Community Action for Suicide Prevention in Nunavut, Canada
Michael J. Kral
Wayne State University
Indigenous peoples have long called for a reclamation of their lives and lands.
Control was taken away from them, and they are taking it back, slowly. While this is
the case for land claims and political processes, it is also taking place at the
community level. Indigenous communities are increasingly controlling their own
resources, from education and health to police, housing, and cultural institutions.
This is also taking place for suicide prevention, a significant problem for Indigenous
peoples where their young people are taking their lives in large numbers.
My story begins with a study that began in Nunavut, Canada in 1994 on Inuit
wellness, sadness, social change, and suicide (Kral et al., 2011). I have been
conducting community-based participatory action research with Inuit since that
time, some of it on suicide (Kral, 2012, 2013). This presentation is about what works
for suicide prevention in Inuit communities, what I call Indigenous best practices.
One question is whether action drives knowledge. This work is based on what
others discussed in their presentations in Tromso. Christina Larsen talked about
local problems demanding local solutions, and about youth empowerment and
involvement. Malcolm King spoke of the importance of community engagement, of
communities shaping interventions, and on youth as leaders.
In this initial study, the Inuit Steering Committee invited one community,
population of about 480, to participate that had the highest suicide rate in the
Northwest Territories and Nunavut. By the time we were ready to go there, in 1998,
Inuit Steering Committee members told me that this community had not had a
suicide in about four years. They said that the community had done something itself
to stop the suicides, and that when there I should find out what they did so that we
could share this with other communities. So I did this. It turned out that the Hamlet
Council had organized frequent meetings of all community members to talk about
suicide and what they can do about it. The local youth committee did the same with
all the youth in this community. Finally, the Housing Committee decided to remove
from each house the number one method of suicide: the closet rod from every closet,
where young people hang themselves at night. These were powerful messages
within the community for suicide prevention. At the meetings Inuit talked about
helping each other, looking out for one another, about showing they cared for each
other. And it all worked. Unfortunately, the suicides returned, the first one a year
later while I was in the community. This is where the issue of community program
sustainability is in need of great attention.
I also conducted this research in a second community, Igloolik, with a
population of about 1300. We worked very closely with their youth committee on
the initial study. After we left, this committee re-organized itself for suicide
prevention and decided they would do something. With the help of Isuma, the film
company in Igloolik, they opened a youth center. This was a place for youth to come
together, play games, watch movies, and just hang out. Cultural activities were also
planned, such as having Elders speak about cultural traditions, and the youth
committee also put together peer counselors and for a while even had a crisis line.
The community had had a large number of suicides in the previous years. After the
youth center opened, suicides stopped for about two years. The community had a
2
celebration of no suicides. Community members knew that the youth center had
been successful. High school attendance had increased significantly, and break and
entry crime done by young males had almost stopped. It appears that the youth
center benefitted youth in many ways. Unfortunately, financial problems closed the
center. In the next eight years, suicides returned again in large numbers.
I returned to Igloolik eight years later to conduct an ethnographic study for
almost a year. This was my medical anthropology dissertation at McGill University.
One of my research questions was to study the process of community action for
youth well-being, largely because of what the first community and the youth
committee in Igloolik had done. I began working with the next generation of the
youth committee, called the Amittuq Youth Society. Their goal was to re-open the
youth center. Together with two older Inuit, we organized all the youth in the
community to come together to talk about what they wanted to see in the youth
center. We gathered a large crowd. I had found out that there were grants from the
Nunavut and federal governments for this, much of which focused on culture. So we
asked the youth if there were cultural activities they wanted to see in the center. The
youth were enthusiastic. Inuit youth are very interested in learning about their
culture, in learning cultural practices. The youth came up with 26 different solid
suggestions for the center. Then with the Amittuq Society we organized these
suggestions into three major themes. We put these themes into grant applications
and sent them out. Most of the grants were received. The youth center finally
opened again, and its opening was a community celebration. Many Inuit came to the
opening, and Amittuq Society members went on the roof of the center to throw
3
candies out to all the children below during the opening. Was the youth center
successful? In the eight years since it opened, compared to the eight years before
that, suicides have decreased in the community by 70%. Although we don’t know
exactly how this happened, it appears that the youth center worked.
These two communities are examples of what can happen at the community
level for suicide prevention. There have been other Inuit communities where
suicides have come down after something began in the community. What is
interesting and very important, every community did something unique, something
that made sense to them. There was no prescriptive program. What all these
communities did have in common, however, was that they owned their programs.
They had created and run them. Outside programs are known to have never worked.
Communities were driving their own interventions, even if they were Western
products. Youth were being the leaders in this community action. This is a form of
empowerment, of youth empowerment, of community empowerment. It is an
example of collective efficacy, collective agency, that is tied to mental health (Kral &
Idlout, 2009). It is what I call sovereignty on the ground, a decolonizing of
intervention. This is indigenism (Niezen, 2003) at the community level, a
reclamation that brings hope. Indigenous communities in control of their own
resources have lower suicide rates (Chandler & Lalonde, 1998). Indigenous peoples
can prevent suicide themselves.
Health Canada of the Canadian government has begun to support Indigenous
communities developing their own suicide prevention programs and activities. The
National Aboriginal Youth Suicide Prevention Strategy began in 2005. Rather than
4
giving so-called evidence-based programs to Indigenous communities, and these
programs do not work well with North American minority populations (Castro
Barrera, & Martinez, 2004; Castro, Barerra, & Holleran, 2010), Health Canada now
funds Indigenous communities across the country to develop and run their own
suicide prevention programs (Kral et al., 2009). Over 200 communities and
Indigenous organizations have been funded. What is needed is an evaluation of
these programs, which the two studies funded by CIHR are now doing. This is
critically important research, to show that such programs work and to determine
more clearly how they work.
Another area in need of attention for suicide prevention is the Inuit family.
The family has historically been at the center of Inuit social structure (Briggs, 1995),
as it has for Indigenous peoples (DeMallie, 1998). Inuit are a family-based
collectivist culture. Today the family is still the most important feature of Inuit wellbeing (Kral et al., 2011). Yet the family has changed considerably since the
colonial/imperial government era of the 1950s-70s in Inuit Canada. These changes
have been the most negative and lasting effect of this colonialism, with increasing
intergenerational segregation and significant changes in parenting and child-parent
relations (Kral, 2012). We have found that in spite of family being the most
important resource for suicide prevention and, in addition to friends, being the
people Inuit youth go to when they are not doing well – resilience for Inuit youth is
ecological and relational – Inuit youth spend very little time with their parents and
elders (Kral et al., in press). This is very different from the recent past only two
generations ago, when parents and elders were the mentors and teachers. What is
5
needed are programs in Inuit communities to bring families together. Inuit
recognize that such programs are needed. Inuit youth need adult mentors who love
them. It is because talking to family members has kept suicidal Inuit from killing
themselves that such community efforts need to take place.
References
Briggs, J. L. (1995). Vicissitudes of attachment: Nurturance and dependence in Canadian
Inuit family relationships, old and new. Arctic Medical Research, 54, 21-32.
Chandler, M. J., & Lalonde, C. E. (1998). Cultural continuity as a hedge against suicide
in Canada’s First Nations. Transcultural Psychiatry, 35, 191-219.
Castro, P. G., Barrera Jr., M., & Martinez, C. R. (2004). The cultural adaptation of
prevention interventions: Resolving tensions between fidelity and fit. Prevention
Science, 5, 41-45.
Castro, P. G., Barerra Jr., M., & Holleran, L. K. (2010). Issues and challenges in the
design of culturally adapted evidence-based interventions. Annual Review of
Clinical Psychology, 6, 213-239.
DeMallie, R. J. (1998). Kinship: The foundation of Native American society. In R.
Thornton (Ed.), Studying Native America: Problems and prospects (pp. 306-356).
Madison, WI: University of Wisconsin Press.
Kral, M. J., & Idlout, L. (2009). Community wellness and social action in the Canadian
Arctic: Collective agency as sunjective well-being. In L. J. Kirmayer & G. G.
Valaskakis (Eds.), Healing traditions: The mental health of Aboriginal peoples
in Canada. Vancouver, BC: University of British Columbia Press.
Kral, M. J., Wiebe, P. K., Nisbet, K., Dallas, C., Okalik, L., Enuaraq, N., & Cinotta, J.
6
(2009). Canadian Inuit community engagement in suicide prevention.
International Journal of Circumpolar Health, 68, 292-308.
Kral, M. J., Idlout, L., Minore, J. B., Dyck, R. J., & Kirmayer, L. J. (2011). Unikkaartuit:
Meanings of well-being, unhappiness, health, and community change among
Inuit in Nunavut, Canada. American Journal of Community Psychology, 48,
426-438.
Kral, M. J. (2012). Postcolonial suicide among Inuit in Arctic Canada. Culture,
Medicine and Psychiatry, 36, 306-325.
Kral, M. J. (2013). “The weight on our shoulders is too much, as we are falling”:
Suicide among Inuit male youth in Nunavut, Canada. Medical Anthropology
Quarterly, 27, 63-83.
Kral, M. J., Salusky, I., Inuksuk, P., Angutimarik, L., & Tulugadjuk, N. (in press).
Tungajuk: Stress and resilience among Inuit youth in Nunavut, Canada.
Transcultural Psychiatry.
Niezen, R. (2003). The origins of indigenism: Human rights and the politics of identity.
Berkeley, CA: University of California Press.
Contact author at [email protected] after August 2014. Before that he is at
[email protected].
7