The Arbutus Review • Fall 2014 • Vol. 5, No. 1 Mental Wellness through Culture: An Examination of Youth Suicide Rates in Canada’s Aboriginal Communities and Recommendations for Public Policy Marla Turner* University of Victoria craigmarla2@yahoo.ca Abstract This paper recognizes the high rate of Aboriginal youth suicide in Canada and the need for an intervention strategy. According to statistics, the high rate of suicide cannot be applied to all Abo- riginal communities. There are areas where youth suicide is non- existent, thus a blanket assumption, such as all Aboriginal youth are at an elevated risk, only perpetuates stigmatization. The bio- medical focus of mainstream health care and colonial perspective of other services often fail to acknowledge the determinants be- hind youth suicide within Aboriginal communities. The literature reveals that healthy communities, with low rates of youth suicide, share a common identity, practice cultural continuity and are self-determining. In order to facilitate healthy environments for Aboriginal youth, Canadians must go beyond thinking of health in terms of treating symptoms. We must instead examine and address the historical and contemporary constructions of racism and cultural genocide and work toward developing public policy promoting culturally safe processes. Keywords: youth; suicide; cultural continuity; cultural safety; social determinants; colonialism; self-determination; decolonization; com- munities; Aboriginal *I would like to thank Charlotte Reading for the inspiration, support, and encour- agement she has provided during my time as a student in the undergraduate program within the school of Public Health and Social Policy. I would also like to thank my fellow online students who generously shared their perspectives and feedback. 177 mailto:craigmarla2@yahoo.ca Turner I. Introduction In 2003, Health Canada identified Aboriginal youth as being five-to-seven times more likely to commit suicide than non-Aboriginalyouth (Kirmayer, 2012). However, this general statistic cannot be applied to all First Nation communities. Many communities within British Columbia reported no suicides in a five year period, while oth- ers revealed suicide rates up to 800 times the national average (Chan- dler & Lalonde, 1998). The changing demographics in Canada have added an even more critical component to the communities exhibit- ing high suicide risk. While the general population has nearly dou- bled in size during the last sixty years, the population of Aboriginal people has become seven times larger (Waldram, Herring & Young, 2007). Growing numbers of Aboriginal youth and the disproportion- ate rates of suicide within Aboriginal communities require public pol- icy to promote culturally safe processes, not only in health care, but throughout Canadian society. This paper examines a select body of literature to provide informa- tion on the social, economic and cultural conditions within commu- nities expressing both high and low risk of youth suicide, and to ex- plore the cultural initiatives within Aboriginal communities working to promote the mental wellness of youth. The paper applies findings from the literature to assess the development of public policy aiming to close the gap of health inequity experienced by many Aboriginal people. II. Literature review In order to give an overview of the current research on youth suicide in Aboriginal communities, a brief literature review was conducted. Scholarly, peer-reviewed articles published between 2010 and 2014 were electronically searched using search terms related to youth sui- cide and aboriginal communities, and Canadian public health. The result was 44 articles, which were further narrowed to seven pub- lications by excluding those discussing urban environments and/or 178 The Arbutus Review • Fall 2014 • Vol. 5, No. 1 focusing on issues other than youth and mental wellness. The selected literature gives a variety of factors and conditions contributing to a high risk of youth suicide in Aboriginal commu- nities. These range from systemic issues such as historical events and colonial processes, to specific behaviours such as substance use and domestic violence (Tousignant, 2013). Tousignant notes that sui- cide is the “result of interaction between the psychobiological factors and contemporary stress” (p. 401). Thus, a discussion on youth sui- cide requires a broad perspective in order to unravel the multiple and complex roots explaining the differential levels of suicide risk within Aboriginal communities (Wesley-Esquimaux & Snowball, 2013). Additional factors related to youth suicide noted in the litera- ture include the intergenerational trauma stemming from residen- tial school experiences, overcrowded housing, and unresolved crime (Tousignant, 2013). Authors Finley, Morris, Hardy and Nagy (2010) mention various social determinants that influence the wellbeing of youth, such as early life experiences, education, employment, work- ing conditions, food security and social exclusion. Another article suggests that the mental wellness of Aboriginal youth is associated with identity and colonization, where current programs and services failed to “instill a sense of native pride” for Aboriginal participants (Lavalee & Poole, 2010). Several implications for public health practice and policy develop- ment were also discussed within the literature. Webster (2012) notes that current suicide prevention strategies within Aboriginal commu- nities are substandard because of a lack government funding to pro- mote culturally relevant research and sufficient community data. An- other article suggests the “urgent need to increase the number of eval- uations of preventative interventions” (Clifford, Doron & Tsey, 2013, n.p.) by using solid research designs to create evidence-based, cul- turally relevant programs (Clifford, Doron & Tsey, 2013). However, three articles selected in the literature review note that the specific concepts of culture promoting health must be defined by Aboriginal communities in order to promote “cultural authenticity” within pro- grams (Nygard, 2012; Webster, 2012; Clifford, Doron & Tsey, 2013). 179 Turner 1. The determinants underlying differential rates of abo- riginal youth suicide The Royal Commission on Aboriginal Peoples states that children, “according to tradition…are gifts from the spirit world and must be treated well or they will return to that realm” (First Nations, 2007, p. 7). Yet, out of all the groups in the world identifiable by culture, Aboriginal youth in Canada are the most likely to take their own lives (Chandler, Lalonde, Sokol & Hallet, 2003). Why, despite being considered a gift in Aboriginal culture, are so many youth choosing to die? The answer lies in the historical and contemporary determinants influencing the lives of Aboriginal people. 1.1 Socio-economic determinants Many determinants of suicide, expressed in communities with high risk, are socio-economic in nature. On average, Aboriginal suicide victims are younger than non-Aboriginals who take their own lives and are more likely to be using alcohol at the time of death (Waldram, Herring & Young, 2007). The use of alcohol and other substances can be seen as a measure of coping with feelings of hopelessness and in- adequacy (Waldram, Herring & Young, 2007). Waldram, Herring and Young (2007) identify four risk factors for substance which include parental and sibling role modeling, cultural stress, lack of social sup- port and learned helplessness. Former Chief of the Assembly of First Nations, Phil Fontaine, states despite Canada being a wealthy nation, “First Nations endure poverty and third world conditions in their own home land” (First Nations, 2007, p.26). In 2001, a census identified Aboriginal youth living in families as more than twice as likely to live in poverty as non-Aboriginal youth (First Nations, 2007). In the same year, the First Nations Regional Longitudinal Health Survey reported that the median annual income of households on reserve, with children, was less than half of the Canadian median income. Housing, water supply and sewage control is often sub-standard in First Nations communi- ties (Waldram, Herring & Young, 2007). Levels of literacy and edu- 180 The Arbutus Review • Fall 2014 • Vol. 5, No. 1 cation are also far below average (First Nations, 2007). Furthermore, since “there are few job or training opportunities available to Abo- riginal youth, on reserve or off, they are left with little choice” (First Nations, 2007, p. 29) but to adopt often harmful coping strategies (First Nations, 2007). The mainstream marginalization of Aboriginal status can com- pound other sources of stress (MacNeil, 2008). Life in high risk com- munities has been shown to include family dysfunction, loss of cul- tural beliefs, and the inability to meet basic needs or attain the skills to do so, allowing feelings of low self-esteem and hopelessness to de- velop (MacNeil, 2008). When a suicide does occur within a commu- nity, the risk becomes higher for other youth, since a chain reaction can result. Imitating the act becomes an option if they “identify with the victim, blame themselves, and believe they are meant to be the next victim” (p.8). 1.2 Historical determinants Historical factors continue to play a role in the mental health and rates of suicide among Aboriginal youth. Destructive colonial prac- tices strived to assimilate Indigenous peoples, causing trauma and dis- connection from traditional beliefs and cultures. Residential schools removed children from their families, communities were dislocated from traditional territories and the expression of culture was forbid- den (White & Jacobs, 1992). In Historic Trauma and Aboriginal Heal- ing, Wesley-Equimaux and Smolewski (2004) describe the effects of colonialism on youth today. They present the idea that “residue of unresolved, historic, traumatic experiences and generational or unre- solved grief is not only being passed down from generation to genera- tion, it is continuously being acted out and recreated in contemporary Aboriginal culture” (p. 3). Evidence to this claim lies in the social problems of communities with a high rate of youth suicide. Social scientists have also noted the prevalence of substance, domestic, and sexual abuse “is largely from the destruction of Indigenous culture” (MacDonald, 2009, p. 177). 181 Turner 1.3 Political determinants Western-based political ideology and policies of past and present have an oppressive effect on Aboriginal youth and are a factor in creating the sense of hopelessness known to be present before a youth com- mits suicide (MacDonald, 2009). The control held by the Canadian state over Aboriginal affairs, such as resources and services, can be traced as the main reason Aboriginal youth are over-represented in Canada’s child welfare system (MacDonald, 2009). Despite the closing of residential schools, many children continue to be removed from their homes and placed in care because of per- ceived neglect (Blackstock, 2011). However, in most cases, basic needs of Aboriginal children are unmet because of “political factors such as gaps in jurisdictional accountability, and at times, a lack of due pro- cess in family courts” (MacDonald, 2009, p. 178). In a CBC interview, Cindy Blackstock (2011) expresses policy, which sets Aboriginal fam- ilies up for failure, is the reason children are put into care by child welfare workers. Instead of removing children and causing further trauma to families, the state needs to address underlying issues, such as addiction, poverty, unemployment, literacy, and education (Black- stock, 2011). Currently, Canada participates in the unjust practice of blaming Aboriginal parents for the inadequate care of their children, without addressing the policies that are the cause of the neglect (Blackstock, 2011). In cases where youth are not placed in care when families are unable to provide, they may be left with little option but to rely on crime in order to meet food and shelter needs, partly explaining the disproportionate rates of Aboriginal youth in the correctional system (National, 2007). 2. Determinants in communities with low suicide risk 2.1 Cultural continuity As previously mentioned, the prevalence of youth suicide is not a concern in every Aboriginal community (Chandler & Lalonde, 1998). 182 The Arbutus Review • Fall 2014 • Vol. 5, No. 1 In their article, Chandler and Lalonde (1998) reveal the presence of cultural continuity protects youth by facilitating a healthy transition from adolescence to adulthood. Continuity in a community is defined as the process of cultural rehabilitation or the attempt to reconstruct traditional practices. A community’s effort to re-establish culture an- chors youth to a positive vision of themselves in the future (Chandler & Lalonde, 1998). Chandler, Lalonde, Sokol and Hallet (2003) describe the presence of six markers of cultural continuity as creating a healthy environ- ment for youth. Their study correlates the low incidence of suicide in a community with the following markers: the effort to secure land claims, the success in attaining a degree of self-government (polit- ical and economic independence), band-administered schools, com- munity owned or controlled fire and police services, band and tribal councils having control of health services, and the existence of a fa- cility constructed for the sole purpose of hosting cultural activities. In such communities, youth experience an opportunity to contribute to cultural preservation, develop a positive identity and be in control of their future and destiny (Chandler et al., 2003). In order to provide a more detailed explanation of the concept of cultural continuity, a few of the ground-level activities taking place within the markers are identified. In the article “Aboriginal language, knowledge and youth suicide,” Hallet, Chandler and Lalonde (2007) report that the rate of suicide disappears in communities where more than half of the members have knowledge of a traditional language. The authors define language as the most important method of cul- tural continuity because it expresses “another way of looking at the world, of explaining the unknown and making sense of life” (Battiste, as cited in Hallet et al., 2007, para. 3). Ceremonies are also important for the continuation of culture. They are known to facilitate the “dis- charge of emotion…and provide powerful group empathy and cohe- sion which reinforce(s) the social self-image of each individual partic- ipant” (Hart, 2002, p. 59). Elders are central figures for facilitating the cultural transmission in Aboriginal communities by providing guid- ance, counselling and performing ceremonies (Hart, 2002, p. 58). Tra- 183 Turner ditional activities, such as hand-drumming, have also been proven to empower people to take control over their health in a holistic manner by incorporating physical, mental, spiritual and emotional aspects of wellness (Goudreau et al., 2008). 2.2 Self-determination As Chander and Lalonde (1998) note, self-determination, where a pop- ulation group has political freedom to guide their own course of ac- tion, is closely related with cultural continuity. Self-determination is accomplished when a community establishes a cohesive identity, gains control and is accountable for political, economic and social structures that affect the members (Reading, 2012). Chandler et al. (2003) report low suicide rates within Aboriginal communities having achieved a degree of self-determination. However, such an achieve- ment requires strong leadership, support from the community and ap- propriate support from non-Aboriginal groups (Reading, 2012). Vari- ations of these requirements exist in each community and acquiring them can be difficult and take time (Reading, 2012). Nevertheless, when public policy fails to promote self-determination and instead focuses on specific issues such as housing or education, significant long-term change is unlikely (Reading, 2012). 3. Public policy to reduce suicide risk Cultural continuity, tied with a degree of self-determination, is proven to provide Aboriginal youth with a healthy environment and decrease the impact of socio-economic, political and historical factors influenc- ing the risk of suicide (Chandler et al., 2003). However, not all com- munities have an opportunity to achieve such measures. Cultural continuity and self-determination are not equally attainable, as each community experiences different impacts, obstacles and levels of op- pression. Therefore, rather than developing policy based on statis- tics, which may create blame and further oppress communities, pol- icy must be shaped to ensure all youth have the opportunity to ex- perience themselves as continuous in time (Chandler et al., 2003). In 184 The Arbutus Review • Fall 2014 • Vol. 5, No. 1 order to support communities in establishing healthy environments for youth, cultural safety must be embedded within public policy. 3.1 Defining cultural safety The term “cultural safety” originated in New Zealand to address the inequitable health outcomes experienced by Maori people after re- ceiving culturally inappropriate and insensitive care (De & Richard- son, 2007). The process begins with self-reflective exercises promot- ing a deeper sense of awareness, where individuals examine their beliefs, social position in the world and how they relate to others. De and Richardson (2007) note the way “not everyone believes or does exactly the same thing” (para. 20). Thus, if we are consumed by our personal perspectives, we “risk inadvertently stereotyping people by putting together lists of what we think people do or believe based on assumptions, myths and stereotypes” (De & Richardson, 2007, para. 20). Applying cultural safety to public policy has potential to pro- mote respectful relations among diverse groups, which will go much farther in promoting health than if cultural safety is limited to inter- actions within health care (De & Richardson, 2007). Viewing Aboriginal youth suicide through a culturally safe lens highlights much of the hopelessness leading to the loss of life as be- ing rooted in structural and institutional racism within medical, edu- cational and economic systems. For instance, Western medicine dis- regarded traditional practices during European settlement (White & Jacobs, 1992). After Aboriginal healing practices failed to help peo- ple regain health, traditional medicine was further stigmatized and labelled inadequate (White & Jacobs, 1992). Since religion and cul- ture are part of Aboriginal medicine, they too, were disregarded (Wal- dram, Herring & Young, 2007). Residential schools split up families and encouraged children to “despise in themselves all those things which were essential to their identity” (White & Jacobs, 1992, p. 19). Exclusion from the economy was enacted by the state in the form of laws. Land was confiscated, resources were denied and Aboriginal people starved. Chief Seattle said the ways of the white man brought “the end of living and the beginning of survival” (White & Jacobs, 185 Turner 1992, p. 127) as traditional perspectives historically held little value for many Euro-Canadians. 4. Policy implications Public policy promoting an advanced level of self-awareness and ed- ucation on oppression and marginalization is required to hasten so- cial change and allow youth to feel hopeful about the future. Self- determination, in the form of communities taking control of resources and services, has been connected to a low risk of youth suicide. Cana- dians must acknowledge and respect the ability of Aboriginal per- spectives to provide the framework for healthy communities. As an example, MacDonald (2009) writes the meaning of autonomy in Aboriginal communities needs to be grounded in traditional culture. Otherwise policy may be shaped by Western-based assumptions re- garding political practices, and work to off-load responsibility onto communities while giving no means for adequate funding (Reading, 2012). Such practice will only serve to further oppress communities if inadequate resources and funding are available. Public policy can facilitate wellbeing for Aboriginal youth by mod- elling and promoting culturally safe processes and behaviors to all Canadians. For instance, programs and services within every sector need regulations which adhere to cultural safety. Since cultural con- tinuity is established as a central concept in reducing youth suicide risk in a community (Chandler & Lalonde, 2003), such initiatives need to be valued rather than labelled or stigmatized by the general pop- ulation. Space that is safe, respectful and appreciative of the many forms of cultural transmission must be created. Policy makers wishing to aid in the process of establishing cul- tural continuity need to have knowledge of local perspectives and respect Aboriginal diversity and world views. In her research article, Parent (2011) identifies that when working with Aboriginal youth, policy makers, educators and practitioners must focus on youth in- terests, strengths, perspectives and historical and contemporary con- texts in order to facilitate a healthy outcome. To focus on individual 186 The Arbutus Review • Fall 2014 • Vol. 5, No. 1 deficits is to be blind to the structural and institutional inequalities that exist. Building self-awareness and knowledge of social power imbalances, while staying open to different perspectives and world views, are initial steps toward establishing a level of cultural safety. The Aboriginal concept of the connection between all living things is central to creating supportive environments for youth. The method of acknowledging a sense of interconnectedness, regardless of her- itage and cultural differences, will allow everyone to benefit (Barlow & Reading, 2008). III. Conclusion The alarming frequency of Aboriginal youth suicide in certain com- munities reflects the unjust nature of Canada’s past and present atti- tudes regarding Aboriginal people. The transition to young adult- hood can be an overwhelming experience and the wellbeing of a population is often reflected by the resiliency of the young mem- bers. Socio-economic, political and historical determinants of suicide, unique to Aboriginal populations, have been identified as causal fac- tors. Markers of cultural continuity and self-determination have been proven to enable communities to provide healthy, supportive envi- ronments for youth. Decision makers must embrace cultural safety theory and embed the practices within public policy. The promotion of self-awareness and education on social the determinants of health will work to relinquish oppressive assumptions and aid in building health equity. 187 Turner References Barlow, J. & Reading, C. (2008). Relational care: A guide to health care and support for Aboriginal people living with HIV/aids: Fi- nal report. Canadian Aboriginal Aids Network. Retrieved from http://www.catie.ca/en/resources/relational-care-guide-health- care-and-support-aboriginal-people-living-hivaids Blackstock, C. (2011). Q & A with Cindy Blackstock. Retrieved from www.cbc.ca/doczone/8thfire/2011/11/cindy-blackstock.html Chandler, M. & Lalonde, C. (1998). Cultural continuity as a hedge against suicide in Canada’s First Nations. 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Victoria, BC: Community Panel and Family and Children Services. 190 http://search.proquest.com.ezproxy.library.uvic.ca/docview/1314476453?accountid=14846 http://search.proquest.com.ezproxy.library.uvic.ca/docview/1314476453?accountid=14846 http://ezproxy.library.uvic.ca/login?url=http://site.ebrary.com/lib/uvic/Doc?id=10078906 http://ezproxy.library.uvic.ca/login?url=http://site.ebrary.com/lib/uvic/Doc?id=10078906 Text Box http://dx.doi.org/10.1503/cmaj.109-4282 Text Box http://dx.doi.org/10.100 7/s11469-009-9265-6 Introduction Literature review The determinants underlying differential rates of aboriginal youth suicide Socio-economic determinants Historical determinants Political determinants Determinants in communities with low suicide risk Cultural continuity Self-determination Public policy to reduce suicide risk Defining cultural safety Policy implications Conclusion