Donna Apak is crying so hard she can barely get the words out.
She has been asked to talk about a significant life event she overcame before joining this class for future Inuit mental-health counsellors. For Ms. Apak, 47, it was the suicide of her eldest daughter, Diane.
Ms. Apak was fishing outside her Baffin Island community six years ago when a small group came to tell her that Diane, distraught over the death of the grandmother who helped raise her, had killed herself. She was 21.
When Ms. Apak finishes sharing her story in Inuktitut, her first language, she wipes her eyes and tosses her Kleenex in a cardboard box that is already half-filled with the discarded tissues of her fellow trainees, all of whom hope to gain the skills to ease the suffering of Inuit like Diane.
After Diane died, “I thought I was going to be in the dark forever,” Ms. Apak says later in an interview. “But no.” Ms. Apak started seeing Inuit counsellors through a non-profit called the Ilisaqsivik Society and, four years later, she felt strong enough to begin training as a counsellor herself.
The training program Ms. Apak is participating in is called Our Life’s Journey, and it is unique in Nunavut.
In a territory where most providers of front-line mental-health services are English-speaking southerners, Our Life’s Journey, or OLJ, trains Inuit to provide talk therapy delivered in Inuktitut and rooted in Inuit values.
The organization that runs it, the Ilisaqsivik Society, is an Inuit non-profit that offers counselling at a decommissioned health centre building in Clyde River, a community of 1,200 on the eastern coast of Baffin Island. Its reach extends beyond Clyde River: The society also dispatches teams of Inuit counsellors to other Nunavut communities, often in response to the suicides that still haunt the territory, despite a small but encouraging drop in the rate over the past 20 years.
Ilisaqsivik and the OLJ program are now poised to play a major role in how mental-health and addiction services are delivered in Nunavut. The federal and territorial governments, along with Nunavut’s lead Inuit organization, have tapped Ilisaqsivik to train a new work force of Inuit counsellors for the Nunavut Recovery Centre, the first residential addictions and trauma treatment facility in the territory. Construction of the centre in the capital of Iqaluit is expected to be finished in late 2025.
The recovery centre plan, first announced in 2019, is tacit acknowledgment that Nunavut’s mostly southern-run mental-health system isn’t meeting all the needs of Inuit, the demographic group with the highest per-capita suicide rate in Canada. A Statistics Canada study published in 2019 found Inuit were nine times likelier to take their own lives than non-Indigenous people in Canada; alcohol and drug dependence are often factors in those deaths.
In Nunavut, where 85 per cent of the population is Inuit, there isn’t a single psychiatrist who lives in the territory. Psychiatric services are delivered by southern physicians who care for their patients with a blend of in-person trips to Nunavut communities and virtual visits.
In 24 fly-in hamlets outside of Iqaluit, every health centre has at least one mental-health nursing position, but those posts are filled almost exclusively by southerners who don’t speak Inuktitut and are often on short-term contracts. That leaves Inuit mental-health patients with little choice but to tell their stories over and over to a non-Inuk stranger who doesn’t speak their first language.
Consistent care from the same providers is important for good mental and physical health, said Allison Crawford, a psychiatrist at Toronto’s Centre for Addiction and Mental Health and the program director for psychiatric services in Nunavut.
“Unfortunately, the health system as it is in Nunavut cannot support that in any aspect of health,” she acknowledged. “There are family doctors that come and go, there are nurses that come and go, there are psychiatrists that come and go, which is why it’s so important to have community supports that don’t come and go.”
That is where Ilisaqsivik comes in. In Clyde River, the society’s work is everywhere you turn. It is the largest employer in the hamlet. With an annual budget of about $7-million, Ilisaqsivik runs a small preschool, a breakfast program at the K-12 school, an after-school youth drop-in program, a counselling service and a roving trauma response team. It is raising money for a new purpose-built wellness centre to replace its existing building.
Ilisaqsivik also has an Inuit heritage and research arm and a social enterprise arm that owns Clyde River’s two hotels, as well as 11 rental properties, valuable sources of income for an organization that is hoping to become less beholden to government and charitable largesse.
In the meantime, Ilisaqsivik is counting on $11.8-million in funding over five years to expand, evaluate and refine its Our Life’s Journey training program in preparation for the opening of the Nunavut Recovery Centre and the creation or expansion of on-the-land addiction treatment programs in all three regions of the territory.
That funding, announced in 2019, was supposed to come from the Makigiaqta Inuit Training Corporation, part of Nunavut Tunngavik Inc. (NTI), the territory’s top Inuit land claims organization. But three years later, not a cent has reached Ilisaqsivik, according to Malcolm Ranta, the society’s executive director.
The holdup comes down to a disagreement between NTI, which wants the Government of Nunavut to commit in a memorandum of understanding that it will hire OLJ graduates for open positions at the recovery centre, and the Nunavut Department of Health, which said in a written statement that it wouldn’t be “fair” to Ilisaqsivik to make the $11.8-million in Makigiaqta funding “contingent on the actions of a third party.” (Separately, a spokeswoman for Nunavut’s Department of Executive and Intergovernmental Affairs stressed that the government is working with NTI to “assure the hiring of Our Life’s Journey Inuit counsellors.”)
As Kilikvak Kabloona, the chief executive officer of NTI, pointed out, the Makigiaqta Inuit Training Corporation was formed using $175-million in funds secured through a settlement with the federal government. Its purpose is to increase Inuit employment in the public and private sectors.
NTI doesn’t want to distribute the money to Ilisaqsivik for OLJ until it has a clear and detailed hiring guarantee from the territorial government. “We’re not satisfied with, ‘Oh, yeah, we’re gonna hire them,’” Ms. Kabloona said. “It’s not good enough to hire one, or one per year, or whatever would happen under the current system.”
In 10 years, the Our Life’s Journey program has graduated 61 participants, 19 of whom went on to earn a professional counselling certificate from the Indigenous Certification Board of Canada. If Ilisaqsivik hopes to produce an Inuit counselling work force in time for the opening of the Nunavut Recovery Centre, it needs the funding to ramp up – and fast.
The organization that is now Ilisaqsivik got its start in a janitor’s closet at Clyde River’s only school in the mid-1990s. Jukeepa Hainnu, then a Grade 6 teacher, was desperate to save a student who had tried to hang himself.
Another teacher suggested adding the boy to the waiting list for a visiting mental-health nurse, but Ms. Hainnu feared he would take his own life before outside aid arrived. She invited an Inuit elder to speak to the boy instead, an approach that got him over the hump of his immediate crisis.
Emboldened by that success, Ms. Hainnu and her colleagues found a couple of local elders who were willing to make themselves available to troubled students. They emptied a janitor’s closet of mops and cleaning supplies, installed a desk, and turned the room into a makeshift Inuit counselling centre.
“We saw a huge difference in the children,” said Ms. Hainnu, now the vice-chair of Ilisaqsivik’s all-Inuit board of directors. “So we started asking for more funding.”
Not long after, the Government of Nunavut agreed to let the fledgling organization take over an old health centre it was about to close, giving the organization room to grow.
A key turning point came in 2012, when Ilisaqsivik partnered with Life Works Counselling and Training Services, a company now based outside Calgary, to develop a training program for Inuit counsellors. Ilisaqsivik hoped to marry the best of southern and Inuit mental-health knowledge to produce a training program that could be completed by Inuit without any postsecondary education in four (later five) two-week training sessions conducted over a year or two.
By the time of Ms. Apak’s Our Life’s Journey training in May, the program was being delivered entirely in Inuktitut, without English-speaking helpers from the south. Two female elders, one of whom lived in a traditional outpost camp on the tundra outside Clyde River until the mid-1980s, led the session entirely in Inuktitut.
OLJ courses cover counselling fundamentals, loss and grief, trauma and recovery, addictions and treatment, and Inuit knowledge and interventions, among other topics. This week, the curriculum focuses on self care and self management because most participants are, like Ms. Apak, shouldering immense grief, often stemming from the suicide of loved ones.
To go from survivor to counsellor, participants in OLJ’s self-management week must learn to guard their own mental well-being. That starts with looking for reasons to be proud of themselves.
Facilitator Regilee Piungituq, a dark-haired 69-year-old with a big, bright laugh, starts an afternoon session by passing around a Ziploc bag with the names of the 10 people taking part in the training, including a man with a ball cap pulled over his eyes who looks to be in his early 20s and an older married couple. Ms. Piungituq instructs everyone to select a name and compose a note of praise for that participant.
When Trina Yank, 42, stands to read the note written for her, she breaks down. “I want to be a mother like you if I ever have kids,” she reads, weeping. Later, the mother of five explains in an interview that she recently separated from her husband. Most of her children are now living in Iqaluit without her. She is hoping to find a job in the capital, ideally in a helping profession where she can put her OLJ skills to use.
On the next day of training, Ms. Piungituq and her co-facilitator, Elisapee Quassa, 68, invite the participants to gather in small groups and fill a sheet of chart paper with answers to the question: What would you do on your last day on Earth?
None mention scrumptious meals or exotic getaways. Their replies are a classically Inuit blend of the practical and spiritual. Several stress the importance of up-to-date wills. Others speak of what the Bible says about the final days, a nod to the Anglican church’s continuing influence in the eastern Arctic, particularly among older Inuit.
In the midst of the exercise, Ms. Hainnu, the former teacher who helped found Ilisaqsivik, pops her head into the classroom. She says something in Inuktitut. A cheer rises up. Someone in Clyde River has caught a seal and brought it to the Piqqusilirivvik Cultural School where the OLJ training is taking place.
Expertly wielding knives and ulu, the half-moon tools Inuit women use to scrape skins and slice meat, the OLJ students cut into a seal splayed on the ground on a slab of cardboard. They pop bits of raw seal into their mouths and lick the blood from their fingers, relishing a fresh meal they would never find at a counselling course in the south.
One of the OLJ graduates working in Clyde River is William Kautuq, a full-time counsellor at Quluaq, Clyde River’s K-12 school. Some struggling students come to him voluntarily, while others spend time with him on in-school suspensions for bad behaviour.
Mr. Kautuq assigns suspended students odd jobs around the school or takes them hunting and fishing, all the while encouraging them to talk. He tells his regulars, “if you’re about to get mad, come and see me before being destructive or hurting anyone.”
When suicidal students open up, Quluaq principal Alyssa Paul says it’s usually to express a “generalized statement about not wanting to be alive.” Their hopelessness often stems from family conflict, including physical, sexual or emotional abuse in their overcrowded homes, she adds.
“We have a full-time counsellor at our school, but it’s not enough,” says Ms. Paul, an Inuk from Labrador. “Kids aren’t really comfortable going to the health centre and speaking with someone from the south who literally leaves every couple of weeks.”
When tragedy strikes Clyde River, Ms. Paul can call in a cadre of backup counsellors from Ilisaqsivik. “That’s a huge help,” the principal says. She doesn’t know how schools in Nunavut’s other hamlets get by without it.
Still, a homegrown Inuit counselling service has not saved Clyde River from Nunavut’s long-standing suicide crisis. Three young men took their own lives in just over a month in the spring of 2021. Two worked at Ilisaqsivik. One was school counsellor Mr. Kautuq’s younger brother.
“It just really tells me how complicated and complex” suicide is, says Mr. Ranta, the executive director of Ilisaqsivik. “I think about that a lot. You always get on edge if things have been too quiet for too long.”
Last year stands out as an abnormally tragic one for Clyde River in the decades of suicide statistics that Jack Hicks, an adjunct professor in community health and epidemiology at the University of Saskatchewan, has compiled from chief coroners in Nunavut and the Northwest Territories. His records show one suicide in the community in 2020 and none in 2019 or 2018.
Over all, Mr. Hicks’s analysis contains glimmers of hope for Nunavut: It reveals a 17-per-cent drop in the suicide rate in the territory over the past 17 years, from a high of 120 deaths per 100,000 population in 2004 to roughly 100 per 100,000 in the past few years. The key driver is a roughly 50-per-cent drop in the suicide rate among youth aged 15 to 24, the same age group that drove the increase from the 1970s to the early 2000s.
Mr. Hicks, who spent five years conducting a study that compared Nunavut Inuit who died by suicide to controls of similar age and sex from the same communities who didn’t, found that those who took their own lives suffered a greater degree of childhood trauma, including physical and sexual abuse by family.
He also found the sharp increase in the Inuit suicide rate during the 1970s and 1980s was driven by the suffering of the first generation of children to grew up in year-round communities after their parents were coerced by federal policies into permanent settlements in the mid-to-late 20th century, a profound and bewildering break from their traditional lives on the land.
Expecting an Inuit peer counselling service on its own to undo decades of intergenerational trauma and entrenched poverty isn’t realistic, Mr. Hicks said. Some Inuit need the formal psychiatric care that Dr. Crawford and her out-of-territory colleagues provide.
The Nunavut Suicide Prevention Strategy calls for a wide range of culturally appropriate mental-health services, he added. “Is it part of a wider solution?” Mr. Hicks said of Ilisaqsivik. “Absolutely.”
For Ms. Apak, Ilisaqsivik’s services, including regular support from Ms. Piungituq, and her OLJ training, have made all the difference. They’ve helped her control her alcohol and gambling addictions and taught her to forgive her daughter for taking her own life.
On the last day of her training in May, Ms. Apak joined her classmates for a snowmobile ride to a cabin complex outside Clyde River, the site of Ilisaqsivik’s new 28-day on-the-land recovery program. There, they burned the cardboard box of tissues that accumulated over two weeks of crying and laughing at OLJ, releasing their tears to float away over the tundra.
The Globe and Mail
The Globe and Mail’s health reporter Kelly Grant is taking an in-depth look at health care in Nunavut and the challenges its residents face accessing it. Over the course of 2022, she’ll examine why the territory’s residents have some of the worst health outcomes in the country and what changes are needed to deliver better care.
Ms. Grant is working with photographer Pat Kane. Based in Yellowknife, Mr. Kane takes a documentary approach to his stories that focus on Northern Canada. Mr. Kane identifies as mixed Indigenous/settler and is a proud Algonquin Anishinaabe member of Timiskaming First Nation in Quebec.
If you have information to help inform The Globe’s reporting on Nunavut, please e-mail [email protected]
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