Canada needs a national suicide prevention strategy – because they work

Ten days before she stood in the House of Commons to denounce the staggering suicide rates among First Nations and Inuit peoples, Health Minister Jane Philpott dismissed the need for a national suicide prevention strategy.

"I actually am not convinced that strategies are the way that we're going to get things done," she told the audience on April 3, at a one-day conference in Ottawa organized to highlight the importance of the social determinants of health.

"The answer is going to be in the things that we're talking about tonight – when people have access to a high quality of education, when they have access to jobs, when they have money in their pockets, when they have hope – that's when we are going to be able to make progress."

Philpott's rejection of a strategy is both startling and disheartening.

Attawapiskat, Pimicikamak, Nunavut

Philpott did not know, when she commented, about the wave of attempted suicides in Attawapiskat, Ont. Six days later, the chief and council would declare a state of emergency that, propelled by MP Charlie Angus, would draw international attention to the remote James Bay community.

But Philpott was already aware of the six completed suicides and more than 140 attempts in the Pimicikamak First Nation in Cross Lake, Man. She'd met chiefs from Northern Ontario, where the simple crosses in the yards of Pikangikum's homes are terrible monuments to the 100 suicides of its members over the last 30 years.

Philpott had also spoken, that night, about the deaths by suicide in Nunavut – nearly 500 since the territory was created, 14 of them this year alone. She understands the urgency of a federal response.

The Health minister is right about the importance of addressing the social determinants of health if our indigenous communities are to heal. She's wrong about the effectiveness of suicide prevention strategies.

Few provinces, territories have robust strategies

Suicide prevention strategies save lives. In 21 OECD countries that implemented strategies, suicide rates dropped – primarily among youth and the elderly, the two populations most at risk in Canada. Both the United Nations and the World Health Organization (WHO) have called on all nations to implement national strategies.

Yet, asked why Canada does not have a national strategy with a specific focus around suicide by indigenous people, Philpott said "almost every province in the country has a suicide strategy and a suicide framework."

"Strategies will not be our answer," she added. "Taking action to close the (socio-economic) gaps will."

Few of our provinces and territories actually have a robust suicide prevention strategy. Most have loose frameworks or blueprints, like Manitoba's youth suicide prevention strategy. They point the way, but lack the components of a true strategy. Or, as in Nunavut, the strategies suffer from struggles to implement them.

3,000 lives saved in Quebec

Strategies require elements designed to achieve specific targets and goals. They have timelines, and individuals, organizations or government departments accountable for implementation.

Effective strategies require governments willing to commit the necessary dollars. They're driven by leaders ready to expend their political capital to address the underlying risk factors in suicide, including inadequate access to mental health and addictions treatment, childhood sexual and physical abuse, and intergenerational trauma.

Quebec has an effective strategy. Since 1999, when the province implemented Help for Life, Quebec has cut its overall suicide rate by more than half. Youth suicide rates have declined even more steeply. Over a decade, Quebec's prevention strategy saved nearly 3000 lives.

The one high-risk population in Quebec where the strategy has not reduced suicide rates is among indigenous youth. Indigenous communities opted to develop their own prevention approaches.

Remember a 15-year-old Junior Ranger

Since Philpott expressed her views about prevention strategies, the impetus for change has intensified. Attawapiskat's anguish has come to stand for the immobilizing grief devastating thousands of First Nations, Metis, and Inuit families across Canada.

One of the communities now grieving is Taloyoak, Nunavut, where a 15-year-old Junior Ranger died by suicide in March. He was, Nunavut MLA Emiliano Qirngnuq told the territorial legislature, "a leader amongst his student peers."

Philpott understands that we are losing too many potential leaders. She appears seized - as many Canadians now are - by the need to stop the suicides. And she is a rising cabinet star in a government vowing to embrace evidence-based decision making. That's why her stance on a national prevention strategy is so disturbing.

An 'obvious failure in leadership'

A national strategy and implementation plan could co-ordinate long and short-term action, focusing on the highest-risk populations. It could incorporate a centre for research-driven policymaking, concentrating expertise to inform decisions and allocate resources.

Perry Bellegarde, national chief of the Assembly of First Nations, is calling for a national strategy. So is Ontario Regional Chief Isadore Day. ITK President Natan Obed won't wait for the federal government. He's driving forward an Inuit-specific suicide prevention strategy for the entire Inuit Nunangat.

When in opposition, Indigenous Affairs Minister Carolyn Bennett was among the loudest critics of the former Conservative government's inaction on even a framework, which the Federal Framework for Suicide Prevention Act promised in December 2012.

"It's an obvious failure in leadership," Bennett said in an interview last June.

It's time this evidence-informed government acts on the evidence.