Psychiatrist urges co-operation among Nunavut agencies

Dr. Alison Crawford said the education and health departments should co-operate more to identify at-risk children and to promote better mental health among children. (PHOTO BY STEVE DUCHARME)

Mental health expert Dr. Alison Crawford, in evidence she gave Sept. 16 at this month’s Nunavut coroner’s inquest, called for more cooperation among Government of Nunavut agencies to combat the territory’s disturbingly high rate of suicide.

“The scope for understanding suicide goes beyond the scope of medical terms,” said Crawford, who’s an assistant professor of psychiatry at the University of Toronto.

Crawford said she believes more conversation should occur between health workers and the rest of the community to identify and treat the warning signs that lead to suicidal behavior.

Many of these signs, she says, are best monitored beyond the traditional scope of health services: in schools, the community, or the justice system.

“We are facing a crisis among our youth,” she said.

The rate of suicide in Nunavut is 9.8 times higher than the rest of the country.

But for certain demographics, particularly children aged 10 to 14, that factor could be 50 times greater than the national average.

Because many of the people affected by suicide are so young, Crawford recommended that more cooperation between the education and health departments would be a good start for monitoring warning signs among youth.

Programs could also be developed between the two agencies to promote mental health among children, she suggested.

The arrangement falls into her larger strategy of a “circle of care” — where individuals struggling with mental illness are recognized and cared for across multiple government agencies working collectively.

However, when a GN protocol was presented to her in preparation to her testimony, Crawford admitted to the inquest that its existence came as a surprise — despite her years of frontline experience in the territory.

The Interagency Information Sharing Protocol was drafted in early 2015 to allow for the sharing of sensitive data pertaining to “at-risk” people among GN departments.

Deputy ministers in the departments of health, family services, justice, education and the RCMP signed the document in June 2015.

As for its implementation, Crawford knows little.

“It looks to be an attempt to do some of the things that I’ve talked about and other witnesses have talked about [at the inquest]: bring sectors together, collaborate around the care of ‘at-risk’ people, share information in order to make that happen,” said Crawford.

“I can’t speak to whether it is being used by other members of the team, or whether there’s been an attempt to disseminate this widely. It did surprise me that I was not aware of it.”

Crawford believes disconnection between sectors in GN services and the communities is a serious challenge to addressing suicides in the territory.

Among her recommendations to the jury, she pushed for the need to educate health care workers, most of them non-Inuit, in the cultural traditions of the region.

“It should feel safe to come for health care. For some people, the health system does not always feel like a safe place,” Crawford said.

Much of the services provided, especially in remote areas, are viewed as an outside entity and many people will not confide in a system they don’t trust.

She recommended more local engagement and development of health care within communities to allow them to treat mental illness locally.

Dispute all this, Crawford believes mental health care is improving — albeit slowly.

She credits organizations such as the Ilisaqsivik Society in Clyde River as a “by Inuit, for Inuit” approach that has achieved considerable success at a local level.

Six jurors will continue to hear testimony this week and next from government workers, Inuit organizations, experts on mental health and family members affected by suicide.

They will submit a series of recommendations on Nunavut’s suicide crisis at the inquest’s conclusion Sept 25.