Reducing the Incidence of Suicide in Indigenous Groups – Strengths United through Networks (RISING SUN): Workshop 3

The Inuit Circumpolar Council (ICC), Inuit Tapiriit Kanatami (ITK) and the Canadian Institutes of Health Research (CIHR) hosted a collaborative workshop under the 2015-2017 U.S. Chairmanship of the Arctic Council. The workshop focused on ways to effectively prevent suicide among Indigenous peoples in the circumpolar region.

On March 1-2 2017, the Inuit Circumpolar Council (ICC), Inuit Tapiriit Kanatami (ITK) and the Canadian Institutes of Health Research (CIHR), with support from the Indigenous and Northern Affairs Canada (INAC), hosted the third of a series of collaborative workshops held under the 2015-2017 U.S. Chairmanship of the Arctic Council. The workshop focused on ways to effectively prevent suicide among Indigenous peoples in the circumpolar region and brought together over 80 stakeholders from across the Arctic States including researchers, policymakers, Indigenous organizations, youth, and community leaders.

Key themes:

• the need to acknowledge the impact of colonization and rapid social and environmental changes on mental wellness and suicide that have taken place in the past two decades;
• the great variation of suicide rates across communities, even within a single jurisdiction, and the importance of understanding the role of resilience in this variation;
• successful prevention strategies must be community-based and should integrate Indigenous ways of knowing;
• the importance of involving youth in developing solutions, tightening their relation to the land, and creating strong linkages with Elders and culture; and,
• the need to move from intention to action, and from action to impact.

The workshop also provided an update and allowed participants to give feedback on the NIMH-led Reducing the Incidence of Suicide in Indigenous Groups – Strengths United through Networks (RISING SUN) initiative, developed under the U.S. Chairmanship. Delegates examined how the RISING SUN initiative complemented key strategies such as ITK’s National Inuit Suicide Prevention Strategy  and the Plan for Suicide Prevention Among Sami People in Norway, Sweden, and Finland.

Research Perspectives – Best Practices and Remaining Gaps

There are examples of existing and inspiring programs based on community knowledge and strengths that are supported by locally initiated research. As well, there is a growing evidence base to support community-led interventions. Presentations and discussions acknowledged that non-Indigenous solutions could be adapted to Indigenous needs based on community culture, language, and context. However, challenges were noted as well. For example, in research, it can be difficult to be innovative because success is sometimes based on what has already been done. Other challenges include the investment of time needed to develop methodologies, the sustainability of community-based efforts that limit our understanding of the impacts of interventions over time, shifting priorities at different political levels, and limited socio-cultural awareness among service providers and researchers.

Acknowledging these challenges, the participants also highlighted positive trends. A paradigm shift among the research community was recognized, with an increasing number of researchers appreciating community perspectives and Indigenous ways of knowing. Attention was also paid to the concept of resilience, which goes above and beyond identifying potential risk or protective factors.

Progress Update on the RISING SUN Initiative

RISING SUN has produced a common set of community-based, consensus-driven, and prioritized outcomes for use in evaluating suicide prevention interventions across the Arctic States. Common outcomes and their measures, developed through an iterative engagement with Permanent Participants (i.e., indigenous peoples’ organizations represented in the Arctic Council), community leaders, and mental health experts, will facilitate data sharing, evaluation, and interpretation of the effects of interventions across service systems. These outcomes and their corresponding measures may also aid health workers to better serve the needs of their communities and may help policy makers measure progress, evaluate the scale up of interventions, and identify cultural and regional challenges to implementation. By the end of the 2015-2017 US Chairmanship of the Arctic Council, the project will result in an online toolkit with common outcomes and measures for suicide prevention efforts, applicable across the Arctic, which could expand Arctic States’ capacity to evaluate the effectiveness of evidence-based interventions to combat suicide.

In addition to developing the toolkit, complementary activities have taken place. Such activities include focus groups in the Northwest Territories of Canada involving youth, Elders, healers, and service providers, where a number of participants shared their experiences through stories and lived experiences. Key agreed-upon concepts from these sessions included the importance of having a common understanding and language, the importance of culture, challenges facing youth, and the challenges associated with the lack of connection with Elders. Additional outreach was conducted in Alaska during the Annual Convention of the Alaskan Federation of Natives where participants - including youth, Elders and other community representatives - were asked to identify and rank relevant RISING SUN outcomes. The highest ranked outcomes were increased early interventions for depression, anxiety, drug use, and violence. A component analysis was conducted to determine what kinds of items could be grouped together. Results indicated grouping along three dimensions: 1) clinical items clustered with community items (cultural continuity of care); 2) connections between relationships (increasing youth belonging); and 3) social connections and supports.

This latter work in Alaska was further complemented by interviews with Elders, youth, and tribal leaders, around what is being done to foster healthy youth. Key themes that emerged included: relationships to land and water through place-based values; intergenerational relationships; and relationships to history and the past, to ways of knowing, and of self in one’s community. In terms of next steps, it was noted that the U.S. National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH) aims to continue to work toward securing a web-based platform where the RISING SUN materials can be hosted and used by a broad audience.

The Way Forward

Speaking to the upcoming 2017-2019 Finnish Chairmanship of the Arctic Council, Dr. Heidi A. Ericksen, from the Sámi National Centre of Mental Health and Substance Abuse, indicated plans to utilize the RISING SUN Networks and continue the work on mental wellness and suicide prevention. A conference is already being planned in Finland for 2018 to discuss the implementation of promising practices.