The human, and financial cost of trauma in Nunavut

Bellwood Health Services treatment centre, which helps individuals and families heal from addiction and “discover the freedom of being well,” is located in Toronto. (PHOTO COURTESY OF BELLWOOD HEALTH SERVICES)

Nunavut Tunngavik Inc. vice-president Jack Anawak says addiction treatment requires trauma counselling, otherwise you’re just treating the symptoms, not the root causes. (PHOTO BY LISA GREGOIRE)

The Inuusiqsiurvik treatment centre in Apex, which closed in 1999, is now the Qimaavik women’s shelter. (FILE PHOTO)

OTTAWA — Jack Anawak wrote two letters while attending a residential alcohol and drug treatment program in Toronto during the autumn of 2012.

One was to his deceased mother who, after being burned in an accident, had been sent from their home in Repulse Bay to a hospital in Brandon, Manitoba. She never returned north, and eventually died, March 23, 1958. Anawak was eight.

“I missed you so much,” he read aloud to his counsellor and fellow clients at the Bellwood Health Services treatment centre. He was finally able to tell her how he felt, and to say goodbye. “I wish I could have been there when they cut your long hair.”

The second letter was to Jack Anawak, the child who, by age nine, was already a victim of sexual assault at the Sir Joseph Bernier residential school in Chesterfield Inlet.

“I wish I would have been there,” he wrote to his former self. “You will do things, you will do questionable things. But you are a kind person, you are a good person at heart, and I will always be there for you, as a 62-year-old person. I will take care of that little innocent boy.”

Anawak, a long-time Inuit leader, politician and currently vice-president of Nunavut Tunngavik Inc., has been through addictions treatment before, but each time, he addressed the symptoms, not the trauma he suffered: the trauma of abuse, of losing his mother and later, two brothers to suicide, and of losing traditional society, which made most Inuit feel inferior and dependent.

Nunavut residents have paid a high price for the social upheaval of the last five decades. Police, nurses, judges and coroners could all describe the toll alcohol and drug addiction has taken on the physical and mental health of Nunavut Inuit.

Every year, the Government of Nunavut pays millions of dollars to send residents south for addiction treatment.

The figures are contained in the GN’s annual procurement activity report which lists all government contracts in a given year — from janitorial services to jet fuel.

If you add up all the contracts paid to addiction centres, or those items which contain the word “addiction” in the contract title, it comes to $3.8 million for the fiscal year 2011/2012. That’s roughly one per cent of the budget of what was, until April 1, the Department of Health and Social Services.

In that same year, according to the procurement activity report, the Liquor Commission, through Department of Finance, ordered $2.4 million worth of beer, wine and liquor for Nunavut residents, a figure that would likely double if bootlegged alcohol were included.

While the GN struggles to deal with widespread mental health issues, it hopes to at least minimize the impact by targeting bootlegging and binge drinking.

The GN is expecting to revamp the territory’s Liquor Act based largely on recommendations from the Nunavut Liquor Act Review Task Force which tabled its report in 2012.

The new act could lead to over-the-counter beer and wine sales at warehouses in Iqaluit and Rankin Inlet. That hasn’t happened since the Iqaluit warehouse was closed for direct sales in 1975.

Anawak, who sat on the task force, said he supports this move though he agreed it would be controversial.

“If people really want to get alcohol, they will get it,” he says over breakfast during a recent visit to Ottawa. “Instead of creating a bunch of bootleggers, maybe the best way to do it is to let people get alcohol here in limited amounts.”

The government’s task force response, tabled in the legislature March 19, also mentioned expanding territorial treatment centres with a mobile addictions centre pilot program slated for Cambridge Bay, but that program has been plagued by delays.

Nunavut has not had a designated addiction treatment centre since Inuusiqsiurvik in Apex closed in 1999.

Coincidentally, Linda Bell, who helped get that centre running in 1993, is the chief executive officer of Bellwood Health Services in Toronto, where Anawak went for treatment last fall.

In a recent interview, Bell said she learned many lessons from the centre’s failure, including the importance of establishing a culturally-relevant treatment model. One of the criticisms of Inuusiqsiurvik at the time was that it relied too heavily on a southern-based model.

She suggested a centre would have greater success if it had long-term commitment from staff and board members and an established network of post-treatment aftercare, training and employment programs in the communities.

“Otherwise, it’s just throwing people back into a risky environment,” Bell said.

The GN has been quiet about the success or possible expansion of its “mobile addictions treatment pilot” in Cambridge Bay, although an evaluation of that test-run, which took place late in 2012, was to be delivered in February.

Until the GN establishes another treatment centre in Nunavut, Bellwood’s seems like a good option, albeit expensive. For the past year, the centre has offered Inuit-specific trauma counselling as part of its 45-day residential treatment program which costs $685 per day for a total of $30,825.

Anawak, one of five Inuit who have undergone the program, said it was comprehensive and extremely effective. He credits that portion of his treatment — three times a week for six weeks with counsellor Kathy Adetuyi — with helping him to finally regain control of his life.

“It gets to the point where it’s no longer a chore to be alive,” he said. “You learn to love yourself. You’re not focusing on the negative parts of your life. They’re passed. They’re not my problem anymore. You have to live from here on. It’s a good feeling to get your mojo back.”

When asked to put together the Inuit-specific component of treatment, Adetuyi said she visited the Mamisarvik Healing Centre in Ottawa to see what they offered.

She then spent months researching the history of colonial change in Inuit society including the impacts of relocation, religion, tuberculosis, the change from nomadic to sedentary lifestyles, the sled dog slaughter, Project Surname, residential schools and the epidemic of suicide in the North.

Now she brings those issues to the table when she talks with clients, exploring how they might have impacted Inuit and their families. Then she reminds them to celebrate Inuit contributions, values, achievements and leaders. Of course, she’s not an Inuk and fully accepts her limitations.

“I also have my own cultural heritage. How would I feel if I went to a treatment centre and the person offering the culturally relevant portion wasn’t of that culture?” Adetuyi asks.

“That’s why I will always defer to their knowledge. They are the experts of their lives, of their stories, of their experiences. I can bring the pen and paper to the session and I can bring what I know but it’s what they add to it that really authenticates the process.”

Inuit are particularly vulnerable to relapse, she adds, because of strong family ties: it’s hard to resist when family members want you to drink with them or who make your life stressful with their needs and demands.

But strong families can also be an advantage, she added, and Inuit can draw from the resilience and perseverance of their ancestors.

Anawak has now become an advocate not only for mental health and suicide prevention in Nunavut, but trauma counselling. He speaks about it at every opportunity, because that’s what he says leaders should do.

“Let’s not get victimized by the fact we have the highest rates of suicide. Let’s accept it and decide, what are we going to do about it,” Anawak says. “We need to spread the word. The leadership can’t be hesitant. But maybe they’re too close to the situation or maybe they’re part of the problem.”

He says he’ll always be in recovery but will continue to promote mental health, something he says is the key to Nunavut’s success.

But the key to Anawak’s personal future is a little girl named Jacqueline, Anawak’s grandchild, born on his birthday, Sept. 26, 2011, and who took his middle name for her own: Iyerak. Anawak got that name from his grandmother when he was born and says he felt her presence all his life, even after she died.

He’s hoping he can provide that same comforting presence to Jacqueline as she finds her own path in the new Nunavut.