice the general population. Males Females Total Contemporary: Māori population is 15% of overall New Zealand population. First World Indigenous Table 3: Aotearoa/New Zealand: 2015 Suicide PACIFIC OCEAN Suicide Prevention conference Rates. Overall data, and sex-specific data for āM ori and non-Māori figures was retrieved from Ministry of held in Aotearoa in 2016, Health - Manatū Hauora (2017). Total data for Māori and presenting the Turamarama non-Māori figures were mean-valued, as they Declaration for Suicide Prevention. were not available from data sources NORTH (Ministry for Culture and Heritage, 2018) ISLAND Māori Peoples Auckland Data indicates that Māori peoples TASMAN SEA are at higher risk of suicide than non-Māori peoples. Māori males accounted for 25.3 and Māori females 11.5 suicide deaths per 100 000 in 2015. This is compared to non-Māori males at 14.7 and non-Māori females 4.7 suicide deaths per 100 000 peoples (Ministry of Health- Manatū Hauora, 2017). While New Zealand’s general suicide rate has increased over the past four years, Māori men are disproportionately Wellington represented in the statistics, with a 12 per cent increase of suicide deaths per 100 000 people in the last year, according to provisional5 data (Flahive, 2018). SOUTH ISLAND Christchurch

PACIFIC OCEAN

AOTEAROA NEW ZEALAND

Map 3: Aotearoa/New Zealand.

5 Provisional data is unreviewed or unedited data that has yet been finalised.

10 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION More recent 2018 provisional figures show an increase in āM ori deaths compared to other populations, as seen in the graph below (Flahive, 2018).

Suicide Rates, New Zealand (Provisional)

26 24 22 20 18 16 14 12 10 8 6 4 2 Number of Suicide deaths per 100 000 People

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Asian Māori Pacific Other

Table 4: Suicide Rates Aotearoa/New Zealand (Provisional). Provisional figures for Aotearoa/New Zealand adapted from the data by the Ministry of Justice. ‘Other’ represents all other peoples not identifying as Asian, Māori, or Pacific (Flahive, 2018).

Youth

The most recent Child and Youth Mortality Review Committee’s report on suicide between 2002-2016 found that Māori children aged between 10 to 14 accounted for 60 percent of all suicides in that age group (New Zealand Mortality Review Data Group, 2018).

Considering around 45% of the Māori population are aged between 0-19 years, youth suicide is of major concern. Risk Factors

Social and cultural factors, historic disadvantage, discrimination, prejudice and exclusion have been linked with Māori suicides. Māori-specific suicide prevention frameworks have been developed as effective strategies to prevent youth suicide (McClintock & McClintock, 2017 and McClintock et al, 2017).

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 11 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION TURTLE ISLAND: NORTH AMERICAN CONTINENT

Some Indigenous peoples from across the Americas share similar BRIEF TIMELINE creation stories around the formation of what is widely accepted as North America6. Turtle Island is home to many First Nations bands, The First Nations, Metis and Inuit with some groups transcending the US and Canadian border- as peoples lived on the northern half of modern geopolitical borders are a colonial construct and not definitive North America since approximately of tribal boundaries or lands. Suicide rates across North America/Turtle 12,000 years ago. Island differ depending on the region, and some groups have stronger First Nations peoples lived in organised data on suicide deaths than others. societies across North America; maintaining sustainable economies, politics and rich spiritual beliefs and CANADA cultures. Overview 1600-1700’s: The French and British Canada has an estimated population of 36.7 million people, with colonised/invaded and fought over approximately 1.7 million people identifying as Aboriginal persons in modern day Canada. Systemic upheaval the 2016 Census (Statistics Canada, 2018c). and displacement of Indigenous peoples from traditional land through war, violence Historically, suicide was a rare occurrence amongst Indigenous and forced relocation. Canadian people, and it was only after contact with Europeans and the effects of colonialism that suicide became prevalent (Kirmayer, 1876: The Indian Act was passed, 2007). The higher rates of suicide in Indigenous communities has been controlling First Nations through forced linked to historic trauma, cultural losses, and social upheavals that assimilation, removal of children, were a result of European settlement and colonisation (Public Health desecration of traditional lands and Agency of Canada, 2016). residential schooling. Disaggregated data for suicide deaths in Canada in Indigenous and 1940’s and 1950’s: Inuit in Canada’s non-Indigenous populations is not readily available. The Canadian north displaced by European settlers for Government in the Working Together to Prevent Suicide in Canada: resources and military purposes. The Federal Framework for Suicide Prevention has identified that there is a great need to enhance suicide information, including data and Ongoing impacts of colonisation place research as currently this information is fragmented, complex, and Indigenous Canadians as an at risk group. difficult to access (Public Health Agency of Canada, 2016). Higher rates of physical and mental illness, compared to non-Indigenous Canadians. Indigenous Populations Suicide rates can often be extremely high, Canada has three distinct Indigenous groups. First Nations, Métis, and whereas, before the 19th century suicide Inuit making up 4.9% of Canada’s total population (IWGIA, 2018). was extremely rare amongst Indigenous First Nations, Inuit, and Métis are collectively referred to as Indigenous Canadians. peoples (Centre for Suicide Prevention, 2013). It needs to be recognised that in some circumstances; Canada is home to approximately 1.7 million Indigenous people. They …terms may differ from those used by individuals to self-identify. For make up approximately 4.9% of the example, the NunatuKavut Community Council refers to the group it total population. represents as “Southern Inuit” although individually some community members may use the terms ‘Métis’ or ‘Inuit-Métis.’ (Pollock, Mulay, (The Canadian Research Institute for the Advancement of Women, 2016; Canada Guide, 2018; Indigenous Valcour & Jong, 2016) and Northern Affairs Canada, 2018)

6 The North American continent includes all Provinces and Territories of Canada, and the mainland States of the United States of America including the State of Alaska; however, does not encompass the State of Hawai’i and Other Pacific Islands.

12 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION Statistics representing Indigenous groups of Canada are not always readily available, however, the distinctions in suicide rates between these groups are made clearer below.

Suicide Rates: First Nations, Inuit and Overall Canadian Population

160 135 140

120

100

80

60

40 24 12 20 Number of Suicide deaths per 100 000 People 0 First Nations throughout All Inuit Regions in Canada Total Canada in 2000 1999-2003 period in 2001

People

Table 5: Suicide Rates: First Nations, Inuit and Overall Canadian Population at Various Periods. Table adapted from “The Human Face of Mental Health and Mental Illness in Canada 2006” (Government of Canada, 2006), showing the elevated suicide rates in Indigenous communities compared to the general population of Canada with the available data across various period between 1999-2003.

Inuit Peoples uicide among Inuit in Canada began to rise in the 1960s, especially among the first generation of young people growing up in settled communities. Historically, there was no evidence of high suicide rates in Inuit communities (Public Health Agency of Canada, 2016).

Inuit Nunangat is the homeland of Inuit of Canada. Inuit Nunangat ARCTIC OCEAN encompasses the land, ice, and sea of the Inuit communities INUVIALUIT located in the four Inuit regions, Beaufort Inuvialut, Nunavut, Nunavik, Sea Ban Bay Nunatsiavut (Inuit Tapiriit Clyde River Kanatami, 2009). The population Ban Island of Inuit Nunangat is around 86% Aboriginal identifying peoples7 Yukon NUNATSIAVUT (Li & Smith, 2016). Northwest NUNAVUT Territories Newfoundland & Labrador

Hudson Bay NUNAVIK

CANADA QUEBEC

USA

Map 4: Inuit Nunangat Regions in Canada.

7 Largely Inuit population, with a small percentage of First Nations and Métis peoples

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 13 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION Data shows Inuit communities have significantly higher suicide rates than First Nations and Métis populations (Public Health Agency of Canada, 2006). Inuit Nunangat have rates of suicide between 5-25 times the rate of suicide compared to mainstream rates for the whole of Canada (Inuit Tapiriit Kanatami, 2016). A more specific figure according to the Canadian Government shows suicide in Inuit Nunangat is more than six times higher than the rate in non-Indigenous regions (Webster, 2016).

Inuit Regions Suicide Rates

140 120.3 120

100

76.9 80

60

40 31.1 17.1 20 11.2 5.3 Number of Suicide deaths per 100 000 People 0 Inuit Nunangat (Inuit Regions) Overall

Males Females Total

Table 6: Inuit Regions Suicide Rates between 2004-2008. Inuit Nunangat (Inuit Regions with high Inuit Population) and overall Canada data for the 2004-2008 period collected from Statistics Canada (2018a). Indigenous and non- Indigenous disaggregated data is currently unavailable.

More recent figures released in 2016, show Inuit Nunangat had a suicide rate of 73.6 per 100 000 peoples compared to the mainstream Canadian suicide rate of 10.8 per 100 000, showing a slight decrease (Pollock, Mulay, Valcour & Jong, 2016).

First Nations Peoples First Nations identify as status and non-status Indians living on and off reserves, with around 614 First Nations bands8 (Olson, 2013; Public Health Agency of Canada, 2006). The figures show the comparison of suicide rates between First Nations peoples and the general population over the 1979-2000 period (Kirmayer, 2007).

Figures collected over the 1993-2009 period suggest First Nations people experience suicide rates at 31.8 per 100 000 people in some regions (Pollock, Mulay, Valcour & Jong, 2016).

Comparison of Suicide Rates of First Nations and General Canadian Population

40

30

20

10

0 Number of Suicide deaths per 100 000 People 1979-1981 1982-1984 1985-1987 1988-1990 1991-1993 1999 2000

First Nations (Status Indian) General Population

Table 7: Comparison of Suicide Rates of First Nations and Overall Canadian population between 1979-2000. Graph adapted from Kirmayer (2007).

8 Bands refers to a group or tribe of First Nations or Indian people. Sometimes referred to as a basic unit of government representing the group. 14 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION Métis Peoples Métis peoples identify as a group of people of mixed First Nations and European ancestry, distinct from First Nations, Inuit, and non-Aboriginal peoples (Public Health Agency of Canada, 2006). There is currently no available suicide data specific to Métis-identifying peoples.

Youth Suicide Suicide is responsible for 40% of deaths in Inuit youth, compared with 8% across Canada (Webster, 2016). Rates for Inuit youth in some areas are up to 40 times the national average (Crawford, 2016).

Regional Disparity The highest age-standardised mortality rates in Canada are in Aboriginal subregions in Labrador with the highest region reaching 165.6 suicide deaths per 100 000 people ARCTIC (Pollock, Mulay, Valcour & Jong, 2016). OCEAN Labrador is a part of Canada’s easternmost province ALASKA Newfoundland and Labrador (IWGIA, 2018). ATLANTIC

NORTHWEST NUNAVUT OCEAN NEW FOUNDLAND TERRITORIES Risk Factors Research indicates an important CANADA link between suicide risk and Hudson Bay trauma resulting from BRITISH COLUMBIA assimilative policies with QUEBEC James the legacy of colonisation PACIFIC ALBERTA Bay in some Aboriginal OCEAN MANITOBA ONTARIO Ottawa communities SASKATCHEWAN

(Public Health Agency Toronto of Canada, 2016). NEW BRUNSWICK USA Inuit people and other Indigenous Canadians are 8 times more at-risk and vulnerable to adverse social determinants, such as living in overcrowded homes, that has an impact on Map 5: Canada, with regions including peoples mental and physical health (Webster, 2016). Newfoundland and Labrador shown.

Other risk factors include;

• A lack of resources including food, • Lack of access to basic health care facilities, • High rates of mental trauma rooted in forced settlements and residential schooling as a result of colonisation (Olson, 2013), • High rates of abuse and childhood adversity (Webster, 2016).

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 15 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION BRIEF TIMELINE UNITED STATES OF AMERICA

Native American peoples have been in North and South America for at least Overview 30,000- 40,000 years. The United States of America’s current population is estimated at around 328 million people (United States Census Bureau, 2018). American Indian peoples lived in harmony America includes the modern borders on the North American with nature, with in-depth cultural history continent, the State of Alaska, and the State of Hawai’i. American and the development of agricultural farming Samoa, Guam, the Marshall Islands, Palau, the Federated States and extensive inter-group trade. of Micronesia, and the Northern Mariana Islands are included 1492: European invasion began, beginning as associated states or territories of the USA. The Indigenous the process of colonisation of the ‘New peoples of these associated states or territories are represented World’. under the broader term ‘Other Pacific Islanders’ in demographics documentation. The American Indian population was about 240,000 in 1890, dropping from an CANADA estimated 8 million.

NORTH 1778 to 1871: There were more than NEW MONTANA DAKOTA 500 treaties signed between the USA YORK SOUTH government and Native American tribes, DAKOTA Washington DC with all these treaties being violated in some way by the USA government. CALIFORNIA UTAH COLORADO 1800’s: With Native American peoples resisting the invasion of their traditional NEW OKLAHOMA lands and desecration of culture, the ARIZONA MEXICO ATLANTIC governments of the USA stripped OCEAN Native American tribes of their land and sovereignty; confining them to reservations

and legally controlling their movements and ALASKA freedom. HAWAII Children were forcibly removed from their families and culture into residential schools, Indigenous religious practices were MEXICO prohibited on reservations and traditional Map 6: The United States of America. hunting rights and practices were restricted. Simplifying America’s population into Indigenous and non-Indigenous Ongoing effects of colonisation place peoples does not capture the complexity of America’s history and American Indian peoples as a risk group, the ethnic demographics of the current population. A snapshot of the with heightened rates of physical and history of colonisation in the USA is provided for context. mental health issues and suicide. Indigenous Populations Today, there are approximately 6 million The American Indian9 and Alaska Native population is estimated Native Americans in the USA, making up to be around 2.5-6 million people (IWGIA, 2018). There are 573 2% of the American population in 2015. American Indian/Alaska Native tribal entities in the US (Indian Affairs (Pauls, 2018; Scholastic, 2018; Infoplease, 2017) Bureau, 2018). Native Hawaiians10 and Other Pacific Islanders have an estimated population of 1.2 million people (Hixon, Hepler & Kim, 2012).

9 Data sources overwhelmingly use the term ‘American Indian,’ however ‘American Indian’ and ‘Native American’ are interchangeable terms for the Indigenous peoples of the United States of America. ‘Alaska Native’ is a term specific to the Indigenous peoples residing and originating from the area encompassing the State of Alaska, and other self-identifying individuals. 10 Native Hawai’ian peoples are the Indigenous Polynesian peoples that, before colonisation, lived in and exercised sovereignty in the modern American State of Hawai’i.

16 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION Suicide rates for Native American and Alaska Native peoples aged 15-24 years are twice as high as non- Indigenous Americans at 27.22 suicide deaths per 100 000 people (Rao, Pell & England-Kennedy, 2017).

There are currently no estimates of suicide rates for the non-Indigenous population. These rates are more accurately comparable to the overall American population.

United States of America: 2016 Suicide Rates

35 33.1

30

25 21.4 21.4

20

13.5 15 10.3 10.1 10 6.7 6.0 3.6 5 Number of Suicide deaths per 100 000 People 0 American Indian Native Hawaiian and Overall /Alaska Native Other Pacific Islander

Males Females Total

Table 8: United States of America: 2016 Suicide Rates. Overall data sourced from the American Foundation of Suicide Prevention Indian/Alaska Native data sourced from Jiaquan et al. (2018). Native Hawaiian and Other Pacific Islander data sourced from Center of Disease Control and Prevention (2017). Note that in some instances, Native Hawaiian and Other Pacific Islander is also grouped with Asian population counts. Non-Indigenous figures currently unavailable.

American Indian and Alaska Native Peoples Suicide among American Indians and Alaska Natives increased by 3% between 2014-2016.

As reported in the 2016 National Healthcare Quality and Disparities Report (Agency for Healthcare Research Quality, 2017) suicide is the second leading cause of death for American Indian and Alaska Native populations between the ages of 10-34.

In 2014, the suicide rate for non-Hispanic American Indian/Alaska Native males aged 25–44 was the highest among all racial and ethnic groups in the United States, at 48 per 100 000 peoples. This was 60% higher than in 1999 at 30 per 100 000 peoples (Curtin, Warner & Hedegaard, 2016).

Native Hawai’ian At 26% of all fatal injuries, suicide is the most common cause of death among all Hawaiian residents (Hawai’i Health Data Warehouse, 2017). Further information is currently unavailable.

Youth Native Hawai’ian peoples, particularly youth, have a higher prevalence of suicide attempts compared to non-Indigenous youth at 14.1% compared to 7.1% respectively (Galanis, 2016).

Youth suicide in Native American and Alaskan communities is 70% higher than the rates of the general population of the United States (Herne, Bartholomew & Weahkee, 2014).

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 17 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION Elderly American Indian and Alaska Native elders have lower rates of suicide than elders from other ethnic groups. The reasons for this are hypothesised as cultural resilience and connectedness (Rao, Pell & England- Kennedy, 2017).

Risk Factors According to the Suicide Prevention Resource Center’s reports on suicide among racial/ethnic populations, common risk factors for American Indians and Alaska Natives include:

• Historical trauma- such as forced relocation, removal of children, prohibition of the use of native languages and cultural traditions, and outlawing of traditional religious practices. • Alcohol and drug abuse • Disconnection from family and culture • Acculturation to mainstream culture • Discrimination and prejudice- with LGBT identifying peoples at higher rates of suicide deaths, attempts, and ideation than their heterosexual counterparts- both Indigenous and non-Indigenous. • Community violence, with American Indian/Alaska Native youth at 2.5 times the exposure to trauma that their mainstream counterparts • Lack of access to and use of mental health services (Suicide Prevention Resources Center, 2013).

18 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION CIRCUMPOLAR REGIONS

Indigenous peoples living in the circumpolar Arctic regions across Finland, Sweden, Norway, Russia, Greenland, and North America have been found to account for some of the highest suicide rates in the world. However, it is important to note there is great variance in the Arctic region within and across Indigenous populations of different territories and contexts (Stoor, Kaiser, Jacobsson, Renberg & Silviken, 2015). For a more comprehensive understanding of this region, recommended reading is Suicide in circumpolar regions: an introduction and overview (Young, Revich, & Soininen, 2015)

For Inuit Canadians see Canada For Alaska Native peoples see United States of America

SÁPMI: SCANDINAVIA Overview Countries represented in Northern Europe or Scandinavia are Norway, Sweden, Finland and Russia. The Sámi peoples refer to their Indigenous lands, that spread across these four countries, as Sápmi. However, there is not a clear definition (I.e. accepted by the nation states) on where these lands begin and end. A map developed by the International Work Group on Indigenous Affairs provides an overview (IWGIA, 2018).

HISTORY OF SÁPMI Sámi Peoples Information about the history on the Between 80 000 to 100 000 Sámi peoples are believed to colonisation of Sápmi is scarce and live across Finland, Norway, Sweden, and Russia (Bacchi, incomplete. However, the Nordic 2017; Silviken, Haldorsen & Kvernmo, 2006). However, nation states (todays Norway, the Nordic countries do not allow registration of ethnicity, Sweden and Finland) and Russia including Sámi identity, in public records. This makes gradually seized control of Sámi obtaining basic demography of the Sámi population lands through advancing from the complicated and obtaining continuous and updated south and along the shores of the statistics on suicide and other health statistics Gulf of Bothnia and the northern impossible (Sámi Norwegian National Finnmark Atlantic. Violent policies of both Advisory Unit on Mental Health and discrimination and assimilation were Substance Abuse part of the colonization. Today, the & Saamicouncil, 2017). Inari Kola Peninsula Sámi are in minority throughout Knowledge on Girjas their homelands, except in small Sárri village suicide among Rovaniemi municipalities in northernmost Sámi are therefore Kallak Norway. based on cohort studies comparing suicides in majority populations with those of Sámi ethnicity in Sámi areas Norway RUSSIA (Silviken, Haldorsen & Kvernmo, 2006), Sweden (Hassler et al, 2005) and Finland (Soininen & Pukkola, 2008), respectively. Even FINLAND though the information is outdated, these statistics are still the best available and show that generally, suicide is higher among NORWAY Helsinki Sámi than majority populations in the same periods. Oslo Stockholm SWEDEN ESTONIA DENMARK LATVIA Map 7: Sápmi region, Northern Europe. LITHUANIA

Sápmi

GERMANY POLAND

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 19 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION Northern Norway 1970-1998 It was reported an increased suicide risk amongst Indigenous Sámi in Arctic Norway between 1970-1998 study, as compared to the overall reference population. In particular, males between 15-24 were at the highest risk at a rate of over 50 suicide deaths per 100 000 people as seen in Table 9 below (Silviken, Haldorsen & Kvernmo, 2006).

Suicide Rates in Sámi, Northern Norway 60

50

40

30

20

10 Number of Suicide deaths per 100 000 People 0 0-14 15-24 25-34 35-44 45-54 55-64 65-

Male Female Age Group

Table 9: Suicide Rates in Sámi, Northern Norway. Adapted from Silviken, Haldorsen & Kvernmo (2006).

Northern Sweden 1961-2001 Reindeer herding Sámi men, in particular, were at a significantly higher risk of suicide between 1961-1980. Reindeer herding and non-reindeer herding Sámi cohorts presented similar mortality rates when compared to the reference population. This indicated significant differences between the Sámi and the overall reference population. Hence the difference is not solely due to regional disparity (Hassler et al., 2005).

Northern Finland 1979-2005 Traditional Sámi nomadic lifestyles including reindeer breeding, hunting and gathering, ceased around the 1960s, with Sámi people’s health still being affected by the change. Although suicide occurred among some Indigenous groups in the Arctic, it was rare, and the rate has increased in more recent years. Between 1979-2005 suicide amongst Sámi men was 70% more common than the general population (Soininen & Pukkola, 2008).

Youth and Culture In Sweden, suicidality has been found to be more common among young adult Sámi (Omma, Sandlund & Jacobsson, 2013), and reindeer herding Sámi (Kaiser & Salander Renberg, 2012), with strong themes around suicide as a consequence for losing, or having lost Sámi identity, fighting for Sámi culture, and difficulties in getting help as a Sámi person (Stoor, Kaiser, Jacobsson, Renberg & Silviken, 2015).

Risk Factors The diversity of the Sámi populations and different contextual factors in different countries makes it hard to provide a general overview of risk factors for suicide among Sámi. However, the Plan for Suicide Prevention among Sámi in Norway, Sweden and Finland (Sámi Norwegian National Advisory Unit on Mental Health and Substance Abuse & Saamicouncil, 2017) put forth eleven strategies for suicide prevention including the need to protect and strengthen Sámi culture in order to strengthen resilience to suicide, as well as prevent discrimination and violence against Sámi peoples. Similar to other Indigenous groups, acculturation, a loss of culture and communities have attributed to higher suicide rates.

Russia experiences roughly 30 000 suicide deaths per year and around 10 times more attempt suicide. Whilst Sámi people’s traditional lands are on the Kola peninsula in the Northwest of Russia, many other Indigenous groups inhabit Russia. Sources from Indigenous groups across Russia suggest elevated suicide rates may have connections to a lack of sense of Indigenous belonging, a lack of strengthened cultural identity, and weakened resilience (Sumarokov, Brenn, Kudryavtsev & Nilssen, 2014).

20 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION PREFACE: Greenland attained self-governance in 2009, and while this makes it different to other countries in this project the ongoing repercussions of historical colonisation reflects the same reality for Indigenous peoples in colonised countries. Despite differences, Greenland is included in this paper due to the elevated suicide rates of Inuit Greenlanders.

BRIEF TIMELINE KALAALLIT NUNAAT: GREENLAND

Greenland Inuit people make up Overview the majority of the Greenland population. The Inuit people of Greenland suffer some of the highest rates of suicide in the world, with 82.8 suicide deaths per 100 000 people reported in 2015 (Hersher, 1720s: Modern colonisation of 2016). Of the 55 860 citizens of Greenland, 90% are Inuit, descendants of the Greenland. The Danes used the Thule people and related to Inuit people in other polar regions (Bolliger & Gulis, term ‘colony’ as synonymous with 2018). Albeit different from the relationships between coloniser and colonised mission and trade station. regions in other countries, Greenland’s colonial history, and subsequent sociocultural change has impacted significantly on suicide rates (Bjerregaard & Community ownership of the land Lynge, 2006). was interpreted by the Danish as ‘no ownership’ or ‘crown land’. Overall Rates As a result, in 1850 mines were established without permission Rates of suicide in men are 4.3 higher than women in Greenland, with young from Inuit Greenlanders. men at the highest risk nationally (Hersher, 2016; Bjerregaard & Lynge, 2006).

1953: Colonial status of Greenland Risk Factors formally ended. The biggest factor in changes in mental health and suicide rates in these time periods was the change from subsistence fishing to a living based on wage- Inuit Greenlanders were forced earning. Relocation to larger communities, a change in family structure, and to learn Danish and their native discrimination between Inuit Greenland from remote areas and more urban- language was taught as an living peoples have contributed to higher suicide rates and mental health elective. concerns (Bjerregaard & Lynge, 2006). Racial discrimination systematically in place with Danish employees paid higher wages. CANADA SVALBARD €NORWAY„ 2009: Greenland attained self-government, however the Inuit community still suffer QAANAAQ (Thule) from colonisation and a rapid Qaasuitsup modernisation period. Greenland Kommunia National Park has some of the highest suicide rates in the world.

(Peterson, 1995: Ringgaard, 2016) UPERNAVIK ITTOQQORTOORMIIT

UUMMANNAQ Kommuneqarfik QEQERTARSUAQ ILULISSAT Sermersooq QASIGIANNGUT KANGAATSIAQ SISMIUT KANGERLUSSUAQ ICELAND Qeqqata MANIITSOQ kommunia TASILAQ

NUUK KALAALLIT NUNAAT PAAMIUT GREENLAND NARSAQ IVITTUUT QAQORTOQ Kommune NANORTALIK Kujalleq

Map 8: Kalaallit Nunaat/Greenland.

GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 21 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION APPENDICES

APPENDIX 1: TABLE: SUICIDE DATA FOR OVERALL POPULATIONS AT LATEST AVAILABLE YEAR

Suicide Data for Overall Populations at Latest Available Year

30

25 21.4 21.9 19.1 20 16.3 16.4 13.7 15 13.5 12.6 11.0 11.1 10 6.5 6.2 5.7 6.0 6.1 5 Number of Suicide deaths per 100 000 People 0 Australia (2017) Canada (2016) USA (2016) NZ/Aotearoa (2015) Northern Europe /Sápmi (Mean Value)

Males Females Total

Table 10: Overall suicide rates here include the mainstream population and the Indigenous population. Australia (Australian Bureau of Statistics, 2018); Canada (Public Health Agency of Canada, 2016), USA (Center of Disease Control and Prevention, 2017), NZ/Aotearoa (Stats New Zealand, 2017), Northern Europe/Sápmi (OECD, 2017).

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24 | GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION

The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention