Toboggan Hill, outside Igloolik, Nunavut, should awe visitors with an expanse of blinding white that seems to stretch on forever. Instead, the beauty of this unforgiving land has been scarred with scores of homemade white crosses dotting the hillside. Most inscriptions read "Death by suicide," and the vast majority were under the age of 16.
The youth suicide rate in Nunavut is already 28 times higher than the rest of Canada; earlier this year, the territory's coroner's office released statistics showing suicides there overall reached a record high in 2013, with 45 people dead. Earlier this month, SickKids in Toronto and the Nunavut government announced an ambitious new telepsychiatry program that will connect the renowned hospital's psychiatrists with at-risk Inuit of all ages, but mostly the young.
"Our mandate has always been to work with under-serviced rural areas, and there is no greater under-serviced area than Nunavut," says David Willis, clinical manager of telemedicine at SickKids's Tele-Link Mental Health Program. "The biggest challenge for us is building trust. We've worked 15 years with the First Nation and aboriginal peoples of Ontario through Tele-Link, and in many of those communities it took us five to six years to gain their trust."
Willis's program has provided 12,000 consultations to underserved Northern Ontario rural communities. But, he said, the old way of helping had to change.
"The historical precedent is that we fly in, stay for a while, and then we get the hell out. We know that the fly-in/fly-out model doesn't work. Our goal in Nunavut is to build trust and help them understand we aren't going anywhere," he said.
Instead, three high-definition video screens in Toronto will be manned by a team of 10 SickKids psychiatrists, and 10 additional screens will be located in remote health centres in Nunavut where there are no resident psychiatrists. While donations from Cisco Canada and the Royal Bank of Canada will cover some of the cost of the screens, the goal is that the Nunavut government will, after three years, take over financing the program.
The void to be filled is huge, says Esther Warriner, manager of mental health and addictions for Nunavut.
"We have psychiatric nurses and other health-care workers in each of the 11 communities that I oversee. We've made progress in getting better mental-health support into the region, but it's still very scant. Visiting psychiatrists only come to these communities two or three times a year, so Tele-Link will allow us immediate – and much more accessible – access to high-level mental-health resources," said Warriner, a psychiatric nurse originally from Winnipeg.
At a two-day conference on Nunavut at SickKids earlier this month, at least a dozen front-line mental-health-care professionals from the territory joined key members of the Tele-Link team. Candice Waddell, mental-health program and project co-ordinator for the territory, told those gathered that front-line mental-health workers in Nunavut struggle with a feeling of isolation.
"The biggest challenge at the community level is support for the staff. You can feel quite lonely," she said. "We're trying to put in infrastructure to support our staff at the local levels, and Tele-Link is another extension to give us more professional support as well as function as a sounding board to assist in developing new programs to assist people with mental health and other needs."
In recent years, Warriner said her team has shifted from operating in crisis mode to a more preventive, educational-outreach kind of program.
"We see really young kids with suicidal thoughts and so we're working to get into the elementary school system early to teach them coping skills. Some days, the case loads are overwhelming. … The psychiatric nurses are usually the only mental-health game in town, so they're dealing with everything from a child hearing voices to a suicidal 10-year-old to someone who has gone off their meds. That's all in a day's work," she said.
Tele-Link will give her nurses the connections to consult and debrief, and the support to know they're on the right track. For all the sad news stories they come across, Waddell stressed that she's continually impressed by the resiliency of the youth she meets on a daily basis.
"These kids constantly come together to help one another. A program like this is going to help make these children even stronger," she said.
It could also save money. It costs $75,000 to send patients south by medevac, and residential treatment programs cost hundreds of thousands of dollars.
"If we can keep more treatment and care in the communities, it's a win-win situation," SickKids's Willis said. "There is great value in building mental-health champions within the Inuit community itself. This is just a foot in the door."