INJURY PREVENTION
Volume 7 Number 3
Winter Issue, 1997
INTENTIONAL INJURY: SUICIDE
by Peter McFarlane [Intro] [Main characteristics distinguishing Aboriginal from non-Aboriginal suicides] [Community Problems/Community Solutions ] [Successful Prevention Projects] [The Warning Signs of Suicide] [Mourning and Healing in Big Cove] [Bibliography]
In the fall of 1992 in Big Cove, a Miqma'q community of 2,000 people on the Richibucto River in eastern New Brunswick, there was a sense that suicide was stalking the community.
In a matter of months, four community members took their own lives. After a call for help, a judicial inquest was held into the deaths. But people kept dying. By February 1993, three more band members had committed suicide, bringing the total to seven in little more than a year. Finally, the government was persuaded to put emergency resources into the community and Big Cove launched an intensive suicide intervention and prevention program that finally ended the string of deaths.
The Big Cove example shows that, by tapping into all available resources, communities can make a difference in suicide prevention. But nationally the Aboriginal suicide rate remains at an alarming level. Aboriginal people commit suicide at a rate three times higher than the Canadian average and suicide remains the greatest single cause of injury deaths for Aboriginal People. (1) In the two-year period between 1991 and 1993, a total of 480 Native people (360 men and 120 women) took their own lives.
The most significant difference in the nature of Aboriginal suicides from the Canadian average is the youth of its victims. Unlike in the general Canadian population, where suicides remain relatively stable or even increase with age, a very large proportion of Aboriginal suicides take the lives of Native teenagers and young adults. In the 15-19-year-old age group, Aboriginal people have a suicide rate almost six times higher than the national average; in the 20-24 age group, it is more than five times higher.
Along with the differences in scope, there also appear to be significant differences in the leading causes of Aboriginal and Canadian suicides.
In Canada as a whole, victims are twice as likely to have been diagnosed with a mental illness (clinical depression and schizophrenia) and much more likely to have a history of suicide in their family.(2) In Aboriginal suicides, problems associated with community breakdown play a much more prominent role. According to one recent British Columbia study, the main characteristics distinguishing Aboriginal from non-Aboriginal suicides were:
a more powerful effect of adverse community conditions
In narrowing the focus, the British Columbia study determined the profile of a typical Aboriginal victim is an unmarried male in his late teens or early twenties. He is likely to have been separated from family members in childhood, often in foster care, or to have come from a family that was itself unstable. In a large number of these cases, physical or sexual abuse was also present. In a majority (77 per cent), alcohol or drug abuse was also an important factor.(4)The study found that 90 per cent of the victims were unemployed, even though they were slightly better educated than their peers.It should also be noted that for every suicide that is actually carried out, there are an estimated 50 to 150 unsuccessful attempts. Most of these are "parasuicides," where the individual goes through with the act of suicide, but inflicts an injury that is not sufficient to end their life. Yet parasuicides, which are generally made by women, must be taken extremely seriously since they often precede a successful suicide attempt.
Parasuicides are rare in males because, as one study suggests, men fear ridicule if they survive a suicide attempt. In place of parasuicides, men find other sources of self-injurious and potentially suicidal behaviour that are considered more "masculine."(5) These include excessive drinking or drug use, drinking and driving, and impulsive criminal acts. These self-destructive behaviours are viewed as counterparts to parasuicides and individuals involved in them must be considered as high suicide risks.
The link between alcohol use and Aboriginal suicides is, as mentioned, a major and complex one. Alcohol is twice as likely to be a factor in Aboriginal suicides than in the general population, and appears to be both a major contributor to suicide and an indicator of the type of self-destructive behaviour and community breakdown that often precedes it.
Community Problems/Community Solutions
A Health and Welfare sponsored study observed that Aboriginal suicide is "the most convincing indicator of the effect of poor social conditions and cultural stress in First Nations, particularly among youth."(6)
To be successful, a suicide prevention program should focus on the Aboriginal community as well as the individual. As in other areas of injury prevention, the community must be involved in setting up the program, and the program should also focus on the development of skills among Aboriginal people. Risk factors such as unemployment, community stress, and childhood abuse or neglect, can be reduced by programs to enhance job skills, life coping skills and parenting skills. Treatment for alcohol abuse is also a central part of any suicide prevention program.
The types of prevention projects in Aboriginal communities that have shown the most success are those that:
a. provide education about feelings and depression;
b. attempt early detection of high-risk youths so that they can be helped;
c. screen teens in school programs to identify at-risk youths;
d. develop crisis centres and hotlines; and
e. improve training of health care professionals on suicide prevention issues;
f. As in the Big Cove example, suicides in the Aboriginal population also have a strong tendency to occur in clusters. This means suicide prevention measures should immediately be put into effect after a suicide.In his suicide prevention workshops, Clive Linklater urges interveners to be proactive, "to visit all the people who you even hear about that are thinking about suicide. Every person at risk should be put on a risk scale and those who have gone as far as making a plan for their suicide need to be encouraged to talk about it." (7)
One of the most innovative programs in getting the issue discussed among the young is the Deana Don't Do It project. It was developed through a partnership between the Peekiskwetan "Let's Talk Society" and Desmarais, Alberta. Instead of simply presenting the facts on paper, they taped a call-in show where the topic of the day is teen suicide. The callers -- all young Aboriginal performers -- help to identify and explain youth suicide within the talk-show format.
Project coordinator, Simon Latcham, says the tape tries to increase awareness and understanding of the risk of teen suicide, help people recognize the warning signs and prepare people to offer help or to seek help for a teen who is suicidal. A version of the tape has also been made in the Bush Cree dialect.
Virtually all studies of successful prevention programs in Aboriginal communities point to the importance of drawing on the strength and wisdom of elders in designing such programs. One British Columbia study even found an inverse correlation between the number of teenage suicides in a community with a high percentage of elders reflected in a lower suicide rate.
Studies also show that elders, particularly women, have a suicide rate below the national average. Because of their low suicide rate and the stability they offer to communities as a whole, elders can serve as the strong centre pole of a suicide prevention program. Unemployment, retirement, illness, etc., may produce stress that promotes suicidal behavior.
THE WARNING SIGNS OF SUICIDE
Source: Your Life! Our Future!: Suicide Prevention Resource Kit.
Mourning and Healing in Big Cove
Claudia Simon, the director of Big Cove's health centre, recalls the sense of crisis that gripped the community in the fall and winter of 1992-93. Over the previous year, seven community members had committed suicide and even a judicial inquest, with the hearings held in the community, had done nothing to halt the deaths. Finally, in early 1993, the call went out for help and in March of that year, the community organized a massive intervention and prevention campaign. It began with a Mourning and Healing Week, with activities planned 24 hours a day for the entire seven days. "There were talking circles, traditional healers and church-sponsored events," Claudia Simon recalls. "We had people come in from all over the Atlantic region to mourn with the community and to help them get on with their healing."
Trained intervenors were brought in to work one-on-one with those still considered at high risk, with the local treatment centre transformed into an intervention centre. As part of the ongoing program, community members were sent out for training in both intervention and suicide prevention and returned to train the caregivers in the social services department, alcohol and drug abuse prevention workers, teachers, youth counsellors, the police, and community members at large. "Every available person that could be trained with the two-day suicide prevention course," Ms. Simons says, "was trained. It was an unbelievable project."
To offer further crisis support, the community set up a mobile crisis centre, with a cell phone number for people to call when they were in need of help. The new suicide prevention team members took turns taking the phone home at night to handle the calls. Claudia Simon remembers it was a stressful time for those who were working at their jobs during the day, and fielding the suicide hotline calls in the evening or late at night. Since then, Big Cove has set up its own permanent crisis centre, and its hotline operates from 8 p.m. to 8 a.m. when other social services are closed.
The ongoing program also involves public awareness campaigns, support groups for family members of suicide victims and intensive work in the schools, where a child psychologist specialist has been hired to work with young people at risk.
Claudia Simon advises that other communities not wait until they lose seven members before they act. The first step, she says, should be to get the people talking about the suicide.
"Before 1992 in Big Cove," she says, "you could not even say the word suicide. It was something in the closet and the feeling was, if we don't talk about it, it won't happen again. People were scared -- everyone is scared when suicide happens to friends or family members."
"But the more people talk about it," she says, "the more they can understand it."
Speaking openly about the issue also prompts people to want to act. "And at that point," she says, "you are in a position to bring in people to train community members in intervention. People need to be given the tools. Suicide is such a multifaceted problem. There is not just one cause, but many causes."
The concern now, Claudia Simon says, is that since the immediate crisis has ended, people are starting to talk about winding down some of the prevention programs. "This would be a big mistake. Suicide prevention must be ongoing," she says. "It's something that communities need to work at all of the time."
Bibliography
1. Cited in Injury Prevention News, Vol. 8 No. 2, February/March 1995, p.15.
2. Canada's Mental Health, Health and Welfare Canada, September 1992, p.22.
3. Aboriginal Suicides in Britsh Columbia: An Executive Summary, April 1991, p.17.
4. Canada's Mental Health, Health and Welfare Canada, September 1992, p.22.
5. Gender and acceptibility of suicidal behavior among adolescents, paper #35, XVIIth Congress of the International Association for Suicide Prevention.
6. Trends in First Nations Mortality: 1979-93, p.63.
7. National Suicide Prevention Workshop: Summary of Proceedings, Health and Welfare Canada, p.4.
copyright © 1997 NIICHRO 05/01/98
