Teams of mental-health workers have travelled to Attawapiskat to help the remote northern Ontario reserve contend with an epidemic of suicide attempts among its young people.
But can short-term therapeutic interventions, especially when delivered by outsiders, be effective in stemming the tide of self-harm? And what is needed to sustain any beneficial effects such intercessions may have once these emergency workers go home?
The Cree First Nation community declared a state of emergency just over a week ago after 11 youth attempted to take their own lives this month, followed by 28 others in March. Community leaders also subsequently thwarted a suicide pact by 13 other young people, including a nine-year-old child.
Chief Bruce Shisheesh said Saturday on Twitter that another five children attempted suicide on Friday evening in Attawapiskat. He hopes a planned meeting with Indigenous and Northern Affairs Minister Carolyn Bennett will be the beginning of real change for Attawapiskat. Bennett and local MP Charlie Angus — the NDP critic for aboriginal affairs — are to visit the fly-in community today.
Laurence Kirmayer, founder and director of the Network for Aboriginal Mental Health Research at McGill University in Montreal, says crisis counselling and other supportive interventions are critical for stopping this so-called "suicide contagion."
"The analogy would be like an emergency room in a city," Dr. Kirmayer said. "And there is definitely a place for that.
"If somebody is acutely suicidal, then having emergency services available, having somebody be in a safe place … having a chance to assess what's going on and to give some support and maybe begin some kind of treatment, it can all be helpful.
"However, if people are seen in the emergency room and they're suicidal and you return them to exactly the same circumstances that led to that problem, then they may still be at risk."
Such suicide contagion among youth is driven by a sense of despair, the legacy of white European expansion policies that took away indigenous populations' autonomy and sought to destroy their native cultures and traditional languages. The trauma of sexual and physical abuse from residential schools continues to reverberate within many families, often leading to widespread substance abuse.
For many living on remote or rural reserves, poverty, inadequate housing, contaminated water and a lack of educational and employment opportunities add to the sense of hopelessness felt by many aboriginal youth, who may see death as their only escape.
Rod McCormick, a Mohawk psychotherapist and researcher at Thompson River University in Kamloops, B.C., said it's "important and necessary" for Attawapiskat to have help from fly-in teams – both to ramp up the response but also to give respite to mental health professionals already on the reserve, who have been burned out trying to contain the crisis.
Still, given the long-standing Third World living conditions and deeply embedded emotional pain that are the daily realities of life on the reserve, such temporary aid – though welcome – may only provide a Band-aid solution, he suggested.
"They can stop the bleeding, so to speak, if they've got enough people there to do it, but it won't fix things," Dr. McCormick said.
Psychotherapy, for instance, involves building a trusting relationship between therapists and their clients – a process that takes time, especially when those mental-health workers are coming from outside the community and if they're non-aboriginal.
"That in itself would probably take a couple of weeks," he said. "And then if you know they're not going to stick around, you're much less likely to open up to them.
"So I don't think they're going to be able to address any of the root causes of the problems … The underlying causes, whether it's a lack if sense of hope or emotional pain they can't deal with – they're still there.
"It's like a powder keg. It can go off pretty quickly."
The Ontario government has sent in an emergency medical assistance team (EMAT) to offer relief to full-time nurses and other primary-care providers at the Attawapiskat Hospital, who are part of the Weeneebayko Area Health Authority, or WAHA.
"I would say they had reached the max in their ability to deal with the situation, for sure," agreed Deborah Hall, vice-president of clinical services for WAHA, which covers a massive territory around James Bay and Hudson's Bay.
"They needed time to care for themselves, so EMAT's offered us 30 days of respite," she said. "So at the end of 30 days, our team will be in a much better place to support the community in whatever way the community needs our support."
Hall, who has travelled to Attawapiskat, said WAHA has also sent in a new team to care for people who come to the hospital, including two traditional healers, two mental-health counsellors and a social worker who speaks Cree.
While emergency aid given by fly-in mental health workers has a critical role to play, Dr. Kirmayer said longer-term solutions are needed.
For instance, his network is in the midst of setting up a culturally based, family-centred mental health promotion project called Listening to One Another to Grow Strong, which will provide a tool kit for indigenous communities to build their own programs, aimed at preadolescents.
Designing such programs based on their own traditions also helps empower communities, eliminating the sense that solutions are being imposed from outside, he said.
"The aim is to use culture and identity to strengthen youth awareness … [to give them] a proud sense of where they come from."
Dr. McCormick is setting up a centre at his university called All My Relations, which is examining what healing practices from the past could help bolster mental health within indigenous communities today, especially among their young people.
Among them are naming ceremonies, in which a community member who is struggling and at risk is given a traditional aboriginal name – often that of an ancestor – and family members stand up and take responsibility for watching over the person and helping them to live up to that name.
"It connects them at so many levels, and it puts responsibility on people as well," he said.
"So I think healing has to come from within the community, both at the individual level through resilience training and through the community being re-empowered … to realize that you do have solutions."
"They might not look like the ones that exist in mainstream Toronto or Vancouver, but they worked for your ancestors for thousands of years and we just have to bring them back."