Suicide strategy in turmoil
No follow-up to action plan, says president of Embrace Life Council
Michele LeTourneau
Northern News Services
Monday, April 20, 2015
NUNAVUT
Despite the development of suicide prevention strategies, there has been no evaluation of their impact and efforts to prevent suicides have not extended to the 25 communities in Nunavut.
Embrace Life Council president Yvonne Niego is hopeful that an evaluation of the Nunavut Suicide Prevention Strategy will be
completed soo - NNSL file photo |
"One thing that may have been overlooked, this was prior to my time, but an evaluation framework. There was no forethought in what would be evaluated, how it would be evaluated. I think that's why we were behind getting the evaluation underway," said Yvonne Niego, president of the Embrace Life Council.
The strategy clearly states, "The Action Plan also commits the implementation committee, consisting of all partners, to ongoing evaluation and monitoring of the implementation of the strategy's goals and objectives, to ensure a continuing momentum as well as continuing accountability and responsibility by each of the committee member organizations to ensure the vision as outlined ... is achieved."
The Nunavut Suicide Prevention Strategy, already operating under a one-year extension, lapsed March 31 and its unclear what, if any, successes have come of it.
The strategy and action plan were created as a result of a partnership formed in 2008 between the Government of Nunavut (GN), Isaksimagit Inuusirmi Katujjiqatigiit (Embrace Life Council), Nunavut Tunngavik Inc. (NTI) and the RCMP.
Developed after community consultations held between April and September 2009, the strategy was approved in October 2010 by all the partners.
The action plan, with 41 items, came in effect in September 2011.
A much-referenced evaluation was expected by the end of March this year and was the reason for the extension of the strategy last year.
Aarluk Consulting of Iqaluit was contracted in the fall of 2014 by the Embrace Life Council, on behalf of the strategy's implementation committee, to conduct the evaluation.
Niego says the evaluation should be in the hands of the prevention strategy's implementation committee soon.
Nunavut now has two suicide prevention strategies dating back to 2007 under its belt, with no measurable difference in completed suicides - except the 2013 spike that spurred the announcement by the chief coroner that her office would conduct an inquiry into suicide in the territory. That announcement came in January 2014 and the inquiry has yet to be scheduled.
"What was the process by which it didn't really happen?" asks Jack Hicks about the strategy.
Hicks is a suicide prevention specialist and instructor in Child Studies at Carleton University in Ottawa. He was once a suicide prevention advisor to the territorial government and was involved in the extensive multi-year, multi-party Nunavut Suicide Follow-Back Study: Identifying the Risk Factors for Inuit Suicide in Nunavut.
"There has not yet been an Inuk champion of suicide prevention," Hicks says.
"If you look at really serious suicide prevention success stories, one of which is Quebec ... They published a strategy and then they did it. They actually aggressively pursued it. They actually did it all, which required money, leadership and mobilizing a lot of people. Suicide prevention, generally, requires a champion."
Quebec published a suicide prevention strategy in 1998, the first jurisdiction in Canada to do so. In 10 years, youth suicide dropped by half in that province.
Hicks says no one in Nunavut has yet played that leadership role.
In what appears to be a hastily-assembled progress report for the fiscal year ending March 2014 tabled by Health Minister Paul Okalik on March 16, over-arching commitments are vaguely addressed while individual action items are not.
For example, under the first commitment titled "The GN will take a more focused and active approach to suicide prevention," there are four action items, one of which is strengthening interagency collaboration at the community level.
"In reality right now, contrary to the strategy, our Community Wellness Committee hasn't met in over a year," said a 10-year Nunavut service provider, who spoke on the condition their name, community, affiliation or position not be referenced in any way.
"And interdepartmental work does not functionally occur at the regional or community level. Many staff fundamentally oppose community development because addressing the needs and opportunities in the sector actually makes them trigger with their own historical trauma."
This source made it clear that the action plan needed to be extended again, "this time for two years until March 31, 2017."
"Community consultations and a formal performance audit during that time would flush out the gaps, weaknesses and successes. And by community, I don't mean consulting with the local hamlet, but with everyday people, not-for-profits and practitioners who are in the trenches. Clear benchmarks and milestones need to be measured by an independent third party."
Niego said she expects the evaluation will reveal "the communities, the front-line people in the communities, haven't heard of the strategy or feel they aren't a part of the strategy or don't feel it's working."
"That's what I would expect."
South Baffin MLA David Joanasie was on track last June when he submitted written questions to the then minister of Health. It wasn't until the fall sitting that a response was tabled.
| In 2014, there were 27 completed suicides and 79 suicide attempts in the territory |
Joanasie asked: "With respect to each of the 41 objectives listed in the Nunavut Suicide Prevention Strategy Action Plan, what specific actions, initiatives and expenditures were undertaken between Sept. 1, 2011 and March 31, 2014, by the identified partners/stakeholders responsible for achieving each objective?"
He also asked about the status of achieving each objective's anticipated result and what specific mechanisms and methodology were being used by the strategy partners to measure the extent to which each objective's anticipated result had been achieved.
The Department of Health, now under Paul Okalik's direction, basically responded to each question by pointing to the "comprehensive evaluation" which will presumably answer all these questions.
In his presentation at the Nunavut at 15 conference in Ottawa in early February, Hicks picked apart Nunavut's suicide prevention strategy, pointing out the GN's failure to implement.
Two items in particular stood out. The first was item 7.3, to pilot a social and emotional learning curriculum in elementary schools throughout Nunavut.
The territorial government's comment on the item through the Department of Education is the same cut-and-paste words used to respond to Joanasie's questions in the Legislative Assembly: "This action item is a joint responsibility with other Nunavut Suicide Prevention Strategy partners. Data is being collected from all partners and will be available when the evaluation report is publicly released."
Repeat the scenario with item 5.4: collecting and releasing data on suicide attempts to get "a clearer picture of the full range of suicidal behaviour in Nunavut today, and the ability to detect changes over time."
In fact, the GN can't provide that data. Department of Health assistant deputy minister Rosemary Keenainak told Hicks in a letter to get that information from the RCMP. The department's acting manager of communications sent Nunavut News/North to the Office of the Chief Coroner, who, in fact, does not collect data on attempted suicide. The office did not reply to a Nunavut News/North query to confirm that the office only collects numbers on deaths. The RCMP was holding raw, un-interpreted data.
The Quebec strategy clearly states that government's Department of Health and Social Services would provide leadership, even as it strove to work together with partners. In the Nunavut strategy, it's all partnership and no leadership. Much like the on-the-ground service provider who spoke with Nunavut News/North, Hicks points to historical trauma throughout the population, including leadership, as a force that impedes progress, calling it "the defining reason why the system can't move forward."
In 2014, there were 27 completed suicides and 79 suicide attempts in the territory.
