Nunavut's chief coroner has called a special inquiry in response to a record number of suicides in the territory last year.
Padma Suramala says 45 people killed themselves in 2013 — a significant increase from the previous high of 34 and a figure that brings the territory's suicide rate to 13 1/2 times the national average.
"It is devastating to me and to my coroners," she said Thursday.
"We are exhausted, mentally stressed out. There is no end to it."
Suicide, especially among the young, has long been one of Nunavut's most pressing and tragic social ills.
Almost everyone in Nunavut knows someone who has committed suicide. The territory is replete with stories, including one last May, in which a grandmother who was distraught over the suicide of her granddaughter killed herself in turn.
A major study released last June revealed the depth of mental-health problems. It concluded the territory's citizens have higher rates of both major psychiatric illness and depression than the general Canadian population.
The study found that the deaths it looked at tended to be among single, unemployed males with relatively less education. The average age was 24. They had roughly double the rates of alcohol and cannabis abuse than control group members.
Almost half the people who killed themselves had been either sexually or physically abused as children compared with just over one-quarter of the comparison group. Almost two-thirds of those who committed suicide had been diagnosed before their deaths with severe depression.
The study also raised questions about the availability of mental- health services in the North. It found only 17 per cent of those who committed suicide had ever been hospitalized for psychiatric problems. About the same percentage had been prescribed medication.
Nunavut brought in a suicide prevention plan in 2011. Since then, the government and other partners have instituted public awareness and education campaigns and have sought to increase the availability of counsellors in tiny, isolated communities. Funding for such efforts has increased in the last two budgets.
Critics have criticized its implementation and pointed out that community meetings don't necessarily help someone struggling.
Lynn Ryan MacKenzie of Nunavut's Health Department said progress has been made. Seven mental-health nurses are now stationed in communities around the territory and some communities are taking matters in hand through local wellness committees.
Hall Beach, for example, puts a mental-health worker in its school. It organizes social gatherings for people and soccer games for kids.
"It's part of the solution," said Ryan MacKenzie. "It's building relationships and breaking down the stigma around mental illness.
"The less isolated people are, it helps reduce the risk."
Still, she admits last year's numbers are sobering.
"Those of us that are working on this, it challenges us to recommit our efforts and redouble our efforts."
Suramala said that her inquiry can help the fight against suicide by keeping the issue in the public eye.
"We can bring the risk factors to the public in order to bring more awareness and let everybody know what the risk factors are," she said. "By this inquest, maybe we can bring more counselling services or more recreation centres in the communities which will reduce the social risk factors.
"By bringing in some recommendations, maybe governments will act and bring up more resources."
Suramala said the inquiry is likely to be held in the Nunavut capital of Iqaluit this fall. She hopes it will hear from bereaved families and front-line workers as well as experts and mental-health organizations.
Some studies have linked the territory's high suicide rate with government disruption of traditional Inuit lifestyles decades ago.
One 2008 study correlated rising suicide rates among Inuit in Alaska, Nunavut and Greenland with the period when governments encouraged them to move into communities.
In all three countries, suicide rates began to rise among the first generation born in towns — the sons and daughters of those who had grown up on the land. That trend began in north Alaska in the 1960s, in Greenland in the 1970s and in Nunavut in the 1980s.
— By Bob Weber in Edmonton